The 'radiographer-referrer game': image interpretation dynamics in rural practice.

INTRODUCTION: Effective interprofessional communication is intrinsic to safe health care. Despite the identified positive impact of collaborative radiographic interpretation between rural radiographers and referrers, communication difficulties still exist. This article describes the strategies that Australian rural radiographers use for communication of their radiographic opinion to the referring doctor. METHODS: In a two-phase interpretive doctoral study completed in 2012, data were collected from radiographers working in rural New South Wales, Western Australia and Tasmania using a paper based questionnaire followed by in-depth semistructured interviews. Data were analysed thematically in order to identify, analyse and report the emergent themes. RESULTS: The overarching theme was Patient Advocacy, where in the interest of patient care radiographers took measures to ensure that a referring doctor did not miss radiographic abnormalities. Strong interprofessional relationships enabled direct communication pathways. Interprofessional boundaries shaped by historical hierarchical relationships, together with a lack of confidence and educational preparation for radiographic interpretation result in barriers to direct communication pathways. These barriers prompted radiographers to pursue indirect communication pathways, such as side-stepping and hint and hope. CONCLUSION: A lack of formal communication pathways and educational preparation for this role has resulted in radiographers playing the radiographer-referrer game to overtly or covertly assist referrers in reaching a radiographic diagnosis. The findings from this study may be used to plan interventions for strengthening interprofessional communication pathways and improve quality of healthcare for patients.

Assessing competence in undergraduate nursing students: the Amalgamated Students Assessment in Practice model.

Assessment of competence is characterised by ambiguity and inconsistency despite its critical role in assessing readiness for entry to the nursing profession. In 2012 the Amalgamated Student Assessment in Practice (ASAP) model and tool were developed and trialled within an Australian University. Developed in response to the inadequacies of existing tools to assess competence, the ASAP model offers an integrated multilayered assessment that is designed to enable focussed diagnosis of practice deficits and implementation of targeted support. The ASAP model was evaluated by gathering clinical facilitator and student feedback over two 13-week semesters during practice and formal meetings, as well as review of student performance data. The ASAP model functioned effectively as an assessment tool, focussed diagnostic tool, removal from Professional Experience Placement (PEP) support tool and a framework for documenting evidence. Student failure rates decreased and the number of complaints and successful appeals was reduced. The ASAP model offers comprehensive focussed assessment of nursing students' performance in practice. It supports both formative and summative feedback and can be used to accurately identify specific areas of practice deficiency requiring redirection and support. It is transferable across settings and assessors.

Do you want to play? Factors influencing nurse academics' adoption of simulation in their teaching practices.

Simulation based education (SBE) in healthcare is gaining popularity. It provides an opportunity for students to acquire and practice clinical skills in a safe and controlled environment and is also a potential solution to alleviating the increasing pressure on clinical placement availability. While there is growing evidence of the value of simulation to learners there is little understanding of the factors that influence academics attitudes towards and choices about the use simulation. Through an exploratory research design using semi-structured interviews, nurse academics' opinions, experiences and attitudes regarding simulation were captured. Thematic analysis was conducted utilising a cross comparative approach. Three themes Simulation as a Separate Entity; Getting Political, and Academic Adaptation were identified. These themes were then explored through the five essential characteristics of innovation identified in the persuasion phase of Roger's Diffusion of Innovation Model (1995). The findings indicated that in order to successfully integrate simulation into a university curriculum, the factors influencing nurse academics' attitudes and choices around simulation must be understood and addressed to avoid fragmentation of teaching and learning and to support strong learning outcomes.

The invisible nurse--behind the scenes in an Australian OR.

THE DWINDLING NUMBER of RNs choosing to work in the OR has been caused by many factors, such as restricted undergraduate exposure to the perioperative experience and fewer postgraduate opportunities. PRESSURE TO IDENTIFY alternative health care workers to replace RNs in the OR is escalating to a point where the role of the perioperative RN, as currently understood, is threatened. FINDINGS from an Australian ethnographic study suggest that both patients and non-nursing colleagues have limited appreciation of the contribution that perioperative nurses make. THE NEED FOR NURSES to take a proactive stance on this subject is discussed within the context of professional and structural change.