Discrimination of educational outcomes between differing levels of critical care programmes by selected stakeholders in Australia: a mixed-method approach

The learning needs and clinical requirements of post graduate critical care nursing students in rural and regional contexts: A scoping review

OBJECTIVES

The objective of this review was to establish the learning needs and clinical requirements of postgraduate critical care nursing students preparing for clinical practice in rural and regional contexts.

REVIEW METHOD USED

Scoping review.

DATA SOURCES

Published and unpublished empirical studies.

REVIEW METHODS

A scoping review based on database searches (CINAHL and Medline) using Aromataris and Munn's four-step search strategy, plus subsequent forward reference search strategy was undertaken, applying predetermined selection criteria. The review aligned to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Review. Studies were uploaded into Endnote 20© for storage and into Covidence 2.0© for data extraction. Screening was undertaken by a primary reviewer, with a secondary reviewer evaluating the studies identified as relevant by the first reviewer. Qualitative codes were derived, and reflexive thematic analysis synthesised the results of the review, using Braun and Clarke's six-phase process.

RESULTS

Nine foundational learning needs for critical care nursing students were extracted from the literature. The nine established foundational learning needs were: behavioural attributes/personal base; critical thinking and analysis; ethical practice; identification of risk; leadership, collaboration, and management; professional practice; provision and coordination of clinical care; research knowledge, standards of care, and policy development; and the health consumer experience. Discerning learning needs specific to rural and regional critical care nursing students was difficult. Only one study that met the inclusion criteria was identified. This study identified some instances of interest in relation to rural and regional learning needs. These instances were related to preparation of rural students for low-volume, high-stake situations; transfer of critically ill patients; stabilisation and preparation of critically ill patients; and care of specific patient groups such as, critically ill, bariatric, paediatric, obstetric, trauma, and patients with behavioural issues.

CONCLUSIONS

Limited literature exists within the rural and regional critical care nursing educational context, making it difficult to determine the unique learning needs of students within this group. This scoping review lays the groundwork for further research into the needs of critical care nursing students situated within the rural and regional context.

Academic and professional characteristics of Australian graduate emergency nursing programs: A national study

BACKGROUND

Specialist graduate emergency nursing education programs are essential to the delivery of high quality and safe healthcare to patients with complex needs in emergency care. Little is known about tertiary emergency nursing programs in Australia. This study aimed to determine the academic and professional characteristics of Australian emergency programs.

METHOD

This embedded mixed-method study examined the academic and professional characteristics of Australian emergency programs in two interdependent phases: (1) document and content analysis of Australian graduate emergency nursing program websites; and (2) semi-structured interviews with the associated convenors. The data underwent framework analysis using eight pre-identified categories of (i) course entry, (ii) fee arrangement, (iii) mode of delivery, (iv) volume of learning, (v) clinical assessment, (vi) employment requirements, (vii) graduate expectations, and (viii) influence of healthcare employers and professional engagement.

RESULTS

Prior clinical experience and the requirement for concurrent practising in an emergency care environment influenced were common, however fee arrangements were not clearly articulated. The College of Emergency Nursing Australasia Practice Standards for the Emergency Nursing Specialist featured in part within 12 programs, principally to guide development of clinical assessments.

CONCLUSION

Establishment of emergency nursing graduate practice standards could better inform the design and delivery of emergency nurse programs, and yield benefits in terms of graduate expectations and satisfaction and improved patient care.

Sensory processing disorder: Perceptions on the clinical role of advanced psychiatric nurses

Background

No description of the clinical role of the advanced psychiatric nurse in the management of children with sensory processing disorder could be found for the South African context. This is a loss in clinical nursing practice with regard to diagnosis, treatment and research.

Aim

To explore and clarify the perceptions of healthcare professionals in South Africa on the clinical role of the advanced psychiatric nurse in sensory processing disorder to provide a description of this role.

Setting

The research was conducted by inviting registered healthcare professionals practicing in South Africa to complete several rounds of an on-line survey.

Methods

An explorative and descriptive design was used. Purposive sampling was used to identify an initial sample of healthcare professionals, followed by snowball sampling. The Delphi technique was implemented with three sequential rounds, gathering data on the perceptions of the healthcare professionals regarding the clinical role of the advanced psychiatric nurse in sensory processing disorder.

Results

The following main themes crystallised from the data - (1) Specialised training of the advanced psychiatric nurse (APN) on sensory processing disorder; (2) Interventions carried out by the APN with regard to sensory processing disorder; (3) Adequate support to the family with regard to sensory processing disorder; and (4) Referral of a child with sensory processing disorder.

Conclusion

The study indicates that the healthcare professionals who are experts in delivering healthcare to children with sensory processing disorder agree that the APN with additional training in this condition has a clinical role to play in rendering healthcare to these healthcare users. A preliminary clinical role description could be formulated. Recommendations for nursing practice, nursing education and further research were formulated.

Reaching their potential: Perceived impact of a collaborative academic-clinical partnership programme for early career nurses in New Zealand

BACKGROUND

The dynamic nature of healthcare ensures that early career nurses enter an uncertain and complex world of practice and consequently require support to develop their practice, build confidence and reach their potential. The New Zealand Nurse Entry to Practice programme for registered nurses in their first year of practice has been operating since 2005 to enable safe and confident practice, improve the quality of care, and positively impact on recruitment and retention. This academic and clinical programme was offered as a partnership between a university and a clinical provider with postgraduate academic credits gained.

AIM

The aim of this study was to explore the perceived impact of postgraduate university education for early career nurses in one regional health area of New Zealand.

METHODS

Participants were registered nurses who had completed the early career nurse programme and their clinical preceptors. The research was conducted via an online survey of 248 nurses and three focus groups to explore how the programme was experienced and its impact on knowledge and practice.

RESULTS

Early career nurses and their preceptors found that the programme enables improved knowledge and skills of patient assessment, application of critical thinking to clinical practice, perceived improvement in patient care delivery and outcomes, enhanced interprofessional communication and knowledge sharing, and had a positive impact on professional awareness and career planning.

CONCLUSIONS

This clinical-academic partnership positively impacted on the clinical practice and transition experience of early career nurses and was closely aligned to an organization's strategic plan for nursing workforce development.

Evaluation of postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning: a descriptive study

OBJECTIVE

The aim of this study was to evaluate postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning (TBL).

RESEARCH METHODOLOGY/DESIGN

A descriptive pre and post interventional design was used. Study data were collected by surveys and observation.

SETTING

University postgraduate critical care nursing programme.

MAIN OUTCOME MEASURES

Students' attitudes to learning within teams (Team Experience Questionnaire) and student engagement (observed and self-reports).

RESULTS

Twenty-eight of 32 students agreed to participate (87% response rate). There were significant changes in students' attitudes to learning within teams including increases in overall satisfaction with team experience, team impact on quality of learning, team impact on clinical reasoning ability and professional development. There was no significant increase in satisfaction with peer evaluation. Observation and survey results showed higher student engagement in TBL classes compared with standard lecturing.

CONCLUSION

Postgraduate critical care nursing students responded positively to the introduction of TBL and showed increased engagement with learning. In turn, these factors enhanced nurses' professional skills in teamwork, communication, problem solving and higher order critical thinking. Developing professional skills and advancing knowledge should be core to all critical care nursing education programmes to improve the quality and safety of patient care.

The Power of Synergy: An Academic/Clinical Partnership for Transformational Change

Background. A programme of postgraduate study was developed in partnership between a health board and a university in New Zealand, having identified critical thinking and practice change as key determinants of good care delivery. Aim. To explore the impact after 12 months of a postgraduate programme for registered nurses on patient assessment and clinical reasoning, and the status of implementation plans for improved patient care. Design. Outcome evaluation using a survey and focus groups. Setting. On location at a hospital in a small city in New Zealand that provides healthcare services for 102,000 people across rural and urban areas. Participants. Registered nurses who had completed the programme (N=28) and seven clinical mentors. Methods. A survey, focus groups, and follow-up data about quality improvement projects were used to explore how the programme was experienced and its impact. Results. The survey revealed perceptions of improved knowledge and skills but a lack of confidence in communicating with medical staff. Of 28 quality improvement projects planned, all but three had been implemented and were still in use. Two themes were generated from focus group data: “new ways of thinking” and “doing things differently.” Conclusions. This academic/clinical partnership positively influenced nurses’ knowledge and skills, encouraged critical thinking and self-efficacy, and resulted in the sustained implementation of nurse-initiated projects intended to improve patient care.

Clinical role of the nurse: concept analysis

AIMS AND OBJECTIVES

To identify the attributes of the concept 'clinical role of the nurse' in the literature.

BACKGROUND

The concept of nurses' clinical role is frequently mentioned in literature, but hardly explored in conceptual terms. This has implications for nursing practice and education.

DESIGN

Qualitative and descriptive study, which corresponds to the first phase in the concept development of the qualitative concept analysis method - identification of concept attributes.

METHODS

The critical literature analysis method was used to identify the antecedents, defining attributes and consequences of the nurse's clinical role. A systematic literature search was undertaken in International Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature and Latin American and Caribbean Health Sciences.

RESULTS

The clinical role was shown to be a process of complex interaction between nurse and patient, with critical thinking, informed experience and a sense of clinical autonomy as its antecedents. Consequences of nurses' clinical role include transformations in the organisation and process of nursing practice. A theoretical proposal was elaborated for the concept of the clinical role of the nurse, identifying the defining attributes, antecedents and consequences.

CONCLUSIONS

The clinical role of the nurse concept that was developed represents innovative evidence on the theme. Nevertheless, a deeper understanding of nurses' clinical role is needed, as well as refinement of its conceptual components. This study should be integrated into a field research project, designed to illuminate how nurses manifest and articulate the concept in clinical practice.

RELEVANCE TO CLINICAL PRACTICE

Knowledge of clinical role attributes, associated with nursing competencies, can contribute to reflection on the dimensions involved in nursing practice and inform not only teaching and professional practice, but also health policies.

Where is the evidence that master's level nursing education makes a difference to patient care? A literature review

AIM

This paper reports on a literature review conducted to explore whether there is evidence that postgraduate nursing education at master's level affects patient care.

BACKGROUND

Continued nursing education has been shown to benefit nurses' development, though little research has been conducted in relation to patient benefit. It is increasingly widespread that nurses pursue education to master's level.

METHOD

Following a systematic review of the literature fifteen studies of mixed methodology and design were examined and data extracted using thematic analysis. Five common themes emerged relating to master's level nursing education that may ultimately affect patient care: increased confidence and self esteem; enhanced communication; personal and professional growth; knowledge and application of theory to practise; and analytical thinking and decision making.

CONCLUSION

It is apparent that there are positive gains for nurses who undertake postgraduate nursing study at master's level related to professional and personal qualities which may provide direct benefit to patients. The supportive evidence extracted from the literature was scant, however. Future research needs to focus on developing measurable and observable criteria against which the educational and skill based outcomes for master's level performance can be evaluated including constraints that may adversely affect a nurse's ability to apply knowledge and skills acquired.