Transition from clinical manager to university lecturer : a self-reflective case study

This paper is a case study exploring the author’s use of reflective practice to facilitate the transition in role from a clinical manager with teaching responsibilities in a critical care unit to university lecturer. The similarities and differences in the roles with respect to learner characteristics, teaching contexts and effective teaching strategies are discussed. Brookfield’s model provides the methodological framework for the process of critically reflective practice undertaken to support and inform the transition. This case study describes a novice academic’s reflection through the four lenses of autobiography, the theoretical literature, student feedback and the perspectives of colleagues as she seeks to optimise student engagement and learning using the large lecture as the teaching and learning activity. The author suggests that the use of a framework such as Brookfield’s model that supports critical reflection may be of significant benefit to accelerate the personal and professional growth of new academic staff in their teaching practice.

Optimizing safety, fidelity and usability of an Intelligent Clinical Support Tool (ICST) for acute hospital care: an Australian case study using a multi-method Delphi Process

This research focuses on a major health priority for Australia by addressing existing gaps in the implementation of nursing informatics solutions in healthcare. It serves to inform the successful deployment of IT solutions designed to support patient-centered, frontline acute healthcare delivery by multidisciplinary care teams. The outcomes can guide future evaluations of the contribution of IT solutions to the efficiency, safety and quality of care delivery in acute hospital settings.

Optimising safety, fidelity and usability of an Intelligent Clinical Support Tool (ICST) for acute hospital care: an Australian case Study using a multi-method Delphi process

This research focuses on a major health priority for Australia by addressing existing gaps in the implementation of nursing informatics solutions in healthcare. It serves to inform the successful deployment of IT solutions designed to support patient-centered, frontline acute healthcare delivery by multidisciplinary care teams. The outcomes can guide future evaluations of the contribution of IT solutions to the efficiency, safety and quality of care delivery in acute hospital settings.

Assessing Australian undergraduate clinical learning

Determining the clinical preparedness of undergraduate nursing students is vital in developing graduates who are ready to assume the roles of registered nurses. This paper reports findings relating to clinical assessment in Australian undergraduate nursing programs. Using data collected in a national survey and selected case studies, current assessment practices are described. Although students were increasingly exposed to a narrower range of clinical experiences, claims to comprehensive preparation of nurses remain prominent. Issues in the congruity between assessment methods and purported outcomes of clinical learning programs are discussed.

A problem-based approach to clinical education in dietetics

Developing the clinical skills and knowledge of dietetic students provides a challenge for both universities and health care agencies. Deakin University has recently adopted a group learning model using problem-based learning to deliver the clinical component of the Master of Nutrition and Dietetics course. This approach was designed to enhance integration of clinical theory and practice, develop closer links between on-campus and off-campus learning environments and provide students with more active learning experiences. The impact of the new approach was evaluated using student questionnaires, academic and competency outcomes, and a focus group convened with hospital supervisors. The evaluation indicated that students generally thought that this method of learning had helped to integrate their basic knowledge with dietetic case management. There was no difference in academic scores from the previous year and an apparent reduction in the number of students requiring additional placement time to mee t competency standards. Hospital supervisors were supportive of the changes, although they had some reservations regarding the time and structure of clinical placements. As a result of this evaluation, recommendations for future development of the program include introducing problem-based learning to students earlier in their course, providing additional placement days during the block and increasing the amount of time dedicated to more complex topics. Based on the evaluation results obtained, this collaborative learning using a problem-based approach will continue to be used in the clinical education program at Deakin University.

Role of knowledge and ability in student nurses` clinical decision-making

Little is known about the acquisition of decision-making skills in nursing students as a function of experience and academic ability. Knowing how experience and academic skills interact may help inform clinical education programs and formulate ways of assessing students' progress. The aims of the present study were to develop a problem-solving task capable of measuring clinical decision-making skills in novice nurses at different levels of domain-specific knowledge; and to establish the relative impact on decision-making of domain-specific knowledge and general ability as determinants of the acquisition of decision-making skills. Three types of clinical problems of increasing complexity were developed. Sixty second-year and third-year student nurses with high and low academic scores were studied in terms of their ability to generate hypotheses for a hypothetical case, recognize disconfirming information and the need to access additional information, and diagnostic accuracy. The results showed that general academic ability and knowledge function partly independently in the acquisition of expertise in nursing. Academic ability affects decision-making in low complexity tasks, but as case complexity increases, domain-specific knowledge and experience determines decision-making skills. There are important differences in the way novices with different levels of knowledge and ability make clinical decisions and these can be studied by systematically increasing the complexity of the decision task. These results have implications for the way in which clinical education is structured and evaluated.

Socio-economic factors in obesity: a case of slim chance in a fat world?

The global obesity pandemic has been well-documented and widely discussed by the public, the media, health officials, the food industry and academic researchers. While the problem is widely recognised, the potential solutions are far less clear. There is only limited evidence to guide decisions as to how best to manage obesity in individuals and in populations. While widely viewed as a clinical and public health problem in developed countries, it is now clear that many developing countries also have to grapple with this problem or face the crippling healthcare costs resulting from obesity-related morbidity. There is also abundant evidence that obesity is socio-economically distributed. In developed countries persons of lower socio-economic position are more likely to be affected, while in developing countries, it is often those of higher socio-economic position who are overweight or obese. The aim of this paper is to briefly review the evidence that links socio-economic position and obesity, to discuss what is known about underlying mechanisms, and to consider the role of social, physical, policy and cultural environments in explaining the relationships between socio-economic position and obesity. We introduce the concept of ‘resilience’ as a potential theoretical construct to guide research efforts aimed at understanding how some socio-economically disadvantaged individuals manage to avoid obesity. We conclude by considering an agenda to guide future research and programs focused on understanding and reducing obesity among those of low socio-economic position.

Championing telemedicine in New Zealand : the case of utilizing video conferencing in psychiatry and dermatology

This research explores the factors that could influence telemedicine success in two hospitals involved in a rural setting in New Zealand. Findings from the cases revealed that telemedicine utilising the video conferencing technology (TMVC) was adopted based on its cost-benefit to the hospitals. This is necessary but considering the impact of other factors, specifically the compatibility factor could have made the adoption decision more effective earlier on. The administration manager was the primary instigator of TMVC in psychiatry in one of the hospitals, whereas in the other hospital it was the dermatologist. Therefore, this research emphasises the importance of the tight coupling between the roles of both the management and the clinical champions for TMVC to succeed in New Zealand. However, the research results suggest the limited use of the technology in the cases.

Reconceptualising the objectives of a pilot study for clinical research

This is a methodological study in which a case report is used to retrospectively analyse the link between a successful pilot study and stalled main study to identify potential methodological weaknesses in the planning process. The analysis identified unanticipated influences related to hospital processes and discipline boundaries that adversely influenced participant recruitment and retention for a clinical trial. The findings of the study demonstrate that, whilst the pilot is an important step in research planning to confirm the design and operational processes for a study, a thorough analysis of the relevant health service environment is an important additional objective for the pilot study.

Case review: septic shock in the pregnant patient

This case study involves a 36-year-old female at 15 weeks gestation who presented with severe lower abdominal pain post amniocentesis and subsequently deteriorated into a state of septic shock whilst in the ED. The circumstances surrounding this patient's presentation and subsequent clinical course are presented. The assessment and management of septic shock is also described with specific consideration to this patient's pregnant state.

Consumer notes clinical indicators : determining inter-rater reliability with multiple users, nominal categories and several cases

A method of determining inter-rater reliability when there are multiple raters, nominal rating categories and several cases is described and applied in the development of an instrument for auditing the ANZCMHN (1995) standards of practice for mental health nursing in New Zealand. Clinical statements (n=41) from the O’Brien et al (2002a, 2003) study, which reflected nursing behaviours contributing to the achievement of the standards of practice, were used to audit consumer files. During two Phases, the clinical indicator statements were refined and rules for judging the achievement of each statement from case note documentation were established. The resultant statements have adequate inter-rater reliability for the assessment of nursing practice with respect to the ANZCMHN (1995) standards of practice.

New Zealand development and trial of mental health nursing clinical indicators - a bicultural study

This paper describes the development and validation of bicultural clinical indicators that measure achievement of mental health nursing practice standards in New Zealand (ANZMCHN, 1995, Standards of practice for mental health nursing in New Zealand. ANZCMHN, Greenacres). A four-stage research design was utilised including focus groups, Delphi surveys, a pilot, and a national field study, with mental health nurses and consumers as participants. During the national field study, consumer files (n=327) from 11 District Health Boards, and registered nurses (n=422) completed an attitude questionnaire regarding the regularity of specific nursing and service activities. Results revealed a variation in the mean occurrence of the clinical indicators in consumer case notes of 18.5–89.9%. Five factors with good internal consistency, encompassing domains of mental health nursing required for best practice, were derived from analysis of the questionnaire. This study presents a research framework for developing culturally and clinically valid, reliable measures of clinical practice.

Assessment and case conceptualization in sex offender treatment

The assessment of sexual offenders consists of the systematic collection of clinically relevant information in order to detect clinical phenomena or problems and to provide clear treatment targets. The result of this process is a conceptual model, or case formulation, representing the client’s various problems, the hypothesized underlying mechanisms, and their interrelationships. The focus of this article is on the importance of psychological assessment and case formulation in the rehabilitation and management of individuals convicted of sexual offences. First, we make a number of general points about the importance of evidence based assessment and clinical reasoning in case formulation. Second, we review key elements of contemporary sexual offender theory that highlights the heterogeneity evident among sex offenders and the implications for case formulation and treatment planning. Third, we discuss the role of case formulation for risk assessment and management. Finally, we illustrate our major points with a brief case study and conclude with a brief consideration of the value of case formulations.

Moving beyond resistance to restraint minimization : a case study of change management in aged care

Aim: This case study describes a quality initiative to minimize restraint in an Australian residential aged care facility.

Approach: The process of improving practice is examined with reference to the literature on implementation of research into practice and change management. The differences between planned and emergent approaches to change management are discussed. The concepts of resistance and attractors are explored in relation to our experiences of managing the change process in this initiative. The importance of the interpersonal interactions that were involved in facilitating the change process is highlighted.

Implications: Recommendations are offered for dealing with change management processes in clinical environments, particularly the need to move beyond an individual mind-set to a systems-based approach for quality initiatives in residential aged care.

Processes influencing the development of graduate nurse capabilities in clinical risk management : an Australian study

Objectives: To explore and describe key processes influencing the development of graduate nurse capabilities in clinical risk management (CRM).

Methods: This study was undertaken using an exploratory descriptive case study method. Four sample units of analysis were used, notably: 2 cohorts of graduate nurses (n = 11) undertaking a 12-month graduate nurse transition program; key stakeholders (n = 34), that is, nurse unit managers, clinical teachers, preceptors, a quality manager, a librarian, and senior nurse administratiors employed by the participating health service; patient outcome data; and pertinent literature.

Results: Data strongly suggested that graduate nurse capabilities in CRM were most influenced not by their supposed lack of clinical knowledge and skills but by their lack of corporate knowledge. The failure to provide new graduate nurses with pertinent information on CRM at the beginning of their employment and thereafter at pertinent intervals during the graduate nurse year program aslo hindered the development of their capabilities to manage clinical risk.

Conclusions: Management and educational processes pertinent to informing and involving new graduate nurses in a hospital's local CRM program (including information about the organization's local policies and procedures) need to be implemented systematically at the very beginning of a new graduate's employment and thereafter throughout the remainder of the graduate nurse year.