The influence of the supernumerary clinical nurse educator role on advancing graduate nurses’ quality of patient care: A mixed-methods study in a private Western Australian health service

Theoretical and anecdotal evidence suggests that the presence of the supernumerary clinical nurse educator (CNE) in the acute care hospital clinical environment will positively affect patient quality outcomes. However, the supernumerary role suffers from scrutiny in response to the financial constraints of healthcare organisations, and is questioned regarding sustainability. The lack of empirical research diminishes the CNE role and its benefit for patient quality of care. This research focuses on newly qualified graduate registered nurses (GRNs) employed in a graduate programme and supported by the CNE in the clinical environment in order to articulate the effect of the supernumerary CNE on the GRNs’ patient outcomes. The mixed-methods research describes the CNE role specifically related to the GRNs’ transition to practice and quality of patient care. The results suggest that the CNE’s value derives from the supernumerary presence—through the resource-rich educator role and the experiential learning opportunities provided. These play a significant role in the GRNs’ successful transition to practice and clinical confidence. The ability of GRNs to safely engage in patient care is linked to CNE role translation into practice, promotion of evidence-based care theory and policy in practice, and progression of reflective practices influencing GRNs’ professionalism and maturity. The CNE role is identified as a congruent clinical leader who is approachable, supportive, connected and passionate about patient care. Undesirable attributes of the CNE role are associated with unsuitable personal characteristics, incompatible relationships with the clinical nurse manager and GRNs, and an inability to meet the expectations and criteria of the role. The organisational demands of role reassignment and role relief produce role strain and conflict that reduce the value of the CNE role. The audience who will profit from this research include present and future CNEs, nurses, clinical and administrative leaders, and healthcare organisations. The implications of this study not only relate to the role of CNEs in supporting GRNs’ transition to practice in the acute care hospital setting, but also to CNEs’ clinical leadership. CNEs are a practical solution to champion the success of the newly qualified registered nurse—our future nursing workforce

\u27Ice in the Family\u27: Exploring the experiences of close family members when another family member is using methamphetamine: A longitudinal qualitative study

Objective: To explore the experiences of close family members when another family member is using methamphetamine and how the family member responds over time. Background: Methamphetamine use has widespread implications and harms for both people who use the drug and those that live with them. While there is a significant representation in the literature relating to family members of people who use drugs or alcohol, there are limited studies specifically considering family members experiences of methamphetamine use. Families have been shown to have both positive and negative impacts on people using drugs, but less is known on the impact on the family members themselves. Study design and methods: Multiple semistructured qualitative interviews were conducted with 11 families (17 individual participants) from regional and metropolitan Western Australia over a 12-month period. Interpretative Phenomenological Analysis was used in data collection and analysis. Results: Four main themes were identified: 1. The New Lifeguard describes family members’ unplanned insertion into a new role and their rapidly changing experience of the person using methamphetamine. 2. Hit by the Wave demonstrates participants’ experience of repeated and unpredictable impacts on their lives. 3. Life in the Ocean describes the groundlessness associated with changes to goals and family structure. 4. Learning to Surf illuminates the changing strategies employed over time, moving away from trying to fix the person, to participants managing their own wellbeing. Discussion: This study identified common aspects within the lived experience of close family members of people using methamphetamine and ascertained a commonality in the process of this experience. Significant impacts to all areas of life were reported, and distress was fluctuating and unpredictable in line with the cyclical nature of the drug use. Participant responses to these changes varied over time between resentment and trying to fix things, and acceptance and resilience, while gaining or maintaining like-minded supports. Conclusion: Understanding the issues faced by families around this unique drug is vital in providing informed interventions for this group. Family members experience a broad range of financial, social and health impacts and harms over a protracted length of time. They are often not the focus of available support and in adapting to these issues, will themselves seek support away from treatment services for the person using methamphetamine. Implications for practice: Understanding the complex journey of families has a broad range of implications (and opportunities) for a variety of areas such as criminal justice, family support and child protection. There is an opportunity for these areas to consider broader and more specific supports and approaches, and to develop more appropriate, bespoke, and inclusive treatment for families of people using methamphetamine. What is already known about the topic? Methamphetamine is recognised worldwide as a harmful drug with few effective treatments for methamphetamine dependence. Few studies exist exploring the specific impact of methamphetamine on family members. Fewer studies explore the experiences over time. What this paper adds: Family members with a relative who is using methamphetamine experience a range of harms in many areas of their lives. The impact of methamphetamine use is unpredictable and takes place over long periods of time, affecting both individual family members and impacting on the overall structure of the family unit. Families and family members adapt their approach over time, from attempting to fix the situation, to stepping back and seeking support from others who they perceive to be in similar circumstances

Care and communication between health professionals and patients affected by severe or chronic illness in community care settings: a qualitative study of care at the end of life

Background: Advance care planning (ACP) enables patients to consider, discuss and, if they wish, document their wishes and preferences for future care, including decisions to refuse treatment, in the event that they lose capacity to make decisions for themselves. ACP is a key component of UK health policy to improve the experience of death and dying for patients and their families. There is limited evidence about how patients and health professionals understand ACP, or when and how this is initiated. It is evident that many people find discussion of and planning for end of life care difficult, and tend to avoid the topic. Aim: To investigate how patients, their relatives and health professionals initiate and experience discussion of ACP and the outcomes of advance discussions in shaping care at the end of life. Design and data collection: Qualitative study with two workstreams: (1) interviews with 37 health professionals (general practitioners, specialist nurses and community nurses) about their experiences of ACP; and (2) longitudinal case studies of 21 patients with 6-month follow-up. Cases included a patient and, where possible, a nominated key relative and/or health professional as well as a review of medical records. Complete case triads were obtained for 11 patients. Four cases comprised the patient alone, where respondents were unable or unwilling to nominate either a family member or a professional carer they wished to include in the study. Patients were identified as likely to be within the last 6 months of life. Ninety-seven interviews were completed in total. Setting: General practices and community care settings in the East Midlands of England. Findings: The study found ACP to be uncommon and focused primarily on specific documented tasks involving decisions about preferred place of death and cardiopulmonary resuscitation, supporting earlier research. There was no evidence of ACP in nearly half (9 of 21) of patient cases. Professionals reported ACP discussions to be challenging. It was difficult to recognise when patients had entered the last year of life, or to identify their readiness to consider future planning. Patients often did not wish to do so before they had become gravely ill. Consequently, ACP discussions tended to be reactive, rather than pre-emptive, occurring in response to critical events or evidence of marked deterioration. ACP discussions intersected two parallel strands of planning: professional organisation and co-ordination of care; and the practical and emotional preparatory work that patients and families undertook to prepare themselves for death. Reference to ACP as a means of guiding decisions for patients who had lost capacity was rare. Conclusions: Advance care planning remains uncommon, is often limited to documentation of a few key decisions, is reported to be challenging by many health professionals, is not welcomed by a substantial number of patients and tends to be postponed until death is clearly imminent. Current implementation largely ignores the purpose of ACP as a means of extending personal autonomy in the event of lost capacity. Future work: Attention should be paid to public attitudes to death and dying (including those of culturally diverse and ethnic minority groups), place of death, resuscitation and the value of anticipatory planning. In addition the experiences and needs of two under-researched groups should be explored: the frail elderly, including those who manage complex comorbid conditions, unrecognised as vulnerable cases; and those patients affected by stigmatised conditions, such as substance abuse or serious mental illness who fail to engage constructively with services and are not recognised as suitable referrals for palliative and end of life care. Funding: The National Institute for Health Research Health Services and Delivery Research programme

The clinical nurse educator as a congruent leader: A mixed method study

Educational leadership in the clinical setting has an influence on the promotion and achievement of competent and confident nurses. In Australia, the newly qualified registered nurse entering the workforce is exposed to a variety of experiential learning opportunities and engages with the nurse who is responsible for the clinical learning and development (clinical nurse educator) in the first-year graduate program. There is limited research examining the clinical nurse educator role and actual and potential leadership in the workforce. This study aimed to articulate the extent to which the clinical nurse educator is perceived as a clinical leader in the acute hospital setting. And specifically, the relationship of the role to the congruent leadership style. A mixed method convergent design (QUANT + QUAL) approach used (1) an online questionnaire with open and closed ended questions for the graduate nurses and (2) semi-structured individual interviews with graduate nurses, their clinical nurse educators and their nurse managers. Findings confirmed the clinical nurse educator leadership was visible, approachable, and relational with clearly identified values and passionate patient-centred principles. Challenges to the clinical nurse educator identity and confidence exist and impact the clinical role and leadership value. The clinical nurse educator did not need to be in a management position to lead and influence graduates’ successful transition to practice and integration into the clinical environment. The clinical nurse educator exhibits a congruent leadership style through engagement and promotion of the graduate nurses in their first year of nursing. The education role is of significance to meet contemporary health care expectations and promote quality patient care and new nurse retention in the healthcare organisation

Where are all the graduates?

The University of Notre Dame Australia is seeking to understand the pathway of our graduating students. Initial data collection in 2020 will provide essential information on the graduates’ workforce destination in their first year of practice. With this understanding, we can ensure that our entry to practice programs are preparing our graduates for the reality of employment and the workplace

Innovations in postgraduate work integrated learning within the perioperative nursing environment: A mixed method review

Purpose: To determine the impact of the Graduate Diploma of Perioperative Nursing on student learning and career progression. Participants and setting: A validated mixed methods descriptive survey was sent to participants (n=67). Findings were analysed using descriptive statistics and results were further investigated using a focus groups of 12 individuals. Methods: Overall 96 per cent of graduates were satisfied with the program and agreed that the program had improved their delivery of patient care and enhanced their application of theoretical knowledge to clinical skills. Three themes were identified from data from the focus groups: ‘learning’, ‘empowerment’ and ‘opportunity’. Qualitative findings confirmed program satisfaction among participants who valued the learning experience. Conclusion: The Graduate Diploma of Perioperative Nursing provides a unique opportunity for nurses in Western Australia to engage in a workplace supported program to consolidate their specialised practice. With significant cutbacks occurring in nursing education across both the private and public health care sectors, the profession should advocate for the role of work integrated learning as a strategy to support nurses’ development in a complex and changing health workplace

Nurse Managers’ perceptions of mentoring in the multigenerational workplace: a qualitative descriptive study

Objective: To examine how nurse managers in metropolitan healthcare organisations in Western Australia perceive intergenerational mentoring and its place in the contemporary workforce. Background: Mentoring in nursing has benefits for professional career success, new role transition and as a strategy to mitigate negative workplace influences. Study design and methods: A qualitative descriptive study with 20 nurse managers from public and private health services. Face to face semi-structured interviews were held at a neutral location. The interview schedule included 10 questions which were audio-recorded and transcribed verbatim. Thematic analysis was applied to data to generate themes and present the results. Results: Four main themes were identified: conceptualising mentoring, adding value, influences and support mechanisms, and workforce investment. The nurse managers described the positive and negative aspects of their understanding of intergenerational mentoring practice in the contemporary clinical setting. Discussion: The nurse managers highlighted the importance of life experience in mentoring relationships and how mentoring was generationally bi-directional. As part of everyday nursing practice mentoring was evident despite clinical and organisational challenges. Clear benefits identified were the creation of a positive workforce, promotion of quality patient-centred care, and retention of staff. Mentoring has traditionally occurred face to face however, the recent coronavirus pandemic has provided a catalyst for increasing the use of online mentoring across all generations. Conclusion: The nurse managers were willing to be involved in intergenerational mentoring in either a mentor or mentee role or both. This view of practice occurred throughout the professional work life of nurses with benefits for all generations and the continuity of organisational values. Implications for practice: Mentoring is a practice necessary for promoting best practice in patient care and effective relationships in teams of staff. Consideration of accessibility through e-mentoring could increase involvement and take mentoring forward in the digital age

Development of a professional practice competency for undergraduate nursing students: A mixed-method study

Nursing professionalism relates to the knowledge, skills, conduct, behaviour and attitudes of registered nurses. Difficulties related to student assessment of professionalism have been anecdotally described as a disparity between the meaning of the term ‘professionalism’ to nurses and its application and measurement in clinical practice. The aim of this study was to develop a professional practice competency for undergraduate nurses on clinical placement. An exploratory sequential mixed-methods approach with a two-phase design was used to develop the competency. Phase one, the Delphi method with 16 expert nurses, was used to develop the competency. This involved the thematic analysis of key statements over four rounds, five key themes were identified (attitudes, communication, knowledge, standards, relationships) that formed the framework and 33 individual competency statements. This was followed by phase 2, content validity, using the Table of Specification with 58 clinical facilitators. The findings confirmed the statements (80% consensus) deemed important to assess the essential construct of nursing professional practice. It is envisaged that the professional practice competency will assist student insight into their professional role and subsequently allow adjustment and achievement of professional practice competency

Intensive care nurses perceptions on barriers impeding the provision of end of life care in the intensive care setting: a quantitative analysis

Background: Intensive care nurses look after the most critically ill patient population with the highest mortality rate on a daily basis. Whilst research to date has highlighted and provided some insights into the current provision of end of life care, further research is much needed to improve the efficacy of nurses existing practice. Objective: To investigate the specific barriers and contextual characteristics that nurses experience within the Intensive Care Unit environment. Study Methods: The National Questionnaire of Critical Care Nurses Regarding End of Life Care was used to collect quantitative and qualitative data to answer the research questions. This study was conducted in a major intensive care unit located in a tertiary public hospital in metropolitan Western Australia. Results: The respondent rate was 67.31%. Obstacles with the highest perceived intensity score (PIS) reported by participants involved issues around the communication and practice of end of life care including family interaction. The ranges of mean scores for supportive behaviours were much higher than the ranges for obstacles. These supportive behaviours included allowing family members to have adequate time alone with the patient after death, and families being taught how to engage with the dying patient. Conclusion: The findings reflect that the most intense and frequently occurring obstacles are consistent with past research. A perceived negative end of life care experience by the nurse was found to negatively impact the nurse’s psychological and physiological health. The research demonstrates the need for a stronger multidisciplinary patient centred approach. It is envisaged that the findings will support the review and development of appropriate guidelines to support nurses caring for intensive care patients in the initial and progressive phases of end of life care. What is already known about this topic? ICU patients have the highest incidence of mortality in the acute care setting with one in four patients dying in an ICU, accounting for 15% of all hospital deaths annually. This patient population presents nurses with a set of unique, yet significant challenges related to increased rate of mortality. There is a significant amount of existing literature that has explored moral distress amongst nurses, particularly in relation to end of life care. What this paper adds: This research suggests that there continues to be obstacles that impede critical care nurse’s ability to facilitate EOLC in the ICU setting. The participants of this study highlighted the need for stronger emphasis being placed on decision making processes, communication, and standardised practice. The most supportive behaviours reported were associated with practice that could be initiated by the nurse such as, allowing family members adequate time with their loved one pre and post death, and teaching family members how to act and engage with their loved ones during this time

Transition to practice: Supporting first year nurses within a collaborative faith based graduate program

Objective: Faith-based organisations play a major role in health care in Australia providing a unique service supported by compassionate and concerned staff. In response to the changing Australian health care landscape the increasing demands placed on first year registered nurses, a graduate program provided in partnership with a Catholic University, engages students in academic and clinical learning. The study aimed to determine if the provision of nursing care in the context of catholic faith and values provides first year nurses with a supportive learning environment. Methods: This study used a mixed method explanatory sequential design in two phases: (1) quantitative online surveys sent to graduate nurses (n = 60) to report on their perceptions of work integrated learning prior to and during their first year of nursing at the private catholic hospital; and (2) focus groups were conducted to explore key themes in further detail. The evaluation occurred at both the halfway and the end point of the 12-month Graduate Program. Data was analysed using descriptive statistics and theming of the text data to identify emergent ideas. Results: The findings suggest that the graduate nurses felt engaged with the programs academic and clinical learning outcomes. This was achieved in a supportive pastoral care environment underpinned by catholic faith and values. Conclusions: The Graduate Program in collaboration with a Catholic University School of Nursing and Midwifery has provided a positive learning experience and support structure for its first year registered nurses with the achievement of a formally recognised qualification