Safe medication administration : Perspectives from an appreciative inquiry of the practice of registered nurses in regional Australia
- Authors: Martyn, Julie-Anne , Paliadelis, Penny
- Date: 2019
- Type: Text , Journal article
- Relation: Nurse Education in Practice Vol. 34, no. (2019), p. 111-116
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- Description: Registered Nurses (RNs) are regulated health professionals who are educated and accountable for safe medication administration (MA). Binding their practice are standards, policies, procedure and legislation. MA competence is taught and assessed during professional pre-registration education programs. However, different philosophies, theories and models are used by education providers making curriculum content disparate and competency frameworks diverse. Additionally, healthcare contexts are increasingly complex and clinical environments unpredictable. Competency models must respect contemporary practice. This paper focusses on the outcomes of Australian PhD research that combined Appreciative Inquiry (AI) principles with a qualitative study to identify MA safety strategies. In this 2-phase descriptive study, twenty RNs were observed then interviewed about their MA experiences. This paper discusses the interview findings. The participants explained how they assessed patient's needs and implemented strategies to administer medications safely. They presented their actions as being underpinned by a desire to do ‘the right thing for the patient’ despite their practice going beyond traditional procedural frameworks and not reflecting organisational protocols. Instead, they developed common strategies to enhance safe MA. The participants’ described using clinical reasoning and patient-centredness during MA. This study contributes to the knowledge needed for future practice development by highlighting what works.
The safe administration of medication : Nursing behaviours beyond the five-rights
- Authors: Martyn, Julie-Anne , Paliadelis, Penny , Perry, Chad
- Date: 2019
- Type: Text , Journal article
- Relation: Nurse Education in Practice Vol. 37, no. (2019), p. 109-114
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- Description: This paper discusses the findings from the observation phase of a more extensive, appreciative inquiry qualitative study exploring registered nurses' experiences of administering medications. The observations aimed to explore the participants' application of the five-rights of medication administration in practice. Twenty registered nurses working in inpatient medical/surgical units at a regional Australian hospital were observed administering medications from the commencement to the completion of their shift. A data collection tool based on the five-rights of medication administration was used. The findings indicated that medication administration was not as routine as the rights framework suggests. Indeed, what was observed rarely reflected all the criteria of the rights framework. Notably, in practice, some of the rights were unable to be observed because the critical thinking that underpins the rights are implicit. However, the participants were observed to implement strategies beyond those described by the rights framework that ensured safe and timely medication administration. In brief, medication administration in contemporary healthcare settings is more complicated than the linear process suggested by the rights framework. So more attention is warranted, to the safe practice strategies of nurses who, to deal with complex clinical contexts. Their person-centred strategies respond to patient circumstances and maintain safety.
Factors that affect the job satisfaction of Saudi Arabian nurses
- Authors: Alotaibi, Jazi , Paliadelis, Penny , Valenzuela, Fredy‐Roberto
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Nursing Management Vol. 24, no. 3 (2016), p. 275-282
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- Description: Background Saudi Arabia has a chronic shortage of Saudi national nurses. This research contributes to a greater understanding of how job satisfaction influences the recruitment and retention of Saudi nationals within the nursing profession. Methods Qualitative data were gathered from Saudi nurses and content analysis was used to identify themes in the written responses. Results Four main themes emerged from the data: lack of educational opportunities and support and the poor image of the nursing profession, perceptions of favouritism, high workloads and stressful work environment and the effect of religion on job satisfaction. Conclusions Saudi nurses would be more satisfied with their jobs if they had greater access to educational opportunities and if there was a reduction in workload and the perceived favouritism in the workplace was addressed. Religion was also found to play a significant role in supporting job satisfaction. Implications for nursing management These findings suggest the development of educational scholarships, as well as policies that better support equity in the workplace, to address Saudi nurses’ level of job satisfaction. The generally positive impact of cultural and religious beliefs is also highlighted in this study.
Learning from clinical placement experience : Analysing nursing students' final reflections in a digital storytelling activity
- Authors: Paliadelis, Penny , Wood, Pamela
- Date: 2016
- Type: Text , Journal article
- Relation: Nurse Education in Practice Vol. 20, no. (2016), p. 39-44
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- Description: This paper reports on the learning potential of a reflective activity undertaken by final year nursing students, in which they were asked to recount two meaningful events that occurred during their clinical placements over the duration of their 3-year nursing degree program and reflect on how these events contributed to their learning to become beginning level Registered Nurses (RNs). This descriptive qualitative study gathered narratives from 92 students as individual postings in an online forum created within the University's learning management system. An analysis of the students' reflections are the focus of this paper particularly in relation to the value of reflecting on the identified events. Four themes emerged that clearly highlight the way in which these students interpreted and learned from both positive and negative clinical experiences, their strong desire to fit into their new role and their ability to re-imagine how they might respond to clinical events when they become Registered Nurses. The findings of this study may contribute to developing nursing curricula that better prepares final year students for the realities of practice. © 2016 Elsevier Ltd.
The development and evaluation of online stories to enhance clinical learning experiences across health professions in rural Australia
- Authors: Paliadelis, Penny , Stupans, Ieva , Parker, Vicki , Piper, Donella , Gillan, Pauline , Lea, Jackie , Jarrott, Helen Mary , Wilson, Rhonda , Hudson, Judith , Fagan, Anthea
- Date: 2015
- Type: Text , Journal article
- Relation: Collegian Vol. 22, no. 4 (2015), p.397-400
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'Right' for publication: Strategies for supporting novice writers across health and medical disciplines
- Authors: Paliadelis, Penny , Parker, Vicki , Parmenter, Glenda , Maple,
- Date: 2014
- Type: Text , Journal article
- Relation: Australian Health Review Vol. , no. (2014), p.165-168
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Effective interprofessional collaboration in rural contexts : A research protocol
- Authors: Mitchell, Rebecca , Paliadelis, Penny , McNeil, Karen , Parker, Vicki , Giles, Michelle , Higgins, Isabel , Parmenter, Glenda , Ahrens, Yvonne
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 69, no. 10 (2013), p. 2317-2326
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- Description: Abstract AIM: To describe the research protocol that will be used to investigate factors contributing to effective interprofessional practice in a rural context in Australia. BACKGROUND: Interprofessional practice is a key strategy for overcoming rural health challenges; however, our knowledge of interprofessional initiatives and consequences in rural areas is limited. DESIGN: A modified realistic evaluation approach will be used to explore the structures, systems, and social processes contributing to effective interprofessional outcomes. This 'context-mechanism-outcome' approach provides a useful framework for identifying why and how interprofessional practice works in rural contexts. METHOD: Initial propositions regarding the factors that explain effective collaborative practice will be generated through interviews with lead clinicians, policy-makers, and clinician managers. Clinician interviews, document analysis, and multi-participant focus groups will be used as evidence to support, refine, or redevelop the initial propositions. This will allow the development of a model of rural interprofessional practice that will explain how and why collaborative approaches work in rural environments. This study is funded by an Institute of Rural Clinical Services and Teaching grant (January 2010). DISCUSSION: Rural healthcare challenges are well documented; however, studies investigating the nature of interprofessional practice in rural contexts are not common. Rural contexts also present research design, particularly data collection, challenges. This proposed research is one of the first to identify the factors that facilitate or constrain effective interprofessional work in rural settings. This is particularly important, given the continuing workforce shortages and maldistribution and poorer health outcomes in rural communities globally.
Nurse managers don't get the corner office
- Authors: Paliadelis, Penny
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Nursing Manager Vol. 21, no. 2 (Special Issue) (2013), p. 377-386
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- Description: To provide an original perspective on the power and status of first-line nurse managers by observing their working environment. BACKGROUND: The role of first-line nurse managers includes clinical, administrative and managerial components, with their responsibilities not always reflected in their level of organizational power. The business literature suggests that an appropriately resourced workspace is not merely functional, it also confers power and status. METHOD: Twenty Australian rural nurse managers' workspaces were observed, as part of a larger qualitative study that explored their role and organizational power using semi-structured interviews. The observational data consisted of detailed researcher notes that were analysed thematically. RESULTS: The nurse managers' workspaces were suboptimal and did not provide sufficient physical space or resources for the participants' to manage tasks effectively. These results were considered using Kanter's theory of organizational power. IMPLICATIONS FOR NURSING MANAGEMENT: The findings support those reported in the business literature that inadequate physical workspaces are counterproductive in terms of both functionality and organizational power. Suggestions are made regarding the workspace needs of first-line nurse managers, based on a closer alignment between the work environment and their role responsibilities. These findings have implications for decisions regarding organizational support of first-line nurse managers.
Negotiating Intersections: Inter-Professional Practice in Rural Health Care Contexts
- Authors: Parker, Vicki , Mitchell, Rebecca , McNeil, Karen , Ahrens, Yvonne , Higgins, Isabel , Parmenter, Glenda , Paliadelis, Penny , Giles, Michelle
- Date: 2012
- Type: Text , Conference paper
- Relation: International Journal of Qualitative Methods Vol. 11, p. 750-751
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- Description: Health care in most contexts depends on teams of professionals with diverse skills working together synergistically to achieve optimal outcomes for patients and their families. The way is which interprofessional practice occurs in rural healthcare varies from that which occurs in metropolitan areas. This variation reflects the social, economic and geographic characteristics of rural communities. Further, rural workforce challenges and lack of access to resources and services are compounded by the difficulties associated with the intersection of speciality driven metropolitan models and the generalist models of care that are a feature of rural health care. This study’s aim was to examine how IPP happens in rural contexts, and to identify barriers, enablers and existing and potential models of IPP. Interviews were conducted with health professionals (nurses, doctors and allied health) in a range of rural healthcare contexts (Hospitals, GP practices, Multi-Purpose Services and Community centres) in NSW, Australia. Interview data were supplemented with document review and review of communication systems. Findings suggest that the nature of IPP in rural contexts is diverse and determined by a number of critical factors including rurality, connection to community, availability of staff, funding programs and specific interests and skills of staff. Rural IPP is characterised by a small numbers of professionals across few professions, focus on generalist practice and informal communication systems. IPP is growing in response to changes in government funding models and policy and through the establishment or strengthening of pivotal co-ordinating roles, with a clear mandate to involve other professionals and patients in decision making.
(W)riting across and within: Providing a vehicle for sharing local nursing and midwifery projects and innovation
- Authors: Parker, Vicki , Giles, Michelle , Parementer, Glenda , Paliadelis, Penny , Turner, Catherine
- Date: 2010
- Type: Text , Journal article
- Relation: Nurse education in pracice Vol. 10, no. 6 (2010), p. 327-332
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- Description: Summary Introduction This paper describes the development and outcomes of a locally-based journal that is contributed to and managed by nurses, midwives and academics within an area health service (AHS) in NSW, Australia. Background Nurses and midwives are often engaged in scholarly and rigorous activities aimed at improving practice and patient outcomes. However, often these endeavours remain unreported, unpublished and hence not shared for the benefit of others. Reasons given for nurses’ and midwives’ persistent reluctance to publish are well documented in the literature. Lack of expertise and understanding of the publication process, together with lack of confidence and opportunity are the reasons most often cited. To overcome these barriers we developed a local journal called Handover that provides a non-threatening, supportive opportunity for nurses and midwives to develop skills in writing and reviewing articles for publication. Handover was established and is managed by editorial committee members from the area health service and the two local universities. Each institution agreed to co-fund the journal which is published twice yearly. Two editions of the journal have been published with wide ranging content and contributions from across the AHS. Writing mentorship and support systems have been established. Reviewers workshop have been conducted and novice reviewers mentored by experienced reviewers. Conclusion Our experience indicates that a locally based and owned journal can motivate and support novice writers and offers one solution to many of the barriers to publication identified in the literature. Keywords
Bush Battles: The Challenges of Providing Acute Health Care in Rural Contexts in Australia
- Authors: Parker, Vicki , Giles, Michelle , Parmenter, Glenda , Higgins, Isabel , Paliadelis, Penny , White, Angela
- Date: 2010
- Type: Text , Conference paper
- Relation: The 16th International Interdisciplinary Conference Vol. 9, p. 377-377
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- Description: Introduction. In Australia, the rural health care environment is characterized by increasing disadvantage in relation to access to services and resources. Within this context, health professionals are challenged to provide what they feel is good-quality health care in a community of which they are a part. This paper presents the results of a study which aimed to • identify challenges confronting health care professionals in rural acute care settings and • facilitate interprofessional collaboration in working toward improved patient outcomes and staff participation. Method. A mixed method approach involved a consultative, participatory process. An initial survey was followed by focus groups and workshops. The target population was health care professionals across disciplines, in rural acute care facilities within one large Area Health Service in NSW, Australia. Workshops facilitated interdisciplinary collaboration to identify strategies for addressing concerns with the aim of developing priorities for practice change projects. Results. Results highlighted issues to do with staffing, isolation and communication as most significantly impacting on staff and patient outcomes. Access to resources and support services was the most frequently cited challenge. Results were consistent across professions and sites within the Area Health service. Focus groups identified a range of issues related to geographic and professional isolation, working with and apart from larger centers, generalist practice, and insufficient services and staff. Conclusion. Findings point to the urgent need to support clinicians through the mobilization of strategies that are context specific, locally based and led, but at the same time transferrable across sites.
The lure of the bush : Do rural placements influence student nurses to seek employment in rural settings?
- Authors: Lea, Jackie , Cruickshank, Mary , Paliadelis, Penny , Parmenter, Glenda , Sanderson, Helena , Thornberry, Patricia
- Date: 2008
- Type: Text , Journal article
- Relation: Collegian Vol. 15, no. 2 (May 2008), p. 77-82
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- Description: The aim of this study was to investigate whether rural clinical placements for student nurses at a rural university in New South Wales influence their decision to join the rural and remote Registered Nurse workforce. The study utilised a convenience sample of final year Bachelor of Nursing students at a rural university campus, and consisted of two stages of data collection. Stage One employed a pre- and post-clinical placement survey design that elicited both demographic and qualitative data. Stage Two consisted of individual interviews with a sample of final year nursing students while they were on a rural clinical placement. The findings highlight the factors that influence final year students' decisions to seek employment in rural healthcare facilities. These findings will be of interest to nurse academics concerned with ensuring that undergraduate nursing curricula relate to rural nursing practice in Australia and to those involved in recruitment of new graduate RN's to rural nursing practice.
The working world of nursing unit managers
- Authors: Paliadelis, Penny
- Date: 2008
- Type: Text , Journal article
- Relation: Australian Health Review Vol. 32, no. 2 (2008), p. 256-264
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- Description: his paper seeks to explore the responsibility and power of the role of nursing unit managers (NUMs) in rural New South Wales using Kanter's theory of organisational power as a framework. Using in-depth individual interviews with twenty NUMs, data were analysed from four perspectives to gain a deep understanding of the NUMs' working world. The findings show that the NUMs' role is substantive, encompassing both clinical and managerial functions. Overall, the findings indicate that the participants lacked power commensurate with their role responsibilities.
Caring for each other: How do nurse managers 'manage' their role?
- Authors: Paliadelis, Penny , Cruickshank, Mary , Sheridan, Alison
- Date: 2007
- Type: Text , Journal article
- Relation: Journal of Nursing Management Vol. 15, no. 8 (November 2007), p. 830-837
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- Description: Aim: This article will report on one aspect of a larger study that explored the working lives of nursing unit managers in Australia. The support of nursing unit managers is the focus of this article. Background: There is evidence in the recent literature that nurses are not generally supportive of each other and that nursing unit managers are not adequately supported to manage their expanding administrative and managerial responsibilities. Method: A qualitative feminist approach was used to conduct individual interviews with 20 nursing unit managers employed in the public healthcare system in Australia. Results: The results indicated that participants did not feel supported by the wider organization, but gained support from within their own ranks. Conclusions: The results showed a strong support system within the participant group, despite evidence in the literature that nurses, generally, are not supportive of each other. The results of this study may be used in the development of more effective support mechanisms for nurse managers.
Rural nursing unit managers : Education and support for the role
- Authors: Paliadelis, Penny
- Date: 2005
- Type: Text , Journal article
- Relation: Rural and remote health Vol. 5, no. 1 (January 2005), p. 325
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- Description: INTRODUCTION: Nursing unit managers (NUMs) occupy the often unenviable position of first-line management in many health services in Australia. As such, their role is complex and multifaceted requiring an intertwining of their clinical and managerial responsibilities. While there is an abundance of studies that explore and describe the various management roles in many professions and industries, little is known about the experiences of nurses as managers, particularly in rural settings. This article focuses on the education and support needs of rural nursing unit managers. METHODS: A qualitative study design was used to explore the stories of a number of nursing unit managers in rural New South Wales, Australia. Data was collected using semi-structured individual interviews. Data was analysed using a voice-relational method as a framework for more clearly hearing the voices of participants. This method of data analysis is particularly useful for hearing from those who do not usually have a 'strong' voice, for gaining an understanding of the context of the interviews, and for acknowledging the role of the researcher in the research process. All NUMs employed in a single regional health authority in rural Australia were invited to participate. RESULTS: Out of 42 NUMs in the region, 20 agreed to be interviewed. Nursing unit managers were asked to reflect on their experiences prior to and during the early days within the position. In summary, all the NUMs: believed they were promoted because of their clinical expertise; felt unprepared for the managerial and administrative aspects of their role; continued to identify as nurses rather than as managers; found the role isolated them from their former peer group. Those employed in small facilities had limited opportunities for education and peer support. CONCLUSIONS: Based on the NUMs' experiences and suggestions, the following information would have helped them to cope with the demands of their new role: information and discussions about the role expectations of first-line manager, from both an employee and employer perspective; human resource and financial management skill development; leadership skills; negotiation and conflict resolution; a clear and realistic role description.
An exploration of the role that expert knowledge plays in the assessment of undergraduate clinical competence: registered nurses' experiences
- Authors: Paliadelis, Penny , Cruickshank, Mary
- Date: 2003
- Type: Text , Journal article
- Relation: Rural and remote health Vol. 3, no. 2 (2003 2003), p. 191-191
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- Description: INTRODUCTION: This phenomenological study, conducted in rural Australia, explored the experiences of registered nurses (RNs) responsible for assessing the clinical competence of undergraduate nursing students. The purpose of the study was to gain insight into the experiences of a group of registered nurses who assess student competence by exploring how they perform the assessment process. A key assumption on which this study was based is that the participants are 'expert nurses', as defined by Benner. METHOD: Participants were recruited using purposive sampling from a population of registered nurses who assessed the clinical performance of undergraduate nursing students studying at a rural university in New South Wales, Australia. Individual unstructured interviews were conducted and audiotaped with the participants' permission. The analysed data were given to all participants to check for accuracy and validation and a thematic analysis of the data was conducted. RESULTS: Four themes were identified; the major theme, described in this article, was identified in all the narratives. The participants all acknowledged that they use their expert nursing knowledge to assist them when assessing the clinical competence of nursing students. The participants used a variety of terms to describe this type of knowledge such as intuition, instinct, gut feeling and 'just knowing'. CONCLUSION: While the findings of this study confirmed that experienced nurses unconsciously use their expert nursing knowledge when making decisions about students' competence, the findings also indicated a lack of awareness or underestimation of the value of expert clinical knowledge. These findings reinforce the need for further investigation to determine the role of expert nursing knowledge in the clinical competency assessment process. This is particularly significant for rural registered nurses employed in small health-care facilities, who often assume the role of assessors of student clinical competence.