Nurse-led primary health care for homeless men: a multimethods descriptive study.

AIM: To explore the primary healthcare needs and health service use of homeless men in inner Sydney. BACKGROUND: People experiencing homelessness have greater health needs than the general population and place high demands on tertiary care, which is expensive and may not be the optimum service for their needs. Accessible, approachable and affordable primary healthcare services could improve the health of homeless persons and potentially decrease costs to the healthcare system. METHODS: A multimethod design using a cross-sectional survey (n = 40) and administrative data (n = 2 707 daily summaries) collected from a nurse-led primary healthcare clinic for homeless men in Sydney. FINDINGS: Survey respondents were aged 27-76 years. Health problems reflected multimorbidity, with mental health issues present in almost all respondents. The majority had attended the clinic more than 20 times in the past year and said the services, treatments and referrals helped them avoid the emergency department. Administrative data indicated that medication administration was the most frequent service provided. Referrals to other health services doubled over the 7-year period. DISCUSSION: Multiple morbidities, particularly mental health issues, are associated with homelessness. A proactive approach by nurses including preventative services appeared to overcome barriers to health service use. CONCLUSION: This nurse-led primary healthcare clinic highlights the importance of providing services to homeless men with multiple comorbidities. Respect and trust in addition to easy access to health services appear to be important facilitators of health service use. IMPLICATIONS FOR NURSING, AND IMPLICATIONS FOR HEALTH POLICY: A greater number of primary health services that collaborate with specialist services, including nurse-led clinics, may facilitate health care for persons who are homeless, reducing the burden on acute services.

The structure of nursing: a national examination of titles and practice profiles.

AIM: To identify the practice patterns of the Australian registered nurse workforce according to position title and to map these disparate titles across all jurisdictions of the country. INTRODUCTION: Effective nursing workforce planning can contribute to improved patient care and increased effectiveness and efficiency of healthcare systems. BACKGROUND: The prevailing approach to nursing workforce planning focuses on number of nursing staff needed in relation to the number of patients. The level of expertise and skill mix of registered nurses as a variable in workforce planning is rarely considered. METHODS: A national cross-sectional electronic survey of registered nurses in Australia was conducted using the validated Advanced Practice Role Delineation tool developed from the Strong Model of Advanced Practice. The study involved a sample of 5599 registered nurses. RESULTS: Sixty-six nursing position titles nationally were mapped using cluster analysis technique and gave rise to seven clusters of equivalent Australian jurisdictional nursing position titles and practice profiles. DISCUSSION: Effective workforce policy and planning is reliant upon access to reliable evidence. This research is an international first in that it has provided comprehensive knowledge of the clinical level and practice profiles of a national nursing workforce. IMPLICATIONS FOR NURSING POLICY: Effective, patient-centred workforce planning must consider both the numerical and expertise mix of a nursing workforce. This research provides Australian health service and policy planners with evidence-base knowledge of the nursing workforce. Internationally, this research establishes a platform from which to develop validated tools and established processes to support replication of this research.

Policies to sustain the nursing workforce: an international perspective.

AIM: Examine metrics and policies regarding nurse workforce across four countries. BACKGROUND: International comparisons inform health policy makers. METHODS: Data from the OECD were used to compare expenditure, workforce and health in: Australia, Portugal, the United Kingdom (UK) and the United States (US). Workforce policy context was explored. RESULTS: Public spending varied from less than 50% of gross domestic product in the US to over 80% in the UK. Australia had the highest life expectancy. Portugal has fewer nurses and more physicians. The Australian national health workforce planning agency has increased the scope for co-ordinated policy intervention. Portugal risks losing nurses through migration. In the UK, the economic crisis resulted in frozen pay, reduced employment, and reduced student nurses. In the US, there has been limited scope to develop a significant national nursing workforce policy approach, with a continuation of State based regulation adding to the complexity of the policy landscape. The US is the most developed in the use of nurses in advanced practice roles. Ageing of the workforce is likely to drive projected shortages in all countries. LIMITATIONS: There are differences as well as variation in the overall impact of the global financial crisis in these countries. CONCLUSION: Future supply of nurses in all four countries is vulnerable. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Work force planning is absent or restricted in three of the countries. Scope for improved productivity through use of advanced nurse roles exists in all countries.

The UK defence anaesthesia experience with the Zambia Anaesthesia Development Programme.

For 18 months UK military anaesthetic trainees have been travelling to Zambia for a 3-month fellowship under the auspices of the Zambia Anaesthesia Development Programme. In this article we will discuss the history, current state and future intent of the fellowship in order to better inform the anaesthetic cadre and wider UK Defence Medical Services.

A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter.

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a 'now window' of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

The Delphi technique: a comparison of results obtained using two expert panels.

The Delphi technique is a useful method of obtaining group consensus. However, "consensus" is not usually defined when this technique is used. This paper describes a study in which two panels of experts (registered nurses who were nurse managers or involved in management education) were asked to identify the competencies expected of first-line nurse managers using the Delphi technique. The results from both panels are compared. Prior to the commencement of the Delphi rounds a baseline mean of 3.00 ("agree" on the Likert scale used) was set for the inclusion of items. The level at which consensus was achieved was defined as the point at which 10% or less of the 168 competencies provided to the panel moved above or below this point of inclusion. A total of 156 of the 168 competencies (93%) presented to the two panels were either retained or rejected by both.

Nursing in the 1980s and 1990s--a challenge for managers.

The 1980s have seen a significant number of pressures placed on the health care system and the nursing profession. Such pressures include an adverse economic climate, the impact of technology, the rise of consumerism, the transfer of basic nurse education into the tertiary education sector and the move to privatization in health care. These pressures require skills not previously expected of nurse administrators in order to effect a smooth transition through these times of change. Failure to manage effectively has led to staff shortages and increased industrial militancy, two symptoms present in Australia at the moment. An overview of the present climate in this country is presented for consideration of effective management practices for the future.

Context and culture--the influence on role transition for first-line nurse managers.

The role of nurse managers at all levels is the subject of much debate in Australia. It has been argued that their role is not essential and increasingly new organisational structures are being implemented which do not include nurse managers. This paper describes reasons why nurses, who are mainly female, face conflict when making the transition to the role of manager in the male dominated health care system of today. It argues that the values which nurses are able to bring to these positions are those increasingly valued by the community they serve. It is not nurses who should change, but the values held by the organisations in which they are employed if society's needs are to be well served.

Health promotion as a nursing function: perceptions held by university students of nursing.

Health care in Australia is more often perceived to be illness rather than health focused in nature. The increasing cost of health care has prompted a movement towards health promotion in the community demanding increasing involvement of health care professionals. This three year study was undertaken to determine the attitudes of students towards health promotion on entry and throughout a tertiary nursing programme. This longitudinal study was exploratory in nature and examined the attitudes of two student cohorts over the programme's three years. Entering students cited the health promotion function more frequently than did those nearing programme completion. There is a need to emphasise health promotion as a role if this is seen as desirable behaviour for comprehensively educated nurses. The perceptions of three intakes of students were examined. The function of health promotion was perceived to be important by entry students and was within the three most frequently mentioned functions.

The value of drills in developing and maintaining numeracy skills in an undergraduate nursing programme.

The purpose of this study was to determine whether mathematical drills enhanced the ability of students of nursing to calculate drug dosages accurately. First year students were drilled and then tested over the next 2 years in drug calculations. It was found that repeated drilling improved students' ability to calculate drug doses but that this skill level diminished over time, in some instances to predrill levels of accuracy. An increase in the number of correct calculations was noticed in the two semesters in which students had a clinical placement leading the authors to conclude that, contrary to previous findings, work experiences do enhance the ability to calculate medication dosages. As safety and competency are essential in those areas of nursing practice which depend on mathematical ability, educational strategies which develop and retain mathematical skills are needed.

The effects of graduate nurse education on clinical practice and career paths: a pilot study.

The recent proliferation of graduate courses in nursing has increased the need for educational administrators to evaluate the impact of such programmes on clinical practice and the career of participants. 40 registered nurses undertaking graduate studies were surveyed as a pilot for an extensive longitudinal study of their perception of the effects of study on work performance and career opportunities. Overall, positive effects were noted by respondents on their job satisfaction, self-esteem, professional thinking and career moves. Increases in professional behaviours such as mentoring, research and writing for publication were noted. Negative consequences were noted by a minority and were related to alterations to health status and increased levels of stress.

Australian nurse educators identify gaps in expert practice.

In Australia, nurses face a double-barreled challenge to their role. With the rapid adoption of new health care technologies coupled with increasing economic constraints, they find themselves "doing more with less." In this context of continuous change, it is useful to determine what expert nurse clinicians deem the most essential skills, attitudes and knowledge required for practice in complex technological environments. Separate panels of 28 educators and 43 cardiac nurse clinicians participated in a national Delphi study rating the importance to the nursing role of 107 items drawn from the international literature on expert practice and technology. Indicating the importance of each item in both the "real" and "ideal" worlds of practice, educators identified 58 items where they felt actual practice was substantially far from the ideal. For 16 of these items relating to empowerment of patients, nursing research, and technology policy, the educators rated clinical behavior below the median of the real world scale, indicating substandard performance of a role or inadequate assimilation of a concept. The implications for the definition of expert practice and for curricula development are discussed.

A shared vision--bridging the theory-practice gap.

The recruitment and retention of nurses continues to be an issue which the nursing profession must address. This paper will argue that the resolution of this problem lies in greater collaboration between the higher education and health care sectors. Collaborative strategies should focus on two major aspects. First of all, strategies to bridge the theory-practice gap are important for the retention of new graduates. Secondly, support for first-line nurse managers is needed since these managers are significant in the assimilation of new graduates into the workforce.

Disaster planning strategies for hospitals.

Considerable agreement exists on objectives for disaster planning in hospitals. However, different strategies have been proposed to achieve these objectives. Some of these strategies are considered from the view point of those hospital personnel directly involved in disaster plans.

Nursing managers--a time to change.

The health care delivery system and the nursing profession have a dynamic relationship. The increasingly complex nature of nursing is reflected in recent industrial awards which have created a clinical career structure. The introduction of a clinical pathway should enable nursing managers to focus their attention on management issues and practices, rather than clinical problems. However, two significant barriers to effective management remain: the basis of appointment of nurses to managerial positions and the lack of management education available. Both issues must be addressed by the profession.

The role of nursing unit managers in New South Wales--a Delphi survey.

This study identified the competencies expected of first-line nursing management in New South Wales hospitals. The competencies were determined from the literature and submitted to a Delphi panel of 16 expert nursing administrators and academics whose task it was to delineate those competencies which first-line nursing managers (nursing unit managers) should possess. Considerable consensus existed as only two rounds were required, with little change in opinion occurring between the two rounds. Of the 168 competencies, 12 did not reach the baseline mean of 3.000 (maximum 4.000) and were excluded. The results from both rounds are presented.

Caring nurses: the dilemma of balancing costs and quality.

This paper explores the tensions visible in the rhetoric and practice of today's health care system. This system is becoming dominated by the views of economic rationalists where decisions are based on principles more frequently associated with private enterprise. One could argue that health care should be managed as a business, however, the ethics which guide such a business must be examined closely to ensure the integrity of the caring which is implicit in much of the practice in health care. Individuals in today's society value humanistic functions more than ever before. The caring function of nursing is perhaps the most significant determinant of the quality of care received from a patient's perspective, and one to which there is little cost attached in dollar terms. While it is difficult to measure and cost the caring that nurses provide, it must be done to ensure that these qualities are maintained and enhanced. More importantly, strategies must be developed to provide cost-effective quality indicators of the caring function implicit in the nurse's role. (This is an abridged version of a paper delivered at the Nursing Economic$ International Symposium 1993 in Hobart, Tamsania.)

The role of the Advanced Casualty Management Team in St John Ambulance Australia (New South Wales District).

St John Ambulance is a household name synonymous with the teaching and provision of first aid. Recently the organisation has developed pre-hospital emergency care services through the introduction of the St John Ambulance Australia Advanced Casualty Management Team in New South Wales. The Advanced Casualty Management Team represents a move away from the practice of first aid by lay personnel and is a natural extension of the traditional work and principles of St John Ambulance. This article provides an overview of the Advanced Casualty Management Team and discusses its contribution to pre-hospital trauma care delivery.