The role of the psychiatric consultation-liaison nurse in the general hospital.

The mainstreaming of psychiatric services has increased the amount of contact nurses have with clients experiencing mental health problems within the general hospital environment. A review of the literature suggests that general nurses find themselves lacking in the skills, confidence and knowledge to care adequately for these patients. The aim of this paper is to discuss the potential contribution of the psychiatric consultation-liaison nurse in addressing such problems in order to improve health outcomes for patients experiencing mental health problems. While a number of positions for Psychiatric Consultation-Liaison Nurses are being created throughout Australia, there is a paucity of literature relating to the development of this important role. This paper is intended to contribute to the advancement of a body of knowledge in this area.     

A descriptive survey to identify the perceived skills and community skill requirements of mental health staff

Throughout the 1990s mental health care has shifted from a hospital to a community-based service. Government policy indicates that staff require further education as a result of the shift to community care. However, none of the United Kingdom policy documents or mental health literature prescribes what education is required. Consequently this multidisciplinary study aimed to identify what skills, if any, were required by hospital-based staff to move to a community-based working environment. Study findings suggest advantages in perceiving skills as overlapping and interconnecting. Five common core skills and skill differences between professional groups are identified. It is argued that core skills are central and common to all groups and specialist skills are those that distinguish professional groups one from another and different grades of staff within professional groups. While problems of multidisciplinary education are considered, nevertheless a case is made for educating staff in core skills within a multidisciplinary environment which may be beneficial in achieving community care goals.     

Physical assessment: implications for nurse educators and nursing practice

AIM: In New Zealand, the physical assessment of a patient has traditionally been the domain of the medical profession. As a country implementing advanced practice roles, with an expectation that both nurse practitioners and registered nurses will use physical assessment skills, the relevancy of physical assessment for each scope of practice has currency. The aim of this literature review was to discover what could be learnt from the experiences of Western countries that already incorporate physical assessment skills into nurses' health assessment. FINDINGS: Nurses in the USA, and more recently Canada and Australia, readily incorporate physical assessment skills into their nursing practice as a component of health assessment. The international literature identified that any change to the nurse's role in health assessment, to include physical assessment skills, requires strategies that involve the regulatory, educational and practice components of nursing. CONCLUSION: Nurses and other health professionals must perceive that this role expansion will improve health outcomes for the diverse populations accessing health care. Teaching physical assessment skills within a holistic health model will enable nurses to contribute a more comprehensive health assessment to the planning and monitoring of people's health care.     

A challenge for community psychiatric nursing: is there a future in primary health care?

The growing debate surrounding the role of the community psychiatric nurse (CPN) in the United Kingdom is reviewed. Issues which have attracted significant interest and which form the focus of this paper are the prioritization of CPN services, CPN attachment to primary health care (PHC), and the effectiveness of clinical interventions. The requirement for CPNs is now to concentrate services on people experiencing severe and enduring mental health problems. Innovative and effective clinical and social interventions for this client group are beginning to disseminate into everyday CPN practice. Problem-solving family interventions, cognitive therapies and case management are three such examples. The past, present and possible future role for CPNs working in primary health care settings with people experiencing nonpsychotic mental health problems is a particular focus in this paper. Drawing on the relevant literature, central issues addressed are the process and outcome of CPN work with nonpsychotic service users, reasons for the growth of CPN involvement in PHC, and the overall expansion of interest in mental health interventions within the primary health care environment. The literature suggests that this expansion has been strategically unplanned, but that mental health need amongst primary health care service users is significant. The concluding contention of this paper is that a future role for CPNs in primary care does exist.     

The use of simulation to address the acute care skills deficit in pre-registration nursing students: a clinical skill perspective

The increase in patient acuity in primary and secondary settings is continuing, with a corresponding increase in the need for technological competence in these areas. Evidence, however, both nationally and internationally, suggests that these expectations are not being met. This paper offers a review of the literature on acute care, with a specific focus on pre-registration nursing students and the development of acute care skills. Three themes are discussed: factors contributing to the acute care skills deficit, the knowledge and skills required to work in acute care and strategies used to support the acquisition of acute care skills. In response to the review, and based upon the evidence-based solutions identified, the clinical skills team at Bournemouth University designed and developed two teaching sessions, using simulation and role play to support the acquisition of acute care skills in pre-registration students. Student evaluations identify that their knowledge, competence and confidence in this area have increased following the teaching sessions, although caution remains regarding transferability of these skills into the practice environment.     

Mental health issues within the general health care system: the challenge for nursing education in Australia

The mental health content of undergraduate nursing programs has consistently been identified as inadequate in preparing graduate nurses with the knowledge and skills for, and interest in, a career in mental health nursing. Since the introduction of generic nursing education, undergraduate programs have become primarily focused on the development of generalist skills, with specialisation occurring at postgraduate level. The integration of mental health services within the broader health care system in Australia has led to a significant increase in the prevalence of mental health problems within the general health care setting. The relevant literature suggests that nurses are not well prepared to meet the mental health care needs of this population. The aim of this paper is to briefly outline the incidence of mental health problems within the general health care system, the implications for nursing, and the potential role which nursing could play in recognising, and providing appropriate care for the treatment of mental health problems. The implications for nursing education, and the need for mental health nursing skills to be considered essential for all nurses will be discussed.     

Shifting paradigms. Teaching gerontological nursing from a new perspective

Gerontological health care is undergoing a revolution, much like that of the feminist movement of the 1960s. Fundamental changes in health care require revisions in nursing education to ensure appropriate care of older adults in the least restrictive environment. The purpose of this study is to promote the preparation of future nurses who have the knowledge and the skills necessary to provide nursing care for the growing cohorts of older adults. A theoretical rationale for a new perspective in nursing education is discussed. An experiential clinical learning activity based on the functional model of gerontological health care is examined. This home visit clinical learning activity provides nursing students with the opportunity to practice nursing reflective of the health care needs of older adults. Strategies for replication of this clinical learning activity are provided.     

The effects of cooperative learning on students enrolled in a level 1 medical-surgical nursing course

This study was undertaken to create an environment that the literature contends will be more conducive to learning and one that will build the necessary social skills impacting students' performance. These social skills are essential if a nurse is to be effective in her role as a competent provider of care as well as an effective member of the inter-disciplinary health care team. The concept of cooperative learning was applied to nursing theoretical content in an effort to (a) decrease attrition rates in a first level medical-surgical nursing course, (b) increase student's knowledge and (c) enhance student's patient-teaching skills. Increased knowledge was assessed by student's performance on teacher-made paper and pencil examinations. The Classroom Life Instrument questionnaire was used for feedback on the teaching strategy and the Griffin tool was the basis for the pre-test and post-test assessment and implementation of the patient teaching plan.     

Developing clinical leadership skills in student nurses

A number of policy documents in recent years have identified the need for strong leadership within the NHS. The NHS Plan (2000) states that nurses need to take a lead role in the running of local health services. It also suggests that strong leadership is needed at a clinical level. The literature identifies a number of skills deemed to be essential for clinical leadership, some of these are difficult to achieve through pre-registration nurse education as they relate to an awareness of the structures and processes of the NHS and the ability to visualise or predict the future. Other skills relate to personal traits and qualities and it is these skills that are discussed. Four skills are identified for discussion; self-knowledge, communication skills, risk taking, and keeping informed. This paper analyses the way these skills are currently developed in one University's pre-registration nursing curriculum and concludes that although many opportunities are available to develop these skills in the classroom environment, there are many pressures that prevent use of these skills in a practice environment.     

The role of ultrasound simulators in education: an investigation into sonography student experiences and clinical mentor perceptions

Simulation as an effective pedagogy is gaining momentum at all levels of health care education. Limited research has been undertaken on the role of simulated learning in health care and further evaluation is needed to explore the quality of learning opportunities offered, and their effectiveness in the preparation of students for clinical practice. This study was undertaken to explore ways of integrating simulation-based learning into sonography training to enhance clinical preparation. A qualitative study was undertaken, using interviews to investigate the experiences of a group of sonography students after interacting with an ultrasound simulator. The perceptions of their clinical mentors on the effectiveness of this equipment to support the education and development of sonographers were also explored. The findings confirm that ultrasound simulators provide learning opportunities in an unpressurised environment, which reduces stress for the student and potential harm to patients. Busy clinical departments acknowledge the advantages of opportunities for students to acquire basic psychomotor skills in a classroom setting, thereby avoiding the inevitable reduction in patient throughput which results from clinical training. The limitations of simulation equipment to support the development of the full range of clinical skills required by sonographers were highlighted and suggestions made for more effective integration of simulation into the teaching and learning process. Ultrasound simulators have a role in sonography education, but continued research needs to be undertaken in order to develop appropriate strategies to support students, educators and mentors to effectively integrate this methodology.     

A phenomenological investigation into the role the clinical nurse specialist

This research study adopts a phenomenological approach to investigate how a group of clinical nurse specialists think and experience their role. It reviews the literature on the clinical nurse specialist from 1943, when Frances Reiter first coined the phrase 'nurse clinician', to the present time, when individuals are committed to a range of initiatives aimed at improving the quality of the British National Health Service and patient care. The study investigates and analyses their views and conveys the personal meaning of clinical nurse specialists 'lived experience' in the role. Findings of the study suggest that clinical nurse specialists are experienced practitioners who strive to be in positions in which they influence patient care and utilize advanced knowledge, expertise and leadership skills in a multidisciplinary environment. The literature proposes that for the role to be recognized and accepted individuals need to be educated at an advanced level, demonstrate practice based in research and have a firm base as a specialist in nursing. The findings clearly suggest that while the role of the clinical nurse specialist can be influenced in a positive manner by the organization and guided by the individual, it is important to acknowledge that the role is in a transitional phase. Finally, the research suggest the importance of establishing a clear role definition in a creative and supportive environment allowing for a autonomy, professional growth and the development of individuals as clinically competent nurse specialists.     

Problem based learning in the clinical setting--a systematic review

Problem based learning (PBL) is widely utilised as a curricula modality within the health professions and extensive literature exists to support its application. Recently nurse educators have embarked on the PBL journey as a method of contextualizing theory into practice in the classroom and clinical setting. The University of Queensland, in partnership with key health care providers, introduced an innovative undergraduate nursing curriculum in 2004. The curriculum incorporates problem based learning, clinical skills sessions, lectures and clinical practice as part of an intense weekly program from first year onwards. The program facilitates integration of evidence based theoretical and clinical knowledge driven by the PBL philosophy. However, in reality is PBL utilised by clinicians as a method of clinical teaching in undergraduate health professional programs? A systematic review of the literature was undertaken to answer this question revealing a paucity of evidence supporting or confirming the application of PBL in the clinical setting. The findings of this review highlight the current gaps in the PBL literature, supporting further research into the role of PBL as a teaching strategy for undergraduate nurses in the clinical practice setting.     

Nurses in the C-suite: leadership beyond chief nurse

The US health care system is reaching a critical point. Consistent cost increases coupled with a struggling economy has illuminated the burden of more than $650 billion annually in health care expenditures. The ability to afford health care is a growing concern for individuals, businesses, and state and federal governments. In addition to costs, variability in quality, and utilization belie any claims of a rational and consistent system of care. Transformational change will require leaders to shape our future health care institutions. Nursing has historically not been considered as a leadership source for change of this magnitude. However, due to the sheer size of nursing, core skills, and competencies, nurses could be a viable resource. Competencies needed for nurse, health care, and physician executives were compared using the HealthCare Leadership Alliance data, which created a body of knowledge that identifies competencies in 5 domains. Findings demonstrate that nurses, health care executives, and physicians possess more than 80% of the competencies reviewed. To successfully take on the role of leading institutional response to the dramatically changing health care environment, nurses must not only have the requisite leadership skills and experience, they must also have an expectation of themselves to lead at this level.     

Educating patients with type 2 diabetes

The patient is the self-manager of type 2 diabetes. The role of the health care professional is to provide the knowledge, skills, and behavior change support to empower the patient to do so. Recent governmental, financial, and clinical factors influence how health care professionals perform this role. Such factors coupled with a growing body of research evidence are shaping the way diabetes self-management education is provided.     

Public health nurses perception of clinical leadership in Ireland: narrative descriptions

Aim  The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses' in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery.
Background  Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles.
Method  Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery.
Results  Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective.
Conclusions  Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor.
Relevance to nurse managers  Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.     

Using social reminiscence to teach therapeutic communication skills

The nursing profession universally accepts the premise that effective communication skills are essential for RNs to function in any health care environment. This article discusses the use of social reminiscence as a teaching tool to encourage the development of these skills. Various approaches to teaching effective communication skills that have been discussed in the literature are described and evaluated. The rationale for social reminiscence to enhance communication is presented, and the teaching/learning experience is described. Finally, the strengths and weaknesses of using social reminiscence as a teaching tool are discussed.     

An academic-business partnership for advancing clinical informatics

A jointly funded partnership between the school of nursing at a large midwestern university and a premier health care information technology supplier represents a pioneering event for education and for the health care information technology industry. The impetus for this partnership arose from Institute of Medicine reports published in late 1999 and early 2001 addressing the quality, error, and waste in the health care system in the United States. The Simulated E-hEalth Delivery System (SEEDS) provides opportunities based on best practices in education to learn and practice clinical skills in a state-of-the-art environment using a live-production, clinical information system designed for care delivery. A pilot project that began with a small cohort of baccalaureate nursing students has been implemented and extended. SEEDS will also be extended to other health professional programs.     

Using simulation to improve the capability of undergraduate nursing students in mental health care

IntroductionMental health care is an increasing component of acute patient care and yet mental health care education can be limited in undergraduate nursing programs. The aim of this study was to establish if simulation learning can be an effective method of improving undergraduate nurses' capability in mental health care in an acute care environment.InterventionUndergraduate nursing students at an Australian university were exposed to several high-fidelity high-technology simulation activities that incorporated elements of acute emergency nursing practice and acute mental health intervention, scaffolded by theories of learning. This approach provided a safe environment for students to experience clinical practice, and develop their skills for dealing with complex clinical challenges.MethodsUsing a mixed method approach, the primary domains of interest in this study were student confidence, knowledge and ability. These were self-reported and assessed before and after the simulation activities (intervention) using a pre-validated survey, to gauge the self-rated capacity of students to initiate and complete effective care episodes. Focus group interviews were subsequently held with students who attended placement in the emergency department to explore the impact of the intervention on student performance in this clinical setting.ResultsStudents who participated in the simulation activity identified and reported significantly increased confidence, knowledge and ability in mental health care post-intervention. They identified key features of the intervention included the impact of its realism on the quality of learning. There is some evidence to suggest that the intervention had an impact on the performance and reflection of students in the clinical setting.DiscussionThis study provides evidence to support the use of simulation to enhance student nurses' clinical capabilities in providing mental health care in acute care environments. Nursing curriculum development should be based on best-evidence to ensure that future nursing graduates have the skills and capability to provide high-quality, holistic care.