Teaching and learning innovations for postgraduate education in nursing

This paper begins with a literature review of blended learning approaches, including the creation of learning spaces in the online environment and the model of community of inquiry and collaborative learning promoted by Garrison and others. This model, comprising of three elements including ‘social presence’, ‘cognitive presence’ and ‘teaching presence’, guides academics in the development and delivery of quality programs designed to enhance each student’s experience of their course. The second part of this paper is the application of blended learning for the Deakin University Master of Nursing Practice (Nurse Practitioner), including a range of online independent learning activities, Elluminate Live use (a real time online program) and on-campus contact with students. The application of these flexible and innovative online modalities offered in this course, have been designed to promote quality learning experiences for students around their employment commitments and lifestyle factors. As an off-campus course, the Master of Nursing Practice (Nurse Practitioner) presents as a more flexible option for nurses residing in various parts of Australia. The three core elements of the model of community of inquiry and collaborative learning by Garrison and others have been integrated through online teaching and learning access and face-to-face contact for one day in two trimesters of the academic year. The success of blended learning approaches are underpinned by effective communication and interactions between both academics and students.

Human resource management activities on the front line : a nursing perspective

Objective: To identify the practical human resource management (HRM) issues that may impact on job satisfaction, nurse retention and ultimately quality of patient care of the nurse unit manager's (NUM) role.
Background: NUMs are in the unique position within the healthcare industry to impact upon and effect large numbers of people, including nurses, doctors, patients and their families, and processes on a daily basis. More effective HRM practices could improve performance in terms of staff satisfaction, positive patient outcomes and the cost effectiveness of staff retention.
Method: Two focus groups, one group of nine NUMs and one group of five staff nurses, were conducted at an Australia public hospital. A descriptive phenomenological approach informed data generation and data analysis.
Results: The NUMs reported that they were not adequately trained in the skills required to effectively manage staff conflict such as manipulation and bitterness, requiring disciplinary intervention on an ongoing basis. The consequences included reduced staff morale, decreased staff satisfaction, increased stress to the NUM and ultimately retention issues for both the NUM and Unit staff.
Conclusion: This study highlights the potential impact of inadequate implementation and understanding of HRM policy and practice by NUMS on the front line. Further research is required to understand why this phenomenon exists and how it can be remedied.

Nursing home administrators’ perspectives on a study feedback report : a cross sectional survey

Background
This project is part of the Translating Research in Elder Care (TREC) program of research, a multi-level and longitudinal research program being conducted in 36 nursing homes in three Canadian Prairie Provinces. The overall goal of TREC is to improve the quality of care for older persons living in nursing homes and the quality of work life for care providers. The purpose of this paper is to report on development and evaluation of facility annual reports (FARs) from facility administrators’ perspectives on the usefulness, meaningfulness, and understandability of selected data from the TREC survey.
Methods
A cross sectional survey design was used in this study. The feedback reports were developed in collaboration with participating facility administrators. FARs presented results in four contextual areas: workplace culture, feedback processes, job satisfaction, and staff burnout. Six weeks after FARs were mailed to each administrator, we conducted structured telephone interviews with administrators to elicit their evaluation of the FARs. Administrators were also asked if they had taken any actions as a result of the FAR. Descriptive and inferential statistics, as well as content analysis for open-ended questions, were used to summarize findings.
Results
Thirty-one facility administrators (representing thirty-two facilities) participated in the interviews. Six administrators had taken action and 18 were planning on taking action as a result of FARs. The majority found the four contextual areas addressed in FAR to be useful, meaningful, and understandable. They liked the comparisons made between data from years one and two and between their facility and other TREC study sites in their province. Twenty-two indicated that they would like to receive information on additional areas such as aggressive behaviours of residents and information sharing. Twenty-four administrators indicated that FARs contained enough information, while eight found FARs ‘too short’. Administrators who reported that the FAR contained enough information were more likely to take action within their facilities than administrators who reported that they needed more information.
Conclusions
Although the FAR was brief, the presentation of the four contextual areas was relevant to the majority of administrators and prompted them to plan or to take action within their facility.

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.

Professional nursing governance in a large Australian health service

Background: Professional nursing governance refers to the processes and structures that influence nursing practice within an organisation. This study measured the effect of structured meeting communication processes on nurses' perceptions of professional governance.

Method: The intervention was implemented in eight hospital wards. After three months, nurses on the intervention wards and eight matched-control wards completed the Index of Professional Nursing Governance (n = 225). Data were compared with a sample of Magnet® (n = 3) and non-Magnet (n = 46) hospitals.

Results: There was substantial variation in nurses' perceptions of governance across the 16 wards, irrespective of the intervention. Compared to non-Magnet hospitals, the overall score and three of the six subscales scores were higher in this study. Magnet hospitals scores, however, were typically higher suggesting greater progress towards shared governance.

Conclusions: Professional nursing governance can be highly variable across individual wards and tailored interventions should be considered.

Managing patient deterioration : a protocol for enhancing undergraduate nursing students’ competence through web-based simulation and feedback techniques

Aims: To describe a funded proposal for the development of an on-line evidence based educational program for the management of deteriorating patients.
Background: There are international concerns regarding the management of deteriorating patients with issues around the ‘failure to rescue’. The primary response to these issues has been the development of medical emergency teams with little focus on the education of primary first responders.
Design/Methods: A mixed methods triangulated convergent design. In this four phase proposal we plan to 1. examine nursing student team ability to manage deteriorating patients and based upon these findings 2. develop web based educational material, including interactive scenarios. This educational material will be tested and refined in the third Phase 3, prior to evaluation and dissemination in the final phase.
Conclusion: This project aims to enhance knowledge development for the management of deteriorating patients through rigorous assessment of team performance and to produce a contemporary evidence-based online training program.

Providing quality mental health nursing in primary health care settings in Kenya : A discussion paper.

Kenya, a country of 38 million people in East Africa has about 75 Psychiatrists and 500 Psychiatric Nurses, the majority work in the private sector and mainly in urban areas. Mental illness is common in Kenya, however, specialist services are sparse and primary care struggles to cope, and this has been worsened by general health programs which have been slow to appreciate the significance of mental health. The World Health Organisation recommends that provision of good quality mental health care does not only involve increasing the number of health workers but changing the skill mix and developing new competencies among existing workers. Successful implementation of mental, neurological and substance abuse disorder services in Kenya will depend on nurses, who constitute majority of the workforce located in provinces, districts and community clinics.

This discussion paper will address s key workforce issues affecting the up-scaling of mental health services, and the delivery of quality mental health nursing care in primary health care settings in Kenya. Strategies to develop skills and competencies of new and existing personnel will be discussed.

Mind the gap! : A discussion on the disparity between low and high income countries in the provision of mental health care and the implications for capacity building in Kenya’s nursing workforce.

About fourteen per cent of the global burden of disease has been attributed to mental, neurological and substance use disorders. A number of initiatives have been launched in recent years to respond to this, the World Health Organisation (WHO) introduced the Mental Health Gap Action Programme (mhGAP) to address the widening gap between what is needed to provide adequate mental health services and what is currently available, especially in low and middle income countries where the gap is widest.
This discussion paper will focus on mental health nursing in Kenya, a country in East Africa with a population of 42 million people. Mental illness is common in Kenya with up to twenty five per cent prevalence rates, yet mental health services are sparse at the tertiary and primary care level and mental health remains a low budget and policy priority for the government. The aim of this paper is to raise participants’ awareness of the challenges of delivering mental health nursing care in low-income countries such as Kenya, and to explore possible solutions to the problem.