Guest editorial

Advances in contemporary modelling of clinical nursing care

Judith Lathlean
Health Research, School of Health Sciences, University of Southampton, United Kingdom

PP: 133 - 135

Article Text

This special issue of Contemporary Nurse, Advances in Contemporary Modelling of Clinical Nursing Care, has been dedicated to collecting and presenting an array of work emanating from initiatives which demonstrate an impact on patient care, improving working conditions or changing nursing workforce. Whilst these papers stem primarily from New South Wales and other neighbouring States in Australia, it is clear that the messages and lessons that can be learnt are far reaching throughout the Asia-Pacific rim and indeed worldwide. This can be set within a global context - of endeavours to meet the challenges of increasing and changing pressures in health care and nursing in particular.

I was delighted to be asked to contribute the editorial for this edition. My particular passion is the pursuit of research into and evaluation of new ways or organising nursing and health care, especially where there is an emphasis on different methodological approaches which are innovative and/or value the involvement of stakeholders - nurses, health care workers, patients and members of the public. I have engaged in research which examines new nursing roles (see for example Lathlean, 2007) and have been intrigued - through my association with Newcastle University (NSW) - by the synergy that exists between developments in the UK and Australia in this respect (see Chiarella, Hardford, & Lau, 2007). Also I am highly supportive of the movement towards Clinical Academic Careers for nurses and allied health professionals - a relatively new approach in the UK (UK CRC, 2010) but an established trajectory in Australia (NSW Department of Health, 2010) whereby academia and practice are straddled by those occupying joint or integrated roles.

The key theme that unites such endeavours and those described in the papers is a desire to improve, to bring evidence to bear from research and scholarly activity on patient care - and to do so in ways that have not necessarily been tried before. Thus considering the many and varied papers in this edition, one is struck by, for example, the accounts of attempts to improve the care of older people - a great priority in health care internationally - in one instance by focusing on nursing leadership to deliver high quality care (Venturato & Drew, 2010) and in another, by the emphasis on the alleviation of pain in older people in the acute care setting (Phelan et al., 2010).

Others look at particular aspects to do with a key challenge in health care - that of patient safety. This is demonstrated in the papers by Duff and Walker (2010) - in respect of improving the safety and efficacy of warfarin therapy - and in the use of multidisciplinary knowledge transfer to transform patient safety (Cross, Moore, & Ockerby, 2010). In a similar vein the paper by Jefferies (2010) explores the engagement of clinicians in policy through the use of nursing documentation.

New models of nursing care and ways of organising it are reflected in several of the papers but one in particular, that by Fairbrother, Jones, and Rivas (2010), is aimed at the implementation and evaluation of a change from one form of allocation (individual) to another, that of team nursing within an acute setting.

Methodologically there are three very interesting papers. The first by Brunero and Lamont (2010) combines both modelling and e-learning, a second (Li et al., 2010) takes the now tried and tested, but nevertheless challenging approach of participatory action research, and shares experiences of participating in an action research project designed to improve the care of older people at risk of delirium. A third, by Rivas and Murray (2010), describes the experiences of the use of action learning sets in an acute setting. All of these combine experimentation with learning - both for participants and the audiences. Another paper (by Higgins and colleagues) considers the challenges and benefits of doing research in clinical settings and presents some useful conclusions All of the papers look to the future but one especially is deliberately referring to a vision, using a modelling technique to plot nursing practice (Moss, Walsh, & Mitchell, 2010).

Whilst many of the studies described are rooted in local initiatives, pilot studies and exploratory studies, what is being examined is the very essence of nursing care. And strikingly these are not issues that are particular to Australia or to any one continent. The same challenges and considerations are also to be found throughout UK nursing and midwifery as well, for example. All health systems are being required to work better, more efficiently, 'smarter', often with fewer resources yet still with the patient at the centre. This can only be achieved if there is enthusiasm and innovation at grass roots level as well as leadership from above - and these papers are a testament to that!

In conclusion it should be remembered that from small acorns large oak trees grow! There is considerable grounds for believing that many of these initiatives will be sustainable and develop further from humble beginnings into robust 'projects'. In addition they provide a number of exciting methodological approaches and lens through which service improvements can be made and evaluated.

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