Educational content and strategies to support nurses from culturally and linguistically diverse backgrounds caring for patients considering voluntary assisted dying: The Australian experience.

OBJECTIVES: Drawing on findings from a qualitative study that aimed to explore the knowledge and attitudes of nurses from culturally and linguistically diverse (CALD) backgrounds about voluntary assisted dying (VAD). The study also aimed to identify the strategies that assist nurses in their readiness and preparation for exposure to VAD. This paper reports on the educational content and strategies that could assist nurses from CALD backgrounds to be better prepared when they encounter VAD requests. BACKGROUND: Around the world, healthcare professionals have roles to play in caring for patients requesting voluntary assisted dying. Nurses, particularly those from diverse geographic and clinical settings, have voiced inadequate knowledge and understanding about voluntary assisted dying. DESIGN: A qualitative descriptive approach was undertaken. METHODS: Data collection involved one focus group and 16 in-depth interviews. A total of 21 nurses from CALD backgrounds were recruited from one Australian state. Thematic analysis was conducted to interpret the data. FINDINGS: Nurses identified their knowledge gaps and specified the need for education and workplace training on VAD, its legal and ethical aspects, clarity on their role, communication techniques and how VAD intersects with their practice. They suggested various teaching strategies that could prepare nurses to work safely and confidently in a clinical environment where voluntary assisted dying is an option for patients. CONCLUSION: Given the high number of nurses from diverse backgrounds working in the Australian health sector, these nurses need to be fully prepared to care for patients requesting VAD.

Cognitive and Behavioral Changes Arising From Spirituality.

This article aims to explore the concept of spiritual transformation and address the question, 'How does spirituality bring about changes in cognition and behavior?' It draws on the findings of a larger qualitative study that explored the essence of spirituality and spiritual engagement from the perspective of palliative care clients and caregivers. Four clients and ten caregivers from across regional South Australia participated in the larger study utilizing van Manen's phenomenology. Secondary analysis of the qualitative data was undertaken to highlight the statements and phrases that portrayed the marked changes in thinking and behavior catalyzed by spirituality. The findings relate to the participants' spiritual beliefs and practices that helped them journey through the process of death and dying. Spirituality is a plausible explanation of the transformation that occurred, manifested by new thinking and behavior.

Nurses' Perceptions and Attitudes About Euthanasia: A Scoping Review.

AIM: Nurses have a critical role in providing holistic care for people with life-limiting conditions. However, they experience internal moral conflict and powerlessness when patients request them to assist in the dying process. A scoping review was undertaken to determine what is known about nurses' perceptions and attitudes of euthanasia. Review Methods: Several databases were searched that yielded both qualitative and quantitative primary peer-reviewed research studies that focused on nurses, their perceptions and attitudes about euthanasia. Descriptive and explorative analyses of the data set from the research studies were undertaken. Results: A total of 23 studies were included in the review. Opinions about euthanasia were mixed. Two key concepts emerged from the review: some nurses were positive and/or supportive of euthanasia, while some were negative and/or unsupportive of euthanasia. The main factors associated with being positive and/or supportive were because of (a) extreme uncontrollable pain, unbearable suffering, or other distressing experiences of the patient, (b) legality of euthanasia, and (c) right of the patient to die. The factors that determined nurses' negative and/or unsupportive attitude included (a) religion, (b) moral/ethical dilemmas, (c) role of gender of the health professional, and, (d) poor palliative care. Conclusions: The matter of euthanasia has challenged nurses considerably in their aim to deliver holistic care. There were several crucial factors influencing nurses' perceptions and attitudes, and these were affected by their personal, professional and transpersonal perspectives. The potential implications to nurses relate to education, practice, and research. Nurses need to be informed of existing legislation and provided in-depth education and professional guidelines to help direct action. Further research is needed to explore the impact on nurses' emotional well-being, clarify their role/s and determine the support they might require when involved with euthanasia.

Voices from the Field: Regional Nurses Speak About Motivations, Careers and How to Entice Others to Pursue Mental Health Nursing.

The aims of this study are three-fold: determine the factors that motivate nurses to pursue mental health nursing; identify the strategies that might attract nursing students and practising nurses to pursue mental health nursing as a professional career; and identify the difficulties of nurses in achieving their preferred clinical specialty. A descriptive qualitative study design with semi-structured interviews was used. Fifteen mental health nurses from rural and regional South Australia were interviewed. Interviews were transcribed verbatim, and thematic analysis was undertaken. Of the fifteen participants, thirteen were females and two were males; their average age was 50 years. The factors that motivated the participants to pursue mental health nursing were categorized as intrinsic and extrinsic. There were many strategies that might attract nursing students and nurses to the field, but the most popular suggestion was the provision of high quality meaningful clinical placements. Other strategies were to convey the personal satisfaction derived from being a mental health nurse, promote mental health nursing aggressively, and provide employment incentives. The study also highlighted the importance of addressing stigma, and greater education and support for nurses to pursue a mental health career.

Finding Paradise Within: How Spirituality Protects Palliative Care Clients and Caregivers From Depression.

The aims of this article are to explore the experience of depression among palliative care clients and caregivers, describe the strategies they use in coping with depression, and clarify the role of spirituality in preventing and/or overcoming depression. This article discusses an aspect of the findings of a larger doctoral study that explored the nature of spirituality and spiritual engagement from the viewpoint of individuals with life-limiting conditions and their caregivers. van Manen's phenomenology was used in the study. The data generated from the doctoral study were subjected to secondary analysis to uncover the experience of depression. The methodology underpinning the secondary analysis was phenomenology also by van Manen. Fourteen clients and caregivers from across regional and rural South Australia informed the study. Data collection involved in-depth nonstructured home-based interviews that were audiotaped and transcribed verbatim. The findings highlighted relate to participants succumbing to depression, but having spiritual beliefs and practices helped them cope. One of the most insightful understanding was the role spirituality played in protecting individuals from depression, encapsulated in the theme "finding paradise within." Spirituality, understood from a religious or secular perspective, must be embedded in palliative care as it assisted in preventing and overcoming depression.

Factors impacting on psychological wellbeing of international students in the health professions: A scoping review.

BACKGROUND: There are increasing numbers of international students undertaking health professional courses, particularly in Western countries. These courses not only expose students to the usual stresses and strains of academic learning, but also require students to undertake clinical placements and practice-based learning. While much is known about general issues facing international students, less is known about factors that impact on those studying in the health professions. OBJECTIVES: To explore what is known about factors that influence the psychological wellbeing of international students in the health professions. DESIGN: A scoping review. DATA SOURCES: A range of databases were searched, including CINAHL, Medline, Scopus, Proquest and ERIC, as well as grey literature, reference lists and Google Scholar. REVIEW METHODS: The review included qualitative or quantitative primary peer reviewed research studies that focused on international undergraduate or postgraduate students in the health professions. The core concept underpinning the review was psychological issues, with the outcome being psychological and/or social wellbeing. Thematic analysis across studies was used to identify key themes emerging. RESULTS: A total of 13 studies were included in the review, from the disciplines of nursing, medicine and speech-language pathology. Four key factor groups emerged from the review: negotiating structures and systems, communication and learning, quality of life and self-care, and facing discrimination and social isolation. CONCLUSIONS: International health professional students face similar issues to other international students. The nature of their courses, however, also requires negotiating different health care systems, and managing a range of clinical practice issues including with communication, and isolation and discrimination from clinical staff and patients. Further research is needed to specifically explore factors impacting on student well-being and how international students can be appropriately prepared and supported for their encounters.

LOCATIONS OF CLINICAL PLACEMENTS CRUCIAL FOR LEARNING AND WORK READINESS.

The value of clinical placements in the Bachelor of Nursing program cannot be over emphasised. Students undertake a variety of clinical experiences during the three-year program in order to develop and hone an effective range of competencies for a beginning Registered Nurse.

Employment experiences of immigrant workers in aged care in regional South Australia.

PURPOSE: The contributions of immigrant workers to the aged care workforce cannot be overemphasised. The report of the National Institute of Labour Studies records a significant number of immigrants in the aged care industry in Australia. The number of overseas-born workers in the residential aged care sector had risen steadily, according to recent workforce statistics. However, the employment positions these immigrant workers fill have perennially been labelled as low-paying and low-status, warranting more research into the plight of immigrant workers, especially those in regional areas. This study investigates the current employment experience of immigrant workers working in aged care in regional South Australia. METHODS: This qualitative study is based on a focus group consisting of seven immigrant workers (five personal carers, one home support worker and one allied health assistant), who shared their individual perceptions of their employment experience. The workers were employed by three aged care facilities run by a community-based not-for-profit organisation governed by one incorporated body. Thematic analysis was used to analyse the focus group data. This article reports on part of the findings of a larger research study where the authors have included the perceptions of co-workers and managers about working with immigrant workers. RESULTS: This study reveals mixed experiences of immigrant workers with employment in aged care. Satisfaction came from positive and encouraging client feedback, enriching work experience, flexible hours and simply having a job. Dissatisfaction came from constraints with time, workload, staffing, poor peer relations, discriminatory practices and the nature of the job itself. Immigrant workers do not experience a strong support infrastructure. Limitations of the study include the small sample size used and the focus on one regional city. CONCLUSIONS: This study suggests that aged care facility managers and executive officers can enhance positive work experience of immigrant workers by making some workplace reforms.

Palliative care clients' and caregivers' notion of fear and their strategies for overcoming it.

OBJECTIVE: This paper aims to clarify our understanding of fear and explore the strategies employed by people with life-limiting conditions and their caregivers in addressing the emotion of fear as they journey through the dying process. The role of fear is discussed: different kinds of fear, the tangible and intangible measures by which people manage their fear, and the ways of transcending fear. METHOD: The findings of a larger research project funded by the Australian Department of Health and Ageing are drawn upon. In-depth interviews were conducted with clients and caregivers relating to the psychosocial and emotional issues in palliative care. Secondary analysis was utilized to examine the perceptions of fear in this cohort. RESULTS: While there were many other findings, the results highlighted in this paper relate to the notion of fear among interview participants. Interview data showed that people with life-limiting conditions and their caregivers had different types of fear and employed a variety of strategies to deal with fear. Four themes emerged embodying these strategies: calling on their own resilience and inner resources, maintaining human relationships, gaining the ability to "keep one step ahead" in the dying process, and engaging in spirituality and religion. SIGNIFICANCE OF RESULTS: The implications of the findings for healthcare professionals are highlighted. The recognition of emotions is embedded in palliative care; healthcare professionals should view the management of emotions as an integral part of professional practice. Addressing fear is essential because unresolved fear can impinge on one's ability to cope. Our paper brings together different perspectives on fear and how vulnerable individuals attempt to cope with it while at the same time providing a view of the challenges confronting healthcare professionals who are engaged with them and committed to optimizing health outcomes for palliative care clients and their caregivers.

The relational model of spiritual engagement depicted by palliative care clients and caregivers.

This paper aims to explicate the essence of spiritual engagement from the perspective of palliative care clients and their caregivers. Van Manen's hermeneutic phenomenological approach guided this study. In-depth interviews of 14 rural Australian participants with experience of a life-limiting condition provided rich discourse of the lived experience of spiritual engagement. This research highlights spiritual engagement represented in a relational model developed from a creative synthesis of the emerging themes. Spiritual engagement is associated with 'personal transformation', 'human values of love, compassion and altruism', 'maintaining relationships', 'participating in religious practices' and 'culture'. The findings of this research are supported by Mayes' observations on spirituality, that is, the 'pursuit of a trans-personal and trans-temporal reality that serves as the ontological ground for an ethic of compassion and service'.

Evaluating the effectiveness of a university health sciences experience program for regional Year 10 students.

OBJECTIVE: The main aim of this pilot program was to raise secondary students' awareness of university studies and careers in the health sciences through a three-day program. Further aims of the program were to increase the participants' knowledge of health issues through group activities, and provide an opportunity to interact with university staff and health professionals. DESIGN: The participants were surveyed at the conclusion of the program using an online questionnaire (30 items) consisting of both open and closed questions. SETTING: The program and evaluation were carried out at a regional campus of a metropolitan-based university during the mid-year vacation. PARTICIPANTS: Fourteen Year 10 students (11 female, 3 male; 5 from government schools, 9 from a non-government school) from a regional city completed the evaluation. MAIN OUTCOME MEASURES: Satisfaction with the program, increased awareness of pathways into university, and changes in attitude about university as a career option. RESULTS: The evaluation revealed that the participants had had a pleasant learning experience, which had led them to feel positive about university studies in general and as an option for themselves. They made useful suggestions for improvements. CONCLUSION: The evaluation of the effectiveness of the program showed that it had achieved its objectives. It also provided the program organisers with insights regarding timing and activities, which will be useful in improving future programs targeting secondary students.

Philippine academic visit: brief but life-changing.

As one way of inculcating international perspectives in its graduates, the University of South Australia includes in its programs various opportunities for students to study abroad. It also encourages incoming short-term exchange and full-program international students. In 2001, the Discipline of Nursing and Rural Health (Whyalla Campus) sent two graduating students to a developing country in Asia, the Philippines, for a twelve-week academic experience. Despite problems causing the visit to be curtailed, much was learned. Participant and organiser insights are described, sharing valuable lessons to inform future plans and ensure better results. What could be regarded as a failed academic visit, nevertheless offered a life-changing opportunity and significant learning outcomes, reinforcing the belief that international academic experiences are extremely worthwhile for students and participating institutions. These experiences provide an important path to cultural understandings, and to personal and professional development.