Exploring and developing student midwives' experiences (ESME) : an appreciative inquiry study

Background: There is increased focus on investing in midwifery students as our future workforce. Inquiring into what helps to support an enriched learning experience for student midwives in clinical placements is timely. Aim: To work collaboratively with key stakeholders (student midwives, midwives) in clinical placements to generate an experience-based understanding of what works well in relation to the student midwife experience and from this understanding, co-create ways to enhance students’ experiences. Design: An appreciative inquiry approach was used to discover what matters and what works well at present in the student midwife experience from the perspective of student midwives, midwives, and midwifery managers and to use this knowledge to create enhanced experiences in the future. Data were generated across four local health districts in New South Wales, Australia. Data were analysed using immersion crystallisation and then mapped to the ‘Senses Framework’. Setting: Four midwifery units in tertiary teaching public hospitals in NSW. Participants: There were 124 participants in this study: 45 midwifery students and 76 employed midwives. Measurements and findings: The data culminated in the refinement of the ‘Senses Framework’ for use in the midwifery learning context. Student midwives and midwives valued experiences that helped them to feel safe, to feel that they belong, to experience continuity in their learning and work, to have a sense of purpose, to have their achievements and their contributions to be recognised and to feel that they matter. Furthermore, the midwives themselves valued the experience of these senses in supporting them to be facilitators of learning in the workplace. The relational framework for learning together in the work-place has the potential to support achievement of the sense of security, belonging, continuity, purpose, achievement and significance for all involved. Key conclusions: There is much to celebrate in what is being achieved currently in promoting excellence in learning experiences in the midwifery context. In particular this study has made conscious the contribution that student midwives and midwives can and do make to enable the positive and reciprocal relationships that develop in the student midwife experience that support the nurturing of enriched learning environments. This study emphasised that learning in the workplace is a relational endeavour, rooted in the day to day engagement between student midwives, midwives and others. By mapping these positive processes to the senses framework these processes are made more explicit and provide guidance for enhancing the learning experience in the midwifery context. Implications for practice: The framework and related inquiry tools developed from the study may be useful in other settings to further test out the impact of this relational approach to learning for student midwives

HVEM Signalling Promotes Colitis

Background Tumor necrosis factor super family (TNFSF) members regulate important processes involved in cell proliferation, survival and differentiation and are therefore crucial for the balance between homeostasis and inflammatory responses. Several members of the TNFSF are closely associated with inflammatory bowel disease (IBD). Thus, they represent interesting new targets for therapeutic treatment of IBD. Methodology/Principal Findings We have used mice deficient in TNFSF member HVEM in experimental models of IBD to investigate its role in the disease process. Two models of IBD were employed: i) chemical-induced colitis primarily mediated by innate immune cells; and ii) colitis initiated by CD4+CD45RBhigh T cells following their transfer into immuno-deficient RAG1-/- hosts. In both models of disease the absence of HVEM resulted in a significant reduction in colitis and inflammatory cytokine production. Conclusions These data show that HVEM stimulatory signals promote experimental colitis driven by innate or adaptive immune cells

Exploring values in nursing: generating new perspectives on clinical practice

Objective The \u27Essentials of Care\u27 (EoC) program seeks to develop a shared vision amongst nurses within particular workplace teams. The purpose of this study was to describe the experiences of nurses during the process of exploring their values and developing these into a shared vision at both an individual level and as a team. Design A qualitative, focus group design was used to provide an accurate representation of the nurses experiences in reflecting on their values and developing these into individual ward/unit vision statements. Six focus groups were conducted by independent researchers. The focus group discussions were recorded and transcribed by an independent researcher. The transcription provided the data for thematic analysis. Setting This study was conducted in two tertiary hospitals from the same Local Health District in New South Wales, Australia. Subjects Forty-two nurses from fourteen hospital wards or units participated in the study. Seventeen were facilitators of the program and the remainder were nursing staff who had undertaken the program. Main outcome measures The authors independently interpreted the transcripts using inductive qualitative analysis, reaching consensus on emergent themes. Representative quotations were chosen for each theme. Results Six themes emerged which describe the experiences of nurses during the exploration of individual and team workplace values which were then developed into shared visions. The emergent themes were: shared values and commitment to patient care; empowerment and ownership for cultural change; real and observable outcomes; the meaning of the team; different active learning approaches equalling the same outcome; and culture change results in new perspectives. Conclusion This study supports the benefits of value-based programs. Exploring values led to new perspectives on clinical practice, both individually and collectively by the nursing teams

Exploring the nursing and midwifery champion through narrative analysis

Background: Nursing and midwifery champions are seen in a variety of clinical settings to drive innovation and implement evidence-based care. They are often referred to as change champions and clinical leaders undertaking quality improvement initiatives aimed to improve healthcare outcomes. Little is known about their journey, why they accept the role, stay in the role and the support needed that enhances their professional development. Aim: To discover the journey of the nursing and midwifery champion. Methods: A qualitative design using narrative analysis. Findings: Four themes were revealed in this study: Walking your own path: becoming a champion; me myself and I: how being a champion relates to me as a person; the journey of a champion: things that happened along the way; foundations to flourish: influences and keys to growth as a champion and what's in it for me: reasons for being a champion. These themes encapsulate the events, actions and occurrences that shaped the journey of champions. Discussion: The evolution of nurses and midwives into champions is an interesting journey, influenced by many factors. Making a difference in the lives of others is the driving force behind their pursuit of becoming champions. They seek professional development opportunities which are supported by influential managers and role models. Conclusion: A nursing and midwifery champion is responsible for influencing, guiding and implementing initiatives to improve healthcare outcomes. Understanding how they become champions, key influences on their development and the reasons they stay in the role is beneficial to those involved in shaping and supporting emerging nursing and midwifery champions

An innovative model of supportive clinical teaching and learning for undergraduate nursing students: The cluster model

Students look forward to their clinical practicum to learn within the context of reality nursing. As educators we need to actively develop models of clinical practicum whereby students are supported to engage and learn in the clinical learning environment. The aim of this paper is to describe an innovative model of supportive clinical teaching and learning for undergraduate nursing students as implemented in a large teaching hospital in New South Wales, Australia. The model of supportive clinical teaching and learning situates eight students at a time, across a shift, on one ward, with an experienced registered nurse from the ward specialty, who is employed as the clinical teacher to support nursing students during their one to two week block practicum. Results from written evaluation statements inform the discussion component of the paper for a model that has proved to be successful in this large healthcare facility. © 2010 Elsevier Ltd