The sum of all parts: an Australian experience in improving clinical partnerships.

AIM: To create a collaborative partnership between the education provider (University) and the placement provider (Hospital) to facilitate the identification and development of strategies to improve capacity and capability for nursing clinical placements. This partnership was labelled (TULIP) to identify the two partners and it purpose as a learning investment project. BACKGROUND: The quality of clinical learning is interdependent on the collaborative clinical health partnerships between Hospital, University, preceptors/facilitators and students. Success is dependent on communication between all key stakeholders within the partnership, to meet capacity and capability demand. DESIGN: Collaborative quality assurance project in combination with two research projects. METHOD: Quantitative and qualitative measurements of student perceptions, preceptor understanding and organisation partnership capacity and capability over a three year period in an acute care hospital. RESULTS: Qualitative and quantitative data from students and preceptors, and hospital quality assurance data linked to become the TULIP framework for a clinical placement development model that addresses the key components of strategic communication, resourcing and staff acknowledgement between stakeholders. CONCLUSIONS: The outcomes achieved demonstrated student engagement, clinical leadership from registered nursing staff, and the establishment of a collaborative partnership between hospital executives and staff, and the university resulting in an increased capacity. The TULIP project has provided both partners with a sustainable plan for growth in student placements, improved strategies to develop clinical leadership practice in individual nurses and a better clinical learning environment for staff that uses a framework that is transferrable to other health settings.

Tool for Evaluating the Ways Nurses Assess Pain (TENAP): psychometric properties assessment.

Elderly people with cognitive impairment are at risk for under-treatment of pain due to their inability to communicate. Poor knowledge and attitudes of nurses toward pain in this population may result in inadequate pain assessment. This study used a descriptive correlational design to develop and validate a tool to assess nurses' knowledge, attitudes, and reported practice of pain assessment in cognitively impaired elderly patients in acute care settings. The Tool for Evaluating the ways Nurses Assess Pain (TENAP) has two sections: (1) nurses' knowledge and attitudes about pain assessment and management and (2) two vignettes to assess reported practice. Content validity was established by an expert panel of three geriatric-trained nurse clinicians, and pilot tested with a convenience sample of 10 nurses. The psychometric properties were tested with a sample of 263 Registered and Enrolled nurses working in medical wards of two public hospitals in Singapore. The final version of TENAP comprised 29 items. Content validity index ranged from 0.84 to 1.00. The scale took 10 to 15 minutes to complete and items were easily understood. Results from the factor analysis suggested that Section A demonstrated one factor (13 items) while Section B had two distinct factors (16 items), one for each vignette, supporting construct validity of the scale. Cronbach's alphas for all factors were acceptable. TENAP was feasible, valid, and reliable for assessing nurses' knowledge, attitudes, and reported practice of pain assessment in cognitively-impaired elderly patients. Further testing of the tool with a larger sample of nurses in other practice contexts is needed.

Effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes: a systematic review.

EXECUTIVE SUMMARY: Background As a chronic condition, the prevalence of Type 2 diabetes is increasing worldwide and adherence to oral medications, an essential component of self-management, has been shown to improve glycaemic control. However compliance with oral medication adherence remains poor. Educating people with Type 2 diabetes is an important strategy to enhance self-management ability, including medication-taking behaviour.Objectives The overall objective of the review was to determine the effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes. INCLUSION CRITERIA: Types of participants Studies involving adults over 18 years old with Type 2 diabetes, with or without co-morbidities, currently taking oral hypoglycaemic medication without insulin treatment, and with aglycated haemoglobin (HbA1c) > 7.0% prior to the intervention were considered. Aglycated haemoglobin (HbA1c) concentration of less than 7.0%, is important in order to delay or prevent diabetes-related complications. Participants could be from the primary, tertiary or acute care setting.Types of intervention The review focused on various forms of educational interventions delivered by healthcare professionals aimed at improving participants' knowledge.Types of outcomes The review evaluated outcomes measuring oral hypoglycaemic adherence including HbA1c, fasting blood glucose levels and other relevant indicators.Types of studies Studies that were randomized controlled trials (RCTs) or case-control studies were considered.Search strategy A three-stage search strategy was employed. Papers in English and between the years 1990-2009 were searched in the following databases: CINAHL, Medline, Mosby's Nursing Consult, PsycINFO, PubMed, ScienceDirect, Scopus, TRIP and Web of Science. Full text was retrieved when the titles and abstracts of studies fulfilled the inclusion criteria.Methodological quality Full papers were assessed for methodological quality independently by two reviewers using critical appraisal checklists from the Joanna Briggs Institute (JBI). A third reviewer was consulted whenever there were disagreements between the two reviewers.Data collection/extraction Details of each study included in the review were extracted using standardized data extraction forms developed by JBI. Extraction was conducted independently by two reviewers.Data synthesis Meta-analysis was not possible due to methodological and statistical heterogeneity of the included studies. Hence study findings are presented in narrative form.Results Seven studies included in the final review consisted of seven RCTs. Five studies concluded that the educational intervention was effective in promoting oral hypoglycaemic adherence compared to usual care. These included pharmacist-led interventions, individual diabetes education provided by nurses and diabetes group education based on a self-management approach. Similarities among these interventions were provision of information on oral hypoglycaemic medication and the need for regular education sessions. However, small samples in some studies limited generalization of results. CONCLUSIONS: Implications for practice Increased knowledge of oral hypoglycaemic issues and reinforcement of the importance of medication adherence were useful in promoting adherence. Regular education sessions allow individuals to reinforce information and educators to identify barriers to medication adherence. Educational interventions focusing on self-management strategies appear more likely to achieve positive outcomes.Implications for research Further trials involving larger samples and populations with poor glycaemic control are needed. The effects of educational interventions, influence of additional take-home written material, the optimal interval length of follow-up and duration of education sessions, and specific processes of individual or group education which have been identified as effective need further exploration.

RN as gatekeeper: gatekeeping as monitoring and supervision.

AIMS AND OBJECTIVES: To understand the variation of ways that students understand the informal or buddy registered nurse role during facilitated clinical experience, and to identify the relationship between student learning and student understanding and experience of the registered nurse role during clinical experience. BACKGROUND: Student clinical experience is an essential aspect of all undergraduate nursing programs. Students expect registered nurses to supervise and support them and to provide learning experiences during clinical placement. Both positive and negative experiences have been reported in the research literature. The quality of the relationship between the registered nurse and the student directly affects the learning outcome for students. DESIGN: Qualitative research using a phenomenographic approach. METHODS: Semi-structured individual interviews with 24 students from all three years of an undergraduate nursing program at a metropolitan university in Brisbane, Queensland, Australia, who voluntarily participated in this study. Interviews were conducted at the completion of a recent clinical experience. RESULTS: While adequate monitoring and supervision is an expectation of students, there is a wide variation in the way registered nurses appear to understand this aspect of student learning. In the category of description, 'registered nurse as gatekeeper: gatekeeping as monitoring and supervision', student conceptions were identified as: registered nurse awareness, registered nurse vigilance, promoting learning/developing learning and growing (as) students. Students identified their experiences and the strategies they used when monitoring and supervision were lacking or limited. CONCLUSIONS: The findings of this study illuminate the need for recognition of the complexity of the informal registered nurse role with students and highlight the areas that should be addressed to promote quality student learning experiences. RELEVANCE TO CLINICAL PRACTICE: Registered nurses need adequate preparation for their informal role to support and supervise undergraduate students in clinical placement to ensure the safe development of student competence and confidence for their graduate registered nurse role.

Assessing psychometric properties of scales: a case study.

AIM: This paper is a report of a study to examine the construct validity of The Nursing Students' Attitudes and Awareness of Research and Development within Nursing Scale. BACKGROUND: The validity of instruments is critical in ensuring that data collected are sound and that the data measures what it purports to measure. When a new instrument is used in a different population or when it has been modified, it is useful to re-examine the construct validity of the instrument. METHOD: A survey design was used in September 2004 with a sample of 615 undergraduate nursing students to test the factor structure of The Nursing Students' Attitudes and Awareness of Research and Development within Nursing Scale and to estimate its similarity to the factor structure reported for the original scale developed and tested in a group of Registered Nurses. RESULTS: Using Maximum Likelihood Factor Analysis and then Principal Axis Factoring, we were unable to obtain a similar factor structure to that originally identified for the scale. Our data resulted in a two-factor structure. One factor consisted of 16 items that reflected a positive attitude to nursing research and the other consisted of 14 items that reflected a negative attitude to nursing research. CONCLUSION: The substantially different factor structure identified suggests that this scale requires further refinement and testing. This case study highlights the importance of a systematic and comprehensive approach to determining construct validity of scales, thus enabling researchers to determine their suitability as data collection instruments.

RN as gatekeeper: student understanding of the RN buddy role in clinical practice experience.

Students may be informally buddied with registered nurses (RNs), during their clinical experience. This paper describes one component of a larger phenomenographic study that explored the qualitatively different ways students understand the RN buddy role during clinical experience and the implications of this understanding for student learning. The perception of the RN as gatekeeper was an unexpected finding and is the focus of this report. Phenomenography is a field of descriptive research concerned with the variation in ways people experience and understand similar phenomena. This approach was used to identify the variation in experience and understanding of students with buddy RNs. Individual semi-structured interviews were conducted with a purposive sample of 24 students from one university in Queensland, Australia. The two variations in understanding of the role discussed in this paper are: understanding as an expectation, and RN as gatekeeper: gatekeeping as access. The research highlights that the various ways RNs promote or block access for students influence the quality of the learning experience. Formal recognition of the complexity of the RN role is essential to ensure RNs have adequate preparation for their role with students.

A phenomenographic study of registered nurses' understanding of their role in student learning--an Australian perspective.

BACKGROUND: Students may be 'buddied' with registered nurses during their clinical experience since the designated clinical facilitator cannot be available for each student at all times. Little is known about the way registered nurses understand this informal role. OBJECTIVES: The rationale for this study was to gain an insight of the variation of understanding registered nurses have of their role with students, and explored the qualitatively different ways registered nurses perceive their role with students on clinical experience and the implications of this understanding for student learning. DESIGN: A phenomenographic approach was used to identify the variation of understanding and meaning of the role of the registered nurse with students on clinical practice from the perspective of the registered nurse. Phenomenography is a field of descriptive research concerned with the variation in ways people experience and understand similar phenomena. SETTINGS AND PARTICIPANTS: A purposive sample of 30 registered nurses from 15 public and private hospitals in central and south eastern Queensland, Australia. METHODS: Individual semi-structured interviews from a final sample of 28 interviews were analysed to identify Categories of Description. RESULTS: Eight variations of understanding registered nurses have of their informal role with students were identified. The registered nurses' understanding varies from a focus that is 'student-centred', to 'completion of workload-centred', to 'registered nurse control', to a preference for no contact with students. As a consequence some students may have positive learning experiences while others will have limited learning opportunities. CONCLUSIONS: The research highlights the varied ways registered nurses understand their role with students that may promote or impede the quality of student learning and development to meet professional competency standards. Formal recognition of the complexity of the registered nurse role by health care agencies and tertiary education providers is essential to ensure registered nurses have adequate preparation for their role with students.

RN as gatekeeper: Student understanding of the RN buddy role in clinical practice experience.

Students may be informally buddied with registered nurses (RNs), during their clinical experience. This paper describes one component of a larger phenomenographic study that explored the qualitatively different ways students understand the RN buddy role during clinical experience and the implications of this understanding for student learning. The perception of the RN as gatekeeper was an unexpected finding and is the focus of this report. Phenomenography is a field of descriptive research concerned with the variation in ways people experience and understand similar phenomena. This approach was used to identify the variation in experience and understanding of students with buddy RNs. Individual semi-structured interviews were conducted with a purposive sample of 24 students from one university in Queensland, Australia. The two variations in understanding of the role discussed in this paper are: understanding as an expectation, and RN as gatekeeper: gatekeeping as access. The research highlights that the various ways RNs promote or block access for students influence the quality of the learning experience. Formal recognition of the complexity of the RN role is essential to ensure RNs have adequate preparation for their role with students.

Teaching people with Parkinson's disease about their medication.

PD is a progressive neurodegenerative disorder affecting an estimated 78,000 Australians. Predominantly it affects older people, although or younger. Medications to treat PD are aimed at controlling symptoms as there is no known cure. A regime of PD medications may involve taking doses at frequent intervals and adverse reactions are common. Education of the person with PD, their close carers and family that covers medications, observational techniques and dealing with side effects, along with unpredictable worsening of PD symptoms, may result in improvement in quality of life. When the person with PD has realistic expectations about PD drug therapy then the ability to cope with the physical disability caused by symptoms may be improved. It is important to educate about any possible interaction with commonly taken drugs including dietary supplements and over-the-counter medication. Before a medication education session, nurse activities should include assessment of the person with PD and their support network, development of an appropriate education plan and subsequent implementation, followed by evaluation. Ongoing nursing support at each clinic visit can provide opportunity for evaluation. An individualised session guided by the principles of adult learning theory may provide a successful tool for use in the education of people with PD as well as healthcare professionals. A large amount of available information and untested educational material does not address the educational needs of people with PD with regard to their medications. There is a need for further research in this area. The effectiveness of a one-on-one educational session about PD medication supported by printed, individualised PD medication information may provide more appropriate education and lead to improved quality of life. It is the focus of a planned research study.