Health Sciences

Faculty of Health Sciences, Bendigo

School of Nursing & Midwifery

RESEARCH

Current Research

• The Comparative Effectiveness Of Temazepam and Sleep Hygiene After Discharge From Acute Hospital
• Pharmacists and Nurses: a preliminary study of interdisciplinary collaboration between nurses and pharmacists on patients knowledge of medication and disease states with special reference to heart failure patients
• An Evaluation of Dissemination Strategies for AMI Best Practice Guidelines
• Mental illness and homelessness in the Loddon Southern Mallee Region
• Professional boundaries in rural settings
• Specialist nursing in small rural hospitals
• Factors that promote or inhibit regional and rural midwives use of the midwifery model in the care of childbearing women
• Evaluation of eating disorders programs
• Evaluation of GP engagement in service co-ordination
• The impact of nurses stories on student learning
• Reliability in clinical assessment

The Comparative Effectiveness Of Temazepam and Sleep Hygiene After Discharge From Acute Hospital
Researchers: Les Fitzgerald, Dr Helen Aikman, Leigh Kinsman, Debbie Ludeman, Jenny Howe, Dr John Gault, Prof Kenn Raymond
A recent evaluative study of early outpatient cardiac rehabilitation patients (n=112) conducted at Mount Alvernia Mercy Hospital indicated that 30% of respondents experienced sleeping difficulties post hospital discharge. Approximately the same percentage experienced emotional disturbances. A common therapeutic approach to sleeping difficulties is the prescription of a hypnotic, such as Temazepam. The effectiveness of Temazepam in reducing time to sleep and increasing sleep duration is well established (Cuanang et al., 1982; Roehrs et al., 1986). However, the use of Temazepam in specific patient populations has not been widely researched and no studies have been undertaken to examine the effectiveness of Temazepam in people newly discharged from hospital. This study aims to compare effectiveness of Temazepam and sleep hygiene in reducing patient reported sleep disorders post discharge from acute hospital.

Pharmacists and Nurses: a preliminary study of interdisciplinary collaboration between nurses and pharmacists on patient’s knowledge of medication and disease states with special reference to heart failure patients
Researchers: Sharon Kendall, Prof Kenn Raymond, Melissa Deacon-Crouch

Aims
1. To develop a comprehensive patient information module that encompasses information deemed to be important from both a pharmacist and nursing point of view for the patients with heart disease in Australia;
2. To develop strategies for the optimised delivery of such information and, devise a subsequent research project that would measure patient-related outcomes that verifies if the provision of such information from a team of pharmacists and nurses is beneficial to the patient.
The research plan is divided into 2 sections. Initially focus groups of clinical nurses and hospital pharmacists will be interviewed to determine what constitutes important information that the patient with heart disease must know from their point of view.
The second stage is to quantify the type on information that the patient deems to be important. A sample of 100-200 inpatients with heart disease from hospital medical and surgical wards will be used. Patients will be asked to complete a questionnaire concerning their information needs. The questionnaire will focus on ascertaining patients’ knowledge about their disease; drug treatments and; lifestyle modifications that may be necessary.

An Evaluation of Dissemination Strategies for AMI Best Practice Guidelines.
Researchers: Leigh Kinsman, Prof Ruth Endacott

The Loddon Mallee Department of Health Services (via the Loddon Mallee Region Emergency and Critical Care Services Committee - LMRECCCC) disseminated “Guidelines for the Early Management of Acute Myocardial Infarction” via a process of consultation, publication and education throughout the region in 2002.
The aim of this study is to evaluate the impact on efficient and timely administration of thrombolytic drugs as recommended in the guidelines. Thrombolytic drugs have a significant impact on both mortality and morbidity for people suffering an AMI.
The study aim will be achieved by retrospective medical records audit at four participating hospitals utilising an interrupted time series design.
This project is being overseen by LMRECCCC.

Mental illness and homelessness in the Loddon Southern Mallee Region
Researchers: Magaret Grigg, Prof Fiona Judd

The aim of this study is to estimate the number of people with a mental illness, treated by Bendigo Psychiatric Services, who are homeless or living in marginal housing. The research team will undertake this through:
• mapping marginal housing in the region,
• development of a survey instrument to identify patients current housing circumstances
• interviews with key informants
Early findings highlight the range and diversity of housing across the region. Fourteen percent of patients were identified as marginally housed; despite this, case managers only identified housing as an issue for 6% of their patients. Detailed data analysis is currently underway.

Professional boundaries in rural settings
Researchers: Professor Ruth Endacott, Prof Fiona Judd
Margaret Grigg, Anita Wood

The intrinsically stressful nature of rural health practice is well recognised. One distinctive dilemma in rural practice is dual relationships. Rural mental health workers are often required to provide treatment for patients with whom they have had a previous or concurrent personal or other relationship. These dual relationships pose particular challenges in a rural setting. This project aims to compare the issues associated with dual relationships and professional boundaries for mental health workers in metropolitan, regional and rural settings. Data will be collected through semi-structured focus groups and thematic analysis will be used to compare and contrast the experiences of mental health workers with dual relationships in different communities.

Specialist nursing in smaller rural hospitals
Researchers: Professor Ruth Endacott, Michelle Price

The role of nurses in rural settings has received much attention in recent years. However, whilst attempts have been made to explore specific aspects of the nursing role, there is an absence of research evidence regarding roles undertaken by individual nurses in diverse settings. This study aims to identify and explore: how specialist nursing care is provided in rural settings; how nursing roles are shaped and defined when nurses have to undertake a number of different specialities; the range of nursing roles undertaken in rural settings; the responsibilities and decisions made by rural nurses in their daily lives and the factors influencing current work patterns.

Factors that promote or inhibit regional and rural midwives use of the midwifery model in the care of childbearing women
Researchers: Fran Sheean, Professor Sue MacDonald, Professor Ruth Endacott

In the midwifery model of care, the midwife is the primary carer as she works in partnership with the woman during the pregnancy-postnatal continuum, and seeks assistance from other health professionals as the need arises. Most rural midwives are required also to be nurses whose work is primarily care of the sick. In this project rural women will be interviewed to seek their perceptions of the maternity care they have received. Rural midwives will also be interviewed to determine if they have difficulties reconciling two different philosophies of care, and to ascertain what factors facilitate or impede the implementation into practice of the midwifery model of care.

Evaluation of eating disorders programs
Researchers: Professor Ruth Endacott, Melissa Deacon-Crouch, Susan Kidd

This study is funded by Barwon Health and Bendigo Health Care Group to evaluate two Eating Disorders programs, established through Department of Human Services (DHS) funding. The aims of the evaluation are twofold:
1. To evaluate the effectiveness of specific structures, processes and outcomes of the two Eating Disorders programs
2. To make recommendations as to their general applicability across the primary health and mental health sectors.
The researchers are employing stakeholder evaluation methods (Fourth Generation Evaluation Guba & Lincoln, 1989) and taking a formative approach with regular progress reports. This enables the program teams to incorporate stakeholder perspectives into the developing program. A range of mainly qualitative strategies will be used to gather the data, including focus group interviews, in-depth interviews and documentary analysis.

Evaluation of GP engagement in service co-ordination
Researchers: Dr Helen Aikman, Maria Sheldon, Professor Ruth Endacott

This study provided an evaluation of three Service Coordination – Enhanced Primary Care facilitation projects designed to enhance GP engagement across three Divisions of General Practice in Central Victoria. The three projects are part of the broader Service Co-ordination activities conducted by the Central Victorian Health Alliance (CVHA). The emphasis of the strategies was on engaging the GPs rather than improving the care planning. Hence the process of engagement was evaluated, rather than any outcomes/impact on patient management. Data collection processes included individual and group interviews, observation of workshops, meetings and other events, and further discussions to clarify issues arising from the observation. Strategies that were clearly successful included: developing existing systems, processes and initiatives; visible support from the Divisions of General Practice; the practical working through of the care planning process. Whilst general practitioners and practice staff were the focus of the evaluation, the findings and recommendations are applicable across the primary care sector.

The impact of nurses’ stories on student learning
Researchers: Cathy Nugent, Melissa Deacon-Crouch, Professor Ruth Endacott

Nurses’ stories highlight the distinction between knowledge gleaned from textbooks and that gained by experience and have also been identified as useful learning tools for students; facilitating their access to cumulative clinical wisdom. Previous research suggests that nurses develop clinical wisdom using an inductive process by observing their patients whilst drawing on previous experience. In this way many clinicians will recall ‘paradigm cases’ that help to shape or reshape their perspective on particular problems. The aim of this study is to examine the impact of a narrative learning approach on students’ perceptions of their clinical placements.

Reliability in clinical assessment
Researchers: Judith Downie, Jim Kevin

Assessment of nursing students takes place both through theoretical assessment and clinical, practice-based, assessment. There is currently some anecdotal evidence to suggest that clinical assessment tools are being used in a less than uniform fashion across the region and this study seeks to address the reasons why. This problem is also identified in the literature (eg Watson, Simpson, Topping & Porock, 2002; Williams, Wellard & Bethune, 2001). The aims of this study are to:
1. examine the reliability of the existing clinical assessment tool used to assess students during clinical placement in the undergraduate nursing programs.
2. identify any education needs for assessors to facilitate a better understanding of the existing tool. Our clinical assessors are of varied backgrounds and so require varying levels of support to meet the role of clinical teacher.
3. identify any changes that may be required in the design of the assessment tool in order to improve reliability.