Changing academic practice to prepare nursing undergraduates for an evidence-based approach

Evidence based practice (EBP) has been accepted as a process to assist health professionals in clinical decision making to improve patient outcomes. It requires applying skills in a prescribed sequence to critique existing practices. Many countries, including Australia, require nurses to demonstrate competencies in EBP skills to be registered. In the last ten years, this has lead to universities incorporating EBP in undergraduate nursing degree courses. The literature reports many challenges including students’ difficulties in critically appraising research evidence, and their need for both simplification of the process and extensive support. The purpose of our study was to investigate the effectiveness of a standalone introductory EBP subject for a diverse group of third-year undergraduates, based on a novel but challenging approach to assessment. Despite many changes made in the second iteration of the subject, most students’ perceptions of the subject’s difficulty remained unchanged. This research aligns with the issues identified in the literature and has wider applicability to the teaching of rapidly changing disciplines, where evidence-driven consumers have easy access to information and expect up-to-date practices.

Advanced nursing practice : a global perspective

Aim: To review the titles, roles and scope of practice of Advanced Practice Nurses internationally.----- Background: There is a worldwide shortage of nurses but there is also an increased demand for nurses with enhanced skills who can manage a more diverse, complex and acutely ill patient population than ever before. As a result, a variety of nurses in advanced practice positions has evolved around the world. The differences in nomenclature have led to confusion over the roles, scope of practice and professional boundaries of nurses in an international context.----- Method: CINAHL, Medline, and the Cochrane database of Systematic Reviews were searched from 1987 to 2008. Information was also obtained through government health and professional organisation websites. All information in the literature regarding current and past status, and nomenclature of advanced practice nursing was considered relevant.----- Findings: There are many names for Advanced Practice Nurses, and although many of these roles are similar in their function, they can often have different titles.----- Conclusion: Advanced Practice Nurses are critical for the future, provide cost-effective care and are highly regarded by patients/clients. They will be a constant and permanent feature of future health care provision. However, clarification regarding their classification and regulation is necessary in some countries.

Neonatal palliative care attitude scale : development of an instrument to measure the barriers to and facilitators of palliative care in neonatal nursing

OBJECTIVE The aim of this research project was to obtain an understanding of the barriers to and facilitators of providing palliative care in neonatal nursing. This article reports the first phase of this research: to develop and administer an instrument to measure the attitudes of neonatal nurses to palliative care. METHODS The instrument developed for this research (the Neonatal Palliative Care Attitude Scale) underwent face and content validity testing with an expert panel and was pilot tested to establish temporal stability. It was then administered to a population sample of 1285 neonatal nurses in Australian NICUs, with a response rate of 50% (N 645). Exploratory factor-analysis techniques were conducted to identify scales and subscales of the instrument. RESULTS Data-reduction techniques using principal components analysis were used. Using the criteria of eigenvalues being 1, the items in the Neonatal Palliative Care Attitude Scale extracted 6 factors, which accounted for 48.1% of the variance among the items. By further examining the questions within each factor and the Cronbach’s of items loading on each factor, factors were accepted or rejected. This resulted in acceptance of 3 factors indicating the barriers to and facilitators of palliative care practice. The constructs represented by these factors indicated barriers to and facilitators of palliative care practice relating to (1) the organization in which the nurse practices, (2) the available resources to support a palliative model of care, and (3) the technological imperatives and parental demands. CONCLUSIONS The subscales identified by this analysis identified items that measured both barriers to and facilitators of palliative care practice in neonatal nursing. While establishing preliminary reliability of the instrument by using exploratory factor-analysis techniques, further testing of this instrument with different samples of neonatal nurses is necessary using a confirmatory factor-analysis approach.

Designing to maintain human agency in context-aware systems

This paper describes a series of design games, specifically aimed at exploring shifts in human agency, how they are managed, and the impact this will have on the design of future context-aware applications. The games focussed on understanding information handling issues in dental practice with participants from the University of Queensland Dental School playing an active role in the activities. Participatory design activities reveal how technology solution impact on dental practices. By finding methods of representing technological possibilities in ways which can easily be understood we enhance the contribution that dentists can make to the design process.

Maintaining human agency in the design on context-aware systems : Design games in a dental surgery

This paper describes a series of design games, specifically aimed at exploring shifts in human agency in order to inform the design of context-aware applications. The games focused on understanding information handling issues in dental practice with participants from a university dental school playing an active role in the activities. Participatory design activities help participants to reveal potential implicit technical resources that can be presented explicitly in technologies in order to assist humans in managing their interactions with and amidst technical systems gracefully.

Being ethical : how process drama assists pre-service drama teachers to reflect on professional ethics

This research thesis focuses on the experiences of pre-service drama teachers and considers how process drama may assist them to reflect on key aspects of professional ethics such as mandatory codes or standards, principled moral reasoning, moral character, moral agency, and moral literacy. Research from higher education provides evidence that current pedagogical approaches used to prepare pre –professionals for practice in medicine, engineering, accountancy, business, psychology, counselling, nursing and education, rarely address the more holistic or affective dimensions of professional ethics such as moral character. Process drama, a form of educational drama, is a complex improvisational group experience that invites participants to create and assume roles, and select and manage symbols in order to create a fictional world exploring human experience. Many practitioners claim that process drama offers an aesthetic space to develop a deeper understanding of self and situations, expanding the participant’s consciousness and ways of knowing. However, little research has been conducted into the potential efficacy of process drama in professional ethics education for pre-professionals. This study utilizes practitioner research and case study to explore how process drama may contribute to the development of professional ethics education and pedagogy.

Re-invent yourself: from London intensive care nursing and the Nigerian oil fields to an an academic library in Brisbane; a career change worth making.

A complete change of career forces a seismic shift in every aspect of your life. From day one, you have to face the loss of long held beliefs, behaviours, the known world of self, and security. We came from professions that themselves are poles apart, and many of the challenges we faced entering the profession were the same: juggling full-time work, part time study, and family commitmemts, taking a pay cut, and loss of social life. But over a short period of time we both transitioned to our new profession successfully. so what make our successful transition possible?

Inter-agency working : good intentions and interaction dynamics

This paper explores inter-agency working and examines the implications of inter-agency operations for delivering multi-domain service outcomes. Cross-agency collaborative approaches to service delivery are suggested to provide the vehicle for achieving integrated service and policy goals. However, it is argued these need to be crafted ‘fit’ for purpose’ and may not be the requisite approach for all joint purposes. Moreover, some commentators suggest that the optimism about these partnership arrangements and cross-agency actions to resolve complex multi-dimensional problems may be misplaced and propose that further research into the actual rather than desired consequences of these arrangements may find that, at times, partnership working creates negative effects. While collaboration and partnerships are often framed as the way to achieve real breakthroughs in service delivery across agencies, there remain key challenges to interagency working. As more and insistent calls for agencies and other community actors to work together in resolving complex social problems are heeded, the implications of working across organizational boundaries need to be further investigated. This paper investigates cases of inter-agency programmes to understand the dimensions and limitations of inter-agency working. The paper concludes by offering a framework for better inter-agency working that has applicability across all sectors.