Migrant families' access to ECEC and family policies: The Australian and Italian case compared.

This paper analyses in a comparative perspective the degree of convergence in migrant families' access to early childhood education and care (ECEC) and work/family policies in two different welfare state regimes: Italy and in Australia. Using a framework based on the concept of conditionality-or the notion that access to support is conditional and based on an individual's personal and familial characteristics, circumstances or behaviors--the analysis examines the extent to which policies designed to support families with young children are accessible to migrant families. It argues that access to ECEC and family policies is restricted in both Italy and Australia according to a series of conditions, but that these conditions apply differently to people of different migrant statuses. In doing so the paper aims to improve our understanding of how welfare states respond to needs associated with migration for children and families and the extent to which they tend to converge.

Industry views about the Banned Drinker Register in the Northern Territory: Early lessons from a qualitative evaluation.

INTRODUCTION AND AIMS: The Northern Territory Government has recently planned and implemented an extensive suite of alcohol harm minimisation policies, including the reintroduction of the Banned Drinker Register (BDR). It is an explicit alcohol supply reduction measure that places persons who consume alcohol at harmful levels onto a register, prohibiting the purchase of alcohol from take-away liquor outlets. This paper explores industry stakeholders' perspectives regarding the extent to which the BDR is meeting its objectives to improve community health and safety by reducing alcohol-related harms. DESIGN AND METHODS: Interviews and one focus group were conducted with 66 alcohol industry stakeholders from urban and remote locations. Focusing on outcomes both central (crime and safety) and peripheral (health and therapeutic support) to the stakeholders' interest, the authors used inductive thematic analysis to examine participants' perceptions about the effectiveness of the BDR. RESULTS: Analysis revealed mixed views about the effectiveness of the BDR. There is a tension between the objective to address public amenity and decrease crime, as expressed by the participants, compared to the health-focused approach to therapeutic services and referrals identified in other sources. DISCUSSION AND CONCLUSIONS: Drawing on these findings, alongside other relevant sources, the authors argue there is a need for a more effective communication strategy to the public and professional community to enhance the capacity of the BDR to meet its goals. The authors recognise the limitations of alcohol industry stakeholder views and identify the need for a comprehensive evaluation approach that includes multiple stakeholder perspectives.

Feedback in clinical practice: Enhancing the students' experience through action research.

Feedback within clinical practice is known to be central to the learning and development of student nurses and midwives. A study that focused on student experience of assessment identified that a high proportion of students reported that they had received insufficient feedback whilst on clinical placement. In response to this academics and members of the clinical education team set out to explore this with a view to improving the student experience using action research. Key findings indicated that responsibility for feedback on clinical placement lies with both students and mentors, distinct factors can enable effective feedback and that positive outcomes for mentors and students resulted through engaging with the project. The process, outcomes and actions taken to improve practice are the focus of this paper.

Exploring the experiences of patients attending day hospitals in the rural Scotland: capturing the patient's voice.

AIMS AND OBJECTIVES: To understand the meaning of person-centred compassionate care for people attending day hospitals in rural Scotland. BACKGROUND: Increasing numbers of older people are living with chronic conditions and require support to live at home. Intermediate care services such as day hospitals can enable this. Much previous research about day hospitals focused on organisational aspects of care. This study set out to capture the voice of the patient using this service. DESIGN: A descriptive qualitative study. METHODS: Individual interviews were undertaken in participant's homes using emotional touchpoints as prompts to help patients discuss their experience of care within a day hospital (n = 15). Data were analysed using thematic analysis. RESULTS: Four main themes were identified from the data: Relationships, Feeling Valued, Expectations and Perceived Benefits. The findings showed that relationships with staff and other patients were important. The patients also wanted to feel valued, and helping others was part of this. The patients had clear expectations of the service but had an acute awareness of the benefits of attending the day hospital such as coordination of their care. Overall, the patients were highly satisfied, felt that care was person-centred and recognised the advantages of remaining close to home. CONCLUSIONS: At a time when enabling health and social care integration is a priority, this study provides insight into the patient perspective of intermediate care. The findings reveal what matters to patients cared for in the community and how this service can respond to this. RELEVANCE TO CLINICAL PRACTICE: This study provides insight for healthcare practitioners caring for patients in the community and those responsible for planning and resourcing this service. It should also start a dialogue about how these services could be used more.

Compassionate Care: Student nurses' learning through reflection and the use of story.

INTRODUCTION: Current concern in health care about delivering care that is compassionate has important implications for how compassion is taught and made explicit in nurse education curricula. This paper will describe the use of stories within the curricula to enhance knowledge and skills in compassionate caring. METHODOLOGY: The Leadership in Compassionate Care Programme (LCCP) was a 3-year action research project that sought to capture what compassionate care means within practice and utilise this learning within education. Stories gathered within clinical practice were used to stimulate reflective learning as part of a nursing module that teaches recognition of acute illness and deterioration at Edinburgh Napier University. Students listened to stories which included experiences of staff, students, patients and relatives and related these to their own experiences in practice. In this paper, examples from the online discussions are discussed with reference to one of six themes that emerged from the LCCP, that of caring conversations. FINDINGS: The discussions suggest that reflective learning and the use of stories about the experience of giving and receiving care can contribute to the development of the knowledge, skill and confidence that enable student nurses to provide compassionate relationship centred care within practice. CONCLUSIONS: Reflective learning can be a valuable strategy for students to ponder new knowledge and allow predetermined ideas to be challenged. Stories can initiate this process and help student nurses to understand not only the needs of others, but their own expectations and values, which in turn can inform how they plan and deliver person centred compassionate care.

Clarifying misconceptions about compassionate care.

AIM: To discuss the meaning of compassionate care as it applies to staff, patients and families in health and social care settings, its application to practice and how organizational infrastructures affect the delivery of care. BACKGROUND: The term compassion has assumed headline status and inclusion in current health and social care policy. Clarity of what the term means in practice is needed and may help to promote delivery of compassionate care consistently across health and social care settings. DESIGN: Discussion paper. DATA SOURCES: This article draws on data from an action research programme (Leadership in Compassionate Care Programme, 2007-2011) that focused on embedding compassionate care into practice and education and related literature focused on compassionate person-centred care. A literature search was conducted and articles published in English relating to the terms compassionate, person-centred care between 1999-2011 were included. DISCUSSION: Perceptions of compassion, practising compassion and the infrastructure to support compassion are discussed. IMPLICATIONS FOR NURSING: It is anticipated that this discussion will prompt further debate, raise awareness and help to clarify the meaning of compassion in everyday practice with patients, relatives and staff, so that it can be more clearly named, valued and defended. CONCLUSION: This article challenges some of the beliefs and values that underpin the meaning of compassionate care and its application to practice. It brings greater clarity to the meaning of compassion, which could be used to form the basis of shared visions of caring, both strategic and operational, across organizations.

A 'good death' at home: community nurses helping to make it possible.

The number of people dying at home rather than in a hospital is increasing, albeit slowly. This coincides with a growing emphasis across the UK to increase choice and enable individuals to both live and die well, and in the preferred setting of their choice. While most health professionals would support this approach, it is clear that providing end of life care in the community to all, irrespective of where they live, is complex. Communities face different challenges to hospital based care settings, one of these being geographical distances. This article discusses current end of life policies and how the community nurse is central to their implementation. It draws on some recent research which has identified the important steps that enable a community nurse to facilitate a good death and a particular research study which illustrated the unique role of the Community Nurse in providing end of life care in a rural setting, but also the challenges.

Developing global citizenship online: an authentic alternative to overseas clinical placement.

BACKGROUND: This paper presents the findings of a pilot project to develop and evaluate an international nursing module delivered using a collaborative online platform between nursing programmes in Scotland, USA and Finland. The purpose of the project was to provide an authentic international nursing experience for nursing students, allowing them to explore and contrast the nursing and health care issues in an international context. METHODS: The pilot cohort ran in September 2011 with a total of 22 students with a mix of students from both undergraduate and postgraduate programmes. A mixed methods research design was used to evaluate the students' experience using an anonymous online questionnaire and the collection of testimonials from students based on their experience. RESULTS: The results demonstrated high levels of satisfaction with the learning experience. Four key themes-learning together, widening horizons, developing autonomy and learning beyond frontiers-emerged from the qualitative data. CONCLUSIONS: Developing confidence from the shared learning experience has real implications for the global mobility of the nursing workforce as it helps to prepare nurses for a career beyond their own country's borders. The pilot module has clearly demonstrated that the use of Web 2.0 technology in the forms of a wiki may effectively be employed to provide an online learning environment to allow cross institutional learning.

Online video in clinical skills education of oral medication administration for undergraduate student nurses: a mixed methods, prospective cohort study.

BACKGROUND: Improvements in the safety of the prescribing, dispensing and administration of medicines are identified as a priority across international healthcare systems. It is therefore essential that higher education institutions play their part in helping to meet this patient safety objective. New developments in clinical skills education which are aligned to emerging educational theory are available, but evaluations and supportive evidence are limited. OBJECTIVES: To evaluate the use of an online best practice exemplar as an adjunct to the clinical skills teaching of oral medication administration to undergraduate student nurses. DESIGN: Mixed-methods prospective cohort design. SETTINGS AND PARTICIPANTS: Two intakes of undergraduate nursing students (n=168, n=154) undertaking a first year clinical skills based module at a British university. METHODS: The Control group received standard teaching using lectures and skills classes facilitated by experienced clinical skills lecturers. The Intervention group received the standard teaching and unlimited access to an online video clip of medication administration. Performance and satisfaction were measured using module assessment results and a satisfaction questionnaire. Qualitative data were gathered using focus groups (n=16, n=20). RESULTS: The Intervention group was significantly (p=0.021) more likely to pass the assessment and rate their satisfaction with the teaching significantly higher (p<0.05) on more than half of the items from the Student Satisfaction Survey. Two Categories were identified from focus group data; Classroom Learning and Transfer to Practice. Classroom Learning included four themes of Peers, Self, Teaching and Time and when Classroom Learning was positive, the Transfer to Practice of the clinical skill was enhanced. CONCLUSIONS: An online video of a best practice exemplar as an adjunct to taught clinical skills sessions improves student assessment results and satisfaction ratings. The video was also reported to positively influence all themes identified in Classroom Learning and was perceived to promote the Transfer to Practice of teaching input.

Using syringe drivers in palliative care within a rural, community setting: capturing the whole experience.

The aim of this research was to understand how the introduction of a syringe driver, which is considered routine practice in many palliative care settings, impacted on patients, carers and community nurses within a rural, community setting. A phenomenological study was conducted exploring the experiences from the perspective of patients (n=4), carers (n=9) and community nurses (n=12) when syringe drivers are used at home. We interviewed patients and carers in their own homes and conducted two focus groups with community nurses who had an interest in palliative care but were not specialists. Despite the wide use of syringe drivers within palliative care, our study found their use among community nurses, particularly in rural areas can be variable with frequent time lapses between a nurse's exposure, impacting on both their technical abilities and knowledge. In-depth interviews with patients revealed few barriers to their use, but carers clearly identified areas where their expectations and experiences differed and where more information setting realistic goals of care would have been helpful. The authors conclude that although nurses require competencies related to syringe drivers, they also need an in-depth knowledge of the actions of the drugs and the likely changes which occur physiologically as patients approach the end of their life. This will ensure accurate information is delivered, and facilitate meaningful dialogue.

Developing a nursing education project in partnership: leadership in compassionate care.

The prominence of the caring dimension has never had such a high profile in healthcare practice before. As a result of this, the Leadership in Compassionate Care Project has evolved. A unique feature is the partnership between Edinburgh Napier University and NHS Lothian. Engaging with and helping qualified and student nurses to value and promote the delivery of compassionate care is a primary focus of the project. This article outlines key policy drivers, the project's four main strands, and the aims, processes and perceived impact on practice.