Team based vs patient allocation systems in nursing: a comparative evaluation and socio-cultural discussion

This thesis reports on an effort to promote, implement and experimentally evaluate the ‘team nursing’ model of nursing care in comparison with an ‘individual patient allocation’ model of care at a large Sydney teaching hospital, as an ameliorating response to a workplace experiencing low job satisfaction and lack of adequate skilled manpower. A systematic review of available research (1980-2004) in relation to models of nursing care, leading up to the project’s development and implementation between 2002-4, is reported as background to the workplace change project described. This review indicated a need for more experimental evaluations of models of care initiatives. In the active arm of the experimental study subsequently conducted, an action research approach was taken to pursue the change to the team nursing model of nursing care. Experimental and focus group-based qualitative evaluation methods were employed to assess the merits of making this change in approach to daily nursing work organization in inpatient acute care settings. Both experimental and qualitative evaluation findings indicated that multiple benefits were accrued by making a shift away from an individual practice-focused model of care towards a collective practice-focused model. A novel 14-item tool for the measurement of job satisfaction in nursing was employed as a key measure of outcome of the model of care change. The results of validation studies in relation to this tool are presented. In an effort to contextualize the results of the project within the wider nursing socio-historical frame, the disposition of nurse executives and senior academics towards teaming and the models of care agenda is explored via thematic and post-structuralist analyses of an interview-based study. The thesis draws from multiple research paradigms in order to bring the results of the project work and its evaluation and the qualitative study among nursing leaders, together. Clinical autonomy is isolated and discussed as a central concern of both practicing and academic nurses. Post-structurally defined models of both the contemporary challenge for acute care nursing and a unifying model for the future are presented and discussed

Third-generation professional doctorates in nursing: the move to clarity in learning product differentiation

Context: Professional doctorates have been a part of the academic landscape for many years. Over this time, their focus, structure and mode of delivery have changed significantly as the terrain of professional practice has developed. In this paper we articulate this development over time through discussion of the evolution of first- and second-generation professional doctorates, and argue that there is a need for a third-generation doctorate with greater clarity regarding focus, structure and mode of delivery, in the context of advanced professional practice. Aims: A scoping review was undertaken of the development of professional doctorates in the discipline of nursing to inform thinking with regard to future design work for a post-masters (nurse practitioner endorsement) professional doctorate. Conclusion: In the context of the absence of any identified published outcome-based evidence of the value of first- or second-generation professional doctorates in general, and specifically in nursing, a third-generation evolution is proposed. This is based on the conclusion that the lack of identified outcomes is based not only on the axiomatic absence of research, but also that this may be symptomatic of a prevailing lack of clarity in programme design. A third-generation professional doctorate for nursing offers an opportunity to focus on congruence and internal consistency between the aims of the programme, learning outcomes, learning content and design, and the assessment. Implications for practice development: - The third-generation professional doctorate would no longer need to be distinguished from other degrees via an expression of what it is not, but rather would set out what it is - The educational product, with clear processes and content that are congruent with the course aims, could be clearly described as a self-contained entity more capable of producing measurable outcomes - Practice development is an integral part of the learning product through being a prescribed method in the research component of the coursesch_nur7pub5315pub2 [4

An international effort towards developing standards for best practices in analysis, interpretation and reporting of clinical genome sequencing results in the CLARITY Challenge

There is tremendous potential for genome sequencing to improve clinical diagnosis and care once it becomes routinely accessible, but this will require formalizing research methods into clinical best practices in the areas of sequence data generation, analysis, interpretation and reporting. The CLARITY Challenge was designed to spur convergence in methods for diagnosing genetic disease starting from clinical case history and genome sequencing data. DNA samples were obtained from three families with heritable genetic disorders and genomic sequence data were donated by sequencing platform vendors. The challenge was to analyze and interpret these data with the goals of identifying disease-causing variants and reporting the findings in a clinically useful format. Participating contestant groups were solicited broadly, and an independent panel of judges evaluated their performance. RESULTS: A total of 30 international groups were engaged. The entries reveal a general convergence of practices on most elements of the analysis and interpretation process. However, even given this commonality of approach, only two groups identified the consensus candidate variants in all disease cases, demonstrating a need for consistent fine-tuning of the generally accepted methods. There was greater diversity of the final clinical report content and in the patient consenting process, demonstrating that these areas require additional exploration and standardization. CONCLUSIONS: The CLARITY Challenge provides a comprehensive assessment of current practices for using genome sequencing to diagnose and report genetic diseases. There is remarkable convergence in bioinformatic techniques, but medical interpretation and reporting are areas that require further development by many groups

Factors influencing how senior nurses and midwives acquire and integrate coaching skills into routine practice: a grounded theory study

Aim: To introduce a theory which describes the process of and explicates the factors moderating, the acquisition and integration of leadership coaching skills into the routine practice of senior nurses and midwives. Background: Organizations invest significant resources in leadership coaching programs to ensure that coaching is embedded as a core function of the manager\u27s role. However, even after training, many managers remain unable to undertake this role successfully. The process by which health professionals translate ‘manager as coach’ training into successful practice outcomes, has remained largely unexplored. Design: A grounded theory study design. Methods: Data, collected between February 2012–May 2013, included in-depth interviews with 20 senior nurses and midwives who had attended a leadership coaching program and analysis of nine reflective practice journals. Multiple researchers coded and analysed the data using constant comparative techniques. Results: The outcomes of coaching training ranged from inappropriate use of the coaching skills through to transformed managerial practice. These outcomes were influenced by the dynamic interaction of three central domains of the emergent theoretical model: pre-existing individual perceptions, program elements and contemporaneous experiences. Interactions occurred within the domains and between them, impacting on activators such as courage, motivation, commitment and confidence. Conclusion: The study offers new insights into how senior nurses and midwives acquire and integrate coaching skills into their routine practice. The process is described as multifactorial and dynamic and has implications for the training design, delivery and organizational support of future leadership coaching programs

Models of care choices in today’s nursing workplace: where does team nursing sit?

This paper provides an overview of the developmental history of models of care (MOC) in nursing since Florence Nightingale introduced nurse training programs in a drive to make nursing a discipline-based career option. The four principal choices of models of nursing care delivery (primary nursing, individual patient allocation, team nursing and functional nursing) are outlined and discussed, and recent MOC literature reviewed. The paper suggests that, given the ways work is being rapidly reconfigured in healthcare services and the pressures on the nursing workforce projected into the future, team nursing seems to offer the best solutions

Reducing emotional distress in nurses using cognitive behavioral therapy : a preliminary program evaluation

Introduction: Workplace stress among nurses has been associated with high absenteeism, low work satisfaction, and poor retention rates. Aim: This pilot study evaluated the effectiveness of a 1 day stress management program on nurses' stress levels. Methods: The nurse participants attended an 8 h face-to-face interactive workshop based on cognitive behavioral therapy. The subjects also were given a self-directed manual with reading and exercises to use after the workshop. The nurses were assessed at baseline and at 6 weeks postworkshop attendance using the Nurse Stress Scale (NSS). They were asked to rate their level of stress at work, outside of work, and their overall stress. The participants also were asked to evaluate the perceived usefulness of the workshop at follow-up. Results: The sample consisted of 18 new graduate nurses halfway through their first year. The NSS subscales "nurse-doctor conflict", "death and dying", and "nurse-nurse conflict" showed statistically significant improvement at follow-up. The ratings of stress at work, outside of work, and the overall stress also showed statistically significant improvement. Conclusions: The workshop was well-received by the new graduate nurses. The pre/post findings suggest a beneficial effect of the intervention. The authors are encouraged by the results and now plan to conduct a multisite, randomized controlled trial to seek to establish a wider evidence base for the intervention

Using and understanding consumer satisfaction to effect an improvement in mental health service delivery

Using and understanding consumer satisfaction to effect an improvement in mental health service delivery Consumer satisfaction is today, widely accepted as a measure of the level and quality of service received by consumers. The aim of this survey-based study is to explore consumer satisfaction with quality of care, staff, environment and discharge in a south eastern Sydney adult acute inpatient mental health unit. A cross-sectional analysis is pursued in order to identify aspects of the patient stay, which form an associative relationship with an overall rating of consumer satisfaction on a 10-point scale. During the survey period, there were 182 discharges. Seventy questionnaires (38.5%) were returned from this group. The survey results highlight a number of areas of identified need, enabling the service to prioritize organizational systems around meeting these needs. Multiple regression analysis identified three items in the survey, which were independently significant associates of overall consumer satisfaction. They included being happy with the service provided by the consumer support worker, having support for services on discharge and feeling safe and secure on the ward. The model containing these three items accounted for 50% of the variation in overall satisfaction. Two primary interventions have been developed because survey administration which, it is hoped, will address issues raised in the survey. The interventions were the development of an admission and discharge pathway and a ward-based psychosocial intervention programme, which includes the involvement of consumer support workers

Prevalence and predictors of metabolic syndrome among patients attending an outpatient clozapine clinic in Australia

Objective: This study aimed to determine the prevalence and predictors of metabolic syndrome in an outpatient clozapine clinic in Australia. Methods: Metabolic syndrome is a cluster of some of the most dangerous cardiovascular risk factors, and its high prevalence in people with mental illness has been demonstrated. Patients attending a clozapine clinic were screened for the following: age, gender, ethnicity, waist circumference, blood pressure, high-density lipoprotein level, low-density lipoprotein level, blood sugar levels, total cholesterol level, triglycerides level, weight, body mass index, insulin resistance level, length of time on clozapine, clozapine dose, smoking status, family history of diabetes and cardiovascular disease, and personal history of polycystic ovarian syndrome. All the variables that were found to be significantly associated with metabolic syndrome were entered into a multivariate logistic regression analysis. Results: Seventy-three patients were screened for metabolic syndrome using the International Diabetes Federation's (2007) definition. Forty-five (61.6%) patients met the criteria for the syndrome. Increased blood sugar level, high diastolic blood pressure, older age, increased waist circumference, raised triglycerides level, and higher body mass index emerged as significant predictors of metabolic syndrome in the sample. Conclusions: This study adds further support for the systematic screening for metabolic syndrome in patients receiving clozapine. The need for intervention programs which screen for and address the modifiable risk factors of metabolic syndrome is discussed