Development and reliability testing of the quality clinical placement evaluation tool.

AIMS AND OBJECTIVES: To develop and test the content and face validity, and reliability of the quality clinical placement evaluation tool. BACKGROUND: The importance of clinical experience during undergraduate nursing degrees is undisputed. To date, tools available to measure quality of clinical placements have focused on single perspectives, that of the undergraduate or that of the supervising nurse. The quality clinical placement evaluation tool was proposed to provide an assessment of clinical placement experiences informed by supervising ward nurses and undergraduate stakeholders. DESIGN: The study employed a cross-sectional design. METHODS: The internal validity of an existing instrument was evaluated by an expert panel and modified for use in the acute care sector. Surveys were completed by undergraduate students (n = 48) and supervising ward nurses (n = 47). Factor analysis was used to identify themes drawn from the literature and explore redundancy of items. Reliability was assessed using Cronbach's alpha for internal consistency and test-retest (five to seven days apart). RESULTS: Reliability testing showed good internal consistency for the tool; test-retest reliability testing results were moderate to good for students and fair to moderate for nurses. Factor analysis identified three core themes related to supervising ward nurse responses that could also be applied to undergraduate nurses. The domains identified were the following: welcome and belonging; support to meet learning needs; and confidence and competence: reflections on learning. CONCLUSIONS: The quality clinical placement evaluation has shown statistically acceptable levels of reliability and validity for measuring the quality of clinical placement from perspectives of undergraduates and supervising ward nurses. RELEVANCE TO CLINICAL PRACTICE: The tool provides tertiary institutions, acute care facilities, wards and individuals with the means to capture views of the quality of clinical placement which can also be used to undertake comparisons over time and between sites.

Investigating the feasibility of promoting and sustaining delivery of cardiac rehabilitation in a rural community.

INTRODUCTION: Members of rural communities face the dual burden of high rates of cardiovascular disease and barriers to accessing cardiac rehabilitation programs (CRPs). While rural healthcare providers recognise the need for local delivery of such programs, they are constrained by funding and resource limitations. METHODS: This research sought to explore the feasibility, acceptance and support for the delivery of a secondary prevention CRP in a rural community. Eight local participants were recruited to a pilot CRP following cardiac surgery, diagnosis of cardiovascular disease and/or identification by health practitioners as being at risk of developing cardiovascular disease. The key measures of success were the ability of the team to provide a program based on self-management principles, with a local and collaborative focus. The Health Education Impact Questionnaire (HeiQ) was used to measure the effectiveness and outcomes of the CRP. Qualitative data were also used in order to enhance understandings of the efficacy of CRPs in rural settings from the participant perspective. RESULTS: The delivery of a pilot program that engaged local healthcare providers in partnerships with local residents was successful. Local provision was clearly a positive aspect of the program. Participants described the program as supportive, holistic and convenient, providing new information in a framework that supported self-management. The program encouraged local collaboration that enabled continuation of the program. CONCLUSIONS: Local support from health professionals and participants provided strong motivation for attendance; however, the location of the program in a rural setting did not remove all travel barriers. Adhering to the principles of empowerment inherent in a self-management approach to rehabilitation meant accepting fluctuating attendance as individuals managed priorities in their lives.

More than just clowns--Clown doctor rounds and their impact for children, families and staff.

Admission to hospital is recognised as a difficult time for children and families. This study explored clown doctor activities in an acute paediatric setting and the impact their activities have on children, their families, other health professionals and clown doctors themselves. We used observation, semi-structured interviews and focus groups with children and parents and staff and clown doctors and results provide a rich description of the work of clown doctors. The major themes were 'the encounter - in the moment' of the interaction of the child and the clown doctor and 'beyond the encounter'. The findings show that the impact of clown doctor visits is experienced beyond the immediate interaction, and this has not been clearly articulated in previous studies. This study highlights the multifaceted and complex nature of the work of the clown doctors and the high level of skill required as they modify and interpret play, activities and environment based on individual need and response.