The Development and Implementation of a Model of Nursing Clinical Practice: A Journey.

The Ottawa Hospital (TOH) is a large academic health sciences centre that employs over 4,300 nurses. TOH came into existence in 1998 with the provincially mandated merger of five academic and community hospitals. In addition to the challenges of merging competitive cultures and differing work processes, patient care was carried out at the different campuses through diverse delivery models. This proved to be problematic in the program management model adopted by the amalgamated organization.

The recovery mosaic: older women's lived experiences after a myocardial infarction.

OBJECTIVE: The purpose of this study was to examine the experience of recovery in women 65 years of age and older during initial recovery from acute myocardial infarction. DESIGN: The study was designed with Heideggerian phenomenology, purposive sampling, and unstructured interactive interviews. Data were analyzed with interpretive processes of hermeneutics. SETTING: The study was set in a Canadian metropolitan teaching hospital and in patient homes. PARTICIPANTS: Seven women who had had a first time myocardial infarction were recruited. Age ranged from 67 to 86 years (mean, 74 years). RESULTS: Analysis revealed that recovery for these women was highly contextual and consisted of life experience resembling a mosaic, in which the women described how they "created a new picture for themselves." The data were clustered into 4 substantive themes that included: life is scattered; trying to make sense of it; learning to live with it; and getting settled. CONCLUSION: The older women in this study underestimated their susceptibility to acute myocardial infarction, were avid planners and coordinators of their recovery, equated the loss of the homemaker role to job loss, used their ability to socialize as an indicator of the recovery progress, and lacked support to perform household duties, such as laundry, and those women with fewer symptoms "cheated" in relation to activity and diet. These findings may serve as a basis for the development of healthcare strategies reflective of older women's recovery.

Preceptoring a student in the final clinical placement: reflections from nurses in a Canadian Hospital.

AIM: To capture personal reflections on being a preceptor and to identify the supports and challenges to enacting the role. BACKGROUND: Prior to graduation from a nursing programme, students begin the transition in roles from student to practicing health-care professional. To ease this transition, preceptorship programmes have been implemented to foster professional socialization and help students achieve confidence in their practice during their final clinical placement (consolidation experience). Preparation for the preceptor role is dependent upon the information offered by the agency as well as by the educational institution. Nursing staff are requested for much of the calendar year to work with increasing numbers of undergraduate students at various levels, function as preceptors in the final clinical experience (consolidation) as well as be involved in the orientation of newly hired nurses. METHODS: This qualitative study used one-on-one tape recorded interviews with nurses who had previous experience as a preceptor. Thematic analysis of the transcribed data resulted in the emergence of an overall theme and categories. RESULTS: Eight nurses were interviewed from a variety of units including medical surgical as well as critical care. The overriding theme from the analysis was 'safe passage'. This safe passage was for the patient and the student and was accomplished through the process of teaching and a clear view of the preceptor role. Challenges to the role were lack of recognition by other nursing staff as well as limited support from some faculty advisors. Supports for the role were the visible presence and ongoing support by faculty advisors as well as the hospital workshop. CONCLUSION: This study highlighted the importance of support from nursing faculty as well as recognition by fellow nurses of the workload involved when being a preceptor. RELEVANCE TO CLINICAL PRACTICE: Preceptors play an important role with students prior to graduation. Both the hospital and educational institutions need to ensure that nurses are given the necessary support, recognition and resources.

The Haven: a pilot referral centre in London for cases of serious sexual assault.

OBJECTIVE: Several schemes have been reported to improve treatment of rape and to encourage reporting. The development of a comprehensive forensic and follow up service for complainants of sexual assault is described, and activities of the first year are reviewed. DESIGN: Retrospective review of case records of complainants examined in The Haven. SETTING: Department of Sexual Health in a London teaching hospital. SAMPLE: All case records, 676 complainants, from the first year of cases seen in The Haven. METHODS: Description of setting up a service in partnership between the National Health Service and the Metropolitan Police, called The Haven. Analysis of a standardised proforma used for case records. RESULTS: Mean age of complainants is 26 years (range 11-66); 6% were male. Assailant was categorised as a stranger in 52% of cases; attack involved physical violence in 50% of cases; 24% of victims had genital injuries; 39% had other physical injuries. Immediate care given at time of forensic examination included 30% of women receiving emergency contraception and 5% of clients receiving post-exposure prophylaxis against HIV. Fifty-five percent of clients returned for a sexual health screen and/or counselling. Thirty-one percent received screening for sexually transmitted infections and 12% were diagnosed with one or more infections. CONCLUSIONS: Requirements following sexual assault include forensic examination, first aid, postcoital contraception, prevention and management of sexually transmitted infections and psychosocial support. Provision of these services within a sexual health setting is feasible.