A qualitative study investigating the similarities and differences of diploma and undergraduate nursing (adult) students

The aims of this study were to explore the preconceptions of pre-registration undergraduate and Diploma of Higher Education in Nursing (Dip.H.E.) (Adult) students have in relation to their programme and the nursing profession, and students' perceptions as their programmes progress. In addition the study aimed to explore how pre-registration undergraduate and Dip.H.E. (Adult) students perceive their preparation for the qualified role, and compare pre-registration undergraduate and diploma nursing students' actual performance in the clinical area near to qualification. The study used grounded theory methodology (Glaser and Strauss 1967). Undergraduate (n=20) and Dip.H.E. (n=22) nursing (Adult) students from two institutions in Scotland were used. Findings from the focus groups indicated that both groups were apprehensive about their first clinical placement, especially in relation to their own self-confidence and the uncertainty about their role within those placements. All students wanted to have the qualities of a 'good nurse' and expected to learn these qualities from clinical staff. Diploma level education was perceived as giving students better practical skills, while degree level education was perceived as giving students better theoretical skills. At the mid-point of the programmes, diploma participants were more confident in their practical ability, while undergraduate participants were more confident in their theoretical ability. The clinical learning environment had a major effect, both positive and negative, on both sets of students' practical abilities. Students had experienced good and bad mentors, which had affected the integration of theory and practice, had 'shaped' their learning experience, and had resulted in different degrees of supervision and feedback. Overall, both groups of participants expressed their anxiety about their lack of practical skills, and their opportunities to link theory to practice

The perceived effects of a performance management programme on the professional knowledge attitudes and behaviour of temporary teachers at a metropolitan high school

During 1988 the Temporary Teacher Performance Management Programme was introduced in Western Australian State high schools by the Ministry of Education. The purpose of the programme was to provide all temporary teachers with access to a full performance management process, Including an Induction and appraisal suitable to their background and the amount of time they have spent at the school. This case study involved eight temporary teachers from a metropolitan high school. It examined their perceptions of the nature, function, determining factors and need for modification of the Temporary Teacher Performance Management Programme. The major question underlying the research was this: From the metropolitan temporary teacher\u27s point of view, what effect did the programme have on their professional knowledge, attitude and behaviour, and what were their perceptions for its future? To answer the major research question several subsidiary questions were pursued. These Included questions about the variation in what should have taken place during the programme according to Ministry guidelines and what actually did happen; what professional development occurred as a result of the programme; and what factors determined whether the programme had a positive or negative effect. A qualitative study, using naturalistic data collection methods was undertaken to allow participants freedom of response and to permit insight into reasons for those responses. The main emphasis of the study was on discovery rather than the testing of theory. As a study of eight temporary teachers was not intended to produce generalizations that cover all temporary teachers\u27 thoughts on the programme. Analysis of the data was based on participants\u27 responses rather than a predetermined framework. Information and feedback from the temporary teachers\u27 point of view has already assisted in further development of the programme both at the school and Central Office level. It will also contribute to theory building in the area of teacher performance management. The exploration of the complexity of the participants\u27 feelings and perceptions of the programme will provide a basis for developing hypotheses about the Temporary Teacher Performance Management Programme. The inquiry also may be considered a pilot study for future research

Equine Assisted Learning for Primary School Children: Experiences of Teachers and Trainers

Equine-Assisted Learning Programme (EALP) was delivered by Equitots Lanarkshire Community Interest Company to promote the development of life skills using an experiential learning approach. The EALP focussed on activities that would improve confidence, communication, resilience, achievement, teamwork and relationships. The project aimed to evaluate the experiences of teachers and programme trainers of an EALP delivered by Equitots Lanarkshire. The research questions were: RQ1: What aspects of the programme work (or not)? RQ2: What changes in cognitive, psychomotor or social skills were witnessed during and/or after the EALP in the children or young persons? RQ3: What experiences do teachers and programme trainers report about the EALP? The intervention involved 25 sessions with 5 schools, with 4 children per school attending 5 sessions each. Primary schools were from two local authority areas in Scotland, UK. The intervention involved a variety of activities designed with and without the pony for primary school children (aged between 8-11). Ethical approval was gained through University of Stirling General University Ethics Panel GUEP509, and management approval was granted via the Head of Education in both Local Authorities. Sample: Seven teachers from 5 schools and one programme trainer volunteered to take part in the study. Participants were informed that they could withdraw at any time and refuse to answer any questions. Audio-recorded face-to-face or telephone interviews using a semi-structured set of questions, approximately 60-90 minutes in length, were used to collect data from participants. Data were held securely using General data Protection Regulation guidelines. Data were analysed using thematic analysis. The main findings of the research are described within each research question: RQ1: Travelling to the facility, working directly with the pony (such as riding, grooming, and understanding equine behaviour), as well as craft activities (such as making a coat of arms) were cited as being active ingredients of the intervention that teachers felt worked really well for children within the EALP. There were no negative aspects of the programme identified, apart from the further availability of such a programme to children within each council area. RQ2: There were examples of immediate impact for the children, and this was often carried on for months after the intervention. Positive changes in social skills such as those associated with positive behaviour (e.g. building relationships with the teacher and other children), as well as improvement in the children’s confidence and communication skills, were provided as examples throughout every interview. Cognitive skills, such as maths, were improved by carrying out applied work during the sessions. RQ3: Interview data revealed that teachers’ experiences of EALP was viewed as an excellent means of engaging children in learning. It was generally more difficult to engage children within the classroom than within the outdoor environment with ponies. Teachers noted areas where they were proud of their children’s achievements both at EALP, and also in the months after the intervention. In conclusion, this qualitative exploration of the impact of the EALP intervention found that it was positive in terms of the positive influence it appears to have on the cognitive, psychomotor, and social improvement seen in children both during and after the intervention. More evaluative research is needed before the impact is fully understood. Early evidence would suggest that it may have the potential to have a significant impact on the way the child learn, as well as having longer-term benefits

Does cancer type influence the impact of recurrence? : a review of the experience of patients with breast or prostate cancer recurrence

Objective: Patients will experience a plethora of issues when faced with a recurrence of their cancer. It is unclear if cancer type is a significant factor in how recurrence is experienced by an individual. The aim of the current review is to explore the evidence base and summarise the experiences of patients specifically with a recurrence of breast or prostate cancer (the most common for women and men, respectively) and then provide a comparison of these experiences. These experiences include the physical, psychological and psychosocial issues that arise at this time.  Methods: A systematic search was conducted of studies published between January 1994 and April 2019. Due to the mix of research designs used previously in the literature, this review was conducted in an integrative manner; allowing for inclusion of diverse research designs. Results were synthesised narratively, with data categorised according to physical, psychological, and psychosocial indices of quality of life. The review protocol was registered in the international database of prospective systematic reviews in health and social care- (CRD42019137381).  Results: Fifteen breast cancer and six prostate cancer articles were identified, each reporting one relevant study. Patients reported several negative issues at the time of a breast or prostate cancer recurrence. Similarities were found between cancer types, with physical problems such as fatigue, psychological issues including anxiety and depressive symptoms, and psychosocial concerns such as issues with healthcare professionals common in both cancers. Certain findings were inconsistent across studies, with some experiences differing between studies rather than due to cancer type.  Conclusions: Differences in the experience of recurrent cancer appear to be more heavily influenced by individual factors, rather than cancer type. Findings are confounded by gender; and should be considered preliminary. Effects of recurrence should be studied in samples where cancer type and gender are not confounded. Concerns are raised about available study quality and differing outcome measures in this interpretation. Care and support of the individual at the time of a cancer recurrence is a key focus. Future research suggestions with implications for clinical practise are included.Publisher PDFPeer reviewe

Equine Assisted Learning for Primary School Children: Experiences of Teachers and Trainers

Equine-Assisted Learning Programme (EALP) was delivered by Equitots Lanarkshire Community Interest Company to promote the development of life skills using an experiential learning approach. The EALP focussed on activities that would improve confidence, communication, resilience, achievement, teamwork and relationships. The project aimed to evaluate the experiences of teachers and programme trainers of an EALP delivered by Equitots Lanarkshire. The research questions were: RQ1: What aspects of the programme work (or not)? RQ2: What changes in cognitive, psychomotor or social skills were witnessed during and/or after the EALP in the children or young persons? RQ3: What experiences do teachers and programme trainers report about the EALP? The intervention involved 25 sessions with 5 schools, with 4 children per school attending 5 sessions each. Primary schools were from two local authority areas in Scotland, UK. The intervention involved a variety of activities designed with and without the pony for primary school children (aged between 8-11). Ethical approval was gained through University of Stirling General University Ethics Panel GUEP509, and management approval was granted via the Head of Education in both Local Authorities. Sample: Seven teachers from 5 schools and one programme trainer volunteered to take part in the study. Participants were informed that they could withdraw at any time and refuse to answer any questions. Audio-recorded face-to-face or telephone interviews using a semi-structured set of questions, approximately 60-90 minutes in length, were used to collect data from participants. Data were held securely using General data Protection Regulation guidelines. Data were analysed using thematic analysis. The main findings of the research are described within each research question: RQ1: Travelling to the facility, working directly with the pony (such as riding, grooming, and understanding equine behaviour), as well as craft activities (such as making a coat of arms) were cited as being active ingredients of the intervention that teachers felt worked really well for children within the EALP. There were no negative aspects of the programme identified, apart from the further availability of such a programme to children within each council area. RQ2: There were examples of immediate impact for the children, and this was often carried on for months after the intervention. Positive changes in social skills such as those associated with positive behaviour (e.g. building relationships with the teacher and other children), as well as improvement in the children’s confidence and communication skills, were provided as examples throughout every interview. Cognitive skills, such as maths, were improved by carrying out applied work during the sessions. RQ3: Interview data revealed that teachers’ experiences of EALP was viewed as an excellent means of engaging children in learning. It was generally more difficult to engage children within the classroom than within the outdoor environment with ponies. Teachers noted areas where they were proud of their children’s achievements both at EALP, and also in the months after the intervention. In conclusion, this qualitative exploration of the impact of the EALP intervention found that it was positive in terms of the positive influence it appears to have on the cognitive, psychomotor, and social improvement seen in children both during and after the intervention. More evaluative research is needed before the impact is fully understood. Early evidence would suggest that it may have the potential to have a significant impact on the way the child learn, as well as having longer-term benefits

Assessment of patients with head and neck cancer using the MD Anderson Dysphagia Inventory: Results of a study into its comprehensiveness, comprehensibility and relevance to clinical practice

Kate Toft - ORCID: 0000-0002-0129-9329 https://orcid.org/0000-0002-0129-9329Background The MD Anderson Dysphagia Inventory (MDADI) is a widely used patient-reported outcome measure (PROM) which assesses dysphagia-related quality of life (QoL) in head and neck cancer (HNC). Despite its common use in HNC research and clinical practice, few of its psychometric properties have been reappraised since its inception. The aim of this study was to perform a survey-based qualitative analysis of UK HNC clinicians’ perceptions of the content validity of the MDADI, evaluating it across the parameters of relevance, comprehensiveness and comprehensibility as per the COSMIN guideline for PROM assessment. Results Four themes relating to the content validity of the MDADI were identified: (1) MDADI items lack clarity of definition of the terms ‘swallowing’, ‘eating’ and ‘dysphagia’; (2) the MDADI is perceived to be overly negative in tone including items that service users may find distressing or disempowering; (3) items in the tool are exclusory to specific subgroups of patients, such as those who are nil by mouth or socially isolated; and (4) modifications to the MDADI were suggested and encouraged to make it more clinically useful and patient-centred. Conclusions This study indicates that MDADI's content validity is ‘insufficient’ when rated by COSMIN parameters. This has significant implications for its continued use in HNC research and clinical practice. Further re-evaluation of the content validity of the MDADI is warranted, with potential future amendment of items being indicated if the results of this study are corroborated in subsequent research.https://doi.org/10.1111/1460-6984.13026aheadofprintaheadofprin

Scottish Ambulance Service New Clinical Response Model

Evaluation suggests new model accurately identifies patients in greatest need through emergency 999 calls

Learning Analytics Suggest A Positive Experience

Massive Open Online Courses (MOOCs) are a relatively new phenomenon not just in healthcare but also in education as a whole (Sarabia-Cobo et al, 2015; Parkinson, 2015). Their main purpose is to capture the attention of a diverse and global audience in order to increase knowledge through the provision of university level education (Sneddon et al, 2018; Hebdon et al, 2016). The Scottish Improvement Science Collaborating Centre, University of Dundee, developed a care and compassion MOOC hosted by FutureLearn, a digital education platform. This five-week MOOC provided learning resources, activities and information to healthcare professionals and the public in order to help raise awareness and understanding of compassion and improve the provision of compassionate care. A Realistic Evaluation approach was taken which provided an opportunity to utilise mixed methods of data collection thus allowing for the complex nature of the educational intervention to be examined (Pawson and Tilley, 1997). Quantitative data from 957 participants were collected through the MOOCs demographic database and included attrition/retention rates, mechanisms of learning and self-reported impact. In keeping with realistic evaluation, the key components of context, mechanism and outcome were considered throughout analysis. Findings from the quantitative research show potentially promising retention rates with only 8% of enrolees choosing to no longer take part in the course. Of the 957 respondents who completed the pre course survey, 441 (46%) undertook the course to help their career, 311 (32%) to help their academic studies, 349 (36%) for personal reasons and 698 (73%) for social networking (multiple responses were allowed). 94 learners completed the post course survey. Amongst these, 91 respondents rated how the MOOC met their overall needs with 93% providing a positive response and 7% either a negative response or unable to answer. Therefore this paper will discuss a MOOC as a pedagogical approach to teaching the essential and complex healthcare related subject of compassion. It will also consider participants’ experiences of learning and the impact this may have on the work practices of healthcare professionals

NCRM report for SAS

Executive Summary The Scottish Ambulance Service (SAS) responds to around 1.8 million calls per year, including responses to 700,000 emergency and unscheduled incidents. Of these responses, over 500,000 are received through the 999 call service. SAS transfers around 90,000 patients between hospitals each year and responds to over 150,000 urgent requests for admission, transfer and discharge from GPs and hospitals (SAS, 2015). In 2017 SAS began to implement a new clinical response model (NCRM). The aims of the NCRM are to: - Save more lives by more accurately identifying patients with immediately life-threatening conditions, such as cardiac arrest; - Safely and more effectively send a matched resource first time to all patients based on their clinical need. The University of Stirling, commissioned to carry out an independent evaluation of the NCRM using data provided by SAS and NHS Information Services Division (ISD), considered the following questions: 1. Are patients with Immediately Life Threatening (ILT) conditions more quickly and accurately identified? 2. Are more lives saved as a consequence of the best available resources being dispatched to the patient? 3. Are improved clinical outcomes achieved if the matched resources are sent first time for patients with non-ILT conditions? Methods A quantitative analysis was conducted comparing SAS data on response to 999 calls from a pre-NCRM implementation time-period (January 2016) and a post-implementation time-period (January 2017 and January 2018). NHS ISD linked additional data from the Unscheduled Care Data Mart (UCDM) to the SAS data. UCDM contains emergency department data (ED) and data from the National Records of Scotland (NRS) for mortality data. Data were examined for the purple code (the highest risk category of call to the 999 service) and within the purple category, those patients in cardiac arrest. The same analyses were conducted for the remaining colour codes and a selection of clinical categories within these colour codes: breathing difficulties (red), stroke (amber) and falls (yellow). Key Findings Interpreting this data It should be noted that data is taken from only three (and in some cases two) time points and only from the month of January. While this does allow some relevant comparisons between the years, the findings cannot be generalised to the whole year and the whole time-period in question (January 2016 – January 2018). In addition, call volume was approximately 9% higher in 2018 compared to 2017 and 2016 (which were similar) with over 4,000 more calls in January 2018. Further analysis of the data using data from each month, as well as individual-level data (rather than it being aggregated), would allow much more robust and relevant evidence of change and the impact on the service and patients. 1. Are patients with Immediately Life Threatening (ILT) conditions more quickly and accurately identified? Patients with ILT conditions (purple calls) would appear to be more accurately identified post-NCRM with a noticeable increase in patients coded with ILT conditions by 2018. The time to respond to ILT conditions was slightly longer (but not statistically significant). Speed Resource allocation was used as an indicator of speed of identification. We found that resource allocation (and in turn response times) did not differ significantly between January 2016 (pre-NCRM) and January 2017 (post-NCRM introduction) for ILT (purple) calls. However, there was a longer time to allocate resources (i.e. identify) purple calls in 2018 compared to 2016 and this was statistically significant. For all other colour codes, 2017 and 2018 resource allocation were also significantly slower than 2016 (except amber 2017 calls) as expected with a priority-based system. Call handlers were provided with further training and development in the process of triage over the course of 2016 onwards, with the aim of more accurately allocating patients into the most appropriate category, and therefore it was to be expected that time to allocate resources and identification into the correct category would take longer. Accuracy Comparing 2016 (pre-NCRM) and 2017 (post-NCRM introduction) outcomes data, we found that sensitivity (correctly identifying a purple, ILT condition) was higher in 2017 compared to 2016, but specificity (correctly identifying a non-ILT condition) was lower in 2017. Overall accuracy (the likelihood of being correctly identified as either ILT or non-ILT) was not different between the two-time points. Similar results were also seen for the cardiac arrest cases within the purple calls. 2. Are more lives saved as a consequence of the best available resources being dispatched to the patient? Survival for purple-coded patients is markedly lower with respect to all other causes (as one would expect) and reflects that purple-coded calls/conditions are a unique category (in terms of risk of death) and represent the majority of incidents where patients face an immediate threat to life (ILT). The risk of death across the other colour codes is small in comparison and therefore differences of survival seem to exist only for the purple-coded patients. The cardiac arrest rate within the purple coded is around 53%. Survival analysis for all patients within the purple code and specifically for those affected by cardiac arrest are considered next. There seems to be a considerable (~20%) increase in survival for all purple-coded patients comparing January 2016 to January 2017, which is constant over time from time 0 (confirmed dead when the ambulance arrives at the scene) to 30 days post-call. When comparing January 2016 to January 2018 for the same group, survival also increased (~10%). The number of lives saved, 30 days post-call, in patients with ILT conditions in January 2016 (pre-NCRM) was 32 (14.2% of purple calls), and in post-NCRM in January 2017 was 134 (28.6% of purple calls) and in January 2018 was 182 (26.6% of purple calls). Although the numbers of patients with ILT conditions has increased, the data from the specificity and sensitivity analysis (Table 14) shows that there is no difference in false positive rates between the years. This suggests that the acuity of these patients remains very high and that the increase in volume represents patients correctly identified with the highest requirement for immediate response. Therefore, the increase in survival probability with those with ILT conditions is not likely to be caused by artificial inflation caused by conservative allocation of patients with ILT conditions to the purple code but rather by appropriate allocation and intervention(s) to those patients at risk from death due to ILT conditions. In terms of the 2018 survival probability being lower than in 2017, it is possible that the higher call-load in 2018 has limited the impact previously seen in 2017. Continued monitoring of these data is needed to identify how mortality has been impacted by the NCRM over the longer-term. 3. Are improved clinical outcomes achieved if the matched resources are sent first time for patients with non-ILT conditions? Overall survival for all non-ILT codes (Red, Amber, Yellow and Green) was similar, as noted above (where purple calls carry much higher risk of death). For these codes there was also no clear difference in survival in 2017 versus 2016 or 2018 versus 2016. Breathing difficulty (a sub-set of the red calls) seems to have worsened between 2016 and 2017, with 451 patients having a decrease in survival from 3% to 6%, with the gap widening as time passes. However, by 2018, survival was at 2016 levels despite the number of incidents (n=2044) back to the levels seen in 2016 (n=2018). No differences between years seem to be present for stroke or falls. Data on further clinical outcomes were not available within this dataset to analyse in any further detail. Conclusions By January 2018 the number of incidents (n=52,871) had increased by 9% when compared to January 2016 (n=48,544), amounting to over 4000 more incidents in 2018 than seen in 2016 or 2017. During this time of high demand in 2017 and particularly 2018, the NCRM does accurately identify patients who have the greatest need for services from SAS. The NCRM’s identification and triage of patients into triage categories, although taking time for the call handler and dispatching system, can get the ambulance and its crew to patients with the greatest need and this has improved the survival of those with immediate life-threatening conditions. Those with lower acuity needs are responded to but in a longer time period as expected when using a priority-based system (but with no apparent impact on survival). These conclusions are reached in the context of analysing aggregated data over three fairly short time-periods and further research over a longer time frame, with longitudinal data on individual cases, would further improve the evidence base for the NCRM