I am a nurse researcher and educator with a focus on palliative and end of life care, ethics and care decision making. I am experienced in not for profit community service governance. I have skills in mentoring, professional development and curriculum development.
The increasing evidence that spirituality is a critical component for promoting health and well-b... more The increasing evidence that spirituality is a critical component for promoting health and well-being has made spirituality more significant to nursing practice. However, although nurses' perceptions of spirituality have been studied in western countries, there has been little research on this topic in Southeast Asian countries where religions other than Christianity predominate. This study explores Malaysian nurses' perceptions of spirituality and spiritual care and examines associations between socio-demographics and their perceptions. The Malaysian Nurse Forum Facebook closed group was used for data collection with 208 completed the online survey. The participants considered that spirituality is a fundamental aspect of nursing. Nonetheless, half of the respondents were uncertain regarding the use of the spiritual dimension for individuals with no religious affiliation. Significant differences were found between educational levels in mean scores for spirituality and spirit...
Australasian emergency nursing journal : AENJ, Jan 4, 2015
Managing death in the emergency department is a challenge. Emergency nurses are expected to provi... more Managing death in the emergency department is a challenge. Emergency nurses are expected to provide care to numerous patient groups in an often fast-paced, life-saving environment. The purpose of this study was to describe the experiences of emergency nurses in providing end-of-life care, which is the care delivered to a patient during the time directly preceding death. Data were collected from 25 emergency nurses during three focus group interviews. The interviews were transcribed and analysed using the qualitative techniques of grounded theory. Ten categories emerged from the data that described a social process for managing death in the emergency department. The categories were linked via the core category labelled 'dying in the emergency department is not ideal', which described how the emergency department was an inappropriate place for death to occur. To help manage the influence of the environment on end-of-life care, nurses reported strategies that included moving dy...
Studies have indicated that family members or health professionals may not know or predict their ... more Studies have indicated that family members or health professionals may not know or predict their older relatives' or patients' health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging. To understand the experiences and perspectives of older people regarding advance care planning. A systematic review of qualitative studies and meta-synthesis was conducted. CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched. A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people's willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed ...
Communication about end of life care may involve difficult conversations for patients, family mem... more Communication about end of life care may involve difficult conversations for patients, family members and health professionals. However, a lack of understanding of a person's wishes about their future care may result in a loss of dignity for the person, and additional distress for their family members and health professionals and burden to the healthcare system. This article discusses the barriers to advance care planning and provides some guidance for the general practitioner in undertaking advance care planning with patients and their families. Tips for initiating end of life discussions with patients and families utilising the 'PREPARED' acronym, and ensuring appropriate care delivery are included. Involving patients and their family members in advance care planning may be challenging and time consuming for GPs. However, there are a number of resources to support this activity in relation to training, communication support and Medicare item funding.
Home care services have characteristics that are distinctive from other health care settings. Thu... more Home care services have characteristics that are distinctive from other health care settings. Thus, they require different management systems to those traditionally used in institutional settings. Typical management models often require adaptation for home care services in areas such as staffing, education and support. This includes performance appraisal, where traditional models may be inappropriate when clinicians work alone, with little supervision. This article describes an experience of adapting a performance appraisal tool, in order to be more relevant for staff working in home-based care. The project arose from staff frustration with the expectation of management that a tool developed for institutional settings would be appropriate for the home setting. This frustration gave the impetus for developing a successful appraisal system, and because of staff involvement, the model was wholeheartedly embraced. The process of development is discussed, and the model explained, with co...
Palliative care nurses are at risk of work stress because their role involves exposure to frequen... more Palliative care nurses are at risk of work stress because their role involves exposure to frequent deaths and family grieving. Little is known about their degree of stress or whether they suffer stress or burnout more than nurses in other disciplines. Aim: The aim of this paper is to critically examine the current literature concerning stress and burnout in palliative care nurses. Results: Sixteen papers were included in the review. Although work demands were a common cause of stress in the studies reported, there was no strong evidence that palliative care or hospice nurses experienced higher levels of stress than nurses in other disciplines. Common causes of stress were the work environment, role conflict, and issues with patients and their families. Constructive coping styles appeared to help nurses to manage stress. Conclusion: Managers have a key role in providing education and training for palliative care nurses to support their personal development and to help reduce vulnerab...
Abstract: This paper reports on a review of the literature, in preparation for a larger study, to... more Abstract: This paper reports on a review of the literature, in preparation for a larger study, to explore the issues which may influence access to palliative care services for older Chinese patients in Australia. The review found that ethnic minority groups face numerous problems due to ...
To identify and examine existing research exploring how people with dementia and nurses view acut... more To identify and examine existing research exploring how people with dementia and nurses view acute hospital care. Admission to hospital can be traumatic for a person with dementia due to an inability to cope with unfamiliar environments, faces and routines. Adverse behavioural and health outcomes can result. Dementia adds complexity to patient care. Inability to deliver appropriate care is a source of stress and frustration for nurses. Integrative review of the literature 2005-2015 reporting the experience of people with dementia and nurses caring for them in an acute hospital setting (n= 24). Hospitals focus on acute medical care; consequently people with dementia are considered low priority and a disruption to normal routine. Risk management often takes priority over patient dignity. People with dementia are stigmatised. Families have significant roles to play in the care of a person with dementia in hospital but are often excluded. Nurses struggle to complete even basic patient c...
People with dementia can find hospital admission frightening and intimidating due to the unfamili... more People with dementia can find hospital admission frightening and intimidating due to the unfamiliar environment, faces and routines (Hermann, Muck, and Nehen 2014). The resultant anxiety can lead to disturbed behaviour including wandering, aggression, falls, injuries, deconditioning and a longer length of stay (Galvin et al 2010).
ABSTRACT Recruitment of participants from minority cultures is problematic for any type of resear... more ABSTRACT Recruitment of participants from minority cultures is problematic for any type of research; but more particularly for palliative care research however, because of the perceived additional vulnerability of participants who are facing the end of their life. Even though the goal of palliative care is to improve the quality of the remaining life, the processes involving such vulnerable people require careful consideration. This consideration is doubly important when participants come from minority cultures. This study discusses the recruitment difficulties in a study focusing on the palliative care needs of Chinese people in Australia. Despite being part of Australian society for most of its’ colonized history, Chinese people remain a minority culture and place great importance on their particular culture and traditions. Significant recruitment issues were experienced due to language and cultural constraints, including that death and dying are taboo subjects. The access and recruitment processes utilized in this research are discussed as well as diverse strategies used to achieve involvement.
Objectives: The aim of this study was to explore the type of relationship and the process of deve... more Objectives: The aim of this study was to explore the type of relationship and the process of developing these relationships between nurses and patients in palliative care units in Japan. The special contribution that culture makes was examined to better understand the intensity of nurses' grief after the death of their patient. Methods: Thirteen Japanese registered nurses currently practicing in palliative care units were interviewed between July 2006 to June 2009. Theoretical sampling was utilised and the data were analysed using grounded theory methodology. Constant comparison was undertaken during coding processes until data saturation was achieved. Results: Significant cultural influences emerged both in the type of relationship nurses formed with patients and in the way they developed relationships. The type of relationship was termed 'human-to-human', meaning truly interpersonal. The cultural values of 'Uchi (inside) and Soto (outside)' have particular impl...
The provision of palliative care is an essential component of health care, as all health care pro... more The provision of palliative care is an essential component of health care, as all health care providers come into contact with clients at various points along their trajectory of dying.
This article introduces the primary beliefs about ancestor worship, Taoism, Confucianism, Buddhis... more This article introduces the primary beliefs about ancestor worship, Taoism, Confucianism, Buddhism and traditional Chinese medicine that have influenced Chinese people for thousands of years, particularly in relation to death and dying. These cultures and traditions remain important for Chinese people wherever they live. Over a long period, Chinese people have integrated these philosophies and religions to form the basis of their culture and traditions. Although they agree that death is a natural part of the life span, a unique belief about death and dying has emerged among the Chinese from this integration. From this, the people find a significant definition of death and dying.
This article aims to: Discuss the inclusion of the perspectives of people with dementia in resear... more This article aims to: Discuss the inclusion of the perspectives of people with dementia in research. Consider the major challenges involved in the process of interviewing people with dementia. Provide recommendations for those involved in interviewing people with dementia in hospital. People with dementia are frequent consumers of health care and often have a poor experience in hospital but have been largely excluded from direct participation in research until recently. Limited understanding of the specific communication needs of people with dementia restricts access to the person's viewpoint. Recommendations for interviewers which consider the specific requirements of people with dementia are presented. This is a discursive article drawing on the experience of interviewing people with dementia in three separate studies. The conclusions that will be discussed are recommendations for researchers which were formulated following examination of the reflective journals written during...
The increasing evidence that spirituality is a critical component for promoting health and well-b... more The increasing evidence that spirituality is a critical component for promoting health and well-being has made spirituality more significant to nursing practice. However, although nurses' perceptions of spirituality have been studied in western countries, there has been little research on this topic in Southeast Asian countries where religions other than Christianity predominate. This study explores Malaysian nurses' perceptions of spirituality and spiritual care and examines associations between socio-demographics and their perceptions. The Malaysian Nurse Forum Facebook closed group was used for data collection with 208 completed the online survey. The participants considered that spirituality is a fundamental aspect of nursing. Nonetheless, half of the respondents were uncertain regarding the use of the spiritual dimension for individuals with no religious affiliation. Significant differences were found between educational levels in mean scores for spirituality and spirit...
Australasian emergency nursing journal : AENJ, Jan 4, 2015
Managing death in the emergency department is a challenge. Emergency nurses are expected to provi... more Managing death in the emergency department is a challenge. Emergency nurses are expected to provide care to numerous patient groups in an often fast-paced, life-saving environment. The purpose of this study was to describe the experiences of emergency nurses in providing end-of-life care, which is the care delivered to a patient during the time directly preceding death. Data were collected from 25 emergency nurses during three focus group interviews. The interviews were transcribed and analysed using the qualitative techniques of grounded theory. Ten categories emerged from the data that described a social process for managing death in the emergency department. The categories were linked via the core category labelled 'dying in the emergency department is not ideal', which described how the emergency department was an inappropriate place for death to occur. To help manage the influence of the environment on end-of-life care, nurses reported strategies that included moving dy...
Studies have indicated that family members or health professionals may not know or predict their ... more Studies have indicated that family members or health professionals may not know or predict their older relatives' or patients' health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging. To understand the experiences and perspectives of older people regarding advance care planning. A systematic review of qualitative studies and meta-synthesis was conducted. CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched. A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people's willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed ...
Communication about end of life care may involve difficult conversations for patients, family mem... more Communication about end of life care may involve difficult conversations for patients, family members and health professionals. However, a lack of understanding of a person's wishes about their future care may result in a loss of dignity for the person, and additional distress for their family members and health professionals and burden to the healthcare system. This article discusses the barriers to advance care planning and provides some guidance for the general practitioner in undertaking advance care planning with patients and their families. Tips for initiating end of life discussions with patients and families utilising the 'PREPARED' acronym, and ensuring appropriate care delivery are included. Involving patients and their family members in advance care planning may be challenging and time consuming for GPs. However, there are a number of resources to support this activity in relation to training, communication support and Medicare item funding.
Home care services have characteristics that are distinctive from other health care settings. Thu... more Home care services have characteristics that are distinctive from other health care settings. Thus, they require different management systems to those traditionally used in institutional settings. Typical management models often require adaptation for home care services in areas such as staffing, education and support. This includes performance appraisal, where traditional models may be inappropriate when clinicians work alone, with little supervision. This article describes an experience of adapting a performance appraisal tool, in order to be more relevant for staff working in home-based care. The project arose from staff frustration with the expectation of management that a tool developed for institutional settings would be appropriate for the home setting. This frustration gave the impetus for developing a successful appraisal system, and because of staff involvement, the model was wholeheartedly embraced. The process of development is discussed, and the model explained, with co...
Palliative care nurses are at risk of work stress because their role involves exposure to frequen... more Palliative care nurses are at risk of work stress because their role involves exposure to frequent deaths and family grieving. Little is known about their degree of stress or whether they suffer stress or burnout more than nurses in other disciplines. Aim: The aim of this paper is to critically examine the current literature concerning stress and burnout in palliative care nurses. Results: Sixteen papers were included in the review. Although work demands were a common cause of stress in the studies reported, there was no strong evidence that palliative care or hospice nurses experienced higher levels of stress than nurses in other disciplines. Common causes of stress were the work environment, role conflict, and issues with patients and their families. Constructive coping styles appeared to help nurses to manage stress. Conclusion: Managers have a key role in providing education and training for palliative care nurses to support their personal development and to help reduce vulnerab...
Abstract: This paper reports on a review of the literature, in preparation for a larger study, to... more Abstract: This paper reports on a review of the literature, in preparation for a larger study, to explore the issues which may influence access to palliative care services for older Chinese patients in Australia. The review found that ethnic minority groups face numerous problems due to ...
To identify and examine existing research exploring how people with dementia and nurses view acut... more To identify and examine existing research exploring how people with dementia and nurses view acute hospital care. Admission to hospital can be traumatic for a person with dementia due to an inability to cope with unfamiliar environments, faces and routines. Adverse behavioural and health outcomes can result. Dementia adds complexity to patient care. Inability to deliver appropriate care is a source of stress and frustration for nurses. Integrative review of the literature 2005-2015 reporting the experience of people with dementia and nurses caring for them in an acute hospital setting (n= 24). Hospitals focus on acute medical care; consequently people with dementia are considered low priority and a disruption to normal routine. Risk management often takes priority over patient dignity. People with dementia are stigmatised. Families have significant roles to play in the care of a person with dementia in hospital but are often excluded. Nurses struggle to complete even basic patient c...
People with dementia can find hospital admission frightening and intimidating due to the unfamili... more People with dementia can find hospital admission frightening and intimidating due to the unfamiliar environment, faces and routines (Hermann, Muck, and Nehen 2014). The resultant anxiety can lead to disturbed behaviour including wandering, aggression, falls, injuries, deconditioning and a longer length of stay (Galvin et al 2010).
ABSTRACT Recruitment of participants from minority cultures is problematic for any type of resear... more ABSTRACT Recruitment of participants from minority cultures is problematic for any type of research; but more particularly for palliative care research however, because of the perceived additional vulnerability of participants who are facing the end of their life. Even though the goal of palliative care is to improve the quality of the remaining life, the processes involving such vulnerable people require careful consideration. This consideration is doubly important when participants come from minority cultures. This study discusses the recruitment difficulties in a study focusing on the palliative care needs of Chinese people in Australia. Despite being part of Australian society for most of its’ colonized history, Chinese people remain a minority culture and place great importance on their particular culture and traditions. Significant recruitment issues were experienced due to language and cultural constraints, including that death and dying are taboo subjects. The access and recruitment processes utilized in this research are discussed as well as diverse strategies used to achieve involvement.
Objectives: The aim of this study was to explore the type of relationship and the process of deve... more Objectives: The aim of this study was to explore the type of relationship and the process of developing these relationships between nurses and patients in palliative care units in Japan. The special contribution that culture makes was examined to better understand the intensity of nurses' grief after the death of their patient. Methods: Thirteen Japanese registered nurses currently practicing in palliative care units were interviewed between July 2006 to June 2009. Theoretical sampling was utilised and the data were analysed using grounded theory methodology. Constant comparison was undertaken during coding processes until data saturation was achieved. Results: Significant cultural influences emerged both in the type of relationship nurses formed with patients and in the way they developed relationships. The type of relationship was termed 'human-to-human', meaning truly interpersonal. The cultural values of 'Uchi (inside) and Soto (outside)' have particular impl...
The provision of palliative care is an essential component of health care, as all health care pro... more The provision of palliative care is an essential component of health care, as all health care providers come into contact with clients at various points along their trajectory of dying.
This article introduces the primary beliefs about ancestor worship, Taoism, Confucianism, Buddhis... more This article introduces the primary beliefs about ancestor worship, Taoism, Confucianism, Buddhism and traditional Chinese medicine that have influenced Chinese people for thousands of years, particularly in relation to death and dying. These cultures and traditions remain important for Chinese people wherever they live. Over a long period, Chinese people have integrated these philosophies and religions to form the basis of their culture and traditions. Although they agree that death is a natural part of the life span, a unique belief about death and dying has emerged among the Chinese from this integration. From this, the people find a significant definition of death and dying.
This article aims to: Discuss the inclusion of the perspectives of people with dementia in resear... more This article aims to: Discuss the inclusion of the perspectives of people with dementia in research. Consider the major challenges involved in the process of interviewing people with dementia. Provide recommendations for those involved in interviewing people with dementia in hospital. People with dementia are frequent consumers of health care and often have a poor experience in hospital but have been largely excluded from direct participation in research until recently. Limited understanding of the specific communication needs of people with dementia restricts access to the person's viewpoint. Recommendations for interviewers which consider the specific requirements of people with dementia are presented. This is a discursive article drawing on the experience of interviewing people with dementia in three separate studies. The conclusions that will be discussed are recommendations for researchers which were formulated following examination of the reflective journals written during...
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Papers by Susan Lee