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Policies in long term conditions care continue to develop rapidly in England. Currently there is a focus on the integration of services and enabling patient and carer choice. Integration of care across disciplines and services is complex and community nursing services are commonly central to reorganization processes in long term condition care. This paper presents the findings of a mapping of the evidence on integration in long term condition services. Literature on horizontal integration including integrated teams will first be discussed, followed by an exploration of the evidence on vertical integration exemplified by integrated care pathways and disease management programmes. As a relatively recent service innovation, the mapping found a lack of evidence of the effectiveness of integration in long term conditions. Furthermore, the paper highlights the potential tension between vertical integration structures such as care pathways and the patient choice and empowerment agenda in long term conditions. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has impacted healthcare education and delivery, including both theory and practice learning. Academic staff responded rapidly to move teaching online during the first lockdown, with many returning to practice to deliver care or upskill practice staff to work in critical care. Many pre-registration students responded by becoming paid NHS employees, contributing to care delivery while remaining on their programme of study. Practice learning partners, despite the challenges of the pandemic, continued to support students to achieve their registration status. This occurred within the context of the Emergency and Recovery Standards, published by the Nursing and Midwifery Council between March 2020 and September 2021. This paper sets out the response of students, practice learning partners and higher education institutions involved in pre-registration nursing and midwifery programmes. [ABSTRACT FROM AUTHOR]

A hospice service in south east England determined to develop a new hospice-at-home service to enable greater patient choice and facilitate patients dying at home, which is often a patient's preferred place. As a first step, a literature review was commissioned to establish the evidence base to inform the design of the new service. A range of research had been reported on hospice-at-home services, but the service configurations evaluated in these studies and the context in which they operated had not been described in detail. This paper briefly summarises the results of the literature review and then describes the new service that was established, including the setting and context. Experiences with the service in terms of activity, acceptability, and problems are described. The aim is to assist providers and commissioners seeking to establish or develop similar services and to help them predict the likely impact of such services. INSETS: Box 1. Case study illustrating how the new hospice-at-home...;Box 2. Examples of carers¿ comments on the new hospice-at.... [ABSTRACT FROM AUTHOR]

In England, there has been a long standing tendency to seek to reform health services via large-scale structural reorganization and via seeking (at least in principle) to boost the power of health care commissioners to redesign services. Based on a review of community nursing services in an urban Primary Care Trust, this paper argues that such an approach has led to a situation where positive service development has stalled as senior managers prepare for the next reorganization (rather than focus on service improvement); where the underlying causes of failure to bring about universal transformation of community health services have not been addressed by ongoing organizational changes; and where providers now seem to look to commissioners to change services (rather than changing them themselves). In contrast, the paper argues that there is significant scope for those working in and managing community health services to focus on what is within their power to change—rather than waiting for others to do it for them. [ABSTRACT FROM AUTHOR]

Experience feedback data is increasingly recognised as being helpful in improving healthcare services, and in meeting patient and family needs. This end-of-life care project, based on the principles of appreciative inquiry, sought to learn from the experiences of bereaved people whose relative had died in an acute hospital setting. Informal feedback, offered during a routine telephone call, was thematically analysed and interpreted in an appreciative manner. Confirmatory representations of caring practices and behaviours were identified, categorised and disseminated in a way that enabled staff to come to know and understand end-of-life care at its best, rather than as a set of problematised events. The findings served as a benchmark for individuals and teams to assess and progress their practice reflectively. The authors conclude that staff receptiveness to informal bereaved family feedback may be enhanced by focusing on the positive qualities of end-of-life care within existing practices. [ABSTRACT FROM AUTHOR]

Background: The demand for hospice-at-home (HH) nurses is increasing due to an ageing global population and many people preferring to die at home. Therefore, the retention of existing HH nurses is vital. Aims: This paper explores HH nurses' experiences of caring for dying patients to discover the factors that enable them to maintain their enthusiasm for their work, and cope with the challenges of working in a patient's home. Methods: This qualitative study consisted of multiple unstructured interviews with 16 HH nurses conducted in England. Findings: The interviews show that HH nurses: use a broad range of coping mechanisms; encounter intense, complex, unpredictable and ethically unclear challenges; identify a need for more support; and love their job. Conclusion: In order for nurses to continue to enjoy their job, extra support to incorporate protected time for debriefing at the end of an HH nurse's shift is needed. Nurses also need training to develop positive coping skills, external supervision on a one-to-one basis as needed, and have their value demonstrated, by their employers and managers recognising and acknowledging them. These factors are likely to facilitate in the retention of employment of HH nurses. [ABSTRACT FROM AUTHOR]

This paper outlines a service improvement project undertaken in one acute cardiac ward within a regional NHS trust in the east of England that explored the impact of advancing patient- and family-centred care within an acute adult setting. The project was implemented and evaluated over a 9-month period between March and December 2012 and data collected via a pre and post-intervention survey. The results demonstrated that the majority of family carers wanted to be involved in patient care. The provision of flexible family visiting, facilitated and supported family carer involvement in care provision and improved partnership working between family carers and the multidisciplinary team, had a positive impact on the patient and family carer experience. This project has demonstrated the value of involving family carers in acute adult inpatient care provision and the importance of flexible family visiting to enable this to be successful. [ABSTRACT FROM AUTHOR]

Little is known about the quality of the end-of-life care patients receive at home. This paper reports findings from a study that explored bereaved relatives' and carers' experiences of end-of-life care at home using the Care of the Dying Evaluation (CODE) questionnaire. Narrative data from questionnaires completed by 72 carers of patients who had died at home in the North West of England underwent qualitative analysis. In general good quality care was provided, but there were times when adequate support was not evident in relation to pain control and what to expect when death was imminent. The study provides useful information for those who provide end-of-life care at home. [ABSTRACT FROM AUTHOR]

Background/Aims: Poor multidisciplinary teamwork on labour wards may lead to adverse consequences for women and babies. The labour ward co-ordinator is a central role in the multidisciplinary team; however, there has been little research into explore the skills and attributes necessary for this role. This study aimed to explore the labour ward co-ordinator's skills and attributes and their impact on multidisciplinary team working. Methods: Constructive grounded theory was used to explore the perceptions of 21 labour ward multidisciplinary team members recruited using theoretical sampling from a maternity unit in northern England. Results: Labour ward co-ordinators play significant roles in ward organisation, team situational awareness and a well-functioning multidisciplinary team. Co-ordinators had situational awareness through a 'helicopter view' of the ward, supported decision making and were approachable. Excellent labour ward co-ordinators used situational awareness to pre-empt emergencies and forward plan. Conclusions: The labour ward co-ordinator role requires a different skillset to that of midwives delivering one-to-one care in labour. To develop midwives into the co-ordinator role, attention to continuing professional development is essential. Recruitment of consultant midwives dedicated to supporting midwives delivering care to women in labour should be considered. [ABSTRACT FROM AUTHOR]

Infection control has long been the focus of the attention of anyone working in healthcare, due to the risks posed to patients and staff if appropriate infection control procedures are not followed properly. This article explores a recap of important infection control measures and also outlines the Government's policy for tackling antimicrobial resistance, and its link to infection control procedures. The article covers the key points of the recent publication from NHS England on the topic of infection control. [ABSTRACT FROM AUTHOR]

This article provides a comparative review of the interpretation and implementation of clinical governance frameworks within the four home countries of the UK - England, Northern Ireland, Scotland and Wales. Clinical governance has become one of most significant and important concepts in modern health care. The article considers the policy background and the many definitions of clinical governance, but specifically compares the various strategic and operational approaches to delivery of clinical governance in different parts of the UK. It is suggested that these variations in approach, by each of the four UK countries, can lead to confusion for healthcare professionals in trying to understand, implement and monitor elements of clinical governance in practice. [ABSTRACT FROM AUTHOR]

There is increasing demand for nurses to work in primary care. This is driven in part by the need to retain current levels but also by the modernisation plans for primary care services, which require new roles for nurses, new ways of working and more nurses in primary care settings. While campaigns for increased recruitment of hospital nurses and doctors has been largely successful in recent years, primary care has still to see the impact. This article reports on a Department of Health (England) funded project that aimed to identify strategies and exemplars to assist primary care trusts (PCTs) and the workforce development confederations (WDCs) in strategic health authorities in attracting and retaining nurses to primary care at registered nurse level. It reports on the range of initiatives identified, the perceived benefits and challenges. It concludes by proposing a strategic model for planning for the recruitment and retention of primary care nurses. [ABSTRACT FROM AUTHOR]

Emeritus Professor Alan Glasper, University of Southampton, discusses the impact and success of Care Quality Commission hospital inspections since publication of the report into Mid Staffordshire NHS Trust. [ABSTRACT FROM AUTHOR]

Ambulatory care (AC) is an approach within which inpatient chemotherapy regimens and supportive care are delivered in an outpatient service. Patients receive their treatments and supportive care daily in AC and stay at a nearby hotel or their home, rather than in an inpatient bed. A systematic literature search found a growing amount of literature on AC and the specific regimens used. However, little was found on AC with regard to the patient experience, safety, the benefits and challenges of running an AC service. This series of three articles is based on the authors' experiences of working within an AC service at a major London teaching hospital. The authors discuss the approach and explore how it can improve the patient experience. They look at the roles of the multidisciplinary team and their part in patient safety, and the benefits, challenges and cost considerations of an AC service. [ABSTRACT FROM AUTHOR]

Background: The community matron (CM) role was introduced in England to provide a single point of access to patients living with comorbid long-term conditions who had, or were at risk of, frequent emergency hospitalisation. Aim: This study explored the factors that affected embedding of the CM role. The qualitative study was undertaken in community health services in two cities and a rural area in central England. Method: Participants comprised health professionals (n=30) including CMs, community service managers, and service commissioners; patients (n=10); and their family carers (n=5). Results: Findings reveal that participants were largely positive about the role. However, difficulties with role setup had led to numerous changes in service delivery, which affected how the role has embedded. Conclusion: Many aspects of the CM role are invisible to other health professionals. Invisibility of community nursing, rather than autonomy of the CM role, seems to be a key factor in the challenges of embedding the role. [ABSTRACT FROM AUTHOR]

Transition from children’s to adult services has long been recognised as challenging. Yet many young people and their families continue to have poor experiences, with a lack of collaboration and communication between the different agencies involved in the transition process. This article highlights the complexities of transition and how it is addressed for young people with complex health needs in Hertfordshire with a dedicated transition nurse coordinator providing support for the young people on the caseload; bridging the gaps between children’s and adult services; and providing continuity until the young person is established in adult services. [ABSTRACT FROM AUTHOR]

Personal health budgets (PHBs) were introduced at 61 sites across England; 20 of which were evaluated in a report published in November 2012. There has been collective resistance to PHBs and negative reporting in the professional healthcare press. However, there is some early evidence that PHBs are proving to be successful. Nurses in the community are having a pivotal role in their implementation. This article addresses a number of negative and often misleading myths about PHBs that have been publicised in some areas of the professional press. INSETS: Box 1. A 45-year-old disabled woman;Box 2. A young disabled man. [ABSTRACT FROM AUTHOR]

Aims: Evidence-based practice is an approach to clinical decision making which combines the best available evidence with individual patient care. Debate as to what makes good evidence and how this should be applied in practice as well as ambiguity about the meaning of evidence-based practice and concern regarding its conflict with other models of occupational therapy, have created uncertainty for occupational therapists attempting to become 'evidence-based'. The aim of this study was to explore the meanings attributed to evidence-based practice by occupational therapists and to propose a definition and framework of evidence-based practice that reflects participants' perceptions. Method: A mixed methodology qualitative design incorporating focus groups, in-depth interviews and observation was used to explore perceptions of evidence-based practice by occupational therapists at one setting in England. Findings: The findings indicate that evidence-based practice is typically associated with use of research but that this is only partially relevant to occupational therapy and the treatment of individuals. A definition of and framework for evidence-based occupational therapy which reflects these findings is presented. Conclusion: Acknowledgement of a range of evidence, from research findings to clients' self-reports, corresponds with participants' conception of clinical reasoning as a complex process that takes multiple factors into account. This, together with participants' client-centred approach and emphasis on the human experience of health encounters, forms the basis of a reconfiguration of evidence-based occupational therapy. [ABSTRACT FROM AUTHOR]

Valuing People: A New Strategy for Learning Disability for the 21st Century (Department of Health, 2001a,b) aimed to introduce 'health facilitation' to improve the identification of health needs and access to appropriate care for people with learning disabilities. One London Borough took a leading role in implementing this new function, in the form of dedicated, fun-time health facilitators. The authors examined the implementation and its impact, employing an innovative collaboration between professionals from practice, education and research. The clinical nurse involved was observed during her first year of health facilitation. The authors evaluated her impact on professionals, people with learning disabilities and the wider system of health. In some areas (for example, information technology) the health facilitator could make little progress in one year. However, she connected with a widening circle of local people and services, for example, in introducing health action plans for adults with a learning disability. Across the Borough some professionals became more aware of specific health issues in their local population. [ABSTRACT FROM AUTHOR]

Recognition that there was a lack of knowledge about what services existed for adults aged 18-65 years with an acquired neurological condition in North Cumbria, and how they were accessed and coordinated, led to a project to identify community rehabilitation provision and explore potential service models. Interviews were undertaken with service providers, and focus groups, interviews and a questionnaire were undertaken with services users and carers. The five areas of concern to emerge from a thematic analysis of the data related to service provision; respite care and day time occupation, transport and geography co-ordination of services, and information. There were differences in perspectives and priorities. Having one point of contact for access to all services emerged as the preferred model, although this would not address the gaps in service provision. Despite the recognition that the National Service Framework for Long-term Conditions (Department of Health (DH), 2005b) has promoted service development for the target group, there is still a need to work towards greater coherence in service provision across a plurality of providers. [ABSTRACT FROM AUTHOR]

This study aimed to examine the involvement of occupational therapists in the development of intermediate care services in England. A non-experimental survey design was employed and a postal questionnaire was sent to 414 members of the specialist section of the College of Occupational Therapists: Older People. Quantitative and qualitative data from the 159 respondents was analysed using descriptive statistics and content analysis respectively Results indicate that the occupational therapists in this study were heavily involved in the development of intermediate care services. This included the creation and monitoring of integrated equipment stores and in the extension of their role to include intermediate care coordination. Intermediate care provision for older people with mental health problems was seen to be an area requiring further development. The National Service Framework for older people continues to provide opportunities for occupational therapists working to further develop and shape services for this growing sector of society. [ABSTRACT FROM AUTHOR]

Background The new General Medical Services contract in England means many GPs have transferred out-of hours work to their primary care organization, with implications for continuity of palliative care in community hospitals. Aim To examine existing arrangements for out-of-hours medical cover in community hospitals, focusing on palliative care. Methods Telephone survey of community hospital managers/ senior nurses across England and Wales. Results Interviews (n=62) revealed nursing staff were satisfied with existing out-of-hours care. Concern was expressed about the future of out-of-hours medical care from GPs as new services will cover larger areas, meaning unknown doctors may attend, taking longer to arrive. Conclusion Arrangements for out-of-hours medical cover in community hospitals are in transition, threatening the continuity of care for dying patients. [ABSTRACT FROM AUTHOR]

The article discusses that the latest evidence from Guest et al (2020) compares data from 2012-2013 to 2017-2018 and reports that there is an increase in the number of wounds and increase in the financial cost. Topics discussed include the National Wound Care Strategy Programme's will be recommending that those working at a senior level in tissue viability; and framework provides a standard for all levels of multi-professional clinicians, educationalists, researchers and managers.

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a recent report showing how trusts rated as outstanding by the regulator have embedded a culture of change that involves all staff [ABSTRACT FROM AUTHOR]