Knowledge and attitudes of ED staff before and after implementation of the emergency nurse practitioner role

Introduction
The Emergency Nurse Practitioner (ENP) role was implemented in the Emergency Department (ED) at The Northern Hospital (TNH) in April 2004. Implementation of the ENP role occurred as part of a Department of Human Services funded project to establish the ENP model as an effective and sustainable model of care delivery in Victorian EDs.

Aim
The aim of this study was to examine the attitudes and knowledge of ED medical and nursing staff prior to, and following, implementation of the ENP role.

Methods
The design was a pre-test/post-test design and the Northern Emergency Nurse Practitioner Staff Survey was used for data collection. A total of 104 ED staff completed the pre-test survey and the post-test survey was completed by 79 ED staff.

Results
The attitudes and knowledge of ED medical and nursing staff changed significantly during implementation of the ENP role. Pre-test data indicated that staff were generally supportive of the role but had a poor understanding of the requirements for endorsement and how the role would function in clinical practice. Post-test data showed significant increases in support for the ENP role, a greater understanding of the requirements to become an ENP and increased understanding of the logistics and functions of an ENP.

Conclusion
The implementation of the Nurse Practitioner role within the emergency department of The Northern Hospital, Victoria Australia has been a positive experience for both medical and nursing staff.

Designing the future in wound care: the role of the nurse practitioner

The nurse practitioner is emerging as a new level and type of health care. Increasing specialisation and advanced educational opportunities in nursing and the inequality in access to health care for sectors of the community have established the conditions under which the nurse practitioner movement has strengthened both nationally and internationally. The boundaries of responsibility for nurses are changing, not only because of increased demands but also because nurses have demonstrated their competence in varied extended and expanded practice roles. The nurse practitioner role reflects the continuing development of the nursing profession and substantially extends the career path for clinical nurses.

This paper describes an aspect of a large-scale investigation into the feasibility of the role of the nurse practitioner in the Australian Capital Territory (ACT) health care system. The paper reports on the trial of practice for a wound care nurse practitioner model in a tertiary institution. In the trial the wound care nurse practitioner worked in an extended practice role for 10 months. The nurse practitioner practice was supported, monitored and mentored by a clinical support team. Data were collected relating to a range of outcomes including definition of the scope of practice for the model, description of patient demographics and outcomes and the efficacy of the nurse practitioner service.

The findings informed the development of clinical protocols that define the scope of practice and the parameters of the wound care nurse practitioner model and provided information on the efficacy of this model of health care for the tertiary care environment. The findings further suggest that this model brings expert wound care and case management to an at-risk patient population. Recommendations are made relating to ongoing research into the role of the wound care nurse practitioner model in the ACT health care system.

Nurse practitioner standards project : report to the Australian Nursing & Midwifery Council

The aims of the project have been to conduct research that will inform a description of the core role of the nurse, core competency standards for the nurse and standards for education and program accreditation for nurse preparation leading to regsitration and authorisation.

Nurse practitioner standards : an Australian and New Zealand research collaboration

This paper will report the findings from research conducted in Australia and New Zealand to inform development of standards for nurse practitioner education and practice competencies. In New Zealand and Australia the nurse practitioner is a new and unique level of health-care provider. The shifting boundaries caused by health-care reform have created impetus and demand for development of new models of health-care, but have also created some uncertainty regarding nurse practitioner standards, education and models of care. The title, Nurse Practitioner, is now legislated in New Zealand and most jurisdictions in Australia but there is scant research to inform development of nurse practitioner standards. This research, sponsored by the Australian Nursing Council and the Nursing Council of New Zealand, was conducted to develop generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. The study involved collection and triangulation of data from a range of sources across Australia and New Zealand including: in-depth interviews with 15 nurse practitioners from different geographical and clinical contexts; curriculum survey of all nurse practitioner courses in the two countries and interview with convenors of these courses; collation of the authorisation/registration processes and policies from states and territories in Australia, New Zealand and internationally. These data were analysed within and across the data modalities to provide information on standards for nurse practitioner practice and education. Findings from the study included identification of the core role of the nurse practitioner as it is expressed in New Zealand and Australia and generic standards for nurse practitioner competencies, education and authorisation. These findings will standardise expectations, support mutual recognition of nurse practitioner authorisation across the two countries and make an important contribution to the current international debate on nurse practitioner standards and scope of practice.

Implementing elements of Schon's reflective practitioner in an undergraduate public relations program

While the internship unit in a public relations degree is often viewed as the foremost area of experiential learning it can fail to deliver significant learning outcomes for student and teacher. This paper explores the use of other activity-based learning (ABL) methods as implemented in the Deakin University public relations undergraduate degree. The paper applies Donald Schon's concept of the reflective practitioner to learning undertaken in an internship unit and compares this application to two other units where ABL is used and the focus is on creating a client-professional relationship. For the purpose of this paper information was analysed using the 2006 on-campus cohort only. The cohort was further refined to include those students who successfully completed the degree of BA in public relations. Student internship evaluation forms and unit records were viewed to gain statistical information.

A practitioner's report on the interactive effects of socio-demographic barriers to travel

Researchers have viewed constraints as a subset of reasons for not engaging in a particular behavior. This study investigates the impact of two-way interactions between age, income, and life stage (forming groups of more and less constrained respondents) on dependent variables comprising intentions held by Australian residents to travel intrastate, interstate or overseas for a vacation. A representative sample of 49,105 Australian respondents is utilized. Binary logistic regression is used to profile respondents who intend to take a domestic or an overseas holiday of more than three days duration. This paper finds that the interactions between the constraint variables of age, income and life stage are important in explaining travel preferences. Constraint groups are then formed by combining the important constraint variables. There are significant levels of vacation travel by even the most constrained groups as well as significant amounts of non-travel by the least constrained sectors of our society. Marketing insights and recommendations are provided for the most constrained travel group and the least constrained travel group.

A controlled trial of internet-based cognitive-behavioural therapy for panic disorder with face-to-face support from a general practitioner or email support from a psychologist

Background: Panic disorder (PD) is one of the most common anxiety disorders seen in general practice, but provision of evidence-based cognitive-behavioural treatment (CBT) is rare. Many Australian GPs are now trained to deliver focused psychological strategies, but in practice this is time consuming and costly.

Objective: To evaluate the efficacy of an internet-based CBT intervention (Panic Online) for the treatment of PD supported by general practitioner (GP)-delivered therapeutic assistance.

Design: Panic Online supported by GP-delivered face-to-face therapy was compared to Panic Online supported by psychologist-delivered email therapy.

Methods: Sixty-five people with a primary diagnosis of PD (78% of whom also had agoraphobia) completed 12 weeks of therapy using Panic Online and therapeutic assistance with his/her GP (n = 34) or a clinical psychologist (n = 31). The mean duration of PD for participants allocated to these groups was 59 months and 58 months, respectively. Participants completed a clinical diagnostic interview delivered by a psychologist via telephone and questionnaires to assess panic-related symptoms, before and after treatment.

Results: The total attrition rate was 20%, with no group differences in attrition frequency. Both treatments led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity and quality of life. There were no statistically significant differences in the two treatments on any of these measures, or in the frequency of participants with clinically significant PD at post assessment.

Conclusions: When provided with accessible online treatment protocols, GPs trained to deliver focused psychological strategies can achieve patient outcomes comparable to efficacious treatments delivered by clinical psychologists. The findings of this research provide a model for how GPs may be assisted to provide evidence-based mental healthcare successfully.

Practitioner perspectives on the family risk evaluation tool : an aide to decision making or 'just another form to fill in'?

The findings of research that explored how child protection practitioners in Queensland used the Structured Decision Making (SDM) tools are presented, focusing on how the Family Risk Evaluation tool (FRET) was used in decision making. The main finding was that the FRET was not used to assist the decision making of practitioners and consequently was ineffective in targeting the children most in need of a service. For practitioners, it was 'just another form to fill in'. As suggested by the participants in this research, a better strategy than the implementation of the SDM tools to improve decision making is the development of practitioner expertise through higher education.