Rose Chapman

Coping strategies in clinical practice: the nursing students' lived experience.

Abstract This phenomenological study was designed to understand the lived experience of nursing students coping with the demands of their clinical practice. The Husserlian phenomenological approach was used. The data revealed several strategies that fourteen student nurses utilised to cope with the demands of their undergraduate clinical program. The participants discussed having a strong determination to complete their course and talking things over with family, friends, and other students as means of helping them get through it. They considered that only other nursing students could really understand the experience of being a student nurse. Therefore, a very effective student grapevine operated in their undergraduate program. The grapevine was used to disseminate information about all aspects of the course. Other strategies discussed by the participants were ‘playing the game’ and doing only what was necessary to complete the undergraduate program. This paper describes the learning strategies used by nursing students during their clinical practice, which has implications for clinical teachers and schools of nursing.

Types of Patients in a Psychiatric Intensive Care Unit

Objective: This paper reports the findings of a descriptive study of a patient population over a three-month period on an eight bed psychiatric intensive care unit (PICU) in Western Australia. The report provides a quantitative insight into the profile of patients in PICUs. It provides information on patients’ diagnoses, presenting signs, symptoms and/or behaviours, legal codes assigned to patients, treatment interventions and management. Method: Data were collected prospectively from August to October 1999. A total of 122 patients were admitted to the PICU during the review period. Data were entered into an Access program then exported to SPSS (Version 9 for Windows) for analysis and frequency distributions were obtained. Results: The results confirmed that the majority of patients admitted to the PICU were assessed as a high level of risk or needed containment. This finding is in line with the admission criteria developed by staff working in the PICU. It also supports the view that staff working in these units require expertise and confidence to communicate with and manage potentially aggressive and highly aroused patients. Conclusion: This study demonstrates the importance of ongoing evaluations of patient populations in promoting best practice initiatives in psychiatric care.

Establishing best practice guidelines for administration of intra muscular injections in the adult: A systematic review of the literature

Abstract This article describes best practice guidelines for the administration of intramuscular injections developed after the identification of 300 abstracts and a review of 150 articles on the subject area. While the administration of medication via the intramuscular route is a daily occurrence for nurses working in both hospitals and community settings, several concerns and complications have been identified with the procedure. Routinely, nurses are required to make numerous decisions regarding factors such as needle size, length and the site to be used during the administration of medication into muscle tissue. Therefore, it is important that relevant up-to-date guidelines are available to assist nurses to make informed decisions about the technique to use. Techniques delivering medication to the correct site will facilitate efficacious outcomes for the client and ensure the delivery of quality nursing care in all health care settings.

Emergency Department Mental Health Triage and Consultancy Service: an advanced practice role for mental health nurses.

Abstract This paper describes a four-month preparatory training program for mental health nurses to provide an Emergency Mental Health Triage and Consultancy Service in the emergency department. The emergency department is an important gateway for patients presenting with psychiatric/psychosocial problems and mental health professionals need to provide prompt and effective care to this group of patients. Prior to the implementation of the service, it was acknowledged that occupational stress and burnout could affect the turnover of mental health nurses in the department. Therefore, a training program was employed to prepare a number of experienced mental health nurses to work at an advanced practitioner level. The four-month training program developed at Fremantle Hospital in Western Australia provided support, guidance and clinical supervision. In the first 12 months of the service, five mental health nurses completed the program, thus creating a pool of nurses who were able to provide the service. The results demonstrated that providing mental health nurses with a structured program was instrumental in facilitating their movement to an advanced practitioner level. The nurses were able to apply advanced knowledge and skills to assess and manage clients with complex mental health /psychosocial problems. Furthermore, on leaving the emergency department these nurses were able to utilise the advanced skills in other areas of mental health nursing practice.

Community mental health care: documenting the role of the nurse.

Abstract In Australia, the process of deinstitutionalisation has resulted in the closure or downsizing of many large stand-alone psychiatric hospitals. The aim of modern community mental health care is to provide treatment and rehabilitation for people, who have a mental illness, in their local community. This aim is supported by the Australian National Mental Health Strategy that outlines the importance of health professionals, carers, and consumers working together to obtain the best therapeutic outcomes. This study was undertaken to obtain information regarding the current role of the community mental health nurse (CMHN). All community mental health nurses working in the Adult Program at the Directorate of Mental Health Services, Fremantle Hospital and Health Service in Western Australia participated in the study. The study was completed in November 2000. The results showed that the CMHNs’ role focused on six main areas. These areas included the day-to-day management of clients, working with carers and their families; crisis work for both existing and first time contacts; as well as liaison and advocacy work. The finding of this study demonstrate CMHN’s work most often with acutely ill and psychotic patients and their families. Therefore, CMHN’s play a pivotal role in promoting and sustaining the philosophy of community mental health care. In addition, the liaison work within the community completed by CMHN’s is vital to address the mental health needs of the community and to reduce the stigma associated with mental illness. The documented findings of this study provide challenges for the further expansion of the CMHN’s role and the development of best practice initiatives in community mental health care.

Leading Change and Advancing Health by Enhancing Nurses' and Midwives' Knowledge, Ability and Confidence to Conduct Research through a Clinical Scholar Program in Western Australia

This paper reports on an evaluation of a Clinical Scholar Program initiated at a hospital in Western Australia. The aim of the program was to build the capacity of nurses and midwives to conduct research and evidence-based practice within the hospital. The program was based on a previous program and consisted of six teaching days and four hours per month release for proposal preparation. At the end of the program participants were asked to complete a short anonymous questionnaire. The answers were analysed using standard processes of qualitative analysis. Themes emerging from the data included program strengths, individual gains, ability to conduct research, and areas for improvement. The findings highlighted that, while the participants considered that they were more knowledgeable and confident to conduct research, they still required support. The Clinical Scholar Program has provided a way to increase the capacity of clinicians to participate in research activities.

Interpersonal relationships between registered nurses and student nurses in the clinical setting—A systematic integrative review

BACKGROUND A significant proportion of undergraduate nursing education occurs in the clinical setting in the form of practising skills and competencies, and is a requirement of all nursing curriculum for registration to practice. Education in the clinical setting is facilitated by registered nurses, yet this interpersonal relationship has not been examined well. OBJECTIVE To investigate the experience of interpersonal relationships between registered nurses and student nurses in the clinical setting from the point of view of the registered nurse. DESIGN Integrative review Review methods: The databases of MEDLINE, CINAHL and OVID were searched. Key words used included: Registered Nurse, Preceptor, Buddy Nurse, Clinical Teacher, Mentor, Student Nurse, Nursing Student, Interpersonal Relationships, Attitudes and Perceptions. Additional review of the literature was manually undertaken through university library textbooks. RESULTS 632 abstracts were returned after duplicates were removed. Twenty one articles were identified for full text read (quantitative n=2, mixed n=6, qualitative n=14); of these, seven articles addressed the experience of interpersonal relationships between registered nurses and student nurses in the clinical setting from the point of view of the registered nurse and these were reviewed. CONCLUSIONS Providing education for registered nurses to enable them to lead student education in the clinical setting communicates the organizational value of the role. Registered nurses identified being supported in having the time-to-teach were considered important in facilitation of the clinical teaching role. The integrative review did not provide evidence related to the impact diverse clinical settings can have on the relationships between registered nurses and student nurses revealing an area for further examination.

An essay about health professionals’ attitudes to lesbian, gay, bisexual and transgender parents seeking healthcare for their children

BACKGROUND This paper is a polemic essay about an important but sometimes controversial subject. Lesbian, gay, bisexual and transgender (LGBT) clients can be reluctant to reveal their sexual orientation to health professionals from whom they may be seeking health care for their children. Family-centred care (FCC), where care is planned around the whole family not just the individual child, is widely used across the world, but unless all aspects of the families who present for care are respected, care delivery is compromised. This is particularly important for minority groups and potentially vulnerable families such as LGBT. AIM This descriptive essay discusses the use of health services by LGBT parents, how seeking health care is influenced by perceived perceptions of LGBT people held by health professionals, and examines factors affecting such seeking of health care. DISCUSSION We show that LGBT people may be unwilling to disclose sexual identity to health professionals when seeking health care for their children. Health professionals attitudes can be affected by factors such as gender, age, religious and political affiliations, education level and previous interactions with LGBT people. CONCLUSION We conclude our argument with the assertion that all parents, including those from minority groups such as LGBT, who bring their children for health care need supportive family-centred care, and only by ensuring that the health professionals delivering care are well educated about all aspects of sexuality will care be family-centred.

Evaluation of staff cultural awareness before and after attending cultural awareness training in an Australian emergency department.

INTRODUCTION Cultural awareness of emergency department staff is important to ensure delivery of appropriate health care to people from all ethnic groups. Cultural awareness training has been found to increase knowledge about other cultures and is widely used as a means of educating staff, however, debate continues as to the effectiveness of these programs. AIM To determine if an accredited cultural awareness training program affected emergency department staff knowledge, familiarity, attitude of and perception towards Australian Aboriginal and Torres Strait Islander people. METHOD One group pre-test and post-test intervention study compared the cultural awareness of 44 emergency department staff towards Aboriginal and Torres Strait Islander people before and after training. The cultural awareness training was delivered in six hours over three sessions and was taught by an accredited cultural awareness trainer. RESULTS The cultural awareness training changed perception but did not affect attitude towards Aboriginal and Torres Strait Islander people in this group. CONCLUSION Future strategies to improve staff cultural awareness need to be investigated, developed, implemented and evaluated.

Admission and Discharge Practices: High Dependency Unit Audit Outcome

Abstract This paper presents the findings of a retrospective audit of admission and discharge practices of a nurse led High Dependency Unit (Nurse Specials Unit) in Perth, Western Australia. The aim of the study was: • to review the effectiveness of the inclusion and exclusion guidelines for patients admitted to the Nurse Special Unit (NSU); • to identify characteristics of admitted patients; and • to determine the level of adherence to admission protocols for documentation of patient condition, plan of care, medical and Clinical Nurse Consultant review. The sample comprised all patients admitted to the NSU from September 2004–March 2005, excluding those (50) in the pilot study (n = 154). This audit revealed patients were primarily elderly and admitted for close nursing supervision. Inclusion and exclusion criterion were adhered to, however documentation of patient data, in relation to current status and plan of care, was poorly completed and frequently absent during intra hospital transfer. This lack of clear documentation poses a significant risk to the patient. Further research is required to determine strategies that result in appropriate and useful transfer documentation. In addition, the content of transfer data that permits continuity of care needs to be determined.