Andrew Scanlon

An evaluation of a structured learning programme as a component of the clinical practicum in final year bachelor of nursing programme: a pre–post-test analysis

AIM AND OBJECTIVE To evaluate the impact of a structured learning programme as a component of the clinical practicum in final year bachelor of nursing course on the students report of their anxiety and self-efficacy pre-post programme participation. BACKGROUND Student anxiety and low levels of self-efficacy are known to affect the quality of clinical learning. A three-day structured learning programme at the commencement of an acute care clinical placement was designed to reduce student anxiety and enhance self-efficacy. DESIGN A pre-post test design. METHOD OUTCOME MEASURES The hospital anxiety and depression scale (The HAD) and the general self-efficacy scale (GSES-12) were administered prior to the commencement of the structured learning programme (time one) and at the end of the programme (time two). RESULTS One hundred and twenty final year students undertaking an acute care clinical placement participated in the programme in three cohorts and completed the questionnaires at time one and 118 at time two. FINDINGS Students levels of anxiety >8 with The HAD pre-post programme 53 vs. 30% (p < 0·001). Levels of self-efficacy <40 with the GSES-12 pre-post programme were 7 vs. 4% (p < 0·001). CONCLUSIONS Participation in the structured learning programme resulted in a statistically significant reduction in student anxiety and increase in self-efficacy across the three cohort groups. This effect can be achieved with the development of a relatively low cost/low technology structured learning programme that is part of an acute care clinical placement. RELEVANCE TO CLINICAL PRACTICE Nurse educators should not assume that students are less anxious about their acute care clinical placements as the semester proceeds. There is a typical correlation between increased anxiety and decreased self-efficacy which is likely to impact on student learning in the clinical setting. Significant results can be achieved with a relatively low cost and a low technology enabling intervention.

Medical futility in the care of non-competent terminally ill patient: Nursing perspectives and responsibilities

BACKGROUND Debate continues on the use of medical technology to prolong life independent of the quality of the outcomes. As a consequence, acute care nurses often find themselves in situations where they are asked to carry out physicians orders, in the context of a patients deteriorating condition, which may be at odds with professional and personal ethical standards. This can cause nurses to become distressed when struggling with the ethical dilemmas involved with medical futility. PURPOSE This paper is a perspective on nursing considerations of our Code of Ethics and the concept of medical futility in acute nursing care. The utility of the Code is examined through a clinical vignette. METHOD A database search using the keywords medical futility and acute care limited to 2008 to 2012 and a secondary hand search of these references identified thirty journal publications. The Code of Ethics was examined via a clinical scenario pertinent to an acute environment. FINDINGS This paper examines the ethical principles that underpin nursing and illustrates how the code of ethics may serve as sign posts when faced with caring for a terminally ill patient that is inappropriately managed. CONCLUSION Understanding how individual nurses may address ethical dilemmas when faced with medical futility can better enable the nurse to fulfil their role as patient advocate, health promoter and alleviator of suffering. Ongoing education and communication to decrease any ambiguity or anguish associated with a patients impending death optimises apt outcomes.

Advanced nursing practice hours as part of endorsement requirements for nurse practitioners in Australia: A definitional conundrum

Purpose: To define what can be considered to be nursing practice, time that can be calculated as the practice of nursing as well as what is considered to be advanced nursing practice and how all this can be related to the current endorsement process for nurse practitioner (NP) in Australia. Data sources: Current codes and guidelines cited by the Nurse and Midwifery Board of Australia related to nursing practice and NPs, cited competency standards from the Australian Midwifery Accreditation Council, as well as published material of peak nursing bodies from within Australia as well as internationally were used. Information was also obtained through government health and professional organization websites. All information in the literature regarding current and past status and nomenclature of advanced practice nursing was considered relevant. Conclusions: The definitional entanglement of what is considered to be nursing practice, the calculation of specific hours and what is advanced nursing practice interferes with endorsement of NPs in Australia, and a clear understanding of what is meant by advanced practice is required to move forward. Implications for practice: Dependent on how practice is interpreted by the Nurse and Midwifery Board of Australia directly affects the outcome of the endorsement proceedings for individual NP candidates.

An evaluation of a structured learning program as a component of the clinical practicum in undergraduate nurse education: A repeated measures analysis

BACKGROUND There is evidence that nursing students experience stress and anxiety and a reduction in self-efficacy when undertaking clinical placements. Previous reports have identified that a structured three-day program within the Bachelor of Nursing (BN) clinical practicum reduces the students self-report of anxiety and increases self-efficacy. However, it is unreported whether these improved outcomes are sustained for the duration of the clinical placement. OBJECTIVE The aim of this study was to evaluate the duration of the effect of a three-day structured learning program within the clinical placement on final year Bachelor of Nursing students report of anxiety and self-efficacy pre- and post-program participation in this intervention and following completion of the clinical practicum. DESIGN A repeated measures design. SETTING University-based Clinical School of Nursing, acute care clinical practicum. PARTICIPANTS Final year Bachelor of Nursing students. METHODS The intervention comprised the three-day program on starting the clinical practicum. A questionnaire included the anxiety subscale of The Hospital Anxiety & Depression Scale (The HAD) and the General Self-Efficacy Scale (GSES-12). The questionnaire was completed on day one (time one), upon completion of the three-day program (time two) and upon completion of placement on day 18 (time three). RESULTS The questionnaire response rate varied over time. There was a statistically significant effect in reducing anxiety over time: F(1.73,74.46)=25.20, p<0.001 and increasing self-efficacy over time F(1.32,41.04)=7.72, p<0.004. CONCLUSIONS This is the first report that we are aware of that has measured final year Bachelor of Nursing students report of both anxiety and self-efficacy over repeated measures of time. Students continue to benefit from a structured learning program and the benefit of the intervention is sustained for the clinical placement duration.

Developing the clinical mentor role through e-learning.

La Trobe University/Austin Health Clinical School of Nursings final-year undergraduate students undertake an integrated clinical-theoretical experience during which the clinical practicum is facilitated by registered nurses in a mentor model of education. The success of this model is contingent on the educational preparation of the registered nurse for the role of mentor. This article describes the development of a more flexible Web-based preparation program for registered nurses to assist them to fully adopt the role of mentor.

The impact on long term health outcomes for STEMI patients during a period of process change to reduce door to balloon time

Background: Guidelines for the management of ST-segment elevation myocardial infarction (STEMI) recommend a ‘door to balloon time’ (DTBT) within 90 minutes. It is unclear whether strategies to reduce DTBT translate to improved longer-term health outcomes for STEMI patients. Aims: This study sought to determine whether implemented strategies to improve timely management of STEMI reduced DTBT and impacted upon health outcomes such as length of stay, unplanned readmission and 12-month mortality. Predictors of timely management for STEMI were also examined. Methods: A five-year review was undertaken on primary percutaneous coronary intervention for STEMI in one tertiary hospital. Comparisons were made between process change groups and DTBT. Logistic regression identified predictors of timely management. Results: 470 STEMI patients underwent immediate primary percutaneous coronary intervention. Process change improved the median DTBT (109 min vs. 72 min, p<0.001) with no significant effect on length of stay (p=0.83), unplanned cardiac readmissions (p=0.68) or 12-month mortality (9.0% vs. 8.6%, p=0.64). Those receiving timely treatment (i.e. DTBT< 90 min) were younger (p<0.05), male (p<0.03), presented via ambulance (p<0.004), during business hours (p<0.0001) and had a lower Thrombolysis In Myocardial Infarction score (p<0.006). Timely treatment was associated with lower 12-month mortality (3.7% vs. 15.7%, p<0.0001) and increased uptake of inpatient cardiac rehabilitation (p<0.005), with length of stay and unplanned readmission similar between groups (p=NS). Conclusions: Process changes improved DTBT but had no effect on length of stay, readmission rate or 12-month mortality. Yet, timely management was critical to 12-month outcomes. Further studies are required to explore the barriers to timely treatment.

Cardiac rehabilitation in the acute care setting: Integrative review

BACKGROUND Phase one cardiac rehabilitation (CR) is an essential component of care for patients with coronary heart disease. With optimal program delivery, health outcomes can be improved. OBJECTIVES To conduct an integrative review that explores Phase one CR for patients hospitalised with coronary heart disease. DESIGN Integrative literature review (2003-2014) Data sources: The literature search included Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Experta Medica Database (EMBASE), Psycinfo, Clinical Practice Guidelines Portal, Cochrane Library, Clinical Evidence (BMJ) and Google Scholar. REVIEW METHODS The Joanna Briggs Institute critical appraisal tools relevant to study methodology were utilised. Studies included for review were peer reviewed, published in English. Studies included Phase one CR intervention/s or the provision of education to patients diagnosed with coronary heart disease in the acute care setting prior to hospital discharge. RESULTS In the past decade cardiac researchers have predominantly focused on patients and health professionals perceptions, CR interventions, and patient education. Factors that impede delivery of Phase one CR, such as time, workload etc. were also reported. CONCLUSIONS The implementation of Phase one CR delivery requires optimisation to enable patients with coronary heart disease to achieve positive health outcomes post hospitalisation. Future interventions should address the factors that impede delivery of Phase one CR.