Elizabeth Morrow

‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care

Background There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’. Aim To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment. Methods Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. Results Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p <0. 001). Conclusions Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing.

Handbook of service user involvement in nursing and healthcare research

Service USer involvemenT in nUrSing & HealTHcare reSearcH Handbook of Service USer involvemenT in nUrSing & HealTHcare reSearcH H a n d bo o k o f er v ic e U er in v o lv em en T in n U r in g & H ea TH c a r e r eSea r c H Elizabeth Morrow annette boaz Sally brearley fiona Ross This book fills an important niche in the market providing practical expert advice on service user (patients, carers and the public) involvement in nursing and healthcare research. an invaluable guide for anyone working or involved in nursing and healthcare research, this book provides a step-by-step guide to the principles and process of involvement, including understanding the rationale for involvement, designing involvement, working with service users, and evaluating what has been achieved.

Carer engagement in the hospital care of older people: an integrative literature review

AIM The aim of this review was to explore the concept of carer engagement in the hospital care of older people and to build theory to inform future research and practice. BACKGROUND Carer engagement can help to improve the delivery and continuity of care provided to older people in hospital. However, definitions, guidance and structures for carer engagement in hospitals are lacking and there can be tensions and conflicts about the role of carers in hospitals. METHOD Integrative literature review. Literature searches identified 2745 peer-reviewed articles and studies published between January 1990 and November 2015 in the following databases: PubMed, Cochrane, Medline, EMBASE and CINHAL. After applying inclusion/exclusion criteria, the sample (103 articles) was subject to thematic analysis. RESULTS Current evidence on carer engagement is dispersed across different research literatures on clinical conditions and contexts. Six distinct components of carer engagement were identified: patient caregiving, information sharing, shared decision-making, carer support and education, carer feedback and patient care transitions. CONCLUSION Hospitals can adopt a more consistent and comprehensive approach to carer engagement for older people by developing and supporting the different components of carer engagement identified. IMPLICATIONS FOR PRACTICE The integrated model of carer engagement developed here could help staff and hospitals to develop strategies, staff training and resources that work with rather than against carers. The findings can inform future research on carer engagement interventions and associated outcomes for patients, carers and staff.

Exploring research impact in the assessment of leadership, governance and management research:

Research is increasingly under the spotlight to demonstrate impact as well as ‘World Class’ quality. Impact measures were introduced into the United Kingdom’s Research Excellence Framework in 2014, and are being adopted in other countries. However, impact is a concept that is both loosely applied and often contested. It needs unpacking to build understanding about how it can be effectively evaluated. This article uses findings from a subsample of 1309 research-based case studies in leadership, governance and management submitted to the Research Excellence Framework. The mixed-method study used Complex Adaptive Systems as a lens to explore perspectives of impact as a consequence of research, as a process and as an emerging concept. We describe some of the rich patterns of impact practices, mechanisms for exchange, connections with context, and types of measures, used to evidence impact. The article helps to illuminate the complexity of impact and implications for its evaluation.

The Voluntary Sector and Public Services: Context, Continuity and Change

In this chapter we examine the context to some of the current debates over the respective roles of the state and voluntary sector in public service provision. Our aim is to provide an account of recent policy trends in this area, and in doing so to highlight some of the continuities in the history of the relationship between the voluntary sector and the state which might seem, at first glance, to be rather distinct. Throughout, we discuss recent developments in the voluntary sector’s public service role in the context of what came before, outlining some of the literature dealing with the contribution of voluntary action to public services before sketching two significant stages in the relationship between the voluntary sector and the state: the influence of the New Public Management on public services, and in particular on the ‘mainstreaming’ of the voluntary sector into government policy since 1997. Our account is then brought up to date with an analysis of some of the implications of these shifts. Our argument is that there are common threads running through each of these periods which remain influential today, and despite some of the significant changes which have accompanied recent government policy, a genuine appreciation of the relationship between the voluntary sector and the state needs to take these into account.