Mixed methods study of a new model of care for chronic disease: co-design and sustainable implementation of group consultations into clinical practice

Objectives: Group consultations are used for chronic conditions, such as inflammatory arthritis, but evidence of efficacy for treatment to target or achieving tight control is lacking. Our aim was to establish whether group consultation is a sustainable, co-designed routine care option and to explore factors supporting spread. Methods: The study used mixed methods, observational process/outcome data, plus qualitative exploration of enabling themes. It was set in two community hospitals, in 2008-19, with a third hospital from 2016, and was triangulated with primary care qualitative data. There was a total of 3363 arthritis patient attendances at 183 clinics during 2008-19. The early arthritis cohort comprised 46 patients, followed monthly until the treatment target was achieved, during 2016-19. Focus groups included 15 arthritis and 11 osteoporosis group attendees. Intervention was a 2 h group consultation, attended monthly for early/active disease and annually for stable disease. Measurements included attendance, DAS, satisfaction and enabling themes. Results: There was a mean number of 18.4 patients per clinic ( n  = 16, 2010-15; n  = 18, 2016; n  = 20, 2017; n  = 23, 2018-19). Forty per cent (1161/2874) of patients with DAS data reached low disease activity (DAS < 3.2) or remission (DAS < 2.6). Forty-six early arthritis patients followed monthly until they achieved remission responded even better: 50% remission; and 89% low disease activity/remission by 6 months. Qualitative analysis derived five main enabling themes (efficiency, empathy, education, engagement and empowerment) and five promotors to translate these themes into practice (prioritization, personalization, participation, personality and pedagogy). Limitations included the prospectively collected observational data and pragmatic design susceptible to bias. Conclusion: Co-designed group consultations can be sustainable, clinically effective and efficient for monthly review of early active disease and annual review of stable disease. Promoting factors may support effective training for chronic disease group consultations

Workplace violence experienced by nursing students: A UK survey

© 2016 Elsevier Ltd. Aims: To appreciate the nature and scope of workplace violence amongst a sample of the UK nursing student population during clinical placement and to recommend strategies universities can implement to successfully manage the impact. Background: Workplace violence is defined as a violent act(s) directed toward workers and can include physical, psychological or verbal behaviour. It is prevalent in nursing and causes victims work-based stress that can affect not only the individual but also the quality of care. Similar negative experiences amongst students can have a direct impact on the development of future professional skills. Design: This study employed a cross-sectional survey design. Questions were uploaded in the format of a commercial internet survey provider (SurveyMonkey.com) and distributed across a sample of nursing schools in the UK. The survey was voluntary and employed a validated tool to assess workplace violence and was based on a similar study in Australia. The number of respondents was 657. This paper reports on the quantitative results. Findings: Nearly half of the students (42.18%) indicated they had experienced bullying/harassment in the past year while on clinical placement. One-third (30.4%) had witnessed bullying/harassment of other students and 19.6% of incidents involved a qualified nurse. The unwanted behaviours made some students consider leaving nursing (19.8%). Some respondents said the standard of patient care (12.3%) and their work with others (25.9%) were negatively affected. Conclusions: Workplace violence can influence nursing students' attitude toward the profession and their level of satisfaction with the work. Whilst it was reassuring to note that the majority of the participants knew where/how to report, only one fifth had actively reported an episode of bullying/harassment. Current students are the nurses and leaders of the future and have a key role in shaping the culture of generations to come. Universities and clinical providers need to work together to reduce the incidence and impact of workplace violence in order to improve the culture of practice

Workplace violence: a qualitative study drawing on the perspectives of UK nursing students

Background: Workplace violence (WV) remains problematic and highly prevalent in healthcare with student nurses being especially vulnerable. Aim: To investigate the impact of WV from the perspectives of nursing students Methods: A qualitative design was employed. 444 nursing students in the UK participated in the study. Findings: The qualitative data was analysed, coded and three main themes have emerged; (1) violence culture in nursing, (2) tolerating violence and (3) the impact of the violence. Discussion: The undesirable truth is each year nearly more than half of the students face WV in environments where such behaviour becomes culturally embedded and passed between generations of nurses. This process of normalization requires intervention that will break this cycle to enable more appropriate workplace behaviours to flourish. Conclusion: The impact of WV can be extremely destructive for the individual, the profession and ultimately patient care with large numbers choosing to leave at a time when there is a national shortage of qualified staff. Key Words: Nursing, nursing students, violence, workplace, workplace violenc

A co-creation approach to strategic enhancement of assessment and feedback in Nursing and Midwifery

This paper reports upon the use of a co-creation methodology to enhance Nursing and Midwifery students' experience of assessment and feedback in the university and on clinical placement. The approach uses an adaption of Experienced Based Co-design (Robert et al 2015) used to improve healthcare service delivery informed by the 'students as partners' literature (e.g. Healey et al 2014) whereby staff and students worked together in facilitated workshops to answer assessment challenges raised in the 2016 NSS and create practical solutions including co-designed module-specific rubrics (marking scheme) and a series of in-class activities specifically aimed at using the rubrics to improve performance