Looking back – what advice would you give your first year self… hear are some of the things I would have liked to have known more about!
Practice-informed nursing: The future of transformative nursing education and research in a technological context
Three significant factors will impact on the future of nursing education and research in Australia
- Entrenchment of a culture of patient safety among practice-ready graduates while offering transformative educational experiences to nursing students and building resilient communities. Rural and regional communities, Indigenous people, and international inclusiveness and connectivity will be particularly important.
- Entrepreneurial nursing academics will be pivotal in developing innovative ways to fund practice and research projects; deliver quality-learning programs; and produce a strategic mix of research outputs. This is critical because of cuts to funding across the higher education sector and increasing competition for research grants.
- Capitalising on E Health – using the term broadly to cover not only storing, retrieving, maintaining and sharing patient records safely and effectively, but also electronic health service delivery assisted by communications technologies, such as web-conferencing, internet-based interventions, and the use of apps and social media. And there’s also E Health in academia – the way that the technologies are revolutionising the teaching, learning and research environment for nursing. Nursing academics’ expertise in E Health technologies will undoubtedly need to expand in the future.
transformative practice informed patient safety
The health industry expects universities to produce nursing graduates who are practice-ready and proficient in delivering quality health care where patients are safe, health risk is reduced, and deterioration is detected and responded to quickly. The graduates must be prepared for the high acuity of workplaces in the health sector, and must possess the indispensable attribute of resilience. Industry also expects graduates to be skilled in collaborative teamwork and capable of leadership and supervision early in their careers (Australian Commission on Safety and Quality in Health Care, 2010; Australian Institute of Health and Welfare, 2014; NSW Health, 2013).
A new era in the nursing discipline is dawning where transformative models of service and care are prioritised. The transformative process surpasses the traditions of ‘evidence-based practice’ and ‘life-long learning’, which frequently uses ‘time-spent’ as a metric to determine learning outcome.
Instead, future nursing needs contemporary continuous transformative learning, and practice-informed research using continuous models that are more flexible and nimble, in order to enhance capacity to adapt to rapid changes. Preparing students to be practice-ready has become increasingly challenging within the traditional three-year degree program, where specialty themes compete for inclusion. There is a need for innovative and entrepreneurial practice-informed teaching and learning to invigorate future curriculums, in conjunction with a balanced approach to practice-informed research agendas.
Postgraduate courseware will need to align with, and adapt to, market forces. In Australia, this includes addressing the changes announced by government to create Primary Health Networks and Health Care Homes, and ensuring the supply of qualified nurses to fill posts in these national centres (for example, Credentialed Mental Health Nurses). Advocating for appropriate reimbursement of specialist nurses will be a critical driver of postgraduate education (Australian College of Mental Health Nurses, 2013).
nurse entrepreneurialism in higher education
Funding for the higher education sector has been dwindling in recent years leading to major budgetary challenges, particularly for regional universities. Popular, high-enrolment courses like Bachelor of Nursing will continue to be important and strategic contributors to the overall university budgets.
International university ranking analysts suggest that “strongly motivated academics can offset to some degree limited funding” (Williams, Leahy, de Rassenfosse, & Jensen, 2016). Actively seeking collaborations will be vital to ensuring research funding success at the highest level, and so will serious attention to grantsmanship.
Nursing curriculum, with its expensive practicums, will undergo closer fiscal scrutiny in the future. So will other teaching related expenditure, with imperatives to maintain industry accreditation, to provide quality educational experiences for students, to have genuine consumer participation in curriculum design, and to incorporate digital and simulated pedagogies while managing cost effectiveness.
A particular challenge for nursing is to improve the impact of nursing research generally. Co-investigative nurse membership of collaborative interdisciplinary research teams has been important. A newer challenge is to move towards a position of excellence in nurse-led health research. New opportunity exists to do this, with the Australian Research Council looking to widen the definition of measurable impact to include category 2 and 3 grants, and with impact metrics increasingly linked to Google open access outputs, and international linkages including co-authorship (Williams et al., 2016).
Nurse researchers will need to be grant-ready and this includes building track record in grant success, and generating publications from their research. Concurrently, nursing scholars will need to develop industry and research linkages (including international higher degree research student intakes), together with the technological skills to generate outputs in digital domains.
safe and effective e health innovations
State and Federal governments are turning their service delivery focus and funding streams toward E Health services to meet growing expectations across the Australian consumer population (Australian Bureau of Statistics, 2013; Australian Commission on Safety and Quality in Health Care, 2015). For example: digital gateways for triaging and accessing health care service provision (Department of Health, 2015), managing patient health records, and delivering, monitoring and evaluating health interventions (Christenson & Petrie, 2013; Department of Health, 2016; Department of Health, 2015; E Mental health strategy for Australia, 2012; Keast, 2016).
E Health skills will need to be recognised as a core competence in future nursing curriculums (Australian Commission on Safety and Quality in Health Care, 2015). The rise of E Health presents opportunities for nursing with improved digital pedagogy learning design systems to produce nursing graduates who are practice-ready for the new and evolving practice domain of safe E Health. This has particular relevance for including and servicing rural and regional communities.
The nursing academy in Australia is trending against the odds. Nationally, enrolments are high, outputs and impact are strengthening despite dwindling higher education budgets for the discipline. Nursing academics will continue to drive the Australian nursing discipline into the future as they transform their focus towards practice-informed teaching and learning, practice-informed research integrated with international connectivity, and stronger collaborative relationships with the health sector and wider society.
- Australian Bureau of Statistics. (2013). Internet Activity, Australia, December 2012. (8153.0). Canberra: Australian Bureau of Statistics. Retrieved from http://www.abs.gov.au/
- Australian College of Mental Health Nurses. (2013). A Survey of Credentialed Mental Health Nurses working in the Mental Health Nursing Incentive Program.
- Australian Commission on Safety and Quality in Health Care. (2015). Australian Commission on Safety and Quality in Health Care Annual Report 2014/15. Retrieved from http://www.safetyandquality.gov.au/
- Australian Commission on Safety and Quality in Health Care. (2010). National Consensus Statement: Essential Elements for Recognising and Responding to Clinical Deterioration. (pp. 1-24). Sydney: Australian Commission on Safety and Quality in Health Care (ACSQHC).
- Australian Commission on Safety and Quality in Healthcare. (2016). Safety in E Health. Retrieved from http://www.safetyandquality.gov.au/
- Australian Institute of Health and Welfare. (2016). Primary Health Network (PHN) data. Retrieved from http://www.aihw.gov.au/
- Australian Institute of Health and Welfare. (2014). Australia’s Hospitals 2013-14. Retrieved from Australian Institute of Health and Welfare:http://www.aihw.gov.au/
- Australian Research Council. (2016). 2015-2016 State of Australian University Research ERA National Report. Retrieved from: http://www.arc.gov.au/
- Best, O. (2015). The cultural safety journey: An Australian nursing context. In O. Best & B. Fredericks (Eds.), Yardjuligin: Aboriginal and Torres Strait Islander Nursing and Midwifery Care (pp. 51-73). Port Melbourne: Cambridge University Press.
- Christenson, H., & Petrie, K. (2013). Information technology as the key to accelerating advances in mental health care. Australian and New Zealand Journal of Psychiatry, 47(2), 114-116.
- Department of Health. (2015). Australian Government Response to Contributing Lives, Thriving Communities – Review of Mental Health Programmes and Services. Canberra: Australian Government Retrieved from http://www.health.gov.au/
- Department of Health. (2016). Health Budget 2016–17. Retrieved from http://www.health.gov.au/
- Department of Health. (2015). e-Health. Retrieved from http://www.ehealth.gov.au/
- E-mental health strategy for Australia. (2012). Canberra: Commonwealth of Australia Retrieved from http://www.health.gov.au/
- Godbold, N., & McCaffery, K. (2015). Improving care by listening: care communication and shared decsion-making Communicating quality and safety in health care (pp. 164-175). Port Melbourne: Cambridge University Press.
- Keast, K. (2016). How technology will advance nursing practice. Retrieved from http://healthtimes.com.au/
- Little, F., O’Brien, A., Gray, M., Wilson R. L., & Finn, A. (2015). Scoping novel rural mental health clinical placements for undergraduate nursing and social work students in Northern NSW. Final Report: 20th November 2015. Retrieved from Hunter & Central Coast Interdisciplinary Clinical Training Network:
- NSW Health. (2013). Policy Directive: Recognition and Management of Patients who are Clinically Deteriorating. (PD2013_049). Sydney: NSW Ministry of Health.
- Usher, K., Woods, C., Casella, E., Glass, N., Wilson R. L., Mayner, L., . . . P., I. (2014). Australian health professions student use of social media. Collegian, 21(2), 95-101. doi:10.1016/j.colegn.2014.02.004
- Williams, R., Leahy, A., de Rassenfosse, G., & Jensen, P. (2016). U21 Ranking of National Higher Education Systems 2016. Retrieved from http://www.universitas21.com/
- Wilson, R. L., Ranse, J., Cashin, A., & McNamara, P. (2013). Nurses and Twitter: The good, the bad, and the reluctant. Collegian(0). doi:http://dx.doi.org/10.1016/j.colegn.2013.09.003
In Australia, moves are afoot to review and implement changes to the mental health services and programs on offer – including those offered to young people. Change always produces some tensions, and that will be the case again in this situation… but something had to give… change was needed to see equitable improvements, and none more obvious than for rural young people with mental health problems. So here we go – join me on the slippery slope of mental health care reform roller coaster!
The media have labelled the staged funding reductions to early psychosis services as “Futures will be lost. Health fears as youth pychosis program dropped” Read about it here: http://www.smh.com.au/federal-politics/political-news/futures-will-be-lost-health-fears-as-youth-psychosis-program-dropped-20160429-goi1hu.html
This begs more questions: The future of who…? Who will be advantaged…? And, who will be disadvantaged…? How do we achieve fairer and more equitable care for all of our young people throughout Australia? There are no easy answers or solutions… to suggest there are is to reveal a flippant disregard for the complexity of meeting the mental health needs of young people today.
I’m an optimist…
I hope that the government have got this right… and that a redistribution of youth psychosis program money will benefit young rural people more equitably as a result… Of course, advocating for the equitable mental health needs of young rural people has been my long-term professional activity of mine! So, I can only hope that this new direction to send funds to the primary health networks – will in fact work for rural and regional young people where the gaps are larger! There are some risks to note. For example, how will people be mobilised from their comfort zones to take up work in new geographical regions…? Will this be supported in the recruitment of appropriate servicing of populations? Will it really be equitable? Or just equal? Will health professionals be contracted using brokerage models as they are ‘commissioned’ for services? And, if they are, how will this new model ensure that health professionals are able to be fully employed at reasonable pay rates, in keeping with their level of expertise? How will we mitigate the risk of under-employment of people in low population communities yet maintain equitable service levels? How will the ‘gaps be filled’? Has this been fully considered?
I don’t think that the new approach to funding of youth mental health care this is such a bad thing for rural and regional young people. I have been calling for a more equitable and inclusive distribution of the mental health dollar for many years now… (eg https://www.researchgate.net/publication/275340216_Rural_nurses_A_convenient_co-location_strategy_for_rural_mental_health_care_of_young_people )
… it has not always made me popular…
The harsh reality is that rural youth often have much longer durations of untreated mental illness, poorer access to mental health services and poorer prognosis as a result… And, the largely urban-centric models of specialist youth mental health care have not met the demands for rural youth with mental health care needs. Something needs to give a little… perhaps this new funding model will be it… But – it needs to explain how it will include nursing expertise to promote mental health among young people at its core… Because, nurses are already there in all communities… and they represent a present resource that can be better engaged in primary care.
How will nurses be engaged in the primary mental health care of young rural people? The role of nursing in the models of care continues to be vaguely described at best in current strategy offerings… Only using nurses for managing chronic care (ie the Mental Health Nurse Incentive Program) is a sure-fire for short-changing the mental health of young people… becasue… young people have simply not lived long enough to have ‘achieved’ chronic mental illness status… rendering them ineligible for government supported nursing care in the main! Thus, how will this new model of funding utilise the expertise of nurses to deliver primary mental health care to young people and mitigate the early identification and intervention end of the care spectrum problems? Remembering of course that nurses make up the largest proportion of health professionals representing and the largest proportion of human resource for mental health service delivery throughout the country? Nurses need to be a large chunk of the journey towards successful new models of care – yet they seem to be overlooked in the latest iteration of change. Why?
I am not yet convinced the the Primary Health Networks will be the solution… but I am prepared to be open-minded about the possibilities… I hope we are seeing the beginnings of something substantially more useful than reshuffling deck chairs. I think closer federal collaboration with state health, education, family and community services and police/ justice services will bring more profitable benefits. But, while a two tier government approach persists in mental health service delivery (Federal and State/s), problems in administering equitable services will also persist with bureaucratic double-ups inevitable, ultimately soaking up some of the direct clinical and research spend potentials.
I agree with McGorry, that many gains have been achieved through the concentrating of specialist expertise in a small number of specialist services, and that it would be a shame to lose this. But, having built this considerable national human resource – if it were mobilised and dispersed across the country (for example, the experts geographically relocated) this have a benefit of authentically redistributing the talent and in doing so benefit more people over time. Is it time to mobilise the specialist population for greater good in health service delivery? A question for health geographers and health ecologists to ponder. Will redistribution of funding trigger a wider set of conditions in communities such that mental health is more effectively promoted? I think that this is possible: https://www.researchgate.net/publication/280134451_Rural_Mental_Health_Ecology_A_Framework_for_Engaging_with_Mental_Health_Social_Capital_in_Rural_Communities
It is not all bad news, a new model could bring with it ‘catch-up’ conditions to more vulnerable and harder to reach young populations who should have convenient access to local mental health support where and when they require it. The challenge is for mental health professionals to work together using digital technologies to bring us together, it is after all what we expect of our clients these days! That is, to be satisfied with e mental health/ telehealth and digital gateway (triage) delivery….
Perhaps health professionals will also need to adapt our practices in the ways that we work and collaborate with each other – building virtual centres of excellence rather than geographical catchments of excellence. In doing so, some castles will be dismantled – and new ones will emerge… shifts in the sands of time across the landscape of mental health service and evidence development and delivery are inevitable.
It is clear that the health budget in Australia will never be able to fund sufficient levels of mental health service delivery for Australian young people – our present budgets don’t go near sufficiency. Finding ways to squeeze a few extra drops of oil out of the rag are always going to be critical… the challenge is out for mental health researchers to be prudent in devising ways in which we can continue to do more, with less, and for politicians and policy makers to take heed of evidence as it emerges… And finally, for clinicians to be ready to adapt to the changing times as they evolve. None of that is easy!
Relevant other links:
- Be more curious about everything, you will learn more that way.
- Being kind will get you everywhere you need to go.
- Not everyone will agree with you – that is fine! Don’t take critique to personally – but use it to make you more capable, resilient and strong.
- Follow your instinct with people – the right thing to do is probably the right thing to do. Trust your gut feeling.
- Read everything you can about nursing topics. Read every new journal issue you can! That way your gut feeling will be steeped in evidence!
- Learn to write as soon as you can… academic writing seemed pointless in first year… but good communication skills get you everywhere in life – and life is easier if you can write (and reference)! It does matter after all…
- There are a lot of good people out there; and there are a lot of not so nice people too. But, be nice to everyone – sometimes the background story for the not-so-nice people explains why they are not-so-nice.
- Listen more…
- Be with people more… It is risky – but I mean really be with them… emotionally, helpfully, and compassionately. Be prepared to really care.
- Remember – every time you see a naked or semi-naked person – it is an opportunity to practice your assessment skills! Don’t ever be ‘too posh to wash’.
- People are never called ‘the shower’ or ‘toileting’, ‘a turn’ or a ‘room number’. Rather, think of it as a privilege to help someone who can’t do stuff for themselves they would rather do for themselves and in private.
- You will get hurt emotionally; there will be pain. Use your vulnerability and turn it into your strength. Talk to senior colleagues about reflecting on your practice and developing your resilience early on.
- Love what you do… not everyone around you will share that joy – but it is OK to love nursing! Jump in boots and all – don’t hold back. Some of the people you care for from day one prac onwards will stay in your memory for life.
- You were right… the computer unit (where you learnt to write a program to produce an image of your initials), and the music unit (where you had to perform a solo song) did not add a great deal to your nursing skills… but you got HD’s in those units, so something good came of something you didn’t want to do! Be prepared to do some stuff you don’t want to do… and try not to grizzle too much about it.
- Stay curious, and be prepared to learn new things, whether you think they are useful right now, or not. You will be amazed at how knowledge weaves and scaffolds your nursing thinking from many different directions and disciples. Turns out E Health is big these days – something I couldn’t foresee in first year. Things change – stay nimble and ready to change and adapt!
- Remember to keep some chewing gum handy for those smelly jobs you will have to do. Don’t moan about it in the pan room either.
- Remember to keep some tissues handy for the sad jobs you will have to do.
- It is cool to wash your hands – all the time, before and after everything. Don’t wait to be asked… just do it!
- Black tea with sugar is great for recovering after you faint during a nursing procedure! (You did/will a couple of times…)
- Buy your own stethoscope…no body likes to share earpieces or wax!
- If the person/patient says they have pain – they do… believe them.
- Stay curious and read more.
I love the buzz of a nursing conference… I am attending this one: http://www.rcn.org.uk/__data/assets/pdf_file/0019/620317/RCN-2015-research-Book-of-Abstracts.pdf
These days – a prerequisite to getting the most out of conference attendance is making sure you have a Twitter handle – here is mine @rhondawilsonmhn You need one of these so you can follow the Twitter concurrent Twitter conversation which extends the discussions a great deal. Conferences usually have a hashtag to follow… this one is #research2015. Putting the hashtag in the twitter search engine and saving it allows you to visit and participate in the conversation. I think I got about 25 new followers yesterday alone by doing this – that extends my professional network and puts me in touch with nursing colleagues around the world. Meeting people #IRL (In Real Life) is then made easier – because you already have had an introduction connection. Here are the social media analytics for yesterday!
78 Avg Tweets/Hour
6 Avg Tweets/Participant
My twitter network started to expand at breakfast yesterday with meeting Dr Camille Cronin from Essex –@ – sharing some ideas about nursing scholarship.
Then – at registration, caught up with a colleague that I first met on Twitter a couple of years ago (in Perth Australia!)… We follow each other on Twitter… a mental health nurse academic @ from Scotland.
Then the snowballing commenced! So many interesting people to meet over coffee and so many mints to collect in exhibition area.
Day one (yesterday) 20 April, 2015 was a buzz! Here are my highlights from the sessions:
The big theme shining though: The essential and most valued work of nursing are the invisible interventions, actions, the caring, the listening, the being with and sitting with, the provision of kindness and comfort, being engaged and present… those are the nursing attributes that matter to our patients. Nursing is not limited to bunch of skills: how well we can write our notes, administer a pill, insert a tube… it is about how we engage when we are doing the technical work… Very motivational.
- Prof Jill Maben spoke about the soulless factories of healthcare… and called for a humanising of health care for patients and nurses…a refreshing reminder to value the listening and being with our patients – to engage, connect and care. My tweet:
- Aussie Nurse, Elizabeth McCall – presented her research findings about brief interventions to address alcohol harms in a rural A&E department… she urged ED nurses to take the opportunity to ensure that they deliver appropriate brief interventions in A&E. A good qualitative study by a research active practitioner. My Tweet:
- Then – off to hear Dr Paul Gill (Cardiff) give a great presentation encouraging Nurse PhD success. My tweet:
- Jill Taylor (somewhere in Scotland) gave a impassioned presentation of her PhD about the work of Health Visitor nursing and the emotional labour involved – the stories in her data were compelling listening. My Tweet:
- Prof Lesley Wilkes (Australia) gave a fascinating report of her research about the experience of Refugee Health Nurses working in NSW, Australia. Loved this one… and really made me think… I wondered how it might be if the Refugee Health Nurses of the future had their own lived experiences of asylum seeking…
- John McKinnon (Lincoln, UK,) spoke about empathy… my pick of the day… I was glued to the whole presentation – the ways that nurses use empathy as a vital nursing intervention is a critical nursing experience… I heard a rumour he has a book coming out…. I will be lining up to buy it!
- Austyn Snowden gave a terrific presentation about the challenges of achieving ethics approvals – very impressive presentation: View it here
The bar has been set high… Day two is about to start… I am inspired by my colleagues and the company I am in here…
…. no Robin Hood sightings yet…
Last night the media revealed a government mental health report that highlights the need for improved funding of community based mental health services in Australia, triggering a diverse social media conversation about some of the pertinent issues.
Key highlights include people reporting:
- barriers to accessing mental health care
- major challenges when seeking mental health care for the first time
- being turned away from mental health care when help was needed
- suicides related to lack of timely access or followup to mental health care
- the suicide rate has been largely steady in Australia for many years – a failure to reduce mortality
- recognition that suicide is preventable – and especially so if we can improve access and point of care service delivery for mental health help seekers
A recommendation from the leaked report is reportedly that a significant investment be injected into improving community based mental health services. This is a good idea. It is not a new idea – there have been many advocates and voices bringing forth this suggestion. More mental health professionals at the the cutting edge – in primary health and in community health and other settings. More investment in helping young people – enabling their care, not inserting more barriers and waiting until they become so unwell that hospitalisation is the only choice. Community mental health care is a poorly funded and barely accessible – unless you get lucky. Luck is not a sustainable commodity on which to base the ongoing mental health of the population. The social media discussion is one that should generate some pressure to release the report to the public and to invite the public to generate new ideas to address the challenges of providing a fair, equitable and accessible mental health service to the population.
Here are some of the links to the recent social media conversation:
Mental health nurses have a great deal to contribute to the development of improved models of mental health care delivery for Australia, and they need to leading and consulting in the current debate. Some are bring more prominence to the debate by reminding the community that mental health nurses are here to help, an that they should not be overlooked in the develop of new models, policy and governance. mental health nurses should be included as full members of committees that seek to bring progress and improvement to what many are terming a ‘broken service’ (mental health service). Using the hashtag #heretohelp , nurses are advocating for inclusion and for improvement. If you see a #heretohelp hashtag – consider retweeting it or sharing it to show support for mental health nurses.
Nurses do an amazing job working to care and prevent many deaths caring for people with a wide range of mental health problems. In our acute services they are working with people in crisis and restoring many people to health and wellness. Among health professionals – nurses are the great proportion of clinicians caring for people with mental illness. That position gives nurses an important perspective on the delivery of mental health care. Nurses need to be listened to, and their work considered carefully in future planning.
I am a mental health nurse, bucket loads of clinical experiences and plenty of research experience as well… I have published work that makes recommendations for improving the delivery of mentla health care to rural people… here are soem of my ideas and recommendations in this portfolio of papers: https://www.researchgate.net/profile/Rhonda_Wilson3
I am #heretohelp – join me!
Another paper… this time addressing the very important topic about pre-registration mental health nursing education in Australia.
Mental Health First Aid training is designed to equip people with the skills to help others who may be developing mental health problems or experiencing mental health crises. This training has consistently been shown to increase: (1) the recognition of mental health problems; (2) the extent to which course trainees’ beliefs about treatment align with those of mental health professionals; (3) their intentions to help others; and (4) their confidence in their abilities to assist others. This paper presents a discussion of the potential role of Mental Health First Aid training in undergraduate mental health nursing education. Three databases (CINAHL, Medline, and PsycINFO) were searched to identify literature on Mental Health First Aid. Although Mental Health First Aid training has strong benefits, this first responder level of education is insufficient for nurses, from whom people expect to receive professional care. It is recommended that: (1) Mental Health First Aid training be made a pre-requisite of pre-registration nurse education, (2) registered nurses make a larger contribution to addressing the mental health needs of Australians requiring care, and (3) current registered nurses take responsibility for ensuring that they can provided basic mental health care, including undertaking training to rectify gaps in their knowledge.
Click here for more details… Happell, Wilson, McNamara 2014 MH Nurse Curriculum
…and follow for latest publication: here… https://www.researchgate.net/publication/265127066_Undergraduate_mental_health_nursing_education_in_Australia_More_than_Mental_Health_First_Aid