Core competencies for Registered Nurse preceptors: A mapping review of quantitative studies.

AIMS: To review the contemporary international literature on nurse preceptor competencies and map the components and their descriptors. REVIEW METHODS: A mapping review. DATA SOURCES: Articles reporting evidence-based and validated Registered Nurse (RN) preceptor competencies published between 2013 and 2022 were identified. Open access databases such as PubMed and Google Scholar and the library healthcare databases Scopus and CINAHL were searched. The authors collaborated at each review stage that included screening, article selection, tabulation, mapping and preparation of findings. RESULTS: Seven quantitative studies were included. Three were based on existing nurse preceptor competency data sets and four were purposely developed using collaborative research methods. Each study validated findings through a survey of nurse stakeholders. Three key competencies shared across all studies were 'facilitating teaching', 'being a role model' and 'evaluating student's performance'. The number of competency categories ranged from three to 10 and the accompanying item descriptors from 9 to 83. Although terminology describing data sets was inconsistent, similarity was seen across competency domains. CONCLUSION: The contemporary nursing preceptor role is considered an emerging specialist education role. The results offer a set of validated preceptor competency descriptors, applicable to practice, that provide insight into ways employers may recruit, support and retain nurse preceptors. IMPLICATIONS FOR THE PROFESSION: The mapped results provide a concise summary of nurse preceptor competency research internationally that can inform further development of RN preceptors. IMPACT: This review addresses the lack of consensus around nursing preceptor competencies for clinical supervision of undergraduate nursing students. Seven competency domains were identified describing key preceptor role capabilities. The domains Facilitator', 'Role model' and 'Evaluator' featured across the included studies: 'More than 300 competency descriptors were reported'. Our review results could better prepare RN preceptors for their important role. Employers of RN preceptors could use the results to design performance competencies that may enhance nursing preceptorship. REPORTING METHOD: This review adheres to the PRISMA-ScR EQUATOR guidelines as the recommended reporting method for mapping reviews.

Assessing implementation fidelity of an on-site pharmacist intervention within Australian residential aged care facilities: A mixed methods study.

BACKGROUND: An on-site pharmacist (OSP) intervention was implemented which sought to improve medication management within residential aged care facilities (RACFs) in the Australian Capital Territory, Australia. The objectives of this mixed methods study were to evaluate the implementation fidelity of the OSP intervention and to determine the moderating factors which influenced delivery of this intervention. METHODS: This convergent parallel mixed methods study was underpinned by Hasson's conceptual framework for implementation fidelity. Implementation fidelity for seven intervention RACFs was quantitatively assessed using three quantitative data sets: (1) range of OSP intervention activities delivered; (2) random sample of 10% of medication reviews assessed for quality; (3) proportion of residents who received at least one medication review. Semi-structured interviews (n = 14) with managers and OSPs across the intervention RACFs were conducted to identify moderating factors which may have influenced OSP intervention delivery. RESULTS: The OSP intervention was generally delivered as intended with overall medium levels of implementation fidelity. This delivery was supported by a range of facilitation strategies with most participants perceiving that the intervention was delivered to a high standard. RACF managers and OSPs were mostly well engaged and responsive. A number of potential barriers (including the part-time OSP role, COVID-19 pandemic, RACFs spread out over a large area with significant distance between resident dwellings) and facilitators (including the pharmacist support meetings, OSPs who took time to establish relationships, RACF managers who actively supported OSPs and worked with them) for OSP intervention delivery were identified which have potential implications for the roll out of OSPs within Australian RACFs. CONCLUSION: In this study, the implementation fidelity of OSP intervention delivery was assessed with overall medium levels of fidelity found across the intervention RACFs. This suggested that the OSP intervention can generally be delivered as intended in real world RACFs. OSP intervention delivery was influenced by a range of moderating factors, some of which posed barriers and others which facilitated the OSP intervention being delivered as intended.

Decision-making in nursing research and practice-Application of the Cognitive Continuum Theory: A meta-aggregative systematic review.

AIM: To explore how the Cognitive Continuum Theory has been used in qualitative nursing research and to what extent it has been integrated in the research process using the Qualitative Network for Theory Use and Methodology (QUANTUM). BACKGROUND: Theory, research and nursing are intrinsically linked, as are decision-making and nursing practice. With increasing pressure on nurses to improve patient outcomes, systematic knowledge regarding decision-making is critical and urgent. DESIGN: A meta-aggregative systematic review. METHODS: DATABASES: CINAHL, Medline, PsycINFO, Embase and PubMed were searched from inception until May 2022 for peer-reviewed research published in English. Seven studies were included and assessed for methodological quality using the Joanna Briggs Institute checklist for qualitative research. A meta-aggregative synthesis was conducted using Joanna Briggs methodology. The QUANTUM typology was used to evaluate the visibility of the Cognitive Continuum Theory in the research process. RESULTS: The review identified five synthesised findings, namely: 1. the decision-making capacity of the individual nurse, 2. nurses' level of experience, 3. availability of decision support tools, 4. the availability of resources and 5. access to senior staff and peers. Only two of seven studies rigorously applied the theory. The included studies were mainly descriptive-exploratory in nature. CONCLUSION: The transferability of the Cognitive Continuum Theory was demonstrated; however, evolution or critique was absent. A gap in the provision of a patient-centric approach to decision-making was identified. Education, support and research is needed to assist decision-making. A new Person-Centred Nursing Model of the Cognitive Continuum Theory has been proposed to guide future research in clinical decision-making. RELEVANCE TO CLINICAL PRACTICE: Nurses make numerous decisions every day that directly impact patient care, therefore development and testing of new theories, modification and revision of older theories to reflect advances in knowledge and technology in contemporary health care are essential.

Interprofessional collaboration between prescribers, managers, nursing staff and on-site pharmacists within residential aged care facilities: a mixed-methods study.

BACKGROUND: A new on-site pharmacist (OSP) intervention within residential aged care facilities (RACFs) is being investigated to help improve medication management. Interprofessional collaboration amongst prescribers, nursing staff and pharmacists is critical to improving RACF medication management. OBJECTIVE: To explore the extent of interprofessional collaboration and the nature of the working relationships between OSPs and prescribers, managers and nursing staff. METHODS: A mixed-methods study was undertaken within the context of a 12-month cluster randomised controlled trial. Semi-structured interviews were conducted with data analysed using framework analysis, and a survey based upon the Physician-Pharmacist Collaboration Index (PPCI) was distributed at two time points (T1 at 3 months and T2 at 9 months after OSP commencement) across seven intervention RACFs. RESULTS: The qualitative data (n = 33 interviews) findings related to the processes supportive of these relationships e.g. on-site proximity, OSP personality and perceived (or beneficial) benefits of OSPs working with health care team members (such as OSPs being trusted and providing reassurance to RACF health care team members). The PPCI survey mean scores at T1 (n = 33) and T2 (n = 19) suggested that OSPs were able to establish positive working relationships at 3 months and that positive relationships also existed at 9 months. The integrated findings suggested that the working relationships between OSPs and health care team members were generally positive. CONCLUSIONS: This study is the first to explore interprofessional collaboration between OSPs and health-care team members in RACFs. The findings suggest that OSPs can positively contribute to interprofessional collaborative care within RACFs.

Cultural considerations at end-of-life for people of culturally and linguistically diverse backgrounds: A critical interpretative synthesis.

PURPOSE/AIM: To establish cultural considerations for people from culturally or linguistically diverse backgrounds at the end-of-life in Australia. BACKGROUND: Globally, there is a rapidly increasing proportion of the ageing population, and high levels of migration to Australia, the Australian healthcare community must recognise individualised and cultural needs when approaching death and end-of-life care. Many people from culturally and linguistically diverse backgrounds do not traditionally practice the palliative care approaches that have been developed and practised in Australia. DESIGN: A Critical Interpretive Synthesis. METHODS: A review protocol was established using PRISMA 2020 guidelines and the literature searched using CINAHL, PubMed, Psych INFO and Medline from January 2011 to 27th February 2021. This search protocol results in 19 peer-reviewed results for inclusion in critical analysis. RESULTS: Included studies were qualitative (14), quantitative (4) and mixed methods (1). Four themes were identified from the literature: (i) communication and health literacy; (ii) access to end-of-life care services; (iii) cultural norms, traditions and rituals; and (iv) cultural competence of healthcare workers. CONCLUSIONS: Healthcare workers have an essential role in providing care to people with life-limiting illnesses. Cultural considerations during end-of-life care are imperative for the advancement of nursing practice. To achieve effective care for people of culturally and linguistically diverse backgrounds during end-of-life care, healthcare workers need to increase their education and cultural competency. There is inadequate research conducted within specific cultural groups, rural and remote Australian communities and individual cultural competence of healthcare workers. IMPLICATIONS FOR PRACTICE: Continuing advancement within nursing practice relies on health professionals adopting a person-centred and culturally appropriate approach to care. To ensure individualised person-centred care is provided in a culturally appropriate way, healthcare workers must learn to reflect on their practice and actively advocate for people with culturally and linguistically diverse backgrounds during end-of-life care.

'It enables the carers to see the person first': Qualitative evaluation of point-of-care digital management system in residential aged care.

AIMS AND OBJECTIVES: To evaluate acceptability, efficiency, and quality of a new digital care management system in a residential aged care home (RACH). BACKGROUND: Improving care quality and efficiency in RACH, while simultaneously upgrading data management, is a priority for communities and governments. DESIGN: Participatory action research with mixed methods data collection was employed to evaluate a digital care management system implemented at a 169-bed RACH. This paper reports qualitative findings of the 2-year evaluation. METHODS: Qualitative data were collected using focus groups with residents, visitors, nurses, managers, care workers, and consultants; resident/visitor and staff hallway interviews and responses to open-ended questions in online staff surveys. Data were analysed thematically under the four predetermined study objectives. Reporting adhered to COREQ guidelines. RESULTS: 325 data captures from 88 participants, over seven data sources were coded. Findings indicate that the system was acceptable to both residents and staff due to perceptions of time-saving and improved quality of care. Increased efficiency was perceived through timeliness as well as reduced time spent retrieving and documenting information. Quality of care was improved through care scheduling individualised to resident needs, with reminders to avoid missed care. Relatives were reassured and activities were scheduled to loved one's preferences. The co-design implementation process was successful through commitment to quality from leadership teams and prioritising the focus on the holistic needs of the residents. CONCLUSION: A strong emphasis on co-design with care staff in developing and implementing the digital care system contributed to a system that supported nursing and care work, facilitated reporting and documentation, and improved resident care and well-being including identification of missed care. RELEVANCE TO CLINICAL PRACTICE: Nurses, carers, administrators, and advocates can support the co-design creation of information systems that suit the workflow of an organisation and keep the focus on individualised models of care provision.

The Experiences of Clinical Academic Nurses: A Meta-Aggregation.

OBJECTIVE: Historically, clinical academic careers were only available for dental and medical professions. The title of a clinical academic nurse is recognized as a role that concurrently engages in both clinical practice and research. This systematic review aimed to synthesis qualitative evidence to understand the experiences of clinical academic nurses. DATA SOURCES: A meta-aggregation systematic review was conducted. Key search terms were used in CINAHL and MEDLINE. The review has been reported according to ENTREQ checklist. This meta-aggregation review followed the principles from Joanna Briggs Institute (JBI) and the reviewers conducted a methodological quality assessment on all included studies. Qualitative studies which explored experiences of clinical academic nurses were included. CONCLUSION: A total of 2,202 articles identified five studies met the inclusion criteria. Five synthesized findings from the included qualitative studies, related to (i) clinical academic preparation, (ii) challenges, (iii) enablers, (iv) clinical practice, and (v) role expectation of clinical academic nursing roles. The meta-aggregation has identified that although there are numerous clinical academic nursing discussion articles, commentaries, and editorials on the topic area, few empirical studies have explored the perceptions and experiences of clinical academic roles in nursing. IMPLICATIONS FOR NURSING PRACTICE: This systematic review has highlighted the variety of reported experiences of clinical academic nursing in relation to implications for practice, research, and leadership. Clinical academic roles are being developed across the nursing professions outside of medicine, and effective leadership it is important to support sustainable career pathways and curricula and to enable the evaluation of these roles. This review has made an important contribution to the literature by highlighting several issues to consider in developing and safeguarding the progress already made in clinical academic nursing career pathways.

A co-designed health information system implementation into residential aged care: A mixed-method evaluation.

INTRODUCTION: Internationally, the adoption of technology into residential aged care settings has been slow and fraught with multiple challenges for residents, staff and service providers. The aim of this study was to evaluate the acceptability, efficiency, and quality of health information system implementation into aged care. METHODS: Three-stage, mixed-methods participatory action research, concurrent with the natural experiment of a co-designed health information system implementation into a 169-bed aged care home in Australia. Data were collected pre-, during, and post implementation between 2019 and 2021. Qualitative data included focus groups, interviews, and observations. Quantitative data included work observations, pedometers, record audits, incident reports and staff and resident surveys. There were 162 participants composed of 65 aged care residents, 90 staff, and 7 managers/consultants. RESULTS: Improved work efficiency included reduced staff time searching for information (6%); reduced nurse time on documentation (20.4% to 6.4%), and 25% less steps. Documentation improvement included resident assessments (68% to 96%); resident-focused goals (56% to 88%) and evaluations (31% to 88%). The staff reported being better equipped to manage the 'delicacies of dignity'. CONCLUSION: Implementation of a health information system into a residential aged care facility was associated with improved resident-focused care and staff efficiency. CLINICAL RELEVANCE: Technology can support nurses and care staff to spend more time with residents in residential aged care homes, improve the quality of resident care, and assist meeting regulatory reporting requirements. Flexible and tailored co-design strategies can enhance both effectiveness and success of technology implementation into residential aged care.

The conscious state of the dying patient: An integrative review.

OBJECTIVES: The cognitive state of the dying in the last days of life may deteriorate, resulting in a reduced ability to communicate their care needs. Distressing symptoms, physical and existential, may go unrecognized and untreated. The objectives of this integrative review were to systematically interrogate the literature to determine the changing conscious state of dying adults and to identify changes in their care needs. METHODS: An integrative review protocol was registered with PROSPERO (CRD42020160475). The World Health Organization definition of palliative care informed the review. CINAHL, MEDLINE (OVID), Scopus, PsycINFO, Cochrane Library, and PubMed were searched from inception to October 2019 using search strategies for each database. Inclusion and exclusion criteria were applied. Methodological quality was appraised using the Joanna Briggs Institute Checklist for the Case Series appraisal tool. Extracted data were synthesized using a narrative approach. RESULTS: Of 5,136 papers identified, 11 quantitative case series studies were included. Six themes were identified: conscious state and change over time, awareness, pain, absence of holistic care, the voiceless patient, and signs and symptoms of dying. SIGNIFICANCE OF RESULTS: In the last days of life, the physical and conscious state of the dying patient declines, resulting in an inability to express their care needs. Dignity in dying and freedom from pain and suffering are both an imperative and a human right; and unvoiced care needs can result in unnecessary suffering and distress. This review revealed that little is known about how healthcare professionals assess holistic care needs at this vulnerable time. Although much has been written about palliative and end-of-life care, the assessment of care needs when patients are no longer able to voice their own needs has largely been ignored, with little attention from clinical, educational, or research perspectives. This gap in evidence has important implications for the dying and their families.

Determinants of seasonal influenza vaccination hesitancy among healthcare personnel: An integrative review.

AIMS AND OBJECTIVES: To explore the determinants of and behaviour change models for seasonal influenza vaccination compliance among healthcare personnel. BACKGROUND: COVID-19 vaccine hesitancy among healthcare personnel may be better understood by exploring determinants of seasonal influenza vaccine hesitancy. DESIGN: Integrative literature review. METHODS: A systematic search was conducted in accordance with PRISMA guidelines. Six thousand and forty-eight articles were screened. Seventy-eight met inclusion criteria. Due to the heterogeneity of included articles, a narrative synthesis was conducted utilising a conceptual matrix to identify thematic categories. RESULTS: Six thematic categories were identified as influencing HCP SIV compliance: 'perceived vulnerability', 'trust', 'past behaviour', 'professional duty', 'access and convenience' and 'knowledge and experience'. The Health Belief Model (HBM) was the most commonly utilised health behaviour change model within the seasonal influenza vaccination context. Few studies have examined seasonal influenza vaccine acceptance and uptake within the Australian HCP context, particularly involving community care and aged care. CONCLUSIONS: Factors that appear to relate to influenza vaccination compliance among HCP can be grouped according to several thematic categories, and they also appear influential in COVID-19 vaccine uptake. In particular, an emerging focus on 'trust' or the more emotive considerations of decision-making around health-protective behaviours requires further exploration in the context of a pandemic. Efforts to influence these domains to increase compliance, however, are likely to be impeded by a lack of a well-developed and tested behaviour change model. RELEVANCE TO CLINICAL PRACTICE: Healthcare personnel (HCP) face high levels of occupational exposure to seasonal influenza every year. An emerging focus on 'trust' and the more emotive considerations of decision-making around health-protective behaviours requires further exploration in the context of a pandemic.

Ten statements to support nurse leaders implement e-health tools for nursing work in hospitals: A modified Delphi study.

AIM: To use expert consensus to develop guidance for nurse leaders implementing e-health tools to support nursing work in hospitals. BACKGROUND: Nurse leaders are increasingly required to make decisions about the selection, development, implementation and optimisation of e-health tools for nursing work in hospitals. Guidance in this rapidly evolving and complex space is limited. DESIGN: A two-phase modified Delphi study. METHODS: Phase one involved in-depth interviews with five nursing informatics experts. Analysis used the qualitative framework method, informed by the Theoretical Domains Framework (TDF), to develop statements for an anonymous online Delphi scoring survey. This was distributed using snowball sampling methods to Australian nurse informatics leaders and experts. Final analysis involved synthesis of qualitative and quantitative data. The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist. RESULTS: Ten guidance statements to support nurse leaders to implement e-health tools in hospitals were developed from the synthesis of qualitative interview data and 29 experts' responses to the 55-item Delphi response survey. CONCLUSION: Implementation of e-health tools for nursing work is complex in health settings and requires careful examination of multiple factors and interactions between clinicians, tools, service users and the health organisation. This research proposes ten statements to support nurse leaders with decisions about implementing e-health tools to support nursing work in hospitals. RELEVANCE TO CLINICAL PRACTICE: The ten statements developed by this research provide a resource to assist policy and practice decisions about e-tools to ensure they are suited to supporting nursing work. Nurse leaders can use the ten statements for guidance in the selection, development, implementation and optimisation of e-health tools to ensure suitability and adaptation for nursing work in hospitals.

The experience of women following first acute coronary syndrome: An integrative literature review.

AIM: There is lack of evidence and research understanding among women's lived experiences following first acute coronary syndrome, thus their recovery process remains poorly understood. To date research has largely focused on men's experience of acute coronary syndrome while this area of health care and recovery has considerable impact on women's health and quality of life. Our aim was to review the literature exploring lived experience of women following first acute coronary syndrome. DESIGN: Integrative review of the literature. DATA SOURCE: We searched PubMed, MEDLINE, EMBASE, CINAHL and Scopus from 2008-2018 for articles published in English. REVIEW METHOD: Of 1675 publications identified, 18 qualitative, quantitative, and mixed method studies met our inclusion criteria. Quality of included studies was assessed using Joanna Briggs Institute quality assessment tools. Findings were integrated using thematic synthesis. RESULTS: Experiencing acute coronary syndrome was reported to have significant impacts on women's lives. The most common issues reported were physical limitations, fear, and uncertainties about the future, sexual dissatisfaction, and social isolation. Women also reported to have higher short- and long-term mortality rate, stroke, recurrent, and hospital readmissions compared with men. CONCLUSION: This review identified current knowledge and gaps about lived experience of women following first acute coronary syndrome. It is anticipated that the information gained from this literature review will support new research aimed at improving the care women receive following acute coronary syndrome and therefore enhance their recovery and quality of life. IMPACT: This review contributes to the current body of knowledge by addressing women's physical, psychosocial, and sexual state following acute coronary syndrome. Improvement in women's quality of life after acute coronary syndrome necessitates further research which ultimately results in better management and treatment of women and their recovery following first acute coronary syndrome.

Using the framework approach to analyse qualitative data: a worked example.

BACKGROUND: Data management and analysis are crucial stages in research, particularly qualitative research, which accumulates large volumes of data. There are various approaches that can be used to manage and analyse qualitative data, the framework approach being one example widely used in nursing research. AIMS: To consider the strengths and challenges of the framework approach and its application to practice. To help the novice researcher select an approach to thematic analysis. DISCUSSION: This paper provides an account of one novice researcher's experience of using the framework approach for thematic analysis. It begins with an explanation of the approach and why it was selected, followed by its application to practice using a worked example, and an account of the strengths and challenges of using this approach. CONCLUSION: The framework approach offers the researcher a systematic structure to manage, analyse and identify themes, enabling the development and maintenance of a transparent audit trail. It is particularly useful with large volumes of text and is suitable for use with different qualitative approaches.

Developing an infrastructure to support clinical academic careers.

Research and evidence-based practice underpins the delivery of high-quality patient care. Developing the research capacity and capability of nurses, midwives and allied health professionals requires a robust emphasis and the necessary support infrastructure to encourage and develop practitioners to follow a clinical academic career pathway. Clinical academic partnerships between higher education and healthcare institutions can offer a blend of required expertise with mutual benefits. This article reports on a recent Florence Nightingale Foundation and Council of Deans of Health Leadership Scholarship improvement project to establish an infrastructure to support the development of clinical academic roles to enhance the provision of evidence-based patient care in the North East of Scotland.

The liminal self in people with multiple sclerosis: an interpretative phenomenological exploration of being diagnosed.

AIMS AND OBJECTIVES: To explore the lived experience of the meaning of being diagnosed with multiple sclerosis on the individual's sense of self. BACKGROUND: The time leading up to and immediately following the diagnosis of multiple sclerosis has been identified as a time period shrouded by uncertainty and one where individuals have a heightened desire to seek accurate information and support. The diagnosis brings changes to the way one views the self which has consequences for biographical construction. DESIGN: A hermeneutic phenomenological study. METHODS: In-depth qualitative interviews were conducted with 10 people recently diagnosed with multiple sclerosis. The data were analysed using interpretative phenomenological analysis. FINDINGS: This study presents the three master themes: the 'road to diagnosis', 'the liminal self' and 'learning to live with multiple sclerosis'. The diagnosis of multiple sclerosis may be conceptualised as a 'threshold moment' where the individual's sense of self is disrupted from the former taken-for-granted way of being and propose a framework which articulates the transition. CONCLUSION: The findings highlight the need for healthcare professionals to develop interventions to better support people affected by a new diagnosis of multiple sclerosis. The conceptual framework which has been developed from the data and presented in this study provides a new way of understanding the impact of the diagnosis on the individual's sense of self when affected by a new diagnosis of multiple sclerosis. This framework can guide healthcare professionals in the provision of supportive care around the time of diagnosis. RELEVANCE FOR CLINICAL PRACTICE: The findings provide practitioners with a new way of understanding the impact of the diagnosis on the individual's sense of self and a framework which can guide them in the provision of supportive care around the time of diagnosis.

The experiences of support persons of people newly diagnosed with multiple sclerosis: an interpretative phenomenological study.

AIM: This study explores the experience of the diagnosis of Multiple Sclerosis for the support person and identifies the impact on their lives. BACKGROUND: At the time of diagnosis, the support person may not be readily identified in a traditional caring role; however, the diagnosis itself brings with it the possibility of changes to the roles in the relationship and possible consequences for biographical construction. DESIGN: A hermeneutic phenomenological study. METHODS: A convenience sample of nine support persons was interviewed between December 2008-March 2010. The data were analysed using interpretative phenomenological analysis. FINDINGS: The participants in this study were often not readily identifiable as 'carers'; however, the diagnosis of Multiple Sclerosis implied a shift towards a caring role at some point in the future. The uncertainty surrounding the nature and progression of the condition left this identity hanging, incomplete and as such contributed to a liminal way of being. CONCLUSIONS: This paper reveals that biographical disruption is not limited to the person diagnosed with Multiple Sclerosis but that the support person also undergoes a transition to their sense of self to that of 'anticipatory carer'. The findings provide insight into the biographical and emotional impact of Multiple Sclerosis on the support persons early in the development of the condition.

The role of the community nurse in care provision for people with multiple sclerosis.

Multiple sclerosis (MS) is a degenerative neurological condition that is often diagnosed in young adults in their 20s and 30s and is more common in women than in men. The long-term and unpredictable nature of the condition poses significant challenges for care delivery. The UK has one of the highest incidences of MS in the world, and care delivery for people with long-term conditions such as MS in the UK is changing: whereas previously it predominantly took place from a hospital setting, it now more commonly occurs in a primary care setting. In addition, patients and carers are recognised as equal partners in the planning and delivery of care. This article explores the approaches used by community nurses providing care to patients and families in a multiagency context.

Developing global citizenship online: an authentic alternative to overseas clinical placement.

BACKGROUND: This paper presents the findings of a pilot project to develop and evaluate an international nursing module delivered using a collaborative online platform between nursing programmes in Scotland, USA and Finland. The purpose of the project was to provide an authentic international nursing experience for nursing students, allowing them to explore and contrast the nursing and health care issues in an international context. METHODS: The pilot cohort ran in September 2011 with a total of 22 students with a mix of students from both undergraduate and postgraduate programmes. A mixed methods research design was used to evaluate the students' experience using an anonymous online questionnaire and the collection of testimonials from students based on their experience. RESULTS: The results demonstrated high levels of satisfaction with the learning experience. Four key themes-learning together, widening horizons, developing autonomy and learning beyond frontiers-emerged from the qualitative data. CONCLUSIONS: Developing confidence from the shared learning experience has real implications for the global mobility of the nursing workforce as it helps to prepare nurses for a career beyond their own country's borders. The pilot module has clearly demonstrated that the use of Web 2.0 technology in the forms of a wiki may effectively be employed to provide an online learning environment to allow cross institutional learning.

The use of podcasts to enhance research-teaching linkages in undergraduate nursing students.

An understanding of research is important to enable nurses to provide evidence-based care. However, undergraduate nursing students often find research a challenging subject. The purpose of this paper is to present an evaluation of the introduction of podcasts in an undergraduate research module to enhance research-teaching linkages between the theoretical content and research in practice and improve the level of student support offered in a blended learning environment. Two cohorts of students (n=228 and n=233) were given access to a series of 5 "guest speaker" podcasts made up of presentations and interviews with research experts within Edinburgh Napier. These staff would not normally have contact with students on this module, but through the podcasts were able to share their research expertise and methods with our learners. The main positive results of the podcasts suggest the increased understanding achieved by students due to the multi-modal delivery approach, a more personal student/tutor relationship leading to greater engagement, and the effective use of materials for revision and consolidation purposes. Negative effects of the podcasts centred around problems with the technology, most often difficulty in downloading and accessing the material. This paper contributes to the emerging knowledge base of podcasting in nurse education by demonstrating how podcasts can be used to enhance research-teaching linkages and raises the question of why students do not exploit the opportunities for mobile learning.