The power of professional nursing practice--an essential element of patient and family centered care

Understanding power and learning how to use it is critical if nurses' efforts to shape their practice and work environments are to be successful. As part of our efforts to develop a Fast-Track BSN-to-PhD nursing program, we met with nurse leaders from six organizations to explore what power means, how nurses acquire it, and how they demonstrate it in their practice. Through these discussions, we identified eight characteristics of powerful nursing practice that, together, form a framework that can guide nurses' efforts to develop a powerful practice and shape the health care delivery settings and academic institutions in which they work. In this article we review recent studies of organizational power and share discussions which helped us better understand nursing power and the ways in which it is manifested. We also reflect on what power means for individual nurses and the profession and discuss how our insights influenced our Fast-Track program.

Personal and professional impact of a course on contemplative practices in health and illness

A nursing graduate course focused on the impact of alternative healing modalities, particularly those that are contemplative in nature, on their professional and personal lives demonstrated that up to 4 years later students found the content to be of value. Suggestions for incorporation of CAM in mainstream nursing courses are shared.

Improving patient safety by using interprofessional simulation training in health professional education

Modern medicine is complex. Reports and surveys demonstrate that patient safety is a major problem. Health educators focus on professional knowledge and less on how to improve patient care and safety. The ability to act as part of a team, fostering communication, co-operation and leadership is seldom found in health education. This paper reports the findings from pilot testing a simulated training program in interprofessional student teams. Four teams each comprising one medical, nursing, and intensive nursing student (n = 12), were exposed to two simulation scenarios twice. Focus groups were used to evaluate the program. The findings suggest that the students were satisfied with the program, but some of the videos and simulation exercises could be more realistic and more in accordance with each other. Generally they wanted more interprofessional team training, and had learned a lot about their own team performance, personal reactions and lack of certain competencies. Involving students in interprofessional team training seem to be more likely to enhance their learning process. The students' struggles with roles, competence and team skills underline the need for more focus on combining professional knowledge learning with team training.

Evaluation of a clinical performance assessment tool (CPAT) within a critical care context

Internationally, the assessment of nursing clinical performance has remained a challenge at undergraduate and postgraduate level. The clinical performance assessment tool (CPAT) was developed to measure paediatric intensive care (PIC) and adult critical care (ACC) postgraduate nursing students' developing clinical performance. The CPAT was based upon the Australian Competency Standards for Specialist Critical Care Nurses, which are recognised as the professional standards for specialist level critical care nurses in Australia. A two phase descriptive correlational study was undertaken to examine the applicability, validity and reliability of the CPAT. Data collection included experienced clinical nurses' validation of the CPAT (Phase 1), the students' and assessors' documentation using the CPAT and individual semi-structured interviews (Phase 2). The revised CPAT, incorporating the second edition of the competency standards, was further evaluated (Phase 3) by reviewing how the document had been used and surveying students and assessors. The findings supported the format and approach based on the ACCCN competency standards. The CPAT facilitated assessors to assist students to develop their clinical performance. However, substantial refinement and modification of the CPAT was required to make it useful as a clinical assessment tool. The significance of this was supported by the subsequent research examining the construct validity of the competency standards. However, the link with the ACCCN competencies remains evident, and this indirectly further supports the utility of having nationally agreed standards for professional practice within specialty areas.

Storytelling as an educational strategy for midwifery students

This article describes the use of purposive storytelling as a creative teaching strategy in the nurse-midwifery education program at San Diego State University and the University of California, San Diego. Student evaluations over a 4-year period showed overwhelming support for the inclusion of storytelling into a weekly didactic midwifery course. Benefits, such as increased cognitive learning, enhanced role transition, and emotional clarification were identified in the students' comments. The students' comments further supported the efficacy of incorporating storytelling into midwifery education. A review of the literature confirms the growing popularity of storytelling in both health care and education, and a conceptual framework is also provided. Further research is needed to examine the benefits of this worthwhile technique in promoting learning, stimulating interest, and facilitating the development of critical thinking.

Competency and capability: imperative for nurse practitioner education

OBJECTIVE

The objective of this study was to conduct research to inform the development of standards for nurse practitioner education in Australia and New Zealand and to contribute to the international debate on nurse practitioner practice.

SETTING

The research was conducted in all states of Australia where the nurse practitioner is authorised and in New Zealand.

SUBJECTS

The research was informed by multiple data sources including nurse practitioner program curricula documents from all relevant universities in Australia and New Zealand, interviews with academic convenors of these programs and interviews with nurse practitioners.

PRIMARY ARGUMENT

Findings from this research include support for master's level of education as preparation for the nurse practitioner. These programs need to have a strong clinical learning component and in-depth education for the sciences of specialty practice. Additionally an important aspect of education for the nurse practitioner is the centrality of student directed and flexible learning models. This approach is well supported by the literature on capability.

CONCLUSIONS

There is agreement in the literature about the lack of consistent standards in nurse practitioner practice, education and nomenclature. The findings from this research contribute to the international debate in this area and bring research informed standards to nurse practitioner education in Australia and New Zealand.

Involving NHS service users in teaching advanced clinical skills

With the development of advanced practice roles in nursing, innovative ways of delivering programmes are continually sought by academic staff working within higher education. This study explores the ways in which NHS service users can be included in education programmes to develop clinical examination skills for nurses. Although small scale and exploratory, this study concluded that NHS service users benefit from making a contribution towards the education of healthcare staff and feel empowered in the process.

Modeling Mentorship and Collaboration for BSN and MSN Students in a Community Clinical Practicum

This project uses an innovative approach to facilitate mentorship and collaboration among BSN and MSN students within a community health practice environment. In a pilot test using a clinical model, graduate and undergraduate students were matched as mentors and mentees. These students worked with faculty and clinic staff to develop a mentorship network and effective collaborative practice within an interdisciplinary team, while implementing health promotion education programs for clinic clients. Ten students participated in the process and evaluated it as effective and valuable in the development of professional roles, as well as in validating the model variables used in the project.

Bridging the specialist-generalist divide: a creative Master's programme initiative

This article outlines the development of a new Master's programme that is suitable particularly for those who are interested in managing palliative care in generalist care contexts. Disseminating the essence of excellent palliative care provision, accessible by the minority to the majority in need, has been an issue for some time. National Service Frameworks identify the contribution of both education and workforce planning to facilitate such provision. A gradual shift in design of palliative programme provision has seen the emergence of education that is more malleable to varied practice contexts. This new MSc Palliative Care Programme is centred on interprofessional education, and through collaborative working, shares modules with a neighbouring university to produce financially viable provision. Essential palliative content is delivered in compulsory taught modules, however, elective options include open or work-based modules that facilitate palliative practice development tailored to specific context need. Postgraduate study, associated with leading practice, means that a few key staff can significantly impact disseminating enhanced palliative practice across care environments. In this way, in the community and in institutions where the majority of older people dying of chronic illness are cared for, resources can be used purposefully to maximize the chance of 'a good enough death' (McNamara, 2001).

Online education: a survey of faculty and students

OBJECTIVE

This study examines faculty and student perspectives related to online learning.

METHOD

Baccalaureate-degree radiologic technology students and graduate nursing students were surveyed to determine their support for online education. Additionally, faculty at the same institution who were experienced in online teaching were surveyed.

RESULTS

The results in this study agreed with some aspects from the body of knowledge on online learning.

Discovering cultural aspects of nurse-patient relationships

The purpose of this article is to illuminate modes of inquiry that unconceal cultural aspects of the meaningful life-world of individuals. To present strategies for acquiring cultural awareness, sensitivity, and competence based on insights gained from these modes of inquiry. Nurses can acquire and implement culturally competent patient care by inquiring into individual's personal interpretations of their life's world experiences rather than relying on catalogs of cultural attributes or by adhering to popularly held opinions. By following the procedures for augmenting culturally competent nursing outlined in this article nurses reported being able to provide a more culturally competent, higher quality of patient care.

Family nurse practitioner students utilization of Personal Digital Assistants (PDAs): implications for practice

Personal Digital Assistants (PDAs) are a readily accessible source of information to aid in the delivery of patient care. A pilot group of five Family Nurse Practitioner students used PDAs to organize data and access information relevant to patient care. Utilization of the PDAs in the clinical setting provided practice guidelines, textbook information and protocols that were readily accessible. The PDA made it possible for students to utilize preexisting knowledge with additional learning resources. The PDAs were purchased with funds provided from a United States Department of Health and Human Services, Health Resources and Services Administration (HRSA) grant.

Using innovative strategies to enhance health promotion critical literacy

New and improved teaching strategies are required to engage students in meaningful coursework to enhance critical thinking, problem-solving, and decision-making. Advanced practice nurses are responsible for producing creative and realistic health promotion and disease prevention proposals, which have the potential for implementation as part of a course requirement. Unfortunately, these proposals often lack the sophistication and critical literacy necessary to effectively communicate the student's knowledge and understanding of their ideas. Infusing critical thinking and critical literacy into all curricula is one of the stated goals of the university-wide "Enhancing Critical Literacy Project." This learning-centered program serves as the platform for this article and the early adoption of selected student assessment techniques. Concepts presented as part of a critical literacy enhancement seminar provides the theoretical underpinning of this approach and is designed to encourage student innovation through creative writing. A detailed description of the various strategies and their implementation are discussed.

Graduate students' perceptions of online teaching and relationship to preferred learning styles

As the nursing faculty shortage continues, the online format is being used more frequently for delivery of graduate nursing courses. Its effect on students' learning and their perceptions of online teaching needs to be investigated. This descriptive study examines the students' learning styles; their perceptions of six online nurse educator courses, the faculty, and the asynchronous format; and their overall perceptions of online teaching and learning.

Introducing problem-based learning into research methods teaching: student and facilitator evaluation

The evidence base for the effectiveness of problem-based learning (PBL) has never been substantively established, although PBL is a generally accepted approach to learning in health care curricula. PBL is believed to encourage transferable skills, including problem-solving and team-working. PBL was used to deliver a postgraduate research methods module and a small evaluation study to explore its efficacy was conducted amongst the students (n = 51) and facilitators (n = 6). The study comprised of an evaluation questionnaire, distributed after each themed group of PBL sessions, and a group discussion conducted 4 weeks after the conclusion of the module, which was attended by student representatives and the facilitators. Questionnaire data was analysed using SPSS, and a transcript of the interview was subjected to content analysis. The results indicated that students felt that a PBL approach helped to make the subject matter more interesting to them and they believed that they would retain knowledge for a longer period than if their learning had used a more traditional lecture format. Students also perceived that PBL was effective in its ability to enhance students' understanding of the group process. All those involved in the PBL process reinforced the pivotal role of the facilitator. This study indicates that there is potential for PBL to be used beyond the more usual clinical scenarios constructed for health care professional education and further exploration of its use in areas such as building research capability should be undertaken.