Collegian

Doing the simple things well

Sandy Middleton — 2012-06-01

Nursing is a core discipline in health care delivery. Our trial, discussed below, has provided compelling high level evidence that ‘careful attention to aspects of nursing and general care appears to generate large benefits’ ().

A conversation about practice development and knowledge translation as mechanisms to align the academic and clinical contexts for the advancement of nursing practice

2012-03-26

Summary: Practice development (PD) and knowledge translation (KT) have emerged recently as methodologies which assist advancement in gathering and using evidence in practice. For nursing to benefit from these methodologies there is a need to advance the dialogue between academia and the service sector concerning the use and further development of these methodologies as well as how we create the most effective partnerships between academia and practice. To advance this dialogue and to gain insights into the similarities and differences between KT and PD and between the academic and the service sectors, four conversations from different leaders in these sectors have been gathered and are presented here.These four discrete narratives are presented to showcase the diversity of sector contexts in relation to PD and KT methodologies. Narrative One focuses on some of the theoretical and policy issues related to creating partnerships between traditional “knowledge creation systems” (universities) and “knowledge utilization systems” Narrative Two discusses how a large school of nursing responded to the challenge of creating partnerships for practice development in an attempt to bridge the academic/service divide and produce benefits to both organisations. Narratives Three and Four describe the view of practice development from the service side. The final section of the paper presents an agenda for discussion and action based on the emerging set of principles.

High Fidelity Patient Silicone Simulation: A qualitative evaluation of nursing students’ experiences

Kerry Reid-Searl, Brenda Happell, Lea Vieth, Anne Eaton — 2011-10-17

Summary: Clinical experience is recognised as a source of fear and anxiety for undergraduate nursing students. Simulated learning experiences have been identified as potentially increasing confidence, however most techniques do not always reflect clinical reality or are too costly. The aim of the current study is to explore nursing students’ perceptions of the use of High Fidelity Silicone Simulation, developed by one university academic to overcome these limitations. A simulated patient with a personal and medical history is developed and brought to life through wearing life-like silicone props including face, hands and torso. The academic is able to adapt responses to direct student learning. This paper presents the findings from a qualitative exploratory study of nursing students’ responses to this technique. Twenty-one students in second or third year of the nursing program participated in one of three focus groups to discuss their experiences. Data were analysed using a thematic approach. Data analysis revealed three main themes: preparation for clinical reality, reducing fear/increasing confidence, and taking out of comfort zone. These findings suggest that this technique has the potential to increase nursing students’ sense of preparedness for their clinical experience, thus reducing the negative impact of fear and apprehension.

The management of behavioural problems associated with dementia in rural aged care

Kaye Ervin, Sarah Finlayson, Maddalena Cross — 2012-03-29

Summary: Background: In Australia 60–80% of all residents in aged care facilities have a cognitive impairment related to dementia with this figure predicted to increase. The associated behavioural and psychological disorders associated with dementia frequently result in the prescription of antipsychotic drugs to assist in limiting disruptive or concerning unmet needs behaviour. Antipsychotic prescription rates in aged care facilities are estimated to be as high as 80% despite the well known adverse effects in this population. Person centred care approaches to management of behavioural and psychological symptoms of dementia (BPSD) has not been widely implemented despite its reported effectiveness. Other interventions aimed at reducing antipsychotic use in aged care has been limited and the barriers to the use of non pharmacological strategies are poorly researched.Methodology: In this study a 43 point questionnaire was distributed to 6 rural aged care facilities to assess nurses’ knowledge of non pharmacological and pharmacological interventions, and the frequency, perceived barriers and efficacy of both strategies. Resources and information bases utilised in behaviour management was also explored.Findings: The results indicated that staff have a good knowledge of possible underlying causes of BPSD, but a poor understanding of appropriate methods of management and resources available to assist them. Time constraints were frequently cited by respondents as problematic in managing behavioural problems. The results of this study suggest the need for utilisation of tools to assist nurses to identify target behaviours, implementation of appropriate management and access to the resources available.

Supporting rural and remote area nurses to utilise and conduct research: An intervention study

Anne Gardner, Wendy Smyth, Bronia Renison, Tina Cann, Mary Vicary — 2011-10-20

Summary: Background: Nurses are expected to embrace research and evidence-based practice but in rural/remote facilities it is particularly difficult to develop and utilise research skills.Objectives: This collaborative study aimed to explore nurses’ orientation to research and address known inhibitors to engagement with research in rural/remote north Queensland locations.Participants: The sample comprised nurses from two rural/remote areas within a regional health service. Methods A pre-test post-test intervention study with two levels of data collection: responses to Edmonton Research Orientation Scale administered 3 times to all nurses, and number of research proposals developed. This intervention comprised provision of face-to-face workshops, paper-based resources, and informal videoconference, email and telephone contact.Results: Survey response rates varied from 56% to 34%. Two-thirds of respondents were over 40years old; 75% were Registered Nurses. One quarter rated understanding of journal articles as poor or very poor and 50% rated their knowledge of research similarly. However, 50% said research had changed the way they practiced. Older nurses, nurses with tertiary qualifications and those with senior appointments had more positive orientation to research scores. Several locally relevant research proposals were developed from one site; two received internal funding for further development and implementation. The intervention also led to increased utilisation of library resources which has continued past this study's end.Conclusions: The variation in uptake between sites reinforces the need for locally targeted support. This study has gone beyond measuring research utilisation by including evaluation of support mechanisms to engage nurses in developing research proposals.

Change for the better: An innovative Model of Care delivering positive patient and workforce outcomes

Tina Cann, Anne Gardner — 2011-10-17

Summary: Objective: To evaluate patient and workforce outcomes following the implementation of the Practice Partnership Model of Care.Design: Pre-test–post-test design.Setting: A 29-bed surgical ward at a tertiary-level regional hospital.Subjects: Summary de-identified data from all patients and ward nursing staff in the study period.Interventions: The Practice Partnership Model of Care has four main components: working in partnership; clinical handover at the bedside; comfort rounds; and environmental modifications. These reflect patient-centered and quality focused initiatives and use a total quality improvement framework that aims to transform care at the bedside.Main outcome measures: Patient outcomes: changes in patient safety (measured by numbers of medication errors and patient falls); satisfaction with care (use of the call bell system, number of complaints and compliments). Workforce outcomes: changes in staff satisfaction (measured through staff sick leave).Results: A statistically significant reduction in use of nurse call bells (p=<0.001) post-implementation. Medication errors and patient falls reduced, with an overall reduction of 4% in staff sick leave.Conclusions: The Practice Partnership Model of Care positively affected patient and workforce outcomes, suggesting further exploration of this model in other hospital contexts is warranted.