A qualitative study of the use of a supportive care pathway for end of life care in an intensive care unit

Background: Providing palliative care support in intensive care settings is beneficial, however, barriers to delivering high-quality end-of-life care remain. To address this, pathways have been used to improve the quality of palliative care in generalist settings. This study describes the views of health professionals using a supportive care pathway in intensive care. Design: Qualitative semi-structured interviews were conducted with ten health professionals working in a surgical intensive care unit. The data were analysed thematically. Results: Participants were positive about the effect of the supportive care pathway on patient care, particularly in enabling consensus in care planning. Some expressed concerns including the difficulty of identifying the ‘correct patients’ for the pathway, the risk of it becoming a ‘self-fulfilling prophecy’, and a euphemism for dying. Conclusion: Pathways are one potential mechanism for guiding care planning and communicating the goals of care to colleagues, patients and families, thus contributing to improvements in palliative care. </jats:sec

An evaluation of staff engagement programmes in four National Health Service Acute Trusts

Purpose – The purpose of this paper is to report the findings from an evaluation project conducted to investigate the impact of two staff engagement programmes introduced to four National Health Service (NHS) hospital Trusts in England. It seeks to examine this development in the context of current policy initiatives aimed at increasing the level of staff involvement in decision-making, and the related literature. \ud \ud Design/methodology/approach – A mixed-methods approach incorporating document analysis, interviews, a survey and appreciative inquiry, informed by the principles of impact evaluation design, was used. \ud \ud Findings – The main finding to emerge was that leadership was crucial if widespread staff engagement was to be achieved. Indeed, in some of the trusts the staff engagement programmes were seen as mechanisms for developing leadership capability. The programmes had greater impact when they were “championed” by the Chief Executive. Effective communication throughout the organisations was reported to be a prerequisite for staff engagement. Problems were identified at the level of middle management where the lack of confidence in engaging with staff was a barrier to implementation. \ud \ud Practical implications – The nature of the particular organisational context is crucial to the success of efforts to increase levels of staff engagement. The measures that were found to work in the trusts would need to be adapted and applied to best meet the needs of other organisations. \ud \ud Originality/value – Many health care organisations in England will need to harness the efforts of their workforce if they are to meet the significant challenges of dealing with financial restraint and increasing patient demand. This paper provides some insights on how this can be done

Bridging the research-practice gap

Health service redesign researchers from the National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care for Birmingham and the Black Country (NIHR CLAHRC BBC) investigated the process of large scale service redesign. In order to engage clinical staff and service users in the study, and to ensure findings were disseminated as widely as possible, the team included professional communicators who helped to connect researchers and key stakeholders. The NHS ‘communications fellows’ provided expertise in professional communication approaches and links to a wider network of communications professionals. The use of a range of communications industry techniques was vital in establishing effective communication channels to share interim and final research findings. The benefits of using a selection of key techniques is examined and recommendations are made that could help other researchers capitalise on professional communication approaches to help ensure the impact of their work is fully realised. While the need for authoritative academic papers and reports is acknowledged, it is concluded that harnessing the huge potential of new communication technologies, and traditional journalistic instincts, may be the missing link in knowledge transfer. </jats:p

Analysing poor nursing care in hospitals in England: The policy challenge

There have been several high profile reports of poor nursing care in hospitals in England of late. Criticism of nursing has also featured prominently in the popular media. This paper examines the complex mix of contributory factors that have created this situation, and identifies the issues that need to be addressed if policy making in this area is to improve the situation. Action is required in a number of areas, including: strengthening ward leadership, introducing measures such as “intentional rounding”, and acknowledging the “emotional labour” of caring, however many recommendations have centred on the education of nurses and seemingly overlooked these other crucial issues.Le travail infirmier en Angleterre a fait l’objet de nombreuses critiques qui font état d’un déclin de la qualité du soin comme care (Francis Inquiry 2013; The Health Service Ombudsman’s report [Abraham 2011), Care Quality Commission 2011). Les commentaires proposés - notamment dans les médias populaires - tendent à faire porter la responsabilité de ces dysfonctionnements sur les infirmières. Cet article remet en question cette explication en analysant l’ensemble des facteurs qui engendrent un déficit de qualité des soins.Plusieurs publications officielles dans la première décennie des années deux mille ont relevé des pratiques défaillantes de soins infirmiers engendrant des douleurs chez les patients, des négligences de soin lors des repas, des toilettes. D’une manière plus générale, la personne malade n’apparaît ni respectée, ni bien soignée (Abrahams 2011; CQC 2011). Ces rapports ont été amplement médiatisés. En première analyse, les raisons invoquées soulignent que le niveau de formation des infirmières serait inversement proportionnel à leur capacité à prendre soin des personnes malades (Marrin 2009).L’article met ces questions en perspective en les replaçant dans leur contexte politique. L’approche présentée s’appuie sur une analyse de la littérature sur le soin infirmier et le travail de l’infirmière praticienne. Les auteures relèvent six axes principaux qui affectent la qualité des soins ; l’organisation spatiale des services, le rôle de la responsable du service, la définition d’objectifs non uniquement quantitatifs, la culture organisationnelle, l’attention envers les équipes soignantes, la formation des soignants et la prise en compte du travail émotionnel du soignant. L’article montre que le déficit en soin relève de la combinaison de ces facteurs. L’amélioration des soins délivrés requiert qu’ils soient donc considérés conjointement. Ils sont successivement présentés ci-dessous.L’organisation spatiale des services isole désormais les patients et les soignants contrairement aux services Nightingale où les infirmières pouvaient voir l’ensemble des patients et être vues par eux. Pour préserver la confidentialité et réduire les infections, tout en limitant le risque d’isolement des personnes, des rondes systématiques ont eu un effet positif aux États-Unis et ont été développées aussi au Royaume-Uni.Le rôle de la responsable du service comporte trois aspects (experte en nursing et gestionnaire de l’équipe soignante, formatrice des infirmières et des autres soignants, éducatrice vis-à-vis des patients). Cependant les rôles d’expert clinique et de manager d’équipes peuvent entrer en tension et engendrer un moindre investissement des soignantes dans le cas de relations tendues et de désaccord avec le chef de service sur les finalités de l’activité du service. En Angleterre, les cadres infirmiers ont de nombreuses perspectives d’emploi. Ils évitent les services dans lesquels ils estiment que la qualité des relations interprofessionnelles ou la rémunération ne correspondent pas à leurs attentes et aux responsabilités exigées.Un autre facteur qui nuit aux soins est la multiplication des objectifs et des évaluations essentiellement quantitatives qui ont été définies et imposées, parfois en contradiction avec le sens et la valeur que les soignants donnent à leur travail. La culture organisationnelle a aussi un impact important sur l’efficacité et la qualité des soins délivrés. Le lien entre bien-être des personnes malades et celui des équipes est avéré.De nombreux débats ont eu lieu dans la presse médicale et populaire sur la formation des infirmières, qui ont généralement condamné la réforme des années quatre-vingt, au motif qu’elle ne produisait pas des infirmières capables d’une attitude compassionnelle. Le programme « Project 2000 » a introduit des changements importants dans la formation infirmière. Il avait pour objectif de former des infirmières d’un niveau universitaire et de développer leur esprit critique. Le recours aux stagiaires comme force de travail sur les terrains de stage était par ailleurs limité. Aucune preuve n’a été donnée que ce système engendrait une qualité des soins dégradée. Un autre point en discussion porte sur le caractère invisible et non organisé du travail émotionnel des infirmières, qui peut conduire celles-ci au burn-out et déboucher sur des soins de mauvaise qualité.Selon cette analyse de la littérature, les faiblesses relevées dans les soins délivrés aux personnes malades apparaissent donc imputables aux modèles d’organisations soignantes et non à la catégorie de personnel stigmatisé que sont désormais les infirmières

Exploring senior nurses' experiences of leading organizational change

Purpose – The aim of this paper is to explore Senior nurses’ experiences of leading organizational change. There is a substantial literature reporting middle-level nurse managers’ experiences of change; however, there is less evidence concerning senior nurses’ perspectives. In view of this, interview data collected from senior nurses, as part of a study of major organizational change, were analysed to redress this imbalance. Design/methodology/approach – In-depth semi-structured interviews (n = 14) were conducted with senior nurses (between 2009 and 2012). Findings – Senior nurses’ activity centred on leadership and workforce issues, internal influences and external pressures. In periods of change, appropriate leadership was vital, and “weak” leaders were considered to have an adverse effect on teams. Concerns were expressed about financial strictures and their impact on patient care and service provision. The senior nurses were striving to provide the best quality of service delivery with the limited resources available. Concentration on operational matters was necessary to maintain stability in periods of change. However, this prevented senior nurses from influencing strategic decision-making in their organizations. Practical implications – If senior nurses are to realise their potential to operate at a strategic level, they need to be given time and support to lead, rather than just react to change. This research emphasises the importance of a “nursing voice” to inform board-level decisions and maintain a focus on patient care. Originality/value – This research sheds light on the work of a key group of staff in health-care organizations. Understanding senior nurses’ experience of and contribution to change is a useful contribution to health services research. </jats:sec