An Evaluation of the Return to Practice Programme (Nursing) at City University of London (2017-2018)

In response to concerns over a predicted chronic nursing shortage recent focus has been placed on Return to Practice (RTP) programmes, which aim to increase the nursing workforce by enabling former nurses to return to the profession. In order to encourage former nurses to return to practice, it is important to understand the motivations, expectations and experiences of current returnees by evaluating RTP programmes. Aims: To evaluate the RTP programme by exploring the views and experiences of returnees to nursing, and of the nursing staff who support them. Methods: This was a mixed methods study: an electronic survey of all students currently or recently on the RTP programme at City, University of London; and interviews with a range of stakeholders, including returnees, mentors and senior managers, at North East London Foundation Trust (NELFT). Descriptive statistics were used to summarise quantitative responses to the survey and Framework method was employed to analyse qualitative data. Results: Seventy-four responses to the survey were received; eight interviews were carried out with returnees, and five with NELFT staff. Overall, data suggests that the programme has been very successful: most views were positive, many were very positive. Though returnees found the course fairly challenging, they also found it largely fit for purpose. There were many useful suggestions about how to improve and promote the programme. There were also some reservations about the organisation of placements and of mentorship arrangements, the latter largely due to the difficulty of arranging for time for returnees and their mentors to work together. Recommendations: RTP programmes should be continued and if possible expanded. Wider advertising, ideally involving successful RTP returnees, should be used to attract more recruits, and funding for returnees should be maintained or increased. Higher Education Institutions (HEIs) should offer support to enable RTP nurses to return to study and to achieve their academic objectives as smoothly as possible. This may include responding to the individual learning needs of RTP nurses and allowing flexibility for students who need longer for private study. National Health Service (NHS) Trusts/Boards should ensure that Human Resource (HR) departments are willing and able to deal quickly with arrangements for employed RTP students. Processes for arranging placements should include realistic timetables for Disclosure and Barring Service (DBS) checks to be carried out. NHS providers should consider the suggestion that returnees can arrange their own placements if they wish. NHS providers should make even greater efforts to ensure that front-line staff understand the position of RTP nursing students, what they can expect from them and what their responsibilities to them are. Recent RTP graduates should be encouraged and enabled to support future RTP students. As champions of the programme, they should support the Trust in clarifying to existing staff what RTP students need and can be permitted to do

Improving the oral health of older people in care homes (TOPIC): a protocol for a feasibility study

BACKGROUND: Evidence for interventions promoting oral health amongst care home residents is weak. The National Institute for Health and Care Excellence (NICE) guideline NG48 aims to maintain and improve the oral health of care home residents. A co-design process that worked with residents and care home staff to understand how the NG48 guideline could be best implemented in practice has been undertaken to refine a complex intervention. The aim of this study is to assess the feasibility of the intervention to inform a future larger scale definitive trial. METHODS: This is a protocol for a pragmatic cluster randomised controlled trial with a 12-month follow-up that will be undertaken in 12 care homes across two sites (six in London, six in Northern Ireland). Care homes randomised to the intervention arm (n = 6) will receive the complex intervention based on the NG48 guideline, whilst care homes randomised to the control arm (n = 6) will continue with routine practice. The intervention will include a training package for care home staff to promote knowledge and skills in oral health promotion, the use of the Oral Health Assessment Tool on residents by trained care home staff, and a 'support worker assisted' daily tooth-brushing regime with toothpaste containing 1500 ppm fluoride. An average of ten residents, aged 65 years or over who have at least one natural tooth, will be recruited in each care home resulting in a recruited sample of 120 participants. Assessments will be undertaken at baseline, 6 months and 12 months, and will include a dental examination and questionnaires on general health and oral health administered by a research assistant. A parallel process evaluation involving semi-structured interviews will be undertaken to explore how the intervention could be embedded in standard practice. Rates of recruitment and retention, and intervention fidelity will also be recorded. A cost-consequence model will determine the relevance of different outcome measures in the decision-making context. DISCUSSION: The study will provide valuable information for trialists, policymakers, clinicians and care home staff on the feasibility and associated costs of oral health promotion in UK care homes. TRIAL REGISTRATION: ISRCTN10276613. Registered on 17th April 2020. http://www.isrctn.com/ISRCTN10276613

Putting Guidelines into Practice: Using Co-design to Develop a Complex Intervention Based on NG48 to Enable Care Staff to Provide Daily Oral Care to Older People Living in Care Homes

Objectives: 1) Explore the challenges of providing daily oral care in care homes; 2) Understand oral care practices provided by care home staff; 3) Co-design practical resources supporting care home staff in these activities. Methods: Three Sheffield care homes were identified via the ‘ENRICH Research Ready Care Home Network’ and three to six staff per site were recruited as co-design partners. Design researchers led three co-design workshops exploring care home staff’s experiences of providing daily oral care, including challenges, coping strategies and the role of current guidelines. New resources were prototyped to support the use of guidelines in practice. The design researchers developed final resources to enable the use of these guidelines in-practice-in-context. Findings: Care home staff operate under time and resource constraints. The proportion of residents with dementia and other neurodegenerative conditions is rapidly increasing. Care home staff face challenges when residents adopt ‘refusal behaviours’ and balancing daily oral care needs with resident and carer safety becomes complex. Care home staff have developed many coping strategies to navigate ‘refusal behaviours’. Supporting resources need to ‘fit’ within the complexities of practice-in-context. Conclusions: The provision of daily oral care practices in care homes is complex and challenging. The co-design process revealed care home staff have a ‘library’ of context-specific practical knowledge and coping strategies. This study offers insights into the process of making guidelines usable for professionals in their contexts of practice, exploring the agenda of implementing evidence-based guidelines

Developing and testing a principle-based fidelity index for peer support in mental health services

Purpose Evidence suggests that the distinctive relational qualities of peer support—compared to clinical-patient relationships—can be eroded in regulated healthcare environments. Measurement of fidelity in trials of peer support is lacking. This paper reports the development and testing of a fidelity index for one-to-one peer support in mental health services, designed to assess fidelity to principles that characterise the distinctiveness of peer support. Methods A draft index was developed using expert panels of service user researchers and people doing peer support, informed by an evidence-based, peer support principles framework. Two rounds of testing took place in 24 mental health services providing peer support in a range of settings. Fidelity was assessed through interviews with peer workers, their supervisors and people receiving peer support. Responses were tested for spread and internal consistency, independently double rated for inter-rater reliability, with feedback from interviewees and service user researchers used to refine the index. Results A fidelity index for one-to-one peer support in mental health services was produced with good psychometric properties. Fidelity is assessed in four principle-based domains; building trusting relationships based on shared lived experience; reciprocity and mutuality; leadership, choice and control; building strengths and making connections to community. Conclusions The index offers potential to improve the evidence base for peer support in mental health services, enabling future trials to assess fidelity of interventions to peer support principles, and service providers a means of ensuring that peer support retains its distinctive qualities as it is introduced into mental health services