A Delphi study to validate an advanced practice nursing tool

Aim This paper is a report of a study conducted to validate an instrument for measuring advanced practice nursing role delineation in an international contemporary health service context using the Delphi technique. Background Although most countries now have clear definitions and competency standards for nurse practitioners, no such clarity exists for many advanced practice nurse roles, leaving healthcare providers uncertain whether their service needs can or should be met by an advanced practice nurse or a nurse practitioner. The validation of a tool depicting advanced practice nursing is essential for the appropriate deployment of advanced practice nurses. This paper is the second in a three-phase study to develop an operational framework for assigning advanced practice nursing roles. Method An expert panel was established to review the activities in the Strong Model of Advanced Practice Role Delineation tool. Using the Delphi technique, data were collected via an on-line survey through a series of iterative rounds in 2008. Feedback and statistical summaries of responses were distributed to the panel until the 75% consensus cut-off was obtained. Results After three rounds and modification of five activities, consensus was obtained for validation of the content of this tool. Conclusion The Strong Model of Advanced Practice Role Delineation tool is valid for depicting the dimensions of practice of the advanced practice role in an international contemporary health service context thereby having the potential to optimize the utilization of the advanced practice nursing workforce.

Implementation and evaluation of a new model of nursing practice in radiation oncology

Patients undergoing radiation therapy for cancer face a series of challenges that require support from a multidisciplinary team which includes radiation oncology nurses. However, the specific contribution of nursing, and the models of care that best support the delivery of nursing interventions in the radiotherapy setting, is not well described. In this case study, the Interaction Model of Client Health Behaviour and the associated principles of person-centred care were incorporated into a new model of care that was implemented in one radiation oncology setting in Brisbane, Australia. The new model of care was operationalised through a Primary Nursing/Collaborative Practice framework. To evaluate the impact of the new model for patients and health professionals, multiple sources of data were collected from patients and clinical staff prior to, during, and 18 months following introduction of the practice redesign. One cohort of patients and clinical staff completed surveys incorporating measures of key outcomes immediately prior to implementation of the model, while a second cohort of patients and clinical staff completed these same surveys 18 months following introduction of the model. In-depth interviews were also conducted with nursing, medical and allied health staff throughout the implementation phase to obtain a more comprehensive account of the processes and outcomes associated with implementing such a model. From the patients’ perspectives, this study demonstrated that, although adverse effects of radiotherapy continue to affect patient well-being, patients continue to be satisfied with nursing care in this specialty, and that they generally reported high levels of functioning despite undergoing a curative course of radiotherapy. From the health professionals’ perspective, there was evidence of attitudinal change by nursing staff within the radiotherapy department which reflected a greater understanding and appreciation of a more person-centred approach to care. Importantly, this case study has also confirmed that a range of factors need to be considered when redesigning nursing practice in the radiotherapy setting, as the challenges associated with changing traditional practices, ensuring multidisciplinary approaches to care, and resourcing a new model were experienced. The findings from this study suggest that the move from a relatively functional approach to a person-centred approach in the radiotherapy setting has contributed to some improvements in the provision of individualised and coordinated patient care. However, this study has also highlighted that primary nursing may be limited in its approach as a framework for patient care unless it is supported by a whole team approach, an appropriate supportive governance model, and sufficient resourcing. Introducing such a model thus requires effective education, preparation and ongoing support for the whole team. The challenges of providing care in the context of complex interdisciplinary relationships have been highlighted by this study. Aspects of this study may assist in planning further nursing interventions for patients undergoing radiotherapy for cancer, and continue to enhance the contribution of the radiation oncology nurse to improved patient outcomes.

Incorporating community history into urban redevelopment

A community history project must be relevant to each person within it so that they see themselves as part of the socio-cultural fabric of the area and feel a sense of ownership of their environment. The Mill Albion community history project is a diverse, multi-layered public history/art program that captures the social heritage of The Mill Albion and allows the community to contribute to their ongoing history. The Albion Flour Mill was built in 1930 at a time when Australia was feeling the effects of its worst economic depression and continued operations for more than 72 years. After ceasing operation in 2005 the site was left to deteriorate. The FKP Property Group purchased the land to undertake a new urban redevelopment project, drawing on the design principles of a traditional ‘village’, while valuing the importance of remembering the community that once included the Flour Mill. This paper reflects on the this project and showcases some of the culturally creative ways this community’s history was told, using methods such as digital stories, contemporary and historical photography and oral history.

A story worth telling : putting oral history and digital collections online in cultural institutions

Digital platforms in cultural institutions offer exciting opportunities for oral history and digital storytelling that can augment and enrich traditional collections. The way in which cultural institutions allow access to the public is changing dramatically, prompting substantial expansions of their oral history and digital story holdings. In Queensland, Australia, public libraries and museums are becoming innovative hubs of a wide assortment of collections that represent a cross-section of community groups and organisations through the integration of oral history and digital storytelling. The State Library of Queensland (SLQ) features digital stories online to encourage users to explore what the institution has in the catalogue through their website. Now SLQ also offers oral history interviews online, to introduce users to oral history and other components of their collections,- such as photographs and documents to current, as well as new users. This includes the various departments, Indigenous centres and regional libraries affiliated with SLQ statewide, who are often unable to access the materials held within, or even full information about, the collections available within the institution. There has been a growing demand for resources and services that help to satisfy community enthusiasm and promote engagement. Demand increases as public access to affordable digital media technologies increases, and as community or marginalised groups become interested in do it yourself (DIY) history; and SLQ encourages this. This paper draws on the oral history and digital story-based research undertaken by the Queensland University of Technology (QUT) for the State Library of Queensland including: the Apology Collection: The Prime Minister’s apology to Australia’s Indigenous Stolen Generation; Five Senses: regional Queensland artists; Gay history of Brisbane; and The Queensland Business Leaders Hall of Fame.