While most clients show improvement in therapy, anomalously, 5% to 10% actually worsen, and a significant minority of clients shows little or no response to therapy. Earlier studies developed clinical support tools (CSTs) designed to provide feedback to therapists about potential problem areas and to improve the likelihood of a positive outcome for clients identified as at-risk for a negative outcome in therapy (Harmon et. al. 2007; Slade, Lambert, Harmon, Smart, & Bailey, 2008; Whipple et al., 2003). While varying from study to study, the CSTs looked at five domains: therapeutic alliance, motivation to change, social support, life events, and perfectionism. More than 100 questions were used to assess these domains. The major goal of this study was to streamline the CST measures to increase efficiency. Toward that end, a new instrument consisting of 37 questions was developed by administering questionnaires to 169 patients at a rural Utah mental health center. In addition, the life events and social support questions were given to 76 students at Brigham Young University and 88 randomly selected residents of Utah County. Using item response analysis and mean scores for each dimension, subscale cut scores were developed for four dimensions: therapeutic alliance, motivation for therapy, social support, and life events. The perfectionism subscale was dropped from the questionnaire because perfectionism was deemed to be too stable to be useful for the intended use of the measure. Cut scores were also developed for each individual question. These subscale and individual item cut scores are intended to help clinicians identify potential problem areas to be explored during the course of therapy.

Researchers have found evidence that when clinicians use an evidence-based feedback system that uses Clinical Support Tools (CST) for not-on-track clients, deterioration rates fall and success rates improve (Shimokawa et al., 2010). Despite multiple studies finding evidence in support of using the CST, there has been a discrepancy between effect sizes (i.e., d = 0.5; Simon et al., 2012). As such, further replicate of these past studies is needed to discover if small effect sizes still persist and if so, what possible variables may contribute to inconsistent findings. For the current study, it was predicted that the use of the CST would result in significantly lower OQ-45 scores at treatment termination after controlling for the intake OQ-45 score. Additionally, previous research indicated that the combined intervention of the progress feedback plus CST would significantly reduce deterioration rates with those NOT. Out of 1,122 participants, 172 were randomly assigned to one of two conditions: The CST feedback group (n = 71) and the no CST feedback group (n = 101). There was not a significant difference in the mean OQ-45 scores for the CST feedback group (M = 2.39, SD = 20.95) and the no CST feedback group (M = 4.17, SD = 19.74). The results of this study raise questions about how regularly the therapists were monitoring their clients' progress feedback and whether the CST are effective. Additionally, the author evaluates the timing of when the CST were administered to clients and when therapists reviewed the feedback.

Aims and objectives: To describe newly graduated nurses’ experiences of the intervention practitioner training nurse.  Background: Newly graduated nurses need support to establish the profession. Several studies have shown that the first years in the profession, is the most challenging time. Method: The intervention practitioner training nurse was initiated to empower, and support newly graduates nurses in their professional role. Data were collected through semi-structured interviews with ten newly graduate nurses having experience of the intervention. The data were analysed using qualitative content analysis. Results: The analysis results in the overarching theme; “Organizational prerequisites” The theme consisted of three categories, "Activator" comprised the subcategories compiliating and attractive workplace. This involved that the practitioner training nurse were the activator creating a clear structure and the wards became more attractive workplaces. “Supportive nursing" comprised the subcategories present assistance, emotional support, and patient safety. This involved that practitioner training nurse constituted an important support function and helped to ensure patient safety. “Professional development” comprised the subcategories nurse's competence, feeling of security, and learning. This created the opportunity for professional development. Conclusion: The newly graduate nurses' experience of the intervention shows that the creation of an organisational structure enabled the practitioner training nurse to be an important support and to contribute to professional development. This was accomplished by strategic decision of the hospital management. Relevance to practice: The results of the current study can be transferred to other similar healthcare organizations and can be a support for managers who plan to initiate interventions to empower and support newly graduated nurses.

Patient-focused research systems have been developed to monitor and inform therapists of patients' treatment progress in psychotherapy as a method to enhance patient outcome. The current study examined the effects of providing treatment progress information and problem-solving tools to both patients and therapists during the course of psychotherapy. Three hundred seventy patients at a hospital-based outpatient psychotherapy clinic were randomly assigned to one of two treatment groups: treatment-as-usual, or an experimental condition based on the use of patient/therapist feedback and clinical decision-support tools. Patients in the feedback condition were significantly more improved at termination than the patients in the treatment as usual condition. These findings are consistent with past research on these approaches although the effect size was smaller in this study. Treatment effects were not a consequence of different amounts of psychotherapy received by experimental and control clients. Not all therapists were aided by the feedback intervention.

The purpose of the study was to explore and describe the perceptions of the pupil nurses at their second year level towards clinical support at the private hospital in the Limpopo Province. Qualitative approach including exploratory, descriptive and contextual study design was followed. The target population for this study included pupil nurses at their second year level (n=20) following a two year programme leading to enrolment as a nurse from a private nursing education institution in the Limpopo Province. Data was collected utilizing written narratives, and focus group interviews. Field notes and audio tape were used to capture data. Data saturation was reached on twelve participants. Data were thematically analysed using Tesch’s method of open coding. The results revealed lack of clinical support. Lack of clinical support was attributed to inadequate educators for accompaniment, registered nurses’ uncaring attitude and not fulfilling their mentorship role, and pressure on pupil nurses to meet the high clinical demands. Pupil nurses were found not to be assuming full responsibilities over their practical learning. Therefore, it is mandatory as nurse educators, managers and researchers to take note of the gaps identified and intervene utilising recommendations provided to enhance clinical support. / Health Studies / M.A. (Nursing Science)