The construction of a subset of ICNP® for patients with dementia: a Delphi consensus and a group interview study

BACKGROUND: The International Classification for Nursing Practice (ICNP®) 2013 includes over 4000 concepts for global nursing diagnoses, outcomes and interventions and is a large and complex set of standardised nursing concepts and expressions. Nurses may use subsets from the ICNP as concepts and expressions for research, education and clinical practice. The objective of this study was to identify and validate concepts for an ICNP subset to guide observations and documentation of nursing care for patients with dementia.

METHOD: The process model for developing ICNP subsets was followed, according to the guidelines adopted by the International Council of Nursing (ICN). To identify relevant and useful concepts for the subset, a modified form of the Delphi method was used. Six nurses working in healthcare services in three municipalities in Norway with postgraduate education in geriatric psychiatry and dementia care participated in two Delphi sessions. The participants reviewed and scored the concepts included in the suggested subset and had an opportunity to rewrite them and offer alternatives. To validate the subset after the Delphi study, a group interview was conducted with six other nurses with postgraduate education in geriatric psychiatry and dementia care. The group interview was recorded and transcribed, and summative content analysis was used.

RESULTS: Suitable concepts for an ICNP subset to guide observations and documentation of nursing care for patients with dementia were identified. In total, 301 concepts were identified, including 77 nursing diagnoses, 78 outcomes and 146 nursing interventions. An increased focus on concepts to describe basic psychosocial needs such as identity, comfort, connection, inclusion and engagement was recommended by nurses in the validation process.

CONCLUSIONS: Relevant and pre-formulated nursing diagnoses, goals and interventions were identified, which can be used to develop care plans and facilitate accuracy in the documentation of individuals with dementia. The participants believed that it may be difficult to find formulations for all steps of the nursing process. In particular, nursing diagnoses and psychosocial needs are often inadequately documented. The participants highlighted the need for the subset to contain essential information about psychosocial needs and communication.

Solving problems collaboratively online : experiences of Australian and Chinese heritage university students

The research reported in this paper is part of a larger project designed to compare the online collaborative learning behaviours of Chinese Heritage Culture (CHC) university students, for whom a Chinese dialect is a first language, with Australian university students of European descent, and for whom English is a first language. The collaborative learning discussion focussed on in the research involved fellow students, rather than tutorial staff, facilitating those discussions.

The first component of the research was quantitative, comprising a questionnaire on readiness for online learning, and a quantitative analysis of student postings to a student-led collaborative problem solving task conducted online. The first component of the research (reported in Smith et at, 2005) showed no differences between the two groups in their willingness to self-manage their own learning, but did show that the CHC students were significantly less comfortable than the Australian students with online learning. Student postings to the online discussions were classified into organisational postings, social postings, and intellectual. There were substantial differences between the two groups in their patterns of online postings among those classifications, as well as differences in the length of postings made.

This paper will explore these findings in more detail through qualitative data generated through interviews with a subset of students from each group. Interview data provided further insight into the lesser comfort with e-learning among CHC students. Students from both groups felt there were inefficiencies in the online discussion, but CHC students also felt rather marginalised by the process. Australian students were more likely to evaluate the experience in terms of its capacity to achieve required learning outcomes in a time efficient way, while CHC students expressed more concern about how the process had impacted upon them personally. The interview data also indicated that a tutor sensitive to cultural difference is important for comfort among the CHC students in particular, since there is need for encouragement to those students to make reflective inputs to the discussion.

Nurses’ perspectives on the care provided to cancer patients

Background: Optimal care for patients with cancer involves the provision of effective physical and psychological care. Nurses are key providers of this care; however, the effectiveness of care is dependent on the nurses’ training, skills, attitudes, and beliefs.
Objective: The study reported in this article explored cancer nurses’ perceptions of their ability to provide psychosocial care to adults with cancer and their subsequent evaluation of the effectiveness of the care provided. This study was the first part of a larger project that evaluated the effectiveness of Proctor’s model of clinical supervision in an acute care oncology environment.
Methods: An exploratory qualitative design was used for this study. One focus group interview was conducted with 10 randomly selected registered nurses working within the oncology units at a major Melbourne tertiary referral hospital. Analytic themes were developed from the coded data using content analysis.
Results: The 4 analytic themes to emerge from the data were frustration, difficult to look after yourself, inadequate communication processes, and anger.
Conclusion: The findings from this study indicate that, although informal mechanisms of support are available for oncology nurses, most of these services are not accessed.
Implications for Practice: Leaders in cancer care hospital settings need to urgently develop and implement a model of support for their oncology nurses who are attempting to provide psychosocial support to oncology patients.

Community, commitment, and the ten 'commandments' : singing in the coro furlan

Successful ageing involves maintaining well-being and actively engaging with life through the making and sustaining of relationships within community. Membership of community music groups by older people can enhance quality of life, give a sense of fulfillment, offer the possibility for personal growth and create a platform through which they share and celebrate cultural identity and diversity. This study explores community and cultural engagement by members of the Coro Furlan, an Italian male community choir in Melbourne, Australia. This case study is part of a current wider research project, Well-being and ageing: community, diversity and the arts in Victoria (Australia), begun in 2008, which explores how the arts foster well-being in ageing communities. In this case study, members of the Coro Furlan volunteered to participate in a focus group interview in 2009. The transcript was analysed using Interpretive Phenomenological Analysis which seeks to explore the lived world of participants. Analysis of the data identified three broad themes: a sense of community, the maintenance of cultural identity and sustaining a sense of well-being through shared music making. The findings demonstrate the strength of the bonds formed by choir membership with high levels of commitment reflected in their ten ‘Commandments’ that were first documented in Italian in the 1970s. The choir members consider themselves to be the custodians of Friulian choral music in Australia, as well as performers of music from Italy and other countries. Singing in this choir has offered the predominantly older members an opportunity to value, learn, and share music in formal and informal settings. This paper identifies how music engagement can facilitate successful ageing through commitment to community, singing and following the ten ‘Commandments’ of the Coro Furlan.

The impact of the expanded nursing practice on professional identify in Denmark

Purpose: This article explores the concept of professional identity of Danish nurses working in an expanded practice. The case study explores the experiences of a small group of Danish nurses with a new professional category that reaches into a domain that customarily belonged to physicians. The aim of this case study was to explore the impact of “nurse consultations,” representing an expanded nursing role, of 5 nurses focusing on their perception of autonomy, self-esteem, and confidence.


Methods: The case study used semistructured interviews with 5 participants triangulated and validated with participant observations, a focus group interview, and theoretically derived insights.


Findings: This study indicates that nurses working within a new expanded professional practice see themselves as still engaged in nursing and not as substitute physicians. The study also suggests that the involved nurses gained a higher sense of autonomy, self-esteem, and confidence in their practice. These elements have a positive impact on their professional identity.


Conclusion: The research demonstrates that for the nurses involved in expanded professional practice, the boundaries of professional practice have shifted significantly. The research indicates that an expanded practice generates a new domain within the professional identity of nurses.

Balancing risk? First year performing arts students’ experience of a community arts event

This study examines participants’ responses to first year students’ street performances as a non-placement work-integrated learning (WIL) activity over a two year period. The purpose of the study was to determine: (1) community perception, (2) continuous improvement, and (3) future needs. Data was collected through surveying participants’ post-viewing of the street performances, students’ reflective notes, and a recorded focus group interview. The findings indicated that audience members require additional assistance to value the students’ street performances. The results revealed that students require more guidance around researching the sites of practice, understanding group work dynamics, relaxation methods, intra- and interpersonal skill development, conflict resolution and how to effectively build community relations with the local government Council. From the findings, specific recommendations for continual improvement are made. These include offering an explanation of the street performances’ historical and aesthetic connections to the building sites for audience members, affording battery operated body-microphones and light rostrum for improved sight lines, delivering group dynamics information and arranging opportunities for students to engage more effectively with the Council. While the recommendations in this study are intended to advance the field of research that evaluates non-placement WIL performing arts curriculum in higher education, the findings are relevant to any group-based performance activity in learning and teaching.

Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks

BACKGROUND: Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. OBJECTIVES: Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. METHODS: A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. RESULTS: Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. CONCLUSION: Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix.

A collaborative autoethnography study to inform the teaching of reflective practice in STEM

The paper explores a collaborative self-study, autoethnography research project, which aided in informing practice for the teaching of reflective practice in Science, Technology, Engineering and Mathematics (STEM) at an Australian university. Self-report methods were used, because it enabled the collection of a variety of self-awareness data generated processes to help produce insights and understandings. This was achieved by undertaking a systematic approach to the exploration of a critical friendship between two academic support staff members alongside reflections from a recorded, focus group interview with nine STEM teachers. Four self-awareness data generated processes were used: (1) self-reflections; (2) collaborative reflections; (3) reflections on pertinent literature findings and (4) reflections from nine STEM teachers. A thematic analysis of the data was undertaken, which resulted in the discovery of three turning points such as moments of understandings that challenge assumptions and/or lead to new insights. The findings indicated that a STEM-centric, scaffolded approach that utilised the scientific method for reflective practice enabled the development of a shared understanding around teaching and assessing reflective practice for STEM teachers. First, because it boosted self-confidence and second, because it reduced scepticism around reflective practice as a non-scientific form of learning.

Why we interview now-reflexivity and perspective in a longitudinal study

This paper discusses a longitudinal, interview-based study of Australian secondary school students that explores the interaction between school ethos and forms of subjectivity. The study was designed to enable prospective and retrospective understandings of identity over time. It is suggested that this methodology encourages a reflexive self-positioning for both participants and researchers and, in the accumulation of an archive of perspectives, responds to poststructuralist critiques of contingency and construction in research interviews. Second, it is argued that the richness of longitudinal research invites more than one kind of analysis, and that working with and across conventionally divergent theoretical approaches can be fruitful. This is discussed with reference to Bourdieu's account of social field and habitus, and Hollway and Jefferson's notion of the 'defended subject'.

A descriptive interview with 64 patients discharged from an acute-psyciatric-inpatient service

Background Acute-mental-health services receive hundreds of admissions every year. Some of these patients will continue to be case-managed by community mental-health teams on discharge from the acute unit while others will not remain in contact with the mental-health service. This study compares the findings of comprehensive interviews conducted with current and past patients of the community mental-health service 3 or more years following case closure from the community ambulatory service.
Methods Between 1 July 1999 and 30 June 2001, there were 2245 closed cases identified at Barwon Health. Letters of invitation to participate in a research project were sent to people who had suffered from psychotic illnesses, and had been case-closed by community mental-health services between the above dates and had not been in contact with the Community and Mental Health Service for at least 6 months. A second group of participants was recruited from people who had also been case-closed by community mental health teams in Barwon Health during the 1999–2001 2-year-time window but whose cases had been re-opened and who were in case management with Barwon Health at the time of the study. All participants were interviewed using the Diagnostic Interview for Psychosis.
Results Letter responses were received from 17 men and 18 women, aged 40.7 ± 12.0 (mean ± SD), who were interviewed. A second group of 17 men and 12 women, aged 40.9 ± 9.6 (mean ± SD) of currently case-managed patients was interviewed. All interviewees reported a detailed history of mental illness. Persistent social dysfunction and impaired quality of life were reported in both groups.
Conclusion Patients suffering from psychotic disorders who had been case-closed by community mental-health teams and had been discharged to the care of their general practitioners or elsewhere continued to show evidence of significant impairment due to mental illness 3 years after being case-closed.

Examination of the stability and consistency of investigative interviewer performance across similar mock interview contexts

Purpose. Three studies examined the degree to which investigative interviewers’ adherence to best-practice guidelines is consistent across similar mock interviews.
Method. In each study, two interviews were administered within a period of several hours. Further, group and individual stability of interviewer performance was analysed, and performance was measured by calculating the proportion of open-ended and leading questions as well as the presence of predetermined problem behaviours. The studies varied depending on the type of interview paradigm employed. Interviewer performance in Study 1was measured in a group context where participants rotated between the role of interviewer, child respondent, and observer. In Study 2, an adult played the role of a child recalling abuse but this occurred in isolation (participants did not observe others or play the child). Study 3 was similar to Study 2 except that in each interview an unfamiliar child aged 5–7 years recalled an innocuous event.
Results. Interviewer performance was relatively stable across tasks, although the strength of the relationship between measures varied across analyses. Improvement in open-ended question usage occurred in Study 1 but not Studies 2 and 3. Irrespective of the assessment context, the dichotomous rating scale yielded greater consistency than when questions were tallied. Further, group stability overestimated individual stability. The practical implications of these findings for trainers and researchers are discussed.

The effects of practice on children's ability to apply ground rules in a narrative interview

Despite the widespread use of ground rules in forensic interview guidelines, it is unknown whether children retain and apply these rules throughout narrative interviews. We evaluated the capacity of 260 five- to nine-year-olds to utilize three ground rules. At the beginning of the interview all children heard the rules; half also practiced them. Children then responded to open-ended prompts about a repeated laboratory event and were assessed for their application of the rules. Logistic regressions revealed that practice only benefitted the use of the "don't know" rule. Although the children accurately answered "don't understand" and "correct me" practice questions, practice appeared to give no greater benefit than just hearing the rules. Results suggest that the current format of ground rule practice in interview guidelines is appropriate for the "don't know" rule, but the other rules may require more extensive practice with this age group. Copyright © 2015 John Wiley & Sons, Ltd.

Explaining engagement in self-monitoring among participants of the DESMOND self-monitoring trial: a qualitative interview study

BACKGROUND: The Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) Self-monitoring Trial reported that people with newly diagnosed type 2 diabetes attending community-based structured education and randomized to self-monitoring of blood glucose (SMBG) or urine monitoring had comparable improvements in biomedical outcomes, but differences in satisfaction with, and continued use of monitoring method, well-being and perceived threat from diabetes. OBJECTIVES: To explore experiences of SMBG and urine monitoring following structured education. We specifically addressed the perceived usefulness of each monitoring method and the associated well-being. METHODS: Qualitative semi-structured interviews with 18 adults with newly diagnosed type 2 diabetes participating in the DESMOND Self-monitoring Trial (SMBG, N=10; urine monitoring, N=8)~12 months into the trial. Analysis was informed by the constant comparative approach. RESULTS: Interviewees reported SMBG as accurate, convenient and useful. Declining use was explained by having established a pattern of managing blood glucose with less frequent monitoring or lack of feedback or encouragement from health care professionals. Many initially positive views of urine monitoring progressively changed due to perceived inaccuracy, leading some to switch to SMBG. Perceiving diabetes as less serious was attributable to lack of symptoms, treatment with diet alone and-in the urine-monitoring group-consistently negative readings. Urine monitoring also provided less visible evidence of diabetes and of the effect of behaviour on glucose. CONCLUSIONS: The findings highlight the importance for professionals of considering patients' preferences when using self-monitoring technologies, including how these change over time, when supporting the self-care behaviours of people with type 2 diabetes.

Australian prosecutors perceptions of the utility of child investigative interview protocols

Investigative interviews with alleged victims form the central plank of evidence in the prosecution of child sexual abuse. Despite interviewers being provided with a guiding framework, child sexual abuse cases are often not prosecuted because of poor-quality evidence. The purpose of this study was to elicit feedback from prosecutors about the structure and format of current interview protocols and the ways in which these could potentially be improved from an evidential perspective. Focus group discussions (ranging in length from 180 to 190 minutes) were conducted with 13 Crown prosecutors representing every jurisdiction of Australia. Thematic analysis of the focus group discussions revealed that prosecutors were supportive of the structure of interview protocols, however, concerns were raised about four of the interview elements. These elements were the oath and truth–lie competency test, the ground rules, the practice narrative and eliciting a disclosure. The prosecutors’ concerns and their implications for protocol developers and trainers are discussed.