Florence Nightingale's legacy for clinical academics: A framework analysis of a clinical professorial network and a model for clinical academia

The role of healthcare leaders in implementing equitable clinical academic pathways for nurses: An integrative review

AIM

To identify and synthesize empirical evidence on the role of healthcare leaders in the development of equitable clinical academic pathways for nurses.

DESIGN

Integrative literature review.

DATA SOURCES

Literature was searched using CINAHL, PubMed, ProQuest and Google Scholar databases.

REVIEW METHODS

A total of 114 eligible articles published between 2010 and2022 were screened, 16 papers were selected.

RESULTS

Results highlighted the need for consistent national, regional, and organizational policy approaches to developing clinical academic careers for nurses. Government health departments and National Health boards must focus on increasing engagement in research and evidence-based nursing practice for high-quality patient care. Discriminatory practices and attitudes were identified as barriers. Discrimination due to gender was evident, while the impact of race, ethnicity, and other social categories of identity are under-researched. Educational leaders must unravel misconceptions about research, highlighting its relevance to patient care and bedside nurses' work. Academic leaders together with executive nurses, research funders and professional nursing bodies must create appropriately remunerated career structures. Transformative approaches are required to develop the clinical academic nurse role and understand its value in clinical practice.

CONCLUSION

Multiple elements exist within complex systems that healthcare leaders can navigate collaboratively to develop and implement clinical nurse academic roles. This requires vision, acknowledgement of the value of nursing research and the importance of evidence-based research infrastructures.

IMPACT

Findings highlight the collaborative role of healthcare leaders as critical to the success of critical academic careers for nurses. This review can inform those still to formalize this innovative role for nurses.

REPORTING METHOD

The review complies with the PRISMA guidelines for reporting systematic reviews. This paper contributes evidence about the healthcare leader's role in developing clinical academic pathways for nurses to the wider global clinical community.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was included in this review.

Assessing the success of a research leadership programme for senior nurses and midwives: A mixed methods programme evaluation

AIMS

In 2018 the National Institute of Health and Care Research, United Kingdom, launched a 3-year Senior Nurse and Midwife Research Leader Programme to support nurse and midwifery research leaders to develop research capacity and capability within NHS organisations. We report the results of a service evaluation of the programme strengths, areas for improvement and achievement of programme aims.

DESIGN

Partially mixed, concurrent mixed methods programme evaluation, including: (a) meeting evaluation (survey), (b) annual evaluation (survey) and (c) qualitative stakeholder interviews.

METHODS

Survey results were quantitatively analysed using descriptive statistics. Interviews were audio-recorded, transcribed, deductively coded using elements within the logic model and analysed using the seven-stage framework analysis method.

RESULTS

Satisfaction with the programme was high (75%). The main perceived benefit of the programme was being part of a network. Challenges included accessing learning resources, lack of opportunity to network and lack of clarity about the programme aims. Meetings were evaluated as relevant and helpful (mean 93%), thought-provoking (92%), inspiring (91%), at the appropriate level (91%) and aligned with the programme aims (90%). All meetings were ranked as highly beneficial by attendees (92%). Stakeholder feedback on the programme success reflected the importance of leadership, the programme design and content, 'connection and community' and communication with and about the cohort. Overall, the anticipated programme aims were met, evaluating well from both the perspective of those on the programme and the wider stakeholder group. There has been a lack of investment in schemes to support research leadership development for nurses/midwives. A novel programme to support nursing/midwifery research leadership was positively evaluated. The programme is a useful model to support future capacity and capability building for nurses/midwives. The work is reported with reference to the SQUIRE 2 and SRQR checklists. No patient or public contribution.

Could you give me a leg up …? Models, frameworks and support structures to help aspiring clinical academic speech and language therapists

BACKGROUND

Increasing research capacity and capability for the speech and language therapy (SLT) profession is a key national strategic driver, with many speech and language therapists (SLTs) aspiring to a clinical academic (CA) career. There are known benefits but also acknowledged challenges with this career path, including limited funding opportunities and a poorly established career trajectory.

AIMS

To present models, frameworks and support structures that can be used by aspiring SLT CAs to chart research knowledge and skills, and plan career development. Organisational models are also presented to facilitate SLT CA career development and research capacity-building.

METHODS & PROCEDURES

A narrative review was conducted using a literature search of published peer-reviewed journals across four electronic databases: Medline, CINAHL, AMED and Embase, with additional search for grey literature through internet searches. Search results were screened against eligibility criteria by two researchers, with full-text articles retrieved and reviewed by four researchers independently.

RESULTS & DISCUSSION

The database search and grey literature search combined identified 610 records. Full-text screening of 66 records resulted in 19 articles or grey literature sources being included within the narrative review.

MAIN CONTRIBUTION

This paper details models, frameworks and support structures pertinent to SLTs that can be used at an individual and organizational level to assist CA skill development and career paths.

CONCLUSION & IMPLICATIONS

The national climate is looking positive for aspiring SLT CAs. The time is now to take the initiative and use the support structures available to show our CA value and develop the necessary skills outlined within these resources to fulfil our ambitions.

WHAT THIS PAPER ADDS

What is already known on the subject Interest in CA careers within the SLT profession is increasing. Whilst there are known benefits to embedding research within clinical practice, barriers exist including the strategic and operational steps individuals can take to make the career path a reality. What this study adds This narrative review has searched the literature for CA models, frameworks and support structures created for nurses, midwives and allied health professionals. These tools are presented and discussed, with special consideration and focus to the SLT profession. What are the clinical implications of this work? This paper will provide SLTs with the tools to support their personal CA career development as well as advocate for CA roles within their teams and organisations. Organisational models are also presented to support SLT managers to foster a CA path for workforce development.

Local Level Economic Evaluation: What is it? What is its Value? Is it Sustainable?

In Australia, local health services with allocated budgets manage public hospital services for defined geographical areas. The authors were embedded in a local health service for around 2 years and undertook a range of local level economic evaluations for which three decision contexts were defined: intervention development, post-implementation and prioritisation. Despite difficulties in estimating opportunity costs and in the relevance of portfolio-based prioritisation approaches, economic evaluation added value to local decision-making. Development-focused (ex ante) economic evaluations used expert elicitation and calibration methods to synthesise published evidence with local health systems data to evaluate interventions to prevent hospital acquired complications. The use of economic evaluation facilitated the implementation of interventions with additional resource requirements. Decision analytic models were used alongside the implementation of larger scale, more complex service interventions to estimate counterfactual patient pathways, costs and outcomes, providing a transparent alternative to the statistical analyses of intervention effects, which were subject to high risk of bias. Economic evaluations of more established services had less impact due to data limitations and lesser executive interest. Prioritisation-focused economic evaluations compared costs, outcomes and processes of care for defined patient populations across alternative local health services to identify, understand and quantify the effects of unwarranted variation to inform priority areas for improvement within individual local health services. The sustained use of local level economic evaluation could be supported by embedding health economists in local continuous improvement units, perhaps with an initial focus on supporting the development and evaluation of prioritised new service interventions. Shared resources and critical mass are important, which could be facilitated through groups of embedded economists with joint appointments between different local health services and the same academic institution.

Research delivery secondments: A scoping review

AIM

To explore and summarise published literature with regards to secondments to clinical research and to identify the gaps in research to inform further work.

DESIGN

Systematic scoping review.

METHOD

A scoping review was undertaken in accordance with the Patterns, Advances, Gaps, Evidence and Research framework. Databases searched included CINAHL, PubMed, Medline and Embase. Inclusion/exclusion criteria were applied by two independent reviewers. Two reviewers independently retrieved full-text studies for inclusion and applied the framework as a tool for synthesising Patterns, Advances, Gaps, Evidence and Research recommendations.

RESULTS

Six papers and one abstract published between 2003 and 2018 were included. All secondees (n = 34) were released from NHS posts, with secondments (where specified) ranging in duration from 0.25 to 2 years and for 40%-100% of their working hours. All seven papers reported benefits for personal and professional development, predominantly in the form of personal reflections. Few described involvement with research delivery teams.

CONCLUSION

Published initiatives vary in nature and lack standardised reporting and measurement of impact. Further research is required to identify benefits at a departmental or organisational level, the facilitators for setting up secondments and the application of knowledge gained from secondment opportunities.

IMPLICATIONS FOR THE PROFESSION

Undertaking a research secondment is reported to offer professional and personal benefit for clinical staff. Research secondments are one way in which a research culture can practically be embedded within clinical settings.

IMPACT

This scoping review identified a lack of published empirical research seeking to understand research secondments as a tool to enhance research and evidence engagement. Although there is a suggestion that secondments could positively impact staff retention, there is limited evidence about the benefit for the organisation or for patient care. These findings have implications for staff, managers and their organisations.

REPORTING METHOD

The PRISMA-ScR guidelines were used to guide reporting.

NO PATIENT OR PUBLIC CONTRIBUTION

This was not relevant to the research design.

Assessing the quality of nursing clinical placement: A quantitative cross-sectional study

AIM

To evaluate the quality of nursing clinical placement among nursing students.

DESIGN

This is a descriptive cross-sectional study.

METHODS

Two hundred eighty two nursing student completed self-administered, online questionnaires. The questionnaire assessed participants' socio-demographic data, and the quality of their clinical placement.

RESULTS

The students had a high mean score for the overall satisfaction of their clinical training placement with high mean score for the item of "patient safety was fundamental to the work of the units" and the item of "I anticipate being able to apply my learning from this placement," while the lowest mean score was related to "This placement was a good learning environment" and "Staff were willing to work with students." Patient or Public Contribution: Quality of clinical placement is critical for improving the everyday quality of care for patients who are in desperate need of caregivers with professional knowledge and skills.

A Survey of Resources and Nursing Workforce for Clinical Research Delivery in Paediatric Intensive Care Within the UK / Ireland

Introduction

Clinical research within Paediatric Intensive Care (PICU) is necessary to reduce morbidity and mortality associated within this resource-intensive environment. With UK PICUs encouraged to be research-active there was a drive to understand how centres support research delivery.

Aim

To identify the research workforce available within UK/Ireland PICUs to support clinical research delivery.

Method

An electronic survey, endorsed by the Paediatric Critical Care Society (PCCS), was designed and reported in accordance with CHERRIES guidelines. The survey was distributed by email to all UK/Ireland Nurse Managers and Medical/ Nursing Research leads, aiming for one response per site during the period of April-June 2021. Only one response per site was included in analysis.

Results

44 responses were received, representing 24/30 UK/Ireland sites (80% response rate). Responses from n = 21/30 units are included (three excluded for insufficient data). 90% (n = 19/21) units were research active, although only 52% (n = 11) had permanent research roles funded within their staffing establishment. The majority of units (n = 18, 86%) had less than two WTE research nurses. Resources were felt to be sufficient for current research delivery by 43% of units (n = 9), but this confidence diminished to 19% (n = 4) when considering their ability to support future research. The top barriers to research conduct were insufficiently funded/unfunded studies (52%; n = 11), clinical staff too busy to support research activity (52%; n = 11) and short-term/fixed-term contracts for research staff (38%; n = 8).

Conclusion

Despite the perceived importance of research and 90% of responding UK/Ireland PICUs being research active, the majority have limited resources to support research delivery. This has implications for their ability to participate in future multi-centre trials and opportunities to support the development of future medical/nursing clinical academics. Further work is required to identify optimum models of clinical research delivery.

UK Palliative trainees Research Collaborative (UK-PRC): the first 5 years - 0-100 study sites

OBJECTIVES

Palliative care research suffers from underfunding and a workforce spread across multiple settings leading to a lack of large-scale studies. To facilitate multisite research and audit we set up the UK Palliative trainees Research Collaborative (UKPRC), the first national trainee-led audit and research collaborative in palliative care. Here, we critically review the progress and potential of the UKPRC since its inception in 2016, identifying key challenges and facilitators. Members of the UKPRC steering committee collaborated to write this reflection, reviewing existing evidence regarding trainee-led research collaboratives.

FINDINGS

The UKPRC has representation from 16/19 UK training regions. Projects are run by a core team; local collaborators collect data at each site. The collaborative is supported by academic leads and newly qualified consultants to develop a culture of continuous improvement in practice. We have conducted four national projects to date, including an audit covering 119 sites. Facilitators for our work include a focus on inclusivity and national representation; support from recently qualified consultants to ensure continuity; and taking a pragmatic approach, focusing initially on straightforward projects to build momentum. Challenges include the step from national audit to multisite, patient-facing research and maintaining continuity in a membership with high turnover.

CONCLUSIONS

There is potential to change practice through large scale data collection via the trainee-led collaborative model. Collaboration is especially important in a small specialty with limited resources. The UKPRC has demonstrated 'proof of concept' and has the potential to support and sustain a culture where research can flourish within palliative care.

Clinical academic radiographers - A challenging but rewarding career

OBJECTIVES

To explain what a clinical academic career can be, what it can lead to for the individual, profession and most importantly the patient, and why these roles are so important to radiography.

KEY FINDINGS

Multiple challenges to the adoption of clinical academic careers exist, including achievable measurable outcomes, visibility & senior support, and balancing different time demands. Equally the rewards are wide ranging and can advance both the individual and profession through role extension opportunities, increased career progression, patient benefits, and academic and research skills.

CONCLUSION

Clinical academic careers can provide advantages for the individual, department, profession and most importantly the patient with advanced clinical practice through evidenced based research.

IMPLICATIONS FOR PRACTICE

Improving clinical academic careers within Radiography will promote research participation and increase radiographic roles in patient-centred research delivery and development. Combining evidenced based research with academic skills will lead to improved patient care and better clinical outcomes.