Core topics of health care ethics. The identification of core topics for interprofessional education

OBJECTIVES: The aim of this project was to identify core topics of health care ethics that could be taught through an inter-professional approach to undergraduate education. DESIGN: Five nominal group technique workshops. Setting and participants: Teaching staff from different professional disciplines in our university (nursing branches, occupational therapy and physiotherapy). RESULTS: Seven core topics of health care ethics that are common across all disciplines were identified. However participants in all workshops identified the need for case studies used in teaching and learning to be specific to the clinical setting encountered by the student. CONCLUSION: Despite the identification of core topics that apply to all disciplines, caution should be taken when seeking to integrate these into an inter-professional undergraduate programme. There is evidence from other studies that students have difficulty in transferring knowledge from one context to another. In view of this, an inter-professional approach to health care ethics teaching to a group, members of which do not encounter shared clinical ethical problems may be inappropriate. It is suggested that inter-professional learning in undergraduate health care ethics should focus on facilitating learning in the clinical area with students who share similar ethical encounters, in which case the learning will be truly inter-professional.     

Managers' roles in the professional growth of Iranian clinical nurses

Any progressive organization should consider investing in its clinical nurses' professional growth if it desires to survive and succeed in offering care. Managers play a significant role in facilitating clinical nurses' professional growth. A content analysis study was conducted with 20 clinical nurses and managers in Iran in order to describe how they experienced managers' roles in relation to their professional growth. They believed that managers played two major roles in their professional growth process: motivating and inhibiting. From the participants' point of view, managers, through supporting, encouraging, and valuing staff and creating opportunities for learning, played a facilitating role in their professional growth. But, whenever the staff did not receive this support, they became discouraged and did not make any progress. The results can be used to improve management and, consequently, to enhance the professional growth of staff.     

Peer coaching: the next step in staff development

A common problem in continuing nursing education and staff development is the transfer of learning to clinical practice. Peer coaching offers a solution to this problem. Initiated by educators, peer coaching has been researched in educational settings and found to be effective in facilitating the transfer of newly acquired knowledge and skill into classroom teaching strategies. This article describes the background, components, process, characteristics, and benefits of peer coaching. A specific example of using peer coaching to teach clinical breast examination skills is used to illustrate the application of peer coaching to the staff development of healthcare professionals. Peer coaching is the next step in nursing staff development.     

Nursing students' perceptions about clinical learning environment in Turkey

Clinical education has a vital role in nursing curriculum. Clinical education environment can be enhanced by feedbacks provided by students. The purpose of this research was to search factors that affect the clinical learning environment. A qualitative approach was used. 36 nursing students were recruited from school of nursing in Turkey. It was found that students are negatively affected by communication errors and feedbacks given in the presence of patients by instructors. The constant presence of instructors may be the source of stress for some students. Besides peer support and favourable communication with peers have a positive impact on student learning. Communication with hospital staff and instructors are important. The study revealed that student learning is affected by the level of confidence and support displayed by patients. In order to ensure the most favourable learning environment for students, it is essential that cooperation should be increased between school staff and clinical staff, instructor skills should be developed, and students should be supported in the clinical environment.     

A new paradigm for practice education

This paper explores the complex nature of professional practice. It suggests that educating for all practice disciplines is about to undergo a paradigm shift whereby the value of practical education and experience will be better understood, more rigorously analyzed and integrated with propositional knowledge in the construction of personal professional knowledge and identity. It relates this cross disciplinary position to the present problems of skills deficits which are evident in nurses at the point of registration and demonstrates how routinization and internalization of process and tacit knowledge can create problems for students and newly qualified staff nurses. It also suggests how this can be addressed.It discusses the present culture of 'clinical education by default', unavailability of mentors and resources, and general lack of formal collaborative structures between education and service institutions and suggests that the present system cannot sustain the complex demands, expectations and pace of the clinical context and the evolution of nursing practice. Clinical credibility is an issue as is the current heavy clinical workload of staff nurse mentors, and several collaborative clinical education models are outlined which ensure that staff nurses or resident clinical educators are available and can make clinical teaching their priority. History and the present crisis in nursing suggest that there is a case for mandatory collaborative education/service structures to ensure adequate funding and to monitor the effectiveness of selected models so that staff nurse mentors can work with lecturer colleagues to articulate and teach the complexities of clinical practice through related research.It is predicted that this collaborative approach is capable of addressing both the skills deficits and the wider intellectual challenge of developing a new paradigm of practice education and providing an integrated base for continuing professional development.     

Developing the credibility of continuing education

The paper begins by acknowledging both the need for nursing to be a research based profession, and the reasons for the well-documented theory-practice gap. It goes on to suggest that what is not so well-documented is an examination of the reasons for the commitment gap between basic and continuing education. The relevance of continuing education to clinical staff will be discussed in relation to the change in the content of nursing theory--from the unwieldy 'certainty-based' medical model, to a more flexible, thus perhaps 'uncertainty-based' medical model. The paper will explore the author's belief that clinical staff need to feel a sense of security in their knowledge base, which therefore leads them at times to reject nursing theory. The paper proposes that a legal framework for nurses practice gives the clinical staff the security in their practice to view the relevance of new nursing theory.     

Assisting demented patients with feeding: problems in a ward environment. A review of the literature

A critical review of the literature on assisting demented patients with feeding difficulties identifies that care at mealtimes is often task-centred, causing stress in both patients and staff and inadequate patient care. Nurses may even be inducing dependency in this vulnerable patient group. The staff to whom this care is most often delegated do not receive sufficient education or training to enable them to achieve a sufficient degree of empathy with the patient although there is evidence in the literature to suggest that this is a necessary requirement. It is also apparent that nurses use inadequate assessment criteria, perhaps due to the fact that there is an element of commonality in the feeding behaviour of demented patients which nurses feel they have seen many times and are able to deal with. The introduction of primary nursing, increased education of nursing assistants and improved assessment procedures to combat these problems are recommended. The process of change is briefly outlined and in conclusion some areas for future research are stated.     

Review of nursing documentation in nursing home wards — changes after intervention for individualized care

Using standardized assessment instruments may help staff identify needs, problems and resources which could be a basis for nursing care, and facilitate and improve the quality of documentation. The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) especially developed for the care of elderly people, was used as a basis for individualized and documented nursing care. This study was carried out to compare nursing documentation in three nursing home wards in Sweden, before and after a one-year period of supervised intervention. The review of documentation focused on structure and content in both nursing care plans and daily notes. The greatest change seen after intervention was the writing of care plans for the individual patients. Daily notes increased both in total and within parts of the nursing process used, but reflected mostly temporary situations. Even though the documentation of nursing care increased the most, it was the theme medical treatment which was the most extensive overall. A difference was seen between computer-triggered Resident Assessment Protocol (RAP) items, obtained from the RAI/MDS assessments, and items in the nursing care plans; the former could be regarded as a means of quality assurance and of making staff aware of the need for further discussions. The RAI/MDS instrument seems to be a useful tool for the dynamic process in nursing care delivered and as a basis for documentation. The documentation should communicate a patient's situation and progress, and if staff are to be able to use it in their everyday nursing care activity, it must be well-structured and freely available. The importance of continuing education and supervision in nursing documentation for development of a reliable source of information was confirmed by the present study.     

Changing nursing practice through reflection on the Roper, Logan and Tierney model: the enhancement approach to action research

To the clinical practitioner both nursing models and nursing research may currently be viewed as distant and élitist In the current political climate neither may be highly valued by practitioners or managers Yet, by facilitating group reflection on the nursing model identified in the ward philosophy and adopting the enhancement approach to action research, surgical nurses were empowered to effect change and, consequently, to enhance the quality of patient care in their ward The study was undertaken in two phases over a 15-month period and utilized a multi-method approach In phase 1 triangulation of the data enabled the practitioners/co-researchers to identify and reflect on patients 'psychological needs within the independence/dependence continuum of the Roper et al (1990) model Phase 2 involved a collaborative approach to the planning, implementation and evaluation of innovations which resulted from reflection on practice Nurse-doctor relationships including anaesthetist non-compliance were, though, a controversial issue Collaborative practice was undermined by the co-researchers' ambivalence concerning feedback from the medical staff Overall, however, the individual contribution of each co-researcher was recognized and valued They had both choice and control which enabled them to develop personally and professionally Group reflection was seen as an essential feedback strategy during the change process     

实习护生对护理相关法规知识掌握情况的调查分析

目的了解实习护生对护理相关法规知识的掌握情况.方法选择2003年在本院实习的大专、本科护生100名,自行设计问卷进行调查.内容包括一般资料,护理相关法规理论知识、临床典型医患纠纷案例处理、护生对护理相关法规教育的需求.结果实习护生对护理相关法规知识掌握不够,存在着许多盲区和误区,对临床上常见的可能导致的医患纠纷事件缺乏处理能力,存在许多模糊甚至错误的认识.护生对护理相关法规知识非常需要.结论对护理专业学生应开设护理法规课程,实习期间进行护理相关法规知识培训.     

A study of the effects of the appointment of a clinical nurse educator in one Victorian emergency department

The Clinical Nurse Educator (CNE) project saw the appointment and evaluation of a CNE position in the Emergency Department at Dandenong Hospital, Australia. The study aimed to identify the educational needs of nursing staff, the self reported levels of knowledge of nursing staff, the perceptions of nursing staff surrounding education and clinical support and to compare responses over the 6 month period to identify any statistically significant changes. Data was collected at three intervals during the study period and the responses compared using the Kruskal-Wallis test(H). Since the appointment of the CNEs, the reported levels of knowledge increased for all areas of emergency nursing included in the study. Tutorials, in-service education sessions, direct clinical support and self-directed learning packages were reported to be useful educational methods. There were increases in the reported adequacy of in-service education (P = 0.0000), level of clinical support and satisfaction with current level of knowledge in emergency nursing. Nursing staff found the process of basic and advanced life support assessment less intimidating (P = 0.0031), more important and less affected by workload constraints of the ED (P = 0.0002). The reported thoroughness of orientation of new employees (P = 0.0005) and levels of clinical support and education when orientated to the triage role (P = 0.0225) also increased.     

实习前护理本科生对护理相关法规知识掌握情况的调查分析

目的:了解实习前护理本科学生对护理相关法规知识的掌握情况。方法:选择西北民族大学、甘肃中医学院2006级实习前护理本科学生116名,采用自行设计的问卷进行调查。调查内容包括一般资料、护理相关法规理论知识、临床典型医患纠纷案例处理、护理本科生对护理相关法规教育的需求。结果:实习前护理本科学生对护理相关法规知识存在着许多盲区和误区,对临床常见的可能导致的医患纠纷事件缺乏预见性和及时处理能力。结论:护理本科学生迫切需要护理相关法规知识的学习,对护理专业学生应增加护理法规课程的学时及相关专题讲座和典型案例的分析,实习前进行护理相关法规强化培训及特殊科室护理相关法规培训。     

Cultural approach in nursing care of North African Muslims needing palliative care

Working in a multi-cultural medical establishment, concerning both patients and nursing staff, calls for deliberations regarding the intercultural as well as palliative approach in nursing care. These deliberations are: 1) intra-personal, in questioning the nursing staff on his/her values, beliefs, convictions, personal culture and identity, as well as opinions regarding health, illness and death. 2) Interpersonal, in recognizing the other person through his/her culture, values, individuality, while taking into account his/her opinions on health, illness and death. The goal of this project is to initiate this intercultural approach by first studying the culture from the perspective of North African Muslims currently hospitalized. It will develop in three steps: The first step to consider consists in training health-care professionals. The second step will lead to the preparation of pedagogical support concerning "nursing care and North African culture". The third step should significantly demonstrate the intercultural approach in clinical nursing procedures. In the future, the project's aim should progress towards a health-care collaboration in which each patient feels implicated regardless of his/her condition, culture, beliefs, education or lifestyle.     

Staff nurses' perceptions of supernumerary status compared with rostered service for Diploma in Nursing students

BACKGROUND/RATIONALE: In the Republic of Ireland, the amount of clinical teaching expected of staff nurses has increased substantially in the wake of the transfer of nursing education to universities, and the advent of supernumerary status for students. A modicum of previous research noted that staff nurses are unclear about their role in relation to facilitating the clinical learning of supernumerary students. AIMS OF THE PAPER: To explore staff nurses' perceptions of their role in the facilitation of learning for university-educated diploma students in the clinical area and their attitudes towards these students. DESIGN/METHODS: Sixteen staff nurses were interviewed in depth using semi-structured interviews. Data were analysed qualitatively, using content analysis, with the help of the software package NUD*IST. FINDINGS: Among the central themes to emerge, upon which this article is focused, was participants' perceptions of supernumerary status compared with rostered service for diploma students. Data suggested that the rostered status of students was generally favoured by staff nurses over and above supernumerary status because, unlike supernumerary students, rostered students did not disrupt the existing social structure within the clinical setting. Both structuration theory and role theory are drawn upon to explain the reproduction of the prevailing social structure, where the concentration is on getting through nursing work with little emphasis on the supervised learning of supernumerary students. STUDY LIMITATIONS: This study is constrained by eliciting only the views of staff nurses. Further studies are required of student nurses' experiences of rostered service and supernumerary status. CONCLUSIONS: Because staff nurses are part of the system within which they work, they need to modify their role to include active student teaching as a legitimate component of that role.     

Nursing leaders of tomorrow: a peer selection process

Aims This paper describes a case presentation of a process for using peer evaluation to identify and select new nursing leaders in hospital settings. Background A reliable method for identifying emerging leaders has yet to be defined. Often, it is based only on managerial observation and evaluation, and does not involve staff opinion. Methods We developed a three‐tiered selection process consisting of: confidential peer voting, head nurse recommendations and a personal interview. Results Forty‐three potential leaders were enrolled in our leadership training workshop. Twelve graduates of this workshop were chosen to fill leadership positions in the hospital. Conclusions Peer recognition of potential nursing leaders might serve as a critical component in the process of selecting future nursing leaders. Implications for nursing management Combining peer evaluation with structured leadership selection may be beneficial for the early recognition of future nursing leaders. This approach is not commonly used in the leader identification and selection process. It may contribute to a sense of trust between management and staff, and promote transparency as well as legitimacy in the selection process.     

Staff Nurses' Perception of Their Role in a Dedicated Education Unit Within the Intensive Care Unit

The dedicated education unit (DEU), a model for clinical nursing education, is a partnership in which professional nurses are trained to participate in the clinical education of nursing students. This study evaluated the perceptions of staff nurses who acted as clinical teaching associates to senior nursing students in an intensive care unit setting using the DEU model. Other nursing programs may benefit from the outcomes experienced in this application of the DEU model.     

临床护理人员护理继续教育现状分析

[目的]分析临床护理人员继续教育的现状,了解护理继续教育的影响因素,为科学开展继续教育提供依据.[方法]随机抽取国内10所综合医院临床护理人员2 727人,使用"临床护理人员继续教育问卷"进行调查.[结果]92.0%以上的护理人员认识到护理继续教育的必要性和重要性,90.1%护理人员护理继续教育的目的是荻取知识、提升技能,影响其参加护理继续教育的因素主要是精力和时间不足(68.7%)、机会欠缺(48.6%)及经费问题(44.5%).[结论]更新观念、强化认识,科学统筹、激发动力,拓宽渠道、突出实效,切实达到护理继续教育的最终目的.     

Enhancing OSCE preparedness with video exemplars in undergraduate nursing students. A mixed method study

BackgroundObjective structured clinical examinations (OSCEs) are designed to assess clinical skill performance and competency of students in preparation for ‘real world’ clinical responsibilities. OSCEs are commonly used in health professional education and are typically associated with high levels of student anxiety, which may present a significant barrier to performance. Students, including nursing students, have identified that flexible access to exemplar OSCEs might reduce their anxiety and enable them to better prepare for such examinations.AimTo implement and evaluate an innovative approach to preparing students for OSCEs in an undergraduate (registration) acute care nursing course.MethodA set of digitized OSCE exemplars were prepared and embedded in the University-based course website as part of usual course learning activities. Use of the exemplars was monitored, pre and post OSCE surveys were conducted, and qualitative data were collected to evaluate the approach. OSCE grades were also examined.FindingsThe online OSCE exemplars increased self-rated student confidence, knowledge, and capacity to prepare and provided clarity around assessment expectations. OSCE exemplars were accessed frequently and positively received; but did not impact on performance.ConclusionVideo exemplars aid student preparation for OSCEs, providing a flexible, innovative and clear example of the assessment process. Video exemplars improved self-rated student confidence and understanding of performance expectations, leading to increased engagement and reduced anxiety when preparing for the OSCE, but not overall OSCE performance. Such OSCE exemplars could be used to increase staff capacity and improve the quality of the student learning experience.     

The application of student-centered teaching to nursing education

Nursing education in Taiwan is currently facing an extensive reform toward student-centeredness. However, few articles were found in the Taiwanese nursing literature focusing on student-centered teaching and nurse educators in Taiwan may have different interpretations of it. Misinterpretation of the term 'student-centeredness' may lead educational reform into inconsistency or ineffectiveness. This study aims to expand student-centered teaching's application to nursing education, stressing that not only the teaching techniques but also a consistent thinking approach is essential for educational reform. The content of this article addresses the meaning of student-centeredness and the differences between teacher-centeredness and student-centeredness. The article also advocates Weimers' five key changes toward student-centered teaching: the balance of power, the function of content, the role of the teacher, the responsibility for learning, and the purpose and process of evaluation, and further expounds their application to nursing education. Hopefully this article can provide Taiwanese nursing educators and students with an explicit view of student-centeredness and facilitate a more effective application of it to educational reform in nursing.