Lorna Moxham

Supporting bachelor of nursing students within the clinical environment: Perspectives of preceptors

UNLABELLED Student learning in the clinical environment is a cornerstone of pedagogy for students undertaking a Bachelor of Nursing in Australia. METHOD This paper presents the results of a survey that was conducted with registered nurses who preceptor students for universities in Australia. FINDINGS Findings reveal that some preceptors do not hold the qualification they are preceptoring students to obtain, that university involvement in preparation of preceptors is scant and that resource provision and communication from universities to preceptors is considered problematic. Registered nurses choose to act as preceptors for reasons that are both altruistic and professional. They are often employed in senior positions and as such find it difficult to manage time and resolve role conflict. CONCLUSION This paper concludes that the registered nurses who preceptor students generally have a positive experience but require greater involvement by universities in their preparation, particularly when they are responsible for the direct assessment of students. The paper posits this may be best achieved by universities creating effective lines of communication and ongoing support. This will sustain collaborative and meaningful engagement with registered nurses who preceptor undergraduate students.

Collaborative voices: ongoing reflections on nursing competencies

Abstract In a rapidly changing Australian health care environment, providers of undergraduate nursing programs are continually upgrading their assessment methods to ensure that graduates are competent and safe to practice. Competence assessment is based on the existing Australian Nursing & Midwifery Council (ANMC) Competency Standards for Registered Nurses. It is acknowledged that there are issues surrounding the validity and reliability of current assessment methods, primarily due to organisational constraints both at the University and the service provider level.There are a number of highly reliable tools available that enable assessment of nursing students in the psychomotor domain. Assessment in other domains is less precise.This paper explores some of the issues relating to competence assessment processes in order to promote discussion and discourse between educators, facilities and policy makers. It is envisaged that increased debate will result in an enhanced level of academic and clinical preparation for the upcoming nursing workforce in this country.

Mental health nursing education in preregistration nursing curricula: a national report.

The Australian Mental Health Nurse Education Taskforce conducted a national examination of mental health content of preregistration nursing curricula in order to develop a framework for including mental health in future curricula. This paper presents the qualitative findings from national consultations about the framework. Content analysis of data was undertaken, and the findings show four key themes. First, the mental health content of curricula should be increased; second, overall mental health nursing leadership should be strengthened; third, mental health consumer participation should be increased in all aspects of curricula; and finally, a repository should be established for mental health teaching resources.

Mental health content of comprehensive pre-registration nursing curricula in Australia

In 2008 the final report of the Mental Health Nurse Education Taskforce was released. This paper presents the findings of the report’s survey into the mental health content of generic pre-registration nursing curricula in Australia. A questionnaire was sent to all nursing schools providing pre-registration curricula. Results indicate curricula contained a wide range of mental health theory and clinical hours. While the majority of universities incorporated most of the 20 key topics recommended by the Mental Health Nurse Education Taskforce in their courses, few addressed issues such as Indigenous mental health. There was considerable competition for placements between universities, and concern about the quality of some placements. Nurse academics with formal qualifications in mental health and specialist clinical mental health nurses were mainly involved in teaching theory. Specialist mental health clinicians and clinical educators were the key groups engaged in students’ clinical education, and preceptorship was the most common form of clinical supervision. Consumers and carers had limited involvement in the development or provision of mental health content of pre-registration curricula. Greater attention is needed to increasing the mental health content in pre-registration curricula. Furthermore, initiatives should be developed to increase access to clinical placements and reduce competition for places between universities.

Human resource management strategies for the retention of nurses in acute care settings in hospitals in Australia

It is paramount that there is an adequate nursing workforce supply for now and in the future, to achieve equitable and quality health outcomes and consumer access to healthcare, regardless of geographic location. Nursing forms the largest body of employees in the health care system, spanning all segments of care. A shortage of nurses, particularly in the acute care settings in hospitals, jeopardizes the provision of quality health care to consumers. This article provides a literature review of Australian State and Federal Government reports into nurse retention. All reports discuss staff turnover rates; the average age of nurses; enrolment numbers in nursing courses; workloads; nursing workforce shortfalls and the effect on the work environment; leadership and management styles; organizational culture; change management; the mobility of nursing qualifications both locally and internationally and the critical need to value nurses. Then why has the situation of nurse retention not improved? Possible reasons for the continued nurse shortage and the promise of strategic HRM in addressing nurse retention are discussed.

Constructing a nursing identity within the clinical environment: The student nurse experience

Abstract Background: Nursing identity is an important element of being a nurse. Student nurses begin the construction of their nursing identity during their clinical placements. Aim: The aim of this research was to examine how the student nurses of a regional Australian university construct their identity when on off-campus clinical placement. Methods/ Design: Using a constructivist approach an online survey was used to elicit data in response to the question ‘What elements are needed during the work integrated learning experience to enable undergraduate nursing students to construct their nursing identity?’ Results/Findings: Findings reveal five key elements to the construction of students’ nursing identity; positive role models, belonging, peer support, critical thinking abilities and confidence. Conclusion: Such findings are important as they provide information for student nurses, preceptors and educators in guiding clinical placement experiences that are able to facilitate the development of the nursing identity.

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.

New graduate mental health nurse competencies

Aggression during psychiatric hospitalization is frequent, problematic, and a major challenge for nurses and mental health services more generally. The strength of the therapeutic alliance between nursing staff and patients has been posited as an important protective factor that can limit the likelihood of aggression. This study examined the relationship between interpersonal style, perceived coercion, and psychiatric symptoms on the therapeutic alliance between patients and staff, and how each, in turn, is related to aggression. Participants in this study were 79 patients admitted to an acute psychiatric hospital. Each participant was interviewed to determine perceived coercion, symptoms of psychiatric illness, interpersonal style, and therapeutic alliance. Incidents of aggression were recorded at discharge through a review of incident forms, file review, and interviews with unit nursing staff. The results showed that a hostile-dominant interpersonal style and symptoms of paranoia predicted poor therapeutic alliance, contributing 14% of the variance in therapeutic alliance scores. A dominant interpersonal style predicted aggression towards staff. Therapeutic alliance, perceived coercion, and symptoms of psychiatric illness did not predict aggression. Implications for engagement in treatment and the prevention of aggression are discussed.

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.