Comparison of the traditional and block mode of delivery on undergraduate nursing students' perceived levels of preparedness to use evidence-based practice: a two-group experimental study.

OBJECTIVES: To examine how delivery time impacted on undergraduate nursing students' preparedness for evidence-based practice (EBP) by comparing the traditional semester mode and block mode of delivery models. METHODS: This two-group experimental study compared the traditional semester and block modes of delivery using a self-reported questionnaire. The factor of time was the variable in relation to learning with the block mode delivery being in a compressed timeframe. RESULTS: From a purposive sample, 219 students participated in the self-reported questionnaire. There were only two significant differences were the block mode of delivery students responded less positively to the statements 'the unit of study prepared them for knowledge and skills for EBP' and 'EBP should be discussed and shared in practice'. CONCLUSIONS: The transition from the traditional semester mode to the block mode delivery has had minimal impact on undergraduate nursing students' perceptions of EBP and its application to clinical practice.

Activity-based funding for safety and quality: A policy discussion of issues and directions for nursing-focused health services outcomes research.

AIMS: A discussion of the implications and opportunities arising from the Commonwealth of Australia health care reform agenda; linking pricing with quality, with particular reference to directions for nursing-focused health services outcomes research directed to improve the safety and quality of health care practices. BACKGROUND: National activity-based funding in Australia is a policy-focused development. As the relationship between cost and quality becomes apparent, the role of clinicians and their contribution to high quality care has become a pressing issue for leadership, teaching, and research. DESIGN: Discussion paper DATA SOURCES: This paper is based on seven years' experience as a member of a Commonwealth of Australia statutory committee-the Clinical Advisory Committee of the Independent Hospital Pricing Authority-and is supported by relevant literature and theory. IMPLICATIONS FOR NURSING: To date, unravelling the linkage, especially causal relationships, between direct care nursing and patient safety outcomes has not been well established. New activity-based funding data elements developed for national implementation in Australia provide accessible and meaningful standardised data for measurement of never events, hospital-acquired complications, and preventable readmissions.

Building workforce capacity for complex care coordination: a function analysis of workflow activity.

BACKGROUND: The care coordination workforce includes a range of clinicians who manage care for patients with multiple chronic conditions both within and outside a hospital, in the community, or in a patient's home. These patients require a multi-skilled approach to support complex care and social support needs as they are typically high users of health, community, and social services. In Australia, workforce structures have not kept pace with this new and emerging workforce. The aim of the study was to develop, map, and analyse workforce functions of a care coordination team. METHODS: Workflow modelling informed the development of an activity log that was used to collect workflow data in 2013 from care coordinators located within the care coordination service offered by a Local Health Network in Australia. The activity log comprised a detailed classification of care coordination functions based on two major categories - direct and indirect care. Direct care functions were grouped into eight domains. A descriptive quantitative investigation design was used for data analysis. The data was analysed using univariate descriptive statistics with results presented in tables and a figure. RESULTS: Care coordinators spent more time (70.9%) on direct care than indirect care (29.1%). Domains of direct care that occupied the most time relative to the 38 direct care functions were 'Assessment' (14.1%), 'Documentation' (13.9%), 'Travel time' (6.3%), and 'Accepting/discussing referral' (5.7%). 'Administration' formed a large component of indirect care functions (14.8%), followed by 'Travel' (12.4%). Sub-analyses of direct care by domains revealed that a group of designated 'core care coordination functions' contributed to 40.6% of direct care functions. CONCLUSIONS: The modelling of care coordination functions and the descriptions of workflow activity support local development of care coordination capacity and workforce capability through extensive practice redesigns.

Nursing-sensitive indicators: a concept analysis.

AIM: To report a concept analysis of nursing-sensitive indicators within the applied context of the acute care setting. BACKGROUND: The concept of 'nursing sensitive indicators' is valuable to elaborate nursing care performance. The conceptual foundation, theoretical role, meaning, use and interpretation of the concept tend to differ. The elusiveness of the concept and the ambiguity of its attributes may have hindered research efforts to advance its application in practice. DESIGN: Concept analysis. DATA SOURCES: Using 'clinical indicators' or 'quality of nursing care' as subject headings and incorporating keyword combinations of 'acute care' and 'nurs*', CINAHL and MEDLINE with full text in EBSCOhost databases were searched for English language journal articles published between 2000-2012. Only primary research articles were selected. METHODS: A hybrid approach was undertaken, incorporating traditional strategies as per Walker and Avant and a conceptual matrix based on Holzemer's Outcomes Model for Health Care Research. RESULTS: The analysis revealed two main attributes of nursing-sensitive indicators. Structural attributes related to health service operation included: hours of nursing care per patient day, nurse staffing. Outcome attributes related to patient care included: the prevalence of pressure ulcer, falls and falls with injury, nosocomial selective infection and patient/family satisfaction with nursing care. CONCLUSION: This concept analysis may be used as a basis to advance understandings of the theoretical structures that underpin both research and practical application of quality dimensions of nursing care performance.

Status of costing hospital nursing work within Australian casemix activity-based funding policy.

Australia has a long history of patient level costing initiated when casemix funding was implemented in several states in the early 1990s. Australia includes, to some extent, hospital payment based on nursing intensity adopted within casemix funding policy and the Diagnostic Related Group system. Costing of hospital nursing services in Australia has not changed significantly in the last few decades despite widespread introduction of casemix funding policy at the state level. Recent Commonwealth of Australia National Health Reform presents change to the management of the delivery of health care including health-care costing. There is agreement for all Australian jurisdictions to progress to casemix-based activity funding. Within this context, nurse costing infrastructure presents contemporary issues and challenges. An assessment is made of the progress of costing nursing services within casemix funding models in Australian hospitals. Valid and reliable Australian-refined nursing service weights might overcome present cost deficiencies and limitations.

Nurse staff allocation by nurse patient ratio vs. a computerized nurse dependency management system: a comparative cost analysis of Australian and New Zealand hospitals.

Coding, costing, and accounting for nursing care requirements in Australian public and private hospitals lacks systematic research. Nurse costing for two nurse staffing allocation methods--nurse patient ratios and a computerized nurse dependency management system--were compared. Retrospective nursing workload management data were obtained from hospital information systems in 21 acute care public and private hospitals in Australia and New Zealand. Descriptive statistics, cost analysis, and cost modeling were conducted for 103,269 shifts of nursing care. The comparison of costs for nursing staff by nurse-patient ratios and by a computerized nurse dependency management system demonstrated differences. The provision of nursing care using the computerized nurse dependency management system was, overall, lower in cost than for nurse-patient ratios.

An evaluation of a wellness guide for older carers living in the community.

OBJECTIVE: To assess the usefulness and effectiveness of a wellness guide and to identify whether its use by a group of older "new" carers would make them healthier and knowledgeable of community resources. DESIGN AND SAMPLE: Pretest, posttest measures of physical and mental health and a questionnaire with associated focus groups. A purposive sample of 21 older carers who were "new" carers was selected for the study. MEASURES: Locus of control (LOC), Short Form 12, depression anxiety stress scale, and questionnaire. RESULTS: Participants embraced the wellness guide as an excellent resource. It changed their behavior and improved their health on LOC measures, although changes in physical and mental health were not statistically significant. CONCLUSIONS: The wellness guide assisted carers' preparedness for their role and enhanced their sense of personal control over demanding situations.

Foundations for a nursing services reference model.

The Nursing Services Reference Model (NSRM) is presented as a theoretical position and discussion paper. The aims are to describe the components of the NSRM concept, to explain why such a model needs to be developed and to explore methodological issues in the development of a NSRM. The concept is important to address as it may illuminate a most pressing problem faced by the Australian health care industry where the content and activity of nursing practice is not embedded as computer processable data in health information system structures. Digital documentation of nursing content and activity is urgently needed to enable reliable electronic processing of nursing services. However, it is necessary, prior to this, to develop a reference model that describes the range of nursing services in an unambiguous manner.

Care coordination for chronic and complex health conditions: An experienced based co-design study engaging consumer and clinician groups for service improvement.

BACKGROUND: Evidence shows that engaging consumers and clinicians in development of health services creates a more responsive, integrated service that better meets the needs of consumers and the community of practice it serves. Further, consumer and clinician participation in service development processes can boost confidence and motivation levels in organisational employees and help foster clinical accountability. OBJECTIVE: To see where consumers' care experiences could be improved by better understanding where care coordination organisational systems needed improvement. METHODS: Experienced based co-design informed an investigation of consumer and clinician experiences of a care coordination service and involved the sharing of those experiences across service employees in a series of iterative and feedback loops over eighteen months (July 2012-January 2014). Formal participants included care coordination clinicians (n = 13) and consumers. Data from formal participants were collected during September-December 2012, consisting of consumer video-recorded and clinician audio-recorded interviews. Interview transcriptions were analysed to identify service "touch points", being emotionally significant events related to key service aspects that connect or disconnect consumers and/or clinicians. RESULTS: Results revealed that consumers highly valued the transdisciplinary skill base of the care coordination workforce, though service improvements were needed for transition support, quality discharge planning and conveying better understandings of care coordination activity both internally and externally. CONCLUSION: Incorporating consumer and clinician view-points about their experiences, including the production of a DVD, facilitated conversations across the entire service about care coordination provision and provided a catalyst for design improvement that may otherwise have been difficult to achieve. Some changes to the service were made such as improved client complaints processes, new roles for the care coordination service, and enlisting clinical staff to undertake motivational interviewing training to promote greater consumer self-management capacity. In this study, the user experience was given a platform within a larger healthcare workforce capability development project.

An analysis of high-cost users at an Australian public health service organization.

High-cost users generate extremely high costs when compared with average users in the same diagnostic-related group (DRG). They represent a major financial loss for a health service organization. The research was conducted using an area health service patient database for online analytical processing to produce descriptive statistics and graphs of 'high-cost' and 'non-high-cost users'. Trends and patterns were identified across key variables derived from clinical, financial and operational categories. The main results are: 20% of costs are spent by 3% of the population; elective admission is higher in the high-cost group; tracheostomy has the most number of cases and is the most expensive DRG; LOS is mostly longer for complex cases however, high costs can be attributed to other factors. In conclusion, these findings are potentially useful to patients, medical staff, management and health service decision-makers. The limitation of this study is the exclusion of profitability.

Wireless communications in acute health-care.

Before a particular form of wireless communication is implemented within a health-care institution, consideration should be given to the system's capacity for transmitting voice, data and video information, as well as its reliability and coverage. An important associated choice concerns the best combination of user devices that will enable secure and rapid transmission of data to clinical staff at the point of care. Several technologies are available. No new technology that is likely to become available over the next five years will address the two main concerns of health service organizations: the need for non-interference with sensitive equipment; and the need for immediate communication of urgent messages. We therefore believe that health industries with a mobile workforce will gain five to eight years of useful life from cordless telephone systems and that paging or other radio-based devices will remain an important mode of communication for at least the next five years, especially where emergency communication is concerned.

Using clinical data for nursing research and management in health services.

Nurses generate large quantities of data at different operational levels in a health service organization. Administrative managerial data include the number of nursing hours per patient day and cost data related to nursing services while clinical data include the documentation of direct patient care only. In this paper, we explain standard clinical data elements in the HIS (Hospital Information System). The construction of the data is traced from patients' medical records to coding procedures within ICD (International Classification of Disease) classification and DRG (Diagnostic Related Groups) of casemix. Examples are given from Australian data and definitions, but much of the same information can be found in hospital information systems throughout the world. Practical applications that demonstrate how patient data can be used for research and management purposes in nursing are given. Finally, future directions and issues related to the use of datasets for nursing research are explored.

Implementation issues for mobile-wireless infrastructure and mobile health care computing devices for a hospital ward setting.

mWard is a project whose purpose is to enhance existing clinical and administrative decision support and to consider mobile computers, connected via wireless network, for bringing clinical information to the point of care. The mWard project allowed a limited number of users to test and evaluate a selected range of mobile-wireless infrastructure and mobile health care computing devices at the neuroscience ward at Southern Health's Monash Medical Centre, Victoria, Australia. Before the project commenced, the ward had two PC's which were used as terminals by all ward-based staff and numerous multi-disciplinary staff who visited the ward each day. The first stage of the research, outlined in this paper, evaluates a selected range of mobile-wireless infrastructure.

The "managed care" idea: implications for health service systems in Australia.

The growth of corporatism in health-care in the US, and the consequences arising from US models of health-care delivery systems provide an enormously valuable point of comparison with health systems of other developed economies, such as Australia. If lessons are to be learnt from the US, then an analysis of the structure and performance of the US health-care system provides important background for understanding and assessing contemporary policy changes to administrative and organizational designs and techniques for patient care in Australia.