This is a methodological study in which a case report is used to retrospectively analyse the link between a successful pilot study and stalled main study to identify potential methodological weaknesses in the planning process. The analysis identified unanticipated influences related to hospital processes and discipline boundaries that adversely influenced participant recruitment and retention for a clinical trial. The findings of the study demonstrate that, whilst the pilot is an important step in research planning to confirm the design and operational processes for a study, a thorough analysis of the relevant health service environment is an important additional objective for the pilot study.
This paper reports on a successful nurse practitioner-led Pressure Ulcer Prevention Program (PUPP), established with members from nursing, allied health and senior management, within a regional area health service in Australia. The aims of PUPP were to quantify the prevalence of pressure ulcers within the health organisation, evaluate the policy compliances, identify cost effectiveness by implementing appropriate pressure redistributing surfaces and raise awareness of pressure ulcer prevention amongst all levels of clinical staff. The strategies include annual point prevalence study across 41 facilities, mattress replacement and online education program. The prevalence survey data were collected by skin inspection and chart audits by the trained surveyors. Since this quality improvement program commenced in 2008, it has demonstrated a reduction in pressure ulcer prevalence by 16.4%, increased pressure ulcer risk assessment by 7.9% and use of appropriate pressure-relieving devices by 46.5%, which led to cost saving of AUD 500 000. This paper highlights the patient and organisation benefits that management and clinicians can accomplish through a systemic collaborative approach, in particular with strong support from the Area Executive Team of the health organisation.
Purpose
In Australia, nurse practitioners (NPs) were first endorsed in 2000. After more than a decade, the number of NPs remains relatively small with previous research suggesting medical resistance as a key reason for this. This article presents a selection of narratives from a study that explored the transition experiences of newly endorsed NPs with particular attention to relationships with their medical colleagues.
Data sources
A critical ethnographic approach was undertaken to explore the experiences of 10 Australian NPs who were interviewed three to four times for up to an hour throughout their first year of practice.
Conclusions
Participants’ narratives provide insight into their transition to practice and the barriers and facilitators to their new role. In contrast to previous research, medical colleagues were generally supportive and collegial while resistance was demonstrated most often by senior nurses yielding positions of power.
Implications for practice
This study provides insight into the influences that key health professionals have over the transition of NPs. Despite the fact there are still negative attitudes being expressed by some medical associations, in this study medical colleagues were largely supportive of the NP role and that integral to the development of these interprofessional relationships was mutual respect and effective communication.
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