Karen Wotton

Clinician and student evaluation of a collaborative clinical teaching model

Dedicated Education Units (DEU) are, existing health care units collaboratively developed by clinicians and academics as clinical teaching and learning environments dedicated to students from Flinders University, Adelaide, Australia. Throughout each semester students from all year levels work together as peer teachers and learners supported by academics and clinicians. The School of Nursing and Midwifery first introduced the Dedication Education Units in 1997 with the aim of providing optimal and flexible clinical learning environments for undergraduate nursing students. In this evaluative study students (n=121) and clinicians (n=127) perceived the DEU clinical placement configuration to: maintain quality of patient care, foster student relationships, provide an environment where students and academics were accepted as members of the clinical team and increase the collaborative relationship between clinicians, students and academics.

Prevalence, risk factors and strategies to prevent dehydration in older adults

The treatment of dehydration in older adults admitted from residential care to an acute hospital setting may lead to haemodynamic stability. There is however an increased risk for short or long term alterations in physiological, cognitive and psychological status and ultimately, decreased quality of life. Such acute care admissions could be decreased where preventative strategies tailored to address individual risk factors are combined with more frequent assessment of the degree of hydration. The questionable reliability of assessment criteria in older adults increases the need to use multiple signs and symptoms in the identification and differentiation of early and late stages of dehydration. This article reviews various risk factors, explores the reliability of clinical signs and symptoms and reinforces the need to use multiple patient assessment cues if nurses are to differentiate between, and accurately respond to, the various causes of dehydration. Specific strategies to maintain hydration in older adults are also identified.

Theory meets practice: Evaluation of a model of collaboration: academic and clinician partnership in the development and implementation teaching

The difficulty nursing students experience in making the transition from the university to clinical context is attributed to the gap between theory and practice, and education and service. Collaboration between academics and clinicians in the provision of undergraduate education is considered to be a strategy for overcoming these problems. A project team consisting of four academics and six clinicians collaboratively developed and implemented an acute care topic, in the third year of a pre-registration nursing course at the School of Nursing, Flinders University. A review of the literature did not provide examples of collaborative models relevant to undergraduate teaching. The subsequent model, devised by the project team, focused on technical, cultural and interpersonal aspects of collaborative teaching. The model was evaluated by illuminative research methods. Participants in the project included academics (n = 4), clinicians (n = 6) and students (n = 104). Student questionnaires and academic and clinician interviews were used to inform evaluation procedures. The qualitative data was coded and analysed based upon the definitions and characteristics of collaboration described by Henneman et al (1995). Study findings demonstrated that the model was effective in facilitating collaborative relationships necessary for the successful development and implementation of reality-based learning for students.

Third-space fluid shift in elderly patients undergoing gastrointestinal surgery: Part 1: Pathophysiological mechanisms

Abstract Third-space fluid shift, the movement of body fluid to a non-functional space, is a frequently occurring and potentially fatal clinical phenomenon. Little published research exists however in medical or nursing journals concerning its incidence, significance and ramifications in elderly patients undergoing major gastrointestinal surgery. This initial article, part I, explores fluid movement between fluid compartments and uses these principles to discuss the pathophysiology of the two distinct phases of third-space fluid shift. Part II will examine the criteria nurses could use in the clinical assessment of patients in both first and second phases third-space fluid shift and discuss the clinical reliability of these criteria.

Flushing an I.V. line: A simple but potentially costly procedure for both patient and health unit

Abstract This observational study investigated the Intravenous (I.V.) medication administration technique of Registered Nurses (n = 47) using the injection port of a concurrent intravenous infusion. Study findings showed that the majority of nurses adhered to the most common although debatable recommended guideline in stopping the concurrent infusion and slowly administering the medication in the syringe over 3–5 minutes, prior to flushing the line quickly. Nurses failed to account for the dead space in the I.V. line when calculating the administration rate for pre and post medication flush. Similarly, the benefits of continuing the concurrent infusion when administering intravenous medication were not taken into consideration. Based upon these study findings, we recommend changes to procedural guidelines for I.V. medication.

Nursing Students' Integration of Theory and Practice: the development and implementation of a practice and theoretical framework for teaching — a case study

Abstract Skills in clinical decision‐making are integral to the efficiency and effectiveness of health‐care delivery. This article describes the use of case‐study method in order to develop skills in clinical decision‐making in students of nursing. A model of topic development is described. Aspects of topic development included: the selection of appropriate cases; the use of guidelines for analysis of cases and the development of interrelated formats for teaching. Data from student surveys on topic and lecturer evaluation indicated that, generally, students were satisfied with the teaching methodology. Student responses to a pre‐ and post‐test showed that they developed skills in clinical decision‐making.

Third-space fluid shift in elderly patients undergoing gastrointestinal surgery Part II: Nursing assessment

Abstract Third-space fluid shift is the mobilisation of body fluid to a non-contributory space rendering it unavailable to the circulatory system. It is a recurrent clinical phenomenon requiring swift identification to minimise deleterious effects. Nurses experience difficulties however in its early identification, diagnosis and subsequent treatment because of the lack of consensual and consistent information regarding third-spacing. This article, part II, building on the previous article, explores the clinical validly and reliability of signs and symptoms of both phases of third-space fluid shift. In addition it reinforces the use multiple patient assessment cues if nurses are to differentiate between, and accurately respond to, the various causes of both hypovolaemia and hypervolaemia. It assists nurses to increase their knowledge and understanding of third-space fluid shift in patients undergoing gastrointestinal surgery.