Developing sustainable nursing and allied health professional research capacity

BACKGROUND

Research provides the evidence on which to base effective, safe clinical services. Engaging healthcare staff in research improves healthcare. However, clinical staff may not want to leave clinical practice to develop their research experience. Gaining postdoctoral research experience is a difficult step to make and opportunities are limited.

AIM

To describe an approach to developing sustainable research capacity by supporting nurses and allied health professionals to develop their postdoctoral research skills while remaining in clinical practice.

DISCUSSION

An approach to developing nursing, midwifery and allied health professionals (NMAHPs)'s postdoctoral research skills was devised and implemented in an acute NHS hospital in England. This collaborative approach involved negotiating strategic support from senior managers and incorporated an action-learning framework to develop and fund a research project addressing a clinical priority.

CONCLUSION

A 'whole organisation' approach is needed to develop postdoctoral nurse and NMAHP researchers that requires a reflexive model with strategic, organisational and individual support encompassing action learning and corporate buy-in from senior managers.

IMPLICATIONS FOR PRACTICE

Taking such an approach can enable nurses to remain in practice while developing NMAHP-led research. This shows its usefulness to senior managers and enables nurses to have the knowledge and confidence to support others to develop their research skills.

Approaches to community-based palliative care provision by children's hospices in the UK

The number of children in the UK with life-limiting conditions and the demand for home-based palliative care is increasing. Children's hospices remain a dominant provider of palliative care. This study aimed to determine the approaches taken by children's hospices across the UK in meeting the planned and unplanned health needs of children and their families who receive palliative care at home. In addition, the survey aimed to identify the professional composition of community teams and the number of children and families supported by each service. An internet-based questionnaire survey was sent to all children's hospices in the UK, comprising ten questions exploring the size of the team, geographical areas covered, workforce composition, services offered and approaches to managing unplanned, out of hours care. Responses were received from 14 (26%) of the hospices. A total of 1,618 children and their families were being cared for by these hospices, of whom 825 received care at home. Registered nurses constituted the greatest proportion of staff and were employed by all teams. Care provided at home was broadly split into two categories: planned short breaks and responsive palliative nursing. The latter comprised advance care planning, anticipatory prescribing and active symptom control. Out of hours care was usually offered in the form of telephone support. Models of community-based care are evolving to include nurses practising at specialist and advanced levels, allowing more children with increasingly complex conditions to be cared for at home.

Non-medical prescribing: a reflective case study on prescribing anticoagulation for deep vein thrombosis

Prescribing is a high-risk, complex skill. There are more than 50,000 nurse prescribers in the UK, and it is important that they undertake regular reflection on their clinical practice to enhance their skills. This article reflects on the clinical factors that influenced the author's decision-making when prescribing anticoagulation medication for a patient with deep vein thrombosis. It also explores the evidence base for commonly prescribed anticoagulants.

Development of a capability-based training programme for an advanced nurse practitioner

Although there is a long history of advanced nursing practice in the UK, without registration it is difficult to ensure that all staff who regard themselves as advanced practitioners have the necessary clinical acumen. This article explores how a capability-based training programme was developed for one advanced nurse practitioner (ANP) in the care of older people in a community healthcare NHS trust. It also considers whether the programme could be replicated for other clinicians wishing to train for a specific advanced practice role. The programme was developed as part of a service improvement project and used work-based practice to identify the clinician's learning needs. Various learning tools were used and the trainee ANP recorded their development in a portfolio of work including reflections and clinical summaries. The main direction for learning was through the use of a written programme guide that set out benchmarks to be achieved during the two-year programme. The trainee ANP met the requirements of the programme and was appointed to a senior ANP post at the end of the two years. There is merit in using a standardised capability-based training programme when developing advanced practitioners. Standardisation allows an organisation to ensure that advanced practitioners can provide an appropriate level of clinical practice to older patients with complex needs.

Using two models of workplace facilitation to create conditions for development of a person-centred culture: A participatory action research study

AIMS AND OBJECTIVES

To examine facilitation in workplace learning where nurses are focused on creating person-centred cultures; to provide a framework for novice and proficient facilitators/practitioners to learn in and from their own workplaces and practices; and to provide the conditions where practitioners can gain an understanding of the culture and context within their own workplace.

BACKGROUND

Evidence suggests that person-centred cultures depend on purposeful, facilitated practice-based learning activities. For person-centredness to become more meaningful to nursing leaders in their daily work, focus must be placed on their acquisition and use of facilitation skills. The facilitation framework "Critical Companionship" remains an exemplar in the development of expert facilitation skills. Two sequential facilitation models were developed as "steps" towards Critical Companionship, as a framework for novice and proficient facilitators and practitioners to learn in and from their own workplaces and practices.

DESIGN AND METHODS

This research, situated in a critical social science paradigm, drew on participatory action research to devise, explore and refine two facilitation models: Critical Allies and Critical Friends. The researcher adopted an insider approach to work with five nursing leaders, which was subsequently reported using the EQUATOR guidelines on best practice in reporting of participatory action research.

RESULTS

The results show the complexity of enabling facilitation within the workplace. Four themes and twelve subthemes emerged from the data that describe the attributes needed to facilitate workplace learning and reveal that managers can have an active role in enabling person-centred culture development.

CONCLUSIONS

This research adds to the body of knowledge on developing person-centred culture. It offers practical stepping stones for novice and proficient facilitators to enable embodiment of the skills necessary to facilitate learning in person-centred cultures. The models offer a workplace-friendly pathway with practical methods and further contribute to our understanding of how we create person-centred cultures.

RELEVANCE TO CLINICAL PRACTICE

Facilitation of practice development and workplace learning remains the most effective methods to develop person-centred cultures. This research introduces a pathway for clinical leaders/managers to become facilitators with their own teams, maximising the impact on the culture where care is delivered.

Action learning: staff development, implementing change, interdisciplinary working and leadership

Action learning (AL) is a process that supports problem-solving by applying a questioning formula to challenge issues and prompt actions. Initially developed to support organisational change, AL is now recognised as a motivating and influencing process for team development, individual goal setting, change initiatives, quality improvement and leadership development. Learning from observation and practice is central to its approach, which lends itself to healthcare settings. It is especially useful to managers seeking to implement change, enhance quality and promote teamwork in multidisciplinary settings.

Developing clinical reasoning and effective communication skills in advanced practice

Clinical reasoning and effective communication are fundamental skills for nurses working at an advanced level of practice. Clinical reasoning processes are designed to enable the nurse to establish the nature of a patient's presenting condition before focusing on problem-solving techniques that can guide the appropriate course of treatment. This article explores the concept of clinical reasoning in advanced practice and outlines the various approaches that nurses can take. It also details the role of effective communication in advanced practice. A case study is used to demonstrate the specific stages involved in clinical reasoning.

Keeping support and clinical supervision on your agenda

Support and clinical supervision can benefit staff and service users. Inquiries have highlighted lack of support and clinical supervision as potential contributory factors for adverse care events. For support and clinical supervision to be embedded effectively, leaders and managers must value and promote them in their organisations. This article describes practical steps to support implementation of clinical supervision. By examining the main stages of supervision and preparation, evaluation of process and outcomes, and practical considerations, the article supports healthcare managers to encourage staff engagement and to implement a clinical supervision process.

Meeting the evolving demands of neurointervention: Implementation and utilization of nurse practitioners

Growth in the neurointerventional field, as a result of the emergence of thrombectomy as the gold standard treatment for large vessel occlusions, has created complex challenges. In an effort to meet evolving demands and fill workflow gaps, nurse practitioners have taken on highly specialized roles. Neurointerventional care has rapidly evolved similarly to interventional cardiac care, in that nurse practitioners are successfully being incorporated as procedural assistants in catheterization laboratories. Similar utilization of nurse practitioners in interventional neuroradiology holds the capacity to decrease physician workload, mitigate stresses contributing to burn-out, and reallocate more physician time to procedures. Nurse practitioner practice faces procedural, clinical, legal and interpersonal barriers. Despite calls for expanded practice by the Institutes of Medicine, a paucity of nurse practitioner training opportunities exists. Fragmented privileging processes contribute to environments where nurse practitioners must navigate hurdles without established interventional neuroradiology-specific precedent. Increased nurse practitioner mentorship, fluoroscopy law standardization, physician support surrounding nurse practitioner autonomy, and role consistency is imperative for optimal nurse practitioner utilization. Nurse practitioners are uniquely equipped to bridge evolving gaps through the provision of safe, efficacious care, and generating revenue at lower costs. Discussion surrounding nurse practitioner use to bridge workflow gaps is an exciting opportunity for future practice development.

The importance of reflecting on practice: How personal professional development activities affect perceived teamwork and performance

AIMS AND OBJECTIVES

To examine the relationships between participation in personal professional development activities (e.g., coaching, mentoring), teamwork and performance; to investigate the mediating and moderating effects of reflective thinking and perceived usefulness of development activities.

BACKGROUND

Professional development is associated with better performance and attitudes towards one's work. This study adds to this research by focusing on understanding this effect and the conditions under which this occurs.

DESIGN

Cross-sectional survey study.

METHODS

Participants were 244 nurses working in a large, metropolitan acute public hospital. They completed a questionnaire consisting of validated measures and provided information on frequency of participation and perceived usefulness of personal professional development activities. We analysed data using regression-based moderated mediation analyses.

RESULTS

The relationship between frequency of participation in personal professional development activities and both perceived teamwork and performance was mediated by reflective thinking. Perceived usefulness of development activities moderated the relationship between frequency of participation in personal professional development activities and reflective thinking.

CONCLUSION

Our results highlight the importance of professional development activities that go beyond knowledge- or skill-based training. Activities that cater to nurses' personal professional development needs are also associated with more positively perceived teamwork and performance. Results provide insights into the mediating mechanisms: Participation in personal professional development activities encouraged reflective thinking, which was associated with better perceived teamwork and performance. This association between personal professional development activities and reflective thinking was even stronger where nurses perceived the activities as useful.

RELEVANCE TO CLINICAL PRACTICE

Personal professional development activities enhance reflection in and on practice as these activities were linked with higher perceived quality of care and teamworking. It is important to ensure that the positive effects of personal professional development activities should target nurses' professional development needs and need to be perceived as useful by those who undertake them.

The role and experiences of advanced nurse practitioners working in out of hours urgent care services in a primary care setting

GPs' workload has increased significantly in recent years affecting their ability to provide high-quality services, and consequently there is increasing focus on nurses to provide a solution. There is little evidence of how advanced nurse practitioners (ANPs) experience their role in out of hours (OOH) services, and it is important to understand their perceptions of this and the challenges they may face in supporting service development and improvement. This article evaluates the role and experiences of ANPs working in an OOH urgent primary care service and identifies important factors that affect their roles. Positive factors enable job satisfaction, but challenges associated with knowledge base, perceptions, role definitions and isolation must be considered for quality and governance purposes. The article describes how supportive systems must be in place to enable mentorship, supervision programmes and development of this group of advanced practitioners.

Exploring the role of advanced nurse practitioners in leadership

There have been several changes to healthcare services in the UK over recent years, with rising NHS costs and increasing demands on healthcare professionals to deliver high-quality care. Simultaneously, public inquiries have identified suboptimal leadership throughout the NHS, which has been linked to a lack of clear leadership across the healthcare professions. In nursing, the role of the advanced nurse practitioner is regarded as a solution to this leadership challenge. This article examines the background to the development of the advanced nurse practitioner role. It also explores the various factors that may affect nurse leadership and the role of the advanced nurse practitioner, including professional identity, gender, nursing's strategic influence, clinical outcomes, and recruitment and retention. The article concludes that while advanced nurse practitioners can positively influence clinical outcomes and cost efficiency, they must also be adequately prepared to undertake a leadership role.

Collaborative communication: learning from advanced clinical practice patient consultations

Advanced nurse practitioners, and nurses aspiring to this role, are required to understand how to communicate effectively and on a collaborative basis with patients and carers during consultations, with the aim of enhancing patient outcomes such as improved patient satisfaction, ability to self-manage healthcare needs and adherence to care plans. This article explores collaborative communication in consultations and how best to achieve this, using the author's doctoral observational research based on the findings of a mixed methods observational study of communication in advanced clinical practice patient consultations.

Teaching nursing homes: the Norwegian experience 20 years on

Background

The Norwegian teaching nursing home (TNH) programme was launched in 1997 to address the continued challenges and threats to quality in long-term care. They included high turnover, inadequate recruitment of qualified staff, poor image and inadequate learning opportunities in long-term care for students, and lack of opportunities for knowledge and skill development for staff. Research into the particular challenges and needs in long-term care was very limited. The aim of the programmes was to establish partnerships between selected nursing homes, universities and university colleges. Together the institutions would address the challenges by developing quality development programmes, initiating research and improving teaching in collaboration. During the first project period (1997-2003), the TNHs proved to be efficient in launching quality-improvement programmes, improving teaching of students and staff and supporting relevant research. Following a formal evaluation, the programme was established on a permanent basis in 2004. Since then the programme has gone through a number of changes, including growing in numbers, being widened to include home care services, and changing focus from local developments to also being vehicles for national quality initiatives.

Aim

This paper describes the current programme of teaching nursing homes in relation to its goals, organisation and responsibilities.

Results

The strong learning network among the institutions contributes to the robustness of the programme which focuses on developing and implementing evidence-based care and creative learning environments for students and staff.

Conclusions

The programme has altered since its inception to ensure it remains a sustainable innovation for improving the care of older people.

The effect of a leadership support programme on care home managers

AIM

To explore the effect of the My Home Life 12-month leadership support programme on care home managers' leadership skills and professional development, and their relationships with staff, residents and relatives.

METHOD

A qualitative study of 15 care home managers was undertaken, using focus groups to explore the study's aims and objectives. Data were analysed using Colaizzi's phenomenological method.

FINDINGS

The leadership support programme enabled managers to develop their leadership skills, which had a positive effect for them and for their relationships with staff, residents and relatives. Conclusion Participation in the programme enabled managers to make real practice development improvements with meaningful effect for residents.

Implementing Dementia Care Mapping as a practice development tool in dementia care services: a systematic review

Dementia Care Mapping (DCM) is an observational tool set within a practice development process. Following training in the method, DCM is implemented via a cyclic process of briefing staff, conducting mapping observations, data analysis and report preparation, feedback to staff and action planning. Recent controlled studies of DCM's efficacy have found heterogeneous results, and variability in DCM implementation has been indicated as a potential contributing factor. This review aimed to examine the primary research evidence on the processes and the barriers and facilitators to implementing DCM as a practice development method within formal dementia care settings. PUBMED, PsycINFO, CINAHL, The Cochrane Library-Cochrane reviews, HMIC (Ovid), Web of Science and Social Care Online were searched using the term "Dementia Care Mapping". Inclusion criterion was primary research studies in any formal dementia care settings where DCM was used as a practice development tool and which included discussion/critique of the implementation processes. Assessment of study quality was conducted using the Mixed Methods Appraisal Tool. Twelve papers were included in the review, representing nine research studies. The papers included discussion of various components of the DCM process, including mapper selection and preparation; mapping observations; data analysis, report writing and feedback; and action planning. However, robust evidence on requirements for successful implementation of these components was limited. Barriers and facilitators to mapping were also discussed. The review found some consensus that DCM is more likely to be successfully implemented if the right people are selected to be trained as mappers, with appropriate mapper preparation and ongoing support and with effective leadership for DCM within the implementing organization/unit and in organizations that already have a person-centered culture or ethos. Future development of the DCM tool should consider ways to save on time taken to conduct DCM cycles. More research to understand the ingredients for effective DCM implementation is needed.

Implementation of e-portfolios for the professional development of Admiral Nurses

Nurses are required to maintain their fitness to practise through continuing professional development activities, and must demonstrate this by maintaining a portfolio of evidence that should be available for inspection every three years. The Nursing and Midwifery Council introduced revalidation in 2016 to demonstrate that nurses are practising safely and effectively. Nurses, however, are busy healthcare professionals and, as well as clinical practice, they have other demands on their time, such as providing evidence for annual appraisals. Admiral Nurses, specialist dementia nurses who support families living with dementia, also have a three-tier competency framework designed to demonstrate their acquired expertise and knowledge in dementia care. To support Admiral Nurses in managing these activities, the charity Dementia UK gave them access to the PebblePad e-portfolio system. This article details the implementation and outcomes of this project.

Working in a storied way-Narrative-based approaches to person-centred care and practice development in older adult residential care settings

AIMS AND OBJECTIVES

To evaluate the effects of the implementation of a methodological framework for a narrative-based approach to practice development and person-centred care in residential aged care settings.

BACKGROUND

Care in long-term residential settings for older people is moving away from the biomedical approach and adopting a more person-centred one. Narrative can help shape the way care is planned and organised. The provision of person-centred care that is holistic and that takes account of resident's beliefs and values can be enhanced by incorporating narrative approaches to care within a practice development framework.

DESIGN

The chosen methodology was participatory action research.

METHODS

Between 2010-2014, a methodological framework of narrative practice was implemented in two residential care settings, comprising 37 residents and 38 staff, using an action research approach. Three action cycles: (i) narrative practice and culture identification, (ii) developing narrative practice and (iii) working in a storied way emerged during the implementation.

RESULTS

Key outcomes emerged in relation to the findings. These were based on narrative being, knowing and doing and centred around the key outcomes of (i) how people responded to change (narrative being), (ii) the development of shared understandings (narrative knowing) and (iii) intentional action (narrative doing).

CONCLUSION

The implementation of a framework of narrative practice demonstrated that how people respond to change, the development of shared understandings and intentional action were interrelated and interlinked. It illustrated the importance of ensuring that practice context is taken account of in the implementation of action research and the importance of ensuring that narrative being, knowing and doing are clear and understandable for change to occur.

RELEVANCE TO CLINICAL PRACTICE

Implementation of a narrative approach to care can develop new ways of working that value biography and promote the development of a co-constructed plan of care.

Involving the public in mental health and learning disability research: Can we, should we, do we?

WHAT IS KNOWN ON THE SUBJECT?: UK health policy is clear that researchers should involve the public throughout the research process. The public, including patients, carers and/or local citizens can bring a different and valuable perspective to the research process and improve the quality of research undertaken. Conducting health research is demanding with tight deadlines and scarce resources. This can make involving the public in research very challenging. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first time the attitudes of researchers working in mental health and learning disability services towards PPI have been investigated. The principles of service user involvement in mental health and learning disability services may support PPI in research as a tool of collaboration and empowerment. This article extends our understanding of the cultural and attitudinal barriers to implementing PPI guidelines in mental health and learning disability services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Researchers in mental health and learning disability services need to champion, share and publish effective involvement work. Structural barriers to PPI work should be addressed locally and successful strategies shared nationally and internationally. Where PPI guidelines are being developed, attention needs to be paid to cultural factors in the research community to win "hearts and minds" and support the effective integration of PPI across the whole research process.

ABSTRACT

Introduction Patient and public involvement (PPI) is integral to UK health research guidance; however, implementation is inconsistent. There is little research into the attitudes of NHS health researchers towards PPI. Aim This study explored the attitude of researchers working in mental health and learning disability services in the UK towards PPI in health research. Method Using a qualitative methodology, semi-structured interviews were conducted with a purposive sample of eight researchers. A framework approach was used in the analysis to generate themes and core concepts. Results Participants valued the perspective PPI could bring to research, but frustration with tokenistic approaches to involvement work was also evident. Some cultural and attitudinal barriers to integrating PPI across the whole research process were identified. Discussion Despite clear guidelines and established service user involvement, challenges still exist in the integration of PPI in mental health and learning disability research in the UK. Implications for practice Guidelines on PPI may not be enough to prompt changes in research practice. Leaders and researchers need to support attitudinal and cultural changes where required, to ensure the full potential of PPI in mental health and learning disability services research is realized. Relevance statement Findings suggest that despite clear guidelines and a history of service user involvement, there are still challenges to the integration of PPI in mental health and learning disability research in the UK. For countries where PPI guidelines are being developed, attention needs to be paid to cultural factors in the research community to win "hearts and minds" and support the effective integration of PPI across the whole research process.

"Little things matter!" Exploring the perspectives of patients with dementia about the hospital environment

BACKGROUND

Recognising demographic changes and importance of the environment in influencing the care experience of patients with dementia, there is a need for developing the knowledge base to improve hospital environments. Involving patients in the development of the hospital environment can be a way to create more responsive services. To date, few studies have involved the direct voice of patients with dementia about their experiences of the hospital environment.

DESIGN AND METHOD

Using an action research approach, we worked with patients with dementia and a team of interdisciplinary staff on a medical unit to improve dementia care. The insights provided by patients with dementia in the early phase shaped actions undertaken at the later stage to develop person-centred care within a medical ward. We used methods including go-along interviews, video recording and participant observation to enable rich data generation.

AIM

This study explores the perspectives of patients with dementia about the hospital environment.

RESULTS

The participants indicated that a supportive hospital environment would need to be a place of enabling independence, a place of safety, a place of supporting social interactions and a place of respect.

CONCLUSIONS

Patient participants persuasively articulated the supportive and unsupportive elements in the environment that affected their well-being and care experiences. They provided useful insights and pointed out practical solutions for improvement. Action research offers patients not only opportunities to voice their opinion, but also possibilities to contribute to hospital service development.

IMPLICATIONS FOR PRACTICE

This is the first study that demonstrates the possibility of using go-along interviews and videoing with patients with dementia staying in a hospital for environmental redesign. Researchers, hospital leaders and designers should further explore strategies to best support the involvement of patients with dementia in design and redesign of hospital environments.

Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning

WHAT IS KNOWN ON THE SUBJECT?: There is consistent evidence that service users and carers feel marginalized in the process of mental health care planning. Mental health professionals have identified ongoing training needs in relation to involving service users and carers in care planning. There is limited research on the acceptability of training packages for mental health professionals which involve service users and carers as co-facilitators. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A co-produced and co-delivered training package on service user- and carer-involved care planning was acceptable to mental health professionals. Aspects of the training that were particularly valued were the co-production model, small group discussion and the opportunity for reflective practice. The organizational context of care planning may need more consideration in future training models. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses using co-production models of delivering training to other mental health professionals can be confident that such initiatives will be warmly welcomed, acceptable and engaging. On the basis of the results reported here, we encourage mental health nurses to use co-production approaches more often. Further research will show how clinically effective this training is in improving outcomes for service users and carers.

ABSTRACT

Background There is limited evidence for the acceptability of training for mental health professionals on service user- and carer-involved care planning. Aim To investigate the acceptability of a co-delivered, two-day training intervention on service user- and carer-involved care planning. Methods Community mental health professionals were invited to complete the Training Acceptability Rating Scale post-training. Responses to the quantitative items were summarized using descriptive statistics (Miles, ), and qualitative responses were coded using content analysis (Weber, ). Results Of 350 trainees, 310 completed the questionnaire. The trainees rated the training favourably (median overall TARS scores = 56/63; median 'acceptability' score = 34/36; median 'perceived impact' score = 22/27). There were six qualitative themes: the value of the co-production model; time to reflect on practice; delivery preferences; comprehensiveness of content; need to consider organizational context; and emotional response. Discussion The training was found to be acceptable and comprehensive with participants valuing the co-production model. Individual differences were apparent in terms of delivery preferences and emotional reactions. There may be a need to further address the organizational context of care planning in future training. Implications for practice Mental health nurses should use co-production models of continuing professional development training that involve service users and carers as co-facilitators.

'Who's actually gonna read this?' An evaluation of staff experiences of the value of information contained in written care plans in supporting care in three different dementia care settings

WHAT IS KNOWN ON THE SUBJECT?: A written plan is designed to improve communication and co-ordinate care between mental health inpatient wards and community settings. Reports of care plan quality issues and staff and service user dissatisfaction with healthcare bureaucracy have focused on working age mental health or general hospital settings. Little is known about mental health staff perspectives on the value of written care plans in supporting dementia care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Competing demands on staff time and resources to meet administrative standards for care plans caused a tension with their own professional priorities for supporting care. Mental health staff face difficulties using electronic records alongside other systems of information sharing. Further exploration is needed of the gap between frontline staff values and those of the local organization and managers when supporting good dementia care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Frontline staff should be involved in designing new information systems including care plans. Care plan documentation needs to be refocused to ensure it is effective in enabling staff to communicate amongst themselves and with others to support people with dementia. Practice-based mentors could be deployed to strengthen good practice in effective information sharing.

ABSTRACT

Background Reports of increased healthcare bureaucracy and concerns over care plan quality have emerged from research and surveys into staff and service user experiences. Little is known of mental health staff perspectives on the value of written care plans in supporting dementia care. Aim To investigate the experiences and views of staff in relation to care planning in dementia services in one National Health Service (NHS) provider Trust in England. Method Grounded Theory methodology was used. A purposive sample of 11 multidisciplinary staff were interviewed across three sites in one NHS Trust. Interviews were transcribed, coded and analysed using the constant comparative method. Findings Five themes were identified and are explored in detail below: (1) Repetition; (2) the impact of electronic records on practice; (3) ambivalence about the value of paperwork; (4) time conflicts; and (5) alternative sources of information to plan care. Discussion Participants perceived that written care plans did not help staff with good practice in planning care or to support dementia care generally. Staff were frustrated by repetitive documentation, inflexible electronic records and conflicting demands on their time. Implications for practice Frontline staff should be involved in designing new information systems including care plans.

EQUIP training the trainers: an evaluation of a training programme for service users and carers involved in training mental health professionals in user-involved care planning

WHAT IS KNOWN ON THE SUBJECT?: UK NHS policy highlights the importance of user and carer involvement in health professional training. We know little about service user and carer motivations and experiences of accessing training courses for delivering training to health professionals and how well such courses prepare them for delivering training to healthcare professionals. 'Involvement' in training has often been tokenistic and too narrowly focused on preregistration courses. There is limited data on how best to prepare and support potential service user and carer trainers. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study adds to the international literature by highlighting service user and carer motivations for accessing a training course for delivering training to health professionals. Service users and carers wanted to gain new skills and confidence in presentation/facilitation as well as to make a difference to healthcare practice. We also learned that service users desired different levels of involvement in training facilitation - some wanted to take a more active role than others. A one-size-fits-all approach is not always appropriate. Encountering resistance from staff in training was a previously unidentified challenge to service user and carers' experience of delivering training in practice and is a key challenge for trainers to address in future. Professional training involvement can be enhanced via specialist training such as the EQUIP training the trainers programme evaluated here. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When training service users and carers to deliver training to mental health professionals, it is important that service users are equipped to deal with resistance from staff. It is important that service user and carer roles are negotiated and agreed prior to delivering training to healthcare professionals to accommodate individual preferences and allay anxieties. Training for service users and carers must be offered alongside ongoing support and supervision. Mental health nurses (and other health professionals) will be better able to involve service users and carers in care planning. Service users and carers may feel more involved in care planning in future.

ABSTRACT

Introduction Limited evidence exists on service user and carer perceptions of undertaking a training course for delivering care planning training to qualified mental health professionals. We know little about trainee motivations for engaging with such train the trainers courses, experiences of attending courses and trainees' subsequent experiences of codelivering training to health professionals, hence the current study. Aim To obtain participants' views on the suitability and acceptability of a training programme that aimed to prepare service users and carers to codeliver training to health professionals. Method Semi-structured interviews with nine service users and carers attending the training programme. Transcripts were analysed using inductive thematic analysis. Results Participants' reasons for attending training included skill development and making a difference to mental health practice. Course content was generally rated highly but may benefit from review and/or extension to allow the range of topics and resulting professional training programme to be covered in more depth. Trainees who delivered the care planning training reported a mix of expectations, support experiences, preparedness and personal impacts. Implications for Practice Mental health nurses are increasingly coproducing and delivering training with service users and carers. This study identifies possibilities and pitfalls in this endeavour, highlighting areas where user and carer involvement and support structures might be improved in order to fully realize the potential for involvement in training.

The inter-play between facilitation and context in the promoting action on research implementation in health services framework: A qualitative exploratory implementation study embedded in a cluster randomized controlled trial to reduce restraint in nursing homes

AIM

To explore the inter-play between external facilitation and nursing home contexts relative to intervention outcomes.

BACKGROUND

The Promoting Action on Research Implementation in Health Services framework is frequently used to theoretically inform implementation and research in nursing and recent reviews indicate high face validity for health services. However, the inter-play and relationship between framework sub-elements of evidence, context and facilitation and the prospective utility in non-English speaking contexts warrant further illumination.

DESIGN

In an overarching single-blind cluster-randomized controlled trial, we applied participatory action research and ethnography from August 2011-June 2015 to evaluate a standardized education intervention to reduce restraint and agitation in nursing home residents living with dementia. The trial results are published elsewhere.

METHODS

Prospectively informed by the PARIHS framework, a research team and eight facilitators participating in dual roles as action researchers designed, implemented, and evaluated the intervention. How contextual factors influenced the facilitation processes were explored in focus group interviews (1), reflection notes (84) written by the facilitators' after each education session, ethnographic field studies (6 homes), and co-analysis workshops (5). Directed content analysis was used to analyse data.

RESULTS

Clinical leaders taking roles of internal facilitator influenced the success of implementation, while complex and fluctuating context elements determined whether restraint use was reduced- or not. The PARIHS framework was found to be relevant in a non-English nursing home setting, albeit some elements merit further conceptualization.

CONCLUSIONS

Our findings confirm the prospective utility of the PARIHS framework for implementation in a non-English context, particularly the notion of implementation processes as dynamic and multifaceted.

Interventional Oncology Service Development

Interventional oncology is rapidly expanding its suite of oncologic therapies, providing unique proven therapeutic benefits. To grow a practice alongside other oncology specialties, knowledge of cancer fundamentals is required. Areas of interest include methods to assess disease stage, treatment toxicity, and response. Additionally, techniques to leverage opportunities and resources available at one's institution toward practice development and efficiency will be reviewed.