Keeping our nursing and midwifery workforce : factors that support non-practising clinicians to return to practice

BACKGROUND: Within Australia and internationally (Health Workforce Australia, 2012) an increasing and on-going nursing workforce shortage is documented. Recent international estimates indicate that there will be ongoing and significant gaps in the supply of a nursing workforce; the United Kingdom is predicted to have a reduction of 12.12% nurses over the coming eight years if a current 'steady state' is maintained (Buchan and Seacombe, 2011); Canada is predicted to have a shortage of 60,000 nurses by 2022 (Tomblin et al., 2012) with Australia's anticipated nursing shortage reported as over 90,000 by the year 2025 (Health Workforce Australia, 2012). Queensland Health in response to their tracked emerging nursing and midwifery workforce shortages developed a nursing and midwifery refresher programme to return registered staff back to the workforce. A study was undertaken between 2008 and 2010 to provide an understanding of how non-practising nurses and midwives maybe supported back into the workforce. METHODS: Programme applicants (444) were invited to respond to an on-line survey designed to understand what aspects of the programme supported their learning and ability to return to the workforce. This number represents those who applied but not all completed or commenced the programme. Descriptive statistics (Polit and Beck, 2008) were used to collate quantifiable survey responses and free text and unsolicited responses were themed. RESULTS: The survey received a 35.5% response rate (n=158) with a return of 20% of unsolicited comments in the form of e-mail responses which were included in the themed results. Key themes supporting participants' learning and ability to return to the workforce were: Respondents were 94% female and 6% male, with 37.7% >51 years of age. Child rearing was the foremost reason for female staff relinquishing workforce roles (36.6%). The primary reason for returning to the workforce was maintenance of registration (40.5%). Both theory and clinical placement components were seen by participants as contributing to their confidence to return to the health workforce. CONCLUSION: The Queensland Nursing and Midwifery Refresher Programs provided a structured programme for registered, non-practising nurses and midwives to return to the Queensland Health workforce. Responses indicated that clinical supervision and contract learning should be central to a return to workforce induction programme for registered but non-practising nurses and midwives. The majority of nurses and midwives returning to the workforce were approaching retirement age in 10-15 years.

The Games Concept Approach (GCA) as a mandated practice : views of Singaporean teachers

This paper reports on the views of Singaporean teachers of a mandated curriculum innovation aimed at changing the nature of games pedagogy within the physical education curriculum framework in Singapore. Since its first appearance over 20 years ago, Teaching Games for Understanding (TGfU), as an approach to games pedagogy has gathered support around the world. Through a process of evolution TGfU now has many guises and one of the latest of these is the Games Concept Approach (GCA) a name given to this pedagogical approach in Singapore. As part of a major national curricular reform project the GCA was identified as the preferred method of games teaching and as a result was mandated as required professional practice within physical education teaching. To prepare teachers for the implementation phase, a training program was developed by the National Institute of Education in conjunction with the Ministry of Education and well known experts in the field from the United States. For this part of the study, 22 teachers from across Singapore were interviewed. The data were used to create three fictional narratives, a process described by Sparkes (2002a) and used more recently by Ryan (2005) in the field of literacy. The stories were framed using Foucault’s (1980/1977) notion of governmentality and Bernstein’s (1996) notion of regulative discourse. The narratives reveal tales of confusion, frustration but also of hope and enthusiasm.

Data driven and practice-based evidence : design and development of efficient and effective clinical decision support system

Decision-making is such an integral aspect in health care routine that the ability to make the right decisions at crucial moments can lead to patient health improvements. Evidence-based practice, the paradigm used to make those informed decisions, relies on the use of current best evidence from systematic research such as randomized controlled trials. Limitations of the outcomes from randomized controlled trials (RCT), such as “quantity” and “quality” of evidence generated, has lowered healthcare professionals’ confidence in using EBP. An alternate paradigm of Practice-Based Evidence has evolved with the key being evidence drawn from practice settings. Through the use of health information technology, electronic health records (EHR) capture relevant clinical practice “evidence”. A data-driven approach is proposed to capitalize on the benefits of EHR. The issues of data privacy, security and integrity are diminished by an information accountability concept. Data warehouse architecture completes the data-driven approach by integrating health data from multi-source systems, unique within the healthcare environment.

Current practice in nutrition diagnosis and intervention for the management of Parkinson's disease in Australia and Canada

Aim To document current practice by dietitians in Australia and Canada in the nutrition management of Parkinson's disease. This will help identify priority areas for review and development of practice guidelines and direct future research. Methods Current practice in the phases of the Nutrition Care Plan was captured using an online survey distributed to Dietitians Association of Australia members and Practice-Based Evidence in Nutrition subscribers through their email newsletters. The results of the diagnosis, intervention and monitoring phases are presented here. Results Eighty-four dietitians responded. There was consistency in practice for nutrition issues that are encountered in other populations, such as malnutrition and constipation. There was more variation in practice in the nutrition issues that are more specific to Parkinson's disease, such as nutrition and meal interactions with medication. A lack of awareness of emerging treatments, such as deep brain stimulation surgery, appears to exist in the responding dietitians. Conclusions The variation in practice that was present for the nutrition issues specific to Parkinson's disease may reflect the lack of quality evidence and subsequently evidence-based guidelines in these areas. Work to provide background information about treatment options and to translate current evidence for the nutrition issues that are specific to Parkinson's disease into practice recommendations should be completed.

Research around practice partnerships: An example of building partnerships to address overweight and obesity in children

Prevention and management of childhood overweight and obesity is a health priority for governments and communities throughout the developed world. A conceptual model, Research around Practice in Childhood Obesity (RAPICO), has been developed to guide capacity building in a coordinated 'bench to fieldwork' initiative to address this public health problem. Translation of research findings into sustainable responses with optimal fit requires consideration of context-specific relevance, cost-effectiveness, feasibility and levels of available support. The RAPICO model uses program theory to describe a framework for progressing practitionercommunityresearch partnerships to address low, medium and high levels of risk for childhood overweight and obesity within community settings. A case study describing the development of a logic model to inform risk-linked responses to childhood overweight and obesity is presented for the Ipswich community in south-east Queensland.

Developing a best practice pathway to support improvements in Indigenous Australians' mental health and well-being: A qualitative study

Objective: There is a need to adapt pathways to care to promote access to mental health services for Indigenous people in Australia. This study explored Indigenous community and service provider perspectives of well-being and ways to promote access to care for Indigenous people at risk of depressive illness. Design: A participatory action research framework was used to inform the development of an agreed early intervention pathway; thematic analysis Setting: 2 remote communities in the Northern Territory. Participants: Using snowball and purposive sampling, 27 service providers and community members with knowledge of the local context and the diverse needs of those at risk of depression were interviewed. 30% of participants were Indigenous. The proposed pathway to care was adapted in response to participant feedback. Results: The study found that Indigenous mental health and well-being is perceived as multifaceted and strongly linked to cultural identity. It also confirms that there is broad support for promotion of a clear pathway to early intervention. Key identified components of this pathway were the health centre, visiting and community-based services, and local community resources including elders, cultural activities and families. Enablers to early intervention were reported. Significant barriers to the detection and treatment of those at risk of depression were identified, including insufficient resources, negative attitudes and stigma, and limited awareness of support options. Conclusions: Successful early intervention for wellbeing concerns requires improved understanding of Indigenous well-being perspectives and a systematic change in service delivery that promotes integration, flexibility and collaboration between services and the community, and recognises the importance of social determinants in health promotion and the healing process. Such changes require policy support, targeted training and education, and ongoing promotion.

The social tasks of learning to become a physical education teacher: Considering the HPE subject department as a community of practice

Initial teacher education (ITE) students participate in various workplaces within schools and in doing so, form understandings about the numerous, and at times competing, expectations of teachers’ work. Through these experiences they form understandings about themselves as health and physical education (HPE) teachers. This paper examines the ways communities of practice within HPE subject department offices function as sites of workplace learning for student teachers. In particular this research focused on how ITE students negotiate tacit and contradictory expectations as well as social tasks during the practicum and the ways in which their understandings are mediated through participation in the workspace. Qualitative methods of survey and semi-structured interview were used to collect data on a cohort of student teachers during and following their major (10 week) practicum experience. Analysis was informed by theories of communities of practice (Wenger, 1998), workplace learning (Billett, 2001), and social task systems (Doyle, 1977). It was evident that considerable effort, attention, and energy was expended on various interrelated social tasks aimed at building positive relationships with their supervisor and other HPE teachers at the school. The social dynamics were highly nuanced and required a game-like approach. In our view the complexity that student teachers must negotiate in striving for an excellent evaluation warrants specific attention in physical education teacher education (PETE) programs. This study raises questions regarding our responsibilities in sending student teachers into contexts that might even be described as toxic. We offer some suggestions for how PETE might better support students going into practicum contexts that might be regarded as problematic workplaces.

Leveraging lessons learned in organizations through implementing practice-based organizational learning and performance improvement - An opportunity for context-based intelligent assistant support (CIAS)

Organizations that leverage lessons learned from their experience in the practice of complex real-world activities are faced with five difficult problems. First, how to represent the learning situation in a recognizable way. Second, how to represent what was actually done in terms of repeatable actions. Third, how to assess performance taking account of the particular circumstances. Fourth, how to abstract lessons learned that are re-usable on future occasions. Fifth, how to determine whether to pursue practice maturity or strategic relevance of activities. Here, organizational learning and performance improvement are investigated in a field study using the Context-based Intelligent Assistant Support (CIAS) approach. A new conceptual framework for practice-based organizational learning and performance improvement is presented that supports researchers and practitioners address the problems evoked and contributes to a practice-based approach to activity management. The novelty of the research lies in the simultaneous study of the different levels involved in the activity. Route selection in light rail infrastructure projects involves practices at both the strategic and operational levels; it is part managerial/political and part engineering. Aspectual comparison of practices represented in Contextual Graphs constitutes a new approach to the selection of Key Performance Indicators (KPIs). This approach is free from causality assumptions and forms the basis of a new approach to practice-based organizational learning and performance improvement. The evolution of practices in contextual graphs is shown to be an objective and measurable expression of organizational learning. This diachronic representation is interpreted using a practice-based organizational learning novelty typology. This dissertation shows how lessons learned when effectively leveraged by an organization lead to practice maturity. The practice maturity level of an activity in combination with an assessment of an activity’s strategic relevance can be used by management to prioritize improvement effort.

Nutrition, growth and body composition in preterm infants

The goal of neonatal nutrition in the preterm infant is to achieve postnatal growth and body composition approximating that of a normal fetus of the same postmenstrual age and to obtain a functional outcome comparable to infants born at term. However, in clinical practice such a pattern is seldom achieved, with growth failure and altered body composition being extensively reported. The BabyGrow preterm nutrition study was a longitudinal, prospective, observational study designed to investigate nutrition and growth in 59 preterm infants following the implementation of evidence-based nutrition guidelines in the neonatal unit at Cork University Maternity Hospital. Nutrient delivery was precisely measured during the entire hospital stay and intakes were compared with current international recommendations. Barriers to nutrient delivery were identified across the phases of nutritional support i.e. exclusive parenteral nutrition and transition (establishment of enteral feeds) phases of nutrition and nutritional strategies to optimise nutrient delivery were proposed according to these phases. Growth was measured from birth up to 2 months corrected age and body composition was assessed in terms of fat mass and lean body mass by air displacement plethysmography (PEA POD) at 34 weeks gestation, term corrected age and 2 months corrected age. Anthropometric and body composition data in the preterm cohort were compared with a term reference group from the Cork BASELINE Birth Cohort Study (n=1070) at similar time intervals. The clinical and nutritional determinants of growth and body composition during the neonatal period were reported for the first time. These data have international relevance, informing authoritative agencies developing evidence-based practice guidelines for neonatal nutritional support. In the future, the nutritional management of preterm infants may need to be individualised to consider gestational age, birth weight as well as preterm morbidity.

Using WebCT to Support a Community of Practice

Reflecting a view of “teaching as both an intellectual and practical activity” the Queen’s University Bachelor of Education program has multi-week in-school practicum sessions separated by periods of on-campus course work. The expectation is that teacher candidates will bring together theory and practice as they reflect upon their daily classroom experiences. The reality often is that, while isolated from the university environment and caught up in the pressures of teaching, little deep reflection takes place. For reflection and critical examination of experience to occur, teacher candidates need to share and discuss on a daily basis their practice teaching experience. For the past few years, students in my secondary school mathematics curriculum course, through a WebCT based conference, have been provided, while away from campus, with a place for on-going sharing of teaching stories and dilemmas. In the Fall of 2004 eight-five percent of the class took part in the discussions, posting a total of 667 messages over a 9 week period. In an effort to increase the value of this practicum conference we have analysed the topic threads arising in the conversation, surveyed the participants concerning their impressions of the sharing experience, and conducted in-depth interviews with a sampling of the class. This session will present the results of this study and provide an opportunity to discuss ways in which an online discussion can support the building of community and the exchange of experience while students in professional programs are disbursed in practice/clinical settings.