The effect of continuing professional education on perioperative nurses’ relationships with medical staff: findings from a qualitative study

Nurses' and nurse educators' experiences of a Pediatric Nursing Continuing Professional Development program in Rwanda

OBJECTIVES

In 2016, a Pediatric Nursing Continuing Professional Development (PNCPD) program was created and implemented in Kigali, Rwanda, through the Training, Support, and Access Model (TSAM) for Maternal, Newborn, and Child Health (MNCH). This partnership project between Canada and Rwanda provided pediatric nursing education to forty-one Rwandan nurses and nurse educators in 2018 and 2019. The objective of this research study was to explore the experiences of nurses and nurse educators applying pediatric knowledge and skills to academic and clinical settings after participating in the PNCPD program.

METHODS

This study was situated within an interpretive descriptive perspective to explore the ways in which knowledge gained during the PNCPD program in Rwanda was applied by nurses and nurse educators in their nursing practice, both academically and clinically. Data was collected through individual interviews. Inductive content analysis was used for data analysis.

RESULTS

The analysis of the interviews resulted in the emergence of five themes: Transformations in Pediatric Nursing Practice, Knowledge Sharing, Relationship-Based Nursing, Barriers and Facilitators to Knowledge Implementation, and Scaling-up PNCPD within the Health System.

CONCLUSIONS

The results of this study have the potential to inform positive changes to child health care in Rwanda, including scaling up pediatric nursing education to other areas of the healthcare system.

Nurses' Autonomy and Perceived Barriers to Pain Management in Nursing Home Residents

Nurses' autonomy is essential for optimal pain management in nursing home (NH) residents. However, little is known about nurses' autonomy and how it relates to the issue of unrelieved pain in NH residents in Jordan and beyond. The current descriptive comparative study aimed to compare the prevalence of barriers to pain assessment and management in NH residents, perceived by nurses according to their autonomy level. Participating nurses were found to have low levels of clinical autonomy. A significant difference in the prevalence of perceived barriers to pain assessment and management was found among nurses according to their autonomy level. Findings provide a better understanding of nurses' autonomy and their perceived barriers to pain assessment and management in NH residents. Findings also highlight the significance of nurses' autonomy for the assessment and management of pain in NH residents. [Journal of Gerontological Nursing, 47(8), 45-52.].

Views of Bedouin physicians and nurses on nursing as a profession in Israel: There is more to strive for

Bedouin society poses challenges to attempts at modernization. Great efforts are being made to expand the number of nurses coming from the Bedouin population. This cross-sectional study among 201 Bedouin nurses and physicians from southern Israel examined differences in their views on nursing as a profession and its relationship to the working environment, using a self-administered questionnaire. Bedouin physicians demonstrated less positive attitudes towards the nursing profession than did nurses, but perceived the nursing work environment more positively. Compared to nurses, physicians ranked both nurses' involvement in policy practice and their clinical contribution to quality care lower, but scored nurses' dependence on physicians' orders higher. They also ranked teamwork and professional nursing development higher, and the autonomy of nurses lower. In conclusion, the perception of nursing as a profession in Bedouin society is linked to cultural fundamentals, gender, and the social status of women. Managers of multicultural teams, especially those including Bedouin-origin healthcare workers, should be aware of the effect of cultural background and should take care to address social disparities and eliminate differences in perspectives.

Fit for purpose? Evaluation of CPD courses for nurses in an Irish university teaching hospital

INTRODUCTION

acute tertiary hospitals require knowledgeable, skilled registered nurses to care for patients in specialist areas. It is also a professional responsibility that nurses maintain skills and competence. This article reports on stage 1 of an action research study to evaluate the delivery of continuing professional development (CPD) courses for registered nurses in an acute hospital in Ireland.

METHODS

an audit and qualitative self-reporting questionnaire was used to obtain data. The questionnaire focused on the areas of teaching learning and outcomes. Overall, five CPD courses, each of 26 weeks' duration, were evaluated.

RESULTS

teaching delivery was all didactic and was delivered primarily by clinical staff with expert knowledge and skills, but the teaching approaches varied. The curriculum content was identified as excessive and at a high level for an introductory course, with a large volume of classroom-based theoretical delivery. Participant learning was reported as excellent in the clinical areas; however, this was counterbalanced by heavy workloads and staffing shortages. Participant motivation was also found to influence learning. From an outcome perspective the development of new knowledge and skills was reported in participants who had undertaken the courses, and participants reported that the CPD courses assisted in recruitment and retention.

CONCLUSION

although many positive aspects of the CPD courses were identified, it is clear that some changes were required with particular reference to theoretical delivery and curriculum content.

Factors that affect scrub practitioner non-technical skills: A literature review

Non-technical skills are the cognitive and interpersonal behaviours that compliment clinical competence in surgery. Effective use of non-technical skills is essential for scrub practice, because they facilitate anticipation of the surgeon's requirements and promote appropriate communication behaviours. This literature review analyses the factors that may influence a scrub practitioner's use of non-technical skills during surgery. Recommendations are made that are intended to improve their use by reducing behavioural variations during surgery.

The healthcare team's perception of the role of the perioperative nurse: A qualitative study

The surgical process requires the coordination of a number of professionals who understand their own roles and responsibilities, as well as those of the team. In the perioperative setting, expectations are established around behaviors and competencies of every team member. These expectations are influenced by knowledge, training and experience, and may ultimately influence results and the ability to adapt and respond to work demands. In Chile, there exists an ambiguity and lack of definition in the role of the nurse. The objective of this study was to examine the healthcare team's perception of the current role of the perioperative nurse, as well as the expected and desired characteristics of the role from the team's perspective. A qualitative, descriptive case study was carried out, using semi-structured interviews conducted with a purposive sample of surgeons, anaesthesiologists, professional nurses and technical nurses from three hospitals in Santiago, Chile. The accounts were analysed using an inductive, thematic format. It was found that the current perioperative nursing role, with a predominance of administrative charting, recordkeeping and guidelines for the management of safety, quality control and human and material resources, restricts direct patient care. Expected characteristics of the role included comprehensive theoretical and practical training and the development of relational skills for teamwork, direct patient care and advocacy in the surgical context. These results provided initial steps towards redefining the role of the perioperative nurse, strengthening collaborative efforts and optimising patient care during a time of high vulnerability.

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.

Aseptic practice recommendations for circulating operating theatre nurses

Aseptic practices prevent exposure of a surgical wound to microbes, operating theatre environment and personnel. The circulating nurse assists the operating theatre personnel and supervises aseptic practices preventing surgical site infections. In the absence of analytical tools, few studies exist on intraoperative nursing-related aseptic practices. This study introduces recommendations to assess the role of the circulating nurse in aseptic practices. The authors used international recommendations and research findings to construct a 20-item self-report instrument with a demonstrated reliability across the scale. The authors structured the scale based on three phases: establishment; maintenance; and disestablishment of a sterile operating field. The tool was tested among operating theatre and day surgery nurses, and compared the differences in the mean acceptance rates of aseptic practice recommendations based on background characteristics. College-level nurses and nurses with 15 or more years' work experience accepted the recommendations at higher levels than bachelor-level nurses and nurses with less work experience. Continual assessment of the evidence base and comprehensive evaluation represent important components in further developing the tool. A reasonable number of items covering clinical practice are necessary for assessing the effectiveness and cost-effectiveness of aseptic practices, and a larger response rate is needed to validate the tool in future.

Illuminating the process: enhancing the impact of continuing professional education on practice

BACKGROUND

There has been significant global investment in continuing professional education (CPE) to ensure healthcare professionals have the knowledge and skills to respond effectively to the needs of patients/service users. However, there is little evidence to demonstrate that this investment has had a tangible impact on practice. Furthermore, the current emphasis on evaluating outcomes has overlooked the importance of underlying processes which, when positive, are essential to good outcomes.

OBJECTIVE

The aim of this study was to identify the processes that key stakeholders perceive to be most important in facilitating a positive impact of CPE on practice.

DESIGN/METHOD

A qualitative design using two rounds of semi-structured interviews which were recorded and transcribed prior to analysis, informed by template analysis techniques.

SETTING

Two acute trusts, one primary care trust and two higher education institutions in one geographical region in England.

PARTICIPANTS

Representatives from four stakeholder groups-students, managers, educators and members of each healthcare organisation's governing board. A total of 35 interviews were conducted in the first round and 31 interviews in the second round (n=66).

RESULTS

Four overarching themes were identified that illuminate stakeholders' perspectives of the important factors affecting the process of CPE: organisational structure, partnership working, a supportive learning environment and changing practice.

CONCLUSIONS

This study suggests that a positive organisational culture, effective partnership working between key stakeholders with an understanding of each other's perspectives, aspirations and constraints, and a supportive learning environment in both the practice setting and education environment are central to establishing a culture and context where CPE can thrive and exert a positive influence on improving patient/service user experience and care. It is argued that an understanding of the processes that facilitate effective CPE is a crucial first step before it is possible to meaningfully evaluate outcomes.

Perioperative nursing in public university hospitals: an ethnography

BACKGROUND

In recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of perioperative nursing and how do nurses facilitate the interaction between nursing care and technology in highly specialized operating rooms in public university hospitals?

METHODS

An ethnography involving participant observations and interviews was conducted during a 9-month study period. The participants comprised 24 nurses from 9 different operating wards at 2 university hospitals in different regions of Denmark.

RESULTS

Patients were addressed as either human beings or objects. Likewise, the participants' technical skills were observed and described as either technical flair or a lack of technical skills/technophobia. The different ways in which the technical skills were handled and the different ways in which the patients were viewed contributed to the development of three levels of interaction between technology and nursing care: the interaction, declining interaction, and failing interaction levels.

CONCLUSION

Nursing practice at the interaction level is characterized by flexibility and excellence, while practice at the declining interaction level is characterized by inflexibility and rigidity. Nursing practice at the failing interaction level is characterized by staff members working in isolation with limited collaboration with other staff members in operating rooms. Considering that the declining and failing interaction levels are characterized by inflexibility, rigidity, and isolation in nursing practice, nurses at these two levels must develop and improve their qualifications to reach a level of flexible, excellent interaction. Nurse leaders must therefore refocus their skills on proficiency in perioperative nursing.

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.

Nurses' perceptions of standardised assessment and prevention of complications in an ICU

AIMS AND OBJECTIVES

To describe nurses' perceptions of evidence-based recommendations to prevent complications in a Malaysian intensive care unit.

BACKGROUND

Ventilator-associated pneumonia, catheter-related blood stream infection and pressure ulcer are three frequent adverse events in the intensive care unit. Implementing evidenced-based practice is critical in prevention of these complications.

DESIGN

A qualitative focus group study.

METHODS

Focus groups were conducted with nurses in the intensive care unit of a regional hospital in Malaysia following evidence-based interventions. Focus group transcripts were analysed using the method of thematic analyses.

RESULTS

Thirty-four nurses participated in eight focus groups. The main themes derived from the interviews: (1) nurses' knowledge impacts on the change process; (2) initial resistance, ambivalence and movement to acceptance; and (3) hierarchical organisational structure can hinder the change process.

CONCLUSION

Enhancing nurses' knowledge and attitudes of evidence-based practice, providing them with tools to monitor their clinical practice, and empowering them to change practice are likely to be important in influencing clinical outcomes. Increasing the emphasis on evidence-based practice in nursing curricula and engaging in cultural change processes in the workplace are necessary to improve clinical outcomes.

RELEVANCE TO CLINICAL PRACTICE

These findings provide valuable information for implementing clinical practice improvement interventions.