Practice Development Programme Research Articles

Evaluation of an Advanced Practice Provider Onboarding and Development Program.

To evaluate the impact of implementing a comprehensive secondary onboarding and development program within a hospital medicine group at a large tertiary academic medical institution. This was a mixed-methods study with physician and advanced practice providers (APPs) at an academic medical institution. For quantitative methods, improvement in competencies was determined using a pre-and posttest for APPs and pre- and postevaluation scores from collaborating physicians. APPs also participated in a pre- and post-self-assessment. For qualitative methods, experiences in the secondary onbo.arding and development program were assessed using semistructured interviews. For quantitative results, there were a total of 25 APPs who completed the pre- and posttest and were evaluated by at least 9 physicians. The average pretest score for APPs was 71.7% and the average posttest score was 83.0%. The average score for physicians' evaluations of APPs was 4.24/5 and increased to 4.38/5 in the postprogram evaluations. The average score for APP self-assessment pretraining was 3.52/5 and after the 12-month onboarding training, average scores increased to 3.84/5. For qualitative results, 4 APPs and 6 physicians were interviewed. Three of the APPs reported having more confidence in treating patients, whereas 1 APP viewed the program as a refresher course. All of the APPs mentioned that they would recommend the program to other APPs. Physicians reported that the program was beneficial in standardizing the care provided among the different types of APPs (physician assistants and nurse practitioners). All of the physicians also would recommend the program to other physicians and APPs.

Future-proofing ecological knowledge management practices in the workplace: Lessons from the pandemic

The COVID-19 pandemic compelled businesses to adopt effective ecological knowledge management strategies to navigate the ensuing difficulties brought about by changing work setups and mobility restrictions. This study employs a grounded theory approach to explore the emergence of such strategies and their impact on overcoming institutional obstacles in knowledge management. Twenty-two managers with at least five years of eco-managerial experience were interviewed, resulting in the identification of critical practices. These included virtual collaborative tools, electronic knowledge databases, agile knowledge management techniques, communities of practice, training and skill development programs, hybrid working patterns, strategies for knowledge transition and succession, and programs that promote mental health and work-life balance. By adopting virtual collaboration tools and electronic knowledge databases, access to and dissemination of information are expedited and secured, fostering teamwork and institutional success. Agile ecological knowledge management techniques enable businesses to pivot quickly, fortifying their resilience and adaptability during unpredictable periods. The endorsement of ecological and human well-being and work-life balance initiatives increases employee morale and psychological well-being. Knowledge-sharing strategies, such as the formulation of communities of practice, foster professional development and teamwork. Training and ecological upskilling programs equip employees with essential competencies, whereas the hybrid work setup offers adaptability and compensates for fewer interpersonal interactions. Businesses must prioritize these ecological knowledge management strategies to enhance their organizational resilience.

Evaluating the use of narrative pedagogy in person-centred care and human factors in perioperative practice education

Background: There is an international effort to develop understanding from human factors theory and implement this in healthcare to improve person-centred care and patient safety. Aim: This project aimed to evaluate the use of narrative pedagogy to teach human factors to perioperative personnel in the workplace. Methods: Using the action research model, an interactive learning session based on lessons from serious incidents was developed and delivered to perioperative staff in an NHS Trust within a practice development programme. Data were collected in the form of questionnaires and peer reviews to evaluate the learning session, and thematically analysed. Findings: The use of narrative pedagogy to explore human factors theory empowered participants to speak up, and this influenced the workplace safety culture. Conclusion: Narrative pedagogy reconnects healthcare employees with compassionate approaches to person-centred care, and this provides powerful motivation to improve the safety culture. Further studies should focus on different applications of narrative pedagogy in workplace learning, and creative approaches to teaching human factors. Implications for practice: • Narrative pedagogy can be a conduit to develop person-centred practice • Engaging staff through interactive practice development sessions can encourage expansive learning about human factors and their application in practice • Narrative pedagogy motivates healthcare staff to improve the safety culture in practice

Knowing the person of the resident – a theoretical framework for Person-centred Practice in Long-term Care (PeoPLe)

Background: Demographic change and a shift of values in society bring new challenges for the long-term care of older people, suggesting the institutional model of care should give way to one that places the person at the centre of decision making. Aim: To describe the development of a theoretical framework for person-centred practice with older people in long-term care. Development process: The framework was developed by synthesising original empirical research, existing evidence and existing theory, using an iterative and integrated approach to theory development based on a dialogical understanding of knowledge construction. The project formed part of a five-year research and practice development programme on person-centred practice in long-term care in Austria. Results: The Person-centred Practice Framework for Long-Term Care (PeoPLe) is a theoretical framework of person-centred practice, consisting of five constructs: prerequisites, practice environment, person-centred processes, fundamental principles of care, and outcome. It is dependent on the macro-context of healthcare delivery. Conclusion: PeoPLe provides a comprehensive theoretical framework for the development of person-centred practice in long-term care. The framework can be used to guide empirical inquiry, education and practice development. Implications for practice: The Person-centred Practice Framework for Long-term Care (PeoPLe) is a comprehensive theoretical framework that sets out principles for the operationalisation of person-centred practice with older people in long-term care The Fundamental Principles of Care component of the PeoPLe framework is reported to appeal to many practitioners and may serve also as a low-threshold starting point for practice development The Fundamental Principles of Care component may steer the development of person-centred processes and individual care plans with persons in care. It can, for example, be used to guide assessment, case conferences and documentation

A pilot cluster randomised trial of the Medicinesand Alcohol Consultation (MAC): an intervention to discuss alcohol use in community pharmacy medicine review services

BackgroundAlcohol interventions are important to the developing public health role of community pharmacies. The Medicines and Alcohol Consultation (MAC) is a new intervention, co-produced with community pharmacists (CPs) and patients, which involves a CP practice development programme designed to integrate discussion of alcohol within existing NHS medicine review services. We conducted a pilot trial of the MAC and its delivery to investigate all study procedures to inform progression to a definitive trial.MethodsThis cluster pilot RCT was conducted in 10 community pharmacies in Yorkshire, UK, with a CP from each who regularly conducted Medicine Use Review (MUR) and New Medicine Service (NMS) consultations. Randomisation was conducted using a secure remote randomisation service. Intervention CPs (n = 5) were trained to deliver the MAC in MUR/NMS consultations. Control CPs (n = 5) provided these services as usual. Consecutive MUR/NMS patients were asked by CPs to participate, screened for eligibility (consumption of alcohol at least twice per week), and baseline data collected for those eligible. A two-month follow-up telephone interview was conducted. Blinding of CPs was not possible, but patients were blinded to the alcohol focus of the trial. Primary outcomes were total weekly UK units (8 g of ethanol per unit) of alcohol consumption in the week prior to follow-up, and confidence in medications management. Trial procedures were assessed by recruitment, attrition, and follow-up rates.Results260 patients were approached by CPs to take part in the trial, 68% (n = 178) were assessed for eligibility and 30% (n = 54) of these patients were eligible. Almost all eligible patients (n = 51; 94%) consented to participate, of whom 92% (n = 47) were followed-up at 2 months; alcohol consumption was lower in the intervention arm and confidence in medication management reduced slightly for both groups. Exploration of recall issues at follow-up showed a high level of agreement between a two-item quantity/frequency measure and 7-day guided recall of alcohol consumption.ConclusionsThe pilot trial demonstrates the feasibility of implementing the MAC in community pharmacy and trial recruitment and data collection procedures. However, decommissioning of MURs means that it is not possible to conduct a definitive trial of the intervention in this service.Trial registrationISRCTN57447996

Magnitude of Malnutrition and Associated Factors Among Pregnancy and Lactating Mother in Meisso Health Center, Meisso Woreda, Oromia Region

Introduction: Malnutrition is one of the major nutritional problems in which the physical function of an individual is impaired to the point which cannot longer maintain adequate body performance process such as growth, physical work and resisting and recovery from the disease. Malnutrition usually stems from low economical situation, poor personal and environmental hygiene and ignorance are contribute to magnitude of high incidence of acute problem of malnutrition. Recent studies found that the center of the problems is the break ward socio economic development of the country which in turn results in one of the lowest standard of living, low level of social service, poor environmental conditions. In this respect it no disheartening to the not that the state of the health service in Ethiopia is low even when compared to the sub-Saharan Africa countries. Objective: To assess magnitude of malnutrition and associated factors among pregnancy and lactating mother in Mi'esso health center, Mi'essoworeda, Oromia Region, Ethiopia. Methods: Institutional based cross sectional study was employed. The study was conducted from Feb 1-May 30, 2017 among pregnancy and lactating in Mi'essoworeda. A total of 304 sample was selected by systematic random sampling from the list of Clients, with different socio-demographic and the collected data was analyses by using computer with the total budget of 4,846.9 Ethiopian birr. Result: The nutritional status of pregnancy and lactating mother based on their weight and height the BMI of the respondents indicates overweight accounts 12.6%, underweight 30.3%, and majority of the pregnancy and lactating mother accounts for 57.2% were normal nutritional level. The weight and height/ length of the pregnancy and lactating mother included in the study were between 1.56m to 1.78m and weight 53kg to 84kg. From multiple logistic regression analysis family income (AOR=2.056, 95%CI=1.051-4.023) and age of women (AOR=2.169(1.015-4.634) were significantly associated with the nutritional status of the study participants. Recommendation: Facilitate rural-urban community's access to information on nutrition like feeding practice sanitation, health and development program during pregnancy and lactate and efforts to expand awareness of women education using selected dietary during pregnancy and lactation. Funding Statement: This research work didn't obtained any financial aid from any organization except the Author them selves. Declaration of Interests: Authors should disclose all the financial and non-financial relationships that could be perceived so that doesn't result any influence to their professional judgment or bias their work. This manuscript can't be influenced by a secondary interest (e.g., financial gain) , this would include disclosing the names of (and relationship with) any pharmaceutical, biologics, medical device, and diagnostic companies for which an author (or one of their close family members) is employed, contracted for, provides services, or has otherwise collaborated with. Ethics Approval Statement: In order to confirm the ethical and legal standard of the investigator, approval was obtained from the ethical review board of Harar Health Science College. The survey was commence after written consent obtained from Mi’esso Health Center.

Magnitude of Malnutrition and Associated Factors among Pregnancy and Lactating Mother in Meisso Health Center, Meisso Woreda, Oromia Region

Introduction: Malnutrition is one of the major nutritional problems in which the physical function of an individual is impaired to the point which cannot longer maintain adequate body performance process such as growth, physical work and resisting and recovery from the disease. Malnutrition usually stems from low economic situation, poor personal and environmental hygiene and ignorance are contributed to magnitude of high incidence of acute problem of malnutrition. Recent studies found that the center of the problem is the backward socio-economic development of the country which in turn results in one of the lowest standard of living, low level of social service, poor environmental conditions. In this respect it no disheartening to the not that the state of the health service in Ethiopia is low even when compared to the Sub-Saharan Africa countries. Objective: To assess magnitude of malnutrition and associated factors among pregnancy and lactating mother in Mi’esso health center, Mi’esso Woreda, Oromia Region, Ethiopia. Methods: Institutional based cross-sectional study was employed. The study was conducted from February 1 to May 30, 2017 among pregnancy and lactating in Mi’esso Woreda. A total of 304 sample was selected by systematic random sampling from the list of Clients, with different socio-demographic and the collected data was analyses by using computer with the total budget of 4846.9 Ethiopian birr. Results: The nutritional status of pregnancy and lactating mother based on their weight and height the BMI of the respondents indicates overweight accounts 12.6%, underweight 30.3%, and majority of the pregnancy and lactating mother accounts for 57.2% were normal nutritional level. The weight and height/length of the pregnancy and lactating mother included in the study were between 1.56 m to 1.78 m and weight 53 kg to 84 kg. From multiple logistic regression analysis family income (AOR=2.056, 95%CI=1.051-4.023) and age of women (AOR=2.169 (1.015-4.634)) were significantly associated with the nutritional status of the study participants. Recommendation: Facilitate rural-urban community’s access to information on nutrition like feeding practice sanitation, health and development program during pregnancy and lactation and efforts to expand awareness of women education using selected dietary during pregnancy and lactation.

Magnitude of Malnutrition and Associated Factors Among Pregnancy and Lactating Mother in Meisso Health Center, Meisso Woreda, Oromia Region

Introduction: - Malnutrition is one of the major nutritional problems in which the physical function of an individual is impaired to the point which cannot longer maintain adequate body performance process such as growth, physical work and resisting and recovery from the disease. Malnutrition usually stems from low economical situation, poor personal and environmental hygiene and ignorance are contribute to magnitude of high incidence of acute problem of malnutrition. Recent studies found that the center of the problems is the break ward socio economic development of the country which in turn results in one of the lowest standard of living, low level of social service, poor environmental conditions. In this respect it no disheartening to the not that the state of the health service in Ethiopia is low even when compared to the sub-Saharan Africa countries. Objective: To assess magnitude of malnutrition and associated factors among pregnancy and lactating mother in Mi’esso health center, Mi’essoworeda, Oromia Region, Ethiopia. Methods: Institutional based cross sectional study was employed. The study was conducted from Feb 1-May 30, 2017 among pregnancy and lactating in Mi’essoworeda. A total of 304 sample was selected by systematic random sampling from the list of Clients, with different socio-demographic and the collected data was analyses by using computer with the total budget of 4,846.9 Ethiopian birr. Result: The nutritional status of pregnancy and lactating mother based on their weight and height the BMI of the respondents indicates overweight accounts 12.6%, underweight 30.3%, and majority of the pregnancy and lactating mother accounts for 57.2% were normal nutritional level. The weight and height/ length of the pregnancy and lactating mother included in the study were between 1.56m to 1.78m and weight 53kg to 84kg. From multiple logistic regression analysis family income (AOR=2.056, 95%CI=1.051-4.023) and age of women (AOR=2.169 (1.015-4.634) were significantly associated with the nutritional status of the study participants. Recommendation: Facilitate rural-urban community’s access to information on nutrition like feeding practice sanitation, health and development program during pregnancy and lactate and efforts to expand awareness of women education using selected dietary during pregnancy and lactation.

‘It’s a nice place, a nice place to be’. The story of a practice development programme to further develop person-centred cultures in palliative and end-of-life care

Background Palliative and end of life care services need to be person-centred. However, it cannot be assumed that such services are ‘naturally’ person-centred as in reality they face the same pressures and challenges as any other service. This is the case in the practice development research reported in this paper. Whilst the service had good patient and family feedback/satisfaction, the context of care provision for staff did not reflect these same levels of satisfaction. This contrast poses challenges for organisations in the context of staff well-being and the sustainability of person-centred care. The work undertaken in this project aimed to address this issue. Aim To implement a programme of practice development to further the development of a culture of person-centred practice in the Marie Curie Care (MCC) Edinburgh Hospice. Methods The programme was theoretically informed by The Person Centred Practice Framework of McCormack and McCance (2017) and operationalised through the methodology of Transformational Practice Development. Thirteen multidisciplinary team members formed a project group and participated in 10 x 4 hour workshops of learning and development, spread over a 12-month period. Practice development activities were planned in-between the workshops to be undertaken by the group members. Evaluation data were collected prior to the practice development work commencing, as a continuous process throughout the 12-months and at the end of the project period. Data collected included patient and staff stories, practice observations, creative expressions and routinely collected data. These data were analysed through a participatory approach with the group members and theorised through the lens of human flourishing. Findings The findings are located within a framework for exploring the conditions for human flourishing. They illustrate the tension between person-centred care and person-centred cultures. Key findings demonstrate the need for all persons to be ‘known’ in order for effective person-centred relationships to exist, the significance of shared values, the importance of addressing ‘small’ practice changes as well as the need to ensure the hearing of different voices. Findings fromn routine collected data further demonstrate the relationship between the development of a person-centred culture with patient and staff outcomes. Conclusions and Implications for Practice This project is one of the first to explicitly use a framework for human flourishing to analyse the relationship between person-centred culture and care provision. The programme demonstrates the importance of person-centred cultures for sustainable person-centred care. Implications for practice include: 1. Practice settings need to be clear about the difference between patient and person-centredness. 2. The engagement of a multidisciplinary team in interdiscioplinary systematic transformational practice development has the potential to transform the culture and context of care and produce sustaiunable outcomes. 3. Human flourishing is an appropriate focus to adopt in exploring how practice settings embrace the principles of person-vcentredness for all persons.

Sustaining a culture of practice development in an acute adolescent inpatient mental health unit.

It is recognized that facilitating change in workplace culture is a significant challenge in healthcare service delivery. Practice development strategies and principles provide a framework for initiating and sustaining programs focused on enhancing patient-centered care by concentrating on the therapeutic attributes of nursing. However, little literature exists on explicating "what worked" in practice development programs. This paper details the processes, people, resources, and relationships that enabled the successful implementation, and led to the sustainability, of a practice development program employed in an acute adolescent mental health unit in Sydney, Australia. Following an external review of the unit, a meeting of key stakeholders was convened and subsequently an advisory panel formed to address specific issues facing nursing staff. This process resulted in the development of an educational package and adoption of the tidal model as the framework for mental health nursing practice in the unit. Clinical reasoning sessions and journal article presentations were incorporated to consolidate and maintain the change in nursing care. A planned, structured, and inclusive practice development programhas transformed the nursing culture and vastly improved the care provided to adolescents presenting in acute states of distress to this mental health unit.

Developing cultures of person-centredness

Introduction: (comprising context and problem statement) A national two year practice development programme took place in the Republic of Ireland from 2007 to 2010. The programme was commissioned to support staff to implement a framework for person-centred nursing practice-centred practice in residential settings for older persons. Eighteen sites took part in the programme and staff and managers from a variety of disciplines used a person-centred framework and practice development model to develop their practice. Since the programme finished there is evidence that this work sustained and in some places continued to grow. The Health Service Executive in Ireland (HSE) now wishes to extend this programme to all services incrementally using the same methodology so that care and practices can be more fully integrated from a workplace culture perspective. Short description of practice change implemented: Process and outcome evaluation demonstrated improvements in practice and workplace culture for staff and improvements in care experiences for residents. A number of validated tools were used, both process and outcome that engaged residents and staff. Evidence indicated increased choice for residents and more meaningful relationships between them and staff to name but two. There was for example evidence of changes in workplace culture with improvement to quality of communication and support between staff, greater role satisfaction, improved staffing and resources, and greater commitment to the setting. Aim and theory of change: The overall aims of the programme were to: implement a framework for person-centred practice[1] for older people across multiple settings in Ireland, through a collaborative facilitation model and to carry out an evaluation of the processes and outcomes. The programme drew on numerous principles from different yet complementary theories and approaches: emancipatory practice development, co-operative inquiry and a specific person-centred nursing framework. Targeted population and stakeholders: Eighteen residential units for older people were involved in this programme. Along with residents in targeted sites, staff groups represented different areas within the units and grades i.e. Nurse Mangers, Staff Nurses, Health Care Assistants, Housekeeping, Catering and Administration staff. Timeline: An initial two year programme took place 2007 – 2010. The HSE will now replicate this programme by introducing a further three year national programme to develop cultures of person-centredness system wide which commences in February 2017. Highlights: (innovation, Impact and outcomes) This is an innovative methodology and programme that has been replicated in many different settings internationally such as New South Wales, Netherlands, Norway, Malta, UK, and others. Using this methodology and framework staff were facilitated to critically explore their practice and Comments on sustainability: For long term sustainability it is vital that practice development activities contribute to the professional and personal development of staff and managers. The development of staff key facilitation and practice development knowledge and skills enabled staff to work effectively with colleagues to changes their workplace culture. Comments on transferability: This programme has transferability to any care setting demonstrated in the variety of settings it has been introduces in for example in the New South Wales programme Essentials of Care[2] The focus is on developing cultures of person-centredness that supports person-centred practices. Conclusions: (comprising key findings) The HSE had demonstrated considerable impact on care experiences for both service users and staff through the introduction of this programme in older persons’ residential services. Discussions: Developing workplace culture will impact on the immediate experience of both staff and service users[3]. Recognising the enablers and consequences of workplace culture development means that the focus is on basic assumptions that influence actions[4]. Lessons learned: Involvement and engagement of managers in organisations is essential to the success of culture change. Managers are part of the culture and therefore need to be part of making change.

Developing the practice manager workforce

Following the announcement of the general practice development programme as part of the General Practice Forward View, Dave Hancock looks at the training available now and promised for the future

Perspectives and experiences of nurses as facilitators within a Practice Development program

BackgroundHealth services are challenged to change and adapt to meet the changing needs of the populations they serve. To support this, the ‘Essentials of Care’ Practice Development program was developed in Australia. Local facilitators play a key role in its delivery and achievements. AimsThis study aimed to gain insights into the experiences of clinical nurses in Practice Development facilitation roles in an acute hospital, including training for the role and changes occurring within themselves and their workplaces. MethodsA qualitative interpretive design used purposive sampling for a two-phase study using semi structured interviews and focus groups with data analysed using Framework Analysis. ResultsTwelve Registered Nurses with an average of two years’ experience in a facilitator role were interviewed and attended focus groups in 2011. Five key themes were identified: (1) facilitator as enabler, (2) the necessary team approach to facilitation, (3) valuing both internal and external models of facilitation, (4) preparation and training for role, and (5) perceived changes: to the facilitator and to the workplace. Individuals’ ongoing development resulted from reflection, mentorship, role-modelling and co-facilitation; facilitation skills were recognised as relevant for nursing beyond their Program role. Ward culture gains were valued as distinct from measurable patient outcomes such as reduced medication errors. ConclusionFindings provide insights into facilitators’ experiences of this Practice Development role and contribute to better understanding of effective processes for nursing practice change in acute health services. Recommendations were proposed to support future role and post-holder development.

Australian Technical Teachers’ Experience of Technology Integration in Teaching

This study investigated teachers’ conceptions of technology integration into their teaching from two renowned technical and vocational education (TVE) institutes in New South Wales, Australia. Thirteen teachers were interviewed using qualitative techniques informed by the phenomenographic approach. The analysis of the data revealed that TVE teachers perceived the use of technology in teaching in four qualitatively different ways: (a) upgrading teacher knowledge, (b) ease of communication, (c) effective teaching, and (d) flexible teaching. Some findings align with existing phenomenographic studies of teachers’ conceptions held in the context of university education. This study contributes to teachers’ conceptions literature by identifying “flexible teaching” as one of the most significant conceptions of teaching within the context of TVE teaching in particular and higher education in general. The findings of the study could have an impact on teaching practice and faculty development programs in both TVE and other higher educational institutes.

Patients’ experiences of in-hospital care when nursing staff were engaged in a practice development programme to promote person-centredness: A narrative analysis study

BackgroundThe drive towards person-centred approaches to care delivery has been increasingly promoted. This is in response to the significant challenges within health and social care organisations, which impact on the care experience for patients and their families. ObjectiveThe aim of this paper is to illuminate the experiences of patients of care received in hospital wards during the intervention phase of a programme to develop person-centred practice. DesignA narrative enquiry study was conducted which is a particular way of exploring complex cultural or social patterns. Structural narrative analysis was used to generate explanation and interpretation of in-hospital patients’ care experience. SettingRecruitment was from four different hospital sites in one health care organisation, focussing on patients who were admitted to the nine wards/units where the nursing teams were participating in a practice development programme that had the intention of promoting person-centredness. ParticipantsParticipants were people aged over 18 and receiving care and treatment in the identified wards/units. Twenty-six patients were recruited. MethodsNarrative interviews were audio-recorded at four month intervals and transcribed. The records were subjected to a process of structural analysis. ResultsThe findings offer insight into patients’ experiences of care in a range of clinical settings in which an explicit intervention to promote person-centred practice was underway. There was one overriding theme formulated: Vulnerability at the junctures of systems, care processes and nurses’ responses. From this main theme, we derived four sub-themes: (1) confronting vulnerability, (2) experiencing exemplary care, (3) experiencing misalignments in systems, care processes and nurses’ responses, and (4) sharing in a sense of belonging with ward nurses. ConclusionsIn-hospital patients are exposed to vulnerability in the care experience. They placed value on exemplary care. Experiences of misalignments in systems, care processes and nurses’ responses disempower patients and heighten a sense of vulnerability. The ward nursing teams were generating a family like atmosphere. Patients responded by sharing a sense of belonging with ward nurses. These findings confirm components that have influenced the development of person-centred practice, such as the importance of the context and culture of care. They also offer new insights that may contribute to on-going practice development work.

Paper 2: Conceptualizing the Transition from Advanced to Consultant Practitioner: Role Clarity, Self-perception, and Adjustment

BackgroundInterest in the influence of emotions on behaviour, decision making, and leadership has accelerated over the last decade. Despite this, the influence of emotions on career advancement and behaviour within radiography and radiotherapy has largely been ignored. The ease of transition from one work role to another within an individual's career may be influenced by previous experience, personal characteristics, organizational environment, culture, and the nature of the role itself. Consequently, the transition from the often well-defined role of advanced or specialist practitioner to the more fluid role of consultant practitioner is associated with changing emotions as reported in the first part of this two-part series. What remains unexplored are the emotional triggers that pre-empt each stage in the transition cycle and how our understanding of these might support the successful implementation of consultant practitioner roles. ObjectivesTo explore the emotional triggers that pre-empted each stage in the transitional journey of trainee consultant radiographers as they moved from advanced to consultant practitioner within a locally devised consultant development program. DesignLongitudinal qualitative enquiry. Methods and SettingsFive trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. ResultsAlthough all trainee consultant radiographers experienced the emotional events described in the first part of this two-part series in a predictable order (ie, elation, denial, doubt, crisis, and recovery), the timing of the events was not consistent. Importantly, four emotional triggers were identified, and the dominance of these and the reaction of individuals to them determined the emotional well-being of the individual over time. ConclusionsThis study provides a unique and hitherto unexplored insight into the transition journey from advanced or specialist practitioner. Importantly, the findings suggest that commonly adopted supportive change interventions may, in fact, trigger the negative emotions they are intended to alleviate and disable rather than enable role transition.

Paper 1: Conceptualizing the Transition from Advanced to Consultant Practitioner: Career Promotion or Significant Life Event?

BackgroundThe diversification of nursing and allied health profession (AHP) roles has seen unprecedented growth as organizations have sought to optimize limited health care resources. Within the UK health care system, the nonmedical consultant is viewed as the pinnacle of the clinical career ladder. Yet, nearly 15 years after their introduction, recruitment to these positions remains slow. Criticisms of nonmedical consultant practice include a lack of role clarity, a failure to work across the four domains of consultant practice, a lack of suitable applicants, and poor preparedness of new appointments. Although there is evidence exploring the nature and effectiveness of established consultant roles, little research addresses the development phase of aspiring consultants. ObjectivesTo explore the transitional journey experienced by trainee consultant radiographers as they move from advanced to consultant practitioner within a locally devised consultant development programme. DesignLongitudinal qualitative enquiry. Methods and SettingsFive trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. ResultsA challenging journey was recounted involving five key emotional stages that occurred in a consistent and predictable order (ie, elation, denial, doubt, crisis, and recovery). The identified stages had close parallels with Hopson's Life Events model, suggesting that transition to consultant practice is a significant life event rather than a straightforward job promotion. ConclusionsCurrent emphasis on the four domains of practice, although providing a clear framework for expected external role outcomes, overlooks the importance of the internal or subjective career development on the perceived success or failure of the role. Employers, educators, and professional bodies have a responsibility to facilitate aspirational consultants to explore and enhance their internal career development, offering more time to define themselves and their role with support to guide them through the transition journey.

Sustaining a culture of practice development in an acute adolescent inpatient mental health unit.

It is recognized that facilitating change in workplace culture is a significant challenge in healthcare service delivery. Practice development strategies and principles provide a framework for initiating and sustaining programs focused on enhancing patient-centered care by concentrating on the therapeutic attributes of nursing. However, little literature exists on explicating "what worked" in practice development programs. This paper details the processes, people, resources, and relationships that enabled the successful implementation, and led to the sustainability, of a practice development program employed in an acute adolescent mental health unit in Sydney, Australia. Following an external review of the unit, a meeting of key stakeholders was convened and subsequently an advisory panel formed to address specific issues facing nursing staff. This process resulted in the development of an educational package and adoption of the tidal model as the framework for mental health nursing practice in the unit. Clinical reasoning sessions and journal article presentations were incorporated to consolidate and maintain the change in nursing care. A planned, structured, and inclusive practice development program has transformed the nursing culture and vastly improved the care provided to adolescents presenting in acute states of distress to this mental health unit.

The Aspire to Inspire programme in aged care: the final chapter, one year on

Background and aims: The Aspire to Inspire practice development programme took place in the services within one region of an aged care provider in Australia. One year after it ended, the programme team looked back to see how practice development is faring in the region. Method: In this paper, we present a two part reflection one year on. We have drawn on individual reflections written by the programme team facilitators, and on the Person-Centred Care Framework. Conclusion: We found that strong values and beliefs were still present, especially among the programme facilitators and others who had been active in the practice development programme. We also found that a systematic approach and the use of facilitation in everyday work were still valued and that project team members were using a wide range of practice development methods, tools and processes in their new roles. We also found, unsurprisingly, that a wide scale organisational redesign weighed heavily on people, influencing their thinking and feeling about work and their commitment to the job. In summary – and this is tentative – more programmes and projects need to revisit how successful practice development has been in sustaining itself and its impact after formal programmes are completed. Implications for practice: There are implications for practice developers in terms of designing evaluation research and strategies. We found that although practice developers do seem to be more resilient than others during organisational redesign, major changes of this nature have a negative impact on the sustainability of practice development.

Unlocking the doors: introducing practice development to Canadian healthcare

From my early days as a nursing assistant in complex continuing care, I recognised that all was not well in healthcare. I was particularly troubled with practices that I perceived to be antithetical to ‘caring’ and I struggled to facilitate change within my very limited circle of influence. I remember well the day I asked for the key to open the balcony doors on the unit so I could take patients out for a breath of fresh air. Being told by the registered nurse that ‘those doors haven’t been opened in 15 years and that isn’t going to change’, was what I now appreciate as the start of my practice development journey. Although I have had the privilege of observing and contributing to more quality healthcare practices in my subsequent roles as a registered nurse, advanced practice nurse and, most recently, Director of Interprofessional Practice, I am also keen to know how far we have yet to go in bringing that ‘fresh air’ I sought decades ago to our patients through more person centred means. I think our lack of progress can be attributed in part to evolving technologies in healthcare that pull our attention away from the human-to-human exchange that has the most impact on patients’ experience of care. Practice development holds the promise of keeping us focused on our caring practices, in balance with the seductive lure of high tech solutions, to address gaps in our quality care. Canada is not alone in its need of healthcare improvement; media and scholarly literature across the globe abound with examples of poor quality care and calls to action across healthcare sectors, settings and specialties. Canada is, however, distinct because of the absence of practice development as a systematically adopted methodology for meeting quality improvement priorities at provincial, national or even local levels. This is despite how embedded practice development has become at local and national levels in both practice and academic settings beyond North America, with examples including the Older Persons Services National Practice Development Programme in the Republic of Ireland, the New South Wales-based Essentials of Care programme in Australia and the England Centre for Practice Development hosted by Canterbury Christ Church University. These success stories, as well as the breadth of related theoretical and empirical literature that has evolved over the past 20 years, have not influenced Canadian healthcare practices much beyond the level of individual academics and practitioners – a relatively small group of converts.