The core role of the nurse practitioner: practice, professionalism and clinical leadership.

AIM: To draw on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. BACKGROUND: Enacted legislation provides for mutual recognition of qualifications, including nursing, between New Zealand and Australia. As the nurse practitioner role is relatively new in both countries, there is no consistency in role expectation and hence mutual recognition has not yet been applied to nurse practitioners. A study jointly commissioned by both countries' Regulatory Boards developed information on the core role of the nurse practitioner, to develop shared competency and educational standards. Reporting on this study's process and outcomes provides insights that are relevant both locally and internationally. METHOD: This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner program curricula and interviews with 15 nurse practitioners from the two countries. Data were analysed according to the appropriate standard for each data type and included both deductive and inductive methods. The data were aggregated thematically according to patterns within and across the interview and material data. FINDINGS: The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care. CONCLUSION: A clearly articulated and research informed description of the core role of the nurse practitioner provides the basis for development of educational and practice competency standards. These research findings provide new perspectives to inform the international debate about this extended level of nursing practice. RELEVANCE TO CLINICAL PRACTICE: The findings from this research have the potential to achieve a standardised approach and internationally consistent nomenclature for the nurse practitioner role.

Identifying the core competencies of mental health telephone triage

Aims and objectives. The primary aim of this study was to identify the core competencies of mental health telephone triage, including key role tasks, skills, knowledge and responsibilities, in which clinicians are required to be competent to perform safe and effective triage.
Background. Recent global trends indicate an increased reliance on telephone-based health services to facilitate access to health care across large populations. The trend towards telephone-based health services has also extended to mental health settings, evidenced by the growing number of mental health telephone triage services providing 24-hour access to specialist mental health assessment and treatment. Mental health telephone triage services are critical to the early identification of mental health problems and the provision of timely, appropriate interventions. In spite of the rapid growth in mental health telephone triage and the important role these services play in the assessment and management of mental illness and related risks, there has been very little research investigating this area of practice.
Design. An observational design was employed to address the research aims.
Methods. Structured observations (using dual wireless headphones) were undertaken on 197 occasions of mental health telephone triage over a three-month period from January to March 2011.
Results. The research identified seven core areas of mental health telephone triage practice in which clinicians are required to be competent in to perform effective mental health telephone triage, including opening the call; performing mental status examination; risk assessment; planning and action; termination of call; referral and reporting; and documentation.
Conclusions. The findings of this research contribute to the evidence base for mental health telephone triage by articulating the core competencies for practice. Relevance to clinical practice. The mental health telephone triage competencies identified in this research may be used to define an evidence-based framework for mental health telephone triage practice that aims to improve the quality, consistency and accuracy of telephone-based mental health triage assessment.

Re-composing the elephant' : bringing the big picture back into IS research

Information Systems is a practice-based discipline. It experiences periodic debates about the rigour and relevance of its research. The tensions between pretensions to be a ‘real’ science (rigour) and the need to contribute to practice (relevance) are intensified at a time of low student enrolment, lack of a clear identity, and uncertainties about the viability of our discipline. This essay argues that decomposing phenomena into narrow topics of research to achieve rigour is damaging to our discipline if we fail to then ‘recompose’ or integrate these back into understanding, lessons and guidelines for application to real-world practices. This argument is illustrated through recent work on the motors that drive changes in technology appropriation. It highlights the importance of plurality of theories and methods in understanding complex real-world phenomena in order to achieve both rigour and relevance.

Servizi Sociali Territoriali e Università: Esempi di Sinergie Possibili per un Percorso di Qualità

Although – or because – social work education in Italy has for some 15 years now been exclusively in the domain of the university the relationship between the academic world and that of practice has been highly tenuous. Research is indeed being conducted by universities, but rarely on issues that are of immediate practice relevance. This means that forms of practice develop and become established habitually which are not checked against rigorous standards of research and that the creation of knowledge at academic level pays scant attention to the practice implications of social changes. This situation has been made even worse by the dwindling resources both in social services and at the level of the universities which means that bureaucratic procedures or imports of specialisations from other disciplines frequently dominate the development of practice instead of a theory-based approach to methodology. This development does not do justice to the actual requirements of Italian society faced with ever increasing post-modern complexity which is reflected also in the nature of social problems because it implies a continuation of a faith in modernity with its idea of technical, clear-cut solutions while social relations have decidedly moved beyond that belief. This discrepancy puts even greater strain on the personnel of welfare agencies and does ultimately not satisfy the ever increasing demands for quality and accountability of services on the part of users and the general public. Social workers badly lack fundamental theoretical reference points which could guide them in their difficult work to arrive at autonomous, situation-specific methodological answers not based on procedures but on analytical knowledge. Thirty years ago, in 1977, a Presidential Decree created the legal basis for the establishment of social service departments at the level of municipalities which created opportunities for the direct involvement of the community in the fight against exclusion. For this potential to be fully utilized it would have required the bringing together of three dimensions, the organizational structure, the opportunities for learning and research in the territory and the contribution by the professional community. As this did not occur social services in Italy still often retain the character of charity which does not concern itself with the actual causes of poverty and exclusion. This in turn affects the relationship with citizens in general who cannot develop trust in those services. Through uncritical processes of interaction Edgar Morin’s dictum manifests itself which is that without resorting to critical reflection on complexity interventions can often have an effect that totally the opposite to the original intention. An important element in setting up a dynamic interchange between academia and practice is the placement on professional social work courses. Here the looping of theory to practice and back to theory etc. can actually take place under the right organizational and conceptual conditions, more so than in abstract, and for practitioners often useless debates about the theory-practice connection. Furthermore, research projects at the University of Florence Social Work Department for instance aim at fostering theoretical reflection at the level of and with the involvement of municipal social service agencies. With a general constructive disposition towards research and some financial investment students were facilitated to undertake social service practice related research for their degree theses for instance in the city of Pistoia. In this way it was also possible to strengthen the confidence and professional identity of social workers as they became aware of the contribution their own discipline can make to practice-relevant research instead of having to move over to disciplines like psychology for those purposes. Examples of this fruitful collaboration were presented at a conference in Pistoia on 25 June 2007. One example is a thesis entitled ‘The object of social work’ and examines the difficult development of definitions of social work and comes to the conclusion that ‘nothing is more practical than a theory’. Another is on coping abilities as a necessary precondition for the utilization of resources supplied by social services in exceptional circumstances. Others deal with the actual sequence of interventions in crisis situations, and one very interestingly looks at time and how it is being constructed often differently by professionals and clients. At the same time as this collaboration on research gathers momentum in the Toscana, supervision is also being demanded more forcefully as complementary to research and with the same aim of profiling more strongly the professional identity of social work. Collaboration between university and social service filed is for mutual benefit. At a time when professional practice is under threat of being defined from the outside through bureaucratic prescriptions a sound grounding in theory is a necessary precondition for competent practice.

Fallbasiertes E-Learning durch dynamische Verknüpfung von Fallstudien und Fachinhalten. Neue Diskussionsansätze zu einem vernachlässigten Konzept

Der Einsatz von Fallstudien kann als wichtiges Bindeglied zur Verknüpfung von Theorie und Praxis betrachtet werden. Fallstudien ermöglichen die Anwendung theoretischen Grundlagenwissens und die Entwicklung überfachlicher Kompetenzen. Damit können sie einen wichtigen Beitrag zur beruflichen Handlungskompetenz genau dort leisten, wo praktische Erfahrungen im Rahmen der Aus-und Weiterbildung nicht möglich sind. Der Einsatz von Fallstudien sollte aus diesem Grund nicht nur den „klassischen“ Anwendungsdisziplinen wie den Rechtswissenschaften, der Betriebswirtschaftslehre oder der Psychologie vorbehalten sein. Auch im Bereich der Informatik können sie eine wichtige Ergänzung zu den bisher eingesetzten Methoden darstellen. Das im Kontext des Projekts New Economy1 entwickelte und hier vorgestellte Konzept zur didaktischen und technischen Aufbereitung von Fallstudien am Beispiel der IT-Aus- und Weiterbildung soll diese Diskussion anregen. Mit Hilfe des vorgestellten Ansatzes ist es möglich, unterschiedliche methodische Zugänge zu einer Fallstudie für eine computerbasierte Präsentation automatisch zu generieren und mit fachlichen Inhalten zu verknüpfen. Damit ist ein entscheidender Mehrwert gegenüber den bisherigen statischen und in sich geschlossenen Darstellungen gegeben. Der damit zu erreichende Qualitätssprung im Einsatz von Fallstudien in der universitären und betrieblichen Aus- und Weiterbildung stellt einen wichtigen Beitrag zur praxisorientierten Gestaltung von Blended Learning-Ansätzen dar.(DIPF/Orig.)

Verringerung von trägem Wissen durch E-Learning. Am Beispiel einer Akustik-Lern-CD

Die Entwicklung der Akustik-Lern-CD hatte das Ziel, den Anwendungsbezug von theoretischem Wissen bei Regelverstärkern zu fördern. Die Studenten konnten nach dem theoretischen Unterricht zwar Hüllkurven zeichnen und Kompressionsraten berechnen, hatten aber Probleme, in konkreten Situationen wie z.B. beim Übersteuern von Instrumenten den korrekten Regelverstärker auszuwählen. Um einen besseren Wissenstransfer zu erreichen, werden bei der Lern-CD dem Lerner Situationen angeboten, in denen eigene Konstruktionsleistungen möglich sind und in denen kontextgebunden, interaktiv gelernt werden kann.(DIPF/Orig.)

Evaluation of two instruments of perceived symptom intensity in palliative care patients in an outpatient clinic

AIMS AND OBJECTIVES: To evaluate the test-retest stability in assessments of perceived symptom intensity on the Edmonton Symptom Assessment System-revised and the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. The possible interchangeability between the instruments and the patients' experiences of completing the instruments were also studied. BACKGROUND: The two instruments assess the same symptoms, but the symptom intensity is assessed on 11-point numerical scales on the Edmonton Symptom Assessment System-revised and on four-point verbal descriptive scales on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. Both instruments are commonly used; however, uncertainty exists about which instrument should be recommended and about the interchangeability of the instruments. DESIGN: This study used a test-retest design with inter-scale comparisons. METHODS: Data from 54 patients with cancer who were receiving palliative care in an oncology outpatient clinic were self-reported by the patients in the clinic, at home and when patients returned to the clinic. RESULTS: The assessments on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative verbal rating scales showed a higher level of test-retest stability than the assessments on the Edmonton Symptom Assessment System-revised numerical scoring scales, indicating higher reliability. The correspondence between the verbal categories and the numerical scores of symptom intensity were low because different verbal categories were used by patients who assessed the same numerical score. CONCLUSIONS: The test-retest stability in the assessments was higher on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative and the results show that assessments on the two instruments could not be used interchangeably. Therefore, the symptom instrument chosen must be specified and unchanged within a patient to improve efficacy in clinical practice. RELEVANCE TO CLINICAL PRACTICE: The Edmonton Symptom Assessment System-revised or the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative can be used for initial assessments of patients, but should not be compared or used interchangeably. It is vitally important to have individual follow-up for all patients who score an instrument.

Implementação da metodologia de cuidados Humanitude

Objectives: To implement Humanitude Care Metodology in the context the teaching and care practice. Relevance and impact of the project Training nursing students in Clinical Practice to develop skills of relationship and communication through the appropriation of Humanitude Care Methodology; Implementation and dissemination of Humanitude Care Methodology in care units; Creating a reference framework for humanized care, evaluation of its effectiveness and accreditation. Productivity/Main Achievements Organization of International Conferences and workshop Education course in Humanitude lectured to the ESEnfC teachers 7 oral scientific presentations in international health congresses with abstracts published on indexed journals 5 book publications

Rigour versus Relevance Revisited : Evidence from IS Conference Reviewing Practice

A commonly held belief in the IS discipline is that rigour and relevance are contrary to each other and that addressing both is virtually impossible. It is also believed widely that the editorial practices of our premier conferences and journals over-emphasise rigour on the cost of relevance. However, while these two topics have been filled with numerous subjective discussions, more solid evidence into the true relationship between rigour and relevance and the impact of conference editors on this relationship is still outstanding. This paper contributes to this debate by deriving empirical evidence from a comprehensive and detailed analysis of the characteristics of the submissions and the reviewing practices of three recent IS conferences. It provides first insights into the actual relationship between rigour and relevance and into the role conference chairs play in balancing rigour and relevance. Besides the outcomes that the current set of evaluation criteria does not provide a straight forward proxy for relevance to practitioners, the paper offers two main contributions. First, empirical insights are provided that rigour and relevance do in fact not have to be mutually exclusive. Second, the editorial practices at conferences are skewed towards rigorous papers rather than relevant papers.

But what makes it doctoral? Taking on the traditionalists : interdisciplinary, practice-led doctoral research in the creative industries - a case study in academic politics, research, rigour and relevance

This paper examines a Doctoral journey of interdisciplinary exploration, explication, examination...and exasperation. In choosing to pursue a practice-led doctorate I had determined from the outset that ‘writing 100,000 words that only two people ever read’, was not something which interested me. Hence, the oft-asked question of ‘what kind of doctorate’ I was engaged in, consistently elicited the response, “a useful one”. In order to satisfy my own imperatives of authenticity and usefulness, my doctoral research had to clearly demonstrate relevance to; productively inform; engage with; and add value to: wider professional field(s) of practice; students in the university courses I teach; and the broader community - not just the academic community. Consequently, over the course of my research, the question, ‘But what makes it Doctoral?’ consistently resounded and resonated. Answering that question, to satisfy not only the traditionalists asking it but, perhaps surprisingly, some academic innovators - and more particularly, myself as researcher - revealed academic/political inconsistencies and issues which challenged both the fundamental assumptions and actuality of practice-led research. This paper examines some of those inconsistencies, issues and challenges and provides at least one possible answer to the question: ‘But what makes it Doctoral?’

Collaborative practice:a strategy to improve the relevance of health services research.

Health services research has emerged as a tool for decision makers to make services more effective and efficient. While its value as a basis for decision making is well established, the incorporation of such evidence into decision making remains inconsistent. To this end, strengthening collaborative relationships between researchers and healthcare decision makers has been identified as a significant strategy for putting research evidence into practice.

Review of Marine Spatial Planning Best Practice of Relevance to Ireland

Making room for new marine uses and safeguarding more traditional uses, without degrading the marine environment, will require the adoption of new integrated management strategies. Current management frameworks do not facilitate the integrated management of all marine activities occurring in one area. To address this issue, the government developed Harnessing Our Ocean Wealth – An Integrated Marine Plan (IMP) for Ireland. Harnessing Our Ocean
Wealth presents a ‘roadmap’ for adopting an integrated approach to marine governance and for achieving the Government’s ambitious targets for the maritime sector, including: exceeding €6.4 billion turnover annually by 2020, and doubling its contribution to GDP to 2.4% by 2030. As part of this roadmap, Harnessing Our Ocean Wealth endorses the development of an appropriate Marine Spatial Planning (MSP) Framework. One way to develop an MSP Framework is to learn from early adapters. Critical assessments of key
elements of MSP as implemented in early initiatives can serve to inform the development of an appropriate framework. The aim of this project is to contribute to the development of this framework by reporting on
MSP best practice relevant to Ireland. Case study selection and evaluation criteria are outlined in the next section. This is followed by a presentation of case study findings. The final section of the report focuses on outlining how the lessons could be transferred to the Irish context.