Jane Currie

How far is too far? Exploring the perceptions of the professions on their current and future roles in emergency care

Background and aims: How far is too far? Recent government policy and demographic growth have led to role changes within the professions in emergency care. Healthcare professionals have extended and expanded their scopes of practice to include duties outside their traditional role boundary. Nurses in particular are able to see and treat patients more independently. These expanded roles mean there is growing overlap between professional roles and responsibilities and one wonders—how far is too far? Where should role expansion cease? The aim of this research was to explore the perceptions of the professions on their current and future roles in emergency care. Methods: A qualitative design, utilising semistructured interviews was employed. Eight respondents, including doctors and nurses of all grades, were purposefully sampled from an emergency department within a large UK teaching hospital. Results: Content analysis revealed five key themes: role boundaries; driving forces; managing risk; training and future professional roles. Conclusions: Of genuine concern to the respondents was the lack of standardisation within the expansion of healthcare roles. In terms of “how far is too far”, the respondents believed that greater clarification of training and scope of practice is required, enabling clinical roles to develop more consistently.

Impact of community based nurse-led clinics on patient outcomes, patient satisfaction, patient access and cost effectiveness: A systematic review

BACKGROUND The role and scope of nursing practice has evolved in response to the dynamic needs of individuals, communities, and healthcare services. Health services are now focused on maintaining people in their communities, and keeping them out of hospital where possible. Community based nurse-led clinics are ideally placed to work towards this goal. The initial impetus for these services was to increase patient access to care, to provide a cost-effective and high quality streamlined service. OBJECTIVES This systematic review aimed to identify the impact of nurse-led clinics in relation to patient outcomes, patient satisfaction, impact on patient access to services, and cost effectiveness. METHODS A review of community based nurse-led clinic research in Medline, CINAHL and Embase was undertaken using MeSH terms: Nurse-managed centres, Practice, Patterns, Nurse, Ambulatory Care, keywords: nurse-led clinic, nurse led clinic, community and phrases primary health care and primary care. Papers were appraised using the Joanna Briggs Appraisal criteria. RESULTS The final review comprised 15 studies with 3965 participants. Most studies explored patient satisfaction which was largely positive towards nurse-led clinics. Patient outcomes reported were typically from self-report, although some papers addressed objective clinical measures; again positive. Access was reported as being increased. Cost-effectiveness was the least reported impact measure with mixed results. CONCLUSIONS Nurse-led clinics have largely shown positive impact on patient outcomes, patient satisfaction, access to care and mixed results on cost-effectiveness. Future research evaluating NLCs needs to adopt a standardised structure to provide rigorous evaluations that can rationalise further efforts to set up community based nurse-led clinical services.

Workforce characteristics of privately practicing nurse practitioners in Australia: Results from a national survey.

Purpose Australian private practice nurse practitioner (PPNP) services have grown since legislative changes in 2010 enabled eligible nurse practitioners (NPs) to access reimbursement for care delivered through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). This article provides data from a national survey on the workforce characteristics of PPNPs in Australia. Method PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. There were 73 completed surveys. Conclusions One of the intentions of expanding access to MBS and PBS for patients treated by NPs was to increase patients’ access to health care through greater flexibility in the healthcare workforce. The results of this survey confirm that the workforce characteristics of PPNPs provide a potentially untapped resource to meet current primary healthcare demand. Implications for practice The findings of this study allow us to understand the characteristics of PPNP services, which are significant for workforce planning. The focus of PPNP practice is toward primary health care with PPNPs working predominantly in general practice settings. The largest age group of PPNPs is over 50 years and means a proportion will be retiring in the next 15 years.

A systematic review examining the effectiveness of blending technology with team-based learning

BACKGROUND Technological advancements are rapidly changing nursing education in higher education settings. Nursing academics are enthusiastically blending technology with active learning approaches such as Team Based Learning (TBL). While the educational outcomes of TBL are well documented, the value of blending technology with TBL (blended-TBL) remains unclear. This paper presents a systematic review examining the effectiveness of blended-TBL in higher education health disciplines. OBJECTIVES This paper aimed to identify how technology has been incorporated into TBL in higher education health disciplines. It also sought to evaluate the educational outcomes of blended-TBL in terms of student learning and preference. METHOD A review of TBL research in Medline, CINAHL, ERIC and Embase databases was undertaken including the search terms, team based learning, nursing, health science, medical, pharmaceutical, allied health education and allied health education. Papers were appraised using the Critical Appraisal Skills Program (CASP). RESULTS The final review included 9 papers involving 2094 student participants. A variety of technologies were blended with TBL including interactive eLearning and social media. CONCLUSION There is limited evidence that blended-TBL improved student learning outcomes or student preference. Enthusiasm to blend technology with TBL may not be as well founded as initially thought. However, few studies explicitly examined the value of incorporating technology into TBL. There is a clear need for research that can discern the impact of technology into TBL on student preference and learning outcomes, with a particular focus on barriers to student participation with online learning components.

Development of a self-assessment teamwork tool for use by medical and nursing students

BackgroundTeamwork training is an essential component of health professional student education. A valid and reliable teamwork self-assessment tool could assist students to identify desirable teamwork behaviours with the potential to promote learning about effective teamwork. The aim of this study was to develop and evaluate a self-assessment teamwork tool for health professional students for use in the context of emergency response to a mass casualty.MethodsThe authors modified a previously published teamwork instrument designed for experienced critical care teams for use with medical and nursing students involved in mass casualty simulations. The 17-item questionnaire was administered to students immediately following the simulations. These scores were used to explore the psychometric properties of the tool, using Exploratory and Confirmatory Factor Analysis.Results202 (128 medical and 74 nursing) students completed the self-assessment teamwork tool for students. Exploratory factor analysis revealed 2 factors (5 items - Teamwork coordination and communication; 4 items - Information sharing and support) and these were justified with confirmatory factor analysis. Internal consistency was 0.823 for Teamwork coordination and communication, and 0.812 for Information sharing and support.ConclusionsThese data provide evidence to support the validity and reliability of the self-assessment teamwork tool for students This self-assessment tool could be of value to health professional students following team training activities to help them identify the attributes of effective teamwork.

Mapping the field of military nursing research 1990–2013: A bibliometric review

BACKGROUND Over the past 20 years, military forces worldwide have been engaged in a number of conflicts and humanitarian operations and the impact of this on the field of military nursing research is unknown. The aim of this bibliometric review was to investigate the research field of military nursing in the main databases with the purpose to describe trends in military nursing research since 1990. OBJECTIVES To identify military nursing papers in the main databases and to describe the field of military nursing research for the period 1990-2013 in terms of research productivity, trends in topic focus, trends in authorship and country of publication. METHOD Bibliometric review of published military nursing research papers was undertaken in March 2014 and data was extracted and coded and trends were analyzed using SPSSv21. RESULTS In total 237 articles were included in the review. The majority of publications emanating from America (n=175, 73.8%) and the quantity of papers has increased significantly since the commencement of the second Gulf War in Iraq from 2003 onwards (n=156, 65.8%). This has been accompanied by a shift in topic focus from professional (n=16, 20.3%) and occupational issues (n=17, 21.5%) pre 2003, to clinical (n=48, 30.4%) and an increase in multidisciplinary research from 4% in 1990-94 to 29% in 2010-13. The mean citations were 10.6 (sd 17.0) and the mean references per paper post 2003 showed a marked increase from 23.5 to 25.4. CONCLUSION The military nursing research field appears stronger than it has been in the past twenty years and has demonstrated increased transferability to other fields. To maintain this momentum and further develop the field of military nursing research, military forces worldwide need to devise focused nursing research strategies that involve international and multidisciplinary collaboration.

Implementation of a clinical governance framework to 17 Combat Service Support Brigade, Australian Army

Purpose In 2012, Headquarters 17 Combat Service Support Brigade (HQ 17 CSS Bde) implemented a clinical governance framework. The framework is intended as a quality improvement tool through which excellence in deployed healthcare is achieved. The purpose of this paper is to describe the implementation of this clinical governance framework to 17 CSS Bde and present feedback provided by users on their application of the clinical governance framework. Design/methodology/approach An electronic survey was disseminated to the four 17 CSS Bde deployable health battalions (n=1,061). Qualitative data were analysed using descriptive statistics and qualitative data using thematic analysis. Findings In total, there were 105 responses providing valid data for analysis. The data identified mixed understanding and awareness of clinical governance amongst participants, and pinpointed aspects of the framework that needed refinement. Practical implications The results highlight important challenges implementing a clinical governance framework for deployable health units. The authors propose embedding clinical governance education in all army soldier and officer health courses to remedy deficits in knowledge and understanding. Recommendations for further development of the clinical governance framework are also made with particular emphasis on education, clinical risk and clinical evaluation. Originality/value This paper offers unique insight into the implementation of a clinical governance framework to the 17 CSS Bde, Australian Army. The results suggest that levels of understanding and awareness of clinical governance are stalling its translation through the military hierarchy. The data identify that implementation of a clinical governance framework is not easy, even within a military environment where the culture is to follow orders and obey the chain of command.

Collaborative arrangements and privately practising nurse practitioners in Australia: results from a national survey.

Objective Since the introduction of legislative changes in 2010, services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for subsidisation through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). To provide eligible services, PPNPs must collaborate formally with a medical practitioner or an entity that employs medical practitioners. This paper provides data from a national survey on these collaborative arrangements in Australia. The aim of the study was to evaluate the impact of PPNP services on patient access to care in Australia. Methods PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed using thematic analysis. Seventy-three surveys were completed. Results Ninety-three per cent of participants reported having a collaborative arrangement in place. Frequency of communication ranged from daily (27%) to never (1%). Participants reported that collaborative arrangements facilitate learning, patient care and offer support to PPNPs. However, for some PPNPs, organising a formal collaborative arrangement is demanding because it is dependent on the availability and willingness of medical practitioners and the open interpretation of the arrangement. Only 19% of participants believed that collaborative arrangements should be a prerequisite for PPNPs to access the MBS and PBS. Conclusion Although there are benefits to collaborative arrangements, there is also concern from PPNPs that mandating such arrangements through legislation presents a barrier to establishing PPNP services and potentially reduces patient access to care. Collaboration with medical practitioners is intrinsic to nursing practice. Thus, legislating for collaborative arrangements is unnecessary, because it makes the normal abnormal. What is known about the topic? To access the MBS and PBS, PPNPs are required by law to have a collaborative arrangement with a medical practitioner or entity that employs medical practitioners. To date, the effects of these collaborative arrangements on PPNP services in Australia have not been known. What does the paper add? This paper provides unique data from a national survey on collaborative arrangements between PPNPs and medical practitioners in Australia. What are the implications for practitioners? Although there are benefits to collaborative arrangements, there is also concern that mandating such arrangements presents a barrier to establishing PPNP services and potentially reduces patient access to care.