ORCID Profile
0000-0002-6168-0455
Current Organisations
Murdoch University
,
Royal Surrey County Hospital NHS Foundation Trust
,
University of Surrey
,
University of Technology Sydney
,
King's College London
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Publisher: Wiley
Date: 02-06-2020
DOI: 10.1111/JOCN.15307
Publisher: Springer Science and Business Media LLC
Date: 11-11-2009
Publisher: Wiley
Date: 06-07-2023
DOI: 10.1111/JAN.15764
Abstract: To critically evaluate the concepts of harm and re‐traumatization in the research process and to explore the ethical implications of conducting research on distressing topics using our research on the experiences of nurses working during the COVID‐19 pandemic as an exemplar. Longitudinal qualitative interview study. Using qualitative narrative interviews, we explored the impacts of the COVID‐19 pandemic on nurses' psychological well‐being in the UK. To reduce the potential for harm to both research participants and researchers, the members of the research team were keen to establish ways to reduce the power differential between the researcher and participants. We found that our collaborative and team‐based approach, with participant autonomy and researcher reflexivity embedded into the research framework, enabled the sensitive generation of data. Reduction of potential harm for both participants and researchers in the generation of at times highly distressing data with a traumatized population was achieved through a respectful, honest and empathetic approach within a team that met frequently for reflection. The research participants were not harmed by our research, instead they expressed gratitude at being given space and time to tell their stories in a supportive environment. Our work advances nursing knowledge through accentuating the value of giving autonomy to research participants to control their stories whilst working within a supportive research team with emphasis placed on reflexivity and debriefing. Nurses working clinically during COVID‐19 were involved in the development of this study. Nurse participants were given autonomy over how and when they participated in the research process.
Publisher: Wiley
Date: 27-02-2013
DOI: 10.1111/NIN.12025
Abstract: The rise of managerialism within healthcare systems has been noted globally. This paper uses the findings of a scoping study to investigate the management of poor performance among nurses and midwives in the United Kingdom within this context. The management of poor performance among clinicians in the NHS has been seen as a significant policy problem. There has been a profound shift in the distribution of power between professional and managerial groups in many health systems globally. We examined literature published between 2000 and 10 to explore aspects of poor performance and its management. We used Web of Science, CINAHL, MEDLINE, British Nursing Index, HMIC, Cochrane Library and PubMed. Empirical data are limited but indicate that nurses and midwives are the clinical groups most likely to be suspended and that poor performance is often represented as an in idual deficit. A focus on the in idual as a source of trouble can serve as a distraction from more complex systematic problems.
Publisher: BMJ
Date: 13-03-2015
Publisher: Mark Allen Group
Date: 02-07-2018
DOI: 10.12968/JOHV.2018.6.7.352
Abstract: The altered landscape surrounding the commissioning of public health provision has affected the nature and range of health visitor services across England. This is the first of two articles reporting evidence from a programme of research that focused on how health visiting works, also reporting service user and workforce perspectives. Evidence for a service model is offered based on universal principles and maximising the capacity of the health visiting resource. Where service specifications fail to give careful attention to this evidence, the reshaped services for children and families may miss core ingredients that enable health visitors to make a difference, delivering a proportionate and successful child health programme for the early years.
Publisher: Wiley
Date: 16-01-2021
DOI: 10.1111/JAN.15526
Abstract: To critically examine nurses' experiences of speaking up during COVID‐19 and the consequences of doing so. Longitudinal qualitative study. Participants were purposively s led to represent differing geographical locations, specialities, settings and redeployment experiences. They were interviewed (remotely) between July 2020 and April 2022 using a semi‐structured interview topic guide. Three key themes were identified inductively from our analysis including: (1) Under threat: The ability to speak up or not (2) Risk tolerance and avoidance: Consequences of speaking up and (3) Deafness and hostility: Responses to speaking up. Nurses reported that their attempts to speak up typically focused on PPE, patient safety and redeployment. Findings indicate that when NHS Trusts and community services initiated their pandemic response policies, nurses' opportunities to speak up were frequently thwarted. Accounts presented in this article include nurses' feeling a sense of futility or of suffering in silence in relation to speaking up. Nurses also fear the consequences of speaking up. Those who did speak up encountered a ‘deaf’ or hostile response, leaving nurses feeling disregarded by their organization. This points to missed opportunities to learn from those on the front line. Speaking up interventions need to focus on enhancing the skills to both speak up, and respond appropriately, particularly when power, hierarchy, fear and threat might be concerned. Nurses working clinically during COVID‐19 were involved in the development of this study. Participants were also involved in the development of our interview topic guide and comments obtained from the initial survey helped to shape the study design.
Publisher: SAGE Publications
Date: 09-01-2015
Abstract: We trace the legacies of filmed patient narratives that were edited and screened to encourage engagement with a participatory quality improvement project in an acute hospital setting in England. Using Gabriel’s theory of “narrative contract,” we examine the initial success of the films in establishing common grounds for participatory project and later, and more varied, interpretations of the films. Over time, the films were interpreted by staff as either useful sources of learning by critical reflection, dubious (invalid or unreliable) representations of patient experience, or as “closed” items available as auditable evidence of completed quality improvement work. We find these interpretations of the films to be shaped by the effect of social distance, the differential outcomes of project work, and changing organizational agendas. We consider the wider conditions of patient narrative as a form of quality improvement knowledge with immediate potency and fragile or fluid legitimacy over time.
Publisher: Wiley
Date: 11-1993
Publisher: BMJ
Date: 07-2022
DOI: 10.1136/BMJOPEN-2022-061771
Abstract: Unprofessional behaviours encompass many behaviours including bullying, harassment and microaggressions. These behaviours between healthcare staff are problematic they affect people’s ability to work, to feel psychologically safe at work and speak up and to deliver safe care to patients. Almost a fifth of UK National Health Service staff experience unprofessional behaviours in the workplace, with higher incidence in acute care settings and for staff from minority backgrounds. Existing analyses have investigated the effectiveness of strategies to reduce these behaviours. We seek to go beyond these, to understand the range and causes of such behaviours, their negative effects and how mitigation strategies may work, in which contexts and for whom. This study uses a realist review methodology with stakeholder input comprising a number of iterative steps: (1) formulating initial programme theories drawing on informal literature searches and literature already known to the study team, (2) performing systematic and purposive searches for grey and peer-reviewed literature on Embase, CINAHL and MEDLINE databases as well as Google and Google Scholar, (3) selecting appropriate documents while considering rigour and relevance, (4) extracting data, (5) and synthesising and (6) refining the programme theories by testing the theories against the newly identified literature. Ethical review is not required as this study is a secondary research. An impact strategy has been developed which includes working closely with key stakeholders throughout the project. Step 7 of our project will develop pragmatic resources for managers and professionals, tailoring contextually-sensitive strategies to reduce unprofessional behaviours, identifying what works for which groups. We will be guided by the ‘Evidence Integration Triangle’ to implement the best strategies to reduce unprofessional behaviours in given contexts. Dissemination will occur through presentation at conferences, innovative methods (cartoons, videos, animations and/or interactive performances) and peer-reviewed journals. CRD42021255490.
Publisher: Wiley
Date: 19-11-2012
DOI: 10.1111/JAN.12050
Publisher: BMJ
Date: 10-2018
DOI: 10.1136/BMJOPEN-2018-024254
Abstract: (i) To synthesise the evidence-base for Schwartz Center Rounds (Rounds) to assess any impact on healthcare staff and identify key features (ii) to scope evidence for interventions with similar aims, and compare effectiveness and key features to Rounds. Systematic review of Rounds literature scoping reviews of comparator interventions (action learning sets after action reviews Balint groups caregiver support programme clinical supervision critical incident stress debriefing mindfulness-based stress reduction peer-supported storytelling psychosocial intervention training reflective practice groups resilience training). PsychINFO, CINAHL, MEDLINE and EMBASE, internet search engines consultation with experts. Empirical evaluations (qualitative or quantitative) any healthcare staff in any healthcare setting published in English. The overall evidence base for Rounds is limited. We developed a composite definition to aid comparison with other interventions from 41 documents containing a definition of Rounds. Twelve (10 studies) were empirical evaluations. All were of low/moderate quality (weak study designs including lack of control groups). Findings showed the value of Rounds to attenders, with a self-reported positive impact on in iduals, their relationships with colleagues and patients and wider cultural changes. The evidence for the comparative interventions was scant and also low/moderate quality. Some features of Rounds were shared by other interventions, but Rounds offer unique features including being open to all staff and having no expectation for verbal contribution by attenders. Evidence of effectiveness for all interventions considered here remains limited. Methods that enable identification of core features related to effectiveness are needed to optimise benefit for in idual staff members and organisations as a whole. A systems approach conceptualising workplace well-being arising from both in idual and environmental/structural factors, and comprising interventions both for assessing and improving the well-being of healthcare staff, is required. Schwartz Rounds could be considered as one strategy to enhance staff well-being.
Publisher: Royal College of General Practitioners
Date: 17-07-2023
Publisher: Emerald
Date: 13-05-2014
Publisher: Oxford University Press (OUP)
Date: 06-1998
DOI: 10.1093/HER/13.2.185
Abstract: The new approach to pre-registration nursing education in the UK (Project 2000) has an overt health focus as well as a specific remit to prepare nurses for a role as promoters of health. Data reported in this paper illuminate Project 2000 students' understanding of the concepts of health promotion and health education, and indicate the extent to which qualified nurses who have completed this new Project 2000 programme perceive themselves to be prepared for a health promotion role. Findings indicate that students are confused about the terms health education and health promotion, although most feel there is a distinction between the two. Students' descriptions emphasize in idualistic approaches, and lifestyle and behaviour changes. Many recognize that health promotion should have a broader application and demonstrate a sophisticated grasp of the philosophy underpinning the promotion of health through their general perceptions of nursing. This understanding is not labelled health education or health promotion, but is embedded in their articulation of concepts such as holism, patient-centred care and enhancing independence. Paradoxically, both students and Project 2000 qualified nurses (diplomates) illustrate a clear grasp of the more complex issues surrounding the concept of health promotion while remaining confused by the terminology and its relationship to practice.
Publisher: BMJ
Date: 2017
Publisher: Springer Science and Business Media LLC
Date: 24-04-2009
Publisher: BMJ
Date: 23-12-2015
DOI: 10.1136/BMJ.H6933
Publisher: Elsevier BV
Date: 03-2022
Publisher: Wiley
Date: 07-1997
DOI: 10.1046/J.1365-2648.1997.1997026161.X
Abstract: This is the first of two papers which address aspects of the findings of a large scale study commissioned by the English National Board which set out to examine the impact of Project 2000 on perceptions of the philosophy and practice of nursing. The findings presented here suggest that there have been fundamental shifts in perceptions of the nature and discipline of nursing. Students and diplomates of the course perceive themselves as knowledgeable doers, with their practice well grounded in theory and research. They value the interpersonal skills teaching and place the patient firmly at the centre of care delivery, viewing the patient holistically and being prepared to be fierce patient advocates where necessary. It is difficult to determine the extent to which these shifts can be attributed to the Project 2000 course, although the Project 2000 approach to education appears to be an important factor.
Publisher: BMJ
Date: 25-09-2015
Publisher: Wiley
Date: 02-1992
DOI: 10.1111/J.1365-2648.1992.TB01871.X
Abstract: A postal questionnaire survey design was utilized to establish a national overview of perceptions of health education practice in general acute ward settings. Questionnaires were sent to in iduals identified as the most senior nurse within each district health authority in England (n = 195). Respondents were asked to specify--with the help of their nursing teams--the progress made on wards within their respective district health authorities in relation to a range of health education activities. A response rate of 73% (n = 142) was achieved. The majority of responses reflected the perceptions of senior nurse managers or their deputies. The data showed that respondents felt health education activities generally are a feature of nursing practice on acute wards. However, on the majority of wards, they were seen as only partially included into some areas of nursing practice. On only a small proportion (4%) of wards was health education of any type reported not to be a feature of practice. Of the five specific health education areas explored in the questionnaire, 'patient education' and 'information-giving' were felt to be occurring on a significantly greater number of wards and significantly more frequently than 'encouraging patients and their families to participate in care'. Data analysis also showed that all the activities specified--that is, patient education, information-giving, healthy lifestyle advice and encouraging patient and family participation in care--were positively correlated.
Publisher: Elsevier BV
Date: 03-2010
Publisher: Wiley
Date: 12-1995
DOI: 10.1111/J.1365-2648.1995.TB03118.X
Abstract: Health promotion is a concept which is frequently used, but is often ill defined. Current health care trends, and the emphasis on the nurse of the future as a promoter of health suggest that it would be useful to attempt to clarify the concept. This paper develops a conceptual analysis of health promotion using the process developed by Rodgers (1989). Attributes, antecedents, consequences and references are described following an examination of the ongoing debate in the literature surrounding the meaning of the concept. Empirical work is also reviewed which suggests that nurses' understandings of the concept are firmly embedded in the more traditional approach rather than the more modern or new paradigm approach to health promotion. A model case is described, and the analysis results in a proposed definition of health promotion which it is hoped will stimulate further discussion.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.NEDT.2016.04.007
Abstract: This paper draws on a narrative review of the literature, commissioned to support the Health Visitor Implementation Plan, and aimed at identifying messages about the knowledge, skills, and abilities needed by health visitors to work within the current system of health care provision. The scoping study and narrative review used three complementary approaches: a broad search, a structured search, and a seminal paper search to identify empirical papers from the health visitor literature for review. The key inclusion criteria were messages of relevance for practice. 378 papers were reviewed. These included empirical papers from the United Kingdom (UK) from 2004 to February 2012, older research identified in the seminal paper search and international literature from 2000 to January 2016. The review papers were read by members of the multidisciplinary research team which included health visitor academics, social scientists, and a clinical psychologist managed the international literature. Thematic content analysis was used to identify main messages. These were tabulated and shared between researchers in order to compare emergent findings and to confirm dominant themes. The analysis identified an 'orientation to practice' based on salutogenesis (health creation), human valuing (person-centred care), and viewing the person in situation (human ecology) as the aspirational core of health visitors' work. This was realised through home visiting, needs assessment, and relationship formation at different levels of service provision. A wide range of knowledge, skills, and abilities were required, including knowledge of health as a process and skills in engagement, building trust, and making professional judgments. These are currently difficult to impart within a 45week health visitor programme and are facilitated through ad hoc post-registration education and training. The international literature reported both similarities and differences between the working practices of health visitors in the UK and public health nurses worldwide. Challenges related to the education of each were identified. The breadth and scope of knowledge, skills, and abilities required by health visitors make a review of current educational provision desirable. Three potential models for health visitor education are described.
Publisher: RCN Publishing Ltd.
Date: 24-04-2013
Publisher: Springer Science and Business Media LLC
Date: 22-08-2012
Abstract: Patients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process. One dataset was collected using a narrative interview approach, (n = 13) and the other using a postal survey (n = 82). Datasets were analyzed separately and then compared to determine whether similar priorities for improving patient experiences were identified. There were both similarities and differences in the improvement priorities arising from each approach. Day surgery was specifically identified as a priority in the narrative dataset but included in the survey recommendations only as part of a broader priority around improving inpatient experience . Both datasets identified appointment systems , patients spending enough time with staff , information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to ‘relational’ aspects of patient experience. Those identified by the survey typically related to more ‘functional’ aspects and were not always sufficiently detailed to identify specific improvement actions. Our analysis suggests that whilst local survey data may act as a screening tool to identify potential problems within the breast cancer service, they do not always provide sufficient detail of what to do to improve that service. These findings may have wider applicability in other services. We recommend using an initial preliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient experience.
Publisher: Springer Science and Business Media LLC
Date: 29-04-2012
Publisher: Wiley
Date: 29-03-2022
DOI: 10.1111/JAN.15236
Publisher: SAGE Publications
Date: 06-1999
DOI: 10.1177/001789699905800202
Abstract: This paper describes the development of indicators of quality in the health promo tion work of primary health care nurses through a study commissioned by the Health Education Authority (HEA). The study commenced with a review of the accident- prevention literature in primary health care nursing and three in-depth workshops with locality-based project teams consisting of commissioners of primary health care nursing services, primary health care nurses themselves, and their managers. Potential indicators of quality were identified from the literature and explored further within the workshops. The second phase of the study involved refining and testing the relevance of the indicators in practice through stakeholder interviews and the third phase focused on case studies of six areas of primary health care nursing prac tice. Client perspectives were actively sought and ten consumer-focused process indicators emerged. These have the potential to provide measures of quality in health promotion activities undertaken by primary health care nurses.
Publisher: Wiley
Date: 25-04-2012
DOI: 10.1111/J.1748-3743.2012.00326.X
Abstract: Few empirical studies have directly examined the relationship between staff experiences of providing healthcare and patient experience. Present concerns over the care of older people in UK acute hospitals - and the reported attitudes of staff in such settings - highlight an important area of study. AIMS AND OBJECTIVES. To examine the links between staff experience of work and patient experience of care in a 'Medicine for Older People' (MfOP) service in England. A mixed methods case study undertaken over 8 months incorporating a 149-item staff survey (66/192 - 34% response rate), a 48-item patient survey (26/111 - 23%), 18 staff interviews, 18 patient and carer interviews and 41 hours of non-participant observation. Variation in patient experience is significantly influenced by staff work experiences. A high-demand/low-control work environment, poor staffing, ward leadership and co-worker relationships can each add to the inherent difficulties staff face when caring for acutely ill older people. Staff seek to alleviate the impact of such difficulties by finding personal satisfaction from caring for 'the poppets' those patients they enjoy caring for and for whom they feel able to 'make a difference'. Other patients - noting dehumanising aspects of their care - felt like 'parcels'. Patients are aware of being seen by staff as 'difficult' or 'demanding' and seek to manage their relationships with nursing staff accordingly. The work experiences of staff in a MfOP service impacted directly on patient care experience. Poor ward and patient care climates often lead staff to seek job satisfaction through caring for 'poppets', leaving less favoured - and often more complex patients - to receive less personalised care. Implications for practice. Investment in staff well-being and ward climate is essential for the consistent delivery of high-quality care for older people in acute settings.
Publisher: BMJ
Date: 2013
Publisher: National Institute for Health and Care Research
Date: 08-2019
DOI: 10.3310/HSDR07280
Abstract: The ‘Productive Ward: Releasing Time to Care’™ programme (Productive Ward PW) was introduced in English NHS acute hospitals in 2007 to give ward staff the tools, skills and time needed to implement local improvements to (1) increase the time nurses spend on direct patient care, (2) improve the safety and reliability of care, (3) improve staff and patient experience and (4) make structural changes on wards to improve efficiency. Evidence of whether or not these goals were met and sustained is very limited. To explore if PW had a sustained impact over the past decade. Multiple methods, comprising two online national surveys, six acute trust case studies (including a secondary analysis of local audit data) and telephone interviews. Surveys of 56 directors of nursing and 35 current PW leads 88 staff and patient and public involvement representative interviews 10 ward manager questionnaires structured observations of 12 randomly selected wards and documentary analysis in case studies and 14 telephone interviews with former PW leads. Trusts typically adopted PW in 2008–9 on their wards using a phased implementation approach. The average length of PW use was 3 years (range 1 to 7 years). Financial and management support for PW has disappeared in the majority of trusts. The most commonly cited reason for PW’s cessation was a change in quality improvement (QI) approach. Nonetheless, PW has influenced wider QI strategies in around half of the trusts. Around one-third of trusts had impact data relating specifically to PW the same proportion did not. Early adopters of PW had access to more resources for supporting implementation. Some elements of local implementation strategies were common. However, there were variations that had consequences for the assimilation of PW into routine practice and, subsequently, for the legacies and sustainability of the programme. In all case study sites, material legacies (e.g. display of metrics data storage systems) remained, as did some processes (e.g. protected mealtimes). Only one case study site had sufficiently robust data collection systems to allow an objective assessment of PW’s impact in that site, care processes had improved initially (in terms of patient observations and direct care time). Experience of leading PW had benefited the careers of the majority of interviewees. Starting with little or no QI experience, many went on to work on other initiatives within their trusts, or to work in QI at regional or national level within the NHS or in the private sector. The research draws on participant recall over a lengthy period characterised by evolving QI approaches and system-level change. Little robust evidence remains of PW leading to a sustained increase in the time nurses spend on direct patient care or improvements in the experiences of staff and/or patients. PW has had a lasting impact on some ward practices. As an ongoing QI approach continually used to make ongoing improvements, PW has not been sustained, but it has informed current organisational QI practices and strategies in many trusts. The design and delivery of future large-scale QI programmes could usefully draw on the lessons learnt from this study of the PW in England over the period 2008–18. This National Institute for Health Research Health Services and Delivery Research programme.
Publisher: BMJ
Date: 10-02-2016
DOI: 10.1136/BMJ.I563
Publisher: Elsevier BV
Date: 03-2008
Publisher: SAGE Publications
Date: 27-06-2020
Abstract: Schwartz Center Rounds® (‘Rounds’) are multidisciplinary forums where health care staff come together to reflect upon the emotional impact of their work. In each Round, a small number of staff (panellists) share experiences through stories to trigger reflection in audience members. Previous research has identified impacts associated with Rounds’ attendance, but little is known about the experience and impact of Rounds from panellists’ perspectives. This study is the first to explore the role of disclosure and reflection through storytelling in Rounds, specifically exploring panellists’ motivations, experiences and reported impacts associated with panel participation. Interviews with 50 panellists, from nine case-study sites in the United Kingdom, representing acute, community and mental health National Health Service trusts and hospices. Data were analysed using thematic analysis. Most panellists spoke positively about their experience of sharing their stories in Rounds. Reported impacts included: increased emotional resilience and acceptance of experiences reduced negative assumptions about colleagues and increased approachability and trust increasing tolerance and compassion the creation of a space to stop and think and to reframe negative patient experiences facilitating greater empathy and emotional disclosure becoming more visible and normative, thereby helping change culture. Impacts on staff were similar regardless of contextual variability, including their professional group or role, with the exception of impact on patient care, which was not mentioned by non-clinical staff. The extent of panel preparation and audience characteristics (e.g. size, composition and response to their stories) influenced panellists’ experiences and outcomes. Rounds highlight the important role of disclosure and reflection through storytelling to support panellists with the emotional aspects of their work, providing a space for support with the emotional demands of health care, reducing the need for employees to be stoic. Panel participation also offers an important source of validation in organizations marked by scrutiny.
Publisher: Hindawi Limited
Date: 10-05-2011
DOI: 10.1111/J.1365-2834.2011.01219.X
Abstract: To examine the evidence of how poorly performing nurses and midwives are managed in the UK National Health Service (NHS). Nurses and midwives form the largest clinical group in the NHS. There is little evidence, however, about poor performance and its management in nursing and midwifery literature. The present study comprised a literature search, analysis of recent Nursing and Midwifery Council (NMC) data and observation at NMC fitness to practice hearings. Nurses and midwives are the clinical groups most likely to be suspended in the NHS Trusts do not report data on suspensions therefore no data exist on numbers, reasons for suspensions, managerial processes, gender, area of work, or ethnicity of those suspended the few major research projects identify variable management practices, the significant financial cost to the NHS and the personal cost to those suspended there is evidence that inexperienced, poorly trained, or poorly supported managers use suspension inappropriately. Our observation supported this. There is a need for robust data gathering and research in the field of NHS managerial practice. Managers should refrain from adopting punitive forms of performance management. Frontline staff and management need better training and support for dealing with poor performance.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.IJNURSTU.2014.07.013
Abstract: There is increasing international interest in universal, health promoting services for pregnancy and the first three years of life and the concept of proportionate universalism. Drawing on a narrative review of literature, this paper explores mechanisms by which such services might contribute to health improvement and reducing health inequalities. Through a narrative review of empirical literature, to identify: (1) What are the key components of health visiting practice? (2) How are they reflected in implementing the universal service rovision envisaged in the English Health Visitor Implementation Plan (HVIP)? The paper draws upon a scoping study and narrative review. We used three complementary approaches to search the widely dispersed literature: (1) broad, general search, (2) structured search, using topic-specific search terms, (3) seminal paper search. Our key inclusion criterion was information about health visiting practice. We included empirical papers from United Kingdom (UK) from 2004 to February 2012 and older seminal papers identified in search (3), identifying a total of 348 papers for inclusion. A thematic content analysis compared the older (up to 2003) with more recent research (2004 onwards). The analysis revealed health visiting practice as potentially characterized by a particular 'orientation to practice.' This embodied the values, skills and attitudes needed to deliver universal health visiting services through salutogenesis (health creation), person-centredness (human valuing) and viewing the person in situation (human ecology). Research about health visiting actions focuses on home visiting, needs assessment and parent-health visitor relationships. The detailed description of health visitors' skills, attitudes, values, and their application in practice, provides an explanation of how universal provision can potentially help to promote health and shift the social gradient of health inequalities. Identification of needs across an undifferentiated, universal caseload, combined with an outreach style that enhances uptake of needed services and appropriate health or parenting information, creates opportunities for parents who may otherwise have remained unaware of, or unwilling to engage with such provision. There is a lack of evaluative research about health visiting practice, service organization or universal health visiting as potential mechanisms for promoting health and reducing health inequalities. This paper offers a potential foundation for such research in future.
Publisher: MDPI AG
Date: 14-09-2022
Abstract: People bereaved by suicide are affected psychologically and physically and may be at greater risk of taking their own lives. Whilst researchers have explored the impact of suicide on family members and friends, the area of colleague suicide has been neglected and postvention guidance for supporting surviving colleagues is often poorly developed. This critical integrative review explored the impact of colleague suicide on surviving co-workers and reviewed postvention guidance for workplaces. Systematic searches found 17 articles that met the inclusion criteria. Articles were appraised for quality and extracted data were analysed using a thematic network method. Article quality was moderate. Two global themes were developed: impact of a colleague suicide comprised themes of ‘suicide loss in the workplace’ ‘professional identities and workplace roles’ ‘perceptions of professional uniqueness’ and ‘professional abandonment and silencing’. Postvention following a colleague suicide comprised ‘in idualised responses’ ‘the dual function of stigma’ and ‘complex pressure on managers’. A unifying global network ‘after a colleague suicide’ describes the relationships between all themes. A series of disconnects between existing postvention guidance and the needs of impacted workers are discussed. This review demonstrates the need for robust, systemic postvention for colleagues impacted by the complex issue of colleague suicide.
Publisher: Elsevier BV
Date: 02-2022
Publisher: Elsevier BV
Date: 07-2017
Publisher: Wiley
Date: 25-02-2016
DOI: 10.1111/JAN.12912
Abstract: To understand nurses' perceptions and experiences of work role transitions. Globally an uncertain healthcare landscape exists and when changing work roles nurses experience periods of transition when they may not cope well. A greater understanding of work role transitions may help facilitate workforce retention and successful careers. Mixed methods systematic review. Six data bases were searched for peer reviewed primary empirical research, published in English language between January 1990 and December 2014, supplemented by hand and citation searching. Evidence for Policy and Practice Information and Co-ordinating Centre methods for systematic reviews principles were followed. Analysis and synthesis of the qualitative and quantitative papers was conducted separately using thematic analysis. A third synthesis combined the narrative findings and a narrative synthesis of results is presented. Twenty-six papers were included. Across nurses' work role transitions two pathways were found: Novice and Experienced. 'Novice' comprises pre-registration and newly qualified nurses. 'Experienced' comprises, Enrolled/Licensed Practical Nurse to Registered Nurse, experienced to specialist nurse and clinical role changes. Each pathway results in different emphasizes of two themes 'Striving for a new professional self' includes emotional upheaval and identity while 'Know how' includes competence and boundaries. Novice nurses are more susceptible to the extremes of emotional upheaval while experienced nurses' competence eases aspects of transitions while boundary issues pervade. Informed work and educational environments are required for all groups of nurses. Using existing models of transition can facilitate successful in idual transitions and develop the workplace.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.IJNURSTU.2011.03.011
Abstract: An association between quality of care and staffing levels, particularly registered nurses, has been established in acute hospitals. Recently an association between nurse staffing and quality of care for several chronic conditions has also been demonstrated for primary care in English general practice. A smaller body of literature identifies organisational factors, in particular issues of human resource management, as being a dominant factor. However the literature has tended to consider staffing and organisational factors separately. We aim to determine whether relationships between the quality of clinical care and nurse staffing in general practice are attenuated or enhanced when organisational factors associated with quality of care are considered. We further aim to determine the relative contribution and interaction between these factors. We used routinely collected data from 8409 English general practices. The data, on organisational factors and the quality of clinical care for a range of long term conditions, is gathered as part of "Quality and Outcomes Framework" pay for performance system. Regression models exploring the relationship of staffing and organisational factors with care quality were fitted using MPLUS statistical modelling software. Higher levels of nurse staffing, clinical recording, education and reflection on the results of patient surveys were significantly associated with improved clinical care for COPD, CHD, Diabetes and Hypothyroidism after controlling for organisational factors. There was some evidence of attenuation of the estimated nurse staffing effect when organisational factors were considered, but this was small. The effect of staffing interacted significantly with the effect of organisational factors. Overall however, the characteristics that emerged as the strongest predictors of quality of clinical care were not staffing levels but the organisational factors of clinical recording, education and training and use of patient experience surveys. Organisational factors contribute significantly to observed variation in the quality of care in English general practices. Levels of nurse staffing have an independent association with quality but also interact with organisational factors. The observed relationships are not necessarily causal but a causal relationship is plausible. The benefits and importance of education, training and personal development of nursing and other practice staff was clearly indicated.
Publisher: Royal College of General Practitioners
Date: 29-12-2014
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.IJNURSTU.2010.07.018
Abstract: Several systematic reviews have suggested that greater nurse staffing as well as a greater proportion of registered nurses in the health workforce is associated with better patient outcomes. Others have found that nurses can substitute for doctors safely and effectively in a variety of settings. However, these reviews do not generally consider the effect of nurse staff on both patient outcomes and costs of care, and therefore say little about the cost-effectiveness of nurse-provided care. Therefore, we conducted a scoping literature review of economic evaluation studies which consider the link between nurse staffing, skill mix within the nursing team and between nurses and other medical staff to determine the nature of the available economic evidence. Scoping literature review. English-language manuscripts, published between 1989 and 2009, focussing on the relationship between costs and effects of care and the level of registered nurse staffing or nurse-physician substitution/nursing skill mix in the clinical team, using cost-effectiveness, cost-utility, or cost-benefit analysis. Articles selected for the review were identified through Medline, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Google Scholar database searches. After selecting 17 articles representing 16 unique studies for review, we summarized their main findings, and assessed their methodological quality using criteria derived from recommendations from the guidelines proposed by the Panel on Cost-Effectiveness in Health Care. In general, it was found that nurses can provide cost effective care, compared to other health professionals. On the other hand, more intensive nurse staffing was associated with both better outcomes and more expensive care, and therefore cost effectiveness was not easy to assess. Although considerable progress in economic evaluation studies has been reached in recent years, a number of methodological issues remain. In the future, nurse researchers should be more actively engaged in the design and implementation of economic evaluation studies of the services they provide.
Publisher: Springer Science and Business Media LLC
Date: 30-08-2012
Publisher: Elsevier BV
Date: 06-2020
Publisher: Springer Science and Business Media LLC
Date: 18-07-2021
DOI: 10.1186/S12913-021-06483-4
Abstract: Healthcare work is known to be stressful and challenging, and there are recognised links between the psychological health of staff and high-quality patient care. Schwartz Center Rounds® (Rounds) were developed to support healthcare staff to re-connect with their values through peer reflection, and to promote more compassionate patient care. Research to date has focussed on self-report surveys that measure satisfaction with Rounds but provide little analysis of how Rounds ‘work’ to produce their reported outcomes, how differing contexts may impact on this, nor make explicit the underlying theories in the conceptualisation and implementation of Rounds. Realist evaluation methods aimed to identify how Rounds work, for whom and in what contexts to deliver outcomes. We interviewed 97 key informants: mentors, facilitators, panellists and steering group members, using framework analysis to organise and analyse our data using realist logic. We identified mechanisms by which Rounds lead to outcomes, and contextual factors that impacted on this relationship, using formal theory to explain these findings. Four stages of Rounds were identified. We describe how, why and for whom Schwartz Rounds work through the relationships between nine partial programme theories. These include: trust safety and containment group interaction counter-cultural/3rd space for staff self-disclosure story-telling role modelling vulnerability contextualising patients and staff shining a spotlight on hidden stories and roles and reflection and resonance. There was variability in the way Rounds were run across organisations. Attendance for some staff was difficult. Rounds is likely to be a ‘slow intervention’ the impact of which develops over time. We identified the conditions needed for Rounds to work optimally. These contextual factors influence the intensity and therefore degree to which the key ingredients of Rounds (mechanisms) are activated along a continuum, to produce outcomes. Outcomes included: greater tolerance, empathy and compassion for self and others increased honesty, openness, and resilience improved teamwork and organisational change. Where optimally implemented, Rounds provide staff with a safe, reflective and confidential space to talk and support one another, the consequences of which include increased empathy and compassion for colleagues and patients, and positive changes to practice.
Publisher: Wiley
Date: 15-02-2011
DOI: 10.1111/J.1365-2702.2010.03480.X
Abstract: Aim and objective. To explore why innovations in service and delivery are adopted and how they are then successfully implemented and eventually assimilated into routine nursing practice. Background. The ‘Productive Ward’ is a national quality improvement programme that aims to engage nursing staff in the implementation of change at ward level. Design. Mixed methods (analysis of routine data, online survey, interviews) to apply an evidence‐based diffusion of innovations framework. Method. (1) Broad and narrow indicators of the timing of ‘decisions to adopt’ the Productive Ward were applied. (2) An online survey explored the perceptions of 150 respondents involved with local implementation. (3) Fifty‐eight interviews in five organisational case studies to explore the process of assimilation in each context. Results. Since the launch of the programme in May 2008 staff in approximately 85% of NHS acute hospitals had either downloaded Productive Ward materials or formally purchased a support package (as of March 2009). On a narrower measure, 40% (140) of all NHS hospitals had adopted the programme (i.e. purchased a support package) with large variation between geographical regions. Four key interactions in the diffusion of innovations framework appeared central to the rapid adoption of the programme. Despite widespread perception of significant benefits, frontline nursing staff report that more needs to be carried out to ensure that impact can be demonstrated in quantifiable terms and include patient perspectives. Conclusions. The programme has been rapidly adopted by NHS hospitals in England. A variety of implementation approaches are being employed, which are likely to have implications for the successful assimilation of the programme into routine nursing practice. Relevance to clinical practice. This paper summarises the perceived benefits of the Productive Ward programme and highlights important lessons for nurse leaders who are designing (or adapting) and then implementing quality improvement programmes locally, particularly in terms of how to frame such initiatives – and provide support to – ward‐level staff.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: SAGE Publications
Date: 22-08-2017
Abstract: This article draws from sociological and socio-legal studies of dispute between patients and doctors to examine how healthcare professionals made sense of patients’ complaints about healthcare. We analyse 41 discursive interviews with professional healthcare staff working in eight different English National Health Service settings to explore how they made sense of events of complaint and of patients’ (including families’) motives for complaining. We find that for our interviewees, events of patients’ complaining about care were perceived as a breach in fundamental relationships involving patients’ trust or patients’ recognition of their work efforts. We find that interviewees rationalised patients’ motives for complaining in ways that marginalised the content of their concerns. Complaints were most often discussed as coming from patients who were inexpert, distressed or advantage-seeking accordingly, care professionals hearing their concerns about care positioned themselves as informed decision-makers, empathic listeners or service gate-keepers. We find differences in our interviewees’ rationalisation of patients’ complaining about care to be related to local service contingences rather than to fixed professional differences. We note that it was rare for interviewees to describe complaints raised by patients as grounds for improving the quality of care. Our findings indicate that recent health policy directives promoting a view of complaints as learning opportunities from critical patient/consumers must account for sociological factors that inform both how the agency of patients is envisaged and how professionalism exercised contemporary healthcare work.
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.NEDT.2012.10.012
Abstract: Understanding and improving 'patient experience' is essential to delivering high quality healthcare. However, little is known about the provision of education and training to healthcare staff in this increasingly important area. This study aims to ascertain the extent and nature of such provision in England and to identify how it might be developed in the future. An on-line survey was designed to explore training provision relating to patient experiences. To ensure that respondents thought about patient experience in the same way we defined patient experience training as that which aims to teach staff: 'How to measure or monitor the experience, preferences and priorities of patients and use that knowledge to improve their experience'. Survey questions (n=15) were devised to cover nine consistently reported key aspects of patient experience identified from the research literature and recommendations put forward by professional bodies. The survey was administered to (i) all 180 providers of Higher Education (HE) to student/qualified doctors, nurses and allied health professionals, and (ii) all 390 National Health Service (NHS) trusts in England. In addition, we added a single question to the NHS 2010 Staff Survey (n=306,000) relating to the training staff had received to deliver a good patient experience. Two hundred and sixty-five in iduals responded to the on-line survey representing a total of 159 different organizations from the HE and healthcare sectors. Respondents most commonly identified 'relationships' as an 'essential' aspect of patient experience education and training. The biggest perceived gaps in current provision related to the 'physical' and 'measurement' aspects of our conceptualization of patient experience. Of the 148,657 staff who responded to the Staff Survey 41% said they had not received patient experience training and 22% said it was not applicable to them. While some relevant education courses are in place in England, the results suggest that specific training with regard to the physical needs and comfort of patients, and how patient experiences can be measured and used to improve services, should be introduced. Future developments should also focus, firstly, on involving a wider range of patients in planning and delivering courses and, secondly, evaluating whether courses impact on the attitudes and behaviors of different professional groups and might therefore contribute to improved patient experiences.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.CTIM.2019.03.023
Abstract: The objectives of this study were to identify: 1) the extent to which final year chiropractic students used components of person-centred care in a clinical setting and 2) determine the effect of chiropractic students' use of person-centred care on musculoskeletal pain. An observational study was conducted at three Western Australian chiropractic teaching clinics. Pragmatic in idualised chiropractic care was delivered to 108 adults who experienced non-specific spinal pain. The instruments used in this study were the Consultation and Relational Empathy questionnaire, Picker Musculoskeletal Disorder Questionnaire, and Numerical Rating scale for Pain intensity. Participants experienced reductions in pain that exceeded the level required for minimal clinically reported improvement. In addition, high levels of empathy and patient -centred care were reported. Ceiling effects for the measures assessing empathy and patient-centred care precluded analyses examining the relationship between changes in pain intensity, empathy, and patient-centred care. The participants in this study displayed very positive attitudes about most aspects of the chiropractic students' person-centred care skills. Person-centred care processes for which there was considerable scope for improvement included advice about alternative treatment options, and the adaptation of lifestyle and workplace situations to alleviate pain and enhance health. Our findings also showed that the participants experienced clinically important improvement in pain. However, the skewed nature of our dataset precluded identifying whether the students' person-centred care skills influenced such improvement.
Publisher: Wiley
Date: 30-06-2014
DOI: 10.1111/HEX.12226
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.SAPHARM.2010.05.002
Abstract: Supplementary prescribing (SP) is a drug therapy management model implemented in the United Kingdom since 2003. It is a voluntary partnership between an independent prescriber a supplementary prescriber, for ex le, nurse or pharmacist and the patient, to implement an agreed patient-specific clinical management plan (CMP). To investigate pharmacist prescribers' views and experiences of the early stages of SP implementation. A qualitative, longitudinal study design was used. A purposive, maximum variability s le of 16 pharmacist supplementary prescribers, trained in Southern England, participated. Eleven were hospital pharmacists, owing to the overrepresentation of hospital pharmacists in the first cohort. Two semistructured interviews were conducted with each participant, at 3 and 6 months after their registration as prescribers. The Framework approach was used for data collection, management, and analysis. Three typologies of pharmacists' experiences were identified: "a blind alley", "a stepping stone" and "a good fit". Despite some delays in its implementation, SP was seen as a step forward. Some participants also believed that it improved patient care and pharmacists' integration in the health care team and increased their job satisfaction. However, there was a concern that SP, as first implemented, was bureaucratic and limited pharmacists' freedom in their decision making. Hence, pharmacists were more supportive of the then imminent introduction of a pharmacist independent prescribing (IP) role. Despite challenges, the SP role represented a step forward for pharmacists in the United Kingdom. It is possible that pharmacist SP can coexist with IP in the areas suitable for CMP use. Elsewhere, SP is likely to become more of a "stepping stone" to an IP role than the preferred model for pharmacist prescribing. Future research needs to objectively assess the outcomes of pharmacist SP, preferably in comparison with IP, to inform decision making among pharmacists regarding the adoption of such an innovative role.
Publisher: Springer Science and Business Media LLC
Date: 08-07-2019
Publisher: Elsevier BV
Date: 03-2003
DOI: 10.1016/S0277-9536(02)00103-X
Abstract: Social capital has become a popular term over the past two decades amongst researchers, policy makers and practitioners from varied disciplines. This popularity, however, has resulted in a great deal of confusion over the nature and application of social capital in different contexts. This confusion has made it difficult to identify and measure social capital within the evaluation of specific social and health programmes, one of the aims of which may be to stimulate social capital. This paper identifies a theoretical model that seeks to capture the dynamic nature of social capital to assist in the development of research methods that will facilitate its measurement and exploration within such programmes. The model reported in the paper identifies the key components of social capital and expresses the relationship between those components in a dynamic system based on Marx's description of the process of capital (economic) exchanges expressed in the M-C-M' cycle. The M-C-M' cycle is the transformation of money (M) into commodities (C), and the change of commodities back again into money (M') of altered value. The emphasis within the paper is on the capital element of the concept and its transactional nature with the aim of avoiding the pitfall of attributing social capital in relation to social behaviours in isolation of context and interaction. Importantly, the paper seeks to distinguish the central elements of social capital from some of the antecedent factors and outcomes often attributed to and confused with social capital adding to the problem of providing valid measurement. The model is presented as the basis for the measurement of social capital within a transactional process involving the investment of social resources in a cyclical process, which may result in net gains or losses. This process is described as the R-C-R' cycle following Marx's model of economic capital, with the focus being on the transfer of social resources (R) rather than money (M). R represents an internal resource held by in iduals, C the external resource or commodity they obtain from the network and the R' the internal resource of altered value. The possibilities of the model in assisting in the measurement of social capital specifically in assessing formal networks are explored.
Publisher: BMJ
Date: 29-07-2019
DOI: 10.1136/BMJQS-2019-009457
Abstract: The ‘Productive Ward: Releasing Time to Care’ programme is a quality improvement (QI) intervention introduced in English acute hospitals a decade ago to: (1) Increase time nurses spend in direct patient care. (2) Improve safety and reliability of care. (3) Improve experience for staff and patients. (4) Make changes to physical environments to improve efficiency. To explore how timing of adoption, local implementation strategies and processes of assimilation into day-to-day practice relate to one another and shape any sustained impact and wider legacies of a large-scale QI intervention. Multiple methods within six hospitals including 88 interviews (with Productive Ward leads, ward staff, Patient and Public Involvement representatives and senior managers), 10 ward manager questionnaires and structured observations on 12 randomly selected wards. Resource constraints and a managerial desire for standardisation meant that, over time, there was a shift away from the original vision of empowering ward staff to take ownership of Productive Ward towards a range of implementation ‘short cuts’. Nonetheless, material legacies (eg, displaying metrics data storage systems) have remained in place for up to a decade after initial implementation as have some specific practices (eg, protected mealtimes). Variations in timing of adoption, local implementation strategies and contextual changes influenced assimilation into routine practice and subsequent legacies. Productive Ward has informed wider organisational QI strategies that remain in place today and developed lasting QI capabilities among those meaningfully involved in its implementation. As an ongoing QI approach Productive Ward has not been sustained but has informed contemporary organisational QI practices and strategies. Judgements about the long-term sustainability of QI interventions should consider the evolutionary and adaptive nature of change processes.
Publisher: SAGE Publications
Date: 18-10-2012
Abstract: This article examines the importance of some informal work practices among community nurses during a period of significant organizational change. Ethnographic fieldwork in two purposively selected adult community nursing services in England comprised 79 hours of observation of routine practice, 21 interviews with staff and 23 interviews with patients. We identified the informal work practice of ‘catching up’, informal work conversations between immediate colleagues, as an important but often invisible aspect of satisfying work relationships and of the relational care of patients. Drawing on anthropological literatures on ‘communities of practice’ the article examines two central issues concerning the practices of ‘catching up’: (1) how informal learning processes shape community nursing work (2) how this informal learning is shaped both in relation to the ideals of community nursing work and the wider political and organizational contexts of community nursing practice. Our findings highlight the distinctive value of informal workplace ‘catch ups’ for nurses to manage the inherent challenges of good home care for patients and to develop a shared ethic of care and professional identity. Our findings also indicate the decline of ‘catching up’ between nurses along with diminishing time and opportunity for staff to care holistically for patients in present service climates.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: SAGE Publications
Date: 1997
DOI: 10.1177/136140969700200108
Abstract: The emphasis on health as opposed to disease in the Project 2000 curriculum is consistent with the concept of the nurse of the future working across both institutional and non-institutional settings. This paper presents data from focus group interviews in two study centres which shed light on the Project 2000 course as a preparation for community nursing practice. The views of managers and senior clinical practitioners illuminate some key issues. Focus group participants acknowledged that the course provided a greater emphasis on health than traditional courses and that students appear to gain a broader understanding of health within the community at large than students on traditional courses. More controversial issues which emerged from the data include the constraints inherent in the community nursing service as a result of its current structure, issues of skill mix and in particular a health visiting service which does not lend itself to the creation of staff nurse posts.
Publisher: Hindawi Limited
Date: 19-11-2015
DOI: 10.1111/HSC.12307
Abstract: The study aimed to develop an understanding of health visitor recruitment and retention by examining what existing staff and new recruits wanted from their job, their professional aspirations and what would encourage them to start and stay in employment. Following a period of steady decline in numbers, the health visitor workforce in England has recently been invested in and expanded to deliver universal child public health. To capitalise on this large investment, managers need an understanding of factors influencing workforce retention and continuing recruitment of health visitors. The study was designed using an interpretive approach and involved students (n = 17) and qualified health visitors (n = 22) from the north and south of England. Appreciative inquiry (AI) exercises were used as methods of data collection during 2012. During AI exercises students and health visitors wrote about 'a practice experience you have felt excited and motivated by and briefly describe the factors that contributed to this'. Participants were invited to discuss their written accounts of practice with a peer during an audio-recorded sharing session. Participants gave consent for written accounts and transcribed recordings to be used as study data, which was examined using framework analysis. In exploring personal meanings of health visiting, participants spoke about the common aspiration to make a difference to children and families. To achieve this, they expected their job to allow them to: connect with families work with others use their knowledge, skills and experience use professional autonomy. The study offers new insights into health visitors' aspirations, showing consistency with conceptual explanations of optimal professional practice. Psychological contract theory illustrates connections between professional aspirations and work commitment. Managers can use these findings as part of workforce recruitment and retention strategies and for building on the health visitor commitment to making a difference to children and families.
Publisher: Routledge
Date: 17-07-2014
Publisher: Royal College of General Practitioners
Date: 27-09-2015
Publisher: SAGE Publications
Date: 24-01-2016
Abstract: A wide range of patient benefits have been attributed to single room hospital accommodation including a reduction in adverse patient safety events. However, studies have been limited to the US with limited evidence from elsewhere. The aim of this study was to assess the impact on safety outcomes of the move to a newly built all single room acute hospital. A natural experiment investigating the move to 100% single room accommodation in acute assessment, surgical and older people’s wards. Move to 100% single room accommodation compared to ‘steady state’ and ‘new build’ control hospitals. Falls, pressure ulcer, medication error, meticillin-resistant Staphylococcus aureus and Clostridium difficile rates from routine data sources were measured over 36 months. Five of 15 time series in the wards that moved to single room accommodation revealed changes that coincided with the move to the new all single room hospital: specifically, increased fall, pressure ulcer and Clostridium difficile rates in the older people’s ward, and temporary increases in falls and medication errors in the acute assessment unit. However, because the case mix of the older people’s ward changed, and because the increase in falls and medication errors on the acute assessment ward did not last longer than six months, no clear effect of single rooms on the safety outcomes was demonstrated. There were no changes to safety events coinciding with the move at the new build control site. For all changes in patient safety events that coincided with the move to single rooms, we found plausible alternative explanations such as case-mix change or disruption as a result of the re-organization of services after the move. The results provide no evidence of either benefit or harm from all single room accommodation in terms of safety-related outcomes, although there may be short-term risks associated with a move to single rooms.
Publisher: Springer Science and Business Media LLC
Date: 19-08-2021
DOI: 10.1186/S12913-021-06785-7
Abstract: It is the responsibility of healthcare regulators to ensure healthcare professionals remain fit for practice in healthcare settings. If there are concerns about an in idual healthcare professional they may undergo a fitness to practice investigation. This process is known to be hugely stressful for doctors and social workers, but little is known about the impact of this experience on other professions. This study explores the experiences of registrants going through the process of being reported to the UK’s Health and Care Professions Council (HCPC) and attending fitness to practice (FTP) hearings. We discuss the implications of this process on registrants’ wellbeing and, from our findings, present recommendations based on registrants experiences. In doing so we articulate the structural processes of the HCPC FTP process and the impact this has on in iduals. This study uses semi-structured interviews and framework analysis to explore the experiences of 15 registrants who had completed the FTP process. Participants were s led for maximum variation and were selected to reflect the range of possible processes and outcomes through the FTP process. The psychological impact of undergoing a FTP process was significant for the majority of participants. Their stories described influences on their wellbeing at both a macro (institutional/organisational) and micro (in idual) level. A lack of information, long length of time for the process and poor support avenues were macro factors impacting on the ability of registrants to cope with their experiences (theme 1). These macro factors led to feelings of powerlessness, vulnerability and threat of ruin for many registrants (theme 2). Suggested improvements (theme 3) included better psychological support (e.g. signposting or provision) proportional processes to the incident (e.g. mediation instead of hearings) and taking context into account. Findings suggest that improvements to both the structure and conduct of the FTP process are warranted. Implementation of better signposting for support both during and after a FTP process may improve psychological wellbeing. There may also be value in considering alternative ways of organising the FTP process to enable greater consideration of and flexibility for registrants’ context and how they are investigated.
Publisher: Springer Science and Business Media LLC
Date: 25-05-2017
Publisher: Elsevier BV
Date: 09-2023
Publisher: Wiley
Date: 14-06-2020
DOI: 10.1111/JOCN.15354
Publisher: Elsevier BV
Date: 09-2020
Publisher: National Institute for Health and Care Research
Date: 11-2018
DOI: 10.3310/HSDR06370
Abstract: Schwartz Center Rounds ® (Rounds) were introduced into the UK in 2009 to support health-care staff to deliver compassionate care, something the Francis report (Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry . London: The Stationery Office 2013) identified as lacking. Rounds are organisation-wide forums that prompt reflection and discussion of the emotional, social and ethical challenges of health-care work, with the aim of improving staff well-being and patient care. How, in which contexts and for whom Rounds participation affects staff well-being at work, increases social support for staff and improves patient care. (1) A scoping review of Rounds literature and comparison with alternative interventions (2) mapping Rounds providers via a survey, telephone interviews and secondary data (3) a two-wave survey of (i) new attenders/non-attenders in 10 sites to determine the impact on staff engagement and well-being and (ii) interviews with Rounds attenders, non-attenders, facilitators, clinical leads, steering group members, board members and observations in nine case study sites to (4) describe experiences and (5) test candidate programme theories by which Rounds ‘work’ (realist evaluation). (1) International literature (English) (2) all Rounds providers (acute/community NHS trusts and hospices) at 1 September 2014 (survey/interview) and 15 July 2015 (secondary data) (3) 10 survey sites and (4 and 5) nine organisational case study sites (six of which also took part in the survey). (1) Ten papers were reviewed for Rounds and 146 were reviewed for alternative interventions. (2) Surveys were received from 41 out of 76 (54%) providers and interviews were conducted with 45 out of 76 (59%) providers. (3) Surveys were received from 1140 out of 3815 (30%) in iduals at baseline and from 500 out of 1140 (44%) in iduals at follow-up. (4 and 5) A total of 177 interviews were conducted, as were observations of 42 Rounds, 29 panel preparations and 28 steering group meetings. (1) The evidence base is limited compared with 11 alternative interventions, Rounds offer a unique organisation-wide ‘all staff’ forum in which disclosure/contribution is not essential. (2) Implementation rapidly increased between 2013 and 2015 Rounds were implemented variably challenges included ward staff attendance and the workload and resources required to sustain Rounds and costs were widely variable. (3) There was no change in engagement, but poor psychological well-being (12-item General Health Questionnaire) reduced significantly ( p 0.05) in Rounds attenders (25% to 12%) compared with non-attenders (37% to 34%). (4 and 5) Rounds were described as interesting, engaging and supportive four contextual layers explained the variation in Rounds implementation. We identified four stages of Rounds, ‘core’ and ‘adaptable’ components of Rounds fidelity, and nine context–mechanism–outcome configurations: (i) trust, emotional safety and containment and (ii) group interaction were prerequisites for creating (iii) a countercultural space in Rounds where staff could (iv) tell stories, (v) self-disclose their experiences to peers and (vi) role model vulnerability (vii) provide important context for staff and patient behaviour (viii) shining a spotlight on hidden staff and patient stories reduced isolation and enhanced support/teamwork and (ix) staff learned through reflection resulting in ripple effects and outcomes. Reported outcomes included increased empathy and compassion for colleagues and patients, support for staff and reported changes in practice. The impact of Rounds is cumulative and we have identified the necessary conditions for Rounds to work. Rounds outcomes relied on self-report, fewer regular attenders were recruited than desired, and it was not possible to observe staff post Rounds. Rounds offer unique support for staff and positively influence staff well-being, empathy and compassion for patients and colleagues. The adaptation of Rounds to new contexts and to increase reach needs evaluation. The National Institute for Health Research Health Services and Delivery Research programme.
Publisher: National Institute for Health and Care Research
Date: 08-2022
DOI: 10.3310/GUWS9067
Abstract: The introduction of ‘Freedom to Speak Up Guardians’ into every NHS trust in England was intended to support workers and trusts to better raise, respond to and learn from speaking-up concerns. However, only broad guidance was provided on how to implement the role. As a result, there is the potential for important local differences to emerge as the role is implemented across England. The overall aim of this study was to better understand the implementation of Guardians in acute trusts and mental health trusts. The Freedom to Speak Up Guardian role was conceptualised as a complex intervention consisting of several interacting and interlocking components spanning the macro level (national organisations), the meso level (in idual trusts) and the micro level (employees, teams and wards/units). A mixed-methods study was designed, which consisted of three work packages: (1) a systematic narrative review of the international literature regarding interventions promoting ‘speaking up’ by health-care employees (2) semistructured telephone interviews with Guardians working in acute hospital trusts and mental health trusts and (3) qualitative case studies of Freedom to Speak Up Guardian implementation, consisting of observations and interviews undertaken in four acute trusts and two mental health trusts. Interviews were also undertaken with national stakeholders. Acute trusts and mental health NHS trusts in England. Work package 2: Freedom to Speak Up Guardians ( n = 87) were interviewed. Work package 3: 116 interviews with key stakeholders involved in pre-implementation and early implementation decision-making, workers who had spoken up to the Guardian, and national stakeholders. Wide variability was identified in how the Guardian role had been implemented, resourced and deployed by NHS trusts. ‘Freedom to Speak Up Guardian’ is best considered an umbrella term, and multiple versions of the role exist simultaneously across England. Any comparisons of Guardians’ effectiveness are likely to be possible or meaningful only when this variability is properly accounted for. Many Freedom to Speak Up Guardians identified how a lack of available resources, especially time scarcity, negatively and significantly affected their ability to effectively respond to concerns their opportunities to collect, analyse and learn from speaking-up data and, more generally, the extent to which they developed their role and speak-up culture. It is possible that those whom we interviewed were more receptive of Freedom to Speak Up Guardians or may have been biased by ‘socially desirability’, and their answers may not always have represented respondents’ true perceptions. Optimal implementation of the Guardian role has five components: (1) establishing an early, collaborative and coherent strategy congruent with the values of Freedom to Speak Up fosters the implementation of (2) policies and robust, yet supportive, practices (3) informed by frequent and reflexive monitoring of Freedom to Speak Up implementation that is (4) underpinned by sufficient time and resource allocation that leads to (5) a positive implementation climate that is congruent with Freedom to Speak Up values and is well placed to engender positive and sustainable Freedom to Speak Up culture and the well-being of a Guardian. The following recommendations for future research are considered to be of equal priority. Studies of the speaking-up experiences of minority communities and ‘seldom-heard’ workforce groups are a priority requirement. There is also value in undertaking a similar study in non-hospital settings and where peripatetic working is commonplace, such as in ambulance services and in primary care settings. The role of human resources and ‘middle managers’ in the management of concerns is an area requiring further research, especially regarding concerns relating to unprofessional and transgressive behaviours. Devolved administrations in Scotland and Wales have adopted different approaches to speaking up research undertaken in these contexts would offer valuable comparative insights. Researching the Guardian role ≥ 5 years post implementation is recommended to understand the medium-term impact and the longer-term sustainability of the role and well-being of Guardians. This study is registered as ISRCTN38163690 and has the study registration CRD42018106311. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research Vol. 10, No. 23. See the NIHR Journals Library website for further project information.
Publisher: SAGE Publications
Date: 04-08-2017
Abstract: Although investment in staff development is a prerequisite for high-quality and innovative care, the training needs of front line care staff involved in direct care have often been neglected, particularly within dementia care provision. The Care Certificate, which was fully launched in England in April 2015, has aimed to redress this neglect by providing a consistent and transferable approach to the training of the front line health and social care workforce. This article describes the early stages of an 18-month evaluation of the Care Certificate and its implementation funded by the Department of Health Policy Research Programme.
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.IJNURSTU.2017.11.010
Abstract: Ever-growing demands on care systems have increased reliance on healthcare support workers. In the UK, their training has been variable, but organisation-wide failures in care have prompted questions about how this crucial section of the workforce should be developed. Their training, support and assessment has become a policy priority. This paper examines: healthcare support workers' access to training, support and assessment perceived gaps in training provision and barriers and facilitators to implementation of relevant policies in acute care. We undertook a qualitative study of staff caring for older inpatients at ward, isional or organisational-level in three acute National Health Service hospitals in England in 2014. 58 staff working with older people (30 healthcare support workers and 24 staff managing or working alongside them) and 4 healthcare support worker training leads. One-to-one semi-structured interviews included: views and experiences of training and support translation of training into practice training, support and assessment policies and difficulties of implementing them. Transcripts were analysed to identify themes. Induction training was valued, but did not fully prepare healthcare support workers for the realities of the ward. Implementation of hospital policies concerning supervision and formal assessment of competencies varied between and within hospitals, and was subject to availability of appropriate staff and competing demands on staff time. Gaps identified in training provision included: caring for people with cognitive impairment managing the emotions of patients, families and themselves and having difficult conversations. Access to ongoing training was affected by: lack of time infrequent provision attitudes of ward managers to additional support workforce training, and their need to balance this against patients' and other staff members' needs and the use of e-learning as a default mode of training delivery. With the current and unprecedented policy focus on training, support and assessment of healthcare support workers, our study suggests improved training would be welcomed by them and their managers. Provision of training, support and assessment could be improved by organisational policy that promotes and protects healthcare support worker training formalising the provision and availability of on-ward support and training and IT support provided on a drop-in basis. Challenges in implementation are likely to be faced in all international settings where there is increased reliance on a support workforce. While recent policies in the UK offers scope to overcome some of these challenges there is a risk that some will be exacerbated.
Publisher: Mark Allen Group
Date: 02-08-2018
DOI: 10.12968/JOHV.2018.6.8.404
Abstract: This is the second of two articles reporting evidence from a programme of research that focused on how health visiting works, including service user and workforce perspectives. Evidence and professional expertise indicate that a set of essential features enable health visitors to achieve the desired impact of improving child public health. These include organising services in a way that enables positive parent–health visitor relationships, continuity and co-ordination and the flexibility to use professional knowledge and autonomy in practice. Where service specifications give careful attention to this evidence, it is more likely that health visitors will be able to deliver a successful child health programme for the early years.
Publisher: BMJ
Date: 02-2014
Publisher: Emerald
Date: 27-04-2012
DOI: 10.1108/09526861211221464
Abstract: This paper aims to focus on facilitating large‐scale quality improvement in health care, and specifically understanding more about the known challenges associated with implementation of lean innovations: receptivity, the complexity of adoption processes, evidence of the innovation, and embedding change. Lessons are drawn from the implementation of The Productive Ward: Releasing Time to Care™ programme in English hospitals. The study upon which the paper draws was a mixed‐method evaluation that aimed to capture the perceptions of three main stakeholder groups: national‐level policymakers (15 semi‐structured interviews) senior hospital managers (a national web‐based survey of 150 staff) and healthcare practitioners (case studies within five hospitals involving 58 members of staff). The views of these stakeholder groups were analysed using a diffusion of innovations theoretical framework to examine aspects of the innovation, the organisation, the wider context and linkages. Although The Productive Ward was widely supported, stakeholders at different levels identified varying facilitators and challenges to implementation. Key issues for all stakeholders were staff time to work on the programme and showing evidence of the impact on staff, patients and ward environments. To support implementation, policymakers should focus on expressing what can be gained locally using success stories and guidance from “early adopters”. Service managers, clinical educators and professional bodies can help to spread good practice and encourage professional leadership and support. Further research could help to secure support for the programme by generating evidence about the innovation, and specifically its clinical effectiveness and broader links to public expectations and experiences of healthcare. This paper draws lessons from the implementation of The Productive Ward programme in England, which can inform the implementation of other large‐scale programmes of quality improvement in health care.
Publisher: SAGE Publications
Date: 22-12-2009
Publisher: Hindawi Limited
Date: 21-04-2019
DOI: 10.1111/JONM.12753
Abstract: There is an international policy trend for building government hospitals with greater proportions of single-occupancy rooms. The study aim was to identify advantages and disadvantages for patients and nursing staff of a pending move to 100% single-room hospital, in anticipation of the challenges for nurse managers of a different ward environment. This paper presents these findings, summarizing potential advantages and disadvantages as well as comparison with findings from similar studies in England. Mixed method case study design was undertaken in four wards of a large hospital with multi-bed rooms. Three components of a larger study are reported here: nurse surveys and interviews, patient interviews of their experiences of the current multi-bedroom environment and expectations of new single-room environment. Integration was achieved via data transformation where results of the nursing staff survey and interviews and patient interviews were coded as narrative allowing for quantitative and qualitative data to be merged. Four constructs were derived: physical environment patient safety and comfort staff safety and importance of interaction. There are important factors that inform nurse managers when considering a move to an all single-room design. These factors are important for nurses' and patients' well-being. This study identified for nurse managers key factors that should be considerd when contributing to the design of a 100% single-room hospital. Nurses' voices are critically important to inform the design for a safe and efficient ward environment.
Publisher: Royal College of General Practitioners
Date: 2010
Publisher: Elsevier BV
Date: 07-2022
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.IJNURSTU.2013.09.009
Abstract: Research on Indian nurses has focused on their participation as global migrant workers for whom opportunities abroad act as an incentive for many to migrate overseas. However, little is known about the careers of Indian nurses, or the impact of a globalized health care market on nurses who remain and on the profession itself in India. To explore nurses' accounts of entry into nursing in the context of the globalisation of the nursing profession in India, and the salience of 'migration' for nurses' in idual careers. Qualitative interview study (n=56). The study drew on interviews with 56 nurses from six sites in Bangalore, India. These included two government hospitals, two private hospitals, a Christian mission hospital, a private outpatient clinic and two private nursing colleges. Participants were selected purposively to include nurses from Christian and Hindu backgrounds, a range of home States, ages and seniority and to deliberately over-recruit (rare) male nurses. Interviews covered how and why nurses entered nursing, their training and career paths to date, plans for the future, their experiences of providing nursing care and attitudes towards migration. Data analysis drew on grounded theory methods. Nursing is traditionally seen as a viable career particularly for women from Christian communities in India, where it has created inter-generational 'nurse families'. In a globalizing India, nursing is becoming a job 'with prospects' transcending traditional caste, class and gender boundaries. Almost all nurses interviewed who intended seeking overseas employment envisaged migration as a short term option to satisfy career objectives - increased knowledge, skills and economic rewards - that could result in long-term professional and social status gains 'back home' in India. For others, migration was not part of their career plan: yet the increases in status that migration possibilities had brought were crucial to framing nursing as a 'suitable job' for a growing number of entrants. The possibility of migration has facilitated collective social mobility for Indian nurses. Migration possibilities were important not only for those who migrate, but for improving the status of nursing in general in India, making it a more attractive career option for a growing range of recruits.
Publisher: Wiley
Date: 03-1998
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2017
End Date: 2020
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2010
End Date: 2013
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2014
End Date: 2017
Funder: NIHR Evaluation, Trials and Studies Coordinating Centre
View Funded ActivityStart Date: 2002
End Date: 2005
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2010
End Date: 2013
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2008
End Date: 2011
Funder: NIHR Evaluation, Trials and Studies Coordinating Centre
View Funded ActivityStart Date: 2014
End Date: 2015
Funder: Health Services and Delivery Research Programme
View Funded ActivityStart Date: 2012
End Date: 2014
Funder: NIHR Evaluation, Trials and Studies Coordinating Centre
View Funded ActivityStart Date: 2016
End Date: 2017
Funder: National Institute for Health Research
View Funded ActivityStart Date: 2007
End Date: 2012
Funder: National Institute for Health Research
View Funded ActivityStart Date: 2018
End Date: 2020
Funder: Health Services and Delivery Research Programme
View Funded ActivityStart Date: 2016
End Date: 2018
Funder: Health Services and Delivery Research Programme
View Funded Activity