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Background: The development of a nurse-led approach to managing epilepsy in adults with an intellectual disability (ID) offers the potential of improved outcomes and lower costs of care. We undertook a cluster randomised trial to assess the impact on costs and outcomes of the provision of ID nurses working to a designated epilepsy nurse competency framework. Here, we report the impact of the intervention on costs., Method: Across the United Kingdom, eight sites randomly allocated to the intervention recruited 184 participants and nine sites allocated to treatment as usual recruited 128 participants. Cost and outcome data were collected mainly by telephone interview at baseline and after 6 months. Total costs at 6 months were compared from the perspective of health and social services and society, with adjustments for pre-specified participant and cluster characteristics at baseline including costs. Missing data were imputed using multiple imputation. Uncertainty was quantified by bootstrapping., Results: The intervention was associated with lower per participant costs from a health and social services perspective of -£357 (2014/2015 GBP) (95% confidence interval -£986, £294) and from a societal perspective of -£631 (95% confidence interval -£1473, £181). Results were not sensitive to the exclusion of accommodation costs., Conclusions: Our findings suggest that the competency framework is unlikely to increase the cost of caring for people with epilepsy and ID and may reduce costs., (© 2019 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Background: In adults with intellectual disability (ID) and epilepsy there are suggestions that improvements in management may follow introduction of epilepsy nurse-led care. However, this has not been tested in a definitive clinical trial and results cannot be generalised from general population studies as epilepsy tends to be more severe and to involve additional clinical comorbidities in adults with ID. This trial investigates whether nurses with expertise in epilepsy and ID, working proactively to a clinically defined role, can improve clinical and quality of life outcomes in the management of epilepsy within this population, compared to treatment as usual. The trial also aims to establish whether any perceived benefits represent good value for money., Methods/design: The EpAID clinical trial is a two-arm cluster randomised controlled trial of nurse-led epilepsy management versus treatment as usual. This trial aims to obtain follow-up data from 320 participants with ID and drug-resistant epilepsy. Participants are randomly assigned either to a 'treatment as usual' control or a 'defined epilepsy nurse role' active arm, according to the cluster site at which they are treated. The active intervention utilises the recently developed Learning Disability Epilepsy Specialist Nurse Competency Framework for adults with ID. Participants undergo 4 weeks of baseline data collection, followed by a minimum of 20 weeks intervention (novel treatment or treatment as usual), followed by 4 weeks of follow-up data collection. The primary outcome is seizure severity, including associated injuries and the level of distress manifest by the patient in the preceding 4 weeks. Secondary outcomes include cost-utility analysis, carer strain, seizure frequency and side effects. Descriptive measures include demographic and clinical descriptors of participants and clinical services in which they receive their epilepsy management. Qualitative study of clinical interactions and semi-structured interviews with clinicians and participants' carers are also undertaken., Discussion: The EpAID clinical trial is the first cluster randomised controlled trial to test possible benefits of a nurse-led intervention in adults with epilepsy and ID. This research will have important implications for ID and epilepsy services. The challenges of undertaking such a trial in this population, and the approaches to meeting these are discussed., Trial Registration: International Standard Randomised Controlled Trial Number: ISRCTN96895428 version 1.1. Registered on 26 March 2013.

The significant policy changes in UK health care over the past decade have led to a consequent shift in the delivery of nurse education to ensure the development and sustainability of a knowledgeable nursing workforce. One of the most recent, radical and important initiatives is Modernising Nursing Careers, which outlined four key priority areas for nursing, all of which have implications for nurse education. In light of this initiative, we explore the extent to which the modernisation of nursing careers is rhetoric or reality for UK nurse education - we are on the precipice of great change. To facilitate this, we move chronologically through the issues of recruitment and access; pre-registration preparation; and post-qualification education and careers. In discussing these issues, we demonstrate that more changes are needed to produce nurses who are flexible, visionary and prepared to take risks. We suggest that vision, leadership and strong realignment with health priorities are needed to bring nurse education to a point where nurses are truly prepared for the demands of a 21st century health service.

AIM: To explore the nature of the nurse clinical supervisor role. BACKGROUND: Although clinical supervision in nursing has been widely explored, few studies have considered the specific role of nurse clinical supervisors. METHOD: A phenomenological approach was used to explore what it means to be a clinical supervisor. Focus groups interviews were conducted with 12 nurse clinical supervisors within one National Health Service (NHS) Trust. RESULTS: Three main categories of themes that represented the essence of the clinical supervisors' role were uncovered. CONCLUSIONS: The research demonstrated that nurses who undertake the clinical supervisor role are rarely offered guidelines for fulfilling the role. The findings reveal gaps in the structure of the clinical supervisor's role which could be hampering successful clinical supervision. IMPLICATIONS FOR NURSING MANAGEMENT: The study adds to the existing evidence base and serves to inform managers of the nature of the nurse clinical supervisor role and how it could be better facilitated. The data shed light on the needs of nurse clinical supervisors who often adopt this role in addition to their other clinical and professional commitments. The findings indicate that managerial support in the form of prioritizing training and offering support mechanisms help nurses to effectively fulfil the clinical supervisor role. [ABSTRACT FROM AUTHOR]

Aim. This paper is a discussion of the use of poststructuralism as a means of exploring power and empowerment in nursing. Background. Power and empowerment are well-researched areas of nursing practice, but the issue of how to empower nurses and patients continues to cause debate. Power and empowerment are complex issues and other researchers have provided some clarity by proposing three theoretical approaches: critical social theory, organizational theory and social psychological theory. We support their work and propose an additional poststructural approach as a means of analyzing power and empowerment in nursing. Discussion. The concept of power in nursing may be critiqued by drawing on the work of Michel Foucault and paying particular attention to two areas: disciplinary power and knowledge/power relationships. Foucault's contention was that behaviour is standardized through disciplinary power and that power and knowledge are intertwined. Nurses who seek an understanding of empowerment must first grasp such workings as hierarchical observation, normalizing judgement, the examination, and power/knowledge relationships, and that cognizance of such issues can promote nursing practice that is empowering. They need to adopt a more critical stance to understanding power and empowerment in nursing, and one way of fostering such criticism is to view nursing practice through a poststructural lens. Conclusion. A poststructural approach merits a place alongside other approaches to understanding power and empowerment in nursing. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore the meaning of empowerment for nursing students in relation to their clinical practice experiences. Background. Empowerment and power are well-researched areas of nursing practice, particularly in relation to Registered Nurses. Furthermore, several studies have considered the experiences of nursing students in terms of nursing culture and socialization. However, few researchers have focused specifically on nursing student empowerment. Method. The critical incident technique was used and anonymous data were collected between November 2005 and January 2006. One hundred and nine written critical incidents were provided by 66 nursing students relating to empowering and disempowering experiences in clinical practice. The data were content analysed. Findings. Nursing students experience both empowerment and disempowerment in clinical placements, centring on three issues: learning in practice, team membership and power. Continuity of placement, the presence of a mentor and time underpinned empowering experiences whereas their absence had a disempowering effect. Conclusion. The consequences of nursing student empowerment are high self-esteem, motivation for learning and positive regard for placement. Supportive mentors play a pivotal role in the empowerment of nursing students and it is essential for the nursing profession that they are supported to undertake their mentorship role. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The research outlined in this paper aimed to establish a consensus view amongst primary healthcare professionals about the competencies that district nurses need in order to fulfil an effective role in health promotion. BACKGROUND: In recent years there has been a growing emphasis on health promotion in primary care in the United Kingdom and health promotion is becoming increasingly important to nurses who work in the community. However, consideration of the role of the district nurse in health promotion is rather restricted and consequently district nurses have limited access to empirical evidence, from which they can develop their work in health promotion. DESIGN AND METHODS: The Delphi technique was used for this study. Seventy-two primary healthcare professionals were mailed a series of three questionnaires, which achieved response rates of 86, 87.5 and 78.9%. RESULTS: There was a consensus amongst the panellists that district nurses require a range of competencies to engage effectively in health promotion. These were categorized to produce a definitive list of eight knowledge-, seven attitude- and eight skill-related competencies. CONCLUSIONS: For the first time, this study achieves a consensus on the competencies needed by district nurses to engage in health promotion. RELEVANCE TO CLINICAL PRACTICE: District nurses should feel encouraged to develop their health promotion role in light of the fact that many of the competencies that they require for this activity have been identified as essential for their day-to-day nursing practice. The research highlights the fact that new paradigm health promotion is a concept that has moved beyond the academic arena and is recognized as significant by practising health professionals. [ABSTRACT FROM AUTHOR]