The client and family experience of attending a nurse-led clinic for chronic wounds.

BACKGROUND: The quality of life for individuals with chronic wounds is diminished due to poor health-related outcomes and the financial burden of wound care. The literature has shown nurse-led wound care to have a positive impact on wound healing and psychosocial wellbeing. However, there is minimal research investigating the lived experience of attending a nurse-led clinic for chronic wounds. The purpose of this study was to explore the client and family experience of attending a nurse-led clinic for chronic wounds. METHODS: Qualitative descriptive study. Semi-structured telephone interviews were transcribed verbatim and thematic analysis was undertaken. RESULTS: Twelve clients and two family members participated, and the average length of interviews was 20min. Three main themes emerged: (1) expecting and managing pain; (2) receiving expert advice and reflecting on previous care; and (3) managing the cost of care. There was an emphasis on the impact of chronic wounds on pain and the ability to complete the activities of daily living. Expert advice, client satisfaction and physical accessibility were highlighted as benefits of the clinic. Cost and minimal client education were identified as challenges of the clinic. CONCLUSIONS: The findings demonstrated that chronic wounds have a significant impact on the client and family attending the nurse-led clinic. Comprehensive pain assessment, improved social support, better client education and cost-effective care is required to optimise the experience for people attending the nurse-led clinic.

A program quality framework: a collaborative teaching team approach to quality assurance, quality enhancement and staff capacity building.

A global shortage of registered nurses provides a further impetus to retain nursing students and graduate safe nurses. While various frameworks support curriculum design and describe the need for ongoing curriculum evaluation and monitoring, there is little in the literature to support the enactment and ongoing quality enhancement of curricula. Translation of the curriculum plan into the delivered curriculum relies on academics who may or may not be adequately prepared for course writing and teaching in higher education settings, despite their discipline expertise. Additionally, there are well recognized issues of curriculum drift where curriculum innovations and changes are whittled away over time by incremental changes to courses that interfere with the integrity of the accredited curriculum. We propose an evidence-based Program Quality (ProQual) Framework that takes a holistic, collaborative, and systematic approach to monitoring and enhancing curriculum quality and program delivery over the life of the curriculum while developing staff capability and scholarship.

Supporting learners in prison healthcare work-integrated learning settings through simulation: a cross-sectional study.

BACKGROUND: Nursing students and nurse preceptors indicate that a comprehensive orientation is vital to successful work-integrated learning placements in Prison Health Services. The aim of this study was to implement and evaluate a Prison Health Service orientation package that included innovative asynchronous online video simulations with branched decision-making and feedback opportunities to stimulate learning and improve students' feelings of preparedness for a placement in this setting. METHODS: A cross-sectional pre and post design was used to evaluate the resource. Students were given access to the package and invited to complete a pre-placement survey evaluating the resource and their feelings of preparedness for placement. Following placement, they re-evaluated the resource in terms of how well it prepared them for the placement and how well prepared they felt. Third year Australian undergraduate nursing students from one university who completed a Prison Health Service work-integrated learning placement in 2018, 2021, and 2022 were invited to participate. Placements were unavailable in 2019 and 2020. Independent t-tests were used to determine differences in scale means and level of preparedness between pre- and post-survey responses. RESULTS: Twenty-three of 40 (57.5%) eligible nursing students completed the pre-placement survey and 13 (32.5%) completed the post placement survey. All respondents to the pre-placement survey indicated that they felt satisfactorily, well, or very well prepared after completing the orientation package prior to their clinical placement. Students were significantly more likely to consider themselves well prepared by the package after they had attended placement (p < .001). All students post placement indicated that overall, the simulation resources and the specific simulation scenario about personal boundaries and management of manipulative behaviours was useful for their placement. The majority of students would recommend the orientation package to other students. Suggestions for improvement included streamlining the resource to reduce the time to complete it. CONCLUSIONS: Asynchronous online simulation with the capacity for branched decision making and feedback along with a comprehensive online orientation package were perceived as useful to prepare undergraduate students for placement in the Prison Health Service work-integrated learning setting.

The experiences and needs of metastatic spinal cancer family caregivers at home: a systematic review.

PURPOSE: Family caregivers have high responsibilities for caring for persons with metastatic spinal cancer; however, understanding the experiences and needs of family caregivers face to overall recent, what is nurse-led could support them to meet their needs appropriately? Thus, the study aimed to review the experiences and needs of metastatic spinal cancer caregivers at home in the past decades. METHODS: A qualitative systematic review of 8 studies was undertaken. Analysed studies were conducted in different countries (Australia, Cyprus, Italy, Kenya, Pakistan, Thailand, and Turkey), covering a population of 92 caregivers. Thematic analysis was applied to identify family caregiver experiences and needs. RESULTS: Thematic analysis identified four key themes from the included studies: (1) complexity of needs, (2) caregivers' role and physical needs, (3) complexity of psychosocial needs, and (4) understanding supportive care. CONCLUSIONS: The results across 8 different countries indicate that family caregivers of metastatic spinal cancer commonly face diverse challenges in many diverse geographical contexts across cultures, requiring biomedical, practical, physical, and psychosocial support from healthcare systems within the matrix of broader challenges and resources available to improve supportive care for such service users.

Facilitating learning on clinical placement using near-peer supervision: A mixed methods study.

BACKGROUND: Graduating nursing students report lower competence in leadership and delegation skills, which may be due to lack of sufficient opportunities to practice leadership skills such as delegation and supervision. A near-peer clinical supervision model, in which third-year students supervise first-year students on placement, may provide a mechanism to develop graduating students' leadership skills while improving the learning experience for junior students. OBJECTIVES: To evaluate nursing students' experiences and perceptions of participating in a near-peer clinical supervision model. DESIGN: A mixed methods design including an anonymous post-placement survey of students, and a group interview. SETTINGS: Medical and surgical wards in three Australian hospitals. METHOD: Forty-three first-year nursing students were supervised by 92 third-year nursing students on clinical placement under the supervision of a registered nurse in a near-peer supervision model. RESULTS: Twenty-seven first-year (69.2%) and 43 third-year (46.7%) students completed the questionnaire. First-years reported that being supervised by a senior student was a positive experience and would recommend it to other students (4.49/5 ± 0.71), and indicated that third-year students behaved professionally, were knowledgeable, and provided opportunities to ask questions (4.52-4.81/5). Third-year students reported gaining confidence, teaching, delegation and leadership skills (4.21-4.49/5). Qualitative responses supported the quantitative findings. Additional findings were the need for greater preparation of ward registered nurses to work in the model. CONCLUSIONS: Both groups enjoyed working in a near-peer clinical supervision model. The model provided opportunities for senior students to develop leadership and delegation skills and a positive experience of placement for junior students. Further attention to preparation of ward registered nurses would improve model delivery.

Supporting culturally and linguistically diverse (CALD) undergraduate nursing students undertaking clinical placements in Australia: An exploratory qualitative study of clinical facilitator and CALD student perceptions.

BACKGROUND: Internationalisation of higher education has contributed to the increasing number of culturally and linguistically diverse students in higher education programs worldwide. While there is some literature on the experiences and needs of these students, there is little evidence on what resources can be used to support these students when learning in the clinical setting. AIM: This study aimed to evaluate the usefulness of an existing handbook developed for clinical facilitators to enhance culturally and linguistically diverse nursing students' learning, and to explore the facilitator and student perceptions of their clinical placement support needs. DESIGN: This exploratory qualitative study, involving culturally and linguistically diverse Bachelor of Nursing students and clinical educators, was conducted in a multi-campus School of Nursing and Midwifery at Griffith University, Australia, in collaboration with health services. Focus groups and individual interviews with clinical facilitators and culturally and linguistically diverse nursing students were conducted. Activity theory provided the conceptual framework for this study and the qualitative data analysis was informed by grounded theory. RESULTS: Clinical facilitator focus groups and interviews generated three themes: understanding culturally and linguistically diverse students' needs; supporting culturally and linguistically diverse students; and improving learning resources for facilitators and students. Student focus groups generated three themes: wanting to be more prepared for clinical placement; feeling supported by facilitators and interacting with others in a different context; and creating resources to support learning. CONCLUSIONS: Supportive clinical environments are key to the work-integrated learning success of culturally and linguistically diverse nursing students. The findings of this qualitative research study, involving clinical educators and culturally and linguistically diverse Bachelor of Nursing students identify the pressing need to develop readily accessible resources to support the clinical learning of culturally and linguistically diverse students and their educators. Resources development should be attentive to complexities at the intersection of workplace culture and students' developing understanding.

Clinical facilitators' experience of near peer learning in Australian undergraduate nursing students: A qualitative study.

BACKGROUND: To mitigate escalating costs in clinical supervision of undergraduate nursing students and alleviate clinical facilitators' teaching burden, the near-peer learning model has become popular. Studies on near-peer learning have been on students' views of the model with a paucity of literature on clinical facilitators' experiences. AIM: To explore clinical facilitator experiences of the near-peer learning model. DESIGN: A qualitative descriptive design was used with a purposeful sample of clinical facilitators involved in near-peer learning of nursing students. SETTING: Two teaching hospitals participated. Two medical and two surgical wards were selected from each. PARTICIPANTS: Eleven clinical facilitators who had experienced using near-peer learning. METHODS: Focus group and individual interviews were conducted with clinical facilitators using a semi-structured interview guide following ethics approval. Data were analysed using content analysis. RESULTS: Four themes emerged: 1) Congruent student dyad characteristics 2) Clinical facilitator attributes of confidence in students' knowledge and effective time and conflict management, 3) Availability of suitable skills, and 4) Facilitator support and preparation on the model. These themes appear to promote optimum learning outcomes of the near-peer model including empowering students, junior students gaining practice in foundation skills and senior students gaining competence in leadership, mentoring and nurturing skills. Barriers included incongruent student characteristics resulting in conflict and trust issues, senior student not knowing how to teach, give feedback or teaching inaccurate information; facilitator's lack of confidence in students' knowledge level, inadequate time to manage the student dyad and resolve conflict; inadequate support and preparation from university staff; and unavailability of suitable skills. CONCLUSION: Successful implementation requires careful selection of student dyads, appropriate clinical environment and support for clinical facilitators. Our findings provide a better understanding of the near-peer model for future implementation.

Supporting Australian clinical learners in a collaborative clusters education model: a mixed methods study.

BACKGROUND: Nursing student numbers have risen in response to projected registered nurse shortfalls, increasing numbers of new graduates requiring transitional support and pressure on clinical placements. A Collaborative Clusters Education Model, in which Entry to Practice facilitators coach ward-based registered nurses to support students' and new graduates' learning, may address placement capacity. The research aim was to evaluate the acceptability of the Collaborative Clusters Education Model to stakeholders by examining their perceptions of the facilitators and barriers to the model in its implementation. METHODS: A convergent mixed methods evaluation approach was adopted. The study took place in a large Australian health service in south-east Queensland. Participants included Bachelor of Nursing students, Entry to Practice facilitators, ward-based registered nurses, academics and new graduates. A mixed methods design was used. Elements included an online survey of nursing students, and interviews with new graduates, Entry to Practice facilitators, ward-based registered nurses, and academics. Descriptive statistics were calculated on quantitative data. Thematic analysis was conducted on qualitative data. RESULTS: Participants included 134 (of 990) nursing students (response rate 13.5%), five new graduates, seven Entry to Practice facilitators, four registered nurses, and three nurse academics. Students rated facilitators' effectiveness highly (4.43/5 ± 0.75), although this finding is tempered by a low response rate (13.5%). For learners, the model provided access to learning experiences, although preferences for sources of support differed between students and new graduates, and further clarification of responsibilities was required. For other stakeholders, three themes emerged: students' and new graduates' integration into the workplace can promote learning; tensions arise in new ways to approach performance assessment; and aligning expectations requires high levels of communication. CONCLUSIONS: This evaluation found that acceptability was good but at risk from limited clarity around roles and responsibilities. Further research into this model is recommended.

The outcomes and experience of people receiving community-based nurse-led wound care: A systematic review.

AIMS AND OBJECTIVES: To review the literature related to the outcomes and experience of people receiving nurse-led care for chronic wounds in the community. BACKGROUND: Chronic wounds lead to a poor quality of life and are an economic burden to the Australian healthcare system. A lack of awareness into the significance of chronic wounds leads to limited resources being available to facilitate the provision of evidence-based care. The majority of chronic wounds are managed by nurses in the community, and a better understanding into current models of care is required to inform future practice. DESIGN: A systematic quantitative literature review. METHODS: A systematic search was conducted in four electronic databases, and the inclusion criteria were as follows: English language, peer-reviewed, published from 2009-2019 and primary research. The data were compiled into an Excel database for reporting as per the Pickering and Byrne (Higher Education Research & Development, 33, 534.) method of systematic quantitative literature review. This review used the PRISMA checklist. The Mixed Methods Appraisal Tool was used for quality appraisal. RESULTS: Twelve studies were included in the review. Home nursing care, social community care and nursing within a wound clinic were identified as three types of nurse-led care in the literature. The findings demonstrate that nurse-led care was cost-effective, reported high levels of client satisfaction and contributed to improved wound healing and reduced levels of pain. CONCLUSIONS: Nurse-led care is a positive experience for people with chronic wounds and leads to better outcomes. The findings suggested a need for further client education and specialised training for healthcare practitioners managing chronic wounds. RELEVANCE TO CLINICAL PRACTICE: This review demonstrates that nurse-led care for people with chronic wounds in the community is cost-effective and improves client outcomes. Raising awareness into the significance of chronic wounds aims to promote the resources required to facilitate evidence-based care.

The experiences of the agency registered nurse: An integrative literature review.

AIM: To examine experienced registered nurses' motivations for choosing agency work, their experiences and perceptions of agency nursing and how they meet their regulatory professional development obligations. BACKGROUND: Agency registered nurses are employed by healthcare organizations to meet staffing shortfalls and contain costs. METHODS: Using an integrative review framework, four databases (CINAHL, Medline, Embase and Scopus) were systematically searched between 2000 and 2017: study selection followed the Preferred Reporting Items for Systematic reviews and Meta-analyses. RESULTS: Our search identified 491 sources. From these, two primary qualitative sources were included in this review. Four themes were identified: orientation, allocation of the agency nurse, isolation in clinical practice and lack of education opportunities. CONCLUSION: Given the limited literature on agency nurses and how to support them, further research is required on this subject. IMPLICATIONS FOR NURSING MANAGEMENT: Support for agency nurses is necessary, so they can seamlessly integrate with the healthcare team to provide safe patient care. This review may assist managers to identify strategies to effectively engage and support agency registered nurses in the acute care nursing team. The gaps identified highlight the need for further research to explore agency nurses' motivations, and support needs to inform future strategic workforce planning.

Volunteers motivations and involvement in dementia care in hospitals, aged care and resident homes: An integrative review.

OBJECTIVE: To review the current literature related to the role of volunteers in dementia care in hospitals, aged care and resident homes. DESIGN: Integrative review method was used to identify and analyse current literature. METHOD: Data extracted included; author, methodology, sample, aims, data collection and analysis, findings, limitations, and comments. The Mixed Methods Appraisal Tool (MMAT) version 2011, was used to appraise the quality of the final articles. DATA SOURCES: Databases searched included CINAHL, Medline, ProQuest Central and PubMed. Keywords and MeSH terms: dementia, cognitive impairment, Alzheimer's disease, volunteers, volunteering, voluntary workers, hospital, acute care, aged care, residents. RESULTS: 14 articles reviewed, and three major themes revealed: volunteer motivation, volunteer involvement, and understanding roles. Recommendations to assist with future volunteer programs in dementia care are presented. CONCLUSION: Volunteer programs are beneficial to patients, family, volunteers, health care, and staff. Research of volunteers' needs, motivations and role required, aiming to improve support and training.

Exploring the expectations of preceptors in graduate nurse transition; a qualitative interpretative study.

Preceptors provide fundamental support for the graduate registered nurse, acting as both teacher and role model with an aim to transition the graduate to becoming an independent practitioner. The purpose of this study was to investigate the expectations of the preceptor role from the preceptor's perspective. An interpretative phenomenological approach was used to explore the experience of being a preceptor with seven nurses working in acute clinical areas. Three themes emerged from the thematic analysis; balancing the preceptor role, exploring past experiences reveals current expectations and developing relationships. Participants had distinctive views on their role during the graduates' transition period, which were influenced by personal experience. Preceptors discussed their role including; education and support and the influence of the connection with the graduate nurse. The participants reflected on their own experiences and how this challenged their role expectations. Graduate characteristics were also highlighted to influence the balance of support. Overall the role of the preceptor was a complex role of balancing support and guidance while aiming to achieve professional development. The development of communication workshops and relationship building programs may be useful in addressing the multiple influencing elements of this relationship.

Redesigning clinical education for nursing students and newly qualified nurses: A quality improvement study.

Rising numbers of students are required to address the forecast nursing shortage. Health services are challenged to release experienced nursing staff to become supervisors in clinical supervision models and preceptorship models require significant investment in registered nurse education for effectiveness. One health service in southeast Queensland, Australia, developed an innovative clinical education model that draws upon the strengths of supervision and preceptor models, and is consistent with the Dedicated Education Unit model, without the dedicated university and prescribed attendance requirements. Using an iterative qualitative approach and learning circle methods, the aim was to determine feasibility of the model, using information gathered from clinical facilitators, who were the key implementers. Model feasibility was found to be dependent upon three key activities undertaken by the facilitators: align stakeholder expectations with the new model, clarify roles and responsibilities within clusters, and develop strategies for collecting information about student performance. The experience of implementing the model has raised further questions about how students, newly qualified nurses and registered nurses learn in localised work units and what practice pedagogies can be developed to support learning from, as well as improve practice.

Student nurses' perceptions of clinical placements in Australian Prison Health Services: A mixed methods study.

Increasing demands for clinical placements have forced tertiary institutions to look for alternative placements for third year nursing students. While Prison Health Services provide an opportunity for nursing students to engage in care of offender populations with significant chronic illnesses, there has been little evaluation of such placements. Third year undergraduate nurses (18/46) participated in a mixed methods study to provide evidence-based research on students' perceptions of clinical placements in Prison Health Services. Quantitative and qualitative data were collected via an anonymous survey and individual interview. Whilst the majority of students valued the opportunity to increase their knowledge and clinical skills and felt supported by preceptors, challenges included being psychologically ill-prepared for the physical and emotional aspects of placement, and witnessing poor attitudes and behaviours of staff, which impacted on the quality of their experience. Recommendations include changes to orientation programs and introduction of simulation to help students feel better prepared and supported during placements in prison settings. Refining the selection process for placements in this setting will also help to ensure student suitability for clinical placement in Prison Health Services.

Best practice in clinical facilitation of undergraduate nursing students.

Clinical facilitation is critical to successful student clinical experience. The research reported in this paper used an interpretive case study to explore perspectives of clinical facilitators on what constitutes best practice in clinical facilitation of undergraduate nursing students. Eleven clinical facilitators from South East Queensland, Australia, participated in focus groups, interviews and a concept mapping exercise to gather their perspectives on best practice. The data gathered information regarding their prior and current experiences as registered nurses and facilitators, considering reasons they became clinical facilitators, their educational background and self-perceived adequacy of their knowledge for clinical facilitation. Analysis was through constant comparison. Findings of the study provided in-depth insight into the role of clinical facilitators, with best practice conceptualised via three main themes; 'assessing', 'learning to facilitate' and 'facilitating effectively'. While they felt there was some autonomy in the role, the clinical facilitators sought a closer liaison with academic staff and feedback about their performance, in particular their assessment of the students. Key strategies identified for improving best practice included educational support for the clinical facilitators, networking, and mentoring from more experienced clinical facilitators. When implemented, these strategies will help develop the clinical facilitators' skills and ensure quality clinical experiences for undergraduate nursing students.

Enhancing student nurses' medication calculation knowledge; integrating theoretical knowledge into practice.

BACKGROUND: Accurate calculation of dosages and safe administration of medications in clinical practice is an essential skill for the registered nurse. Appropriate educational preparation of student nurses is the key to ensuring they become safe practitioners in the workforce. A review of the literature on different approaches for teaching and assessing medication calculation with student nurses revealed three main factors that influenced student nurses' ability to calculate medications accurately and identify mistakes. These factors include mathematical ability, particularly around multiplying with decimals, understanding medication formulas, and conceptualising medication dose. OBJECTIVES: This study evaluated teaching interventions that focused on improving the students' understanding of mathematical calculations, medication formulas and conceptualising medication doses. DESIGN: Evaluation study with teaching interventions and Time 1 and Time 2 medication tests. PARTICIPANTS: 156, 2nd year Bachelor of Nursing students from an Australian University. METHOD: The teaching interventions over 8 weeks included teaching decimals and basic mathematical skills, using the correct mathematical formula for the medication and linking the medication to the patient case study. Time 1 and Time 2 medication tests out of ten, student demographics and reasons for attending tutorials were collected to evaluate the effectiveness of the teaching interventions. RESULTS: For Time 1 medication test pre interventions, the mean was 7.3 with a mode of 8 out of ten. Maths and incorrect medication formula were the most common mistake. For Time 2 medication test post interventions, the mean was 9.3 with a mode of 10. The most common reason for incorrect answer Time 2 was incorrect medication formula. The students identified that the smaller tutorial sizes and remediation of errors was the main reason for continued attendance. CONCLUSIONS: The teaching intervention improved the accuracy of students' medication calculation, specifically, understanding the correct formula to use and identifying errors of calculation.

Undergraduate nursing students' placement in speciality clinical areas: understanding the concerns of the student and registered nurse.

INTRODUCTION: Student nurses in Australia are regularly placed in acute clinical areas providing them with clinical experience to link theory with real patient situations. Specialist clinical areas such as day oncology and renal dialysis often exclude students on the basis that their clinical area may not be able to meet normal clinical expectations, including holistic care of four to six patients with minimal direction from the registered nurse. However, specialist clinical areas provide students with unique learning experiences. This paper reports on an evaluation of speciality clinical placements for student nurses with an aim to increase our understanding of this type of placement. METHODS: Semi-structured audiotaped interviews were undertaken with 7 third year final semester students and 13 registered nurses working with the third year students. All interviews were transcribed and a thematic analysis conducted. FINDINGS: Key themes from the students and registered nurses were knowledge and preparedness for specialist placement, team work and being included and customising learning needs. CONCLUSION: Speciality placements provide a valuable experience for the undergraduate nurse including opportunities to see excellence in team work, communication and assessment as well as identifying future intention to become an oncology or renal specialist nurse.