Development and validation of a novel approach to work sampling : a study of nurse practitioner work patterns

Objectives: This methodological paper reports on the development and validation of a work sampling instrument and data collection processes to conduct a national study of nurse practitioners’ work patterns. ---------- Design: Published work sampling instruments provided the basis for development and validation of a tool for use in a national study of nurse practitioner work activities across diverse contextual and clinical service models. Steps taken in the approach included design of a nurse practitioner-specific data collection tool and development of an innovative web-based program to train and establish inter rater reliability of a team of data collectors who were geographically dispersed across metropolitan, rural and remote health care settings. ---------- Setting: The study is part of a large funded study into nurse practitioner service. The Australian Nurse Practitioner Study is a national study phased over three years and was designed to provide essential information for Australian health service planners, regulators and consumer groups on the profile, process and outcome of nurse practitioner service. ---------- Results: The outcome if this phase of the study is empirically tested instruments, process and training materials for use in an international context by investigators interested in conducting a national study of nurse practitioner work practices. ---------- Conclusion: Development and preparation of a new approach to describing nurse practitioner practices using work sampling methods provides the groundwork for international collaboration in evaluation of nurse practitioner service.

An action research approach for the professional development of Vietnamese nurse educators

Nurse education in Viet Nam is undergoing substantial reform. In order to facilitate the change, in 2007 the Viet Nam Nurses Association formed a collaborative partnership with the School of Nursing and Midwifery at an Australia university. This collaboration gave rise to the Viet Nam Nursing Capacity Building Project under the leadership of Professor Genevieve Gray, funded by the Atlantic Philanthropies. The new four year competency based nursing curriculum frame is expected to be implemented in September 2011 following approval by the Viet Nam Ministry of Education. The focus of this paper is the Teaching Fellowships Program, an initiative of the Viet Nam Nursing Capacity Building Project, developed to help meet the challenges associated with leading and dealing with the curriculum change. The paper explores the development of the program and justifies an action research approach, illuminates key issues, and briefly refers to changes to the next fellowship program.

Development and interrater reliability testing of a telephone interview training programme for Australian nurse interviewers

Summary Background The final phase of a three phase study analysing the implementation and impact of the nurse practitioner role in Australia (the Australian Nurse Practitioner Project or AUSPRAC) was undertaken in 2009, requiring nurse telephone interviewers to gather information about health outcomes directly from patients and their treating nurse practitioners. A team of several registered nurses was recruited and trained as telephone interviewers. The aim of this paper is to report on development and evaluation of the training process for telephone interviewers. Methods The training process involved planning the content and methods to be used in the training session; delivering the session; testing skills and understanding of interviewers post-training; collecting and analysing data to determine the degree to which the training process was successful in meeting objectives and post-training follow-up. All aspects of the training process were informed by established educational principles. Results Interrater reliability between interviewers was high for well-validated sections of the survey instrument resulting in 100% agreement between interviewers. Other sections with unvalidated questions showed lower agreement (between 75% and 90%). Overall the agreement between interviewers was 92%. Each interviewer was also measured against a specifically developed master script or gold standard and for this each interviewer achieved a percentage of correct answers of 94.7% or better. This equated to a Kappa value of 0.92 or better. Conclusion The telephone interviewer training process was very effective and achieved high interrater reliability. We argue that the high reliability was due to the use of well validated instruments and the carefully planned programme based on established educational principles. There is limited published literature on how to successfully operationalise educational principles and tailor them for specific research studies; this report addresses this knowledge gap.

Development of clinical competencies for emergency nurse practitioners : a pilot study

Background: Nurse practitioner education and practice has been guided by generic competency standards in Australia since 2006. Development of specialist competencies has been less structured and there are no formal standards to guide education and continuing professional development for specialty fields. There is limited international research and no Australian research into development of specialist nurse practitioner competencies. This pilot study aimed to test data collection methods, tools and processes in preparation for a larger national study to investigate specialist competency standards for emergency nurse practitioners. Research into specialist emergency nurse practitioner competencies has not been conducted in Australia. Methods: Mixed methods research was conducted with a sample of experienced emergency nurse practitioners. Deductive analysis of data from a focus group workshop informed development of a draft specialty competency framework. The framework was subsequently subjected to systematic scrutiny for consensus validation through a two round Delphi Study. Results: The Delphi study first round had a 100% response rate; the second round 75% response rate. The scoring for all items in both rounds was above the 80% cut off mark with the lowest mean score being 4.1 (82%) from the first round. Conclusion: The authors collaborated with emergency nurse practitioners to produce preliminary data on the formation of specialty competencies as a first step in developing an Australian framework.

Investigating the impact of a leadership development program for nurse unit managers on the satisfaction of nursing staff

Background and significance: Nurses' job dissatisfaction is associated with negative nursing and patient outcomes. One of the most powerful reasons for nurses to stay in an organisation is satisfaction with leadership. However, nurses are frequently promoted to leadership positions without appropriate preparation for the role. Although a number of leadership programs have been described, none have been tested for effectiveness, using a randomised control trial methodology. Aims: The aims of this research were to develop an evidence based leadership program and to test its effectiveness on nurse unit managers' (NUMs') and nursing staff's (NS's) job satisfaction, and on the leader behaviour scores of nurse unit managers. Methods: First, the study used a comprehensive literature review to examine the evidence on job satisfaction, leadership and front-line manager competencies. From this evidence a summary of leadership practices was developed to construct a two component leadership model. The components of this model were then combined with the evidence distilled from previous leadership development programs to develop a Leadership Development Program (LDP). This evidence integrated the program's design, its contents, teaching strategies and learning environment. Central to the LDP were the evidence-based leadership practices associated with increasing nurses' job satisfaction. A randomised controlled trial (RCT) design was employed for this research to test the effectiveness of the LDP. A RCT is one of the most powerful tools of research and the use of this method makes this study unique, as a RCT has never been used previously to evaluate any leadership program for front-line nurse managers. Thirty-nine consenting nurse unit managers from a large tertiary hospital were randomly allocated to receive either the leadership program or only the program's written information about leadership. Demographic baseline data were collected from participants in the NUM groups and the nursing staff who reported to them. Validated questionnaires measuring job satisfaction and leader behaviours were administered at baseline, at three months after the commencement of the intervention and at six months after the commencement of the intervention, to the nurse unit managers and to the NS. Independent and paired t-tests were used to analyse continuous outcome variables and Chi Square tests were used for categorical data. Results: The study found that the nurse unit managers' overall job satisfaction score was higher at 3-months (p = 0.016) and at 6-months p = 0.027) post commencement of the intervention in the intervention group compared with the control group. Similarly, at 3-months testing, mean scores in the intervention group were higher in five of the six "positive" sub-categories of the leader behaviour scale when compared to the control group. There was a significant difference in one sub-category; effectiveness, p = 0.015. No differences were observed in leadership behaviour scores between groups by 6-months post commencement of the intervention. Over time, at three month and six month testing there were significant increases in four transformational leader behaviour scores and in one positive transactional leader behaviour scores in the intervention group. Over time at 3-month testing, there were significant increases in the three leader behaviour outcome scores, however at 6-months testing; only one of these leader behaviour outcome scores remained significantly increased. Job satisfaction scores were not significantly increased between the NS groups at three months and at six months post commencement of the intervention. However, over time within the intervention group at 6-month testing there was a significant increase in job satisfaction scores of NS. There were no significant increases in NUM leader behaviour scores in the intervention group, as rated by the nursing staff who reported to them. Over time, at 3-month testing, NS rated nurse unit managers' leader behaviour scores significantly lower in two leader behaviours and two leader behaviour outcome scores. At 6-month testing, over time, one leader behaviour score was rated significantly lower and the nontransactional leader behaviour was rated significantly higher. Discussion: The study represents the first attempt to test the effectiveness of a leadership development program (LDP) for nurse unit managers using a RCT. The program's design, contents, teaching strategies and learning environment were based on a summary of the literature. The overall improvement in role satisfaction was sustained for at least 6-months post intervention. The study's results may reflect the program's evidence-based approach to developing the LDP, which increased the nurse unit managers' confidence in their role and thereby their job satisfaction. Two other factors possibly contributed to nurse unit managers' increased job satisfaction scores. These are: the program's teaching strategies, which included the involvement of the executive nursing team of the hospital, and the fact that the LDP provided recognition of the importance of the NUM role within the hospital. Consequently, participating in the program may have led to nurse unit managers feeling valued and rewarded for their service; hence more satisfied. Leadership behaviours remaining unchanged between groups at the 6 months data collection time may relate to the LDP needing to be conducted for a longer time period. This is suggested because within the intervention group, over time, at 3 and 6 months there were significant increases in self-reported leader behaviours. The lack of significant changes in leader behaviour scores between groups may equally signify that leader behaviours require different interventions to achieve change. Nursing staff results suggest that the LDP's design needs to consider involving NS in the program's aims and progress from the outset. It is also possible that by including regular feedback from NS to the nurse unit managers during the LDP that NS's job satisfaction and their perception of nurse unit managers' leader behaviours may alter. Conclusion/Implications: This study highlights the value of providing an evidence-based leadership program to nurse unit managers to increase their job satisfaction. The evidence based leadership program increased job satisfaction but its effect on leadership behaviour was only seen over time. Further research is required to test interventions which attempt to change leader behaviours. Also further research on NS' job satisfaction is required to test the indirect effects of LDP on NS whose nurse unit managers participate in LDPs.

An exploratory study for the development of emergency nurse practitioner specialist clinical practice standards

This thesis presents a mixed methods study to develop specialty specific clinical practice standards for Emergency Nurse Practitioners. This is the first time in Australia that Nurse Practitioners standards have been developed for a clinical specialty. These standards will guide educational preparation for the role and ongoing Continuous Professional Development for endorsed Emergency Nurse Practitioners.

The assessment and development of drug calculation skills in nurse education: a critical debate

The drug calculation skill of nurses continues to be a national concern. The continued concern has led to the introduction of mandatory drug calculation skills tests which students must pass in order to go on to the nursing register. However, there is little evidence to demonstrate that nurses are poor at solving drug calculation in practice. This paper argues that nurse educationalists have inadvertently created a problem that arguably does not exist in practice through use of invalid written drug assessment tests and have introduced their own pedagogical practice of solving written drug calculations. This paper will draw on literature across mathematics, philosophy, psychology and nurse education to demonstrate why written drug assessments are invalid, why learning must take place predominantly in the clinical area and why the key focus on numeracy and formal mathematical skills as essential knowledge for nurses is potentially unnecessary.

Learning, development, and support needs of community palliative care clinical nurse specialists

Background: The palliative care clinical nurse specialist (PC-CNS) is a core member of the specialist palliative care team. According to professional policy, the role has four specific components: clinical practice, education, research, and leadership and management. Little is known about how to support staff in this role. Aim: The aim of this study was to explore what learning, development, and support PC-CNSs in one hospice need to enable them to fulfil all components of their role. Design: Using a descriptive exploratory approach, semi-structured interviews were undertaken with a purposive sample of community PC-CNSs from a hospice in Northern Ireland. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Findings: Seventeen interviews were analysed and three themes identified: influence of organisational culture, influence of the individual, and learning and development solutions. Conclusions: Participants reported that the PC-CNS role was stressful. They identified that the organisational culture and indeed individuals themselves influenced the learning and development support available to help them fulfil the four components of the role. Working relationships and stability within teams affected how supported individuals felt and had implications for managers in meeting the needs of staff while balancing the needs of the service.

A children's nurse's role in the global development of a child with diabetes mellitus.

The nursing care of a six year old with type 1 diabetes reveals the importance of accurate control of the condition for normal physical, emotional and cognitive development. Clearly the children's nurse can educate and support the child, parents and extended family towards achieving independence and self-care. Theoretical knowledge of normal child maturation can guide nurses to constantly adapt their modes of communication and nursing skills, so as to promote every aspect and stage of the child's growth. Prevalence of type 1 diabetes is increasing, and nurses should use their close professional involvement with patients to assist research at every opportunity.

Establishing a nurse practitioner collaborative: evolution, development, and outcomes

The first Australian palliative care nurse practitioner (NP) was endorsed in 2003. In 2009 the Victoria Department of Health funded the development of the Victorian Palliative Care Nurse Practitioner Collaborative (VPCNPC). Its aim was to promote the NP role, develop resources, and provide education and mentorship to NPs, nurse practitioner candidates (NPCs), and health service managers. Four key objectives were developed: identify the demographic profile of palliative care NPCs in Victoria; develop an education curriculum and practical resources to support the training and education of palliative care NPCs and NPs; provide mentorship to NPs, NPCs, and service managers; and ensure effective communication with all key stakeholders. An NPC survey was also conducted to explore NPC demographics, models of care, the hours of study required for the role, the mentoring process, and education needs. This paper reports on the establishment of the VPCNPC, the steps taken to achieve its objectives, and the results of the survey. The NP role in palliative care in Australia continues to evolve, and the VPCNPC provides a structure and resources to clearly articulate the benefits of the role to nursing and clinical services. The advanced clinical practice role of the nurse practitioner (NP) has been well established in North America for several decades and across a range of specialties (Ryan-Woolley et al, 2007; Poghosyan et al, 2012). The NP role in Australia and the UK is a relatively new initiative that commenced in the early 2000s (Gardner et al, 2009). There are over 1000 NPs across all states and territories of Australia, of whom approximately 130 work in the state of Victoria (Victorian Government Health Information, 2012). Australian NPs work across a range of specialties, including palliative, emergency, older person, renal, cardiac, respiratory, and mental health care. There has been increasing focus nationally and internationally on developing academic programmes specifically for nurses working toward NP status (Gardner et al, 2006). There has been less emphasis on identifying the comprehensive clinical support requirements for NPs and NP candidates (NPCs) to ensure they meet all registration requirements to achieve and/or maintain endorsement, or on articulating the ongoing requirements for NPs once endorsed. Historically in Australia there has been a lack of clarity and limited published evidence on the benefits of the NP role for patients, carers, and health services (Quaglietti et al, 2004; Gardner and Gardner, 2005; Bookbinder et al, 2011; Dyar et al, 2012). An NP is considered to be at the apex of clinical nursing practice. The NP role typically entails comprehensively assessing and managing patients, prescribing medicines, making direct referrals to other specialists and services, and ordering diagnostic investigations (Australian Nursing and Midwifery Council, 2009). All NPs in Australia are required to meet the following generic criteria: be a registered nurse, have completed a Nursing and Midwifery Board of Australia approved postgraduate university Master's (nurse practitioner) degree programme, and be able to demonstrate a minimum of 3 years' experience in an advanced practice role (Nursing and Midwifery Board of Australia, 2011). An NPC in Victoria is a registered nurse employed by a service or organisation to work toward meeting the academic and clinical requirements for national endorsement as an NP. During the period of candidacy, which is of variable duration, NPCs consolidate their competence to work at the advanced practice level of an NP. The candidacy period is a process of learning the new role while engaging with mentors (medical and nursing) and accessing other learning opportunities both within and outside one's organisation to meet the educational requirements. Integral to the NP role is the development of a model of care that is responsive to identified service delivery gaps that can be addressed by the skills, knowledge, and expertise of an NP. These are unique to each individual service. The practice of an Australian NP is guided by national standards (Nursing and Midwifery Board of Australia 2014). It is defined by four overarching standards: clinical, education, research, and leadership. Following the initial endorsement of four Victorian palliative care NPs in 2005, there was a lull in recruitment. The Victoria Department of Health (DH) recognised the potential benefits of NPs for health services, and in 2008 it provided funding for Victorian public health services to scope palliative care NP models of care that could enhance service delivery and patient outcomes. The scoping strategy was effective and led to the appointment of 16 palliative care nurses to NPC positions over the ensuing 3 years. The NPCs work across a broad range of care settings, including inpatient, community, and outpatient in metropolitan, regional, and rural areas of Victoria. At the same time, the DH also funded the Centre for Palliative Care to establish the Victorian Palliative Care Nurse Practitioner Collaborative (VPCNPC) to support the NPs and NPCs. The Centre is a state-wide service that is part of St Vincent's Hospital Melbourne and a collaborative Centre of the University of Melbourne. Its primary function is to provide training and conduct research in palliative care. The purpose of the VPCNPC was to provide support and mentorship and develop resources targeted at palliative care NPs, NPCs, and health service managers. Membership of the VPCNPC is open to all NPs, NPCs, health service managers, and nurses interested in the NP role. The aim of this paper is to describe the development of the VPCNPC, its actions, and the outcomes of these actions.

An exploration of the impact of a mandatory quality assurance program on the staff nurse's commitment to professional development /

This study explored experiences in relation to the impact of the College of Nurses of Ontario's (CNO's) mandatory Quality Assurance (QA) program on registered nurses (RNs) working in a clinical setting of an acute care hospital. A qualitative descriptive research design was used and data collection was done in 2 stages. First, a survey with open-ended questions was given to 45 nurses. Second, 8 respondents from the survey were interviewed using a semistructured format. Data were obtained from 2 groups-diploma-prepared and post diploma-prepared RNs. Findings demonstrated that the CNO's QA program had varying influences on the RNs' learning paths, and these differences appeared to be related to the educational background of the individual. The diploma-prepared nurses reported that their commitment to professional development was influenced by their level of internal motivation, the pressures associated with time, and the need for a strong external motivator, namely the obligation of management to conduct formal performance appraisals. They further reported that the QA program played a part in positively altering their commitment to continuing education. The post-diploma baccalaureate nurses reported that the QA program played a positive role in influencing their ongoing learning, along with their level of internal motivation, the work and health care environment, and the element of professionalism. Several implications for nursing practice, theory, and fiirther research also became evident.

Development and psychometric testing of the clinical learning environment, supervision and nurse teacher evaluation scale (CLES+T): The Spanish version

Background: The Clinical Learning Environment, Supervision and Nurse Teacher scale is a reliable and valid instrument to evaluate the quality of the clinical learning process in international nursing education contexts. Objectives: This paper reports the development and psychometric testing of the Spanish version of the Clinical Learning Environment, Supervision and Nurse Teacher scale. Design: Cross-sectional validation study of the scale. Setting: 10 public and private hospitals in the Alicante area, and the Faculty of Health Sciences (University of Alicante, Spain). Participants: 370 student nurses on clinical placement (January 2011–March 2012). Methods: The Clinical Learning Environment, Supervision and Nurse Teacher scale was translated using the modified direct translation method. Statistical analyses were performed using PASW Statistics 18 and AMOS 18.0.0 software. A multivariate analysis was conducted in order to assess construct validity. Cronbach’s alpha coefficient was used to evaluate instrument reliability. Results: An exploratory factorial analysis identified the five dimensions from the original version, and explained 66.4% of the variance. Confirmatory factor analysis supported the factor structure of the Spanish version of the instrument. Cronbach’s alpha coefficient for the scale was .95, ranging from .80 to .97 for the subscales. Conclusion: This version of the Clinical Learning Environment, Supervision and Nurse Teacher scale instrument showed acceptable psychometric properties for use as an assessment scale in Spanish-speaking countries.