A grounded theory of interdependence between specialist and generalist palliative care teams across healthcare settings.

BACKGROUND: Individuals with palliative care needs face increased risk of discontinuity of care as they navigate between healthcare settings, locations and practitioners which can result in poor outcomes. Little is known about interactions that occur between specialist and generalist palliative care teams as patients are transition from hospital to community-based care after hospitalisation. AIM: To understand what happens between inpatient specialist palliative care teams and the generalist teams who provide post-discharge palliative care for shared patients. DESIGN: A constructivist grounded theory approach, using semi-structured interviews and constant comparative analysis, including coding, memo-writing and diagram construction. SETTINGS/PARTICIPANTS: Interviews (n = 21) with specialist palliative care clinicians and clinicians in other specialties providing generalist palliative care. Specialists had training in palliative care and worked in specialty palliative care practices; other clinicians worked in primary care or oncology and did not have specialised palliative care training. RESULTS: A grounded theory of interdependence between specialist and generalist palliative care teams across healthcare settings was constructed. Two states of inter-team functioning were found which related to how teams perceived themselves: separate teams or one cross-boundary team. Three conditions influenced these two states of inter-team functioning: knowing the other team; communicating intentionally; and acknowledging and valuing the role of the other team. CONCLUSIONS: Teams need to explicitly consider and agree their mode of functioning, and enact changes to enhance knowledge of the team, intentional communication and valuing other teams' contributions. Future research is needed to test or expand this theory across a range of cultures and contexts.

Preparing for practice: students' reflections on their final clinical experience.

Nursing students in their last clinical experience before graduating often encounter stressful situations and face unique challenges. To help students prepare for their transition into practice, both faculty and nurses in the clinical setting need a thorough understanding of what nursing students are thinking and feeling as they near the end of their academic program. This study was conducted to explore the cognitive and emotional responses of baccalaureate nursing students during their final clinical experience. Thirty-two senior nursing students wrote "thinking-in-action" reflections weekly during a 6-week period in the last semester of their nursing program. Reflections were analyzed using qualitative methods; seven themes emerged: being aware of human vulnerability, feeling the weight of registered nurse (RN) responsibility, recognizing limits, evaluating self, seeing the patient/family perspective, confronting ethical issues, and facing reality versus expectations. These findings help nurses in education and practice more fully understand the issues that students face in preparing for practice and may lead to strategies to smoothen the stressful transition from being a student to becoming an RN.

Examining the role of technology in learning: an evaluation of online clinical conferencing.

The rapidly expanding use of instructional technology requires faculty openness to new teaching and learning situations. This study compared two instructional methods of conducting clinical conferences for baccalaureate nursing students: online versus face-to-face. Quantitative and qualitative data were collected from 77 students in 10 clinical sections of a senior capstone nursing course. Mean scores for all 11 items on the clinical evaluation tool were higher for students who had conferences online than those in face-to-face conferences. Four of the 11 items were statistically significant, reflecting greater participation and convenience for online participants. Online students also reported greater opportunities to reflect on ethical issues. There were no significant differences in quiz scores between the groups when students were tested on content covered in their clinical conferences. Students identified advantages including opportunities for flexibility and equal participation. Barriers included unfamiliarity with technology and lack of face-to-face-contact. The findings suggest that students can successfully achieve the intended purpose of clinical conferences through an online instructional technique. Ongoing research in the use of technology is necessary to meet student needs, enhance student learning, and support evidence-based practice in nursing education.