Dr Robyn Rosina

Dr Robyn Rosina

Lecturer

School of Nursing and Midwifery

Career Summary

Biography

I began my nursing career in 1981 with general hospital training. I went on to complete a Certificate in Paediatric Nursing at the Royal Alexandria Hospital for Children in Sydney.  I quickly developed an interest in how children and young people 'bounced back' from crisis, trauma, illness, injury and disability.  Whilst working with young offenders at Yasmar with the Department of Juvenile I completed a Graduate Diploma in Sexual and Reproductive Health, Adolescent Mental Health and Child and Family Health and numerous drug and alcohol and related courses. I then completed a Masters of Nursing with a dissertation on Youth Suicide: A general hospital nursing perspective.  My clinical work continued working with an Adolescent Medical Consultancy Team at a Tertiary Paediatric Hospital, Child/Adolescent Psychiatric Liaison at a Tertiary Hospital and state wide Child/Adolescent Mental Health Consultancy/Educative work. My leadership and management experience has included roles as a statewide child/adolescent mental health nurse manager and a statewide clinical director of Adolescent Health and Research. Alongside the latter roles I completed a Doctorate in Nursing titled "Young People and Chronic Illness: A more responsive healthcare world". In recent years I have shifted to roles in professional practice and research in a tertiary hospital and, teaching and learning conjoint with a university. I am currently appointed as an lecturer in nursing (mental health and leadership and management) with a research interest in clinical teaching, caring in nursing and leadership/management research.

Qualifications

  • Doctor of Nursing, University of Technology Sydney
  • Diploma in Adolescent Mental Health by Distance Ed, The New South Wales Institute of Psychiatry

Keywords

  • Adolescent Health
  • Child, Adolescent & Adult Mental Health
  • Chronic Illness
  • Clinical Teaching
  • Pastoral Care

Languages

  • English (Mother)

Fields of Research

Code Description Percentage
111005 Mental Health Nursing 50
130304 Educational Administration, Management and Leadership 50

Professional Experience

UON Appointment

Title Organisation / Department
Lecturer University of Newcastle
School of Nursing and Midwifery
Australia
Edit

Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Chapter (3 outputs)

Year Citation Altmetrics Link
2017 Rosina R, 'Considering the developmental context of youth and young adults', Potter and Perry's Fundamentals of Nursing, Elsevier Australia, Chatswood Australia (2017)
2017 Rosina R, Fraser J, 'Psychosocial development and response to illness', Paediatric Nursing in Australia Principles for Practice, Cambridge University Press, Sydney 55-78 (2017)
2014 Rosina R, Fraser J, 'Children Families and their Communities in Australia', Paediatric Nursing in Australia: principles for practice, Cambridge University Press, Port Melbourne (2014)

Journal article (6 outputs)

Year Citation Altmetrics Link
2011 Rosina R, O'Sullivan M, Baldeo A, 'Aged Care and Ministry: a glimpse into the world of frail aged and thoughts of some of those who care for them', Health Matters, Winter 26-27 (2011)
2008 Potter E, Cashin A, Andriotis H, Rosina R, 'Examining the role of nursing in (Youth) drug court programs', Journal of Addictions Nursing, 19 182-187 (2008)

There is a paucity of literature examining the role of nursing and nurse practice models in Drug Court Programs and specifically Youth Drug Court Programs. There is also no evalua... [more]

There is a paucity of literature examining the role of nursing and nurse practice models in Drug Court Programs and specifically Youth Drug Court Programs. There is also no evaluation of health services provided by nurses in these settings. Hence, there is little to guide services in setting up such a role and benchmarking efficacy. This paper briefly outlines the purpose and functions of Drug Courts, examines the New South Wales (NSW), Australia, Youth Drug and Alcohol Court Program process, and summarizes the role of the nurse within this program. This role is then compared to that of the nurse in other Drug Court Programs, and future implications and goals for such nursing positions are discussed.

DOI 10.1080/10884600802505070
Citations Scopus - 2
2007 Lynch C, Matthews R, Rosina R, 'Health as a mediator of change in the trajectory of young people in contact with the criminal justice system', International Journal of Adolescent Medicine and Health, 19 269-276 (2007)

Health care services in Juvenile Detention Centres have historically been provided by the criminal justice system. These health services have focused on assessment and treatment o... [more]

Health care services in Juvenile Detention Centres have historically been provided by the criminal justice system. These health services have focused on assessment and treatment of presenting health problems and have been hampered by the lack of clinical algorithms and standardised protocols expected of health run services. There is now comprehensive information on the health needs and prevalence of ill health, both physical and mental, for the population of adolescents in contact with the criminal justice system. This information has led to a greater understanding of the causative relationship between disadvantage, trauma, ill health and behaviour judged to be criminal as well an understanding of the need for a population health approach to underpin intervention. Young people in contact with the criminal justice system in New South Wales were found to come from disadvantaged backgrounds, have significant physical and mental health problems as well as increased risk behaviours and their associated health sequelae. This prevalence data can be used to plan service delivery and shape a model of delivery. Paradoxically incarceration offers an opportunity to target high prevalence health presentations and to screen for emerging physical and mental health problems. The potential to ameliorate life long conditions that impact on personal quality of life, and personal and system economic costs are of importance. There is the potential for some health interventions, such as mental illness and drug and alcohol to have an impact on the trajectory and lethality of recidivist behaviour. More research is required to examine health interventions with the potential to positively impact on long-term health outcomes as well as re-offending. © Freund Publishing House Ltd.

DOI 10.1515/IJAMH.2007.19.3.269
Citations Scopus - 1
2003 Rosina R, Crisp J, Steinbeck K, 'Treatment adherence of youth and young adults with and without a chronic illness', Nursing and Health Sciences, 5 139-147 (2003)

The present study was undertaken to explore the psychosocial functioning of young people with chronic illness, their beliefs about treatment adherence, difficulties with adherence... [more]

The present study was undertaken to explore the psychosocial functioning of young people with chronic illness, their beliefs about treatment adherence, difficulties with adherence and concerns about living with their illness. A small correlational study was undertaken to compare the psychosocial functioning of young people, with and without chronic illness, aged between 12 and 24 years. Subjects were recruited from a metropolitan teaching hospital. Group 1 included 44 young people with chronic illness; Group 2 included 41 young people without chronic illness. Both groups were divided on the basis of age: younger (12-18 years, n = 24); older (19-24 years, n = 61) and sex (female = 43; male = 42). Subjects completed the Achenbach self-report questionnaire as a measure of psychosocial functioning, and a second questionnaire constructed for this study to explore treatment adherence. Psychosocial functioning scores were found to be similar on the majority of subscales. Young women with chronic illness were, however, found to have significantly higher internalizing scores than young women without chronic illness. A significant negative relationship was found for the chronic illness group between internalizing scores and treatment adherence. The findings highlight potential areas of difficulty in psychosocial functioning of some young people with chronic illness. They also suggest the existence of a subgroup of young people with chronic illness who experience more problems than their peers. More research is needed to generate evidence about this possible subgroup to determine predictors of psychosocial functioning and test the timing and efficacy of psychosocial interventions.

DOI 10.1046/j.1442-2018.2003.00149.x
Citations Scopus - 28
2003 Starling J, Rosina R, Nunn K, Dossetor D, 'Child and adolescent telepsychiatry in New South Wales: Moving beyond clinical consultation', Australasian Psychiatry, 11 S117-S121 (2003)
Citations Scopus - 12
2002 Rosina R, Starling J, Nunn K, Bridgland K, 'Telenursing: Clinical nurse consultancy for rural paediatric nurses', Journal of Telemedicine and Telecare, 8 48-49 (2002)
DOI 10.1258/13576330260440844
Citations Scopus - 8
Show 3 more journal articles
Edit

Grants and Funding

Summary

Number of grants 8
Total funding $156,320

Click on a grant title below to expand the full details for that specific grant.


20185 grants / $65,320

Retaining Registered Nurses Beyond First Graduate Year$25,000

This project aims to evaluate the impact that Group Clinical Supervision has on the new graduate Registered Nurses. Specifically, their ability to thrive in the workplace rather than simply survive. The primary aim is to build clinical competence and confidence to remain with the LHD beyond 2 years.

There is significant concern that new Registered Nurses simply survive clinically and professionally during their early years, rather than thrive into their professional future. The researchers seek to understand what sustains and enables new Registered Nurses in the first years of employment and what factors enable them to remain in the nursing workforce. The researchers hypothesise that clinical supervision provided within the first year of nursing strengthens clinical competence and confidence. This research will aims to explore the efficacy group clinical supervision and other professional support strategies within the clinical learning environment of the new graduate nurse.

Funding body: Central Coast Local Health District

Funding body Central Coast Local Health District
Project Team

Janet Chesworth, Rachel O'Neil, Dr Robyn Rosina and Catherine Lothian

Scheme Robyn Rosina
Role Investigator
Funding Start 2018
Funding Finish 2019
GNo
Type Of Funding Other Public Sector - Local
Category 2OPL
UON N

Retaining RNs Beyond the First Graduate Year$10,320

The project will measure the efficacy of group clinical supervision as professional support strategy for first year graduate nurses and to explore if nurses in early graduate years are thriving or simply surviving. The intended outcomes of this project will be to deliver an evidenced-based ongoing group clinical supervision program to Registered Nurses in the first, second and third graduate year. Second to understand more about what are the barriers and enablers for new Registered Nurses to thrive in their chosen profession and our patient care workforce beyond the first year.

 

Funding body: Central Coast Local Health District

Funding body Central Coast Local Health District
Project Team

Janet Chesworth, Rachael O'Neil, Robyn Rosina

Scheme Research Grant
Role Investigator
Funding Start 2018
Funding Finish 2019
GNo
Type Of Funding Other Public Sector - State
Category 2OPS
UON N

Nursing and Midwifery Research Scholarship$10,000

Background:
Families are connected to a CFHN service following the birth of a new baby in NSW, in which all families are given a Personal Health Record (PHR) commonly referred as a ‘Blue Book’ (NSW Government 2017). The PHR is a resource for parents/carers, which provides health information on childhood growth, development, safety and scheduled immunisations (NSW Government 2017). Within the PHR there are eight child developmental health checks for a health professional to complete, as well as developmental milestones, growth, screening tests and childhood immunisations to be reviewed and documented. Within CFHN, all PHR checks are conducted in collaboration with parents/carers by utilising the ‘Learn the signs. Act early’ milestone monitoring tool to assist both family and the CFHN if there is any concerns about how a child is growing, developing or behaving (NSW Government 2018).
 
The essential components to an individual’s long-term health, well-being and social function are built by the early life experiences, care and attachment provided by a parent or caregiver (Shepherd 2011) and a CFHN is ideally placed to identify and support families early (Myors, Schmied & White 2014). The CFHN works within the NSW Health’s Supporting Families Early Maternal and Child Health Primary Care Policy (NSW Department of Health 2009) by conducting comprehensive assessments, identification of family and child vulnerabilities and strengths and on-going parental support and intervention strategies.
 
The CFHN supports families by identifying vulnerabilities and risk factors across several domains including the child, parent-infant relationship, family dynamics, environment and life events. A CFHN nurtures, supports and promotes the parent-child relationship, whilst monitoring and promoting child health and development (Hesson et al. 2017). Children’s future health outcomes rely on the early identification of health and or developmental problems with support and the linking early intervention services (Hesson et al. 2017). It is clear that CFHN are uniquely positioned to identify developmental concerns, support growth and optimise healthy lifestyle choices for children and their families.
 
The schedule of developmental checks for children provide screening and surveillance opportunities to ensure that children at risk of poorer outcomes are identified with timely intervention commenced, prior to school entry (Australian Health Ministers’ Advisory Council, 2011). Ongoing research stresses the importance of the early childhood years as a time of increased neural pathway development (Luby et al 2013). Engaging parents into CFHN services for child developmental checks is a public health imperative.
 
Aim:
To understand access barriers and enablers for attendance at CFHN services, inform strategic models of care to increase attendance rates for child developmental health checks for CCLGA children.
 
Methods:
Study design
A mixed methods research design will guide this study, to uncover and understand the complexities for families in their choice (or not) to access and engage with CFHN services within the CCLGA. The combination of both quantitative and qualitative data collection methods provides the opportunity to gain the best understanding of the research questions, aims and objectives (Hesse-Biber, 2010; Ridenour & Newman, 2009). The results are then integrated for interpretation (Collins, 2010; Creswell & Plano Clark, 2011). A mixed methods research design is particularly salient to comprehend and tackle the complexities of health care delivery (Andrew & Halcomb, 2009).
 
Study population and sampling
All parents (approximately 950) who have had a Universal Health Home Visit within a 3-month period (February – April 2019) will be invited to participate in the study via email.
All CFHN (approx. 65) who work within CCLHD will be informed of the study at team meetings and via email communication by the project team and participation invited. It is anticipated that approximately 20 CFHN will consent to participate in the focus groups.
 
Study implementation
The study will consist of 4 phases.
 
Phase 1: Exploratory phase
An initial literature review will be undertaken to gather broad information about:
  1. Known barriers and enablers for parents to attend CFHN services
  2. Existing models of care for parents to attend CFHN services
  3. Processes for developing new models of care, service pathways and guidelines.
National and state benchmarking:
Key stakeholders will be contacted in each LHD in NSW and each state and territory to gain information about CFHN models of care, service pathways and guidelines.
Organise meeting to check data collection and analysis prior to commencement.
 
Phase 2: Sample, data collection and analyses
CFHN
  1. All CFHN (approx. 65) will be sent an email survey to gather data about their perceptions of the barriers and enablers for parents to access CFHN service for child developmental health checks. Demographic data will also be collected, including qualifications and years as a CFHN.
  2. Three focus groups will be conducted with CFHN (approx. 20) to gather rich data about the barriers and enablers for parents to attend CFHN services for child developmental health checks.
 
Parents/Carers
  1. Survey questionnaires will be sent to parents who have had a Universal Health Home Visit over a 3-month time-frame, including both first time parents as well as those who have had a subsequent child. This will provide both prospective and retrospective data about parents’ perceived and actual engagement with CFHN service for child development health checks. Demographic data will also be collected.
  2. Three focus groups will be conducted with parents to gather rich data about the barriers and enablers for parents to attend CFHN services for child developmental health checks.
 
Data analysis
Quantitative data will be analysed using descriptive statistics – frequencies, means, standard deviations and ranges – and inferential statistics - chi-square and independent t-tests - to identify any relationships between the data sets.
Qualitative data from the focus groups will be transcribed verbatim and analysed using directed content (Hsieh & Shannon 2005) and thematic analysis techniques (Braun & Clarke, 2006; Green et al. 2007).
Integration of quantitative and qualitative data will enhance the findings (Bryman, 2006) by the emergence of new data findings (Andrew, Salamonson & Halcomb, 2008).
 
Phase 3: Development of new models of care, service pathways and guidelines
Data from the literature review, integrated data analyses and the documented current care pathways will be examined in detail to identify gaps and challenges in the current approach to service delivery, to design an effective service response and care pathways for parents of infants and children.
 
Phase 4: Pilot and evaluate new models of care, service pathways and guidelines
Child and family health nurses (approximately 8) from two community health centres (1 north and 1 south), will be informed of the new models of care and service pathways at a workshop.
These same CFHN will implement the new service pathways in the community health centre that they work for a period of 3 months. Numeric data will be collected to identify any changes in attendance for child developmental health checks. Analyses of this data will determine what changes, if any, need to be made to either the new service pathways. Once finalised, new guidelines will be developed and the service pathways will be implemented and evaluated with the remaining CFHN work force.
 

3.3 Expected Outputs and End-users

  1. Identify the anticipated research outputs (e.g. academic papers, completed experiments and/or trials, pilot data, clinical guidelines, new processes, disclosures and patents) (200 words max)
The outputs of this study will include:
 
  • Academic papers published in peer reviewed journals;
  • The development of new clinical guidelines and policies at both a local and state level;
  • A new model of care and pathways for parents of young children to access child and family health nursing services
  • Practice development with innovative clinical change
 
  1. Identify the end-users of your research outputs (end-users include patients other researchers who may use your study results, policy makers, government organisations, healthcare providers and industry) (100 words max)
End-users of the research outputs will include:
 
  1. Child & family health nurses who work within CCLHD;
  2. Clinical leaders within the division of Central Coast Kids & Families (CCK&F);
  3. Parents of infants/ children who reside within the Central Coast LGA;
  4. CFHN services in other LHDs;
  5. Policy makers within NSW Ministry of Health
 
  1. How will your study increase the likelihood that your research outputs are accessed and utilised by end-users? (200 words max)
The CCK&F senior clinical leaders as well the CFHN with CCLHD will be kept informed of the progression of the study throughout the duration. At the completion of the study oral presentations will be given to the senior clinical leaders and the CFHN workforce to inform them of the research outputs.
A number of strategies will be used to inform parents of the new pathways and model of care for CFHN services. These will include:
  • Written information provided to women while they are an inpatient in the maternity unit.
  • Written and verbal information provided to families by CFHNs at the UUHV.
  • Written information will be placed on the CCLHD website
  • Written information will be placed in local newspapers.
  • Written information will be provided to local radio stations for broadcast.
  • The research team will contact key stakeholders within NSW MoH to inform them of the outputs of the study
 

3.4 Anticipated Impact (300 words max)

Describe the potential impact from your research, including how this research will benefit the Central Coast community.
Uptake of the research outcomes by the end-users will include:
  • CFHN will work with new service pathways and thereby access and engage with increased numbers of families who have infants and children from birth to 5 years.
  • Clinical leaders within the division of CCKF will support the CFHN workforce as they negotiate the new service pathways for families. Potential workforce and budget issues will be identified and resolved.
  • Parents of infants/ children who reside within the Central Coast LGA will increase their access and engagement with CFHN services. This will result in increased PHR routine health checks per child with resultant increase early identification and intervention for identified concerns, optimising developmental outcomes for children prior to school entry.
  • Policy makers within NSW MoH will develop new policies which align with the research outcomes thereby improve public policy for families with pre-school aged children.
  • Early identification and intervention of developmental concerns by CFHN will generate economic benefits as referral to secondary and tertiary child health services will be decreased and with enhanced long term potential for children.

Funding body: NSW ministry of health

Funding body NSW ministry of health
Project Team

Dr Karen Myors, Dr Robyn Rosina, Ms Virginia Hunter, Ms Ashleigh Burt, Ms Suzanne Kelspa, Ms Karen Stevenson

Scheme Nursing and Midwifery Office, NSW Ministry of Health
Role Investigator
Funding Start 2018
Funding Finish 2019
GNo
Type Of Funding Other Public Sector - State
Category 2OPS
UON N

EFAR study: Enhancing Families Attendance Rates for child development health checks at Child & Family Health Nursing Services.$10,000

Funding body: NSW Ministry of Health

Funding body NSW Ministry of Health
Project Team

Dr Karen Myers, Dr Robyn Rosina, Suzanne Kelpsa, Naomi Fenton, Karen Stevenson, Virgina Henderson

Scheme Nursing and Midwifery Office Research Study
Role Investigator
Funding Start 2018
Funding Finish 2019
GNo
Type Of Funding External
Category EXTE
UON N

EFAR study: Enhancing Families Attendance Rates for child development health checks at Child & Family Health Nursing Services.$10,000

Funding body: Central Coast Local Health District

Funding body Central Coast Local Health District
Project Team

Dr Karen Myers, Dr Robyn Rosina, Suzanne Kelpsa, Naomi Fenton, Karen Stevenson, Virginia Hunter

Scheme Robyn Rosina
Role Investigator
Funding Start 2018
Funding Finish 2019
GNo
Type Of Funding External
Category EXTE
UON N

20172 grants / $16,000

Exploring Unplanned Re-admissions to Psychiatric Hospitals$15,000

Funding body: NSW Ministry of Health

Funding body NSW Ministry of Health
Project Team

Anne Louise Elsom, Mario Fantini, Lyndall Scott, Naveen Savio, Laura Christie, Dr David Lienert, Stephanie Brown, Shannon Gooley and Dr Robyn Rosina

Scheme NSW Ministry of Health
Role Investigator
Funding Start 2017
Funding Finish 2018
GNo
Type Of Funding Other Public Sector - State
Category 2OPS
UON N

‘Children’s Mental Health & Wellbeing: Connecting Education and Health Science’ collaborative work sessions$1,000

Funding body: Ourimbah Strategic Research Grant

Funding body Ourimbah Strategic Research Grant
Project Team

I-Fang Lee, Sarah Jeong, Robyn Rosina

Scheme University of Newcastle
Role Investigator
Funding Start 2017
Funding Finish 2017
GNo
Type Of Funding CRC - Cooperative Research Centre
Category 4CRC
UON N

20141 grants / $75,000

Clinical Facilitation: A future focussed on Quality$75,000

Funding body: Higher Education Training Institute

Funding body Higher Education Training Institute
Project Team

Rose McMaster, Robyn Rosina, Elizabeth Cleary

Scheme NSW Ministry of Health, HETI
Role Investigator
Funding Start 2014
Funding Finish 2015
GNo
Type Of Funding Other Public Sector - State
Category 2OPS
UON N
Edit

Research Supervision

Number of supervisions

Completed0
Current3

Current Supervision

Commenced Level of Study Research Title Program Supervisor Type
2018 PhD The Frequency and Duration of Seclusion for Women in Forensic Mental Health Settings and Their Experiences - A Mixed Methods Approach PhD (Nursing), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2017 PhD An Exploration of Patient Safety in Mental Health Setting PhD (Nursing), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2017 PhD The frequency and duration of seclusion for women in forensic mental health settings and their experiences – A mixed methods approach
<h1><span style="color:windowtext;"><span>1<span style="font:7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><span style="color:windowtext;">INTRODUCTION AND BACKGROUND&nbsp;</span></h1><h2><span style="color:windowtext;"><span>1.1<span style="font:7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><span style="color:windowtext;">Background Information</span></h2><p style="margin-top:0cm;margin-right:0cm;margin-bottom:6.0pt;margin-left:70.9pt;line-height:normal;">&nbsp;</p><h1><span style="color:windowtext;"><span>2<span style="font:7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><span style="color:windowtext;">STUDY AIM</span></h1><h2><span style="color:windowtext;"><span>2.1<span style="font:7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><span style="color:windowtext;">Primary Aims</span></h2><p style="margin-left:35.45pt;">This study has two primary aims.</p><ol><li>To identify factors associated with the frequency and duration of seclusion events for women in forensic mental health settings. </li><li>To explore the experiences and perspectives of women who are subjected to seclusion in forensic mental health settings. </li></ol><p style="margin-left:53.45pt;">&nbsp;</p><p style="text-indent:35.45pt;">The study objectives are to:</p><ol><li>Prospectively collect and examine demographic data, forensic and psychiatric history, and hospital admission data of women in forensic mental health settings</li><li>Collect data pertaining to the use of seclusion for women in forensic mental health settings. Data will include seclusion commencement and cessation, documented reason for seclusion, frequency and the duration of each seclusion event for each participant</li><li>Identify factors that are associated with the frequency and duration of seclusion for women in forensic mental health settings</li><li>Examine the link between factors associated with seclusion and the frequency and the duration of seclusion</li><li>Explore the woman&rsquo;s experience of seclusion in forensic mental health settings, and identify potential links to the frequency and duration of the seclusion event</li></ol><p style="margin-left:36.0pt;">This study will prospectively collect seclusion data over a two-year period with the aim of identifying factors associated with the frequency and duration of seclusion and use interviews with women to describe the experience of seclusion during admission to a forensic mental health setting. </p>
Nursing, University of Newcastle Co-Supervisor
Edit

Research Projects

Clinical Education: Evidence informing agenda 2015 -

 

Contact – Dr Robyn Rosina

 

Dr Robyn Rosina RN DON – lecturer/researcher

University of Newcastle

Faculty of Health and Medicine, School of Nursing and Midwifery

Lecturer – Researcher - Ourimbah Campus.

Chittaway. NSW

61 4348 4608

Email: Robyn.rosina@newcastle.edu.au

Bio: Robyn began her nursing career in 1981 with general hospital training. Robyn went on to complete a Certificate in Paediatric Nursing at the Royal Alexandria Hospital for Children in Sydney.  She quickly developed an interest in perinatal, infant, child and youth mental health and the challenge of teaching difficult concepts such as working with the mentally ill and people in crisis. Her doctoral studies were about the mental health outcomes of children and young people with chronic illness. Robyn has 20 years in clinical and university educator experience.  Robyn is currently appointed as a lecturer and researcher in nursing with a research interest in clinical teaching, children’s mental health and leadership research.

Dr Rose McMaster RN PhD - Professor of Nursing

Yamaguchi University – Japan

Email: rosemc@yamaguchi-u.ac.jp

Bio: Rose is a registered general nurse, with psychiatric qualifications, who has worked in a variety of areas. She has more than 25 years’ experience in tertiary education, including various teaching, leadership and management roles.

Rose has been in Japan since April 2017 and is enjoying the challenges of increasing her cultural knowledge, understanding the role of editing, completing publications and conference presentations, writing collaborative grants, teaching students and supporting staff in a variety of projects. Rose is a member SSTI Nu Chapter.

 

Acknowledgements: Elizabeth Cleary, Susan Gilbert and Wai-Leng Wong (in memorial)

Melbourne July 2018:  29th International Nursing Research Congress

Innovative Global Nursing Practice and Education through Research and Evidence-Based

Topic: Nursing Education

Category: Clinical and Researchers and Leaders

Clinical Nurse Education: Evidence Leading Reform Agenda

Completed work

Preferred presentation: Oral

Abstract summary: Participants will experience an understanding of the current reform agenda in clinical education. Research evidence will be presented to evidence the direction of change for nursing education and underpin the urgent need for nursing to participate and influence reform.

Main Points

Introduction:

  • Clinical education has changed without responsive change in nursing clinical teaching pedagogy, teaching skills and capacity to manage the tensions of multi-orgnisational partnerships
  • Clinical Education broadly is gradually shifting back to hospitals interdisciplinary clinical schools
  • Clinical nurse educator (CNE) role is somewhat ambiguous, and complex varying from context to context whilst mitigating responsibilities as a guest in one facility and employed by another
  • Many nurses transition from practice to educator without specific training
  • Clinical nurse educators are most often casually employed with limited to access to educational preparation, orientation and supervision
  • CNE skills have rarely been examined or evaluated but thought to be present alongside clinical practice

Body:

CNE needs to be a respected clinical leader that loves nursing, has considerable emotional intelligence, is a critical thinker and a robust individual in sometimes hostile environments

  • CNE requires high-level teaching and learning skills for diverse students and have capacity to operate across increasingly technological learning environments

Conclusion:

Nursing needs robust evidence to contribute and position it leadership to influence and shape the clinical education reform agenda

Keywords step:

Clinical nursing education

Clinical education

Clinical nurse education skill set

Abstract

The dynamic of clinical education has changed immensely without responsive change in nurse clinical teaching pedagogy, teaching skills and capacity to manage the tensions of multi-organisational relationships crucial for student learning outcomes. The clinical teaching context is gradually shifting from universities back to hospitals.  Clinical nurse educators, who facilitate learning for undergraduate nurses, are swirling in this change professionally, technologically and industrially.

 

The complexities of the clinical nurse educator’s (CNE) role are well recognised within the literature. The CNE acts as a professional role model, ensures appropriate clinical experiences are secured for learning and for the assessment of student performance Sanderson and Lee (2012). The World Health Organisation describe the CNE competencies under 8 broad themes: theoretical principles of adult learning, curriculum and implementation, nursing practice, research and evidence, communication, collaboration and partnership, ethical principles and professionalism monitoring and evaluation, management, leadership and advocacy (WHO, 2016). Within these themes, many skills and attributes are necessary, requiring specific preparation and professional development. Pivotal to success is the ability to form strategic clinical alliances to procure specific learning experiences and resources for student placement outcomes (Bvumbwe, 2016). The skilled insight attributed to this type of relationship brokerage cannot be underestimated or deemed instinctive among all CNEs.

There is persistent ambiguity around the role and the unpredictability of outcomes, which may in part may be a consequence of little consensus about the role and the most effective model for clinical facilitation (Sanderson & Lea, 2012; Fox, 2013). In addition, the unsupervised and autonomous nature of the role explains why the student and CNE experiences are so diverse resulting in inconsistent outcomes for students (Andrews & Ford, 2013) and therefore quality of future patient care.

Pre-requisites and academic qualifications for the CNE role vary considerably (McCarthy & Murphy, 2010). Adequate preparation and training are fundamental to equip the CNE to surmount the array of demands inherent in the role (Fox, 2013; Needham, McMurray & Shaban, 2016). Abbey et al as cited in Mackay, Brown, and Joyce-McCoach (2014) argues that to provide high quality clinical learning experiences university employers have a responsibility to provide appropriate orientation, training and supervision to CNEs. Despite this fact, many CNEs transition from clinical practice to undertake the role without the benefit of specific academic education and ongoing professional development, or supervision (Mower, 2017).

While a CNE may be a competent clinician, evidence suggests that experienced clinicians do not necessarily make skilled educators (Murray & Main cited in Mamhidir, Kristofferzon, Hellstrom-Hyson, Persson, & Martensson, 2014). Andrews and Ford (2013) propose that the CNE requires specific educational qualifications, recent and relevant clinical experience alongside the ability to work with experiential learning models. Additionally, the CNE requires a thorough understanding of university and clinical placement systems and related curriculum.

 

The teaching skills required of the CNE have rarely been described or evaluated but assumed present alongside clinical nursing experience. The professional development and leadership potential of this role has been neglected. This is despite the increasing complexity and demand for high-level clinical teaching and assessment skills, for increasingly diverse student cohorts.

 

This paper will present the results of a mixed method study which has two aims: to identify the required skills of a clinical nurse educator and to explore the professional issues challenging clinical nurse teaching and the clinical learning environment.  A descriptive study method was utilised to explore the essential skills required of CNEs to undertake their role effectively, and, the workplace barriers and enablers to the role. Data were collected from a cohort of clinical nurse educators (n=86) utilising an open-ended survey instrument.  A thematic analysis method was used to analyse and code the data gathered from the survey.

 

The survey participants have provided a strong consensus that the CNE needs to be a respected clinical leader that loves nursing, has considerable emotional intelligence, is a critical thinker and a robust individual that can practice in learning environments, that are at times, somewhat hostile to the cause of preparing undergraduate nurses for professional registration.  The survey findings have identified that the CNE requires high-level teaching and learning skills for diverse students and have capacity to operate across increasingly technological learning environments.  The CNE mitigates multiple complexities whilst a guest in the healthcare service and reliant upon on the mentoring capacity of nursing staff, in the spirit of cooperation rather than accountability. It is likely that the essential skills of a CNE are a collective of knowledge, skills, attitudes and behaviours. However, the role is considered challenging but paradoxically highly rewarding in its mission to prepare undergraduate nursing students for professional registration.

This study has identified that the role and skills required of today’s CNE are far more diverse and complex than previous understandings of the role.  The survey findings hold a strong consensus that today’s CNE is most likely a Registered Nurse with a Master’s level qualification not in clinical teaching, with significant clinical experience, not necessarily current, but often working casually and or part time across more than one healthcare campus with more than one employer. The findings concur with results of Needham’s study (2016) where further educational support including necessary assessment/ teaching skills and mentoring from experienced colleagues would improve the quality of facilitation.

 

The findings of this research will challenge historical understandings of clinical nurse teaching practice whilst recognising the emerging shift from disciplinary to interdisciplinary clinical education coordinated by hospital clinical schools.  Nursing needs robust evidence to contribute and position itself effectively to influence and shape the reform agenda. This research will make a significant contribution to enable the nursing profession to take a lead role to influence much needed clinical teaching reform now and into the future.


Enhancing Families Attendance Rates for child developmental checks at Child & Family Health Nursing Services 2018 -

Background
The early childhood years, birth to age 6, is a time of increased neurobiological development (McCain & Mustard, 1999; Shonkoff & Phillips, 2000). Infant development is dependent upon a complex interplay between genetics and environment (Tallon, Kendall & Snider, 2015). The physical, social and emotional health and wellbeing of young children is integral to the development of healthy functioning adults (Shepherd, 2011). A relational trend has been identified between childhood adversity and disease in adult life (Blair & Hall, 2006).
 
The NSW Ministry of Health (MoH) promotes a CFHN Universal Health Home Visit (UHHV) to all parents/carers of infants to complete the 1 – 4 week check. In 2017 the CFHN service within CCLHD completed 3225 (85%) UUHV to new parents. This high rate dramatically decreased for older children:
  • 6-8 week check, 880 (23%) completed
  • 6 month check, 785 (21%) completed
  • 12 month check, 621 (16%) completed
  • 18 month check, 377 (10%) completed
  • 2 year check, 386 (10%) completed
  • 3 year check, 346 (9%) completed
  • 4 year check, 305 (8%) completed.
 
The schedule of child developmental health (CDH) checks provide screening and surveillance opportunities to ensure that children at risk of poorer outcomes are identified with timely intervention commenced (Australian Health Ministers’ Advisory Council, 2011). Engaging parents into CFHN services for CDH checks is a public health imperative. Child and family health nurses are qualified and well placed to support families and children in the pre-school years (Myors, Schmied & White, 2014).
 
Problem statement
Attendance rates for parents at CCLHD CFHN clinics for child developmental health checks dramatically decrease with a downward trend after the initial UHHV.
 
Project aim
We aim to increase attendance for Child Developmental Health Checks during early childhood to age 5 years. Child Developmental Health Checks provide opportunities for assessment and to implement prevention and early intervention strategies prior to school entry. To achieve this aim we need to understand barriers to and reasons for non-attendance of Child Developmental Health Checks.
 
Project methods
  1. A literature review will be conducted to identify the diversity of CFHN service models, parents’ perceptions of CFHN services as well as knowledge gaps to inform this project and make a further contribution to the literature.
Child Family Health Nurses (CFHN)
  1. Surveys will be sent to all CFHN working in CCLHD to gather data about their perceptions of the barriers and enablers for parents to access CFHN service for CDH checks.
  2. Focus groups will be conducted with CFHN to gather rich data about their perceptions of the barriers and enablers for parents to attend CFHN services for CDH checks.
Parents/Carers
  1. Surveys will be sent to parents after their Universal Health Home Visit over a 3-month time-frame. This will include both first time parents (prospective data) as well as those who have had a subsequent child (retrospective data) about parents’ perceived and actual engagement with CFHN service for CDH checks. Demographic data will also be collected.
  2. Focus groups will be conducted with parents to gather rich data about the barriers and enablers for parents to attend CFHN services for CDH checks.
Recommendations
  1. Data will be used to develop new models of care, service pathways and guidelines that reflect families’ choices and promote service access and engagement.
Pilot and evaluation
  1. Pilot and evaluate the new models of care, service pathways and guidelines.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

3.2 Specific Project Details (1200 words max)

Scientific description of the project – Aims, method, research activities, durations. Please include a list of key references as an Appendix to your application.
Research Question
What are the barriers and enablers for parents to attend child and family health nursing clinics for child developmental health checks within the CCLGA?
Aim
Understand CFH access barriers and enablers, inform strategic models of care to increase attendance rates for child developmental health checks for CCLGA children.
Objectives
  1. Understand barriers and enablers to access CFHN services
  2. Identify strategies to build models of care that enable CFHN service uptake by families
  3. Make recommendations that reflect family preferences to access and engage with CFHN services
  4. Pilot and evaluate the new recommendations.
 
Translational outcomes
  • Knowledge about how to strengthen organisational and system capacity to meet the needs of parents and children from birth to 5 years to increase child development health checks and maximise intervention outcomes prior to school entry.
  • The development of a sustainable CFHN service framework for ongoing quality improvement that translates to better health outcomes for children.
 
Study design
A mixed methods research design will guide this study, to uncover and understand the complexities for families in their choice (or not) to access and engage with CFHN services within the CCLGA. The combination of both quantitative and qualitative data collection methods provides the opportunity to gain the best understanding of the research questions, aims and objectives (Hesse-Biber, 2010; Ridenour & Newman, 2009). A mixed methods research design is particularly salient to comprehend and tackle the complexities of health care delivery (Andrew & Halcomb, 2009).
Specifically, a convergent mixed method design (Creswell & Plano Clark, 2011) will be used.  A convergent (also known as concurrent or simultaneous) design refers to the collection and analysis of both quantitative and qualitative data components at the same time. The results are then integrated for interpretation (Collins, 2010; Creswell & Plano Clark, 2011).
 
Study population and sampling
All parents (approximately 950) who have had a Universal Health Home Visit within a 3-month period (September - November 2018) will be invited to participate in the study via email. Email addresses are collected from women at the time of consent by the Statewide Infant Screening – Hearing (SWIS-H) team.
All CFHN (approx. 65) who work within CCLHD will be informed of the study at team meetings and via email communication by the project team and participation invited. It is anticipated that approximately 20 CFHN will consent to participate in the focus groups.
 
Study implementation
The study will consist of 4 phases.
 
Phase 1: Exploratory phase
An initial literature review will be undertaken to gather broad information about:
  1. Known barriers and enablers for parents to attend CFHN services
  2. Existing models of care for parents to attend CFHN services
  3. Processes for developing new models of care, service pathways and guidelines.
National and state benchmarking:
Key stakeholders will be contacted in each LHD in NSW and each state and territory to gain information about CFHN models of care, service pathways and guidelines.
Organise CREDDIT HMRI meeting to check data collection and analysis prior to commencement
Phase 2: Sample, data collection and analyses
CFHN
  1. All CFHN (approx. 65) will be sent an email survey to gather data about their perceptions of the barriers and enablers for parents to access CFHN service for child developmental health checks. Demographic data will also be collected, including qualifications and years as a CFHN.
  2. Three focus groups will be conducted with CFHN (approx. 20) to gather rich data about the barriers and enablers for parents to attend CFHN services for child developmental health checks.
 
Parents/Carers
  1. Survey questionnaires will be sent to parents who have had a Universal Health Home Visit Visit over a 3-month time-frame, including both first time parents as well as those who have had a subsequent child. This will provide both prospective and retrospective data about parents’ perceived and actual engagement with CFHN service for child development health checks. Demographic data will also be collected.
  2. Three focus groups will be conducted with parents to gather rich data about the barriers and enablers for parents to attend CFHN services for child developmental health checks.
Data analysis
Quantitative data will be analysed using descriptive statistics – frequencies, means, standard deviations and ranges – and inferential statistics - chi-square and independent t-tests - to identify any relationships between the data sets.
Qualitative data from the focus groups will be transcribed verbatim and analysed using directed content (Hsieh & Shannon 2005) and thematic analysis techniques (Braun & Clarke, 2006; Green et al. 2007).
Integration of quantitative and qualitative data will enhance the findings (Bryman, 2006) by the emergence of new data findings (Andrew, Salamonson & Halcomb, 2008).
 
Phase 3: Development of new models of care, service pathways and guidelines
Data from the literature review, integrated data analyses and the documented current care pathways will be examined in detail to identify gaps and challenges in the current approach to service delivery, to design an effective service response and care pathways for parents of infants and children.
 
Phase 4: Pilot new models of care, service pathways and guidelines
Child and family health nurses (approximately 8) from two community health centres (1 north and 1 south), will be informed of the new models of care and service pathways.
These same CFHN will implement the new care pathways in the community health centre that they work for a period of 3 months. Numeric data will be collected to identify any changes in attendance for child developmental health checks. Analyses of this data will determine what changes, if any, need to be made to either the new care pathways. Once finalised, new guidelines will be developed and the care pathways will be implemented with the remaining CFHN work force.
 
Time Line
August 2018
• establish advisory committee and Terms of Reference
• submit Ethics application
• inform CFHN of project
September – November 2018
  • Ethics approval obtained
  • Promotion of research to parents and key stakeholders
  • Draft literature review including review of care pathways, procedures and guidelines
  • email surveys to parents
  • commence focus groups and interviews
  • commence transcriptions and analyses
December - February 2018
• complete focus groups and interviews
• complete transcriptions
• continue analyses
March – April 2019
• Complete analyses
• Commence development of new models of care, service pathways and guidelines
May – July 2019
• Pilot new models of care, service pathways and guidelines with the CFHN at the two sites
• Complete final ethics report
• Prepare papers for publication
• Share findings at local seminars and other conferences.
• Plan next steps for ongoing evaluation.
 
 

3.3 Expected outputs and end-users

  1. Identify the anticipated research outputs (e.g. academic papers, completed experiments and/or trials, pilot data, clinical guidelines, new processes, disclosures and patents, etc.) (200 words max)
The outputs of this study will include:
  • Academic papers published in peer reviewed journals;
  • The development of new clinical guidelines and policies at both a local and state level;
  • A new model of care and service pathways for parents of children, birth to 5 years, to access child and family health nursing services.
 
 
  1. Identify the end-users of your research outputs (end-users include other researchers who may use your study results, policy makers, government organisations, healthcare providers, patients and industry) (200 words max)
The end-users of this study will include:
  1. Child & family health nurses who work within CCLHD;
  2. Clinical leaders within the division of Central Coast Kids & Families (Nursing Unit Managers, Nurse Managers, Clinical Nurse Consultants, Clinical Nurse Educators);
  3. Parents of infants/ children who reside within the Central Coast LGA;
  4. Policy makers within NSW MoH.
 
 
  1. How will your study increase the likelihood that your research outputs are accessed and utilised by end-users? (200 words max)
The CCKF senior clinical leaders as well the CFHN within CCLHD will be kept informed of the progression of the study throughout its duration at meetings, via emails and at in-service sessions. At the completion of the study oral presentations will be given to the senior clinical leaders and the CFHN workforce to inform them of the research outputs.
A number of strategies will be used to inform parents of the new pathways and model of care for CFHN services. These will include:
  • Written information provided to women while they are an inpatient in the maternity unit.
  • Written and verbal information provided to families by CFHNs at the UUHV.
  • Written information will be placed on the CCLHD website.
  • Written information will be placed in local newspapers.
  • Written information will be provided to local radio stations for broadcast.
The research team will work with key stakeholders (NSW MoH, Family & Community Services, Aboriginal Health, Early childhood settings, professional bodies) to inform them of the outputs of the study.
 

3.4 Anticipated IMPACT (300 words max)

Describe the potential impact from your research (e.g. If your end-users utilise your research outcomes what will the consequence be? Examples include advancing knowledge, improving clinical implementation, the generation of community benefit, improving public policy, and/or the generation of economic benefit?)
Uptake of the research outcomes by the end-users will include:
  • CFHN will work with new pathways to care and thereby access and engage with increased numbers of families who have infants and children from birth to 5 years.
  • Clinical leaders within the division of CCK&F will support the CFHN workforce as they negotiate the new pathways to care for families. Potential workforce and budget issues will be identified and resolved.
  • Parents of infants/ children who reside within the Central Coast LGA will increase their access and engagement with CFHN services. This will result in increased PHR routine health checks per child with resultant increase early identification and intervention for identified concerns, optimising developmental outcomes for children prior to school entry.
  • Policy makers within NSW MoH will develop new policies which align with the research outcomes thereby improve public policy for families with pre-school aged children.
  • Early identification and intervention of developmental concerns by CFHN will generate economic benefits as referral to secondary and tertiary child health services will be decreased and with enhanced long term potential for children.


Enhancing Families Attendance Rates for child developmental checks at Child & Family Health Nursing Services 2018 -

Background
The early childhood years, birth to age 6, is a time of increased neurobiological development (McCain & Mustard, 1999; Shonkoff & Phillips, 2000). Infant development is dependent upon a complex interplay between genetics and environment (Tallon, Kendall & Snider, 2015). The physical, social and emotional health and wellbeing of young children is integral to the development of healthy functioning adults (Shepherd, 2011). A relational trend has been identified between childhood adversity and disease in adult life (Blair & Hall, 2006).
 
The NSW Ministry of Health (MoH) promotes a CFHN Universal Health Home Visit (UHHV) to all parents/carers of infants to complete the 1 – 4 week check. In 2017 the CFHN service within CCLHD completed 3225 (85%) UUHV to new parents. This high rate dramatically decreased for older children:
  • 6-8 week check, 880 (23%) completed
  • 6 month check, 785 (21%) completed
  • 12 month check, 621 (16%) completed
  • 18 month check, 377 (10%) completed
  • 2 year check, 386 (10%) completed
  • 3 year check, 346 (9%) completed
  • 4 year check, 305 (8%) completed.
 
The schedule of child developmental health (CDH) checks provide screening and surveillance opportunities to ensure that children at risk of poorer outcomes are identified with timely intervention commenced (Australian Health Ministers’ Advisory Council, 2011). Engaging parents into CFHN services for CDH checks is a public health imperative. Child and family health nurses are qualified and well placed to support families and children in the pre-school years (Myors, Schmied & White, 2014).
 
Problem statement
Attendance rates for parents at CCLHD CFHN clinics for child developmental health checks dramatically decrease with a downward trend after the initial UHHV.
 
Project aim
We aim to increase attendance for Child Developmental Health Checks during early childhood to age 5 years. Child Developmental Health Checks provide opportunities for assessment and to implement prevention and early intervention strategies prior to school entry. To achieve this aim we need to understand barriers to and reasons for non-attendance of Child Developmental Health Checks.
 
Project methods
  1. A literature review will be conducted to identify the diversity of CFHN service models, parents’ perceptions of CFHN services as well as knowledge gaps to inform this project and make a further contribution to the literature.
Child Family Health Nurses (CFHN)
  1. Surveys will be sent to all CFHN working in CCLHD to gather data about their perceptions of the barriers and enablers for parents to access CFHN service for CDH checks.
  2. Focus groups will be conducted with CFHN to gather rich data about their perceptions of the barriers and enablers for parents to attend CFHN services for CDH checks.
Parents/Carers
  1. Surveys will be sent to parents after their Universal Health Home Visit over a 3-month time-frame. This will include both first time parents (prospective data) as well as those who have had a subsequent child (retrospective data) about parents’ perceived and actual engagement with CFHN service for CDH checks. Demographic data will also be collected.
  2. Focus groups will be conducted with parents to gather rich data about the barriers and enablers for parents to attend CFHN services for CDH checks.
Recommendations
  1. Data will be used to develop new models of care, service pathways and guidelines that reflect families’ choices and promote service access and engagement.
Pilot and evaluation
  1. Pilot and evaluate the new models of care, service pathways and guidelines.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

3.2 Specific Project Details (1200 words max)

Scientific description of the project – Aims, method, research activities, durations. Please include a list of key references as an Appendix to your application.
Research Question
What are the barriers and enablers for parents to attend child and family health nursing clinics for child developmental health checks within the CCLGA?
Aim
Understand CFH access barriers and enablers, inform strategic models of care to increase attendance rates for child developmental health checks for CCLGA children.
Objectives
  1. Understand barriers and enablers to access CFHN services
  2. Identify strategies to build models of care that enable CFHN service uptake by families
  3. Make recommendations that reflect family preferences to access and engage with CFHN services
  4. Pilot and evaluate the new recommendations.
 
Translational outcomes
  • Knowledge about how to strengthen organisational and system capacity to meet the needs of parents and children from birth to 5 years to increase child development health checks and maximise intervention outcomes prior to school entry.
  • The development of a sustainable CFHN service framework for ongoing quality improvement that translates to better health outcomes for children.
 
Study design
A mixed methods research design will guide this study, to uncover and understand the complexities for families in their choice (or not) to access and engage with CFHN services within the CCLGA. The combination of both quantitative and qualitative data collection methods provides the opportunity to gain the best understanding of the research questions, aims and objectives (Hesse-Biber, 2010; Ridenour & Newman, 2009). A mixed methods research design is particularly salient to comprehend and tackle the complexities of health care delivery (Andrew & Halcomb, 2009).
Specifically, a convergent mixed method design (Creswell & Plano Clark, 2011) will be used.  A convergent (also known as concurrent or simultaneous) design refers to the collection and analysis of both quantitative and qualitative data components at the same time. The results are then integrated for interpretation (Collins, 2010; Creswell & Plano Clark, 2011).
 
Study population and sampling
All parents (approximately 950) who have had a Universal Health Home Visit within a 3-month period (September - November 2018) will be invited to participate in the study via email. Email addresses are collected from women at the time of consent by the Statewide Infant Screening – Hearing (SWIS-H) team.
All CFHN (approx. 65) who work within CCLHD will be informed of the study at team meetings and via email communication by the project team and participation invited. It is anticipated that approximately 20 CFHN will consent to participate in the focus groups.
 
Study implementation
The study will consist of 4 phases.
 
Phase 1: Exploratory phase
An initial literature review will be undertaken to gather broad information about:
  1. Known barriers and enablers for parents to attend CFHN services
  2. Existing models of care for parents to attend CFHN services
  3. Processes for developing new models of care, service pathways and guidelines.
National and state benchmarking:
Key stakeholders will be contacted in each LHD in NSW and each state and territory to gain information about CFHN models of care, service pathways and guidelines.
Organise CREDDIT HMRI meeting to check data collection and analysis prior to commencement
Phase 2: Sample, data collection and analyses
CFHN
  1. All CFHN (approx. 65) will be sent an email survey to gather data about their perceptions of the barriers and enablers for parents to access CFHN service for child developmental health checks. Demographic data will also be collected, including qualifications and years as a CFHN.
  2. Three focus groups will be conducted with CFHN (approx. 20) to gather rich data about the barriers and enablers for parents to attend CFHN services for child developmental health checks.
 
Parents/Carers
  1. Survey questionnaires will be sent to parents who have had a Universal Health Home Visit Visit over a 3-month time-frame, including both first time parents as well as those who have had a subsequent child. This will provide both prospective and retrospective data about parents’ perceived and actual engagement with CFHN service for child development health checks. Demographic data will also be collected.
  2. Three focus groups will be conducted with parents to gather rich data about the barriers and enablers for parents to attend CFHN services for child developmental health checks.
Data analysis
Quantitative data will be analysed using descriptive statistics – frequencies, means, standard deviations and ranges – and inferential statistics - chi-square and independent t-tests - to identify any relationships between the data sets.
Qualitative data from the focus groups will be transcribed verbatim and analysed using directed content (Hsieh & Shannon 2005) and thematic analysis techniques (Braun & Clarke, 2006; Green et al. 2007).
Integration of quantitative and qualitative data will enhance the findings (Bryman, 2006) by the emergence of new data findings (Andrew, Salamonson & Halcomb, 2008).
 
Phase 3: Development of new models of care, service pathways and guidelines
Data from the literature review, integrated data analyses and the documented current care pathways will be examined in detail to identify gaps and challenges in the current approach to service delivery, to design an effective service response and care pathways for parents of infants and children.
 
Phase 4: Pilot new models of care, service pathways and guidelines
Child and family health nurses (approximately 8) from two community health centres (1 north and 1 south), will be informed of the new models of care and service pathways.
These same CFHN will implement the new care pathways in the community health centre that they work for a period of 3 months. Numeric data will be collected to identify any changes in attendance for child developmental health checks. Analyses of this data will determine what changes, if any, need to be made to either the new care pathways. Once finalised, new guidelines will be developed and the care pathways will be implemented with the remaining CFHN work force.
 
Time Line
August 2018
• establish advisory committee and Terms of Reference
• submit Ethics application
• inform CFHN of project
September – November 2018
  • Ethics approval obtained
  • Promotion of research to parents and key stakeholders
  • Draft literature review including review of care pathways, procedures and guidelines
  • email surveys to parents
  • commence focus groups and interviews
  • commence transcriptions and analyses
December - February 2018
• complete focus groups and interviews
• complete transcriptions
• continue analyses
March – April 2019
• Complete analyses
• Commence development of new models of care, service pathways and guidelines
May – July 2019
• Pilot new models of care, service pathways and guidelines with the CFHN at the two sites
• Complete final ethics report
• Prepare papers for publication
• Share findings at local seminars and other conferences.
• Plan next steps for ongoing evaluation.
 
 

3.3 Expected outputs and end-users

  1. Identify the anticipated research outputs (e.g. academic papers, completed experiments and/or trials, pilot data, clinical guidelines, new processes, disclosures and patents, etc.) (200 words max)
The outputs of this study will include:
  • Academic papers published in peer reviewed journals;
  • The development of new clinical guidelines and policies at both a local and state level;
  • A new model of care and service pathways for parents of children, birth to 5 years, to access child and family health nursing services.
 
 
  1. Identify the end-users of your research outputs (end-users include other researchers who may use your study results, policy makers, government organisations, healthcare providers, patients and industry) (200 words max)
The end-users of this study will include:
  1. Child & family health nurses who work within CCLHD;
  2. Clinical leaders within the division of Central Coast Kids & Families (Nursing Unit Managers, Nurse Managers, Clinical Nurse Consultants, Clinical Nurse Educators);
  3. Parents of infants/ children who reside within the Central Coast LGA;
  4. Policy makers within NSW MoH.
 
 
  1. How will your study increase the likelihood that your research outputs are accessed and utilised by end-users? (200 words max)
The CCKF senior clinical leaders as well the CFHN within CCLHD will be kept informed of the progression of the study throughout its duration at meetings, via emails and at in-service sessions. At the completion of the study oral presentations will be given to the senior clinical leaders and the CFHN workforce to inform them of the research outputs.
A number of strategies will be used to inform parents of the new pathways and model of care for CFHN services. These will include:
  • Written information provided to women while they are an inpatient in the maternity unit.
  • Written and verbal information provided to families by CFHNs at the UUHV.
  • Written information will be placed on the CCLHD website.
  • Written information will be placed in local newspapers.
  • Written information will be provided to local radio stations for broadcast.
The research team will work with key stakeholders (NSW MoH, Family & Community Services, Aboriginal Health, Early childhood settings, professional bodies) to inform them of the outputs of the study.
 

3.4 Anticipated IMPACT (300 words max)

Describe the potential impact from your research (e.g. If your end-users utilise your research outcomes what will the consequence be? Examples include advancing knowledge, improving clinical implementation, the generation of community benefit, improving public policy, and/or the generation of economic benefit?)
Uptake of the research outcomes by the end-users will include:
  • CFHN will work with new pathways to care and thereby access and engage with increased numbers of families who have infants and children from birth to 5 years.
  • Clinical leaders within the division of CCK&F will support the CFHN workforce as they negotiate the new pathways to care for families. Potential workforce and budget issues will be identified and resolved.
  • Parents of infants/ children who reside within the Central Coast LGA will increase their access and engagement with CFHN services. This will result in increased PHR routine health checks per child with resultant increase early identification and intervention for identified concerns, optimising developmental outcomes for children prior to school entry.
  • Policy makers within NSW MoH will develop new policies which align with the research outcomes thereby improve public policy for families with pre-school aged children.
  • Early identification and intervention of developmental concerns by CFHN will generate economic benefits as referral to secondary and tertiary child health services will be decreased and with enhanced long term potential for children.


Adults Leaving Mental Health Inpatient Care: Reducing unplanned readmissions within 28 days 2017 -

Purpose of the Plan

This plan outlines the goals, objectives and scope of the project. It includes roles and responsibilities of team members, timelines for deliverables and outcomes.

This plan is an agreement between Anne Louise Elsom Project Manager, Naveen Savio Project Manager, Executive Sponsor, Mario Fantini Sponsor, Gosford Hospital Mental Health Inpatient Unit, Mental Health Steering Committee and Project Team and relevant stakeholders associated with the project.

Case for Change

Unplanned readmissions to public mental health units remains a major challenge for mental health services throughout Australia. In 2011-12 the national 28-day readmission rate was 14.4% with NSW at 15.4%, the highest rate. Interestingly, the readmission rate to public mental health units after receiving community care within the preceding seven days prior to admission in 2011-12 nationally was 30.8% with NSW at 31% and the ACT the highest at 73.5% (Australian Institute of Health and Welfare 2015). In 2011 Australia had the third highest readmission rate among the OECD countries for patients diagnosed with schizophrenia with over 50% readmitted within 30 days (Allison and Bastiampillai, 2015).

The NSW Health Annual Report 2011-12 set a target for NSW 2021 to keep people healthy and out of hospital by improving mental health outcomes. These targets include reducing mental health readmission within 28 days to any facility, increase the rate of community follow-up within seven days of discharge from a NSW public mental health unit and increase the number of adults and adolescents with mental illness who are diverted from court into treatment.

The Key Performance Indicator for CCLHD for unplanned readmission within 28 days from the Gosford Adult Mental Health Unit had been trending above the accepted target for over 8 months and as of January 2017 was 16.7%. We need to explore our discharge planning processes well before discharge, at the point of discharge and throughout the 28-day target and beyond. The project will apply the NSW Centre for Healthcare Redesign methodology to identify any breakdown in discharge planning and follow-up post discharge. Solutions will be developed to address root causes and implement strategies to improve mental health consumer flow and discharge planning within Gosford Mental Health Inpatient Unit. The project will specifically examine the pathways of discharge planning, transfer, and discharge to identify any delays in assessment, treatment and management/transfer of care.

Project Approach

1. Goal and Objective

Goal

To improve the experience for people with mental health issues admitted to Gosford Mental Health Inpatient Unit by improving discharge planning and care transition between hospital and community settings.

Project Objective

To reduce the overall unplanned readmission rates at Gosford Mental Health Inpatient Unit from 16.7% to less than 8% by June 2018, as measured by the Service Agreement between CCLHD and NSW Ministry of Health: all admissions within 28 days of separation %.

Benefits

A reduction in the Hospital Unplanned Readmission rate will demonstrate the right treatment, at the right place, at the right time for every patient, every time in conjunction with a successful transition to the community, with the right community supports in place.

Individually tailored discharge planning and improved advanced care planning by June 2018.

Results of patient/carer surveys will demonstrate increased consumer and carer satisfaction with access to a holistic hospital care plan, discharge plan and advanced community treatment plan.

Results of staff surveys will demonstrate improved staff satisfaction, collaboration and cohesion between all members of the units multi-disciplinary team, community services, Primary Health Network & NGO’s.

Reduction in the per capita cost of health care for people that are readmitted by reducing the average length of stay from xx days to xx days by June 2018.

2. Scoping the Project

The project will apply the NSW Centre for Healthcare Redesign methodology to examine causes and solutions to an increased unplanned readmsiion rate.

To complete the project existing staffing resources employed by Central Coast Local Health District will be utilised with additional NSW Health Innovation Scholarship funding allowing release time for one staff member.

In Out

Patient Consumers with a primary mental health condition who are readmitted to Gosford Mental Health Inpatient Unit within 28 days of discharge from the same facility. Patients that present to Gosford Hospital including S22, s20 presentations and ED presentatins with a presenting problem related to the previous admission. Patients with a primary Drug & Alcohol related presentation Patients with primary diagnosis of dementia or delirium. Patients with a planned readmission.

Process Screen, interview and review patients/carers, treating teams and medical record of patients readmitted within 28 days of previous admission to Gosford Hospital Mental Health Inpatient Unit. Interview/Focus Groups with NUM, Senior Nursing, MO’s, Allied Health Staff and community mental health teams

Organisation Gosford Mental Health Inpatient Unit Wyong Mental Health Inpatient Unit, PECC, Miri Miri initially

Technology Access to Performance and Casemix Data (Casemix App, Patient Flow Portal, HRT Datasets, ABM Portal, Monthly performance reports and the Retrospective Daily Readmissions Report). Laptop, Internet, Phone, Printer/Scanner

Facility Gosford Hospital Wyong Hospital initially

Assumptions Timely access to accurate data will be provided by the Performance Management Unit and other data custodians. The Project Sponsor will actively support the project and will provide timely decision making to allow the project to proceed to schedule. Gosford Mental Health Teams are committed to improving the care pathway and processes and as a result reduce the unplanned readmission rate and improve the experience of consumers.

Constraints Significant major redevelopment planning work of Gosford Hospital will be occurring concurrently with the project. This will place additional time impost on some of the key stakeholders. The introduction of electronic medication records within mental health creating change in business process and additional staff resources to support initiation. CCLHD will be undergoing Accreditation Survey in December placing additional work load and time constraints on project steering committee and project team members.

External

Dependencies Many mental health consumers are socio economically disadvantaged with poor access to GP’s, low levels of private healthcare insurance, poor health outcomes, high unemployment rates and have a high prevalence of drug and alcohol problems.

3. Governance, Roles and Responsibilities

Project Team and Steering Committee

Name Position

Steering Committee

Dr David Lienert Clinical Director, Mental Health

Mario Fantini Operational Nurse Manager, Mental Health

David Duerden Service Development Manager, Mental Health

Simon Hill Adult Community Manager, Mental Health

Anne Louise Elsom Project Lead, CNC Mental Health

Naveen Savio Project Lead, CNS Gosford Mental Health Inpatient Unit

Project Team

Anne Louise Elsom Clinical Nurse Consultant - Mental Health

Lyndal Scott Clinical Nurse Consultant - Mental Health Inpatient Units

Naveen Savio Clinical Nurse Specialist Gosford Mental Health Inpatient Unit

Laura Christie Nurse Manager Acute Care Teams - Mental Health

Stephanie Brown Social Worker – Gosford Mental Health Inpatient Unit

Shannon Gooley Manager Assertive Outreach Team – Mental Health

Dr Robyn Rosina Lectur


Retaining Registered Nurses beyond the First Graduate Year: Thriving or Simply Surviving their First Year 2017 -

Purpose of the Plan

This plan outlines the goals, objectives and scope of the project. It includes roles and responsibilities of team members, timelines for deliverables and outcomes.

This plan is an agreement between Anne Louise Elsom Project Manager, Naveen Savio Project Manager, Executive Sponsor, Mario Fantini Sponsor, Gosford Hospital Mental Health Inpatient Unit, Mental Health Steering Committee and Project Team and relevant stakeholders associated with the project.

Case for Change

Unplanned readmissions to public mental health units remains a major challenge for mental health services throughout Australia. In 2011-12 the national 28-day readmission rate was 14.4% with NSW at 15.4%, the highest rate. Interestingly, the readmission rate to public mental health units after receiving community care within the preceding seven days prior to admission in 2011-12 nationally was 30.8% with NSW at 31% and the ACT the highest at 73.5% (Australian Institute of Health and Welfare 2015). In 2011 Australia had the third highest readmission rate among the OECD countries for patients diagnosed with schizophrenia with over 50% readmitted within 30 days (Allison and Bastiampillai, 2015).

The NSW Health Annual Report 2011-12 set a target for NSW 2021 to keep people healthy and out of hospital by improving mental health outcomes. These targets include reducing mental health readmission within 28 days to any facility, increase the rate of community follow-up within seven days of discharge from a NSW public mental health unit and increase the number of adults and adolescents with mental illness who are diverted from court into treatment.

The Key Performance Indicator for CCLHD for unplanned readmission within 28 days from the Gosford Adult Mental Health Unit had been trending above the accepted target for over 8 months and as of January 2017 was 16.7%. We need to explore our discharge planning processes well before discharge, at the point of discharge and throughout the 28-day target and beyond. The project will apply the NSW Centre for Healthcare Redesign methodology to identify any breakdown in discharge planning and follow-up post discharge. Solutions will be developed to address root causes and implement strategies to improve mental health consumer flow and discharge planning within Gosford Mental Health Inpatient Unit. The project will specifically examine the pathways of discharge planning, transfer, and discharge to identify any delays in assessment, treatment and management/transfer of care.

Project Approach

1. Goal and Objective

Goal

To improve the experience for people with mental health issues admitted to Gosford Mental Health Inpatient Unit by improving discharge planning and care transition between hospital and community settings.

Project Objective

To reduce the overall unplanned readmission rates at Gosford Mental Health Inpatient Unit from 16.7% to less than 8% by June 2018, as measured by the Service Agreement between CCLHD and NSW Ministry of Health: all admissions within 28 days of separation %.

Benefits

A reduction in the Hospital Unplanned Readmission rate will demonstrate the right treatment, at the right place, at the right time for every patient, every time in conjunction with a successful transition to the community, with the right community supports in place.

Individually tailored discharge planning and improved advanced care planning by June 2018.

Results of patient/carer surveys will demonstrate increased consumer and carer satisfaction with access to a holistic hospital care plan, discharge plan and advanced community treatment plan.

Results of staff surveys will demonstrate improved staff satisfaction, collaboration and cohesion between all members of the units multi-disciplinary team, community services, Primary Health Network & NGO’s.

Reduction in the per capita cost of health care for people that are readmitted by reducing the average length of stay from xx days to xx days by June 2018.

2. Scoping the Project

The project will apply the NSW Centre for Healthcare Redesign methodology to examine causes and solutions to an increased unplanned readmsiion rate.

To complete the project existing staffing resources employed by Central Coast Local Health District will be utilised with additional NSW Health Innovation Scholarship funding allowing release time for one staff member.

In Out

Patient Consumers with a primary mental health condition who are readmitted to Gosford Mental Health Inpatient Unit within 28 days of discharge from the same facility. Patients that present to Gosford Hospital including S22, s20 presentations and ED presentatins with a presenting problem related to the previous admission. Patients with a primary Drug & Alcohol related presentation Patients with primary diagnosis of dementia or delirium. Patients with a planned readmission.

Process Screen, interview and review patients/carers, treating teams and medical record of patients readmitted within 28 days of previous admission to Gosford Hospital Mental Health Inpatient Unit. Interview/Focus Groups with NUM, Senior Nursing, MO’s, Allied Health Staff and community mental health teams

Organisation Gosford Mental Health Inpatient Unit Wyong Mental Health Inpatient Unit, PECC, Miri Miri initially

Technology Access to Performance and Casemix Data (Casemix App, Patient Flow Portal, HRT Datasets, ABM Portal, Monthly performance reports and the Retrospective Daily Readmissions Report). Laptop, Internet, Phone, Printer/Scanner

Facility Gosford Hospital Wyong Hospital initially

Assumptions Timely access to accurate data will be provided by the Performance Management Unit and other data custodians. The Project Sponsor will actively support the project and will provide timely decision making to allow the project to proceed to schedule. Gosford Mental Health Teams are committed to improving the care pathway and processes and as a result reduce the unplanned readmission rate and improve the experience of consumers.

Constraints Significant major redevelopment planning work of Gosford Hospital will be occurring concurrently with the project. This will place additional time impost on some of the key stakeholders. The introduction of electronic medication records within mental health creating change in business process and additional staff resources to support initiation. CCLHD will be undergoing Accreditation Survey in December placing additional work load and time constraints on project steering committee and project team members.

External

Dependencies Many mental health consumers are socio economically disadvantaged with poor access to GP’s, low levels of private healthcare insurance, poor health outcomes, high unemployment rates and have a high prevalence of drug and alcohol problems.

3. Governance, Roles and Responsibilities

Project Team and Steering Committee

Name Position

Steering Committee

Dr David Lienert Clinical Director, Mental Health

Mario Fantini Operational Nurse Manager, Mental Health

David Duerden Service Development Manager, Mental Health

Simon Hill Adult Community Manager, Mental Health

Anne Louise Elsom Project Lead, CNC Mental Health

Naveen Savio Project Lead, CNS Gosford Mental Health Inpatient Unit

Project Team

Anne Louise Elsom Clinical Nurse Consultant - Mental Health

Lyndal Scott Clinical Nurse Consultant - Mental Health Inpatient Units

Naveen Savio Clinical Nurse Specialist Gosford Mental Health Inpatient Unit

Laura Christie Nurse Manager Acute Care Teams - Mental Health

Stephanie Brown Social Worker – Gosford Mental Health Inpatient Unit

Shannon Gooley Manager Assertive Outreach Team – Mental Health

Dr Robyn Rosina Lectur


Challenges in Adolescent Health. Chapter 8 - Health mediating change in juvenile offending 2010


Nursing practice in the Youth Drug Court 2008


Reaching Cross-Agency Consensus in a Research Agenda: using a Delphi survey (organisational produced report completed) 2007


Edit

Dr Robyn Rosina

Position

Lecturer
School of Nursing and Midwifery
Faculty of Health and Medicine

Contact Details

Email robyn.rosina@newcastle.edu.au
Phone (02) 4348 4608

Office

Room BE1-24
Building Health Precinct Building
Location Ourimbah
10 Chittaway Road
Ourimbah, NSW 2258
Australia
Edit