PUBLICATIONS 2008

Relationships between aggression management training, perceived self-efficacy and rural general hospital nurses' experiences of patient aggression
Contemporary Nurse

Hills, D.

Abstract
Relationships between nurses' experiences of patient aggression in the previous three months, participation in aggression management training in the previous five years and perceived self-efficacy in dealing with patient aggression are reported. Over 76 per cent of general hospital nurses employed by a rural Area Health Service in New South Wales, Australia experienced patient aggression within a three-month period. Registered Nurses and Midwifes were most affected, with over 83 per cent experiencing recent patient aggression. Most of this aggression was in the form of verbal abuse. Almost 40 per cent of nurses had not participated in aggression management training or updates in the previous five years. Approximately 70 per cent of survey respondents reported their perceived self-efficacy in dealing with patient aggression in the low to mediumhigh range. No significant association was detected between participation in aggression management training in the previous five years and the frequency of patient aggression experienced in the previous three months. Significant though very weak associations were detected between participation in aggression management training, the proportion of patient aggression experienced as verbal abuse and perceived self-efficacy in dealing with patient aggression.The findings of this and other studies highlight the need for more rigorous approaches to evaluating the effectiveness of aggression management training and undertaking patient aggression management research more broadly.

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The duration of clinical placements: A key influence on nursing students' experience of belongingness
Australian Journal of Advanced Nursing

Levett-Jones, T., Lathlean, J., McMillan, M., & Higgins, I.

Abstract
Objective: This paper reports selected findings from a study that investigated nursing students’ experience of belongingness. The manner in which this experience is influenced by the duration of students’ clinical placements is the focus of the discussion.

Design: A mixed method, multi-site case study approach using an anonymous online survey: the Belongingness Scale - Clinical Placement Experience was completed by 362 students, 18 of whom also participated in semi-structured interviews.

Setting: The setting for the study was two Australian universities and one university in the United Kingdom offering undergraduate nursing programs.

Subjects: Third year undergraduate students (n=362) were recruited into the study.

Main outcome measure: Nurses experience of belongingness and the influence of the duration of clinical placement on the experience of belongingness.

Results: Students' self-concept, degree of self-efficacy, confidence, resilience, willingness to question or conform to poor practice, career decisions, capacity and motivation to learn were all impacted by the extent to which they experienced belongingness. Differences in belongingness scores between the students from the three sites were statistically significant, with participants from the United Kingdom scoring higher than those from either of the Australian sites, F(2, 355) = 21.70, p = <.001, ηp2  = 0.11. Although the reasons for these results are multifactorial, this study found the duration and structure of clinical placements to be one of the most important factors affecting students’ belongingness.

Conclusion: A consolidated period of practice for students to 'settle in' and establish collegial relationships is an important influence on their experience of belonging and a necessary precursor to their active and participative learning. Findings from this study call for a re-examination of the assumptions, educational philosophies, policies and practices that underpin the duration of clinical placements in contemporary undergraduate nursing programs.

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Mentorship in contemporary practice: the experiences of nursing students and practice mentors
Impact factor

Myall, M., Levett-Jones, T., & Lathlean, J.

Summary
Aim: Mentorship in contemporary practice: the experiences of nursing students and practice mentorsThis paper explores the role of the mentor in contemporary nursing practice in the UK. It presents findings from a recent study which investigated the impact of a locality-based nursing education initiative on students, practice mentors and academic staff and draws on another study, conducted in the same setting and two Australian sites, to examine the perceptions of nursing students and mentors.

Background: Within nursing, mentorship is integral to students’ clinical placement experiences and has attracted increasing interest among researchers. Despite a plethora of studies focussing on mentoring and its nature and application within the practice setting, limited attention has been paid to the extent to which guidelines provided by regulatory bodies for nursing inform and influence the practice of mentoring in contemporary health-care settings.

Design: The study used a two-phased design with data on mentorship being focussed on the second phase.

Method: Data were collected using an online survey questionnaire of pre-qualifying students and a postal questionnaire for practice mentors.

Findings: The findings highlight the importance of mentorship for prequalifying students and emphasise the need to provide mentors with adequate preparation and support. They confirm previous research, but also highlight improvements in bridging the gap between rhetoric and reality for mentorship. Results are further strengthened when compared with those of the second study.

Conclusion: Findings provide new evidence of a narrowing of the gap between the theory and practice of mentoring and for the continuing implementation of national standards to clarify the roles and responsibilities of the mentor. They also suggest the benefits of developing such standards in countries with similar systems of support for nursing students.

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Belongingness: A prerequisite for nursing students' clinical learning
Nurse Education Today

Levett-Jones, T., & Lathlean, J.

Summary
The concept of belongingness has intuitive appeal. Human beings are social creatures; the need to belong and be accepted is fundamental, and social exclusion can be devastating. This paper reports on the selected findings from the qualitative phase of mixed-methods study that explored nursing students’ experience of belongingness while on clinical placements. The 18 interview participants in this study were from Australia and the United Kingdom. They provided a range of perspectives on belongingness and how it influenced their placement experience. Central to this discussion was their strong belief that belonging is a prerequisite for clinical learning. This theme dominated all of the interviews. Given that the primary purpose of clinical placements is for students to learn to nurse, there needs to be a clear understanding of the relationship between belongingness and learning. With reference to the published literature and excerpts from interview transcripts, this paper proposes that reconceptualising nursing students’ clinical learning experiences through a ‘lens of belongingness’ provides a new perspective and reveals yet unexplored insights.

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Belongingness: A prerequisite for nursing students' clinical learning
Nurse Education Today

Levett-Jones, T., & Lathlean, J.

Summary
The concept of belongingness has intuitive appeal. Human beings are social creatures; the need to belong and be accepted is fundamental, and social exclusion can be devastating. This paper reports on the selected findings from the qualitative phase of mixed-methods study that explored nursing students’ experience of belongingness while on clinical placements. The 18 interview participants in this study were from Australia and the United Kingdom. They provided a range of perspectives on belongingness and how it influenced their placement experience. Central to this discussion was their strong belief that belonging is a prerequisite for clinical learning. This theme dominated all of the interviews. Given that the primary purpose of clinical placements is for students to learn to nurse, there needs to be a clear understanding of the relationship between belongingness and learning. With reference to the published literature and excerpts from interview transcripts, this paper proposes that reconceptualising nursing students’ clinical learning experiences through a ‘lens of belongingness’ provides a new perspective and reveals yet unexplored insights.

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Peer Physical Examination: Time for a Rethink?
Medical Journal of Australia

Outram, S., & Nair, K.

Health Inequities: The need for action by schools of medicine
Medical Teacher

Sanson-Fisher, R., Outram, S., & Williams, N.

Summary
Background: It is well recognised that marked inequalities in mortality and morbidity exist between populations particularly those in lower socio-economic groups, including Indigenous and some ethnic minorities. Academic medicine has not yet articulated a clear stance on reducing health inequity within communities.

Aim: To develop criteria that medical schools can implement to reduce health inequity. These criteria will enable the performance of a medical school’s commitment to health equity to be measured.

Results and Conclusion: We suggest that the contribution to lessening health inequity should be seen as an integral and important role of undergraduate medical education and the academic institutions that provide such programs. Five strategies aimed at increasing the commitment of medical and other undergraduate health students to work with disadvantaged groups to improve their health are described. They include student selection to increase representativeness of students and importantly, support for retention and academic success; undergraduate curriculum, both core and elective, to address inequality and provide skills necessary to implement change in a range of areas that impact on health; academic physicians modelling the above by actively working in and for disadvantaged groups; developing centres of excellence carrying out research in health inequity, particularly intervention rather than solely descriptive research and creating high status academic appointments in key designated positions addressing inequity. Schools of Medicine could be rated on their action on these criteria so that benchmarking across institutions could occur.

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