Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Barriers to Implementing a Nursing Clinical Development Unit

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Barriers to Implementing a Nursing Clinical Development Unit

Article excerpt

INTRODUCTION

Nursing Clinical Development Units (NCDU), also termed Clinical Development Units and Nursing Development Units, originated from the United Kingdom in the 1980s. Their implementation was viewed as an important strategy to enhance the development of nurses and of nursing practice, and was supported by substantial government funding. There is currently estimated to be more than 300 NCDU in the United Kingdom (Schiereck 2000).

The available literature supports the value of NCDU in promoting nursing leadership, decreasing the gap between research and practice, fostering collaboration between academic institutions and the clinical field and promoting innovative in nursing practice (Flint & Wright 2001; Gerrish & Ferguson 2000; Greenwood & Kearns 1996; Greenwood & Parsons 2002a; Happell & Martin 2004; Scholes 1996;Wright 1989;Wynaden & Rose 1998).

However, the implementation of NCDU is not a simple or straight forward process. The main barriers identified include: workload, lack of resources, resistance from staff, turnover of, or stress experienced by NCDU leaders and lack of support from management (Atsalos & Greenwood 2001; Gerrish & Ferguson 2000; Greenwood & Parsons 2002b; Greenwood 1999).

The literature describing NCDU within the mental health field is extremely limited and refers to NCDU as single units, or as part of a larger implementation process of which the mental health units constitute a small proportion (Greenwood 1999; Wynaden & Rose 1998).This paper refers to the introduction of NCDU in twelve mental health settings in Victoria,Australia, facilitated by the Centre for Psychiatric Nursing Research and Practice (CPNRP) at the University of Melbourne.

The CPNRP developed a training program to support the introduction of NCDU. The program consisted of workshops conducted one day per week over a nine week period.The aim of the program was to equip clinical leaders of the units with the skills and knowledge that would assist them to lead the required changes within the clinical setting. A training program was utilised to implement NCDU in collaboration with the University of Western Sydney (Greenwood 1999).

The aim of the program was to support and enhance the ability of clinical leaders to develop the framework for cultural change based on the contribution of psychiatric nursing to improved health outcomes for service users. Content included: nursing leadership, professional development, introduction to research and research utilisation and, creating a culture of change.

The formal program was funded and supported by the CPNRP. The participating units were required to undertake to release at least two staff to attend the program. Providing two staff was to minimise the risk of losing momentum in the establishment of the NCDU if one staff member were to leave employment or be re-employed in a position outside of the unit, as was the experience with the initial program operated by the University of Western Sydney (Greenwood 1999).

METHODS

An evaluation conducted at the completion of the training program suggested that it had been a valuable experience and participants had gained a greater understanding of NCDU and how to implement the process within the workplace (Happell & Martin 2002). In order to determine the extent to which the program actually assisted with the NCDU implemented, an impact evaluation was undertaken. In-depth, semi-structured interviews were conducted with nurses who had completed the NCDU program. Broadly, they were asked to describe their experiences of implementing an NCDU.

The interviews were audiotaped and transcribed verbatim to enable an accurate account of the interviews. Data were analysed using a content analysis approach to facilitate the identification of main themes based on the work of Cresswell (1998) to identify the main themes. Barriers to implementation was one major theme, and will be the focus of this paper. …

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