Collegian RSS feed: Articles in Press. Collegian is the official journal of the Royal College of Nursing, Australia. Collegian aims to reflect the broad interests of nurses and the nursing profession, and to challenge nurses to emerging areas of interest. It publishes articles on professional, policy and practice issues. Most papers published in Collegian are peer reviewed by a double blind process using reviewers who meet high standards of academic and clinical expertise. Other papers are published at the discretion of the Editor if they contribute to nursing knowledge and debate. Collegian is distributed to members of the College and is available by separate subscription. The College is the peak national professional organisation for nurses in Australia. Its mission is to benefit the health of the community through promotion and recognition of professional excellence in nursing. To purchase books on Nursing or to browse our comprehensive range of specialised nursing titles, please visit us at shop.elsevier.com.au. Shop.elsevier.com.au/Nursing Awareded its first Impact Factor for 2010. http://www.collegianjournal.com//inpress?rss=yesElsevier Inc.en © 2012 Royal College of Nursing, Australia. Published by Elsevier Inc. All rights reserved. Collegian1322-76962012-05-10 © 2012 Royal College of Nursing, Australia. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.collegianjournal.com/article/PIIS1322769612000364/abstract?rss=yesSummary: The use of Objective Structured Clinical Examination/Objective Structured Clinical Assessment (OSCE/OSCA) has been well documented. How assessors currently view the process, and if the OSCA tool still fulfils the assessment requirements, is unclear. In this study, the beliefs and expectations of assessors towards the assessment tool used in an undergraduate nursing degree to assess clinical skills was investigated. A cross-sectional study used semi-structured interviews and focus groups with 16 lecturers in nursing from a rural Australian university. This represents 65% of the total nurse academic staff employed there. The key issues that the academic staff raised reflect those from previous studies, such as the use of OSCA as formative assessment or a quality check process before the clinical practice. The OSCAs were seen as a good assessment tool, which gave students the opportunity to receive feedback on their performance in relation to clinical skills. The drawbacks identified in relation to the use of OSCAs were that the OSCA was seen as stressful to students. This drawback was thought to be further compounded if there was a lack of congruence regarding essential criteria between assessors. If not adequately addressed these drawbacks will erode the potential the OSCA tool has to foster uniformity, which was one of the main reasons for its implementation.Nurse academics perceptions of the efficacy of the OSCA tool - Corrected ProofStéphane Bouchoucha, Lolita Wikander, Catherine Wilkin10.1016/j.colegn.2012.03.008Collegian (2012)2012-05-10Collegian2012-05-10http://www.collegianjournal.com/article/PIIS1322769612000376/abstract?rss=yesSummary: Graduate nurses in general practice became a feature of New Zealand's health care system in 2008 following an expansion of the New Entrant to Practice Programme. General practice in New Zealand comprises general practitioner business owners who employ nursing and administration staff. Practice nurses are an ageing workforce in New Zealand, it is imperative therefore to attract younger nurses into general practice. This paper reports a section of the findings from a constructivist grounded theory study which examines the use of information by practice nurses in New Zealand. Initially data were collected using the ethnographic technique of observation and field notations in one general practice. Theoretical sensitivity to the value of role models was heightened by this first phase of data collection. A total of eleven practice nurses were interviewed from six general practices. One practice nurse agreed to a second interview; five of the interviewees were new graduate nurses and the other six were experienced practice nurses. The grounded theory constructed from this research was reciprocal role modelling which comprises the following three categories, becoming willing, realising potential and becoming a better practitioner. Graduate nurses and experienced practice nurses enter into a relationship of reciprocal role modelling. Becoming willing, the first core category of this grounded theory features three sub-categories: building respectful relationships, proving yourself and discerning decision making which are reported in this paper. Findings from this study may address the reported phenomenon of ‘transition shock’ of newly graduated nurses in the work place.Becoming willing to role model. Reciprocity between new graduate nurses and experienced practice nurses in general practice in New Zealand: A constructivist grounded theory - Corrected ProofKaren J. Hoare, Jane Mills, Karen Francis10.1016/j.colegn.2012.03.009Collegian (2012)2012-05-07Collegian2012-05-07http://www.collegianjournal.com/article/PIIS1322769612000455/abstract?rss=yesSummary: Early recognition and management of patient deterioration are essential nursing skills, and can be improved through education and experience. However, both nursing students and registered nurses may have few opportunities to develop and maintain the emergency management skills necessary to ensure patient safety. Using both theory and empirical evidence, we have developed a simulation-based educational model, ‘FIRST2ACT’ (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends), to provide nurses with a high-fidelity learning experience. The model has been tested in three different settings: it is highly acceptable to learners, adaptable to different training needs, and shows promise in improving actual clinical performance.Patient deterioration simulation experiences: Impact on teaching and learning - Corrected ProofPenny Buykx, Simon Cooper, Leigh Kinsman, Ruth Endacott, Julie Scholes, Tracy McConnell-Henry, Robyn Cant10.1016/j.colegn.2012.03.011Collegian (2012)2012-05-07Collegian2012-05-07http://www.collegianjournal.com/article/PIIS132276961200042X/abstract?rss=yesSummary: To meet the expected shortfalls in the number of registered nurses throughout the coming decade Australian universities have been recruiting an increasing number of students from culturally and linguistically diverse (CaLD) backgrounds. Given that international and domestic students who use English as an additional language (EAL) complement the number of native English speaking nursing students, they represent a valuable nurse education investment. Although university programmes are in a position to meet the education and learning needs of native English speaking nursing students, they can experience considerable challenges in effectively equipping EAL students with the English and academic language skills for nursing studies and registration in Australia. However, success in a nursing programme and in preparing for nurse registration can require EAL students to achieve substantial literacy skills in English and academic language through their engagement with these tertiary learning contexts. This paper discusses the education implications for nursing programmes and EAL students of developing literacy skills through pre-registration nursing studies to meet the English language skills standard for nurse registration and presents intervention strategies for nursing programmes that aim to build EAL student capacity in using academic English.Embedding international benchmarks of proficiency in English in undergraduate nursing programmes: Challenges and strategies in equipping culturally and linguistically diverse students with English as an additional language for nursing in Australia - Corrected ProofPaul J. Glew10.1016/j.colegn.2012.04.002Collegian (2012)2012-04-30Collegian2012-04-30http://www.collegianjournal.com/article/PIIS1322769612000315/abstract?rss=yesSummary: Background: This article reports on an international collaborative study which compared school-based health care in the United States of America, Canada and Australia.Method: Tri-nation school-based health care was compared and contrasted through the utilisation of a series of interpretive case studies. Grounded theory approaches informed the data analysis and reporting processes.Findings: Unlike the US, Canadian and Australian school students rarely have access to school-based health care on site. All three nations face structural, cultural and societal barriers, often related to limited resources which limit the effectiveness of school-based health care.Discussion: The benefits of school-based health care and providing comprehensive services through schools can include healthier children, better learning, healthier parents, and healthier communities. Unfortunately, based on our research, comprehensive school health services have not been adequately implemented in the US, Canada or Australia.Implications for practice: Given the findings of this study, increased comprehensive school-based health services are urgently needed in the US, Canada and Australia.Barriers to providing school-based health care: International case comparisons - Corrected ProofDenise Seigart, Elaine Dietsch, Michèle Parent10.1016/j.colegn.2012.03.003Collegian (2012)2012-04-23Collegian2012-04-23http://www.collegianjournal.com/article/PIIS1322769612000327/abstract?rss=yesSummary: Background: There is increasing use of complementary and alternative medicines (CAMs), particularly amongst patients with cancer. This paper aims to better understand the types of CAM people are using and explore the reasons for using these approaches. This paper will also identify what patients want from health professionals in relation to CAM and the actions and attitudes of health professionals towards CAM. Finally, this paper will discuss the potential implications for health services.Method: Two surveys were conducted, a self-administered survey was completed by oncology patients; and a second online survey completed by staff.Results: Patients used CAM as an adjunct to services they receive from conventional health services, not as an alternative. The positive and empowering role that complementary health practices play in people's lives was a common theme as was the need for CAM to be used with care.Survey responses by health care staff revealed mixed views of CAM. Most staff had positive views about CAM as a treatment adjunct and said they responded to patients accordingly. Only a minority expressed scepticism and were less inclined to support CAM use by their patients. Nevertheless, few staff instigated discussions around CAM.Conclusion: This paper presents key considerations for health services wanting to better respond to CAM and adopt an integrated approach to health care.Complementary health therapies: Moving towards an integrated health model - Corrected ProofJulieanne Hilbers, Craig Lewis10.1016/j.colegn.2012.03.004Collegian (2012)2012-04-16Collegian2012-04-16http://www.collegianjournal.com/article/PIIS1322769612000297/abstract?rss=yesSummary: International evidence indicates that nurses working in primary care can provide effective care and achieve positive health outcomes for patients similar to that provided by doctors. Nurse practitioners employed in primary health care perform some tasks previously exclusive to the GP role due to their advanced skills, knowledge and training. In November 2010 Medicare provider rights and Pharmaceutical Benefits Scheme rights were provided for nurse practitioners working in private practice, and in collaboration with a medical practitioner. However, there is limited evidence about how acceptable nurse practitioners are to Australian consumers and what knowledge consumers have of the nurse practitioner role in the delivery of primary health care. The aim of this study was to examine Australian health care consumers’ perceptions of nurse practitioners working in primary health care. This paper reports on the results of seven focus groups (n=77 participants) conducted around Australia. Focus groups participants were asked how acceptable nurse practitioners are as provides of primary health care. Although there was some confusion about the role of nurse practitioners and how this role differed from other primary health care nurses, participants in the focus groups were very positive about nurse practitioners and would find them acceptable in providing primary health care.How acceptable are primary health care nurse practitioners to Australian consumers? - Corrected ProofRhian Parker, Laura Forrest, Nathaniel Ward, James McCracken, Darlene Cox, Julie Derrett10.1016/j.colegn.2012.03.001Collegian (2012)2012-04-12Collegian2012-04-12http://www.collegianjournal.com/article/PIIS1322769612000352/abstract?rss=yesSummary: Aim: We hypothesised that patients treated for breast cancer would benefit from targeted therapeutic action delivered by general practitioners on the recommendations of a multidisciplinary team based in primary care.Methods: Patients scheduled for follow-up visits at a hospital surgical clinic were invited to complete a self-administered care needs assessment and be interviewed by a breast care nurse. Members of the multidisciplinary team discussed the audio-recorded interviews within 2 weeks. The team made recommendations for each patient, which were presented to the general practitioner as a suggested ‘care plan’. Health status information was collected via the Short Form 36 and Anxiety and Depression data via the Hospital anxiety and Depression Scale at recruitment and 3 months later.Results: Among the 74 women who were invited to participate, 21 were recruited over a 6-month period (28%), 19 of whom completed the study (90%). The mean age was 55 years (range 38–61 years) and the mean time in follow-up was 23 months (range 16–38 months). The team identified a median of three problems per patient (range 2–7) and made an average of two recommendations per patient for referral to an allied health professional (range 0–5). At 3 months, 17 women had attended their general practitioner, 11 of whom felt their condition had improved as a result of the intervention. There was no significant change in Short Form 36 or Hospital Anxiety and Depression Scale score after the intervention.Conclusions: Primary care-based multidisciplinary review of treated breast cancer patients is feasible and, for most, results in benefit. However, only a minority of eligible patients participated in this pilot study and the logistics of organising the reviews warrants careful consideration.Cancer care coordinator: Promoting multidisciplinary care—A pilot study in Australian general practice - Corrected ProofMoyez Jiwa, Glenys Longman, Deepa Sriram, Jill Sherriff, Kathy Briffa, Toni Musiello10.1016/j.colegn.2012.03.007Collegian (2012)2012-04-09Collegian2012-04-09http://www.collegianjournal.com/article/PIIS1322769612000340/abstract?rss=yesSummary: A significant body of research has shown a relationship between nurse staffing (in particular, skill-mix: the proportion of Registered Nurses [RNs]) and both morbidity and mortality. This relationship is typically investigated by measuring the incidence of Nursing Sensitive Outcomes (NSOs) under different skill-mix levels. Yet whilst the evidence suggests that richer skill-mix is associated with a lower incidence of NSOs, recent Australian policy reforms have proposed the replacement of Registered Nurses with less qualified staff. The present study sought to examine the relationship between staffing, skill-mix, and incidence of NSOs at two hospitals in one Australian state. The study sought to determine the rate of occurrence of several NSOs, the relationship of skill-mix to that rate, and the number of patients affected per annum. It was found that the current rate of NSOs across wards ranged from 0.17% to 1.05%, and that there was an inverse relationship between the proportion of hours worked by RNs and NSO rates: an increase of 10% in the proportion of hours worked by RNs was linked to a decrease in NSO rates by between 11% and 45%. It was estimated that increasing the RN staffing percentage by 10% would mean 160 fewer adverse outcomes for patients per year across these two hospitals. Importantly, increases in nursing hours overall (without increases in skill-mix) had no significant effect on patient outcomes. These findings challenge current policy recommendations, which propose increasing the number of unregistered staff without increasing skill-mix.Nursing work directions in Australia: Does evidence drive the policy? - Corrected ProofMichael Roche, Christine Duffield, Chris Aisbett, Donna Diers, Helen Stasa10.1016/j.colegn.2012.03.006Collegian (2012)2012-04-06Collegian2012-04-06http://www.collegianjournal.com/article/PIIS1322769612000339/abstract?rss=yesSummary: This paper explores the concept of ‘insider’ and ‘outsider’ and the challenges involved in conducting research when the researcher finds themself living the phenomenon under study. Recent literature has been drawn on to explain the context of the ‘insider’ and ‘outsider’ in regard to the stance of the researcher. This is followed by an overview of the personal experiences of the author. The advantages and disadvantages of being an insider within the context of the phenomenon of study are discussed along with the challenges and implications for a researcher ‘living their PhD research’.Accidental insider: Living the PhD study - Corrected ProofCaryn West, Lee Stewart, Kim Foster, Kim Usher10.1016/j.colegn.2012.03.005Collegian (2012)2012-04-05Collegian2012-04-05http://www.collegianjournal.com/article/PIIS1322769612000303/abstract?rss=yesSummary: Despite recent increases in nurse recruitment in Australia, the current nursing workforce is still below the predicted numbers for the future demands. The combination of an ageing workforce, high nursing staff turnover and an inability to attract and retain nurses is eroding the capacity of the health care sector to appropriately respond to the care needs of the community. Currently, the nursing workforce may have as many as four generations working together. Differences in employment needs and values, work ethics, attitudes towards authority, and professional aspirations, contribute to some of the cross-generational problems that emerge and the turnover of nursing staff. Strategies to improve the retention rates of nurses need to focus on building a cohesive workforce by utilising the strengths and skill sets that characterise different generations of nurses, and creating the conditions in which nurses across all generations feel supported and valued. The aim of this article is to explain how effective leadership, teamwork and mentoring can assist efforts to promote generational cohesion and address the decline in the number of nurses in the workforce.Effective leadership, teamwork and mentoring – Essential elements in promoting generational cohesion in the nursing workforce and retaining nurses - Corrected ProofLorraine Nelsey, Sonya Brownie10.1016/j.colegn.2012.03.002Collegian (2012)2012-04-04Collegian2012-04-04http://www.collegianjournal.com/article/PIIS1322769612000182/abstract?rss=yesSummary: Over the past two decades, the number of clinical trials conducted globally has increased thereby increasing demand for nurses working as Clinical Trial Nurses (CTNs), sometimes known as Clinical Research Nurses. The role and professional issues for these nurses in Australia has not been empirically formulated. Sixty-seven clinical trial nurses were surveyed nationally using a modified version of the Clinical Trials Nursing Questionnaire (CTNQ). Findings revealed the complex CTN role can include the coordination of the trials on one or more sites. This involves all domains listed in the questionnaire from protocol development, ethics approval applications, recruitment and consenting of participants in trials, to administering or assisting with treatments within the bounds of their practice code and the evaluation of protocols. Professional issues documented were: being undervalued in the nursing workforce, having no formal educational preparation for the role and minimal recognition in publications emanating from research in which they were involved. These nurses bring their practice knowledge to benefit research outcomes that may contribute to improving patient/client care.The role of clinical trial nurses: An Australian perspective - Corrected ProofLesley Wilkes, Debra Jackson, Charmaine Miranda, Roger Watson10.1016/j.colegn.2012.02.005Collegian (2012)2012-03-28Collegian2012-03-28http://www.collegianjournal.com/article/PIIS1322769612000157/abstract?rss=yesSummary: Resilience has been suggested as an important coping strategy for nurses working in demanding settings, such as paediatric oncology. This qualitative study explored paediatric oncology nurses’ perceptions of their development of resilience and how this resilience underpinned their ability to deal with work-related stressors. Five paediatric oncology nurses were interviewed about their understanding of the concept of resilience, their preferred coping mechanisms, and their day-today work in paediatric oncology.Using thematic analysis, the interviews were subsequently grouped together into seventeen initial themes. These themes were then grouped into seven major aspects that described how the participants perceived resilience underpinned their work. These “seven aspects of forming resilience” contributed to an initial understanding of how paediatric oncology nurses develop resilience in the face of their personal and professional challenges.Several key strategies derived from the findings, such as improved rostering, support to a nurse's friend and family, and a clinical support nursing role, could be implemented at an organizational level to support resilience development within the paediatric oncology setting.Exploring resilience in paediatric oncology nursing staff - Corrected ProofMelissa Zander, Alison Hutton, Lindy King10.1016/j.colegn.2012.02.002Collegian (2012)2012-03-27Collegian2012-03-27http://www.collegianjournal.com/article/PIIS1322769612000170/abstract?rss=yesSummary: The purpose of pre-service nursing education programs is to prepare competent graduates who are able to function as safe, professional registered nurses. An extensive element of these programs is the teaching of physical assessment skills, with most programs educating students to perform over 120 such skills. Previous research from North America suggests that the majority of skills taught to nurses in their pre-service programs are not used in practice. As part of a larger study, an online survey was used to explore use of 121 physical assessment skills by Australian nurses. Recruitment occurred via mailed invitation to members of the Australian Nursing Federation. Data were extracted from 1220 completed questionnaires returned by nurses who were mostly employed in New South Wales, were female and experienced nurses. Respondents indicated that they used only 34% of skills routinely. Results reinforce evidence found in the literature that many of the skills taught to nurses are either not used at all (35.5%) or are used rarely (31%). These findings have implications for the teaching of physical assessment skills in pre-service nursing programs, and raise questions about the value of extensive skills teaching in the context of contemporary health care. Further research into barriers to the use of physical assessment skills in nursing and the need for comprehensive skills preparation for the generalist nurse is likely to offer some solutions to these questions.The use of physical assessment skills by registered nurses in Australia: Issues for nursing education - Corrected ProofMelanie Birks, Robyn Cant, Ainsley James, Catherine Chung, Jenny Davis10.1016/j.colegn.2012.02.004Collegian (2012)2012-03-23Collegian2012-03-23http://www.collegianjournal.com/article/PIIS1322769611000680/abstract?rss=yesSummary: The current shortage of health professionals necessitates new approaches to clinical education that can expand the number of undergraduate students undertaking clinical placements without increasing the burden on clinical staff or placing patients at risk. Interprofessional education has the potential to help increase clinical capacity whilst enriching students’ clinical experience. This paper reports on a project which investigated the potential for interprofessional education to increase undergraduate clinical placement capacity in clinical settings. The project utilised an exploratory descriptive methodology to obtain the views of health care professionals about the use of interprofessional education in clinical education at three rural health facilities in Victoria, Australia. Participants (n=57) had a key role with each health care facility in coordinating and facilitating undergraduate clinical placements. This paper examines the clinicians’ views about the central role that leadership plays in actioning interprofessional education in the clinical setting. Whilst interprofessional education was regarded favourably by the majority of participants, data indicated that leadership from education providers, health services, and regulatory authorities was crucial to enable interprofessional education to be implemented and sustained within the clinical learning environment. Without leadership from each of these three spheres of influence, interprofessional education will continue to be difficult to implement for undergraduate students and compromise their exposure to an important aspect of the working life of health care professionals. Such a failure will limit graduates’ readiness for collaborative and cross-disciplinary practice.Interprofessional clinical education: Clinicians’ views on the importance of leadership - Corrected ProofKaren Missen, Elisabeth R. Jacob, Tony Barnett, Lorraine Walker, Merylin Cross10.1016/j.colegn.2011.10.002Collegian (2011)2011-11-24Collegian2011-11-24