‘I feel like a salesperson’: the effect of multiple-source care funding on the experiences and views of nursing home nurses in England

The difficulties faced in the recruitment and retention of nursing staff in nursing homes for older people are an international challenge. It is therefore essential that the causes of nurses' reluctance to work in these settings are determined. This paper considers the influence that multiple-source care funding issues have on nursing home nurses' experiences and views regarding the practice and appeal of the role. The methodology for this study was hermeneutic phenomenology. Thirteen nurses from seven nursing homes in the North East of England were interviewed in a sequence of up to five interviews and data were analysed using a literary analysis method. Findings indicate that participants are uncomfortable with the business aspects that funding issues bring to their role. The primary difficulties faced are: tensions between care issues and funding issues; challenges associated with 'selling beds'; and coping with self-funding residents' changing expectations of care. The findings of the study suggest that multiple-source care funding systems that operate in nursing homes for older people pose challenges to nursing home nurses. Some of these challenges may impact on their recruitment and retention

Transformational leadership can improve workforce competencies.

Staffing problems can arise because of poor delegation skills or a failure by leaders to respond appropriately to economic factors and patient demographics. Training dilemmas, meanwhile, can arise because of managers' confusion about what constitutes 'training' and what constitutes 'education', and where responsibility of provision lies, with the consequence that they neglect these activities. This article uses Kouzes and Posner's (2009) transformational leadership model to show how managers can respond. Leaders who challenge budgets, consider new ways of working and engage effectively with the workforce can improve productivity and care, while those who invest in appropriate learning will have a highly trained workforce. The author explains how integration of leadership roles and management functions can lead to innovative problem solving

Care home staff's experiences and views of supporting the dietary management and choices of older residents with obesity

BackgroundRising numbers of older people with obesity living in care homes is an international phenomenon. Addressing dietary management of residents with obesity is a cause of debate and controversy. On one hand, the ‘obesity paradox’ suggests obesity protects against morbidity in frail older people. On the other hand, obesity reduces functional status and restricts activity for this group. This paper considers care home staff’s experience and views of supporting dietary management and choice for residents with obesity within the context of this controversy. DesignIn this qualitative study, 33 staff from seven care homes in the North East of England participated in focus groups, and data were analysed using Braun and Clarkes’s (2006) six phase thematic analysis approach. FindingsFindings indicate that participants’ support of dietary management and choice for residents with obesity may be strongly influenced by the care home environment. Care priorities, dietary management approaches, care home life, and family involvement in residents’ dietary intake facilitate and encourage weight gain, and as such, pose challenges for staff attempting to support weight management of residents with obesity.ConclusionFindings suggest that in the care home setting, nutrition policy, guidelines and service commissioning processes, and staff nutrition education, should include management of obesity. Furthermore, families should be supported to understand the implications of their own caring behaviours on residents’ nutritional status

An exploration of the role and status of nurses working in nursing homes for older people: a hermeneutic phenomenological study

Older people residing in nursing homes have complex needs requiring the input of nurses skilled in managing multi-morbidities and psychosocial issues. However, in England, nursing homes have proven to be unappealing work settings for potential staff, while nurses who do work in these settings are often afforded low status. Such contradictions pervade current understanding of the nature of work in nursing homes. To-date, few studies have investigated the views and experiences of nursing home nurses themselves regarding the contradictions that arise from role and status issues. This study explores English nursing home nurses’ views regarding status and role. The aims of the study were constructed as follows: To explore the experiences and views of nursing home nurses working with older people regarding their status and role. -To generate an understanding of how and why these experiences and views occur. -To explore whether emerging insights regarding nursing home nursing can inform workforce development processes. The methodology utilised was hermeneutic phenomenology, based upon the philosophies of Gadamer and Iser. Thirteen nurses from seven nursing homes were each interviewed five times using an episodic interview technique. Data analysis methods were adapted from Van Manen’s hermeneutic phenomenological approach, and Iser’s literary reception theory methods. Four categories emerged from the data - nursing ‘residents’ rather than ‘patients’, business role, stigma, and isolation and exclusion. From these categories, three themes were ascertained - uncertainty about role identity, unpreparedness for the demands of the role, and low occupational status. Participants feel uncertain, unprepared and stigmatised because they are positioned at the intersection of health and social care – a location where health and social care funding issues cross, and healthcare and social care work overlaps. Understanding generated from this study can inform workforce development processes

Whole systems approach: Advanced Clinical Practitioner development and identity in primary care

Purpose: The purpose of this paper is to ascertain primary care Advanced Clinical Practitioners’ (ACP) perceptions and experiences of what factors influence the development and identity of ACP roles, and how development of ACP roles that align with Health Education England’s capability framework for advanced clinical practice can be facilitated in primary care. Design/methodology/approach: The study was located in the North of England. A qualitative approach was used in which 22 staff working in primary care who perceived themselves to be working as ACPs were interviewed. Data analysis was guided by Braun and Clarke’s (2006) six phase method. Findings: Five themes emerged from the data – the need for: a standardised role definition and inclusive localised registration; access to/availability of quality accredited educational programmes relevant to primary care and professional development opportunities at the appropriate level; access to/availability of support and supervision for ACPs and trainee ACPs; a supportive organisational infrastructure and culture; and a clear career pathway. Originality/value: Findings have led to the generation of the Whole System Workforce Framework of INfluencing FACTors (IN FACT), which lays out the issues that need to be addressed if ACP capability is to be maximised in primary care. This paper offers suggestions about how IN FACT can be addressed

Older people’s views and experiences of engagement in standardised patient simulation

Background - The last two decades have witnessed initiatives aimed at improving the care of older people, including educating nurses so that they are equipped with the skills to care for older people with frailty and complex multimorbidities. It has been suggested that involvement of older service-users in nurse education can facilitate the development of nurses’ caring skills by promoting understanding of the reality of older people’s situations. One method of involving older service-users is standardised patient simulation. While some recent studies have acknowledged the importance of considering standardised patients’ experiences and perceptions of simulation, to-date few have focused specifically on the experiences of older people. Methods - In this qualitative study, data was collected via focus groups whereby older people were invited to discuss their views and experiences of involvement in SPS. Data were analysed using open coding. Findings - Four themes emerged from the data, demonstrating that involving older people in SPS may be beneficial for their wellbeing. The four themes were: ‘using personal experiences to improve care’, ‘having a sense of purpose’, ‘preparation and support for SPS’, and ‘feeling appreciated’. Discussion - Whilst most participants reported that they enjoyed the SPS activities, engagement appeared to have had a much deeper significance for them. Many participants’ responses suggested that involvement assisted them to ‘make sense’ of their experiences of illness and healthcare, and also gave a sense of purpose, of belonging and of being valued. Conclusion - Findings support the need for nurse educators to consider developing SPS programmes that involve older people

Hydration practices in residential and nursing care homes for older people

Aim: To scope and explore hydration practices in care homes. Background: Older residents do not regularly consume adequate fluids to support health. Achieving this is difficult with residents who have coexisting health, sensory and functional problems, as well as challenging hydration habits. Design: This project used a sequential exploratory mixed method design to scope and explore existing hydration practices. Methods: Data were collected via two stages. First was a survey of hydration practices. Twenty-nine responses were received from 81 care homes (response rate: 35.8%). Second was the exploration of practitioners' experiences and perceptions of hydration practice via semi-structured interviews (54 staff: 43 interviews). Descriptive statistics summarised the survey findings. Open coding and thematic analysis were applied to the qualitative data, and details of the methods are reported in adherence to COREQ criteria. Results: It is important to provide hydration support in addition to regularly offering drinks to residents. Hydration practices include the following: use of social interaction to encourage drinking; verbal and nonverbal prompts to drink; giving fluids with routine practices and social activities; providing drinks-related activity, use of aids and equipment to support drinking; and creating a drink-friendly environment. Practices are implemented in care homes; however, no one care home implements all these hydration strategies at any one time. Conclusions: Older care home residents need support and encouragement to drink adequate fluids which can be difficult to achieve with residents who have complex needs and challenging drinking habits. In addition to the routine offer of drinks, hydration support should be used to facilitate residents to drink sufficient amounts of fluid. Relevance to clinical practice: Staff working in care homes have an important role in assessing the hydration needs of residents and using multiple hydration practices to support residents to achieve their hydration requirements

Treating Central Catheter–Associated Bacteremia Due to Methicillin-Resistant Staphylococcus aureus: Beyond Vancomycin

Methicillin-resistant Staphylococcus aureus is a frequent cause of hospital-associated infections, including central catheter-associated bacteremia. Vancomycin has been the drug of choice for treating this type of bacteremia for decades in patients who have no contraindications to the antibiotic. However, resistance to vancomycin is an emerging problem. Newer antibiotics approved by the Food and Drug Administration have activity against methicillin-resistant S aureus Some of the antibiotics also have activity against strains of S aureus that are intermediately susceptible or resistant to vancomycin. This article uses a case study to highlight the clinical signs of vancomycin failure and describes the indications for and appropriate use of alternative antimicrobials such as ceftaroline, daptomycin, linezolid, tigecycline, and telavancin. (Critical Care Nurse 2016;36[4]:46-57)

An exploration of the challenges of providing person-centred care for older care home residents with obesity

The aim of this study was to explore care home staff's views on the prevalence of obesity in older people and how well prepared they were for any rise in applications for placements. Thematic analysis was used to analyse focus group interview data collected from seven care homes/33 participants in N.E. England. Findings revealed rises in demand by older people with obesity for care home admittance, consistent with rising prevalence of obesity in this demographic nationally. Findings also highlight implications of rising prevalence of obesity in older people, particularly care home staff's ability to deliver person-centred care (PCC) and the importance of appropriate support/recognition of this as an emergent issue to be addressed at a higher executive level and by health/social care authorities. Ways of ensuring PCC are discussed. Given continuing trends towards rising prevalence of obesity in this population, the findings possess broader translational potential

Scoping the application of primary care advanced clinical practice roles in England

Purpose: This study aims to scope the profile and application of an advanced clinical practitioner (ACP) roles in primary care in the North of England and how these roles meet the requirements of Health Education England's (HEE’s) ACP workforce capability framework. Design/methodology/approach: A two-stage design was used. Stage 1 analysed health and social care workforce intelligence reports to inform scoping of numbers of ACPs working in primary care. Stage 2 used two surveys. Survey 1 targeted ACP leads and collected strategic-level data about ACP application. Survey 2 targeted staff who perceived themselves to be working as ACPs. Survey 2 was in three parts. Part 1 collected demographic data. Part 2 required participants to record their perceived competence against each of the HEE ACP framework capability criteria. Part 3 required respondents to identify facilitators and barriers to ACP practice. Findings: Despite the introduction of HEE's ACP capability framework, there is inconsistency and confusion about the ACP role. The results indicated a need for standardisation of role definition and educational and practice requirements. The results also suggested that some ACPs are not working to their full potential, while some staff who are employed as “gap-fillers” to provide routine clinical services perceive themselves as ACPs despite not working at the ACP level. Originality/value: Although previous research has explored the application of ACP practice in primary care, few studies have considered ACP application in the light of the introduction of workforce capability frameworks aimed at standardising ACP practice