Kerry Reid-Searl

Student evaluation of simulation in undergraduate nursing programs in Australia using quality indicators

Student evaluation of the implementation of evidence-based quality indicators for simulation experiences in undergraduate nursing programs in 2012 was explored in this study. The evaluation instrument used five specific measures derived from quality indicators. Students evaluated 10 simulation learning experiences in the first and second years of undergraduate nursing programs at two universities in Australia. Overall, students (n = 85) reported that simulation contributed to their achievement of objectives, but they did not always feel supported in these sessions. Student preparation and orientation was scored lower than other components of the simulation experience. Students reported very good scores for perceived realism and fidelity of simulation sessions, particularly the silicone mask and high-fidelity sessions, which implies that learning from simulation is transferable into the clinical practice setting. However, patient charts and other clinical documents were not always considered to be realistic. Debriefing was scored very highly overall and for both approaches used for debriefing. The student-evaluation instrument was an effective means of measuring student-related quality indicators across a range of simulation sessions. It identified areas for the improved delivery of simulation sessions.Student evaluation of the implementation of evidence-based quality indicators for simulation experiences in undergraduate nursing programs in 2012 was explored in this study. The evaluation instrument used five specific measures derived from quality indicators. Students evaluated 10 simulation learning experiences in the first and second years of undergraduate nursing programs at two universities in Australia. Overall, students (n = 85) reported that simulation contributed to their achievement of objectives, but they did not always feel supported in these sessions. Student preparation and orientation was scored lower than other components of the simulation experience. Students reported very good scores for perceived realism and fidelity of simulation sessions, particularly the silicone mask and high-fidelity sessions, which implies that learning from simulation is transferable into the clinical practice setting. However, patient charts and other clinical documents were not always considered to be realistic. Debriefing was scored very highly overall and for both approaches used for debriefing. The student-evaluation instrument was an effective means of measuring student-related quality indicators across a range of simulation sessions. It identified areas for the improved delivery of simulation sessions.

Supervising medication administration by undergraduate nursing students: influencing factors

BACKGROUND The administration of medication is an important skill nursing students need to learn in the clinical setting to develop safe practices. Legally within Queensland, registered nurses are required to provide personal supervision for this process. Research undertaken by the authors suggests the supervision students receive frequently falls short of what is legally required. AIMS AND OBJECTIVES The aim of the study was to examine the factors that influence the experiences of final-year undergraduate nursing students when administering medications in the clinical setting. DESIGN A grounded theory approach was used with constant comparative analysis to identify categories from the data. METHODS The experiences of final-year nursing students were explored using a grounded theory approach. In-depth, semi-structured interviews were conducted with 28 final-year undergraduate nursing students in Queensland, Australia. RESULTS Supervision was found to be the central issue influencing medication administration for students. Three main factors were identified as influencing the supervision provided by registered nurses: attitudes of the registered nurse, communication from the university, and busyness and having time. CONCLUSIONS The extent to which registered nurses provide direct supervision to nursing students when administering medication is influenced by factors inherent within the clinical environment. RELEVANCE TO CLINICAL PRACTICE The factors influencing the supervision provided by registered nurses needs further exploration that effective strategies can be implemented to ensure safe practices in relation to medication administration can be implemented.

Graduate nurses and nursing student's behaviour: Knowledge and attitudes toward smoking cessation

BACKGROUND Smoking remains the largest single cause of preventable mortality. In rural Australia where the incidence of smoking is higher, health is substantially worse than other Australians. Smoking cessation is difficult with many attempts made before success. Health professionals are in a prime position to assist smoking cessation but are failing to consistently assess tobacco use and assist patients quit. Nurses who form the largest cohort of health care professionals, should play a part in smoking cessation yet their influential role is hugely underutilised. Given the strategic place of nurses to advance the anti-smoking message during clinical interactions, data was needed on smoking rates as well as on smoking attitudes and behaviours. OBJECTIVES To determine the smoking rates and behaviour as well as attitudes of nurses toward assisting hospitalised patients to cease smoking. DESIGN Descriptive survey research design. PARTICIPANTS Non-probability sampling of undergraduate nursing students (n=153) and graduate nursing students (n=64) from a regional nursing school in an Australian university. METHODS Survey. RESULTS Factor analysis revealed four clearly differentiated factors, non-smokers rights, cessation beliefs, cessation attitudes and therapeutic relationships. Significant differences were present in nurses perceptions of smoking rights across age categories but not for other factors, no significant gender differences were noted across categories, nor were significant differences noted between levels of nursing qualifications across categories however smoking status revealed significant differences in perceptions of rights. CONCLUSIONS Student and graduate nurses are aware that they are role models and that they have an influential role in modifying patient behaviour. When it comes to assisting patients to cease tobacco use, age and smoking status of nurses influence their actions. Nursing curriculums need to emphasise the role nurses play in smoking cessation and give them the tools they need to help patients QUIT.

Articulating expectations for PhD candidature upon commencement: ensuring supervisor/student ‘best fit’

The journey towards completion of a PhD is a bumpy one for many. One of the major factors that influence successful and on-time thesis completion is the relationship that the PhD candidate has with her or his supervisor. This paper presents results from research undertaken using a 12-item survey to collect data from a purposive sample: PhD candidates and their supervisors, regarding expectations related to the programme of doctoral study. Results indicate that candidates and supervisors both agree that the relationship is a vital component of the journey, and both have equally high expectations that the relationship needs to be warm and supportive. The doctoral journey is a shared one. To make the journey as positive as possible, supervisors and candidates need to articulate their expectations clearly, which can be achieved via the use of a simple set of statements that both complete as used in this research or by dialogue. However it is done, it needs to occur early in the candidature so that both parties know what the other expects.

Rediscovering the essence of nursing: exploring the impact of in clinical experience in Thailand for undergraduate nursing students from Australia.

Cultural competence is now widely recognised as an essential characteristic for undergraduate nursing students. Clinical experience in foreign countries has become increasingly popular as a strategy to enhance cultural awareness and competence. However, published research articulating the experience and outcomes of these initiatives is relatively rare, particularly from an Australian perspective. This paper presents the findings of a qualitative, exploratory research project. Individual semi-structure interviews were conducted with eight undergraduate nursing students before, during and at the conclusion of a four week clinical placement in Surin, Thailand. Data analysis identified the following major themes: first interview - anticipation; second interview - making a difference; contrasting worlds; and part of the group; third interview - reality check and group dynamics. These findings suggest that international clinical experience has potential benefits beyond the development of cultural competence. The importance of caring in nursing and the importance of group dynamics were particularly valued by student participants.

Caring for children with complex emotional and psychological disorders: experiences of nurses in a rural paediatric unit

AIMS To explore the experiences of general nurses towards caring for children with mental health issues and to identify strategies to improve management of these children. BACKGROUND There has been an increase of children and adolescents with complex emotional and psychological disorders being admitted to paediatric units of general hospitals due to a lack of specialist child and youth mental health facilities. The study is situated in a 16 bed paediatric unit of a rural public hospital. As the closest inpatient child mental health unit of this kind is more than 600 km away, the paediatric unit admits children and adolescents with a primary psychiatric diagnosis. DESIGN A participatory action research approach guided this study. METHODS Focus groups and individual interviews were conducted with a purposive convenience sample of all nursing staff (n = 20) working in the paediatric unit. Verbatim interview transcripts were analysed to identify the major themes. RESULTS Two main themes emerged from data analysis: (1) role preparation and adequacy; (2) lack of support and resources. Participants suggested several strategies to address these concerns including: improving relationships with mental health services, professional development, and developing a greater appreciation for mental health interventions. CONCLUSIONS There is a clear need for an increased understanding of mental health practices, an improved relationship between general and mental health services and continuing professional development to ensure nurses possess the skills and confidence to provide quality care to children admitted to a paediatric unit with a mental health diagnosis. RELEVANCE TO CLINICAL PRACTICE Few general nurses have mental health training and, through no fault of their own, may be providing less than optimal care to children who are admitted with a mental health diagnosis. Through a desire to improve care, the following participatory action research project was instigated.

Promoting mental health care in a rural paediatric unit through participatory action research

OBJECTIVE To explore, advance and evaluate mental health practices in a rural general paediatric unit through participatory action research. DESIGN A participatory action research approach guided this study, providing an opportunity for nursing staff to become actively involved in the design, direction and outcomes of the research. SETTING A 16-bed paediatric unit of a rural general hospital. PARTICIPANTS A purposive convenience sample of all paediatric nursing staff (n = 20; of 24 nurses). OUTCOME MEASURES In the first phase of this study, focus groups were conducted to explore the experiences of nurses. RESULTS Participants considered mental health to be a specialist discipline area and the role of the mental health nurse to be complex. They felt that their lack of training and experience with mental health issues was detrimental to the delivery of optimal patient care. There was concern about differing approaches to treatment, relationships with other mental health services and the suitability of the ward environment for young people with a mental health problem. Participants called for training by qualified mental health staff and the development of policies and clinical guidelines to facilitate their delivery of care to patients with a mental health problem in an acute medical environment. CONCLUSIONS There is a clear need for nursing specialities to work together to ensure that optimal care is given to patients admitted to general hospital with a mental health issue. Given the absence of accessible specialist child mental health inpatient units in regional and remote areas, upskilling paediatric nurses must be a priority.

Recognising our role: improved confidence of general nurses providing care to young people with a mental illness in a rural paediatric unit.

OBJECTIVE To implement and evaluate strategies suggested by general nurses to improve management of children and adolescents with mental health problems admitted to a paediatric unit of a general hospital. BACKGROUND The first phase of a study using a Participatory Action Research approach identified several concerns associated with general nurses providing care to young people with mental disorders in paediatric units of general hospitals, together with suggestions for strategies to address these issues. This paper describes the second and third phase of the Participatory Action Research study, involving the implementation and evaluation of these strategies. DESIGN Participatory Action Research. METHODS Actions that occurred during phase two of the Participatory Action Research study included revision and introduction of policies and procedures for mental health care in the unit, education and training sessions for paediatric nursing staff and opportunities to strengthen communication between existing mental health services. In phase three, two focus groups were conducted to explore current perceptions of mental health care delivery in the unit and evaluate change, following phase two. RESULTS Changes in clinical practice for paediatric mental health care were acknowledged by participants. Reflection has assisted nurses to better understand their strengths and weaknesses and to acknowledge and challenge the assumptions on which their ideas, feelings and actions about patients with mental health issues are based. Participants also recognised the existing skills and expertise they possess that are relevant to the management of young people with a mental health problem, although they continue to seek ongoing education and support in this field. CONCLUSIONS This study demonstrates that through Participatory Action Research it is possible to enhance mental health nursing care in a rural paediatric unit. RELEVANCE TO CLINICAL PRACTICE Such changes have the potential to improve the experience of young people and their families whilst receiving treatment for mental health conditions in a general paediatric unit.

Whatever It Takes: Nursing Students' Experiences of Administering Medication in the Clinical Setting

This research was conducted to examine experiences of nursing students in administering medication in the clinical setting. Grounded theory was utilized, involving in-depth interviews with 28 final-year students. In this article, we examine the importance participants attached to conforming to the prevailing culture, and their responses when offered what they considered inadequate supervision. Three main categories emerged: norming for the survival of self, conforming and adapting for benefit of self and others; and performing with absolute conscience. Subsequently, the model of contingent reasoning was developed to explain the actions of students. Contingent reasoning was influenced by the relationship with the registered nurse and individual characteristics of the students. Contingent reasoning was validated by participants and is discussed in relation to Kohlberg’s theory of moral reasoning and other relevant nursing literature. This model has the potential to enhance understanding of how students make decisions, and ultimately to positively influence this process.

Lived experience practitioners and the medical model: world’s colliding?

Abstract Background: Australian mental health policy requires that mental health services facilitate meaningful and genuine consumer participation in all aspects of mental health services. Roles for practitioners who work from their own experience of significant mental health challenges and mental health service use have been implemented in many services to promote participation and the development of more consumer focused services. Aims: To enhance understanding of perspectives of individuals working in lived experience roles to more closely understand their experiences and opinions about these roles. Method: A grounded theory study interviews were conducted with 13 lived experience practitioners. Results: The medical model was a core category arising from this work. Participants described the medical model as a prevailing culture within mental health services from their personal and professional experiences. This culture imposed a major limitation on the implementation, effectiveness and development of lived experience roles and themselves as individuals. It was also seen as a major limitation to the progress of Recovery orientated reform. Conclusions: The development of Recovery oriented services requires a strong lived experience practitioner workforce, with appropriate resourcing and support available. The current medical model approach requires critique to facilitate reform and avoid tokenism.