Online multidisciplinary integrated rural healthcare education programs during the COVID-19 pandemic for students from different universities: experiences and guidelines

Purpose

The COVID-19 pandemic has led to “forced innovation” in the health education industry. High-quality training of the future rural health workforce is crucial to ensure a pipeline of rural health practitioners to meet the needs of rural communities. This paper describes the implementation of an online multidisciplinary teaching program focusing on integrated care and the needs of rural communities.

Design/methodology/approach

A multidisciplinary teaching program was adapted to allow students from various disciplines and universities to learn together during the COVID-19 pandemic. Contemporary issues such as the National Aged Care Advocacy Program for Residential Aged Care COVID-19 Project were explored during the program.

Findings

This case study describes how the program was adopted, how learning needs were met, practical examples (e.g. the Hand Hygiene Advocacy within a Rural School Setting Project), the challenges faced and solutions developed to address these challenges. Guidelines are proposed for remote multidisciplinary learning among health professional students, including those in medical, nursing, pharmacy, dentistry, and allied health disciplines.

Originality/value

The originality of this program centers around students from multiple universities and disciplines and various year levels learning together in a rural area over an extended period of time. Collaboration among universities assists educators in rural areas to achieve critical mass to teach students. In addition it provides experiences and guidance for the work integrated learning sector, rural health workforce practitioners, rural clinical schools, universities, policy makers, and educators who wish to expand rural online multidisciplinary learning.

Exploring the Intersection Between Academic and Professional Practice During the COVID-19 Pandemic: Undergraduate and Graduate Nursing Students' Experiences

Background

The coronavirus disease-2019 (COVID-19) pandemic has implications for students who are also nurses.

Purpose and Methods

This qualitative descriptive study used a practice development approach to explore the intersection between academic and professional work experiences for undergraduate Post-Diploma Registered Practical Nurses bridging to Registered Nurse Bachelor of Science in Nursing students and Master of Nursing graduate nursing students during the first wave of the COVID-19 pandemic. The study incorporated critical aesthetic reflections that focused on the personal and aesthetic ways of knowing, as a data collection approach and knowledge dissemination strategy.

Results

Analysis of the narrative component of participants’ reflections revealed the following themes: sensing a “call to duty,” experiencing a myriad of emotions, shifting societal and individual perceptions of nursing, and learning in an uncertain environment.

Conclusions

The results of the study can inform educational strategies and academic policies to support this unique nursing population, who are frontline practitioners as well as student learners.

The Differences in Experiences Among Multi-Level Healthcare Leaders, Between the First and the Second Wave of the COVID-19 Pandemic: Two Cross-Sectional Studies Compared

PURPOSE

To identify the differences in experiences during wave I and II of the COVID-19 pandemic among healthcare leaders.

BACKGROUND

It is expected, that working conditions for COVID-19-pandemic frontline staff will change, as health care organizations have gained experience with handling the consequences of the disease.

METHODS

An online survey was sent out to Danish health care leaders during the first and the second pandemic wave. Comparative analyses were performed in relation to three key characteristics: management level, management education and experiences as a leader.

RESULTS

Eighty-nine health care leaders completed both surveys. Significant differences were found within the entire group across the key characteristics as they felt more prepared for each stage of the situation, they had more influence on the decisions taken, and they felt more concerned about the quality of treatment and care and their own health. Further significant results related to the three key characteristics were found at 1) Management level: The heads of department experienced being better informed, having more overview of their tasks and that these were meaningful. The ward managers experienced being more able to work in consistency with own beliefs and values, though they felt more overloaded. 2) Level of management education: Leaders, without a formal management education, experienced being more supported by staff. 3) Years of experiences as leader: Leaders with more than five years of experience, experienced being more prepared and informed, had more influence on decision-making, and were more worried about their own health.

CONCLUSION

The learning from experience that happens naturally in crisis situations is the reason why the leaders feel more prepared. However, there is a need for further leadership and practice development, to create contexts where leaders feel more ready for all aspects of their role.

Insights to Identifying and Managing Pain in Persons With Dementia in Long-Term Care: A Mixed Methods Study Comparing the Abbey Pain Scale and Pain Assessment in Advanced Dementia Scale

Pain is usually identified by specific behaviors driven by the need for relief; however, persons with dementia present a unique challenge for nurses in assessing and managing pain. The aim of this mixed methods study was to explore the relationship between two observational pain scales, expressed need-driven behaviors, and likelihood of medication administration for persons with dementia. The qualitative strand examined nurses' perceptions regarding facilitators and barriers to pain scale use. Quantitative data analysis indicated the Abbey Pain Scale was significantly correlated with behaviors (r[26] = 0.41, p < 0.05) and approached significance with medication administration (r[26] = 0.35, p = 0.067). Qualitative analysis identified three core themes: (a) Challenges in Assessing Persons With Dementia for Pain; (b) Facilitators and Barriers to Pain Management; and (c) Difficulty Caring for Persons With Dementia. Clinical implications suggest the need for a systematic, consistent method of observing pain-related behaviors in persons with dementia. [Journal of Gerontological Nursing, 47(2), 21-30.].

Improving clinical handover in a paediatric ward: implications for nursing management

AIM

To describe how nursing staff in a paediatric ward improved the conduct of clinical handover, using a practise development approach.

BACKGROUND

ISBAR (Identify, Situation, Background, Assessment and Recommendation) is a mnemonic tool to aid the safe transfer of patient information in clinical handover. The nurses identified the need to improve the use of ISBAR, and other issues related to handover that could compromise patient safety and constrain family-centred care.

METHOD

Sixty-one percent of nurses on the ward contributed to issue identification and the design of the educational material, including a set of written and video resources and incorporating the role of a handover coach. Staff performance was evaluated before and after access to the resources using self-administered Likert scales, observation and a focus group.

RESULTS

After the intervention, there was a stronger relationship between the participants' understanding of ISBAR and their application of it in handover. Further, there were statistically significant increases in improved handover practises, including family inclusion and safety checks.

IMPLICATIONS FOR NURSING MANAGEMENT

A practise development approach is useful in the provision of education to guide clinical performance in patient handover. Nurse managers can use this approach to empower their staff to make positive changes to practise.

Improving patient and staff outcomes using practice development

Purpose

The purpose of this paper is to examine the impact of a practice development program, “Essentials of Care” (EOC), on patient and staff outcomes, workplace culture and service delivery.

Design/methodology/approach

A descriptive study design was used to explore the impact of EOC in a district hospital rehabilitation ward. EOC focuses on embedding a person-centered culture within clinical areas and is structured from practice development methodologies. EOC was implemented in a metropolitan district hospital rehabilitation, older person 20-bed, ward.

Findings

Two projects were implemented during EOC. These projects led to nine significant patient and staff outcomes for medication and continence care practices. Outcomes included a reduction in older person complaints by 80 percent, pressure injuries by 62 percent, ward multi resistant staphylococcus aureus infection rates by 50 percent, clinical incidents by 22 percent, older person falls by 14 percent (per 1,000 bed days) and nursing sick leave by 10 percent. There was also a 13 percent improvement in the post nursing workplace satisfaction survey.

Research limitations/implications

This is a single site study and findings may not be suitable for generalizing across ward settings and broader population groups.

Originality/value

The EOC program led to significant improvements for and in clinical practices, staff satisfaction and ward culture. Specifically, the EOC program also identified significant cost savings and brought together the healthcare team in a cohesive and integrated way not previously experienced by staff. Practice development strategies can champion service quality improvement, optimal patient outcomes and consistency within healthcare.

Knowledge 'Translation' as social learning: negotiating the uptake of research-based knowledge in practice

BACKGROUND

Knowledge translation and evidence-based practice have relied on research derived from clinical trials, which are considered to be methodologically rigorous. The result is practice recommendations based on a narrow view of evidence. We discuss how, within a practice environment, in fact individuals adopt and apply new evidence derived from multiple sources through ongoing, iterative learning cycles.

DISCUSSION

The discussion is presented in four sections. After elaborating on the multiple forms of evidence used in practice, in section 2 we argue that the practitioner derives contextualized knowledge through reflective practice. Then, in section 3, the focus shifts from the individual to the team with consideration of social learning and theories of practice. In section 4 we discuss the implications of integrative and negotiated knowledge exchange and generation within the practice environment. Namely, how can we promote the use of research within a team-based, contextualized knowledge environment? We suggest support for: 1) collaborative learning environments for active learning and reflection, 2) engaged scholarship approaches so that practice can inform research in a collaborative manner and 3) leveraging authoritative opinion leaders for their clinical expertise during the shared negotiation of knowledge and research. Our approach also points to implications for studying evidence-informed practice: the identification of practice change (as an outcome) ought to be supplemented with understandings of how and when social negotiation processes occur to achieve integrated knowledge. This article discusses practice knowledge as dependent on the practice context and on social learning processes, and suggests how research knowledge uptake might be supported from this vantage point.

The need for predictability in coordination of ventilator treatment of newborn infants--a qualitative study

OBJECTIVE

New strategies for interprofessional collaboration are needed to achieve best practice in the care of ventilated newborns. This study explores what physicians and nurses believe to be important to improve collaboration during ventilator treatment.

METHODS

Qualitative data collected from one focus group were analysed using Gittell's theory of relational coordination.

RESULTS

To optimise communication about and coordination of ventilator treatment, six strategies were needed: (1) a pathway toward the goal for each newborn, (2) regular meetings, (3) accurate communication following an established pattern in the rounds conference, (4) collaboration to improve interprofessional level of knowledge, (5) courage to communicate one's own point of view, and (6) flexible responsibility in extubation situations.

CONCLUSION

By identifying weak areas in collaboration, nurses and physicians were inspired to suggest and discuss concrete improvements of work practices in the neonatal intensive care unit. Nurses and physicians can coordinate ventilator treatment by using a pathway and at the same time enhance nurses' involvement and responsibility in order to increase the flexibility of job boundaries, allowing the professions to cover for each other's work.

The Power of Synergy: An Academic/Clinical Partnership for Transformational Change

Background. A programme of postgraduate study was developed in partnership between a health board and a university in New Zealand, having identified critical thinking and practice change as key determinants of good care delivery. Aim. To explore the impact after 12 months of a postgraduate programme for registered nurses on patient assessment and clinical reasoning, and the status of implementation plans for improved patient care. Design. Outcome evaluation using a survey and focus groups. Setting. On location at a hospital in a small city in New Zealand that provides healthcare services for 102,000 people across rural and urban areas. Participants. Registered nurses who had completed the programme (N=28) and seven clinical mentors. Methods. A survey, focus groups, and follow-up data about quality improvement projects were used to explore how the programme was experienced and its impact. Results. The survey revealed perceptions of improved knowledge and skills but a lack of confidence in communicating with medical staff. Of 28 quality improvement projects planned, all but three had been implemented and were still in use. Two themes were generated from focus group data: “new ways of thinking” and “doing things differently.” Conclusions. This academic/clinical partnership positively influenced nurses’ knowledge and skills, encouraged critical thinking and self-efficacy, and resulted in the sustained implementation of nurse-initiated projects intended to improve patient care.

Fostering person-centered care among nursing students: creative pedagogical approaches to developing personal knowing

Person-centered care (PCC) is grounded in principles of respect, autonomy, and empowerment and requires the development of interpersonal relationships. For nursing students to engage in PCC, they need to intentionally develop personal knowing, which is an essential attribute of therapeutic relationships. Developing personal knowing, as well as professional knowledge, positions students to enact PCC in their practice. Faculty members play a vital role in fostering the development of personal knowing by creating opportunities for students in which genuine and respectful dialogue, reflection, self-awareness, and critical thinking can take place. This article explores several creative approaches faculty have used to actualize these qualities in their teaching-learning encounters with nursing students at various stages of their students' professional development. These approaches offer experiential teaching-learning opportunities that foster the development of personal knowing, as well as constructive and respectful relationships between faculty and students, therefore laying the groundwork for PCC in practice settings.

Practice what you preach: developing person-centred culture in inpatient mental health settings through strengths-based, transformational leadership

The experience of nursing staff and consumers in inpatient mental health wards is often reported as being negative. Efforts to improve culture and practice have had limited success, with ineffective leadership, staff resistance, and unresponsive organisational culture identified as common barriers to change. Practice development has been promoted as an approach to developing person-centred culture that enables professional development through participation, learning and empowerment. For person-centred practice to flourish, organisational leadership at all levels must reflect the same principles. In preparation for the opening of a new integrated mental health service, an inpatient mental health team participated in a practice development project. An action research approach was used to facilitate a series of "away days," initially with the nursing team and then other members of the multidisciplinary team (MDT). Transformational leadership principles were adopted in the facilitation of team activities underpinned by strengths and solution-focused practices. Evaluation of the project by staff members was very positive and there was a high level of participation in practice development activities. The project resulted in the creation of a development plan for the ward, which prioritised five key themes: person-centred care, personal recovery, strengths-based principles, and evidence-based and values-based care. The project outcomes highlight the importance of leadership, which parallels the ideals promoted for clinical practice.

Barriers and enablers to implementation of a New Zealand-wide guideline for assessment and management of cardiovascular risk in primary health care: a template analysis

AIM

The aim of this study was to identify the enablers and barriers to guideline implementation in a primary healthcare setting by employing the Promoting Action on Research Implementation in Health Services (PARIHS) framework as a template for data analysis and interpretation.

BACKGROUND

The use of clinical practice guidelines is pivotal to improving health outcomes. However, the implementation of guidelines into practice is complex, unpredictable, and, in spite of much investigation, remains resistant to explanation of what works and why. Optimising the enablers and minimising the barriers to implementation of a guideline for reducing cardiovascular disease risk has the potential to significantly reduce the burden of disease. The PARIHS framework has been successfully applied in a number of clinical contexts and has been found useful in illuminating the barriers and enablers to evidence implementation.

APPROACH

This qualitative study involved focus groups with 20 primary healthcare nurses, 4 general practitioners, 5 managers, and individual interviews with 3 funder/planners who discussed their contribution to the use of a guideline for the assessment and management of cardiovascular risk. Template analysis based on the PARIHS framework was applied to semi-structured narrative data to provide an in-depth analysis of the barriers and enablers to implementation of the guideline.

CONCLUSIONS

The lack of facilitation of the guideline into practice was a major barrier to implementation. Implementation plans that address the concerns and complexities of everyday practice are an essential aspect of guideline development. The PARIHS framework was found to be comprehensive and accommodating of the complexity of everyday practice associated with guideline implementation in primary health care. The pertinence of the framework confirms its usefulness as a tool to guide implementation.

The Admiral Nurse Academy: a clinical academic pathway to support a specialist dementia nursing service

Purpose

This paper seeks to provide an overview of The Admiral Nurse Academy, which provides a web‐based resource for the clinical and academic development of all admiral nurses. Its role is to: facilitate changes to practice development and group supervision; support knowledge development and learning and regulate the Admiral Nurse Induction Programme. The introduction of the Admiral Nurse Competency Framework in 2003 marked its beginning.

Design/methodology/approach

The paper provides background on the development and role of Admiral Nursing and an overview of The Admiral Nurse Academy in providing training.

Findings

The need for Admiral Nurses to develop a transparent framework of regulating their practice and learning is consistent both with developments in nursing more widely and with recent UK policy emphasis on enhancing the quality of the dementia care workforce. In addition to offering a clinical and academic pathway tailored to each Admiral Nurse, the academy offers a route for those practicing at an advanced level to ensure their clinical expertise and leadership skills are commensurate with master's level qualifications. Dementia UK promotes and maintains the business development of admiral nursing. A senior Admiral Nurse group maintains and oversees the academy.

Originality/value

At a time when public sector resources are shrinking whilst demands on care services and calls for improved care quality are increasing, The Admiral Nurse Academy offers a timely reminder of the importance of practice development for specialist nurses working with people with dementia and their family carers wherever they may be in the service system and whatever their level of need.

Engaged scholarship and research impact: integrating the doing and using of research in practice

Demonstrating impact from research has always been a key consideration in the knowledge production business. However, it can be argued that the models and frameworks available for enabling such impact to be demonstrated are poorly developed. Those that do exist are predominantly derived from a linear uni-dimensional perspective of the knowledge flow from the academy to practice. Little sustained attention has been given to the development of models and ways of working that go beyond traditional approaches to impact monitoring through impact factors and citation indices. Engaged scholarship offers a framework that has as an explicit intention, the creation of connections between researchers/universities and practitioners/health care providers.

In this paper a model is offered derived from the theory of ‘engaged scholarship’. The principles of engaged scholarship will be outlined, as well as an articulation of engaged scholarship as an approach to the co-production of knowledge. An example of a practice development and evaluation study will be offered that is consistent with the principles of engaged scholarship. The need for a strategic approach to the development of engaged scholarship will be highlighted, as well as the need for sustained partnerships between the academy and practice.