Self-assessment of clinical nurse mentors as dimensions of professional development and the capability of developing ethical values at nursing students: A correlational research study.

INTRODUCTION: Providing adequate training for mentors, fostering a positive mentorship culture and establishing the necessary operational procedures for ensuring mentorship quality are the keys to effective clinical mentoring of nursing students. PURPOSE: The purpose of the research was to explain different dimensions of clinical mentors' professional development and their capability of developing ethical values in nursing students. METHODS: A non-experimental quantitative research design was employed. Data were collected by means of a questionnaire administered to the population of clinical mentors (N=143). The total number of questions was 36. Descriptive statistics were used, and bivariate analysis, factor analysis, correlation analysis and linear regression analysis were performed. RESULTS: The professional development of clinical nurse mentors was explained (R(2)=0.256) by career advancement (p=0.000), research and learning (p=0.024) and having a career development plan (p=0.043). Increased professional self-confidence (R(2)=0.188) was explained by career advancement (p=0.000) and the time engaged in record keeping (p=0.028). Responsibility for the development of ethical values in nursing students (R(2)=0.145) was explained by the respondents' level of education (p=0.020) and research and learning (p=0.024). Applying ethical principles and norms into practice (R(2)=0.212) was explained by self-assessed knowledge in ethics (p=0.037) and research and learning (p=0.044). CONCLUSIONS: Clinical nurse mentors tended to lack a career development plan, had low work time spent on research and insufficiently participated in education and training activities, which turned out to be significant explanatory factors of their professional development and their capability of developing ethical values in nursing students. The research showed that nursing and higher education managers often failed to assume responsibility for the professional development of clinical nurse mentors.

Effects of community based cardiac rehabilitation: Comparison with a hospital-based programme.

BACKGROUND: With typically fewer than 35% of eligible patients attending outpatient cardiac rehabilitation (CR), more accessible provision is required. Community-based cardiac rehabilitation is one option but its effects need to be compared with those of hospital-based CR. AIMS: The purpose of this study was to compare changes in health-related quality of life (HRQOL), anxiety and depression, and exercise and smoking rates, between attendees at community-based and hospital-based CR programmes. METHOD: A prospective comparative cohort design was used. Consecutive patients admitted to Aberdeen Royal Infirmary and eligible for CR were recruited and followed up by self-report questionnaire. Outcomes were health status (RAND-36), Hospital Anxiety and Depression Scale (HADS), Godin Leisure-Time Exercise and smoking status. RESULTS: There were 136 of 179 (75%) attenders at community-based CR, compared to 169 of 209 (80%) at hospital-based CR (p=0.242). In univariate analysis, there were no significant differences between the two groups in health status, HADS, and frequency or intensity of exercise immediately after the CR programme or six months later. Adjusting for other significant factors, patients who attended community CR reported higher RAND-36 energy scores at six months compared with attenders at hospital CR (p=0.020), but were less likely to undertake frequent exercise (p=0.041). CONCLUSIONS: Community-based CR appears to achieve similar attendance rates and effects on health status and health behaviour as hospital-based CR. This option might help overcome the poor attendance of patients with long travelling times to hospital-based CR.

Effectiveness of theory-based invitations to improve attendance at cardiac rehabilitation: a randomized controlled trial.

BACKGROUND: Despite well-established evidence of benefit from cardiac rehabilitation, typically fewer than 35% of eligible patients attend. OBJECTIVE: The purpose of this study was to evaluate whether theory-based invitations increase attendance at cardiac rehabilitation. METHOD: The study was a randomized controlled trial (RCT) with two by two factorial design. A total of 375 participants with acute myocardial infarction or coronary revascularization was recruited from medical and surgical cardiac wards at Aberdeen Royal Infirmary (ARI). They were randomly assigned to receive either the standard invitation letter or a letter with wording based on the 'theory of planned behavior (TPB)' and the 'common sense model of illness perception', and either a supportive leaflet with motivational messages or not. The primary outcome was one or more attendances at cardiac rehabilitation. RESULTS: The theory-based letter increased attendance at cardiac rehabilitation compared to the standard letter (84% versus 74%, odds ratio (OR) 2.93, 95% confidence interval (CI) 1.54-5.56), independent of age, gender, working status, hypertension, identity and TPB constructs. The number needed to treat (NNT) was 9 (95% CI 7-12). The motivational leaflet had no significant effect on attendance at rehabilitation (OR 1.02, 95% CI 0.57-1.83). CONCLUSIONS: The use of theory-based wording in invitation letters is a simple method to improve attendance at cardiac rehabilitation. Our letter, reproduced in this paper, could provide a template for practitioners and researchers.

Attitudes to brain donation for Parkinson's research and how to ask: a qualitative study with suggested guidelines for practice.

AIM: To describe factors people consider important in deciding whether or not to donate their brain for research after death. BACKGROUND: Brain tissue retrieved at post-mortem is needed to further research into neurological conditions such as Parkinson's disease. Previous research has focussed mainly on attitudes to organ donation for transplantation. DESIGN: Data were gathered and analysed using a qualitative approach based on grounded theory. METHODS: Nineteen people who had made a decision about brain donation, five people with Parkinson's and 14 unaffected individuals, were identified through theoretical sampling. Interviews conducted between September 2007-January 2008 were analysed to identify themes representing the concerns of participants, when making a decision. FINDINGS: The three main themes identified were views and beliefs about post-mortem, the importance of family and the things people do not talk about. Although participants were more familiar with the concept of organ donation for transplantation, unanimous support was expressed for brain donation for research. However, beliefs about death and post-mortem, influence of family and the difficulty in talking and thinking about things to do with death all posed barriers to consent when actually asked to make a decision. For some, however, being asked had acted as a catalyst, transforming previously held positive attitudes into a decision to consent. CONCLUSION: Guidelines for asking developed from these findings highlight the importance of discussing the issue to raise awareness in potential donors, involving family members, and giving accurate and appropriate information to inform, reassure and to dispel misconceptions.

Faith communities and their assets for health promotion: the views from health professionals and faith leaders in Dundee, in Scotland.

Within the European Union, as well as in Canada and the United States (US), health promoters employ a number of strategies to encourage community-based health improvements. This involves the creation of innovative health promotion partnerships to support and enable people to choose and engage in healthy living practices. Compared to the US, in other Western countries, such as the United Kingdom, faith communities have largely been ignored in health promotion partnerships. This study established existing evidence about health promotion in faith communities in Scotland by examining the perceptions and attitudes concerning health promotion among faith leaders and health promotion professionals. We conducted 33 semi-structured interviews with health promotion professionals (n = 9) and representatives of Christian and non-Christian faith communities (n = 24). The majority of participants expressed an interest in the concept of health promotion in a faith community and could readily envision its application in their area of work. Both groups identified multiple physical assets, as well as social supports within faith communities that could be directed towards healthy living activities. Faith groups and church organisations may constitute potential partners and new settings to increase community capacity for health promotion. Further research and funding for demonstration projects may be particularly helpful to provide evidence of the strengths and limitations of faith-based health promotion in Scotland, which in turn could inform health promotion practice and policy.

The buck stops here: midwives and maternity care in rural Scotland.

OBJECTIVE: To explore and understand what it means to provide midwifery care in remote and rural Scotland. DESIGN: Qualitative interviews with 72 staff from 10 maternity units, analysed via a case study approach. SETTING: Remote and rural areas of Scotland. PARTICIPANTS: Predominantly midwives, with some additional interviews with paramedics, general surgeons, anaesthetists and GPs. FINDINGS: Remote and rural maternity care includes a range of settings and models of care. However, the impact of rural geographies on decision-making and risk assessment is common to all settings. Making decisions and dealing with the implications of these decisions is, in many cases, done without onsite specialist support. This has implications for the skills and competencies that are needed to practice midwifery in remote and rural settings. Whereas most rural midwives reported that their skills in risk assessment and decisions to transfer were well developed and appropriate to practising in their particular settings, they perceived these decisions to be under scrutiny by urban-based colleagues and felt the need to stress their competence in the face of what they imagined to be stereotypes of rural incompetence. CONCLUSIONS: This study shows that skills in risk assessment and decision-making are central to high quality remote and rural midwifery care. However, linked to different perspectives on care, there is a risk that these skills can be undermined by contact with colleagues in large urban units, particularly when staff do not know each other well. There is a need to develop a professional understanding between midwives in different locations. IMPLICATIONS FOR PRACTICE: It is important for the good working relationships between urban and rural maternity units that all midwives understand the importance of contextual knowledge in both decisions to transfer from rural locations and the position of midwives in receiving units. Multiprofessional CPD courses have been effective in bringing together teams around obstetric emergencies; we suggest that a similar format may be required in considering issues of transfer.

Developing the community environmental health role of the nurse.

This paper is a report from one phase of an exploratory case study. It investigated the environmental health concerns of members of communities within one city in the North East of Scotland. Individual interviews with stakeholders (n=21) and four focus groups were conducted with a convenience sample of community nurses (n=19). Community nurse participants believed that their environmental health role remains underdeveloped. They indicated that they do not view the NHS as a resource for environmental health information. An environmental role is constrained by the NHS not being perceived as a source of information or expert in environmental health. They described limited contact between community nurses and public health medicine and uncertainty and conflict of interest between clinical groups regarding the scope of an environmental health role. Policy makers could support the development of an environmental advocacy role--a pilot of this is required.

A survey of faith leaders concerning health promotion and the level of healthy living activities occurring in faith communities in Scotland.

Faith groups constitute a growing health promotion partner in North America where they help increase community capacity. However, in the United Kingdom this collaboration is seemingly far less developed. This study sought to find evidence of health promotion in faith communities and examine perceptions and attitudes concerning health promotion among faith leaders. It also sought to establish the level to which health-promoting activities currently occur in, and are organized by, places of worship in one Scottish city, Dundee. The authors distributed a self-administered questionnaire to representatives of all faith communities in Dundee (response rate 71%, n = 50). The survey identified existing, well-formed community groups, some of whom already engaged in health-promoting activities, and shared similar interests with health promotion professionals. Generally, faith leaders were positive towards the concept of health promotion and many considered health promotion to be compatible with their mission. Not all denominations were equally involved in health promotion activities, for example, some conducted annual one-off activities, while others had well-established walking groups or exercise classes. The responses suggest a degree of readiness by faith communities to engage, if invited, in health promotion programmes. These results also indicate that faith groups may constitute untapped resources, poised to contribute to local health promotion efforts. The article concludes that as the National Health Service (NHS) invests in community-based health initiatives that can have long-term sustainability, it is reasonable to make links between what is happening in North America, the interest in health promotion reported by faith leaders in this study and the possibilities for their participation in voluntary sector community health partnerships.

Being and doing politics: an outdated model or 21st century reality?

AIM: This paper presents a discussion of how critical social theory can be used as a tool for research, reflection and exploration of the political role of the nurse. BACKGROUND: Sociological theory can be used to examine ideologies within nursing systems in order to contribute to the future development of the profession. The importance of critical social theory has been identified in the literature as being directly relevant to holism which is central to the nature of nursing. DATA SOURCES: Texts published in English were identified from 1990 to 2008 using the keywords critical social theory, community nursing, political advocacy, social justice, sociological theory, health inequalities, health democracy, equity and inequality. DISCUSSION: Critical social theory can be used as a tool to highlight ethical ways to practise nursing. One reason for examination of the community nurse's political role is a shift in focus from the individual as patient to communities experiencing health inequalities. Nursing needs to decide whether the profession will work at the political level, and where advocacy and citizenship are located within a community role. CONCLUSION: Nurse educators must prepare nurses for political participation, and nurse managers need to focus on national and local contexts in order to encourage policy analysis and community engagement within nursing practice. An understanding of critical social theory can aid decision-making in relation to global and local policy, enable the nursing profession to respond to social injustice, and permit nurses to work with communities in the pursuit of community health.

Improving uptake of cardiac rehabilitation: using theoretical modelling to design an intervention.

BACKGROUND: Attendance rates at cardiac rehabilitation remain low with typically fewer than 35% of eligible patients attending. Much of the poor attendance stems from invited patients failing to attend. AIM: To design a theoretically based intervention to improve attendance at cardiac rehabilitation. METHODS: Our methods followed recommendations that have been developed from the Medical Research Council (MRC) framework for the design of complex interventions. We conducted three processes that progressed simultaneously: 1) literature review for evidence on epidemiology, behavioural theory, and efficacy of interventions; 2) expert meetings on behavioural theory and to select target points for intervention; and 3) development and theoretical modelling of the intervention. RESULT: Our final interventions were a theoretically worded invitation letter and leaflet based on the Theory of Planned Behaviour and the Common Sense Model of Illness, designed to: a) motivate patients through professional recommendation; b) provide simple information on the contents of cardiac rehabilitation emphasising ease for participants; c) reassure participants that the programme is tailored to their personal needs in a safe supervised environment; and d) reinforce the benefits of attending cardiac rehabilitation. CONCLUSION: A theoretically worded letter and leaflet could be an inexpensive intervention to improve attendance at cardiac rehabilitation. The letters and leaflets will now be evaluated in a randomised trial.

I felt like a real nurse - student nurses out on their own.

In the United Kingdom, the education of nurses to be 'fit for practice' has received considerable attention having a catalytic effect on the way nursing programmes are organised. A period of clinical practice is now recommended in the final stages of nurse education to help prepare students for the role of registered practitioner. In the study area, the opportunity for student nurses in the final stages of their programme to visit patients and clients on their own in the community is given to facilitate achievement of the competencies required for entry to the nursing register. The aim of the study reported here was to discover what this experience meant for students in their final year. A qualitative methodology utilising one-to-one, semi-structured interviews was adopted. The tape-recorded interviews were transcribed and the content analysed to reveal codes, categories and themes. The findings revealed that being 'out on their own' was valued by students who felt they were taking on the role of a 'real nurse'. The main themes to emerge were: building confidence, developing professionalism in relationships, learning to manage care, developing knowledge and gaining insight, and being included and supported. The opportunity for final stage students to work independently in whatever setting they are placed is recommended as important for their professional development.

Competence development among nurses: the process of constant interaction.

BACKGROUND: The importance of competence to nursing practice was the motivation for this study, which explored nurses' experience in developing their competence as they progress through their careers. METHODS: In accordance with grounded theory method, data collection and data analysis were performed simultaneously using the constant comparative method. RESULTS: Data revealed that nurses developed competence through an iterative process called "the process of constant interaction." This five-stage process was found to be a complex, ongoing interpersonal dynamic between the nurse and the surrounding world. CONCLUSIONS: Although the nurse is the key player in the process of his or her own competence development, employers have a pivotal responsibility in facilitating the nurse's progress toward ongoing professional competence, which is a key element of the quality of care.

Midwives' competence: is it affected by working in a rural location?

INTRODUCTION: Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK, the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings, regarding their competence and confidence with respect to 'competencies' identified as being those which all professionals should have in order to provide effective and safe care for low-risk women. METHOD: This was a comparative questionnaire survey involving a stratified sample of remote and rural maternity units and an ad hoc comparison group of three urban maternity units in Scotland. Questionnaires were sent to 82 midwives working in remote and rural areas and 107 midwives working in urban hospitals with midwife-led units. RESULTS: The response rate from midwives in rural settings was considerably higher (85%) than from midwives in the urban areas (60%). Although the proportion of midwives who reported that they were competent was broadly similar in the two groups, there were some significant differences regarding specific competencies. Midwives in the rural group were more likely to report competence for breech delivery (p = 0.001), while more urban midwives reported competence in skills such as intravenous fluid replacement (p <0.001) and initial and discharge examination of the newborn (p <0.001). Both groups reported facing barriers to continuing professional development; however, more of the rural group had attended an educational event within the last month (p <0.001). Lack of time was a greater barrier for urban midwives (p = 0.02), whereas distance to training was greater for rural midwives (p = 0.009). Lack of motivation or interest was significantly higher in urban units (p = 0.006). CONCLUSION: It is often assumed that midwives in rural areas where there are fewer deliveries, will be less competent and confident in their practice. Our exploratory study suggests that the issue of competence is far more complex and deserves further attention.

Competencies and skills for remote and rural maternity care: a review of the literature.

AIM: This paper reports a review of the literature on skills, competencies and continuing professional development necessary for sustainable remote and rural maternity care. BACKGROUND: There is a general sense that maternity care providers in rural areas need specific skills and competencies. However, how these differ from generic skills and competencies is often unclear. METHODS: Approaches used to access the research studies included a comprehensive search in relevant electronic databases using relevant keywords (e.g. 'remote', 'midwifery', 'obstetrics', 'nurse-midwives', education', 'hospitals', 'skills', 'competencies', etc.). Experts were approached for (un-)published literature, and books and journals known to the authors were also used. Key journals were hand searched and references were followed up. The original search was conducted in 2004 and updated in 2006. FINDINGS: Little published literature exists on professional education, training or continuous professional development in maternity care in remote and rural settings. Although we found a large literature on competency, little was specific to competencies for rural practice or for maternity care. 'Hands-on' skills courses such as Advanced Life Support in Obstetrics and the Neonatal Resuscitation Programme increase confidence in practice, but no published evidence of effectiveness of such courses exists. CONCLUSION: Educators need to be aware of the barriers facing rural practitioners, and there is potential for increasing distant learning facilitated by videoconferencing or Internet access. They should also consider other assessment methods than portfolios. More research is needed on the levels of skills and competencies required for maternity care professionals practising in remote and rural areas.

Treatment of minor illness in primary care: a national survey of patient satisfaction, attitudes and preferences regarding a wider nursing role.

BACKGROUND: This study investigated patient opinion about the provision of nurse-led vs. doctor-led primary health care in the treatment of minor illness. DESIGN: A postal questionnaire survey including discrete choice experiment (DCE) of a national sample followed by telephone interviews with respondent volunteers. SETTING AND PARTICIPANTS: A large random sample of the population of Scotland from a range of general practices including traditional and extended practice nursing roles was invited to participate. MAIN OUTCOME MEASURES: Patient satisfaction with, opinion of and preference for practice nurse (PN) vs. doctor consultation in primary care in relation to gender, age, education and income. RESULTS: Questionnaire response rate was 49% (1343 of 2740). Women, younger people, the less well-educated and those with higher income had a more positive attitude towards the PN. Older people had a more positive attitude to the doctor. Results from the DCE indicated that whilst most respondents would prefer a doctor consultation, many would be happy to consult with a nurse if other aspects of the consultation were improved. Forty-eight people were interviewed. The main perceived differences between doctors and nurses were academic ability and qualifications. Most respondents thought nurses could deal with relatively minor problems and should be able to prescribe some drugs. CONCLUSION: Patients would always want their choice of health professional to be available at first contact. However, this study suggests that, in primary health-care practices, if nurses take on more roles previously the preserve of doctors, patients would accept them, particularly if patients receive information on nurses' capabilities.

The use of triangulation for completeness purposes.

Triangulation in research refers to the use of multiple techniques for gathering and/or handling data within a single study The original purpose of triangulation was to seek confirmation of apparent findings. There now appears to be support for a second purpose - completeness. This paper reviews the arguments surrounding the use of triangulation, and shows how its use facilitated one researcher's attempt to provide a complete picture of the phenomenon explored in a qualitative study of the adequacy of the nurse education system in Malta.

A study of continuing nurse education in Malta: the importance of national context.

The literature recommends that in the light of the constant changes in the contexts in which nurses perform [Buerhaus, P., 1997. The future of the nurse labour market. Image 29(4), 313-318], nurse education systems should incorporate specialised and continuing education [Lenera, V., 1987. The Nurse and the Future: Role and Function. In: Health Care and Nurse Education in the 21st Century. Commission of the European Communities, Brussels; Castledine, G., McGee, P., 1998. Advanced and Specialist Nursing Practice, Blackwell Science Ltd., Oxford; Chiarella, M., 1998. Developing the credibility of continuing education. Nurse Education Today 10, 70-73 ]. Using a qualitative approach, the research study reported in this article explored views of student and qualified nurses in Malta about such educational opportunities. Data were collected using questionnaires administered by post to student and qualified nurses in Malta (n=172) [Fenech Adami, M., 2002. An exploratory study of the adequacy of the nurse education system in Malta. PhD Thesis. University of Aberdeen.]. In congruence with the literature, the findings revealed widespread support for and interest in specialised and continuing education in general [Nolan, M., 1994. Continuing professional education: identifying the characteristics an effective system. Journal of Advanced Nursing 22, 551-560; Wilson-Barnett, J., 1994. Evaluating the clinical nurse specialist - a review. International Journal of Nursing Studies 31(6), 561-571]. However, some of the findings challenge that which is recommended in the literature. The findings should contribute to the effective development of specialised and continuing education opportunities in Malta. Moreover, by their divergence from the literature, these findings illustrate that nurse education should always be planned against a backdrop of the context in which it is to be delivered. In turn, the findings point out the importance of researching education within specific contexts rather than simply extrapolating research evidence and subsequent recommendations on nurse education from one national context to another.

Nursing education and the Research Assessment Exercises.

Prior to 1989, the funding of British universities was the responsibility of the University Grants Committee (UGC). The UGC's traditional role was to represent the universities to government, and to act as a buffer between the two, the aim being to enable the universities to be independent of central (political) control ( 1 ).