Liaison Nurses Research Articles

Differences in the characteristics, treatment, and outcomes of patient groups reviewed by intensive care liaison nurses in Australia: A multicentre prospective study

BackgroundThere is a lack of knowledge about tasks intensive care unit liaison nurses (ICU LNs) perform during patient review, despite this role operating in at least 31 acute care hospitals in Australia. ObjectivesTo evaluate the tasks that ICU LNs perform during patient review in the following referral subcategories: review after ICU discharge, rapid response team (RRT) review, and ward referral. MethodsA 2-month prospective observational study using standardised case report forms to collect data on patients reviewed by ICU LNs in 20 Australian hospitals was conducted. ResultsFrom 3799 patients screened, 3542 were included, among whom 1933 (54.6%) were men, and the mean (standard deviation) age was 63 (19.4) years. The admitting units were surgical 1765 (49.8%) and medical 1696 (47.9%), and the breakdown of referral types were routine review after ICU discharge (1732; 47.9%), RRT review (1208; 34.1%), and ward referral (602; 17.0%). Patients subject to ward and RRT reviews were older, more likely to be medical admissions with less favourable vital signs on the initial review, and less likely to have repeat reviews. Of note, ward reviews were more likely to receive palliative care. Intensive care liaison nurse–initiated medication prescription and investigation ordering was uncommon. The most common interventions included consultation with medical staff, bedside education, adjusting oxygen flow and patient position, and directing the change in frequency of vital sign measurement. In-hospital mortality was lower in patients reviewed after ICU discharge (2.3%), compared with those after RRT review (2.8%) and ward referral (4.4%). ConclusionsMost patients were reviewed after ICU discharge or in the context of the RRT. RRT and ward patients were less physiologically stable and more likely to die in hospital. The most common interventions performed by the ICU LN were nontechnical skills including clinical education, consultation with medical staff, and changes to vital sign frequency. Finally, the most common medication therapies administered related to intravenous therapy and electrolyte administration.

GESTÃO DE ALTA PARA A CONTINUIDADE DO CUIDADO: EXPERIÊNCIA DAS ENFERMEIRAS DE LIGAÇÃO DE PORTUGAL

Objetivo: descrever as atividades de continuidade do cuidado desenvolvidas pelas enfermeiras de ligação nos serviçoshospitalar. Método: estudo descritivo, exploratório, realizado de setembro/2016 a março/2017, em 15 hospitais dePortugal, com 107 enfermeiras. Os dados foram coletados com um questionário semiestruturado e analisados pormeio das frequências absolutas. Resultados:51 (47,7%) dos pacientes que necessitam de cuidados continuados sãoidentificados por médicos e enfermeiras assistenciais, 69 (64,5%) utilizam critérios para a identificação dos riscospara a alta do paciente. Os elementos considerados no planejamento de alta são: reabilitação motora e funcional,54 (30,86%); e preparo do cuidador, 41 (23,43%). As transferências das informações para continuidade do cuidadoocorrem majoritariamente por correio eletrônico, 58 (25,55%). Conclusão: as atividades para a continuidade do cuidadonão são homogêneas entre os profissionais que realizam atividades de ligação, mas contribuem para estratégias maisconsolidadas para o enfrentamento da descontinuidade do cuidado.

One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry

BackgroundThe purpose of this registry-based retrospective study was to investigate the risk factors related to one-year mortality in displaced intracapsular fragility hip fracture patients.MethodsPatients were screened from the Fragility Fracture Registry. Inclusion criterion was displaced intracapsular hip fracture patients with atypical or pathological fractures excluded. One-year mortality was investigated against risk factors including age, gender, past medical history, pre-fracture mobility (PFM), pre-operation ASA grade, delayed surgery over 48 h, post-surgical complications, and length of stay at acute orthopedic ward (LOS).ResultsA total of 1050 patients were included for further analysis. Gross one-year mortality was 14.9%. One-year mortality was significantly higher in patients who received non-operative treatment and those who received surgery but delayed over 48 h after admission (both p < 0.001). Male gender (OR = 2.708), advanced age (OR = 1.359), higher risk ASA grades (III to V) (OR = 1.990), past history of gastrointestinal disease (OR = 1.671), and renal impairment (OR = 1.984) were related to higher one-year mortality. The mortality of patients in PFM grade 3 and LOS group 3 was significantly higher (OR = 2.240 and 1.722, respectively).ConclusionsHigher age, male gender, past gastrointestinal disease and renal impairment, ASA grade over 3, indoor confined pre-fracture ambulatory, and stay at hospital over 15 days were risk factors related to higher one-year mortality in surgically treated displaced intracapsular hip fracture patients. A multi-disciplinary approach is advised to patients identified with these risks factors and co-managed by orthopedic surgeons, geriatricians, and fracture liaison nurses.

Abstract P-406: IMPROVING COMMUNICATION WITHIN MULTI-DISCIPLINARY TEAMS IN CHILDREN WITH LIFE LIMITING CONDITIONS

Aims & Objectives: 60% of children admitted to RMCH PICU might benefit from palliative care (previous case review). Co-coordinating and maintaining continuity of care in these children with multi-speciality input is challenging. Weekly Multi disciplinary Team Meeting (MDT) and follow up was introduced in PICU to improve care in this cohort. Methods Weekly MDT meeting (co-located specialist teams, Intensivists, palliative care consultant, family liaison nurses) were held over a year. Spectrum of Palliative Care Needs was used to 1. Recognise children who might benefit from palliative care 2. Identify need for MDT/Lead consultant/End of life discussions if not already done 3. Update community and specialist teams 4. Discuss/Review advanced care plan (ACP). Results Actions from 32 MDTs were analysed (minimum 2 meetings monthly) in children with palliative care needs (62%). Actions that had to take place within the hospital were completed: Liaising with specialist nurses: 7; Initiating ACP: 4; Identifying ICU lead: 16; Recognising need for end of life discussions, planning for death and place of death: 14; referral to in-house palliative care team: 17; Organising MDT: 11. However only 44% of local teams (outside hospital) were contacted (action that involved teams outside the hospital) and feedback from local teams after discharge was inconsistent. Conclusions Weekly MDT meetings to identify children who might benefit from palliative care are a good start to improving communication and maintaining continuity of care. More initiatives need to be taken by the intensivists in speciality hospitals to improve communication with the wider network of professionals looking after children with life limiting conditions.

Plea for round-the-clock access to liaison nurses in hospitals

Plea for round-the-clock access to liaison nurses in hospitals

Application of follow-up care by liaison nurses in patients transferred out of the intensive care unit

Objective To explore the intervention effect of liaison nurses on the follow-up care of patients transferred out of the intensive care unit. Methods Totally 156 ICU patients from January to December 2016 were selected as the research object by convenient sampling, with 71 patients from January to June as the control group and 85 patients from July to December as the treatment group. Patients in the control group received conventional transfer, while a team of ICU liaison nurses was established to provide continuing nursing services to the patients transferred from ICU into general wards in terms of the treatment group so that potential risks could be found and intervened as early as possible. The average length of stays, rate of unexpected return to ICU within 48 hours, and incidence of nursing complications were compared between the two groups. The State Anxiety Inventory and Chinese Version of Critical Care Family Satisfaction Survey were used to compare the level of transfer anxiety and family satisfaction of the patients in the two groups. Results The patients in the treatment group showed a shorter average length of stays and a lower rate of unexpected return to ICU within 48 hours and incidence of nursing complications than the patients in the control group (P<0.05) . The patients in the treatment group had a lower score in transfer anxiety (P<0.05) . The score in any dimension of family satisfaction and the total score of the patients in the treatment group were higher than those of the patients in the control group (P<0.05) . Conclusions Liaison nurses have showed a good effect on the follow-up care of patients transferred out of ICU, which is significant to some extent. Key words: Intensive care units; Liaison nurse; Transferred patient; Follow-up care

Enacting a model of integrated care for people with complex health needs

Introduction : Improving health care through integrated care has been a goal for governments and policymakers internationally for three decades. However, it is still unclear how integrated care can be achieved in practice. This doctoral study examined how a model of integrated care evolved as an approach to caring for people with complex health needs. The case is HealthOne, a NSW government initiative, located in primary health care. Theory / Methods : Drawing on resources from actor-network theory, practice theory and integrated care literatures, this study explored how a model of integrated care was enacted in practice. The multi-sited, mobile ethnographic fieldwork extended from 2011 to 2013. Data was collected from shadowing HealthOne liaison nurses, observing meetings, semi-structured interviews and documents. The focus was on work practices associated with care of HealthOne clients carried out by a range of health and social care professionals. Results : The enactment of integrated care emerged as a relatively unstructured form of integration, understood as linkage. While embedded practices such as working in silos and protecting client confidentiality reacted uneasily to the model of care, practices including engaging clients and working with general practitioners fostered change. This enactment of integrated care was an approach to new ways of working reliant on relational practices encouraging engagement with the model of care. HealthOne liaison nurses and case conferences held together shifting relations and emerging practices. Care was individualised and attuned to the client’s immediate needs and the realities of the local context. Discussion : Policy positioned HealthOne as a new model of care that would encompass primary care and community-based services, with integrated patient-centred care provided by multidisciplinary teams. The absence of adequate structural arrangements for shared care and lack of supportive technologies were matters of concern. Practice change evolved in uneasy tension with stability, rather than as a straightforward replacement of old with new. The policy did not work in practice entirely as envisaged, however, a form of integrated care was accomplished in practice as an ongoing, fluid process of negotiation and adaptation. Conclusions : Since there were no funding incentives, formal agreements or shared care arrangements organising practice, enacting integrated care relied on creating flexible informal partnerships across professional and organisational silos with individual clinicians and services. The HealthOne approach to integrated care became cooperative care management facilitated through liaison nurses and case conferences acting as mechanisms of integration. Lessons learned : Engagement of practitioners and clients are key dependencies. Future initiatives should establish partnership agreements with private practitioners and social care services involved in integrated care. Clinical integration should be supported by systems and structures to facilitate multidisciplinary care management and care planning. Limitations : The data and findings may not be representative of all HealthOne sites, or of a different timepoint in HealthOne’s evolution. Suggestions for future research : Future studies are recommended that foreground the clients' experiences and outcomes from integrated care initiatives. Investigation of how the HealthOne model of integrated care has been embedded in practice and further evolved would produce valuable and complementary findings to this study.

The ketogenic diet is effective for refractory epilepsy associated with acquired structural epileptic encephalopathy.

Ketogenic diet therapies have proven efficacy for refractory epilepsy. There are many reports of their use in the genetic developmental and epileptic encephalopathies; however, little attention has been paid as to whether the diet is also effective in individuals with an acquired structural aetiology. We observed remarkable efficacy of the diet in two patients with hypoxic-ischaemic encephalopathy. We then analysed our cases with refractory structural epilepsies of acquired origin to characterize their response to the ketogenic diet. The classical ketogenic diet was implemented with dietary ratios of 3:1 to 4.4:1. Seizure frequency at 1month, 3months, 6months, 1year, and 2years was ascertained. A responder was defined as greater than 50% seizure reduction compared to baseline. Seven of the nine patients were responders at 3months. Somewhat surprisingly we found that the ketogenic diet was effective in patients with a developmental and epileptic encephalopathy due to an acquired structural aetiology. This cohort may not be routinely considered for the ketogenic diet because of their structural and acquired, rather than genetic, basis. The ketogenic diet should be considered early in the management of patients with acquired structural encephalopathies as it can improve seizure control with the potential to improve developmental outcome. The ketogenic diet was effective in children with epilepsy associated with an acquired structural aetiology.

Health professionals’ and coroners’ views on less invasive perinatal and paediatric autopsy: a qualitative study

ObjectiveTo assess health professionals’ and coroners’ attitudes towards non-minimally and minimally invasive autopsy in the perinatal and paediatric setting.MethodsA qualitative study using semistructured interviews. Data were analysed thematically.ResultsTwenty-five health professionals...

658 - Chemotherapy Order Review: The Role of the Liaison Nurse

Topic Significance & Study Purpose/Background/Rationale: The number of patients transplanted by the Pediatric Hematopoietic Stem Cell Transplant Program at Boston Children's Hospital increased by 65% in fiscal year 2016 as compared to fiscal year 2008. The increase in the number of admissions corresponds with an increase in number of chemotherapy orders. Often orders requiring modification, missing lab values and incomplete consents or treatment plans are discovered by bedside nurses during the order review process. The role of a Liaison Nurse was introduced in the spring of 2016. This nurse reviews chemotherapy orders, consents, treatment plans and pertinent lab results in advance of Hematopoietic Progenitor Cell Transplant (HPCT) admission. Methods, Intervention, & Analysis: The Liaison Nurse reviews chemotherapy orders, treatment plans, consents and lab values prior to admission. Prior to implementing the Liaison Nurse role, bedside nursing staff completed an audit to capture the number of orders requiring clarification of consent or clarification of treatment plan and/or modifications to ordered chemotherapy or supportive care. Post implementation, the Liaison Nurse collected data on the same metrics. Findings & Interpretation: Audit results between December 2015 and March 2016, prior to introduction of the Liaison Nurse, demonstrated 27%-67% of sampled chemotherapy orders needed consent, treatment plan or order modification before final verification could occur. The most recent quarter, (July 1, 2017-September 30, 2017), demonstrated 10 of 21, (48%), of patients admitted required clarification of consent, treatment plan or modifications to ordered chemotherapy or supportive care. These clarifications and modifications were requested by the Liaison Nurse prior to the bedside nurse review of the orders. Discussion & Implications: Previously collected quarterly data post implementation of the Liaison nurse role in the review process demonstrated that between 19-60% of the total orders written required consent, treatment plan or order modifications. While the number of required interventions remains consistent with data collected prior to the implementation of the Liaison Nurse role, fewer of these interventions are requested by the bedside nurse during at 0-6% of requests. Though the time it took to review orders was not measured, the time it takes a bedside nurse to review chemotherapy orders is reduced if the review process does not need to be interrupted for modification requests or clarification. Interceptions have also inspired programmatic process improvements and template revisions.

Roles and Responsibilities of the Home Care Liaison Nurse : A Review of the Literature

Roles and Responsibilities of the Home Care Liaison Nurse : A Review of the Literature

"Keeping it on your radar"-assessing the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood: A qualitative study from the early detection of type 1 diabetes in youth study.

SummaryAimsThe aim of this study was to explore from the perspectives of key stakeholders involved in the pathway to diagnosis, the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood.MethodsQualitative interviews and free‐text analyses were undertaken in 21 parents with a child diagnosed with type 1 diabetes, 60 parents without a child diagnosed with type 1 diabetes, 9 primary healthcare professionals, 9 teachers and 3 community diabetes liaison nurses. Data were analysed thematically and 30% double coded.ResultsTwo key themes were identified, namely the importance of widespread awareness and knowledge and seeking healthcare professional help. Parents with a child diagnosed with type 1 diabetes described seeking opinions from a number of individuals prior to seeking health professional help. Healthcare professionals recognized the rarity of the condition and the need for it to be kept on their “radar”, to ensure they considered it when examining an unwell child. The process of obtaining a primary healthcare appointment was identified as potentially playing a crucial role in the diagnostic process. However, most parents with a child diagnosed with type 1 diabetes described receiving an appointment on the day they sought it.ConclusionsKnowledge and awareness of type 1 diabetes in childhood remain limited in the general population and misconceptions persist relating to how children present with this serious condition. An effective community‐based intervention to raise awareness amongst key stakeholders is required to ensure children receive a timely diagnosis once symptomatic.

'Falls not a priority': insights on discharging older people, admitted to hospital for a fall, back to the community.

Falls are common among older people and a leading cause of injury-related hospitalisation. The immediate post-hospitalisation period is a risky time for further falls. This paper explores discharge strategies from the perspectives of older people hospitalised for a fall and liaison nurses assisting people to return home. Exploratory mixed methods were used. Semi-structured interviews with older people were conducted regarding their experience of the fall and discharge strategies. Quality of life, falls risk and functional capacity were measured by questionnaire. Liaison nurses were also interviewed. Interviews were audio-recorded, transcribed and thematically analysed. Mixed-method synthesis occurred using role-ordered matrix analysis. Older people (n=13) and liaison nurses (n=6) participated. Older persons' quality of life was average and falls risk high. Thematic analysis revealed three key themes: 'falls are not a priority', 'information not given, or given and not retained' and 'reduction in confidence and independence'. Role-ordered matrix analysis identified differences between acute and rehabilitative hospital stays. Older people hospitalised for a fall present a unique opportunity for implementation of falls prevention strategies. However, hospitalisation is often a time of crisis with competing priorities. Timing and relevance are crucial for optimal uptake of falls prevention strategies, with the primary care setting well-placed for their implementation.

Providers perspectives on mandated local health networks for older adults in the province of Quebec, Canada

Background : In 2004, the government of Quebec made major reforms in the organisation of its health system by implementing Local Health Networks (LHNs) focused on the needs of various sub-populations. Informed by two prominent pilot projects (1, 2), the Ministry of Health and Social Services aimed at improving the continuity, coherence, quality and efficiency of health and social services by mandating the implementation of LHNs for older people with complex needs in its territory following a co-ordination model of integration (3). Understanding how mandated innovations are adopted and routinized in different contexts may give insights on which components of the innovation work where and why they work. Hence this project questions how and why does the implementation of LHNs for older adults vary between three LHNs in Quebec according to the perspectives of providers? Theory/Methods : A multiple case study, consisting of a highly urban, an urban and a rural setting. Semi-structured interviews of providers (n=29) and key documents were collected. Analysis done with the NVIVO software was based on themes inspired by The Rainbow Model of Integrated Care(4) which distinguishes 59 constructs in six interlinked integration dimensions: clinical, professional, organisational, system, functional and normative integration. Results : Variable implementation of components of LHNs in all three cases. Providers reported great variability in the implementation of clinical integration components such as the elaboration of individualised care plans for patients, care coordination through case management, and the engagement of patients/caregivers in the organisation and delivery of care. Providers experienced professional integration through the usage of multidisciplinary client evaluation tools, which facilitated inter-professional collaborations. Merging organisations of the LHNs and creating various inter-organisational strategies such as liaison nurses, aimed at promoting organisational integration, ensured continuity of services. Usage of various health information systems by providers eased functional integration, communication and collaborations between partners. Pertaining to system integration, the three cases shared the same political, economic and social climate. Discussion : Variability in the implementation of LHNs in the cases studied may be attributed to several factors. Characteristics of the local context, such as lack of appropriate personnel resulted in the rural LHN not instituting case managers or liaison nurses, a problem not faced in the other two cases. Characteristics of the innovation, such as the cumbersomeness of the multidisciplinary client evaluation tool resulted in some providers not using it in their LHNs. Providers often worked with multiple unaligned health information systems which varied within and between cases due to inappropriate managerial decisions. Mostly, providers ensured optimal care delivery to their clients by adjusting to these variations. Conclusion : The breadth and depth of different components of LHNs varied across the cases. Providers need flexibility and adaptability while carrying out their duties. Lessons learned : Different factors may influence the implementation variability of LHNs, which in turn influences the way providers perform their duties. Limitations : Only one perspective was studied, and these findings may be generalised only to similar LHNs. Suggestions for future research : Effects analysis of the implementation of the LHNs for older people.

“Counting the intangible”: The use of evaluation tools and indicators to measure integrated care outcomes in the Basque Country

Introduction : There is currently the debate about how to measure the elements that are key to “successful integrated care”, which are the outcomes that should be achieved and which evaluation tools can be used. The Basque Country has been implementing integrating care policies since 2010. One of the cornerstones of this strategy has been the launch of 13 Integrated Care Organisations (ICOs) to integrate under the same structure Primary and Secondary Care Services (1). Since 2014, changes have been introduced in the metrics of the Contract-Programme (CP) that regulates de relationship between the Ministry of Health (commissioner) and each ICO (health providers). These changes, based on Kelly and Hurst (2), are both qualitative and quantitative and aim to provide the Ministry of Heath with a new framework to evaluate the success of all integrated care policies being implemented. Moreover, one of the new indicators being introduced in the new Contract Programme is IEMAC-ARCHO (3), which is an instrument with 75 items for ICOs to perform a self-assessment in terms of their degree of implementation of chronic care management models and is based on the Chronic Care Model (4). Aims, objectives and results : In this abstract we would like to explore the co-relation in the evolution of the results of both the CP and IEMAC across time. In order to do that we have selected some of the actions/policies behind the new indicators in the CP (see in Figure 1) such as: (i) the provision of case managers and liaison nurses, (ii) systematized agreements with ”outsiders” such as social and community care, (iii) unified health care records, (iv) patient empowerment and participation among others. All these elements aim to improve continuity of care and improve the experience of care across settings. On the other hand in Figure 2 shows the results from 20 evaluations using IEMAC sessions that were conducted with 18 ICOs. Each session was run by health professionals and managers from both levels of care (Primary and Hospital Care) and actors from other areas such as mental health and social care were also represented. The self assessment o IEMAC allows each ICO to identify areas of improvement, define a plan and implement it following what the CP requests. Conclusions : Integrated care is a dynamic process that involves cultural change and measuring that can be rather hard. However evaluation tools are necessary for tracking the evolution of key aspects for integrated care and the various changes that occur when implementing integrated care policies. Looking at the results we can observe a positive evolution of both CP indicators and IEMAC-ARCHO, which indicates good degree of achievement of the policies implemented by the Ministry of Health. In addition to being useful for evaluation purposes, both the CP and IEMAC are powerful tools to identify line of actions and improvement areas that can be supported by the Ministry of Health. References : 1- Toro Polanco N, Berraondo Zabalegui I, Perez Irazusta I, Nuno Solinis R, Del Rio Camara M. Building integrated care systems: a case study of Bidasoa Integrated Health Organisation. International Journal of Integrated Care. 2015;15(2). DOI: http://doi.org/10.5334/ijic.1796 2- Kelley E, Hurts J. Health Care Quality Indicators Project. Conceptual framework Paper. Organization for Economic Co-operation and Development Health Working. Papers No 23, 2006 3- IEMAC. Assessment of Readiness for Chronicity in Heath Care Organisations. [cited 2016 24 Oct] Available from: http://www.iemac.es/internacional.asp 4- Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the Chronic Care Model in the new millennium. Health Aff (Millwood). 2009 Jan-Feb;28(1):75-85

Evaluation of a learning disability liaison nurse service

Learning disability liaison nurses can ensure that people with learning disabilities receive high-quality care in hospital. This article reports the findings from an evaluation of a learning disability liaison nurse service. Over a five-year period 750 referrals were received. Of these, 387 (52%) were women and the mean age of those referred was 46 years. People with severe/profound learning disabilities tended to be younger when referred. Most referrals were to the medical department and the mean length of stay for those admitted was 8.6 days. The main source of referral has changed over time with hospital staff being the main source of referrals for the past three years. Around 95% of people referred were recorded as having a successful completion of their care episode.This evaluation contributes to the evidence base for these specialist roles. It provides a longer-term view of patterns of referral and the characteristics of people with learning disabilities who have been supported by the liaison nurse.

Can more appropriate support and services be provided for people who attend the emergency department frequently? National Health Service staff views

BackgroundInterventions designed to help Emergency Department (ED) staff manage frequent attenders are labour-intensive and only benefit a small sample of frequent attenders. We aimed to use the in-depth knowledge of...

Exploring the value of mental health nurses working in primary care in England: A qualitative study.

Aims/Question General practice is typically the first point of access to healthcare. This study explores what value a Primary Care Liaison Nurse (PCLN) service, established in 2011, can bring to people with mental health problems in primary care. Method Semi-structured interviews were used to elicit participants' experiences and perspectives on the value of a PCLN service. Participants included ten interviews with seven general practitioners and three senior practitioners working in primary care mental health services. Thematic analysis, based on a 6-phase approach, was used to describe and explore the data collected. Results Five main themes were derived from the thematic analysis of the interviews relating to: integration; clinical effectiveness; patient centred care; access; and efficiency. Discussion The study suggests that the PCLN service can improve the quality of care and is generally highly valued by its stakeholders. The study identifies particularly valued elements of the service, including having a duty worker, as well as aspects which could be improved, such as patient criteria. Implications for practice This is a relatively new service and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area.

Utilising the Canterbury Dedicated Education Unit model of teaching and learning to support graduate nurses

AbstractThis study was designed to answer the research question: Can the Canterbury Dedicated Education Unit model of clinical teaching and learning support graduate registered nurses in their first year of practice? A descriptive exploratory case study approach was utilised. Data were gathered via three focus groups with a total of eleven participants. Thematic analysis was undertaken to identify patterned meaning across the dataset. Two primary themes evident were; support, and recruitment and retention. The main theme of support had five associated subthemes: peer support, organisational support, liaison nurse support, team support for the graduate registered nurses and team support for the staff. An unexpected finding was the positive contribution of the Nurse Entry to Practice Programme Liaison Nurse as a conflict broker who was able to mitigate the escalation of concerns. Another unexpected finding was the positive contribution of the use of Canterbury Dedicated Education Unit of clinical teaching and learning to the recruitment and retention of graduate registered nurses. It is clear the Canterbury Dedicated Education Unit model of clinical teaching and learning provides a significant amount of support to the graduate registered nurses because of the structure of the model. Ngā ariā matuaI hoahoatia tēnei rangahau hei whakautu i te pātai rangahau: Ka āwhina te tauira whakaako, ako ā-hōhipera o te Canterbury Dedicated Education Unit i ngā tapuhi rēhita whai tohu i tō rātou tau tuatahi i te mahi tapuhi? I whakamahia tētahi huarahi whakamārama mātai tūāhua tūhura. I kohia ngā raraunga i roto i ētahi rōpū arotahi e toru, tekau mā tahi te hunga whakauru. I whakamahia he tātaritanga ā-ia hei tautohu i ngā ia puta noa i te huinga raraunga. E rua ngā ia matua i puta; tuatahi ko te tautoko, tuarua ko te whakauru mai ki te mahi tapuhi, me te pupuri. E rima ngā ia o raro i te ia matua o ‘te tautoko’; te tautoko a ngā hoamahi, te tautoko a te whakahaere, te tautoko a te tapuhi takawaenga, te tautoko ā-kapa mō ngā tapuhi rēhita whai tohu, me te tautoko ā-kapa i ngā kaimahi. Tētahi kitenga kāore i matapaetia i te tīmatanga ko te āwhina whai hua o te Tapuhi Takawaenga mō te Nurse Entry to Practice Programme, nā te mea i taea e ia ngā māharahara te whakamārie kia kore ai e hē kē atu. Tētahi atu kitenga kāore i matapaetia i te tīmatanga ko te āwhina whai hua o te whakamahi i te Canterbury Dedicated Education Unit ki te whakaurunga me te pupuri mai o ngā tapuhi rehita whai tohu. He mārama tonu kua tino āwhina te tauira whakaako, ako ā-hōhipera o te Canterbury Dedicated Education Unit i ngā tapuhi rēhita whai tohu, nā te āhua o te hanganga o te tauira. Key words / Ngā kupu matuaDedicated Education Units; graduate nurses /tapuhi whai tohu; support /tautoko; recruitment and retention/ te whakauru me te pupuri

リエゾン精神看護専門看護師と精神科リエゾンチームでの活動について(シンポジウム,第24回日本精神保健看護学会学術集会)

リエゾン精神看護専門看護師と精神科リエゾンチームでの活動について(シンポジウム,第24回日本精神保健看護学会学術集会)