Nursing Online – November 2009

Nursing research highlights

The Australian Journal of Advanced Nursing continues to provide an excellent forum for new and original research and analysis for Australian and international nurse researchers. Below is a selection from the latest edition.

Fear of falling
Stephen Harding and Andrew Gardner (University of Adelaide).

The purpose of the paper is to describe the ‘fear of falling’ phenomenon, to raise clinicians’ awareness and to consider the associated risk factors. Fear of falling can be experienced in any clinical setting or within people’s own homes. The paper argues that individual clinicians and the treatment and care teams should consider fear of falling in people with a disordered gait or balance, or in the months following a fall, particularly where there is a recognised decline in ‘recent’ activity or obvious activity avoidance and changes in patterns of activity.

Fear of falling is an under-recognised phenomenon. This paper suggests a range of assessment tools and outlines some management options that are available to clinicians in order to address the problem of fear of falling.

The psychosocial needs of families during critical illness: comparison of nurses’ and family members’ perspectives
Trish Kinrade (Social Worker, Geelong Hospital), Alun C. Jackson (University of Melbourne) and Jane E. Tomnay, (School of Rural Health, University of Melbourne).

The purpose of this paper is to explore the needs of relatives whose family member is unexpectedly admitted to an Intensive Care Unit and compare ranked need statements between family members and nurses. This is a descriptive study using the Critical Care Family Needs Inventory (CCFNI) to measure, rank and compare a series of need statements.  The research was conducted in an ICU in regional Victoria. Comparative analysis of the data revealed that there were minor differences identified in the rank order of the need statements listed in the CCFNI among nurses and family members. A comparison with previous studies also identified minor differences in both the rank order of individual need statements and the five factor analysis categories previously established.
The researchers concluded that the CCFNI continues to be a good diagnostic tool in family needs assessment.

The breast or bottle? Women’s infant feeding choices in a subsequent birth after a previous Caesarean Section
Dr Pam McGrath and Mrs Emma Phillips (International Program of Psycho-Social Health Research, Central Queensland University).

The objective of the study was to explore, from mothers’ perspectives, the experiences and decision making associated with a subsequent birth following a Caesarean Section (CS) of which feeding their newborns was a specific focus. This article presents the sub-set of findings on infant feeding choices.

Twenty women who had given birth at Redland Hospital after experiencing a previous CS were invited to participate. Tape-recorded interviews were conducted six weeks postpartum. The findings identify that mothers fell into three different attitudinal groups regarding their decision making with respect to feeding their newborn.

The first perspective was based on a strong commitment to breastfeeding, which was often maintained in the face of quite significant difficulties. The second perspective was a complete refusal to breastfeed and a clear decision to bottle feed made prior to the birth and adhered to irrespective of alternative advice or persuasion. The third perspective was an initial desire to breast-feed that was easily thwarted by difficulties. The findings emphasise the importance of facilitating for CS births an environment that promotes bonding and breast-feeding by ensuring, where possible, that there is no separation of mother and baby after the birth, maximum opportunity for skin-to-skin contact, time for the mother to breastfeed the baby in the period immediately after the birth and no supplementation of breastfeeding with formula.
The success of the midwife or maternity nurse in relation to supporting breastfeeding was, in part, impacted on by the mother’s pre-determined approach to feeding the newborn. Breastfeeding support for attitudinal groups one and three were most likely to be successful, while the second group was refractory to nursing breastfeeding assistance.

Pursuing the golden mean – moral decision making for precarious newborns
Dr Tamara Zutlevics (Patient Ethicist, Children Youth Women’s Health Service, Visiting Scholar Flinders University, South Australia).

The purpose of this paper is to demonstrate a need, and develop a process, for moral decision making regarding precarious newborns. This paper argues that it is imperative for health-care institutions to develop a formal process of ethical review for decision making regarding precarious newborns.

Broadly, precarious newborns are those that are either born with congenital anomalies that are either life threatening or pose a risk of significant morbidities, and extremely premature babies who are otherwise physically normal.

After identifying some of the reasons why decision making regarding these infants is particularly fraught, some examples are used to draw out the problems that arise in the absence of a formal decision-making process.

The authors conclude that Aristotle’s metaphor of the golden mean provides a frame—work for a moral decision-making process, which can be beneficially utilised in complex cases involving precarious newborns. The decision making process advocated in the paper is briefly characterised as a co-operative discursive one, based on inclusive representation and underpinned by core ethical principles such as non-maleficence, beneficence, justice, and transparency.