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Aims and objectives To explore the impact of implementing an electronic health record system on staff at a Scottish hospice. Background Electronic health records are broadly considered preferable to paper-based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice. Design Naturalistic prospective repeated-measures mixed-methods approach. Methods Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free-text comments and focus group. Participants were all 150 employees of a single hospice in Scotland. Results Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change. Conclusions It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the 'J-curve' theory of organisational change, and as such, it is both predictable and manageable for other organisations. Relevance to clinical practice It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity ('J' curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper aims to explore student nurses' experiences of bioscience learning, teaching and application within the practice setting. It draws upon the social learning theory of communities of practice to consider the issues raised. Background The teaching of bioscience within many nursing curricula has shifted from traditional to more integrated approaches. Student nurses recognise bioscience as a valuable component of their studies, but many find it challenging. The focus of previous research in this area has often focussed on bioscience learning in theoretical rather than practice settings. Design A phenomenological study. Methods Data were collected via focus group or interview with a total of seven students across two campuses in a Scottish university. Participants were offered the opportunity to share their experiences at both the end of year one and year two of their studies. A thematic analysis was undertaken independently then jointly by the authors. Results The findings suggest that although participants recognise the value of bioscience within practice settings, they found that opportunities for learning were often limited. Bioscience-related learning, teaching and application was perceived to have been given less legitimacy by the practice setting than other aspects of placement activity. To enhance bioscience approaches participants expressed a desire for more structured and integrated approaches within both practice and university along with further peer learning opportunities. Conclusions Students recognise that bioscience knowledge is important in relation to the provision of safe and effective care. They request greater structure and consistency in relation to the learning, teaching and application of this topic during their placements. Relevance to clinical practice Those with a stake in educating nurses within clinical settings may find the views of student nurses on the topic of bioscience learning useful when planning and facilitating placement experiences. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? According to estimates more than half of adult mental health service users are parents, but their experiences are largely lacking from research literature., Parental mental illness can often be viewed from a risk perspective., Parents with mental illness and their families have unmet support needs., What this paper adds to existing knowledge? Parents with mental illness want acknowledgement that they can be able and responsible., Many parents adopt an expert by experience identity., Fathers can feel their parental role is not recognized and mothers express fears of being judged if they discuss their illness., What are the implications for practice? Adult mental health services need to recognize and support parental role of service users., Joint care planning and family oriented care should be promoted., Professionals should take advantage of the knowledge of these parents and they could be more actively engaged in service development., Abstract Introduction Parental mental illness is often viewed from a risk perspective. Despite this, being a parent can be both valuable and motivating. Research literature lacks the perspective of mothers and fathers, who have experienced mental illness. Aim This study explores how parents with mental illness construct their identities as mothers and fathers and their experiences with health and social care services. Method Three focus groups with 19 participants were conducted in Finland and Scotland. Methods of discourse analysis have been used in to analyse the interview data. Results Adult service users want their parenting role recognized and supported. Parents have knowledge and skills which can be utilized and many have adopted an expert by experience identity. Discussion Being able to see oneself as a 'good' parent can be challenging but important. Parents may require support, but want to be included in the planning of their care. Services could make more use of the knowledge and skills parents and families have, and joint working could lessen parents' anxieties. Implications for practice Mental health practitioners are in a key position in providing more family centred, resource focused care. Service user expertise should be acknowledged in clinical practice. [ABSTRACT FROM AUTHOR]

law j., mccann d. & o'may f. (2011) Managing change in the care of children with complex needs: healthcare providers' perspectives. Journal of Advanced Nursing 67(12), 2551-2560. Abstract Aim. This paper is a report of a descriptive qualitative study of the role and activities of nursing and allied health professionals caring for children with complex needs in a community setting. Background. Health care is changing in terms of service provision and delivery, with an increased focus on person-centred care, prevention and community-based services. The role of nursing and allied health professionals is central to these changes but is not well described in terms of capacity, or the knowledge and skills required to meet increasing demand. Method. Within four Health Boards, semi-structured telephone interviews were conducted in 2007 with three nursing and four allied health managers, followed by four focus groups with 15 nursing and 11 allied health practitioners; in addition, three nurses and one speech therapist were interviewed by telephone. Results. Respondents identified challenges related to communication and information systems, equity of service provision, family-centred care and partnership working. Generic and specialized knowledge and skills are needed, although providing the right skills in the right place can often prove problematic with potential implications for service provision. Conclusion. Findings support the adoption of integrated partnership working, going beyond the identification of key professionals, to developing a set of criteria against which future service provision could be judged. Research priorities were identified; comparative evaluation of services, better understanding of the transition process and a clearer sense of the individual's response to the increasing customization of services. [ABSTRACT FROM AUTHOR]

Aims and objectives. To evaluate the impact and effectiveness of Flying Start NHS™ on the confidence, competence and career development of newly qualified practitioners. Background. The first year of practice as a registered nurse, midwife, or allied health professional is recognised as challenging. This paper presents the findings of a two-year evaluation of Flying Start NHS™, a web-based programme developed by NHS Education Scotland to support newly qualified health professionals during the transition from student to qualified practitioner. Design. Descriptive design with one to one and focus group interviews, plus a survey. Methods. The evaluation employed a multi-method approach including telephone interviews with Flying Start NHS™ leads/coordinators ( n = 21) and mentors ( n = 22) and focus groups with newly qualified practitioners ( n = 95). An online survey was completed by 547 newly qualified practitioners. Results. A majority of newly qualified practitioners reported that Flying Start NHS™ had been useful in terms of clinical skills development and confidence. Those who were able to take protected time were more likely to complete the learning units and report that the support they received was good. Both newly qualified practitioners and mentors reported a lack of time. Newly qualified practitioners who took up posts in the community expressed greater satisfaction with the support received. Conclusions. NHS Boards should ensure that there is an ethos of support at all levels, as well as an understanding of the purpose of Flying Start NHS™ and what newly qualified practitioners require to do to complete it. The expectation that newly qualified practitioners will enrol on Flying Start NHS™ should be accompanied by an expectation that they will complete the programme in their first year, coupled with support to enable them to do so. Relevance to clinical practice. Undertaking Flying Start NHS™ in the first year of employment increases clinical skills development and confidence. Mentors require training and time to enable them to provide support. [ABSTRACT FROM AUTHOR]

Aim: To evaluate Advanced Nurse Practitioner (ANP) role implementation in primary care across Scotland in contributing to primary care transformation, and establish what works, for whom, why and in what context. Design: A realist evaluation using multiple case studies. Methods: Two phases, conducted March 2017 to May 2018: (1) multiple case studies of ANP implementation in 15 health boards across Scotland, deductive thematic analysis of interviews, documentary analysis; (2) in‐depth case studies of five health boards, framework analysis of interviews and focus groups. Results: Sixty‐eight informants were interviewed, and 72 documents were reviewed across both phases. ANP roles involved substitution for elements of the GP role for minor illness and injuries, across all ages. In rural areas ANPs undertook multiple nursing roles, were more autonomous and managed greater complexity. Mechanisms that facilitated implementation included: the national ANP definition; GP, primary care team and public engagement; funding for ANP education; and experienced GP supervisors. Contexts that affected mechanisms were national and local leadership; remote, rural and island communities; and workload challenges. Small‐scale evaluations indicated that ANPs: make appropriate decisions; improve patient access and experience. Conclusions: At the time of the evaluation, the implementation of ANP roles in primary care in Scotland was in early stages. Capacity to train ANPs in a service already under pressure was challenging. Shifting elements of GPs workload to ANPs freed up GPs but did little to transform primary care. Local evaluations provided some evidence that ANPs were delivering high‐quality primary care services and enhanced primary care services to nursing homes or home visits. Impact ANP roles can be implemented with greater success and have more potential to transform primary care when the mechanisms include leadership at all levels, ANP roles that value advanced nursing knowledge, and appropriate education programmes delivered in the context of multidisciplinary collaboration. [ABSTRACT FROM AUTHOR]

Aims and objectives: To understand the different factors that impact on the involvement of adult family members in the care of critically ill patients from the perspective of patients, families and nurses, with the aim to inform the enactment of a patient‐ and family‐centred care intervention to support the patient–family–nurse partnership in care involvement. Background: Existing evidence lacks theoretical underpinning and clarity to support enactment of patient‐ and family‐centred care and involvement of families in the care of the critically ill patient. Design: Qualitative exploratory design using thematic analysis. Methods: This study was conducted at two adult intensive care units in two tertiary university hospitals in the central belt of Scotland. Between 2013–2014, we conducted semi‐structured interviews with critically ill survivors (n = 19) and adult family members (n = 21), and five focus groups with nurses (n = 15) across both settings. Data were digitally recorded, transcribed verbatim, and uploaded in NVivo 10. Data were analysed thematically using a constructivist epistemology. Ethical approval was obtained prior to data collection. Data are reported according to the Consolidated Criteria for Reporting Qualitative Research checklist. Results: Family's situational awareness; the perceived self in care partnership; rapport and trust; and personal and family attributes were the main factors that affected family involvement in care. Two key themes were identified as principles to enact patient‐ and family‐centred care in adult intensive care units: "Need for 'Doing family'" and "Negotiations in care involvement." Conclusions: Negotiating involvement in care requires consideration of patients' and family members' values of doing family and the development of a constructive patient–family–nurses' partnership. Relevance to clinical practice: Future policy and research should consider patients' and family's needs to demonstrate family bonds within a negotiated process in care participation, when developing tools and frameworks to promote patient‐ and family‐centred care in adult intensive care units. [ABSTRACT FROM AUTHOR]

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Aims and objectives To examine (1) nursing lecturers' and (2) preregistration nursing students' perspectives of user and carer involvement in the formal assessment of preregistration nursing students' clinical practice. Background The involvement of service users and carers in the assessment of clinical practice in nursing education is a recent phenomenon. The Nursing and Midwifery Council Standards in the UK clearly reflect a shift in thinking from paternalistic approaches to person-centred approaches. This shift in thinking includes service user and carer involvement in student nursing assessment and there is evidence that this is being developed in several countries. Design Located in the interpretive paradigm, data from a two-staged, multicentre qualitative study are presented. Methods Interpretive analysis of semi-structured, one to one interviews with nursing lecturers (n = 15) and focus groups with nursing students (n = 51) across 11 Higher Educational Institutions. Results There is a strong commitment for working alongside service users and carers in the education and training of nursing students; however, involving service users and carers in formal practice assessment is identified as more challenging compared with other areas of service user/carer involvement. Service user/carers should provide feedback/review or comment, but not necessarily formal, summative 'assessment'. Conclusions The evidence base for involving users and carers in assessment is limited. Involvement of users and carers in providing feedback to nursing students is welcomed. However, concerns exist about the preparedness of users and carers for formal clinical assessment. Relevance to clinical practice Discussion and clarification with clinical mentors and user and carer groups is necessary to understand if they agree with the policy direction of user and carer involvement in the assessment of nursing students. Quality assurance concerns are raised by students and lecturers when involving user and carer in assessing nursing students' clinical skills. Mentors are seen as key to this process, but little is known about their perspectives. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the experiences of patients with intellectual disabilities, family and paid carers regarding the role of liaison nurses and the delivery of compassionate, person-centred care. From this to propose a model of person-centred care embedded in these experiences. Background People with intellectual disabilities have a high number of comorbidities, requiring multidisciplinary care, and are at high risk of morbidity and preventable mortality. Provision of compassionate, person-centred care is essential to prevent complications and avoid death. Design A qualitative design was adopted with Interpretative Phenomenological Analysis for data analysis. Methods Semistructured interviews and focus groups were conducted. Data were analysed with a focus on compassionate, person-centred care elements and components. Themes were modelled to develop a clinically meaningful model for practice. Results Themes identified vulnerability, presence and the human interface; information balance; critical points and broken trust; roles and responsibilities; managing multiple transitions; 'flagging up' and communication. Conclusions The findings provide the first 'anatomy' of compassionate, person-centred care and provide a model for operationalising this approach in practice. The applicability of the model will have to be evaluated further with this and other vulnerable groups. Relevance to clinical practice This is the first study to provide a definition of compassionate, person-centred care and proposes a model to support its application into clinical practice for this and other vulnerable groups. [ABSTRACT FROM AUTHOR]

Aims To examine the role of learning disability liaison nurses in facilitating reasonable and achievable adjustments to support access to general hospital services for people with learning disabilities. Design Mixed methods study involving four health boards in Scotland with established Learning Disability Liaison Nurses ( LDLN) Services. Quantitative data of all liaison nursing referrals over 18 months and qualitative data collected from stakeholders with experience of using the liaison services within the previous 3-6 months. Methods Six liaison nurses collected quantitative data of 323 referrals and activity between September 2008-March 2010. Interviews and focus groups were held with 85 participants included adults with learning disabilities ( n = 5), carers ( n = 16), primary care ( n = 39), general hospital ( n = 19) and liaison nurses ( n = 6). Results/findings Facilitating reasonable and achievable adjustments was an important element of the LDLNs' role and focussed on access to information; adjustments to care; appropriate environment of care; ensuring equitable care; identifying patient need; meeting patient needs; and specialist tools/resources. Conclusion Ensuring that reasonable adjustments are made in the general hospital setting promotes person-centred care and equal health outcomes for people with a learning disability. This view accords with 'Getting it right' charter produced by the UK Charity Mencap which argues that healthcare professionals need support, encouragement and guidance to make reasonable adjustments for this group. LDLNs have an important and increasing role to play in advising on and establishing adjustments that are both reasonable and achievable. [ABSTRACT FROM AUTHOR]

Aims and objectives. To investigate the dynamics of domestic abuse awareness and recognition among primary healthcare professionals and abused women. Background. Domestic abuse is a serious, public health issue that crosses geographical and demographic boundaries. Health professionals are well placed to recognise and respond to domestic abuse, but empirical evidence suggests that they are reluctant to broach the issue. Moreover, research has shown that women are reluctant to disclose abuse. Design. A two-phase, qualitative study was conducted in Scotland. Methods. Twenty-nine primary health professionals (midwives, health visitors and general practitioners) participated in the first phase of the study, and 14 abused women took part in phase two. Data were collected in 2011. Semi-structured, individual interviews were conducted with the health professionals, and three focus groups were facilitated with the abused women. Data were analysed using a framework analysis approach. Findings. Differing levels of awareness of the nature and existence of abuse are held by abused women and primary healthcare professionals. Specifically, many women do not identify their experiences as abusive. A conceptual representation of domestic abuse - the "abused women, awareness, recognition and empowerment' framework - arising from the study - presents a new way of capturing the complexity of the disclosure process. Conclusion. Further research is necessary to test and empirically validate the framework, but it has potential pedagogical use for the training and education of health professionals and clinical use with abused women. Relevance to clinical practice. The framework may be used in clinical practice by nurses and other health professionals to facilitate open discussion between professionals and women. In turn, this may empower women to make choices regarding disclosure and safety planning. [ABSTRACT FROM AUTHOR]

Aims and objectives To work with parents and public health nurses (health visitors), to identify and design a range of public health interventions to provide support to parents of young children. Background In the UK, only vulnerable families are now eligible for pro-active health visiting interventions on an individual family basis beyond the early days. Public health approaches are recommended for the majority of families who are not eligible for one-to-one professional support. Design Focus groups were carried out with parents of young children, health visitors and other professionals working with them. Methods The study was carried out in a semi-rural area of Scotland, consisting of a small town, and the surrounding rural area, including one area of deprivation. The area is served by a team consisting of six health visitors and one health assistant, based in two health centres in the area. Nineteen parents, five members of the health visiting team and 11 other professionals from health, education and social work took part via an invitation to contact the research team. Results The needs of parents identified by both parents and professionals could best be met by social support, with skilled facilitation and suitable resources. The resolution of tensions between caseload-based and population-based health visiting, as well as the management of the tensions inherent in these changes, seems to be vital in order to implement these approaches. Many parents would like information made available online. Conclusions Services to support families with young children need to be designed from the perspectives of parents and their needs. Relevance to clinical practice Services need to be set up in partnership with parents to provide them with information and access to peer and professional support, using public health approaches. Multiagency working, including among senior managers, may be the most effective way of providing this support. [ABSTRACT FROM AUTHOR]

cameron s., harbison j., lambert v. & dickson c. (2012) Exploring leadership in community nursing teams. Journal of Advanced Nursing 68(7), 1469-1481. Abstract Aims. This article is a report on a study investigating how leadership is perceived in community nursing teams and how these perceptions are translated into working practices of team leaders. Background. The consensus in community nursing literature is that leadership is important, and especially so in a time of change. However, little empirical evidence exists on how leadership works in practice. Method. The study adopted an exploratory descriptive design, utilising individual semi-structured interviews and focus groups in four case-studies, with a total of 54 participants. Two case-studies focussed on district nursing teams and two involved public health nursing teams, located in two geographical areas. Participants debated their understanding of the concept of leadership, its associated practices and behaviours in teams, if they saw themselves as leaders, and what preparation was required. The study was undertaken in 2009. Framework analysis techniques were employed to analyse the data. Findings. A 'quasi-family' model of leadership emerged, with significant emphasis on the importance of personal relationships and support. Nursing grade had a greater impact on perceptions of leadership than geographical context or professional and clinical focus. Conclusion. No clear fit with any existing theoretical framework was identified. However, nurses in the highest grade banding, in particular, demonstrated practices associated with transformational leadership. Nurses expressed the very clear need to be acknowledged, respected and valued, and that those who provided this support were regarded as good leaders. [ABSTRACT FROM AUTHOR]

The article presents a study on community nursing in Scotland and generalist working. Changes to the role of community nurse from specialist disciplines to a generalist community health nurse model were reportedly proposed in Scotland. The study explored the role of a community health nurse as opposed to the roles of a specialist. It has been concluded that discourses on job empowerment, satisfaction and consultation is important to be utilized for discussions on future role changes.

Aims. To investigate how one aspect of anticipatory care is understood and delivered in practice. 'Anticipatory care' in this context can be understood as proactive care, which is oriented towards prevention of adverse events. Background. Scotland has identified the intention to move away from a preoccupation with acute care and invest in health improvement and anticipatory care. Community nurses are the key, yet little is known about how they understand and deliver anticipatory care. Methods. A qualitative case study design using individual in-depth interviews (n = 10), observation (n = 9) and focus groups (n = 5) was selected. Five focus group interviews were carried out with district nurses, practice nurses and health visitors. Subsequently, nine observation events took place, each focused on a single nurse/client encounter. Data were collected during 2008 and 2009 in one Community Health Partnership in Scotland. Findings. Two approaches to anticipatory care emerged; these were influenced by participants' roles and responsibilities. Approach 1 derives from Government policy agenda and is focused on protocol-focused management of long-term illness. Approach 2 is synonymous with long-standing nursing activity focused on holistic care of individual patients. Both approaches are proactive in nature. Conclusions. There is scope to develop a more conceptually complex model of anticipatory care, building on this initial exploration, within which all aims, roles, practices and methods of evaluation can be located and clearly visible. This offers the potential to enable practitioners to interpret and apply policy - otherwise change may be limited and result in service gaps. [ABSTRACT FROM AUTHOR]