Contemporary challenges of nursing CPD: Time to change the model to meet citizens’ needs

The purpose of this paper is to present the evidence shared with a citizen consensus panel detailing key issues associated with how nursing CPD can best influence the quality of health and social care experienced by citizens and communities. It presents a summary of contemporary theory, research and evidence of the effectiveness of nursing CPD and outlines four key challenges: (i) how to strengthen the focus on patient experience as the starting point for CPD; (ii) the lack of evidence of CPD effectiveness and accountability in its transfer to practice; (iii) evaluation of CPD effectiveness; and (iv) involving citizens in targeting CPD where it is most needed. It briefly describes the methods used to facilitate public consultation through a citizen consensus panel as part of a collaborative project with the RCN Strategic Research Alliance in 2020 and outlines 7 themes identified as important by the public for future development. The main challenge for nursing is capitalizing on the workplace as a learning resource that can integrate learning with development, improvement, knowledge translation, inquiry and innovation. This requires skilled facilitators, particularly at meso- levels, and systems leaders with the full skillset to develop system-wide cultures of learning that enable everyone to flourish and create good places to work. The paper concludes that the development of CPD process measures would indicate how CPD investment contributes to person-centred, safe and effective care and system transformation and enable commissioners and education providers to optimize CPD’s full potential

Carbonisation of biomass-derived chars and the thermal reduction of a graphene oxide sample studied using Raman spectroscopy

Chars and carbonised chars were produced from three different oxygen-rich precursors (Pinus radiata wood, Phormium tenax leaf fibres, and sucrose crystals). These non-graphitisable carbons were analysed with Raman spectroscopy in order to study the nanostructural development which occurs with increasingly severe heat treatments up to approximately 1000 °C. The thermal reduction of a graphene oxide sample was similarly studied, as this is considered to involve the development of nanometre-scale graphene-like domains within a different oxygen-rich precursor. Increasing the heat treatment temperatures used in the charring and carbonisation processes, led to significant changes in a number of parameters measured in the Raman spectra. Correlations based on these parameter changes could have future applications in evaluating various char samples and estimating the heat treatment temperatures employed during their manufacture. After production heat treatment temperatures exceeded 700 °C, the Raman spectra of the carbonised chars appeared to be largely precursor independent. The spectra of these carbonised chars were similar to the spectra obtained from thermally-reduced graphene oxides, especially when compared to a wide range of other carbonaceous materials analysed using this particular methodology. Partial reduction of a graphene oxide sample due to reasonably mild laser exposures during Raman analysis was also observed

Studying carbonisation with raman spectroscopy

Raman spectroscopy can provide fast and non-destructive analysis of carbonaceous materials. As it is able to detect nanometre-sized structural features, Raman spectroscopy is widely used in the study of carbon nanotubes, fullerenes, graphenes, and many other carbon-rich materials. Raman analysis has previously shown potential for estimating the heat treatment temperatures (HTT) employed in the preparation of Japanese cedar charcoals which suggested future usefulness in quality control . In the current work, Raman spectroscopy was used to investigate the nanostructural development which had occurred within various chars prepared and carbonised at a range of heat treatment temperatures between ≈ 340°C and 1000°C. Chars were produced from sucrose sugar as standard precursor of high purity and two sources of biomass common in New Zealand (Radiata pine wood and Harakeke leaf fibres). In chars produced at lower HTTs, signals could be detected which were interpreted as representing hydrogen-rich amorphous carbon structures. In contrast, the Raman spectra of well-carbonised chars produced at higher HTTs featured signals consistent with graphene-like structures with coherent domains limited in size to below a few nanometres across. Measurement of such signals provides the ability to evaluate the extent of nanostructural development, identify char samples which are ‘undercooked’ when compared to other char samples, and estimate effective HTTs used in the production of a given char sample. More detailed Raman analysis of Radiata-derived chars was carried out, including analysis of chars produced from carbonising pyrolysis tars. Results of Raman analysis were correlated to H/C atom ratios obtained through elemental analysis for these chars produced from Radiata pine

Exitus: Agent-based Evacuation Simulation for Individuals with Disabilities in a Densely Populated Sports Arena

In this paper we present an agent-based evacuation model which may be used to support private sector organizations withcapabilities-based planning efforts surrounding likely terrorist attack scenarios. The model is distinguished by its explicitconsideration of individuals with disabilities in respect to the characteristics influencing their ability to negotiatesurroundings. The virtual environment is also classified according to several accessibility traits shown to have adisproportionate effect upon behavior during an emergency. The results of an experiment simulating the truck bombing of anintermountain west sports arena reveal special areas of concern for arena managers and identify those who are most at risk orindividuals with lower stamina. Ultimately, the model can be used to inform policy makers of more effective, evidence-basedevacuation planning methods based on a better understanding of the behavior of heterogeneous populations duringemergency situations

Facilitating the development of a shared purpose in a university department: the first stage towards developing a culture of shared governance

Background and context: The structure of higher education departments tends to be hierarchical or, at the other extreme, characterised as ‘a galaxy of individual stars’ (Handy, 1993 p 190). Ours was no exception. However, changes in the way nursing education was provided, internal growth and development followed by a period of austerity, presented our school with an unprecedented opportunity. We found ourselves in a position where we had the possibility to change. Aims: The aim of the paper is to share our reflections on the process and outcomes to date of a culture change project in a university department. The purpose of this opening part of the project was to enable creative and collegial opportunities to work together. Conclusions: An inclusive culture can make a difference to peoples’ lives and reflect the underpinning principles of person-centred practice. This project has enabled us to define our shared purpose, clarify our values, make commitments and set standards. Overall, though it has allowed us to see each other as people who have emerged from behind a faceless organisational structure. Implications for practice: The values of inclusiveness, integrity and professionalism are important for a shared understanding and effective collaborative functioning within university departments internationally, especially those that espouse person-centredness Staff teams can be structured around professional and personal development needs but these also provide a direct link to both departmental and organisational purposes aligned to education Managerial support, staff participation and an experienced facilitator are vital for successful cultural change. Our project has been UK based but we believe these experiences to be transferable and of interest to university departments elsewhere that aspire to create cultures that enable staff, and therefore students and the wider community, to flouris

East of England Eyecare Workforce Transformation through increasing capacity and capability, integrating advancing practice initiatives and the Ophthalmic Practitioner Training programme (OPT):Phase 1: Final Report

A three phased project aims to address the integration of eyecare workforce development within wider initiatives (across population groups/specialties) and strengthen workforce capability and capacity to deliver eyecare on a whole-system basis across East of England. Phase 1 aimed to 1) build the foundation for growing capability and capability of the whole workforce across different contexts to meet the needs of people with actual/potential eye conditions to optimise existing workforce ‘assets’, while taking a supportive approach to identifying and addressing learning needs and 2) make recommendations for Health Education England (Eastern); Integrated Care Systems (ICSs) and Higher Education Institutes (HEIs) to inform subsequent stages

Strengthening nursing, midwifery and allied health professional leadership in the UK - a realist evaluation

Purpose: This paper aims to share the findings of a realist evaluation study that set out to identify how to strengthen nursing, midwifery and allied health professions (NMAHP) leadership across all health-care contexts in the UK conducted between 2018 and 2019. The collaborative research team were from the Universities of Bangor, Ulster, the University of the West of Scotland and Canterbury Christ Church University. Design/methodology/approach: Realist evaluation and appreciative inquiry were used across three phases of the study. Phase 1 analysed the literature to generate tentative programme theories about what works, tested out in Phase 2 through a national social media Twitter chat and sense-making workshops to help refine the theories in Phase 3. Cross-cutting themes were synthesised into a leadership framework identifying the strategies that work for practitioners in a range of settings and professions based on the context, mechanism and output configuration of realist evaluation. Stakeholders contributed to the ongoing interrogation, analysis and synthesis of project outcomes. Findings: Five guiding lights of leadership, a metaphor for principles, were generated that enable and strengthen leadership across a range of contexts. – “The Light Between Us as interactions in our relationships”, “Seeing People’s Inner Light”, “Kindling the Spark of light and keeping it glowing”, “Lighting up the known and the yet to be known” and “Constellations of connected stars”. Research limitations/implications: This study has illuminated the a-theoretical nature of the relationships between contexts, mechanisms and outcomes in the existing leadership literature. There is more scope to develop the tentative programme theories developed in this study with NMAHP leaders in a variety of different contexts. The outcomes of leadership research mostly focussed on staff outcomes and intermediate outcomes that are then linked to ultimate outcomes in both staff and patients (supplemental). More consideration needs to be given to the impact of leadership on patients, carers and their families. Practical implications: The study has developed additional important resources to enable NMAHP leaders to demonstrate their leadership impact in a range of contexts through the leadership impact self-assessment framework which can be used for 360 feedback in the workplace using the appreciative assessment and reflection tool. Social implications: Whilst policymakers note the increasing importance of leadership in facilitating the culture change needed to support health and care systems to adopt sustainable change at pace, there is still a prevailing focus on traditional approaches to individual leadership development as opposed to collective leadership across teams, services and systems. If this paper fails to understand how to transform leadership policy and education, then it will be impossible to support the workforce to adapt and flex to the increasingly complex contexts they are working in. This will serve to undermine system integration for health and social care if the capacity and capability for transformation are not attended to. Whilst there are ambitious global plans (WHO, 2015) to enable integrated services to be driven by citizen needs, there is still a considerable void in understanding how to authentically engage with people to ensure the transformation is driven by their needs as opposed to what the authors think they need. There is, therefore, a need for systems leaders with the full skillset required to enable integrated services across place-based systems, particularly clinicians who are able to break down barriers and silo working across boundaries through the credibility, leadership and facilitation expertise they provide. Originality/value: The realist evaluation with additional synthesis from key stakeholders has provided new knowledge about the principles of effective NMAHP leadership in health and social care, presented in such a way that facilitates the use of the five guiding lights to inform further practice, education, research and policy development