Research Vignettes
Dr Robin Ray
Dr Robin Ray was awarded her PhD in 2007. Her research developed new insights into the social support systems accessed by family caregivers of people living with motor neurone disease (MND).
Providing care in life-limiting degenerative illness redefines relationship boundaries, changes roles and confronts understandings of personhood. Caring for a person with MND is particularly challenging because in this illness physical function deteriorates whilst the mind remains alert. As the person loses function, family members and sometimes friends, become increasingly involved in providing hands-on care, usually the role of a trained nurse. Caregiving can create opportunities to deepen relationships and gain greater insights into the self. Yet, on the other hand, watching a relative or friend deteriorate and not being able to do anything to stop the process brings continual losses that are often hard to comprehend and difficult to manage. The concept of emotional labour has been recognised in workers who need to carry out their job in a positive manner regardless of the situation. Robin’s research indicated that family and friends who engage in care provision also need support to manage emotional labour.
Normal social relationships are not structured to provide the level of trust and support that caregivers need during several years of providing care. Instead, caregiving relationships between the caregiver and the care receiver, the caregiver and the health care system, and the caregiver and their social network, are subject to the more fluid concept of socio-connective trust. Socio-connective trust is a multifaceted, dynamic trust that flows between people in the supportive care network. It consists of the following dynamics: structural trust (habitual actions, taken-for-granted assumptions and socio-cultural constructions), functional trust (indebtedness, reciprocity, and social capital), and caregiver constructs (expectations of behaviour arising from a lifetime of commitment to another).
Robin’s work has implications for health and social care workers who are often only resourced to supplement care for the person diagnosed with a degenerative illness. Understanding the dynamics of socio-connective trust over the illness trajectory enables health professionals to assess and respond to the needs of family caregivers on a regular basis. Given that the healthcare system in Australia expects family members to care for their relatives and friends at home, more relevant support is needed for informal caregivers.
Robin has presented her work at international and national conferences and published in high impact journals.
Supervisor: Professor Annette Street
Dr Ian Baldwin
Dr. Ian Baldwin completed his PhD in early 2006. Ian’s research addressed the provision of artificial support of failing kidneys in critically ill patients. Over the last 20 years a commonly used treatment known has been continuous renal replacement therapy or ‘CRRT.
This requires a skilled nurse to manage the treatment plus a dedicated CRRT machine. However success of CRRT has been limited by clotting of patient blood in the circuits and membranes, the availability of skilled nurses to manage the treatment, and the high cost of the commercially made fluids used for the treatment. This can make continuous treatment ineffective or impractical, with frequent interruptions, expense, and the difficulty of providing large numbers of machines and skilled nurses. It also means that patients must be connected to the CRRT machine 24 hours a day often impacting upon their comfort and sleep patterns.
Ian compared CRRT with a new technique termed extended daily diafiltration or 'EDDf' applied for 8 hours each day. The outcome data demonstrated that the 8 hour technique produced no significant or clinical differences in waste removal and also had the advantage of using fluids manufactured at the bedside. This approach was less likely to clot in the shorter time frame of use, was cheaper, and less dependant upon a large pool of skilled nurses and purchase of machines. Importantly this daily treatment also allows for time without treatment, where the patient is not continuously tethered to the machine. The machine can therefore potentially be used for up to 3 patients within a 24 hour period.
Despite previous single treatment reports highlighting success with this new approach, there has been no adequate comparative study with traditional continuous approaches. The only published comparative study failed to reveal data over several days of use, and did not report on key variables of interest to clinicians. Ian’s study has made such a comparison and provides comparative data for many important clinical care variables necessary for clinicians prescribing and using EDDf as an alternative treatment to CRRT in the intensive care unit.
Ian’s work has changed clinical practice in both Australia and overseas. In the latter context he has been sought as an invited speaker at forthcoming renal replacement conferences in San Diego, USA, and Vicenza, Italy.
Supervisors: Dr Bill Koch and Professor Rhonda Nay.