Nursing research series

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https://hdl.handle.net/2440/65374

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Browsing Nursing research series by Author "Wiechula, R."

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    Improving older people's care in one acute hospital setting: a realist evaluation of a KT intervention
    (School of Nursing, The University of Adelaide, 2011) Kitson, A.; Wiechula, R.; Zeitz, K.; Marcoionni, D.; Page, T.; Silverston, H.
    Background: Older people make up an increasingly large group using acute care facilities yet the nature of the care is often not conducive to their personal needs, wellbeing and recovery. This research explored how a structured intervention (called the KT Toolkit) could help frontline clinical staff improve the care for older people going through one acute hospital setting in South Australia. Methods/Design: The case study approach used draws on the overarching framework of realist evaluation, a methodology designed to test, refine and explain what is happening in complex situations. Seven parallel teams within the organisation selected one discrete clinical area each for improvement through the introduction of evidence based practice guidelines. Each improvement team’s progress was recorded using multiple data sources including ethnographic observations, semi structured interviews, document reviews and other routinely collected data on nursing care. Each of the seven journeys was analysed and synthesised according to the principles of realist evaluation where the role of the researchers (and stakeholders) is to elucidate what things work for which teams in what particular circumstances thus arriving at a set of explanatory statements. Results: Four broad mechanisms appeared to be affecting the way improvements were being introduced into the clinical areas by the seven different teams: building on existing structures and support; optimising existing human potential; focus on the older person and on-going support through facilitation. Within these mechanisms a range of different actions and behaviours were noted but collectively the teams were able to show how these mechanisms enabled them to make progress in improving discrete aspects of care for their older patients. Conclusions: The use of realist evaluation as the overarching methodological framework enabled the research team to document and interpret the complex interactions happening at the level of everyday practice. Such interpretations enabled the research team to engage the clinical teams and work with them on on-going improvements. We found that even trying to improve the so-called simplest of aspects of care (e.g. weighing patients as part of nutritional care) was fraught with challenges. Also, our use of the realist method raised a number of theoretical and methodological questions that need further refining and in particular how realist evaluation relates to knowledge translation (KT) conceptual frameworks.
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    ItemOpen Access
    The future shape of the nursing workforce: a synthesis of the evidence of factors that impact on quality nursing care
    (School of Nursing, University of Adelaide, 2013) Kitson, A.; Wiechula, R.; Conroy, T.; Muntlin Athlin, A.; Whitaker, N.; Faculty of Health Sciences
    BACKGROUND To effectively respond to the growing demand for healthcare, governments need to consider how to recruit and retain their healthcare staff. This challenge is recognised by the nursing and midwifery professions. This umbrella review, supported by a group of nurse leaders in Australia, aimed to identify those elements known to support a high quality workforce by drawing on the best available Australian and international evidence. The findings provided recommendations that relate to practice, research, education and policy initiatives to help shape the future nursing workforce in Australia and internationally. METHOD An umbrella review of published systematic reviews was undertaken focusing on the Australian and international evidence for factors that are known to impact upon the ability of nurses and midwives to deliver high quality patient care. A total of 79 systematic reviews published between 1995 and 2012 met the inclusion criteria and of these 50 were considered of sufficient quality and were included in the results.