A Unique Model for Developing Continuing Education Resources for Health Professionals in Geographically Dispersed Health Organizations.

ABSTRACT: The provision of high quality, equitable, and accessible education resources is a key to supporting continuing professional development (CPD) in health organizations. The Health Education and Training Institute (HETI) and its operational model for districts (District HETI Operational Model), is a novel approach that supports this imperative for over 155,000 staff working across the state of New South Wales (NSW), Australia. The model uses three principles in education and training development. These include collaborative partnerships, rapid resource development, and effective leadership within virtual teams. A state-wide learning management system has been implemented to support this initiative. Over 451 standardized, education, and training online modules have been developed for medical, nursing and midwifery, dental, allied health, and nonclinical NSW Health employees since 2013. These educational resources are accessible 24 hours a day. Cost-effective online programs have enabled more than 13.6 million learner completions. Program evaluations highlight the value of these resources in providing a positive learning experience. Furthermore, the District HETI Operational Model has been recognized by multiple national and international excellence awards in learning and development. The principles of the District HETI Operational Model apply to other health organizations that may choose to adopt a similar model. Such a model may support equity of access to contemporary, standardized, evidence-based education resources for health professionals working across geographically and clinically diverse environments. Implementation of a similar model for future CPD interventions warrants consideration by practitioners, researchers, and policymakers.

Attitudes of health professionals to using routinely collected clinical data for performance feedback and personalised professional development.

OBJECTIVES: To learn the attitudes of health professionals, health informaticians and information communication technology professionals to using data in electronic health records (eHRs) for performance feedback and professional development. DESIGN: Qualitative research in a co-design framework. Health professionals' perceptions of the accessibility of data in eHRs, and barriers to and enablers of using these data in performance feedback and professional development were explored in co-design workshops. Audio recordings of the workshops were transcribed, de-identified, and thematically analysed. SETTING, PARTICIPANTS: A total of nine co-design workshops were held in two major public hospitals in Sydney: three for nursing staff (ten participants), three for doctors (15 participants), and one each for information communication technology professionals (six participants), health informaticians (four participants), and allied health professionals (13 participants). MAIN OUTCOME MEASURES: Key themes related to attitudes of participants to the secondary use of eHR data for improving health care practice. RESULTS: Six themes emerged from the discussions in the workshops: enthusiasm for feeding back clinical data; formative rather than punitive use; peer comparison, benchmarking, and collaborative learning; data access and use; capturing complex clinical narratives; and system design challenges. Barriers to secondary use of eHR data included access to information, measuring performance on the basis of eHR data, and technical questions. CONCLUSIONS: Our findings will inform the development of programs designed to utilise routinely collected eHR data for performance feedback and professional development.

An eHealth Capabilities Framework for Graduates and Health Professionals: Mixed-Methods Study.

BACKGROUND: The demand for an eHealth-ready and adaptable workforce is placing increasing pressure on universities to deliver eHealth education. At present, eHealth education is largely focused on components of eHealth rather than considering a curriculum-wide approach. OBJECTIVE: This study aimed to develop a framework that could be used to guide health curriculum design based on current evidence, and stakeholder perceptions of eHealth capabilities expected of tertiary health graduates. METHODS: A 3-phase, mixed-methods approach incorporated the results of a literature review, focus groups, and a Delphi process to develop a framework of eHealth capability statements. RESULTS: Participants (N=39) with expertise or experience in eHealth education, practice, or policy provided feedback on the proposed framework, and following the fourth iteration of this process, consensus was achieved. The final framework consisted of 4 higher-level capability statements that describe the learning outcomes expected of university graduates across the domains of (1) digital health technologies, systems, and policies; (2) clinical practice; (3) data analysis and knowledge creation; and (4) technology implementation and codesign. Across the capability statements are 40 performance cues that provide examples of how these capabilities might be demonstrated. CONCLUSIONS: The results of this study inform a cross-faculty eHealth curriculum that aligns with workforce expectations. There is a need for educational curriculum to reinforce existing eHealth capabilities, adapt existing capabilities to make them transferable to novel eHealth contexts, and introduce new learning opportunities for interactions with technologies within education and practice encounters. As such, the capability framework developed may assist in the application of eHealth by emerging and existing health care professionals. Future research needs to explore the potential for integration of findings into workforce development programs.

Pediatric Nurses' Perceptions of Medication Safety and Medication Error: A Mixed Methods Study.

This study aims to outline the current workplace culture of medication practice in a pediatric medical ward. The objective is to explore the perceptions of nurses in a pediatric clinical setting as to why medication administration errors occur. As nurses have a central role in the medication process, it is essential to explore nurses' perceptions of the factors influencing the medication process. Without this understanding, it is difficult to develop effective prevention strategies aimed at reducing medication administration errors. Previous studies were limited to exploring a single and specific aspect of medication safety. The methods used in these studies were limited to survey designs which may lead to incomplete or inadequate information being provided. This study is phase 1 on an action research project. Data collection included a direct observation of nurses during medication preparation and administration, audit based on the medication policy, and guidelines and focus groups with nursing staff. A thematic analysis was undertaken by each author independently to analyze the observation notes and focus group transcripts. Simple descriptive statistics were used to analyze the audit data. The study was conducted in a specialized pediatric medical ward. Four key themes were identified from the combined quantitative and qualitative data: (1) understanding medication errors, (2) the busy-ness of nurses, (3) the physical environment, and (4) compliance with medication policy and practice guidelines. Workload, frequent interruptions to process, poor physical environment design, lack of preparation space, and impractical medication policies are identified as barriers to safe medication practice. Overcoming these barriers requires organizations to review medication process policies and engage nurses more in medication safety research and in designing clinical guidelines for their own practice.

Domains of practice and Advanced Practice Nursing in Australia.

A key component of workforce reform is the international growth in Advanced Practice Nursing (APN) roles. This study evaluated one APN role in Australia, the Clinical Nurse Consultant (CNC). All 56 CNCs employed in a tertiary hospital in New South Wales took part in the study. Demographic and work activity data were collected by an online questionnaire. Face-to-face interviews included the administration of a 50-point tool to score the level of practice of each CNC against five domains. The domains of practice did not appear to have played a central role in the design of these CNC roles despite being defined in the industrial legislation and linked to a pay structure. There was widespread variability in the level of practice both within and between the CNC grades as well as significant differences in job content. Few CNCs managed to achieve a moderate level of practice across all five domains. The findings suggest that the distinctive features of the CNC roles as articulated in the domains of practice are often not realized in practice.

Development of a tool to describe the role of the clinical nurse consultant in Australia.

AIMS AND OBJECTIVES: To develop a tool for defining and measuring the role characteristics and responsibilities of an advanced practice nursing role in Australia. BACKGROUND: Internationally, there is considerable confusion about the precise role responsibilities of advanced practice nursing positions. In Australia, the clinical nurse consultant is an advanced practice role with five nominated domains of practice. However, there are no tools for measuring the performance of clinical nurse consultants against the listed domains. DESIGN AND METHODS: Participants were 56 clinical nurse consultants at a tertiary public hospital. The existing literature, an online survey, and position descriptions were used to generate the a priori themes for the initial template. Semi-structured interviews were conducted (in 2010) to test the template characteristics. The template underwent multiple iterations in its development. RESULTS: A 50-item tool was devised, which consisted of five domains with a ten-point hierarchical scale within each domain. In preliminary testing, the revised template was found to provide greater clarity regarding roles and grades than the original position descriptions. CONCLUSIONS: Further testing and refinement of the modified rating scale is needed, but it offers the possibility of a new tool that can be used by health service managers to determine the grade of a clinical nurse consultant position and for evaluating role performance. RELEVANCE TO CLINICAL PRACTICE: This preliminary study suggests that the tool provides a useful means of measuring advanced nursing practice and responsibilities across different domains and levels of appointment. The tool may be able to be adapted for use with other advanced practice nursing roles both within Australia and internationally.

The role and functions of Clinical Nurse Consultants, an Australian advanced practice role: a descriptive exploratory cohort study.

BACKGROUND: The NSW Health Policy Directive (NSW Department of Health, 2000) lists clinical service and consultancy; clinical leadership; research; education; clinical services planning and management as the five domains of practice for nurses appointed as Clinical Nurse Consultants (CNCs), an Australian advanced practice nurse (APN) role. However, there is no clear definition of what is meant by advanced practice in the Australian nursing context. Nowhere is this more evident than in differentiating between the roles of Clinical Nurse Consultants (CNCs) and Nurse Practitioners (NP) in NSW. To date, limited empirical research has been done to characterise or delineate CNC role activity and responsibility. OBJECTIVES: To investigate (i) the nature of CNC roles, activities and responsibilities, (ii) differentiate between CNCs by their work patterns and activities, and (iii) empirically conceptualize and differentiate ways CNCs practice in terms of an APN typology. PARTICIPANTS: The study sample was 56 CNCs at one tertiary level public hospital in Australia. METHODS: A descriptive exploratory cohort study was conducted to explore CNC role characteristics and patterns of activity. Data were triangulated using an online survey, a follow-up survey, and semi-structured interviews. The data were analysed using descriptive statistics to examine differences between CNC work patterns and role activities. The survey data and the individual reports were thematically analysed to investigate for difference across the population of CNCs. RESULTS: Interpretation of survey and interview data led to an analyst-developed CNC typology of four CNC categories based on the work patterns and activities of Sole Practitioner, Clinic Coordinator, Clinical Team Coordinator and Clinical Leader. The typology was based on the themes interprofessional, role focus, clinical focus and setting as these themes distinguished and differentiated CNC roles. CONCLUSIONS: The study provides evidence of great diversity and prioritization within CNC roles. The CNC typology identified in this study is similar to the categorisation of the roles of APNs reported by other researchers. With further testing, the CNC typology could be useful to service managers and policy makers in making decision on the category of CNC required for a position and may also be able to be applied to other APN roles.

Director of nursing and midwifery leadership: informed through the lens of critical social science.

AIMS: Highlight the use of critical social science theories, practice development principles and a situational leadership framework within transformational leadership to inform Directors of Nursing and Midwifery (DoNM) practices as leaders. BACKGROUND: Healthcare is constantly changing, unpredictable, strives for quality service and cost containment, which can result in stress and crisis for healthcare workers. DoNM leadership is critical to supporting and leading staff through these complex times within healthcare. KEY ISSUES: Understanding theories, frameworks and their application to real-world practice can assist in supporting individuals and teams to navigate through the changing healthcare environment. CONCLUSION: Blending critical social science theories with practice development principles and the situational leadership framework can assist the DoNM to enact transformational leadership to support the development of individuals and teams to meet the complex healthcare needs of patients within the clinical setting. IMPLICATIONS FOR NURSE MANAGEMENT: This article contributes through the practical application of critical social science theories, practice development principles and situational leadership framework within transformational leadership as an approach for enacting DoNM leadership. To further understand and develop in the role of the contemporary DoNM in leadership, these directors are encouraged to publish their work.

Enhancing cardiac rehabilitation nursing through aligning practice to theory: implications for nursing education.

This article presents a case study that examined the work practice of nurses in a cardiac step-down unit (CSDU). The action research included interviews, participant observation, and a self-reporting questionnaire. Nurses in the unit used a conceptual framework that was inconsistent with the rehabilitation-oriented nursing necessary to enhance patient outcomes in a CSDU. The results of this study show that a need exists for greater alignment between the practice and the educational preparation of nurses who work in a CSDU. A framework such as Dorothea Orem's Self-Care Theory of Nursing (1995) offers a conduit for nurses to deliver care appropriate to CSDU patient needs. However, there is a need for continuing education for nursing staff to align the cardiac rehabilitation nursing philosophy and the theories that underpin it (such as the Self-Care Theory) with nursing practice. Practice development provides a mechanism through which to examine the congruence between patient needs and nurse perception of those needs.

Stepping out: education for cardiac recovery.

This paper reports on the conduct of study that investigated the experience of nurses working in a Cardiac Step Down Unit (CSDU). The study was undertaken in order to identify factors that inhibit the smooth running of the unit and impact upon patient care. Case study design was used to explore practices in the CSDU. Data collection strategies included focus groups, semi structured interviews, surveys, self-report, and observation of nursing activity. The case study approach enabled generation of data sets that illuminate the context, culture and working environment of the unit. It was found that the nursing care provided in the unit focussed on the provision of technology oriented rather than patient oriented care and that nurses experienced lack of role clarity about the care they provided. A number of recommendations that emerged from the study have since been implemented in practice and the effect of these changes are being evaluated in a follw up study.

Clinical practice development in Central Coast Health.

Engagement in clinical practice development may be achieved in a range of ways. In this paper we describe the formation of a strategic plan for clinical practice development for Central Coast Health. The plan specifically builds on the work that has already been achieved by clinicians and is inclusive of the multi-disciplinary team. In order to clarify the strategic direction, three levels of clinical practice development are offered as examples of increasingly intensive clinical practice development. In the strategic plan senior personnel are recruited to support area-wide developments. At the same time clinicians are supported to work on specific local projects creating a simultaneous top-down and bottom-up approach. Preparation of clinicians for the challenges of team building and change in practice ensures that people choosing to engage in clinical practice have realistic expectations of the commitment and rewards that may be expected.