Mary Chiarella | The University of Sydney (original) (raw)
Papers by Mary Chiarella
Journal of the American Association of Nurse Practitioners, Oct 1, 2016
Nursing Ethics, Aug 27, 2013
Complaints against nurses can be made on several grounds and orders, including removal from the r... more Complaints against nurses can be made on several grounds and orders, including removal from the registry of nurses, can be made as a result of these complaints. Boundary violations generally relate to complaints around criminal charges, unsatisfactory professional conduct or professional misconduct or a lack of good character. This article explores the spectrum of boundary violations in the nurse–patient relationship by reviewing disciplinary cases from the New South Wales Nurses and Midwives Tribunal and Professional Standards Committees. The complaints spanned a spectrum of behaviours, from minor infringements such as inappropriate compliments to intimate touching and sexual intercourse. Furthermore, the majority of respondents were men, although men comprise a minority of the nursing profession. This phenomenon is discussed in terms of gender stereotyping and nursing work. In addition, the possibility that improved supervision may have gone some way to preventing the violations is explored.
Routledge eBooks, Jul 30, 2020
Monash bioethics review, Apr 1, 1990
This paper sets out to explore the concept of honesty in nursing relationships — in particular in... more This paper sets out to explore the concept of honesty in nursing relationships — in particular in relationships with doctors, nurses and patients. It argues that although honesty is considered to be a desirable moral attribute in nursing, in reality nurses have not been honest in their relationships with these groups. The paper attempts to analyse the social, political and professional influences which have brought about this situation, in order to provide an explanation for this phenomenon, and thus assist in addressing it as a problem.
Journal of Advanced Nursing, Nov 1, 2007
Australian Critical Care, Mar 1, 1992
Nurse Education Today, Feb 1, 1990
Journal of Obstetric, Gynecologic, & Neonatal Nursing, Jul 1, 2019
Primary Health Care, May 26, 2016
Nurse author & editor, Mar 1, 2007
Australian Critical Care, Feb 1, 2003
Health Care Analysis, Nov 1, 1995
ConclusionEconomic (mis)management in Australia has understandably been influenced by the experie... more ConclusionEconomic (mis)management in Australia has understandably been influenced by the experiences of countries such as the UK and the USA with which Australia has traditionally had a close relationship. However, the uncritical acceptance of economic rationalism is an indication of our nation's seduction by the possibility of a ‘quick fix’ for a struggling economy. In accepting economic rationalism there has been a dismissal, or at least a failure to take account of, both past Australian experiences and the overseas experience—including the recent experience of a close neighbour, New Zealand, whose health system is under severe strain.The introduction of economic rationalist programmes into the Australian health sector was an attempt to contain expenditure and at the same time reduce dependence on the public system. This has failed to happen on both counts. Its only real ‘achievement’ has been to produce yet more evidence of the practical inadequacies of economic rationalism in general.
International Nursing Review, Oct 16, 2013
To investigate and synthesize the international literature surrounding nurse practitioner (NP) pr... more To investigate and synthesize the international literature surrounding nurse practitioner (NP) private practice models in order to provide an exposition of commonalities and differences. NP models of service delivery have been established internationally and most are based in the public healthcare system. In recent years, opportunities for the establishment of NP private practice models have evolved, facilitated by changes in legislation and driven by identification of potential patient need. To date, NP private practice models have received less attention in the literature and, to the authors' knowledge, this is the first international investigation of NP private practice models. Integrative literature review. A literature search was undertaken in October 2012. Database sources utilized included Medical Literature Analyses and Retrieval (MEDLINE), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and the Cochrane Database of Systematic Reviews (CDSR). The grey literature was also searched. The following Medical Subject Headings (MeSH) and search terms used both individually and in combination included nurse practitioners; private practice; joint practice; collaboration; and insurance, health and reimbursement. Once literature had been identified, a thematic analysis was undertaken to extract themes. Thirty manuscripts and five publications from the grey literature were included in the final review. Private practice NP roles were identified in five countries, with the majority of the literature emanating from the USA. The thematic analysis resulted in the identification of five themes: reimbursement, collaborative arrangements, legislation, models of care and acceptability. Proportionally, there are very few NPs engaged in private practice internationally. The most common NP private practice models were community based, with NPs working in clinic settings, either alone or with other health professionals. Challenges in the context of legislation and financial reimbursement were identified in each country where private practice is being undertaken.
Nursing Ethics, Jan 17, 2017
Introduction: Healthcare practitioners have a legal, ethical and professional obligation to obtai... more Introduction: Healthcare practitioners have a legal, ethical and professional obligation to obtain patient consent for all healthcare treatments. There is increasing evidence which suggests dissonance and variation in practice in assessment of decision-making capacity and consent processes. Aims: This study explores healthcare practitioners’ knowledge and practices of assessing decision-making capacity and obtaining patient consent to treatment in the acute generalist setting. Methods: An exploratory descriptive cross-sectional survey design, using an online questionnaire, method was employed with all professional groups invited via email to participate. Data were collected over 3 months from July to September 2015. Survey content and format was reviewed by the liaison psychiatry team and subsequently contained five sections (demographics, general knowledge and practice, delirium context, legal aspects and education/training). Descriptive, univariate and bivariate analysis of quantitative data and qualitative content analysis of qualitative data were undertaken. Ethical considerations: The study was approved by the institutional Human Research and Ethics Committee and informed consent was taken to be provided by participants upon completion and submission of the de-identified survey. Results: In total, 86 participants engaged the survey with n = 24, exiting at the first consent question. Almost two-thirds of respondents indicated that all treatments required patient consent. Knowledge of consent and decision-making capacity as legal constructs was deficient. Decision-making capacity was primarily assessed using professional judgement and perceived predominantly as the responsibility of medical and psychology staff. A range of patient psychological and behavioural symptoms were identified as indicators requiring assessment of decision-making capacity. Despite this, many patients with delirium have their decision-making capacity assessed and documented only sometimes. Uncertain knowledge and inconsistent application of legislative frameworks are evident. Many participants were unsure of the legal mechanisms for obtaining substitute consent in patients with impaired decision-making capacity and refusing treatment. Conclusion: The legal context of decision-making capacity and consent to treatment appears complex for healthcare practitioners. Professional, ethical and legal standards of care in this context can benefit from structured education programmes and supportive governance processes. An understanding of why ‘duty of care’ is being used as a framework within the context of impaired decision-making capacity is warranted, alongside a review of the context of Duty of Care within health policy, guidance and faculty teaching.
International journal of nursing, 2015
Australian Nursing Journal, Mar 1, 2008
The most important role for nurses and other health professionals in relation to planning for end... more The most important role for nurses and other health professionals in relation to planning for end-of-life care is to develop skills in having conversations about advance care planning as a regular part of health care, rather than as an issue that arises only when a person is terminally ill. (non-author abstract)
Journal of the American Association of Nurse Practitioners, Oct 1, 2016
Nursing Ethics, Aug 27, 2013
Complaints against nurses can be made on several grounds and orders, including removal from the r... more Complaints against nurses can be made on several grounds and orders, including removal from the registry of nurses, can be made as a result of these complaints. Boundary violations generally relate to complaints around criminal charges, unsatisfactory professional conduct or professional misconduct or a lack of good character. This article explores the spectrum of boundary violations in the nurse–patient relationship by reviewing disciplinary cases from the New South Wales Nurses and Midwives Tribunal and Professional Standards Committees. The complaints spanned a spectrum of behaviours, from minor infringements such as inappropriate compliments to intimate touching and sexual intercourse. Furthermore, the majority of respondents were men, although men comprise a minority of the nursing profession. This phenomenon is discussed in terms of gender stereotyping and nursing work. In addition, the possibility that improved supervision may have gone some way to preventing the violations is explored.
Routledge eBooks, Jul 30, 2020
Monash bioethics review, Apr 1, 1990
This paper sets out to explore the concept of honesty in nursing relationships — in particular in... more This paper sets out to explore the concept of honesty in nursing relationships — in particular in relationships with doctors, nurses and patients. It argues that although honesty is considered to be a desirable moral attribute in nursing, in reality nurses have not been honest in their relationships with these groups. The paper attempts to analyse the social, political and professional influences which have brought about this situation, in order to provide an explanation for this phenomenon, and thus assist in addressing it as a problem.
Journal of Advanced Nursing, Nov 1, 2007
Australian Critical Care, Mar 1, 1992
Nurse Education Today, Feb 1, 1990
Journal of Obstetric, Gynecologic, & Neonatal Nursing, Jul 1, 2019
Primary Health Care, May 26, 2016
Nurse author & editor, Mar 1, 2007
Australian Critical Care, Feb 1, 2003
Health Care Analysis, Nov 1, 1995
ConclusionEconomic (mis)management in Australia has understandably been influenced by the experie... more ConclusionEconomic (mis)management in Australia has understandably been influenced by the experiences of countries such as the UK and the USA with which Australia has traditionally had a close relationship. However, the uncritical acceptance of economic rationalism is an indication of our nation's seduction by the possibility of a ‘quick fix’ for a struggling economy. In accepting economic rationalism there has been a dismissal, or at least a failure to take account of, both past Australian experiences and the overseas experience—including the recent experience of a close neighbour, New Zealand, whose health system is under severe strain.The introduction of economic rationalist programmes into the Australian health sector was an attempt to contain expenditure and at the same time reduce dependence on the public system. This has failed to happen on both counts. Its only real ‘achievement’ has been to produce yet more evidence of the practical inadequacies of economic rationalism in general.
International Nursing Review, Oct 16, 2013
To investigate and synthesize the international literature surrounding nurse practitioner (NP) pr... more To investigate and synthesize the international literature surrounding nurse practitioner (NP) private practice models in order to provide an exposition of commonalities and differences. NP models of service delivery have been established internationally and most are based in the public healthcare system. In recent years, opportunities for the establishment of NP private practice models have evolved, facilitated by changes in legislation and driven by identification of potential patient need. To date, NP private practice models have received less attention in the literature and, to the authors' knowledge, this is the first international investigation of NP private practice models. Integrative literature review. A literature search was undertaken in October 2012. Database sources utilized included Medical Literature Analyses and Retrieval (MEDLINE), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and the Cochrane Database of Systematic Reviews (CDSR). The grey literature was also searched. The following Medical Subject Headings (MeSH) and search terms used both individually and in combination included nurse practitioners; private practice; joint practice; collaboration; and insurance, health and reimbursement. Once literature had been identified, a thematic analysis was undertaken to extract themes. Thirty manuscripts and five publications from the grey literature were included in the final review. Private practice NP roles were identified in five countries, with the majority of the literature emanating from the USA. The thematic analysis resulted in the identification of five themes: reimbursement, collaborative arrangements, legislation, models of care and acceptability. Proportionally, there are very few NPs engaged in private practice internationally. The most common NP private practice models were community based, with NPs working in clinic settings, either alone or with other health professionals. Challenges in the context of legislation and financial reimbursement were identified in each country where private practice is being undertaken.
Nursing Ethics, Jan 17, 2017
Introduction: Healthcare practitioners have a legal, ethical and professional obligation to obtai... more Introduction: Healthcare practitioners have a legal, ethical and professional obligation to obtain patient consent for all healthcare treatments. There is increasing evidence which suggests dissonance and variation in practice in assessment of decision-making capacity and consent processes. Aims: This study explores healthcare practitioners’ knowledge and practices of assessing decision-making capacity and obtaining patient consent to treatment in the acute generalist setting. Methods: An exploratory descriptive cross-sectional survey design, using an online questionnaire, method was employed with all professional groups invited via email to participate. Data were collected over 3 months from July to September 2015. Survey content and format was reviewed by the liaison psychiatry team and subsequently contained five sections (demographics, general knowledge and practice, delirium context, legal aspects and education/training). Descriptive, univariate and bivariate analysis of quantitative data and qualitative content analysis of qualitative data were undertaken. Ethical considerations: The study was approved by the institutional Human Research and Ethics Committee and informed consent was taken to be provided by participants upon completion and submission of the de-identified survey. Results: In total, 86 participants engaged the survey with n = 24, exiting at the first consent question. Almost two-thirds of respondents indicated that all treatments required patient consent. Knowledge of consent and decision-making capacity as legal constructs was deficient. Decision-making capacity was primarily assessed using professional judgement and perceived predominantly as the responsibility of medical and psychology staff. A range of patient psychological and behavioural symptoms were identified as indicators requiring assessment of decision-making capacity. Despite this, many patients with delirium have their decision-making capacity assessed and documented only sometimes. Uncertain knowledge and inconsistent application of legislative frameworks are evident. Many participants were unsure of the legal mechanisms for obtaining substitute consent in patients with impaired decision-making capacity and refusing treatment. Conclusion: The legal context of decision-making capacity and consent to treatment appears complex for healthcare practitioners. Professional, ethical and legal standards of care in this context can benefit from structured education programmes and supportive governance processes. An understanding of why ‘duty of care’ is being used as a framework within the context of impaired decision-making capacity is warranted, alongside a review of the context of Duty of Care within health policy, guidance and faculty teaching.
International journal of nursing, 2015
Australian Nursing Journal, Mar 1, 2008
The most important role for nurses and other health professionals in relation to planning for end... more The most important role for nurses and other health professionals in relation to planning for end-of-life care is to develop skills in having conversations about advance care planning as a regular part of health care, rather than as an issue that arises only when a person is terminally ill. (non-author abstract)