Poor care and the professional duty of the registered nurse

Concerns have been raised in recent years about standards of care in the UK. Notable failures have been identified in the care of vulnerable older adults. This article identifies and discusses some logical steps which might be taken to minimise the risk of individual and systemic care failure in settings for older adults. These steps include frank discussion about ageism to promote empowerment and respect for older people; ensuring robust policies are in place that support and encourage the reporting of poor care; and ensuring that registered practitioners are aware of their accountability for their actions and also their omissions should they witness poor care. In addition to reducing the risk of poor care, these steps could contribute to having a more confident, competent and empowered workforce

Willis and the generic turn in nursing

Over the past months a series of articles in the journal have drawn attention to concerns about aspects of the quality of nursing care in the UK (Paley, 2013; Darbyshire, 2013; Rolfe and Gardner, 2014; Roberts and Ion, 2014). Jackson et al.’s (2014) recent review of the whistleblowing literature indicates that these concerns are more widespread. This view is echoed by Ion et al. (2015) who noted that student nurses from across the world encountered poor practice while on placement. In the UK this has led to a good deal of reflection with some arguing that the problem is a function of chronic under funding of health services and a workforce which is understaffed (Randall and Mckeown, 2014). For others, the issue is tied to the way in which nurses are educated. This is the view taken by Lord Willis whose Shape of Caring report was published in March (Willis, 2015)

I want it all and I want it now. Challenging the traditional nursing academic paradigm

A recent Twitter chat facilitated by the @NurseEducToday socialmedia team provoked a particularly strong reaction among a range of contributors. The focus of the discussion – expectations of the nurse academic – resulted in a high level of engagement from several participants who clearly held strong views, which were surprisingly polarised. Here we explore aspects of this polarization; and what it might mean for nurses working in academia. Our aim is to reflect on what this dialogue might tell us about current thinking in the profession, specifically around how nurse academics see themselves, what they expect from self and others, and what they are prepared to do to meet these,often, self-generated expectations

Nursing and midwifery students' encounters with poor clinical practice:a systematic review

The aim of this paper was to systematically review evidence about nursing and midwifery students’ encounters with poor clinical care.We undertook a systematic review of English language empirical research using multiple databases from inception to April 2016. Hand searching was also undertaken. Included papers contained accounts of empirical research which reported on students’ encounters with poor care. These were quality-assessed, information was extracted into tables, and study results were synthesized using thematic analysis.N=14 papers met inclusion criteria; study quality was moderate to good. Study synthesis revealed four themes: i) encounters with poor practice: students encounter poor practice that is likely to be worthy of professional sanction; ii) while intention to report is high in hypothetical scenarios, this appears not always to translate to actual practice; iii) a range of influencing factors impact the likelihood of reporting; iv) the consequences of encountering and subsequently reporting poor practice appeared to have a lasting effect on students.Research is required to determine the frequency and nature of students' encounters with poor care, when and where they encounter it, how to increase the likelihood that they will report it, and how they can be supported in doing so

Accounting for actions and omissions:a discourse analysis of student nurse accounts of responding to instances of poor care

Aims: To explore how nursing students account for decisions to report or not report poor care witnessed on placement and to examine the implications of findings for educators. Background: Concern has been raised about the extent to which cases of poor care go unreported. Failure to report cases may have serious consequences for patient safety. Design: Semi structured interviews were conducted with 13 under graduate students at a UK university during 2013. They were asked to consider their response to episodes of poor practice witnessed on placement. Methods: Data were transcribed verbatim and categorized according to whether or not students reported concerns. Cases were analysed in accordance with Potter and Wetherall’s version of discourse analysis to identify the discursive strategies used to account for decisions to report or not report poor practice. Results: Participants took care to present themselves in a positive light regardless of whether or not they had reported an episode of concern. Those who had reported tended to attribute their actions to internal factors such as moral strength and a commitment to a professional code. Those who had not or would not report concerns provided accounts which referred to external influences that prevented them from doing so or made reporting pointless. Conclusion: This study provides information about how students account for their actions and omissions in relation to the reporting of poor care. Findings suggest ways educators might increase reporting of concerns

Factors influencing student nurse decisions to report poor practice witnessed while on placement

Background: While it is commonly accepted that nursing care is generally of a good standard, it would be naïve to think that this is always the case. Over recent years concern about aspects of the quality of some nursing care has grown. In tandem with this, there is recognition that nurses do not always report poor practice. As future registrants, student nurses have a role to play in changing this culture. We know, however, relatively little about the factors that influence student decisions on whether or not to report. In the absence of a more nuanced understanding of this issue, we run the risk of assuming students will speak out simply because we say they should. Objectives: To explore influences on student decisions about whether or not to report poor clinical practice which is a result of deliberate action and which is witnessed while on placement. Methods: Qualitative interviews were conducted with thirteen pre-registration nursing students from the UK. Participants included both adult and mental health nurses with an age range from 20–47. Data were analysed to identify key themes. Category integrity and fit with data was confirmed by a team member following initial analysis. Results: Four themes emerged from the data. The first of these, ‘I had no choice’ described the personal and ethical drivers which influenced students to report. ‘Consequences for self’ and ‘Living with ambiguity’ provide an account of why some students struggle to report, while ‘Being prepared’ summarised arguments both for and against reporting concerns. Conclusion: While there is a drive to promote openness in health care settings and an expectation that staff will raise concerns about quality of care, the reality is that the decision to do this can be very difficult. This is certainly the case for some student nurses. Our results suggest ways in which educationalists might intervene to support students who witness poor practice to report

The Individual Recovery Outcomes Counter:preliminary validation of a personal recovery measure

Aims and methodThe Individual Recovery Outcomes Counter (I.ROC) is to date the only recovery outcomes instrument developed in Scotland. This paper describes the steps taken to initially assess its validity and reliability, including factorial analysis, internal consistency and a correlation benchmarking analysis.ResultsThe I.ROC tool showed high internal consistency. Exploratory factor analysis indicated a two-factor structure comprising intrapersonal recovery (factor 1) and interpersonal recovery (factor 2), explaining between them over 50% of the variance in I.ROC scores. There were no redundant items and all loaded on at least one of the factors. The I.ROC significantly correlated with widely used existing instruments assessing both personal recovery and clinical outcomes.Clinical implicationsI.ROC is a valid and reliable measure of recovery in mental health, preferred by service users when compared with well-established instruments. It could be used in clinical settings to map individual recovery, providing feedback for service users and helping to assess service outcomes.</p

Factor validation and Rasch analysis of the individual recovery outcomes counter

Objective: The Individual Recovery Outcomes Counter is a 12-item personal recovery self assessment tool for adults with mental health problems. Although widely used across Scotland, limited research into its psychometric properties has been conducted. We tested its' measurement properties to ascertain the suitability of the tool for continued use in its present form.Materials and methods: Anonymised data from the assessments of 1,743 adults using mental health services in Scotland were subject to tests based on principles of Rasch measurement theory, principal components analysis and confirmatory factor analysis.Results: Rasch analysis revealed that the 6-point response structure of the Individual Recovery Outcomes Counter was problematic. Re-scoring on a 4-point scale revealed well ordered items that measure a single, recovery-related construct, and has acceptable fit statistics. Confirmatory factor analysis supported this. Scale items covered around 75% of the recovery continuum; those individuals least far along the continuum were least well addressed.Conclusions: A modified tool worked well for many, but not all, service users. The study suggests specific developments are required if the Individual Recovery Outcomes Counter is to maximise its' utility for service users and provide meaningful data for service providers.*Implications for Rehabilitation*Agencies and services working with people with mental health problems aim to help them with their recovery.*The individual recovery outcomes counter has been developed and is used widely in Scotland to help service users track their progress to recovery.*Using a large sample of routinely collected data we have demonstrated that a number of modifications are needed if the tool is to adequately measure recovery.*This will involve consideration of the scoring system, item content and inclusion, and theoretical basis of the tool

Mental health nurses’ attitudes, experience, and knowledge regarding routine physical healthcare:systematic, integrative review of studies involving 7,549 nurses working in mental health settings

Background: There has been a recent growth in research addressing mental health nurses’ routine physical healthcare knowledge and attitudes. We aimed to systematically review the empirical evidence about i) mental health nurses’ knowledge, attitudes, and experiences of physical healthcare for mental health patients, and ii) the effectiveness of any interventions to improve these aspects of their work.Methods: Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple electronic databases were searched using comprehensive terms. Inclusion criteria: English language papers recounting empirical studies about: i) mental health nurses’ routine physical healthcare-related knowledge, skills, experience, attitudes, or training needs; and ii) the effectiveness of interventions to improve any outcome related to mental health nurses' delivery of routine physical health care for mental health patients. Effect sizes from intervention studies were extracted or calculated where there was sufficient information. An integrative, narrative synthesis of study findings was conducted.Results: Fifty-one papers covering studies from 41 unique samples including 7,549 mental health nurses in 14 countries met inclusion criteria. Forty-two (82.4%) papers were published since 2010. Eleven were intervention studies; 40 were cross-sectional. Observational and qualitative studies were generally of good quality and establish a baseline picture of the issue. Intervention studies were prone to bias due to lack of randomisation and control groups but produced some large effect sizes for targeted education innovations. Comparisons of international data from studies using the Physical Health Attitudes Scale for Mental Health Nursing revealed differences across the world which may have implications for different models of student nurse preparation.Conclusions: Mental health nurses' ability and increasing enthusiasm for routine physical healthcare has been highlighted in recent years. Contemporary literature provides a base for future research which must now concentrate on determining the effectiveness of nurse preparation for providing physical health care for people with mental disorder, determining the appropriate content for such preparation, and evaluating the effectiveness both in terms of nurse and patient- related outcomes. At the same time, developments are needed which are congruent with the needs and wants of patients