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Publications (3)5.69 Total impact

  • Jessica Schluter, Philippa Seaton, Wendy Chaboyer
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    ABSTRACT: The past decade has seen increased patient acuity and shortened lengths of stays in acute care hospitals resulting in an intensification of the work undertaken by nursing staff in hospitals. This has ultimately led to a reconsideration of how nursing staff manage their work. The aim of this study was to understand how medical and surgical nurses from two Australian hospitals conceive their scope of practice in response to the available grade and skill mix of nurses and availability of unlicensed health care workers and other health care professionals. By exploring these meanings, this study aimed to build an understanding of how nursing work patterns were shifting in the face of changing patient acuity, patient profiles and nursing skill mix. A constructivist methodology, using critical incident technique (CIT) was used to explore nurses' role and scope of practice. Twenty nurses, 16 registered nurses (RNs) and four enrolled nurses (ENs), discussed significant events during which they perceived they were undertaking either patient care activities they should be undertaking, or activities that should have either been delegated or undertaken by a higher level of care provider. Five themes emerged from the data: (1) good nurses work in proximity to patients providing total patient care; (2) safeguarding patients; (3) picking up the slack to ensure patient safety; (4) developing teamwork strategies; and (5) privileging patients without mental illness or cognitive impairment. A pattern woven throughout these themes was the idea of negotiation. RNs were struggling with the notions that direct patient care was sometimes not the best use of their time, and delegation did not equate with laziness. Negotiation has become a fundamental aspect of nursing practice given the variety of nursing care providers currently employed in acute care settings. Negotiation has allowed nurses to redefine appropriate nurse-patient proximity, promote patient safety and find innovative ways of working in nursing teams.
    International journal of nursing studies 04/2011; 48(10):1211-22. · 1.91 Impact Factor
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    ABSTRACT: The past decade has seen increasing patient acuity and shortening lengths of stays in acute care hospitals, which has implications for how nursing staff organise and provide care to patients. The aim of this study was to describe the activities undertaken by enrolled nurses (ENs) and registered nurses (RNs) on acute medical wards in two Australian hospitals. This study used structured observation, employing a work sampling technique, to identify the activities undertaken by nursing staff in four wards in two hospitals. Nursing staff were observed for two weeks. The data collection instrument identified 25 activities grouped into four categories, direct patient care, indirect care, unit related activities and personal activities. Two hospitals in Queensland, Australia. A total of 114 nursing staff were observed undertaking 14,528 activities during 482h of data collection. In total, 6870 (47.3%) indirect, 4826 (33.2%) direct, 1960 (13.5%) personal and 872 (6.0%) unit related activities were recorded. Within the direct patient care activities, the five most frequently observed activities (out of a total of 10 activities) for all classifications of nursing staff were quite similar (admission and assessment, hygiene and patient/family interaction, medication and IV administration and procedures), however the absolute proportion of Level 2 RN activities were much lower than the other two groups. In terms of indirect care, three of the four most commonly occurring activities (out of a total of eight activities) were similar among groups (patient rounds and team meetings, verbal report/handover and care planning and clinical pathways). The six unit related activities occurred rarely for all groups of nurses. This study suggests that similarities exist in the activities undertaken by ENs and Level 1 RNs, supporting the contention that role boundaries are no longer clearly delineated.
    International Journal of Nursing Studies 03/2008; 45(9):1274-84. · 2.25 Impact Factor
  • Jessica Schluter, Philippa Seaton, Wendy Chaboyer
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    ABSTRACT: This paper is a description of the development and processes of the critical incident technique and its applicability to nursing research, using a recently-conducted study of the Australian nursing workforce as an exemplar. Issues are raised for consideration prior to the technique being put into practice. Since 1954, the critical incident technique has been used to study people's activities in a variety of professions. This five-step technique can be modified for specific settings and research questions. The fruitfulness of a study using the technique relies on gaining three important pieces of information. First, participants' complete and rich descriptions of the situation or event to be explored; secondly, the specific actions of the person/s involved in the event to aid understanding of why certain decisions were made; thirdly, the outcome of the event, to ascertain the effectiveness of the behaviour. As in other qualitative methodologies, an inductive analysis process can be used with the critical incident technique. Rich contextual information can be obtained using this technique. It generates information and uncovers tacit knowledge through assisting participants to describe their thought processes and actions during the event. Use of probing questions that determine how participants take part in certain events, or act in the ways they do, greatly enhances the outcome. A full interpretation of the event can only occur when all its aspects are provided. The critical incident technique is a practical method that allows researchers to understand complexities of the nursing role and function, and the interactions between nurses and other clinicians.
    Journal of Advanced Nursing 02/2008; 61(1):107-14. · 1.53 Impact Factor