The accessibility of research-based knowledge for nurses in United Kingdom acute care settings

Background. The successful dissemination of the results of the National Health Service (NHS) research and development strategy and the development of evidence based approaches to health care rely on clinicians having access to the best available evidence; evidence fit for the purpose of reducing the uncertainties associated with clinical decisions. Aim. To reveal the accessibility of those sources of information actually used by nurses, as well as those which they say they use. Design. Mixed method case site, using interview, observational, Q sort and documentary audit data in medical, surgical and coronary care units (CCUs) in three acute hospitals. Results. Three perspectives on accessibility were identified: (a) the humanist-in which human sources of information were the most accessible; (b) local information for local needs-in which locally produced resources were seen as the most accessible and (c) moving towards technology-in which information technology begins to be seen as accessible. Nurses' experience in a clinical specialty is positively associated with a perception that human sources such clinical nurse specialists, link nurses, doctors and experienced clinical colleagues are more accessible than text based sources. Clinical specialization is associated with different approaches to accessing research knowledge. Coronary care unit nurses were more likely perceive local guidelines, protocols and on-line databases as more accessible than their counterparts in general medical and surgical wards. Only a third of text-based resources available to nurses oil the wards had any explicit research base. These, and the remainder were Out of date (mean age of textbooks 11 years), and authorship hard to ascertain. Conclusion. A strategy to increase the use of research evidence by nurses should harness the influence of clinical nurse specialists, link nurses and those engaged in practice development. These roles Could act as 'conduits' through which research-based messages for practice, and information for clinical decision making, could flow. This role should be explored and enhanced

Acute care nurses' perceptions of barriers to using research information in clinical decision-making

Aim. To examine the barriers that nurses feel prevent them from using research in the decisions they make. Background. A sizeable research literature focusing on research utilization in nursing has developed over the past 20 years. However, this literature is characterized by a number of weaknesses: self-reported utilization behaviour; poor response rates and small, nonrandom sampling strategies. Design. Cross-case analysis involving anonymised qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 h, and 122 nurses were involved in the Q modelling exercise (response rate of 64%). Results. Four perspectives were isolated that encompassed the characteristics associated with barriers to research use. These related to the individual, organization, nature of research information itself and environment. Nurses clustered around four main perspectives on the barriers to research use: (1) Problems in interpreting and using research products, which were seen as too complex, 'academic' and overly statistical; (2) Nurses who felt confident with research-based information perceived a lack of organizational support as a significant block; (3) Many nurses felt that researchers and research products lack clinical credibility and that they fail to offer the desired level of clinical direction; (4) Some nurses lacked the skills and, to a lesser degree, the motivation to use research themselves. These individuals liked research messages passed on to them by a third party and sought to foster others' involvement in research-based practice, rather than becoming directly involved themselves. Conclusions. Rejection of research knowledge is not a barrier to its application. Rather, the presentation and management of research knowledge in the workplace represent significant challenges for clinicians, policy-makers and the research community

‘Making the best of things’: relatives' experiences of decisions about care-home entry

Despite the growing awareness of the significance of helping a relative to relocate to a care home as a key phase in the care-giving career, relatively few British studies have explored this experience in depth. Informed by a constructivist perspective, this study sought a better understanding of nursing home placements from the viewpoint of relatives. Data were collected in 37 semi-structured interviews involving 48 people who had assisted a close relative to move into a nursing home. Analysis revealed three perceived phases to the transition: ‘making the best of it’, ‘making the move’ and ‘making it better’. The relatives' experiences through these phases had five perceived elements, all of which were continua, from absent to very strong, reflecting the extent to which they were felt. They were: operating ‘under pressure’ or not; ‘in the know’ or ‘working in the dark’; ‘working together’ or ‘working alone’; ‘in control of events’ or not, and ‘supported’ or ‘unsupported’ both practically and emotionally. This paper reports findings about the first phase of the transition, ‘making the best of it’, and documents the experiences of decision-making about nursing home placements. It is argued that health and social care practitioners have enormous potential to influence whether or not helping a relative to move into a nursing home is perceived as a positive choice

A video life-world approach to consultation practice: The relevance of a socio-phenomenological approach

This article discusses the [development and] use of a video life-world schema to explore alternative orientations to the shared health consultation. It is anticipated that this schema can be used by practitioners and consumers alike to understand the dynamics of videoed health consultations, the role of the participants within it and the potential to consciously alter the outcome by altering behaviour during the process of interaction. The study examines health consultation participation and develops an interpretative method of analysis that includes image elicitation (via videos), phenomenology (to identify the components of the analytic framework), narrative (to depict the stories of interactions) and a reflexive mode (to develop shared meaning through a conceptual framework for analysis). The analytic framework is derived from a life-world conception of human mutual shared interaction which is presented here as a novel approach to understanding patient-centred care. The video materials used in this study were derived from consultations in a Walk-in Centre (WiC) in East London. The conceptual framework produced through the process of video analysis is comprised of different combinations of movement, knowledge and emotional conversations that are used to classify objective or engaged WiC health care interactions. The videoed interactions organise along an active or passive, facilitative or directive typical situation continuum illustrating different kinds of textual approaches to practice that are in tension or harmony. The schema demonstrates how practitioners and consumers interact to produce these outcomes and indicates the potential for both consumers and practitioners to be educated to develop practice dynamics that support patient-centred care and impact on health outcomes

Nature-based supportive care opportunities: A conceptual framework

Objective: Given preliminary evidence for positive health outcomes related to contact with nature for cancer populations, research is warranted to ascertain possible strategies for incorporating nature-based care opportunities into oncology contexts as additional strategies for addressing multidimensional aspects of cancer patients’ health and recovery needs. The objective of this study was to consolidate existing research related to nature-based supportive care opportunities and generate a conceptual framework for discerning relevant applications in the supportive care setting. Methods: Drawing on research investigating nature-based engagement in oncology contexts, a two-step analytic process was used to construct a conceptual framework for guiding nature-based supportive care design and future research. Concept analysis methodology generated new representations of understanding by extracting and synthesising salient concepts. Newly formulated concepts were transposed to findings from related research about patient-reported and healthcare expert-developed recommendations for nature-based supportive care in oncology. Results: Five theoretical concepts (themes) were formulated describing patients’ reasons for engaging with nature and the underlying needs these interactions address. These included: connecting with what is genuinely valued, distancing from the cancer experience, meaning-making and reframing the cancer experience, finding comfort and safety, and vital nurturance. Eight shared patient and expert recommendations were compiled, which address the identified needs through nature-based initiatives. Eleven additional patient-reported recommendations attend to beneficial and adverse experiential qualities of patients’ nature-based engagement and complete the framework. Conclusions: The framework outlines salient findings about helpful nature-based supportive care opportunities for ready access by healthcare practitioners, designers, researchers and patients themselves

Innovative learning in action (ILIA) issue three: Employability, enterprise & entrepreneurship

The theme of the 3rd issue of ILIA is Employability, Enterprise and Entrepreneurship, reflecting the University of Salford’s Learning and Teaching Strategy and our Goal “To produce graduates with the skills, creativity, confidence and adaptability to succeed in the labour market and make a meaningful contribution to society”. The creativity, problem solving and change orientation this implies recognizes Salford’s distinctive strengths in this regard, and provides us with a conceptualization of employability which embraces enterprise and entrepreneurship, manifest in the form of selfemployment, but equally relevant to those working within organizations i.e. to intrapreneurship. The contributions to this edition provide us with examples of excellent practice demonstrating how practitioners at Salford have responded to the challenge of providing a quality learning experience for our students. Consideration of the papers and snapshots reveal how colleagues have embedded employability into teaching and learning and assessment strategies, and into frameworks of student support, in differing and innovative ways, across the institution. As this edition of ILIA goes to print work is underway to develop an Employability Policy and Strategy for the University. Designed to provide a coherent and progressive approach to Employability, Enterprise and Careers Education and Guidance, this Strategy will be able to build on the good practice evident both in this edition of ILIA and across the institution. ILIA therefore has once again provided us with a range of perspectives on a key area of curriculum design and development. It also has provided an opportunity to reflect on practice and student learning, to share experience and hopefully to identify future areas for collaboration

A virtual practice community for student learning and staff development in health and social work inter-professional education. Mini-project evaluation report.

Interprofessional education (IPE) has been widely advocated and developed as a means to encourage effective collaboration in order to improve public sector services. An IPE curriculum was introduced at Bournemouth University from 2005 for all nursing branches, midwifery, occupational therapy, physiotherapy, operating department practice and social work students (n=600). Challenges of this ambitious and large scale project included facilitating meaningful interprofessional learning while balancing structural complexities of professional body requirements and the logistics of large student numbers and multi-site teaching. A web-based simulated community was created, known as Wessex Bay, as a learning resource to facilitate interprofessional learning around case scenarios. An evaluation of student and staff experiences of IPE over two years, focusing principally on the use of technology in the education process was implemented. Student and staff data were collected via e-surveys, focus groups and open-ended questionnaires with additional feedback from external reviewers specifically on Wessex Bay. Qualitative data were subjected to thematic analysis. Whilst the findings are not claimed to be representative, they provide a rich insight into student and staff experiences of technology enhanced learning in IPE. The richness and complexity of data has led to a number of project outcomes with wide-ranging implications for interprofessional education. This research has led to the identification of three major territories of praxis in which individuals, both students and tutors, are operating in IPE, namely professional differences and identity, curriculum design and learning and teaching strategies, and technology enhanced learning. For the purposes of this report, we will discuss the findings related to student and staff experiences of technology enhanced learning in IPE. The evaluation of the findings highlighted three issues; the level of student and staff knowledge and skill in using learning technologies impacted significantly on learning; there was a need to capitalise on the use of web-based learning resources by increasing interactivity within the scenarios; and finally student and staff experiences of the learning resources was enhanced by a positive learning culture to facilitate creative use of materials. All project aims and objectives were met, and whilst more focused staff and student development in using learning technology is required, a culture of working interprofessionally among students and academic staff has begun to develop, leading to the sharing of ideas about content and learning processes. Recommendations resulting from the project include the introduction of assessed development of student and staff learning technology skills; development of more interactive web-based learning embedded within the case scenarios; and streamlining of the scenarios to provide fewer, but more developed, cases

Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial

OBJECTIVE: To evaluate the cost effectiveness of standard treatment with and without the addition of ward based non-invasive ventilation in patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease. DESIGN: Incremental cost effectiveness analysis of a randomised controlled trial. SETTING: Medical wards in 14 hospitals in the United Kingdom. PARTICIPANTS: The trial comprised 236 patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease and mild to moderate acidosis (pH 7.25-7.35) secondary to respiratory failure. The economic analysis compared the costs of treatment that these patients received after randomisation. MAIN OUTCOME MEASURE: Incremental cost per in-hospital death. RESULTS: 24/118 died in the group receiving standard treatment and 12/118 in the group receiving non-invasive ventilation (P=0.05). Allocation to the group receiving non-invasive ventilation was associated with a reduction in costs of £49 362 ($78 741; 73 109), mainly through reduced use of intensive care units. The incremental cost effectiveness ratio was £645 per death avoided (95% confidence interval £2310 to £386), indicating a dominant (more effective and less costly) strategy. Modelling of these data indicates that a typical UK hospital providing a non-invasive ventilation service will avoid six deaths and three to nine admissions to intensive care units per year, with an associated cost reduction of £12 000-53 000 per year. CONCLUSIONS: Non-invasive ventilation is a highly cost effective treatment that both reduced total costs and improved mortality in hospital

The Pictor Technique: Exploring Collaborative Working in Nursing

Pictor is a graphical visual technique with its origins in personal construct psychology and phenomenology. It was developed to explore experiences of collaborative working in health and social care contexts, but may be used in any setting where people with different backgrounds or perspectives need to interact around a specific task or goal. In this case study, we outline the principles behind the method and describe how it is used to collect data, and how such data may be analysed. We present a case example from a recent study of collaborative working among nurses and other professionals in relation to the care of people with cancer and long-term conditions. We conclude by reflecting on the strengths and weaknesses of the technique

New ways of working in acute inpatient care: a case for change

This position paper focuses on the current tensions and challenges of aligning inpatient care with innovations in mental health services. It argues that a cultural shift is required within inpatient services. Obstacles to change including traditional perceptions of the role and responsibilities of the psychiatrist are discussed. The paper urges all staff working in acute care to reflect on the service that they provide, and to consider how the adoption of new ways of working might revolutionise the organisational culture. This cultural shift offers inpatient staff the opportunity to fully utilise their expertise. New ways of working may be perceived as a threat to existing roles and responsibilities or as an exciting opportunity for professional development with increased job satisfaction. Above all, the move to new ways of working, which is gathering pace throughout the UK, could offer service users1 a quality of care that meets their needs and expectations