Diana Keatinge

Children with disruptive behaviours II: Clinical and community service needs

Objective: To assist in health service planning by determining the perceived clinical and community service needs of families resident in the Hunter region who care for a child manifesting disruptive behaviour.

Doing clinical research: The challenges and benefits

Abstract The need for research in practice is well documented within nursing and other health care disciplines. This acceptance is predicated on the belief that clinically applied research will inform and improve practice and health service delivery resulting in better outcomes for consumers and their families. Nurses, however, find doing clinical research challenging. This paper describes nurses’ experiences of doing clinical research. The main challenges of doing clinical research arise from a culture that prioritises practice where nursing work is core business and there is the need to address immediate and short term goals. There are also problems associated with the use of research language amongst clinical nurses and ambiguity in relation to research role expectations. Lack of support and resources for doing research along with keeping up the momentum for a research project also pose significant challenges. The benefits of doing clinical nursing research include experiential learning that has the potential to lead to practice change and improved patient outcomes that are evidence based.

The value of new parent groups in child and family health nursing

A reorganization of child and family health nursing services followed policy changes in New South Wales, Australia, in the late 1990s. However, the introduction of universal and sustained home visiting to all new parents limited resources available to provide support groups for new parents. This qualitative research study used a case study approach to examine the impact of new parents’ group attendance on mothers and on mothers’ interactions with their baby. Key findings demonstrated that attendance at a group created an opportunity, the overarching theme, for both the mothers and infants. New Parent groups appear to be as important as other modes of nursing service delivery to children and parents and serve a different purpose to center-based or home visits.

Orientation strategies during delirium: are they helpful?

AIM This paper critiques literature that reports older person experiences of orientation strategies in relation to current recommendations for the management of older person delirium and makes recommendations for future research. BACKGROUND Delirium is a common syndrome in hospitalised older people and a difficult syndrome for health care staff to manage. During delirium, older people describe experiencing altered states of reality and use of orientation strategies as part of their care. Orientation, a non-pharmacological approach to the management of delirium, is recommended as a care strategy in evidence-based guidelines and protocols. METHOD Discursive paper. DISCUSSION This paper considers published research into the experiences of hospitalised older people during an episode of delirium and questions the appropriateness of orientation strategies. How care strategies are experienced by older people is emphasised. An approach to care which is a flexible balance of reality orientation and validation therapy, synchronised with the changing reality and reactions of the older person, is identified as a care recommendation from research. CONCLUSION When delirium is experienced during hospitalisation, health care staff have a responsibility to provide care that is person-centred and sensitive to the older persons needs. It has been assumed that no harm comes from the use of orientation approaches, and delirium management guidelines have recommended this approach. However, orientation strategies can lead to mistrust of, and distancing from, health care staff and family, so impeding their relationships with carers. Care practices that consider the older person to be unique and that synchronise with the older persons changing experiences of reality are suggested for further research. RELEVANCE TO CLINICAL PRACTICE Caring for an older person in delirium is challenging for health care staff. Reconsideration of, and research into, care strategies during delirium has the potential to improve the quality of care for hospitalised older people.

Implementing and evaluating a professional practice framework in child and family health nursing: A pilot project

AIM This paper describes the implementation and evaluation of the NSW Child and Family Health Nursing Professional Practice Framework in one health district in New South Wales, Australia. BACKGROUND Child and family health nurses provide specialised, community based primary health care to families with children 0-5 years. A state wide professional practice framework was recently developed to support child and family health nurses. METHODS Online learning, clinical practice consultancies and skill assessments related to routine infant and child health surveillance were developed and implemented. Child and family health nurse reviewers gained competency in the various education and assessment components. Reviewers replicated this process in partnership with 21 child and family health nurses from two rural and one regional cluster. Evaluation questionnaires and focus groups were held with stakeholder groups. FINDINGS Participation provided nurses with affirmation of clinical practice and competency. Education and assessment processes were user friendly and particularly helpful for rural and remote nurses. Managers reported greater confidence in staff competence following project participation. CONCLUSION Detailed planning and consultation is recommended before implementation of the Framework. Online learning, skills assessments and model of clinical practice consultancies were identified as central to ongoing orientation, education and professional development.

Creating a nursing development unit in a dementia care context

Keatinge D, Scarfe C. International Journal of Nursing Practice 1998; 4: 120–125 Creating a nursing development unit in a dementia care context This paper describes the process through which a Nursing Development Unit (NDU) was created in a 29-bed unit in which nurses care for severely demented residents. The question about whether or not ethics clearance is required for the development phase of NDUs is discussed, and the framework in which to develop the NDU described. The benefits of using Participatory Action Research as the basis for undertaking a continuous process of reflection and change is highlighted. It is also suggested that two key elements necessary for NDUs are that they are ‘owned’ by the staff who work in them and that they are supported by senior management of the organisations in which they exist.

Children with disruptive behaviours I: service utilization.

Objective: To describe the demographic characteristics and patterns of service utilization in the Hunter region (NSW, Australia) of families caring for a child manifesting disruptive behaviour.

Registered nurses’ experience of mentoring undergraduate nursing students in a rural context: a qualitative descriptive study

Background: Registered nurses in a rural context are expected to support undergraduate students during clinical placement, however, they may experience challenges that are unique to the rural context. Aim: To describe the registered nurses’ experience of mentoring undergraduate nursing students on clinical placements in a rural context. Design: Qualitative descriptive study. Method: Data were collected from nine participants at two rural hospitals in Australia. Individual semi-structured interviews were conducted and content analysis was used to analyse data. Findings: Four categories emerged from the data: ‘The challenges of mentoring’, ‘Supporting students and facilitating learning’, ‘Supporting registered nurses who mentor undergraduate nursing students’ and ‘The rewards of mentoring’. Conclusion: The experience of the rural registered nurse mentor is affected by limited staffing and skill mix, the generalist nature of their work, time constraints and lack of information about students. They need flexible strategies, improved communication and information about students attending clinical placements.