FLIGHT NURSING IN AUSTRALIA: A HIDDEN PROFESSION A critical qualitative inquiry into the work of Flight Nurses in Australia By Genevieve Mary Brideson Registered Nurse, Registered Midwife, BNg(Hons), Grad Cert Ng (Aviation), Grad Cert Ng (OT) A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy Flinders University Faculty of Medicine, Nursing & Health Sciences School of Nursing & Midwifery March 2017 Contents LIST OF TABLES ................................................................................................................................V LIST OF FIGURES ..............................................................................................................................VI ABSTRACT .....................................................................................................................................VII STATEMENT OF ORIGINALITY ........................................................................................................IX ACKNOWLEDGEMENTS ...................................................................................................................XI LIST OF ABBREVIATIONS ..............................................................................................................XIII CANDIDATE’S LIST OF PUBLICATIONS GENERATED DURING THIS PHD ............................. XVI CHAPTER 1 SETTING THE SCENE ................................................................................................. 1 1.1 INTRODUCTION .......................................................................................................................... 1 1.2 AEROMEDICINE IN AUSTRALIA: AN ABBREVIATED HISTORY .......................................................... 2 1.2.1 Organisations with Flight Nurses delivering aviation based healthcare.............................. 3 1.2.2 Prioritisation of patients/aeromedical triage ........................................................................ 5 1.2.3 Interhospital transfers .......................................................................................................... 7 1.3 REVEALING THE TRUE FACE OF FLIGHT NURSING ........................................................................ 8 1.4 RESEARCH AIMS ..................................................................................................................... 10 1.5 RESEARCH QUESTIONS ........................................................................................................... 10 1.6 THE METHODOLOGICAL APPROACH USED IN THE STUDY ........................................................... 10 1.6.1 Data collection and analysis in CQI ................................................................................. 12 1.7 IMPORTANCE FOR FUTURE RESEARCH ...................................................................................... 13 1.8 ORGANISATION OF THE THESIS ................................................................................................. 14 1.9 SUMMARY ............................................................................................................................... 16 CHAPTER 2 THE STATE OF KNOWLEDGE IN FLIGHT NURSING ............................................. 17 2.1 INTRODUCTION ........................................................................................................................ 17 SECTION A HISTORICAL BACKGROUND ................................................................................... 18 2.2 CURRENT KNOWLEDGE OF FLIGHT NURSING ............................................................................. 18 2.3 WAR AS THE CATALYST FOR AEROMEDICINE ............................................................................. 19 2.4 FLIGHT NURSING BEGINS 1910-1950 ....................................................................................... 19 2.4.1 Marie Marvingt: the first Flight Nurse ................................................................................ 19 2.4.2 International Flight Nurses – civilian ................................................................................. 22 2.4.3 Australian Flight Nursing – civilian .................................................................................... 24 2.5 WOMEN AVIATORS: NURSING AND AIR AMBULANCE IN THE OUTBACK ......................................... 25 2.5.1 Nancy Bird Walton............................................................................................................. 25 2.5.2 Robyn Dicks (nee Miller): the ‘Sugar Bird Lady’ ............................................................... 26 2.5.3 Other early Australian aviatrix ........................................................................................... 27 2.6 MILITARY FLIGHT NURSING ...................................................................................................... 28 2.6.1 International beginnings .................................................................................................... 28 2.6.2 Australian beginnings ........................................................................................................ 30 i Flight Nursing in Australia: A Hidden Profession Contents 2.7 SUMMARY SECTION A .............................................................................................................. 31 SECTION B SYSTEMATIC LITERATURE REVIEW ...................................................................... 32 2.8 FLIGHT NURSE LITERATURE ACROSS THE DECADES: INTRODUCTION .......................................... 32 2.8.1 Australian literature ........................................................................................................... 32 2.8.2 International literature ....................................................................................................... 35 2.9 SEARCH STRATEGY: PEER REVIEWED LITERATURE ................................................................... 37 2.9.1 Distribution of peer reviewed literature ............................................................................. 39 2.9.2 Excluded papers................................................................................................................ 39 2.9.3 Included studies pre critical appraisal ............................................................................... 40 2.9.4 Critical appraisal of the studies ......................................................................................... 41 2.9.5 Included studies post critical appraisal.............................................................................. 48 2.9.6 Phenomenon of interest .................................................................................................... 48 2.10 SUMMARY SECTION B .............................................................................................................. 53 2.11 CONCLUSION ........................................................................................................................... 54 CHAPTER 3 METHODOLOGY AND METHODS ............................................................................ 55 3.1 INTRODUCTION ........................................................................................................................ 55 3.2 STUDY AIMS ............................................................................................................................ 56 3.3 RESEARCH QUESTIONS ........................................................................................................... 56 3.4 CRITICAL QUALITATIVE INQUIRY: THEORY AND METHOD ............................................................. 57 3.4.1 Critical Qualitative Inquiry as theory .................................................................................. 57 3.4.2 Texts and language ........................................................................................................... 67 3.5 THE RESEARCHER IN CRITICAL QUALITATIVE INQUIRY ............................................................... 69 3.6 CRITICAL QUALITATIVE INQUIRY AS METHODS ........................................................................... 70 3.7 RESEARCH DESIGN ................................................................................................................. 71 3.7.1 Informant recruitment and selection .................................................................................. 71 3.7.2 Data collection ................................................................................................................... 73 3.7.3 Ethical considerations ....................................................................................................... 76 3.7.4 Rigour ................................................................................................................................ 78 3.7.5 Data analysis ..................................................................................................................... 79 3.8 SUMMARY ............................................................................................................................... 81 CHAPTER 4 THE IMAGE OF FLIGHT NURSING ........................................................................... 83 4.1 INTRODUCTION ........................................................................................................................ 83 4.2 FLIGHT NURSES: STEREOTYPICAL IMAGES OF NURSING ............................................................ 86 4.3 RECRUITMENT OF NURSES