'Speaking up for safety': A graded assertiveness intervention for first year nursing students in preparation for clinical placement: Thematic analysis.

BACKGROUND: The international literature highlights patient safety as a critical issue in contemporary health care. Poor interpersonal relationships and ineffective health care team communication are identified as dominant human factors contributing to clinical errors and adverse events. Of concern is that some students appear to lack the skills to speak up for themselves, their patients and others when witnessing unsafe practice on clinical placement. STUDY AIMS: To elicit student and staff perspectives on the quality, effectiveness and appropriateness of an assertiveness-based communication activity prior to clinical placement. DESIGN: The study used a qualitative design. A communication module was offered in the second week of the practice laboratory and involved the use of two graded assertiveness frameworks. SETTING: School of Nursing, Midwifery and Paramedicine, at a regional university in South East Queensland, Australia. PARTICIPANTS: Of the 535 first year undergraduate nursing students enrolled in the laboratory courses, 73 (13.6%) completed an anonymous online survey. Individual interviews were conducted with a university student wellbeing coordinator and student mentor to gain their perspectives of the data. METHODS: An evaluation survey with seven qualitative questions and individual semi-structured interviews were employed. Data was analysed using a thematic approach. RESULTS: Five major themes emerged from the survey data: vicarious learning, establishing boundaries, support in practice, advocacy awareness and practice utility. Three themes emerged from the interviews: empowerment and confidence; support and preparation for advocacy; and authentic learning. CONCLUSIONS: Findings indicate that teaching assertiveness skills and establishing a preparatory framework for 'speaking up for safety' early in a nursing students tertiary education can have important psychosocial implications for their confidence, empowerment and success. The activity provided an authentic learning experience with perceived practical application to the workplace and, has the potential to enhance first year curricula by improving communication tools used for students preparing for practice.

Narrative research methods with vulnerable people: sharing insights.

BACKGROUND: Families with hereditary illnesses have complex and unique experiences that are important for nurses to understand. In New Zealand, a Maori family predisposed to an aggressive gastric cancer recently participated in research to explore their healthcare experiences. The family constituted a vulnerable group, so the methodology needed to be inclusive and respectful. The authors chose to use narrative research. AIM: To share insights from conducting narrative research with a vulnerable family. DISCUSSION: Narrative research aligns well with nursing values. Numerous aspects of the methodology help to reduce power imbalance, enhance openness and explore wide-ranging experiences. These include: cultural humility; use of conversational cues rather than scripted research questions; the adoption of an empathic, curious stance; and working in partnership. Each of these aspects helps to foster an environment conducive to full exploration of experiences. People's stories are their own, and so researchers need to exercise humility and meticulous safe-keeping of data so that the whole experience is collaborative. When stories are conveyed to others, effort needs to be applied so that lessons are compelling for others and have generative, change-making potential. CONCLUSION: Narrative research is a fitting methodology for nurses researching the experiences of vulnerable populations. Illness can be disempowering, but recounting stories may help participants with healing, adaptation and coping. IMPLICATIONS FOR PRACTICE: New knowledge about illness, recovery and nursing care can be generated using a critical approach to analysis. By gaining a deeper understanding of people's experiences of illness, nurse researchers can co-create and share compelling narratives that may create empathy and change.

In my day II: Reflecting on the transformative potential of incorporating celebrations into the nursing curriculum.

Understanding one's history is a powerful way to build a sense of belonging, identity and connection. Similarly, history learning can be a powerful component in the core curriculum for undergraduate nursing. History learning develops thinking skills transferable to and necessary in nursing practice. Additionally, awareness about the profession's struggles, achievements and enduring concerns is raised and belief that an individual or group can have influence is affirmed. Perseverance, commitment and seeing the big picture gives a nurse's career meaning and purpose. All of these factors can produce a transformed perspective in today's learners, who are often present-focused, isolated and disconnected from the past and the profession. This paper reports an evaluation of a second interactive learning experience held at the University of the Sunshine Coast to celebrate International Nurses Day 2010. In a previous paper, we shared our initial insights after the success of the first event, and now build upon those insights by examining the transformative learning provoked by the experience, from the points of view of students and staff.

Working toward an understanding of the impact of hereditary cancers.

Hereditary diffuse gastric cancer is a genetically inherited aggressive form of stomach cancer. Once the person is diagnosed as having this gene, they have a 75%-80% chance of inheriting the cancer. People who are at risk of this genetic mutation have to meet many challenges relating to the implications of the disease. An understanding is required by nurses to guide them in the provision of care for those afflicted with this inherited form of gastric cancer. A review of literature has been undertaken relating to other genetically inherited cancers including hereditary nonpolyposis colon cancer, familial adenomatous polyposis, and hereditary lobular breast cancer. The findings from the literature assist nurses in understanding the physical and psychological implications of genetically inherited cancer; however, further study is required to gain a complete understanding of the implications of hereditary diffuse gastric cancer.

Diffuse gastric cancer.

Gastric cancer is one of the leading causes of cancer deaths around the world. This article provides an overview of gastric cancer using a unique case study involving a New Zealand Maori family genetically predisposed to diffuse gastric cancer. The pathophysiology of diffuse gastric cancer, including prognosis, diagnosis, and treatment, along with important patient considerations is highlighted.