Registered nurses' experience of mentoring undergraduate nursing students in a rural context: a qualitative descriptive study.

Background: Registered nurses in a rural context are expected to support undergraduate students during clinical placement, however, they may experience challenges that are unique to the rural context. Aim: To describe the registered nurses' experience of mentoring undergraduate nursing students on clinical placements in a rural context. Design: Qualitative descriptive study. Method: Data were collected from nine participants at two rural hospitals in Australia. Individual semi-structured interviews were conducted and content analysis was used to analyse data. Findings: Four categories emerged from the data: 'The challenges of mentoring', 'Supporting students and facilitating learning', 'Supporting registered nurses who mentor undergraduate nursing students' and 'The rewards of mentoring'. Conclusion: The experience of the rural registered nurse mentor is affected by limited staffing and skill mix, the generalist nature of their work, time constraints and lack of information about students. They need flexible strategies, improved communication and information about students attending clinical placements.

A student's perspective of managing data collection in a complex qualitative study.

AIM: To highlight from a doctoral student's perspective some of the unexpected and challenging issues that may arise when collecting data in a complex, qualitative study. BACKGROUND: Using a qualitative approach to undertaking a PhD requires commitment to the research topic, the acquisition of a variety of research skills and the development of expertise in writing. Despite close research supervision and guidance, the first author of this paper experienced unexpected hurdles when collecting data. This article highlights these hurdles and compares them with similar and dissimilar challenges raised by a social researcher with 30 years' experience (White 2012). DATA SOURCES: The first author's experience of field research during her PhD candidature. REVIEW METHODS: Informed by a critical theoretical perspective, a snowballing technique was used to examine issues related to data collection by a doctoral student in a qualitative research study. DISCUSSION: The first author found the logistics of qualitative data collection, concerns about transparency, role confusion and power differentials with participants, and the effective use of video recording technology, unexpectedly challenging. Many of these issues are highlighted in the literature and/or during research supervision. However, the student researcher remains a novice when entering the field. It is often only on reflection after encountering the hurdle that the student recognises future pre-emptive or alternative methods of data collection. CONCLUSION: The challenges faced as a doctoral student managing the data collection phase of the study concurred with White's discussion of some of the 'real life challenges that novice researchers might face' (2012). Specific guidance and prudence are needed by research students to know when enough data have been collected for manageable analysis within the limits of candidature. Use of reflexivity and mindfulness practised by the student during this phase assisted the ability to reflect, respond and learn from issues as they arose and aim for a harmonious work, study and life balance. IMPLICATIONS FOR PRACTICE/RESEARCH: This paper highlights these issues and offers suggestions for other research higher degree students facing similar challenges when collecting data in a complex qualitative study.

Implementing and evaluating a professional practice framework in child and family health nursing: a pilot project.

AIM: This paper describes the implementation and evaluation of the NSW Child and Family Health Nursing Professional Practice Framework in one health district in New South Wales, Australia. BACKGROUND: Child and family health nurses provide specialised, community based primary health care to families with children 0-5 years. A state wide professional practice framework was recently developed to support child and family health nurses. METHODS: Online learning, clinical practice consultancies and skill assessments related to routine infant and child health surveillance were developed and implemented. Child and family health nurse reviewers gained competency in the various education and assessment components. Reviewers replicated this process in partnership with 21 child and family health nurses from two rural and one regional cluster. Evaluation questionnaires and focus groups were held with stakeholder groups. FINDINGS: Participation provided nurses with affirmation of clinical practice and competency. Education and assessment processes were user friendly and particularly helpful for rural and remote nurses. Managers reported greater confidence in staff competence following project participation. CONCLUSION: Detailed planning and consultation is recommended before implementation of the Framework. Online learning, skills assessments and model of clinical practice consultancies were identified as central to ongoing orientation, education and professional development.

Orientation strategies during delirium: are they helpful?

AIM: This paper critiques literature that reports older person experiences of orientation strategies in relation to current recommendations for the management of older person delirium and makes recommendations for future research. BACKGROUND: Delirium is a common syndrome in hospitalised older people and a difficult syndrome for health care staff to manage. During delirium, older people describe experiencing altered states of reality and use of orientation strategies as part of their care. Orientation, a non-pharmacological approach to the management of delirium, is recommended as a care strategy in evidence-based guidelines and protocols. METHOD: Discursive paper. DISCUSSION: This paper considers published research into the experiences of hospitalised older people during an episode of delirium and questions the appropriateness of orientation strategies. How care strategies are experienced by older people is emphasised. An approach to care which is a flexible balance of reality orientation and validation therapy, synchronised with the changing reality and reactions of the older person, is identified as a care recommendation from research. CONCLUSION: When delirium is experienced during hospitalisation, health care staff have a responsibility to provide care that is person-centred and sensitive to the older person's needs. It has been assumed that no harm comes from the use of orientation approaches, and delirium management guidelines have recommended this approach. However, orientation strategies can lead to mistrust of, and distancing from, health care staff and family, so impeding their relationships with carers. Care practices that consider the older person to be unique and that synchronise with the older person's changing experiences of reality are suggested for further research. RELEVANCE TO CLINICAL PRACTICE: Caring for an older person in delirium is challenging for health care staff. Reconsideration of, and research into, care strategies during delirium has the potential to improve the quality of care for hospitalised older people.

Doing clinical research: the challenges and benefits.

The need for research in practice is well documented within nursing and other health care disciplines. This acceptance is predicated on the belief that clinically applied research will inform and improve practice and health service delivery resulting in better outcomes for consumers and their families. Nurses, however, find doing clinical research challenging. This paper describes nurses' experiences of doing clinical research. The main challenges of doing clinical research arise from a culture that prioritises practice where nursing work is core business and there is the need to address immediate and short term goals. There are also problems associated with the use of research language amongst clinical nurses and ambiguity in relation to research role expectations. Lack of support and resources for doing research along with keeping up the momentum for a research project also pose significant challenges. The benefits of doing clinical nursing research include experiential learning that has the potential to lead to practice change and improved patient outcomes that are evidence based.

Parents' perceptions and needs of children's hospital discharge information.

Two linked descriptive qualitative studies, conducted 12 months apart aimed to identify parents' perceptions of discharge information relating to a recent admission of their child to hospital. Study one participants included parents (n = 7) who telephoned a paediatric telephone triage service seeking information about their child's postdischarge care. Study 2 included parents (n = 12) of children admitted to a regional hospital's general paediatric ward. Data were collected via semi-structured interviews conducted with parents following their child's discharge from hospital. These data were analysed using qualitative content analysis separately. The studies were linked in so far as the results from study one informed the modification of the design of study two and its interview protocol. Both studies revealed verbal as well as written information is helpful to parents, plain language usage is important, messages from the health-care team are sometimes inconsistent, and parents need information specific to their particular circumstances.

The value of new parent groups in child and family health nursing.

A reorganization of child and family health nursing services followed policy changes in New South Wales, Australia, in the late 1990s. However, the introduction of universal and sustained home visiting to all new parents limited resources available to provide support groups for new parents. This qualitative research study used a case study approach to examine the impact of new parents' group attendance on mothers and on mothers' interactions with their baby. Key findings demonstrated that attendance at a group created an opportunity, the overarching theme, for both the mothers and infants. New Parent groups appear to be as important as other modes of nursing service delivery to children and parents and serve a different purpose to center-based or home visits.

Outcomes of a nurse-led telephone triage service in Australia.

This paper reports on a study which comprised the first comprehensive evaluation of the Kids Kare Line telephone triage service in which experienced registered nurses respond to parents' requests for health-care advice for their child. This service is located in an acute care hospital in regional New South Wales, Australia. One hundred and one parents who telephoned the Kids Kare Line responded to a telephone-administered survey designed to determine the service's efficiency and effectiveness. Responses demonstrated that parents sought advice about a range of issues, of which the management of fever was the most frequent. All but five parents considered their call to have been answered promptly, all parents understood the advice provided to them and 96% of parents were satisfied with this advice. Fifty parents identified that they had not used another service or health practitioner for the same issue subsequent to their Kids Kare Line telephone call.

Innovative leadership and management in a nursing home.

The Australian Aged Care Reform Package, implemented from October 1997, has led radical changes in nursing practice in residential aged care facilities. Apart from anecdotal evidence, however, little is known about the impact of the Reform Package on nursing staff and their practice in nursing home facilities. In an attempt to explore these issues a qualitative explorative research study was conducted in one nursing home during 2000-2001. The study found that the impact of policy change on nursing staff and their practice depended on the management's leadership in interpreted the new policy and implemented innovative strategies in order to meet its requirements. The findings of the study highlight management's 'no them vs. us' and 'holistic' approach that considered both nursing staff and residents as whole beings. Integral to this approach was management's recognition that in order to facilitate teamwork, appropriate standards of nursing practice and resident care, and staff job satisfaction four resource elements must be provided. These elements comprise material, environmental, psychosocial and psychological resources. Management's provision of each of these resources ensured that nurses considered this nursing home 'a nice place to work'.

Parents' perspectives of health-care delivery to their chronically ill children during school.

This study sought to identify parents' perspectives about issues relating to the provision of health care to their chronically ill children while they are at school. A survey of parents with school-aged children attending the paediatric subspecialty outpatients clinic in a large teaching hospital was designed to collect both qualitative and quantitative data about this topic. Findings included that 48% (n =161) of parents participating in the study said their child required some form of care or attention while at school. Highest scoring areas of need included supervision of meals (36%), administering insulin (19%), and administering nebulizers/puffers (19%). In addition, 75% of parents with children requiring health care while in school said that special knowledge and skill was required to deliver this care; 56% of these parents did not feel that teachers had the knowledge that would enable them too look after their chronically ill child during school hours.

Versatility and flexibility: attributes of the Critical Incident Technique in nursing research.

This article explores the value of using the Critical Incident Technique to capture qualitative data relating to nurses' experiences in three diverse clinical contexts: (i) neonatal intensive care; (ii) palliative care; and (iii) care of the demented elderly. It is suggested that this technique enables the researcher to capture the reality of contemporary nursing practise, and nurses' experiences of that practise. It is also suggested that the versatility and flexibility of the Critical Incident Technique reveals the subtleties and complexities in nurses' experiences of practising nursing in diverse contexts, thereby promoting a deeper understanding of meanings underpinning this practise.

Communication: principal barrier to nurse-consumer partnerships.

An 8-month pilot study conducted in urban, rural and remote areas of Australia sought to identify barriers to nurse-consumer partnerships, as well as strategies to overcome these barriers. One hundred and ninety-nine Registered Nurses (RNs) and 36 consumers participated across 14 workshops to collect data for the pilot study. Analysis of these data found that nurses' perceptions of partnership with consumers were diverse. Nevertheless, participants in the workshops identified 'communication' as the principal barrier to nurse-consumer partnerships. Contexts in which communication barriers occur grouped easily under the themes of information transfer, documentation, education, personal and interpersonal situations, guidelines and policy, organizational structures, politics, resources and time. Workshop participants also worked together to identify/recommend strategies through which the most important barriers to communication in nurse-consumer partnerships could be addressed.