Developing a workbook for primary care nursing students

There is a continuing need to prepare a nursing workforce that is adaptable within a range of care settings. The faculty of health at Staffordshire University seconded a lecturer practitioner for a 12-month period to conduct an audit on primary care placements. Mentors were involved in the audit in order to include their views and opinions alongside those of students

What Can We Learn From the Existing Evidence of the Business Case for Investments in Nursing Care: Importance of Content, Context, and Policy Environment

Decisions of health care institutions to invest in nursing care are often guided by mixed and conflicting evidence of effects of the investments on organizational function and sustainability. This paper uses new evidence generated through Interdisciplinary Nursing Quality Research Initiative (INQRI)-funded research and published in peer-reviewed journals, to illustrate where the business case for nursing investments stands and to discuss factors that may limit the existing evidence and its transferability into clinical practice. We conclude that there are 3 limiting factors: (1) the existing business case for nursing investments is likely understated due to the inability of most studies to capture spillover and long-run dynamic effects, thus causing organizations to forfeit potentially viable nursing investments that may improve long-term financial stability; (2) studies rarely devote sufficient attention to describing the content and the organization-specific contextual factors, thus limiting generalizability; and (3) fragmentation of the current health care delivery and payment systems often leads to the financial benefits of investments in nursing care accruing outside of the organization incurring the costs, thus making potentially quality-improving and cost-saving interventions financially unattractive from the organization\u27s perspective. The payment reform, with its emphasis on high-quality affordable patient-centered care, is likely to strengthen the business case for investments in nursing care. Methodologically rigorous approaches that focus on broader societal implications of investments in nursing care, combined with a thorough understanding of potential barriers and facilitators of nursing change, should be an integral part of future research and policy efforts

Compassion in emergency departments. Part 1: nursing students’ perspectives

Compassion is a topical issue in clinical nursing practice, nurse education and policy, but a review of the literature reveals that nursing students’ experiences of compassionate care receives little attention. In this three-part series David Hunter and colleagues explore compassion in emergency departments (EDs) from nursing students’ point of view. Part one provides findings of a professional doctorate study of nursing students’ experiences of compassionate care in EDs, part two explores the barriers to compassionate care in this clinical setting that emerged from the study, and part three considers factors that enable and support compassionate care provision in EDs. Aim: The aim of the study was to explore nursing students’ experiences of the provision of compassionate care in EDs. Method: The underpinning methodology was an exploratory-descriptive qualitative design. A total of 15 nursing students from across the west of Scotland, who had been placed in eight different EDs, participated in face-to-face interviews which were audio recorded, transcribed and analysed. Findings: Two major themes emerged ‘doing the little things’ and ‘a strange, new world: the uniqueness of the ED’. The students also identified barriers and enablers to providing compassionate care which are discussed in parts two and three. Conclusion: Despite the challenges of working in the most acute of clinical settings, nurses can provide compassionate care to patients and their relatives. However, this is not universal because certain groups of patients considered ‘challenging’ do not receive equitable compassionate care

Implementing advance care planning in routine nursing home care : the development of the theory-based ACP+ program

Background While various initiatives have been taken to improve advance care planning in nursing homes, it is difficult to find enough details about interventions to allow comparison, replication and translation into practice. Objectives We report on the development and description of the ACP+ program, a multi-component theory-based program that aims to implement advance care planning into routine nursing home care. We aimed to 1) specify how intervention components can be delivered; 2) evaluate the feasibility and acceptability of the program; 3) describe the final program in a standardized manner. Design To develop and model the intervention, we applied multiple study methods including a literature review, expert discussions and individual and group interviews with nursing home staff and management. We recruited participants through convenience sampling. Setting and participants Management and staff (n = 17) from five nursing homes in Flanders (Belgium), a multidisciplinary expert group and a palliative care nurse-trainer. Methods The work was carried out by means of 1) operationalization of key intervention components identified as part of a previously developed theory on how advance care planning is expected to lead to its desired outcomes in nursing homes into specific activities and materials, through expert discussions and review of existing advance care planning programs; 2) evaluation of feasibility and acceptability of the program through interviews with nursing home management and staff and expert revisions; and 3) standardized description of the final program according to the TIDieR checklist. During step 2, we used thematic analysis. Results The original program with nine key components was expanded to include ten intervention components, 22 activities and 17 materials to support delivery into routine nursing home care. The final ACP+ program includes ongoing training and coaching, management engagement, different roles and responsibilities in organizing advance care planning, conversations, documentation and information transfer, integration of advance care planning into multidisciplinary meetings, auditing, and tailoring to the specific setting. These components are to be implemented stepwise throughout an intervention period. The program involves the entire nursing home workforce. The support of an external trainer decreases as nursing home staff become more autonomous in organizing advance care planning. Conclusions The multicomponent ACP+ program involves residents, family, and the different groups of people working in the nursing home. It is deemed feasible and acceptable by nursing home staff and management. The findings presented in this paper, alongside results of the subsequent randomized controlled cluster trial, can facilitate comparison, replicability and translation of the intervention into practice