Identifying educational priorities for occupational therapy students to prepare for mental health practice in Australia and New Zealand: opinions of practising occupational therapists

BACKGROUND: The effective preparation of occupational therapy students for mental health practice is critical to facilitate positive consumer outcomes, underpin optimal practice and support new graduates' professional identity. This project was established to determine a set of 'educational priorities' for occupational therapy students to prepare them for current (and future) entry-level practice in mental health, from the perspective of mental health occupational therapists in Australia and New Zealand. METHODS: The study included two phases. In Phase One, participants identified what they considered to be important educational priorities for occupational therapy students to prepare them for practice in mental health. For Phase Two, an 'expert panel' was assembled to review and rank these using a Policy Delphi approach. RESULTS: Eighty-five participants provided educational priorities in Phase One. These were grouped into a total of 149 educational themes. In Phase Two, the expert panel (consisting of 37 occupational therapists from diverse locations and practice settings) prioritised these themes across three Delphi rounds. A final priority list was generated dividing educational themes into three prioritised categories: 29 'Essential', 25 'Important' and 44 'Optional' priorities. Highest-ranked priorities were: clinical reasoning, client-centred practice, therapeutic use of self, functional implications of mental illness, therapeutic use of occupation and mental health fieldwork experience. CONCLUSION: The priority list developed as part of this project provides additional information to support the review of occupational therapy curricula across Australia and New Zealand to ensure that new graduates are optimally prepared for mental health practice.

How new graduate nurses experience patient death : a systematic review and qualitative meta-synthesis

Background

Patient death is an emotional and demanding experience for nurses, especially for new graduate nurses who are unprepared to deliver end-of-life care. Understanding new graduate nurses’ experience of death and dying will inform the design of training programs and interventions for improvements in the quality of care and support of new graduates.

Objective

To summarize new graduate nurses’ experience with patient death by examining the findings of existing qualitative studies.

Design

Systematic review methods incorporating meta-synthesis were used.

Methods

A comprehensive search was conducted in 12 databases from January 1990 to December 2014. All qualitative and mixed-method studies in English and Chinese that explored new graduate nurses’ experience of patient death were included. Two independent reviewers selected the studies for inclusion and assessed each study quality. Meta-aggregation was performed to synthesize the findings of the included studies.

Results

Five primary qualitative studies and one mix-method study met inclusion and quality criteria. Six key themes were identified from the original findings: emotional experiences, facilitating a good death, support for family, inadequacy on end-of-life care issues, personal and professional growth and coping strategies. New graduate nurses expressed a variety of feelings when faced with patient death, but still they tried to facilitate a good death for dying patients and provide support for their families. The nurses benefited from this challenging encounter though they lacked of coping strategies.

Adaptation and validation of a survey instrument measuring perceived preparedness of nursing graduates

BACKGROUND: In Australia, a significant percentage of bachelor of nursing students are employed in the aged care sector, or in aged care settings, as assistants in nursing (AINs) or personal care assistants. However the value of aged care in nursing education is often overlooked. AIM: To outline the adaptation and validation of a survey, originally developed for medical graduates, for use with nursing graduates. DISCUSSION: Adaptation of the instrument was undertaken as part of a doctoral study that aimed to explore whether employment as an undergraduate assistant in nursing (AIN) in aged care prepares new graduates for clinical work. CONCLUSION: Outlining each step of the modification process can help nurse researchers who want to adapt existing instruments to meet their research objectives. IMPLICATIONS FOR PRACTICE: Undergraduate AIN employment has the potential to supplement clinical learning without the restrictions inherent in the student role. Furthermore, it has the potential to enhance recruitment and retention in the aged care sector.

A Euro-American-Australian study of the mechanical engineering profession as a foundation for the study of mechanical engineering attributes

The increasing attribute focus in the formation (engineering education, training, work-based learning and experience) of engineers now being adopted by engineering education accrediting bodies is based on meeting the perceived needs of professional practice. Related to this is an increasing expectation of new graduates being work-ready rather than relying on work-based learning and experience to develop many of the essential professional practice attributes.

The scope of the mechanical engineering profession is broad and practitioners contributing to debate on attribute requirements have their own individual views of the nature of the profession, largely influenced by their own professional formation. As a foundation for detailed study on attribute requirements for effective Australian professional mechanical engineers, in this paper we provide a concise study of the development of the established scope of practice and knowledge base of the profession over the last two centuries. Formation practices in Europe and the United States played significant roles in the 19th century.

We conclude with a discussion on the impact of the considerable changes currently affecting mechanical engineering practice in the UK, US and Australia, including organisational, technical and societal expectations, industry profile, and educational factors.

Workforce trends in specialist and GP obstetric practice in Victoria

OBJECTIVE: To provide a contemporary picture of the general practitioner and specialist obstetric workforce in Victoria.

DESIGN, PARTICIPANTS AND SETTING: Postal census by questionnaire of all 317 Fellows and 961 Diplomates on the Victorian database of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in September 2003.

MAIN OUTCOME MEASURES: Sex, age and geographical distributions and patterns of retirement from and recruitment to the GP and specialist obstetric workforce in Victoria.

RESULTS: 244 Fellows (77.0%) and 652 Diplomates (67.8%) participated. The average age of Diplomates was 42 years; only 20% were involved in procedural obstetrics. Of GPs practising procedural obstetrics, 56% intended to cease within 7 years. Two-thirds of specialist obstetricians continued to practise obstetrics. Among those ceasing obstetrics, almost half had done so since 2000. Among Fellows ceasing obstetric practice, there is a peak in the 50-60-years age group, but cessation of obstetric practice occurred across all age groups.

CONCLUSION: The proportion of GPs involved in procedural obstetrics has fallen markedly over the past decade, with half of those ceasing practice in the 40-50-years age group. New GPs entering the workforce with the Diploma and overseas doctors are unlikely to meet the procedural workforce shortfall. Attracting the large cohort of doctors aged 40-50 years back to obstetric practice must be a priority. Given the pattern of retirements from obstetrics, there will be insufficient numbers of specialists to maintain current levels of service. The reasons include non-participation in obstetrics by new graduates and international medical graduates, the inadequate number of new graduates, and the predominance of women among specialists aged under 40 years, whose work output tends to be affected by family commitments.

Standardising differences? Theorising 'identities' and pedagogical approaches to working with diversity

‘Race’, socio-economic status, gender and ethnicity are theorised as fluid, dynamic and interconnected categories of identity within post-structural theories. Understanding identities as socio-culturally constructed offers opportunities to think differently about how teachers and teacher education students position themselves and are positioned within these discourses. In Australia, where the teaching profession is overwhelmingly Anglo-Australian (Rizvi 1992; Santoro et al, 2001), mono-lingual and of middle-class background, Australian students are becoming far more linguistically and culturally diverse. Since engagement with teachers who ‘know’ their students, (Delpit, 1995) and the communities from which they come is a major predictor of successful educational outcomes, the growing disparity between teachers’ and students’ cultural and classed experiences is of concern. While teacher education programs focus on developing the attributes in new graduates to work productively with difference, the actualities of doing so are problematic.

This paper reviews some current Australian, North American and United Kingdom approaches to working with student teachers’ constructs of self in terms of ethnicity, ‘race’ and class in order to problematise taken-for-granted ideas of ‘normal’. It considers debates that surface around ‘individuality’ versus ‘collective’ differences; additionally, some of the resistances and dilemmas that emerge when ‘white’, middle class students are asked to rethink their own positionality are examined. Questions regarding what constitutes productive ways to teach inclusive and transformative pedagogies are raised in light of current theory and practice.

Mapping drug calculation skills in an undergraduate nursing curriculum

The ability to calculate drug dosages correctly is an essential skill for registered nurses to possess. Performing drug calculations accurately is not a skill that new graduates have the luxury of developing over time. Drug errors are in many instances directly related to either the administration of an incorrect dose or incorrect infusion rate (Gladstone, 1995) caused by calculation errors. A strategy for implementing drug calculation skills into our new under graduate nursing curriculum was initiated to assist students in developing proficiency in drug calculations. The aim of this program is to promote the development of calculation skills in undergraduate nursing students, rather than simply assessing their skills.

The nature and implications of support in graduate nurse transition programs : an Australian study

It is widely recognized that support is critical to graduate nurse transition from novice to advanced beginner-level practitioner and to the integration of neophyte practitioners into safe and effective organizational processes. Just what constitutes support, however, and why (if at all) support is important, when, ideally, support should be given, by whom, how, and for how long, have not been systematically investigated. Building on the findings (previously reported) of a yearlong study that had, as its focus, an exploration and description of processes influencing the successful integration of new graduate nurses into safe and effective organizational processes and systems, the findings presented in this article strongly suggest that support is critical to the process of graduate nurse transition, and that integration into “the system” is best provided during the first 4 weeks of a graduate nurse transition program and thereafter at the beginning of each ward rotation; that “informal teachers” and the graduate nurses themselves are often the best sources of support; and that the most potent barriers to support being provided are the untoward attitudes of staff toward new graduates. Drawing on the overall findings of the study, a new operational definition of support is proposed and recommendations are made for future comparative research on the issue.

Clinical placement and rurality of career commencement : a pilot study

This article reports on a project that aimed to discover whether rural placement can influence new graduates to take up rural positions, and what factors play a role in the decision-making. This pilot study reports the findings from a pre-survey of students (n = 110) who completed a questionnaire at the end of their rural placement in the Greater Green Triangle region, Australia. Findings are compared with matched questionnaire responses for students who subsequently completed a post-survey after graduation and who commenced work (n = 28). Rural placement appears to be associated with commencing rural practice after graduation. More graduates with an urban home address commenced rural practice than graduates with a rural home address who started their careers in the city. Longer placements may sway those with a city background to start work in a rural area.

Scenarios as springboards for reflection on practice : stimulating discussion

Increasingly there is an expectation that new graduates will have developed, prior to their induction into teaching, sound theoretical knowledge in relation to practice. However, in Australia, many pre-service teachers have insufficient time in the field to develop reflective practice and to observe how experienced teachers enhance their own knowledge through reflection on practice. In this article we discuss one way to introduce teacher education students to the notion of reflective practice. We explore the potential of scenarios to develop reflective thinking in pre-service teacher education students and highlight the processes and requisite criteria for developing scenarios that capture the rich and complex experiences of classroom practitioners. The scenario presented here has been fashioned from a pre-service teacher's story of classroom practice collected from her during an interview for a research project. While the scenario was intended for use only with pre-service teachers in order to increase their knowledge-base and analytical skills, when it was trialled with a group of experienced teachers in order to ascertain its suitability for novice teachers, an unexpected outcome was that it resonated with the teachers in ways that enabled them also to reflect more deeply on their professional practices. We speculate that the processes of scenario construction may also be valuable in other settings where reflective practice is a professional requisite.

Learning to reason: a journey of professional socialisation

One of the key attributes that health professional students and new graduates develop during professional socialisation is clinical reasoning ability. Clinical reasoning is a complex skill that is essential for professional practice. There is limited research specifically addressing how physiotherapists learn to reason in the workplace. The research reported in this paper addressed this gap by investigating how experienced physiotherapists learned to reason in daily practice. This learning journey was examined in the context of professional socialisation. A hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated, semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants' learning journeys were diverse, although certain episodes of learning were common or similar. Role models, mentors and colleagues were found to be influential in the development of reasoning. An important implication for the professional socialisation of physiotherapists and other health professionals and for those involved in practice development is the need to recognise and enhance the role of practice communities in the explicit learning of clinical reasoning skills.

University and employer expectations of new dietetic graduates

Objectives:  The first objective of this study was to identify the knowledge, skills and attributes (KSAs) that employers seek in newly graduated dietitians. The second objective was to compare the KSAs that employers seek in newly graduated dietitians to the Deakin University Graduate Attributes and to the Dieticians Association of Australia (DAA) Competencies in order to determine if there is a mismatch.

Methods:   Views were gathered from a combination of group and individual in-depth, semistructured interviews with 19 employers from a range of employment settings and sorted into an existing framework using the DAA Competencies and the Deakin University Graduate Attributes. Data from taped interviews were transcribed and sorted into a table of generic skills and a KSAs matrix.

Results: Employers sought graduates who had practical knowledge of dietetics and the workplace, Key skills sought included communication, interpersonal, work management and information technology skills. Key attributes sought were the ability to be a team player, to demonstrate some insight into one's own limitations, to demonstrate an appropriate level of initiative, and to be flexible and adaptable. There was a large overlap between the KSAs identified by employers as being important and those that have been identified by the DAA and Deakin University. However, there were some areas of mismatch. The University and employers valued information technological skills, whereas the DAA did not state these as a competency. The University and the industry employers were concerned about the global perspective, but the DAA and the clinical employers were not.

Conclusions: The results of this study show a large overlap between the KSAs valued by the profession, the University and the employers.

Registered nurses' perceptions of new nursing graduates' clinical competence: a systematic integrative review

Over the past decade, many questions have been raised about graduates' clinical competence and fitness for practice upon completion of their undergraduate education. Despite the significance of this issue, the perspectives of registered nurses have rarely been examined. This systematic review explores the perceptions of experienced registered nurses regarding the clinical competence of new nursing graduates. Original research studies published between 2004-2014 were identified using electronic databases, reference lists, and by searching "grey literature." Papers were critically reviewed and relevant data extracted and synthesized using an approach based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis. From 153 studies initially identified, 15 original research papers were included. Four main research themes were identified: clinical/technical skills, critical thinking, interaction/communication, and overall readiness for practice. Areas of concern in relation to the clinical competence of new nursing graduates specifically related to two themes: critical thinking and clinical/technical skills. Further research is required on strategies identified within the literature with the ultimate aim of ensuring new nursing graduates are safe and competent practitioners.