A process to gain access for research in the clinical setting.

Researchers and clinical nurses need to collaborate to develop the clinical setting. Negotiating access to do research in the clinical setting can be challenging. The task of gaining access is often omitted and scarcely described in the literature. The aim of this article is to describe a process to gain access based on the authors' individual and collective experience through reflective conversations. The process consists of four key components: researcher, review board, gatekeepers and participants. Each component is linked and a crucial step to gain access to the clinical setting and ultimately to the participants. The gaining access process may prepare novice researchers for the specific considerations, time and effort required to initiate research in the clinical setting.

Patients' experiences of triage in an emergency department: A phenomenographic study.

BACKGROUND: Triage, predominantly done by nurses in the emergency department, is globally accepted as essential to prioritise the acuity of patient care. Patients with low acuity illness often express frustration and disgruntlement with the triage process and long waiting times. Consequently, some patients leave the emergency department unseen, which may negatively affect their health outcomes. In order to change practice efficiently, triage nurses should provide patients an opportunity to share their experiences. OBJECTIVE: This paper deals with exploring the understanding patients' emergency department triage experiences. DESIGN: A phenomenographic approach was used to explore and understand patients' triage-related experiences in an emergency department. METHODS AND CONTEXT: Semi-structured individual interviews were conducted with 10 purposively selected participants who were triaged as yellow or green in an emergency department in a public hospital in Botswana. Collaborative creative hermeneutic data analysis by 11 nurses working in the same context identified categories of description. RESULTS: Three categories of description emerged from patient experiences, namely triage environment, triage nurse and waiting times. Following data analysis, the nurses reflected that they were not aware of the consequences in the way triage was currently conducted. Consensus was reached that they should move away from focusing on a biomedical model towards person-centred triage, which then underpinned the outcome space for triage in the emergency department. CONCLUSION: The reality in the emergency department is that patients' needs, wishes and expectations are neglected, leaving them dissatisfied and disgruntled. Moving towards person- centred triage may improve their overall experience of triage. What is already known about this topic?

Twelve tips for supervisors to move towards person-centered research supervision in health care sciences.

The research supervisory role is becoming increasingly complex due to issues such as diversity of students; mismatched expectations between the student, supervisor and higher education institution and shorter and specific time-bound research outcomes. The current postgraduate research supervision culture and supervision practices should change. Moving towards person-centered research supervision practices may enhance the research environment, as healthful relationships between supervisors and postgraduate students may lead to increased postgraduate research outcomes. Using a World Café, we critically reflected on our existing research supervision practices. All healthcare educators involved in postgraduate research supervision were purposively selected to participate. During the café, we explored and shared ideas in a safe space. Twelve tips emerged, which can be implemented to move existing supervision practices towards person-centered research supervision practices. We present these twelve tips from the perspective of the four constructs of person-centeredness as outlined by McCormack and McCance - pre-requisites, environment, process, and outcomes. The use of these tips may enable both supervisors and students to flourish. Avoiding routine, ritual supervision practices and embracing person-centredness, will enable supervisors to form healthful relationships and put the postgraduate student at the heart of our supervision practices.

Promoting a person-centred workplace culture in a public nursing education institution in South Africa by fostering effective teamwork amongst nurse educators.

BACKGROUND: Promoting a person-centred workplace culture in organisations is one of the most challenging tasks for both employers and employees. Person-centred workplace cultures and effective teamwork have been linked to achieving optimal organisational outcomes. AIM: We report nurse educators' perceptions of the elements required for effective teamwork to promote a person-centred workplace culture in a public nursing education institution in South Africa. METHODS: A consensus meeting with 32 participants, purposively selected from a population of nurse educators and nursing managers. Data were collected during the consensus meeting, which was facilitated by two external nursing education experts. Data were analysed thematically. RESULTS: Three main themes emerged during the consensus meeting in relation to effective teamwork. The first theme was positive work relations, with categories of: knowing self and others, respecting self and others and trusting self and others. The second theme that emerged was effective communication with categories of: sharing information, cultural sensitivity and diversity. The third theme was group cohesion with categories of: active participation, adherence to work plan, collective vision of goals and collective decision making. CONCLUSION: Positive work relations open the door towards effective teamwork. Effective communication ensures the smooth dissemination of information and feedback to facilitate effective teamwork and in turn promote a person-centred workplace culture.

Challenges nurse educators experience with development of student nurses' clinical reasoning skills.

Traditional teacher-centred teaching strategies do not always facilitate the development of desired clinical reasoning skills required for nursing practice. A multiphase study was conducted to facilitate a process of change towards improving educational practices in order to promote the development of undergraduate student nurses' clinical reasoning skills. The study was conducted at a military nursing education institution. This paper reflects on Phase 1, where a descriptive, qualitative study was conducted to explore the challenges nurse educators experienced in utilizing teaching and learning strategies that could promote the development of clinical reasoning skills in undergraduate student nurses. Unstructured interviews were conducted with 16 nurse educators who were selected purposively. Interviews were recorded, transcribed and data were analysed for content. The findings indicate that the clinical learning environment, the military environment, and various role players in the environment are instrumental in nurse educators not utilizing educational practices that promote the development of clinical reasoning skills in undergraduate student nurses. Addressing nurse educator challenges and empowering them with the means, opportunity and skills to utilize student-centred teaching and learning strategies may contribute to the development of undergraduate student nurses' clinical reasoning skills. Raising awareness of challenges nurse educators experience in implementing student-centred facilitation of learning can assist in developing strategies to ensure nurse educators become more student-centred in their teaching.

Critical Care Nurses' Reasons for Poor Attendance at a Continuous Professional Development Program.

BACKGROUND: Society demands competent and safe health care, which obligates professionals to deliver quality patient care using current knowledge and skills. Participation in continuous professional development programs is a way to ensure quality nursing care. Despite the importance of continuous professional development, however, critical care nurse practitioners' attendance rates at these programs is low. OBJECTIVE: To explore critical care nurses' reasons for their unsatisfactory attendance at a continuous professional development program. METHODS: A nominal group technique was used as a consensus method to involve the critical care nurses and provide them the opportunity to reflect on their experiences and challenges related to the current continuous professional development program for the critical care units. Participants were 14 critical care nurses from 3 critical care units in 1 private hospital. RESULTS: The consensus was that the central theme relating to the unsatisfactory attendance at the continuous professional development program was attitude. In order of importance, the 4 contributing priorities influencing attitude were communication, continuous professional development, time constraints, and financial implications. CONCLUSION: Attitude relating to attending a continuous professional development program can be changed if critical care nurses are aware of the program's importance and are involved in the planning and implementation of a program that focuses on the nurses' individual learning needs.

The support needs of high-risk antenatal patients in prolonged hospitalisation.

OBJECTIVE: to identify and describe the support needs of high-risk antenatal patients hospitalised for more than five days. DESIGN: a qualitative, explorative and descriptive design. In-depth interviews were conducted with pregnant women during their stay in hospital until data saturation was reached. SETTING: an antenatal unit in a private hospital in Gauteng Province, South Africa. PARTICIPANTS: 11 antepartum women who had been hospitalised for five days or more and were of any gestation period. FINDINGS: three main themes emerged: (a) a need for social support; (b) improvement of the environment; and (c) assistance with emotional adaptation and acceptance of prolonged hospitalisation. KEY CONCLUSION: prolonged hospitalisation of high-risk antenatal patients disrupts the usual adaptation to pregnancy. These patients develop specific needs during hospitalisation. Findings suggest that the length of hospitalisation influences the specific support needs of antenatal patients. IMPLICATIONS FOR PRACTICE: this study identified a link between social and environmental support, emotional adaptation, acceptance of hospitalisation of high-risk antenatal patients and improvement of their health status. Through reflection on these themes, recommendations can be made and strategies implemented to meet the support needs of high-risk antenatal patients.