Clinical academic careers for general practice nurses: a qualitative exploration of associated barriers and enablers

Background The delivery of research in healthcare in the UK is dependent on a subgroup of clinicians – clinical academics – who concurrently engage in clinical practice and academic activities. The need to increase access to such roles for general practice nurses has been identified, although the need for a robust career framework remains. Aims This study, with a qualitative interview and focus group design, aimed to explore the concept of clinical academic careers for general practice nurses by identifying barriers and enablers associated with pursuing and performing such roles. Methods General practice nurses (n = 18) and general practitioners (n = 5) engaged in either an audio -recorded interview or focus group. Verbatim transcripts were subjected to thematic analysis. Results Four themes were identified: awareness and understanding; career pathway; personal and professional attributes; and organisational factors. Awareness and understanding were generally poor. Participants suggested that the career pathway was unclear, although it was generally assumed that such roles were ‘out of reach’ and require a minimum of Master’s level education. An interest in research and the confidence to perform such duties were reported as the required personal and professional attributes. Organisational factors included the need for employers to understand the value and benefit of general practice nurse clinical academic roles, along with ensuring that the inevitable competing demands of such a role were appropriately managed. Conclusions This study highlights the difficulties faced by general practice nurses wishing to pursue a clinical academic career. Academia is seemingly placed on a pedestal, emphasising the need to embed research training early in nursing education to alter general practice nurse perceptions that clinical academic roles are unobtainable. The development of a robust career pathway for general practice nurse clinical academic roles may have a positive impact on the retention of experienced general practice nurses and attract newly qualified nurses. This research provides evidence as to the need for one

Understanding the distribution of A&E attendances and hospital admissions for the case managed population: A single case cross sectional study

Aim To describe the characteristics of case-managed patients presenting at accident and emergency (A & E) and to explore the distribution of their attendances and admissions. Background Recently, the UK Government announced extended-hours primary care provision in an effort to reduce the growing utilization of A & E. No evidence is available to understand the use of acute services by this high-risk patient group. Method A cross-sectional design utilising routinely collected anonymsed A & E attendance and hospital admission data from 2010 to 2015. Results The case-managed population is typically 70 years and older and most often arrive at A & E via emergency services and during the night (00:00–08:59). A large proportion are subsequently admitted having a statistically significant A & E conversion rate. No variables were predictive of admission. Conclusion The high level of A&E conversion could indicate case-managed patients are presenting appropriately with acute clinical need. However, inadequate provision in primary-care could drive decisions for admitting vulnerable patients

The effectiveness of therapies for dual language children with developmental language disorder: a systematic review of interventional studies

Purpose: This study aims to understand the effect of therapies on dual language children with developmental language disorder (DLD) on a range of bilingual language outcomes, compare with second-language-only therapy and determine whether there is any cross-linguistic transfer. Methods: A systematic review of English articles in 10 electronic databases was conducted. Screening, reviewing and appraising were performed independently by two reviewers. Quality was appraised and findings synthesised in accordance with the research questions. Results: Nine reports were identified. Five studies were found to be low in bias and therefore high in quality. Two were medium bias and two were high. Key findings were that instruction in the first language is required to support its continued acquisition and that bilingual instruction does not limit second language growth. Conclusions: There is no identified evidence to suggest that second-language-only is better than bilingual therapy for dual language children with DLD for the development of the second language. There is evidence to suggest that bilingual therapy is equally effective for second language development, and also supports development of the first language. Further work is required to understand the efficacious doses of both languages in order to develop cost effective therapies and achieve optimal outcomes

Clinical Academic Careers for General Practice Nurses: A qualitative exploration of associated barriers and enablers

Background: The delivery of research in healthcare is dependent on a sub-group of clinicians – clinical academics – who concurrently engage in clinical practice and academic activities. The need to increase access to such roles for GPNs has been identified, though the need for a robust career framework remains. Aims and objectives: This study aimed to explore the concept of clinical academic careers for general practice nurses (GPNs) by identifying barriers and enablers associated with pursuing and performing such roles. Design: qualitative interview and focus group design. Methods: GPNs (n=18) and general practitioners (GPs) (n=5) engaged in either an audio recorded interview or focus group. Verbatim transcripts were subject to thematic analysis. Results: Four themes were identified: awareness and understanding; career pathway; personal and professional attributes; and organisational factors. Awareness and understanding was generally poor. Participants suggested that the career pathway was unclear, though it was generally assumed that such roles were “out of reach” and require a minimum of Master’s level education. An interest in research and the confidence to perform such duties were reported as the required personal and professional attributes. Organisational factors included the need for employers to understand the value and benefit of GPN clinical academic roles, along with ensuring that the inevitable competing demands of such a role were appropriately managed. Conclusions: This study highlights the difficulties faced by GPNs wishing to pursue a clinical academic career. Academia is seemingly placed upon a pedestal, emphasising the need to embed research training early in nursing education to alter GPN perceptions that clinical academic roles are unobtainable. Relevance: The development of a robust career pathway for GPN clinical academic roles may have a positive impact on the retention of experienced GPNs and attract newly qualified nurses. This research provides evidence as to the need for one

Risk factors associated with heel pressure ulcer development in adult population: A systematic literature review

Aims The main aim of this systematic literature review was to identify risk factors for development of heel pressure ulcers and quantify their effect. Background Pressure ulcers remain one of the key patient safety challenges across all health care settings and heels are the second most common site for developing pressure ulcers after the sacrum. Design Quantitative systematic review. Methods Data sources: Electronic databases were searched for studies published between 1809 to March 2020 using keywords, Medical Subject Headings, and other index terms, as well as combinations of these terms and appropriate synonyms. Study eligibility criteria: Previous systematic literature reviews, cohort, case control and cross-sectional studies investigating risk factors for developing heel pressure ulcers. Only articles published in English were reviewed with no restrictions on date of publication. Participants: patients aged 18 years and above in any care setting. Study selection, data extraction, risk of bias and quality assessment were completed by two independent reviewers. Disagreements were resolved by discussion. Results Eleven studies met the eligibility criteria and several potential risk factors were identified. However, eligible studies were mainly moderate to low quality except for three high quality studies. Conclusions There is a paucity of high quality evidence to identify risk factors associated with heel pressure ulcer development. Immobility, diabetes, vascular disease, impaired nutrition, perfusion issues, mechanical ventilation, surgery, and Braden subscales were identified as potential risk factors for developing heel pressure ulcers however, further well-designed studies are required to elucidate these factors. Other risk factors may also exist and require further investigation

Using knowledge discovery through data mining to gain intelligence from routinely collected incident reporting in an acute English hospital

Purpose: Incident reporting systems are commonly deployed in healthcare but resulting datasets are largely warehoused. This study explores if intelligence from such datasets could be used to improve quality, efficiency, and safety. Design/methodology/approach: Incident reporting data recorded in one NHS acute Trust was mined for insight (n = 133,893 April 2005-July 2016 across 201 fields, 26,912,493 items). An a priori dataset was overlaid consisting of staffing, vital signs, and national safety indicators such as falls. Analysis was primarily nonlinear statistical approaches using Mathematica V11. Findings: The organization developed a deeper understanding of the use of incident reporting systems both in terms of usability and possible reflection of culture. Signals emerged which focused areas of improvement or risk. An example of this is a deeper understanding of the timing and staffing levels associated with falls. Insight into the nature and grading of reporting was also gained. Practical implications: Healthcare incident reporting data is underused and with a small amount of analysis can provide real insight and application to patient safety. Originality/value: This study shows that insight can be gained by mining incident reporting datasets, particularly when integrated with other routinely collected data

An integrated safety measurement model : a new perspective for performance measurement

Performance measurement systems provide an opportunity not only to determine if organisations are effectively delivering their strategy and meeting their vision, but also to enable improvements. In 2009, the NHS implemented the NHS Performance Framework (Department of Health 2009), which has since been altered yearly in line with changing governments and policy alterations. Although originally designed to be applied to Primary Care Trusts (PCTs) from April 2010, the NHS reform, which seeks the replacement of PCTs with GP Consortia, has rendered the framework redundant in primary care (Department of Health 2010a). Since then, the NHS Outcomes Framework (Department of Health 2010b) has been published, and focuses on 5 outcome domains that are expected to show national level performance across the whole of the NHS. This high level system has failed to provide a performance picture of any individual service, of which there are many, in addition to proving reliant on outcome (lagging) indicators which have long been recognised as a poor singular method for measuring performance (Eccles and Pyburn 1992; Kaplan and Norton 1992). This study advocates service specific performance measurement and the engagement of stakeholders during the design process to develop leading and lagging indicators of value to the stakeholders. This is in particular with efforts to shift the onus onto patients to maintain health; as is true of the case management programme, which forms the case study for this research. The case management programme aims to reduce expensive hospital admissions for patients with complex long term conditions (LTCs) (Department of Health 2005). It expects to be able to achieve this by implementing a case management approach to oversee the most at risk patients, to develop an integrated care plan and to empower patients to become actively involved in their care at home. This paper will present the underlying literature that supports the development of a safety measurement model and describes the methodology used to gain validation by a key stakeholder group

A stakeholder derived framework for safety assessment in the NHS case management programme

Patient safety measurement methods are dominated by outcome measurement, reducing them to counts of harm or adverse events. Performance measurement recognises the limitations of the sole use of outcome indicators and proposes the use of measures throughout the system, in particular the determinants of the desired outcomes. Furthermore, it promotes stakeholder engagement in the design of measures in order to understand their expectations and how they contribute. This is particularly important in healthcare services, such as the NHS case management programme, where patient contribution is growing. This programme is a response to the ageing population and the subsequent increase in complex long term conditions, aiming to deliver care in the home to empower patients so they are able to care for themselves to a greater extent. In comparison to the institutionalised setting, the home setting is relatively unexplored. Therefore, this research has provided an opportunity to examine the concept of safety in a care service with an increasing demand from a vulnerable population. The research aimed to develop a conceptual framework for safety measurement that was: 1) reflective of key stakeholders; 2) able to incorporate the system; and 3) representative of the home-delivered healthcare of the case management programme. An exploratory, sequential mixed method design within the critical realist philosophy, which was guided by the principles of performance measurement, was adopted. A case study utilising 13 interviews with nine patients and six carers (two interviews were held jointly) and three focus groups with 17 case management nurses was deployed. This enabled in-depth exploration of their perspectives regarding safety, including: their definitions of safety, who was involved, the contributing factors, and which outcomes were most important. Intriguing, important or contradictory findings were further examined using a survey (patient n=35, carer n=19 and case management nurse n=26), which aimed to determine the level of agreement with these qualitative findings and identify any statistically significant differences between the stakeholder groups. Through engagement with stakeholders, this research has established a definition of safety that represents the type of care provided by the case management programme. In particular, it recognises the importance of meeting the care needs of this patient population, acknowledging that the alternative would facilitate disease progression, exposing patients to unnecessary harm. Understanding the patient perspective has proven to be particularly important because of the level of control asserted by patients on the structure, processes and outcomes of care. This level of control is an integral component of the proposed conceptual framework. Of greatest significance is the incorporation of the patients' living environments and their resources into the structure of care, as well as the involvement of their daily self-care activities in the processes of care. Consequently, the framework is inclusive of non-traditional safety outcomes, such as functional health status, because they help sustain patient controlled structures and processes, which in turn influence traditional measures of harm. The conceptual framework is a guide to the assessment of safety in case management that specifies a range of factors that facilitate the condition of safety, providing a holistic overview of the complex, nested system of care required to manage long term conditions

Using knowledge discovery through data mining to gain intelligence from routinely collected incident reporting in an acute English hospital

Purpose: Incident reporting systems are commonly deployed in healthcare but resulting datasets are largely warehoused. This study explores if intelligence from such datasets could be used to improve quality, efficiency and safety. Incident reporting data recorded in one NHS acute Trust was mined for insight (n=133,893 April 2005-July 2016 across 201 fields, 26,912,493 items). An a priori dataset was overlaid consisting of staffing, vital signs and national safety indicators such as falls. Analysis was primarily nonlinear statistical approaches using Mathematica V11. The organisation developed a deeper understanding of the use of incident reporting systems both in terms of usability and possible reflection of culture. Signals emerged which focused areas of improvement or risk. An example of this is a deeper understanding of the timing and staffing levels associated with falls. Insight into the nature and grading of reporting was also gained. Healthcare incident reporting data is underused and with a small amount of analysis can provide real insight and application to patient safety. This study shows insight can be gained by mining incident reporting datasets, particularly when integrated with other routinely collected data