Nurse Education

• Aboriginal and Torres Strait Islander health workers

  • They improve the health of the islander communities

  • They assist the islanders in controlling and managing their health and well-being.

  • They enhance effective communication between health professionals and the islanders.

  • They are often advocates and act as interpreters.

  • They can ensure that person has a good understanding of the health advice and treatment provided.

  • They also promote a better understanding of the cultural beliefs and health care practices of both parties.

Types of Nurse Education Programs

• Vocational nursing programs

  • It is provided by the vocational education and training (VET) sector.

  • ENs and EENs usually provide basic direct care. EENs can administer a limited range of medications.

  • ENs practice include assessment, intervention and evaluation of the person's health care status.

    • They are associates to RNs.

    • They also monitor ongoing impacts of nursing care.

    • They must practise under the supervision of RNs.

• Registered nursing programs

  • On 24 August 1984, the Commonwealth Government of Australia decided that RNs would be educated in universities rather than hospitals.

  • To become a licensed RN in Australia now, a nurse needs to have graduated from a baccalaureate program.

• Degree programs

  • Nurse education has moved away from process-based curricula to programs informed by nursing standards which demonstrate the complex and dynamic nature of contemporary nursing.

  • Australian nursing schools offer expedited Bachelor of Nursing (BN) programs.

  • These programs may include summer terms to abbreviate the curriculum or be tailored for students who already hold a relevant certification in another subject and get credit for earlier learning.

  • Some universities offer nursing students the opportunity to pursue an online program.

  • The nurse who holds a bachelor's degree experiences greater autonomy, responsibility and participation in institutional decision making and in career advancement.

• Postgraduate nurse education

  • Applicants must first meet requirements established by the university to gain entry.

    • The applicant must be a Registered Nurse, licensed or eligible for licensing.

    • The applicant generally must hold a baccalaureate degree in nursing or a course deemed appropriate.

    • The applicant must provide evidence of scholarly ability.

• Master's programs

  • Generally take from 1 to 2 years to complete.

  • These are postgraduate and provide specialised knowledge and skills that enable nurses to assume advanced roles in practice, education, administration and research

• Doctoral programs

  • They can be undertaken at most universities but depend largely on the availability of appropriate HDR supervisors.

  • Graduates are awarded the degree of Doctor of Philosophy (PhD) or a professional doctorate (EdD).

• Entry to practice

  • Entry level professionals need a bachelor's degree.

  • NMBA and ANMAC set the legal and ethical parameters of nursing practice and choose the title for registered nurses.

• Continuing professional education/professional development

  • These are terms that refer to formalised experiences designed to build upon or revise the knowledge or skills of practitioners.

  • Participants may receive certificates of completion or attain specialisation within a specific area.

  • Continuing professional education is the responsibility of every practising nurse and AHPRA monitors this through annual licence renewal.

Nursing Research and Evidence-based Practice

• A major goal of nursing research is to improve health care and outcomes.

• Evidence can be gained from a qualitative, quantitative or mixed methods approach.

• No matter the research paradigm, research design and analysis is based on a systematic, scientific approach.

Research approaches

Approaches to nursing research

• Quantitative research

  • These progresses through systematic, logical steps according to a specific plan to collect information, often under conditions of considerable control, which is analysed using statistical procedures.

  • It is most frequently associated with positivism or logical positivism, a philosophical doctrine that emphasises the rational and the scientific.

  • It is often viewed as 'hard' science and uses deductive reasoning and empirically measurable attributes.

• Qualitative research

  • It is often associated with naturalistic inquiry, which explores the subjective and complex lived experiences of human beings.

  • Describe their aims as seeking answers to questions about the 'what' , 'how' or 'why' of a phenomenon, and research that tends to focus on the qualities of things rather than quantity.

  • Data collection and analysis often occur concurrently

  • Using the inductive method, data are analysed by identifying themes and patterns to develop a theory, model or framework that helps explain the processes under observation.

• Mixed methods research

  • It is used to overcome the limitations that a single approach may impose.

  • This approach is becoming increasingly popular as researchers appreciate that problems are often complex and can best be answered by taking advantage of using multiple ways to explore a research question.

  • It enables a breadth and depth of understanding and substantiation.

Protecting the rights of human participants

• Human research ethics committees {HRECs)

  • Play a central role in the ethical oversight of research involving humans.

  • HRECs review research proposals involving human participants to ensure that they are ethically acceptable and in accordance with relevant standards and guidelines.

  • Australian Health Ethics Committee (AHEC) plays an important role in this system.

• National Statement

  • It mandates that HRECs assess and approve all human participant research applications.

  • It also outlines the ethical principles and values that should guide research design and conduct, which HRECs should consider while considering applications.

  • The purpose of the National Statement is 'to promote ethically good human research'.

• Right not to be harmed

  • The risk of harm to a research participant is exposure to the possibility of injury that is beyond everyday situations.

  • The risk can be physical, emotional, legal, financial or social.

• Right to full disclosure

  • Full disclosure: the act of making clear the person's role in a research situation, is a basic right.

  • It means that deception, either by withholding information about a person's participation in a study or by giving the person false or misleading information about what participating in the study will involve, must not occur.

• Right of self-determination

  • This means that participants should feel free from constraints, coercion or any undue influence to participate in a study.

  • Nurses need to be aware of power differentials when recruiting potential participants, as many people will feel compelled to say 'yes'.

• Right to privacy/confidentiality and anonymity

  • Confidentiality: Any information a participant relates will not be made public or available to others without the participant's consent.

  • Investigators must inform research participants about the measures that provide for these rights.

Quantitative Research Process

• The research question or problem

  • The investigator's initial task is to narrow a broad area of interest to a circumscribed problem that specifies exactly the intent of the study

  • A research problem has significance, if it has the potential to contribute to nursing science by enhancing care, testing or generating a theory, or resolving a day-to-day clinical problem.

  • Researchability: Means that the problem can be subjected to scientific investigation.

  • Feasibility: pertains to the availability of time as well as the material, financial and human resources needed to investigate the research problem.

  • Dependent variable: It is the behaviour, characteristic or outcome that the researcher wishes to explain or predict.

  • Independent variable: It is the presumed cause of or influence on the dependent variable.

• Define the study's purpose or rationale

  • The statement of the study's purpose indicates what the researcher intends to do about the research problem that has been identified.

  • The study purpose includes what the researcher will do, who the participants will be and where the data will be collected.

• Review the related literature

  • It is important to acquire an understanding of the topic, know what has already been done on it, understand how it has been researched and grasp what the key issues are that need addressing.

  • Reviewing the literature provides a complete picture, which could remain partially hidden if a single piece of research or other information is viewed in isolation.

• Formulate hypotheses and define variables

  • Hypothesis: a prediction of the relationship between two or more variables.

  • Hypothesis formulation requires sufficient knowledge about a topic to predict the outcome of the study

  • It also requires operational definitions, which specify the instruments or procedures by which concepts will be measured.

• Select a research design to test the hypothesis

  • Research design: It is the overall plan for conducting the study to answer the research question/s or test the research hypotheses.

  • It includes the study setting, participant group, recruitment strategies, type of data to be collected and ethical considerations, as well as strategies to control extraneous variables and reduce bias

  • Experimental design: The investigator 'manipulates' the independent variable by administering an experimental treatment to some participants while withholding it from others

  • Quasi-experimental design: The investigator 'manipulates' the independent variable but without either the randomisation or the control that characterises true experiments.

  • Non-experimental design: The investigator does not 'manipulate' the independent variable.

• Select the participant group and setting

  • Population: includes all possible members of the group who me,et the criteria for the study

  • Participant group: also known as sample or study cohort, is the segment of the population from whom the data will actually be collected.

  • Sometimes research participants are called subjects but if nurses are using a person-centred framework, they would call the person a participant, not a subject.

• Conduct a pilot study

  • A trial run is conducted to assess the adequacy and feasibility of the research design.

  • By identifying any problems or flaws during the pilot study, the investigators can refine and strengthen the research design.

• Collect the data

  • The research process relies on empirical data, collected from the observable world. Conclusions are derived from collected data.

  • Validity: It is the degree to which the data collection tool (instrument) measures what it is supposed to measure.

  • Reliability: It is the degree of consistency with which an instrument measures a concept or variable.

• Analyse the data

  • Descriptive statistics: procedures that summarise large volumes of data, are used to describe and synthesise data, showing patterns and trends.

    • Include measures of central tendency and measures of variability.

  • Measures of central tendency: describe the centre of a distribution of data, denoting where most of the participants lie.

    • Include the mean, median and mode.

  • Measures of variability: indicate the degree of dispersion or spread of the data.

    • Include the range, variance and standard deviation.

  • Mean : a measure of central tendency, computed by summing all scores and dividing by the number of participants; commonly symbolised as x- or M.

  • Median: a measure of central tendency, representing the exact middle score or value in a distribution of scores

    • The value above and below which 500/o of the scores lie.

  • Mode: the score or value that occurs most frequently in a distribution of scores.

  • Range: a measure of variability, consisting of the difference between the highest and lowest values in a distribution of scores.

  • Variance: a measure of variance or dispersion, equal to the square of the standard deviation.

  • Standard deviation: the most frequently used measure of variability, indicating the average to which scores deviate from the mean; commonly symbolised as SD or S.

• Communicate conclusions and implications

  • Implicit in conducting research is the requirement to share the knowledge generated with others.

  • This can be done by publication in professional journals, books or reports, or by presenting the results at professional conferences, seminars or workshops.

  • Interpreting the results, communicating the findings and suggesting directions for further study conclude the research process.

• Evidence-based practice (EBP)

  • In EBP, the nurse integrates research findings with clinical experience, the preferences of the health service user and available resources in planning and implementing care.

  • Significant sources of EBP data are the Cochrane Database of Systematic Reviews and the Joanna Briggs Institute (JBI).

  • Data found in these resources often combines research to increase the power of the findings of numerous studies, each too small to produce reliable results individually.

  • The Cochrane Collaboration is an international organisation dedicated to making up-todate, accurate information about the effects of health care readily available.

  • JBI promotes and supports the synthesis, transfer and utilisation of evidence through identifying feasible, appropriate, meaningful and effective health care practices to assist in the improvement of health care outcomes globally

Qualitative Research Process

• Ethnography: research that provides a framework to focus on the culture of a group of people.

• Phenomenology: research that investigates people's life experiences and how they interpret those experiences.

• Grounded theory: research to understand social structures and social processes.

  • This method focuses on generation of categories that explain patterns of behaviour of the people in the study, and results in the development of a substantive theory.

Critiquing Research

• Substantive and theoretical dimensions.

  • Nurses must assess the study's

    • importance,

    • conceptualizations,

    • theoretical framework, and

    • research question-design congruence.

• Methodological dimensions.

  • Methodological aspects include the

    • study's research design,

    • sample size and representativeness (in a quantitative approach), sampling design,

    • instrument validity and reliability,

    • research process, and

    • data analysis procedures.

• Ethical dimensions.

  • Nurses must assess if human participants' rights were safeguarded

  • Also assess whether ethical issues impacted the study's scientific usefulness or participants' well-being.

• Interpretive dimensions.

  • Nurses must verify the study's discussion, findings, and consequences.

  • The research topic and conceptual framework must be linked to the results.

  • Review the study's implications, limitations, and reproducibility or generalizability to comparable groups.

• Presentation and stylistic dimensions.

  • These convey the study strategy and findings.

  • The research report must be clear, succinct, and well-organized.

  • Presentation guidelines exist.

  • Journals have strict stylistic requirements.