The progress of family health nursing in remote and rural Scotland.

Since 2001 the World Health Organization Europe's family health nurse (FHN) role has been developing in remote and rural areas of Scotland. In 2003, an independent evaluation identified a need for facilitation of the FHN role and family-health orientated approaches with local primary health care teams. The Scottish Executive Health Department appointed three part-time, regionally-based family health practice development facilitators (FHPDFs) in December 2003 to work over an 18-month period. This article presents findings from a small study which sought these FHPDFs' judgements on individual FHN autonomy and supportive colleague action at 24 sites where FHNs were practising. These judgements reveal a picture of mixed progress that is consistent with findings from other related research. This collective overview is presented in the form of a new typology and the resultant implications for future development of family health nursing are discussed

An analysis of policy to practice initiatives in Scotland: what are the key lessons learned?

Aim - The study sought to identify and explain common issues and lessons arising from four national health policy initiatives related to nursing, midwifery and allied health professions (NMAHPs) in Scotland between 2005 and 2010. Background - The Scottish government has been seeking effective practice developments in NMAHPs through enacting policy initiatives to improve patient care. Despite many of these initiatives being individually evaluated, no integrative systematic study has been undertaken to synthesise better understandings. Design - Multiple case study design involving qualitative research was the main methodology. Methods - The study used purposive and snowball sampling and in-depth interviews to elicit the views of 24 stakeholders. Findings - This study enabled identification and explanation of key generic lessons such as internal policy alignment, good leadership and governance at all levels, effective communication, and sustainability linked to policy external alignment. Conclusion and implications for nursing management - Findings highlight the importance of strategy for internal policy alignment involving top-down and cross-sectional cooperation and appraising external policy alignment when progressing a sustainable policy initiative. At all levels, leadership is important to provide clear guidance, manage different expectations and enable understanding of initiatives for enactment. Analysis of such initiatives would be useful in preparing nurse managers

An analysis of the development of family health nursing in Scotland through policy and practice 1998-2006.

In 1998 World Health Organisation Europe outlined a vision of a new community-based nurse called the Family Health Nurse (FHN) who would help individuals, families and communities to cope with illness and to improve their health. Scotland was the first European country to develop this idea through policy, education and practice. The two phase national pilot project (2001-2006) primarily involved remote and rural regions. Despite its vanguard position, Scottish family health nursing has been subject to little in-depth critical analysis. This thesis addresses this deficit by analysing why and how family health nursing developed in Scotland. The research methods used are: critical review of textual sources; empirical research into policy, education and practice; and critical review and application of relevant theoretical perspectives to enable interpretation. Grounded primarily in constructivism, this approach builds explanation of the development of family health nursing in Scotland as a phenomenon in contemporary nursing history. This explanation highlights the importance of key factors and processes, particularly: agency at policy formulation level; use of the piloting mechanism to mediate knowledge production, containment and expansion; tensions between generalism and specialism as manifest within the promulgated FHN concept, the educational programme, and the FHN role as it was variously enacted in practice; related difficulty in engaging substantially with families; and the strong influence of local context on the nature and scope of FHN role development, especially in terms of situated power and embedded culture of place. The explanation is summarised as a synoptic story. A new integrative, explanatory model of the development of family health nursing in Scotland is also posited. This knowledge is then examined in relation to contemporary community nursing and primary care in order to understand influence and implications. This highlights the importance of the development of family health nursing in shaping the new Community Health Nurse (CHN) role which emerged from the Review of Nursing in the Community in Scotland 2006. The new explanatory model constructed within the thesis is then applied in its more generic MAPPED format (Model for Analysing Policy to Practice Executive Developments) to analyse the new policy formulation advancing the CHN role and to anticipate key developmental factors and processes. On this basis, the thesis argues that the MAPPED model is potentially valuable for the analysis of developments that require purview from policy through to practice. The thesis concludes by summarising its contributions to understandings of community nursing policy, practice, research and theory, and makes a number of related recommendations

A follow-up study of professionals' perspectives on the development of family health nursing in Scotland: a questionnaire survey.

Background: In 1998 the World Health Organisation Europe introduced the Family Health Nurse concept. The envisaged role of this community-based nurse was seen as multi-faceted and included helping individuals, families and communities to cope with illness and improve their health. During 2000-2002 Scotland led enactment of the concept through education and practice, and the first research study evaluating its operation and impact in remote and rural areas was published in 2003. Objective: This study's purpose was to follow up health care professionals' perspectives on the development of family health nursing in remote and rural areas of Scotland since 2002. Methods: The main research method used was questionnaire survey of all the established family health nurses in these areas and all other health and social care professionals with whom they had regular work-related contact. Where novel contexts or practice patterns emerged, further investigation was undertaken through telephone interviews. Findings: Twenty-three family health nurses (88%) and 88 of their colleagues (52%) returned questionnaires. Eight family health nurses were interviewed. The dominant theme within the findings was the gradual, positive development of a role which tended to maintain established community nursing service provision, yet also supplement this with a limited expansion of family health services and public health activities. The flexibility and wide scope of the FHN role in terms of providing generalist community health nursing services was clearly evident. However, capacity to engage with whole families was found to vary widely in practice. Conclusions: Within remote and rural Scotland family health nursing is gradually consolidating and developing, but its particular aspiration to engage with whole families is often difficult to enact and is not a priority within mainstream UK primary care policy, planning or provision

An evaluation of the process and initial impact of disseminating a nursing e-thesis.

Aim. This paper is a report of a study conducted to evaluate product, process and outcome aspects of the dissemination of a nursing PhD thesis via an open-access electronic institutional repository. Background. Despite the growth of university institutional repositories which make theses easily accessible via the world wide web, nursing has been very slow to evaluate related processes and outcomes. Method. Drawing on Stakes evaluation research methods, a case study design was adopted. The case is described using a four-phase structure within which key aspects of process and impact are reflexively analysed. Findings. In the conceptualisation/re-conceptualisation phase, fundamental questions about the purpose, format and imagined readership for a published nursing PhD were considered. In the preparation phase, seven key practical processes were identified that are likely to be relevant to most e-theses. In the dissemination phase email invitations were primarily used to invite engagement. The evaluation phase involved quantitative indicators of initial impact, such as page viewing and download statistics and qualitative feedback on processes and product. Conclusion. Analysis of process and impact elements of e-thesis dissemination is likely to have more than intrinsic value. The advent of e-theses housed in web-based institutional repositories has the potential to transform thesis access and use. It also offers potential to transform the nature and scope of thesis production and dissemination. Nursing scholars can exploit and evaluate such opportunities

The PhD thesis as a virtual guest house.

PhD theses. Who reads them? Within UK nursing the answer is: hardly anybody, save a few PhD supervisors, students and enamoured academics. Since the millennium, the Royal College of Nursing’s Steinberg Collection of over 1000 hard bound theses has seen around 250-300 episodes of access each year. This low level of thesis usage is also characteristic of university libraries in the UK (Copeland and Penman 2004), where processes for accessing these tombstone-like tomes are often tortuous. However, libraries throughout the world are increasingly making electronically formatted theses (e‐theses) freely accessible on‐line via web‐based Institutional Repositories (Copeland et al. 2005). This offers an opportunity to transform PhD access and use. North America, Australia, Sweden, Germany and the UK have been in the vanguard of development. Following a slow start, UK nursing is gradually waking up to this opportunity. At the time of writing, within Scotland, there are five nursing PhD theses available electronically. This article draws on recent experience of actively disseminating a new nursing PhD electronically (Macduff 2007), and on many nights spent in guest houses during academic research work

Theory-based interventions to aid healthcare staff prevent and control healthcare-associated infections: an integrative review protocol.

The objective of this integrative review is to synthesise the best available evidence on (i) what and (ii) how theory has been implemented in the development of interventions aiding healthcare staff to prevent and control healthcareassociated infections. Consequently the specific review questions to be addressed are: 1. What theory-based interventions have been implemented to aid healthcare staff prevent and control healthcare-associated infections? 2. How are these interventions structured and applied? 3. To what extent are these interventions effective

Disentangling complexity: a visualisation-led tool for healthcare associated infection training

Training in infection prevention and control (IPC) measures is crucial to minimise the incidence of healthcare-associated infections (HAIs), a growing cause of patient illness and death in hospital. This paper describes a participative approach to developing a prototype tablet-based digital training tool using dynamic visualisation-led techniques to raise awareness and understanding of IPC and HAIs for hospital-based staff. An evidence-based and iterative visualisation prototyping process was used to engage staff and invite contributions from across a number of roles within the NHS, a typically hierarchical sector. Findings suggest the visualisation-led approach was helpful in articulating the behaviours of pathogens and staff and their interactions within the complex setting and service ecology of the NHS and in making IPC training materials clearer and more engaging

Creative Methods to Envision Nursing Practices Addressing Antimicrobial Resistance (AMR): a report on the use of arts and humanities approaches to co-design healthcare service innovation

Re-envisaging Infection Practice Ecologies in Nursing (RIPEN) through Arts and Humanities Approaches is a collaborative research project that has used a novel combination of methods to explore and develop nursing’s engagement with the pressing problem of antimicrobial resistance (AMR). This report presents an overview of the rationale for, and design of, the project before featuring the methods used in the workshops that were central to its progress. In the third section we reflect on the learning that has accrued and this is then summarised in the final section along with specific recommendations. In presenting this material we hope to give the reader insight into how we have addressed RIPEN’s central question: How can relevant arts and humanities-based approaches help nurses to re-envisage their infection control practice ecologies in response to antimicrobial resistance? We believe this should be of relevance to four main audiences: Nursing and healthcare professionals engaged in practice, education and/or research to address antimicrobial resistance and infection prevention Designers, artists and researchers using and developing creative methodologies applied to healthcare practice and service improvement. Policymakers, activists, public officials and funders seeking to further understand and explore the creative potential of innovative approaches to complex healthcare challenges. Communities of practice interested in exploring the use of co-design and visual methods to understand complex challenges and opportunities in healthcare

Using an arts-based methodology to explore healthcare workers’ conceptions of pathogens in the context of healthcare associated infections

Background and objective: The invisibility of pathogens under normal circumstances is a particular challenge for healthcare staff seeking to prevent and control infection in clinical areas. Within this context, very little is known about the extent to which these staff use the mind’s eye to visualise pathogens and their relationship to healthcare associated infections. This presentation reports on an initial study which addressed this knowledge deficit by exploring how healthcare workers envisage pathogens in the hospital context. Methods: Ten hospital-based healthcare workers and two patient representatives participated in an in-depth workshop combining risk identification, making activities and in-depth interviews. This methodology was based on Sullivan’s Dimensions of Visualisation framework relating to data, text, ideas and objects. A descriptive cross case analysis approach was used to summarise and synthesise the data. Findings: Participants described their respective roles and routines and indicated perceived loci and foci for pathogens and associated risks. Few of the participants actively visualised pathogens in their mind’s eye during clinical practice. However, through the making activity, the study elicited mental images of pathogens from all participants and this yielded detailed insights into imagined pathogen characteristics. Conceptions appeared to be influenced primarily by microbiology and infection control campaigns. Conclusion: Sullivan’s Dimensions of Visualisation framework proved useful in structuring this initial enquiry and merits wider application and evaluation by qualitative health researchers. Moreover, with increasing international interest in the role of mental models in influencing clinical IPC practice, further research on the nature and impact of visual representations is merited