Learning needs assessment as a vehicle for integrating staff development into a professional practice model

Restructured nursing roles resulting from innovative professional practice models and participative governance systems create a demand for new and expanded competencies. The impact for nursing staff development is the concurrent requirement to develop programs that match the skill/competency requirements of nurses in emerging practice models. This article recounts how one nursing department implemented a learning needs assessment (LNA) process as a means of integrating staff development into professional nursing practice.     

Ward sisters' objectives in developing nursing and problems with development

AIM: The study aimed at ascertaining the objectives, development strategies and problems of ward sisters in developing nursing. BACKGROUND: More knowledge is needed of first-line management in order to be able to develop organizations and ward sisters' professional training. METHODS: Data collection was by a questionnaire completed by 37 ward sisters in two Finnish hospitals. Thirty-six ward sisters responded to the open-ended questions and their answers were analysed using content analysis. FINDINGS: As for their objectives, ward sisters emphasized a functioning working community and good care. Good care was based on a variety of theoretical ideas, on the quality and economy of care. The means by which these objectives could be achieved were process thinking, reflection on action, leadership and the development of the working community. The leadership strategies mentioned were profit management and participatory leadership. In developing the working community, ward sisters relied on collaboration, good climate and training. Ward sisters' problems with developing nursing care were related to resources, work organization and the working community. CONCLUSIONS: Besides expertise in nursing, ward sisters are required to have skills in leading and developing the working community, collaboration and especially the ward's climate.     

Advancing working and learning through critical action research: creativity and constraints

Continuous professional development is an essential component within many health care ‘Learning Organisations’. The paper describes the first phase of an initiative to develop a professional practice development framework for nurses in an NHS general hospital. The project was undertaken within a critical action research methodology. A tripartite arrangement between the hospital, a university and professional nursing organisation enabled clinical, educational and research support for the nurses (co-researchers) engaged in the project. Initial challenges were from some managers, educationalists and the ethics committee who did not appear to understand the action research process. A multi-method approach to data collection was undertaken to capture the change process from different stakeholders’ perceptions. Triangulation of the data was undertaken. Despite organisational constraints, transformational leadership and peer support enabled the co-researchers to identify and initiate three patient-focused initiatives. The change process for the co-researchers included: enlightening personal journey, exploring the research–practice gap, enhancing personal and professional knowledge, evolving cultural change and collaborative working, empowering and disempowering messages. A hospital merger and corporate staff changes directly impacted on the project. A more flexible time-scale and longer term funding are required to enable continuity for trust-wide projects undertaken in dynamic clinical settings.     

“造口护理工作坊”在肠造口护理中的作用

[目的]采用“造口护理工作坊”业务培训的方式加强临床护理人员对造口相关知识及护理操作的认识,提高对造口相关并发症的预防和处理能力。[方法]成立造口专业小组,组织造口相关科室护士长及护理骨干进行业务培训。[结果]提高了临床护理人员的专业知识,掌握了规范的造口相关操作,并对如何预防和护理造口相关并发症有了一定的了解。[结论]“造口护理工作坊”业务培训的方式为临床护理人员提供了学习、交流平台,提高了对造口病人全方面护理的重视,促进了造口专业的发展。     

Nurses' reflections on pain management in a nursing home setting.

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.     

护理业务管理模式的改革与成效

目的:医院抓护理业务建设,满足病人需求,提高护理内涵。方法:医院建立护理业务技术管理小组;引入竞争机制,开展病人选护士活动;运用目标战略管理模式实行临床护士规范化培训;尝建新型护理业务管理制度;试点开展“专病专护”,加强护理人员知识库管理;全面推进整体护理。结果:护理科技含量、护理技术满意度、护士任职能力和护理人员知识层次都有了明显的提高,结构多元化。结论:护士中形成了“有为才有位”的护理观。     

Strategies to facilitate effective caring for patients in primary health care clinics

BackgroundCaring is described as the innermost core of nursing which occurs in a relationship between the patient and the care provider. Although caring in nursing is associated with maintaining and strengthening of the patient’s sense of dignity and being a person, there seems to be a gap between caring theories in nursing, healthcare policies and caring for patients by professional nurses in primary health care clinics. Developing strategies that will facilitate effective caring for patients by professional nurses in primary health care clinics within an ethical and mindful manner became an area of focus in this study.ObjectivesTo develop strategies to facilitate effective caring for patients by professional nurses in primary health care clinics in South Africa.MethodStrategies were developed based on the conceptual framework developed in Phase 2, which was derived from synthesis of the results of Phase 1 of the previously conducted study and supported by literature. The conceptual framework reflects the survey list of Dickoff, James and Wiedenbach’s practice theory.ResultsThree strategies were developed: 1) facilitating maintaining of the empowering experiences; 2) facilitating addressing the disempowering experiences by professional nurses, and 3) facilitating addressing of the disempowering primary health care clinic systems.ConclusionThe developed strategies, being the proposed actions, procedures and behaviours, could facilitate effective caring for patients by professional nurses in primary health care clinics.     

The Duke-NICHE program: an academic-practice collaboration to enhance geriatric nursing care

The Duke-Nurses Improving Care of Healthsystem Elders (NICHE) is an example of an academic-practice partnership between a university-based school of nursing and a health system that aims to improve care of older adults by simultaneously enhancing the expertise of frontline nursing staff, accelerating the implementation of evidence-based care approaches, and generating scientific knowledge at the point of care. This article describes the processes used to develop the partnership, and reports initial outcomes and lessons learned. Although challenging to develop and sustain, academic-health system partnerships hold potential to improve care through both improved implementation of evidence and stimulating new research at the point of care.     

Practice change: the process of developing and implementing a nursing care delivery model for geriatric rehabilitation

The authors describe a participative management approach was used to develop and implement a nursing care delivery model for geriatric rehabilitation. This approach led to a sense of shared decision making and established consensus among the majority of staff. An integrated primary and modular nursing model that incorporated a geriatric resource nurse role was developed to maximize accountability and continuity of care. Ongoing evaluation will further clarify the impact of this model on staff and patient outcomes.     

养老机构护理员护理安全风险认知现状与干预对策

目的对养老机构护理员进行护理安全风险认知水平的调查与干预,以提高护理员服务能力。方法2018年2—7月采用自行设计调查问卷调查东莞市9家公办养老机构的95名护理员对老年护理安全风险的认知现状,比较专业技术培训前后护理员护理安全风险认知水平。结果培训前护理员老年护理安全风险知识总分(121.06±9.50)分,得分率65.44%,各维度得分率由高及低依次是皮肤护理安全(得分率74.65%),跌倒安全(得分率73.35%),进食安全(得分率70.23%),认知障碍风险(得分率65.01%),服药安全(得分率48.90%)。培训后护理员对护理安全风险的认知总分及各维度得分均高于培训前(P<0.01)。结论东莞市养老机构护理员对老年护理安全风险的认知水平较低,针对性的专业培训可提高其护理安全认知水平,降低护理安全风险,从而提高其对老年人的照护水平。     

Developing the nursing care of breast cancer patients: an action research approach

? This study set out to develop the nursing care of breast cancer patients at the Central University Hospital in Turku, Finland, using the methods of action research and to evaluate the results of the development effort from the point of view of both patients and nursing staff. ? A theoretical model of the care of cancer patients was constructed on the basis of existing knowledge of how people react in stress and crisis situations or at different stages of a difficult illness. ? A specific care programme for breast cancer patients was also planned for the hospital's oncology and surgical units. ? Data were collected using questionnaires. ? Results indicated that our theoretical model of the care of cancer patients worked reasonably well. They also clearly highlighted the areas in which there is room for further improvement. ? Patients' experiences of the nursing staff were generally positive and the majority of the nursing staff also regarded the development project as a success.     

医护联合查房在CCU病房中的应用

目的：探讨医护联合查房在CCU病房中的应用效果。方法：应用我院CCU病房中医护联合查房的实例,分析医护联合查房对CCU病房的益处。结果：医护联合查房充分发挥护士的积极性与主动性,提高护士自身的业务水平,改善了护理质量,从而大大减轻患者的痛苦,促进患者更好更快的康复。结论：医护联合查房不仅促进护士专业化知识,而且促进医生对护理知识的了解,也增进患者对疾病的认识,提高患者对医护人员的信任度和满意度,最终促进患者恢复。     

The Magnet process: one appraiser's perspective

Achieving Magnet designation is a journey to excellence. Although excellence is never quite attained, Magnet organizations have nursing leaders who are able to implement innovative nursing programs that attract and retain nursing's best and brightest. These leaders have raised the bar on excellence and are able to demonstrate performance that is in the upper quartile among benchmarks. Even though financial pressures require astute budgetary skill, these leaders do fund research and education programs, are involved in shared leadership/governance activities, and are thus able to demonstrate fiscal accountability in the process. Nurse leaders in Magnet organizations have a highly engaged professional staff as evidenced by active participation in shared governance activities. These leaders have not only created interdisciplinary approaches to patient care and clinical documentation, acuity, and research but also they have hardwired these activities into the fabric of the organization.     

Community nurses' understanding of the community stoma care nurse

The aim of this research was to explore community nursing staff's understanding and perception of the role of the community stoma care nurse and make recommendations to develop a closer working relationship. Prior to this research it was assumed that community nursing staff had little understanding of the community stoma care nurse role and saw the role as one that deskilled community nurses. Findings of this research revealed that community nursing staff have a good understanding of the role and view it as a valuable resource that supports patients and nursing staff and offers an expert service. Recommendations based on this study are that, even though community staff have a good understanding of the community stoma care nurse role, both still need to improve communication so that the teams work more effectively and efficiently for the benefit of patients.     

The role of support staff in pediatric palliative care: their perceptions, training, and available resources

Pediatric palliative care requires the orchestrated efforts of a multidisciplinary care team of medical staff, nursing, psychosocial staff, and other healthcare professionals. Augmenting this team are support staff including financial counsellors, volunteers, secretaries, and others not involved in the direct administration of medical services. Prior research in palliative care has studied the perceptions, training, and professional resources of medical staff and social workers, but neglected to investigate such factors in support staff. Our study examined the effect of involvement in end-of-life pediatric care on support staff. We found this community to consist of a heterogeneous population of hospital employees, who develop numerous, substantial, direct interactions with dying children and their families. They indicated that such experiences had caused some adverse outcomes in their lives, and that few felt they had sufficient knowledge or training in palliative care. Our respondents voiced noteworthy opinions on symptom control, cultural issues, and spirituality pertinent to pediatric palliative care. Support staff play a key role in the palliative care team; research and resources need to be directed to educating, training, and supporting them.     

Developing leaders at every level: accountability and empowerment actualized through shared governance

The shortage of frontline nursing staff and their managers in acute care organizations necessitates strategies to both use and recognize the unique knowledge and skills of these individuals. The authors describe one organization's successful implementation of a shared decision-making structure that promotes an empowering work environment in which professional fulfillment and personal satisfaction can flourish. With support and opportunity, leaders are developed across all levels of nursing.     

Substitution in nursing practice: clinical, management and research implications

The introduction of market forces into health care delivery systems has had a number of important influences on the roles nurses perform. There have been increasing efforts to find alternative and more cost-effective ways of delivering care. One facet of this situation has been the examination of the roles and responsibilities of registered nurses (RNs) with the view of exploring different ways of using professional skills and determining if RN services are always required. One result of this has been the increased use of unlicensed personnel. The substitution of professional nursing staff by unlicensed personnel has become a major concern for practitioner, manager and client alike. This paper reviews some of the concepts of economic substitution as well as the assumptions advanced for the use of unlicensed personnel in clinical areas as a substitute for nursing services. While there has been increased use of unlicensed staff, the evaluation of clinical outcomes has been poor. This paper reviews primarily the hospital-based evidence about the impact of using unlicensed personnel in practice, and suggests there are methodological problems with the research published to date. Findings suggest that substitute service providers generally 'do no harm'. By contrast, evidence is presented indicating the major contributions nurses make to client care when adopting advanced practice roles (acting as a substitute for other professionals).     

Staff perceptions concerning barriers and facilitators to end-of-life care in the nursing home

Although many nursing home residents have chronic, life-limiting conditions, most die without the benefit of palliative care or with palliation delayed until the last days of life. The goal of this study was to determine whether the presence of a comprehensive palliative care program in nursing homes would affect the knowledge and attitudes of the staff. The intervention group was able to identify more problems in delivering palliative care than the control group, but this only reached statistical significance on 2 items. Nevertheless, the current study suggests that the presence of a palliative care program within a nursing home does increase general knowledge of the problems faced in caring for the dying.