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.
Description:
The purpose of this study was to evaluate the treatment integrity of Family-focused Grief Therapy (FFGT), a preventive intervention designed for families at high risk of poor functioning during palliative care and bereavement. From the 81 families participating in a randomized controlled trial (53 assigned to therapy), 28 were randomly selected for this study of treatment fidelity using the ITGT integrity measure. A total of 109 family sessions were appraised. This represented a review of 62 % of treated families, 38 % of total therapy sessions, and 87% of the 15 participating therapists. Weighted mean percentage occurences therapist behaviors permitted trends in therapy application to be observed. Inter-rater reliability using the FFGT integrity measure was satisfactory, with 88 % overall agreement. Eighty-six percent of therapists adhered faithfully to core elements of the model. Therapist competence was evidenced by a strong therapeutic alliance (94 %), affirmation of family strengths in over 90%, and focus on agreed themes in 76 % of sessions. Therapists averaged 10 grief-related questions per session, 7 on communication-related issues during assessment, 7 on conflict late in therapy, and 4 on cohesiveness across the course of therapy. Consistent application of FFGT, with attention to its low-key themes of family communication, cohesiveness, conflict resolution, and shared grief has been demonstrated. The model is generalizable when applied by family therapists. (C) 2004 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Description:
Over the past decade, many questions have been raised about graduates' clinical competence and fitness for practice upon completion of their undergraduate education. Despite the significance of this issue, the perspectives of registered nurses have rarely been examined. This systematic review explores the perceptions of experienced registered nurses regarding the clinical competence of new nursing graduates. Original research studies published between 2004-2014 were identified using electronic databases, reference lists, and by searching "grey literature." Papers were critically reviewed and relevant data extracted and synthesized using an approach based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis. From 153 studies initially identified, 15 original research papers were included. Four main research themes were identified: clinical/technical skills, critical thinking, interaction/communication, and overall readiness for practice. Areas of concern in relation to the clinical competence of new nursing graduates specifically related to two themes: critical thinking and clinical/technical skills. Further research is required on strategies identified within the literature with the ultimate aim of ensuring new nursing graduates are safe and competent practitioners.
Description:
Occupational therapy driver assessment and rehabilitation is an advanced and complex area of practice. Users of this service require that occupational therapy driver assessors are, and remain, competent in their role. Competency standards support and inform occupational therapy driver assessment and rehabilitation practice, ensure standardisation of practice, and determine whether practice can be deemed competent. Competency standards for occupational therapy driver assessors in one Australian state, Victoria, were published in 1998 to provide a benchmark for service provision and guide training. Since then, occupational therapy driver assessor practice has undergone further developments and growth, including a significant increase in research evidence underpinning this advanced practice area. As a result, the competency standards required revision to reflect contemporary practice and enable their use and application across all Australian states and territories. The purpose of the research program reported in this thesis was to revise and validate the Australian Competency Standards for Occupational Therapy Driver Assessors and determine if education and practice using these standards led to increased adherence to their use in clinical practice. A sequential, exploratory, mixed methods design was used within a pragmatist research paradigm to revise and validate the competency standards for occupational therapy driver assessors from a national perspective. Four separate research studies were conducted. In the first study, an overview was undertaken to summarise the current evidence for including cognitive and perceptual assessments within fitness-to-drive evaluations, to inform the revision of the competency standards for occupational therapy driver assessors. The second study involved focus groups with Australian occupational therapy driver assessors and expert educators and identified the changes and revisions required to be made to the Victorian competency standards for occupational therapy driver assessors. Content themes and changes were extracted from the focus groups and combined with research evidence to draft the revised standards. The third study collected feedback from consumers and Australian driver licensing authorities to incorporate into the revised draft. This was followed by a two-round Delphi process with Australian occupational therapy driver assessors to achieve consensus and validate the Australian Competency Standards for Occupational Therapy Driver Assessors. A high level of consensus on the content of all competency standards and underlying practice behaviours was obtained in the final round. Finally, a mixed-methods multiple case-study methodology was adopted, and multiple forms of evidence were collected from file audits, semi-structured interviews and an individualised education session with occupational therapy driver assessors. This study demonstrated that, for this sample, occupational therapy driver assessors’ adherence to the Australian Competency Standards for Occupational Therapy Driver Assessors increased following an individually tailored education package about the standards. The research in this thesis has contributed to the evidence base for occupational therapy driver assessor practice. The Australian Competency Standards for Occupational Therapy Driver Assessors have been revised, validated and published, and the impact of an education package to increase adherence has been investigated. These competency standards: (i) assist occupational therapy driver assessors’ clinical practice, support occupational therapy registration and regulatory agencies to evaluate practice against a standard and (iii) provide universities with a framework to deliver postgraduate training in occupational therapy driver assessment and rehabilitation. Finally, this research has described a process that can be utilised in other areas of occupational therapy practice to develop and validate competency standards.
Description:
Occupational therapy driver assessment and rehabilitation is an advanced and complex area of practice. Users of this service require that occupational therapy driver assessors are, and remain, competent in their role. Competency standards support and inform occupational therapy driver assessment and rehabilitation practice, ensure standardisation of practice, and determine whether practice can be deemed competent. Competency standards for occupational therapy driver assessors in one Australian state, Victoria, were published in 1998 to provide a benchmark for service provision and guide training. Since then, occupational therapy driver assessor practice has undergone further developments and growth, including a significant increase in research evidence underpinning this advanced practice area. As a result, the competency standards required revision to reflect contemporary practice and enable their use and application across all Australian states and territories. The purpose of the research program reported in this thesis was to revise and validate the Australian Competency Standards for Occupational Therapy Driver Assessors and determine if education and practice using these standards led to increased adherence to their use in clinical practice. A sequential, exploratory, mixed methods design was used within a pragmatist research paradigm to revise and validate the competency standards for occupational therapy driver assessors from a national perspective. Four separate research studies were conducted. In the first study, an overview was undertaken to summarise the current evidence for including cognitive and perceptual assessments within fitness-to-drive evaluations, to inform the revision of the competency standards for occupational therapy driver assessors. The second study involved focus groups with Australian occupational therapy driver assessors and expert educators and identified the changes and revisions required to be made to the Victorian competency standards for occupational therapy driver assessors. Content themes and changes were extracted from the focus groups and combined with research evidence to draft the revised standards. The third study collected feedback from consumers and Australian driver licensing authorities to incorporate into the revised draft. This was followed by a two-round Delphi process with Australian occupational therapy driver assessors to achieve consensus and validate the Australian Competency Standards for Occupational Therapy Driver Assessors. A high level of consensus on the content of all competency standards and underlying practice behaviours was obtained in the final round. Finally, a mixed-methods multiple case-study methodology was adopted, and multiple forms of evidence were collected from file audits, semi-structured interviews and an individualised education session with occupational therapy driver assessors. This study demonstrated that, for this sample, occupational therapy driver assessors’ adherence to the Australian Competency Standards for Occupational Therapy Driver Assessors increased following an individually tailored education package about the standards. The research in this thesis has contributed to the evidence base for occupational therapy driver assessor practice. The Australian Competency Standards for Occupational Therapy Driver Assessors have been revised, validated and published, and the impact of an education package to increase adherence has been investigated. These competency standards: (i) assist occupational therapy driver assessors’ clinical practice, support occupational therapy registration and regulatory agencies to evaluate practice against a standard and (iii) provide universities with a framework to deliver postgraduate training in occupational therapy driver assessment and rehabilitation. Finally, this research has described a process that can be utilised in other areas of occupational therapy practice to develop and validate competency standards.
Description:
Aims and objectives: The aim of this study was to explore perceptions of qualified nurses on the abilities of newly registered nursing graduates to perform a variety of clinical skills. Background: Evidence from the literature suggests that undergraduate nursing programmes do not adequately prepare nursing students to be practice-ready on completion of their nursing courses. Design: A descriptive quantitative design was used. Methods: Participants were recruited through the Australian Nursing and Midwifery Federation, Victorian branch. A brief explanation of the study and a link to the survey were promoted in their monthly e-newsletter. A total of 245 qualified nurses in the state of Victoria, Australia participated in this study. A survey tool of 51 clinical skills and open-ended questions was used, whereby participants were asked to rate new nursing graduates' abilities using a 5-point Likert scale. Results: Overall participants rated new nursing graduates' abilities for undertaking clinical skills as good or very good in 35·3% of skills, 33·3% were rated as adequate and 31·4% rated as being performed poorly or very poorly. Of concern, essential clinical skills, such as critical thinking and problem solving, working independently and assessment procedures, were found to be poorly executed and affecting new registered nurses graduates' competence. Conclusion: The findings from this study can further serve as a reference for nursing education providers to enhance nursing curricula and work collaboratively with healthcare settings in preparing nurses to be competent, safe practitioners on completion of their studies. Relevance to clinical practice: Identifying key areas in which new nursing graduates are not yet competent means that educational providers and educators from healthcare settings can focus on these skills in better preparing our nurses to be work ready.
Description:
The study examined whether the magnitude of same-sex-favouring implicit gender bias depends on individual differences in self-esteem and gender identity as theorized by Greenwald et al. The Implicit Association Test (IAT) was used to measure implicit self-esteem, gender identity, and gender attitudes. Explicit self-esteem and gender identity were measured with questionnaires. The IAT revealed a strong automatic preference for female words in 34 female undergraduates but, surprisingly, no significant gender bias in 32 males. Individual levels of this gender bias were predicted in both sexes by IAT-derived implicit measures of self-esteem and gender identity, as well as by their interaction. Neither declared gender identity nor explicit self-esteem added to the prediction. The results are discussed in terms of balanced identity design and the potential influence of method effects on the findings. Copyright (C) 2002 John Wiley Sons, Ltd.
Investigating the impact of participation in alternative education from a positive youth development perspective : A case study of the School for Student Leadership
Description:
The School for Student Leadership (SSL) has existed since 2001 as an alternative residential educational setting for Year 9 students in Victoria, Australia. It was designed in response to growing calls for more effective ways of engaging middle school students. A review of the literature illustrated a dearth of research regarding alternative programs and schools, particularly from a positive youth development (PYD) perspective, and relating to long term effects of participation. This study investigated student participants’ perceived development in relation to the Five Cs - Confidence, Competence, Character, Connection and Care, concepts derived from the framework of PYD. It also examined differences in perceptions of students attending a shorter five-week program, compared to the standard nine-week program, as well as differences between male and female participants. This case study was undertaken utilising a mixed methods approach, using pre and post program surveys and interviews. Between 2013 and 2014, 385 students were surveyed and 58 interviews conducted over nine program offerings. The participants were then followed up one year post program, with 172 surveys returned and 14 interviews conducted. With the assistance of computer software programs, both the quantitative and qualitative data was analysed and then triangulated to form the findings. Participants’ ratings for each of the Five Cs were higher at the end of the program, and effect sizes, though generally small, when combined with the qualitative data indicated the program as having a significant positive impact, although this diminished slightly one year post program. Little discernible difference was found between the five- and the nine-week programs, and only slight differences between the two genders. The set of recommendations that emanated from this research should be of assistance for both the SSL and other schools, particularly in relation to enhancing attributes such as the Five Cs.
Description:
The School for Student Leadership (SSL) has existed since 2001 as an alternative residential educational setting for Year 9 students in Victoria, Australia. It was designed in response to growing calls for more effective ways of engaging middle school students. A review of the literature illustrated a dearth of research regarding alternative programs and schools, particularly from a positive youth development (PYD) perspective, and relating to long term effects of participation. This study investigated student participants’ perceived development in relation to the Five Cs - Confidence, Competence, Character, Connection and Care, concepts derived from the framework of PYD. It also examined differences in perceptions of students attending a shorter five-week program, compared to the standard nine-week program, as well as differences between male and female participants. This case study was undertaken utilising a mixed methods approach, using pre and post program surveys and interviews. Between 2013 and 2014, 385 students were surveyed and 58 interviews conducted over nine program offerings. The participants were then followed up one year post program, with 172 surveys returned and 14 interviews conducted. With the assistance of computer software programs, both the quantitative and qualitative data was analysed and then triangulated to form the findings. Participants’ ratings for each of the Five Cs were higher at the end of the program, and effect sizes, though generally small, when combined with the qualitative data indicated the program as having a significant positive impact, although this diminished slightly one year post program. Little discernible difference was found between the five- and the nine-week programs, and only slight differences between the two genders. The set of recommendations that emanated from this research should be of assistance for both the SSL and other schools, particularly in relation to enhancing attributes such as the Five Cs.