Decision-making models used by `graduate nurses` managing patients` medications

Background. Nurses in a graduate programme in Australia are those who are in the first year of clinical practice following completion of a 3-year undergraduate nursing degree. When working in an acute care setting, they need to make complex and ever-changing decisions about patients' medications in a clinical environment affected by multifaceted, contextual issues. It is important that comprehensive information about graduate nurses' decision-making processes and the contextual influences affecting these processes are obtained in order to prepare them to meet patients' needs.
Aim. The purpose of this paper is to report a study that sought to answer the following questions: What are the barriers that impede graduate nurses' clinical judgement in their medication management activities? How do contextual issues impact on graduate nurses' medication management activities? The decision-making models considered were: hypothetico-deductive reasoning, pattern recognition and intuition.
Methods. Twelve graduate nurses who were involved in direct patient care in medical and surgical wards of a metropolitan teaching hospital located in Melbourne, Australia participated in the study. Participant observations were conducted with the graduate nurses during a 2-hour period during the times when medications were being administered to patients. Graduate nurses were also interviewed to elicit further information about how they made decisions about patients' medications.
Results. The most common model used was hypothetico-deductive reasoning, followed by pattern recognition and then intuition. The study showed that graduate nurses had a good understanding of how physical assessment affected whether medications should be administered or not. When negotiating treatment options, graduate nurses readily consulted with more experienced nursing colleagues and doctors.
Study limitations. It is possible that graduate nurses demonstrated a raised awareness of managing patients' medications as a consequence of being observed.
Conclusions. The complexity of the clinical practice setting means that graduate nurses need to adapt rapidly to make sound and appropriate decisions about patient care.

How graduate nurses use protocols to manage patients` medications

Aims and objectives. The aim of the study was to determine how graduate nurses use protocols in their medication management activities. The objectives were to: examine the extent of adherence to various protocols in relation to medication activities and determine how the ward environment impacts on graduate nurses' use of protocols to manage patients' medications.
Background. Protocols help newly qualified nurses integrate new knowledge into practice and promote effective decision-making
Design. A descriptive prospective qualitative design was used.
Methods. Twelve graduate nurses involved in direct patient care in medical, surgical and specialty wards of a metropolitan teaching hospital participated in the study. Participant observations were conducted with the graduate nurses during a two-hour period when medications were being administered to patients. In-depth interviews were conducted with each nurse immediately after observations and demographic data were collected on participating nurses and patients in their care, including all medications prescribed. Protocols associated with medication management activities for the clinical settings were also transcribed.
Results. Six themes were evident from the data: availability and use of protocols, scrutinizing patients' identity before medication administration, double-checking certain medications before administration, writing incident reports, following specific policies and timing the administration of medications.
Conclusion. Graduate nurses adhered to protocols if they were perceived not to impede with other nursing activities. Participants were also more likely to follow protocols if they felt encouraged to make their own decisions and if there was a decreased likelihood that disciplinary action would be involved.
Relevance to clinical practice. Experienced health professionals should encourage graduate nurses to comply with medication protocols and to make clinically reasoned decisions about medication activities. By providing peer support and acting as role models, experienced health professionals can also demonstrate to graduate nurses how effective protocol use is an important component of quality patient care.

Student's perceptions of compulsory asynchronous online discussion

Online discussion boards are increasingly being used by tertiary educators as tools for encouraging student interaction and for developing learning networks. In particular, educators who have adopted a socio-constructivist approach to teaching are keen to facilitate collaborative learning in which students share their experiences and perspectives, and construct knowledge together through shared meanings. In this paper, the findings from an electronic survey of 72 distance education students’ perceptions of an online discussion assessment item (ODAI) are presented. The study revealed that the majority of the respondents enjoyed the ODAI, and agreed that the online discussions had allowed them to achieve a range of cognitive and social learning outcomes, and to develop some important graduate skills.

Nursing educations and graduates : profiles for 2001 and projections for 2002

The present study was commissioned for the National Review of Nursing Education. This is the second of two national studies commissioned to map in detail nursing education programs and to profile and make future projections regarding graduates from undergraduate and postgraduate nursing education courses in Australia.

The first study was undertaken in 2001 by Deakin University School of Nursing under the auspices of the 2001 Evaluation Investigations Project titled "Nursing Education and Graduates: Profiles for 1999, and 2000 with projections for 2001". This project sought data on nursing education within Australia in order to improve the accuracy of nursing education databases and to strengthen the ability of DETYA to provide advice on workforce planning. Issues that arose from that project included differences in data sets for undergraduate nursing courses in Australia and the complex process of attempting to tease out and accurately quantify postgraduate specialty courses when a trend towards postgraduate generic courses was evident. Approximately 26% of postgraduate domestic student enrolment data were reported utilising a generic nursing course category.

The purpose of this study was, therefore, twofold. Firstly, this study validated and extended the existing database developed in the previous study mapping in detail the full range of undergraduate programs offered by tertiary education providers across Australia that lead to an initial qualification and entry into nursing practice.

New data about the following was sought:

* Undergraduate nursing degrees (both three-year and four-year courses);
* Double/combined nursing degrees;
* Courses offered by private universities;
* Four-year bachelor degrees that concurrently provide both initial nurse registration and preparation for specialty nursing practice;
* Courses that facilitate ‘fast-tracking’ of students for initial nurse registration with previous tertiary or nursing studies,
* Hours and configuration of clinical experience in undergraduate nursing courses.

Securing the oral tradition : reflective positioning and professional conversations in midwifery education

We postulate that positioning is a powerful tool in guiding and transforming student professional learning and practice development. In our experiences with students enrolled in he Graduate Diploma of Midwifery, we determined that positioning elaborates individual scholarship and identity formation of the learner midwife in practice settings. Positioning Theory, developed by Harré and other authorities, is a psycho-sociological 'ontology' or concept of how individuals metaphorically position or locate themselves, and others, within institutions and societies. Three key components of positioning theory include 'position', 'speech act' and 'storylines', developing from the everyday social interactions of professional conversations. Reflective positioning can be applied as an analytical tool for the moment-to- moment exchanges inherent in practice related conversations, occurring between midwives and midwifery students. These moment-to-moment interactions of professional conversations can be used by students to complete or fill their learning gaps. Positioning therefore, provides a novel, contemporary theoretical framework to 'unpack' or understand the complexity of midwifery practice and yet is complementary with reflective practice. Excerpts are used to demonstrate reflective positioning applications by students. Midwives are encouraged by health services and by the University to provide student support through a 'preceptorship' program to supervise, work with and assess students for competence in midwifery practices. We claim that reflective positioning by students within professional conversations with their preceptor/midwives, are the construction sites for learning and where identity formation of each student as a future midwife is both shaped and transformed. Both academics and managers of health services need to embrace the value of workplace conversations, the sites of rich oral traditions of nursing and midwifery. Thus, in seeking claim to our rich oral traditions, all students will benefit from engagement in reflective positioning to promote their professional learning and practice development.

What is the on-campus experience? Engineering student study and work

Accreditation for off-campus engineering programmes has proven to be problematic. In Australia, off-campus programmes are compelled to contain mandatory residential sessions so that offcampus students can have an `on-campus experience'. This paper explores the nature of modern oncampus undergraduate engineering study, and finds that it now typically involves at least part-time employment and has more in common with off-campus study than the on-campus experience enjoyed by most of the current institutional (education and professional) administrators when they completed their undergraduate studies. Rather than ignore student term-time work, engineering programmes should use it to enhance the development of desirable graduate attributes.

Predictors of timely doctoral student completions by type of attendance: the utility of a pragmatic approach

Federal government changes to the funding of doctoral students have focused the attention of university management on their completion rates. The aims of this paper are to inform the allocation of institutional resources in a manner that improves the likelihood of timely doctoral completions and to highlight a process that can also be used for analyses of other key indicators of progression and attrition. The analyses and model development used national data readily available to all universities, which are collected in a standard approach through the Graduate Destinations Survey (GDS). The findings show that the most important variable for timely completion was attendance (full-time compared with part-time), whereby in terms of full-time equivalent (FTE) years of study, part-time students were far more likely to complete quickly than full-time students. For the full-time students, the key predictors of timely completion were residency, field of study and English-speaking background (ESB). The timeliness of part-time students was predicted by field of study and ESB. This study confirms that there is considerable variation by discipline for timely doctoral completions. The pragmatic application and prospective test of the derived models present a variety of opportunities for research student administrators. For example, those full-time students scoring highly represented a concentration of timely graduates more than 7.5 times higher than the lowest-scoring group - almost an order of magnitude of difference. In short, university management could gain tremendous value from more widely using the data available.

Designing and delivering clinical risk management education for graduate nurses : an Australian study

In order to enhance their capabilities in clinical risk management (CRM) and to be integrated into safe and effective patient safety organisational processes and systems, neophyte graduate nurses need to be provided with pertinent information on CRM at the beginning of their employment. What and how such information should be given to new graduate nurses, however, remains open to question and curiously something that has not been the subject either of critique or systematic investigation in the nursing literature. This article reports the findings of the third and final cycle of a 12 month action research (AR) project that has sought to redress this oversight by developing, implementing and evaluating a CRM education program for neophyte graduate nurses. Conducted in the cultural context of regional Victoria, Australia, the design, implementation and evaluation of the package revealed that it was a useful resource, served the intended purpose of ensuring that neophyte graduate nurses were provided with pertinent information on CRM upon the commencement and during their graduate nurse year, and enabled graduate nurses to be facilitated to translate that information into their everyday practice.

From student to therapist : follow up of a first cohort of Bachelor of occupational therapy students

Aim: This study aimed to investigate the perception of graduate students on their preparation for practice, at 7 months post graduation.
Method: Using an anonymous postal questionnaire, 18 respondents (58% response rate) provided data on the nature of current employment, the experience as a graduate therapist, and perceptions of their undergraduate experience in preparing them for practice.
Results: Fifty percent of the respondents were practising in a rural environment. There was a significant positive relationship between respondents perception of their curriculum and fieldwork experiences and their preparation for practice (rho = 0.52, p < 0.05, and rho = 0.55, p < 0.05, respectively). Of the fieldwork experiences, respondents rated block placements as more beneficial to practice than non-traditional placements. However, a correlational analysis showed the non-traditional placement was significantly related to preparation for practice (rho = 0.54, p < 0.05). On a sevenpoint Likert scale, respondents rated themselves from 5.2 to 5.7 for perceived self-competence as a newly graduated practitioner with community-based graduates having the higher rating. Confidence in clinical decision-making was rated 5.0 to 5.6 with community-based graduates having higher rating. Respondents reported a positive perception that the undergraduate program prepared them to enter the workforce and practise as an occupational therapist (mean ratings 5.5 to 6.2).
Conclusion: Respondents felt adequately prepared to enter the occupational therapy profession and workforce. Strengths and weaknesses in their preparation are discussed as well as the need for further research.

The story of fable : a narrative analysis of the experience of four registered nurses in their first year of practice

This research explores the transition from student to registered nurse from the perspective of the new graduate. This interpretive study uses narrative analysis as the methodology. Individual stories were collected and processed using the method of core story creation and emplotment (Emden 1998). Four newly registered nurses were invited to share stories related to how they were experiencing their role. Participants were encouraged to tell their stories in response to the open question 'what is it like to be a registered nurse?' In the final step of the analysis one honest and critical story has been crafted (Barone 1992) using a process termed emplotment thus disclosing the themes that allow the stories to be grasped together as a single story (Polkinghorne 1988, Emden 1998). The final story of 'Fable' gives insight into the ways in which newly registered nurses experience their role. Becoming a registered nurse is not easy however, Fable finds that nursing is more than just a job and describes many rewarding experiences. It is hoped that the outcomes of this research will be valuable to students, graduates, nurse academics and the profession of nursing generally by enhancing understandings of the relationship between the graduate and the actual employment experience.

Course websites, computer proficiency and need for achievement : implications for MBA student performance

Course websites have become a basic requirement for course promotion and delivery in many universities. This study explores the relationship between perceived usefulness of course websites and student performance in an accounting course within a Masters of Business Administration (MBA) programme. Data from 48 students were found to support several hypotheses. Specifically, the findings of the study indicate that there is a significant correlation between the perceived usefulness of course website features such as lecture notes, tutorial questions and solutions and the frequency of use or access by students of such course website features. Further, we found that the perceived usefulness of course websites was positively related to students’ computer proficiency, but not with the frequency with which students missed classes. The findings also indicate that students with high need for achievement achieved better performance scores, but there was no significant relationship between perceived usefulness of course website and performance. These findings have several implications for the design and development of course websites at post-graduate level, and for future research examining the link between information technology and accounting education.

Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers

• There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers.

• This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work.

• Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate.

• Three major themes emerged from interview data: planning for ward allocation, communication and professionalism.

• In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff.

• Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses.

• For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration.

• A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles.

• The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled – with the aim of providing quality patient care.

Situational and dispositional influences on student learning

This research investigates influences of situational and personal factors on student learning. Personal factors (e.g. test anxiety, student life values, culture) are considered more influential than situational factors (e.g. assessment weighting, assessment type). The findings have implications for policies and practices associated with teaching, assessment, and effective study skills.