Introduction of Undergraduate Nursing Students to an Objective Structured Clinical Examination.

BACKGROUND: The Objective Structured Clinical Examination (OSCE) is used increasingly in nursing education. The purpose of this article is to report on the qualitative evaluation of the first implementation of a medication administration OSCE within an Australian school of nursing. METHOD: A two-stage data gathering strategy was undertaken. The first stage was to survey participants' pre-OSCE and the second stage involved surveying the same participants' immediately post-OSCE. A constant comparison analysis method was used. RESULTS: The first stage data analysis (pre-OSCE) were classified into three themes: (a) Student Anxiety, (b) Student Preparedness, and (c) The Effectiveness of This Style of Assessment. The three key themes from the second stage (post-OSCE) analysis were: (a) Feelings Toward the OSCE, (b) Assessor Interaction, and (c) The OSCE Environment. CONCLUSION: Although they found it stressful, the participants valued the OSCE experience. The OSCE gave the students confidence in their capabilities of medication management. [J Nurs Educ. 2017;56(4):231-234.].

What level of competency do experienced nurses expect from a newly graduated registered nurse? Results of an Australian modified Delphi study.

BACKGROUND: Individuals who have recently completed accredited courses and are eligible to register as a nurse in Australia are often referred to as not being 'work-ready' by clinically based colleagues. This project identified the level of competence that can be reasonably expected of a newly registered nurse (RN) graduating in Australia. The research was undertaken using the necessary skills identified by Crookes and Brown in 2010. METHODS: A consensus methodology using a modified Delphi technique invited experienced nurses to identify the level of competency expected by the new RN in each of the skills areas. RESULTS: More than half of respondents did not believe that new graduates could practice independently in 18 of the 30 skills areas. There were only four skills areas where more than two thirds of the respondents believed the new graduate could operate independently. CONCLUSIONS: There is a lack of clarity about the level of competency of the newly graduating registered nurse in Australia. The profession and employers need clarity regarding the areas and level of competence that can reasonably be expected of a newly graduated RN. Utilising the findings of this research will enable the skills and competencies to be integrated into eligibility to practice programmes. Further research needs to be undertaken to review the foci of nursing preparation programmes to meet the needs of novice practitioners and the health care consumer population.

What are the 'necessary' skills for a newly graduating RN? Results of an Australian survey.

BACKGROUND: There appears to be a sense of disappointment with the product of contemporary nursing programs in Australia in that new graduate RNs are often referred to as not possessing appropriate skills by clinical colleagues. This work identifies the skills that the profession believes that newly graduating RN's should possess at the point of registration. METHODS: A qualitative consensus methodology was used in the form of a modified Delphi survey. Expert panels were used to review and validate data. RESULTS: Consensus was reached on the top 25 skills areas that can be reasonably expected of a new graduate Registered Nurse in Australia. The top ranked skills areas included efficient and effective communication, professional nursing behaviours, privacy and dignity and managing medication administration. CONCLUSIONS: The consensus methodologies used to develop the skills areas indicated broad agreement across the profession in Australia. The complexity and context of practice was highlighted in the comments within the Delphi rounds. Interestingly no new skills were added and none removed from the initial list - some were prioritised over others but the majority agreed that all the skills areas were important for a newly graduating nurse.

An audit of skills taught in registered nursing preparation programmes in Australia.

BACKGROUND: A competitive Carrick Institute Competitive Grant (CG7-523) was obtained to explore what skills were taught and what assessment of practice approaches were used in nursing programmes in Australia. The intention was twofold; firstly to identify what skills were being taught which would contribute to the development of an assessment of practice toolkit for eligibility to practice programmes in Australia. This paper specifically reports on the skills taught in nursing programmes in Australia. METHODS: A qualitative research methodology was used through a documentary analysis of university curriculum documents. This was undertaken independently by two researchers; the data was then reviewed by an expert group. The skills taught were explored, listed and categorised using a conceptual framework, then refined and reported. RESULTS: Over 1300 skills were initially identified within nursing programmes across Australia; these were 'clustered' using a framework into 30 skills areas. These included psychomotor skills to skills areas that relate to human factors such as communication, team work, leadership and supervision. CONCLUSIONS: A wide range of skills were referred to in university nursing programme curriculae in Australia. There were some significant variations; some universities taught their student nurses how to manage a client/patient requiring external invasive ventilator support. There were however a number of similar skills areas identified; such as acute care assessment skills (monitoring vital signs) and mental health assessment skills. The range of skills taught within nursing curriculum is challenging as there is only limited time to expose students to those skills and afford the student the opportunity to practice those skills in order to achieve competence prior to registration.

The development of a model of education for casual academic staff who support nursing students in practice.

Nursing is predominantly a practice based profession where clinical placement for pre-registration nursing students is a significant component of their programme, as this is pivotal in achieving work readiness of the graduate registered nurse. It is therefore important to ensure nursing students have high quality clinical placements that are supervised by well-prepared experienced registered nurses. This paper discusses one component of the reconnaissance phase of a wider action research project being undertaken in a metropolitan university in NSW, Australia seeking to enhance the development and support of casual academic staff known as clinical supervisors who support students in clinical placement. The outcomes attributed to this project are the development of a participation model which has resulted in a collaborative partnership between the university and clinical supervisors and secondly, the embedding of solution focused ways of working and practice development into the program. The information from the reconnaissance phase of this project confirms the need for further research into the implementation of the participatory model to ensure that future education and support process are developed through collaboration.

Clinical simulation in Australia and New Zealand: through the lens of an advisory group.

Across Australia, innovations in simulation to enhance learning in nursing have been occurring for three decades and nursing is, and needs to be, a leading player in simulation knowledge diffusion. However, expertise is unevenly distributed across health services and education providers. Rather than build on the expertise and achievements of others, there is a tendency for resource duplication and for trial and error problem solving, in part related to a failure to communicate achievements for the benefits of the professional collective. For nursing to become a Leader in the use of simulation and drive ongoing development, as well as conducting high quality research and evaluation, academics need to collaborate, aggregate best practice in simulation learning, and disseminate that knowledge to educators working in health services and higher education sectors across the whole of Australia and New Zealand. To achieve this strategic intent, capacity development principles and committed action are necessary. In mid 2010 the opportunity to bring together nurse educators with simulation learning expertise within Australia and New Zealand became a reality. The Council of Deans of Nursing and Midwifery (CDNM) Australia and New Zealand decided to establish an expert reference group to reflect on the state of Australian nursing simulation, to pool expertise and to plan ways to share best practice knowledge on simulation more widely. This paper reflects on the achievements of the first 18 months since the group's establishment and considers future directions for the enhancement of simulation learning practice, research and development in Australian nursing.

Post-discharge management following hip fracture--get you back to B4: a parallel group, randomized controlled trial study protocol.

BACKGROUND: Fall-related hip fractures result in significant personal and societal consequences; importantly, up to half of older adults with hip fracture never regain their previous level of mobility. Strategies of follow-up care for older adults after fracture have improved investigation for osteoporosis; but managing bone health alone is not enough. Prevention of fractures requires management of both bone health and falls risk factors (including the contributing role of cognition, balance and continence) to improve outcomes. METHODS/DESIGN: This is a parallel group, pragmatic randomized controlled trial to test the effectiveness of a post-fracture clinic compared with usual care on mobility for older adults following their hospitalization for hip fracture. Participants randomized to the intervention will attend a fracture follow-up clinic where a geriatrician and physiotherapist will assess and manage their mobility and other health issues. Depending on needs identified at the clinical assessment, participants may receive individualized and group-based outpatient physiotherapy, and a home exercise program. Our primary objective is to assess the effectiveness of a novel post-discharge fracture management strategy on the mobility of older adults after hip fracture. We will enrol 130 older adults (65 years+) who have sustained a hip fracture in the previous three months, and were admitted to hospital from home and are expected to be discharged home. We will exclude older adults who prior to the fracture were: unable to walk 10 meters; diagnosed with dementia and/or significant comorbidities that would preclude their participation in the clinical service. Eligible participants will be randomly assigned to the Intervention or Usual Care groups by remote allocation. Treatment allocation will be concealed; investigators, measurement team and primary data analysts will be blinded to group allocation. Our primary outcome is mobility, operationalized as the Short Physical Performance Battery at 12 months. Secondary outcomes include frailty, rehospitalizations, falls risk factors, quality of life, as well as physical activity and sedentary behaviour. We will conduct an economic evaluation to determine health related costs in the first year, and a process evaluation to ascertain the acceptance of the program by older adults, as well as clinicians and staff within the clinic. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT01254942.