RCN International Nursing Research Conference and Exhibition 2019

Tuesday 3 - Thursday 5 September 2019 Sheffield Hallam University, UK

Conference abstracts

kindly supported by media partner Accrue up to 27 hours #research2019 of CPD The abstracts included in this brochure have been printed as submitted by the authors with some minor editing to maintain RCN house style. The RCN does not assume any responsibility for the accuracy or quality of the information provided in this book of abstracts. Authors are fully responsible for the content of their abstracts including accuracy of the facts, statements and references.

This year’s conference marks the 60th anniversary of the Research Society Meeting.

2 Contents

Keynote speakers...... page 4 Concurrent session 6 – Thursday 5 September...... page 59 Concurrent session 1 – Theme 6.1: Workforce...... page 59 Tuesday 3 September...... page 6 Theme 6.2: Research Careers...... page 60 Theme 1.1: Education...... page 6 Theme 6.3: Methods...... page 61 Theme 1.2: Research Policy...... page 7 Theme 6.4: Public Health...... page 62 Theme 1.3: Women’s Health...... page 9 Theme 6.5: New Roles...... page 63 Theme 1.4: Emergency Care...... page 11 Theme 6.6: Nursing Issues...... page 63 Theme 1.5: Methods...... page 12 Theme 6.7: Mental Health...... page 64 Theme 1.6: Surgery...... page 14 Theme 1.7: Patient Outcomes...... page 16 Concurrent session 7 – Thursday 5 September...... page 66 Concurrent session 2 – Theme 7.1: Safe Staffing...... page 66 Tuesday 3 September...... page 18 Theme 7.2: Methods...... page 67 Theme 2.1: Education...... page 18 Theme 7.3: Acute and Sub-acute Care...... page 68 Theme 2.2: Mental Health...... page 19 Theme 7.4: Care Homes and Frailty...... page 70 Theme 2.3: Patient Safety...... page 21 Theme 7.5: Dementia...... page 72 Theme 2.4: Workforce...... page 23 Theme 7.6: Patient Safety...... page 73 Theme 2.5: Teenagers and Young Adults Theme 7.7: Workforce...... page 75 with Cancer...... page 24 Theme 2.6: Methods...... page 26 Symposia 1-5 – Theme 2.7: Patient Experience...... page 28 Tuesday 3 September ...... page 78 Concurrent session 3 – Symposia 6-11 – Wednesday 4 September...... page 31 Wednesday 4 September...... page 90 Theme 3.1: Dementia...... page 31 Symposia 12-16 – Theme 3.2: Clinical...... page 31 Thursday 5 September...... page 104 Theme 3.3: PPI (Patient and Public Involvement)...... page 33 Posters – Theme 3.4: Public Health...... page 34 Tuesday 3 September...... page 117 Theme 3.5: Mental Health...... page 35 Poster Tour A...... page 117 Poster Tour B...... page 120 Concurrent session 4 – Poster Tour C...... page 124 Wednesday 4 September...... page 36 Poster Tour D...... page 127 Theme 4.1: Cancer...... page 36 Theme 4.2: Older People ...... page 37 Posters – Theme 4.3: Children and Young People...... page 39 Wednesday 4 September ...... page 129 Theme 4.4: Women’s Health...... page 40 Poster Tour E...... page 129 Theme 4.5: Workforce...... page 42 Poster Tour F...... page 132 Theme 4.6: Patient Use of Mobile Poster Tour G...... page 136 Applications...... page 44 Poster Tour H...... page 138 Theme 4.7: Service and Innovation and Posters – Improvement...... page 45 Thursday 5 September...... page 141 Concurrent session 5 – Poster Tour I...... page 141 Wednesday 4 September...... page 47 Poster Tour J...... page 142 Theme 5.1: End-of-life Care...... page 47 Poster Tour Q...... page 144 Theme 5.2: Children and Young People...... page 49 Theme 5.3: Infection Prevention and Control. page 50 Theme 5.4: Diabetes...... page 52 Theme 5.5: Education...... page 53 Theme 5.6: Medication Errors...... page 54 Theme 5.7: Advanced Practice...... page 56

3 Keynote speaker abstracts

Keynote speaker abstracts Tuesday 3 September, Wednesday 4 September, 10.20-11am 10.40-11.25am

Location: Pennine Lecture Theatre Location: Pennine Lecture Theatre Biography Hugh McKenna is a Professor and Dean at Ulster University. He has Conquering research The impact of impact over 250 publications including Professor Hugh McKenna CBE 16 books and over £4 million in impact: Reaching the PhD BSc (Hons) RMN RGN RNT grants; he has supervised 18 PhD summit, making a DipN(Lond) AdvDipEd FFN students to successful completion. difference and surviving His published work has been cited RCSI FEANS FRCN FAAN MAE, 13,534 times with over 36,000 reads Professor Angela Mary Tod PhD Professor of Nursing, Ulster on ResearchGate. He is Visiting MSc MMedSci BA(Hons) RN, University, UK Professor in Slovenia and Australia Professor of Older People and Care, Twitter: @mckenna_ho and chairs an accreditation panel University of Sheffield, Sheffield, UK in Hong Kong. In 2017, he was Summary of session Summary of session appointed to chair Sub Panel 3 Hugh will outline how the Research for the UK Research Excellence Researchers are under more Excellence Framework’s (REF) Framework 2021, which he also pressure than ever to achieve and emphasis on research impact has chaired in REF2014. In 2018 he demonstrate impact. The research changed the focus of research chaired the Swedish Research impact agenda has been critiqued activities and outcomes in many Council’s Clinical Research Review. because of political and financial In 2018, he was identified as one countries. Using data from the last motivations for the current focus. REF, he will show how nursing of 70 Most Influential Nurses since the founding of the NHS in However, as nurses working in in the UK is contributing to 1948. He chairs the largest mental research or using research we have economic, cultural, social and health health, addiction and learning different motivations for achieving improvement internationally. disability charity on the island of research impact. Our incentives Intended learning outcomes Ireland. He has honorary doctorates are linked to our own practice and from University of Maribor and • Understand the importance of commitment to patients. We strive Edinburgh Napier University and research impact. to use research to achieve excellence appointed to the Academia Europea, in practice, quality healthcare • Describe how nursing research which advises the EU. and effective clinical practice/ has contributed to global impact interventions. This presentation in a variety of fields. revisits research impact, its • Explain how nurses can ensure definitions, challenges, some models that their research is more and mechanisms to enhance impact impactful. as well as some applied research impact examples. Intended learning outcomes • Understand why research impact is vital to improve health care quality. • Understand how to achieve research impact. • Identify their role in achieving research impact.

4 Keynote speaker abstracts

Thursday 5 September, 9.05-9.45am

Biography Location: Pennine Lecture Theatre Biography Angela is Professor of Older People Linda H Aiken PhD is the Claire and Care in the School of Nursing Fagin Professor of Nursing, and Midwifery at the University of New international Professor of Sociology, Director of Sheffield. Her nursing background evidence on the impact Center for Health Outcomes and is in cardiology and cardiac of safe nurse staffing Policy Research, and Senior Fellow rehabilitation. Angela has many interventions of the Leonard Davis Institute of years of experience conducting Health Economics at the University Professor Linda H Aiken, RN, and applying research into health of Pennsylvania, Philadelphia, PhD, Professor and Director, care, as well as posts focusing USA. Dr. Aiken conducts research Center for Health Outcomes and on research capacity building in on relationships between health Policy Research, University of nurses, midwives and allied health care workforce factors and patient Pennsylvania School of Nursing, professionals. outcomes in over 30 countries. Philadelphia, USA Her research has mainly focused She is the author of more than Twitter: @LindaAiken_Penn on care for adults and older people. 300 scientific papers. She is an The particular research focus is Summary of session elected member of the US National in patient experience studies, There is a large research literature Academy of Medicine, a former especially in areas of public health, showing that better nurse staffing President of the American Academy health inequalities and health care in hospitals is associated with of Nursing, and an Honorary Fellow access. Recent work includes a better patient outcomes and nurse of the Royal College of Nursing. growing portfolio research in lung retention. More countries and cancer, mesothelioma, people with states are enacting policies to Parkinson’s, neutropenic sepsis, and require hospitals to meet at least intermediate care for older people. minimum safe nurse staffing levels. Angela’s methodologically expertise However, little is known about lies in qualitative research, in stand- the success of these interventions alone and mixed method studies. and there is an ongoing debate among some stakeholders as to whether safe nurse staffing policies improve outcomes for patients and nurses. We review new research findings addressing whether patient outcomes improve as a result of safe nurse staffing policies and the extent to which nurses are more satisfied with their jobs in jurisdictions with safe nurse staffing policies. The implications for England are discussed. Intended learning outcomes • Describe international interventions to improve nurse staffing in hospitals. • Explain the evidence from outcomes evaluations of countries that have adopted safe nurse staffing standards.

5 Concurrent session 1: Tuesday 3 September 2019

1.1 Theme: Education 100% (n=23 nurses) remain in Abstract the organisation with 75% moving Background: Health care middle Session no: 1.1.1 Abstract no: 0377 into leadership and/or research managers have traditionally been Research Topic: Service Innovation and positions. Case studies of projects had expected to be self-taught and to learn Improvement, Workforce and Employment a demonstrable impact on patient while working. (1). An increasingly (including health and wellbeing roles, experiences, outcomes and cost savings. complex health care context makes research careers) Wider organisational and NHS impact health care middle managers more Methodology: Mixed was demonstrated through multiple dependent on relational skills such Research Approach: Evaluation (process, dissemination activities. as communication, negotiation, impact) Conclusion: The CNF initiative, implementation, analysis (2) and provides foundational opportunities to networking (3). It is necessary to Engaging and developing upskill and enable frontline nurses to improve knowledge of leadership embark on the first steps of a clinical in health care and to develop health frontline clinical nurses academic career pathway, whilst gaining care middle managers’ capacity and to drive care excellence: vital exposure to leadership skills and capability (1, 3). Evaluating the Chief Nurse knowledge. Innovating and modelling Aims: To explore how health care Excellence in Care Junior clinical academic skills on the frontline middle managers, who participated Fellowship initiative is essential in breaking down existing in a learning network in rural barriers to clinical academic careers and northern Norway, experienced that Presenter: Louise Bramley PhD, encouraging senior leaders to realise this participation contributed to the Nottingham University Hospitals NHS the value and impact of supporting development of capacity and capability Trust, UK front-line nurses to undertake this for leadership. Co-presenters: Joseph Manning, UK; career pathway. Joanne Cooper, UK Methods: The study was guided by a Biography critical hermeneutic perspective. Health Abstract Dr Louise Bramley is currently the lead care middle managers’ lifeworld and Background: There is an for Clinical Research in the Institute system world was contrasted through internationally recognised shortage of for Nursing and Midwifery Care their reflection and critical questioning registered nurses. Nursing workforce Excellence at Nottingham University in three focus groups during December deficits have been linked directly Hospitals Trust. She is a qualified nurse 2014. The participants were recruited to poorer patient outcomes and and continues to practice clinically. from a learning network: one user staff experience (Aiken et al, 2014). Her research interests include issues representative and health care middle Flexible and innovative workforce affecting the frail elderly, compassion in managers from one local hospital, one solutions are required to overcome nursing and end of life care. She is a key municipal homecare, and one municipal these challenges including those that figure in driving forward the Clinical long-term care facility. The analysis combine opportunities for clinical and Academic Career agenda for nurses and was guided by critical hermeneutic academic development (Association of allied health professionals both within principles according to the work of UK University Hospitals, 2016, Health Nottingham University Hospitals Trust Kvale and Brinkmann and of Alvesson Education England, 2015). and nationally. and Sköldberg. Aim: To describe the implementation Results: The results showed two main and present an evaluation of the ‘Chief themes: Nurse Excellence in Care Junior’ (CNF) 1. Trusted interaction despite bespoke Fellowship initiative, designed Session no: 1.1.2 Abstract no: 0358 organizational and structural to develop the foundational clinical Research Topic: Leadership and framing. and academic skills of front-line junior Management 2. Knowledgeable understanding of a clinical staff. Methodology: Focus Groups complex context. One of the central Method: The CNF Fellowship is an Research Approach: Qualitative contrasts in the results concerned innovative initiative to empower junior approaches (eg: discourse analysis, health care middle managers’ front-line nurses to make significant ethnography, critical theory, grounded experiences of a lack of trust both impacts on patient care through quality theory, phenomenology) internally in their own organization improvements projects, whilst gaining and across organizational academic experience and leadership Building trust: Health boundaries and the ways in which skills as a foundation to becoming their learning network enhanced future nursing research leaders. care middle managers’ the feeling of trust among the The initiative involved two main experiences developing participants. components: a bespoke development leadership capacity and programme and an improvement capability in a publicly Conclusions: Trust was experienced as a central part of health care middle project that was supported by clinical funded learning network and academic mentors. The initiative managers’ leadership capacity and was evaluated using structured Presenter: Trude Anita Hartviksen OT capability in today’s complex health feedback, case studies and data on MRSc PhD student, Faculty of Nursing care organizations. The learning dissemination activities. and Health Sciences, Nord University, network enhanced trust by including Norway relational components such as Results: Nurses report positive impact Co-authors: Jessica Marianne Aspfors, transformative learning, reflection, on their personal and professional Norway; Lisbeth Uhrenfeldt, Norway group work and knowledge sharing development and job satisfaction. but also by facilitating informal

6 Concurrent session 1: Tuesday 3 September 2019

networking such as participating in of 60 participants, 39 (65%) engaged 1.2 Theme: Research Policy meals and competing in a quiz across with phase one of the data collection, organizational borders. a quantitative questionnaire capturing Session no: 1.2.1 Abstract no: 0192 Biography opinion of e-learning as a means of Research Topic: Leadership and continuing professional development. Trude Anita Hartviksen is a PhD Management Of those 39, a further 12 agreed to canddiate based in Nord University, Methodology: Other collection method participate in phase two, qualitative Bodø, Norway. Her research focuses Research Approach: Other approaches face to face interviews. on health care middle managers’ Discussion: Through analysis of experiences of developing capacity Releasing capacity for and capability in a complex context. research data emerging themes where Hartviksen is an occupational therapist, identified, these included the flexibility nurses to engage in with twenty years of experience in and challenges when engaging with research: An organisational health care middle management and e-learning, along with the knowledge development approach acquisition and retention. Comparisons quality and improvement work both in Presenter: Sally Fowler Davis, hospitals and municipalities. She works were also made to that of the more traditional approaches to continuing Doctorate in Business Administration, as a lecturer in the Faculty of Nursing Sheffield Hallam University, UK and Health Sciences at Nord University. professional development. Whilst many of the themes had parody with existing Abstract literature base, motivation did emerge Background: Research is defined as as a key theme not previously discussed a ‘core function’ in UK health service Session no: 1.1.3 Abstract no: 0184 in depth in relation to e-learning. organisations. Current evidence Research Topic: Nursing, Midwifery or Conclusions: Implications of the suggests that there is an association Support Worker Education study concluded that the impact between the engagement of individuals Methodology: Mixed e-learning has on the continuing and health care organisations in professional development of registered Research Approach: Mixed Methods research and improvements in health Research nurses is influenced by three main care performance (Boaz et al 2015). factors; motivation to engage, the value Clinical management involvement, of e-learning and challenges to effective especially professional and service The impact of e-learning on engagement. Whilst challenges still management is key to achieving the the continuing professional exist when engaging with e-learning it improvement and the new research development of registered has potential to be used as a platform capacity (Fowler Davis 2014). A nurses for achieving valuable learning coordinated participatory method experiences. is used to release the organisational Presenter: Helen Beckett RN Child MA Biography capacity to engage nurses in clinical Education for Health Professionals, academic research. Swansea University, UK Helen Beckett is a registered children’s nurse with 18 years of experience Method: Using the Academic Abstract in caring for children and young Directorate research strategy to engage Background: The emergence of people in the acute care setting. In senior nurses a process of continuous e-learning in recent years has afforded 2015 an opportunity in practice organisational improvement was the learner the opportunity to engage education presented itself, this led co-designed, involving; individual with evidence-based continuing to the successful undertaking of MA applications to pre masters and pre professional development in a flexible, in Education for Health Professions doctoral awards, team and service level engaging manner. The underpinning graduating from Swansea University in research initiatives to develop new philosophy of which encompasses a 2018. Since 2017 Helen has moved full ways of working and organisational learner-centred approach, that relies time into education, firstly as a clinical planning associated with joint clinical upon self-direction and motivation skills tutor at Swansea University, then and academic posts in nursing. (Brekelmans, Maassen, Poell, taking post as Child Health Lecturer at Leadership engagement and support WeststrateDr, Geurdes, 2016). the university in April 2018. As well as was characterised by senior nurses Aim: The focus of the research was to teaching a wide variety of topics across identifying; research-ready staff, critical explore the concept of e-learning and the pre-registration nursing degree, issues for service development where its perceived value amongst registered Helen has a keen interest in clinical research would stimulate improvement nurses as a method for engaging with skills and simulation. and providing permission and access lifelong learning. to the existing research infrastructure within the NHS Trust. Methodology: To bring a holistic, balanced understanding to the impact Discussion: A strategic commitment e-learning has on the continuing to organisational research, is aligned professional development of to the commitment from the National registered nurses the research strategy Institute of Health Research (NIHR) incorporated a two-phase data to achieve clinical academic careers collection process utilising a sequential for nurses, midwives and Allied Health explanatory mixed methods design Professionals. The commitment from (Creswell & Creswell, 2018). service managers and senior nurses, motivated by the drive to achieve Results: Between February 2018 clinical service improvement is an and June 2018 in a potential number important factor and is supported by

7 Concurrent session 1: Tuesday 3 September 2019

a partnership using academic partners Aim: To develop the concept of therapy and is a member of the to support organisational learning and ‘researcher practitioner engagement’ @Otalkresearch Twitter chat team. commitment to research activity. The in health care research and produce a She is currently studying full time alignment of research learning and conceptual model. for a PhD in the School of nursing at development with clinical planning Methods: Analysis of related Ulster University where her research and patient benefit has the potential definitions and published incidences is exploring the concept and culture to address the capacity gap, engaging of researcher practitioner engagement of engagement between researchers nurses as researchers. (theoretical stage) combined based in academic institutions in the Conclusion: Supporting nurses to with the experiences of academic UK and nursing, midwifery and therapy climb, in parallel, both clinical and researchers (n=17) and practitioners practitioners. academic career ladders (Westwood et (n=8) (fieldwork stage) identified al 2018) is having an important effect the attributes, antecedents and and will impact on improved health consequences of this concept. Data Session no: 1.2.3 Abstract no: 0182 outcomes and patient benefit. were collected via online focus groups Biography using audio-visual technology and Research Topic: Methodology thematically analysed. Methodology: Mixed As an organisational scientist and health services researcher, Sally Results: Participants were unanimous Research Approach: Case Study Fowler Davis has a wide range of that an explicit concept is necessary policy implementation experience, to develop authentic practitioner and academic researcher engagement in Methodological paper: a growing understanding of co- How real-world research production research methods and an health care research. Valuing clinical interest in implementation science. knowledge of practitioners from using interpretative case She has a clinical background and formative stages of a study and ensuring study design impacted continuing registration as an Allied practitioners’ perspectives are reflected on collaboration with Health Professional (AHP) and a strong in problem solving and decision making in relevant research activities form the participants and promoted interest in the health of older adults inclusivity and the wellbeing of older populations. essence of this concept. However, it was Her research interests are currently clear that an imbalance of power which Presenter: Nita Muir, Doctorate in associated with the measurement of largely rests with academic researchers Education, University of Brighton, UK is often a challenge to realising this health outcomes and measuring the Abstract concept in practice. quality and impact of services https:// Background: Real world research is Discussion and conclusion: The www.shu.ac.uk/about-us/our-people/ an applied approach to understanding derived conceptual model will be staff-profiles/sally-fowler-davis social life and systems (Robson presented with detailed discussion 2016). Using this approach enabled a around the attributes, antecedents and pragmatic study design for investigating consequences which inform its content. Session no: 1.2.2 Abstract no: 0460 an extensive European nurse education Factors reported to strengthen or network that spanned over 14 European Research Topic: Research Process Issues threaten the feasibility of this concept countries, which communicated in over Methodology: Focus Groups will be discussed and illustrative cases seven languages with 30 organisational presented. Use of this model may Research Approach: Other approaches members. positively influence researcher and practitioner engagement in health Aims: The aim of this paper is to The concept of ‘researcher care research; use of its consistent explore how an interpretative case practitioner engagement’ in terminology and evaluation of outcomes study design provided a holistic portrait health care research can contribute to an evidence base of network activity using three different to advance this concept further and methods of data collection alongside Presenter: Nikki Daniels MAEd BSc an iterative and bespoke analysis. (Hons), Ulster University, UK ultimately improve research use and impact in practice. Through the different methods there Co-authors: Karen Casson, UK; were regular points of interaction which Patricia Gillen, UK Biography promoted participant engagement. Abstract Nikki Daniels has worked as a senior Methodological discussion: An Background: Meaningful interaction lecturer at the University of Derby embedded single case study design between academic researchers and since 2005. Her professional interest was utilised (Yin, 2014) which had a practitioners during knowledge is in the development of evidence- clear theoretical development at the production is claimed to enhance based practice and in particular beginning yet also had the flexibility research use and impact (Bowen & the professional development of to be inductive and iterative as the Graham, 2013; McCormack, 2011). health care practitioners. Teaching fluidity of the research evolved. The On scoping literature where academic responsibilities have spanned both pre research began with a preliminary focus researchers reported engaging frontline and post registration programmes and group that framed the research from practitioners such as nurses, midwives a range of disciplines at master’s level, the perspective of the participants. and therapists in study design and focusing predominately on research This method enabled interpreters conduct, examples related mostly to methods, evidence based practice, to be present and communication one aspect of the research process, developing masters level study skills occurred in range of languages with theoretical guidance was limited and and dissertation supervision. Nikki co- meaning validated via drawings. The evidence to support claims of impact ordinates the doctoral network within subsequent conceptual framework sparse. her own profession of occupational provided the scaffolding for the

8 Concurrent session 1: Tuesday 3 September 2019

second stage of research which was 1.3 Theme: Women’s Health 2. Muti from traditional healers’: a documentary analysis of artefacts/ Working in complex spaces; and documents produced by the network Session no: 1.3.1 Abstract no: 0189 3. Compassionately sick at times”: over several years. Findings from this Research Topic: Women’s health Emotional impact of forensic care were then triangulated with data from Methodology: Focus Groups work. eight interviews with participants of the Discussion and conclusions: Those network using a cross-case analytical Research Approach: Qualitative approaches (eg: discourse analysis, working in FCCs are often working in framework. ethnography, critical theory, grounded difficult circumstances and a number of Conclusion: Researching across theory, phenomenology) factors, both professional and societal different cultures can be complex mediate against provision of effective requiring cultural sensitivity and The experiences of staff care. Greater attention is required in flexibility that can be difficult to working in forensic terms of health service development incorporate in some research designs. and the wider challenges of pervading This paper concludes by promoting the care facilities providing societal norms surrounding violence value of case study design within the support to those who have against women. These findings, which context of real-world research which experienced sexual violence form the basis of the presentation, have aide’s collaboration, inclusivity and in South Africa resonance for sexual violence care and offers rich analytical insights that is services more widely. useful within a real-world research Presenter: Julie McGarry DHSci context. MMedSci BA RN (mental health and Biography Biography adult), University of Nottingham Julie McGarry is Associate Professor School of Health Sciences, UK in the School of Health Sciences at the Dr Nita Muir is an experienced nurse Co-presenters: Moreoagae Randa, University of Nottingham, UK. Julie and nurse academic. She is currently South Africa; is an established academic researcher the programme lead for undergraduate Abstract with expertise and professional nursing at the University of Brighton background in the field of safeguarding with the responsibility for ensuring Background: While recognised (adults and children), gender based a range of nursing courses achieve as a global concern, sexual violence violence and intimate partner violence/ strategic, national and operational has been identified as a large-scale domestic violence and abuse with a objectives. Her research interests are problem in South Africa (Connolly, focus towards survivors’ experiences in work-based learning, pedagogic 2017) with the health care needs of and the development of effective multi- practices which develop clinical women who have been subject to agency (health/social care/criminal decision making in patient safety and sexual violence are largely provided justice) responses. cultural understanding in nursing. by designated public health facilities. Methodologically she practices While a number of these are specialized predominately in a qualitative domain multi-agency facilities (Thuthuzela Care with experience of case study research, Centres) a significant number offer Session no: 1.3.2 Abstract no: 0430 focus groups, interviews, NVivo but mainly essential medical/forensic care Research Topic: Women’s health has recently engaged in simulation/ (Forensic Care Centres). The role of observational research and Q-sort health care professionals is pivotal in Methodology: Interviewing methods. Nita is keen to engage providing support to victims of sexual Research Approach: Qualitative in wider pedagogically orientated violence in South Africa (Medecins Sans approaches (eg: discourse analysis, research. Frontieres, 2017). However, despite the ethnography, critical theory, grounded nature of the work and the associated theory, phenomenology) complexities, alongside the variation in service provision, there is relatively Nurses’ understanding little available evidence with regard of domestic violence and to the experiences of those working in Forensic Care Centres (FCCs). abuse (DVA) against women in Saudi Arabia Aim: To explore the experiences of staff in FCCs who provide support to women Presenter: Kafi Alshammari, Master who have experienced sexual violence. degree in nursing science and PhD candidate, Faculty of Nursing, Methods: A qualitative study Community Health Nursing and incorporating focus groups with a range Mental Health Department, King Saud of staff (n=12) in two Forensic Centres University, Riyadh, Saudi Arabia in one city within Gauteng Province, and School of Health Sciences, The South Africa. Data were collected University of Nottingham, UK during March 2016. Thematic analysis Co-presenters: Julie McGarry, UK; of transcribed focus group data was Catrin Evans, UK undertaken by the authors (Ritchie & Lewis, 2003). Abstract Findings: Three themes were Aim: To explore the practices, identified: understanding, and knowledge 1. We help them to do away with the among nurses and nurses’ students idea of self-blame: Everyday work; surrounding domestic violence and

9 Concurrent session 1: Tuesday 3 September 2019

abuse within the context of Saudi Session no: 1.3.3 Abstract no: 0307 Discussion: There are benefits and Arabia. challenges to using this innovative Research Topic: Women’s health approach in an attempt to integrate Background: DVA for women Methodology: Delphi includes a number of harms and is well evidence from research and clinical Research Approach: Action Research / experience, and gain consensus from an established as a global health issue Participatory Inquiry / Practice Development (WHO, 2015). Within the particular expert group of practitioners, to develop context of Saudi Arabia a number of an intervention that is compatible with societal and cultural factors including A modified, real-time, their professional ethos and deliverable issues regarding women’s rights and the technological Delphi study: in practice. hidden nature of DVA within marriage Collaborating with health Conclusions: Involving practitioners have the potential to limit women’s in the development of interventions ability to access or receive appropriate visitors to develop a new will, hopefully, contribute to consistent, health care and support (Almosaed, guide for perinatal mental confident, competent practice and 2004). health practice improved outcomes. Methodology and Methods: A Presenter: Catherine Lowenhoff, Biography hermeneutic phenomenology approach Doctoral candidate, Oxford Brookes Catherine Lowenhoff has worked (Heidegger, 1962) was used to inform University, UK in the field of perinatal and infant the study. Convenience sampling was Abstract mental health for over 20 years. First used to identify study participants as a health visitor, then as a nurse and data was gathered through semi- Background: A survey of health visitor (HVs) revealed a lack of consultant in perinatal and infant structured interviews (n =18) with mental health and currently as PhD qualified and student nurses in one clarity regarding the content of perinatal mental health interventions student focussing on the role of health city in Saudi Arabia. Data collection visitors in supporting mothers with was undertaken between October (Lowenhoff, 2017). Respondents wanted a manualised, evidence-based mental health problems. Submersion in 2017-February 2018. Analysis was the perinatal mental health literature continuously performed throughout intervention that was effective, feasible for HVs to deliver and acceptable over the last four years has inevitably the interview process to identify raised more questions than answers. consistent themes and transcripts were to mothers. The core components of effective, acceptable and feasible There are three key messages that she carefully evaluated to develop situated has incorporated into her research. structures and a general structure (van- interventions were extracted from literature reviews, amalgamated with 1. No matter how effective an Manen, 1990). The study identified the intervention is in an RCT, it will not phenomenon of nurses understanding the components recommended by survey respondents and presented to work in the real world of clinical of DVA, how it was manifested in each practice if it is not acceptable to the text and how it comes into being. a group of expert HVs in the form of a modified, real-time, technological people expected to deliver it or the Findings: Three themes were identified: Delphi study. people expected to benefit from it. 1. being disempowered Aims: To seek consensus from a group 2. Training alone is not enough to 2. constrained by social forces of expert health visitors regarding the change practice as there are other 3. questioning the dominant religious components that should be included in contextual factors that influence the interpretation. a perinatal mental health intervention; implementation and sustainability to incorporate the findings in a guide of interventions. Discussion and Conclusions: for practice. Findings suggest that nurses are 3. It is necessary to explore beyond reluctant to engage in situations of DVA Method: Over six meetings Jan 2016- the constraints of conventional for a number of reasons including lack June 2017, 27 expert HVs were invited interventions in order to develop of education and/or knowledge. It also to discuss, and vote on (using audience innovative, effective and acceptable highlighted how being constrained by response voting pads), the components solutions. social forces including family, husband that they thought should be included and siblings all played a vital role in in a HV perinatal mental health reluctance to intervene or report DVA. intervention. It also illuminated the centrality of Results: The discussions revealed the interpretation of Islamic tradition complexities of delivering support to and religion. This study provides mothers with mental health problems. an essential contribution to existing Flexibility and choice favoured the body of knowledge in Saudi Arabia identification of a range of evidence- and a discussion of the findings and based strategies that might be helpful. A implications for nursing will form the manual incorporating the findings from basis of the presentation. the Delphi approach was produced that Biography included suggestions for assessment, psychoeducation, therapeutic Kafi Alshammari PhD candidate, School interventions, nurturing relationships of Health Sciences, The University and self-care. The expert HVs took the of Nottingham, UK; Lecturer in the manual back to their teams to consider Faculty of Nursing, Community whether it would be a useful guide Health Nursing and Mental Health for practice. There was unanimous Department, King Saud University, agreement that it was. Riyadh, Saudi Arabia.

10 Concurrent session 1: Tuesday 3 September 2019

1.4 Theme: Emergency Care 95%CI: 17.7-25.2). A total of five focus Presenter: Catherine Daniel BPsycNurs groups involving 30 staff identified the PGDipN(MhlHlth) MN PhD, Session no: 1.4.1 Abstract no: 0408 key challenges for nurses in initiating Department of Nursing, The University Research Topic: Acute and critical care drug screening were time pressures, of Melbourne, Australia perceptions of role legitimacy and lack Methodology: Mixed Co-authors: Marie Gerdtz, Australia; of training. Most of the 270 consumers Jonathan Knott, Australia; Research Approach: Mixed Methods who were interviewed (81.9%) felt Research Stephen Elsom, Australia; Roshani it was appropriate to be questioned Prematunga, Australia about drug use and were comfortable Screening and brief answering questions related to this Abstract intervention for drug use in during their ED visit (86%). Aims and Objectives: This research Conclusion: Nurses are ideally aimed to determine the validity of the emergency department: two different methods for predicting Perspectives of nurses and positioned to carry out drug screening and brief interventions for people with violence risk at triage. consumers acute behavioural disturbances in the Background: Clinical practice Presenter: Marie Gerdtz BN Cert A&E ED. This approach is acceptable to guidelines recommend prevention of GDAET PhD, Department of Nursing, most ED consumers. Nurses require patient violence requires a systematic University of Melbourne, Australia, training in detection, referral and harm process to identify those at risk, yet Co-authors: Celene Yap, Australia; minimisation strategies. evidence supporting risk screening Catherine Daniel, Australia; Jonathan Biography processes in practice remains limited. Knott, Australia Design: A mixed methods design Marie Gerdtz is currently Professor was used to compare the predicative Abstract and Head, Department of Nursing, validity of a derived statistical model for Background: Emergency departments Melbourne School of Health Sciences, identifying risk of violence with nurses’ (EDs) represent a frontline point of The University of Melbourne. Her clinical judgement of violence risk at access to health services for people scholarship is informed by 15 years triage. with acute behavioural disturbances of practice as a Registered Nurse in and concurrent illicit drug use (Rikki J, the specialty of emergency care. Marie Method: In Phase 1 a 12-month 2018). holds an appointment as an honorary retrospective study was conducted to Aims and Objectives: researcher at Melbourne Health identify the clinical and demographic where she works with colleagues from factors significantly associated with the 1. To determine the prevalence of medicine, pharmacy and mental health occurrence of patient violence using illicit drug use for all individuals on an inter-disciplinary program of logistic regression model. Violence admitted to the ED Behavioural research aimed at preventing and was defined as any event requiring a Assessment Unit (BAU). responding to acute behavioural coordinated hospital wide response 2. To explore perspectives of staff and disturbance in the emergency to patient aggression (Code Grey). In consumers regarding routine drug department. Clinical implementation Phase 2 nurses determined the risk screening and brief interventions of her research findings are enhanced of violence using clinical judgment for drug use. by the strong partnerships she has at triage. Estimates of sensitivity Method: A mixed methods study established within the health care and specificity, likelihood ratios and conducted in three phases: industry and with government. To predictive values were established. 1. an observational study of date, she has completed over 90 peer Results: The predictive model prevalence reviewed publications in scholarly developed in Phase 1 identified risk journals, government reports and factors including arriving with a 2. focus group interviews with nurses book chapters and has obtained over police escort and requiring a mental regarding barriers and enablers to AUD$4.2M research funding from a health assessment (OR=18.88; drug screening range of industry sources and nationally 95%CI=12.9,27.97; OR=11.68, 3. a consumer survey regarding public competitive schemes. 95%CI=9.13,14.94 respectively). The acceptability of drug screening. final model predicted 7.1% (41/574) of The setting was a metropolitan tertiary all presentations who required a Code referral hospital in Australia. Grey response during their ED stay. Session no: 1.4.2 Abstract no: 0410 A consecutive sample of adults In Phase 2 of the study nurses’ clinical admitted to the ED BAU were asked Research Topic: Service Innovation and judgement of violence risk on arrival about their drug use and underwent Improvement yielded a sensitivity of 52% to predict point of care saliva (POC) testing for Methodology: Mixed violence risk and a specificity of 98% cannabis and methamphetamines Research Approach: Action Research / of patients not at risk for violence. The (July-December 2017). All nurses Participatory Inquiry / Practice Development positive likelihood ratio was estimated working at the study site were invited to at 21.34 and negative likelihood ratio participate in a focus group (August to was 0.49. The positive predictive value October 2018). A random sample of ED Violence risk screening in was 24% and negative predictive value consumers were surveyed regarding the the emergency department: 99%. acceptability of routine drug screening Comparing the predictive Conclusion: The predictive model (March-April 2019). validity of a statistical for violence risk screening established Results: The prevalence of meth/ model to nurses’ clinical in this study performed poorly when amphetamine use was 21.2% (97/457; compared to nurses’ clinical judgements judgement alone. Importantly Triage nurses

11 Concurrent session 1: Tuesday 3 September 2019

clinical judgements of violence risk, comprehensive understanding of 1.5 Theme: Methods demonstrated acceptable levels of how urgent and emergency services sensitivity and specificity. are currently working with regard to Session no: 1.5.1 Abstract no: 0314 Biography frequent users. Data was extracted Research Topic: Methodology within four themed areas and a Methodology: Mixed Dr Cathy Daniel has both a clinical thematic synthesis was used to establish and academic role. Cathy is a Mental the current international context Research Approach: Other approaches Health Lecturer and the Coordinator of within these services. A Taxonomy was Post Graduate Mental Health Nursing developed to reveal the unmet needs Reflections on using at The University of Melbourne. Cathy which created dependency on urgent the MRC guidance for has continued to work with ED in a and emergency services. 32 purposeful research capacity for several years and clinical interviews and 16 observational developing and evaluating has developed policy and education sessions were also undertaken for complex interventions as for ED nurses on minimising the this study. This multi-perspective a guiding framework for a use of mechanical restraint. She has study enabled the triangulation of completed a Masters Research Degree mixed methods, multiphase the three data collection methods to research study in minimising mechanical restraint create integrity in the applicability and in acute health in 2010. In 2015 she generalisability of the findings. Presenter: Catherine Lowenhoff, completed a PhD at The University of Doctoral candidate, Oxford Brookes Results: The study revealed that Melbourne that explored how the how University, UK diverse definitions and thresholds were the risk of violence can be accurately Abstract identified at ED triage. Cathy has a being employed by all services and clinical role in Consultation Liaison the language used to describe these Background: It is recommended that Psychiatry at The Royal Melbourne individuals was often negative and one or more theoretical frameworks Hospital, and contributes to quality subjective. Therefore, a single definition should be used to inform the different initiatives to reduce the reliance on and threshold for the identification phases of research. The enhanced coercive interventions in acute health. of frequent users has been selected development phase (Bleijenberg et and advocated for standardisation al, 2018) of the MRC guidance for within all services. A Taxonomy of developing and evaluating complex Frequent Users has been developed and interventions was used as a framework Session no: 1.4.3 Abstract no: 0168 clinically evaluated within this study. to guide a programme of research. This separates the main heterogeneous Aims: Research Topic: Inequalities in Health group into five main sub-groups. Methodology: Mixed The taxonomy can be used in clinical To consider the role of health visitors Research Approach: Qualitative practice to identify the frequent user’s in reducing the proportion of mothers approaches (eg: discourse analysis, unmet needs which may be creating with mental health problems who are ethnography, critical theory, grounded their dependence upon urgent and not receiving the help they need that theory, phenomenology) emergency services. will lead to recovery. Conclusions: This study has enabled To use a systematic approach to The identification and the creation of a Taxonomy which identify the size of the problem; the management of frequent can be used within clinical practice to existing evidence base; the theoretical explanation for how interventions users of urgent and initiate conversations with the aim of supporting the unmet needs of frequent are supposed to work; the needs of emergency health care users. intervention providers and recipients; Presenter: Nicola Worrillow, MSc the identification of practice barriers Specialist Community Public Health Biography and facilitators; and, using all the Nursing, Leeds Beckett University, UK Nicola is a senior lecturer in nursing information from the previous phases, Co-authors: Jane South, UK; Michelle at Leeds Beckett University. She is to ‘prioritise, reduce, select and refine’ Briggs, UK currently finalising her PhD study the intervention components most which is focused on frequent users likely to confer benefit that will achieve Abstract of urgent and emergency health care the best fit with practice and context Aim: The aim of the study was to services. She is a qualified specialist (Bleijenberg et al, 2018 p.90). explore how, internationally, frequent community public health nurse and Methods: The rationale and process users of urgent and emergency health has worked in various urgent and for the methods used to achieve the care services are identified and emergency settings. Nicola has had the aims of the research will be explained managed. To explore this phenomenon, opportunity to present at UK, Europe during the course of the presentation. the definitions, thresholds and and USA conferences on how urgent These include a hermeneutic systematic management approaches used by and emergency services can improve literature review (Boell & Cecez- urgent and emergency services were their support and management of this Kecmanovic, 2014); a critical appraisal examined. The main heterogeneous population. of a NICE guideline; a literature review frequent user population was based on the BeHEMOTH mnemonic also deconstructed to expose why (Booth & Carroll, 2015); an online individuals become dependent upon survey; and a Delphi study. services. Results: The end result is an Method: A systematic mapping intervention framework to guide the exercise was undertaken to capture support that health visitors provide to a wide range of data to gain a mothers with mental health problems.

12 Concurrent session 1: Tuesday 3 September 2019

Discussion: The purpose of this models researchers can use, few Essentials of Nursing Practice and presentation is to provide an overview provide guidance for applying them or Essential Clinical Skills for Nurses, of the steps taken in each of the give overviews of their philosophical both key textbooks for first year nursing stages of intervention development underpinnings. students. Currently Catherine is commensurate with the MRC guidance Aims: To share insights encountered researching nursing students’ views of for complex interventions and to when undertaking concept analysis and health and illness, and whether these discuss the benefits, challenges and present an adapted model based on the alter during a pre-registration nursing serendipitous discoveries of using the work of Rodgers (1989) and Tofthagen programme. guidance that have both frustrated and and Fagerstrøm (2010) created to enhanced the experience of research for overcome these. a novice researcher. Discussion: The purpose of concept Session no: 1.5.3 Abstract no: 0422 Biography analysis is to analyse, define, develop Catherine Lowenhoff has worked and evaluate a concept. Thus, in its Research Topic: Cardiovascular Disease and Stroke, Patient Experience, Methodology in the field of perinatal and infant simplest form, concept analysis is the mental health for over 20 years. First application of a specified method to Methodology: Interviewing as a health visitor, then as a nurse examine a concept of interest in order to Research Approach: Qualitative consultant in perinatal and infant ascertain its attributes. Irrespective of approaches (eg: discourse analysis, mental health and currently as PhD discipline, research studies undertaken ethnography, critical theory, grounded theory, phenomenology) student focussing on the role of health for the purpose of developing visitors in supporting mothers with knowledge should commence with an mental health problems. Submersion in exploration of the existing knowledge Using qualitative methods the perinatal mental health literature and the development of a conceptual to apply clinical trial data in and theoretical understanding of the over the last 4 years has inevitably a real-life clinical setting raised more questions than answers. phenomena to be researched. Such There are three key message that she an approach enables a concept to be Presenter: Amy Ferry BSc (Hons), has incorporated into her research. used more effectively by evaluating The University of Edinburgh, UK 1. No matter how effective an strengths, limitations and variations Co-authors: Fiona Strachan, intervention is in an RCT, it will not that will enhance the contribution UK; Nicholas Mills, UK; Sarah work in the real world of clinical made. Concepts are the building blocks Cunningham-Burley, UK practice if it is not acceptable to the of theory (McKenna and Cutcliffe, Abstract 2005), so any attempt to build or use a people expected to deliver it or the Background: A clinical trial is theory without a clear understanding of people expected to benefit from it. evaluating the potential for high- these building blocks risks the danger 2. Training alone is not enough to sensitivity cardiac troponin assays to of laying faulty theoretical foundations. change practice as there are other permit clinicians to rule out myocardial Concepts, therefore, play a fundamental contextual factors that influence the infarction earlier and discharge role in the development of knowledge. implementation and sustainability patients directly from the Emergency of interventions. Conclusion: Concept analysis Department (High-STEACS/NCT 3. It is necessary to explore beyond is a valuable tool when used with 01852123). A qualitative interview the constraints of conventional an understanding of a model’s study nested within the trial protocol interventions in order to develop philosophical underpinnings and explored how patient experience innovative, effective and acceptable when sufficient measures are taken of chest pain may be shaped by the solutions. to assure analytical depth, rigour and implementation of an early rule-out transparency. The experiences of a pathway. novice nurse researcher described will Methods: Participants were recruited Session no: 1.5.2 Abstract no: 0190 be helpful in informing others who before (n=23) and after (n=26) are commencing a local, national or Research Topic: Methodology implementation of an early rule-out international study. Methodology: Other collection method pathway. Purposive sampling ensured Research Approach: Other approaches Biography representation across age and sex Catherine is an experienced nurse, categories. Face to face, semi-structured interviews provided the basis for an Making sense of concept lecturer at the School of Health Sciences, University of East Anglia and interpretive thematic analysis of data. analysis PhD student at the Norwich Medical Findings: Interview content did not Presenter: Catherine Delves-Yates MSc School. She started her career as a appear to be dictated by assessment BSc RN, The Norwich Medical School, student at the Nightingale School of pathway with common themes University of East Anglia, UK Nursing, London and has worked arising from both sets of interviews. Co-presenters: Andrea Stockl, UK; clinically in adult and paediatric critical A phased illness episode was revealed Jenny Moore, UK care in the UK, and has taught and extending before and after the in- Abstract nursed in America, Africa and Nepal. hospital event. Interviews revealed Catherine is an honorary lecturer at the differing priorities of the clinical Background: Concept analysis is the University of UEA and the Higher pathway (the rule-out of myocardial frequently the first step novice nurse Institute of Applied Medical Sciences, infarction) to the holistic patient view researchers take when beginning Cameroon and an international advisor desired by participants themselves. their work. However, the value of to the Patan Academy of Health Confirmation of the absence of disease concept analysis in generating theory Sciences, Nepal. She is the editor of did not provide all patients with the is contested: although there are many

13 Concurrent session 1: Tuesday 3 September 2019

reassurance they desired. Repetition 1.6 Theme: Surgery Patients consistently reported of the symptom story to multiple significant pain, physical restriction, practitioners before implementation Session no: 1.6.1 Abstract no: 0444 and psychological impact on their of the new pathway was a source of Research Topic: Patient Experience, quality of life. Surprisingly, only the frustration for participants. Providing Methodology, Chronic Illness psychological impact was influenced by pre-test information regarding the Methodology: Interviewing the mode of failure. troponin test, in addition to active Research Approach: Qualitative Conclusions: We found a previously listening and building a trustful approaches (eg: discourse analysis, unreported high personal burden of clinician-patient relationship related ethnography, critical theory, grounded living with a failed TKA and that the to positive expressions of reassurance theory, phenomenology) reason for failure impacts the mental within interviews. Participants assessed burden. This is important because using the early rule-out pathway The unreported patient mental distress is modifiable by holistic appeared to have a lesser orientation to patient care and highlights the need for use the episode of chest pain as a cue burden of living with improved communication and support to action to appraise their future health a failed total knee in this vulnerable group. status. replacement Biography Conclusion: Qualitative research Presenter: Rachel Penman BN, The Rachel Penman is an experienced has provided a mechanism through University of Edinburgh, UK which to explore how the biochemical research nurse currently employed Co-authors: Colin Howie, UK; David by The University of Edinburgh in evidence from which the early rule-out Hamilton, UK pathway was derived may be applied the Department of Orthopaedics and in a clinical environment. Effective Abstract Trauma, and is undertaking a Masters clinician-patient communication was Background: Total knee arthroplasty degree (by research) at The University a key link in translating scientific data (TKA) is generally successful; of Edinburgh Medical School evaluating into a real-life clinical context that however, one in five patients report patient experience in revision total knee responds to patients’ needs. dissatisfaction with their outcome. replacement. Biography Surprisingly little is known about the patient burden and experience of living Amy Ferry began her career working with a failed TKA. in pre-clinical trials before retraining Session no: 1.6.2 Abstract no: 0093 to become a cardiology nurse. After 11 Aims: To evaluate the patient experience of a failed TKA from the Research Topic: Patient Safety (including years working in front-line nursing she human factors, infection, prevention and patients’ perspective. then chose to combine her experience control etc) by moving into clinical research Methods: Semi-structured qualitative Methodology: Mixed interviews were conducted pre- nursing. Amy is a member of the Research Approach: Qualitative University of Edinburghs’ HighSTEACS operatively with 10 patients (seven approaches (eg: discourse analysis, Research team, which has supported females, mean age 70, range 42- ethnography, critical theory, grounded her in blending the roles of Research 77) who were undergoing revision theory, phenomenology) Nurse and Nurse Researcher. Nested TKA. Interviews were transcribed verbatim and analysed thematically within a clinical trial, her current work Exploring positive deviance aims to improve the assessment of using a phenomenological approach. patients presenting to hospital with Codes were generated by a single in the enhanced recovery suspected acute coronary syndrome researcher using NVivo v12 software pathway for total hip and by firstly investigating the role that and independently verified to ensure knee arthroplasty patient gender plays in the assessment validity. Themes were derived from Presenter: Sally Moore RGN BA MSc, of patients with suspected acute these codes and agreed by a panel of Bradford Institute for Health Research, coronary syndrome, and secondly, three reviewers. UK uses qualitative methodology to Results: Three clear themes were Co-author: Lesley Hughes, Jersey explore the impact of early discharge evident. Patients reported significant pathways on patients who have had burdens in terms of pain, physical Abstract myocardial infarction ruled out as a restrictions, and the psychological Background: Internationally, diagnosis. Amy aims to build a career impact of dealing with the illness patient safety is moving away from with improvement in patient care at its burden. A range of reasons for failure of retrospectively trying to ‘find and fix’ core, with the desire to bring expertly TKA were seen in this group. The pain problems (Lawton et al 2014), towards conducted qualitative inquiry to the and physical restriction themes were looking for elements of positive practice mainstream of health care research. consistent across all patients; however, that can be emulated in order to the psychological impact varied with improve patient outcomes (Mannion failure aetiology. Those with a sudden and Braithwaite, 2017). onset problem (for example, septic or Aims: To identify positively deviant traumatic failure) felt much deeper behaviour in a high performing distress than those with gradual onset enhanced recovery pathway (ERP) for problems. total hip and knee arthroplasty. Discussion: There is a significant Methods: We used 28-day emergency personal burden to the patient with re-admissions and patient-reported a failed TKA that has not been well outcomes to identify two ERP providers, reported in the medical literature.

14 Concurrent session 1: Tuesday 3 September 2019

one is performing exceptionally well Safety: developing an intervention interviewed and 130 hours of practice (site A) and one that performed to promote organisational were observed, incorporating 100 above average (site B). We undertook learning using patient reports of preoperative anaesthetic visits and 24 ethnographic observations (O’Reilly, organisational safety and patient nurse-led preoperative assessments. 2012), in depth interviews, focus groups safety incidents. Whilst pain was discussed in 100% of and documentary analysis, conducted • A behaviour change approach cases; analysis revealed four aspects of over eight months with 54 health care to implementing patient safety culture that effected pain discussions professionals. Analysis focused on ‘what guidelines with the Yorkshire including: ‘patient safety’, ‘surgical works’ in enhanced recovery. Health Innovation and Education productivity’, ‘power’ and ‘unconscious Results: Both sites had strong focus Cluster. bias’. on patient preparation and education, Discussion: High levels of initial observations revealed little productivity and the prioritisation difference between the two. Further Session no: 1.6.3 Abstract no: 0198 of patient safety over holistic care observation, focus groups and Research Topic: Patient Education, negatively impacted on the quality and interviews, told a different story; at Inequalities in Health, Pain Management depth of preoperative interactions and Site A, all staff worked as one multi- Methodology: Mixed pain planning and management. These disciplinary team across the ERP, were also influenced by unconscious Research Approach: Qualitative whereas site B worked as disparate approaches (eg: discourse analysis, bias and power, as interactions were teams each running their own parts ethnography, critical theory, grounded influenced by health care professionals’ of the ERP. The ability to problem theory, phenomenology) negative unconscious biases solve was displayed very differently (surgical specialities and gender) and across both sites, site A pre-empted paternalistic practices limited patient problems putting lasting solutions in A critical ethnographic empowerment and levels of nursing place, site B staff constantly solved view of preoperative pain staff autonomy. problems as they occurred. Overall, planning and management Conclusions: Cultural work-based five themes emerged; Leadership and for day surgery patients. practices, which are often hidden and Engagement; Autonomy, Relationships Presenter: Claire Ford RGN BSc unconscious, can negatively impact on and Communication; Patient (Hons) PGD and FHEA, Northumbria the quality and depth of preoperative Empowerment, and Resilience. University, UK pain interactions. Raised awareness of Discussion and conclusions: these is therefore vital if pain is to be Looking for positive performance has Abstract treated holistically and effectively. once again highlighted the importance Background: Pain is a universal Biography of strong, distributed leadership that phenomenon, which in the case recognises and respects the whole team of surgery, is often predictable. Claire graduated from Northumbria and everyone’s part in the delivery Management strategies for University with a first class honours of care. This is the key to success at postoperative pain should, therefore, degree in adult nursing, and a Trust A, however, despite identifying include preoperative patient distinction in midwifery (postgraduate problems at Trust B, teams were still preparation and discussion of potential diploma). Claire received an academic managing to deliver better than average individualised analgesic regimes (Chow achievement award for both her care due to their personal resilience and et al, 2012). However, postoperative nursing and midwifery studies and ability to problem solve. pain management remains problematic, received the ‘Heath medal’, which was awarded for both academic and clinical Biography and there is limited research investigating the culture aligned with excellence in nursing. Claire currently Sally is a Patient Safety Research Nurse preoperative practices for day surgery works as a Lecturer at Northumbria working at the Yorkshire and Humber patients University, which includes contributing Patient Safety Translational Research to the delivery of a range of modules Aims: Culture is often difficult Centre at the Bradford Institute of across preregistration health care to unravel, as 90% is internal and Health Research. She is a registered programmes, both nationally and unconscious (Hall, 1976). This nurse who worked as the Matron internationally. This has incorporated research project, with the use of critical for the Operating Theatres and the involvement in a simulation-training ethnography, examines the extent to Endoscopy Unit at a District General programme for Thailand Nurse which pain is discussed preoperatively, Hospital before moving into patient Educators, simulated clinical skills and undercovers hidden cultural safety research. She has been part of the sessions for medical students from St practices influencing health care research team on the following projects: George’s University and participation professionals’ preoperative interactions. • PACT partners at care transitions. in the delivery of nursing modules Methods: Critical ethnography to undergraduate students in Malta. • A behaviour change approach to allows for an eclectic data collection Claire’s interests are centred on clinical preventing acute kidney injury. and analysis process (Carspecken, skills, perioperative care, gynaecology • Supporting ward teams to use 1996). Thus, quantitative (timings) and women’s health and pedagogical patient feedback to improve the and qualitative (observations and teaching methods, which encourage quality and safety of patient care. interviews) data collection methods learning through a variety of media, • Developing a patient led were utilised, and data was analysed including those methods that employ classification of patient incident and triangulated using reconstructive more technological interventions. reports. and statistical data analysis. • Patient Involvement in Patient Results: Over eight months, 20 members of staff were also

15 Concurrent session 1: Tuesday 3 September 2019

1.7 Theme: Patient • The IRQ was completed by Session no: 1.7.2 Abstract no: 0251 250 patients: 51% male, aged Outcomes Research Topic: Public and Patient 17-89, who rated each item on Involvement, Service Innovation and Session no: 1.7.1 Abstract no: 0461 importance/worry. Items with Improvement, Health and Social Policy a mean score above 5 (6 in the Research Topic: Patient Experience, Methodology: Interviewing emotional domain), which reduced Cancer Research Approach: Qualitative the list to 166 items. After review Methodology: Mixed approaches (eg: discourse analysis, by researchers, clinicians and ethnography, critical theory, grounded Research Approach: Mixed Methods patients, 66 items were retained for theory, phenomenology) Research the Content Validity Questionnaire (CVQ) Exploring identity and A sequential mixed methods • The CVQ was completed by study to develop a sarcoma- 34 patients and 23 health care social support in recovery specific patient-reported professionals. Items with a content through photovoice outcome measure validity ratio of <.31 were removed Presenter: Sarah Rhynas, The • Cognitive interviews were University of Edinburgh, UK Presenter: Rachel Taylor PhD MSc conducted with 10 patients Co-authors: Lisa Scholin, UK; Fiona DipRes RSCN RGN, University College on the final 22 items to test Cuthill, UK; Aisha Holloway, UK; London Hospitals NHS Foundation comprehension. Minor changes Brandon Walker, UK Trust, UK were made to four. Co-authors: Ana Martins, UK; Lorna Abstract Fern, UK; Lindsey Bennister, UK; Conclusion: SAM comprises of 22 Background: Recovery from addiction Craig Gerrand, UK; Maria Onasanya, items reflecting physical, emotional, can be a challenging and fluctuating UK; Lesley Storey, UK; Mary Wells, social, financial wellbeing and sexuality. journey and individual support needs UK; Jeremy Whelan, UK; Rachael This systematic process of using patient vary throughout. Recovery services have Windsor, UK; Julie Woodford, UK experience to develop the content of changed significantly internationally in SAM will ensure it measures what is Abstract recent years, now emphasising solutions important to patients. and service-user experiences alongside Background: Introducing patient- Biography traditional treatment approaches. reported outcome measures (PROMs) into clinical practice is Dr Rachel Taylor is Director of the Aim: This project aimed to explore known to improve patient-clinician Centre for Nurse, Midwife & AHP Led what helps people to achieve and communication, patient experience Research (CNMR) and Senior Research sustain recovery, in relation to social and outcomes. While there are many Fellow on the Cancer Clinical Trials support and individual identity generic cancer PROMs there are none Unit at University College London changes. developed specifically for patients with Hospitals NHS Foundation Trust Methods: A photovoice study with sarcoma so these may not capture (UCLH). Rachel’s clinical background eight people in sustained recovery, issues that are tumour-specific (Storey is an adult/children’s trained nurse but recruited through a peer researcher, et al 2019). This paper will report how she has worked in research since 1995. was undertaken over eight months (Dec the content of the Sarcoma Assessment Rachel is leading NMAHP capability 2017-July 2018). Participants took Measure (SAM) was identified to reflect and capacity across UCLH, with a photographs exploring their lives in the issues patients with sarcoma face focus on developing clinical academic recovery, facilitated by a photographic when living with and beyond diagnosis. careers and increasing exposure to artist. Individual interviews and two research. She also leads a programme of Method and results: The content of focus groups were conducted to discuss research focusing on teenage and young SAM has been developed systematically photographs and key questions. All data adult cancer care, with current grants over a number of stages: were analysed using inductive thematic from the NIHR, Sarcoma UK, Bone analysis. • In-depth interviews were Cancer Research Trust and Teenage Results: Recovery was perceived conducted with 121 patients: 50% Cancer Trust. Rachel is a member male; aged 13-82; with soft tissue to be built on simple principles and of the National Cancer Research ingredients, which vary in quantity sarcoma (62%), bone (28%) and Institute (NCRI) Psycho-oncology and gastrointestinal stromal tumours for each person. This included having Survivorship Clinical Studies Group structure and routines in early recovery, (10%). Content analysis of the (CSG) and the Health Services Research interview transcripts identified being able to receive and give support subgroup of the NCRI Teenage and in peer-support groups and having role 1,405 post-diagnosis experience Young Adult and Germ Cell Tumour statements models who are sustaining recovery. CSG. Gratitude was a recurring theme, • Experience statements were which made participants feel grounded reviewed, repetition was removed in their recovery and brought about and sentences were refined to form developments in self-identity over time. 395 ‘items’ which were included in an Item Reduction Questionnaire Discussion: Photographs reinforced (IRQ) grouped as physical, participants’ stories of what recovery emotional, social and financial meant to them and how new identities wellbeing and sexuality began to flourish; connecting and re- connecting with themselves and others,

16 Concurrent session 1: Tuesday 3 September 2019

finding serenity in nature or city life, unable to adhere to recommendations. Biography and experiencing life in a new state of Interventions for improving self-care Oliver Rudolf Herber is currently mind. Future services in the UK and adherence show variable results, employed as a senior lecturer at the beyond could build on these elements, largely because of a lack of underlying Institute of General Practice (IFAM) supporting individuals to develop new theoretical models. This prevents at the medical faculty of the Heinrich identities. Using photovoice techniques identification of causal mechanisms Heine University Dusseldorf, Germany. to explore identity has raised interesting and active component(s) driving the Dr Herber is a qualified adult nurse methodological challenges. intervention. and a health services researcher with Conclusion: This study shows that Aims: This study aims to develop a a particular interest in enhancing people in recovery experience changes comprehensive manual for designing self-care competence in individuals in personal and social identity. Peer-led theory-based behaviour change with long-term conditions. His community support is a key resource for interventions (BCIs). methodological expertise include sustaining recovery and professionals Methods: Behaviours associated qualitative meta-summary/meta- have important roles in signposting, with non-adherence to HF self-care synthesis techniques, longitudinal supporting and appreciating the were extracted from qualitative and qualitative research, complex importance of these services in quantitative meta-reviews by two intervention design involving behaviour facilitating identity transformation. researchers independently (Stage 1; change, ecological momentary Biography February 2019), and mapped onto the assessment as well as the advancement of research methodologies. Over the Sarah has a background in the nursing COM-B behaviour model to determine years, Oliver has established a reliable care of older people, those living with appropriate areas for change (Stage 2; international network, conducting dementia and alcohol related brain February 2019). Behaviours were then research or engaging in scholarly damage. Recent research has included mapped onto appropriate behaviour activities with scientists from New work around the discharge of older change techniques (BCTs), using advice Zealand, the US, Norway, Sweden, people from acute hospitals to care from patients and clinicians to ensure the Netherlands and the UK. In 2016, homes and the experiences of those in applicability and relevance (Stage Oliver was appointed Fellow of the recovery from alcohol related harm. 3; March 2019). Finally, qualitative European Academy of Nursing Science She has an interest in personal identity, interviews, in combination with the (FEANS). Since 2018 he is a selected exploring how those identities develop Delphi technique, will be conducted member of the International Nursing in health care settings, care homes with patients and health professionals Leadership Educational Programme and in response to life events. Sarah to fine-tune BCI content and increase (NURSE LEAD) for postdoctoral nurses has a developing interest in creative the likelihood of acceptance (Stage 4). to become a nurse leader. approaches in qualitative research. In Results: A comprehensive intervention recent years she has used photovoice manual is produced containing BCIs methods to engage with participants for enhancing self-care adherence of who had never engaged with research patients with HF. BCIs are described and then to bring research findings to a according to the following eight wider public audience. descriptors to ensure reproducibility: 1. content of intervention elements 2. characteristics of self-care tutors Session no: 1.7.3 Abstract no: 0275 3. target population characteristics Research Topic: Public Health (including 4. delivery location health promotion), Cardiovascular Disease 5. delivery mode, and Stroke, Methodology 6. format Methodology: Mixed 7. intensity Research Approach: Other approaches 8. duration. Discussion: Subsequent studies are Developing a theory-based planned, including an exploratory trial intervention manual to pilot test the interventions described to enhance self-care of in the manual, and a full randomised patients with heart failure controlled trial. The BCIs are created to be implemented successfully in Presenter: Oliver Herber RN BScN any given health care system due MCommH AFHEA FEANS, Institut to continual patient and public für Allgemeinmedizin (Institute for involvement. General Medicine), Germany Co-author: Amanda Whittal, Germany Conclusions: The manual produced from this study provides guidance in Abstract practice regarding which interventions Background: Heart failure (HF) are most applicable for enhancing self- represents a growing public health care adherence, in order to improve issue. International guidelines illness outcomes and quality of life for recommend on-going self-care for HF HF patients. management, yet patients are often

17 Concurrent session 2: Tuesday 3 September 2019

2.1 Theme: Education showed excellent reliability 0.979 [CI reality (VR) within higher education 0.940, 0.997] p=0.000. Cronhbach’s institutions has increased (Dubovi, Session no: 2.1.1 Abstract no: 0013 Kappa for each of the case examples Levy and Dagan, 2017). However, while Research Topic: Nursing, Midwifery showed high levels of internal validity. there is an abundant array of research or Support Worker Education, e-Health Kruskill-Wallis testing demonstrated no from the gaming and entertainment (including informatics and telehealth), significant difference in decisions made industries, there is currently limited Leadership and Management based on age, nursing role, length of evidence within the arena of health care Methodology: Other collection method time registered and region of the UK. practice (Smith and Hamilton, 2015). Research Approach: Quantitative (not Conclusion: The A2A 3Cs tool could Aims: To increase the body of included in another category) potentially be used to refine and develop empirical data examining this a more aligned approach to policy innovative teaching strategy, the staff at Professional regulation and professional guidance, promote Northumbria University implemented consistency in perspectives about what a research project with undergraduate in social media (PRISM): is deemed to be unprofessional in the nursing students, exploring and Validation of a tool for nursing profession and in the education evaluating the use of VR videos. making decisions about of nurses and health care professionals Methods: 160 second-year professional behaviours on on the topic of e-professionalism. undergraduate adult nursing students, social media Biography were asked to watch a 360-degree VR video relating to breaking bad news. Presenter: Gemma Ryan DHSci MSc Gemma has a diverse background as a Seventeen volunteer undergraduate PGCertHE PGCert BSc (Hons) DipHE qualified teacher with QTLS/QTS and students participated in one of three RN Adult Teacher; QTLS/QTS; SFHEA, is also a registered adult nurse and focus groups. Focus groups were audio Open University, UK nurse teacher (SFHEA). Her experience recorded, transcribed verbatim, and Co-author: Marc Cornock, UK includes secondary, further and higher education (maths, biology, health and analysed independently by all three Abstract social care) with extensive experience members of the research team, using Background: There is ongoing debate of online and distance learning. Gemma thematic analysis. around the concept of e-professionalism has worked in NHS (community and Results: Four central themes emerged in the health care professions, with secondary care) and the private health from the findings which have been many incidents of unprofessional care sector (surgical ward, endoscopy incorporated into a multimodal behaviour still reported despite policy and residential care) through from pedagogical model, to assist health care and professional guidance having been staff nurse to management. Her recent academics when integrating virtual in place for several years. A realist work is within private elderly care reality within their existing learning ethnographic study over four years and research management/service and teaching strategies. The model identified inconsistent opinion across improvement in a community NHS comprises the following: the nursing profession about what is trust. Research interests include • Elements needed to increase or is not ‘professional’ in social media. realist methodology, professional fidelity. As a result, a decision making tool was accountability, social media and • The importance of session debrief. developed: Awareness to Action (A2A) education. 3Cs. • The realities of using virtual reality Aim: This project aimed to evaluate as a teaching pedagogy. and validate the A2A 3Cs decision • Effective use of the learning making tool for assessing whether Session no: 2.1.2 Abstract no: 0356 environment. behaviours in social media are Research Topic: Nursing, Midwifery or Conclusions: In order for the acceptable, unacceptable, professional Support Worker Education successful implementation of VR, or unprofessional. Methodology: Focus Groups education facilitators need to be aware Method: A pre-test, post-test survey Research Approach: Mixed Methods of how the four core findings can design was employed to assess the Research impact on the use of this novel teaching internal validity and reliability of the strategy. Researchers suggest that tool during January to November 2018. failure to consider all four aspects of Participants were presented with five Does virtual reality have the model may negatively impact on examples of behaviour in social media a place within health care the overall level of immersion. Moving and used the tool to assess what action education? A focus group forward the next step is to implement they would take (if any). A survey was exploration of 360-degree the pedagogical model, make the necessary changes and re-evaluate. also used to evaluate the usability, videos to teach non- usefulness and relevance to nursing Biography practice. Ethical approval was granted technical skills Before joining the academic team at from two higher education institutions. Presenter: Laura Park, BSc (Hons), Northumbria University, Laura worked Participants were recruited through Northumbria University, UK as a staff nurse for the NHS. Laura’s social media, two higher education Co-presenter: Claire Ford, UK teaching interests are predominately institutions and an NHS trust. Co-author: Andrew Melling, UK within teaching clinical skills and Results: 45 nurses completed the Abstract simulation within the pre-registration pre-test, post-test validation component Background: Due to increased adult nursing programme. This passion and 122 evaluated the tool. Using accessibility of more advanced levels for clinical skills teaching has resulted SPSS v24.0, Intraclass correlation of technology, the use of virtual in Laura co-creating and developing the

18 Concurrent session 2: Tuesday 3 September 2019

skills for practice website. The website in England, from September 2018 to 2.2 Theme: Mental Health is a repository that houses a number March 2019. Participating trusts were of videos, posters and podcasts that stratified by quality and safety rating Session no: 2.2.1 Abstract no: 0454 demonstrates to students the correct (SOF score), geographical location Research Topic: Mental health technique of carrying out a specific (urban/rural), trust size (small/large), Methodology: Interviewing clinical skill. This interest has led to and randomised 1:1 to the shadowing further developments within TEL, in intervention arm or routine support Research Approach: Qualitative approaches (eg: discourse analysis, particular around the use of VR as a arm. 64 novice and experienced ward ethnography, critical theory, grounded novel teaching strategy. Laura’s other sisters/charge nurses were recruited theory, phenomenology) research passions include IPW, which is to the study. The primary outcome the focus of her PhD study. was self-reported confidence in novice ward sisters/charges measured pre Service users’ perceptions and post intervention. Secondary of safety in the acute mental outcomes were changes in leadership health inpatient setting Session no: 2.1.3 Abstract no: 0471 practice, professional environment Presenter: Natalie Cutler, Registered and prevalence of burnout measured Research Topic: Leadership and Nurse, BN, MN(MntlHlth), MPubHlth, by Leadership Practice Inventory Management, Workforce and Employment PhD candidate, University of (including health and well being roles, (LPI), Revised Professional Practice Wollongong, Australia research careers) Environment scale (RPPE), and Co-authors: Jenny Sim, Australia; Massachusetts Burnout Inventory Methodology: Statistical Analysis Elizabeth Halcomb, Australia (descriptive and correlational) (MBI). Research Approach: Quantitative (not Results: Data will be presented for Abstract included in another category) 22 NHS sites. Early analysis, to be Background: Safety is a priority in completed in July, demonstrates an acute mental health inpatient settings A pragmatic cluster impact of peer shadowing on ward (NMHWG 2005). What constitutes sister/charge nurse confidence. safety from a service delivery randomised controlled (organisational) perspective is clear trial of a peer shadowing Discussion and conclusion: Preliminary analysis supports the in local, national and international intervention for novice hypothesis that a peer shadowing mental health policy (ACSQHC 2017; ward sisters/charge nurses intervention improves self-reported OECD 2018). Despite being primary in acute NHS hospitals in confidence in novice wards sisters/ stakeholders, the service users’ perspective of what constitutes safety is England charge nurses, with the potential to provide reciprocal benefit for not well understood however. Presenter: Ruth Harris PhD MSc BSc experienced peers. We will also share Aim: This presentation outlines the (Hons) RGN, King’s College London, findings about the challenges to findings from a qualitative study which UK implementation and suggestions for explored the perceptions of safety held Abstract further refinement. by service users who had experienced admission to an acute mental health Background: It has long been inpatient unit. acknowledged that the ward sister/ charge nurse is a pivotal role in Methods: Fifteen (15) individual health care. However, little is known interviews were conducted in 2013 about how to prepare and support and 2014 as part of a PhD study. The new post holders. A recent study transcripts were analysed thematically, found shadowing a more experienced informed by a phenomenographic peer ward sister was associated with approach. Three (3) themes were adjustment to the role (McKenna identified. 2016). Shadowing is an experiential Results: One of the themes identified and pedagogical approach to learning in this study related to the practice and characterised by workplace immersion behaviour of nurses. In this theme, and direct observation which has been participants perceived safety in terms of associated with improved confidence, nurses who demonstrated availability, a reduction in medical errors and responsiveness and caring. Availability improved insight and understanding of meant that nurses were present; workplace challenges. responsiveness meant that nurses Aims: To examine whether a peer reached out to them, and acted in shadowing intervention improves accordance with their needs; and caring self reported confidence, leadership meant that nurses treated them with practice, professional environment and kindness, compassion and empathy. reduces prevalence of burnout in novice Discussion: From an organisational ward sisters/charge nurses compared to perspective, safety is predominantly routine support. understood as the reduction or Methods: A pragmatic, two-arm elimination of harm. This does not align cluster randomised controlled trial was with the service user perspective, which conducted with 22 acute NHS trusts orients safety more toward the inclusion

19 Concurrent session 2: Tuesday 3 September 2019

of supportive factors than the exclusion intention of inclusion), however, this Session no: 2.2.3 Abstract no: 0166 of harmful ones. is not problematized and there is little Research Topic: Mental health literature focused on nurses’ experience Conclusion: This study provides an Methodology: Mixed insight into mental health service users’ of negotiating partnership working with service users. Research Approach: Qualitative experience and perceptions of safety. approaches (eg: discourse analysis, Although this is an Australian study, Aim: This paper presents an ethnography, critical theory, grounded the findings have broad implications autoethnographic exploration of the theory, phenomenology) for nurses working in similar systems, author’s experience of working closely such as many in the OECD. The with a psychiatric service-user in Understanding social impact of this research will be a more academic and research related activities prescribing for people with inclusive understanding of safety that over a period of seven years. co-morbid mental and can be used to inform not only nursing Method: Autoethnographic approach practice, but mental health policy and focusing on the self-other hyphen physical health conditions. the development of person-centred (Fine 1994) as the space between the A realist evaluation measures for service evaluation. two of us in which our subjectivities Presenter: Emily Wood PhD, Biography meet and are negotiated I draw on University of Sheffield, UK Natalie has over 25 years’ experience Ahmed (2014, 2012) and others Co-authors: Sally Ohlsen, UK; Sarah- in mental health nursing, and has to analyse the emotional work that Jane Fenton, UK; Scott Weich, UK; worked across a range of clinical, happened. Attempting to take the side Janice Connell, UK education, leadership, policy, volunteer of the service-user from my subjective Abstract and advocacy roles in the public and position as psychiatric nurse, is problematised. Background: The UK Government private sector. She has completed a has committed to a widespread Master of Nursing (Mental Health) Findings: Negotiating this relationship expansion of social prescribing and Master of Public Health. After a for both of us was emotionally (DDCMS 2018). Social prescribing is a quarter of a century, Natalie remains challenging. As a psychiatric nurse I way of connecting NHS patients with enthralled with her chosen field. She is find myself positioned as representative community resources to help improve a lifelong learner, and hopes to inspire of a system which had caused pain and health and wellbeing (Bickerdike et al nursing students to lead the way in their hurt to this (and many other) service 2017) and reduce isolation own chosen field. Natalie is currently user. I confront shame and anger, Aims: This evaluation explored how completing a PhD study exploring whilst also becoming the object towards social prescribing is being accessed and the meaning of safety in acute mental which anger and hurt are directed. used by adults with comorbidities and health inpatient units. She hopes that Discussion: My analysis identifies what is working or not working and her research will contribute to better that whilst the work that we attempted why. experiences and outcomes for people was motivated by the hope that it would who use mental health services. enable the service user voice to be heard Method: In 2018, a realist in the dominant discourses of mental evaluation was conducted in a social health services, academia and mental prescribing organisation servicing a health nursing, this was in tension with socioeconomically deprived part of a Session no: 2.2.2 Abstract no: 0514 a fear of/being colonised/colonising city in the North of England. Using an iterative process of interviews with key Research Topic: Mental health which became insurmountable. stakeholders (n=35) including staff, Methodology: Other collection method Conclusion: The discursive positions referrers and clients, a stakeholder Research Approach: Other approaches of service user and psychiatric workshop (delegates n=15) and live professional have significant graphic recorder; the mechanisms and implications for successful partnership context behind the changes for this Uncharted water: An working. autoethnographic analysis cohort where explored and refined and Biography developed into a programme theory of negotiating partnership Dr Rosie Stenhouse is a lecturer in which was compared to Antonovsky’s working with a mental mental health at the University of Salutogenesis model (Antonovsky health service user Edinburgh. She is interested in issues 1979). Presenter: Rosie Stenhouse, MRes, of power within the mental health Results: Social Prescribing delivered PhD, RMN, FHEA, The University of system and uses discourse analysis benefits via a range of mechanisms. Edinburgh, UK and other critical methods to explore The programme theories were this. Rosie also uses poetry and other mapped onto Salutogenesis theory Abstract creative methods in her research and of health. Clients, staff and referrers Background: Working in partnership is associate director of the Centre for reported outcomes as increased health with people who use the health system Creative Relational Inquiry at the knowledge and more appropriate is an expectation of UK Government University of Edinburgh. service use (comprehension); increased and local health policy. Within the ability to self-manage and reduced field of mental health those who use/ stress (manageability); increased have used the psychiatric system have social connectedness, confidence and often experienced it as marginalising. self-worth (motivation). Clients were Development of partnership working empowered to mobilise and reflect with services-users provides the on the resources they already have potential for their voices to be heard available to them (enabling their ‘sense within dominant discourses (the of coherence’).

20 Concurrent session 2: Tuesday 3 September 2019

Discussion: By focusing on person- 2.3 Theme: Patient Safety Discussion: Passive informational centred and client-determined resources, and unreliable web searches goals using an asset (strengths) Session no: 2.3.1 Abstract no: 0365 accounts for most current decision based approach to increasing a Research Topic: Primary and Community support usage. Conflicting views were client’s, comprehension, motivation, Care, e-Health (including informatics expressed about the potential for manageability, social prescribing and telehealth), Service Innovation and DDDSS to both increase anxiety and enables them to cope with stressors and Improvement bolster confidence in clinicians and move in a health promoting direction. Methodology: Focus Groups the public. It is important that current It is important to understand how Research Approach: Qualitative infrastructure is able to cope with any and why social interventions have the approaches (eg: discourse analysis, new technologies, and that they can be potential to affect change. ethnography, critical theory, grounded integrated effectively with both existing Conclusions: By applying theory to theory, phenomenology) technology and current practices. social prescribing we have attempted Conclusions: DDDSS may have a role to develop a theoretical explanation for Clinical decision support in supporting the public and clinicians its popularity and the positive findings systems for differential in primary and out of hours care; from case studies. however, it is important that the needs diagnosis in primary Biography of the end user are considered during and out of hours care: A design or implementation. This applies Emily Wood is a mental health nurse qualitative descriptive focus not only to Scotland, but to primary and health services researcher. She is group study care services in general. More research currently working on several projects is needed into how these systems can be Presenter: Chris McParland MSc, the including experiences of advanced integrated into clinical practice. nurse practitioners, interventions University of Glasgow, UK for people with co-morbid mental Co-authors: Mark Cooper, UK; Bridget Biography and physical health conditions and Johnston, UK Chris McParland is a research assistant retention issues for mental health Abstract at the School of Medicine, Dentistry and staff. Other interests include animal- Nursing, University of Glasgow. He is Background: As Scotland’s assisted therapies and environmental also a registered nurse, with a clinical older population grows, general interventions for mental well-being, background in emergency department practitioner numbers are declining in spiritual care for mental health services nursing. the community, leading to increased users and the physical health care of pressure on primary and out of hours people with mental health conditions. care services. Technology may have She works primarily with realist a role, particularly in supporting the evaluations and pragmatic mixed Session no: 2.3.2 Abstract no: 0456 advanced nurse practitioners working methods designs. in these services during this challenging Research Topic: Patient Safety (including time. human factors, infection, prevention and control etc) Aims: The aim of this study was to Methodology: Other collection method examine the needs of key stakeholders Research Approach: Quantitative (not in relation to differential diagnosis included in another category) decision support systems (DDDSS): systems which generate a differential diagnosis based on clinical information Nursing-sensitive patient entered by the user. outcomes: An Australian Methods: Convenience and snowball case study on developing a sampling were employed to recruit data registry for measuring 29 participants to one of six focus groups held in Scotland between April the quality and safety of and June 2018. Groups were audio nursing practice recorded, transcribed verbatim, and Presenter: Jenny Sim, RN, Bachelor analysed thematically. The sample Applied Science (Nursing), Grad Dip comprised seven members of the Clinical Nursing, Grad Dip Business public, seven general practitioners, 13 Administration, PhD, University of advanced nurse practitioners, and two Wollongong, Australia allied health professional advanced Co-authors: Joanne Joyce-McCoach, practitioners. Australia; Robert Gordon, Australia; Results: Four themes emerged: Conrad Kobel, Australia 1. current practice Abstract 2. attitudes to differential diagnosis Background: Nursing-sensitive decision support systems patient indicators provide important 3. implementation considerations data on the impact nursing practice has on patients. 4. desirable characteristics of differential diagnosis decision Aim: To describe the development, support systems. testing and implementation of a data registry of nursing-sensitive indicators

21 Concurrent session 2: Tuesday 3 September 2019

for measuring the quality and safety conceptual framework and indicator set risk stratification, escalation, referrals of nursing practice in three hospitals for measuring the quality and safety of and care planning were extracted. Two in Australia using a multi-site, cross- nursing practice. Jenny has developed a reviewers undertook data extraction sectional design. program of research on measuring both working independently. Disagreements Methods: Retrospective data were the quality and the safety of nursing were resolved by discussion. Data were obtained in 2016 from administrative care in Australia and internationally analysed using descriptive statistics. data sets (nurse staffing, patient flow and is particularly interested in Results: One hundred and forty four and adverse events) in three hospitals in research on pressure injuries. Jenny is (n=144) NHS providers were contacted NSW, Australia. Periodic observational the Director of the Australian Nursing and 103 responded to the FOI request. surveys were conducted on pressure Outcomes Collaborative also known as Four reported policies as “under injury prevalence, documentation AUSNOC and is empowering nurses review” and 99 trusts supplied relevant of processes of care (pressure injury to research the structure, process and policies (response rate 72%). Document prevention, falls prevention, patient outcome components of nursing care so governance appeared to be inconsistent identification) and hand hygiene that we can measure the impact nursing across the NHS trusts with variations practices. Patients provided data on care has on patient outcomes. in form, content and review processes. the caring attitudes/actions of nurses Falls assessments varied in terms of prior to discharge using the Caring risk factors assessed, scoring, timing Assessment Tool. The Nursing Work of initial and subsequent assessments, Session no: 2.3.3 Abstract no: 0400 Index-Revised: Australian (NWI-R:A) source of underpinning evidence, was used to assess nurses’ perceptions Research Topic: Patient Safety (including escalation and referral pathways. of their practice environment. Patient human factors, infection, prevention and Discussion and conclusions: experience/satisfaction was obtained control etc), Quality Standards, Health and Social Policy Preventing avoidable harm is from retrospective Press Ganey® central to the duty of care of health Methodology: Documentary Research surveys. care organisations3. Nationally, Results: The development of Research Approach: Other approaches and internationally, falls rates are the Australian Nursing Outcomes considered nurse sensitive indicators Collaborative (AUSNOC) occurred Organisational approaches and a marker of organisational in three phases. Phase one involved to prevent falls in in-patient performance. The extent of variability development of data definitions and across documents, if taken as a a data codebook; phase two involved acute hospital settings: S barometer of sound governance, has the development and testing of data documentary analysis of implications in terms of consistency, collection methods; and phase three English National Health meeting expectations of the public and involved development of data reports Service (NHS) policies and assuring compliance with regulatory and data dissemination strategies. This standards and best practice. guidelines presentation will provide an overview Biography of these three phases and includes Presenter: Annie Topping PhD RN descriptive data from the indicator set. FHEA, University Hospitals Annie Topping is Professor of Nursing Birmingham NHS Foundation Trust, UK at the University of Birmingham and Discussion: Collection of data was Co-presenter: Jessica Timmins, UK University Hospital Birmingham focused on the following constructs: NHS Foundation Trust. She is an Care and Caring; Communication; Abstract experienced clinical nurse, educator and Coordination and Collaboration; Background: The cost of falls to the health service researcher with particular and Safety. Data was collected and UK NHS are estimated to be in excess expertise in qualitative and mixed disseminated at unit level. Wards £2.3 billion1, irrespective of the human methods and improvement research. that actively participated in data harm resulting from falling. For in- collection methods had higher levels patient falls survivors the consequences of engagement with data reports and can be loss of independence, injury, implemented quality improvement pain, distress, extended hospital stay, projects to improve nursing care disability and even death. Although falls processes. are not limited to older people, 77% of Conclusion: Nursing-sensitive reported inpatient falls occur in those patient outcomes provide important over 65 years and these falls are more data at the unit level that nurses can likely to result in harm2. use to improve patient outcomes. Aims: To investigate prevention Data from AUSNOC can be feasibly and management of falls policies, collected and used to benchmark and guidelines, in use in acute NHS nursing performance, evaluate patient Trusts to examine variations in outcomes, and identify areas for governance, assessment of risk and risk practice improvement. minimisation strategies. Biography Methods: All English acute NHS Jenny is an experienced nurse academic Trusts were approached via freedom and researcher who also has experience of information (FOI) e-addresses to as a senior manager in the Australian supply current policies, procedures health care system. Jenny completed and guidelines. Information relating to her PhD in 2015 and developed a document governance, falls assessment,

22 Concurrent session 2: Tuesday 3 September 2019

2.4 Theme: Workforce offer; valuable rotation opportunities; Abstract opportunity to create an adaptable Research utilization in nursing practice Session no: 2.4.1 Abstract no: 0436 workforce; accelerated skills has shown to improve quality of care Research Topic: Leadership and development; enhanced supportive and health care costs, however, the Management mechanisms and opportunity to put extent to which nurses use research Methodology: Mixed the patient first. The impact of CP in practice remains questionable on skills development was positive, Research Approach: Mixed Methods (Squires et al 2011). It is known that Research average scores against each skills leadership is crucial in nurses’ research domain substantially increased. CP had utilization (Cummings et al 2018) a positive impact on job satisfaction, whilst empowerment is argued to be an The evaluation of Compass: in particular statements concerning important factor that affects leadership An enhanced support support, learning/development, and (MacPhee et al 2011). Yet the effects programme for newly career development. Evaluation will be of empowerment on nurses’ use of completed May 2019. qualified nurses research in practice is largely unknown. Biography This grounded theory study aimed to Presenter: Jo Lidster RGN Doctorate gain a theoretical understanding of MSc PGCert Ed BSc, Sheffield Hallam Dr Jo Lidster is the Deputy Head of the role of empowerment in nurses’ University, UK Nursing and Midwifery (Interim), at research utilization, including the Co-presenter: Mary Dougan, UK Sheffield Hallam University. She is responsible for the Department’s post impact of related contextual factors. Abstract graduate and international portfolio. Beginning with purposive sampling The Compass Programme (CP) is a new This includes working closely with and later progressing to theoretical initiative implemented by Rotherham stakeholders and practice partners to sampling, 20 semi-structured NHS Foundation Trust (TRFT) as a develop a quality learning experience. interviews of nurses in various roles recruitment and retention initiative Jo leads on learning, teaching and within one health board in Scotland was for newly qualified nurses (NQN). It is assessment developments for the done from September 2017 to August a 12-month rotation programme with Department as well as supporting 2018. additional support provided, delivered placement learning initiatives. She has Findings: The findings of this in addition to preceptorship. The goal had a number of key roles including study illuminate the links between is: To increase recruitment numbers leading research and innovation empowerment and nurses’ professional by making TRFT more attractive, and research informed teaching identity to achieve sustained research improve retention by providing developments as well as course leader utilization. extra opportunities, and have to roles. Jo is an adult nurse and prior Results: Preliminary results show a knowledgeable, capable and contented to working in education worked in theoretical model that illustrates five staff. The purpose of this evaluation is and managed acute and critical care main categories that empower nurses to examine if the initial aims, objectives settings. She teaches on a range of structurally as well as psychologically and outcomes of the CP were being met. undergraduate and postgraduate in affecting their understanding Methods: Using a mixed methods courses in the areas of research of their own professional identity: study design this evaluation examines: methods and evidence based practice, integrating research into the nursing • experience of nurses undertaking health care education and supporting role; keeping researchers in practice; CP learners in practice. Jo’s research building relationships; shifting culture; interests include nurses’ professional • impact of CP on skills development and impactful opinion leaders. Other identity and their transition into new issues explored within this study using • impact of CP on job satisfaction. roles. positional maps are participants’ Data was also collected from NQNs various stances and perceptions of undertaking preceptorship in order to the medical-nursing power struggle, compare. The evaluation was designed Session no: 2.4.2 Abstract no: 0295 encapsulated as autonomy vs collaboratively between Sheffield Research Topic: Leadership and authoritative working cultures and Hallam University researchers and Management the impact of the nurse manager’s senior nurses. Participants completed Methodology: Interviewing perception of research on research the CP questionnaire, completed utilization. This study provides valuable Research Approach: Qualitative at the start, middle and end of the approaches (eg: discourse analysis, guidance for nursing leaders at all levels programme. Self-assessment spider ethnography, critical theory, grounded of health care delivery in understanding diagrams reflecting the CP outcomes theory, phenomenology) the role of professional identity in and objectives, used at the start and end research utilization and the use of of the preceptorship programme. The empowerment in affecting change. The role of empowerment Job Satisfaction Survey was adapted Biography from the NHS Staff Survey (permissions in reconstructing nurses’ granted) used at start and end of professional identity to Azwa is a full-time PhD researcher in preceptorship, and end of CP. Nursing Studies at the University of achieve research utilization: Edinburgh, currently in her third year. Focus group interviews following A grounded theory study Having had clinical experience in a completion of CP. Presenter: Azwa Shamsuddin MSc variety of clinical areas in Malaysia, she Findings: Early analysis of findings Clinical Nursing, University of is well-placed in her research interests indicate CP had a positive impact on Edinburgh, UK around nursing workforce issues NQN’s as well as for the organisation. Co-authors: Elaine Haycock-Stuart, and leadership. Her primary focus is It offers an enhanced recruitment UK; Sheila Rodgers, UK on qualitative research, particularly

23 Concurrent session 2: Tuesday 3 September 2019

grounded theory, alongside a basic question. The methods were inspired 2.5 Theme: Teenagers and understanding of statistics, she hopes by The Joanna Briggs Institute and Young Adults with Cancer to progress to mixed methods studies techniques developed by Kvale and in her research career. She is an active Brinkmann. Inspired by Sandelowski Session no: 2.5.1 Abstract no: 0483 proponent of research-based nursing and Barroso, the results were illustrated Research Topic: Patient Experience, practice, having run a workshop on by the effect size. Methodology, Cancer systematic reviews for clinical nurses in Results: Twenty-three studies Methodology: Other collection method Malaysia which she hopes to continue. published between January 2005 and Research Approach: Survey Azwa is currently working towards February 2019 were included. The her UK nursing registration and looks findings revealed two main themes, forward to future work both clinically and from these, the following meta- Research priority setting and academically in the UK with synthesis was developed: Health care exercise for teenage collaborations in Malaysia. middle managers develop capacity and young adult cancer: and capability individually in an empowering context. A central contrast reducing the mismatch and Session no: 2.4.3 Abstract no: 0357 was shown concerning how health care influencing the agenda from middle managers experience a need Research Topic: Leadership and priority to funding Management to develop self-confidence based on Presenter: Faith Gibson, Great confidence from an empowering context Methodology: Documentary Research Ormond Street Hospital for Children and their experiences in a typical work NHS Foundation Trust and University Research Approach: Systematic Review situation with low self-confidence and and other Secondary Research of Surrey, UK little support from upper management. Co-authors: Susie Aldiss, UK; Lorna Conclusions: This review provides Fern, UK; Robert Phillips, UK Confidence and evidence of the need for a different Abstract self-confidence as approach in health care based on criticisms of present management and a Background: The research agenda complementary building is frequently set by health care blocks for health care suggestion to move from command and control leadership styles to leadership professionals and researchers. Yet middle managers’ development processes based on increasing evidence illustrates research development of capacity building self-confidence among health questions and outcomes prioritised and capability: A systematic care middle managers through various by professionals may not be aligned to those experiencing the disease: a review and meta-synthesis means, such as confidence, respect, empowerment, networking, support mismatch exists (Chalmers et al 2013). Presenter: Trude Anita Hartviksen OT and feedback. Aims: To conduct a UK-wide survey MRSc PhD student, Faculty of Nursing Biography of young people who have experienced and Health Sciences, Nord University, cancer, carers and professionals, Norway Trude Anita Hartviksen is a PhD to identify and prioritise research Co-authors: Jessica Marianne Aspfors, candidate based in Nord University, questions to inform decisions of Norway; Lisbeth Uhrenfeldt, Norway Bodø, Norway. Her research focuses research funders and support the case on health care middle managers` Abstract for research with this unique cancer experiences of developing capacity population. Background: Health care middle and capability in a complex context. managers are the leadership level Hartviksen is an occupational therapist, Method: We followed the James Lind closest to clinical context (1), and with twenty years of experience in Alliance method (JLA, 2018). A steering thus, have the central responsibility of health care middle management and group was established. Research implementing new knowledge, policies quality and improvement work both in questions were gathered from young and legislation to ensure safe and hospitals and municipalities. She works people, carers and professionals via up-to-date health services (2). Health as a lecturer in the Faculty of Nursing an online survey. Submitted questions care management has developed to be and Health Sciences at Nord University. were checked to ensure they were primarily top-down controlled, whereas unanswered. Interim prioritisation health care middle managers have was undertaken through a second experienced a loss of involvement and survey to identify the highest priority autonomy (1, 3). questions. Top priorities were agreed at a consensus workshop. Aims: To identify the available evidence and critically discuss how Results: Eight-hundred and fifty-five health care middle managers develop potential questions were gathered from their leadership capacity and capability 292 respondents; refined into 208 in a health care system characterized by unique questions. Seven were already high complexity. answered and 16 were ongoing studies, therefore removed. One-hundred and Methods: This systematic review was seventy-four respondents completed the performed from a critical hermeneutic interim survey prioritising 30 research perspective and was based on an a questions: prioritisation of these priori published protocol. The three- questions was debated at a workshop step literature search performed attended by 25 young people, carers, using six databases was led by a PICo and professionals. The Top 10 questions

24 Concurrent session 2: Tuesday 3 September 2019

reflect the breadth of young people’s Session no: 2.5.2 Abstract no: 0329 AYA cancer nurses. Guidance is being experiences; recognising cancer is formulated for staff, assisting partners Research Topic: Cancer not always curable, young people are enabling them to be better informed Methodology: Interviewing supported by a wide network of family when caring for AYAs with cancer. Research Approach: Qualitative and friends and future research should Conclusion: This research was focus not only on drug trials but also approaches (eg: discourse analysis, ethnography, critical theory, grounded completed in an area of practice where the delivery of holistic care. theory, phenomenology) little is known about the role of partners Discussion and conclusion: in AYA cancer care. The intention is The Top 10 research priorities have now to disseminate information for been identified using a rigorous, An examination of the role partners widely through publication person-centred approach involving of partners in helping to and presentation. stakeholders typically not involved meet the support needs Biography in setting the research agenda: thus, of adolescents and young reducing the mismatch and describing Jane Davies’ background is in children shared priorities. We discuss how adults with cancer and young people’s (CYP) nursing. describing priorities is only the first Presenter: Jane Davies PhD LLM BSc Following 15 years in practice, she step; how far these priorities influence (Hons) Dip App SS (open) RGN RSCN, worked at the University of Chester research undertaken and funding Senior Lecturer and Postdoctoral before going to Cardiff University available is yet to emerge (Gibson, Research Fellow, Cardiff University, UK in 2001. Jane became a Florence Nightingale Scholar in 2002. She 2018). Abstract worked as Professional Head for CYP Biography Background: Experiencing cancer nursing between 2007 and 2012 and Faith Gibson is Professor of Child as an adolescent or young adult (AYA) completed an LLM in medical law in Health and Cancer Care at Great is not common. In the UK each year 2007. She was promoted to senior Ormond Street Hospital for Children between 2013 and 2015, there was lecturer in 2011 and completed a PhD NHS Foundation Trust and University an average of 2,630 new cases of in 2015. The PhD examined decision of Surrey. Faith Gibson has over 25 cancer in AYAs aged between 15 and making in adolescents and young adults years’ experience in children’s cancer 24 years (Cancer Research UK 2018). (AYAs) with cancer. In the final year of nursing: that includes periods in clinical The diagnosis of cancer can interrupt my PhD Jane was awarded a visiting practice, education and research. She early adult development (Davies, Kelly researcher residency at the Brocher took up her current post, which is a and Hannigan 2018). The initiation, Foundation, Geneva collaborating joint appointment, in April 2016. Her maintenance, growth and enhancement with international colleagues. In 2017, main fields of research and supervision of romantic relationships are an she worked with colleagues in Sydney include: example of this ‘interruption’. after obtaining a European Oncology • Improving process and outcomes of Aim: The aim of this study was to Nursing Research Travel Award. In care for children/young people with examine and understand the role of 2017, she was awarded an RCBC Wales cancer and their families. partners in meeting the support needs Postdoctoral Fellowship, exploring the of AYAs with cancer. role of partners in helping to meet the • Improving assessment and needs of AYAs with cancer. management of symptoms. Methods: A purposive sample of 10 partners aged 16-30 years both • Improving skills of the nursing male and female were invited to take workforce to deliver cancer care. part in the study. They were recruited Session no: 2.5.3 Abstract no: 0267 • Understanding and improving from two specialist cancer centres survivorship care. where their partners were receiving Research Topic: Nursing, Midwifery or • Improving the experiences of treatment. Semi-structured interviews Support Worker Education children and young people in were undertaken with partners on Methodology: Questionnaire hospital. two occasions. Each participant was Research Approach: Survey Faith has presented at national and also asked to keep an unstructured electronic/handwritten diary for two international conferences, and has Evaluation of a simulated edited four textbooks and published months during the study. Thematic over 150 research publications. She analysis was undertaken utilising Braun online clinical ethics continues to play an important and and Clarke’s six steps to iteratively committee for teaching influential role in developing practice, examine the data, develop codes and ethics to professionals through leadership and research, in the identify themes (Braun and Clarke 2006). working with adolescents care of children and young people being and young adults with treated for cancer. Results: Themes identified included: supporting those who were unwell prior cancer to and at diagnosis; identifying as the Presenter: Maria Cable RN BSc (Hons) primary carer; navigating relationships MA, Coventry University, UK with parents; the nature of physical Co-presenters: Emily Gartshore, UK and emotional care; continuing with Co-author: Debbie Critoph, UK; Laura employment and education; impact on Strumidlo, UK the relationship; and getting through. Abstract Discussion: Discussions have taken Background: Health care place with an advisory group and senior professionals are constantly presented

25 Concurrent session 2: Tuesday 3 September 2019

with ethical challenges and dilemmas, Nurse Specialist in Haematology/ 2.6 Theme: Methods never more so than within the field Oncology, a Nurse Manager establishing of Adolescent and Young Adult a chemotherapy service in a district Session no: 2.6.1 Abstract no: 0342 Cancer Care where ethical decision general hospital and laterally as an Research Topic: Research Process Issues making is often highly complex and academic at Coventry University. Methodology: Mixed multifaceted. To consolidate knowledge She has worked closely with Teenage of biomedical ethical principles an Cancer Trust developing accredited and Research Approach: Mixed Methods Research online postgraduate course has created non-accredited education initiatives a simulated Clinical Ethics Committee for multi-professional health care (CEC) to discuss the case of a 15-year- workers. She is research active with a Enhancing the impact old boy with complex learning special interest in the role of the Youth of qualitative research difficulties who refuses curative cancer Support Co-ordinator in AYA Cancer findings: Development of treatment. The purpose of this is to care, as well as workforce development, challenge decision making based on communication skills and leadership. evidence-based reporting moral intuition and consider various Twitter Handle @Mariacable2 guidance for meta- biomedical, ethical and lay perspectives. ethnography Aims: To implement and evaluate the Presenter: Nicola Ring PhD MSc BSc use of a simulated online CEC as an SocSci Nursing, Edinburgh Napier educational tool in an international University, UK cohort of postgraduate nurses and Co-authors: Emma France, UK; allied health professionals working Maggie Cunningham, UK; Ruth with adolescents and young adults with Jepson, UK; Margaret Maxwell, UK; cancer. Isabelle Uny, UK; Rachel Roberts, UK; Methods: A purposive sample of 22 Edward Duncan, UK; Ruth Turley, UK; students undertaking the Postgraduate Jane Noyes, UK Certificate in TYA Cancer Care was Abstract used. Since June 2017 we have run Background: Qualitative research two simulated online CEC’s, facilitated findings are often over-looked as a by a chair of a real CEC. Following source of evidence in health decision- this experience, 12 students opted making. Bringing findings of several to provide evaluation data on the studies together (synthesis) can usefulness of this tool and impact on enhance insights and provide new their knowledge and understanding of interpretations. Noblit and Hare’s ethics through an online survey. (1988) meta-ethnography is a Results: Anecdotal and formal systematic, interpretive seven-phase evaluative online feedback reports approach. It is the most widely- this exercise as a positive learning used methodology for synthesising experience which prompted students qualitative health research. Published to think differently about approaching meta-ethnographies are often poorly ethical challenges in practice. Many reported reducing confidence in their students had not heard of such findings and potential utility of such committees and have sought where they research to impact on practice and might access same locally. policy. Discussion/Conclusions: This Aim: To increase the impact of meta- online experience strengthens the need ethnography by improving the quality to initiate and foster ethical reflection and transparency of findings through and include lay perspectives as a development of the first tailored meta- contextual and experiential learning ethnography reporting guidance. process. It was an authentic form of Methods: The NIHR-funded eMERGe simulation that facilitated collaborative project (June 2015-May 2017) learning as well as nurturing a TYA involved a rigorous, mixed-methods cancer ‘Community of Practice’. There design comprising two systematic is benefit of online simulation for reviews to identify good practices improving biomedical ethical education in meta-ethnography conduct and across disciplines and an international reporting, interviews with 14 users audience of evidence syntheses to identify Biography their reporting priorities, consensus Maria Cable is an Associate Professor studies to agree guidance content, and in Adult Nursing and Adolescent/ iterative development of the guidance. Young Adult Cancer Care, Coventry International experts, lay advisors and University and Professional Doctorate end users of meta-ethnography were Candidate at Cardiff University. Her involved throughout. professional background is as a cancer Results: Nineteen reporting criteria nurse in different roles such as Clinical relating to the seven phases of meta-

26 Concurrent session 2: Tuesday 3 September 2019

ethnography were systematically Session no: 2.6.2 Abstract no: 0411 one individual method. ‘Side by side’ developed along with detailed displays (Kuckartz 2017) presenting Research Topic: Methodology explanatory guidance for users. This the interaction between coherent and Methodology: Mixed evidence-based guidance identifies divergent data and cross paradigm the level of clarity and completeness Research Approach: Mixed Methods synthesis will be used to illustrate the required of meta-ethnography reports Research underpinning principles and stages of such as details of how qualitative a planned integration strategy. With studies were identified, selected Integration in mixed the intention of stimulating debate, this and synthesised; what alternative methods research (MMR): paper seeks to demonstrate the benefits interpretations of the data were of integrative synthesis and theorisation considered; and methods of meta- Principles and practice in MMR to provide impactful ethnographer reflexivity. in a study investigating explanations for problems encountered Discussion and Conclusion: assessment decisions of in nursing practice. Qualitative research has a key role in undergraduate nursing Biography evidence-based practice and policy- student competence Dr Sarah Burden is a Reader in the making by helping to understand the Presenter: Sarah Burden PhD RN School of Health and Community views and experiences of patients and SFHEA, Leeds Beckett University, UK Studies at Leeds Beckett University professionals. Well conducted and Co-authors: Annie Topping, UK (LBU), UK. A Registered Nurse, reported meta-ethnographies can Abstract experienced nursing academic and a enhance the impact of synthesised Senior Fellow of the HEA, she is widely qualitative research. Use of the eMERGe The increasing proliferation of Mixed experienced in curriculum development reporting guidance will help improve Methods Research (MMR) in nursing and delivery, with her teaching, the quality of meta-ethnography reflects a pragmatic but nevertheless research supervision and research reporting thereby increasing the intentional ‘needs-based’ approach to activity concerned with practice impact on health decision-making. explore complex social phenomena. based education and assessment, and The reporting guidance will benefit MMR is capable of supporting a deeper evaluation of the use of educational researchers, guideline developers, understanding of the phenomenon of strategies such as Simulation in End of journal editors, peer reviewers and interest. Integration by connecting, Life Care. She is an active member and patients. building, merging and embedding researcher in the Centre for Dementia Biography data draws on the strengths of both Studies at LBU, involved in exploring quantitative and qualitative paradigms Nicola Ring is Associate Professor training and education in Dementia and often a more comprehensive of Child Health Nursing in the care, and is currently Deputy Chair of understanding of health problems School of Health and Social Care at the RCN Education Forum Steering ensues (Fetters et al 2013, NIH Edinburgh Napier University. She Committee, where she has contributed 2018). Selecting a MMR approach has a background in nursing (adult to publications on placement learning is not necessarily a natural or easy and child), health visiting and clinical and mentoring practices. methodological choice; the challenges effectiveness/clinical governance. associated with integrating qualitative Nicola was a co-applicant on the and quantitative data not least when eMERGE project which developed results may conflict or confound Session no: 2.6.3 Abstract no: 0152 meta-ethnography reporting guidance. can be demanding. Epistemological She specialises in qualitative research Research Topic: Inequalities in Health concerns regarding the compatibility but has experience in mixed methods of paradigms, alongside discussion of Methodology: Other collection method approaches. Her clinical research integration strategies to develop meta- Research Approach: Qualitative focus is the management of long-term inferences (integrative findings from approaches (eg: discourse analysis, conditions especially asthma. MMR), and whether data integration ethnography, critical theory, grounded theory, phenomenology) is the only possible outcome of MMR, shape the many debates. Appraisal of studies reveal discrepancies between Using creative principles for integration and real world methodologies with practice with commentators identifying hard to reach groups: limited, if any, integration, tendency for under-theorization and presentation Health inequalities, of multiple methods rather than MMR intersectionality and the (Fetters et al 2013, Kuckartz 2017, NIH role of decriminalisation 2018). in sex work (The Leeds This paper will demonstrate Managed Approach as a integration is central to the rigorous execution of the principles and case study) practice of MMR. Data drawn from Presenter: Fiona Meth MSc a sequential embedded MM study PGDip(Nur) PGCAP, Leeds Beckett investigating assessment decisions of University, UK undergraduate student competence Abstract in practice will be used to illuminate Aims: The ‘Managed Approach’ is a the processes employed to achieve pilot partnership safety initiative and integration extending beyond any

27 Concurrent session 2: Tuesday 3 September 2019

tolerance zone in a strict geographically sex workers in Leeds. She developed an 2.7 Theme: Patient limited area of Leeds. Scire (2018) interest in creative methodologies after Experience outlined key health issues that affect working on a research project in 2016 street sex workers in Leeds (TB, mental that looked at Post Traumatic Growth Session no: 2.7.1 Abstract no: 0281 health, CHD and respiratory disorders). in Asylum Seekers and Refugees, using Research Topic: Public and Patient A local health needs assessment in 2016 artefacts. Involvement found that 27% of service users (with Methodology: Documentary Research an average age of 28) had COPD, 18% had a heart condition, 50% had chest Research Approach: Qualitative infections, and 20% of respondents approaches (eg: discourse analysis, ethnography, critical theory, grounded reported 4 or more long term health theory, phenomenology) conditions. (Scire, np, 2018). This is a similar picture nationally and has far reaching public health implications “Same same or different?” (Department of Health, 2014). Most A review of reviews of research on sex workers to date focuses person-centred and patient- on STIs and sexual health, and not on wider public health issues. centred care Presenter: Inger K Holmström, PhD, Methodological discussion: In RN, Mälardalen University, Sweden order to better understand and give Co-authors: Jakob Håkansson, voice to the intersectionality of their Sweden; Tomas Kumlin, Sweden; lives, and the continued impact of the Elenor Kaminsky, Sweden; Karin stigma and bias that the women face, Skoglund, Sweden; Jessica Höglander, a grounded theory approach (Feminist Sweden; Annelie Sundler, Sweden; Constructivist theory) is being utilised, Emelie Condén, Sweden using narratives from semi structured interviews, and an adjunctive creative Abstract methodology (timelines). The Background: During the last decades, conference presentation will focus different types of centeredness have on pilot stage interviews completed been launched in health care such as this year. Timelines were chosen as family-, patient- and person-centred a non-threatening way of eliciting care (Coyne et al 2018). They seem to narratives around which discussions share a common goal to put the person of respondents’ journeys through in need of care in the foreground, rather their lives in terms of their health than the health care professionals and wellbeing could take place. At and biomedical aspects. Patient- and present nationally and internationally, person-centred care seems at a first decriminalisation of sex work is being glance to be similar, or is there a widely debated (Amnesty 2016). The difference? data from the timeline approach draws Aim: To provide a synthesis of already out women’s experiences to hopefully synthesized literature on person- and inform future policy and decision patient-centred care in order to identify making. similarities and differences between the Conclusion: The usefulness of two concepts. creative methodologies will be explored, Methods: A synthesis of review particularly in relation to working articles was conducted to locate with hard to reach groups, looking at synthesized literature published how to address some of the ethical between January 2000 and March considerations in conducting research 2017. Nine authors screened, extracted with this group of people who by data, and quality appraised the sources. virtue of being hard to reach are often A total of 21 articles deemed relevant overlooked and go unheard. to this overview were synthesized using Biography a thematic analysis according to Braun Fiona Meth is a Senior Nurse Lecturer and Clarke (2006). at Leeds Beckett University. She has a Results: The analysis resulted in nine long-standing interest in social policy, themes, common to both person-and qualitative methodologies and health patient-centred care: inequalities, having a Masters in Urban 1 empathy Planning and previously having worked in Social Policy Research at Queen Mary 2 respect University, LSE and Shelter before 3 engagement training to be a nurse. Fiona is currently 4 relationship undertaking a part-time PhD at Leeds 5 communication Beckett University, and also works as a volunteer outreach worker with street 6 shared decision-making

28 Concurrent session 2: Tuesday 3 September 2019

7 holistic focus Health Care Centers are the first instance (three to five years of age) participation 8 individualized focus for care for persons who are not acutely in health visits in the child health ill. Children between 0-18 years account care. In her current research she is 9 coordinated care. for 23% of all visits to Primary Health still focusing children and health care The analysis further revealed that Care Centers. These children are always professionals in primary health care, the goal of person-centred care is a accompanied by parents or guardians. child health care and school health care. meaningful life, in contrast to the goal Thereby the health care professionals of patient-centred care, which is a need to relate to two individuals in the functional life. care situation. Parents or guardians Session no: 2.7.3 Abstract no: 0137 Discussion: Clarification of the are a resource for their child, and concepts may assist nurses, researchers they should be given the opportunity Research Topic: Learning/ intellectual and educators to develop the relevant to participate with the child in caring disability, Patient Experience, Methodology aspects of care. Person-centred care situations. The care relation between Methodology: Interviewing the health care professional the parent broadens and extends the perspective of Research Approach: Qualitative patient-centred care by considering the and the child influences the outcome of approaches (eg: discourse analysis, whole life of the patient. the encounter in the caring situation. ethnography, critical theory, grounded theory, phenomenology) Conclusions: There are evidently a Aim: To describe health care number of similarities between patient- professionals’ reflections on encounters and person-centred care but the goals with parents seeking care for their The experiences of differ. The similarities are at the surface children at the Primary Health Care Center. orthopaedic and trauma and there are important differences hospital care from the when the concepts are regarded in Method: Repeating reflective forums light of their different goals. This is (n=6) with health care professionals perspectives of adults with important for nurses to consider in (n=8) regarding encountering children an intellectual/learning organization of care and in individual in primary health care situations disability in England, patient encounters. was used as data collection method. UK: An Interpretative Biography A qualitative content analysis with inductive approach was used to describe Phenomenological (IPA) Inger K Holmström PhD RN is the health care professionals’ reflections. study Professor in Caring Sciences at Results: Encountering parents who Presenter: Mary Drozd, RGN MSc Mälardalen University, and associate seek care for their children in Primary BA (Hons) PGCE FHEA ENB 219, researcher at Uppsala University, Health Care Centers are described as University of Wolverhampton, UK Sweden. Her main research interests a balancing act. Meaning the health Co-presenters: Darren Chadwick, UK; are communication in health care, care professionals in the ongoing care Rebecca Jester, UK the patient-professional encounter, situations balance between different especially in telephone nursing, person- Abstract perspectives and expectations. This centred care and qualitative research Introduction: Musculoskeletal balancing act includes: approaches. conditions and injuries are prevalent • To have beliefs about parent’s in people with intellectual disabilities perceptions and expectations and have significant impacts on • To encounter parents and children wellbeing. This study was important Session no: 2.7.2 Abstract no: 0412 as a unit and unique individuals as this group seldom have their voices Research Topic: Primary and Community • To guide parents. heard and their experiences valued and Care interpreted. Conclusion: The prerequisite for Methodology: Focus Groups health care professionals to create a Aim: To better understand the Research Approach: Qualitative caring relationship with parents and orthopaedic and trauma hospital approaches (eg: discourse analysis, children in a care situation involves experiences from the perspective of ethnography, critical theory, grounded understanding and encountering people with an intellectual disability. theory, phenomenology) parents’ and children’s perspectives. Methods: A qualitative perspective Also, a caring relationship benefits the focusing on peoples’ lived experiences Encountering parents care situation, children’s health and was utilized. A purposive sample of in Primary Health Care the parents’ trust in the health care five participants was recruited and Centers: A balancing professionals. one-to-one, semi-structured interviews Biography were undertaken. Analysis of the act between different interviews employed an interpretative perspectives and Maria Harder is a Public Health Nurse phenomenological analytical expectations and Associate Professor in Caring framework. Science. She had her PhD degree from Presenter: Maria Harder RN Public Karolinska Institutet in 2011. She Results: A cross-case comparison Health Nurse, Associate Professor works as a researcher and teacher in was undertaken and the themes below Caring Science, School of Health Care the School of Health Care and Social represent common experiences across and Social Welfare, Research group Welfare in Mälardalen University, participants: ChiP, Mälardalens University, Sweden Sweden. She also works as a Project • Communication problems. Co-authors: Maja Söderbäck, Sweden Manager and Health Care Development • Lack of person-centred care. Abstract Officer in child health care. In her • Issues related to pain. doctoral thesis she explored children’s Background: In Sweden Primary • Lack of confidence in hospital care.

29 Concurrent session 2: Tuesday 3 September 2019

• The support of carers. • Incompetence of hospital staff. • Loneliness. Implication for practice: Specific and on-going education and training of health care staff is required to improve orthopaedic and trauma care for people with an intellectual disability around: • Effective communication • Regular and competent pain assessment and management • Including and valuing carers of adults with an intellectual disability • Person-centred care for all Biography Mary is undertaking a Professional Doctorate in Health and Wellbeing at the University of Wolverhampton, Institute of Health Professions where she works as the Course Leader for the MSc Advanced Clinical Practice. The research study is entitled, ‘The orthopaedic or trauma hospital experiences of people with a learning disability.’ Mary has over 30 years’ experience as a Registered Nurse within orthopaedic nursing. She was a member of the National Steering Committee for Royal College of Nursing (RCN) Society of Orthopaedic and Trauma Nursing for 8 years from 2009-2013 and was re-elected 2013-2018. She has been part of the working group developing the updated national competency framework for orthopaedic and trauma practitioners due to be published by the Royal College of Nursing in 2019. Mary has published papers in peer reviewed journals, chapters in key orthopaedic nursing text books along with being a regular presenter at orthopaedic nursing conferences.

30 Concurrent session 3: Wednesday 4 September 2019

3.1 Theme: Dementia in safety and person centred care when 3.2 Theme: Clinical acknowledged and all parties act in the Session no: 3.1.1 Abstract no: 0398 best interest of the individual. Residents Session no: 3.2.1 Abstract no: 0363 Research Topic: Dementia, Patient retain and hold a level of responsibility Research Topic: Service Innovation and Safety (including human factors, infection, for their own safety and wellbeing, but Improvement, Workforce and Employment prevention and control etc), Older People the degree to which this is possible (including health and wellbeing roles, Methodology: Mixed is directly affected by their degree of research careers) Research Approach: Qualitative cognitive and physical ability. Methodology: Questionnaire approaches (eg: discourse analysis, Conclusions: Acknowledgement of Research Approach: Survey ethnography, critical theory, grounded the extent to which staff and relatives theory, phenomenology) hold responsibility for the safety and Resilience and wellbeing of residents with significant determination: Nursing Safety culture, disability can enable person centred safety and risk management. This insights into clinical responsibility and power offers translatable findings within older academic careers and roles in UK care homes: How is people’s care. in the East Midlands responsibility for safety Biography negotiated in England care Presenter: Louise Bramley, PhD, Emily Gartshore is a Registered Nurse, Nottingham University Hospitals, UK homes? Lecturer and Doctoral Student currently Co-authors: Emma Rowley, UK; Diane Presenter: Emily Gartshore RN MRes in her final year of a PhD based in the Trusson, UK MSc, University of Nottingham, UK University of Nottingham Centre of Abstract Co-authors: Stephen Timmons, UK; Health Innovation Leadership and Justin Waring, UK Learning and is a part time Lecturer in Background: A research-active workforce is important to the NHS, Abstract teenage and young adult cancer care at Coventry University. Her clinical which aims to harness the best research Background: Internationally, care background is in oncology and teenage and innovation to improve patient homes are vital settings providing 24- and young adult cancer care and her outcomes and transform services (NHS hour long-term care residential care or research interests include health and England 2017). Nurses are well placed nursing care to a growing population of wellbeing, safety culture, long-term care to devise solutions to problems, through vulnerable older people with complex and teenage and young adult cancer research, in day to day practice. Despite needs and high levels of dependency. care. NIHR investment in clinical academic These individuals are at significant risk training, nurses remain less successful of harm and are often dependent on than AHP colleagues (NIHR 2017) others to meet their safety needs. With and challenges exist at local level for care homes facing many challenges in Session no: 3.1.2 Abstract no: 0117 role implementation and substantive relation to funding, increasing demand contracts that combine font-line and staff shortages it is essential that WITHDRAWN nursing practice and research. steps be taken to understand safety Methods: A multi-professional cultures in this setting. survey and qualitative interviews Aims: To explore safety cultures in care were conducted with those aspiring homes using a narrative ethnographic to, or working in clinical academic case study approach. roles across the East Midlands in Methods: 200 hours of observation January 2018. Data was analysed by were undertaken across two England professional group using descriptive care home sites between January 2018- statistics and thematic analysis. December 2018. 65 narrative interviews Results: Survey responses were were completed with residents, relatives received from 19 nurses, with and staff across four care home sites. five of these also undertaking Results: Safety cultures in care homes qualitative interviews. Resilience and are complex and stem from the way determination are employed to secure that individuals in these setting make funding and overcome barriers when sense of their situation or job role and combining academic study with clinical the interactions between residents, roles. Even though financial sacrifices relatives and staff. Who holds power were sometimes necessary, nurses were and responsibility for safety depends driven to explore interventions that on multiple factors including, the will ultimately benefit patients, carers, residents’ level of cognitive or physical colleagues and the NHS more widely. ability, relationships with the resident, Convincing managers and colleagues perceived role within the care home and of the value of research by sharing underpinning values. research findings was seen as essential, alongside encouraging and supporting Discussion: Power relationships other nurses to pursue clinical academic between residents, relatives and staff careers. in care homes can offer improvements

31 Concurrent session 3: Wednesday 4 September 2019

Conclusion: Despite challenges, research training framework, providing Imaging Education. She has more nurses are working in clinical academic an introduction to ‘hands on’ clinical- than 25 years of experience in higher roles at the frontline and undertaking academic research. education, supporting the rapid research that has multiple potential Aims: To provide a national development of health professions by benefits, including greater efficiency, evaluation of four completed cohorts working with many organisations across increased patient safety and satisfaction (approximately 400 individuals) to the UK and overseas. She is currently and cost benefits for the NHS. As role ascertain progression onto further the programme lead for the HEE North models, they encourage and support training and research-related roles. NIHR Integrated Clinical Academic future clinical academics which is Internship programme. Research Methodology: A mixed methods crucial for addressing issues around interests are related to supporting project used framework analysis to recruitment and retention of talented and developing the health workforce, combine initial themes emerging from staff. Investing in training for nurses including leading several educational stakeholder focus groups, with findings is vital in developing and retaining a and research projects across from an online survey distributed research-active workforce where patient radiography, allied health professions to previous cohorts of Interns, their care remains the central consideration. and nursing. She has expertise in managers and academic mentors. qualitative methodologies to investigate Biography Ten semi-structured interviews workforce transformation, guideline subsequently explored the challenges Dr Louise Bramley is currently the lead development and practitioner and opportunities afforded by the for Clinical Research in the Institute behaviours. for Nursing and Midwifery Care internships. Excellence at Nottingham University Results: Important differences Hospitals Trust. She is a qualified nurse regarding programme aims, and continues to practice clinically. recruitment strategies and expectations Her research interests include issues emerged. 104 Interns completed affecting the frail elderly, compassion in the survey (40 nurses), and while nursing and end of life care. She is a key progression through the ICA framework figure in driving forward the Clinical was achieved by some, it was noted Academic Career agenda for nurses and to be highly competitive. Participants allied health professionals both within noted achievements beyond the Nottingham University Hospitals Trust Internship including career and and nationally. research role progression, sustaining research activity beyond the Internship, and supporting a research culture. All groups noted challenges in covering Session no: 3.2.2 Abstract no: 0502 clinical lists, with middle manager and Research Topic: Research Policy, institutional support essential for future Workforce and Employment (including progression. health and wellbeing roles, research careers) Discussion: Research Internships Methodology: Questionnaire are highly valued, but are not without Research Approach: Mixed Methods their challenges. Even with supportive Research organisations and managers, releasing staff time from busy clinical Research internships: An environments is difficult. Expectations vary, with some programmes highly evaluation of progression selective, and others offering wider within and beyond the ‘taster’ opportunities. Closer liaison HEE/NIHR Integrated between different Internship providers Clinical Academic Careers and the other levels of the ICA Programme framework may be beneficial. Conclusions: There is no clear Presenter: Julie Nightingale PhD MSc consensus on the measures of DCR(R), Sheffield Hallam University, UK success for Internships, with variable Co-presenters: Robin Lewis, UK expectations between regions, Co-authors: Kate Grafton, UK; Shona employers and individuals. However Kelly, UK; Sally Fowler Davis, UK; examples of impacts, outputs and Carrie Langham, UK; Brooke Bianco, progression are noted by many interns, UK; Deborah Harrop, UK progressing to new roles, developing Abstract research activities, and having positive Background: In partnership with effects on their workplace. the National Institute for Health Biography Research, Health Education England Julie Nightingale is a diagnostic delivers the Integrated Clinical radiographer by background, and Academic (ICA) Careers programme works in the Department of Allied to nurses, midwives and allied health Health Professions at Sheffield Hallam professionals within England [1]. The University as a Professor of Diagnostic Internship is the entry point to this

32 Concurrent session 3: Wednesday 4 September 2019

3.3 Theme: PPI Session no: 3.3.2 Abstract no: 0362 PPI in dementia research. The paper will be co-presented by the group Research Topic: Public and Patient Session no: 3.3.1 Abstract no: 0402 Involvement, Dementia, Research Process facilitator and a group member affected WITHDRAWN Issues by dementia. Methodology: Other collection method Biography Research Approach: Other approaches Jane McKeown is a mental health nurse working in a clinical academic An approach to enabling role. In her role within Sheffield Health and Social Care NHS FT Jane people living with dementia has recently been appointed as one of to influence research design seventy National Institute for Health Presenter: Jane McKeown PhD RMN, Research Senior Nurse Research The University of Sheffield, UK Leaders. Jane also works as a lecturer Co-presenters: Howard Gordon, UK at the University of Sheffield, School Abstract of Nursing and Midwifery. Jane’s work has an emphasis on developing and This paper offers critical reflection on evaluating methods and approaches one approach to enable meaningful to enable the views and experiences patient and public involvement (PPI) in of people living with dementia to dementia research. be captured and shared to inform South Yorkshire Dementia Research dementia care practice, education and Advisory Group comprises people research. Her PhD explored the use living with dementia, family carers of life story work with people with or supporters of people living with dementia in health and social care dementia and others affected or practice. Jane is Chair for the South interested in dementia in some way. Yorkshire Dementia Research Advisory The group meets quarterly to offer Group, which invites researchers to researchers in South Yorkshire a forum share their research ideas with people to share some aspect of their research in living with dementia in order to receive order to receive critical feedback from critical feedback from ‘experts by people affected by dementia. Initially experience’. established to aid researchers to achieve PPI on funded research bids, the group has evolved to educate and influence researchers and student researchers in appreciating the range of benefits of seeking the knowledge of ‘experts by experience’ in order to improve their research design. This paper presents some of the conditions and considerations perceived as necessary in order to ensure involvement is a positive and meaningful experience for all involved (group members and researchers). These include: careful planning of the agenda in terms of a balance between informality and pace whilst also progressing through the business of the meeting; advice to researchers on ways of presenting their ideas in order to gain the best engagement with group members; and the required facilitation in terms of creating a safe and supportive atmosphere and enabling everyone to share their views. Three short case study examples will be used to illustrate what helps and what hinders these conditions and considerations. Notions of power, voice, ethics and authenticity in relation to patient and public will be discussed. This paper will be of interest to researchers and students interested in exploring and developing meaningful

33 Concurrent session 3: Wednesday 4 September 2019

3.4 Theme: Public Health and formative (knowledge and skills) Abstract: The paper will explore, ***. Interview themes identified desire preliminary findings, using the work of Session no: 3.4.1 Abstract no: 0256 for clear definitions of CS, consistent Balint to inform the analysis of digital Research Topic: Sexual Health, Workforce delivery, and safety within groups. diaries generated by nursing students and Employment (including health and Key relationships and control of the when in clinical placements. wellbeing roles, research careers) CS structure were considered central Background: The researchers Methodology: Mixed to ideal CS; the flexible arrangements experience in sexual health Research Approach: Mixed Methods doctors experienced indicating a highlighted nursing care which Research potential solution. Perceived barriers to did not address patient’s sexuality effective CS included: causing mismanagement. There is Managing short-term, 1. resources little research on how nurses process 2. organizational ethos the emotional impact of their work, high-intensity interactions: and how these unconscious emotions 3. supervisory skills. Does clinical supervision effect nursing care. This paper explores meet the needs of the sexual Discussion: As the central resource how teachers can develop nurses who in sexual health care, it is vital that health nurse? meet the NMC’S expectations of non- nurses are supported to maintain judgmentally in relation to sexuality Presenter: Jenny Dalrymple RN RM consistent high standards and longevity and the impact on nursing care. MN PhD, NHS Greater Glasgow and of wellbeing. This Scotland-wide (NMC.2015). Balint’s psychodynamic Clyde, UK study highlights deficits in current theory brings understanding to the Co-authors: Jamie Frankis, UK; Imali CS provision and evidence to support unconscious feelings experienced in Fernando, UK; Lorraine Kelso, UK; innovative future interventions tailored nursing care (Montford and Skrine, Satinder Panesar, UK; Karen Lorimer, to nurses providing short term, highly 1993). Listening closely to the UK focused care both in sexual health and reflections of student nurses in the Abstract beyond. digital diary puts the researcher in Background: Sexual health nurses *p<0.05**p<0.01***p<0.001 touch with the feelings experienced work with patients who increasingly Biography at the time; Clifford argues that these bring complex sexual, mental health provide powerful learning forums Jenny Dalrymple is a sexual health (Clifford in Barnes et al, 1998). and social issues. Patient expressions nurse based at the Sandyford sexual Methods: Participants were recruited of stigma and anxiety, and experiences health service in NHS Greater from the second-year undergraduate of gender-based violence are common Glasgow and Clyde. She is currently nursing degree at one Higher Education within this specialty. Treatments are on a post-doctoral clinical academic Institute in England. In total 27 tailored towards minimal attendances, research fellowship jointly funded students were recruited, three groups restricting opportunities for ongoing by NHS Greater Glasgow and Clyde participated in online discussion supportive relationships. It is unclear and Glasgow Caledonian University. groups, seven digital diaries and if current clinical supervision (CS) Her research interests include older three interviews completed. Data was provision adequately addresses this adults’ sexual health, HIV and sexually analysed using pluralistic methodology, type of care delivery. Our mixed transmitted infection (STI) risk narrative and Balint theories to explore methods study, conducted from May- reduction and sexual health service the emotions invoked in the diaries. November 2018, examined sexual improvement. Her current projects health nurses’ experiences of CS. include clinical supervision for sexual Findings: Findings reveal how student Methods: We invited all sexual health health nurses and assessing factors nurses navigate nursing care and the nurses in mainland Scotland (n=205) associated with HIV testing among complexity of working with trained to complete an online questionnaire, older and younger men who have sex nurses with value judgements. The including the Manchester Clinical with men. diversity in student nurses reveals Supervision Scale (MCSS), based on a variety of linguistic resources and Proctor’s model. Inferential analysis emotional responses. The use of examined demographic and workplace Balint as a methodology enabled the factors related to CS effectiveness. Session no: 3.4.2 Abstract no: 0178 researcher to understand how student nurses process emotions and gives a We subsequently conducted semi- Research Topic: Sexual Health structured interviews with n=11 nurses greater understanding of the complex Methodology: Other collection method and n=6 trainee specialty doctors, nature of nursing care. which were thematically analysed, Research Approach: Evaluation (process, impact) Biography providing organisational context and depth. Su Everett is a Senior Lecturer at The use of Balint Middlesex University and a Senior Results: From 109 (53% response Nurse Practitioner in Sexual Health rate) nurse participants, 61 (56%) methodology to explore at the Royal Free Hospital. She is the currently received CS. Two-thirds how nurses process the nurse representative for the Faculty (64%, n=39) completed the MCSS. sensitive sexual health of Reproductive sexual health journal. Those receiving at least some individual issues arising from working Previously Su was chair of the RCN supervision rated CS as significantly Sexual Health Forum that merged with more effective for the total MCSS** in the clinical area other forums to become the RCN Public and across all three sub-domains; Presenter: Su Everett RN RM BSc Health Forum. Over the years Su has normative (everyday practice)*, (Hons) MSc PGCert (HE), Middlesex contributed to the RCN’s work on sexual restorative (emotional support) ** University, UK health and the RCOG guidance on

34 Concurrent session 3: Wednesday 4 September 2019

abortion. She has published three books 3.5 Theme: Mental Health helpline support, opportunity to self- on Sexual Health and Contraception refer to mental health liaison team and and is currently writing a fourth Session no: 3.5.1 Abstract no: 0252 increased voluntary sector support. book. She is currently undertaking Research Topic: Mental health Discussion: The patient narratives a PhD focusing on sexuality in the Methodology: Interviewing reflected a lack of choice in terms undergraduate programme, exploring of service options and poor patient the potential of the nursing curriculum Research Approach: Qualitative approaches (eg: discourse analysis, experience. Prior trauma was to develop nurses who are non- ethnography, critical theory, grounded compounded by loneliness and severe judgemental and tolerant of differences theory, phenomenology) social isolation. and diversity. Biography Understanding why people Karon Glynn is undertaking a Doctorate in mental distress attend of Professional Studies at Sheffield the emergency department: Hallam University; the study is in the writing up stage. Karon has a From a patient perspective background in mental health and Presenter: Karon Glynn RMN RLDN, learning disability nursing and is Sheffield Hallam University, UK currently a commissioner in a NHS Co-presenters: Sally Fowler Davis, UK; England specialised commissioning Russell Ashmore, UK team; commissioning high cost low Abstract volume mental health services which includes: high, medium and low Background: There is pressure secure mental health and learning on Accident and Emergency (A&E) disability services. Previously she has departments and access targets across had experience commissioning local England have failed. People in mental mental health hospital and community health crises are sometimes unable to services across a number of Clinical address underlying loneliness, isolation Commissioning Groups as well as and acute distress and attend A&E experience in delivering direct patient but their needs are not being fully care in provider trusts and in social met. This professional doctorate study care. investigated experiences of people who regularly attended A&E and describes the unique decision to attend, their care experience and their reflections on what Session no: 3.5.2 Abstract no: 0266 would work well for them. Research Topic: Mental health, Chronic Aim: The aim was to collate patient Illness perspectives to inform future commissioning and practice. Methodology: Interviewing Research Approach: Qualitative Methods: A narrative research approaches (eg: discourse analysis, approach was used that included six ethnography, critical theory, grounded patient interviews utilising a non- theory, phenomenology) interrupting method, in order to capture their unique stories. A narrative analysis was used. The data was Understanding how collected between November 2016 and Scottish community nurses’ June 2017. work with individuals Results: The findings showed that: experiencing mental there were high degrees of loneliness distress while living with a and isolation; many had experienced long-term condition significant trauma; there was no other option other than A&E available Presenter: David Banks PhD MA BSc 24/7. Participants were directed to (Hons) DMS Grad Cert Ed RMN RGN, the emergency department by other Centre for Person-centred Practice professionals or taken there by friends Research, Division of Nursing, Queen and once there they believed they Margaret University, UK waited longer than other patients. Abstract They reported significant stigma and Aims: This project seeks to understand discrimination; they were not listened how Scottish Community Nurses to or believed and they felt they were support people living with a long term being judged and shunned; one was condition who are experiencing mental told that she should not be there. The distress participants were able to communicate a number of alternative support Methods: In-depth interviews were options that would have helped them conducted with 25 Community Nurses including: preventative interventions; employed across five Scottish Health

35 Concurrent session 3: Wednesday 4 September 2019

Boards in 2018/19. A stakeholders identity and social exclusion. Since 4.1 Theme: Cancer meeting was held with people 2018, as a member of the Scottish affiliated to COPE Scotland, who have Government Taskforce on Rape and Session no: 4.1.1 Abstract no: 0006 lived-experience of anxiety and/or Sexual Violence, David has been leading Research Topic: Primary and Community depression. Feedback from other key a Pan Scotland MSc Forensic Advanced Care, Chronic Illness, Cancer informants, a literature review and this Practitioner Pathway curriculum Methodology: Interviewing event informed construction of open development at QMU. He is the QMU Research Approach: Qualitative ended questions. Data was transcribed programme pathway leader for MSc/PG approaches (eg: discourse analysis, and analysed thematically. Fieldwork Dip Person Centred Practice (Mental ethnography, critical theory, grounded was funded by QNIS Scotland. Health and Wellbeing) and the QMU theory, phenomenology) Results: Previous career experiences Academic Link Person for the NHS Scotland South of Scotland PG Masters since pre-registration: Participants Living on: An exploration came from a wide variety of hospital Training Programme in Cognitive and community based backgrounds. Behavioural Therapy. of healthful cancer This included experience of working survivorship among grey with people experiencing long-term nomads conditions, and mental health issues. Presenter: Moira Stephens RN Assessment and building PhD MSc BSc (Hons), University of relationships: Divergent practices Wollongong, Australia were revealed based on assumptions Co-authors: Elizabeth Halcomb, regarding job roles, the perceived needs Australia; Jan Dewing, UK of the person and their competence in Abstract working with people with mental health issues. Background: Cancer is primarily both a life-limiting and a chronic condition of To intervene or not: Differing ageing and older people. Older people, levels of awareness around power however, are not a homogeneous group; relationships, specifically where there are several generations and many interventions were taking place, home different groups to be considered. or clinic. Interventions more likely Grey nomads are one such group and to be initiated by nurses with specific are characterised as being retired and education/training. Another influencing travelling domestically for extended factor was working relationships within periods of time, usually in a caravan or the Inter-professional team. motorhome. An increasing number of Referral: Referral was driven by a older Australians, colloquially known wide range of practices based on formal as ‘grey nomads’, take to the road on and informal working relationships. retirement. In 2011, Australia’s grey Mental Health services clearly valued, nomad population was estimated to be but access was problematic. Some about 2% of the total (Davies 2011). nurses’ priorities meant mental health The seasonal nature of the grey nomad of their patients was not always lifestyle provides challenges for both addressed. receiving and delivering health care to Assets, strengths and possibilities: support cancer survivorship. There is Practitioners revealed intriguing little known about the health and health skillsets. Some wished to consolidate needs, cancer-related or otherwise, this work through further education of grey nomads (Halcomb et al 2017, and experience. There was local Raven 2016). evidence of innovation, through service Design: Prospective qualitative phase development, extension of role and of a larger, sequential, explanatory, advancing practice. mixed-methods project. Conclusions: The findings challenge Methods: A series of 14 semi- some assumptions by Health structured, in-depth interviews were Education England (HEE) about the conducted over six months (August- characteristics of Practice Nursing in December 2016) with 14 self-identified Scotland. Finally, innovatory work by grey nomads living with a diagnosis of individual nurses could be affected cancer. Interviews were transcribed by competing pressures from the new verbatim and analysed using thematic GMC Contract. analysis. Biography Findings: Participants travelled David Banks is a Lecturer in Nursing at despite of, and because of, their cancer the Centre for Person-centred Practice diagnosis. These two key themes, Research, Division of Nursing, Queen with their associated sub-themes, Margaret University, Edinburgh. He explain how older people incorporated has specific research interests and their cancer-related work, that is to publications in mental health, social say, managing their cancer-related

36 Concurrent session 4: Wednesday 4 September 2019

follow-up and treatment health needs Session no: 4.1.2 Abstract no: 0384 3. Initiating well-being support into their travelling life; how they Research Topic: Children and Young 4. Coordination and follow-up. normalised it; and how they developed People, Nursing, Midwifery or Support These themes form the basis of a new strategies for healthful survivorship. Worker Education, Cancer nursing model: “The Divorced Family Conclusion: Participants were Methodology: Mixed Focused Care Model” which can be living healthfully in that they were Research Approach: Qualitative applied to promote the mental health living a lifestyle that promoted their approaches (eg: discourse analysis, and well-being of double bereaved well-being. Participants developed ethnography, critical theory, grounded children and young adults. strategies in response to their changed theory, phenomenology) Conclusions: A profound gap for environment and thus created new adequate support of double bereaved capacity to support what they wanted Parental cancer and death children and young adult and their to do. Despite being cancer survivors divorced families has been identified, — some of whom were undergoing in divorced families: with a need for improved support active treatment — participants gained Double bereavement and services throughout the illness and ‘healthfulness’ through their chosen interventions targeted the death phases apparent. This study nomadic lifestyle. related child’s and young demonstrates the ways that nurses can Biography adult’s mental health (Part intervene to target divorced families Moira Stephens is a senior lecturer of an ongoing PhD-study) within cancer care populations to improve children and young people’s in nursing at the University of Presenter: Rhonda Wilson RN BNSc future mental health and well-being Wollongong, Australia. Moira is a MNurs(Hons) PhD, University of through application of the Divorced registered nurse and enjoyed 30 Canberra, Australia Family Focused Care Model. years in bone marrow transplant and Co-authors: Jette Marcussen, cancer nursing in the UK, Australia Denmark; Lise Hounsgaard, Denmark; Biography and Saudi Arabia. Moira is passionate Frode Thuen, Norway PhD student, Master in Educational about teaching undergraduate and Psychology and RN. Worked many post graduate health care professional Abstract years as a senior lecturer. Interests in students and enabling them to become Background and aim: This study bereavement, mental Health and Family discerning and critical users of investigated the experiences of children Nursing and in this study particular in information and empathetic, skilled and young adults experiencing double children and young adult experiencing delivers of health care. Moira is a past bereavement (parental divorce and double bereavement when a divorced president of the European Blood and subsequent parental cancer and parent dies of cancer. Marrow Transplant Nurses’ Group; death). Almost half of Danish children, founding member and past president who experience parental death, also of the Haematology Society of Australia experience the divorce of their parents. and New Zealand Nurses’ Group and Our literature review revealed that Session no: 4.1.3 Abstract no: 0105 currently editor of the Australian children and young adults have an Journal of Cancer Nursing. Moira increased risk for developing mental Research Topic: Patient Experience, gained her PhD from Sydney Medical health problems and will require Cancer, Men’s health School and her doctoral research support from health professionals. The Methodology: Interviewing explored the experience of living with study presents new knowledge about Research Approach: Qualitative multiple myeloma the topic of which double bereavement and introduces approaches (eg: discourse analysis, evolved from her everyday interactions a new nursing model to promote the ethnography, critical theory, grounded with people affected by myeloma. mental health of children and young theory, phenomenology) adults. Method: The qualitative study Impact of prostate cancer interviewed 20 nurses and conducted on younger men’s sense of a field study including 27 children and masculinity and daily lives young adults from divorced families Presenter: Bróna Mooney PhD MSc to explore children’s experiences of MA BNS(Hons), RGN, RNT, National double bereavement, and nursing University of Ireland, Galway, Ireland interventions to target promotion of Co-authors: Gerard Fealy, Ireland; children´s and young adults mental Philip Larkin, Switzerland health. Analysis was conducted according to Ricoeurs interpretation Abstract theory. Background: Prostate cancer is the Results: Double bereaved children most common male cancer in Ireland and young adults experience multiple and approximately one third of men losses, whether they lose a custodial or are under the age of 65 years at time non-custodial parent, and they require of diagnosis. A review of the literature support to promote mental health well- revealed that there was a dearth of being. The study revealed four themes: research internationally examining 1. Collecting information about family younger men’s experience and how structure gender and masculinity influence men’s experience of the disease. 2. Assessing need for support

37 Concurrent session 4: Wednesday 4 September 2019

Aim of study: The aim of this 4.2 Theme: Older People and treat the patient as possibly study was to examine younger men’s suffering. In both scenarios, I will show experience of prostate cancer diagnosis, Session no: 4.2.1 Abstract no: 0160 how the patient’s responses evidence treatment and survival. In particular, Research Topic: Older People that the nurse’s practices were received this inquiry aimed to understand men’s as compassionate. Methodology: Observation experiences of prostate cancer and how Conclusion/discussion: The the experience impacted on men’s sense Research Approach: Qualitative approaches (eg: discourse analysis, present study expands the knowledge of masculinity and daily lives. ethnography, critical theory, grounded base regarding nurse-patient Methods: Interpretative theory, phenomenology) interaction, through the identification Phenomenological Analysis was used to and articulation of verbal and non- examine 26 younger men’s experience Researching compassion in verbal skills nurses use to achieve of prostate cancer following treatment compassionate care. These findings for prostate cancer. Data was collected nurse-patient interaction provide empirical evidence that using semi-structured interviews from using conversation analysis future communication skills training June to October 2016 and data analysis Presenter: Rachael Drewery BSc can be built upon. They also add to a was guided by Smith’s Interpretative MSc MA RN SCPHN (HV), University growing body of knowledge about the Phenomenological Analysis approach of Nottingham School of Health complex skill set possessed by nursing (Smith et al, 2009). Sciences, UK professionals. Results: Four super-ordinate themes Co-authors: Alison Edgley, UK; Alison Biography emerged. Men’s testimonies in this Pilnick, UK; Joanne Cooper, UK; Ruth During Rachael Drewery’s twenty- study point to evidence that the effect Parry, UK year nursing career she has worked of prostate cancer diagnosis and need Abstract in a variety of specialities including to adjust to and cope with side-effects oncology, paediatric bone marrow of treatment had a notable impact on Background: Despite recent health care policy stipulating that nurses transplant and health visiting. Prior men’s sense of masculinity and daily to commencing her PhD, Rachael lives. should act in a compassionate manner, compassion remains poorly and worked on an intensive home visiting Discussion: Prostate cancer caused vaguely conceptualised. Whilst previous programme with vulnerable families. disruptions to younger men’s energy research has argued that compassion She has always worked in areas levels, physical strength, mental health, is part of effective nurse-patient where effective communication skills sexual and urinary function. Men’s interaction, there is little detailed are critical to providing people with experience was influenced by their knowledge about how compassion is ongoing nursing care, during periods adherence to traditional masculine actually enacted in practice. of vulnerability. In recent years, she narratives, which both assisted men has become particularly interested Aim: To identify and describe ways in in their recovery and deprived them in how nurses research and evidence which compassion is enacted within of important sources of social and the communication skills that they nurse-patient interaction. emotional support. use to care for patients. During Conclusions: This study has Methods: The study uses conversation an NIHR-funded MA in research contributed to scholarship on the effects analysis (CA), an inductive approach methods, Rachael completed a pilot of prostate cancer on younger men and involving the collection and analysis of project using conversation analysis offers valuable insights into younger audio-visual recordings of naturally- (CA) to explore health visitor-client men’s experience of the disease, occurring interaction (Clayman & interaction. The research highlighted particularly relating to men’s ability to Gill, 2004). Audio-visual recordings the potential of CA, for expanding the perform normal activities of daily living of consultations (n.40) between older nursing profession’s knowledge about following treatment and how social in-patients and advanced clinical the communication skills that we are in and cultural influences construct and practitioners have been collected. Using practice. Hence, I she is using CA in her impacted on their sense of masculinity. a definition of compassion developed PhD research to explore the enactment from a literature review and from of compassion in nurse-patient Biography how CA conceptualises interaction, interaction. Dr Bróna Mooney is a College Lecturer recordings have been analysed to in nursing studies at the National identify the verbal and non-verbal University of Ireland, Galway. She practices that show how compassion completed her PhD studies in 2018, is achieved within the interactional examining ‘Younger men’s Experience context. of Prostate Cancer: Influence on Findings: Findings demonstrate their sense of masculinity and daily that compassion is fundamentally an lives’. She has worked in the area of interactional phenomenon involving nursing education for 18 years and has both nurse and patient. Using previously held posts at the University recordings, I will show the verbal of Dublin, Trinity College and St and non-verbal practices nurses use James’s Hospital School of Nursing. to display compassion in response to She undertook her nursing training observable patient conduct, such as at St Vincent’s Hospital, Dublin and crying. I will also show cases in which, her clinical practice background is in although the patient’s observable the area of intensive care nursing and conduct does not indicate suffering, the cancer care. nurse’s responses display compassion

38 Concurrent session 4: Wednesday 4 September 2019

Session no: 4.2.2 Abstract no: 0103 themselves. All of these factors, mixed The toolkit explicates ‘what good with strong emotions of fear, guilt and looks like’ in relation to each theme, Research Topic: Dementia, Acute and critical care, Older People a lack of autonomy are contributing to in a written resource and animated the shortfalls of care that are being seen film clips. It includes key questions Methodology: Mixed nationally. for dementia care leaders to facilitate Research Approach: Qualitative reflective practice and documentation approaches (eg: discourse analysis, Biography to support implementation. ethnography, critical theory, grounded Emily is a Consultant Admiral Nurse theory, phenomenology) at Dementia UK working towards her Discussion: This research found a Clinical Academic Doctorate at the lack of robust empirical evidence on University of Southampton. Emily is a the effectiveness of care interventions, The effect of the work but has used findings from the system on nursing staff mental health nurse by background and has specialised in dementia care since ethnography of patient experiences to capacity for relational care qualifying in 2014. develop a toolkit. One of the study’s with people with dementia strengths is the prominence of the patient ‘voice’. The experiences of Presenter: Emily Oliver BSc RMN, older hospital patients with dementia/ Dementia UK, UK Session no: 4.2.3 Abstract no: 0203 delirium are seldom considered in Abstract research. This study has shown that Research Topic: Dementia, Patient The Department of Health estimates eliciting meaningful data is possible and Experience that a typical general hospital in the extremely valuable. Methodology: Mixed UK will have 100 people with dementia Conclusions: The Dementia Care Research Approach: Mixed Methods admitted at any given time with Leaders Toolkit has the potential Research approximately one in four hospital beds to transform hospital care for older occupied by someone with a diagnosis patients with cognitive impairment. It (Department of Health 2009). Due to Development of an provides an evidence based approach, this increasing prevalence of people evidence-based dementia enabling staff to focus on three with dementia in hospitals, providing care leaders toolkit key areas, to optimise the patient high quality care for this patient group experience. is now a public health priority, however, Presenter: Clare Abley PhD MSc PGDL Biography ongoing reports have identified BSc (Hons) Nursing RCN, Newcastle consistent failures. Many empirical Hospitals NHS Foundation Trust, UK Dr Clare Abley is nurse consultant studies have explored care for people Abstract vulnerable older adults for the with dementia in hospitals commenting Newcastle upon Tyne Hospitals NHS Background: Approximately 50% on the impact of contextual features on Foundation Trust and honorary clinical of patients in hospital aged 65 and nursing care, however, most of these senior lecturer Newcastle University. above, have dementia and/or delirium have been based on acute hospital She focuses on the care of older people, (RCPsych 2005). Staff need to be wards (Featherstone, Northcott et al including those living with dementia. enabled to meet the needs of these 2019) and limited research has been In her nurse consultant role she chairs patients. conducted in specialist older persons the Trust dementia care steering wards. Aim: To develop a toolkit to improve group, has led on development of the general hospital care for older people Trust dementia strategy, monitors its This ethnographic study has with cognitive impairment (dementia/ implementation and provides clinical contributed to this gap in the knowledge delirium). leadership for the Trust dementia base providing an in-depth exploration care team. Her recent NIHR Clinical into the impact of the work system on Methods: The study design Lectureship (2014-19) focused on relational care for people with dementia incorporated three work streams: a improving general hospital care for on medicine for older person’s wards. mixed methods systematic review of older people with cognitive impairment Data was collected between January care interventions using narrative (dementia and / or delirium) and 2017 and March 2018 and consisted synthesis, a single case study (one NHS resulted in the development of an of 125 hours observations and 26 Trust) of hospital patient experiences evidence based toolkit for dementia interviews with nursing staff (health using ethnographic observations care leaders. During the next 12 months care support workers and nurses). and staff and carer interviews, and the subsequent co-design of a toolkit further work will be undertaken to The results highlight that nursing staff with stakeholders. Ethnographic data evaluate its use and impact locally, plan capacity for relational care for sits at an was analysed using Interpretative national roll out and apply for further organisational level and not with the Phenomenological Analysis. funding for a feasibility study. individuals themselves. Nursing staff are continuously balancing the needs Results: The systematic review found of the patients with the priorities of the no sufficiently robust evidence of the organisation which is detrimental to effectiveness of interventions to be the care they provide. Rigid routines incorporated into an evidence based and expected task durations are causing toolkit. Therefore a toolkit focusing nursing staff to become “task blind” on the patient experience has been in which they cannot see the patient developed based on three key themes behind the task. Power imbalance no that emerged from the ethnography: longer sits within the medical-nursing valuing and empowering the patient hierarchy but within the nursing teams and optimising the social environment.

39 Concurrent session 4: Wednesday 4 September 2019

4.3 Theme: Children and others and using practice knowledge Session no: 4.3.2 Abstract no: 0153 in relation to research. Outcomes Young People Research Topic: Sexual Health include increased reach of research to Methodology: Interviewing Session no: 4.3.1 Abstract no: 0201 marginalised groups, increased number of HVs and SNs doing research, and the Research Approach: Qualitative Research Topic: Children and Young co-production of research projects and approaches (eg: discourse analysis, People, Public Health (including health ethnography, critical theory, grounded promotion), Service Innovation and outputs based on what practitioners theory, phenomenology) Improvement advise. Methodology: Other collection method Conclusion: These initiatives have Experiences of school Research Approach: Other approaches been developed during turbulent times and have been sustained through a health nurses on guiding focus on what matters and what is adolescents in their Using ‘Capacity for Impact’ achievable, underpinned by string decision-making about principles to strengthen capacity and impact theory. The reproductive health in Ogun health visitors’ and original Capacity framework has been State of Nigeria school nurses’ research extensively used internationally and across differently professional groups Presenter: Dr Toyin Ogunyewo, PhD, engagement and activity to and the mechanisms identified by Nursing, University of Jos, Nigeria make a difference Cooke et al (2018) paper reinforces the Abstract Presenter: Sue Peckover RGN HV need to make a difference. Background: School health nurses PhD RGN MMedSci, Sheffield Hallam Biography have a responsibility to guide University, UK Dr Sue Peckover is Reader in Public adolescents in their decision making Co-presenters: Jo Cooke, UK; Louise Health Nursing at Sheffield Hallam about reproductive health. This Wolstenholme, UK University. Sue has a health visiting is necessary because studies have Abstract background and has practiced, taught, established that risky decision-making Background: Research is core researched and published in the field in reproductive health accounts for business for the NHS. All nurses have of child and family health and welfare. a large proportion of adolescent an important role in utilising evidence, Sue’s research interests include public mortality. Adolescent reproductive engaging with research, supporting health, safeguarding children, domestic health entails unprotected sex, unsafe study recruitment and undertaking abuse, e-technologies and professional abortion, and HIV/AIDs. Guiding research. Whilst progress is evident, knowledge and practices. Her research adolescents in their decision making public health nurses, health visitors has an applied and inter-disciplinary about reproductive health is an adaptive (HV) and school nurses (SN) have been focus and has been widely published. role of school health nurses which much less visible (Cowley et al, 2013) Sue joined Sheffield Hallam University requires they are prepared to take up Aims: We will describe two innovative in January 2014 having previously the role. initiatives that address this challenge held posts in the Centre for Applied Purpose: The purpose of the study and consider the key organisational, Childhood Studies at the University was to explore the experiences of practical and philosophical/aspirational of Huddersfield and at the University school health nurses on the provision elements contributing to their success. of Sheffield School of Nursing and of guidance to adolescents in their Examples of what these initiatives have Midwifery. decision making about reproductive achieved will also be shared. health. Discussion: Drawing upon, and Methods: This is an exploratory, extending the principles of research descriptive and contextual study. The capacity building described by Cooke study took place in the secondary (2005), the paper discusses two school environment. Qualitative inter-linked initiatives supporting research approach was used for the HVs and SNs to engage, influence, study. The participants for the study develop and deliver research. Both were purposively selected from among act as communities of practice (CoP) school health nurses and adolescents. operating at different levels: a region- Semi-structured interviews and focus wide research network and a Trust- group discussions were used to obtain wide research interest group. Both data for school health nurses and school initiatives have embraced and shaped adolescents respectively. The data the ‘Capacity for Impact’ principles collected was transcribed in verbatim, that extend the Cooke framework and inductive content analysis was by being mindful on what matters employed. for practice, impact on services and Results: The findings from the data people. Both display infrastructure, showed that what school health nurses leadership, membership with agreed provide is not proximate to guidance responsibilities, and accountability to rather some form of health talk which funders. There is a strong emphasis on has no bearing on decision-making building research skills and confidence. process of adolescents in reproductive Opportunities are sought through health. Findings further show that they linkages and collaborations with

40 Concurrent session 4: Wednesday 4 September 2019

lack adequate skills and the knowledge 4.4 Theme: Women’s Health you’re becoming yourself finally” needed for guidance. (Kate:486) and Women’s Business: Implication for nursing practice: Session no: 4.4.1 Abstract no: 0498 The “stuff of legend” that only can be School health nurses need to move Research Topic: Public Health (including experienced and shared by women beyond their formalized roles toward health promotion), Under Represented (Rose:278). adaptive and proactive ones as this Groups (including black and minority Conclusions: This study contributes helps in further evolving a true ethnic), Women’s health to alternative discourse offering insight professional status. Methodology: Interviewing into the complex, individualised nature Biography Research Approach: Qualitative of the natural transition to menopause. approaches (eg: discourse analysis, The implications of the study are Dr Toyin Ogunyewo was born in 1963. ethnography, critical theory, grounded considered within a contemporary He attended University of Ibadan for theory, phenomenology) context in terms of strengthening policy, his Bachelor of Science, Master of heightening awareness of the needs of Science degree in Nursing, and another We work, we play, we women; to employers, clinicians and Master of Science degree in Medical with women themselves. Sociology. Toyin obtained his PhD in change: Women’s lived nursing from the University of the experience of the transition Biography Western Cape. He has been working to natural menopause Yvonne is a dual registered nurse at the University of Jos as a Lecturer (RGN/RMN) and a lecturer within Presenter: Yvonne Middlewick RGN in the Department of Nursing Science. the School of Health Sciences at the RMN Registered Teacher MSc in Currently, he is a Senior Lecturer University of Southampton. She is the Science, PGCert in Clinical leadership, and has up to 20 publications to his Programme Lead for the BN (Hons) PGCert in Academic Practice, BSc credit. Toyin has been a lecturer in the nursing programmes and the four (Hons) in Nursing Studies, PhD Department of Nursing Science for year MNurs programme leading to Student, University of Southampton, upwards of twelve years. Currently, dual registration. Her early career was UK he is a Senior Lecturer. His area of working in gynaecology and breast Co-authors: Tracy Long-Sutehall, UK; specialisation is Community Health surgery which led to an ongoing interest Michelle Myall, UK Nursing with a bias in school nursing in women’s health and wellbeing. This that focuses on adolescent decision- Abstract was pivotal in influencing the focus making in reproductive health. Background: The transition to natural of her PhD study exploring the lived menopause affects midlife women experience of the transition to natural who have not experienced surgical or menopause particularly when so many chemical interventions. Contemporary women work in health care. Along with Session no: 4.3.3 Abstract no: 0114 women are more likely to experience studying and working she spent time WITHDRAWN the transition while they are working as a volunteer researcher for 28 Too and yet little is known about how the Many, a charity that is working to end menopause impacts on women’s life/ the practice of female genital mutilation work balance. (FGM). Her role as a volunteer Aims: To explore how women make researcher contributed to the profiling sense of their transition to menopause; of FGM and its impact in Senegal. the meaning they attribute to their experiences within the context of their lives; and to understand the shared perspectives of women as they transition to menopause. Methods: Interpretative Phenomenological Analysis [IPA] was used to explore the lived experiences of five women aged 45-58 years old; two registered health care professionals, two student health care professionals and a qualified teacher working in higher education with health care students. Data were collected via semi-structured interviews and analysis guided by the idiographic, phenomenological and heuristic principles of IPA. Discussion: Data analysis generated three higher order concepts capturing the biopsychosocial experiences of the women who participated in this study: Losses: “I kind of assumed that it was something that lasted for a year or two and then it went and you went back to normal” (Kate:36), Liberation: Freedom from “cultural baggage...to feel that

41 Concurrent session 4: Wednesday 4 September 2019

Session no: 4.4.2 Abstract no: 0158 4. Social isolation and loneliness - Session no: 4.4.3 Abstract no: 0284 Social isolation seen as a method Research Topic: Patient Experience, Research Topic: Patient Experience, Women’s health of controlling the potential threat Women’s health of social interaction with other Methodology: Interviewing Methodology: Questionnaire pregnant women. Research Approach: Qualitative Research Approach: Mixed Methods approaches (eg: discourse analysis, 5. Guilt - Participants reported Research ethnography, critical theory, grounded ‘constant guilt’ that they were to theory, phenomenology) blame for their miscarriages. Termination of pregnancy 6. Professional care - Women procedures: Patient choice, Hope for the best, but expressed the importance of supportive care and understanding emotional impact and expect the worst: How do health professionals. satisfaction with care women experience the Conclusions: Data from this study early waiting period of a Presenter: Joanne Fletcher MA gave candid personal insight into BA(Hons) DipILM RN, Sheffield new pregnancy following the lived experience of the waiting Teaching Hospitals, UK recurrent miscarriage? period of a new pregnancy. The study Co-authors: Jennifer Heath, UK; Presenter: Sarah Bailey, PhD MSc adds valuable information to the Natalie Mitchell, UK limited body of evidence regarding RGN RM RHV, University Hospitals Abstract the understanding of the initial Southampton NHS Foundation Trust, Background: Termination of UK experience of pregnancy following RM and highlights the unmet needs of this pregnancy (TOP) is a common Abstract vulnerable patient population. procedure with approximately 190,000 abortions performed in England and Introduction: Recurrent miscarriage Biography (RM) is an extremely distressing Wales each year. In recent years, new Sarah Bailey has extensive clinical condition. Increased levels of distress abortion methods have increased experience working as a clinical and anxiety are common during the choices for women. The decision to nurse, research nurse, midwife and early waiting period of any subsequent terminate a pregnancy is not easy and health visitor, mainly within the pregnancy whilst the woman waits for can be influenced by many factors, arena of women’s health. In 2013 confirmation that her pregnancy is which may impact on how a woman she was awarded a National Institute ongoing and viable (Ockhuijsen et al copes with the procedure. of Health Research (NIHR) Clinical 2013, 2014), posing a significant threat Aims: To investigate whether women Doctoral Research Fellowship. Her to the woman’s psychological well- felt that they were able to choose their research investigated the development being. TOP method of choice, what factors of supportive paradigms of care for influenced their choice and what effect Methods: A qualitative process women who have experienced recurrent their choice had on emotional responses evaluation employed semi-structured miscarriage and focused on improving and satisfaction with care. interviews to explore initial experience their psychological well-being during of pregnancy following RM. This was the early ‘waiting period’ of a new Methods: A mixed method prospective nested within a two-centre feasibility pregnancy. She successfully completed comparative study in which women study of a novel self-help intervention her PhD in 2018. Post-doctorally requesting a TOP between 5 and 18 aimed at improving psychological Sarah works in a novel cross division weeks gestation under Ground C of wellbeing during the stressful waiting clinical/academic/specialist research the 1967 Abortion Act were asked to period of a new pregnancy. Data for role. This has enabled her to develop a complete a semi-structured pre-TOP this study were collected between April specialist role leading the development interview and questionnaire and a 2014 and May 2018. Data saturation and evaluation of supportive nursing post-TOP questionnaire four weeks was achieved after 14 interviews and care for recurrent miscarriage patients after the procedure. Quantitative data analysed using a thematic network working as an academic lead for this was collected using the Patient Health approach (Attride -Stirling 2001). speciality and to develop the next step Questionnaire, Generalised Anxiety Results: Six main organising themes in her programme of research whilst Disorder Scale, Positive and Negative were identified: maintaining her established links with Affect Scale, Impact of Event Scale (Revised) and Client Satisfaction 1. ‘Preparing for the worst’ - Women research nursing. She is one of the Questionnaire. Statistical analysis was reported that they ‘prepare for the NIHR Training Advocates (Nursing) carried out using SPSS. Qualitative worst,’ fully expecting a further information was analysed using content miscarriage to occur. analysis. 2. Uncertainty and emotional turmoil Results: 120 women were included in - Women continually ruminate the study, this represents 37.4% of the between the potential outcomes women invited to participate. Pre-TOP of their new pregnancy. Levels of emotion-based factors did not differ anxiety and worry are extreme, between abortion method groups. Most affecting every aspect of their lives. women felt they were able to choose 3. Monitoring for symptoms of their preferred method. Decisions ongoing pregnancy - Women were were based on factors associated hyper-vigilant in their monitoring with the procedure, lifestyle or social and checked compulsively for onset circumstances, emotional or other of vaginal bleeding.

42 Concurrent session 4: Wednesday 4 September 2019

factors. When no choice was perceived 4.5 Theme: Workforce people. Negative themes included a lack reasons reported were: of time for practice, fears of stigma, 1. gestation too far along Session no: 4.5.1 Abstract no: 0234 and difficulty keeping a regular practice schedule due to shift work. or Research Topic: Mental health, Research Process Issues, Workforce and Employment Discussion and Conclusions: 2. an appointment not available in the (including health and wellbeing roles, There was significant interest in the required timeframe. research careers) continued use of workplace-facilitated These women found the procedure Methodology: Mixed mindfulness programming for stress more stressful. All women reported Research Approach: Mixed Methods reduction. Participants requested more high satisfaction with care. Research flexible practice and content delivery Conclusion: Being able to choose options, as well as content tailored to preferred method is important in Using mindfulness training health care-specific workplace stressors. reducing procedure-related stress and Research is currently underway to ensuring high satisfaction with care. to mitigate workplace stress develop health care-specific content and Service development can be improved and burnout risk for nurses practices for the workplace. Providing by understanding patient’s experiences. and staff during mandated workplace-based mindfulness training Biography organisational change can reduce the risk of stress, burnout, and staff turnover in health care Presenter: Sara Belton, RN, College of Joanne is a registered nurse with over organizations. 30 years working in women’s health. Nursing, University of Saskatchewan, She is currently employed as Consultant Canada Biography Nurse Gynaecology at Sheffield Abstract Dr Sara Belton is an Assistant Professor Teaching Hospitals Foundation Trust, at the College of Nursing, University Background: Research has shown specialising in early pregnancy and of Saskatchewan, Saskatoon, Canada. how workplace stress negatively affects abortion care. She is also a qualified She is a former Emergency Room nurses, and can influence burnout sonographer. Her research interests nurse who has worked in global health and staff turnover in health care include the patients and staffs research, health policy and planning, organizations.1,2,3 In 2018, thirteen experiences, and she is currently PI on and health system administration and local health networks were mandated to a number of local and national research management. She received her PhD combine into one provincial system in projects. She is the co-founder and in Social Psychology from the London Saskatchewan, Canada. In an attempt co-chair of British Society of Abortion School of Economics for a dissertation to mitigate the potential workplace Care Providers. She was previously a that focused on the barriers and stress of nurses and other staff during member of the RCN Women’s Health facilitators of health system access this transition, an online mindfulness Forum and has worked on national for children and families affected training course was provided to all guideline development groups for the by HIV/AIDS. Her current area of employees. The impacts of this program RCN, RCOG and NICE. research examines the use and impact and implications for nursing practice of mindfulness-based interventions settings will be discussed. on workplace stress and occupational Aims: To discuss the results of this health. research and apply them to nursing practice issues, particularly workplace stress, burnout, and staff well-being. Methods: After completion of a one Session no: 4.5.2 Abstract no: 0110 month online course, self-selected Research Topic: Workforce and participants (N=87) reported their Employment (including health and wellbeing experiences and outcomes via an roles, research careers) online survey or in-person interview. Methodology: Questionnaire Data collection took place during Research Approach: Survey May- December 2018, and included quantitative and qualitative questions on the barriers and facilitators of Violence and aggression program participation and personal experienced by New experiences. Thematic analysis was Zealand nurses used to group and categorize responses Presenter: Jinny Willis BSc for their qualitative content, with (Hons) PhD, New Zealand Nurses quantitative analysis ongoing. Organisation, New Zealand Results: Participants reported the Co-presenters: Sue Gasquoine, New course was beneficial in reducing their Zealand; Sandra Richardson, New stress, with over 75% interested in Zealand; Paula Grainger, New Zealand continuing a workplace-based practice. Positive themes included improved Abstract personal life and workplace satisfaction, Background: Violence and aggression decreased stress and anxiety, and against nurses is common in health increased coping and tolerance when care settings but national data for New facing challenging situations and Zealand is lacking.

43 Concurrent session 4: Wednesday 4 September 2019

Aims: To determine the prevalence of ranging from epidemiology studies to critical tipping/turning points and violence and aggression against New randomized controlled clinical trials of personal thresholds. The large sample, Zealand nurses. novel therapies for diabetes and lipid volume, and depth of disclosures made Methods: The New Zealand Nurses disorders. the adversities more easily detected, Organisation (NZNO) is a professional leaving no doubt concerning the and industrial organisation with a demanding and high-risk nature of total membership of more than 52,000 nurses’ work. Session no: 4.5.3 Abstract no: 0486 nurses, midwives, health-care workers Conclusion: These unique insights and students. An online survey, hosted Research Topic: Workforce and concerning adversities experienced on the Survey Monkey (Pro) platform, Employment (including health and wellbeing by nurses within the environment was sent by email to a randomly roles, research careers) that they respond to it, can inform selected sample of NZNO members. Methodology: Mixed practice, education, policy and research. Questions asked specifically about Research Approach: Survey Even if nurses have high intrinsic physical assault, verbal abuse and resilience resources if their external sexual innuendo directed against nurses environment is poor, their risks will by patients/service users or relatives. A mixed methods research be increased; knowing these risks Free text comments were also collected. study: Exploring resilience is key to appropriate interventions Standard demographic questions in contemporary nursing being instigated. More broadly, this including gender, age, qualifications roles in Wales improved understanding can help and ethnicity were also included. nurses’ resilience and lead to better Presenter: Judith Benbow MA, School Consent was implied by completion and environmental support for nurses of Health care Sciences, Cardiff submission of the survey questionnaire. striving to deliver quality care. University, UK Results: Data were collected between Co-author: Daniel Kelly, UK; Aled Biography 8 January and 12 February 2019. Jones, UK Judith Benbow has a background A total of 1436 responses were Abstract in adult critical care nursing and received, representing a response has enjoyed a variety of clinical and Background: Nursing is categorised rate of 29.6%. Over the preceding 12 educational roles. Judith is currently as a highly stressful occupation, stress months, a total of 260 (25%) members Senior Lecturer at Cardiff University’s and burnout are known consequences reported being physical assaulted; School of Health care Sciences and of health care workplace adversity, 637 (62.5%) members reported being Royal College of Nursing Wales PhD which can negatively affect care. verbally abused and 215 (21.4%) had Research Fellow. experienced sexual innuendo, abuse or Resilience can buffer stress. Nurses’ threats from patients/service users or ability to perform is inextricably linked relatives. In an average week, 35% of to challenges and support available respondents experienced verbal abuse (Maben et al, 2012). However, limited and 12% of respondents were subjected research exists that examines nurses’ to physical assault. understanding of resilience and its Discussion: Violence and aggression relevance to workplace environments. against health care staff has previously Aim: To explore a more holistic socio- been reported in a regional emergency ecological (Ungar 2011) examination department in Christchurch, New of nurses’ resilience. To provide novel Zealand. This first national survey insights into the intrinsic and extrinsic confirms that violence and aggression influences, that shape resilience of against health care staff is not a nurses in Wales. regional phenomenon, nor restricted to Methods: A mixed methods design emergency department staff. consisting of a purposely-designed Conclusion: The extent to which New questionnaire and analysis of free Zealand nurses experience physical or text responses exploring perceptions verbal abuse in the course of performing of resilience and work environments their role is unacceptably high. These was employed (December 2016). data will inform development of policy Participants included Registered and procedures to reduce violence and Nurses (N = 1459) from across Wales, aggression against nurses. quantitative and qualitative responses Biography including 8,000 free-text comments (over 89,000 words), were descriptively Dr Jinny Willis is the Principal analysed utilising “Smart Survey”, Researcher for the New Zealand Nurses SPSS, Excel and Microsoft Word and Organisation. Prior to her appointment shared with stakeholders (March 2018). to this role in 2017, Jinny was Findings: The number and scope employed as a Scientific Officer in the of adversities experienced will be Lipid and Diabetes Research Group at discussed, within the context of Christchurch Hospital. Undergraduate recent research and policy. First, training in Clinical Biochemistry and environmental then individual a PhD in Biochemistry led to research adversities including factors that can including laboratory and clinical studies increase the risks for nurses. Then

44 Concurrent session 4: Wednesday 4 September 2019

4.6 Theme: Patient Use of quality managers and six residents. Session no: 4.6.3 Abstract no: 0326 Analysis highlighted four key themes Mobile Applications Research Topic: Primary and Community around good practice: Care, Patient Experience, e-Health Session no: 4.6.1 Abstract no: 0118 1. Training (including informatics and telehealth) WITHDRAWN 2. Food Methodology: Mixed 3. Quality and Safety Research Approach: Systematic Review and other Secondary Research 4. Workforce. Session no: 4.6.2 Abstract no: 0246 Themes were used to design a digital guide incorporating text, photographs A mixed methods Research Topic: Older People, Service and videos, to enable staff to use the systematic review of the Innovation and Improvement evidence to support their residents to effects of patient online self- Methodology: Mixed eat and drink safely. diagnosing in the ‘smart- Research Approach: Mixed Methods The guide was piloted by 57 staff over Research phone society’ on the health 12 weeks. Remote monitoring of activity care professional-patient showed that pages were displayed a A consensus-based total of 1913 times, with Food as the relationship and medical approach to the most viewed section (33%). authority development of a digital 73% of people reported the guide Presenter: Annabel Farnood, PhD dysphagia management helped them do their job more student, University of Glasgow, UK effectively and 88% would recommend Co-authors: Bridget Johnston, UK; guide for care homes it to others. 90% reported the guide was Frances Mair, UK Presenter: Sue Pownall PhD, Sheffield easy to use. Abstract Teaching Hospitals NHS Foundation Discussion: Using a co-design Trust, UK Background: The internet is approach to the development of a becoming increasingly popular and Co-presenters: Elizabeth Barnett, UK; digital guide to support dysphagia Julie Skilbeck, UK becoming a commonplace for patients management in care homes resulted to self-diagnose and seek health Co-authors: Sally Fowler Davis, UK; in a resource which was evaluated Angel Jimenez-Aranda, UK information online. It is important to positively for content, design and understand the influence this may have Abstract usability. Funding is now being sought on the patient-health care professional Background: Dysphagia (difficulty for a large scale evaluation. relationship. swallowing) is common in older people. Biography Aims: To systematically review Up to 75% of nursing home residents Sue Pownall is Head of Sheffield Adult qualitative, quantitative and mixed have swallowing difficulties. Effective SLT Service, Honorary Professor at method evidence concerning the management of dysphagia is complex Sheffield Hallam University and the public and health care professionals’ and multi-dimensional. Without proper Academic Director for the Therapeutics perceptions of public online self- understanding of what is needed and Palliative Care Directorate in diagnosis and health information residents’ health and well-being are Sheffield Teaching Hospitals NHS seeking, and how this can impact compromised. An integrated whole Foundation Trust. Sue is co-lead for the patient-health care professional systems approach across both catering the Yorkshire and Humber CRN AHP relationship. and clinical services is required. Specialty Group and also co-lead of Methods: The systematic literature Aim: To develop and evaluate an the South Yorkshire CAHPR Hub. search was conducted using five evidence based digital guide to Sue’s clinical specialism is in the area databases: MEDLINE, EMBASE, effectively manage dysphagia in care of dysphagia and she has extensive CINAHL, SCOPUS and ACM. Studies homes. experience of working with patients published between 2007-2018 were Study Design: A consensus based, co- who present with dysphagia resulting included. Relevant data were extracted, design approach was used to: from a range of medical conditions, and quality appraised using the mixed across clinical pathways and from both • examine the evidence-base, methods appraisal tool, and a thematic acute and community settings. Sue is views of residents, staff and analysis was conducted. The theoretical an active researcher with an interest in company representatives to framework for the review was assessment and treatment interventions better understand management Normalisation Process Theory (NPT) – for dysphagia, implementation of and shared decision-making in all results were mapped using the NPT research into clinical practice and dysphagia care framework. educational approaches to skill sharing Results: Twenty-eight articles met the • co-design a digital guide that across professional boundaries. promotes adoption of best practice inclusion criteria for the review. The findings indicated that patients found • conduct a validation process of the the internet to be a complementary guide. information source alongside health Findings: A purposive sample of care professionals, as well as a means four homes were recruited. Eight for self-diagnosis. People used the focus groups were conducted with 37 internet to reduce uncertainty, often members of the workforce and semi- because they had not fully understood structured interviews were carried out everything said in consultations. with four care home managers, four Patients tended to present information

45 Concurrent session 4: Wednesday 4 September 2019

to the health care professional to 4.7 Theme: Service results of the multiple regression support the therapeutic relationship Innovation and analysis showed that nurse manager’ rather than to challenge it. Most gender and having managerial patients hoped the outcome of this Improvement experience more than seven years would help support the development Session no: 4.7.1 Abstract no: 0199 found to be the effecting factors for of a partnership with their health care organizational silence behaviour. Research Topic: Leadership and professional. Health care professionals Discussion: Nurse Managers have had mixed reviews regarding patient’s Management, Quality Standards, Workforce and Employment (including health and an important role of being the voice online health information seeking but wellbeing roles, research careers) of their subordinates in front of the generally agreed on the importance of Methodology: Questionnaire hospital executive management. collaboration with patients. Positive work environment decreases Research Approach: Quantitative (not Conclusion: Most people found included in another category) the level of silence. This study showed health care professionals to be that the nurse managers who have the most valued source of health positive work environment do not stay information. The internet has the Perception of nurse silent and raise their concerns freely in potential to be beneficial if the online managers’ workplace order to improve their organization. health information being sought, environment and its impact Conclusion: Positive work is accurate and relevant and health on organizational silence environment is a contributing factor care professionals react in a positive level for communication. Organizational and supportive manner to internet- silence can cause problems about informed patients. These findings can Presenter: Begum Yalcin BSN PhD, Koc nursing turnover and patient safety. inform recommendations for practice, University School of Nursing, Turkey Nurse managers have an important professional development and further Co-authors: Saliha Koc, Turkey; role creating a safe environment for research. Nilgun Goktepe, Turkey; Emine communication. Biography Turkmen, Turkey; Sonay Sonay Canbolat, Turkey; Nese Bakoglu, Biography Annabel Farnood is a 2nd year nursing Turkey; Sehriban Serbest, Turkey Begum Yalcin was born in Istanbul. PhD student at the University of She obtained her BSN degree from Koc Abstract Glasgow. Annabel has been a registered University School of Nursing in 2008 nurse for over four years and works Background: Organizational silence and completed her PhD on Nursing clinical hours whilst pursuing her is defined as an active and conscious Management at Istanbul University PhD. Her PhD is focused on the area of act of withholding the ideas that can in 2017. She worked as an ER nurse digital health and specifically focuses improve the organization. Workplace between 2008-2011. Since 2011 she on online self-diagnosis and the impact environment can affect the climate has been working at Koc University this has on the relationship between the of the organizations’ communication School of Nursing as a lecturer. She public and health care professionals. styles. Behaviours of managers as role teaches nursing management and models are effective in the employee supervise students in clinical settings. silence within the organization because She is also an Instructor for Semahat they are responsible for creating strong Arsel Nursing Education and Research organizational cultures that can support Center. This centre is a continuing professional nursing practice. education centre for professional Aim: This study aimed to determine nurses. Her research interests are the relationship between workplace teamwork development strategies, environments that may affect nurse organizational communication and managers’ silence behaviours. silence, and nursing education. Method: This study conducted in hospitals chains in Turkey between April 2018-July 2018. Nurse Session no: 4.7.2 Abstract no: 0271 Manager Practice Environment Scale, Organizational Silence Behaviour Scale WITHDRAWN and sixteen social-demographic and job related questions were asked to the participants. The questionnaire were sent via email to the all 265 nurse managers working in that hospital chains. Results: 169 nurse managers participated into the study. The results indicated that nurse managers had low scores from organizational silence behaviour scale (2.46±.69) and high scores from nurse- manager practice environment scale (4.94±.55). Due to the results of Pearson Correlation analysis, there was a strong negative correlation between two scales. The

46 Concurrent session 4: Wednesday 4 September 2019

Session no: 4.7.3 Abstract no: 0348 and analysis.2 5.1 Theme: End-of-life Care Research Topic: Service Innovation and Results: Early results suggest Session no: 5.1.1 Abstract no: 0107 Improvement, Chronic Illness SNAP is acceptable to HCPs and Methodology: Interviewing patients with COPD across settings; Research Topic: End of Life Care, Cardiovascular Disease and Stroke Research Approach: Qualitative modifiable implementation barriers approaches (eg: discourse analysis, were identified. Patients described Methodology: Interviewing ethnography, critical theory, grounded how SNAP facilitated expression of Research Approach: Qualitative theory, phenomenology) their unmet support needs. HCPs approaches (eg: discourse analysis, reported how SNAP enabled new ethnography, critical theory, grounded needs-led conversations (including theory, phenomenology) Facilitating person- future care conversations), even where centred care: Feasibility patient-HCP relationships were well- Bereaved families’ and acceptability of the established. Analysis completes May experiences of end-of-life Support Needs Approach 2019. care in the acute stroke for Patients (SNAP) Discussion: Enabling patients to identify and communicate their support setting in Wales, UK: A Presenter: Morag Farquhar PhD MSc needs to HCPs, including supportive BSc (Hons) RGN PGCert, University of qualitative interview study input in responding to those needs, East Anglia (UEA), UK Presenter: Tessa Watts PhD MSc BA has the potential to enable delivery Co-authors: Carole Gardener, UK; Gail (Hons) RN (Adult), Cardiff University, of person-centred care. Identifying Ewing, UK School of Health care Sciences, UK modifiable barriers will inform SNAP Co-authors: Manju Krishnan, UK; Abstract training refinement. Mohammed Bakar, UK; Tal Anjum, Background: The Support Needs Conclusion: SNAP appears feasible UK; Jaspal Mann, UK; Sophie Picton, Approach for Patients (SNAP) is and acceptable, benefitting patients UK; Sharon Storton, UK; Lynda a 5-stage complex intervention to with COPD and their HCPs across care Connor, UK; Sarah Yeap, UK; Mushtaq facilitate delivery of person-centred settings. https://thesnap.org.uk/ Wani, UK care in progressive non-malignant conditions, such as chronic obstructive Biography Abstract pulmonary disease (COPD). Morag has worked in health Background: Stroke is the second services research for over 30 years, SNAP intervention comprises: leading cause of death worldwide predominantly in palliative and and the fourth in the UK (Stroke 1. the validated SNAP tool: designed supportive care. An early graduate Association 2018). Despite impressive for purpose, comprising 15 nurse (King’s College London), she advances in diagnostics, therapeutics evidence-based questions to help holds a Masters in Medical Sociology and care, dying within thirty days of patients consider areas where they and PhD (University of London) on hospitalization following severe acute may need more support1 the definition and measurement of stroke is unfortunately not uncommon 2. the SNAP approach: a needs-led quality of life in older people. Research (Cowey et al, 2015). Improving end- conversation between the patient interests include breathlessness in of-life care after stroke is a priority and health care professional (HCP) advanced disease, palliative care, of international governments and to express, prioritise and address informal carers, older people, and professional organisations. This unmet support needs identified methodology – particularly developing paper reports findings from a through the patient-completed and testing of interventions. As a larger evaluation of a staff training tool. Senior Lecturer at UEA she leads a intervention for end-of-life care after Feasibility and acceptability of SNAP in research programme on improving stroke in one University Health Board clinical practice requires investigation. care and support for patients and in Wales, UK. carers living with advanced disease, Aim: To explore the feasibility and Aim: This study sought to explore including the SNAP and Learning about acceptability of the SNAP intervention bereaved families’ experiences of end- Breathlessness programmes. in clinical practice. of-life care after stroke following the • SNAP (the Support Needs training intervention’s implementation. Methods: HCPs from three care Approach for Patients) is settings (primary, community, Method: A qualitative exploratory developing and testing an secondary) were recruited in the approach was adopted. A convenience intervention to enable person- East of England. SNAP-trained HCPs sample of bereaved (> three months) centred care in progressive disease implemented the intervention with family members of people who had died (Marie Curie grant): https:// patients with COPD (n=56) over a in the acute stroke setting following thesnap.org.uk four-month period and participated a severe, acute stroke was recruited in monthly qualitative interviews to • Learning about Breathlessness by health board research nurses monitor tool use and identify modifiable (LaB) is developing an educational between February and May 2018. barriers to SNAP delivery. Purposively intervention for carers of patients Data were generated using in-depth, sampled patients (n=20) who received with breathlessness in advanced semi-structured, face to face, digitally the intervention were interviewed about malignant and non-malignant audio-recorded interviews, either in the experience. End of pilot HCP focus disease (LaB2: NIHR RfPB grant). participants’ homes or at the University. groups explored barriers and facilitators Interviews were fully transcribed, to delivering SNAP (data collection: anonymised and analysed using Braun July 2018-March 2019). Normalisation and Clarke’s (2006) thematic approach. Process Theory guided data collection

47 Concurrent session 4: Wednesday 4 September 2019

Results: Nine women participated. support, but many lack knowledge/ the definition and measurement of Analysis identified three major themes: confidence in caring, experiencing quality of life in older people. Research doing care at the end-of-life; toward anxiety and helplessness. The Learning interests include breathlessness in the realisation of a certain manner of about Breathlessness programme advanced disease, palliative care, good death and the variable nature and (LaB) is addressing this. LaB1 informal carers, older people, and quality of interaction with health care identified six topics carers want to methodology – particularly developing professionals. learn about breathlessness1. LaB2 and testing of interventions. As a Discussion: In terms of delivering is working with carers and clinicians Senior Lecturer at UEA she leads a compassionate, dignified, individualised to co-develop a prototype web-based research programme on improving comfort care to dying people, families’ educational intervention for carers on care and support for patients and experiences were positive. However, breathlessness. Content for five of the carers living with advanced disease, participants articulated needs for better six topics has been established, but including the SNAP and Learning about privacy throughout the dying trajectory we need to understand more about Breathlessness programmes: and timely, proactive communication learning needs for the sixth topic, • SNAP (the Support Needs with health care professionals. “Knowing what to expect in the future”. Approach for Patients) is Conclusion: End-of-life care after Aims: To establish what carers of developing and testing an stroke in acute hospital environments people with breathlessness in advanced intervention to enable person- is challenging and communicating with disease want to learn about “Knowing centred care in progressive disease families of imminently dying people is what to expect in the future”. (Marie Curie grant): https:// delicate, difficult territory. Nevertheless, Methods: Two disease-specific focus thesnap.org.uk there is still much work to do in terms groups and six interviews conducted • Learning about Breathlessness of supporting health care professionals’ (January 2019) with bereaved carers (LaB) is developing an educational to have timely, open, sensitive of people with breathlessness due to intervention for carers of patients communication with these families. cancer/COPD (n=12) recruited across with breathlessness in advanced Biography settings. Data were sought on what malignant and non-malignant carers would have liked to have known disease (LaB2: NIHR RfPB grant). Tessa is a Senior Lecturer in the School about “what to expect in the future”. of Health care Sciences at Cardiff Data transcribed; content analysis University. Tessa is a qualitative conducted; validation sought from researcher with an academic grounding Carer Advisory Group (CAG) and Study Session no: 5.1.3 Abstract no: 0464 in the social sciences and nursing. Advisory Group (SAG: includes clinical Research Topic: End of Life Care She is particularly interested in end of experts). life care nursing and the boundaries Methodology: Other collection method between palliative and end of life care. Results: Carers wanted to learn Research Approach: Systematic Review about: coping with symptom changes and other Secondary Research as the patient’s condition worsened, discussing ‘the future’ with others, The palliative care needs Session no: 5.1.2 Abstract no: 0397 accessing care/support, administrative tasks (for example, death registration), of people with motor Research Topic: End of Life Care and coping with emotions after patient neurone disease (MND) and Methodology: Focus Groups death. Findings were validated by the their informal caregivers: Research Approach: Qualitative CAG and SAG. Follow-on workshops approaches (eg: discourse analysis, with current carers and patients A qualitative evidence ethnography, critical theory, grounded reviewed the resulting draft topic synthesis theory, phenomenology) webpages for utility and sensitivity. Presenter: Kate Flemming PhD MSc Discussion: Bereaved carers were PG Cert BSc (Hons) RN, University of What do informal carers able to express what they would have York, UK of people living with liked to have known regarding what to Co-author: Victoria Turner, UK breathlessness in advanced expect in the future, enabling creation Abstract of sensitive website content. disease want to learn about Background: Despite being a “Knowing what to expect in Conclusion: This study establishes terminal neurodegenerative disease, relevant and appropriate content the future”? the role of palliative care is less for what carers of people with recognised for MND than for conditions Presenter: Morag Farquhar PhD MSc breathlessness in advanced disease such as cancer. Understanding the BSc (Hons) RGN PGCert, University of want to learn about “Knowing what to palliative care needs of patients and East Anglia (UEA), UK expect in the future”. carers impacts on, and guides, the Co-authors: Sylvia Barnes, UK; Gail Biography development of health care services and Ewing, UK policy for this population. Morag has worked in health Abstract services research for over 30 years, Aim: To explore the palliative care Background: Breathlessness is predominantly in palliative and needs of adult patients and their distressing, disabling and common supportive care. An early graduate informal carers living with MND, in advanced cancer and non-cancer nurse (King’s College London), she or bereaved carers of people with conditions. Informal carers (family holds a Masters in Medical Sociology MND through a qualitative evidence members/friends) provide unpaid and PhD (University of London) on synthesis.

48 Concurrent session 5: Wednesday 4 September 2019

Method: Four electronic databases and Implementation Methods Group. 5.2 Theme: Children and were searched (MEDLINE, CINAHL, Kate has recently worked with the Young People PsycINFO, Social Science Citation WHO on the use of qualitative Index), from inception until November evidence synthesis to inform guideline Session no: 5.2.1 Abstract no: 0447 2018 using terms for MND, ALS, development for complex interventions. Research Topic: Children and Young palliative care, and a qualitative People research filter. Relevant data were Methodology: Other collection method extracted from included papers and checked by a second reviewer. Papers Research Approach: Qualitative were appraised for quality although approaches (eg: discourse analysis, ethnography, critical theory, grounded there was no a priori threshold for theory, phenomenology) excluding papers. The review was conducted using Thematic Synthesis (Thomas and Harden 2008). Children coming to Results: The searches identified 410 hospital: Working with internationally based papers of which children to develop child- 39 were included, representing the centred resources experiences of 480 people with MND Presenter: Lucy Bray RN (Child), BA and 373 informal caregivers. (Hons) MSc PhD, Edge Hill University, Two analytical themes were UK determined. The first related to Co-authors: Bernie Carter, UK; experiences at distinct biographical Ed Horowicz, UK points in the MND disease trajectory through which all individuals passed. Abstract The second represents commonalities in Background: Despite the evidence experiences which overlay the trajectory highlighting the positive outcomes of disease, including living a life which for children who are informed and contained uncertainty, unremitting supported when having procedures loss and a need to plan for the future. such as X-rays and blood tests, we know Palliative care was rarely discussed and that children continue to have poor was associated by patients and carers experiences of undergoing procedures. with end of life only. There is a lack of empirical data directly from children about how they can be Discussion and Conclusion: best supported before, during and after Despite being a life-limiting condition procedures. people with MND and their carers have limited awareness of, or involvement Aim: This presentation will discuss a with, palliative care services. There are research study which aimed to develop clear points in the disease trajectory a deeper understanding of what where palliative care input could impact children want in terms of information on and enhance patient and carer and support during procedures and experience of the disease, particularly at showcase the resource developed from times of significant physical change. the findings. Biography Methods: This participatory qualitative research study used Dr Kate Flemming is a highly drama as a creative method. Two experienced academic and nurse, drama workshops used scenarios to internationally known for her leading help children improvise and express research and service innovation in their opinions and thoughts about palliative care nursing. Kate leads procedures. Children with experience by example through her pioneering of hospital were recruited through clinical leadership and research in flyers distributed to drama groups Palliative Care within the Hospice within the UK. Semi-structured field and community settings most notably notes captured the dialogue, phrases involving St Leonard’s Hospice, York. and actions of the scenes. Data were Kate’s research programme focuses on collected in October 2018. Thematic complex interventions including patient analysis was used to identify, analyse and carer experience of palliative and develop themes. care across different service models, Results: Fifteen children aged seven disease types and morbidities, including to 14 years participated in the drama motor neurone disease and heart workshops. Two themes of ‘having to failure. This work is closely integrated be brave but feeling scared inside’ and with her methodological expertise in ‘wanting to get involved but feeling too qualitative evidence synthesis. Kate is afraid to ask’ were generated. Children internationally known for her quality felt ‘left-out’ of adult-dominated approach to research and acts as co- interactions in hospital and they wanted convener of the Cochrane Qualitative

49 Concurrent session 5: Wednesday 4 September 2019

to know more about what would happen Abstract nurse and academic with over 20 during their procedure and have some Background: If children are prepared years of experience of working with choice in how procedures were carried and informed about what will happen children, young people and families, out. throughout a procedure such as an both clinically and as a researcher Discussion: The findings informed X-ray or blood test, they are more likely within a range of health care settings. the development of a resource called to have a positive experience. Despite Lucy is passionate about improving the Children Coming to Hospital, consisting this children frequently have unmet health of children and young people of animations and a comic which aims information needs resulting in them and most of her work focusses around to ensure evidence directly impacts and experiencing uncertainty and anxiety. using innovative methods to facilitate hopefully improves the experiences of Finding out what children want to the involvement of children and young children attending hospital for planned know before they attend hospital for people in research and their health procedures. a procedure could provide benefits care. Lucy Bray is a Professor of Child Health Literacy and her work focusses Conclusions: Children need to be able to for children, their families and health professionals. on the education, information needs access resources to help them know what and preparation of children, young is going to happen before, during and after Aims: This research aimed to people and their parents for surgery, their procedure. investigate children’s information Biography procedures and interventions. Her work needs before they attend hospital for a explores how children and young people Professor Lucy Bray is a children’s planned procedure. The study aimed to can be provided with information in a nurse and academic with over 20 directly inform the development of an meaningful and timely way and how years of experience of working with app (Xploro) specifically designed for this influences their interactions with children, young people and families, children. health professionals. both clinically and as a researcher Methods: An activity sheet within a range of health care settings. underpinned a semi-structured Lucy is passionate about improving the qualitative interview with children health of children and young people attending hospital in the UK for a Session no: 5.2.3 Abstract no: 0463 and most of her work focusses around planned procedure. The interview Research Topic: Children and Young using innovative methods to facilitate focussed on the information children People, Patient Experience, Cancer the involvement of children and young thought was important or useful to Methodology: Observation people in research and their health know before coming to hospital for a care. Lucy Bray is a Professor of Child procedure. Data were collected from Research Approach: Case Study Health Literacy and her work focusses April to July 2018 and analysed using on the education, information needs content analysis techniques. “It’s a very good vehicle to and preparation of children, young Results: 106 children aged between create your relationship”: people and their parents for surgery, 8-12 years participated in an procedures and interventions. Her work Importance of the physical interview. Many children expressed environment when explores how children and young people that they had unmet information can be provided with information in a needs regarding their procedure. The creating a social hospital meaningful and timely way and how children identified three categories of environment this influences their interactions with important information to know before health professionals. Presenter: Sarah Lea, University a procedure; procedural information, College London Hospitals NHS sensory information and self-regulation Foundation Trust, UK information. Children thought it was Co-authors: Rachel Taylor, UK; Faith Session no: 5.2.2 Abstract no: 0446 important to know procedural and Gibson, UK sensory information first and then Research Topic: Children and Young scaffold this with information to help Abstract People them cope with and self-regulate the Background: Specialist units for Methodology: Interviewing situation. teenagers and young adults (TYA) with Research Approach: Qualitative Discussion: This study demonstrated cancer are estimated to provide for only approaches (eg: discourse analysis, that children have unmet information half of TYA in England; the rest being ethnography, critical theory, grounded needs regarding procedures; the cared for in child/adult environments. theory, phenomenology) information they perceive as important Centred mainly on specialist units can vary to that currently provided to alone, previous research has described Children’s information them by health services. The findings the importance of the environment on from this study have directly informed experiences of cancer care. Whether needs before coming to this is the same or different for all hospital for a planned the development of an app (Xploro) for children attending hospital for places of care has yet to be determined. procedure: Informing the procedures. Aims: To explore the impact of the development of a child- Conclusion: It is important that physical health care environment on centred app resources for children are developed young people and professionals’ social experiences during care. Presenter: Lucy Bray RN (Child) BA with children to ensure their content is (Hons) MSc PhD, Edge Hill University, child-centred. Methods: A multiple-case study was conducted in 28 hospitals in England, UK Biography Co-authors: Ashley Sharpe, UK; between 2014-2015, across child, Professor Lucy Bray is a children’s Victoria Appleton, UK TYA, and adult settings. It included:

50 Concurrent session 5: Wednesday 4 September 2019

semi-structured interviews with TYA Results: Hand hygiene adherence (n=29) and health care professionals rate (number of hand hygiene activity (n=41); observations in 24 hospitals observed divided by total number (total=120hrs). Thematic analysis was of opportunities) was 46.24%. Key used to analyse transcripts/field notes. 5.3 Theme: Infection themes that arose out of the interview Results: Three key themes were Prevention and Control data included how nurses identified apparent relating to the physical and patients who may be at increased Session no: 5.3.1 Abstract no: 0036 social environment and the relationship risk of developing an infection, their between the two. The provision of a WITHDRAWN perceptions of how they adhere physical space for socialising was vital to infection control practices, and as it enabled: TYA to come together; specific characteristics of the home engage in peer support opportunities; Session no: 5.3.2 Abstract no: 0293 environment which may inhibit infection control practices. socialise with existing peers; and to Research Topic: Patient Safety (including spend time with their family away from human factors, infection, prevention and Discussion: Previous research has their hospital bed. Although fun, bright control etc) highlighted that home care nurses self- décor was beneficial, the impact of the Methodology: Mixed reported a high-rate of compliance with social space had greater significance. Research Approach: Mixed Methods infection control practices (Russell, The majority of those in child/adult Research et al, 2018). The results of this study settings reported poor experiences of suggest that actual compliance with social interaction when in hospital. infection control practices, such as Infection prevention Discussion and Conclusion: This hand hygiene, is low. There are specific study has compared experiences across and control in homecare factors related to the environment child/adult settings, against those in settings: Results of an which need to be taken into account bespoke TYA care: advocating for the observation and interview when exploring infection prevention for patients being nursed in community provision of dedicated spaces which study bring TYA together. Previous research settings. Presenter: Dawn Dowding PhD has reported that TYA have a poor Conclusions: Results from this RN FAAN, Division of Nursing, experience in adult (Dean and Black, study can be used to inform future Midwifery and Social Work, School 2015), and child care settings. Services initiatives to improve infection control of Health Sciences, The University of must be skilfully developed to create and prevention practices in home care Manchester, UK optimal spaces to deliver holistic, age- nurses. Co-authors: David Russell, USA; appropriate care (Lea et al, 2018). This Marygrace Trifilio, USA; Margaret Biography will assist the structure, design and McDonald, USA; Jingjing Shang, USA commissioning of TYA health services Dawn Dowding is Professor in Clinical that are fit for purpose. Abstract Decision Making, Division of Nursing, Midwifery and Social Work, School Background: In the USA, a significant Biography of Health Sciences, University of portion of home health patients are re- In 2013, Sarah joined the Manchester, UK. She is a health services hospitalised during their episode of home BRIGHTLIGHT study team as a PhD researcher, nurse and psychologist care because of infection (Shang, et al, student, sponsored by London South with expertise in the field of health 2015). There has been little prior research Bank University. Sarah’s particular care decision-making and nursing on infection control practice, including part of the project is a case study informatics. Her particular research barriers and facilitators to infection looking at the culture of care and care interests are the development and prevention, in home care settings. experiences of young people with evaluation of decision support tools, cancer, not only in specialist centres Aims: To assess home care nurses’ and more recently the application of but also out in different hospital infection control practices and barriers/ Health Information Technology for settings. Sarah has recently completed facilitators to effective infection assisting decision making in practice. her doctorate. Previously a Sports prevention and control in a home care Before her position at Manchester, Therapist and then qualifying as a agency. Dawn was Professor of Nursing at children’s nurse as a post-graduate, Methods: A mixed-methods study. Columbia University School of Nursing Sarah has worked as a staff nurse in Fifty home care nurses were observed and the Visiting Nurse Service of New the teenage and young adult cancer across eight home care visits each (400 York (which is the largest not-for- service in University College London observations). Data on infection control profit home care agency in the USA). Hospital alongside doing her PhD. practices were collected between Additional past appointments include Last year, she stepped away from November 2017 and October 2018 Professor of Applied Health Research, the clinical area to focus full-time using the WHO hand-hygiene tool. University of Leeds UK and a Harkness on her development as a researcher, Following the observations, all nurses Fellow in Health Care Policy and and currently works as the Research were interviewed about their views of Practice from 2009-2010, working Facilitator for the BRIGHTLIGHT team. infection control. at Kaiser Permanente, Oakland, This role entails working on aspects of Adherence rates for hand hygiene California. Dawn is an elected fellow of the BRIGHTLIGHT study, in addition were calculated from observation the American Academy of Nursing. to working on some of BRIGHTLIGHT’s data. Interviews were transcribed and affiliated studies. ​ analysed using thematic analysis.

51 Concurrent session 5: Wednesday 4 September 2019

Session no: 5.3.3 Abstract no: 0233 Discussion: The results suggest a necessity for change interventions. Research Topic: Patient Safety (including human factors, infection, prevention and Infection Prevention and Control control etc) policies need to be well-defined Methodology: Mixed regarding NSG use, more accessible, and form part of mandatory training. Research Approach: Mixed Methods Research With current NHS and societal emphasis upon sustainability and environmental assets, use of resources Use of non-sterile gloves in needs to be responsible, and based on the ward environment: An clinical understanding. evaluation of health care Conclusion: Multi-modal workers’ perception of risk interventions are recommended to and decision making change habitual and ritual behaviours. Reviewing the indications for glove Presenter: Ashley Flores MSC BSc use and amending organisational (Hons) RN Dip Infection Control, policy to reduce the indications for Surrey & Sussex Health care NHS glove use would be beneficial. Leaders Trust, UK in each professional staff group are Co-presenters: Martha Wrigley, UK necessary to influence practice across Abstract an organisation, taking into account Background: Research suggests motivating factors. that an overuse of non-sterile gloves Biography (NSG) in health care settings can affect Ashley Flores, MSc BSc (Hons) RN Dip hand hygiene compliance. Health Infection Control is a Nurse Consultant care workers (HCWs) are less likely to and Deputy Director of Infection wash their hands after wearing gloves, Prevention and Control at Surrey & consequently increasing the risk of Sussex Health care NHS Trust. She infection. initially graduated as BSc Psychology Aims: The aims of this study were (Hons) at the University of Leeds to explore the accuracy of HCW risk before completing her nurse training assessment and decision making in Glasgow in 1996. Ashley worked in regard to the use of NSG, and in a range of clinical areas before compliance with guidelines. specialising in Infection Prevention Methods: The study was conducted in and Control in 2000. She completed two acute NHS Trusts and a community her MSc in Infection Prevention and social enterprise, focusing on HCWs Control in 2006. Ashley is an active in the wards. A cross-sectional survey researcher and her interests include the of staff using a self-completion use of gloves and the effect of glove use questionnaire was conducted, followed on hand hygiene, and the management by qualitative semi-structured of urinary catheters. Ashley is also a interviews. member of the Infection Prevention Results: The data set consisted of 1084 Society Research and Development questionnaires and thirteen interviews. Committee. There were highly significant differences at the 95% probability level between staff groups, unqualified staff being significantly more likely than qualified staff to report NSG use when not indicated (p<0.0001). The primary motivating factor for staff to wear NSG was for personal protection; the secondary motivating factor being the protection of patients. Staff were motivated by a desire to create an image of professionalism, cleanliness, and to protect patients’ dignity. Respondents were more likely to follow the lead of seniors in their own profession.

52 Concurrent session 5: Wednesday 4 September 2019

5.4 Theme: Diabetes at baseline is a factor that influences Session no: 5.4.2 Abstract no: 0196 effectiveness of anti-VEGF therapy at Research Topic: Patient Education, Session no: 5.4.1 Abstract no: 0011 longer timepoints. Diabetes, Children and Young People Research Topic: Inequalities in Health Conclusions: This review showed Methodology: Other collection method Methodology: Other collection method that having a higher number of Research Approach: Systematic Review Research Approach: Systematic Review injections, a lower baseline age, and and other Secondary Research and other Secondary Research a smaller baseline lesion size, and a higher baseline visual acuity led to better effectiveness of anti-VEGF A narrative review of What demographic and therapy for nAMD. The results of this the efficacy of cognitive clinical factors influence review highlight the importance of behavioural interventions the visual response to patients receiving regular anti-VEGF to improve well-being in anti-vascular endothelial injections to achieve the best possible visual outcomes, and nurses must take young people with type 1 growth factor therapy in the lead in encouraging adherence to diabetes patients with neovascular treatment regimes. Presenter: Alice Lewis BSc (Hons) age related macular Biography Nursing (Child), Leeds Children’s Hospital, UK degeneration in the UK and Claire graduated from the University Co-author: Alison Rodriguez, UK other comparable health of Liverpool in 2010 with a degree in care settings? A systematic Adult Nursing. She then undertook a Abstract review variety of clinical roles. In 2012 she Background: Type 1 diabetes is a began a role as a specialist research long-term, complex condition that Presenter: Claire Gill BN (Hons) RGN nurse with The Brain Infections Group requires daily self-monitoring of blood MClin Res, University of York, UK at the University of Liverpool. During glucose levels and the administration Co-authors: Tracy Lightfoot, UK; this time she was also awarded a of insulin injections. Clinical guidelines Catherine Hewitt, UK; Richard Gale, part-time NIHR Masters Studentship, suggest all young people with type UK and completed a master’s degree in 1 diabetes should have psychosocial Abstract Clinical research at the University of support to help them cope with Background: It is known that nAMD Manchester in 2015. In 2015 Claire also diagnosis, emphasising cognitive is one of the leading causes of blind undertook a three month secondment behavioural therapies (CBT) (NICE, registrations in the developed world. with the University of Oxford as a 2015). With an ageing population in developed research nurse and project manager Aim: To explore whether CBT countries, this will lead to an increase on a trial for a potential treatment for interventions improve psychosocial in the burden of visual disability due to Ebola, working in Sierra Leone during well-being, self-management and nAMD. The incidence of nAMD in the the Ebola crisis. The topic of Claire’s glycaemic control in young people with UK is estimated to be 450 per million. PhD is Variation in UK neovascular age- type 1 diabetes. It is predicted that the burden of related macular degeneration outcomes. Methods: CINAHL, Medline and nAMD will increase by a third between Age-related macular degeneration is PsychINFO databases were searched to 2010 and 2020. Although the overall the leading cause of blindness in people identify 5 trials. The search was limited effectiveness of anti-VEGF treatment is aged over 50 in the developed world. to randomised controlled trial (RCT) clear, there is individual variability in studies, from year 2000 that examined clinical response and therefore visual the efficacy of CBT type interventions outcome. The pivotal phase III clinical for young people with type 1 diabetes trials of anti-VEGF agents demonstrate compared to other supportive this individual variability amongst their interventions. The quality of the studies sample of participants. were evaluated using a recognised Research aim: To explore the CASP tool (Critical Appraisal Skills demographic and clinical factors that Programme, 2017). influence the effectiveness of anti- Results: In the five trials included, vascular endothelial growth factor CBT interventions were beneficial (anti-VEGF) for neovascular macular for young people with type 1 degeneration. diabetes. Three of the trials found Methods: Study eligibility criteria: significant improvements in one or patients with nAMD being treated with more psychosocial outcomes. Most anti-VEGF, associated demographic and interventions only had positive results clinical factors, in comparable settings on glycaemic control in young people to UK hospitals. A narrative synthesis with poorest control. A combination was conducted. of coping skills training and intensive Results: 28 papers were included in diabetes management showed most this review. The main finding of this promise. review was that the number of anti- Discussion: Few RCT studies have VEGF injections that patients receive been conducted with young people with and age and lesion size at baseline are type 1 diabetes. The review found that factors that influence the effectiveness CBT-type interventions can improve of anti-VEGF therapy. Visual acuity

53 Concurrent session 5: Wednesday 4 September 2019

psychosocial well-being and self- 5.5 Theme: Education Focus group data (n=6) provides management in young people. For those deeper understanding of quantitative with the poorest glycaemic control, a Session no: 5.5.1 Abstract no: 0167 data, with themes of “not knowing”, CBT intervention alongside intensive WITHDRAWN “situating the self” “feeling real”, and “a diabetes management delivered by fuller perspective” identified. health care could improve psychosocial Discussion/Conclusion: well-being and better diabetes Participants rated their psychological outcomes. Session no: 5.5.2 Abstract no: 0361 safety during the simulation highly, Conclusion: Psychological support demonstrating that application of Research topic: Nursing, Midwifery or needs to be widely available in standard Support Worker Education simulation theory and best practices diabetes care for young people with can result in positive learning Method: Mixed greater use of CBT interventions. outcomes. However, perceptions about Health professionals require additional Research approach: Mixed Methods aspects of psychological safety in training to provide the ongoing Research relation to design components varied psychological support that young people and will be discussed in relation to need to improve self-management. The element of current literature. Our study results Further research is needed to explore psychological safety in help inform simulation development, what other psychosocial interventions and can be applicable for optimizing could improve glycaemic control and clinical simulations using simulation learning in any area of psychosocial outcomes. actors: Learner ratings and nursing education and practice. Biography experiences Biography My name is Alice Lewis and I am 24 Presenter: Faith Wight-Moffatt PhD Dr Faith Wight Moffatt is an Assistant years old. I studied BSc (Hons) Nursing RN, Dalhousie University, Canada. Professor at the School of Nursing, (Child) at the University of Leeds and Background: Use of clinical Faculty of Health and the Department gained a first-class degree. I am now simulation is common in nursing of Obstetrics & Gynecology, Faculty working as a Children’s Staff Nurse at education and practice, intended of Medicine, Dalhousie University, Leeds Children’s Hospital on a specialist to facilitate integration of nursing Halifax, Nova Scotia, Canada. She is medical ward where I care for patients knowledge, skills and attitudes in a graduate from Memorial University with anything from diabetes to asthma, scenarios designed to simulate clinical of Newfoundland, Boston College gastrointestinal diseases to epilepsy, situations in a laboratory setting. and the University of Toronto. She cystic fibrosis to sepsis etc. I have been Research to identify influences of teaches foundations of nursing, nursing qualified for nearly two years now. simulation design and other factors care of families, research methods on nursing student learning has and evidence-based practice. Her been limited, possibly restricting research passions include investigating opportunities for optimal learning. effectiveness of specific nursing Session no: 5.4.3 Abstract no: 0255 Aim: The aim of this research study interventions in strengthening physical WITHDRAWN was to investigate factors influencing and psychological health outcomes BScN student knowledge, critical of childbearing women, their babies thinking, self-confidence, satisfaction, and families, and in testing new ways psychological safety, and experiences of supporting student learning. Faith of home visit simulations with actors also is active in advocating for the portraying mothers and families with importance of inclusion/maintenance a new baby at home. This presentation of maternity nursing education as core will focus on the results specific to the in Canadian entry-to-practice nursing factor of psychological safety. education. Methods: Mixed-methods involved questionnaires and focus groups. Psychological safety data were collected via a 12 Likert-type item instrument; higher scores equate to higher perceived safety (score maximum = 52). Focus groups allowed qualitative exploration of perceptions regarding psychological safety. Our samples were of convenience; questionnaire sample size determination was for a power >.80, alpha = .05, and medium effect size. Results: Data were collected between March 2017 and April 2018, across three academic terms. The mean psychological safety score was 42.40 (SD 7.66), n= 79. Regression analysis of factors associated with psychological safety will be reported.

54 Concurrent session 5: Wednesday 4 September 2019

Session no: 5.5.3 Abstract no: 0141 of person-centred practice for people 5.6 Theme: Medication with dementia. These changes were Research Topic: e-Health (including Errors informatics and telehealth) noted across all health professionals and informal carers. All (100%) Methodology: Questionnaire Session no: 5.6.1 Abstract no: 0156 of participants recommended the Research Topic: Patient Safety (including Research Approach: Experimental programme as an effective training tool. Research human factors, infection, prevention and Discussion: Participants reported control etc) that the VDT training had a significant Methodology: Statistical Analysis The impact of a virtual impact on their understanding of (descriptive and correlational) reality training programme the impact of dementia, helping Research Approach: Quantitative (not on health professionals’ participants to bring their theoretical included in another category) knowledge, understanding understanding of dementia ‘to life’. and empathy Conclusion: The virtual reality Medication administration experience is an effective, well received Presenter: Florence Sharkey RN & training programme providing a incidents reported as RNT (UK) RN & RNT (ROI) DipHE unique opportunity to experience causing patient death in BSc (Hons) MSc PGCE, Cert Nurse dementia. It has a significant impact England and Wales between Prescribing, FHEA, Western Health & in understanding and insight into the 2007-2016 Social Care Trust, Ireland world of dementia. Co-author: Kevin Moore, UK Presenter: Marja Härkänen RCN PhD, Biography University of Eastern Finland, Finland Abstract Florence is the Lead Nurse for Research Co-authors: Katri Vehviläinen- Background: Dementia is one of and Development within the Western Julkunen, Finland; Trevor Murrells, the major causes of disability and Health & Social Care Trust in Northern UK; Bryony Franklin, UK; Anne Marie dependency among older people Ireland. Florence has over 20 years of Rafferty, UK worldwide. Virtual Reality programmes experience within a variety of different Abstract offer a new and innovative sensory fields of nursing ranging from medicine, Background: The World Health distortion programme designed to clinical nurse specialist in palliative Organization (WHO) launched a provide participants with a greater care within the hospital and community third global patient safety challenge understanding of people living with settings and within education a lecturer “Medication Without Harm”, aimed dementia. To date, limited research has in nursing. She completed her MSc in at improving medication safety, been undertaken on the impact of such 2009 with Southampton University because medication errors are found programmes. and has been awarded a Research to be a leading cause of injury and Aim: To investigate the impact of Internship with Florence Nightingale avoidable harm in health care systems the Virtual Dementia Tour (VDT) Foundation in London to explore the globally (WHO 2019). Medication programme on understanding of the implications of living with both diabetes administration is a routine nursing thoughts, emotion and behaviour of and dementia for individuals and their tasks and known to be prone to people with dementia. informal carers. errors. Medication administration Methods: A quasi-experimental errors may contribute to patient one sample quantitative repeated harm and mortality, thus additional measures research design using a understanding of such incidents is psychometrically acceptable instrument required. was used to measure changes in the knowledge, understanding and Aims: The aims of this study were to empathy levels. A convenience sample analyse medication administration of health care professionals (n=233) errors reported in as resulting in death, who participated in the virtual reality to identify the drugs concerned, and training programme in February to describe medication administration - March 2019 completed pre and error characteristics (location of error, post experience questionnaires. The error type, patient’s age) by drug group. programme, using virtual reality Methods: Medication administration technologies, allowed participants to errors reported in acute care in 2007- appreciate the symptoms of moderate 2016 (n=517,384) were obtained from dementia. Full ethical approval was the National Reporting and Learning gained. System for England and Wales. Of Results: The findings demonstrated those, incidents reported as resulting a positive and statistically significant in death (n=229) were analysed. Drugs impact on participant’s knowledge and were classified by using the British understanding of empathy. Participants National Formulary. Drug categories also reported that the training allowed were described by medication them to ‘walk in the shoes’ of the administration errors’ year, location, person with dementia. Significant patient age, and error category based on increases were noted across empathetic the incidents’ original classification. understanding of cognitive/emotive Results: Errors were most often impact of dementia; the behaviours of reported on wards (66.4%, n=152), people with dementia and the provision and in patients aged over 75 years

55 Concurrent session 5: Wednesday 4 September 2019

(41.5%, n=95). The most common Session no: 5.6.2 Abstract no: 0273 alike-sound-alike medications (5%) error category was omitted medicine were the most common indirect Research Topic: Patient Safety (including or ingredient (31.4%, n=72) and human factors, infection, prevention and factors. Challenges existed mostly most common drug groups were control etc) in digital (68%), verbal (50%) and cardiovascular (20.1%, n=46) and Methodology: Documentary Research printed communication (27%). False nervous system (10.0%, n=23), presumptions (26%) of work-process Research Approach: Mixed Methods antibacterials (n=20), cytotoxic drugs Research between professionals appeared as (n=8), and insulin (n=7). Most errors communication barriers. Frequent in patients under 12 years concerned process challenges were that drugs to treat infection; cardiovascular What do incident reports prescriptions were not communicated drugs were most common among other tell about communication (39%) or read (23%). age groups. related to medication Discussion: MIComHos tool revealed Discussion and conclusions: incidents? detailed information of communication Interventions should focus on avoiding related to medication incidents. dose omissions, and administration Presenter: Tiina Syyrilä PhD Patients’ communication was rarely of drugs especially for patient over 75 candidate, MSc RN, University of detected from the incident reports, years old, as well as safe administration Eastern Finland, Finland but when it was observed, it often of parenteral anticoagulants and Co-authors: Katri Vehviläinen- had prevented or minimized error. antibacterial drugs to prevent the most Julkunen, Finland; Marja Härkänen, Unjustified presumptions of colleagues’ serious of medication administration Finland work process caused medication errors. Abstract incidents. Biography Background: WHO’s (2017) Target of Marja Härkänen is a registered halving medication errors necessitates Conclusions: To reduce medication nurse (2002), nurse teacher (2011), new interventions. Communication is incidents, patients and relatives and PhD in Health Sciences (2015). a major factor in medication incidents should be advised about medication In her dissertation thesis she (Keers 2013). However, little is known communication, and professionals studied medication-related adverse about medication communication should share information about their outcomes and their contributing (Manias 2019). work processes between colleagues and factors. Her post doc study’s (MASI - Aims: The aim of the study was to units. Medication administration safety and assess communication related to Biography interventions) aims are to study the medication incidents. Mrs Tiina Syyrilä is a PhD candidate, medication administration safety and Methods: This was a mixed MSc, and RN. She started as an skills of nurses. Her post doc study methods study in a university early stage researcher in University has been funded by the Finnish Work hospital district serving 1.6 million of Eastern Finland in February Environment Fund 2015-2016, by population. A convenience sample of 2019. Her doctoral thesis focuses on the Finnish Foundation of Nursing 500 voluntarily submitted incident communication related to medication Education 2016, by the Finnish Cultural reports was obtained from January incidents in hospital contexts. Foundation 2017, and by the Academy to June 2015. “Medication incidents Her interest in patient safety and of Finland 2017-2020. The research and communication in hospital” medication safety issues derives from collaboration has been made with the (MIComHos) assessment tool was clinical experiences as quality lead in King’s College London since 2016 under utilized. The tool included 12 structured an abdominal clinic and nurse manager guidance of Professor Anne Marie organizational variables, dichotomous in Helsinki University Hospital. She Rafferty. variables of 145 indicator phrases has gained clinical nursing experience of communication, and three open- since graduating 1991 and worked as ended questions. Quantitative data a staff nurse among adult patients, were statistically analysed. Extracted mainly in surgery wards in Finland. qualitative data (108 sample phrases) She has some nursing experience also were used to describe detected in the UK as an agency nurse between communication factors. 2009-2012. In the UK, she worked in a Results: Most frequent university hospital, community nursing communication pairs were nurse- and military rehabilitation care. In nurse (68%) and nurse-physician addition, she has gained experience (42%). Communication concerning about developing virtual public hospital incidents happened mostly inside services on local and national levels in the unit (77%) and seldom between Finland. hospitals and primary health care (3%). Individual factors such as psychological ability were detected among patients in 20% and professionals’ guideline noncompliance in 65% of cases. Lack of communication coordination (38%) was detected as an organizational factor. Environment (7%) and look-

56 Concurrent session 5: Wednesday 4 September 2019

Session no: 5.6.3 Abstract no: 0078 themselves. Yet, they detected strategies 5.7 Theme: Advanced to cope with their error. More, they Research Topic: Methodology Practice translated their experiences into Methodology: Other collection method constructive lessons and identified ways Session no: 5.7.1 Abstract no: 0245 Research Approach: Systematic Review to prevent any future errors. Finally, the and other Secondary Research Research Topic: Acute and critical care, meta-synthesis contributes to sharing Workforce and Employment (including the accounts of nurses who experienced health and wellbeing roles, research careers) errors, a better self-management and A meta-synthesis of Methodology: Observation how registered nurses self-reflection of their experiences, medicine safety training by nurse Research Approach: Qualitative make sense of their lived approaches (eg: discourse analysis, educators, influence the ways nursing ethnography, critical theory, grounded experiences of medication leaders support frontline nurses, theory, phenomenology) errors influence policies and initiatives about medications and improve the overall Presenter: Efstratios Athanasakis Situated learning in RN BSc MA, Nottingham University learning climate about medicine safety. Hospitals, UK Biography discharge decision making. Abstract I have completed my BSc degree (2011) An ethnographic study of Background: Medication errors are in general nursing in Greece. Moved ANPs in the ED a frequent phenomenon in nursing, as to the UK in 2014 and started working Presenter: Rachel King, The University the nurses are primarily responsible for for the National Health System in the of Sheffield, UK the preparation and administration of Northwest of the country. Currently Co-authors: Angela M Tod, UK; Tom medicines to patients. Little is known I live in East Midlands, where I have Sanders, UK about how nurses make sense of their completed my MA degree in Research Abstract experiences of medication errors as a Methodology degree and work as a Background: Emergency departments lived phenomenon. respiratory staff nurse in an admissions unit. Since being nursing student, I have (EDs) in the UK are under increasing Aim: To aggregate, synthesise and participated in workshops, conferences pressure, due to waiting time targets, interpret the qualitative evidence of with poster and oral presentations and the aging population and workforce studies which explored nurses’ lived published papers about various nursing shortages. One solution has been experiences of medication errors. topics. However, my main research the introduction of advanced nurse Method: The meta-synthesis design interest concerns medicine safety practitioners (ANPs); a role plagued by Sandelowski & Barroso (2007) and medication errors in nursing, for by international ambiguity of scope of is adopted, followed by thematic which both of my dissertations for my practice, education, and regulation. analysis by Thomas & Harden degrees presented. My last work was Standards for UK advanced practice (2008). Qualitative studies (1980- about the methodological and ethical have recently been published, although 2018) retrieved from PUBMED, considerations in the investigation are not compulsory (Health Education BNI, CINAHL, EMBASE, AMED, of nurses’ experiences of medication England 2017, Royal College of Nursing PsychINFO, ProQuest, ScienceDirect errors. 2017). and Wiley Online Library. The Aim: The aim of this research was to PRISMA flowchart used to retrieve explore knowledge mobilisation (how studies, the CASP (Critical Appraisal knowledge is acquired and processed) Skills Programme) tool and COREQ in discharge decision making (DDM) by (Consolidated criteria for Reporting ANPs in the ED. Qualitative research) checklist to Method: An ethnographic study appraise their quality. was undertaken (between September Results: A total of 326 papers 2016 and July 2017) in a single ED identified, and eventually 8 qualitative in the North of England. Data was studies included. Eight themes collected by observation of ANPs developed: ‘moral impact’, ‘emotional (n=5) and interviews with ANPs and impact’, ‘constructive learning’, ‘impact senior clinicians (n=13), and analysed on professional registration and thematically. employment’, ‘nurses’ coping strategies Findings: Findings indicate that the with the experience’, ‘patient and drivers for role development differed family’, ‘identification of contributing between stakeholders. Managers factors to medication errors’, viewed the role as medical substitution, ‘preventive measures for medication whereas ANPs saw it as a hybrid errors’ and 17 subthemes. between nursing and medicine. The Conclusion: To my knowledge, this ANP role blurred significantly with is the first meta-synthesis that focuses medicine. Boundary blurring was on this topic. It provides a holistic characterised by role ambiguity perspective on how registered nurses and knowledge gaps. Knowledge made sense of their lived experiences mobilisation in DDM by ANPs was of medication errors. The moral and messy and complex, illustrated by the emotional impact of medication wide variety of knowledge sources errors to nurses was devastating for accessed, and preference for shortcuts

57 Concurrent session 5: Wednesday 4 September 2019

to knowledge – such as smartphone Session no: 5.7.2 Abstract no: 0171 are or if efforts to standardise and apps. ANPs valued opportunities regulate this group are welcomed either Research Topic: Health and Social Policy for ‘situated learning’ from medical by the ANPs themselves, or by their Methodology: Questionnaire colleagues, peers and through clinical employers. Research Approach: Other approaches experience. Conclusion: The four pillars of Discussion: Tensions in the drivers for advanced practice are not equally ANP role development led to differences The Advanced Level valued. ANPs still have a wide range of in role understanding and expectations. Nursing Practice cohort job titles and pay bands. Reasons for ANPs filled their knowledge gaps in study and against credentialing are explained. a variety of ways. The implications of Biography the findings in preparing ANPs to be Presenter: Emily Wood, PhD, autonomous discharge decision-makers University of Sheffield, UK Emily Wood is a mental health nurse are discussed (Lave and Wenger 1991). Co-authors: Rachel King, UK; Bethany and health services researcher. She is Taylor, UK; Steven Robertson, UK; currently working on several projects Conclusion: Role clarity and Tony Ryan, UK; Angela M Tod, UK including experiences of advanced consensus are crucial in managing Abstract nurse practitioners, interventions boundary blurring. In light of the for people with co-morbid mental mess and complexity of knowledge Background: Advanced Nursing and physical health conditions and mobilisation ANPs prefer knowledge via Practice (ANP) is not a protected retention issues for mental health situated learning and shortcuts. title in the UK and is poorly defined. staff. Other interesting include animal Biography In order to improve patient safety assisted therapies and environmental and create a recognised standard for Following a degree in pharmacology, interventions for mental well-being, advanced practice, the RCN developed I completed a master’s in health care spiritual care for mental health services credentialing, including four pillars sciences with registration as a nurse in users and the physical health care of of advanced practice. The RCN has 2000. I have worked clinically as a nurse people with mental health conditions. developed credentialing partly in in emergency admissions, substance She works primarily with realist response to the NMC’s decision not misuse, and primary care, most recently evaluations and pragmatic mixed to regulate ANPs. Few nurses are as an advanced nurse practitioner methods designs. credentialed, however the scheme is set (ANP). In 2015, I commenced a PhD at to expand, so it is crucial to understand the University of Sheffield’s School of nurses’ experiences of the system and Health and Related Research (ScHARR) its impact. Session no: 5.7.3 Abstract no: 0212 exploring knowledge mobilisation in discharge decision-making by ANPs Aim: The overall aim of the study is to Research Topic: Patient Experience map the cohort’s experience as ANPs in the emergency department, funded Methodology: Mixed by NIHR CLAHRC YH. I have been and their attitude to, and the impact of, the RCN credentialing system. Research Approach: Mixed Methods working as a research associate at the Research School of Nursing and Midwifery, since Method: This is a four-year 2018, as part of a team undertaking longitudinal cohort study. The cohort a programme of work on nursing contains nurses who are eligible to The identification of workforce issues, funded through a join the credentialing system (but complex processes, strategic research alliance with the may or may not have joined) and delivered by palliative care Royal College of Nursing. I currently will be a sampling frame for other clinical nurse specialists, supervise PhD students with a focus studies relevant to ANPs. Annual on advanced nursing practice and questionnaires will yield data to that benefit patients in am a Fellow of the Higher Education investigate job satisfaction, experiences acute settings: A literature Academy (FHEA). and wellbeing. review Results: After the first recruitment Presenter: Alison Humphrey, round the cohort has 125 members. Registered nurse, Sheffield Teaching This presentation will include the Hospitals, UK results from the first annual survey Co-presenters: Vanessa Spawton, UK (collected Oct 2018-Mar 2019). Job Abstract titles and associated pay bands vary dramatically as does time dedicated Background: According to the to the four pillars of advanced European Academy of Nursing Science practice. Sectors such as mental (EANS) nursing is a complex activity. health and learning disabilities are Clinical Nurse Specialists (CNSs) underrepresented. in Palliative Care deliver complex interventions including emotional Discussion: To our knowledge, this support for patients. The CNSs role is the first attempt to understand the increasingly requires justification in working environment and experiences terms of ‘value for money’ (Marples et of ANPs in the NHS. At present we al 2011). do not know how many ANPs there

58 Concurrent session 6: Thursday 5 September 2019

6.1 Theme: Workforce research to gain in-depth information Method: Narrative synthesis from the about the factors identified to further findings of: Session no: 6.1.1 Abstract no: 0018 understanding on how these factors • quantitative data analysis of Research Topic: Workforce and influence nurses’ intentions to leave and national workforce data to explore possible solutions. Employment (including health and wellbeing • quantitative analysis of roles, research careers) Relevance to practice: The shortage anonymised electronic staff Methodology: Questionnaire of critical care nurses is currently a records semi-structured and group Research Approach: Survey global issue impacting costs, patient interviews with nurse managers safety and quality of patient care. These and nurses in district nursing findings may inform strategies and services Factors influencing nurses’ development of interventions that may • systematic review of interventions intentions to leave adult help to improve turnover and reduce to address retention in home nurses’ shortages in the adult critical critical care areas: A cross- visiting nurses. sectional survey care settings. Findings: The size and composition Presenter: Nadeem Khan PhD student, Biography of the workforce is presented in Oxford Brookes University, UK Professional development nurse in comparison to other sectors and Abstract critical care and a part-time PhD countries. Comparisons by region and student. Background: The shortage of critical employing organisation demonstrate care nurses has been an ongoing issue variation in size, as well as stability and for many decades. Although all areas of turnover. Interviews with managers and nurses identify some key issues nursing are affected, critical care areas Session no: 6.1.2 Abstract no: 0457 are especially vulnerable to recruitment which are similar and others distinct and retention problems. High nursing Research Topic: Primary and Community from those of nurses working in turnover in critical care areas is evident, Care, Workforce and Employment (including other sectors. The evidence base for health and wellbeing roles, research careers) however research into the factors that interventions to improve retention of influence nurses’ intentions to leave Methodology: Mixed home visiting nurses is sparse. adult critical care areas is limited. Research Approach: Mixed Methods Conclusion: The synthesis of findings Research Aim: To explore factors that may generates explanatory theories and influence nurses’ intentions to leave ideas about interventions which require adult critical care areas. Investigating workforce and further investigation and testing in different contexts, including other Design: A cross-sectional survey retention issues in home countries. design was used via an online self- visiting nurses Biography administered questionnaire. Presenter: Vari Drennan PhD MSc Methods: An adapted version of the BSc RN RHV, Joint Faculty Kingston Vari Drennan MBE is professor of Nursing Work Index-Revised tool was University & St George’s University of health care and policy research. She used to collect quantitative data via a London, UK joined the academic community after working as a senior community health cross sectional survey. This study was Abstract conducted from November 2017 to service manager and professional head March 2018 in 263 adult critical care Background: Health care systems of community nursing. Her academic units across England. Surveys were internationally are challenged to background is sociology and social distributed via the national lead for improve patient experience and policy. She has undertaken a wide critical care networks. The data were population health within financial range of research concerned with: new analysed using chi-square tests, t-tests, constraints. One strategy for many roles and workforce developments; factor analysis and logistic regression countries, including the UK, has been to health and social care workforce issues, analysis to determine factors which are increase the focus on primary care and health and social care services for older associated with nurses’ intentions to care outside of hospitals. Many, but not people, particularly those with long leave adult critical care areas. all countries, have home visiting nurse term conditions such as dementia; services, known as district nursing in health service provision for women, Results: Autonomy, work the UK. In parts of the UK this group particularly those socially excluded; and environment, working relationships, of nurses have paradoxically been interfaces between the health service opportunities for professional described as in declining numbers. and the criminal justice system. All of development and age were statistically her research activities involve the public significantly associated with nurses’ Aim: This paper draws on a and service users. She is particularly intentions to leave adult critical care programme of studies undertaken in interested in the interface between areas. England 2015-2019 to investigate: policy and practice in arenas where • the extent of changes in the Conclusions: This study highlighted public service delivery involves multiple composition of the nursing key factors that influence nurses’ agencies. Vari was awarded an MBE workforce over time intentions to leave adult critical in 2016 for services to health service care areas. These factors need to be • the stability and turnover rates research, development and nursing. considered when developing strategies • evidence for the interventions to to improve turnover. The study also increase retention. highlighted the need for qualitative

59 Concurrent session 6: Thursday 5 September 2019

6.2 Theme: Research multiprofessional individual, team and Session no: 6.2.2 Abstract no: 0195 organisational perceptions of research Careers Research Topic: Research Policy which impact the resulting behaviours Methodology: Questionnaire Session no: 6.2.1 Abstract no: 0175 and culture. The aim is to describe what could work better, in what context Research Approach: Survey Research Topic: Workforce and Employment (including health and wellbeing in relation to the CRN role. Evidence roles, research careers) related to perceived social and physical Nurses who are doctors barriers, communication, and the Methodology: Other collection method (PhD): Why do they do it perceptions of multiprofessional Research Approach: Systematic Review colleagues including their resulting and where do they go? and other Secondary Research behaviours towards CRNs will be Presenter: Susan M Hampshaw situated within the context of NHS BA (Hons) MSc, The University of What could work better leadership, demonstrating how a lack Sheffield, UK and in what context in of visibility/awareness at individual, Co-presenter: Jo Cooke, UK clinical research nursing? team and organisational level can affect Abstract organisational culture in relation to A Realist Review to explore research. The review demonstrates Background: Nurses, midwives and the factors influencing how each element, has the potential to allied health professionals (NMAHP) impact on CRN experiences, affecting have a poorly developed clinical multiprofessional academic career route, although there perceptions of the CRN role their ability to successfully recruit patients to research. is a need to develop this (Westwood et Presenter: Linda Tinkler, MClinRes al 2018). Little is known about what (Leadership) BSc (Hons) RN, The Conclusion: This ViPER session will happens to NMAHPs who undertake a University of Sheffield, UK share the findings of the work to date doctorate, and whether they use these Co-presenterss: Angela M Tod, UK; and discuss implications/collect views skills in the next career steps. Previous Steven Robertson, UK on the continuation of the research. work highlights NHS NMAHP clinical Abstract Biography academic structures are inconsistent at best or non-existent (Cooke et al, 2016). Introduction and Background: Linda has worked as a Clinical Research The importance of clinical research in Nurse and an Academic Research Nurse Aims: improving health outcomes is widely over the last decade, supporting and • Develop insight into the acknowledged. The Clinical Research leading the delivery of a range of NIHR motivations, perceived benefits Nurse (CRN) role is a fundamental portfolio studies whilst supporting and risks of doctoral level study for aspect of this agenda, yet the role Clinical Fellows with PhD/MDs in a NMAHPs. specialist Gastroenterology team. Linda remains broadly misunderstood outside • Understand the career pathways now works as a Trust Lead, driving the of clinical research. Increasingly, for NMAHPs and the role of their NMAHP Research agenda in a large evidence highlights the challenges faced doctorate within this. by CRNs in practicing within their roles. North East NHS Foundation Trust. During her career, Linda has developed Methods: An e-survey was developed The evidence review described is the based on literature and views from first part in a Royal College of Nursing her own programme of qualitative research exploring the barriers to a community of practice. This was (RCN) Strategic Research Alliance PhD distributed via professional networks Scholarship. successful research delivery through the perceptions and experiences of Clinical and Twitter (closed March 2019) Methods: The CRN role can be Research Nurses. She is currently Results: The survey was completed described as a complex policy continuing this work through a PhD by 228 people (21% were Nurses); intervention; therefore, a realist Review funded by the RCN Strategic Research 46.6% had completed in a hospital/ is underway to answer: Alliance at the University of Sheffield inpatient setting. 29.8% had employer • What factors influence how clinical School of Nursing & Midwifery. Linda funding and 59.6% studied part time. research is perceived by health care is a qualified coach with an interest The most frequent motivations for professionals? in Leadership in the NHS and was starting a doctorate were professional • What impact do the perceptions/ awarded a Florence Nightingale development (74.1%) and intellectual influences have on clinical research Leadership Scholarship in 2018. Linda curiosity (74.5%). 43% had undertaken nurse experiences, practice and has recently been appointed to the some form of capacity building before successful patient recruitment to NIHR 70@70 Senior Nurse Leader starting. Benefits of doctoral study to research in the NHS? programme. employers included critical thinking Initial searches included the and a deepened subject knowledge. Cochrane Library of Systematic Further analysis will highlight examples Reviews(n=1), BNI/CINAHL/ of good practice and ways that clinical HMIC(n=21) grey literature including academic balance can be sustained, The King’s Fund(n=3) The Health and difference in professional groups. Foundation(n=2) and theses (n=4), Barriers and pitfalls will also be shared. with searches continuing as appropriate Discussion: Findings will be to the realist methodology. delivered in the context of the doctoral Results: The review will reconcile value literature and policy related to published and un-published evidence clinical-academic careers. We will on the range of factors that impact on make recommendations for action for

60 Concurrent session 6: Thursday 5 September 2019

individuals and organisations wishing 6.3 Theme: Methods comparison with the findings from a to support clinical academic careers for thematic analysis, followed by analysis NMAHPs. Session no: 6.3.1 Abstract no: 0150 of the intervention and implementation Biography WITHDRAWN using NPT. Elements of the theory- practice gap, largely overlooked in I am public health principal at trials evidence, were clarified through Doncaster Council where I am lead eliciting other active ingredients and for reducing health inequalities. My Session no: 6.3.2 Abstract no: 0374 mechanisms of delivery using NPT and portfolio also includes building capacity logic modelling. to develop research which is closers Research Topic: Public Health (including to policy and practice and which can health promotion), Midwifery, Methodology Conclusion: NICE guidance (2010) is principally based on evidence from improve health and wellbeing. I am Methodology: Interviewing an honorary research fellow at the trials and would benefit from being Research Approach: Evaluation (process, combined with knowledge derived from School Health Related Research at the impact) University of Sheffield ScHARR where logic models and research based on I co-lead the Knowledge into Action social theories, such as NPT. Routinely theme and teach on the Knowledge Combining normalisation incorporating NPT, or similar, and logic Mobilisation module of the MPH process theory and logic models should be considered when programme. I also work in the Health implementing trial-based interventions modelling to enhance into complex, public health systems. Equity and Inclusion Theme. I have impact in a complex long standing interest in the knowledge Biography intervention: A critical to action gap and am an NIHR CLAHRC Susan Jones is a research associate in YH funded PhD candidate examining reflection research and evaluation of public health knowledge use (specifically NICE) in Presenter: Susan Jones RGN BSc MSc, initiatives. In 2019 she is due to submit local government using realist methods. Teesside University, UK her doctoral degree thesis, which I am also an honorary research fellow Co-author: Sharon Hamilton, UK looks at Normalisation Process Theory at Rotherham, Doncaster, and South Abstract and its use in evaluating complex Humber Community Mental Health interventions. Susan has completed a Background: This paper arises from NHS Trust. number of qualitative studies both in observing that complex interventions primary and secondary health care. in public health, even when devised Topics include smell and taste post- from high-quality, trial-based evidence, stroke, stopping smoking in hospital, often fail to achieve expected outcomes treatment of frozen shoulder and back and impact in practice. Addressing this pain. These studies have focused on theory-practice gap will be discussed in the experiences of staff and patients. the context of Medical Research Council Since 2012 her main research has been (MRC) Guidance, Process evaluation looking at implementing changes to of complex interventions (Moore et al, maternity and stop smoking services 2014). MRC guidance (2014) refers to to support pregnant smokers to quit. using Normalisation Process Theory Recently she has been evaluating (NPT) (May & Finch, 2009) and also to introducing smoke free policies into using logic modelling (Kellogg, 2004) mental health trusts. but does not give any examples of them being used together. Combining this theory (NPT) and method (logic modelling) in an innovative way are the focus of this paper. A researched example of the implementation of a complex intervention based on National Institute for Health and Care Excellence (NICE) Public Health guidance: 26 Quitting smoking in pregnancy and following childbirth (2010) will be used to illustrate the proposed method. Aim: To consider the contribution of NPT together with logic modelling to improving the impact of a complex intervention. Methodological discussion: NPT shows promise as an analytical tool, since it focuses on eliciting the implementation process of an intervention, and its feasibility and sustainability in context. A logic model can be used to hypothesise the intervention process; allowing for

61 Concurrent session 6: Thursday 5 September 2019

6.4 Theme: Public Health prison health research. These findings Abstract can support the prison health research Background: Specialist community Session no: 6.4.1 Abstract no: 0270 agenda, whilst informing policy makers public health nurses (SCPHNs)—who Research Topic: Criminal justice/prison and funding bodies regarding key areas provide universal health promoting nursing for focus. services to families with children Methodology: Delphi Conclusions: There remains a gap in in the 0–19 age range – are well Research Approach: Survey our understanding of the perception placed to influence lifestyle-related of prison health priorities from the health behaviours at an early stage. perspective of those who are detained To undertake this work effectively a Defining research priorities in the prison setting. This is an area for toolkit of health promotion strategies for prison health in future research. is required. This presentation reports Scotland: A Delphi study Biography the findings of a small study which examined the impact of teaching Presenter: Aisha Holloway, The Aisha Holloway is Professor of Nursing Motivational Interviewing skills to University of Edinburgh, UK Studies and Head of Nursing Studies health visitor and school nurse students Co-authors: Lisa Scholin, UK; Iris Ho, at The University of Edinburgh. A (Day et al, 2018). It was undertaken UK Registered Adult Nurse, she has a at a university in the north of England clinical background in General and Abstract which has pioneered the teaching Acute Medicine as well as Intensive Background: Prison health in of motivational interviewing and Care. With a programme of research Scotland was the focus of a recent behaviour change skills within the spanning over 20 years, Aisha’s work Scottish Parliamentary short Inquiry. SCPHN curriculum. has a particular focus on alcohol There is an acknowledgment from key related harm and global public health, Aims: The aim was to examine stakeholders that further evidence with a methodological expertise in student perspectives about if, and how, to better understand prison health is Randomised Controlled Trials (RCTs) education in behaviour change skills needed to enhance the prison health and the development and evaluation of impacts on the nature and effectiveness agenda. complex interventions and innovative of consultations with clients. Aims: This study aimed to define multi-disciplinary, public engagement Methods: The study took place in research priorities for the next 15 years methodologies for research co- 2017. Focus groups, attended by 11 in Scotland using an adapted Delphi production. A Florence Nightingale SCPHN students examined students’ method. Leadership Scholar, former Hon Nurse views and perspectives about engaging Methods: The study was carried out Consultant for Alcohol Research and with clients and utilising behaviour with two rounds between December Policy at Scottish Government, and change skills in practice. Transcribed 2018 and March 2019. The sampling current Adjunct Professor at Johns and anonymised data was analysed criteria for this study were: Hopkins School of Nursing, Baltimore, using a thematic approach. 1. people who are or have been USA, Aisha’s personal and professional Results: Findings indicate that involved in prison health research journey has at its core, a commitment SCPHN students had begun to apply or the provision of services in to develop political nurse leadership to an approach based on Motivational criminal justice system and lead, shape and inform the contribution Interviewing to consultations in community in Scotland. of the nursing profession and elevate practice as a result of their education. its global positioning of influence. 2. people with lived experience of Key themes arising from the data Aisha has recently been appointed as detention or incarceration in were: changing approach, skills and Programme lead for research (Evidence Scotland. Ninety-six prospective techniques, education and learning, use for effective practice) for the Nursing participants were invited for taking in practice, and time. Now Global campaign. part in the study. Responses from round one were Discussion and conclusions: content-analysed and collated into Findings of this small study suggest topics and themes subsequently used Session no: 6.4.2 Abstract no: 0325 that an intensive and skills-based to design the second round of survey approach has enhanced the therapeutic Research Topic: Public Health (including questions. Results from round two health promotion) communication skills of SCPHN were analysed using frequency and students. This is likely to have a Methodology: Focus Groups descriptive tests to determine the substantial impact on practice and number of responses that reached 70% Research Approach: Qualitative client outcomes. A shift towards client- approaches (eg: discourse analysis, consensus by the panel. led consultations rather than advice ethnography, critical theory, grounded Results: Through the analytic process, theory, phenomenology) giving is evident. Time constraints 11 themes and 50 topics emerged from and competing practice priorities can the first-round survey. Consensus was be challenging. In order to ensure achieved for 28 out of 50 topics or seven Putting new therapeutic health and social care practitioners out of 11 themes in the second round. communication skills are equipped to address behaviour Top themes rated by the panel were into public health nursing change with clients, consideration mental health and learning disabilities, should be given to including a skill- practice: the student based approach within future education substance use, reintegration and experience continuity of care, and person-centred programmes. culture and service users’ voice. Presenter: Patricia Day, Sheffield Biography Hallam University, UK Discussion: Substance use and Co-presenters: Gayle Hazelby, UK Pat Day is an experienced nurse and reintegration are key priorities for teacher. She worked in acute adult

62 Concurrent session 6: Thursday 5 September 2019

Aim:care settings To investigate for several the yearsbenefits after to England were recruited via email and 6.6 Theme: Nursing Issues patientsqualifying in as acute a nurse. settings Pat thatbecame are took part (in December 2018) in one of achieveda school nurse through 20 complexyears ago. processes This of three focus groups. The number of focus Session no: 6.6.1 Abstract no: 0366 CNSsrole fitted in Palliative well with Care. her interests in group participants ranged from three to Research Topic: Workforce and Methods:family health, A mixed health methods promotion literature and nine with fifteen participants in total. Employment (including health and well reviewpublic health.was undertaken Pat enjoys by working two Palliative with Data were transcribed and analysed being roles, research careers) Carechildren CNS’s and within young a peopleclinical and team has in thematically. Methodology: Mixed anspecialist NHS Trust. skills Thein mental search health strategy and Results: Findings suggest that TNA Research Approach: Mixed Methods includedsexual health. four facets;Pat is a patients sexual health with development is facilitated by; affordable Research palliativepractitioner care and needs; runs CNSa youth role; clinic acute local training, role clarity with good hospital;once a week beneficial on Saturdays. patient She outcomes. also has support networks and clear pathways an honorary contract with Sheffield Gender, diversity and Results: 123 articles were sourced, for career progression. Conversely, Children’s Hospital and supports the nursing profession: 26 were full text screened and six such development can be challenged teenagers with mental health issues in selected. Complex interventions, by; problems in placement settings, Ensuring that nurses are a secondary school. Pat is passionate patient benefit and acute setting were role ambiguity and future career valued and paid their worth about nursing and loves teaching rarely discussed. No articles captured uncertainty. students about primary care and public Presenter: Rachael McIlroy, Royal patient benefit from complex CNS Discussion: A combination of health. College Nursing, UK interventions. There was reference to practical and workplace identity issues Co-authors: Kate Clayton-Hathway, complexity with developing emotionally impact TNA experiences. In turn, these UK; Heather Griffiths, UK; Anne Laure supportive relationships with patients. experiences influence and modify their Humbert, UK; Sue Schutz, UK The6.5 literature Theme: suggests New valueRoles in the CNS career aspirations in both positive undertaking a key worker role. and negative ways. To maximise what Abstract Discussion:Session no: 6.5.1While Abstract we know no:that 0335 ‘A TNAs bring to the nursing workforce Background: This presentation covers requires alignment of their aspirations Researchspecialist palliativeTopic: Workforce care nurse and has the the main points of a forthcoming paper Employmentknowledge and (including expertise health to andundertake wellbeing with organisation and clinical area written in collaboration between Oxford theroles, care research that benefitscareers) patients and their requirements. Brookes University and the RCN. The Methodology:families’ (Coller Focus and GroupsBlythe 2017) there Conclusion: There are clear paper examines issues at the nexus of gender, pay and nursing to better isResearch little evidence Approach: to define Qualitative the complex opportunities and challenges to the interventionsapproaches (eg: that discourse benefit analysis, patients in emerging TNA role. This exploratory understand barriers to a sustainable theethnography, acute setting. critical theory, grounded study will inform a larger cohort study profession. The presentation covers the main results from the literature review; Conclusion:theory, phenomenology) The literature review following TNAs over time to consider quantitative analysis; and stakeholder was undertaken by the CNS team to these issues in more detail. interviews. Traineedefine patient nursing benefit. associates: There is a gap in Biography The literature review examines the literature to support and justify the Steve worked as a nurse and health An exploratory study of an inequalities in the context of nursing, CNS contribution. It therefore remains visitor for over twenty years before emerging role drawing on historical, sociological, difficult to demonstrate the value for commencing a career in research Presenter: Steven Robertson PhD, cultural and political developments money of the role in the acute setting, in 1999. His main interests and University of Sheffield, UK that have shaped a female dominated although patients and families appear to publications are around social theories Co-presenters: Rachel King, UK workforce. appreciate care co-ordination. Further of masculinity and their application to Abstractstudies into this patient population are public health and health promotion. The quantitative analysis focuses warranted. on the pay, well-being and working Background: The Trainee Nursing He has recently developed a focus conditions within nursing, using data AssociateBiography (TNA) role has been on research relating to the nursing from the Labour Force Survey and the Alisondeveloped Humphrey as one solution – Clinical to nursing workforce including an interest in safe RCN Employment Survey. The analysis Nurseworkforce Specialist shortages in Palliative in England. Care The staffing, skill mix and emerging roles focuses on gender as a form of power Therapeuticsrole aims to fill and a Palliativeperceived Care,gap between in nursing. He was formally Professor relation, and extends that perspective Sheffieldhealth care assistantsTeaching andHospitals registered NHS of Men’s Health and Gender and is by extending to other diversity grounds Trust.nurses Qualifications: but also offers anAdvanced alternative currently programme Director for such as ethnicity, age and disability. Diplomaroute into in registered Adult Nursing. nursing. PG Policy Cert the Strategic Research Alliance at the It highlights that nurses are among Clinical,assumptions Midwifery have been and madePublic that Health 50% University of Sheffield. He also holds the least paid health professionals Nursing.of TNAs will MSc go in on Advancing to become Professional registered an Adjunct Professor role at Waterford within the health sector despite being Practicenurses, and Current that therole:Hospital transition into Institute of Technology in Ireland. a graduate profession and shows that Specialistnursing will Palliative be smooth Care with Team low Steve has published three books and while there is evidence of a gender pay Interests:attrition rates. Palliative These Care assumptions in non-cancer, over 75 peer-reviewed publications. He gap in the health sector, there is only a Palliativeare yet to Carebe tested. in Learning This exploratory Disability, is Editor-in-Chief of the International marginal gap in nursing suggesting that Evaluationstudy contributes of Seven to Daythis emergingWorking and and Journal of Men’s Social & Community the issue is not gender at the individual clinicalcurrently academic under-researched work in palliative area of care Health and Mental Health Section level but how it operates at a more nursing.workforce development. Editor the American Journal of Men’s Health. structural level. The data also suggests Aim: To gain early insight into that there is evidence of an ethnicity the motivations, experiences and pay and restricted career progression aspirations of TNAs. opportunities for nurses Method: TNAs registered on two Session no: 6.5.2 Abstract no: 0413 The paper includes voices of key cohorts (one approaching completion WITHDRAWN nursing stakeholders, presenting and one which started training six a qualitative analysis of interviews months ago) at a University in Northern

63 Concurrent session 6: Thursday 5 September 2019

exploring the current issues and original study, the Cronbach Alpha 6.7 Theme: Mental Health challenges facing the workforce. internal consistency coefficient of the At the heart of the report is the concept survey was found to be 0.94. Ethical Session no: 6.7.1 Abstract no: 0450 of value: the value of work done and and institutional approvals were gained Research Topic: Mental health, the care given, the value of individuals before data collection. Data were Inequalities in Health, Health and Social as nurses, and the value given to the analysed using IBM SPSS Statistics 21.0 Policy nursing profession. Not valuing nursing and LISREL 8.51. Methodology: Interviewing manifests itself through low pay, low Findings: Content validity indices of Research Approach: Qualitative scope for progression and challenging 33 items were .94. The factor loadings approaches (eg: discourse analysis, working conditions. This corresponds of all items were between 0.31 and 0.89. ethnography, critical theory, grounded to the challenges facing nursing: As a result of the confirmatory factor theory, phenomenology) recruitment, retention, reward and analysis, it was determined that the representation. factor structure (consisting of 33 items Mapping the field: Are Biography and 5 factors) of the original scale was verified without any modification. The organisational and Rachael McIlroy is the Senior Research goodness of fit indices were χ2/df=2.97, structural factors impacting Lead in the Employment Relations RMSEA=0.067 and CFI=0.88. In on mental health nurses’ Department at the Royal College addition, similar results were obtained Nursing. She leads on the RCN’s ability to provide physical with the goodness of fit indexes health care? research activity in relation to pay, of the original survey. Cronbach’s working conditions and working coefficient alpha was .91 for the total Presenter: Gearoid Brennan BA (Hons) environments within the UK nursing scale (it varied between .88-.94 for the BN MN RMN AFHEA, Department workforce. subscales). of Nursing Studies, The University of Edinburgh, UK Results: Turkish version of the Co-authors: Rosie Stenhouse, UK; Nursing Teamwork Survey is a current, Graeme D Smith, UK Session no: 6.6.2 Abstract no: 0511 valid and reliable tool used to assess five factors of teamwork of nurses. Abstract Research Topic: Methodology, Leadership Background: People with serious and Management Biography mental illness experience higher rates of Methodology: Questionnaire Gülcan Taşkıran graduated from physical co-morbidities. These include Research Approach: Other approaches Başkent University with a Bachelor’s HIV infection, cardiovascular disease, Degree in Nursing and Health Services metabolic disorders and certain types of Department in 2012. She graduated cancer. There appears to be ambiguity The psychometric testing with a first degree in her department of the nursing teamwork surrounding nursing roles in addressing from Başkent University in Ankara. these health inequalities. Previous survey in Turkey Before she graduated, she stayed for six studies have highlighted certain Presenter: Gülcan Taşkıran, Florence months in Holland with the Erasmus organisational and structural factors Nightingale Faculty of Nursing, Program. After graduation, she worked which play a role but without significant Istanbul University-Cerrahpaşa, as a nurse at a university hospital in depth of how they impact on nursing Turkey İstanbul. While she was working, she practice. Co-author: Ülkü Baykal, Turkey started her Master Degree at İstanbul University in Nursing Administration. Aims: The study aimed to examine Abstract She graduated from her Master Degree how registered mental health nurses Aim: The aim of the study is to test in 2015. Then she started to work working in one UK mental health the validity and reliability of Turkish as a Research Assistant in 2016 at service understood their role in adaptation of ‘Nursing Teamwork Florence Nightingale Nursing Faculty providing physical health care to people Survey’ which has been developed of Istanbul University in the Nursing with mental distress. In particular, the for measuring overall teamwork and Administration Department. After that, impact of organisational and structural five factors of teamwork: trust, team she started doctorate degree at Istanbul factors, relationships and educational orientation, backup, shared mental University in Nursing Administration competencies on their role. models, and team leadership. in 2016. Now she is studying in the Methods: This study was informed Methods: This is a methodological doctorate thesis. Up to 2017, she by Pierre Bourdieu’s Theory of study. The sample of the study consisted participated in lots of congress, Practice (1977). Semi-structured 1:1 of 444 nurses who selected with seminars and courses on Nursing. interviews were conducted with nurses convenience sampling and worked as Her academic interests are nursing (n=7 inpatient, n=7 community) bedside nurses in three hospitals in administration, disaster management, working in one UK service between Istanbul, who had at least six months patient safety, medical errors and social January-May 2018. Interviews were of experience and volunteered to media in nursing. transcribed verbatim and analysis was participate in the study. ‘Nursing informed by Braun and Clarke’s (2006) Teamwork Survey’ was used to collect Thematic Analysis. The study received data. This survey has 33 items and five a favourable ethical opinion from the subscales. The scale is a 5-Likert type author’s institution. (1=Rarely, 2=Sometimes, 3=Often, Results: Analysis reveals that mental 4=Mostly, 5=Always). Higher scores health nurses’ physical health care indicate better teamwork. In the practice takes place in a complex field.

64 Concurrent session 6: Thursday 5 September 2019

Their work in this area is often invisible. produced by organisations in England the Journal of Psychiatric and Mental This field is shaped by the burden of and Wales. The study raised concerns Health Nursing and Mental Health accountability and its use as a form of about the safety of patients being Practice. In 2013 he was awarded an symbolic violence, the unpredictability observed. In response the Department Akinsanya special commendation by the of mental health, emotional labour of of Health (1999) attempted to RCN Research Society for innovation in caring, poor organisational support and standardise guidance on observation, doctoral studies in nursing. tensions around boundaries in care. however there is no legal requirement It is questionable what role policy is for organisations to comply with this or playing in influencing practice. other guidance. Two decades later it is Discussion/Conclusions: The unclear whether Bowers et al’s concerns study highlights various structural have been addressed. factors impacting on mental health Aim: To determine what guidance nurses ability to address patients is provided by organisations on the physical health needs. Services need to implementation of observation in give consideration as to how they are England and Wales. going to remove such barriers, which Method: During May 2017 a Freedom should help nurses to practice more of Information request was submitted competently, confidently and would to all mental health trusts in England allow them to develop creative practice (n=57) and health boards in Wales without fear of blame. (n=7) asking them to supply a copy Biography of their observation policy. Policies Gearóid is a PhD student within the were analysed using thematic content Department of Nursing Studies at The analysis. University of Edinburgh. He works Results: All organisations had clinically as a staff nurse within NHS an observation policy. Twenty Lothian’s acute mental health inpatient organisations provided patients with service at the Royal Edinburgh written information on observation. Hospital. He currently holds a Florence Seven themes were generated: Nightingale Foundation travel ‘observation versus engagement’; scholarship. ‘terminology’; ‘purpose of observation’; ‘reasons for observation’; ‘patient information’; ‘initiating, increasing, decreasing and terminating Session no: 6.7.2 Abstract no: 0083 observation’; and ‘who observes?’ Research Topic: Mental health, Quality Discussion: Local policies remain Standards, Health and Social Policy variable in content and quality and to Methodology: Documentary Research do not reflect contemporary research. Research Approach: Qualitative There is a lack of consistency on: approaches (eg: discourse analysis, the terminology used to describe ethnography, critical theory, grounded observation; who should undertake theory, phenomenology) the intervention; and which mental health professionals are responsible Engagement and for increasing and decreasing levels of observation. Finally, despite rhetoric to observation in mental the contrary policies remain focused on health nursing: A review observation over engagement. of policies in England and Conclusion: There is a need to Wales produce evidence-based standards that Presenter: Russell Ashmore PhD, organisations are required to comply Sheffield Hallam University, UK with. Abstract Biography Background: Globally, observation Russell Ashmore is a senior lecturer at is a widely used intervention for Sheffield Hallam University. Qualifying preventing mental health inpatients as a registered mental health nurse from harming themselves or others. in 1987, Russell has worked in day It requires nurses to be within close hospitals, acute inpatient settings and proximity of the patient for a specified the community. He has published on period of time. a variety of subjects including; Section 5(4) of the Mental Health Act 1983, International guidelines for this nurses’ interpersonal skills, nurses’ practice are conspicuous by their relationship with the pharmaceutical absence. Bowers et al (2000) raised industry, clinical supervision, and concerns about the availability and nurses’ experiences of stalking. He content of observation policies is a member of the editorial board of

65 Concurrent session 6: Thursday 5 September 2019

7.1 Theme: Safe Staffing 1:8 > 65% of shifts over 12 months. engagement between nurses and Directors of Nursing reported that patients”. Consequently, “Intentional Session no: 7.1.1 Abstract no: 0490 biggest challenge to achieving safe Rounding” (IR), an hourly or two- Research Topic: Acute and critical care, staffing was difficulty filling posts; hourly structured bedside round Workforce and Employment (including average RN vacancy rate was 10%. developed by the US Studer Group health and wellbeing roles, research careers), Discussion: External pressures to address fundamental elements of Health and Social Policy (lack of workforce supply and reduced nursing care, was implemented. Methodology: Mixed access to temporary staffing), have Aims: The study investigated the Research Approach: Mixed Methods constrained NHS hospital Trusts from impact and effectiveness of IR on the Research fully implementing policies aimed at organisation, delivery and experience of ensuring safe staffing on acute wards. care in hospital wards in England. Implementation and impact Conclusions: Policies provided Methods: Mixed-method, realist of policies for safe staffing leverage, raising the profile of nurse evaluation including a national survey staffing at board level. However failure of NHS trusts (n=108, 70%) and in- in acute hospitals: A mixed to assess the national increase in depth case studies of IR in six wards methods study workforce required has impeded policy (across three trusts) investigating the Presenter: Jane Ball PhD BSc (Hons) implementation locally. perspectives of senior managers (n=17), RN, University of Southampton, UK Biography nursing staff (n=33), other health Co-authors: Peter Griffiths, UK; Jo care professionals (n=26), patients Professor Jane Ball (RN, PhD) started Rycroft Malone, UK; Jeremy Jones, (n=34) and carers (n=28); 188 hours of undertaking research into nursing UK; Chris Burton, UK; Jane Lawless, observation; and cost analysis. workforce and related policy in UK; Rob Couch, UK; Hannah Barker, 1990. She has worked at Institute Results: 97% of NHS trusts had UK for Employment Studies, as Policy implemented IR, although with Abstract Adviser at the RCN, as Deputy Director considerable variation. Observations demonstrated that fidelity to the Background: The public inquiry of the National Nursing Research IR protocol was low. Opinion was into a care scandal in an NHS hospital Unit (King’s College London) and divided about whether all patients in England highlighted that nurse since 2014 has been based at the should receive IR however all nursing staffing decisions had been taken University of Southampton. She also staff thought IR should be tailored to without consideration of patient safety. holds an affiliated research position individual patient need. Few nurses felt National policies for ‘safe-staffing’ were at Karolinska Institute (Stockholm, IR improved the quality or frequency of developed in response. Sweden). Her research focusses on exploring how features of nursing their interactions with patients. Instead, Aim: To examine the implementation staff perceived the main benefit of IR of national safe staffing policies in NHS employment and deployment are related to quality of care, patient was documented evidence that care had acute hospitals and identify factors that been delivered despite concerns that influenced implementation. outcomes and organisational effectiveness. this evidence was not always reliable. Methods Patients and carers valued the relational 1. Analysis of national workforce data aspects of communication with staff, since 2010 however, this was rarely linked to IR. 2. National survey of Directors of Session no: 7.1.2 Abstract no: 0452 Conclusions: Evidence indicates Nursing (N=147, response rate Research Topic: Older People effectiveness of IR, as currently implemented, is weak. However, there 61%) Methodology: Mixed is also evidence of a lack of clarity 3. Realist informed evaluation of Research Approach: Evaluation (process, in the purpose and expectations of policy implementation in 4 case impact) IR and lack of staff preparation and study hospitals. resources to support its introduction Results: New approaches to staff Intentional rounding in and sustainability. Concerns were planning, rostering and board expressed that IR oversimplifies awareness of safe staffing were viewed hospital wards: What works, for whom and in nursing, privileges a transactional as the most helpful changes. Clearly and prescriptive approach over defined leadership, a shared sense of what circumstances? relational nursing care, and prioritises accountability, consideration wider Presenter: Ruth Harris PhD MSc BSc documentation and risk management workforce issues such as recruitment (Hons) RGN, King’s College London, UK above individual responsive care. and retention, engagement with Co-authors: Sarah Sims, UK; Mary Biography external stakeholders and a high degree Leamy, UK; Ros Levenson, UK; Nigel of goodwill, were factors associated with Davies, UK; Sally Brearley, UK; Robert Ruth Harris is Professor of Health successful implementation. The number Grant, UK; Stephen Gourlay, UK; Care for Older Adults at King’s College of nursing staff employed in the NHS Giampiero Favato, UK; Fiona Ross, UK London. She is a nurse and her research acute sector increased since 2013 by focuses on the impact of the nursing 10% for registered nurses (RNs) and Abstract and the multi-professional workforce 30% for support staff (HCAs). Staffing Background: Part of the government on processes of care and patient per admissions had not increased, due response to care failures at Mid outcomes, particularly for older people to concurrent increase in admission Staffordshire NHS Trust was to and those with chronic conditions. numbers. 25% of Trusts reported the announce the policy imperative of Her clinical background is in acute RN per number of patients exceeded introducing “regular interaction and medical nursing and care of older

66 Concurrent session 6: Thursday 5 September 2019

people. She has worked in a range of on experiences of violence and 7.2 Theme: Methods research posts, with responsibility to aggression at work, most of which lead research studies and other research replicated those used by Richardson et Session no: 7.2.1 Abstract no: 0359 capacity building activities in clinical al (2018). Research Topic: Methodology and academic settings. Her current A working group has been convened to Methodology: Documentary Research work includes a NIHR HS&DR funded develop and implement an evidence- study to evaluate intentional rounding Research Approach: Qualitative based strategy drawing on national approaches (eg: discourse analysis, by nurses on acute wards and a NIHR and international data that sees ethnography, critical theory, grounded HS&DR funded study to enhance NZNO working at multiple levels with theory, phenomenology) patient activity in acute stroke units members, employers and government. (CREATE study). Ruth is an associate NZNOs Nursing Education and Reconsidering narrative editor of the International Journal Research Foundation (NERF) have set of Nursing Studies, a Fellow of the their 2019-2025 research priorities method in nursing research European Academy of Nursing Science which include research that relates Presenter: Michael Traynor, RN and Chair of the RCN Research Society. to workforce and working conditions HV MA(Cantab) PhD, Middlesex and safety including violence and University, UK aggression towards nurses alignment Abstract with likeminded organisations seeks Session no: 7.1.3 Abstract no: 0455 to achieve a balance between the Background to the method/ Research Topic: Workforce and experiences of distress and urgency debate: Narrative analysis, in various Employment (including health and wellbeing of NZNO members affected and a forms, is a popular qualitative method roles, research careers), Health and Social perspective that offers a responsive in nursing research. Narrative research Policy rather than reactive position so that is considered to foreground individual Methodology: Other collection method the complexities of nursing practice human experience because it prioritises Research Approach: Action Research / contexts, including mental health, an effort to understand the world Participatory Inquiry / Practice Development forensic services and dementia care, can from a research participant’s—often a be included. patient’s—viewpoint. Narrative analysts commonly understand humans as Achieving impact with Conclusion: Impactful research and making sense of, or finding meaning in, research informed policy policy can achieve a measurable effect experience through the telling of stories. on the work and wellbeing of nurses development It is argued that identity is established and therefore health and wellbeing through the practice of telling one’s Presenter: Sue Gasquoine RN outcomes for care recipients. story and that coherence of the told BA MPhil, New Zealand Nurses Biography self is a sign of good mental health. The Organisation, New Zealand job of the researcher is to record such Co-presenter: Jinny Willis, New I was appointed as Nursing Policy meanings and use them to inform some Zealand Adviser/Researcher to the Professional Services Team at the New Zealand aspect of nursing practice (Hill Bailey, Abstract Nurses Organisation (NZNO) in Montgomery et al 2013). Background: This critical reflection March 2017. I am also an adviser to Aims of the paper: The aims of this on a research related issue was the Nursing Education and Research methodological paper are: motivated by a briefing requested by Foundation Board which supports 1. To critique some of the above the New Zealand Nurses Organisation nurses with scholarships and grants humanist assumptions at work in (NZNO) management team on violence for education and research. Prior some forms of narrative analysis and aggression towards nurses which to joining NZNO I worked in as an taken up in nursing. established this as a global issue academic in nursing education for 25 2. To draw on poststructuralist and for all health workers and has been years including seven years as Head psychoanalytic theory to present an investigated by New Zealand nurses, of Department. Teaching research alternative approach to narrative. for example Rolls (2006). It also drew to undergraduate nursing students on more recent research including and supervising and examining the Methodological discussion/ Richardson et al (2018). research of postgraduate students of presentation: Post-structuralism places Aim: To draft and consult on a position the health professions were highlights. structures at the centre of analysis and statement on violence and aggression My research interests and publications decanters the individual, meaning that towards nurses for the organisation. include: online professionalism for we can only tell stories that already exist (Butler 2001). Some psychoanalysts Methods: NZNOs member health professionals; inter-professional understand the human subject as consultation process distributes a education to enable teamwork and unknown to itself. This unknowability draft via the website seeking feedback. collaboration in health care; and since is always a threat to the authority of the Analysis of the extensive feedback joining NZNO, researching nursing ‘I’ proposed as the teller of a story. The received, including from members workforce and policy development advantage, in ethical terms, of expecting who had been assaulted at work, issues such as violence and aggression gaps, contradiction and ‘failure’ in a clearly signalled the need for a clear towards nurses and the development of story is that the researcher may not and unequivocal position statement school-based nursing services. demand, and work to find, coherence that supported a whole of organisation and consistency within the stories of response. others. Results: The biennial employment Conclusion/summarising the survey of members included questions contribution of the paper: This

67 Concurrent session 7: Thursday 5 September 2019

paper attempts to critique common use of a QES can help make nursing 7.3 Theme: Acute and Sub- assumptions at work in a popular research findings more impactful. acute Care research method in nursing. It proposes Methodological discussion: The a more theoretically developed presentation will outline the different Session no: 7.3.1 Abstract no: 0231 alternative with potential to enable aspects of nursing intervention Research Topic: Acute and critical care, more nuanced analysis of stories told by research that a QES can help address Leadership and Management, Health and patients or nurses. eg: exploring the experiences of living Social Policy Biography with a condition, which can impact Methodology: Observation Michael Traynor has a background in on the feasibility and acceptability Research Approach: Qualitative the study of literature. He has worked of an intervention; factors affecting approaches (eg: discourse analysis, in research roles in Australia, the RCN implementation, including context; ethnography, critical theory, grounded in London and currently works in the how a system may change when theory, phenomenology) Centre for Critical Research in Nursing an intervention is introduced; and Midwifery, Middlesex University. understanding the experiences of those receiving an intervention which Constrained compassion: He has recently written about the An ethnography exploring promotion of resilience among nurses. may impact on its implementation His new book ‘Stories of Resilience: and effectiveness. Three basic compassion in the acute tales from the front line of nursing’ is methodologies for conducting a QES, hospital setting relevant to nursing research, will be being published by Routledge. Presenter: Donna Barnes PhD, outlined along with an appraisal of their University of Derby, UK strengths and limitations. Exemplars Co-authors: Jane Seymour, UK; Paul will be provided of where the use of a Crawford, UK; Joanne Cooper, UK Session no: 7.2.2 Abstract no: 0308 QES has helped enhance the impact of nursing research. Abstract WITHDRAWN Conclusion: Qualitative evidence Background: This paper reports syntheses have an important role a study which contributes empirical to play in providing an in-depth findings to the global debate regarding understanding of patient, carer and compassion in health care. Specifically, Session no: 7.2.3 Abstract no: 0481 health professional’s experiences, how a shared organisational Research Topic: Methodology views and priorities of, and for, health commitment to noticing and Methodology: Other collection method care. In achieving this they can inform responding to the suffering of others (Worline and Dutton, 2017) can lessen Research Approach: Systematic Review and enhance the impact of research and other Secondary Research findings, particularly in topics relevant the impact of the problematic aspects to nursing. of contemporary health care (Crawford et al, 2014). Discourse on compassion Biography The role of qualitative in the UK (UK) is unique, due to a evidence synthesis in Dr Kate Flemming is a highly series of National Health Service enhancing the impact of experienced academic and nurse, (NHS) scandals, whereby poor care was internationally known for her leading nursing research framed as a ‘lack of compassion’. Media research and service innovation in coverage accused NHS care, specifically Presenter: Kate Flemming PhD MSc palliative care nursing. Kate leads nurses, of lacking compassionate PG Cert BSc (Hons) RN, University of by example through her pioneering values, which justified changes to York, UK clinical leadership and research in nursing recruitment, regulation and Abstract Palliative Care within the Hospice education as well as national health and community settings most notably policy. NHS Trusts were scrutinised Background: Qualitative evidence involving St Leonard’s Hospice, York. to demonstrate ‘values-based culture’, synthesis (QES) is an umbrella term Kate’s research programme focuses on despite scant evidence to support the for the methodologies associated with complex interventions including patient efficacy of these strategies for improving the systematic review of qualitative and carer experience of palliative care (Patterson et al, 2016). research evidence (Booth et al 2016). care across different service models, Aim: To investigate compassion within Undertaking a QES enables researchers disease types and morbidities, including the context of one acute NHS setting, to gain a greater understanding of motor neurone disease and heart examining facilitators, inhibitors, and individual’s experiences, views, beliefs failure. This work is closely integrated the enactment of compassion. and priorities for nursing and health with her methodological expertise in care (Flemming et al 2019). They can qualitative evidence synthesis. Kate is Methods: An ethnographic design either be conducted as stand-alone internationally known for her quality involving patients, visitors and staff reviews or integrated with some form approach to research and acts as co- was conducted from September of quantitative systematic reviews convener of the Cochrane Qualitative 2015-August 2016 using participant eg a review of interventions, to help and Implementation Methods Group. observation and in-depth interviews. understanding of the effectiveness and Kate has recently worked with the Thematic, key-event and deviant-case impact of those interventions. WHO on the use of qualitative analyses were utilised. Aim of the paper: The paper will evidence synthesis to inform guideline Findings: Poor care, where this exists present the role QES can play in development for complex interventions. does not equate to a lack of compassion. enhancing the understanding of nursing Nonetheless, contextual conditions interventions and their complexity. In facilitate and inhibit compassionate doing so, it will demonstrate how the care, with the result that staff develop

68 Concurrent session 7: Thursday 5 September 2019

strategies including compromise to deal significant body of work relating to She returned to Northern Ireland with inherent challenges. person-centeredness, the delivery of in 2007 to become Lead Nurse for Discussion: This paper argues person-centred care, and the impact Paediatrics and Neonatology in a Health the monolithic focus on staff values of the environment on care delivery; & Social Care Trust. She and her NI as a strategy for improving care is there is no current evidence that links team were involved in the Paediatric detrimental to staff and patient well- person-centred practice, staff and International Nursing Study (PINS), being. It assigns responsibility for patient experience, and the single room exploring nursing key performance compassionate care to nursing staff, environment. indicators. Shortly before retiring in while divorcing it from the challenging Aim: To explore the influence of 2016 Rosie was offered the opportunity context of contemporary health care. a 100% single-room, acute-care to undertake a PhD at Ulster University and she is now close to submission Conclusions and environment on the experience of of her thesis. Rosie has presented recommendations: Factors related person-centred practice, from the nationally and internationally, has to organisational context need to be perspective of staff and patients. contributed to several published papers, recognised and incorporated into Methods: An explorative ethnography published a literature review related to strategies for improving care. National study underpinned by the Person- her PhD and has written chapters for policy must shift from mandating staff centred Practice Framework two books. to be more compassionate, and move (McCormack and McCance 2017) was towards creating more compassionate used within a new inpatient block in health care environments. a district general hospital in Northern Biography Ireland. The data collection methods Session no: 7.3.3 Abstract no: 0154 included observations of practice (108 I worked as a palliative care nurse in hours), patient interviews (n=9), and Research Topic: Rehabilitation hospices and acute hospital settings staff reflexive groups (n=3). Data was Methodology: Interviewing for many years, looking after a range collected between March and June 2018 Research Approach: Qualitative of patients and their families. In and thematically analysed using the approaches (eg: discourse analysis, 2013, I won an Economic and Social Braun and Clark Framework (2006). ethnography, critical theory, grounded Research Council scholarship to explore theory, phenomenology) compassionate care and began a four Results: The results of the data year doctoral study. I present the results analysis suggest tentative themes of of this at the conference. I am currently managing the physical environment; Finding a safe way: A a lecturer/researcher at the University managing expectations; organising grounded theory of male of Derby, teaching adult and mental delivery of care; developing nurse practice in inpatient relationships. health nursing students about research rehabilitation and evidence-based practice, as well Discussion: The themes in this study Presenter: Mark Baker PhD, University as supporting other research projects. reflect how the physical environment of Sydney, Australia My interests are qualitative research, can create tensions between ensuring staff well-being and developing privacy and maintaining patient safety Abstract compassionate organisations. with an emerging hotel culture. The Aim: To report on a grounded theory limitations of the built environment can study to identify and make visible impact on the organisation and delivery male nurse practice in inpatient of care and meaningful engagement rehabilitation in Australia. Session no: 7.3.2 Abstract no: 0187 may become less evident in single Background: In Australia (Pryor, rooms. New environments inevitably Research Topic: Acute and critical care 2005) and internationally (Long, lead to new ways of working, and staff Methodology: Mixed Kneafsey, Ryan & Berry, 2002) nurses require a sustained period of support to contribute to rehabilitation broadly Research Approach: Qualitative make the step change needed to adapt approaches (eg: discourse analysis, through a range of nursing activities. to the new physical workplace. ethnography, critical theory, grounded This contribution is largely reported theory, phenomenology) Conclusion: There is little published from a female or gender neutral evidence on the impact of the single- perspective. Despite the work of male room environment on care delivery The influence of a 100% nurses being explained in a range of and experience. This study identifies other specialities (Fisher, 2009), their single-room environment the positive and negative impacts of work within inpatient rehabilitation on the experience of the environment on person-centred remains unexplored. care. Further consideration should be person-centred practice in Methods: Constructivist grounded given to staff preparation for change acute care theory methodology and methods, and managing the public’s expectations informed by symbolic interactionism, Presenter: Rosemary Kelly MSc around new facilities. (Nursing) RSCN, Ulster University, UK guided data collection and analysis Co-authors: Donna Brown, UK; Tanya Biography leading to the emergence of a McCance, UK; Christine Boomer, UK Rosie trained as a Paediatric Nurse in substantive theory. Data were collected Belfast and spent 20 years in clinical from interviews and observation of Abstract practice in a leading children’s hospital practice from October 2013 to April Background: The role of the in London. She also spent four years 2015 in inpatient rehabilitation and physical environment in facilitating working as a school nurse in an inner included 23 male nurse participants, 15 person-centeredness in health care city area. Rosie completed her MSc patient participants, and 63.5 hours of remains unclear. While there is a in 2005 at City University London. observation.

69 Concurrent session 7: Thursday 5 September 2019

Results: Male nurses were mindful 7.4 Theme: Care Homes and Discussion and Conclusions: The of patient perceptions about nursing Frailty important and feasible components being an occupation for women and of an intervention for frail older male nurses being sexual threats, Session no: 7.4.1 Abstract no: 0008 people were identified. There was which led to the problem of ‘potential some concern that some important Research Topic: Older People for misinterpretation’. To address components would not be included in this problem, male nurses engaged Methodology: Delphi the final intervention as they did not in a three-phase process known as Research Approach: Mixed Methods meet consensus for feasibility. It was ‘assessing and managing risk’ in Research therefore decided to present the results order to minimise risk and to keep to research stakeholders, including themselves safe in practice. However, Designing a nurse-led older people and carers to further two contextual conditions, ‘type of holistic assessment and refine the intervention ensuring it was care’ and ‘urgency of care’, influenced comprehensive and appropriate to the need for ‘assessing and managing care planning intervention their needs. The intervention will then risk’. The core category and substantive (HAPPI) to support frail be tested in a feasibility randomised grounded theory to explain these results older people in primary controlled trial. is ‘finding a safe way’. care Biography Discussion/Conclusion: Presenter: Helen Lyndon RN MSc BSc, Helen Lyndon, Nurse Consultant Theoretically, gender relations affected University of Plymouth, UK Older People/NIHR Clinical Academic the daily working lives of male nurses in Co-authors: Bridie Kent, UK; Jos M Doctoral Research Fellow. Helen inpatient rehabilitation. Interpersonal Latour, UK; Jonathan Marsden, UK has worked as a district nurse, nurse relationships were used by male nurses Abstract leader, community matron, nurse to counter the risk of misinterpretation practitioner and nurse consultant in and to enact the range of problem Background: Frailty is a clinical primary/community care settings. solving strategies encountered in syndrome associated with ageing which She set up services for older people their working lives. However, male progresses through cumulative cellular in the Cornwall including Hospital- nurse efforts were often influenced damage over the life course. Frailty at-Home, Community Matrons and by conditions outside of their control manifests when multiple body systems Telehealth. In 2016 she completed a and they practised cautiously to keep fail, the more systems that fail, the more two-year secondment to NHS England themselves safe in order to practise likely it is that the person will become as Clinical Lead for Frailty. In April nursing. frail and lose independence (Clegg et 2017, Helen was awarded a NIHR/HEE Biography al 2013). To meet the challenges of the Clinical Academic Doctoral Research increasingly frail, older population, Mark Baker is a registered nurse Fellowship. Helen’s PhD study with the we need to provide proactive, University of Plymouth aims to develop in the UK and Australia, holding a holistic person-centred care using a Bachelor of Nursing, Master of Nursing, and test an assessment and care standardised intervention in primary planning intervention for frail older Graduate Diploma of Nursing (mental care. This should be cost and time- health), Diploma of Health Service in primary care using mixed methods effective and should enable resources to research. Management, Professional Certificate be targeted at patients who will benefit of Teaching and Learning in Higher most. and Professional Education, and a Doctorate of Philosophy. Mark was Aims: The aim of this e-Delphi Session no: 7.4.2 Abstract no: 0193 awarded his PhD for ‘Finding a safe survey was to gain consensus from an way: a grounded theory of male nurse expert panel on the components of a Research Topic: Acute and critical care, practice in inpatient rehabilitation’ at holistic assessment and care planning Older People, Patient Experience intervention for frail older people in The University of Sydney. He currently Methodology: Interviewing primary care. works full-time as a Senior Teaching Research Approach: Case Study Fellow at King’s College London. Methods: A three-round modified Mark is a member of the Australasian e-Delphi approach was used with an Rehabilitation Nurses’ Association and expert panel of 33 specialist older One chance to get it right: the Nightingale Fund Council, as well people and primary care nurses in the Exploring perspectives as being an editorial board member UK. Panel members gave ideas about on decision-making for and contributor to two peer-reviewed the components of an intervention that discharge to care home professionals journals: Journal of are important and will improve clinical Australasian Rehabilitation Nurses’ outcomes and these were combined Presenter: Gemma Logan BSc (Hons) Association, and British Journal for with other components identified MN PhD Candidate, Queen Margaret Neuroscience Nursing. from reviewing the literature. In University and NHS Lothian, UK subsequent rounds components were Co-authors: Sarah Rhynas, UK; Jenni rated for importance and feasibility K Burton, UK; Juliet MacArthur, UK and consensus was established by 75% Abstract panel agreement. Background: Discharge from acute Results: Thirty-six components met hospital to care home is a complex the consensus threshold importance, and life changing process. Previous however only eleven components met work found variation in documented the consensus threshold for feasibility. discharge practices and identified

70 Concurrent session 7: Thursday 5 September 2019

the complexity of patients involved her career combining both clinical and Methods: Semi-structured interviews (Harrison et al, 2017). academic/research pathways in 2014, were conducted with a purposive Aim: This study aimed to explore the undertaking a Masters in Nursing in sample of care home managers (n=28) perspectives of key stakeholders who Clinical Research at The University from the population of care homes with contribute to decision-making about of Edinburgh and working as a staff access to the HVS service (n=96). Care discharge to care home. nurse with older people. Following homes were chosen for their use of the completion of the Masters, Gemma HVS service, size, geographical location Methods: A case-study research was appointed as a Research Nurse and resident demographic. Thematic design was used to explore the at the National CJD Research and analysis used for the analysis of the experiences of six people admitted to Surveillance Unit in Edinburgh where interviews. hospital from home for whom discharge she worked part time on a study to to care home was planned. Each dataset Results/discussion: There was a identify missed cases of Prion disease included semi-structured interview data reduction in the number of emergency in older adults with atypical Dementia. from a person, their significant others 999 calls. The flexibility and timely Gemma worked here for a duration of and multidisciplinary professionals access to a health professional was three years, during which time she also (n=30). Health records were also highly valued, particularly out of became the Principal Investigator for a reviewed. Datasets were analysed using hours. Care ‘in situ’ was preferred to qualitative study exploring care home an inductive thematic approach before care in hospital. There were however discharge decision-making. Gemma’s cross dataset analysis. several challenges. Due to constant clinical and research interests include staff turnover, there was a ‘patchy’ Results: Discharge from hospital older people, acute hospital discharge lack of awareness of the HVS, and a to care home was found to be a and person-centred practice. residual use of emergency 999 calls as fragmented process. Professionals the default position by some care home were uncertain about the process staff. resulting in disjointed communication. A professional division of roles/ Session no: 7.4.3 Abstract no: 0462 Conclusions: The provision of a responsibilities was evident. Patients 24/7 HVS for care homes does make a Research Topic: Older People were keen to talk about, and rationalise qualitative difference to the experience their decision-making. Family members Methodology: Interviewing of care home residents suffering minor highlighted the complexity of balancing Research Approach: Qualitative injury or illness risk and care needs. The significance of approaches (eg: discourse analysis, Biography ethnography, critical theory, grounded the decision to the individual and their theory, phenomenology) Dr Robin Lewis is a senior lecturer family was often not reflected in the at Sheffield Hallam University. He professionals’ responses. was awarded his PhD in 2007 and is Discussion: The hospital context Plugging the gap: an expert in workforce development has the potential to facilitate decision- Evaluating a home visiting in health care. His area of research making in practical ways and in service for care homes interest lies in the development of new permitting conversations about care Presenter: Robin Lewis PhD, Sheffield roles and new ways of working. He has needs/wishes. Professionals should Hallam University, UK extensive experience in undertaking recognise the person and the centre of evaluation research and is currently decision-making, recognising an inter- Abstract working on a number of funded projects disciplinary shared responsibility for Background: All the evidence shows evaluating the impact of new roles such supporting them. Better understanding that there is a clear need to avoid as the Advanced Clinical Practitioner of the discharge process and improved unnecessary Emergency Department (ACP) role. He also has an interest in communication is central to enhancing (ED) attendance and hospital admission the impact of the third sector on health the experience of older people and their in frail, older adults who are resident care, and in developing partnerships families. in care homes. Targeting clinical between Higher Education Institutions Conclusion: Exploring the resources at these frail older adults such as Sheffield Hallam University perspectives of key stakeholders who requiring urgent care for relatively and third sector, not for profit contribute to decision-making about minor conditions which do not need an organisations. discharge to care home has offered emergency ambulance is both clinically a valuable opportunity to gain in- and cost effective and would greatly depth insights into the complexity contribute to the experience of the of this process. The findings have older person. A 24/7 rapid response demonstrated that this is a life changing home visiting services (HVS) staffed decision, requiring greater recognition by advanced clinical practitioners was by health care professionals and commissioned in a large metropolitan offering opportunity to improve person- area in the North of England. The centred discharge practice. service remit was to treat minor injury and illness on scene via a clinical triage Biography and referral pathway. Gemma Logan is undertaking a Aims: The aim of the study was to PhD at Queen Margaret University examine the perceptions of care home in collaboration with NHS Lothian managers regarding the HVS service, focused on person-centred discharge and the factors that affected its use by for older people. She also works part the care home staff. time as a staff nurse. Gemma began

71 Concurrent session 7: Thursday 5 September 2019

7.5 Theme: Dementia Family carers: impact of dementia on Session no: 7.5.3 Abstract no: 0279 function and behaviour; social and Research Topic: Dementia Session no: 7.5.1 Abstract no: 0209 psychological impact of dementia; Methodology: Focus Groups WITHDRAWN diagnosis; needs of carers and younger people living with dementia. Research approach: Qualitative approaches (eg: discourse analysis, Services staff: having a purpose; social ethnography, critical theory, grounded Session no: 7.5.2 Abstract no: 0317 support; future priorities. theory, phenomenology) Research Topic: Dementia The findings from Themes 1-2 are Methodology: Interviewing presented using verbatim quotes to Prison initiatives to support illustrate points made. The implications Research Approach: Qualitative older prisoners and approaches (eg: discourse analysis, for nursing practice will be drawn out ethnography, critical theory, grounded including how family carers can be those with dementia: the theory, phenomenology) better supported; how services can be prisoner’s lived experience made more age-specific; nurses’ role Presenter: Joanne Brooke, Professional Experiences of health and in meeting social and psychological Doctorate, RN, Birmingham City support needs of persons with YOD and University, UK social care by persons with family carers; nurse’s role in support young onset dementia and during and after diagnosis of YOD. Abstract family carers: Implications The presentation will conclude with Background: The prevalence for nursing recommendations for nurses around of dementia in the prison setting reviewing existing services and is increasing (Brooke et al 2018). Presenter: Tracey Williamson PhD Initiatives to support older prisoners MSC BSc (Hons) RGN Association influencing service design, enhanced family engagement and meeting social, and those with dementia have been for Dementia Studies, University of implemented (Hodel and Sanchez, Worcester, UK psychological and information needs. Implications for practice centre on 2012), but have not been robustly Co-authors: John Chatwin, UK; Luisa evaluated (Peacock et al 2018). The Rabanal, UK; Chris Sewards, UK nurses creating young dementia- friendly environments and services. aim of this study was to explore Abstract Policy implications are less reliance on- prisoners lived experience of attending Dementia is often associated with one-size-fits-all approaches to dementia an initiative exclusively designed for ageing, yet not only affects older adults. services. older prisoners including those with dementia. There are over 40,000 people in the UK Biography living with dementia who are under 65 Method: A phenomenological years of age. Tracey is a Registered Nurse with a inductive study conducted in a category background in the NHS working in C male prison within Her Majesty’s Between 2015 and 2018, the Salford older people’s care settings latterly Institute for Dementia led a three- Prison Service in England and Wales, as a Nurse Consultant. Following a which implemented a work group year study exploring the experiences Department of Health PhD fellowship, of people living with YOD from the and a social group for prisoners over she undertook a programme of work the age of 55. Data were collected in perspective of persons living with YOD, around patient and public involvement their care partners and health and 2017 through focus groups (n=4) with in research, technology co-design and prisoners (n=11) attending the work social care related service providers. evaluation of services. Recently she has Data collected 02/2016-4/2018. group (n=2) and social group (n=2). focused in the dementia field including Focus groups were completed, audio The study included interviews with 72 evaluation of dementia environments recorded, transcribed verbatim, and participants (22 with YOD aged 52-67; (hospital and care home) and thematic analysis was completed. 25 carers; and 25 staff from health and experiences of people living with young social care organisations). Uniquely a onset dementia. She is a participatory Result: Participants from the social dedicated Development Worker focused researcher. In her joint-funded post group were older and more physically on the engagement and support of as Dementia Carers Count Professor and cognitively impaired than those participants to make involvement in of Family Care in Dementia, Tracey is attending the work group. Three themes research easier for them. working to establish a programme of emerged across both groups. Firstly, the need to feel safe, attending these Thematic analysis using the approach of research with an emphasis on family initiatives provided older prisoners Braun and Clarke (2006) identified the carers of persons with dementia. with a safe haven away from boisterous following themes: Her focus on family and friends will ensure much needed research on their and unsettled youngsters. Secondly, the Persons with YOD: the process of need to have a purpose and belong to a diagnosis; the impact of living with experiences and needs, in the hope of making these more positive experiences group, which motivated older prisoners YOD; the needs of people with YOD; to complete activities. Thirdly, the need living well with YOD. wherever possible and helping family carers to be better supported and more to feel included and not excluded, to resilient. support this all initiatives should be open to older prisoners.

72 Concurrent session 7: Thursday 5 September 2019

Conclusion: Prisoners experienced 7.6 Theme: Patient Safety the support and safety of attending groups created and designed for older Session no: 7.6.1 Abstract no: 0407 prisoners and those with dementia, Research Topic: Patient Safety (including however also expressed the need to be human factors, infection, prevention and integrated into wider prison initiatives. control etc) Both the social and work group Methodology: Mixed supported prisoners with dementia Research Approach: Mixed Methods to be active in the prison setting and Research not be unduly locked in their cells. The impact of these initiatives beyond prisoner’s experiences needs to be Pressure injury prevalence further explored. and practice improvement: Biography A realist evaluation of Dr Joanne Brooke is a Registered nursing care and nursing Adult Nurse and a Chartered Health knowledge to reduce Psychologist.Joanne’s research pressure injuries in# an background includes work across Australian hospital medical, psychological and nursing fields, including the approaches of Presenter: Jenny Sim RN Bachelor quantitative and qualitative designs Applied Science (Nursing), Grad Dip from randomized controlled trials Clinical Nursing, Grad Dip Business to epidemiological studies. Joanne’s Administration, PhD, University of focus has been within dementia and Wollongong, Australia diabetes, although now focuses on the Co-authors: Valerie Wilson, Australia; wider aspect of mental health, cognitive Karen Tuqiri, Australia impairment and delirium. Joanne has Abstract published a number of papers on the Background: Pressure Injuries place link of diabetes and dementia, and a significant burden on the health the importance of the development care system and cause patient harm. of cognitive screening tools that are Hospital acquired pressure injuries validated for people with diabetes, (HAPI) can be prevented by high and is currently exploring dementia quality nursing interventions. and cognitive impairment in offenders serving a prison sentence. Aim: To explore how periodic pressure injury prevalence (PIP) surveys can impact on HAPI rates and the knowledge and attitudes of nursing staff towards preventing pressure injuries in an acute care hospital. Methods: A concurrent, two phase, case study design was used to assess PIP and the knowledge and attitudes of nursing staff towards preventing pressure injuries in 4 wards at a large teaching hospital in NSW, Australia. Data was collected from July 2018 to February 2019. The PIP survey also collected data on nursing care processes to assess risk and plan interventions. Multiple action learning sets were then used for staff to identify areas of improvement and make changes. PIP and the knowledge and attitudes of nursing staff towards preventing pressure injuries were then re- measured at the end of the project. Results: The rate of HAPI prevalence decreased from 4.6% to 1.9% during the project. Nurses’ initial knowledge and attitudes towards prevention of pressure injuries revealed a strong knowledge on risk assessment (82.6%) and poor knowledge on prevention (31.1%). Nurses’ knowledge on

73 Concurrent session 7: Thursday 5 September 2019

most themes of the Pressure Injury Session no: 7.6.2 Abstract no: 0372 BMI, falls other assessment tools and Prevention Knowledge Assessment co-morbidities were used varyingly to Research Topic: Patient Safety (including Tool (PUKAT 2.0) increased during the human factors, infection, prevention inform a diagnosis of frailty. project. and control etc), Research Ethics and Discussion: This study may not have Discussion: Four wards participated Governance, Older People captured all those where frailty was a in this study. Some wards engaged with Methodology: Documentary Research factor in length of stay or risk of death. the action learning sets and used Plan- Research Approach: Quantitative (not The importance of clearly documenting Do-Study-Act cycles to improve nursing included in another category) frailty indicators is evident. care processes and nursing knowledge Conclusion: Assessment for frailty on during this project. Wards with higher admission or during a hospital stay is a levels of engagement improved patient Does the use of the term ‘frailty’ adequately describe significant factor in determining patient outcomes by reducing pressure injuries outcome. Further study is needed to and increased nursing knowledge. cause of death in an older consider the impact of education on Conclusion: Pressure injuries are population admitted to practice. preventable. Nurses’ knowledge hospital and how has Biography and attitudes towards prevention in ‘frailty’ been identified, combination with valid and reliable Margaret is a senior academic, in the data can assist nurses working in acute assessed and managed in Nursing and Midwifery Department care hospitals to prevent pressure hospital? at Sheffield Hallam University, with specialist interests in pain management injuries. Presenter: Margaret Dunham RGN and older people’s needs in particular. BA (Hons) MSc PhD, Sheffield Hallam Biography Margaret has worked at the University University, UK Jenny is an experienced nurse academic since 2006, previously having worked Co-authors: Ali Ali, UK; Ian Eady, UK; and researcher who also has experience as a non-clinical academic at the Sally Fowler Davis, UK as a senior manager in the Australian University of Sheffield. Margaret health care system. Jenny completed Abstract specialises in older people’s experiences her PhD in 2015 and developed a Background: Frailty is a significant of health care, focusing on their pain conceptual framework and indicator set factor in the morbidity and mortality experiences. Since 2013 she has been for measuring the quality and safety of of older people. Increasing numbers of Associate Editor of the British Pain nursing practice. Jenny has developed a older people are admitted to hospital Society’s Pain News and is currently program of research on measuring both and are either admitted with frailty or chairman of the British Pain Society the quality and the safety of nursing become frail after admission. Frailty Older People Special Interest Group. care in Australia and internationally may be a cause of death but is not an Margaret also works with groups locally and is particularly interested in inevitable consequence of ageing. This and nationally to improve and enhance research on pressure injuries. Jenny is leads to questions of how frailty might experiences of pain services. Margaret the Director of the Australian Nursing be detected and prevented. This is currently supervises three PhD Outcomes Collaborative also known as primary research to explore the clinical students. Her current research activities AUSNOC and is empowering nurses practices associated with ‘frailty’ at end include reviewing documentation of to research the structure, process and of life -intended to inform a range of frailty in the records of older people in outcome components of nursing care so discussions about the multi-disciplinary an acute NHS hospital and considering that we can measure the impact nursing management of older people. older people’s experiences of non- care has on patient outcomes. Aim: To explore the practices of cancer related palliative care services. identifying, assessing and managing frailty in the older patient population against the frailty good practice guide Session no: 7.6.3 Abstract no: 0477 Fit for Frailty. Methods: Ethical approval was gained Research Topic: Patient Safety (including human factors, infection, prevention and to undertake a retrospective case note control etc) analysis of the medical records of Methodology: Mixed older people who died, in a large NHS hospital, between January and June Research Approach: Mixed Methods 2017 (N=176) with the term ‘frailty’ Research noted on their death certificates. Thirty sets of notes were randomly selected. Sharing learning from Data was collected relating to the practice to improve patient assessment and management of frailty (BGS 2014). safety (SLIPPs): Gathering Results: Preliminary analysis suggests and exploring student that the identification of frailty is accounts of practice not always clearly or consistently learning experiences about documented on admission however patient safety during in-patient stay, most had Presenter: Alison Steven BSc(Hons) been referred to the local frailty unit MSc PGCRM RN, Northumbria for assessment. The use of trends in University, UK

74 Concurrent session 7: Thursday 5 September 2019

Co-authors: Valerie Larkin, UK; Lucy Biography 7.7 Theme: Workforce Patterson, UK; Sarah Morey, UK Dr Alison Steven BSc(Hons) MSc Session no: 7.7.1 Abstract no: 0485 Abstract PGCRM RN is Associate Professor/ Background: SLIPPs is an EU Reader in Health Professions education Research Topic: Nursing, Midwifery or Support Worker Education, Acute and co-funded project involving the UK, at Northumbria University with over critical care, Health and Social Policy Finland, Spain, Norway and Italy. 20 years’ experience in health services Project principles are: education for research. She gained her PhD in 2002 Methodology: Observation patient safety is complex and socially from Newcastle university Medical Research Approach: Qualitative situated; experiential placement school. Her research focuses on health approaches (eg: discourse analysis, professions education, learning and ethnography, critical theory, grounded learning is powerful; reflection and theory, phenomenology) reflexivity are important; much wellbeing for the enhancement of safety can be learned from student’s lived and quality in professional practice. experiences. Alison has undertaken research across The health care assistant- a spectrum of settings into practice Aims: To gather and study student registered nurse dyad: A based education, mentoring, practice experiences and reflections on development, organisation and delivery, new concept of team placement learning events related and knowledge translation. She has Presenter: Rachael Carroll MSc BSc to patient safety. An overview of UK lead or been involved in over 30 funded (Hons) RMN, De Montfort University, student’s use of the tool and experience projects. She teaches a range of health UK of recording learning events will be professions from undergraduate to presented. Abstract post graduate level and supervises Health care assistants (HCAs) are Methods: An online tool was doctorates - with 11 successful PhDs integral to adult nursing teams. Their developed drawing on established completions to date. Currently Alison role and responsibilities has been approaches and existing work (Steven et leads the ‘Sharing learning from widely debated. However, it is unclear al 2014, Tella et al 2015), development practice to improve patient safety’ how HCAs make sense of and enact included pre-testing, piloting across project (SLIPPS) co-funded by the their role. five countries and translation into 5 Erasmus + programme of the European languages. Ethical approvals were Union. Ethnographic methodology was used to gained and accounts gathered. describe and explain the HCA’s role and Statistical analysis was undertaken. their contribution to the nursing team. Interviews were held between October Data was collected in 2017, on four 2018-April 2019 with students who had in-patient adult wards, in one hospital. used the tool (n=6) and thematically Observations followed by interviews analysed (Saldana 2016) to explore were conducted with HCAs (n=22) and experience of recording events and tool their paired Registered Nurses (n =24). use. Analysis found that HCAs and Results: Between November 2017 Registered Nurse (RN), when paired and April 2019, 91 UK nursing student for a shift in a bay, formed a “dyadic accounts were collected, data gathering team”. Within the dyadic team, the is ongoing. Descriptive statistical HCA and the RN joined and separated analysis will be presented. From the in order to complete all of the nursing interviews three themes emerged: tasks. To be able to contribute to Events and Significance; Processing to the HCA – RN dyad, HCAs needed add meaning; Educating others. to be able to work non-dependently Discussion and conclusions: A and interdependently from their RN range of events were recorded from partner. Non-dependent working was diverse placements. The majority were achieved through carrying out the identified by students as episodes routine scaffolding. This comprised of good practice and related to of three levels of tasks; compulsory communication, decision making and timed tasks, mandatory flexible tasks, team working, potentially indicating a and RN requested tasks. The extent of preference for learning from positive the success of non-dependent working experiences. Interview findings suggest was reliant on the RN having trust in the tool stimulates processes of picking the HCA. Inter-dependent working apart, dissecting and questioning to included any tasks that required two add meaning, with unexpected impacts people and relied upon the willingness including taking the event record back of the RN to co-work. When a HCA into practice for team learning. Thus was able to work non-dependently and the tool acts as both data collection inter-dependently, their contribution to device and educational intervention. the HCA-RN dyadic nursing team was The multinational tool has relevance for considered successful and effective by an international audience. This paper both partners. contributes to developing knowledge Through exploration of how HCAs regarding how students learn about make sense of and enact their role, the patient safety during placements. importance of the relationship with

75 Concurrent session 7: Thursday 5 September 2019

the RN that they were paired with has Aims: To explore hospital and care Session no: 7.7.3 Abstract no: 0378 been highlighted. Working as a separate home nurse perspectives on the Research Topic: Older People entities and a cooperative pair within roles they need to perform to ensure Methodology: Mixed the HCA-RN dyad increased the success quality transitional care for people of completion and documentation of all living with dementia who return to Research Approach: Mixed Methods nursing tasks within the shift time. their nursing home from hospital; Research Biography and the extent to which they consider Naylor’s components applicable to this Contributing to workforce Rachael Carroll has been a mental transition. health nurse for over 20 years. In 2014, excellence for older people Rachael moved from her post as a ward Methods: Sixteen registered nurses health care: Evaluating the sister to become a research fellow at De from two hospitals and seventeen from four nursing homes in England contribution of a specialist Montfort University, Leicester. Here, programme for expert Rachael took the opportunity to study participated in focus groups or the role of the Health Care Assistant interviews, from May to August 2018. A nurses and allied health in an adult nursing environment at deductive analysis was conducted. professionals doctoral level and is now in her final Results: Hospital and care home Presenter: Joanne Fitzpatrick BSc PhD year. Rachael also holds a post as the nurses described roles which mapped RN PGCEA, King’s College London, UK Practice Development Lead at De on to six of the eight components and Co-presenter: Ivanka Ezhova, UK Montfort University. were cited as ensuring quality of care Co-author: Nicky Hayes, UK at transition for residents living with dementia. These included complexity Abstract management, care continuity, caregiver Background: More needs to be done Session no: 7.7.2 Abstract no: 0440 engagement, accountability, patient to get the best outcomes for older people living with complex needs. Research Topic: Dementia, Workforce and and caregiver well-being and patient A key contribution to achieving this Employment (including health and wellbeing engagement. Roles pertaining to patient roles, research careers) and caregiver education were absent. is workforce transformation and development, building a workforce for Methodology: Interviewing Discussion: Quality transitional care for people living with dementia quality, one that is able to deliver safe, Research Approach: Qualitative high quality care; to innovate; to lead approaches (eg: discourse analysis, requires that nurses perform multiple and to inspire others; and to value the ethnography, critical theory, grounded roles, many of these identified by theory, phenomenology) Naylor and colleagues, though requiring voice of older people. Helping achieve some modification for residents with this is an innovative postgraduate programme for specialist nurses and Optimising nursing care of dementia returning back to nursing homes; and not all apply. allied health professionals working people living with dementia across a range of services and settings Conclusion: The study findings can in England to care for older people. who return to their nursing be used to inform future care home and home from hospital hospital policies, and staff training. Aims: To evaluate the impact of this programme on participants’ Presenter: Angela Richardson, Biography professional development, and the Centre for Applied Dementia Studies, development and quality improvement University of Bradford, UK Angela is a full time final year PhD of older persons’ services. Co-authors: Alison Blenkinsopp, UK; student in the Alzheimer’s Society Kathryn Lord, UK; Murna Downs, UK funded Doctoral Training Centre on Methods: A mixed methods approach, Transitions in dementia care at the comprising a longitudinal survey Abstract University of Bradford. She has a (n=198) and focus groups with Background: Improving transitional clinical background in mental health programme participants (n=48) and care has received global attention nursing with a special interest in a longitudinal survey with managers from researchers and policy makers. dementia care and previously worked as and colleagues (n=42). This paper will Many nursing home residents live with a nurse lecturer. Her research is focused present the findings of the focus groups; dementia and co-morbidities, placing on the transition between hospitals focus group data collection commenced them at risk of hospital admission. and care homes for people living with in October 2015 and ended in March The transition back to nursing homes dementia. 2019. The focus groups explored from hospital is fraught with negative participants’ vision for older people outcomes, yet we lack evidence to care, motivations and experiences of the improve care between these settings. programme, and views about its impact Recent research identified eight for professional development and for components required for quality older people care and services. Data are transitional care for older adults moving being thematically analysed. between hospital and their own home Results: To date, three interrelated (Naylor et al 2017). Little is known and interdependent themes are: about UK nurses’ perspective on the building confidence through knowledge relevance of these components for their and skills, like-minded network to role in the transition from hospital to influence care and services, and nursing home; including their relevance recognition of expertise. for residents with dementia. Discussion and conclusions: This innovative programme develops

76 Concurrent session 7: Thursday 5 September 2019

a critical mass of nurses and allied health professionals working in older people care who are expert thinkers and practitioners, skilled collaborators, and influential role models and leaders. To ensure that the voice of older people is heard and actioned, we need a long- term strategy that commits to the ongoing development and support, and valuing of a workforce of nurses and allied health professionals working in older people services. Biography Dr Joanne Fitzpatrick is reader in Older People’s Health care at King’s College London. Her research interest and expertise involve nurse education and performance, older person care, the organisation and delivery of health care for older people in the acute and care home sectors, health care workforce caring for older people.

77 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

Symposium 1 methodological contributions to programmes of this kind. understanding the factors that may References Abstract no: 0179 enable or inhibit implementation will be of high interest to practitioners, Bridges J, May CR, Griffiths P, Fuller educators, policy makers and A, Wigley W, Gould L, Barker H & Intervention studies to researchers. Libberton P (2017) Optimising impact support compassionate and sustainability: a qualitative care in practice: Context, process evaluation of a complex methodology and outcomes Paper 1 intervention targeted at compassionate care. BMJ Quality & Safety, 26(12), Lead: Mary Flatley, University of 970-977. Surrey, UK CLECC and Schwartz Gould L, Griffiths P, Barker H, Symposium Statement: Chaired by Rounds: Design and Libberton P, Mesa-Eguiagaray I, Professor Ruth Harris, this symposium delivery of two intervention Pickering RM, Shipway LJ & Bridges reports from two multi-centre studies, J (2018). Compassionate care each focusing on context, methodology studies in compassionate intervention for hospital nursing teams and outcomes in the evaluation of care caring for older people: a pilot cluster complex interventions to support Authors and affiliation: Professor randomised controlled trial BMJ Open, compassionate care in practice. Both Jackie Bridges, University of 8, e018563 studies were funded by NIHR in Southampton, UK; Professor Jill response to Francis Inquiry concerns Maben, University of Surrey, UK Maben J Taylor, C Dawson, J Leamy, raised about compassionate care. One Abstract M McCarthy, I Reynolds, E Ross, S study (Schwartz) focuses on Schwartz Shuldham, C Bennett, L Foot, C (2018) Centre Rounds; organisation-wide Background: The consistent delivery A Realist informed mixed methods forums for health care staff where of compassionate health care to evaluation of Schwartz Center staff share stories about their work to health care recipients is a matter of Rounds® in England. Health Services prompt group reflection and discussion global concern. The development and and Delivery Research Volume: 6, of the emotional, social or ethical evaluation of effective interventions Issue: 37, Published in November 2018 challenges of health care work. The to address this concern is of prime https://doi.org/10.3310/hsdr06370 other (CLECC) focuses on supporting importance. ward nursing teams to develop Aims: To introduce two intervention leadership and team reflective practices studies targeted at the promotion of Paper 2 in the workplace. Both interventions compassionate hospital care. are designed to support staff and to Methods: The Creating Learning enhance compassionate care practices. Environments for Compassionate Creating Learning The symposium begins with a joint Care (CLECC) intervention focuses Environments for paper outlining the studies, detailing on supporting ward nursing teams Compassionate Care each intervention, and the challenges to develop leadership and team (CLECC): Developing and of access, time and support, laying the reflective practices in the workplace. evaluating the feasibility of A pilot cluster RCT and associated groundwork for the subsequent papers. a complex intervention This is followed by a paper reporting process evaluation was conducted on findings from the CLECC study, in six hospital wards in two hospitals Authors and affiliation: Professor particular qualitative findings on the to assess the feasibility of the CLECC Jackie Bridges, University of influence of organisational context on intervention in practice and evaluate Southampton, UK implementation and outcomes of the its impact. Schwartz Centre Rounds Abstract are multidisciplinary organisation- intervention. Pilot trial outcomes will Background: Despite concerns also be reported. A third paper draws wide forums for health care staff where staff meet (usually monthly) to share about the degree of compassion in on realist evaluation methodology contemporary health care, there is a to report the important contextual stories about their work to prompt group reflection and discussion of the dearth of evidence for health service elements of Schwartz Rounds and managers about how to promote how these contextual factors facilitate emotional, social or ethical challenges of health care work. A realist evaluation compassionate health care. This paper the mechanisms of the intervention reports on the implementation of to fire or not in different settings methodology was used to evaluate Schwartz Rounds in nine case studies the Creating Learning Environments to produce outcomes in terms of for Compassionate Care (CLECC) reflection, empathy and compassion. in England where Rounds have been implemented since 2009. intervention by four hospital ward The symposium concludes with a panel nursing teams. CLECC is a workplace discussion that draws on findings from Findings: This paper will report each educational intervention focused on both studies to explore the impact of study’s intervention and evaluation developing sustainable leadership context, methodology and outcomes on methodologies, providing opportunities and work-team practices designed to the implementation of interventions of for comparative analysis. We will also support team relational capacity and this kind in health care settings. share data about the challenges of compassionate care delivery. access, time and support to implement This symposium’s focus on the the interventions as planned, Objectives: To identify and explain context of implementation, illuminating the strategies required the extent to which CLECC was measurement of their consequences for successful implementation of implemented and sustained in existing and the identification of the different work practices by nursing staff in two

78 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

acute hospitals, and to report pilot trial Paper 3 to the intervention and sufficient outcomes. support for Rounds in practice, Realist Methods: Pilot cluster RCT with evaluation with a focus on context + primary outcome measure of quality A realist evaluation of mechanism = outcome allowed the of staff-patient interactions (n=273) Schwartz Centre Rounds: contextual factors which allowed key and longitudinal process evaluation how interventions may mechanisms to fire to be identified. using normalisation process theory. work differently in different References Data gathered included staff contexts and why interviews (n=47), observations (n=7 Pawson R, Tilley N. (1997) Realistic over 26 hours), and ward manager Authors and affiliation: Professor Jill evaluation. London: Sage. Maben, University of Surrey, UK questionnaires on staffing (n=4). Maben J Taylor, C Dawson, J Leamy, Results : Frontline staff were keen Background: Despite concerns about M McCarthy, I Reynolds, E Ross, S to participate in CLECC, were able the degree of empathy and compassion Shuldham, C Bennett, L Foot, C (2018) to implement many of the planned in current health care settings, A Realist informed mixed methods activities and valued the benefits to there is a lack of organisation –wide evaluation of Schwartz Center their wellbeing and to patient care. interventions, open to all, to support Rounds® in England. Health Services The quality of interactions between staff to deliver compassionate health and Delivery Research Volume: 6, staff and patients also improved, care. This paper reports data from the Issue: 37, Published in November 2018 although not significantly so. Factors evaluation of Schwartz Centre Rounds https://doi.org/10.3310/hsdr06370 outside of the direct influence of the in the UK, an intervention which ward teams mediated the impact and supports staff to share stories about sustainability of the intervention. These their work to prompt group reflection Paper 4 factors included an organizational and discussion of the emotional, social culture focused on tasks and targets or ethical challenges of health care that constrained opportunities for staff work. Intervention studies to mutual support and learning. Objectives: To identify the key support compassionate Conclusions: Relational work in contextual elements of Schwartz care in practice: A panel caregiving organisations depends not Rounds and how these facilitate the discussion mechanisms of the intervention to fire just on individual caregiver agency Authors and affiliation: Mary but also on whether or not this work (or not) in different settings to produce outcomes. Flatley, University of Surrey, UK; is adequately supported by resources, Professor Jackie Bridges, University norms and relationships located in Methods: Realist evaluation in of Southampton, UK; Dr Mary Flatley, the wider system. High cognitive nine case study sites examining staff Homerton University Hospital NHS participation in compassionate nursing well-being at work and reported staff Foundation Trust, UK care interventions such as CLECC by and patient outcomes. Data gathered senior nurse managers is likely to result included staff interviews (n=177), The need to better understand how in improved impact and sustainability. observations (n=42 Rounds; 29 panel complex interventions such as CLECC and Schwartz rounds are implemented, References preparation and 28 steering group meetings). their causal effects and the impact of Bridges J, May CR, Griffiths P, Fuller Results: Rounds were described context are increasingly recognized as A, Wigley W, Gould L, Barker H & by staff as interesting, engaging and crucial for policy and practice (Moore et Libberton P (2017) Optimising impact supportive and staff appreciated the al, 2015). Drawing on findings from two and sustainability: a qualitative opportunity to learn more about multi-centre studies that explored the process evaluation of a complex their colleagues and digest patient feasibility of interventions to support intervention targeted at compassionate cases, understand their perspectives compassionate hospital care, this panel care. BMJ Quality & Safety, 26(12), and motivations resulting in greater discussion will consider and explore 970-977. understanding, empathy and tolerance key contextual factors that can support or inhibit implementation in acute Gould L, Griffiths P, Barker H, towards colleagues and patients. hospital settings. Libberton P, Mesa-Eguiagaray I, Four contextual layers explained Pickering RM, Shipway LJ & Bridges variation in Rounds implementation The Creating Learning Environments J (2018). Compassionate care and nine CMOs detailed how for Compassionate Care (CLECC) intervention for hospital nursing teams Rounds work. Contextual elements intervention focuses on supporting caring for older people: a pilot cluster included: (i) individual capabilities ward nursing teams to develop randomised controlled trial BMJ Open, and characteristics of key actors leadership and team reflective practices 8, e018563 (e.g. facilitators); (ii) interpersonal in the workplace. A pilot cluster RCT relationships; (iii) the organisational and associated process evaluation was setting and (iv) the intra-structural conducted on six hospital wards in two setting. hospitals to assess the feasibility of the Conclusions: Rounds offer a safe, CLECC intervention in practice and reflective space for staff to share stories evaluate its impact. Schwartz Centre with their peers about their work and its Rounds are organisation-wide forums impact on them. Enhancing compassion for health care staff where staff share and empathy in caregiving relationships stories about their work to prompt is complex and depends on a range of group reflection and discussion of the contextual factors to support fidelity emotional, social or ethical challenges

79 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

of health care work. Trained facilitators Symposium 2 NMAHPs was launched in the UK. guide discussion of emerging themes The first stage of the ICA pathway and issues, allowing time and space Abstract no: 0262 is for early career NMAHPs to for the audience to comment and / participate in a pre-master’s clinical or reflect on similar experiences. A academic internship scheme. One such realist evaluation was conducted in Developing research programme has been taking place at case studies in nine organisations capacity in nursing, the University of Central Lancashire to understand how Rounds work to midwifery, allied health and since 2014. The programme consists produce their outcomes and what social care: Collaborative of 30 days’ secondment from clinical contextual factors influence this. practice over 9-12 months, including approaches eight training days comprising Panel members are senior investigators Lead: Josephine Gibson, PhD RGN, sessions on good clinical practice in drawn from both study teams. University of Central Lancashire, UK research, ethics, data collection and Discussions will be chaired by Professor analysis (qualitative and quantitative); Ruth Harris and will be initiated by Symposium Statement poster presentations, and writing for a small number of key questions. The provision of evidence-based health publication. The programme has been Audience members will be encouraged care depends on the existence of robust completed by 27 health professionals to ask additional questions, and the research findings which reflect the most from across Lancashire and Cumbria discussion will conclude with a closing pressing concerns of patients, service including: nurses, occupational statement from each member. users, carers and practitioners. Nurses, therapists, therapy assistants, References midwives, allied health professionals physiotherapists, health care assistants and social care practitioners provide and psychologists. An optional aspect Bridges J and Fuller A (2015) the vast majority of direct health and of the programme is to complete Creating learning environments social care, yet hitherto they have rarely two modules as part of a degree or for compassionate care (CLECC): a contributed to the evidence base for masters pathway. An evaluation of programme to promote compassionate their own professions, when compared the programme found that there is care by health and social care teams. with their medical counterparts. the potential for considerable impact International Journal of Older People The introduction of formal funding in clinical practice from the research Nursing, 10, 48-58. schemes for clinical academic careers undertaken, the networks developed Moore GF, Audrey S, Barker M, Bond, in nursing, midwifery and allied health and from personal and professional L, Bonell C, Hardeman W, Moore may go some way to address this, but development. Collaboration and L O’Cathain A, Tinati T, Wight D innovative approaches are needed to support from other interns, colleagues (2015). Process evaluation of complex overcome barriers to development. and managers enhances engagement interventions: Medical Research In this session we will outline the in the programme. Outputs from the Council guidance. British Medical major challenges and opportunities in programme have included changes Journal, 350, h1258. clinical academic career development, to clinical practice, contribution to present three programmes which have organisational strategy, peer-reviewed Maben J, Taylor C, Dawson J, Leamy taken different approaches to fostering publications, conference presentations, M, McCarthy I, Reynolds E, Ross S, novice and early career practitioner- and successful funding applications Shuldham C, Bennett L, Foot C, researchers by enabling them to develop at masters, pre-doctoral and doctoral (2018) A Realist informed mixed and deliver projects which address the fellowship level. This presentation will methods evaluation of Schwartz Center needs of patients, service users and also include a personal perspective from Rounds® in England. Health Services communities in North West England, one of the participants, reflecting on her and Delivery Research Volume: 6, and will learn from the experiences of internship journey. Issue: 37, Published in November 2018 early career practitioner-researchers https://doi.org/10.3310/hsdr06370. themselves. References Department of Health (2012). ICA HEE/NIHR Integrated Clinical Paper 1 Academic Programme for non-medical health care professions. Retrieved from https://www.nihr.ac.uk/funding- Evaluation of a research and-support/funding-for-training- internship scheme for and-career-development/training- health care practitioners programmes/nihr-hee-ica-programme/ Authors and affiliation: Dr Stephanie Finlay, V. (2012). Developing the Role Jones, Ms Anne-Marie Timoroksa, of the Clinical Academic Researcher Dr Josephine Gibson, University of in the Nursing, Midwifery and Central Lancashire, UK Allied Health Professions. London, Department of Health. Abstract The development of a research culture in nursing, midwifery and allied health professions (NMAHPs) is essential for the provision of evidence-based health care. In 2012 an integrated clinical academic (ICA) pathway for

80 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

Paper 2 inform future, local Clinical Academic Paper 4 Trainee programmes and clinical academic career progression that can sit Everybody wants to be a alongside and feed into NIHR Academy Building research capacity ‘CAT’: Developing a clinical programmes. aligned with health and academic trainee scheme References social care partners’ Authors and affiliation: Dr Philippa Association of UK University Hospitals priorities Olive, Lancashire Teaching Hospitals (AUKUH) (2016) Transforming health Authors and affiliation: Mrs Joanna NHS Foundation Trust, UK care through clinical academic roles in Harrison, Ms Colette Miller, University Abstract nursing, midwifery and allied health of Central Lancashire, UK professions: A practical resource for Clinical academic careers in nursing, Career development of the health care health care provider organisations. midwifery and the allied health workforce has been an integral part Available at: https://www.england. professions (NMAHPs) are relatively of the capacity building theme of the nhs.uk/leadingchange/research-and- new. Though much has been achieved, NIHR Collaboration for Leadership evidence/useful-resources (Accessed 23 the number of NMAHPs participating in Applied Health Research and Care July 2019) in national research training schemes (CLAHRC) North West Coast. By remains comparatively small. To engaging with partner organisations develop and support local NMAHP- across the region, we have promoted, Paper 3 led research and clinical academic encouraged and supported health care career progression, Lancashire professionals to engage with career Teaching Hospitals NHS Foundation From staff nurse to NIHR development opportunities that are available regionally and nationally. Trust (LTHTr) and the University of doctoral fellow Central Lancashire (UCLan) formed These opportunities include internships the UCLan/LTHTR Clinical Academic Authors and affiliation: Mrs Alison that support the development Faculty. Launched in 2016, the Clinical McLoughlin, University of Central of research, evaluation and Academic Faculty was tasked with Lancashire, UK implementation skills, and encourage the sharing of this learning within developing and establishing successful Alison Mcloughlin will use her personal organisations and with other partners. and sustainable infrastructure to career journey to highlight some paths Internships have been fundamental in support the growth of our NMAHP that can be taken by others to expand supporting the work being undertaken clinical academic research community their research knowledge, experience in the Partner Priority Programme, and clinical academic research careers and careers. With a background in working on projects which address at all levels and stages of development. acute medicine she specialised in stroke the needs of the CLAHRC’s NHS and care. She then spent time as a clinical As part of this initiative we introduced local authority partners whilst building research nurse. Prior to her successful a new Clinical Academic Trainee capacity in research knowledge and National Institute for Health Research (CAT) role specifically for early career skills in their organisations. NMAHPs to undertake an evidence- (NIHR) Doctoral Research Fellowship based health care improvement project (DRF) application she worked as part Internships have also been beneficial of importance and benefit for their of a small team (Clinical Academic in motivating health care professionals clinical team and patient population. Faculty) tasked with developing interested in developing their research This CAT role is a three-year, ‘4+1’ research capacity and capability careers, and we have supported a model (four days per week clinical at Lancashire Teaching Hospitals number of potential clinical academics practice and one day protected research NHS Foundation Trust whilst also with preparing successful bids for NIHR time). In Year 1 training is focused maintaining direct clinical practice as a Fellowships. on information literacy leading to an Stroke Specialist Nurse. evidence review, in Year 2 the focus Alison is now based in the Stroke is on implementation science and in Research Team at the University of Year 3 the emphasis is on developing Central Lancashire. Her doctoral the CATs’ clinical academic career project is focusing on neurological progression. assessment and monitoring in acute Our Clinical Academic Trainee stroke. This talk will: programme was developed to offer • Briefly outline her project and her early career clinical academic research top tips for applications opportunities, and to embed evidence- • Explore how individuals can based health care and patient-focused search out and grasp opportunities research and innovation in practice. keeping their goals in mind In this presentation we detail the • Highlight the importance of components of, and systems to support, support and mentoring when our early career NMAHP Clinical undertaking a research journey Academic Trainee programme. With very few similar models in operation • Discuss why perseverance and we have learned much along the resilience can be important way about what works (or not) and attributes in getting you where you why. We will share our experiences, want to be. insights and programme evaluation to

81 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

Symposium 3 Paper 1 References

Abstract no: 0217 Dewing J, Eide T and McCormack B Philosophical and (2017) Philosophical perspectives on methodological foundations person-centredness for health care Person-centred practice research in McCormack B van Dulmen for person-centred research for personal S Eide H Skovdahl K and Eide T (eds). research: Organising for transformation and service Person-centred Health care Research. international impact Oxford, Wiley-Blackwell. innovation Authors and affiliation: Professor Jan Health Foundation (2014) Person- Lead: Professor Jan Dewing, Dewing, Queen Margaret University centred Care made simple. Available PhD, Queen Margaret University Edinburgh, UK at: www.health.org.uk/topics/person- Edinburgh, UK Abstract centred-care (Accessed 23 July 2019) Symposium Statement Background: Person-centred World Health Organisation (2015) The symposium presents five papers cultures and person-centred care are WHO global strategy on people- that are all linked together through growing in popularity within health centred and integrated health services. the ideas and principles of person- care policy and practices around the WHO/HIS/SDS/2015.6 Available at: centredness and person-centred world (World Health Organisation www.who.int/servicedeliverysafety/ practice research. Fundamentally, 2015). It is therefore vital that nursing areas/people-centred-care/global- each presenter and their research research in this field is nurtured and strategy/en/ (Accessed 23 July 2019) share similar values and commitments can demonstrate its effectiveness and about i) the philosophical ideas and a longer term impact for a range of methodological principles that underpin stakeholders (Health Foundation 2015). Paper 2 the body of knowledge on person- Aims: The presentation will focus on: centred practice research (Dewing et al 2017) ii) all the presenters are linked i) the philosophical ideas that Building capacity for together via a research centre at a underpin one body of person- centred practice research organised transformation of person- Scottish University and iii) also via with centred cultures in a large an International Community of Person- within a research centre at a centred Practice Research (ICoP). The Scottish University and with NHS organisation: Lessons various presenters have established an International Community of learnt and outcomes Practice Research (ICoP) and working relationships with each other Authors and affiliation: Dr Debbie international partners (Dewing et al and all are international partners, with Baldie, Tayside NHS Board and QMU 2017) others, in the ICoP. Edinburgh, UK ii) the methodological principles that We have chosen four research initiatives create the foundations for critical Abstract (plus an overview paper) that illustrates and creative research within the Background: The association the shared values and principles research centre and the ICoP. between staff experience and patient underpinning our research and yet outcomes and experience is well also highlights the range and diversity Discussion: This presentation sets the scene for the remainder of the understood (Doyle, C et al, 2012). of our research activities in Scotland Person-centred cultures that focus and internationally. It is very evident symposium. The presentation will show the plurality and complexity of person- on human flourishing enable the in papers two- four that our research continual critique and improvement requires a practice based presence; centred practice research, perhaps both a challenge but also a strength of care cultures and care outcomes that the ‘doing’ of the research and the (McCormack et al, 2011). There is ‘being’ of the researcher mostly takes of this type of research. It will argue that person-centred research must evidence to indicate how care cultures place in health care provider settings can be enhanced at the micro level and where possible researching with have coherence with the underpinning values, assumptions and ideas and yet and in particular the facilitation this others in and about their practices, requires (Martin, 2018). Less is known services and organisations. Paper five avoid seeking a single ‘fit’ approach. The session will also consider the however about how capacity and focuses on the preparation of new capability for facilitation of person- nursing and health care researchers growing need for this nursing research to be organised in a way that creates centred cultures using a practice from a range of countries to learn how development methodology can be can to become a person-centred researchers maximum impact at an international level. be built across a whole organisation and and contribute to developing impact in what sorts of impact that has. this field of research. Conclusions: Philosophy and methodology have an evaluative aspect Aims: The presentation will i)share Dewing J, Eide T and McCormack B as a form of knowledge and help nurse findings from a collaborative, person- (2017) Philosophical perspectives on researchers achieve deeper levels of centred research project that sought to person-centredness for health care understanding needed to generate understand the impact of a year-long research in McCormack B van Dulmen new knowledge that is necessary for practice development programme S Eide H Skovdahl K and Eide T (eds). transformation and service innovation. and; ii)describe the opportunities and Person-centred Health care Research. This however, needs to sit alongside the challenges in facilitating a co-designed Oxford, Wiley-Blackwell. pragmatic need for creating impact. programme that seeks to span across staff-learners’ needs and theoretically informed prerequisites for person- centred facilitation.

82 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

Discussion: This presentation will a person-centred culture through a Slater P, McCance T, & McCormack highlight our key findings from the first practice development approach in all B (2015): Exploring person-centred year of this development programme. the nursing departments. Working in practice within acute hospital settings. It will focus on the opportunities and partnership with the ICoP, a project International Practice Development challenges associated with developing group was established to lead the Journal, vol. 5 (suppl). communities of practitioners seeking practice based research forward. And to work in person-centred ways; the so, the journey had begun...... opportunities and challenges with Aims: To implement person-centred Paper 4 facilitating a co-designed programme; a culture across four hospitals. description and critique of the research Methods: The project team translated methods used to explore outcomes and A national programme to the Person-centred Framework by our key research findings. enable cultures of person- McCormack & McCance (2017) into Conclusion: Service innovation and German as the guiding model of person- centredness research can play complimentary roles centredness that the teams are working Authors and affiliation: Mrs Lorna within complex systems. Taking a towards making real in their workplaces Peelo-Kilroe, Health Service Executive, pragmatic, multi-method approach can and practices. Irish Health Service, Ireland & QMU both help inform stakeholders of impact Edinburgh, UK and the requirements needed to achieve In workshops and in group meetings such impact. Developing capacity a range of active learning methods The Irish Health Service Executive for person-centred cultures develops were used (Dewing 2010): for example (HSE) has introduced a National research ideas and an increased installations, role plays, story-telling, Programme to Enable Cultures of vitality and subsequent capability to painting to enable nurse leaders to Person-centredness across all settings – undertaking further person-centred become familiar with the model, and to services, administration and corporate. research. critically reflect on the implications for The aim of the programme is twofold: them and for the teams they work with References 1. to enable a culture of person- from development of a person-centred centred practice throughout the Doyle C, Lennox L, Bell DA Systematic culture. HSE as a means of achieving better review of evidence on the links Results: Nurse leaders committed to outcomes for persons using and between patient experience and work together in intentional person- providing services; clinical safety and effectiveness BMJ centred ways. In the site groups, nurse 2. to develop the necessary facilitation Open 2013;3:e001570. DOI: 10.1136/ leaders began to recognise and reflect skills, capabilities and supporting bmjopen-2012-001570 on ‘person-centred moments’. The structures to embed this approach McCormack B, Dewing J, McCance leaders engaged in a creative work system-wide. The HSE is partnered T, (2011) Developing person-centred around creating vision statements for with Queen Margaret University, care: addressing contextual challenges person-centredness; and learnt how Edinburgh. Phases 1 and 2 are through practice development. Online they might facilitate similar leaning completed and phase 3 has just Journal of Issues in Nursing, 16 (2). activities with teams in the workplace. commenced. They also started working on plans to Manuscript 3. Available at: https:// Aims: To share the learning from this engage team members in developing ro.uow.edu.au/cgi/viewcontent. national programme, the methodology a shared vision of person-centredness cgi?article=3490&context=smhpapers and methods used and the findings and what this then means for (Accessed 23 July 2019) from the first year throughout the HSE. developing practice. Methods: Progress and evaluation Martin A, Manley K (2018)Developing Discussion: In the presentation the were based on the Person-centred standards for an integrated approach project will be outlined and a discussion Practice Framework (McCormack to workplace facilitation for about how the workshops and active and McCance, 2017). Primary data interprofessional teams in health learning have already begun to have an analysis, carried out at mid and end and social care contexts: a Delphi effect will be shared. study, Journal of Interprofessional points included focus groups with all Care, 32:1,41-51, DOI: Conclusions: Active learning methods participants, purposeful selection of 10.1080/13561820.2017.1373080 contributed a lot to starting a person- participants for telephone interviews, centred journey towards a person- individual reflective accounts and centred culture. The methods seemed testimonials. We used secondary Paper 3 to be useful even with a diverse group data gathered by participants and of nurse leaders unused to this work of their active learning groups analysed working and learning. using Creative Hermeneutic Analysis The journey towards a References (Boomer and McCormack, 2008). This person-centred culture in a data include records of learning group Dewing J (2010): Moments of Swiss hospital group sessions, activities undertaken in the movement: active learning and practice workplace, learning form observations, Authors and affiliation: Ms development, in: Nurse Education in language exercises, staff and resident Therese Hirsbrunner, Development Practice, vol. 10, pp. 22-26. narratives. SolothurnerSpitäler AG, Switzerland McCormack B & McCance T (2017). Results: Results from the first year Background: In their strategical Person-centred practice in nursing and of the programme identified five considerations, the nursing health care theory and practice. West key common themes and four key management team at a Swiss hospital Sussex: John Wiley & Sons Ltd. outcomes. These will be presented in group decided to commit to develop the session.

83 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

Discussion: The approaches used practice research, there is a need to Symposium 4 challenged traditional thinking on build internationally capacity in this adult ways of learning and opened up field of nursing research. Abstract no: 0476 possibilities for participants and active Aims: To discuss how one research learning groups to co-create and co- centre is preparing Doctoral candidates Development and design a new future for person-centred in the field of person-centred research. workplace cultures. implementation of an Methods: Drawing on contributions Conclusions: This programme from the research of all the Doctoral intervention to increase appears to offer a sustainable, candidates (PhD and Prof Doc) retention and decrease accredited approach that builds within an International Community burnout of early career capacity by imbedding cultures of of Practice at one university, a nurses person-centredness within services synthesis was carried out to map out Lead: Judy Brook, BSc, MSc, RHV, RN systematically and incrementally. The the philosophical, methodologies and (Child), RGN, Snr Fellow HEA, City, findings may be of interest to other methods that are being developed. health services interested in a system University of London, UK Discussion: The presentation will wide approach. share the findings of the synthesis and Symposium Statement References map them against core principles of In the UK health care workforce, there Boomer C, McCormack B (2008) person-centred practice research and is a growing shortfall of nurses, with Creating the Conditions for Growth: the Vitae Researcher Development a vacancy rate of over 10% (41,000 Report on the Royal Hospitals and Framework (RDF) to demonstrate WTE vacancies) in England (Buchan Belfast City Hospitals Collaborative how effective the doctoral training is et al 2019). Turnover is higher shortly Practice Development Programme with preparing candidates to become after qualification (Zhang, et al, 2016). independent researchers of the future. Despite extensive literature on nurse McCormack B, Titchen A (2014) Conclusions: There are multiple retention, there is a lack of knowledge No beginning, no end: an ecology of and complex factors that interplay to about: human flourishing. International influence doctoral preparation. Novice 1. the components that are effective in Practice Development Journal 4 (2) researchers in person-centred research interventions to increase retention [2] Available at: https://www.fons. require generic research training that org/library/journal/volume4-issue2 2. the benefits of co-production as a is embedded within the values, ideas, model to develop interventions (Accessed on 23 July 2019) principles and approaches of person- 3. the development of social networks McCormack B, McCance T, (eds) (2017) centred research. There is a need to as a strategy to retain early career Person-centred Practice in Nursing move towards clearer international nurses. and Health care. Theory and Practice. clarification on what person-centred Oxford: Wiley Blackwell. research training looks like. The papers submitted for this References symposium report on four aspects of a Burdett Trust for Nursing funded study Paper 5 Cashin A, Casey M, Fairbrother G, to develop, implement and evaluate Graham I, Irvine I, McCormack B and an intervention to increase retention Thoms D (2017) Third-generation of early career nurses. The study is a Future impact: Building professional doctorates in nursing: partnership between City, University nursing research capacity the move to clarity in learning product of London and a large inner city health in person-centred research differentiation. International Practice care organisation with a turnover of Development Journal 7 (2) 4 https:// through a doctoral nursing staff higher than the national doi.org/10.19043/ipdj.72.004https:// average. programme including an www.fons.org/Resources/Documents/ international community of Journal/Vol7No2/IPDJ_0702_04.pdf The first paper reports the process and findings of a large systematic review practice. Vitae (2011) Researcher Development Framework V2. London, Careers undertaken to inform the development Authors and affiliation: Mrs Kate Research and Advisory Centre https:// of the intervention, exploring which Sanders, Foundation of Nursing www.vitae.ac.uk/vitae-publications/ components of interventions to Studies & QMU Edinburgh, UK rdf-related/researcher-development- increase retention and reduce turnover Background: The training of doctoral framework-rdf-vitae.pdf contributed to effectiveness. The second candidates is largely an apprenticeship paper reports on the development of in which the trainee is supervised by the intervention using a co-production an ‘expert ‘researcher to become an process involving early career nurses independent researcher. This training and nursing students, reporting process is known to be highly variable (Cashin acceptability from the perspective et al 2017). Many factors influence of group members. The third paper the effectiveness of research training reports a mixed methods evaluation including the interplay between the of the feasibility and acceptability of supervisor and supervision research the co-designed intervention from relationship; the institution and/ the perspective of student nurses or graduate programme and the and academic staff involved in the organisation or agency funding the implementation. The final paper is PhD/Prof Doc. In person-centred a methodological paper discussing

84 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

the novel use of self-drawn network Results: In total 11,656 papers Abstract diagrams to identify social capital and were identified, resulting in 53 Background: Co-production is support in practice, implemented as one eligible studies. Data detailing the becoming popular for engaging service aspect of the intervention. characteristics of the interventions and users and staff in health care service individual components were extracted. The four papers together showcase improvement. Experience Based Co- Interventions that led to improved aspects of a large study that both design (EBCD) is a well-established turnover or retention rates included individually and collectively, inform co-production method (Dimopoulos- internship/residency programmes educational and clinical practice to Bick, et al, 2018) but use of the toolkit or orientation/transition to practice retain early career nurses. with students and early career nurses is programmes. Beneficial programmes innovative. lasted 27 to 52 weeks and contained a teaching, preceptor or mentor Aim: To co-produce an intervention to Paper 1 component. improve retention and reduce turnover with students and early career nurses Discussion: Despite a large and evaluate the process regarding Characteristics of number of studies being identified, acceptability and group member successful interventions inconsistent and poor methods limited experience. to increase retention of the conclusions that could be drawn. Improved standardization of method, Method: A co-production group of five nurses: A systematic review outcome measures and reporting of nursing students and two early career Authors and affiliation: Mrs Judy intervention studies is required. nurses, met six times in summer 2018 Brook, Professor Leanne Aitken, with two research project facilitators. Conclusions: Organisations Discussion was initiated by a bespoke Professor Debra Salmon, Dr Julie employing early career nurses are MacLaren, Dr Jennie Brown, Miss film outlining the local and national recommended to assess their current retention issues and subsequently Leyla Ahmet, City, University of interventions against the identified London, UK focused on the transition from student successful components to improve to qualified nurse, including suggestions Abstract effectiveness of recruitment and to ease this transition. retention strategies. Background: Nurses leaving Evaluation of the co-production their roles, particularly soon after References process used a multi methods qualification, present significant Brook J, Aitken L, Webb R, MacLaren approach including: 1) the barriers to building the global nurse J and Salmon D (2019). Characteristics published EBCD evaluation questions; workforce. In England, nurse shortages of successful interventions to reduce 2) an acceptability questionnaire are particularly acute with 36,000 nurse turnover and increase retention of early based on the Theoretical Framework vacancies in 2018 (NHS Pay Review career nurses: A systematic review. of Acceptability (Sekhon et al 2017); 3) Body 2018), despite implementing International Journal of Nursing semi-structured interviews exploring interventions to increase the nursing Studies, 91, pp. 47–59. doi:10.1016/j. group members’ experience; 4) reflexive workforce (NHS Improvement 2018). ijnurstu.2018.11.003. facilitator field notes. Descriptive data Aim: To evaluate the characteristics were used to analyse the questionnaire of successful interventions to promote NHS Pay Review Body (2018) National data, and interviews and field notes retention and reduce turnover of early Health Service Pay Review Body 31st were thematically analysed. report: 2018, Available at: www.gov. career nurses. Results: Participants successfully uk/government/publications/national- Method: This systematic review was co-produced an intervention. Data health-service-pay-review-body-31st- conducted according to Preferred indicated members found the process report-2018 (Accessed 23 July 2019) Reporting Systems for Systematic acceptable, enjoyable and aligned with Reviews and Meta Analyses (PRISMA) NHS Improvement (2019) Improving their personal values. Interviews and guidelines. Online databases were staff retention, Available at: https:// field notes data revealed added value searched in April 2018 to identify improvement.nhs.uk/improvement- for all members related to the group relevant studies published in English offers/improving-staff-retention/ interaction. Challenges identified between 2001 and 2018. Included (Accessed 23 July 2019) related to member commitment and studies used turnover or retention fixed boundaries of the project. figures as measures of effectiveness Discussion: Challenges with co- to evaluate interventions designed to Paper 2 production in an educational context increase retention or reduce turnover related to difficulties with member of early career nurses. Joanna Briggs commitment but the process offered Institute Critical Appraisal Tools for Co-production of a nurse opportunities for all group members to Quasi Experimental and Randomised retention intervention with develop transferrable interpersonal and Controlled Trials were used to assess students and early career problem solving skills. the quality of studies. Effectiveness of nurses: Challenges and Conclusions: Co-production was an interventions, as measured through acceptable and effective approach to retention or turnover data guided successes designing an intervention to improve the comparison between studies. Authors and affiliation: Mrs Judy retention and reduce turnover from the Appropriate measures of central Brook, Professor Debra, Professor perception of group members. tendency and dispersion were Leanne Aitken, Dr Julie MacLaren, calculated and presented, based on the Dr Jennie Brown, Miss Leyla Ahmet, References normality of the data. City, University of London, UK Dimopoulos-Bick T, Dawda P, Maher

85 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

L, Verma R and Palmer V (2018). found the sessions helpful for dealing for lower turnover. Using self-drawn Experience-Based Co-Design: Tackling with stressful situations and developed network diagrams (MacLaren 2018) common challenges, Journal of Health transferrable skills applicable to may provide a measure for social Design, 3(1) pp. 86–93. both professional and personal lives. capital and embeddedness within an Participants found scheduling of the organisation. Sekhon M, Cartwright M and Francis sessions during placement blocks JJ (2017). Acceptability of health care Aim: To explore the use of a social difficult, as this was perceived to interventions: an overview of reviews networking methodology as part of an conflict with multiple competing and development of a theoretical intervention to increase retention of priorities. Key perceived benefits were framework, BMC Health Services early career nurses. opportunities to share experiences in Research 17(88) DOI 10.1186/s12913- Methodological discussion: Final a group and explore personal values, a 017-2031-8 stage nursing students were asked focus on mindfulness techniques, and between May 2018 and March 2019 to developing transferrable skills. identify and create ego-centric network Paper 3 Discussion: Low attendance diagrams of their professional social reflected participants’ concern about networks in their placement area. negotiating absence from placements. Network diagrams were annotated Feasibility of an Incorporating sessions into simulated with detail on relationship, strength of intervention to improve practice blocks of the nursing connection and attributes promoting early career nurse retention programme may maximise impact and learning (MacLaren 2018), and mapped attendance. and reduce burnout onto the four typologies identified in the Conclusion: The content of the Developmental Networks Framework: Authors and affiliation: Mrs Judy additional sessions was appropriate receptive, traditional, opportunistic, Brook, Professor Leanne Aitken, to support participants as newly entrepreneurial (Higgins and Kram Professor Debra Salmon, Dr Julie qualified nurses but advanced planning 2001). Participants were supported to MacLaren, Dr Jennie Brown, Miss is required to schedule the sessions analyse and discuss their own networks Leyla Ahmet, City, University of effectively. and the diagrams were analysed London, UK References independently by researchers. Background: Nurse retention is a Preliminary results indicate that social significant issue globally, with a nursing Buchan, J., Charlesworth, A., Gershlick, network mapping offers an easily vacancy rate of over 10% (41,000 B. and Seccombe, I. (2019) A critical administered method of collecting WTE vacancies) in England (Buchan moment: NHS staffing trends, retention data about student support in practice. et al 2019). This project explores the and attrition, Available at: https://www. To avoid differences in interpretation implementation of a co-designed health.org.uk/publications/reports/a- of verbal and written instructions mindfulness, psychological and critical-moment Accessed 21.03.19 for administration of data collection, interpersonal skills-based intervention Sekhon, M., Cartwright, M. and Francis, further clarification is required. to increase early career nurse retention J.J. 2017. Acceptability of health care In the context of group discussion in an inner-London health care trust. interventions: an overview of reviews consideration should be given to The intervention comprised of four and development of a theoretical the impact of social desirability for additional curriculum days for final framework, BMC Health Services entrepreneurial networks. stage pre-registration student nurses, Research 17(88) DOI 10.1186/s12913- implemented between January and May 017-2031-8 Conclusions: Social networking 2019. methodology offers an innovative method to help individuals explore their Aim: To test feasibility of a new own professional networks and discuss intervention designed to increase Paper 4 implications for their professional early career nurse retention in one development. This may be a useful organisation for improving nurse Exploring the use of self- predictor of the need for additional retention and reducing burnout with student support. The methodology early career nurses. drawn network diagrams to identify social capital and requires explicit verbal and written Methods: An explanatory, instruction in guiding participants, and sequential, mixed-methods design support in practice care not to value network typologies was used. Prospective, concurrent Authors and affiliation: Mrs Judy above each other. and retrospective questionnaire data Brook, Professor Leanne Aitken, References were collected during implementation Professor Debra Salmon, Dr Julie to assess feasibility and acceptability. MacLaren, Dr Jennie Brown, Miss Brook J, Aitken L, Webb R, MacLaren Qualitative data were collected via semi- Leyla Ahmet, City, University of J. and Salmon D (2019) Characteristics structured interviews to add context to London, UK of successful interventions to reduce the questionnaire data. Quantitative Background: Many interventions turnover and increase retention of early data were analysed and presented have been implemented to improve career nurses: A systematic review. descriptively; interviews were analysed early career nurse retention (Brook et International Journal of Nursing thematically. al 2019), but there is little published Studies, 91, pp. 47–59. doi:10.1016/j. Results: Thirty-nine final stage adult evidence of focus on community ijnurstu.2018.11.003. and child nursing students at City, and nurse relationships within an Heinen MM et al, (2012) Nurses’ University of London participated in the organisation, or ‘social capital’ (Heinen intention to leave their profession: A intervention and the feasibility study. et al 2012). Increased psychological cross sectional observational study in Initial analysis indicates participants and social engagement is a predictor

86 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

10 European countries Available at: Symposium 5 auspices of evidence based practice. As www.journalofnursingstudies.com/ the critical discourse around knowledge article/S0020-7489(12)00330-6/ Abstract no: 0375 mobilisation (KMb) has developed there fulltext#sec0070 (Accessed 23 July has been a shift from a linear model of; 2019) researcher does research, puts research Knowledge Mobilisation in paper or book, practitioner uses MacLaren JA (2018) Supporting nurse through ‘Collective Making’ knowledge (known as Mode 1 KMb) to mentor development: An exploration of a Mode 2 model that acknowledges that developmental constellations in nursing in nursing and health knowledge is a social and contextually mentorship practice, Nurse Education services research fluid thing, and recognises that there in Practice, 28, 66e75 Lead: Daniel Wolstenholme, BSc RGN are many other forms of knowledge, MMedSci, Sheffield Teaching Hospitals besides research evidence, that are used NHS Foundation Trust, UK in day to day life and decision making. Symposium Statement Mode 2 KMb is also referred to as co- production or co-creation (Greenhalgh This symposium will present, a et al 2016) . theoretical background, and then a series of case studies to explore current Aims of the paper: Mode 2 Kmb is issues in Knowledge Mobilisation. heralded as having the best chance of It will outline the current thinking getting knowledge into practice, and around knowledge mobilisation and yet there are challenges about bringing how it impacts on delivering ‘evidence people together to do such activity. In based practice’ and therefore impact, in the literature the challenges are often nursing research and practice. typified as being about Power, Voice, Trust and Time. Without a conscious After presenting the process model for attention to these factors the process is ‘collective making’ the following papers unlikely to work. This paper presents will illustrate the process, drawing from an emergent process model (Langley, a range of case studies undertaken by Wolstenholme, Cooke 2018) drawn the Translating Knowledge into Action from the KMb Literature and from Theme of the National Institute for the presenting teams’ own practice Health Research, Collaboration for within the National Institute for Health Leadership in Applied Health Research Research (NIHR), Collaboration for and Care, in partnership with other Leadership in Applied Health Research teams and researchers across England, and Care (CLAHRC) Yorkshire and spanning a broad range of areas from Humber (YH). domestic abuse, to promoting activity Methodological discussion: The after stroke and mental and physical paper proposes that a process of co-morbidities. ‘collective making’, using methods The symposium will conclude with that preference creative practices are reflections on commonalities across more likely to enable Mode 2 KMb. these diverse projects and a reflection The process has an impact on the on how the model might support nurses participants, the knowledge (to be and nurse researchers to better combine mobilised) and the implementation research and other forms of evidence to process. We will present how this deliver best practice to their patients, impact is enabled. clients and carers. Conclusion: Using these methods enables complex and diverse views and forms of evidence to be synthesised, Paper 1 delivering contextually sensitive solutions. ‘Collective Making’: A References contribution to knowledge Greenhalgh T, Jackson C, Shaw S, et mobilisation practice al (2016) Achieving Research Impact Authors and affiliation: Mr Daniel Through Co-creation in Community- Wolstenholme, Sheffield Teaching Based Health Services: Literature Hospitals NHS Foundation Trust, Review and Case Study. The Millbank UK; Dr Joe Langley, Sheffield Hallam Quarterly 94(2): 392–429. University, UK Langley J, Wolstenholme D and Cooke J Abstract (2018) ‘Collective making’ as knowledge mobilisation: the contribution of Background: Knowledge mobilisation participatory design in the co-creation is the practice of getting knowledge of knowledge in health care. BMC into practice. Historically, in nursing, Health Services Research 18(1). BMC this has focussed on getting research Health Services Research: 585 evidence into practice, under the

87 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

Paper 2 to provide effective support. This information delivery regarding study helped us develop prototype of exercise educational resources which has the 4. a stroke survivor’s passport to Using participatory potential to be implemented in various access relevant and customised approaches to develop GP practices. We will look for further information while keeping one’s tools to help primary care funding opportunities to get some funds medical record in one place to develop the intervention further and nurses support women 5. a buddy box to increase wellbeing to test its feasibility. victims of domestic violence among survivors. from black and ethnic Discussion: Collaborating with design communities Paper 3 students allowed creative methods to be brought to the fore. The use of such Authors and affiliation: Dr Parveen methods supported people who may A Ali, University of Sheffield, UK; Enhancing the uptake have otherwise struggled to contribute Dr Julie McGarry, University of of exercise after stroke: in workshops to engage fully, and the Nottingham, UK START (Small Task Aid focus on practical solutions valued the Abstract participants contribution in a way that Recovery Time) more traditional approaches may not Domestic violence and abuse (DVA) Authors and affiliation: Dr Remi Bec, have. is a major public health and social Sheffield Hallam University, UK problem that affects millions people References Background: Stroke is the fourth in every community, culture and leading cause of death and of adult User Centred Health care Design (2015) country. However, migrant women disability in the UK affecting 152,000 Better Services by Design. Available at: and those from Black and Minority individuals annually and costing the UK http://www.bsbd.org.uk/ (accessed 13 Ethnic communities (BME) experience health economy nearly £9 billion. August 2019) additional barriers when accessing A quarter of these strokes are recurrent, health and social care services. and they can often be preventable We still do not know the extent to through being physically active. Yet Paper 4 which nurses working in primary less than half of adults over the age care are adequately prepared to of 65 years in the UK achieve the respond to DVA victims generally recommended levels of activity, and Avachat: Co-designing a and those from BME communities in this declines further after stroke and virtual agent to support particular. There is a need to explore transient ischaemic attack. self-management for the perspectives of nurses working Aims: The aim of this project was individuals living with in primary care and victims of DVA to explore ways to promote exercise about roles, responsibilities of nurses physical and mental in stroke survivors living in Sheffield comorbidities and expectations on the provision (UK) using creative co-production of appropriate services to those workshops. Authors and affiliation: Mrs Cheryl experiencing DVA. Such knowledge Grindell, Sheffield Teaching Hospitals Methods: Following the double may help in understanding the factors NHS Foundation Trust, UK diamond approach (User Centred affecting nurses’ ability to identify Health care Design 2015) the Background: Individuals living with and manage DVA in primary care multidisciplinary team facilitated a long-term physical health conditions, setting. This session aims to presents series of 5 workshops. Through using such as chronic obstructive airways our learning as to how we used a co-creative methods, this design- disease (COPD), frequently experience participatory co-production approach led project co-defined a series of mental health problems (National this issue and to develop an educational briefs which were co-developed and Institute for Care and Excellence 2009, resource to support nurses working in prototyped. 2010). This co-morbidity can have primary care, who support BME women a significant impact on individual’s victims/ survivors of DVA. Throughout the project, 71 people were levels of emotional distress and their involved (such as stroke survivors, We engaged with 74 participants who health outcomes leading to increased health care professionals, social contributed 18 individual interviews, health care use (2). Health care services services, commissioners) including four focus group discussions and two are struggling to meet this demand ten students from the product design participatory workshops attended the and are increasingly moving into the course (Sheffield Hallam University), first and second workshop respectively. community. Digital tools are being who were paired with stroke survivors Participants included women victims of promoted to support patients to self- and health care professionals to develop domestic violence and abuse, domestic manage their health (de Silva D 2011). their own brief. violence workers, nurses, GPs, and One such technology is the autonomous specialist support workers from GP Results: Five briefs emerged from the virtual agent. surgeries. research: Objective: To co-design the content, 1. a marketing campaign to burst functionality and interface modalities of Both nurses and female participants myths and promote physical an autonomous virtual agent to support felt that nurses are not always able activity self-management for patients with an to support women effectively and exemplar long-term condition (Chronic that they need further education and 2. a video raising awareness of the Pulmonary Obstructive Disease). training to improve their knowledge, benefits of promoting exercise understanding and skills to be able 3. a staff training package about Methods: We conducted two co-design

88 Symposia: Tuesday 3 September 2019, 1.55-3.25pm

workshops with adults with COPD and health professionals to explore the look, sound, format and content of an autonomous virtual agent. A video- based scenario prototype was used to test the acceptability of the virtual agent with adults with COPD and health professionals involved in their care. Results: As well as the look, sound and format of the virtual agent four priority self-management scenarios, for which adults with COPD would like to receive support, were identified from the co-design workshops: at time of diagnosis (information provision); during acute exacerbations (crisis support); during periods of low mood (emotional support); and for general self-management (motivation). The virtual agent was iteratively developed and the video based scenario prototype was found to be acceptable to 12 adults with COPD. They felt the system would be particularly useful for individuals living alone. Conclusions: The co-design process allowed the research team to identify key design principles, content and functionality to underpin an autonomous agent for delivering self- management support to older adults living with COPD and potentially other long-term conditions. References National Institute for Care and Excellence (2009) Clinical Guidelines 91. Depression in adults with chronic physical health problems: treatment and management. National Collaborating Centre for Mental Health: London. National Institute for Care and Excellence (2010) Clinical Guidelines 101. Chronic obstructive pulmonary disease: management of COPD in adults in primary and secondary care. National collaborating Centre for mental health: London. de Silva D. (2011) Evidence: Helping people help themselves. A review of the evidence considering whether it is worthwhile to support self- management. The Health Foundation.

89 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

Symposium 6 Paper 1 better understand the views of Saudi women in relation to breast cancer and Abstract no: 0435 mammography screening to design A systematic review more effective interventions for this and narrative summary population. The pyramid of of workplace-based evidence: Challenges and References interventions to increase opportunities for nursing The Organization of Islamic breast mammography research Cooperation Available at: screening uptake: www.researchgate.net/ Lead: Dr Susanne Cruickshank, PhD, publication/325734778_Statistical_ MSc, BSc, University of Stirling, UK implications for research in Saudi Arabia Yearbook_of_the_OIC_Member_ Symposium Statement Countries_2018 (Accessed 23 July Authors and affiliation: Ms Manal 2019) Historically evidence has been Hakami, Susanne Cruickshank, Rob categorised according to a hierarchy. Polson, Gill Hubbard, University of Hoffmann TC, Glasziou PP, Boutron The evidence pyramid has been Stirling, UK I, Milne R, Perera R, Moher D, described in different ways but all of et al (2014) Better reporting of Abstract them focus on weaker study designs interventions: template for intervention in the bottom (expert opinion, Background: The global burden of description and replication (TIDieR) qualitative studies) and strong designs breast cancer is growing and is one checklist and guide. British Medical at the very top, systematic reviews and of the leading causes of death among Journal. doi:10.1136/bmj.g1687. meta-analysis. The problem with this women. Mammography screening Michie S, Prestwich A, (2010) approach is that it assumes that all uptake is very low in Islamic countries Are interventions theory-based? clinical problems, or indeed all research compared to non-Islamic countries. Development of a Theory Coding questions, lend themselves to the Workplaces provide a convenient Scheme. Health Psychology. 29:1–8 stronger designs. In reality, there are a location for reaching large groups of number of steps needed to move from women in Islamic countries. As a first the bottom to the top of any pyramid. step towards developing an effective Paper 2 Nurses benefit from using a stepped workplace intervention in Saudi Arabia, approach in their research careers and aimed to increase mammography learning their craft, gaining confidence screening rates, we conducted a Opportunities and comprehensive systematic review to to appraise evidence and using the challenges when updating outcomes to determine the best provide an overview of the available research method to answer the clinical evidence in this area. Cochrane reviews: question/problem. Objective: This review aimed to Specialist breast care identify randomised controlled trials This symposium presents papers that nurses for supportive care that assessed the effectiveness of reflect a shared interest in undertaking of women with breast workplace interventions to increase research in the field of breast cancer breast mammography screening in cancer (UK and internationally). Appraising Islamic countries. Authors and affiliation: Ms Tamara the evidence systematically using Brown, Maria Noblet Susanne Methods: Thirteen databases were different approaches is presented in Cruickshank, University of Stirling, UK paper 1 and 2 while paper 3 describes searched in English language or Arabic the use of normalisation process theory with no date restriction. Abstract within an acceptability study to inform Result: Of a total of 1374 papers Background: Cochrane methodology the development of a pilot trial. Each identified, no studies about workplace to conduct systematic reviews is paper considers their contribution interventions in Islamic countries to internationally recognised as ensuring within the pyramid of evidence and the increase mammography screening the highest standards of quality in learning gained. The researchers are uptake were found. Broadening our summarising the best available evidence at different stages in their career; Ms search beyond Islamic countries, we to improve health care decision making. Hakami is a PhD student (paper 1), Ms found three educational intervention Cochrane methodology is continually Brown a Research Fellow (paper 2), from the USA (n=2) and China (1). being developed and this provides and Dr Cruickshank an independent The TIDier checklist and theory coding challenges to reviewers who regularly researcher (paper 3). scheme were used to describe the update reviews. intervention function and theoretical Aim: To describe our experiences of basis respectively. updating a Cochrane review conceived Conclusion: The findings illustrate over a decade ago that assessed the the lack of knowledge about existing effects of interventions carried out workplace interventions to enhance by Breast Care Nurse’s on quality of mammography screening uptake in life outcomes for women with breast women. This presentation will discuss cancer. A breast care nurse (BCN) is the benefits of systematically reviewing a registered nurse with a qualification the evidence prior to undertaking or specialist knowledge in breast care. research. The author was able to change Interventions by BCNs aim to support the path of her research design to women and help them cope with the

90 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

impact of the disease on their quality Mini-AFTERc, into their consultations. response to clinical problem: definition of life. Method: A mixed methods sequential and clinical features of fear of cancer Methodological discussion: Using design was used, informed by recurrence. Supportive Care Cancer our experiences of updating a Cochrane Normalisation Process Theory. Data 24(8): 3265-3268. http://dx.doi. review we describe how both the collection took place between Nov org/10.1007/s00520-016-3272-5 Cochrane methodological tools and the 2017 and Feb 2018. Phase 1: UK interventions themselves have changed SBCNs were emailed a web-based over time. We introduce debate about survey to investigate how breast the opportunities and challenges posed cancer survivors’ FCR is currently through improved reporting standards, identified and managed, and their particularly assessing the quality of willingness to utilise the Mini-AFTERc. the body of evidence using the GRADE Phase 2: a purposive sample of approach. respondents (n=20) were interviewed Conclusions: Reviews are continually to augment phase 1 responses, and updated to improve the evidence base explore views on the importance of and the reporting of this evidence, addressing FCR, interest in the Mini- to improve our understanding of the AFTERc intervention, skills required components of interventions, to inform and challenges to delivering the the development of future interventions intervention. and the direction of further research. Results: Ninety nurses responded to This paper reports on our experience the survey. There was no consensus of building a body of evidence, how on the size of the problem or unmet the evidence base has changed and need. SBCNs estimated that 20-100% our experience of using Cochrane tools people experience moderate FCR and within the nursing field as a case study. 10-70% severe FCR. The interviews References identified that clinical conversations are focused primarily on giving Cochrane Library (2019) Accessed information about signs and symptoms on 13 August 2019 from www. of recurrence rather than addressing cochranelibrary.com/about/about- the psychological aspects of fear. cochrane Cruickshank S, Kennedy Conclusion: Findings indicate wide C, Lockhart K, Dosser I, Dallas L. variability in how FCR was assessed. Specialist breast care nurses for Using NPT to inform the study design supportive care of women with provided a useful structure to illicit breast cancer. Cochrane Database information to assist the planning of a of Systematic Reviews 2008, Issue pilot trial, the focus of this presentation. 1. Art. No.: CD005634. DOI: In particular how, and what was 10.1002/14651858.CD005634.pub2 required to test the efficacy of the Mini-AFTERc intervention in clinical practice, a step often overlooked in the Paper 3 development of trials that can lead to assumptions being made about roles Acceptability of specialist and relationships that either do not exist or as we found, are highly variable. breast cancer nurses to embed a fear of cancer References recurrence intervention in Cruickshank S, Steel E, Fenlon D, their daily practice: How Armes J, Scanlon K, Banks E, Humphris G (2018) A feasibility study of the can normalisation process Mini-AFTER telephone intervention for theory help? the management of fear of recurrence Authors and affiliation: Dr Susanne in breast cancer survivors: a mixed- Cruickshank, University of Stirling, UK methods study protocol http://dx.doi. Introduction: Fear of cancer org/10.1186/s40814-017-0161-8 recurrence (FCR) is defined as “fear, Cruickshank S, Steel E, Fenlon D, worry, or concern about cancer Armes J, Banks E, Humphris G (2019) returning or progressing”. It is one Specialist Breast Cancer Nurses’ views of the most frequent unmet needs on implementing a fear of cancer reported in the immediate post- recurrence intervention in practice: a treatment phase. Our aim was to mixed methods study. Supportive Care investigate how Specialist Breast in Cancer DOI: 10.1007/s00520-019- Cancer Nurses (SBCN) respond to their 04762-9 patients’ fears of cancer recurrence and analyse their views about embedding Lebel S, Ozacinci G,Humphris G, a new psychological intervention, the Mutsaers B, Thewes B, Prins J, Dinkel A, Butow P (2016) From normal

91 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

Symposium 7 - Please and doors we have needed to open; success helped us to secure over a note this has now moved exploring with participants, ‘the why’, further £700k to support nursing/ ‘why now’, and ‘how’, and the impact. AHP research for five years through the to Thursday 5 September, NIHR GOSH BRC Award.

11.15am-12.40pm Conclusions: Challenges remain in Paper 1 Abstract no: 0488 terms of space, and clarity around ‘new roles’, but with a clear strategy, links to Clinical Academic Careers local and national initiatives, we have Single site approach the structures in place to build and for nurses/AHPs: Building to developing clinical sustain CAC going forward. a strategy for success academic careers: Strategy, References Authors and affiliation: Dr Kate Oulton, personal and organisation Great Ormond Street Hospital for Westwood G, Richardson A, Latter impact Children NHS Foundation Trust, UK S, Macleod Clark J, Fader M (2018) Building clinical academic leadership Lead: Professor Faith Gibson, PhD MSc Abstract RGN RSCN ONC Cert Cert Ed RNT capacity: sustainability through FRCN, Great Ormond Street Hospital Background: In 2014, Great Ormond partnership. Journal of Nursing for Children NHS Foundation Trust Street Hospital for Children NHS Research, 23(4), pp. 346-357 and University of Surrey Trust (GOSH) Biomedical Research Centre (BRC) funded the first Symposium Statement Clinical Academic Programme Lead Paper 2 The Integrated Clinical Academic specifically for Nursing and Allied (ICA) Programme was launched in Health Professionals (AHP). Funded 2013, an amalgamation of previous initially for three years, they were Why would anyone move programmes, consolidated in a revised embedded within the existing Centre for from a ‘Structured, busy, Health Education England (HEE) Outcomes and Experience Research in demanding managerial Clinical Academic Careers Framework. Children’s Health, Illness and Disability Matron role’ to an This revised document reinforces the (ORCHID). ‘Unstructured creative, Mandate from the Government to HEE) Aims: The goal was to enhance the to develop a workforce that embraces research culture to make the clinical exploratory, indulgent PhD research and innovation. Diversity in academic career (CAC) pathway for student role’? nursing and allied health professional nurses/AHPs a more attractive choice, Authors and affiliation: Mrs Polly (AHP) roles has always been highly ultimately leading to better engagement Livermore, Great Ormond Street evidenced at Great Ormond Street and interest in research, and increased Hospital for Children NHS Foundation Hospital for Children NHS Foundation research capacity and capability Trust and University of Surrey, UK Trust. This was continued in 2014 with (Westwood et al, 2018). Abstract financial support from the Biomedical Methods: A rich and varied Research Centre (BRC) we were able programme of support was developed Background: A matron role is a highly to appoint to a post that would initiate and delivered through the ORCHID respected position within the NHS, one and sustain a mixed portfolio of Clinical Academic Faculty: including which has often taken years of climbing activities to facilitate these professions an Academic Inquiring Minds (AIM) the career ladder. However, it does on a clinical academic pathway. Forum to network, share ideas and not come without responsibility and Uncertainty has been a constant ‘friend’ engage in critical debate, training daily pressure. Despite being proud on this journey; financial investment workshops, guest lectures and a of my senior role within the Trust, I has not always felt secure, success writing mentorship scheme. Capacity have always known that I would work (however that is defined) is not always building was facilitated through a towards a PhD at some point in my guaranteed. This is a journey where we bespoke internship scheme aimed at career. The journey has not always been have taken every opportunity to ‘take supporting individuals to disseminate easy, but as I enter my third and final people with us’, either through our their research, implement findings and year, it has definitely been well worth it belief in professionals that they can be secure further funding. (so far that is!). successful on this pathway, or through engaging with those outside of nursing, Results: The programme has positively Aim: This paper will present the and AHP roles, to evidence, ‘the why’, impacted the research environment, journey taken and challenges faced ‘why now’, and ‘how’. Our learning has facilitating multi-professional working along the way, encouraging others to be been incremental, we have learnt from and national/international clinical brave and risk changing the status quo others running similar programmes, and research collaborations. Twenty- for a different life. and listened to members of our Clinical one nurses/AHPs have secured Methods: I will provide some Academic Faculty to continuously NIHR or Health Education England background to previous roles attained improve what we provide. In 2020 we funding to undertake a Masters in and present the drivers for applying for will see our first NIHR C-DRF fellow Clinical Research and 11 obtained fellowship funding. Through describing complete their programme, we will be doctoral funding, including seven my experience completing a National ready, and we will have in place agreed NIHR Clinical Doctoral Research Institute of Health Research (NIHR) individual work plans that map clear Fellowship Awards, generating income Clinical Doctoral Research application in excess of £1.5 million. Six nurses/ pathways. In this symposium, we want form and subsequent interview, I will AHPs have undertaken a development to share with you some of our journey, then briefly present the subject to my internship to disseminate findings to evidence our strategy and thinking, PhD study. The obstacles and benefits from their Masters, using these to to share opportunities we have grasped, will be discussed along the way. influence clinical care. Our ongoing

92 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

Discussion: Twelve years ago, the 2. how these will be explored through Paper 4 ‘Finch report’ investigated the barriers a concurrent mixed methods study faced by nurses wanting to pursue a pre and post implementation research career (2007). These barriers, 3. my experience during this process. Clinical academic careers evident in the majority of NHS Trusts for nurses/AHPs: Have we Methods: The creative methodology today, include: education and training; of ‘World Café’ workshop was used to turned the corner yet, yes/ employment structures; lack of capacity explore stakeholder perspectives of no? in the workforce; need for financial what ‘Going Digital’ means to them support. In Trusts that can see the Authors and affiliation: Professor Faith as patients or parents, or staff, raising potential to modernise careers and Gibson, Great Ormond Street Hospital important ethical and legal dilemmas provide support, encouragement and for Children NHS Foundation Trust that needed consideration. Findings secondment opportunities (like my and University of Surrey, UK from the workshops will be shared Trust), then nurses and allied health Research is vital to in addition to my learning, including Background: professionals have a distinct advantage. provide the transformative and sustain- challenges faced. However, if nurses have a passion for able health and care services we need to research and ultimately want to lead Discussion: Important issues were deliver the NHS Long Term Plan (www. future programmes of clinical/health raised, with children and young people longtermplan.nhs.uk). A clinical aca- service research, then a degree of wanting to know who is looking at their demic workforce has an important role tenacity is essential from the outset. health data, not wanting to be reminded to play, but we need to build capacity of their condition(s) all the time, and Conclusion: Completing a PhD is not and capability, we need to lead in nurs- the worry of reading something they did for everyone, but if you want one, then ing and allied health professions (AHP), not want to or were not meant to read. do not give up. to improve health outcomes for patient Stakeholders wanted assurances that benefit (Macleod Clark, 2014). References their health data is safe, and debated Aim: We set out to build capacity issues surrounding the Mental Capacity Finch Dame J (2007) Developing the and capability in nursing and AHPs, Act (2005), fluctuating capacity to best research professionals - Qualified to positively influence the research access their data. This methodology graduate nurses: recommendations culture, to offer leadership and gives stakeholders a way of having a for preparing and supporting clinical academic support to those wanting to voice in the biggest change the Trust academic nurses of the future. Report of take a journey towards being a clinical has ever seen. the UKCRC Subcommittee for Nurses in academic. Clinical Research (Workforce) Conclusion: Determination Methods: Developing a research and resilience can prevail! Being centre at Great Ormond Street Hospital instrumental in developing, managing (GOSH), now known as the Centre for and conducting this study is developing Paper 3 Outcomes and Experience Research in my clinical academic skills rapidly and Children’s Health, Illness and Disability effectively with the additional reward (ORCHID), was the first step in the late that workshop findings will help shape Being in the right place at 1990s. The foundations were put in the service the Trust provides for the the right time: Going digital place, PhD prepared nurses and AHPs benefit of all stakeholders. – The implementation of were recruited to the centre, and we References EPIC Electronic patient have cemented a Research and Clinical Brown J, Isaacs D and The World Academic Faculty within that structure. records (EPR) and its People, passion, and drive have been at impact on patients, parents Café Community (2001) The World Café: Living knowledge through the forefront of the methods we have and staff conversations that matter, Systems capitalised on in our ambitious, but Authors and affiliation: Mrs Pippa Thinker 12 (5) 1-5 realistic plan. Sipanoun, Great Ormond Street Discussion: The preparation of Hospital for Children NHS Foundation Brown J, Isaacs D and The World Café clinical staff to undertake research is Trust and University of Surrey, UK Community (2005) The World Cafe a strategic priority. Yet challenges for Book: Shaping Our Futures Through Trusts, such as GOSH, include how best Background: I had two PhD Conversations that Matter, San Research Fellow Internships, then to identify, support and further develop Francisco: Berrett-Koehler Publishers, those aspiring to or considering clinical disappointment followed, I was not Inc funded through an application to the academic roles within and outside the NIHR. Fear not, opportunity awaits, Burke C and Sheldon K (2010) established pathways (Westwood et al, which I grasped to undertake a Trust- Encouraging workplace innovation 2018), and supporting those who are wide, world first study about the using ‘World Café’ model, Nursing not yet clear of their preferred career implementation of electronic patient Management 17 (7) 14-19 Mental option. Partnerships are key, as are role records (EPR) in a paediatric tertiary Capacity Act 2005 models, champions throughout a Trust hospital, forms my PhD study at are essential, at all levels. University College London and is part Conclusion: Our aim is to share some of my Clinical Academic Pathway. of our past, as well as plans for our Aim: The aim of this presentation is to: future, and in this final paper of the symposium we will welcome discussion 1. highlight the potential issues and debate to assist us and others to associated with the transition ‘turn that corner’. of GOSH to becoming a digital hospital

93 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

References Symposium 8 Advanced Nursing, 1,1, 1-1. https:// doi.org/10.1111/j.1365-2648.1976. Macleod Clark J (2014) Clinical Abstract no: 0235 tb00422.x academic leadership - moving the profession forward. Journal of Research in Nursing, 19(2), pp.98-101. Scholarly publishing and Paper 1 NHS Long Term Plan Available at: research impact: A tribute www.longtermplan.nhs.uk (Accessed 23 to James P Smith Views on research impact in July 2019) Lead: Professor Roger Watson, BSc nursing and publishing Westwood G, Richardson A, Latter S, PhD RN, University of Hull, UK Macleod Clark J, Fader M (2018) Symposium Statement Authors and affiliation: Professor Building clinical academic leadership Alison Tierney, University of Adelaide, capacity: sustainability through For research to make an impact it Australia partnership. Journal of Nursing first needs to be known about and Abstract Research, 23(4), pp. 346-357. publishing in scholarly journals is still the main medium for the dissemination The pioneers of nursing research of research. in the UK in the 1950s and 1960s were motivated by an ambition to It used to be sufficient for researchers improve practice and patient care over just to ‘get published’ and research generating nursing knowledge. But as productivity was reflected in quantity. Florence Nightingale declared: ‘reports With ever-increasing scrutiny of are not self-executive’ and that, early in research, particularly through national the research planning process, a post- research assessment exercises, the publication implementation strategy emphasis has shifted from quantity should be devised. to quality and, more recently, with a growing focus on research impact. There certainly was clear understanding among UK nurse researchers from the Journals have responded to these shifts outset that research must be published, in emphasis with tighter quality control and the RCN monographs issued of content and by guiding authors to through the 1970s from the ‘Study of present papers in ways that maximise Nursing Care’ project (https://tinyurl. potential for impact. Preoccupation com/y67dxps2; accessed 26 March with journal impact factor rankings 2019) represent some of the first has given way to a focus on measures substantive publications from that early of author impact and, increasingly, era of UK nursing research. those established citation metrics are being complemented by new alternative But few practising nurses were reading ways of assessing the broader impact of research. Nursing practice was still published research. rooted in tradition and routines, and university-based nurse education This symposium will examine these had barely begun. Nursing research trends in the context of research in and nursing practice were operating nursing and will open up discussion in separate worlds (Tierney 1974). of how journals can continue to play a The so-called ‘gap between research crucial role in disseminating research and practice’ became a real concern with impact. (Hunt 1981). Practitioners blamed The symposium is supported by Wiley, ‘ivory-tower’ researchers for writing the publisher of Journal of Advanced in gobbledegook, and researchers Nursing (JAN). JAN’s current Editor blamed practitioners for failing to try to in Chief, Roger Watson, and his understand research and implement its predecessor Alison Tierney are two findings. This simplistic duel was based of the speakers, both mindful of the on lack of understanding – on both aspiration of James P Smith, the sides - of the complexities of research Founding Editor, who in launching the and the process of its translation and journal said it must not become ‘an end utilisation. in itself’ but, instead, “a means towards Based on ‘lived experience’ – and the ends of improving the effectiveness” drawing on the literature – this paper of practice, education and management. will try to chart how our thinking in JPS died last year. This symposium is nursing about the value - the impact - of in honour of Jim. Paying tribute at this research has developed over time, and conference is fitting because Jim was how that thinking has been shaped. one of the founding members of this Key policy initiatives, movements RCN group. such as ‘evidence-based’ health care, References developments in journal publishing and, more recently, the demands of Smith JP (1976) Editorial. Journal of

94 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

external research assessment all have This session will explain the concept of undertaken at public expense should contributed to shaping our views over Altmetrics and, using a recent example provide evidence of the benefits. The time on the value of research in and for from Journal of Advanced Nursing impact must influence areas including: nursing, and for its wider benefit for (Dardas et al, 2018), will demonstrate the economy; society; quality of life; h e a l t h a n d s o c i e t y. what form these mainly take and the culture; and health care. Universities References relationship between Altmetrics and must produce impact case studies traditional citation metrics of the kind and explain how they support the Tierney, AJ (1974) Research at ward generated by Clarivate and Scopus. The development of impact from their level. Nursing Times, 9 May, 717-718. implications of Altmetrics for academic research. These case studies must research and publishing and for the be underpinned by internationally Hunt J (1981) Indicators for nursing forthcoming REF will be explored. Ways recognised publications. practice: the use of research findings. of increasing social media attention for Journal of Advanced Nursing, 6,3, In REF2021, (REF2021, 2019) research research will also be explored. 189-194 impact will account for 25% of the total References REF profile. This represents a 56% Dardas LA, Woodward A, Scott J, Xu H, increase in the weighting for impact Paper 2 Sawair FA. (2019) Measuring the social case studies since REF2014. When you impact of nursing research: An insight consider that the results of the exercise enable the allocation of around Measuring the impact of into altmetrics. Journal of Advanced Nursing Available at: https://doi. £2 billion each year to UK universities, published research org/10.1111/jan.13921 (Accessed 23 this is not an inconsiderable percentage. Authors and affiliation: Professor July 2019) Furthermore, since a four-star impact Roger Watson, University of Hull, UK case study equates with six four-star Seglen, PO (1997) Why the impact papers, the benefits of producing good Abstract factor of journals should not be used for case studies are evident. Impact of academic publications raises evaluating research BMJ 314, 498-502. One would expect an applied discipline different ideas in people’s minds and Watson R, McDonagh R and Thompson like nursing to score high on impact. such impact has changed and evolved. DR (2017) h-indices: an update on the This symposium paper will show Traditionally, publication impact in performance of professors in nursing in how quality publications underpin science and social sciences has been the UK. Journal of Advanced Nursing research Impact, how to differentiate measured by the extent to which work 73: 999-1001 outstanding impact from weak impact is cited in other publications expressed and how researchers can ensure that either in total or over time, as in the their work is impactful. controversial impact factor (Seglen, Paper 3 1997). Academics also measure their References own citation impact, with the h-index REF2014 (2011) Assessment gaining popularity (Watson et al, 2016). Research outputs and framework and guidance on Impact was initially only considered impact in the REF: A quality submissions HEFCE, Bristol within the field where the research was relationship REF2021 (2019) Guidance on generated, and little consideration was Authors and affiliation: Professor submissions Research England, Bristol given to impact outside that field on the Hugh McKenna, University of Ulster, (https://www.ref.ac.uk/publications/ well-being of people and the economy. UK guidance-on-submissions-201901) Where impact was seen outside a field, Accessed 23 July 2019) it was unclear how it got there and For almost 30 years the quality of what the extent of the impact was. This publicly funded research in UK universities has been assessed in a has changed since the UK Research Paper 4 Excellence Framework, and similar series of exercises now called the exercises elsewhere, have introduced Research Excellence Framework assessment of research impact, (REF). Australia, Sweden, New Zealand Postgraduate research specifically defined in terms of broader and other countries have run similar students and early career impact on society. exercises. The results are mainly used to inform the allocation of research researchers and the One relatively new way of measuring funding and provide accountability for publication process impact—which essentially bridges the tax payers’ money. Authors and affiliation: Dr Parveen A gap between impact within a field of Ali, University of Sheffield, UK research and impact outside of it—is In their early iterations, it was the Altmetrics® (www.altmetric.com; outputs of research – most commonly Publishing in scholarly journal is accessed 21 March 2019) whereby in the form of research papers considered prestigious, but challenging. impact via social and other forms of published in journals – that was the When someone undertakes a PhD, they media are measured. Altmetrics— main focus of the assessment. Outputs are encouraged to consired publication. meaning ‘alterative metrics’—was still account for 60% of the overall However, can research students developed in 2010 and in only a few rating derived from scoring each understand the publishing process and years the major publishers have been submitted output on a 5-point scale. negotiate the issues associated with studying them and making them visible In 2014, REF (REF2014, 2011) submission, peer review, revision – alongside articles on their journal included research impact. Governments and rejection (Ali, & Watson, 2016)? webpages. believe those whose research work is Are research students provided with

95 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

opportunities to learn how to achieve Symposium 9 Triggle N (2018) NHS ‘haemorrhaging’ research impact? nurses as 33,000 leave each year. BBC Abstract no: 0431 News. Available at: https://www. The process, speed and opportunities bbc.co.uk/news/health-42653542 for publication change rapidly. Journal (Accessed 23 July 2019) articles, book chapters or books used Retention of newly qualified to be the form of publications with nurses (NQNs) in the UK a few dominant publishers. With Paper 1 advanced information technology National Health Service and internet, opportunities to publish (NHS) have increased. It is easier to publish Lead: Dr Jane Wray, PhD, Faculty of Retention of newly qualified in blogs, for example, but increasingly Health Sciences, University of Hull, UK nurses (NQNs): A Rapid difficult to pick a reputable journal Symposium Statement where one should aim to publish Evidence Assessment (REA) their work. There are many predatory It is hard to remember a time in any Authors and affiliation: Dr David journals and it is difficult for even part of the world when there has not I Barrett, Dr Jane Wray, Dr Helen experienced researchers to recognise been concerns regarding a shortage Gibson, Professor Roger Watson, these (Van Nuland, & Rogers 2017). of nurses. This is especially acute Faculty of Health Sciences, University At the same time, to make publishing in the UK National Health Service of Hull, UK process contemporary, interesting, and (NHS) where we are currently losing Abstract futuristic, and to maximise research more nurses from the NHS than we impact, it is essential to exploit various are recruiting (Triggle 2018). Nurses Background: Nursing workforce options such as podcast, graphical are lost at many points in their shortages continue to concern the abstract and use of social media. But career trajectory through planned profession and retention strategies are how do we ensure that we prepare our retirement, premature retirement, central to long-term solutions (Buchan future generation for all of these? What career change and the pressures of 2017). NQNs are one group at risk can we do ensure research students other commitments. In addition to from early exit from the workforce as and novice researcher are kept up to the large number of nursing students they report feeling overwhelmed by the speed of changes in publication who ‘drop out’ during their nursing expectations, unprepared for the role process while meeting demands of their programmes—up to 25% according to and lacking in confidence (Ke et al studies? some (Siddique 2018)—we also lose 2017). nurses within one year of registration Aim: Present the findings of an REA on This paper is intended to inject into the and entering employment; some of NQNs retention during transition. symposium views of a younger nurse these leave the NHS and some leave the researcher to encourage speculation Methods: Database searching profession. This symposium will include about how journals and the publishing (CINAHL complete, Academic four presentations from three teams process may need to change and search premier, Open Grey, ERIC* on work related to the experience and exploit new disruptive approaches and (Education), Web of Science - Social retention of NQNs and will use a range technologies in order to modernise Science Citation Index and PubMed) of designs including systematic review, and maximise their role in promoting was undertaken during February – and qualitative methods. the publication of research that makes April 2018. The REA used an adapted an impact, both within and beyond Three of the presentations are from methodology (Varker et al 2015) and nursing. It will also explore what can be studies funded by the Burdett Trust for comprised the following stages: done to prepare our research students Nursing. A rapid evidence assessment 1. Classification of papers using RAE and novice researchers for future (Paper 1) will cover international tool publication challenges. research on retention of NQNs. 2. Quality assessment using CASP Paper 2 will present the perspectives References 3. Data extraction of students, NQNs academics and Ali PA & Watson R (2016). Peer review managers on issues related to 4. Narrative and the publication process. Nursing transition. Papers 3 and 4 (respectively) 5. Final assessment and scoring open, 3(4), 193-202. will focus on the concept of ‘job 6. Reporting. embeddedness’ to explain findings from Van Nuland SE, & Rogers KA (2017). Results: 2,647 references were telephone interviews with NQNs on Academic nightmares: Predatory identified and 49 papers were included their experience of the workplace and publishing. Anatomical Sciences in the final review; RCTs N=2, finally, online peer support to promote Education, 10(4), 392-394 Quantitative studies N=8, Systematic NQN well-being. Reviews N=8, Qualitative studies N=31. Following the presentations there will Discussion: There was considerable be a chaired discussion around the variation in definition of ‘NQN’ and emerging issues and the impact of this length of time of the transition period. on retention of the nursing workforce. Study quality was generally moderate References to low. Experimental studies were all pre-post intervention with no blinding Siddique H (2018) Quarter of UK of participants and quantitative studies student nurses drop out before were single location or programme with graduation, study finds. The Guardian small numbers. Outcomes measures Available at https://tinyurl.com/ included organisational commitment, y5bkm3xk (Accessed 23 July 2019)

96 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

confidence, satisfaction, stressors and organisational socialisation occurs. (2018) Reducing Pre-registration and intention to quit – all of which Transition frameworks and support Attrition and Improving Retention were proxy measures for retention. (e.g. preceptorship) are seen as central (RePAIR). Available at www.hee.nhs. Of the systematic reviews, only two to supporting NQNs during this uk/our-work/reducing-pre-registration- papers reported sufficiently on search period (Brooks et al 2019), enhancing attrition-improving-retention (Accessed methods, critical appraisal and competence and confidence and 24 July 2019) analysis. Qualitative studies focused reinforcing the ‘flaky bridge’ (Health on preceptorship, experiences of NQNs Education England 2018). and support with considerable variation Aim: To share findings from interviews Paper 3 in quality and reporting styles. with students, NQNs, academics and Conclusion: Despite decades of clinical managers on the transition research into the experiences of NQNs period. Job embeddedness: Towards a theory of and development of schemes and Methods: Semi-structured interviews frameworks to support them during were conducted with students (final retention in newly qualified this period, there is little substantive or year, final semester of programme), nurses/midwives robust evidence in terms of impact on NQNs (at 1 month post starting Authors and affiliation: Professor retention. employment), academics and clinical Austyn Snowden, School of Health References managers (n=32). Data was collected and Social Care, Edinburgh Napier during 2018. A volunteer sample University, UK; Dr Rosie Stenhouse, Buchan J, Charlesworth A, Gershlick was recruited to the study and the Edinburgh University, UK B and Seccombe I. (2017) Rising interviews were part of larger project Background: There is a complex pressure: The NHS workforce funded by the Burdett Trust for Nursing relationship between personal challenge. Workforce profile and trends into successful transition and retention attributes such as emotional of the NHS in England. The Health of NQNs. All data was imported into intelligence, and performance Foundation Available at: www.health. NVivo (V12) and content analysis levels in nurses. This longitudinal org.uk/publications/rising-pressure- undertaken. the-nhs-workforce-challenge (Accessed study has followed a large (n=897) 23 July 2019) Findings: The following themes will cohort of nurses/midwives from be presented; The person in transition 2013, measuring engagement levels, Ke YT, Kuo CC and Hung CH (2017) (emotional responses, identity, and emotional intelligence, resilience The effects of nursing preceptorship on managing expectations of self and of and burnout yearly, alongside proxy new nurses’ competence, professional others), The professional in transition measures of performance such as socialization, job satisfaction and (accountability and the competence – retention, academic grade and following retention: A systematic review. Journal confidence continuum), Organisational qualification, pay. This presentation of Advanced Nursing 73, pp. 2296 – Culture and Context (academic, clinical summarises key statistical findings 2305 and organisational enablers of and over the last five years to show why barriers to supportive transition). Varker T, Forbes D, Dell L, Weston A, engagement was the most important Merlin T, Hodson S. and O’Donnell M Discussion: There is consensus that attribute, and so a deeper investigation (2015) Rapid evidence assessment: a supportive environment during the into engagement of newly qualified increasing the transparency of an transition period is important for nurses is now relevant. emerging methodology. Journal of successful transition. The role of the Aim: to explore the experience of Evaluation in Clinical Practice 21(6), preceptor is seen as pivotal, however newly qualified nurses in relation to pp. 1199-1204 wider organisational support from the their sense of fit with the workplace multi-disciplinary team, peers and the environment organisation is equally important (if not Method: Semi-structured telephone more so) in ensuring that NQNs become Paper 2 interviews with a purposive sample effectively socialised into the profession of 23 newly qualified nurses (male= and feel competent and confident. Perspectives on support 6 female= 17) about their experience References of the workplace and the transition to during the transition from becoming a newly qualified nurse. Data Duchscher J (2008) A process of student to newly qualified were collected 2017-2018 in Scotland becoming: The stages of new nurse and analysed thematically. nurse (NQN): Views of graduate professional role transition. students, NQNs, academics Journal of Continuing Education in Findings: Four themes emerged not and clinical managers Nursing, 39 (10), pp. 441-450 fitting into the work environment; feeling supported; coping emotionally; Authors and affiliation: Dr Jane Wray, Brook J, Aitken LM, Webb R, MacLaren and having a growth mindset. Lack Dr Helen Gibson, Dr David I Barrett, J and Salmon D (2019) Characteristics of fit was a function of poor resources Professor Roger Watson, Faculty of of successful interventions to reduce in terms of staffing and support, Health Sciences, University of Hull, UK turnover and increase retention of early interference of work with home life, and Abstract career nurses: A systematic review. a feeling of isolation. These experiences International Journal of Nursing Background: The transition from contributed to participants voicing Studies, 91 pp. 47-59 doi: 10.1016/j. student to NQN is seen as a period doubts about staying in nursing. ijnurstu.2018.11.003 characterised by ‘transition shock’ Conversely, those who felt supported (Duchscher 2008) in which professional Health Education England (HEE). described being invested in and

97 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

experienced a sense of collegiality. 2014). Symposium 10 Discussion: The findings are Aim: To explore the experiences of theoretically consistent with the concept online peer support for NQNs accessed Abstract no: 0170 of ‘job embeddedness’. Where there via smartphone or PC. was a lack of fit between the person’s Method: The Burdett Trust for Transitions from paediatric expectations, life context out with job Nursing funded this two-phase study. to adult health services and the job environment; participants Phase one involved nine focus groups experienced distress that subsequently with NQNs to refine an online peer for people with complex impacted on their long-term vision of support intervention (n=25 Registered intellectual disabilities: remaining in the profession. General Nurses and n=25 Registered Learning from carers and Conclusion: The concept of job Mental Health Nurses). Focus groups nurses embeddedness explains the findings were conducted between June 2018 and Lead: Juliet MacArthur, PhD MSc, here and offers managers a structured February 2019. Phase two involves 30- PGCert BSc RN RNT, NHS Lothian, UK way of planning to ensure newly 40 NQNs joining an online peer group qualified nurses feel part of a team. for three months to access emotional Symposium Statement References support via the online platform. The number of children and young Findings: Qualitative data from adults with intellectual disabilities Snowden A, Stenhouse R, Marshall S, the focus groups was analysed using (ID) is increasing and more are living Duers L, Brown N, Carver F, & Young J thematic analysis with the aid of longer with a range of complex health (2018). The relationship between NVivo software. Phase one themes needs. A well-managed transition from emotional intelligence, previous caring will be presented and include growing paediatric to adult phealth services experience, and successful completion in confidence, supporting each is crucial for both the individuals of a pre-registration nursing/midwifery other, sharing experiences, feeling and their family/carers. However, degree. Journal of Advanced Nursing, overwhelmed and sharing information evidence suggests that people with 74, pp. 433–444. online. ID continue to experience poorly Štiglic G, Cilar L, Novak Ž, Vrbnjak D, Discussion: Online peer support managed transitions, with insufficient Stenhouse R, Snowden A, & Pajnkihar M offers a sustainable and accessible coordination, communication and (2018). Emotional intelligence among means of support for NQNs. Developing planning. This symposium will present nursing students: Findings from a supportive peer networks provides four inter-related papers stemming cross-sectional study. Nurse Education opportunities to promote psychological, from a Scotland-wide research study Today, 66, pp. 33–38. social and emotional well-being. conducted 2016-2019 that explored Practical information and advice can the transition from paediatric to adult Stenhouse R, Snowden A, Young J, also be shared. health care for people with complex Carver F, Carver H, & Brown N (2016). ID from the perspective on nurses Do emotional intelligence and previous Conclusion: Online peer support and family carers, with an aim of caring experience influence student could be beneficial for new nurses; developing a guide for best practice and nurse performance? A comparative it can increase NQN wellbeing and an educational resource for nurses. The analysis. Nurse Education Today, 43, potentially decrease intention to leave study involved ten parents who had pp 1–9 the organisation and the profession. recently been through the transition References process with their child and 46 nurses with varying roles and from a range of Paper 4 Bautista JR and Lin TTC (2017) Nurses’ use of mobile instant messaging specialties. applications: A uses and gratifications Paper 1 sets the international context A qualitative study of perspective. International Journal of on transitions for young people with ID experiences of online peer Nursing Practice, 23(5), pp. 1–9 from a systematic review that identified support for newly qualified Edwards D, Hawker C, Carrier J, four emerging themes that carry nurses (NQNs) et al (2015) A systematic review of relevance for nursing. the effectiveness of strategies and Authors and affiliation: Analisa Paper 2 presents the experiences of interventions to improve the transition Smythe, Birmingham and Solihull family carers of young people with ID from student to newly qualified nurse. Mental Health NHS Foundation Trust, who have been through the transition International Journal of Nursing UK; Catharine Jenkins, School of process and consider the role that Studies, 52(7), pp. 1254–1268. Nursing and Midwifery, Birmingham nurses can play to provide person- City University, UK; Professor Jan Green J, Wyllie A and Jackson D (2014) centred care. Oyebode, Centre for Applied Dementia Social networking for nurse education: Paper 3 presents data from the study Studies, University of Bradford, UK Possibilities, perils and pitfalls. which identified the hallmarks of Background: It is important that the Contemporary Nurse, 47(1-2), pp. effective transition planning and psychological well-being of NQNs is 180–189. focuses on the contribution that nurses addressed (Edwards et al, 2015). Online should make in relation to planning, peer support could be beneficial in preparation and setting up processes addressing wellbeing and can decrease that ensure continuity. stress, isolation and anxiety and foster a sense of community (Bautista and Paper 4 outlines the education resource Lin, 2017; Green, Wyllie and Jackson, developed from the outcomes of the research to promote the role of nurses

98 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

in ensuring an effective transition properties of health transitions from pressure”. Overall, families expressed and presents the findings from the paediatric to adult health services with a strong need for greater recognition feasibility study to test the resource in a need to focus on time span, critical of their needs, particularly in terms of two Health Boards. points and events. The implications for information and support during this nursing policy, practice and education period. Furthermore they stressed will be considered with a focus on the importance of recognising their Paper 1 transition planning, co-ordination, expertise to make the transition to adult communication and raising awareness health services smoother. of issues pertaining to capacity and Discussion: Nurses have previously Setting the international consent. been identified as instrumental to the context on transitions: References transition process (Betz, 2007) and can A fragmented landscape play an important role in counteracting Brown M, MacArthur J, Higgins A, some of the challenges described by for young people with Chouliara Z 2019. Transitions from intellectual disabilities and carers in this study. Nurses need to child to adult health care for young ensure they take responsibility for their families people with intellectual disabilities: A providing information and support to Authors and affiliation: Dr Juliet systematic review. Journal of Advanced carers and people with ID, coordinating MacArthur, NHS Lothian, UK Nursing DOI: 10.1111/jan.13985 the transition process through Abstract Meleis AI, Sawyer LM, Im E, Hilfinger multidisciplinary collaboration and Messias DK, & Schumacher K 2000. enabling continuity of person-centred As a foundation to this Scotland-wide Experiencing transitions: An emerging care in adult health services. research study a systematic review was middlerange theory. Advances in Conclusion: Whilst families want to undertaken to examine the experiences Nursing Science, 23, p12–28 be involved in the transition process of health transitions for young people they do not want to feel that they are with intellectual disabilities (ID) responsible for the ensuring that all and their carers and determine the Paper 2 the needs of their family are met. implications for nursing practice Nurses need to play a central role in (Brown et al, 2019). coordinating the transition process. The views and experiences A systematic review and critical References appraisal of relevant literature of families of young adults published 2007-2017 was carried out with intellectual disabilities Betz CL (2007) Facilitating the in AMED, ASSIA, CINAHL, MEDLINE, in Scotland Transition of Adolescents with PsycINFO, PubMed and Science Direct Developmental Disabilities: Nursing Authors and affiliation: Mrs Anna Sociological Abstracts databases. A Practice Issues and Care. Journal of Higgins, Edinburgh Napier University, total of 12 out of 637 papers met the Pediatric Nursing, 22(2), 103-115. UK inclusion criteria and a narrative review DOI: https://doi.org/10.1016/j. was undertaken. Research had been Abstract pedn.2006.07.006 undertaken in France, Netherlands, UK, Background: Family members play Brown M, MacArthur J, Higgins A, Canada and the USA with an equal split a crucial role during transition from & Chouliara Z (2019 – in press). between qualitative and quantitative paediatric to adult health services; Transitions from child to adult health research designs. however the experience of families of care for young people with intellectual The overall findings indicate that young people with ID may not have disabilities: A systematic review. current services in most countries are been fully considered when planning Journal of Advanced Nursing. doi: often ill-prepared to respond to the effective processes (Brown et al, 2019) 10.1111/jan.13985 Aims: To investigate and understand multifaceted health needs of young Cohen E, Kuo DZ, Agrawal R, Berry J G, the experience of families and carers people with ID at the point of transition Bhagat SKM, Simon, TD, et al (2011). of young people of with complex ID of from paediatric to adult health care. Children with medical complexity: An the transition between child and adult There were four emerging themes: emerging population for clinical and health services. 1. becoming an adult research initiatives. Pediatrics, 127, 2. fragmented transition process and Methods: Ten family carers of young 529–538. http://dx.doi.org/10.1542/ care adult with ID and complex care needs peds.2010-0910 who were in the process of or had 3. parents as advocates in emotional recently completed a transition from turmoil; and (iv) making paediatric to adult health services Paper 3 transitions happen. participated in a one-to-one, semi- The findings were interpreted within structured interview. Meleis et al’s (2000) Transition Theory Results: Thematic analysis revealed The nursing role in effective recognising transitions as complex that these carers’ experiences of transition planning processes occurring simultaneously transition had been largely negative for young adults with in multiple dimensions. Consistent and five themes were identified: “a intellectual disabilities with this theoretical framework the deep sense of loss”, “an overwhelming review reiterates the importance of process”, “parents making transitions Authors and affiliation: Professor awareness, engagement, adapting to happen”, “a shock to the adult health Michael Brown, Queen’s University change and difference as being core care system” and “the unbearable Belfast, UK

99 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

Background: Children and adults intellectual disabilities: A qualitative health conditions across clinical settings with complex ID are likely to be cared study. Research in Developmental and focuses on the following areas: for by nurses throughout their lives Disabilities, 70, 94-103. 1. multiple morbidities and health whether this is at home, school or in Young-Southward G, Philo C, & Cooper inequalities for people with a primary care and hospital settings. SA (2017) What effect does transition learning disability Given the challenge that young people have on health and well-being in young 2. transition and why it matters and their families face during the people with intellectual disabilities? A transition from paediatric to adult 3. needs of the young person and systematic review. Journal of Applied services is it essential to understand their family at the point of Research in Intellectual Disabilities, the role nurses can play delivering transition - the nursing perspective 30(5), 805-823. safe, effective and person-centred care 4. welfare and legal system changes during this period. Brown M, Macarthur J, Higgins A, & relevant to transition. Chouliara Z (2019) Transitions from Aim: To explore the involvement of The education resource will be piloted child to adult health care for young nurses in facilitating the transition from in two NHS Board areas in Scotland people with intellectual disabilities: A child to adult health services for young with nurses, including Learning systematic review. Journal of Advanced adults with intellectual disabilities. Disability Liaison Nurses, child health Nursing. doi: 10.1111/jan.13985 Methods: An interpretative qualitative nurses, primary care nurses and general design was used involving forty-six hospital nurses. (n=46) nurses from across Scottish Paper 4 References health services with experience of facilitating the transition from child Brown M, MacArthur J, McKechanie A, Mack S., Hayes M & Fletcher J 2012 to adult health services. Data were The development and collected from June 2016-July2017. Learning Disability Liaison Nursing Qualitative one-to-one interviews piloting of an educational Services in South East Scotland: A were conducted, and data analysed to resource “Transitions mixed methods impact and outcome identify emergent themes. from child to adult’s health study. Journal of Intellectual Disability Research 56 (12) pp.1161-1174. Results: Nurses make many and care for young adults with varied contributions and are involved learning disabilities” for in all aspects of the transitions nurses. process, including proactive transitions preparation, multiagency Authors and affiliation: Anna Higgins, transition planning, facilitating the Edinburgh Napier University, UK transitions process and care pathway Previous research undertaken by implementation and supporting Brown et al (2012) has shown that continuity of care in adult health young people with learning disabilities services. are faced with many challenges due to Discussion: The transitions process their long-term health conditions and can be complex and cause anxiety dependency upon all health services for the young adults with intellectual when they go through transitions disabilities and their family. Careful, between services and move from early planning is required to ensure children to adult services. During these that the process is smooth and effective. transitions, their care can reach critical Nurses have important contributions points. If these points are not supported to play supporting and facilitating managed in a person centred way, the transition from child to adult service users and their family carers health services and can take a strong run higher risks for morbidity and leadership role. Implications for mortality, and suffer from higher levels nursing practice, education and future of distress, and confusion. Nurses are research will be presented. in an ideal position to address care and Conclusion: Previous research support needs at the time of transition focusing on other patient groups for children with learning disabilities highlights the important role that with long-term health conditions. nurses play throughout the transitions As part of the wider study the current process. In relation to young adults nursing best practice at the time of with intellectual disabilities nurses transition was identified and used to need to undertake a range of roles that develop and pilot an education resource can be integrated into their practice to for nurses in practice on how best to ensure that the transitions experience is manage transition between child and smooth and effective. adult health services for people with References learning disabilities and their families and carers. The education resource Young-Southward G, Cooper seeks to increase awareness, skills and SA, & Philo C (2017) Health and confidence in managing transitions wellbeing during transition to between services for people with adulthood for young people with learning disabilities with long-term

100 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

Symposium 11 the future health care workforce to have Vries K, Haq I, Wright J (2017) How the sufficient knowledge and skills to do we enhance undergraduate health Abstract no: 0438 ensure that people affected by dementia care education in dementia? A review of receive the best possible care and the role of innovative approaches and support (Department of Health, 2015). development of the Time for Dementia Time for Dementia In practice, this knowledge is often programme, International Journal of Lead: Stephanie Daley, PhD MSc lacking. In response to this challenge, Geriatric Psychiatry, 32, 68-75, doi/ DipCOT, Brighton and Sussex Medical the Brighton and Sussex Medical abs/10.1002/gps.4602 School, UK School and the University of Surrey Symposium Statement have developed the Time for Dementia programme (Banerjee et al, 2017). Paper 2 Time for Dementia is an innovative The programme takes an innovative undergraduate education programme approach to dementia education developed for nursing and other health for medical, nursing and paramedic Whole sight: New ways of care students in order that the future students by providing longitudinal seeing dementia resulting workforce can truly deliver person- contact between students and a family from relational learning centred care and be able to meet the affected by dementia over a two period. needs of those living with dementia. with people living with Methods: The aim of this study was dementia This symposium aims to give an to evaluate the Time for Dementia overview of research evolving from programme in terms of process Authors and affiliation: Dr Wendy the Time for Dementia programme, and its impact on student attitudes, Grosvenor, University of Surrey, UK; from four nested studies. The first understanding and knowledge towards Dr Stephanie Daley, Brighton and presentation will provide an overview dementia, using a mixed methods Sussex Medical School, UK of the programme, background design. This involved assessing Abstract literature, rationale, evaluation quantitative outcomes (dementia Background: Dementia is one of design and preliminary findings. The knowledge, attitudes and empathy) the key health and social challenges second presentation will focus on the at baseline, 12 and 24 months for of the 21st Century. Multiple deficits experience of adult nursing students intervention and control group have been identified in dementia and Time for Dementia. The third students. It also involved undertaking education by UK policy makers and, presentation relates to a qualitative 39 individual qualitative interviews and from September 2015, the Department study on the implementation factors five focus groups which were analysed of Health mandated that undergraduate affecting Time for Dementia within using thematic analysis health care curricula included Higher Education Institutes (HEIs) and Results: Evaluation results have dementia. Here I explore one particular undergraduate health care curricular shown statistically significant novel approach, the Time for Dementia change more generally. The final improvements in dementia knowledge Programme, which had at its core presentation will provide longitudinal and attitudes. Qualitatively four key longitudinal learning from people with and cross section data from the Time areas of learning have been identified; dementia and their carers. for Dementia programme on nursing improved insight and understanding Methods: This is a constructivist clinical preferences towards older about dementia, overcoming negative grounded theory qualitative study. Data people, and will explore methodological attitudes and assumptions, relational were generated over three years with 12 considerations about how these are learning and enhanced dementia undergraduate adult nursing students. measured and how these change during practice. Methods used to collect data during this training. Conclusions: Our research has study included face-to-face interviews This symposium will be of relevant to demonstrated positive impacts on (n=12 students), focus group (n=5 researchers interested in dementia, students that have been through the students), reflective journals, memos. older people, and long-term conditions programme. Our students have received Consistent with the grounded theory as well as programmatic educational an education programme which will approach, literature was also recognised evaluation. equip them to understand the needs as a source of data. of patients with dementia, regardless Results: Individual interviews (n=12) of the area of health care which they and one focus group (n=5) with adult Paper 1 practice in. Our outcomes have led to student nurses were completed yearly programme delivery to a much wider over three years. Students reframed group of undergraduate health care their perceptions of dementia, as Time for dementia: A new students, and to the development of attention was given to broadening model of undergraduate another condition specific programme, their view to encompass the person’s health care dementia for Autism. lives and relationships. Increasing education? References awareness led to a person centred shift to participants’ practice and New Ways Authors and affiliation: Dr Stephanie Department of Health. Prime Minister of Seeing dementia which resulted in Daley, Brighton and Sussex Medical Challenge on Dementia 2015-2020, development of a new theory of Whole School, UK London (UK): Department of Health; Sight. New Ways of Seeing needs 2015. Abstract conditions in order to be established; Background: In the UK the number Banerjee S, Farina N, Daley S, Adaptive Thinking, Building of people living with dementia is set to Grovesnor W, Hughes L, Hebditch M, Relationships and Transformative rise exponentially. There is a need for Mackrell S, Niforooshan R, Wyatt C, de Learning.

101 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

Conclusions: Findings suggest that Methods: A qualitative study was Background: A current international participants realised that they can be completed using semi-structured issue is ensuring health care active in their contribution to care, interviews with 12 staff working on the professionals are both competent make change, and serve as change programme from the different sites. and willing to work with older adults agents in dementia care. This study Data was analysed using thematic with complex needs. This includes add to the evidence that involving analysis. dementia care; which is widely people with dementia in education is Findings: Three key themes were recognised as a priority. Yet research a valuable learning resource for adult identified from the analysis suggests that working with older nursing students. Although the focus of people is unattractive to student nurses 1. decision to adopt this study was on adult branch nursing (Garbrah et al, 2017). However, factors students’, it could be argued that the 2. implementation phase influencing preferences for working findings are relevant to health care 3. delivery phase. with people with dementia are not well educators in a variety of disciplines of understood. Facilitators include; leadership, health care. This has implications for motivation, and resilience. Challenges Aim: To explore nursing student career researchers, policy makers and health include; time, resources, and fit within preferences for working with people care educators. curricula. with dementia. Conclusion: This study provides Methods: This is a secondary analysis Paper 3 valuable insight about the challenges of data collected as part of the Time for and facilitators encountered when Dementia study (Banerjee et al, 2017). introducing innovative change into A modified career ranking exercise was The challenges and undergraduate health care education. used (Stevens and Crouch, 1998) to facilitators involved in The findings of this study can inform assess changes in preferences over time embedding and replicating innovators understanding of common and factors related to these preferences (n= 488). A content analysis of open- the Time for Dementia challenges and facilitators when implementing innovation within ended questions was conducted to Programme in different undergraduate nurse and health care identify factors influencing preferences HEI sites education. Longitudinal learning has (n= 110). Authors and affiliation: Ms Yvonne applicability across a range of long-term Results: Preferences for working with Feeney, Dr Stephanie Daley, Brighton conditions and student outcomes. These older adults and working with dementia and Sussex Medical School, UK findings can be used to more effectively decreased during training and was Background: Higher Educational manage longitudinal curricular change an unpopular career choice. At the Institutions (HEIs) have a responsibility within nursing education. univariate level, students’ preferences to ensure undergraduate nursing and References for working with people with dementia other health care students are educated were positively associated with the Algoso M, Peters K, Ramjan L, East in dementia. Traditionally students experience of knowing someone with L (2016) Exploring undergraduate completed block rotations, however dementia, knowledge, attitudes and nursing students’ perceptions of this method may limit development of taking part in Time for Dementia. working in aged care settings: A review core values and attributes necessary Only attitude scores were significantly of the literature. Nurse Education to provide person-centred care to associated with preferences after Today. 2016 Jan 1;36:275-80. those with dementia (1). Students accounting for other variables. Reasons given for a higher preference of completing longitudinal models in Banerjee S, Farina N, Daley S, working with people with dementia dementia report positive learning Grosvenor W, Hughes L, Hebditch was enhanced skills and knowledge. outcomes, increased knowledge, and M, Mackrell S, Nilforooshan R, Wyatt In contrast, lack of knowledge and better understanding of dementia (2). C, de Vries K, Haq I. (2017) How do experience was cited as a reason for In 2015, Brighton and Sussex Medical we enhance undergraduate health low preference. Negative factors also School and University of Surrey piloted care education in dementia? A review included communication difficulties a longitudinal programme; Time for of the role of innovative approaches with patients and the challenging Dementia; for nursing, medical, and and development of the Time for nature of the work. paramedic students. The programme’s Dementia Programme. International success led to further replication in Journal of Geriatric Psychiatry. 2017 Discussion and conclusion: three new HEI’s across a range of Jan;32(1):68-75 This paper adds to the literature by student disciplines. Time for Dementia confirming that working with dementia is an innovative programme of change, is not a popular career for nursing and curricular change is a complex Paper 4 students and outlines possible ways task. Understanding common factors to promote working with people with that help and hinder implementation dementia. across sites would be advantageous Student nurse preferences References for other HEI’s considering this type for working with people Banerjee S, Farina N, Daley S, of innovation. The aim of the study with dementia was to investigate the challenges and Grosvenor W, Hughes L, Hebditch M, facilitators involved in embedding Authors and affiliation: Ms Molly Mackrell S, Nilforooshan R, Wyatt C, and replicating the Time for Dementia Hebditch, Dr Stephanie Daley, Brighton De Vries K, Haq I, Wright J (2017) How Programme in different HEI sites. and Sussex Medical School, UK do we enhance undergraduate health

102 Symposia: Wednesday 4 September 2019, 3.45-5.15pm

care education in dementia? A review of the role of innovative approaches and development of the Time for Dementia Programme. [Review]. International Journal of Geriatric Psychiatry January, 32, 68-75. Garbrah W, Valimaki T, Palovaara M, Kankkunen P (2017) Nursing curriculums may hinder a career in gerontological nursing: An integrative review. International Journal of Older People Nursing, 12. Stevens J, Crouch M (1998) Frankenstein’s nurse! What are schools of nursing creating? Collegian, 5, 10-15.

103 Symposia: Thursday 5 September 2019, 1.45-3.15pm

Symposium 12 Paper 1 study participants. IRB 38(1): 7–12. Charles A, Rid A, Davies H, Draper, Abstract no: 0126 H, Prisoners as research participants: The recruitment of older current practice and attitudes in the UK prisoners within the closed Journal of Medical Ethics 2016;42:246- Developing the methods setting of a prison: The 252 used in your PhD study concept of anonymity Lead: Helen Aveyard, PhD, Principal Authors and affiliation: Professor Lecturer for Student Experience, Paper 2 Joanne Brooke, Birmingham City Oxford Brookes University, UK University, UK Symposium Statement Abstract The recruitment of people In this symposium, we present Background: Health research who have experienced a examples from three different research within prison settings is essential to bereavement into research projects which illustrate how those enable the development of new and studies undertaking a PhD or equivalent can innovative treatments for prisoners, Authors and affiliation Mrs Katie engage with developing the research which are delivered effectively and methods used in their study. PhD Mccallum, Dr Helen Walthall, Oxford within the prison regime. However, Brookes University, UK; Professor students often focus on the need unique research challenges need to to develop new knowledge and are Debra Jackson, Professor of Nursing, be addressed and these include the University of Technology, Sydney conscious that this will be the primary concept and processes of maintaining focus of assessment at viva. However, (UTS), Australia; Dr Helen Aveyard, participant’s anonymity. Prison settings Principal Lecturer for Student those studying for a PhD or professional are closed environments and prisoners doctorate are required not only to Experience, Oxford Brookes University, movements are controlled by prison UK develop new knowledge but also to guards, which are witnessed by other develop and reflect on the methods prisoners. This closed and controlled Abstract by which they have obtained this environment creates breeches of Background: As with any study, new knowledge. Examination of the anonymity when movement is due the recruitment of people who have methods used in the study is one way to participating in a research study experienced a bereavement needs to reassure examiners that the method (Charles et al 2016). to be carefully considered. Those of enquiry has been rigorous and that Aim: To explore the concept and who have suffered a bereavement confidence can be had in the results process of maintain anonymity when are often considered as vulnerable. that follow. Reflection on the research participating in research within Ethics committees and those who methods used within a study can be a prison setting. Methodological plan studies need to be mindful of this undertaken in different ways. Aim: discussion: The discussion will include when they consider how they approach In this symposium we discuss three the understanding of anonymity in a people who they would like to invite to different approaches. Methodological prison setting and the processes that participate. Yet adopting a stance that is discussion: In the first example, we can be implemented to support but too protective can inhibit the research discuss how the concept of memory not guarantee anonymity of prison that might not in fact result in harm to is often taken at face value within participants. A number of strategies those who participate and might benefit qualitative studies and the implications will be discussed, which have been future patients. of this for the research method that through experience rather than formal Aim: To explore possible recruitment incorporates use of memory. In the guidelines, such as wide dissemination methods for inviting those who have second example, we explore how the of participant information sheets that experienced a bereavement into practicalities of how focus group data are requested to be returned by all research. can be collected in different countries prisoners to an expression of interest and in different languages. In the Methodological discussion: We box, research interviews coincide third example, we discuss the ethical undertook a focused mapping review with the prison regime and regular implications of different approaches to explore current international movement of prisoners, or within to the recruitment of people who recruitment practices. A focused routine health appointments. have recently been bereaved into mapping review provides a snapshot of research studies. Conclusion: Different Conclusion: Ethically, it remains current practice. Unlike a conventional methodological considerations will important to explain to potential literature review in which the results arise from different projects and their participants the impact of the closed of studies are analysed, the aim analysis will complement the overall and controlled environment of the of a focused mapping review is to findings of the project. prison, and as such guards and explore trends and common practice prisoners may become aware of their in methods used in the published contribution, although all possible literature over a particular time frame. processes have been put in place. We explored the methods used to recruit those who had experienced a bereavement in published papers, References with interest in the reflections of these Christopher PP, Stein D, Johnson E, methods by the researchers who had Rich D, Friedmann D, Clarke G, Lidz used them. The common approaches W (2016) Exploitation of prisoners will be discussed in this session. in clinical research: perceptions of Conclusion: The assumptions that

104 Symposia: Thursday 5 September 2019, 1.45-3.15pm

certain groups are too vulnerable to be participants with dementia. Australia; Dr Helen Aveyard, Principal recruited into studies needs exploring Aim: To discuss a human rights-based Lecturer for Student Experience, Oxford in order to ensure that those who framework for researchers working with Brookes University, UK are willing to participate have the people living with dementia. Background: Memory is a complex opportunity to do so. Methodological discussion: phenomena; it is the subject of References Understanding the needs of people vigorous debate particularly in the with dementia who are involved in field of psychology. There is now ample Bradbury-Jones C, Breckenridge J, evidence that memory is not a straight Clarke MT, Herber OR, Wagstaff C, research is essential to develop adapted methodologies that aim to maximise forward snapshot of past events but Taylor J (2017) The state of qualitative can be re-processed and altered with research in health and social science their participation. Currently there is no guidance for researchers on time. Hence it is now acknowledged literature: a focused mapping review that reliance on the memory of those and synthesis. International Journal how to effectively involve people with dementia in research. Having a human who are providing witness in legal cases of Social Research Methodology, 20, can be fallible and indeed has led to 627-645. rights-based framework ensures that the participants rights are protected miscarriages of justice. Harrop E, Morgan F, Byrne A, Nelson and gives researchers the ability to Aim: The aim of this session is to A (2016) “It still haunts me whether be flexible and develop strategies to explore the way memory is used we did the right thing”: a qualitative involve people in any stage of dementia. within qualitative nursing research. analysis of free text survey data on the Effective communication between Methodological discussion: In bereavement experiences and support researchers and people with dementia is qualitative research, particularly in needs of family caregivers. BMC essential in order to promote inclusion. nursing, we often rely on memory; Palliative Care, 15, 92. The development of a person-centred and yet, somewhat surprisingly, often approach to obtain informed consent is there is little discussion about the Holdsworth LM (2015). Bereaved an important issue to be considered if implications of doing so. Memory is carers’ accounts of the end of life and research aims to support the rights of often fallible, and given so, we explore the role of care providers in a ‘good people with dementia. its role in qualitative research and death’: A qualitative study. Palliative the implications this might have on Medicine, 29, 834-41 Conclusion: Current research needs to evolve towards a more inclusive subsequent data analysis. We will philosophy, but it is the researchers’ also explore the possible effect on Paper 3 responsibility to be able to adapt the participants when they recall their methods and develop new strategies memories of difficult events with of active involvement of people with researchers. We will also explore Involving people with dementia in research. the way in which these factors were dementia in research: considered in a PhD project in which References the memories of people over 65 were A human rights based Hellstrom I, Nolan M, Nordenfelt sought. approach L, & Lundh U (2007) Ethical Conclusion: The use of memory in Authors and affiliation: Mrs Alicia and methodological issues in research is not as simple as it might Diaz-Gil, Professor Jane Appleton, interviewing persons with dementia. seem and requires further discussion Dr Olga Kozlowska, Oxford Brookes Nursing Ethics, 14(5), 608-619. amongst nurse researchers. University, UK; Professor Joanne doi:10.1177/0969733007080206 References Brooke, Birmingham City University, Rivett E (2017) Research involving UK; Professor Debra Jackson, Baddeley A, Eysenck MW, Anderson people with dementia: a literature Professor of Nursing, University of MC (2015) Memory. Second edition. review. Working with Older People, Technology, Sydney (UTS), Australia Psychology Press, London. 21(2), 107-114. doi:doi:10.1108/ Background: Traditional research WWOP-11-2016-0033 WHO. (2015) Dempsey L, Dowling M, Larkin P methods have been proven to be et al (2016) Sensitive interviewing Ensuring a human rights-based exclusionary towards people with in qualitative research. Research in approach for people living with dementia. This raises issues regarding Nursing & Health. 39, 6, 480-490. the rights of this group of people to dementia. Available at: www.who.int/ access research and contribute to mental_health/neurology/dementia/ Gaydos HL (2005) Understanding society. Recent published literature dementia_thematicbrief_human_ personal narratives: an approach to discusses how the benefits of involving rights.pdf (Accessed 24 July 2019) practice. Journal of Advanced Nursing. persons with dementia in research 49, 3, 254–259 outweigh the risks. Several dementia organisations are acting as the voice Paper 4 of people with dementia. These organisations advocate for people with dementia and their human rights, The use of memory in claiming their right to be an active asset qualitative research for research. Yet their participation is Authors and affiliation: Ms Emma still limited due to the lack of flexibility Blakey, Dr Helen Walthall, Oxford of researchers and ethics committees Brookes University, UK; Professor on applying different methodologies Debra Jackson, Professor of Nursing, that adapt better to the requirements of University of Technology, Sydney (UTS),

105 Symposia: Thursday 5 September 2019, 1.45-3.15pm

Paper 5 the focus and the group: enhancing Symposium 13 analytical rigor in focus group research. Qualitative Health Research, 10(3), Abstract no: 0296 The collection and analysis 293-308. of focus group data from Morgan DL (Ed) (1993) Successful Facilitating transformation different countries and focus groups: Advancing the state of from within the workplace. languages the art (Vol. 156). Thousand Oaks, CA, Embracing person-centred Authors and affiliation: Mr US: Sage Publications. Mamdooh Alzyood, Oxford Brookes systems and processes Onwuegbuzie AJ, Dickinson WB, through participatory University, UK; Professor Joanne Leech NL, & Zoran AG (2009) A Brooke, Professor of Nursing, qualitative framework for collecting and research Birmingham City University, UK; analyzing data in focus group research. Lead: Michele Hardiman, PhD MA Professor Debra Jackson, Professor International Journal of Qualitative (Health Mgt) HDip Dip RGN, RPN, of Nursing, University of Technology, Methods, 8(3), 1-21. Research and Education Facilitator, Sydney (UTS), Australia; Dr Helen Galway Clinic, Ireland Aveyard, Principal Lecturer for Student Experience, Oxford Brookes Symposium Statement University, UK The symposium will enable Background: Focus groups are a attendees to see the application of popular method of collecting data purposeful, facilitated and person- about topics where it is anticipated centred philosophies and research that the data will be enhanced by principles, integrated and translated discussion amongst participants into meaningful participation in and that this will add to its rigour. the development of person-centred The methods for undertaking focus cultures. McCormack and McCance groups are well established and many (2017) stress the need for a whole authoritative texts are provided that system approach to enabling cultures guide researchers through the process. of person-centredness. The presenters This includes how to collect and are a team who have strategically analyse the group data. However, there connected the development of is little guidance for how to proceed workplace facilitators, the integration when the data is collected in different of technology with the personal countries and in different languages. and professional development and Aim: to explore how the principles of participation of nurses. They will focus group research are applied when share the linking of theory, evidence focus groups are conducted in different and practical action to unravel language and in different countries. contemporary challenges, including Methodological discussion: There technology use ‘to fit’ within the are many examples of focus group complexity of nursing practice. discussions which have been held in The first presenter will describe the different countries, yet examination development of two empirically derived of how researchers have managed the models created as part of a doctoral issues of translation, transcription and study, to enable nursing leaders working analysis are often given little attention in practice develop the skills necessary in published papers, the assumption to become facilitators of person-centred being that data is managed in the same cultures. The second presenter then way as if collected in one country and in presents practice based research that one language. Yet questions arise about draws on the models to develop a work- when translation and transcription based facilitation team within an acute should take place, whether data from hospital setting and the flourishing different countries should be analysed of the nurses who participated in the separately and then combined or process. The third presenter describes whether data should be amalgamated at the development of a bespoke electronic the time of collection. We discuss how nursing record underpinned by the these issues were managed within a principles of practice development PhD project in which focus group data and person-centredness bringing were collected in two countries and in theory into practical action. Setting the two languages. Conclusion: Detailed scene for successful implementation consideration of data collection is of an Electronic Medical Record that required when data is collected in nurses believe captures the essence of different countries and in different their practice. The final presenter will languages. report on the outcomes of a completed References evaluation research study on the electronic record and the outcomes Kidd PS & Parshall MB (2000) Getting for care, the organisation and on the

106 Symposia: Thursday 5 September 2019, 1.45-3.15pm

work-based facilitators who were co- development. created; underpinned by critical social researchers in the programme. Conclusions: This research adds to science theory, practice development the body of knowledge on developing principles and strategic nursing person-centred culture. It offers leadership. This will be presented Paper 1 practical stepping stones for novice and expanded on in the session. and proficient facilitators to enable An empirically designed method of embodiment of the skills necessary facilitation; “Facilitation on the Run”, Using two models of to facilitate learning in organisations. was also tested. This provided nurses workplace facilitation The models offer a workplace friendly with a model and skill set to prepare to create conditions pathway with practical methods and and develop themselves to influence for development of a further contribute to our understanding others and practice across the hospital. person-centred culture: of how we create person-centred Results: The programme resulted in cultures. a progressive move towards a person- A participatory action References centred culture, improved experiences research study of care, enhanced perception of Authors and affiliation: Dr Michele McCormack B, McCance T (2017) flourishing among nurses, decreased Hardiman, Galway Clinic, Ireland Person-Centred Practice in Nursing and the number of complaints, improved Health Care, Theory and Practice. Wiley retention of nurses and attracted Abstract Blackwell, Sussex. higher quality candidates. Data will be Background: Evidence suggests presented in the session. that person-centred cultures depend Titchen A (2000) Professional Craft Discussion: Flourishing requires four on purposeful, facilitated practice Knowledge in Patient-Centred Nursing elements to exist; to feel challenged, based learning activities. For and the Facilitation of its Development. connected, have autonomy and use our person-centredness to become more DPhil Thesis, University of Oxford. valued competencies. This programme meaningful to nursing leaders in their (Lodged in British Library; Department enabled nurses to develop their own daily work, focus must be placed on of Educational Studies, University of flourishing. Facilitation on the Run their acquisition and use of facilitation Oxford and; RCN Library (Steinberg offers methods to create conditions skills. The facilitation framework Collection). where a person-centred, culture can ‘Critical Companionship’ remains an become a reality, consequently the exemplar in the development of expert opportunity for flourishing emerged. facilitation skills. Two sequential Paper 2 facilitation models were developed as Conclusion: Cultural transformation is a slow process requiring intentional ‘steps’ towards Critical Companionship, Facilitating and enabling as a framework for novice and proficient and purposeful action. It is the way of facilitators and practitioners to learn work-based facilitators in a person living, being, doing, enquiring in and from their own workplaces and the midst of practice and becoming, with the ultimate practices. Authors and affiliation: Miss Laura outcome; human flourishing. Aims: To examine facilitation in Taheny, Galway Clinic, Ireland References workplace learning where nurses are Abstract Gaffney M (2011) Flourishing: how to focused on creating person-centred Background: Internationally, achieve a deeper sense of well-being, cultures; to provide a framework for person-centred practice is being meaning and purpose - even when novice and proficient facilitators/ integrated in health care policy to facing adversity. Penguin Ireland, practitioners to learn in and from address concerns which arose as a Dublin. their own workplaces and practices; result of failures in meeting minimum to provide the conditions where Hardiman M, Dewing J (2014) standards of care. The Person-Centred practitioners can gain an understanding Critical Ally and Critical Friends: Practice Framework states that a of the culture and context within their Stepping Stones to Facilitating Practice “Healthful Culture” will emerge as an own workplace Development. International Journal of outcome; which is linked to flourishing. Practice Development, 4(1). Methods: This research, situated Flourishing as an outcome from in a critical social science paradigm, developing person-centred cultures McCormack B, McCance T (2017). drew on participatory action research needs to be better understood. This can Person-Centred Practice in Nursing to devise, explore and refine two be done by learning through practice and Health Care, Theory and Practice. facilitation models: Critical Allies based approaches to research. Wiley Blackwell, Sussex. and Critical Friends. The researcher Aims: adopted an insider approach to work with five nursing leaders, within an • To prepare nurses to be work- acute hospital setting. based facilitators (WBF) of person- centred practice. Results: Show the complexity of enabling facilitation within the • To test a specific method of workplace. Four themes and twelve facilitation; “Facilitation on the sub-themes emerged from the data Run” developed as part of a PhD that describe the attributes needed to research study. facilitate workplace learning and reveal Methods: A programme of systematic that mangers can have an active role practice development activities at in enabling person-centred culture micro, meso and macro levels was

107 Symposia: Thursday 5 September 2019, 1.45-3.15pm

Paper 3 anchor to successful implementation aspects of nursing practice. of an electronic nursing record that • Prepared co-researchers to take nurses report satisfaction in everyday part in a documentary/record of Designing and use. Further studies are currently care analysis against the named implementing an electronic underway on the impact of the record in model of person-centred practice. supporting a person-centred culture. nursing record as part of • Prepared co-researchers to take the integrated hospital References part in observations of practice information system: A American Nurses Association (2010). and staff interviews to see how the practice development Principles for nurse documentation: record of care is used in every day care. approach guidance for registered nurses. Available at: www.nursingworld. • Shared feedback to staff groups Authors and affiliation: Ms Sinead org/~4af4f2/globalassets/docs/ with the Galway Clinic and made Hanley, Galway Clinic, Ireland ana/ethics/principles-of-nursing- recommendations for education Background: The evolution of documentation.pdf (Accessed 24 July and learning. nursing documentation and the move 2019) Results: The indicators of culture to electronic solutions to provide Bøgeskov BO, & Grimshaw-Aagaard SL S showed that most departments accurate and immediate access to all (2018) Essential task or meaningless were ready for the project and were the information needed to provide care burden? Nurses’ perceptions of the responsive to new ideas and practices; is a priority for hospitals and health value of documentation. Nordic Journal suggesting the record of care should care settings throughout the UK and of Nursing Research. have been adopted and absorbed into Ireland. As an eHealth agenda moves practice. The results indicate that the forward, albeit slowly, the needs of Hussey P & Rodger D (2014) Nursing record of care was visible in daily care nurses as the largest contributors of roles and interagency communication practices to varying degrees. This and care processes in an acute hospital demonstrating requirements for the other findings will be discussed, setting can often be far removed from future models of care. Available as well as the co-researchers learning the debate on the implementation of a at: http://doras.dcu.ie/19996/1/ outcomes. HIS. The complexity of nursing practice Final_PARTNERS_Report_170614.pdf can pose challenges to the development (Accessed 24 July 2019) Discussion: This project supported of a record that meets all of the the development of research knowledge professional standards whilst capturing and skills for nurses with a view to the essence of the relationship between Paper 4 building research and evaluation the nurse and his/her patients. Vendors capacity within the nursing team. and suppliers of hospital information Conclusion: It was anticipated that systems who largely cater for the US An evaluation of an the unique record would contribute market are less likely to have an off the electronic nursing record significantly to the knowledge, shelf record available for nurses in UK/ Authors and affiliation: Professor Jan understanding and impact of person- Ireland. Within the context of an acute Dewing, Queen Margaret University, UK centred documentation within hospital with an existing HIS in Ireland, an electronic format for nursing Background: Research by Bøgeskov this paper describes the process of internationally. and Grimshaw Aagaard (2018) found designing and implementing a bespoke that nurses are divided between a References record for nurses that is person-centred positive view of documentation as whilst also maintaining the discrete Bogeskov BO and Grimshaw-Aagaard S something essential, and a negative one content of an electronic record. (2018) Essential task or meaningless of it being a meaningless burden that burden? Nurses’ perceptions Aims: distracts nurses from their ‘real’ work. of the value of documentation. 1. Describe the process of developing The Galway Clinic in Ireland introduced Nordic Journal of Nursing a shared vision, design and an e-record of care in 2017. Research 39 (1) 9-19 https://doi. implementation plan using Practice Aims: To evaluate the nursing org/10.1177/2057158518773906 Development (PD) processes and contribution within the overall record McCormack B and McCance T (2017) methodology. of care. The Person-centred Practice in Nursing 2. Demonstrate the collaborative, 1. To evaluate how the Electronic and Health Care: Theory and Practice. inclusive and participative Nursing Record contributes to Oxford Wiley Blackwell. process leading to successful person-centredness within based implementation of a person- on The Person-centred Framework centred electronic nursing record. (McCormack and McCance 2017) Methods: Using PD methodologies 2. To suggest how the GCCENR can and principles to involve end users and be further developed and any clinical leaders in the development of strategic and education/learning a person-centred and evidenced based implications. record. Methods: Results: Successful implementation • Ascertained the current level and adoption of the electronic record by of person-centredness in the nurses in the hospital. documentation and made Conclusion: Involving the end user observations relevant to other in a meaningful way served as an

108 Symposia: Thursday 5 September 2019, 1.45-3.15pm

Symposium 14 4 will provide a more organisational career. The session will highlight the and strategic perspective. Together different funding routes applied to, the Abstract no: 0496 the papers will highlight different anxieties of sharing and disseminating approaches and opportunities, discuss early attempts at the research, the barriers and facilitators at an individual joy of success and the impact and Planting a range of trees and organisational level, and show potential for learning from rejection and feeding the forest: the impact of research nurse clinical from funding award applications Describing the different academics, with examples from across to publications. The importance of routes to impact of the UK. resilience, wide collaboration, humility and determination will be shared in clinical academic career addition to the immense fulfilment of trajectories in clinical Paper 1 being fortunate to benefit from a range research nursing of funding sources, mentorship and supervision to eventually commence Lead: Professor Mary Wells, Imperial Leaves may fall, but the College Health Care NHS Trust, UK a nationally funded PhD with real tree continues to grow: potential to impact on policy and Symposium Statement The story of developing practice which is now in progress. The drive to support and attract a research career whilst References nurses to undertake research training, delivering and supporting alongside their clinical activity has, thus Sanders J and Mcilfatrick S (2019) Is far, had a relatively limited impact on the research of others 0.1% Acceptable? Council of Deans the numbers of individuals following Authors and affiliation: Ms Linda for Health Available at: https:// a clinical academic pathway. Nurses Tinkler, Newcastle Hospitals NHS councilofdeans.org.uk/2019/01/is-0-1- are the least successful group of health Foundation Trust, UK & University of acceptable/ (Accessed 24 July 2019) professionals outside of medicine in the Sheffield, UK Tinkler L, Smith V, Yiannakou Y, NIHR ICA Programme, and there are Abstract Robinson L (2017) Professional identity many challenges to growing research and the Clinical Research Nurse: A capacity in a context of serious nursing In recent years a considerable increase qualitative study exploring issues shortages. The forest remains sparse has been observed in the visibility of impacting on participant recruitment with limited established evergreens, and the drive to support and enable in research. Journal of Advanced though saplings are beginning to grow. Nurses, Midwives and Allied Health Nursing 74(2):318-328 DOI:https:// Professionals to undertake research, doi.org/10.1111/jan.13409 3. Clinical academic nurses, who remain alongside their clinical role. Despite clinically active whilst developing as the increased awareness and the AUKUH (2016) Transforming health researchers, have the potential introduction of funding schemes such healthcare through clinical academic to contribute significantly to improving as the NIHR ICA pathway, the number roles in nursing, midwifery and patient outcomes and experience, whilst of individuals successfully following a allied health professions. Available advancing nursing practice through clinical academic pathway remain low. at: https://www.medschools.ac.uk/ education, service development and media/2325/aukuh-transforming- innovation. Clinical Academics and Clinically Active healthcare.pdf (Accessed 24 July 2019) Health Researchers have the potential There are a range of routes through the to contribute significantly to improving forest into a clinical academic career, patient outcomes and experience, Paper 2 from clearly defined pathways such as whilst also supporting advancement the NIHR ICA programme to bespoke in practice in their Multiprofessional and individual trajectories, carved out colleagues, through leading education The bigger the roots, by individuals. The role of the Clinical and driving innovation within their stronger the tree: Research Nurse (CRN) is particularly clinical services. suited to clinical academic development Undertaking a PhD due to the research-related training and This session will use the metaphor of alongside a clinical research understanding of the core principles a tree to illustrate the career trajectory nurse role associated with ethical guidelines, of one clinical research nurse who, Authors and affiliation: Ms Anita regulatory expectations, research over a ten year period advanced Immanuel, East Suffolk and North design and successful implementation from supporting and delivering the Essex NHS Foundation Trust, UK of research in clinical environments. research studies of other health care The CRN can be described as a strong professionals, to supporting and leading Abstract the development, ethical, patient sapling with a range of important roots When one looks at a tree, the bigger and public involvement and practical already established at the outset of a the roots are, the stronger the tree is. elements of the studies of medical clinical academic career. There has been a steady increase in clinical fellows undertaking their PhDs/ clinical research nurses pursuing a PhD This symposium will share four MDs, to eventually developing and alongside their research nurse role. This perspectives to demonstrate the leading on her own research. potential for CRNs to transition into session will use a “tree roots analogy” clinical academics. Papers 1 and 2 will The session will describe the challenges to illustrate the advantages and illustrate two contrasting research faced and overcome, the opportunities challenges encountered and overcome, pathways, providing insights into taken and missed, the resources the opportunities available, for a clinical the ups and downs and advantages available and will share the highs and research nurse undertaking a PhD of a CRN background. Papers 3 and lows of carving out a clinical academic alongside her clinical research nurse

109 Symposia: Thursday 5 September 2019, 1.45-3.15pm

role; the roots being the skills developed saplings along the way. As a CRN I the last eight years. There is a UK-wide as a clinical research nurse, which were have worked across numerous clinical aspiration to grow the proportion of instrumental in and formed the basis areas so growing different branches to the nursing and midwifery workforce of embarking on a PhD. This session form an established tree. This growth in clinical academic roles (Carrick- will discuss the dual role of a clinical has provided a range of diverse and Sen et al, 2016) and at present NHS research nurse and nurse researcher exciting opportunities. As a paediatric Lothian has 0.4% engaged in this type and the many doors that opened research nurse my Masters project of activity, which compares to around during the journey. One such example aimed to validate a paediatric blood 5% of the UK medical workforce in was the awarding of a prestigious pressure machine and as a matron substantive clinical academic posts travel fellowship through a rigorous overseeing the research workforce of (Medical Schools Council, 2018). application and interview process. a large teaching hospital my doctorate examined the national CRN workforce A successful orchard is characterised One of the complex skills developed structure. Managing teams and links by the diversity of its fruit trees and as a clinical research nurse was with higher education have enabled each variety has specific features submitting numerous applications me to plant saplings along the way as I which influence cultivation. This for ethics approval. The knowledge have supported research understanding paper will focus on the potential of and experience acquired enabled and clinical academic careers for Clinical Research Nurses (CRNs) who the approval process for the PhD undergraduate and postgraduate currently make up 11% (n=4) of the to be much more seamless. Wider nurses. Recently my career has NHS Lothian ‘crop’, with two others networking with fellow research nurses facilitated the opportunity to sit on working up doctoral proposals and two nationally and internationally enabled national committees so growing new former CRNs in post-doctoral academic collaboration with experts in the field of roots to support further growth. positions influencing practice-based my PhD. The role of a CRN within a new forming research as Honorary Research Consultants. CRNs benefit from their This session presents how an national workforce has afforded grounding in research governance understanding of research methodology, me a unique career trajectory. My and processes, with a thorough ethics, consent, communication, and current leadership role supporting a understanding of the complexities confidentiality, developed as a clinical large research workforce and recent of recruitment, consent and data research nurse, formed a strong appointment as a senior research leader management. This can lead to a strong foundation for my PhD journey. It within the NIHR 70@70 programme growth spurt and firm branches to will also describe the experiences that will provide further opportunities for support the design and conduct of high underpinned my choice to pursue me to facilitate research understanding quality studies. a doctoral programme in cancer and ensure ongoing growth of the survivorship for patients treated for forest. Critical to the success of the NHS haematological malignancies, while References Lothian orchard has been a Master working in the forefront of running of Nursing in Clinical Research Jones HC (2017) Exploring the complex cancer clinical trials. programme (50% theory and 50% experience of Clinical Research Nurses practice placements) that provided the working within acute NHS trusts ideal conditions for newly qualified and determining the most effective Paper 3 ‘sapling’ to grow. The positive career way to structure the workforce: A pathways of the four cohorts (n=17) mixed methods study. PhD Thesis who undertook this programme available at https://kclpure.kcl.ac.uk/ Establishing a tree 2013-2017 demonstrates the potential portal/en/theses/exploring-the- alongside developing this type of focussed post graduate experience-of-clinical-research-nurses- course to provide the right fertiliser saplings working-within-acute-nhs-trusts-and- and supportive stakes for the saplings Authors and affiliation: Dr Helen determining-the-most-effective-way- to blossom and bear the fruit that Jones, Royal Free London, UK to-structure-the-workforce(7334ff35- will become future clinical academic 2c8e-4061-ac92-bbfb15991736).html As a nursing student of the late leaders, founded on excellence in 1980s, research lacked a presence clinical research. and significance in my training. As I References transitioned into the role of a qualified Paper 4 nurse, the forest was empty and Carrick-Sen D, Richardson A, Moore research appeared a sparse, unknown Growing an orchard A & Dolan S (2016). Transforming concept that formed minimal relevance healthcare through clinical academic to a nurse. However, within four years of clinical academics: roles in nursing, midwifery and of qualifying I was appointed to a Harvesting the clinical allied health professions: A practical relatively new role of a clinical research research nurse apples resource for healthcare provider nurse (CRN) within a large London Authors and affiliation: Dr Juliet organisations. Report, The Association teaching hospital. This would form the MacArthur, NHS Lothian, UK of UK University Hospitals, London, setting to plant the tree and set me on a November. research career trajectory. NHS Lothian has been successful in its strategic approach to nurturing clinical Medical Schools Council (2018) Clinical My 25-year career as a CRN has Academia Available at: https://www. run parallel with my development academics and there are currently 34 nurses and midwives at or working medschools.ac.uk/our-work/clinical- as a clinical researcher and enabled academia (Accessed 24 July 2019) me to not only become established towards doctoral level qualifications; a within the forest but also plant other 212% increase in doctoral students in

110 Symposia: Thursday 5 September 2019, 1.45-3.15pm

Symposium 15 organisations across the UK and Methods, Results and Discussion: what may influence the presence of Three aspects of the research Abstract no: 0298 factors; programme will be presented: 4. Challenges of implementing carer 1. An overview of development, How do we ensure family assessment and support via the validation and initial CSNAT intervention in acute care implementation of the CSNAT: a carers are supported during during patient discharge; qualitative study with 75 bereaved end-of-life caregiving? 5. Considerations for implementing carers (01/2008-12/2008) Lessons from a programme assessment and support via the identified the 14 support need of research on carer CSNAT intervention for carers domains that constitute the assessment and support of people with Motor Neurone CSNAT; a survey of 225 current Disease. carers (04/2009-06/2010) Lead: Professor Gunn Grande, BA established CSNAT’s content and Conclusion: Comprehensive, carer-led (Hons) MPhil PhD, Division of Nursing, criterion validity; implementation assessment and support is a substantial Midwifery and Social Work, School studies with 29 practitioners in change from usual practice. To be of Health Sciences, The University of two hospices (08/2010-12/2010; successful, implementation of practice Manchester, UK 01/2011-04/2012) identified use of change requires planning, preparation the CSNAT as a significant change Symposium Statement and involvement of several levels within in practice and the importance Background: Family carers provide an organisation. vital support for patients at end-of-life, of adopting a person-centred shouldering the bulk of caregiving and approach. making care at home possible. Most Paper 1 2. Two cluster randomised control come unprepared for the role, learn trials of the CSNAT intervention through stressful ‘trial and error’, and (UK: n=681 carers; 05/2012- suffer considerable impact on their The Carer Support 11/2014); (Australia: n=322 own health. To better enable carers to Needs Assessment Tool carers; 03/2012-02/2014) showed support patients and look after their (CSNAT) intervention for a reduction in caregiver strain in own health, and ultimately improve comprehensive, person- current carers, and lower early grief and better physical/mental health patient care, we need to ensure centred assessment and their support needs are consistently in bereavement. assessed and addressed. This requires support for family carers: 3. A national implementation study a comprehensive person-centred and Principles and evidence in 36 organisations (11/2013- carer-led approach to ensure that input base 09/2014) and a hospice case study is targeted towards carers’ own support Authors and affiliation: Professor (11/2015-12/2016) provided key needs and priorities. Such an approach Gunn Grande, Division of Nursing, insights into practitioners’ training entails a change in practice and change Midwifery and Social Work, School needs and vital organisational management. of Health Sciences, The University structures/processes needed to Aim: To present core principles of Manchester, UK; Dr Gail Ewing, embed the intervention in practice, and challenges of implementing University of Cambridge, UK; Dr Janet to underpin a CSNAT intervention comprehensive, person-centred carer Diffin, Dr Lynn Austin, The University Training and Implementation assessment and support across care of Manchester, UK Toolkit. settings. Abstract Conclusion: This paper identifies Discussion: This symposium the evidence base for the CSNAT Background: The Carer Support comprises a set of interlinked intervention and its accompanying Needs Assessment Tool (CSNAT) presentations from a programme toolkit to deliver comprehensive, intervention comprises an evidence- of empirical research into person-centred carer assessment and based comprehensive tool incorporated the development, testing and support for family carers. into a person-centred process of implementation of improved support assessment and support for carers of for carers of people with life-limiting people with life-limiting conditions. It Paper 2 illnesses, both within and beyond the was developed from a programme of hospice setting. It will present: research, subsequently implemented 1. The principles and evidence behind across practice settings (community, Ten recommendations an intervention for comprehensive hospital, hospice). The CSNAT’s impact for organisational change carer assessment and support, the nationally and internationally is Carer Support Needs Assessment to enable person-centred substantial: 87 UK services are licensed assessment and support Tool (CSNAT) intervention; to use the intervention, the tool has 2. Factors required at practitioner and been translated into 13 languages, and for carers during end-of- organisation level (both structures is used in 27 countries. life care: A mixed methods and processes) to implement carer Aim: To outline the research to study assessment and support in health develop, validate and implement care practice; Authors and affiliation: Dr Gail Ewing, the CSNAT intervention and its University of Cambridge, UK; Professor 3. The extent to which these accompanying toolkit to support Gunn Grande, Division of Nursing, identified, core implementation training and practice implementation Midwifery and Social Work, School factors are present in hospice within organisations. of Health Sciences, The University of

111 Symposia: Thursday 5 September 2019, 1.45-3.15pm

Manchester, UK • Role models/champions carers. Other recommendations were Abstract • Pathways for communication about reportedly met at a high rate: recording carer assessment/support demographic carer data (95%), Background: Carers play a vital role consistent identification of carers within • Procedures for monitoring/auditing in supporting patients at end-of-life hospices (87%), senior management processes and outcomes of carer (EOL), enabling care at home and support for carers (78%) and assessment/support preventing hospital (re)admission. EOL communication in-house around carers care policy promotes comprehensive Discussion: Achievement of (71%). Approximately half reported person-centred assessment and comprehensive, person-centred carer use of carer champions (56%), carer support for carers, but without a clear assessment and support requires whole- support included in work descriptions implementation strategy this remains systems change; a cultural shift at (55%) and provision of carer support an aspiration. practitioner and organisational levels. training (49%). Less frequently met Aim: To develop recommendations Carers’ fit within service provision also were monitoring and auditing of carer for organisational structures/ urgently needs clarification support (31%), and consistent storage processes required for implementation Conclusions: These 10 of carer-specific data (18%). of comprehensive person-centred recommendations are key building Discussion: Providing well designed assessment and support for carers in blocks to enable policy aspirations and implemented formal assessment EOL practice. about comprehensive carer support to and support services for carers can Methods: be implemented in practice. enhance the experience and capabilities 1. Secondary analysis of existing of this crucial, unpaid workforce within end-of-life care. Most organisations research data on implementation Paper 3 of person-centred carer assessment met recommendations for structures and support in 36 organisations and processes to achieve assessment allowing initial identification of The current provision of and support for carers, although structures/processes that facilitate assessment and support comprehensiveness of provision varied, or hinder implementation. and formal assessment provision for family carers within UK occurred at a low rate. 2. Expert consultation (December 2016): focus groups with 19 lead hospice services: A national Conclusion: Some recommendations practitioners/hospice managers survey are well established in UK hospices, to expand, refine and validate Authors and affiliation: Dr James though particular areas for Stage 1 findings and develop draft Higgerson, Dr Christine Rowland, improvement include the use of recommendations. Professor Gunn Grande, Division person-centred processes specific to carers: formal assessment, action plans, 3. Wider stakeholder consultation of Nursing, Midwifery and Social recording processes and monitoring (January 2017): two professional Work, School of Health Sciences, The systems. workshops (23 participants: University of Manchester, UK: Dr Gail hospice, hospital, community, Ewing, University of Cambridge, UK policy and academics), online Background: In 2018 Hospice Paper 4 survey (62 participants) and two UK published 10 national carer workshops (nine participants) recommendations for organisational to validate draft recommendations change needed to deliver current Exploring the use of the and explore delivery challenges. end-of-life-care policy guidance Carer Support Needs Results: Ten recommendations were for comprehensive, person-centred Assessment Tool (CSNAT) assessment and support for family identified for structures/processes intervention to support necessary to achieve comprehensive, carers. The Hospice UK Organisational person-centred carer assessment and Survey of Carer Assessment and family carers at hospital support that are not normally met by Support (HUK-OSCAS) was conducted discharge at end-of-life to provide a snapshot of where the current EOL care provision: Authors and affiliation: Dr Alex Hall, hospice sector stood in relation to these. • Consistent identification of carers Professor Gunn Grande, Dr Christine within the care setting Aims: To identify the structures and Rowland, Division of Nursing, processes currently in place to achieve • Demographic and contextual Midwifery and Social Work, School assessment and support for carers data on who the carer is and their of Health Sciences, The University of patients receiving end-of-life care situation of Manchester, UK; Dr Gail Ewing, through UK hospice organisations. University of Cambridge, UK • A method/protocol for assessing Methods: All hospices providing carers and responding to Background: Most patients in adult services within Hospice UK’s assessment hospital at end-of-life wish to die at membership (n=200) were eligible home, but family carers often feel • A recording system for carer to participate in a cross-sectional unprepared to support this wish. The information (separate from patient survey between March and June 2018. CSNAT intervention may be able to data) Descriptive statistics were used to prepare carers in this context and • A process for training staff about examine responses. facilitate ongoing support. Carers and carer assessment/support Results: 115 (58%) hospices practitioners have recommended a • Available time/workload capacity responded to the survey. 37% used two-stage process, in which the CSNAT for carer assessment/support a formal carer assessment process; intervention is introduced to carers in • Support from senior managers 13% reported a specific action plan for hospital and followed up post-discharge

112 Symposia: Thursday 5 September 2019, 1.45-3.15pm

in the community. of Health Sciences, The University Symposium 16 Aim: To explore the feasibility of using of Manchester, UK; Dr Gail Ewing, the CSNAT intervention to support University of Cambridge, UK Abstract no: 0353 carers at hospital discharge of patients Background: Motor neurone disease at end-of-life. (MND) is a debilitating condition that Responding to the problem is physically and mentally demanding Methods: Case study exploring of conflict and containment use of the CSNAT intervention in an for carers. There are no current UK English health care organisation (May interventions that can provide MND in emergency departments: - December 2018). Participants were carers with the support they need to Towards and integrated palliative care practitioners in a hospital fulfil their caregiving role and look after model of care their own wellbeing. setting (n=13) and a community Lead: Professor Marie Gerdtz, PhD, setting (n=4). We conducted pre- Aim: To explore carers’ experiences Department of Nursing, University of and post-implementation interviews of supporting a loved one with MND, Melbourne, Australia exploring practitioners’ perceptions to adapt the CSNAT intervention to fit and experiences of using the CSNAT the context of MND care, and to test Symposium Statement Approach. We also observed team implementation of the adapted CSNAT- Background: Interpersonal conflict, meetings and reviewed implementation MND intervention. including aggressive and violent procedures. Methods: Stage 1 (December 2017 behaviour, is a common clinical Results: Prior to using the CSNAT – February 2018): focus groups and problem reported in acute ealth care intervention, practitioners emphasised interviews with 14 bereaved and 19 settings worldwide. This is particularly the potential value of its structure current carers to explore support the case in emergency departments and focus to enhance their practice. needs, key moments during patient where those affected by drugs and Reflections after implementation illness, and support services. Stage 2 alcohol, as well as physical and mental suggested that the CSNAT intervention (May – June 2018): workshops with 24 illness, undergo assessment and had helped practitioners feel more practitioners and 19 carer advisers to treatment. Violent and aggressive confident in assessing carers’ needs adapt the CSNAT intervention. Stage behavior threatens staff and consumer and in supporting carers to lead the 3 (November 2018 – June 2019): safety and has a negative impact identification of their own support implementation of the CSNAT-MND on the therapeutic relationship, in needs. Challenges included finding time in three specialist MND services; which nurses and consumers work in and space in the acute setting to assess interviews with practitioners and carers partnership to restore health and well- carers’ needs prior to discharge, and exploring their experiences. being. Interventions used to manage in developing a recording system for this behaviour may involve the use of Results: Carers have to deal with a restrictive interventions. There are carer assessment information that was devastating diagnosis, a constantly separate from patient data. serious risks associated with restraining changing situation, and receive variable practices. These risks include physical Discussion: The CSNAT intervention support that rarely focuses on their injury and death, re-traumatisation of helped to introduce a cultural shift at own needs. An additional focus on people with a history of trauma, loss of practitioner level by allowing practice to relationships was added into the dignity and psychological harm. become more comprehensive and carer- adapted CSNAT-MND. Carers wanted led. However, the CSNAT intervention practitioners to endorse carer support Aims: To present evidence arising struggled to fit into services that are routinely and consistently in order to from original research studies into the overwhelmingly patient-focussed. legitimise carer needs. Implementation problem of conflict and containment in of the CSNAT-MND should first emergency departments. Our work will Conclusions: The CSNAT consider the nature of the problem and intervention may be feasible for use at introduce the intervention, with a dedicated assessment and planning then present an innovative model of hospital discharge, but structural and care that: procedural constraints within acute conversation at a later stage. care and transition to community can Discussion: Carers of people with 1. identifies at risk populations pose challenges for carer support that MND urgently require routine and 2. limits the use of restrictive require further investigation. consistent support that focuses on their interventions needs, and including the changing 3. considers perspectives of staff and nature of relationships. Implementation consumers Paper 5 of the CSNAT-MND requires the 4. considers approaches to consumer establishment of a clear protocol education, harm minimisation and defined at service level. Adapting and implementing optimizes referral pathways. Conclusions: This project provides the Carer Support Needs Approach: The symposium will begin insights into how carers of people by reporting the outcomes of a multi- Assessment Tool (CSNAT) with MND want to be assessed and centre retrospective study of restraining intervention to support supported, how this process can be practices in five Australian emergency delivered as part of routine practice, carers of people with motor departments. This paper will provide and the feasibility of implementing the neurone disease the clinical and medico-legal context CSNAT-MND in practice. Authors and affiliation: Dr Alex Hall, in which physical and mechanical Dr Sarah Croke, Dr Christine Rowland, restraint occurs within emergency Dr Gunn Grande, Division of Nursing, care settings. An innovative model of Midwifery and Social Work, School care developed in one ED setting will

113 Symposia: Thursday 5 September 2019, 1.45-3.15pm

then be presented. Staff and consumer 95%CI: 58.4-67.1) were restrained Melbourne & Department of Nursing/ perspectives on screening for illicit under a Duty of Care rather than Melbourne School of Health Sciences/ drug use among those presenting with the Mental Health Act. Physical University of Melbourne, Australia; acute behavioural disturbance will be restraint was used for 165 (33.4%, Dr David Kong, Centre for Medicine considered alongside evidence for the 95%CI: 29.3-37.8) patients, 296 were Use and Safety/Monash University implementation of brief interventions mechanically restrained (59.9%, &Pharmacy Department/Ballarat and referral in this vulnerable 95%CI: 55.4-64.3), median restraint Health Services, Australia; Professor population of ED users. The symposium time 180 minutes IQR: 75-360), and Kay Stewart, Centre for Medicine will conclude with a presentation 388 chemically restrained (78.5%, Use and Safety/Monash University, that describes the adaptation of the 95%CI: 74.6-82.0). Approximately half Australia; Professor David Taylor, Safewards model to emergency care the people mechanically restrained Emergency Department/Austin Health, settings. were discharged home or to an ED Australia observation ward, only 81 (16.4%, Abstract 95%CI: 13.3-20.0) were admitted to a Paper 1 mental health ward. Background: Acute behavioural disturbance (ABD) is an increasing Conclusion: Restrictive interventions clinical problem facing health services Restrictive interventions in in the ED are largely occurring under and emergency departments (EDs) emergency departments: An a Duty of Care and only a minority of (Alarcon Manchego et al, 2015). A people will be admitted to a mental Australian perspective behavioural assessment unit (BAU) with health ward. Care for those managed highly resourced six beds, is established Authors and affiliation: Professor under Mental Health Act (2014) which to create a safe and therapeutic Jonathan Knott, Miss Sheriden covers assessment and treatment of environment for patients with ABD Dobson, Emergency Department, The mental illness has a strong clinical (George et al, 2018). Royal Melbourne Hospital, Australia; governance framework and focus on Dr Catherine Daniel, The University minimising restrictive interventions, Aims: To assess the impact of the BAU of Melbourne, Australia; Professor however this not the case for the for patients presenting to the ED with Marie Gerdtz, Department of Nursing, majority of people who are restrained in ABD. University of Melbourne, Australia; Australian EDs. Methods: The impact on the ED length Professor Andis Graudins, Dandenong References of stay (LOS), restrictive intervention Hospital, Emergency Department, rates, time to medical and mental health Australia; Professor Biswadev Mitra, Mental Health Act (2014) Available review was evaluated with a pre-post The Alfred Hospital, Emergency & at: http://www.legislation.vic.gov. intervention study. Face-to-face semi- Trauma Centre, Australia; Professor au/Domino/Web_Notes/LDMS/ structured interviews were conducted Bruce Bartley, Geelong Hospital, PubStatbook.nsf/f932b66241ecf1b7c with adults who had received care in the Emergency Department, Australia; Dr a256e92000e23be/0001F48EE2422 BAU (Yap et al, 2017). The participants Pauline Chapman, Ballarat Hospital, A10CA257CB4001D32FB/$FILE/14- were asked about their experiences of Emergency Department, Australia 026aa%20authorised.pdf (Accessed 24 receiving care in the BAU. All interviews Abstract July 2019) were analysed thematically. Results: In 12 months from 1 April Background: Internationally, a 2016, 2,379 patients were admitted to detailed understanding of restrictive Paper 2 the BAU. They were compared with a practices that are used in emergency similar cohort of 3047 patients from departments is lacking. the 2015 ED population. The BAU Aims: To describe restrictive Behavioural assessment resulted in a decreased ED LOS (180 interventions that occur in five unit: A new model of care min vs 328 min, P < 0.001), a decreased Australian EDs. for patients with complex wait for a medical review (40 min vs Methods: A multicenter retrospective psychosocial needs 68 min, P < 0.001), and a decreased study involving five EDs collated data wait for a mental health review (117 Authors and affiliation: Professor on all people who attended for ED care min vs 139 min, P = 0.001). Patients George Braitberg, Melbourne Health in 2016 including the rate of security in the BAU cohort were less likely to and Centre for Integrated Critical calls for threats to self, patients or staff, have mechanical restraint (6.6% vs Care, University of Melbourne, and any restrictive interventions used. 9.0%, p<0.001) or sedation (6.6% vs Australia; Dr Jonathan Knott, From each site, 100 people who had a 8.2%, P<0.001). Data saturation was Emergency Department/Melbourne restrictive intervention were randomly achieved from 13 participants recruited Health and Centre for Integrated identified and detailed data extracted from May to September 2016. Trusting Critical Care, University of Melbourne, from the medical record. relationships and needs or wants Australia; Professor Marie Gerdtz, following sedation were identified as the Results: In 2016, 327 454 people Department of Nursing| Melbourne main themes. presented to the five EDs; the rate of School of Health Sciences/ Faculty security codes for unarmed threats of Medicine, Dentistry and Health Conclusions: This new model of care was 1.49% (95%CI: 1.45-1.54). Within Sciences, Australia; Ms Susan can improve patient flow through the the population that had a security Harding, Dr Steven Pincus, Ms ED, decrease restrictive interventions code, 942 had at least one restrictive Michelle Thompson, Emergency and establish trusting patient-staff intervention (24.3%, 95%CI: 23.0- Department/Melbourne Health, relationship. This specifically designed 25.7). Details were extracted on 494 Australia; Dr Celene Yap, Centre for unit may be adopted by other EDs to individuals. The majority (62.8%, Integrated Critical Care, University of improve the quality of care for this

114 Symposia: Thursday 5 September 2019, 1.45-3.15pm

complex and challenging group of 1. an observational study of Paper 4 patients. prevalence References 2. focus group interviews with nurses Adapting and implementing Alarcon Manchego P, Knott J, Graudins regarding barriers and enablers to safewards for emergency drug screening A, Bartley B & Mitra B (2015). departments Management of mental health patients 3. a consumer survey regarding public Authors and affiliation: Miss Ashleigh in Victorian emergency departments: acceptability of drug screening. A 10 year follow-up study. Emergency Ryan, Miss Kate Bendall, Peninsula Medicine Australasia, 27, 529-536. The setting was a metropolitan tertiary Health, Emergency Department, referral hospital in Australia. A Australia; Miss Marisol Corrales, Braitberg G, Gerdtz MF, Harding consecutive sample of adults admitted Department of Human Services, S, Pincus S, Thompson TM & Knott to the ED BAU were asked about their Australia; Dr Catherine Daniel, J (2018). Behavioural assessment drug use and underwent point of care Professor Marie Gerdtz, Department of unit improves outcomes for patients saliva (POC) testing for cannabis and Nursing, The University of Melbourne, with complex psychosocial needs. methamphetamines (July-December Australia; Miss Monique Rosenbauer, Emergency Medicine Australasia, 30, 2017). All nurses working at the study Peninsula Health, Emergency 353-358. site were invited to participate in a focus Department & Bendigo Health, Emergency Department, Australia Yap CYL, Knott JC, Kong DCM, Gerdtz group (August to October 2018). A random sample of ED consumers were M, Stewart K & Taylor DM (2017). Safewards is an internationally surveyed regarding the acceptability of Don’t Label Me: A Qualitative Study of recognised model aimed at reducing routine drug screening (March-April Patients’ Perceptions and Experiences of harm from restrictive interventions 2019). Sedation during Behavioral Emergency while promoting safety. The Safewards in the Emergency Department. Results: The prevalence of meth/ model originated in the UK, and Academic Emergency Medicine, 24, amphetamine use was 21. 2% (97/457; following a successful trial was rolled 957-967 95%CI: 17.7-25.2). A total of five focus out to all mental health services in groups involving 30 staff identified the Victoria, Australia. Staff and patients key challenges for nurses in initiating reported increased engagement, safety Paper 3 drug screening were time pressures, and confidence in preventing conflict, perceptions of role legitimacy and lack or reducing its impact. The results also of training. Most of the 270 consumers demonstrated a reduction in the use Screening and brief who were interviewed (81.9%) felt it was of restrictive interventions, which are intervention for drug use in appropriate to be questioned about drug known to cause harm to patients and the emergency department: use and were comfortable answering staff1. The need for a similar change questions related to this during their ED Perspectives of nurses and in Emergency Departments (ED) was visit (86%). highlighted in 2019 implementation of consumers Conclusion: Nurses are ideally Safewards in ED. positioned to carry out drug screening Authors and affiliation: Professor The Safewards ED pilot focuses on and brief interventions for people with Marie Gerdtz, Department of Nursing, improving outcomes and experiences acute behavioral disturbances in the University of Melbourne, Australia; for patients presenting to ED and ED. This approach is acceptable to Dr Celene Yap, Dr Catherine Daniel, staff. The model also aims to address most ED consumers. Nurses require Department of Nursing, University increasing rates of occupational violence training in detection, referral and harm of Melbourne, Australia: Professor in an environment where patients are minimisation strategies. Jonathan Knott, Emergency often acutely unwell on arrival, length Department, The Royal Melbourne References of stay is short, turnover is rapid, and Hospital, Australia time to build rapport is limited. The Rikki J, Cindy W & Kim U (2018). Rates Background: Emergency departments ten ED Safewards interventions have and features of methamphetamine- (EDs) represent a frontline point of been adapted to reflect this unique related presentations to emergency access to health services for people environment. Each intervention is departments: An integrative literature with acute behavioral disturbances designed to reduce “flashpoints”, or review. Journal of Clinical Nursing, 27, and concurrent illicit drug use (Rikki J, situations that may lead to conflict. 2569-2582. 2018). Using an exploratory model, staff and Aims and Objectives: patients in the ED have been challenged 1. To determine the prevalence to look for ways of improving their of illicit substance use for all interactions and enhancing their individuals admitted to the ED environment, using creative and simple Behavioural Assessment Unit measures. (BAU). This paper will outline how a cost 2. To explore perspectives of staff and effective and adaptable model is being consumers regarding routine drug implemented to a new environment, screening and brief interventions with a new patient population. for drug use. The model’s potential impact on Method: A mixed methods study staff culture, de-escalation skills, conducted in three phases: collaboration, and language will also be explored. The 10 interventions and

115 Symposia: Thursday 5 September 2019, 1.45-3.15pm

exploring the impact of Safewards in ED has not been previously reported. This paper will describe the 10 skill-based interventions, challenges, opportunities, and the innovative nature of this intervention in an ED setting. References Fletcher J, Spittal M, Brophy L, Tribble H, Kinner S, Elsom S, and Hamilton B (2017) Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement. International Journal of Mental Health Nursing, 26, pp 461-471.

116 Posters: Tuesday 3 September 2019

Poster tour A workforce allowing the expansion of a As one of the largest teaching hospitals wide portfolio of studies within clinical in the country, Sheffield Teaching Led by Bridie Kent areas. Hospitals NHSFT has an obligation to set the standards in improving Theme: Clinical Academic Careers Results/Conclusions: The role has been implemented successfully and care and putting evidence behind our Poster No: 1 Abstract no: 0458 is still evolving with opportunities practice through research. It is one of the Trusts’ five key objectives to deliver Research Topic: Patient Safety (including to improve practice from incident excellent research, education and human factors, infection, prevention and learning and programmes of audit and control etc) monitoring. Responsive education for innovation. Jessop Wing has developed a research delivery team that currently Methodology: Other collection method staff can be delivered following these includes a Research Lead Consultant, Research Approach: Other approaches findings providing regular and relevant updates and consolidation for our four Research Nurses, three Research research workforce. Midwives, a Clinical Trials Assistant Lead Research Nurse and a Research Co-ordinator to achieve Additionally by providing support in this objective. Specialist (LRNS) role for the clinical areas we have been able Quality Assurance and to coordinate, manage and resolve This delivery team would like to share Education: Ensuring a incidents, provide risk assessments and the methods used to engage with all continual cycle of quality robust plans for undertaking complex levels of NHS staff and our patient/ and ward-based studies. service user population with the and responsive education research process to ensure that research Presenter: Jane Forbes, RN, RM, is part of the core business to our BSc, MRes, University Hospital Poster No: 2 Abstract no: 0385 excellent health care delivery. Southampton NHS Foundation Trust, Topics within our presentation include: UK Research Topic: Research Process Issues Co-presenters: Marie Nelson, UK; Methodology: Other collection method • Inclusion of research to induction Emma Munro, UK Research Approach: Action Research / schedules Participatory Inquiry / Practice Development Abstract • Taking on student placements within the research delivery team Aim/purpose: In Clinical Research it is necessary to establish and maintain Making research core • Representing research at open day quality assurance systems to ensure business: Methods to or recruitment events compliance with regulations and engage NHS staff and • Holding Research Cafes as informal concordats relevant to clinical research participants with research learning events delivery. To supplement this paradigm • Having research updates as Presenter: Tom Almond, , Sheffield we created a role to provide experienced standing items at clinical forums, Teaching Hospitals NHS Foundation and specialised clinical support for MDT meetings, staff huddles and Trust, UK Nurses/AHPs setting up and delivering executive meetings complex and ward-based IMP studies. Co-presenterss: Sheila Duffy, UK; • Advocating the national Research The post will ensure oversight, Clare Pye, UK; Lynne Smart, UK; Champions initiative education and support to clinical areas. Hilary Rosser, UK; Liz Taylor, UK; The role encompasses study audits and Alice Carey, UK; Lynsey Murtagh, UK; • Running a Small Grant Scheme to programmes of internal monitoring Beth Lally, UK stimulate research ideas identifying areas for learning and Abstract • Maintaining an experienced Patient development. and Public Involvement Panel (PPI) The Jessop Wing at Sheffield Teaching Methodology: The LRNS role evolved Hospitals NHSFT is a purpose built unit from recognition of the need for that incorporates all services relating Poster no: 3 Abstract no: 0448 additional and specific clinical support to reproductive health and childbirth Research Topic: Methodology to aid the collaboration and integration including: within clinical areas of research in Methodology: Nominal Group Technique • a maternity service supporting line with our increasing portfolio of approximately 7,000 births per year Research Approach: Other approaches complex studies. The LRNS offers an • a regional neonatal intensive care opportunity to provide expertise and unit providing specialist care for all specialised ‘hands on’ support whilst WhatsApp Doc? The impact premature and unwell term babies also providing development through of using WhatsApp on • a tertiary referral centre responsive education sessions following gynaecology unit comprising developing doctoral student local audit findings. This ensures outpatients/colposcopy, daycare, identity, supporting role equity in standards across all research terminations, emergency areas and early identification and adaptation and personal admissions, early pregnancy resolution of issues leading to improved effectiveness assessment, general gynaecology, participant safety and high quality data Presenter: Sally Bassett, RN. MSc uro-gynaecology and oncology collection. (Lond), MSc (Oxon), Oxford Brookes services University, UK This specialist role provides a visible • an assisted conception unit that Co-presenters: Karen Lascelles, UK and accessible point of expertise as well is one of the most successful fully as an opportunity to share best practice NHS managed centres of its kind in Abstract and learning throughout the research the country Background: The challenges and

117 Posters: Tuesday 3 September 2019

experiences of doctoral students is Poster no: 4 Abstract no: 0176 facilitators and barriers to developing well recognised (Aitchison C and NMAHP research emerging from Research Topic: Workforce and Mowbray S 2013). A WhatsApp group Employment (including health and well thefree text responses and interview that exceeded all expectations of the being roles, research careers) transcripts. cohort was established at the outset Methodology: Mixed Results: The online survey received 37 of a 5-year professional doctorate in Research Approach: Other approaches responses (July-Aug 2017). Facilitators nursing programme. A Nominal Group and barriers to developing NMAHP Technique was used one year into the research in the trust were identified programme to identify the impact of the Developing a local strategy from: WhatsApp Group. to support NMAHP Facilitators: Aims: To examine WhatsApp data and led research in a UK • National/Regional support establish the impact that the WhatsApp district general hospital; group had on the cohort in developing • Examples of success doctoral personal effectiveness. Results from A Florence • Increased funding Methods: The Nominal Group Nightingale Emerging • Senior level organisational support Leader Scholarship project Technique (Delbecq and van de Ven Barriers: 1971, Dobbie et al 2004) was adopted to Presenter: Linda Tinkler, MClinRes • Time collectively review WhatsApp data and (Leadership) BSc (Hons) RN, identify, refine and rank order themes Newcastle upon Tyne Hospitals NHS • Access to available funding through self-facilitated workshops and Foundation Trust, UK • Lack of confidence subsequent electronic communication. Co-authors: Jacqueline McKenna MBE, • Lack of awareness of how to access Analysis was conducted into the UK; James Limb, UK; Clare Westwood, support to progress ideas. WhatsApp activity over time. UK; Sharon Hamilton, UK Conclusion: The findings, which are Results: Seven themes were identified Abstract presented in the poster, were pivotal in from the WhatsApp data with venting Background: In recent years, in informing the development of a local and sharing, humour and academic the UK there has been national and NMAHP research strategy. The work support being ranked as the most local strategic investment to support has also contributed to the visibility of important to the cohort members. Over Nurses, Midwives and Allied Health this agenda in the trust. an 8-month period, WhatsApp activity Professionals (NMAHPs) to undertake ranged from 137 messages in a month research alongside clinical activity. to 618 messages in a month. Peaks of This investment aims to create a Poster No: 5 Abstract no: 0043 activity corresponded with periods of workforce of clinical academics and high academic demand, however not Research Topic: Workforce and clinically active health researchers with Employment (including health and well all periods of high academic demand the research skills and knowledge to being roles, research careers) resulted in an increase in WhatsApp further the evidence base within their Methodology: Other collection method activity. discipline. Research Approach: Evaluation (process, Discussion: The ease of contact impact) associated with WhatsApp appears Influenced by this strategic agenda, to have accelerated the psychosocial scoping work was undertaken in one identity and cohesion of the cohort. UK NHS trust (through a Florence Using the Visible ImpaCT Students agreed that in relation to Nightingale Foundation Emerging Of Research (VICTOR) support, WhatsApp serves a different Leader Scholarship), as a precursor to developing a strategic approach questionnaire to evaluate more important role than the dedicated the benefit of an NHS university online discussion fora. to NMAHP research. The aim was to identify the barriers and facilitators funded fellowship Conclusion: Introduction of experienced by the NMAHP workforce informal WhatsApp groups at the programme for nurses, in undertaking research within their commencement of professional midwives and allied health roles. doctorate study provide a simple mode professionals (NMAHP) of supportive contact, this can impact Methods: Data were collected in one organisation, through an online Presenter: Rachel Taylor PhD MSc the development of cohort identity and DipRes RSCN RGN, University College unity that may accelerate confidence survey shared with all NMAHPs. The survey, adapted from a national survey, London Hospitals NHS Foundation in acquiring personal doctoral Trust, UK effectiveness. Tutors should consider included additional questions to explore encouraging students to establish such the perceived barriers and facilitators Co-authors: Judith Holliday, UK; Jo groups and be aware of the implications to undertaking research in an NMAHP Cooke, UK; Julie Hogg, UK for other formal learning platforms. role. Additionally, four purposively Abstract sampled senior NMAHPs were Introduction: There is increasing interviewed. Interviews were digitally emphasis on developing a NMAHP recorded, transcribed and anonymised. workforce that is research active Graphs and spreadsheets of the (Carrick-Sen et al 2016), with the categorical, numerical and free text provision for clinical academic careers survey responses were produced. Free being provided for by the National text responses(n=24) were analysed via Institute for Health Research (NIHR). thematic analysis alongside interview However, the low number of successful transcripts. This poster presents the

118 Posters: Tuesday 3 September 2019

applicants suggests there are barriers Poster no: 6 Abstract no: 0106 Conclusion: By delivering the in achieving this. The CNMR was programme in the workplace, and Research Topic: Workforce and launched in 2010 to support NMAHPs Employment (including health and well providing mentoring, this novel to develop clinical academic careers. being roles, research careers) programme overcomes many of the Funding bid was received in 2016 to Methodology: Mixed traditional barriers to participating in backfill two days a week, for up to a continuous professional development. Research Approach: Evaluation (process, year, to give NMAHPs time to make impact) We built productive relationships competitive applications to the NIHR. between programme leaders and The aim of this paper is to describe participants to understand the specific how VICTOR was used to evaluate the Research capacity building contextual and organisational needs CNMR fellowship programme. for nurses and allied health of the group. We collaboratively Methods: VICTOR was developed by professionals to enable developed the materials for research awareness activities, engaged a broad the Yorkshire and Humber CLAHRC research evidence-based as a way of measuring the impact of cohort through our masterclasses, and research. It contains 23 items in five practice – a novel, proof-of- encouraged champions to be agents domains, which are responded to concept programme of change for implementing research as yes/no/not yet. Respondents are Presenter: Silvie Cooper, PhD, evidence into practice. asked to provide written detail support University College London, UK the response. VICTOR was designed Co-presenter: Julie Sanders, UK Poster no: 7 Abstract no: 0287 so multiple stakeholders completed Co-author: Nora Pashayan, UK the questionnaire so impact could be Abstract Research Topic: Nursing, Midwifery measured from various perspectives. or Support Worker Education, Service The 2016/17 cohorts (n=6) of Background: Building research Innovation and Improvement fellows were asked to complete the capacity for nurses and allied health Methodology: Other collection method questionnaire. These were analysed professionals could enable successful Research Approach: Other approaches using a framework approach. translation of research into clinical practice, and improve patient care and Results: Key benefits of the fellowship outcomes. Introduction of junior were time, opportunities to develop collaborations, increasing awareness Aims: We report on the development of research nurse fellow to colleagues about research, helping a proof-of-concept coordinated multi- role to integrate clinical to develop a research culture within strategy programme to build research research activity amongst NMAHP, being able to publish and capacity among nurses and health care professionals that surmounts many of front-line research naïve present at conferences. Lack of support staff from line managers and posts not being the usual barriers to engagement. Presenter: Jennie Walker, PhD RN, backfilled were noted to be challenges. Our programme was informed by Nottingham University Hospitals Conclusion: Although some research evidence, and developed in Trust, UK challenges with the fellowship partnership with a UK National Health Co-presenters: Karen Asher, UK programme were identified, all of the Service (NHS) Trust, and delivered to recipients had found it to be a positive nursing and allied health professional Abstract experience and were able to undertake (AHP) staff at the Trust. Programme Background: Despite the fact that a lot of scholarly activity. Although activities included: research is an essential component of VICTOR was not designed to evaluate a. active dissemination of easily evidence-based practice and clinical an activity, the structure proved to be accessible research messages, effectiveness, it is not commonplace for helpful in guiding respondents to think relevant to clinical practice nurses to engage with and undertake through the impact of the fellowship. b. increasing research literacy research within their daily clinical and interpretive skills through practice. Reasons for not engaging in interactive masterclasses clinical research are commonly cited as lack of time, lack of knowledge and lack c. mentoring point-of-care staff to of support (Scala et al 2016). Given the enable translation of research challenges of limited staff and resources evidence into practice. a novel approach was required to These activities were designed empowering front-line nurses to engage collaboratively to raise the profile of in research. research practice among nursing and Approach: A bespoke programme AHP workforces to improve awareness, was devised 0.2WTE over six months engagement and use of research in to provide training and insight in to clinical settings. the clinical research process and the Discussion: Engagement with the role of the research nurse. The aim programme and initial feedback show of the programme was to develop that it is feasible to use this programme the knowledge, skills and research to deliver training to NHS point-of-care networks of research naïve nurses staff in their workplace. The impact of working clinically at a large acute this programme on clinical practice and inner-city hospital Trust. Activities patient care is under evaluation. included GCP training, insight visits, shadowing research teams and working

119 Posters: Tuesday 3 September 2019

towards NIHR research competencies. associated with their engagement in Poster tour B As confidence progressed fellows research. were allocated a portfolio of studies Methods: A single centre mixed Led by Rachel King within their usual clinical setting. This methods study collected data January- Theme; Acute Care and Nursing Care facilitated development of research June 2018 via a survey and 14 audio- skills consistent with their clinical recorded focus group discussions. Poster no: 9 Abstract no: 0469 speciality, and assisted with the All nurses (n=373) working at one Research Topic: Patient Education, dissemination of information to clinical national specialist orthopaedic hospital Patient Experience, Cancer teams regarding forthcoming and in England were invited to particpate. Methodology: Mixed actively recruiting studies in the locality. Qualitative data underwent thematic Research Approach: Action Research / Impact: Three nurses were appointed analysis and descriptive statistics Participatory Inquiry / Practice Development to and completed the initial programme were used to present questionnaire April-October 2018. Two staff extended responses. the opportunity for an additional six- Results: Only 20 (27%) of our Spreading the news months (0.2 WTE) to further advance sample (n=75) reported a desire to about neutropenic sepsis: their research skills. All fellows made be involved in research, and most translating complex ideas progressive advancement with research had never published or presented into patient care competencies across the programme. their work (n=65, 87%; n=46, 61%). Presenter: Rachel Mead, Registered Preliminary evaluations at six months Research priorities focused on 1. Nurse , Sheffield Teaching Hospitals identified an increased awareness of Understanding and improving patient NHS Foundation Trust, UK research studies within the areas where and staff experiences 2. Improving Co-authors: Martina Davies, UK; the fellows were based (40.6%). Wider processes, systems and workload Daniel Wolstenholme, UK; Cheryl organisational evaluation is ongoing to models 3. Interventions to improve Grindell , UK; Remi Bec, UK; Angela M evaluate the effectiveness of the ongoing clinical outcomes. Key themes arising Tod, UK; Clare Warnock, UK commitment from each of the fellows from the focus group discussion data to continue as research ambassadors were research activity, priorities and Abstract within their clinical areas. motivation, culture and leadership, and Background: Neutropenia is a side resources. effect of chemotherapy that leaves Poster no: 8 Abstract no: 0161 Discussion: Although some patients at high risk of life-threatening acknowledged its importance, infection and sepsis. It usually occurs Research Topic: Leadership and particpants did not see research as outside of hospital so patients need Management, Service Innovation and part of the nursing role and struggled to recognise the symptoms early and Improvement, Chronic Illness to identify project ideas. In contrast, contact the cancer centre for advice Methodology: Focus Groups two Scandinavian studies[2,3] report (NICE 2012). A local study identified Research Approach: Mixed Methods increasingly positive attitudes towards that while some patients seek advice Research research by nurses. However, these immediately, others delay (Warnock survey studies do not provide a picture et al 2018). Little research exists to Orthopaedic nurses’ of views and experiences related to explain this variation and how it can be engagement in clinical research engagement within the NHS. addressed. research An exploration Conclusion: There is still significant Aim: To explore variation in advice work required to build research capacity seeking behaviours regarding potential of ideas, facilitators and and capability within the nursing neutropenic infection and co-create challenges workforce. Key to success is developing interventions that support patients to Presenter: Suzanne Bench, PhD, MSc, effective leaders, who create a positive take appropriate action. PGDipHE, RGN, Royal National and supportive research culture across Methods: A three stage study was Orthopaedic Hospital, UK an organisation, to strengthen the carried out between May 2016 and Co-authors: Julie-anne Dowie-Baker, research voice of nursing and drive February 2019 by project partners UK; Paul Fish, UK improvements in future care. from clinical practice, academic Abstract research and co-creative design. Stage one contained semi-structured Background: Clinical nursing staff interviews with 24 patients who had are in an excellent position to identify experienced neutropenic infection. research questions that matter to Stage two involved two staff and patient patients and families, [1] however, workshops to explore interview themes, although previous international identify and prioritise interventions. studies have identified individual Stage three used a series of design, and organisational barriers to nurses’ test and evaluate cycles with patients research utilisation, little data exists and staff to co-create outputs. Novel on nurses’ engagement in research, approaches were utilised to overcome particularly within the orthopaedic challenges to patient participation. speciality. Results: Analysis of the interviews Aims: To explore orthopaedic nurses’ identified barriers and facilitators views regarding the research priorities to patients contacting the centre for neuro-musculoskeletal care and for advice. The workshops used the perceived barriers and facilitators

120 Posters: Tuesday 3 September 2019

this data to create clinically useful of sufficient conditions for a positive theatre emergency prompt-cards, products and tools including pen patient experience. aiming to improve team performance portraits, representations of patient Results: No results indicated NLPSA and non-technical skills. Forty theatre characteristics that can be used to was less safe than other sedation staff (surgeons, anaesthetists, operating tailor interventions. Products, ranging methods for such cases. No deaths, department practitioners (ODPs) and from information cards to service re- reversals of sedation, or need for theatre nurses) from two hospitals design were developed and evaluated anaesthetic support occurred. Cardiac in South East England participated, collaboratively. tamponade occurred in two cases, but undertaking simulated emergency Discussion: The interviews and this was not significant when compared scenarios with and without prompt- workshops provided new insights into to other practices (Fisher Exact Test cards randomised. factors that influenced whether patients 0.0925; insignificant at P<0.05). Aims: The study aimed to assess followed advice. These supported the HCA revealed three clusters describing the impact and perception of development of interventions that patient experience: positive (n=17), using emergency prompt-cards have the potential to be more clinically mostly positive (n=37) and negative during simulated operating theatre effective as they are derived from (n=8). FsQCA constructed an equifinal emergencies on team performance. patient perspectives. model of pathways resulting in a Methods: Validated questionnaire Conclusion: Using mixed methods positive experience. This model assessing self-reported perceptions of research within a clinically focused included combinations of intravenous team-working in simulated scenarios project provided a systematic approach medication (fentanyl, midazolam (Malec, 2007), structured observations, to developing interventions that reflect and paracetamol), patient body mass and 8 multi-professional focus groups the ways in which patients engage with index and age. This model had a high with a total of forty (N=40) theatre staff. information and advice. consistency value (0.858674) but Data-collection 2017. moderate coverage (0.613544). Results: The questionnaire data Conclusion: Moderate solution revealed that the perception of effective Poster no: 10 Abstract no: 0479 coverage indicated that a causal team performance during simulated Research Topic: Pain Management factor had been omitted. Some emergencies was significantly higher sedationists facilitated consistently in the teams using the prompt cards Methodology: Questionnaire positive experiences without their compared to those without. Research Approach: Mixed Methods cases matching the model’s solution Research Focus group participants desired to terms. In the case study phase, their help and work as an effective team practice will be studied, both to explain during emergencies, but some felt Nurse-led procedural their success, and to comment on the unable to speak up due to the hierarchy transferability of the protocol’s results sedation and analgesia within the team. The prompt-cards to other cardiac catheter laboratories. during pulmonary vein appeared to give, in particular nurses isolation and ODPs, the authority to get involved Presenter: Stuart Barker, BA (Hons), Poster no: 11 Abstract no: 0497 during emergencies by assigning clearer RGN, Northumbria University, UK roles and responsibilities, facilitating Research Topic: Acute and critical care assertiveness and confidence. The Abstract Methodology: Mixed prompt cards acted as both an aide- Background: Nurse-led sedation Research Approach: Mixed Methods memoire for verification of knowledge protocols are common, yet cardiac Research and a physical reminder to delegate disease represents a risk factor effectively. (Sneyd, 2013). Subsequently, nurse- Discussion and conclusions: led procedural sedation and analgesia Team performance During this presentation we will (NLPSA) during cardiac ablation is during emergencies in highlight the complex team working rarely practiced or studied (Conway et the operating theatre: A interactions to be considered when al, 2014). Such a protocol has potential simulation-based mixed managing change and introducing benefits in resource management methods study new interventions in operating (Gaitan et al, 2011), and allows theatre culture. The focus groups operators to focus on the case (Furniss Presenter: Carin Magnusson, PhD, provide unique data from a multiple and Sneyd, 2015). However, NLPSA University of Surrey, UK professional perspectives, stimulating must be safe and effective in managing Co-authors: Simon Bettles, UK; Mark a discussion focusing on professional pain and anxiety. Joy, UK hierarchies and ‘speaking up’ in the Method: An NLPSA protocol for Abstract context of patient safety. cardiac ablation was studied, using a Background: Emergencies in survey followed by case studies. The operating theatres (example cardiac survey was completed by 64 patients arrests and massive haemorrhage) undergoing pulmonary vein isolation. are high risk events, requiring Safety was studied using Fisher’s Exact effective teamwork (Arriaga et al, Test to compare rates of complications 2013). Evidence suggests that team to previous studies. Hierarchical performance during emergencies can Cluster Analysis (HCA) and Fuzzy be improved by using prompt-cards Set Qualitative Comparative Analysis (Harrison et al, 2006). We developed (FsQCA) were used to construct a model one of the UK’s first set of operating

121 Posters: Tuesday 3 September 2019

Poster no: 12 Abstract no: 0135 but there is considerable need for more predicted by education (t=2.24, research due to a paucity of existing p=0.03). There was no significant Research Topic: Public Health (including health promotion), Nursing, Midwifery work. relation between HL and learning style or Support Worker Education, Acute and among the participant’s (Chi-Square critical care 3.436, p = 0.48). However, 12.9% of the Poster no: 13 Abstract no: 0101 Methodology: Other collection method participants with inadequate literacy Research Approach: Systematic Review Research Topic: Patient Education preferred multimodal learning style, and other Secondary Research Methodology: Questionnaire about 11.1% preferred bimodal and 19.3% preferred single learning modal. Research Approach: Quantitative (not included in another category) Conclusion and Implications A Scoping Review: The for Practice: Health care providers, case for prioritising especially the nurses should assess the improving orthopaedic Assessing functional health patients’ HL and learning style in order trauma nursing skills in low literacy and learning to tailor their communications and tomiddle income countries style preferences among related health teaching materials. Presenter: Jennifer Klunder, BSc Egyptian inpatients: A (Hons), MPH (Hons), University of cross-sectional study Poster no: 14 Abstract no: 0341 Salford, UK Presenter: Naglaa Youssef, PhD, WITHDRAWN Abstract Medical Surgical Nursing, College of Nursing, Princess Nourah bint Background: Traumatic orthopaedic Abdulrahman, Saudi Arabia injuries are responsible for 5.8 million Co-presenters: Hanan Al Sebaee, deaths every year, with 90% occurring Poster no: 15 Abstract no: 0286 Egypt in Low to Middle Income Countries. Abstract Research Topic: Nursing, Midwifery or Approximately six times as many people Support Worker Education are injured due to trauma than those Background: Over the past few Methodology: Other collection method who die of it, and these injuries are decades, studies of Health Literacy Research Approach: Mixed Methods associated with significant morbidity (HL) and learning style have increased Research and disability. The economic impact for dramatically. However, information individuals and the countries can be about the health literacy and learning devastating, and skilled nursing care is style of Egyptian patients remains Diet and fluids tolerated: required to manage and reduce risks of scarce. content analysis of written injuries such as open fractures. Nursing Purpose: This study aimed to assess descriptions of nursing care is an under-utilised resource in global functional health literacy (FHL) and health, but little research exists into Presenter: Elizabeth Lumley, RGN, learning style preferences among BA (Hons), MSc, The University the availability of skilled orthopaedic Egyptian Inpatients in a University nurses in Low to Middle Income of Sheffield and Sheffield Teaching Hospital and to determine the Hospital NHS Trust, UK Countries, or what training in available relationship between the two concepts. to support development. Co-presenters: Daniel Wolstenholme, Methods: A cross-sectional UK; Clare Warnock, UK Objectives: This scoping review correlational survey was conducted over aims to build upon the scarce body of a period of six months (from August Abstract existing research by critically discussing 2017 to January 2018). A convenience Background: Nursing documentation existing work and identifying key areas sample of 280 (84.84% response should accurately communicate for future research. rate) patients was recruited from 10 information about the patient’s Methodology: A structured literature medical and surgical wards at one of condition, nursing interventions and search was conducted, searching three the biggest university teaching hospitals outcomes (Jeffries et al 2012). Previous databases (Medline, CINHAL and in Cairo city. Four measurements were research identified disconnection SOLAR) with key words and phrases to utilized in this study together with the between what is recorded, and the identify current literature. demographic data sheet: (1) the Short nursing care delivered (De Marinaet Results: 11 papers identified to version of the Test of FHL in Adults al 2010). However, there is a lack of meet the search criteria, but only four (S-TOFHLA), (2) the Rapid Estimate of research offering detailed analysis of the papers specifically on nursing care. Key Adult Literacy in Medicine (REALM), content and quality of nursing entries. themes identified include the need to (3) the CHEW screening of HL and (4) Aim: To evaluate the quality and prioritise nursing education in Low to the Arabic VARK™. content of nursing documentation using Middle Income Countries and upskill Results: The mean age of the content analysis. and utilise the nursing workforce to participants was 40 years (SD 16.81). Methods: 18 sets of anonymised competently provide care to patients The level of HL in the participants was nursing notes were obtained between with traumatic injuries within their low. 57.1% had inadequate/marginal August-September 2016, from two existing capacity. HL level. 15.4% had low reading inpatient wards. Each dataset contained Conclusions: Significant investment ability score. Age (t = 3.76, p = 0.000), seven days of nursing documentation, in orthopaedic nursing is needed in Low education (t = 2.69, p = 0.008) and with a minimum of two entries per to Middle Income Countries to reduce present of co-morbidity (t=2.03, p = 24-hours. Statements were initially morbidity and mortality from traumatic 0.04,) predicted the patients’ REALM-R categorized into themes, including injuries and retain the local workforce, score, while the STOFHLA was only activities of daily living. Each care

122 Posters: Tuesday 3 September 2019

statement was then examined using could be difficult, time-consuming Poster no: 17 Abstract no: 0015 quality criteria identified from the because of the nature of the topic itself Research Topic: Nursing, Midwifery or literature, including evidence of and if the research protocol is not well Support Worker Education SOAPIE (subjective, objective data, designed the participants’ recruitment Methodology: Questionnaire assessment, planning, implementation, could be even more difficult. Research Approach: Survey evaluation) (Groot et al 2018). Aim: To examine the range of Statements were coded red, amber reflections about the methodological or green, dependent on the degree to and ethical considerations the Virtual engagement which they met the criteria, green being investigation of nurses’ experiences of learning opportunities high quality evidence. medication errors entails. pilot: The collaborative Results: A total of 2092 statements, Methodological discussion: A involving 19,622 words were analysed. experiences of student literature review took place to retrieve nurses in the UK and New 38% were rated as red (786), 50% were studies published in English from 1990- rated as amber (1,045) and 12% were 2018 on PUBMED, BNI, CINAHL, Zealand rated green (261). Characteristics of ScienceDirect and Wiley Online Presenter: Hazel Cowls, Registered the statements in each quality category Library. The follow methodological nurse, University of Plymouth, UK were identified. considerations identified: participants’ Co-authors: Kim Young, UK; Michelle Discussion: The findings provide recruitment, data collection, Honey, New Zealand detailed insights into the characteristics data analysis; and the ethical Abstract and quality of nursing documentation. considerations included: phrasing of The high number of entries categorised sentences and words, participants’ Background: It is important for as red contributed little to providing recruitment, location of interviews, student nurses to gain competency to a coherent description of the patient’s type of interviews, management of practice as connected professionals condition or care given. emotionality, management of the and to have a global perspective on health and nursing. However, student Conclusion: Our study revealed reported medication error incidents, qualitative researcher or nursing exchanges are expensive and take time significant variation in the quality of from a busy programme of study. nursing documentation. Identifying professional?. The present piece of characteristics of the statements from work refers only to a specific number Aims: The aim of the study was to each quality category may potentially of considerations; however, the provide the students with a weekly provide the basis for developing an reported key facets can vary among e-learning activity to provide a more approach that communicates care more researchers and communities the study global perspective of nursing and effectively. The next project stage is a is implemented. It reveals points of how health care utilising international consensus study to identify language to manage through every stage of the e-collaboration. and statements that can be used in study, how these can be constructed Methods: Participants were drawn clinical practice, to bridge the gap adequately and improved as the study from a small convenience sample of between care given and care recorded. progresses. undergraduate nursing students from Conclusion: The research about Plymouth University and the University medication errors can be complex of Auckland. For this pilot, nine third Poster no: 16 Abstract no: 0148 at times and might need attention, year nursing students from each site Research Topic: Methodology, Research therefore the development of were sought. However, a total of 15 Process Issues, Ethical and Philisophical researchers’ skills and the identification volunteers were recruited to the study. Issues of methodological needs of the field The student nurses were asked to Methodology: Other collection method are necessary. This discursive paper is participate in audio/video conferencing Research Approach: Systematic Review useful for future qualitative researchers once a week for four weeks. The and other Secondary Research and can be used as a guide to investigate students were placed into three groups nurses’ experiences or parts of it can be with each having three UK students and integrated in similar projects. By facing two NZ students. The researchers were Methodological and as many as possible methodological and interested in the students’ experience of ethical considerations ethical considerations, and establishing working in small collaborative groups in investigating nurses’ solutions for them, the study’s validity, and their experience of e-engagement experiences of medication reliability, rigor are enhanced and the sessions. An anonymised evaluation study is ethically robust. form including ten Likert scale errors statements, plus three open ended Presenter: Efstratios Athanasakis, questions was used to collect the data RN, BSc, MA, Nottingham University using a secure online platform. Ethical Hospitals, UK approval was sought and granted by Abstract both participating Universities’ Ethics Committees for the project. Results: Background: This discursive paper Of the 15 participants 13 responded summarises the methodological and to the survey, giving a response rate ethical considerations that a qualitative of 87%. Qualitative and quantitative researcher would possibly deal with data highlighted that students found when investigate medication errors that this collaborative activity enabled in nursing, and particularly nurses’ them to engage purposefully with other experiences of medication errors. Such nursing students. sensitive and emotive field of research

123 Posters: Tuesday 3 September 2019

Discussion: The process enabled Poster tour C the impact and the response to the students to develop international impact of dyslexia on the individual; connections related to future career Led by Dominic Roche the OSCE as an assessment process; opportunities and employment. A future recommendations for student number of students expressed interest Theme: Education / Learning disability support and preparation for the OSCE in working overseas. Poster no: 18 Abstract no: 0346 examination. Conclusion: It was clear that students Research Topic: Nursing, Midwifery or Implications for Practice: It benefited from the e-engagement. As Support Worker Education offers suggestions on developing the cultural differences were noted, but Methodology: Mixed OSCE as an inclusive assessment similarities were also found. Limitations strategy, promotion of inclusive Research Approach: Mixed Methods included managing time differences Research teaching and learning strategies when using synchronous audio/video within nurse education and changes conferencing. to the theoretical and clinical support Objective Structured currently offered to students with Clinical Examination dyslexia on nursing programmes. (OSCE): Perceptions Conclusion: It is the first study to and experiences of pre- consider the OSCE with regard to nursing students with dyslexia and registration nursing offers an opening for future studies. students with dyslexia Presenter: Tamzin Dawson, DEd, MA Ed, RN(Child), RGN, RNT, London Poster no: 19 Abstract no: 0475 South Bank University, UK Research Topic: Nursing, Midwifery or Abstract Support Worker Education Methodology: Questionnaire Background: Pre-registration nursing programmes are mainly Research Approach: Evaluation (process, an undergraduate degree training impact) in the UK. The Equality Act (2010) directs education towards widening Inequalities and challenges participation, with universities offering to delivering basic and inclusive criteria to extend access to all. Ensuring students meet strict fitness- advanced anatomy to-practice criteria stipulated by the education for nurses: Can professional body, however, creates a we do better? dichotomy between disability legislation Presenter: Siobhan Connolly, MSc, The and professional regulation. Objective University of Edinburgh, UK Structured Clinical Examinations Co-authors: Colin Chandler, UK; Tom (OSCE) are a method of assessment that Gillingwater, UK; Gabrielle Finn, UK requires students to perform clinical assessments and answer questions Abstract within standardised conditions and an Background: The Francis inquiry allotted time. To date few studies have and more recently, the Gosport report, considered the impact of the OSCE on detailed poor care standards and an nursing students with dyslexia. inability to challenge medical decisions Aim: To explore perceptions and that led to sustained patient morbidity experiences of nursing students with and mortality. There is evidence that dyslexia who have undertaken the challenging medical decision-making OSCE as a method of assessment. may, in part, be caused by the widely reported bioscience deficits in nursing Methods: Two-phase mixed methods education. Critics have argued that approach was used. A purposive sample a lack of basic sciences in nursing of 24 nursing students in year 3 of their education compromises safe practice. course, were approached to participate However, the oppositional argument in an online questionnaire, with 12 is that the basic sciences are the remit responding. Six students participated of medicine due to their reductionist further in object elicitation interviews, approach toward clinical care. which were analysed using the ‘Framework Analysis’ method (Richie Aim: To explore collaboration and and Spence, 1994). access to resources between nursing and anatomy faculties. Findings: There were two streams of findings identified. Firstly Method: A Survey was distributed participants as unique individuals to nursing and anatomy departments who experienced both difficulties and throughout the UK. 51% responses success in their learning. In the second rate from nursing schools; 84% from stream there were three themes; medical schools.

124 Posters: Tuesday 3 September 2019

Results: Throughout the UK and emphasises how research can enable the Poster no: 21 Abstract no: 0039 Ireland the data revealed that 80% NHS to transform services and improve Research Topic: Learning/ intellectual of nursing schools had no affiliation patient experiences and outcomes disability with anatomy departments despite (DH, 2014, p.32). This commitment is Methodology: Interviewing 65% of nursing educators believing underpinned by legislation (DH 2012) that collaboration is important. In which places a statutory duty on CCGs Research Approach: Qualitative approaches (eg: discourse analysis, contrast, 85% of anatomists believe to promote research, and the use of ethnography, critical theory, grounded access to resources and collaboration research evidence, to support evidence- theory, phenomenology) is vital for nurses to learn, research based practice and decision-making. and integrate their anatomy into Aims: To explore the process of clinical practice. Despite the desire of developing an e-based critical appraisal The Being Warm Being nursing bioscientists to have a collegial tool to support the application of Happy Project: A partnership with expert scientists, they research evidence to practice for staff participatory research reported that educational leaders, based working as evidence-based practitioners study in social sciences were unsupportive and decision-makers. due to professional tribalism that placed Presenter: Angela M Tod, PhD MSc Method: An R&D support service boundaries on shared knowledge. MMedSci BA RN, University of hosted by a local CCG based in the Others believed that anatomists were Sheffield, UK north of England was approached in closed off to establishing partnerships. Co-authors: Bethany Taylor, UK; relation to improving the integration However, anatomists held a different Daniel Wolstenholme, UK; Melanie of knowledge informed commissioning view, evocatively reporting a medical Chapman, UK; Annie Ferguson, UK; and help to inform commissioning monopoly on teaching hours, facilities Jodie Bradley, UK; Alison Owen, UK; decision-making and the integration and resources that negate the needs Vicky Farnsworth, UK of research into clinical practice. In of all allied health professionals. collaboration with a local HEI, online Abstract Thus, creating educational inequities material was developed to be easily Background: Being cold at home or and marginalisation for pre and post accessible initially to health care being in fuel poverty impairs health and registration student’s ability to access professionals in commissioning, and can kill. Adults with a learning disability anatomical expertise and resources. managers, as an ‘e-learning’ package. are at a greater risk of inequalities and Conclusion: An urgent This was peer reviewed and piloted material deprivation that the general multidisciplinary dialogue to ensure among a small cohort of commissioners population, and are therefore more equal access to scientific expertise and and library-based professionals. likely to be cold at home. The Cold resources in the age of team-based Outcome: The subsequent learning Weather Plan for England expects health care delivery. tool is being considered for national nurses and other health professionals to roll-out by Health Education England act in order to prevent such avoidable, cold related harm. Poster no: 20 Abstract no: 0238 (HEE). Aims: The Being Warm Being Happy Research Topic: Service Innovation and Discussion: The process of collaboration between professional (BWBH) project aimed to understand Improvement, Research Process Issues what influenced adults with a learning Methodology: Other collection method groups and the stages of development are outlined. Barriers and levers disability (AWLD) in their ability to Research Approach: Action Research / experienced during the development keep warm at home, how this impacted Participatory Inquiry / Practice Development and pilot-testing of the Critical upon their health, and what could be APPraisal e-based tool (CAPP) are done to facilitate keeping warm and CAPP in hand: The considered. well at home. collaborative production Conclusion: The process of inter- Method: Participatory methods were professional collaboration and the used to conduct an in-depth interview of the Critical APPraisal study with 10 households with an online training app (CAPP) negotiation of the technical detail requires careful planning and strong AWLD, plus a co-production stage to to support evidence-based levels of communication. On-line translate the household findings into practice and decision- packages allow professional groups to solutions to address the problems making integrate learning with daily practice. identified. All data collection and analysis were conducted collaboratively Presenter: Clare Whitfield, PhD, with researchers who had a learning Faculty of Health Sciences, University disability. The study took place between of Hull, UK December 2017 and August 2018. Co-presenters: Marie Girdham, UK; Results: The findings provide Danielle Hook, UK understanding of the energy needs and Abstract experiences of participants as well as Background: NHS England and their emotions, attitudes and values Clinical Commissioning Groups (CCGs) related to energy. Impacts on physical are committed to supporting research and emotional health are considered. and the use of research evidence in Co-production findings identified the NHS. This is reflected in key policy solutions to improve awareness of documents, such as the NHS Five Year strategies and services to prevent cold Forward View (DH 2014) and the New related harm. The presentation will also NHS 10 Year Plan (DH 2019), which reflect on the participatory nature of the

125 Posters: Tuesday 3 September 2019

study, novel data analysis techniques Method: Research was conducted by months in post. and points to ways in used and associated benefits. a group of student learning disability which adjustment to the role could be Discussion: The study used novel nurses and midwives in November enhanced. participatory approaches to generate 2018. Using a qualitative open-ended Background: This doctoral research is a unique understanding of how AWLD questionnaire, data was collected from unique in that it is a UK study involving can keep warm and well at home. Some 22 participants, recruited via purposive HCAs newly employed in an acute practical solutions were generated, sampling. Thematic analysis was used hospital setting. It resonates with the including messages for nurses caring to analyse the data. current focus on the development of the for AWLD. Findings/Discussion: The key non-registered nursing workforce. Conclusion: The findings engendered finding was that participants described Method: The rationale for a valuable understanding, outputs and confidence not competence. Even more phenomenological hermeneutic methodological developments that will striking was the correlation between approach based on the theoretical make a contribution to future health exposure and confidence levels. Those concepts of Heidegger will be outlined. care practice and research. with a lack of experience showed In depth semi- structured interviews a concerning level of confidence, were conducted at 3-4 weeks and six highlighting a lack of awareness of months into their role. The second Poster no: 22 Abstract no: 0269 the challenges facing women with interviews were conducted in the learning disabilities. Findings suggest Research Topic: Learning/ intellectual Spring of 2016. Interview transcripts disability, Nursing, Midwifery or Support participants who have some learning were analysed for the two time frames Worker Education, Inequalities in Health disability awareness are more aware of and then as a whole using an approach Methodology: Questionnaire challenges and their lack of confidence informed by van Manen (2014). and competence, but don’t know where Research Approach: Qualitative Results: The analysis highlighted to seek support. All participants stated approaches (eg: discourse analysis, the impact of the clinical environment they did not feel sufficiently supported ethnography, critical theory, grounded on the experience of the study by their training and they would like theory, phenomenology) HCAs. Being part of an induction learning disability awareness to be part cohort and classroom learning had of their university studies. Confidence Not limited relevance. Two key themes of Conclusion: This study raises the Competence: Student ‘Belonging to their role’ and ‘Belonging concern that it is increasingly common to their ward’ were identified as midwives’ perceptions of for people with learning disabilities significant. to become parents however, student supporting women with a Discussion: The findings informed the midwives feel ill-equipped and learning disability development of a theoretical framework unsupported to meet this population’s Presenter: Josie Capel, University of for the lived experience of HCAs needs and argues for inclusion of Huddersfield, UK that illustrates how their experience learning disability awareness within Co-presenters: Ann-Marie Holmes, straddles theories of Transition in pre-registration midwifery education. UK; Katie Damer, UK nursing and theories developed Co-authors: Gemma Dawson, UK; through the study of apprenticeship, in Hannah Barnes, UK; Katie Kay, UK Poster no: 23 Abstract no: 0313 particular Newcomer Adjustment and Abstract Legitimate Peripheral Participation Research Topic: Acute and critical care, (Lave and Wenger 1991). The findings Methodology, Workforce and Employment Background: There is increasing point to the significance of the ward prevalence of individuals with learning (including health and well being roles, research careers) as a potential Community of Practice disabilities becoming parents, Castell (Andrew et al 2008). and Kroese (2016) estimated the Methodology: Interviewing Conclusion: The presentation increase to be 40% since the 1990’s. Yet Research Approach: Qualitative provides an opportunity to acknowledge current midwifery curriculum includes approaches (eg: discourse analysis, a workforce with experiences akin to no mandatory learning disability ethnography, critical theory, grounded theory, phenomenology) those seen in traditional apprenticeship training. The literature suggests people roles and consideration of the relevance with learning disabilities do not have of established strategies for novices equal or adequate access to maternity The lived experiences of in nursing. The findings highlight the services. Worryingly expectant mothers health care assistants newly potential to optimise the impact of the who have learning disabilities access clinical workplace. midwifery support a less than the appointed to an acute NHS general public even though they are Trust: The impact of the more likely to require more support ward as an environment for (Castel and Kroese 2016). newcomer development Aims: Presenter: Rosemary Webster, RN BSc • To explore student midwives’ MSc DHSci, University Hospitals of confidence and competence in Leicester, UK supporting women with learning Abstract disabilities within maternity services. Aim: This presentation highlights • To propose inclusion of learning the impact of the clinical workplace disability awareness in midwifery on the lived experience of health care education. assistants (HCAs) in their first six

126 Posters: Tuesday 3 September 2019

Poster tour D sharing was performed in various to measure resilience in nurses. ways, with a combination approach The review considered qualitative, Led by Vari Drennan of different communication channels quantitative and mixed methods, seen as good practice. Lack of time however only quantitative studies met Theme: Workforce and the number of programmes teams the inclusion criteria. Two reviewers Poster no: 24 Abstract no:0379 were required to support were seen assessed methodological quality of the as challenges to the implementation studies. Bias was assessed using the WITHDRAWN and sustainability of link programmes. Cochrane risk of bias tool. Programmes without a clear link to Results: Ten studies were identified clinical practice were harder to support. after screening, including three Poster no: 25 Abstract no: 0088 Discussion: This study builds randomised controlled trials and seven on previous research, increasing quasi-experimental studies conducted Research Topic: Workforce and understanding of the facilitators and across a range of in-hospital specialties. Employment (including health and well barriers to link programme uptake and Eight individual resilience interventions being roles, research careers) success by drawing out key motivational were described comprising a Methodology: Interviewing drivers for engagement. Furthermore, combination of emotional regulation Research Approach: Qualitative it identifies design and implementation training, cognitive skills training, approaches (eg: discourse analysis, factors that impact on effectiveness. mindfulness training and spiritual ethnography, critical theory, grounded practice. Four studies demonstrated theory, phenomenology) Conclusions: Consideration is required when establishing link a significant increase in resilience programmes to ensure that roles align or hardiness, however, evidence for Managers and link with motivational drivers and to limit effectiveness of interventions was practitioners’ views and overburden on clinical teams. limited due to low quality and high risk experiences of link roles of bias. and link programmes Conclusion: This is the first Poster no: 26 Abstract no: 0403 systematic review of interventions to Presenter: Chantelle Moorbey, CRN improve resilience in nurses. A number Research Topic: Workforce and Wessex, UK of strategies were identified, however Co-authors: Jane Prichard, UK Employment (including health and well being roles, research careers) supporting evidence is weak with heterogeneity in terms of defining and Abstract Methodology: Other collection method assessing resilience. With an increasing Background: Link Practitioners Research Approach: Systematic Review focus on staff retention and avoiding (link nurses/AHPs/HCAs) are used and other Secondary Research worldwide, across many specialisms, burnout in the NHS, the importance to cascade good practice, upskill teams of resilience should be high on the and enhance patient care. Although A systematic review of national agenda with interventions some evidence exists showing the resilience interventions for supported by high quality research. potential impact these link roles and qualified nurses programmes can have on improved Presenter: Alice Cubbin, RGN MSc, Poster no: 27 Abstract no: 0094 care, there is little evidence on the Countess of Chester Hospital, UK views and experiences of those Research Topic: Workforce and undertaking the roles and supporting Abstract Employment (including health and well the programmes. Background: Nurses are under being roles, research careers) Methodology: Focus Groups Aims: To explore the views and pressure at work and this is increasing experiences of link practitioners and susceptibility to emotional, physical, Research Approach: Mixed Methods Research their managers regarding link roles and and mental exhaustion. Resilience is the programmes. ability to adapt to adverse conditions while maintaining a sense of purpose, Methods: A qualitative study using Exploration of the balance and wellbeing. Training semi-structured interviews was programs that develop and improve relationship between conducted with a purposive sample of coping mechanisms may be able to workplace stresses and four managers and 10 link practitioners enhance resilience. Nursing staff retention, from an NHS Community Trust during December 2017 to March 2018. The Aim: The aim of this systematic within a hospital emergency participants either managed link review is to synthesize the evidence of department in the UK resilience training for qualified nurses practitioners or had a link role. The Presenter: Angela Harris MSC, and discover if training increases interviews were audio recorded, Sheffield Teaching Hospital, UK transcribed verbatim and analysed resilience. Abstract thematically. Method: A search was conducted Results: Link roles are valued for guided by PRISMA. The review The problem this management project their potential to create expertise and included studies that introduced explored was the relationship between improve care. Motivation to undertake interventions aimed at increasing workplace stresses and staff retention a link role was driven by interest in the resilience and measured the outcome within the setting of a hospital specialism, professional development, pre and post intervention. The study emergency department. The aim was to promote shared learning and to included peer reviewed studies from to explore factors that can influence improve care. The job of information 2000 to 2018 that were published and reduce the stress on individual in English and used a validated tool nurses in the emergency department

127 Posters: Tuesday 3 September 2019

and offer solutions. The type and growing needs of General Practice in the cause of stress were considered UK (and elsewhere). GPNs think their alongside understanding solutions and role is poorly understood and possibly recommendations to reduce stress. undervalued (Ipsos Mori, 2017). Role status is an important marker of The methods included secondary data workforce satisfaction (DeClercq and to establish staffing profile over the last Belaustegiuigoitia, 2017) and warrants three years (2015-2018) and the results further investigation given the cost from a patient safety questionnaire benefits of nurses working in this way which explored links to team safety and (NHS, 2016) stress. Primary data was collected using seven focus groups with nurses based in Aim: To produce subjective evidence the emergency department. of how status perceptions impact GPN job satisfaction, and use the evidence The finding from the data identified to influence workforce policy decision that key themes for nurses leaving making. the emergency department and cause Methods: Data of GPN lived of stress included; staffing shortages, experiences gathered from semi lack of education and development structured interveiws (20) and focus opportunities including career groups (3) transcribed verbatim and progression, leadership support and analysed thematically. peer support. To address these issues some immediate initiatives have been Findings: Role status is important introduced including appointment of an to GPNs and universally defined by education team. Weekly HR meetings comparison to GPs. It is increased have been implemented to manage by undertaking roles like prescribing and support sickness and absence, the medication which are seen as equalling appointment of senior nurses including a doctor and decreased by continuing a nurse consultant and matron within in traditional nurse roles like smear the emergency department this will taking which are seen as assisting the enable a visible leadership presence to doctor. Some younger GPNs are leaving provide support across the ED. because they lack status or a regulated career pathway and pay scale. Many Recommendations have been are frustrated by barriers to gaining implemented to reduce any further a generalist skill set which is highly workforce shortages with a clear focus valued and seen as essential to patient on retention. Wellbeing and emotional satisfaction and holistic care. support and the management of stress Discussion and conclusion: GPNs have also been considered and the intentionally chose nursing and yet can implementation of regular debriefs and only increase their status by gaining psychological support and development medical skills. This is creating a multi- of Schwartz rounds as a result of this tiered nursing system which does not project. foster team working and can impact job satisfaction and possibly retention. There is an urgent need to consider how Poster no: 68 Abstract no: 0318 the GPN role is given the status it needs Research Topic: Workforce and to attract and retain high quality nurses Employment (including health and well and assure a future for primary care being roles, research careers) facing ever increasing demands from Methodology: Interviewing governments and the public. Research Approach: Qualitative approaches (eg: discourse analysis, ethnography, critical theory, grounded theory, phenomenology)

Valuable partner or useful helper? Exploring the role status perceptions of general practice nurses (GPNs) Presenter: Jan Glaze, Ringmead Medical Practice Heath Hill Abstract Background: GPNs are taking on medical roles in order to meet the

128 Posters: Wednesday 4 September 2019

Poster tour E from the general population to be 2. Perceived barriers while providing used to make recommendations for EoLC Led by Lynne Ghasemi treatment decisions in end of life care. 3. Robust support from the team as a Theme: End of life Conclusion: In the study discussed, facilitator while providing EoLC dual realist review generates useful 4. Symptom management Poster no: 28 Abstract no: 0081 outcomes for a difficult to study 5. Future training and support. Research Topic: End of Life Care, population. If supported by further Methodology testing, dual realist review may be Further, eight sub-themes emerged Methodology: Other collection method a useful way to inform treatment within these themes. decisions and direct primary research in Research Approach: Systematic Review Conclusion: Overall, participants and other Secondary Research other hard to study areas. considered providing EoLC as part of their profession and established Poster no: 29 Abstract no: 0300 they were able to provide appropriate Dual realist review as a physical care. However, participants research method to support Research Topic: End of Life Care, Nursing, identified challenges in providing clincial decisions in hard to Midwifery or Support Worker Education, emotional and psychological support Service Innovation and Improvement study areas: Discussion of a to dying patients and their families. Methodology: Interviewing successful study concerning Further training on communication Research Approach: Qualitative and usage of equipment may improve the use of compression approaches (eg: discourse analysis, the standard of EoLC. Research on therapy for symptom ethnography, critical theory, grounded perceived barriers while providing theory, phenomenology) control in lower limb EoLC is recommended. swelling in end-of-life care Experiences of general Presenter: Joanna O’Brien, MSc, St Poster no: 30 Abstract no: 0355 Joseph’s Hospice, UK nurses while caring for end Research Topic: End of Life Care Abstract of life patients in an acute care setting: A qualitative Methodology: Interviewing Background: Realist review has its Research Approach: Evaluation (process, roots in philosophy, social science interview study impact) and evaluation (Pawson et al, 2004) Presenter: Teju Limbu, MSc Clinical and has recently been adopted in Research, City Hospital, Nottingham health care (Rycroft-Malone et al, University Hospital, UK Improving palliative care 2012). Realist review examines the Co-author: Paul Taylor, UK for the homeless context, mechanism and outcome of an Abstract Presenter: Helen Smith, RGN RN intervention (RAMESES project, 2014). (Children) ANP, St Luke’s Hospice, UK Background: The number of deaths This provides a complex understanding Co-presenters: Jo Lenton, UK of how, why and when an intervention occurring in hospitals continues to rise, works. This paper discusses a new many in settings other than specialist Abstract approach, using two parallel realist palliative care, oncology or critical care. Background: Homeless individuals reviews, to generate evidence to support Nurses working outside these specialist have a high prevalence of serious health treatment decisions in areas where environments report end of life care issues and reduced life expectancy; primary research is difficult to carry (EoLC) as a source of stress; we, with the average age of death being out. therefore, aimed to understand these only 47 years for men and 43 years for experiences further. Aims: The study aims to demonstrate women (Crisis 2012). Despite this they the successful use of dual realist Aims and Methods: This semi- experience significant barriers to health review. It uses evidence from the structured interview study aimed to care including palliative care (Elwood- general population to inform treatment investigate the experiences of general Sutton et al 2016). decisions in end of life care patients nurses while caring for end of life Aim: To look at how access to palliative with lower limb swelling. (EoL) patients. Band 5 nurses were care services in the local area could be recruited from two orthopaedic wards Method: Two realist reviews of the improved for homeless individuals with in an acute trust. Open questions were life limiting conditions. literature were conducted in September used to explore general experiences, 2017. Five electronic databases were and further prompts discussed factors Methods: Semi-structured interviews searched; CINAHL, MEDLINE, which enable or hinder delivery of care. were undertaken with individuals who Embase, AMED and Cochrane. The interviews were audio-recorded, work with homeless people daily and Findings were screened using inclusion transcribed and analysed with Nvivo who have had experience of caring for and exclusion criteria, quality assessed software. Thematic analysis was used to individuals who had required palliative and qualitative and quantitative data analyse the data. care. (Nine individuals took part from was extracted. The results allowed a three different homeless organisations) programme theory to be drawn for the Results: Eight participants were recruited; interviews lasted between 22 Results: A thematic analysis of the use of compression to treat oedema interviews was carried out; four key in the general population and for the and 33 minutes. On analysis five themes emerged: themes were identified; the lack of development of oedema in end of life suitable accommodation for homeless care. The two programme theories had 1. Understanding and preference for individuals with palliative care sufficient similarities to allow evidence EoLC needs, lack of knowledge regarding

129 Posters: Wednesday 4 September 2019

current palliative care provision the enhanced symptoms present for University of Glasgow, UK amongst professionals working with patients at the end of life. The findings Co-author: Bridget Johnston, UK the homeless, the need for enhanced are relevant to other end-stage chronic Abstract training and support around palliative diseases. care and advanced care planning and Background: Older prisoners Aims: To determine if the use of represent the fastest growing age group the lack of flexibility and understanding self-management interventions assists of health care professionals. in UK prisons (Sturge, 2018), and are coping for patients with COPD at the twice as likely to develop palliative and Conclusions: The study highlights the end of life. end-of-life care (PEOLC) needs than need for several changes and a different Methods: 25 qualitative studies were someone of the same age and gender approach to supporting individuals who identified for inclusion throughout outside prison (Pazart et al, 2018). are homeless but also have palliative January to May 2018, following the care needs. Several proposed changes Aims: To explore current practice in application of pre-determined inclusion relation to PEOLC in prisons, and to have been identified including the and exclusion criteria. Findings development of palliative care beds make recommendations for its future were developed using a novel meta- provision within a local hostel, training for staff ethnographical approach, creating around advanced care planning and new concepts from the perceptions of Methods: Rapid review methodology early identification of individuals who patients and health care professionals. was employed. ASSIA, CINAHL, may benefit from referral to palliative Embase, MEDLINE, NCJRS and Results: care services and improvements in Scopus were searched for primary education and training to reduce the • Self-management is acceptable to research articles published from 2014- stigma and discrimination often faced patients with COPD at the end of 2018 (Wion & Loeb’s (2016) systematic by homeless individuals. life. review collected data to mid-2014). • Disease acceptance remains Screening was undertaken by a single unaddressed for many patients at author with a verifier. Quality appraisal Poster no: 31 Abstract no: 0484 the end of life. was undertaken by two researchers Research Topic: End of Life Care, • Patients perceive the health care independently. Extracted data was Respiratory, Chronic Illness professional contact within a self- subject to a thematic analysis, and Methodology: Documentary Research management intervention of more presented as a narrative synthesis. PRISMA Guidelines were followed. Research Approach: Systematic Review benefit than the intervention itself. PROSPERO ID: CRD42019118737. and other Secondary Research • Health care professionals find patients with COPD at the end of Results: 411 studies were reduced life complex to manage and have a to 27 by deduplication and screening. A qualitative systematic Most of the 27 studies employed review of the use of self- differing opinion of the preferences for end of life care to the patients qualitative methods (16), and many managemnt as a coping themselves. were from the United States (13). The most prevalent findings were: fostering strategy for patients • The existential needs of patients at with chronic obstructive relationships with people both inside the end of life remain unaddressed and outside of prison is important pulmonary disease at the for those with COPD. to prisoners with PEOLC needs (11 end of life Conclusions: Self-management studies); inmate hospice volunteers Presenter: Louise Bolton, RN/PhD interventions for patients with COPD build and maintain close relationships Student - RCN Strategic Research at the end of life have some potential with the prisoners in their care (seven Alliance - University of Sheffield, to impact upon their ability to cope, studies); and the conflict between care Coventry University, UK however the intervention content and custody can have a negative impact requires exploration. Further work is on the delivery of PEOLC in prison Co-authors: Elizabeth Horton, UK; required to identify the educational (seven studies). Charlotte Bolton, UK needs of health care professionals to Discussion: PEOLC in prison presents Abstract deliver a supported model of self- a number of unique challenges. These Background: Chronic Obstructive management to patients. challenges should be met not only with Pulmonary Disease (COPD) is the novel solutions (such as the inmate fourth leading cause of death worldwide Poster no: 32 Abstract no: 0277 hospice volunteer model), but also (World Health Organisation, 2018). through well-established palliative care Advanced COPD symptoms include Research Topic: Criminal justice/prison practices, such as encouraging visitation severe breathlessness, fatigue, reduced nursing, End of Life Care, Inequalities in and ensuring important relationships mobility, anxiety and depression, Health are maintained. Given the number of resulting in social isolation and Methodology: Mixed recently published studies about PEOLC increased dependence. (Lozarno et Research Approach: Systematic Review in prisons, and the growing number al 2012) A holistic and consistent and other Secondary Research of countries conducting research in approach to palliative care within this area, it may be time for a further COPD remains absent internationally, A rapid review of the systematic review. alongside limited access to palliative

care resources (Elkington, 2005). Self- literature on palliative and management interventions have been end of life care in prisons: successful within earlier stages of COPD 2014-2018 and have potential to impact upon Presenter: Chris McParland MSc, The

130 Posters: Wednesday 4 September 2019

Poster no: 33 Abstract no: 0437 Method: In September 2016, we Japanese older people wish to spend the delivered a launch event to a pilot terminal phase of their illness at home Research Topic: End of Life Care, Nursing, Midwifery or Support Worker Education, cohort of 10 nursing homes; expanding but the actual rate of home death was Methodology in the current programme to 31. 13%, and in hospital was 73% (Ministry Methodology: Mixed Nursing homes agreed to attend 20 of Health, 2018). According to data in sessions of a curriculum decided by the England (2016), death at home was Research Approach: Evaluation (process, impact) participants, based on EOLC priorities, 23% and in hospital was 47%. There are delivered fortnightly via an online small-scale community-based services platform. Initially IT support was (CBS) in Japan, which are available Enhancing Community required. close to home in Japan. CBS can provide end-of-life care (EOLC) within Health Outcomes (Project Each session comprised a brief their facilities or at home ECHO): Developing a lecture and two anonymised case community of practice for presentations from participants with Aim: This study aimed to evaluate the facilitated discussions. Knowledge training program for CBS staff on EOLC nursing homes in End of in Japan. Life Care (EOLC) and self-efficacy surveys were completed pre-programme, midway, Method: A total of 32 staff from CBS Presenter: Lynne Ghasemi, St Luke’s and on completion. Individual session participated in the training program Hospice, UK evaluations were also completed. based on the focus group discussion on Co-presenters: Lynne Ghasemi, Results: Total attendances since EOL topics in Sep.2017 and Sep.2018. UK; Connor Browne, UK; Emma commencement reached 851 A survey was conducted before, after, Westerdale, UK individuals over 50 ECHO sessions, and three months after training to Co-authors: Jane Manson, UK; Laura ranging from 7-43 individual evaluate this program using Kirkpatrick McTague, UK; Sam Kyeremateng, UK; participants per session. In further & Kirkpatrick (2005) Four Levels Clare Gardiner, UK programmes homes became more self- Evaluation Model. Data from focus sufficient with their IT needs. group discussion were categorized Abstract according to the effect of the training. 19 self-efficacies were analysed from Background: Nursing home clinicians Results: The participants obtained programme 2. Self-reported confidence report low confidence in providing end knowledge on EOLC significantly pre to post ECHO programme increased of life care (EOLC) for residents (p<0.001), and they gained confidence across all areas. The largest increase 1. Limited access to training after the training (p=0.096) [Level 2: was symptom management, the and education due to staffing Learning]. After three months, 62.5% smallest was pressure area care. constraints, travel to education of participants answered that they providers and cost compound this. Session evaluations identified became conscious and think of EOLC Deficits in quality end-of-life care participants felt less isolated and [Level 3: Behavior]and the training was for nursing home (NH) residents although daunting at first via a tele- useful [Level 1: Reaction]. Qualitative are well known and low end-of- conferencing platform, they found data indicated facilitated intentional life knowledge scores represent the sessions enjoyable and confidence participation in training [Behavior]; an important target for quality improved. sharing satisfaction and fulfilment improvement. Conclusions: Attendance, recruitment [Reaction]; acquisition of knowledge 2. Project ECHO via tele-mentoring and retention rates indicate ECHO and establishing readiness for EOLC shares best practice, enabling is popular, accessible and supports [Learning]. case-based learning to manage nursing home staff delivering EOLC, Discussion: This program improved complexity by developing resulting in improved self-reported Reaction, Learning and Behavior of communities of practice in health knowledge and confidence. CBS staff, but could not reach Level 4: care settings that may be hard to Results of model. It is required to tailor reach the program to individual needs and Poster no: 34 Abstract no: 0180 3. We piloted and subsequently ran continue providing the program for a three programmes of the ECHO Research Topic: End of Life Care, Primary longer period. model facilitating EOLC education and Community Care, Methodology Conclusion: These results suggest that to nursing home clinicians. Methodology: Mixed the training program with focus group Research Approach: Mixed Methods discussion has effects to promote EOLC Research through CBS in Japan and other similar services in the world. Evaluation of training program on end-of-life care through community-based services (CBS) in Japan Presenter: Chizuru Nagata, RN, Yamaguchi University, Japan Co-authors: Masae Tsutsumi, Japan; Asako Kiyonaga, Japan Abstract Background: More than half of

131 Posters: Wednesday 4 September 2019

Poster no: 35 Abstract no: 0340 the quality of care based on access Poster tour F to the Hospice services 24 hours a Research Topic: End of Life Care day, seven days a week. Focus group Led by Nita Muir Methodology: Focus Groups participants identified how, since they Research Approach: Action Research / had had this service, their confidence in Theme: Cancer and research strategy Participatory Inquiry / Practice Development EOL care had improved, inappropriate Poster no: 36 Abstract no: 0227 admissions were prevented and their Research Topic: Nursing, Midwifery or skill in EOL care had increased (Turner Service evaluation of end- Support Worker Education, Methodology, of-life care arrangements J et al 2019). Cancer of a hospice to care home Methodology: Mixed initiative Research Approach: Mixed Methods Research Presenter: James Turner, HND, RMN, BA (Hons), MA, Dip CAT, PG Dip Ed., RNT, SFHEA, PhD, Sheffield Hallam Nurses’ assessment of University, UK spiritual pain for patients Co-presenters: Joan Healey, UK; Jon with terminal cancer in Painter, UK; Russell Ashmore, UK Japan: Questionnaire Abstract development This project was a partnership based Presenter: Aiko Tanaka, RN, PHD, approach to evaluate the introduction, Yamaguchi University, Japan performance and outcomes of a Hospice Co-presenters: Chizuru Nagata, Japan end of life (EOL) care home pilot. The Co-authors: Miyuki Goto, Japan; care home pilot aimed to work with all Keiichiro Adachi, Japan; Rose care homes in a local catchment area McMaster, Japan; and provide a multi-stepped service to them. The principles were: Abstract • Care home staff will have direct Background: The leading cause of access to Hospice services 24 hours death in Japan is cancer, which account a day, seven days a week. for 27.9% of the total death in 2017 (Ministry of Health, Labor and Welfare, • The Hospice at Home team will 2018). People facing death with support people to stay in their care terminal cancer are said to have total home, bringing appropriate hospice pain including spiritual pain. support to them. Aims: This study aimed to develop a • The Hospice will work with care questionnaire to assess nurses’ clinical home staff to provide education and reasoning for spiritual pain of patients support staff with decision making with terminal cancer in Japan and to which may prevent unnecessary make an effective intervention. hospital admissions. Methods: Phase1: Semi-structured • The hospice will continue to visit interviews were conducted from July responsively day and night to 2016 to March 2017 with 24 nurses support staff and residents with with experience of end-of-life care for palliative care needs during their more than 3 years. Questions included illness. the methods on how they assess and A two-step analysis of Hospice supplied intervene in spiritual pain. The data data and focus group data collected were analyzed qualitatively by using a by Sheffield Hallam University (SHU) modified grounded theory approach researchers was commissioned. Hospice (Kinoshita, 2007). data included patient and care home Phase2: Pilot testing questionnaire activity data, planned and bespoke was conducted from January to March education evaluation data, and calls 2019 with 12 cancer nursing specialists to the advice line. Focus groups from to evaluate the questions in four ranks: staff who had accessed the service were very appropriate (4) to inappropriate undertaken by SHU researchers after (1). The obtained responses were the service had been implemented and analyzed using content validity index data analysed for themes. (CVI) (Lynn, 1986). The evaluation found care home staff Results: received a level of responsiveness 1. A total of 28 question items were that met their needs and were highly extracted after analysis from supportive of the service continuing. interviews and include “making Activity data analysis found significant effort to relieve pain and other cost savings in inappropriate physical symptoms of the patient”, admissions, an uptake and impact on “having information on who the

132 Posters: Wednesday 4 September 2019

patient’s real key person is”, and Aims: This study sought to identify Co-authors: Sonja Kummer, UK; Steve “ knowing what patients value in and explore perceived barriers and Edwards, UK; Julie Hoole, UK; Diana their life”. facilitators to cancer rehabilitation Greenfield, UK 2. Six nursing specialists answered services in South Wales, UK from the Abstract the pilot questionnaire. Based on perspective of health care professionals working within these services. Background: The recent NHS Long the recommended level for the CVI, Term Plan advocates ‘personalised three items were excluded. Methodology: Digitally recorded, care and support’ for people affected Discussion: The excluded three semi-structured face-to-face one- by cancer (NHS England 2019). items were considered to depend on on-one interviews were conducted However, there is limited evidence on the individual patient’s situation and with a purposive sample of health the impact of support interventions. nurse’s sense of value and not essential care professionals (n=20) working in Implementation requires up-skilling for nurses’ clinical reasoning. The two specialist cancer rehabilitation the workforce, including increasing the CVI of the remaining 25 items were services in South Wales between March confidence of professionals to discuss appropriate. and November 2018. Transcribed, patient’s holistic needs, referral to anonymised data were analysed using Conclusions: The study determined support services, offering more holistic Braun and Clarke’s (2006) thematic 25 question items for a questionnaire support. framework. to assess nurses’ clinical reasoning of Aim: We aimed to measure nursing spiritual pain for patients with terminal Results: While the two cancer workforce confidence in the provision cancer. These question items will be rehabilitation services operated of personalised holistic care to people useful to conduct future national survey. differently, common system, personal affected by cancer through the delivery and patient related barriers and of a learning and development facilitators existed. Professional programme. Poster no: 37 Abstract no: 0382 boundaries among certain health care professional groups were highlighted. Methods: 18 learning and Research Topic: Service Innovation and development courses were delivered Improvement, Cancer, Rehabilitation Managerial attitudes were considered vital to enhancing effective cross on five topics, specifically selected to Methodology: Interviewing boundary working. support greater ‘personalised care and Research Approach: Qualitative support’ for people affected by cancer. approaches (eg: discourse analysis, Discussion: Findings from this study 263 delegates, mainly clinical nurse ethnography, critical theory, grounded contribute to a better understanding specialists in cancer care, participated theory, phenomenology) of health care professionals’ perceived between July 2018 and March 2019. barriers and facilitators to cancer Knowledge, skills and confidence were rehabilitation services. Notably, findings self-reported by delegates pre and post Barriers and facilitators highlight an absence of health care to cancer rehabilitation course, using a rating scale from 1 “I professional consensus on the precise don’t feel confident “to 5 “I feel very services in South Wales, meaning of cancer rehabilitation. confident”. UK: perspectives of Conclusion: Being informed of the Results: Self-rated confidence oncology health care barriers and facilitators to cancer was statistically significantly higher professionals. rehabilitation services enables health post-course for all five courses when care providers to know how to improve compared with a pre-course (mean 2.6 Presenter: Tessa Watts, PhD MSc BA these services to ensure that they (Hons) RN (Adult), School of Health vs 4.1, p<0.05): recovery package (2.7 can be used to their full potential. vs 4.22); holistic needs assessment care Sciences, Cardiff University, UK Information on common problems in Co-presenters: Judit Csontos, UK (2.82 and 4.32); cancer and learning cancer rehabilitations services can be difficulties (2.88 vs 4.17); cancer Co-authors: Deborah Fitzsimmons, shared with other health care services UK; Dominic Roche, UK and mental health (2.8 vs 4.18); internationally. motivational interviewing (1.81 to Abstract 3.74): all p<0.05). Background: Cancer and its Poster no: 38 Abstract no: 0368 Discussion and conclusion: treatments can bring about a range Provision and participation in Research Topic: Cancer of physical and psychosocial sequelae learning and development courses, that may affect individuals’ physical Methodology: Statistical Analysis specifically designed to support greater (descriptive and correlational) and psychosocial functioning, work ‘personalised care and support’ for and family life and financial situations. Research Approach: Action Research / people affected by cancer, are shown Categorised as a complex intervention Participatory Inquiry / Practice Development to increase professionals’ confidence by the National Institute for Health and in supporting patients. More work is Care Excellence, cancer rehabilitation Personalised care and required to establish whether this led seeks to optimise individuals’ health, support for people affected to sustainable change in practice with wellbeing and functioning in the resulting improved patient experience. aftermath of cancer and its treatments. by cancer: the impact of Cancer rehabilitation can have a learning and development NHS England 2019 Supporting people positive impact on quality of life (Scott interventions on to live better with and beyond cancer et al 2013). However, for reasons which https://www.england.nhs.uk/cancer/ are not yet fully understood, 30% of professional confidence living/ accessed 05/04/2019 the UK cancer population has unmet Presenter: Richard Metcalfe, rehabilitation needs (National Cancer Macmillan/South Yorkshire Bassetlaw Action Team 2013). & North Derbyshire Cancer Alliance, UK

133 Posters: Wednesday 4 September 2019

Poster no: 39 Abstract no: 0473 Survey results: 29 nurses completed face to face interviews at two children’s the survey (8.7% of NHIVNA tertiary care NHS Trusts was used. Research Topic: Workforce and Employment (including health and well membership). The majority had clinical Investigators whose studies recruit being roles, research careers) roles (79%, n=23). CYP were accessed via the LCRN, R&I departments and internal Trust Methodology: Mixed All respondents supported developing research forums. Recorded interviews Research Approach: Action Research / a research strategy. The majority were transcribed verbatim and the Participatory Inquiry / Practice Development agreed the proposed themes captured Framework Approach used for analysis research priorities. 54% (n=15) were to develop themes and categories. A participatory approach to already involved in research that would sit under these themes. 50% (n=13) Results: Eight participants took developing an HIV nursing expressed a preference for being part from a range of health care research strategy involved in a specific theme. backgrounds. Investigators recognised the value that CYP bring when advising Presenter: Hilary Piercy PhD MA BSc, Discussion: Developing the on their research projects, and PGDip RGN RM, Sheffield Hallam research strategy with full stakeholder respectful attitudes towards partnership University, UK involvement enabled NHIVNA to working were evident. However, CYP’s establish a shared focus around agreed Co-authors: John McLuskey, UK; involvement needs to carefully planned research priorities. The strategy Michelle Croston, UK; Matthew from the initial research concept, and document provides a five year vision Grundy-Bowers, UK support for investigators to fully embed for HIV nursing research including an Abstract PPI into their practice needs to be in operational plan [3]. Background: The HIV nursing place. Conclusion: This initiative represents workforce has a key role in enabling Recommendations: PPI activities an important milestone for HIV nursing HIV services to deliver high quality with CYP should be promoted to NHS in the UK. care in the context of substantial strategic managers and specific CYP PPI financial pressures [1]. A core aim of training resources developed to help the National HIV Nursing Association Poster no: 40 Abstract no: 0508 ensure investigators feel supported. (NHIVNA) is to support evidence- Careful planning for the recruitment of based practice through promotion Research Topic: Public and Patient a diverse range of CYP with a flexible Involvement of high quality research. NHIVNA approach to inclusion is essential. Methodology: Interviewing have adopted a strategic approach Dissemination Strategy: Plans to increasing research activity and Research Approach: Qualitative include presentation of findings at the approaches (eg: discourse analysis, supporting research capacity and INVOLVE conference and publication capability development. ethnography, critical theory, grounded theory, phenomenology) in ‘Patient Education and counselling’ Aim: To develop a National Research as well as via other LCRN, Trust, and Development strategy for HIV University PPI and research events. Nursing. Investigators of studies Social media will also facilitate wider Methods: recruiting children or dissemination. young people (CYP): Conclusions: Participants had a Two stage project involving: Perceptions of CYP’s positive attitude towards CYP informing • A consensus workshop involving a involvement in research as their research projects. Strategies do purposive sample of 14 to outline need to be in place, however, to ensure scope of the strategy and identify advisors. The VOLUNTEER that the impact of CYP’s involvement is research priority areas. Nominal study maximised. Group Technique (NGT) using Presenter: Heather Rostron, RN three rounds of structured activities (Child), BSc (Hons) Nursing Studies to generate qualitative information (Child), MSc Clinical Research Poster no: 41 Abstract no: 0415 and aggregate judgements to Methods, Leeds Teaching Hospitals Research Topic: Public and Patient achieve consensus [2]. NHS Trust, UK Involvement, Acute and critical care • An online survey of NHIVNA Methodology: Other collection method membership to: 1) canvass Abstract Research Approach: Case Study opinions on the outcomes of the Background: Patient and Public workshop, 2) establish individual Involvement (PPI) with children and Establishing a Patient and Public levels of research experience and young people (CYP) is an increasingly Involvement Group for Critical Care Research engagement. recognised practice in health care Presenter: Nicola Rea, MSc, Clinical research, however evidence of the Results: Workshop outcomes: The Research and BSc (Hons) Nursing, attitudes of investigators whose studies nominal question ‘what direction does NHS Lothian, UK HIV nursing research needs to be recruit children and young people Co-author: Corrienne McCulloch, UK moving in?’ generated 60 responses (CYP) towards PPI does not exist. which were organised into 12 broad Aim: The aim of the study was to Abstract categories. Subsequent rounds achieved determine the views and attitudes of Background: Global attention has consensus agreement of three research investigators whose studies recruit CYP, been given to Patient and Public themes: to the emerging practice of involving Involvement (PPI) in research with • Health care delivery. CYP as advisors in their studies. PPI recognised as a pre-requisite • Patient experience. Methods: A qualitative, exploratory for obtaining funding and gaining • Developing a workforce. methodology using semi structured favourable ethical approval (NIHR,

134 Posters: Wednesday 4 September 2019

2018). PPI provides a unique Poster no: 42 Abstract no: 0416 organisations such as the RCN/ perspective on research, using personal NMC Research Topic: Acute and critical care, insights and experiential knowledge Service Innovation and Improvement, • Is involved in numerous trust wide (NIHR, 2018). The expertise of PPI Research Process Issues dissemination of projects and representatives improves the quality Methodology: Other collection method clinical updates of research, through strengthening Research Approach: Action Research / • Members have provided support the research design and enhancing its Participatory Inquiry / Practice Development across the Trust to new researchers relevance (Bench et al, 2017). Methods: A launch event was held This presentation will explain how the in 2018 were patients and researchers A unique approach to Council/Forum was set up and has experienced in PPI presented to supporting evidence-based been nurtured over the years to provide an audience of former intensive practice a unique approach to engaging staff in EBP activities with benefits to the care patients, family members Presenter: Alan Carroll organisation, the membership and the and researchers followed by round Co-authors: Irene Mabbott, Alison ultimately, the care received by patients. table discussions on PPI. Audience Walker, Kay Housely, Joann Barker, members were invited from previous Rachel Mead, Lizzie Lumley, Helen PPI activities within the Edinburgh Baston, Sheffield Teaching Hospitals - Critical Care Research Group (ECCRG) Evidence Based Practice Forum, UK and the ICUsteps Edinburgh (2018), a patient and family support group. In Abstract accordance with the NIHR national Background: Supporting Evidence PPI standards (2018) feedback was Based Practice (EBP) and engaging sought with the aim to measure the frontline clinical staff can be difficult – impact of the event. Feedback revealed specifically in view of competing time increased awareness and understanding constraints. Harnessing, nurturing and of PPI from patients and researchers, sustaining an approach for interested generating a keen interest to establish a staff to come together in EBP activities formal PPI group. has been in progress since 1998 at a Discussion: As a result of this event, large acute NHS hospital Trust. there were organised discussions Aims: The Evidence Based Council between individual researchers and – now the Evidence Based Practice PPI group members, which led to Forum brings together interested staff lay summaries being reviewed and from the Trust and associated academic influencing the design of future studies. institutions to share ongoing work in PPI group members also became their areas, garner advice/support and co-applicants on grants and attended maintain project momentum. It is our Research Ethics Committee review. understanding that this Council/Forum Furthermore, this event facilitated approach is unique in its setup and collaboration with other speciality maintenance over the years. specific PPI leads, through sharing Method: The Council/Forum was set expertise and resource. However, in up to allow staff to become involved in addition to funding; adaptability and a wide range of EBP activities. Initially, investment of time is essential to build this was with a nursing focus but has relationships with group members to developed to be a multidisciplinary make PPI more meaningful (Bench et approach sharing good work but also al, 2017). initiating service evaluation, clinical Implications for practice: audit and research projects. The ‘Reliving’ ICU experiences, managing group meets bi-monthly with various expectations to avoid overburdening subgroup projects running alongside. patients and recognising individual Results/Conclusions: The Evidence motivations presented as challenges Based Practice Forum: during this initial event, requiring • Celebrates its 20th year in research nurses to take on the role of 2018/2019 ‘gatekeeper’ (Bench et al, 2017). • Uses a bottom up approach across the organisation • Has built a reputation for involving clinical and academic staff and getting things done • Has a burgeoning membership including clinically based staff • Has been used as a pioneering consultation mechanism both within the Trust and for external

135 Posters: Wednesday 4 September 2019

Poster tour G the often implicit expressions of unpredictable nature to on call that emotional distress may challenge does not allow for pre-planning and Led by Sue Gasquoine nurses’ attentiveness and the provision on call is getting noticeably busier. of emotional support. Sex, age and Despite the challenges on call this was a Theme: Service Delivery other influencers can risk making the highly valued portion of the transplant Session no: communication less equal and less coordinator role providing autonomy person-centred. The results can be used and valued clinical decision making in a Poster no: 43 Abstract no: 0225 in education: for training in detecting life changing operation. Research Topic: Nursing, Midwifery or and responding to emotional distress Conclusion: In light of the increased Support Worker Education, Older People and providing emotional support. number of donors and potential donors, Methodology: Observation Conclusions: Home care consideration for staffing a resilient Research Approach: Quantitative (not communication contains important transplant coordinator on call rota is of included in another category) person-centred aspects; however, there a priority. The impact that the twenty are challenges in the form of implicit four hour on call rota has on the staff Home care communication: expressions of emotional distress. noticeably extends to family members and relates mainly to sleep deprivation. Moving beyond the surface Increased frequency of on call shifts has Presenter: Jessica Höglander, MSc, Poster no: 44 Abstract no: 0387 the potential for work related stress and RN, Mälardalen University, Sweden Research Topic: Chronic Illness a decrease in job satisfaction. Abstract Methodology: Interviewing Background: The ageing population Research Approach: Qualitative Poster no: 45 Abstract no: 0306 is increasing internationally, and the approaches (eg: discourse analysis, importance to respond to older persons’ ethnography, critical theory, grounded Research Topic: e-Health (including ifnormatics and telehealth) needs has been stressed in order to theory, phenomenology) maintain their health. Many older Methodology: Questionnaire persons wish to stay in their homes, 24 hours on call for Research Approach: Qualitative approaches (eg: discourse analysis, even when health declines and they transplant need home care. For some, home care ethnography, critical theory, grounded theory, phenomenology) represent more than being cared for: Presenter: Melanie Phillips, BSc (hons) the nurses become someone they can Biological Sciences, Dip Health(Adult talk to. Nurse), PhD student, NHS Lothian, UK Frequent callers to Aim: To explore the naturally occurring Abstract telenursing services communication between nursing The number of organ transplants in Presenter: Sofia Skogevall, RN, MSc, staff and older persons during home the UK has risen in the past ten years PhD student , Mälardalen University, care visits, with a focus on emotional and deceased donors have increased Sweden distress and from a person-centred by 95% (NHSBT, 2018). Last year Co-authors: Inger K Holmström, perspective. 1574 deceased donors benefited 5090 Sweden; Jakob Håkansson, Sweden; Methods: This thesis explored the recipients who received an organ Elenor Kaminsky, Sweden communication between nursing staff transplant (NHSBT, 2018). Abstract (n = 31) and older persons (n = 81) in Staff resilience across transplant in 188 audio-recorded home care visits. In this abstract, the first part of the UK has been the recent concern The data were collected from August a project labelled SURF- study for NHS Blood and Transplant and the 2014 to November 2015, and analysed of facilitating registered nurses’ British Transplant Society prompting using the Verona Coding Definitions of (RNs’) work with frequent callers to the Transplant and Sustainability Emotional Sequences [VR-CoDES] and telenursing services, is presented. Resilience Summit to discuss measures the Roter Interaction Analysis System to recruit and to keep existing staff Background: An increased share of [RIAS]. (Armstrong L. & Forsythe J., 2018). health care is supplied over telephone. Results: The older persons often Swedish health care Direct (SHD) expressed emotional distress in the The aim of this ethnographical inquiry receives about 5 million calls yearly. form of hints (cues), and explicit was to determine the impact of twenty Telephone RNs are expected to keep expressions of emotional distress were four hours on call for transplant for calls short and efficient, be accessible uncommon. Most emotional distress a team of renal recipient transplant and maintain patient safety. Some were expressed by older females coordinators (RTC). callers make repeated calls, and are and to female nurses. Nurses often Methods: All of a current on- call labelled frequent callers (FCs). responded by providing space rather RTC rota of five, were asked to provide Aim: The aim of the present study was than reducing it for further disclosure a video diary just after completing a to describe telephone RNs’ views of of older persons’ emotional distress. 24 hr on-call shift. This was then used encountering calls from FCs. Responses that provided space were to inform one to one, recorded, semi Method: The study has a descriptive foremost given to older females and to structured qualitative interviews. design with qualitative approach. The persons aged 65-84 years. Home care Results: Emergent themes from the data consisted of a survey with closed- visits further revealed a high degree of interviews and diaries were sleep and open ended questions to RNs. Data person-centred communication. deprivation had a lasting effect on was collected from Aug 2017 to July Discussion: The communication the participants and those that they 2017. A total of 199 RNs at 10 SHD was mostly person-centred, but shared their life with. There was an sites participated. The open-ended

136 Posters: Wednesday 4 September 2019

questions were analyzed by content reported benefits for care recipients Poster no: 47 Abstract no: 0423 analysis. and providers (Billings, et al, 2018; Research Topic: Primary and Community Results: RNs found it difficult to Drennan, et al, 2018). Led by HZ Care, e-Health (including ifnormatics care for FCs since they perceived that University of Applied Sciences in the and telehealth), Service Innovation and nothing they did changed the FCs’ Netherlands, Transforming Integrated Improvement situation. RNs reported loneliness and Care in the Community (TICC) is Methodology: Mixed mental ill health amongst FCs. RNs an Interreg2seas funded project Research Approach: Other approaches described being afraid of missing urgent focusing on the wider implementation aspects in the call since FCs often called and evaluation of this model across about the same issues. RNs suggests a Europe. Kent Community Health Exploring the role of standardized care plan for FCs. NHS Foundation Trust (KCHFT) is decision support systems sponsoring the UK evaluation, involving Discussion: FCs do not get the for differential diagnosis in collaboration with Medway Community care they need or want and therefore Health care and Kent County Council. out of hours and primary they continue to call. Since the RNs care in Scotland perceives it difficult to care for FCs Aims: To compare Buurtzorg Presenter: Chris McParland, MSc, The and were afraid of missing something (intervention) against standard care University of Glasgow, UK urgent it is of importance to follow up (comparison) from the experience of on their suggestions on how to optimize patients, carers and staff. Co-authors: Mark Cooper, UK; Bridget the care for FCs. Method: Intervention and comparison Johnston, UK; Annabel Farnood, UK Conclusion: The knowledge of RNs’ sites have been selected across the Abstract county of Kent. Care providers are work with FCs and their suggestions Background: Out of hours and gatekeepers to the recruitment of how to manage these tasks contribute primary care services in Scotland are patients/carers. Staff are directly with direction for changes amongst changing. Advanced practice roles recruited by the research team. Data is policy makers and health care now allow nurses and allied health collected from consented participants organizations. It is evident that professionals to provide consultations via completion of questionnaires at telephone RNs need support, guidelines that would traditionally have been specific points over a two year period. and tools to optimize care for FCs. undertaken by a GP. Technology can Questionnaires are available online & support clinicians in these times of hard copy, with support available to change. Differential Diagnosis Decision Poster no: 46 Abstract no: 0122 patients. Patient data is also collected Support Systems (DDDSS) provide from GP surgeries regarding changes Research Topic: Patient Experience, clinicians with a differential diagnosis in care. Focus groups will be conducted Service Innovation and Improvement, based on clinical findings, and are yearly with intervention teams. Workforce and Employment (including available to the public in the form of Quantitative and qualitative methods health and well being roles, research careers) symptom checkers. Methodology: Mixed will be used to analyse the data. 100 participants will be recruited across Aims: To identify the needs of out of Research Approach: Evaluation (process, hours and primary care clinicians and impact) KCHFT sites. the public with regard to DDDSS, and Results: Recruitment and data to assess the strengths and weaknesses collection is continuing (n= 24), and of available systems. Transforming Integrated analysis of preliminary data is being Care in the Community undertaken. New Buurtzorg teams are Methods: A rapid review, a market (TICC): Evaluation of the in the process of set-up and comparison research survey, and qualitative focus implementation of the sites have been identified. groups were conducted between March and July 2018. Buurtzorg model with Discussion & Conclusion: To Results: The focus group results integrated health and social address the challenges of delivering community health care the Buurtzorg are published elsewhere (McParland, care teams model is currently being evaluated. This Cooper & Johnston, 2019). The market Presenter: Daniel Da Costa, DipHigEd project involves collaboration between research activity identified several Nursing Studies (Mental Health), MSc service providers within the county commercially available systems which (Distinction) Interprofessional Health of Kent. KCHFT is sponsoring the UK provided different levels of decision & Social Care, PhD (Pharmacy practice evaluation, demonstrating its growth as support, but only four which provided in stroke), Kent Community Health research active Trust. support for differential diagnosis. These NHS Foundation Trust (KCHFT), UK systems were made by DXplain, Isabel, PEPID and VisualDx. Novel features Co-authors: Lee Tomlinson, UK; such as natural language processing Bethany Baldock, UK (Isabel), offline access (PEPID), vast Abstract image libraries (VisualDx) and tailored Background: Provision of care questions to refine the differential for an ageing population presents a (DXplain) distinguish these tools from significant challenge. The Buurtzorg one another. The rapid review found model involves self-managing, mixed- 15 primary research articles concerned skilled teams (including nurses) with commercially available DDDSS. working at a neighbourhood level with Isabel was associated with the highest responsibility for all aspects of service rate of accurate diagnosis retrieval delivery. Previous evaluations have (Riches et al, 2016), and also appeared

137 Posters: Wednesday 4 September 2019

most frequently in the research. Several Poster tour H partnering organisations. Data were studies looked at DXplain, one included analysed thematically. PEPID, and one VisualDx. Led by Russell Ashmore Results: Eight themes were identified Discussion: There are a small number Theme: Mental Health across the staff data; five themes of systems commercially available were identified from the service user which can be classed as a DDDSS. The Poster no: 48 Abstract no: 0396 experience data. Findings showed majority of research focuses on one Research Topic: Children and Young that while some staff and service users system, and mostly in experimental WITHDRAWN recognised the benefits of thorough settings. Research is required to explore preparation for such radical change, how all of these DDDSS work in clinical many staff reported receiving mixed practice and how they can help nurses. messages about how they should act, Poster no: 49 Abstract no: 0376 especially when enforcing the new Research Topic: Public Health (including policy. Where there was a culture of health promotion), Mental health consistent support from senior staff, Methodology: Interviewing prioritisation and clear communication, becoming smokefree on-site was more Research Approach: Evaluation (process, impact) likely to be normalised. Conclusion: The opportunity exists to advocate for change to smoking Supporting mental health behaviour in mental health trusts. service users to stop However, even when change is initiated smoking: Findings from a by national guidance, challenges remain process evaluation of the when embedding new ways of behaving. implementation of nicotine management policies into Poster no: 50 Abstract no: 0169 two mental health trusts Research Topic: Cardiovascular Disease Presenter: Susan Jones, RGN BSc MSc, and Stroke, Patient Experience Teesside University, UK Methodology: Interviewing Co-authors: Sharon Hamilton, UK; Research Approach: Qualitative Stephanie Mulrine, UK; Heather approaches (eg: discourse analysis, Clements, UK ethnography, critical theory, grounded theory, phenomenology) Abstract Background: People with mental health issues are known to die Differing approaches to disproportionately earlier than the future health status in general population due, in part, to response to chest pain higher smoking rates (DHSC, 2017; Presenter: Amy Ferry, BSc (Hons), Williams et al, 2015). In response, The University of Edinburgh, UK guidance on smoking reduction was Co-authors: Fiona Strachan, UK; produced by the National Institute for Sarah Cunningham-Burley, UK; Health and Care Excellence (2013). This Nicholas Mills, UK paper reports the process evaluation undertaken in two UK mental health Abstract NHS Trusts, following the implemented Background: An interview study of nicotine management policies exploring how implementation of an developed in response to this guidance. early rule-out pathway for myocardial Aim: To explore the implementation infarction may shape patient experience process and identify opportunities and of chest pain revealed how an acute challenges to normalising the changes. chest pain presentation may provide an opportunity for patients to consider Methods: A qualitative process their future health and risk of heart evaluation of attitudes towards nicotine disease. management policies and experiences of implementation took place. Data Methods: Participants were recruited were collected between November before (n=23) and after (n=26) 2016-April 2017, using semi-structured implementation of an early rule-out interviews with a purposive sample of pathway. Purposive sampling ensured staff (n=51), members of partnering representation across age and sex organisations (n=5), service users categories. Face to face, semi-structured (n=5) and carers (n=2). Data from interviews provided the basis for an service users and carers were analysed interpretive thematic analysis of data. together; as was data from staff and

138 Posters: Wednesday 4 September 2019

Findings: Analysis revealed three treatments offered and their uptake. possible perspectives by which Aspects of service delivery: considers Poster no: 51 Abstract no: 0276 participants may relate to their future the wider context in which treatment health status: Research Topic: Older People, Service decisions are made and its influence Innovation and Improvement, Cancer 1. continuing good health was taken upon decision making among clinicians for granted,therefore did not have Methodology: Interviewing and older service users. particular salience in their everyday Research Approach: Qualitative Discussion: Our study revealed that lives approaches (eg: discourse analysis, perceptions of frailty often influenced ethnography, critical theory, grounded treatment decisions made by and for 2. the way in which participants theory, phenomenology) reacted to the chest pain episode older people with lung cancer. However, varied in accordance with their diverse factors were also important, position in the adult life course The influence of including how patients perceive and their current health status. perceptions of frailty on themselves in relation to dimensions Some of these participants used treatment decision making of frailty and the perspectives of health care staff on the clinical utility of the chest pain presentation, and in older people with lung therefore the recognition of a assessment tools. physical manifestation of ill health, cancer: A qualitative study Conclusion: This study identified as a trigger to appraise health Presenter: Julie Skilbeck, RN; PhD, diverse factors which may influence behaviours Sheffield Hallam University, UK the acceptability and adoption of frailty 3. current health status appeared to Co-authors: Clare Warnock, UK; Janet assessment in practice. have dominance over the acute Ulman, UK; Nancy Ali, UK; Angela M chest pain episode, leading to Tod, UK Poster no: 52 Abstract no: 0229 discourses of fatalism and certainty Abstract of future ill health. Participants Background: Currently there is Research Topic: Public Health (including health promotion) assessed using the early rule-out little research exploring the influence pathway appeared to have a lesser of perceptions of frailty on patients’ Methodology: Other collection method orientation to use the episode of or clinicians’ decisions regarding Research Approach: Systematic Review chest pain as a cue to action to treatment for older people with lung and other Secondary Research appraise their future health status. cancer. Existing research has identified This suggests orientation towards that age is associated with variation in Factors influencing patient health goals may be modified by the treatment and access to clinical trials. delay among pulmonary clinical assessment process. Multiple factors have also been found Conclusions: Consideration of future to influence treatment decision making tuberculosis patients: A health goals appears to be a reactive among older people, including the systematic literature review rather than a proactive process. A oncologist’s recommendations (Puts et Presenter: Kampanart Chaychoowong, clinical consultation may be oriented to al2015). Frailty assessment tools have BPH MPH PGDip in research training, provide a teachable moment to increase been developed that have the potential PhD student, Faculty of Health perception of personal risk to future ill to support treatment decision making Sciences, University of Hull, UK health. This may have implications for (Clegg et al 2016) but their applicability Co-authors: Roger Watson, UK; David how the public may act to information to older people with lung cancer has not I Barrett, UK given in screening programs for been explored. Abstract cardiovascular disease. Aims: To explore the perspectives of Aim: To explore factors which may older people and health care staff on influence pulmonary TB patients the influence of frailty on treatment delaying initial TB presentation and decision making in lung cancer. treatment. Methods: A prospective qualitative Search strategy: An integrative exploratory study was undertaken. review. The following key words were Between September 2018 and April used, tuberculosis, delay, factor, and 2019 semi-structured interviews were interval. Databases searched were conducted with older patients with lung CINAHL, Academic Search Premier, cancer (n=10); and a range of health and Medline in between 2000 – 2018. care professionals (n=12) including PRISMA Flow Diagram was then used respiratory physicians, clinical nurse to help improving the reporting of specialists and oncologists. The data systematic review. were audio-recorded, transcribed verbatim and analysed using Methods: Papers were critically Framework Analysis. appraised using the CASP critical appraisal tools for cohort, case-control, Results: Three themes were identified. systematic reviews, and qualitative Perceptions of frailty: illustrates studies while the questionnaire how participants viewed frailty and recommended by Greenhalgh (2014) its relevance to their treatment. was used for cross-sectional studies, Decision making conversations: details and the Mixed Method Appraisal Tool the diverse factors that influence was used for mixed methods studies.

139 Posters: Wednesday 4 September 2019

Results: A total 213 studies (11 Aims: To systematically identify and qualitative studies, 194 quantitative synthesize literature on the support studies, and 2 mixed methods studies) needs of COPD carers and map them was reviewed. Twenty-five influential to the CSNAT items to explore its factors emerged. These were; gender, comprehensiveness for COPD carers. age, education, occupation, income, Methods: English language studies history of being prisoner, alcohol use, published between 1997-2017 were cigarette use, drug use, TB knowledge, identified against predetermined TB recognition , TB stigmatisation, inclusion/exclusion criteria through number of family members, social searches of MEDLINE, CINAHL, support, chronic disease, symptom type, EMBASE, CDSR, ASSIA, PsycINFO self-treatment, type of the first health and Scopus. Further studies were care facility, reason for consultation, identified through searching reference number of visits, travelling distance, lists and citations of included papers. travelling time, mode of transportation, Papers were critically appraised, and health insurance, and expenses for data extracted and synthesised by treatment. two reviewers. Identified needs were Conclusions: The literature review mapped to CSNAT items. pointed out the essentials for further Results: 24 studies were included. study of how these factors may Results suggest that carers have support influence patients in delaying in needs in a range of domains including treatment. Health policymakers and physical, social, psychological and health providers should consider these spiritual. Many of these needs are findings when developing policies unmet. Particular areas of concern to improve health service system relate to: prolonged social isolation, especially TB screening system. accessing services, emotional support and information needs. Findings also suggest additional CSNAT items may Poster no: 53 Abstract no: 0404 be required in order to encompass Research Topic: Respiratory the full range of needs of this group, Methodology: Other collection method particularly relating to difficulties Research Approach: Systematic Review within patient-carer relationships and and other Secondary Research carer-clinician relationships. Discussion: The literature indicates Support needs of informal that COPD carers would benefit from identification and response to their carers of patients with support needs by clinicians. The CSNAT COPD and implications for may be a means to achieve this but it improving carer support requires additional items in order to be Presenter: Morag Farquhar, PhD MSc comprehensive for COPD carers. BSc (Hons) RGN PGCert, University of Conclusion: The CSNAT requires East Anglia (UEA), UK additional items. Future planned work Co-presenter: Kerry Micklewright, UK will develop these items with COPD Abstract carers. Background: Informal carers play a key supportive role for patients with Chronic Obstructive Pulmonary Disease (COPD). The care they provide also plays a vital role in relieving pressure on health and social services. However, caring can have a considerable impact on health and wellbeing and carers may have unidentified support needs of their own. The Carer Support Needs Assessment Tool (CSNAT) may be a means to identify these but it was developed predominantly with carers supporting cancer patients at the end of life.

140 Posters: Thursday 5 September 2019

Poster Tour I country. Identifying the factors that dialogic/performance narrative analysis affect the job satisfaction of migrant (Riessman 2008) and NVivo software. Led by: Rachel McIlory nurses can help employers, recruiters Results: Each participant produced and policymakers to further develop Theme: Workforce diversity their own individual narrative of health services to be more culturally experience as a BME academic, but Poster no: 55 Abstract no: 0119 competent; this can assist in retention there are also commonalities across of internationally recruited nurses Research Topic: Workforce and the stories. Although each story told of working in the UK. Employment (including health and well ‘multiple oppressions’ that shaped their being roles, research careers) journey, the most significant appears to be their struggle to overcome racial Methodology: Statistical Analysis Poster no: 56 Abstract no: 0224 (descriptive and correlational) discrimination and how this has shaped Research Topic: Translational Research Research Approach: Survey their career trajectory, personal and (including black and minority ethnic) professional lives and the significant Methodology: Interviewing impact it has had on their experience Job satisfaction of Filipino Research Approach: Qualitative within higher education. nurses working in the UK approaches (eg: discourse analysis, Conclusions: By providing an Presenter: Anna Reyes, MSc BSc RN, ethnography, critical theory, grounded insight into the experiences of BME theory, phenomenology) University College London Hospitals nurse educators it is hoped that NHS Foundation Trust, UK BME academics will be empowered Co-author: Alison Coutts, UK An exploration of the to challenge and change current Abstract experience of BME health HEI institutional policies and act as educators in UK higher successful role models for BME nursing Background: The UK has been students. relying on the international recruitment education institutions of overseas nurses to alleviate its (HEIs) shortages (RCN, 2015). Filipino nurses Poster no: 57 Abstract no: 0395 Presenter: Donna Scholefield, MSc, constitute a significant proportion of BSc (Hons), RN, PGDip HE, Middlesex Research Topic: Translational Research migrant nurses in the UK, and yet little University, UK (including black and minority ethnic) is known about their perception of job Methodology: Interviewing satisfaction. Abstract Research Approach: Qualitative Background: Studies have Aim:The aim of this study was to approaches (eg: discourse analysis, explore the factors associated with demonstrated unequivocally that many ethnography, critical theory, grounded the job satisfaction of Filipino nurses Black Minority Ethnic (BME) academics theory, phenomenology) working in the UK. experience discrimination within HEIs resulting in marginalisation, Methods: A cross-sectional online The lived experience and paper-based survey using the damaged self-esteem and stunted employee satisfaction questionnaire career progression (Bhopal 2014). of Nigerian nurses on extracted from the Qualtrics library These experiences are widespread as integrating into British was conducted across the UK. A parallels can also be found in other nursing: Implications for international HEIs. There are few convenience sample of Filipino nurses the health care workforce (N= 69) completed the survey. Data studies focussing on the BME nurse Presenter: Iyore Monday Ugiagbe, were analyzed using Spearman’s rho academic experiences, but the existence MSc, MEd, PGDip, RN, FHEA, correlation and regression analysis. of discrimination within this group has implications for BME student Middlesex University, UK Results: The results showed that nurses’ learning, aspirations and career Abstract the majority of Filipino nurses progression. were satisfied with their job (71 %). Background: In 2018, there were Demographic variables such as age, Aims: This study aims to gain an 88,631 (43.9%) BME staff in London years of working, band level and work insight into BME nurse academic’s NHS trusts and overseas trained nurses department did not have any significant experiences of discrimination, to form 21.3% of BME nurses in the effect on their level of job satisfaction. determine the impact on progression NHS (WRES,2019). However, there However, team relationship and and development and also the coping is institutional racism (Archibong & practice environment were the strategies used to overcome racialised Darr,2010) which has an impact on job components that significantly experiences. the integration as well as retention of influenced their job satisfaction. Methods: Narrative research BME and overseas nurses and therefore Discussion and Conclusion: methodology was used to capture the patient care in the NHS/ Some Nigerian Achieving positive job satisfaction for experiences and the meaning that nurses have successfully progressed and its nurses is a challenge for any health participants attributed to them. A appear integrated into the NHS despite care institution due to the ongoing snowball sampling technique was used institutional racism. This study uses economic and social problem of our to identify and recruit participants the Agar and Strang (2008) framework time. It is vital for organizational from England and Scotland. Ten BME to interpret the lived experiences of policies to be considerate of each ethnic academics from a range of background, nurses perceived to have navigated the group as their needs will be different ages and positions were interviewed challenges and integrated into the UK; from others and have their ways of between 2017 and 2018 using semi- to understand ‘the ‘how’ of workforce effectively adapting to their host structured in-depth interviews. To date race equality’ (WRES, 2019:5). two ‘Stories’ have been analysed using

141 Posters: Thursday 5 September 2019

Aim: To elicit the lived experiences of Poster tour J 1. Constructions of moral judgement Nigerian nurses who are perceived to 2. Maintaining positive self- have successfully integrated into the Led by Susan Jones representations. NHS. Theme: Pregnancy Conclusions: The negative portrayal Methods: 10 UK registered nurses of of teenage pregnancy within wider Nigerian heritage were recruited by a Poster no: 59 Abstract no: 0157 society, impacts the ongoing stigma mixture of purposive and snowballing Research Topic: Sexual Health attached to teenage pregnancy within sampling. Recorded open-ended semi- Methodology: Interviewing the teenage population. Approaches structured interviews were conducted such as peer education and peer between July 2018 and March 2019, Research Approach: Evaluation (process, impact) support used in reproductive health transcribed and analysed using Nvivo should not be considered neutral, 12. Nurses recruited for the study taken for granted processes, but may included nurses who had attained the ‘Other girls’: A qualitative be complex and more nuanced. Health NHS agenda for change band 7 or exploration of teenage and social care professionals supporting higher. mothers’ views on young parents should be aware of the Results: There are facilitators and teen pregnancy in potential for stigma, discrimination, barriers to integration in the NHS isolation and exclusion within teenage which are shaped by immigration contemporaries peer groups. processes, employers’ practices, social Presenter: Catriona Jones, MSc, capital and personal characteristics University of Hull, UK Poster no: 60 Abstract no: 0242 such as education, resilience, Co-authors: Clare Whitfield, UK; motivation and personal values. Mark Hayter, UK; Julie Seymour, UK Research Topic: Midwifery, Service Innovation and Improvement, Women’s Discussion: There are essential Abstract markers, means and themes central health Background: Perspectives that to feeling integrated into the UK Methodology: Mixed consider teenage mothers as a ‘social and participants’ interpretation of Research Approach: Mixed Methods problem’ are well described in the integration into the UK health care are Research literature. However, the attitudes discussed. towards teenage mothers held by Conclusion: Effective integration of other teenage mothers are not well An mHealth physical overseas trained nurses could be used understood. Given the growing use of activity intervention for to resolve the shortage of nurses in the peer support in the reproductive health NHS and could improve staffing and pregnant women with of teenagers, the attitudes of teenage obesity patient care. Findings are discussed mothers towards their contemporaries in relation to global nursing shortages is worthy of exploration. Presenter: Michaela Senek, Sheffield and racism towards migrant nurses Hallam University, UK Aims: We aimed to examine the worldwide. Co-authors: Michaela Senek; Hora discourse around teenage pregnancy Soltani; Madelynne Arden in teenage mothers who have recently experienced teenage pregnancy and Abstract motherhood for themselves. Introduction: Adverse maternal and Methods: 40 mothers aged 16 -19, infant health outcomes are associated who had recently given birth and with a rise in obesity and excessive used a homebased sexual health gestational weight gain (GWG), which service took part in semi structured may be modified with physical activity interviews to explore their views on (PA) in pregnancy (1). Using mHealth pregnancy in other teenagers. The technology and social media (SM) fieldwork took place between April has the potential to reach widely at a 2013 and July 2014. Interviews were low cost to deliver PA interventions to transcribed and their content coded support women with GWG management and analyzed manually to identify core (2). themes (Braun and Clarke 2006). The Aim: To develop and test the feasibility, analytical framework of ‘othering’ of a walking intervention for women (Brons 2015), and resistance are used who are pregnant and obese using to examine their discourse around mHealth technology; and qualitatively teenage pregnancy in teenage mothers. evaluate views and experiences of the Results: Findings indicate that intervention design teenage pregnancy and parenting in Methods: A feasibility randomised teenage mother contemporaries is not controlled trial (RCT) of a PA always viewed positively. Some teenage intervention was developed using the mothers in this study used strategies Capability, Opportunity, Motivation- to distance themselves from perceived Behaviour model as per NICE negativity. Two overarching themes guidelines, to deliver self-monitoring, emerged from the data: goal setting and ‘information about

142 Posters: Thursday 5 September 2019

health consequences’ behaviour change Aims: This review aims to explore the Poster no: 62 Abstract no: 0519 techniques. Primary outcome measures lived experiences of repeat pregnancy Research Topic: Patient Experience were feasibility of recruitment, attrition, among adolescent mothers, to identify Methodology: Questionnaire and trial procedures. Secondary the gap in research knowledge about outcomes were engagement in a SM their experiences of a repeat adolescent Research Approach: Quantitative (not group, PA levels (steps), GWG and pregnancy. included in another category) maternal and infant outcomes. Methods: A systematic review Results: Forty participants were approach was used to identify relevant The use of novel non- recruited to the trial. Uptake rate was research. The search terms were invasive interventions 55%. Retention rate was 85% in the applied to the electronic database to improve the patient intervention and 75% in the control via EBSCOhost including CINAHL, group. Compliance was relatively MEDLINE, PsycINFO and Academic experience of intravitreal high with all participants achieving Search Premier in between 2000-2017. injections (IVT): Gaze within 90% of their personal PA The quality of individual included fixation target. The level of engagement in the papers was critically appraised using Presenter: Anar Shaikh, MSc, SM group varied, with some ‘active’ the CASP (2017) and NIH (2014). Moorfields Eye Hospital NHS and some ‘lurking’ participants. The Results: From the 413 studies Foundation Trust, UK interviews revealed that participants retrieved, 52 were eligible, meeting Co-presenter: Roxanne Crosby- found it practical and convenient to both the inclusion and the quality Nwaobi, UK access health information via a closed criteria. The eligible studies were Facebook group. HPs reported barriers synthesised using a thematic approach Abstract to providing lifestyle support due to (Bettany-Saltikov, 2012). Ten main Background: Patients often have limited resources, knowledge and time. themes associated with the lived negative associations with the mere Conclusion: Recruitment and experiences of repeat pregnancies thought of a needle entering the eye, adherence rates and Facebook amongst adolescent women emerged, resulting in increased anxiety, pain participation, suggest that the study namely: understanding pregnancies and perception and an adverse colouring of may be feasible and acceptable. It is outcome; self-perceptions of being a the patient experience. Another area recommended that a pilot is conducted repeat adolescent mother; experiences of dissatisfaction was the inability/ to test the feasibility throughout the of contraceptive failure; childbearing hesitation to follow instructions to pregnancy, prior to a large RCT. intention and decision making; correctly position the eye in preparation fathers; educational attainment and for the needle insertion (gaze fixation). peers; family support; financial and Aim: To evaluate the effect of the use Poster no: 61 Abstract no: 0381 employment difficulties; attachment of gaze fixation points to aid globe Research Topic: Children and Young to conventional institutions; and positioning on the patient and injector People, Nursing, Midwifery or Support supportive intervention from health experience. Worker Education, Methodology care providers. Methods: With reference to the Methodology: Other collection method Conclusions: The literature review literature on cardinal positions of gaze, Research Approach: Systematic Review highlighted adolescent mothers’ we were able to construct and secure and other Secondary Research experiences as mixed; whether to the walls of the injection room, A3 experiences of being a repeat sized coloured shapes as points of gaze Second pregnancy among adolescent mother were negative or fixation for the patients during the IVT positive depends on the adolescents’ adolescents and how procedure. All patients were required social context and the support they to have had at least one injection do they experience: A receive. Nurses and policy makers previously using standard injection systematic literature review should consider these findings when procedure. Gaze fixation points were Presenter: Parichat Arayajaru, PhD developing and delivering services to used by the injector to instruct for Nursing student, Faculty of Health this group. globe positioning for injection site Sciences, University of Hull, UK access. Questionnaires about the Co-authors: Clare Whitfield, UK; experience of using this novel approach Barbara Elliott, UK was administered to both the patient and the injector after the procedure. Abstract Bivariate analyses were conducted Background: Early motherhood using SPSS v24. among adolescents is related to a Results: 65 patients participated. range of socio-economic issues, health 56.9% were female. Mean age of issues, and also impacts on social population=74±11.7 years. More population development which includes nurse injectors participated in the low maternal educational attainment, study (78.5%). 76.9% of patients and low family income and high levels of 86.2% of injectors preferred the use of unemployment (UNFPA, 2013). There the gaze fixation points to during the are a limited number of studies which procedure. 71.9% of patients and 84.6% focus on the lived experiences of women of injectors reported less anxiety about who experience repeat adolescent unsanctioned eye movement during the pregnancy. procedure due to the fixation points.

143 Posters: Thursday 5 September 2019

Discussion: The use of gaze fixation Poster tour Q patients reported that their sleep was points to enhance to instructions given affected due to anxiety. to patients for globe positioning has Led by Elaina Reid Discussion: High levels of IVT-related been shown to be acceptable to the vast Theme: Patient Experience anxiety were reported in this patient majority of patients and injectors. Both population. Having a good experience patients and staff reported less anxiety Poster no: 63 Abstract no: 0513 at every injection may be important in associated with this aspect of IVT Research Topic: Patient Experience reducing overall anxiety levels. Most administration. of the reported reasons for anxiety are Methodology: Questionnaire Conclusion: More research is required amenable. Research Approach: Survey into this non-invasive method of Conclusions: More patient-focussed improving the patient experience. research should be conducted to Patient reported determine what measures may help the intravitreal injection (IVT) majority of patients. -related anxiety in the IVT service Poster no: 64 Abstract no: 0364 Presenter: Roxanne Crosby-Nwaobi, Research Topic: Research Ethics and PhD, Moorfields Eye Hospital NHS Governance, Service Innovation and Foundation Trust, UK Improvement, Women’s health Abstract Methodology: Questionnaire Background: Intravitreal injections Research Approach: Other approaches of therapeutics have become the mainstay of several ophthalmological Clinical outcome measures conditions. Patients undergoing this procedure often express anxiety and and patient satisfaction discomfort related in part due to the within a continence service actual procedure and in part due to for the management of the psychological wariness of having a urinary incontinence in needle inserted into the eye1-3. women Aim: To determine the level of patient Presenter: Sarah Titman, reported IVT -related anxiety in a UK Physiotherapist BSc (Hons) PGcert, NHS Trust Sheffield Teaching Hospitals NHS Methods: A convenience sample of Trust, UK patients attending the IVT service Co-presenters: Sarah Titman, UK; were invited to complete a survey Angela Stroughair, UK questionnaire over a one-month Abstract period. All patients had had at least one previous IVT injection and were able to Background: Urinary incontinence understand the English language. The (UI) is common within the female questions related to causes of IVT- population with an average of 1 in related anxiety, impact of injections 3 women experiencing symptoms. on daily life and impact of IVT-related Outcomes for first line conservative anxiety on activities of daily living. Data treatment of UI are very good with was collected between August 2017 – research suggesting that women are October 2017. eight times more likely to significantly improve than without treatment Results: 592 patients completed (Dumoulin and Hay-Smith 2018). the questionnaire. The mean age was Our service consists of specialist 74±13 years. 54 % of patients were continence nurses and women’s health female. 77% of patients were retired physiotherapists who have unique skills and 12% were employed full-time. 79% in managing these problems. patients reported IVT-related anxiety; 64% moderate to severe anxiety. Level Rationale: It is widely recognised that of IVT-anxiety experienced showed a UI can significantly affect quality of life. weak inverse correlation to number of Measuring this on an individual basis injections (r=-0.09). The main reported through validated outcome measures causes of anxiety were pain (28%), can provide effective and reliable potential to move inappropriately markers to assess clinical change during treatment (30%). Anxiety following conservative treatment. It causing the patient severe discomfort is also important to record changes in was associated with waiting for the treatment and outcomes of intervention injection (50%), speculum insertion to support ongoing service provision. (51%), needle entry (60%), surgical Method: The team collected condition drape (38%).27.7% reported anxiety specific outcome measures for urinary up to 3 days prior. More than 1/3 of incontinence (IIQ-7 and UDI-6) over a

144 Posters: Thursday 5 September 2019

twelve month period and collated the support students in developing their use of sedation can help but carries results to show an overall change in skills as student-writers and reflective with it risks, delay and complicate symptoms and patient progress. This practitioners. discharge (Parr Vijinski et al 2018). was supported by individual patient Design: A qualitative approach Music medicine is a patient centred feedback on experiences of attending was employed to explore emergent intervention which is safely and easily appointments, clinical care and themes in students’ poems and student administered (Yinger and Gooding subjective outcomes after treatment. reactions to creative writing teaching 2015). Results: Improvements in symptom strategies. Aim: The aim of this study is to review scores were identified in both outcome Setting: A university based in the the literature to identify the efficacy measures, with very high numbers of South East of England. of music medicine in the endoscopy patients recording an improvement in setting, thus far, and to guide further Participants: A cohort of 25 scores after treatment (96.5% UDI- research in this area. students undertaking a Health Science 6 and 100% IIQ-7). Average score Foundation Degree. Methods: An iterative approach changes for were UDI-6 = 30 and IIQ-7 was adopted to the literature search, Methods: Data collected from student = 28.3 out of 100. as advocated by Grant and Brettle poems was analysed thematically using (2004). Databases searched included , Patient satisfaction was high, all the framework of Braun and Clarke CINAHL (Cumulative Index of Nursing patients recorded extremely likely or (2006). very likely to recommend the service to and Allied Health Literature) with full Results:Students found the experience others. text, Pubmed, Medline, EBSCOhost of writing poetry challenging at first, E-journals Database and The Cochrane Conclusion: The completion of but ultimately rewarding. Compared Library. Grey literature and hand condition specific outcome measures with writing more formal academic searching was also employed. Thematic and patient feedback is imperative reflections, many students valued the analysis was then used to determine in data collection to support ongoing opportunity to express their emotions the key themes and issues, enabling service provision and demonstrate and experiences more freely. Analysis conclusions to be drawn on the efficacy clinical effectiveness. Patient perceived of the student poems also revealed of music medicine and identifications of outcomes were very good and a rich bank of data relating to key areas for further research. improvements noted in condition professional themes and students’ lived Findings: Results overall from specific outcomes measures. experiences. thirteen studies indicated that music Conclusions: Poetry writing helps as an intervention in the endoscopy Poster no: 65 Abstract no: 0303 students to develop writing craft and setting is beneficial and was found to reflective skills. It encourages students reduce anxiety, sedation dosage, pain, Research Topic: Nursing, Midwifery or to articulate often complex emotions Support Worker Education, Workforce and procedure length and stress on the Employment (including health and well associated with their professional lives, patient. being roles, research careers) thereby providing invaluable insights into the everyday lives of health care However, 3 studies found no Methodology: Documentary Research workers. This paper should provide significant reduction in anxiety, pain, Research approach: qualitative others working in nursing education sedation dosages, procedure time and approaches (eg: discourse analysis, willingness to repeat the procedure. ethnography, critical theory, grounded with a deeper understanding of possible theory, phenomenology) benefits of incorporating poetry writing Conclusion: The findings of this into the curriculum. literature review on music medicine as a non-pharmacological intervention Using poetry to develop cannot be generalised to the wider writing confidence and Poster no: 66 Abstract no: 0165 population at this moment in time. reflective skills in nursing Research Topic: Acute and critical care, Methodology among studies is variable. Patient Experience, Quality Standards education However, there is evidence that music Methodology: Other collection method Presenter: Camille Cronin, RN, medicine is beneficial and that further BSc(Hons), MSc, MEd, PhD, School Research Approach: Systematic Review research into this area is warranted. and other Secondary Research of Health and Human Sciences, Hence, a qualitative study with patient, University of Essex, UK self-selected music is planned which Co-authors: Caroline Hawthorne, UK Is music medicine it is hoped will inform future practice Abstract an effective non- more conclusively. Background: Non-traditional pharmacological students entering nursing programmes intervention in the at university often experience endoscopy setting? difficulties with the academic literacy A literature review requirements of their courses, in particular academic and reflective Presenter: Dale Ware, RGN, MSc, writing. Levels of student anxiety Manchester Foundation NHS Trust, UK may also be affected by other issues Abstract including the pressures of managing Background: Endoscopic procedures work, family and study commitments. can be anxiety provoking and Objectives: To explore how classroom- uncomfortable for the patient. The based poetry writing activities might

145 Posters: Thursday 5 September 2019

Poster no: 67 Abstract no: 0338 Study4 provided useful insights into the effectiveness of a self-assessment Research Topic: Mental health alongside further workshop evaluation. Methodology: Delphi Analysis supported developing the self- Research Approach: Action Research / assessment as a self-rating scale. Participatory Inquiry / Practice Development Findings supported the PM technique as accessible to participants, Development and focussing their thinking as part of the evaluation of a pictorial therapeutic encounter. Responders metaphor technique in the valued the technique in developing therapeutic encounter the relationship, generating insights and stimulating recall of problem Presenter: James Turner, HND, RMN, procedures. Workshops validated BA (Hons), MA, Dip CAT, PG DipEd, their current practice and increased RNT, SFHEA, PhD, Sheffield hallam confidence. University, UK

Abstract A four-part action research study, was designed and administered to explored and evaluate the use of metaphor and pictorial metaphor (PM) in the therapeutic encounter. Metaphors are present in the therapeutic encounter yet there have been few systematic studies of the development and effects of working with metaphor and especially pictorial metaphor (Turner, 2014). Study1, evaluated the technique at workshops across three groups of staff: Cognitive Analytic Therapy (CAT), CRUSE Counsellors and Nurses. Study1 achieved support for the direction of the research with some preliminary cautions and process considerations to take forward (Turner 2011, 2012). Study2, a Delphi study of expert practice, using the CAT international community. Seventy Six unique statements for consensus rating were extrapolated from an initial questionnaire in a three round Delphi Study. A number of insights as to the process and function of metaphor were achieved. Study3 developed, evaluated and refined a workshop and associated training materials to support therapist’s practice in metaphor and PM. Analysis found development of practitioner’s skill in this area. Evaluation questionnaires and follow up reflective questionnaires were used to capture reflections on utilising the technique post workshop. Study3 further extended the metaphor practice to include nurses and counsellors supporting the technique in wider therapeutic applications. Study4, a pilot of Metaphor and Pictures-Self Assessment Learning Framework (MaP-SELF) measured participant’s perceived competence.

146 147 007 699 August 2019