Publications

  • Se Ok Ohr, Sarah Jeong, Vicki Parker, Margaret McMillan
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    ABSTRACT: The migration of nurses has been a global phenomenon, and the integration of overseas-qualified nurses within host countries has led to debate worldwide. Evidence suggests that support provided by organizations can vary and that there is minimal information on the nature and extent of organizational support required to enhance a smooth transition of overseas-qualified nurses into nursing practice. This explorative study tour examined the organizational support provided to enhance overseas-qualified nurses' transition into the nursing workforce in two countries. The various support mechanisms provided to overseas-qualified nurses in different organizations include transition, acculturation, mentoring programs, and initial settlement assistance. The successful transition of overseas-qualified nurses into a host country is a complex issue. A robust support system for these nurses should be based on ethical considerations and a team approach that is linked to strong leadership. In addition, education and support for existing staff is essential for a successful transition of overseas-qualified nurses into practice. Lessons learnt from this study tour might also be relevant to the transition of other overseas-qualified health professionals, such as doctors and allied health professionals, in host countries.
    Nursing and Health Sciences 09/2013; · 0.71 Impact Factor
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    Vicki Parker, Michelle Giles, Gena Lantry, Margaret McMillan
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    ABSTRACT: AIMS: This study aimed to explore new graduates' experiences of entering the nursing workforce in NSW, Australia, and to identify factors that impact on their transition to the workforce, satisfaction and likelihood of retention. BACKGROUND: The nature of new graduates' experiences in their first year of employment has been shown to have a significant impact on their future career directions. It is well reported that often these experiences are stressful and unsatisfying. METHODS: A mixed method cross sectional design was used combining quantitative and qualitative approaches. Data was gathered by online survey and focus groups. RESULTS: A total of 282 new graduates, aged 21 to 54, responded to the online survey (response rate 24%). Overall, respondents were satisfied with their recruitment process (mean 3.54) and support for professional development (mean 3.37) but job satisfaction was rated lower (mean 2.91). Qualitative findings from focus groups and survey comments revealed a number of key factors impacting on the experience of transition for new graduates. These are; the nature of the workplace environment, the level and nature of support available to new graduates, together with their propensity to learn and adapt to workplace cultures and to accommodate their own expectations and the expectations of others, and to a lesser degree, the amount of prior experience. CONCLUSION: There is an urgent need to develop and test a range of evidence based approaches that will both empower nurses and embed systematic approaches that enable equitable and contextually relevant stewardship of new graduate nurses into the future.
    Nurse education today 07/2012; · 0.91 Impact Factor
  • Sarah Y. Jeong, Margaret McMillan, Isabel Higgins
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    ABSTRACT: Older Australians with cognitive impairment benefit from advance care planning (ACP). However, myths and misunderstandings prevail. Data for this case study involving mixed methods were collected to explore experiences of older people and family members with ACP in three residential care facilities. Close analysis of phenomena within ACP led to greater awareness of what constitutes ‘dying well’. The implications of ACP are not limited to planning for wanted or unwanted medical treatments toward/at the end of life but are expanded to the achievement of gerotranscendence. The study provides insights into mutually beneficial health care decision making for ageing populations.
    Journal of Religion Spirituality & Aging 01/2012; 24:146-163.
  • T. E. Stone, M. McMillan
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    ABSTRACT: The aim of the research was to investigate swearing and verbal aggression in Australian inpatient settings, including incidence, gender, patient motivation, and nursing interventions. A mixed methods approach utilizing the Overt Aggression Scale and a survey of 107 nurses' perceptions of their experience of swearing was used. High levels of swearing and verbal aggression were found, with differing patterns for male and female patients. Nurses subjected to swearing experienced high levels of distress, especially females. All nurses appeared to use a limited range of interventions to deal with patient aggression. In order to provide optimal care for patients, there is a clear need to improve nurses' ability to predict and prevent aggression.
    Perspectives In Psychiatric Care 10/2011; 47(4):194-203. · 1.04 Impact Factor
  • Sarah Yeun-Sim Jeong, Isabel Higgins, Margaret McMillan
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    ABSTRACT: The aim of this paper is to report the findings of a case study that explored the phenomenon of advanced care planning and advance care directives in residential care settings in Australia. In particular, this paper focuses on the experiences of Registered Nurses with advanced care planning and advance care directives. Nurses need to know how to engage with residents and families when they invest time and effort on advanced care planning and documentation of advance care directives. A case-study design involving participant observation, field note recording, semi structured interviews and document analysis was used. Data were collected over 7 months. Data analysis involved thematic content analysis. The factors that enhanced and inhibited the experiences of the Registered Nurses with advanced care planning were identified. The enhancing factors include; 'it is their essence of who they are', and 'back-up from family members and other nursing staff’. The inhibiting factors are 'lack of time', 'a culture of do everything and don't go there', and 'lack of family involvement'. The findings of the current study provided nurses with evidence of the positive nature of experiences of older people, family members, and nurses themselves with advanced care planning in an attempt to better implement and practise advanced care planning.
    International Journal of Older People Nursing 09/2011; 6(3):165-75.
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    ABSTRACT: It is claimed that an interprofessional approach to health care aims to provide optimal client care, reduce duplication of services, address gaps in service delivery and prevent adverse consequences to patients. Hence there is widespread international interest in interprofessional education in undergraduate programs. However, after employment in the Australian health care workforce, there is limited opportunity for this. The continued education and training of health professionals and other care workers frequently occurs in a climate where professional development is dominated by the existence of professional demarcations. In order to enhance interprofessional collaboration in health care practice and education, mechanisms to guide individual performance within a multi-professional health team are required. This paper presents both the process and outcomes of a consultancy undertaken in order to determine core competencies for collaborative interprofessional practice in a community and aged care service.
    Contemporary nurse: a journal for the Australian nursing profession 04/2011; 38(1-2):160-70. · 0.44 Impact Factor
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    T E Stone, M McMillan, M Hazelton
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    ABSTRACT: Despite its prevalence there has been little academic research into swearing, and certainly none on its impact on nurses and nursing practice. Nurses are, of all health workers, most likely to be targets of verbal aggression, and up to 100% of nurses in mental health settings report verbal abuse. The literature contains no reference to the effects on nurses of exposure to swearing. This paper reports the findings of a questionnaire study of 107 nurses working in three clinical settings, which used a mixed methods approach. Participants reported high levels of swearing by patients, 32% citing its occurrence from one to five times per week and 7% 'continuously'; a similar incidence arose across the nursing teams at all sites, but being sworn at in anger by another staff member happened rarely. The study failed to show significant differences in the frequency of swearing between mental health and paediatric settings, but did find gender-based differences in both frequency of use and offendedness. High degrees of distress among nurses subjected to swearing were evident; moreover, respondents appeared to have only a limited range of interventions to draw upon in dealing with exposure to such treatment.
    Journal of Psychiatric and Mental Health Nursing 08/2010; 17(6):528-34. · 0.80 Impact Factor
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    Sarah Yeun-Sim Jeong, Isabel Higgins, Margaret McMillan
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    ABSTRACT: The aim of the study was to investigate the phenomenon of Advance Care Planning and the use of Advance Care Directives in residential aged care facilities in Australia. The objectives were to: investigate the implementation process of Advance Care Planning and the use of Advance Care Directives; investigate the outcomes of Advance Care Planning and experiences of people involved in Advance Care Planning and Advance Care Directives, including residents, families and nursing staff. Benefits of Advance Care Planning for older residents are considerable given their degenerative health-breakdown and minimal chance of recovery. To date, the use of Advance Care Planning and Advance Care Directives is limited and models of service delivery and processes are needed to enhance best practice with Advance Care Planning and positive outcomes for older Australians. Case study. The study conducted using multiple sources of evidence to enrich understanding of the phenomenon of Advance Care Planning. The researcher engaged in data collection over six months involving participant observation, field notes, semi-structured interviews and document analysis. The findings contribute to the limited knowledge of options currently available to older adults and their families in their decision-making about end-of-life care options. PERMISSION TO CONDUCT THE STUDY: Prior to commencement of the data collection, ethics clearances from the University of Newcastle and the regional Area Health Service were achieved. Permission to access the residential aged care facilities to undertake the study was obtained from the relevant residential aged care facility ethics committees or designated authorities. The researcher undertook several strategies to ensure all the ethical principles were considered and adhered to while conducting the project. The research identified the components and factors involved in the Advance Care Planning process and in attaining desired outcomes. The conceptual framework developed elaborates how Advance Care Planning should be implemented and what may constitute successful implementation of Advance Care Planning in residential aged care facilities. The four main elements (input, throughput, output, feedback), and 20 sub-elements were requisites for nurses to initiate and implement the Advance Care Planning. The essential components for end-of-life care are identified in the implementation processes of Advance Care Planning in residential aged care facilities. The study contributes to greater awareness of the processes needed for 'dying well' and highlights the need to explore experiences of 'successful dying' and the way nurses contribute to these events. The case study identified four determinative requisites for successful implementation of Advance Care Planning in aged care facilities: the expert nurse, discussion, education and involvement of a multidisciplinary team. Nurses should take these factors into account and use person-centred approach in formalised processes to encourage participation in plans for end-of-life care.
    Journal of Clinical Nursing 02/2010; 19(3-4):389-97. · 1.32 Impact Factor
  • Terry Joyce, Margaret McMillan, Michael Hazelton
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    ABSTRACT: A qualitative approach was used to explore workplace experiences of nurses who have a mental illness. Interview transcripts from 29 nurses in New South Wales, Australia were subjected to discourse analysis. One significant finding was a theme depicting the need for support and trust. This superordinate theme encompassed four subelements: declaring mental illnesses, collegial support, managerial support, and enhancing support. Most of the participants portrayed their workplace as an unsupportive and negative environment. A number of colleagues were depicted as having little regard for the codes for professional nursing practice. This paper shows how nurses in the study dealt with the workplace support associated with mental illness.
    International journal of mental health nursing 12/2009; 18(6):391-7. · 1.29 Impact Factor
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    ABSTRACT: This paper is a report of selected findings from a study exploring the relationship between belongingness and placement experiences of preregistration nursing students. Staff-student relationships are an important influence on students' experiences of belongingness and their clinical learning. The need to belong is universal and pervasive, exerting a powerful influence on thought processes, emotions, behaviour, health and happiness. People deprived of belongingness are more likely to experience diminished self-esteem, increased stress and anxiety, depression and a decrease in general well-being. Nursing students' motivation and capacity to learn, self-concept, confidence, the extent to which they are willing to question or conform to poor practice and their future career decisions are influenced by the extent to which they experience belongingness. During 2006, 18 third year students from two Australian universities and one United Kingdom university participated in in-depth semi-structured interviews. Data were analysed thematically. Participants described placement experiences spanning a continuum from those promoting a high degree of belongingness to those provoking intense feelings of alienation. Staff-student relationships (including receptiveness, inclusion/exclusion, legitimization of the student role, recognition and appreciation, challenge and support) were the most important influence on students' sense of belonging and learning. Similarities between sites were remarkable, despite the differences in healthcare and higher education systems. Staff-student relationships are key to students' experience of belongingness. Understanding the types of interactions and behaviours that facilitate or impede students' belongingness and learning are essential to the creation of positive clinical experiences.
    Journal of Advanced Nursing 03/2009; 65(2):316-24. · 1.53 Impact Factor
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    ABSTRACT: This paper reports the development and psychometric testing of the Belongingness Scale-Clinical Placement Experience, an instrument designed to measure the extent to which nursing students experience belongingness related to their clinical placements. The need to belong is a global concept that exerts a powerful influence on cognitive processes, emotional patterns, behavioural responses, health and well-being. Diminished belongingness impedes students' motivation to learn. Measuring belongingness specific to the clinical environment and comparing different cohorts requires valid and reliable instruments. Scales for measuring belongingness were identified following a critical review of the literature. From these a new 34-item instrument was developed. During 2006 the instrument was tested with students (n = 362) from two Australian universities and one university in the south of England. Principal component analysis with varimax rotation was used to determine construct validity and Cronbach's coefficient alpha determined the scale's internal consistency reliability. Differences in belongingness scores were statistically significant, with the British cohort scoring higher than either of the Australian sites. The scale demonstrated high internal consistency (alpha 0.92). Principal component analysis yielded a three-component structure termed Esteem, Connectedness and Efficacy and each subscale demonstrated high internal consistency: 0.9; 0.82; 0.8 respectively. The scale was reliable and valid for the three cohorts. Results indicated that the instrument is capable of differentiating between respondents and cohorts. Further research in different contexts would be valuable in taking this work forward.
    Collegian Journal of the Royal College of Nursing Australia 01/2009; 16(3):153-62. · 0.73 Impact Factor
  • Vicki Parker, Margaret McMillan
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    ABSTRACT: In spite of the increasing significance of cultural diversity for nursing, some Australian nurse teachers are not well prepared for the challenges they face, nor have nursing curricula been re-conceptualized to meet the changing needs of society and more specifically nursing students. Although numerous teaching and Learning programmes for inclusion of diversity are reported in the literature, both within Australia and overseas, there appears to be little commitment to the adoption of a more fundamental change in curricula and teaching and learning practices. In particular there appears to be little attention to how teachers negotiate meaningful social dynamics within multicultural learning contexts. This article reports on the findings of a study carried out across two Schools of Nursing in Australia. The purpose of the study was to explore why schools have been reluctant to move to more culturally diverse models of teaching and learning. This paper reports on the findings of focus groups with teachers about their experiences of teaching in the context of cultural diversity. Study findings explore teachers' perceptions of cultural diversity and its impact on teaching and learning nursing. Teachers reported a range of tensions arising from lack of a shared philosophical view about curricula generally, lack of consideration of diversity as a significant issue for both teachers and students, limited perceptions of community as a key driver of curricula and a reluctance to address the difficult and contentious issues arising from diversity in the classroom.
    Collegian Journal of the Royal College of Nursing Australia 02/2008; 15(4):143-9. · 0.73 Impact Factor
  • Terry Joyce, Michael Hazelton, Margaret McMillan
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    ABSTRACT: This qualitative study explored the workplace experiences of nurses who have a mental illness. The ultimate goal of the study was to gain insights that would lead to the development of more supportive environments for these nurses. Interviews were conducted with 29 nurses in New South Wales, Australia. The interview transcripts were subjected to discourse analysis. One significant finding was the theme 'Crossing the boundary - from nurse to patient'. This encompassed three sub-themes: 'Developing a mental illness', 'Hospital admission', and 'Being managed'. For most of the participants, being a nurse with a mental illness was largely a negative experience. Often, nurses without a mental illness actively sought to reform the participants' behaviour to enforce what was seen as appropriate conduct for a professional nurse. This paper shows how nurses in this study dealt with the early concerns associated with mental illness.
    International journal of mental health nursing 01/2008; 16(6):373-80. · 1.29 Impact Factor
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    ABSTRACT: The main aim of this study was to explore the immediate needs of the relatives of acutely ill older people during hospitalisation. The research question posed was: 'What are the immediate needs of the relatives1 of acutely ill older people in the hospital setting?' A descriptive qualitative approach was utilized, with ethnographic data collection methods and thematic data analysis. Unstructured interviews were conducted with relatives of older people who were admitted for acute care. The setting for the study included two large tertiary referral hospitals located in two area health services in New SouthWales,Australia. Analysis of data revealed two themes: being informed and being there. Being informed describes the nature of the information that relatives need and why this is so important to them. Being there illustrates how relatives perceive their roles and responsibility during hospitalisation. It highlights the importance of this and the impact it has on individuals The findings highlight the importance of appreciating the family's experiences in relation to the care of their older family member. They point to the need for education of stakeholders to focus on relatives as well as the older patient, improved assessment incorporating a whole of family approach on admission to hospital, and finally, facilitating positive relationships between ward staff and families.
    Contemporary nurse: a journal for the Australian nursing profession 11/2007; 26(2):208-20. · 0.44 Impact Factor
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    ABSTRACT: That the population is ageing poses many challenges for health care planners. Some argue that these challenges, exacerbated by limited funding, maintaining increased community expectations and the need for quality health care outcomes, may be overcome by exploring alternate models of care. These ideas have led health planners to reconceptualise contemporary philosophies of care with the current emphasis on multidisciplinary teams and a person-centred approach to care. This paper presents a model for the care of older people in the acute care setting. The concepts for the development of the model were derived from the international literature. In the model the care of older people is underpinned by a philosophy of person-centredness. The complex nature of care is represented along with those factors that enable a person-centred approach to be taken. The functions of the model in practice are highlighted and discussion of how it is being implemented within the acute care sector outlined.
    Contemporary nurse: a journal for the Australian nursing profession 11/2007; 26(2):164-76. · 0.44 Impact Factor
  • Sarah Yeun-Sim Jeong, Isabel Higgins, Margaret McMillan
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    ABSTRACT: This paper describes one aspect of a study that investigated how Advance Care Planning (ACP) was implemented in residential care facilities (RACFs) in Australia and the role of a Clinical Nurse Consultant (CNC) for ACP. Three RACFs were included in the study. This paper focuses on the implementation process of ACP by the CNC in the RACFs. The preliminary findings highlight the need to dispel the myths about ACP and Advanced Care Directives (ACDs), and how the CNC acted as a broker for ACP. The CNC's role is represented by a Nursing Brokerage Model. By revealing how ACP is implemented the research contributes to the limited existing knowledge of options that are currently available to older adults and their families in order to help them make care choices about the end of their lives.
    Contemporary nurse: a journal for the Australian nursing profession 11/2007; 26(2):184-95. · 0.44 Impact Factor
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    ABSTRACT: The use of flexible non-contract nursing staff is increasing in Australia and in other countries where there is currently a nursing shortage. There is sparse empirical evidence relating to the experience of these nurses. This focus group study with six groups of enrolled and registered nurses in one regional health authority in New South Wales reports on the challenges and rewards of working through the casual pool. The textual data were coded and reported in themes and subthemes; the overarching theme is balance of social and professional life, while subthemes are social politics, nursing work and professional performance. The results reveal that nurses who work from the casual pool have insight into the work environment and culture of clinical teams that is untapped formally. They have little or no chance to provide clinical teams with feedback or receive feedback on their own performance. The consequence of this study has been the development of a two-way performance intervention to promote high standards of care from nurses who work from the casual pool and the promotion of safe clinical environments and cultures.
    International Journal of Nursing Practice 09/2007; 13(4):229-36. · 0.88 Impact Factor
  • Vicki Parker, Margaret McMillan
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    ABSTRACT: This paper examines factors that have lead to increasing internationalisation in nursing workforce and nursing education and contends that education and support for nurse managers and nurse academics is required in order to better prepare them for the challenges they will face. There are many benefits to be gained from internationalisation of nursing, the most significant being greater cross-cultural understanding and improved practices in workplaces across countries. However, the way in which nursing and nurses contribute to the international agenda is crucial to maintaining standards of education and nursing care in Australia and in countries with whom Australians collaborate. Internationalisation poses numerous challenges that need to be carefully thought through. This paper seeks to unravel and scrutinize some of the issues central to internationalisation in nursing, particularly in the Australian context.
    Contemporary nurse: a journal for the Australian nursing profession 05/2007; 24(2):128-36. · 0.44 Impact Factor
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    ABSTRACT: The psychological and social sciences literature is replete with assertions that human beings are fundamentally and pervasively motivated by the need to belong. This paper reports on some of the findings from the qualitative phase of a mixed-method, multi-site study that explored nursing students' experience of belongingness while on clinical placements. Students from Australia and the United Kingdom were interviewed to identify factors that impact upon and are consequences of belongingness. A montage of participants' stories is used to illustrate some of the key features of clinical workplaces that are conducive to the development of belongingness. Contextual factors and interpersonal dynamics were seen to have a significant bearing on students' experiences. Clinical leaders/managers who were welcoming, accepting and supportive, and nursing staff who were inclusive and encouraging, facilitated students' perception of being valued and respected as members of the nursing team. Additionally, the provision of consistent, quality mentorship was identified as important to students' feelings of connectedness and fit. The experience of belongingness, in turn, enhanced students' potential for learning and influenced their future career decisions. Alternatively, alienation resulted from unreceptive and unwelcoming clinical environments and from the dissonance created when students' personal and professional values did not articulate with those evident in practice environments. Consequently, distress, detachment and disengagement occurred and students' capacity and motivation for learning was negatively impacted.
    Contemporary nurse: a journal for the Australian nursing profession 05/2007; 24(2):162-74. · 0.44 Impact Factor

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