A Gadamerian hermeneutic study of nurses' experiences of recognising and managing patients with clinical deterioration and critical illness in a NHS trust in Wales.

Aim: To interpret nurses' experiences of caring for patients with clinical deterioration and critical illness in a Welsh NHS Trust. Methodology: A Gadamerian hermeneutic study drawing on eight in-depth interviews using a purposive sampling technique of nurses who had experienced caring for patients with clinical deterioration. Data collection occurred during 2004. Other data sources included the historical context and the researcher's preunderstandings of the phenomena: clinical deterioration; suboptimal care and critical illness. Data were analysed using a dialogical approach and guided by conditions necessary for Gadamerian hermeneutic interpretation. Findings: The interpretation revealed that recognition of clinical deterioration included general and focused perception of triggers. These included; vigilance in the observation and scanning of patients; perception of clinical deterioration informed by historical and experiential awareness of triggers; and the use of selective combinations of historical, behavioural, interpersonal and physiological triggers. Response to clinical deterioration was influenced by the professional knowledge and confidence of the nurse, organisational culture, workload balance and skill mix. A model of professional gaze emerged that involved a circle of scanning, focused observation, waiting and balancing conditions for an effective response. Conclusions: What is known is that junior medical and nursing staff lack the knowledge, skills and support network required to recognise and respond effectively to patient clinical deterioration in acute hospital settings. The evidence base to support the clinical effectiveness of national guidelines, produced in 2007, for recognising and responding to physiological evidence of clinical deterioration was inconclusive at the time of this study. What this research adds is a model of professional gaze that highlights the complex and professional clinical decision making process involved in nurses' recognition and response to triggers in patient clinical deterioration. This process begins before physiological changes occur and the model provides a structure for recognising clinical concern that can be applied and tested in clinical settings. The model also highlights nurses' strategies for facilitating effective management of these patients

Evaluation of a multidisciplinary adult integrated respiratory service in the UK.

Rationale, aims and objectives: Care integration, particularly for patients with long-term chronic conditions has been viewed as a key imperative for service improvement over the last decade [1]. In common with other industrialised nations, major care providers such as the National Health Service (NHS) in the United Kingdom (UK) have undertaken service evaluation to identify factors for effective integrated care in the context of increasing demand but also cost-constraints. The aim of this paper is to report on an early process evaluation of a newly established Adult Integrated Respiratory Service (AIRS) in three localities in England. Method: Applied qualitative methods using semi-structured interviews with clinical practitioners (n=19) plus focus group with service users (n=5). University research ethics approval was secured. Findings: Despite finding staff commitment and enthusiasm for a new regional approach, as well as a very positive acclaim from service users, the study highlighted personal and organisational issues and concerns during the first four months of service implementation. The analysis revealed four inter-related themes: service in transition; resistance to change; communication; and challenges to integrated working. The findings support conceptual and organisational elements of integrated care described elsewhere [2, 3]. The role of leadership and change management in the successful implementation of integrated care is explored. Conclusions: The findings from a regional adult integrated respiratory service evaluation in England highlights the potential of collective leadership with authentic involvement of all stakeholders to effect successful change to build locally owned models for integrated care. Further longitudinal research would yield valuable insights as the service evolves

Dorset Adult Integrated Care Service (DAIRS): Service Evalaution

EXECUTIVE SUMMARY This early process evaluation of the newly established Dorset Adult Integrated Respiratory Service (DAIRS) in three localities in Dorset was conducted by Bournemouth University using a mixed-methods approach. Our evaluation showed staff commitment and enthusiasm for a pan-Dorset approach to respiratory care and a very positive acclaim from service users. Mindful of the fact that DAIRS had been in operation for four months only, the evaluation flags up strengths and issues of concern at the initial stages of service implementation. Discussion of the findings has been linked with current thinking to emerge in the White Paper from NHS Improving Quality around service improvement and change management (Bevan & Fairman, 2014). Given that DAIRS has been commissioned in the first instance for a period of two years, this early evaluation will be valuable for stakeholders to address the issues raised in a timely manner. Recommendations 1. Build upon the high levels of satisfaction to engage service user users more widely in the on-going development of DAIRS. 2. Shared documentation needs to be agreed and implemented as soon as possible, including the DAIRS card. 3. DAIRS should be officially launched with appropriate information for different stakeholders: service users, community staff and non-DAIRS hospital staff. 4. The change process should be actively managed; concerns and challenges expressed by participants should be acknowledged and a supportive environment provided for collaborative problem-solving. 5. Consider selection and use of grass roots ‘change champions’ across the sites and disciplines to facilitate a more inclusive model of organisational change. 6. Further integration between localities should be explored particularly around staff education, as well as to facilitate on-going peer support. 7. New staff would benefit from being supernumerary for their first month and visiting neighbouring DAIRS localities. 8. Inclusion and exclusion criteria need to be revisited to ensure a shared understanding amongst DAIRS staff, particularly around co-morbidities. 9. Information and service provision concerning emotional support for service users and carers needs to be reviewed. 10. The current Single Point of Access System (SPOA) should be reviewed to improve compliance. 11. Information Technology (IT) systems and possibilities for joint DAIRS systems should be explored. 12. Perceived financial inequities need to be addressed in service planning. 13. Our evaluation provides a base-line for future work, a further more comprehensive evaluation after two years of DAIRS operation is needed to inform future funding and service development. Suggested factors to include: • Outcome data • Cross-locality service user involvement (avoiding winter peak time), using systematic PREM questionnaire distribution processes. • Community staff perspectives. • Input from related respiratory services, currently not part of DAIRS. • Investigation of impact of a differing skill mix across localities. • More detailed service user feedback. • Evaluation of staff education (DAIRS and non-DAIRS)

The history of disaster nursing: from Nightingale to nursing in the 21st century

Background: Nurses have a rich history in performing their duty both domestically and internationally in response to a disaster. Comprising the largest proportion of the healthcare workforce, nurses possess a unique opportunity to inform disaster planning and management. With the ongoing threat from COVID-19 and continuing conflict, humanitarian aid needs, epidemics and natural disasters; the capacity of nurses to continue to respond in times of global need is unparalleled. Aims: The aim of this paper is to explore the developments in the field of disaster nursing. Mapping key changes in policy, practice and outcomes. Methods: A qualitative interpretive historical review was conducted to examine core developments in the history of disaster nursing, examining key organisations (e.g. World Health Organization, International Council of Nurses), national and international policies and historical accounts. Results: 29 articles were analysed, and politics, strategic perspectives and nursing identity (‘sense of duty’ and roles) emerged from the literature. The influence of professionalisation and public health/health promotion emerged next. A total of 10 articles refer to disaster nursing specifically, of which 4 of these are reports/policy. Conclusions: Nurses have spent centuries building the trust and legitimacy of the profession. Disaster nursing goes beyond the expectations of a registered nurse. The responsibilities of a disaster nurse encompass wider community health promotion, critical decision-making beyond the individual patient, resilience and ethical challenges. Whilst significant advancements have emerged in the last 30 years, further research, and representation of the profession at a strategic and political level could enhance the effectiveness of nurses’ roles in the 4 phases of disaster response: mitigation, preparation, response and recovery

An evaluation of the progress made towards the implementation of treatment summaries for cancer patients across Wessex

This report details an evaluation of the implementation of treatment summaries for cancer patients across the Wessex Deanery, encompassing Hampshire, Dorset and the Isle of Wight. The service evaluation commenced at the end of September 2015 and this report presents the progress made towards the implementation of cancer treatment summaries (CT) across the Wessex Deanery and service users’ experiences of receiving the TSs from two NHS Trusts in the catchment area. The survey results present the progress that has been made in the first six months of implementation and include descriptive data relating to the progress and process of implementation. The qualitative findings from an analysis of service user experience are presented and the findings from the evaluation are discussed in the context of national policy and the wider literature

The creation of a virtual locality placement enabled student nurses to achieve practice hours during the pandemic

To creation of a virtual locality placement during the pandemic created the opportunity for students to gain an understanding of the challenges that face individuals, families and groups in their achievement of health and well-being while living in the Covid-19 pandemic. A variety of concepts gained by students were identified from student feedback, as well as how to move forward - dissemination to other HEI's, inclusivity, inter-professional learning and creativit

The Delphi of ORACLE: An Expert Consensus Survey for the Development of the Observational Risk Assessment of Contractures (Longitudinal Evaluation)

Objective: Despite rising prevalence rates, no standard tool is available to identify individuals at risk of developing contractures. This study aimed to gain expert consensus on items for the development of the Observational Risk Assessment Tool for Contractures: Longitudinal Evaluation (ORACLE) for care home residents. Design: A two-round, online modified Delphi study. Participants: Panellists were qualified healthcare professionals with a background in physiotherapy, occupational therapy, nursing, and rehabilitation medicine. Main outcome measures: In the first round, the experts were asked to rate the predesigned list of items on a Likert scale while in the second round, consensus was sought in the areas of disagreement identified in the previous round. Results: The two rounds of the Delphi survey included 30 and 25 panellists, respectively. The average clinical and academic experience of the panellists was 22.2 years and 10.5 years, respectively. The panel demonstrated a high level of consensus regarding the clinical factors (10 out of 15 items); preventive care approaches (9 out of 10 items), and contextual factors (12 out of 13 items) ranging from 70% to 100%. Conclusion: This Delphi study determined expert consensus on items to be included in a contracture risk assessment tool (ORACLE). The items were related to factors associated with joint contractures, appropriate preventive care interventions, and potentially relevant contextual factors associated with care home settings. The promise of a risk assessment tool that includes these items has the capacity to reduce the risk of contracture development or progression and to trigger timely and appropriate referrals to help prevent further loss of function and independence

Factors associated with joint contractures in adults: a systematic review with narrative synthesis.

Purpose: The primary objective of the review was to collate the available evidence on factors associated with joint contractures in adults. Methods: A systematic literature search was conducted on MEDLINE, CINAHL, AMED, and EMBASE. Studies that involved participants aged ≥18 and assessed joint contracture as a primary or secondary outcome were included. Two independent reviewers screened studies against the eligibility criteria, performed data extraction, and assessed the quality of evidence. A narrative synthesis by domain and sub-domain was undertaken. The protocol was registered on PROSPERO: CRD42019145079. Results: Forty-seven studies were included in the review. Identified factors were broadly classified into three major domains: sociodemographic factors, physical factors, and proxies for bed confinement. Sociodemographic factors were not associated with joint contractures. Functional ability, pain, muscle weakness, physical mobility, and bed confinement provided the most consistent evidence of association with joint contractures. The evidence regarding the relationship between spasticity and joint contractures remains unclear. Other factors might be important, but there was insufficient evidence to make inferences. Conclusions: The review identified and collated evidence on factors associated with joint contractures, which can be utilised to develop effective prevention and management strategies