Susan Read

Piloting an evaluation of triage

This paper takes a broad view of the work involved in pilot studies of evaluation research. Drawing on their experience of preparation for a field experiment in a British Accident and Emergency department, which was to evaluate the effectiveness of a nurse triage system, the authors stress the importance of careful observation of the system to be studied, in the environment in which it is to be studied. In addition, the usual evaluations of research instruments which comprise formal pilot studies are included.

Changing roles in nursing: a literature review of influences and innovations

Objectives: to develop a comprehensive picture of the range of recent nursing role developments in the UK, and to present evidence of the effectiveness of such developments. Design: a review of the literature from January 1993 to May 1998 Findings: a large majority of the papers available are descriptive in nature, or report on small studies, often with poorly designed or described methodologies. Three main forces behind role developments in nursing are professional, managerial and policy forces. Changes have taken four forms: discrete new roles, ‘creeping’ role developments, specific interventions and policy-driven alteration in the focus or philosophy of care. Nursing staff have adapted and enhanced new roles which may be technically oriented, incorporating their professional imperatives (e.g. health promotion) and using philosophies of collaborative, holistic care to provide enhanced information-giving and continuity of care. Gaps in the evidence are highlighted. This paper arises from a report prepared for and funded by the Nursing and Midwifery Staffs Negotiating Council (Read & Shewan 1998).

Patients’ opinions of acute chest pain care: a qualitative evaluation of Chest Pain Units

AIM This paper is a report of a study to explore the experiences of individuals receiving Chest Pain Unit care and routine Emergency Department care for acute chest pain. BACKGROUND Chest Pain Units were established in the United States of America with the aim of reducing admissions and costs, whilst improving quality of life and care satisfaction. Trials showed these units to be safe and practical; however, there was a need to establish whether Chest Pain Units could be cost-effective in the United Kingdom, and whether use of a nurse-led protocol could be acceptable to patients. METHOD We carried out 26 semi-structured interviews in 2005-2006 with patients across seven trial Chest Pain Units in the United Kingdom (14 in intervention sites and 12 in control sites) to explore issues that patients considered were important in their care experiences, and to develop possible explanations for the main trial outcomes. We analysed transcripts using the Framework approach to identify themes relating to care experiences. FINDINGS Differences in care experiences were more distinct between individual sites than between control and intervention sites. Satisfaction with care was high overall. Interactions with healthcare professionals, in particular specialist nurses, were valued in terms of reassurance, calming effect and competence. Indications for care improvement concerned information-giving about investigations, diagnosis, and self-care advice. Patients with non-cardiac causes needed to feel more supported after discharge. CONCLUSION Differences between modes of care may not coincide with identified trial outcomes. Qualitative methods can identify aspects of care that improve patient acceptability. The specialist nurse role appears particularly important in providing satisfactory individualized chest pain care.

Nurse-led care: The importance of management support

The focus of this paper is the importance of proper management planning and support to underpin the provision of nurse-led care. The authors record of research in this field has left her with a lasting impression that nurse-led services often fail to reach their full potential, at least in part because of inadequate management. The main body of the paper consists of a brief account of a Department of Health-funded project, Exploring New Roles in Practice (ENRiP). In this three-stage study, members of the teams undertook a mapping exercise in a 20% sample of acute trusts throughout England to identify the emerging range and purpose of new roles for nurses and members of the professions allied to medicine (PAMs). The resulting database provided the sampling frame for 32 case studies to clarify the range of issues relating to the introduction of new roles. The database in its entirety also provided the population for a survey designed to establish the generalisability of the conclusions emerging from Stages One and Two. The research findings provided evidence on which to base a guidance document encapsulating the lessons learned during the project. The implications of its findings for management of nurse-led services are discussed and compared with advice given by the author in 1995 in the report Catching the Tide.

Coming in from the cold? An analysis of research proposals submitted by the Nursing Section at ScHARRI, 1994-1997

The Nursing Section at SCHARR was established in 1994 as one of six groups that constituted the Sheffield Centre for Health and Related Research (SCHARR). Based at the University of Sheffield, SCHARR was established as a response to the imperatives outlined in NHS Research and Development Strategy documentation for multidisciplinary health services research (HSR). The Nursing Section at SCHARR has always been fully supportive of such principles and over the past three years has worked with many different health-care researchers to maximise the nursing contribution to health services research. This paper analyses the features of 50 proposals made by the Nursing Section to funding bodies since 1994. Approximately half (52%, n=26) of all bids were successful and led to a total of nurse-related research grants worth 2.7 million pounds. Projects were significantly more likely to be funded if the method proposed was qualitative (or a combination of methods) or the lead researcher was a nurse. However, research was no more likely to be funded if a medical colleague was named as a collaborator, a statistician or health economist was involved in the bid, there were more than three named collaborators on the proposal, or the bid came from more than one university. The implications of these results are discussed in the context of recent critical commentaries on the topic of nursessupposed relative disadvantage in obtaining funds for multidisciplinary health services research.

Exploring the impact of Acute Pain Teams (APTs) on patient outcomes using routine data: can it be done?

Acute Pain Teams (APTs) in every hospital performing surgery have been advocated to improve the management of post-operative pain. Poor postoperative analgesia is a perennial problem that may result in complications such as chest infection and pulmonary embolus which may have an impact on outcomes such as mortality and length of stay. This paper considers the feasibility of using routine data to explore the impact of APTs on patient outcomes, using as an illustrative example a study which investigated relationships between the introduction of APTs and post-operative length of stay and in-patient post-operative mortality.