985 resultados para nurse-led


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This paper examines a Doctoral journey of interdisciplinary exploration, explication, examination...and exasperation. In choosing to pursue a practice-led doctorate I had determined from the outset that ‘writing 100,000 words that only two people ever read’, was not something which interested me. Hence, the oft-asked question of ‘what kind of doctorate’ I was engaged in, consistently elicited the response, “a useful one”. In order to satisfy my own imperatives of authenticity and usefulness, my doctoral research had to clearly demonstrate relevance to; productively inform; engage with; and add value to: wider professional field(s) of practice; students in the university courses I teach; and the broader community - not just the academic community. Consequently, over the course of my research, the question, ‘But what makes it Doctoral?’ consistently resounded and resonated. Answering that question, to satisfy not only the traditionalists asking it but, perhaps surprisingly, some academic innovators - and more particularly, myself as researcher - revealed academic/political inconsistencies and issues which challenged both the fundamental assumptions and actuality of practice-led research. This paper examines some of those inconsistencies, issues and challenges and provides at least one possible answer to the question: ‘But what makes it Doctoral?’

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The cost of surgical instrumentation is a major investment for any operating theatre. Repair or premature replacement of instruments is an additional financial burden. Although instrument care, handling, cleaning and sterilisation are usually components of orientation programs for instrument processing personnel, it should also be included in the scrub nurse orientation program. A thorough knowledge of the historical development of instruments; instrument classification and purpose; and careful use and handling will equip the scrub nurse in fulfilling a vital role in preventative maintenance of surgical instrumentation

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This thesis applied a grounded theory methodology to generate a theoretical understanding of the challenging and ambiguous dimensions of the contemporary role of the public-sector nurse educator within Australia. New knowledge provides a useful structure to examine nurse educator support and mechanisms to foster constructive workplace learning, collaborative relationships and effective contributions to better health care.

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With a focus on intention and motivation, this paper describes a study involving three organisational communities and their collective effort to develop and provide more inclusive housing for people with disabilities and their families. While many studies, such as that by Rocha & Miles (2009), focus on commercial organisations, and sustainability from an economic perspective, this study involves a not-for-profit organisation (the accommodation and service provider) as well as a research organisation and a design action group volunteering their services free of charge. From this pro-bono context, the paper describes a case study that explores the nature of the collective as a basis for creative practice and political activism and the theoretical implications and wider application in terms of emerging research in the area of collaborative entrepreneurship and design activism.

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This article examines the design of ePortfolios for music postgraduate students utilizing a practice-led design iterative research process. It is suggested that the availability of Web 2.0 technologies such as blogs and social network software potentially provide creative artist with an opportunity to engage in a dialogue about art with artefacts of the artist products and processes present in that discussion. The design process applied Software Development as Research (SoDaR) methodology to simultaneously develop design and pedagogy. The approach to designing ePortfolio systems applied four theoretical protocols to examine the use of digitized artefacts to enable a dynamic and inclusive dialogue around representations of the students work. A negative case analysis identified a disjuncture between university access and control policy, and the relative openness of Web2.0 systems outside the institution that led to the design of an integrated model of ePortfolio.

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The aim of this small-scale study was to assess what knowledge senior nurses within a general intensive care unit (GICU) had in relation to intra-arterial blood pressure (IABP) waveform analysis. Its core objective was: To assess what knowledge was held by the senior nursing team with regard to arterial waveform interpretation, arterial waveform morphology and the technical aspects associated with arterial waveform monitoring.

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Aim The aim of this paper was to explore the concept of expertise in nursing from the perspective of how it relates to current driving forces in health care in which it discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. Background Expert nursing practice can be argued to be central to high quality, holistic, individualized patient care. However, changes in government policy which have led to the inception of comprehensive guidelines or protocols of care are in danger of relegating the ‘expert nurse’ to being an icon of the past. Indeed, it could be argued that expert nurses are an expensive commodity within the nursing workforce. Consequently, with this change to the use of clinical guidelines, it calls into question how expert nursing practice will develop within this framework of care. Method The article critically reviews the evidence related to the role of the Expert Nurse in an attempt to identify the key concepts and ideas, and how the inception of care protocols has implications for their role. Conclusion Nursing expertise which focuses on the provision of individualized, holistic care and is based largely on intuitive decision making cannot, should not be reduced to being articulated in positivist terms. However, the dominant power and decision-making focus in health care means that nurses must be confident in articulating the value of a concept which may be outside the scope of knowledge of those with whom they are debating. Relevance to clinical practice The principles of abduction or fuzzy logic may be useful in assisting nurses to explain in terms which others can comprehend, the value of nursing expertise.

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This paper explores the concept of expertise in intensive care nursing practice from the perspective of its relationship to the current driving forces in healthcare. It discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. It argues that nursing expertise which focuses on the provision of individualised, holistic care and which is based largely on intuitive decision-making cannot and should not be reduced to being articulated in positivist terms. The principles of abduction or fuzzy logic, derived from computer science, may be useful in assisting nurses to explain in terms, which others can comprehend, the value of nursing expertise.

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This chapter contains sections titled: Introduction Acute pain Chronic pain Rationale for service development Evaluation use of audit and CPD Justifying the advanced nursing contribution to develop nurse prescribing in pain management Conclusions References

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Background Nutrition screening identifies patients at risk of malnutrition to facilitate early nutritional intervention. Studies have reported incompletion and error rates of 30-90% for a range of commonly used screening tools. This study aims to investigate the incompletion and error rates of 3-Minute Nutrition Screening (3-MinNS) and the effect of quality improvement initiatives in improving the overall performance of the screening tool and the referral process for at risk patients. Methods Annual audits were carried out from 2008-2013 on 4467 patients. Value Stream Mapping, Plan-Do-Check-Act cycle and Root Cause Analysis were used in this study to identify gaps and determine the best intervention. The intervention included 1) implementing a nutrition screening protocol, 2) nutrition screening training, 3) nurse empowerment for online dietetics referral of at-risk cases, 4) closed-loop feedback system and 5) removing a component of 3-MinNS that caused the most error without compromising its sensitivity and specificity. Results Nutrition screening error rates were 33% and 31%, with 5% and 8% blank or missing forms, in 2008 and 2009 respectively. For patients at risk of malnutrition, referral to dietetics took up to 7.5 days, with 10% not referred at all. After intervention, the latter decreased to 7% (2010), 4% (2011) and 3% (2012 and 2013), and the mean turnaround time from screening to referral was reduced significantly from 4.3 ± 1.8 days to 0.3 ± 0.4 days (p < 0.001). Error rates were reduced to 25% (2010), 15% (2011), 7% (2012) and 5% (2013) and percentage of blank or missing forms reduced to and remained at 1%. Conclusion Quality improvement initiatives are effective in reducing the incompletion and error rates of nutrition screening, and led to sustainable improvements in the referral process of patients at nutritional risk.

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Becoming a researcher, like any process of cultural initiation, is a complicated negotiation of processes and identity. While it is tempting to imagine that a researcher is just 'one who researches', the reality is far more complex and can be thought of as a journey rather than a sudden change of role. In practice-led research there is often a final and difficult assessment that needs to be made of that journey, and this requires the collation and integration of seemingly schizophrenic elements into one coherent body of findings. This paper attempts to outline the underlying “system of methods used in a particular area of study or activity” that have defined my research journey. It discusses the various elements that have informed and directed this enquiry, which include, but are not limited to: practice-led research, reflexivity, and post/academic writing, all underpinned by a feminist approach.

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Constant changes in the global economic environment require companies to revisit traditional assumptions about how businesses create and capture value (Teece, 2010). In recent years, management practice literature has focused largely on better understanding business models and business model innovation (Amit, Zott and Massa, 2010; Johnson, Christensen and Kagermann, 2008). Much has been written on the benefits of linking design and design thinking to organisational strategies and business transformation. However, very little has been researched and reported on regarding the impact of design led approaches to triple bottom-line opportunities such as, social innovation enterprise. In the context of this paper Design Led Innovation is defined as the tools and approaches which enable design thinking to be embedded as an element of cultural transformation within a business. Being Design Led requires a company to have a vision for top line growth founded on deep customer insights and expanded through customer and stakeholder engagements. The outcomes of this are then mapped to all aspects of the business, enabling the vision to be successfully implemented and achieved. It is the latter part of this definition where we believe Design Led Innovation has the greatest value in transforming social innovation enterprise into a sustainable business venture. However, we also acknowledge that enabling these firms to think strategically about their business model is difficult given the unique operational and funding challenges that often characterize many social enterprises. The purpose of this paper, therefore, is to pose the question, do sustainable innovation enterprise innovate their business model? And if so, how? It is the authors’ opinion that such enterprises only innovate at the product or system level without a complete understanding of the business model structure, which underpins the long term viability. However, in this paper we challenge this notion and explore if such firms can overcome their size and operational constraints to become sustainable enterprises using a design led approach. This is achieved through contextualizing business model innovation, briefly defining social innovation enterprise and profiling a new and emerging industry in Australia – Clean Technology. Future research challenges and opportunities are also presented.

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This paper focuses on a practice-led research project where the author as artist/researcher participates in a Queensland-wide women’s history project to celebrate Queensland’s Suffrage Centenary in 2005. The author participated in the Women’s Historical Shoebox Collection, where Queensland women were invited to decorate and fill a shoebox with personal and symbolic items that speak about their lives and the lives of their women forebears. This paper explores the practice-led research process that enabled the artist/researcher to design and assemble her contribution. Fredericks describes the iterative process of developing the shoebox and the themes that developed through her artistic practice. She also describes the content of her shoebox and explains the symbolism underpinning the items. The Women’s Historical Shoebox Collection is now owned by the State Library of Queensland and the Jessie Street National Women’s Library.

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This chapter focuses on demonstrating the role of Design-Led Innovation (DLI) as an enabler for the success of Small to Medium Enterprises (SMEs) within high growth environments. This chapter is targeted toward businesses that may have been exposed to the concept of design previously at a product level and now seek to better understand its value through implementation at a strategic level offering. The decision to engage in the DLI process is made by firms who want to remain competitive as they struggle to compete in high cost environments, such as the state of the Australian economy at present. The results presented in this chapter outline the challenges in the adoption of the DLI process and the implications it can have. An understanding of the value of DLI in practice—as an enabler of business transformation in Australia—is of benefit to government and the broader design community.

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Chapter 1: Introduction Overview and background Chapter 2: Conducting clinical audit of nurse practitioner practice The nature and purpose of clinical audit-- Data collection tools for clinical audit-- References and readings Chapter 3: Researching nurse practitioner practice The nature and purpose of clinical practice research-- Data collection tools for researching practice-- References and readings Chapter 4: Researching nurse practitioner service Principles and purpose of health services research-- Data collection tools for researching health services-- References and readings Chapter 5: Researching nurse practitioner patient outcomes Principles and purpose of researching patient outcomes-- Data collection tools for researching patient outcomes-- References and readings Chapter 6: Conducting a nurse practitioner census National workforce census-- Data collection tools for National/State census of nurse practitioners--References and readings