Nigel Davies

A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39

Abstract Background: Interprofessional education (IPE) aims to bring together different professionals to learn with, from, and about one another in order to collaborate more effectively in the delivery of safe, high-quality care for patients/clients. Given its potential for improving collaboration and care delivery, there have been repeated calls for the wider-scale implementation of IPE across education and clinical settings. Increasingly, a range of IPE initiatives are being implemented and evaluated which are adding to the growth of evidence for this form of education. Aim: The overall aim of this review is to update a previous BEME review published in 2007. In doing so, this update sought to synthesize the evolving nature of the IPE evidence. Methods: Medline, CINAHL, BEI, and ASSIA were searched from May 2005 to June 2014. Also, journal hand searches were undertaken. All potential abstracts and papers were screened by pairs of reviewers to determine inclusion. All included papers were assessed for methodological quality and those deemed as “high quality” were included. The presage–process–product (3P) model and a modified Kirkpatrick model were employed to analyze and synthesize the included studies. Results: Twenty-five new IPE studies were included in this update. These studies were added to the 21 studies from the previous review to form a complete data set of 46 high-quality IPE studies. In relation to the 3P model, overall the updated review found that most of the presage and process factors identified from the previous review were further supported in the newer studies. In regard to the products (outcomes) reported, the results from this review continue to show far more positive than neutral or mixed outcomes reported in the included studies. Based on the modified Kirkpatrick model, the included studies suggest that learners respond well to IPE, their attitudes and perceptions of one another improve, and they report increases in collaborative knowledge and skills. There is more limited, but growing, evidence related to changes in behavior, organizational practice, and benefits to patients/clients. Conclusions: This updated review found that key context (presage) and process factors reported in the previous review continue to have resonance on the delivery of IPE. In addition, the newer studies have provided further evidence for the effects on IPE related to a number of different outcomes. Based on these conclusions, a series of key implications for the development of IPE are offered.

Using Twitter™ to drive research impact: A discussion of strategies, opportunities and challenges

Researchers have always recognised the importance of disseminating the findings of their work, however, recently the need to proactively plan and drive the impact of those findings on the wider society has become a necessity. Firstly, this is because funders require evidence of return from investment and secondly and crucially because national research assessments are becoming powerful determinants of future funding. In research studies associated with nursing, impact needs to be demonstrated by showing the effect on a range of stakeholders including service users, patients, carers, the nursing workforce and commissioners. Engaging these groups is a well-known challenge influenced by lack of access to academic journals, lack of time to read long complex research papers and lack of opportunities to interact directly with the researchers. This needs to be addressed urgently to enable nursing research to increase the impact that it has on health delivery and the work of clinical practitioners. Social media is potentially a novel way of enabling research teams to both communicate about research as studies progress and to disseminate findings and research funders are increasingly using it to publicise information about research programmes and studies they fund. A search of the healthcare literature reveals that advice and guidance on the use of social media for research studies is not well understood or exploited by the research community. This paper, therefore, explores how using social networking platforms, notably Twitter™ offers potential new ways for communicating research findings, accessing diverse and traditionally hard-to-reach audiences, knowledge exchange at an exponential rate, and enabling new means of capturing and demonstrating research impact. The paper discusses approaches to initiate the setup of social networking platforms in research projects and considers the practical challenges of using Twitter™ in nursing and healthcare research. The discussion is illuminated with examples from our current research. In summary, we suggest that the use of social media micro-blogging platforms is a contemporary, fast, easy and cost effective way to augment existing ways of disseminating research which helps drive impact.

What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? A realist evaluation protocol

Introduction Intentional rounding (IR) is a structured process whereby nurses in hospitals carry out regular checks, usually hourly, with individual patients using a standardised protocol to address issues of positioning, pain, personal needs and placement of items. The widespread implementation of IR across the UK has been driven by the recommendations of the Francis Inquiry although empirical evidence of its effectiveness is poor. This paper presents a protocol of a multimethod study using a realist evaluation approach to investigate the impact and effectiveness of IR in hospital wards on the organisation, delivery and experience of care from the perspective of patients, their family members and staff. Methods and analysis The study will be conducted in four phases. Phase 1: theory development using realist synthesis to generate hypotheses about what the mechanisms of IR may be, what particular groups may benefit most or least and what contextual factors might be important to its success or failure which will be tested in subsequent phases of the study. Phase 2: a national survey of all NHS acute trusts to explore how IR is implemented and supported across England. Phase 3: case studies to explore how IR is implemented ‘on the ground’, including individual interviews with patients, family members and staff, non-participant observation, retrieval of routinely collected patient outcomes and cost analysis. Phase 4: accumulative data analysis across the phases to scrutinise data for patterns of congruence and discordance and develop an overall evaluation of what aspects of IR work, for whom and in what circumstances. Ethics and dissemination The study has been approved by NHS South East Coast—Surrey Research Ethics Committee. Findings will be published in a wide range of outputs targeted at key audiences, including patient and carer organisations, nursing staff and healthcare managers.

Interprofessional education in maternity services: Is there evidence to support policy?

ABSTRACT Against a backdrop of poor maternity and obstetric care, identified in the Morecambe Bay Inquiry, the UK government has recently called for improvements and heralded investment in training. Given the complex mix of professionals working closely together in maternity services addressing the lack of joined up continuing professional development (CPD) is necessary. This led us to ask whether there is evidence of IPE in maternity services. As part of a wider systematic review of IPE, we searched for studies related to CPD in maternity services between May 2005 and June 2014. A total of 206 articles were identified with 24 articles included after initial screening. Further review revealed only eight articles related to maternity care, none of which met the inclusion criteria for the main systematic review. The main reasons for non-inclusion included weak evaluation, a focus on undergraduate IPE, and articles referring to paediatric/neonatal care only. Fewer articles were found than anticipated given the number of different professions working together in maternity services. This gap suggests further investigation is warranted.

Review: Perception of work-related empowerment of nurse managers

The reviewed study examines the perceptions of work-related empowerment in nurse managers in Lithuania. The study adopts a cross-sectional survey approach utilising adaptations of questionnaires developed originally by Canadian researchers (Irvine et al., 1999; Laschinger et al., 2001) to explore both structural and psychological aspects of empowerment. This is an interesting paper which is relevant and timely to current health care. Challenges over the past decade relating to the quality of nursing care have led to increased focus on whether services are well led (Care Quality Commission, 2017). Increasingly there is realisation that traditional models of leadership need to be replaced with collective leadership approaches (West et al., 2014). The paper is of relevance to chief nurses, leadership consultants, human resource trainers, and nurse managers themselves. The study adds to the collective narrative around leadership at middle manager level with a specific focus on empowerment, which is under-researched in this group of nurses, suggesting implications for practice (on three counts: management, leadership development and clinical care) and research. Each of these aspects is explored further in this review.

Realist synthesis of intentional rounding in hospital wards: exploring the evidence of what works, for whom, in what circumstances and why

Background Intentional rounding (IR) is a structured process whereby nurses conduct one to two hourly checks with every patient using a standardised protocol. Objective A realist synthesis of the evidence on IR was undertaken to develop IR programme theories of what works, for whom, in what circumstances and why. Methods A three-stage literature search and a stakeholder consultation event was completed. A variety of sources were searched, including AMED, CINAHL, MEDLINE, PsycINFO, HMIC, Google and Google Scholar, for published and unpublished literature. In line with realist synthesis methodology, each study’s ‘fitness for purpose’ was assessed by considering its relevance and rigour. Results A total of 44 papers met the inclusion criteria. To make the programme theories underpinning IR explicit, we identified eight a priori propositions: (1) when implemented in a comprehensive and consistent way, IR improves healthcare quality and satisfaction, and reduces potential harms; (2) embedding IR into daily routine practice gives nurses ‘allocated time to care’; (3) documenting IR checks increases accountability and raises fundamental standards of care; (4) when workload and staffing levels permit, more frequent nurse–patient contact improves relationships and increases awareness of patient comfort and safety needs; (5) increasing time when nurses are in the direct vicinity of patients promotes vigilance, provides reassurance and reduces potential harms; (6) more frequent nurse–patient contact enables nurses to anticipate patient needs and take pre-emptive action; (7) IR documentation facilitates teamwork and communication; and (8) IR empowers patients to ask for what they need to maintain their comfort and well-being. Given the limited evidence base, further research is needed to test and further refine these propositions. Conclusions Despite widespread use of IR, this paper highlights the paradox that there is ambiguity surrounding its purpose and limited evidence of how it works in practice.

Review: Silence of a scream: application of the Silences Framework to provision of nurse-led interventions for ex-offenders

The reviewed study explores how nurses can truly recognise and respond to ex-offenders’ health needs. The framework used follows that originally formulated by Laura Serrant (Serrant-Green, 2011) and is based on her doctoral thesis with black Caribbean men. The reviewer of the original paper (French, 2011) noted that the framework complemented quantitative data about factors influencing sexual health decisions, providing a way to understand how the social world is constructed and a deeper knowledge of what constitutes reality for individuals. Likewise, this holds true in this paper within the context of the health pathway followed by ex-offenders. The paper was particularly interesting and adds to the nursing literature on three counts. First, the exploration of the ‘Silences Framework’ in another setting is to be commended. The paper picks up the challenge in many qualitative studies to show the authenticity or ‘validity’ of research methods by applying the approach, or ‘replicating’ the design, with different groups. This not only helps the reader to form views about the strength and authority of the earlier study, but also provides legitimacy in this case. This was a challenge set up by Serrant when she developed the tool (Serrant-Green, 2011) and suggested that it was presented for use by other researchers. Second, the paper provides a framework to help nurses effectively address the health needs of ex-offenders – an area where there is a lack of research. As the authors point out, research findings are consistently presented from a professional perspective, which reinforces an outmoded stance where the voices of ex-offenders are missing. The authors recognise that released offenders are disproportionately impacted by considerable health needs when they leave prison, often living at the edge of society and finding access to health care in traditional forms difficult, again justifying the potential for nurse-led interventions.