Robert McSherry

The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care

AIMnThe aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs.nnnBACKGROUNDnThe challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing.nnnKEY ISSUESnExcellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice.nnnCONCLUSIONSnCreating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations.nnnIMPLICATIONS FOR NURSING MANAGEMENTnThe importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing.Mcsherry R., pearce P., Grimwood K. & Mcsherry W. (2012) Journal of Nursing Management20, 7–19 nThe pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care n nAimu2002 The aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs. n nBackgroundu2002 The challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing. n nKey issuesu2002 Excellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice. n nConclusionsu2002 Creating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations. n nImplications for nursing managementu2002 The importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing.

Promoting evidence-based practice through anintegrated model ofcare: patient case studiesas a teaching method

This paper intends to encourage debate on how evidence-based practice may be achieved through developing an integrated approach to teaching clinical practice skills by using case study as a teaching method. This is achieved by examining societal, social, and political changes as well as the changes that have occurred in nurse education over the past 15 years. What evidence-based nursing is, the processes required to practice it effectively and how case study as a teaching method can support these processes are described. Finally, the paper describes how, as educationalists involved in curriculum development, the introduction of an integrated approach to teaching clinical skills may be a way forward in resolving the concerns highlighted by the recent Department of Health (DoH) publications.

Research awareness: managerial challenges for nurses in the Republic of Ireland

BACKGROUNDnIn spite of the growing body of literature, the reality of getting research into practice remains problematic.nnnOBJECTIVEnThe present study aimed to establish contemporary levels of research awareness among nurses in Ireland.nnnPOPULATION, SAMPLE, SETTINGnA random sample of 234 registered nurses (RNs).nnnMETHODSnA self-report survey Research Awareness Questionnaire (RAQ) was used to collect data in March 2005.nnnRESULTSnMost agreed (92%) that research can improve patient care and 93% agreed that it is the way forward to change clinical practice. Most nurses perceived research as being integral to their role. However, 71% of the nurses within the present study indicated that they had insufficient support and encouragement from peers and professionals. Similarly, 69.2% indicated insufficient support from management.nnnCONCLUSIONSnConsistent with other countries, nurses in Ireland have a positive attitude towards evidence-based nursing but face many obstacles which include a lack of time, support, knowledge and confidence.nnnIMPLICATIONS FOR NURSING MANAGEMENTnNurse managers have a vital role in the use and dissemination of research among staff. It is imperative that nurse managers have clinical expertise, research awareness training, and awareness to promote research-based practice and attempt to provide positive role modelling in addition to protected time for research efforts.timmins f., McCabe c. & McSherry r. (2012) Journal of Nursing Management20, 224–235 Research awareness: managerial challenges for nurses in the Republic of Ireland n n n nBackgroundu2002 In spite of the growing body of literature, the reality of getting research into practice remains problematic. n n n nObjectiveu2002 The present study aimed to establish contemporary levels of research awareness among nurses in Ireland. n n n nPopulation, sample, settingu2002 A random sample of 234 registered nurses (RNs). n n n nMethodsu2002 A self-report survey Research Awareness Questionnaire (RAQ) was used to collect data in March 2005. n n n nResultsu2002 Most agreed (92%) that research can improve patient care and 93% agreed that it is the way forward to change clinical practice. Most nurses’ perceived research as being integral to their role. However, 71% of the nurses within the present study indicated that they had insufficient support and encouragement from peers and professionals. Similarly, 69.2% indicated insufficient support from management. n n n nConclusionsu2002 Consistent with other countries, nurses in Ireland have a positive attitude towards evidence-based nursing but face many obstacles which include a lack of time, support, knowledge and confidence. n n n nImplications for nursing managementu2002 Nurse managers have a vital role in the use and dissemination of research among staff. It is imperative that nurse managers have clinical expertise, research awareness training, and awareness to promote research-based practice and attempt to provide positive role modelling in addition to protected time for research efforts.

Exploring the lecturer/practitioner role: individuals perceptions of the lived experience

This study explored the individual experiences of lecturer practitioners during the development of their role while on secondment to a university. The method was an inductive approach influenced by phenomenology using a sample of six qualified nurses fro m a variety of clinical backgrounds in both the community or hospital settings. Data from the unstructured interviews was collected, recorded and analysed using Burnards method of Thematic Content Analysis (Burnard 1991). Common themes emerged highligh ting the positive and negative aspects of the lecturer practitioner role; expectations, support, credibility, time-management, and contractual issues. The findings will assist with future role development in the university, provide information for other universities and Trusts considering introduction and development of the role as well as individuals who may be interested in taking up the challenge of the lecturer practitioner post.

What are the effective ways to translate clinical leadership into health care quality improvement

The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader’s role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks.

Level of confidence in venepuncture and knowledge in determining causes of blood sample haemolysis among clinical staff and phlebotomists

AIMS AND OBJECTIVESnTo investigate the association between confidence level in venepuncture and knowledge in determining causes of blood sample haemolysis among clinical staff and phlebotomists.nnnBACKGROUNDnVarious collection methods are used to perform venepuncture, also called phlebotomy, the act of drawing blood from a patient using a needle. The collection method used has an impact on preanalytical blood sample haemolysis. Haemolysis is the breakdown of red blood cells, which makes the sample unsuitable. Despite available evidence on the common causes, extensive literature search showed a lack of published evidence on the association of haemolysis with staff confidence and knowledge.nnnDESIGNnA quantitative primary research design using survey method.nnnMETHODSnA purposive sample of 290 clinical staff and phlebotomists conducting venepuncture in one North England hospital participated in this quantitative survey. A three-section web-based questionnaire comprising demographic profile, confidence and competence levels, and knowledge sections was used to collect data in 2012. The chi-squared test for independence was used to compare the distribution of responses for categorical data. anova was used to determine mean difference in the knowledge scores of staff with different confidence levels.nnnRESULTSnAlmost 25% clinical staff and phlebotomists participated in the survey. There was an increase in confidence at the last venepuncture among staff of all categories. While doctors scores were higher compared with healthcare assistants, p ≤ 0·001, nurses were of wide range and lowest. There was no statistically significant difference (at the 5% level) in the total knowledge scores and confidence level at the last venepuncture F(2,4·690) = 1·67, p = 0·31 among staff of all categories.nnnCONCLUSIONnEvidence-based measures are required to boost staff knowledge base of preanalytical blood sample haemolysis for standardised and quality service. Monitoring and evaluation of the training, conducting and monitoring haemolysis rate are equally crucial.nnnRELEVANCE TO CLINICAL PRACTICEnAlthough the hospital is succeeding in providing regular training in venepuncture, this is only one aspect of quality. The process and outcome also need interventions.

Measuring healthcare workers perceptions of what constitutes a compassionate organisational culture and working environment: Findings from a quantitative feasibility survey.

INTRODUCTIONnHealth care organisation cultures and working environments are highly complex, dynamic and constantly evolving settings. They significantly influence both the delivery and outcomes of care.nnnAIMnPhase 1 quantitative findings are presented from a larger three phase feasibility study designed to develop and test a Cultural Health Check toolkit to support health care workers, patients and organisations in the provision of safe, compassionate and dignified care.nnnMETHODOLOGYnA mixed methods approach was applied. The Cultural Health Check Healthcare Workers Questionnaire was distributed across two National Health Service Hospitals in England, UK. Both hospitals allocated two wards comprising of older people and surgical specialities.nnnFINDINGSnThe newly devised Cultural Health Check Staff Rating Scale Version 1 questionnaire was distributed to 223 health care workers. Ninety eight responses were returned giving a response rate of 44%. The Cultural Health Check Staff Rating Scale Version 1 has a significant Cronbach alpha of .775; this reliability scaling is reflected in all 16 items in the scale. Exploratory factor analysis identified two significant factors Professional Practice and Support and Workforce and Service Delivery. These factors according to health care workers significantly impact on the organisation culture and quality of care delivered by staff.nnnCONCLUSIONnThe Cultural Health Check Staff Rating Scale Version 1 questionnaire is a newly validated measurement tool that could be used and applied to gauge health care workers perceptions of an organisations level of compassion. Historically we have focused on identifying how caring and compassionate nurses, doctors and related allied health professionals are. This turns the attention on employers of nurses and other related organisations.nnnIMPLICATIONS FOR NURSING MANAGEMENTnThe questionnaire can be used to gauge the level of compassion with a health care organisation culture and working environment. Nurse managers and leaders should focus attention regarding how these two factors are supported and resourced in the future.

A reflective qualitative appreciative inquiry approach to restoring compassionate care deficits at one United Kingdom health care site

BACKGROUNDnFollowing declining health care practices at one UK health care site the subsequent and much publicized Francis Report made several far-reaching recommendations aimed at recovering optimal levels of care including stringent monitoring of practice. The aftermath of these deliberations have had resounding consequences for quality care both nationally and internationally.nnnDESIGNnA reflective qualitative appreciative qualitative inquiry using a hybrid approach combining case study and thematic analysis outlines the development and analysis of a solution-focused intervention aimed at restoring staff confidence and optimal care levels at one key UK hospital site. Personal diaries were used to collect data.nnnDATA ANALYSISnData were analysed using descriptive thematic analysis.nnnDISCUSSIONnThe implications of the five emerging themes and the 10-step approach used are discussed in the context of understanding care erosion and ways to effect organisational change.nnnCONCLUSIONnA novel approach to addressing care deficits, which provides a promising bottom-up approach, initiated by health care policy makers is suggested for use in other health care settings when concerns about care arise. It is anticipated this approach will prove useful for nurse managers, particularly in relation to finding positive solutions to addressing problems that surround potential failing standards of care in hospitals.

Establishing Excellence: Where Do We Go From Here?

The chapter explores the pedagogical basis of establishing excellence in educational practice. This is achieved by: exploring what excellence means and its relevance to higher educational practice; applying excellence to pedagogical approaches in particular (heutagogy) and offering ways of how to measure and demonstrate excellence within the curriculum. The chapter is based on a workshop presentation delivered at the HEA York, UK, in March 2014 entitled ‘Excellence within the curriculum a lesson from EPAS’ at a Higher Education Academy (HEA) sponsored event exploring ‘Community Development and Engagement’.

Involving carers in the teaching, learning and assessment of masters students

Involving patients and carers in teaching, learning and assessment focuses the students on person-centred care by providing the opportunity to listen to, and reflect on, the perspective of patient and/or carer and also allows the students the opportunity to work in partnership with them to effect meaningful change. This paper presents an example at Teesside University where two informal carers have been involved as partners in the programme team of The Master of Arts in Advancing Practice over the past four years. In year two of the programme, the student is required to work within their organisation and governance policies to identify, implement and evaluate a practice development change project. Involving carers at critical points throughout the year has enriched, supported and challenged the students learning. Evaluation has highlighted the role that carers can play in bringing a new dimension to the students learning experience. The authors believe that direct involvement of this kind has much potential for other programmes in improving health and social care education which, in turn, will improve health and social care services.