Public participation in the design of educational programmes for cancer nurses: a case report

Methodology or method? A critical review of qualitative case study reports

Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services (n=12), social sciences and anthropology (n=7), or methods (n=15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

Pitfalls, perils and payments: service user, carers and teaching staff perceptions of the barriers to involvement in nursing education

BACKGROUND

There is an impetus to involve service users and carers in the education of nurses and a general consensus in the literature about the benefits that this brings to all involved. Whilst these benefits are well rehearsed in the literature there is little written about the potential barriers to service user and carer involvement in nurse education.

OBJECTIVE

The objective of this study was to investigate service users, carers and staff views on the potential barriers to becoming engaged in nurse education.

DESIGN

A qualitative study using focus group discussions (FGD) was used to canvas the views of service users, carers and teaching staff.

SETTING

A large school of nursing in the North West of England.

PARTICIPANTS

38 service users and carers recruited from the North West of England and 23 nursing and midwifery teachers and lecturers.

METHODS

Focus group discussions were employed as the main data collection method. The data were analysed using thematic analysis.

RESULTS

Six themes occurred in the data as being negatively associated with potential and actual involvement: not knowing the context of the group, lack of preparation of the group, not being supported, not being allowed to be real, not receiving feedback, not being paid appropriately.

CONCLUSIONS

The process of involvement is not without difficulties. These data show that some consideration needs to be given to the potential barriers to involvement if the engagement of service users and carers is to be effective.

'A caring professional attitude': What service users and carers seek in graduate nurses and the challenge for educators

With the publication of the new NMC standards for pre-registration nursing education, undergraduate curricula are being written in universities across England. There are many drivers for the curricula but one that has until recently received scant attention is the service user's and carer's voice. This paper discusses the findings of a qualitative study that asked 52 service users and carers about the qualities they sought in nurses and their views on nurse education. Eight focus groups were conducted with a broad range of service users and carers from primary and secondary care, and voluntary organisations. Data were analysed using the framework approach facilitated by a qualitative analysis software programme. The sample was diverse, but there were similarities in the qualities they valued in nurses. They sought technical competence, knowledge and willingness to seek information, but overwhelmingly prioritised 'a caring professional attitude'. This was articulated as empathy, communication skills and non-judgmental patient centred care: major themes in the new NMC standards. Our participants also expressed concern about whether the educational preparation of nurses can develop these caring qualities. We discuss this concern, the challenges for nurse educators it presents and how we can engage service users and carers in shaping and delivering our new curricula.

Service user involvement in nurse education: a report on using online discussions with a service user to augment his digital story

Service user involvement is a key element within current pre- and post-registration nurse education in the U.K. but achieving this is challenging. Most service user involvement is through classroom visits. Digital stories, film and audio are alternatives but lack the interactivity and development of reflection that can be achieved through face-to-face contact. This report reviews the background to service user involvement in healthcare professional education then provides a reflective account of a novel initiative whereby a spinal-injured patient was involved in creating a digital story around some of his in-hospital experiences and then engaged in online discussions with post-registration nursing (degree) and practice educator (masters) students. These discussions provided a richer experience for the students enabling them to reflect more deeply on how nursing care is delivered and perceived by service users. The report concludes that digital stories can be used with repeated groups to inspire discussion and reflection. Augmenting such digital stories with online discussions with the service user whose story is told helps practitioners develop greater empathy, insight and understanding which are beneficial for improving service delivery and nursing care.

The involvement of users and carers in health and social research: the realities of inclusion and engagement

In this article we explore the challenges to researchers intending to involve vulnerable populations in health and social care research, and provide evidence-based recommendations to support the proactive inclusion of these populations in the research process. We provide a rationale for the study, followed by the introduction and descriptions of our research experiences (presented as two case studies) to provide a contextual backcloth for the discussion.We highlight the inherent challenges in empowering vulnerable populations in research, based on the combination of our own and other people's experiences. Collectively, these illustrate and underpin practice issues, relate theory to practice in a meaningful way, and facilitate the recognition of the realities in future development in this important area of involving users and carers. We conclude by providing recommendations for future practice and research development from a wider, international perspective.

Storytelling and professional learning: a phenomenographic study of students' experience of patient digital stories in nurse education

This paper reports the findings of a phenomenographic study which sought to identify the different ways in which patient digital stories influence students' professional learning. Patient digital stories are short multimedia presentations that combine personal narratives, images and music to create a unique and often emotional story of a patients' experience of health care. While these are increasingly used in professional education little is known about how and what students learn through engagement with patient digital stories. Drawing upon interviews with 20 students within a pre-registration nursing programme in the UK, the study identifies four qualitatively different ways in which students approach and make sense of patient digital stories with implications for learning and professional identity development. Through an identification of the critical aspects of this variation valuable insights are generated into the pedagogic principles likely to engender transformational learning and patient centred practice.

User and carer involvement in the training and education of health professionals: A review of the literature

BACKGROUND

Health policy requires consumer involvement in services, research and education but little is known about how consumers are being involved in healthcare education, the effect on learning and practice, nor how involvement initiatives are being evaluated.

OBJECTIVES

To describe methods of involving consumers in healthcare education, discuss ways in which initiatives have been evaluated, and identify areas for development in education, practice and research.

DESIGN

All papers reporting specific initiatives involving consumers in health care worker training and education were included. Viewpoint articles and studies of consumers training consumers were excluded.

DATA SOURCES

Cinahl, Medline, Assia, PsycINFO, British Nursing Index, Social Science Citation Index, citations from reference lists, relevant websites and personal communication with key people known to be working in this area.

REVIEW METHODS

A narrative approach was taken with categorisation of data to reflect objectives of selected studies; method of involvement; process issues and evaluation.

RESULTS

Thirty-eight papers were included; most provide small-scale qualitative studies of mental health service users and focus on process rather than outcome. Various methods of involvement are described and consumers consistently prioritise the need for training in interpersonal skills over 'technical' skills. There is little research into organisational strategies and no studies investigate the effect of consumer involvement on practice. Two studies indicated that students exposed to consumer involvement demonstrate more empathic understanding and better communication skills.

CONCLUSIONS

There is tentative evidence that consumer involvement in training enhances workers' skills in the manner prioritised by consumers. However, if consumer involvement in training and education is to facilitate services that reflect the priorities of the people using them, it must be developed in partnership with service providers; further research is needed to explore the impact of consumer involvement and to track the development of organisational consumer involvement strategies, also systems for supporting consumers need to be established, including training for both consumers and staff.

A review of literature about involving people affected by cancer in research, policy and planning and practice

OBJECTIVE

To systematically review the literature on involving people affected by cancer in healthcare research, policy and planning and practice.

METHODS

Database searches, cited author, and grey literature searches were conducted.

RESULTS

131 documents were included. Rationales for the agenda of involvement represent two polar characteristics of modernity: individualism and collectivism. In research, people acted as advocates, strategists, advisors, reviewers and as participatory researchers. In policy and planning, people were involved in one-off involvement exercises and in longer-term partnerships. Men, those with rare cancers, children, and people who are socially deprived have been rarely involved. There is little research evidence about the impact of involvement. Training and information, resources and a change in attitudes and roles are required to implement an agenda of involvement.

CONCLUSION

The USA, the UK, followed by Canada and Australia have promoted an agenda of involvement.

PRACTICE IMPLICATIONS

A dissemination strategy to share good practice; involvement of all types of people; an individualised and flexible approach; training, resources and a shift in thinking from paternalism towards partnership working are required. More research is needed about the impact of involvement and relationships between rationales for involvement and implementation.

Learning from the experience of working with consumers in educational developments

AIM

The aim of this paper is to report the experience of working with local parents as collaborators in an educationally focussed research study. This work subsequently led to the development of a new module aimed at professionals providing parenting support. The ensuing discussion centres on the involvement of healthcare consumers in the development of educational programmes.

METHODS

Focus group interviews were held with local parents to identify their various experiences of parenting support services. In addition the interviews were used as a means of recruiting local parent volunteers willing to join the research advisory group. This group had the task of guiding both the research and development of the educational programme.

FINDINGS

Involvement of the parents introduced fresh insights to both the understanding of the content of parent education module and the necessary ingredients needed for effective consumer involvement.

CONCLUSION

Lecturers have gained first hand experience of working collaboratively with parents in carrying out a research study and curriculum development. Three key issues emerged from this experience. These included the identification of who the consumer is, the approaches and skills required by professionals and lastly the importance of resources to support this commitment.

Collaboration, user involvement and education: a systematic review of the literature and report of an educational initiative

Collaboration is advocated widely through government policy as part of enormous change within the Health Service (Department of Health 1998, 2000b). Directives from policy regarding collaboration impact onto organizations, professions and individuals including users of the service. A literature review suggests that there would appear to be limited anecdotal, discursive or rigorous evidence available on collaboration at all levels including involving users. However, literature does demonstrate a mounting body of evidence that collaboration with users is being promoted as a way of working. This paper reviews the literature around collaboration and user involvement in the context of cancer care. Findings suggest that there is confusion of terminology around collaboration and user involvement. Benefits of and barriers to user involvement are identified and these are explored in the context of caring for the patient with cancer. An evaluation of a team-based educational initiative designed to help health-care professionals working within the cancer arena to explore ways to collaborate with users is presented. Findings suggest that education may be one way to develop collaboration between health-care professionals and service users.