Clinical nursing education: Constructing a teaching model from processes and practice

The current complexity of client care can only benefit from teaching approaches that foster critical reflection and independence of learning in nursing students in actual health care settings. There is value to the nursing profession in understanding the balance between intellectual, strategic and moral acts of teaching within a humanistic, authoritarian or liberal teaching style that stimulates, supports and develops clinical competence and self-direction of learning in students within a nurturing learning environment. In order to further understand the concept of clinical education, a naturalistic, case study inquiry was undertaken in Western Australia. The purposes of the study were first, to construct an understanding of clinical education, the complexities of the clinical educator’s role and responsibilities within the context of the clinical milieu. Second, the researcher aimed to theorise about the context and processes of clinical educators’ teaching and learning interactions with students in the clinical milieu that resulted from the three clinical educator cases. A particular focus in this study was to further understand the ways clinical educators guided aspects of students' learning that required critical thinking and reflective practice. In doing so, this dissertation explains the processes of clinical teaching as described by the participants and observed by the researcher. Clinical educators in pre-registration, undergraduate nursing programmes from two Western Australian universities were identified as major stakeholders in clinical nursing education and were invited to participate. The understanding of clinical education that resulted from the case study is developed and explained in this dissertation. Recent developments within clinical nursing education are marked by increasing complexity within a context of raised client expectations, cultural diversity, technological advances, and fiscal constraint. Within such a learning milieu, clinical educators develop plans for teaching based on knowledge of the curriculum and experience in clinical teaching. They respond to students’ expectations and needs, act as advocates for student initiated client care, and make professional judgements about students’ cognitive, psychomotor and affective competencies. The researcher applied a constructivist approach to create a contextual understanding of clinical educators’ role, responsibilities and processes of clinical teaching. Activities of teaching were identified as being intellectual and strategic (Green, 1971; Hellgren, 1985) and moral (Fenstermacher, 1990; Sirontik, 1990; Stewart, 1993). For the purpose of this dissertation, the intellectual, strategic and moral acts have been adopted for application to the findings on clinical teaching. Those findings were reconstructed in a model developed by the researcher which situates activities of clinical teaching within styles of teaching. The activities of clinical teaching referred to in this dissertation are intellectual, strategic and moral acts of teaching. The styles of teaching referred to in this dissertation are humanistic, authoritarian, liberal and misanthropic and were derived from the literature on Invitational Teaching (Purkey & Novak, 1984; Ripley, 1986). The researcher hypothesises about the regard for student learning that might arise from the various relationships in the model. This thesis adds to the practice of clinical education by suggesting the value of identifying clinical educators’ styles and strategies as a means to nurturing independent life-long learning in students. The benefit of self-direction is a professional who can effectively function regardless of the unpredictable circumstances inherent in the clinical setting and negotiate his/her own learning. Recommendations for further study include the need to validate the constructed model of clinical practice teaching and to determine if the model is predictive of effective clinical learning outcomes that can be validated against various levels of students. Also, there is a need to determine transferability and application of the clinical practice teaching theory to other countries with similar undergraduate academic preparation of Registered Nurses

Research protocol for the exploration of experiences of aboriginal Australian mothers and healthcare professionals when using the Edinburgh postnatal depression scale:A process-oriented validation study using triangulated participatory mixed methods

INTRODUCTION: Adopting a process-oriented framework for test validation can help to establish whether this tool has the potential to be an acceptable, valid and reliable indicator of depression for mothers and mothers-to-be. This mixed-methods research protocol seeks to explore the views and experiences of Aboriginal mothers and healthcare professionals in relation to the Edinburgh Postnatal Depression Scale (EPDS), and is intended to highlight potential barriers in perinatal mental health conceptualisation, engagement and response style. METHODS AND ANALYSIS: Thematic analysis will be applied to interview transcripts of Aboriginal Australian mothers (n=6+) and healthcare professionals (n=6+) to identify key themes. The process-focused validation model will use narratives about experiences of using the EPDS as the priority point of analysis. Item-level data and process-level (experience) data are key phenomenological data. The interview-based narratives will be then compared with EPDS scores to check for points of congruence and divergence. This will be done at two time points, antenatally and postnatally, to assess changes in assessment processes and perceptions. Bridging evidence-based research with clinical practice in an Aboriginal Australian context will be facilitated by an investigation of the perceived cultural relevance and likely clinical effectiveness of EPDS. Such evidence is critical to understanding whether the EPDS fulfils its intended purpose. The guiding principles in designing this research protocol is to benefit the well-being of young Aboriginal families and communities through partnership with Aboriginal women. ETHICS AND DISSEMINATION: Ethics approval was obtained from Human Research Ethics Committee of Murdoch University and from Western Australian Aboriginal Health Ethics Committee (WAAHEC). Participating healthcare sites and services have provided letters of support. Results of this study will be submitted for publication in a peer-reviewed journal

Health promotion in an Australian Aboriginal community: the Growing Strong Brains ® toolkit

AIM: The aim of this paper is to describe the implementation and evaluation of the Growing Strong Brains® (GSB) toolkit in a remote Aboriginal community in Western Australia (WA) over a 2-year period, 2018-2019. BACKGROUND: Ngala, a community service organisation in WA, developed the GSB toolkit in 2014, a culturally appropriate and interactive resource to build knowledge of early childhood development within Aboriginal communities. This was in response to evidence that a higher percentage of children in Aboriginal communities were developmentally vulnerable compared to the rest of the population. The GSB toolkit promotes awareness and understanding of early brain development pre-birth and in the early years of a child\u27s life. METHODS: The project was underpinned by participatory action research (PAR). Reflective PAR review cycles (n = 5) monitored local community engagement, navigated challenges and utilised community strengths. Fifty-nine local service providers attended a 2-day formal training. Data were collected by using various methods throughout the project, including feedback following training, focus groups, surveys, one-on-one interviews using yarning techniques and reflective feedback from the Project Lead. FINDINGS: Establishing local Aboriginal project staff was pivotal to the success of the project. When delivering services for and with Aboriginal people, it is essential that cultural competence, safety and decision-making is carried through from planning to implementation and evaluation, and involves genuine, respectful and authentic relationships. Sufficient time allocation directed towards building relationships with other service providers and local community members needs to be considered and built into future projects.The Growing Strong Brains® project is embedded within the local community, and anticipated implementation outcomes were achieved. The support of the local people and service providers was beyond expectation, enabling the building of local capacity, and the development of a common understanding of the key messages from the GSB toolkit to allow integration throughout all levels of the community. This project has been important to build on the strategies necessary to introduce, implement and evaluate the GSB toolkit in other remote Aboriginal communities

Aboriginal children and family connections to primary health care whilst homeless and in high housing mobility: observations from a Nurse Practitioner-led service

Aim: This article documents the impact of a Nurse Practitioner-led primary health service for disadvantaged children living in housing instability or homelessness. It identifies that First Nations children miss out on essential primary care, particularly immunisation, but have less severe health conditions than non-First Nations children living in housing insecurity. Background: Health services for homeless populations focus on the 11% of rough sleepers, little is done for the 22% of children in Australia living in housing instability; many of whom are from First Nations families. Little is known of the health status of these children or their connections to appropriate primary health care. Methods: This research implemented an innovative model of extended health care delivery, embedding a Nurse Practitioner in a homeless service to work with families providing health assessments and referrals, using clinically validated assessment tools. This article reports on proof of concept findings on the service that measured immunisation rates, developmental, medical, dental and mental health needs of children, particularly First Nations children, using a three-point severity level scale with Level 3 being the most severe and in need of immediate referral to a specialist medical service. Findings: Forty-three children were referred by the service to the Nurse Practitioner over a 6-month period, with nine identifying as First Nations children. Differences in severity levels between First Nations/non-First Nations children were Level 1, First Nations/non-First Nations 0/15%; Level 2, 10/17%; and Level 3, 45/29%. Forty-five percent of First Nations children had no health problems, as compared to 29% on non-First Nations children. Immunisation rates were low for both cohorts. No First Nations child was immunised and only 9% of the non-First Nations children. While numbers for both cohorts are too low for valid statistical analysis, the lower levels of severity for First Nations children suggest stronger extended family support and the positive impact of cultural norms of reciprocit

Early mortality among Aboriginal and Non-Aboriginal women who had a preterm birth in Western Australia: A population-based cohort study

Background: Having a preterm ( \u3c 37 weeks\u27 gestation) birth may increase a woman\u27s risk of early mortality. Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have higher preterm birth and mortality rates compared with other Australian women. Objectives: We investigated whether a history of having a preterm birth was associated with early mortality in women and whether these associations differed by Aboriginal status. Methods: This retrospective cohort study used population-based perinatal records of women who had a singleton birth between 1980 and 2015 in Western Australia linked to Death Registry data until June 2018. The primary and secondary outcomes were all-cause and cause-specific mortality respectively. After stratification by Aboriginal status, rate differences were calculated, and Cox proportional hazard regression was used to estimate adjusted hazard ratios (HR) and 95 % confidence intervals (CI) for all-cause and cause-specific mortality. Results: There were 20,244 Aboriginal mothers (1349 deaths) and 457,357 non-Aboriginal mothers (7646 deaths) with 8.6 million person-years of follow-up. The all-cause mortality rates for Aboriginal mothers who had preterm births and term births were 529.5 and 344.0 (rate difference 185.5, 95 % CI 135.5, 238.5) per 100,000 person-years respectively. Among non-Aboriginal mothers, the corresponding figures were 125.5 and 88.6 (rate difference 37.0, 95 % CI 29.4, 44.9) per 100,000 person-years. The HR for all-cause mortality for Aboriginal and non-Aboriginal mothers associated with preterm birth were 1.48 (95 % CI 1.32, 1.66) and 1.35 (95 % CI 1.26, 1.44), respectively, compared with term birth. Compared with mothers who had term births, mothers of preterm births had higher relative risks of mortality from diabetes, cardiovascular, digestive and external causes. Conclusions: Both Aboriginal and non-Aboriginal women who had a preterm birth had a moderately increased risk of mortality up to 38 years after the birth, reinforcing the importance of primary prevention and ongoing screening

Improving access to primary care for Aboriginal babies in Western Australia: Study protocol for a randomized controlled trial

Background: Despite a decade of substantial investments in programs to improve access to primary care for Aboriginal mothers and infants, more than 50 % of Western Australian Aboriginal babies are still not receiving primary and preventative care in the early months of life. Western Australian hospitals now input birth data into the Western Australian electronic clinical management system within 48 hours of birth. However, difficulties have arisen in ensuring that the appropriate primary care providers receive birth notification and clinical information by the time babies are discharged from the hospital. No consistent process exists to ensure that choices about primary care are discussed with Aboriginal families. Methods/Design: We will undertake a population-based, stepped wedge, cluster randomized controlled trial of an enhanced model of early infant primary care. The intervention is targeted support and care coordination for Aboriginal families with new babies starting as soon as possible during the antenatal period or after birth. Dedicated health professionals and research staff will consult with families about the families\u27 healthcare needs, provide information about healthcare in the first 3 months of life, offer assistance with birth and Medicare forms, consult with families about their choice for primary care provider, offer to notify the chosen primary care provider about the baby\u27s health needs, and offer assistance with healthcare coordination at the time of discharge from the hospital. We will evaluate this model of care using a rigorous stepped wedge approach. Our primary outcome measure is a reduced hospitalization rate in infants younger than 3 months of age. Secondary outcome measures include completed Aboriginal and Torres Strait Islander child health screening assessments, immunization coverage, and satisfaction of the families about early infant primary care. We will also assess the cost effectiveness of the model of care. Discussion: This study will be conducted over a 4-year period in partnership with birthing hospitals and primary care providers including Western Australian Aboriginal Community Controlled Health Services and the new Primary Health Networks. The results of our trial will be used to develop improved primary care models and to improve health outcomes for all Aboriginal infants. These are vital steps toward more equitable health service delivery for the Aboriginal and Torres Strait Islander children in Australia. Trial Registration: Australian New Zealand Clinical Trials Registry Registration number: ACTRN12615000976583Date registered: 17 September 2015. © 2016 McAullay et al

The EPDS and Australian Indigenous women: a systematic review of the literature

Problem The Edinburgh Postnatal Depression Scale (EPDS) is considered the gold standard in perinatal mental health screening and the Australian Clinical Practice Guidelines recommend universal use. However, screening rates are four times lower with Indigenous Australian women compared to non-Indigenous women. Difficulties have been reported using the EPDS in this context. Background Evidence demonstrates the link between perinatal mental health and maternal and child outcomes. Indigenous Australian maternal and child health and wellbeing outcomes remain unacceptably poor across all measured parameters and reported psychological distress and child removal rates are increasing. Methods A systematic literature review was conducted to assess the effectiveness, validity, reliability, and cultural safety of the EPDS in the Indigenous Australian context and identify the availability and suitability of any adaptations. Findings The EPDS has not been validated for use with Indigenous Australian women. Discussion The findings and limitations identified in this review are consistent with concerns in other countries about the cross-cultural use of the EPDS and its sensitivity in predicting risk for postnatal depression amongst Indigenous women. Where adaptations of the EPDS have been used there has been no psychometric and cultural validation beyond the remote communities in which they were developed. Conclusions There is no evidence to demonstrate that the EPDS in its current form and application is suitable for screening with Indigenous Australian women. Urgent work is required to evaluate and/or develop culturally meaningful screening tools that are predictive of risk for social and emotional wellbeing and perinatal mental distress in this context