Jane Cioffi

Using a simulation strategy: An educator's experience.

As students are expected to apply their knowledge in clinical settings educators need to use learning strategies that provide students with experiences that facilitate knowledge application. The use of simulations has been identified to be such a strategy. However, their use in the classroom has been described as burdensome for educators. Consequently educators may avoid using them. This paper describes the experience of an educator preparing, implementing and evaluating the use of simulations with midwifery students. In conclusion, the educator found the experience to be worthwhile and well received by students.

Environmental approach to reducing agitation in older persons with dementia in a nursing home

Objective:  This paper reports the effects on challenging (agitated) behaviours, such as aggression, noisiness and wandering, when persons with dementia were relocated to a special unit.

Team nursing in acute care settings: nurses' experiences.

Abstract A shift to the practice of team-based models of nursing care has occurred as a response to skill mix changes in acute health care settings. Little is known about nurses’ experience of working in teambased models of nursing care delivery. This paper reports the findings of a qualitative study of the experiences of nurses working in teams in acute care settings in an area health service. Main findings are benefits of team nursing, team approach, team effectiveness, increased responsibility, availability of support and engagement with the multidisciplinary team. These findings have implications for understanding the essential elements of team nursing as experienced by team members; providing key messages for health services implementing team nursing and giving direction for further research.

Change process during redesign of a model of nursing practice in a surgical ward

AIM This paper reports a case study of nursing practice model redesign in a surgical ward at a large metropolitan acute care hospital in Sydney, Australia. BACKGROUND Literature suggests that factors such as financial restraints and shortage of nurses necessitate redesign of nursing care. METHOD A descriptive case study design was used. The nursing practice model was changed from a patient allocation model to a team-nursing model and a new role of Clinical Activities Coordinator was introduced. RESULTS This study has confirmed that people need to be able to empower themselves to ensure an effective change process. It was also apparent in the case study that the staff were resistant to the redesign. CONCLUSIONS Change is a difficult process, which needs to involve all stakeholders. The planning process needs to consider the characteristics of the context such as workload and skill required, and the measures such as patient and staff satisfaction and health outcomes.

Multidisciplinary teams caring for clients with chronic conditions: Experiences of community nurses and allied health professionals

Abstract In Western societies the community prevalence of chronic conditions is increasing rapidly. Evidence has shown the benefits of care given to these clients by multidisciplinary teams. However, the experience of diverse health professionals working in these teams is not well understood. This study presents the experiences of members in multidisciplinary teams caring for clients with chronic conditions in the community. A qualitative descriptive study was used with a purposive sample of 34 multidisciplinary team members who participated in focus groups that were audio-taped, transcribed and analysed. Team members’ experiences of working in multidisciplinary teams are described within three categories: shared purpose, working in the team, and tensions within the team. The findings provide direction for addressing team effectiveness, including issues of team leadership and evaluation of team performance.

Nurses’ experiences of caring for culturally diverse patients in an acute care setting

Abstract Identification of nurses’ experiences of caring for culturally diverse patients in acute care settings contributes to transcultural nursing knowledge. This qualitative study aims to describe nurses’ experiences of caring for culturally diverse adult patients on medical and surgical wards in an acute care setting. These experiences identify current practice and associated issues for nurses caring for culturally diverse clients. A purposive sample of ten registered nurses was interviewed and transcripts analysed. Main findings were acquiring cultural knowledge, committing to and engaging with culturally diverse patients. Strategies for change developed from these findings focus on increasing cultural competency of nurses by: implementing a formal education program; developing partnerships with patients and their families to increase cultural comfort; and increasing organisational accommodation of the culturally diverse with policy review and extension of resources. Further research to explore issues for bilingual nurses and to describe the experiences of culturally diverse patients and their families in general acute care settings is recommended.

Defining pastoral care for older people in residential care

Abstract The concept and definition of pastoral care in aged care remains ambiguous. This paper reports on the defining characteristics and meaning of pastoral care from the perspective of older recipients, their family members and pastoral care workers. Using a qualitative descriptive approach semistructured in-depth interviews were conducted with 18 pastoral care workers and 11 older people. Transcribed data were analysed using NVivo software and coded for emerging themes. The defining characteristics of pastoral care that emerged from analysis of transcribed interviews were: a trusting relationship, spiritual support, emotional support and practical support. Findings also portray the role of the pastoral care worker as spiritual guide, confidante, and emotional and practical supporter acting within a trusting relationship. Future studies should confirm these results by exploring the perceptions of experts in the field of pastoral care.

Clients with chronic conditions : community nurse role in a multidisciplinary team

AIMS AND OBJECTIVES To define and validate the role of the community nurse in a multidisciplinary team caring for clients with chronic and complex needs. BACKGROUND A key factor in optimising care for clients with chronic and complex conditions in the community is the use of multidisciplinary teams. A team approach is more effective as it enables better integration of services. The role of the community nurse in the multidisciplinary team has as yet not been delineated. DESIGN A modified Delphi technique was used in this study. METHODS A group of 17 volunteer registered nurses who were experienced in the care of clients with chronic conditions and complex care needs in the community formed a panel of experts. Experts were emailed a series of three questionnaires. RESULTS Main findings show that the role of the community nurse in a multidisciplinary team for clients with chronic conditions has six main domains - advocate, supporter, coordinator, educator, team member and assessor. CONCLUSION A consensus on the role of the community nurse in the multidisciplinary team is described. The six key role domains reaffirm the generic role of the nurse and the validation of the role clarifies and reinforces the centrality of the community nurse in the team. Further refinement of the community nurse role is indicated to increase comprehensiveness of role descriptors particularly for the role domain, advocate. RELEVANCE TO CLINICAL PRACTICE Community nurses working in multidisciplinary teams caring for clients with chronic conditions can define their role as a team member. The working relationship of the community nurse with other health professionals in the multidisciplinary team as a key approach to more integrated care for clients and carers enables the use of this approach to be better understood by all team members. With this increased understanding, community nurses are in a position to build stronger and more effective care teams.

Clients’ experiences of a weight‐management programme: a qualitative study

Weight‐management programmes to address obesity are an important strategy for improving community health. Some enrollees in this type of a programme are long term, repeatedly enrolling term after term, while others are short term, enrolling on average for two terms. This paper describes and compares the experiences of long‐ and short‐term enrollees of a community weight‐management programmes. Six long‐term and six short‐term enrollees in the maintenance stage of their behaviour change volunteered to participate in interviews. Both groups found the programme to be beneficial and enjoyable, and said they had learned strategies for weight control that empowered them to manage and sustain their weight loss. Long‐termers identified they had greater need for weight monitoring and ongoing support. The recommendations are to review aspects of such programmes, address ongoing support outside the class and investigate further the greater reliance of long‐term enrollees on external support.

Loss of clinical nursing expertise: a discussion paper.

There is evidence to suggest that there is a general decline in clinical expertise in nursing as a result of experienced clinicians leaving the profession. The expertise of clinical nursing practice is an important resource and needs to be captured and made available to others as loss of this knowledge and expertise has implications for clinical outcomes. This paper aims to discuss the current nursing workforce, loss of clinical expertise, the nature of expertise and the way it can be captured. Clarification and articulation of clinical knowledge of nursing experts provides the means for knowledge to be transferred to a less experienced workforce and be available in an accessible form in the workplace. Leverage of nursing expertise in this manner has the potential to benefit less experienced staff, hold clinical nursing expertise in the workplace and improve clinical outcomes and satisfaction with performance.