Lesley Baillie

Evaluation of the Royal College of Nursing’s ‘Dignity: at the heart of everything we do’ campaign: exploring challenges and enablers

Dignity in care has become a key policy, practice and political priority. This development has become more pressing as media, anecdotal and research reports have highlighted dignity deficits in care. In response to such reports and to concerns of the membership and general public, the Royal College of Nursing initiated a high-profile campaign (Dignity: at the heart of everything we do) involving engagement with stakeholders, a survey of members and the development and dissemination of educational and practice development materials. This article details findings from part of the evaluation of the Royal College of Nursing dignity campaign, which used a qualitative case study design across seven UK sites. The study used interviews with 51 staff members, direct observation of the physical care environment and document analysis, and data were analysed using thematic analysis. The article focuses on two areas: enablers (staff receptivity and creativity; organisational support and leadership; and campaign educational materials) and challenges (time constraints; and staff attitudes and insight).

Educating a health service workforce about dementia: a qualitative study

Purpose People who are living with dementia are core health service users but there are ongoing concerns about the quality of their care and the need for improved education of healthcare staff. This paper reports on a qualitative study that investigated staff perspectives of an ethnodrama (‘Barbara’s Story’) which was used to educate an entire health service workforce and promote a person-centred approach to care. Design/Methodology/Approach The study used a qualitative, longitudinal design with focus groups held with clinical (nurses, allied health professionals, medical) and non-clinical staff. In Phase 1 there were 10 focus groups (n=67 participants) and one individual interview. In Phase 2 there were 16 focus groups (n=77 participants) and three individual interviews. Findings Barbara’s Story raised awareness of dementia, engaged staff emotionally and prompted empathetic responses and improved interactions. The project’s senior leadership, whole organisation and mandatory approach were well-supported, with a perceived impact on organisational culture. The project helped to embed practice developments and initiatives to support person-centred care. Barbara’s story is now well integrated into the organisation, thus supporting sustainability. Originality/value Whilst there are increasing resources for educating about dementia, there are fewer evaluations, particularly for large-scale initiatives, and there is a lack of focus on long-term effects. The study findings indicate that education about dementia can be delivered to a whole work force in a sustainable manner, to prompt empathy, raise awareness, support person-centred care and impact on individual behaviour and organisational culture.

An exploration of the 6Cs as a set of values for nursing practice

In 2012, after several high-profile cases of poor quality care in England and concerns about a lack of compassion and a need to refocus on values, the Department of Health in England published a new strategy for nursing, midwifery and care staff: Compassion in Practice. The strategy included the 6Cs (care, compassion, courage, communication, competence and commitment) and in the follow-on framework, produced by NHS England in 2016, the 6Cs were included again. This article explains the background to the 6Cs and highlights the other values frameworks that nurses and midwives must work within too. Nursing theorists have studied caring extensively and the earlier set of 6Cs, produced by a Canadian nurse Sister Simone Roach, is explained in the article. The meaning of the DHs 6Cs is then explored in detail with reference to previous research and nursing theory.

Perspectives: We need to talk about the 6Cs: perspectives on a recent debate:

In 2012, following a consultation exercise with over 9000 nurses, midwives, care staff and patients, the Department of Health (DH) for England published Compassion in Practice: Nursing, Midwifery and Care Staff: Our Vision and Strategy (DH, 2012). The document includes a framework called the ‘6Cs’ (care, compassion, courage, communication, competence and commitment), sometimes referring to them as ‘values and behaviours’ but elsewhere as ‘fundamental values’. This variation in how they are described indicates some lack of clarity about their purpose, as values are generally defined as beliefs or principles that influence behaviour (Baillie and Black, 2014). Nevertheless, the DH (2012) aimed to embed the 6Cs in all nursing, midwifery and care-giving settings throughout England’s National Health Service (NHS) and social care. The promotion of the 6Cs has since gathered pace, with the support of ‘Care Makers’ who are healthcare staff and students who have volunteered to be ambassadors for the 6Cs, as well as a dedicated website and social media. The 6Cs appear to have attracted widespread acceptance, and their status within nursing and midwifery in England now seems without question. For example, in the recently published review of the future education and training of registered nurses and care assistants in England, Lord Willis argued for a focus on the ‘best interests of patients and the public, ensuring that registered nurses, carers and care assistants are adhering to the 6Cs’ (Willis, 2015: 14). This statement implies that the 6Cs are established as the guiding principles for nursing, but there appears to have been no questioning or critical review of the apparent acceptance of the 6Cs into the nursing and midwifery professions. The recent 6Cs debate at London South Bank University [https://www.lsbu.ac.uk/aboutus/news/HSC-debate-kicked-off-with-the-6cs] with a simultaneous Twitter chat was a welcome opportunity for nurses and other healthcare professionals to engage in discussion about the 6Cs and hear a range of perspectives from the speakers and the audience. The motion was ‘The 6Cs can improve care’ and the audience voted on six related statements before and after the debate; the varied responses across the audience confirmed the need for a debate. There was a wide-ranging discussion, but there were two overarching themes that

How does the length of day shift affect patient care on older people's wards? A mixed method study

BACKGROUND Internationally, studies have focused on whether shift length impacts on patient care. There are also ongoing concerns about patient care for older people in hospital. The study aim was to investigate how length of day shift affects patient care in older peoples hospital wards. OBJECTIVES 1) To explore how length of day shift affects patient care in older peoples wards; 2) To explore how length of day shift affects the quality of communication between nursing staff and patients/families on older peoples wards DESIGN: A mixed method case study. SETTINGS The study was based on two older peoples wards in an acute hospital in England. One ward was piloting two, overlapping 8h day shifts for 6 months while the other ward continued with 12h day shifts. PARTICIPANTS AND METHODS Qualitative interviews were conducted with 22 purposively recruited nursing staff (17 registered nurses; 5 nursing assistants). An analysis of patient discharge survey data was conducted (n=279). Twenty hours of observation of nursing staffs interactions with patients and families was conducted, using an adapted version of the Quality of Interaction Schedule (301 interactions observed), with open fieldnotes recorded, to contextualise the observations. RESULTS There were no statistically significant differences in patient survey results, or quality of interactions, between the two wards. There were three overall themes: Effects of day shift length on patient care; Effects of day shift length on continuity of care and relationships; Effects of day shift length on communication with patients and families. Nursing staff believed that tiredness could affect care and communication but had varied views about which shift pattern was most tiring. They considered continuity of care was important, especially for older people, but had mixed views about which shift pattern best promoted care continuity. The difficulties in staffing a ward with an 8h day shift pattern, in a hospital that had a 12h day shift pattern were highlighted. Other factors that could affect patient care were noted including: ward leadership, ward acuity, use of temporary staff and their characteristics, number of consecutive shifts, skillmix and staff experience. CONCLUSIONS There was no conclusive evidence that length of day shift affected patient care or nursing staff communication with patients and families. Nursing staff held varied views about the effects of day shift length on patient care. There were many other factors identified that could affect patient care in older peoples wards.

Increasing nurse and midwife engagement in research activity.

Nurses and midwives should be able to perform, interpret and implement the results of clinical research to improve the quality of patient care. Increasing the research capacity and capability of healthcare professionals requires strong leadership and a strategic approach. This article describes how one NHS trust supports engagement of nurses and midwives in research through the development of a research strategy and a centre for nurse and midwife-led research.

Measuring the impact of nurses and nursing: the core values

healthcare values. However, it is difficult to argue for evidence-based practice and the value of nursing if we are not creating the evidence on which to base our practice. Patients feel that relational aspects of nursing are very important: the approach of the nurse is the most important factor in securing a good experience for patients, enabling them to be ‘treated as a human being not a case’ with compassion, respect, empathy and by staff who are ‘interested in YOU’ (Maben and Griffiths, 2008: 7). We work in a health service where numbers matter and the measurable is influential. The lack of evidence on important aspects of nursing care has contributed to a largely reductionist debate about staffing levels and numbers of nurses needed on a shift in acute care. The focus is on maintaining the minimum nurse staffing needed to prevent harm, rather than what nurse staffing is needed to deliver excellence and individualised patient-centred care that encompasses our nursing values. Current staffing in acute care (and likely other settings) leaves many tasks undone (Ball et al, 2013), with the tasks essential for safety prioritised and ‘relationship’ aspects of nursing neglected. ‘Comfort/talk to patients’ was felt to have been left undone by 53% of nurses in acute care across Europe (UK: 66%) on their last shift because of insufficient time, with educating patients reported as not done by 41% (UK: 52%) (Ball et al, 2013; Ausserhofer et al, 2014). These are surely key elements of the nursing role? But without evidence of a measurable difference made to patients, it is difficult to argue our case in a metrics-obsessed resource-constrained health service. Lack of time to perform what nurses have been trained to do and indeed what they came into nursing for and want to do, leaves many feeling frustrated, stressed and burnt out. They feel they cannot reliably deliver care of the standard to which they aspire (Heinen et al, 2013). Nurses are being counted as a homogenous commodity to be provided in a numbers game that hospitals are obliged to report on, with little debate on quality rather than quantity; we are reduced to the minimum acceptable for safety rather than enough for excellence in care. Unless we can capture nursing’s unique contribution to positive aspects of care, such as compassion and dignity, we will be in a weak position to argue for the importance of enabling nurses to deliver care as they wish to. In the last issue of BJN (Deaton et al, 2014) we discussed the need for knowledge and evidence in nursing. However, there is a problem with definitions and outcome measures that demonstrate the value of the nursing contribution to patient care. While work has started to define ‘nurse-sensitive indicators’ (Griffiths et al, 2008) these focus on measuring what we can quantify: patient numbers, waits and length of stay, falls, pressure ulcers and infections. These are obviously very important, but our inability to articulate the value of nursing in relational aspects of care means that we are often focusing on preventing harms rather than doing good. When nurses are asked what is important to them, they vote overwhelmingly for personcentred care rather than more easily measured metrics (McCance et al, 2011). There has been little research trying to capture the value of nursing in terms of our core values and nursing’s unique contribution to patient care. Indeed, it is not clear that we even agree what constitute our core nursing values: are they the 6 Cs (Care, Compassion, Competence, Communication, Courage and Commitment); kindness, respect and dignity as in the new draft Nursing and Midwifery Council (NMC) code; or the NHS Constitution multidisciplinary values (respect, dignity, compassion, getting the basics right every time, improving lives and patient involvement)? It is a pity that these high-level values are not aligned. Many values are poorly defined and we are lacking a consensus on how to improve or measure them. Although academics have conducted concept analyses on some, practical operational definitions and agreement on what behaviours demonstrate the values are few. Indeed, they are maybe easier to identify if they are absent than present. For instance, dignity has been much talked about, with numerous recommendations, but attempts to measure it, or interventions with measurable outcomes, are lacking. We simply do not have evidence on what works (and just as importantly what does not work). There is a similar lack of evidence on interventions related to most of our other values. Does it matter that we cannot measure many of the core elements and values in nursing practice? Most are likely to be difficult to measure directly, but can be observed from behaviours. They are multi-factorial and require multidisciplinary behaviours. Additionally, nursing should not be the sole custodian of Measuring the impact of nurses and nursing: the core values

Education and compassion: complementary not contradictory

British Journal of Nursing, 2014, Vol 23, No 22 1213

Personal information documents for people with dementia: Healthcare staff ’s perceptions and experiences:

Person-centred care is internationally recognised as best practice for the care of people with dementia. Personal information documents for people with dementia are proposed as a way to support person-centred care in healthcare settings. However, there is little research about how they are used in practice. The aim of this study was to analyse healthcare staff ’s perceptions and experiences of using personal information documents, mainly Alzheimer’s Society’s ‘This is me’, for people with dementia in healthcare settings. The method comprised a secondary thematic analysis of data from a qualitative study, of how a dementia awareness initiative affected care for people with dementia in one healthcare organisation. The data were collected through 12 focus groups (n = 58 participants) and 1 individual interview, conducted with a range of healthcare staff, both clinical and non-clinical. There are four themes presented: understanding the rationale for personal information documents; completing personal information documents; location for personal information documents and transfer between settings; impact of personal information documents in practice. The findings illuminated how healthcare staff use personal information documents in practice in ways that support person-centred care. Practical issues about the use of personal information documents were revealed and these may affect the optimal use of the documents in practice. The study indicated the need to complete personal information documents at an early stage following diagnosis of dementia, and the importance of embedding their use across care settings, to support communication and integrated care.

Review: Burnout and its relationship to empathy in nursing: a review of the literature

Compassion in nursing has developed a high profile in recent years following several reports about poor care in England and a lack of compassion, but there is much less discussion about empathy, which is a related, but different, concept. The authors of the reviewed study suggest that empathic interactions are a necessary prerequisite for compassion, but that this emotional engagement can, for some nurses, lead to burnout and a subsequent inability to provide compassionate care. They argue for a better understanding of the relationship between empathy and burnout, thus providing the rationale for this paper.