Nursing research series
Permanent URI for this collection
Browse
Recent Submissions
Item Open 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 SciencesBACKGROUND 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.Item Open Access Reclaiming and redefining the Fundamentals of Care: Nursing's response to meeting patients' basic human needs(School of Nursing, The University of Adelaide, 2013) Kitson, A.; Conroy, T.; Kuluski, K.; Locock, L.; Lyons, R.Executive Summary: A group of nurse leaders, health policy, health care researchers and clinicians attended a seminar at Green Templeton College, University of Oxford in June 2012 to debate and draw up an action plan around integrating the fundamentals of care (FOC) into the patient centred care (PCC) agenda. Participants at the seminar acknowledged that despite significant improvements in delivering more compassionate and patient-centred care, health systems continue to face challenges in meeting the basic needs of many of our most vulnerable patients due to a range of complex factors. The invitational group, over the course of two days, discussed a number of initiatives being used by health systems to improve patient care in this area. These included issues around regulation of care; preparation and training of nurses; ways that factors such as dignity, compassion and kindness can be promoted in health systems; the use of techniques such as hourly rounding, patient involvement in systems redesign and a number of other innovations required to build and redesign the health system around the patient. A framework to guide and shape the ongoing debate has emerged from the meeting. This framework, called The Fundamentals of Care (FOC) Framework comprises three core dimensions: statements about the nature of the relationship between the nurse and the patient within the care encounter; the way the nurse and the patient negotiate and integrate the actual meeting of the fundamentals of care; and the system requirements that are needed to support the forming of the relationship and the safe delivery of the fundamentals of care. The group has produced an implementation plan which is meant to stimulate discussion and debate within key stakeholder groups. These suggested actions are an attempt to turn the more abstract parts of the framework into practical actions at the level of the care encounter between any nurse and any patient in any health system where nursing takes place. There are proposed actions for clinicians and managers; the educators of nurses; and for researchers and policy makers. The framework will be further refined as part of the ongoing work of the International Learning Collaborative (ILC),one of the core groups of nurse leaders and academics who are leading this international agenda. Feedback is welcomed on this position paper.Item Open Access 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.