Search

Background: The delivery of research in healthcare in the UK is dependent on a subgroup of clinicians – clinical academics – who concurrently engage in clinical practice and academic activities. The need to increase access to such roles for general practice nurses has been identified, although the need for a robust career framework remains. Aims: This study, with a qualitative interview and focus group design, aimed to explore the concept of clinical academic careers for general practice nurses by identifying barriers and enablers associated with pursuing and performing such roles. Methods: General practice nurses (n = 18) and general practitioners (n = 5) engaged in either an audio -recorded interview or focus group. Verbatim transcripts were subjected to thematic analysis. Results: Four themes were identified: awareness and understanding; career pathway; personal and professional attributes; and organisational factors. Awareness and understanding were generally poor. Participants suggested that the career pathway was unclear, although it was generally assumed that such roles were 'out of reach' and require a minimum of Master's level education. An interest in research and the confidence to perform such duties were reported as the required personal and professional attributes. Organisational factors included the need for employers to understand the value and benefit of general practice nurse clinical academic roles, along with ensuring that the inevitable competing demands of such a role were appropriately managed. Conclusions: This study highlights the difficulties faced by general practice nurses wishing to pursue a clinical academic career. Academia is seemingly placed on a pedestal, emphasising the need to embed research training early in nursing education to alter general practice nurse perceptions that clinical academic roles are unobtainable. The development of a robust career pathway for general practice nurse clinical academic roles may have a positive impact on the retention of experienced general practice nurses and attract newly qualified nurses. This research provides evidence as to the need for one. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to understand the effect of therapies on dual language children with developmental language disorder (DLD) on a range of bilingual language outcomes, compare with second-language-only therapy and determine whether there is any cross-linguistic transfer. Methods: A systematic review of English articles in 10 electronic databases was conducted. Screening, reviewing and appraising were performed independently by two reviewers. Quality was appraised and findings synthesised in accordance with the research questions. Results: Nine reports were identified. Five studies were found to be low in bias and therefore high in quality. Two were medium bias and two were high. Key findings were that instruction in the first language is required to support its continued acquisition and that bilingual instruction does not limit second-language growth. Conclusions: There is no identified evidence to suggest that second-language-only is better than bilingual therapy for dual language children with DLD for the development of the second language. There is evidence to suggest that bilingual therapy is equally effective for second-language development, and also supports development of the first language. Further work is required to understand the efficacious doses of both languages in order to develop cost effective therapies and achieve optimal outcomes. [ABSTRACT FROM AUTHOR]

Background: Clinical academics are health professionals who provide direct patient care alongside engaging in health research. Despite the generally agreed consensus that such roles enhance evidence-based care, availability and uptake has been sporadic in non-medical professions. With no data readily available regarding general practice nurses undertaking clinical academic roles, there is a need to understand the barriers and enabling factors that impact general practice nurses considering or pursuing a clinical academic career. Aims: This review aims to address the question 'What are the barriers and enablers relevant to general practice nurses in the UK pursuing clinical academic careers?' by providing an overview of the relevant existing literature and drawing out the implications for policy and practice. Methods: Literature published in the past 10 years was systematically searched. Using agreed inclusion criteria, papers were first screened on titles and abstracts, with papers included at this stage reviewed as full texts. Results: Thirteen papers met the criteria for inclusion. The extraction and synthesis of findings allowed for the development of three themes: roles and responsibilities; embarking on a clinical academic career; and organisational research culture. Conclusions: Findings suggest that infrastructure developments are required across higher education institutions and general practice organisations to bring about a cultural change to equip and empower general practice nurses to consider and pursue clinical academic careers. [ABSTRACT FROM AUTHOR]

Background: Delays to the transfer of care from hospital to other settings represent a significant human and financial cost. This delay occurs when a patient is clinically ready to leave the inpatient setting but is unable to because other necessary care, support or accommodation is unavailable. The aim of this study was to interrogate administrative and clinical data routinely collected when a patient is admitted to hospital following attendance at the emergency department, to identify factors related to delayed transfer of care when the patient is discharged. We then used these factors to develop a predictive model for identifying patients at risk for delayed discharge of care.Methods: This is a single centre, retrospective, cross-sectional study of patients admitted to an English National Health Service university hospital following attendance at the emergency department between January 2018 and December 2020. Clinical information (e.g., NEWS scores), as well as administrative data that had significant associations with admissions that resulted in delayed transfers of care, were used to develop a predictive model using a mixed-effects logistic model. Detailed model diagnostics and statistical significance, including receiver operating characteristic analysis, were performed.Results: Three-year (2018-20) data were used; a total of 92,444 admissions (70%) were used for model development and 39,877 (30%) admissions for model validation. Age, gender, ethnicity, National Early Warning Score, Glasgow admission prediction score (GAPS), Index of Multiple Deprivation decile, arrival by ambulance and admission within the last year were found to have a statistically significant association with delayed transfers of care. The proposed eight-variable predictive model showed good discrimination with 79% sensitivity (95% confidence intervals: 79%, 81%), 69% specificity (95% CI: 68%, 69%) and 70% (95% confidence intervals: 69%, 70%) overall accuracy of identifying patients who experienced a delayed transfer of care.Conclusion: Several demographic, socio-economic and clinical factors were found to be significantly associated with whether a patient experiences a delayed transfer of care or not following an admission via the emergency department. An eight-variable model has been proposed, which is capable of identifying patients who experience delayed transfers of care with 70% accuracy. The eight-variable predictive tool calculates the probability of a patient experiencing a delayed transfer accurately at the time of admission. [ABSTRACT FROM AUTHOR]

Evidence highlights the intrinsic link between nurse staffing and expertise, and outcomes for service users of healthcare, and that workforce retention is linked to the clinical and organisational experiences of employees. However, this understanding is less well established in mental health. This study comprises a retrospective observational study carried out on routinely collected data from a large mental healthcare provider. Two databases comprising nurse staffing levels and adverse events were modelled using latent variable methods to account for the presence of multiple underlying behaviours. The analysis reveals a strong dependence of the rate of adverse events on the location and perceived clinical demand of the wards, and a reduction in adverse events where registered nurses exceed 'clinically required levels'. In the first study of its kind, these findings present significant implications for nursing workforce policy and present an opportunity to not only improve safety but potentially impact nurse retention. [ABSTRACT FROM AUTHOR]

Purpose: Incident reporting systems are commonly deployed in healthcare but resulting datasets are largely warehoused. This study explores if intelligence from such datasets could be used to improve quality, efficiency, and safety.Design/methodology/approach: Incident reporting data recorded in one NHS acute Trust was mined for insight (n = 133,893 April 2005-July 2016 across 201 fields, 26,912,493 items). An a priori dataset was overlaid consisting of staffing, vital signs, and national safety indicators such as falls. Analysis was primarily nonlinear statistical approaches using Mathematica V11.Findings: The organization developed a deeper understanding of the use of incident reporting systems both in terms of usability and possible reflection of culture. Signals emerged which focused areas of improvement or risk. An example of this is a deeper understanding of the timing and staffing levels associated with falls. Insight into the nature and grading of reporting was also gained.Practical Implications: Healthcare incident reporting data is underused and with a small amount of analysis can provide real insight and application to patient safety.Originality/value: This study shows that insight can be gained by mining incident reporting datasets, particularly when integrated with other routinely collected data. [ABSTRACT FROM AUTHOR]

Objectives: Nursing is a safety critical activity but not easily quantified. This makes the building of predictive staffing models a challenge. The aim of this study was to determine if relationships between registered and non-registered nurse staffing levels and clinical outcomes could be discovered through the mining of routinely collected clinical data. The secondary aim was to examine the feasibility and develop the use of 'big data' techniques commonly used in industry for this area of healthcare and examine future uses. Setting: The data were obtained from 1 large acute National Health Service hospital trust in England. Routinely collected physiological, signs and symptom data from a clinical database were extracted, imported and mined alongside a bespoke staffing and outcomes database using Mathmatica V.10. The physiological data consisted of 120 million patient entries over 6 years, the bespoke database consisted of 9 years of daily data on staffing levels and safety factors such as falls. Primary and secondary outcomes: To discover patterns in these data or non-linear relationships that would contribute to modelling. To examine feasibility of this technique in this field. Results: After mining, 40 correlations (p<0.00005) emerged between safety factors, physiological data (such as the presence or absence of nausea) and staffing factors. Several inter-related factors demonstrated step changes where registered nurse availability appeared to relate to physiological parameters or outcomes such as falls and the management of symptoms. Data extraction proved challenging as some commercial databases were not built for extraction of the massive data sets they contain. Conclusions: The relationship between staffing and outcomes appears to exist. It appears to be non-linear but calculable and a data-driven model appears possible. These findings could be used to build an initial mathematical model for acute staffing which could be further tested. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to discover and describe how patients, carers and case management nurses define safety and compare it to the traditional risk reduction and harm avoidance definition of safety. Background Care services are increasingly being delivered in the home for patients with complex long-term conditions. However, the concept of safety remains largely unexplored. Deign A sequential, exploratory mixed method design. Methods A qualitative case study of the UK National Health Service case management programme in the English UK National Health Service was deployed during 2012. Thirteen interviews were conducted with patients ( n = 9) and carers ( n = 6) and three focus groups with nurses ( n = 17) from three community care providers. The qualitative element explored the definition of safety. Data were subjected to framework analysis and themes were identified by participant group. Sequentially, a cross-sectional survey was conducted during 2013 in a fourth community care provider (patient n = 35, carer n = 19, nurse n = 26) as a form of triangulation. Findings Patients and carers describe safety differently to case management nurses, choosing to focus on meeting needs. They use more positive language and recognize the role they have in safety in home-delivered health care. In comparison, case management nurses described safety similarly to the definitions found in the literature. However, when offered the patient and carer definition of safety, they preferentially selected this definition to their own or the literature definition. Conclusion Patients and carers offer an alternative perspective on patient safety in home-delivered health care that identifies their role in ensuring safety and is more closely aligned with the empowerment philosophy of case management. [ABSTRACT FROM AUTHOR]

Perceptions on safety in community care have been relatively unexplored. A project that sought to understand the multiple perspectives on safety in the NHS case-management programme was carried out in relation to the structure, process, and outcome of care. This article presents a component of the nursing perspective that highlights an important element in the structure of nursing care that could potentially impede the nurses' ability to be fully effective and safe. A single case study of the case-management programme was undertaken. Three primary care organisations from three strategic health authorities participated, and three focus groups were conducted (one within each organisation). In total, 17 case management nurses participated. Data were audiotaped and transcribed verbatim and subjected to framework analysis. Nursing staff attitudes were identified as a structure of care that influence safety outcomes, particularly their perceptions of the care setting and the implications it has on their role and patient behaviour. Greater understanding of the expected role of the community nurse is necessary, and relevant training is required for nurses to be successful in empowering patients to perform more safely. In addition, efforts need to be made to improve patients' trust in the health-care system to prevent harm and promote more effective utilisation of resources. [ABSTRACT FROM AUTHOR]

The establishment of an integrated research culture in medicine has contributed to the ongoing success of medical science in treating disease. Research examining the effectiveness of services and care is of increasing priority, and is a branch of research open to all health professionals. This article provides an overview of the research process aimed at health professionals with novice research skills. It will provide tools and resources to guide health professionals in the development of research concepts leading to a feasible protocol. [ABSTRACT FROM AUTHOR]

The establishment of an integrated research culture in medicine has contributed to the ongoing success of medical science in treating disease. Research examining the effectiveness of services and care is of increasing priority, and is a branch of research open to all health professionals. This article provides an overview of the research process aimed at health professionals with novice research skills. It will provide tools and resources to guide health professionals in the development of research concepts leading to a feasible protocol. [ABSTRACT FROM AUTHOR]