Re-defining nursing expertise in the United kingdom

There is now international recognition of the importance of practice expertise in modern and effective health services. The Expertise in Practice Project in the United Kingdom began in May 1998 and continued to 2004. It included nurses working in all four countries of the United Kingdom, and it covered clinical specialists from pediatrics to palliative care. The project added to the current understanding of what nursing practice expertise is, through the identification and verification of attributes and factors which enable expert practice. The proposed framework offers a language for sharing what constitutes practice expertise and offers insight into what occurs between the expert practitioner and the people that experience their care. The Expertise in Practice Project demonstrates that nurses affect change and facilitate performance and organizational development.     

E-mentoring in public health nursing practice

Attrition in the public health nursing work force combined with a lack of faculty to teach public health prompted development of a "long-distance" learning project. Practicing associate degree nurses enrolled in an online course in population-based practice worked with experienced public health nurse "e-mentors." Student-mentor pairs worked through course assignments, shared public health nursing experiences, and problem-solved real-time public health issues. Nursing faculty served as coordinators for student learning and mentor support. Over 3 years, 38 student-mentor pairs participated in the project. Students reported they valued the expertise and guidance of their mentors. Likewise, mentors gained confidence in their practice and abilities to mentor. Issues related to distance learning and e-mentoring centered around use of technology and adequate time to communicate with one another. E-mentoring is a viable strategy to connect nurses to a learning, sharing environment while crossing the barriers of distance, agency isolation, and busy schedules.     

Nurse experts jump-start clinical simulation in rehabilitation nursing: supporting new graduate transition to competence

This article outlines a high-fidelity simulation project developed and implemented by expert staff nurses at a specialty rehabilitation hospital. The project is designed to educate new graduate nurses on appropriate care for patients after a rare spinal cord surgical procedure. Due to the complicated nature of the surgery, patients are highly acute and may present with specific complications that need to be addressed for positive patient outcomes. Expert staff nurses imparted their knowledge in developing a scenario emphasizing common and unusual postsurgery patient presentations. The scenario was implemented as a teaching exercise for new graduate nurses, with experienced staff nurses as facilitators of learning in a safe, nonthreatening environment. New graduate nurses were overwhelmingly positive in the postsimulation debriefing, reporting increased confidence and knowledge necessary to care for these patients. Future endeavors include expanding involvement of staff nurses in simulation education and researching new graduate transition through simulation.     

Doing phenomenological research collaboratively

Collaborative research between nurses employed in the academic and practice sectors is a cost-effective and innovative way to investigate aspects of clinical practice, articulate clinical and teaching expertise, and extend professional practice knowledge. In collaborative ventures, researchers from different institutional cultures often work together to investigate a particular area of interest. This poses challenges in relation to the perceptions, understandings, and interpretations of the research question and of the mode of inquiry, particularly when investigating through the qualitative paradigm. The purpose of this article is twofold. The first is to clarify some of the challenges experienced while conducting collaborative research and describe the steps taken to ensure consistency between the purpose of the research and the phenomenological research design used to explore the learning that nursing students acquire in their final clinical practicum. Second, it was thought that by illuminating this learning, registered nurses working as preceptors and those supporting new graduates could gain insight into the complexities of learning the skills of safe and competent practice from the student's perspective. This insight is essential in creating a strategy between education and practice to minimize the duplication of learning opportunities and lessen the cost of supporting newly registered nurses, which may be at the expense of investment in the professional development of experienced registered nurses.     

A capstone teaching project for undergraduate nursing students: development of a visual teaching-learning tool

The purpose of this article is to describe an original teaching-learning capstone project designed to promote active learning by senior nursing students as they transition to professional practice. The centerpiece of the capstone experience is the creation of a three-dimensional educational tool called a Visual Project, which addresses the learning needs of patients, their families, or the nursing staff. Students create their project during the spring semester of their senior year, when they are paired with an experienced, baccalaureate-prepared nurse preceptor. Students present their projects to both the nursing unit in which they worked and the faculty and students of the nursing school. Students consistently express a sense of accomplishment when they present their projects and recognize that they themselves have undergone the same teaching-learning process that was the focus of their project.     

Cognitive integration in health professions education: Development and implementation of a collaborative learning workshop in an undergraduate nursing program

Cognitive integration is integral to health professions education as it facilitates the ability to synthesize various types of knowledge and apply them in a clinical context. Nursing education is one main field of study that is subsumed under the umbrella of health professions education. Future nurses require learning, not just of skills but also of the knowledge that underpins those skills. They need to be able to cognitively integrate various forms of content and skills so that they can translate them to actual patient management and care during clinical practice. Several educational strategies have been implemented and have been shown to be effective in promoting cognitive integration in health professions learners, both individually and as a group. One of these strategies is collaborative learning. This study describes how a developed collaborative learning workshop was implemented to aid cognitive integration in year 1 undergraduate nursing students prior to their clinical postings. It also looks into the perceptions of students through qualitative findings from focus group discussions. Generated themes include ‘integrating and bridging knowledge for practice’, ‘having tutors with different and complementing expertise’, ‘preparing mindsets by clear objectives’ and ‘timing and case variability’.     

Staff nurses lead the way for improvement to shared governance structure

The Magnet? model encompasses structural empowerment, transformational leadership, exemplary professional practice, and new knowledge, innovations, and improvements. As the American Nurses Credentialing Center reminds us, great leaders, structures, and nurses lead to great knowledge, innovation, and outcomes. One organization experienced the wisdom in this model through restructuring the systemwide staff nurse councils. The authors describe the steps by which this restructuring was accomplished and some of the positive effects on the work environment.     

Partner, Learn, Progress: a conceptual model for continuous clinical education

In practice disciplines, such as nursing, learning can be maximised through experience located in the clinical setting. However, placement in the clinical setting does not automatically mean that the learner's professional practice will improve. Experiences in 'real-life' settings need to be effectively facilitated to obtain the desired outcomes. This paper through the discussion of 'Partner, Learn, Progress' details a conceptual model for promoting learning in the clinical context. 'Partner' refers to the positive association between the learner and the experienced clinician that engenders trust. It occurs on a personal level in the context of a broader social and political environment. 'Learn' refers to the process whereby the experienced clinician is able to assist the learner make sense of theoretical knowledge or knowledge that has previously been 'distal' to their practice to be integrated into their immediate practice. The clinician requires to be cognisant of the learner's existing knowledge level so that the activities and accompanying discussion assist in making connections between theory and practice. Learning incorporates mutual collaboration whereby the learner is able to practise the application of knowledge in a safe context and make their own connections. The further exploration of meanings through experiences, feelings, attitudes leads the learner to 'progress': the development of knowledge. Such a conceptual model provides a framework for educators and supervisors of clinical learning to educate and learn from the next generation of nurses that will lead the nursing profession into the future.     

Teaching complex trauma care in a curriculum challenges critical thinking and clinical judgment--how nurses can help.

Incorporating complex content into a nursing curriculum presents students with the knowledge and thinking skills necessary to enter a career in nursing. A level 1 trauma center is a prefect environment to advance these thinking skills. Nurses act as professional role models and teachers as they clarify and explain their thinking to a student. When experienced nurses show invitational behaviors to students and share their knowledge with them, they ignite a strong desire within the student to progress. Caring, communication, and inclusion are key components that synergize the teaching/learning experience. The development of critical thinking is a continuous process that is best achieved through collaboration between the student, faculty, and professional, experienced nurses.     

“Refreshed…reinforced…reflective”: A qualitative exploration of interprofessional education facilitators’ own interprofessional learning and collaborative practice

While there is extensive research examining the outcomes of interprofessional education (IPE) for students, minimal research has investigated how facilitating student learning influences the facilitators themselves. This exploratory case study aimed to explore whether and how facilitating IPE influences facilitators’ own collaborative practice attitudes, knowledge, and workplace behaviours. Sixteen facilitators of an online pre-licensure IPE unit for an Australian university participated in semi-structured telephone interviews. Inductive thematic analysis revealed three emergent themes and associated subthemes characterising participants’ reflexivity as IPE facilitators: interprofessional learning; professional behaviour change; and collaborative practice expertise. Participants experienced interprofessional learning in their role as facilitators, improving their understanding of other professionals’ roles, theoretical and empirical knowledge underlying collaborative practice, and the use and value of online communication. Participants also reported having changed several professional behaviours, including improved interprofessional collaboration with colleagues, a change in care plan focus, a less didactic approach to supervising students and staff, and greater enthusiasm impressing the value of collaborative practice on placement students. Participants reported having acquired their prior interprofessional collaboration expertise via professional experience rather than formal learning opportunities and believed access to formal IPE as learners would aid their continuing professional development. Overall, the outcomes of the IPE experience extended past the intended audience of the student learners and positively impacted on the facilitators as well.     

Retaining and transferring nursing knowledge through a hospital internship program

In healthcare, organizations recognize that human capital is their most valuable asset. The importance of investing in knowledge workers is imperative given the current and future shortage of health professionals. Knowledge acquisition occurs through continuous learning and the transfer of information from those who are highly experienced to those who are less qualified. At St. Michael's Hospital, two innovative and unique programs were created for the transfer of knowledge. The first was a nurse fellowship program that enabled experienced nurses to spend two to three months learning new skills to advance clinical practice. The second was a nurse internship program in which new graduates spend three to four months in their area of hire to enhance clinical practice through skill development and prioritization of patient care needs. This paper describes both programs and presents an evaluation of the new-graduate internship program as an opportunity for professional development and career enhancement For nurse interns, the program promotes self-esteem and professional confidence, improves job satisfaction and rewards nurses for their contribution. For nurse preceptors, the program provides job enrichment, experience in teaching and recognition by the organization and peers that they are knowledge experts. In healthcare, organizations have come to acknowledge that their most valuable asset is human capital, in particular, knowledge workers (Horibe 1999). Knowledge workers contribute a composite of information, intellectual property and experience (Horibe 1999), acquired by study, investigation, observation or practice (Webster's Dictionary 1989). Investing in knowledge workers is investing in the future. In this regard, organizations have implemented recruitment and retention strategies to attract, retain and advance the highest calibre of health professional. Knowledge workers contribute to an organization through their ideas, analyses of complex situations and sound judgment in decision-making (Horibe 1999). They further develop these skills over the course of their career through continuous learning. This paper will focus on the importance of investing in nurses as knowledge workers. In particular, given the shortage of nurses and the reality that 25% of today's nurses can retire over the next 10 years (CNA 2001), it is imperative that knowledge transfer occur from highly experienced to less experienced nurses.     

Creating and sustaining an academic‐practice Partnership Engagement Model

Public health clinical educators and practicing public health nurses (PHNs) are experiencing challenges in creating meaningful clinical learning experiences for nursing students due to an increase in nursing programs and greater workload responsibilities for both nursing faculty and PHNs. The Henry Street Consortium (HSC), a collaborative group of PHNs and nursing faculty, conducted a project to identify best practices for public health nursing student clinical learning experiences. Project leaders surveyed HSC members about preferences for teaching‐learning strategies, facilitated development of resources and tools to guide learning, organized faculty/PHN pilot teams to test resources and tools with students, and evaluated the pilot team experiences through two focus groups. The analysis of the outcomes of the partnership engagement project led to the development of the Partnership Engagement Model (PEM), which may be used by nursing faculty and their public health practice partners to guide building relationships and sustainable partnerships for educating nursing students.     

Incorporating outcomes research into clinical practice: the four-step approach

Outcomes research is designed to develop new and generalizable knowledge about care delivery, interventions, and patient outcomes. Advanced practice nurses are asked not only to participate in outcomes research but also to develop and maintain outcomes research projects and databases and to demonstrate the effectiveness of their own care practices through outcomes research. A four-step approach is described as an easy way in which to help advanced practice nurses engage in outcomes research at any site and with any patient population. The four steps are: Step I: identify and describe current practice in nursing-medical care and its outcome(s); Step II: data collection; Step III: data analysis; and Step IV: praxis: putting the research into practice. Participating in outcomes research will allow advanced practice nurses to improve healthcare services and to secure the role of advanced practice nurses in the changing healthcare arena.     

Supporting ethics educators in Canadian occupational therapy and physical therapy programs: A national interprofessional knowledge exchange project

Ethics education is the cornerstone of professional practice, fostering knowledge and respect for core ethical values among healthcare professionals. Ethics is also a subject well-suited for interprofessional education and collaboration. However, there are few initiatives to gather experiences and share resources among ethics educators in rehabilitation. We thus undertook a knowledge exchange project to: 1) share knowledge about ethics training across Canadian occupational and physical therapy programs, and 2) build a community of educators dedicated to improving ethics education. The objectives of this paper are to describe this interprofessional knowledge exchange project involving ethics educators (with a diversity of professional and disciplinary backgrounds) from Canadian occupational and physical therapy programs as well as analyze its outcomes based on participants’ experiences/perceptions. Two knowledge exchange strategies were employed: an interactive one-day workshop and a wiki platform. An immediate post-workshop questionnaire evaluated the degree to which participants’ expectations were met. Structured telephone interviews 9–10 months after the workshop collected participants’ perceptions on whether (and if so, how) the project influenced their teaching or led to further interprofessional collaborations. Open-ended questions from the post-workshop questionnaires and individual interviews were analyzed using qualitative methods. Of 40 ethics educators contacted, 23 participated in the workshop and 17 in the follow-up interview. Only 6 participants logged into the wiki from its launch to the end of data collection. Five themes emerged from the qualitative analysis: 1) belonging and networking; 2) sharing and collaborating; 3) changing (or not) ways of teaching ethics; 4) sustaining the network; and 5) envisioning the future of ethics education. The project attained many of its goals, despite encountering some challenges. While the wiki platform proved to be of limited benefit in advancing the project goals, the interactive format and collaborative nature of the one-day workshop were described as rewarding and effective in bringing together occupational therapy and physical therapy educators to meet, network, and share knowledge.     

Critical companionship: Part 1

This article is the first of two presenting critical companionship as a metaphor and framework for learning from healthcare experiences. Critical companionship is a helping relationship in which an experienced facilitator (often, but not necessarily, a colleague) accompanies another on an experiential learning journey, using methods of 'high challenge' and 'high support' in a trusting relationship. The overall purpose of critical companionship is to enable others to practise in ways that are person centred and evidence based. Critical companionship is effective in a variety of one-to-one or group learning contexts, such as practice development projects, organisational change, practitioner research, work-based learning, clinical supervision and action learning. In this article, the development and testing of the critical companionship framework, through action research, are briefly described. The framework is then presented and illustrated with exemplars of critical-companionship expertise in an acute medical ward. Part 2 highlights how the framework was used in a practice development programme with NHS trusts for older people's services, to help nurses to become critical companions.     

Advancing evidence-based practice: a program series

The call to evidence-based practice (EBP) is evolving and empowers nurses to form innovative learning partnerships with colleagues to nourish wisdom, strengthen critical thinking, integrate research knowledge, and celebrate contributions in leading best practice. Based on clinician interest, Advancing Evidence-Based Practice: A Program Series was designed for nurses to showcase initiatives using Mercy Nursing's EBP Model. Mentoring guides their efforts. This opportunity creates learning partnerships that encourage participants to reflect about their practice and network with colleagues about what is important for clinical excellence. It also nurtures professional growth in research development and formal presentations.     

Reflective education for professional practice: discovering knowledge from experience

To continually develop as a discipline, a profession needs to generate a knowledge base that can evolve from education and practice. Midwifery reflective practitioners have the potential to develop clinical expertise directed towards achieving desirable, safe and effective practice. Midwives are 'with woman', providing the family with supportive and helpful relationships as they share the deep and profound experiences of childbirth. To become skilled helpers students need to develop reflective skills and valid midwifery knowledge grounded in their personal experiences and practice. Midwife educators and practitioners can assist students and enhance their learning by expanding the scope of practice, encouraging self-assessment and the development of reflective and professional skills. This paper explores journal writing as a learning strategy for the development of reflective skills within midwifery and explores its value for midwifery education. It also examines, through the use of critical social theory and adult learning principles, how midwives can assist and thus enhance students learning through the development of professional and reflective skills for midwifery practice.     

The educational preparation of undergraduate nursing students in pharmacology: clinical nurses' perceptions and experiences of graduate nurses' medication knowledge

This paper explores clinical nurses’ perceptions and experiences of graduate nurses’ pharmacology knowledge. Six focus group interviews were conducted with clinical nurses of various appointment levels at two metropolitan public and two regional public hospitals in Victoria, Australia. Four major themes emerged from the study. First, participants indicated that graduate nurses had an overall lack of depth of pharmacology knowledge. While clinical nurses indicated that graduate nurses had enormous deficits in their pharmacology education, these deficits were not confined to graduate nurses—all nurses experienced difficulties in understanding and demonstrating pharmacological concepts in the clinical practice setting. Second, there was an unstructured approach to addressing the continuing education needs of graduate nurses. Third, theoretical and clinical principles of pharmacology knowledge were perceived to be important for practice. Fourth, improvements for nursing education involved the need for undergraduate students to take greater responsibility in monitoring and administering medications and the need for more structured learning experiences. The ultimate goal of consolidating pharmacology knowledge for graduate nurses is to optimise medication use, thereby improving the health outcomes of patients. Current teaching and learning opportunities appear to be inadequate in their efforts to enhance and improve graduate nurses’ pharmacology knowledge. These inadequacies need to be addressed if the ultimate goal is to become a reality.     

Nursing students can help support evidence-based practice on clinical nursing units

AIMS: A research study was designed to explore whether research utilization projects underwent by student nurses could have an impact on nursing practice on clinical nursing units. BACKGROUND: The use of evidence-based practice is becoming essential for nursing managers and nursing staff, but there are many barriers to implementing research findings in practice. Student nurses can be used to assist when staff nurses do not have time during the work day. METHODS: Baccalaureate nursing students completed a research utilization project during their final comprehensive clinical experience. Telephonic interviews were conducted with the students' preceptors 5 months after the students' clinical experience, to obtain their perceptions of the impact of the student project on the nurses' knowledge and practice. RESULTS: The staff nurse preceptors reported the projects were well received with the primary impact of the projects being to educate the nursing staff and patients and thus improve the level of nursing practice on the clinical units. CONCLUSIONS: Student research utilization projects are one way to save time for staff nurses and increase their awareness of current research findings.