Choice to live and die at home is supported by palliative care policy; however, health resources ... more Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care. The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge. Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings. 34 international studies revealed themes of 'the nursing relationship', 'environment', 'communication', 'support' and 'the holistic client centred district nursing role. Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural ar...
The use of NBs as a mode of analgesia for #NOF in the ED is not common practice despite the repor... more The use of NBs as a mode of analgesia for #NOF in the ED is not common practice despite the reported clinical benefits of quicker onset of pain relief, decreased use of additional analgesia and decreased amounts of analgesia required when more than one mode of analgesia is prescribed. This study aims to test the hypothesis that the implementation of educational and awareness strategies increases knowledge, and implementation of the evidence based use of nerve blocks NB's, as a mode of analgesia for elderly patients with a fractured neck of femur (#NOF) in the Emergency Department (ED). A retrospective clinical audit of medical records using explicit chart review pre and post implementation. Implementation of educational and awareness strategies on pain management to clinical staff in the ED resulted in a significant increase in the administration of NBs, use of multimodal analgesia, and a reduction in average milligrams of morphine administrated to elderly patients with #NOF. The number of older people with #NOF presenting to the ED in Australia is increasing and historically, pain management in this group of patients could be improved. This study demonstrated that an audit, intervention and re-audit design that focused on the implementation of educational and promotional strategies informed by evidence on current and best practice standards were successful in improving delivery of analgesia to elderly patients with #NOF in the ED.
Nurse practitioners in Victoria, Australia must be prepared to Masters level before seeking nurse... more Nurse practitioners in Victoria, Australia must be prepared to Masters level before seeking nurse practitioner (NP) endorsement. The challenge from a university curriculum development perspective was to develop a programme that prepares the NP theoretically and clinically for their advanced practice role.
Aim The aim of this study was to identify and explore nurse managersÕ and clinical nursesÕ percep... more Aim The aim of this study was to identify and explore nurse managersÕ and clinical nursesÕ perceptions of quality improvement as related to their practice. Background The quality improvement process has become an integral component of health care service delivery. The pivotal role that nurse managers and clinical nurses play in the success of quality improvement initiatives is consistently reported throughout the literature. Published evidence has primarily focused on nursesÕ perceptions of ÔqualityÕ and the importance of the nurse's role. However, the literature fails to provide evidence that nurse managers and clinical nurses agree with this. Method Research was conducted at one large regional hospital in Australia in the year 2000 and used a descriptive qualitative research methodology. Data were collected using semistructured interviews with six nurse managers and six clinical nurses on two consecutive occasions and analysed using constant comparative analysis. Results Nurse managersÕ and clinical nursesÕ understanding of the concept of quality improvement and how it applies to the practice of nursing differed. Each group identified that quality improvement can be beneficial to nursing practice, but blamed each other for potential benefits not being realized. Both nurse managers and clinical nurses offered similar solutions with varied emphasis on how quality improvement could improve nursing practice and patient outcomes. Conclusion The quality improvement process requires review. Nurse managers and clinical nurses offered divergent views of the identified deficiencies in the way quality improvement is implemented that reduce its clinical impact. Integral to the success of any quality improvement process is the inclusion of views of both nurse managers and clinical nurses.
To explore whether hospital discharge practices meets the needs of the family carer of a person w... more To explore whether hospital discharge practices meets the needs of the family carer of a person with dementia. Qualitative methodology utilizing semistructured interviews with the primary family carer of a person with dementia after hospital discharge. Purposive sampling methods were used to recruit family carers within 2 months of discharge from hospitals in the state of Victoria, Australia. Twenty-five family carers were interviewed. Key issues that families found problematic include: coordination of discharge planning, the ability of the staff to address family members' needs, poor engagement with family, and perceived lapses in care delivery. Findings suggest that a number of changes to hospital processes and health professionals' practices are needed in order to better meet the transitional needs of family carers of people with dementia. Considerations for practice to improve the quality of hospital discharge preparation for family carers of people with dementia are provided.
International Journal of Mental Health Nursing, 2005
Mainstreaming of mental health care and the prevalence of mental illness have increased the requi... more Mainstreaming of mental health care and the prevalence of mental illness have increased the requirement for care by nurses in the general hospital setting. In rural Australia, mental health services are limited and nurses have less access to support and education. Little is known about how these factors influence attitudes and the care of people with mental illness in rural hospitals. A qualitative descriptive study was used to investigate nurses' attitudes to caring for people with mental illness, the issues that impact on their ability to provide care, and the effect of education, experience, and support. In 2003, 10 nurses from two wards in a rural hospital were interviewed. Participants from one ward had education and support from mental health nurses. Attitudes were found to be inextricably linked to issues that influence nurses' ability to provide care. Dislike was apparent from nurses who suggested it was not their role. Others identified fear, causing avoidance. Conversely, those receiving support and education described increased comfort, with some nurses expressing enthusiasm for mental health care, seeing it as integral to nursing. The priority of physical care, time constraints, environmental unsuitability, rurality, and the lack of skill, knowledge, and mental health services reduced safety and effective care. A limited ability to help was reported, despite support for Mental Health Strategy goals. Positive experience promoted through education and support was required for nurses to improve care and attitudes. Notably, collaboration with mental health nurses was identified as helping nurses overcome fear and increase competence in caring for people with mental illness.
The oral testimony of forty men entering nursing (1950-2000) and twenty men entering midwifery (1... more The oral testimony of forty men entering nursing (1950-2000) and twenty men entering midwifery (1970-2000) in Australia is littered with descriptions of gender discrimination. Men identify many of the barriers they encountered entering a female dominated profession. The Nurses' Registration Act in the States of Victoria (1958) and Tasmania (1952) explicitly stated no male could be registered as a midwife and this paper focuses on the personal accounts of three men (1974-1976) to change this legal impediment. In twenty-first century Australia the percentage of male midwives, like many countries around the world, remains very small, and depending on the state or territory of Australia is between 1 to 2.7 percent.
Background. It is acknowledge that discharge planning benefits both consumers and hospitals. What... more Background. It is acknowledge that discharge planning benefits both consumers and hospitals. What is not widely understood is the experience that the family carer of a person with a dementia has and whether the hospitals meet their in-hospital and post-hospital needs.
Aims and objectives. This paper examined the available evidence concerning hospital discharge pr... more Aims and objectives. This paper examined the available evidence concerning hospital discharge practices for frail older people and their family caregivers and what practices were most beneficial for this group.Background. Hospital discharge practices are placing an increasing burden of care on the family caregiver. Discharge planning and execution is significant for older patients where inadequate practices can be linked to adverse outcomes and an increased risk of readmission.Design. Literature review.Methods. A review of English language literature published after 1995 on hospital discharge of frail older people and family carer’s experiences.Results. Numerous factors impact on the hospital discharge planning of the frail older person and their family carer’s that when categorised focus on the role that discharge planning plays in bridging the gap between the care provided in hospital and the care needed in the community, its potential to reduce the length of hospital stay, the impact of the discharge process on family carer’s and the need for a coordinated health professional approach that includes dissemination of information, clear communication and active support.Conclusion. The current evidence indicates that hospital discharge planning for frail older people can be improved if interventions address family inclusion and education, communication between health care workers and family, interdisciplinary communication and ongoing support after discharge. Interventions should commence well before discharge.Relevance to clinical practice. An awareness of how the execution of the hospital discharge plan is perceived by the principal family carer of a frail older person, will allow nurses and others involved with the discharge process to better reconcile the family caregivers’ needs and expectations with the discharge process offered by their facility. The research shows there is a direct correlation between the quality of discharge planning and readmission to hospital.
Choice to live and die at home is supported by palliative care policy; however, health resources ... more Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care. The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge. Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings. 34 international studies revealed themes of 'the nursing relationship', 'environment', 'communication', 'support' and 'the holistic client centred district nursing role. Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural ar...
The use of NBs as a mode of analgesia for #NOF in the ED is not common practice despite the repor... more The use of NBs as a mode of analgesia for #NOF in the ED is not common practice despite the reported clinical benefits of quicker onset of pain relief, decreased use of additional analgesia and decreased amounts of analgesia required when more than one mode of analgesia is prescribed. This study aims to test the hypothesis that the implementation of educational and awareness strategies increases knowledge, and implementation of the evidence based use of nerve blocks NB's, as a mode of analgesia for elderly patients with a fractured neck of femur (#NOF) in the Emergency Department (ED). A retrospective clinical audit of medical records using explicit chart review pre and post implementation. Implementation of educational and awareness strategies on pain management to clinical staff in the ED resulted in a significant increase in the administration of NBs, use of multimodal analgesia, and a reduction in average milligrams of morphine administrated to elderly patients with #NOF. The number of older people with #NOF presenting to the ED in Australia is increasing and historically, pain management in this group of patients could be improved. This study demonstrated that an audit, intervention and re-audit design that focused on the implementation of educational and promotional strategies informed by evidence on current and best practice standards were successful in improving delivery of analgesia to elderly patients with #NOF in the ED.
Nurse practitioners in Victoria, Australia must be prepared to Masters level before seeking nurse... more Nurse practitioners in Victoria, Australia must be prepared to Masters level before seeking nurse practitioner (NP) endorsement. The challenge from a university curriculum development perspective was to develop a programme that prepares the NP theoretically and clinically for their advanced practice role.
Aim The aim of this study was to identify and explore nurse managersÕ and clinical nursesÕ percep... more Aim The aim of this study was to identify and explore nurse managersÕ and clinical nursesÕ perceptions of quality improvement as related to their practice. Background The quality improvement process has become an integral component of health care service delivery. The pivotal role that nurse managers and clinical nurses play in the success of quality improvement initiatives is consistently reported throughout the literature. Published evidence has primarily focused on nursesÕ perceptions of ÔqualityÕ and the importance of the nurse's role. However, the literature fails to provide evidence that nurse managers and clinical nurses agree with this. Method Research was conducted at one large regional hospital in Australia in the year 2000 and used a descriptive qualitative research methodology. Data were collected using semistructured interviews with six nurse managers and six clinical nurses on two consecutive occasions and analysed using constant comparative analysis. Results Nurse managersÕ and clinical nursesÕ understanding of the concept of quality improvement and how it applies to the practice of nursing differed. Each group identified that quality improvement can be beneficial to nursing practice, but blamed each other for potential benefits not being realized. Both nurse managers and clinical nurses offered similar solutions with varied emphasis on how quality improvement could improve nursing practice and patient outcomes. Conclusion The quality improvement process requires review. Nurse managers and clinical nurses offered divergent views of the identified deficiencies in the way quality improvement is implemented that reduce its clinical impact. Integral to the success of any quality improvement process is the inclusion of views of both nurse managers and clinical nurses.
To explore whether hospital discharge practices meets the needs of the family carer of a person w... more To explore whether hospital discharge practices meets the needs of the family carer of a person with dementia. Qualitative methodology utilizing semistructured interviews with the primary family carer of a person with dementia after hospital discharge. Purposive sampling methods were used to recruit family carers within 2 months of discharge from hospitals in the state of Victoria, Australia. Twenty-five family carers were interviewed. Key issues that families found problematic include: coordination of discharge planning, the ability of the staff to address family members' needs, poor engagement with family, and perceived lapses in care delivery. Findings suggest that a number of changes to hospital processes and health professionals' practices are needed in order to better meet the transitional needs of family carers of people with dementia. Considerations for practice to improve the quality of hospital discharge preparation for family carers of people with dementia are provided.
International Journal of Mental Health Nursing, 2005
Mainstreaming of mental health care and the prevalence of mental illness have increased the requi... more Mainstreaming of mental health care and the prevalence of mental illness have increased the requirement for care by nurses in the general hospital setting. In rural Australia, mental health services are limited and nurses have less access to support and education. Little is known about how these factors influence attitudes and the care of people with mental illness in rural hospitals. A qualitative descriptive study was used to investigate nurses' attitudes to caring for people with mental illness, the issues that impact on their ability to provide care, and the effect of education, experience, and support. In 2003, 10 nurses from two wards in a rural hospital were interviewed. Participants from one ward had education and support from mental health nurses. Attitudes were found to be inextricably linked to issues that influence nurses' ability to provide care. Dislike was apparent from nurses who suggested it was not their role. Others identified fear, causing avoidance. Conversely, those receiving support and education described increased comfort, with some nurses expressing enthusiasm for mental health care, seeing it as integral to nursing. The priority of physical care, time constraints, environmental unsuitability, rurality, and the lack of skill, knowledge, and mental health services reduced safety and effective care. A limited ability to help was reported, despite support for Mental Health Strategy goals. Positive experience promoted through education and support was required for nurses to improve care and attitudes. Notably, collaboration with mental health nurses was identified as helping nurses overcome fear and increase competence in caring for people with mental illness.
The oral testimony of forty men entering nursing (1950-2000) and twenty men entering midwifery (1... more The oral testimony of forty men entering nursing (1950-2000) and twenty men entering midwifery (1970-2000) in Australia is littered with descriptions of gender discrimination. Men identify many of the barriers they encountered entering a female dominated profession. The Nurses' Registration Act in the States of Victoria (1958) and Tasmania (1952) explicitly stated no male could be registered as a midwife and this paper focuses on the personal accounts of three men (1974-1976) to change this legal impediment. In twenty-first century Australia the percentage of male midwives, like many countries around the world, remains very small, and depending on the state or territory of Australia is between 1 to 2.7 percent.
Background. It is acknowledge that discharge planning benefits both consumers and hospitals. What... more Background. It is acknowledge that discharge planning benefits both consumers and hospitals. What is not widely understood is the experience that the family carer of a person with a dementia has and whether the hospitals meet their in-hospital and post-hospital needs.
Aims and objectives. This paper examined the available evidence concerning hospital discharge pr... more Aims and objectives. This paper examined the available evidence concerning hospital discharge practices for frail older people and their family caregivers and what practices were most beneficial for this group.Background. Hospital discharge practices are placing an increasing burden of care on the family caregiver. Discharge planning and execution is significant for older patients where inadequate practices can be linked to adverse outcomes and an increased risk of readmission.Design. Literature review.Methods. A review of English language literature published after 1995 on hospital discharge of frail older people and family carer’s experiences.Results. Numerous factors impact on the hospital discharge planning of the frail older person and their family carer’s that when categorised focus on the role that discharge planning plays in bridging the gap between the care provided in hospital and the care needed in the community, its potential to reduce the length of hospital stay, the impact of the discharge process on family carer’s and the need for a coordinated health professional approach that includes dissemination of information, clear communication and active support.Conclusion. The current evidence indicates that hospital discharge planning for frail older people can be improved if interventions address family inclusion and education, communication between health care workers and family, interdisciplinary communication and ongoing support after discharge. Interventions should commence well before discharge.Relevance to clinical practice. An awareness of how the execution of the hospital discharge plan is perceived by the principal family carer of a frail older person, will allow nurses and others involved with the discharge process to better reconcile the family caregivers’ needs and expectations with the discharge process offered by their facility. The research shows there is a direct correlation between the quality of discharge planning and readmission to hospital.
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Papers by Les Fitzgerald