This exploratory, descriptive research used a case study approach to analyse the role of the midwife in providing maternal and infant care in Australia. Midwives from the states of New South Wales, Victoria and Western Australia comprised the target population. These midwives were considered to be representative of the general midwifery population practising in the diverse settings of Australia.A triangulation of methods (Denzin, 1970) was used for data collection. This included observational field work, a questionnaire survey of a randomly selected sample of registered midwives (n=1754), and in-depth interviews (n=75), using a grounded theory approach (Glaser and Strauss, 1967; Strauss and Corbin, 1990).The questionnaire, in-depth interviews and observational field work addressed the practice of midwives:1. as documented in policies and procedures in practice settings.2. as defined by the Australian College of Midwives Incorporated in Standards for the Practice of Midwifery (1989), based on the International Confederation of Midwives' Definition of a Midwife (World Health Organisation, 1976).Data obtained through the survey questionnaire were analysed using descriptive analysis (Wilson, 1985) to portray a summarization of the entire data set. A thematic content analysis was used for the open-ended questions of the survey (Burnard, 1991). In an attempt to discover the 'how and why' questions associated with the study's survey findings, the constant comparative method of analysis of data from in-depth interviews was deemed appropriate (Glaser, 1978; Field and Morse, 1985; Chenitz and Swanson, 1986). This allowed a more abstract level of conceptualization that led to the development of a paradigm reflective of the midwives' practice domain (Strauss and Corbin, 1990).Lack of opportunities to practise throughout all stages of pregnancy and childbirth was identified as ++ / the major problem limiting the Australian midwives' practice domain. An explanatory process of Optimising Opportunities for Holistic Midwifery Practice emerged explaining midwives' actions and interactions throughout the four stages of optimising: revealing the image; influencing decision making; changing the paradigm; and expanding the profession.The findings of the study provide an analysis of Australian midwifery practice that considers factors facilitating and/or impeding the professional role and development of Australian midwives, and their ability to provide care that meets consumer needs.

Models of nursing practice create a context, boundary, direction and expectations for nurses, patients and other members of the health care team. The literature is scanty in regard the experience of Australian nurses faced with the process of redesign in their workplace. This study presents a case study of the process of designing a new model for a surgical ward in a large hospital in Western Sydney and explored the nurses’ experiences of this redesign process. The participants were the nurses working in the ward and the nurse managers associated with the ward management and included the nurse unit manager and directors of nursing. Data for the case study were accessed from a number of sources for different purposes. The case study of the redesign of the model of nursing practice showed that change is a difficult process, which needs to involve all stakeholders. There are a number of implications for clinicians, managers and educators from this case study. Managers and clinicians must share an effective communication process during redesign and identify common outcomes. Clinicians need to be encouraged to work towards a vision of nursing practice through debate and education. Educators must be used to support the redesign process by preparing nurses to undertake change, provide information on models of nursing practice and change theory. Recommendations for future research include evaluations of the role of education in redesign and the effect of redesign from patient perspective. Other studies could include descriptive studies of nurse managers’ experiences of redesign in a clinical setting and reasons why nurses are resistant to change. / Master of Nursing (Hons)

Doctor of Philosophy / Aim and significance: The aim of this research was to investigate how evidence-based practice (EBP) in nursing homes is understood in the context of Taiwan, a non-Western country. There is a growing movement towards using research evidence to inform practice in the nursing profession with variable success. To date, factors that promote or inhibit implementation of EBP in health care have been investigated through research conducted in hospital settings in Western countries. Remarkably little is known about nurses’ experience and perceptions of EBP in residential aged care facilities (RACFs), especially in non-Western countries. Method: The study adopted a mixed method approach. Subjects were recruited from six nursing homes in the Hsinchu district of Taiwan. In Stage 1, 89 registered nurses completed a comprehensive questionnaire specifically developed for this project. It was designed to elicit information about (1) their experience of and attitudes towards research and EBP; (2) the barriers they perceive to its implementation; and (3) what strategies they believe would enhance its implementation in the nursing home setting. In Stage 2, six nursing managers participated in semi-structured in-depth interviews that explored the same topic areas as those in the questionnaire but used an open-ended format which allowed for new themes to emerge. Findings: The majority of nurses and nursing managers expressed positive attitudes towards research and EBP but reported relatively little experience in its implementation. Nurses relied most heavily on knowledge derived from past experience and on interactions with nursing colleagues, medical staff and patients to inform their clinical practice. They identified the main barriers to EBP as: insufficient authority to change practice, their own lack of research knowledge and insufficient time to implement new ideas in the workplace. They believed EBP would be facilitated by: improved access to computers and internet facilities in the workplace; more effective research training; collaboration with academics; and dedicated time to search for and read research articles. As anticipated, nurses viewed the issues from a practical stance in relation to their own time, resources and lack of authority to effect change. Nursing managers expressed similar views to the nurses in relation to attitudes towards EBP implementation. However, they identified barriers which related to aspects of the organizational framework. In particular, they expressed concerns about issues such as budgetary constraints, staff quality (notably the reliance on minimally trained assistants in nursing (AINs) for direct resident care), as well as factors that reflected the wider political and economic context of health care in Taiwan. Conclusion: The findings of this study have implications for research, policy and practice in both Western and non-Western countries. Further research on EBP would be beneficial if conducted in settings other than hospitals, such as RACFs. There remains also the need to examine the potential for EBP in different social-cultural contexts, such as those in non-Western countries. Nursing managers have generally been excluded in previous research but, because of their particular role, there is a need to examine their perspectives of EBP and then compare these with those of the nurses. In Taiwan specifically, policy change is needed at both government and institutional levels to encourage and support the development of protocols and procedures for the implementation of EBP. If EBP was a government requirement for accreditation and a standard for protocols in hospitals and RACFs, it would lead to improved standards of care and cost effectiveness. This study supports the findings of a number of investigations conducted in Western countries which indicate that further education and training in research for nurses may lead to higher standards of patient care, greater job satisfaction and higher staff retention rates.

Concern for the plight of rural veterinary practice in Australia existed throughout the 20th century. During the 1970s, the profession highlighted the problems faced by rural practitioners and in 2003, the Frawley Review examined current rural veterinary services. However, neither influenced the course of rural practice in Australia. The present thesis examined the status of rural practice in Western Australia from the 1960s to the present day. It did this by investigating the historical changes in agriculture during this period and their effect on rural practice. The practice at Katanning, in rural Western Australia, was used as a case study – a study of the changes and adaptions made by that practice to remain viable. In 2006, surveys of both rural practitioners and government veterinary officers were conducted to obtain information of the veterinary services being provided to rural Western Australia. In addition, oral history interviews with a number of respondents to the surveys were carried out. Rapid expansion of Western Australian agriculture took place during the 1960s and was matched by growth in rural veterinary services. A government subsidy scheme recruited a number of veterinarians to the state. A Preventive Medicine/Animal Production service with sheep was established at Katanning in 1967. The reasons for developing such a service, its promotion, the results achieved and its subsequent failure are documented in the thesis. The 1970s was a troubled decade for agriculture and for those servicing it. The collapse of the beef-cattle boom was accompanied by a 20% reduction in veterinary staff in rural practice Australia-wide and a number of changes were implemented at Katanning to meet these circumstances. The 1980s saw a reduction in the economic significance of agriculture in Western Australia. At the same time, students from the Veterinary School at Murdoch University began graduating and, for the first time in the profession’s history, an overproduction of veterinarians existed. The 1990s was a period of relative stability, but was accompanied by major changes for the profession and rural practice. Many practices adopted merchandising and the sale of pet foods to supplement dwindling income. Previously, a male dominated profession, during this decade, it rapidly changed to one dominated by female graduates. Accompanying this gender change there was an increase in the demand for part-time work, whereas previously the profession had been predominantly a full-time vocation. The present decade opened with a questioning of the direction being taken by the profession and its undergraduate education. The current study revealed that the government veterinary services in Western Australia have contracted in size and scope, whilst at the same time, most rural practitioners attend companion animals at the expense of economic livestock. As a result, veterinary services to economic livestock have reduced and are likely to continue to do so and suggestions are made to counter this trend.

Models of nursing practice create a context, boundary, direction and expectations for nurses, patients and other members of the health care team. The literature is scanty in regard the experience of Australian nurses faced with the process of redesign in their workplace. This study presents a case study of the process of designing a new model for a surgical ward in a large hospital in Western Sydney and explored the nurses’ experiences of this redesign process. The participants were the nurses working in the ward and the nurse managers associated with the ward management and included the nurse unit manager and directors of nursing. Data for the case study were accessed from a number of sources for different purposes. The case study of the redesign of the model of nursing practice showed that change is a difficult process, which needs to involve all stakeholders. There are a number of implications for clinicians, managers and educators from this case study. Managers and clinicians must share an effective communication process during redesign and identify common outcomes. Clinicians need to be encouraged to work towards a vision of nursing practice through debate and education. Educators must be used to support the redesign process by preparing nurses to undertake change, provide information on models of nursing practice and change theory. Recommendations for future research include evaluations of the role of education in redesign and the effect of redesign from patient perspective. Other studies could include descriptive studies of nurse managers’ experiences of redesign in a clinical setting and reasons why nurses are resistant to change. / Master of Nursing (Hons)

Institutions of higher education are harnessing the communication ability of the Internet to offer classes and academic degree programs. This study investigated adult students during their first semester in a distance delivered doctoral program. The purpose of the study was to examine the use of web-based communication tools and their ability to establish a community of practice enabling the new students to share solutions related to distance doctoral study. This case study included the entire cohort of a distance delivered Ed.D. in Agricultural Education administered jointly by Texas Tech and Texas A&M Universities. Data collection methods included a semi-structured telephone interview, containing an adapted Sense of Community Index and postings on a Wiki (editable web page). Data analysis produced a participants’ profile and their use of web-based communication tools. This study found that (a) a variety of web-based tools enabled the students to connect with their cohort on a routine basis, (b) it is possible to establish a community of practice using a variety of web-based communication tools, (c) after one semester the cohort is an embryonic community of practice (d) the students were able to assist each other with concerns that helped them acclimate to learning online and their doctoral program, (e) students appreciate the flexibility that distance education offers but some prefer a traditional education, (f) students were frustrated with the technology during the first few weeks of their program, (g) new doctoral students desire instruction in the use of the course management system, the online library, and scholarly writing, (h) the students feel a strong sense of community, (i) use of web-based communication tools are vital as they assist in the student’s learning, (j) students felt isolated from their cohort until they participated in a group project even though they had the use of web-based communication tools at their disposal. The results of this study suggest that opportunities for students to engage socially with their peers should be built into the design of online classes and degree programs. Future research is recommended to examine the sustainability and desirability of virtual communities of practice.

As the health care system experienced a complex tapestry of transitions in the past decade, first-line managers (FLMs) strived to maintain a sense of stability for themselves and their staff in chaotic work environments. Individuals across the nation are striving to ensure health care team members have quality work environments. The paucity of literature examining the perceptions FLMs have of their work environment prompted this study. <p>This study provided FLMs employed in regional and provincial hospitals in Saskatchewan a voice to share their perceptions of their work environments with others. It is an adaptation of the descriptive survey design used by Remus, Smith, and Schissel (2000) in their study of staff nurses. The adaptation was based on the literature, making it applicable to FLMs, and incorporating the six Quality Worklife Indicators (QWI) of the Canadian Nurses Associations (CNAs) Quality Professional Practice Environments framework. The questionnaire also incorporated open-ended questions that enabled respondents to elaborate on their perceptions of their work environments.<p>The total population of 113 FLMs in regional (FLMRs) and provincial (FLMPs) hospitals in Saskatchewan was invited to participate in this study. Sixty-nine respondents (61.1%) chose to do so. FLMRs had a higher, although not significant, response rate, (67.6% n=23) than did FLMPs (58.2% n=46). The researcher attempted to make personal contact and correspond with each invited participant when distributing the questionnaires. In the open ended questions, participants in this study described intertwined multidimensional roles and responsibilities resulting in unmanageable workloads. They faced daily challenges involving relationships, putting out fires, balancing system/personnel relationships, staffing issues, resources, time, and salary. FLMs who successfully resolved their challenges felt a sense of accomplishment or reward, increasing their self confidence in their ability to successfully fill their roles as a FLM. FLMs described that being a change agent, teamwork, recognition by others, relationships, working with patients, and control over practice as the most rewarding elements within in their practice environments. The Environment Perception Scale responses reflected positive perceptions of work environments on all subscales except control over workload. Overall, FLMPs had a slightly more positive perception of their work environments than did FLMRs, except on the control over workload subscale. However, there were no significant differences between the groups except on the innovation and creativity subscale, where FLMRs scored significantly lower.<p>Study results offer senior administrators, professional associations, government, educators, and others an opportunity to increase their understanding and awareness of the perceptions FLMs have of their practice environment. Awareness of these perceptions will facilitate supporting or strengthening the rewards FLMs perceive in their practice environments, resulting in a richer practice environment. Identification and awareness of the perceived challenges is the first step in addressing them. Educators will find these results useful in better preparing future leaders of nursing for formal management roles.

The purpose of this study was to explore the servant-leadership role of selected Catholic high school principals, and to investigate how this leadership ideal is manifest in their daily professional lives. I employed a qualitative case study design, using the constructivist paradigm. The data gathering methods consisted of several interviews with each of the six participants, and extended field observation engagements with two of the principals.<p> For the participants of this study, family background, professional and extra-curricular experiences, and priests, were important sources of their notions of servant-leadership. Participants perceived Faith in Jesus Christ, and the positive outcomes of their Faith-informed professional practice as progenitive of their notions of servant-leadership.<p> The culminating framework from this study identified faith in Jesus Christ as the foundation of participants servant-leadership. According to this framework, respondents childhood experiences, mental models, passions, motivations, and professional convictions, served as antecedents to their identity formation which, in turn, propelled them towards servant-leadership. This framework delineated five aspects of servant-leadership: faith in the Lord Jesus Christ, community-inspired vision, relational credibility, sustained trust, and service. Service was identified as the culminating dimension, with the understanding that servant-leadership is established and strengthened in the very act of rendering service (through the day-to-day characteristics of servant-leadership), without which servant-leadership for Catholic school principals was considered meaningless.<p> According to the findings from study data, servant-leader signifying and inspiring qualities required of the servant-leader, included the following: altruism, patience, compassion, caring for the interests and growth of followers, living by example, and the unselfish desire to serve others. Additional fruits of servant-leadership are empowerment and respect for followers, establishment of healthy relationships, support for one another, collaborative leadership, offering constituents different possibilities for development, community building, self sacrifice of the leader for his/her community, and the servant-leader truly representing the idea of service to members of the school community.<p> Strategies for success in servant-leadership included tenacity of purpose, respect for all in the school community, fostering collaboration, care and trust of followers, and avoidance of needless reprimands in the event of failure. An underlying theme of this study is that servant-leadership provides hope for followers because of its exceptional interest in helping them develop their potentials and grow to become leaders. This study generated several implications for policy, practice, and further research. First, the policy requiring principals of Catholic high schools to be practicing Catholics and to pattern their leadership practices on the servant-leadership model warrants continuance. Second, a policy that superintendents of Catholic school districts make an intentional choice to promote servant-leadership would serve a good purpose. Third, using vivid servant-leadership symbols as a way of making a lasting impression on new principals during the hiring process is a practice worth continuing. Fourth, directors, superintendents, principals, and chaplains need to continue the practice of exemplary servant-leadership as an inspiration to new and other leaders. And, finally, a future researcher on this same topic may wish to include the perceptions of staff members, parents, and students in focus groups to generate in-depth data for analyses.

Let's see if we can move this puppy into the ETD collection in SMARTech.

As the health care system experienced a complex tapestry of transitions in the past decade, first-line managers (FLMs) strived to maintain a sense of stability for themselves and their staff in chaotic work environments. Individuals across the nation are striving to ensure health care team members have quality work environments. The paucity of literature examining the perceptions FLMs have of their work environment prompted this study. <p>This study provided FLMs employed in regional and provincial hospitals in Saskatchewan a voice to share their perceptions of their work environments with others. It is an adaptation of the descriptive survey design used by Remus, Smith, and Schissel (2000) in their study of staff nurses. The adaptation was based on the literature, making it applicable to FLMs, and incorporating the six Quality Worklife Indicators (QWI) of the Canadian Nurses Associations (CNAs) Quality Professional Practice Environments framework. The questionnaire also incorporated open-ended questions that enabled respondents to elaborate on their perceptions of their work environments.<p>The total population of 113 FLMs in regional (FLMRs) and provincial (FLMPs) hospitals in Saskatchewan was invited to participate in this study. Sixty-nine respondents (61.1%) chose to do so. FLMRs had a higher, although not significant, response rate, (67.6% n=23) than did FLMPs (58.2% n=46). The researcher attempted to make personal contact and correspond with each invited participant when distributing the questionnaires. In the open ended questions, participants in this study described intertwined multidimensional roles and responsibilities resulting in unmanageable workloads. They faced daily challenges involving relationships, putting out fires, balancing system/personnel relationships, staffing issues, resources, time, and salary. FLMs who successfully resolved their challenges felt a sense of accomplishment or reward, increasing their self confidence in their ability to successfully fill their roles as a FLM. FLMs described that being a change agent, teamwork, recognition by others, relationships, working with patients, and control over practice as the most rewarding elements within in their practice environments. The Environment Perception Scale responses reflected positive perceptions of work environments on all subscales except control over workload. Overall, FLMPs had a slightly more positive perception of their work environments than did FLMRs, except on the control over workload subscale. However, there were no significant differences between the groups except on the innovation and creativity subscale, where FLMRs scored significantly lower.<p>Study results offer senior administrators, professional associations, government, educators, and others an opportunity to increase their understanding and awareness of the perceptions FLMs have of their practice environment. Awareness of these perceptions will facilitate supporting or strengthening the rewards FLMs perceive in their practice environments, resulting in a richer practice environment. Identification and awareness of the perceived challenges is the first step in addressing them. Educators will find these results useful in better preparing future leaders of nursing for formal management roles.