Cherene Ockerby

Journeying through clinical placements--an examination of six student cases.

INTRODUCTIONnHow student nurses are permitted to participate in healthcare settings during placements is central to their skill development, formation of occupational identity and retention in nursing. Novices participation and learning was mapped through their clinical experiences from student to graduate, as part of a multi-method longitudinal study examining nurses workplace learning.nnnMETHODSnTwenty-nine second and third year nursing students participated in a series of interviews over a two year period. Six students, representing a cross-section of a student cohort form the basis of this case study. Interviews were transcribed verbatim and thematically coded.nnnRESULTSnFour themes encapsulating the participants journeys through clinical situations were identified; (a) creating learning opportunities, (b) gaining independence, (c) becoming part of the team and (d) generational differences. The themes reflect the development of novice nurses and the nuances of the workplace as a learning environment.nnnDISCUSSIONnThe cases highlight the importance of supportive placements that comprise openness with opportunities, tolerance of inter-generational differences and invitations to become part of the nursing team. The challenge for nurse educators is how to best prepare students for the complexities of the social, cultural and political arena of clinical practice.

Clinical Learning Environment Inventory: Factor analysis

AIMnThis paper is a report of the psychometric testing of the Clinical Learning Environment Inventory.nnnBACKGROUNDnThe clinical learning environment is a complex socio-cultural entity that offers a variety of opportunities to engage or disengage in learning. The Clinical Learning Environment Inventory is a self-report instrument consisting of 42 items classified into six scales: personalization, student involvement, task orientation, innovation, satisfaction and individualization. It was developed to examine undergraduate nursing students perceptions of the learning environment whilst on placement in clinical settings.nnnMETHODnAs a component of a longitudinal project, Bachelor of Nursing students (n = 659) from two campuses of a university in Australia, completed the Clinical Learning Environment Inventory from 2006 to 2008. Principal components analysis using varimax rotation was conducted to explore the factor structure of the inventory.nnnRESULTSnData for 513 students (77%) were eligible for inclusion. Constraining data to a 6-factor solution explained 51% of the variance. The factors identified were: student-centredness, affordances and engagement, individualization, fostering workplace learning, valuing nurses work, and innovative and adaptive workplace culture. These factors were reviewed against recent theoretical developments in the literature.nnnCONCLUSIONnThe study offers an empirically based and theoretically informed extension of the original Clinical Learning Environment Inventory, which had previously relied on ad hoc clustering of items and the use of internal reliability of its sub-scales. Further research is required to establish the consistency of these new factors.

Student centredness in clinical learning: the influence of the clinical teacher.

AIMnThis article reports a longitudinal study examining how nursing students learn on clinical placements in three cohorts of undergraduates at a large Australian university.nnnBACKGROUNDnPreceptorship models of clinical learning are increasing in popularity as a strategy to maximize collaboration between university and healthcare organizations. A clinical education model, underpinned by preceptorship, was offered by an Australian university in partnership with a tertiary healthcare organization to some students.nnnDESIGNnThe study utilized a mixed method approach of surveys and interviews.nnnMETHODnIt was hypothesized that students participating in the preceptorship partnership model would have more positive perceptions of the clinical learning environment than students participating in other models of clinical education. Data were collected over 3u2003years, from 2006-2008, using a modified Clinical Learning Environment Inventory from second (nu2003=u2003396) and third (nu2003=u2003263) year nursing students. Students were classified into three groups based on which educational model they received.nnnRESULTSnOn the inventory factor, Student centredness, a Welch test indicated an important difference between the responses of students in the three groups. Games-Howell post hoc test indicated that students in the clinical preceptorship partnership model responded more positively than students who had both a clinical teacher and a preceptor in a non-preceptorship partnership model.nnnCONCLUSIONnDeveloping sustainable approaches to enhance the clinical learning environment experience for student nurses is an international concern. The significance of continuity of clinical teachers to the contribution of student centredness is an important aspect to be considered.

Outcomes of a clinical partnership model for undergraduate nursing students

Abstract Background: Over the last decade several innovative approaches to enhance students’ transition to graduate nurse year have been implemented or piloted. This paper describes a study that investigated how the social practices of clinical partnership placement model underpin workplace learning for undergraduate students as they transitioned to graduate. Methods: A mixed method approach was utilized comprising individual interviews with students, observation of clinical workplaces across six different areas of nursing practice, student surveys of the clinical learning environment and participant workshops. Results: Three themes were identified that influenced participants’ preparedness for work and enhanced the transition into the workplace: ‘organizational familiarity’, ‘continuity’ and ‘social participation’. Conclusion: A clinical partnership model offers a degree of work readiness for novices when commencing their professional practice role. It enables individuals to participate and engage in workplace activities which are a central component of their learning.

The effects of conservative treatment for constipation on symptom severity and quality of life in community-dwelling adults.

PURPOSE Constipation is a common symptom in the general community that incurs considerable cost and negative effects on quality of life. This article reports the effects of an individualized, multimodal, conservative intervention on symptom severity and quality of life in community-dwelling adults who presented with constipation and specific lower urinary tract symptoms to a community-based continence service. DESIGN The study was a within-subject, pretest-posttest design that utilized purposeful recruitment. The sample was drawn from a clinical population of patients attending a community-based continence service. METHODS Twenty-seven community-dwelling adults aged 35 to 83 years (mean age 63.85 years) who presented with lower urinary tract symptoms and constipation received individualized conservative treatment of constipation that comprised advice on dietary supplementation, fluid intake, exercise, position to defecate, the gastrocolic reflex, and over-the-counter laxatives. Participants completed the Patient Assessment of Constipation Symptom Questionnaire (PAC-SYM) and the Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) prior to the intervention and 8 to 12 weeks later. RESULTS Wilcoxon signed ranks test results indicated that the intervention significantly reduced the severity of overall constipation symptoms measured by the PAC-SYM (T = 75.5, P < .01). In particular, there were significant improvements in abdominal and stool symptoms subscales. Participants also reported statistically significant improvements in their overall quality of life as measured by the PAC-QOL (T = 48.5, P < .01). There were significant improvements in relation to psychosocial discomfort, worries and concerns, and satisfaction as measured by the PAC-QOL. While no participants felt in control of their situation “all of the time” prior to treatment, 26.9% of participants reported feeling in control of their situation “all of the time” following treatment. CONCLUSION The severity of constipation symptoms are reduced following a multimodal, individually tailored conservative intervention. This improvement in symptoms corresponds with quality-of-life improvements.

The role of informal caregivers during cancer patients’ recovery from chemotherapy

AIMSn(i) To investigate the availability, perceived importance and roles of informal caregivers in the recovery of patients treated at day oncology centres and (ii) identify differences between patients with and without informal caregivers in the extent to which they experienced symptoms, and the level of bother symptoms caused.nnnMETHODnPatients from three Australian hospitals (n = 122) were recruited during cycles 1 or 2 of adjuvant chemotherapy. Participants completed a modified version of the Rotterdam Symptom Checklist (RSCL) each day for 5 days after chemotherapy. A telephone interview conducted 10 days post-treatment explored the availability, importance and roles of caregivers. During the interview, participants also completed the modified RSCL in which they were asked about the extent to which they experienced, and were bothered by, each symptom over the prior 5 days combined.nnnRESULTSnOverall, 71% of participants had an informal caregiver in the 5 days postchemotherapy, commonly a partner. More women (71%) than men (48%) had a caregiver (p < 0.05). Caregivers were perceived to be highly important; they were more important for women than men (U = 213.50, p < 0.01). The most common assistance caregivers provided was meal preparation and emotional support and companionship. On days 6-10 postchemotherapy, the extent to which overall physical symptoms were experienced was higher for patients with a caregiver than without (U = 987.50, p < 0.05); similarly their symptoms caused more bother (U = 966.00, p < 0.01).nnnCONCLUSIONSnThese findings highlighted the importance of informal caregivers to patients postchemotherapy. It is imperative that patients are informed of the importance of this support so a caregiver can be arranged, if possible. Understanding the needs of patients following chemotherapy would enable health professionals to advise patients, with or without caregivers, how to best prepare for and manage their recovery at home.

Intradialytic Laughter Yoga therapy for haemodialysis patients: a pre-post intervention feasibility study

BackgroundLaughter Yoga consists of physical exercise, relaxation techniques and simulated vigorous laughter. It has been associated with physical and psychological benefits for people in diverse clinical and non-clinical settings, but has not yet been tested in a haemodialysis setting. The study had three aims: 1) to examine the feasibility of conducting Laughter Yoga for patients with end stage kidney disease in a dialysis setting; 2) to explore the psychological and physiological impact of Laughter Yoga for these patients; and 3) to estimate the sample size required for future research.MethodsPre/post intervention feasibility study. Eighteen participants were recruited into the study and Laughter Yoga therapists provided a four week intradialytic program (30-min intervention three times per week). Primary outcomes were psychological items measured at the first and last Laughter Yoga session, including: quality of life; subjective wellbeing; mood; optimism; control; self-esteem; depression, anxiety and stress. Secondary outcomes were: blood pressure, intradialytic hypotensive episodes and lung function (forced expiratory volume). Dialysis nurses exposed to the intervention completed a Laughter Yoga attitudes and perceptions survey (nu2009=u200911). Data were analysed using IBM SPSS Statistics v22, including descriptive and inferential statistics, and sample size estimates were calculated using G*Power.ResultsOne participant withdrew from the study for medical reasons that were unrelated to the study during the first week (94xa0% retention rate). There were non-significant increases in happiness, mood, and optimism and a decrease in stress. Episodes of intradialytic hypotension decreased from 19 pre and 19 during Laughter Yoga to 4 post Laughter Yoga. There was no change in lung function or blood pressure. All nurses agreed or strongly agreed that Laughter Yoga had a positive impact on patients’ mood, it was a feasible intervention and they would recommend Laughter Yoga to their patients. Sample size calculations for future research indicated that a minimum of 207 participants would be required to provide sufficient power to detect change in key psychological variables.ConclusionsThis study provides evidence that Laughter Yoga is a safe, low-intensity form of intradialytic physical activity that can be successfully implemented for patients in dialysis settings. Larger studies are required, however, to determine the effect of Laughter Yoga on key psychological variables.Trial registrationAustralian New Zealand Clinical Trials Registry - ACTRN12614001130651. Registered 23 October 2014.

A learning partnership: exploring preceptorship through interviews with registered and novice nurses

Novice nurses encounter numerous factors that impact on their learning in the complex healthcare workplace. Registered nurses often work one‐on‐one with novices as preceptors to facilitate the development of novices’ clinical skills and socialisation into the profession. This paper explores the concept of preceptorship from novice nurses’ and preceptors’ perspective, drawing upon data from a project between a large healthcare organisation and a university in Melbourne, Australia. The study, framed in ethnomethodology, included fieldwork observation, interviews and student surveys; this paper focuses on data collected over a series of individual interviews with nursing students (n = 28) and preceptors (n = 25). Thematic analysis yielded six key themes: workplace socialisation, empathy, individuality, willingness to engage, changing support and a realisation [by novices about the preceptor role]. Findings highlight the complexity of workplace learning that is influenced by the idiosyncrasies of the individuals involved and the social milieu in which the learning takes place.

Laughter and humor therapy in dialysis.

Laughter and humor therapy have been used in health care to achieve physiological and psychological health‐related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis patient population. Studies from other groups such as children, the elderly, and persons with mental health, cancer, and other chronic conditions are included to inform potential applications of laughter therapy to the dialysis population. Therapeutic interventions could range from humorous videos, stories, laughter clowns through to raucous simulated laughter and Laughter Yoga. The effect of laughter and humor on depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose may have applications to the dialysis context and require further research.

Construct validity and reliability of the Handover Evaluation Scale.

AIMS AND OBJECTIVESnTo examine the psychometric properties of the Handover Evaluation Scale using exploratory and confirmatory factor analysis.nnnBACKGROUNDnHandover is a fundamental component of clinical practice and is essential to ensure safe patient care. Research indicates a number of problems with this process, with high variability in the type of information provided. Despite the reported deficits with handover practices internationally, guidelines and standardised tools for its conduct and evaluation are scarce. Further work is required to develop an instrument that measures the effectiveness of handover in a valid and reliable way.nnnDESIGNnSecondary analysis of data collected between 2006-2008 from nurses working on 24 wards across a large Australian healthcare service.nnnMETHODSnA sample of 299 nurses completed the survey that included 20 self-report items which evaluated the effectiveness of handover. Data were analysed using exploratory factor analysis and confirmatory factor analysis supported by structural equation modelling.nnnRESULTSnAnalyses resulted in a 14-item Handover Evaluation Scale with three subscales: (1) quality of information (six items), (2) interaction and support (five items) and (3) efficiency (three items). A fourth subscale, patient involvement (three items), was removed from the scale as it was not a good measure of handover.nnnCONCLUSIONSnThe scale is a self-report, valid and reliable measure of the handover process. It provides a useful tool for monitoring and evaluating handover processes in health organisations, and it is recommended for use and further development.nnnRELEVANCE TO CLINICAL PRACTICEnMonitoring handover is an important quality assurance process that is required to meet healthcare standards. This reliable and valid scale can be used in practice to monitor the quality of handover and provide information that can form the basis of education and training packages and guidelines to improve handover policies and processes.