Jackie Bridges

Interprofessional care co-ordinators: the benefits and tensions associated with a new role in UK acute health care

While more flexible models of service delivery are being introduced in UK health and social care, little is known about the impact of new roles, particularly support worker roles, on the work of existing practitioners. This action research study aimed to explore the impact of one such new role, that of interprofessional care co-ordinators (IPCCs). The general (internal) medical service of a UK hospital uses IPCCs to provide support to the interprofessional team and, in doing so, promote efficiency of acute bed use. Using a range of methods, mainly qualitative, this action research study sought to explore the characteristics and impact of the role on interprofessional team working. While the roles flexibility, autonomy and informality contributed to success in meeting its intended objectives, these characteristics also caused some tensions with interprofessional colleagues. These benefits and tensions mirror wider issues associated with the current modernisation agenda in UK health care.

Interventions for compassionate nursing care: A systematic review

BACKGROUND Compassion has been identified as an essential element of nursing and is increasingly under public scrutiny in the context of demands for high quality health care. While primary research on effectiveness of interventions to support compassionate nursing care has been reported, no rigorous critical overview exists. OBJECTIVES To systematically identify, describe and analyse research studies that evaluate interventions for compassionate nursing care; assess the descriptions of the interventions for compassionate care, including design and delivery of the intervention and theoretical framework; and to evaluate evidence for the effectiveness of interventions. REVIEW METHODS Published international literature written in English up to June 2015 was identified from CINAHL, Medline and Cochrane Library databases. Primary research studies comparing outcomes of interventions to promote compassionate nursing care with a control condition were included. Studies were graded according to relative strength of methods and quality of description of intervention. Narrative description and analysis was undertaken supported by tabulation of key study data including study design, outcomes, intervention type and results. RESULTS 25 interventions reported in 24 studies were included in the review. Intervention types included staff training (n=10), care model (n=9) and staff support (n=6). Intervention description was generally weak, especially in relation to describing participants and facilitators, and the proposed mechanisms for change were often unclear. Most interventions were associated with improvements in patient-based, nurse-based and/or quality of care outcomes. However, overall methodological quality was low with most studies (n=16) conducted as uncontrolled before and after studies. The few higher quality studies were less likely to report positive results. No interventions were tested more than once. CONCLUSIONS None of the studies reviewed reported intervention description in sufficient detail or presented sufficiently strong evidence of effectiveness to merit routine implementation of any of these interventions into practice. The positive outcomes reported suggest that further investigation of some interventions may be merited, but high caution must be exercised. Preference should be shown for further investigating interventions reported as effective in studies with a stronger design such as randomised controlled trials.

Older people in accident and emergency: implications for UK policy and practice

A previous review described the literature outlining the characteristics and special needs of older people using accident and emergency (A&E) services, the service initiatives aimed at meeting these needs, and the implications of the findings for UK policy and practice. The review identified a lack of clear evidence to guide the development of specialist services for older people attending A&E. In particular it was noted that there was a deficit of work in the UK context. This seemed, in part at least, to be based on ambivalence about the legitimacy of developing specialist services in the emergency department for this group of patients, despite the large numbers of older people attending. However, the paper also noted encouraging trends and a move away from a preoccupation with whether or not older people were appropriate A&E attenders, to a consideration of how best to meet the particular needs of this group, that paralleled past developments of specialist services for children.

Cancer treatment decision-making processes for older patients with complex needs: a qualitative study.

Objectives Although older people can experience complex health and social care needs alongside a primary cancer diagnosis, little is understood about how cancer treatment decisions are made for this population. This study aimed to investigate how cancer treatment decisions are formulated for older people with complex health and social care needs and the factors that shape these processes. Design Qualitative study involving semistructured interviews and non-participant observations. Framework approach used for data analysis. Setting Breast and colorectal cancer services in five English NHS hospital trusts. Participants Interviews: purposive sample of 22 clinicians directly involved in a face-to-face clinical role with patients regarding cancer treatment and care, maximising variation across clinical roles, tumour types and trusts. Observations: purposive sample of five cancer multidisciplinary meetings, maximising variation across location, team size and tumour type. Results The initial stages of cancer treatment decision-making are team-based, medically dominated and focused on the cancer. For patients with complex health and social care needs that extend beyond cancer pathology, later and less visible stages in the decision-making process are more haphazard and may result in less effective and workable treatment plans, as individual clinicians struggle to devise and deliver these plans without breaching time-based targets. Conclusions Service targets that focus resources solely on the presenting disease can disadvantage older patients with complex health and social care needs that extend beyond this primary diagnosis. Care should be taken to ensure time-based targets do not disincentivise thorough and timely assessment that can lead to the formulation of treatment plans tailored to individual needs and circumstances.

Informal carers: a Marxist analysis of social, political, and economic forces underpinning the role

Increasingly, families are being called to provide care to their elderly family members. Nursing has an important role to play in enabling families to assume such responsibilities. In this article, however, it is argued that nursing needs to examine its goals for nursing care and approaches to care delivery in their broader social, political, and economic context. Marxist theory is introduced and used to raise questions about taken-for-granted aspects of nursing practice and trends in health policy as they relate to family carers for the elderly. The article specifically examines assumptions about family, women, and household economies that are inherent in traditional nursing theory. It is argued that nursing needs to move its focus of action beyond work at the individual and family level to include work at system and policy levels. To do so, nursing must examine theoretical perspectives that enable such an inquiry into practice.

Creating learning environments for compassionate care: a programme to promote compassionate care by health and social care teams

BACKGROUND The consistent delivery of compassionate health and social care to older people is a matter of global concern to the nursing profession and the public it serves. The development and evaluation of effective interventions to address this concern is of prime importance. AIMS AND OBJECTIVES This paper draws on findings from previous research to propose the use of a novel implementation programme designed to improve and support the delivery of compassionate care by health and social care teams. INTERVENTION Creating Learning Environments for Compassionate Care (CLECC) is a 4-month implementation programme designed for hospital ward nursing teams caring for older people, but relevant to other teams working with other client groups. The programme focuses on using workplace learning to promote change at unit/ward/team level by enabling the development of leadership and team relational practices which are also designed to enhance the capacity of individual team members to relate to older people. Existing research evidence suggests that optimising relational capacity in this way will support the delivery of compassionate care. CONCLUSIONS This evidence-based intervention is designed to develop and sustain the relational work required by managers and team members to support care delivery and has the potential to address widely documented variations in care quality. IMPLICATIONS FOR PRACTICE Attention should now be paid to establishing the feasibility of the intervention in practice.

Older people in A&E: Literature review and implications for British policy and practice

As the proportion of older people in the population rises, health services must continue to develop to meet their special needs. This includes accident and emergency (A&E) services which work at the interface between primary and secondary health care for individuals of all ages. This literature review aimed to answer the following questions: 1) What are the characteristics and special needs of older people in A&E? 2) Which of the current literature describes, evaluates or advocates service initiatives aimed at meeting the needs of older people in A&E? 3) What are the policy implications of the literature reviewed for British A&E services?

Measuring outcomes of long-term care for older people

There comes a time in the lives of a minority of older people when the extent of their disabilities makes it impossible for them to continue living in their own homes. When this happens, long-term institutional care may be the only option. Given that most residents in long-term care are over 75 years old and that the numbers in this age group will increase into the next century, we can expect an increase in the number of people requiring long-term care.

The role of the dementia specialist nurse in acute care: a scoping review

AIMS AND OBJECTIVES To identify the potential benefits of dementia specialist nursing and to inform the implementation of roles to support people with dementia during hospital admission. BACKGROUND Extended stays and adverse events mean that hospital admissions are costly for people with dementia, and patient experiences and outcomes can be poor. Specialist nurses have been identified as having potential to enhance care quality, reduce excess stays and reduce costs, but the evidence base for dementia specialist nurse roles has not previously been synthesised. DESIGN Scoping review. DATA SOURCES Cochrane Library, Campbell Collaboration, Clinical Evidence, Evidence-Based Medicine, York Centre for Reviews and Dissemination, PubMed, Medline, CINAHL and PsycInfo databases and internet searches and personal libraries/expert consultation to identify grey literature. METHODS Initial scoping searches were used to inform more focused systematic searches. Studies directly evaluating dementia nurse specialist roles or giving evidence of effectiveness of interventions/services that could be delivered by them to improve core outcomes were identified by one reviewer and verified by a second reviewer. RESULTS While direct evidence for the effectiveness of these roles is lacking, a number of areas were identified in which a nurse specialist role could make a contribution, including preventing adverse events and improving patient experiences and outcomes. There is a considerable body of evidence for the effectiveness of these interventions although the volume of evidence for specific interventions is not always significant. CONCLUSIONS The evidence indicates that a skilled dementia specialist nurse, undertaking a clearly defined role, and working directly with people with dementia and their carers for a significant proportion of the time, could benefit people with dementia in hospitals and their family carers. RELEVANCE TO CLINICAL PRACTICE Clear guidance for the development and implementation of dementia specialist nurse roles in acute hospital settings.

Dignity and significance in urgent care: older people’s experiences

In this paper we report the role that a sense of significance plays in the experiences of older patients in urgent care settings, and explore the factors that influence these experiences. The paper draws on findings from a UK study in which 69 patients and 27 relatives from 31 English NHS Trusts were interviewed about their urgent care experiences using semi-structured qualitative interviews. Key among the findings was that older patients experienced a diminished sense of their individual significance. Some questioned the legitimacy of their presence in the urgent care setting and believed that they mattered little in relation to other patients and the other tasks which health professionals were undertaking. The three key features of this diminished sense of significance were: the primacy of technical, medical care; an imbalance of power; and the subordination of patients’ non-medical needs. These features suggest that interventions to enhance care delivery that promotes a sense of significance will need to target practitioners and the wider organisational culture.