The first Australian nurse practitioner census : a protocol to guide standardized collection of information about an emergent professional group

Internationally, collection of reliable data on new and evolving health-care roles is crucial. We describe a protocol for design and administration of a national census of an emergent health-care role, namely nurse practitioners in Australia using databases held by regulatory authorities. A questionnaire was developed to obtain data on the role and scope of practice of Australian nurse practitioners. Our tool comprised five sections and included a total of 56 questions, using 28 existing items from the National Nursing and Midwifery Labour Force Census and nine items recommended in the Nurse Practitioner Workforce Planning Minimum Data Set. Australian Nurse Registering Authorities (n = 6) distributed the survey on our behalf. This paper outlines our instrument and methods. The survey was administered to 238 authorized Australian nurse practitioners (85% response rate). Rigorous collection of standardized items will ensure health policy is informed by reliable and valid data. We will re-administer the survey 2 years following the first survey to measure change over time.

Using a design led disruptive innovation approach to develop new services : practising innovation in times of discontinuity

Organisations face increasing competition from new firms in emerging markets and their past superior products may no longer provide competitive advantage in markets based on different cost and value differentials. A shift in design practices from product solutions to health services which are accessible and affordable by all is required. This paper explores a design led approach to innovation to assist medical device companies develop new services and experiences and reshape their notions of the nature, development and deployment of health care services. This approach uses design tools and methodologies that are grounded in the authentic understandings of stakeholder experiences, to assist an organisation create a vision of likely future health care scenarios. Through this process, organisations can explore the complexities in the delivery of future health care services in new and emerging markets allowing them to tailor product and service solutions which focus on being accessible and affordable by all. The industry based case study for the design of health services in carried out in emerging economies. The contribution of this work in advancing research into design innovation and future research directions are also presented.

How does small business impact on utilization of industry-led supply chain innovation capacity

This research uses confirmatory factor analysis and structural equation modelling to examine how organizational size - made up of four dimensions - control, resources, trust and complexity - impacts on utilization of industry-led supply chain innovation capacity in a traditional agribusiness industry, the Australian beef industry. It confirms small business rather than larger business accords greater importance to exploiting supply chain dynamic capabilities, particularly in relation to utilizing industry –led supply chain innovation capacity. For small business in Australian beef supply chains, being agile and able to adapt and align their business practices with supply chain partners is integral to ensuring these businesses remain relevant and competitive in this market. In theoretical terms this is supported by authors in the dynamic capabilities literature as they argue these types of capabilities enable organizations to innovate faster (or better), often leading to the creation of newer sources of competitive advantage.

A snapshot of Australian nurse practitioners’ extended practice activities

Introduction The Australian Nurse Practitioner Project (AUSPRAC) was initiated to examine the introduction of nurse practitioners into the Australian health service environment. The nurse practitioner concept was introduced to Australia over two decades ago and has been evolving since. Today, however, the scope of practice, role and educational preparation of nurse practitioners is well defined (Gardner et al, 2006). Amendments to specific pre-existing legislation at a State level have permitted nurse practitioners to perform additional activities including some once in the domain of the medical profession. In the Australian Capital Territory, for example 13 diverse Acts and Regulations required amendments and three new Acts were established (ACT Health, 2006). Nurse practitioners are now legally authorized to diagnose, treat, refer and prescribe medications in all Australian states and territories. These extended practices differentiate nurse practitioners from other advanced practice roles in nursing (Gardner, Chang & Duffield, 2007). There are, however, obstacles for nurse practitioners wishing to use these extended practices. Restrictive access to Medicare funding via the Medicare Benefit Scheme (MBS) and the Pharmaceutical Benefit Scheme (PBS) limit the scope of nurse practitioner service in the private health sector and community settings. A recent survey of Australian nurse practitioners (n=202) found that two-thirds of respondents (66%) stated that lack of legislative support limited their practice. Specifically, 78% stated that lack of a Medicare provider number was ‘extremely limiting’ to their practice and 71% stated that no access to the PBS was ‘extremely limiting’ to their practice (Gardner et al, in press). Changes to Commonwealth legislation is needed to enable nurse practitioners to prescribe medication so that patients have access to PBS subsidies where they exist; currently patients with scripts which originated from nurse practitioners must pay in full for these prescriptions filled outside public hospitals. This report presents findings from a sub-study of Phase Two of AUSPRAC. Phase Two was designed to enable investigation of the process and activities of nurse practitioner service. Process measurements of nurse practitioner services are valuable to healthcare organisations and service providers (Middleton, 2007). Processes of practice can be evaluated through clinical audit, however as Middleton cautions, no direct relationship between these processes and patient outcomes can be assumed.

Clients’ understanding of the role of nurse practitioners

Introduction: Nurse Practitioners (NPs) have an emerging role in the Australian healthcare system. However, there remains a dearth of available data about public understanding of the NP role. ---------- Aim: To evaluate clients’ understanding of the role of the NP and their satisfaction with education received, quality of care and NP knowledge and skill. ---------- Method: All authorised NPs working in a designated NP position in Western Australia and those working in three area health services in New South Wales (NSW) were invited to recruit five consecutive clients to complete the self-administered survey. ---------- Results: Thirty two NPs (NP response rate 93%) recruited 129 clients (client response rate 90%). Two thirds of clients (63%) were aware they were consulting an NP. The majority rated the following NP related outcomes as ‘excellent’ or ‘very good’: education provided (89%); quality of care (95%); and knowledge and skill (93%). Less than half reported an understanding that NPs could prescribe medications (40.5%) or interpret X-rays (33.6%). Clients of NPs practising in a rural or remote setting were more likely than those in an urban setting to have previously consulted an NP (p=0.005), and where applicable would to prefer to see a NP rather than a doctor (p=0.022). ---------- Discussion: Successful implementation and expansion of the NP role requires NP visibility in the community. Despite high levels of satisfaction more awareness of the scope of the NP role is required.

Changing to learner-centred education : challenges experienced by nurse educators in Taiwan

This paper reports the challenges experienced by nurse educators in changing a teacher-centred, content-driven approach to teaching and learning to a learner-centred, process-driven approach within a School of Nursing in Taiwan. While a general movement towards a learner-centred approach was achieved, the curriculum transformation process was complex and inevitably slow with many challenges. First the study is outlined, with the key challenges experienced by the participating nurse educators explicated and illuminated with excerpts drawn from the research data. This is followed by a discussion of possible reasons for the challenges and how they were overcome and the transition process from teacher-centred to learner-centred education facilitated.

Aesthetic tensions : evaluating outcomes for practice-led research and industry

This paper explores principles of contemporary aesthetics to suggest a basis for determining qualitative outcomes of artistic works in two contexts: the arts industry and the academy setting of practice-led research. Commonly articulated measures of quality—creativity and innovation—are questioned as mere rhetoric if not framed in specific ways in the two discrete settings. The paper also interrogates generally held assumptions that a longer time to develop work and greater periods of self-reflexivity will produce higher calibre artistic outcomes. The unease produced by apparent differences in qualitative outcomes between art works created in an industry setting and those created through practice-led research is analysed through three interconnected framing devices: intention, contextual parameters and criteria for evaluation, in conjunction with the relationships between the art work, the artist and the audience/viewer/listener. Common and differentiated criteria in the two contexts are explored, leading to the conclusion that innovation is more likely to be revealed in the end product in an industry context whereas in practice-led research it may be in the methodological processes of creating the work. While identifying and acknowledging that the two contexts encourage and produce distinctive qualitative artistic outcomes, both of value to the arts and the academy, the paper recommends ways in which closer formal liaison between industry artists and practice-led artists and supervisors might occur in order to ensure ongoing mutual influence and relevance.

Research-led educational renewal and economic-cultural convergence

The 'Queensland Model' grew out of three convergent agendas: educational renewal, urban redevelopment, and the Queensland state government's 'Smart State' strategy.

Overcoming challenges to collaboration: Nurse educators’ experiences in curriculum change

This article describes challenges to effective collaboration encountered by nurse educators as they transformed a unit within a school of nursing in Taiwan. This study introduced collaborative action research as a vehicle for curriculum change. Although the team achieved positive outcomes in transforming a unit, the collaborative process was complex with four major challenges: meaning, time, work culture, and conflicting views. This article provides an overview of the study, and the major challenges posed by working together are expounded and illustrated with excerpts drawn from the study data. Possible reasons for the challenges, how these challenges were overcome, and facilitation of the collaborative process are discussed.

Design Led Innovation : exploring the synthesis of needs, technologies and business models

The term Design is used to describe a wide range of activities. Like the term innovation, it is often used to describe both an activity and an outcome. Many products and services are often described as being designed, as they describe a conscious process of linking form and function. Alternatively, the many and varied processes of design are often used to describe a cost centre of an organisation to demonstrate a particular competency. However design is often not used to describe the ‘value’ it provides to an organisation and more importantly the ‘value’ it provides to both existing and future customers. Design Led Innovation bridges this gap. Design Led Innovation is a process of creating a sustainable competitive advantage, by radically changing the customer value proposition. A conceptual model has been developed to assist organisations apply and embed design in a company’s vision, strategy, culture, leadership and development processes.

Motivations and intentions : a case study of design-led activism

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.

An introduction to the constraints-led approach to learning in outdoor education

Participation in outdoor education is underpinned by a learner's ability to acquire skills in activities such as canoeing, bushwalking and skiing and consequently the outdoor leader is often required to facilitate skill acquisition and motor learning. As such, outdoor leaders might benefit from an appropriate and tested model on how the learner acquires skills in order to design appropriate learning contexts. This paper introduces an approach to skill acquisition based on ecological psychology and dynamical systems theory called the constraints-led approach to skills acquisition. We propose that this student-centred approach is an ideal perspective for the outdoor leader to design effective learning settings. Furthermore, this open style of facilitation is also congruent with learning models that focus on other concepts such as teamwork and leadership.

Development and validation of a pregnancy symptoms inventory

BACKGROUND. Physical symptoms are common in pregnancy and are predominantly associated with normal physiological changes. These symptoms have a social and economic cost, leading to absenteeism from work and additional medical interventions. There is currently no simple method for identifying common pregnancy related problems in the antenatal period. A validated tool, for use by pregnancy care providers would be useful. AIM: The aim of the project was to develop and validate a Pregnancy Symptoms Inventory for use by healthcare professionals (HCPs). METHODS: A list of symptoms was generated via expert consultation with midwives and obstetrician gynaecologists. Focus groups were conducted with pregnant women in their first, second or third trimester. The inventory was then tested for face validity and piloted for readability and comprehension. For test-re-test reliability, it was administered to the same women 2 to 3 days apart. Finally, outpatient midwives trialled the inventory for 1 month and rated its usefulness on a 10cm visual analogue scale (VAS). The number of referrals to other health care professionals was recorded during this month. RESULTS: Expert consultation and focus group discussions led to the generation of a 41-item inventory. Following face validity and readability testing, several items were modified. Individual item test re-test reliability was between .51 to 1 with the majority (34 items) scoring .0.70. During the testing phase, 211 surveys were collected in the 1 month trial. Tiredness (45.5%), poor sleep (27.5%) back pain (19.5%) and nausea (12.6%) were experienced often. Among the women surveyed, 16.2% claimed to sometimes or often be incontinent. Referrals to the incontinence nurse increased > 8 fold during the study period. The median rating by midwives of the ‘usefulness’ of the inventory was 8.4 (range 0.9 to 10). CONCLUSIONS: The Pregnancy Symptoms Inventory (PSI) was well accepted by women in the 1 month trial and may be a useful tool for pregnancy care providers and aids clinicians in early detection and subsequent treatment of symptoms. It shows promise for use in the research community for assessing the impact of lifestyle intervention in pregnancy.

Teaching design led innovation : the future of industrial design

The profession of industrial design is changing and with that so must industrial design education. The newly derived final year industrial design unit at the Queensland University of Technology (QUT) was created to initiate such a change. A designers’ role in industry is no longer limited to the invention process surrounding human cantered design but has now evolved into design led innovation. This paper reflects upon the teaching methods employed over a two-year period and improvements made over that time to the unit. The student project outcome is to produce a design solution that integrates an underlying novel technology into a new product and or service, with business strategies and manufacturing details being fully integrated into the design process. It is this integrated approach to industrial design teaching that will foster a more grounded and resourceful future designer.

Clinical education for nephrology nurse practitioner candidates in Australia : a consensus statement

Objectives: To develop recommendations for the clinical education required to prepare Australian Nurse Practitioner candidates for advanced and extended practice in nephrology settings. Methods: Using the Delphi research technique a consensus statement was developed over a nine month period. All endorsed and candidate Nephrology Nurse Practitioners (NNP) were invited to participate as the expert panel. The Delphi research technique uses a systematic and iterative process. The expert panel were asked to generate a list of items which were then circulated to all NNPs. They were asked to determine their degree of agreement or disagreement with each statement using a 5-point Likert scale There was opportunity for free-text comments to be provided if desired. Results from each round were collated; the document was refined and circulated to the experts for a subsequent round. Consensus was demonstrated after three Delphi rounds. Results: The consensus statement comprises four components explaining the role and membership of the mentorship team, the setting and location of NNP clinical education, learning strategies to support the NNP, and outcomes of NNP clinical education. Demographic questions in the final survey revealed information about the qualifications, years of experience, and practice location of Australian NNPs. Conclusions: The consensus statement is not prescriptive but it will inform NNP candidates, university course providers and mentors about the expected extended nephrology specific clinical education that will enable the NNP to provide advanced nursing care for patients regardless of the stage of chronic kidney disease (CKD) and the practice setting.