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Children's nursing and interprofessional collaboration: challenges and opportunities.

Interprofessional working has been the subject of recent debate in the nursing press. Despite this heightened scrutiny little attention has been given to putting this development in the context of practitioners working within children's nursing. This paper seeks to redress this imbalance by focusing on the challenges and opportunities for professional development that interprofessional collaboration working offers. This is illustrated by acknowledging existing themes of good practice, and identifying the potential for new ways of working that maintain professional status, skills and knowledge but also facilitate wider collaboration.

Attitude of Health Personnel↗

The extended role of the nurse: the United Kingdom perspective.

There has been considerable discussion and debate in the United Kingdom regarding the role and function of the nurse. This article outlines the main tenets of the debate, namely the extended/expanded role and function, and gives a brief overview of the situation to date. Professional guidance from the United Kingdom Central Council for Nurses, Midwives and Health Visitors is explored and the implications this has for the nurse in the exercise of accountability. The legal implications of the nursing function in an expanded role capacity is discussed, in particular in relation to legal accountability, with reference to existing case law. Recommendations are made for the development of the expanded role.

Forecasting↗

From delegation to specialization: nurses and clinical trial co-ordination.

This paper considers an area of clinical research that has been delegated by physician-researchers to nurses and others in the United States, that of clinical trials co-ordination. It uses interviews with nurse trial co-ordinators to explore the occupational processes by which the boundaries of work enactment and the definition of work have been established by nurses and others. It then discusses the occupational processes that have been established to formalize a role for nurses in clinical research. It raises the question of (and offers speculation on) whether specialization alone will distinguish nursing from other occupational groups engaged in clinical research work.

Attitude of Health Personnel↗

Creating what sort of professional? Master's level nurse education as a professionalising strategy.

This paper reports on a detailed analysis of selected findings from a larger study of master's level nurse education. It locates some features of such education within the contemporary situation of nursing as a profession and interprets the role of master's level nurse education as a professionalising strategy. In-depth interviews were undertaken with a purposive sample of 18 nurse lecturers drawn from eight universities in the United Kingdom. The interview agenda explored participants' perspectives of the characteristics of master's level performance in practice. Interview transcripts were interpreted by drawing upon hermeneutic methodology. The following themes emerged. (a) The credibility of the master's level nurse was of central importance. In terms of the literature of professionalisation, this may be interpreted as a factor in enhancing the legitimacy of nursing as an occupation. (b) The clinical capability attributed to the nurse is interpreted as leading to an increase in the authority commanded by the expert professional. Thus, the individual capability of the master's level nurse enhances the attribution of autonomous skill to the occupation as a whole. (c) The master's level nurse is seen to exercise influence and leadership and this strengthens the power and status of nursing. Nursing does not have the appearance of a 'traditional' profession, neither has it a clear stance as a 'new profession'. Rather it appears to be especially responsive to the tide of public opinion manifest through government edicts. While nursing is employing rhetoric that espouses both positions, the direction of master's level education is anomalous.

Attitude of Health Personnel↗

Audits, errors and the misplace of clinical indicators: revisiting the Quality in Australian Health Care Study.

Publication of the Quality in Australian Health Care Study in 1995 represented a defining moment for Australian health care providers. The high incidence and cost of preventable adverse events underscored a need for defined process, error recognition and audit cycle. Despite this, surgical audit has continued to emphasize clinical indicators relevant to technical performance. The greatest burden of preventable error can be traced to deficiencies in the process by which management expectations are supported. Recognizing this, the focus of clinical audit must be expanded. In particular, outcome assessment should be routine rather than sporadic, and should broadly encompass safety, effectiveness and efficiency. Devolving this responsibility to paraclinical groups is in itself insufficient. Quality and safety cannot be adequately addressed unless surgeons actively participate in audit cycle. Failure to meet this challenge in a transparent and timely manner potentially undermines the future of professional autonomy.

Australia↗

Scholarship of practice for a practice profession.

At a time of shrinking resources, rapidly changing health care environments, and increased demands for solutions to pressing health issues, concerns regarding the relevance of nursing research for practice are again being raised. After the national debate surrounding definitions of scholarship across disciplines and having established respectability for past and current contributions to knowledge development, nursing may now begin to reconceptualize what constitutes scholarship in a practice profession. This article addresses two central questions related to the scholarship of nursing practice: (1) How is scholarship of practice in a practice of profession defined? and (2) What characteristics differentiate the new conceptualizations of scholarship of practice from traditional research models? The results include a delineation of scholarship of practice and a differentiation of characteristics between scholarship of practice and traditional research approaches. Implications for nursing education are also addressed.

Clinical Nursing Research↗

The lived experiences of autonomous Angolan midwives working in midwifery-led, maternity units.

OBJECTIVE: to describe the lived experiences of autonomous midwives working in Angolan midwifery-led maternity units. DESIGN: a qualitative approach using semi-structured, audiotaped interviews, in Portugese. Data were analysed in a six-step process. SETTING: three midwifery-led maternity units in the most densely populated suburbs in the capital of Angola, Luanda. The average number of deliveries per unit was 2500 per year. PARTICIPANTS: 11 midwives from the three maternity units. FINDINGS: four main areas emerged: society/culture, significant others, personal self and professional self. Sub-areas, concepts and supporting statements were defined in each area. KEY CONCLUSIONS: the midwives served within a population living in rough circumstances but which maintained strong traditional roots. The midwives did not support homebirths, but did assist when needed. The midwives described their professional role as a 'calling', which was very independent. Cure, was considered more important than care, and strong emotions were expressed when discussing cases of failure. The partograph was viewed as an important instrument and continuous learning as crucial in their role as autonomous midwives. IMPLICATIONS FOR PRACTICE: the model of a midwifery-led delivery unit described in this study may be used in other countries facing the same problems as Angola. Difficulties concerning transfer should be seriously considered as well as adequate education for the midwives. A pre-requisite in order for peripheral maternity units to have any impact on maternal morbidity and mortality, is a well-organised first-referral level.

Adaptation, Psychological↗

Supporting students' learning and professional development through the process of continuous assessment and mentorship.

This paper is based on the results of two studies carried out by the writer, over a period of 6 years (1991-1996), aimed to establish what happens in nursing practice in relation to assessing clinical competence of nursing students and the support they receive during their Nurse Education Programme. Study number one (1991-1995) was based upon the experiences and perceptions of 155 skilled practitioners and 300 students from three Colleges of Nursing and 45 interested practitioners, who volunteered to join the research at a later date because they were experienced assessors and mentors. Many themes and categories emerged. One in particular was that of the role of the practitioner who has been charged with the responsibility of assessing student performance on practice placement. Initial interviews with 155 practitioners of varying experience as assessors were used to design a questionnaire containing both context free and context specific items. Subsequent follow-up interviews were undertaken with both students and practitioners and non-participant observation of practitioners working with students were carried out. The majority of students accepted the dual role and at times, even the triple role of assessors, mentors and/or supervisors forced upon practitioners, provided that the practitioners assessing them were well prepared and 'trained' as assessors, were perceived to be 'fair', 'competent', 'skilful' and 'knowledgeable' (Neary 1997a). Study two (1992-1994) aimed to establish the process and outcomes of practitioner-teachers and mentorship in Wales, and was based on the data from a much extended period of semi-structured interviews with policy makers, managers, teachers and nurse practitioners (n = 360, 330 analyzed in detail) spanning 10 months, which gave an invaluable pictures of ongoing changes in the placement areas and the basis from which to construct a widely administered questionnaire (n = 1332) dealing with context-free and context-specific factors underpinning the definition of the mentor role, selection and relationship with students. Similar logic lay behind the use of reflective semi-structured diaries which asked 138 students and 133 practitioners to keep during practice placements. This study showed the practitioners readily adopted the term 'mentor' to describe their role in their relationship with students in clinical practice. How they were selected for this role proved to be more complex (Davies et al. 1994). for the purpose of this paper the data from both studies is merged to give a stronger and more focused picture of how both students and practitioners perceived their roles in the assessment and support systems which were in action at the time of the studies.

Attitude of Health Personnel↗