Sandra. Walker

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.

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.

Working in caseload midwifery care: The experience of midwives working in a birth centre in North Queensland

BACKGROUND Pregnancy, birth and child rearing are significant life events for women and their families. The demand for services that are family friendly, women focused, safe and accessible is increasing. These demands and rights of women have led to increased government and consumer interest in continuity of care and the establishment in Australia of birth centres, and the introduction of caseload midwifery models of care. AIM The aim of this research project was to uncover how birth centre midwives working within a caseload model care constructed their midwifery role in order to maintain a positive work-life balance. METHODS A Grounded Theory study using semi-structured individual interviews was undertaken with seven midwives who work at a regional hospital birth centre to ascertain their views as to how they construct their midwifery role while working in a caseload model of care. FINDINGS The results showed that caseload midwifery care enabled the midwives to practice autonomously within hospital policies and guidelines for birth centre midwifery practice and that they did not feel too restricted in regards to the eligibility of women who could give birth at the centre. Work relationships were found to be a key component in being able to construct their birth centre midwifery role. The midwives valued the flexibility that came with working in supportive partnerships with many feeling this enabled them to achieve a good work-life balance. CONCLUSION The research contributes to the current body of knowledge surrounding working in a caseload model of care as it shows how the birth centre midwives construct their midwifery role. It provides information for development and improvement of these models of care to ensure that sustainability and quality of care is provided to women and their families.

A comparison of silicone and polyurethane PICC lines and postinsertion complication rates: a systematic review

Purpose To determine postinsertion complication rate for peripherally inserted central catheters (PICCs), in particular the difference between silicone and polyurethane lines in general population groups as well as oncology and non-oncology patient groups. Methods A systematic review of prospective and retrospective studies in the English language between January 2000 and October 2013 focusing on postinsertion complication rates for PICCs in the adult population. Joanna Briggs Institute tools were used to extract data from the final 19 articles with information collated relating to catheter type, patient type, overall complication rate, rates of infection, occlusion, dislodgment, phlebitis, thrombus and rupture. Results Overall, the PICCs complication rates ranged from 8 to 50%. Although both lines saw similar overall rates upon closer observation, the strengths and weaknesses of both lines are shown. Polyurethane PICC lines were found to provide lower rates of infection, dislodgment, thrombus and rupture complications. Mixed results were found with catheter line occlusions, overall averages showing polyurethane lines slightly higher rates than silicone. Oncology patients however saw opposite results. Phlebitis rates saw the largest division among the postinsertion complication rates, with 6.7% more phlebitis in the general patient group and 14.5% in the oncology group more for those with polyurethane PICC lines compared with the silicone. Conclusions Both silicone and polyurethane PICC lines exhibit nearly identical overall average postinsertion compilation rates; however, it is the type of complications experienced that differ. Overall, oncology patients can expect to experience higher levels of postinsertion complications.

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.