A multi-dimensional analysis of person-centred collaborative practice for designing an educational curriculum in continuing care centres.

A significant transformation occurring in the continuing care industry is an attempt to shift the culture from impersonal institutions into true person-centred care (PCC) homes. This approach re-orients the facility's values, attitudes, norms and hierarchies while creating flexible role descriptions to promote collaborative teamwork. PCC practices will require healthcare teams to develop new approaches that empower residents and families to become partners in the development of a plan of care. This report outlines a study, which will gather data from an organizational policy analysis and interviews with residents and healthcare staff. These data will be examined through a sociological lens to identify areas for team improvement. The results will guide the design of a training curriculum to be delivered using traditional and multi-modal hi-fidelity simulation methods.

Development and introduction of a comprehensive tobacco control policy in a Canadian regional health authority.

BACKGROUND: Tobacco control policies in health care settings are necessary to protect patients, employees, physicians, visitors, and volunteers from the dangers of secondhand smoke. This report documents the process of developing and introducing a comprehensive tobacco control policy in one Canadian regional health authority. CONTEXT: Capital Health (CH), a health authority that has 30,000 employees and serves 1.6 million people, is responsible for 18 hospitals and primary care facilities, 33 continuing care facilities, 29 public health locations, and 9 community care facilities. CH recently determined that it needed to revise its tobacco control policy because its facilities had different directives regarding tobacco use, some of which did not reflect the best current knowledge about the health risks associated with exposure to secondhand smoke. METHODS: The new smoke-free policy needed to be developed and executed within a narrow time frame, which required careful planning as well as the support of patients and CH staff members. An essential part of the new policy was the prevention of nicotine withdrawal among people required to undergo involuntary tobacco abstinence. The plan also included an integrated screening, intervention, and referral process designed to optimize health benefits for patients and staff members who smoked, as well as for those who did not. CONSEQUENCES: CH decided to close all smoking rooms (including those in psychiatry, palliative care, geriatrics, eating disorder, and tuberculosis units), to ban smoking in outdoor areas, to stop all sales of tobacco products in CH facilities, to require smoke-free environments during home visitations, and to reject funding from the tobacco industry. INTERPRETATION: By implementing a consistent ban on indoor and outdoor smoking, CH is contributing to a comprehensive tobacco control policy that is arguably a regional health authority's most profound opportunity for health promotion.

Munchausen syndrome and Munchausen syndrome by proxy in a student nurse.

Most faculty are not prepared for the possibility of encountering Munchausen syndrome (MS) in nursing students and Munchausen syndrome by proxy (MSP) in nursing students' children. When confronted with MS or MSP, their first reaction is often hostility coupled with a sense of betrayal. Given that individuals with this condition are attracted to helping professions, the authors describe both conditions in a case in which a nursing student presented with MS and the student's daughter was a victim of MSP. The focus is on protection of any children and the public, psychiatric treatment for the offender, and assistance for faculty.

Student nurse stress in the preceptorship experience.

Student nurses appear to experience significantly more stress during their academic preparation than they do during the first year of employment. Preceptorship is among the most stressful of student experiences. It is within the context of a challenging and at times daunting work environment that two complete strangers (preceptor and student) strive to accommodate one another within a professional capacity. If the relationship between preceptor and student is less than successful, not only can it be frustrating and disheartening, but it can result in student stress and disillusionment about nursing and an inability to integrate and learn. Using a hypothetical case, the authors discuss the importance of student assessment, close communication between faculty and preceptors, and quick responses to student stress as a means by which to circumvent the serious potential of student burnout in the practice setting.

Supporting preceptors.

For effective teaching of nursing students and management of stress of increased workloads, preceptors require a great deal of support from nursing faculty, peers, and administrative personnel. Through a mailed survey, 295 preceptors reported that they would have appreciated more support. The best support is the continued and visible presence and involvement of instructors, which can be provided in person, by telephone, or via fax. This is best achieved if nurse educators, directors, and deans view themselves as copreceptors.

Being a preceptor is stressful!

Results of a mail survey of 295 preceptors indicated preceptoring nursing students can be a stressful experience, with overwork identified as the main source of stress. Overwork resulted from unsuitability of students for the clinical area, lack of time, and insufficient feedback and guidance. The findings suggest that both students and preceptors require proper readiness assessment and preceptorship preparation. Preceptorship stress needs to be acknowledged; it can be addressed through workload adjustments and by providing feedback and support from nurse educators, peers, and managers.