Graham R. Williamson

Vocation, Friendship and Resilience: A Study Exploring Nursing Student and Staff Views on Retention and Attrition

Introduction: There is international concern about retention of student nurses on undergraduate programmes. United Kingdom Higher Education Institutions are monitored on their attrition statistics and can be penalised financially, so they have an incentive to help students remain on their programmes beyond their moral duty to ensure students receive the best possible educational experience. Aims: to understand students’ and staff concerns about programmes and placements as part of developing our retention strategies. Design: This study reports qualitative data on retention and attrition collected as part of an action research study. Setting: One University School of Nursing and Midwifery in the South West of England. Participants: Staff, current third year and ex-student nurses from the adult field. Methods: Data were collected in focus groups, both face-to face and virtual, and individual telephone interviews. These were transcribed and subjected to qualitative content analysis. Results: Four themes emerged: Academic support, Placements and mentors, Stresses and the reality of nursing life, and Dreams for a better programme. Conclusions: The themes Academic support, Placements and mentors and Stresses and the reality of nursing life, resonate with international literature. Dreams for a better programme included smaller group learning. Vocation, friendship and resilience seem instrumental in retaining students, and Higher Education Institutions should work to facilitate these. ‘Vocation’ has been overlooked in the retention discussions, and working more actively to foster vocation and belongingness could be important.

Nurses Over 50. Options, Decisions and Outcomes

Working patterns and retirement decisions of people over 50 have important implications for labour supply in an ageing workforce, nowhere more so than in a sector such as the National Health Service threatened with severe staff shortage. In this context, a study by researchers at the University of Hull examined the options and decisions taken by nurses over 50, and the outcomes in terms of their movement in and out of the NHS. They found that:

Illustrating the ethical dimensions of action research.

Introduction Lecturer practitioner (LP) roles are no longer new in the United Kingdom (UK), having been established initially in the 1980s to overcome the theory/practice gap in nursing (Lathlean 1992). Teachers were seen as being far removed from practice, while practitioners did not know about the theoretical elements that might inform their work (Cave 1994). This perceived situation was widely regarded as a ‘problematic, even embarrassing sign of failure within education, practice and research’ in nursing, which it was essential to rectify (Rafferty et al 1996). Furthermore, as Lathlean (1992) discusses, a long history of ‘ideological differences between school and service’ meant that students were illprepared for the reality of work after qualification. The current political climate and policy context are favourable for higher education institutions and trusts seeking to strengthen the links between service and education (Fairbrother 2000, Waters 1999). There are explicit calls from government to expand the number of LPs in order to support pre-registration students. For example, the Department of Health (1999) calls for a strengthening of pre-registration education and training, with better teacher support a priority. However, there are several problems with the role. Although introduced to bridge the theory-practice gap (Hewison and Wildman 1996), some LPs do not see this as their primary role (Lathlean 1992, McCrea et al 1998), or do not actually work with pre-registration students (Fairbrother

Undergraduate Nurses' and Midwives' Participation and Satisfaction with Live Interactive Webcasts

Introduction: E-Learning methods such as webcasting are being used increasingly in healthcare education, including that of nurses and midwives. Webcasting means live synchronous broadcasting over the internet, where students participate simultaneously in text ‘chat room’ interactive discussions when logged on to a webpage where they can see and hear a presentation such as a PowerPoint lecture, a list of other participants, and access ‘chat rooms’. Aims: This paper reports student participation and satisfaction with the use of webcasting in a third year undergraduate nursing and midwifery research methods module in one higher education institution faculty of health and social work in the southwest of England, with students from distributed geographical locations. Materials and Methods: Students chose either webcasts or face-to-face lectures. Following each of the four webcasts, a web-based evaluation questionnaire was administered in a cross-sectional survey design. Results: Two thirds of students took part in webcasts and found them to be an acceptable teaching and learning strategy. Travel and cost savings were noted through not travelling to the main university campus, and these were statistically significantly correlated with students’ perception of gaining from the module and their overall satisfaction with webcasting. Across the four webcasts 5446 purposeful messages were posted indicating engagement with the material under study. Conclusions and Recommendations: Webcasting is an effective teaching and learning strategy which is popular with students, allows remote access to teaching and learning, and offers time and cost savings to students. Further research is required to investigate the educational potential of this new technology.

Investigating Women's Experiences of Asthma Care in Pregnancy: A Qualitative Study.

Background : Most asthmatic women have normal pregnancies and complications are infrequent when their asthma is well-controlled. Symptom control and medical treatment are concerning to pregnant asthma suffers, as is the impact that their illness and treatment might have on their unborn baby. The aim was to investigate in a qualitative study the thoughts and feelings of women’s experiences of asthma in pregnancy. Twenty-two women with asthma who had a pregnancy within two years were asked to participate. Seven women were interviewed when data saturation was achieved. Interviews were transcribed and analysed using the ‘Framework’ Method, independently analysed by two researchers and consensus reached concerning the construction of themes. The key themes that emerged were Asthma and pregnancy; Pregnancy and post-natal experiences; and Health professionals. These findings are globally interesting because of the prevalence of maternal asthma and they illustrate participants’ experiences concerning their asthma care and their views on its improvement. Pregnant asthmatic women have concerns about their care and treatment which might be alleviated by outreach, joint working between respiratory doctors and nurse specialists, midwives and General Practice nurses. Targeted educational activities could form a part of this care delivery.

Thrombolysis administration by nurses: An evolving UK evidence base?

BACKGROUND In the United Kingdom, an estimated 240,000 people suffer myocardial infarction yearly. Whilst primary angioplasty has emerged as the treatment of choice for many patients, thrombolytic agents are an effective class of medications which reduce myocardial damage, morbidity and mortality. They are most effective when given at the earliest opportunity, and United Kingdom government policy and professional standards aim to reduce these delays. This can be facilitated by nurse-led services. AIM This systematic review of the literature charts the development of nurse thrombolysis in relation to UK government policy and assesses the research evidence since 2003. FINDINGS Six papers met the inclusion criteria, and the following themes emerged: Thrombolysis is safely administered by nurses, Nurse-led thrombolysis improves door-to-drug time, Nurse-led thrombolysis is seen as a positive change in practice, Issues in Emergency Department thrombolysis administration. CONCLUSIONS Although the evidence retrieved does not rate highly in the accepted hierarchy of evidence, nurses can be accurate and safe in diagnosis and treatment of acute myocardial infarction; nurse-led thrombolysis reduces door-to-drug times; and these services are supported by other professionals. Local clinical leadership and local thrombolysis protocols have provided the greatest improvements. Managing acute myocardial infarction including primary angioplasty facilities and administering early thrombolysis are clearly core elements of emergency care that need to be provided on a full 24 h, 7 days a week basis by appropriate frontline clinical staff.

Longitudinal Evaluation of the Impact of Placement Development Teams on Student Support in Clinical Practice

Aims: To investigate the impact of a new structure for supporting healthcare students and mentors in practice placements (Placement Development Teams). Introduction: The English Model National Partnership Agreement for healthcare education required Strategic Health Authorities, Higher Education Institutions and National Health Service Trusts to redesign strategies for student support. Placement Development Teams are one English University’s response to this. Materials and Methodology: This study was phase 2 of a longitudinal qualitative evaluation of Placement Development Teams. Data were collected after establishment of Placement Development Teams, and compared and contrasted with those collected prior to their implementation. Telephone interviews were conducted with key educational stakeholders in Trusts and Strategic Health Authorities. Focus groups were conducted with third year non-medical healthcare students and first year paramedics working in 16 NHS Trusts in the south west peninsula of England. Results: Pre-Placement Development Teams, themes from the students’ data were: Supportive and unsupportive behaviour of staff; Mentor allocation; Placement allocation; Benefits of students to the placement area and Perceived control over the learning experience. Post-Placement Development Teams, the themes were Communication; Supportive and unsupportive behaviour of staff; The effect of peers on the placement experience; Knowledge and perceptions of the work of the PDTs. Form the staff data, pre-Placement Development Teams the themes were: Vision for improving student support. Post-Placement Development Teams themes from the staff data were how they provided a central point of contact for student and mentor support; and how they supported students and mentors. Conclusion: Support of students and mentors is particularly important following the introduction of The English Model National Partnership Agreement for healthcare education. Placement Development Teams can facilitate partnership working between higher education institutions and placement providers for student support.

Women’s experiences of personalised support for asthma care during pregnancy: A systematic review of the literature

BackgroundAsthma and pregnancy are both sources of anxiety for women. Although there has been a focus on physiological management of asthma and pregnancy, there has been little research on the impact that personalised support can have on asthma care during pregnancy. This systematic review and narrative synthesis of the literature set out to answer the question ‘What are women’s experiences of asthma care, its management and education, during pregnancy?’MethodsThis systematic review was carried out using accepted methodology from the York Centre for Reviews and Dissemination. Electronic database searches were conducted using PsycInfo, CINAHL, MedLine, Google Scholar and the Cochrane Library, using the combination search terms: ‘Asthma’ AND ‘Pregnancy’ AND ‘Care’ AND (‘Education OR Information OR Experience’). Hand searching of journals and searches for grey literature were also undertaken. Independent quality appraisal by the three authors took place using the criteria detailed by Kmet et al. (Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields, 2004).ResultsAll papers scoring in excess of 60% were deemed to be of adequate quality for inclusion, of which there were five: two qualitative designs and three quantitative designs. The designs were too methodologically heterogeneous to permit statistical meta-analysis so narrative review and synthesis was undertaken. Despite an embryonic evidence bases, it is reasonable to conclude that personalised care has beneficial outcomes for pregnant asthmatic women.ConclusionsLarger randomised controlled trials investigating personalised care are required to build an evidence base which can establish the efficacy of such interventions.

Personal budgets for all? Implementing self-directed support in mental health services

Personal budgets provide people with more choice and control over how their needs are met and, allied to new thinking concerning individualisation of mental health care, are increasingly a feature of international governmental responses to long-term care. This study was based in an English National Health Service Health and Social Care Trust covering a large predominantly rural area. We aimed to develop self-directed support and understand more fully service-user and carer involvement in the process, using an action research design. Data collection took place between 2007 and 2011, and the project ran in three sequential spirals collecting qualitative data. Findings showed users and carers, and trust recovery coordinators acknowledged the need for cultural change, personal budgets’ effect on outcomes, and service-users’ capacity to manage these responsibilities. We conclude that moving to personal budgets can be empowering for mental health services users, but is problematic and may present challenges to service-users with fluctuating mental health. Recruiting service-users and carers to participate in research illuminates their otherwise-hidden perspectives, and our use of service-users as coresearchers is a process that others might want to emulate.

Risk assessment in mental health: introducing a traffic light system in a community mental health team

Aims: To reports a study in which action research approach was utilised to introduce a new system of risk assessment, based on traffic lights, into a community mental health team. Background: Risk management is a serious concern in community mental healthcare where there is less direct, real-time supervision of clients than in other settings, and because inadequate management of risk can have fatal consequences when service users are a risk to themselves and/or others. Design: An action research design was undertaken, using three phases of Look, Think and Act. Methods: Data were collected between January and March of 2012. In the action research phases, qualitative data were collected in focus groups with the team’s multi-disciplinary mental health professionals. Data were transcribed verbatim and analysed thematically, which involved agreement of themes and interpretations by two researchers. The Look, Think and Act phases guided the development of the project; team members worked collaboratively on the traffic light system, implemented and evaluated it. Findings: Themes were constructed that were discussed across the focus groups. These themes were: Ease of use; Risk identification and management; Legal status; Different teams’ views of risk; Post-implementation evaluation. Conclusion: Action research has been used to implement change in mental health risk management. Others internationally would benefit from considering a Traffic Light System, and in using action research to implement it.