The lived experience of clinical development unit (nursing) leadership in Western Sydney, Australia

BACKGROUND: A network of nine Clinical Development Units (Nursing) (CDU(N)) were recently created in the Western Sydney Area Health Service. These units are designed to develop patient-focused nursing practice through group process and action research, based on principles of transformational leadership. AIMS OF THE STUDY: Although there is documented evidence from Australia and the United Kingdom (UK) that CDUs and Nursing Development Units (NDUs) are very successful in improving both patient and staff satisfaction, there is also growing evidence that the stressors experienced by nurse leaders are threatening the survival of some of these units. This study set out to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership when these stressors were likely to impinge. STUDY DESIGN: Hermeneutic phenomenology was employed in order to identify how these experiences changed over time. Two rounds of interviews were conducted: approximately 4--6 months after the launch and, again, 12 months later. FINDINGS: The Clinical Development Unit (Nursing) philosophy provided a framework on which these very motivated leaders began to enhance nursing accountability in their units through reflective practice and participatory governance. While reinforcing many previously published positive and negative aspects of Clinical Development Units and Nursing Development Units, this paper also highlights how the expectations and experiences of these leaders changed over time with unanticipated pressures of work, a high turnover of clinical leaders, a perceived diminution of management support and unrealistic self-expectations. A significant theme that emerged as these stressors began to impinge was the leaders' own need for leadership in order to sustain their confidence and motivation. IMPLICATIONS FOR NURSING: Insights harvested from this study have since been incorporated into a revised leadership preparation programme and support mechanisms for the leaders of eight new Clinical Development Units (Nursing) in the Western Sydney Area Health Service.     

Royal Rehabilitation Centre Sydney: towards Clinical Development Units (Nursing)

Clinical Development Units (Nursing), also known as Practice Development Units and Nursing Development Units, are nursing units that continually strive for excellence in nursing practice. Nursing units endeavouring to attain, or having achieved, the standards required of a Clinical Development Unit (Nursing)--CDU(N)--provide a very motivating and stimulating environment for nursing professional development. This paper provides readers with an understanding of the underpinnings of a CDU(N) along with why and how a nursing unit would strive for this status. A priority of senior nurse management at a rehabilitation facility in Sydney, the Royal Rehabilitation Centre, has been working towards the upgrading of every nursing unit in their facility to the level of a CDU(N) over the past three years. By way of an innovative course, the Clinical Development and Leadership course developed by Professor Jennifer Greenwood in 1997, senior nurses are being provided with the knowledge and skills to enable them to work towards their goal of becoming part of a Clinical Development Unit (Nursing).     

Exploring the impact of the implementation of a nursing clinical development unit program: What outcomes are evident?

Nursing Clinical Development Units have become popular as a framework for the facilitation of the professional development of nursing and to contribute to improved outcomes for consumers of health care services. An exploratory evaluation of the Nursing Clinical Development Unit program implemented by the Centre for Psychiatric Nursing Research and Practice was undertaken using a qualitative approach. This paper focuses on the findings relating to outcomes. A number of positive outcomes were identified including: changes within nursing practices; the development of more positive attitudes by nurses, a greater focus on research utilization and evidence-based practice; and an increase in professional development activities, including conference presentations. Despite these positive findings, the need for more structured evaluation and an increased emphasis on dissemination of findings was identified.     

Barriers to implementing a Nursing Clinical Development Unit

The available literature has identified Nursing Clinical Development Units as a strategy to promote, and bring about changes in, nursing practice. While the literature has also identified a number of barriers to the effectiveness of Nursing Clinical Development Units, very little of this research has been undertaken in a mental health environment. This paper presents findings from a qualitative evaluation of a Nursing Clinical Development Unit Program specifically targeted at the mental health field. In-depth interviews were conducted with participants of this program (n=14). Data analysis reveals the following barriers: not enough resources; grasping the concept; staff turnover; and staff resistance.     

Changing the culture of mental health nursing: the contribution of nursing clinical development units

The reluctance of nurses to utilise research findings in their practice has been extensively discussed in the literature. Nursing Clinical Development Units (NCDU) represent one approach to facilitating a greater interaction between research and nursing practice. This paper presents the results of an impact evaluation of an NCDU program operating in Victoria, Australia. In-depth interviews were conducted with participants in the NCDU program (n = 14). The findings suggest an increase in accessing and ultilising research by nurses since the introduction of the program, with an increased focus on evidence-based practice.     

Developing a nursing research culture in the university and health sectors in Western Sydney, Australia

The context for the development of a research culture in both the health and education sectors in Australia is similar to that in other developed countries. Contextual factors, especially those resulting from increasing fiscal constraint, militate against improved research productivity for nurses in both university and health sectors. Despite this, however, an impressive range of initiatives have been designed and introduced, both unisectorally and intersectorally, in the last 14 months to expedite the development of a nursing research culture in Western Sydney. The former include, in the University of Western Sydney (UWS), reward systems for research productivity and development, the funding of Designated Research Groups and Faculty Research Support Units. In the health service they include the funding of a Clinical Development Unit (Nursing)--CDU(N)--leadership program and the provision in 1997-98 of seed funds for research projects to be undertaken in the CDU(N)s. Intersectoral initiatives include the joint funding of four 'clinical' nursing Chairs, other sub-professorial positions and a 'flagship' series of nursing research seminars. All these initiatives will be described, together with an assessment of their impact to date, in terms of (1) research productivity, (2) improved intersectoral relationships and (3) heightened visibility and appreciation of nursing and nursing research.     

From the Guest Editor— Psychogerontological Nursing,Issue #2

The reluctance of nurses to utilise research findings in their practice has been extensively discussed in the literature. Nursing Clinical Development Units (NCDU) represent one approach to facilitating a greater interaction between research and nursing practice. This paper presents the results of an impact evaluation of an NCDU program operating in Victoria, Australia. In-depth interviews were conducted with participants in the NCDU program (n = 14). The findings suggest an increase in accessing and ultilising research by nurses since the introduction of the program, with an increased focus on evidence-based practice.     

The Centre for Psychiatric Nursing Research and Practice: an innovative approach to enhancing clinical nursing research in the psychiatric/mental health field

The available nursing literature suggests that nurses engaged in clinical practice hold a somewhat ambivalent attitude towards nursing research. On the one hand, its value is acknowledged, but on the other, its relevance to clinical practice is questioned. This situation poses a significant barrier to the involvement of clinicians in research and the utilisation of findings in practice. This paper describes the implementation of a model to facilitate the development of a systematic research approach at the Centre for Psychiatric Nursing Research and Practice in Victoria, Australia. The development of strong relationships between the Centre and the clinical field was considered crucial in determining the success of this initiative. The introduction of a number of programs to foster the conduct and utilisation of clinical research are described, including: The Nursing Clinical Development Unit Program, the Clinical Research Fellowship Program, clinical research projects, the Collaborative Psychiatric Nursing Conference and strategies to encourage the dissemination of research information. In combination, these initiatives are expected to contribute to a systematic approach to engendering a research culture within psychiatric nursing in Victoria, Australia.     

THE CENTRE FOR PSYCHIATRIC NURSING RESEARCH AND PRACTICE: AN INNOVATIVE APPROACH TO ENHANCING CLINICAL NURSING RESEARCH IN THE PSYCHIATRIC/MENTAL HEALTH FIELD

The available nursing literature suggests that nurses engaged in clinical practice hold a somewhat ambivalent attitude towards nursing research. On the one hand, its value is acknowledged, but on the other, its relevance to clinical practice is questioned. This situation poses a significant barrier to the involvement of clinicians in research and the utilisation of findings in practice. This paper describes the implementation of a model to facilitate the development of a systematic research approach at the Centre for Psychiatric Nursing Research and Practice in Victoria, Australia. The development of strong relationships between the Centre and the clinical field was considered crucial in determining the success of this initiative. The introduction of a number of programs to foster the conduct and utilisation of clinical research are described, including: The Nursing Clinical Development Unit Program, the Clinical Research Fellowship Program, clinical research projects, the Collaborative Psychiatric Nursing Conference and strategies to encourage the dissemination of research information. In combination, these initiatives are expected to contribute to a systematic approach to engendering a research culture within psychiatric nursing in Victoria, Australia.     

Nursing and health care in Sweden.

Sweden, one of the Nordic countries, has a long history of social justice and equality of access to health care. Nursing plays an important role in this and nursing education is of a high standard. The aim of this paper is to describe Sweden's health system and nursing within it, thereby giving Australian nurses information which may generate an interest in, and provide background for, collaborative work. It is part of a series initiated by the first author who visited Sweden, Iceland and England in 2000 under the auspices of a Churchill Fellowship, and who has returned to Sweden and England to continue work begun during the Fellowship. Sweden's health service is characterised by an ethic of egalitarianism and high standards; primary health care plays a large role and tertiary health care is easily accessible. Nursing in Sweden is of a high standard, with devolvement of responsibility and decision-making to those working in the wards and units. Nursing education has been influenced by the historical development of nursing in Europe and today, Swedish nurses enjoy a high standard of university education with government support readily available to make specialist education accessible. Because of the similarities in both the cultures, and nursing, in Australia and Sweden, Australian nurses would find Sweden a wonderful country in which to implement cross-cultural, collaborative work. This paper provides     

Nursing practice environment: How does one Australian hospital compare with magnet hospitals?

Magnet hospitals are recognized institutions of nursing excellence that provide an environment for the promotion of nursing and high-quality patient care. The Magnet Recognition Program, developed by the American Nurses Credentialing Centre, acknowledges health-care institutions that not only attract and retain nursing staff but also recognize nursing excellence in the delivery of quality patient care. Our study aimed to adapt the existing Practice Environment Scale to the Australian context and to pilot its use in measuring the nursing practice environment at a metropolitan hospital in Sydney, Australia. Nursing staff from four wards at a 400 bed major metropolitan acute general hospital in Sydney, Australia completed a self-administered questionnaire about their practice environment. Data were compared with the published norms from magnet and non-magnet hospitals in the USA, and means of two subscales were not significantly different from magnet hospital means. Hospitals could benefit from undertaking a similar practice environment baseline measure prior to applying for accreditation, thus enabling targeting of pre-identified service gaps and areas for improvement.     

Nursing unit: nurses co-ordinating hospital care--an answer to new challenges in acute medicine

Some patients at university hospital no longer need frequent medical treatment but complex professional nursing care. At University Hospital (Inselspital) Bern a Nursing Unit with six beds was run as a pilot project based on experiences in British Nursing Development Units. The care concept was specifically developed and based on a definition of professional nursing, an evidence-based practice approach, resource oriented self management, and caring. Primary nursing was used, and the primary nurse was responsible for the coordination and steering of patient care. The project was evaluated prospectively. During the pilot phase, 37 patients were cared for on the NU. On average, 85% of the beds were occupied, patients were hospitalized for 21.5 days and had a mean age of 68.9 years. They were older than the University Hospital's average patient, and cases were more complex than the University Hospital's average case. The nurses' experiences were mainly positive. Their enhanced responsibility and the structured care process were seen as a challenge allowing them to enlarge their abilities. With this project, the University Hospital built up innovative services for patients with complex nursing problems. The project showed that well trained nurses can take on more responsibility for this patient group than in the context of conventional care models.     

Nursing doctoral education in Turkey

Quality health care is an issue of concern worldwide, and nursing can and must play a major and global role in transforming the healthcare environment. Doctorally prepared nurses are very much needed in the discipline to further develop and expand the science, as well as to prepare its future educators, scholars, leaders, and policy makers. In 1968, the Master of Science in Nursing Program was initiated in Turkey, followed by the Nursing Doctoral Education Program in 1972. Six University Schools of Nursing provide nursing doctoral education. By the graduating year of 2001, 154 students had graduated with the Doctor of Philosophy in Nursing (Ph.D.), and 206 students were enrolled in related courses. Many countries in the world are systematically building various collaborative models in their nursing doctoral education programs. Turkey would like to play an active role in creating collaborative nursing doctoral education programs with other countries. This paper centres on the structure and model of doctoral education for nurses in Turkey. It touches on doctoral programs around the world; describes in detail nursing doctoral education in Turkey, including its program structure, admission process, course units, assessment strategies and dissertation procedure; and discusses efforts to promote Turkey as a potential partner in international initiatives to improve nursing doctoral education.     

Engaging Beyond the Bedside Nurses in a Large Pediatric Health Care System

Health care systems have a growing need to expand the nursing role to meet the needs of the patients and the community they serve. As the nursing role expands beyond clinical operations, there is a greater gap in connecting with other nursing colleagues. Additionally, engaging all nurses throughout health care systems is a challenging task for nursing leaders. This article offers a systematic way to identify and engage nurses working in positions beyond the bedside (BTB) within a large health care system. Nursing leaders implemented an initiative to connect BTB nurses to the chief nursing officer and the nursing strategic plan. Nursing leaders created innovative ways to engage, connect, and professionally develop BTB nurses within the healthcare system.     

Invisible partners: the Royal Australian Army Nursing Corps pathway to the Malayan Emergency

This paper highlights the role of women from the Royal Australian Army Nursing Corps who served in the Malayan Emergency. The British administrators of Malaya declared an Emergency in 1948 in response to threats posed by Chinese Communist Terrorists. Australia was slow to support Britain, but in 1955 Australian ground troops, accompanied by six Army nurses were deployed to Malaya. The nurses worked in British Military Hospitals, continuing the traditions of their antecedents; yet their contributions remain hidden from view. The exact number of Australian nurses who served in the Emergency is unknown, because of the poor record-keeping of the Southeast Asian conflicts. However, it is estimated that 33 Australian Army nurses served in Malaya from 1955, with some continuing their service into the early 1960s. The experiences of four of these nurses are revealed in this paper: they are no longer invisible partners.     

Creating a nursing development unit in a dementia care context

Keatinge D, Scarfe C. International Journal of Nursing Practice 1998; 4: 120–125 Creating a nursing development unit in a dementia care context This paper describes the process through which a Nursing Development Unit (NDU) was created in a 29-bed unit in which nurses care for severely demented residents. The question about whether or not ethics clearance is required for the development phase of NDUs is discussed, and the framework in which to develop the NDU described. The benefits of using Participatory Action Research as the basis for undertaking a continuous process of reflection and change is highlighted. It is also suggested that two key elements necessary for NDUs are that they are ‘owned’ by the staff who work in them and that they are supported by senior management of the organisations in which they exist.     

Using the WWW to teach undergraduate nurses clinical communication

On-line learning is increasingly being used in nursing education. Nevertheless, there is still insufficient evidence to demonstrate: whether students respond positively when this form of learning is used to teach relatively practical or clinical subjects; whether it is effective; and whether it is fair to students with less access to, or familiarity with, computers and the internet. In 2003, an on-line Unit on clinical communication was developed for Australian undergraduate nurses in partnership between an Australian School of Nursing and the Department of Clinical Psychology. Students were overwhelmingly positive in their evaluation of the Unit although some regretted the lack of face-to-face contact with tutors and peers. The best aspects of the Unit included the content and structure being perceived as interesting, fun and informative, the relevance of the material for them as nurses, flexibility to work independently, promotion of critical thinking and gaining an understanding of client issues. Neither their evaluation nor their final grades were related to students' age or whether they preferred on-line or traditional learning. Students who had readily available computer access, however, had better final grades. Also, students' grades were correlated with how often they accessed the Unit.     

The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care

Mcsherry R., pearce P., Grimwood K. & Mcsherry W. (2012) Journal of Nursing Management 20, 7–19
The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care Aim The aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs. Background The challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing. Key issues Excellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice. Conclusions Creating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations. Implications for nursing management The importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing.