A preceptorship toolkit for nurse managers, teams and healthcare organisations

The transition from student to newly qualified nurse can be challenging. A period of preceptorship is recommended to support newly qualified nurses in their new work environment, and to give them time to adapt and gain confidence. Researchers have developed a toolkit based on previous research that contains several resources that nurse managers, teams and organisations can use to develop and improve preceptorship for newly qualified nurses. The toolkit includes an organisational support tool, a managerial support framework, a supernumerary time tool and a local culture of support tool. This article describes these resources and gives an example of how the toolkit can be adapted locally.Chesterfield Royal Hospital funded the original research project upon which this is base

Supporting newly qualified nurses in the UK: a systematic literature review

Aim: This is a systematic literature review of the existing published research related to the development of preceptorship to support newly qualified nurses in the United Kingdom (UK). Background: It has been known for some time that newly qualified nurses experience a period of unsettling transition at the point of registration. In the UK, preceptorship has been the professional body’s recommended solution to this for over 20 years. Data Sources: Searches were made of the CINAHL Plus and MEDLINE databases. Review Methods: A systematic review was carried out in August 2011. Twelve separate searches were conducted generating 167 articles, of which 24 were finally reviewed. Papers were critically reviewed and relevant data were extracted and synthesised using an approach based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis ( PRISMA). Results and Discussion: A results table is presented of the twenty-four sources generated by the systematic search. Three themes were identified from the empirical evidence base: ‘Managerial Support Framework’; ‘Recruitment and Retention’; and ‘Reflection and Critical Thinking in Action’;. Conclusion: There is strong evidence that the newly qualified nurse benefits from a period of supported and structured preceptorship, which translates to improved recruitment and retention for the employing organisations. Recommendations for Further Research and Practice: The existing literature provides an evidence base upon which to construct a preceptorship programme and a means by which to measure its efficacy and monitor its future development. Case study research projects should be considered for future preceptorship programmes in order to find the most effective methods of delivery.Research funded by Chesterfield Royal Hospital NHS Trus

Outcomes of a research project to identify the enablers and barriers to effective preceptorship for newly qualified nurses

Poster presentationFunded by Chesterfield Royal Hospital NHS Trus

Prospective associations between sedentary time, physical activity, fitness and cardiometabolic risk factors in people with type 2 diabetes.

AIMS/HYPOTHESIS: The aim of this study was to examine the prospective associations between objectively measured physical activity energy expenditure (PAEE), sedentary time, moderate-to-vigorous-intensity physical activity (MVPA), cardiorespiratory fitness (CRF) and cardiometabolic risk factors over 4 years in individuals with recently diagnosed diabetes. METHODS: Among 308 adults (mean age 61.0 [SD 7.2] years; 34% female) with type 2 diabetes from the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION)-Plus study, we measured physical activity using individually calibrated combined heart rate and movement sensing. Multivariable linear regression models were constructed to examine the associations between baseline PAEE, sedentary time, MVPA, CRF and cardiometabolic risk factors and clustered cardiometabolic risk (CCMR) at follow-up, and change in these exposures and change in CCMR and its components over 4 years of follow-up. RESULTS: Individuals who increased their PAEE between baseline and follow-up had a greater reduction in waist circumference (-2.84 cm, 95% CI -4.84, -0.85) and CCMR (-0.17, 95% CI -0.29, -0.04) compared with those who decreased their PAEE. Compared with individuals who decreased their sedentary time, those who increased their sedentary time had a greater increase in waist circumference (3.20 cm, 95% CI 0.84, 5.56). Increases in MVPA were associated with reductions in systolic blood pressure (-6.30 mmHg, 95% CI -11.58, -1.03), while increases in CRF were associated with reductions in CCMR (-0.23, 95% CI -0.40,-0.05) and waist circumference (-3.79 cm, 95% CI -6.62, -0.96). Baseline measures were generally not predictive of cardiometabolic risk at follow-up. CONCLUSIONS/INTERPRETATION: Encouraging people with recently diagnosed diabetes to increase their physical activity and decrease their sedentary time may have beneficial effects on their waist circumference, blood pressure and CCMR.The trial is supported by the Medical Research Council (grant reference no. G0001164), the Wellcome Trust (grant reference no. G061895), National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Networks) and National Institute of Health Research under its Programme Grants for Applied Research scheme (RP-PG-0606-1259). SJG is a member of the NIHR School for Primary Care Research. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health. We are grateful to Diabetes UK for providing patient information materials.This is the final version of the article. It first appeared from Springer via http://dx.doi.org/10.1007/s00125-015-3756-

Sperm Swimming Velocity Predicts Competitive Fertilization Success in the Green Swordtail Xiphophorus helleri

Sperm competition is expected to favour the evolution of traits that influence the performance of sperm when they compete to fertilize a female's eggs. While there is considerable evidence that selection favours increases in sperm numbers, much less is known about how sperm quality contributes towards competitive fertilization success. Here, we determine whether variation in sperm quality influences competitive fertilization success in the green swordtail Xiphophorus helleri, a highly promiscuous livebearing fish. We use artificial insemination as a method of controlled sperm delivery and show that sperm swimming velocity is the primary determinant of fertilization success when ejaculates from two males compete to fertilize a female's eggs. By contrast, we found no evidence that sperm length had any effect on siring success. We also found no evidence that pre- and postcopulatory sexual traits were phenotypically integrated in this species, suggesting that the previous observation that reproductive skew favours males with high mating rates is unlikely to be due to any direct association between sperm quality and male sexual ornamentation

The effects of integrated care: a systematic review of UK and international evidence

BACKGROUND: Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS: The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS: One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS: Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION: Prospero registration number: 42016037725

Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study

Background: Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision. Methods: TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8–10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743. Findings: Between Feb 22, 2012, and Dec 19, 2014, 55 patients were randomly assigned at 15 sites; 27 to organ preservation and 28 to radical surgery. Cumulatively, 18 patients had been randomly assigned at 12 months, 31 at 18 months, and 39 at 24 months. No patients died within 30 days of initial treatment, but one patient randomly assigned to organ preservation died within 6 months following conversion to total mesorectal excision with anastomotic leakage. Eight (30%) of 27 patients randomly assigned to organ preservation were converted to total mesorectal excision. Serious adverse events were reported in four (15%) of 27 patients randomly assigned to organ preservation versus 11 (39%) of 28 randomly assigned to total mesorectal excision (p=0·04, χ2 test). Serious adverse events associated with organ preservation were most commonly due to rectal bleeding or pain following transanal endoscopic microsurgery (reported in three cases). Radical total mesorectal excision was associated with medical and surgical complications including anastomotic leakage (two patients), kidney injury (two patients), cardiac arrest (one patient), and pneumonia (two patients). Histopathological features that would be considered to be associated with increased risk of tumour recurrence if observed after transanal endoscopic microsurgery alone were present in 16 (59%) of 27 patients randomly assigned to organ preservation, versus 24 (86%) of 28 randomly assigned to total mesorectal excision (p=0·03, χ2 test). Eight (30%) of 27 patients assigned to organ preservation achieved a complete response to radiotherapy. Patients who were randomly assigned to organ preservation showed improvements in patient-reported bowel toxicities and quality of life and function scores in multiple items compared to those who were randomly assigned to total mesorectal excision, which were sustained over 36 months’ follow-up. The non-randomised registry comprised 61 patients who underwent organ preservation and seven who underwent radical surgery. Non-randomised patients who underwent organ preservation were older than randomised patients and more likely to have life-limiting comorbidities. Serious adverse events occurred in ten (16%) of 61 non-randomised patients who underwent organ preservation versus one (14%) of seven who underwent total mesorectal excision. 24 (39%) of 61 non-randomised patients who underwent organ preservation had high-risk histopathological features, while 25 (41%) of 61 achieved a complete response. Overall, organ preservation was achieved in 19 (70%) of 27 randomised patients and 56 (92%) of 61 non-randomised patients. Interpretation: Short-course radiotherapy followed by transanal endoscopic microsurgery achieves high levels of organ preservation, with relatively low morbidity and indications of improved quality of life. These data support the use of organ preservation for patients considered unsuitable for primary total mesorectal excision due to the short-term risks associated with this surgery, and support further evaluation of short-course radiotherapy to achieve organ preservation in patients considered fit for total mesorectal excision. Larger randomised studies, such as the ongoing STAR-TREC study, are needed to more precisely determine oncological outcomes following different organ preservation treatment schedules. Funding: Cancer Research UK

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

An ethnographic study of the implementation and development of nurse consultant roles

The plan to implement the new role of nurse consultant across England was announced in 1998. A review of the literature highlighted there was a lack of knowledge about nurse consultants specifically and that previous implementation of new nursing roles had been problematic. This lack of knowledge underpinned the need for further exploration and led to the development of this study, the aim of which was to develop an understanding of the implementation and development of the nurse consultant role. A two stage focused ethnography was undertaken within one acute NHS hospital trust in England. The first stage involved documentary analysis and in-depth interviews with thirteen strategic stakeholders who were executive directors and senior directorate managers responsible for developing nurse consultant posts. The second stage involved: two in-depth interviews and five days of participant-observation with six nurse consultants, in-depth interviews with eleven clinical staff who worked with the nurse consultants, including medical consultants, clinical nurse specialists, ward sisters and matrons, and follow-up interviews with six of the first stage strategic stakeholders. The first stage findings identified that the factors which influenced the trust’s decision to develop nurse consultant posts were complex, with three strategic stakeholder decision making patterns emerging: realising, complying and resisting the opportunity. The interviews with strategic stakeholders also highlighted their expectations of the ‘ideal’ nurse consultant. The second stage identified a three phase ‘apprenticeship’ development process from which a model of nurse consultant preparation emerged. This model highlighted the extent to which individuals were prepared for their role. Findings which related to the ability of the nurse consultants to achieve their expectations for the role led to the development of a model of expectation realisation, which highlighted the extent to which they had achieved a sense of ‘being different’. Their ability to achieve their expectations was influenced by a range of organisational contextual and cultural factors. From the findings of the study as a whole a conceptual framework for nurse consultant transition was developed. The study findings reflected many issues reported in other studies of new nursing roles and nurse consultants. However, this study makes an important contribution to new knowledge through the development of a transitional framework which as a whole provides an understanding of the complexity of the inter-relationship of organisational and individual factors which affect new role implementation. In addition the individual models and typologies presented within the framework provide new insights into particular factors which affect successful role implementation which are useful for individuals and organisations and challenge some of the current evidence base. In particular the findings have practical implications for how decision makers analyse the readiness of the context and culture of the service for the implementation of new roles, and how they prepare their service to promote the ability of post-holders to achieve service expectations. Insight into how individuals can effectively develop the skills and knowledge required for the role provides evidence for nurses planning their careers, and importantly for organisations and education providers to provide the necessary development opportunities for individuals to attain the experience required. The findings provided new insight into nurse consultant expectations and the factors which affected their ability to realise their expectations which are helpful to individuals and organisations to plan for effective transition and successful role implementation.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

An ethnographic study of the implementation and development of nurse consultant roles

The plan to implement the new role of nurse consultant across England was announced in 1998. A review of the literature highlighted there was a lack of knowledge about nurse consultants specifically and that previous implementation of new nursing roles had been problematic. This lack of knowledge underpinned the need for further exploration and led to the development of this study, the aim of which was to develop an understanding of the implementation and development of the nurse consultant role. A two stage focused ethnography was undertaken within one acute NHS hospital trust in England. The first stage involved documentary analysis and in-depth interviews with thirteen strategic stakeholders who were executive directors and senior directorate managers responsible for developing nurse consultant posts. The second stage involved: two in-depth interviews and five days of participant-observation with six nurse consultants, in-depth interviews with eleven clinical staff who worked with the nurse consultants, including medical consultants, clinical nurse specialists, ward sisters and matrons, and follow-up interviews with six of the first stage strategic stakeholders. The first stage findings identified that the factors which influenced the trust’s decision to develop nurse consultant posts were complex, with three strategic stakeholder decision making patterns emerging: realising, complying and resisting the opportunity. The interviews with strategic stakeholders also highlighted their expectations of the ‘ideal’ nurse consultant. The second stage identified a three phase ‘apprenticeship’ development process from which a model of nurse consultant preparation emerged. This model highlighted the extent to which individuals were prepared for their role. Findings which related to the ability of the nurse consultants to achieve their expectations for the role led to the development of a model of expectation realisation, which highlighted the extent to which they had achieved a sense of ‘being different’. Their ability to achieve their expectations was influenced by a range of organisational contextual and cultural factors. From the findings of the study as a whole a conceptual framework for nurse consultant transition was developed. The study findings reflected many issues reported in other studies of new nursing roles and nurse consultants. However, this study makes an important contribution to new knowledge through the development of a transitional framework which as a whole provides an understanding of the complexity of the inter-relationship of organisational and individual factors which affect new role implementation. In addition the individual models and typologies presented within the framework provide new insights into particular factors which affect successful role implementation which are useful for individuals and organisations and challenge some of the current evidence base. In particular the findings have practical implications for how decision makers analyse the readiness of the context and culture of the service for the implementation of new roles, and how they prepare their service to promote the ability of post-holders to achieve service expectations. Insight into how individuals can effectively develop the skills and knowledge required for the role provides evidence for nurses planning their careers, and importantly for organisations and education providers to provide the necessary development opportunities for individuals to attain the experience required. The findings provided new insight into nurse consultant expectations and the factors which affected their ability to realise their expectations which are helpful to individuals and organisations to plan for effective transition and successful role implementation