Exploring the Intersection Between Academic and Professional Practice During the COVID-19 Pandemic: Undergraduate and Graduate Nursing Students' Experiences

Background

The coronavirus disease-2019 (COVID-19) pandemic has implications for students who are also nurses.

Purpose and Methods

This qualitative descriptive study used a practice development approach to explore the intersection between academic and professional work experiences for undergraduate Post-Diploma Registered Practical Nurses bridging to Registered Nurse Bachelor of Science in Nursing students and Master of Nursing graduate nursing students during the first wave of the COVID-19 pandemic. The study incorporated critical aesthetic reflections that focused on the personal and aesthetic ways of knowing, as a data collection approach and knowledge dissemination strategy.

Results

Analysis of the narrative component of participants’ reflections revealed the following themes: sensing a “call to duty,” experiencing a myriad of emotions, shifting societal and individual perceptions of nursing, and learning in an uncertain environment.

Conclusions

The results of the study can inform educational strategies and academic policies to support this unique nursing population, who are frontline practitioners as well as student learners.

Breaking bad news to patients in the emergency department

Breaking the news of potentially serious and new diagnoses to patients in the emergency department (ED) is a common but challenging aspect of the autonomous practitioner's role. It is a complex process, requiring expertise and skill. If the news is delivered appropriately there is evidence to suggest a beneficial effect on the patient's ability to cope, yet there is little formal training available and literature focused on the ED setting is limited. This article aims to guide and prepare autonomous practitioners in the ED to break bad news to patients, including during remote consultations introduced due to the coronavirus disease 2019 pandemic. It identifies the importance of preparation; different approaches to breaking bad news, namely the six-stage SPIKES framework and a case study exploring its application in practice; the range of potential patient reactions and how these can be managed, including the provision of support; and how to involve and communicate with other members of the multidisciplinary team. Suggestions for further training are outlined.

Der Pneumonie keine Chance geben

No chance for pneumonia - A campaign for mobilization in the context of a practice project addressing pneumonia prevention Abstract. Background: Healthcare-associated infections (HAI) in inpatients are associated with complicated treatment. In Europe, 5.5 % of inpatients develop HAI. About half of these infections could be avoided. In the Clinic for traumatology of the university hospital Zurich, we developed interventions to reduce HAI. Thereby, we focused on non-ventilator-associated hospital-acquired pneumonia (nvHAP). Aim: Besides reducing nvHAP rates, we intended to improve patient mobility, to empower nurses, and to strengthen interprofessional collaboration. Methods: To achieve these aims, we performed a practice development project comprising inhouse training, workshops, information posters, structural changes and a mobilization campaign. Results: Patient mobilization increased by 40 %, duration of mobilization sessions by 46.5 %. The semi-annual comparison shows a sustainable improvement of 7.6 %. Nurses reported knowledge gain, considerably improved interprofessional collaboration and increased quality of caring. Discussion: Combining various methods and following an interprofessional approach resulted in sustainable effects. Limitations and transfer: Targeted practice development proves to be suitable for promoting patient mobility. Regular repetitions and physiotherapy services at off-peak times are essential to ensure sustainability.

Quilting emergent advanced practice nursing educator identity: an arts-informed approach

OBJECTIVES

Arts-informed pedagogy in the graduate nursing classroom is used to support the integration of theory with advanced practice nursing (APN) competencies (Canadian Nurses Association, 2008, 2019).

METHODS

Using the patterns of knowing (Carper, 1978; Chinn & Kramer, 2018), Iwasiw & Goldenberg's curriculum development model (2015) and practice development (McCormack, Manley, & Titchen, 2013), two course professors facilitated the delivery of an innovative arts-informed approach in a nursing graduate program, the Quilt.

RESULTS

The Quilt was meant to invite graduate students to critically reflect and create a visual depiction of their emergent identities as advanced practice nurse educators (APNEs). As three graduate student authors, we reflect on our experiences engaging with arts-informed pedagogy to explore the features of the collective APNE identity. The design and delivery of the Quilt is described.

CONCLUSIONS

Finally, we discuss the lessons learned, and the value of arts-informed pedagogy to support the meaningful integration of theory amongst graduate nursing students becoming APNEs.

Perceptions and beliefs about the regulation of advanced nurse practitioners

BACKGROUND

The role of the advanced nurse practitioner (ANP) is not regulated in the UK, which has led to wide variation in the skills, competencies and academic qualifications of nurses using this title. Urgent treatment centres (UTCs) require a broad and experienced knowledge base to meet the demand of patients presenting with undifferentiated illnesses and injuries, which can be stressful and challenging.

AIM

To examine the perceptions and beliefs about ANP regulation, and to explore and discuss any ideas about proposed regulation.

METHOD

The author used interpretative phenomenological analysis to uncover valuable insights into the experiences of two ANPs working in an UTC, and their beliefs around regulation of the ANP role.

RESULTS

Both ANPs had different backgrounds and qualifications yet still had similar perceptions and beliefs regarding the regulation of ANPs. Five main themes were developed from the interview transcripts.

CONCLUSION

This study identified the need to consider the importance of ANPs' identity and the complex regulatory process required to standardise the role.

Effectiveness of Dementia Care Mapping™ to reduce agitation in care home residents with dementia: an open-cohort cluster randomised controlled trial

OBJECTIVES

Agitation is common and problematic in care home residents with dementia. This study investigated the (cost)effectiveness of Dementia Care Mapping™ (DCM) for reducing agitation in this population.

METHOD

Pragmatic, cluster randomised controlled trial with cost-effectiveness analysis in 50 care homes, follow-up at 6 and 16 months and stratified randomisation to intervention (n = 31) and control (n = 19). Residents with dementia were recruited at baseline (n = 726) and 16 months (n = 261). Clusters were not blinded to allocation. Three DCM cycles were scheduled, delivered by two trained staff per home. Cycle one was supported by an external DCM expert. Agitation (Cohen-Mansfield Agitation Inventory (CMAI)) at 16 months was the primary outcome.

RESULTS

DCM was not superior to control on any outcomes (cross-sectional sample n = 675: 287 control, 388 intervention). The adjusted mean CMAI score difference was -2.11 points (95% CI -4.66 to 0.44, p = 0.104, adjusted ICC control = 0, intervention 0.001). Sensitivity analyses supported the primary analysis. Incremental cost per unit improvement in CMAI and QALYs (intervention vs control) on closed-cohort baseline recruited sample (n = 726, 418 intervention, 308 control) was £289 and £60,627 respectively. Loss to follow-up at 16 months in the original cohort was 312/726 (43·0%) mainly (87·2%) due to deaths. Intervention dose was low with only a quarter of homes completing more than one DCM cycle.

CONCLUSION

No benefits of DCM were evidenced. Low intervention dose indicates standard care homes may be insufficiently resourced to implement DCM. Alternative models of implementation, or other approaches to reducing agitation should be considered.

First steps to integrate general palliative care into a cardiac hospital setting - using dialogue-based workshops

BACKGROUND

Heart failure is a chronic, life-threatening illness with multiple acute events. Palliative care alongside standard treatment is recommended for these patients. There is a lack of knowledge and research literature on how to integrate palliative care interventions for heart failure patients in a general hospital setting.

AIM

The aim of this study was to produce new insight for developing and integrating general palliative care into heart failure treatment.

METHODS

Guided by action research, we conducted an interdisciplinary workshop inspired by Tsoukas dialogue theory, where tension between perspectives is used as a facilitator of dialogue and the generation of new insights. Perspectives were incorporated through selected patient narratives and professionals' experiences. Data from the workshop were analysed using a thematic analysis. The findings are interpreted with Kleinman's theory on illness and disease and discussed using Tsoukas theory and additional research.

RESULTS

General palliative care must be initiated from the patient's perspective and wishes. Doing so requires understanding and uniting the different perspectives and objectives of heart failure treatment and palliative care. One way of doing this is through a narrative approach with interdisciplinary teams. However, this requires organisational efforts and adaptation to the specific cardiac setting.

CONCLUSION

Integrating palliative care principles into cardiology is a complex issue. Developing palliative care for heart failure patients requires more than simply designing a set of guidelines. Rather, a wider outlook involving perspectives, competences and organisation is necessary. Acknowledging such considerations, we designed an intervention centred on three elements: standard heart failure treatment, integrated sessions applying a narrative approach and monthly interdisciplinary conferences.

RELEVANCE

This article adds to the current research literature on changing palliative care practice for heart failure patients and the value of integrating different perspectives.

Assessment and management of metastatic bone cancer in emergency departments

A cancer diagnosis in emergency departments (EDs) is often associated with advanced or metastatic cancer. Patients with bone metastases have a complex range of physical and psychological needs. Meeting the needs of patients with cancer is an important part of the role of emergency nurses, but evidence suggests that they often do not feel adequately prepared to provide effective care for this patient group. This article uses a case study of a patient who presented to an ED with metastatic cancer in his right lower limb, to provide an overview of bone metastases, including the relevant anatomy, pain management and psychological support. The article also outlines the signs and symptoms of bone metastases and discusses patient assessment, symptom management and available treatments.

Newly graduated registered nurses' evaluation of their preparedness, confidence and attitudes towards clinical assessments

BACKGROUND

Historically, it has been reported that new graduates make limited use of their clinical assessment skills, yet these form the basis for making nursing decisions and selecting all nursing interventions.

AIMS AND OBJECTIVES

To explore new graduates' preparedness for, and confidence with, clinical assessment and their reliance on electronic monitoring. To identify barriers that hinder, and strategies that enable, clinical assessment.

DESIGN

A mixed-method study comprising a cross-sectional, quantitative survey and qualitative data, gathered using the World Café method.

METHODS

Data were collected from volunteers (n = 137) of all new graduates (n = 160) working in adult settings for a New Zealand district health board over a 1-year period. A paper-based survey explored use of clinical assessment, using a five-point Likert scale. Qualitative data comprised written records of group discussions and individual responses to four questions with thematic analysis of results. A STROBE checklist was used.

RESULTS

Most (n = 128) new graduates agreed/strongly agreed that clinical assessment was part of their role. Most (n = 119) agreed/strongly agreed that assessing patients by technology alone was inadequate. Thirty-six did not agree/strongly agree that they were well-prepared to perform clinical assessment. Forty-one did not agree/strongly agree that they were confident to perform clinical assessment, particularly those aged ≥30 years. Factors limiting use of clinical assessment were lack of time, knowledge, skill, confidence, reliance on doctors and an unsupportive work environment. Factors that would enhance clinical assessment involved increased supervision by experienced staff, provision of short courses and more in-service education on clinical assessment.

CONCLUSIONS

New graduates acknowledged that clinical assessment was part of their role and involved more than electronic monitoring. However, many lacked confidence and preparedness for clinical assessment in their work area, particularly those aged ≥30 years, potentially limiting clinical assessment use. Supportive changes, including short courses to revise clinical assessment skills and supervision of workplace-specific clinical assessments, could help new graduates more confidently and efficiently assimilate clinical assessment into their practice.

RELEVANCE TO CLINICAL PRACTICE

This research identified reasons that caused a cohort of new graduates to make limited use of their clinical assessment skills. It also reports the practical solutions they considered would help them increase their use of clinical assessment and thus support their decision-making in nursing practice.

Involvement of Patient and Family Representatives in Health-Care Job Interview Panels

Objectives:

The involvement of patient and family representatives in job interview panels is sparsely documented. This study was conducted at a newly established university hospital in Denmark. The aim was to identify different perspectives on attitudes and experiences associated with involving patient and family representatives in the recruitment process for senior staff. Furthermore, the aim was to highlight considerations and reservations related to the subsequent implementation process.

Methods:

Inspiration was drawn from formative evaluation research.

Data Sources:

Seventeen telephone interviews with applicants, 49 e-mail responses from staff, and unsolicited e-mails to the researcher.

Analysis Strategy:

Interpretive description.

Results:

Learnings from the study showed among other things that the participating staff experienced widespread skepticism before participation in the job interview panels, but their experience in the panels led them to consider the patients’ and families’ input to be beneficial to the entire recruitment process. The considerations and reservations raised were divided into 5 themes.

Conclusions:

The results provide a relevant starting point to negotiate and refine the aims of collective patient involvement related to a given situation—such as health-care recruitment processes.

Expanding the emergency nurse role to meet demand: nurse and physician perspectives

BACKGROUND

Emergency departments (EDs) in New Zealand are experiencing growing demand because of rising attendances, and this is having a negative effect on patients, staff and organisations. The expansion of traditional nursing roles is one solution that has been explored internationally to ameliorate the adverse effects of increasing patient attendances.

AIM

To explore the attitudes of registered nurses and physicians employed in emergency medicine towards an expanded role for registered nurses in the ED setting.

METHOD

A mixed-methods approach was adopted, in which data were collected in two phases, using interviews and questionnaires. Semi-structured, face-to-face interviews were held with clinical and non-clinical staff employed in emergency medicine, and questionnaires were distributed to 140 physicians and nurses employed in one ED. The data were analysed to identify themes and to determine the differences between nurse and physician respondents.

FINDINGS

Ten ED staff were interviewed, including non-clinical managers (n=4), physicians (n=2) and nurses (n=4). Analysis of the interviews identified five themes: driving change; expanded nurse role; optimal environment; facilitating change; and optimising outcomes for patients. A total of 70 questionnaires were returned, with 63 from nurses and seven from physicians. Nurse respondents were more supportive than their physician colleagues of the need to expand the nursing role in the ED.

CONCLUSION

The existing New Zealand nursing scope of practice has the capacity to develop roles, with nurses supporting this change more than physicians. If role expansion is undertaken, serious consideration needs to be given to developing clear professional boundaries to maintain patient safety and department flow.

Factors influencing adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development: An integrative review

WHAT IS KNOWN ON THE SUBJECT

CS was developed to give healthcare professionals a space to reflect, problem solve and recognise their own practice. It is different from managerial supervision as it is for the benefit of the individual staff member's personal and professional development firstly, but can potentially benefit the quality of care delivered by the organisation. There have been a range of problems associated with inpatient mental health nurses' engagement in CS and in experiencing the benefits of CS. This is concerning for the delivery of high quality care and the recruitment and retention of inpatient mental health nurses.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

This paper explores and identifies factors influencing adequate and effective CS for inpatient mental health nurses' personal and professional development. It identifies 6 themes incorporating enablers and barriers for inpatient mental health nurses' CS which lead to practice recommendations for improvement.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

This paper advocates a needs analysis to improve access to CS for inpatient mental health nurses. This review specifically adds further knowledge relating to inpatient mental health nurses' engagement with CS which the application of the needs analysis could influence.

ABSTRACT

Introduction Clinical supervision (CS) has been recognized as a reflective mechanism in inpatient mental health nursing practice; however, it remains unclear what adequate and effective supervision entails for inpatient mental health nurses. Aim To explore factors which influence adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development. Method Whittemore and Knafl's model for ensuring rigour was utilized. This included stages to address problem identification, literature searching, data evaluation, data analysis and presentation. Seven electronic databases were searched with hand searching/Internet searching. Fourteen retrieved articles were selected and appraised using the Mixed Method Appraisal Tool (MMAT). The data extracted from the papers were analysed thematically. Results The review synthesis resulted in identifying six themes: (a) what makes CS effective; (b) reflection; (c) the facilitation of professional identity and knowledge through CS; (d) participation; (e) knowledge and understanding of CS; and (f) the facilitation of personal awareness and coping. Discussion This review adds further knowledge on the identification of effective CS for inpatient mental health nurses as a defined occupational healthcare group. Implications for practice A suggested needs analysis is presented to improve access to CS options with the aim of promoting effective CS and increased engagement.

A day in the life of an advanced clinical practitioner in older people's care

Advanced clinical practitioners (ACPs) are master's-level educated, experienced and competent nurses or allied healthcare professionals who practise a high degree of autonomy and undertake complex decision-making. This article offers a reflective account of advanced clinical practice in an older person's unit specialising in rehabilitation and complex discharge planning. It illustrates how ACPs work autonomously with medical colleagues to provide patient-focused care, enhance the multidisciplinary team and provide safe, high-quality care. The article also describes various aspects of the role for nurses or allied healthcare professionals who might consider this career path.

Treating buckle fractures in children with a soft cast and home removal: a quality improvement initiative

Buckle fractures of the distal radius are unique to children and a frequent presentation in the emergency department (ED). In University Hospital Waterford, Ireland, the treatment of buckle fractures followed the traditional method involving a rigid cast and a follow-up hospital appointment. However, the latest literature indicates that buckle fractures are stable and heal without complication, so a minimalist approach to treatment is recommended. Therefore, the advanced nurse practitioners in the ED introduced a change in protocol at the hospital. This involved the use of a soft cast for removal at home, with verbal and written discharge information and no follow-up appointment. An audit was conducted to ensure that this new protocol was safe and effective, and the time and distance saved by patients through avoiding a return hospital visit was estimated. Treatment in a soft cast with verbal and written discharge information revealed a successful outcome for all 88 patients included in the audit. Avoiding return hospital visits resulted in significant travel time and distance savings for patients and families.

Zwischen Traum und Trauma - Aufbau und Betrieb einer Kohortenstation für Patient_innen mit COVID-19 in einem Akutspital - Eine Fallstudie

Between dream and distress - Setting up and running a cohort ward for COVID-19 Patients at an acute hospital - A case study Abstract. Background: In the context of the pandemic, hospitals must be able to care for COVID-19 patients within a very short timeframe.

OBJECTIVE

Description of the setting up of a cohort ward for patients with COVID-19 on a surgical ward including the development of the nursing team.

METHODS

The intrinsic retrospective case study describes the situation, identifies special phenomena in a reflective manner and links them to existing knowledge. Data were anecdotal, routine data were collected in the context of nursing practice development.

RESULTS

Setting up the cohort ward in a Swiss hospital consisted of structural and technical planning, infection control measures, the establishment of interprofessional structures, and internal communication. During the four-week operation, 71 patients were treated. The use of practice development methodology initiated a cultural change. The reflection describes a field of tension between "dream and distress": As a dream, the lived experience of optimal care, with well-functioning processes, sufficient material, sufficient personnel and a very good interprofessional cooperation was evaluated. Distress in the form of high infection rates as well as psychological and physical stress did not occur. After the cohort ward was closed, there was a risk working back in normal operations based on existing economical and organizational conditions, with the knowledge that a different cooperation and organization is possible.

CONCLUSIONS

Positive experiences from the "crisis mode" should be used to further develop essential operations during normal times.

Advanced ophthalmic nurse practitioners: the potential to improve outcomes for older people with cataracts

An ageing population has led to a substantial increase in the prevalence of visual impairments, which can compromise lifestyle, health and general physical and psychological well-being. Age-related cataracts can have a negative effect on older people's quality of life but can be corrected by surgery. It is imperative that older people have access to cataract surgery and, given government objectives of NHS efficiency gains, advanced level nurse practitioners have the potential to increase capacity for and access to cataract surgery. This article outlines the aetiology of cataracts, developments in ophthalmic nursing and the broadened scope of practice of advanced ophthalmic nurse practitioners (AONPs). It explores how the AONP is well-placed to provide high quality care to the older person who requires cataract surgery. Professional drivers for role development are explored in relation to older people.

Using Participatory Methods to Engage Multidisciplinary Clinical Staff in the Embedding of Trauma-Informed Care and Practice Principles in a Sub-Acute Mental Health Inpatient Unit

Changing multidisciplinary team practice is difficult, even in circumstances where the staff support such change. This methodology paper describes the successful use of respectful and participatory methods and processes to engage multidisciplinary clinical staff in practice change. These methods are described and discussed in relation to a clinical practice change project that sought to embed trauma-informed care and practice (TICP) in a sub-acute mental health unit. TICP is a critical new paradigm for multidisciplinary mental health services that involves the recognition of the high rates of abuse and trauma suffered by those with mental illness and the need to both understand the effects of this abuse and trauma and to respond to them appropriately. The principles of the paradigm need to be introduced throughout mental health services, but especially in inpatient units where a predominantly biomedical perspective can preclude a more holistic approach. This paper outlines the background of TICP and describes in detail the four TICP-compatible, participatory methods and processes used to engage staff in the embedding of TICP principles in their everyday practice. The participatory approaches employed reflected TICP principles and addressed issues including the engagement of staff in the change project, the identification of TICP-compatible care practices currently used in the unit, the identification of issues related to the further embedding of TICP in everyday care, and the generation of solutions to the issues raised. The processes undertaken were underpinned by a heuristic framework to maintain staff engagement. This paper is not intended to be a recipe for TICP change. However, the methods and processes described may be adapted to be of practical use in the design of TICP and other practice change initiatives in multidisciplinary clinical settings.

The Venus model for integrating practitioner-led workforce transformation and complex change across the health care system

AIMS AND OBJECTIVES

The aim of this paper is to present the Venus model for workforce transformation, demonstrating its research origins, theoretical foundations, and practical application for enabling individuals, teams, and services to sustain transformation in the workplace.

METHODS

The paper provides a brief synopsis of how the Venus model was generated from four large-scale mixed-method studies embracing workforce transformation, safety culture, integrated facilitation, and continuous professional development.

RESULTS

The Venus model has five stems and identifies key integrated skill sets pivotal to successful transformation, which are interdependent: Being able to facilitate an integrated approach to learning, development, improvement, knowledge translation, inquiry, and innovation-drawing on the workplace itself as an influential resource; Being a transformational and collective leader building relationships that encourage curiosity, creativity, and harnessing the talents of all not just a few; Being a skilled practice developer focused on achieving the key values of being person-centred, and the ways of working that are collaborative, inclusive, and participative; Applying improvement skills that enable small step change using measurement wisely to focus on measuring what is valued as well as evaluating positive progress; and, finally Facilitating culture change at the micro-systems level while being attuned to the organizational and systems enablers required to support this.

CONCLUSION

The paper concludes with consideration of implications for implementation of the model and its relevance for practice, policy, education, and future research as well as outlining potential limitations and conclusions.

What to look for during constant observations: Expert consensus and a tool for observations recording

WHAT IS KNOWN ON THE SUBJECT?: Supportive observations is the practice of closely monitoring patients who are acutely unwell in order to keep them safe. There are no formal guidelines for nursing staff on what to observe during observations. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: A consensus of expert opinion suggests that the clinically meaningful behaviours in supportive observations focus on six factors: agitation, self-harm and suicide, violence, negative influence, disengagement and positive behaviour. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These aspects of patient presentation should be a part of the decision-making discussions about observations. The Mersey Care Supportive Observations Recording Tool that emerged from this consensus may assist with recording the relevant information. Abstract Introduction Supportive observations are common in mental health care but there are no guidelines on best practice or what should be documented in observations records. Aim To develop expert consensus on the important aspects of patient presentation that inform clinical decision-making about observations and to develop a recording tool from this consensus. Method A Delphi methodology was used to consult an expert panel of mental health clinicians and academics to agree on what aspects of patient presentation during constant observations are important in informing clinical decisions. Thematic analysis was applied to the agreed item set to extract common aspects of presentation and behaviour. Results The panel considered 118 individual items across three rounds of consultation and agreed that 51 items were important to clinical decisions about observations. Thematic analysis found six man themes: agitation, self-harm and suicide, violence, negative influence, disengagement and positive behaviour. Subthemes were used to create the MerseyCare Supportive Observations Recording Tool (MSORT). Discussion These data represent the first expert consensus on the aspects of patient presentation that are important to clinical decisions. Implications for practice Consensus items should be recorded in observations records and be considered in decision-making about observations. The MSORT may aid observations recording.

Advanced nurse practitioners can lead comprehensive geriatric assessment in acute hospitals

With an increasingly ageing population comes a greater risk of frailty, a distinct health state in which multiple body systems gradually lose their inbuilt reserves. The ability to recognise important frailty markers and conduct specialist comprehensive assessments of potentially frail older people admitted to acute hospitals is important to improve their health and well-being. This article explores the role of the advanced nurse practitioner (ANP) in identifying frailty and leading comprehensive geriatric assessment (CGA) for older people admitted to acute hospital settings. A small evaluation of CGA led by an ANP in a district general hospital found that a well-rounded assessment of patients living with frailty could be carried out, and that such assessments reduced unscheduled readmission within 28 days of discharge and overall length of hospital stay by six days. In a challenging climate, in which healthcare services seek to deliver effective and efficient care to the frail older population, ANPs can ensure a timely and specialist approach to CGA.

Multidisciplinary team attitudes to an advanced nurse practitioner service in an emergency department

AIM

The aim of this study was to examine an emergency department's (ED) multidisciplinary teams' (MDTs) attitudes towards an advanced nurse practitioner (ANP) service. The ED in question is not the author's place of work.

METHOD

A Likert-type questionnaire was used to gain a total attitude score (TAS), which was analysed in relation to participants' gender, age, professional background, level of education and years of experience in the ED, as well as previous and current contact with emergency nurse practitioners and/or ANPs. A total of 115 questionnaires were distributed, and respondents included doctors, nurses, managers, pharmacists, radiographers and a physiotherapist. Participants provided qualitative data to explain their choices, and were asked to describe positive and negative aspects of an ANP service. The data were analysed using a mixed-methods approach.

FINDINGS

The TASs were generally positive and there were no statistical differences between the professional groups, although there was some resistance from participants.

CONCLUSION

Overall, the MDT believes the ANP service will improve patient care, waiting times, team divisions and patients' experiences in the ED if the roles and responsibilities are clearly defined and communicated. In addition, the service should receive enough funding to ensure its sustainability and appropriate supervision by a senior doctor should be made available.

Review of a nurse consultant's role: Identifying the contribution made to people living with and beyond cancer

Aim

To evaluate a new nurse consultant (NC) role, four specific objectives were set including examining the NC's contribution to the local implementation over a 30-month time period of the Recovery Package and assessing changes at a patient/professional/system level.

Methods

An evaluative process was agreed using Donabedian's (2005) model for measuring the quality of care provided. It focused on the NC's contribution to the Trust's LWBC agenda including a review of Recovery Package metrics, analysis of the NC template recording activity across different domains, 360-degree feedback and personal reflections.

Results

The evaluation demonstrated the NC's influence on individual patient care with an increase in three of the four Recovery Package metrics to the Trust; improvements in delivery of services and a higher level of participation in activities aimed at raising awareness to LWBC at a regional and national level. Broader influences of this role were also evident.

Applying transformational leadership in nursing practice

The updated Nursing and Midwifery Council (NMC) standards of proficiency for nurses emphasise the importance of nurse leadership, while the NHS has also developed models to support leadership development. There are several approaches to leadership that are applicable in nursing practice. Transformational leadership is an approach that focuses on the attributes and behaviours of the leader required to empower and motivate team members. This article outlines the four elements of transformational leadership - idealised influence, inspirational motivation, intellectual stimulation and individualised consideration - and discusses these in relation to the NMC standards. It also describes the advantages and disadvantages of transformational leadership, and suggests ways that this approach can be applied in nursing practice.

Assessment and management of patients with tibial plateau fractures in emergency departments

Tibial plateau fractures are complex injuries and relatively common presentations in emergency departments (EDs), yet the diagnosis is not always obvious. Patients with this injury are managed increasingly in EDs by registered advanced nurse practitioners (RANPs), who are recognised in Ireland as senior clinical decision-makers. RANPs are broadening their scope of practice to maximise their responses to current and emerging challenges in healthcare services. They use a range of skills, including taking comprehensive health histories, problem solving, clinical decision-making and using their expert judgement to diagnose and create management plans for patients who attend EDs. In Ireland, RANP is a protected title and practitioners work within an agreed scope of practice, meeting criteria set by the Nursing and Midwifery Board of Ireland to register. RANPs ensure continuity of care, improve the quality of care, provide a quick response to patient care, reduce waiting times and improve flow of patients through EDs. The main scope of RANPs' practice in emergency care includes management of patients with non-life-threatening limb conditions or injures, such as a tibial plateau fracture. This article gives an overview of tibial plateau fractures, including anatomy, and presents a case study to analyse critically the management of a patient with this injury and the care provided by a RANP. In the context of the case study, the article reviews the RANP's diagnostic decisions and the available management options.

Establishing an advanced care academy and its role in advanced practitioner development

Advanced clinical practice (ACP) roles evolved to fill gaps in healthcare provision and improve consistency in standards of care. Historically, variance in service specific requirements, combined with inconsistent approaches to role governance and education, resulted in a multitude of ACP roles and remits. Definitions of roles and titles vary, but there is agreement on academic level and role competency assessment. Irrespective of these definitions, staff and services need support to operationalise guidance. In Scotland, development of advanced practice roles is supported through regional NHS Advanced Practice Academies. One Scottish Board has initiated a local board level advanced care academy to fulfil the three key components of advanced practitioner development: master's level theoretical knowledge, effective supervision and robust clinical competency assessment in practice. This development model, known as the 'triangle of capability', has allowed rapid progress with the advanced practice agenda, which is a central component of sustainable healthcare provision.