Development and implementation of a national online application system for cross-jurisdictional linked data.

The Population Health Research Network (PHRN) is an Australian national data linkage infrastructure that links a wide range of health and human services data in privacy-preserving ways. The data linkage infrastructure enables researchers to apply for access to routinely collected, linked, administrative data from the six states and two territories which make up the Commonwealth of Australia, as well as data collected by the Australian Government. The PHRN is a distributed network where data is collected and managed at the respective jurisdictional and/or cross-jurisdictional levels. As a result, access to linked data from multiple jurisdictions requires complex approval processes. This paper describes Australia's approach to enabling access to linked data from multiple jurisdictions. It covers the identification of, and agreement to, a minimum set of data items to be included in a unified national application form, the development and implementation of a national online application system and the harmonisation of business processes for cross-jurisdictional research projects. Utilisation of the online application system and the ongoing challenges of data linkage across jurisdictions are discussed. Changes to the data custodian and ethics committee approval criteria were out of scope for this project.

The Cost of Organ Donation: Potential Living Kidney Donors' Perspectives.

Living kidney transplantation is a treatment option for some people with end-stage kidney disease. The procedure has low complication rates and positive outcomes; despite this evidence, the number of living kidney donations has decreased in recent years, and the causes are not well understood. This qualitative study sought to explore the experiences of potential living kidney donors before the transplantation. A total of 19 semistructured interviews were conducted with potential living kidney donors in Perth, Western Australia. Results reported here relate to participants' experience of the employment and financial implications of living kidney donation. Participants incurred direct and indirect costs during the time leading up to the transplantation, and many had concerns about the potential financial impact during the recovery period. Employment status, occupation type, and financial commitments affected participants' experiences, and financial concerns were exacerbated for those who were donating to their partners. Results suggest that potential living kidney donors would benefit from tailored financial planning advice to help them prepare for the time of the surgery and the recovery period.

Clinical placements and nursing students' career planning: a qualitative exploration.

Many nursing students enter undergraduate programmes with preconceived ideas about their future nursing careers, and intend to practice in particular areas such as midwifery or paediatrics. Through clinical placements, students are exposed to different clinical areas and professional socialization is facilitated. However, little is known about the influence of clinical placements on students' career intentions. This paper reports nursing findings drawn from a large qualitative study conducted in Victoria, Australia that sought to explore the influence of health professional students' clinical placements on their future career intentions. Participants were invited to be involved in either face-to-face or focus group interviews depending upon their own preference. Thematic data analysis revealed three main themes: 're-affirming career choice', 'working in a particular area' and 'work location'. Findings from the study add to our understanding of factors influencing nursing students' planning for their future careers including the impact of clinical placements.

'They don't know much about us': educational reform impacts on students' learning in the clinical environment.

Placements are an integral component of the medical, nursing, and allied health curriculum. Literature on problem-based learning indicates that curriculum change can impact student experience. However, outside of the nursing literature, there is little research on the impact of education reform on students' experiences of placements. This paper reports on medical, midwifery and paramedic students' perception of the impact of education reform they experienced in the clinical setting. A qualitative study using a semi-structured schedule was conducted. Data was collected using focus groups (17), individual interviews (48) and written responses (2) from undergraduate students (103) and graduates (27) from a tertiary institution in Victoria, Australia. Recorded interviews were analysed, coded and categorised into themes. Whilst students indicated they were prepared for the impact of educational reform on their placement experience, they perceived that clinical educators responsible for teaching them were less prepared. Three themes were identified from the data: clinical educator's lack of familiarity with new curriculum, clinical educator's negative attitudes to curricular change and looking to the future. Our study advances the understanding of the implications of education reform during the clinical placement of medical, midwifery, and paramedic students. Whilst important lessons can be learned from the medical and nursing literature this study highlights that staff responsible for curriculum change need to action change management process to ensure that the clinical educators are able to deliver the revised program.

Exploring continuous clinical placement for undergraduate students.

Clinical placements are integral to health professional preparatory courses. These placements allow for the application of classroom-based learning into real patient care situations. In doing so, they provide opportunities for applying theoretical knowledge into practice contexts, skills development and socialisation into the chosen profession. However, despite its recognised importance across health professions, little has been written about optimal structures for supporting clinical learning. This paper presents one group of findings from a larger qualitative study aimed at exploring health professional student's clinical experiences and their impact on career intentions. Findings reported here present a group of undergraduate midwifery student's perspectives on a "home" hospital clinical placement model where continuous clinical placements were taken in the same agency (or hospital group) for 2 days per week over the final 2 years of their course. Two main themes emerged from the data analysis, these being, 'familiarity' and 'continuity'. It is concluded that continuous placements in the same clinical setting have the potential to offer greater opportunities for learning and early professional socialisation than traditional block (Monday to Friday) placements. They can offer a more integrated approach to classroom theory and its application into practice.

Influence of clinical placement on undergraduate midwifery students' career intentions.

OBJECTIVE: to explore the influence that clinical placements have on career intentions for undergraduate midwifery students. DESIGN: a qualitative approach involving a combination of focus group and individual interviews. SETTING: the study was part of a larger study undertaken across a range of health disciplines within one university. PARTICIPANTS: 11 Bachelor of Midwifery students who had either undertaken their first or last clinical placement. FINDINGS: data were managed with QSR NVivo and analysis was influenced by the work of Strauss and Corbin. Two main themes emerged: midwifery as a career choice and future midwifery career. Findings indicated that students entered the course with preconceived ideas of midwifery and where they would practice after graduation. Clinical placements allowed students to experience the reality of midwifery practice, promote identification with the profession, and influenced decision-making about future careers. Finally, it raised limitations placed on diversity of available clinical experience. KEY CONCLUSIONS: clinical placements are essential for midwifery preparation. They challenge students' preconceived ideas about midwifery practice and assist them to develop perspectives on, and directions for, their future careers. The diversity and quality of placement experience plays a significant role in career decision-making and employment choices. IMPLICATIONS FOR PRACTICE: positive placement experiences influence where students will choose to work after graduation. These experiences can directly influence the organisations and clinical areas chosen by students for graduate practice.

"Researcher saturation": the impact of data triangulation and intensive-research practices on the researcher and qualitative research process.

Theoretically and methodologically sound qualitative research demands an extended period of fieldwork and the use of multiple methods to achieve data saturation and develop the grounded theory. Little is known about the experiences of researchers who conduct such studies. The authors explore these matters by drawing on their experiences of conducting a 3-year qualitative study with women about their gynecological cancer journey. Their fieldwork consisted of participant observation and in-depth interviews with women and health professionals. They demonstrate that researchers who are involved in all phases of emotionally demanding research; that is, data collection (recruiting, observing, expanding field notes, and interviewing), transcription, and data analysis repeatedly relive difficult events, which might potentially compromise the researchers' well-being and, in turn, the research process and data validity. The authors discuss how researchers can deal effectively with these matters during fieldwork and propose a more formal approach to debriefing.

Money matters: students' perceptions of the costs associated with placements.

CONTEXT: Placements are an integral component of the medical, nursing and allied health curricula. However, apart from the relocation costs associated with placements, little research on students' understandings and experiences of the financial implications of placements has been carried out. OBJECTIVES: We report on students' financial concerns associated with placements, which emerged as a main theme in a broader study we conducted on the impact of undergraduate student placement experiences on graduate practice. METHODS: We conducted a qualitative study which included focus group discussions (n = 17), individual interviews (n = 48) and written responses (n = 2) with undergraduate students (n = 103) and graduates (n = 27) from a tertiary institution in Victoria, Australia. RESULTS: Students identified that income generation and the costs associated with transport and placement location contributed to the financial burden of placements. Students also spoke of the implications of high financial strain impacting on their accumulation of debt as well as on their health and wellbeing. DISCUSSION: Our study advances our understanding of the implications of financial hardship experienced by medical, nursing and allied health students. In our study, students, regardless of their placement location, experienced increased demands and associated stress as a result of managing placements, paid employment and limited financial resources. We recommend that further quantitative research be conducted to measure the variables identified as emerging themes in this study.

Discourses of normality and difference: responses to diagnosis and treatment of gynaecological cancer of Australian women.

By comparison to other cancers such as breast and lung cancer, women in Australia are relatively infrequently diagnosed with gynaecological cancers. Apart from cervical cancer, public health information on gynaecological cancer is limited, as are published stories from gynaecological cancer survivors in women's magazines. Our qualitative study investigated how women with gynaecological cancers develop an identity in relation to their illness, and examined the extent of, and reasons for, a sense of perceived difference. The study was conducted between 2001 and 2003 and included in-depth interviews with 52 women aged 27-80 years diagnosed with gynaecological cancer within the past 5 years. Our analysis illustrates how women draw on a wider cancer discourse to make sense of their own illness, which gave them a sense of commonality. However, some women, predominantly those who were diagnosed with cancer of the vulva or vagina, or who underwent particular uncommon or unfamiliar treatments such as brachytherapy, had difficulties situating their illness within the wider cancer discourse. This had implications for women when accessing social support.

Complementary medicine use by Australian women with gynaecological cancer.

AIMS AND OBJECTIVES: Social and cultural factors are identified that impact on complementary therapy use among Australia-born and immigrant women diagnosed with gynaecological cancer. METHODS: A qualitative study design including in-depth interviews with women diagnosed with gynaecological cancer (N=53) and participant observation was conducted. RESULTS: Approximately one-third of women utilized complementary and alternative medicine, with this being determined by current health concerns and health beliefs related to the efficacy of different modalities. Four types of complementary therapy users emerged: consequential, therapeutic, informed and exploratory. CONCLUSION: There was a relatively low uptake of complementary treatments. Choice was influenced by women's socio-demographic background, clinical and personal history, lack of personal experiences of gynaecological cancer among study participants' kin and friends, and lack of popular alternative literature on such cancer.

'He's telling us something'.

Drawing on in-depth interviews with patients and participant observation notes from a cancer support group and outpatients department, we analyse the experiences of Australian-born and immigrant women with gynaecological cancer to describe cancer diagnosis disclosures from the patients' perspectives and examine women's treatment decision-making. Data suggest that most women did not question the surgeon's recommendation and assumed a passive role in treatment decision-making. The contextual factors which impacted on this pattern were the unavailability of an alternative biomedical treatment path, the perception of the metropolitan hospital as a centre of clinical excellence with extensive experience in treating women with gynaecological cancer, and lay understandings of the nature of gynaecological cancer as 'a killer'. We also discuss the circumstances under which a few women took on the role of primary decision-maker.