Karen Ford

Quality clinical placements for undergraduate nursing students: a cross-sectional survey of undergraduates and supervising nurses.

AIM   This article is a report of a mixed method study of the quality of clinical placements for second year undergraduate nursing students in an acute care hospital. BACKGROUND   In response to the current and predicted workforce shortages, greater numbers of nursing undergraduate places are being offered at tertiary institutions. This means that requests for clinical places in hospitals to support undergraduate students has risen. Little is known about the impact of increased numbers on the quality of clinical placement as a learning experience and this is of concern as demand grows and the means of assessing capacity is still unknown. METHODS   A 5-point Likert Scale questionnaire, including free text fields, was administered to undergraduates (n = 178), clinical facilitators (n = 22) and supervising ward nurses (n = 163) at two time points in 2009. The survey targeted the quality of the clinical placement in four domains: welcoming and belongingness; teaching and learning; feedback; confidence and competence. Findings.  The findings demonstrated consistently high scoring of the clinical placement experience by both undergraduates and registered nurses. There were higher ratings of levels of support from clinical facilitators compared to supervising ward nurses evident in data associated with the items on the questionnaire relating to teaching and learning. CONCLUSION   The results are indicative of the professional commitment of nursing staff to support the next generation of nurses. The findings also give a mechanism to communicate outcomes of undergraduate support to nurses in practice, and highlight steps which can be taken to ensure high quality clinical placement continues.

Development of children's assent documents using a child-centred approach.

The call for researchers to obtain children’s informed assent, prior to their participation in medical procedures and research, has increased over recent years and parallels moves to implement child-centred approaches to health care. This article describes the processes used to include children in developing a research information sheet and assent form for use in future research into children’s understandings of their surgery and hospital experiences. The process involved primary school children aged between six and 12 years. Children worked in small groups to consider information to include in these documents. Their words were collated to construct the research information sheet and assent form. Working with children resulted in documents that were more understandable for their intended audience. The article includes discussion of ‘language’, ‘understandability’ and ‘readability’; concepts that researchers seeking to work with children need to come to terms with if they are to obtain ‘informed assent’.

Researching children's health experiences: The place for participatory, child-centered, arts-based approaches.

A central concern when conducting qualitative health research with children is eliciting data that genuinely reflect their perspectives. Invariably, this involves being child-centered and participatory. Drawing and photography increasingly accompany dialogic methods to facilitate childrens communication through arts-based and verbal modes of expression. However, little literature is available on how arts-based tools shape data. We suggest that researchers need to be attentive to how such tools can liberate, constrain and frame data generated by children, drawing attention to the promises of such approaches as well as the conundrums that can arise from their use. We explore the place for participatory, child-centered, arts-based approaches using examples of the use of drawing and photography in our own studies.

Child-centred nursing : promoting critical thinking

Child-Centred Nursing presents a unique approach by bringing children to the fore of the discussion about their health and health care. It encourages you to think critically about children, their families and contemporary practice issues. It promotes reflection on how you can develop innovative practice so as to improve children’s health outcomes and their experiences of health care. Clinical case studies and critical thinking exercises are included in each chapter, creating and sustaining a clear link between professional practice, research and theory. The book is essential reading for all pre-registration and post-graduate students studying children’s and young people’s health care.

Clinical facilitator learning and development needs: exploring the why, what and how.

This study explores the practice experiences of clinical facilitators providing a voice for nurses undertaking the role, a group who up until now has been silent. Seven clinical facilitators from acute care areas within Tasmania participated in the interpretive and participatory study. Three core aspects of clinical facilitation identified were the why, what and how of facilitation. The study identified why nurses became clinical facilitators, what their experiences involved - both positive and negative; and enabled exploration as to how the role could be better supported in the future, through addressing ongoing professional development learning needs. Results of this study have provided in depth insight into the world of the clinical facilitator. The importance of key strategies to implement ongoing professional development through mentorship, provision of feedback and the development of communities of practice are seen as imperative to ensure the role of clinical facilitator reaches its full potential to bridge the gap between theory and practice experienced by undergraduates during clinical placements. Such strategies will help ensure quality clinical placements for undergraduate nursing students.

More than just clowns – Clown Doctor rounds and their impact for children, families and staff

Admission to hospital is recognised as a difficult time for children and families. This study explored clown doctor activities in an acute paediatric setting and the impact their activities have on children, their families, other health professionals and clown doctors themselves. We used observation, semi-structured interviews and focus groups with children and parents and staff and clown doctors and results provide a rich description of the work of clown doctors. The major themes were ‘the encounter – in the moment’ of the interaction of the child and the clown doctor and ‘beyond the encounter’. The findings show that the impact of clown doctor visits is experienced beyond the immediate interaction, and this has not been clearly articulated in previous studies. This study highlights the multifaceted and complex nature of the work of the clown doctors and the high level of skill required as they modify and interpret play, activities and environment based on individual need and response.

‘I didn’t really like it, but it sounded exciting’: Admission to hospital for surgery from the perspectives of children

It is a mark of respect for children that their views around their healthcare are listened to and considered. To date, too little attention has been paid to children’s views and experiences of admission to hospital for surgery. This paper presents findings from a constructivist grounded theory study of children’s experiences of admission to hospital for surgery (from their perspectives). Age appropriate data collection techniques were used and included interviews with children and their drawings and stories. Ten children, aged 6–12 years, who were admitted to hospital for surgery participated in the research. The children were able to clearly articulate aspects of their experience, including their fears and anxieties, the things they enjoyed and the things that assisted them to cope with their experience. The substantive theory developed was ‘children’s reframing of their sense of selves to incorporate the experiences of hospitalization and surgery’. Children require information and support to alleviate their anxieties around the time of their surgery. With pressures on children’s services, increased day surgery rates and shorter admissions, nurses who care for children around this time are challenged to find ways of knowing each child’s story and the fears that they have.

Development and reliability testing of the quality clinical placement evaluation tool

AIMS AND OBJECTIVES To develop and test the content and face validity, and reliability of the quality clinical placement evaluation tool. BACKGROUND The importance of clinical experience during undergraduate nursing degrees is undisputed. To date, tools available to measure quality of clinical placements have focused on single perspectives, that of the undergraduate or that of the supervising nurse. The quality clinical placement evaluation tool was proposed to provide an assessment of clinical placement experiences informed by supervising ward nurses and undergraduate stakeholders. DESIGN The study employed a cross-sectional design. METHODS The internal validity of an existing instrument was evaluated by an expert panel and modified for use in the acute care sector. Surveys were completed by undergraduate students (n = 48) and supervising ward nurses (n = 47). Factor analysis was used to identify themes drawn from the literature and explore redundancy of items. Reliability was assessed using Cronbachs alpha for internal consistency and test-retest (five to seven days apart). RESULTS Reliability testing showed good internal consistency for the tool; test-retest reliability testing results were moderate to good for students and fair to moderate for nurses. Factor analysis identified three core themes related to supervising ward nurse responses that could also be applied to undergraduate nurses. The domains identified were the following: welcome and belonging; support to meet learning needs; and confidence and competence: reflections on learning. CONCLUSIONS The quality clinical placement evaluation has shown statistically acceptable levels of reliability and validity for measuring the quality of clinical placement from perspectives of undergraduates and supervising ward nurses. RELEVANCE TO CLINICAL PRACTICE The tool provides tertiary institutions, acute care facilities, wards and individuals with the means to capture views of the quality of clinical placement which can also be used to undertake comparisons over time and between sites.

FUNdamentally important: humour and fun as caring and practice:

Play is important. It is important to children’s social, physical and emotional development and to their sense of well-being and sense of themselves. Children’s play takes many different forms ranging from physical, fantasy and imaginative play, reading, watching a DVD, telling jokes and spending time with friends and family. Play is both silly and serious. It is silly – a source of fun, giggles and joy – and yet, simultaneously, it is the means by which children can make meaning in their world. The need for play does not disappear when a child is sick and in hospital. Indeed, the need for play is never more fundamental than when a child is engaging with such a challenging and complex environment. Being in hospital is not normal. Whether a child is experiencing admission to hospital for the first time or they are returning to hospital for the thirtieth visit, hospital is a challenging place. Admission to hospital requires children to subjugate their bodies to others, for example, through undergoing invasive and potentially painful treatments and procedures. Not only do children have to cope with what is happening to their bodies but they also are required to learn the norms of social behaviour within the hospital. These norms reflect the unfamiliar and socially constructed space of the wards, departments and treatment rooms, settings over which they often have little or no understanding and almost no control. Journal of Child Health Care 15(4) 247–249 a The Author(s) 2011 Reprints and permission: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1367493511429498 chc.sagepub.com

Delirium: the lived experience of older people who are delirious post-orthopaedic surgery.

Delirium is a common, potentially preventable and reversible cause of postoperative functional disability, morbidity, and mortality. It can lead to increased health-care use and also poses a substantial challenge for nurses caring for patients who experience delirium after surgery. Predominantly, the published work concentrates on diagnosis, reduction of the modifiable risk factors, and treatments. Compared with this body of published work, the experience of delirium from a patients perspective has been largely ignored except for a limited number of qualitative research reports. The importance of researching the lived experience of delirium is that a better understanding may lead to more empathic, therapeutic nursing care and help other sufferers to know they are not alone. The aims of the study were to explore and clarify the lived experience of delirium. Eleven patients were recruited to the study following discharge post-surgery from an orthopaedic ward of a major tertiary hospital. The study used a qualitative descriptive approach and incorporated grounded theory data analysis processes. The findings of this study provide an insight into the incomprehensible emotional pain suffered by patients while they were delirious and the disparate feelings of remorse, guilt, and shame they experienced after the episode of delirium. Following this study, recommendations for nursing practice include formal follow-up support for patients with post-delirium episodes and more research into the long-term impact of the experience of delirium.