Supporting Australian clinical learners in a collaborative clusters education model: a mixed methods study.

BACKGROUND: Nursing student numbers have risen in response to projected registered nurse shortfalls, increasing numbers of new graduates requiring transitional support and pressure on clinical placements. A Collaborative Clusters Education Model, in which Entry to Practice facilitators coach ward-based registered nurses to support students' and new graduates' learning, may address placement capacity. The research aim was to evaluate the acceptability of the Collaborative Clusters Education Model to stakeholders by examining their perceptions of the facilitators and barriers to the model in its implementation. METHODS: A convergent mixed methods evaluation approach was adopted. The study took place in a large Australian health service in south-east Queensland. Participants included Bachelor of Nursing students, Entry to Practice facilitators, ward-based registered nurses, academics and new graduates. A mixed methods design was used. Elements included an online survey of nursing students, and interviews with new graduates, Entry to Practice facilitators, ward-based registered nurses, and academics. Descriptive statistics were calculated on quantitative data. Thematic analysis was conducted on qualitative data. RESULTS: Participants included 134 (of 990) nursing students (response rate 13.5%), five new graduates, seven Entry to Practice facilitators, four registered nurses, and three nurse academics. Students rated facilitators' effectiveness highly (4.43/5 ± 0.75), although this finding is tempered by a low response rate (13.5%). For learners, the model provided access to learning experiences, although preferences for sources of support differed between students and new graduates, and further clarification of responsibilities was required. For other stakeholders, three themes emerged: students' and new graduates' integration into the workplace can promote learning; tensions arise in new ways to approach performance assessment; and aligning expectations requires high levels of communication. CONCLUSIONS: This evaluation found that acceptability was good but at risk from limited clarity around roles and responsibilities. Further research into this model is recommended.

Redesigning clinical education for nursing students and newly qualified nurses: A quality improvement study.

Rising numbers of students are required to address the forecast nursing shortage. Health services are challenged to release experienced nursing staff to become supervisors in clinical supervision models and preceptorship models require significant investment in registered nurse education for effectiveness. One health service in southeast Queensland, Australia, developed an innovative clinical education model that draws upon the strengths of supervision and preceptor models, and is consistent with the Dedicated Education Unit model, without the dedicated university and prescribed attendance requirements. Using an iterative qualitative approach and learning circle methods, the aim was to determine feasibility of the model, using information gathered from clinical facilitators, who were the key implementers. Model feasibility was found to be dependent upon three key activities undertaken by the facilitators: align stakeholder expectations with the new model, clarify roles and responsibilities within clusters, and develop strategies for collecting information about student performance. The experience of implementing the model has raised further questions about how students, newly qualified nurses and registered nurses learn in localised work units and what practice pedagogies can be developed to support learning from, as well as improve practice.

Balancing personalized medicine and personalized care.

The current description of personalized medicine by the National Institutes of Health is "the science of individualized prevention and therapy." Although physicians are beginning to see the promise of genetic medicine coming to fruition, the rapid pace of sequencing technology, informatics, and computer science predict a revolution in the ability to care for patients in the near future. The enthusiasm expressed by researchers is well founded, but the expectations voiced by the public do not center on advancing technology. Rather, patients are asking for personalized care: a holistic approach that considers physical, mental, and spiritual well-being. This perspective considers psychological, religious, and ethical challenges that may arise as the precision of preventive medicine improves. Psychological studies already highlight the barriers to single gene testing and suggest significant barriers to the predictive testing envisioned by personalized medicine. Certain religious groups will likely mount opposition if they believe personalized medicine encourages embryo selection. If the technology prompts cost-containment discussions, those concerned about the sanctity of life may raise ethical objections. Consequently, the availability of new scientific developments does not guarantee advances in treatment because patients may prove unwilling to receive and act on personalized genetic information. This perspective highlights current efforts to incorporate personalized medicine and personalized care into the medical curriculum, genetic counseling, and other aspects of clinical practice. Because these efforts are generally independent, the authors offer recommendations for physicians and educators so that personalized medicine can be implemented in a manner that meets patient expectations for personalized care.

Study of the therapeutic effects of proximal intercessory prayer (STEPP) on auditory and visual impairments in rural Mozambique.

BACKGROUND: Proximal intercessory prayer (PIP) is a common complementary and alternative medicine (CAM) therapy, but clinical effects are poorly understood, partly because studies have focused on distant intercessory prayer (DIP). METHODS: This prospective study used an audiometer (Earscan(R) 3) and vision charts (40 cm, 6 m "Illiterate E") to evaluate 24 consecutive Mozambican subjects (19 males/5 females) reporting impaired hearing (14) and/or vision (11) who subsequently received PIP interventions. RESULTS: We measured significant improvements in auditory (P <0.003) and visual (P <0.02) function across both tested populations. CONCLUSIONS: Rural Mozambican subjects exhibited improved audition and/or visual acuity subsequent to PIP. The magnitude of measured effects exceeds that reported in previous suggestion and hypnosis studies. Future study seems warranted to assess whether PIP may be a useful adjunct to standard medical care for certain patients with auditory and/or visual impairments, especially in contexts where access to conventional treatment is limited.