Letters to the Editor
Neville C Brown
Post-registration and Post Enrolment Course Coordinator, Hampstead Rehabilitation Centre, Adelaide SA
Pauline Glover
Senior Lecturer, School of Nursing, Flinders University of South Australia, SA
PP: 054 - 055
Article Text
Dear Editor,
I note with interest your publication (in Volume 2, Number 1) of a report on recent research conducted on staff in Australian nursing homes. I am pleased that your journal appears to place such a high priority on nursing research.
The research project presented is an extremely valuable contribution to the issue of education in Australian nursing homes. The finding that appropriate inservice training is the single most important factor in influencing standards of care comes as no surprise to me as an educator. However, like most research projects, it would not be doing its job if it did not suggest further avenues of enquiry. I would like to suggest some alternative proposals arising from the results obtained.
A relatively small amount (39.2%) of registered nurses in nursing homes have some form of post-registration qualification, and a lack of influence of post-registration qualifications on the outcome variables in nursing homes is noted by the researchers. The researchers also note that the majority of these post-registration qualifications have little relevance to the care required (eg midwifery). I would suggest that this in itself may constitute a strong argument as to why post-registration qualifications have so little influence on care in nursing homes. It warrants further investigation whether a higher percentage of registered nurses with relevant post-registration qualifications such as gerontic or rehabilitation, would have a significant influence on the outcome variables within nursing homes.
I note with concern the finding that enrolled nurses find their work more 'boring, stressful and exhausting' than other categories of staff. Whilst not disputing the finding, I believe that the answer does not simply lie in 'training'. I suggest other explanations for this phenomena may include the following: their work really is boring, stressful and exhausting; registered nurses do not understand the role and function of enrolled nurses, or utilise them appropriately, forcing them to practice outside their scope of expertise thus creating stress; registered nurses are so involved with paperwork that most of the responsibility for direct care, physical work and responsibility for supervision of nurse assistants devolves to the enrolled nurse either by accident or design; there appears to be a marked lack of suitable post enrolment courses which I believe would enhance the skills and job satisfaction of enrolled nurses. I note that the study did not report a survey of what percentage of enrolled nurses possessed such qualifications.
I congratulate the researchers for raising these issues and hope that the outcomes of this research result in improved training for staff and improved standards of care within Australian nursing homes.
Dear Editor,
I read with interest the article 'Maternal-infant health beliefs and infant feeding practices: the perception and experience of Vietnamese women in Sydney' published in Contemporary Nurse, September 1992. Studies such as this can only inform nurses and midwives about beliefs related to health care in 'other' countries. This article caused me to reflect on an experience that I had.
My first baby was born in Singapore in 1972. I was the only European woman in the hospital. I wanted to get out of bed and shower. I wanted to breast feed. I wanted some midwife support. I wanted my extended family-mainly my Mum! I was frowned on for having a shower two hours after my baby was born and I received no support to establish lactation (luckily I was a midwife and had some knowledge). I was cared for by non midwives who did not speak very much English and wanted me to bottle feed my baby. I did not have my Mum. I had little support. I was unhappy and unsure.
Rossiter's article led me to think about what we as health care professionals espouse. ANRAC competency 10 'Acts to enhance the dignity and integrity of individuals and groups' indicates that we provide culturally specific, individualised, holistic health care. But do we? Indeed, can we? What are the constraints and barriers that are put in our way? It is my belief that all health professionals must be sensitive to the needs of all cultural groups. Where we are able, we must incorporate cultural practices into our care. The most important factor is that research about cultural beliefs must be shared.
Thank you
Joh Rossiter
Dear Editor,
Re: Guest Editorial (Volume 2, Number 1) The proposed 'Consent to Medical Treatment and Palliative Care Act' will empower individuals to control medical decisions and interventions when they are not legally competent through temporary or permanent mental incapacity or unconsciousness.
People with Alzheimer's disease or other dementias can be subjected to treatments, including resuscitation, because they cannot make their wishes known. Medical Power of Attorney provides for a trusted nominee to decide about continuation or withdrawal of treatment. Recently some mentally competent elderly people answered questions whether they wished resuscitation to be initiated and certain illnesses and accidents treated. They were clear about the amount of 'interference' that was tolerable at certain ages and states of physical and mental competence. They wished to have a say in their future and minimise the concerns of carers or families. They were positive about the exercise which they thought should be asked of all competent individuals on admission to residential care.
Health professionals have previously had no legal protection when a narcotic has probably contributed to death even though the dose was appropriate for the control of pain. The giver and/or prescriber could in theory be arraigned for manslaughter, leading to the reluctance of some health workers to use large doses. For the sake of terminally ill patients who need such care, the legal situation needed to be clarified.
The proposed Act will extend patients' control over their lives, particularly where severe physical and/or mental compromise can trigger discord among staff and families. It should therefore be welcomed for its intention to empower patients to state who will decide for them and what action they wish taken.
Anne Pickhaver
Adelaide SA
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