Enhancing new graduate nurses and midwives person-centredness through clinical supervision during COVID-19; evaluation of a non-randomized intervention study

AIM

The aim of the study was to evaluate a person-centred model of clinical supervision to enhance person-centredness.

DESIGN

Experimental, quantitative.

METHODS

One hundred and three New Graduates were supported to reflect through a person-centred lens (July-December 2020). Evaluation was undertaken at 6 months using: the Manchester Clinical Supervision Scale-26 (effectiveness of supervision) and the Person-centred Practice Inventory (measures attributes of the nurse/midwife, the care environment and person-centred processes). Due to participation difficulties, scores were calculated by attendance rates using descriptive and inferential statistics.

RESULTS

Regular attendees scored higher on the supervision's effectiveness; however, this did not reach efficacy. 'Finding time' to attend contributed to low scores. Supervision scored well on its supportive function when attended. Many New Graduates perceived a decline in their care environment. Attendance aside, New Graduates averaged an increased in their person-centred attributes and processes. Greater participation was found in those who scored higher at baseline on their person-centred attributes and processes, and this higher scoring continued at 6 months than those who attended less.

CONCLUSION

New Graduates who perceive themselves as person-centred and reflective at baseline are more likely to attend a person-centred clinical supervision and score higher at 6 months than those who attended less often. New Graduates found support within supervision during challenging times.

IMPLICATIONS FOR PRACTICE FOR PROFESSIONAL AND/OR PATIENT CARE

For successful implementation of Person-centred Clinical Supervision, New Graduates need support to attend, as attendance supports them to begin seeing value in the process.

IMPACT

This intervention kept person-centred practice at the forefront of New Graduates reflection, in a time of extreme change. The research has implications for nursing and midwifery management with the imperative to deliver person-centred care and create the person-centred cultures for staff to feel supported and empowered.

REPORTING METHOD

Transparent Evaluation of Non-randomized Designs (TREND).

PATIENT OF PUBLIC CONTRIBUTION

No patient or public contribution.

CONTRIBUTION TO WIDER COMMUNITY

New Graduates grow their person-centredness over their transitioning year; however, this can be enhanced with regular clinical supervision underpinned by person-centred theory. Clinical supervisors can provide support to New Graduates when the environment is challenged.

Solving the shortage of psychiatric - mental health nurses in acute inpatient care settings

INTRODUCTION

This debate essay proposes possible remedies to the shortage of nurses in acute inpatient mental health settings and draws inspiration from a Journal of Psychiatric and Mental Health Nursing editorial, Glascott and McKeown (2022, 29, 767).

AIM

The aim is to stimulate debate within the profession. The art and science of nursing continues to develop but staffing shortages in key areas undermine practice, leadership, academic and policy efforts to improve the quality of care for people attending services.

METHOD

This is a debate essay which draws on the authors' experience and presents ideas based on extant literature.

RESULTS

Organisational, professional and wider societal challenges are explored. Practice-based solutions as well as recommendations for improving the terms and conditions of employment of nurses are made. Opportunities which may empower the nursing profession are promulgated.

DISCUSSION

It is intended that this paper will provoke further discourse and may reflect the 'call to action' advocated by Glascott and McKeown (Journal of Psychiatric and Mental Health Nursing, 2022, 29, 767).

IMPLICATIONS FOR PRACTICE

While the focus is on acute inpatient mental health nursing, the ideas presented may have an application to wider nursing groups or a wider cadre of public sector workers.

Preventing and recognising skin tears using a standardised approach

Skin tears, defined as traumatic wounds caused by mechanical forces, can be debilitating for individuals, causing pain and reduced mobility. Although skin tears can develop throughout the lifespan, older age can make the skin increasingly susceptible to this type of injury. Studies have found wide variation in the incidence and prevalence of skin tears, in part because of suboptimal recognition and reporting practices among healthcare professionals. Effective prevention of skin tears requires a standardised approach to risk assessment, prevention, recognition and classification, such as that offered by the International Skin Tear Advisory Panel (ISTAP) best practice recommendations. This article examines the literature on the incidence, prevalence, prevention and recognition of skin tears, and outlines some of the ISTAP best practice recommendations on risk assessment, prevention and recognition. The authors also consider the need for patient and healthcare professional education to optimise the prevention of skin tears.

The Nurse-Police Assistance Crisis Team (N-PACT): A new role for nursing

AIM

This study aimed to gain insights into forensic nurses' perspectives and approaches to behavioural crisis situations, comparing them to disciplines traditionally involved in first-line behavioural crisis response.

DESIGN

This study used a descriptive, qualitative exploratory design and was informed by Systems Theory.

METHODS

The study was carried in the United States, between 2022 and 2023. Data were gathered through four focus groups: police officers (n = 12), co-response (mental health) clinicians (n = 13), sexual assault nurse examiners (n = 6) and correctional nurses (n = 4). Thematic analysis was performed.

REPORTING METHOD

The Standards for Reporting Qualitative Research (SRQR) guidelines were used.

RESULTS

Findings revealed temporal themes in crisis response: (1) Searching for Historical Information; (2) Safety and Acting at the Present Scene; and (3) Future Strategies and Interventions. Common priorities (e.g. safety and de-escalation) were identified across groups. Notably, nurses demonstrated a comprehensive approach, addressing physical and mental health assessments, substance involvement, and physical injury evaluation.

CONCLUSION

This study proposes the creation of a novel nursing role within first-line multidisciplinary teams (MDTs) for crisis response-the Nurse-Police Assistance Crisis Team (N-PACT). Nurses bring expertise and comprehensive assessment skills to enhance crisis responses, particularly in cases involving mental health emergencies, medical crises, and drug-related incidents.

IMPLICATIONS

Forensic nurses, with their diverse competencies and comprehensive training, are highly valuable assets within MDTs. Their expertise extends to proficiently conducting mental and physical assessments, ensuring safety and adeptly navigating situations that intersect with the legal system.

IMPACT

The N-PACT concept can improve outcomes and streamline the allocation of resources, particularly considering the number of police calls involving behavioural crises.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Exploring the implementation of person-centred care in nursing practice

Person-centred care involves nurses working in partnership with patients to ensure their needs and preferences are at the centre of their healthcare, as well as considering the biographical and social factors that are relevant to the person's health. This aims to support patients in developing the knowledge, confidence and skills to make informed decisions about treatment and to manage their own care where possible. This article discusses the concept of person-centred care and considers some of the facilitators and barriers that may affect its implementation in healthcare practice. It also explores some of the approaches that nurses can use to support person-centred care, such as cultural humility and role modelling.

A call for digital inclusion initiatives in mental health services: An integrative review

WHAT IS KNOWN ON THE SUBJECT?: Digital tools such as video calls or mobile phone applications (apps) are increasingly used in the provision of mental healthcare. There is evidence that people with mental health problems are more likely to face digital exclusion: that is, they do not have access to devices and/or skills to use technology. This leaves some people unable to use digital mental health services (e.g., apps or online appointments) or to benefit more generally from access to the digital world (e.g., online shopping or connecting with others virtually). People can be digitally included through initiatives that provide devices, Internet and digital mentoring to increase knowledge and confidence when using technology. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Some initiatives in academic studies and grey literature have been shown to increase access to and knowledge of technology, but this has been outside of mental health care settings. There are currently limited digital inclusion initiatives that take into consideration the specific needs of people with mental health problems, and how they can be equipped and familiarised with digital technologies to help their recovery journey and everyday life activities. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further work is needed to improve the provision of digital tools in mental health care, with more practical digital inclusion initiatives to ensure equal access for all. If digital exclusion is not addressed, the gap between people with and those without digital skills or access to technology will continue to grow, enlarging mental health inequalities.

ABSTRACT

INTRODUCTION: The rise in the provision of digital healthcare during the pandemic has called attention to digital exclusion: inequality in access and/or capacity to use digital technologies. Digital exclusion is more profound in people with mental health problems, leaving an implementation gap of digital practice in mental health services.

AIM

Identify the available evidence of (a) addressing digital exclusion in mental health care and (b) the practical solutions to enhance uptake of digital mental health.

METHOD

Digital inclusion initiatives were searched from both academic and grey literature available and published between the years 2007 and 2021.

RESULTS

A limited number of academic studies and initiatives were found that supported people with mental health difficulties who had limited skills and/or access to overcome digital exclusion.

DISCUSSION

Further work is needed to combat digital exclusion and establish ways to reduce the implementation gap in mental health services.

IMPLICATIONS FOR PRACTICE

Access to devices, Internet connectivity and digital mentoring for mental health service users is essential. More studies and programmes are needed to disseminate impact and results for digital inclusion initiatives for people with mental health problems and to inform best practice for digital inclusion within mental health services.

Development and acceptability of the person-centred observation and reflection tool for supporting staff and practice development in dementia care services

BACKGROUND

Observational tools can support the understanding of the complex needs of older people with dementia and aid delivery of person-centred care. However, existing tools are complex and resource intensive to use.

OBJECTIVES

To develop and evaluate the acceptability and feasibility of a low-resource, observational tool to support staff reflection and practice development.

METHODS

Intervention development of the Person-Centred Observation and Reflection Tool (PORT) and acceptability and feasibility study, using surveys and focus groups in the UK, Norway and Spain.

RESULTS

PORT was reported as easy, accessible and acceptable to use. The observation was identified as powerful for individual staff development and provided an evidence-based source for underpinning individualised care planning. Potential time challenges associated with implementation were identified.

CONCLUSION

Initial evaluation indicates PORT is an acceptable and feasible tool for use in health and social care settings for older people. Further research is needed on implementation models and the impacts of PORT use.

IMPLICATIONS FOR PRACTICE

PORT may be a useful tool to support individual staff development in care settings and person-centred care planning for people with dementia.

Community children's nursing: developing a bespoke model of post-registration education

Community children's nurses provide a vital service between the hospital and home environment, supporting children, young people and families with their health needs. In the UK, the number of educational pathways providing a specialist practitioner qualification in community children's nursing has declined significantly in recent years. This has left many community children's nursing services with little or no access to educational programmes, despite the rising demand. The four UK governments, together with regulatory bodies such as the Nursing and Midwifery Council, have embarked on ambitious transformation of post-registration career frameworks and standards, the long-term impact of which is uncertain. This article discusses an approach that one community children's nursing service in Scotland took to address these challenges by liaising with a local university and accessing a bespoke advanced practice programme.

Co-creating system-wide improvement for people with traumatic brain injury across one integrated care system in the United Kingdom to initiate a transformation journey through co-production

BACKGROUND AND OBJECTIVE

There is a need for better integration of services across communities and sectors for people living with traumatic brain injury (TBI) to meet their complex needs. Building on insights gained from earlier pilot work, here we report the outcomes of a participatory workshop that sought to better understand the challenges, barriers and opportunities that currently exist within the care pathway for survivors of TBI.

METHODS

A diverse range of stakeholders from the acute and rehabilitation care pathway and the health and social care system were invited to participate in a 3-h workshop. The participants worked in four mixed subgroups using practice development methodology, which promotes person-centred, inclusive and participatory action.

RESULTS

Thematic analysis identified shared purposes and values that were used to produce a detailed implementation and impact framework for application at both the level of the care interface and the overarching integrated care system. A variety of enablers were identified that related to collective values and behaviours, case management, team leadership and integrated team working, workforce capability, evidence-based practice and resourcing. The clinical, economic, cultural and social outcomes associated with these enablers were also identified, and included patient safety, independence and well-being, reduced waiting times, re-admission rates, staff retention and professional development.

CONCLUSION

The co-produced recommendations made within the implementation and impact framework described here provide a means by which the culture and delivery of health and social care services can be better tailored to meet the needs of people living with TBI. We believe that the recommendations will help shape the formation of new services as well as the development of existing ones.

PATIENT OR PUBLIC CONTRIBUTION

Patient and public involvement have been established over a 10-year history of relationship building through a joint forum and events involving three charities representing people with TBI, carers, family members, clinicians, service users, researchers and commissioners, culminating in a politically supported event that identified concerns about the needs of people following TBI. These relationships formed the foundation for the interactive workshop, the focus of this publication.

The improvement in research orientation among clinical nurses in Qatar: a cross-sectional study

BACKGROUND

The main barrier to engaging nurses in research is the lack of research knowledge and skills.

AIM

To explore the influence of research workshops on the research orientation of nurses in a large referral hospital in Qatar.

DISCUSSION

This article describes a cross-sectional study involving 564 nurses working in 14 health facilities who attended research workshops in Qatar. The authors collected data using the Edmonton Research Orientation Survey (EROS) as well as questions considering support and barriers to research. Descriptive statistics were used to summarise and determine the sample characteristics and distribution of participants. The participants who attended the workshop were found to have a higher orientation towards the EROS sub-scales of evidence-based practice, valuing of research, involvement in research, being at the leading edge of the profession and support for research, compared to those who did not attend the workshop. There was no statistical difference between the groups in the research barrier sub-scale.

CONCLUSION

Despite significant improvements in their responses to the EROS research orientation sub-scales after attending the workshop, the nurses still reported many barriers to being actively engaged in research.

IMPLICATIONS FOR PRACTICE

Healthcare organisations should assist with integrating evidence-based practice into healthcare. There is a need for research education for clinical nurses to bring evidence into clinical practice to improve the quality of patient outcomes. Increasing the research capacity of nurses will lead to their emancipation in addressing the flaws in clinical practice and motivate them to use evidence in patient care.

Assessing the impact of a payor-funded embedded clinical pharmacist on patient and provider satisfaction in a private primary care practice

DISCLAIMER

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

With expanding roles of clinic-embedded pharmacists comes the need to identify routes for optimization, soliciting and addressing feedback, and justifying the position(s) to the employing institution. Studies have demonstrated the benefit of integrating pharmacists into healthcare teams, but these opportunities remain largely limited to major health systems due to a lack of billing avenues for and familiarity with the services pharmacists can provide.

METHODS

With funding from and partnership with a third-party payor, a pharmacist was incorporated into a private physician-owned clinic to be a resource to the providers and provide comprehensive medication management to patients. Patient and provider experiences were assessed by survey and interview, respectively, utilizing both Likert-scale and free-response questions. The responses were coded, analyzed, and aggregated into themes. The demographic and Likert-scale responses were analyzed using descriptive statistics.

RESULTS

Patients reported a high level of satisfaction with the pharmacist's service, indicating that they felt more comfortable managing their medications and that they would recommend the pharmacist to a family member or friend. Provider satisfaction was also high, with providers stating that they found the recommendations by the pharmacist helpful, that the recommendations improved cardiovascular risk factors in their patients with diabetes, and that, overall, they were satisfied with the care provided by the pharmacist. The primary concern from the providers was a lack of understanding regarding how best to reach and utilize the service.

CONCLUSION

Overall, an embedded clinical pharmacist providing comprehensive medication management at a private primary care clinic had a positive impact on both provider and patient satisfaction.

[Advanced nursing practice model for head and neck cancer: A practice development project]

Advanced nursing practice model for head and neck cancer: A practice development project Abstract. Background: Head and neck cancer confronts patients and their families with big challenges due to complex treatments as well as changes in vital functions and appearance. They require multifaceted support and benefit from coordinated, interprofessional collaboration and advanced nursing practice. Problem/aim: In a tertiary head and neck cancer center, a coordinating contact person was missing for patients, families and the care team. Therefore, a project was launched to develop an advanced nursing practice program. Methods: Methods included an advanced nursing practice concept, approaches for practice development, and action research. The project consisted of four phases: Stakeholder analysis and literature review were followed by the definition of the advanced nursing practice program, which was then tested during a pilot phase, and evaluated using structural/process data and stakeholder interviews. Results: Evidence-based, continuous, person-centered care was improved across the care continuum for patients/families. The nurses' expertise was supported and the collaboration with internal/external clinicians was facilitated. Patients/families valued the continuity offered by the advanced practice nurse. Discussion: The methodological approaches supported a goal-oriented approach; especially participatory practice development helped to address employees' concerns. Limitations/transfer: To date, a sustainable program cannot yet be warranted. For similar projects, an approach with stakeholder analysis, multidisciplinary focus, and early evaluation planning is recommended.

Advanced clinical practice in paediatric haematology and oncology: developing a capability document

Specialist roles have been developed to provide holistic care to children and young people with cancer, one of which is the advanced clinical practitioner (ACP) in paediatric oncology and haematology. A survey showed that paediatric oncology and haematology ACPs in the UK work in a wide variety of roles and that their numbers vary greatly between treatment centres. The survey also confirmed the need for a national standardised framework delineating the knowledge, skills and expertise required of ACPs working in paediatric oncology and haematology. This article describes the development of a capability document to support and standardise advanced practice in paediatric oncology and haematology. The document reflects the advanced level of critical thinking, autonomy and decision-making required of ACPs and has been endorsed by the Children's Cancer and Leukaemia Group and by the Royal College of Nursing. It is hoped that it will support ACPs to consistently deliver high-quality, safe care for the benefit of children and young people with cancer and their families.

Answering the ethical call of the other: A test of the Strong Relationality Model of Relationship Flourishing

The philosophical framework of strong relationality has gained greater attention in scholarship and yet empirically testing models built on this important framework are rare. The present study tests predictions made by the Strong Relationality Model of Relationship Flourishing (SRM), which centers on the role of Ethical Responsiveness for relationship health. In doing so, we introduce common fate modeling as a methodological approach for strong relationality research. We used longitudinal data from 1512 couples collected as part of the German longitudinal panel study of families. Results support the Strong Relationality Model's prediction that Ethical Responsiveness (as measured by perceived partner support) positively alters the impact of stress on Gratitude-Recognition (elements of the Responsible Action domain of the SRM), which then increases couples' intimacy (an element of the Relational-Connectivity domain of the SRM). Recommendations for clinical assessment and intervention are given as well as recommendations for future research on the Strong Relationality Model.

Resilience amongst Ontario registered practical nurses in long-term care homes during COVID-19: A grounded theory study

AIMS

This study aimed to understand how the personal and professional resilience of Registered Practical Nurses working in long-term care (LTC) homes in Ontario were impacted during the Coronavirus 2019 pandemic.

BACKGROUND

Registered Practical Nurses are primary regulated healthcare providers that have worked in Ontario LTC homes during the COVID-19 pandemic. As frontline workers, they have experienced increased stress secondary to lockdowns, changing Ministry of Health recommendations, social isolation and limited resources. LTC homes experienced almost a third of all COVID-19-related deaths in Ontario. Understanding registered practical nurses' (RPNs) resilience in this context is vital in developing the programs and supports necessary to help nurses become and stay resilient in LTC and across a range of settings.

METHODS

Purposive sampling was used to recruit 40 Registered Practical Nurses working in LTC homes across Ontario for interviews. Charmaz's Grounded theory guided in-depth one-on-one interviews and analyses completed between April to September 2021.

RESULTS

Registered Practical Nurse participants represented 15 (37.5%) private, and 25 (62.5%) public LTC homes across Ontario Local Health Integration Networks. Findings informed two distinct perspectives on resilience, one where nurses were able to maintain resilience and another where they were not. Sustaining and fraying resilience, presented as bimodal processes, was observed in four themes: 'Dynamic Role of the Nurse', 'Preserving Self', 'Banding Together' and 'Sense of Leadership Support'.

CONCLUSION

Resilience was largely drawn from themselves as individuals. Resources to support self-care and work-life balance are needed. Additionally, workplace supports to build capacity for team-based care practices, collegial support in problem-solving and opportunities for 'connecting' with LTC nursing colleagues would be beneficial. Our findings suggest a role for professional development resources in the workplace that could help rebuild this workforce and support RPNs in providing quality care for older adults living in LTC.

PATIENT OR PUBLIC CONTRIBUTION

Our research team included two members of the Registered Practical Nurses Association of Ontario, and these team members contributed to the discussion and design of the study methodology, recruitment, analysis and interpretation. Further, RPNs working in long-term care during the COVID-19 pandemic were the participants in this study and, therefore, contributed to the data. They did not contribute to data analysis or interpretation.

Moral distress in advanced practice nurses during the COVID-19 pandemic

BACKGROUND

Moral distress arises when a person is aware of the right course to take but is prevented from acting on it by institutional constraints. While this concept has been considered by nursing ethicists for many years, it has been particularly associated with the unprecedented healthcare conditions caused by the coronavirus disease 2019 (COVID-19) pandemic.

AIM

To investigate the level of moral distress affecting advanced practice nurses (APNs) in the UK during the COVID-19 pandemic.

METHOD

This was a mixed-methods study in which a bespoke cross-sectional survey was sent to 243 APNs from across the UK who had been recruited to a broader longitudinal cohort study. The survey asked about their experiences, well-being and moral distress. Open-ended questions asked about their concerns regarding the health and well-being of their patients and colleagues.

FINDINGS

A total of 97 APNs completed the survey, yielding a 40% response rate. Levels of moral distress were significantly higher among APNs working in secondary care (P=0.026) compared with those working in primary care. All of the respondents expressed concerns about patients due to delayed care and about the mental well-being of their colleagues, particularly those who were redeployed to COVID-19 wards.

CONCLUSION

The COVID-19 pandemic has caused moral and psychological distress for APNs. However, the type of distress and its direct causes varied among these practitioners. Tailored support is required to address moral distress and subsequently improve staff retention.

Dementia care in acute hospitals: A framework for practice development and theory-based evaluation

AIM

The aim was to generate a framework for dementia care in acute hospitals.

DESIGN

Framework development with logic modelling.

METHODS

In phase one, we identified relevant elements of the framework by analysing several sources and by critically discussing them within the research team. We created the framework with logic modelling. In phase two, we adapted the framework in expert workshops and by reanalysing the included sources. We used the first stage of CReDECI 2 checklist for reporting.

RESULTS

The framework describes necessary activities within four main bundles of measures: "developing structures and processes," "developing competences and attitudes," "building relationships" and "ensuring a social environment and adequate stimulation." The overarching outcome is a person-centred hospital culture, manifesting itself on different levels. The framework illustrates the necessity of an organization-wide person-centred culture for achieving positive outcomes for people with dementia, their relatives and health professionals.

Assessing and managing people exposed to conducted energy device (Taser) discharge

The use of conducted energy devices - better known under the brand name Taser - by police officers is subject to scrutiny. Consequently, the clinical assessment and management of people who have been exposed to Taser discharge is also subject to scrutiny. In 2021 the Conducted Energy Device Joint Working Group published a new guideline on assessment in police custody after Taser discharge. The guideline enables any appropriately trained and competent healthcare professional, including nurses, to undertake post-Taser assessments and determine the person's fitness to be detained in police custody. This would be done in the first instance by nurses working in police custody suites, but emergency department (ED) nurses may also be involved, as people who have been 'tasered' may need referral to the ED. This article explains how Tasers work, their physiological effects and potential complications, and the required approaches to clinical assessment and management as outlined in the new guideline.

Development and Assessment of Professional Competences among Polish Nursing Students during a 3-Year Education Cycle Trying

The essence of the profile of nursing professional competences are basic behavioral characteristics, as well as mastering practical skills. The aim of this study was determination of the development of professional competences of perceiving a patient by first-, second-and third-year students of licentiate nursing study. The study was of a longitudinal character, and lasted for 3 years. The research instrument used was the Ascent to Competence Scale, and traditional assessment of students’ knowledge and skills. A statistically significant relationship was observed between the average grade in practical education from all three years, and competences in student–teacher relationship. Higher grades in theoretical education were accompanied by lower results obtained by students in the area of nursing competences. The respondents’ opinions concerning the development of knowledge and professional skills were relatively high among first-year students, which may be related with a sharp increase in nursing knowledge, whereas third-year students considered it important to perceive a considerable development of professional competences. The results of this study can help in the design of education programs meeting quality standards, and alignment with students and population health needs, which is adequate to the assumptions of the WHO Global Strategic Directions for Nursing and Midwifery 2021–2025.

'Guiding Lights for effective workplace cultures': enhancing the care environment for staff and patients in older people's care settings

While much attention has been given to organisational culture, there has been less focus on workplace culture. Yet workplace culture strongly influences the way care is delivered, received and experienced. An effective workplace culture is crucial for the well-being of individual staff members and teams as well as for patients' experiences and outcomes of care. This article describes the 'Guiding Lights for effective workplace cultures' which were developed by the authors and provide a framework to assist in understanding and promoting effective workplace cultures and creating environments where staff and patients feel safe and valued. There are four Guiding Lights: 'collective leadership', 'living shared values', 'safe, critical, creative learning environments' and 'change for good that makes a difference'. Each one articulates what good workplace cultures are through descriptors and intermediate outcomes and together produce a set of ultimate outcomes. The Guiding Lights provide nurses working in older people's care settings with an opportunity to learn from, and celebrate, what is going well in their workplaces and to consider areas that require further development.

[Journal clubs in nursing practice: An online survey of German university hospitals]

Journal clubs in nursing practice: An online survey of German university hospitals Abstract. Background: Journal clubs (JCs) are an evidence-based method for enabling nursing professionals to develop a scientifically based practice. Research results can be made available to nurses to directly influence their nursing practice. The level of implementation in German university hospitals is currently unknown. Aim: This study surveyed the current state of JCs at German university hospitals. The aim is to develop recommendations for the implementation of JCs for nursing practice. Methods: The online survey of all 27 representatives of the "Network of Nursing Science and Practice Development" of the VPU e.V. was conducted from October to November 2020. The questionnaire was developed based on literature. The data analysis was descriptive. Results: 15 of the 19 clinics surveyed currently implement, or have previously implemented, a JC (response rate 70,4%). In approximately half of the clinics, JC is an established structure that is also offered as part of advanced training and continuing education (46,6%) and is used to develop and expand methodological, scientific competencies (86,6%). Positive experiences, but also structural problems in the implementation of a JC were reported. Approximately one quarter of the clinics evaluate their JC regularly (26,7%). Conclusions: JCs at German university hospitals are currently being established. In order to establish JCs on a permanent basis, EBN knowledge must be continuously imparted in further education and training; in addition, JCs should be an essential component of academic role profiles.

Developing a competency framework for early career nurses undertaking post-registration education in care for older people

BACKGROUND

Within gerontological nursing as a postgraduate nursing specialty, there is a lack of consensus regarding the standardised competencies and education development required, particularly in the UK.

AIM

To develop and evaluate a competency framework for early career nurses undertaking post-registration education in a UK university in care for older people living with frailty.

METHOD

The competency framework was developed as part of a broader gerontological education-career pathway intervention to improve competence and retention among early career nurses. A four-step process was used to develop the framework guided by a consensus building approach. A mixed-methods approach to the evaluation was adopted, with an online survey, one-to-one interviews and focus group interviews with students and organisational stakeholders.

FINDINGS

A total of 33 students completed the competency framework as part of an academic module, 30 of whom took part in the evaluation. There was consensus among interviewees that the competencies confirmed 'what they knew already' and identified areas they needed to develop. Survey respondents reported that the competency framework was a useful part of the education-career pathway.

CONCLUSION

The competency framework was acceptable to students and feasible to complete. It also enabled students to appreciate the unique knowledge and skills that underpin gerontological nursing and to evidence their expertise using a structured approach.

Comprehensive geriatric assessment: outcomes of an advanced nurse practitioner-led service for older people requiring emergency surgery

A comprehensive geriatric assessment (CGA) is a holistic multidimensional review of older people living with frailty or at risk of frailty. In emergency surgical settings, CGAs can be used to identify medical issues and geriatric syndromes among older patients and consequently try to improve their post-operative outcomes. However, there is a lack of geriatrician input in hospitals beyond medical wards, which means that older people who need emergency surgery do not always undergo a CGA, with potential negative repercussions for their post-operative outcomes. One solution to this issue is to employ advanced nurse practitioners (ANPs) to deliver equivalent services. This article presents and discusses the results of an audit of an ANP-led CGA service for older people admitted to hospital for emergency surgery. The ANP reviewed 147 patients during the audit period and identified frailty in 37% and new medical issues in 89% of patients. Interventions initiated by the ANP based on the CGA included requests for additional investigations, referral to allied health professionals and discharge planning. The audit results suggest that ANPs can conduct CGAs in emergency surgical settings effectively.

How nurses and midwives engage with patient experience data to inform person-centred quality and safety improvements

AIMS AND OBJECTIVES

To explore how nurses and midwives engage with patient experience data collected via a mobile health app to inform person-centred practice improvements.

BACKGROUND

A large amount of data is collected in healthcare, yet there is limited evidence outlining how nursing and midwifery staff utilise patient experience data to inform person-centred quality and safety improvements.

METHODS

This study utilised action research, underpinned by Practice Development methodology and has been reported using the SQUIRE 2.0 checklist. Six clinical units (medical short stay, acute medical, surgical, oncology/haematology, day surgery and maternity) in a large health district in Australia engaged in three cycles of data collection using a mobile health app. The app captured patient experience data relating to the person-centred KPIs developed and tested by McCance et al. (2012). Staff used the data to develop and evaluate person-centred practice.

RESULTS

A number of improvements in scores and practice occurred through engaging with the data in a cyclical way. All six clinical units saw an improvement in four or more of the KPIs in the patient survey results from cycle one to cycle three, with two clinical units improving in all eight. On average across the six units, there was also an increase in time nurses/midwives were visible to their patients, an increase in clinical documentation reflecting the patients' needs and what was important to them, an increase in positive comments and a decrease in negative comments in patient stories.

CONCLUSION

This study shows that collecting and utilising data from the person-centred KPIs in a collaborative and cyclical way lead to enhanced patient experience and the development and implementation of person-centred quality and safety improvements.

RELEVANCE TO CLINICAL PRACTICE

Capturing and utilising data that are meaningful to nursing/midwifery teams in a cyclical, action-orientated approach result in person-centred practice improvements that enhance the experience of those that are receiving and delivering patient care.

Assessing sense of coherence as an element of primary-focused health services in schools for children and adolescents with complex health care needs

AIM

This study aimed to clarify if sense of coherence (SOC) could be used as an element of primary-focused health services in schools.

BACKGROUND

The United Arab Emirates (UAE) is striving to develop a high-quality, primary-focused health care system. School health care services are well established in the UAE but have not yet been fully used to play a key role in this development.

METHODS

This is a cross-sectional survey study to explore adolescents' SOC and their behavioural, psychosocial and clinical outcomes.

RESULTS

A total of 408 adolescents participated in this study. Compared with others, adolescents with higher SOC had better adherence to treatment, fewer visits to the school nurse, better self-efficacy, fewer hyperactivity problems, fewer emotional problems, more prosocial behaviours and fewer conduct problems.

CONCLUSION

Implementing interventions that improve SOC may support improved well-being among adolescents. The findings also support the use of SOC and salutogenesis as a framework to reinforce primary health care services for this population.

IMPLICATIONS FOR NURSING MANAGEMENT

Health service managers can utilize SOC as a framework to focus service on illness prevention and health promotion, they should collaborate with education authorities to include more health-related topics as part of school curricula to promote students' SOC and, finally, they should assess and build awareness of SOC and associated tools among school nurses and primary health care providers.

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.