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Biomedical subjects

C Duffield

Publications and source records attributed to C Duffield.

At least 19 recordsLinked to original sources
PubMed2004

Validation of the Algase Wandering Scale (Version 2) in a cross cultural sample.

This study examined the psychometric properties of an expanded version of the Algase Wandering Scale (Version 2) (AWS-V2) in a cross-cultural sample. A cross-sectional survey design was used. Study subjects were 172 English-speaking persons with dementia (PWD) from long-term care facilities in the USA, Canada, and Australia. Two or more facility staff rated each subject on the AWS-V2. Demographic and cognitive data (MMSE) were also obtained. Staff provided information on their own knowledge of the subject and of dementia. Separate factor analyses on data from two samples of raters each explained greater than 66% of the variance in AWS-V2 scores and validated four (persistent walking, navigational deficit, eloping behavior, and shadowing) of five factors in the original scale. Items added to create the AWS-V2 strengthened the shadowing subscale, failed to improve the routinized walking subscale, and added a factor, attention shifting as compared to the original AWS. Evidence for validity was found in significant correlations and ANOVAs between the AWS-V2 and most subscales with a single item indicator of wandering and with the MMSE. Evidence of reliability was shown by internal consistency of the AWS-V2 (0.87, 0.88) and its subscales (range 0.88 to 0.66), with Kappa for individual items (17 of 27 greater than 0.4), and ANOVAs comparing ratings across rater groups (nurses, nurse aids, and other staff). Analyses support validity and reliability of the AWS-V2 overall and for persistent walking, spatial disorientation, and eloping behavior subscales. The AWS-V2 and its subscales are an appropriate way to measure wandering as conceptualized within the Need-driven Dementia-compromised Behavior Model in studies of English-speaking subjects. Suggestions for further strengthening the scale and for extending its use to clinical applications are described.

Aged↗
PubMed2001

Profile of first-line nurse managers in New South Wales, Australia, in the 1990s.

AIMS: To determine a demographic profile, employment history and career plans of a sample of nursing unit managers (first-line managers) in New South Wales (NSW), Australia in 1999. To compare the profile of first-line nurse managers in 1999 with those in 1989. BACKGROUND: This study replicates another undertaken a decade earlier (see Duffield 1992). Tracking the changes to nurse manager positions is important, given changes to the educational preparation of nurses and restructuring within hospitals which have occurred in the past decade. METHOD: The same questionnaire was used in both studies, with minor amendments and the addition of two items to reflect changes to organizational structures, whereby nurse managers are now responsible for non-nursing staff. In 1999 all first-line nurse managers in the largest health service in NSW were invited to participate in the study. RESULTS: A response rate of 77% was achieved. There were few differences of note in the demographic profile from 1989 to 1999. However educationally, first-line nurse managers in 1999 were more highly qualified. A greater proportion had higher degrees and increasingly, in the management discipline. CONCLUSION: Perhaps reflecting these qualifications, more managers in 1999 indicated their intention to move to more senior management positions in the next decade. The mode for experience in this role of 1 year in both 1989 and 1999 reflects a worrying trend of high turnover and inexperience amongst this group of managers. While maternity relief might account for this result, further research needs to determine more precise reasons. The ad hoc bases on which expert clinicians (clinical nurse specialists) act as the manager in his/her absence need to be critically examined. Alternative strategies such as introducing a formal second- in-charge position may ensure more successful recruitment and retention of staff to these critical management positions.

Adult↗
PubMed2001

The role and preparation of first-line nurse managers in Australia: where are we going and how do we get there?

Organizational restructuring is impacting heavily on the first-line nurse managers' role. Given their critical role, it is important that the best and most talented are attracted to and prepared to be first-line managers. The authors provide an overview of the role of first-line nurse managers in Australia, proposing that nurse administrators take a more active role than has traditionally been the case in ensuring staff are appropriately educated and selected for management positions.

Australia↗
PubMed2001

The role of nursing unit managers in educating nurses.

This paper presents the findings of a work sampling study undertaken in New South Wales (Australia) to ascertain the amount of time spent by nursing unit managers directly educating nurses. The results indicate that they spend very little time in teaching, traditionally one of their role tasks. It is argued that their teaching at unit level should focus on their role as leader, mentor, preceptor and coach. This role shift needs to be articulated to managers and nurses to minimise confusion over the role and to ensure that direct teaching is placed into the hands of expert clinicians.

Education, Nursing↗
PubMed2000

The role of the Advanced Casualty Management Team in St John Ambulance Australia (New South Wales District).

St John Ambulance is a household name synonymous with the teaching and provision of first aid. Recently the organisation has developed pre-hospital emergency care services through the introduction of the St John Ambulance Australia Advanced Casualty Management Team in New South Wales. The Advanced Casualty Management Team represents a move away from the practice of first aid by lay personnel and is a natural extension of the traditional work and principles of St John Ambulance. This article provides an overview of the Advanced Casualty Management Team and discusses its contribution to pre-hospital trauma care delivery.

Efficiency, Organizational↗
PubMed1999

Nursing as a career choice: perceptions of school students speaking Arabic, Serbo-Croatian, Spanish, Turkish or Vietnamese at home.

Australia is a multicultural society and nowhere is this more evident than in Sydney where 25% of the population speaks a language other than English. In one of the largest area health services in New South Wales, the five most frequently spoken languages at home are Arabic, Serbo-Croatian, Spanish, Turkish or Vietnamese, with these language groups comprising 12% of Sydney's population. Yet nurses speaking one of these five languages comprise less than 1% of the nursing workforce. A cost-effective method of addressing the shortage of nurses speaking languages other than English is to recruit students who already speak another language into the profession. This study examined high school students' perceptions of nursing in order to determine appropriate methods of recruiting students speaking one of these languages. Implications for the design of recruitment campaigns are also discussed.

Attitude to Health↗
PubMed1998

Australian nurses and device use: the ideal and the real in clinical practice.

Clinical nurses use an increasing number of technological devices when providing care. While the clinical devices themselves must undergo rigorous multidimensional assessment, it is the proficiency of the user that ultimately determines the devices' efficacy. Thus, the knowledge, skills and attitudes that nurses bring to their decision-making and use of technology are crucial elements in the technology assessment process. Technological proficiency is imperative in the current climate of rapid patient throughput in complex technological environments. This paper reports some of the findings of an Australian study, using two national Delphi panels, whose primary objective was to determine the knowledge, skills and attitudes required of expert clinicians for practice in cardiac care. Panels of 28 educators and 42 cardiac nurse clinicians completed a questionnaire indicating the importance of 107 characteristics of expert cardiac practice for both the 'real' and 'ideal' worlds of practice. Comparative results will be reported for 29 items within the thematic groups. Effective use of technology, Informed decisions regarding equipment and Critical approach to the use of technology. Both panels accepted all 29 items in these three thematic groups but indicated differences in the level of agreement on the importance of items between the 'real' and 'ideal' worlds of practice. Discussion centres around those areas where improvement is needed.

Australia↗
PubMed1997

Determining and discerning expert practice: a review of the literature.

Although the nature and characteristics of expert practice have been described in the literature, the description is incomplete. How expertise is gained is not fully understood, and definitions of expert competencies have yet to be developed. Essential issues for education arise from the demand for knowledge for expert practice. Because expertise is gained in the context of practice, expertise cannot be achieved out of context or taught as an academic exercise. A clear picture of the practice of expert nurses is necessary so that those in the profession can know and articulate expert practice and direct it to the community.

Clinical Competence↗
PubMed1997

The cardiac nurse's role: an Australian Delphi study perspective.

In Australia, as in many parts of the Western world, technological advances in healthcare have affected the roles of healthcare professionals, including nurses. Cost constraints, efficiency, and effectiveness measures also influence staffing numbers, roles, and skill mix. Specialty nurse education programs are changing, and many are moving from the hospital environment to the higher education sector. Initiatives to introduce the American Advanced Nurse Practitioner role in some environments have begun, although the current advanced practice roles are proving problematic. Specialist professional groups are striving to develop competencies or standards for practice. An understanding of what is required of expert clinicians for practice in complex technological environments such as cardiac care would be useful for both practitioners and academics. A national Delphi study was undertaken to determine what knowledge, skills, and attitudes were required of expert cardiac nurses in relation to technology in the cardiac care environments in both the "real" and the "ideal" worlds of practice. Separate panels of 28 cardiac educators and 42 cardiac nurse clinicians were given a questionnaire of 107 items and asked to indicate on a 6-point Likert scale the importance of each item to the nursing roles in both the "real" and "ideal" worlds. On the final, third round, respondents ranked the three most important items in each of the 13 thematic groups. Overall, the clinicians accepted all 107 items as important to their role, and for the majority of these they, felt that they were performing quite close to their "ideal." This article presents the 32 items for which the clinicians felt the "real" world was quite far from the "ideal" as represented by a gap of > or = 2 between the real and ideal medians. Also, despite being accepted as part of the role through the ideal scores, 21 items achieved a real world median of 3.5 or less, which indicates that in the real world these aspects of nursing are not being valued or practiced to the level clinicians would like. These two sets of items should be of greatest interest to clinicians currently in the role and to those interested in specialty education at all levels.

Australia↗
PubMed1996

The impact of the technological care environment on the nursing role.

Proliferation of acute health care technology creates problems and benefits for nurses and patients. In this paper the impact of technology on the nursing work role is reviewed through the international literature. The thrust of the nursing literature has, not surprisingly, matured over time as the use of technology has become well established in the acute care environment, and three themes can be identified. The implications for acute care nurse specialists, including their educational needs, are set in context of the Australian health care system, with particular reference to the cardiac care environments.

Australia↗
PubMed1996

Do clinical nurse specialists and nursing unit managers believe that the provision of quality care is important?

The nursing profession has a long tradition of evaluating the quality of its product in order to ensure that the best possible care can be given. However, in the climate of economic rationalism which prevails worldwide, it is possible that the emphasis on fiscal restraint has distracted nurses from their previous focus on quality. This paper discusses the findings of two research studies designed to determine the competencies expected of nursing unit managers and clinical nurse specialists. Discussion focuses specifically on their roles in the provision of quality care.

Clinical Competence↗
PubMed1995

CNSs' perceptions of role competencies: one Australian perspective.

A survey of 373 CNSs employed in hospitals in New South Wales, Australia, was undertaken to determine the competencies they believed necessary to fulfill that role. This study was designed as a sequel to a similar study of role competencies of first-line nurse managers in the same state. Factor analysis was used to identify a variety of role dimensions. Results indicate that CNSs perceive their role as extremely comprehensive, yet a significant potential to overlap with the role of managers was evident. In addition, some interesting features of the CNS role emerged that may generate both professional approval and concern. The strength of the respondents' acceptance of competencies that link their clinical role to activities that directly influence the quality of care is heartening; however, a number of clinically based competencies, including some of those related to patient care management or quality of care, either loaded weakly or did not load at all on the factor structure. Concern may be felt regarding the claim of these specialized clinicians to competencies traditionally seen as strongly associated with the managerial role. Should specialist clinicians take on too many managerial functions, significant role overload could result, and affect quality care provision.

Attitude of Health Personnel↗
PubMed1995

A profile of the clinical nurse specialist in one Australian state.

The nursing profession in Australia implemented progressively in each state new clinical career structures commencing in 1986. While the structures differ, all states introduced the position of CNS. The role and responsibilities associated with this position also differ. The role of CNS in Australia is different from that described in the North American literature. Findings of a study that established a profile of CNSs in the heavily populated state of New South Wales are described. Data on education, experience, and career plans were obtained from 373 CNSs in 19 hospitals. The results enable some comparison with first-line nurse managers whose role is very similar to the American position of head nurse. As with their managerial counterparts, the Australian CNSs' lack formal educational preparation and were demonstrating a low rate of participation in educational programs at the time of the study. However, 82% of respondents intended to remain in clinical practice. This is significant since this was a major goal in development of a clinical career structure.

Adult↗
PubMed1995

Nurse managers and their future in New South Wales.

The goal of International Perspectives is to share the views of nurse leaders, from countries other than the United States, on global healthcare issues. The focus is on identifying healthcare management problems and their implications, research priorities, policy development, and ethicalmoral dilemmas faced by nurse administrators. You are encouraged to send the names and addresses of international nurse leaders who might be interested in participating, as well as your ideas, for format and content of the department.

Forecasting↗
PubMed1994

The effects of graduate nurse education on clinical practice and career paths: a pilot study.

The recent proliferation of graduate courses in nursing has increased the need for educational administrators to evaluate the impact of such programmes on clinical practice and the career of participants. 40 registered nurses undertaking graduate studies were surveyed as a pilot for an extensive longitudinal study of their perception of the effects of study on work performance and career opportunities. Overall, positive effects were noted by respondents on their job satisfaction, self-esteem, professional thinking and career moves. Increases in professional behaviours such as mentoring, research and writing for publication were noted. Negative consequences were noted by a minority and were related to alterations to health status and increased levels of stress.

Career Mobility↗
PubMed1994

Caring nurses: the dilemma of balancing costs and quality.

This paper explores the tensions visible in the rhetoric and practice of today's health care system. This system is becoming dominated by the views of economic rationalists where decisions are based on principles more frequently associated with private enterprise. One could argue that health care should be managed as a business, however, the ethics which guide such a business must be examined closely to ensure the integrity of the caring which is implicit in much of the practice in health care. Individuals in today's society value humanistic functions more than ever before. The caring function of nursing is perhaps the most significant determinant of the quality of care received from a patient's perspective, and one to which there is little cost attached in dollar terms. While it is difficult to measure and cost the caring that nurses provide, it must be done to ensure that these qualities are maintained and enhanced. More importantly, strategies must be developed to provide cost-effective quality indicators of the caring function implicit in the nurse's role. (This is an abridged version of a paper delivered at the Nursing Economic$ International Symposium 1993 in Hobart, Tamsania.)

Australia↗