Lack Of Organisational Support Research Articles

Evidence based practices are critical care nurses ready for it?

In the emergence of the evidence based practice movement, critical care nurses have struggled to identify scientific evidence on which to base their clinical practice. While the lack of critical care nursing research is a major concern, other important issues have significantly stalled the implementation of evidence even when it is available. A descriptive study of 274 critical care nurses was undertaken to examine nursing research activity in Victorian critical care units. The study aimed to identify critical care nurses' research skills, the barriers encountered in participation and implementation and the current availability of resources. Results revealed that 42 per cent of the nurses who participated in the study believed that they were not prepared adequately to evaluate research, and less than a third believed they were sufficiently skilled to conduct valid scientific studies. An association was found between nurses' ability to confidently perform research activities and higher academic qualifications. The study found that there is a lack of organisational support and management commitment for the development of evidence based nursing. In order to facilitate the implementation of evidence based practice, clinicians must be made aware of the available resources, be educated and mentored when carrying out and using clinical research, and be supported in professional initiatives that promote evidence based practice. It is argued that this will have positive implications for patient outcomes in the critical care environment.

Support Funding for Australian Rural and Remote Health Workforce: A Medical - Nursing Mismatch

Successive Australian federal governments have introduced numerous strategies aimed at reducing the differentials in health status between rural and remote populations and their metropolitan counterparts. Foremost among these strategies have been those focused on increasing the numbers of medical practitioners in rural and remote areas (Australian Institute of Health and Welfare, 1998a). The paper challenges the prioritisation of this strategy, identified as a "planning priority" by the Commonwealth government. The 1999-2000 Federal Budget allocated $171 million to "significantly improve access to services in rural and remote areas of Australia and to strengthen the rural workforce". Nurses provide 90% of the health services to these populations yet receive only 0.9% of funding in direct role specific support. This systematic neglect of nursing services results in high turnover as nurses desert their posts, frustrated by lack of organisational support, and subsequent inability to provide adequate care in the difficult circumstances in which they must function. Interruptions to clinical health care provision and health promotion activities diminish health enhancement opportunities for the communities with demonstrated high levels of need (Australian Institute of Health and Welfare [AIHW], 1999; Commonwealth Department of Health & Aged Care, 2000; Kreger, 1991; NSW Health Department, 1998).

Recruitment and retention: perceptions of rural mental health workers.

Recruitment and retention of professionals is a major issue in rural health care. Following a literature review and series of focus groups, a questionnaire to ascertain why professionals applied for, stayed in and would consider leaving rural mental health work was constructed. The questionnaire also included questions regarding possible initiatives that could be undertaken to improve recruitments. The questionnaire was distributed through informal networks to over 900 professionals. Four hundred and seventy eight questionnaires were returned, representing a 52% return rate. According to the response work related issues were generally more important than lifestyle/personal issues particularly as reasons for applying for rural work. Lack of organisational support and professional isolation were important detractors of rural work, with strong support being expressed for initiatives that would address these issues. The findings suggest that recruitment action might highlight the scope, variety, challenge and autonomy aspects of work, with retention focusing on professional support and contact and increased organisational support.

Physician-delivered smoking cessation advice: issues identified during ethnographic interviews

Objective-To identify the factors that physicians believe impair their ability to provide smoking cessation advice to their patients. Design - Ethnographic interviews of physicians. Setting - Non-academic primary care practice. Subjects -18 of 27 physicians who had recently participated in the intervention group of a randomised clinical trial to increase the rate at which physicians give smoking cessation advice. Main outcome measures -Factors that the interviewees reported were affecting their ability to give smoking cessation advice. Results -The interviews generated 439 statements that we sorted into 19 cate gories. We judged 10 of the categories to be statements about medical practice and smoking in general, and nine of the categories to represent barriers to giving smoking cessation advice. The barriers described by the interviewees included: lack of patient interest, lack of physician perceived self-efficacy, lack of time, lack of organisational support, lack of reward to the physician, lack of peer support, lack of staff support, and lack of interest on the part of the physician. The com mercial promotion of tobacco was also identified as a barrier to giving smoking cessation advice. Conclusions - As reported by physicians who had participated in a trial to provide smoking cessation advice in their own practices, the barriers to giving smoking cessation advice are more than a lack of knowledge that smoking is a health hazard and the lack of skills to help the patient stop smoking. These additional barriers may need to be addressed if physicians are to improve the rates at which they identify their patients who smoke and assist them in quitting.