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Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Nursing and Midwifery, Griffith Health, More people die of cardiovascular disease in Australia than from any other condition. Acute Coronary Syndrome (ACS) is the acute event of the chronic condition coronary heart disease (CHD) represents a continuing spectrum of three conditions and can be divided into unstable angina, non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). Patients’ symptoms in all three conditions are self managed by the first line medication sublingual glycerine trinitrate (SLGTN). The aim of management of ACS is to minimise symptoms and improve quality of life (QOL). Education of this complex medication such as recommended route, timing, side effects, prophylactic use and response to emergency when symptoms are not relieved are essential for the person to be able to effectively self administer the medication. Nitrates such as SLGTN have different biovariabilities and pharmokinetic properties which can have potent adverse effects such as vasodilatation if not taken correctly. Patients self-manage and prevent angina symptoms using SLGTN and rest when they are home; therefore it is essential that they have adequate knowledge of SLGTN and its use. However previous studies have reported patients have poor knowledge of SLGTN and appropriate symptom management.

Background - Fatigue negatively impacts on the lives of people with multiple sclerosis (MS). While primary MS-related fatigue may be difficult to treat, the authors hypothesised that secondary fatigue may respond to targeted strategies addressing causal factors such as pain, depression and sleep disturbance. Methods - A prospective, multi-centre study was conducted over six months to establish the clinical utility and efficacy of a practical screening tool for the assessment of fatigue and associated factors: the Brief Fatigue and Associated Symptoms Scale (BFASS). A total of 158 people with MS attending outpatient clinics were recruited across three sites. Results - The BFASS provided a structured approach to assessment and increased referrals by MS nurses for clinically significant contributors to fatigue. As expected, severity of fatigue was correlated with pain, depression, daytime sleepiness and quality of life scores. Mean scores for fatigue also showed a small reduction from baseline (M = 39, SD = 19) to 6-month follow-up (M = 35, SD = 19). From the perspective of MS nurses, implementing a screening tool for fatigue and associated factors uncovered previously hidden problems and it improved symptom management. Conclusion - The BFASS is recommended for MS clinicians as a brief, structured assessment of fatigue, providing clinically meaningful cut-offs for referral, and facilitating conversations about hidden MS-related problems that reduce quality of life.

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Nursing and Midwifery, Griffith Health, Little is known about the post arrival sexual health related issues affecting young refugee background Australians and how they interact with their parents, partners, and peers regarding these culturally sensitive topics. Without an understanding of what influences their knowledge, attitudes and beliefs, sexual decision making, and behavioural intent, it is difficult to determine this group’s sexual health needs. The purpose of this study was to explore and describe the sexual health knowledge, attitudes and beliefs, and behaviour of the 16-24 year old Queensland Sudanese community members. This research also explored the broader Queensland Sudanese community’s attitudes and beliefs and the intergenerational factors perceived to be influencing sexual health literacy, patterns of behaviour, and health service utilisation. This descriptive research was conducted using a four phase convergent parallel mixed methods design. Extensive community consultation was undertaken during Phase 1 Project conceptualisation; Phase 2 Pilot study assessed the feasibility of the proposed research process; Phase 3 involved concurrent data collection and analysis from three equally weighted parallel strands; and Phase 4 the convergence and interpretation of Phase 3 data. The Phase 3 parallel strands included: (i) a written survey with 16-24 year old community members; (ii) interviews with a sub-sample of the survey participants; and (iii) five community focus group discussions (FGD) with adults. The National Survey of Australian Secondary Students and Sexual Health (NSASSSH) tool was adapted for use in this study. Descriptive, correlational, and Multivariate Analysis of Variance statistics were used to analyse the survey data. Following separate concurrent thematic analysis of the qualitative data, the convergence and triangulation of strand data were conducted, without transformation, via a process of comparing and contrasting the independent findings.

Background and Purpose: It has become imperative for health professionals to have information literacy, including database searching skills, to enable them to practise contemporary quality patient care, and developing information literacy requires computer literacy and self-directed learning (SDL). More than the half of the current nursing workforce in Taiwan graduate from an Associate Degree in Nursing (ADN) program, but the effectiveness of integrating e-learning to promote the information literacy and SDL of students in the ADN program is unclear. This study investigated whether a researcher-developed web-enhanced education intervention guided by Knowles' Adult Learning Theory (KALT) would improve Taiwanese ADN students' online searching knowledge, skills, self-efficacy, and self-directed learning. The 10-week intervention comprised a self-paced online learning package, an online forum, a face-to-face tutorial, and an optional weekly drop-in session. [...], Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Nursing and Midwifery, Griffith Health, Full Text

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Nursing and Midwifery, Griffith Health, Breast cancer is the leading cancer in women worldwide; one in eight will be diagnosed before the age of 75 years. Of those diagnosed 25% are under the age of 50 years and likely to be premenopausal and have family responsibilities (Coyne & Borbasi, 2006; Sammarco, 2001). Although all women regardless of age experience difficulties, younger women face significant difficulties after their diagnosis related to their phase of life (Bloom, Stewart, Chang, & Banks, 2004). The diagnosis and treatment of breast cancer is a time of intense physical and emotional disturbance. The women rarely go through this alone. They are supported by their family members who are distressed and lost in the situation. During this time families experience a range of responses including changes to communication, role and sense of control as they respond to the diagnosis and treatment for breast cancer. While family is the mainstay of support for young women with breast cancer there is little research that has addressed the family response to breast cancer. The aim of this research was to explore the strengths and resources young women and their family members use during treatment for breast cancer. The use of a family framework allowed the unique nature of the family response to breast cancer to be explored. A two phase mixed method approach informed by the Resiliency Model of Family Stress, Adjustment and Adaptation (McCubbin & McCubbin, 1993) was used, to investigate the strengths and resources used by the family in response to breast cancer treatment. A total of 111 participants, women with breast cancer and their family members completed the composite questionnaire. A non-parametric analysis of the quantitative data included descriptive statistics, correlations between variables and changes over time. Personal interviews with 14 women with breast cancer and nine family members added richness to the research data. A family case study analysis of the 36 families provided information on the

Background: Nurse-led telephone follow-up offers a relatively inexpensive method of delivering education and support for assisting recovery in the early discharge period; however, its efficacy is yet to be determined. Aim: To perform a critical integrative review of the research literature addressing the effectiveness of nurse-led telephone interventions for people with coronary heart disease (CHD). Methods: A literature search of five health care databases; Sciencedirect, Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest and Medline to identify journal articles between 1980 and 2009. People with cardiac disease were considered for inclusion in this review. The search yielded 128 papers, of which 24 met the inclusion criteria. Results: A total of 8330 participants from 24 studies were included in the final review. Seven studies demonstrated statistically significant differences in all outcomes measured, used two group experimental research design and valid and reliable instruments. Some positive effects were detected in eight studies in regards to nurse-led telephone interventions for people with cardiac disease and no differences were detected in nine studies. Discussion: Studies with some positive effects generally had stronger research designs, large samples, used valid and reliable instruments and extensive nurse-led educative interventions. Conclusion: The results suggest that people with cardiac disease showed some benefits from nurse-led/delivered telephone interventions. More rigorous research into this area is needed.

The purpose of this study was to examine the impact of pain on functioning across multiple quality of life (QOL) domains among individuals with multiple sclerosis (MS). A total of 219 people were recruited from a regional MS society membership database to serve as the community-based study sample. All participants completed a questionnaire containing items about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the preceding 2 weeks. Respondents who reported pain then completed an in-person structured pain interview assessing pain characteristics (intensity, quality, location, extent, and duration). Comparisons between participants with and without MS-related pain demonstrated that pain prevalence and intensity were strongly correlated with QOL: physical health, psychological health, level of independence, and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. These findings suggest that for people with MS, pain is an important source of distress and disability beyond that caused by neurologic impairments.

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Nursing and Midwifery, Griffith Health, Type II diabetes is a serious problem in Taiwan. The prevalence of Type II diabetes in the whole population is between 5 to 10% and 11% in people over 45 years of age. Diabetes is the fifth leading cause of death, and care costs are 4.3 times higher than for people without diabetes. Self-management is the cornerstone of diabetes control. Failure to motivate or empower people to self-manage their diabetic condition has been identified as an important issue in research literature. Developing effective and efficient strategies to promote self-management of diabetes is important in order to prevent serious complications. The aim of the present study was to determine whether participation in a Motivational Interview (MI) by Taiwanese people with Type II diabetes would improve their self-management and well being. This three phase RCT included a small qualitative component. The sample was made up of 286 people from a large tertiary teaching hospital in Southern Taiwan. Participants were randomly allocated into either the MI group or the usual care group. Phase I provided baseline measures, phase II the intervention and phase III involved re-testing to establish the effectiveness of the intervention at three months follow-up. Content of the interview was modified according to an assessment of participant’s Stage of Change; an approach underpinned by the Transtheoretical Model (TTM). The Motivational Interview (MI) encompassed a variety of interviewing and counselling techniques and information sharing. The control group was provided with usual care that included diabetes educational sessions and attendance at a Diabetes Club provided by hospital nursing staff...

Objectives: The objective of this study was to examine the extent to which pain-related beliefs and coping strategies predicted measures of adjustment to pain among people with multiple sclerosis (MS), over and above that accomplished by demographic and clinical variables. Methods: Participants were a community-based sample of people with chronic MS-related pain (N = 105) who completed postal surveys and standardised interviews that included measures of demographic and MS-related variables, typical pain intensity, psychological functioning, pain interference, pain beliefs and coping strategies. Results: Pain-specific beliefs and coping strategies were associated with and explained a significant proportion of the variance in adjustment to pain (24−34%) among people with MS, over and above that accomplished by demographic and disease-related variables and pain intensity. Compatible with previous studies, greater endorsement of pain constancy and catastrophizing were significant predictors of poorer adjustment, whereas perceived ability to decrease pain and increasing behavioural activities in response to pain were related to positive adaptation. Discussion: These findings provide support for the premise that psychosocial factors remain central in disability-related pain and suggest the possibility that interventions targeting these variables would reduce the negative impact of pain among people with MS.

Over the past few decades a major paradigm shift has occurred in the conceptualisation of chronic pain as a complex multidimensional phenomenon. Yet, pain experienced by individuals with a primary disability continues to be understood largely from a traditional biomedical model, despite its inherent limitations. This is reflected in the body of literature on the topic that is primarily driven by positivist assumptions and the search for etiologic pain mechanisms. Conversely, little is known about the experiences of and meanings attributed to, disability-related pain. Thus the purpose of this paper is to discuss the use of focus group methodology in elucidating the meanings and experiences of this population. Here, a distinction is made between the method of the focus group and focus group research as methodology. Typically, the focus group is presented as a seemingly atheoretical method of research. Drawing on research undertaken on the impact of chronic pain in people with multiple sclerosis, this paper seeks to theorise the focus group in arguing the methodological congruence of focus group research and the study of pain experience. It is argued that the contributions of group interaction and shared experiences in focus group discussions produce data and insights less accessible through more structured research methods. It is concluded that a biopsychosocial perspective of chronic pain may only ever be appreciated when the person-in-context is the unit of investigation.

The study described in this article aimed to identify issues relating to incontinence and assess the impact of referral to a continence adviser on the lives of people with multiple sclerosis (MS). The study design used an in-depth, two-phase anonymous mail survey within a general community as nominated by the participants. Fifty-six people participated in phase 1 and eleven people completed phase 2. The results indicated that incontinence is a problem for the vast majority of participants — people with MS. One-third of the eligible participants took up the option of a consultation, assessment and treatment from a continence nurse. Reasons for not taking up the visit from the continence nurse included ‘managing OK’, ‘didn’t think it would help’, ‘embarrassed’ and ‘too busy’. Increasing awareness of urinary incontinence in the community is important and education needs to focus on at-risk groups in presenting the range of options available to assist people experiencing incontinence.

Background: The birth of a very premature infant is a critical event in the life of a family and studies have shown that mothers of these infants are at greater risk of psychological distress than mothers of full-term infants. Study design: A total population study of mothers of preterm infants born at less than 32-week gestation at a tertiary referral hospital. Subjects and methods: Sixty-two mothers of very preterm infants (<32 weeks) participated in the present study which examines correlates of maternal depressive symptomatology at 1 month following very premature birth. Information was obtained from structured questionnaires completed by mothers at 1 month after infant admission to neonatal intensive care. Results: Forty percent of the mothers reported significant depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS). Logistic regression analysis indicated that high maternal stress resulted in an increased likelihood of depressive symptoms (OR 1.15, CI 1.04–1.26, p<0.01). Higher levels of maternal education (p<0.05), and increased perception of support from nursing staff (OR 1.06, CI 0.88–1.00, p<0.05) resulted in decreased likelihood of depressive symptoms. Conclusions: The birth and subsequent hospitalisation of a very premature infant evokes considerable psychological distress in mothers. These results have implications for policy development in order to enhance family centred care in the neonatal intensive care.

The risk of continuing depression in mothers of very premature infants after discharge has not been studied in any depth. This study compared reports of maternal depressive symptomatology at one month after infant birth (Phase 1) and three months following infant hospital discharge (Phase 2). Fifty-two mothers completed the Edinburgh Postnatal Depression Scale at these two points in time. Results indicate that the percentage of mothers who reported high levels of depressive symptoms significantly decreased between Phase 1 and Phase 2. Logistic regression analysis indicated that depression scores at Phase 1 and maternal stress at Phase 2 were important factors in explaining depression scores at Phase 2.

The aim of the study was to identify from people with MS and their families, what information, in what format and when in the course of the disease they felt would assist the newly diagnosed person with MS and their family. A state wide cross sectional self-report study design was utilised for this research project. Thirty-four people with MS and 18 family members participated in the research proper. Participants self selected. The people with MS and family and friends who participated in this research wish to be provided with a range of information. They recommended that the newly diagnosed and their families be provided with information that reflects their personal needs, be provided in person in both group and individual sessions and include research aimed at cures and therapies, counselling and support services early in the course of the disease.

The assessment of people with disabilities is complex. The priorities adopted and issues addressed vary. The Multiple Sclerosis Disability Profile was developed and is currently used to assess people with MS in Australia. However, little is known about its psychometric properties and people with MS have not had a previous opportunity to comment on its relevance to them. Therefore the reliability and validity of the Disability Profile was assessed using widely used assessment methods and the views of people with MS. Standard methods for assessing the characteristics of assessment scales were used and one hundred and three people with MS were asked to nominate important issues that need discussing when assessing the person with MS. Support people and health professionals provided additional views. The research was conducted from a theoretical perspective that considers the relationship between disability and citizenship. The internal consistency of the Disability Profile was found to be excellent (Cronbach's Alpha= 0.9656). Furthermore it was found that the inter-rater reliability of the Multiple Sclerosis Disability Profile can be improved with clearer operational definitions, increased training for health professionals in the use of the instrument and reduced number of responses per item. Moreover the assessment of disability needs to be improved to achieve more sensitivity and to incorporate the handicap score devised in the course of this study. These amendments will enable improved discrimination when assessing handicap. However further research is required to assess the reliability and validity of the amended instrument. As the Disability Profile is a starting point for assessment, therapy and support for the person with MS, the revisions proposed here offer health professionals a holistic assessment instrument with acceptable reliability and viability.