Can proactive support prevent unscheduled care? A controlled observational retrospective cohort study in cancer patients in Scotland

INTRODUCTION

Preventative spend is a global health and social care strategy. Improving Cancer Journeys (ICJ) is a proactive, holistic, multidisciplinary project consistent with this agenda, currently being rolled out across Scotland and parts of UK. ICJ helps people with cancer access whatever support they need to mitigate their most pressing concerns. This study hypothesised that ICJ service users should subsequently use less unscheduled care than matched cohorts not using ICJ.

METHODS

Retrospective observational cohort study using linked national datasets. N = 1,214 ICJ users in Glasgow were matched for age, sex, deprivation, cancer type, stage, and diagnosis year to two control groups: 1. Cancer patients from Glasgow before ICJ (pre-2014), 2. Cancer patients from rest of Scotland during study period (2014-2018). Cancer registrations were linked for 12-month baseline and study periods to: NHS24 calls, A&E admissions, inpatient hospital admissions, unscheduled care, number & cost of psychotropic prescriptions. Per-person mean service uses were compared between groups.

RESULTS

There was a significant increase in NHS24 calls in the ICJ group (0.36 per person vs. -0.03 or 0.35), more and longer A&E attendances in ICJ (0.37 per person vs. 0.19 or 0.26; 2.19 h per person vs. 0.81-0.92 h), more and longer hospital admissions in ICJ (4.25 vs. 2.59 or 2.53; 12.05 days vs. 8.37 or 8.64), more care pathways involving more steps in ICJ (0.77 spells vs. 0.39 or 0.57; 1.88 steps vs. 1.56 or 1.21), more psychotropic drug prescriptions and higher costs in ICJ (1.88 prescription vs. 1.56 or 1.21; £9.51 vs. £9.57 or £6.95) in comparison to both control groups.

DISCUSSION

ICJ users sourced significantly more unscheduled care than matched cohorts. These findings were consistent with much of the comparable literature examining the impact of non-health interventions on subsequent health spend. They also add to the growing evidence showing that ICJ reached its intended target, those with the greatest need. Together these findings raise the possibility that those choosing to use ICJ may also be self-identifying as a cohort of people more likely to use unscheduled care in future. This needs to be tested prospectively, because this understanding would be very helpful for health and social care planners in all countries where proactive holistic services exist.

Holistic needs assessment in outpatient cancer care: a randomised controlled trial

DESIGN

Analyst blinded, parallel, multi-centre, randomised controlled trial (RCT).

PARTICIPANTS

People with confirmed diagnoses of cancer (head and neck, skin or colorectal) attending follow-up consultation 3 months post-treatment between 2015 and 2020.

INTERVENTION

Holistic needs assessment (HNA) or care as usual during consultation.

OBJECTIVE

To establish whether incorporating HNA into consultations would increase patient participation, shared decision making and postconsultation self-efficacy.

OUTCOME MEASURES

Patient participation in the consultations examined was measured using (a) dialogue ratio (DR) and (b) the proportion of consultation initiated by patient. Shared decision making was measured with CollaboRATE and self-efficacy with Lorig Scale. Consultations were audio recorded and timed.

RANDOMISATION

Block randomisation.

BLINDING

Audio recording analyst was blinded to study group.

RESULTS

147 patients were randomised: 74 control versus 73 intervention.

OUTCOME

No statistically significant differences were found between groups for DR, patient initiative, self-efficacy or shared decision making. Consultations were on average 1 min 46 s longer in the HNA group (respectively, 17 m 25 s vs 15 min 39 s).

CONCLUSION

HNA did not change the amount of conversation initiated by the patient or the level of dialogue within the consultation. HNA did not change patient sense of collaboration or feelings of self-efficacy afterwards. HNA group raised more concerns and proportionally more emotional concerns, although their consultations took longer than treatment as usual.

IMPLICATIONS FOR PRACTICE

This is the first RCT to test HNA in medically led outpatient settings. Results showed no difference in the way the consultations were structured or received. There is wider evidence to support the roll out of HNA as part of a proactive, multidisciplinary process, but this study did not support medical colleagues facilitating it.

TRIAL REGISTRATION NUMBER

NCT02274701.

Men's perspectives of caring for a female partner with cancer: A longitudinal narrative study

Increasing evidence on men's involvement in informal, unpaid care has not transferred to the research literature around men's experiences. The aim was to explore the perspectives of men who are caring for a female partner with cancer over 1 year. Longitudinal narrative interviews (n = 22) were conducted with eight men in the UK from 2018 to 2019. Participants were aged from 32 to 76 years old, were all white British and in heterosexual relationships with women diagnosed with a range of cancer types. Interviews were transcribed and then analysed using a structural and performance approach to narrative analysis. We present, across four scenes, a process of change, transition and emotion management as the men were launched into a role that came with new responsibilities and expectations. Our study advances knowledge by highlighting the way that men perform and reflect on their negotiation with masculine discourses while supporting their partner, with implications for policy, research and practice.

Chaplains Work in Primary Care

Health is holistic, but health services are often not. Primary care is the first point of contact for patients in the UK, and at least two in every three present with complex bio-psycho-socio-economic issues. In Scotland, the Community Chaplaincy Listening (CCL) service was created to see if chaplains could help. CCL involves specially trained chaplains listening to patients referred to them by general practitioners (GP) for spiritual support. Between 2018 and 2019, 143 people used CCL and completed baseline and post-discharge outcome measures. Mean Scottish PROM scores rose from 7.94 (± 3.4) at baseline to 12 (± 3.5) post discharge, a statistically and clinically significant rise of 4.06 (95% CI, 3-5.12), t(50) = 7.7, p < 0.0001, d = 1.08. The improvement was seen whether patients self-described as religious, spiritual, both, or neither. Health-related quality of life outcomes were mixed but patients referred to the service scored some of the lowest baseline EQ-5D-3L scores ever seen in the literature. Together these results suggest that CCL worked in primary care, especially for patients historically considered "difficult to treat." Limitations of the study are considered alongside implications for commissioners and service developers.

'Pinholes in my arms': the vicious cycle of vascular access

BACKGROUND

Vascular access devices (VADs) are essential for delivery of intravenous therapies. There are notable gaps in the literature regarding a focus on patient experience and meaning-making related to living with a VAD, specifically a central venous access device (CVAD).

AIMS

To explore how patients make sense of living with a CVAD.

METHODS

This study followed an interpretive phenomenological analysis (IPA) approach. Purposive sampling was used to identify 11 cancer patients who had a CVAD in situ. One-to-one semi-structured interviews were performed. Interviews were digitally recorded, transcribed and analysed by the lead author.

FINDINGS

Four superordinate themes were identified: the self under attack; being rescued/being robbed; protection of others/protection of self; bewilderment and dismay at lack of staff competence.

CONCLUSION

Having a CVAD affects the psychological, social, and personal self and impacts on self-esteem and self-image. Despite this, CVADs are accepted by patients and are eventually 'embodied' by them.

Statistical fit is like beauty: A rasch and factor analysis of the Scottish PROM

Chaplains help people face some of the most complex, intractable and traumatic issues in their lives. Spiritual care works. Unfortunately, spiritual needs are rarely met in health and social care because a) spiritual distress is not recognised as such, and b) chaplain interventions are undervalued and misunderstood. The Scottish Patient Reported Outcome Measure (PROM) © was created to help provide evidence for the impact of chaplain interventions. The aim of this study was to establish whether the PROM could also be used to identify patients in need of chaplain interventions. To test this psychometrically, Rasch and Confirmatory Factor Analysis was conducted on an international dataset of post intervention PROMS from UK, Europe and Australia completed between 2018-2020 (n = 1117). The data fit the Rasch model, and the PROM demonstrated uni-dimensionality, construct validity and reliability, meaning PROM scores represent a coherent concept. Higher scores represented lower levels of spiritual distress, and the mean score was 12 out of 20. PROM score of 9 was one standard deviation below the norm, a metric routinely used to identify 'clinically important difference' in psychometric scales. A Scottish PROM^© score of 9 and under could therefore identify people for whom chaplaincy may be beneficial. The clinical implications of this are considerable.

'It was quite a shock': A qualitative study of the impact of organisational and personal factors on newly qualified nurses' experiences

AIMS AND OBJECTIVES

To explore how newly qualified nurses' work experiences are constructed through the interplay between self, workplace and home-life influencing their retention.

BACKGROUND

Nurses are critical to achieving the goal of universal health coverage. However, shortages of nursing staff are endemic. Of particular concern, newly qualified nurses are more likely to leave the nursing workforce. The point of transition to working as a newly qualified nurse is a time of vulnerability. Most studies attempt to discover why nurses leave. This study uses the concept of job embeddedness to examine the experience of this transition and first two years of practice to understand what might help newly qualified nurses stay.

DESIGN

Qualitative approach using semi-structured telephone interviews.

METHODS

Self-selecting sample of nurses (n = 23) who participated 1-year (n = 12) and 2 years (n = 11) post-qualification. Participants were part of a larger longitudinal cohort (n = 867) study which has followed them since September 2013 when they entered nurse education in two Scottish universities. Thematic analysis was used to understand the interplay between organisation/workplace and the individual.

RESULTS

Three themes were developed: transition shock; workplace factors and work/life balance. Two further subthemes were developed: experience of support and belonging; and feeling unsupported and alienated. Eight participants had changed job or left, and two were looking to leave nursing.

CONCLUSION

This study highlights how the experience of transition shock can be positively or negatively impacted by the workplace environment, and how in turn this impacts the home environment. Ultimately, this impacts retention of newly qualified nurses.

RELEVANCE TO CLINICAL PRACTICE

Having adequate support resources, such as staffing, supportive team morale, professional development and family-friendly work environment, can create a work environment where they feel the purpose and meaningfulness of working as a nurse. This 'job embeddedness' can potentially enhance nurse retention. Reporting follows the COREQ checklist.

What Did Chaplains Do During the Covid Pandemic? An International Survey

Chaplains' unique contribution is to healthcare is to respond to the spiritual, religious and pastoral needs of patients and staff. This is their sole purpose, to provide a presence and space to meet individual need and promote healing, even when cure isn't possible. Their value is priceless to families in desperate times. However, despite growing evidence for their impact, chaplains are commonly undervalued and misunderstood by their organisations, and the global pandemic revealed the consequences of this confusion. Whilst some chaplains were applauded as heroes along with their fellow health colleagues, others were seen as little more than an infection risk. A survey was designed to capture and learn from the full range of chaplain experiences of the impact of the pandemic across the globe. In June 2020, 1657 chaplains responded from 36 countries. They all experienced considerable disruption to their usual practice, with enforced social distancing having the biggest impact. Out of necessity they embraced technology to maintain contact with patients and families, and shifted focus of their support to staff. Whilst some chaplains were viewed as essential employees by their organisations, most were not. Despite the majority thinking that their organisations understood what they did, chaplains themselves were neither clear or unclear about their role during and post pandemic. More surprisingly, they felt similarly unclear about their role before the pandemic. This paper concludes that in general chaplains lack leadership skills, and confusion about their role will persist until this changes.

'Nobody will put baby in the corner!': A qualitative evaluation of a physical activity intervention to improve mental health

Physical activity is beneficial for mental health, but people with mental health issues are less likely to be physically active than the general population. Socially prescribed programmes of activity are rarely adhered to, with high levels of drop out, and the proportion of people who continue after programmes have finished is even smaller. Lasting change therefore needs a fundamental change in behaviour, so an intervention grounded in behaviour change theory may be more likely to succeed. The aim of this original study was to understand the facilitators and barriers to participation and adherence to a supportive, personalised, physical activity programme for patients with mental health conditions. The intervention entailed a 16-week programme of activity, tailored to individual capability, supported by a dedicated 'behaviour change' practitioner trained in motivational interviewing. Fourteen people who had completed the intervention were interviewed in three focus groups in 2018. Data were transcribed verbatim then analysed for barriers and facilitators using Framework Analysis and the Theoretical Domains Framework. Twenty-five overarching themes were identified, which mapped onto 11 domains from the framework. Ten themes were barriers and 15 facilitators. Barriers included stigma, negative self-beliefs and difficulty trusting others. The facilitators reframed these negative attributes. For example, participants described feeling confident as a function of achieving personalised goals and learning something new. The intervention changed the way participants thought and acted. This original intervention has succeeded where many have failed, as it changed the way these participants with mental health conditions thought about physical activity. By reframing it as personally achievable and physically beneficial, participants' attitudes and behaviour changed as well, making it more likely they would sustain physical activity in future. These unique findings are likely to translate internationally due to the simplicity of the intervention, and the potential to improve lives of the most vulnerable.

Undergraduate nursing and midwifery student's attitudes to mental illness

Aim

To explore levels of stigma in students of all fields of nursing and midwifery at different years and examine the impact of exposure to people with mental illness.

Design

A cross-sectional survey was used.

Methods

The Community Attitudes to Mental Illness questionnaire was administered to all branches of student nurses (adult health, mental health, child health and learning disability) and midwives in all three years in one Higher Education Institution (HEI) in Scotland.

Results

Mental health nursing students scored significantly better on all stigma subscales. Stigma worsened with a little professional exposure to people with mental illness but then improved with increasing exposure. Both personal exposure and professional exposure to people with mental illness change perceptions. The professional results follow a J-curve. Current plans for cross-field experience involving short or virtual placements during student nurse training are likely to worsen stigma rather than improve it.

Meeting psychosocial needs to improve health: a prospective cohort study

Background

Cancer impacts on patients and their families across a range of different domains. For that reason, optimal cancer care has moved away from a disease-centric focus to a more holistic approach in order to proactively support people with their individual needs and concerns. While international policy clearly advocates this agenda, implementation into routine care is limited. Therefore, relevant interventions that measurably improve patient outcomes are essential to understand if this ideal is to become routine multidisciplinary practice. The aim of this study was to analyse the impact of a proactive, holistic, community-based intervention on health-related quality of life in a cohort of people diagnosed with cancer. Secondary aim was to explore the relationship between changes in health status and: cancer type, cancer stage, number of concerns expressed and change in severity of concerns pre and post intervention.

Method

Prospective observational cohort study. A convenience sample of 437 individuals were referred to the service ‘Improving the Cancer Journey (ICJ) in the UK. Each completed the Euroqol EQ-5D-3 L and visual analogue scale (VAS) and a Holistic Needs Assessment (HNA) during initial visit to the service and again at follow-up review, median 84 days later. Change between scores was tested with paired t-tests and relationships between variables with multiple regression models with heteroscedasticity-consistent standard errors.

Results

Participants were White British with median age between 50 and 64 years. Cancer type and stage were varied. EQ-5D utility scores improved at follow-up by 0.121 [0.0891–0.153], p < .001, and VAS scores improved by 7.81 [5.88–9.74], p < .001. The strongest predictor of change was a decrease in severity of concerns. Cancer stage ‘palliative care’ contributed to a reduction in health status.

Conclusion

This study is the first to show that a holistic community intervention dedicated to supporting the individual concerns of participants had both a statistically significant and clinically meaningful impact on participants’ health-related quality of life. The mean change in EQ-5D scores was more than the ‘minimally important clinical difference’ described in the literature. This is important because while quality of life has multiple determinants, this study has shown for the first time that it is possible to capture a clinically meaningful improvement as a function of reducing someone’s personally identified concerns.

How to synthesise original findings back into the literature: a reintroduction to concurrent analysis

BACKGROUND

All studies need to integrate their findings back into the literature to explain how the new knowledge changes understanding. This process can be anxiety-provoking, especially when new literature appears to threaten the originality of the study.

AIM

To reintroduce 'concurrent analysis' (CA) - a method of synthesising relevant literature with primary data.

DISCUSSION

CA treats all data as primary data. To illustrate the technique, the authors synthesise relevant literature with findings from a doctoral study of patients' experiences of vascular access devices.

CONCLUSION

CA raised new questions that would otherwise have remained unasked. For example, it revealed cultural differences in the way patients react to suboptimal treatment.

IMPLICATIONS FOR PRACTICE

Nurse researchers are best placed to influence policy and practice when they can articulate the transferability of their findings. CA is a practical method of achieving this.

A J curve of interprofessional change: co-locating non-health partners in an oncology unit

BACKGROUND

Internationally, clinicians face increased demand, pressure on resources and unmet patient needs. A community social support service was co-located within cancer clinics in Glasgow, Scotland to help address some of these needs.

AIM

To analyse the impact of the service on clinical staff and to propose an explanatory theory of change.

METHOD

Qualitative exploratory design, using thematic analysis of semistructured interviews with 8 nurse specialists and 2 medical oncologists from lung, breast, head and neck, and gastrointestinal oncology teams in Glasgow in 2018-2019.

FINDINGS

Four themes captured this process: 'The conversation', 'A better experience', 'Freedom to focus' and 'Working hand in hand'.

CONCLUSION

Together, these four themes explained the process of effective interprofessional working. This process would have been predicted by the J-curve literature on diffusion of innovations. Linking J-curve theory to this successful process provides new understanding that could prove essential for clinical teams who are implementing change within their practice.

Health professionals' lack of knowledge of central venous access devices: the impact on patients

BACKGROUND

the literature on the patient experience of living with a central venous access device (CVAD) is growing, but remains sparse. It suggests that patients accept having a CVAD as it should reduce episodes of repeated cannulations. However, a recent doctoral study found the reality did not live up to this hope.

AIM

the study objective was to uncover the global, cross-disease experience of patients with CVADs.

METHOD

an online survey was sent to an international sample of people living with CVADs.

FINDINGS

74 people from eight countries responded. Respondents corroborated the PhD findings: painful cannulation attempts continued after CVAD insertion because of a lack of clinical knowledge. Participants lost trust in clinicians and feared complications due to poor practice.

CONCLUSION

clinicians often lack the necessary skills to care and maintain CVADs. This leads to a negative patient experience.

A qualitative study on the perceived impact of using an integrated community-based supportive cancer service

OBJECTIVE

"Improving the Cancer Journey" (ICJ) is an original, community-based, multidisciplinary service offering holistic support to people diagnosed with cancer in Scotland. It is the first service of its kind in the UK. The aim of this qualitative study was to explore the experiences of people who have used this service.

METHOD

Twenty service users were purposively sampled to capture a diverse range of age, sex, cancer types, and deprivation status. Semi-structured interviews explored their experiences of using ICJ. Interviews were transcribed verbatim and thematically analysed.

RESULTS

Thirteen women and seven men (mean age 58 years) were interviewed. Three themes were identified: "one person, one place," "routes to unexpected support" and "safety net."

CONCLUSION

Improving the Cancer Journey was perceived to be beneficial because it met the holistic needs of the ICJ service users. By helping people address concerns earlier rather than later, it prevented problems becoming unmanageable. Having an accessible expert to guide and support them through a range of services provided reassurance and created the space to self-manage at a time of distress. These original findings are internationally relevant because there is little evidence on the impact of holistic support services from the patient perspective.

Proactive community support tailored to holistic needs: A cohort study

Background

It is increasingly internationally recognized that a cancer diagnosis impacts on people practically and financially as well as physically and psychologically. It is less clear what to do about this. This study introduces an original community service designed to mitigate this wider impact. Nonclinical “link officers” use holistic needs assessment (HNA) to help newly diagnosed people identify and quantify the severity of their physical, psychological, practical, financial, and social concerns. A care plan is then agreed, usually involving community interventions from partner agencies. Following intervention, assessment is repeated. The primary aim of this study was to establish whether there was a significant difference between initial assessment and follow‐up, postintervention. Secondary aim was to identify potential predictors of increased levels of concern at baseline and follow‐up.

Method

Pre‐ and postintervention observational cohort study. Paired t test examined the difference in mean (SD) concern severity between baseline and follow‐up. Multiple linear regression models were computed to hypothesize potential predictors of initial concern severity and severity change.

Results

The service saw 2413 people 2014‐2017. Participants identified average 5.5 (4.7) concerns, financial concerns being most frequent. Mean severity at baseline was 7.12 (out of 10) (2.50), reducing to 3.83 (3.49) post‐treatment, paired t(4454) = 64.68, P < 0.0001, reduction of 3.31 (95% CI 3.21‐3.41). Factors associated with higher initial concern included unemployment and caring responsibilities. Unemployment was also associated with a smaller reduction of concern severity at follow‐up.

Conclusion

Patient level of concern went from a level associated with specialist referral to a much more manageable level. This original finding is internationally significant because it extends Khera et al's (2017) “provocative idea” that all patients should be screened for financial problems to show that they can be helped with all their concerns. This article describes a successful, transferable model of community care.

Emotional intelligence among nursing students: Findings from a cross-sectional study

BACKGROUND

Emotional intelligence in nursing is of global interest. International studies identify that emotional intelligence influences nurses' work and relationships with patients. It is associated with compassion and care. Nursing students scored higher on measures of emotional intelligence compared to students of other study programmes. The level of emotional intelligence increases with age and tends to be higher in women.

OBJECTIVES

This study aims to measure the differences in emotional intelligence between nursing students with previous caring experience and those without; to examine the effects of gender on emotional intelligence scores; and to test whether nursing students score higher than engineering colleagues on emotional intelligence measures.

DESIGN

A cross-sectional descriptive study design was used.

SETTINGS AND PARTICIPANTS

The study included 113 nursing and 104 engineering students at the beginning of their first year of study at a university in Slovenia.

DATA

Emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire (TEIQue) and Schutte Self Report Emotional Intelligence Test (SSEIT).

METHODS

Shapiro-Wilk's test of normality was used to test the sample distribution, while the differences in mean values were tested using Student t-test of independent samples.

RESULTS

Emotional intelligence was higher in nursing students (n = 113) than engineering students (n = 104) in both measures [TEIQue t = 3.972; p < 0.001; SSEIT t = 8.288; p < 0.001]. Although nursing female students achieved higher emotional intelligence scores than male students on both measures, the difference was not statistically significant [TEIQue t = -0.839; p = 0.403; SSEIT t = -1.159; p = 0.249]. EI scores in nursing students with previous caring experience were not higher compared to students without such experience for any measure [TEIQue t = -1.633; p = 0.105; SSEIT t = -0.595; p = 0.553].

CONCLUSIONS

Emotional intelligence was higher in nursing than engineering students, and slightly higher in women than men. It was not associated with previous caring experience.

A screening tool for predicting gatekeeping behaviour

Aim

To develop a typology and screening tool for gatekeeping behaviours by nurses responsible for recruitment in palliative care research.

Design

Concurrent analysis.

Method

Two focus groups were conducted in 2015 with nine qualified hospice community nurses involved in recruitment to a trial in palliative care. The literature was searched for research into gatekeeping from 2000–2016. All narrative examples of gatekeeping activity were coded using gerunds. Common codes were then grouped and interpreted as a social process.

Results

Gatekeeping is normal and should be expected. A continuum typology emerged, ranging from unintentional to active disengagement. Justification ranged from forgetting to deliberately not mentioning the study for fear of burdening patients. Viewing gatekeeping as a continuum allowed for the creation of a screening tool designed to collaboratively discuss and hence mitigate specific types of gatekeeping behaviour before they occur. This is a unique international contribution to this persistent issue.

Two years of unintended consequences: introducing an electronic health record system in a hospice in Scotland

AIMS AND OBJECTIVES

To explore the impact of implementing an electronic health record system on staff at a Scottish hospice.

BACKGROUND

Electronic health records are broadly considered preferable to paper-based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice.

DESIGN

Naturalistic prospective repeated-measures mixed-methods approach.

METHODS

Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free-text comments and focus group. Participants were all 150 employees of a single hospice in Scotland.

RESULTS

Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change.

CONCLUSIONS

It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the 'J-curve' theory of organisational change, and as such, it is both predictable and manageable for other organisations.

RELEVANCE TO CLINICAL PRACTICE

It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity ('J' curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically.

Patient Reported Outcome Measure of Spiritual Care as Delivered by Chaplains

Chaplains are employed by health organizations around the world to support patients in recognizing and addressing their spiritual needs. There is currently no generalizable measure of the impact of these interventions and so the clinical and strategic worth of chaplaincy is difficult to articulate. This article introduces the Scottish PROM, an original five-item patient reported outcome measure constructed specifically to address this gap. It describes the validation process from its conceptual grounding in the spiritual care literature through face and content validity cycles. It shows that the Scottish PROM is internally consistent and unidimensional. Responses to the Scottish PROM show strong convergent validity with responses to the Warwick and Edinburgh Mental Well-Being Scale, a generic well-being scale often used as a proxy for spiritual well-being. In summary, the Scottish PROM is fit for purpose. It measures the outcomes of spiritual care as delivered by chaplains in this study. This novel project introduces an essential and original breakthrough; the possibility of generalizable international chaplaincy research.

Protocol for a mixed methods longitudinal enquiry into the impact of a community based supportive service for people affected by cancer

BACKGROUND

Globally, cancer rates are increasing. In Scotland, it is estimated that 2 in 5 people will develop cancer in their lifetime. Therefore, this is crucial time to provide personalised care and support to individuals affected by cancer. In response to this a community based supportive cancer service was launched in Glasgow, Scotland. The aim of this service is to proactively provide those affected by cancer with an assessment of their needs and personalised support where needed. To our knowledge, there is no other service like this in the United Kingdom.

METHODS

The aim of this study is to understand if and how the service impacts upon the experiences and outcomes of people living with and affected by cancer. The study uses a sequential mixed methods design across a 5 year time point. Data gathering includes questionnaires, interviews, observations and reflective diaries. Participants include people affected by cancer who have used the service, a comparative sample who have not used the service, individuals who deliver the service and wider stakeholders. Outcomes include measures of patient activation, quality of life, health status, and social support. Data collection occurs at baseline, 2.5 years and 4 years with data from observations and reflective diaries supplemented throughout.

DISCUSSION

This study evaluates an innovative community based cancer service. It focuses on impact and process issues relevant to a) the individuals in receipt of the service, b) the service providers, and c) the wider culture. As the programme evolves overtime, the research has been designed to draw out learning from the programme in order to support future commissioning both within Scotland and across the UK.

Do emotional intelligence and previous caring experience influence student nurse performance? A comparative analysis

BACKGROUND

Reports of poor nursing care have focused attention on values based selection of candidates onto nursing programmes. Values based selection lacks clarity and valid measures. Previous caring experience might lead to better care. Emotional intelligence (EI) might be associated with performance, is conceptualised and measurable.

OBJECTIVES

To examine the impact of 1) previous caring experience, 2) emotional intelligence 3) social connection scores on performance and retention in a cohort of first year nursing and midwifery students in Scotland.

DESIGN

A longitudinal, quasi experimental design.

SETTING

Adult and mental health nursing, and midwifery programmes in a Scottish University.

METHODS

Adult, mental health and midwifery students (n=598) completed the Trait Emotional Intelligence Questionnaire-short form and Schutte's Emotional Intelligence Scale on entry to their programmes at a Scottish University, alongside demographic and previous caring experience data. Social connection was calculated from a subset of questions identified within the TEIQue-SF in a prior factor and Rasch analysis. Student performance was calculated as the mean mark across the year. Withdrawal data were gathered.

RESULTS

598 students completed baseline measures. 315 students declared previous caring experience, 277 not. An independent-samples t-test identified that those without previous caring experience scored higher on performance (57.33±11.38) than those with previous caring experience (54.87±11.19), a statistically significant difference of 2.47 (95% CI, 0.54 to 4.38), t(533)=2.52, p=.012. Emotional intelligence scores were not associated with performance. Social connection scores for those withdrawing (mean rank=249) and those remaining (mean rank=304.75) were statistically significantly different, U=15,300, z=-2.61, p$_amp_$lt;0.009.

CONCLUSIONS

Previous caring experience led to worse performance in this cohort. Emotional intelligence was not a useful indicator of performance. Lower scores on the social connection factor were associated with withdrawal from the course.

Validation of the electronic Holistic Needs Assessment

Macmillan Cancer Support UK have developed an electronic Holistic Needs Assessment (eHNA) to: (1) help people living with cancer express all their needs, (2) help those helping them better target support. eHNA consists of 48 items each ranked from zero (no problem) to 10. There has been no psychometric analysis of this tool and so its validity and reliability are untested. The aim of this study was to evaluate the psychometric properties of the eHNA by examining its construct validity. Objectives were to (a) test whether the eHNA measured holistic concerns and (b) analyse the factor structure of the eHNA. Objectives were achieved through a secondary analysis of 5421 responses to eHNA using concurrent application of Rasch analysis and principal component analysis. All the items bar one fit with the Rasch rating model and were equivalently important to people. Differential item functioning was evident according to whether people were described as curative or not. A 12-factor solution explained 46 % variance. Of this the emotional/spiritual factor explained the most variance accounting for 15 %. The eHNA was internally consistent and conceptually coherent with the construct of holistic needs assessment. Clinical focus is best directed to the individual items highlighted by the patient except where patients check too many problems for the clinician to accurately prioritise. In these cases only, the emotional/spiritual factor may help identify appropriate clinical action. Strengths and weaknesses of the analyses are discussed, particularly in relation to ‘at risk’ subsamples such as those classified as non-curative.

Evaluating holistic needs assessment in outpatient cancer care--a randomised controlled trial: the study protocol

INTRODUCTION

People living with and beyond cancer are vulnerable to a number of physical, functional and psychological issues. Undertaking a holistic needs assessment (HNA) is one way to support a structured discussion of patients' needs within a clinical consultation. However, there is little evidence on how HNA impacts on the dynamics of the clinical consultation. This study aims to establish (1) how HNA affects the type of conversation that goes on during a clinical consultation and (2) how these putative changes impact on shared decision-making and self-efficacy.

METHODS AND ANALYSIS

The study is hosted by 10 outpatient oncology clinics in the West of Scotland and South West England. Participants are patients with a diagnosis of head and neck, breast, urological, gynaecological and colorectal cancer who have received treatment for their cancer. Patients are randomised to an intervention or control group. The control group entails standard care--routine consultation between the patient and clinician. In the intervention group, the patient completes a holistic needs assessment prior to consultation. The completed assessment is then given to the clinician where it informs a discussion based on the patient's needs and concerns as identified by them. The primary outcome measure is patient participation, as determined by dialogue ratio (DR) and preponderance of initiative (PI) within the consultation. The secondary outcome measures are shared decision-making and self-efficacy. It is hypothesised that HNA will be associated with greater patient participation within the consultation, and that shared decision-making and feelings of self-efficacy will increase as a function of the intervention.

ETHICS AND DISSEMINATION

This study has been given a favourable opinion by the West of Scotland Research Ethics Committee and NHS Research & Development. Study findings will be disseminated through peer-reviewed publications and conference attendance.

TRAIL REGISTRATION NUMBER

Clinical Trials.gov NCT02274701.

The relationship between emotional intelligence, previous caring experience and mindfulness in student nurses and midwives: a cross sectional analysis

BACKGROUND

Emotional Intelligence (EI), previous caring experience and mindfulness training may have a positive impact on nurse education. More evidence is needed to support the use of these variables in nurse recruitment and retention.

OBJECTIVE

To explore the relationship between EI, gender, age, programme of study, previous caring experience and mindfulness training.

DESIGN

Cross sectional element of longitudinal study.

SETTING AND PARTICIPANTS

938year one nursing, midwifery and computing students at two Scottish Higher Education Institutes (HEIs) who entered their programme in September 2013.

DATA

Participants completed a measure of 'trait' EI: Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF); and 'ability' EI: Schutte's et al. (1998) Emotional Intelligence Scale (SEIS). Demographics, previous caring experience and previous training in mindfulness were recorded.

METHODS

Relationships between variables were tested using non-parametric tests.

RESULTS

Emotional intelligence increased with age on both measures of EI [TEIQ-SF H(5)=15.157 p=0.001; SEIS H(5)=11.388, p=0.044]. Females (n=786) scored higher than males (n=149) on both measures [TEIQ-SF, U=44,931, z=-4.509, p<.001; SEIS, U=44,744, z=-5.563, p<.001]. Nursing students scored higher that computing students [TEIQ-SF H(5)=46,496, p<.001; SEIS H(5)=33.309, p<0.001. There were no statistically significant differences in TEIQ-SF scores between those who had previous mindfulness training (n=50) and those who had not (n=857) [U=22,980, z=0.864, p = 0.388]. However, median SEIS was statistically significantly different according to mindfulness training [U=25,115.5, z=2.05, p=.039]. Neither measure demonstrated statistically significantly differences between those with (n=492) and without (n=479) previous caring experience, [TEIQ-SF, U=112, 102, z=0.938, p=.348; SEIS, U=115,194.5, z=1.863, p=0.063].

CONCLUSIONS

Previous caring experience was not associated with higher emotional intelligence. Mindfulness training was associated with higher 'ability' emotional intelligence. Implications for recruitment, retention and further research are explored.

Against intimacy: focusing on the task in hand in PhD supervision

Worldwide, more nurses are undertaking doctoral studies now than at any other time. However, there is little high-quality evidence focused on investigating successful completion of such studies. Instead there is considerable literature dedicated to untested assumptions about the nature of the supervisory relationship. This article reflects on three critical incidents to show that the key to successful PhD completion may have much less to do with the supervisory relationship than this literature assumes. Success is rather grounded in clear understanding of how all the pertinent tasks fit together. A free online interactive resource is introduced as one method of facilitating this clarity within the supervisory relationship. The effectiveness of this resource could be tested, thereby generating meaningful data for PhD students and their supervisors.

IMatter: validation of the NHS Scotland Employee Engagement Index

Background

Employee engagement is a fundamental component of quality healthcare. In order to provide empirical data of engagement in NHS Scotland an Employee Engagement Index was co-constructed with staff. ‘iMatter’ consists of 25 Likert questions developed iteratively from the literature and a series of validation events with NHS Scotland staff. The aim of this study was to test the face, content and construct validity of iMatter.

Methods

Cross sectional survey of NHS Scotland staff. In January 2013 iMatter was sent to 2300 staff across all disciplines in NHS Scotland. 1280 staff completed it. Demographic data were collected. Internal consistency of the scale was calculated. Construct validity consisted of concurrent application of factor analysis and Rasch analysis. Face and content validity were checked using 3 focus groups.

Results

The sample was representative of the NHSScotland population. iMatter showed very strong reliability (α = 0.958). Factor analysis revealed a four-factor structure consistent with the following interpretation:

My experience as an individual

My experience with my direct line manager

My experience with my team

My experience with my organisation

Each subscale also showed high level of internal consistency within all disciplines. Rasch analysis confirmed the majority of items fit with the latent trait of staff engagement with infit statistics between 0.7 and 1.3; and showed a good spread of item difficulty covering person ability. Focus groups found the questionnaire valid it terms of brevity, relevance and clarity.

Conclusions

iMatter showed evidence of high reliability and validity. It is a popular measure of staff engagement in NHS Scotland. Implications for practice focus on the importance of coproduction in psychometric development.

Ethics and originality in doctoral research in the UK

AIM

To show that the ethics governance process in the UK is not necessarily conducive to innovative investigation by doctoral students.

BACKGROUND

Doctoral students need to demonstrate an original contribution to knowledge. This paper critically evaluates the concept of knowledge in relation to the concept of research paradigms. The purpose of this is to situate different claims to originality and show that original knowledge in nursing is always ethical knowledge of nursing.

DATA SOURCES

Academic databases, local and national policy documents.

REVIEW METHODS

Ethics governance procedures in nurse research in the UK are summarised. These are contrasted with ethical issues embedded in day-to-day nursing practice.

DISCUSSION

The author's argument is that current methods of ethics governance for doctoral research in the UK can be detrimental to the construction of original knowledge in nursing. This is because original research in nursing necessarily affects the ethics of care, but the gatekeeping function of risk-averse ethics committees tends to prevent students attempting ethically complex studies. This means less important research gets carried out.

CONCLUSION

To mitigate these issues, doctoral students need to develop a solid understanding of the ethics governance process. They need to build relationships with relevant ethics committees. University ethics committees are ideally placed to help with this process.

IMPLICATIONS FOR RESEARCH/PRACTICE

Without original research practice will remain reactive. Originality entails risk on the part of both researcher and ethics committee. Positive risk taking is more feasible in the context of collaboration and mutual understanding. Nurses should become more active in research governance.

Concordance: a concept analysis

AIM

To report an analysis of the concept of concordance.

BACKGROUND

Adherence-based medicines interventions are known to be of limited success. Concordance appears to offer an alternative approach consistent with person-centred approaches to decision-making. However, the application of the principle of concordance appears inconsistent. This article considers the extent to which any of this confusion may be a function of the different usage of the term concordance in the disciplines of nursing, general medicine, psychiatry and pharmacy.

DESIGN

Rodger's evolutionary method of concept analysis.

DATA SOURCES

CINAHL, Medline, PsychINFO, Cochrane library, Psychology and Behavioural Sciences Collection were searched for publications between 2000 and 2012 with combinations of key words including concord*, adherence, compliance, medic*, psychiatr*, pharm*, nurs*.

REVIEW METHODS

Rodgers' evolutionary analytic method was used to identify and explore the concept of concordance across healthcare disciplines. A representative sample of papers was identified from the source disciplines. Over 500 papers were identified. Exclusion criteria limited the final sample to 60 papers in total, entailing 15 per discipline. Each discipline's papers were analysed for references, antecedents, consequences, attributes and surrogates separately. The team then worked together to cross-check these interpretations.

RESULTS

There was minimal agreement between the disciplines suggesting each discipline practised a different conceptualization of concordance. The main point of agreement was that better research is required to articulate the scope and value of partnership working.

CONCLUSION

The results clarified a distinct and currently missing research agenda.