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Clinical facilitation is critical to successful student clinical experience. The research reported in this paper used an interpretive case study to explore perspectives of clinical facilitators on what constitutes best practice in clinical facilitation of undergraduate nursing students. Eleven clinical facilitators from South East Queensland, Australia, participated in focus groups, interviews and a concept mapping exercise to gather their perspectives on best practice. The data gathered information regarding their prior and current experiences as registered nurses and facilitators, considering reasons they became clinical facilitators, their educational background and self-perceived adequacy of their knowledge for clinical facilitation. Analysis was through constant comparison. Findings of the study provided in-depth insight into the role of clinical facilitators, with best practice conceptualised via three main themes; ‘assessing’, ‘learning to facilitate’ and ‘facilitating effectively’. While they felt there was some autonomy in the role, the clinical facilitators sought a closer liaison with academic staff and feedback about their performance, in particular their assessment of the students. Key strategies identified for improving best practice included educational support for the clinical facilitators, networking, and mentoring from more experienced clinical facilitators. When implemented, these strategies will help develop the clinical facilitators' skills and ensure quality clinical experiences for undergraduate nursing students. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore families' perceptions of shift-to-shift bedside handover. Background. The potential role families can play in bedside handover is unknown. Understanding family members' perceptions can provide a foundation for nurses to tailor their bedside handover to family members' perceptions, encouraging their involvement and potentially improving patient care. Design. Qualitative study, using case study methodology. Methods. The study was conducted with eight family members in one rehabilitation ward in Queensland, Australia, in 2009. Data included observations of bedside handover, field notes and in-depth interviews. Thematic analysis of data was conducted to identify unique and common themes indicative of family perceptions. Results. Three major themes emerged. The first, understanding the situation, consisted of three subthemes: feeling informed, understanding the patient's condition and understanding patient's treatment. The second theme was interacting with nursing staff, with five subthemes, including sharing information, clarifying information, assisting in care, asking questions and interpreting for the patient. The final subtheme was finding value, which contained five subthemes: feeling at ease, feeling included, valuing individualisation, preparing for the future and maintaining patient privacy. Conclusions. Bedside handover provides an opportunity to involve family members in patient care and promote family-centred care core concepts. Family members value the chance to participate and can ultimately improve the accuracy of handover communication. Relevance to clinical practice. Bedside handover is beneficial for nurses, patients and family members and embodies patient and family-centred care. Managers should consider its implementation in hospitals, developing strategies such as standard operating protocols for a more family inclusive approach to communication. Nurses may require further training to best undertake bedside handover and involve family members in care. The study suggests expansion of research into this important area of family-centred care. [ABSTRACT FROM AUTHOR]

The article describes a case study conducted from March to August 2008 involving the placement of whiteboards in 3 inpatient wards in a university-affiliated regional teaching hospital and in a day clinic in the Queensland health service district in Australia and aimed to describe the integration of white boards in ward routines. The findings showed that using whiteboards have the capacity to promote teamwork and accountability specially in the context of information sharing. The need for a planned approach and issues relating to their use are noted.

Background: Little is known about the influences on nurses' decisions to withhold surgical patients' oral medications pre and postoperatively or the degree to which decisions are consistent. The literature is devoid of information that clarifies whether or at what point withholding a particular oral medication may constitute a medication error., Purpose: This study sought to redress this gap in knowledge and identify factors influencing nurses' decisions about withholding surgical patients' oral medications., Methods: This interpretive study recruited a convenience sample consisting of nine nurses from surgical wards in public and private hospitals on the Gold Coast, Queensland and northern New South Wales to participate in individual interviews. Data were transcribed and analysed using inductive content analysis to identify common themes., Findings: Three main themes illustrated important influences on nurses 'decisions, including ward culture, nurses' perceptions of their roles and patient factors., Conclusions: The complex issues surrounding nurses' decisions when withholding surgical patients' oral medications are identified in this research. The findings will help to inform quality and safety in future medication management and lead to higher quality and safer patient care.

Background: Patient participation in handover is one aspect of patient-centred care, where patients are considered partners in care. Understanding the patient perspective provides a foundation for nurses to tailor their bedside handovers to reflect patients' thoughts and beliefs and encourage their active involvement in decision-making., Aim: This study examined patients' perspectives of participation in shift-to-shift bedside nursing handover., Methods: A descriptive case study was conducted with 10 patients in one Queensland hospital who had experienced bedside handover during their hospitalisation in 2009. Participants were asked their views about bedside handover including its benefits and limitations, their existing and potential role in handover, the role of family members, and issues related to confidentiality. Data were analysed using thematic content analysis., Findings: Four themes emerged from the analysis. First, patients appreciated being acknowledged as partners in their care. Second, they viewed bedside handover as an opportunity to amend any inaccuracies in the information being communicated. Third, some preferred passive engagement rather than being fully engaged in the handover. Fourth, most patients appreciated the inclusive approach of handover as nurse-patient interaction., Conclusions: Bedside handover provides an opportunity for patients to be involved as active participants in their care. They value having access to information on an ongoing basis, and although not all choose the same level of interaction, they see their role as important in maintaining accuracy, which promotes safe, high quality care.

Background: Nurses' perspectives of maintaining quality practice is important in the context of today's safety and quality agenda. This study provides a snapshot of registered nurses' perspectives on practice quality in one Australian ICU., Methods: A mini-ethnographic case study examined how quality is embedded in the culture of ICU nursing. Semi-structured interviews of 10 informants were analysed using Spradley's (Spradley JP. The ethnographic interview. Sydney: Holt, Rinehart and Winston, Inc.;1979) ethnographic guidelines., Findings: Three major themes influenced nursing quality: maintaining cohesiveness in a complex and stressful environment; rapid, effective and respectful communication; and specialist knowledge gained through experience and formal learning., Conclusion: The nurses reported satisfaction with the quality of their ICU practice, but revealed factors that could diminish quality and contribute to job dissatisfaction. Given current recruitment and retention issues and the link between satisfaction and retention, it is important to consider this these factors in advancing the knowledge base for workforce planning.

This quality improvement project implemented bedside handover in nursing. Using Lewin's 3-Step Model for Change, 3 wards in an Australian hospital changed from verbal reporting in an isolated room to bedside handover. Practice guidelines and a competency standard were developed. The change was received positively by both staff and patients. Staff members reported that bedside handover improved safety, efficiency, teamwork, and the level of support from senior staff members.

Aim: To investigate general surgical patients' perspectives of the adequacy and appropriateness of their discharge planning., Objectives: To identify any aspects of discharge planning that could be strengthened to assist people in managing their posthospital care and maintaining continuity of care., Background: Appropriate discharge planning is a priority in today's healthcare environment in which patients are discharged 'quicker and sicker', sometimes without home support. Adequate and appropriate discharge planning helps promote health literacy, which has benefits for both patients and their caregivers in helping them manage postsurgical recovery at home., Design: A qualitative, interpretive study was designed in which patients were interviewed at least one week after they returned home from hospital., Methods: Purposeful sampling was used to interview 13 general surgical patients from one of three hospitals (two public and one private) in New South Wales and Queensland, Australia. Data were collected in unstructured interviews and analysed using thematic analysis. Reflective analysis by individual research team members generated preliminary themes, which were then analysed collectively by all members of the research team to achieve consensus on patients' perspectives., Results: Themes included a 'one-size-fits-all' approach to providing discharge information; inconsistent or variable advice from different health professionals; a lack of predischarge assessment of their home and/or work conditions and the need for follow-up assessment of patient and carer needs., Conclusions: The findings of this study illuminate the need for a more individualized approach to discharge planning, taking into account the patient's age, gender, surgical procedure and family and community support for immediate and longer-term nursing follow-up., Relevance to Clinical Practice: Patients would be more adequately prepared for their recovery period at home, by encouraging client-centred, interdisciplinary communication between health practitioners; adopting a flexible, approach to discharge planning which is tailored to individual needs of postsurgical patients, particularly in relation to advice and information related to recovery; and encouraging and supporting adequate health literacy for self-management.

The current health service response to women's domestic violence related health issues seeks to categorise their presenting symptoms into physical and psychological ailments This gives a narrow and somewhat simplistic focus to what is a complex phenomenon and may obscure women's experiences and limit the opportunities to provide proactive health care. The purpose of this study was to expand knowledge about the health issues of women who are subjected to domestic violence, by affording primacy to women's accounts of health, in order to problematise current services and establish a more woman-centered underpinning for healthcare. The study involved narrative analysis of nine interviews with women who spoke about their health and health issues while they lived with domestic violence. Findings revealed that health was complex, and that health issues were not adequately addressed by health services, in fact health care responses were implicated in further adversely affecting the health of participants. These findings illuminate patterns that underlie individual realities of health and give a foundation from which current services can be evaluated and further developed in ways that may be more sensitive to women's realities and needs.

Objective: To investigate recovery from total hip replacement over a three-year period on the basis of patient perceptions of health-related quality of life, demographic (age, gender, family support) and clinical characteristics (co-morbidities, hospital admissions), use of and satisfaction with health services, unmet health needs and social re-engagement., Design: Telephone survey of patients' scores on the the 36 item Short Form health survey (SF 36) at three-years as a basis for comparison with scores 12 weeks after discharge; analysis of survey responses on demographic and clinical variables, health services use and satisfaction, unmet health needs and resumption of pre-operative social activities., Setting: One tertiary hospital in South East Queensland, Australia., Participants: Sixty-two total hip replacement patients from an original cohort of 95 participants in a study three years previously to investigate these variables at one, two, four, eight and 12 weeks post-discharge., Main Outcome Measures: SF36 scores, survey responses on number and type of co-morbidities, age, family support, type and frequency of health services used, satisfaction with services, hospital admissions, resumption of social activities., Results: No significant differences were found on any SF-36 scores, but General Health had declined. Women's Physical Functioning scores fell below population norms, men's remained above the norms. Physical composite scores showed a decline with age, and the Mental Composite Scores increased with age. The number of co-morbidities had increased over three years, with 58% being admitted to hospital. Half reported unmet health needs, related primarily to non-hip problems. Only general practitioner services were used monthly or more, with satisfaction ratings remaining high for all services used. Participation in social activities was increased from prior to surgery for 42% of participants., Conclusions: Recovery after hip replacement surgery is dramatic, especially in alleviation of pain, but for older patients, there is a subsequent decline in general health concomittant with others in this demographic group. Differences in men's and women's patterns of recovery suggests differential planning to provide more realistic expectations for recovery and aftercare.

Aims of the Study: The study investigated health-related quality of life in relation to demographic and clinical factors, and health service use and satisfaction by older total hip replacement (THR) patients following discharge from one Australian Hospital., Rationale: Understanding health-related quality of life and patterns of service use during recovery informs caregiving and patient and family education needs for discharge planning and case management., Background: Post-discharge, older THR patients have a high rate of health services use. Few valid measures of outcomes link nursing discharge or case management to patient-identified health status or service needs., Research Methods: Ward nurses conducted telephone interviews to study self-perceived health-related quality of life using Medical Outcomes Study Short-Form (SF-36) and responses to an accompanying questionnaire on demographics, service use and satisfaction at 1, 2, 4, 8, and 12 weeks postdischarge. SF-36 scores were compared with Australian population norms according to age and gender to determine the relative extent of postdischarge recovery., Results: Psychosocial recovery preceded physical recovery, which steadily improved. Physical component summary scores reached population norms and mental component summary scores exceeded norms by week 1. No differences in quality of life were found by age, but women took longer to recover physically. Those who lived alone did not have lower scores than those with residential support. General practitioners were seen most often; nursing visits were frequent only in weeks 1 and 2, specialist visits occurred at weeks 8 and 12. Allied health, hospital and pathology services were used less often. Most patients were satisfied or very satisfied with all services used., Discussion/conclusions: An almost immediate impact on quality of life was evident, probably indicating successful pain alleviation. Service use indicated adequate discharge planning and successful recovery. Having ward nurses as researchers was instrumental to continuity of communication between patients, families and service providers, which suggests increased potential for continuity of care.