The value of nursing :
"... encourage workplace cultures that respect nurses’ days off and vacation time, promote nurses’ prompt departure at the end of a shift..." Witkoski Stimpfel et al. (2012).
"... the development of safe nurse-to-patient staffing ratios established nationally and used by commissioners and service regulators would be of economic value to the NHS ... RCN. (2012).
"As nurse staffing levels increase, patient risk of nosocomial complications and hospital length of stay decrease, resulting in medical cost savings, improved national productivity, and lives saved." Dall et al (2009).
"By providing quality care, registered nurses reduce both the length of hospital stay among patients receiving acute care interventions and the number of readmissions among clients receiving care at home." CNA (2009).
"The lower the proportion of professional nursing staff employed on a unit, the higher the number of medication errors and wound infections. The less experienced the nurse, the higher the number of wound infections. Nurse staffing models that included a lower proportion of professional nursing staff in the mix used more nursing hours in this study." McGillis Hall et al (2004).
"There is a direct relationship between nurse staffing and patient well-being." DPE (2003)
"After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction." Aiken et al (2002).
References:
Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., Silber, J.H. (2002) Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. Journal of the American Medical Association. October 23/30, Vol 288, No. 16
CNA (2009) The value of Registered Nurses. Fact Sheet. Canadian Nurses Association. Ontario. page 2.
Dall, T.M., Chen, Y.J., Seifert, R.F., Maddox, P.J., Hogan, P.F. (2009) The Economic Value of Professional Nursing. Medical Care. January - Volume 47 - Issue 1 - pp 97-104.
DPE Research Department. (2003) Fact Sheet 2003–1. Washington. The Department of Professional Employees. AFL-CIO.
McGillis Hall, L., Doran, D., Pink, G.H. (2004) Nurse Staffing Models, Nursing Hours, and Patient Safety Outcomes. Journal of Nursing Administration January - Volume 34 - Issue 1 - pp 41-45
Witkoski Stimpfel, A., Sloane, D.M., and Aiken, L.H. (2012) The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. HEALTH AFFAIRS 31, NO. 11: 2501–2509
webPage for research and private study
Wednesday: 20th March 2013. 11.50 – 13.15 Concurrent session 1 – Dublin 1
1.8 Theme: Health care support workers
1.8.2
The characteristics and workplace activities of nursing auxiliaries and health care assistants.
Felicity Hasson, University of Ulster, UK
1.8.1
'To keep a person in their own wee corner'! An exploration of the roles and responsibilities of the home help and domiciliary care worker, a grounded theory approach. Kevin Moore, University of Ulster, UK
1.8 Theme: Health care support workers
1.8.1
‘To keep a person in their own wee corner’! An exploration of the roles and responsibilities of the Home Help and Domiciliary Care Worker, a Grounded Theory approach.
Presenter: Kevin Moore, Lecturer in Nursing,
Associate Member Institute of Nursing and Health
Research, University of Ulster, UK
Author(s): Moore, K.D., Ryan, A.A., Boore, J.R.P.
Abstract
Background: Worldwide demographic trends indicate an expansion in the elderly population, a
reduction in the numbers of young adults available for employment in support roles, changes in the ability of family members to provide informal support, and in general significant changes in
the health and dependency levels of older people (Laing & Buisson, 2002, LIVINDHOME, 2011). These changes will have a direct impact on the nature and type of services provided by primary health care teams, and home care services as indicated within the Compton Review (2011).
Aim: The study sought to explore service provision and the roles and responsibilities of home helps and domiciliary care workers and to make recommendations for future service planning and provision.
Method: The study involved two distinct phases. This paper reports Phase 1 only which utilised a Grounded Theory approach (Strauss & Corbin, 2008) with qualitative methods using 14 focus group interviews and 5 semi-structured interviews. Total participants (n=179).
Results: Positive aspects of role attributed to perceived levels of satisfaction in working and caring for older people, fulfilling important and vital role. Caring linked to preserving the client’s dignity, respect, rights and independence with motivation for a person-centred focus, with familiarity, trust, and knowing the person. The promotion of hope amidst endogenous and exogenous challenges to care provision was also central to care. The location of care, whether rural or urban can have a direct influence on care provision.
Conclusions: The role of the Home Help/DCW is an extremely important and interconnected one to care in the community. Evidence supports a work force that is motivated by altruism and a personcentred caring ethos. Workers value the importance of their role, but, there exists that disconnect between valuing of role, and its’ recognition within the wider Health & Social Care context.
1.8.2
The characteristics and workplace activities of Nursing auxiliaries and
Health Care Assistants
Presenter: Felicity Hasson, University of Ulster, UK
Author(s): Felicity Hasson; Northern Ireland: UK;
Professor Hugh McKenna, Northern Ireland, UK;
Dr Sinead Keeney, Northern Ireland; UK
Abstract
Background: The deployment of unregistered care workers is an important feature across in
the healthcare workforce, nationally and internationally. However, despite the prominence of their role in patient care, evidence on their use, title, preparation and consequences remains limited. This study addresses some of these gaps in the empirical literature.
Aim: This paper reports on the personal characteristics, role and educational attainment of health care assistants working in the NHS and private care home sector.
Methods: During 2010, a purposive sample of 111 HCAs and nursing auxiliaries based in the NHS and private care homes took part in semi-structured interviews and completed demographic questionnaires. The interviews explored the role of the assistant.
Results: Data indicate that the majority of participants were female, aged 40 plus and were an
experienced workforce. Most held a NVQ level 2 in health and social care (43.2% n=48); however their title, role and preparation varied across and within clinical settings. Core tasks revolved around direct patient care; however more technical/ clinical aspects were identified. Findings suggest that HCAs are undertaking tasks for which they have not been trained. Blurred and contested role boundaries between the health care assistant and nursing auxiliary caused tension and threats to identity, which had implications for teamwork and quality of patient care.
Discussion: The fluid roles of the health care assistant and nursing auxiliary have enabled them
to work beyond their remit, regardless of educational attainment. This has implications for patient safety, reaffirming the need for their competence to be reassessed. Managers also need to be aware of the assistant role hierarchy and the tensions that result from blurred demarcations.
Conclusions: It is recognized that healthcare assistants and nursing auxiliaries make an important contribution to health care; nonetheless, the need for clear boundaries linked to minimum standards is required.
Wednesday: 20th March 2013. 14.30-15.55 Concurrent session 2 Grand 4
2.4 Theme: Leadership
2.4.1
The emotional demands of nursing leadership: challenges and strategies for career sustainability
Professor Debra Jackson, University of Technology, Sydney, Australia
2.4.2
Exploring the link between leadership, leadership behaviours, organisational culture and motivation in nursing
Dr Julia Egan NHS Tayside, UK
2.4.3
Resonant leadership and workplace empowerment in reducing workplace incivility
Dr Heather Laschinger, The University of Western Ontario,Canada
14.30 – 15.55 Concurrent session 2 – Wednesday 20th March 2013
2.4 Theme: Leadership/concordance
2.4.1
The emotional demands of nursing leadership: challenges and
strategies for career sustainability.
Presenter: Professor Debra Jackson, University of Technology Sydney, Australia
Author(s): Debra Jackson, University of Technology Sydney, Australia; John Daly,
University of Technology Sydney, Australia; Lesley Wilkes, University of Western Sydney, Australia; Wendy Cross, Monash University, Melbourne, Victoria, Australia
Abstract
Background: Leadership is identified as a crucial area that requires further development in nursing.In order to provide appropriate preparation and support for nurses aspiring to leadership roles, there is a need to acknowledge and better understand the realities and everyday challenges of leadership.
Aims: To identify and describe some challenges and difficulties experienced by nursing leaders, and develop strategies to mitigate these, thus assisting aspiring and incumbent nursing leaders in successfully meeting the demands of leadership.
Method: Oral narratives were gathered from 30 nursing deans in three countries during June 2011 to March 2012. Narrative was transcribed and subject to thematic analysis.
Results: The themes highlight the emotional demands of leadership. Issues raised included
loneliness, being unpopular, needing to take hard decisions, distancing, being guarded, dealing with betrayal and personal attack, working with failure, drawing on personal courage, redefining friendships, rebuilding relationships and maintaining positivity even in the face of unrelenting pressure. Protective strategies included active reflective processes, developing a supportive peer network, seeking out mentoring and striving for work/life balance.
Discussion: Leadership carries considerable emotional demands. The ability to mitigate these
demands is essential to effective leadership; while inability to do so could lead to burnout and loss of potentially effective leaders. There is a need to ensure that nurse leaders recognise the emotional demands of leadership, have access to adequate personal support, and strategies in place for effective self-care.
Conclusion: It is essential that aspiring and incumbent nursing leaders are able to meet the
emotional demands associated with leadership. To be effective, nursing leaders require highly
developed reflective skills, the ability to self-regulate emotional responses, exercise self-control and actively engage in emotionally protective behaviours.
2.4.2 Exploring the link between leadership, leadership behaviours,
organisational culture and motivation in nursing
Presenter: Dr Julia Egan, Consultant in Public Health Nursing, NHS Tayside, UK
Author(s): Julia Egan, Scotland, UK.
Abstract
Background: Leadership has become an important area in recent years particularly in relation to improving efficiency, effectiveness and quality of services. As nurses provide 80% of care in the NHS their role is pivotal in achieving any change. Despite the importance placed on leadership in the NHS, literature shows little is known about perceptions of leadership, how leaders function or what importance staff place on the culture and context in which they work.
Aims: This qualitative study aimed to; explore how leadership and leadership behaviours within the NHS and particularly nursing, function in practice and what part organisational culture plays in how these behaviours develop and function.
Methods: The study used a case study approach applying grounded theory and thematic network analysis to data generation and analysis. Over three phases, 28 interviews were undertaken with executives, directors, and specialist clinical and non-clinical staff.
Findings: Leadership comprises two elements; one relating to individuals and one relating to how individuals function in organisations. Secondly, three models of leadership emerged and how these apply differs according to role and hierarchy. Thirdly, leadership and management are distinct components. In nursing a number of complexities make these roles challenging, and the culture and context of health boards influence how these function in practice. Finally this research concludes that staff value a clear set of characteristics, styles and behaviours not related to vision and change but which centre on character, values, integrity and engagement.The study has considerable implications for emerging work on leadership in the NHS and for the future development of leadership roles in nursing. This presentation will focus on the key characteristics, styles and behaviours valued by nurses and their relationship to improving quality, motivation, performance and patient care.
2.4.3
‘Lets join hands and jump together’: Readiness and implementation of skill mix change
in general practice
Presenter: Professor Annie Topping, Professor of Nursing, Institute for Research in Citizenship and Applied Human Sciences University of Huddersfield, UK
Author(s): Annie Topping (UK), Idah Nkosana-Nyawata (UK), Valerie Featherstone (UK) and John Stephenson (UK)
Abstract
Background: The last 10 years has seen major changes in the ways general practices deliver
UK primary care services. In a context of skill shortages, cost containment, policy reform,
quality improvement and increasing volume of interventions delivered in primary care, new ways of working are becoming the norm. Skill mix, such the introduction of advanced nurse practitioners (ANPs) and health care assistants (HCAs), has fundamentally re-engineered the primary care workforce (1).
Aim: This study explored the features of general practices that successfully accommodate and demonstrate readiness to re-design and implement skill mix.
Design: Five GP practices serving different population size, demography and geography participated in a multi-case mixed methods study (2) design. Team Climate Inventory [TCI-14] (3) was administered to all staff. Following exploratory analysis hierarchical regression modelling was undertaken. Semi-structured interviews with ANPs, general
practitioners (GPs), practice nurses (PNs), HCAs and business managers were analysed using thematic analysis.
Findings: 122 clinical and non-clinical informants completed the TCI-14. Mean TCI-14 scores
were consistently high (50.8 – 59.0) across all subscales, for all practices, suggesting willingness to work collectively toward shared goals. Size of practice made no difference to mean scores, but higher mean scores were associated with proportion of clinical staff, years employed in the practice (p=<0.001) and gender. Comparison of TCI-14 with patient experience Quality and Outcome Framework (QOF) scores showed no significant
differences. The changing architecture of primary care and role of skill mix in delivering patient
services emerged in the qualitative data.
Discussion: Organisational willingness, demonstrated by TCI-14 score, may be an indication
of readiness to consider change. Case analysis indicated no single change model was in operation but openness, transparency, commitment and maximising staff capability appeared to be attributes associated with readiness.
Conclusion: This presentation will focus on the conditions that contributed to successful
workforce re-design.
S 6 Symposium – Wednesday 20 March 16.30 – 18.00 Copenhagen 1
Symposium 6
Inclusive methodologies for conceptualising and implementing self-management. Empowered
users or abandoned patients?
Presenter: Professor Sue Latter, , University of Southampton, UK
This symposium consists of four inter-linked papers that focus on the contemporaneous
concept of self-management. We seek to discuss self-management, using the case study of stroke,
and highlight limitations in the measurement of self-management and how these may be best
addressed. We discuss our experience of involving patients in the conceptualisation of self-management and why this is important to further debate. Finally, we discuss the impact of self-management upon patients and consider the challenges to patients and health care professionals in developing effective self-managers.
Presentation one led by Emma Boger, provides an overview of the measurement of self-management in relation to stroke. Consideration is given to how self-management is currently measured internationally, drawing on the findings of a recent systematic review. Recommendations for future practice are proposed for discussion.
Presentation two led by Emma Boger, discusses the importance of involving patients in research
focused on the conceptualisation of self-management. The challenges of engaging with vulnerable
groups are considered, with strategies to encourage this discussed. Findings from two
qualitative studies are discussed with particular focus on a case study of a patient that highlights
the potential challenges in trying to effectively self-manage.
Presentation three led by Dr Matthew Hankins, discusses the methodology underpinning the
measurement of patient experience and how this commonly overlooks or actively excludes patient
involvement, using examples from a wide range of conditions. Recommendations for qualitative and
quantitative stages in developing measures are presented.
Presentation four, led by Dr Sara Demain considers the notion of the ‘Burden’ associated with selfmanagement following stroke. Findings of an in-depth qualitative interview study are discussed,
with particular consideration given to delivering minimally disruptive self-care rehabilitation. A
preliminary conceptual framework for the burden of self-management following stroke is presented.
Paper 1
How well are we measuring self-management in stroke? A systematic review of patient
reported outcome measures.
Presenter: Emma Boger, PhD student, Faculty of Health Sciences, University of Southampton
Sara Demain, NIHR Post Doctoral Research Fellow, Faculty of Health Sciences, University of
Southampton
Sue Latter, Professor of Nursing, Faculty of Health Sciences, University of Southampton
Background: Self-management is a term adopted to refer to the strategies decisions and activities
individuals take to manage a health condition. Self-management has potential importance for
reducing the impact of illness and the strain on health service systems (Coster and Norman, 2009).
The use of well-developed outcome measures would provide evidence that could enhance selfmanagement in this patient group (Palfreyman, 2011).
Aims: To review the properties of outcome measures used in stroke self-management to
inform researchers and clinicians and to make recommendations for future practice.
Methods: Systematic searches of electronic databases, government websites, generic internet
search engines and hand searches of reference lists were conducted. Evidence of measurement
properties (reliability, validity, responsiveness) were sought using a standardized checklist. The
extent of involvement of patients in measure development and theoretical underpinnings of
each intervention was also explored.
Results: 13 studies of stroke self-management originating from six countries were first identified.
43 different measures were adopted by self-management interventions. Six (46%) studies included
untested measures. Eleven (85%) studies included at least one measure without reported reliability
and validity in stroke populations. Three measures adequately included patients in their development
(SSEQ, SIPSO, SA-SIP30).
Discussion: Few interventions specifically stated a theoretical underpinning and no intervention
measured self-management as a discreet concept. Outcome measures which are related, indirect
or proxy indicators of self-management and with questionable reliability and validity, contribute to
an inability to sensitively evaluate the effectiveness of stroke self-management interventions.
Conclusions: Future enquiry into how self-management in stroke operates, would help to clarify
the nature and range of specific self-management activities to be targeted in interventions. Enquiry
would also elucidate those aspects of self-management that may be conducive to measurement.
References
COSTER, S. & NORMAN, I. 2009. Cochrane reviews of educational and self-management interventions to guide nursing practice: a review. International Journal of Nursing Studies, 46, 508-528.
PALFREYMAN, S. 2011. Patient-reported outcome measures and how they are used. Nurs Older
People, 23, 31-6.
Paper 2
‘Just getting on and doing it yourself’: Capturing the meaning of
self-management to patients.
Presenter: Emma Boger, PhD student, Faculty of Health Sciences, University of Southampton
Sara Demain, NIHR Post Doctoral Research Fellow, Faculty of Health Sciences, University of
Southampton
Sue Latter, Professor of Nursing, Faculty of Health Sciences, University of Southampton
Background: ‘Self-management’ is often used by professionals to denote those activities patients
do to maintain health (Wilson et al., 2006). However, little is known about what it means in
practice to people following stroke.
Aims: To share our experience of exploring self-management following a focus group and
interview study conducted with people following stroke. We seek to highlight the patient perspective
of self-management and consider the challenges to professionals of working with informed
and active users of health services. We present the perspective of a patient on self-managing
following a stroke.
Discussion: Adequately seeking the perspective of patients may involve working with vulnerable
groups, such as those with impairment. We highlight some of the challenges in involving vulnerable
groups and the strategies used to help facilitate involvement.
References
WILSON, P., KENDALL, S. & BROOKS, F. 2006. Nurses’ responses to expert patients: the rhetoric
and reality of self-management in long-term conditions: a grounded theory study. International
Journal of Nursing Studies, 43, 803-818.
Paper 3
Developing measures of patient experience: maximally-inclusive methodologies
Presenter: Mathew Hankins, Senior Lecturer in Public Health, Faculty of Health Sciences,
University of Southampton
Background: The measurement of patient experience is increasingly viewed as an important
outcome in its own right and the use of patientreported outcome measures (PROMs) and other
questionnaire measures is becoming routine in NHS practice and healthcare research. The methodology
for developing and validating these measures is well-established, yet commonly excludes the patient from the development process. This is especially problematic for measures of subjective experience such as healthrelated
quality of life and treatment burden, since it is the patient’s perspective that is of interest.
Aims: To provide an overview of the qualitative and quantitative methods used to develop measures
of patient experience. By focusing on the inclusiveness of these methods, it will be argued that
current methods actively exclude patient input into the development of patient experience measures.
Examples will be drawn from our research across a range of conditions.
Discussion: Despite the need for patient involvement in the development of measures of patient
experience, commonly used methods exclude patient-derived content. We propose maximallyinclusive
methodology for both the qualitative and quantitative phases of measure development.
Paper 4
The burden of self-management on
patients and families
Presenter: Sara Demain, NIHR Post Doctoral Fellow, Faculty of Health Sciences, University of
Southampton
Background: Self-care and self-management are important government strategies for managing the
growing challenge of long-term illness. Research has focussed on developing interventions to
promote behaviour change and self-management. Until recently, however, little attention has been
paid to understanding the work of self-care and the burden this places on patients and carers (May
et al, 2009). Stroke rehabilitation, which is increasingly community based, provides a good opportunity
for exploring patient and carer self-care burdens.
Objectives: To use the case of stroke rehabilitation to generate a conceptual model of the workload of
self-management and the treatment burdens this generates for people with stroke and their families.
Methods: In-depth qualitative interviews with people with stroke (n= 24) and associated family
and friends (n<24) undertaking and supporting self-care rehabilitation were conducted. Participants
were purposively sampled for age, gender, stroke severity, ethnicity and aphasia. Interviews
focussed on the burdens (the hassles, difficulties, and stresses) generated by stroke self-care
rehabilitation, the consequences of these for rehabilitation adherence as well as suggestions
for making engagement with self-care rehabilitation easier. Interviews were digitally recorded and
transcribed. Data were analysed using Framework analysis
Results: Key themes, identified from the data, forming the basis of the conceptual framework of
the workload and burdens of stroke self-care rehabilitation will be presented, together with data
extracts to support these. Initial findings highlight the workload of coordinating care needs, finding
support and negotiating services and the negative impacts of self-care rehabilitation on spousal and
family relationships and self-identity.
Discussion: The discussion will relate the findings to existing research, current self-care policy
and consider recommendations for delivering minimally disruptive self-care rehabilitation.
References
12. MAY, C., MONTORI, V.M., MAIR, F.S. 2009. We need minimally disruptive medicine. BMJ,
339:b2803.
09.00 – 10.25 Concurrent session 3 – Thursday 21st March 2013. Grand 5
3.3 Theme: Perspectives on palliative care
3.3.1
Exploring public awareness of palliative care
Presenter: Dr Sonja McIlfatrick, Reader, University of Ulster, UK
Author(s): Sonja McIlfatrick, UK/Ireland, Hasson F, McLaughlin, D, Roulston, A, Rutherford, L, McCrory, N, Kernohan, G, Payne, C, Noble, H, Johnston, G
Abstract
Background: International research suggests that the general public appear to be confused about
what palliative care is and who provides it (Hirai et al. 2011; McCarthy et al. 2011). Evidence suggests
that this can lead to negative impressions and consequences for the quality of care provided to the
dying and bereaved (Seymour et al. 2010). Given the aging population and the increasing number
of patients requiring palliative care it is vital to explore the public’s perception of such services.
Objective(s): To explore public’s perceptions of palliative care.
Methods: A sequential exploratory mixed methods research design was used. Phase 1 involved a
descriptive, self-report, survey. The sample for the study included members of the Patient and Client
Council Membership Scheme (n=4000). A survey pack was distributed via on line and by post. Data
was analysed using SPSS and descriptive and inferential statistics were used to summarise the data.
Phase 2 comprised semi-structured telephone interviews with those respondents who indicated a
willingness to participate from stage 1 (n=60). The purpose of the interviews was to provide greater
insight into the perceptions on palliative care with a focus on strategies that could be developed to
raise awareness among the general public. These interviews were tape recorded, supplemented by
field notes and content analysed.
Results: Key themes emerged from the telephone interviews focusing on an overall perception of
palliative care and the importance of developing targeted strategies for raising public awareness
of palliative care. Over 583 questionnaires were returned (Postal=344; Online = 239). The analysis
of the questionnaire is ongoing but is exploring inter-group comparisons and significant differences
on variables such as age and gender
Conclusions: The general public have differing perceptions and views on palliative care & the
findings can inform policy makers on strategies to raise awareness of palliative care.
3.3.2
Perceptions of patients and clinical research professionals regarding
participation in a palliative clinical trial
Presenter: Mary Murphy, University of Ulster, UK
Author(s): Mary Murphy, Northern Ireland, UK; Eilis McCaughan, Northern Ireland, UK; Richard
Wilson,Northern Ireland, UK; Donna Fitzsimons, Northern Ireland, UK.
Abstract
Background: Informed consent has the dual function of protecting patients from potentially
risky treatments, and ensuring their autonomy (Jefford and Moore 2008). However, in some
clinical scenarios the validity of informed consent can be questioned, on the grounds of patients’
understanding of what is involved, their motivation for trial participation and perceived vulnerability
(Cohn and Larson 2007).
Aims: This study seeks to understand the main issues patients with incurable cancer, consider
when making decisions regarding consent for a trial with palliative intent. It also seeks to identify
the issues the research team perceive as important to patients and to compare the two perspectives.
Methods: A classic grounded theory approach using in-depth interviews with a theoretical sample
of 15 patients and 13 nurses and doctors from the clinical research team. We analysed each interview
using standard grounded theory approaches. Results: Preliminary findings suggest that
patients’ decisions are influenced by a variety of factors including seeing the trial as their only hope
for prolongation of life, a desire to avoid passivity and the persuasive language used by doctors and
nurses during consent process. Clinicians held very positive views on research participation, stating
that it offers patients a better standard of care, and some described ‘selling’ the trial to patients.
Conclusion: These preliminary findings demonstrate that patients’ motivation for trial consent
is complex and that they perceive themselves in a paternalistic relationship with their doctor
and thus are influenced by the language used. Research nurses are viewed as less paternalistic,
and play an important role in helping the patient to balance the information, before making a decision.
3.3.3
Nurses beliefs, attitudes and behaviours in palliative sedation:
evidence from a multicentre study in the UK
Presenter: Professor Jayne Brown, Professor of Palliative Care, De Montfort University, UK
Author(s): Jayne Brown UK, Jane Seymour UK, UNBIASED Group
Abstract
Background: Some patients experience refractory symptoms towards the end of life and palliative
sedation is sometimes used to relieve those symptoms 1. Nurses play an important role in the
practice of palliative sedation, however little is known about their experiences or understanding
of palliative sedation.
Aim: to examine what nurses from specialist and non-specialist palliative care settings understand
by sedation in end of life care for patients with cancer, and their experiences with the practice
Methods: UK Nurses (n=35); with a range of palliative care experience from 4 months to 30 years;
took part in 7 focus groups in 2010/11. Participants were drawn from hospice, acute hospital, specialist
palliative care, community specialist and nonspecialist nursing teams. Data were analysed using
NVivo, taking a constant comparison approach.
Findings: Nurses understood palliative sedation as part of a regime of symptom management of which
sedation was a side effect rather than an objective. Practice was described as a gradual progression
with the aim of giving ‘the smallest amount of sedation for the greatest symptom control’.
Some nurses found its use in existential suffering to be ‘difficult’. Requests for euthanasia, while
rare, had been experienced by most participants. Nurses were keen to avoid hastening death or to
be perceived as doing so and some had concerns about the proximity of sedation administration
to death of a patient. Decision making, a team activity, was more difficult at night and weekends.
Nurses identified gaps in their knowledge and understanding. Barriers to sedation practice
included negative attitudes of other staff and patients’ families. Facilitators included experience,
‘knowing’ the patient and levels of trust between nurses and other health professionals’, patients
and families.
Conclusion: These findings draw attention to key roles nurses have in decision making, implementation
and monitoring of palliative sedation and have implications for practice.
Thursday 11.00 - 12.20 d+m
11.00 Chair’s remarks
Professor Martyn Jones, Chair Scientific Committee & Professor of Healthcare Research, School of Nursing & Midwifery, University of Dundee, UK
11.10-11.50 Keynote presentation: Establishing a nursing centre of research excellence
Professor Wendy Chaboyer, National Centre for Research Excellence in Nursing (NCREN), Griffith University, Australia
11.50-12.00 The Mary Seacole Awards
Presented by Laura Serrant-Green, Director of Research & Enterprise, University of Wolverhampton, UK
12.00-12.20 Presentation of the Justus Akinsanya Award
Presented by Professor Michael Traynor, Professor of Nursing Policy, Middlesex University, London, UK
Fringe Library Bar
Thursday 21 March
Title: Quality indicators for Doctoral Education in Nursing: how are they measured and assessed?
Presenters:
Dr Sonja McIlfatrick, Reader in Nursing Research and Development, University of Ulster and
Professor Hugh McKenna FRCN, Pro-Vice-Chancellor (Research and Innovation), University of Ulster
4.2 Theme: Diabetes/young adults Rotunda
4.2.1
Psychosocial Factors and Type 1 Diabetes in Young Adults with Type 1 Diabetes
Presenter: Dr Laurie Quinn, University of Illinois at Chicago, USA
Author(s): Laurie Quinn, USA, Denise Kent, USA, Pam Martyn-Nemeth, USA
Abstract
Background: The incidence of type 1 diabetes (T1DM) is increasing worldwide at a rate of 3%
per year. Recent evidence suggests that young or ‘emerging adults’ have difficulty managing the
multiple demands of T1DM while transitioning to adulthood.
Purpose: The purpose of this cross-sectional descriptive study was to explore the relationships
among fear of hypoglycemia (FOH), fear of complications (FOC), self-management, self-efficacy
(SE), diabetes knowledge, and quality of life (QOL) in young adults aged 18-35 years with duration of
diabetes ⥠1 year to provide a basis for future interventions with this vulnerable group.
Methods: The data were collected via web (Survey Monkey) during 2010.
Results: The sample consisted of 180 young adults with T1DM ages 27.4 ± 4.7 (mean and SD), who
were predominantly female 149/31 (F/M) and had higher than recommended glucose levels (A1C: 7.4
± 1.5%). In regression analysis FOH, FOC and SE significantly predicted QOL in young adults with
T1DM (F (3, 176) = 67.67, p <.005). Subjects (53.1%) reported that they maintained their ‘blood
glucose levels high when planning on attending a long meeting or party’; while 27.2% reported that
they kept their ‘blood glucose levels high when anticipating being alone’. Assuming possible
adaptation to T1DM over time, we examined these factors in a subsample of the subjects (ages: 18-30
years, duration of diabetes > 5 and < 15 years [n=64]). These numbers were consistent with the
larger study as 47.2% reported keeping blood glucose high for meetings etc. and 31.7% reported
maintaining higher blood glucose levels when alone.
Conclusions: Psychological factors, such as FOH, may lead to poor self-management habits.
Sustained elevations in blood glucose levels likely contribute to diabetes complications. Implications:
Interventions designed to address factors such as FOH may impact glucose control and the
genesis of complications; therefore decreasing personal, familial and socio-economic costs.
4.2.2
The experiences of young adults with degenerative conditions on general adult wards
Presenter: Professor Bryony Beresford, University of York, UK
Abstract
Background: Improving the preparation for, and transfer to, adult health care for young people with
chronic illnesses is a policy and practice priority. However, inpatient episodes are not typically
feature in transition planning. This is particularly pertinent when the trajectory of the condition
means acute admissions are likely to occur soon after the transfer from paediatrics to adult health.
Aims: To describe the experiences of young adults with degenerative conditions admitted to general
adult wards.
Methods: Semi-structured interviews with 34 young adults (17-25 yrs) with childhood diagnosed
degenerative conditions including cystic fibrosis (12), muscular dystrophies (14) and renal disease
(8); and 19 parents (recruited via young adult participants). Results: Poor in-patient experiences were identified
as the most difficult aspect transition. One or more factors contributed to these negative
experiences. Families felt unprepared for the differences between children’s and adult wards, such
as the age and condition of other patients and restricted visiting hours. Staff lacked knowledge
of the young adults’ condition, and this could lead to sub-optimal care. Staff assumed that the young
adult wanted to make their own treatment choices without parental support. There was little flex in
ward policy (and practical facilities) to accommodate overnight stays, despite the young adults’
need for care and support. Young adults felt socially isolated and lacking peer support.
Discussion and Conclusions: The findings highlight the need, where necessary, to incorporate
admissions to adult wards into transition planning processes. Specialist teams may want to consider
training staff on the wards onto which their young adult patients are admitted. Ward managers may
wish to review policies on extended/overnight visiting with respect to young adults with particular
conditions. Young adults’ preferences for the involvement of their parents in consultations/ decision-making should be identified.
4.2.3
Glucose derangement among a stroke cohort: implications for glucose monitoring practice
Presenter: Elizabeth Laird, Lecturer of Nursing, University of Ulster, UK
Author(s): Elizabeth A Laird, N Ireland; Vivien Coates, N Ireland; Assumpta Ryan, N Ireland;
Diane Lyttle, N Ireland; Evie McCrum-Gardner, N Ireland.
Abstract
Background: Hyperglycaemia is commonly observed among adults admitted to hospital with
acute stroke. Nurses have a major role in the monitoring of glucose, and subsequent management of
glucose derangement.
Aims: To explore glucose derangement among a stroke cohort, and establish an evidence base to
inform glucose monitoring practice after stroke. Methods: A descriptive cohort study was
conducted of 112 consecutively admitted adults (61% women, mean age 74 years) with acute
stroke to all three district hospitals in one NHS Trust, to examine glucose derangement and its
management. Data were collected in 2009.
Results: Eighteen (16%) adults had a history of diabetes mellitus, but 41 (36.6%) of the
cohort experienced hyperglycaemia (glucose > 7.8mmol/l) in the first five days. There was a significant
difference in number of days of near patient glucose monitoring for those with diagnosed
diabetes (M = 15.88 days, SD24.78) and those without (M = 1.74 days, SD=10.88, t(17.15)=2.3,
p=.034), mean difference = 14.1, 95% CI: 1.2 to 27). Hypoglycaemic events (glucose < 4.0mmol/l)
were experienced by 11(10%) adults. Only two of the hypoglycaemic episodes involved adults with
a history of diabetes mellitus. None of the adults who experienced hypoglycaemia had received
intravenous or subcutaneous insulin. Whilst a history of diabetes mellitus prompted near patient
glucose monitoring, only 15 (16%) of the 94 adults without a history of diabetes mellitus received
such monitoring.
Discussion: Much research has focussed on hyperglycaemia after stroke; our study indicates the
additional risk of hypoglycaemia. This finding reinforces the need for vigilance in glucose monitoring
and management.
Conclusions: Irrespective of diabetes mellitus status, all adults admitted to hospital with stroke
should have their glucose monitored in the first 5 days.
15.35 – 17.00 Concurrent session 5 – Thursday 21th March 2013 EC
5.6 Theme: Older people
5.6.1
Concept Analysis of Personal Grooming: understanding the presentation of self.
Presenter: Jan Woodhouse, University of Chester, UK
Author(s): Jan Woodhouse, UK
Abstract
There are a plethora of studies investigating matters of hygiene and of body image in relation
to nursing and other disciplines. However, the topic of ‘personal grooming’, whilst noted as an
everyday activity (1), has received scant attention in nursing research. Therefore the concept has
formed the basis of a grounded theory PhD study, investigating its definition, the normal activities
of personal grooming and changes in personal grooming activity brought about by the life course.
To enable a thorough understanding of the concept of ‘personal grooming’ the use of Concept Analysis,
as defined by Walker and Avant (2005), has been utilised. This model helps to explore the related
concepts, the antecedents and consequences of the concept, its critical attributes, as well as
assisting in an academic definition of personal grooming. Data, drawn from focus groups and the
literature, enable this process. The presentation will outline these stages of concept analysis and
the subsequent findings, which will be presented in a visual model format. Part of the process of Concept Analysis is to exemplify different cases where the concept may, or may not apply, such as a model case, a borderline case and a contrary case. Examples, drawn from songs, help to provide such cases.
The presentation will then consider the relevance and importance of understanding personal
grooming in nursing. Personal grooming has been cited as essential to the sense of self (3)
and attention to it may help in maintaining good psychological health in people who encounter the
needs of health and caring services. The presentation will conclude with an outline of future study and time for questions.
5.6.2
The moving and handling of older adults with osteoporosis while in hospital: preliminary findings.
Presenter: Dr Margaret Smith, Senior Lecturer, Queen Margaret University, UK
Author(s): Margaret Smith, Scotland, UK; Lindesay Irvine, Scotland, UK; Savina Tropea, Scotland, UK; Fiona O’May, Scotland, UK; Shona Cameron, Scotland, UK; Jackie Berg, Scotland, UK
Abstract
Introduction: Older people can have complex needs arising from the acute illness precipitating
hospital admission, multiple co-morbidities, cognitive or functional deterioration, polypharmacy,
and significant social care needs (RCP 2012, Conroy and Cooper 2010). Frail older patients
require access to comprehensive geriatric assessment and cohesive care approaches (RCP 2012).
Osteoporosis is a skeletal disease leading to altered bone structure, lowered bone density,
reduced strength (IOF 2012), and increased low trauma fracture risk. One in three women and one
in five men aged 50 years+ will experience low trauma fracture in their lifetime, with the most
common sites for such fractures being the hip, spine and wrist (IOF 2012). Research generally focuses on fractures arising from falls. However, increased bone fragility heightens the risk of either spontaneous fractures
or low trauma fractures sustained during routine moving and handling (M&H) of patients with osteoporosis.
Some patients with osteoporosis report anxiety about M&H during hospital procedures
(Osteoporosis News Winter & Spring 2010), supporting exploration of M&H from both healthcare
staff’s and patients’ perspectives. The findings reported refer to qualitative interviews with the former.
Materials and Methods: A descriptive qualitative research design, and literature review, explored
the views of healthcare staff about the M&H needs of people (aged 65+) with osteoporosis while in
hospital. A purposive sample of 25 healthcare staff from one Health Board participated in semi-structured
interviews (during May to October 2012), and data were submitted to qualitative data analysis.
Results and Discussion: Themes included adhering to manual handling guidelines, M&H
of frail older persons, and the ethics of providing physical care.
Conclusion: Specific findings guiding safe patient handling for frail older people complement
standard manual handling guidelines. This research informs a collaborative education and
quality initiative with NHS staff.
5.6.3
A grounded theory study of the nursing team contribution to the rehabilitation of older hospitalised adults with mobility needs.
Presenter: Dr Rosie Kneafsey, Senior Lecturer in Adult Nursing, Coventry University, UK
Author(s): Rosie Kneafsey, United Kingdom
Abstract
Aims of presentation: To present a grounded theory of the nursing contribution to hospitalised patients’ mobility rehabilitation (Kneafsey 2012). In particular, a two part core category entitled ‘Care to Keep Safe – Safe to Care’ will be discussed.
Background: For many older adults, an admission to hospital has a negative impact on walking ability,
leading to a reduced level of functional independence (Brown et. al. 2009). Within the international literature, it is suggested that nurse-led, targeted in-patient rehabilitation interventions may have the capacity to prevent hospital induced functional deterioration (e.g Resnick 2011).
Objectives: The study set out to describe and explain the nursing and care assistant contribution to hospitalised patients’ mobility rehabilitation. Methods: A grounded theory, case study design underpinned the study, which was completed between June 2007 and December 2009. Data collection took place in a general rehabilitation ward, a regional spinal injuries unit and stroke rehabilitation ward. Semi-structured interviews with 39
rehabilitation staff and 61 hours of non-participant observation comprised the data set.
Findings: The notion of ‘Care to Keep Safe’ was used to described how nurses and care assistants
focused primarily on preventing patient problems rather than focusing on rehabilitation goals. The
concept of ‘Safe to Care’ was used to highlight the factors which led registered nurses to take a back
seat in relation to patients’ mobility rehabilitation.
Conclusions: Significant changes in the teamworking and policy context for rehabilitation practice
are needed to enable nurses and care assistants to become more involved in the processes of mobility
rehabilitation. The problem of hospital induced immobility in older adults should be identified as
a form of avoidable harm. In this light, low mobility in older adults could be the target of nurse-led
patient safety initiatives. This would direct the nursing focus towards an active role in implementing
intentional strategies to promote mobility.
17.00-18.00 Ask the PhD Examiner?
This will be a facilitated panel “Question Time’ event where the audience can ask questions of experienced supervisors and examiners all those questions they previously had wanted to ask but had not felt able or had not until now had the opportunity to ask
Professor Annie Topping, University of Huddersfield, UK
Social event
A complimentary reception has been organised at the Stormont Parliment building. Details are:
Thursday 21 March 2013
18.30 Coaches leave front entrance of Europa Hotel for city tour en route to reception
Kindly provided by Belfast Visitor & Convention Bureau
19.00 Reception at Stormont parliament building
Kindly sponsored by University of Ulster with entertainment provided by Belfast Visitor & Convention Bureau
20.30 Final coaches leave Stormont parliament building for city centre
09.00 – 10.25 Concurrent session 6 – Friday 22 March 2013 Grand 4
6.4 Theme: Undergraduate/ preregistration education
6.4.1
Online Video in Clinical Skills Education for Undergraduate Student Nurses: A Mixed Methods Prospective Cohort Study
Presenter: Agi Holland, Lecturer, Edinburgh Napier University, UK
Author(s): Agi Holland, Scotland, Gill McCrossan, Scotland, Fiona Smith, Scotland,
Elizabeth Adamson, Scotland, Susan Watt, Scotland, Kay Penny, Scotland
Abstract
Background: Improvements in the safety of the prescribing, dispensing and administration of medicines are identified as an international priority (Department of Health 2003). It is essential that higher education institutions play their part
Aim: To evaluate the use of an online best practice exemplar as an adjunct to the clinical skills
teaching of oral medication administration to undergraduate student nurses
Methods: A mixed methods, prospective cohort design gathered data from two successive intakes
(n=168, n=154) undertaking a clinical skills module from September 2009 – May 2010. The Control
group received standard teaching using lectures and skills classes. The Intervention group received
the standard teaching and unlimited access to an online video clip of medication administration.
Performance and satisfaction were measured using module assessment results and a Student
Satisfaction Survey (SSS). Qualitative data were gathered using focus groups (n=16, n=20)
Results: The Intervention group was significantly (p=0.021) more likely to pass the assessment
and rate their satisfaction with the teaching significantly higher (p<0.05). Two Categories were
identified from focus group data; Classroom Learning and Transfer to Practice
Discussion and Conclusions: Previous research evaluating computer based video instruction
(CBVI) for clinical skills are limited in terms of their applicability to an undergraduate nursing setting
and methodology in relation to small sample sizes and lack of statistical power and control groups.
Additionally, no evidence is available which evaluates unlimited access to online CBVI as an
adjunct to taught clinical skills sessions despite this approach being best aligned to educational
theory. Our study addresses these limitations and provides strong evidence to support the use of
online video as a teaching adjunct to taught clinical skills input. The presentation will give an overview
of the project, detailed results and findings and share our experiences of developing and integrating
this innovative clinical skills teaching intervention into the curriculum
6.4.2
Establishing brief intervention training Into pre egistration Nurse training.
Presenter: Maxine Holt, Manchester Metropolitan University, UK
Abstract
Brief interventions provide a structured way to deliver advice and constitute a step beyond brief
advice. Brief interventions aim to equip people with tools to change attitudes and handle underlying
problems. The potential for nurses to engage in this role is, unprecedented across other health
care professions. This three year project presents the findings, from focus groups and interviews
with student nurses across 4 Higher Education Institutions, who experience brief intervention
training, as part of their nurse education.
Aim: Evaluate the impact of adding brief intervention training into the core nurse training curricula
on both the participating lecturers and the student nurse. 937 student nurses across four HEI’s participated
in the study over the three-year period as they progressed through their training.
Findings: Inclusion of Brief Intervention training in the pre-registration nursing curriculum results in
increased awareness of health promoting opportunities in student nurses, together with increased
confidence in creating health promoting opportunities in clinical practice.
Recommendations: Introduction of brief intervention training into pre-registration education
meant that students were more able to recognise opportunities for brief interventions and should
be supported. Consideration should be given to adding brief intervention training into pre registration curricula
as this report suggests that such training has an impact upon student confidence levels. The development of an agreed curriculum may be as effective as the development of specific lesson plans and teaching materials.
The inclusion of all teaching staff and all branches of nurse education was likely to contribute to a
positive experience for HEI’s and students. Formal student assessment in year 1 is important.
Support materials to be used in clinical practice should be practical – such as pocket sized to suit
clinical working environments.
6.4.3
Teaching clinical skills to undergraduate nursing students using a multiple intelligence teaching approach – an
experimental study.
Presenter: Linda Sheahan, Nursing lecturer, Waterford Institute of Technology, Ireland
Author(s): Linda Sheahan Rep of Ireland, Prof Alison While UK, Dr. Jacqueline Bloomfield UK
Abstract
Background: The clinical competency of nursing students has raised questions about the adequacy
of current methods of teaching clinical skills in the undergraduate nursing programme. It is argued
that despite the rhetoric of a student-centred approach; nurse education remains wedded to
conventional teaching approaches, which fail to engage with the individual. This paper presents the
findings of a doctoral research study which used a multiple intelligence teaching approach (MITA)
for skills teaching, a five-phase model developed by Weber (2000), as the method of teaching. This
study also accounted for the influence of individual learning styles (Felder and Solomon 1988),
the students’ multiple intelligences development assessment scale (Shearer 1999) and MI assessment
preferences questionnaire.
Aims: The aim of this study was to measure the effectiveness of using Multiple Intelligences Teaching Approach (MITA) for teaching clinical skills to first year undergraduate nursing students and to measure if MITA affected objective structured clinical examinations (OSCE) Results:
Methods: This study employed a parallel randomised controlled trial with first year nursing students in a third-level institute in the South of Ireland (n= 90). Participants were randomly allocated using computer generation by the Head of Department to a control group (conventional teaching) (n= 44) or a treatment group (MITA) (n=
46). Students were subsequently assessed using OSCEs. Data was collected from September 2011
to May 2012.
Results: Findings showed a strong preference for the multiple intelligence of interpersonal (M
= 62.58; SD 13.45) and learning style preference of sensing (M = 1.68; SD 0.95). Results identified
participants in the experimental group had higher scores in all three OSCEs examined at the end of
the semester (p = 0.01).
Discussion and Conclusion: The findings indicate that MITA has great potential in nursing education
and clinical skills development, particularly in terms of reinforcing learning into the individual’s
professional development and clinical practice.
11.00 – 12.25 Concurrent session 7 – Friday 22 March 2013 Rotunda
7.7 Theme: Education/workforce
7.7.1
12-hour shifts A & E what is the evidence? A scoping review
Presenter: Professor Ruth Harris, Professor of Nursing Practice and Innovation, Kingston
University and St. George’s, University of London, UK
Author(s): Ruth Harris, England, UK; Sara Christian, England, UK; Jenny Parr, Associate Director of Nursing, Waitemata District Health Board, New Zealand Formerly Director of Nursing, Kingston Hospital, Kingston, UK
Abstract
Background: The use of 12-hour shifts in the organisation of the nursing workforce has increased considerably over the last 20 years. The impetus for this development has been to address several issues: continuity of care, staff shortages and staffing costs. While there is some support for 12-hour shifts, often by nurses themselves
in relation to work-life balance, there have also been some concerns about reduced patient safety, staff fatigue and increased staff turnover. These concerns require investigation particularly as the Francis Report into the failings in Mid Staffordshire, which is expected to have widespread influence across the NHS, is due to be published imminently.
Aim: This paper reports a scoping review examining the extent, range and nature of evidence available
internationally around the impact of 12-hour shift patterns within nursing as well as other occupational
fields. This evidence will inform future research and workforce development.
Methods: Items of literature were identified primarily from electronic database searches. Grey literature relating to policy was sought by searching government and other websites. The review was guided by Arksey and O’Malley (2005) to map the key concepts underpinning this area of research and main sources and types of evidence
available.
Results: A wide range of literature was reviewed. The majority of studies address the impact of 12-hour shifts from a worker perspective with mixed findings; there was evidence of staff fatigue but predominantly positive self reports of the impact on work-life balance. Very few studies focused directly on patient safety and none in the
UK.
Conclusion: The collated evidence from the studies is inconclusive; further research is required for us
to understand this widely accepted approach to shift patterns particularly focusing on the longer term consequences on quality, cost and safety of patient care.
7.7.2
Supporting transition from student to registered nurse: a collaborative research study.
Presenter: Dr Bill Whitehead, University of Derby, UK
Author(s): Bill Whitehead, (UK) ; Pat Owen, (UK); Elaine Beddingham,(UK); Maxine Simmons,(UK);
Merryn Barton,(UK); Carl Walker,(UK); and Lorraine Henshaw,(UK).
Abstract
Background: Internationally it has been shown since Kramer’s seminal research in the 1970s that
newly qualified nurses (NQNs) can suffer ‘reality shock’ (Kramer 1974) in their transition from
student to qualified nurse. In the United Kingdom (UK) it is a recommendation of the Department of
Health (DH 2010) to have a period of preceptorship for all newly registered health professionals,
including nurses, to support them during this transition period. This study presents findings from a
UK collaborative project between an NHS Acute Hospital Trust and a University which suggests the
level and type of support required by NQNs.
Aim: To identify the level and type of support required to facilitate the transition from student to registered nurse.
Methods: This study is based on a methodological approach of a case study design using naturalistic
enquiry (Lincoln and Guba 1985). 6 Focus groups and 10 one to one semi structured interviews were
conducted between March and August 2012. The purposive sample of key actors including preceptees;
preceptors; sisters; matrons; senior matrons and Learning Environment Managers resulted in a
total sample of 50 participants. Audio recordings and notes were transcribed and analysed using
content analysis supported by NVIVO software.
Results: The results will show the type and level of support NQNs need in their transition and will
be presented as a content narrative supported by direct quotations from participants.
Discussion: Key findings for example managerial support; protected time and education preparation
will be discussed in relation to the literature.
Conclusions: The study demonstrates that NQNs benefit from a period of structured support through
transition which also enhances recruitment and retention and should translate to improved quality
of care and patient safety.
7.7.3
A community workforce for the future: A framework for placing students in General Practice
Presenter: Marie Therese Massey, Senior Lecturer, Sheffield Hallam University, UK
Author(s): Marie Therese Massey UK
Abstract
Background: Across the UK 27% of the NHS community nursing workforce are due to retire in the next ten years and a viable workforce for the future is needed. In light of this Practice Nurses are identified as essential partners in providing the infrastructure to shape this. However placing students in General Practice continues to be a
challenge for nursing educators. A clear understanding of the challenges would inform future nursing curricula.
Aims: Against this background a study was developed that aimed to determine the extent to which Practice Nurses, in a city in the north of England, were informally facilitating students’ learning in clinical Practice as well as identifying the barriers, whether real or perceived, that were encountered. The phenomenon of whether nursing
culture was influenced by the presence of student nurses was investigated at the same time.
Method: A mixed method research design was employed. Data was collected from Practice Nurses
between June and July 2012. First by self-completion questionnaires (n=38), which were analysed
descriptively and then by semi-structured interviews with a sub-sample of participants (n=6). A
qualitative interpretive framework was utilised to analyse the data from the interviews. Themes were
identified and subjected to thematic analysis.
Results: Overall the study’s findings highlighted that the presence of student nurses in General Practice was a positive experience for the participants, but not without its challenges. Barriers included the historical attitudes of other members of staff to the presence of students.
Discussion: The conflicting perspectives of members of the General Practice team were highlighted
in the data. Innovative methods suggested for breaking down barriers included peer support and positive role modelling within the Practice Nurse Community. The implications of these findings, the limitations for clinical practice and recommendations for future nursing curricula will be given as part of this presentation.
Fringe Library Bar
Friday 22 March
Time: 12.30 - 13.20
Title: RCN Research Society Annual Meeting
Presenters: Members of the RCN Research Society Steering Committee
Symposium 1 - 17. 13.30 - 14.55 Friday 22nd March 2013
Generating clinically relevant and impactful economic evidence of nurse-led services in practice
Presenter: Dr Chih Hoong Sin, Principal, Office for Public Management, UK
Understanding the cost of services and their outcomes in monetary terms has become crucial in the current financial climate. While often couched in the language of ‘efficiency’, many of the recent developments in the UK and elsewhere in Europe have been characterised by ‘cuts’. Ill-informed cuts can jeopardise efficiency and compromise the quality of care. Frontline nurses contribute towards the efficiency agenda through innovations. They are also ideally placed to generate data to support innovations and improvements. While nurses routinely assess clinical effectiveness, they need to develop new capabilities to be able to argue from an economic as well as a clinical standpoint. The three papers in this symposium describe the importance of nurses generating clinically relevant and impactful evidence in practice. The first paper underlines the importance of supplementing evidence on clinical effectiveness with a robust economic case. The second paper describes a programme designed to build capability within the nursing workforce to demonstrate the economic impact of nurse-led services. The third paper presents an economic assessment of a heart failure nurse liaison service conducted by a nurse who has undergone the programme described in the preceding paper. It further reflects on the lessons learned from the process.
Paper 1
Generating clinically relevant, impactful evidence in practice
Presenter: Co-presenter: A. McMahon,
Globally health service providers are challenged to continue to meet the demand for health services in the face of diminishing resources. Nurses offer a unique insight into how these challenges can be met. They also experience the impact of austerity measures first hand. In order to ground its response to austerity measures in the UK, in the realities of nursing practice, the Royal College of Nursing launched its Frontline First Campaign. The campaign sought to engage RCN members in the development of an evidence base demonstrating the realities of contemporary nursing on the frontline. Nurses were invited to report on cuts to front line services, their experiences of waste in the system and nurse-led innovations in practice. One nurse-led innovation submitted stood out from the crowd. Marina Lupari had incorporated a robust economic assessment into the redesign of services for older people with multi-morbid chronic conditions, demonstrating both the clinical and cost benefits of her innovation (Bell, K 2011). Skills in economic assessment are limited across the public sector and the nursing profession is no exception. The RCN therefore worked in partnership with the Office for Public Management, a not for profit enterprise with expertise in economic assessment to demonstrate the value of ‘monetising’ nurse-led innovations and increasing their impact. Two case studies of Frontline First innovations were developed using the bespoke OPM ‘EAT’ methodology (Ryrie and Anderson 2011). The first was an innovation to reduce the incidence of pressure ulcers in care homes. The second was a whole system redesign of respiratory services. This paper will provide an overview of the RCN Frontline First campaign and examine the nature of nursing innovation in practice. The two monetised case studies will be presented to demonstrate the potential to generate clinically relevant, impactful evidence, in practice.
References
Bell, K. (2011) Fresh Ideas from the Frontline. RCN Bulletin 12th January pp 6-7
http://www.rcn.org.uk/__data/assets/pdf_file/0011/389189/Frontline_First_award_-_3_finalists.pdf
Ryrie, I. and Anderson, B. (2011) Tool to assess the cost and quality benefits of nursing innovation, Nursing Management, vol. 18, no. 4, pp. 29-31.
Paper 2
Developing a programme to build capability within the nursing workforce to demonstrate the value of nurse-led services and to use the evidence to transform care
Presenter: Co-presenter: C. Hoong Sin
In the UK, the potential contribution of clinicians to efficiency targets through innovations in practice has been calculated at £9bn per year (Gainsbury 2009) and we know that nurses play a key role in this. Yet, nurses are taking on more responsibilities and there is evidence that services and nurse numbers are being cut. The response to the economic case studies produced for the Frontline First Campaign indicates that such evidence can be influential. Definitions of ‘worth’ and ‘value’, however, are contentious and nurses must have a role in shaping understandings of value. Emerging evidence from our work suggests that nurse-led quality and efficiency drives are more likely to be sustainable when nurses themselves are equipped to argue from an economic as well as a clinical standpoint. A bespoke programme was developed by OPM to build nursing capability in economic assessment. The programme incorporates training and support to use an Economic Assessment Tool (Ryrie and Anderson 2011), and the facilitation of its spread and adoption by the workforce. This paper discusses how the programme was designed to embed HM Treasury (2003) requirements in accessible ways for non-expert audiences. These are based on international standards required of any economic assessment. It proceeds to outline the programme’s key components, what these involve, and what they aim to achieve. Over and above the programme’s substantive content, this paper further discusses the process of delivering the programme. Programme delivery, in partnership with the RCN, builds up a community of practice within the nursing workforce, encourages nurses to engage with other colleagues, and equips them with the skills to know how to make sense of the evidence to work with others to transform care. The programme achieved endorsed award status from the Institute for Leadership and Management, thereby contributing towards nurses continuing professional development.
References
Gainsbury, S. (2009) Clinical improvements could save the NHS £9bn a year, Health Service Journal, 19 November 2009. Available at: www.hsj.co.uk/5008572.article (Last accessed: 4 October 2012).
HM Treasury (2002) The Green Book: Appraisals and Evaluations in Central Government, London: The Stationery Office.
Ryrie, I. and Anderson, B. (2011) Tool to assess the cost and quality benefits of nursing innovation, Nursing Management, vol. 18, no. 4, pp. 29-31.
Paper 3
Demonstrating the value of nurse-led services – findings from an economic assessment of a nurse-led heart failure liaison service and reflections on lessons learned from the process
Presenter: Co-presenter: J. Nicholl
The Heart Failure Nurse Liaison Service (HFNLS) in Tayside, Scotland, offers support for patients who have suffered from heart failure, left ventricular systolic dysfunction (LVSD) and congestive cardiac failure across NHS Tayside. An economic assessment of the service was conducted by applying the Economic Assessment Tool methodology (Ryrie and Anderson 2011). By following HM Treasury guidance, the costs of setting up and delivering the service were itemised systematically, covering both direct and indirect costs. Against the documented costs, a range of benefits contributing towards the NHS’s Quality, Innnovation, Productivity and Prevention (QIPP) agenda were identified. Some of these were monetisable benefits, while others were qualitative outcomes. For example, patients reported a greater sense of wellbeing within the HFNLS. In addition, 8.3% of HFNLS patients were re-admitted, compared with 27.3% of similar patients not referred to HFNLS. If re-admitted, the length of stay of HFNLS patients is 4.8 days shorter compared with similar patients not referred. Monetisable savings were calculated for avoided admissions and length of stays. The service also contributed to monetisable savings for the Community Health Partnerships. Overall, the estimated efficiencies amounted to around £489 per patient within the HFNLS.
This paper will present this economic case study and share reflections on the process from clinical practice. The experience of having undergone the programme has been one marked by a heightened sense of empowerment. With the case study having an immediate impact, it has enabled nurses to feel that they can play a vital role in influencing commissioning and funding decisions, and that evidence in practice can be used to find ways of
improving the service to deliver greater quality and efficiency impact.
Reference
Ryrie, I. and Anderson, B. (2011) Tool to assess the cost and quality benefits of nursing innovation,
Nursing Management, vol. 18, no. 4, pp. 29-31.
Symposium 17 Grand 5 Unfortunately Symposium 17 was not presented.
BRIGHTLIGHT: a lesson in collaboration
Presenter: Dr Rachel Taylor, Senior Research Fellow/Senior Research Manager, University
College London Hospitals NHS Foundation Trust & London South Bank University, UK
Approximately 2,000 young people aged 13 – 24 years, are diagnosed with cancer each year in
England. Although this represents less than 1% of cancer incidence, cancer is the main cause of death
outside accidents in this population. Improvements in survival for 13 – 24 year olds have been less than for younger children and older adults. In recognition of this survival deficit NICE issued the Improving Outcome Guidance in 2005. This stated young people less than 19 should be referred to a principal treatment centre and those aged 19 – 24 should have ‘unhindered access to age appropriate care.’
BRIGHTLIGHT is a programme of research comprising of four inter-connected workstreams evaluating
teenage and young adult cancer care in England. Central to BRIGHTLIGHT is a cohort study
involving 2,012 young people followed over three years. Success of BRIGHTLIGHT depends upon
three main criteria: accessing all young people in England; recruiting all young people in England;
and retaining all young people through the study period. The BRIGHTLIGHT project has evolved
through collaboration and feasibility work and the team has strove to extend collaboration to a wider
group of stakeholders in order to address these three main criteria. This symposium presents four papers. The first introduces the BRIGHTLIGHT collaboration framework outlining the range of professionals
and organisations required to identify, recruit and data collect throughout England. The second
paper reports the discussion groups held nationally with clinical trials researchers, which identified
problems and challenges to recruitment into BRIGHTLIGHT. Paper three describes the development
of the survey reflecting young people’s cancer experiences and introduces BRIGHTLIGHT’s
commercial partners, Ipsos MORI who validated the survey and methods of survey administration.
Finally, the fourth paper describes how user involvement with young people has been incorporated
throughout BRIGHTLIGHT, with young people progressing from consultation to co-researchers in
BRIGHTLIGHT.
Acknowledgement
This symposium presents independent research funded by the National Institute for Health
Research (NIHR) under its Programme Grants for Applied Research Programme (RP-PG-1209-10013).
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the
Department of Health.
We would like to thank the cancer community and health professionals in all the NHS Trusts in
England participating in BRIGHTLIGHT for their support.
Paper 1
Overview of collaboration: from academic to industry
Presenter:
Rachel Taylor, Senior Research Manager, University College London Hospital NHS
Foundation Trust;
Catherine O’Hara, Research & Intelligence Officer, North West Cancer Intelligence Service;
Louise Hooker, Teenage Cancer Trust Lead Nurse, University Hospitals of Southampton NHS
Foundation Trust;
Lorna Fern, Research & Development Coordinator; Jeremy Whelan, Professor of Medical Oncology
National Cancer Research Institute TYA Clinical Studies Group on behalf of the BRIGHTLIGHT Team
BRIGHTLIGHT is a national evaluation of teenage and young adult cancer care. The BRIGHTLIGHT
cohort will consist of young people aged 13 – 24 years diagnosed with cancer in England between
July 2012 and July 2013. Data collection is at five time points over three years. The study design
has required a complex negotiation of collaboration to enable all young people to be identified
and recruited, and for initial data collection to be carried out face-to-face in their home.
The BRIGHTLIGHT collaboration framework involves:
• North West Cancer Intelligence Service (NWCIS)
• Collaboration with the NWCIS enables identification of all newly diagnosed young people with cancer through reviewing monthly Cancer Waits dataset.
• Researchers nationally
• Collaboration with the NIHR Cancer Research Network (NCRN) to critical enable recruitment in every Trust in England. BRIGHTLIGHT also includes researchers from three academic organisations.
• Health professionals
To ensure recruitment of all young people BRIGHTLIGHT needs to open in every NHS Trust in England.
Facilitated by the NCRN, BRIGHTLIGHT has collaborated with health professionals nationally to identify principal investigators to allow recruitment in over 80% of NHS Trusts. Industry: National data collection in young
people’s homes requires a national body of interviewers with training and expertise in survey administration. This is been facilitated through collaboration with Ipsos MORI’s Social Research Institute.
Young people: Consultation, collaboration, co-researchers and co-applicant; young people’s involvement in BRIGHTLIGHT is central to our recruitment and retention strategy. It will also ensure results generated by BRIGHTLIGHT will influence practice in a way that is relevant to them.
Conclusion: BRIGHTLIGHT will provide the most extensive evaluation of cancer services in England. This paper will discuss how, in addition to improving services for young people, it will highlight the critical role of the NCRN and multi professional collaboration for facilitating national studies.
Paper 2
Collaboration with researchers:bridging between trial and survey
Presenter:
Stefan Durkacz, Research Manager, Ipsos MORI Social Research Institute;
Rachel Taylor, Senior Research Manager, University College London Hospitals NHS Foundation Trust;
Lorna Fern, Research & Development Coordinator, National Cancer Research Institute TYA Clinical
Studies Group
Jeremy Whelan, Professor of Medical Oncology on behalf of the BRIGHTLIGHT Team
Background: Clinical research, including clinical trials, in England is supported by the National Institute for Health Research (NIHR) Cancer Research Network (NCRN). The 32 local networks covering the whole of the NHS in England employ more than 700 researchers, supporting over 600 studies within the portfolio. Researchers in the
NCRN are mainly from a health or scientific background with the primary role of conducting clinical
trials. In order to collaborate on BRIGHTLIGHT NCRN researchers were faced with a number of
challenges:
1. Researchers mostly recruit to specific tumour types rather than an age group spanning a numerous tumours.
2. The NCRN comprises mainly of researchers with expertise in recruiting to adult studies; BRIGHTLIGHT
includes ‘children’.
3. The NCRN portfolio contains a number of non-trial studies however researchers have limited experience of survey methods.
Aims: Using novel online methodology we aimed to explore with researchers their perceived role in recruitment, identify potential challenges and pose solutions.
Methods: Ideation Exchange is an online, telephone- moderated discussion method, which allows larger numbers of participants compared to face-to-face. Critically, all participants remain anonymous facilitating honest and hierarchy free discussion. As participants enter the discussion directly into the online programme, transcripts are
available immediately.
Results: Thirty-four researchers from 21 networks participated in two Ideation Exchanges. A number
of challenges to recruitment were identified, including being able to identify young people, making initial contact and gaining consent. Researchers unfamiliar with talking to young people expressed their anxieties in approaching and communicating with children.
Summary: Ideation Exchange was a successful method in engaging participants from a wide geographical area. Researchers openly expressed their anxieties and perceived difficulties with the protocol. Transcripts were available immediately facilitating ‘FAQ document’ to be produced and circulated throughout the networks within a
week of the discussion group in order to alleviate researcher anxiety.
Paper 3
Collaboration with Industry: survey validation & delivery
Presenter: Julia Pye, Methods Director, Ipsos MORI Social Research Institute;
Lorna Fern, Research & Development Coordinator, National Cancer Research Institute TYA Clinical
Studies Group;
Anita Solanki, Cohort Manager, University College London Hospitals NHS Foundation Trust;
Rachel Taylor, Senior Research Manager, University College London Hospitals NHS Foundation Trust on behalf of the BRIGHTLIGHT Team
Background: Patient-reported outcome measures (PROM) have become core to assessing quality of
health care to ensure quality is based on patients’ views and not solely those of providers. However,
the extent to which quality assessment reflects patients’ views and experience depends on the
outcome measure; its conceptual basis and how it was developed.
Aims: To develop and validate an outcome measure, the BRIGHTLIGHT Survey, for use with
young people with cancer that accurately reflects their experience.
Methods:
Stage 1: develop the theoretical basis of the BRIGHTLIGHT Survey through a systematic
review of literature and semi-structured interviews with eleven young people.
Stage 2: identify core domains and generate questions.
Stage 3: validate the BRIGHTLIGHT Survey (health professionals’ review, and cognitive interviews with young people).
Stage 4: validate the methods of survey administration through focus groups with young people and their families.
Results: Ten common themes emerged in the metasynthesis of 17 papers identified in the review and eight themes emerged from the interviews with young people, which formed the basis of a conceptual model of the cancer experience. The conceptual model underpinned the core domains and related questions of the BRIGHTLIGHT Survey e.g. quality of life, social support, financial impact, achieving life goals. Content was reviewed by health professionals and refined through cognitive interviews with 22 young people. Three focus
groups with 11 young people refined the accompanying documents and consent forms, changed the
time-point of survey administration and confirmed the appropriateness of methods of administration.
Conclusion: The BRIGHTLIGHT Survey has been developed to accurately reflect young people’s experience of cancer. This is important to ensuring young people remain interested in completing it over a three year period and to ensure changes in care will be based on young people’s experience and need rather than being determined by providers alone.
Paper 4
Collaboration with young people: from consultant to co-researcher
Presenter:
Lorna Fern, Research & Development Coordinator, National Cancer Research Institute
TYA Clinical Studies Group
Faith Gibson, Clinical Professor of Children and Young People’s Cancer Care, London South Bank
University and Great Ormond Street Hospital for Children NHS Foundation Trust;
Rachel Taylor, Senior Research Manager, University College London Hospitals NHS Foundation Trust;
Anita Solanki, Cohort Manager, Jeremy Whelan, Professor of Medical Oncology on behalf of the
BRIGHTLIGHT Team
Patient and public involvement (PPI) is central to healthcare policy and research in the UK. The BRIGHTLIGHT team worked with young people during the feasibility and pilot work. The aim of this paper is to describe the role young people have played in BRIGHTLIGHT highlighting how they have progressed from consultation to working as co-researchers.
BRIGHTLIGHT inception
The National Cancer Research Institute Teenage and Young Adult (TYA) Clinical Studies Group Core
Consumer Group (CCG) comprised of five young people with a previous cancer diagnosis. The CCG
worked as co-researchers to identify priorities for a TYA cancer unit and describe the experience of
cancer care for young people. This work underpinned the development of the patient survey for
BRIGHTLIGHT.
Becoming BRIGHTLIGHT
Young people suggested the original study name ‘essence of TYA cancer care’ or ‘2012 TYA Cancer
Cohort’ was uninspiring. A brand transformation exercise was carried out a WORKSHOP with young
people and independent creative advisors. Young people branded the study BRIGHTLIGHT (light at
the end of the tunnel, leading the way).
Being BRIGHTLIGHT
The Young Person’s Reference Group (YPRG) is a ‘virtual’ steering group with an annual meeting.
Membership is open to all non-BRIGHTLIGHT participants, aged 13-24 at diagnosis within the last
three years. The role of the YPRG varies with study progression but includes advising on content and
editing the study newsletter and website (www. thebrightlightstudy.com), and providing advice
on study conduct. Two members of the YPRG are trained in telephone interviewing and will
interview young people who do not want to take part in BRIGHTLIGHT to explore reasons for this.
Conclusion: The key to longitudinal research is to keep participants engaged throughout the study.
Young people are best place to advice professionals on strategies to do this. This paper will also
discuss evaluation of PPI.
15.00 Chair’s opening remarks
Professor Annie Topping, Professor of Nursing & Director of Centre for Health and Social Care Research, University of Huddersfield, UK
15.10 Closing keynote presentation:
Research in the hidden places - the challenges and opportunities for nurses
Professor Vari Drennan, Faculty of Health and Social Care Sciences, University of London, UK
15.50 Closing remarks
16.00 Close of conference
