Liberating new talents: an innovative pre-registration community-focused adult nursing programme

The drive for a more community-focused approach to pre-registration nursing education as identified in Modernising Nursing Careers, (Department of Health, 2006a) has continued to gather momentum. The research literature identifies that the community context impacts significantly on care delivery, with student nurses often missing the underlying complexities of working in this context; focusing on the task in hand rather than the broader landscape of care (Carr, 2004). In 2008, a community focused pre-registration adult nursing degree pathway was started at Canterbury Christ Church University (CCCU), to prepare a cohort of 16 nursing students to work in the community and general practice setting at the point of registration. Placement learning has been focused within general practice and community through a hub and spoke approach to enable students to develop a deep understanding of the complexities of care in this setting with particular reference to the management of risk and unpredictability. The pilot is being formally evaluated with a particular emphasis on the meaning and relevance of practice learning within these settings. The emerging data will not only provide evidence to promote the community and general practice agenda within pre-registration curricula, but help to clarify the essential skills and knowledge required to prepare students nurses for working in these settings.     

The challenge facing nursing education: to develop clinical performance examination strategies in nursing practice

The clinical performance examinations of qualified health professionals have become a central professional and corporate issue. Nursing experts have to face trends in nursing care delivery toward a clinical competence-based care model that assesses the professional skills and efficacy of nursing professional and students. Objective, structured clinical examination standards and strategies can be effective vehicles for nursing education and practice, promoting the mastery of clinical nursing skills and fostering an evidenced-based practice approach to clinical care.     

Beyond the misapprehension of nursing rituals

TOPIC: The power of nursing symbols and rituals to convey the values of contemporary professional nursing. PURPOSE: To explore the power of symbols and rituals from the perspective of experts in ritual studies, and to demonstrate their significance for the practice of professional nursing. SOURCES: Published literature. CONCLUSIONS: A renewed understanding of the transformative power of nursing symbols and rituals will allow us to see that they do not oppose, but rather complement, science and professional status. Nursing symbols and rituals must not be discarded. They must be reinvented to convey the values of contemporary professional nursing.     

Education, empowerment, and elderly adults--enhancing nursing expertise in the long-term care setting

The rapidly emerging changes in health care needs of elderly individuals have prompted many articles and public policy proposals in support of the advancement of gerontological nursing education. Although more financial support for gerontological expertise is necessary, nurses have begun to move ahead with innovative programs to enhance their own geriatric practice. In this article, the author describes a collaboration among a long-term care facility and local universities created to provide an advanced practice degree program for working nurses interested in gerontology. A needs assessment survey, program planning, and implementation are outlined. The end result is 20 RNs graduating from a master's level program who anecdotally identify increased confidence, critical thinking, and use of research and evidenced-based practice as a result of their graduate studies. The author concludes that more programs accommodating the complex needs of working nurses are needed to develop nursing expertise in gerontology.     

Quality of death: a dimensional analysis of palliative care in the nursing home

Palliative care in nursing homes is increasingly discussed, investigated, and implemented, yet the term lacks conceptual clarity and definition. Furthermore, the components, process, and outcomes of palliative care as it is delivered in the nursing home have not been clearly articulated. This paper provides a dimensional analysis of palliative care in the nursing home to elucidate the concept and its context and consequences, as portrayed through available literature. As a method, dimensional analysis is rooted in symbolic interaction and grounded theory. As such, it provides a useful tool with which to analyze existing literature on palliative care in the nursing home. In this dimensional analysis, communication is the dominant perspective of palliative care in the nursing home. This analysis demonstrates that the consequences of palliative care in the nursing home are personhood and identity, and quality of death rather than quality of life. These consequences suggest that the focus of palliative care should be on the nursing home resident and the dying experience, rather than quality of life and issues around living that exclude the dying experience and do not acknowledge the personhood and identity of the resident. These elements represent a shift in focus away from one that does not include death, toward the dying experience, and that such a change in focus is necessary to achieve palliative care in the nursing home. Finally, the analysis elucidates potential outcome measures for the study of palliative care in nursing homes and outlines possibilities for further research.     

The implementation of a guideline of care for patients with a Sengstaken-Blakemore tube in situ in a general intensive care unit using transitional change theory.

The use of the Sengstaken-Blakemore tube as a life-saving treatment for bleeding oesophageal varices is slowly becoming the least preferred method possibly due to the potential complications associated with its placement. Nursing practice pertaining to the care of this patient group appears ad hoc and reliant on local knowledge and experience as opposed to recognised evidence of best practice. Therefore, this paper focuses on the application of Lewin's transitional change theory used to introduce a change in nursing practice with the application of a guideline to enhance the care of patients with a Sengstaken-Blakemore tube in situ within a general intensive care unit. This method identified some of the complexities surrounding the change process including the driving and restraining forces that must be harnessed and minimised in order for the adoption of change to be successful.     

Evaluation of an evidence-based nursing tool for acute hospitals

Routine documentation of nursing care is an important part of everyday nursing practice. Evaluation of a new evidenced-based nursing assessment tool--the Gloucester patient profile--was carried out in six ward areas in an acute hospital setting. Non-participant observation and nominal group evaluations showed that the new assessment tool took longer to complete than the traditional record, but reduced the amount of paperwork. And more importantly, significantly more nurses completed the nursing record at patients' bedsides, and involved patients and their relatives in the process.     

Research priorities in mental health nursing

This study determined nursing research priorities that focused on mental health nursing in the published literature from 1990 to 1996. Determination of which priorities were related to mental health was completed using 18 sources (experts, organizations, and individual research projects). A content analysis of the 18 sources was completed, and 56 mental health related research priorities were identified. Six categories emerged from the data analysis: support, holism, mental health nursing practice, quality care outcomes, mental health etiology, and mental health delivery systems. As mental health nursing embraces evidenced-based practice, the need for clear research priorities is imperative for knowledge development in the field.     

Qualitative and quantitative approaches in mental health nursing: moving the debate forward

In recent years, two distinct, and apparently opposing, positions have arisen in debates concerned with mental health nursing research, education and practice. Each of the two has its champions and 'gurus', and its detractors. Writers associated with the quantitative camp have argued in favour of: experimental research where the aims are the investigation of the outcomes of nursing care; multidisciplinary rather than unidisciplinary research; a physiological explanation for mental illness; clinical practice which is evidence based, and skills based education. Qualitative camp writers, on the other hand, have argued for: qualitative research to explore the experiences of illness, and of nursing; the preservation of nursing-only research; the relative irrelevance of physical explanations of mental illness, and holistic nursing practice in which clinical techniques are less important than interpersonal relationships. In this paper, we first review and criticize some key ideas associated with these two positions. In our subsequent analysis, we argue that, rather than differing at some fundamental level, the differences found between the two camps may be more a matter of emphasis. The possibilities of reconciliation and synthesis are, finally, presented and discussed.     

Making evidence-based practice a reality in your institution

There are many barriers to ensuring that nursing practice is based on research evidence. This article provides several resources to help the practicing nurse identify what evidence is available upon which to make practice changes. Additionally, strategies for supporting change are discussed and a case study of one particular evidenced-based change--1:1 support by nurses for women in labor--is examined.     

RESEARCH PRIORITIES IN MENTAL HEALTH NURSING

This study determined nursing research priorities that focused on mental health nursing in the published literature from 1990 to 1996. Determination of which priorities were related to mental health was completed using 18 sources (experts, organizations, and individual research projects). A content analysis of the 18 sources was completed, and 56 mental health related research priorities were identified. Six categories emerged from the data analysis: support, holism, mental health nursing practice, quality care outcomes, mental health etiology, and mental health delivery systems. As mental health nursing embraces evidenced-based practice, the need for clear research priorities is imperative for knowledge development in the field.     

循证护理指导脑血管病介入术后护理的研究

目的探讨运用循证护理思维指导经皮股动脉穿刺脑血管介入治疗术后患者的护理效果。方法回顾性分析病例120例,58例作为对照组,给予常规护理。观察组62例,采用循证护理方案,提出护理问题,针对问题查阅相关资料和文献的直接和间接实证,并进行分析、归纳、结合临床实践,制定出护理方案并实施。结果观察组24 h腰背酸痛、腹胀、入睡困难、尿潴留发生率显著低于对照组(P<0.01),两组均未发生并发症。结论运用循证护理可提高脑血管介入治疗术后患者的舒适度,预防并发症,提高护理质量。     

Nursing knowledge, theory and method revisited

With the approach of the 21st century, nursing is having to respond to diverse influences which are remoulding the professional landscape. Not least of these is the changing status of western economies which underpins a drive towards evidence-based practice and an increased emphasis on multidisciplinary approaches to health care delivery. Certainty in health care is now a thing of the past. Central to the way the nursing profession embraces the future is its underlying philosophy: that which articulates professional values and shapes practice, research, education and management. In a time of change it is therefore essential to revisit the philosophical framework which underpins nursing. The debate in nursing research and theory appears to have stressed the polarization of viewpoints. It may be the case that feminist writers, ethnographers, positivist researchers and nursing theorists, in defending their own points of view, diminish rather than enhance professional dialogue. This paper reviews the nature of this debate within nursing and considers the implications that a dichotomous position may have for knowledge, theory and research method within the current context of health care. It then suggests a philosophical framework which could be relevant and accessible across the whole spectrum of nursing activity. In so doing, the paper aims to contribute to the discussion around epistemology and method in a way which encompasses the diversity found within the broad church of nursing.     

Thank-you cards: reclaiming a nursing student ritual and releasing its transformative potential

The giving of a "thank-you card" to the staff of a health service in which clinical experience was gained, is common practice amongst nursing students in Australia. Group reflection, or debriefing, following the clinical experience is also a common practice. As rituals in nursing, they can become routinised, taken-for-granted and have little meaning or influence. This paper discusses an educational activity devised by the author that aimed to transform a relatively innocuous practice into one that had empowering potential for students, giving them voice in the health service culture and emphasizing the need for a more humanized workforce, one that actively seeks out opportunities to give each other helpful feedback so that change is ongoing. The activity drew upon narrative pedagogy, showing students how stories combined with rituals have transformative potential not only for themselves as students, but for the entire culture of nursing. The paper argues that cultural change need not be monumental for it to have enduring effect and it is within the jurisdiction of even the most junior student. The "thank-you card" ritual that students commonly use can be reclaimed and extended so that students become activists in the building of a more humanistic, supportive nursing and learning culture.     

Reinstating district nursing: A UK perspective

As policy directives gather pace for service provision to be delivered in primary care, district nursing has not been recognised as a valuable asset to facilitate this agenda. Investment in district nursing and specialist district nursing education has fallen. This is concurrent with an ageing district nursing workforce, a lack of recruitment and growing caseloads, as district nursing adapts to meet the challenges of the complexities of contemporary healthcare in the community. The district nurse role is complex and multifaceted and includes working collaboratively and creatively to coordinate care. Redressing the shortages of specialist district nurse practitioners with increased numbers of health care support workers will not replace the skill, knowledge, experience required to meet the complex care needs of today's society. District nursing needs to be reinstated as the valuable asset it is, through renewed investment in the service, research development and in specialist practice education. To prevent extinction district nurses need to be able to demonstrate and articulate the complexities and dynamisms of the role to reinstate themselves to their commissioners as a valuable asset for contemporary practice that can meet current health and social care needs effectively.     

Translating change: The development of a person-centred triage training programme for emergency nurses

Within health care, there has been a change in practice from an illness-orientated service to one that is more health-focused and person-centred. The concept of person-centredness is frequently espoused by practitioners as being not only a desirable, but a necessary element of health care provision. Indeed, nationally and internationally, person-centred care has underpinned many healthcare documents and policies. Person-centred practice focuses on providing care, utilising a variety of processes that operationalise person-centred nursing and include working with patients′ beliefs and values, engagement, presence, sharing decision-making and providing for physical needs.In the field of emergency nursing, the incorporation of person-centred care and its holistic foundation may require a significant shift in practice. There is evidence to suggest that emergency nurses view their role as one, which is predominantly concerned with providing urgent physical care, rather than one, which espouses the theories of holistic healthcare. To this extent, being person-centred in the context of emergency care, requires the nurse to move beyond the traditional notions of his/her role and to embrace the more holistic aspects of patient care. The aim of this article is to critically analyse how a change in nurse-led triage training in one Irish Emergency Department facilitated an improved person-centred approach in practice.     

The importance of emancipatory research to contemporary nursing practice

When considering the significant changes that continue to transform nursing practice, a focus on evidenced-based practice has clearly placed nursing research at the forefront of professional practice. The aim of this paper is to highlight the important contribution that emancipatory research methodologies can make to the ongoing development of contemporary nursing practice. A research example demonstrates how an emancipatory framework was applied to a recent doctoral study undertaken with Australian community nurses who provided palliative care. The research focus was on exploring the relationship between the nurse's emotional well-being and their professional practice. The research was epistemologically located within a critical and feminist framework. Emancipatory research is well situated to address the subjective experiences of nurses and to contribute strongly to the future of nursing practice.     

Mad talk: attending to the language of distress

This paper will examine how the narrative of one woman, Madeleine, can be constructed as symptomatic of the diagnosis of schizophrenia, and how it can also be read from other perspectives, particularly a poststructural feminist one. The readings are presented as possibilities for understanding the woman's experiences and the implications of this for mental health nursing practice. A poststructural feminist reading acknowledges the gendered experiences of subjectivity and how those experiences are constructed in language. The purpose of this paper is to identify for mental health nursing practice an approach which recognizes the figurative and literal characteristics of language in order to provide nursing care which positions the individual's experience of mental distress as central. This requires an acknowledgement of Madeleine's path into mental distress rather than simply a categorization of what is observed in a clinical setting. Intervention may need to include a range of strategies: medical and nonmedical, psychotherapeutic and social, physical and environmental. It may also require the provision of sanctuary and security whilst these options are explored.