Practice Development Nurse Research Articles

Contextual influences on knowledge translation capacity in a nursing home organisation: A phenomenological hermeneutical study.

The demand for advanced clinical care in nursing homes (NHs) is increasing. Evidence-based practices and knowledge translation (KT) initiatives are growing to bridge the gap between what is known and what is done. However, research on contextual influence on KT has primarily focused on hospital settings. To expand our understanding of contextual influences on KT capacity in a NH organisation. Lindseth and Norberg's phenomenological hermeneutical method was used to explore and describe practice development nurses' experiences, perspectives and practices regarding how contextual factors influence KT capacity in NHs. Focus group interviews, participant observations, in-depth interviews and non-participant observations provided the data. Two main themes and four subthemes were identified. (1) Continuous limited resources are a cultural condition that inhibits KT readiness; prioritising keeping the NH machinery running at all costs and having contrasting care philosophies undermines KT. (2) Organisational prioritisations leave KT as a missing cogwheel in the machinery; retaining a system of fragmented KT strategies and lacking a structure for collective KT effort. The study showed that KT held a minor role in the fast-paced NH machinery. Contradicting values characterise the NH organisation, resulting in a lack of a common vision and priorities. Building a sustainable KT capacity and providing evidence-based practice necessitates explicit responsibilities, dedicated resources and robust organisational support. Management has a critical role in strengthening the position of KT. Incorporating KT in daily NH practice can help staff become adaptable and confident, capable of meeting the increasing challenges of advanced care that alleviates suffering and promote the health and well-being of NH patients.

Mentoring medical students as a means to increase healthcare assistant status: A qualitative study.

To offer a practical way in which the status of healthcare assistants (HCAs) can be increased by drawing on their experience, knowledge and skillset, whilst mentoring medical students during an HCA project. Qualitative, reflexive thematic analysis. One-to-one semi-structured interviews were conducted between April and June 2019, with 13 participants. Participants included five healthcare assistants; three practice development nurses, two of whom were former HCAs; one registered general nurse and four clinical educators. Two themes were identified: HCAs as silent, invisible caregivers (theme 1) and the formation of an HCA identity through mentoring (theme 2). HCAs are often silent performers of complex patient care with limited opportunity to engage in the interprofessional team dialogue. Social perceptions of HCAs describe them as a marginalised, poorly understood, 'unqualified' group with 'lowly status'. Mentoring medical students allows HCAs to draw on their experience, knowledge and skillset by actively contributing to the learning and development of future doctors. The mentoring of medical students gave HCAs an active voice within the interprofessional team, instilling their confidence and self-worth. Mentoring allowed HCAs to move from a homogenous, group-based social identity to a role-based one that enabled HCAs to reveal the true extent of their work whilst negotiating their place and identity within the interprofessional team. Leaders in healthcare will see that a re-evaluation of HCAs as performers of basic, hands-on patient care is needed to breakdown ingrained beliefs, eliminating a 'us and them' mentality. Involving HCAs in the mentoring of medical students will impact on the personal development of both HCAs and medical students in the cultivation of a future, person-centred, inclusive and collaborative workforce. COREQ guidelines to enhance methodological rigour were strictly adhered to. There is no patient or public involvement.

A93Addressing patient-safety themes and fostering cohesive teamwork through weekly multidisciplinary in-situ simulation in an Acute Care Unit

The Acute Care Unit (ACU) is the busy admissions ward at the trust. Many junior doctors rotate through the ACU for their acute medicine training and the department frequently welcomes newly-qualified nurses or nurses new to the NHS. All staff are involved in managing acutely unwell admissions with a range of presentations. In this dynamic environment, ensuring time is dedicated to teaching is an important part of staff development. In addition, it is important to create opportunities for team-building between disciplines, and evidence shows that this improves outcomes for patients [1]. Teaching for different professional disciplines is often delivered separately. Whilst sometimes preferable, we recognized the department could benefit from simulation sessions involving all members of the clinical team to represent realistic clinical practice. The aims were to: Address recent clinical incidents Practice managing common medical emergencies as a multidisciplinary team Build a greater sense of team between the ACU staff. We designed and implemented a programme of weekly multidisciplinary in-situ simulation on ACU. Sessions involve a range of nursing and medical staff and students and are delivered in an empty bed space on the ACU. Simulations focus on clinical scenarios that might reasonably arise in the department. We use iSimulate technology and re-use the simulation suite’s equipment to reduce resource burden and maintain sustainability. Feedback is collected after each session to quality assure and improve the sessions, and 2 further quality improvement reviews completed to explore how to maximize engagement and learning. This has led to coordination of scenarios with the established weekly seminar-based departmental teaching, to consolidate learning across settings and this is reinforced with a ‘learning point of the week’. Sessions have been successfully delivered on a near-weekly basis throughout the year, despite significant clinical pressures. This has been achieved through coordinated efforts from the simulation team, ACU fellows and registrars, charge nurses and Practice Development Nurse. We estimate to have reached more than 50 colleagues, with typically 4-8 attendees per session. We have rotated through 15 different scenarios and counting, covering key topics including various medical emergencies, violence and aggression, and ‘soft signs’ of deterioration. The programme has been well received, and feedback has specifically commented on the benefit of simulation in a multidisciplinary and in-situ setting. We demonstrate it is possible to maintain an effective regular simulation programme in the department to support patient safety initiatives and team working. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Integrated knowledge translation in nursing homes: exploring the experiences of practice development nurses

BackgroundPractice Development Nurses (PDNs) in Norwegian nursing homes (NHs) hold a specific responsibility for knowledge translation in this increasingly complex healthcare setting. They were involved as end users in an integrated knowledge translation (IKT) study, developing, testing and evaluating the IMPAKT (IMPlementation of Action to Knowledge Translation) intervention. PDNs participated in an educational programme tailored to their own defined needs. In a second intervention component, the PDNs applied their new skills with facilitation, in implementing the National Early Warning Score (NEWS2) in their respective NHs. The aim of this study was to explore 1) the PDNs’ experiences of participating in an IKT educational intervention, and 2) how they applied the learning in planning, tailoring and initial implementation of the NEWS2.MethodsThis is a qualitative exploratory study based on a phenomenological hermeneutical method. Study participants were PDNs working in the nine NHs in the intervention group of the IMPAKT trial. We conducted nine in-depth interviews and eight non-participatory observational sessions of the intervention delivery.ResultsThe PDNs expressed that the educational programme met their needs and enhanced their understanding about leading knowledge translation (KT). They reported a move from operating in a “big black box of implementation” to a professional and structured mode of KT. The gamechanger was a shift from KT as the PDNs’ individual responsibility to KT as an organizational matter. The PDNs reported enhanced competencies in KT and in their ability to involve and collaborate with others in their facility. Organizational contextual factors challenged their KT efforts and implementation of the NEWS2.ConclusionsThis study demonstrates that an IKT approach has the potential to advance and improve staff competencies and NH readiness for KT. However, individual motivations and competencies were challenged within an organizational culture which was less receptive to this new leadership role and level of KT activity.

Optimizing a knowledge translation intervention: a qualitative formative study to capture knowledge translation needs in nursing homes

BackgroundKnowledge translation (KT) has emerged as an important consideration to reduce knowledge-to-practice gaps in healthcare settings. Research on KT approaches in nursing homes (NHs) is lacking. There is a need to understand the challenges faced in NHs and how these can be managed. This study is part of the larger IMPAKT (IMPlementation and Action for Knowledge Translation) study which addresses KT in NHs. The aim of the study presented here was to identify crucial staff and organizational needs in order to inform the development of a KT intervention in NHs.MethodsA multimethod qualitative approach was applied. We invited practice development nurses (PDNs) to describe current practice, and to identify problems and needs concerning KT in NHs. We followed the recommendations of the development phase of the MRC framework for developing complex interventions. Data were collected through four focus groups and participatory observations in six NHs. Analysis was conducted according to structural thematic analysis based on a phenomenological hermeneutic method.ResultsWe identified three themes that expressed the PDNs’ perceived needs for successful KT implementation: (1) narrowing the PDN role, (2) developing an EBP culture and (3) establishing collaborative alliances. Nine subthemes derived from the PDNs’ experiences and current practice, illustrating needs at individual, relational and organizational levels.ConclusionsRigorous development of complex interventions may add relevance to the intervention, increase the likelihood of success and reduce research waste. Insight into the NH context and organization have helped us define problems and articulate needs that must be addressed when tailoring the IMPAKT intervention.Trial registrationThe IMPAKT trial was retrospectively registered in the ISRCTN Registry (Trial ID: 12,437,773) on March 19th, 2020.

89 Improving Pain Assessment and Management for Patients with Cognitive Impairment on the Care of the Older Person (COOP) Wards

Abstract Introduction Patients with cognitive impairment are at risk of underassessment and inadequate management of pain. Self-reporting is unlikely to be a reliable indicator of pain and numerical scales have reduced validity, hence an alternative assessment tool must be used. The Abbey Pain Scale is widely regarded to be user friendly. Regular analgesia should be used for these patients where possible instead of “as required” (PRN). Using QIP methodology, we aimed to improve the use of the Abbey Pain Scale for assessment of patients with cognitive impairment and better analgesia prescribing. Methods Audit of patient records on COOP wards (computer and physical notes, n = 48 first cycle, n = 32 second cycle) before and after staff training, assessing patients with cognitive impairment for: use of Abbey Pain Scale; use of regular paracetamol; pain assessments documented by different healthcare professionals. Results In the first cycle, 16 patients had cognitive impairment: only 1 of these patients (6%) was assessed using the Abbey Pain Scale. Group teaching for the multidisciplinary team on pain assessments was undertaken with practice development nurses. In the re-audit, 13 patients had cognitive impairment and 6 of these (46%) were assessed using the Abbey Pain Scale, showing a clear improvement following staff training. The second cycle showed a 50% increase in the prescription of regular paracetamol for patients with cognitive impairment. There was also a 2.5-fold improvement in therapy staff documenting pain assessments between the two audits. Conclusions Staff training in the use of the Abbey Pain Scale led to an almost 8-fold increase in its use for patients with cognitive impairment. Training on the use of the Abbey Pain Scale should be regularly provided to nurses, physiotherapists and doctors on the care of the older person wards.

The role of practice development nurses in Malta.

To develop an understanding of the role of practice development nurses in Malta and to identify any barriers or opportunities associated with this role. An exploratory single case study methodology was used. Ten of the total population of 11 practice development nurses agreed to participate in the study. Participants were twice interviewed in person about their understanding of the role. Data were analysed thematically. The main themes identified were: professional growth through lifelong learning, leadership in a changing practice environment and fostering research-based clinical practice. Participants reported that ambiguities associated with their role, role conflict and unclear hospital infrastructure were barriers to executing their role effectively. Healthcare organisations should create an appropriate working environment that supports practice development nurses and clearly distinguishes their responsibilities and authority. Practice development nurses should become more socio-economically and politically focused to enable them to function strategically and effectively in their clinical working environment.

Confidentiality in participatory research: Challenges from one study.

This article presents key ethical challenges that were encountered when conducting a participatory qualitative research project with a very specific, small group of nurses, in this case with practice development nurses in Malta. With the small number of nurses employed in practice development roles in Malta, there are numerous difficulties of maintaining confidentiality. Poorly constructed interventions by the researcher could have resulted in detrimental effects to research participants and the overall trustworthiness of the research. Generally, ethical guidelines for research exist to reinforce validity of research; however, there is not an established consensus on how these strategies can be utilised in some types of qualitative field work. The researcher used an exploratory case study methodology. The sample consisted of 10 participants who were interviewed twice using face-to-face interviews, over a period of 2 months. The study was ethically reviewed by the University Research Ethics Committee and the Faculty Research Ethics Committee, University of Malta. The participants referred to in this article have been given adequate information about the study and their consent has been obtained. Numerous strategies for ensuring confidentiality during recruitment of the participants, during data collection, during transcription and data analysis and during dissemination of research results assisted the researcher in responding to potential and actual ethical issues. This article emphasises the main strategies that can be used to respond to ethical challenges when researching with a small easily identifiable group. The learning discussed here may be relevant to or even transferable to other similar research studies or research contexts. These methods fostered a greater credibility throughout the research process and predisposed the participants to greater trust, and thus, they disclosed their experiences and speak more freely, thus enhancing the quality of the study.

Caring for our key carers: HCSWs at Imperial College HT

306 British Journal of Healthcare Assistants June 2012 Vol 06 No 06 Tanis Hand, RCN HCA Advisor, gave an overview of the regulation of the HCSW. She highlighted that regulation plays a key role in keeping our patients at the centre of our care. The RCN, according to Hand, believes that HCAs should be regulated in the interest of the public and is actively supporting steps towards mandatory training. When asked for a show of hands of delegates who believe they as HCAs should be regulated, approximately 90% indicated that they should be. As one of the Trust’s CQUINN targets, dementia has been a national topical issue, heavily driven by the media. Jennie Whitford from the Alzheimer’s Society Friday 20 April 2012 marked the second trustwide healthcare support worker (HCSW) conference at Imperial College Healthcare Trust. Some 100 delegates were in attendance. The day commenced with a welcome from Karen Richards, Senior Nursing education Lead CPG 1 and lead for organising the conference. In her opening remarks, Di Dunne, Head of Nursing, CPG 5, informed the delegates that the patient experience is everybody’s business and spoke about the significant challenges facing the NHS. Dunne stated that the healthcare assistant (HCA) was best placed to comment or make decisions on improving the patient experience. gave a vibrant and thought-provoking presentation on the topic. ‘Dementia is not a diagnosis, but describes a group of symptoms. It is not an old peoples’ disease,’ Whitford admonished. ‘And it is not a natural part of growing old.’ The patient experience was well captured, with four break-out sessions covering the topics: z z ICare, facilitated by Elaine Dix, Senior Nurse for education, CPG 3 z zPatient experience (communication), by Margot Spratley, Practice Development Nurse Renal, on behalf of Fran Naick, Vocational Trainee Manager z zCarers (HCAs)’ Careers, by Karen Richards, CPG1 Caring for our key carers: HCSWs at Imperial College HT

Fit for practice? An exploration of the development of newly qualified nurses using focus groups

Previous research in the newly qualified has primarily focused upon their levels of competence at the time of registration rather than upon the way that this continues to develop over time. Though newly qualified nurses are expected to be competent and able to practice independently without direct supervision the reality is that, for most, their training has not equipped them with the knowledge, skills or confidence necessary for independent practice. This belief provided the foundations for this study designed to gain an understanding of the way that competence develops amongst nurses themselves and how this is seen by their managers and those working with them. It focused neither on what competencies nurses possessed nor on the level of overall competence but rather on the factors influencing the development of competence over time. Research design This qualitative exploratory study relied upon a combination of focus groups and individual interviews to access information and perceptions not readily accessible through more quantitative means. Data collection Data was collected using focus groups involving newly qualified staff, including both those on a development programme and those in substantive posts, experienced qualified nurses (preceptors) and practice development nurses. A total of twelve focus groups were conducted yielding a purposive sample of 105 volunteer participants; groups were continued until no new data emerged and saturation was achieved. Ward managers (5) were interviewed individually and their data was added to that obtained from the focus groups. Analysis Content analysis of the transcripts enabled the material to be explored systematically to identify relevant themes and categories within the data thus helping to clarify descriptions of the major issues identified; these were returned to the participants to ensure validity in data interpretation. Findings Ward managers appear to have low expectations of the newly qualified while ‘new’ nurses themselves believe that they are expected to be able to fulfil tasks that they feel ill-equipped to undertake. This emphasises the need for appropriate support to enable them to develop their knowledge, skills and confidence and enable independent practice. While staff development programmes benefit some, others gain equal value from supportive preceptorship in helping them to develop the clinical and managerial skills necessary in today's healthcare climate.

Partners in Learning Ian Welsh Partners in Learning and CaronSwann Radcliffe Medical Press183£19.9518775555X18775555X

Partners in Learning is both a timely and valuable nurse education resource for a number of reasons. First, it fits in with the emerging recognition of what happens in the university classroom within the professional practice arena (and perhaps more importantly vice versa). Second, given my personal belief that education is every nurse’s business, this volume should have a place on every nurse’s bookshelf. We all have a role in being supportive, critical friends for each other in the name of good patient care. Third, it will be particularly useful for those newly developing roles which are being created to bridge that important interface between practice and theory, such as professional practice facilitators, practice development nurses, RCN Learning Representatives, joint appointments and all others engaged in the educational endeavour, including those completing Post Graduate Certificate in Education (PGCE) programmes. Fourth, it is a well- organised and comprehensive text with helpful chapter summaries (except in the case of Chapter 3, where the summary was omitted). Some chapters could have been strengthened. For example, Chapter 2 on learning theories could have included some discussion of the power of role models and culture bearers in the learning process. Chapter 3 was particularly good in challenging the traditional rhetoric that ‘thinking’ and ‘doing’ are mutually exclusive, especially in relation to nursing, but it could have benefited from a little more attention to learning styles, possibly with some reference to how our understanding of our own learning styles might give added insight into how patients learn. This would be particularly useful in the pursuit of the public health agenda. The paradigm shift from a paternalistic healthcare system to one of partnership also has implications for ‘partners in learning’, particularly in terms of who the principal stake- holders are and how they are factored into the learning equation.

Taking time out

As newly formed group of practice development nurses, the last thing on our minds last year was organising nurses day celebrations. Most of us in post at Medway Maritime Hospital, Kent and were struggling with setting up our own routines and remits.

Clinical guidelines in community hospitals

Nineteen F and G grade nurses, one practice development nurse, two physiotherapists and two occupational therapists working in 11 community hospitals in Leicestershire and Rutland were interviewed about their use of clinical guidelines and their attitude towards them. They were asked questions about sources of clinical guidelines, and a simple gap analysis was carried out. The interviewees were able to identify clinical guidelines that were used locally, and human and organisational resources of guidelines: resource rooms, practice development nurses, link nurses and study days. The use of link nurses, and regular study days, both of which provide cascade learning, work well. Furthermore, in the opinion of the ward nurses, the practice development nurse has a useful role in making nurses aware of guidelines. Generally, the responses about the use of clinical guidelines were positive, although some reservations were noted. There was agreement that regular professional meetings and ward hand-overs provide a natural and effective dissemination route. The interviewees were not aware of any national clinical guidelines. Despite many of the interviewees having access to the internet (generally from home rather than from the hospitals), none could identify any online resources for clinical guidelines or knew that they existed.

The team survey: a tool for health care team development.

The aim of this study was to validate a psychometric tool, the team survey, in a health care setting with a range of teams from a Large National Health Service (NHS) Trust. The team survey was developed by Millward and Ramsay (1998) to measure the team dimensions identified in the cognitive-motivational model of team effectiveness (Millward & Purvis 1998). The team dimensions are team potency, team identification, Shared Mental Models and team meta-cognitions. The psychometric properties of the tool as a reliable and valid predictor of team effectiveness was assessed by way of a survey of 10 teams (comprising 124 members in all) located on different premises, within a large NHS Trust. Team size ranged between 5 and 19 members, with average team size being 10 members. Two independent ratings of 'effectiveness' were made for each team. Factor and multiple regression analyses were employed to identify the most powerful predictors of health care team effectiveness from a cognitive and motivational perspective. The results suggest that the team survey is psychometrically robust within a health care setting. It is concluded that the tool has a potentially key role in informing and evaluating team development initiatives in support of the work of practice development nurses and nursing team leaders.

Nursing management of chemotherapy-induced nausea and vomiting in children. Current prescribing and administration practice – is it being used to its full potential?

Faith GibsonMSc (Cancer Nursing) RGN RSCNONCCert Cert Ed, Education/Research and Practice Development Nurse, South Bank University & Great Ormond Street Hospital for Children NHS Trust, UK. Stephen Face RGNRSCN Dip Advanced Nursing Care ENB 240, Stai Nurse, LionWard Host Defence Unit,GreatOrmond Street Hospital for Children NHS Trust, LondonWC1N 3JH, UK. Sharon Hayden RGN RSCNENB 240, Senior Sister, St John’s Ward,Our Lady’s Hospital for Sick Children,Dublin12, Ireland. Nicki Morgan RGN RSCNENB 240, Practice Educator, RobinWard Host Defence Unit,Great Ormond Street Hospital for Children NHS Trust, LondonWC1N 3JH,UK Correspondence and oiprint requests to: Faith Gibson, Education/Research and Practice Development Nurse, South Bank University,103 Borough Road, London SE10AA,UK

Practice development: a concept analysis

Aims This analysis sets out to explore the nature and scope of the concept of practice development. Background The last 10 years has seen a growing interest in the development of health care practice. However, the exact nature of practice development remains poorly articulated and nebulous. Literature from nursing, medical, accountancy, social work and counselling is used to identify the critical attributes of the concept. Data analysis The analysis uses the techniques developed by Walker & Avant (1995) to collect information on the use of the concept from the literature and to construct cases. Key issues Many of the attributes of practice development are shared by other related concepts such as innovation. However, four critical attributes of practice development were identified and illustrated through case construction. Conclusions An understanding of the nature and scope of practice development is essential if the role of the Practice Development Nurse is to be evaluated. The critical attributes and empirical referents identified in this analysis provide a framework for both role development and evaluation.

Anaesthesia: airway management.

In this month's Back to Basics series, Rachelle Griffiths provides the first article pertaining to anaesthetic practice. The topic is airway management, which is a fundamental aspect of preserving life. The anaesthetic practitioner must ensure that all the necessary equipment for airway management is available. Reading this article will not only provide this knowledge but it will also identify some of the observational factors that are present when difficulties are occurring. The six articles of the previous Back to Basics series, which was much appreciated, were written by Claire Campbell and Marion Taylor. Claire Campbell is Senior Clinical Nurse at the Operating Department, Royal Lancaster Infirmary in Lancaster; Marion Taylor is Practice Development Nurse at the Operating Department, Royal Free Hospital, London.