Winsome St John

Purpose: Prisoners are vulnerable to tobacco addiction and have a smoking prevalence significantly higher than that of the general community. The context of this study was the implementation of a “smoke-free prisons” policy, which imposed forced smoking cessation onto the Queensland, Australian prison population. The study asked the question: “What are the psychosocial processes in which male prisoners engage during smoking cessation in a smoke-free environment?” Design/methodology/approach: Qualitative interviews were conducted with 15 prisoners in South-east Queensland smoke-free correctional centres. Grounded theory methodology was applied to construct a theory of the processes of smoking cessation. Findings: The constructed theory was named Engaging with Quitting. In this model, prisoners proceed through a cycle of evaluations, adjustments and reflections on their reality as related to the smoke-free prison. The study gives first-hand accounts of the prisoners’ use (and abuse) of nicotine replacement therapy. Three personality typologies emerged from the data: The Angry Smoker, the Shifting Opportunist and the Optimistic Quitter. Research limitations/implications: This qualitative study makes no claim of generalisability and cannot be taken to represent all prisoners. Females, youths and culturally diverse prisoners were not represented in the sample. Practical implications: Smoking cessation in prisons must be recognised as an ongoing process, rather than a discrete event. A coordinated approach between custodial and health authorities is required to minimise maladaptive coping strategies. Originality/value: This study provides a descriptive account of the processes prisoners undertake during involuntary smoking cessation and has described the manner in which prisoners manufacture home-made tobacco from nicotine patches. The study has produced an original theory named Engaging with Quitting.

PURPOSE: We investigated strategies used by older and working-aged women to manage urinary incontinence (UI) in their daily lives. DESIGN: Cross-sectional, descriptive study. SUBJECTS AND SETTING: The sample comprised 103 older (>65 years; mean = 74.6 years) and 104 working-aged (18-65 years; mean = 50.3 years) community-dwelling Australian women with self-reported UI. They had experienced UI for an average of 5 years and a majority rated their UI severity as moderate to severe. INSTRUMENT: Based on a comprehensive literature review, a 93-item author-developed questionnaire was developed and pilot tested to identify the type and frequency of strategies used by participants to manage UI. Items were developed that queried demographic and lower urinary symptom characteristics (type, severity, duration). METHODS: Participants were recruited via public and privately funded continence clinics and an advertisement in a local newspaper, with a 66% retention rate following recruitment. Questionnaires were posted to participants with a reply paid envelope for return. RESULTS: The women used a range of strategies to manage UI in their daily lives. A large proportion of women from both groups chose to (1) go to the toilet immediately after urge (older 94%; working-aged 92%); (2) integrate urine loss management a normal part of everyday life (older 81%; working-aged 78%); (3) stopping activities that make them leak (older 85%; working-aged 83%); and (4) using pads and aids for urinary containment (older 87%; working-aged 73%). Older women were more likely to use most of the strategies identified in the questionnaire. These strategies included the following: stop drinking in the evening (older 64%; working-aged 43%; P = .003); organize their bedroom close to the toilet (older 61%; working-aged 36%; P = .001); limit travel (older 45%; working-aged 18%; P = < .001); limit socializing (older 30%; working-aged 11%; P = .001); and limit new relationships (older 25%; working-aged 11%; P = .01). Respondents engaged in a variety of hygiene measures such as washing (older 86%; working-aged 60%; P ≤ .001), changing pads frequently (older 76%; working-aged 58%; P = .008), and using deodorisers (older 68%; working-aged 50%; P ≤ .008). Working-aged women were more likely to modify (older 17%; working-aged 70%; P < .001) or avoid (older 8%; working-aged 32%; P = .001) sexual activity. CONCLUSION: Both older and younger women aimed to normalize UI in their daily lives, using strategies designed to keep the bladder empty, maintain secrecy, and preserve social continence. Knowledge of these strategies and the difference between older and working-aged women will enable health care professionals to initiate more targeted support and advice for women with UI.

Persistent pain negatively impacts upon the individual suffering this condition. Almost all care related to persistent pain is self-managed. Decision-making is a critical skill of the self-manager and without these skills it would be improbable that effective self-management would emerge. However, current theories regarding decision-making and self-management have not adequately accounted for the many difficulties faced by individuals enduring persistent pain and the consequences of these experiences for the decision-maker. This grounded theory study revealed that individuals will transform into three distinct types of decision-makers using three different styles of decision-making in response to the many and varied problems related to the experience of persistent pain. These findings will provide nurses with valuable information to better equip individuals with persistent pain through the decision-making processes necessary for successful self-management.

In this observational study, the perceptions, compliance, techniques, and contextual issues of hand hygiene practices among community clinicians (nurses) during 103 hand hygiene opportunities (based on the World Health Organization "Five Moments for Hand Hygiene") in 40 patient care episodes were examined. Compliance with standard hand hygiene practices was generally poor, with many contextual influences making compliance difficult. Clinician preferences and convenience are important considerations in hand hygiene compliance. Improving home-visiting community clinicians' hand hygiene practices requires addressing contextual issues related to the availability of hand hygiene equipment, such as alcohol-based hand rubs, as well as hand hygiene in-service education to update knowledge on hand hygiene for everyday practice in community settings.

The aim of this grounded theory study was to investigate strategies used by school-based nurses to promote adolescent boys’ access to and engagement with school-based health services. Interviews were conducted with 10 school nurses in South-East Queensland, Australia. The central process identified was creating connections, encompassing three inter-related sub-processes: facilitating communication, mediating contextual issues and bridging cultural issues. These processes incorporate strategies that highlight ways school nurses can engage with boys, individually and collectively, to promote and facilitate help-seeking from school-based health services. Findings inform practice and guidelines for improving boys’ access to school-based health services.

Endorsed Enrolled Nurses (EENs) articulating from diploma level to Bachelor of Nursing (BN) studies at university experience many transitional barriers. Flexible credit arrangements can create further difficulties because students may enter directly into the second year of a degree program, thus foregoing supportive interventions targeting first year students. This qualitative study explored the transitional barriers faced by EENs articulating to the second year of a BN program and the processes employed to adapt to the university learning environment. Lizzio’s (2006) Five Senses of Success Model provided a framework for data analysis. Lizzio’s model highlights how students’ success at university depends on their sense of purpose, capability, resourcefulness, connectedness and academic culture. This study revealed EENs grapple with their dual identity, have difficulty reconciling their academic and clinical competence, and struggle to assimilate to the academic learning environment. Findings illum...

Emmanuel e. & st john w. (2010) Maternal distress: concept analysis. Journal of Advanced Nursing 66(9), 2104–2115. Aim.  This paper is a report of an analysis of the concept of maternal distress.Background.  Although not well‐developed, the concept of maternal distress has offered an important viewpoint in nursing and midwifery practice since the mid‐1990s. Traditionally, understanding of maternal distress has been based on the medical model and dysfunction. The concept of maternal distress needs development so that it describes responses ranging from normal stress responses to those indicating mental health problem/s.Data sources.  The SCOPUS, CINAHL and Medline databases were searched for the period from 1995 to 2009 using the keywords ‘psychological distress’, ‘emotional distress’ and ‘maternal distress’.Review methods.  Steps from Rodgers’ evolutionary concept analysis guided the conduct of this concept analysis.Results.  Four attributes of maternal distress were identified as responses to the transition to motherhood, with the level of each response occurring along a continuum: stress, adapting, functioning and control, and connecting. Antecedents to maternal distress include becoming a mother, role changes, body changes and functioning, increased demands and challenges, losses and gains, birth experiences, and changes to relationships and social context. The consequences of maternal distress are compromised mental health status, maternal role development, quality of life, ability to function, quality of relationships and social engagement. The extent of the impact depends on the level of maternal distress.Conclusion.  Clearer interpretation of maternal distress offers a comprehensive approach to understanding maternal emotional health during the transition to motherhood. Acknowledging women’s experiences and providing more appropriate support could alleviate some of the struggles and hardships experienced by mothers.

Fathers are increasingly expected to engage in infant care. The early postpartum period has been described as a time when work-family conflict, lack of sleep, and fatigue are prominent themes. Research has demonstrated that these themes can have a deleterious effect on work safety. Lack of sleep and fatigue have been linked to workplace accidents, yet few studies have specifically investigated work-family conflict, sleep, and fatigue among men with infants. The need exists to specifically study and measure work-family conflict, sleep deprivation, and fatigue in relation to early fatherhood. Such research could have a direct effect on occupational health nursing practice.