Assessing performance in critical care nursing practice using the Benner Novice to expert model: A pilot study

Background It is often believed that by ensuring the ongoing completion of competency documents and life-long learning in nursing practice guarantees quality patient care. This is probably true in most cases where it provides reassurances that the nursing team is maintaining a safe “generalised” level of practice. However, competency does not always promise quality performance. There are a number of studies that have reported differences in what practitioners know and what they actually do despite being deemed competent. Aim The aim of this study was to assess whether our current competency documentation is fit for purpose and to ascertain whether performance assessment needs to be a key component in determining competence. Method 15 nurses within a General ICU who had been on the unit <4 years agreed to participate in this project. Using participant observation and assessing performance against key indicators of the Benner Novice to Expert5 model the participants were supported and assessed over the course of a ‘normal’ nursing shift. Results The results were surprising both positively and negatively. First, the nurses felt more empowered in their clinical decision making skills; second, it identified individual learning needs and milestones in educational development. There were some key challenges identified which included 5 nurses over estimating their level of competence, practice was still very much focused on task acquisition and skill and surprisingly some nurses still felt dominated by the other health professionals within the unit. Conclusion We found that the capacity and capabilities of our nursing workforce needs continual ongoing support especially if we want to move our staff from capable task-doer to competent performers. Using the key novice to expert indicators identified the way forward for us in how we assess performance and competence in practice particularly where promotion to higher grades is based on existing documentation.

Male nursing students in training: A comparative analysis of hidden advantage and discrimination

Aim The aim of this study was to examine the lived experience of men training to be registered nurses within a regional New Zealand context. Design This study draws upon the key principles of descriptive phenomenology. Sample Five male students enrolled from the 1st and 3rd year of the BN programme. Findings - A Career with Prospects - Gender inequality by superiors; - Developing professional boundaries with female colleagues; - Being unique has its advantages.

Radical nursing and the emergence of technique as healthcare technology

The integration of technology in care is core business in nursing and this role requires that we must understand and use technology informed by evidence that goes much deeper and broader than actions and behaviours. We need to delve more deeply into its complexity because there is nothing minor or insignificant about technology as a major influence in healthcare outcomes and experiences. Evidence is needed that addresses technology and nursing from perspectives that examine the effects of technology, especially related to increasing demands for efficiency, the relationship of technology to nursing and caring, and a range of philosophical questions associated with empowering people in their healthcare choices. Specifically, there is a need to confront in practice the ways technique influences care. Technique is the creation of a kind of thinking that is necessary for contemporary healthcare technology to develop and be applied in an efficient and rational manner. Technique is not an entity or specific thing, but rather a way of thinking that seeks to shape and organize nursing activity, and manage efficiently individual difference(s) in care. It emphasizes predetermined causal relationships, conformity, and sameness of product, process, and thought. In response is needed a radical vision of nursing that attempts in a real sense to ensure we meet the needs of individuals and their community. Activism and advocacy are needed, and a willingness to create a certain detachment from the imperatives that technique demands. It is argued that our responsibility as nurses is to respond in practice to the errors, advantages, difficulties, and temptations of technology for the benefit of those who most need our assistance and care.

The impact of home loan key facts sheets on borrowers' comparisons of loan costs

This thesis evaluates the effectiveness of the prescribed design and distribution requirements of the Australian Government's home loan key facts sheets (KFS) aimed at helping borrowers compare loan costs. The findings show that despite effectively improving borrower decision-making, few borrowers were aware of their existence and function. It was also demonstrated that KFS have had limited market impact over the four year window since introduction, likely due to the requirement that KFS provision is not required unless formally requested by a borrower. Recommendations include transferring the burden of disclosure to lenders in the first instance to address this information gap.

Pull factors attracting residents to Finnish senior houses

Most elderly Finnish residents prefer to age in place, but some relocate because of push factors that create stress in their current homes and pull factors that attract them to a new dwelling. This survey examines the important pull factors that attract seniors to senior houses. Grocery nearby is the strongest pull factor followed by hospital or medical center and public transportation. A factor analysis reveals that attributes can be grouped into three factors: onsite services that allow the residents to maintain an active lifestyle with some luxury, everyday services and facilities that would enable aging in place, and physical activity facilities. Residents have chosen the type of senior housing that supports their lifestyle. Meanwhile, socioeconomic characteristics do not explain the differences in the types of features that attract residents.

Vietnamese nursing students' perceptions of their clinical learning environment: A cross-sectional survey

This study investigated Vietnamese nursing students' perceptions of their clinical learning environment. The study was undertaken in two phases: 1) translation and adaptation of research instrument and 2) a cross-sectional survey was followed. Despite validity issues identified, data from two valid sub-scales and structured questions provided insights into the clinical learning environment that is the environment did not operate from an adult learner philosophy or provide a student-centred environment. The results are significant for development of clinical learning environment in Vietnam and that cultural differences between populations should be carefully considered in future research.

Interaction in the Multicultural Classroom : Towards Culturally Sensitive Home Economics Education

Continuous growth in the number of immigrant students has changed the Finnish school environment. The resulting multicultural school environment is new for both teachers and students. In order to develop multicultural learning environments, there is a need to understand immigrant students everyday lives in school. In this study, home economics is seen as a fruitful school subject area for understanding these immigrant students lives as they cope with school and home cultures that may be very different from each other. Home economics includes a great deal of knowledge and skills that immigrant students need during their everyday activities outside of school. -- The main aim of the study is to clarify the characteristics of multicultural home economics classroom practices and the multicultural contacts and interaction that take place between the students and the teacher. The study includes four parts. The first part, an ethnographical prestudy, aims to understand the challenges of multicultural schoolwork with the aid of ethnographical fieldwork done in one multicultural school. The second part outlines the theoretical frames of the study and focuses on the sociocultural approach. The third part of the study presents an analysis of videodata collected in a multicultural home economics classroom. The teacher s and students interaction in the home economics classroom is analyzed through the concepts of the sociocultural approach and the cultural-historical activity theory. Firstly, this is done by analyzing the focusedness of the teacher s and the students actions as well as the questions presented and apparent disturbances during classroom interaction. Secondly, the immigrant students everyday experiences and cultural background are examined as they appear during discussions in the home economics lessons. Thirdly, the teacher s tool-use and actions as a human mediator are clarified during interaction in the classroom. The fourth part presents the results, according to which a practice-based approach in the multicultural classroom situation is a prerequisite for the teacher s and the students shared object during classroom interaction. Also, the practice-based approach facilitates students understanding during teaching and learning situations. Practice in this study is understood as collaborative teaching and learning situations that include 1) guided activating learning, 2) establishing connections with students everyday lives and 3) multiple tool-use. Guided activating learning in the classroom is defined as situations that occur and assignments that are done with a knowledgeable adult or peer and include action. The teacher s demonstrations during the practical part of the lessons seemed to be fruitful in the teaching and learning situations in the multicultural classroom. Establishing connections with students everyday lives motivated students to follow the lesson and supported understanding of meaning. Furthermore, if multiple tools (both psychological and material) were used, the students managed better with new and sometimes difficult concepts and different working habits, and accomplished the practical work more smoothly . The teacher s tool-use and role as a mediator of meaning are also highlighted in the data analysis. Hopefully, this study can provide a seedbed for situations in which knowledge produced together, as well as horizontally oriented tool-use, can make school-learned knowledge more relevant to immigrant students everyday lives, and help students to better cope with both classroom work and outside activities. KEY WORDS: home economics education, multicultural education, sociocultural perspective, classroom interaction, videoanalysis

Which accelerated nursing students withdraw and fail in their first year of a Bachelor of Nursing (BN)?

Accelerated students in nursing have their first experience of university entering into second year subjects such as pharmacology. These accelerated students may have a Diploma of Nursing or equivalent experience or may be domestic or international graduates in any subject area. We have previously shown that the withdrawal rates are higher for accelerated than traditional students. We now show that of the accelerated students, it is only the diploma students that have difficulty transitioning to a BN.

Reduced attrition of accelerated nursing students from pharmacology – is it associated with graduation?

In order to reduce the attrition of accelerated nursing students in bioscience/pharmacology, we introduced an innovation to help these students. Although this innovation was associated with reduced attritions from the units in their first year at university, we now show that there was a reduced graduation rate of the accelerated students who survived pharmacology, compared to the traditional students.

Elizabeth Engel nee Benjamin-Rasmussen in her home; Silver Springs, Maryland Portraits Women

Digital Image

Elizabeth Engel nee Benjamin-Rasmussen with her daughter Dorel Hall nee Engel in Elizabeth's home; Silver Springs, Maryland Portraits Family

Digital Image

Reproduction of family tree, possibly the Gottschalk Stammbaum from the home of Henriette Gottschalk nee Rothschild Genealogy

Others remember the Gottschalk Stammbaum from the home of Henriette Gottschalk nee Rothschild as having only one tree

Therese Godshaw's nee Molling 70th birthday party at the Krakauer home; Boston Portraits Family

Left to right behind table: John Krakauer, Donald, Michael and Robert Godshaw (Children of Hal and Anne), Grandma Therese Godshaw nee Molling, Julius Pick (Grandfather of Robert, Michael and Donald). In front of table: Wendy and Gerry Godshaw (children of Kurt and Edith.

Nursing physical assessment for patient safety in general wards: Reaching consensus on core skills

Aims and objectives To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Background Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. Design A modified Delphi study. Methods Focus group interviews with 150 acute care registered nurses (RNs) at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care RNs following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Results Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Conclusions Among a large and diverse group of experienced acute care RNs consensus was achieved on a structured core physical assessment to detect early changes in patient status. Relevance to clinical practice Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.

Losing the rural nursing workforce: Lessons learnt from resigning nurses

Background Australian workforce planning predicts a shortfall of nurses by 2025 with rural areas being most at risk. Rural areas have lower retention rates of nurses than metropolitan areas, with remote communities experiencing an even higher turnover of nursing staff. There have been few studies that examine the impact of nurse resignations on rural nursing workforces. Objective This paper is abstracted from a larger study into the reasons why nurses resign from rural hospitals and explores the resignation period. Design A qualitative study using grounded theory methods. Following in-depth interviewing and transcription, data analysis occurred with the assistance of NVivo software. Setting Rural NSW. Participants Twelve registered nurses who had resigned from rural NSW hospitals and not for reasons of retirement, maternity leave or relocation; two participants were re-interviewed. Results While the overall study identified a grounded theory which explained rural nurses resign from hospitals due to a conflict of values, three additional themes emerged about the resignation practices at rural hospitals. The first theme identified a ‘window period’ which was an opportunity for the nurse to be retained. The second theme identified that nurses who had resigned were not involved in formal exit processes such as exit interviews. The third theme captured the flow-on effect from rural nurse resignations resulting in nurses leaving the profession of nursing. Conclusion To facilitate nurse retention, it is important that rural hospitals manage nurse resignations more effectively. This includes re-examining resignation procedures, how nurses are treated and collecting meaningful data to inform retention strategies.