The 100 patient stories project: Patient and family member views on how clinicians (should) enact Open Disclosure - a qualitative study

Objectives To investigate patients’ and family members’ perceptions and experiences of disclosure of healthcare incidents and to derive principles of effective disclosure. Design Retrospective qualitative study based on 100 semi-structured, in depth interviews with patients and family members. Setting Nationwide multisite survey across Australia. Participants 39 patients and 80 family members who were involved in high severity healthcare incidents (leading to death, permanent disability, or long term harm) and incident disclosure. Recruitment was via national newspapers (43%), health services where the incidents occurred (28%), two internet marketing companies (27%), and consumer organisations (2%). Main outcome measures Participants’ recurrent experiences and concerns expressed in interviews. Results Most patients and family members felt that the health service incident disclosure rarely met their needs and expectations. They expected better preparation for incident disclosure, more shared dialogue about what went wrong, more follow-up support, input into when the time was ripe for closure, and more information about subsequent improvement in process. This analysis provided the basis for the formulation of a set of principles of effective incident disclosure. Conclusions Despite growing prominence of open disclosure, discussion about healthcare incidents still falls short of patient and family member expectations. Healthcare organisations and providers should strengthen their efforts to meet patients’ (and family members’) needs and expectations

Patients’ and family members’ views on how clinicians enact and how they should enact incident disclosure: the “100 patient stories” qualitative study

Objectives To investigate patients’ and family members’ perceptions and experiences of disclosure of healthcare incidents and to derive principles of effective disclosure

Traditional Owners of the Great Barrier Reef: the next generation of Reef 2050 actions

In short, this Report: Confirms that there are two options for progressing the integration of Traditional Owner interests in the Reef 2050 Plan. Option 1 (Business As Usual) represents a continuation of the current approach of Government-based review and refinement of the (now 23) Traditional Owner actions in the Reef 2050 Plan. Option 2 (Towards Genuine Co-governance) represents Government taking a far more negotiated approach at the GBR-wide level (and subsequently down to local scales) that applies the principles of Free Prior and Informed Consent. Based on extensive engagement concerning the aspirations of Traditional Owners and their support organisations across the GBR, the overwhelming stated desire and demand is for genuine partnership in the overarching governance of the Reef and far deeper ownership of, and participation in, its active day to day management (Option 2). There is an unambiguous view that the foundations set in the Reef 2050 Plan (Option 1), while a step in the right direction, simply reflect Traditional Owner aspirations in someone else’s planning. Meanwhile, a consistent message from Traditional Owners, fuelled by their existing and emerging rights in sea country, is that this more passive form of involvement cannot continue into the future; that a genuine form of agreement making and active implementation (from GBR to local scales) must emerge

The exchange rate exposure puzzle: The long and the short of it

The exchange rate exposure puzzle has remained robust to empirical scrutiny however evidence suggests the puzzle abates when longer horizons are considered. This paper applies inference that is appropriate in a long horizon setting and finds this evidence is illusory

Protocol of the process evaluation of cluster randomised control trial for estimating the effectiveness and cost-effectiveness of a complex intervention to increase care home staff influenza vaccination rates compared to usual practice (FluCare)

Background: Influenza (flu) vaccination rates in UK care home staff are extremely low. Less than 40% of staff in care homes are vaccinated for influenza (flu), presenting risks to the health of frail residents and potential staff absence from cross-infection. Staff often do not perceive a need for vaccination and are unaware they are entitled to free flu vaccination. The FluCare study, a cluster randomised control trial (RCT), uses behavioural interventions to address barriers. Videos, posters, and leaflets are intended to raise awareness of flu vaccination benefits and debunk myths. On-site staff vaccination clinics increase accessibility. Financial incentives to care homes for improved vaccination rates and regular monitoring influence the environment. This paper outlines the planned process evaluation which will describe the intervention’s mechanisms of action, explain any changes in outcomes, identify local adaptations, and inform design of the implementation phase. Methods/design: A mixed method process evaluation to inform the interpretation of trial findings. Objectives: • Describe the intervention as delivered in terms of dose and fidelity, including adaptations and variations across care homes. • Explore the effects of individual intervention components on primary outcomes. • Investigate the mechanisms of impact. • Describe the perceived effectiveness of relevant intervention components (including videos, leaflets, posters, and flu clinics) from participant perspectives (care home manager, care home staff, flu clinic providers). • Describe the characteristics of care homes and participants to assess reach. A purposive sample of twenty care homes (ten in the intervention arm, ten in the control arm) for inclusion in the process evaluation. Data will include (1) study records including care home site profiles, (2) responses to a mechanism of action questionnaire, and (3) semi-structured interviews with care home staff and clinic providers. Quantitative data will be descriptively reported. Interview data will be thematically analysed and then categories mapped to the Theoretical Domains Framework. Discussion: Adopting this systematic and comprehensive process evaluation approach will help ensure data is captured on all aspects of the trial, enabling a full understanding of the intervention implementation and RCT findings

Developing a minimum data set for older adult care homes in the UK: exploring the concept and defining early core principles

Reforms to social-care in response to the COVID-19 pandemic, in the UK and internationally, place data at the heart of proposed innovations and solutions. The principles are not well established of what constitutes core, or minimum, data to support care home residents. Often, what is included, privileges data on resident health over day-to-day care priorities and quality of life. This Personal View argues for evidence-based principles to base the development of a UK minimum data set (MDS) for care homes. Co-produced work involving care home staff and older people working with stakeholders is required to define and agree the format, content, structure and operationalisation. Implementation decisions will determine the success of an MDS, impacting aspects including data quality, completeness, and useability. Care home staff who collect the data need to benefit from the MDS and see value in their contribution and residents must derive benefit from data collection and synthesis

Piloting of a minimum data set for older people living in care homes in England: protocol for a longitudinal, mixed-methods study

Introduction: Health and care data is routinely collected about care home residents in England, yet there is no way to collate these data to inform benchmarking and improvement. The Developing research resources And minimum data set for Care Homes’ Adoption and use (DACHA) study has developed a prototype minimum data set (MDS) for piloting. Methods and analysis: A mixed-methods longitudinal pilot study will be conducted in 60 care homes (approximately 960 residents) in three regions of England, using resident data from cloud-based digital care home records at two-time points. These will be linked to resident and care home level data held within routine NHS and social care data sets. Two rounds of focus groups with care home staff (n=8-10 per region) and additional interviews with external stakeholders (n=3 per region) will explore implementation and the perceived utility of the MDS. Data will be assessed for completeness and timeliness of completion. Descriptive statistics, including percentage floor and ceiling effects will establish data quality. For validated scales, construct validity will be assessed by hypothesis testing and exploratory factor analysis will establish structural validity. Internal consistency will be established using Cronbach’s alpha. Longitudinal analysis of the pilot data will demonstrate the value of the MDS to each region. Qualitative data will be analysed inductively using thematic analysis to understand the complexities of implementing an MDS in care homes for older people. Ethics and dissemination: The study has received ethical approval from the London Queen’s Square Research Ethics Committee [22/LO/0250]. Informed consent is required for participation. Findings will be disseminated to: academics working on data use and integration in social care, care sector organisations, policy makers, and commissioners. Findings will be published in peer-reviewed journals. Partner NIHR Applied Research Collaborations, the National Care Forum, and the British Geriatrics Society will disseminate policy briefs

Widening participation in nurse education; an integrative literature review

Background: Widening participation into higher education is espoused within educational policy in the UK, and internationally, as a mechanism to promote equality and social mobility. As nurse education is located within higher education it has a responsibility to promote widening participation within pre-registration educational programmes. It could also be argued that the profession has a responsibility to promote equality to ensure its’ workforce is as diverse as possible in order to best address the health needs of diverse populations. Objectives: To undertake an integrative review on published papers exploring Widening Participation in undergraduate, pre-registration nurse education in the UK Design: A six step integrative review methodology was utilised, reviewing papers 2013-2016; published in English. Data sources: Search of CINAHL, Education Source, MEDLINE, PsychINFO, SocINDEX, Science Direct, Business Scource Complete, ERIC, British Library ETOS, Teacher Reference Centre, Informit Health Collection and Informit Humanities and Social Science Collection which highlighted 449 citations; from these 14 papers met the review inclusion criteria. Review methods: Both empirical studies and editorials focusing upon widening participation in pre-registration nurse education in the UK (2013-2016) were included. Papers excluded were non UK papers or papers not focussed upon widening participation in pre-registration nursing education. Research papers included in the review were assessed for quality using appropriate critical appraisal tools Results: 14 papers were included in the review; these were analysed thematically identifying four themes; knowledge and identification of WP, pedagogy and WP, attrition and retention and career prospects. Conclusions: Whilst widening participation is a key issue for both nurse education and the wider profession there is a lack of conceptualisation and focus regarding mechanisms to both encourage and support a wider diversity of entrant. Whilst there are some studies, these focus on particular individual widening participation groups rather than a wider strategic focus across the student lifecycle

FluCare: Results from a randomised feasibility study of a complex intervention to increase care home staff influenza vaccination rates

Background: To protect care home residents, annual staff influenza vaccination uptake is recommended to be greater than 75%. In the UK it is under 40%. With barriers and enablers to care home staff flu vaccine uptake identified, the purpose of this study was to feasibility test a theory informed intervention to improve vaccination rates. Methods: This was a five-arm (one intervention, four different control) study designed to inform the development of a definitive trial protocol. The intervention comprised of videos/posters to change vaccination attitudes, on-site clinics to increase access, a financial incentive for homes to reach target, and monthly monitoring of vaccination uptake. Control arms consisted of a mix of monthly or end of the study monitoring and provision of informational materials to identify the most suitable control arm for a definitive trial. Care homes were recruited via sector associations and purposively allocated. The feasibility outcomes were: ability to recruit enough homes; data quality (variables reported, variable completeness and consistency with a national reporting system); intervention implementation; control arm reactivity bias and signal of efficacy. Staff vaccination data was collated from homes and via a national healthcare tracking system. Process evaluation and economic data collation were undertaken to optimise intervention and research design. Results: Ten homes were recruited as per target within 11 weeks. Recruitment delays meant intervention delivery began towards end of flu season. Only 2 clinics took place in each home. All homes in intervention and chosen control arm (monthly monitoring only) reported all variables with over 90% completeness. There was a 15% difference between control homes’ reported vaccination rates and that in the national healthcare tracker, home reported data was more reliable. Signal of efficacy: intervention arm had a vaccination rate 13.6% higher than control arm. Bias: control arm did not have a higher vaccination rate than usual care control. Conclusions: Better recruitment processes, earlier start in flu season, and data collection direct from care homes are required for a definitive trial. A control arm of monthly monitoring only was identified as optimal for data collection purposes and minimising reactivity bias. The signal of efficacy was acceptable

Cluster randomised control trial protocol for estimating the effectiveness and cost-effectiveness of a complex intervention to increase care home staff influenza vaccination rates compared to usual practice (FLUCARE)

The care home staff influenza vaccination rate in England is significantly lower than the 75% World Health Organisation recommendation. This represents a substantial potential for resident harm. Barriers to staff vaccination stem from individual and organisational levels. Existing interventions address some but not all barriers and are not underpinned by behavioural science theory. This study aims to estimate the effectiveness and cost-effectiveness of a theory-informed intervention to improve care home staff vaccination rates compared to routine practice. Set in care homes with both nursing and residential focus, and a range of ownership status, only homes providing long stay care to older people with a staff vaccination rate below 40% are eligible to participate. Participation expressions of interest will be sought using a variety of approaches prior to seeking consent. The primary outcome measure is the proportion of staff vaccinated at 6 months, with secondary outcome measures being proportion vaccinated at 3 months, numbers of staff sick days, general practitioner and nurse visits to care home, care home resident hospitalisations and mortality. Based on the assumptions that the mean cluster (care home) size is 54 staff, a coefficient of variation of 0.48, control vaccination rate is 55%, intervention 75%, intra-cluster correlation coefficient of 0.2 and with 90% power, and 20% attrition, we require 39 care homes per arm. Blocked randomisation will be at the level of care home, stratified by the proportion of non-white care home staff, and implemented by Norwich Clinical Trials Unit. The intervention comprises co-designed information videos and posters, provision of in-house staff vaccination clinics, and incentive scheme and monthly data collection on trial outcomes. Beyond usual practice, the control arm will additionally contribute monthly data. Data will be collected at the start, monthly and at 6 months, and analysis will be blind to allocation. Statistical analysis will use the intention-to-treat principle with the difference in vaccination rates between groups compared using a random effect logistic regression model at the staff-level. This will be the first study to use a theory-informed intervention designed to comprehensively address identified barriers to care home staff influenza vaccination. Trial registration: ISRCTN ISRCTN22729870. Registered on 24 August 22. Secondary identifiers: R209939, IRAS 316820, CPMS 53812