Exploring the impact of the implementation of a nursing clinical development unit program: what outcomes are evident?

Nursing Clinical Development Units have become popular as a framework for the facilitation of the professional development of nursing and to contribute to improved outcomes for consumers of health care services. An exploratory evaluation of the Nursing Clinical Development Unit program implemented by the Centre for Psychiatric Nursing Research and Practice was undertaken using a qualitative approach. This paper focuses on the findings relating to outcomes. A number of positive outcomes were identified including: changes within nursing practices; the development of more positive attitudes by nurses, a greater focus on research utilization and evidence-based practice; and an increase in professional development activities, including conference presentations. Despite these positive findings, the need for more structured evaluation and an increased emphasis on dissemination of findings was identified.

Developing continuing care: towards a teaching nursing home

This article describes a partnership between staff, residents and relatives of a nursing home for older people with mental health problems, and lecturers within an academic department of nursing. The aim of the partnership is to develop practice and to improve the setting of the care home as an environment for living, working and learning. In our attempts to create a teaching nursing home, we recognize the need to ensure that all participants - residents, relative and staff - feel that they are valued members of the team. We describe our progress to date, together with some of the challenges of working together.

The lived experience of clinical development unit (nursing) leadership in Western Sydney, Australia

BACKGROUND

A network of nine Clinical Development Units (Nursing) (CDU(N)) were recently created in the Western Sydney Area Health Service. These units are designed to develop patient-focused nursing practice through group process and action research, based on principles of transformational leadership.

AIMS OF THE STUDY

Although there is documented evidence from Australia and the United Kingdom (UK) that CDUs and Nursing Development Units (NDUs) are very successful in improving both patient and staff satisfaction, there is also growing evidence that the stressors experienced by nurse leaders are threatening the survival of some of these units. This study set out to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership when these stressors were likely to impinge.

STUDY DESIGN

Hermeneutic phenomenology was employed in order to identify how these experiences changed over time. Two rounds of interviews were conducted: approximately 4--6 months after the launch and, again, 12 months later.

FINDINGS

The Clinical Development Unit (Nursing) philosophy provided a framework on which these very motivated leaders began to enhance nursing accountability in their units through reflective practice and participatory governance. While reinforcing many previously published positive and negative aspects of Clinical Development Units and Nursing Development Units, this paper also highlights how the expectations and experiences of these leaders changed over time with unanticipated pressures of work, a high turnover of clinical leaders, a perceived diminution of management support and unrealistic self-expectations. A significant theme that emerged as these stressors began to impinge was the leaders' own need for leadership in order to sustain their confidence and motivation.

IMPLICATIONS FOR NURSING

Insights harvested from this study have since been incorporated into a revised leadership preparation programme and support mechanisms for the leaders of eight new Clinical Development Units (Nursing) in the Western Sydney Area Health Service.

A pluralistic evaluation of nursing/practice development units

Nursing/practice development units (N/PDU) are perceived as centres for pioneering, evaluating and disseminating innovative practice development and facilitating the professional development of practitioners. This paper reports on a pluralistic evaluation research study of the nursing/ practice development unit accreditation programme provided by the University of Leeds, UK. Individual and focus group interviews were undertaken with key stakeholders involved in six nursing/practice development units. These included: clinical leaders, team members, executive nurses, trust board members, general medical practitioners, nursing/practice development unit steering group members, and accreditation panel members. Stakeholder perceptions of what constituted a successful nursing/practice development unit were elicited and then used to judge the success of the programme. Seven criteria for judging the success of nursing/practice development units were identified. These were: achieving optimum practice; providing a patient-orientated service; disseminating innovative practice; team working; enabling practitioners to develop their full potential; adopting a strategic approach to change and autonomous functioning. The findings highlighted differences between the rhetoric of a successful nursing/practice development unit and the reality in which they function. Whereas all the units were actively involved in innovative practice development, evaluation, dissemination and networking activities, several factors influenced the success of the units, in particular, the role of the clinical leader, the motivation and commitment of nursing/practice development unit members, financial resources, and the nature of support from managers, medical staff and education institutions. Although the nursing/practice development units had made significant progress in developing both healthcare practice and practitioners, there is still a need to consider how the claim that nursing/practice development units benefit patients can be substantiated.

Clinical supervision and support for nurses: an evaluation study

AIM

To assess the effects of clinical supervision and informal support on qualified nurses.

RATIONALE

Earlier small-scale research studies have provided conflicting evidence about the impact of clinical supervision, hence the need for this larger-scale study.

DESIGN

Survey design drawing on an opportunity sample of 211 qualified nurses from 11 randomly selected hospital and community NHS Trusts in one region in England. Quantitative data collection used the Maslach Burnout Inventory (MBI) and the Nursing in Context Questionnaire (NICQ), while qualitative data were based on written critical incidents. The analysis compared supervized with unsupervized nurses.

FINDINGS

The critical incident analysis revealed that supervized nurses continued to use informal support networks as well as their supervision sessions to discuss clinical issues. The MBI found no significant differences in levels of burnout between supervized and unsupervized nurses. However, the NCIQ detected some statistically significant differences, with supervized nurses reporting a more listening and supportive management, coping better at work and feeling that they had better access to support than unsupervized nurses. Closer analysis found that this positive finding was particularly strong among the more junior supervized nurses.

CONCLUSION

Where resources are limited, it is better to concentrate on providing clinical supervision to more junior grades of nurses as a valued form of support during their early years as qualified practitioners.

Nursing development units: factors influencing their progress

Nursing development units (NDUs) have long been advocated as 'test-beds' for pioneering leading-edge practice development. This article reports on the findings of a study examining factors influencing the development of NDUs, and, more recently, established multidisciplinary practice development units (PDUs). Individual and focus group interviews were undertaken with key stakeholders involved in six NDUs/PDUs accredited by the University of Leeds. The findings from the study highlight a number of internal and external factors that have impacted upon the progress made by these units. Importantly, the role of the clinical leader, the staffing establishment, organizational infrastructures to facilitate dissemination and the nature of the support from managers and medical staff have all influenced the success of the NDUs/PDUs. In order to ensure the long-term viability of an NDU/PDU it is essential that practice development is planned and managed in a systematic and coordinated way with a full appraisal undertaken of the human, physical and financial resources necessary to implement and disseminate change and that the work of the NDU/PDU is incorporated in the trust's strategic plans in order to ensure organizational support.

On donkeys, ingratiates, thinkers and...clinical development units

Clinical Development Units celebrate nurses as thinkers and nursing as a highly skilled professional activity. They are typified by the exploration and development of therapeutic, consumer-focused and research-based practice and participatory governance. Establishing and maintaining them, therefore, can be problematic in health care facilities typified by centralism, autocracy and nurses' disempowerment. In this type of facility nurses are treated like donkeys and/or ingratiates. What CDUs are, the standards nurses in them strategically and systematically pursue and their achievements to date will be discussed. In addition,some sociopolitical impediments to their development will be identified together with recommendations for their successful establishment and maintenance.