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Richards DA, Bollen J, Jones B, Melendez-Torres GJ, Hulme C, Cockcroft E, Cook H, Cooper J, Creanor S, Cruickshank S, Dawe P, Doris F, Iles-Smith H, Kent M, Logan P, O'Connell A, Onysk J, Owens R, Quinn L, Rafferty AM, Romanczuk L, Russell AM, Shepherd M, Singh SJ, Sugg HVR, Coon JT, Tooze S, Warren FC, Whale B, Wootton S. Evaluation of a COVID-19 fundamental nursing care guideline versus usual care: The COVID-NURSE cluster randomized controlled trial. J Adv Nurs 2024; 80:2137-2152. [PMID: 37986547 DOI: 10.1111/jan.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
AIM To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID-19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health-related quality of life and cost-effectiveness. DESIGN Parallel two-arm, cluster-level randomized controlled trial. METHODS Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID-19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient-reported co-primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention-to-treat analyses. RESULTS We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570-572 (98.1%-98.5%) patient participants in 14 clusters. We found no evidence of between-group differences on any patient, nurse or economic outcomes. We found between-group differences over time, in favour of the intervention, for three of our five co-primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the 'other' ethnicity subgroup. CONCLUSION We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non-white British patients' experience of care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required. IMPACT Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non-white British patients' experience of care. REPORTING METHOD CONSORT and CONSERVE. PATIENT OR PUBLIC CONTRIBUTION Patients with experience of hospitalization with COVID-19 were involved in guideline development and writing, trial management and interpretation of findings.
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Affiliation(s)
- David A Richards
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jess Bollen
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Ben Jones
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Claire Hulme
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Emma Cockcroft
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Heather Cook
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Joanne Cooper
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Siobhan Creanor
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Phoebe Dawe
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Faye Doris
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Merryn Kent
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Pip Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Abby O'Connell
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jakub Onysk
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Rosie Owens
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Lynne Quinn
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Florence Nightingale School of Nursing and Midwifery, Kings College University London, London, UK
| | | | | | - Maggie Shepherd
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
| | - Holly V R Sugg
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Susannah Tooze
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Fiona C Warren
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Bethany Whale
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Stephen Wootton
- Institute of Human Nutrition, University of Southampton, Southampton, UK
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Maassen S, van Oostveen C, Weggelaar AM, Rafferty AM, Zegers M, Vermeulen H. Measuring the work environment among healthcare professionals: Validation of the Dutch version of the Culture of Care Barometer. PLoS One 2024; 19:e0298391. [PMID: 38421985 PMCID: PMC10903908 DOI: 10.1371/journal.pone.0298391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES A positive work environment (WE) is paramount for healthcare employees to provide good quality care. To stimulate a positive work environment, employees' perceptions of the work environment need to be assessed. This study aimed to assess the reliability and validity of the Dutch version of the Culture of Care Barometer (CoCB-NL) survey in hospitals. METHODS This longitudinal validation study explored content validity, structural validity, internal consistency, hypothesis testing for construct validity, and responsiveness. The study was conducted at seven departments in two Dutch university hospitals. The departments were included based on their managers' motivation to better understand their employees' perception of their WE. All employees of participating departments were invited to complete the survey (n = 1,730). RESULTS The response rate was 63.2%. The content of the CoCB-NL was considered relevant and accessible by the respondents. Two factor models were found. First, confirmative factor analysis of the original four-factor structure showed an acceptable fit (X2 2006.49; df 399; p = <0.001; comparative fit index [CFI] 0.82; Tucker-Lewis index [TLI] 0.80; root mean square error of approximation [RMSEA] 0.09). Second, explanatory factor analysis revealed a five-factor model including 'organizational support', 'leadership', 'collegiality and teamwork', 'relationship with manager', and 'employee influence and development'. This model was confirmed and showed a better fit (X2 1552.93; df 395; p = < 0.00; CFI 0.87; TLI 0.86; RMSEA 0.07). Twelve out of eighteen hypotheses were confirmed. Responsiveness was assumed between the measurements. CONCLUSIONS The CoCB-NL is a valid and reliable instrument for identifying areas needing improvement in the WE. Furthermore, the CoCB-NL appears to be responsive and therefore useful for longitudinal evaluations of healthcare employees' work environments.
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Affiliation(s)
- Susanne Maassen
- Department of Quality and Patientcare, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- TRANZO, Tilburg University, Tilburg, The Netherlands
| | - Catharina van Oostveen
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, Haarlem, The Netherlands
| | | | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing and Midwifery & Palliative Care, King’s College London, London, United Kingdom
| | - Marieke Zegers
- Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Ejebu OZ, Turnbull J, Atherton I, Rafferty AM, Palmer B, Philippou J, Prichard J, Jamieson M, Rolewicz L, Williams M, Ball J. What might make nurses stay? A protocol for discrete choice experiments to understand NHS nurses' preferences at early-career and late-career stages. BMJ Open 2024; 14:e075066. [PMID: 38307538 PMCID: PMC10836387 DOI: 10.1136/bmjopen-2023-075066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/28/2023] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Like many countries, England has a national shortage of registered nurses. Employers strive to retain existing staff, to ease supply pressures. Disproportionate numbers of nurses leave the National Health Services (NHS) both early in their careers, and later, as they near retirement age. Research is needed to understand the job preferences of early-career and late-career nurses working in the NHS, so tailored policies can be developed to better retain these two groups. METHODS AND ANALYSIS We will collect job preference data for early-career and late-career NHS nurses, respectively using two separate discrete choice experiments (DCEs). Findings from the literature, focus groups, academic experts and stakeholder discussions will be used to identify and select the DCE attributes (ie, job features) and levels. We will generate an orthogonal, fractional factorial design using the experimental software Ngene. The DCEs will be administered through online surveys distributed by the regulator Nursing and Midwifery Council. For each group, we expect to achieve a final sample of 2500 registered NHS nurses working in England. For early-career nurses, eligible participants will be registered nurses who graduated in the preceding 5 years (ie, 2019-2023). Eligible participants for the late-career survey will be registered nurses aged 55 years and above. We will use conditional and mixed logit models to analyse the data. Specifically, study 1 will estimate the job preferences of early-career nurses and the possible trade-offs. Study 2 will estimate the retirement preferences of late-career NHS nurses and the potential trade-offs. ETHICS AND DISSEMINATION The research protocol was reviewed and approved by the host research organisation Ethics Committees Research Governance (University of Southampton, number 80610) (https://www.southampton.ac.uk/about/governance/regulations-policies/policies/ethics). The results will be disseminated via conference presentations, publications in peer-reviewed journals and annual reports to key stakeholders, the Department of Health and Social Care, and NHS England/Improvement retention leaders. REGISTRATION DETAILS Registration on OSF http://doi.org/10.17605/OSF.IO/RDN9G.
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Affiliation(s)
- Ourega-Zoé Ejebu
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health and Social Research (NIHR) Applied Research Collaboration (ARC), Wessex, UK
| | - Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Iain Atherton
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | | | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Jane Prichard
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Michelle Jamieson
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | | | - Jane Ball
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health and Social Research (NIHR) Applied Research Collaboration (ARC), Wessex, UK
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Allen D, Jacob N, Strange H, Jones A, Burton C, Rafferty AM. "It's not just about the numbers": Inside the black box of nurses' professional judgement in nurse staffing systems in England and Wales: Insights from a qualitative cross-case comparative study. Int J Nurs Stud 2023; 147:104586. [PMID: 37672970 DOI: 10.1016/j.ijnurstu.2023.104586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Whether implicit or explicit, professional judgement is a central component of the many nurse staffing systems implemented in high-income countries to inform workforce planning and staff deployment. Whilst a substantial body of research has evaluated the technical and operational elements of nurse staffing systems, no studies have systematically examined the role of professional judgement and its contribution to decision-making. OBJECTIVE To explore nurses' use of professional judgement in nurse staffing systems in England and Wales. METHODS A cross-case comparative design centred on adult in-patient services in three University Health Boards in Wales and three National Health Service Trusts in England. Data generation was undertaken between January 2021 and March 2023 through stakeholder interviews, observations of staffing meetings, and analysis of documents and artefacts. Observations were undertaken in clinical areas but limited to three cases by COVID-19 restrictions. Analysis was informed by translational mobilisation theory. FINDINGS Two kinds of professional judgement were deployed in the nurse staffing systems: the judgement of clinical nurses and the judgement of senior nurse managers. The research highlighted the reflexive relationship between professional judgement and data, and the circumstances in which organisations placed trust in people and when they placed trust in numbers. Nurses' professional judgement was central to the generation of data, its interpretation and contextualisation. Healthcare organisations relied on the professional judgements of clinical nurses and senior nurse managers in making operational decisions to mitigate risk, where real-world understanding of the status of the organisation was privileged over formal data. Professional judgement had attenuated authority for the purposes of workforce planning, where data was a master actor. Nurses expressed concerns that strategic decision-making prioritised safety and efficiency, and formal measurement systems did not capture important aspects of care quality or staff wellbeing, which made it difficult to articulate their professional judgement. CONCLUSIONS The implementation of staffing systems is resource intensive. Given limited evidence on which to recommend any specific methodology, the priority for future research is to optimise existing systems. If nurses are to deploy their professional judgement to proactively influence the conditions for care, as well as responding to the challenges of risk mitigation, there is a need for robust systems of nursing measurement aligned with agreed standards of care and a vocabulary through which these judgements can be articulated. TWEETABLE ABSTRACT Health systems depend on nurses' professional judgement for operational staffing decisions, but data is privileged over professional judgement for workforce planning.
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Affiliation(s)
- Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - Nina Jacob
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Chris Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Kent, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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Kelly D, Horseman Z, Strachan FE, Hamilton S, Jones A, Holloway A, Rafferty AM, Noble H, Reid J, Harris R, Smith P. Strengthening the role of the executive nurse director: A qualitative interview study. J Adv Nurs 2023; 79:3809-3823. [PMID: 37232468 DOI: 10.1111/jan.15699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/23/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023]
Abstract
AIM To explore the challenges and opportunities facing executive nurse directors in the UK and identify factors to strengthen their role and support more effective nurse leadership. DESIGN A qualitative descriptive study using reflexive thematic analysis. METHODS Semi-structured, telephone interviews were carried out with 15 nurse directors and 9 nominated colleagues. RESULTS Participants described a uniquely complex role with a broader scope than any other executive board member. Seven themes were identified: preparation for the role, length of time in role, role expectations, managing complexity, status, being political and influencing. Strengthening factors included successful working relationships with other board colleagues, development of political skills and personal status, coaching and mentoring, working within a supportive team culture and having strong professional networks. CONCLUSION Executive nurse leaders are key to the transmission of nursing values and the delivery of safety and quality in healthcare settings. To strengthen this role, the limiting factors and the recommended shared learning identified here should be recognized and addressed at an individual, organizational and professional level. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Given the pressure on all health systems to retain nurses, the role of executive nurse leaders needs to be seen as an important source of professional leadership and their value in actioning health policy into practice recognized. IMPACT New insights have been provided into the executive nurse director role across the UK. Findings have demonstrated challenges and opportunities to strengthen the executive nurse director role. These include recognition of the need for support, preparation, networking and more realistic expectations of this unique nursing role. REPORTING METHOD The study adhered to the Consolidated Criteria for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution.
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Affiliation(s)
- Daniel Kelly
- Royal College of Nursing Chair of Nursing Research, School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Zoe Horseman
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Fiona E Strachan
- Innovative Healthcare Delivery Programme, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Sharon Hamilton
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Aled Jones
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ruth Harris
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Pam Smith
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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Chan EA, Chung B, Chang K, Hui A, Rafferty AM. Students' learning in theory-based simulation: A socio-material study. Med Educ 2023. [PMID: 37655437 DOI: 10.1111/medu.15201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/14/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Simulation-based education (SBE) is crucial to prepare nursing students prior to their clinical learning experience. Theory-based simulation learning is increasingly important for analysing how students learn. This study describes and analyses how nursing students learn through simulation in the context of palliative care communication under a socio-material approach and explores the transfer of their knowledge and skills from simulation to clinical practice. METHODS Twenty-seven final-year nursing students in six groups participated in two simulated scenarios, followed by a debriefing and post-clinical focus groups to capture their reflections and learning. Fourteen of them joined the post-clinical focus groups after completing their clinical placements. Video recordings of the simulation, and the audio recordings from the debriefing, and post-clinical focus groups were transcribed and coded based on the human and non-human elements that were observed. These were triangulated with data collected through team participant observations, an analysis of the existing syllabi and curriculum, and a participant mapping exercise after the simulation. These various data sources illustrate how student learning and reflections took place. RESULTS The three themes of student learning derived from the results and analysis were (1) students' expanded learning of health care communication through a socio-material approach in the context of palliative care; 2) students' discovery of the diverse and complex relations and interactions between humans and materials and (3) students' new perspectives on health care communication and the transfer of knowledge and skills through a socio-material approach in clinical practice. CONCLUSIONS This study highlights how SBE can be further expanded using a socio-material approach to prepare students to learn beyond standardised and cognitively driven approaches and procedures. Student learning demonstrates that SBE may develop beyond high fidelity and standardisation to leave room for emergent learning and increased awareness in learning for students and teachers to optimise learning outcomes and competence.
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Affiliation(s)
| | - Betty Chung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Katherine Chang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Alison Hui
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Anne Marie Rafferty
- The Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK
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Härkänen M, Pineda AL, Tella S, Mahat S, Panella M, Ratti M, Vanhaecht K, Strametz R, Carrillo I, Rafferty AM, Wu AW, Anttila VJ, Mira JJ. The impact of emotional support on healthcare workers and students coping with COVID-19, and other SARS-CoV pandemics - a mixed-methods systematic review. BMC Health Serv Res 2023; 23:751. [PMID: 37443003 DOI: 10.1186/s12913-023-09744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Pandemics such as COVID-19 pose threats to the physical safety of healthcare workers and students. They can have traumatic experiences affecting their personal and professional life. Increasing rates of burnout, substance abuse, depression, and suicide among healthcare workers have already been identified, thus making mental health and psychological wellbeing of the healthcare workers a major issue. The aim of this systematic review is to synthesize the characteristics of emotional support programs and interventions targeted to healthcare workers and students since the onset of COVID-19 and other SARS-CoV pandemics and to describe the effectiveness and experiences of these programs. METHOD This was a mixed method systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the review was registered on PROSPERO [CRD42021262837]. Searches were conducted using Medline, CINAHL, PsycINFO, Cochrane Library, and Scopus databases. The COVIDENCE systematic review management system was used for data selection and extraction by two independent reviewers. The JBI (Joanna Briggs Institute) critical appraisal tools were used to assess the quality of selected studies by two additional reviewers. Finally, data extraction and narrative analysis were conducted. RESULTS The search retrieved 3161 results including 1061 duplicates. After screening, a total of 19 articles were included in this review. Participants in studies were nurses, physicians, other hospital staff, and undergraduate medical students mostly working on the front-line with COVID-19 patients. Publications included RCTs (n = 4), quasi-experimental studies (n = 2), cross-sectional studies (n = 6), qualitative interview studies (n = 3), and systematic reviews (n = 4). Most (63.4%) of the interventions used online or digital solutions. Interventions mostly showed good effectiveness (support-seeking, positive emotions, reduction of distress symptoms etc.) and acceptance and were experienced as helpful, but there were some conflicting results. CONCLUSION Healthcare organizations have developed support strategies focusing on providing emotional support for these healthcare workers and students, but it is difficult to conclude whether one program offers distinct benefit compared to the others. More research is needed to evaluate the comparative effectiveness of emotional support interventions for health workers.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Yliopistoranta 1c, Kuopio, Finland
| | - Adriana López Pineda
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Alicante, Spain
| | - Susanna Tella
- LAB University of Applied Sciences, Lappeenranta, Finland
| | - Sanu Mahat
- Department of Nursing Science, University of Eastern Finland, Yliopistoranta 1c, Kuopio, Finland
| | - Massimiliano Panella
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Matteo Ratti
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Reinhard Strametz
- Wiesbaden Business School of RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - Irene Carrillo
- Health Psychology Department, Miguel Hernández University, Elche, Spain
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College, London, UK
| | - Albert W Wu
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - José Joaquín Mira
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Alicante, Spain.
- Health Psychology Department, Miguel Hernández University, Elche, Spain.
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Padmanathan P, Lamb D, Scott H, Stevelink S, Greenberg N, Hotopf M, Morriss R, Raine R, Rafferty AM, Madan I, Dorrington S, Wessely S, Moran P. Suicidal thoughts and behaviour among healthcare workers in England during the COVID-19 pandemic: A longitudinal study. PLoS One 2023; 18:e0286207. [PMID: 37343030 PMCID: PMC10284388 DOI: 10.1371/journal.pone.0286207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, concern has been raised about suicide risk among healthcare workers (HCWs). We investigated the incidence risk and prevalence of suicidal thoughts and behaviour (STB), and their relationship with occupational risk factors, among National Health Service HCWs in England between April 2020 and August 2021. METHODS In this longitudinal study, we analysed online survey data completed by 22,501 HCWs from 17 NHS Trusts at baseline (Time 1) and six months (Time 2). The primary outcome measures were suicidal ideation, suicide attempts, and non-suicidal self-injury. We used logistic regression to investigate the relationship between these outcomes and demographic characteristics and occupational factors. Results were stratified by occupational role (clinical/non-clinical). RESULTS Time 1 and Time 2 surveys were completed by 12,514 and 7,160 HCWs, respectively. At baseline, 10.8% (95% CI = 10.1%, 11.6%) of participants reported having experienced suicidal thoughts in the previous two months, whilst 2.1% (95% CI = 1.8%, 2.5%) of participants reported having attempted suicide over the same period. Among HCWs who had not experienced suicidal thoughts at baseline (and who completed the Time 2 survey), 11.3% (95%CI = 10.4%, 12.3%) reported such thoughts six months later. Six months after baseline, 3.9% (95% CI = 3.4%, 4.4%) of HCWs reported attempting suicide for the first time. Exposure to potentially morally injurious events, lack of confidence about raising safety concerns and these concerns being addressed, feeling unsupported by managers, and providing a reduced standard of care were all associated with increased suicidal ideation among HCWs during the COVID-19 pandemic. At six months, among clinicians, a lack of confidence about safety concerns being addressed, independently predicted suicidal ideation. CONCLUSION Suicidal thoughts and behaviour among healthcare workers could be reduced by improving managerial support and enhancing the ability of staff to raise safety concerns.
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Affiliation(s)
- Prianka Padmanathan
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, United Kingdom
| | - Danielle Lamb
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Hannah Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sharon Stevelink
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Neil Greenberg
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Richard Morriss
- The Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Anne Marie Rafferty
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Ira Madan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sarah Dorrington
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Simon Wessely
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, United Kingdom
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9
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Millar R, Aunger JA, Rafferty AM, Greenhalgh J, Mannion R, McLeod H, Faulks D. Towards achieving interorganisational collaboration between health-care providers: a realist evidence synthesis. Health Soc Care Deliv Res 2023; 11:1-130. [PMID: 37469292 DOI: 10.3310/kplt1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Background Interorganisational collaboration is currently being promoted to improve the performance of NHS providers. However, up to now, there has, to the best of our knowledge, been no systematic attempt to assess the effect of different approaches to collaboration or to understand the mechanisms through which interorganisational collaborations can work in particular contexts. Objectives Our objectives were to (1) explore the main strands of the literature about interorganisational collaboration and to identify the main theoretical and conceptual frameworks, (2) assess the empirical evidence with regard to how different interorganisational collaborations may (or may not) lead to improved performance and outcomes, (3) understand and learn from NHS evidence users and other stakeholders about how and where interorganisational collaborations can best be used to support turnaround processes, (4) develop a typology of interorganisational collaboration that considers different types and scales of collaboration appropriate to NHS provider contexts and (5) generate evidence-informed practical guidance for NHS providers, policy-makers and others with responsibility for implementing and assessing interorganisational collaboration arrangements. Design A realist synthesis was carried out to develop, test and refine theories about how interorganisational collaborations work, for whom and in what circumstances. Data sources Data sources were gathered from peer-reviewed and grey literature, realist interviews with 34 stakeholders and a focus group with patient and public representatives. Review methods Initial theories and ideas were gathered from scoping reviews that were gleaned and refined through a realist review of the literature. A range of stakeholder interviews and a focus group sought to further refine understandings of what works, for whom and in what circumstances with regard to high-performing interorganisational collaborations. Results A realist review and synthesis identified key mechanisms, such as trust, faith, confidence and risk tolerance, within the functioning of effective interorganisational collaborations. A stakeholder analysis refined this understanding and, in addition, developed a new programme theory of collaborative performance, with mechanisms related to cultural efficacy, organisational efficiency and technological effectiveness. A series of translatable tools, including a diagnostic survey and a collaboration maturity index, were also developed. Limitations The breadth of interorganisational collaboration arrangements included made it difficult to make specific recommendations for individual interorganisational collaboration types. The stakeholder analysis focused exclusively on England, UK, where the COVID-19 pandemic posed challenges for fieldwork. Conclusions Implementing successful interorganisational collaborations is a difficult, complex task that requires significant time, resource and energy to achieve the collaborative functioning that generates performance improvements. A delicate balance of building trust, instilling faith and maintaining confidence is required for high-performing interorganisational collaborations to flourish. Future work Future research should further refine our theory by incorporating other workforce and user perspectives. Research into digital platforms for interorganisational collaborations and outcome measurement are advocated, along with place-based and cross-sectoral partnerships, as well as regulatory models for overseeing interorganisational collaborations. Study registration The study is registered as PROSPERO CRD42019149009. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ross Millar
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Justin Avery Aunger
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Hugh McLeod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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10
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Rafferty AM, Leary A. Nursing notes on a scandal. Future Healthc J 2023; 10:3-6. [PMID: 37786501 PMCID: PMC10538672 DOI: 10.7861/fhj.2023-fr102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
10 years on from the publication of the Francis report, the nursing profession is facing unprecedented challenges; Robert Francis has recently sounded the alarm that the NHS is currently facing 'the Mid Staffordshire scandal playing out on a national level'. In this perspective, we consider the opportunities missed in the last decade in the attempt to secure safe staffing in nursing.
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Affiliation(s)
- Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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11
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Sugg HVR, Richards DA, Russell AM, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Iles-Smith H, Kent M, Logan PA, Morgan LM, Morley N, Rafferty AM, Shepherd MH, Singh SJ, Tooze SJ, Whear R. Nurses' strategies for overcoming barriers to fundamental nursing care in patients with COVID-19 caused by infection with the SARS-COV-2 virus: Results from the 'COVID-NURSE' survey. J Adv Nurs 2023; 79:1003-1017. [PMID: 35467757 PMCID: PMC9111453 DOI: 10.1111/jan.15261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
AIMS To identify strategies used by registered nurses and non-registered nursing care staff in overcoming barriers when providing fundamental nursing care for non-invasively ventilated inpatients with COVID-19. DESIGN Online survey with open-ended questions to collect qualitative data. METHODS In August 2020, we asked UK-based nursing staff to describe any strategies they employed to overcome barriers to delivering care in 15 fundamental nursing care categories when providing care to non-invasively ventilated patients with COVID-19. We analysed data using Framework Analysis. RESULTS A total of 1062 nurses consented to participate in our survey. We derived four themes. 1) Communication behaviours included adapting verbal and non-verbal communication with patients, using information technology to enable patients' significant others to communicate with staff and patients, and establishing clear information-sharing methods with other staff. 2) Organizing care required clustering interventions, carefully managing supplies, encouraging patient self-care and using 'runners' and interdisciplinary input. 3) Addressing patients' well-being and values required spending time with patients, acting in loco familiae, providing access to psychological and spiritual support, obtaining information about patients' wishes early on and providing privacy and comforting/meaningful items. 4) Management and leadership behaviours included training, timely provision of pandemic information, psychological support, team huddles and facilitating regular breaks. CONCLUSIONS Our respondents identified multiple strategies in four main areas of clinical practice. Management and leadership are crucial to both fundamental care delivery and the well-being of nurses during pandemics. Grouping strategies into these areas of action may assist nurses and leaders to prepare for pandemic nursing. IMPACT As these strategies are unlikely to be exclusive to the COVID-19 pandemic, their global dissemination may improve patient experience and help nurses deliver fundamental care when planning pandemic nursing. However, their effectiveness is unknown. Therefore, we are currently evaluating these strategies in a cluster randomized controlled trial.
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Affiliation(s)
- Holly V R Sugg
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David A Richards
- College of Medicine and Health, University of Exeter, Exeter, UK.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Sarah Burnett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma J Cockcroft
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- College of Medicine and Health, University of Exeter, Exeter, UK.,The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | | | - Faye E Doris
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Harriet A Hunt
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Salford, UK.,Northern Care Alliance NHS Group, Salford, UK
| | - Merryn Kent
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Philippa A Logan
- School of Medicine, University of Nottingham, Queens Medical centre, Nottingham, UK
| | - Leila M Morgan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Naomi Morley
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Maggie H Shepherd
- College of Medicine and Health, University of Exeter, Exeter, UK.,NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
| | - Susannah J Tooze
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca Whear
- College of Medicine and Health, University of Exeter, Exeter, UK
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12
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Clarkson C, Scott HR, Hegarty S, Souliou E, Bhundia R, Gnanapragasam S, Docherty MJ, Raine R, Stevelink SA, Greenberg N, Hotopf M, Wessely S, Madan I, Rafferty AM, Lamb D. 'You get looked at like you're failing': A reflexive thematic analysis of experiences of mental health and wellbeing support for NHS staff. J Health Psychol 2023:13591053221140255. [PMID: 36597919 PMCID: PMC10387714 DOI: 10.1177/13591053221140255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Staff in the National Health Service (NHS) are under considerable strain, exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. We interviewed 48 healthcare workers from 18 NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking, such as manager training and peer support facilitated by building in time for this during working hours, but this will require long-term strategic planning to address workforce shortages.
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13
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Mahat S, Rafferty AM, Vehviläinen-Julkunen K, Härkänen M. Negative emotions experienced by healthcare staff following medication administration errors: a descriptive study using text-mining and content analysis of incident data. BMC Health Serv Res 2022; 22:1474. [PMID: 36463187 PMCID: PMC9719256 DOI: 10.1186/s12913-022-08818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Medication errors regardless of the degree of patient harm can have a negative emotional impact on the healthcare staff involved. The potential for self-victimization of healthcare staff following medication errors can add to the moral distress of healthcare staff. The stigma associated with errors and their disclosure often haunts healthcare professionals, leading them to question their own professional competence. This paper investigates the negative emotions expressed by healthcare staff in their reported medication administration error incidents along with the immediate responses they received from their seniors and colleagues after the incident. METHOD This is a retrospective study using a qualitative descriptive design and text mining. This study includes free-text descriptions of medication administration error incidents (n = 72,390) reported to National Reporting & Learning System in 2016 from England and Wales. Text-mining by SAS text miner and content analysis was used to analyse the data. RESULTS Analysis of data led to the extraction of 93 initial codes and two categories i.e., 1) negative emotions expressed by healthcare staff which included 4 sub-categories of feelings: (i) fear; (ii) disturbed; (iii) sadness; (iv) guilt and 2) Immediate response from seniors and colleagues which included 2 sub-categories: (i) Reassurance and support and (ii) Guidance on what to do after an error. CONCLUSION Negative emotions expressed by healthcare staff when reporting medication errors could be a catalyst for learning and system change. However, negative emotions when internalized as fear, guilt, or self-blame, could have a negative impact on the mental health of individuals concerned, reporting culture, and opportunities for learning from the error. Findings from this study, hence, call for future research to investigate the impact of negative emotions on healthcare staff well-being and identify ways to mitigate these in practice.
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Affiliation(s)
- Sanu Mahat
- grid.9668.10000 0001 0726 2490Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1c, Kuopio, Finland
| | - Anne Marie Rafferty
- grid.13097.3c0000 0001 2322 6764King’s College London: Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK
| | - Katri Vehviläinen-Julkunen
- grid.9668.10000 0001 0726 2490Department of Nursing Science, University of Eastern Finland, Kuopio, Yliopistonranta 1, 70210 Finland ,grid.410705.70000 0004 0628 207XKuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Marja Härkänen
- grid.9668.10000 0001 0726 2490Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1c, Kuopio, Finland
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14
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Tanay MAL, Armes J, Oakley C, Bryson L, Johnston R, Moss‐Morris R, Rafferty AM, Roca J, Sage L, Tanner D, Urwin L, Wyatt T, Robert G. Co-designing a behavioural intervention for reducing the impact of chemotherapy-induced peripheral neuropathy symptoms: An evidence- and theory-driven approach. Eur J Cancer Care (Engl) 2022; 31:e13671. [PMID: 35959639 PMCID: PMC9786800 DOI: 10.1111/ecc.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/22/2022] [Accepted: 07/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aims to co-design an evidence- and theory-based behavioural intervention to reduce the impact of chemotherapy-induced peripheral neuropathy (CIPN) symptoms on patients' quality of life. METHODS Guided by the Medical Research Council Framework for developing and evaluating complex interventions, our intervention development process was guided by (a) findings of systematic reviews, (b) inductive analysis of 39 h of observational fieldwork, 12 patient and 11 clinician interviews, (c) deductive analysis using the Common-Sense Model to develop a Self-Regulation Model of CIPN and (d) 17 patients and 18 clinicians co-designing the intervention. RESULTS CIPN perception and coping behaviours were highlighted as processes to target when co-designing an intervention. The processes targeted in our intervention are CIPN perception and coping behaviours, namely, (a) self-monitoring of symptoms, (b) communicating and early reporting of symptoms to clinicians, (c) participating in making chemotherapy dose reduction decisions with their clinicians and (d) engaging in self-management and safety strategies to reduce impact of CIPN symptoms. To address these, a behavioural intervention was deemed suitable. CONCLUSION We developed a self-regulation model of CIPN and a logic model for documenting the proposed mechanism of action of our co-designed behavioural intervention for reducing impact of CIPN symptoms.
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Affiliation(s)
- Mary Anne Lagmay Tanay
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Jo Armes
- School of Health Sciences, Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK
| | | | | | | | - Rona Moss‐Morris
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Jose Roca
- Guy's CancerGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | | | | | - Lauren Urwin
- Oncology and Haematology Rehabilitation UnitGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | - Toni Wyatt
- Oncology and Haematology Rehabilitation UnitGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
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15
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Tierney AJ, Rafferty AM, Holloway A. 50 years since the UK's first nursing professor. J Adv Nurs 2022; 78:e132-e134. [PMID: 36183154 DOI: 10.1111/jan.15425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College, London, UK
| | - Aisha Holloway
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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16
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Woodhead C, Onwumere J, Rhead R, Bora-White M, Chui Z, Clifford N, Connor L, Gunasinghe C, Harwood H, Meriez P, Mir G, Jones Nielsen J, Rafferty AM, Stanley N, Peprah D, Hatch SL. Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff. Ethn Health 2022; 27:1555-1574. [PMID: 34092149 PMCID: PMC7614854 DOI: 10.1080/13557858.2021.1936464] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. DESIGN Twenty-five semi-structured interviews were conducted (October 2020-January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. RESULTS Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. CONCLUSIONS Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by de-contextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake.
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Affiliation(s)
- Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Naomi Clifford
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Luke Connor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cerisse Gunasinghe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paula Meriez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Ghazala Mir
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Anne Marie Rafferty
- Department of Adult Nursing, Florence Nightingale Faculty for Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Nathan Stanley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dorothy Peprah
- London School of Hygiene and Tropical Medicine, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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17
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Zaranko B, Sanford NJ, Kelly E, Rafferty AM, Bird J, Mercuri L, Sigsworth J, Wells M, Propper C. Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study. BMJ Qual Saf 2022; 32:254-263. [PMID: 36167797 PMCID: PMC10176371 DOI: 10.1136/bmjqs-2022-015291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the impact of nursing team size and composition on inpatient hospital mortality. DESIGN A retrospective longitudinal study using linked nursing staff rostering and patient data. Multilevel conditional logistic regression models with adjustment for patient characteristics, day and time-invariant ward differences estimated the association between inpatient mortality and staffing at the ward-day level. Two staffing measures were constructed: the fraction of target hours worked (fill-rate) and the absolute difference from target hours. SETTING Three hospitals within a single National Health Service Trust in England. PARTICIPANTS 19 287 ward-day observations with information on 4498 nurses and 66 923 hospital admissions in 53 inpatient hospital wards for acutely ill adult patients for calendar year 2017. MAIN OUTCOME MEASURE In-hospital deaths. RESULTS A statistically significant association between the fill-rate for registered nurses (RNs) and inpatient mortality (OR 0.9883, 95% CI 0.9773 to 0.9996, p=0.0416) was found only for RNs hospital employees. There was no association for healthcare support workers (HCSWs) or agency workers. On average, an extra 12-hour shift by an RN was associated with a reduction in the odds of a patient death of 9.6% (OR 0.9044, 95% CI 0.8219 to 0.9966, p=0.0416). An additional senior RN (in NHS pay band 7 or 8) had 2.2 times the impact of an additional band 5 RN (fill-rate for bands 7 and 8: OR 0.9760, 95% CI 0.9551 to 0.9973, p=0.0275; band 5: OR 0.9893, 95% CI 0.9771 to 1.0017, p=0.0907). CONCLUSIONS RN staffing and seniority levels were associated with patient mortality. The lack of association for HCSWs and agency nurses indicates they are not effective substitutes for RNs who regularly work on the ward.
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Affiliation(s)
| | - Natalie Jean Sanford
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, UK
| | - Elaine Kelly
- Institute for Fiscal Studies, London, UK.,The Health Foundation, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, UK
| | - James Bird
- Imperial College Healthcare NHS Trust, London, UK
| | - Luca Mercuri
- Research Informatics Team, Imperial College Healthcare NHS Trust, London, UK
| | | | - Mary Wells
- Imperial College Healthcare NHS Trust, London, UK
| | - Carol Propper
- Institute for Fiscal Studies, London, UK .,Department of Economics and Public Policy, Imperial College Business School, London, UK
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18
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Sanford N, Lavelle M, Markiewicz O, Reedy G, Rafferty AM, Darzi A, Anderson JE. Understanding complex work using an extension of the resilience CARE model: an ethnographic study. BMC Health Serv Res 2022; 22:1126. [PMID: 36068564 PMCID: PMC9450258 DOI: 10.1186/s12913-022-08482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Resilient Healthcare research centres on understanding and improving quality and safety in healthcare. The Concepts for Applying Resilience Engineering (CARE) model highlights the relationships between demand, capacity, work-as-done, work-as-imagined, and outcomes, all of which are central aspects of Resilient Healthcare theory. However, detailed descriptions of the nature of misalignments and the mechanisms used to adapt to them are still unknown. Objective The objectives were to identify and classify types of misalignments between demand and capacity and types of adaptations that were made in response to misalignments. Methods The study involved 88.5 hours of non-participant ethnographic observations in a large, teaching hospital in central London. The wards included in the study were: two surgical wards, an older adult ward, a critical care unit, and the Acute Assessment Unit (AAU), an extension unit created to expedite patient flow out of the Emergency Department. Data were collected via observations of routine clinical work and ethnographic interviews with healthcare professionals during the observations. Field notes were transcribed and thematically analysed using a combined deductive-inductive approach based on the CARE model. Results A total of 365 instances of demand-capacity misalignment were identified across the five wards included in the study. Of these, 212 had at least one observed corresponding work adaptation. Misalignments identified include equipment, staffing, process, communication, workflow, and space. Adaptations identified include process, resource redistribution, and extra-role performance. For all misalignment types observed across the five in-patient settings, process adaptations were the most frequently used adaptations. The exception to this was for staffing misalignments, which were most frequently responded to with extra-role performance adaptations. Of the three process adaptations, hospital workers most often adapted by changing how the process was done. Conclusions This study contributes a new version of the CARE model that includes types of misalignments and corresponding adaptations, which can be used to better understand work-as-done. This affords insight into the complexity of the system and how it might be improved by reducing misalignments via work system redesign or by enhancing adaptive capacity.
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Affiliation(s)
- Natalie Sanford
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, James Clerk Maxwell Building 1.32, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Mary Lavelle
- School of Psychology, Queen's University Belfast, Belfast, UK.,NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
| | - Ola Markiewicz
- NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
| | - Gabriel Reedy
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Anne Marie Rafferty
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, James Clerk Maxwell Building 1.32, 57 Waterloo Road, London, SE1 8WA, UK
| | - Ara Darzi
- NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
| | - Janet E Anderson
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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19
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Ying L, Fitzpatrick JM, Philippou J, Zhang Y, Murrells T, Rafferty AM. Front-line staff perspectives on a caring culture in Chinese hospitals: Validation of a Chinese version of the Culture of Care Barometer. J Nurs Manag 2022; 30:2093-2102. [PMID: 35506434 PMCID: PMC9796908 DOI: 10.1111/jonm.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 01/07/2023]
Abstract
AIMS The aim of this study is to examine the psychometric properties of the Chinese version of the Culture of Care Barometer in health care organizations. BACKGROUND There is a lack of tools to gauge the caring culture in Chinese hospitals. The Culture of Care Barometer is a psychometrically sound measure for caring culture developed in Western settings. METHODS This study was guided by Sousa and Rojjanasrira's methodological approach. A total of 2365 staff were recruited from two tertiary hospitals. The Barometer was administered with the Hospital Culture Evaluation Index and Minnesota Satisfaction Questionnaire. RESULTS The content validity index was calculated as 0.99. The goodness-of-fit indices, apart from the model chi-square, which was statistically significant, all exceeded established thresholds for adequate fit. The internal consistency was very satisfactory. Pearson's correlation indicated that the tool has good concurrent and convergent validity. CONCLUSIONS The Barometer is a reliable and valid instrument to assess front-line staff perspectives on a caring culture in Chinese hospitals. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers can use the Barometer to gauge the caring culture in China. Tailored interventions can be designed to address specific domains, and additional support can be provided to more vulnerable departments or staff groups.
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Affiliation(s)
- Liying Ying
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina,Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK,Department of Nursing, School of MedicineZhejiang UniversityHangzhouChina
| | - Joanne M. Fitzpatrick
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Yaping Zhang
- General Office of the AdministrationZhejiang Provincial People's HospitalHangzhouChina
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
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20
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Sermeus W, Aiken LH, Ball J, Bridges J, Bruyneel L, Busse R, De Witte H, Dello S, Drennan J, Eriksson LE, Griffiths P, Kohnen D, Köppen J, Lindqvist R, Maier CB, McHugh MD, McKee M, Rafferty AM, Schaufeli WB, Sloane DM, Alenius LS, Smith H. A workplace organisational intervention to improve hospital nurses' and physicians' mental health: study protocol for the Magnet4Europe wait list cluster randomised controlled trial. BMJ Open 2022; 12:e059159. [PMID: 35902190 PMCID: PMC9341186 DOI: 10.1136/bmjopen-2021-059159] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The increasing burden of mental distress reported by healthcare professionals is a matter of serious concern and there is a growing recognition of the role of the workplace in creating this problem. Magnet hospitals, a model shown to attract and retain staff in US research, creates positive work environments that aim to support the well-being of healthcare professionals. METHODS AND ANALYSIS Magnet4Europe is a cluster randomised controlled trial, with wait list controls, designed to evaluate the effects of organisational redesign, based on the Magnet model, on nurses' and physicians' well-being in general acute care hospitals, using a multicomponent implementation strategy. The study will be conducted in more than 60 general acute care hospitals in Belgium, England, Germany, Ireland, Norway and Sweden. The primary outcome is burnout among nurses and physicians, assessed in longitudinal surveys of nurses and physicians at participating hospitals. Additional data will be collected from them on perceived work environments, patient safety and patient quality of care and will be triangulated with data from medical records, including case mix-adjusted in-hospital mortality. The process of implementation will be evaluated using qualitative data from focus group and key informant interviews. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee Research UZ/KU Leuven, Belgium; additionally, ethics approval is obtained in all other participating countries either through a central or decentral authority. Findings will be disseminated at conferences, through peer-reviewed manuscripts and via social media. TRIAL REGISTRATION NUMBER ISRCTN10196901.
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Affiliation(s)
- Walter Sermeus
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Ball
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jackie Bridges
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Luk Bruyneel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Reinhard Busse
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | - Hans De Witte
- Occupational & Organisational Psychology and Professional Learning, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
- Optentia Research Unit, North-West University, Potchefstroom, South Africa
| | - Simon Dello
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Dorothea Kohnen
- Occupational & Organisational Psychology and Professional Learning, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Julia Köppen
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | - Rikard Lindqvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Bettina Maier
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Wilmar B Schaufeli
- Occupational & Organisational Psychology and Professional Learning, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Smeds Alenius
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Herbert Smith
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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21
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Aunger JA, Millar R, Rafferty AM, Mannion R. Collaboration over competition? Regulatory reform and inter-organisational relations in the NHS amidst the COVID-19 pandemic: a qualitative study. BMC Health Serv Res 2022; 22:640. [PMID: 35562824 PMCID: PMC9099284 DOI: 10.1186/s12913-022-08059-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2021, during the COVID-19 pandemic, England's Department of Health and Social Care (DHSC) released a White Paper outlining proposed legislative reform of the National Health Service (NHS). Key to the proposals is the shift from relationships between providers based on competition, to cooperation, as the central driver of improved performance and quality. Against this background we explore potential regulatory barriers and enablers to collaboration identified by key NHS stakeholders and assess whether the proposed policy changes are likely to deliver the desired improvement in collaborative relationships, in the context of challenges experienced during the COVID-19 pandemic. METHODS We conducted 32 semi-structured interviews with 30 key stakeholders, taking place during the COVID-19 pandemic from Jan 2020 to May 2021. Participants were selected for their expertise regarding collaboration and were recruited purposively. Interviews were conducted online with the use of video conferencing software. The interviews were thematically analysed to identify themes. Proposals contained in the DHSC White Paper helped to structure the thematic analysis, interpretation, and reporting of the results. RESULTS Requirements to compete to provide services, regulatory ability to block collaborative arrangements, lack of collaboration between providers and Clinical Commissioning Groups, and current lack of data sharing were found to hamper collaborative efforts. These issues often negatively affected collaborative relations by increasing bureaucracy and prompted leaders to attempt to avoid future collaborations. Other barriers included opaque accountability arrangements, and erosion of trust in regulators. The COVID-19 pandemic was found to foster collaboration between organisations, but some changes mandated by the new legislation may stifle further collaboration. CONCLUSIONS Many of the proposed legislative changes in the White Paper would help to remove existing barriers to service integration and collaboration identified by stakeholders. However, the proposed shift in the concentration of power from NHS England to the DHSC may exacerbate historically low levels of trust between providers and regulators. Many of the proposed changes fail to address endemic NHS policy issues such as chronic understaffing. Further dialogue is needed at all levels of the health and social care system to ensure future legislative changes meet the needs of all stakeholders.
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Affiliation(s)
- Justin Avery Aunger
- School of Health Sciences, University of Surrey, Guildford, GU2 7YH, UK. .,Health Services Management Centre, Park House, University of Birmingham, Birmingham, B15 2RT, UK.
| | - Ross Millar
- School of Health Sciences, University of Surrey, Guildford, GU2 7YH, UK.,Health Services Management Centre, Park House, University of Birmingham, Birmingham, B15 2RT, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, SE1 8WA, UK
| | - Russell Mannion
- Health Services Management Centre, Park House, University of Birmingham, Birmingham, B15 2RT, UK
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22
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Sanford N, Lavelle M, Markiewicz O, Reedy G, Rafferty AM, Darzi A, Anderson JE. Capturing challenges and trade-offs in healthcare work using the pressures diagram: An ethnographic study. Appl Ergon 2022; 101:103688. [PMID: 35121407 DOI: 10.1016/j.apergo.2022.103688] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/03/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Healthcare workers must balance competing priorities to deliver high-quality patient care. Rasmussen's Dynamic Safety Model proposed three factors that organisations must balance to maintain acceptable performance, but there has been little empirical exploration of these ideas, and little is known about the risk trade-offs workers make in practice. The aim of this study was to investigate the different pressures that healthcare workers experience, what risk trade-off decisions they make in response to pressures, and to analyse the implications for quality and safety. The study involved 88.5 h of ethnographic observations at a large, teaching hospital in central London. The analysis revealed five distinct categories of hospital pressures faced by healthcare workers: efficiency, organisational, workload, personal, and quality and safety pressures. Workers most often traded-off workload, personal, and quality and safety pressures to accommodate system-level priorities. The Pressures Diagram was developed to visualise risk trade-offs and prioritising decisions and to facilitate communication about these aspects of healthcare work.
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Affiliation(s)
- Natalie Sanford
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care King's College London, UK.
| | - Mary Lavelle
- School of Psychology, Queen's University Belfast, UK; NIHR Patient Safety and Translational Research Centre, Imperial College London, UK
| | - Ola Markiewicz
- NIHR Patient Safety and Translational Research Centre, Imperial College London, UK
| | - Gabriel Reedy
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Anne Marie Rafferty
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care King's College London, UK
| | - Ara Darzi
- NIHR Patient Safety and Translational Research Centre, Imperial College London, UK
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23
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Aunger JA, Millar R, Rafferty AM, Mannion R, Greenhalgh J, Faulks D, McLeod H. How, when, and why do inter-organisational collaborations in healthcare work? A realist evaluation. PLoS One 2022; 17:e0266899. [PMID: 35404938 PMCID: PMC9000100 DOI: 10.1371/journal.pone.0266899] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/29/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Inter-organisational collaborations (IOCs) in healthcare have been viewed as an effective approach to performance improvement. However, there remain gaps in our understanding of what helps IOCs function, as well as how and why contextual elements affect their implementation. A realist review of evidence drawing on 86 sources has sought to elicit and refine context-mechanism-outcome configurations (CMOCs) to understand and refine these phenomena, yet further understanding can be gained from interviewing those involved in developing IOCs. METHODS We used a realist evaluation methodology, adopting prior realist synthesis findings as a theoretical framework that we sought to refine. We drew on 32 interviews taking place between January 2020 and May 2021 with 29 stakeholders comprising IOC case studies, service users, as well as regulatory perspectives in England. Using a retroductive analysis approach, we aimed to test CMOCs against these data to explore whether previously identified mechanisms, CMOCs, and causal links between them were affirmed, refuted, or revised, and refine our explanations of how and why interorganisational collaborations are successful. RESULTS Most of our prior CMOCs and their underlying mechanisms were supported in the interview findings with a diverse range of evidence. Leadership behaviours, including showing vulnerability and persuasiveness, acted to shape the core mechanisms of collaborative functioning. These included our prior mechanisms of trust, faith, and confidence, which were largely ratified with minor refinements. Action statements were formulated, translating theoretical findings into practical guidance. CONCLUSION As the fifth stage in a larger project, our refined theory provides a comprehensive understanding of the causal chain leading to effective collaborative inter-organisational relationships. These findings and recommendations can support implementation of IOCs in the UK and elsewhere. Future research should translate these findings into further practical guidance for implementers, researchers, and policymakers.
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Affiliation(s)
- Justin Avery Aunger
- School of Health Sciences, Surrey Research Park, Surrey, United Kingdom
- Health Services Management Centre, Park House, University of Birmingham, Birmingham, United Kingdom
| | - Ross Millar
- Health Services Management Centre, Park House, University of Birmingham, Birmingham, United Kingdom
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Russell Mannion
- Health Services Management Centre, Park House, University of Birmingham, Birmingham, United Kingdom
| | - Joanne Greenhalgh
- Sociology and Social Policy Department, University of Leeds, Leeds, United Kingdom
| | - Deborah Faulks
- Engaging Communities Solutions, Stafford, United Kingdom
| | - Hugh McLeod
- Population Health Sciences, University of Bristol & NIHR Applied Research Collaboration West, Bristol, United Kingdom
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24
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Sims S, Harris R, Hussein S, Rafferty AM, Desai A, Palmer S, Brearley S, Adams R, Rees L, Fitzpatrick JM. Social Distancing and Isolation Strategies to Prevent and Control the Transmission of COVID-19 and Other Infectious Diseases in Care Homes for Older People: An International Review. Int J Environ Res Public Health 2022; 19:ijerph19063450. [PMID: 35329137 PMCID: PMC8955170 DOI: 10.3390/ijerph19063450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 12/18/2022]
Abstract
Older people living in care homes are at high risk of poor health outcomes and mortality if they contract COVID-19 or other infectious diseases. Measures used to protect residents include social distancing and isolation, although implementation is challenging. This review aimed to assess the social distancing and isolation strategies used by care homes to prevent and control the transmission of COVID-19 and other infectious diseases. Seven electronic databases were searched: Medline, CINAHL, Embase, PsycINFO, HMIC, Social Care Online, and Web of Science Core Collection. Grey literature was searched using MedRxiv, PDQ-Evidence, NICE Evidence Search, LTCCovid19.org and TRIP. Extracted data were synthesised using narrative synthesis and tabulation. 103 papers were included (10 empirical studies, seven literature reviews, and 86 policy documents). Strategies used to prevent and control the transmission of COVID-19 and other infectious diseases included social distancing and isolation of residents and staff, zoning and cohorting of residents, restriction of resident movement/activities, restriction of visitors and restriction of staff working patterns. This review demonstrates a lack of empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. Evaluative research on these interventions is needed urgently, focusing on the well-being of all residents, particularly those with hearing, vision or cognitive impairments.
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Affiliation(s)
- Sarah Sims
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Ruth Harris
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Shereen Hussein
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Anne Marie Rafferty
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Amit Desai
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Sinead Palmer
- Personal Social Services Research Unit, University of Kent, Canterbury CT2 7NZ, UK;
| | - Sally Brearley
- School of Nursing, Kingston University and St George’s University London, London SW17 0RE, UK;
| | | | - Lindsay Rees
- Encore Care Homes Management Ltd., Bournemouth BH8 9RL, UK;
| | - Joanne M. Fitzpatrick
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
- Correspondence:
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25
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Couper K, Murrells T, Sanders J, Anderson JE, Blake H, Kelly D, Kent B, Maben J, Rafferty AM, Taylor RM, Harris R. The impact of COVID-19 on the wellbeing of the UK nursing and midwifery workforce during the first pandemic wave: A longitudinal survey study. Int J Nurs Stud 2022; 127:104155. [PMID: 35093740 PMCID: PMC8673915 DOI: 10.1016/j.ijnurstu.2021.104155] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND The specific challenges experienced by the nursing and midwifery workforce in previous pandemics have exacerbated pre-existing professional and personal challenges, and triggered new issues. We aimed to determine the psychological impact of the COVID-19 pandemic on the UK nursing and midwifery workforce and identify potential factors associated with signs of post-traumatic stress disorder. METHODS A United Kingdom national online survey was conducted at three time-points during the first wave of the COVID-19 pandemic between April and August 2020 (T1 and T2 during initial wave; T3 at three-months following the first wave). All members of the UK registered and unregistered nursing and midwifery workforce were eligible to participate. The survey was promoted via social media and through organisational email and newsletters. The primary outcome was an Impact of Events Scale-Revised score indicative of a post-traumatic stress disorder diagnosis (defined using the cut-off score ≥33). Multivariable logistic regression modelling was used to assess the association between explanatory variables and post-traumatic stress disorder. RESULTS We received 7840 eligible responses (T1- 2040; T2- 3638; T3- 2162). Overall, 91.6% participants were female, 77.2% were adult registered nurses, and 28.7% were redeployed during the pandemic. An Impact of Events Scale-Revised score ≥33 (probable post-traumatic stress disorder) was observed in 44.6%, 37.1%, and 29.3% participants at T1, T2, and T3 respectively. At all three time-points, both personal and workplace factors were associated with probable post-traumatic stress disorder, although some specific associations changed over the course of the pandemic. Increased age was associated with reduced probable post-traumatic stress disorder at T1 and T2 (e.g. 41-50 years at T1 odds ratio (OR) 0.60, 95% confidence interval (CI) 0.42-0.86), but not at T3. Similarly, redeployment with inadequate/ no training was associated with increased probable post-traumatic stress disorder at T1 and T2, but not at T3 (T1 OR 1.37, 95% CI 1.06-1.77; T3 OR 1.17, 95% CI 0.89-1.55). A lack of confidence in infection prevention and control training was associated with increased probable post-traumatic stress disorder at all three time-points (e.g. T1 OR 1.48, 95% CI 1.11-1.97). CONCLUSION A negative psychological impact was evident 3-months following the first wave of the pandemic. Both personal and workplace are associated with adverse psychological effects linked to the COVID-19 pandemic. These findings will inform how healthcare organisations should respond to staff wellbeing needs both during the current pandemic, and in planning for future pandemics.
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Affiliation(s)
- Keith Couper
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, UK,Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green, Birmingham, B9 5SS, UK,Corresponding author
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, 57 Waterloo Road, London, SE1 8WA, UK
| | - Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - Janet E. Anderson
- School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham, NG7 2HA, UK,NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Eastgate House, Cardiff, CF24 0AB, UK
| | - Bridie Kent
- Faculty of Health, University of Plymouth, Rolle Building, Drake Circus, Plymouth, PL4 8AA, UK
| | - Jill Maben
- School of Health Sciences, University of Surrey, 30 Priestley Rd, Guildford, GU2 7YH UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, 57 Waterloo Road, London, SE1 8WA, UK
| | - Rachel M. Taylor
- Centre for Nurse, Midwife and AHP Led Research, University College London NHS Foundation Trust, 2nd Floor North, 250 Euston Rd, London NW1 2PG, UK,EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK
| | - Ruth Harris
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, 57 Waterloo Road, London, SE1 8WA, UK
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26
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Affiliation(s)
- Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College, London
| | - Aisha Holloway
- School of Health in Social Science, The University of Edinburgh
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27
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Day G, Robert G, Leedham‐Green K, Rafferty AM. An outbreak of appreciation: A discursive analysis of tweets of gratitude expressed to the National Health Service at the outset of the COVID-19 pandemic. Health Expect 2022; 25:149-162. [PMID: 34543519 PMCID: PMC8652934 DOI: 10.1111/hex.13359] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/17/2021] [Accepted: 08/27/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The early stages of the coronavirus disease 2019 pandemic prompted unprecedented displays of gratitude to healthcare workers. In the United Kingdom, gratitude was a hotly debated topic in public discourse, catalysing compelling displays of civic togetherness but also attracting criticism for being an unhelpful distraction that authorized unrealistic expectations of healthcare workers. Expressions of thanks tend to be neglected as drivers of transformation, and yet, they are important indicators of qualities to which people attach significance. OBJECTIVE This study aimed to use discursive analysis to explore how the National Health Service (NHS) was constructed in attention-attracting tweets that expressed and/or discussed gratitude to the NHS. METHODS Having determined that Twitter was the most active site for traffic relating to gratitude and the NHS, we established a corpus of 834 most-liked tweets, purposively sampled from Twitter searches on a day-by-day basis over the period of the first lockdown in the United Kingdom (22 March-28 May 2020). We developed a typology for tweets engaging with gratitude as well as analysing what the NHS was thanked for. RESULTS Our analysis, informed by a discursive psychology approach, found that the meanings attributed to gratitude were highly mobile and there were distinct patterns of activity. The NHS was predominantly-and sometimes idealistically-thanked for working, effort, saving and caring. Displays of gratitude were seen as incommensurable with failures of responsibility. The clap-for-carers campaign was a potent driver of affect, especially in the early parts of the lockdown. CONCLUSIONS The social value of gratitude is implicated in the re-evaluation of the risks and rewards of healthcare and social care work in the wake of the pandemic. We caution against cynicism about gratitude overshadowing the well-being effects that expressing and receiving gratitude can engender, particularly given concerns over the detrimental effects of the pandemic on mental health. PUBLIC CONTRIBUTION This study involves the analysis of data provided by the public and published on social media.
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Affiliation(s)
- Giskin Day
- Division of Methodologies Research, Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
- Medical Education Research Unit, School of MedicineImperial College LondonLondonUK
| | - Glenn Robert
- Division of Methodologies Research, Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | | | - Anne Marie Rafferty
- Division of Methodologies Research, Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
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28
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Hegarty S, Lamb D, Stevelink SAM, Bhundia R, Raine R, Doherty MJ, Scott HR, Marie Rafferty A, Williamson V, Dorrington S, Hotopf M, Razavi R, Greenberg N, Wessely S. 'It hurts your heart': frontline healthcare worker experiences of moral injury during the COVID-19 pandemic. Eur J Psychotraumatol 2022; 13:2128028. [PMID: 36276556 PMCID: PMC9586685 DOI: 10.1080/20008066.2022.2128028] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Moral injury is defined as the strong emotional and cognitive reactions following events which clash with someone's moral code, values or expectations. During the COVID-19 pandemic, increased exposure to Potentially Morally Injurious Events (PMIEs) has placed healthcare workers (HCWs) at risk of moral injury. Yet little is known about the lived experience of cumulative PMIE exposure and how NHS staff respond to this. Objective: We sought to rectify this knowledge gap by qualitatively exploring the lived experiences and perspectives of clinical frontline NHS staff who responded to COVID-19. Methods: We recruited a diverse sample of 30 clinical frontline HCWs from the NHS CHECK study cohort, for single time point qualitative interviews. All participants endorsed at least one item on the 9-item Moral Injury Events Scale (MIES) [Nash et al., 2013. Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646-652] at six month follow up. Interviews followed a semi-structured guide and were analysed using reflexive thematic analysis. Results: HCWs described being routinely exposed to ethical conflicts, created by exacerbations of pre-existing systemic issues including inadequate staffing and resourcing. We found that HCWs experienced a range of mental health symptoms primarily related to perceptions of institutional betrayal as well as feeling unable to fulfil their duty of care towards patients. Conclusion: These results suggest that a multi-facetted organisational strategy is warranted to prepare for PMIE exposure, promote opportunities for resolution of symptoms associated with moral injury and prevent organisational disengagement. HIGHLIGHTS Clinical frontline healthcare workers (HCWs) have been exposed to an accumulation of potentially morally injurious events (PMIEs) throughout the COVID-19 pandemic, including feeling betrayed by both government and NHS leaders as well as feeling unable to provide duty of care to patients.HCWs described the significant adverse impact of this exposure on their mental health, including increased anxiety and depression symptoms and sleep disturbance.Most HCWs interviewed believed that organisational change within the NHS was necessary to prevent excess PMIE exposure and promote resolution of moral distress.
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Affiliation(s)
- Siobhan Hegarty
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Danielle Lamb
- Department of Applied Health Research, University College London, London, UK
| | - Sharon A M Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Rupa Bhundia
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | | | - Hannah R Scott
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Victoria Williamson
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Reza Razavi
- King's Wellcome Trust EPSRC Centre For Medical Engineering, London, UK
| | - Neil Greenberg
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
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Härkänen M, Vehviläinen-Julkunen K, Franklin BD, Murrells T, Rafferty AM. Factors Related to Medication Administration Incidents in England and Wales Between 2007 and 2016: A Retrospective Trend Analysis. J Patient Saf 2021; 17:e850-e857. [PMID: 32168268 DOI: 10.1097/pts.0000000000000639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to describe medication administration incidents reported in England and Wales between 2007 and 2016, to identify which factors (reporting year, type of incident, patients' age) are most strongly related to reported severity of medication administration incidents, and to assess the extent to which relevant information was underreported or indeterminate. METHODS Medication administration incidents reported to the National Reporting & Learning System between January 1, 2007, and December 31, 2016 were obtained. Characteristics of the data were described using frequencies, and relationships between variables were explored using cross-tabulation. RESULTS A total of 517,384 incident reports were analyzed. Of these, 97.1% (n = 502,379) occurred in acute/general hospitals, mostly on wards (69.1%, n = 357,463), with medicine the most common specialty area (44.5%, n = 230,205). Medication errors were most commonly omitted doses (25.8%, n = 133,397). The majority did not cause patient harm (83.5%, n = 432,097). When only incidents causing severe harm or death (n = 1,116) were analyzed, the most common type of error was omitted doses (24.1%). Most incidents causing severe harm or death occurred in patients aged 56 years or older. For the 10-year period, the percentage of incidents with "no harm" increased (74.1% in 2007 to 86.3% in 2016). For some variables, data were often missing or indeterminate, which has implications for data analysis. CONCLUSIONS Medication administration incidents that do not cause harm are increasingly reported, whereas incidents reported as severe harm and death have declined. Data quality needs to be improved. Underreporting and indeterminate data, inaccuracies in reporting, and coding jeopardize the overall usefulness of these data.
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Affiliation(s)
- Marja Härkänen
- From the Department of Nursing Science, University of Eastern Finland
| | | | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Charing Cross Hospital, Imperial College Healthcare NHS Trust and UCL School of Pharmacy
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
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30
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Oates J, Topping A, Ezhova I, Wadey E, Rafferty AM. Factors affecting high secure forensic mental health nursing workforce sustainability: Perspectives from frontline nurses and stakeholders. J Psychiatr Ment Health Nurs 2021; 28:1041-1051. [PMID: 33565661 DOI: 10.1111/jpm.12740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/19/2020] [Accepted: 01/26/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: There are insufficient nurses to meet current demand for mental health care. This is an international concern. Within England, the impact of staff shortages on the quality of patient care in forensic high secure settings has been highlighted by the national regulatory body for hospitals. Forensic hospital nursing is a distinct specialism within mental health. Forensic nurses must negotiate the therapeutic, ethical and practical challenges of caring for high-risk patients in a locked environment. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: There has been no previous study to ask frontline high secure forensic nurses, union representatives, senior nurses and workforce leads about what factors may be affecting recruitment and retention in their setting. As well as the specialized and challenging nature of the work, participants identified that workforce sustainability was affected by unequal working terms and conditions, the hospital locations and wider national factors, such as changes to how nurse training was funded. They also identified that some strategies that were employed to address workforce shortages, such as day-to-day movement of staff within the hospital and incentive packages for new recruits could be demotivating for established staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Forensic high secure nursing workforce strategies should include training, development and career pathways that are specific to the specialism and extend beyond preceptorship for newly qualified staff. There should be clear and equitable employment terms and conditions with remuneration packages that are consistent within and between organizations. Hospital managers should address the effect that movement of staff between wards may have on nurses' morale, therapeutic relationships and safety culture. ABSTRACT: Introduction There has been no previous study of stakeholders' views on recruitment and retention concerns in high secure forensic settings. Aim To identify factors affecting recruitment and retention in high secure hospitals, from the perspectives of stakeholders with experience in forensic mental health nursing. Method Framework analysis of data from fifteen interviews and three focus groups with frontline nurses, nurse leaders, recruitment leads and union representatives from three high secure hospitals in England. Results Six themes emerged from the data: (a) the unique nature of high secure nursing; (b) the impact of short staffing; (c) wider factors affecting the high secure nursing workforce; (d) the location; (e) staff being on different terms and conditions of work; (f) recruitment strategies. Discussion Multiple factors are likely to simultaneously affect high secure hospital recruitment and retention. Findings on the unique nature of high secure work reflect previous qualitative research. The themes of location, working terms and condition and recruitment strategies have not been previously identified in forensic nursing research. Implications for practice Employers should ensure that employment terms and conditions are equitable and consistent. Furthermore, hospital managers should address the effect that movement of staff between wards may have on morale and therapeutic relationships.
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Affiliation(s)
- Jennifer Oates
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Alice Topping
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Camden & Islington NHS Foundation Trust, London, UK
| | - Ivanka Ezhova
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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31
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Sugg HVR, Russell AM, Morgan LM, Iles-Smith H, Richards DA, Morley N, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Kent M, Logan PA, Rafferty AM, Shepherd MH, Singh SJ, Tooze SJ, Whear R. Fundamental nursing care in patients with the SARS-CoV-2 virus: results from the 'COVID-NURSE' mixed methods survey into nurses' experiences of missed care and barriers to care. BMC Nurs 2021; 20:215. [PMID: 34724949 PMCID: PMC8558545 DOI: 10.1186/s12912-021-00746-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Patient experience of nursing care is associated with safety, care quality, treatment outcomes, costs and service use. Effective nursing care includes meeting patients’ fundamental physical, relational and psychosocial needs, which may be compromised by the challenges of SARS-CoV-2. No evidence-based nursing guidelines exist for patients with SARS-CoV-2. We report work to develop such a guideline. Our aim was to identify views and experiences of nursing staff on necessary nursing care for inpatients with SARS-CoV-2 (not invasively ventilated) that is omitted or delayed (missed care) and any barriers to this care. Methods We conducted an online mixed methods survey structured according to the Fundamentals of Care Framework. We recruited a convenience sample of UK-based nursing staff who had nursed inpatients with SARS-CoV-2 not invasively ventilated. We asked respondents to rate how well they were able to meet the needs of SARS-CoV-2 patients, compared to non-SARS-CoV-2 patients, in 15 care categories; select from a list of barriers to care; and describe examples of missed care and barriers to care. We analysed quantitative data descriptively and qualitative data using Framework Analysis, integrating data in side-by-side comparison tables. Results Of 1062 respondents, the majority rated mobility, talking and listening, non-verbal communication, communicating with significant others, and emotional wellbeing as worse for patients with SARS-CoV-2. Eight barriers were ranked within the top five in at least one of the three care areas. These were (in rank order): wearing Personal Protective Equipment, the severity of patients’ conditions, inability to take items in and out of isolation rooms without donning and doffing Personal Protective Equipment, lack of time to spend with patients, lack of presence from specialised services e.g. physiotherapists, lack of knowledge about SARS-CoV-2, insufficient stock, and reluctance to spend time with patients for fear of catching SARS-CoV-2. Conclusions Our respondents identified nursing care areas likely to be missed for patients with SARS-CoV-2, and barriers to delivering care. We are currently evaluating a guideline of nursing strategies to address these barriers, which are unlikely to be exclusive to this pandemic or the environments represented by our respondents. Our results should, therefore, be incorporated into global pandemic planning. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00746-5.
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Affiliation(s)
- Holly V R Sugg
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Leila M Morgan
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Allerton Building, Frederick Rd, Salford, M6 6PU, UK.,Northern Care Alliance NHS Group, Stott Lane, Salford, M6 8HD, UK
| | - David A Richards
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063, Bergen, Norway
| | - Naomi Morley
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sarah Burnett
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Emma J Cockcroft
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Jo Thompson Coon
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | | | - Faye E Doris
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Harriet A Hunt
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Merryn Kent
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Philippa A Logan
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Anne Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, SE1 8WA, UK
| | - Maggie H Shepherd
- NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.,Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, University Road, Leicester, LE1 7RH, UK.,University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Susannah J Tooze
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Rebecca Whear
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Tanay MAL, Robert G, Rafferty AM, Moss-Morris R, Armes J. Clinician and patient experiences when providing and receiving information and support for managing chemotherapy-induced peripheral neuropathy: A qualitative multiple methods study. Eur J Cancer Care (Engl) 2021; 31:e13517. [PMID: 34643016 PMCID: PMC9286565 DOI: 10.1111/ecc.13517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/13/2021] [Accepted: 09/24/2021] [Indexed: 02/06/2023]
Abstract
Objective To improve patient experience of chemotherapy‐induced peripheral neuropathy (CIPN), it is crucial to identify how patients develop their understanding and perception of CIPN. A wider understanding of the experiences of clinicians who provide CIPN information and support is also needed. This study explored clinician and patient experience of the provision of care, information and support for CIPN. Methods Data were collected between July and November 2019 using multiple qualitative methods. Non‐participant observations were undertaken in colorectal and breast cancer clinics and at clinician stations, including the observation of chemotherapy consultations between patients and clinicians. Semi‐structured interviews with people with cancer and clinicians were also conducted. Data were analysed using inductive reflexive thematic analysis. Results Three major themes emerged: (1) CIPN is a hidden chemotherapy side effect, (2) assessment and management of CIPN is disconnected and (3) patients and clinicians expect openness in CIPN symptom reporting, information provision and management. Conclusion Findings show the need to address the lack of patients' overall familiarity with CIPN. Echoing earlier studies, our findings suggest that knowledge and understanding about CIPN among clinicians are limited or lacking. These insights from patient and clinicians' CIPN experiences can inform future interventions that may address the genuine needs of patients and enhance CIPN support.
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Affiliation(s)
- Mary Anne Lagmay Tanay
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Rona Moss-Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jo Armes
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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33
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Rose L, Yu L, Casey J, Cook A, Metaxa V, Pattison N, Rafferty AM, Ramsay P, Saha S, Xyrichis A, Meyer J. Communication and Virtual Visiting for Families of Patients in Intensive Care during the COVID-19 Pandemic: A UK National Survey. Ann Am Thorac Soc 2021; 18:1685-1692. [PMID: 33617747 PMCID: PMC8522289 DOI: 10.1513/annalsats.202012-1500oc] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/19/2021] [Indexed: 12/21/2022] Open
Abstract
Rationale: Restriction or prohibition of family visiting intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic poses substantial barriers to communication and family- and patient-centered care. Objectives: To understand how communication among families, patients, and the ICU team was enabled during the pandemic. The secondary objectives were to understand strategies used to facilitate virtual visiting and associated benefits and barriers. Methods: A multicenter, cross-sectional, and self-administered electronic survey was sent (June 2020) to all 217 UK hospitals with at least one ICU. Results: The survey response rate was 54%; 117 of 217 hospitals (182 ICUs) responded. All hospitals imposed visiting restrictions, with visits not permitted under any circumstance in 16% of hospitals (28 ICUs); 63% (112 ICUs) of hospitals permitted family presence at the end of life. The responsibility for communicating with families shifted with decreased bedside nurse involvement. A dedicated ICU family-liaison team was established in 50% (106 ICUs) of hospitals. All but three hospitals instituted virtual visiting, although there was substantial heterogeneity in the videoconferencing platform used. Unconscious or sedated ICU patients were deemed ineligible for virtual visits in 23% of ICUs. Patients at the end of life were deemed ineligible for virtual visits in 7% of ICUs. Commonly reported benefits of virtual visiting were reducing patient psychological distress (78%), improving staff morale (68%), and reorientation of patients with delirium (47%). Common barriers to virtual visiting were related to insufficient staff time, rapid implementation of videoconferencing technology, and challenges associated with family members' ability to use videoconferencing technology or access a device. Conclusions: Virtual visiting and dedicated communication teams were common COVID-19 pandemic innovations addressing the restrictions to family ICU visiting, and they resulted in valuable benefits in terms of patient recovery and staff morale. Enhancing access and developing a more consistent approach to family virtual ICU visits could improve the quality of care, both during and outside of pandemic conditions.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, and
| | - Lisa Yu
- King’s Health Partners, London, United Kingdom
| | | | - Amelia Cook
- Cicely Saunders Institute, King’s College London, London,United Kingdom
| | | | - Natalie Pattison
- East and North Hertfordshire National Health Service Trust, Hertfordshire, United Kingdom
- University of Hertfordshire, Hertfordshire, United Kingdom
| | | | - Pam Ramsay
- University of Dundee, Dundee, United Kingdom; and
| | - Sian Saha
- King's College Hospital, London, United Kingdom
| | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, and
| | - Joel Meyer
- Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
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Fitzpatrick JM, Rafferty AM, Hussein S, Ezhova I, Palmer S, Adams R, Rees L, Brearley S, Sims S, Harris R. Protecting older people living in care homes from COVID-19: a protocol for a mixed-methods study to understand the challenges and solutions to implementing social distancing and isolation. BMJ Open 2021; 11:e050706. [PMID: 34348955 PMCID: PMC8342044 DOI: 10.1136/bmjopen-2021-050706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/16/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Older people living in residential and nursing care homes often have complex needs and are at high risk of poor health outcomes and mortality, especially if they contract COVID-19. Care homes use infection prevention and control measures such as social distancing and isolating residents to protect them from COVID-19. The care home sector has stated that implementing social distancing and isolation when caring for residents is a significant challenge. This paper presents the protocol of a mixed-methods study to explore and understand the real-life experiences of implementing social distancing and isolation of residents in care homes for older people from the perspective of residents, families/friends and staff working in and with care homes. The study aims to develop a toolkit of resources for health and care delivery now and for future outbreaks of infectious diseases. METHODS AND ANALYSIS The study will be conducted in three phases. Phase 1 is a rapid review of evidence to collate knowledge on the mechanisms and measures used by care homes and long-term facilities to socially distance and isolate older people or control the spread of other infectious and contagious diseases. The review results will contribute to participant interviews in phase 2 and toolkit development in phase 3. Phase 2 will involve case studies with six care homes in England, involving the conduct of individual interviews with residents, families and friends, and staff, collection of care home policies and protocols related to social distancing and isolation for residents, and routinely collected care home data. A focus group with a purposive sample of external key informants will also be conducted. Phase 3, synthesising findings from phases 1 and 2, will inform the codesign of a toolkit of resources for residents, families/friends and care homes. ETHICS AND DISSEMINATION The study has been approved by Coventry and Warwick Research Ethics Committee (20/WM/0318). To maximise impact, we will work closely with the Study Committees and the Patient and Public Involvement group to ensure the findings reach key stakeholders, including residents, families/friends, care homes, commissioners and organisations representing care home providers. We will disseminate the study outputs in peer-reviewed and professional journals, at professional conferences and via other knowledge transfer activities with the care home sector, and resident and carer organisations. The toolkit comprising evidence-informed guidance and resources and a mosaic film will be hosted on a project webpage. REGISTRATION DETAILS This project is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (Project reference NIHR132541). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. PROSPERO REGISTRATION NUMBER CRD42021226734.
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Affiliation(s)
- Joanne M Fitzpatrick
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Shereen Hussein
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Ivanka Ezhova
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sinead Palmer
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | | | | | - Sally Brearley
- Kingston University and St George's University of London, London, UK
| | - Sarah Sims
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Ruth Harris
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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35
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Porcel‐Gálvez AM, Fernández‐García E, Rafferty AM, Gil‐García E, Romero‐Sánchez JM, Barrientos‐Trigo S. Factors That Influence Nurse Staffing Levels in Acute Care Hospital Settings. J Nurs Scholarsh 2021; 53:468-478. [PMID: 33876892 PMCID: PMC8360162 DOI: 10.1111/jnu.12649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/02/2020] [Accepted: 01/15/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To identify which patient and hospital characteristics are related to nurse staffing levels in acute care hospital settings. DESIGN A cross-sectional design was used for this study. METHODS The sample comprised 1,004 patients across 10 hospitals in the Andalucian Health Care System (southern Spain) in 2015. The sampling was carried out in a stratified, consecutive manner on the basis of (a) hospital size by geographical location, (b) type of hospital unit, and (c) patients' sex and age group. Random criteria were used to select patients based on their user identification in the electronic health record system. The variables were grouped into two categories, patient and hospital characteristics. Multilevel linear regression models (MLMs) with random intercepts were used. Two models were fitted: the first was the null model, which contained no explanatory variables except the intercepts (fixed and random), and the second (explanatory) model included selected independent variables. Independent variables were allowed to enter the explanatory model if their univariate association with the nurse staffing level in the MLM was significant at p < .05. RESULTS Two hierarchical levels were established to control variance (patients and hospital). The model variables explained 63.4% of the variance at level 1 (patients) and 71.8% at level 2 (hospital). Statistically significant factors were the type of hospital unit (p = .002), shift (p < .001), and season (p < .001). None of the variables associated with patient characteristics obtained statistical significance in the model. CONCLUSIONS Nurse staffing levels were associated with hospital characteristics rather than patient characteristics. CLINICAL RELEVANCE This study provides evidence about factors that impact on nurse staffing levels in the settings studied. Further studies should determine the influence of patient characteristics in determining optimal nurse staffing levels.
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Affiliation(s)
- Ana María Porcel‐Gálvez
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
| | - Elena Fernández‐García
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
| | - Anne Marie Rafferty
- Professor of Nursing PolicyAdult Nursing DepartmentFlorence Nightingale School of Nursing and Midwifery, King’s CollegeLondonUK
| | - Eugenia Gil‐García
- Associate Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
| | - José Manuel Romero‐Sánchez
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, Seville, Spain, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1019 “Nursing methods and standardized languages (MELES)”Universidad de CádizCádizSpain
| | - Sergio Barrientos‐Trigo
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
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Lamb D, Greenberg N, Hotopf M, Raine R, Razavi R, Bhundia R, Scott H, Carr E, Gafoor R, Bakolis I, Hegarty S, Souliou E, Rafferty AM, Rhead R, Weston D, Gnangapragasam S, Marlow S, Wessely S, Stevelink S. NHS CHECK: protocol for a cohort study investigating the psychosocial impact of the COVID-19 pandemic on healthcare workers. BMJ Open 2021; 11:e051687. [PMID: 34193505 PMCID: PMC8249177 DOI: 10.1136/bmjopen-2021-051687] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had profound effects on the working lives of healthcare workers (HCWs), but the extent to which their well-being and mental health have been affected remains unclear. This longitudinal cohort study aims to recruit a cohort of National Health Service (NHS) HCWs, conducting surveys at regular intervals to provide evidence about the prevalence of symptoms of mental disorders, and investigate associated factors such as occupational contexts and support interventions available. METHODS AND ANALYSIS All staff, students and volunteers working in the 18 participating NHS Trusts in England will be sent emails inviting them to complete a survey at baseline, with email invitations for the follow-up surveys sent 6 months and 12 months later. Opening in late April 2020, the baseline survey collects data on demographics, occupational/organisational factors, experiences of COVID-19, validated measures of symptoms of poor mental health (eg, depression, anxiety, post-traumatic stress disorder), and constructs such as resilience and moral injury. These surveys will be complemented by in-depth psychiatric interviews with a sample of HCWs. Qualitative interviews will also be conducted, to gain deeper understanding of the support programmes used or desired by staff, and facilitators and barriers to accessing such programmes. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the Health Research Authority (reference: 20/HRA/210, IRAS: 282686) and local Trust Research and Development approval. Cohort data are collected via Qualtrics online survey software, pseudonymised and held on secure university servers. Participants are aware that they can withdraw from the study at any time, and there is signposting to support services if participants feel they need it. Only those consenting to be contacted about further research will be invited to participate in further components. Findings will be rapidly shared with NHS Trusts, and via academic publications in due course.
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Affiliation(s)
- Danielle Lamb
- Department of Applied Health Research, University College London, London, UK
| | - Neil Greenberg
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Reza Razavi
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rupa Bhundia
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hannah Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ewan Carr
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rafael Gafoor
- Department of Applied Health Research, University College London, London, UK
| | - Ioannis Bakolis
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Siobhan Hegarty
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emilia Souliou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anne Marie Rafferty
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Rhead
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Danny Weston
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sam Gnangapragasam
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sally Marlow
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sharon Stevelink
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Jacob N, Burton C, Hale R, Jones A, Lloyd A, Rafferty AM, Allen D. Pro-judge study: Nurses' professional judgement in nurse staffing systems. J Adv Nurs 2021; 77:4226-4233. [PMID: 34138491 DOI: 10.1111/jan.14921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022]
Abstract
AIMS Aim of this study is to better understand the role of nurses' professional judgment in nurse staffing systems. DESIGN Qualitative comparative case study design of nurse staffing systems in England and Wales. METHODS Data will be collected through a variety of sources: individual interviews, observations of relevant meetings and analysis of key documents. Ethical approval for the study was granted in August 2020 from The Healthcare Research Ethics Committee (SREC reference: REC741). Data generation will be informed by science and technology studies and practice theories. DISCUSSION Ensuring adequate numbers of nurses are available to care for patients in response to shifting demand is an international policy priority. Emerging evidence on the use of formal workforce planning methodologies across the developed world highlights both the centrality of nurses' professional judgement in nurse staffing methodologies and the urgent need for theoretically informed research to better understand and conceptualise its contribution to decision-making. This study is designed to address this gap in understanding. It takes advantage of nurses' experiences of managing the service and staffing impacts of the Covid-19 pandemic and differences in strategic approaches to nurse staffing systems between England and Wales. IMPACT The research will: make visible the knowledge and skills that underpin professional judgement in nurse staffing decisions and provide a conceptual language with which to articulate this; lay the foundations for evidence-based programmes of nurse education and continuing professional development; furnish the evidence to inform the development of nurse-led decision support tools to augment professional judgement; and generate wider insights into the effectiveness of nurse staffing systems in practice.
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Affiliation(s)
- Nina Jacob
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Chris Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Rachel Hale
- School of Psychology, Cardiff University, Cardiff, UK
| | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Anne Marie Rafferty
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Richards DA, Sugg HV, Cockcroft E, Cooper J, Cruickshank S, Doris F, Hulme C, Logan P, Iles-Smith H, Melendez-Torres GJ, Rafferty AM, Reed N, Russell AM, Shepherd M, Singh SJ, Thompson Coon J, Tooze S, Wootton S, Abbott R, Bethel A, Creanor S, Quinn L, Tripp H, Warren FC, Whear R, Bollen J, Hunt HA, Kent M, Morgan L, Morley N, Romanczuk L. COVID-NURSE: evaluation of a fundamental nursing care protocol compared with care as usual on experience of care for noninvasively ventilated patients in hospital with the SARS-CoV-2 virus-protocol for a cluster randomised controlled trial. BMJ Open 2021; 11:e046436. [PMID: 34039574 PMCID: PMC8159671 DOI: 10.1136/bmjopen-2020-046436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/21/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Patient experience of nursing care is correlated with safety, clinical effectiveness, care quality, treatment outcomes and service use. Effective nursing care includes actions to develop nurse-patient relationships and deliver physical and psychosocial care to patients. The high risk of transmission of the SARS-CoV-2 virus compromises nursing care. No evidence-based nursing guidelines exist for patients infected with SARS-CoV-2, leading to potential variations in patient experience, outcomes, quality and costs. METHODS AND ANALYSIS: we aim to recruit 840 in-patient participants treated for infection with the SARS-CoV-2 virus from 14 UK hospitals, to a cluster randomised controlled trial, with embedded process and economic evaluations, of care as usual and a fundamental nursing care protocol addressing specific areas of physical, relational and psychosocial nursing care where potential variation may occur, compared with care as usual. Our coprimary outcomes are patient-reported experience (Quality from the Patients' Perspective; Relational Aspects of Care Questionnaire); secondary outcomes include care quality (pressure injuries, falls, medication errors); functional ability (Barthell Index); treatment outcomes (WHO Clinical Progression Scale); depression Patient Health Questionnaire-2 (PHQ-2), anxiety General Anxiety Disorder-2 (GAD-2), health utility (EQ5D) and nurse-reported outcomes (Measure of Moral Distress for Health Care Professionals). For our primary analysis, we will use a standard generalised linear mixed-effect model adjusting for ethnicity of the patient sample and research intensity at cluster level. We will also undertake a planned subgroup analysis to compare the impact of patient-level ethnicity on our primary and secondary outcomes and will undertake process and economic evaluations. ETHICS AND DISSEMINATION Research governance and ethical approvals are from the UK National Health Service Health Research Authority Research Ethics Service. Dissemination will be open access through peer-reviewed scientific journals, study website, press and online media, including free online training materials on the Open University's FutureLearn web platform. TRIAL REGISTRATION NUMBER ISRCTN13177364; Pre-results.
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Affiliation(s)
- David A Richards
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Holly Vr Sugg
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma Cockcroft
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Joanne Cooper
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Faye Doris
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Claire Hulme
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Phillipa Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | | | - G J Melendez-Torres
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Nigel Reed
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne-Marie Russell
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Maggie Shepherd
- NIHR Clinical Research Facility, University of Exeter, Exeter, UK
| | - Sally J Singh
- Cardiac/Pulmonary Rehabilitation, Leicester Royal Infirmary, Leicester, UK
| | - Jo Thompson Coon
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Susannah Tooze
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Stephen Wootton
- Insitute of Human Nutrition, University of Southampton, Southampton, UK
| | - Rebecca Abbott
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Alison Bethel
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Lynne Quinn
- Clinical Trials Unit, University of Exeter, Exeter, UK
| | - Harry Tripp
- Clinical Trials Unit, University of Exeter, Exeter, UK
| | - Fiona C Warren
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca Whear
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Harriet A Hunt
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Merryn Kent
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Leila Morgan
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Naomi Morley
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Lidia Romanczuk
- NIHR Clinical Research Facility, University of Exeter, Exeter, UK
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Donetto S, Desai A, Zoccatelli G, Allen D, Brearley S, Rafferty AM, Robert G. Patient experience data as enacted: Sociomaterial perspectives and 'singular-multiples' in health care quality improvement research. Sociol Health Illn 2021; 43:1032-1050. [PMID: 33834517 DOI: 10.1111/1467-9566.13276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/19/2021] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
Over the last three decades, sociomaterial approaches to the study of health care practices have made an important contribution to the sociology of health care. Significant attention has been paid to the role of technology and artefacts in health care and the operation of actor-networks but less space has been given to questions of ontological multiplicity in health care practices. In this paper, we draw upon our study of patient experience data in five acute hospitals in England to illustrate how treating patient experience data as 'singular-multiples' can enable useful insights into patient experience data work in health care organisations. Our data was generated during 12 months of fieldwork at five participating hospitals and included organisational documents, field notes, informal and formal interviews with frontline and managerial staff and patient representatives at the study sites. We use the examples of the Friends and Family Test (FFT) and the National Cancer Patient Experience Survey (NCPES) in England to consider the multiple nature of data as it is enacted in practice and the work data does when coordinated as an entity in the singular. We argue that, and discuss how, the sociomaterial insights we discuss here are relevant to health care quality and improvement research and practice.
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Affiliation(s)
- Sara Donetto
- Methodologies Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Amit Desai
- Methodologies Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Giulia Zoccatelli
- Methodologies Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sally Brearley
- Independent Patient and Public Involvement Advisor, Sutton, UK
| | - Anne Marie Rafferty
- Methodologies Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Glenn Robert
- Methodologies Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Abstract
OBJECTIVE To identify, appraise and synthesise evidence of interventions designed to promote family member involvement in adult critical care units; and to develop a working typology of interventions for use by health professionals and family members. DESIGN Mixed-method systematic review. DATA SOURCES Bibliographic databases were searched without date restriction up to June 2019: MEDLINE, EMBASE and CINAHL; the Cochrane Central Register of Controlled Trials, Joanna Briggs and Cochrane Libraries. Back issues of leading critical care and patient experience journals were manually searched, as were the reference lists of included studies. All evaluation studies of relevant intervention activities were included; all research designs and outcome measures were eligible. Due to heterogeneity in interventions, designs and outcome measures, the synthesis followed a narrative approach. Service users met with the research team termly. RESULTS Out of 4962 possible citations, a total of 20 studies were included. The overall evidence base was assessed as moderate to weak. Six categories of interventions were identified: environmental unit changes (n=2), web-based support (n=4), discussion-based support (n=6), multicomponent support (n=4), participation in rounds (n=3) and participation in physical care (n=1). Clinical and methodological heterogeneity across studies hindered meta-analysis, hence a narrative synthesis was pursued. Six main outcomes were identified, grouped under two categories: (i) involvement outcomes: communication (mean difference ranged from 6.39 to 8.83), decision-making (mean difference ranged from -0.8 to 5.85), satisfaction (mean difference ranged from 0.15 to 2.48); and (ii) health outcomes: family trauma (mean difference ranged from -7.12 to 0.9), family well-being (mean difference ranged from -0.7 to -4), patient outcomes (relative risk ranged from 1.27 to 4.91). The findings from the qualitative studies were thematically analysed to identify features of the interventions that participants perceived to influence effectiveness. Synthesised into five overarching categories (practicality, development, interaction, reflexivity and bridging), these can serve as principles to inform the future design and development of more refined family member involvement interventions. CONCLUSIONS Future interventions should be developed with much closer family member input and designed by considering the key features we identified. We call for future interventions to be multilayered and allow for a greater or lesser level, and different kinds, of involvement for family members. Choice of intervention should be informed by a baseline diagnostic of family members' needs, readiness and preparedness for involvement. PROSPERO REGISTRATION CRD42018086325.
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Affiliation(s)
- Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Simon Fletcher
- Health, Social Care and Education, Kingston and St Georges University London, London, England, UK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Sally Brearley
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Marius Terblanche
- Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
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Vaughan L, Bardsley M, Bell D, Davies M, Goddard A, Imison C, Melnychuk M, Morris S, Rafferty AM. Models of generalist and specialist care in smaller hospitals in England: a mixed-methods study. Health Serv Deliv Res 2021. [DOI: 10.3310/hsdr09040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The increasing number of older, complex patients who require emergency admission to hospital has prompted calls for better models of medical generalist care, especially for smaller hospitals, whose size constrains resources and staffing.
Objective
To investigate the strengths and weaknesses of the current models of medical generalism used in smaller hospitals from patient, professional and service perspectives.
Methods
The design was a mixed-methods study. Phase 1 was a scoping and mapping exercise to create a typology of models of care, which was then explored further through 11 case studies. Phase 2 created a classification using the Hospital Episode Statistics of acute medical ‘generalist’ and ‘specialist’ work and described differences in workload and explored the links between case mix, typology and length of stay and between case mix and skill mix. Phase 3 analysed the relationships between models of care and patient-level costs. Phase 4 examined the strengths and weaknesses of the models of care through focus groups, a discrete choice experiment and an exploration of the impact of typology on other outcomes.
Results
In total, 50 models of care were explored through 48 interviews. A typology was constructed around generalist versus specialist patterns of consultant working. Twenty-five models were deployed by 48 hospitals, and no more than four hospitals used any one model of care. From the patient perspective, analysis of Hospital Episode Statistics data of 1.9 million care episodes found that the differences in case mix between hospitals were relatively small, with 65–70% of episodes accounted for by 20 case types. The skill mix of hospital staff varied widely; there were no relationships with case mix. Patients exhibited a preference for specialist care in the discrete choice experiment but indicated in focus groups that overall hospital quality was more important. From a service perspective, qualitative work found that models of care were contingent on complex constellations of factors, including staffing, the local hospital environment and policy imperatives. Neither the model of care nor the case mix accounted for variability in the length of stay (no associations were significant at p < 0.05). No significant differences were found in the costs of the models. Professionally, the preferences of doctors for specialist versus generalist work depended on their experiences of providing care and were associated with a healthy organisational culture and a co-operative approach to managing emergency work. Concepts of medical generalism were found to be complex and difficult to define, with theoretical models differing markedly from models in action.
Limitations
Smaller hospitals in multisite trusts were excluded, potentially leading to sample bias. The rapidly changing nature of the models limited the analysis of typology against outcomes.
Conclusions
The case mix of smaller hospitals was dominated by patients with presentations amenable to generalist approaches to care; however, there was no evidence to support any particular pattern of consultant working. Matching hospital staff to better meet local need and the creation of more collaborative working environments appear more likely to improve care in smaller hospitals than changing models.
Future work
The exploration of the relationships between workforce, measures of hospital culture, models of care, costs and outcomes in both smaller and larger hospitals is urgently required to underpin service reforms.
Study registration
This study is registered as Integrated Research Application System project ID 191393.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
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Abstract
Research into gratitude as a significant sociological and psychological phenomenon has proliferated in the past two decades. However, there is little consensus on how it should be conceptualized or investigated empirically. We present a meta-narrative review that focuses on gratitude in health care, with an emphasis on research exploring interpersonal experiences in the context of care provision. Six meta-narratives from literatures across the humanities, sciences, and medicine are identified, contextualized, and discussed: gratitude as social capital; gifts; care ethics; benefits of gratitude; gratitude and staff well-being; and gratitude as an indicator of quality of care. Meta-narrative review was a valuable framework for making sense of theoretical antecedents and findings in this developing area of research. We conclude that greater attention needs to be given to what constitutes "evidence" in gratitude research and call for qualitative studies to better understand and shape the role and implications of gratitude in health care.
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Affiliation(s)
- Giskin Day
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
- School of Medicine, Imperial College London, London, United Kingdom
- Giskin Day, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, James Clerk Maxwell Building, 27 Waterloo Road, London SE1 8WA, UK.
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
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Horseman Z, Hamilton S, Noble H, Jones A, Rafferty AM, Holloway A, Reid J, Harris R, Smith P, Kelly D. Identifying the challenges and opportunities of the executive nurse director role in the UK: a scoping review. Nurs Manag (Harrow) 2020; 27:21-27. [PMID: 33058593 DOI: 10.7748/nm.2020.e1948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 11/09/2022]
Abstract
The executive nurse director role is complex and there is significant variation in the expectations and responsibilities placed on it. The main function of the role is to deliver the nursing agenda and ensure that safety and quality remain the focus of the executive board. However, it is unclear what evidence exists regarding the challenges and opportunities experienced by executive nurse directors. This scoping review, undertaken as part of the Stronger Study, explores the literature published from 2009 onwards on the challenges and opportunities affecting executive nurse directors' ability to deliver the nursing agenda in the UK. Findings from the review suggest that the importance attached to the executive nurse director role is not matched by the amount of research available. Strengthening the executive nurse director role requires a stronger evidence base and an awareness of the benefits of the role.
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Affiliation(s)
- Zoe Horseman
- School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland
| | - Sharon Hamilton
- School of Health and Life Sciences, Teesside University, Middlesbrough, England
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England
| | - Aisha Holloway
- School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Ruth Harris
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England
| | - Pam Smith
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales
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Härkänen M, Franklin BD, Murrells T, Rafferty AM, Vehviläinen-Julkunen K. Factors contributing to reported medication administration incidents in patients' homes - A text mining analysis. J Adv Nurs 2020; 76:3573-3583. [PMID: 33048380 PMCID: PMC7702090 DOI: 10.1111/jan.14532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/03/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
AIMS To describe the characteristics of medication administration (MA) incidents reported to have occurred in patients' own homes (reporters' profession, incident types, contributing factors, patient consequence, and most common medications involved) and to identify the connection terms related to the most common contributing factors based on free text descriptions. DESIGN A retrospective study using descriptive statistical analysis and text mining. METHODS Medication administration incidents (N = 19,725) reported to have occurred in patients' homes between 2013-2018 in one district in Finland were analysed, describing the data by the reporters' occupation, incident type, contributing factors, and patient consequence. SAS® Text Miner was used to analyse free text descriptions of the MA incidents to understand contributing factors, using concept linking. RESULTS Most MA incidents were reported by practical (lower level) nurses (77.8%, N = 15,349). The most common category of harm was 'mild harm' (40.1%, N = 7,915) and the most common error type was omissions of drug doses (47.4%, N = 9,343). The medications most commonly described were Marevan [warfarin] (N = 2,668), insulin (N = 811), Furesis [furosemide] (N = 590), antibiotic (N = 446), and Panadol [paracetamol] (N = 416). The contributing factors most commonly reported were 'communication and flow of information' (25.5%, N = 5,038), 'patient and relatives' (22.6%, N = 4,451), 'practices' (9.9%, N = 1,959), 'education and training' (4.8%, N = 949), and 'work environment and resources' (3.0%, N = 598). CONCLUSION There is need for effective communication and clear responsibilities between home care patients and their relatives and health providers, about MA and its challenges in home environments. Knowledge and skills relating to safe MA are also essential. IMPACT These findings about MA incidents that have occurred in patients' homes and have been reported by home care professionals demonstrate the need for medication safety improvement in home care.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College London Healthcare NHS Trust, London, UK.,UCL School of Pharmacy, London, UK
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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45
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Ying L, Fitzpatrick JM, Philippou J, Huang W, Rafferty AM. The organisational context of nursing practice in hospitals in China and its relationship with quality of care, and patient and nurse outcomes: A mixed-methods review. J Clin Nurs 2020; 30:3-27. [PMID: 32890434 DOI: 10.1111/jocn.15486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Achieving high-quality care and retention of nurses are major concerns for nurse leaders in hospitals. The organisational context is theorised to influence the quality of care and patient and nurse outcomes. This review focuses on China where the healthcare system is different from most Western countries in terms of government healthcare expenditure, public health insurance and healthcare delivery system. OBJECTIVES To explore the organisational context of nursing practice in hospitals in China and its relationship with quality of care, patient outcomes (patient adverse events, safety and satisfaction) and nurse outcomes (burnout, job satisfaction and intention to leave). DESIGN A mixed-methods review. DATA SOURCES The electronic databases PubMed, EMBASE, CINAHL, PsycINFO and China Academic Journals Database were used. METHODS This review was conducted using the SALSA (Search, Appraisal, Synthesis and Analysis) framework. Quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal checklists for cross-sectional studies and qualitative research. A narrative synthesis was conducted and was supported by tabulation of study data. The PRISMA guidelines were used for this review. RESULTS Twenty-three articles met the inclusion criteria and were retrieved, analysed and synthesised. This review supports the link between organisational context, quality of care, and patient and nurse outcomes in the Chinese healthcare system. Aspects of organisational context warrant attention including nurse staffing levels, the shortage of nurses, a lack of nurse participation in hospital affairs and support for the professional development of nurses. CONCLUSIONS The findings suggest that tailored interventions are needed to improve the organisational context of nursing practice in Chinese hospitals and, in particular, to address the nurse workforce issues and organisational leadership and support. The unique policy context of the Chinese healthcare system should be considered when developing these interventions. RELEVANCE TO CLINICAL PRACTICE Recognising the importance of the organisational context, it is imperative that nurse leaders make every effort to legislate for safe nurse staffing and to establish a caring culture to improve quality of care and nurse and patient outcomes.
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Affiliation(s)
- Liying Ying
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China.,Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Joanne M Fitzpatrick
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Wenjie Huang
- Department of Urology and Andrology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Oates J, Topping A, Ezhova I, Wadey E, Marie Rafferty A. An integrative review of nursing staff experiences in high secure forensic mental health settings: Implications for recruitment and retention strategies. J Adv Nurs 2020; 76:2897-2908. [PMID: 32951214 DOI: 10.1111/jan.14521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/08/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022]
Abstract
AIMS To identify the experiences of nursing in high secure forensic mental health settings that may affect staff recruitment and retention. BACKGROUND Recruitment and retention of Registered Nurses is a vital international concern in the field of mental health. The high secure forensic setting presents unique challenges for the nurse. Studies of nurse's experiences in this setting have not previously been reviewed in the context of workforce sustainability pressures. DESIGN An integrative review (Whittemore and Knapfl, 2005). DATA SOURCES A systematic search of data sources: MEDLINE (PubMed), PsycINFO, EMBASE, CINAHL, International Bibliography of the Social Sciences, Applied Social Sciences Index and Abstracts (ASSIA), Social Services Abstracts, ProQuest Social Sciences Premium collection (IBSS, PAIS, and Sociological Abstracts), and Web of Science from inception to December 2019. REVIEW METHODS Data extraction, quality appraisal, and convergent qualitative synthesis. RESULTS Fifteen papers were selected for inclusion in the review, describing 13 studies. Six studies were quantitative, all cross-sectional surveys. There were seven qualitative studies, using a variety of methodologies. Four themes were identified: engagement with the patient group, the ward social environment, impact on the nurse, and implications for practice. CONCLUSION When policymakers address workforce shortages in high secure forensic nursing they must take account of the unique features of the setting and patient group. Nurses must be adequately prepared and supported to function in an ethically and emotionally challenging environment. IMPACT This study identified factors affecting workforce pressures in the speciality of forensic mental health nursing. Findings are of interest to national nursing policymakers and workforce leads in mental health service provider organizations, seeking to promote forensic nursing as a career option and retain nursing staff.
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Affiliation(s)
- Jennifer Oates
- Florence Nightingale Faculty of Nursing, King's College London, London, UK
| | - Alice Topping
- Florence Nightingale Faculty of Nursing, King's College London, London, UK.,West London NHS Trust, London, UK
| | - Ivanka Ezhova
- Florence Nightingale Faculty of Nursing, King's College London, London, UK
| | - Emma Wadey
- NHS England and NHS Improvement, London, UK
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Aunger JA, Millar R, Greenhalgh J, Mannion R, Rafferty AM, McLeod H. Building an initial realist theory of partnering across National Health Service providers. JICA 2020. [DOI: 10.1108/jica-05-2020-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PurposeThe National Health Service (NHS) is facing unprecedented financial strain. These significant economic pressures have coincided with concerns regarding the quality and safety of the NHS provider sector. To make the necessary improvements to performance, policy interest has turned to encouraging greater collaboration and partnership working across providers.Design/methodology/approachUsing a purposive search of academic and grey literature, this narrative review aimed (1) to establish a working typology of partnering arrangements for improvement across NHS providers and (2) inform the development of a plausible initial rough theory (IRF) of partnering to inform an ongoing realist synthesis.FindingsDifferent types of partnership were characterised by degree of integration and/or organisational change. A review of existing theories of partnering also identified a suitable framework which incorporated key elements to partnerships, such as governance, workforce, leadership and culture. This informed the creation of an IRF of partnerships, which proposes that partnership “interventions” are proposed to primarily cause changes in governance, leadership, IT systems and care model design, which will then go on to affect culture, user engagement and workforce.Research limitations/implicationsFurther realist evaluation, informed by this review, will aim to uncover configurations of mechanisms, contexts and outcomes in various partnering arrangements and limitations. As this is the starting point for building a programme theory, it draws on limited evidence.Originality/valueThis paper presents a novel theory of partnering and collaborating in healthcare with practical implications for policy makers and practitioners.
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Leone C, Dussault G, Rafferty AM, Anderson JE. Experience of mobile nursing workforce from Portugal to the NHS in UK: influence of institutions and actors at the system, organization and individual levels. Eur J Public Health 2020; 30:iv18-iv21. [PMID: 32949242 PMCID: PMC7526771 DOI: 10.1093/eurpub/ckaa129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In UK, since 2010 shortages of nurses and policy changes led many health service providers to become more active in recruiting nurses from the European Union Member States. This article analyses the experience of Portuguese nurses working in the English NHS considering the individual and organizational factors that affect the quality and duration of nurses’ migration experience, future career plans and expectations. Twenty-seven semi-structured interviews were conducted at the individual, organizational and policy levels in UK with Portuguese nurses and NHS healthcare staff in 2015–16. The results demonstrate that organizational settings, conditions, actors’ attitudes and level of support influence nurses’ level of commitment to their employer and their overall mobility experience. Professional achievements, professional and personal sources of support made these nurses evaluate their overall mobility experience as positive, even overcoming personal challenges such as homesickness. The results reveal that migration is accomplished through constant interaction between institutions and individual actors at different levels. Understanding the influencing factors as well as the complex and dynamic nature of a professional’s decision-making can design more effective retention responses.
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Affiliation(s)
- Claudia Leone
- Department of Policy and Research, Nuffield Trust, London, UK
| | - Gilles Dussault
- Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Janet E Anderson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Cheevers K, Armes J, Harris J, Rafferty AM. Adaptation and preliminary testing of the registered nursing forecasting (RN4CAST) nurse survey for use in the ambulatory chemotherapy setting. Eur J Oncol Nurs 2020; 47:101794. [PMID: 32674035 DOI: 10.1016/j.ejon.2020.101794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to adapt the Registered Nurse Forecast (RN4CAST) nurse survey making it appropriate to assess the working environments of ambulatory chemotherapy nurses, specifically focusing on care left undone. METHOD A two-phase approach was used. Firstly, cognitive interviews were conducted to adapt role specific sections of the RN4CAST nurses survey. The interviews were analysed to assess comprehension, retrieval, judgement and response processes to create the RN4CAST-chemotherapy assessment tool (CAT) survey. Secondly, a single centre feasibility study was undertaken to assess acceptability of the RN4CAST-CAT survey in an ambulatory chemotherapy setting. Results of the feasibility study were analysed using descriptive statistics and compared with routinely collected patient experience data. RESULTS The cognitive interviews (n=6) resulted in important amendments to the RN4CAST-CAT. Response rate to the feasibility study was acceptable at 57% (n=12) and item completion rate was good (on average only 1 response missing per item). On average nurses looked after nine patients per shift, administered seven chemotherapy treatments and worked an hour and 10 min over their contracted time. Main areas of care left undone were related to verbal communication with patients and assessing patient comorbidities and toxicities. CONCLUSIONS We were able to adapt the RN4CAST to make it suitable for use in the ambulatory chemotherapy setting. Our study offers preliminary evidence that the RN4CAST-CAT and methodology are feasible and acceptable within the ambulatory chemotherapy setting. Larger scale testing is now required and if validated the RN4CAST-CAT has the potential to provide useful insights into the impact of nursing workload on staff experience, patient care and outcomes on ambulatory chemotherapy settings.
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Affiliation(s)
- Katy Cheevers
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Jo Armes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Jenny Harris
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Sharma S, Rafferty AM, Boiko O. The role and contribution of nurses to patient flow management in acute hospitals: A systematic review of mixed methods studies. Int J Nurs Stud 2020; 110:103709. [PMID: 32745787 DOI: 10.1016/j.ijnurstu.2020.103709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increased overcrowding in the emergency department is a potential threat to the quality and safety of patient care. Innovative ways are needed to explore overcrowding, the variables affecting patient flow and interventions necessary for future flow improvement. AIMS AND OBJECTIVES The aim of this review is to explore nurses' role(s) and their contribution to maintaining patient flow in acute hospitals through emergency departments. METHODOLOGY A systematic review of mixed studies (qualitative, quantitative and mixed-method) using narrative synthesis was undertaken. Five major databases-PubMed, CINHAL, BNI, ASSIA and SCOPUS-were searched to identify appropriate primary and secondary studies. Selected studies were critically appraised with a modified CASP tool. Data extraction and analysis was undertaken using narrative synthesis. RESULTS In total, 34 articles (31 primary studies and three systematic reviews) met the inclusion criteria. This systematic review is informed by studies from several countries, including the UK, US, Australia, Canada, and the Netherlands. The qualitative arm of this review explored both the role and function of nurses, as well as their experiences and perspectives of the patient flow process, while the quantitative arm investigated nurses' contribution to patient flow in terms of length of stay (LOS), triage time, and other associated performance data. FINDINGS Nurses' contribution to patient flow spanned their operational, strategic, and expanded roles. Strategic and expanded nursing roles offered the possibility of reducing LOS, triage time, and ED crowding in addition to improving the experience of patients and staff. Nurses in operational roles deployed experiential knowledge pertaining to several invisible aspects of patient flow challenges thereby facilitating decision-making for strategic flow improvement. The experiential knowledge and skills of these nursing roles are central to the success of flow-related interventions. However, the effects of emotional labour (e.g. conflicts, frustrations) of patient flow processes on nurses are significant and may have unaccounted for transaction costs and consequences that need acknowledging in order to be addressed by managers and policy makers. CONCLUSIONS AND RECOMMENDATIONS Policy-makers and senior managers need to capitalise on nurses' experiential knowledge and skills to enhance the strategic design and development of flow management in acute hospitals. Recommendations from this review have potential to deploy those skills and knowledge in flow improvement.
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Affiliation(s)
- Shrawan Sharma
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, England, United Kingdom; London North West University Healthcare NHS Trust Harrow, HA1 3UJ London, England, United Kingdom.
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, England, United Kingdom
| | - Olga Boiko
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, England, United Kingdom
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