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Citation for published version (APA): Oates, J. L. (2016). Subjective wellbeing in UK mental health nurses: findings from a mixed methods research study. In RCN international nursing research conference 2016 Royal College of Nursing.

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Download date: 24. Sep. 2021 RCN international nursing research conference 2016

Wednesday 6 – Friday 8 April 2016 Edinburgh International Conference Centre, The Exchange, Edinburgh EH3 8EE, United Kingdom

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Plenary speaker abstracts 4 Concurrent session 6 63 Wednesday 6 April 10.20 - 11.00 4 Thursday 7 April 14.00 - 14.55 63 Thursday 7 April 09.05 – 09.45 4 Theme: Interviewing...... 63 Theme: Interviewing...... 64 Friday 8 April 09.05 – 09.45 5 Theme: Interviewing...... 65 Friday 8 April 15.35 - 16.15 5 Theme: Focus groups ...... 65 Theme: Qualitative approaches...... 66 Concurrent session 1 6 Theme: Qualitative approaches...... 67 Wednesday 6 April 11.30 - 12.55 6 Theme: Other...... 68 Theme: Action research...... 6 Concurrent session 7 70 Theme: Interviews/case study...... 7 Theme: Mixed methods...... 9 Friday 8 April 09.50 - 10.15 70 Theme: Interviewing...... 11 Theme: Questionnaires...... 70 Theme: Interviewing...... 12 Theme: Interviewing...... 71 Theme: Mixed methods...... 13 Theme: Focus groups ...... 72 Theme: Mixed methods...... 15 Theme: Systematic review ...... 73 Theme: Mixed methods...... 17 Theme: Questionnaires...... 73 Theme: Systematic review ...... 18 Theme: Interviewing...... 74 Theme: Research issues ...... 75 Concurrent session 2 20 Theme: Workforce/employment issues ...... 76 Wednesday 6 April 13.55 - 15.20 20 Concurrent session 8 78 Theme: Action research...... 20 Theme: Focus groups ...... 21 Friday 8 April 11.15 – 11.40 78 Theme: Systematic review ...... 23 Theme: Mixed methods...... 78 Theme: Mixed methods...... 24 Theme: Documentary research ...... 79 Theme: Mixed methods...... 26 Theme: Research issues ...... 81 Theme: Action research...... 27 Theme: Interviewing...... 81 Theme: Survey...... 28 Theme: Systematic review ...... 82 Theme: Rising stars - ViPER ...... 30 Theme: Interviewing...... 84 Theme: Mixed methods...... 85 Concurrent session 3 32 Theme: Interviewing...... 87 Wednesday 6 April 15.50 - 16.45 32 Theme: Mixed methods...... 88 Theme: Rising stars...... 32 Symposia 1 - 7 91 Theme: Mixed methods...... 33 Theme: Mixed methods...... 34 Thursday 7 April 15.25 – 16.25 91 Theme: Mixed methods...... 35 Theme: Qualiatative approaches...... 36 Symposia 8 - 15 102 Theme: Qualiatative research...... 37 Friday 8 April 13.40 - 15.10 102 Theme: Mixed methods...... 38 Theme: Interviewing...... 39 Posters 121 Wednesday 6 April 121 Concurrent session 4 40 Poster tour A...... 121 Thursday 7 April 10.10 - 11.05 40 Poster tour B...... 122 Theme: Interviewing...... 40 Poster tour C...... 124 Theme: Interviewing...... 41 Poster tour D ...... 125 Theme: Case study...... 42 Poster tour E...... 127 Theme: Quantitative research ...... 43 Poster tour ...... 127 Theme: Focus groups/Nominal group technique ...... 44 Theme: Interviewing...... 45 Posters 129 Theme: Qualiatative approaches...... 46 Thursday 7 April 129 Theme: Qualiatative approaches...... 47 Poster tour F...... 129 Poster tour G...... 131 Concurrent session 5 49 Poster tour H ...... 132 Thursday 7 April 11.35 - 12.00 49 Poster tour J...... 133 Theme: Qualiatative approaches...... 49 Poster tour K...... 135 Theme: Focus groups ...... 50 Poster tour ...... 135 Theme: Document research...... 52 Theme: Experimental/Quantitative research...... 53 Posters 137 Theme: Interviewing...... 55 Friday 8 April 137 Theme: Interviewing...... 56 Poster tour L...... 137 Theme: Mixed Methods ...... 58 Poster tour M...... 138 Theme: Statistical analysis...... 59 Poster tour N ...... 140 Theme: Interviewing...... 60 Poster tour P...... 142 Poster tour Q ...... 143

3 Plenary abstracts

Plenary speaker abstracts

cases are examined through a range of theoreti- Wednesday 6 April cal and methodological approaches to capturing Thursday 7 April the emotional labour of nursing supported by 10.20 - 11.00 different sources of evidence generated from 09.05 – 09.45 qualitative research, creative writing, visual art and the digital world. Location: Pentland Auditorium Location: Pentland Auditorium Intended learning outcomes Keynote lecture 1: Identify concepts and critiques which describe Keynote lecture 2: Nursing at the extremes: the role of emotions in nursing and their rela- More poetry is needed: navigating the emotions of tionship to care. Values, scholarship and care Explain how nurses use emotions in a range of nursing research routine and extreme conditions Professor Pam Smith, PhD MSc BNurs RN Professor Gary Rolfe, RMN, BSc, MA, PhD, RNT, Professorial Fellow, University of Describe individual and organisational systems Emeritus Professor of Nursing, Swansea Uni- Edinburgh, United Kimgdom to support nurses’ emotional labour and versity, United Kingdom acknowledge that ‘they don’t come free’ Summary of presentation Summary of presentation Recommended reading list This session explores the extremes experienced In the 60th anniversary year of nursing by nurses, worldwide, working at the frontline of Smith P (1992, 2012) The emotional labour of education at the University of Edinburgh, this care. A series of narratives are presented to show nursing Basingstoke Palgrave Macmillan paper will offer an opportunity to pause and how nurses navigate their emotions to care in Hochschild AR (1983, 2003) The managed reflect on the current state of nursing research extreme conditions of emergency, suffering and heart: the commercialisation of human feeling. from a number of novel historical perspectives. death across the life cycle. Even so-called routine Berkeley, University of California Press It will consider some of the extraneous pressures tasks are in no way ‘ordinary’ and may generate Kelly D and Smith P (2016) Caring, face-work on nurse academics and researchers to conduct high levels of tension, distress and anxiety. The and nursing, in: Allan H, Traynor M, Kelly D and research and write papers of a certain type, and connections between extremes, emotions and Smith P Understanding Sociology in Nursing, focus in particular on the tensions between being care are examined through emotional labour and Chapter 5, London, Sage a nurse and being a university employee. It will other classic studies to understand a modern conclude by suggesting that nursing research paradox that requires nurses to be both compas- should broaden its scope to encompass a wider Biography sionate and financially driven while subjecting variety of scholarly activities, and that nurse them to public scrutiny and critique. Professorial Fellow and former Head, Nursing academics should not forget that they are first Studies, Edinburgh University. Formerly, and foremost nurses. Professor, Surrey and South Bank Universities. Abstract Visiting Professor, King’s College. London. This session explores the extremes experienced Biography BNurs, Manchester University, MSc (Medical by nurses worldwide, working at the frontline Gary Rolfe is Emeritus Professor of Nursing at Sociology) and PhD, London University. Post- of care. A series of narratives are presented to Swansea University. He qualified as a mental doctoral studies with Arlie Hochschild culmi- show how nurses navigate their emotions in health nurse in 1983 and has published widely nating in The Emotional Labour of Nursing. extreme conditions of emergency, suffering and in the fields of action research, practice innova- Florence Nightingale and Fulbright awards to death across the life cycle. Even so-called routine tion, philosophical aspects of nursing, reflec- study US nursing. tasks are in no way ‘ordinary’ and may generate tive practice and the theory-practice gap. His high levels of tension, distress and anxiety. The Nurse and teacher: Tanzania, Mozambique recent work has explored the practice of schol- connections between extremes, emotions and and UK. Most exciting job: Director, Nursing arship in the corporate university and the care are examined through emotional labour Research in a ‘pre-market’ NHS. tensions between the demands to meet academic and other classic studies to understand how a Researching extremes: nurse migration; cente- outcomes and upholding the values of the modern paradox has emerged which requires narians; intensive care; transition from active to nursing profession. nurses to be both compassionate and financially palliative care for children with cancer; maternal driven while subjecting them to public scrutiny and child health in Nepal and Malawi; home ven- and critique. tilation. Twenty-two successful PhD students. The paper explores through a series of case studies how nurses talk and reflect on their clinical experiences at different stages of their careers in order to remain technically and emotionally engaged while caring for people with extreme life threatening and distressing conditions. To what do these nurses attribute their emotional survival? What role does education play? In order to explore these issues, four case studies of working at the extremes are presented involving intensive care, death at a young age, the oldest old and resource poor environments experienced in low income countries. These

4 Plenary abstracts

at the University of Edinburgh where she studied Friday 8 April Friday 8 April for an integrated degree in Nursing and Social 09.05 – 09.45 15.35 - 16.15 Science and graduated Magna Cum Laude. She qualified as a registered nurse and district nurse after experience in the Royal Infirmary of Edinburgh. A Fulbright scholarship enabled her Location: Pentland Auditorium Location: Pentland Auditorium to study for an MSc in mental health nursing at the University of California, San Francisco. Keynote lecture 3: Plenary debate: Her clinical experience was gained as a ward Applying for and conducting This house believes research sister in an acute psychiatric unit in the Royal a large EU research grant: the is the solution to the global Edinburgh Hospital. She returned to the USA to study for an MA and PhD in sociology at Cornell case of RN4CAST nursing workforce crisis University. On her return to the UK she worked Professor Walter Sermeus, RN, PhD, Professor Proposer: Professor Daniel Kelly, Cardiff first in the Department of Public Health at the in Health Care Management and Programme University, Cardiff, United Kingdom University of Oxford, the RCN Research Institute Director for Health Sciences, KU Leuven Seconder: Elizabeth West, University of and the London School of Hygiene and Tropical Institute for Healthcare Policy, Belgium Greenwich, London, United Kingdom Medicine before taking up her current role. Opposer: Professor James Buchan, Queen Professor James Buchan: Professor Buchan has Summary of presentation Margaret University, Edinburgh, United thirty years’ experience in research, evidence and RN4CAST was a European Funded project under Kingdom policy analysis on the health workforce, devel- Framework Programme 7 running from 2009 oping strategic intelligence and policy advice Seconder: Professor Ruth Harris, King’s until 2011. The total grant was 3 million Euro. at national level and internationally on the HR College London, London, United Kingdom The project was highly successful and resulted components of health sector effectiveness. in more than 50 scientific publications and high Biographies He is an Adjunct Professor, at the WHO Collabo- societal impact. The presentation will focus rating Centre, University of Technology, (UTS), Professor Daniel Kelly: Graduate of the inte- on what is takes to write a successful proposal Sydney, Australia; and a Professor at Queen grated Social Science and Nursing degree and to lead a large consortium of researchers Margaret University, Scotland. to success and lessons learnt for future applica- programme at Edinburgh University. On quali- He is qualified in economics and personnel tions to large EU research grants. fying I gained clinical experience in intensive care, hospice and acute oncology settings; management. The current focus of his work is on labour market analysis; health worker Intended learning outcomes including specialist oncology training at the Royal Marsden Hospital in London in the 1980s. migration; health workforce incentive strategies; Describe how they have to write a successful workforce planning; and skill mix. application for a large EU grant I then spent five years in two Charge Nurse roles. The first, at Edinburgh Royal Infirmary, Professor Ruth Harris: Professor Harris, who Describe how to conduct and lead a large consor- was in the Sexual Health service at the height of worked previously in the Joint Faculty of Health, tium of researchers the HIV crisis in the late 1980s. I then returned Social Care and Education based at Kingston to Oncology at the Western General Hospital University and St George’s Medical School, has Recommended reading list in Edinburgh to manage a chemotherapy unit a clinical background in acute medical nursing https://ec.europa.eu/programmes/ that specialised in high dose/trial treatments, and care of older people. She is a King’s alumnus horizon2020/en/what-horizon-2020 including the treatment of young adults. I having completed her BSc, MSc and PhD degrees at King’s and has collaborated previously with Sermeus W, Aiken LH, Van den Heede K, completed the MSc (Advanced Practice, Cancer colleagues based in the Faculty on a number of Rafferty AM, Griffiths P, Moreno-Casbas MT, Nursing) at the University of Surrey during this research projects. Busse R, Lindqvist R, Scott AP, Bruyneel L, time. Brzostek T, Kinnunen J, Schubert M, Schoon- I then moved into education as a Lecturer in Ruth’s research interests include the impact of hoven L, Zikos D; RN4CAST consortium. Nurse Cancer Nursing at the Royal Marsden Hospital/ nursing and multi-professional interventions forecasting in Europe (RN4CAST): Rationale, Institute of Cancer Research and contributed to on processes of care and patient outcomes. design and methodology. BMC Nurs. 2011 Apr the development of innovative cancer and pallia- Previous studies have investigated the develop- 18;10:6. tive care degree programmes for several years. ment and evaluation of new nursing roles and inter-professional team working. Geert Hofstede, Gert Jan Hofstede and Michael In 1998 I was appointed Senior Nurse (Research Minkov: Cultures and Organizations: Software & Development) at University College Hospitals of the Mind. Revised and expanded 3rd Edition. and completed a part-time PhD in Sociology at 550 pages. New York: McGraw-Hill USA, 2010 Goldsmiths, University of London in 2002. This was an ethnographic study of a group of men Biography undergoing treatment for prostate cancer. Walter Sermeus is professor of health care man- For three years I was Senior Research Fellow agement, Leuven Institute for Healthcare Policy, working between UCL Hospitals and City Uni- University of Leuven KU Leuven, Belgium. He versity, London. I was then appointed Reader is Programme Director of the Master in Health in Cancer Nursing at Middlesex University in Care Policy & Management. He is for 2015-16 2005 with subsequent promotion to Professor of Frances Bloomberg International Distinguished Nursing and Cancer Care. Visiting Professor, University of Toronto, I joined Cardiff University in 2011 as The Royal Canada. He was coordinator of the EU-FP7 College of Nursing Chair of Nursing Research. RN4CAST-project, Nurse Forecasting in Europe Elizabeth West: Elizabeth West is Professor of 2009-2011. He is the member of the European Applied Social Research in the School of Health Academy of Nursing Science (EANS). and Social Care where she has been Director of Research since 2007. She was an undergraduate

5 111.30 – 12.55 Concurrent session 1 – Wednesday 6 April 2016 Concurrent session 1 Wednesday 6 April 11.30 - 12.55

Theme: Action research Improving essential care 1.1.2 Abstract number 199 Conclusion: This project adopted a true part- 2:25pm 1.1.1 Abstract number 142 nership approach with service-users in terms 11:30am of study design, data collection, analysis and practice development initiatives. Staff equally In search of improved pressure injury risk Working together: action valued the participative nature of the project, regarding it as an opportunity to think deeply assessment for patients research with service users to about the care they provide. admitted to hospital: improve person-centred care evaluation of a clinical- Presenter: Dr Juliet MacArthur, PhD, MSc, PG Recommended reading list judgement-based tool Cert, BSc, RN, RNT, NHS Lothian, Edinburgh, Berwick D (2013) A promise to learn- a commit- Presenter: Professor Lin Perry, PhD MSc RN, UK ment to act: improving the safety of patients in University of Technology Sydney, Sydney, Co-author(s): Janet Corcoran, Scotland England. London: Department of Health. Australia Francis R (2013) Report of the Mid Staffordshire Co-author(s): Emine Tetik, Australia; Kay Abstract NHS Foundation Trust Public Inquiry. London: Maddison, Australia: Kathryne Hoban, The Stationery Office Background:There have been a number of Australia; Fiona Bampi, Australia independent reviews showing that views of McCormack, B., McCance, T. (2010) Person patients are not being heard in health services Centred Nursing: Theory and Practice Chiches- Abstract (Berwick 2013; Francis 2013). This action ter; Wiley-Blackwell research study took as its starting point the Introduction: Hospital Acquired Pressure Injury (HAPI) risk assessment tools are criticized for principle of patient and public involvement and Biography how to involve service users to improve person- poor performance and complexity (Pancorbo- centred care. It involved two contrasting clinical Strategic lead for Nursing and Midwifery Hidalgo et al. 2006). Research in NHS Lothian which involves imple- services in a Scottish Health Board: Emergency Aims: To evaluate the efficacy of the Pressure mentation of NMAHP Research Framework Department and Evening District Nursing Injury Risk Assessment Tool (PIPRAT), in partnership with University of Edinburgh, Service. developed from a clinical-judgment-based tool Edinburgh Napier University and Queen (Ramstadius 2000), compared to the Waterlow Aims: Collaborate with service users through- Margaret University. Also Lecturer in Clinical Score in correctly identifying those patients truly out the research process, including a service Academic Research at University of Edinburgh ‘at risk’ of HAPI; to compare their feasibility and user co-researcher and service user-led steering which includes delivery of Masters Nursing in acceptability to nurses. group Clinical Research. Strong focus of both roles Learn from service users’ experiences to inform is capacity development for clinical academic Methods: With Ethics Committee approval, in analysis of person-centred care in each setting research careers. Person research is in areas of May-June 2015 Registered Nurses of two Sydney acute hospitals conducted risk assessments for Develop and implement a programme of practice compassionate care, dementia and learning dis- patients at admission using both PIPRAT and development in response to Findings: ability. the Waterlow Score, with randomly assigned Methods: This was a mixed-methods study order of assessment. Patient care was guideline- undertaken 2014-2015, Drawing on an based (NPUAP et al 2014), with HAPI-related action research methodology. The theoretical data extracted from records at discharge. framework both for data collection and analysis Anticipating sensitivity of PIPRAT at least equal was based on McCormack and McCance’s (2010) that of Waterlow (82.4%; Pancorbo-Hidalgo theory of person-centred nursing. Ethnographic et al. 2006), in a population where 50% were style observations and informal interviews earlier reported ‘at risk’ of HAPI, a lower 95% with staff and service users were conducted confidence limit of 0.75 and 0.95 probability (Emergency Department - 34 hours observa- required a sample of n352. tion; Evening Service - 55 hours observation). Semi-structured interviews were also conducted Nurse assessors were surveyed at study conclu- with other service-users (n=8). Following data sion about ease of use and acceptability of the analysis, descriptions of the person-centred tools. care in each setting were shared with staff in a Results: 135 nurses assessed n387 patients. number of workshops. PIPRAT and Waterlow categorised 125 (32.3%) Results: Key issues highlighted from the and 143 (37.0%), respectively, as ‘at risk’; 10 research and subsequent workshops included patients (2.6%) subsequently developed HAPI. the need for: Sensitivity and specificity for correct identifica- Implementation of the ‘Seven-steps to person tion of patients who developed HAPI were 0.60 centred communication’, which was informed and 0.64 for Waterlow, 0.5 and 0.68 for PIPRAT. by the analysis Positive and Negative Predictive Values were 0.04 and 0.98 for both tools. • Leadership development PIPRAT took median <5min to complete, but • Acting on patient feedback Waterlow 5-10min. Nurses rated PIPRAT at • Valuing bank and agency staff

6 11.30 – 12.55 Concurrent session 1 – Wednesday 61 April 2016 median 9 but Waterlow 5 of 10 for (increasing) bilitation needs measures which can support He was clinical lead on the NHS Fife Self Directed ease of use; 85% preferred PIPRAT. care and the improvement of outcomes which Support Pilot Project, part of a Scottish Govern- Discussion: Waterlow misclassified one less are important to patient’s lives, such as par- ment funded programme that was completed in patient who subsequently developed HAPI but ticipation in daily activities, relationships and 2012. more patients ‘at risk’, entailing more preventive community life; embodied in the WHO ICF1. care and longer assessment times. Aim: This projects’s aim was to identify a core Conclusion: PIPRAT’s brevity, simplicity and outcome dataset which is clinically and statisti- potential for at least equivalent assessment cally valid, feasible, and supports multi-discipli- outcomes warrant further attention. nary care and quality improvement. The dataset Theme: Interviews/case study should reflect the priorities of service users, the multi-disciplinary team and data end-users. The 1.2.1 Abstract number 155 Recommended reading list project was conducted 2014-2015. National Pressure Ulcer Advisory Panel, 11:30am Method: Identifying measurement priorities: European Pressure Ulcer Advisory Panel and Consensus approaches were used with: service Pan Pacific Pressure Injury Alliance. Preven- Dementia in the workplace: users with a range of conditions (nominal group tion and Treatment of Pressure Ulcers: Clinical technique), multi-disciplinary healthcare staff exploring the employment- Practice Guideline. Emily Haesler (Ed.). (e-Delphi technique), data users (online survey). related experiences of people Cambridge Media: Perth, Australia; 2014 A multi-disciplinary clinical working group with dementia, their families Pancorbo-Hidalgo PL, Garcia-Fernandez FP, met three times to filter the items list based and employers Lopez-Medina IM. (2006) Risk assessment upon relevance and feasibility, while protecting Presenter: Dr Louise Ritchie, PhD, PGCert, scales for pressure ulcer prevention: a system- service users’ priorities. atic review. Journal of Advanced Nursing vol 54, BA(hons), University of the West of Scotland, Identifying outcome measures: In parallel and no 1, pp94-110 Hamilton, UK iteratively reporting to the working group, Ramstadius B. Preventing institution acquired Co-author(s): Debbie Tolson, Scotland, UK; researchers conducted a systematic review of Mike Danson, Scotland, UK pressure ulcers. Australian Nursing Journal vol outcome measures from: published literature; 7, p10 international neurological outcome datasets; Abstract team suggestions. Measure metrics were Biography reported to the working group. The UK, in line with other European countries, has introduced changes in government policy Lin Perry is Professor of Nursing Research and Results: The consensus approaches identified relating to state pension age and default retire- Practice Development, University of Technology 153 items as priorities across ICF domains. The ment age, which will result in an increasing Sydney and the Prince of Wales Hospital, Sydney working group reduced this to 41. Hospital and Sydney Eye Hospital, South Eastern number of people working into later life. While The literature review identified an initial 549 Sydney Local Health District, New South Wales. there are many economic benefits to this, it measures. The working group finally identified The main focus of her work has been broadly is also likely that there will be an increase in 4 measures: the Neurological Impairment Scale, around research capacity development, service employees experiencing health problems more the Northwick Park Dependency Scale, the UK and practice development and evaluation, with commonly associated with later life. Dementia is FIM+FAM and the PROMIS Global Health scale. major clinical topics of nutrition support and an example of this, and it is currently estimated chronic disease management. Conclusion: Although no decisions were made that 38,000 people under the age of 65 have by researchers, they facilitated decision making dementia in the UK. There is a dearth of research and helped to negotiate between stakeholder exploring the experiences of people with priorities. The final core measures span the ICF dementia in employment (Ritchie et al, 2015). domains. The pilot system is under evaluation This study aimed to explore the employment 1.1.3 Abstract number 400 and due to report at the end of 2016. The future related experiences of people with dementia in order to identify the potential for continued 12:30pm core system will augmentable with satellite measures. employment post diagnosis. Adopting a quali- Shared outcomes in tative case study approach, 17 case studies of Recommended reading list people with dementia aged 50-66, who were still neurorehabilitation in employment or had been in employment in WHO (2002)Towards a Common Language - supporting person the previous 18 months were carried out. Case for Functioning , Disability and Health ICF. studies involved interviews with the person with centred care and multi- Retrieved from http://www.who.int/classifica- dementia, a family member and a workplace rep- disciplinary working - the tions/icf/training/icfbeginnersguide.pdf resentative. A thematic cross-case analysis was Neurorehabilitation Outcomes Turner-Stokes, L. et al., 2014. The Neurological carried out to explore similarities and differences Management System (NROMS) Impairment Scale: reliability and validity as a between the cases. Results will be presented in Presenter: Dr Carina Hibberd, PhD, BSc(hons), predictor of functional outcome in neuroreha- four themes; (1) experiencing dementia in the Stirling University, Stirling, UK bilitation. Disability and rehabilitation, 36(1), workplace; (2) supporting continued employ- pp.23-31. Co-author(s): Claire Torrens, Scotland, ment; (3) work keeps me well; (4) workplace UK; Carina Hibberd, Scotland, Uk; Edward perspectives. While there were many similari- Biography Duncan, Scotland, Uk; Heather Strachan, ties in cases, each case study revealed a different Scotland, Uk; Brian Williams, Scotland, UK Ben Sutherland is clinical lead for the current experience of employment post diagnosis of NROMS Project in Fife. He has clinical expertise dementia. Early intervention is required for a person with dementia to continue employment, Abstract within the setting for this project, a lead role in service improvement in rehabilitation and and practitioners, including occupational health Background: The NHS Fife Rehabilitation work collaboratively with colleagues locally professionals, who work with individuals from Service identified a need for a routinely collected, and nationally applying for research grants and the emergence of first symptoms through to post patient outcomes system which is patient-cen- supporting research within the rehabilitation diagnostic support need to consider the implica- tred and supports care quality standards across setting. tions for employment and the potential financial the service and neurological conditions. Reha-

7 111.30 – 12.55 Concurrent session 1 – Wednesday 6 April 2016 and social impacts on the individual and their collected in 2012 using interviews with mental 1.2.3 Abstract number 316 families. health professionals and observations in an acute in-patient psychiatric ward and assertive 12:30pm Recommended reading list outreach community team. Combining sociological & Ritchie, L., Banks, P., Danson, M. and Tolson, Findings: Data analysis using a theory building D. (2015) ‘Dementia in the workplace: a review.’ approach suggested tensions had minimal psychological perspectives: Journal of Public Mental Health, vol 14, no 1, pp impact and mental health service users are con- integrating normalisation 24-34. structed as ‘objects of risk’ (Hilgartner 1992), Process Theory & theoretical understood as harmful and subject to increased domains framework to Biography surveillance and control as a result. investigate staff compliance Louise has recently taken up post at the Univer- Discussion: Distance between professionals with patient screening. sity of the West of Scotland (UWS) as Lecturer and service users on a spatial, narrative and Presenter: Professor Kay Currie, PhD, MN, in Dementia (Research) in the School of Health, moral level enabled the subjective experience BSc, RN, RNT, Glasgow Caledonian Univer- Nursing and Midwifery. She joined UWS in 2013 and individuality of the person to become lost. sity, Glasgow, UK as a Research Fellow on the Alzheimer’s Society Organisational and professional processes such project Dementia in the Workplace. The aim of as documentation systems, incident inquiries, a Co-author(s): Lesley Price, Scotland, UK; Lynn the project is to examine the experiences of those fear of being blamed alongside responses from Melone, Scotland, UK; Paul Flowers, Scotland, who develop dementia whilst still in employ- local social agencies and community members UK ment, examining the potential for continued were viewed as contributing to the construction employment. Louise has previously been of service users as objects of risk. Abstract involved in research examining the impact of the Conclusion: Recovery orientated mental The aim of this presentation is to explain the physical environment in healthcare, including health care remains rhetoric. Opportunities process of developing data collection instru- the design of dementia care homes and psychi- for mental health nurses and service users to ments and an analytical framework which atric hospitals. Louise completed her under- engage in dialogue, particularly in the context of integrates the use of Normalisation Process graduate degree in psychology before going on to complex decision making should be developed to Theory [NPT] (May et al 2007) and Theoretical complete her PhD at the University of the West promote a relational and a contextual approach Domains Framework [TDF] (Francis et al 2012) of Scotland. to safety. in a novel methodological approach which capi- talises upon an understanding of the person as Recommended reading list embedded within social and cultural contexts, Hilgartner, S. (1992) The Social Construction of in order to develop future interventions. Both 1.2.2 Abstract number 143 Risk Objects or how to Pry Open Networks of of these theoretical frameworks are widely cited, Risk In Short, J. and Clarke, L. (Eds) Organiza- yet a robust literature search failed to locate any 12:00pm tions, Uncertainties and Risk. Boulder. Westview evidence discussing how they can be combined Press. successfully within a single study. Psychiatry is a risk business. Malone, R. (2003) Distal Nursing. Social Science Our multidisciplinary research team was funded The construction of mental and Medicine 56(11): pp.2317-2326 to investigate factors affecting the implementation of hospital screening policies for anti-micro- health service users as risk Szmukler, G., and Rose, N. (2013). Risk assess- bial resistant organisms (AMR). Implementing objects: A multiple case study ment in mental health care: Values and costs. screening is complex and shaped by a range of Behavioral sciences & the law, 31(1): pp.125-140. inquiry psychological and social factors. Previous studies Presenter: Dr Anne Felton, RN (Mental show that a simple Clinical Risk Assessment Health), MN, BA(Hons), PGCHE, RNT, PhD, Biography tool is an effective means of identifying patients Assistant Professor, School of Health Sciences, Anne Felton is an Assistant Professor in mental at risk, enabling appropriate management to University of Nottingham, Nottingham, UK health at the School of Health Sciences, Uni- reduce cross-transmission of infection (Health versity of Nottingham. Anne is interested in Protection Scotland 2011); however, Scottish Abstract decision making in mental health practice and surveillance data indicates that compliance with Background: Levels of containment in mental has conducted research related to this area this screening policy is below the target of 90%, health services are growing, focusing attention including examining the tensions that are created impacting on the effectiveness of this approach. on the coercive role of mental health care, geared for professionals in mental health services dually National guidance on AMR-related screening towards public protection and social control. responsible for risk management and enacting appears straightforward; therefore the questions This has emerged despite health policy char- coercion alongside promoting recovery and remain ‘Why is compliance variable; what are acterised by an emphasis on involving people choice. Anne has published in the field of risk the barriers and enablers to screening? within their own care and the global develop- and mental health practice, social inclusion Hospitals are undoubtedly complex systems, ment of recovery as an influential philosophy and service user involvement in education. She functioning at macro and micro levels, with in mental health practice. The coexistence of led the development and delivery of a series of various social groups operating at organisa- such apparently opposing directions for services modules on person centred nursing care for an tional and team levels whilst the individu- has re-ignited debate concerning the balance in undergraduate nursing programme. Anne has als embedded within these groups will bring mental health care between the desire to support been involved in a number of projects working their own unique perspectives to bear on their people in distress and the pressure to protect in partnership with service users to enable their actions. To address the question of barriers and individuals’ and wider society. participation in nurse education enablers to screening, we adopted both a socio- Aims: The aim of this study was to address logical perspective, applying NPT to examine the question of whether and how mental health the work that takes place within organisations practitioners experience tensions that arise from to embed screening as an intervention, and a delivering care and enforcing control psychological perspective using TDF to explore factors affecting the individuals’ decision to act Methods: A qualitative interpretive inquiry was in specific situations. conducted using multiple case studies. Data was

8 11.30 – 12.55 Concurrent session 1 – Wednesday 61 April 2016 Recommended reading list Theme: Mixed methods Recommended reading list Francis, J.J., O’Connor, D. & Curran, J. (2012). 47) Doherty, L, Fitzsimmons, McIlfatrick (2015) Theories of behaviour change synthesised into 1.3.1 Abstract number 216 Carers’ needs in advanced heart failure: A system- a set of theoretical groupings: introducing a 11:30am atic narrative review. European Journal of Car- thematic series on the theoretical domains diovascular Nursing European Journal of Car- framework. Implementation Science, Vol 7:35. Earlier integration of diovascular Nursing 10.1177/1474515115585237 Available at: http://www.implementation- 24. Hupcey JE, Fenstermacher K, Kitko L, Fogg science.com/content/7/1/35 (accessed 10.11.15) palliative care: examining the palliative care needs and J (2011) Needs of Spousal Caregivers of Patients Health Protection Scotland (2011). NHS Scotland with Heart Failure Followed at Specialized Heart MRSA Screening Pathfinder Programme: quality of life of carers for Failure Centers. J Hosp Palliative Nursing. Update report. Available at http://www. people living with advanced 1;13(3):142-150. documents.hps.scot.nhs.uk/hai/mrsa-screen- heart failure 30. Hudson PL, Hayman-White K. Measuring ing/pathfinder-programme/mrsa-pathfinder- Presenter: Professor Sonja McIlfatrick, Ulster the psychosocial characteristics of family car- update-2011-02-23.pdf (accessed 10.11.15) University Northern Ireland, Newtownabbey, egivers of palliative care patients: psychomet- May, C.R., Finch, T., Mair, F., Ballini, L., UK ric properties of nine self-report instruments. Dowrick, C., Eccles, M., et al. (2007). Under- Co-author(s): Fitzsimmons, D, UK, Doherty, Journal of Pain and Symptom Managment standing the implementation of complex inter- UK 2006;31(3):215-28. ventions in health care: the normalization process model. Health Services Research, vol. 7: Abstract Biography 148, pp. 1-7. doi:10.1186/1472-6963-7-148 Background: Evidence suggests that end-of- Sonja is a registered nurse with approximately twenty years’ experience in palliative Biography life care in heart failure is poor, characterized by high levels of symptoms, inadequate support care practice, education and research. She has Professor Kay Currie is Assistant Head of and poor quality of life. Family carers play a extensive experience in undertaking research as Department for Nursing & Community Health crucial role in supporting advanced HF patients, well as leading and providing strategic direction and Director of the Glasgow Caledonian Uni- undertaking vital disease and medication man- for research. Having qualified as a registered versity WHO Collaborating Centre for Nursing agement. There is a lack of knowledge on the nurse and graduated with a nursing degree from Education, Research & Practice Development. needs and experiences of carers for this group of the University of Ulster in 1991, Sonja began her Kay has a clinical background in cardiology patients. research career completing her MSc in 1999 and her PhD from University of Ulster in 2003. having worked as a ward sister in coronary Aim: To examine the palliative care needs, care for six years before leaving for a post in quality of life, perceived burden and level of Sonja is a Professor in Nursing at Ulster Univer- higher education. She has a special interest preparedness of carers of people living with sity. Within her university role, Sonja is Post- in improving healthcare quality, specifically advanced heart failure. graduate Tutor as well as the lead for the Pallia- person-centred care. Her current research tive Care Strand within the Managing Chronic and teaching focus is on understanding and Methods: A sequential confirmatory mixed Illness Research Centre. Sonja is also a Senior responding to patient experience, particularly methods approach comprising two phases. Investigator in the Palliative Care research in the areas of self-management in chronic heart Phase 1: Postal survey with carers identified via Network for All Ireland Institute of Hospice failure and healthcare associated infection. She a database of patients living with advanced heart and Palliative Care. research interests include: is a member of the ‘Safeguarding Health through failure (NYHA Classification III-IV, ejection decision making at end of life; palliative care Infection Prevention (SHIP) Research Group in fraction <40% and ≥ 1 unscheduled hospital and chronic illness; public awareness of pal- the Glasgow Caledonian University Institute admission in the previous 12 months) across liative care and psychosocial support for carers/ for applied Health research and a collaborator Ireland. Data included measures of depres- families affected by advanced disease in the Scottish Healthcare Associated Infection sion, anxiety, QoL, perceived social support and Research Institute (SHAIPI) consortium, where illness beliefs, caregiver burden, needs assess- she leads a programme of patient experience ment and preparedness for caregiving. and staff perspectives in infection prevention & Inclusion criteria: carers identified by the 1.3.2 Abstract number 180 control research, specializing in the application patient as the main person who provides care. of qualitative research methods. Phase 2: semi structured face to face inter- 12:00pm views with carers (n=20). Thematic analysis of verbatim transcripts was used to identify Does an adapted cardiac emergent themes. Descriptive and inferential rehabilitation programme data analysis using SPSS was undertaken. delivered in a hospice for Results: 82 carer responses was obtained (response rate 47%). Nearly one third of the patients with advanced carers experienced moderate to severe levels chronic heart failure have an of depression and anxiety and their quality of effect on quality of life? life was impacted by their caregiving role. They Presenter: Dr Helen Walthall, PhD, RGN, spent a considerable time on caregiving tasks Faculty of Health and Life Sciences, Oxford with over 60% spending over 50 hours per Brookes University, Oxford, UK week. Themes from the qualitative interviews Co-author(s): Mary Boulton, England, UK; Bee indicated that the carers considered that their Wee, England, UK life is on hold; expressing feelings of isolation and frustration at a perceived lack of support. Abstract Conclusions: Carer’s needs are variable depending on the patients’ medical stability. Background: Chronic Heart Failure (CHF) has A holistic approach is needed to support these poor outcomes, and presents in a predominately carers. elderly group, who have a number of comorbidities (NICOR, 2013). End of life care is often frag-

9 111.30 – 12.55 Concurrent session 1 – Wednesday 6 April 2016 mented and does not meet their needs. Attempts Diploma in Adult Education in 1996 and her PhD analysis of verbatim transcripts and descriptive have been made to adDress this, but significant studies in 2003. Helen is currently a Principal statistical analysis. changes are yet to be seen (Johnson, et al 2012). Lecturer/Programme Lead for the Advanced Results: The DCI was acceptable to the Furthermore, planning end of life care can be and Specialist Practice cluster in the Depart- community nurses. It contributed to the overall difficult due to the uncertainty of the disease tra- ment of Applied Health and Professional Devel- assessment of palliative care patients; identified jectory (Barclay, et al 2011). opment at Oxford Brookes University. She is areas that might not otherwise have been iden- Aims: To explore whether an adapted responsible for a number of undergraduate and tified; supported communication and assisted programme focussing on support and symptom postgraduate specialised clinical courses within the nurses to provide holistic end of life care. management, and delivered in a hospice envi- the department, and teaches on the Advanced Concerns however were expressed that the tool ronment, would be acceptable to and of benefit Practice programmes, including research ‘opened a can of worms’ initiating difficult con- to patients. methods, diagnostic reasoning and advanced versations for which the nurses felt unprepared. clinical assessment. Helen supervises a number Methods: A pre/post intervention study design The patients found that the tool helped them of Master’s thesis, PhD doctoral students and using mixed methods was used to evaluate eight to identify and consider future needs and were Professional Doctorate students and works with week programme delivered twice in a hospice happy to discuss death and dying. nurses to develop and implement the acquisition to patients with advanced CHF. Full ethical Conclusion: The DCI helped nurses to of research skills and knowledge into practice. approval was granted. All participants completed delivered individualised holistic care. Whilst all three standard measures before and after the Helen is research active undertaking a number the nurses wished to continue to use the DCI, programme and were interviewed on comple- of research projects which focus on nursing there were barriers identified such as the time tion about their views and experiences. Fifteen and patients with chronic illness. Her research taken to complete; the identification of suitable participants were recruited through purposive interests include the impact of fatigue and patients and the need for more training to enable sampling from April - December 2014. breathlessness on patients, breathlessness them to initiate difficult conversations on dignity management in heart failure, end of life issues Results: Twelve participants completed the conserving care and end of life care. for patients, support for carers, pressure ulcer study, six in each cohort. Due to sample size assessment and the development of a patient only inferences can be Drawn from the standard Recommended reading list reported outcome measure for patients with measures analysis. No improvements in quality heart failure. Helen works closely with clinical 45) Johnston, Larkin, P, Connelly, Barry, of life or emotional well-being were seen, colleagues in the acute and community NHS C, Narayanasamy,M, Ostlund, Mcilfatrick S however, attitudes to hospice services improved. trusts. (2015) Dignity conserving care in palliative Four themes emerged from Interview analysis; care settings: An integrative review. Journal of positive emotional transference, uncertain Clinical Nursing doi: 10.1111/jocn.12791 future, hospice environment and programme Brown H, Ostlund U, Johnston B 2011 Iden- structure. tifying care actions to conserve dignity in end 1.3.3 Abstract number 217 Discussion: Participants were positive about of life care in rural Scotland: Patients, carers, the structure and delivery of the programme. 12:30pm nurses and GPs perspectives. British Journal of The hospice environment enabled discussion Community Nursing,16 (5) p.238-245. of their symptoms with health professionals ‘It’s like opening a can of Johnston B, Ostlund U, Brown H. (2012) Evalua- but also with other CHF patients developing a tion of the Dignity Care Pathway for community support network. The majority of participants worms’: evaluating a dignity nurses caring for people at the end of life. Inter- valued the social aspect of the programme and care intervention for people national Journal of Palliative Nursing, 18(10), an opportunity to review future choices and with life limiting illness in the 483-489. decisions. community setting Conclusions: Participants valued the Presenter: Professor Sonja McIlfatrick, Ulster Biography programme and wanted to have on-going con- University Northern Ireland, Newtownabbey, Sonja is a registered nurse with approxi- nections with both the participants and the UK mately twenty years’ experience in palliative hospice. Co-author(s): Professor Larkin, Ireland, Dr care practice, education and research. She has Connelly, Ireland, Prof Johnston, UK, Ms extensive experience in undertaking research as Recommended reading list Charnley, Ireland, Dr Murphy, Ireland well as leading and providing strategic direction Barclay S, Monen N, Case-Upton S, Kuhn I, for research. Having qualified as a registered Smith E (2011) End of Life care conversations Abstract nurse and graduated with a nursing degree from with heart failure patients: a systematic lit- Background: Evidence indicates that people the University of Ulster in 1991, Sonja began her erature review and narrative synthesis. British nearing end of life fear loss of dignity and a research career completing her MSc in 1999 and Journal of General Practice, vol 61, no 582, pp central tenet of palliative care is to help people her PhD from University of Ulster in 2003. e49-e62 die with dignity. The Dignity Care Intervention Sonja is a Professor in Nursing at Ulster Univer- Johnson M, Nunn A, Hawkes T, Stockdale S, (DCI), based on the Chochinov theoretical model sity. Within her university role, Sonja is Post- Daley A (2012) Planning for end-of-life care in of dignity care, comprises four components: graduate Tutor as well as the lead for the Pallia- heart failure: experience of two integrated car- education manual; patient dignity inventory, tive Care Strand within the Managing Chronic diology-palliative care teams British Journal of reflective questions and care actions. Illness Research Centre. Sonja is also a Senior Cardiology, vol 19, no 2, pp71-5. Aim: To evaluate the usability and acceptability Investigator in the Palliative Care research National Institute for Cardiovascular Outcomes of a Dignity Care Intervention (DCI) delivered by Network for All Ireland Institute of Hospice Research (NICOR) (2013) National Heart community nurses for people with advanced and and Palliative Care. research interests include: Failure Audit 2012-13. Institute of Cardiovascu- life limiting conditions. decision making at end of life; palliative care lar Science, University College London and chronic illness; public awareness of pal- Method: Mixed methods research design. liative care and psychosocial support for carers/ Semi-structured, face-to-face interviews with families affected by advanced disease Biography patient/carer dyads (n=18), four focus groups Helen Walthall is a qualified adult nurse who with community nurses (n=24) and an online specialises in cardiorespiratory care. Helen survey with community nurses (n=27) were graduated in 1995, completed her Postgraduate conducted. Data were analysed using thematic

10 11.30 – 12.55 Concurrent session 1 – Wednesday 61 April 2016 Theme: Interviewing the UKONS Living With and Beyond Cancer the decisions they made and was the main Forum reason for them not following medical advice. 1.4.1 Abstract number 280 Currently Chair of London Cancer Alliance Social circumstances and general health beliefs also influenced treatment decision making. 11:30am (LCA) Survivorship Pathway Group and a member of the Macmillan Consequences of Discussion: Generally, participants believed The lived experience of Cancer Treatment Collaborative (CCaT) they had actively contributed to treatment Additionally Co Chair of the Royal Marsden decisions. Those who had not followed medical surviving at least five years advice felt that health professionals respected after a diagnosis of prostate Living With and Beyond Cancer (Survivorship) Committee and Co-Chair of the Cancer Nursing their decision. cancer received at or after the Partnership (CNP)which has been formed to Conclusion: The results of this study suggest age of 65 facilitate the delivery of the Recovery Package that patients want to take an active part in Presenter: Dr Natalie Doyle, DNurs MSc BSc, treatment decision making for colorectal cancer. Nurse Consultant, Royal Marsden NHS Foun- Health care professionals need to take into dation Trust, London, UK account the wider influences that contribute to decision making by patients. 1.4.2 Abstract number 358 Abstract Recommended reading list Introduction: Prostate cancer is the most 12:00pm common cancer in older men and the most wide- MacMillan Cancer Support (2012) The Age Old spread male cancer in developed countries. It is Shared decision-making Excuse: The under treatment of older cancer commonly localised and indolent in nature and about treatment for colorectal patient at http://www.macmillan.org.uk/ with treatment is characterised by significant cancer - the perspective of Documents/GetInvolved/Campaigns /AgeOld- long term survival. There is limited research into older patients Excuse/AgeOldExcuseReport-MacmillanCan- what the experience means to men who have cerSupport.pdf (accessed 19th August 2014) Presenter: Dr Jaqualyn Moore, PhD, FHEA, survived more than five years after diagnosis. Ritchie, J., Lewis, J. (2003) Qualitative research RNT, RN, King’s College London This presentation will explore the study practice: a guide for social science students and methods, results and implications for practice of Florence Nightingale Faculty of Nursing & researcher, London: Sage an investigation into the experience of older men Midwifery, London, UK Strohschein, F., Bergman, H., Carnevale, F., with prostate cancer Co-author(s): Karen Gillett, England, UK; Loiselle, C. (2011) Patient decision making Objectives: To explore and interpret the lived Claire McGilly, England, UK; Harriet Watson, among older individuals with cancer, Qualitative experience of men who have survived at least England, UK; Cath Taylor, England, UK Health Research, 21 (7): 900 - 926 five years after a diagnosis of prostate cancer received at or after the age of sixty-five years. Abstract Biography Methods: Hermeneutic phenomenology based Background: Older patients typically receive Jaqualyn is a Lecturer in Nursing at King’s on Heideggerian principles was used to explore less intensive cancer treatment and it is unclear College London. Her research interests include the experiences of ten purposefully selected whether treatment is not appropriate, not patient experience of cancer therapy, support- men. Individual, unstructured interviews were offered, or not accepted (Macmillan Cancer ive cancer care, care needs of older people with audio-recorded and transcribed. Data collected Support, 2012). Few research studies have cancer and professional development of pre-reg- explored cancer treatment decision making between February and July 2012 was analysed istration nurses. applying the hermeneutic circle to uncover by older adults and understanding of the themes, guided by van Manen’s approach. influence of social and cultural factors is limited. Results: A phenomenological interpretation Strohschein et al. (2011) suggest research needs is offered using an antecedent and ten themes to focus on the patient’s experience of health presented within four fundamental human exis- related decisions. They propose that research 1.4.3 Abstract number 263 should focus on understanding the structure, tentials. This demonstrated that each man had 12:30pm unique motivation for undergoing treatment content, influencing factors, and consequences of patient decision making itself. for prostate cancer and this was placed within Venous access, the voice of a fluctuating hierarchy of concerns. Any Aim: To increase understanding of the process the patient lived expereince. treatment consequences were balanced within a of shared decision making about treatment from personal context and a multi-faceted post cancer the perspective of older patients with a diagnosis Presenter: Dr Melissa Robinson-Reilly, Doctor treatment persona evolved to suit each individ- of colorectal cancer. of Philosophy, Faculty of Health & Medicine, School of Nursing & Midwifery, University of ual’s life. Methods: Semi structured interviews were Newcastle, Callaghan, Australia Conclusions: To allow each man to evolve into conducted between June and December 2015 his post cancer treatment persona healthcare with 14 patients aged 65 to 92 who had received Co-author(s): Penny Paliadelis, Australia; professionals should respect his unique under- a diagnosis of colorectal cancer within the Mary Cruickshank, Australia. standing and motivation. Consideration should previous 18 months. Interviews were audio- be given during the planning and delivery of recorded and transcribed verbatim. Data were Abstract care to the position that prostate cancer and its analysed using the framework approach (Richie Background: The literature is replete with consequences occupy within the hierarchy of and Lewis, 2003). research about the evolution around the venous concerns of each individual’s life. Results: Diagnosis of colorectal cancer often access procedure, cannulation, the risks and the followed an acute symptomatic episode with benefits, yet, there is limited research specific to Biography initial treatment decisions being made quickly. the patient experience of venous access. Employed since 2005 as Nurse Consultant, Participants’ main source of information was Aim: The purpose of this study was to under- Living With & Beyond Cancer at The Royal health care professionals. Other sources of infor- stand the patients’ experience of venous access, Marsden NHS Foundation Trust. mation included friends, relatives, the internet with the aim of bringing forth the voices of a and books. Previous experience of cancer President of UKONS (United Kingdom Oncology group of cancer patients who have undergone treatment (their own or other peoples’) affected Nursing Society)2014-2016 and co-founder of repeated venous access/cannulations.

11 111.30 – 12.55 Concurrent session 1 – Wednesday 6 April 2016 Method: Two rural oncology units in New Theme: Interviewing Li, J., Galatsch, M., Siegrist, J., Muller, B.H., South Wales, Australia, were chosen for the Hasselhorn, H.M. (2011) Reward frustration recruitment of fifteen participants in this quali- 1.5.1 Abstract number 170 at work and intention to leave the nursing tative study. At the time of this study, the par- professionâ€’Prospective results from the ticipants had either completed chemotherapy or 11:30am European longitudinal NEXT study. Interna- were currently being treated. Participants were tional Journal of Nursing Studies 48 The toxic vortex: the lived asked to discuss what it was like to be repeatedly Maslach, C., Schaufeli, W. and Leiter,M. P. cannulated. Data was collected via audiotaped experience of frustration in (2001). Job burnout. Annual Review of Psychol- individual interviews, the participants’ stories nursing practice ogy, 52,(1) 397-422. were transcribed and analysed thematically. Presenter: Mr John McKinnon, MSc PG Dip BA The themes that emerged from the participants’ (Hons) RGN RHV RMN, University of Lincoln, Biography stories provided insightful and valuable data Lincoln, UK into their perceptions of being cannulated and John is a senior lecturer in nursing at the uni- the decision-making process regarding how and versity of lincoln with a clincal background Abstract where the procedure occurred. in mental health, critical care, health visiting Background: Frustration describes the and safeguarding. His specialist interests are Results/Discussion: The findings showed emotion experienced in the face of stemmed emotional intelligence and reflection. His that a holistic approach to care was often missing progress in spite of the best efforts being made doctoral studies have been concerned with which caused the participants significant feelings and has been defined by Berkowitz (1981:83) the development of a framework to harness of vulnerability and distress. Gaining insight into as ‘an unexpected barrier to goal attainment’. emotions to inform clinical judgment in nursing their experiences highlighted the considerable The emotion has been identified as destructive practice. His new book ‘Reflection for Nursing impact that the procedure has on patients and to health and productivity in the work place Life’ proposes a fresh approach to the use of better collaborative decision-making between (Maslach, Schaufeli and Leiter, 2001), a source reflection in nursing. clinicians and patients is required. of moral distress (Burston and Tuckett ,2012) Conclusions: There are implications to be and a predictor of the intention to leave nursing considered for policy and practice involving (Li, Galatsch, Siegrist, Muller and Hasselhorn, venous access/cannulation. With the focus on 2011) improving patient outcomes through procedural 1.5.2 Abstract number 318 Aim: The paper aims to examine the sources governance, with the intent of translating this and dynamics of frustration in nursing practice. 12:00pm research into evidence based policy. It is antici- Method: Thirty- three nurses across pated that by understanding the experience of Street level bureaucracy and being cannulated from the patients’ perspective community, public health, paediatrics, mental will contribute to enhancing practice. health and acute adult surgery talked exhaus- the selection of candidates for tively in interview about their experiences of nursing. Biography frustration in their professional lives. The data Presenter: Mrs Jane Welby, MSc. BSc (Hons) was collected in a London teaching hospital trust Melissa is an endorsed Nurse Practitioner within RGN RM, School of Nursing, Faculty of Health and in three community NHS trusts in the East Studies, University of Bradford, Bradford, UK the discipline of Oncology/Palliative Care, Midlands of England between November 2011 Co-author(s): Dr Anita Sargeant - England. Dr having a nursing career spaning over 35years. and August 2012. The interviews were audio- Chris Dearnley - England Melissa was appointed to her first academic taped and transcribed verbatim. The transcripts position in June 2015, within the School of were analysed using Grounded Theory Method. Nursing and Midwifery, at the University of Abstract Newcastle, New South Wales, Australia. As a Results: Frustration was experienced as a toxic vortex like force pulling in other negative Background and Aim - Several factors identi- lecturer at the university, part of Melissa’s role fied by Lipsky (2010) inevitably influence the is supporting students with their clinical com- emotions; a ‘time thief’ which defied proactive planning and undermined good practice. recruitment, nationally and internationally, petency portfolios within the Master of Nursing of candidates for nursing programmes, and degrees, (Nurse Practitioner and Mental Health Suggestions in the extant literature on the pragmatic management of frustration were seen consequently influence the implementation Nurse Practitioner). Melissa completed her PhD of workforce recruitment strategies such as in 2014, awarded Doctor of Philosophy, having as unviable in nursing. Sources of frustration included non listening management, colleagues Framework 15 (HEE 2014). Drawing on Lipsky’s researched the lived experience of venous access, work (2010), and with reference to Foucault with these findings published in the Support- behaving badly and system- reality incompat- ibility. Frustration exerted a vortex effect on (1972-1984), this paper discusses study findings ive Care in Cancer journal in 2015. During her from the perspective of selection personnel who candidature for doctoral studies, Melissa had wellbeing featuring workload drift, non reflective behaviour, accelerated exhaustion, working find themselves in the untenable situation of pri- presented her preliminary findings at five inter- oritising, when demand for places outstrip or is national conferences. Melissa also holds two relationship downturn, loss of autonomy, burnout and giving up. insufficient in meeting organisational and com- Masters’ of Nursing degrees, Nurse Practitioner missioning imperatives. and Palliative Care. Melissa’s career passions Conclusion: Frustration in is the single most includes education, research, and ethics. destructive entity in nursing. As a reflection Method: Grounded theory using theoreti- point within a framework for clinical judgment cal sampling, semi structured interviews and it has potential for identifying hindrances to constant comparative thematic analysis under- good practice and development of strategies to pinned by memos was used. Simultaneous data address them. collection and analysis was undertaken during 2014 in two HEI’s prior to the implementation of the values based recruitment strategy. The Recommended reading list findings have implications for the conduct and Berkowitz, L. (1981) On the Difference between outcomes of the selection process. Internal and External Reactions to Legitimate Findings: The study demonstrates that par- and Illegitimate Frustrations: A Demonstration. ticipants apply the NHS Constitution Values as Aggressive Behaviour. 7(2) 83-96 part of the overall selection process. However, in attempting to meet organisational imperatives,

12 11.30 – 12.55 Concurrent session 1 – Wednesday 61 April 2016 selection personnel are compelled to become to be insufficiently robust in methodologies used Post Graduate Diploma in Cognitive Therapy for street level bureaucrats. They apply a wide range and lacking focus on outcomes for develop- Severe Mental Health Problems, Southampton of organisational and localised filters which con- ment of practitioners and their practice, (Perry University. sequently vary in consistency. These filters may et al, 2013, Happell et al, 2014). The research Master of Arts in Social Research, Goldsmiths materialise at any point in the selection process, presented intends to address this gap. University, London. for example raising the entry tariff at an organi- Aim: To focus on how learners experience Professional Qualifications sational level or applying personal preferences service user involvement and the meaning this Registered General Nurse RN and values as an individual filter. has for them as developing professionals under- Discussion and Conclusion: Street level taking emotional care work. Registered Mental Health Nurse bureaucratic filters therefore play a significant Methodology and Methods: A qualita- Post Graduate Certificate in Adult Education part in determining how many candidates make tive approach, embedded within a pedagogical PGCEA it through the various selection stages and may and ethical framework that views the research Janet currently works as a senior lecturer at ultimately result in the loss of good candidates process and ethical values that underpin pro- Canterbury Christchurch University (Kent) or the selection of poorer candidates. The danger fessional practice, as a parallel process. A case and her academic and clinical interests include is that a recruiting for values strategy simply study design was used to examine a learner psychosocial interventions, creative therapies, becomes another means of filtering, rather than cohort (n17), over year one of a three year under- person centred care and health promotion. Janet being the primary Driver for consistent recruit- graduate programme, (April 2014 to January is committed to developing innovative ways ment outcomes. 2015). From this cohort, 6 students took part in of including the service users voice in profes- 1:1 narrative interviews towards the end of year sional education and has taken a lead in devel- Recommended reading list one. Text data (essays and written classroom oping a strategy for service user involvement in Evans T (2010) Professional Discretion in reflections), were collected from all 17 students her current role and previously when at Kings Welfare Services: Beyond Street Level Bureau- and examined using elements of thematic and College University, London. Janet continues to cracies. Surrey: Ashgate Publishing Group dialogic narrative analysis (Reissman, 2008). work closely with the ‘buddy scheme’ (a local A more detailed case-focused narrative analysis Foucault M and Faubion JD (Editor) (1994) trust initiative), in taking this work forward. was used to examine data from the six students Power: The essential works of Michel Foucault. Her research work includes the ‘socialisation interviewed. London: Penguin Books of graduate mental health learners’ (under- Results: Emerging themes illustrate theoreti- graduate work at South Bank University, 1985), Lipsky M (2010) Street Level Bureaucracy: cal propositions about the positioning of mental the ‘influence of service user involvement in Dilemmas of the Individual in public services. illness and learning disabilities in society (inside education on mental health nurse learners’ (for (30th anniversary expanded edition). New York; and outside the UK), the exercise of power in MA at Anglia university, 1998), and the devel- Russell Sage Foundation. differing health discourses’ and function of opment of compassion in mental health learners emotional labour. Concepts of self presentation (for MA Social Research, Goldsmiths university, Biography (Goffman) and emotional labour (Hoschild) 2015). I am a nurse having registered in the late 1970’s frame the results. and have been a lecturer in the school of nursing Discussion and conclusion: Implications for at the University of Bradford for the past eleven ‘active ingredients’ of service user involvement years. I was very fortunate to have been given the are discussed in relation to developing compas- opportunity to study for a PhD and commenced sionate health care practices. Conclusions con- Theme: Mixed methods in October 2011 on a part time basis. My profes- tribute to an emerging critical debate about a sional interests are in Values based recruitment, global construction of compassion and role of 1.6.1 Abstract number 198 neonatal nursing, public health and healthcare the media and political vested interests in this. law and ethics. 11:30am Recommended reading list Comparison of the expressed Happell, B, Byrne, L, McAllister, M, Lampshire, experiences of survivors of D, Roper, C, Gaskin, C, Martin, G, Wynaden, D, childhood medulloblastoma 1.5.3 Abstract number 252 McKenna, B, Lakeman, R, Platania-Phung, C, with measures of health 12:30pm Harmer, H (2014) Consumer Involvement in the tertiary-level education of mental health pro- & quality of life, and with The experience of service user fessionals: A systematic review, International issues identified during involvement, organisational Journal of Mental Health Nursing,23, p3-16. consultations: improving discourses and development Perry, J, Watkins, M, Gilbert, A, Rawlinson, J rapid and proactive response (2013) A systematic review of the evidence on to problems of compassionate emotional service user involvement in interpersonal skills work for novice mental health training of mental health students. Journal of Presenter: Professor Tony Long, SRN, RSCN. nurse learners. Psychiatric and Mental Health Nursing, 20, RNT, BSc (Hons), MA, PhD, Professor of p525-540. Child & Family Health, University of Salford, Presenter: Mrs Janet Wood, RGN, RMN, Salford, UK Bsc, MA Mental Health, MA Social Research, Reissman, CK (2008) Narrative Methods for the Co-author(s): Eddy Estlin, UK; John Keane, PGCEA, Diploma CBT, Senior Lecturer, Can- Human Sciences, London, Sage. UK; Rao Gattamaneni, UK; Martin McCabe, terbury Christchurch University, Chatham, UK UK; Ian Kamaly-Asl, UK; Goran Nenadic, UK; Biography Azad Dehghan, UK Abstract Academic qualifications Background: Although the inclusion of service BSc Hon Social Sciences South Bank University, Abstract users in professional education is a policy imper- London Background: Children brain tumour survivors ative across the health and social care sector, the Master of Arts in Mental Health, Anglia Univer- face challenges with neurological functioning, benefits of this have been assumed rather than sity. epilepsy, vision, hearing, growth, endocrine, evidenced. Existing research on this is reported

13 111.30 – 12.55 Concurrent session 1 – Wednesday 6 April 2016 and psychosocial functioning (Anderson et al, Biography interpretation of results. In addition, a task & 2001). The cognitive sequelae of medulloblas- After a 10 years clinical career in chilDren’s finish group was convened to guide the Scoping toma therapy include problems of attention, and intensive care nursing, and 14 years in 6 process. memory and intellectual functioning, with poor posts in nurse education, I joined the Univer- Results: fifty-eight relevant policies were iden- educational attainment, adverse employment sity of Salford in 2002 as Senior Lecturer in tified (2001 to 2015) and the commonalities / prospects, inactive lifestyle and diminished Child Health Research. In 2006 I was appointed pertinent for an AMU discharge process, deter- quality of life (MadDrey et al, 2005; Mulhern et Professor of Child & Family Health. mined as relevant to acute care. This research al, 2004). I lead CYP@Salford: a multi-professional is timely and current - it aligns with the recent Aim: To identify discrepancies in family nar- research group which spans health, social publication of the NICE guidance (NG 27)for the ratives; measures of health, quality of life and care and education and focuses on enhancing transition of patients with social needs (NICE, psychological wellbeing; and hospital records to services, improving outcomes and evidencing December, 2015) inform more effective clinic consultations. impacts on children and families. The research Conclusions: This work provides a novel con- Method: Twenty-one patients (11-39 years, group works closely with colleagues in the NHS, tribution to create bespoke discharge guidance 0.5-12 years at diagnosis) were recruited from Local Authorities, the Third Sector, and national for AMUs through a revision of the English follow-up clinics (2013-2014). Seven were 11-16 networks. We have research links with interna- discharge principles (Department of Health, years, and seven 18-24 years to include transitional partners in Scandinavia, the Middle East, 2010). Next Steps: complete the exploratory tion times (changing school/ starting employ- the Far East, Europe and Australia. Case Study (Yin, 2011) using theoretical propo- ment). Health status (HUI), health-related My own research is in two programmes: sitions constructed through Critical Realism quality of life (PedsQL or EORTC QLQ-C30) and improving quality of life outcomes for survivors (Sayer, 2000) to frame & explore the current psychological wellbeing (PI-ED or HADS) were of childhood brain tumour; and enhancing issues within the discharge process. measured. Families were interviewed to elicit the impact of early intervention in services for problems experienced since diagnosis. Clinical neglected chilDren. Recommended reading list records were scanned, and all data was subjected Arksey H., and O’Malley L. (2005) Scoping to text-mining to compare perspectives of pro- Studies: towards a methodological framework. fessionals and patients. www.eprint.whiterose.ac.uk Outcomes: Patients showed severely impaired 1.6.2 Abstract number 420 Wildridge, V., Bell, L. (2004) How Clip became health, characterised by increasing burden of Eclipse: a mnemonic to assist in searching for disability. Multifunctional diminished quality of 12:00pm health policy/management information. Health life was evident for most younger patients. Psy- Information and Libraries Journal 19 (2): 113 chosocial functioning and school problems were Discharge and risk -115. worse than issues of physical functioning. Pain assessment in acute care and cognitive functioning deficits impacted on Evidence for Policy and Practice Infromation quality of life. For some adult patients, motor Presenter: Mrs Liz Deutsch, RGN, DipN., BSC Centre (Eppi) 2010, methods for conducting dysfunction and communication deficit reduced Hons (first), MSc, Heart of England NHS systematic reviews, EPPi centre, on line access quality of life. More emotional distress was Foundation Trust Birmingham and University to paper from Social Research Unit, Institute for recorded for under-18s than for older patients. of Manchester, Ledbury, UK Education, University of London Discussion: Despite physical and cognitive Abstract Biography deficits, younger patients retained aspiration to achieve in life, seeking more positive responses Background: Acute Medicine Units (AMUs) RGN, Dip N., BSc (hons), Dip HSM, MSc, Dip from schools and services. For adults, the also form a crucial part of emergency care, PGR Clinical Doctoral Research Fellow with lifelong impact of the tumour and treatment notwithstanding they adopt generic in-patient National Institute for Health Care Research predominated, followed by limited employment discharge guidance, posited as sub optimal (NIHR) & Consultant Nurse in Acute Medicine, opportunities. Lack of social life was burden- practice for the setting. Heartlands Hospital Liz has 24 years of post reg- some. Patients prioritised school, emotional, Introduction: A Scoping Review of UK istration nursing experience in a variety of chal- cognitive, and physical functioning; while pro- discharge policy/guidance for patients dis- lenging clinical settings; acute and community; fessionals focused more on treatment, investiga- charged from emergency care, specifically AMUs latterly, within a large acute medicine unit, tion, and physical functioning. was conducted as the first stage of the Case Birmingham. Liz has embarked on a new phase of her career and is currently undertak- Conclusion: Consultations now focus more on Study research. ing National Portfolio Research via 3 year full patient-identified priorities. Aim: to critically consider, compare and time Research Fellowship at the University of contrast relevant policy/guidance underpin- Manchester, funded by the National Institute Recommended reading list ning the discharge process and risk assessment; for Health Care Research (NHIR) - the project in order to reinterpret and construct bespoke Anderson DM, Rennie KM, Zielger RS et al. is ‘entitled’ ROAD: Risk Objective Assessment guidance for AMUs facilitating timely patient (2001) Medical and neurocognitive late effects for Discharge. She will soon publish her first discharge. among survivors of childhood central nervous outputs - the Literature Review for ‘assessment system tumours. Cancer 92: 2709-19 Method: the Arksey and O’Malley Scoping of discharge’ and a Scoping Review of National MadDrey AM, Bergeron JA, Lombardo ER et al. methodology were followed: stage one: four Discharge Policies. Liz has 48 peer reviewed (2005) Neuropsychological performance and broad review questions were formed as a guide; articles (Pub-Med) and she is the sole Editor of quality of life of 10 year survivors of childhood stage two: the most relevant discharge policies two multi-author, multi-disciplinary books on medulloblastoma. Journal of Neurooncology 72: were identified using the ECLIPSE framework; discharge-planning. She has a broad portfolio 245-53. stage three: discharge policies were selected, of interests, namely work-based competencies organized and critiqued through an inclusion/ for acute medical nursing skills, clinical assess- Mulhern RK, Merchant TE, Gajjar A, Reddick exclusion criteria focused on topic, popula- ment of the older person; educational develop- WE, Kun LE. (2004) Late neurocognitive tion, setting, discharge process and standards ment with local University providers and within sequelae in survivors of brain tumours in (Evidence for Policy and Practice information the Education Faculty at Heartlands Hospital. childhood. Lancet Oncology 5: 399-408. centre, EPPI); stage four: each of the discharge She currently leads on developing and deliver- process steps/principles from policies were ing critical appraisal skills, academic writing, charted to identify overlaps/gaps; stage five: portfolio development and publishing.

14 11.30 – 12.55 Concurrent session 1 – Wednesday 61 April 2016 1.6.3 Abstract number 331 Recommended reading list students, trainees and employees with personal values consistent with those enshrined in the 12:30pm Brooks, F., et al. (2013) ‘Evaluation of services for children with complex needs: mapping NHS Constitution. In this paper we will present service provision in one NHS Trust.’ Primary the first phase of a program of work which Multi-professional Health Care Research & Development 14(1), pp. tests this intuitive appeal by asking, ‘Does the educational sessions for 52-62. evidence for values based recruitment [VBR] merit the faith that policy makers have placed health visitors caring for Cowley S, Whittaker K, Grigulis A., Malone M., in it?’ The policy of VBR assumes recruiting children with complex Donetto S., Wood H., Morrow E., Maben J., for values and behaviours, and maintaining (2013) Why Health Visiting? A review of the needs: evaluating contexts, and encouraging them in practice, will improve literature about key health visitor interven- mechanisms and outcomes. healthcare quality. Despite NHS employers and tions, processes and outcomes for children and Presenter: Dr Alison Steven, PhD, MSc, the Universities that educate its students being families. (Department of Healt Bsc(Hons), PGC, RN, FHEA, Reader in Health compelled to implement it, there is no robust Professions Education, Northumbria Univer- Pawson, R. and Tilley, N. (1997) Realistic Evalu- evidence to suggest that VBR will actually raise sity, Newcastle upon Tyne, UK ation. London; Sage. quality. Moreover, much of the logic behind Co-author(s): Larkin V.UK, Stewart J.UK, exactly how it is supposed to work is implicit, Stanton B.UK, Bateman B.UK Biography tacit and dispersed between a myriad of think Alison studied for her first degree in Nursing pieces, editorials, and policy documents. Abstract Studies BSc(Hons) at Northumbria University Our paper will detail the realist development gaining a first, before taking up a position as staff (undertaken between April to October 2015) Background: Targeted multi-professional nurse and completing a PhD at Newcastle Uni- of a programme theory, describing the mecha- services are necessary worldwide for best care of versity. Her doctoral study investigated clinical nisms by which VBR (theoretically) promotes children with complex needs. 15% of UK children skills education for Nurse Practitioners using a desired values and behaviours in the health care under five have a complex long-term condition discourse analysis approach. She later worked workforce. We will present the findings of (i) a (Brooks 2013). Nursing and health visiting con- as a research associate, research fellow and then policy document analysis; (ii) a rapid review tributions are associated with better outcomes, senior research associate in Newcastle Univer- of VBR literature; and (iii) interviews with the however there is ongoing need for access to post- sity Medical School. In 2008 Alison came back ‘architects’ of the VBR programme. The theory registration education (Cowley et al 2013). A 3 to Northumbria as Senior Lecturer in Knowledge presented will outline the context, mechanisms hour interactive multi-professional workshop Translation in Public Health working with FUSE and outcomes leading to both the intended for health visitors was developed and delivered (UKCRC funded Centre for Knowledge Transla- consequences of VBR, as well as the policy’s in a community setting in the North of England. tion in Public Health) and in 2011 was appointed unintended consequences. In doing so, we will Aims: Drawing on a realist approach (Pawson to the position of Reader in Health Professions question the empirical and theoretical founda- and Tilley, 1997) this study explored contex- Education. Alison has a longstanding interest in tions for the policy, relevance for other health tual factors, mechanisms at play and short to education and learning both within and across systems, and outline how and why the study of medium term outcomes. health professions.Alison has been involved in its implementation, costs and consequences is Methods: Data collection (documentary, obser- research focused on: patient safety education, needed. vation, interview, questionnaire) was under- education for new roles, developing a National taken at multiple points between June 2014 and CPD framework for nurses working with older Biography people, practice based education for end of May 2015. To identify, unpick and track context, Carl is a health services researcher, nurse and life care, inter-professional education, clinical mechanism and outcome configurations, NHS Foundation Trust Non Executive Director. supervision, knowledge translation, the develop- analysis was iterative Drawing on notions of He held a personal Chair at the University ment of Quality Improvement networks across constant comparison. Data workshops facilitated of York (2009 to 2015) and was appointed Europe, CPD and workforce development. discussion, debate, challenge and agreement of Professor of Applied Health Research at the findings. 17 Health Visitors participated (80%). University of Leeds in February 2015. Carl’s Findings: Several temporally located con- research career has focused on getting evidence textual factors, mechanisms and outcomes into the decisions, judgements and behaviours emerged. A conceptual map will be presented of healthcare professionals. He has co-authored and discussed. The development of ‘emotional Theme: Mixed methods or edited three texts on decision making, safety for learning’ was important and involved judgement and evaluation in nursing and more mechanisms of reciprocity, interactivity and 1.7.1 Abstract number 404 than 120 publications. Professor Thompson sits relevance. Short term outcomes included 11:30am on the NIHR’s HSDr prioritization panel and the network development, informative learning and NHSI’s Knowledge Exchange funding stream. increased confidence. Medium term practice Values based recruitment: He is a former co-editor of the BMJ/RCN Pub- outcomes including accessing support and early lishing journal Evidence Based Nursing and has referral were linked directly to workshop attend- developing a programme attracted funding of more than Â£6m in the last ance. While the workshops positioned health theory for a realist evaluation 10 years. visitors as learners and others as facilitators, Presenter: Professor Karen Spilsbury, PhD, the unanticipated question ‘who actually was RN, Professor of Nursing Research, School of the learner’ emerged to challenge underlying Healthcare, University of Leeds, Leeds, UK assumptions. Co-author(s): Karen Spilsbury, UK Conclusion: The structure, context and facilitation of the workshops engendered various Abstract facilitatory and inhibitory mechanisms leading to a range of outcomes including practice With more than a million people employed in changes. Learning can be taken from the the National Health Service (NHS), the vast workshop format and facilitation which may be majority in front-line patient care, and publi- transferable across contexts and continents. cally voiced concerns over failures in care and quality, it feels intuitively appealing to recruit

15 111.30 – 12.55 Concurrent session 1 – Wednesday 6 April 2016 1.7.2 Abstract number 307 Recommended reading list 1.7.3 Abstract number 101 12:00pm Wilson P, Mathie E, Keenan J, McNeilly E, 12:30pm Goodman C, Howe A, Poland F, Staniszewska S, Kendall S, Munday D, Cowe M, Peckham Effective patient and public S ReseArch with Patient and Public invOlve- Improving nurses’ responses involvement in HTA and ment: a RealisT evaluation - the RAPPORT to intimate partner violence: the importance of good study. Journal: Health Services and Delivery Development of a theory of relationships: Findings Research Volume: 3 Issue: 38 Publication change model from the RAPPORT study date: September 2015. DOI: http://dx.doi. Presenter: Dr Caroline Bradbury Jones, PhD, (ReseArch with Patient org/10.3310/hsDr03380 Reader, University of Birmingham and Public InvOlvement: Mathie, E, Wilson P, Poland, F, McNeilly, E, UK, Birmingham, UK Howe, A, Staniszewska S, Crowe, M, Munday, D, a RealisT Evaluation): a Goodman, C. (2014). Consumer Involvement in Co-author(s): Julie Taylor, UK, Jayne Parry, national evaluation of health health research: a UK scoping and survey. Inter- UK research with patient and pub national Journal of Consumer Studies 38:35-44 Abstract Presenter: Dr Sophie Staniszewska, DPhil Stephens R, Staniszewska, S (2015). One small (Oxon), BSc (Hons), RCN Research Institute, stepâ€¦ Research Involvement and Engage- Background: Intimate Partner Violence (IPV) Warwick Medical School, University of ment; 1:1 doi:10.1186/s40900-015-0005-8 is a universal problem and is considered a sig- Warwick, Coventry, UK nificant public health issue. Nurses are inan ideal position to recognise and respond to IPV Co-author(s): Patricia Wilson, Elspeth Biography but there is significant evidence that they do not Mathie, Julia Keenan, Fiona Poland, Amanda Sophie Staniszewska leads the Patient and Public always respond appropriately. Awareness, rec- Howe, Claire Goodman, Marion Cowe, Diane Involvement (PPI) and Experiences Programme ognition and empowerment have been suggested Munday, Elaine McNeilly, Stephen Peckham, at the RCN Research Institute, Warwick Medical as factors that may positively influence nurses’ Sally Kendall School. Sophie is Co-Editor in Chief of the Biomed IPV responses (Bradbury-Jones et al. 2014). As Journal, Research Involvement and Engage- yet however the mechanisms for how this might Abstract ment, the first international journal focusing on work have not been explored. Background: Patient and public involvement PPI which is co-produced with patients. Sophie is an INVOLVE Associate and a member of the Methods: Using methods and tools from the (PPI) has become a key area in research, inter- field of Theory of Change (Center for Theory nationally. Few studies have developed our NETCC PPI Reference Group. Sophie is also a member of the Health Technology Assess- of Change 2015), we undertook a structured, understanding of PPI in relation to what works, six step analysis. Theory of Change involves a for whom, in what context and why. This presen- ment International Patient/Citizen Involve- ment Steering Group and co-chairs the Methods back-mapping (filling the gaps) from intended tation will focus on key findings from an NIHR outcomes (improved IPV responses among funded study, RAPPORT (Wilson et al 2015), and Impact Group. Sophie recently chaired the NICE Patient Experiences Guideline and Quality nurses) to key domains considered to be which identified the importance of relationships important, i.e. awareness, recognition and in successful PPI in research. Standard and subsequently the NICE Evidence Update. This work was informed by the scoping empowerment. The aim of the process was to Methods: RAPPORT was a national evalua- study Sophie led which developed the Warwick identify the requirements to bring about change. tion of patient and public involvement (PPI) in Patient Experiences Framework. Sophie works Results: We identified the requirements for each health research completed in February 2014. closely with NHS England, advising key policy of the three domains: 1) Awareness (Enhancing Six topic areas were focused on; arthritis, cystic makers in relation to experiences of care. She understanding, increasing confidence, dispel- fibrosis, dementia, diabetes, intellectual and is an advisor to CQC on patient experience and ling myths and stereotypes); 2) Recognition developmental disabilities, and public health. is topic advisor to SCIE on service user experi- (Establishing trusting relationships, creating We used a realist evaluative design to find out ence of social care. Sophie was a member of the opportunities for disclosure); 3) Empowerment what worked best in PPI, in what circumstances Research Excellence Framework 2014 Public (Increasing likelihood of disclosure, appropri- and why. The RAPPORT study comprised of Health, Health Services and Primary Care Panel. ate support and referral). Each requirement area three stages including a national scoping of the Sophie reviews for a range of funding bodies and has a corresponding set of actions for nursing current extent of PPI, a survey of chief investi- international journals, is on the editorial board practice. These cluster around four important gators, and 22 research studies followed over 18 of a number of journals. areas: Education, training and clinical supervi- months to evaluate PPI outcomes. sion; Interpersonal relationships; IPV enquiry; Results: Relationships emerged as a key factor Safety planning. These provide practical steps in in the case studies with the strongest outcomes improving IPV responses among nurses, which and impacts of PPI. There were four compo- in turn can promote the safety of those experi- nents in enabling relationships; time, reciproc- encing IPV. ity, arenas, and skills. This presentation will Conclusions: In this presentation we will examine each of these areas and consider the explore the important mechanisms through implications for future PPI activity in research, which nurses’ responses to IPV can be improved. including the core activity of relationship devel- Education, training and clinical supervision are opment when planning and resourcing PPI. pivotal to this process. The presentation will Conclusion: Patient and public, or citizen appeal to delegates interested in the relation- involvement, has become an important activity ship between nursing, IPV enquiry and safety within research. RAPPORT has identified the planning. importance of relationships in effective PPI. While RAPPORT was carried out in a UK setting, Recommended reading list its findings have transferability internationally, Center for Theory of Change (2015) What is although the cross-cultural equivalence of core Theory of Change? Available: http://www.theo- concepts may require further exploration in a ryofchange.org/what-is-theory-of-change/ country-specific setting.

16 11.30 – 12.55 Concurrent session 1 – Wednesday 61 April 2016 Bradbury-Jones C., Taylor J., Kroll T. & Duncan and marital status (sig. =.010). Loneliness was national prosperity (Dolan, Layard & Metcalfe, F. (2014) Domestic Abuse Awareness and Rec- identified to be prevalent among more than half 2011). This is the first published study of UK ognition among Primary Healthcare Profession- of the sample (68.8%). There was also correlation mental health nurses using validated SWB als and Abused Women: a qualitative investi- between loneliness, age (sig.=.062) and religi- measures. gation. Journal of Clinical Nursing, 23(21-22), osity (sig.=.044). Seven themes emerged from Aims: The aim of the study was to measure the 3057-68). the qualitative data analysis: ‘social loneliness’, SWB of UK mental health nurses, and to identify ‘emotional loneliness’, ‘emotional reactions’, how nurses with high SWB looked after their Biography ‘coping mechanisms’, ‘degree of insight into own mental health. illness’, ‘understanding and view towards mental Caroline is a Reader in Nursing at the University Methods: This was a mixed methods study. illness’, and ‘behavioural reactions’. of Birmingham. Her clinical background is in Data was collected between November 2012 and nursing, midwifery and health visiting. Caroline Discussion: The small sample size of the quan- February 2014. In part one a national sample has a research interest in domestic abuse and titative study reveals the various methodologi- of 237 UK mental health nurses took part in an most of her work is focused on this issue. She cal challenges in implementing research in long online survey using three different measures is particularly interested in how nurses can be term care facilities. However, the qualitative of SWB, including the Warwick Edinburgh supported to respond effectively and appro- study provides useful insights into this popula- Mental Wellbeing Scale (Tennant et al, 2007). priately to the issue. Within this, she is a keen tion experiences of loneliness and self-stigma. In part two a purposive sample of 27 mental advocate of education and training to support Conclusions: The study offers the platform health nurses with high SWB were interviewed nurses in their practice when dealing with for further investigation on the topic, while regarding their mental health and happiness. domestic abuse. discusses implications for policy and practice. Results: Study participants had a relatively low SWB compared to national population samples, Recommended reading list Happy mental health nurses associated certain Singh, A. and Misra, N. (2009) Loneliness, activities and attitudes with their SWB. It was depression and sociability in old age. Industrial associated with spending time in nature, taking Theme: Mixed methods Psychiatry Journal, 18(1), pp. 51-55 exercise, listening to and playing music and practicing mindfulness, reality acceptance, valuing Valiente, C., Provencio, M., Espinosa, R., 1.8.1 Abstract number 112 the self and seeking out pleasurable experiences. Almudena, D. and Franziska, E. (2015) Insight in 11:30am paranoia: The role of experiential avoidance and Discussion: This study has implications for internalised stigma. Schizophrenia Research, occupational health and human resources policy Self-stigma and loneliness 164, pp. 214-220 within healthcare organisations. The findings should inform the content of staff ‘happiness among mentally ill older Sarisoy, G., Kacar, O.F., Pazvantoglu, O., strategies’ and occupational health promotion Korkmaz, I.Z., Ozturk, A., Akkaya, D., Yilmaz, adults in nursing homes activities. S., Boke, O. and Sahin, A.R. (2013) Internalized Presenter: Miss Vasiliki Tzouvara, King’s stigma and intimate relations in bipolar and Conclusion: This is the first study looking spe- College, Florence Nightingale School of schizophrenic patients: A comparative study. cifically as SWB in UK mental health nurses. It Nursing and Midwifery, London, UK Comprehensive Psychiatry 54 (6), pp. 665-672 provides new insights into how mental health nurses perceive their own happiness, and what Abstract Biography can be done to maintain and enhance it. Background: Loneliness associates with I am currently a research associate at King’s negative effects on older adult’s health. On the Recommended reading list College London, Faculty of Nursing home and other hand, mental illness self-stigma associ- Midwifery. I have successfully competed my Oates, J. (2015). Use of Skype in interviews: ates with poor quality of life including increase PhD Viva (University of Bedfordshire) in ageing the impact of the medium in a study of mental social avoidance and isolation, and it is one and mental health research. health nurses. Nurse researcher, 22(4), 13-17. key risk factor of early hospitalisation. There are, therefore, indications upon the potential Tennant R, Hiller L, Fishwick R, Platt S, Joseph inter-relationship between loneliness and self- S, Weich S, Hiller L, Joseph S, Parkinson J, stigma, yet a limited number of studies aimed Secker J, Stewart-Brown S. (2007) The War- at examining it. Also, our knowledge is limited 1.8.2 Abstract number 264 wick-Edinburgh Mental Well-being Scale on how institutionalised (nursing homes) older (WEMWBS): development and UK validation. adults with mental health problems experience 12:00pm Health Quality of Life Outcomes 5:63 loneliness and mental illness self-stigma. Dolan, P., Layard, R., & Metcalfe, R. (2011) Subjective wellbeing in Aims: The aim of this study was: a) to examine Measuring Subjective Wellbeing for Public the inter-relationships between loneliness and UK mental health nurses: Policy: Recommendations on Measures Special self-stigma among older adults with mental findings from a mixed Paper No . 23 March 2011. Report to the ONS. health problems in nursing homes, and b) to methods research study. London: Centre for Economic Performance. explore how this population experiences loneli- Presenter: Miss Jennifer Oates, City University Biography ness and self-stigma. London, London, UK Methods: A mixed-methods approach was Jennifer Oates is a PhD student at City University utilised. The first phase involved a quantitative Abstract London. She is a registered mental health nurse, face-to-face questionnaire survey (n=16),and the with clinical experience in acute care, liaision The conference presentation will focus on a dis- second phase involved an interpretive qualita- psychiatry and community mental health. In cussion of the results of this study, following a tive study (n=10). recent years she has worked in a number of thematic thread from the survey to the interview healthcare regulation and commissiong roles, as Results: More than half of the participants findings. well as working as a lecturer and senior lecturer reported low levels of self-stigma (56.3%), yet a Background: The study of subjective in nursing. Her research focus is the mental substantial number of them scored high on the wellbeing(SWB), or happiness, has gained inter- health and well being of mental health nurses, self-stigma scale (43.8%). The analysis identified national research prominence in recent years although she has also researched and published a relationship between stereotype endorsement with it being seen increasingly as a marker of on aspects of health care regulation and policy.

17 111.30 – 12.55 Concurrent session 1 – Wednesday 6 April 2016 1.8.3 Abstract number 16 Masters degree in Nursing from the University Conclusion: The three studies in this review of Glasgow, Scotland provided useful and credible statements from 12:30pm Doctoral degree from Lund University, Lund non-specialist nurses about their experiences Sweeden with the transitions of patients and significant Icelandic outpatients others during palliative end-of-life care. The Associate Professor at the University of Akureyri, receiving treatment for findings revealed a need for more education and Akureyri, Iceland cancer: Health locus of information in order to provide a good quality Manager of the Hospice home Care in Akureyri, palliative end-of-life care so that the patients live control, symptoms of Iceland depression and anxiety. A as well as possible until they die with dignity quantitative study. Recommended reading list Presenter: Dr Elisabet Hjorleifsdottir, Ph.D. Thorn, H., & Uhrenfeldt, L. (2014). Experi- in nursing, University of Akureyri, Akureyri, ences of non-specialist nurses with patients and Iceland Theme: Systematic review their significant others undergoing transitions Co-author(s): Dóra B. Jóhannsdóttir, Iceland during palliative end-of-life care: a systematic 1.9.1 Abstract number 91 review protocol. The JBI Database of Systematic Abstract 11:30am Reviews and Implementation Reports, 12(11), The concept health locus of control (HLC) has 19-30. been defined as internal or external locus of The challenges of non- Thorn, H., & Uhrenfeldt, L. (in draft). Experi- control. Internal locus of control (ILC) has been specialist nurses providing ences of non-specialist nurses with patients and shown to be linked with healthier lifestyle and palliative end-of-life care to their significant others undergoing transitions better adjustment to illnesses. during palliative end-of-life care: a systematic patients and their significant review. Objectives: To examine HLC in Icelandic out- others: a metasynthesis patients with cancer using the Multidimensional Health Locus of Control Scale-form C (MHLC-C) Presenter: Mrs Hroenn Thorn, Master of Biography and symptoms of depression and anxiety using Public Health, Department of Gyneacology Nurse degree 1991 in the Faroe Islands and Obstetrics, Horsens Regional Hospital, the Hospital Anxiety and Depression Scale Master of Public Healt 2010 in Denmark (HADS). Denmark Worked 9 years as a community nurse,and 10 Co-author(s): Lisbeth Uhrenfeldt, Denmark Method: Cross-sectional study with a sample of years as ward nurse. The last 5 years i have been 150 cancer patients receiving treatment for cure working as quality improvement and research. or palliation. Mean age was 62 years. Descriptive Abstract statistic were used to describe and compare the Background: Evidence exists indicating that characteristics of the data. oncology nurses can perform care that provides Results: Response rate was 72%. MHLC-C the patients with strength as they are transi- 1.9.2 Abstract number 366 external locus of control (ELC), (having faith tioning during end-of-life. Nurses working in in doctors) had the highest mean (31,4). High surgical and medical wards are normally not 12:00pm scores for symptoms of depression (16,7%) specialized in oncology as are nurses working and anxiety (13%). Women scored significantly in hospices and oncology wards. In view of the What is the value of higher than men on symptoms of depression fact that globally, cancer is the leading cause of attendance at palliative day (p=0.038). Participants 60 years and older who death, there is a significant chance that all nurses had faith in doctors had significantly more ELC at some point in their work life will be providing care? A mixed systematic than those who were younger (p=0.020). palliative end-of-life care. review. Participants receiving curative treatment had Aims: The aim of this metasynthesis was to Presenter: Dr Joanne Jordan, BA, PhD, significantly less symptoms of depression identify the experiences of non-specialist nurses Research Fellow, Ulster University, New- (p=0.012) and anxiety (p=0.041) compared when providing palliative end-of-life care to townabbey, UK to those who had treatment for palliation. Sig- patients and their significant others undergoing Co-author(s): Joanne Jordan, Northern nificant positive correlation was found between existential and psychosocial transitions. Ireland; Professor George Kernohan, Northern ELC (believing in coincidences and fate) and ILC Methods: A comprehensive systematic Ireland; Felicity Hasson, Northern Ireland; (0,377/p<0.01); ELC (believing in others) and synthesis was conducted using the Joanna Briggs Mary Rose Holman, Northern Ireland; Sonja ELC (believing in coincidences and fate), (0,323/ Institute Qualitative Assessment and Review McIlfatrick, Northern Ireland, Kevin Brazil, p<0.01). Significant negative correlation was Instrument. The search for evidence aimed at Northern Ireland; Louise Jones, England; Jo found between ILC and symptoms of depression finding both published and unpublished papers. Coast, England (-0,402/ p<0.01); ELC (having faith in doctors) The synthesis of evidence was conducted on 3 and symptoms of depression (-0,220/ p<0.05); levels: findings, categories based on similarity Abstract ELC (having faith in doctors) and frequency and metasynthesis. Background: Previous systematic reviews of of diagnosis (-0,237/ p<0.05). Factor analysis Result: Initially, a total of 1055 titles were evidence of the (cost) effectiveness of pallia- revealed loading between 0.633-0.899 for each identified. Of these, only three papers met the tive care day services have been limited due to item and Cronbach´s alpha was 0,765-0,917. inclusion criteria. The three included papers a lack of primary research and limitations on Conclusion: Locus of control in patients with were assessed independently by both reviewers. included studies. The last reviews, published in first diagnosis and in those with advanced An analysis of the included papers identified 2011, concluded that day care has the potential disease can predict patients’ inner strength and 82 findings which were allocated into 5 catego- to improve patients’ quality of life. well-being. ries: being there for the patient, being ethically Aims: trapped, job satisfaction, and cooperation with 1. To evaluate the effectiveness of clinical, Biography significant others. These categories were pooled psychological, social and spiritual interventions into a metasynthesis; the challenges of non-spe- Clinical nurse specialist in cancer and palliative offered to adults attending palliative care day cialist nurses during palliative end-of-life care. care services.

18 11.30 – 12.55 Concurrent session 1 – Wednesday 61 April 2016 2. To identify which contextual factors (facilitators and barriers) impact on the effectiveness of the interventions. Methods: A systematic approach involving a review team included: primary and review level evidence; published and grey literature; papers in any language, and; studies that focus on adults with life-limiting illness (malignant and non- malignant). We searched relevant electronic databases, hand-searched other sources and contacted relevant authors and content experts. Included studies were quality-appraised and the certainty of evidence assessed. We used expert advice to synthesise quantitative data1; the framework approach2 to synthesise qualitative data; a narrative synthesis for cost-effectiveness data3, and; an overarching narrative synthesis to bring together the quantitative and qualitative evidence in the form of a logic model. Results: Our logic model identifies relevant components of the interventions and context in which they are implemented, and links these to specific impacts or outcomes through the identification of moderators (barriers and facilitators). This process enables the development of theoretical propositions concerning which factors, and mechanisms of interaction, are likely to lead to which outcomes. Conclusions: Although the value of integrating syntheses of qualitative and quantitative evidence in the form of an overarching systematic review is increasingly recognised, examples remain rare. Our review therefore represents an important contribution to review methodology, as well as the evidence base concerning the effectiveness of palliative care day services.

Recommended reading list Centre for Reviews and Dissemination (CRD) (2009) Systematic Reviews. CRD’s Guidance for undertaking reviews in health care. University of York: CRD. Ritchie J & Spencer L (1994) ‘Qualitative data analysis for applied policy research’ in A Bryman & RG Burgess (eds) Analysing Qualitative Data. London: Routledge, pp.173-194. Shemilt I, Mugford M, Byford S et al. (2011) Incorporating economics evidence. In: Higgins JPT, Green S (editors) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Col- laboration. http://www.cochrane-handbook.org

19 213.55 – 15.20 Concurrent session 2 – Wednesday 6 April 2016 Concurrent session 2 Wednesday 6 April 13.55 - 15.20

Theme: Action research student nurses who are experiencing mental the elements of risk when supportive persons health problems. were enabled to administer a medical interven- 2.1.1 Abstract number 382 tion; develop a guiding booklet for practice; Recommended reading list establish any potential impact on relation- 1:55pm ships when this role is taken on and ascertain HEFCE (2015) ‘Understanding provision for the views of both medication prescribers and students with mental health problems and Supporting students with injection administrators. intensive support needs’, HEFCE, London mental health problems: The doctoral study worked with seven families Gardner, L.D. and Lane, H. (2010) ‘Exploring Exploring the tutor-student for between 1 and 5 years, and was completed the personal tutor-student relationship: an in 2014. An action research designed study, relationship through autoethnographic approach’, Journal of Psychi- informed by empowerment theoretical perspec- autoethnography atric and Mental Health Nursing, 17, 4, 342-347 tives and the recovery philosophy was used to Presenter: Ms Lyn Gardner, RMN, BSc, MSc, Foster, K., McAllister, M. and O’Brien, L. (2006)’ explore the study aims. The methods used to PGCEA, Senior Lecturer, Department of Public Extending the boundaries: autoethnography as collect data included case studies, interviews, Health, Policy and Social Sciences, Swansea an emergent method in mental health nursing observations and validated evaluation tools. University, Swansea, UK research, International Journal of Mental Health The study findings suggest that it is achiev- Nursing, 15, 44-53 Abstract able for patients, supportive persons and the NHS to collaboratively work on safely sharing Background: There is increasing recognition Biography the administration of a depot injection under within higher education of the need to support After qualifying as a mental health nurse I a liability framework. The findings suggest students with mental health problems (HEFCE practised within both adult mental health that translating choice and empowerment into 2015), and the personal tutor (PT) is often the services and CAMHS for a number of years. An practice can be developed but requires adjust- first point of contact. From the student’s per- interest in social justice and advocacy led me to ments from both the receiver and deliverer of spective, ‘the experience of personal tutoring take a full-time sociology degree where I learnt services. Concepts like stigma and trusting rela- reveals a parallel process’ (Gardner and Lane more about tackling inequalities in health, which tionships are integral to the delivery of mental 2010) which can offer insights into establishing served to inform the foundations of my subse- health care and need to be understood when effective and compassionate therapeutic rela- quent teaching role in nurse education. I have developing innovative practice and in the under- tionships with people in their care. It is therefore taught within HE for 25 years and during that standing of risk management, particularly risk important that the PT is able to balance the edu- time have maintained a dual focus on sociology within the home. cational demands of the role with the responsi- and mental health practice. I have worked A unique selling point is the development of bility of responding effectively and authentically closely with practitioners in supporting the client and family centred care, within a self-care to the student’s distress. For many PTs, this development of mental health service provision, management model, which is very relevant to presents unforeseen and unexpected challenges which in turn has shaped my teaching. which require reflection and scrutiny of the long-term condition care. ongoing tutor-student relationship. Recommended reading list Aims: The aim of this presentation is to outline a participative methodology for exploring, criti- Crowley, J. (2014) Enabling Carers to administer 2.1.2 Abstract number 325 cally evaluating and developing the role of the Depot Injections: an action research study. PhD PT from the individual perspective of the tutor 2:25pm thesis available at http://gala.gre.ac.uk/11617/ and student. It will be of interest to academics Crowley, J. & Davis, A. (2008) A Researcher’s who wish to more effectively support students Enabling carers/supportive journey for clarity; clarifying indemnity issues with mental health problems. persons to administer depot when carers take on a role in medicines manage- Methodological Discussion: In order to injections within mental ment. Journal of Psychiatric and Mental Health Nursing. vol 15, no 9, pp717-721 explore the PT relationship from the perspec- health tive of the participants, a broadly autoethno- Feetam, C. & White, J. (eds) (2014) Guidance on graphic approach was chosen. Autoethnography Presenter: Dr John Crowley, RN, BSc PhD, the administration to adults of oil-based Depot is a reflective and reflexive research methodol- senior Lecturer, University of Greenwich, and other Long-Acting Intramuscular Antipsy- ogy which privileges the individual voice and London, UK chotic Injections. 4th Ed. Available at: www.hull. focuses on the ‘purposeful use of self’ (Foster et ac.uk/injectionguide al 2006) within a social and cultural context. For Abstract the purposes of this study, the methodology was This innovative project relates to the enable- Biography expanded and developed to include the voices of ment of a family member or ‘supportive person’ John commenced his nursing career as an SEN the students by encouraging them to keep reflec- to administer a prescribed depot injection to a in adult nursing before progressing to nurse tive accounts of their experiences. Although patient with the diagnosis of a mental disorder. registration in both adult and mental health dis- the focus of this presentation is the develop- This medical intervention is usually adminis- ciplines. The majority of his practice has been ment of the methodology, its usefulness will be tered by a mental health nurse. The projects within mental health practice incorporating both illustrated with examples from published and origin was a request by a service user requesting community and in-patient services. His particu- unpublished studies. her husband be enabled to administer her depot lar practice interests include structured family Conclusion: This paper will outline a research injection. work and psychosis, physical health needs of methodology by which tutors can explore, The study aims were to develop a skills and mental health service users and psycho-social develop and evaluate their relationships with knowledge set for the supportive person; explore interventions.

20 13.55 – 15.20 Concurrent session 2 – Wednesday 62 April 2016 John’s seminal moment, relating to practice, informed by on-going data collection from Theme: Focus groups was as a manager, listening to a service users parents and staff. request for a option in the receipt of her depot. The Evaluation phase commences January 2016. 2.2.1 Abstract number 40 This led to working with an enabling niche of Baseline measures will be repeated in order to 1:55pm families, Trust colleagues and other organisa- identify any changes and evaluate the impact of tions in developing the service users request. the interventions. Focus groups and interviews Student nurses’ and mentors’ Ultimately it led to a doctoral study and a job with staff and parents will provide insight into in academia, (Greenwich University) where he the process of change and the perceived success understandings of fitness to currently works as a senior lecturer. Age and of the initiative. practise in pre-registration wisdom makes nursing such an interesting job. Findings: The findings from the first two phases nursing programmes. His current projects within academia include will be presented and illustrate how neonatal Presenter: Dr Elaine Haycock-Stuart, Nursing service user and carer involvement in education staff can contribute to a family-centred model of Studies, School of Health in Social Science, The and a motivational interviewing study in collab- care in which parents are actively involved in the University of Edinburgh, Edinburgh, UK oration with Oxleas NHS Trust. care of their infant on NICU. Co-author(s): Dr Jessica McLaren, UK, Allison John has been married for 30 years to Gill, the Conclusion: The study will provide new McLachlan, UK, Christine James, UK parent of 4 children, a keen cyclist and a school insights into how neonatal staff can support Governor. parents to become actively involved with in the Abstract care of their infant in the neonatal unit. Background: Fitness to practise is a requirement for pre-registration nursing students. Yet Recommended reading list there is a dearth of literature examining fitness 2.1.3 Abstract number 133 Bliss the premature Baby Charity (2015) Bliss to practise conceptualisation amongst nursing students and mentors. Existing fitness to 2:55pm baby report 2015: hanging in the balance. Bliss, London. practise literature focusses on medical students Picker Institute (2012) Parent’s experiences of and there is a preponderance of literature Developing family-centred reviews and descriptive or discursive papers. care in a neonatal intensive neonatal care: a report on the findings from a national attract survey. Picker Institute Europe. Objectives: This study aimed to explore pre-reg- care unit: an action research Vittner D, Casavant S, McGrath J. (2015) A Meta- istration nursing students’ and mentor’s under- study ethnography: Skin to skin holding From the Car- standings of fitness to in nursing programmes. Presenter: Dr Caryl Skene, DMedSci RM, egivers perspective. Advanced in Neonatal Care. Design: A qualitative study in the interpretive RN, Neonatal Nurse Consultant, Jessop Wing 15(3):191-200 paradigm involving 6 focus groups and 4 face Neonatal Unit, Sheffield, UK to face interviews with nursing students and Co-author(s): Professor Kate Gerrish UK, Biography mentors. Fiona Price UK, Dr Liz Pilling UK, Pauline I initially trained as Registered Nurse and Regis- Setting: The 11 Higher Education Institutions Bayliss UK tered Midwife in the North East of England. After providing pre-registration nursing education consolidating my training, I worked oversees in Scotland. Data were collected January 2014- Abstract for 5 years as a midwife and a neonatal nurse March 2015 following ethical approval. Background: Despite the plethora of research in a charity hospital in the Middle East. After Participants: Purposive sampling recruited highlighting the benefits of parental involvement returning to the UK, I worked in various roles mentors and nursing students from pre-regis- in the care of their infants, evidence suggests including Neonatal Sister, Advanced Neonatal tration nursing programmes at different stages that the implementation of family-centred care Nurse Practitioner and Lecturer Practitioner. of educational preparation. in the Neonatal Intensive Care Unit (NICU), is My current role as a Neonatal Nurse Consult- Methods: Qualitatively Driven semi-structured often inadequate and inconsistent (Bliss 2015, ant in a busy tertiary Neonatal Unit in Sheffield focus groups (n = 6) and interviews (n = 4) were Vittner et al 2015, Picker 2012). includes leading and developing a growing team conducted with a total of 35 participants (17 pre- of Advanced Neonatal Nurse Practitioners, Aims: This study utilises a participatory registration nursing students and 18 nursing developing nurse led services and supporting action research approach to enable research- mentors). family centred care. ers, neonatal staff and parents to co-develop, Results: Three themes emerged from the implement and evaluate evidence-based family- My interest in nursing research started early in student and mentor data and are explored: Con- centred strategies in the NICU. my career and I have undertaken a number of ceptualising Fitness to Practise; Good Health research studies exploring issues such as the Setting and Character; and Fear and Anxiety surround- Parental experience of neonatal bereavement ing Fitness to Practise Processes. A 50-cot tertiary NICU in the UK. (Skene 1999), the role of the Advanced Neonatal Sample Nurse Practitioner (Lee, Skelton, Skene 2001) Conclusions: Uncertainty about understandings of fitness to practise contributed to Nurses, members of the neonatal multi-discipli- and Parental involvement in neonatal pain man- a pervasive fear among students and reluc- nary team, parents and their infants. agement (Skene2010). I am currently leading a team of researchers in an action research study tance among mentors to raise concerns about a Methods: The Exploratory phase commenced on relationship centred care in the Neonatal student’s fitness to practise. Both students and in January 2015. Baseline data (focus groups, unit. mentors expressed considerable anxiety and interviews, survey of staff, focus groups, survey engaged in catastrophic thinking about fitness to of parents and parent diaries) described the practise processes. Higher Education Institutes current context and perceived barriers of should reinforce to students that they are fit to parental involvement. This led to the develop- practise the majority of the time and reduce the ment of a number of evidence-based interven- negative emotional loading of fitness to practise tions. processes and highlight learning opportunities. The Intervention phase commenced in April 2015. Three action research cycles were used to test and further refine the interventions,

21 213.55 – 15.20 Concurrent session 2 – Wednesday 6 April 2016 Biography care professionals in the community, accessed by 2.2.3 Abstract number 336 purposive sampling. Focus groups were digitally Elaine is interested in service organisation and 2:55pm delivery for quality healthcare, particularly in recorded and transcribed verbatim, and content respect of health visiting, public health nursing analysis was conducted. and community nursing services. Results: Most participants reported that Women’s experiences of low back and/or pelvic pain Recent research has focused on leadership and basic coping skills to increase the psychosocial team work in primary care and the community adjustment were: having a positive attitude, during pregnancy nursing setting. being patient, living for today and keeping the Presenter: Dr Ciara Close, PhD, Msc,Bsc, normality in the new circumstances. Analysis Elaine has an interest in service user perspec- Queen’s University Belfast, Royal Hospital, also revealed that these coping skills could posi- tives as well as those of the work force and has Belfast, UK tively influence the psychosocial adjustment to investigated people’s experiences of health Co-author(s): Dianne Liddle (N. Ireland), PD by helping the patients and carers: 1) accept and healthcare services in their communities. Marlene Sinclair (N.Ireland), Julie the chronic illness, 2) search for activities to Recently she has been involved in a number of McCullough(N.Ireland), Ciara Hughes reduce the impact of symptoms, and 3) integrate research studies examining the health care expe- (N.Ireland) in their day-to-day new skills to face difficulties riences of families from differing ethnic back- and losses forced by the illness. grounds, service organsiation, leadership and Abstract nursing education. Discussion: A non-pharmacological intervention focused on enabling people with PD and Background: Over two thirds of women Studies completed March 2013, 2014 and 2015 their relatives to acquire coping skills which experience low back pain, almost a fifth experi- consider user and carer involvement in practice would help their adjustment to PD is proposed. ence pelvic pain and half experience a mixture assessment and fitness to practise processes of low back and pelvic pain at some stage in pre-registration programmes and combine Conclusion: Dealing with social changes and during pregnancy (Pennick and Liddle, 2015). Elaine’s research interests in user and carers’ coping skills through this non-pharmacological Currently very little is known about how women views with her interest in the educational prepa- intervention should become part of the nursing experience these conditions and the standard ration of nurses. routines when working with patients with treatments provided, as most of the research has chronic illnesses and their families to improve been quantitative in nature. their quality of life. Aim: To explore the experiences of women with pregnancy-low back and/ or pelvic pain (LBPP) Recommended reading list 2.2.2 Abstract number 211 Methods: Women completing a randomised 1. Ambrosio, L., Senosiain Garcia, JM., Riverol controlled trial investigating reflexology for 2:25pm Fernandez, M., Anaut Bravo, S., Diaz de Cerio pregnancy- low back and/ or pelvic pain were Ayesa, S., Ursúa Sesma, ME., Caparras Civera, invited via email to participate in a focus group N. & Portillo, MC. (2015). Living with chronic The role of coping skills in about their experience of this pain. Focus groups illness in adults: a concept analysis. Journal of the psychosocial adaptation were recorded with a digital audio recorder and Clinical Nurs. 24, 2357-2367. to Parkinson’s disease in after transcription were analysed using thematic patients and family carers: 2. Ambrosio, L., Navarta-Sánchez, MV. & content analysis. Portillo, MC. (2014). Living with Parkinson’s Results: 14 women with a mean age of 33 The qualitative perspective in disease in the community: improving assess- attended three focus groups. Three main themes a mixed-methods study ments and interventions. Primary Health Care. emerged 1) The physical and emotional impact 24 (10), 26-29. Presenter: Dr M Victoria Navarta-Sanchez, of pregnancy-related low back and/ or pelvic Faculty of Nursing, University of Navarra, 3. Creswell, JW. & Plano Clark, VL. (2011). pain had on women’s lives; 2) Women’s attitudes Pamplona, Spain Designing and conducting mixed methods and knowledge towards pregnancy low back Co-author(s): Neus Caparros, Spain; M research (2º Ed.). Thousand Oaks, CA: SAGE and/ pelvic pain 3) Women’s use of treatments Eugenia Ursua, Spain; Sara Diaz de Cerio, Publications. to manage pregnancy LBPP and dissatisfaction Spain; Mario Riverol, Spain; Mari Carmen with standard advice and treatment Portillo, UK. Biography Discussion: LBPP during affected women both PhD, MSc, BSc, RN, Assistant lecturer. Faculty physically and emotionally, a finding which is Abstract of Nursing. University of Navarre, Spain. supported by a growing body of literature to Background: Living with a chronic illness is Victoria is an Assistant lecturer at the University indicate that pregnancy LBPP can not only affect complex due to numerous social disruptions of Navarre involved in the training and evalua- women physical but emotionally (Gutke et al. experienced by patients and families1. However, tion of the clinical practice module of students in 2007). Women’s knowledge of pelvic pain was healthcare nowadays does not seem to consider Nursing Degree. poor and for some this induced fear, which has how influential social changes could be in terms been previously reported by Shepherd (2005). In 2010 she completed an MSc in Nursing of the patients’ and families’ adaptation process The dissatisfaction with health professional Research and in September 2015 she completed to a chronic illness, and health1-2. Specifically, advice and treatment for pregnancy-LBPP is her Doctorate at the University of Navarre. She is there is scarce attention to the psychosocial concerning, as is the use of non-prescribed med- exploring the process of living with ParkinsonÂ´s adjustment faced by patients with Parkinson’s ications for this pain. Disease in patients and their relatives. The final disease (PD) and their relatives2. aim of her PhD was to design a non-pharma- Conclusions: Pregnancy LBPP has physical Aims: To explore which coping skills could ease cological intervention to facilitate that primary and emotional consequences. Women need to the psychosocial adjustment to PD and why, and care nurses can improve coping and psycho- be educated about this pain and on safe manage- based on this knowledge design a non-pharma- social adjustment to illness in patients with ment. Improvements to standard treatment and cological intervention, which could improve the chronic illness and their relatives. Moreover, she advice may be needed. quality of life of PD patients and their relatives. has a keen interest in self-management support Methods: The qualitative phase of a mixed of long-term conditions patients and implemen- Recommended reading list methods study3 will be presented. Data were tation of healthcare services in clinical practice. Pennick V., Liddle S.D. 2013. Interventions for collected through three focus groups in May preventing and treating pelvic and back pain in 2014 with 9 PD patients, 7 relatives and 5 health- pregnancy. Cochrane Database of Systematic

22 13.55 – 15.20 Concurrent session 2 – Wednesday 62 April 2016 Reviews. Available from http://onlinelibrary. reported, their completion mode, timing and phrenia die 20 years younger than the general wiley.com/doi/10.1002/14651858.CD001139. reproducibility. population. Nurses are in a unique position pub3/pdf (Accessed 13th November 2013) Results: 11,836 articles were identified; 68 to impact positively on these deficits, as they (Internet) RCTs met the inclusion criteria. This included are the biggest professional group working in Shepherd, J. 2005. Symphysis Pubis Dys- majority birth-related (47%) trials. The largest mental health services across Europe. However function: a hidden cause of morbidity. British proportion of trial interventions were medicinal it is unclear if mental health nurses see this as Journal of Midwifery 13(5), 301-307. (46%). Overall 840 outcomes were identi- their role. Gray (2012) argues that the reality of practice has not caught up with the rhetoric of Gukte, A., Josefsson, A., Oberg, B. 2007. Pelvic fied. 12.02% of these were Patient-reported- research and calls the current situation a ‘silent girdle pain and lumbar pain in relation to post- outcomes (PROs) and 87.97% were Clinician- scandal’ (p.191). partum depressive symptoms. Spine32(13), reported-outcomes (CROs). 46.6% of the PROs 1430-6. were established measures with a clear history of Aim: This paper aims to present an overview of development and testing. However, the majority the literature regarding this pertinent topic and of PROs (53.3%) were ad hoc, trial-specific explore future research directions. Biography measures without clear evidence of develop- Methods: A narrative literature review. I am currently working as Research Fellow at ment or testing. Moreover, outcomes critical to Relevant databases were searched using key Queen’s University Belfast, working specifically informing feto-maternal wellbeing showed sig- terms. Studies published between 2009-2013 in the field of migrant health and well-being. I nificant reporting heterogeneity. For example; and in English were included. Papers could be completed my PhD in 2014 working on research postpartum haemorrhage. from any jurisdiction. Only original studies were related the impact of complementary therapies Conclusions: This review highlights the sig- included. on mental health and pain during pregnancy. nificant heterogeneity and poor quality of I have an extensive background in health Results: A total of 41 studies are included for reporting outcomes in maternity RCTs. The promotion having worked specifically in an discussion. impact of pregnancy and child-birth as under- acute hospital as a smoking cessation specialist Discussion: Numerous themes emerge from stood from the perspective of the mother was and nutritionist. I also hold an Msc in Health this review. These include; role ambiguity, poorly assessed. These findings underpin the promotion and population health and BSc structural and organisational barriers, lack of importance of seeking to better understand the honors in Nutrition. education and confidence as well as stigma and experience of mothers and the outcomes that illness-related barriers. These all impact on they value in the pursuit of defining accept- mental health nurses’ practice. able and relevant pregnancy-related outcome measures. Moreover, guidance to improve the Conclusion: This review identifies areas for homogeneity of outcome reporting in the form further research. Future studies should adDress Theme: Systematic review of a core outcome set for maternity clinical trials one or more of themes evident in the review. is urgently required. Such studies should help adDress the barriers 2.4.1 Abstract number 326 to mental health nurses meeting the physical 1:55pm Biography health needs of their patients. Dr Mahmud is a PhD student at the University of Recommended reading list Outcome reporting in Birmingham and a Member of the Royal College UK-based maternity trials: of Obstetrics and Gynaecology. She is funded by COLLINS, E., TRANTER, S. AND IRVINE, F. A systematic review of the Wellbeing of Women Entry level scholar- (2012) ‘The physical health of the seriously mentally ill: an overview of the literature’. randomised controlled trials ship awarded to mark the birth of HRH Prince George of Cambridge. Journal of Psychiatric & Mental Health Nursing, Presenter: Dr Ayesha Mahmud, MBBS 19(7), pp.638-646. MRCOG, University of Birmingham, Birming- GRAY, R. (2012) ‘Physical health and mental ham, UK illness: A silent scandal’. International Journal Co-author(s): Kirstie Haywood,UK; Sara 2.4.2 Abstract number 269 of Mental Health Nursing, 21(3), pp. 191-192. Kenyon, UK; Christine Mcarthur, UK; ROBSON, D. AND GRAY, R. (2007) ‘Serious Tabassum Khan, UK; Khalid Ismail, UK. 2:25pm mental illness and physical health problems: A discussion paper’. International Journal of Abstract The role of the mental health Nursing Studies, 44(3), pp. 457-466. Introduction: Pregnancy is a physiological nurse in physical healthcare: state that can significantly impact the health and A literature review. Biography well-being of women. Outcomes are important Presenter: Mr Gearoid Brennan, BA (Hons), Gearoid is a graduate of NUI Maynooth, having for understanding the wide-ranging impact of BN, MN, RMN, Staff Nurse, NHS Lothian, read for a double honours degree in English and pregnancy and childbirth. However, guidance Edinburgh, UK German. He then completed his pre-registration regarding the most appropriate outcomes to Mental Health nursing degree at Edinburgh include in randomised clinical trials (RCTs) of Abstract Napier University. He was awarded the uni- maternity care does not exist. Assessment het- versity medal on graduating for outstanding Background: People with a serious mental erogeneity in clinical trials hinders data compar- achievement. He has recently completed the illness experience poorer physical health and ison and systematic reviews. This review aimed Master of Nursing in Clinical Research at the present with higher rates of cardiovascular to describe the range of outcomes reported in University of Edinburgh, funded by the Scottish disease, metabolic disorders and sexually trans- Maternity RCTs. Government’s Chief Nursing Officer’s Directo- mitted diseases (Robson and Gray 2007). Preva- Methods: A systematic review of UK-based rate. His master’s dissertation was awarded with lence rates are high regardless of country. There maternity RCTs published between 2004-2014 distinction and focused on the role of the mental are multiple interacting and contributing factors was undertaken. Relevant RCT’s were identi- health nurse in addressing the physical health for this including socio-economic issues, stigma fied and study eligibility was assessed by two needs of people with serious mental illness. He and the side effects of psychotropic medication reviewers. The selected RCTs were categorised hopes to pursue a clinical academic career route. to name but a few (Collins et al. 2012). Conse- as per type and timing of intervention. Reviewers He has a keen interest in qualitative methods, quently, it is estimated that people with Schizo- completed data extraction; for all outcomes the social sciences, self-harm and acute psychi-

23 213.55 – 15.20 Concurrent session 2 – Wednesday 6 April 2016 atric care research as well as some of the ethical Recommended reading list Theme: Mixed methods issues inherent in research. He works clinically Nursing and Midwifery Council (2008) as a staff nurse within NHS Lothian’s Royal ‘Standards to support learning and assessment 2.5.1 Abstract number 51 Edinburgh Hospital. When he is not researching in practice’. Nursing and Midwifery Council, 1:55pm or nursing or researching nursing, he enjoys a London spot of baking, cooking, coffee and the gym. Duffy, K. (2003) ‘Failing students: a qualita- What is the quality of end of tive study of factors that influence the decisions life care for those who die regarding assessment of students’ competence at home? A study to explore in practice.’ Glasgow: Glasgow Caledonian Uni- 2.4.3 Abstract number 262 versity. Available from: http://www.nmc-uk. the views and experiences of org/Documents/Archived%2 bereaved carers’ 2:55pm Duffy, K. (2006) ‘Weighing the Balance: A Presenter: Dr Carolyn Lees, RGN, DN, MSc, ‘Failing to fail’ - a systematic grounded theory study of the factors that MEd, PhD, Liverpool John Moore’s University, Liverpool, UK review of where we are now influence the decisions regarding the assessment of students’ competence in practice.’ Co-author(s): Dr. Catriona Mayland, Liverpool Presenter: Dr Kathleen Duffy, PhD, MSc, BA, PhD thesis, Glasgow: Glasgow Caledonian RGN, RNT, Senior Nurse Practice Education, University. Access via http://rcn.sirsidynix. Abstract NHS Lanarkshire, Sharon, UK net.uk/uhtbin/cgisirsi/?ps=VerQF9sVDq/ Background: The quality of end of life care has LONDON/185360011/2/1000 been the focus of much government policy. Col- Abstract lecting data from those who are dying is complex Biography Background: In the United Kingdom (UK) pre- (Mitchell, 2002) but it appears that relatives and registration nurses and midwives are supported Kathleen is currently working as a senior nurse carers’ views provide a valuable evaluation of the and assessed in practice by registrants who have for practice education within NHS Lanarkshire. patient’s end of life care, synergised with their undertaken an approved Nursing and Midwifery She has had a long standing interest in men- own unique experiences as carers. Council mentorship programme (NMC 2008). torship and is best known for her Nursing and Aim: To explore bereaved carers’ experiences of Duffy’s seminal doctoral work (2003, 2006) Midwifery Council scholarship report published end of life care for those who had died at home around ‘failing to fail’ was a catalyst for change in 2004 which reignited the issue of ‘failing to using a validated tool. within the UK with regards to mentorship prepa- fail’. Kathleen started her career in nursing ration and support. But, 10 years on from com- in Glasgow where she undertook a Bachelor Methods: A mixed method approach pletion of that work, is ‘failing to fail’ still an of Arts in Nursing Studies. Following this she comprised of a self completed questionnaire issue for debate? worked in acute medical areas within the city allowing respondents to provide narrative to support their responses. Two hunDred and Aim: The aim of this paper is to present a critical before moving to study for an English National ninety one patients who had an expected death reflection of the findings from a systematic liter- Board General Intensive Care course at the at home were identified. Narrative data from the ature review which explored ‘failing to fail’ from Middlesex Hospital, London. On her return to questionnaires were analysed using framework both a national and international perspective. Glasgow Kathleen continued her career within acute medical areas. A post graduate certificate analysis identifying prominent words and Methods: A multi-stage search strategy of lit- in education and a Masters in Health Studies phrases, expanded to include associated key erature from 2006-2015 was undertaken. Elec- saw Kathleen undertake the role of lecturer words or themes (Richie & Spencer, 1994). tronic database searches were conducted for and then senior lecturer within Glasgow Cal- Results: Four main themes and associated sub English, peer-reviewed, quantitative and quali- edonian University. She completed her thesis themes emerged from the narrative data. The tative primary research, and other published titled: ‘Weighing the Balance: A grounded theory main themes were coordination and continuity evidence-based literature. The Electronic Theses study of the factors that influence the decisions of care, competence, compassion and communi- Online Service was utilised for grey literature regarding the assessment of students’ compe- cation. Quantitative data will not be presented and conference proceedings. The CASP tool was tence in practice’ in 2006. She continues to write here. used to assess the rigour of papers. and publish to support mentors in practice. Discussion: The findings from this study reflect Results: A total of 18 papers were included that generally good quality care was provided for in the literature review. Findings indicate that those who died at home. There were examples of mentors continue to face challenges around the well orchestrated care with services working well emotional aspects of failing a student in practice together, but there were times when adequate and that courage and resilience are central support was not evident. concepts that require to be considered in mentorship preparation and ongoing development. Conclusions: With the number of deaths Identifying and supporting mentors who lack globally set to increase there is a need to identify confidence is required by both lecturers and tools which measure the quality of end of life care practice education facilitators. Of note within for those who choose to die at home in order to the literature reviewed was the absence of the improve the experiences of patients and carers. ‘student’ voice. The CODE questionnaire represents a user friendly, comprehensive tool to achieve this. Discussion: Synthesis of the review highlighted that while many of Duffy’s recommendations for mentorship practice have been imple- Recommended reading list mented since 2006 some of the original findings Mitchell, G.K. (2002) How Well do General remain relevant across the international health- Practitioners Deliver Palliative Care? A System- care arena today; with some of the research rec- atic Review, Palliative Medicine, 16; 457-64 ommendations still to be realised. Richie, J. and Spencer, L. (1994) Qualitative Data Analysis for Applied Policy Research, (Bryman and Burgess, eds) Analysing Qualita- tive Data London

24 13.55 – 15.20 Concurrent session 2 – Wednesday 62 April 2016 Biography a fluid restriction or palliative care. 304 NoAH Aim: To explore, from carers’ perspectives, the I qualified as a registered nurse in 1985 spending tools were completed (54% low, 43% medium, scope, quality and fit of information sharing and most of my clinical practice in community 3% high risk). Average NoAH incompletion was knowledge exchange between carers, cared for, nursing. After gaining a Masters in Education 31%. Increases were observed in documenta- community nurses and respite staff. and a Masters in research I completed a tion of fluid balance charts (46% vs 94%), urine Methods: A qualitative, exploratory study Doctorate in nursing with a particular interest in output charts (9% vs 88%), drinking preferences involving 24 carers, recruited via third sector measuring and capturing the patient experience. (10 vs 32%) and discussions about hydration organisations, was undertaken in Scotland. Par- I have worked in a large NHS Trust responsible (5% vs 13%). ticipants were purposively sampled and took for leading on quality improvement and quality Conclusions: A simple bedside assessment to part in a focus group or individual interview. standard initiatives joining Liverpool John promote oral fluid intake is feasible and accept- Data was collected from August 2013-September Moore’s University in February 2015 as a senior able. After further modifications to achieve 2014. Data was systematically analysed using lecturer responsible for teaching on the under- the ideal combination of risk indicators and constant comparative methods. graduate nursing programme as well teaching responses, we will formally evaluate the impact Results: This paper will report on carers’ ret- research across other programmes within the on health outcomes and resource utilisation. rospective accounts of information sharing school. and knowledge exchange with respite services Biography grouped around three emergent themes: Lloyd Oates completed his undergraduate degree ‘reaching out’; ‘working through’; and ‘moving in Forensic Psychology at Teesside University in on’. Whilst some carers chose not to use tech- 2.5.2 Abstract number 124 2009 before completing his MSc in Health Psy- nology themselves, they typically assumed that chology the following year and continues to work it would be used by health and social care pro- 2:25pm towards achieving a role as a charted Psycholo- fessionals to expedite communications about gist. respite provision. Carers did not perceive community nurses as having a role in helping Development and testing of Working within community and educational them to share information with respite services. a nurse-led oral fluid intake rehabilitation for individuals with acquired risk and response tool for brain injuries and other mental health con- Discussion: For respite services, investing time older inpatients ditions gave Lloyd a range of experience in and effort in establishing meaningful relation- working across the life span. Lloyd went on to ships with carers and those they care for were Presenter: Mr Lloyd Oates, Northumbria complete his PGCert in Low Intensity Therapies consistently highlighted, by carers, as pre-requi- Healthcare NHS Foundation Trust, North and worked as a Psychological Wellbeing Practi- sites to delivery of high quality respite care. Over Shields, UK tioner in IAPT providing therapy for individuals time, however, the need for face-to-face contact Co-author(s): Judy Plank, England, UK; Vicky with common mental health difficulties. was sometimes replaced with use of technologies Riddell, England, UK; Chris Price, England, which had the potential to make communica- Lloyd has worked within third sector research UK. tions between carers and respite services more and been actively involved within the North timely and person-centred. East Psychological Society. Working as part of Abstract the Research and Development team at North- Conclusions: Proactive and responsive Background: Older people in hospital are sus- umbria Healthcare Foundation Trust has seen approaches to relationship-building, structured ceptible to dehydration due to pre-existing and involvement with a number of research projects around regular contacts and reviews, are likely acute health problems. There is no routinely used focused on stroke, older adults, Parkinson’s and to improve information sharing and knowledge standardised nursing assessment to identify dementia research both in and outside of the UK. exchange between carers, cared for people and those patients without intravenous fluids who respite services. The role of community nurses in remain at risk of poor oral fluid intake. facilitating information sharing and knowledge Aim: To develop a nurse-led fluid intake risk exchange requires further exploration. assessment and response protocol for integra- 2.5.3 Abstract number 231 tion into the care of older patients within 48 Biography hours of hospital admission. 2:55pm Linda’s research interests lie broadly within Methods: Thematic analysis of interviews the scope of addressing inequalities and more with staff (n=55), patients and relatives (n=11) Information sharing and specifically on community nurses’ contribu- assisted with development and evaluation. knowledge exchange with tions to promoting the health and wellbeing of After baseline clinical record audit (n=100), the respite care services for older individuals, families and communities. She has Northumbria Assessment of Hydration (NoAH) adults experience of both quantitative and qualita- tool was deployed without blinding on 4 wards tive research methodologies and methods, and across 3 hospitals for a period of 5 months Presenter: Dr Linda McSwiggan, PhD, MSc, of multi-agency working with NHS colleagues, (March-July 2015). Nurses followed three esca- BSc, RGN, RM, HV, DN, Senior Lecturer, social services and third sector services. Linda lating grades of clinical care response according School of Nursing and Health Sciences, Univer- teaches on several undergraduate and postgrad- to a NoAH score from 0-10, which reflected sity of Dundee, Dundee DD1 4JH, UK uate programmes and, since her promotion to medication, communication, visual perception, Co-author(s): Judith Marston, Scotland; Senior Lecturer two year ago, has also taken on fluid consistency recommendation, orientation Martin Campbell, Scotland; Tim Kelly, the role of Lead for Interprofessional Education and ability to drink from a glass. Scotland; Thilo Kroll, Scotland within the School of Nursing and Health Results: Interviewees confirmed that formal Sciences, University oF Dundee. recognition of dehydration risk factors was Abstract an essential component of nursing care, and Background: Globally, respite services play an supported a quick bedside assessment with a important role in supporting older adults and matching graded response such as patient held carers. Not enough is known, however, about intake charts, elicitation of drinking preferences, what facilitates transitions into respite care and and a regular senior nurse review. Amongst maximises understanding among staff about the 650 admissions, 143 were ineligible because the older person for whom they will be caring. patient was already receiving intravenous fluids,

25 213.55 – 15.20 Concurrent session 2 – Wednesday 6 April 2016 Theme: Mixed methods temporary nursing practice, demonstrated by a task orientation to a whole person approach to the development of a programme of clinically nursing care. 2.6.1 Abstract number 397 and policy relevant research in the areas of the Conclusion: Facilitating assistant nurses to healthcare workforce and care for older people. 1:55pm become student nurses assumes appropriate In particular, she is interested in evaluating how recruitment and retention and that prior expe- changes in the composition, organisation and Understanding the registered rience will facilitate studentship and the tran- management of the healthcare workforce impact sition to RN. Policy makers, practitioners and nursing workforce in care on quality of care and outcomes. She has widely educationalists need to be aware of the impact of homes published her work. Karen is a member of the prior experience to support this group of student Presenter: Professor Karen Spilsbury, PhD, National Institute for Health Research Health nurses. RN, Professor of Nursing Research, School of Services and Delivery Research Researcher-led Programme Commissioning Board. Her editorial Healthcare, University of Leeds, Leeds, UK Recommended reading list duties include an Associate Editor role with the Co-author(s): Barbara Hanratty, UK; Dorothy International Journal of Nursing Studies. She is Braeseke, G., Hernadez, J., Dreher, B., Birken- McCaughan, UK a member of the Department of Health’s Care stock, J., Filkins, J., Presuker, U., Stocker, G. & Sector Nursing Taskforce. Waszkiewicz, L. (2014) Development and coor- Abstract dination of a network of nurse educators and Internationally, care homes play an essential regulators (SANCO/1/2009) Final report to the role in providing care for an older population EU Commission. CONTEC to the EU Commis- with increasingly complex health care needs. sion. DG SANCO. 2.6.3 Abstract number 229 Ensuring older people can access ‘good’ nursing Lovegrove M, Griffith R. (2015) Pre-nursing care in care homes is crucial. However, there is 2:55pm degree care experience pilot. End of evaluations limited understanding of the registered nursing summary report. Retrieved from http://www. workforce in this sector. This study (April 2014 From assistant nurse to alliedhealthsolutions.co.uk on 8 July 2015 to February 2015) identifies key issues in relation registered nurse: a UK mixed Nursing Assistant Guides (2015) Your guide to the care and professional development needs methods study exploring to becoming a medical assistant. Vol. 2015. of RNs employed in UK care homes. In particu- Retrieved from http://www. http NursingAs- lar, it addresses characteristics of the workforce, transitions sistantGuides.com on 10 Oct 2015 scope of their roles, education and training, and Presenter: Mrs Victoria Arrowsmith, RN career development. BA PGCEA, Florence Nightingale Faculty Biography of Nursing and Midwifery, King’s College We used multiple methods, with four linked PhD student at King’s College London 2010-2016 strands: rapid review of published literature London, London, UK Senior Lecturer Adult Nursing. Open University. (116 papers); mapping secondary UK data Co-author(s): Ian Norman, UK; Jill Maben, 2001-2013 sources; modified Delphi survey using a ‘panel’ UK, Margaret Lau-Walker, UK. (two rounds, 352 respondents); and telephones Senior Lecturer Adult Nursing. University of interviews (n=16) with care home, primary and Abstract Bedfordshire. 1995-2001 community care staff, as well as leaders in care Background: The trend of facilitating assistant Senior Staff Nurse Operating Theatres Stoke home work (national and international). Each nurses to become registered nurses (RNs) exists, Mandeville Hospital Buckinghamshire. work strand has been analysed thematically for example, in the USA, (Nursing Assistant 1990-1995 but the emphasis of our overall analyses is on Guides 2015) the EU,(Braeseke et al. 2014),while Secretary to the Sports Federation, Port triangulating different accounts and different in the UK bridging programmes are currently Moresby, Papua New Guinea. 1986-1989 methods, to reflect the subtle nuances of stake- being developed(Lovegrove and Griffin 2015). holders’ perspectives. Sister Operating Theatres. General Infirmary at Aim of the study: To understand the work role Leeds. 1974-1980 Despite a role in care homes that is broad and transitions of student nurses who were formerly multifaceted, the sector is struggling to recruit Staff Nurse, Operating Theatres. 1972-1974 employed as healthcare assistants. and retain RNs. There are only estimates of Student Nurse. General Infirmary at Leeds numbers of RNs employed by UK care homes: Methods: Qualitative and quantitative data 1969-1972 were collected from first, second and third year around half (53%) work full time and annual Publications turnover is high (29%). To attract, recruit and students with relevant experience at two UK retain the future nursing workforce, the care universities between September 2010 and July Arrowsmith, V.A. (2005) Preventing Cross home sector needs to consider ways of providing 2012. Survey data from questionnaires (n=297) Infection. In Baillie, L.J. (ed.) Developing challenging and rewarding career pathways. By were analysed for descriptive and inferen- Practical Nursing Skills.2nd ed. London. Arnold combining different organisational and pro- tial statistics. Also, twenty students from each Baillie, L.J. Arrowsmith, V.A. (2005) Meeting fessional views, this paper provides a detailed year group (n=60) were purposively selected Elimination Needs. In Baillie, L.J. (ed.) Devel- picture of the main issues as perceived by a range for interviews. The framework approach and oping Practical Nursing Skills. 2nd ed. London. of stakeholders on this important workforce thematic analysis of the interview data provided Arnold the mechanism for synthesizing the data. issue. Consequently, our findings and recom- Thomas, J. Arrowsmith, V.A. (2002) Working in mendations are located within the ‘realities’ of Results: Findings indicate as students discon- partnership to deliver an innovative pre regis- care home service delivery and will be relevant nect from their prior work role they revision their tration nursing programme. Health Information to practice, education, policy and research. former assistant nurse role, the role of student and Libraries Journal ol. 19, No3 pp161 3 ISSN nurse, the work environment and the role of the 1740 3324 Registered Nurse. They experience role change Biography Lead Reviewer: Cochrane Collaboration Sys- shock as they find, contrary to expectations, Karen is a registered nurse and health services tematic Literature Review, Arrowsmith, V.A. their former role does not automatically or easily researcher. She was recently appointed at the Maunder, J.A. Sargent R.J.Taylor, R. Removal facilitate their transition to Registered Nurse. University of Leeds to an Investment Chair in of nail polish and finger rings, by scrubbed Nursing Research, having previously gained Discussion: A combination of transitions and personnel to prevent surgical infection. (2000- her personal Chair at the University of York. role theory explains students’ experiences as 2016) Her expertise extends to fields central to con- they revision the role of the RN and move from

26 13.55 – 15.20 Concurrent session 2 – Wednesday 62 April 2016 Theme: Action research Recommended reading list Design: Research priority setting project using Fawcett, J & Ellenbecker, CH. (2015). ‘A JLA methods; a survey for interim prioritisa- 2.7.1 Abstract number 1 proposed conceptual model of nursing and pop- tion and a consensus meeting for final priority setting. 1:55pm ulation health’ Nursing Outlook, vol 63, no 3, pp 288-298 Methods: Stroke nurses were invited to select Methodological issues their top 10 priorities from a previously estab- Biography lished list of 226 unique unanswered questions associated with population between September and December 2014. These Dr. Jacqueline Fawcett holds a nursing bacca- health nursing research data were used to generate a list of shared laureate degree (1964) from Boston University research priorities (interim priority-setting Presenter: Dr Jacqueline Fawcett, RN; PhD; and nursing master’s (1970) and PhD (1976) stage). A purposefully selected group of stroke ScD (hon); FAAN, Professor, University of degrees from New York University. She is an nurses attended a final consensus meeting (April Massachusetts- Boston, Boston, USA emerita Professor of the University of Pennsyl- 2015). vania and currently is a Professor in the Depart- Abstract ment of Nursing at the University of Massachu- Results: Ninety-seven respondents completed The increasingly global recognition of many setts Boston. Dr. Fawcett is best known for her the interim prioritisation process, objectively common health-related conditions require metatheoretical work, including analysis and identifying 28 shared priority treatment uncer- population-level rather than individual-level evaluation of nursing conceptual models and tainties. Twenty-seven stroke nurses attended a solutions. Consequently, in recent years, many theories. She has developed three original con- consensus meeting and reached agreement on healthcare experts have called for a shift in ceptual models. Her publications include several the top 10 research priorities related to stroke thinking about health care from an emphasis on nursing textbooks about the nature and structure nursing. Five of the agreed top 10 questions individuals’ disease conditions to population- of nursing knowledge and more than 100 journal related to specific stroke-related impairments, level disease prevention and wellness promotion. articles and book chapters about her empirical including fatigue, cognition, mood, incontinence and effects of thrombolysis. Three related to The purpose of this paper is to discuss innovative research and metatheoretical issues. Dr. Fawcett specific nursing strategies such as goal setting, methodological issues associated with research has recently turned her attention to the intersec- therapy and self-management techniques; and guided by the Conceptual Model of Nursing and tion of nursing and population health. She is a two related to social aspects of coming to terms Population Health, which addresses the intersec- peer reviewer for several nursing journals and with long-term consequences of stroke and the tion of nursing and population health (Fawcett is a former editor of the Journal of Advanced environment for young stroke survivors. & Ellenbecker 2015). This conceptual model Nursing. Among her honors are election to fel- supports studies of attainment of the highest lowship in the American Academy of Nursing Conclusions: The research agenda for stroke possible quality of life for populations, by means in 1979, receipt of a Doctor of Science, Honoris nursing has now been clearly defined, facilitating of culturally aware nursing activities targeted Causa, from Universite Laval, Quebec, Canada in nurses to undertake research which is of impor- to promotion or restoration and maintenance 2012, and being named a Living Legend by the tance to stroke survivors and carers, and central of wellness and to prevention of disease for all Massachusetts Association of Registered Nurses to supporting optimal recovery and quality of life populations. The paper includes a definition of in 2013. after stroke. population health, distinctions between public health and population health, and discussion of Recommended reading list appropriate research methodologies. Questions Pollock A, St George B, Fenton M, Firkins L. are raised about the meaning of population 2.7.2 Abstract number 107 (2012) Top ten research priorities relating to health research and research methods that are life after stroke. Lancet Neurology, vol 11, no 3, consistent with the study of diverse populations, 2:25pm p 209. especially those who are traditionally underrep- Pollock A, St George B, Fenton M, Firkins L. resented in research. Questions about research Top ten research priorities (2014) Top ten research priorities relating to life methods that are appropriate for studies of pop- relating to stroke nursing: after stroke - consensus from stroke survivors, ulations include research designs, recruitment a rigorous approach to caregivers and health professionals. Interna- of research participants who constitute popula- establish a national nurse-led tional Journal of Stroke, vol 9, no 3, pp 313-20. tions rather than samples drawn from populations, instruments, and data analysis techniques. research agenda Biography Findings from studies guided by the Concep- Presenter: Dr Anne Rowat, PHD, PGcertHE, tual Model of Nursing and Population Health BSc, RGN, RNT, Edinburgh Napier University, Anne Rowat is a qualified nurse and lecturer in should advance nursing knowledge about Edinburgh, UK adult nursing at Edinburgh Napier University. upstream factors (socioeconomic factors and Co-author(s): Alex Pollock, Scotland, UK; Post-doctoral research studies are mainly in the physical environment), population factors Bridget St George, Scotland, UK; Eileen field of complications after stroke, including: (genetic factors, behavioral factors, physiologic Cowey, Scotland, UK; Joanne Booth, Scotland, hypoxia and hypotension during feeding and factors, resilience, and health state), health care UK; Maggie Lawrence, Scotland, UK; on patient positioning. Current work includes: system factors (providers, organizations and behalf of the Scottish Stroke Nurses Forum investigating factors associated with the devel- institutions, payers, and policies), and nursing opment of dehydration; nasogastric feeding; self-management; and exercise strategies for activities (population-based nursing practice Abstract processes; culturally aware wellness promotion, stroke patients. Her research work on stroke Aim: To identify the top 10 research priorities restoration, and maintenance; and culturally has informed guidelines and best practice state- relating to stroke nursing. aware disease prevention) that affect the health ments. She is the current chair of the Research outcomes of all populations (population-level Background: It is important that stroke nurses Action Group for the Scottish Stroke Nurses wellness, population-level disease burden, pop- build their research capability and capacity. This Forum, which aims to encourage more stroke ulation-level functional status, population-level project built on a previous James Lind Alliance nursing research. life expectancy, population-level mortality, and (JLA) stroke research prioritisation project, population-level quality of life). which established the shared research priorities of stroke survivors, carers and health professionals relating to life after stroke (Pollock et al, 2012; 2014).

27 213.55 – 15.20 Concurrent session 2 – Wednesday 6 April 2016 2.7.3 Abstract number 71 Care, 3(3), pp.318-323. Available at: http:// Theme: Survey spcare.bmj.com/content/early/2013/01/07/ 2:55pm bmjspcare-2012-000396.full. 2.8.1 Abstract number 206 Ward, D.J. et al., 2013. Using Framework 1:55pm Gatekeeping: a typology and Analysis in nursing research: A worked example. screening tool Journal of Advanced Nursing, 69(11), pp.2423- Care experience prior to Presenter: Professor Austyn Snowden, PhD 2431. RMN, School of Nursing Midwifery and entry into undergraduate Snowden, A. et al., 2015. Evaluating Holistic nursing degrees: the Social Care, Edinburgh Napier University, Needs Assessment in Outpatient Cancer Care: Edinburgh, UK a Randomised Controlled Trial- the study recommendation, rhetoric Co-author(s): Jenny Young, Scotland protocol. BMJ Open, 5(e006840). Available and reality at: http://bmjopen.bmj.com/cgi/content/ Presenter: Ms Sarah Field-Richards, RN, Abstract long/5/5/e006840. MNurSci (Hons), Research Fellow, University Background: Gatekeeping refers to the process of Nottingham, Nottingham, UK where healthcare providers prevent access to Biography Co-author(s): Sarah Field-Richards, England; eligible patients for research recruitment. It is a Austyn Snowden is chair in mental health at Patrick Callaghan, England; Helen Spiby, common issue, particularly in research involving Edinburgh Napier University. He was a clinical England; Gemma Stacey, England; Philip people considered ‘vulnerable’. Explanations for nurse for 20 years and worked in a range of Keeley, England; Sarah Redsell, England; gatekeeping are reasonably well developed and specialties in UK, Australia, Channel Islands Sharon Andrew, England. it has been coherently argued that gatekeeping and Saudi Arabia before becoming a full time is unethical. Nevertheless gatekeeping persists, academic in 2007. His research interests are all Abstract and so a deeper understanding is needed. focused around the impact, function and facilita- Background: In response to the Francis Report tion of systematically listening to people. Aim: The objective of this study was to develop (2013), the Department of Health (DH) (2013) a typology of gatekeeping behaviour in order to He is currently principal investigator on a recommended that individuals complete up to systematically mitigate it. number of externally funded studies, including a year of care experience before commencing Method: EBSCO databases were searched for analysis of consultations in psychiatry and acute nurse training, as a potential means of fostering articles on gatekeeping between 1990 - 2015 and cancer care using MEDICODE; an original values conducive to compassionate care. method of conversation analysis that allows the results imported into NVivo 10. All examples Implicit within this recommendation, is the the researcher to quantify contributions within of gatekeeping behavior were coded using assumption that most individuals have not had conversations and thus measure subtle aspects gerunds to focus on the activity of gatekeeping. care experience prior to nurse training, and this of interventions not previously understood. The codes were condensed into a provisional is problematised within the context of concerns He leads the evaluation of ‘Improving Cancer theoretical framework. surrounding care quality. Prior care experi- Journeys’, a Macmillan Cancer Support UK Two focus groups were then conducted in 2015 ence (PCE) is presented as a change to current project designed to proactively support people with nine qualified hospice community nurses pre-training practices, and as a novel means of newly diagnosed with cancer. He also leads the involved in recruitment to a trial in palliative addressing issues surrounding compassionate development of a Patient Reported Outcome care. Semi-structured questions focused on the care. Leaving aside the question of whether PCE Measure of spiritual care for NHS Education nurses’ actions during recruitment. Both groups fosters the development of students’ caring and Scotland and is particularly interested in vali- were audio-recorded, transcribed verbatim then compassionate attributes, the potential effec- dation studies generally. He is part of a team analysed using the framework analytic process. tiveness of the recommendation is dependent undertaking a longitudinal study examining upon the extent to which the assumption of PCE Results: A continuum typology of gatekeeping the role of emotional intelligence and previous paucity, is an accurate reflection of reality. behavior emerged, ranging from unintentional caring experience in nursing. In this paper he to active disengagement. Justification ranged co-presents findings from an investigation into Aim: To determine the prevalence and charac- from forgetting or perceiving the study as low gatekeeping behaviour in clinicians. teristics of PCE undertaken by students entering priority, to deliberately not mentioning the nursing degrees in September 2015. study for fear of burdening patients or harming Methods: All first-year student nurses therapeutic relationships. attending three UK Universities were invited to Discussion: The typology developed here complete an online survey, to ascertain whether allowed for the creation of an original screening they had undertaken PCE and if so, its character- tool. The presentation details how the typology istics. Descriptive statistics generated in Bristol and screening tool items link and function. Online Surveys are reported. Conclusion: It is important to ascertain and Results: Early data (n=95) shows that 85% of discuss likely gatekeeping behaviour before entrants to nursing reported having had PCE. studies start. Mitigation strategies can then be The majority of these students had PCE of more developed collaboratively. The screening tool than 12-months duration (69.9%) and worked at developed here is introduced as a useful method least 24 hours/week (65.2%). of facilitating early discussion in any study Discussion and Conclusion: These data where clinicians have any responsibility for challenge the assumption implicit within the recruitment. Recruiting clinicians should then DH recommendation regarding the paucity of be free to discuss anxieties they may have in a PCE, since the majority of nursing students supportive environment. had undertaken PCE. Further, a substantial proportion of participants’ PCE exceeded the Recommended reading list recommended duration. These findings suggest Stone, P.C. et al., 2013. Factors affecting recruit- a disparity between the rhetoric and reality sur- ment to an observational multicentre pal- rounding PCE, and that its implementation as liative care study. BMJ Supportive & Palliative a prerequisite for entry into nurse training may

28 13.55 – 15.20 Concurrent session 2 – Wednesday 62 April 2016 not represent a change to current pre-training nurses in the second year of training registered 2.8.3 Abstract number 402 practices, of the scale envisaged by the DH. at three nursing colleges. Descriptive statistics were used to analyse the quantitative data. Two 2:55pm Recommended reading list open ended questions were added to the questionnaire which were subjected to open coding. Person-centred nursing: a Department of Health. (2013). Delivering high quality, effective, compassionate care. Devel- Results: The most stressful aspect of the student study of pre-registration and oping the right people with the right skills and nurse’s clinical experience were the cognitive community nursing students’ right values. A mandate from the government to demands (3.74) made on them followed closely attitudes health education england: April 2013 to March by the demand to hide their emotions (3.64) and Presenter: Dr David Banks, PhD, MA, BSc 2015. London: The Stationary Office. the responsibilities they carry (3.57). Students (Hons), DMS, RMN, RGN, RNT, Lecturer, do however receive good social support (3.42) Francis, R. (2013). Report of the mid stafford- Queen Margaret University, Edinburgh, UK and there is a fairly high sense of community shire NHS foundation trust public inquiry. (3.49) which may ameliorate the negative factors Co-author(s): Gillian Morris, Scotland, UK; London: The Stationery office. in the clinical learning environment. 84.2% of Lesley McKinley, Scotland, UK; Dr Russell the students feel insecure at work and yet the Ashmore, England, UK Biography job satisfaction rate was (74.4%). The qualitative Joanne Lymn is a Professor of Healthcare responses indicate that students use a variety of Abstract Education at the University of Nottingham and coping mechanisms including religion/spiritual Background: Recent inquiries have focused Director of Learning & Teaching in the School of practices, consulting others, getting organised attention on the need for nurses to deliver com- Health Sciences there. Joanne is currently PI on and expressing emotions. passionate person-centred care. The person- a Department of Health funded Policy Research Discussion: The psycho-social environment centred approach (Rodgers, 1967) has a long programme grant exploring the impact of prior of the clinical learning areas is challenging for tradition in mental health (MH) nursing, which care experience on nursing students caring and student nurses which together with the respon- can also be traced in the development of self compassionate behaviours. This four year grant sibilities they carry require resilience in order awareness and communication skills in Project is taking a longitudinal view investigating both to cope. The burden on these students does not 2000 curricula. There have been few attempts to the experience of people who were participants support their learning needs and needs urgent measure nurses’ person-centred attitudes (PCA). in the DH pilot project and the relationship attention. Existing research is dated and not without limi- between having care experience, or not, on proxy tations (Burnard and Morrison, 1991). There is measures of the 6C’s in students who started Recommended reading list also a paucity of research exploring development their nursing studies in 2015. of PCA in students. Brown, H., Gillespie, M., McDonald, J., Miles, L. & O’Mara, L. (2014). Challenging clinical Aims: To examine person-centred attitudes learning environments: experiences of under- amongst undergraduate and postgraduate graduate nursing students. Nursing Education nursing students undertaking community and 2.8.2 Abstract number 93 in Practice. 14: 208 - 213. pre-registration programmes. 2:25pm Edgecombe, K, Jennings, M and Bowden, Method: A sample of 161 MH and 128 Adult M. 2013. International nursing students and pre-registration students and 115 health visitor The psycho-social what impacts their clinical learning: Literature and district nursing students were recruited environment in the review. Nurse Education Today Volume 33, from two UK universities over three years. Par- Issue 2, February 2013, Pages 138-142 ticipants: (1) rated, on a scale between 0 and 70, clinical learning areas in the degree to which they believed their attitudes Johannesburg, South Africa : Kaphagawani, N.C., and Useh, U (2013). to be person-centred in relationships with A student nurse perspective Analysis of Nursing Students Learning Experi- patients; and (2) completed the Nelson-Jones ences in Clinical Practice: Literature Review. and Patterson (1975) 70 item counsellor attitude Presenter: Dr Sue Armstrong, D Cur, MSc, B Ethno Med, 7 (3): 181-185 (2013) scale (CAS) - one measure of PCA. Analysis Ed, B ur, University of the Witwatersrand, consisted of both descriptive and inferential sta- Johannesburg, South Africa Biography tistics. Co-author(s): Lize van Niekerk; Janis Sue Armstrong is currently teaching and super- Key findings: (1) Students’ self-perceptions Johnson; Letta Mathebula; Mpho Mot- vising post-graduate students at the University of their PCA are significantly higher than saanaka; Tamara Simelane; Elfi Kietsmann; of the Witwatersrand. She is actively involved in indicated by their CAS scores; (2) Post registra- South Africa the Nursing Education Association and has con- tion community students and pre-registration tributed to publications related to professional MH students returned higher mean CAS scores Abstract practice, management in nursing education and than adult pre-registration students; (3) No sig- Background: Student nurses in South Africa quality assurance in healthcare. nificant improvements were shown in Adult or spend 4000 hours of their four year course in MH students’ PCA by year three of the course; clinical placements. Anecdotal evidence shows and (4) Post registration community nurses that they find the clinical learning environment did not achieve significantly higher CAS scores stressful and question whether their placements than those obtained from post registration support their learning needs. community nurse students by Burnard and Aim: This study was conducted to determine Morrison (1991). the perspectives of the student nurses of the Discussion and Conclusions: Students psychosocial environment within the clinical possess relatively low levels of patient-centred- learning areas with a view to informing efforts to ness. Nurse education appears to have little improve the wellbeing of student nurses in the impact on the development of patient-centred- clinical learning areas. ness in students. The findings and their implica- Method: A self-administered questionnaire tions for practice and education will be discussed viz. COPSOQ which uses a 5 point Likert scale in detail. was used. The sample consisted of 164 student

29 213.55 – 15.20 Concurrent session 2 – Wednesday 6 April 2016 Recommended reading list Theme: Rising stars - ViPER Biography Burnard, P., Morrison, P. (1991) Client-centred I obtained my first degree, a BSc in Applied Sport counselling: A study of nurses’ attitudes. Nurse 2.9.1 Abstract number 440 Science, from Edinburgh University in 2002. Education Today vol 1, no 2, pp 104-109. 3:50pm Since then, I have held a variety of positions Nelson-Jones, R., Patterson, C.H. (1975) in the sport and fitness industry, as well as Measuring the client-centred attitudes. British Barriers to physical activity competing in elite level athletics. I completed Journal of Guidance and Counselling vol 3, no2, in obese adults: A systematic my MSc in Adult Nursing at the University of the pp 228-236. West of Scotland in October and will graduate literature review this summer. I recently received my PIN and am Rogers, C. R. (1967) On becoming a person: A Presenter: Miss Toni McIntosh, MSc Adult looking forward to beginning my first position as psychotherapist’s view of therapy. Constable, Nursing, BSc(hons) Applied Sport Science, Uni- a staff nurse next month. I have a strong interest London. versity of the West of Scotland, Hamilton, UK in research and since completing my course I have been employed on a temporary basis by Biography Co-author(s): David Hunter, Scotland, UK; Sue Royce, Scotland, UK the RCN as a research assistant. I aim to develop My professional practice began with training as my career as a clinical academic as I strive to a mental health nurse in 1977. I mainly worked improve the patient experience through an Abstract as an acute care charge nurse in Teesside, UK. increase in knowledge and understanding. My My subsequent academic career has largely been Background: Rising rates of obesity are a primary interest is health promotion, particu- spent educating nurses and other health profes- global healthcare challenge, with multiple larly the physical and mental health benefits of sionals in research methods. I was awarded my implications for individuals’ health and health physical activity. I continue to compete at a high PhD from Durham university in 2010. service resources. Physical activity can positively level in running and cycling, however I am pas- influence weight loss and weight loss mainte- My recent publications reflect my current sionate about promoting the benefits of physical nance, however levels are low amongst obese research and practice interests: activity as widely as possible. The above research individuals. was undertaken to fulfil my MSc dissertation. Clifton, A. and Banks, D. (2013) ‘Social theories Aim: To identify the barriers faced by obese informing mental health nursing’’ In Wright, individuals which prevent them from engaging N. and Stickley, T. (Eds.) Theories for Mental with physical activity. Health Nursing: A guide for practice Sage, London. Methodology: A three-step systematic 2.9.2 Abstract number 461 approach was used which began with an initial Banks, D. Clifton, A. Crawshaw, P. and Purdy, scoping search, followed by an electronic 4:20pm M. (2013) Mental health nursing and the man- database search using key words, to identify agement of supervision as a confessional act. English language studies conducted between Enhancing placement Psychiatric and Mental Health Nursing. 2010 and 2015, which focussed on barriers to experiences of nursing Clifton, A. Repper, J. Banks, D. and Remnant, physical activity in the obese population. A students: preparing students J. (2013) Co-producing social inclusion: The reference list search was then carried out to structure/agency conundrum. Psychiatric and identify any further relevant studies, as well for practice. Mental Health Nursing. as manual searching of current journal issues. Presenter: Miss Gina Williams, BSc Biomedi- Cowan, S. Banks, D. Crawshaw, P. and Clifton, A. Both quantitative and qualitative studies were cal Science & current BNurs undergraduate, (2011) ‘Mental health service user included in the review. Papers were assessed for Student nurse, University of Manchester, Manchester, UK involvement in policy development: Social quality using a tool developed by Caldwell et al. inclusion or disempowerment?’ Mental Health (2011) and relevant data extracted. Co-author(s): Williams, G., Cooper, J., Cooke, Review Journal. Results: A total of 17 studies were included in M., Griffiths, J. MacInnes, D. Ashmore, R. Banks, D. and the review, comprised of 11 quantitative, 5 quali- Abstract Flanagan, T. (2010) ‘An examination of the tative and one mixed methods study. Several factors that influence the publication or non- barriers were identified relating to three main Introduction: Peer learning partnerships publication of mental health nursing research: themes: physical barriers, psychological barriers support first year students during their transition Research Report’, 57pp. Burdett Nursing Chari- and external barriers. Physical barriers included to practice whilst preparing more experienced table Trust, London. excess weight, poor fitness and health problems. students for preceptorship, registered practice Psychological barriers included weight percep- and eventually mentorship by improving self- tion, low mood and lack of motivation. External confidence (Christiansen, Bell, 2010) barriers included lack of time, lack of knowledge Method: A working group of students repre- and competing demands. Many of the barriers senting Adult, Mental Health and Child fields are similar to those reported by the general provide a source of peer support to succeed- population, however several were also identified ing cohorts (Dennison, 2010). Supported by which are unique to obese individuals. academic staff and a grant, the primary aims Conclusion: Due to the variety of barriers were to improve nursing preparation, adDress faced by obese individuals, it is important that concerns about practice placements students nurses treat each person as an individual and had identified, maximise learning opportuni- identify the barriers perceived by them, in order ties and signpost individuals to available sources to provide targeted support to overcome these of support in a group context (Sprengel; Job, barriers. 2004). Result: The ‘Placement Enhancement Project’ Recommended reading list created a reflective blog, professional quality Caldwell, K., Henshaw, L. and Taylor, D. (2011) video materials and printable guides; adapting Developing a Framework for Critiquing Health university guidance and developing specific Research: An Early Evaluation. Nurse Education user-focused material to create student-related Today, 31(8), pp e1-e7. publications, bridging the gap between practice

30 13.55 – 15.20 Concurrent session 2 – Wednesday 62 April 2016 and university experiences. This poster explores this process of preparation of nursing students for practice experience, critically reflecting on current literature and policy and presents the responses to the pilot launch of this project and a project evaluation. Outcomes showed 74% of respondents felt there was a dearth of information about specific placement areas and learning opportunities; reflective blogs by experienced students were launched in response. Respond- ents were also asked methods they used to access more information to prepare for practice, topic requests and qualitative feedback on the project. The responses were used to guide future materials. Conclusion: The project encouraged collaboration between academic staff and students, enabling staff insights into undergraduate BNurs student experiences and evidencing benefits of peer learning and support. This project would inform the development of the future nursing workforce by utilising the untapped potential of on-line peer learning networks; increasing satisfaction and developing leadership skills of volunteer students, whilst aiming to improve retention of new students by reducing anxieties and social isolation regarding novel practice experiences.

Recommended reading list Christiansen, A. & Bell, A. (2010) Peer learning partnerships: exploring the experience of pre- registration nursing students. Journal of Clinical Nursing. 19(5-6):803-810 Dennison, S. (2010) Peer Mentoring: Untapped Potential. Journal of Nursing Education. 49(6):340-342 Sprengel, A. & Job, L. (2004) Reducing Student Anxiety by Using Clinical Peer Mentoring With Beginning Nursing Students. Nurse Educator. 29(6):246-250

Biography Gina Williams is a current undergraduate BNurs student; in her final year on the Adult Nursing course she has been involved in the ‘Placement Enhancement Project’ team and the creation of the accompanying booklet for new students. A previous Biomedical Sciences graduate, she has a background interest in research and hopes to continue this upon qualifying this September; combining research with clinical practice. She would also like to acknowledge the continuing hard work and support from the rest of the team and hopes the project can continue and develop over the coming years to help future generations of nurses begin their journey in nursing.

31 315.50 – 16.45 Concurrent session 3 – Wednesday 6 April 2016 Concurrent session 3 Wednesday 6 April 15.50 - 16.45

Theme: Rising stars levels of autonomy necessitated health policy it is unclear as to whether this is a deliber- resolutions that are currently underway and are ate strategy or due to socio-political factors: a 3.1.1 Abstract number 226 fostered by the new CoENS. reduction in the working hours of junior doctors (NHS Management Executive, 1991) and Gov- 4:20pm Recommended reading list ernment targets (DOH 2000, Scottish Govern- ment 2007) and increased ED attendances. Italian nurses’ driving force Boyer, E. L. (1990) Scholarship reconsidered: to influence health policy Priorities of the Professoriate. San Francisco: Aims: To explore ENPs’ perceptions of their Josey-Bass. changing role, catalysts for change and educa- Presenter: Dr Alessandro Stievano, PhD tional needs which might prepare them for this Carpenter, J. (2008) ‘Metaphors in qualitative Nursing, Centre of Excellence for Nursing role and whether these needs are being met. research: Shedding light or casting shadows?’. Scholarship, Rome, Italy Research in Nursing & Health, vol 31, no 3, pp Design: A qualitative, phenomenological study Co-author(s): Dyanne Affonso, USA; Rosaria 274-282. was utilised to study responses from experi- Alvaro, Italy; Laura Sabatino, Italy; Gennaro enced ENPs working in Emergency Care envi- Rocco, Italy. Biography ronments. Alessandro Stievano is currently research coor- Methods: A purposive sample of ENPs in Abstract dinator of the Centre of Excellence for Nursing NHS Lothian, six semi-structured interviews. Background: A goal of the Italian Regulatory Scholarship of Ipasvi Rome - Italy. He is also a Exclusion criteria were subjects working with Board of Nursing -IPASVI Rome- that estab- post-doc researcher for Tor Vergata University - the researcher, practitioners from a non-nurs- lished a Centre of Excellence for Nursing Schol- Rome - Italy and Adjunct Assistant Professor for ing background and ENPs in roles less than arship (CoENS),1 was to influence health policy Michigan State University USA. three years. Inclusion was any ENP in post for via a new infrastructure for nursing programmes a minimum of three years. Colaizzi’s method of The Centre of Excellence for Nursing Scholar- and initiatives. This study identified the chal- data analysis was utilised for analysis of findings. ship is a novel project of the IPASVI Nursing lenges and opportunities for Italian nurses in College of Rome - Italy. The Centre represents a Discussion: The ENP role has expanded in their quest to have health policy implications of unique venture for Italy, and one of the first to be number and scope of practice. Factors influenc- its CoENS programmes. set up in Europe, in line with the positive expe- ing this were cited as increased attendances, Aims: To explore Italian nurses’ perceptions of riences matured in this direction in the United government targets, increased acceptance and the critical reforms that impacted nursing’s goal States, which will definitely contribute to the support and ENPs desire for expansion. to influence health policy. development of competences and enhance per- Conclusion: Three themes emerged; Continu- Methods: A qualitative study via focus groups formances of both individual professionals and ing Professional Development, medical support explored Italian nurses’ perceptions through healthcare teams committed to providing care to and role expansion. ENPs reported expansion a purposive, convenience sample of 66 nurses people. of role due to increased attendances and fewer during December 2012 - July 2013. Study par- The ultimate aim is to fathom the world of doctors in training posts. The level of support ticipants included a cross-section of nurses nursing research to improve the quality of care from senior medics had a direct influence over between 22-65 years old with varying levels of provided to the public and public’s perception of practice development. Difficulties making time education, different working roles and clinical the nursing profession. for CPD were cited by all. It was a small pilot experience. study, to identify emerging themes for develop- Results: Three themes included metaphors2 ment of a larger study over a wider geographical that elucidated health policy implications. area, to ascertain whether the findings are con- ‘Deductive Jungle’, used to communicate dif- sistent around the UK, and develop recommen- 3.1.2 Abstract number 267 ficulties in clinical decision-making and impli- dations for future practice. cated nursing autonomy and responsibility 2:55pm issues. ‘Leopard Spots’ was a way to convey Recommended reading list resistance to changes (e.g. dominance of old The emergency nurse NHS Management Executive (1991) Junior ways of thinking) and implicated health policy practitioner role - thirty years Doctors- the new deal. (Calman report). Depart- that underpinned ongoing nursing reforms. ment of Health, London. ‘Vortex’ depicted nurses’ turbulence from over- on: a pilot study Department of Health (2000). The NHS Plan. A whelming changes, which involved health policy Presenter: Mrs Sue Bagley, RGN, Dip. H.E. Plan for Investment. A Plan for Reform. London supports of the Ministry of Health to further (Teaching and Learning in Practice), MSc Stationary office nursing as a bona fide health profession. Advanced Practice, NHS Lothian, Emergency Scottish Government (2007). Better Health, Discussion: These metaphors disclosed Department, Edinburgh Royal Infirmary, Better Care: Action Plan. www.scotland.gov. powerful images of conflict and struggle particu- Edinburgh, UK uk/publications/2007/12/11103453/1 accessed larly among clinical nurses. Essential changes April 2014 had to be fueled via health policies at the local Abstract and national levels, inclusive of the Italian Background: The Emergency Nurse Practi- Ministry of Health and Education. tioner (ENP) role began in the United Kingdom Conclusions: The reality of nurses continued (UK) in 1984. ENP roles have expanded in devaluation from a lack of recognition and low number and scope of practice since, although

32 15.50 – 16.45 Concurrent session 3 – Wednesday 63 April 2016 Biography of theoretical coding and memoing allowed for 3.2.2 Abstract number 214 the construction of the final substantive theory. Sue Bagley is the Clinical Lead for the Nurse 4:20pm Practitioner Service in the Emergency Depart- Results: The interpretation of identified cat- ment at Edinburgh Royal Infirmary, where she egories was that young adults saw the purpose has worked for the last nine years. She began her of supportive care to be the protection of their Parental decision-making career as a nurse practitioner in 1998, working developing adult identity. Translating a critical about nasal flu vaccine for in a nurse-led minor injuries unit in England. situation, and the threat it posed to their children In 2003, she was appointed team leader for planned biography, young adults sought self- Presenter: Ms Phoebe Moulsdale, MPH, BNurs the ‘Minor Injuries Community Outreach agency within social and professional supportive (hons) child branch, UH Bristol NHS Founda- Team’, having established the team two years care to retain their adult identity. Participation tion Trust, Childrens Research Team, Bristol, before. The team was a new innovation utilising was congruent with the social context of their UK unscheduled care funding and nurse practi- life-stage, and fluid across internal strategies Co-author(s): Aimee Grant, UK; Margaret tioner expertise to prevent unnecessary hospital and use of the external resources. Fletcher, UK; Adam Finn, UK admissions over the winter months. The team Conclusion: To continue young adults’ transi- achieved the Innovations Award in 200x by the tional tasks of young adulthood and to heed their Abstract Community Hospital Association, and the team desire for personal agency the structure and went on to secure permanent funding. delivery of care in this context should be consid- Background: There are ongoing changes to Sue graduated in July 2015 with an MSc in ered in future organizational development. the recommendations for flu vaccine in the UK. Advanced Practice. Her presentation is the Nasal flu vaccine is now offered to children from age 2 reaching up to higher age groups each year. research study which was the focus of her dis- Recommended reading list sertation. This will provide direct protection to immunised http://www.cancerresearchuk.org/health- chilDren, but also provide herd protection to professional/cancer-statistics/teenagers-and- those of all ages including those who are vulner- young-adults-cancers accessed 16.11.2015 able to serious consequences of flu infection. Zebrack, B. (2011) Psychological, social, and There is little UK research examining how behavioral issues for young adults with cancer. parents view flu illness and if they will support Theme: Mixed methods Cancer, 117(S10), 2289-2294. this vaccine programme. 3.2.1 Abstract number 399 Charmaz, K. (2014) Constructing grounded Aim: To explore parents’ perceptions of flu theory. Sage. Thousand Oaks. CA illness in children and why they decide whether 3:50pm to accept or decline nasal flu vaccine for their Biography child. How do young adults (19-24 Louise Soanes is the Teenage Cancer Trust Nurse Methodology: The research adopted a mixed- years old) living with cancer Consultant for Adolescents & Young Adults methods approach. First, a survey was distrib- experiences supportive care? at the Royal Marsden Hospital, London, UK. uted to all parents of children in one primary Presenter: Dr Louise Soanes, DNurs. MSc. Since qualifying she has worked with children, school. Second, 10 survey respondents were BSc., The Royal Marsden NHS Foundation teenagers & young adults with cancer in a variety recruited for in-depth semi-structured inter- Trust, Sutton, UK of clinical settings and institutions and in an views. Themes that emerged from the survey academic post at London South Bank University. were used to structure the interview including: general views on vaccination; risk and side Abstract She has written and lectured widely on CTYA cancer nursing, authored two text-books, and effects; flu illness; herd protection, information Introduction: Cancer in young adulthood written several publications. Louise is a reviewer and trust. is rare (CRUK 2015). Soon after diagnosis the for European Journal of Oncology Nursing and Results: 91% (n=78) of parents sampled in psychosocial consequences of cancer on young the British Journal of Nursing. 2014 were in favour of routine vaccinations adult’s developing personal biography are and 93% (n=80) responded that their child’s largely unknown (Zebrack 2011). Therefore the Louise’s research interests and clinical work vaccines were up to date. However, only 47% organisation and delivery of supportive cancer focuses on survivorship, self-management and of the parents were ‘in favour’ or ‘very much in care in this context has a limited evidence base. patient advocacy. Whilst her professional lead- favour’ of the flu vaccine. From the interviews, This presentation will explore the methodology, ership roles include regional/national strategy the differences between parents in favour and methods, findings and implications for practice and policy to ensure healthcare meets the health not in favour of the universal nasal flu vaccine of a multi-centred study into the experience of and social care needs of adolescents and young programme surrounded the concepts of trust, supportive cancer for young adults with cancer. adults with cancer. community responsibility, controllability and Aim and Objectives: This work sought to the perception of risk. understand how young adults recently diagnosed Conclusion: This study has demonstrated that with cancer identified their supportive care parents who are typically supportive of vaccina- needs and how they perceived and defined the tion may have doubts about the necessity of flu care required to meet these needs. The primary vaccine for their child. This may reduce uptake objective was that research outcomes would add and undermine the programme. The implica- to the current body of knowledge and influence tions of this research have highlighted the need practice development in this area. for clear, accessible and transparent communi- Methods: Using constructivist grounded cation between health authorities and the public, theory (Charmaz (2014) data were collected to build trust. through in-depth interviews, with eleven young adults. Sampling strategies included purposive Biography and theoretical techniques. Data were analysed concurrently through open and focused coding Phoebe graduated from The University of Bir- and the constant comparative method. The use mingham in 2005 in Childrens Nursing. After working on the Liver Unit at Birmingham Childrens Hosptial, Phoebe left to work with

33 315.50 – 16.45 Concurrent session 3 – Wednesday 6 April 2016 Medicins Sans Frontieres on the Ethio-Somali hypertension (n = 44;12.9%) or other causes (n 3.3.2 Abstract number 225 border. On return to the UK, she settled in =118 patients; 34.7%). Increased cost and the Bristol, working in the PICU at Bristol Royal need for nurses in this field was reported too. 4:20pm Hospital for ChilDren. Keen to pursue her Discussion: Prevalence of maintenance dialysis interests in infectious diseases, immunology increased significantly in the four RDCs of the Direct patient care in the and public health, Phoebe then took up a clinical Northern Region of Oman from 322 patients haemodialysis out-patient research nurse postion working mostly on vac- on 31 December 2013, to 382 on 31 December unit cination trials and immunology studies. During 2014. This equates to a 16% increase. Incidence Presenter: Miss Alison Wood, RGN, MSc, this time Phoebe completed her Masters in was higher than MR; therefore, the prevalence BN, PhD Student/Staff Nurse, University of Public Health. Phoebe then became a clinical and cost were rising. Two third of the patients Edinburgh, Edinburgh, Edinburgh, UK nurse specialist in immunology and infec- suggested their cause of RF to be hypertension, tious diseases and she now combines specialist diabetes, or both respectively. nursing and clinical research. Abstract Conclusion: The rising prevalence and Background: Direct patient care (DPC) is a cost implies the emergent need to reduce term found within the Releasing Time to Care the incidence of RF in Oman via adapting an (RTC) programme, part of NHS Scotland’s effective screening program. quality improvement strategy for the NHS. Theme: Mixed methods One aspect of this programme is to determine Recommended reading list the amount of time staff spend providing DPC 3.3.1 Abstract number 111 Abboud, O.,2006. Incidence, prevalence, and and explore the ways time is spent on other treatment of end-stage renal disease in the aspects of care, with the overall aim of increas- 3:50pm Middle East. Ethnicity and Disease Journal, ing time spend delivering DPC. DPC in the RTC 16(2), pp.S2-2-4. programme is regarded as when staff are either Epidemiology, incidence and Department of Health Information & Statistics, at a patient’s bed or near the patient (Wright and mortality rate of renal failure Directorate General of Planning,2013.Annual McSherry 2013). This research has explored the patients in the northern Health Report 2012.[online] Available at: http:// concept of DPC within the haemodialysis out- region of Oman: cross- www.moh.gov.om/en/nv_menu.php?o=stat/ patient unit. sectional study results ahr.html [Accessed May 9, 2014] Aim: To gain an understanding of patient and Hussanien, A., et al., 2012.Epidemiology of nursing staff perceptions and experiences of Presenter: Mrs Ruqiya Al-Za’abi, Nursing and end-stage renal disease in the countries of the DPC within the haemodialysis unit. Health Care, University of Glasgow, Glasgow, Gulf Cooperation Council: a systematic review. Methods: Data were collected over 9 months UK Journal of Royal Society of Medicine Sh Rep, through participant observations, interviews Co-author(s): Elizabeth Tolmie, Scotland, UK; [online] 3(6) doi: 10.1258/shorts.2012.011150. and photographs using an focused ethnographic Ann Marie Rice, Scotland, UK; Nabil Mohsin, Available at: http://www.ncbi.nlm.nih.gov/ approach (Cruz and Higginbottom 2013). Reg- Oman; Ahmed Al-Busaidi, Oman pubmed/22768372 [Accessed May 9, 2014] istered nurses, clinical support workers and patients consented for the observations and Abstract Biography photographs, with semi-structured interviews conducted on a smaller purposive sample com- Background: The epidemiology of renal Ruqiya Al-Za’abi is a PhD student at University prising of 12 patients, 12 registered nurses and 3 failure (RF) in Oman is scarce. There is a paucity of Glasgow, college of medicine, veterinary and clinical support workers. of information on the size and burden of RF life sciences, school of nursing. She acquired her in Oman. The last prevalence of maintenance master degree from University of Central Lanca- Results: Thematic analysis of transcribed data dialysis was reported in 2013 (n =1281; popula- shire, UK and her Bachelor Degree in Nursing uncovered key findings highlighting two distinct tion = 3,855,206). No data was available on the from USA. She has been employed as a nurse and interdependent concepts. The act of care incidence, mortality rate (MR) or characteristics tutor since 2003 teaching adult health nursing established as being safe, providing comfort and of this population. subjects including renal and urinary relevant being individual and care giving with DPC iden- Aims: To measure the burden, prevalence, topics to nursing students in Oman. Her primary tified as being delivered in two ways- actively or incidence and Mr among patients who have research interest is renal disease, in particular, passively. RF and undergo renal dialysis in four dialysis the challenges facing ESRD patients. Ruqiya Discussion: Passive care was identified as one centres in the North of Oman; and to provide hopes to find ways to improve the quality of of the key findings in this study. It relates to staff a description of the major characteristics of the life and renal services for people with ESRD in being physically visible and available for patients studied population. Oman and to disseminate the result of her work. despite not being in close proximity or doing Methods: A cross-sectional study was something directly to them. This care still allows conducted. A proportional sample (n = 341) patients to feel cared for and staff to feel they are of patients from four Renal Dialysis Centres caring for the patients. (RDC) who met the study’s inclusion criteria Conclusion: This understanding of Passive were interviewed using researcher-adminis- Care as a term, particularly in this setting, has tered structured questionnaire during October increased the knowledge on this area. and November, 2014 and patient records were reviewed. Recommended reading list Results: Over the period January 1st, 2014 to Wright S and McSherry W (2013) ‘A systematic December 31st, 2014, the overall incidence was literature review of Releasing Time to Care: the 13 patients per100,000 (96 patients in total). Productive Ward’. Journal of Clinical Nursing, The prevalence was 52 patients per 100,000 Vol 22, no 9-10, pp 1361-1371. (n=382). Mr was four patients per 100,000 (30 Cruz EV and Higginbottom G (2013) ‘The use of patients in total). When asked, patients reported focused ethnography in nursing research’. Nurse the cause of their RF to be hypertension (n =112; Researcher, Vol 20, no 4, pp 36-43. 32.8%); diabetes (n =67; 19.6%); diabetes and

34 15.50 – 16.45 Concurrent session 3 – Wednesday 63 April 2016 Biography problems, time limits and lack of support from delivering excellent patient care and experience Qualifying as a nurse in 2007 from the Univer- the managers. The results were supported by the (HEE 2014). One way to achieve this is through sity of Edinburgh. Gaining clinical experiences results from the interviews with the managers. Values Based Recruitment, a process whereby in general medicine and renal medicine areas as Discussion: The discrepancy between the high individuals are selected based on their ability to a Staff Nurse whilst completing a part time MSc acceptance of the learning experience and the demonstrate the values required for the role. in Advancing Nursing Practice also at the Uni- high proportion of nurses not enrolling can be This paper will show how the Faculty of Health versity of Edinburgh (2009-2011). explained by the barriers reported by nurses and and Life Sciences at Coventry University in col- A full time PhD programme began at the Uni- managers. laboration with 30 patients and carers used a versity of Edinburgh in 2012 with a plan for Conclusion: International research results on descriptive qualitative approach with multiple completion in early 2016. Currently remaining acceptance of mobile learning by nurses (Lahti, data collection methods that included art, role- in a part-time position within haemodialysis as M., Hätönen, H., & Välimäki, M. 2014) are play, focus groups and video vox pops to capture a Staff Nurse. confirmed by results from elderly care nurses in patients and carers experiences of care and what Germany. they value. Thematic analysis was used to analyse the data. Recommended reading list The resultant key themes shaped the development of two e-resources to inform potential Koole, M. L. (2009) A Model for Framing Mobile students of what values and behaviours patients Theme: Mixed methods Learning, from http://auspace.athabascau.ca/ and carers believe are necessary to create a handle/2149/2016 (retrieved 14.11.2015). 3.4.1 Abstract number 232 collaborative, practice-ready workforce. Our Lahti, M., Hätönen, H., & Välimäki, M. (2014) overall aim is to attract pre-registration nursing 3:50pm Impact of e-Learning on nurses’ and student students with the ‘right skills and the right nurses knowledge, skills and satisfaction: A sys- values’ to our courses. tematic review and meta-analysis. International Acceptance of mobile The e-resources will be piloted with both current Journal of Nursing Studies, 51, pp. 136-149. learning by German nurses and prospective students to ascertain the impact working in elderly care Liang, J.-C., Wu, S.-H., & Tsai, C.-C. (2011) of the resources on attracting appropriate Nurses’ Internet self-efficacy and attitudes Presenter: Ms Mathilde Hackmann, nurse, nursing students to our courses. toward web-based continuing learning. Nurse Evangelische Hochschule Soziale Arbeit und Educ Today, 31, 8, pp. 768-773. Diakonie - Protestant University of Applied Recommended reading list Sciences Hamburg, Hamburg, DE Health Education England (2014) Values Based Biography Co-author(s): Katharina Buske, Germany; Recruitment Framework http://hee.nhs.uk/ Mathilde Hackmann is a lecturer at the Protes- Birgitt Höldke, Germany wp-content/blogs.dir/321/files/2014/10/VBR- tant University of Applied Sciences in Hamburg, Framework.pdf Germany. Up to September 2015 she was Abstract Silverman, D (2011) Qualitative research. member of the academic staff at Hamburger London: Sage Publications. Background: Although in Germany long-term Fern-Hochschule, Germany. She qualified as a care for the elderly is well established for two Nurse in 1980 in Thuine (Germany), gained her Waugh, A Smith, D Horsburgh, D Gray, M decades now the quality of services is still an first academic degree (Diplom-Pflegepädagogin (2014) Towards a values-based person specifica- issue for the public. Educational needs of nurses FH) in Osnabrück, Germany and graduated with tion for recruitment of compassionate nursing working in elderly care are therefore discussed an MSc in Nursing and Education from the Uni- and midwifery candidates: A study of registered and mobile learning is seen as a solution for verstiy of Edinburgh, Scotland in 1998. Her pro- and student nurses’ and midwives’ perceptions organising continuing education for those fessional background includes various positions of prerequisite attributes and key skills. Nurse nurses. Little is known how German nurses in basic and further education for nurses and as Education Today Vol.34(9), pp.1190-1195. might accept this learning method. an adviser for community nursing. Funded by the Federal Ministry of Education Biography and Research 7 mobile learning modules were Yvette Brown is a Cross Faculty Service User and developed and tested in 15 organisations of Carer Facilitator providing a strategic direction elderly care in different German regions in 2013 3.4.2 Abstract number 115 to strengthen service user and carer engagement and 2014. within the Faculty of Health and Life Sciences at Aims: The research team evaluated the accept- 4:20pm Coventry University. Personal interests include ance of mobile learning by the managers and the recovery in mental health, cultural perceptions nurses. Weaving the patient and of mental health and service user and carer involvement in higher education. She has been Methods: The research design was developed carer voice into E-resources a mental health nurse for a number of years using the model of Koole (2009), an interna- to shape values based working in a number of mental health acute and tional survey instrument (Liang, Wu, & Tsai, recruitment community settings. 2011) and German instruments on evaluating Presenter: Miss Yvette Brown, RN (Mental workplace issues. 176 nurses completed ques- Health) MSc, PGCE, Coventry University, tionnaires at the start of the learning experi- Faculty of Health and Life Sciences, Coventry, ence and after they finished it. The managers UK provided information in personal interviews. Co-author(s): Arinola Adefila England, UK Pat Survey data were analysed by using SPSS Bluteau, England, UK 22.0Â®. Content analysis of the interviews was supported by using MAXQDA 11Â®. Abstract Results: Only 64 nurses actually enrolled Health Education England has issued a directive in learning modules. Among these nurses to develop a workforce not only with the right acceptance of the learning method was high. skills and in the right numbers; but with the Reported barriers to enrollment were: technical right values to support effective team working in

35 315.50 – 16.45 Concurrent session 3 – Wednesday 6 April 2016 Theme: Qualiatative approaches torship period to allow development of peda- is cited as a key intervention to ensure conti- gogical skills. nuity of care particularly, during transitions in 3.5.1 Abstract number 421 and out of hospital. However evidence suggests Recommended reading list carers struggle to be involved during a hospital 3:50pm admission(2). Ivarsson B. & Nilsson G. (2009) The subject The lived experience of of pedagogy from theory to practice: the view Aims: 1.Identify the facilitators and barriers newly-qualified nurses in the of newly registered nurses. Nurse Education to carer partnership working in acute medical Today, 29: 5, 510-515. wards for older people delivery of patient education Smith J.A., Flowers P. & Larkin M. (2009) Inter- 2.Identify the essential elements of an interven- in an acute care setting. pretative Phenomenological Analysis: Theory, tion to foster carer/staff partnership working in Presenter: Miss Karen Fawkes, MSc BSc RN Method and Research. London: Sage. acute medical wards for older people PGCE FHEA, Florence Nightingale Faculty of Methods: A combination of participant Nursing & Midwifery King’s College London, Biography observation across two acute wards in London London, UK Having qualified as an adult registered nurse in (n=152 hours), interviews with patients(n=10), Co-author(s): Jaqualyn Moore 1987, my nursing career has been spent predom- carers(n=11) and focus groups( n=2) with inately in the acute care setting. The greater part nursing staff was used. The COM-B Model of Abstract of my career was spent working in a vascular behavioural change(3),was employed as a theo- Background: Globally, an increase in chronic surgery unit, a tertiary referral centre, caring retical framework within which data was coded disease prevalence, an aging population and for the broad spectrum of patients who make and analysed . Emergent data was iteratively shortened in-patient length of stay render up this speciality. An interest in nurse education discussed with a stake holder group including imperative the nurse’s ability to provide patient and development led to a post as a practice direct care nurses, carers, organizational change education to support self-management. Pre-reg- development nurse working with qualified staff experts and members of the research advisory istration curricula are designed to prepare the to promote skill development to improve care board. newly-qualified nurse for their role across the quality. A later role as lecturer-practitioner in Results: Key areas for intervention develop- healthcare landscape, yet novice nurses report vascular surgery involved setting up and running ment were: 1) identification and early connec- feeling unprepared for the role of educator a validated and accredited level 6 & 7 course for tion with carers on admission,2) confidence (Ivarsson & Nilsson 2009). nurses on Introduction to Vascular Care. Leaving and skills of nurses , 3)organisational cues Aim: The study aimed to explore the lived acute care, I have, for the last two years, worked and support to foster partnership working and experience of newly-registered adult nurses as a clinical teacher in a large Central London 4) organisation and of nursing work which in the delivery of patient education in acute faculty of nursing, promoting skill acquisition in often mitigated against partnership working care. Method: Using the qualitative approach pre-registration nursing students. Studying for with carers. An intervention mapping exercise of Interpretative Phenomenological Analysis my MSc in Education for Healthcare Profession- forwarded analysis and assisted in the identifi- semi-structured interviews generated data on als I chose to carry out an empirical study for cation of possible outcome measures. the lived experience of newly-qualified nurses my dissertation, examining how novice nurses Conclusions: COM-B argues that 3 compo- in providing patient education (Smith et al perceive patient education. nents: competency, opportunity and motivation 2009). Seven adult nurses formed a purposive all need to be present for behavioural change sample recruited at one central London hospital to occur. Using this framework to analyse the between April and June 2015. data moved intervention. development from a Findings: Three super-ordinate themes were 3.5.2 Abstract number 416 sole focus on individual competency to encom- identified, each with three to four sub-themes. passing systemic and motivational elements to 4:20pm The Professional Self encompassed nursing support changing behaviour in practice. knowledge, skills and values, accepting role responsibility for patient education, whilst iden- Identifying the elements of Recommended reading list tifying lack of clinical knowledge and pedagogi- an intervention to foster Cornwell J, Levenson R, Sonola L, Poteliakhoff cal skill as inhibitors. The Ward Environment partnership working between E (2012).Continuity of care for older hospital incorporated time pressures, heavy workloads, older people’s friends and patients, a call for action. London King’s Fund structural and organisational constraints and family and direct nursing Lowson E, Hanratty B, Holmes L, et al.(2013) occasional colleague hostility as barriers to suc- From ‘conductor’to ‘second fiddle’: Older adult cessful pedagogy whilst collaborative pedagogi- care staff during a hospital stay care recipients’ perspectives on transitions in cal practice with other healthcare profession- family caring at hospital admission. Interna- als and availability of resources were enablers. Presenter: Dr Caroline Nicholson, King’s tional Journal of Nursing Studies. 50: 1197-205. The Nurse-Patient Relationship emphasised the College London, Florence Nightingale Faculty Michie S, van Stralen MM and West R.(2011) importance of the interpersonal relationship of Nursing & Midwifery, London, UK The behaviour change wheel: a new method for in ‘knowing the patient’ whilst highlighting the Co-author(s): J Maben, Uk, E Ream, Uk, Hicks, practical challenges some patients present. characterising and designing behaviour change A, Uk, UK, Handley, A, U.K., Romero, D . U.K. interventions. Implementation Science. 6: 42. Conclusions: The findings suggest that, J Fitzpatrick, U.K. whilst the newly-qualified nurse has the values Biography and attitudes needed for patient education, an Abstract awareness of pedagogy is poorly developed. Caroline is a NIHR postdoctoral research fellow Background: The fundamental importance The formation of core pedagogical skills should at the National Nursing Research, within the of continuity of care for older people during be embedded in pre-registration curricula, Florence Nightingale Faculty of Nursing and acute admissions is highlighted by the Kings promoting practical strategies for the challenges Midwifery at King’s College London. She has Fund(1). Continuity is the degree to which a of clinical practice. Managers should create a over 20 years experience in the NHS, as a clinical series of discrete health care events is experi- pedagogical climate with an expectation that nurse specialist in palliative care and academic enced as coherent and connected and consistent patients will be educated, with support provided in end of life care, including 8 years as a practice with the patient’s needs and personal context. for newly-qualified nurses during their precep- near researcher. Her doctoral and post-doctoral Partnerships with friends and family(carers), work has explored the experiences of older

36 15.50 – 16.45 Concurrent session 3 – Wednesday 63 April 2016 people in primary and institutional care settings capability and clinical academic leaders (HEE undertaken by a team containing at least and developing interventions to facilitate the 2015; AUKUH 2014). In addition, the numbers one nurse and concerned with the practice healthcare workforce to deliver compassionate of nursing and midwifery chairs and the of nursing; 2 where the research was on the and responsive care. She has a long held interest diversity of this leadership group will be consid- practice of nursing, but where nurse represen- in the experience of frail older people and the ered within the wider context of the nursing and tation was not obvious; 3 where the impact was capacities as well as the frailties of living in midwifery professions at large and in compari- either of no relevance to nursing or was relevant late old age. This undeveloped and vital area of son to the medical professoriate. to healthcare generically. All case studies were research has led to an increasing interest in the interrogated by category and coded thematically (re)development of care systems to recognize, Recommended reading list for topic and type of impact. facilitate and enhance the processes and O’Carroll (2013). Trends in the UK nursing pro- Results: 80 diverse impact case studies were products of dignified, supportive nursing care. fessions’ professoriate over the last ten years submitted by nurses. Submissions were across 11 (presentation given at the RCN 2014 research UoAs, the majority in UoA3 (n = 52). A further conference) 55 revealed relevant impact, but nurses did not have an obvious leadership role. 226 case studies Health Education England (2015) Clinical described healthcare practice impact that could Academic Careers Framework: A framework Theme: Qualiatative research impact significantly on the profession, but were for optimising clinical academic careers across not associated specifically with the discipline. health professions, HEE, London 3.6.1 Abstract number 175 Discussion: Nursing research has demonstra- AUKUH (2014) Clinical Academic Careers ble impact. There is a significant body of research 3:50pm Pathway Capability Framework, AUKUH, that could have relevance for nursing but was London Research leadership: a not presented as such. There are implications for nursing in working with users to capture nursing Biography longitudinal study of the research impact. nursing and midwifery Dave O’Carroll has worked for the Royal College Conclusion: There is a hidden impact of of Nursing for 18 years. The RCN represents professoriate nursing that needs to be illuminated. This study nurses and nursing, promotes excellence in Presenter: Mr Dave O’Carroll, BA(Hons), offers unique insights into the current state of practice and shapes health policies. Through- Information and Communications Manager, nursing research impact. Royal College of Nursing, London, UK out his career at the RCN, Dave has worked to promote the value of nursing research to support Recommended reading list high quality patient care and improve practice. Abstract He wants to make it easier for nursing staff to Greenhalgh, T. and Fahy, N. (2015) Research The numbers of healthcare professionals reg- use knowledge in practice and policy making, to impact in the community-based health sciences: istered on the Nursing and Midwifery Council know what knowledge is available and how they an analysis of 162 case studies from the 2014 UK holding a substantive professorial position in can access and contribute to it. Research Excellence Framework. BMC Medicine the UK may serve as a proxy indicator of the 13:232 development of research leadership within the Higher Education Funding Council for England. professions, particularly when compared with 2014 REF: Assessment framework and guidance cognate professional groups. Previous surveys 3.6.2 Abstract number 85 on submissions. Panel A criteria. London (REF were conducted in 2013, 2009, 2005 and 2003 01/2012): HEFCE; 2012. (O’Carroll 2013). 4:20pm Penfield T, Baker MJ, Scoble R, Wykes MC. The survey was repeated in 2015, with an addi- Assessment, evaluations, and definitions of tional question on whether respondents identi- An analysis of nursing impact research impact: a review. Research Evaluation. fied themselves as being in a clinical academic case studies in REF 2014 2013. rvt021. doi: 10.1093/reseval/rvt021. role. In preparation for the 2015 census, the 2013 dataset was reviewed, cleansed and updated Presenter: Professor Julie Taylor, PhD; RN; using institutional websites as the primary data MSc; BSc (Hons); RNT; FRCN, Professor of source. The questionnaire was subsequently Child Protection, University of Birmingham, sent by email to all known nurses and midwives Birmingham, UK holding a chair in the UK (n=260). A reminder Co-author(s): Daniel Kelly, UK; Bridie Kent, email was sent to non-respondents 3 weeks UK; Ann McMahon, UK; Michael Traynor, UK after the first communication. The survey was conducted in September 2015; a 75% response Abstract rate was achieved. Background: The UK’s research excellence Responses were benchmarked against the framework (REF) 2014 rated the research from previous surveys and the geographical distri- 154 universities. For the first time, the impact bution of the 2015 professoriate charted. Joint of research was evaluated in 6975 impact case appointments between a University and NHS and nursing was not assessed separately. Unit Trust were identified alongside the number of Assessment (UoA) 3 covered research in of people working in a clinical academic role. Dentistry, Pharmacy, Allied Health Professions Age range, gender and ethnicity profiles were and Nursing, although nursing research was also compared to previous surveys and the nursing submitted within other UoAs. Users were central workforce as a whole. in leading the assessment of impact case studies. This presentation will provide a comparative Aims: To analyse REF impact case studies to longitudinal analysis and present new baseline categorise the range of direct and indirect impact data on the UK nursing professions’ profes- cases that could be traced back to nursing. soriate workforce. It will discuss these findings Methods: 460 entries were retrieved from the within the context of recent research policy ini- REF database. Category 1 indicated research tiatives to develop a critical mass of research

37 315.50 – 16.45 Concurrent session 3 – Wednesday 6 April 2016 Theme: Mixed methods Discussion and Conclusion: There is sig- with comfort and control outweighing any dis- nificant positive effect on choice of place of birth advantages (sense of isolation) felt by some. 3.7.1 Abstract number 52 and Socio-demographic characteristics (p = Patients appreciated privacy, confidentiality and 0.034),Knowledge on safe delivery (p = 0.047) flexibility for visitors afforded by single rooms. 3:50pm and Accessibility to delivery services (p= 0.049). Nurse staffing was increased (2) and there was however,Attitude towards health facility delivery disruption and reconstitution of work patterns, Determinants of place of (p = 0.050) did not show any significance. often through trial and error. delivery among women of Conclusions: Staff needed to adapt their reproductive age seeking Biography working practices significantly and felt unpre- child welfare services Name-Daniel Muya Gachathi pared for new ways of working with potentially significant implications for the nature in Kandara Subcounty - Tumutumu Hospital 2001-2004 Certificate of teamwork in the longer term. Two thirds of Murang’a County (Echn) our sample of patients preferred single rooms; Presenter: Muya Daniel Gachathi, Masters Egerton University 2006-2009 Diploma eighteen per cent of staff in our survey preferred Of Science In Nursing (Midwifely), Nurse, (Krchn) them to open bays. Hospital accommodation Ministry Of Health Murang’a County Govern- Egerton University 2010-2012 Degree (Bscn) that might suit both staff and patients will be ment, Nairobi, Kenya Mount Kenya University 2013-2015 Masters discussed (3). Co-author(s): Dr Rosemary Okova,Kenya. Ms Degree (Mscn) Fransisca Mwangangi,Kenya Recommended reading list Maben J, Griffiths P, Penfold C, et al. Evaluating Abstract a major innovation in hospital design: workforce Introduction: Worldwide, half a million 3.7.2 Abstract number 234 implications and impact on patient and staff women die annually from pregnancy and child- experiences of all single room hospital accom- birth related complications. Over 90% of deaths 4:20pm modation. Health Serv Deliv Res 2015;3:304. occur in developing countries, (Oguntundeet al., doi:10.3310/hsDr03030 2010). KDHS 2014 indicates Maternal Mortality Workforce implications and Hurst K. UK ward design: patient dependency, Rate (MMR) of 488/100,000. staff and patient experiences nursing workload, staffing and quality-an obser- In Kenya 43% of births occur in health facili- of 100% in patient single vational study. Int J Nurs Stud 2008;45:370-81. ties, while 56% occur at home (KNBS 2010). In room accommodation van de Glind I, de Roode S, Goossensen A. Do Kandara Sub-County, 1,315 (35%) skilled deliv- patients in hospitals benefit from single rooms? eries were reported in 2014. Skilled assistance Presenter: Professor Jill Maben, SRN; BA (Hons); MSc; PhD, Florence Nightingale A literature review. Health Policy 2007;84:153- during childbirth is central to reducing MMr 61. doi:10.1016/j.healthpol.2007.06.002 (KDHS 2009). Faculty of Nursing and Midwifery, King’s College, London, UK Methodology: Mixed study design was used. Biography Kandara Sub County in Murang’a County was Co-author(s): Peter Griffiths, UK,Clarissa Professor Jill Maben is a nurse and social the study area. The target population were Penfold, UK, Michael Simon, Switzerland, scientist in the Florence Nightingale Faculty Women of reproductive age (18-49years). Janet E Anderson, UK, Glenn Robert, UK, Elena Pizzo, UK, Jane Hughes, UK, Trevor of Nursing and Midwifery at King’s College Inclusion criteria - Mothers who had delivered Murrells, UK, James Barlow, UK. London. Jill’s research focuses on the health- within the last 1 year and of sound mind. care workforce, particularly the quality of the Dependent variable Abstract work environment and the effects of these on • Place of delivery. patient care quality and experience. Jill recently Background and objectives There have been few completed a national research study in the UK Independent variable; evaluations in the UK of single room accom- examining the impact of 100% single rooms in • Socio-demographic characteristics modation and its impact on staff and patients. hospital on patient and staff experience and care Most current evidence derives from the USA and • Level of knowledge on safe-motherhood quality outcomes. Scandinavia (1). The building of a new Hospital • Attitude toward health facility delivery with 100% single rooms provided the opportu- In 2013 Jill was in the Health Services Journal ‘Top 100 leaders’ and their inaugural list of Most • Accessibility to maternity. nity for a before and after natural experiment. We report the impact of all single rooms on Inspirational Women in Healthcare. Jill was Sample size of 352 mothers was calculated using awarded an OBE in June 2014 for services to the Fishers et al.,1998 formula. staff and patient experience; and highlight the workforce implications. nursing and healthcare. Data was collected using questionnaire and key informant interview, analyzed using descriptive Methods: Mixed methods pre/post ‘move’ and inferential statistics and findings presented comparison within four nested case study wards in form of tables, graphs and pie charts. in a single acute hospital with 100% single rooms; 249 hours of observation; 55 nursing Findings: Women with high education level staff surveys pre and post and interviews with (48.9%) delivered in hospitals. 80% of married 24 nurses and 32 patients pre and post data are women delivered in hospital. 39.3% of the reported. Data were collected in the new hospital women were not employed and relied on their between September 2012 and June 2013. husband for financial support. 56.7% of women claimed lack of information on services offered Results: Nurses noted improvements in the in hospitals. Lack of satisfaction with service new build (patient comfort and confidentiality; delivery, were barriers to health facility delivery. staff break rooms and central clinical facilities), but single rooms were worse for visibility, sur- Long distances to hospitals. High travelling costs veillance, teamwork, monitoring and keeping also discouraged most 77% women to deliver in patients safe. Nursing staff walking distances hospitals. Poor infrastructure, roads encouraged increased significantly post move. Two-thirds of most 45.2% women to deliver at home. patients expressed a preference for single rooms

38 15.50 – 16.45 Concurrent session 3 – Wednesday 63 April 2016 Theme: Interviewing Conclusion: A greater focus on shared as a ‘threshold moment’ where the individual’s decision making for working aged people with sense of self is disrupted from the former taken- 3.8.1 Abstract number 356 knee osteoarthritis could empower patients and for-granted way of being. We have developed reduce treatment/self-management uncertainty. a framework which articulated the transition, 3:50pm Empowering people to self-manage with confi- drawing from the concept of the liminal self. dence may lessen the negative effects of living ‘Just another knee’: Conclusion: The findings highlight the need with knee osteoarthritis. for health care professionals who support people Perceptions of treatment affected by a new diagnosis of MS to consider decision making and self- Recommended reading list the impact of the diagnosis on the individual’s management for working Arthritis Research UK (2014) What are the sense of self. The conceptual framework which age people with symptomatic symptoms of osteoarthritis of the knee? http:// has been developed from the data presented in knee osteoarthritis www.arthritisresearchuk.org/arthritis-infor- this paper, provides a new way of understanding mation/conditions/osteoarthritis-of-the-knee/ the lived experience of those affected by a new Presenter: Dr Karen Gillett, RGN, PHD, MSC, symptoms.aspx (accessed: 13.06.2015). diagnosis of MS and offers a framework to guide King’s College London health care professionals in the provision of sup- National Institute for Health and Care Excel- Florence Nightingale Faculty of Nursing and portive care around the time of diagnosis. lence (NICE) (2014) Osteoarthritis Care and Midwifery, London, UK management in adults: Clinical Guideline Co-author(s): Jaqualyn Moore, England, CG177 - Methods, evidence and recommenda- Recommended reading list UK, Lindsay Bearne, England, UK, James tions at http://www.nice.org.uk/nicemedia/ Bury, M. (1982) Chronic illness as biographi- Galloway, England, UK, Heidi Lempp, live/14383/66524/66524.pdf (accessed: 13.06. cal disruption. Sociology of Health and Ill-ness, England, UK Ritchie, J. and Lewis, J. (2003) Qualitative 4(2), 167-183. Research Practice, SAGE: London. Smith, J. A., Flowers, P., & Larkin, M. (2009) Abstract Interpretative Phenomenological Analysis. Background: Knee osteoarthritis is the most Biography Theory, method and research. London: SAGE common cause of disability in the UK with pain, Publications. Karen is lecturer in Adult Nursing in the Florence stiffness, joint deformity and mobility problems Nightingale Faculty of Nursing and Midwifery at Turner, V. (1964) Betwixt and Between: The having a substantial impact on quality of life King’s College London. Her research interests liminal period in Rites de Passage. The Proceed- (NICE, 2014). Although associated with the include patient perceptions of treatment ings of the American Ethnological Society (pp. elderly it affects about 25% of people aged 45 decision making and self management. 4-20). years and over (Arthritis UK, 2014). The NICE (2014) guidelines for osteoarthritis advocate ‘a Biography therapeutic relationship based on shared decision-making’ and suggest that this approach Karen is Associate Head of School in the School encourages self-management, reduces reliance 3.8.2 Abstract number 301 of Nursing and Midwifery. As a registered nurse on medication, and empowers people. and academic Karen has conducted a number of 2:25pm research studies in her career related to chancer Aim: To explore the experience and percep- and chronic conditions. this work presents the tions of working age people with symptomatic The liminal self in findings of her rcently completed doctoral study. knee osteoarthritis in relation to (i) treatment decision making, and (ii) self-management. people with multiple Methods: Semi structured interviews were sclerosis: an interpretive conducted with 15 working age people with a phenomenological symptomatic,radiographically diagnosed knee exploration of the experience osteoarthritis. Recruitment targeted partici- of being diagnosed with pants from different health service providers. multiple sclerosis. Interviews took place between February and July 2015 and data were analysed using the Presenter: Dr Karen Strickland, PhD RN, framework approach (Richie and Lewis, 2003). Robert Gordon University, Aberdeen, UK Initial findings were presented to a focus group Co-author(s): A. Worth & C.M. Kennedy for member checking (n=5). Results: Participants felt their worlds were Abstract gradually shrinking, as worsening symptoms Objective: This study aimed to explore the lived limited their ability to take part in previously experience of the meaning of being diagnosed enjoyed activities. They reported negative effects with Multiple Sclerosis on the individual’s sense on health, work, social activities, and quality of of self. life. All participants required knee replacement Design: In-depth qualitative interviews were surgery, but only two were currently on a waiting conducted with 10 people who have been list. The others were considered ‘too young’ recently diagnosed with MS. Of these 8 were for surgery. They reported uncertainty about female and 2 were male. All interviews were treatment decisions/self-management options. conducted between December 2008 and March Discussion: Participants received minimal 2010. All interviews were transcribed verbatim support from health professionals. They were and were analyzed using interpretative phenom- keen to access information for themselves but enological analysis. the lack of evidence base for many self-manage- Results: This paper presents the three master ment options left them uncertain about the best themes: the ‘road for diagnosis’, ‘The liminal approach to take. self’ and ‘Learning to live with MS’. We found that the diagnosis of MS may be conceptualized

39 410.10 – 11.05 Concurrent session 4 – Thursday 7 April 2016 Concurrent session 4 Thursday 7 April 10.10 - 11.05

Theme: Interviewing provision. This includes targeted areas of inter- 4.1.2 Abstract number 392 vention that focus on a student’s first year and 4.1.1 Abstract number 287 reducing variation in provided services. 10:35am 10:05pm Conclusions: With improved understanding of attrition from chilDren’s nursing courses, Exploring the role of nurses in relation to the prescribing Causes of ATtrition in targeted interventions can be developed. Through this study it is envisaged that strategies and administration of CHIlDrens NursinG can be introduced and evaluated. medicines in a paediatric (CATCHING) study hospital ward setting Presenter: Dr Stephen McKeever, R.G.N, RN Recommended reading list Presenter: Dr Albert Farre, BSc, MSc, PhD, (Child), Dip.Trop.Nurse, ENB 415, BSc.(Hons), Orton, S. (2011) Re-thinking attrition in student University of Birmingham and Birmingham Ph.D., Department of ChilDren’s Nursing, nurses. Journal of Health and Social Care Children’s Hospital NHS Foundation Trust, London South Bank University, London, UK Improvement, pp. 1-7. Birmingham, UK Co-author(s): Dr. Lisa Whiting, UK; Dr. David Urwin, S., Stanley, R., Jones, M., Gallagher, A., Co-author(s): Teresa Jordan, UK; Gemma Anderson, UK; Dee Anderson, Dr. Alison Wainwright, P. and Perkins, A. (2010) Under- Heath, UK; Karen Shaw, UK; Carole Cummins, Twycross, UK standing student nurse attrition: learning from UK the literature. Nurse Education Today, 30(2), Abstract pp. 202-207. Abstract Background: Professional, financial and Background: The administration of medi- ethical reasons require nursing to gain an Biography cation is a complex process which carries the increased understanding of student nurse Dr Stephen McKeever is a Senior Lecturer in potential for medication errors. However, the attrition (Urwin et al. 2010). Attrition has been ChilDren’s Nursing in the School of Health and added complexity of paediatric medicines (e.g. previously identified as multifactorial (Orton Social Care at London South Bank University. dose calculations, dilutions, manipulations) 2011). Further work is required to understand Stephen initially trained as adult nurse before makes them even more susceptible to medica- its complexities. Few previous studies have spe- completing a conversion course to become a tion errors (Conroy et al., 2007). cifically focussed on chilDren’s nursing or been chilDren’s nurse in 1997. Since this time his Aims: To explore nurses’ perspectives in conducted following introducing degree based clinical experience has mainly focused on the relation to the prescribing and administration of courses to England. care of the critically ill child. This experience has medicines in the context of a paediatric hospital Aim: To explore causes of attrition from pre- been gained in hospitals in the United Kingdom, ward setting. registration chilDren’s nursing courses across New Zealand and Australia. In 2012, Stephen four London universities graduated with a PhD from The University of Methods: A qualitative case study was undertaken in a general surgical ward of a paediatric Methods: Following University research Melbourne. His doctoral thesis examined elec- hospital in England. Data collection took place ethics approval, an exploratory mixed methods troencephalogram changes occurring in children in in January and May 2015 in two stages. study was conducted. To understand attrition during anaesthesia. First, focus groups were conducted with novice, rates and yearly variation, three years’ data Stephen has an established track record of competent and expert nurses. Second, semi- were obtained from a centrally collated portal. undertaking and publishing research. Topics structured interviews were conducted with Attrition causes were explored through 1:1 semi- of investigation have included neuromonitor- novice, competent and expert nurses. Data were structured interviews with participants who ing, brain injury, pain/sedation, and engaging analysed following stage 1 of data collection to had faced challenges and either ‘left’ or ‘stayed’ nurses in evidence based practice. identify emerging issues and make sampling on their programme. Interview questions were In May 2015, Stephen commenced work on decisions for stage 2, when saturation was con- based on a literature review, previous exit data Causes of ATtrition in CHIlDrens NursinG sidered to be achieved. Data analysis followed and expert opinion. Interviews were recorded, (CATCHING) study. This research has delivered the principles of thematic analysis. Three transcribed and subjected to thematic analysis. valuable insights into why student chilDren’s researchers independently coded the final data Results: Attrition varied according to University nurses stay or leave their programmes. set and discussed data interpretation. Resulting and year. Overall, most attrition occurred in the Away from work Stephen enjoys walking and codes were then collated into themes. first year of programmes and was primarily due has recently completed the 170km Tour du Mont Results: 24 nurses were recruited, 18 took part to academic failure or personal circumstances. Blanc. In addition, Stephen also enjoys skiing in the first stage focus groups and 6 in the second Between July and September 2015, 18 (5 ‘left’, 13 and is a qualified barista. stage interviews. Three broad themes were iden- ‘stayed’) participants were interviewed. Reasons tified: (i) roles and responsibilities of nurses; (ii) for actual or potential attrition were connected the interactional nature of nursing practices; to academic, placement and/or personal issues. and (iii) risk management issues. Many participants were reluctant to disclose issues on the course. Key academic, placement Discussion: Findings suggest that nurses and services were identified however large varia- play a central role in medication risk manage- tions existed in delivery. Support to continue on ment and safety that extends beyond preparing the programme was often obtained away from and administering medications as prescribed universities and students often relied on self- (Smeulers et al., 2014). Equally important was determination. the systemic nature of nursing work, including aspects such as communication and interactions Discussion: This study has implications for future pre-registration chilDren’s nurse

40 10.10 – 11.05 Concurrent session 4 – Thursday 74 April 2016 with other professionals, availability of resources standards supporting district nurse education out the UK, being a member of several working and organisational policies (Choo et al., 2010). being outdated. groups, and is one of the co-ordinators behind Conclusions: The nurses’ role in medication This study aimed to explore the unique knowing @weDistrictNurse on Twitter. She is currently management is a multifaceted and complex one, of district nursing in practice. Understanding undertaking a part time secondment with the which extends beyond what is usually acknowl- this will contribute to future policy and practice. Nursing and Midwifery Council as Non -Medical edged and is pivotal to medication safety. A qualitative study using an interpretative Prescribing/Medicines Management Expert approach within a case study design was adopted Advisor. Recommended reading list involving three Scottish Health Boards as cases. Within each Health Board, interviews with key Choo, J., Hutchinson, A. and Bucknall, T. (2010) informants, and group interviews with district ‘Nurses’ role in medication safety’. Journal nurses were undertaken, using photo elicitation of Nursing Management, Vol. 18, No. 7, pp 4.2.2 Abstract number 355 as a focussing exercise. The data were collected 853-861. in 2013/14 and were analysed using framework 10:35am Conroy, S., Sweis, D., Planner, C., Yeung, V., analysis (Spencer et al. 2003). Collier, J., Haines, L. and Wong, I.C.K. (2007) The study findings depict the complexity of the ‘Help me breathe’ A ‘Interventions to reduce dosing errors in unique knowing in district nurse practice, where comparative analysis of children: a systematic review of the literature’. the context of care is an essential consideration, Drug Safety, Vol. 30, No. 12, pp 1111-1125. decision making processes of in a role that continues to advance. However Smeulers, M., Onderwater, A.T., van Zwieten, health care support workers it is the relationship between and among the and registered nurses caring M.C.B. and Vermeulen, H. (2014) ‘Nurses’ expe- elements, not the elements themselves that con- riences and perspectives on medication safety tribute to the unique knowing. The development for home ventilated children. practices: an explorative qualitative study’. of this knowing does not happen in isolation Presenter: Dr Toby Aslam Mohammed, Prof Journal of Nursing Management, Vol. 22, No. 3, and is complex. In addition to formal education D (H, SC & N), MN (Spec Ed), PGCE HE&FE, pp 276-285. it consists of networks, conversations, engage- RGN, RSCN, RNT, NHS Greater Glasgow and ment with policy, understanding of professional Clyde, Glasgow, UK Biography contexts, adhering to organisational boundaries, I am a psychologist by background, but my and interaction with complex and challenging Abstract research interests lie in the intersection between situations. The study findings therefore have Health Care Support Worker (HCSW) develop- Social Psychology and Medical Sociology. implications for both nurse educators and organ- ment within NHS Scotland has been a central I have worked in various studies in the field of isations. Innovative and alternative approaches component of service redesign (NES 2010). applied health services research, mostly using to developing knowing within curricula, recog- Within the context of long term ventilation qualitative approaches as well as mixed methods. nising practice-based theory of learning and for children, services have been established organisational structures and processes, must to provide direct care to children in the out of My research has mainly focused on exploring be considered. patients and health professionals’ perspectives hour’s period, primarily overnight within the to inform public health and health care services child’s home (Hewitt-Taylor 2009). Recommended reading list delivery. These services are being staffed by HCSWs and BERGEN, A. and WHILE, A., 2005. Imple- RNs (Jardine et al 1999). mentation deficit and street-level bureaucracy: Although these HCSWs have a training policy, practice and change in the development programme to prepare them for their role, little of community nursing issues. Health and Social is known about the decision making processes Care in the Community, 13(1), pp. 1-10. Theme: Interviewing that they use, or if this differs from those of the NURSING AND MIDWIFERY COUNCIL, 2001. Registered Nurse. Standards of specialist education and practice. 4.2.1 Abstract number 373 Utilising a multiple case study approach, this London: NMC 10:05am study aimed to compare the decision making SPENCER, L., RITCHIE, J. and O’CONNOR, process of HCSWs and RNs who care for home W., 2003. Analysis: practices, principles and ventilated children. The unique knowing of processes. In: J. RITCHIE and J. LEWIS, eds, Using a purposive sampling technique five district nurses in practice Qualitative research practice: a guide for social HCSWs and five RNs were recruited to partici- Presenter: Dr Heather Bain, EdD, Pgcert science students and researchers. London: Sage, pate in the study from two of NHS Scotland’s HELT, BA, DipDN, RGN, Senior Lecturer, pp. 199-218. children’s long term ventilation services. School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK Biography Decision making processes were identified through a combination of a ‘Think Aloud’ Dr. Heather Bain is a Senior Lecturer Post- interview, immediately followed by a retrospec- Abstract graduate and Continuing Professional Develop- tive interview. The district nurse is a registered nurse with a ment (CPD) at the Robert Gordon University, This study identified that there were similari- specialist graduate-level education and special- Aberdeen. Prior to coming into education she ties and differences between the HCSWs and ist practitioner qualification recorded with the had both surgical and medical nursing experi- RNs. HCSWs demonstrated an algorithmic UK’s Nursing and Midwifery Council (2001). Key ence, and then had several years experience approach to their decision making processes issues in district nursing practice and education working as a district nursing sister and a team whereas the RNs were more holistic in their within the UK comprise: national policy; local leader of an integrated team. Since coming into approach adopting a wider view of the needs of organisational structures and practice; profes- education in 2002 she has lead the implementa- the child. HCSWs used available care planning sional and disciplinary theory; and practice tion of the Extended Nurse Prescribing course, and pathways to direct their decision making, of individuals (Bergen and While 2005). and subsequently became the course leader of whereas RNs used these to inform, rather than However, there has been a lack of direction in the post registration district nurse course. More direct, their decision making. The influence of district nursing within the UK, with a decline in recently she has led the Masters courses and being a parent within the HCSW group affected numbers of district nurses being educated, and CPD portfolio within the School. Heather has actively promoted community nursing through-

41 410.10 – 11.05 Concurrent session 4 – Thursday 7 April 2016 the decision making process of participants, but Theme: Case study multidisciplinary cooperation and coordination not the outcome. improves access to care in New Zealand. This study has provided new insights into 4.3.1 Abstract number 7 decision processes used by both groups, which 10:05am Recommended reading list have relevance to children’s services, as it is an Sibbald B et al (2004) Changing the skill-mix area which has received minimal research. General practice nursing of the health care workforce. J Health Services in New Zealand (NZ): Research Policy 9: Suppl 1, pp 28-38. Recommended reading list Opportunities and innovation Walker, L., Clendon, J., and Nelson, K. (2015) NES 2010 Guide to HCSW development revised Nursing roles and responsibilities in general edition. NHS Education for Scotland. Edinburgh. - three case studies practice: three case studies Journal of Primary Presenter: Dr Leonie Walker, Bsc MSc PhD, Jardine E. O’Toole M., Paton J.Y. and Wallis Health Care 7(3) pp 236-243 New Zealand Nurses Organisation, Welling- C. 1999 Current status of long term ventilated ton, New Zealand children in the UK: questionnaire survey. BMJ. Biography Vol. 318. Pg 295 - 299. Co-author(s): Jill Clendon, New Zealand; A UK Biology degree, an MSc in Immunology Katherine Nelson, New Zealand Hewitt-Taylor J. 2009 Working with children and applied an Immunology PhD were followed who have complex health needs. Journal of by an academic university research career, and Community Nursing. Vol. 23 No. 5 Pg 24 - 26. Abstract then a Principle Scientific Officer post in applied Background: Changing models of care, and Immunology in a hospital setting, providing Biography rural GP shortages in NZ are leading to nursing cellular Immunology laboratory services. A roles evolving. Changes to nursing scopes career change led to NHS health research man- Following completion of the Post Registration and skill mix, practice ownership/governance agement and direct project work on public Children’s Nursing Programme in Glasgow I models and service innovations have all been health topics ranging from HIV to obesity and became a Staff Nurse and subsequently the reported. Less understood was the impact of diabetes. A final post in the UK saw the estab- Home Care Charge Nurse within the Renal differing nursing roles on professional interac- lishment of the North East England Diabetes Unit at Yorkhill Hospital. As Home Care Charge tions, or patient access to care. Research Network, based within the Clinical Nurse within the Renal Unit I developed the Research Facility at the University of Newcastle, home care service and undertook my Post Aims: To describe the different configurations and a management role overseeing the specialist Graduate Masters in Nursing Degree, with of skill mix in primary care on inter and intra- diabetes research nursing team. Early 2008 saw Specialty in Education at the University of professional collaboration and communication, a move to New Zealand to take up the position Glasgow. Following successful completion of and to explore the potential of expanded nursing of researcher with the New Zealand Organisa- my degree studies I entered Nurse Education in scopes and roles to improve patient access. tion of nurses. Now adjunct Professor at the and subsequently taught children’s nursing for Methods: Purposive sampling identified three Graduate School of Nursing and Midwifery, 8 years. After taking a three-year secondment to practices with different models and nursing Victoria University Wellington. the post of Senior Nurse (Practice Development) roles. Mixed methods (document review, inter- at Yorkhill Sick Childrens Hospital, in Glasgow, views and observation) were used to explore the post became substantive in 2005. Following how teams worked together, including delega- the reorganisation of the Health Board in 2006 I tion, substitution, enhancement and innovation became Head of Practice Development for Acute in roles and their interdisciplinary interactions. 4.3.2 Abstract number 154 Services across Glasgow and Clyde covered A total of twenty two interviews were recorded. 10:35am adult, children’s and maternity services. My A multi-phase, integrative, qualitative and skill current post is that of Assistant Chief Nurse for mix framework analysis (Sibbald, 2004) was GOvernance and Regulation within the same used to compare findings related to nursing skill Food for thought - enhancing board, with a portfolio for Practice Develop- mix across cases. dietary preferences for ment and Practice Education. My interest in Results: Policies, systems, inter and intra-pro- the person with advanced support worker development and complex needs fessional relationships were working well. dementia children stems from my paediatric background Presenter: Mrs Hazel McWhinnie, RN, MSc, and has developed over the years. Three models of primary care ownership, utilising different nursing skill mixes (Regis- PGCert, BA, DipHE, University of the West of tered Nurses, Nurse Practitioners, Enrolled Scotland, Hamilton, UK Nurses, and unregulated Primary Care Practice Co-author(s): Margaret Brown, Scotland Assistants) and planned and opportunistic service innovations are described, demonstrat- Abstract ing considerable flexibility and responsiveness Background: Adopting a nurse-led partner- to local need. ship approach, this project contributed to the Discussion: This project provides evidence of development of a framework to enhance dietary new, evolving nursing practice. This included: preferences for the person with advanced nurses having a greater role in patient man- dementia living in a care home. Innovative agement; nurse-led discharge with community ways of eliciting food and drink preferences and follow up and long term conditions clinics, food consumption were developed by a team outreach, proactive care; nurse prescribing; including family members, nursing and care altered patient pathways; Nurse Practitioners; staff and researchers. nurse business partners and owners; and Nurse When a person with advanced dementia can no Assistants freeing nurses to deliver advanced longer communicate their dietary preferences; nursing care. this reduction of choice impacts on dignity. An Conclusion: Enabling nurses to work to the full adequate nutritional intake is essential for the extent of their scope, along with adjustments to maintenance of physiological, social and psycho- the models of care, freedom to innovate, greater

42 10.10 – 11.05 Concurrent session 4 – Thursday 74 April 2016 logical wellbeing and quality of life (Healthcare Theme: Quantitative research Recommended reading list Improvement Scotland, 2012). Kankkunen P, Vehvilainen-Julkunen K, Pietila Aim: To enhance the dignity of people with 4.5.1 Abstract number 68 A-M & Halonen P (2003a) Is the sufficiency of advanced dementia through the use of innova- 10:05am discharge instructions related to chilDren’s post- tive methods to facilitate their food and drink operative pain at home after surgery? Scandina- choice. Parents’ experience of vian Journal of Caring Science 17, 365-372. Objectives: To explore innovative ways to elicit managing their child’s post- Shum S, Lim. J., Page T, Lamb E, Gow J, food preferences in advanced dementia tonsillectomy pain at home Ansermino JM & Lauder G (2012) An audit To investigate alternative approaches to eating of pain management following pediatric day Presenter: Dr Alison Twycross, PHD MSc DMS and drinking for the person with advanced surgery at British Columbia ChilDren’s Hospital. CertEd(HE) RGN RMN RSCN, London South dementia Pain Research and Management 17, 328-334. Bank University, London, UK Methods: This study involved an explora- Wiggins SA (2009) Family exemplars during Co-author(s): Julie Longard, Canada; Anna tory, collective case study design using mixed implementation of a home pain management Williams, UK; Paul Hong, Canada; Jill methods. Participants included six residents intervention. Issues in Comprehensive Pediatric Chorney, Canada with advanced dementia, their family members Nursing 32 160-179. and staff. Following ethical approval, we used a sensory framework, over a 12 week interven- Abstract Biography tion period in 2014, to investigate the impact of Background: Despite well-established Since September 2013 Alison has been Head of innovative interventions for six residents with evidence to guide pain management many Department for ChilDren’s Nursing and Reader advanced dementia, their families, nursing and children experience moderate to severe pain in ChilDren’s Pain Management at London care staff. at home after common paediatric surgeries South Bank University. She has worked in nurse Results: Residents maintained their nutri- (Kankkunen et al., 2009; Shum et al., 2012; education for 20 years at five different univer- tional status and eating difficulties decreased Wiggins, 2009). Due to changes in chilDren’s sities in England and Scotland. Alison was a as food preferences were explored. Innovative healthcare services, including shorter hospital member of a taskforce that updated the recently sensory approaches to eating and drinking were stays, the task of managing chilDren’s postop- published International Association for the developed in partnership. erative pain is often transferred to parents. Study of Pain’s Curriculum on Pain for Schools of Nursing. Alison is also Secretary of the British Discussion: A partnership approach showed Aim: To understand parents’ experiences of Pain Society’s Education in Pain Special Interest improvements in the quality of the process and managing their child’s post-tonsillectomy pain Group. outcome of eating and drinking for the person at home, including barriers and facilitators to with advanced dementia. Staff and families optimal pain management. As a researcher Alison has focused on exploring enjoyed being involved in the research and were Methods: Semi-structured interviews was what happens in practice and identifying strate- fully immersed in the research and learning carried out from December 2013 - February 2015 gies for improving chilDren’s pain management. process. with 10 parents of typically-developing chilDren, Her current research looks at supporting parents to manage their chilDren’s pain at home (postop- Conclusions: This project enhanced the aged 5-6 years, who had a tonsillectomy with or erative and cancer-related pain). In 2011 Alison quality of life for the person with advanced without adenoidectomy, and experienced no spent six months working in the Centre for dementia by embracing a sensory approach to complications leading to hospitalization. Inter- Pediatric Pain Research in Halifax, Nova Scotia. eating and drinking. views were conducted with parents within three months of their child’s surgery. Interviews were She has edited three books bringing together the transcribed verbatim and content analysis was evidence for chilDren’s pain management. These Recommended reading list used to identify themes in parents’ experiences. are used as key texts internationally. She also Healthcare Improvement Scotland (2012) Results: All children reportedly experienced has over 40 papers published in peer-reviewed Improving Nutrition. Improving Care. Final some postoperative pain although for some journals and is editor of Evidence Based Nursing. report. children this was only mild. Parents used analgesic Drugs and non-Drug methods to Biography manage their child’s pain. Parents reported Hazel McWhinnie is a lecturer in Adult Nursing that their child’s recovery at home placed sig- 4.5.2 Abstract number 73 at the University of the West of Scotland. With nificant short-term burdens on their family, a background in acute nursing care, Hazel has a but many felt the process was worthwhile given 10:35am particular interest in the care of the older adult. the potential long-term health benefits for their Margaret Brown is a senior lecturer in Older child. Parents reported that they were generally Incorporating experiential Persons Health and Wellbeing at the Univer- satisfied with the information they received but learning theory in promoting sity of the West of Scotland. Margaret has a some recommendations for further information regular physical activity particular interest in quality of life in advanced were provided. among childhood cancer dementia. Discussion: The results of this study provide survivors an indication of the barriers and facilitators for parents managing their child’s pain at home. This Presenter: Dr William Li, PhD, Associate provides an opportunity to reflect on practices Professor, The University of Hong Kong School and to identify additional strategies that can be of Nursing, Hong Kong, CN used to support parents in this context. Co-author(s): Dr Joyce Chung Conclusions: This study provides a first-hand account of parents’ experiences of managing Abstract their child’s postoperative pain at home and Background: There is growing concern about reveals some of the factors that help and hinder declining levels of physical activity in childhood parents’ management of their child’s pain. cancer survivors. There has been an increase in the use of experiential learning to promote the psychological well-being of primary schoolchil-

43 410.10 – 11.05 Concurrent session 4 – Thursday 7 April 2016 dren, and to help youth substance abusers and His research focused on providing psychologi- targeted and valuable to the people who most adolescents suffering from chronic illness to cal interventions to those children hospitalized need it. We will report preliminary findings on change their feelings, patterns of thought, and with cancer and childhood cancer survivors, the process and types of questions proposed. behavior [1,2]. This study aimed to examine implementing therapeutic play to hospitalized Discussion with key stakeholders contributes the effectiveness of using experiential learning children, helping cancer and diabetic patients to to better co-ordination, seeking to adDress the in promoting changes in exercise behavior and quit smoking and promoting smoking cessation highest priority areas together. enhancing the physical activity levels, self-effi- to the youth. cacy, and quality of life of Hong Kong Chinese Recommended reading list childhood cancer survivors. McIlfatrick S and Murphy T (2013) Palliative Methods: A randomized controlled trial, care research on the island of Ireland over the two-group pretest and repeated post-test, last decade: a systematic review and thematic between-subjects design was conducted to 71 Theme: Focus groups/Nominal group analysis of peer reviewed publications. BMC Pal- childhood cancer survivors (9-16-year olds). technique liative Care 12:33 doi:10.1186/1472-684X-12-33 Participants in the experimental group joined Perkins et al (2008). ‘What are patients’ pri- a four-day integrated adventure-based training 4.6.1 Abstract number 218 orities for palliative care research? - a question- guided by Kolb’s experiential learning theory naire study’ Palliat Med, vol.22: 7 [3]. Control group participants received the 10:10am same amount of time and attention as the exper- Cowan K, Oliver S. The James Lind Alliance imental group, but not in such a way as to have Identifying palliative and Guidebook. Oxford: UK; 2013 Available at any specific effect on the outcome measures. end of life research priorities Participants’ exercise behavior changes, levels of in Ireland: an innovative Biography physical activity, self-efficacy and quality of life approach Sonja is a registered nurse with approxi- were assessed at the time of recruitment, 3, 6, mately twenty years’ experience in palliative Presenter: Professor Sonja McIlfatrick, Ulster and 9 months after starting the intervention. care practice, education and research. She has University Northern Ireland, Newtownabbey, extensive experience in undertaking research as Results: Participants in the experimental group UK reported statistically significant difference in well as leading and providing strategic direction Co-author(s): Dr L Doherty, UK; Ms C Mulhol- physical activity stages of change (p < 0.001), for research. Having qualified as a registered land, Ireland higher levels of physical activity (p < 0.001) and nurse and graduated with a nursing degree from self-efficacy (p = 0.04) than those in the control the University of Ulster in 1991, Sonja began her group. Besides, there were statistically signifi- Abstract research career completing her MSc in 1999 and cant mean differences (p < 0.001) in physical Background: Palliative and end of life care her PhD from University of Ulster in 2003. activity levels (ï€2.6), self-efficacy (ï€2.0) and research is an underdeveloped research area. Sonja is a Professor in Nursing at Ulster Univer- quality of life (ï€4.3) of participants in the exper- The importance of setting research priorities sity. Within her university role, Sonja is Post- imental group from baseline to 9 months after has been recognized internationally, however graduate Tutor as well as the lead for the Pallia- starting the intervention. to date, this has largely been led by researchers tive Care Strand within the Managing Chronic Conclusions: Experiential learning was found and academics. James Lind Alliance advocate an Illness Research Centre. Sonja is also a Senior to be effective in promoting regular physical approach to research priority setting whereby Investigator in the Palliative Care research activity among childhood cancer survivors. patients, carers and clinicians work together to Network for All Ireland Institute of Hospice agree the most important questions. and Palliative Care. research interests include: Recommended reading list Aim: To identify and prioritise research decision making at end of life; palliative care questions for palliative and end of life care from and chronic illness; public awareness of pal- Wong, C.C. (2004). An adventure-based training the perspective of patients, carers and health liative care and psychosocial support for carers/ for youth substance abusers. Hong Kong Journal care professionals in Ireland. families affected by advanced disease of Paediatric, V9. pp 337-339 Method: Mixed methods four stage approach. Carlson, K.P., Cook, M. (2007). Challenge Stage 1 was part of a larger national study, which by Choice: Adventure-based counseling for involved a survey focused on uncertainties of seriously ill adolescents. Child and adolescent care, (n=1403 responses), subsequently cat- psychiatric clinics of North; V16, pp 909-919 egorized as interventional questions, into a list Kolb, D.A. (1984). Experiential learning: Experi- of questions (n=83). Stage 2: An online survey ence as the source of learning and development. asking user/carer organizations and profes- New Jersey: Prentice Hall. sional groups in Ireland to rate these questions in terms of low to high priority (n=168 responses). Biography Stage 3: Involved a final prioritization workshop, Dr William LI is currently an Associate Professor using nominal group technique undertaken with and the Director of Bachelor of Nursing (FT) user/carers (n=16), resulting in the identifica- Programme at the School of Nursing, the Uni- tion of the top ten research priority for Ireland. versity of Hong Kong. He has a strong research Stage 4: Comprised a strategic workshop with interest in the field of child and adolescent care, academics, researchers and funders from the and has much skill and knowledge in developing, island of Ireland, to develop action plans for validating and testing the psychometric proper- each of the areas. ties of instruments for children. His grants and Results: The top ten areas were identified and international publications encompass a number include aspects such as co-ordination of care; of child and adolescent studies including devel- out of hours; care at home; pain and symptom opment and psychometric testing of instruments management, palliative care and non-cancer and for Chinese children, providing and evaluating advanced care planning. psychosocial interventions for children and ado- Conclusions: This process enables researchers lescents, both in the hospitals and community. to demonstrate that their research is relevant,

44 10.10 – 11.05 Concurrent session 4 – Thursday 74 April 2016 4.6.2 Abstract number 69 tions may be hindered by public health strate- Findings: This paper presents the experience gies which do not take account of these factors. of struggling to live with a fractured ankle iden- 10:35am Conclusion: Efforts to raise the profile of tified through four themes: HPV and increase vaccination rates among i) Suffering which identified ‘being vulnerable’ The human papillomavirus BAME populations will require greater partner- where participants suddenly felt older and emo- and HPV vaccine: accounts ship working with BAME youth, parents and tionally fragile; and ‘renegotiating roles and from young people from community leaders. relationships’, where established partnerships black, Asian and minority were disrupted. ethnic groups in Scotland. Recommended reading list ii) Getting on with daily life highlighted ‘finding Presenter: Dr Elaine Carnegie, RGN, RMN, Fisher H, Trotter CL, Audrey S, MacDonald- ways of doing things’, which required rethinking MMed Sci, PhD, Edinburgh Napier University, Wallis K, Hickman M (2013) Inequalities in the and planning every little activity; and ‘finding Edinburgh, UK uptake of human papillomavirus vaccination: a ways of keeping busy’, which involved reframing systematic review and meta-analysis. Interna- the present and focussing on what was possible. co presenter: Dr Catriona Kennedy, Scotland tional Journal of Epidemiology 42 3 896-908. iii) Struggling to move identified ‘living with Co-author(s): Dr Anne Whittaker, Scotland; Boyce TL, Holmes A (2013) Persistence and hopping’ which felt terrifying; and ‘moving Dr Carol Gray Brunton, Scotland; Dr Janette partnerships: School nurses, inequalities and the forward’ which was constrained by notions of Pow, Scotland; Dr Diane Willis, Scotland; HPV vaccination programme. British Journal of fragility. Ms Nahida Hanif, Scotland; Dr Rhona Hogg, School Nursing 8 2 71-77. Scotland; Dr Shona Hilton, Scotland; Dr Kevin iv) Treatment and being in the trial noted par- Pollock, Scotland; Dr Seeromanie Harding, ticipant’s concerns but also the benefits of ‘living England Biography with CCC’ and ‘living with metal work’; ‘decision A healthcare professional with over 30 years of making’ identified the thoughts and feelings about being in a trial. Abstract experience spanning healthcare, academic and third sector arenas. Training and experience Discussion and Conclusion: Traumatic Background: School nurses play important include research and policy, healthcare man- fracture of the ankle impacts on participant’s roles in delivering human papillomavirus (HPV) agement, general nursing, psychiatric nursing, ways of being and living that makes the first 6-10 vaccination programme in United Kingdom. learning disability nursing and drug counsel- weeks a real struggle. Participants were pleased International research indicates lower HPV ling complimented by Master of Medical Science to have the possibility of avoiding surgery but vaccination uptake rates among Black, Asian in Primary and Community Care and Nursing there were advantages and disadvantages for and Minority Ethnic (BAME) groups (Fisher Doctorate. Areas of interest and expertise both treatments. Nurses have a key role to play et al. 2013) and suggests socio-cultural factors include health inequalities and critical health in facilitating individual’s capacity to cope with influence vaccine refusal (Boyce and Holmes and social policy. and recover from ankle fracture. 2013). However, little is known about how young people from BAME communities understand risks associated with HPV and engage with the Recommended reading list programme. Heidegger, M. (1962) Being and Time. Oxford: Aim: To explore young people from BAME com- Blackwell Publishing Ltd. Theme: Interviewing munities’ understandings of HPV infection and McPhail, S. M. Dunstan, J. Canning, J. & Haines, vaccination. 4.7.1 Abstract number 86 T.P. (2012) Life impact of ankle fractures: quali- Methods: A critical qualitative exploratory tative analysis of patient and clinician experi- study utilising Foucauldian discursive analysis. 10:05am ences. BMC Musculoskeletal Disorders, 13, 224. Seven focus groups and four paired interviews doi: 10.1186/1471-2474-13-224. conducted June-October 2015, with 40 young Recovery from ankle fracture: Willett, K. Keene, D. Morgan, L. Gray, B. people aged 16-26 from BAME communities: patient experience Handley, R. Chesser, T. Pallister, I. Tutton, Black African, Arab, Muslim, and Sikh. Stimulus Presenter: Dr Liz Tutton, PhD, RCNRI, WMS, E. Knox, C. Lall, R. Briggs, A. Lamb, S. (2014) material utilised to explore understandings of University of Warwick ,Coventry, UK Ankle Injury Management (AIM): design of a HPV, experiences of vaccine programme, views pragmatic multi-centre equivalence randomised on universal vaccination. Co-author(s): Willett, K. UK; Keene, D. UK; controlled trial comparing Close Contact Morgan, L. UK; Gray, B. UK; Handley, R. UK; Results: Participants related narratives of Casting (CCC) to Open surgical Reduction and Chesser, T. UK; Pallister, I. UK; Knox, C. UK; Internal Fixation (ORIF) in the treatment of decision-making in relation to vaccination Lall, R. UK; Briggs, A. UK; Lamb, S. UK programme, and lack of public health discourse unstable ankle fractures in patients over 60 on HPV in schools. Most participants had little years. BMC Musculoskeletal Disorders 15:79 Abstract understanding of HPV or of its connection doi: 10.1186/1471-2474-15-79 (12March2014) with cervical smear tests. For young men, there Background: Little is known about early http://httpwww.biomedcentral.com/1471- was a prevailing discourse of being detached recovery from ankle fracture, but a range of 2474/15/79. observers of HPV vaccination. White Northern impacts have been identified up to 2 years post hemisphere norms and assumptions about age injury (McPhail et al. 2012). Biography of sexual debut were challenged by a range of Aim: To explore the experience of treatment Liz Tutton is a Senior Research Fellow at the attitudes across BAME groups. Narratives of and early recovery from a fractured ankle in RCN Research Institute, Warwick Medical obligation and identity of those from religious older people School, University of Warwick, and the Trauma backgrounds permeated personal evaluations Methods: Drawing on Heideggerian Phenom- Research, Kadoorie Centre, John Radcliffe and added social constraints on whether to enology (Heidegger 1962), 36 interviews were Hospital, Oxford. Liz has spent many years discuss or pursue the vaccine. undertaken with patients, 60 years or older, at in nursing, education and research. Research Discussion: Understandings of HPV and 6-10 weeks post-surgery within a randomised interests include: patient and staff experiences engagement with the vaccine programme are controlled trial of two different treatments; open of care; recovery and treatments; core concepts embedded within social identities and practices reduction and internal fixation (ORIF) and close of care such as comfort, participation and hope. such as gender, culture, religion, intimate rela- contact casting (CCC) (Willett et al. 2014). Data Liz currently has a particular focus on recovery tionships. Vaccination within BAME popula- was collected from October 2010 to 2013. from traumatic injury and older people.

45 410.10 – 11.05 Concurrent session 4 – Thursday 7 April 2016 4.7.2 Abstract number 328 Recommended reading list trajectories in non-discriminatory and autono- mous ways. 10:35am Agarwal R et al (2014) Management and survival of patients with FIGO high risk Gestational Results/Discussion: Preliminary findings Trophoblastic Neoplasia. The Journal of Repro- suggest that the majority of participants expe- The immediate and long-term ductive Medicine. 59, 1, 7-12. rienced a variety of discriminatory practices impact of high-dose Bird L and Arthur A (2010) Rehabilitation independent of their presenting partner upon chemotherapy on women programme after stem cell transplantation: a entering the birthing space. Participants accom- with gestational-trophoblastic randomized control trial. Journal of Advanced panied by cis-gender male partners were auto- neoplasia Nursing. 66, 3, 607-615. matically assumed to be heterosexual and little space was made available outside the hetero- Presenter: Ms Clare Warnock, Weston Park norm for an alternate trajectory. For those Hospital, Sheffield Teaching Hospitals NHS Biography participants who were accompanied by female foundation Trust, Sheffield, UK Having worked in oncology nursing since partners, their narratives illuminated the limita- Co-author(s): Kamaljit Singh, England, UK; 1989 I am currently the practice development tions of language and it’s discriminatory power Jane Ireson, England, UK nurse at Weston Park Hospital, the regional during birth. cancer centre for South Yorkshire. My areas of Conclusion: Findings from the study may offer current and previous research focus on clinical Abstract nurses new possibilities for re-visioning health practice issues and have included the experi- Background: High-dose chemotherapy is care spaces, where compassion is inherent in ences of healthcare staff involved in the process associated with significant physical and psycho- new models of care and strategies for perinatal of breaking bad news, nursing competences for social morbidity, potential mortality and slow provider practices are not perpetuated in the survivorship and late effects care and patient’s recovery (Bird and Arthur 2010). It is one of the institutional birthing assumption that often per- experiences of diagnosis and treatment for treatments used in advanced gestational-troph- petuate ‘one size fits all.’ specific conditions such as spinal cord compres- oblastic neoplasia, a rare pregnancy-related sion, brachytherapy radiotherapy and high-dose cancer that affects younger women (Argawal chemotherapy. Recommended reading list et al 2014). Gaining an understanding of their Goldberg, L., Harbin, A., & Campbell, S. (2011). experiences of high-dose chemotherapy provides ‘Queering the birthing space: Phenomenologi- insights into their priorities and concerns. It can cal interpretations of the relationships between also assist with identifying the particular needs lesbian couples and perinatal nurses in the of young women receiving this treatment. Theme: Qualiatative approaches context of birthing care’. Sexualities, 14, pp.173- Aims: To explore the experiences of high-dose 192. chemotherapy among women with gestational- 4.8.1 Abstract number 238 Goldberg, L., Ryan, A., & Sawchyn, J. (2009). trophoblastic neoplasia ‘Feminist and queer phenomenology: A 10:05am Methods: A multi-centre descriptive explora- framework for perinatal nursing practice, tory study using in-depth semi-structured inter- research, and education for advancing lesbian views was conducted. Participants were recruited LGBTQ birthing practices in health’. Healthcare for Women International, from all survivors of high-dose treatment for rural care: holding space for 30, 6, pp. 536-549. gestational-trophoblastic neoplasia in the UK. difference Young, I. (2005). On female body experience: Interviews were carried out between September Presenter: Dr Lisa Goldberg, RN PhD, Throwing like a girl and other essays. Oxford: and November 2014. 10 patients were eligible Dalhousie University, Halifax, Nova Scotia, CA Oxford Universtiy Press. and 8 agreed to participate. Data was analysed using framework analysis, participants were Co-author(s): Megan Aston, Canada; Sylvia Biography involved in verification of the findings. Burrows, Canada; Jennifer Searle, Canada; Shannon Pringle, Canada Lisa Goldberg is an Associate Professor in the Results: Participants described significant School of Nursing, Dalhousie University, Nova physical, psychological and social effects during Abstract Scotia, Canada. Lisa has extensive teaching and following treatment. Many had not antici- experience at the undergraduate and graduate pated the severity of side effects; recovery was Background: Recent changes to cultural com- levels in both the clinical and classroom settings. slow and symptoms prolonged. Returning to petency programs have assisted in educating Her philosophical and pedagogical approach to work was a key milestone but this was difficult nurses on the limitation of their knowledge teaching scholarship is grounded in feminist for some. The impact on their children was a and sense of privilege. Yet, challenges remain phenomenology. major concern and families played a pivotal sup- in understanding how to hold space across dif- portive role. Treatment had a long-term effect ference in rural birthing contexts, where the Lisa’s research program, funded through local, on sexuality and body image. standard(s) for treatment have been historically provincial and national agencies, seeks to grounded in a socio-cultural privileging of het- explore the relational and taken-for-granted Discussion: The findings revealed that erosexuality. practices of nurses and primary care providers in patients require more detailed and accurate their relationships with birthing women, against information about the challenges associated Aim: The aim of the presentation is to offer the landscape of power, gender and heteronor- with high-dose chemotherapy before, during new insights from current research with women mativity. More recently, she completed the and after treatment. The importance of family- who self-identify as lesbian, gay, bisexual, and/ Caritas Coach Education Program through the centred services was highlighted. Professionals or queer during their birth experiences in the Watson Caring Science Institute. This further need to be aware of long term and late effects context of rural care. aligns Lisa’s educational pedagogy and research including sexual health. Methods: Current findings Draw upon scholarship in feminist phenomenology with an interview data (2013-2015) from fourteen Conclusions: The study provides valuable ontology, epistemology, and ethic of careâ€’one LGBQ birthing women across rural Nova Scotia, insights into the multi-dimensional impact of that returns nursing to its foundational begin- Canada. Located within a feminist phenomeno- high dose treatment on women with gestational- nings: Health, healing, and holism toward self, logical framework, the women’s narratives illu- trophoblastic neoplasia. It provides insights that other and the life-world, enacted with embodied minate the ways in which a lack of open space may be important in understanding the expe- intelligence, reflexivity and a moral sensibility. riences of young women receiving high-dose entailed an inability to embody their birthing treatment for other cancers.

46 10.10 – 11.05 Concurrent session 4 – Thursday 74 April 2016 4.8.2 Abstract number 189 to individual women’s needs, which reflects experiences of six high risk women who refused support for breastfeeding. RRS. This innovative approach allowed the par- 10:35am ticipants’ stories to be interpreted from multiple Recommended reading list perspectives as no single interpretation is able to Support for women who create meaning. Prior, E., Santhakumaran, S.,Gale, C., Philipps, wish to breastfeed following L.H.,Modi, N. and Hyde, M.J. (2012) Breast- Results: Different understandings of risk were caesarean birth: views and feeding after caesarean delivery: a systematic central to the decision to refuse RRS. RRS was experiences of women, their review and meta-analysis of world literature, Am perceived as damaging the body and hence was family members, healthcare J Clin Nutr, 95:1113-35. a greater risk to self than cancer risk. Breasts and ovaries were treasured as vital body parts World Health Organization (2012) Global targets professionals and peer which could not be given up or replaced on the 2025. To improve maternal, infant and young supporters basis of risk alone. Participants shared a genetic child nutrition. (www.who.int/nutrition/topics/ Presenter: Dr Yan-Shing Chang, King’s College pessimism of regret and uncertainty as they were nutrition_globaltargets2025/en/, accessed 6 London, London, UK transformed into perpetual patients awaiting October 2014). Co-author(s): Dr Elsa Montgomery, UK; Dr their fate. Cath Taylor, UK; Ms Zoe Chadderton, UK; Biography Discussion: The decision to refuse RRS must Professor Debra Bick, UK be understood within the context of social, Yan-Shing is Research Associate at the Florence cultural and historical influences which shape Nightingale Faculty of Nursing and Midwifery, Abstract experience. The dominant medical model for King’s College London. Her main research dealing with cancer risk may marginalise high Background: The World Health Organisation interests include maternal and child health and risk women and paradoxically expose them to has a target to increase exclusive breastfeeding wellbeing, parenting and relationship support greater risk. The findings from this study are rates globally during the first six months post- across the lifespan. She completed her Masters relevant to all nurses given the prominence of natally to 50% by 2025 (WHO, 2012). In the UK, and PhD degrees at Queens’ College, Cambridge genetics in contemporary health care. the exclusive breastfeeding rate at six months is and is currently undertaking research projects currently around 1%, and evidence of effective aiming at improving postnatal care, including Conclusions: The relationship between genetic approaches to support women to increase the breastfeeding support, for women with testing and cancer prevention is not straight- duration of exclusive breastfeeding is a public pregnancy and birth complications. forward. Genetic information has the potential health priority. Women who have caesarean to harm as well as help. It is important health births (CB) experience considerably more diffi- care providers approach this area from the view- culty than other groups of women in the com- points of those directly involved since without mencement and duration of breastfeeding (Prior understanding; interventions and supportive strategies may be ineffective. et al 2012). Theme: Qualiatative approaches Aims: The aim was to explore breastfeeding experiences and support needs of women who 4.9.1 Abstract number 82 Recommended reading list had planned or unplanned CB from the perspec- Denzin, N. K. (1989). Interpretive biography. tives of women themselves, their nominated 10:05am Beverley Hills, CA: SAGE Publications Inc. family members, healthcare professionals and Saying no: a biographical Dolby-Stahl, S. K. (1985). A literary folkloris- breastfeeding peer supporters. tic methodology for the study of meaning in Methods: Three focus groups were undertaken analysis of why women with personal narrative. Journal of Folklore Research, in London during March-April 2015: two groups a genetic predisposition to 22(1), 45-69. were attended by a total of nine women who developing breast/ovarian had CB from one week to four months previ- cancer refuse risk reducing Biography ously, recruited from a postnatal ward or NHS surgery. Dr Doreen Molloy is a University Teacher breastfeeding support group and three family at the University of Glasgow and has previ- members; one group was attended by eight Presenter: Dr Doreen Molloy, PhD, MSc, ously worked at the University of the West of healthcare professionals and breastfeeding peer BA, RGN, PGCTLHE, University of Glasgow Scotland and Edith Cowan University in Perth, supporters. Data were transcribed and analysed Nursing and Health Care School, Glasgow, UK Western Australia. Following completion of a using thematic content analysis. Co-author(s): Dr Joyce HenDricks, Australia; BA in Social Science, she qualified as a regis- Professor Anne Williams, Australia. Results: Identified themes included (1) recog- tered nurse in 1990 and worked clinically in nition of women’s unrealistic antenatal expecta- oncology for approximately 17 years before tions in contrast to the reality of breastfeeding Abstract entering academia. Dr Molloy is currently a year difficulties following CB (2) desire for ‘continu- Background: Genetic testing for breast/ leader for the Bachelor of Nursing Programme ity of care’ from the same healthcare profes- ovarian cancer susceptibility aims to identify at the University of Glasgow and also acts as an sionals and peer supporters, and (3) need for individuals at high risk of cancer and facilitate academic supervisor for dissertation students. better communication, information, physical, risk-reducing interventions. Risk-reducing Previous clinical posts held include Breast Care emotional and social support for women. surgery (RRS) is the principle primary preven- Nurse, Macmillan Nurse and Clinical Educator. Discussion/Conclusion: Women who have tive intervention as it reduces breast/ovarian She has a particular interest in how develop- CB require planned and effective post-operative cancer risk. Despite this, some women make ments in medicine and health care impact and postnatal care which focuses on meeting what appear to be ‘anti-health’ decisions by on those using the services, especially issues pain relief needs, supports early mobilization refusing RRS. which affect women. It was this interest which and identification of health problems such as Aim: To advance an understanding of why prompted her most recent research which wound infection, if they are to successfully exclu- BRCA1/2 mutation carriers say no to RRS. focused on understanding how advancements in sively breastfeed longer-term. Healthcare pro- clinical genetics impact on women at high risk of Methods: Denzin’s (1989) interpretive fessionals should plan and implement continu- developing breast/ovarian cancer. biography was combined with Dolby-Stahl’s ity of postnatal and post-operative care tailored (1985) literary folkloristic methodology to provide a contextualised narrative of the life

47 410.10 – 11.05 Concurrent session 4 – Thursday 7 April 2016 4.9.2 Abstract number 45 Biography 10:35am I qualified as a Registered Nurse in 1985 at Newcastle-U-Tyne School of Nursing and worked predominantly in the field of critical Advance care planning: the care for the first 10 years of my career. At this experience of frail older point I became interested in palliative and end people receiving care from of life care and worked as a research associate community matrons in the Trent Palliative Care Centre, working Presenter: Dr Julie Skilbeck, Registered on a variety of projects. In 2003 I took up post General Nurse; RNT, Sheffield Hallam Univer- as a Lecturer in Nursing at the University of sity, Sheffield, UK Sheffield, transferring to Sheffield Hallam Uni- versity in 2006. During this time I developed Co-author(s): Antony Arthur, England, UK; an interest in ageing, frailty end of life care and Jane Seymour, England, UK in 2014 was awarded my PhD by the University of Nottingham. I undertook an ethnographic Abstract study to explore the experience of frailty in later Background: Advance care planning (ACP) is life. I have currently been awarded a part-time a key requisite of the End of Life Care Strategy Research Fellowship where I am developing a (DOH 2008). Increasingly this is becoming a portfolio of research focusing on Advance Care focus of the work of Community Matrons (CM). Planning in later life. Yet for frail older people opportunities to engage in discussions regarding individual needs, priorities and preferences for end-of-life care is often limited. Aim: To explore the process of ACP between frail older people and CMs. Study design: A prospective, longitudinal case study design, using ethnographic data collection methods. Ten participants aged 75 years and over, receiving care from a CM, were recruited. Participants followed up approximately monthly for six months or until death. In total, 49 interviews were conducted with older people; 49 CM visits were observed. Medical documents were reviewed for 10 participants. Data was audio- recorded and transcribed verbatim. Analysis involved theme identification, with cross case comparison. Findings: Three themes illuminated how frail older people experienced ACP. ‘Nature of the Relationship’ reveals the importance of the rapport between the frail older person and CMs in enabling ACP discussions to take place. ‘ACP conversations’ illustrates the wishes and wants of frail older people, including emotional experiences. ‘Barriers to facilitating ACP’ details factors that inhibit opportunities for ACP conversations, including competing clinical frameworks of CMs. Discussion: CMs are able to negotiate opportunities to engage frail older people in ACP conversations, although this is dependent on the nature of the relationship and the CMs confidence in pursuing the discussion. Where a frail older person appeared to concentrate on living rather than dying, it was difficult for the CMs to initiate and pursue end-of-life conversations; highlighting the tensions that working within policy frameworks that separate out living from dying brings. Identifying and engaging with the emotional requirements of frail older people could facilitate approaches to ACP.

Recommended reading list Department of Health (2008) End of Life Care Strategy: Promoting high quality care for adults at the end of their lives. DOH, London.

48 11.35 – 13.00 Concurrent session 5 – Thursday 75 April 2016 Concurrent session 5 Thursday 7 April 11.35 - 12.00

Theme: Qualiatative approaches sion and in the development of empathy and healthcare professionals; (2) describing the nursing research as a method and dissemination emergency department environment from the 5.1.1 Abstract number 121 tool. perspective of the trauma patient; (3) illuminat- ing the trauma patient’s feelings and emotions 11:00am Recommended reading list about care in the emergency department. An exploration of poetry Clancy, M. and Jack, K. (2015) Using poetry to Design and Methods: A qualitative research in nursing practice, explore difficult issues in chilDren’s nursing: A design was used and data collected by semi- case study. Journal of Learning Development in structured interviews. The interviews were tran- education and research Higher Education. Awaiting publication date. scribed verbatim and analysed thematically. using autoethnographic Chang, H. V. (2008) Autoethnography as Participants: 13 adult trauma patients admitted methodology Method (Developing Qualitative Inquiry). Left to the trauma unit from the emergency depart- Presenter: Mrs Marie Clancy, B/Nurs, MPH, Coast Press, Walnut Creek, CA. ment of a major trauma centre were included in the study. PGCE, School of Nursing, University of Bir- Muncey, T. (2010) Creating Autoethnographies. mingham, Birmingham, UK Sage Publications, London. Findings: Four themes emerged in the data analysis: ‘Initial impact of the trauma,’ ‘Com- Abstract Biography munication styles,’ ‘Environmental factors,’ and ‘Reflecting on the trauma’. The findings of this Background: Autoethnography is an innova- Marie Clancy is a lecturer in chilDren’s nursing at study can be illuminated using the three stages tive technique used to portray individual expe- the University of Birmingham and previously to related to the concept of liminality (1) Separa- riences within research and life more generally this she worked as a lecturer at the University of tion: the often sudden traumatic event that in creative ways. This can be particularly useful Wolverhampton. During Marie’s nursing career separates the patient from their routine daily when exploring complex feelings and unique she has worked internationally in Australia, New life and brings them to the emergency depart- lived experiences (Muncey, 2010, p2). Writing Zealand, Trinidad, Malawi and Afghanistan. poetry has played a positive and pivotal role per- ment; (2) Transition: the time in the emergency Throughout her clinical, educational and sonally and professionally, particularly during department itself where, in this liminal space, research roles Marie has enjoyed working with times of difficulty. This presentation will focus patients reflect on their emotions, interactions nursing students and children and families. She on three areas of nursing in which poetry can be and environment; (3) Re-assimilation: exit from is currently a reviewer for the journal Nurse beneficial. the emergency department, where participants Researcher and is conducting her PhD using prepare for discharge and return to the outside Topic: Nursing is a rewarding but challenging creative methodology including art and poetry. world. profession. This presentation will follow the author’s career through Australasia, Africa, the Conclusion: A competent trauma team Caribbean and Afghanistan with the resultant combined with compassionate holistic care high levels of child mortality, poverty, cultural was important in contributing to participants’ and political inequalities, and the effects of war. 5.1.2 Abstract number 79 feelings of safely in the emergency department. It will adDress the ways in which poetry has been 12:00pm used as a reflective tool to gain in-depth personal Recommended reading list insight. It will also adDress how poetry has been Patients’ experience of National Audit Office (2010) Major Trauma Care used innovatively with student nurses and how in England, London, The Stationary Office poetry can be used in research. trauma care in the emergency Aims: department of a major Biography • To utilise an autoenthographic stance to holis- trauma centre Imogen Skene is an emergency department tically explore a personal journey Presenter: Miss Imogen Skene, Regis- clinical research nurse at Barts Health NHS tered adult nurse, Barts Health NHS Trust, • To provide a critical reflection of the uses of Trust. She has recently completed a masters in Emergency Department, Royal London poetry in nursing including practice, education clinical research. She trained at the University Hospital, London, UK and research with examples from the literature. of Southampton and has working in emergency Co-author(s): Jason Pott, England, UK; departments in England, Australia and New Methodological Discussion: This paper will Eamonn McKeown, England, UK Zealand. explore the use of poetry by using some of the typical features of autoenthography namely; self-portrayal, context, and culture with self- Abstract reflection (Chang, 2008; Muncey, 2010, p23). Background and rationale: There are 20000 This will include an explanation of the ways in cases of major trauma every year in England which poetry can be used as a pedagogical and (National Audit Office 2010). However little is practice tool (Clancy and Jack, 2015). known about the patients’ experience of trauma Conclusion: This presentation will appeal to care in the emergency department in the UK, conference delegates who may be interested in particularly since the development of the major learning more about autoenthographic methods trauma network in 2010. and/or the use of poetry in nursing. This will Aim: The aim of this study was to describe incorporate poetry used in nursing practice the patient’s experiences of trauma care in the to enhance self-awareness and coping mecha- emergency department by (1) exploring the nisms, nurse education as a trigger for discus- trauma patient’s experience of engagement with

49 511.35 – 13.00 Concurrent session 5 – Thursday 7 April 2016 5.1.3 Abstract number 239 Recommended reading list Theme: Focus groups 12:30pm Oeseburg B, Dijkstra G, Groothoff J, Reijneveld S & Jansen D (2011) Prevalence of chronic health 5.2.1 Abstract number 141 conditions in children with intellectual disabil- 11:00am The experiences of family ity: A systematic literature review. Intellectual carers in the delivery of and Developmental Disabilities 49, 59-85. A Qualitative study of invasive clinical interventions Royal College of Nursing (2012) Managing knowledge sharing at the within community settings. children with health care needs: Delegation of inpatient - community care Presenter: Professor Michael Brown, PhD, clinical procedures, training and accountability MSc, BSc (Hons), PGCE, RGN, RNLD, issues. London: Royal College of Nursing. transition point in mental Professor, Edinburgh Napier University, Whiting M (2014) Children with disability and health. Edinburgh, UK complex health needs: The impact on family life. Presenter: Dr Nicola Wright, PhD, MA, BN, Co-author(s): Louise Hoyle, Scotland; Thanos Nursing Children and Young People 26, 26-30. RN, School of Health Sciences, University of Karatzias, Scotland Nottingham, Nottingham, UK Biography Co-author(s): Emma Rowley UK, Justin Abstract Professor Brown holds a joint clinical academic Waring UK, Arun Chopra New Zealand and Background: Young people with intellectual post as Consultant Nurse in specialist learning Kyri Gregoriou UK. disabilities are living into adulthood, many disability services in NHS Lothian and Professor with complex health morbidity that require of Health and Social Care Research at Edinburgh Abstract invasive clinical interventions to sustain life. Napier University. A trained psychotherapist, Background: Care transitions are critical Little is known about the needs of these young he continues to work clinically with people points in healthcare delivery and are where people as they transition into adult community with learning disabilities who have offended in knowledge sharing problems are most likely to care services and how their needs are being Edinburgh. He was made a Fellow of the Royal occur. Problems can lead to: delayed and unsafe adDressed. College of Nursing in 2015 in recognition of his discharges; unsafe care (eg issues with medica- Aims: To explore the experiences of family contribution to the art and science of nursing and tion) and failed transition experiences. This can carers in the delivery of invasive clinical inter- the care of people with learning disabilities. He have a detrimental impact on a mental health ventions (ICIs) within community settings and Chair of the Royal College of Nursing Learning service user’s recovery. Disability Forum committee and has served identify the future role of Registered Nurses and Aims: The aim of the project was to explore on a range of government and national policy Social Care Support Workers in delivery of ICIs. the processes associated with admission and groups. An active researcher involving people discharge from a mental health inpatient ward to Method: An interpretivist qualitative design with learning disabilities, he has undertaken a the community. Of particular interest were the was used involving semi-structured interviews range of studies, and published in the nursing challenges experienced with sharing knowledge with a sample of n=10 families from across and learning disability literature, on issues at this key transition point. Scotland. including, general healthcare and people with Results: Family carers deliver many invasive intellectual disabilities, liaison nursing models Methods: One inpatient ward acted as the case clinical interventions and have a significant con- and person-centred care, health inequalities study. Qualitative focus group interviews were tribution to make in educating and support Reg- and health improvement, Local Area Coordina- conducted with the stakeholders involved in istered Nurses and Social Care Support Workers. tion, health and social care systems, diabetes the admission and discharge process. In total There are strategic developments needs to be and people with learning disabilities, offending 52 people participated and this included service adDressed in the delivery of invasive clinical behaviours, psychological interventions and Self users, inpatient nurses, health care assistants, interventions in the home setting by Social Care Directed Support. consultant psychiatrists, community mental Support Workers, regarding their education, health practitioners and junior doctors. The data preparation, supervision and accountability was collected in Winter 2013/2014 and analysed when delivering ICIs. Barriers include a reluc- using conventional thematic techniques. tance to carry out invasive clinical interventions Results: Care transitions into and out of both for family carers and staff, anxiety, a lack hospital were typically chaotic, stressful and of knowledge and training and difficulties in emotionally charged. Two forms of knowledge recruiting appropriate staff. sharing was evident - what was written down Discussion: Families, Social Care Support and also the verbal handover. Both processes Workers and Registered Nurses have key roles in were passive on the part of the recipient. This the safe delivery of invasive clinical interventions meant that there were often gaps in the infor- in community settings for both children and mation required or conversely information was adults with intellectual disabilities. Models of duplicated as it was not in the required format education and care have been developed to meet for the receiver. the needs of children and young people in need Discussion: Care transitions in mental health of ICIs, however they are less well developed to are often chaotic, stressful and emotional. meet the needs of young people as they age. Effective knowledge sharing is vital for high Conclusion: There needs to be strategic quality care as it ensures that contextually policy developments focusing on young people relevant information is exchanged between all in need of ICIS and their families this popula- parties in the care relationship. tion cared for in the community to ensure there Conclusion: By reducing the time spent is a workforce fit for purpose to meet future searching for knowledge gaps or receiving dupli- demands. cated knowledge, staff will have more time to deliver care based on best practice.

50 11.35 – 13.00 Concurrent session 5 – Thursday 75 April 2016 Recommended reading list Methods: Semi-structured interviews, focus 5.2.3 Abstract number 119 groups and open-ended questionnaires explored Rowley E, Wright N, Waring J, Gregoriou K and 12:30pm Chopra, A (2014) Protocol for an exploration of the perceptions and understandings of stake- knowledge sharing for improved discharge from holders on the definition, use and impact of CR. a mental health ward. BMJ Open. 4: c005176 Thematic analysis was used to explore the data The role of expert cardiac against the research questions. Thirty stake- rehabilitation staff in Waring J, Marshall F and Bishop S (2015) holders from six states and territories across Understanding the occupational and organi- detecting adverse indicators Australia. Participants included consumers and zational boundaries to safe hospital discharge. and creating a post-discharge carers and individuals with roles in advocacy, Journal of Health Services Research and Policy. research, policy, clinical practice, peer work, safety net 20 (suppl 1) 35-44 education and management. Presenter: Dr Lis Neubeck, PhD, BA (Hons), Wright N, Rowley E, Chopra A, Gregoriou K RN, Sydney Nursing School, The Charles Results: A working definition was agreed by and Waring J (2015, online) From admission to Perkins Centre, University of Sydney, Sydney, participants though many considered CR to be discharge in mental health services: A qualita- Australia used only as a last resort. Participants across tive analysis of service user involvement. Health groups identified negative impacts of CR on Co-author(s): Sue Randall, Australia; Stella Expectations doi: 10.1111/hex.12361 consumers and their families as well as staff and Hsi-Man Lin, Australia; Janice Smith, made various suggestions for change to adDress Australia; Alexander M Clark, Canada; Robyn Biography the identified issues. These findings make an Gallagher, Australia Dr Nicola Wright is currently employed as an important contribution to the international lit- Assistant Professor in Mental Health at the erature in suggesting an operational definition of Abstract School of Health Sciences, University of Not- CR that can be tested in clinical settings. Introduction: International guidelines tingham. She is a registered mental health nurse Discussion and Conclusions: CR needs to recommend cardiac rehabilitation (CR) to ensure and has worked clinically in both inpatient and be considered within current mental health care patients preserve or resume optimal physical, community mental health settings. Nicola’s philosophies of least restrictive practice, recov- psychological and social functioning. The role research interests are currently focused on the ery-orientated, trauma-informed and person- of CR-based exercise and cardiovascular risk following areas: recovery in mental health, care centred care. ‘Chemical restraint should always factor management is crucial in reducing overall transitions, youth mental health and the self be used with restraint,’ only after alternative and cardiovascular mortality, hospital readmis- management of self harm. She has published management strategies have been trialled and sions, and improves cardiovascular risk factors, extensively in relation to mental health care. according to agreed guidelines and protocol. exercise capacity and quality of life. However, She teaches on both the pre registration Bsc and the role of monitoring and expert management MNurSci in Nursing at the University of Not- Biography of complex care needs in CR has received little tingham and is the Deputy Course Lead of the attention. Graduate Entry Nursing programme. Nicola is Professor Eimear Muir-Cochrane is Chair of Aims: This study aimed to investigate the mon- also an Associae editor of the Journal for Mental Nursing (Mental Health) and has been involved itoring processes for potential health risks and Health Training, Education and Practice. in mental health research and education for over thirty years. Eimear’s research focusses subsequent intervention activities undertaken on nursing practices in acute in-patient psy- by CR staff. chiatric units and the consumer experience. Methods: The study used a qualitative design She is passionate about trying to make a dif- with data collected in focus groups and indi- 5.2.2 Abstract number 131 ference in researching seclusion, absconding vidual interviews in New South Wales, Australia 12:00pm and restraint. Currently Eimear is working with between March-June 2015. Focus groups and SA Health on funded projects that include: the interviews were audio-taped and transcribed An examination of the nature of empathy in acute inpatient psychi- verbatim. Framework analysis was used to atric settings, the role of Assistants in Nursing analyse the data. definition of chemical in the observation of psychiatric patients in Results: The sample included 39 CR profes- restraint with psychiatric Emergency Departments, an operational defi- sionals, mostly female (n = 35, 90%) and mean nition of chemical restraint, and the nature of consumers age 51 years (range 28-70 years). The majority code blacks (aggression code call) on medical Presenter: Professor Eimear Muir-Cochrane, were nurses (n = 32, 82%), with the remainder wards. Eimear has received over $2million in BSc (Hons), RN, RMN, Grad Dip Ad Education, from an allied health background (n=7, 18%). national and international research funding and MNS, PhD, Flinders University, Adelaide SA, Mean time since qualification was 27 years published one book, a MOOC and over seventy Australia (range 7 - 48) and mean CR experience was 13.57 refereed journal articles. Her current favourite years (range 1.5- 25). expression is ‘Data is not the plural of anecdote’. Abstract Two major inter-related themes were identi- Details of her books, chapters and research can Background: Chemical restraint (CR) is the fied. Firstly, CR staff were alert to multiple be found here forcible injection with psychotropic medica- and diverse actual and potential health issues/ tion to sedate psychiatric consumers. There http://www.flinders.edu.au/people/eimear. incidents. Secondly, there were ongoing are serious ethical issues regarding its use and muircochrane processes of monitoring and investigation used physical and psychological consequences for to detect these issues. Ongoing contact was the both consumers and staff. Despite the ethical thread that connected these two themes. This uncertainty surrounding the use of CR and the was essential to the monitoring and actions potential for harm, there is little evidence of undertaken because it allowed opportunity to when, how and why these practices are used. develop a more complete patient assessment Aims: The aim of the research was to examine and for observation of a trend. Documentation the perceptions of a broad range of stakeholders of these observations depended on perceived on how chemical restraint is defined and used in severity. adult acute psychiatric and emergency depart- Conclusions: CR is a complex intervention ments, as well as the impact of its use. with a previously unreported role in detecting adverse indicators and creating a safety net

51 511.35 – 13.00 Concurrent session 5 – Thursday 7 April 2016 for participants. This role needs to be clearly discharge decisions. Two key perspectives on • nursing care of people with ARBD in acute articulated to demonstrate that CR is more than risk shaped decision-making: i)the ways in hospital exercise and risk factor management. which adult children consider the safety of their • maintenance of personal identity in dementia parents; ii)professional conceptualisations of and ARBD Biography discharge risk and duty of care. Relationships between patients, professionals and family Dr Lis Neubeck is a Senior Lecturer at the Charles shape the nature and extent of patient involve- Perkins Centre and Sydney Nursing School. ment in decision-making. She is a National Health and Medical Research 5.3.2 Abstract number 256 Council (Australia) Early Career Fellow, and an Discussion: Involving patients in discharge Honorary Senior Research Fellow at the George decision-making can be challenging and con- 12:00pm Institute for Global Health. Her research focuses ceptualisations of risk may be barriers to discus- on innovative solutions to secondary preven- sion. Record keeping surrounding care-home How do we manage patients tion of cardiovascular disease, identification and discharge may not reflect the true dynamics of with acute abdominal pain? A decision-making and individual roles within the management of atrial fibrillation, and use of new national survey of guidelines technologies to improve access to health care. process. Relationships between patient, family and professionals are influential in determining used across the acute care Lis is President of the Australian Cardiovascular how much the patient voice is heard during the Health and Rehabilitation Association (2015- delivery chain process. 2017), chair of the scientific committee for Presenter: Dr Asa Muntlin Athlin, PhD, ACRA 2015, and is on the board of the Cardio- Conclusion: Care-home discharge is a critically MSc, RN, CNS, Uppsala University Hospital, vascular Nursing Council of the Cardiac Society important, life-changing, event in an individu- Uppsala, Sweden of Australia and New Zealand. al’s life. This study provides insights which can Co-author(s): Claes Juhlin, Sweden; Eva inform high quality discharge decision-making Jangland, Sweden reflecting patient, family and professional views. Abstract Recommended reading list Background: Seeking emergency care for acute Theme: Document research National Institute for Health and Care Excel- abdominal pain is one of the most common chief lence. Transition between inpatient hospital complaints worldwide. The variety in acuity is 5.3.1 Abstract number 169 settings and community or care home settings pending between unspecified diagnosis and life- for adults with social care needs - Draft for 11:00am threatening situations and some patients need consultation 2015 14th August 2015. Available hospital admission. The use of guidelines could Discharge to care-home - one from: https://www.nice.org.uk/guidance/ help health professionals in their work to ensure gid-scwave0712/resources/transition- safe quality of care. person, one big decision, lots between-inpatient-hospital-settings-and-com- Aim: To describe and compare the content of of different views! munity-or-care-home-settings-for-adults-with- guidelines regarding management of patients social-care-needs-Draft-guideline-nice2 Presenter: Dr Sarah Rhynas, Bsc, MSc, PhD, with acute abdominal pain used across the acute University of Edinburgh, Edinburgh, UK Verbeek H, Meyer G, Challis D, Zabalegui A, care delivery chain. Soto ME, Saks K, Leino-Kilpi H, Karlsson S, Co-author(s): Azucena Garcia Garrido, Method: In total, 29 ambulance stations, 17 Hamers JPH (2015) Inter-country exploration of Scotland, UK; Juliet MacArthur, Scotland, UK emergency departments and 33 surgical wards factors associated with admission to long-term across Sweden participated in a cross-sectional institutional dementia care: evidence from the Abstract survey during spring 2015. The sample consisted RightTimePlaceCare study J Background: Discharge from acute hospital to of responses from a questionnaire and provided care-home is a life-changing experience, shaping guidelines. Totally, 21 documents were reviewed Biography the remaining years of a person’s life (Verbeek and quality appraised using the AGREE II tool et al 2015, NICE 2015). Despite its importance, Sarah graduated in nursing from Edinburgh (AGREE, 2009). University in 1998 and worked as a staff nurse the processes underlying care-home discharge Results: Less than half of the included settings in Medicine for the Elderly and Acute Medicine decisions are often not clearly articulated and (n=38; 48%) indicated that they had guide- at the Royal Infirmary of Edinburgh. She also the perspectives of patient, family and multidis- lines for management of patients with acute enjoyed a variety of voluntary sector experi- ciplinary team members are poorly understood. abdominal pain. The content of the guide- ences, helping to manage and run services sup- Aims: To present an in-depth analysis of lines varied. Guidelines used in the ambulance porting frail older people and specialist day care discharge from hospital to care-home focussing services were often more structured compared for those living with dementia. on the processes and relationships which shape to the hospital-based guidelines. The guidelines decision-making. After completing an MSc by research she had a medical focus and nursing interventions embarked on PhD work, pursuing interests in Methods: A retrospective case note study were seldom described. However, findings iden- the nursing care of people living with dementia. (n=100) of patients admitted from home and tified that there were limited information about Since completing the PhD Sarah has held a discharged to care-home took place in a Scottish how to use the guidelines in practice. teaching post within Nursing Studies, Univer- teaching hospital, followed by the develop- Discussion: Limited number of guidelines is sity of Edinburgh, and has recently moved to a ment of detailed narrative accounts of 10 in use and seldom they address the aspects of research post which allows her to continue with patients (2014-15). These cases were sampled to nursing care and the importance of this. The work around dementia and the nursing care of highlight a range of patient situations. A detailed approach of the guidelines differ between the older people as well as pursuing an interest in thematic analysis was performed from the nar- different contexts, which means that the same Alcohol Related Brain Damage (ARBD). ratives to explore relationships, communication patient could be treated in different ways during and patient involvement during the process of Sarah’s current research interests are; the same episode of the acute care delivery chain. discharge from acute hospital to care-home. • discharge of older people with dementia from Conclusion: It’s important to ensure high Results: The anxieties, hopes and fears of acute hospital quality care to patients with acute abdominal family members and, to a lesser extent, the views • nursing care of people living with dementia and pain, even before the diagnosis stage. Guide- and circumstances of patients shape care-home nurses’ experiences of caring for this group lines that are in line with the acute care delivery

52 11.35 – 13.00 Concurrent session 5 – Thursday 75 April 2016 chain and focus on the care of the individual of potential donors. The Eye Donor Database Theme: Experimental/Quantitative research patient rather than the routines at the individual and the Potential Donor Audit were also settings are required. reviewed for the same period to determine how 5.4.1 Abstract number 72 many potential corneal donors were referred to 11:35am Recommended reading list Tissue Services, whether consent was obtained and how many proceeded with donation. AGREE Next Steps Consortium (2009). The Validation of the electronic AGREE II Instrument [Electronic version]. Results: Out of the 73% (n=170/233) eligible holistic needs assessment Retrieved 11 - 10 - 15, from http://www. corneal donors, 79% (n=100) were potential agreetrust.org . tissue-only donors and 21% (n=36) had the Presenter: Professor Austyn Snowden, PhD potential to donate solid organs and at least one RMN, School of Nursing Midwifery and Social Care, Edinburgh Napier University, Biography tissue (corneas). While all 36 potential organ and tissue donors were referred to the Specialist Edinburgh, UK Dr Asa Muntlin Athlin, Head of Research at Nurse in Organ Donation (SNOD), none of the Co-author(s): Mick Fleming, Scotland Department of Emergency Care at Uppsala Uni- 100 potential tissue-only were referred to Tissue versity Hospital and Adjunct Senior Lecturer at Services. Of the 36 potential organ and tissue Uppsala University, Uppsala, Sweden. She has Abstract donors referred to the SNOD, only 11 proceeded specialist training in emergency nursing and Background: Macmillan Cancer Support UK with corneal donation and this was mainly due has long and ongoing clinical experience in ED have developed an electronic holistic needs to family refusal. nursing. She has for the last 10 years been under- assessment (eHNA) to: Discussion: Taking into account the refusal taking research within the ED field. Dr Muntlin • Help people living with cancer express all their rate (64%), coroners’ objections (3%) and other Athlin has a wide international collaborating needs, network and is also an associated researcher at logistical problems (3%), 102 corneas rather • Help those helping them better target support. the School of Nursing, at University of Adelaide than 22 could have been donated if all 170 in Australia. Additionally, she is a member of the eligible donors had been referred. • eHNA consists of 48 items each ranked from steering group of International Learning Col- Conclusion: The results of this audit highlight zero (no problem) to 10 (maximum problem). laborative (ILC). a low conversion rate from a relatively high Its validity and reliability are untested. Present research areas are health services number of potential corneal donors. There is Aim: To evaluate the psychometric properties research, and more specifically pain manage- a need to increase corneal donation awareness of the eHNA by examining its construct validity. ment, emergency care processes, patient expe- among healthcare professionals and the public. Objectives: riences, knowledge translation and fundamen- The implementation of strategies to maximise a) Test the internal consistency, and the number of referrals is also recommended. tals of care. Together with Dr Eva Jangland b) Analyse the factor structure of the eHNA. and Professor Alison Kitson she is one of the Principal Investigators for the SMAAPP research Recommended reading list Methods: Analysis of 5421 responses to eHNA obtained in England 2014-2015 using Rasch program - Seamless management of patients Gaum L, Reynolds I, Jones MNA, Clarkson AJ, analysis and principal component analysis seeking care for acute abdominal pain - a per- Gillan HL, Kaye SB. Tissue and corneal donation (Snowden et al, 2015). Differential item func- son-centered approach. A research collaboration and transplantation in the UK. Br J Anaesth. tioning (DIF) was examined for gender and between Sweden and Australia. 2012; 108 (S1): i43-i47. whether people were classified as curative or not. NHS Blood and Transplant (2015) Ocular tissue Results: The eHNA took mean (SD) 7.33 (6.33) advisory group: EPSOD activity report. Available minutes to complete and identified mean 6.39 from: http://www.odt.nhs.uk/pdf/advisory_ (5.86) problems. It demonstrated very good 5.3.3 Abstract number 158 group_papers/OTAG/EPSOD.pdf [Accessed: 3 reliability (Î± = 0.874). All the items bar one fit November 2015]. 12:30pm with the Rasch rating model and were equiva- Ploeg RJ, Niesing J, Sieber-Rasch MH, Willems lently important to people. DIF was evident Barriers to ocular tissue L, Kranenburg K, Geertsma A. Shortage of according to whether people were described as donation despite an adequate number of donors: donation in acute clinical curative or not. A 12-factor solution explained a professional attitude?, Transplantation. 2003; 46% variance. Only one factor explained more settings 76: 948-955. that 5% variance, an emotional/spiritual factor Presenter: Dr Maria Ponto, PhD, MSc. BA, accounting for 15%. Therefore no meaningful RN, RM, Kingston University and St George’s, Biography multi-factorial interpretation of the eHNA could University of London, London, UK Maria Prous is a nurse and a midwife and is be obtained, which adds further weight to the Co-author(s): Maria Ponto, UK currently employed as a Specialist Nurse- Organ Rasch analysis that all the items were equally Donation. She is currently completing MSc in important. Abstract Clinical Leadership. Conclusion: The eHNA is valid and reliable in Background: Nearly all patients who die in Her areas of interest/experience include organ this sample. It is conceptually coherent with the Intensive Care Units (ICU’s) and Emergency and tissue donation for transplantation and construct of holistic needs assessment. Clinical Departments (ED’s) are potential corneal intensive care nursing. focus is best directed to the individual items highlighted by the patient except where patients donors. Yet, the number of referrals from these Dr Maria Ponto is Associate Professor in Nursing check too many problems for the patient/ groups remains low. and MSc Clinical Leadership Course Director. clinician to accurately prioritise. In these cases She is a nurse and a midwife with considerable Aims: To identify the number of potential only, the emotional/spiritual factor may help experience of general nursing, ITU and nurse corneal donors in four ICUs and one ED and to identify appropriate action. Strengths and weak- education. ascertain how many proceed with donation. nesses of the analyses are discussed, particularly Methodology: The electronic medical records in relation to ‘at risk’ subsamples such as those of all patients (n=233) who died in the five par- classified as non-curative. ticipating units from July to December 2014 were retrospectively reviewed using existing ocular tissue donor criteria to assess the number

53 511.35 – 13.00 Concurrent session 5 – Thursday 7 April 2016 Recommended reading list Hypotheses: Measure of spiritual care for NHS Education Snowden, A. & Fleming, M.P., 2015. Validation 1. Consultations will be more collaborative in Scotland and is particularly interested in valida- of the electronic Holistic Needs Assessment. HNA group. tion studies generally. He is part of a team undertaking a longitudinal study examining the role of SpringerPlus, 4(623). Available at: http://www. 2. Self-efficacy and shared decision-making will emotional intelligence and previous caring expe- springerplus.com/content/4/1/623. be scored higher in HNA group. rience in nursing. For all papers, projects and Methods: Randomised controlled trial in presentations please see www.mendeley.com/ Biography multiple UK head and neck and colorectal profiles/Austyn-snowden Austyn Snowden is chair in mental health at cancer clinics in 2015. All consultations were Edinburgh Napier University. He was a clinical audio-recorded and analysed for dialogue ratio nurse for 20 years and worked in a range of (DR) and preponderance of initiative (PI) using specialties in UK, Australia, Channel Islands MEDICODE framework. Post-consultation the and Saudi Arabia before becoming a full time patient completed Lorig self-efficacy scale and 5.4.3 Abstract number 383 academic in 2007. His research interests are all CollaboRATE (Snowden et al, 2015). 12:30pm focused around the impact, function and facilita- Results: Participants were 40 patients at post- tion of systematically listening to people. treatment stage. 22 were randomised to experi- Evidence-based practice He is currently principal investigator on a mental (HNA) group, 18 to control. Mean age was among nurses in Slovenian number of externally funded studies, including 61(8) years: 15 female, 25 male. Most frequent hospitals: A national survey analysis of consultations in psychiatry and acute concerns were physical. There were no signifi- cancer care using MEDICODE; an original cant differences in mean self-efficacy scores (exp Presenter: Dr Brigita Skela-Savic, RN, MSC, method of conversation analysis that allows = 8.1: con = 7.6) or shared decision-making PHD, Associate Professor, Dean, Faculty Of the researcher to quantify contributions within scores (exp = 25.95: con = 25.15) between the Health Care, Jesenice, Slovenia conversations and thus measure subtle aspects groups. The average percentage of conversa- of interventions not previously understood. tion initiated by the clinician was higher in the Abstract He leads the evaluation of ‘Improving Cancer experimental group (exp = 76% con = 49%). Background: Despite verified benefits of EBP, Journeys’, a Macmillan Cancer Support UK Monologue was higher in the control group research evidence across different countries has project designed to proactively support people (con= 65%: exp =38%). Dialogue was higher in shown extremely limited EBP implementation newly diagnosed with cancer. He also leads the the experimental group (exp= 31%: con 19%). among nurses. development of a Patient Reported Outcome Conclusions: Although the study is not yet suf- Measure of spiritual care for NES and is particu- Aim: We investigated EBP beliefs and imple- ficiently powered preliminary findings suggest larly interested in validation studies generally. mentation, followed by the factors explaining that HNA changes the nature and impact of He is part of a team undertaking a longitu- the results in both fields. the clinical consultation. This presentation will dinal study examining the role of emotional Methods: A cross-sectional research design present and interpret the latest results. intelligence and previous caring experience in was employed in March 2015. The sample size nursing. For all papers, projects and presenta- was 534 nurses from 19 Slovenian hospitals. Recommended reading list tions please see www.mendeley.com/profiles/ Standardized instruments EBP Beliefs Scale Austyn-snowden Young, J. et al., 2015. Improving the care of (Cronbach’s Alpha = 0.914) and EBP Implemen- cancer patients: holistic needs assessment. tation Scale (Cronbach’s Alpha = 0.969) were British Journal of Nursing, 23(16), pp.S20-24. used. Obtained data was analyzed using descrip- Snowden, A. et al., 2015. Evaluating Holistic tive statistics, correlation and factor analysis, and linear regression. 5.4.2 Abstract number 104 Needs Assessment in Outpatient Cancer Care: a Randomised Controlled Trial- the study Results: Positive beliefs on EBP were sig- 12:00pm protocol. BMJ Open, 5(e006840). Available nificantly explained by perceived knowledge at: http://bmjopen.bmj.com/cgi/content/ on research (p = 0.007), job satisfaction (p = Randomised controlled trial long/5/5/e006840. 0.000), and length of employment in nursing of holistic needs assessment (p = 0.008). Aversion to EBP was explained by in outpatient cancer: Biography poor perceived knowledge on EBP (p = 0.000) and a lack of education and training in EBP (p = preliminary findings: Austyn Snowden is chair in mental health at Edinburgh Napier University. He was a clinical 0.022), whereas a low level of EBP implementa- Presenter: Professor Austyn Snowden, PhD nurse for 20 years and worked in a range of tion was explained by poor perceived knowledge RMN, School of Nursing Midwifery and specialties in UK, Australia, Channel Islands on research (p = 0.013) and EBP (p = 0.039), Social Care, Edinburgh Napier University, and Saudi Arabia before becoming a full time and the job satisfaction level (p = 0.008). Edinburgh, UK academic in 2007. His research interests are all Discussion: Slovenian RNs have positive focused around the impact, function and facilita- beliefs on EBP and a low level of EBP implemen- Abstract tion of systematically listening to people. tation. The development paradigm of self-mon- Background: Holistic Needs Assessment He is currently principal investigator on a itoring and self-improvement was not present. (HNA) is a checklist completed by the patient number of externally funded studies, including According to the results, some resources prior to consultation. It signposts issues of analysis of consultations in psychiatry and acute required for improved EBP implementation are emotional, practical, financial and clinical cancer care using MEDICODE; an original not made sufficiently available. In addition to concern. The purpose is to identify a patient’s method of conversation analysis that allows perceived knowledge and education provided, individual needs in order to facilitate better col- the researcher to quantify contributions within an important factor is also job satisfaction, laboration and support self management (Young conversations and thus measure subtle aspects which points to the instrumental role of man- et al, 2015). of interventions not previously understood. agement workers in determining nurses’ profes- Aim: This study aims to identify 1) if and how He leads the evaluation of ‘Improving Cancer sional development. HNA affects the type of conversation that goes Journeys’, a Macmillan Cancer Support UK Linking evidence to action: Nursing managers in on during a clinical consultation and 2) if it has project designed to proactively support people Slovenian hospitals should promote the devel- any impact on shared decision-making and self- newly diagnosed with cancer. He also leads the opment of head nurses in research and evidence- efficacy. development of a Patient Reported Outcome based care. They can foster a culture of research

54 11.35 – 13.00 Concurrent session 5 – Thursday 75 April 2016 and EBP. In addition, management workers Theme: Interviewing Recommended reading list must formulate a future vision of research and 1. Kings College (2010) Managing Poor Per- EBP in nursing which should be included at all 5.5.1 Abstract number 146 formance in Nursing and Midwifery; does the levels of hospital care. 11:00am evidence make the grade? Policy Plus evidence, issues and opinions in Healthcare 28 Recommended reading list Management of poor nursing 2. Stone K, Traynor M, Gould D & Maben J Melnyk, B.M., Gallagher-Ford, L., English Long, performance: exploring (2011) The management of poor performance L., & Fineout-Overholt, E. (2014). The establish- ward sister/charge nurses’ in nursing and midwifery: a case for concern. ment of evidence-based practice competencies Journal of Nursing Management 19(6), 803-809. for practicing registered nurses and advanced experience and decision 3. Traynor M, Stone K, Cook H, Gould D & practice nurses in real-world clinical settings: making process Maben J (2013) Disciplinary processes and the Proficiencies to improve healthcare quality, reli- Presenter: Mrs Sonia Nelson, RN, PGDip, MSc, management of poor performance among UK ability, patient outcomes, and costs. Worldviews Belfast Health & Social Care Trust, Belfast, UK nurses: bad apple or systemic failure? A scoping on Evidence-Based Nursing, 11(1), 5-15. Co-author(s): Felicity Hasson, N.Ireland; Paul study. Nursing Inquiry 1-8. Stokke, K., Olsen, N.R., Espehaug, B., & Slater, N.Ireland Nortvedt, M.W. (2014). Evidence based practice Biography beliefs and implementation among nurses: a Abstract Sonia Nelson is a registered Nurse who gained cross-sectional Study. BMC nursing, 13, 8. Background: Management of poor perfor- her BSc (Hons) Professional Development Yoder, L.H., Kirkley, D., McFall, D.C., Kirksey, mance is in an integral part of national and in Nursing, PgDip in Nursing & Midwifery K.M., StalBaum, A.L., & Sellers, D. (2014). Staff international Nursing policy. Ward Sister/ Education and MSc in Developing Practice Nurses’ Use of Research to Facilitate Evidence- Charge Nurses are accountable for managing in Healthcare from the University of Ulster Based Practice. The American journal of nursing, Nursing performance to ensure the delivery of Belfast. Sonia has 30 years of nursing expe- 114(9), 26-37. safe, effective care. Little research to date has rience including 10 years of experience as a explored the factors which effect their decisions Nursing Development Lead within the Belfast Biography to manage poorly performing Nurses in the Health and Social Care Trust. Within this role Dr. Brigita Skela Savic is an Associate Professor Acute Hospital Environment. she continues to facilitate Practice Development in Nursing within Neurosciences at the Royal and Dean of the Faculty of Health Care (FHC) Aim: To explore Ward Sister/ Charge Nurses’ Victoria Hospital, and the Neuro-rehabilitation and Head of the Research Institute at the FHC. experiences and decision making process of wards within Musgrave Park Hospital. Sonia has She is an Associate Professor of Management managing poorly performing Nurses in the maintained her interest in developing Nursing in Health Care and Nursing at FHC on subjects Acute Hospital Environment. connected with research methodology, organi- practice through education ranging from Neuro- Method: An exploratory descriptive qualitative zation, and leadership. She is also a mentor for rehabilitation courses to the development of method was adopted. Semi-structured one-to- PhD students at the Medical faculty University an eLearning programme for safe management one interviews were utilised with a purposive Ljubljana and at the Faculty of organizational of medicines processes. She is a recognised sample of 24 Ward Sisters located across four science University Maribor. teacher with the University of Ulster, facilitating acute hospitals in one region of the United and supervising Nurses working in her Wards Dr. Brigita Skela Savic is a member of the Kingdom. Transcriptions were analysed using to develop their practice and attain their MSc Slovenian Nursing Board at the Ministry of a content analysis approach and was guided by through the Developing Practice in Healthcare Health and a member of different working the Theory of Planned Behaviour. Data was in Pathway. Her research interests include Disabil- groups at the same ministry. She was a member collected between June - August 2013. ity simulation Training for staff working with of the working group for drafting Nursing and Results: Findings show that the policy guide- patients who have traumatic brain injury and Health Care Development Strategy of Slovenia lines for managing poorly performing Nurses research into the management of poor perfor- (2011-2020). She is first author of Slovenian are not always implemented in practice. Instead mance in Nursing. guidelines for nursing education at first Bologna they adopted unregulated and unsystematic level. approaches to manage poor performance despite As of January 2013, Brigita Skela Savic is the acknowledging that working outside of Policy Editor in Chief and Managing Editor of the sci- could render them vulnerable. The factors which 5.5.2 Abstract number 255 entific journal Slovenian Nursing Review. Since influenced the Ward Sisters decisions to perfor- January 2012, she is a member of the Editorial mance manage could be predicted by normative, 12:00pm Board for Slovenian Journal of Public Health behavioural and control beliefs. and a reviewer for Slovenian and international Discussion: Ward Sister/ Charge Nurses do journals. Since 2014, she is a member of Interna- ‘Swimming upstream’: nurse not consistently engage with policy guidelines. tional Advisory Board of review Nurse Education manager role stressors and They adopt ad-hoc responses which have ramifi- Today. coping strategies in western cations for the quality of care provided. Canada Conclusion: Performance management guide- Presenter: Sonia Udod, University of Saskatch- lines which offer a flexible, person centred ewan, College of Nursing, Saskatoon, Canada approach may enhance engagement and potentially narrow the theory-practice gap. A respon- Co-author(s): Greta Cummings, Canada; W. sive approach may meet a greater need in under- Dean Care, Canada standing and accepting accountability within Nursing as to what this means in practice, and Abstract how it feels to practice this in the Ward setting, Aim: The aim of this study examines nurse with confidence. Further research is recom- manager (NMs) role stressors and coping strat- mended in this field. egies in acute care organizations in 3 health regions in Western Canada.

55 511.35 – 13.00 Concurrent session 5 – Thursday 7 April 2016 Background: A stressful workplace can impair of the Top Researcher Award in Socio-Health, management and were visible for patients and decision making and affect the mental and 2013-14. She is a co-investigator on a CIHR grant their relatives. Barriers to the role included physical health of NMs, leading to poor perfor- investigating the integration of internationally staff shortages which led to them being Drawn mance, which ultimately decreases job satisfac- educated nurses, a team member on the evalua- back into the numbers. Organisational and peer tion and may lead to turnover. The complexities tion of the Lean transformation in Saskatchewan support were important enablers. of healthcare and work-life balance demand health care, and the PI on a grant investigating Supervisory sisters continually updated a 360 innovative approaches to achieve and sustain nurse managers’ leadership practices within the degree view of the ward and used it to step in and healthy work environments for NMs. Lean management system. In partnership with step out of activities as needed. They stepped Method: A qualitative exploratory inquiry Dr. Michelle Lobchuk, Dr. Udod investigated up and provided an informed and effective link provides deeper insight into NMs’ percep- family caregivers and nurses’ work life (CANO between the ward and senior levels of the organi- tions of their role stressors, coping strategies, Research Award), was an invited speaker to a sation. Evaluating the impact of the role, espe- and factors and practices in the organizational Think Tank on Family Caregivers, and is now cially less visible aspects, was challenging and context that facilitate and hinder their work. A the PI on a national grant aimed at develop- needs further work. purposeful sample of 30 NMs participated in ing knowledge synthesis on ‘Strategies Used by Chief Nurse Executives and Middle Nurse this study (2013-current). Data were collected Recommended reading list through individual interviews and focus group Managers in Meeting Family Caregiver Com- Pembrey S (1980) The Ward Sister: Key to interviews. Braun and Clarke’s (2006) six phase munication Needs: A Continuum of Healthcare Nursing. RCN London. approach to thematic analysis guided data Contexts in Saskatchewan.’ analysis. Francis R (2013) Report of tjhe Mid-Stafford- shire NHS Foundation trust Public Inquiry. Conclusions: Evidence demonstrates that Final Report. HC947. The Stationery Office, individual factors, organizational practices, London. and structures affect NMs stress that includes 5.5.3 Abstract number 135 an evolving role with unrealistic expecta- Charmaz K (2014) Constructing grounded tions, responding to continuous organizational 12:30pm theory: A practical guide through qualitative change, a fragmented ability to effectively analysis. Save, London. process decisions due to work overload, shifting Stepping in, stepping out, organizational priorities, and being at risk for stepping up: Research Biography stress-related ill health or intent to quit. Study evaluating the ward sister Kate Seers is Professor of Health Research findings suggest that chronic exposure to role supervisory role (REWardSS) and Director of the Royal College of Nursing stress and work complexity affect NMs health Research Institute. She has a long track record Presenter: Professor Kate Seers, PhD DSc, potentially threatening individual, patient, and of undertaking research that makes a difference WMS, University of Warwick, Coventry, UK organizational outcomes. to understanding and improve care. Co-author(s): Linda Watterson, UK; Lynne Conclusion: This study provides evidence- Currie, UK. based practice and policy recommendations for supporting NMs work environments and understanding organizational complexity. As health Abstract care systems contend with predicted nurse and Research from 35 years ago showed the ward Theme: Interviewing manager shortages (Murphy et al., 2009) oppor- sister/manager is central to patient care tunities to support NMs to do meaningful work (Pembrey 1980). Following poor standards of 5.6.1 Abstract number 344 as a way to retain existing managers and attract care, the Francis Report (2013) recommended front line nurses to positions of leadership is ward sisters/managers should be supervisory; 11:00am imperative. Specifically, these findings have not part of the numbers required to provide implications for intervention programs that direct care to patients. This study aimed to Severe mental illness and enhance leadership approaches, address indi- examine the impact of the change to supervisory type 2 diabetes: What are the vidual factors, and work processes. ward sister status. challenges for mental health A Constructivist Grounded Theory (Charmaz service users and healthcare Recommended reading list 2014) approach was used. Interviews were held professionals? with 22 wards sisters in a supervisory role in Braun, V. & Clarke, V. (2006) ‘Using thematic Presenter: Dr Julia Jones, PhD; BA (Hons), two NHS Trusts in the UK. A second interview analysis in psychology.’ Qualitative Research in City University London, London, UK Psychology, 3, 2, pp 77-101. 4-6months later (n=17) explored how expectations had been met and any barriers or enablers. Co-author(s): Frederique Lamontagne- Murphy, G.T., Birch, S., Alder, R., MacKenzie, Four senior nurses were also interviewed and Godwin, UK; Hayley McBain, UK; Kathleen A., Lethbridge, L., Little, L. & Cook, A. (2009) two focus groups (n=14, n=6) took place with the Mulligan, UK; Mark Haddad, UK; Chris Flood, ‘Tested solutions for eliminating Canada’s reg- wider health care team. All interviews and focus UK; David Thomas, UK; and Alan Simpson, istered nurses shortage.’ Ottawa, ON: Canada groups were digitally recorded, transcribed in UK. Nurses Association. Retrieved from: http:// full and took place between March-November www.nursesunion.ca/sites/ 2014. Ethical approval was obtained for this Abstract study. Data were analysed using constant com- Biography Background: People with Severe Mental parison, were coded and emergent themes iden- Illness (SMI) have an almost two-fold risk of Dr. Sonia Udod is an Assistant Professor in the tified. developing type 2 diabetes compared with the College of Nursing, University of Saskatchewan, A core concept of ‘being pivotal’ emerged with general population (Osborn et al, 2008). This Canada. Her program of research focuses on four key categories of reclaiming all the role, increased risk has been attributed to the effects nursing leadership and its effect on the quality of forging a path, leading the way and connecting of anti-psychotic medications and lifestyle nurses work environments leading to improved with the organisation. Supervisory ward sisters factors such as poor diet, obesity and physical patient, nurse and organizational outcomes described how they managed and developed inactivity (Mathur et al, 2012). Given the impor- (2013-18 Research Program, Udod). She is the their team, were a clinical role model, repre- tance of lifestyle in the management of type recipient of a Saskatchewan Health Research sented and negotiated the interface with senior 2 diabetes, it is important that mental health Foundation Establishment Grant and recipient

56 11.35 – 13.00 Concurrent session 5 – Thursday 75 April 2016 service users possess the knowledge and skills Julia is a core staff member of SUGAR (Service Learning outcomes: required to successfully manage their condition. User & Carer Group Advising on Research) and 1. Understand the impact of EO on staff health Challenges also exist for healthcare profession- leads on the research training for the users and and wellbeing. als (HPCs) in the delivery of care for people with carers in the group. 2. Understand implications for practice develop- diabetes and SMI. ment and education of mental health staff. Aims: 1. To gain a greater understanding of the 3. Consider development of specific training for views of service users with SMI regarding the undertaking EO. management of their diabetes 5.6.2 Abstract number 213 2. To gain the views of healthcare professionals Recommended reading list regarding the challenges of delivering recom- 12:00pm mended diabetes care to people with SMI Addo, A.M., McKie, A., Kettles, M.A., Gibb, Nurses and healthcare J., Gass, J., & Yule, M. (2010) Are nurses Methods: Semi-structured interviews were empowered to make decisions about levels of conducted with 14 service users with SMI and support workers experiences patient observation in mental health? Practice type 2 diabetes and 16 HPCs between November of enhanced observations and research report. Nursing Times, vol 106, no9, 2014 and May 2015 in London. The interviews impact on their health and pp.26-28. were informed by the Theoretical Domains wellbeing Framework (TDF) for behaviour change (Cane et Kettles, A.M. & Addo, M. A. (2009) Observa- Presenter: Dr Mary Addo, PhD, MEd, MA Soc al 2012) and data analysis was conducted deduction as an intervention: Time for an overview. Sci, DMS, PgCertTLT, RMN, Lecturer, Robert tively using the TDF as a coding framework. Journal for Psychiatric and Mental Health Gordon University, Aberdeen, UK Nursing, vol 16, no9, pp.813-821. Results: Service users were aware of the need Co-author(s): Ms Jenny Gibb, Scotland, Dr to maintain stable blood glucose levels, take Department of Health (2010) The Boorman AuDrey I. Stephen, Scotland medication, eat healthily and exercise. However, Report on the Health and Well-being of NHS episodes of poor mental health limits their Staff. Available at: http://www.robertson- Abstract ability to manage diabetes. The interviews with cooper.com/files/boorman_download.pdf [Date HCPs revealed role ambiguity regarding the Background: Quality care is fundamental to accessed 2 November 2015]. provision of physical and mental health care for patients’ experience of health services globally, people with SMI within mental health services and the health and well-being of staff is vital for Biography and primary care. quality service delivery. Enhanced observations Mary Addo, PhD, is a Lecturer in Mental Health (EO) are common interventions undertaken by Conclusion: The findings are being used to Nursing at the School of Nursing and Midwifery, nurses and healthcare support workers (HCSW) develop and evaluate a diabetes self-manage- Robert Gordon University. She leads under- to manage patient risks in acute mental health- ment intervention tailored for people with SMI. graduate and postgraduate modules, and super- care. Nurses’ and HCSWs’ perspectives of the vises postgraduate researchers. She has actively impact of this role on their mental health and Recommended reading list contributed to NHS Education Scotland and wellbeing are poorly understood. Scottish Government national initiatives in the Cane, J., O’Connor, D., & Michie, S. (2012). Vali- Aim: This paper explores impacts on nurses’ area of mental health. Her research interests dation of the theoretical domains framework for and HCSW’s related to taking part in EO in acute are Driven by her passion to illuminate the lived use in behaviour change and implementation mental healthcare. experiences of mental health nurses, and to research. Implementation Science, 7, 37. Method: A purposive sample of sixteen nurses inform future workforce planning and patient Mathur, R., Hull, S. A., Boomla, K., & Robson, J. and four HCSWs from a Scottish NHS board area care. (2012). Ethnic differences in primary care man- voluntarily participated. Data were gathered via AuDrey Stephen, PhD, is a research fellow in agement of diabetes and cardiovascular disease digitally recorded semi-structured interviews. the School of Nursing and Midwifery, Robert in people with serious mental illness. British Transcripts were analysed using framework Gordon University. Her main research interest Journal of General Practice, 62, e582-e588. analysis method. is in bereavement and bereavement care. Osborn, D. P., Wright, C. A., Levy, G., King, Results: Five themes emerged: (i) effects of EO Other interests are in staff support in acute M. B., Deo, R., & Nazareth, I. (2008). Relative on health and wellbeing, (ii) decision making care settings, including mental healthcare. She risk of diabetes, dyslipidaemia, hypertension processes; (iii) challenges; (iv) preparation for also supports students from undergraduate to and the metabolic syndrome in people with undertaking EO, and (v) support for staff. doctoral level to develop and pursue engage- severe mental illnesses: systematic review and ment in research and its application in health- metaanalysis. BMC Psychiatry, 8, 84 Discussion: Undertaking EO can be ‘emotion- care practice. ally Draining’ impacting on staff health and Jenny Gibb is the Associate Nurse Director for Biography wellbeing and the care of other patients. Nurses need to have their professional opinions valued the Mental Health and Learning Disabilities Julia is a health geographer by background and in the decision-making process, and central to Services in NHS Grampian. She has an enthu- has worked in mental health research since their ability to deal with EO are opportunities siasm for ensuring a professional nursing 1995 with research posts in Oxford for the RCN to access support including clinical supervision. service where patients receive quality care Institute and at the University of Verona, Italy. The themes provide meaningful insight into and nurses feel confident, well equipped and She has worked at City University London since experiences of EO. supported to deliver this. Her background is in 2005 in a number of research and lecturing roles clinical practice, research and education and and was appointed a Reader in 2009. Current Conclusion: Development of specific training her interests are Driven by promoting staff research interests include the interface between for undertaking EO for nurses and healthcare wellbeing. physical and mental ill-health and collabora- support workers could enable a compassionate tive research between service users, carers and approach to EO as a basis for high quality care healthcare professionals in the fields of mental of the patient, self and others. The outcomes health and kidney care. In her role at City Uni- from this pilot study will inform development of versity London, Julia is a Senior Tutor for a national study. PhD students in the Centre for Mental Health Research and deputy chair of the School of Health Sciences Research Ethics Committee.

57 511.35 – 13.00 Concurrent session 5 – Thursday 7 April 2016 5.6.3 Abstract number 196 Recommended reading list 10%-15% of adults, and is debilitating in approximately 1-2% of this group (Langguth et al 2013). 12:30pm Eriksson, K. (2006) The Suffering Human Being. Chicago: Nordic Studies Press. Consensus exists within the literature that tinnitus is both heterogeneous and complex, Rodgers, B.L., Knafl, K.A. (2000) Concept Exploring young adult service with no cure and treatment options varying in Development in Nursing: Foundations, Tech- users’ perspectives on mental effectiveness. Much of the research undertaken niques, and Applications. Philadelphia: W.B in this area is quantitative in nature; evidence health recovery Saunders Company. exploring the day to day experiences of individu- Presenter: Dr Claire McCauley, Mpharm, Slade, M. (2010) Mental illness and well-being: als living with and managing their tinnitus is MPSNI, MSc, PhD, Researcher, Ulster Univer- the central importance of positive psychology scarce. sity, Derry, UK and recovery approaches. BMC Health Services Aims: To inform nursing practice by exploring Co-author(s): Professor Hugh McKenna, Research, 10 (26). the experiences of individuals living with tinnitus Northern Ireland; Dr Sinead Keeney, Northern and the impact this has on their wellbeing. Ireland; Dr Derek McLaughlin, Northern Biography Ireland Methods: Ethical approval was granted by Dr Claire McCauley is a researcher at Ulster the University Ethics Committee and informed University. Her PhD research explored young Abstract consent was obtained from all participants. adult service user perspectives on mental health Purposive sampling ( N=213) was initially Background: Recovery research has suggested recovery in Northern Ireland. The first phase of undertaken, followed by subsequent snowball that ‘recovery from’ symptoms is only part her PhD study, A Concept Analysis of Mental sampling (Biernacki & Waldorf, 1981). Inclusion of the recovery journey, that ‘recovery in’ the Health Recovery in Young Adulthood has been criteria consisted of adults with long-term experience of mental illness through hope, the published in the Journal of Psychiatric and tinnitus aged 18 years and over. Data were re-establishment of identity and inclusion are Mental Health Nursing. collected via an e-survey portal and face to essential (Slade 2010). This study explored if the Claire is a pharmacist who worked in the local face interviews in February/March 2015 and experience of suffering contributes to the gen- community since 2006. She was awarded Young analysed thematically (Braun & Clarke, 2006). eration of hope, meaning and growth (Eriksson Community Pharmacist of the year in 2011. 2006). Results: Tinnitus is severely debilitating for However, she returned to education at Ulster almost 20% of participants, as opposed to the Aim: This research study aimed to explore University in 2012 completing an MSc in Health 1-2% suggested in existing literature. The expe- young adult service users’ perspectives on Promotion and Public Health. Her MSc thesis on rience is poorly understood by both family and mental health recovery. perinatal depression was published in The Inter- healthcare professionals. Whilst for 17 individu- Methods: The study involved a three phased national Journal of Mental Health Promotion. als tinnitus is not intrusive; others have learned qualitative design. Phase 1: A concept analysis Claire has presented her findings at conferences to live with it, (n = 18) but for most the impact is of recovery was conducted using Rodgers and such as the Refocus on Recovery Conference far more extreme, (n = 41) with some contem- Knafl (2000) evolutionary method. Phase 2: in King’s College, London; The Irish Institute plating suicide (n = 2). Two engagement groups with service users of Mental Health Nursing in Trinity College Conclusions: Tinnitus impacts on every aspect were undertaken for the co-production of the Dublin; The Public Health Agency Annual Sci- of daily living. Furthermore, the effect of tinnitus semi-structured interview schedule. Phase 3: entific Conference in 2015 and at Ulster Univer- can be overlooked by healthcare professionals. Semi structured qualitative interviews were sity’s Mental Health Conferences 2013, 2014 and The findings will be used to develop a personal conducted with 25 young adult services users is a keynote speaker in 2015. Claire was invited toolkit to help individuals manage their tinnitus to ensure an in depth understanding of their to present her PhD findings at the 4th ECMH in and to inform nursing praxis; this future work recovery journey. Riga, Latvia. Claire has presented her findings to will be explored in the session. Results: The phase one findings propose a the All Party Working Group on Mental Health in the Northern Irish Assembly. new conceptual definition suggesting the term Recommended reading list ‘recovery’ is not reflective of the identified con- Biernacki, P., Waldorf, D. (1981) Snowball ceptual characteristics. Phase two developed a Sampling: Problems and Techniques of Chain collaborative method with service users to co- Referral Sampling. Sociological Methods produce a semi-structured interview schedule, Research, vol,10, no2, pp 141-163. which was used in phase three. Phase three Theme: Mixed Methods findings revealed recovery is understood as Braun, V., & Clarke, V. (2006) Using thematic an uncharted, timely and personal process of 5.7.3 Abstract number 113 analysis in psychology. Qualitative Research in engaging and transcending pain. This requires Psychology, vol 3, pp 77-101. 12:30pm the perceptions of painful experiences to be Langguth, B., Kreuzer, P.M., Kleinjung,T., De refocused, taking ownership of its experien- Ridder, D. (2013) Tinnitus: causes and clinical tial learning while discarding its destructive Exploring experiences of management. www.thelancet.com/neurology, potential. Recovery is understood to have real tinnitus: Implications for Vol 12 , September, pp 920 -930. life relevance when it is applied to the contextual nursing practice factors that provide meaning in an individual’s Presenter: Mrs Gill Truscott, MSc, BA(Hons), Biography life. PGCPD, RNT, RGN, Senior Lecturer, Glyndwr I have worked in the clinical speciality of ENT Discussion/Conclusion: This study has University, Wrexham, UK nursing for over 20 years; my last clinical role provided insight into young adult service users’ Co-author(s): Dr Debbie Roberts UK; Dr being that of an ENT nurse practitioner, where I perspectives on mental health recovery, high- Stuart Cunningham, UK; Dr Sara Wheeler, UK predominantly specialised in aural care. During lighting the perceived barriers and the internal this time I also visited Bangladesh on a number processes that are experienced within the Abstract of occasions as a member of the team who process. The findings can be used to provide founded the first cochlear implant programme Background: Tinnitus is described as ‘percep- tailored and targeted information to enable the in the country. provision of care to be more closely aligned to tion of sound in the absence of a correspond- During my time as a nurse practitioner I worked service user perspectives. ing external acoustic stimulus’ (Langguth et al 2013: 920). Globally, tinnitus affects between with many people who had tinnitus, and now as lecturer in nursing and health I have had

58 11.35 – 13.00 Concurrent session 5 – Thursday 75 April 2016 the opportunity to work collaboratively with ences in coherence and differences in outcomes 5.8.2 Abstract number 220 academic colleagues and Action On Hearing were large for Impact of Event Scale Avoidance Loss Wales to explore the impact of tinnitus on subscale (r = -.58, p = .10), Impact of Event Scale 12:00pm the daily lives of those experiencing the phe- total score (r = -.55, p = .13), and clinically sig- nomenon. This research Draws on my clinical nificant changes were found for both the sympa- Developing, implementing expertise and is focused on improving the patient thetic and parasympathetic contributors of heart and embedding a theory- experience and helping nurses to understand the rate variability. based behavioural lived experience of patients in order to inform Conclusion: Results support post intervention intervention to promote clinical practice. I hope to undertake further change and these methods may well be applica- continence in community work in this area, so I can use the findings to ble to other high stress occupations. help individuals cope with and manage their living adults’ symptoms on a day to day basis. Recommended reading list Presenter: Dr Rona Agnew, RGN, Dip DN, NHSGGC, Elderpark Clinic, Glasgow, UK Franke, W, Ramey, S & Shelly, M 2002. ‘Rela- tionship between cardiovascular disease Co-author(s): Professor Jo Booth, Scotland, UK morbidity, risk factors, and stress in a law enforcement cohort’, Journal of Occupational Abstract Theme: Statistical analysis and Environmental Medicine, vol. 44, no. 12, pp. Introduction: Although a high priority for 5.8.1 Abstract number 38 1182-1189. older women, older people are less likely to Miller, L 2008. ‘Stress and resilience in law discuss their bladder or bowel dysfunction with 11:00am enforcement training and practice’, Interna- health care professionals than younger individu- tional Journal of Emergency mental health, vol. als and fewer than half seek care even when their Resilience in police 10, no. 2, pp. 109-124. symptoms are severe. Traditional approaches have focused on activities more associated with Presenter: Dr Sandra Ramey, PhD, Academic Ramey, SL, Downing, NR, Franke, WD, Perk- managing urinary incontinence. With contain- Faculty, The University of Iowa, USA hounkova, Y, & Alasagheirin, MH 2012. ‘Rela- ment costs and the older population increas- tionships among stress measures, risk factors, Co-author(s): Yelena Perkhounkova, PhD ing, cost pressures on the caring services are and inflammatory biomarkers in law enforce- USA, Maria Hein MSW USA, Sophia Chung growing. A change in paradigm is therefore ment officers’. Biology Research for Nursing, vol. PhD USA, Warren Franke PhD USA, Amanda crucial for the future of bladder and bowel care. 14, no.1, pp. 16-26. Anderson MS USA This study aimed to develop and implement into practice a behavioural intervention to enable Abstract Biography paradigm change from management of inconti- Background and Aims: Exposure to stress in Professor Ramey is faculty at the University nence to continence promotion. police work affects performance and health. The of Iowa College of Nursing with a secondary Method: Using previous research evidence1 study examined the feasibility of implement- appointment in the College of Public Health. to guide development, a one hour theory based ing an innovative stress-resilience intervention The study presented here was funded by the US educational workshop, based on lifestyle modifi- for modifying psychological stress, autonomic Department of Justice in 2013. Dr. Ramey has cation and behavioural interventions (BIG) was response to stress and cardiovascular disease worked for the past 14 years with multiple police delivered to all women referred to a continence risk factors in police officers. Additionally, we agencies in the US and Hawaii. Most recently she service in Glasgow between July and December evaluated the applicability, acceptability, com- was invited to testify for the President Obama’s 2014. Immediately following the group, these pliance, and cost of the intervention in real-life Task Force on 21st Century Policing in Wash- women were screened and provided with a conditions (2014). Since police are present inter- ington, DC in Fe. 2015. She was the only nurse bladder diary to complete and bring back to nationally and work in the public domain, the invited to testify. Her research trajectory has their clinic appointment. Pre and post outcome health of police should matter to everyone. included the basic surveillance work to query measures using ICIQ-UI2 and AUASI3, along CVD risk factors and extensive biological studies Methods: Subjects included police officers age with service indicators such as waiting times, of cytokines and inflammatory markers, physical 21 to 65 years (n=40). To self-regulate responses attendance rates, reduced containment costs, inactivity and other risk factors in police. Her to stress, officers were educated on techniques patient satisfaction, were measured. program of research has culminated in the devel- to manage emotional and physical responses to opment of an exciting intervention to increase Findings: 755 women attended a BIG group stress, 2) practiced self-regulation and 3) wore resilience in police in the US. Improving resil- during the data collection period. Mean age a non-invasive heart-rhythm monitor evaluate ience will improve the performance, decision- attending group was 62 years (range 15 to 102 heart rate variability. Data analysis included making and health of police and the intervention years). 99% of women attending considered calculation of differences in outcomes from pre- will also be applicable to other occupations who themselves white, 54% had previously sought to post-intervention testing using a one-sample experience stress in the workplace. treatment. two-sided t-test to compare the average differ- Patient self-reported lower urinary tract ence with null change. Cohen’s d was estimated symptoms and urinary incontinence were sig- and used as an acceptable measure of effect size nificantly improved at 12-weeks post BIG group. (ES) when outcomes before and after an inter- Service outcomes show that waiting times and vention are compared. Pre to post-difference patient attendance rates were improved with an in coherence was tested using a one-sample overall decrease in costs associated with con- two-sided t-test. To evaluate relationships tainment products. between differences in coherence and differences in outcomes, Pearson correlation coeffi- Conclusion: Group education and screening cients (r) were calculated. Correlations among has improved patients perception of their variables were examined. symptoms and leakage. It has had a positive impact on the service delivery and improved Results: Post intervention officers showed access for patient with bladder dysfunction. reduction in diastolic blood pressure (M = -6.8, SD= 9.3, p = .02, d = 0.73), correlation coefficient values for the relationship between differ-

59 511.35 – 13.00 Concurrent session 5 – Thursday 7 April 2016 Recommended reading list 5.8.3 Abstract number 270 Recommended reading list Tannenbaum, C., Agnew, R., Benedetti, A., 12:30pm James S, Gallagher R, Dunbabin J, Perry L: Doneal, T., Van den Heuvel, E. (2013) Effective- Prevalence of vascular complications and ness of continence promotion for older women factors predictive of their development in young via community organisations : a cluster ran- Development of vascular adults with type 1 diabetes: systematic litera- domised trial, BMJ Open 3:e004135 complications in young ture review. BMC Research Notes 2014,7:593 Avery K, Donovan J, Peters T, Shaw C, Gotoh people with type 1 diabetes: a doi:10.1186/1756-0500-7-593 M, Abrams P.( 2004) The ICIQ: a brief and continuing story James S, Perry L, Gallagher R, Lowe J, Dunbabin robust measure for evaluating the symptoms Presenter: Professor Lin Perry, PhD MSc RN, J, McElduff P, Acharya S, Steinbeck K. Service and impact of urinary incontinence. Neurourol University of Technology Sydney, Sydney, usage and vascular complications in young Urodyn. 23(4):322-30 Australia adults with type 1 diabetes. BMC Endocrine Barry MJ, et al. (1992). American Urological Co-author(s): Janet Dunbabin, Australia; Disorders 2014b, 14:39 doi:10.1186/1472-6823- Association symptom index for benign prostatic Robyn Gallagher Australia; Julia Lowe, 14-39 hyperplasia. Journal of Urology, 148(5): 1549- Canada; Steven James, Canada; Kate The Diabetes Control and Complications Trial/ 1557. Steinbeck, Australia Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group: Biography Abstract Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progres- Rona trained as a Registered General Nurse in Introduction: Even in youth Type 1 diabetes is sion of diabetic nephropathy: the Epidemiology Glasgow in 1981. Since then she has had a variety linked to the development of vascular complica- of Diabetes Interventions and Complications of nursing roles including District Nursing, Co- tions that reduce longevity (James et al 2014). (EDIC) study. JAMA 2003, 290(16):2159-2167. ordinator for Older People Services and Primary Regular preventive care and complications Care Adviser for the Royal College of Nursing screening supports maintenance of good blood (Scotland). She completed her PhD in 2012 and glucose control, and can defer onset of compli- Biography her thesis won the Royal College of Nursing cations (DCCT/EDIC 2003). However, this is Lin Perry is Professor of Nursing Research and Research Society Akinsanya award in 2013. As particularly challenging during early adulthood. Practice Development, University of Technol- part of a post doctorate studies Rona carried out Aims: To map health service usage, rates and ogy Sydney and the Prince of Wales Hospital, a randomised controlled trial exploring delivery factors predicting development of vascular Sydney Hospital and Sydney Eye Hospital, of behavioural intervention and self-manage- complications (hypertension, retinopathy and South Eastern Sydney Local Health District, ment workshops to women who were 60 years or nephropathy) in a cohort of young adults (16-30 New South Wales. The main focus of her work is older which achieved the presidential award for years) with type 1 diabetes in the Hunter New broadly around research capacity development, the ‘Best Clinical Trial’ at the American Geriatric England district of New South Wales, Australia. service and practice development and evalua- Society meeting in Seattle May 2012. Rona has tion, with major clinical topics of chronic disease since redesigned continence service in NHSGGC Methods: With Ethics Committee agreement, management, particularly stroke and diabetes. using the findings from the research where we undertook cross-sectional retrospective she currently works as a Service Manager and documentation surveys of case notes of young clinical research fellow for the SPHERE Bladder adults with type 1 diabetes accessing public and Bowel service. This research into practice health services in the area in 2010-2011 (James et al 2014b), then 2012-2014. We reviewed clinic innovation won the Dorothy Mandelsham award Theme: Interviewing and was presented to Rona at the ACA National records, hospital attendances and admissions and associated records, extracting service usage, Conference in Birmingham on the 9th May 2014. 5.9.1 Abstract number 20 Rona also presented her work at this year’s complications screening and vascular com- international continence society conference in plications data. Independent predictors were 11:00am Montreal, Canada. modelled using linear and logistic regression analyses. Selecting the right candidates Results: In 2010-2011 we identified a cohort with the right values for of 707 patients, mean (SD) age 23.0 (3.7) and nursing. 10.2 (5.8) years diabetes duration; 652 were followed to end 2014. Initial analyses revealed Presenter: Mrs Jane Welby, MSc. BSc (Hons) poor routine preventative service usage and RGN RM, School of Nursing, Faculty of Health complications screening (41%-43% had none), Studies, University of Bradford, Bradford, UK with 45%-46% having unplanned acute service Co-author(s): Dr Chris Dearnley, England; contacts. Complications records were incom- Dr Anita Sargeant, England; Professor Gerry plete but hypertension was common, affecting Armitage, England 48.4%. Diabetes duration, glycaemic control, lack of service contact and use of insulin pumps Abstract predicted presence of vascular complications. Background: The values that underpin inter- Later analyses revealed continuing but attenu- national definitions of nursing (WHO 2015; ICN ated patterns, with no significant change in crisis 2015) are analogous, but selecting candidates and routine service usage and increasing rates of for nursing with the right values is an extremely vascular complications. complex responsibility. In the UK, there appears Discussion: Findings flag a continuing picture to be an assumption that core nursing values of suboptimal service support and glycaemic have been lost to technological improvements control in young adults. and advanced practice. Inquiry reports (Francis Conclusion: Better understanding is required 2013; Willis 2015) serve as Drivers for a values of how to engage young people in routine care, to based recruitment (VBR) strategy, being imple- better meet their needs and improve glycaemic mented in 2015 (Health Education England outcomes. 2014). This study explored the values that under-

60 11.35 – 13.00 Concurrent session 5 – Thursday 75 April 2016 pinned selection prior to VBR to determine the 5.9.2 Abstract number 182 Johnson MJ, Oxberry SG, Cleland JGF, Clark values by which stakeholders recruit candidates AL (2010). Measurement of breathlessness for nursing and how these values have been con- 12:00pm in clinical trials in patient with chronic heart structed. failure: the need for a standardized approach: Method: Grounded theory from a social con- Experiences of breathlessness a systematic review. European Journal of Heart structivist perspective was employed using in chronic heart failure: Failure, vol 12 no 2, pp 13 purposive then theoretical sampling consistent patients’ perspective Seo Y, Roberts CL, La Framboise, Yates BC, with the approach. Thirty in-depth individual Presenter: Dr Helen Walthall, PhD, RGN, Yurkovich JM (2011). Predictors of Modifica- interviews were undertaken, and these data were Faculty of Health and Life Sciences, Oxford tions in instrumental activities of daily living in analysed by constant comparison producing a Brookes University, Oxford, UK persons with heart failure. Journal of Cardiovas- number of novel theories. cular Nursing, vol 26, no 2 pp: 89-98. Co-author(s): Mary Boulton, England UK, Findings: Participant’s acknowledged that Crispin Jenkinson, England, UK they selected candidates for nursing based on Biography values, influenced by their experiences but they Abstract Helen Walthall is a qualified adult nurse who were also subject to barriers. Three key themes specialises in cardiorespiratory care. Helen Background: Breathlessness is the most were apparent relating to social science theories: graduated in 1995, completed her Postgraduate common symptom experienced by patients with power relationships; socialisation, and intuition. Diploma in Adult Education in 1996 and her PhD chronic heart failure (CHF) (Heo et al, 2008). studies in 2003. Helen is currently a Principal Discussion: The participant’s in this study It affects activities of daily living and quality Lecturer/Programme Lead for the Advanced had clear personal objectives. These included of life, and is closely linked to mortality (Seo and Specialist Practice cluster in the Depart- recruiting for values which were underpinned et al, 2011). It’s often assessed by frequency of ment of Applied Health and Professional Devel- by perceived equal partnerships with other the symptom and distress caused to the patient opment at Oxford Brookes University. She is stakeholders; the values they held dear which (Johnson et al, 2010), yet this provides little responsible for a number of undergraduate and had been constructed through their experiences, understanding of how it impacts on a patient postgraduate specialised clinical courses within and an intuitive approach which was complex and how it is managed. but arguably based on embodied knowledge and the department, and teaches on the Advanced expertise. Barriers which appear to inhibit the Aims: To explore how patients with CHF Practice programmes, including research process include organisational and commission- describe their experiences of breathlessness, methods, diagnostic reasoning and advanced ing imperatives. how daily life is affected and how they adjust and clinical assessment. Helen supervises a number manage these symptoms. of Master’s thesis, PhD doctoral students and Conclusion: Whilst it appears that the core Professional Doctorate students and works with values by which stakeholders recruit the next Methods: A qualitative study design using semi- nurses to develop and implement the acquisition generation of nurses remain constant, they lack structured interviews was adopted, enabling the of research skills and knowledge into practice. standardisation and transparency suggesting patient to tell their story of living with CHF and that a more strategic selection process address- to discuss their perception of symptoms in the Helen is research active undertaking a number ing partnerships and shared understanding context of their lives. Interviews were conducted of research projects which focus on nursing between stakeholders. between November 2012 and June 2013. The and patients with chronic illness. Her research sample size was 25 obtained through purposive interests include the impact of fatigue and sampling. Interviews were analysed themati- Recommended reading list breathlessness on patients, breathlessness cally. Each transcript was coded for breathless- management in heart failure, end of life issues Grusec JE and Hastings PD (editors) (2006) ness and CHF in general. The coded data were for patients, support for carers, pressure ulcer Handbook of Socialization: Theory and reviewed, discussed and grouped into sub- assessment and the development of a patient Research. New York USA: Guilford Press themes. Full ethical approval was granted reported outcome measure for patients with Health Education England (2014) Values Based Results: Four sub-themes were identified: heart failure. Helen works closely with clinical Recruitment. https://hee.nhs.uk/work-pro- nature of breathlessness, emotional impact of colleagues in the acute and community NHS grammes/values-based-recruitment/ Accessed breathlessness, impact of breathlessness on trusts. 24th September 2015 daily life and managing breathlessness. Partici- Myers D G (2002) Intuition: its powers and its pants also described living with CHF in broader perils. New Haven CT USA: Yale University terms including quality of sleep, changes in roles and loss of valued activities, response to 5.9.3 Abstract number 53 Biography the meaning of CHF for the future and taking control and making choices. I am a nurse having registered in the late 1970’s 12:30pm and have been a lecturer in the school of nursing Discussion: Participants were able to give at the University of Bradford for the past eleven vivid descriptions of breathlessness and the way Student nurse perceptions years. I was very fortunate to have been giving the it affected their lives which are not captured of the delivered curriculum opportunity to study for a PhD and commenced by methods of assessment commonly used within 21st century nursing in October 2011 on a part time basis. My profes- in clinical practice. This limits practitioners’ education sional interests are in Values based recruitment, understanding of breathlessness as experienced Presenter: Mrs Nicola Morrell, M.Ed, Ba neonatal nursing, public health and healthcare by patients. (Hons), RNA, PT, FHEA, Liverpool John law and ethics. Conclusion: A better understanding of Moores University, Liverpool, UK patients’ experiences is required to work with patients to manage their symptoms. Abstract Recommended reading list Background: The health needs of any nation is critically dependant on the relevant and appro- Heo S, Doering LV, Widener J, Moser DK. (2008) priate education of its nurses (Turale, 2011). Predictors and Effect of physical symptom status This research deals with the issue of the com- on health related quality of life in patients with plexities of providing care for the public in the heart failure. American Journal of Critical Care, 21st century, against the expectations of student vol 17, no 2, pp 124-132.

61 511.35 – 13.00 Concurrent session 5 – Thursday 7 April 2016 nurses. Thomas and Davies (2006) discuss how cally in critical care. Nicola in currently nearing nurses have a duty to promote and maintain completion of her PhD at Lancaster University clinical standards to ensure safe and effective and her research interests include amonst other patient care, and this process begins as a pre- things, student experience, curriculum design, registration student nurse, therefore it is imper- teaching and learning, and the links between ative that as educators we get this right from pre- nurse education and work within nursing for the registration. 21st century. Aims: This research illuminates 3rd year student nurses perceptions of if their programme prepares them to practice within the 21st century, and examines what skills and knowledge 3rd year student nurses believe they need to practice. Methods: A qualitative, phenomenological approach was taken, using semi structured interviews from a purposive sample of 3rd year student nurses, to gain the thoughts of 20 3rd year student nurses from a UK HEI, during September 2015. Data collection consisted of undertaking semi structured interviews. Inter- pretive Phenomenological Analysis was the data analysis method employed. The use of IPA is growing within qualitative research, examining how people makes sense of life experiences (Smith, Flowers & Larkin, 2009). Results: Participants felt prepared to register. Participants perceived all skills taught were relevant but discussed how there were other skills which they felt could ease the transition to registrant, and develop their practice within the 21st century. Discussion: Student nurses perceive that they should be acquiring more advanced skills to enable them to ‘hit the ground running’ when registering. Conclusions: Conclusions Drawn were that participants perceived the curriculum to ade- quately prepare them for practice within the 21st century, although allowing pre-registration student’s skill acquisition to develop improved skills would allow them to feel more confident when registering.

Recommended reading list SMITH, J.; FLOWERS, P.; LARKIN, M. (2009) Interpretive Phenomenological Analysis: Theory, Method and Research. London: Sage. THOMAS, E.; DAVIES, B. (2006) Nurse teachers’ knowledge in curriculum planning and implementation. Nurse Education Today, v. 26, p. 572-577. TURALE, S. (2011) Preparing nurses for the 21st century: Reflecting on nursing shortages and other challenges in practice and education. Nursing & Health Sciences, v. 13, n. 3, p. 229-231.

Biography Nicola has worked as a Senior Lecturer at Liverpool John Moores University since 2015. Prior to employment at LJMU Nicola has worked within other North West Universities in a variety of roles. Nicola’s clinical experience is in critical care, where her specialities include cardiothoracic critical care, alongside general critical care. Nicola continues to maintain her clinical credibility through still working clini-

62 14.00 – 14.55 Concurrent session 6 – Thursday 76 April 2016 Concurrent session 6 Thursday 7 April 14.00 - 14.55

Theme: Interviewing relevant, contextual and adolescent specific care 6.1.2 Abstract number 387 to those experiencing chronic illness; care that 6.1.1 Abstract number 159 takes into consideration the impact of T1D by 2:30pm tailoring care that ‘fits’ into, and with, the young 2:00pm person’s life. Transition from active to palliative care in children Images and words: the lived Recommended reading list with cancer: insights from a experience of young people Diabetes Australia, 2010, National policy priori- qualitative study of one unit. with type 1 diabetes ties 2010: better management and prevention of Presenter: Professor Daniel Kelly, PhD, MSc, Presenter: Mrs Ainsley James, BN, Grad diabetes for all Australians, viewed 3 November BSc, RN, School of Healthcare Sciences Cardiff cert. paeds, Grad.cert. HEd, MN, Academic/ 2015, https://static.diabetesaustralia.com.au/s/ University, Cardiff, UK lecturer, Federation University Australia and fileassets/diabetes-australia/283db11a-ec5c- Co-author(s): Pam Smith, UK, Mia Nelson, Monash University, Churchill, Australia 479a-adc3-59dd66935d5d.pdf Rachel McAnDrew Co-author(s): Professor Lisa McKenna, International Diabetes Federation, 2013, Annual Australia; Professor Karen Francis, Australia report 2013, viewed 3 November 2015, http:// Abstract www.idf.org/sites/default/files/attachments/ Abstract IDF-AR2013-final-rv.pdf Background: The period of relapse and transition from active treatment towards palliation van Manen, M 1990, Researching lived experi- Background: Type 1 diabetes (T1D) is a global and end of life care in paediatric oncology is ence: Human science for and action sensitive concern and continues to increase in young considered to be one of the areas of care that is pedagogy, State University of New York Press, populations (International Diabetes Federa- especially challenging (Hinds et al, 2010) and Ontario, Canada. tion 2013). In Australia, there are 10,000 young there is a lack of research to guide practice at people currently transitioning from paediatric these times. to adult care; 30-40% are ‘lost’ from special- Biography ist adult care during transition, with one third With this challenge in mind, this study intended Ainsley James is a published researcher with to investigate the experiences of families, and requiring mental health support (Diabetes over twelve years in clinical practice and ten Australia 2010). Young people diagnosed with the staff who look after them, when treatment years in academia. Her clinical practice experi- fails. T1D experience lifelong changes that some find ence includes general nursing, orthopaedics, Aims: To describe the period of transition, from difficult to accept and cope, while others cope child and adolescent health, and experience active treatment to palliative care, in a paediatric quite well. as an undergraduate clinical educator. She oncology setting. Aims: We aimed to provide young people, with currently teaches undergraduate nursing and a voice to describe what life is like living with midwifery students at Federation University To highlight the aspects of effective and less T1D; to discover the meaning of their lived expe- Australia. Ainsley has an extensive list of pub- effective practice. rience; to inform healthcare professionals about lications with her most recent being issues in To make recommendations to inform support- participants’ experiences; to improve healthcare recruiting young people to research. She is the ive care for families, education and support for experiences of young people by developing rec- recipient of an Australian Postgraduate Associa- professionals, and to inform best practice for the ommendations enabling healthcare profession- tion (APA) Scholarship, enabling full time PhD care of children with incurable cancer. als to tailor care; and inform other young people candidature with Monash University. Her PhD Methods: This was a 16 month study that with T1D so experiences may resonate. research explores and describes the lived experi- employed a qualitative in-depth approach ence of young people aged 16-24 years with type Methods: Using van Manen’s (1990) phenom- including semi-structured interviews with 12 1 diabetes. Using Max van Manen’s approach enological approach, ten participants aged 16-24 bereaved parents. In addition a facilitated dis- to phenomenology, her research utilizes visual years were recruited and interviewed. Interviews cussion group, and individual semi-structured images created by the participants and textual were recorded, transcribed verbatim and the- interviews with 10 paediatric oncology profes- descriptions from interviews, to discover and matically analysed to identify examples of lived sionals too place. experience. Participant’s also created artwork provide insights into the lived experience of Data were analysed thematically in line with the representing their lived experience in photo- young people with type 1 diabetes. stated aims of the study. graphs, drawings and collages. Participants provided interpretations of the artwork, adding Discussion: In this paper we focus on the way further depth, richness and rigour to the lived professionals supported parents to manage experience descriptions and themes. the transition from active treatment to palliative care and inevitable death. We Draw on the FINDINGS: Preliminary findings delivered rich concepts of emotional labour (Hochschild 1983) descriptions and interpretations of participants’ and intelligent kindness (Ballatt and Campling lived experience and centres on a sense of being 2011) to critically examine how staff-parent rela- different, being in control, relationships with tionships facilitated the management of transi- others and accepting the future. The findings tions through three phases - ending, fallow time provided insights, understanding and awareness and new beginnings. It is also possible to identify of young people’s experiences. awareness and emphasis on a clinical culture DISCUSSION/Conclusion: T1D in young that is both ‘kind’ and ‘appropriate’ to changing people is a global concern. By providing powerful needs. insights, healthcare professionals can transform their practice by being better placed to provide

63 614.00 – 14.55 Concurrent session 6 – Thursday 7 April 2016 Conclusions: The findings of this study illus- Theme: Interviewing Biography trated that the environment of care combined I have worked as a lecturer in Nursing Studies with behaviours can give meaning to the loss of a 6.3.1 Abstract number 286 at the University of Edinburgh since May 2014. child. Implications for practice will be examined: 2:00pm I completed my PhD in 2011 at the University such as preparing parents for loss. of Sunderland, where I investigated the expe- Political representation for riences of white health visitors when working Recommended reading list social justice in nursing: across cultures. I then worked for the following Hinds, P.S., Schum, L., Baker, J.N., and Wolfe, J. 3 years as a lecturer in Public Health at the Uni- (2010) Key Factors Affecting Dying Children and lessons learned from versity of Sunderland. Since qualifying as an Their Families. Journal Of Palliative Medicine. participant research with adult nurse in 1989 and then a District Nurse in 8(1):S70-S78. destitute asylum seekers in 1991, I have worked in a variety of community settings. I am particularly interested in health Hochschild A (1983) The Managed Heart: The the UK inequalities, social exclusion and the ways in Commercialisation of Human Feeling. Berkley: Presenter: Dr Fiona Cuthill, School of Health which poverty impacts on health. University of California Press. in Social Science, University of Edinburgh, My research interests to date have explored the Ballatt J & Campling P (2011) Intelligent Edinburgh, UK ways that marginalised groups in society access Kindness: Reforming the culture of healthcare. community organisations to support resilience London: RCPsych Publications. Abstract and this has focused primarily on people who The concept of social justice is making a revival find themselves destitute following the asylum Biography in nursing scholarship (Kagan, Smith and Chinn, process. I am currently working with NHS Professor Daniel Kelly undertook the integrated 2014), in part in response to widening health Lothian looking at the ways that community Social Sciences and Nursing degree at Edinburgh inequalities and inequities in high-income nursing staff negotiate disclosure of gender University between 1979-84. On qualifying he countries. In particular, critical nurse scholars based violence within their day-today work. worked in intensive care and trauma before spe- have sought to develop participatory research In addition, I am interested in the ways that cializing in Oncology. methods using peer researchers to represent nursing staff engage in social justice, what social He undertook the Oncology Nursing training at the ‘voice’ of people who are living in margin- justice is understood to mean within the profes- The Royal Marsden hospital in London before alised spaces in society. In addition, peer par- sion of nursing in the UK and how it is employed returning to Edinburgh to take up two Charge ticipatory research methodologies are used as a in practice situations. Nurse posts in Oncology and HIV. way to empower communities. The aim of this presentation is to report on the experiences of During this time he completed a Masters in nurse and peer researchers as part of a research Advanced Practice (Cancer Nursing) at The Uni- project to explore the experiences of people who versity of Surrey. find themselves destitute following the asylum 6.3.2 Abstract number 212 After this he returned to the Royal Marsden as process in the UK. The focus of the presentation 2:30pm a Lecturer in Cancer Nursing for several years will not be to showcase the research itself, but to before moving to University College Hospitals critically reflect on the extent to which the peer Making sense of the London as Senior Nurse for Research & Devel- researchers in this project were ‘empowered’ opment. as part of the research process . In seeking to unbelievable: A biographical During this time he undertook at PhD at the explore social injustice, three challenges will be narrative study of men who University of London on the embodied impact identified: the lack of a robust political theory, experience IPV from their of prostate cancer. He has worked at a number institutional/professional constraints and an female partners. absence of skills to engage with the politics of London Universities including City Univer- Presenter: Dr Melissa Corbally, DProf (Health of social (in)justice. Each challenge will be sity London as a Senior Research Fellow before and Social Care), School of Nursing and presented, opposing voices outlined and some joining Middlesex University London as Reader Human Sciences, Dublin City University, possible solutions will be suggested. The work then Professor of Cancer Nursing. Dublin, IE of political theorist Nancy Fraser (2009) will be In 2011 he moved to Cardiff University as the used as a conceptual framework, in particular her Royal College of Nursing Chair of Nursing focus on mis/framing and political representa- Abstract Research where his academic background in tion for social justice. In addition, it is suggested Intimate partner abuse is a serious social issue. cancer and palliative care has continued to that social justice needs to be further embedded Presently, there is a lack of understanding about underpin some of his research interests. in nursing policy and curriculum. Finally, nurses how men account for their experiences of female will be encouraged to develop practical political abuse. This study examined how men in Ireland skills to engage with both politics and the media accounted for their experiences of abuse in their in a neoliberal globalizing world. life stories. Using the ten stages of analysis in ‘classic’ Biographical Narrative Interpretive Recommended reading list Method, three cases are presented which were analysed from a social constructionist perspec- Kagan, P. N., Smith, M. C., & Chinn, P. L. (Eds.). tive. (2014). Philosophies and practices of emancipa- tory nursing: social justice as praxis. London: The study found that men constructed abuse Routledge. as both an individual and collective endeavour. Dominant conflicting discourses of masculinity Fraser N. 2009. Scales of justice: Reimagining and intimate partner abuse disadvantaged both political space in a globalizing World. Polity men and their biographical caretakers firstly in Press, Cambridge. identifying abuse. Although men used abuse narratives in accounting for their experience, they were more comfortable using dominant narratives of fatherhood and being a husband in constructing the abuse experience. The bio-

64 14.00 – 14.55 Concurrent session 6 – Thursday 76 April 2016 graphical work of reflection appeared to speed on their knowledge of ITN, ownership, age, a.m. to 8 p.m. All patients (both gender) were recovery in the reconstruction of self. and education, marital and socio-economic between 74 and 85 years of age. The study was These cases illustrate the inadequacy of current status. Data collection involved in-depth indi- reported to the Danish Data Protection Agency abuse definitions and policy which whilst it is vidual interviews with mothers and focus group with reference number (2007-58-0010). changing, remains engendered. Greater sensitiv- discussion with mothers and also health care Results: Based on the old cancer patients ity of nurses to the nature of domestic violence workers. A three phase approach to data inter- interaction with staff, we identified three main amongst male victims along with appreciation pretation was taken to enrich understanding of care challenges from the patients’ perspectives: of how men talk about domestic abuse victimi- the unique experiences of these women as they ‘‘well-being as a matter of different perspec- sation (compared with female victims) is rec- negotiated the tension within their subjugated tives’’, ‘‘vulnerability in contrast to well-being’’, ommended. It is hoped that the findings of the environment. The intent was not triangulation and ‘‘staff mix influences on the care encounter.’’ to confirm a single understanding but about study prompt further exploration into this under Conclusion: The experience of well-being in layering nuanced understanding through the researched area. old cancer patients during hospital admission emergence of stories, themes and performance. was absent or challenged when staff did not Biography acknowledge their individual vulnerability and Biography Melissa is a lecturer in the School of Nursing needs. and Human Sciences, Dublin City University. Anastesia Nzute is presently a Doctoral She lectures undergraduate general nursing candidate at the Faculty of Education, Health Recommended reading list and Wellbeing at the University of Wolverhamp- students in addition to running a module Uhrenfeldt, L., & Høybye, M. T. 2015. Care ton, United Kingdom. She has a degree in Health entitled ‘violence and abuse in society’ for health interaction adding challenges to old patients’ studies, University of Wolverhampton, UK. (with and society students. The paper she is present- well-being during surgical hospital treatment. research interest in Maternal and Child Health, ing today relates to her doctoral study of male International journal of qualitative studies on sexuality, inequality, professional education and victims of domestic abuse completed through health and well-being, 10. http://www.ijqhw. research). She has lectured with the School of the University of Salford, England. net/index.php/qhw/article/view/28830 Midwifery St. Luke`s Hospital, Zaria, Nigeria. She has five unpublished papers relating to her ToDres, L. & Galvin, K. 2010, ‘Dwelling-mobil- research interest and has presented in confer- ity’: An existential theory of well-being’, Interna- ences. She is also an active member of Centre tional journal of qualitative studies on health and for the Advancement of International Education well-being, vol. 5, pp. 10.3402/qhw.v5i3.5444. Theme: Interviewing (CAIPE) and Royal College of Nursing, United 6.4.1 Abstract number 144 Kingdom. Biography Lisbeth Uhrenfeldt serves a position as associate 2:00pm Professor and Head of Clinical Nursing Research at Department of Health, Science and Technol- Utilisation of insecticide 6.4.2 Abstract number 422 ogy, Aalborg University, Denmark She is a treated nets among women in member of two international research networks rural Nigeria: Stories, themes 2:30pm (EANS and EACS) and two Nordic networks and performance (PRANSIT and CARELead. Her background is Older cancer patients in nursing (PhD) and history of Ideas. Presenter: Mrs Anastesia Nzute, Faculty of interaction with staff during Education Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK surgical hospital treatment for colon cancer Co-author(s): Vinette Cross Presenter: Dr Lisbeth Uhrenfeldt, PhD, Depart- Theme: Focus groups Abstract ment of Health, Aalborg University, Aalborg, Denmark Insecticide treated nets (ITNs) have been proven 6.5.2 Abstract number 15 Co-author(s): Mette Terp Høybye, Denmark to be effective in malaria endemic nations and 2:30pm the World Health Organization (WHO) has Abstract provided funding and technical support to Relatives’ attitudes, promoting their distribution to the nations Background: Hospitalized patients are chal- affected. Literature indicates that pregnant lenged in different ways: being away from their experiences and satisfaction women and children under the age of five years usual life, family and surroundings and at the with specialized end-of-life are at the highest risk. Despite increases and same time with experiences of how the health and follow-up care in acute knowledge of the effectiveness of ITN, there is care providers act and treat them how respectful, hospital setting in Iceland. A still low usage among rural Nigerian women. thoughtful, compassionate, holistic, and indi- qualitative study. Although much research has been conducted vidualized the care provided. In addition, during about malaria prevention there is little on the the last decade, hospital stays in Denmark have Presenter: Dr Elisabet Hjorleifsdottir, Ph.D. experiences of rural Nigerian women and their shortened into half the days from 6-10 days to in nursing, University of Akureyri, Akureyri, use of ITNs. However, Nigerian researchers have 2-3 days due to new techniques and to improve Iceland indicated the need for more social participatory postoperative recovery Co-author(s): Svala B. Robertson, Iceland research to enrich our understanding of taken Aim: The aim of this study was to explore how for granted lived experiences of those engaged in the well-being of old hospitalized patients was Abstract the battle to prevent malaria.The study adopted affected by the interaction with staff during Acute hospital settings are generally not con- a hermeneutic phenomenological approach to surgical hospital treatment for colon cancer. sidered as adequate environment for special- explore experiences related to malaria preven- ized end-of-life care offered to patients and tion using ITNs among rural Nigerian women. Methodology: Based on ethnographic methodology with field observations and unstruc- their families. There are various ways to assist It was based on experiential stories of 20 rural grieving family members but more studies are women who were selected purposively, based tured interviews nine individuals were followed during a full day; the hours ranging from 7:45 needed to understand their wishes throughout

65 614.00 – 14.55 Concurrent session 6 – Thursday 7 April 2016 the times of care and after the death of a loved Theme: Qualitative approaches Biography one. Diana Clarke, RN, PhD is Associate Professor Objectives: To investigate relatives’ attitudes, 6.6.1 Abstract number 108 and Associate Dean (Research), in the College of experiences and satisfaction with specialized 2:00pm Nursing, University of Manitoba and Director, end-of-life care in acute hospital setting and to Manitoba Centre for Nursing and Health examine their perspectives on follow-up care. When researchers and Research in Winnipeg, Manitoba, Canada. She Methods: Qualitative approach was applied also is a Research Associate with the Health decision-makers collide over Sciences Centre Adult Mental Health Program. using semi-structured interviews with a ‘evidence’ (with the media purposive sampling of 15 relatives from an acute She has a PhD in Psychology from the Univer- hospital setting in Iceland. The interviews were ready to pounce): The hidden sity of Manitoba and has worked with the St. transcribed and categorized according to their politics of research Boniface General Hospital Department of Psy- chiatry as a Clinical Nurse Specialist and with content where the underlying significance of Presenter: Dr Diana Clarke, Registered Nurse, Health Sciences Centre Adult Mental Health all the elements in the text was combined into College of Nursing, University of Manitoba, Program as the Coordinator of Program Devel- themes. Winnipeg, Canada opment and Evaluation. Her research program Results: Four key themes were identified: Envi- centres around mental health services and inte- ronmental influences on quality of care; commu- Abstract gration of hospital and community services spe- nication in end-of-life care; impact of symptom Background to the issue: In the current cifically focusing on care of mental health pres- burden on the family; fulfilment of needs. climate which favours high impact research entations to emergency departments. Each of the themes encompassed a variation with immediate evidence to inform health care of subthemes. The deeper meaning of all the delivery and systems, researchers can no longer themes was combined in one core category: To engage in research purely for the sake of science experience well-being of the loved one, security and knowledge. Collaboration with end-users and support, emphasis on stability and profes- is imperative, and alignment with the needs of 6.6.2 Abstract number 26 sional confidence in a friendly and quiet envi- the healthcare system, an expectation. However, 2:30pm ronment, reflecting participantsÂ´ own experi- health is becoming increasingly political, incul- ences of end-of-life and follow-up care. cating both small ‘p’ and large ‘p’ political Specialist nurses’ Conclusions: Specialized end-of-life care agendas into the researcher/end-user relation- is and will be practised in hospital settings in ship. Sometimes these agendas are explicit, perceptions of the barriers unforeseeable future. This study indicates that other times implicit, sometimes hidden. Further and facilitators to inviting relatives were generally satisfied with the care complications arise when the issue is of particu- patients to participate in provided but there is a need for improvement lar interest to the media and release of findings research studies: a qualitative with emphasis on environmental factors and through the media can create problems for the descriptive study health care professionals’ communication skills. end-users. Follow-up care after death is needing more Presenter: Ms Caroline French, MRes, RGN, Aims of the paper: We will explore what Queen Mary University, London, UK attention in end-of-life care as well as in future happens when the evidence isn’t what the studies on this subject. decision-maker and policy makers had hoped Co-author(s): Dr Charitini Stavropoulou, UK for. Using case study methodology, we delve Biography into circumstances surrounding an externally- Abstract Clinical nurse specialist in cancer and palliative funded impact evaluation of a controversial Background: Increasing the number of NHS care mental health crisis service and the dilemmas patients offered research study participation is and conflicts that arose for the university-based Masters degree in Nursing from the University a current priority (1). Healthcare professionals researcher. of Glasgow, Scotland play an important role in recruitment to studies Discussion of the issue: Issues explored will by inviting their patients to participate, however Doctoral degree from Lund University, Lund be the researcher’s moral and ethical obligations it is known that some do not invite all eligible Sweeden to present the findings reliably, accurately, and patients (2). A variety of barriers and facilitators Associate Professor at the University of Akureyri, honestly; accountability to the external funding to healthcare professionals inviting patients to Akureyri, Iceland agency; academic freedom; balanced with the participate in research studies have been iden- Manager of the Hospice home Care in Akureyri, need to maintain professional and collegial tified (3). However, most previous research Iceland relationships with those in both the practice relates to experiences of specific trials, and little and policy settings upon whom future research is known about specialist nurses’ perceptions. access and knowledge translation activities may Aim: To explore the perceptions of specialist be dependent; all within the context of media nurses of the barriers and facilitators to inviting scrutiny. adult NHS patients to participate in research Conclusions: When political agendas clash studies during clinical care delivery. with research findings, health systems research- Methods: A cross-sectional qualitative descrip- ers can find themselves in situations where tive design was employed. Participants were they are caught unawares, totally unprepared, 12 specialist nurses from 7 clinical specialties and professionally vulnerable on a number of and 7 NHS Trusts in England, with experience levels. Based on a real-life situation, this paper of inviting patients to a wide range of studies. will provide researchers with some guidance Data were collected from March to July 2015 and wisdom in anticipating, navigating, and with individual semi-structured interviews, and surviving the storm. transcripts analysed using Framework thematic analysis. Results: A wide range of complex and interdependent barriers and facilitators were identified. Perceptions varied between individuals,

66 14.00 – 14.55 Concurrent session 6 – Thursday 76 April 2016 however barriers and facilitators centred on five Theme: Qualitative approaches Recommended reading list main themes: i) assessing patient suitability, ii) Anema, M., G and McCoy, JK. (2010) Com- teamwork, iii) valuing research, iv) the invita- 6.7.1 Abstract number 284 petency-Based Nursing Education: Guide to tion process and v) understanding the study. 2:00pm Achieving Outstanding Learner Outcomes. New Discussion: Findings broadly support existing York: Springer. literature, and several new insights were gained Psychometric properties Straat, JH., van der Ark, LA and Sijtsma, K. into facilitators. Participants reflected on a wide (2014) Minimum Sample Size Requirements for range of experience of different studies and of two self-report clinical competence scales for Mokken Scale Analysis Educational and Psycho- contexts, which may enhance applicability to logical Measurement 74 (5), 809-822. other settings. However, a limitation is that all nursing students. participants had positive general attitudes to Presenter: Miss Deborah Coleman, Queen’s Biography research. University Belfast, Belfast, UK Deborah is a lecturer in the School of Nursing Conclusion: The identified barriers and facili- Co-author(s): Dr Janice Christie, UK; Dr Kevin and Midwifery, Queen’s University, Belfast. She tators provide a basis for reflection for specialist Gormley, Northern Ireland is a co-ordinator for the year 2 Care Delivery nurses, other healthcare professionals, research module in the undergraduate programme and teams, and policymakers with an interest in Abstract is Pathway Leader for the BSc (Hons)/Graduate increasing patient research participation. Rec- Diploma Specialist Practice in Nursing Care of ommendations for practice and for future Background: It is important to assess the Older People. Deborah is a Registered Nurse and research are given. clinical competence of nursing students to gauge their educational needs. Competence can be Specialist Practitioner (District Nursing). measured by self-assessment tools, however, Deborah is a student on the Doctorate of Recommended reading list Anema and McCoy (2010) contend that currently Nursing Practice and is currently writing up her Department of Health (2013) The NHS Consti- available measures should be further psycho- thesis.The teaching and learning strategies, used tution. London: Department of Health. metrically tested. to support nursing students, to develop holistic Fletcher, B., Gheorghe, A., Moore, D., Wilson, Aim: To test the psychometric properties of assessment skills with older people, is the focus S. and Damery, S. (2011) ‘Improving the recruit- Nursing Competencies Questionnaire (NCQ) of her doctoral thesis.The work presented today ment activity of clinicians in randomised con- and Self-Efficacy in Clinical Performance (SECP) is part of the findings from stage one of her study. trolled trials: a systematic review’, BMJ Open, 2, clinical competence scales. 1 [Online]. Available: http://bmjopen.bmj.com/ Method: A non-randomly selected sample of content/2/1/e000496 n=248 2nd year nursing students completed Newington, L. and Metcalfe, A. (2014) ‘Research- NCQ, SECP and demographic questionnaires 6.7.2 Abstract number 192 ers’ and clinicians’ perceptions of recruiting par- (June and September 2013). Mokken Scaling ticipants to clinical research: a thematic meta- Analysis (MSA) was used to investigate struc- 2:30pm synthesis’, Journal of Clinical Medical Research tural validity and scale properties; convergent 6, 3, pp. 162-172. and discriminant validity and reliability were Using nurses to forge a way to also tested for each scale. early detection of skin cancer Biography Results: MSA analysis identified that the NCQ Presenter: Associate Professor Clare Harvey, I qualified as an adult nurse in 2007 and spent is a unidimensional scale with strong scale scal- PhD, RN, BA (Cur), MA, Faculty of Education, the first three years of my career as a staff nurse ability coefficients Hs =0.581; but limited item Eastern Institute of Technology, Napier, New on a stroke ward and then on neuro ITU. I then rankability HT =0.367. The SECP scale MSA Zealand became a research nurse, and worked for four suggested that the scale could be potentially Co-author(s): Colin Beauchamp, Australia; years in several different research nurse roles split into two unidimensional scales (SECP28 Chris Lowings, Australia; Paul Katris, in different NHS Trusts, covering a variety of and SECP7), each with good/reasonable scal- Australia; Thomas Harding New Zealand; clinical specialties. One of these roles was a joint ablity psychometric properties as summed Maria Pearson, New Zealand; Rachel Forrest, post as a senior research assistant in a clinical scales but negligible/very limited scale rankabil- New Zealand academic setting. From this varied research ity (SECP28: Hs = 0.55, HT=0.211; SECP7: Hs experience I developed a strong interest in inves- = 0.61, HT=0.049). Analysis of between cohort Abstract tigating issues around research study conduct differences and NCQ/SECP scores produced in the NHS, as well as a desire to design and evidence of discriminant and convergent Background: Australia has one of the highest conduct my own research. validity; good internal reliability was also found: rates of skin cancer in the world. The Lions Cancer Institute (Western Australia) (LCI) is I was awarded an NIHR studentship to study NCQ Î± = 0.93, SECP28 Î± = 0.96 and SECP7 a community funded organization that has for an MRes Clinical Research at City University Î±=0.89. provided free, population based skin cancer London in 2014, and completed this in 2015. Discussion: In line with previous research screening programmes since 1991. In a study The abstract submitted presents the dissertation further evidence of the NCQ’s reliability and undertaken in 1998, LCI identified that nurses component of this award. validity was demonstrated. However, as the are capable of identifying 96% of surgeon-clas- I am currently undertaking a full-time PhD in SECP findings are new and the sample small sified suspicious lesions (Katris et al., 1998). the field of healthcare research methodology, with reference to Straat and colleagues (2014), In 2011, a further study was initiated in which under a studentship from Queen Mary Univer- the SECP results should be interpreted with the financial and clinical value of non-medical sity London. I continue to work as a research caution and verified on a second sample. health professionals employed in this setting nurse on an ad-hoc basis. Conclusions: Measurement of perceived was explored. self-competence could start early in a nursing Aims: This paper provides the findings from programme to support students’ development of the study, undertaken between 2011 and 2015, clinical competence. Further testing of the SECP which collected data from nurse initiated skin scale with larger nursing student samples from screening across three Australian states. The different programme years is indicated. data examines clinical and cost effectiveness of roles such as NPs, in undertaking skin screening activities that support access to free services.

67 614.00 – 14.55 Concurrent session 6 – Thursday 7 April 2016 Methods: Data that is routinely collected by the Theme: Other mortality in ICU and shows that while staffing LCI from their mobile skin screening service was levels of both nurses and doctors are related to used. Those screenings that included the services 6.8.1 Abstract number 376 patients’ survival chances, nurse staffing levels of a NP candidate, were analysed against clinical are particularly important for the most seriously and budget parameters using Medicare Rates for 2:00pm ill patients. She was a member of the NICE Safe NP services. Staffing guidelines committee and this paper is A critical reflection on the Findings: Our findings show that 32.1% of an attempt, not only to make sense of experience screenings were referred to a medical practi- NICE safe staffing guidelines but to draw out the wider implications for the tioner for the follow up of suspicious lesions, programme NHS. with 4.8% lesions recognised as melanocytic. A Presenter: Professor Elizabeth West, PhD, random follow up of clients post screening by a Professor in Applied Social Science, University NP confirmed 100% accuracy. Medicare rebates of Greenwich, London, UK indicatively tracked for the NP screenings iden- 6.8.2 Abstract number 200 tified a revenue stream that covers screening Abstract costs. 2:30pm The importance of adequate levels of nurse Discussion: There is growing evidence to show staffing was highlighted in the Francis report Fit for the future? The health that the effects of skin cancer can be minimized (2013) which recommended that the National with screening and early diagnosis (Katalinic Institute for Health and Social Care Excellence and health behaviours of et al., 2012). It is important that screening (NICE) be asked to formulate guidance on safe the nursing and midwifery opportunities like the LCI model continue to staffing levels. This paper will give the back- workforce be supported. Using non-medical health pro- ground to the programme of work that NICE Presenter: Professor Lin Perry, PhD MSc RN, fessionals as part of any routine skin screening initiated and planned to conduct for a number University of Technology Sydney, Sydney, service can be a cost effective way of improving of specialist areas, including maternity, acute Australia access to screening that is free to the public. care, accident and emergency, mental health and community. It will explain how NICE approaches Co-author(s): Robyn Gallagher, Australia; Recommended reading list guideline development through the initial litera- Christine Duffield, Australia; David Sibbritt, Australia; Rachel Nicholls, Australia Katris, P., Donovan, R. & Gray, B. 1998. Nurses ture review, committee discussion, field testing Screening for Skin Cancer: An Observation and economic impact assessment. By the time Abstract Study. Australian and New Zealand Journal of the safe staffing programme was terminated Public Health 22, 381 - 383. guidelines had been produced for maternity and Introduction: With nursing workforce acute care but work on A&E and mental health shortages and ageing demographics, nurses’ Katalinic, A., Waldmann, A., Weinstock, M. was not completed. This paper will argue that health is important yet little is known about A., Geller, A. C., Eisemann, N., Greinert, R., one of the key factors leading to the termina- this and its relationship to workforce retention Volkmer, B. & Breitbart, E. 2012. Does skin tion of the programme was the economic impli- (Chan & Perry, 2012). cancer screening save lives? Cancer, 118, 5395- cations of the A&E guidelines which unlike the 5402. Aims: To examine the health and health behav- published guidelines were based on bed numbers iours of the nursing and midwifery workforce of rather than patients. Once the economic impact New South Wales (NSW), Australia. Biography assessment was conducted, the full financial I am an associate Professor and the programme implications of the programme began to Methods: An online survey of established co-ordinator for the postgraduate programmes become clear. Many, including Francis himself, health-related assessments and work-related in nursing and health science at the Eastern expressed regret that the guideline programme questions was emailed and circulated to NSW Institute of Technology, New Zealand. I also was terminated. However, given the financially working nurses and midwives through the NSW have academic status, working in both teaching precarious situation of the NHS, the programme Nurses and Midwives Association and profes- and research at Flinders University of South would undoubtedly have added pressure to sional contacts between Aug 2014- Feb 2015. Australia. My research focuses on professional the financial problems currently being experi- Complete responses from 5,041 nurses and issues in nursing practice, and in advancing enced by Trusts. It is difficult not to conclude midwives were compared to Australian popula- nursing roles, predominantly around nurse prac- that we simply cannot afford safe staffing levels tion values (ABS 2010-12). titioners. I have worked in four countries during across the NHS at this time. Finally, the NICE Results: Self-reported health was ‘excellent- my nursing career, with the first 20 year of that reviews showed that research on nurse staffing very good’ for 50.6% of respondents, but for time, working in my homeland of Zimbabwe, and often lacks internal and external validity and 55.1% of the Australian population. About half later, South Africa. It is not surprising then that few of the studies were conducted in the UK. of all Australians but two thirds of the nursing my other passion is primary health care, where Guidelines are only as good as the research on workforce reported at least 1 chronic disease my research focuses on examining how nurses which they are based so it is important that we diagnosis, with more mental health, asthma play a part in supporting access to healthcare continue to conduct high quality research in the and arthritis. Symptom burden was high with and the equity of that care, within the primary NHS to provide a robust evidence base for future around 40% experiencing, sometimes and health setting. policy development. more often, back and joint pain, headaches, severe fatigue. More than one third suffered Recommended reading list insomnia. Health behaviours - diet, exercise, risky Drinking, smoking, obesity - were little/ Francis R. (2013) Report on the Mid-Stafford- no better, sometimes worse, than the Australian shire NHS Foundation Trust Public Inquiry. population. London: The Stationary Office Almost one quarter (22%) intended to leave their Biography job within 12 months. With other characteristics accounted for, those at greater odds of leaving Elizabeth West is a research professor with a were: younger, working in non-regional areas, long-standing interest in workforce issues. A shift workers, reporting poorer job satisfaction, recent paper explores the relationship between worse general health or breathing problems. nursing and medical staffing and patient

68 14.00 – 14.55 Concurrent session 6 – Thursday 76 April 2016 Discussion: Respondents’ demographic and occupational profiles are representative of NSW registrants (AIHW 2013). Findings revealed a fatigued and symptomatic workforce with health a significant but poorly recognised influence on staff retention. Conclusion: Failure to promote nurses’ health and retain them in the workforce will challenge healthcare systems to provide quality patient care. Educators, managers and policy makers should heed study findings and take steps to promote the health and retention of this workforce.

Recommended reading list Australian Institute of Health and Welfare (2013) Nursing and midwifery workforce 2012. Canberra Australian Bureau of Statistics (ABS) Austral- ian Health Survey 2011-2012 at http://www.abs. gov.au/ausstats/[email protected]/Lookup/4364.0.55.0 01Chapter3002011-12 Chan CW, Perry L. (2012) Lifestyle health promotion interventions for the nursing workforce: a systematic review Journal of Clinical Nursing vol 21, pp2247-2261

Biography Lin Perry is Professor of Nursing Research and Practice Development, University of Technology Sydney and the Prince of Wales Hospital, Sydney Hospital and Sydney Eye Hospital, South Eastern Sydney Local Health District, New South Wales. The main focus of her work has been broadly around research capacity development, service and practice development and evaluation, with major clinical topics of nutrition support and chronic disease management.

69 709.50 – 10.45 Concurrent session 7 – Friday 8 April 2016 Concurrent session 7 Friday 8 April 09.50 - 10.15

Theme: Questionnaires Conclusions: Findings suggest that under- 7.1.2 Abstract number 92 graduate nursing education can play a key role 7.1.1 Abstract number 193 in raising nursing students’ awareness about the 10:20am critical contribution of compassion to patient 9:50am outcomes and provider wellbeing. Fostering self- Building a research culture compassion to build resilience is the precursor to - experiences of novice Self-compassion: The key practicing compassion toward patients; whether researchers ingredient in teaching the nurses’ compassionate practice can be sustained Presenter: Dr Sue Armstrong, D Cur, MSc, B within healthcare systems and cultures is a practice of compassion to Ed, B ur, University of the Witwatersrand, question for further research. nursing students Johannesburg, South Africa Presenter: Dr Anne Hofmeyer, RN PhD, School Recommended reading list Co-author(s): Gisela van Rensburg, South of Nursing & Midwifery, University of South Africa; Nelouise Geyer, South Africa Australia, Adelaide, Australia Bauer-Wu, S & Fontaine, D 2015, ‘Prioritizing Clinician Wellbeing: The University of Virginia’s Co-author(s): Luisa Toffoli, Australia; Rachael Abstract Vernon, Australia; Ruth Taylor, UK; Dorrie Compassionate Care Initiative’, Global Advances Background: The majority of professional Fontaine, USA; Hester Klopper, South Africa; in Health and Medicine, vol. 4, no. 5, pp. 16-22. nurses in South Africa were trained within a Siedine Coetzee, South Africa Adam, D & Taylor, R 2013, ‘Compassionate care: college system and have no experience in con- Empowering students through nurse education,’ ducting research. Professional nurse training Nurse Education Today, vol. 34, no. 9, pp. 1242- Abstract is currently being moved to Higher Education 1245. Background: Research has linked poor which has required nurse educators to be fast- patient outcomes with austerity measures and Mills, J Wand, T Fraser, J 2015, ‘On self-compas- tracked into Master’s degree programmes. This the perceived lack of compassion in healthcare. sion and self-care in nursing: Selfish or essential has caused anxiety and resistance. for compassionate care?’ International Journal Patients say how they are cared for matters just Aim: This paper describes an innovative of Nursing Studies, vol. 52, no. 4, pp. 791-793. as much as receiving quality healthcare. Poor programme designed to build confidence of the working conditions fosters stress, diminished nurse educators and reflects on their experi- resilience and fatigue that compromises nurses’ Biography ences of the programme. ability to provide quality healthcare and to be Dr Anne Hofmeyer is a senior academic in the Method: Three groups of novice researchers, compassionate toward patients, colleagues and School of Nursing & Midwifery, University based in different parts of the country (n=12) themselves (Bauer-Wu & Fontaine 2015). There of South Australia. Previously, she served as followed a programme during 2015 in which is an increasing emphasis on teaching compas- Program Director: Higher Degrees by Research they were required to conduct a complete sion in undergraduate nursing curricula to foster in the School; Associate Professor, Austral- research project and present their findings at a clinician wellbeing and quality patient outcomes ian Catholic University, Victoria; and Assistant national research conference. A semi-structured (Adam & Taylor 2013). Although self-compas- Dean: Undergraduate Programs, Faculty of questionnaire was used to solicit their opinions sion is essential to practice compassion (Mills et Nursing University of Alberta, Canada. of the successes and failures of the programme. al 2015) few studies have explored teaching self- She teaches research and EBP in undergraduate The data was then subjected to a thematic compassion to nursing students. and graduate programs and supervises graduate content analysis and categories and sub-catego- Aim: Explore the impact of a compassion and doctoral students. Her research and ries developed. module on the understanding and practice of teaching interests focus on leadership, compas- Results: Educators used the programme as compassion among final year nursing students sion, palliative care, and how social capital and a means of preparing themselves to follow in a Bachelor of Nursing program at an Austral- civility can foster networks of trust, inclusion Master’s degrees, and believe they gained con- ian University. and cooperation for better outcomes in higher fidence and found the supportive environment, Methods: Two online qualitative surveys education and health systems. the tight schedule and the group work and the were administered via SurveyMonkeyÂ®. The She has diverse disciplinary and interdiscipli- nature of the supervision provided as helpful. first survey elicited participants’ understand- nary research collaborations in South Africa, While providing very positive feedback, the ing of compassion (Phase 1: August 2015). Australia, USA, UK and Canada; in sum problem raised by many of the participants After studying the Compassion Module, par- attracting over $1.7 million in collaborative/ related to competing priorities of work and the ticipants completed the second survey (Phase sole funding. Her publication record includes resentment of colleagues not selected for the 2: October 2015). Institutional ethical approval refereed publications, conference papers, books course. was granted. and book chapters. She serves on the Interna- Discussion: The programme met the objective Findings: Findings were analysed thematically. tional Advisory Committee for the International of encouraging participants to register for their Phase 1 generated superficial understandings of Journal of Africa Nursing Sciences (Elsevier). Master’s degree and provided important oppor- compassion as pity, sympathy, concern for the She participated in the Global Advisory Panel on tunities for networking and building the research suffering of others, and being kind to patients. the Future of Nursing meeting in Seoul, South culture. Participants conducted credible Phase 2 findings revealed deeper understand- Korea, June 2015. Dr Hofmeyer was appointed research and their presentations at the national ings of practicing compassion, now including to serve on the Research Scholarship and conference were well-received and resulted in colleagues and self. We present exemplars of Advisory Council for Sigma Theta Tau Interna- several recruits for future programmes. practicing compassion toward patients, col- tional from 2012-2015 and then as Chair from Conclusion: The success of the programme leagues and self and practical strategies used by 2015-2017. results largely from the nature of the group participants to be resilient, compassionate clini- supervision but the cost-effectivity of such cians.

70 09.50 – 10.45 Concurrent session 7 – Friday 87 April 2016 a labour intensive programme needs to be Methods: Adopting a Descriptive Interpretive retical (i.e. beyond the theory of any one disci- assessed. approach (1)ten young people, two carers and pline) dialogue of research in the same way as twelve practitioners were observed and inter- any other profession. However, a search of the Recommended reading list viewed during and after clinic consultations in nursing literature reveals a notable dearth of a hospital setting in 2012. Data were analysed discussion on conceptual frameworks. The lit- Johnson. BJ and Louw, AL . 2014. Building a using ‘Framework’ , a matrix based analysis erature from outside the discipline also suggests Research Culture from Scratch at a University approach(2) that many doctoral students struggle to identify of Technology. Mediterranean Journal of Social how their conceptual framework developed or Sciences. Vol 5 No 1 January 2014. Results: Themes of normalcy, adherence to treatment, emotional labour and the expert that conceptualisation is inadequate. Yet this Jamerson, PA and Vermeersch, P. 2012 The Role patient are revealed. potentially challenging aspect of a PhD thesis is of the Nurse Research Facilitator in Building a fundamental metatheoretical foundation for Conclusions: Reactions to date suggest that Research Capacity in the Clinical Setting. all doctoral studies with nursing as no exception. the poetry is a powerful medium through which Journal of Nursing Administration. January Metatheoretical and foundational because con- to deliver key messages of the research. It can 2012 - Volume 42 - Issue 1 - p 21-27 ceptual frameworks map out and contextualise convey meaning accessibly in a short time span. Begley, C., McCarron M, Huntley-Moore, S, the ontological and epistemological (i.e. philo- Condell, S and Higgins, A. 2013. Success- Implications sophical) assumptions of the research in relation ful research capacity building in academic Poetry as pedagogy can be used to inform evi- to established paradigms of social thought and nursing and midwifery in Ireland: An exemplar, dence-based teaching in nursing programmes concomitant methodological perspectives. In so Nurse Educ. Today (2013), http://dx.doi. and serves as a powerful medium through which doing they shape the research architecture and org/10.1016/j.nedt.2013.09.016 to disseminate doctoral data. design and provide a structure for theorising. This presentation will critically reflect on the Biography Recommended reading list conceptual framework as a metatheoretical foun- Sue Armstrong works at the Department of Thorne, S, Kirkham, S.R. And Macdonald, E.J., dation for nursing doctoral research and inform Nursing Education at the University of the Wit- 1997 Interpretive Description: a non categorical the debate in the following ways. By defining watersrand in South Africa where she is teaching qualitative alternative for developing nursing and explaining the conceptual framework as a and supervising post-graduate nursing students knowledge. Research in Nursing & Health, vol. contested concept. By advancing the conceptual in the fields of nursing education and nursing 20, no.2, pp169-177. framework as an essential tool to assist nursing dynamics. She is also involved with research doctoral students both to understand and engage Ritchie, J. Lewis, J., 2003. eds. Qualitative in nursing education and health systems. with the metatheoretical discourse of other and Research Practice. London: Sage. She advises on quality assurance and nursing all disciplines and to illustrate the social theory matters and is actively involved in promoting dichotomies and points of integration in their Biography nursing education and research in the country. work. By contextualising the various positions Currently works as a senior lecturer in nursing at defined by the different aims, processes, termi- Queen Margaret University Edinburgh, teaching nology and indicators of knowledge in relation across Undergraduate , Masters and Doctorate to competing paradigms of social theory they programmes. Practice work is in respiratory invoke to help methodological precision. Theme: Interviewing nursing, particularly with young people with Cystic fibrosis. Kath is an executive committee Recommended reading list member of the European Cystic Fibrosis Society 7.2.1 Abstract number 329 Durham, W., Sykes, C., Piper, S. (in press) The Nurse Specialist Interest Group, whose remit is language of doctoral research for nursing: con- 9:50am to advance education, research and clinical skills ceptual frameworks and related terminology. for the improvement of cystic fibrosis nursing Nurse Researcher. Disseminating doctoral data and care. She is joint programme leader of the Masters in Professional and Higher Education at through the medium of verse: Biography Getting to the heart of the QMU. Her interest is qualitative research, particularly in relation to the patient experience, Dr Stewart Piper is a Senior Lecturer in the matter and in education to the student experience. Faculty of Health, Social Care and Education Presenter: Dr Kath Macdonald, DH&SSc, at Anglia Ruskin University where he lectures MSc, RGN, PGCE, Senior Lecturer, QMU, primarily on health promotion and public health Edinburgh, UK and the principles of research. His academic and research interests are the relationship 7.2.2 Abstract number 29 Abstract between health promotion theory and both nursing practice and empowerment. He is the Background: Dissemination of research 10:20am author of Health Promotion for Nurses: Theory findings can take many forms, but is usually and practice (published by Routledge) and has through publication in peer-reviewed journals Conceptual frameworks in published a number of articles in peer review and oral and poster presentations at confer- nursing doctoral research journals and book chapters and presented at ences. One of the challenges for the researcher Presenter: Dr Stewart Piper, PhD, MSc, PGDE, various national and international conferences is how to get the message across with maximum RGN, Anglia Ruskin University, Peterborough, on these themes. Health promotion in nursing impact, in a short time frame and poetry is one UK also formed the focus of his PhD studies. Prior way to address this. to becoming an academic Stewart was a Health Aim: The aim of this paper is to share findings Abstract Promotion Specialist and before this he was an from doctoral research through the medium of The international profile of doctoral research Emergency Care Charge Nurse. poetry. The poetry is based on the narratives of in nursing is on the increase and this is helping young people with a long term condition and nursing to be taken seriously as a research based health care professionals and explores their profession in two ways. Firstly, by developing an perceptions of partnership. Findings support evidence base for practice and secondly by dem- advancing knowledge of user experiences of onstrating its ability to engage in the metatheo- health care.

71 709.50 – 10.45 Concurrent session 7 – Friday 8 April 2016 Theme: Focus groups uploads/system/uploads/attachment_data/ Results: Between September and October 2015 file/168220/dh_094051.pdf accessed August focus groups (n=10) were completed with HCAs 7.3.1 Abstract number 27 2015 (n=3), RN (n=2) and mixed (n=5), with a total of 38 staff. Focus groups lasted between 25 to 32 9:50am Ritchie, R. & Spencer, L. (2002) ‘Qualitative Data Analysis for Applied Policy Research’. In: minutes. Emergent themes included: 1) person- centred care, 2) understanding environment Demonstrating the value M. Hubermann, M. & Miles, M. The Qualitative Researcher’s Companion. Thousand Oaks, Cali- changes, 3) need for a change in staff culture, of co-design: a mobile fornia: Sage Publications. and 4) positive and negative elements of envi- application for persons with ronment changes. dementia and their carers Biography Discussion: Person-centred care emerged as a priority over environment changes. Staff Presenter: Miss Siobhan O’Connor, B.Sc., Siobhan O’Connor is a Lecturer in Adult Nursing discussed the importance of a culture shift and CIMA CBA, B.Sc., RN, Lecturer in Adult at the School of Nursing, Midwifery and Social the need to embrace a different approach to Nursing, School of Nursing, Midwifery & Work, University of Manchester. She has a caring. Positive impacts of the dementia friendly Social Work, University of Manchester, Man- multidisciplinary background with honours ward supported this process, such as a cinema chester, UK B.Sc. Nursing and B.Sc. Business Information room, implementation of the care crew and a Co-author(s): Matt-Mouley Bouamrane, UK; Systems from University College Cork, Ireland regular reminiscence activity. Some elements Catherine A O’Donnell, UK; Frances S Mair; and so her research interests like in the field of were disputed as supporting patients, but did UK nursing informatics. She is currently complet- provide the impression of a non-hospital envi- ing her doctorate at the University of Glasgow, ronment. Minor changes to the environment exploring the digital health engagement and Abstract were recommended. recruitment process to person-centred eHealth Background: The Department of Health set technologies. She is a member of the BCS out a national dementia strategy which aims to British Computer Society, the Health Informat- Recommended reading list create services that meet the needs of people ics Society of Ireland (HISI) and the European Dementia Action Alliance (2014) Dementia with dementia and their carers [1]. A digital Federation for Nursing Informatics (EFMI NI). Friendly Hospital Charter http://www.demen- initiative called ‘My House of Memories’ was @shivoconnor https://soconnor.ie tiaaction.org.uk/rightcarecharter launched to involve people with dementia and their carers in the design of a mobile application AnDrew, J. (2013) A guide to creating a dementia that would allow them to share memories. friendly ward. Nursing Times 109(8): 20-12. Aims: The aim of this case study is to explore Cowdell, F. (2010) The care of older people the impact of co-design and the mobile app on 7.3.2 Abstract number 385 with dementia in acute hospitals. International Journal of Older People 5(2): 83-92. participants to demonstrate its value for people 10:20am with dementia and their families. Methods: A focus group with ten people Impact of a dementia friendly Biography involved in the co-design of the ‘My House of ward environment on the Dr Joanne Brooke is a qualified Adult Nurse and Memories’ app as held in March 2015. This Health Psychologist. Joanne has worked across was followed by interviews with the software care nurses provide for specialities in nursing, although has focused on engineer, project manager, and two of the four patients: A qualitative study. stroke and dementia before entering the world dementia patient-carer dyads. Data was themat- Presenter: Dr Joanne Brooke, Professional of research. Joanne has worked as a clinical ically analysed using the framework approach Doctorate in Health Psychology, Registered research nurse within both clinical trials and [2]. Nurse, University of West London, Brentford, long term disease registers prior to commencing Results: Participants in the co-creation UK her own research studies. Joanne has held the workshops benefited directly from the process posts of Senior Lecturer and Nurse Consultant as they took a sense of pride from creating a per- Abstract and is currently an Associate Professor at the University of West London. sonalised piece of technology that would help Background: The Dementia Action Alliance people with dementia. They also learned how (DAA) has launched the ‘Dementia Friendly to use tablet devices and made personal con- Hospital Charter’ (2014). The creation of a nections and friends. Participants also gained dementia friendly ward should help to reduce immense value from using the mobile app in the ‘care burden’ of dementia for staff (AnDrews their daily life as it facilitated communication 2013). Nurses have reported striving to achieve between persons with dementia, their carers and good care, but felt this was not always possible wider family; it stimulated memory and allowed (Cowdell 2010). However, there is a lack of personal histories to be shared; and it acted as a evidence on the impact of ward environment form of entertainment which provided a level of changes on the care nurses provide for patients normalcy to people living with dementia. with dementia. Discussion: Many digital applications are Aim: To explore the impact of dementia friendly generic and co-design offers one way to create environment ward changes for nurses caring for tailored solutions to meet the needs of people patients with dementia. living with dementia. It is hoped this form of Method: Data were collected from healthcare reminiscence therapy will improve patients’ assistants (HCAs) and registered nurses (RN) mood, cognition and functional ability as well as working on elderly care wards within an acute reduce caregiver strain over time. NHS Foundation Trust in the UK. Nurses’ perspectives were explored via focus groups. The Recommended reading list interview schedule was based on information Department of Health (2009) Living well with from a pilot group and previous literature. Data dementia: A National Dementia Strategy. were analysed using Interpretative Phenomeno- Available at: https://www.gov.uk/government/ logical Analysis (IPA).

72 09.50 – 10.45 Concurrent session 7 – Friday 87 April 2016 Theme: Systematic review Recommended reading list Nurses’ careers were conceived as relational but Franks W, Gawn N, Bowden G.(2007) Barriers analysed primarily from a service delivery per- 7.4.1 Abstract number 114 to access to mental health services for migrant spective. The nurse migration concept (Freeman et al. 2012) also conceived nurses’ careers as 9:50am workers, refugees and asylum seekers, Journal of Public Mental Health; vol 6,pp. 33-41 highly relational. Using theories such as motivation, nurses’ careers as human capital are The mental health and primarily viewed from a macro-level perspec- Biography wellbeing of first generation tive. In comparing the literature, there was little migrants: A systematic - I am currently working as Research Fellow at overlap between the two bodies of literature. Queen’s University Belfast, working specifically Driven by national and international nursing narrative review of reviews in the field of migrant health and well-being. I shortages, including migration from countries Presenter: Dr Ciara Close, PhD, Msc,Bsc, completed my PhD in 2014 working on research facing shortages, this paper argues the nursing Queen’s University Belfast, Royal Hospital, related the impact of complementary therapies career concept reflect recruitment and retention Belfast, UK on mental health and pain during pregnancy. imperatives. In the search for solutions to critical Co-author(s): Anne Kouvonen (Finland) Tania I have an extensive background in health nursing shortages, approaches may have inad- Bosqui (Belfast) Kishan Patel (Belfast) Dermot promotion having worked specifically in an vertently constrained theoretical approaches, O’Reilly (Belfast) Michael Donnelly (Belfast) acute hospital as a smoking cessation specialist specifically, individual level of analysis poten- and nutritionist. I also hold an Msc in Health tially important to effective workforce policy and promotion and population health and BSc Abstract practice. honors in Nutrition. Background: There is lack of clarity around the role of migration in the development of men- Recommended reading list tal-ill health. This situation is made additionally Freeman M., Baumann A., Blythe J., Fisher complex given the plethora of reviews on preva- A. and Akhtar-Danesh N. (2012) Migration: a lence/ risk mental-ill health in migrants, and 7.4.2 Abstract number 408 concept analysis from a nursing perspective. associated risk factors. Reviews use different Journal of Advanced Nursing 68 (5), 1176-1186 definitions to describe migrants and report on 10:20am different conditions, which may overwhelm Rafferty, AM., Xyrichis, A. & Caldwell, C. (2015). health professionals and policy makers. Careers in nursing: Post-graduate education and career pathways in nursing: a policy brief. London: King’s College Aim: To systematically review and summarise Individual, organisational London all systematic reviews (SRs) published interna- and international viewpoints tionally on the mental health of first generation Presenter: Ms Jacqueline Fitzgerald, RGN BA Royal College of Nursing (2015) International migrants (FGMs). (Hons) PGCE MSc, Lecturer, Faculty of Health- Recruitment 2015. London: RCN publishing Methods: Five medical and health databases care Sciences, Bangor University, Bangor, UK were searched for SRs which provided quanti- Biography tative data on the occurrence of mental health Abstract Jacqueline is a lecturer at Bangor University. conditions in FGMs and associated risk factors. Drawing on a study that explored the careers Her research interests are in the international Searches were conducted in August 2015. Two of UK-based migrant nurses, this presentation nursing workforce specifically how nurses reviewers conducted databases and screened critically discusses a literature review of careers careers are constructed. papers for suitability. Methodological quality of in nursing, including the national and interna- papers was assessed by AMSTAR. tional workforce policies implications. Results: Seven SRs (Three moderate quality; To address urgent shortages, some countries four low quality) were suitable for inclusion have again turned to international nurse recruit- representing 72,083 migrants. All SRs reported ment (RCN 2015). Longer term, career pathways Theme: Questionnaires that FGMs were at increased risk of at least are argued to be key to self-sustaining nursing one mental health condition including depres- workforce strategies (Rafferty et al. 2015). 7.5.1 Abstract number 248 sion, anxiety, Post-Traumatic Stress Syndrome, Recognised as both individual and relational, 9:50am and Schizophrenia. Decreased social mobility, careers have implications for individuals and migration to a country with a low gross national organisations. In the case of nurses, including product and differing ethnicity to the population migrant nurses, careers also have implications Mouths in care homes - of the host country, all contributed to poorer for health systems. what’s going on in there? mental health in FGMs. The narrative literature review analysed how Presenter: Dr Camille Cronin, PhD, Lecturer, Discussion: The increased risk of mental-ill the careers of nurses were conceptualised. The University of Essex, Southend on sea, UK health in migrants suggests migrants need for review focused on literature published between Co-author(s): Phillip Cannell, UK mental health services is greater than the indig- 1990 and 2014. The relevance of findings of enous population. However, research indicates the review to the careers of migrant nurses as Abstract migrants underutilise mental health services and portrayed in the nurse migration literature was Background: Dental disease, despite being face barriers to treatment (Franks et al.2007). subsequently examined. This suggests that resources may need to be preventable remains a major public health The literature offered a predominantly high directed towards ensuring culturally appropriate problem globally (ICOHIRP 2015). Dementia income country perspective. Reflecting the ‘ordi- mental health treatment for migrants is available in England is estimated at 676,000 people and nariness of the career’ (Cohen and Duberley along with addressing barriers to treatment. expected to double in the next 30 years (Blow 2013 p.165), a common understanding of career and Baker 2015). The cost of dementia to society Conclusion: FGMs are at increased risk of was frequently assumed. The themes of entry, is more than cancer, heart disease and stroke mental ill health and socio-demographic, geo- participation and exit to, or from nursing corre- (DH 2015). Noble et al’s (2013) review of patients graphical and occupational factors were asso- sponded to the stages of health workforce devel- with cognitive impairment had increased risk of ciated with this increase. Findings may enable opment (WHO 2006). oral health problems than their older counter- improved public health responses to suit the parts’ not suffering dementia with medication, needs of changing populations.

73 709.50 – 10.45 Concurrent session 7 – Friday 8 April 2016 care dependency and restraining behaviour as 7.5.2 Abstract number 361 Recommended reading list contributing factors. 10:20am catania, G. (2015) ‘Effectiveness of complex Methods: We investigated care homes’ assess- interventions focused on quality-of-life assessment of mouth care provision. A survey was ment to improve palliative care patients’ conducted in June 2015 where 68 care homes Knowledge of palliative care outcomes: a systematic review.’ Palliative were recruited purposively. A questionnaire was staff about quality of life Medicine, 29, 1, pp 5-21. emailed to the manager of care homes across one assessement in palliative campbell, M. (2000) ‘Framework for design and unitary local authority and data was analyzed care: a descriptive study evaluation of complex interventions to improve using Microsoft Excel. Presenter: Professor Gianluca Catania, Nurse, health.’ BMJ, 321,7262, pp 694-696. Results: Twenty-eight care homes responded Department of Health Sciences gaining a 41% response rate. There is some University of Genoa, Genoa, Italy Biography record of mouth care (71%), 57% record mouth Gianluca Catania (PhD, RN): researcher at care on admission. Patients continue with their Co-author(s): Fiona Timmins, Ireland; University of Genoa - Department of Health dentists when moving in to a care home (68%, Annamaria Bagnasco, Italy; Giuseppe Aleo, Sciences (Italy). n=19 homes), yet 50% do not get support from Italy; Milko Zanini, Italy; Silvia La Placa, Italy the dentists in their care home. Homes report and Loredana Sasso, Italy His research interests are in the areas of pallia- not receiving any formal training, and 79% tive care, quality of life, nursing science and vali- having no training in mouth care in the last Abstract dation studies year. Most report denture care (96%) and 54% Background: Assessment of quality of life of Participation, as an invited speaker or with oral assess patients’ oral hygiene twice a day. Identi- patients with palliative care needs is crucial to and poster presentations, at numerous con- fied challenges include dementia care, refusal of understand patients’ needs, their experiences, gresses both nationally and internationally in mouth care, lack of understanding and difficul- and effectiveness of interventions. Knowledge the field of nursing science and cancer and pal- ties in accessing dental services. of the staff regarding quality of life assessment liative care. Conclusions: Clear guidance on oral health in palliative care has not been widely tested yet. Winner of grants for palliative care and nursing assessment is required for care homes as Aims: The purpose of this study was to identify science studies. older people have a higher risk of oral disease the level of knowledge among palliative care Member of nursing societies, both national and impacting their quality of life. Dental services staff in Italy regarding the quality of life assess- international, in the field of cancer and palliative will need to adapt to an increasingly older popu- ment in palliative care. nursing (ONS, EONS, HPNA, AIIAO, SICP) lation through the use of greater skill mix in Methods: A descriptive cross-sectional survey 2007-2012 Regional Project Manager of dental teams and the need to explore new ways design involving two hospice units in Italy was Ligurian Region Study ‘Experimental evalua- of commissioning dental care services for vul- used. tion of the effectiveness of quality programs to nerable groups. Forty-three healthcare professionals from two improve pain management in cancer patients hospice units were invited to participate in the admitted in different hospital wards’. Funded by Recommended reading list study through email and directed to the survey National Health Minister Blow E, Baker C (2015) Dementia: Statistics on website. Referee for Journal of Supportive Care in Cancer prevalence and improving diagnosis, care and Questionnaires included a demographic ques- and BMC Nursing research. Briefing paper no 07007, House of tionnaire and the INFO-QoL questionnaire. Commons Library: London The INFO-QoL questionnaire is a new content Department of Health (2015) Prime Minister’s validated questionnaire for assessment of Challenge on dementia 2020, February, p10. knowledge among palliative care staff regarding DH: London the quality of life assessment in palliative care. Theme: Interviewing The Improving Oral Health in Older Persons Ini- Results: To date 32 professionals agreeing tiative (IOHOPI) (2015) Oral Health Inequali- to participate and 27 of them completed the 7.6.1 Abstract number 403 ties. British Dental Journal, vol 218, no6, p323 questionnaire. Preliminary results showed that 9:50am among the 17 knowledge questions assessed, the Biography mean number of correctly answered questions ‘Voices from the silence’: a Camille Cronin (PhD, MEd, MSc, BSc (Hons), was 12 (SD=4.8) with a range from 9 to 15. The RN) is a lecturer in the School of Health and correct answer rate for the entire questionnaire, qualitative study giving voice Human Sciences at the Southend Campus and on average, was 72% (SD=24.9). Further analysis to adults with intellectual contributes to teaching across programmes. Her of items revealed that four questions had a mean disabilities and experience of nursing career spans through clinical practice, score of correct answer lower than 50%. mental health needs. clinical and academic research and healthcare Discussion: Preliminary results showed that Presenter: Dr Paul Sutton, RMN, RNLD, BA, management. Her research interests include staff had a fair knowledge about quality of life MSc, PhD, Research Associate, University of lifelong learning, workplace learning, learning assessment. The knowledge was low on timing West London, London, UK environments, workforce issues and qualitative of quality of life assessment and issues related methodologies. to reliability and validity of quality of life tools. Abstract Conclusions: From these results, we conclude Background: Mental health needs are more that there are significant knowledge deficits that prevalent in people with intellectual disabilities may hamper quality of life assessment in pallia- than in the general population, with practically tive care settings. Our results may inform stake- all categories of mental illness represented. The holders on reinforcing outcome measurements literature, however, indicates that the viewpoints issues in palliative care. of people with intellectual disabilities who have experienced concomitant mental health needs have received minimal exploration.

74 09.50 – 10.45 Concurrent session 7 – Friday 87 April 2016 Research Aim: The primary aim of this to people with intellectual/learning disabilities, Recommended reading list research project was to investigate the experi- psycho-social studies, service user involvement Egerod, .I Storli, S,L. Åkerman E. (2011) ence of mental health needs from the individual in person-centred planning, education and Intensive care patient diaries in Scandinavia: a perspectives of adults with intellectual disabili- training of carers, and spirituality. comparative study of emergence and evolution ties. Nursing Inquiry. 18, 3. pp 235 - 246 Methods: A major focus of the study involved Braun, V. Clarke, V. (2006) ‘Using thematic adapting the psycho-social conception of sub- analysis in psychology’. Qualitative Research in jectivity and methodological framework, which 7.6.2 Abstract number 410 Psychology. 3, 2, pp 77 - 101 has been developed by Hollway and Jefferson (2000,2013), and employing this as a means 10:20am Biography of enabling the inclusion and participation of people with intellectual disabilities in knowledge Corrienne is currently undertaking a PhD part Experiences of family time at the University of Edinburgh as part of production concerning their care and support members with critical care needs. Data production was based on case a Clinical Academic Research Career Scholar- studies of seven service users who have mani- diaries in an intensive care ship with NHS Lothian and the University of fested mental health issues. Methods for data unit Edinburgh. Continuing to work as a critical care research nurse Corrienne has been involved production included ‘free association narrative Presenter: Miss Corrienne McCulloch, BSc in various types of research. Corrienne would interviews’, an examination of relevant case (Hons), Senior Practitioner (Clinical Research), like to continue to develop her skills as a nurse records, and information provided by key care NHS Lothian/ University of Edinburgh, researcher in the area of critical care with her staff. Data analysis involved working with the Edinburgh, UK whole of the material gained during fieldwork, main interests around patient and family experience. and paying attention to links and inconsistencies Abstract within that whole. Background: Diaries are currently used in Results: Information elicited from the research some intensive care units (ICUs) across Europe participants reflected the various traumatic/ and the UK to help patients and family members life events in their individual biographies, and come to terms with the experience of critical Theme: Research issues advancement in the recognition of the emotional illness, providing an account of when the patient needs of people with intellectual disabilities. was in ICU (Egerod, et al 2011). Started in the 7.7.1 Abstract number 321 Experiential data obtained from the participants ICU, the diary is co-created by nurses and family have also contributed to the proposed develop- members, yet research has mainly focused on the 9:50am ment of a theoretical model regarding psycho- diary being used after ICU as an aid to recovery. social subjectivity within the field of Intellectual Aims: This presentation provides an insight Using dyadic data analysis: Disabilities. into family members’ experiences by Drawing the challenges and Discussion: The psycho-social approach on findings from a PhD study exploring the per- opportunities to help improve employed in this project was shown to provide spectives and experiences of patient’s, nurse’s patient and family-caregiver an innovative and effective means of addressing and family member’s use of critical care diaries. the power asymmetry between the researcher outcomes in cardiovascular Methods: Data were collected from February and research participants. disease 2013 to June 2014 using semi-structured inter- Conclusion: Some findings resonate with views with family members (n=6), patients (n=4) Presenter: Dr Patricia Thomson, PhD, MPH, those from previous studies, and have potential and nurses (n=6). Participants were purposively MA, RN, RNT, Senior Lecturer, School of implications for policy makers, service providers sampled in the ICU as a triad. Interviews were Health Sciences, University of Stirling, Stirling, and service users. supplemented with field notes and photographs UK of diary entries. Family members and nurses Co-author(s): Kate Howie, Scotland, UK Recommended reading list were interviewed around the time the patient Hollway, W. and Jefferson, T. (2000) Doing was in ICU and patients were interviewed Abstract between 3 and 6 months post ICU discharge. qualitative research differently, SAGE Publica- Introduction: The statistical analysis of data Transcribed data was analysed using a thematic tions Ltd. : London from pairs such as the patient-family caregiver approach (Braun & Clarke 2006). Hollway, W. and Jefferson, T. (2013) Doing is called dyadic analysis. The pair (or dyad) qualitative research differently - A Psychosocial Results: Key findings for family members is considered a fundamental unit of interper- Approach, SAGE Publications Ltd. : London revealed that the diary was being used in a sonal interaction and relations. Interpersonal number of ways for support during the time in phenomena such as caring and influence have Biography ICU. For example family members referred to often been studied by examining the patient’s the diary for information, used the diary as a way or caregiver’s perspectives in isolation but this Dr Paul Sutton is a Research Associate, Univer- to communicate with their loved one and expe- provides limited understanding of the processes sity of West London. He has held a variety of rienced emotional support from using the diary. that takes place among dyads. Dyadic data posts within the field of Intellectual/Learning analysis allows for the assessment and testing Disabilities for around three decades. During the Discussion and Conclusion: Exploring the of dependency. This is important in terms of early years of his career, he worked as a practi- use of diaries from multiple perspectives is a helping improve patient outcomes and the tioner and a service manager in a range of health unique feature of this research. For the purpose health-related concerns of carers. care settings in England, and in Canada. He sub- of this presentation the focus will be on family sequently moved into higher education where he members, providing valuable insight into how Aim of paper: This paper will present a critical was involved in the delivery and coordination of the diary is used during the time in ICU and analysis of the methodological challenges of con- undergraduate, professional preparation, and highlighting the potential diaries may have in ducting dyadic data analysis and the potential continuing development programmes. In recent supporting family members during this difficult of this innovative research approach to help years, Paul completed studies for a Doctorate at time. improved patient-family caregiver outcomes in the University of Portsmouth. His main research cardiovascular disease. It will promote scholarly interests include; mental health needs in relation debate of the methodological issues involved in

75 709.50 – 10.45 Concurrent session 7 – Friday 8 April 2016 examining the ‘dyad’ as a unit of analysis. It will Theme: Workforce/employment issues during nursing students’ clinical placements, is also discuss the challenges of recruitment, data unclear. The study will make an early, evidence- collection and analysis. 7.8.1 Abstract number 204 based contribution to political, educational and academic debates, surrounding the issue and Methods: Multi-level dyadic modelling, the 9:50am Actor-Partner Interdependence Model (APIM) impact of PCE, upon caring and compassion in nursing. (Kenny et al, 2006), will be critically discussed. Help, hindrance or In this model, a paired regression technique allows investigation of the relationships within indifference? The impact Recommended reading list pairs. For example, the patient-family caregiver of care experience prior to Department of Health (2012). Compassion in predictor variables may be regressed on the commencing nurse training, practice: nursing, midwifery and care staff. Our patient-family caregiver outcome variables in a on caring and compassionate vision and strategy. London: The Stationary single regression model. The advantage of using practice. Office. the APIM is that it provides better insight into Department of Health. (2013). Delivering high dyadic dynamics by taking both the individual Presenter: Ms Sarah Field-Richards, RN, quality, effective, compassionate care. Devel- and the partner contribution into account. MNurSci (Hons), Research Fellow, University of Nottingham, Nottingham, UK oping the right people with the right skills and Discussion: previous studies of dyadic analysis right values. A mandate from the government to Co-author(s): Joanne Lymn, England; Patrick conducted by the authors (Thomson et al 2012) Health Education England: April 2013 to March Callaghan, England; Helen Spiby, England; will be used to illustrate the advantages of using 2015. London: The St this analytical approach over research that has Gemma Stacy, England; Philip Keeley, Francis, R. (2013). Report of the mid stafford- simply included patients and family caregivers England; Sarah Redsell, England; Sharon shire NHS foundation trust public inquiry. as separate entities. The implications for future Andrew, England London: The Stationery office. research and the design of interventions that target the dyad to help improve patient-family Abstract Biography caregiver outcomes will be debated. Background: Identification of failings in nursing care quality led Francis (2013) to Sarah Field-Richards is a Registered Nurse Recommended reading list recommend that care experience should form a and PhD student at the University of Notting- ham. She is also a Research Fellow working on Kenny DA, Kashy DA, Cook WL (2006) Dyadic prerequisite for entry into nurse training. Reit- a Department of Health funded Policy Research Data Analysis. New York, Guilford Press. erating this as a potential means of fostering values conducive to compassionate care, the Programme grant, which aims to explore the Thomson P. Molloy GJ, Chung ML et al. Department of Health (DH) (2013) introduced impact of care experience prior to undertaking (2012) The effects of perceived social support a pilot programme, providing individuals with nurse training, on student nurses’ caring and on quality of life in patients awaiting coronary NHS care experience prior to commencing compassionate skills, values and behaviours. artery bypass grafting and their partners: testing nurse training. There is however little evidence This four-year longitudinal study investigates dyadic dynamics using the Actor-Partner Inter- regarding the impact of prior care experience the experiences of individuals involved in a dependence Model. Psychol (PCE) (pilot-derived or otherwise), on the subse- Department of Health prior care experience quent development of students’ caring and com- pilot project. It also explores the relationship Biography passionate values and behaviours. The appropri- between having undertaken prior care experi- Registered nurse. Senior lecturer and researcher. ateness and effectiveness of the Government’s ence, or not, and proxy measures of the 6Cs, Interest in cardiovascular research with patients response, as a means of addressing concerns amongst student nurses who commenced their and family caregivers. raised by Francis (2013), is therefore unknown. studies in 2015. Today, Sarah will be presenting some early findings from this research. Aim: To explore perceptions and experiences of the impact of PCE, on aspects of caring and compassionate practice. Methods: Semi-structured telephone interviews with eight purposively sampled DH pilot 7.8.2 Abstract number 148 participants (October 2015). Interviews were 10:20am audio-recorded, transcribed verbatim and thematically analysed. The values and behaviours The craft of academic life: defining the 6Cs (DH, 2012) were employed aposteriori as an analytical framework. A challenge for early career Results: Preliminary analysis has identified nurse academics positive, negative, actual and potential impacts Presenter: Professor Elizabeth Halcomb, of PCE on care, compassion, competence, com- RN BN(Hons) PhD FACN, Professor of munication, courage and commitment. The Primary Health Care Nursing/Editor, Nurse nature and discrete characteristics of PCE Researcher, University of Wollongong, Wol- appear influential in determining perceptions of longong, Australia impact. Co-author(s): Associate Professor Kath Peters, Discussion and Conclusions: Early insights Australia; Professor Debra Jackson, UK of this research suggest that PCE can be understood as both a help and hindrance, in the Abstract context of fostering aspects of compassionate Introduction: The existing literature about new care. The study identifies critical implications for academic staff highlights the substantial difficul- future research, including, that caution should ties for those transitioning into new academic be exercised in approaching and evaluating roles (McDermid et al. 2012). In practice-based PCE as a homogenous phenomenon. The extent disciplines such as nursing, recruitment of clini- to which benefits can be ascribed uniquely to cians into academia is common. However, clini- PCE per se, or whether they materialise equally cians are often accustomed to being experts in

76 09.50 – 10.45 Concurrent session 7 – Friday 87 April 2016 their field and are then positioned as novices in Professor Halcomb leads a strong research academia. The disparities between clinical and program in primary care nursing, with particular academic environments also pose unique chal- emphasis on nursing in general practice, chronic lenges for new faculty (Cleary et al. 2011) and disease and nursing workforce issues. She these challenges may inhibit them from pro- also undertakes research around learning and gressing their academic careers (Jackson et al. teaching in nursing, academic workforce devel- 2011). This paper stems from a larger project opment and research methodology. Professor that aimed to enhance leadership capacity in Halcomb has particular interests in mixed Early Career Nurse Academics (ECNA) and methods research and evidence based practice. explore strategies employed by ECNAs and their Professor Halcomb has attracted over $1.9 mentors to support for the career progression. million in research funding, with over $610,000 Methods: Two large Australian Schools of as the first named Chief Investigator. She has Nursing participated in the project. Data were a strong track record of publication, with over collected from early career nurse academics and 95 peer reviewed papers and 12 book chapters. their mentors via semi-structured interviews. Currently, Professor Halcomb is an Editor of Interviews were digitally recorded, transcribed Collegian - The Australian Journal of Nursing and thematically analysed. Practice, Scholarship & Research, an Associate Results: 17 ECNA’s and 16 mentors partici- Editor of BMC Family Practice and member of pated. Four major themes emerged from the the Editorial Board of the Australian Journal of data: Having a vision for the possibilities, Primary Health Care. In 2014 she was appointed Being able to manage the busyness, Avoiding Editor of Nurse Researcher. getting stuck (keeping moving) and, Recognis- ing sources of help and support. As most ECNAs were recruited from a structured clinical environment, they struggled to manage the less- structured and multi-faceted nature of academia. They encountered difficulties with time management and required support from managers and mentors to facilitate career planning and workload management. Conclusion: Discussions within nursing faculty are required to determine what is crucial to the academic role as opposed to what is seemingly most valued. Such discussions should encourage ECNAs to learn the full craft of academia rather engaging in career development at a superficial level using a check list approach to fulfilling promotion requirements.

Recommended reading list Cleary, M., Horsfall, J., & Jackson, D. (2011). Mental Health Nursing: Transitions from practice roles to academia. Perspectives in Psy- chiatric Care, vol 47, no 2, pp 93-97. Jackson, D., Peters, K., AnDrew, S., Salamon- son, Y., & Halcomb, E. J. (2011). ‘If you haven’t got a PhD, you’re not going to get a job’: the PhD as a hurdle to continuing academic employment in nursing. Nurse Education Today, vol 31, no 4, pp 340-344. McDermid, F., Peters, K., Jackson, D., & Daly, J. (2012). Factors contributing to the shortage of nurse faculty: A review of the literature. Nurse Education Today, vol 32, no 5, pp 565-569.

Biography Professor Elizabeth Halcomb is Professor of Primary Health Care Nursing at the University of Wollongong, Australia. She is an experienced academic nurse leader who is committed to developing researchers in both academia and the clinical setting. In addition to being an active supervisor of Bachelors (Honours) and Higher Degree research students Professor Halcomb teaches into the postgraduate coursework programs.

77 811.15 – 12.40 Concurrent session 8 – Friday 8 April 2016 Concurrent session 8 Friday 8 April 11.15 – 11.40

Theme: Mixed methods Conclusions: Insights generated from the potentially lead to improved health and care findings will provide a better understanding of system level outcomes. 8.1.1 Abstract number 305 the challenges faced by nursing now. This will be Aim: The aim is to develop a framework of what essential in guiding how to improve and support 11:15am is important relationally for a ‘successful’ elderly future relational nursing care practices. extra-care housing (ECH) facility (Riseborough Relational capacity of and Fletcher 2008,) and then develop a series of Recommended reading list nursing teams: exploring the questions developed from the research, to check Bridges J, Nicholson C, Maben J, Pope C, Flatley the extent to which the behaviours are present. relationship between team M, Wilkinson C, Meyer J and Tziggili M (2013) Methods: Using Q Methodology (Stephenson context, relational capacity Capacity for care: meta-ethnography of acute 1953), fifty research derived statements were and caring practices care nurses’ experiences of the nurse-patient presented to a cohort of forty people, including Presenter: Paula Libberton, Faculty of Health relationship. Journal of Advanced Nursing residents, staff and wider stakeholders in an Sciences, University of Southampton, South- 69(4): 760-72 elderly ECH environment. Semi structured ampton, UK Department of Health (2014) Hard Truths. The interviews were conducted with each individual as they ‘sorted’ the statements. In addition, Co-author(s): Dr Lisa Gould, UK, Hannah journey to putting patients first. The Stationary demographic data was collected and residents Barker, UK, Dr Ines Mesa, UK, Professor Peter Office, London. completed the Older People’s Quality of Life Griffiths, UK, Professor Jackie Bridges, UK Maben J, Adams M, Peccei R, Murrells T and questionnaire (OPQOL-brief). Robert G (2012) ‘Poppets and parcels’: the links Abstract between staff experience of work and acutely ill Results: Patterns have emerged from the Q sort, older peoples’ experience of hospital care. Inter- showing the distribution of the responses (most Background: There is consensus that older national Journal of Older People Nursing 7(2): to least important). These have been examined people in hospital do not consistently experi- 83-94 alongside the analysis of the semi structured ence nursing care as compassionate (DH 2014). interviews and other collected data. The results Strong evidence exists that the characteris- have informed the development of a behaviour tics of the work setting at ward level are a key Biography based questionnaire to assess the presence in the determinant of whether or not nurses are able Paula is a Lecturer in Nursing with a back- system of the relational attributes that the stake- to enact their caring role (Bridges et al 2013). ground in mental health. Paula has over 15 holders had identified as most important. Characteristics such as: staffing levels; skillmix; years experience in higher education. Paula has ward climate; time; self-compassion; empathy; led a number of initiatives aimed at improving Discussions: A worldwide ageing population and resilience have been suggested as influenc- practice learning environments. More recently, and recent reports of poor quality residential ing factors on the capacity of nurses to engage Paula has devoted time to exploring relational care (CQC 2015) demonstrates the need for high in relational work (Maben et al 2012). There is nursing care in general hospital settings. Paula quality facilities that meet the needs of a diverse limited evidence of the relationship between believes that an effective interface between range of residents. Using relational health as a these factors, nursing staff perceptions of their education, research and practice is the way to benchmark is one way of achieving this relational capacity and caring practices. improve patient outcomes. Involvement in the Conclusions: The findings are influencing Aim: To explore the relationships between research presented has provided the opportunity the organisational design and performance of a nurses’ caring practices, ward-level organisa- to realise this ambition. further five planned ECH facilities and are being tion and perceptions of relational capacity on six explored for further research in other environ- acute wards in two UK general hospitals. ments. Methods: Qualitative interviews with nursing Recommended reading list staff, patients and visitors over an 8 month 8.1.2 Abstract number 302 period focusing on their perceptions of compas- Stephenson, W. (1953) ‘The study of behavior; sionate care on the ward and relational capacity 11:45am Q-technique and its methodology.’ University of of the ward team. Questionnaires adminis- Chicago Press. ix 376 pp. Exploring the role of tered to all nurses and care assistants: Maslach Riseborough, M., Fletcher, P. (2008) Extra Care Burnout Inventory; Jefferson Scale of Empathy; relational value in health and Housing - what is it? CSIP Networks, London and Climate for Care. Patients administered the care in an extra care housing Care Quality Commission (2015). The state of Patient Evaluation of Emotional Care During environment health care and adult social care in England Hospitalisation (PEECH) survey and visitors the Presenter: Dr Elaine McNichol, Phd, Univer- 2014/15. Newcastle Carers Evaluation of Care. Data gathered in 2015 sity of Leeds, Leeds, UK as part of a wider feasibility study on a compas- Biography sionate care intervention. Analysis of qualitative data using a constant comparative method Abstract I am a registered mental health nurse with expe- aiming to explore associations. Triangulation of Background: Human relationships are rience of working in the NHS, as a freelance findings from different datasets to enable com- increasingly recognised as an important facet consultant and within Higher Education. I parisons and explanations to emerge. within health and social care systems, eg: Mid am currently academic lead for service user and carer involvement and am involved in a Results: Data are being analysed at time of sub- Staffordshire. This research explores a number number of funded studies developing a patient mission and will be available for presentation at of relational attributes, focussing on integrity, led approach to service and product innovation, the conference. respect, fairness, empathy and trust and seeks to establish which potential behaviours, activi- working with both the NHS and health technol- ties and processes support these attributes and ogy organisations.

78 11.15 – 12.40 Concurrent session 8 – Friday 88 April 2016 8.1.3 Abstract number 314 Recommended reading list tively from 3 different intakes at different stages of their programme using end of term narra- 12:15pm Bridges, J. Flatley, M. & Meyer, J. 2010. Older people’s and relatives’ experiences in acute tives, presentations and workplace evaluations. care settings: Systematic review and synthesis All data was analysed by the course team. Quantity and quality of of qualitative studies. International Journal of Results: Qualitative data from 57 students interaction between staff and Nursing Studies, 47, pp.89-107. revealed a mixture of responses: ‘they have older patients in UK hospital Reader, T.W. & Gillespie, A. 2013. Patient no time for me at work’, ‘I’m on long days and wards: a descriptive study neglect in healthcare institutions: a system- its hard to fit in study’, ‘they won’t have Band Presenter: Miss Hannah Barker, BN, MSc atic review and conceptual model. BMC health 4 jobs when I finish’, ‘my confidence is like a Public Health Distinction, University of South- services research, 13(156), pp.1-15. roller coaster ride’, ‘it’s so busy there is no time to do my skills book’, ‘my supervisor has many ampton, Southampton, UK Dean, R. Proudfoot, R. & Lindesay, J. 1993. The students and student nurses get priority’, ‘I quality of interactions schedule (QUIS): devel- Co-author(s): Professor Peter Giffiths, Ines am really enjoying learning again and wished I opment, reliability and use in the evaluation Mesa-Eguiagaray, Dr Lisa Gould, Professor started earlier’, ‘I want to understand what I do of two domus units. International Journal of Jackie Bridges at work’. Geriatric Psychiatry, 8, pp. 819-826. Conclusions: Misunderstanding the AP role is Abstract common and lack of clarity in planning for the Biography Background: The quality of interactions AP role. Supervisors have less time to support between hospital patients and staff is key to I graduated with a Bachelor of Nursing Adult learning in the workplace. The AP has a greater shaping experiences during their stay (Bridges Branch degree from the University of Southamp- input into a patient’s treatment with Spilsbury et et al. 2010). Analyses of UK and international ton in 2011. From here I gained 2 jobs working al (2010) identifying up to 61% were either doing care failures indicate that low frequency and as a frontline band 5 staff nurse, I spent one written or oral reports and 30% were involved quality staff-patient interactions can undermine year working in a respiratory/cardio ward and in multi-disciplinary team meetings. Economic quality of care and patient experiences (Reader one year working in a neuroscience intensive Drivers within healthcare are encouraging a & Gillespie 2013). However no studies have care unit. I then read a masters (MSc) in Public dilution of traditional roles and new models of comprehensively explored both the quality Health with the Faculty of Medicine at the Uni- working involving APs are evolving and quantity of interactions in general hospital versity of Southampton, I was drawn to the idea of preventative health care as a way of lessening settings. Recommended reading list Aims & Objectives: To identify the frequency the burden of ill health that is placed on the NHS. During this course I realised that I had a RCN (2015) Become an assistant practitioner, and length of staff-patient interactions, to char- www.rcn.org.uk, [Accessed 13 November 2015]. acterise the quality of staff-patient interactions passion for research. So when I finished the MSc and to identify associations between negative I applied for a job involving research into the Wheeler I (2015) Drivers and barriers for the ratings and patient, observation and interaction delivery of compassionate care in hospitals. It continued development of Assistant Practition- characteristics. brought together my experience of nursing and ers roles, Skills for Health: London. my passion for research. I got the job and I’m Spilsbury, K, Bloor, K, Bartlett, V. (2010) Methods: Managers of six out of seven invited still working there now and love it. wards with high proportion of older inpatients in Assistant practitioners: identity, responsibilities two English acute NHS hospitals agreed to par- and development. www.rcn.org.uk. [Accessed 13 ticipate. Included wards were medicine for older November. 2015]. people (n=4), urology (n=1) and orthopedics (n=1). Eligible patients were randomly sampled, Biography Theme: Documentary research recruited and observed. Ten two-hour observa- Camille Cronin (PhD, MEd, MSc, BSc (Hons), tion sessions per ward were conducted Monday- 8.2.1 Abstract number 259 RN) is a lecturer in the School of Health and Friday, 08:00-22:00 hrs in March/April 2015. Human Sciences at the Southend Campus and Researchers used the Quality of Interaction 11:15am contributes to teaching across programmes. Schedule (QuIS) to rate each staff-patient inter- Her nursing career spans through clinical action as positive, neutral or negative (Dean et The journey to Assistant practice, clinical and academic research and al. 1993). practitioner healthcare management. Her research interests Results: 133 patients were observed during include lifelong learning, learning environ- Presenter: Dr Camille Cronin, PhD, Lecturer, 1554 interactions over 120 hours of planned ments, workforce issues including the role of the University of Essex, Southend on sea, UK observation. An average of six interactions per assistant practitioner and qualitative method- patient per hour were observed. The average Co-author(s): Leigh O’Shea ologies. length of interaction was 101 seconds with 64% lasting <60 seconds. 73% of interactions were Abstract categorised as positive, 17% as neutral and 10% Background: Assistant Practitioners (APs) as negative. Type of care made a difference to have been contributing to the health care the likelihood of a negative interaction, with workforce for some time. They work to a level communication and personal care tasks more above that of a health care assistant (HCA), likely to be rated negatively (OR [95%CI]: 2.71 working under the supervision of a nurse (RCN [1.25,5.90] and 4.24 [1.88,9.53] respectively). 2015). They make up 40% (789,600) of the UK Conclusion: While a high proportion of inter- total workforce where 14,000 are APs (Skills actions were positive, the findings indicate that for Health 2015). The most common route to there is scope for increasing the amount of staff- become an AP is to complete a 2-year foundation patient contact and for further improving the degree in health care, which involves a combina- quality of interactions. tion of study and supervised practice. Methods: Through the collection of course and workplace documentation we investigated APs’ workplace journey. Data was collected prospec-

79 811.15 – 12.40 Concurrent session 8 – Friday 8 April 2016 8.2.2 Abstract number 122 Recommended reading list Results: Trend analysis reveals a transformation of the Spanish health system reducing 11:45am Hochschild AR (1983) The Managed Heart: The Commercialisation of Human Feeling. the number of nurses per capita from 2010. Berkeley:University of California Press. Moreover, reductions in public spending, labour Learning lessons from patient market reforms and widespread unemploy- Scottish Health Council (2009) Making it complaints relating to staff ment have particularly affected nurses in two Better: Complaints and Feedback from Patients ways: increasing the number of job applicants attitudes, behaviour and and Carers about NHS Services in Scotland. for per vacancy between 2009 and 2013, and communication using the Glasgow: Scottish Health Council. the increasing the number of casual positions. concept of emotional labour Taylor D, Wolfe R and Cameron A (2002) Com- Despite the poor job market and decreasing Presenter: Dr Rhona Hogg, RGN HV Cert, BSc, plaints from emergency department patients job security, the number of registered nurses PhD, Clinical Nurse Lead - Applied R&D, NHS largely result from treatment and communica- and nursing graduates in Spain per year has Greater Glasgow and Clyde, Edinburgh, UK tion problems. Emergency Medicine 14, 43-49. continued to grow. Co-author(s): Janet Hanley, Scotland Discussion: With its low birth rate, increased Biography life expectancy and increasing chronic disease, it Abstract After many years of health visiting, I undertook a is critical for Spain to have sufficient nurses now Background: Recent high profile UK enquiries Research Training Fellowship from 1996 - 1998 and into the future. Spain produces nurses, but highlight the need to learn lessons from patient at the University of Edinburgh, funded jointly the inability of the system to employ them has complaints. The most common focus of com- by the Scottish Government and NHS Lothian. led to an increase of migration since 2010. plaints both locally and internationally is I then worked part time as research lead for Conclusions: Spain is becoming a producer staff attitudes, behaviour and communication community nursing and part-time as a health of nurses for foreign markets, principally in (Scottish Health Council 2009, Taylor 2002). visitor until 2009 when I was seconded for a year Europe. It is critical that there be an increased This presentation reports on a study which origi- to work as a community nursing research lead understanding of this phenomenon by Spanish nated in concerns about rising numbers of com- in Kampala, Uganda. I worked with community policy makers, health service providers and plaints in a Scottish Health Board from patients nursing colleagues in an HIV/AIDS organisation educators in order for Spain to develop HHR and their families concerning these areas. to demonstrate the effectiveness of their nurse policy that adDresses the health care needs of -led model of care. On returning to Scotland Aims: 1. To identify and explore patients’ per- the Spanish population. I worked within the newly set up Edinburgh ceptions of good and poor care relating to com- Health Services Research Unit before moving in munication, attitudes and behaviour. Biography 2013 to my current post leading the implemen- 2. To explore how these aspectsof care can be tation of the NHS Greater Glasgow and Clyde Professor Sioban Nelson is the Vice Provost recognised and improved, using the concept Nursing and Midwifery Research Strategy. Academic Programs and Faculty and Academic of emotional labour as a framework (Hoschild Life at the University of Toronto. The former 1983). Dean of Nursing at UofT, Sioban is the author of three books and six edited volumes, including Methods: Fifty randomly selected letters of the acclaimed ‘Say little do much’: Nursing, complaint to one Scottish health board during 8.2.3 Abstract number 257 Nuns and Hospitals in the Nineteenth Century January - June 2011, which related to communi- (University of Pennsylvania Press, 2001) and cation and/ or staff attitudes or behaviours, were 12:15pm the prize-winning Complexities of Care: Nursing analysed thematically. Spanish nursing migration Reconsidered (co-edited, with Suzanne Gordon, Findings: Patients come to healthcare encoun- Cornell University Press, 2006). Her most recent ters with expectations of kind and compas- since the crisis work is a coauthored book (Nelson, Tassone and sionate care. The care they receive affects their Presenter: Professor Sioban Nelson, PhD, RN, Hodges, Cornell 2014) on Interprofessional emotional wellbeing and how they anticipate University of Toronto, Toronto, CA education and practice, ‘Creating the healthcare future health care encounters. Some staff appear Co-author(s): Paola Galbany Estragues, Spain team of the future’. Sioban is currently working calm and kind in a busy environment where on a history of nursing mobility and a series of others present themselves as harassed and projects on nursing in Spain. uncaring. Abstract Dr. Paola Galbany Estragues is a Post-doctoral Background: After the financial crisis of 2008, Discussion: It is important that healthcare Fellow at the University of Toronto. She is a increasing numbers of Spanish nurses are going workers, managers and professional leaders Senior Lecturer in the Department of Nursing, abroad to work. Little is known about this phe- understand and recognise the emotional labour Universitat Autanoma de Barcelona, Spain. associated with displaying good attitudes, nomenon and its impact on Spanish Health behaviour and communication with patients, Human Resources (HHR). rather than this important component of health- Objectives: To examine Spanish nursing care remaining invisible. The target driven migration between 2010 and 2014. culture and consumerist perspective encour- Design: Review of Spanish and European aged among patients mitigate against the softer mobility and HHR data. aspects of care, but this can be overcome by Data sources: We examined data published leaders who demonstrate a person- centred, from Health Statistics, Organization for caring approach to patients and staff. Economic Cooperation and Development Conclusion: This presentation will demon- (OECD) (1996 to 2013), and European directives strate how a framework based on emotional concerning mobility. Spanish sources include labour can be used to make visible and improve Ministry of Education, Culture and Sports (1995 staff attitudes, behaviour and communication in to 2014), Ministry of Employment and Social the healthcare setting. Security (2009 to 2014), Ministry of Health, Social Services and Equality (1997 to 2014), and Statistics National Institute (1977 to 2014).

80 11.15 – 12.40 Concurrent session 8 – Friday 88 April 2016 Theme: Research issues Birks, M (2014) Practical philosophy. In Mills, J. and human agency. Some argue there is an Birks, M. (eds) Qualitative Research. A Practical uneasy border between text, as focus of study, 8.3.2 Abstract number 165 Guide, London: SAGE. Pp 17 - 29 and ‘context’ which lies beyond the text and may be excluded from study. 11:45am Kuwee Kumsa, M., Chambon, A., Chung Yan, M., Maiter, S. (2015) Catching the shimmers of the DA has been used in nursing research to inves- Reflexivity, qualitative social: from the limits of reflexivity to methodo- tigate nurse-client interaction and the operation logical creativity, Qualitative Health Research, of sources of power on nurses and their work. It research, and the PhD 23 (2) 248 - 255 is highly appropriate for such work. process Conclusion summarising the contribu- Presenter: Professor Ruth Northway, PhD, Biography tion of the paper: discourse analysis can MSc (Econ), RNLD, Cert Ed(FE), FRCN, Ruth Northway is Professor of Learning Dis- present a problem to researchers who are Professor of Learning Disability Nursing, Uni- ability Nursing at the University of South Wales steeped in humanist assumptions so a careful versity of South Wales, Pontypridd, UK where she also leads the Unit for Development consideration of its various theoretical bases is in Intellectual Disabilities and is involved in needed. DA has particular relevance to questions Abstract PhD supervision and examination. She edits posed by nurse researchers. Background: Reflexivity requires critical self- the Journal of Intellectual Disabilities and is examination of the researcher’s position within currently Chair of the RCN Research Society Recommended reading list their research, the impact of this on the research, Steering Committee. Buus, N. (2005). ‘Nursing scholars appropriat- and is achieved through a continuous process of ing new Methods: the use of discourse analysis internal dialogue (Berger, 2015). It is viewed as in scholarly nursing journals 1996-2003.’ ‘imperative’ in qualitative research (Birks, 2014) Nursing Inquiry 12(1): 27-33. being both a process through which quality can 8.3.3 Abstract number 9 Traynor, M. (2013). ‘Discourse Analysis’. The be maintained and a source of knowledge gen- Routledge International Handbook of Qualita- eration. Nonetheless, it has also been described 12:15pm tive Nursing Research. C. T. Beck. Abingdon, as a ‘messy’ process (Kuwee Kumsa et al, 2015) Oxon, Routledge: 282 - 294. and this can present challenges for the PhD Methodology: An student (particularly from a practice based disci- introduction to discourse pline such as nursing) both in terms of develop- Biography ing such an approach and reflecting this in their analysis and its usefulness in Michael Traynor studied English Literature at thesis. nursing research Cambridge University before entering nursing. Aims: Presenter: Professor Michael Traynor, MA He is currently Professor of Nursing Policy at (Cantab.) PhD, Professor of Nursing Policy, Middlesex University, UK. He has written exten- • To critically explore the nature of reflexivity. Middlesex University, London, UK sively on discourse analysis and policy issues. • To examine some of the challenges it can present within the PhD process particularly in Abstract the context of practice based disciplines such as nursing. Background to the method/debate: Discourse analysis (DA) is the name given to a range of •To discuss strategies for promoting reflexivity approaches to analysis of text and talk developed Theme: Interviewing and incorporating it within a thesis within the social sciences and linguistics from Methodological Discussion: Nurses under- the 1960s. It has been popular in nursing 8.4.1 Abstract number 37 taking qualitative research as part of their PhD research but often used poorly because research- 11:15am can face particular challenges since they are ers have brought assumptions from other quali- positioned as both nurse and researcher. Reflex- tative approaches that do not apply to DA work Exploring the views and ivity within this context therefore often involves (Buus 2005). critical self-reflection not only as a researcher experiences of using Aims of the paper to: 1) set out the range of mobile information and but also as a clinician and this can be difficult practices that go under the name of discourse and demanding both in terms of maintaining analysis and discuss their different assump- communication technology such an approach and in demonstrating this tions; 2) offer a simple typology of approaches; (mobile phones, laptop or within a thesis. Nonetheless a reflexive approach 3) review some of the debates, dilemmas and tablet computers) by people to research can enhance the quality of both tensions within the field; 4) discuss its use in research and practice. The presentation will with mood disorder: A nursing research and make the case for its use- qualitative study draw upon literature and personal experience fulness in this field. as a PhD student, supervisor and examiner to Presenter: Mr Hamish Fulford, MSc, BN, BA, Methodological Discussion: DA can be achieve the stated aims. A critical approach will PG Dip, School of Nursing and Health Sciences, understood as comprising four fields of focus be taken and practical strategies will be explored. University of Dundee, Dundee, UK (Traynor 2013): Conclusion: Whilst maintaining and demon- Co-author(s): Dr Steve MacGillivray, Scotland, • ‘Identifying code’: Language regularities and strating a reflexive approach can be challeng- UK; Dr Linda McSwiggan, Scotland, UK; Prof linguistics ing it is an essential component of qualitative Thilo Kroll, Scotland, UK. research and strategies need to be in place to • ‘Use and interaction’: Conversation Analysis enable PhD students to develop and demon- • ‘Interpretive repertoires’: Studies of particular Abstract strate reflexivity. activities Background: A systematic review and meta- • ‘Societal discursive practices’: Critical discourse synthesis identified that no research had Recommended reading list analysis and post-structuralism explored how people with mood disorders used Berger, R. (2015) Now I see it, now I don’t: Debates within DA practice concern the relation- mobile information and communication tech- researcher’s position and reflexivity in qualita- ship of ‘discourse’ to the non-discursive and the nology (mICT) in their everyday lives and more tive research, Qualitative Research, 15 (2) 219 relationship between the ‘agency’ of discourse specifically, how they might use mICTs to look - 234 after themselves. This oversight has led to tech-

81 811.15 – 12.40 Concurrent session 8 – Friday 8 April 2016 nology redundancy and high attrition rates. 8.4.2 Abstract number 61 Recommended reading list Further research was therefore required to 11:45am Barrett, D. (2012) ‘The role of telemonitoring in understand the meaning this type of technology caring for older people with long-term condi- held for people with mood disorders. tions’. Nursing Older People, 24, 7, pp 21-25. Aims/Objectives: The study aimed to explore Rethinking presence: A grounded theory of nurses Charmaz, K. (2006) Constructing grounded the views and experiences of using mICTs by theory: A practical guide through qualitative people with mood disorders, and their mental and teleconsultation analysis. Los Angeles: Sage. health care professionals. A qualitative study Presenter: Mr David Barrett, RN, BA(Hons), Strauss, A. & Corbin, J. (1998) Basics of quali- using in-depth, semi-structured interviews with PgDip, PgCert, Faculty of Health and Social tative research: Techniques and procedures thirty people with depression in secondary and Care, University of Hull, Hull, UK for developing grounded theory, 2nd edition. specialist mental health services and 10 mental Thousand Oaks: Sage Publications. health care professionals. Abstract Method: Participants’ data sets were analysed Background: Teleconsultation is the use of Biography using an adapted Grounded Theory approach. video to facilitate real-time, remote interac- David is the Director of Pre-Registration Nurse Grounded theory involves the gradual identifi- tion between healthcare practitioners and cation and integration of categories of meaning Education at the University of Hull. After quali- patients (Barrett, 2012). Though its popularity fying as a Registered Nurse in 1994, he embarked from the data, and the identification of relation- is growing, there is little understanding of how ships between them. on a career in cardiac care. He left the NHS in teleconsultation impacts on the role of nurses. 2002 to commence an academic nursing career. Results: A grounded theory of how mobile Study Aim: The study aimed to develop a technology is used in daily life, and also, more In addition to his teaching and student support theory that offered an evidence-based insight responsibilities, his current role includes the specifically, how it might be used to manage into the use of teleconsultation by nurses. recovery from mood disorder. The core category development and delivery of education, research which emerged from the data forming theory Method: The study adopted a constructiv- and service improvement related to telehealth was ‘Centrality through Inter-connectivity’ and ist grounded theory method (Charmaz, 2006), and telecare. He carries out service evaluations this with its sub-categories will be discussed. supplemented by some Straussian analytical for public and private sector organisations, approaches (Strauss & Corbin, 1998). During has developed a suite of educational resources, Discussion/Conclusion: The research study 2014, 17 Registered Nurses were theoreti- published a number of research and review begins to fill the gap in our understanding in cally sampled and participated in interviews articles, and speaks regularly at events focusing regards to the meaning this type of technology exploring their experiences, knowledge and on Technology Enhanced Care. He has recently holds for people with mood disorder and such feelings surrounding teleconsultation. Inter- completed a PhD exploring nurses’ experi- research might provide valuable information on views were recorded, transcribed and subjected ences of using video-consultation to support the how technology is subjectively and collectively to three-stage, non-linear analysis. delivery of healthcare. perceived. Understanding how mobile technology is used by people with mood disorder and Results: The core category identified from the its role in the management of long-term condi- data was ‘nursing presence’. Four subcategories tions could aid technological design and support of nursing presence were identified: clinical practice. • Operational presence: Administrative, organisational and technical activities Theme: Systematic review Biography • Clinical presence: specific healthcare functions 8.5.1 Abstract number 230 I graduated with a BA (Hons) from the Institute such as patient assessment of Archaeology, University College London in • Therapeutic presence: Activities that support 11:15am the late 1990s and worked as a field archaeolo- patient well-being (e.g. reassurance and gist in research and commercial projects around support) Experiences of well-being and the UK. I completed a PG Dip in Information • Social presence: Social interaction and a feeling suffering after hip fracture: A Technology with University of Abertay Dundee of someone ‘being there’. systematic review and meta- in 2001 and a BN in Mental Health Nursing with synthesis University of Dundee in 2008. Since qualify- The degree to which presence could be achieved ing I’ve worked in acute functional assessment was dependent upon three influencing factors - Presenter: Mrs Birgit Rasmussen, PhD student, wards for both adults and older people with enablers, constraints and compensation. These Master of Humanities and Health, Diploma of mental health problems; substance misuse and factors were products of specific characteristics Medical Research, Horsens Hospital, Depart- latterly as a community mental health nurse. I of teleconsultation, the agents involved in them, ment of Rehabilitation and Department of qualified from University of Abertay Dundee in and the context of care. Research, Horsens, Denmark the summer of 2013 with an MSc (Distinction) Discussion: The findings from the study Co-author(s): Lisbeth Uhrenfeldt, Denmark in Pluralistic counselling and psychotherapy. I suggest that whilst teleconsultation offers a started my PhD studentship with University of different modality of nursing care from ‘tradi- Abstract Dundee/NHS Tayside in September 2013 as a tional’, face-to-face approaches, it still allows for Background: Dependency and limited func- full-time student and working one day a week as a range of roles and functions to be carried out. tional ability is common when older people a community mental health nurse. More broadly, the work suggests that traditional fracture their hip. Experiences of well-being models of ‘nursing presence’ as a transient and seem to be important during recovery and rather nebulous concept are not a true represen- when living with a hip fracture as a balancing of tation of nurses’ work. suffering. Evidence exists that self-confidence Conclusion: Nurses provide different types is important during rehabilitation and when of presence during teleconsultation, with the managing in everyday life after hip fracture. degree of presence dependent on specific char- Identifying the meaning of a hip fracture in older acteristics of video-mediated communication. people can provide a deeper understanding of These conclusions, coupled with a broader dis- what matters during rehabilitation and when cussion of the reconceptualization of nursing managing in everyday life. presence, will be presented.

82 11.15 – 12.40 Concurrent session 8 – Friday 88 April 2016 Aim: To aggregate, appraise, interpret and syn- enrolled as a PhD student at the University of the large body size, and reduced physical perfor- thesise findings from qualitative studies of lived Aarhus, Denmark mance compared to others. A change in identity experiences of well-being and suffering within is found necessary for well-being. one year after discharge with hip fracture. Method: Following the methodology of the Recommended reading list Joanna Briggs Institute, a three-step literature 8.5.2 Abstract number 278 Todres, L. & Galvin, K. (2010), ‘Dwelling- search strategy was developed. Initially, a struc- mobility: An existential theory of well-being’, tured search was performed in the databases 11:45am International Journal of Qualitative Studies on CINAHL, MEDLINE, PsycInfo and EMBASE. Health and Well-being, vol. 5, pp. 10.3402/qhw. Second, Google Scholar was searched for grey Well-being in physical activity v5i3.5444. literature. Third, references and cited citations when severely obese - a Toft, B.S. & Uhrenfeldt, L. (2014), ‘Facilitators of all retrieved studies were reviewed for addi- systematic review and meta- and barriers to physical activity experienced tional studies. Studies included were critically among morbidly obese adults: a systematic appraised and study details were extracted. An synthesis review protocol’, JBI Database of Systematic analysis inspired by Kvale following five steps of Presenter: Mrs Bente Skovsby Toft, B.Sc,MHH, Reviews & Implementation Reports, vol. 12, no. meaning condensation was performed. DipMedRes, Horsens Regional Hospital 6, pp. 13-23. Results: 30 studies were critically appraised, Department of Lifestyle Rehabilitation, Horsens, Denmark leaving 29 studies for inclusion in the analysis. Biography Two main categories emerged, each contain- Co-author(s): Lisbeth Uhrenfeldt, Denmark Bente Skovsby Toft, physioterapist (PT), ing three sub-categories. ‘Balancing a new life’ Bachelor in Sports Science (B.Sc), Master in described how participants strived to regain Abstract Health and Humanities Studies (MHH),Diploma well-being through ‘Adaptations’, ‘Adjustments’ Background: Worldwide inactivity and in Medical Research (DipMedRes). and ‘Worries’. ‘Striving for interaction with new sedentary lifestyle has become a challenge, par- life possibilities’ described the influence from Employed at Horsens Regional Hospital, Depart- ticularly among people living with severe obesity. ‘Supportive interaction’, ‘Missing interaction’ ment of Lifestyle Rehabilitation, Denmark. Small changes are found to improve physical and and ‘Obstacles’ when aiming for well-being. A Experienced in lifestyle intervention among mental health and well-being. A holistic, human- meta-synthesis: ‘Establishing well-being’ was an people with severe obesity. istic approach to patients’ experiences might be abstraction of the categories into a new whole. essential for successful intervention. Conclusion: The meta-synthesis provided Aim: to identify, critically appraise and synthe- evidence that both the sufferings and the pos- size the experiences of facilitators and barriers sibilities of older people need to be adDressed to physical activity among severely obese adults 8.5.3 Abstract number 11 during rehabilitation to support experiences (BMI ≥ 40 kg/m2). of well-being, independency and confidence 12:15pm after a hip fracture. The study contributed with Methodology: The search strategy followed evidence for the development of supportive the guidelines of The Joanna Briggs Institute by The effectiveness of interventions. performing a three-phase search strategy. Quali- behavioural weight loss tative research findings were extracted, pooled interventions in maintaining Recommended reading list and grouped into sub-themes and themes and data from primary studies were extracted and long term weight loss: a Rasmussen, B. And Uhrenfeldt, L., (2014). underwent a hermeneutic text interpretation systematic review. Lived experiences of self-efficacy and wellbeing and a data-driven coding in a five-step procedure Presenter: Dr Jo Gilmartin, PhD, RN, Lecturer, in the first year after hip fracture: a systematic focusing on meaning and constant targeted review protocol of qualitative evidence. The JBI School of Healthcare, University of Leeds, comparison. The theme and sub-themes were Leeds, UK Database of Systematic Reviews and Implemen- merged into the meta-synthesis. tation Reports, 12(10), pp. 73-84. Results: Eight papers were included for the Abstract Pearson, A., Wiechula, R., Court, A. And systematic review, representing the experiences Background: A major challenge in the Lockwood, C., (2005). The JBI model of evi- of physical activity among 212 participants (143 treatment of obesity is the long-term mainte- dence-based healthcare. International Journal women and 69 men). A main theme ‘Identity’ nance of weight loss and prevention of weight of Evidence-Based Healthcare, 3(8), pp. 207-215 developed from the meta-data analysis with the regain. The Department of Health in England Ludvigsen, M.S., Hall, E.O., Meyer, G., Fegran, sub-themes: ‘considering weight’; ‘being able have recommended that health professionals L., Aagaard, H. And Uhrenfeldt, L., (2015). to’ and ‘belonging with others’ and developed should consider behaviour weight loss interven- Using Sandelowski and Barroso’s Metasynthe- the meta-synthesis: ‘Homecoming: a change in tions. sis Method in Advancing Qualitative Evidence. identity’. Objective: To evaluate the effectiveness of Qualitative health research, . Discussion: This study supports the dimen- behavioural weight loss interventions in main- sions doing, being, becoming and belonging taining long term weight loss. Biography as relevant for approaching the experiences of Presenter is physiotherapist with clinical, being a large body in activity. It might contrib- Methods: Using the PRISMA statement teaching and leadership experiences. In 2006 ute to a shared language and a humanistic and we performed a systematic review of rand- a master degree of Humanities and Health existentialistic approach to practice by address- omized controlled trails (RCTs). Data sources Studies, in 2014 a diploma in Medical Research ing the lifeworld of the patients and focusing on involved in the study are the Cochrane Library, was achieved. Based on a published protocol, my well-being. BMI classifications turned out to be MEDLINE, EMBASE, psycINFO and the Web of supervisor and I submitted a qualitative system- problematic, but necessary. Science. Studies were assessed independently by two authors to provide inter-rater reliability. atic review and meta-analysis on the experiences Conclusion: Different motivations and of older people with a hip fracture. obstacles were found in living an active life. Most Results: This review presents the findings from In 2015 a presentation of our work took place of them related to the identity of the person. 13 RCT’s of weight loss maintenance utilising both at an international conference and a Weight loss was considered a motivation for interventions that include diet strategies, behav- national conference. From 1st dec. 2015 I am physical activity, but also uncomfortable due to ioural strategies, lifestyle counselling and Drug

83 811.15 – 12.40 Concurrent session 8 – Friday 8 April 2016 therapy, group therapy and the Internet. The Theme: Interviewing Recommended reading list sample population included adult participants Cummings. J. Bennett.V. (2012) ‘Developing the of 18years+ with a BMI>30kg/m2. The results 8.6.1 Abstract number 74 culture of compassionate care: creating a new revealed that lifestyle interventions targeting 11:15am vision for nurses, midwives and care-givers’. diet and physical activity are effective in sustain- NHS Commissioning Board. Department of ing weight loss up to 2years with extended care. Health. Crown copyright Moreover pharmacology combined with lifestyle Understanding courage in the Francis. R. (2013) Report of the Mid Stafford- interventions was effective. context of nursing shire NHS Foundation Trust Public Inquiry Presenter: Mrs Fiona Barchard, RN BSC Conclusion: There is important evidence that Volumes 1 and 2: Analysis of evidence and Health care studies Ma Clinical leadership the use of behavioural weight loss interventions lessons learned (part 1 and 2) and Volume 3: PGCTHE Studying for Professional Doctorate, are effective in sustaining long terms weight Present and Future Annexes. The Stationary Senior Lecturer/curriculum lead, Northamp- loss, albeit limited. There was high heterogene- office. London. ity among the studies; hence caution is required ton University, Northampton, UK Charmaz. K. (2014) Constructing grounded when interpreting the findings. Also, intention to theory. 2nd ed. Sage. London treat principles and methods to handle missing Abstract data are not clearly reported across some Background: In 2012 a new vision for Nurses, Biography studies. Blinding of participants and outcome Midwives and Care givers (Cummings and assessors is very limited. Bennett 2012), outlined what have come to My current role is Senior lecturer in adult Keywords: Weight loss maintenance, behav- be referred to as the 6 C’s. Reports such as the nursing and Programme leader. I commenced ioural interventions, systematic review, lifestyle Francis report 2013) highlight occasions where work at the University of Northampton in 2006. changes, internet materials, courage was not demonstrated. Although some I teach across pre-registration and Post registra- research is available Internationally there is an tion nursing from level 4 - level 7. The subjects I teach include pathophysiology, recognition of Recommended reading list identified dearth of research studies on courage in Nursing in the United Kingdom (UK) hence the deteriorating patient, leadership, reflection Dombrowski SU, Knittle K, Avenell A, et al. the focus of this study. and complex care. I gained my PGCTHE in 2008 (2014). Long term maintenance of weight loss and was also awarded a teaching fellowship by Aim: To enhance understanding of adult nurses with non-surgical interventions in obese adults: the University. In 2011 I commenced my Profes- use of courage in their everyday professional systematic review and meta-analysis of ran- sional Doctorate and have completed the two practice domised controlled trials. BMJ 348: g2646: 1-12. years taught modules and am now in my second Hersey JC, Khavjou O, Strange LB, et al. Methods: Grounded theory underpinned with year of the Thesis element. My clinical nursing (2012) The efficacy and cost-effectiveness of the epistemology of social constructionism, con- history is I qualified in 1990 as a registered adult a community weight management interven- sistent with Charmaz (2014). Ethical approval nurse and spent sixteen years in Acute Nursing tion: a randomized controlled trial of the health was granted to undertake unstructured inter- practice. The majority of this time was in Critical weight management demonstration. Preventive views with qualified adult nurses on their under- care where I gained experience as a staff nurse, Medicine 54: 42- 49. standing of courage in their professional practice. junior sister, senior sister and Practice develop- Participants were self-selecting, responding to The Cochrane Handbook for Systematic Reviews. ment Nurse. During this time I gained my ENB fliers and presentation of the research premise. www.cochrane.org/handbook. (accessed 10 100, 931 and 998 and Degree in Health care The interviews have been conducted, recorded November 2014). studies and Masters in Clinical Leadership. and transcribed. Nvivo assisted with coding and identification of themes. Biography Results: 12 unstructured interviews with staff Jo Gilmartin is a lecturer at the University of in the acute and community settings have been Leeds currently researching obesity, body image 8.6.2 Abstract number 357 undertaken during 2015. The themes suggest and quality of life. A recent project has impacted nurses view courage as a complex phenomenon. 11:45am the development of body contouring NICE Age, personality, support, confidence, knowledge guidelines. and experience are all seen to be integral to ‘Doing family’: family care Monica Murphy is a lecturer and University courage. The themes from the interview data are involvement in intensive care Student Education Fellow at the University of ready for presentation. Leeds. She is also actively involved in teaching Presenter: Dr Susanne Kean, PhD, University Discussion: The discussion points are around health promotion. of Edinburgh, Edinburgh, UK nurses differing views of the impact of age, Co-author(s): Dr Kalliopi Kydonaki, personality, support structures, confidence, Edinburgh Napier University & Dr Jenni knowledge and experience and how these Tocher, University of Edinburgh influence their ability to be courageous. Is courage inherent, expected, difficult to use and do nurses feel supported? The derived themes Abstract are in the context of the UK experience but may Background: Person-Centred Care (PCC) is resonate with International evidence and col- emphasised in national and international gov- leagues. ernmental policies and healthcare research. Conclusions: Courage as understood by Family involvement in care is an implicit aspect nurses is a complex phenomenon. Understand- of PCC and contemporary evidence suggests ing of this can inform future practice and enable that family members partnering with nurses us to prepare and support nurses to use courage can provide support, reassurance and comfort in the practice setting. to patients. However, what constitutes care involvement in an intensive care setting from the perspectives of families and patients is little explored and understood. Focus of this paper: (1) Is the involvement of families in care in ICU acceptable to families and

84 11.15 – 12.40 Concurrent session 8 – Friday 88 April 2016 patients? (2) What are the care activities families 8.6.3 Abstract number 188 Biography are willing to participate in? 12:15pm Having qualified in 1986 as a RGN I have worked Methods: Data for this qualitative explora- in a variety of settings across secondary care. tory study were collected from two ICUs in two While working as a Matron for surgical services tertiary hospitals in Scotland. Semi-structured Patient perceptions of the health care assistant (HCA) I recognised the significant contribution the interviews were conducted with former ICU Healthcare Assistant (HCA) made to care patients before hospital discharge and adult care delivery: a grounded delivery. During this time I undertook my MSc family members. Data were analysed using theory study. exploring the role of the HCA from the regis- thematic analysis strategies. Ethical approval Presenter: Mrs Sarah Morey, RGN, MSc trants perspective. Having made the transition was granted prior to the study. BA(Hons), PhD student, Northumbria Univer- into academia from my clinical role I took the Results: ‘Doing family’, a dimension of person- sity, Newcastle Upon Tyne, UK opportunity to study full time for my doctorate centred care that emerged as a major theme Co-author(s): Dr Alison Steven, Northumber- exploring the role of the HCA from the patients across interviews, emphasise relationality in land, UK; Rev Dr Pauline Pearson, UK. perspective. This was identified as an area where families. Relationality emphasises the connec- there was a paucity of qualitative research whilst tions within families and their desire to maintain undertaking my MSc. Abstract (family) normality as well as addressing patients’ I am looking forward to completing mid 2016 Background: Healthcare assistants (HCA) emotional support needs. Nineteen former ICU when I hope to return to a lecturing role within play a major part in care delivery in the UK and patients and 16 adult family members were higher education. interviewed. Eleven of the interviews were therefore play a vital role in patient experience. paired (patient with one family member). Aims: This doctoral study explores the patient’s Conclusions: Understanding the importance perceptions of the HCA within the context of of ‘doing family’ as a Driver for family involve- secondary care delivery. ment in ICU care allows an insight into the why Methods: Data was collected in outpatient and Theme: Mixed methods and what of care activities that are acceptable inpatient areas of a large teaching hospital in for ICU patients and their families. This, in turn, North East England between November 2014 8.7.1 Abstract number 147 enhances our understanding for future interven- and October 2015. Following constructivist tion studies which are truly based on the co-con- grounded theory (Charmaz 2014), 20 patient 11:15am structed concept of PCC. interviews were coded and analysed using constant comparison to ensure findings were The development of national Recommended reading list grounded within the data. practice standards for nurses SG (2010) The Healthcare Quality Strategy Initial Findings: Initial findings suggest in Australian general practice for NHS Scotland. The Scottish Government, patients remain unsure about who the secondary Presenter: Professor Elizabeth Halcomb, Edinburgh. care HCA is. They employ a number of strategies RN BN(Hons) PhD FACN, Professor of Schmidt, M. & Azoulay, E. (2012) Having a loved to navigate the complex array of staff, eventually Primary Health Care Nursing/Editor, Nurse one in the ICU: the forgotten family. Current working out which designation of staff is appro- Researcher, University of Wollongong, Wol- Opinions in Critical Care 18(5), 540 - 547. priate for their request. longong, Australia Page, P. (2015) Critical illness trajectory for The concept of connectedness has emerged, Co-author(s): J Bryce, E Foley, M Stephens, C patients, families and nurses - a literature wherein patients value the time and effort that Ashley, Australia review. Nursing in Critical Care, doi: 10.1111/ the HCA invests with them. This investment can nicc.12199 be exclusive to them or inclusive of other patients Abstract and fosters a sense of belonging. Patients value the ‘little things’ with humour often playing a Background: Internationally there is growing Biography large part and adding to the feelings of connect- emphasis on building a strong PHC nursing Susanne Kean RN, MSc, PhD is a nurse by edness between patient and HCA. workforce to meet the challenges of rising background with a research interests revolving chronic and complex diseases. However, there Not all opportunities are taken by the HCA to around families’ and patients’ experiences with has been limited emphasis on examining the bring about a state of connectedness, which critical illness. She is particularly interested in nursing workforce in this setting. patients associate with the process of having families with children and young people and the to deliver task driven care. This can lead to a Aims: This study aimed to revise the com- way they process a critical illness event but also disconnect between the patient and the HCA, petency standards for nurses in Australian in ICU nurses and their experiences in working affecting the patient experience, communication general practice. This paper will present both an with families. Her current research interest and information flow. overview of study findings and a critical discus- include survivorship after critical illness, family sion of the process of developing professional interventions in ICU and delirium. Discussion: The researcher explores how practice standards. concepts such as connectedness are represented in the literature and how this doctoral study Methods: This mixed methods study used two adds to this understanding. online surveys of nurses and a series of fourteen focus groups conducted around Australia during Conclusion: There is little qualitative research 2013-2014. that explores the patient’s perceptions of the HCA, despite this being an important area Results: A total of 561 survey responses were for enhancing the patient experience. The received across the two surveys. Two hunDred researcher would value the opportunity to nurses participated in the focus groups. The final present these findings in more depth. 22 Practice Standards were separated into four domains; 1) Professional Practice, 2) Nursing Care, 3) General Practice Environment and 4) Recommended reading list Collaborative Practice. These standards outline Charmaz, K. (2014) Constructing grounded the broad scope of the role of nurses employed theory. 2nd edn. Los Angeles: Sage within Australian general practice.

85 811.15 – 12.40 Concurrent session 8 – Friday 8 April 2016 Discussion: Professional practice standards are 8.7.2 Abstract number 191 Recommended reading list an important way of defining the role and scope 11:45am KALISCH, B. J., LANDSTROM, G. L. & of practice of a profession to both consumers WILLIAMS, R. A. 2009. Missed nursing care: and other professionals, as well as being a guide Errors of omission. Nursing Outlook, 57, 3 - 9. for curriculum development and measurement Contemporary nursing - MCCARTHY, J. & GASTMANS, C. 2015. Moral of performance. They have clear relevance to tensions at the boundary of distress: A review of the argument-based nursing policymakers, researchers and those in clinical budget, profession and care ethics literature. Nursing Ethics, 22, 131-152. practice as they provide role clarity that will Presenter: Associate Professor Clare Harvey, optimise the contribution of nurses to Austral- PhD, RN, BA (Cur), MA, Faculty of Education, ian general practice. The process of standards Biography Humanities and Health Science, Eastern development provided a number of challenges I am an associate professor and the programme Institute of Technology, Napier, New Zealand to the researchers. co-ordinator for the postgraduate programmes Co-author(s): Eileen Willis, Australia; Patti Conclusion: Professional practice standards in nursing and health science at the Eastern Hamilton, USA; Julie Henderson, Australia; are important for nurses and nursing care. Institute of Technology, New Zealand. I also Luisa Toffoli, Australia; Ian Blackman, Having a rigorous development process is have academic status, working in both teaching Australia; Maria Pearson, New Zealand; Clare important in ensuring that the standards reflect and research at Flinders University of South Buckley, New Zealand both current practice and future scope for the Australia. My research focuses on professional role. issues in nursing practice, and in advancing Abstract nursing roles, predominantly around nurse practitioners. I have worked in four countries during Biography Background: Nursing is described as an art and science, because the core work, caring, my nursing career, with the first 20 years of that Professor Elizabeth Halcomb is Professor of is based on a nurse’s knowledge of the patient time, being in my homeland of Zimbabwe, and Primary Health Care Nursing at the University condition and the skill associated with it. In the later, South Africa. It is not surprising then that of Wollongong, Australia. She is an experienced current health care environment, nursing skills my other passion is primary health care, where academic nurse leader who is committed to are translated into tasks, measured by prede- my research focuses on examining how nurses developing researchers in both academia and termined budgetary factors that reduce nurses’ play a part in supporting access to healthcare the clinical setting. In addition to being an active control over their work. It is known that in this and in the equity of that care, within the primary supervisor of Bachelors (Honours) and Higher environment, care is missed. health setting. Degree research students Professor Halcomb teaches into the postgraduate coursework Aims: This paper reveals the tension created programs. between three masters shown to be in control of nursing work; patients’ actual requirements Professor Halcomb leads a strong research for care; regulation giving nurses the authority 8.7.3 Abstract number 276 program in primary care nursing, with particular to care; and budgets determining resources emphasis on nursing in general practice, chronic available for care. 12:15pm disease and nursing workforce issues. She also undertakes research around learning and Methods: The MISSCARE questionnaire A comparison of ward sisters’ developed by Kalisch et al (2009) was used, with teaching in nursing, academic workforce devel- development needs with opment and research methodology. Professor permission, to survey nurses across four Austral- Halcomb has particular interests in mixed ian states, and New Zealand, between 2012 and those of middle managers in methods research and evidence based practice. 2014. An analysis of the commentaries from the private companies surveys was undertaken, looking for discourse Professor Halcomb has attracted over $1.9 Presenter: Mrs Jacqueline McKenna, RN, that identified how nurses justified missing or million in research funding, with over $610,000 DipN, MMedSci, NHS Trust Development rationing care, within the categories of the three as the first named Chief Investigator. She has Authority, London, UK controllers of care. a strong track record of publication, with over Co-author(s): Amy Armstrong BA (Hons), 95 peer reviewed papers and 12 book chapters. Findings: Our findings show that budgets MBA, PhD Currently, Professor Halcomb is an Editor of dominate nurses’ capacity to care and expose an incongruity between philosophies that Collegian - The Australian Journal of Nursing Abstract Practice, Scholarship & Research, an Associate determine the profession of nursing and those This presentation compares results of a study Editor of BMC Family Practice and member of driving the occupation of nursing. This situation investigating ward sisters’ development needs the Editorial Board of the Australian Journal of results in moral distress (McCarthy & Gastmans, with a previous study of middle managers in Primary Health Care. In 2014 she was appointed 2015), because nurses cannot carry out the care private industry companies (Armstrong and Editor of Nurse Researcher. they decide upon due to external constraints thwarting it. This has professional implications Russell, 2013). on individual nurse accountability for leaving The survey was part of a doctoral study inves- care undone. tigating development of nurses transitioning to Discussion: Research into the repercussions of sister roles because despite national policy rec- budget-driven care on nurses’ liability is essential ommending nurses in these posts require devel- in today’s constrained health care environment, opment a national strategy has not happened. where the patient and the nurse are exposed to The data were collected using a questionnaire risk; the patient through preventable adverse adapted from the study above. The question- events, and the nurse through preventable acts naire was sent to a sample of 228 ward sisters of omission. The findings inform researchers, (174 responded giving a response rate of 76.3 nurses, and policy makers, examining missed/ percent). The responses were submitted between rationalised care worldwide of the dangers that July -December 2013; data were anaylsed using budget directed care has on moral and profes- descriptive statistics during February 2014. sional outcomes. The results offer a national view (n=174) on ward sisters’ current development needs which the researcher used to formulate a core national

86 11.15 – 12.40 Concurrent session 8 – Friday 88 April 2016 curriculum. The comparison to the previous Theme: Interviewing ontology and dementia for the past eight years. middle manager research demonstrated similar- Her previous work experience is in the area of ities between development needs -Influencing, 8.8.1 Abstract number 31 District Nursing in the UK. She migrated with leadership, personal impact and change man- her family from the UK to Australia in 2003 and agement were all top 10 for both groups; barriers 11:15am has had a strong interest in the experiences of to learning - job pressures, lack of time and other UK migrant nurses since this time. She financial constraints were significant barriers New land, new life: United completed her PhD at Edith Cowan University for both samples although in a slightly different Kingdom registered nurses in 2013. order. However there were differences between living the dream the attitude to coaching in the two groups; twice Presenter: Dr Caroline Vafeas, PhD, MA, BSc, as many ward sisters (47 percent) than Ashridge RN, Senior Lecturer, Edith Cowan University, managers (24 percent) reported that they had Joondalup, Australia 8.8.2 Abstract number 171 a mentor or a coach. When asked if they would Co-author(s): Dr Joyce Hendricks pay to have a mentor or coach 18 percent of 11:45am ward sisters said they would, compared with two percent of the Ashridge managers. Abstract Articulating uncertainty: The results give an interesting view on the devel- Background: An increase in the Australian opportunities for nursing opment needs and the attitude of ward sisters population has driven demand for health care practice within the ontology compared with managers in private companies. services. By 2021, it is projected that the Aus- tralian population will reach 25.6 million with of anxiety. The results lead to opportunities for learning an increased need for specialised health services Presenter: Mr John McKinnon, MSc PG Dip BA transfer across public and private sectors; including registered nurses. There is a current (Hons) RGN RHV RMN, University of Lincoln, creative opportunities for learning and growth if shortfall of 61,000 registered nurses in Australia. Lincoln, UK nurses spent some time in private sector middle management and vice versa Aims: The aim of this paper is to explore the experience of United Kingdom (UK) registered Abstract Recommended reading list nurses migrating to Australia. This paper high- Background: Anxiety is a future focused lights the push and pull factors which influence emotion associated with anticipatory hyper Armstrong, A. and Russell, A. (2012) The the decision to migrate to Australia. It also iden- vigilance in the face of uncertainty (Meeton, missing middle: Exploring learning experi- tifies three key attributes related to successful Dash, Scarlet and Davey, 2012). Once a poorly ences of middle managers in the UK. Ashridge: migration. delineated construct confused with fear, anxiety Ashridge Business School Methods: Purposive sampling was used to is now distinguished neurologically, cogni- recruit 21 participants who had migrated to tively and behaviourally (Sylvers, Lilienfeld and Biography Australia between 2003 and 2009. Data was LaPrairie, 2011;Sauerhofer, Pamplona, Bedenk, Jacqueline joined the NHS Trust Development collected by the use of interviews, focus groups Moll, Dawirs, von Hörsten, Wotjak, and Golub, Authority in April 2013 having been the Director and a personal diary. A heuristic inquiry 2012). of Nursing at the Medway NHS Foundation Trust approach was employed to guide this study Aims: This paper presents the findings of an since 2000, and previously been the Director of including data collection and data analysis enquiry into the dynamics of anxiety as part of Nursing at Southmead, Bristol from 1997. (Moustakas 1990). nursing ontology. The study seeks to determine Jacqueline trained as a registered nurse at King’s Results: Three main themes uncovered were, the value of anxiety to nursing practice. College Hospital and had a successful clinical making the move: finding a way, new life: fitting Method: Thirty- three nurses across career in gynaecology. Jacqueline achieved a in and, here to stay. Three main coping strategies community, public health, paediatrics, mental Masters in Medical Science in Clinical Nursing identified in this study were developing resil- health and acute adult surgery talked exhaus- in 1995. ience, finding a new professional identity and tively in interview about their experiences of She implemented the first British model of having the ability to adapt to a new life. Feelings anxiety in their professional lives. The data was shared governance which improves staff of belonging were found to be necessary to make collected in a London teaching hospital trust involvement in 1994, and won the HSJ award the move a success, with the need for friends and and in three community NHS trusts in the East for patient safety in 2005 for the development family being a high priority to all participants. Midlands of England between November 2011 of the Medway Nursing and Midwifery Account- Discussion: This study highlights many issues and August 2012. The interviews were audio- ability System - an improvement framework that need to be considered by UK migrant nurses taped and transcribed verbatim. The transcripts for nursing. Jacqueline received an MBE for prior to embarking on such a massive upheaval were analysed using Grounded Theory Method. services to nursing and health care in the 2010 to their professional and personal life. The Results: Anxiety was not experienced as a Queen’s birthday honours list. She is currently coping strategies identified were found to be single entity but as a series of subtypes on a studying for a PhD at Greenwich University paramount to make the dream a reality. continuum of response to varying degrees of Conclusion: New UK nurse migrants as well uncertainty and levels of risk. Behaviour was as Australian employers must consider the total governed by a ‘what if’ state of understanding impact of migration to ensure this group can live in the shape of raised awareness, concern, high the dream both professionally and personally. anxiety and panic. Anxiety also showed some temporal variation at odds with the extant litera- Recommended reading list ture. Nurses valued anxiety as leverage for exercising accountability. Moustakas, C. (1990). Heuristic research. Newbury Park: Sage Publications. Discussion: The findings show anxiety to be a valuable component in the armoury of nursing Biography judgement Caroline Vafeas is a senior lecturer at Edith Conclusion: Anxiety has potential as a reflec- Cowan University. She has taught under graduate tion point through which to articulate uncer- and postgraduate education, in the fields of ger- tainty and lend shape to nebulous situations.

87 811.15 – 12.40 Concurrent session 8 – Friday 8 April 2016 The place of anxiety as part of a new framework true connections with the co-researchers, as the Theme: Mixed methods for clinical judgement is justified. subjective perspective of the researcher is key to this discovery. 8.9.1 Abstract number 98 Recommended reading list Heuristic Inquiry has six phases: initial engage- 11:15am Meeten, F, Dash, SR, Scarlet, ALS, Davey, ment, immersion, incubation, illumination, GLC. (2012) Investigating the effect of intoler- explication and creative synthesis. These phases Utilizing a six-step program ance of uncertainty on castastrophic worrying underscore data collection. Data analysis evaluation framework and mood. Behaviour Research and Therapy. explores the development of individual depic- 50(11):690-698 tions, composite depictions, an exemplary to measure effectiveness portrait, leading to a final creative synthesis; a Sauerhöfer, E., Pamplona, FA., Bedenk, B., Moll of an innovative bullying way of explaining the phenomenon. GH., Dawirs , RR. von Hörsten, S., Wotjak, C awareness intervention in Golub, Y. (2012) Generalization of contextual Implications for Nursing: This methodology preschoolers fear depends on associative rather than non- can be a valuable method in qualitative nursing Presenter: Dr Michelle Beauchesne, DNSc RNN associative memory components. Behavioural research where the researcher is invested in CPNP FAAN, Associate Professor, Northeast- Brain Research. 233(2) the learning experience and self-discovery. It ern University, West Haven Child Development is an important research approach for qualita- Sylvers, P. Lilienfeld, SO.,. LaPrairie, J.L.(2011) Center Inc, Boston, USA tive nursing studies based on the lived experi- Differences between trait fear and trait anxiety: ence and requires absolute commitment to the Co-author(s): Patrice Farquharson USA; Implications for psychopathology. Clinical Psy- research process as an immersive and personally Patricia Beauchemin, BSN RN USA chology Review.31:122-137 affecting method of knowledge gathering. Abstract Biography Conclusion: The Heuristic Inquiry concepts are applied to the research of nurse migration Review of Literature: Bullying is a traumatic John is a senior lecturer in nursing at the uni- and the personal experience of the researcher. event for children involved affecting self-esteem, versity of lincoln with a clinical background The process is detailed using the researcher’s school performance, and social interactions.1 in mental health, critical care, health visiting own lived experience. This type of methodol- Research shows that aggressive behaviors in and safeguarding. His specialist interests are ogy is used to incorporate the researcher as an young children are often predictive of future emotional intelligence and reflection. His integral part in the research and the centre of aggression towards peers.2 Children as young doctoral studies have been concerned with the the process itself to identify the essence of the as four years can display deliberately aggres- development of a framework to harness emotions experience. sive behaviors to others and are able to identify to inform clinical judgement in nursing practice. themselves or others as victim or aggressor.3 His new book ‘Reflection for nursing practice’ Recommended reading list Experts suggest interventions for this popula- introduces his framework along with a combi- tion are most effective when presented in inter- nation of old and new approaches to reflective Moustakas, C. (1990). Heuristic research. active formats. practice. Newbury Park: Sage Publications. Purpose: The purpose of this paper is to share the process of evaluating the effectiveness of Biography an interprofessional multi-strategy bullying Caroline Vafeas is a senior lecturer at Edith awareness intervention implemented over a 36 8.8.3 Abstract number 30 Cowan University. She has taught undergradu- month period (2012-2015) with a preschool pop- ate and postgraduate education, in the field of ulation to not only discourage such behaviors 12:15pm gerontology and dementia for the past eight but to also promote appropriate social skills. The years. Her previous work experience is mostly evaluation was conducted using the Social Eco- Heuristic inquiry: Taking the in the area of District Nursing in the UK. She logical Model guided by the Center for Disease road less travelled migrated with her family from the UK to Western Control (CDC) Six-Step Public Health Program Australia in 2003 and has had a strong interest Presenter: Dr Caroline Vafeas, PhD, MA, BSc, Evaluation Framework. in the experiences of other UK migrant nurses RN, Senior Lecturer, Edith Cowan University, Summary of Intervention: An interprofes- since this time. She completed her PhD at ECU Joondalup, Australia sional team engaged the broader community to and her study is entitled ‘Migration Matters: The introduce the effects of bullying on preschool Co-author(s): Dr Joyce Hendricks, Western experience of Registered Nurses migrating from aged children through the chilDren’s book and Australia the United Kingdom to Western Australia. This play, The HunDred Dresses, whose themes paper discusses the use of Heuristic Inquiry as illustrate the negative outcomes of bullying Abstract the chosen methodology. and encouraged an open community discourse. Aim: This paper explores the use of Heuristic Resources were created to ensure continuity of Inquiry as a methodology to explore the expe- bullying prevention education in the home and rience of Registered Nurses migrating from the classroom. United Kingdom to Australia. Outcomes: Program evaluation indicates Design: Discussion Paper - Methodology continued success as evidenced against the eval- Background: Heuristic inquiry (Moustakas, uation standards of utility, feasibility, propriety, 1990) positions the researcher at the centre and accuracy. Multiple measures based on the of the process for identifying the essence of six-step process include parent and staff surveys, the phenomenon under investigation. The focus groups with key informants, curricular researcher needs to be internal to the experience changes, and analyses of chilDren’s stories and and be guided by tacit and intuitive knowing Drawings. to form relationships with co-researchers, who Implications for Practice: Strategies to have also lived the experience under investiga- assist professionals to support children and tion. This reciprocal connection leads to creation families meet the challenges of addressing of new knowledge. Engagement with the phe- bullying behaviors and increasing awareness nomenon facilitates self-discovery by revealing are explored. Distinguishing principles between

88 11.15 – 12.40 Concurrent session 8 – Friday 88 April 2016 research and program evaluation methodol- limited. The aim of this study was to develop 8.9.3 Abstract number 137 ogy is outlined. Outcome evaluations, future an evidence-based educational intervention on plans, and implications for public health are breathlessness for informal carers of patients 12:15pm discussed. Suggestions on implementing similar with advanced disease. comprehensive community program evaluation Methods: Stage 1: qualitative indepth inter- ‘Unprecedented strain’ - The processes are shared. views with a purposive sample of 25 patient- nursing practice environment carer dyads from two disease groups (cancer in Irish acute hospitals Recommended reading list and COPD) to identify educational needs and Presenter: Ms Ciara White, PhD(c), MSc, RGN, Fink, P. J. (2013). ‘Eliminating bullying hinges intervention preferences. Stage 2: one-day mul- RNT, Nursing & Midwifery Project Officer, on changing the culture’. Available at http:// tidisciplinary workshop attended by 13 clinical Nursing & Midwifery Plannning & Develop- www.clinicalpsychiatrynews.com. Retrieved experts to identify evidence-based content and ment Unit, Health Services Executive, Dublin, July 25, 2013. the acceptability, accessibility and feasibility of Ireland potential delivery modes. Stage 3: two half-day Vlachou, M., AnDreou, E., Botsoglou, K., & Co-author(s): Dr. Ann Sheridan, Ireland; Ms. workshops with informal carers to co-develop Didaskalou, E. (2011). ‘Bully/victim problems Susanna Byrne, Ireland the intervention, focusing on content format, among preschool chilDren: A review of current language and terminology. Qualitative data were research evidence. Educational Psychology analysed using a Framework approach. Abstract Review’, 23, 329-358. Results: Carers wanted to learn about breath- Background: In recent decades, the Irish Farrington, D.P., Loeber, R, Stallings, R., Ttofi, lessness. Six key topic areas emerged from inter- health care system has undergone immense M.M. (2011) ‘Bullying perpetration and victimi- views with patient-carer dyads: understanding restructuring and reorganization; consequently zation as predictors of delinquency and depres- breathlessnessÍ¾ de-escalating; anxiety and the organisational context in which nursing and sion in the Pittsburgh Youth Study’, Journal of panicÍ¾ keeping activeÍ¾ living positivelyÍ¾ health care is delivered has become a powerful Aggression, Conflict and Peace Research, 3 (2), managing infections (for carers of patients with factor affecting clinical practice and health care pp.74 - 81 COPD)Í¾ and, knowing what to expect in the outcomes. Improving the nursing work envi- future. There was wide variation in how carers ronment in acute hospitals is important for Biography wanted to learn, although written resources advancing the health care quality and patient Michelle A. Beauchesne, an Associate Professor, were less popular than face-to-face, group, safety agenda in Ireland (Scott et. al. 2013). is Director of the DNP Program at Northeast- video and web- based learning. Carers wanted Methods: The hypothesis that the practice ern University in Boston. She received her BSN an intervention that drew on both clinical-prac- environment in Irish acute hospitals can impact from Georgetown University, her MSN from a titioner expertise and peer-carer experience. upon the quality of nursing care provided, and joint program by Boston College and Harvard In general, carers wanted to learn with their on subsequent patient outcomes, is examined Medical School, and her DNSc from Boston Uni- patient. Building on with these findings, the clin- using an Exploratory Sequential Mixed Methods versity and completed a post-doctoral LEND ical-practitioner expert workshop identified evi- Design. In the first phase of the study a qualita- Fellowship in neurodevelomental sciences. dence-based content for the six topic areas and tive approach was used to collect data from staff Her research foci are child development and discussed a potential web-based platform that nurses, clinical nurse managers and senior nurse advanced practice nursing. Michelle is an expert would facilitate multiple modes of access, for managers across three large acute hospitals to pediatric nurse practitioner (PNP) in the care of example via clinicians and established support identify the key nursing practice environment children and families with neurodevelopmental groups or by carers independently. Further co- factors which may be significant predictors disabilities. Dr. Beauchesne maintains an active development of the proposed intervention was of quality nursing care processes and patient practice as consultant to schools and child devel- undertaken with informal carers. outcomes. opment centers in both Massachusetts and Con- Conclusions: Drawing on the expertise of Results: Findings from the qualitative analysis necticut. informal carers, patients and clinical-practition- of the first study phase carried out from August ers this study will inform the design (content and - November 2015, provide a more contextualised delivery mode) of a co-developed educational and current representation of the challenges intervention on breathlessness that is relevant of delivering quality nursing care and provide 8.9.2 Abstract number 354 and acceptable to informal carers. clarity on the factors within the nurse practice environment, which can enhance or impede on 11:45am Biography a nurse’s ability to deliver quality care. Factors identified by participants include nursing Morag is Senior Research Associate and NIHR Developing an educational workforce, increasing patient acuity, specialisms Career Development Fellow at University of in nursing and organisational targets. intervention on Cambridge. Her background is in nursing breathlessness in advanced (King’s College London), with a Masters in Conclusion: Aspects of the clinical practice disease for informal carers Medical Sociology (Royal Holloway & Bedford environment are amenable to change by individual nurses, nursing management and the Presenter: Dr Morag Farquhar, RGN BSc New College) and PhD (QMUL) on the defini- organisations so that improving the workplace (Hons) MSc PhD, Senior Research Associate, tion and measurement of quality of life in older becomes a universal responsibility. The study Dept of Public Health & Primary Care, Univer- people. She leads a programme of research contributes to the growing body of international sity of Cambridge, Cambridge, UK on breathlessness in advanced disease, collaborating with colleagues across University of knowledge regarding effective work environ- Co-author(s): Clarissa Penfold, UK; Gail Cambridge, Manchester, King’s College London ments. The results of this research will support Ewing, UK; Roberta Lovick, UK; Sophie and RAND Europe. the development of empirically informed strate- Howson, UK; Julie Burkin, UK; Sara Booth, gies to enhance nursing practice environments UK; Ravi Mahadeva, UK; John Benson, UK; to facilitate nurses in their delivery of quality David Gilligan, UK; Chris Todd, UK. patient care.

Abstract Background: The evidence-base for educational interventions to support informal carers and enhance their caregiving capacity is 89 11.15 – 12.40 Concurrent session 8 – Friday 8 April 2016

8Recommended reading list Scott, P.A, Kirwan, M., Matthews A., Lehwaldt D., Morris R., Staines A. (2013) Report of the Irish RN4CAST Study 2009-2011: A nursing workforce under strain. RN4CAST National Report for Ireland: Dublin City University. http://www.dcu.ie/sites/default/files/snhs/ pdfs/RN4CAST%20FINAL%20report%20 18%20April%202013.pdf

Biography Ciara has been working as Nursing & Midwifery Quality Care-Metrics Project Officer in the Health Service Executive (HSE) in Ireland since January 2014. Her role involves supporting and guiding the development and implementation of standard and discipline specific nursing and midwifery Quality Care-Metrics across participating health services sites in the region. Ciara is also in her second year of a PhD scholarship and her doctoral research focuses on the impact of the nursing practice environment on the delivery of quality care and nursing sensitive patient outcomes in the Irish acute hospital setting. Ciara’s professional background is in acute nursing and post graduate nurse education. She has worked in a variety of clinical, management and education roles in the specialty of renal nursing in Beaumont Hospital, where she trained as a Registered General Nurse (2000) & Registered Nurse Tutor (2009).

90 15.25 – 16.25S1-7 Symposia – Thursday 7 April 2016 Symposia 1 - 7 Thursday 7 April 15.25 – 16.25

Symposium 1 Paper 1 services with a heavier focus on complaints management, clinicians sometimes suspended their Time: 3:25pm Is it safe to complain? own clinical judgement and at times avoided Room: Fintry (level 3) Exploring the relationship informed discussions with patients if this was between clinicians’ responses believed to carry the risk of the complaint Speaking truth to power: to patient complaints and becoming formalised or accelerated. understanding how concerns care quality Conclusion: The rationalisation of patient complaint about care and safety by clini- and complaints impact from cians, along with the effects of metrics-based ward to board Authors and Affiliation complaints reduction targets in some clinical Dr. Mary Adams, Florence Nightingale Faculty services, must be challenged before concerns Lead: of Nursing and Midwifery, King’s College raised by patients can drive ongoing quality Dr Aled Jones, Senior Lecturer, School of London. improvement work. Healthcare Sciences, Cardiff University Professor Jill Maben, Florence Nightingale Faculty of Nursing and Midwifery, King’s References The eminent safety researcher Professor College London. James Reason (1998) proposed that a ‘safe’ Luxford, K. (2012). ‘What does the patient know Professor Glenn Robert, Florence Nightingale organisational culture could be equated to an about quality?’ International Journal for Quality Faculty of Nursing and Midwifery, King’s ‘informed’ one. That is, a workplace culture in in Health Care 24(5): 439-440. College London. which employees understand, respect and are Maben J. et al (2012) ‘Exploring the relation- alert to information about the many ways in ship between patients’ experiences of care and Abstract which safety can be breached or compromised. the influence of staff motivation, wellbeing and Safe organizations, therefore, tirelessly utilize Background: Recent studies note the ‘predic- affect. Final report. Southampton: NIHR Service multiple sources of information in their efforts tive power of patient perceptions’ to identify Delivery and Organization Programme (2012). to improve their operational delivery and know significant quality and safety issues (Luxford Simmons, R. (2011). ‘Leadership and listening: where the safety ‘edge’ is, in order not to fall over 2012). Patient care complaints can be viewed as the reception of user voice in today’s public it. By extension, organisations that do not have a valuable resources for organisational and indi- services.’ Social Policy & Administration 45(5): safe organizational culture are often character- vidual learning (Simmons 2011). However little 539-568. ized as ignoring or overruling critical informa- is known about clinicians’ attitudes and behav- tion to continue with failing courses of action. iours towards complaints and how these are Sociological insights suggest that factors which shaped and enacted. contribute to an organisation’s journey towards Aims: To understand clinicians’ responses to Paper 2 and eventually over the safety edge often patient care complaints and identify key influ- ‘incubate’ over several weeks, month or years. ences on these. Whistleblowing about the During such ‘incubation periods’ systematic and Methods: Thematic analysis of 26 discursive mistreatment of older people: routine failures occur in collecting, interpreting interviews with clinicians working in 3 services and communicating information (such as the qualitative insights from a (emergency admissions; older people’s acute study of health and social concerns of staff and patients), creating deep medicine; intermediate community care) with pockets of organisational ignorance and ulti- high numbers of informal or informal patient care employees in Wales mately failure (Jones and Kelly, 2014a). care complaints, supplemented by organisa- Authors and affiliations Public inquiries and research studies have noted tional case study data, to examine how com- Dr Aled Jones, Senior Lecturer, School of the powerful cultural norms and defensive plaints are explained and acted upon. The Healthcare Sciences, Cardiff University routines that exist within organizations that interview data and organisational case studies Professor Daniel Kelly, RCN Chair, School of prevents patient or employee concerns and were part of a national study examining the rela- Healthcare Sciences, Cardiff University feedback from being raised, or used effectively tionship between patient experience of care and (Jones and Kelly 2014b). The symposium will staff wellbeing (Maben at al 2012). Abstract contribute to the debate about how organiza- Results: Across the 3 services, three common Background and aims of the study: tions and their employees respond to informa- scenarios of ‘patient complaint’ from clini- tion from patients and employees that may lead Employee ‘whistleblowing’ has emerged as an cians’ perspectives were identified as: ‘over important yet conflicted managerial mechanism, to improvements in the quality of service delivery demanding’; ‘emotional expression’; or and patient safety. Findings from three research aimed at keeping organizations and their ‘advantage seeking’. These scenarios shaped workers trustworthy and accountable. The aims projects undertaken in the UK will be presented, how clinicians’ responded to quality concerns focusing on research into handling patient com- of this research study was to explore the obliga- voiced by patients. These scenarios were influ- tions, attitudes, barriers and enablers that exist plaints, employee whistleblowing and the expe- enced by clinical setting; clinical team and by riences of executive nurses when relaying safety around whistleblowing in older people’s health wider organisational demands for ‘complaint and social care settings in Wales. and quality concerns to members of the board. management’. We will highlight the many deeply engrained Method: Semi structured interviews and focus cultural and relational issues that exist when Discussion: Hearing complaints was often groups (n=50) with registered nurses, nursing handling patient and employee concerns about emotive for staff, particularly in time-pressured assistants, allied health professionals and the quality of care. services. Clinicians’ responded to the event, ancillary workers working in hospitals, nursing/ rather than content, of patient care complaint. In

91 S1-715.25 – 16.25 Symposia – Thursday 7 April 2016 residential homes and domiciliary care teams. Paper 3 References Research ethics and governance approvals were Kelly D, Lankshear A, Jones A (2015) Stress and granted. Data were thematically analysed and Executive nurses’ experiences resilience in a post-Francis world - a qualitative interpreted with reference to relevant sociologi- of presenting quality and study of executive nurse directors in England cal theories. safety information at board and Wales. Final report to the GNC Trust, Results. Managers promoted an ‘open culture’ level: managing stress and London. to encourage the raising of concerns via team building resilience Duffield, C., Roche, M., Blay, N., 2011. The con- meetings and an ‘open door’ managerial ethos. sequences of executive turnover. Journal of Authors and affiliations However, participants described the emergence Research in Nursing 16 (6), 503-514. of workplace norms that seemed to be at odds Professor Daniel Kelly, RCN Chair, School of Francis, R., 2013. Report of the Mid -Stafford- with aims for developing an ‘open culture’. Healthcare Sciences, Cardiff University shire NHS Foundation Trust Public Inquiry. The Questionable norms were described as slowly Professor Annette Lankshear, School of Stationery Office, London. emerging to a point where staff could not Healthcare Sciences, Cardiff University recognize that the ‘abnormal had become the Dr Aled Jones, Senior Lecturer, School of normal’. Healthcare Sciences, Cardiff University Decisions about what to do when staff were confronted with sub-standard practices were Abstract mediated by staff interaction. Wrongdoing that Background and research question: was perceived as ‘less serious’ would result in Directors of Nursing in England and Wales are staff raising concerns directly with colleagues, often the most senior nurses within an organi- or indirectly through the use of humour or sation and may be considered elites in terms of innuendo. No guidance was sought from policy NHS structure. It is to these individuals that staff documents or codes of conduct. and patient concerns may eventually be directed, Conclusions and implications: Better once they are raised, heard and moved upwards understanding of workplace cultures and the through the NHS bureaucracy. It is important to nature of interactions that occur between note that there is dearth of research exploring employees are key to developing a better under- the role of nurse executives in this regard in the standing of whistleblowing behaviours. UK over the last decade. This is despite relatively Participants made reference to the role of high turnover and vacancy rates. The research personal ethics in decisions about reporting questions focused on the experiences of nurse mistreatment, making no reference to codes of executives working at board level and the strate- conduct or regulatory bodies. gies and/or processes deployed to ensure their views and concerns about quality and safety Establishing and maintaining positive workplace were taken into account and treated seriously at values and norms through regular communica- board level. tion with staff, rather than additional external regulation, seems key to establishing an effective Design: Qualitative telephone interviews using whistleblowing and reporting culture. semi-structured interviews. Participants: Purposive sample of 40 executive References board nurses working in NHS England and Wales. Kelly, D. M. and Jones, A. (2013) When care is needed: The role of whistle blowing in promoting Methods: Semi-structured interviews followed best standards from an individual and organi- by a process of thematic data analysis using sational perspective. Quality in Ageing 14 (3) NVivo10 and feedback on early findings from 180-191 participants. Jones, A., & Kelly, D. (2014). Deafening silence? Results: Our findings are presented under three Time to reconsider whether organizations headings: the experiences of executive nurses are silent or deaf when things go wrong. BMJ working with supportive, engaged boards; their Quality & Safety, 23(9), 709-713. experiences of being involved with unsupport- ive, avoidant boards with a poor understanding Jones, A., & Kelly, D. (2014). Whistle-blowing of safety, quality and the executive nursing role and workplace culture in older peoples’ care: and the strategies deployed by executive nurses qualitative insights from the healthcare and to ensure that the nursing voice was heard at social care workforce. Sociology of Health & board. Two prominent and interrelated dis- Illness, 36(7), 986-1002. cursive strategies were used by participants; first briefing and building relationships and preparing and second delivering a credible case. Conclusions: These highly positioned nurses can provide invaluable advice and support to boards around matters of quality and safety. However, the work of nurse executives remains an under-research area and more research is required to better understand the ebb and flow of power and influence at play within hospital boards.

92 15.25 – 16.25S1-7 Symposia – Thursday 7 April 2016 Symposium 2: In our experience, using standardised strategies carried out, can seem to be sidelined (Aveyard, can limit rather than progress the identification Payne and Preston 2016). Additionally, some Time: 3:25pm of keywords and search terms. A good example students accept all papers for inclusion in their is use of Population, Intervention, Comparison, study, irrespective of quality whilst others reject Room: Sidlaw (level 3) and Outcome (PICO) (Richardson et al., 1995). papers on pre-determined quality indicators. PICO enables identification of keywords for Doing a literature review- Aim: In this paper we will consider the different questions about effectiveness (outcomes) of an options for incorporating critical appraisal in a approaches to searching, intervention, but using it to determine search review with a view to optimising the use of the critical appraisal and terms for many health care research questions critical appraisal carried out. is akin to fitting a square peg in a round hole. analysis in undergraduate Methodological Discussion: There are The same is true when using adaptations of this many approaches to critical appraisal in the and postgraduate literature strategy, often resulting in a ‘force fit’. reviews methodological literature (Booth, Papaioannou Aim: In this paper, we will propose a simplified & Sutton 2012) and various tools are available ‘List, Keep and Delete’ approach for identifying to facilitate quality assessment of research and Lead: search terms. Dr Helen Aveyard, Senior Lecturer, Oxford other evidence. Students are generally familiar Brookes University, United Kingdom Methodological Discussion: In this with a range of these tools. What they are less approach, students are encouraged to identify familiar with is how to proceed once the critical Doing a literature review is a common and note the keywords in their research question. appraisal has been undertaken. We will discuss component of many undergraduate and post- Words that would not retrieve relevant litera- the different approaches to the use of critical graduate courses and those undertaking a ture are deleted, with an emphasis on delete appraisal within a literature review and the review tend to follow the structure of a sys- to ensure a sensitive search. For example, key theoretical basis for these. We will then present tematic review, even if they do not achieve the search terms for addressing the question ‘What examples from various published systematic same level of searching, analysis and synthesis is the role of patient education in optimising the reviews to determine how these decisions have as a typical Cochrane review. In this symposium, care of patients receiving oral chemotherapy?’ been made in practice. Their relevance to under- we will explore three aspects of the systematic are ‘patient education’ AND ‘oral chemotherapy’. graduate and post graduate reviews will then be review method; searching, critical appraisal We present examples to illustrate the limitations considered. and data analysis. We will consider how these of standardised search strategies, and propose Conclusion: This paper will emphasise that methods can be facilitated at undergraduate and the List, Keep, Delete approach. critical appraisal is not a ‘stand alone’ activity but postgraduate study. It is anticipated that this that the purpose of the appraisal is to inform the symposium will generate discussion about the Conclusion: This approach has arisen from ongoing analysis of the literature. (251 words) methods that can be used at both undergradu- conducting our own research and experience of ate and postgraduate level study in a literature supervising undergraduate, postgraduate and review so that those doing, or engaged in the doctoral student systematic reviews. We present References supervision of research students, can facilitate this as an alternative method of identifying Aveyard H, Payne S, Preston N J (2016) A post- their students to use the most appropriate and search terms for health care research questions. graduate’s guide to doing a literature review in theoretically defendable approaches in their health and social care. (in press) Maidenhead, research design. References Open University Press. Cooke A, Smith D, Booth A. (2012) Beyond Booth A, Papaioannou D, Sutton A (2012) Sys- PICO: the SPIDER tool for qualitative evidence tematic approaches to a successful literature synthesis. Qual Health Res. 22(10):1435-43. doi: review. London, Sage Paper 1 10.1177/1049732312452938. Using ‘List, keep and delete’ Richardson WS, Wilson MC, Nishikawa J, to identify search terms Hayward RS. (1995) The well-built clinical question: a key to evidence-based decisions. ACP Paper 3 for systematic health care J Club. 123(3):A12-3. reviews Using the most appropriate method of data analysis in a Authors and affiliation review Verna Lavender, PhD, PGCHTE, BSc(Hons) Paper 2 RGN, Senior Lecturer, Oxford Brookes Authors and affiliation University; Michael Mawhinney, MSc, Using critical appraisal Helen Aveyard, PhD, PDCE MA, BSc(Hons) BSc(Hons), PhD student, Oxford Brookes and quality assessment in a RGN, Senior Lecturer, Oxford Brookes University; Helen Aveyard, PhD, PDCE MA, review University and Nancy Preston PhD, BSc(Hons) BSc(Hons),RGN, Senior Lecturer, Oxford RGN, Senior Lecturer, Lancaster University Brookes University. Authors and affiliation Helen Aveyard, PhD, PDCE MA, BSc(Hons) Abstract Abstract RGN, Senior Lecturer Oxford Brookes Background: There are many approaches to Background: Standardised strategies aim to University and Nancy Preston PhD, BSc(Hons) data analysis when doing a literature review. ensure rigour in framing research questions RGN, Senior Lecturer, Lancaster University At undergraduate study, students typically and identify keywords to systematically search undertake form of thematic analysis. At post- literature (Cooke, Smith and Booth, 2012); Abstract graduate level, more detailed approaches are however robust research questions about health Background: Students typically undertake possible and students are expected to engage care are also commonly developed from prac- a critical appraisal to assess the quality of the with a particular approach to either meta tice-focussed problem identification, rather papers included in their literature review. Many analysis or thematic analysis (Aveyard, Payne than using standardised methods. Health care students undertake a critical appraisal of their and Preston 2016). research questions are often open questions that papers commonly but do not use explicitly this in Aim: In this paper, we will examine the various require a comprehensive and sensitive search. their ongoing analysis so that the appraisal, once approaches to data analysis, including meta-eth-

93 S1-715.25 – 16.25 Symposia – Thursday 7 April 2016 nography, meta-synthesis, thematic synthesis Symposium 3: All outcomes were validated measures. Primary and critical interpretative synthesis. outcomes were: 1) Patients’ evaluations of Methodological Discussion: There are Time: 3:25pm nurse communication; 2) Nurses’ perceptions of shared philosophy of care; and 3) Nurse various approaches to the analysis of literature Room: Carrick (level 1) in a review (Melendez- Torres, Grant & Bonell, reported emotional exhaustion. 2015) most of which can be categorized as a A multi-methods evaluation Results: Data were collected from 691 patients, form of thematic analysis or a numerical meta 177 nursing staff, and 15 senior charge nurses. analysis. Students are generally familiar with of a locally augmented We found statistically significant improvements the general principles of a thematic analysis but version of Releasing Time in two of the study’s primary outcomes: patients’ less so with the nuances of the many different to Care, The Productive experiences/evaluations of nurse communica- approaches which are used within different Ward. Findings from a test of tion, and nurses’ shared philosophy of care. In review designs. Furthermore, there can be a effectiveness; lessons learned addition, significant improvements were found perception that a meta-analysis is too complex in: patients’ overall rating of ward quality; even at postgraduate level. We will discuss the about implementation in the nurses’ positive affect; and several items relating different approaches to the analysis of literature acute ward setting; and about to nursing team climate. in a review and consider how students can adopt gathering patient experience Discussion: We believe this is one of the most the most appropriate for their review. We will data robust evaluations of a ward based intervention then consider examples taken from published to date. Findings suggest that the intervention literature reviews, focusing on how the methods Lead: can generate positive impacts for both staff and are used in practice. Dr Carina Hibberd, Stirling University, United patients across a diversity of wards. The inter- Conclusion: This paper will emphasise the Kingdom vention included an augmentation that address- importance of using the most appropriate ing three components around ward culture. We Improving the quality of care on acute wards approach to data analysis within a literature cannot conclude that our findings apply fully to is an international priority. In common with review. (242 words) the traditional version of releasing time to care. other complex problems, this will need multiple remedies. ‘Releasing Time to Care - The Produc- Conclusions: An augmented version of RTC References tive Ward’ (RTC(TM)) has been implemented can have significant benefits for both staff and Aveyard H, Payne S, Preston N J (2016) A post- across the UK and is closely related to inter- patients. Further research is needed into the graduate’s guide to doing a literature review in ventions in the USA and Canada. Through 11 longevity of effect of the intervention and how health and social care. (in press) Maidenhead, modules and expert facilitation, it aims to work benefits can be sustained over time. Open University Press. with nurse teams to improve process and patient Melendez- Torres GJ, Grant S, Bonell C (2015) A centred aspects of care. One Scottish health- systematic review and critical appraisal of quali- board has augmented the teamwork aspects of tative metasynthetic practice in public health to RTC(TM) (here called RTC(TM)-Plus). Here we Paper 2 develop a taxonomy of operations of reciprocal discuss aspects of a multi-method evaluation of A realist evaluation of translation. Research Synthesis Methods DOI RTC(TM)- Plus across 15 acute, adult wards. 10.1002/jrsm.1161 an augmented version of releasing time to care (‘RTC(TM)-Plus’). Paper 1 Authors and affiliation Evaluation of an augmented Edward Duncan, UK ‘Releasing time to care’: Findings from a Stepped Abstract Wedge Trial Background: Various complex policy interventions have been developed nationally, and Authors and affiliation sometimes adapted locally, to improve patient Brian Williams, UK experience and quality of care. One of the most well-known is ‘Releasing Time to Care’ (RTC) Abstract [1]. We conducted a Realist Evaluation [2] of an Background: A number of complex policy augmented version of RTC (‘RTCTM-Plus’), in interventions and strategies have been developed one NHS board from 2012 to 2015. The evalua- nationally, and sometimes adapted locally, to tion was conducted in parallel to a step-wedged improve patient experience and overall quality evaluation of the intervention. of care. One of the most well-known is ‘Releasing Aims: To assess the key contextual features and Time to Care’ (RTC). We evaluated the effective- mechanisms of action that appear to explain and ness of an augmented version of RTC (‘RTCTM- account for RTCTM-Plus outcomes. Plus’). Methods: Eighty-two semi-structured inter- Aims: To assess the impact of the interven- views were conducted with ward staff who tion on patient and staff experience, and, where received the intervention; RTCTM-Plus facili- possible, subsequent behavioural and clinical tators. A group interview was conducted with outcomes study research assistants (n=4) who collected Methods: A non-randomised stepped wedge ward data. Data were analysed iteratively using trial across 15 wards and two hospitals in from Framework Analysis [3]. 2012 to 2015. Data on staff and patient outcomes Results: To differing degrees in different were collected pre and post intervention and at wards, RTCTM-Plus had a positive impact on discharge from wards and 4-6 weeks follow up. practice. A dynamic relationship exists between

94 15.25 – 16.25S1-7 Symposia – Thursday 7 April 2016 various contextual features and mechanisms of declined, the main reason (where specified) was Symposium 4: action. There were changes both in content and feeling too unwell. in the external facilitation of RTCTM-Plus at a Using the independent-samples Mann-Whitney Time: 3:25pm ward level throughout the study. Participants U-test there were significant differences between Room: Harris 1 (level 1) generally perceived a benefit in the RTCTM-Plus the patient group recruited to IPEC and the modules, however, some participants felt that hospital data: the appropriateness of a module to a particular Research on culture: Age- IPEC median age of 66 years (IQR 53-75), ward context was not taken into account. The promoting individuality at the hospital median 64 years (IQR 46-78), p<0.001. relationships between RTCTM-Plus facilitators, bedside the senior charge nurse (SCN), and ward staff, SIMD deprivation decile - IPEC median 7.0 (IQR 4.0-8.0) vs Hospital median 6.0 (IQR 3.0-8.0) appeared fundamental to participants’ success- Lead: p=0.007. ful intervention engagement. Professor Carol Haigh, Manchester Discussion: We believe that there is strong Using Pearson Chi squared test, females appear Metropolitan University, UK likelihood that RTCTM-Plus will have similar to be under-represented - IPEC 48% (704/1486) This symposium brings together the findings of levels of outcome in other Health Board areas in patients were female vs hospital data 53% 2 doctorate level studies and how they brought wards with similar ecosystems: SCNs with good (5502/10418), X2 =11.171, (df1) p<0.01. about changes in the way lectures and sessions leadership skills advocating for the interven- Conclusion: The study appeared to over-rep- related to cultural care is now delivered to tion; skilled facilitators; and ward suitability and resent older people, but under-represented students with a future in the health and social ‘readiness’ for the intervention. females and people from more socially deprived care professions. Conclusion: The effectiveness of RTCTM-Plus areas. Recruitment strategies are discussed. The first 2 papers will discuss how research may depend on selecting wards with an appropri- The overall recruitment rate likely reflected results exposed the shortcomings of some extant ate ecosystem. One size does not fit all. Further that patients were approached whilst still on knowledge about communities often defined by additions to the intervention may be required to the wards, but this strategy related to evaluating their ethnicity and culture. maximise the benefit that can be achieved. experience of the ward rather than the overall hospital. The third paper will provide an explanation of the changes made within the curriculum of the B.Sc. (Hons) in Nursing and the Foundation Paper 3 degree for Health and Social Care as a consequence of this newer understanding. Recruiting patients into a large hospital survey - methodological challenges Paper 1 and solutions The south Asian culture of Authors and affiliation care: Assumptions about Debbie Baldie, UK informal care

Abstract Author Background: Patients’ ratings of their experi- Hetal Patel, Manchester Metropolitan ence of nursing care (HCAHPs survey) on partic- University, UK ipating wards were used as a primary outcome in the IPEC study. Patient experience surveys are Abstract: now considered a useful method, overcoming When considering informal care in the lives some of the limitations of satisfaction surveys1. of people of South Asian (SA) heritage, the Whilst high response rates are advised, to reduce community and family have historically been the risk of non-response bias2, achieving this recognised to be prominent providers. Phrases with patients who are ill in hospital is challeng- such as ‘they look after their own’ have been asso- ing. ciated with discussions about the expectations Aims: This paper outlines recruitment of of care from family and community members overnight patients within this large hospital leading inevitably to assumptions about who survey study; examining sources of sampling will care and how they will care. An assumption bias. We discuss methodological and practical associated with the above phrase is that care is issues associated with recruitment, testing the applied to all caring relationships, thus a dis- effectiveness of strategies to enhance inclusivity. tinction between caring for a spouse, child or Method: We compared participant details with parent is not made in UK studies (Adamson and population characteristics (concurrent NHS Donovan, 2005; Bowes and Wilkinson, 2003; data) to understand the sample sociodemo- Cowan, 2014; Katbamna et al., 2004; Parveen graphic representativeness. We also compared et al., 2011; Parveen and Morrison, 2009). with other relevant surveys. Secondly, the above phrase also implies there is To understand if experience itself was associ- access to a large pool of people from the extended ated with participation we correlated experience family who are available to care because SA’s ratings with recruitment rates. Lastly we themed live in multigenerational households (Lindesay patient refusal reasons. et al., 1997). These views of informal family care practices within the SA community appears sim- Results: The study recruited 1471/6794 plistic and does not necessarily reflect the expe- (21.7%) of eligible patients. 1181 (17.4%) patients

95 S1-715.25 – 16.25 Symposia – Thursday 7 April 2016 riences of informal care from the perspective of Paper 2 Isaacson, 2014. Foronda et al, 2015) suggest those performing care. that the complexity of culture and its meaning This paper will address these assumptions Patient perspective regarding for teaching and professional practice warrants by illustrating how Gujarati-speaking Indian culturally appropriate care further consideration; as previous formulaic Asians living in the UK, who are caring for an approaches to delivering culturally competent elderly relative, experience informal care. Author: care has proved insufficient in meeting the needs of patients. There is a realisation that cultural Data for this research was gathered through 21 Gayatri Nambiar-Greenwood, UK care needs to mean more than the acquisition interviews with 10 families, between March 2011 of cultural facts and customs about the diverse and August 2012. The family group consisted of Abstract: population we nurse (Isaacson, 2014). three generations; the older person, the carer, This paper will present the findings of a Contemporary knowledge in this area concedes and the carer’s adult child. The interviews were Doctorate level Gadamerian Hermeneutic study that the complexity of its meaning has meant analysed using Interpretive Phenomenological on how patients perceive culturally appropriate that, for educators and practitioners alike, that Analysis (IPA; Smith et al., 2009). This paper care. will present qualitative data using case study teaching and understanding ‘how to’ provide Within this study, a total of 21 participants examples, across two of the three generations. cultural care and translating into best practice from the 5 main ethnic groups that made up the at the bedside has proved more challenging than population of the North West of England (White previously thought (Kleinman & Benson, 2006). References: English, White minorities, South Asian, African- With regards to the previous two research -Adamson, J. and Donovan, J. (2005) ‘’Normal Caribbean and Chinese/Oriental group) were studies, the focus of this paper will look at how disruption’: South Asian and African/ Caribbean interviewed. The semi-structured interviews consideration of a slight paradigm shift from relatives caring for an older family member in asked a variety of questions regarding what they culturally competent care to culturally appropri- the UK.’ Social Science and Medicine, 60(1) pp. would expect from nurses in the way they would ate care has informed the teaching practice and 37-48. expect cultural care to be delivered. Analysis was curriculum content within the pre - registra- carried out utilising Attride-Stirling’s (2001) -Bowes, A. and Wilkinson, H. (2003) ‘‘We didn’t tion nursing degree and the foundation degree thematic networks. Two global themes emerged know it would get that bad’: SA experiences of in health and social care courses at Manchester from data analysis. dementia and service response’ Health and Metropolitan University. Social Care in the Community, 11(5) pp. 387-396. Generally, the requirements of the participants -Cowan, M. (2014) ‘The lived experiences of the (be they from the majority or black and minority References Sikh population of south east England when ethnic group) were less ‘culture-specific’ than Foronda, C., Bapitiste, D. and Ousman, K. (2015) caring for a dying relative at home.’ International anticipated. The main focus of the participants ‘Cultural humility : A concept analysis’, Journal Journal of Palliative Nursing, 20(4) pp.179-186. responses centred around their expectations of more positive inter-personal communication of Transcultural Nursing, pp. 1-8. -Katbamna, S., Ahmad, W. Bhakta, P., Baker, R. skills and person-centred care. Isaacson, M. (2014) ‘Clarifying concepts: and Parker, G. (2004) ‘Do they look after their Cultural humility or competency’, Journal of own? Informal support for South Asian carers.’ Having set the scene, the paper will then reflect Professional Nursing, Vol.30, pp.251 -258. Health and Social Care in the Community, 12(5) on what was found within this study in relation pp. 398-406. to the cultural care theories that influence Hogg, C. and Holland, K. (2010) Cultural concepts around cultural care. awareness in nursing and health care. 2nd -Lindesay, J., Jagger, C., Hibbett, M., Peet, S. Edition. London: Taylor and Francis and Moledina, F. (1997) ‘Knowledge, uptake and availability of health and social services among References: Kleinman, A. and Benson, P. (2006) ‘Anthropol- Asian Gujarati and White elderly persons.’ Attride-Stirling, J. (2001) ‘Thematic networks: ogy in the clinic: The problem of cultural com- Ethnicity and Health, 2(1/2) pp.59-69. an analytic tool for qualitative research’. Quali- petency and how to fix it’, PLoS Medicine, Vol.3, (10), pp. 1673 -1676. -Parveen, S., Morrison, V. and Robinson, C. tative Research, 1(3) pp. 385-405. (2011) ‘Ethnic variations in the caregiving role: a qualitative study.’ Journal of Health Psychology, 16(6) pp. 862-872. Paper 3 -Parveen, S. and Morrison, V. (2009) ‘Predictors of familism in the caregiving role: a pilot study.’ Moving from cultural Journal of Health Psychology, 14(8) pp. 1135- competency to culturally 1143. appropriate care: Translating -Smith, J., Flowers, P. and Larkin, M. (2009) Interpretative phenomenological analysis: research, theory to patient theory, method and research. London: Sage bedside Publications Ltd. Author Dr.Eula Miller, UK

Abstract: Increasingly, Cultural competency in health care settings has been a fashionable term for researchers, clinicians and practitioners for a number of decades. In past - times culture within health - care was often synonymous with ethnicity, nationality and language, (Holland & Hogg, 2010). Current ongoing research within MMU, in con- currence with others (Kleinman & Benson, 2006.

96 15.25 – 16.25S1-7 Symposia – Thursday 7 April 2016 Symposium 5: Paper 1 Paper 2 Time: 3:25pm Evidence-based transitional Benchmarks for transition: care: a Cochrane review how active dissemination Room: Harris 2 (level 1) facilitates uptake in practice Can research change practice Author Fiona Campbell, United Kingdom; Katie Biggs, Author where policy has failed: United Kingdom Susie Aldiss, UK transition from child to adult centred services Abstract Abstract Background: There is evidence that the Background: In spite of the growing evidence Lead: process of transition from child to adult health base, the implementation of transitional care Susie Aldiss, Department of Children’s services is often associated with deterioration in remains a challenge and young people/parents Nursing, London South Bank University, UK health (e.g. Lotstein, 2013). Transitional care is report poor experiences (Care Quality Com- Despite the growing evidence base and apparent the term used to describe services that seek to mission (CQC), 2014). The CQC recommend universal acceptance of the concept of transi- bridge this ‘care gap’. In order to develop appro- that existing good practice guides are followed tion, the implementation of transitional care priate services for adolescents, evidence of what to ensure young people are properly supported remains a challenge. There are numerous policy works is needed. through transition. Benchmarks offer a guide/ documents in the United Kingdom (UK) that can Aim: To evaluate the effectiveness of inter- standards that services can measure themselves be charted from 2003-2014 that go some way in ventions designed to improve the transition of against to see how they are doing, and where attempting to tackle gaps in service provision; care for adolescents from child to adult health they can improve (Aldiss et al 2015). however it seems transition services are still services. Aims: To actively disseminate the benchmarks very much professionally driven and not policy Methods: The Cochrane Central Register of for transition to facilitate their use in practice. driven. The system-wide changes referred to Controlled Trials 2015, MEDLINE, EMBASE, in the ‘Children and Young People’s Health Methods: Dissemination of the benchmarks PsycINFO and Web of Knowledge were searched Outcomes Strategy’ (Department of Health, began with their launch at a conference in up to 1 May 2015. Bibliographic searches were 2012) are still not embedded in either health or December 2014. Between May and September undertaken and experts/study authors contacted social care. There remains marked variability 2015, four sites were involved in piloting the for additional studies. Inclusion criteria were: in transitional care (Care Quality Commission, benchmarks: meetings attended by approxi- randomised controlled trials (RCTs), controlled 2014) and in spite of the commitment shown mately 130 professionals, from specialties before and after studies and interrupted time by the few engaged in implementing changes in spanning child and adult health services. In series studies that evaluated the effectiveness of practice and the large amount of guidance that small groups, teams discussed the indicators any intervention aiming to improve the transi- is available, it is clear that there is still much to of best practice for each benchmark factor and tion of care for adolescents from child to adult be done to improve care for young people. The recorded the evidence they would use to demon- health services. Two review authors extracted transition from child to adult services is a crucial strate achievement: feedback was collated from data from the included papers. time in the health of young people who may each site. potentially fall into a poorly managed ‘care gap’. Results: 17,208 records were screened, 67 were Results: In summary the benchmarks: 1) accessed as full text articles and four were eligible What we aim to show here is that strategic, provided a useful focus for more formal and for inclusion. These four RCTs explored different patient focussed research has the power to shared discussions between child and adult types of interventions designed to prepare ado- influence practice, where policy over the last teams, 2) allowed teams to consider what is lescents for transition by improving knowledge 10 years has failed to do so. This symposium currently in place within their service and what and self-management skills, and providing brings together researchers committed to they would like to achieve in the future 3) helped support (a cognitive-behavioural workshop improving the practice of transitional care. The teams to see that some processes are informal/ program, a one-to-one nurse-led teaching symposium lead will set the scene in terms of not well documented and needed formalising 4) session along with use of ‘health passports’, a the landscape of transitional care and timeline helped services to share good practice. web/SMS-based educational intervention and of policy documents. Reference will be made to Discussion and Conclusions: Working with telephone-based support). Two studies reported evidence of the need to change, and what results sites to pilot the benchmarks has demonstrated improved knowledge of condition and one also from poor transitional care. The 3 papers that their usefulness in facilitating dialogue within reported improved self-efficacy and confidence. follow are exemplars of research that seek to teams about improving transition and in sharing understand patient, professional and organi- Discussion and Conclusions: The evidence good practice. The feedback received and types sational factors that together, offer new direc- available is very limited and reflects the com- of evidence listed by professionals was collated tions to inform and support service delivery. The plexities of evaluating transitional care inter- and used to produce a ‘practical guide’ for pro- symposium lead will conclude in terms of new ventions. Since too few studies were eligible fessionals on using the benchmarks for transi- learning offered and facilitate discussion. for inclusion, no firm conclusions can be drawn tion. The active dissemination has ensured quick about the effectiveness of the interventions. uptake of the benchmarks in a number of sites Future evaluations of transitional care interven- across the UK. tions perhaps need to use designs other than RCTs which are more suitable to evaluating References: complex interventions. Aldiss S, Cass H, Ellis J, McCutcheon D, Rose L, Gibson F Transition from child to adult References: care-’its not a one-off event’: development of Lotstein Debra S, Seid Michael, Klingensmith benchmarks to improve experience Journal of Georgeanna, Case Doug, Lawrence Jean M, Pediatric Nursing 30(5) 38-47 Pihoker Catherine, et al. Transition From Care Quality Commission (2014) From the pond Pediatric to Adult Care for Youth Diagnosed into the sea: Children’s transition to adult health With Type 1 Diabetes in Adolescence. Pediatrics services http://www.cqc.org.uk/content/teen- 2013;131(4):e1062-70.

97 S1-715.25 – 16.25 Symposia – Thursday 7 April 2016 agers-complex-health-needs-lack-support-they- References Symposium 6: approach-adulthood Boyatzis, R.E., 1995. Transforming Qualita- tive Information: Thematic Analysis and Code Time: 3:25pm Development, First Printing edition. ed. Sage Room: Ochil (level 1) Publications, Inc, Thousand Oaks, CA. Paper 3 Farre, A., Wood, V., Rapley, T., Parr, J.R., Improving the delivery of Factors affecting the Reape, D., McDonagh, J.E., 2015. Developmen- healthcare through clinical implementation of hospital tally appropriate healthcare for young people: a scoping study. Arch. Dis. Child. 100, 144-151. academic collaboration: the wide developmentally doi:10.1136/archdischild-2014-306749 Glasgow model appropriate healthcare for Hepburn, C.M., Cohen, E., Bhawra, J., Weiser, young people N., Hayeems, R.Z., Guttmann, A., 2015. Health Lead: system strategies supporting transition to adult Dr Susan Kerr, Reader in Public Health, Author care. Arch. Dis. Child. 100, 559-564. doi:10.1136/ Department of Nursing & Community Health, Lorraine Forster, UK archdischild-2014-307320 Glasgow Caledonian University, UK Acknowledgements The proposed symposium will focus on the Abstract setting up of clinical academic initiatives in This presentation summarises independent nursing, with the aim of building research Background: Developmentally appropri- research funded by the National Institute for capacity and capability and improving health- ate healthcare (DAH) for adolescents and Health Research (NIHR) under its Programme care delivery. young adults (AYA) has been described as a Grants for Applied Research scheme: RP-PG- key principle underpinning the practice of ado- 0610-10112. The views expressed in this pres- The introductory paper will set the scene by dis- lescent medicine. In this context, transition is entation are those of the authors and not nec- cussing the development of a formal partnership understood as intrinsic to the overall clinical essarily those of the NHS, the NIHR or the arrangement between NHS Greater Glasgow implementation of DAH for AYA (Farre et al., Department of Health. & Clyde and Glasgow Caledonian University’s 2015). Department of Nursing & Community Health. Aims: (i) To discuss key factors affecting the Two papers will follow which describe the implementation of DAH for AYA, and (ii) to development and implementation of the role of consider how these may inform new directions Clinical Academic Research Fellow and the NHS in the transition agenda. Manager’s role in supporting a research culture in nursing. Methods: We undertook a qualitative multi- site ethnographic study across three hospitals The symposium will be chaired by Ms Mari in England including non-participant observa- Brannigan, Director of Nursing - Partnerships, tions in clinics, wards and meetings; and semi- NHS Greater Glasgow & Clyde. structured interviews with health professionals and managers. Data analysis followed the broad principles of thematic analysis (Boyatzis, 1995). Paper 1 Results: 65 interviews (41 with health professionals and 24 with managers) and non-partic- Strategic decisions and ipant observations (involving 103 health profes- partnership working. sionals and 72 managers) were conducted across the three sites between June 2013 and January Authors 2015. The main factors identified were: lack of Dr Rhona Hogg, Clinical Nurse Lead, Applied a clear understanding and different assumptions Research and Development, NHS Greater of DAH as an approach to clinical work; availa- Glasgow & Clyde bility and engagement with policy/guidance; the role of locally based champions and research; Dr Susan Kerr, Reader in Public Health, the view of AYA as a low priority population; the Department of Nursing & Community Health, level of AYA involvement; availability of relevant Glasgow Caledonian University (GCU) training; resource and space allocation and Professor Joanne Booth, Professor of organisational ability to sustain good practice; Rehabilitation Nursing, Department of communication and teamwork; differences Nursing & Community Health, GCU between paediatrics and adult care. Dr Carol Emslie, Reader, Department of Discussion: Critical challenges and policy Nursing & Community Health, GCU gaps still need to be addressed, many at a health Dr Karen Lorimer, Senior Research Fellow, system level, to improve transition (Hepburn et Department of Nursing & Community Health, al., 2015). Similarly, factors affecting the imple- GCU mentation of DAH both belong and go beyond the limits of a single organisation. However, Abstract successful implementation of DAH may in turn Background: NHS Greater Glasgow & Clyde enable consistency of practice in transitional (NHSGGC) and Glasgow Caledonian University care. (GCU) have recently launched research strat- Conclusions: Understanding DAH and its egies [1, 2] that focus, in part, on developing implementation can offer new routes to a pro- stronger relationships between academia and fessional culture in which transition is routine clinical practice. In this session we will discuss practice. the clinical academic initiatives which have been

98 15.25 – 16.25S1-7 Symposia – Thursday 7 April 2016 set up and the intended benefits to patient care Paper 2 Paper 3 and to each organisation. Progress: Three two-year Clinical Academic Developing and evaluating The clinical academic Research Fellowships (CARFs) have been estab- the clinical-academic role: the research nurse and the lished, funded jointly by GCU and NHSGGC. The view from within. manager: a symbiotic CARFs work two days per week at the university, relationship with their professional appraisal and develop- Authors ment plan undertaken jointly with university Dr Ruth Astbury, Clinical Academic Research Author and clinical managers. Mechanisms are in place Fellow, NHS Greater Glasgow & Clyde Ms Lorraine Forster, Nurse Consultant and to facilitate communication, joint planning and (NHSGGC)/ Glasgow Caledonian University Head of Profession (Sexual Health), NHS evaluation of the posts among the CARFs, their (GCU) Greater Glasgow & Clyde academic and clinical managers and both organ- Mr Andrew McPherson, Clinical Academic isational leads. Research Fellow, NHSGGC/GCU Abstract Research apprenticeships have also been Ms Jenny Dalrymple, Clinical Academic Background: The role of Clinical Academic established to allow practitioners to work with Research Fellow, NHSGGC/GCU research teams at GCU, usually for two days/ Research Fellow (CARF) brings opportunities month for six months. This enables practition- for nurses to work in partnership with managers Abstract ers to develop research skills and also provides and academics to build relationships that academics with insight into current concerns Background: As noted previously, NHS facilitate and allow a collaborative approach to around patient care and service delivery. Greater Glasgow & Clyde and Glasgow Caledo- enquiry that can inform and support the delivery nian University have recently launched research of evidence based practice. Policy drivers [e.g. In addition to the above, a Research Group has strategies which focus on clinical academic 1,2,3] can be used to support the research been set up in each clinical area within NHSGGC collaboration. This has led to the setting up of ambitions of individual nurses and managers to establish research priorities, co-ordinate three jointly funded Clinical Academic Research and to link research, education and practice. research activities and maximise implementa- Fellow (CARF) posts for two years from August CARFs are at the forefront of the interface tion of research findings to improve patient care. 2015. between academic theory and knowledge This facilitates joint working between research transfer and have opportunities to engage mean- active/ interested practitioners and academics. Purpose: This session will report on the collective aims of the three Fellows, their academic ingfully with registrants thereby positively influ- These initiatives are fostering a research culture supervisors, clinical managers, and the academic encing care delivery. among NHSGGC nurses and midwives and and NHS strategic leads for the scheme. The Purpose: This session will focus on how the promoting joint research activities in priority framework [1, 2] and the quantitative and quali- CARF and the nurse manager can work together areas, which in turn should increase the impact tative methods that are being used to support effectively to create a culture of research activity of research. a process evaluation of the CARF roles will be to develop and inform the current evidence base. Challenges: Some nurses and midwives are discussed, with findings from the baseline quali- As a Nurse Consultant, Professional Leader and unable to apply for research opportunities tative review being presented. NHS manager, I am committed to developing because of workload pressures, highly special- As the three CARFs work within different and supporting nursing research capacity and ised roles and lack of management support. This clinical areas and are currently linked to capability across the spectrum of involvement, inequality of access needs to be addressed. separate academic teams within the University, including the role of Clinical Academic Research There is a need for substantive clinical academic a range of experiences are becoming evident Fellow. This joint working has a direct relevance posts but the clinical component at each level which will be shared during the session. The use to nursing practice and actively seeking opportu- requires consideration. of social media as a reflective tool for the CARFs nities for nurses to have meaningful engagement to share their experiences with colleagues within with education and associated research activities References academia and practice and with patients will will support partnership approaches, ensuring also be discussed. evidence into practice and associated succession 1. NHS Greater Glasgow & Clyde (2014) Nursing planning. & Midwifery Research Strategy 2014-2019. NHSGGC, Glasgow. References Conclusion: It is important to consider how to keep motivated research aware practition- 1. Cooke, J. (2005) A framework to evaluate 2. Glasgow Caledonian University (2015) Uni- ers ‘in practice’ and the CARF role is one way research capacity building in health care. BMC versity Research Strategy, GCU, Glasgow. of achieving a win-win solution. The challenge Family Practice, 6:44. doi:10.1186/1471-2296- is sometimes to convince others of the inherent 6-44 value in roles where nurses work in partnership 2. Latter S, MacLeod Clark J, Geddes C, Kitsell with colleagues in Higher Education to support F. (2009) Implementing a clinical academic and promote research activity. career pathway in nursing: criteria for success and challenges ahead, Journal of Research in References Nursing, 14(2):137-148. 1. Scottish Government (2014) Setting the Direction for Nursing & Midwifery Education in Scotland, Scottish Government, Edinburgh. 2. NHS Greater Glasgow & Clyde (2014) Nursing & Midwifery Research Strategy 2014 - 2019, NHS Greater Glasgow & Clyde, Glasgow. 3. Scottish Government, 2010. The Healthcare Quality Strategy for NHSScotland, Scottish Gov- ernment, Edinburgh.

99 S1-715.25 – 16.25 Symposia – Thursday 7 April 2016 Symposium 7: Paper 1 Paper 2 Time: 3:25pm Domestic violence and abuse Silent voices: Exploring the research involving so-called use of narrative in research Room: Kilsyth (level 0) ‘hard to reach groups’ with survivors of domestic Methodological opportunities Author: violence and abuse and challenges in undertaking Dr Parveen Ali, Lecturer, University of Sheffield, UK Authors: domestic violence and abuse Dr Julie McGarry, Associate Professor, School (DVA) research in healthcare Abstract of Health Sciences, University of Nottingham, contexts UK. Domestic violence and abuse (DVA) is a major public health and social problem affecting Dr Kathryn Hinsliff-Smith, Research Fellow, Lead: million people across the globe (World Health School of Health Sciences, University of Dr Julie McGarry, Associate Professor, School Organization 2015). DVA affects all sections Nottingham, UK. of Health Sciences, University of Nottingham, of society regardless of gender, age, ethnicity, Nottingham, UK sexual orientation, social status, and geographi- Abstract Domestic violence and abuse (DVA) is rec- cal location. Research is necessary to ensure Women who have experienced DVA may present ognised as global societal and health concern a comprehensive understanding of DVA and to a number of health services as the direct (World Health Organisation, 2015). DVA exerts to develop strategies to address DVA. Existing result either of injury or through associated a significant impact on the lives and health of evidence suggests that DVA affects people from trauma for example, mental ill-health. To date, those affected. This includes both short and long all ethnic groups, however, research on the expe- however, while there is a growing professionally term physical and psychological ill health. In riences of victims and perpetrators from minority driven evidence base surrounding healthcare 2014 in the UK, the National Institute for Health ethnic communities is limited (Khelaifat, Shaw, encounters with survivors of DVA the voices of and Care Excellence (NICE, 2014) published & Feder, 2014). One reason contributing to such survivors themselves remains largely unheard. guidance that clearly places health care pro- dearth of literature is the difficulties associated Narrative research is increasingly being utilised fessionals at the forefront of identification and with identification and recruitment of research within nursing inquiry as it ‘places the voices effective management of DVA. participants from so-called hard to reach groups of the researched’ (Holloway & Freshwater, Recently within healthcare generally and nursing (Brown, Marshall, Bower, Woodham & Waheed, 2008) at the centre of the research process and more particularly there has been a growing body 2014).. Drawing on a narrative synthesis of lit- as such recognises the value of lived experience of DVA research both in the UK and interna- erature, combined with author’s experiential as a valuable and powerful asset for healthcare tionally. As research in this field continues to learning from conducting DVA research with education and practice (Polkinghorne, 2007). evolve and the boundaries of enquiry continue BME communities and reflections, this pres- This is, in part, due to the recognition that stories to expand a number of potential methodological entation aims to explore the challenges associ- cannot be de-contextualised and can help to opportunities and challenges have been high- ated with identification and recruitment of par- situate professionals within the experience itself. lighted by researchers and commentators within ticipants from Black and Minority Ethnic (BME) However, the use of narrative or story telling is the particular context of DVA research. communities in two research studies exploring not without criticism in terms of validity as ‘they DVA and its various aspects. Strategies to This symposium presents a timely opportunity [stories] are by their nature unique and subjec- overcome such challenges will also be discussed. for both experienced and early career research- tive, which can raise issues around narrative Various challenges associated with ‘working with ers to critically reflect on the opportunities and ‘truth’, memory, authenticity and reader inter- gatekeepers’, ‘community engagement’, ‘reasons challenges associated DVA research in health- pretation’ (Baker, 2015). This presentation for non-participation’ and ‘strategies’ to enhance care contexts. Drawing on their collective expe- will draw on the existing evidence base and recruitment and participation’ will be explored. rience of DVA research alongside the available discourse surrounding the theoretical underpin- This presentation will critically examine the par- evidence, the presenters have identified three ning of narrative research alongside the use of ticular issues that DVA researchers need to be key areas of DVA research within one overarch- this approach in practice and the findings of a mindful of and which may affect successful iden- ing theme. The first presentation explores the recent research study, which utilised a narrative tification and recruitment of participants from challenges of carrying out DVA research with approach to explore DVA survivor’s experiences marginalised and hard to reach groups. so-called ‘hard to reach’ DVA survivor groups of health care encounters, told as a personal such as marginalised communities, black and narrative. A core focus of this presentation will minority ethnic communities (BME) (Presenter References be a critical account of the potential strengths Dr Parveen Ali). The second presentation Khelaifat, N., Shaw, A., & Feder, G. (2014). Why and limitations and challenges of narrative or explores the challenges and possibilities of using are Clear Migrant Definitions and Classifications storytelling as an emergent research method survivor stories as a narrative research meth- Important for Research on Violence Against alongside a consideration of the future possi- odology when researching DVA (Presenter Dr Migrant Women. Arts Social Sci J S, 1, 2. bilities for narrative research within healthcare contexts. Julie McGarry). The third presentation explores Brown, G., Marshall, M., Bower, P., Woodham, the salient ethical challenges of conducting DVA A., & Waheed, W. (2014). Barriers to recruit- research that may be encountered by health ing ethnic minorities to mental health research: References care researchers who themselves are healthcare a systematic review. International Journal of Baker, C. (2015) Narrative in nursing practice, practitioners. This final presentation also draws Methods in Psychiatric Research, 23(1), 36-48. education and research. Journal of Psychiatric together the issues that surround the physical World Health Organization (2015) Violence and Mental Health Nursing. 22, 1-2 safety and emotional wellbeing of DVA research- Against Women. http://www.who.int/topics/ Holloway, I. & Freshwater, D. (2008) Narrative ers and participants (Drs Ali and McGarry). gender_based_violence/en/ Research in Nursing. London: Blackwell. Polkinghorne, D. (2007) Validity Issues in Narrative Research. Qualitative Enquiry. 13:4, 471-486

100 15.25 – 16.25S1-7 Symposia – Thursday 7 April 2016 Paper 3 Domestic violence and abuse research: Ethical challenges for health care researchers and participants

Authors: Dr Parveen Ali, Lecturer, University of Sheffield, UK Dr Julie McGarry, Associate Professor, School of Health Sciences, University of Nottingham, UK.

Abstract A number of methodological approaches have been utilised to investigate DVA within health care settings and both quantitative and qualitative methodologies utilised in DVA research share opportunities and challenges. For instance, challenges associated with identification and recruitment of appropriate participants, negotiating access, ensuring the safety of the participants while maintaining confidentiality and anonymity and the issues of response and recall bias (Kelmendi, 2013). Other issues include the lack of appropriate description of the context in which DVA occurs, the impact of the research on researcher, researched, and vice versa in terms of potential emotional trauma and distress (Dickson-Swift et al. 2008). Irrespective of the methodological approach undertaken, the subject area itself also warrants careful consideration and planning in terms of any safeguarding issues that may emerge during the process of enquiry. Such issues are relevant to researchers generally, but are particularly pertinent to researchers who are health care professionals themselves, such as nurses, midwives, physicians, as they have to abide by the code of conduct of their respective registration regulators (The Nursing and Midwifery Council, UK, 2015). Researchers with such dual responsibilities need to be cognisant of the range of important ethical difficulties intrinsic to investigating DVA in health care settings. The aim of this presentation is to explore the pertinent methodological issues and challenges that DVA researchers need to consider when designing and preparing to carry out DVA research in health care settings involving patients and/or health care professionals or both.

References Dickson-Swift, V., James, E., Liamputtong, P. (2008) Undertaking Sensitive Research in the Health and Social Sciences: Managing Bounda- ries, Emotions and Risks. University Press: Cambridge Kelmendi, K. (2013). Violence against Women: Methodological and Ethical Issues. Psychology, 4(07), 559. The Nursing and Midwifery Council Code (2015). http://www.nmc.org.uk/standards/code/

101 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Symposia 8 - 15 Friday 8 April 13.40 - 15.10

Symposium 8: Paper 1 of action. In Round 2, experts rated ‘necessary’ BCTs. Time: 1:40pm Selecting behaviour change Results: The SR included 33 studies. Identi- Room: Fintry (level 3) techniques for inclusion in an fied studies were too heterogeneous to quantita- intervention to reduce patient tively link BCTs (n=23) with effectiveness. The Developing effective complex delay in acute coronary most frequently identified BCTs were ‘informa- interventions syndrome. tion’ (n=28), ‘instruction’ (n=24) and ‘action planning’ (n=17). Lead: Dr Emma France, Senior Lecturer, NMAHP-RU, University of Stirling, UK Authors: Experts in the Delphi identified 12 techniques as essential: problem solving, action planning, This symposium presents examples of real-life Dr Barbara Farquharson, Lecturer, University social support (practical and emotional), challenges and solutions facing researchers and of Stirling, Scotland, UK; Professor Marie instruction, information about health conse- clinicians as they attempt to design effective, Johnston, University of Aberdeen, Scotland, quences, salience of consequences, prompts/ acceptable and feasible behaviour change inter- UK; Stephan U Dombrowski, Senior lecturer, cues, credible source, pros and cons, compara- ventions relating to nursing and allied health University of Stirling, Scotland, UK; Purva tive imagining of future outcomes, and mental professional (AHP) practice. Abhyankar, Research fellow, University of Stirling,Scotland, UK; Nadine Dougall, Senior rehearsal of successful performance Changing health behaviour is challenging. Inter- lecturer, University of Stirling, Scotland, UK; Conclusion: Systematic, transparent methods ventions delivered by nurses and AHPs tend Claire Jones, University of Dundee,Scotland, of selecting content for interventions are to be complex. The Medical Research Council UK; John McGhee, Senior lecturer, University desirable. Although SRs represent an evi- (MRC) framework for the development of of New South Wales, Australia; Alex Pollock, dence-based approach , there are a number of complex interventions regards it as best practice Senior research fellow, Glasgow Caledonian important limitations to relying solely on this ‘to develop interventions systematically, using University, Scotland, UK; Professor Stuart method (heterogeneity, poor description of the best available evidence and appropriate Pringle, Consultant Cardiologist, Ninewells interventions, potentially missing previously theory’ [1, p. 8]. Theoretically-based interven- Hospital, Dundee, UK; Professor Chris un-trialled techniques, theoretical incoherence). tions - drawing on existing evidence, theory and, Rowland, University of Dundee, Scotland, UK; Supplementing with a consensus approach such if necessary, new primary research - are more Karen Smith, University of Dundee, Scotland, as Delphi offers a transparent, replicable way to likely to be successful than those which are not UK; Professor Shaun Treweek, University overcome some of these difficulties. [1]. The MRC also recommends modelling of of Aberdeen, Scotland, UK; Professor Brian complex interventions prior to definitive evalu- Williams, Director of NMAHP Research Unit & References ation. Dean of Research Enhancement, NMAHP-RU, 1. Craig P, Dieppe P, Macintyre S, Michie S, The five papers presented in this symposium University of Stirling, Scotland, UK. Nazareth I, Petticrew M. (2008). Developing address some of the challenges for complex and evaluating complex interventions: new nursing and AHP intervention development. We Abstract guidance. Medical Research Council, UK. www. present diverse examples from recent feasibility mrc.ac.uk/complexinterventionsguidance projects for a range of patient groups and a new Background: The UK Medical Research framework for describing complex interven- Council’s (MRC) guidance for developing 2. Michie S., Prestwich A. Are interventions tions. Papers 1 , 2 and 3 describe developing the- complex interventions advocates that inter- theory-based? Development of a theory coding oretically-based audio-visual behaviour change ventions should be informed by theory [1]. scheme. Health Psychology. 2010;(1):1-8. doi: interventions for adults with Acute Coronary However, it does not provide detailed guidance 10.1037/a0016939. Syndrome, young people with asthma, and about how to achieve this. Multiple theories of 3. Farquharson B, Dombrowski S, Pollock A, parents of children with cystic fibrosis respec- behaviour change exist, often with conceptually et al. Reducing patient delay with symptoms of tively. Paper 1 presents a systematic method of overlapping constructs. There is evidence that acute coronary syndrome: a research protocol selecting and embedding behaviour change tech- theory is poorly applied [2]. We describe a sys- for a systematic review of previous interventions niques into an intervention to reduce treatment tematic, transparent and replicable approach to to investigate which behaviour change tech- delay. Paper 2 focuses on creating and feasibil- selecting behaviour change techniques (BCTs) niques are associated with effective interven- ity testing an intervention to increase engage- for inclusion in an intervention to reduce patient tions. Open Heart 2014;1:e000079. doi:10.1136/ ment in physical activity. Paper 3 describes an delay in Acute Coronary Syndrome (ACS). openhrt-2014-000079 online action research approach with families Aim: To identify the specific content most likely and clinicians to co-develop an intervention to be effective in reducing patient delay when to increase chest physiotherapy adherence. experiencing symptoms of ACS. Paper 4 describes development of an interven- Methods: A systematic review (SR) and expert tion to improve swallowing difficulties in adults consensus study (Delphi) were undertaken. with head and neck cancer. Paper 5 presents a framework for communicating and describing The SR was conducted as per our pre-specified, interventions to facilitate their future replicabil- published protocol [3] to identify effective BCTs ity. The symposium offers insights into a range from previous interventions to reduce pre-hos- of methodological approaches and solutions for pital delay. For the Delphi, 11 BCT experts iden- developing and communicating complex inter- tified desirable techniques from the latest BCT ventions. Taxonomy (BCTTv1) and the theoretical mode

102 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Paper 2 to encourage young people (12-18 years) with Paper 3 asthma to engage in physical activity. Developing a theory-informed Methods: From January 2013 to December Using action research to interactive animation to 2014 a two-stage mixed-methods approach was develop an intervention to increase engagement in used. In stage 1 a user group (young people with increase children’s adherence physical activity in young asthma, parents, health professionals) partici- to physiotherapy for cystic people with asthma. pated online to inform the intervention develop- fibrosis ment in a highly iterative manner (modelling). The theoretical basis for the intervention was Authors: Authors: then refined and converted into a 3D animation Dr Gaylor Hoskins, Clinical Academic Dr Emma France, Senior lecturer, with accompanying action plan and volitional Research Fellow, NMAHP-RU, School of NMAHP-RU, University of Stirling, UK; Dr help sheet. In stage 2 a web-based interactive Health Sciences, University of Stirling, Stirling, Karen Semple, Research fellow, NMAHP-RU, modelling experiment evaluated effectiveness UK University of Stirling, UK; Dr Mark Grindle, in three key areas: knowledge about asthma, Research fellow, NMAHP-RU,, University Professor Brian Williams, Director of inhaler use, and intention to increase physical of Stirling UK: Dr Gaylor Hoskins, Clinical NMAHP Research Unit & Dean of Research activity. One-to-one interviews and focus groups Academic Research Fellow, University Enhancement, University of Stirling, Stirling, evaluated the acceptability of the animation and of Stirling, UK; and Dr Claire Glasscoe, UK effectiveness of the theoretical basis. Dr Jennifer Murray, Lecturer of Psychology, Honorary Research Fellow, University of Results: Twenty-three people were recruited University of Napier, Edinburgh, UK Liverpool, UK; Professor Chris Rowland, to the user group. Fifty-three individuals were Professor, University of Dundee, UK; Mr Dr Silje Skar, Researcher, NMAHP-RU, School randomised online to intervention or control; Kieran Duncan, Research fellow, University of of Health Sciences, University of Stirling, 26 completed follow-up questionnaires. The Dundee, UK; Ms Elaine Dhouieb, Respiratory Stirling, UK web-based experiment supported the interven- Physiotherapy Clinical Lead, Royal Hospital Dr John McGhee, Deputy Director of NIEA tion’s evidence base but recruitment methods for Sick Children, NHS Lothian; Dr Steve and of the 3D Visualisation Aesthetics Lab, and loss to follow-up need addressed before a Cunningham, Consultant & Honorary Reader University of New South Wales, Sydney, future trial. Though not powered to detect effect, in Paediatric Respiratory Medicine, Royal Australia. the study revealed an increase in intentions to Hospital for Sick Children, NHS Lothian Dylan Gauld, Animator, Duncan of be active. Qualitative feedback indicated the UK; Dr Eleanor Main, Senior Lecturer in Jordanstone College of Art & Design, intervention was understandable, meaning- Physiotherapy, Institute of Child Health, University of Dundee, Dundee, UK ful, engaging and potentially useful within an University College London; Professor Brian Gordon Brown, Formerly National Director of asthma review. Williams, Director of NMAHP Research Unit Asthma UK Scotland Conclusion: The data-led, iterative approach & Dean of Research Enhancement, University Professor Shaun Treweek, Professor of led to successful creation of an interactive 3D of Stirling, UK; Professor Suzanne Hagen, Health Services Research, Health Services animation embedding behavioural theory. Professor, Statistician & Head of NMAHP Research Unit University of Aberdeen, Future work will establish whether acceptability Interventions Programme, NMAHP-RU, Aberdeen, UK levels and perceived effectiveness translate into Glasgow Caledonian University, UK; Professor Professor Falko Sniehotta, Professor of behaviour change. Shaun Treweek, Professor, University of Behaviour Medicine & Health Psychology, Aberdeen, UK; Dr Janet Allen, Director Newcastle University, Newcastle upon Tyne, References of Research, Cystic Fibrosis Trust UK; Dr John McGhee, Senior lecturer, University UK 1. Welsh L, Kemp JG, Roberts RG. Effects of of New South Wales , Australia; Professor Professor Linda Cameron, Professor of physical conditioning on children and adoles- Pat Hoddinott, Chair in Primary Care, Psychological Sciences, University of cents with asthma. Sports Med. 2005;35(2):127- NMAHP-RU, University of Stirling , UK. California, Merced, USA 41. Professor Aziz Sheikh, Professor of Primary 2. Glazebrook C, McPherson AC, Macdonald Abstract Care Research & Development and IA, Swift JA, Ramsay C, Newbould R, Smyth A. Co-Director, The University of Edinburgh, Asthma as a barrier to children’s physical activity: Background: An action research (AR) Edinburgh, UK implications for body mass index and mental approach [1] was used to develop a theoretically- Professor Suzanne Hagen, Professor, health. Pediatrics. 2006 Dec;118(6):2443-9. informed intervention (a film and action plan) to Statistician & Head of NMAHP Interventions improve home chest physiotherapy adherence in 3. Williams B, Anderson AS, Barton K, McGhee Prog. NMAHP Research Unit, Glasgow infants and young children with cystic fibrosis. J. Can theory be embedded in visual interven- Caledonian University, Glasgow, UK AR is a participatory, iterative approach charac- tions to promote self-management? A proposed terised by inquiry as a group activity and a part- model and worked example. Int J Nurs Stud. nership between researchers and participants. Abstract 2012 Dec; 49(12):1598-609. AR is particularly useful for understanding and Background: Aerobic fitness and emotional resolving complex problems and consequently well-being improve with regular physical is increasingly used in developing and refining activity. Additional benefits for people with complex healthcare interventions [2]. asthma include reduced hospital admissions, absenteeism, and medication use, and increased Aim: This paper’s aim is to describe the use ability to cope with asthma [1]. People with of AR and explore the suitability of an online asthma can exercise safely but young people medium for developing an audio-visual inter- with asthma are less physically active than their vention to inform future intervention develop- peers [2]. ment. Aim: This paper how we integrated user-cen- Methodological discussion: The AR tred design [3] with the MRC Framework for approach involved three iterative phases: theo- Complex interventions to develop and test a retical testing, development, and practical theoretically-informed interactive animation testing/ refinement of the intervention. This iterative approach is consistent with the revised

103 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 MRC framework [3]. We used AR in a novel enteral feeding tubes [2], however no consensus Paper 5 way, in online interaction. The intervention exists on the type of exercise, dose (frequency/ was co-developed from May 2014 to April 2015 quantity), or timing of introduction. The Improving intervention with a specially-recruited online group of 14 exercises are challenging for patients and description for multiple parents and 8 clinicians in the United Kingdom. adherence is low [3]. Questions therefore remain audiences. Barriers and solutions to adherence, parents’ about the feasibility and acceptability of a pre- preferences for the intervention content and ventative swallowing exercise programme. Authors: format and for the feasibility study design were Aims: This feasibility study seeks to identify Dr. Edward AS Duncan (Senior Research explored. Advantages of an online environment the optimal characteristics of a patient-focused, Fellow, NMAHP Research Unit, University of for extended AR interactions were its suit- practical, evidence-based Swallowing Interven- Stirling ) & Prof. Brian Williams (Director of ability for this geographically-dispersed popu- tion Package (SiP); to develop a standardised NMAHP Research Unit & Dean of Research lation, reduced participant burden compared swallowing exercise program; to understand the Enhancement, at University of Stirling). to focus groups, and the ease of sharing multi- barriers and facilitators to the SiP adherence; media materials. Challenges included lack of and to examine feasibility of the SiP for patients Abstract researcher control over participants’ response and HNC teams. time, a reduction in parents’ interactions over Background: High quality intervention Methods: We used an iterative multi-method time, difficulties conveying complex informa- description is essential to the development, eval- approach to design the SiP, working with tion succinctly and in an accessible way, and uation and implementation of effective, wide- patients and health professionals. Focus groups limits imposed by the textual format of parents’ spread and sustainable interventions. However, were carried out with patients and carers, to responses. until recently, relatively little attention has been gain an understanding of the potential side- paid to intervention description. The CONSORT Conclusion: Despite these challenges, action effects of HNC treatment. These findings fed [1] statement, and some of its extensions research can be done online rather than face-to- into a consensus day with the project team and [2], contain limited intervention description face and the iterative nature of AR was ideally patient/ academic advisors. We used workshops guidance. More recently a consensus statement suited to this creative project which resulted in and consensus techniques to agree the essential for Intervention Description and Replication successful intervention development. Recom- components of the SiP from an expert profes- (TIDieR) [3] has been developed. However, mendations are made for future intervention sional perspective. Existing protocols, best this is limited to a list of items that should be development using online AR. evidence and expert opinion were used to included when describing an intervention. determine the swallowing exercises most likely References to be feasible and effective in our patient group. Aims: 1) To discuss the importance of intervention description in the development and 1. Waterman H, Tillen D, Dickson R, De Koning Finally the SiP, which includes information and evaluation of (complex) non-pharmacological K. Action research: a systematic review and support, was shown to patients and carers for interventions; 2) To critique current guidance guidance for assessment. Health Technol Assess their feedback. on intervention description; 3) To present a new 2000;5(23):iii-157. Conclusions: The SiP is currently being tested method of intervention description: The INter- in a feasibility study. The SiP comprises five 2. Hoddinott P, Pill R, Chalmers M. Health vention DescrIption TablE (INDIcaTE). professionals, implementation and outcomes: exercises with standardised dose and timing Methodological Discussion: We will argue not reflections on a complex intervention to improve of delivering. Written materials explaining the only that the quality and utility of an interven- breastfeeding rates in primary care. Fam Pract exercises and diary cards have been designed tion’s description is dependent on its ability 2007;24(1):84-91. so that patients can record adherence. A staff manual draws on a behaviour change taxonomy to fulfil a purpose, but also that, at present, 3. Craig P, Dieppe P, Macintyre S, Michie S, to support participants and encourage fidelity in descriptions are not sufficiently delineated. Nazareth I, Petticrew M. (2008). Developing delivery. We argue that descriptions have four potential and evaluating complex interventions: new purposes tied to four potential audiences. Multi- guidance. Medical Research Council, UK. www. dimensional definitions are therefore appropri- References mrc.ac.uk/complexinterventionsguidance ate. Against this background, a review of current 1. Dysphagia Section, Oral Care Study Group, guidance for intervention description will be Multinational Association of Supportive Care critiqued. The paper will present INDIcaTE, an in Cancer (MASCC)/International Society of intervention description table developed by the Paper 4 Oral Oncology (ISOO), Raber-Durlacher JE, authors, as a means of building on current best Brennan MT, et al. Swallowing dysfunction in Developing a swallowing practice and overcoming ongoing intervention cancer patients. Supportive Care in Cancer. description limitations. The structure, mecha- exercise intervention for 2012;20(3):433-443. nisms, and benefits of describing an intervention patients with head and neck 2. Bhayani, M. K., Hutcheson, K. A., Barringer, using INDIcaTE will be presented and two case cancer: the SiP study D. A., Lisec, A., Alvarez, C. P., Roberts, D. B., examples of INDIcaTE used in successful grant Lai, S. Y. and Lewin, J. S. (2013), Gastrostomy applications will illustrate its use in practice. Authors: tube placement in patients with oropharyngeal Conclusion: This paper will provide delegates Professor Mary Wells, Professor of Cancer carcinoma treated with radiotherapy or chemo- with an overview of the state of the art in inter- Nursing Research and Practice, PI radiotherapy: Factors affecting placement and vention description; an awareness of the limi- Dr Emma King, Research Fellow, NMAHP-RU, dependence. Head Neck, 35: 1634-1640 tations of best practice; and an introduction to University of Stirling 3. Shinn, E. H., Basen-Engquist, K., Baum, G., INDIcaTE as an innovative approach to inter- Steen, S., Bauman, R. F., Morrison, W., Garden, vention description that overcomes these limita- Abstract A. S., Sheil, C., Kilgore, K., Hutcheson, K. A., tions, and describes interventions in a manner Barringer, D., Yuan, Y. and Lewin, J. S. (2013), that is meaningful to multiple audiences. Background: Swallowing problems are a Adherence to preventive exercises and self- common side-effect of radiotherapy treatment reported swallowing outcomes in post-radiation for head and neck cancer (HNC), and can have head and neck cancer patients. Head Neck, 35: devastating long-term effects [1]. Exercises 1707-1712 targeting the swallowing muscles can improve long-term outcomes and reduce the use of

104 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 References: Symposium 9: Paper 1 1. Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT 2010 statement: updated Time: 1:40pm The CHAT Study: Barriers and enablers to healthcare guidelines for reporting parallel group ran- Room: Sidlaw (level 3) domised trials. BMC Medicine, 8(1), 18. assistants’ provision of 2. Boutron, I., Moher, D., Altman, D. G., Intervention studies in relational care to older people Schulz, K. F., & Ravaud, P. (2008). Extending relational care in acute in acute settings the CONSORT statement to randomized trials settings: content, context, and of nonpharmacologic treatment: explanation Authors and elaboration. Annals of Internal Medicine, consequences S.Sarre, Research Fellow, Florence Nightingale 148(4), 295-309. Faculty of Nursing and Midwifery, King’s 3. Hoffmann, T. C., Glasziou, P. P., Boutron, I., Lead: College London, UK Professor Jackie Bridges, University of Milne, R., Perera, R., Moher, D., ... & Michie, J.Maben, Professor of Nursing Research, Southampton, UK S. (2014). Better reporting of interventions: Florence Nightingale Faculty of Nursing and template for intervention description and repli- Chaired by Professor Ruth Harris, this Midwifery, King’s College London, UK cation (TIDieR) checklist and guide. BMJ, 348, symposium reports from two multi-centre C.Aldus, Research Fellow, School of Health g1687. studies, each focusing on implementation, fea- Sciences, University of East Anglia, UK sibility and evaluation of complex interven- H.Wharrad, Professor of e-Learning and tions to support relational hospital nursing care Health Informatics, University of Nottingham, for older people. Both studies were funded by UK NIHR in the wake of the Francis Inquiry and A.Arthur, Professor of Nursing Science, School concerns raised about compassionate hospital of Health Sciences, University of East Anglia, nursing care. One study (CHAT) focuses on a UK training intervention for health care assistants (HCAs). The other (CLECC) focuses on supporting ward nursing teams to develop leadership Abstract and team relational practices in the workplace. Background: Problems in the care of older The symposium begins with a paper presenting people in hospitals have been highlighted. Older findings from CHAT study qualitative interviews people judge the care they receive in terms on the barriers and enablers to relational care of relational care; kindness, compassion and in older people’s wards. These findings laid the respectful communication (Bridges et al 2010). groundwork for the CHAT intervention, and its Healthcare assistants (HCAs) deliver an increas- development and implementation are reported ing proportion of direct care to older people, yet in the second paper. This is followed by a paper their training needs are often overlooked. reporting the development and implementation Aims: To identify barriers and facilitators to of the CLECC intervention, together with an HCAs’ implementation of relational care to older overview of methods used to evaluate its feasi- people in acute settings. bility. Between them, these first three papers will enable an appreciation of the content of complex Methods: Interviews with HCAs (n= 30) and interventions targeted at relational nursing other staff (n= 24) working on older people’s care in hospital, in terms of their development, wards in three acute trusts in England, under- proposed mechanisms for change and imple- taken May to November 2014. mentation. The fourth paper takes a more meth- Results: HCAs had received minimal training odological focus and draws on lessons learned on relational care, and training did not always from the CLECC study about evaluating the reflect the practical difficulties faced on the effectiveness of interventions of this kind, with wards. Time was regarded as a key factor in the consequences for patient experiences being relational care, but given the profile of older of particular concern. The symposium concludes patients, many interviewees felt they did not with a panel discussion that draws on findings have enough time to give a timely response or from both studies to explore the impact of the care that they wanted to. Nevertheless, inter- context on the implementation of interventions viewees also spoke of ways of providing good of this kind in acute care settings. The inclusion relational care while carrying out essential tasks. in this symposium of findings about the content A number of tensions made relational care both of each intervention, measurement of their con- important and challenging to achieve: maintain- sequences and the identification of contextual ing patients’ dignity in undignified situations; factors that may enable or inhibit implemen- keeping patients calm in a busy, noisy, unfamil- tation will be of high interest to practitioners, iar environment; and dealing with a high level of educators, policy makers and researchers. need from people with sensory and/or cognitive impairments. Conclusions: There is a need for training in relational care for HCAs founded in the realities of life on the ward. Training should emphasise the ways in which relational care can be woven into everyday activities and tasks and how to support staff in managing their own feelings of stress, frustration and fear, as well as dealing with the emotions of patients.

105 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Reference RCT randomising 12 wards from three hospitals importance. In the context of a mixed methods Bridges, J., M. Flatley, and J. Meyer (2010) where HCAs receive either Older People’s Shoes feasibility study in two English hospitals, this Older people’s and relatives’ experiences in acute or training as usual. Trial outcomes are observed paper will describe the development, delivery care settings: Systematic review and synthesis at HCA, ward and patient level. and evaluation of a novel implementation of qualitative studies. International journal of Conclusions: HCAs work at the point where programme designed to improve and support nursing studies, 2010. 47(1): p. 89-107. relational care is delivered. Their voice needs to the delivery of compassionate care by health and inform the design and evaluation of the training social care teams. they receive. Complex interventions require Creating Learning Environments for Com- transparent reporting not just of the structure passionate Care (CLECC) is a 4 month imple- Paper 2 and mode of delivery but also of the creative mentation programme designed for hospital design process. Researchers should not shy away ward nursing teams caring for older people, The CHAT study: Older from testing training interventions using robust but relevant to other teams working with other people’s shoes - the designs and measuring proximal and distal client groups (Bridges and Fuller, 2015). The challenges of development, outcomes. programme uses workplace learning theory to design and testing a new promote change at team level by enabling the References development of leadership and team relational training intervention for practices which are also designed to enhance the Carver R. Theory for practice: a framework for healthcare assistants capacity of individual team members to relate thinking about experiential education. to older people. Existing research evidence Authors Journal of Experiential Education. 1996;19(1):8- suggests that optimising relational capacity in Arthur A, Professor of Nursing Science, School 13. this way will support the delivery of compas- of Health Sciences, University of East Anglia Hoffmann TC, Glasziou PP, Boutron I, Milne sionate care. Wharrad H, Professor of e-learning and R, Perera R, Moher D, Altman DG, Barbour V, The need to better understand how complex Health Informatics, School of Health Sciences, Macdonald H, Johnston M, Lamb SE, Dixon- interventions such as CLECC are implemented, University of Nottingham Woods M, McCulloch P, Wyatt JC, Chan AW, their causal effects and the impact of context Aldus C, Research Fellow, School of Health Michie S. is increasingly recognized as imperative in Sciences, University of East Anglia Better reporting of interventions: template enabling research to inform policy and practice Sarre S, Research Fellow, Florence Nightingale for intervention description and replication (Moore et al., 2015). The feasibility of CLECC, Faculty of Nursing and Midwifery, King’s (TIDieR) checklist and guide British Medical specifically its workability and integration into College London Journal. 2014;348:g1687. doi: 10.1136/bmj. routine practice, is therefore currently being Maben J, Professor of Nursing Research, g1687. tested with four ward nursing teams in two Florence Nightingale Faculty of Nursing and Kirkpatrick DL, Kirkpatrick JD. Evaluating English hospitals. Evaluation methods include Midwifery, King’s College London training programs. San Francisco: Berrett- qualitative interviews with patients, staff and visitors, observations, and documentary Koehler; 2006. Abstract analysis. Data were collected prior to, during and after implementation to enable assessment Background: Few studies of training inter- over time (May to December 2015), and are ventions observe outcomes beyond the level of being analysed using a constant comparative ‘reaction’, the first of Kirkpatrick’s four-level Paper 3 method. This paper will present an overview of evaluation of training model (Kirkpatrick & Kirk- Creating learning CLECC and its implementation in this study, patrick 2006). While the description of complex together with an overview of methods being used interventions is now commonplace (Hoffmann environments for to evaluate its feasibility. et al, 2014) the design process is rarely reported. compassionate care (CLECC): Aims: To describe the development of a training developing and evaluating References intervention for healthcare assistants (HCAs) to the feasibility of a complex BRIDGES, J. & FULLER, A. 2015. Creating improve the relational care of older people and intervention Learning Environments for Compassionate Care the design of an evaluation using gold standard (CLECC): a programme to promote compassion- methodology. Authors ate care by health and social care teams. Inter- Methodological processes of intervention Jackie Bridges, Professor of Older People’s national Journal of Older People Nursing, 10, development and evaluation design: A series Care, University of Southampton 48-58. of intervention development workshops were Paula Libberton, Lecturer, University of MOORE, G. F., AUDREY, S., BARKER, M., held involving study team members, an HCA Southampton BOND, L., BONELL, C., HARDEMAN, W., and two older people. The group drew on: inter- Hannah Barker, Senior Research Assistant, MOORE, L., O’CATHAIN, A., TINATI, T. & views with HCAs and other staff; focus groups University of Southampton WIGHT, D. 2015. Process evaluation of complex with older people and carers; an expert witness interventions: Medical Research Council panel; and customer care training in four retail Lisa Gould, Research Fellow, University of guidance. British Medical Journal, 350, h1258. organisations. This process produced ‘Older Southampton People’s Shoes’, a two-day training interven- Wendy Wigley, Principal Teaching Fellow, tion delivered by practice development nurses University of Southampton to HCAs. It comprises three units: walking in Peter Griffiths, Professor of Health Services older people’s shoes; getting to know older Research, University of Southampton people; and learning from customer care. Given the ‘hands-on’ nature of HCA work, the theo- Abstract retical basis for the training was derived from The consistent delivery of compassionate health Carver’s framework for understanding experi- care to older people is a matter of global concern. ential education (Carver 1996). To test whether The development and evaluation of effective a definitive randomised controlled trial (RCT) interventions to address this concern is of prime is viable we have conducted a feasibility cluster

106 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Paper 4 Conclusion: Baseline findings indicate that test such an intervention in a cluster RCT?. Data use of experimental design is feasible although from focus groups with older people, interviews Creating learning design will need to account for contamination with HCAs and staff working with HCAs have environments for beyond participating wards. Observation-based informed the development of a new intervention compassionate care (CLECC): measures appear to have most potential to ‘Older People’s Shoes’. enable participation by people with cognitive Panel members are senior investigators drawn feasibility of evaluating impairment. impact on patient care from both study teams. Discussions will be chaired by Professor Ruth Harris and will be References initiated by a small number of set questions. Authors Bridges,J & Fuller (2015) Creating learning Audience members will be encouraged to ask Dr Lisa Gould, Research Fellow, University of environments for compassionate care (CLECC): questions, and the discussion will conclude with Southampton a programme to promote compassionate care a closing statement from each member. Professor Peter Griffiths, Professor of Health by health and social care teams. International Services Research,University of Southampton Journal of Older People Nursing 10(1), 48-58. References Hannah Barker, Senior Research Assistant, Bridges, J. & Fuller, A. 2015. Creating learning University of Southampton environments for compassionate care (CLECC): Ines Mesa, Statistician, University of a programme to promote compassionate care Southampton Paper 5 by health and social care teams. International Dr Ruth Pickering, Medical Journal of Older People Nursing, 10, 48-58. Statistician,University of Southampton Barriers and enablers to Moore, G. F., Audrey, S., Barker, M., Bond, L., Professor Jackie Bridges, Professor of Older implementing complex Bonell, C., Hardeman, W., Moore, L., O’Cathain, People’s Care, University of Southampton. interventions in acute care: a A., Tinati, T. & Wight, D. 2015. Process evalua- panel discussion tion of complex interventions: Medical Research Abstract Council guidance. British Medical Journal, 350, CLECC is a ward-based practice development Authors h1258. programme focused on developing sustain- Jackie Bridges, Professor of Older People’s able ward management and team practices that Care, University of Southampton enhance capacity to provide compassionate care Antony Arthur, Professor of Nursing Science, (Bridges & Fuller 2015). The introduction of University of East Anglia such interventions targeted at supporting the Jill Maben, Professor of Nursing Research, relational work of UK hospital nurses has been King’s College London accompanied by largely qualitative evaluations which have provided important information Abstract about processes of change, and factors influencing change. However, no evaluations to date The need to better understand how complex have enabled a robust assessment of the effec- interventions are implemented, their causal tiveness of these interventions on patient care. effects and the impact of context are increasingly recognized as crucial for policy and practice Aim: To inform future study design, to assess (Moore et al., 2015). Drawing on findings from CLECC’s effectiveness on patient care: to assess two multi-centre studies that explored the fea- performance of outcome measures, to assess risk sibility of interventions to support high quality of contamination between clusters, and estimate relational hospital care, this panel discussion participation and attrition rates, especially for will consider and explore key contextual factors people with cognitive impairment. that can support or inhibit implementation in Methods: Procedures for a cluster RCT are acute hospital settings. The panel will discuss being piloted including randomisation of wards the challenges of delivering a highly context-rel- to participate in CLECC (n=4) or act as control evant intervention within RCTs where interven- (n=2). Outcomes being assessed include quality tion standardization and fidelity are key. of staff-patient interactions, patient evalua- Creating Learning Environments for Compas- tions of care and staff perceptions of empathy. sionate Care (CLECC) uses workplace learning Baseline assessments were undertaken 2 theory to promote leadership and team rela- months before intervention (March/April 2015) tional practices that enhance the capacity of with follow-up at 8 months post-randomisation. individual team members to relate to older Baseline Results: Randomisation was accept- people (Bridges & Fuller 2015). Mixed methods able to managers of invited wards and recruit- including interviews with patients, staff and ment of wards to study was high (86%). We visitors, observations of care, and documentary recruited to target for measuring the quality of analysis have been used to explore its implemen- staff-patient interactions, with 94% of patients tation and evaluation in nursing teams in two approached agreeing to take part (or took part English hospitals. with consultee advice), and 31% of patients The CHAT study (Can Healthcare Assistant observed with evidence of cognitive impairment. Training improve the relational care of older Other questionnaire-based measures performed people? A development and feasibility study less well, with low participation rate (39%) by of a complex intervention) focuses on three nurses and many patients needing help with questions: (1) what are the relational care completing their questionnaires. We observed training needs for HCAs working with older evidence of contamination beyond the interven- people?; (2) can these needs be met as part of tion wards. a discreet intervention?; and (3) is it feasible to

107 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Symposium 10: ment and experience (CQC 2015; CQC 2014). The impetus for the development of clinical Nursing, Midwifery and Allied Health Profes- academic careers came from Birmingham Health Time: 1:40pm sional (NMAHP) clinical academics are ideally Partners, a collaborative group comprised of the placed to create and use evidence, facilitate the University Hospital Birmingham NHS Foun- Room: Carrick (level 1) adoption and spread of best practice, innova- dation Trust, Birmingham Children’s Hospital tion and new technology. There are a substantial NHS Foundation Trust and the University of Developing clinical academic number of policy drivers that support the devel- Birmingham. The group were successful in careers for nurses opment and sustainability of NMAHP clinical establishing a Clinical Academic Internship academic roles. Programme (CAIP), and making a joint appoint- Lead: Despite Local and National training opportuni- ment between UHB and UoB to lead non-medi- Jenny Hiley, University Hospitals Birmingham ties being available, embedding the role within cal clinical academic development. NHS Foundation Trust, UK the clinical setting remains a challenge. A sub- Progress to date: At this early stage the team This symposium will analyse the development stantial number of Local and National initiatives have been able to develop a strategy to develop of clinical academic careers for nurses from a have been developed to overcome a number of the NMAHPS clinical academic workforce. The range of perspectives: national; organisational identified barriers to promote, support, value operationalisation of this strategy involves and personal. The symposium will first provide and embed the development of NMAHP clinical - Talent spotting academic roles. an overview of the national context for clinical - Communication academic careers for nurses (Paper 1) and then We will present recently collated evidence of - Identification of research priorities using a case study approach demonstrate how National initiatives that create and support the clinical academic careers are ‘operationalised’ at role development within the healthcare provider - Creation of multi-disciplinary research groups the level of an NHS Trust and Higher Education setting. These include the development of a with members from NHS and HEIs Institution (Paper 2). It will next describe the building capacity model, an organisation toolkit, - Research design support provision of an innovative regional Clinical including assessment of organisation readiness - Support to identify and apply for external Academic Internship Programme to meet the to develop and support the role, a middle funding research education needs of nurses, midwives, manager resource guide that promotes and allied health professionals and health care sci- maximises clinical support, as well as individual - Educational support for Masters students entists, thus equipping them with the knowledge case studies that demonstrate value and impact - Enabling publication via Writing for Publica- and skills to undertake their own research (Paper of NMAHP clinical academic research activity. tion workshops and writing groups 3). This paper will also outline the initial impact - Clinical Academic Internship Programme at of this programme at an individual, organisa- References: pre-Masters level tional and patient level. CQC (2015) CQC Annual Report 2014/15 - Pre-PhD clinical academic bridging programme The symposium will then highlight a case http://www.cqc.org.uk/search/site/ - Support for individuals to achieve successful example of a nurse, Alison, who undertook the publications?f[0]=im_field_publication_ NIHR doctoral fellowship Clinical Academic Internship Programme. It will type%3A49 Accessed 15th November 2015 illustrate how through the support of her univer- - Support for an individual to achieve successful sity academic supervisors and NHS organisation CQC (2014) CQC Annual Report 2013/14 NIHR Clinical Lecturer application she successfully received funding to take her http://www.cqc.org.uk/search/site/ Conclusion: The challenges are being able research forward in practice (Paper 4). Finally, publications?f[0]=im_field_publication_ to establish a baseline from which to measure Alison will also discuss her personal experi- type%3A49 Accessed 15th November 2015 success, identifying meaningful metrics that ences of embarking on a clinical academic career can be shared nationally and therefore act as a and offer advice to those interested in doing so benchmark, and ensuring sustainability. High- (Paper 5). lights so far include measurable growth in the Paper 2 proportion of research active staff and observing increasing confidence in the value of research First steps: starting from borne of the ‘coal face’. Paper 1 ‘zero’ with the introduction of This paper will use the CARE model developed clinical academic careers Promoting, supporting, by Radford (2015) as a framework to present our case study of zero to here. valuing and embedding Authors clinical academic roles within Dr Amelia Swift, Senior Lecturer in Nursing, References: University of Birmingham and NMAHPS the healthcare provider Radford, M and Young, A (2015). Developing Clinical Academic Lead, University Hospitals setting nursing, midwifery and AHP research: collabo- Birmingham NHS Foundation Trust; Prof ration for future healthcare improvement. Devel- Lorraine Harper, Professor of Nephrology Authors oping a collaborative research model - CARE and Head of Clinical Academic Training, Professor Debbie Carrick-Sen, Florence Model of Research. Presentation delivered at University of Birmingham; Louise Banks, Nightingale Foundation Clinical Chair in the UK Association of UK University Hospitals Head of Education, University Hospitals Nursing and Midwifery PhD, MSc, PGCE, RM, workshop (26th October 2015). RN, University of Birmingham and Heart of Birmingham NHS Foundation Trust England NHS Foundation Trust Abstract Abstract Background: The aspiration to integrate The development of clinical academic roles is awareness, participation and leadership in of National and International interest. There research within the non-medical workforce is a is substantial evidence that confirms that national one that is enacted locally. Some NHS research active healthcare provider organisa- Trusts are further along the path than others. tions have improved patient outcomes, engage- This is the story of a relatively young partnership and therefore is about the first steps.

108 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Paper 3 personal insight into the internship is outlined of young people who use technology to share in Paper 4. self-images’. Feedback on a regional Results: The grant was successful and AL clinical academic internship References: now embarks on her first venture working on programme for nurses, Health Education England (HEE) (2015). a funded research project within an academic midwives, allied health Clinical Academic Careers Framework: A environment. As a novice researcher AL will professionals and health care framework for optimising clinical academic have the opportunity to develop her repertoire of research skills, and experience all stages of scientists careers across health care professions. (HEE Online). Available at: http://hee.nhs.uk/wp- the research process, from proposal prepara- content/blogs.dir/321/files/2014/07/2014- tion, data collection and analysis through to co- Authors 12-CAC-Framework-21-1-15.pdf (accessed 1 Feb production of scholarly papers, seminars and Jenny Hiley, Project Lead CAIP, University 2015) conferences. Hospital Birmingham NHS Foundation Trust; Conclusions: In this presentation we will Dr Amelia Swift, Senior Lecturer in Nursing, National Institute of Health Research (NIHR) explore the benefits and challenges of co-work- University of Birmingham and NMAHPS (2015). HEE/NIHR Integrated Clinical ing within a clinical academic career framework. Clinical Academic Lead, University Hospitals Academic Programme (ICAP) for non-medical Particularly we will focus on steps to success, so Birmingham NHS Foundation Trust health care profession. (NIHR Online). Available at: http://www.nihr.ac.uk/funding/nihr-hee- that those attending the symposium can learn ica-programme.htm (accessed 10 November from our process model of working. The individ- Abstract 2015) ual experiences of AL in developing her clinical academic career will be explored in a separate Background: The need to increase the research Willis P (2015). Raising the Bar. The Shape of paper. capacity of the health care workforce is illustrated Caring: A review of the future Education and in Paper 1 and highlighted in the recent Shape training of registered nurses and care assistants. of Caring Review, which recommends greater (HEE Online). Available at: http://tinyurl.com/ References: research awareness and the key role of nurses in q8wrttv (accessed 10 November 2015) Appleton JV, Cowley S (2008). Health visiting leading and supporting research (Willis, 2015). assessmentâ€’unpacking critical attributes in The expansion of clinical academic careers for health visitor needs assessment practice: A case non-medical health professionals has been study. International Journal of Nursing Studies, outlined by Health Education England (HEE) Paper 4 45(2), 232-245. (HEE, 2015) and further developed through a new Integrated Clinical Academic Programme Crown H (2014). Do you feel confident tackling Developing clinical academic the issue of sexting with students? British (ICAP), which commences with the intern- careers: A case example from ship, offering a taster of clinical academia and Journal of School Nursing vol9 issue 4 p 190-194 research (NIHR, 2015). public health nursing Doring N (2014). Consensual sexting among HEE/Health Education West Midlands (HEWM) adolescents: Risk prevention through abstinence Authors funded the delivery of a pilot West Midlands education or safer sexting. Cyberpsychology: Dr Maria Clark, Lecturer in Nursing, Clinical Academic Internship Programme Journal of Psychosocial Research on Cyberspace University of Birmingham; Alison Lewis, (CAIP) for nurses, midwives, allied health pro- 8(1) article 9 doi: 105817/CP2014 1 Family Nurse, South Warwickshire Foundation fessionals and health care scientists who were NHS Trust; Dr Caroline Bradbury-Jones, interested in embarking on a clinical academic Reader in Nursing, University of Birmingham career and undertaking their own research. This paper describes the programme and highlights Paper 5 Abstract initial findings following an independent evalu- My early experiences of a ation. Background: For the past year, two of the clinical academic career Methods: The regional CAIP provides staff presenters (CB-J & MC) have been undertaking with the knowledge and skills to undertake preparatory work to support a funding applica- Author their own research, through the provision of a tion for a research study into the health impacts Alison Lewis, Family Nurse, South taught programme, research placements and of young people’s use of sexualised self-images; Warwickshire Foundation NHS Trust the support of an academic supervisor. An inde- a considerable issue regarding risk and safety pendent evaluation of the programme combined (Crown 2014, Doring 2014). In the beginning pre and post programme questionnaires and of 2014, they were seeking ways of turning Abstract interviews. ideas into action. At this time AL had finished Background: For the past five years I have a Clinical Academic Internship Programme and Results: Initial evaluation findings reported been working as a family nurse within Family was keen to gain some research experience. All that interns enjoyed participating in the pilot Nurse Partnership. I have always been inter- presenters share a clinical background in health programme, although some challenges were ested in clinical research and in July 2014 was visiting. noted including balancing clinical and intern- lucky enough to secure a place on the first cohort ship work. Feedback from employers has high- Methods: As a way of addressing both these of the West Midlands Clinical Academic Intern- lighted that participation on the internship has needs, AL began to work voluntarily, with the ship Programme (CAIP) (National Institute of helped to increase staff confidence and raise support of her NHS employer, with CB-J and Health Research, 2015; HEE, 2015). I hoped awareness of research in the workplace. MC within a School of Nursing context. She was that the internship would allow me to experi- supported to develop a research proposal that ence first-hand academic research in order to Conclusion: A longitudinal evaluation is related directly to her practice area regarding discover whether this was the route I wanted to planned with the interns post programme to health visiting practice in identifying and undertake with my career. ascertain the impact of the internship on their responding to contemporary public health clinical academic career development. Further Methods: The programme allowed me to have needs (Appleton & Cowley 2008). The study was funding from HEE/HEWM in the past year has time out from my role and immerse myself within entitled: ‘Public health nurses’ knowledge and enabled the launch of two additional intern- the research world. The taught component intro- confidence in promoting positive sexual health ships and a Pre-PhD Preparation Programme. A duced us to a number of academics who gave us a realistic picture of the life of a researcher. The

109 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 placements gave insight into large-scale inter- Symposium 11: Paper 1 national research projects and the support of an academic supervisor enabled me to produce a lit- Time: 1:40pm Global context: Examining erature review and propose a research question the changing landscape Room: Harris 1 (level 1) to explore further. for doctoral education in Results: From the internship, I identified that Critical perspectives on nursing. I would like to work alongside an established doctoral education in research team. My supervisor arranged for me Authors to meet up with two nurse academics (health nursing: an international Professor Sonja McIlfatrick, UK visiting clinical background) who are actively analysis of contexts, models, undertaking health research at University of processes and outputs Abstract Birmingham. We quickly established common Lead: Dr Colin Macduff, Reader, RGU, areas of interest and have been successful in Aberdeen, UK Globally over the last decade there have been attracting funding for a small research project significant changes in doctoral education in entitled ‘Public health nurses’ knowledge and This symposium is comprised of a series of four general and specifically within nursing. There confidence in promoting positive sexual health papers that seeks to provide a critical analysis of are many drivers for these changes including of young people who use technologies to share the international context, models, processes and increased globalisation, mobility; technologi- self-images’. outputs for doctoral education in nursing. This cal advances; alongside demands to ensure will seek to develop and engage overall discus- Conclusion: In the presentation I will discuss employability for global market (EUA, 2015). sion on the challenges that exist, seeking to agree the implications of undertaking the CAIP as The question remains however, what are the consensus and possible actions to overcome the a clinician - namely time management and implications of such a landscape for the future challenges. caseload pressures but how the exposure to of nursing doctoral education? In this paper the highly regarded and experienced academics, Paper 1 draws on Prof McIlfatrick’s knowledge author examines the trends and factors that are keen to support and encourage us non-medical of the global landscape based on her experience influencing the changes, providing a background clinicians is second to none and an experience as President of the International Network for that serves as a context for identifying the most not to be missed. Doctoral Education in Nursing. It will set the compelling issues and concerns for nursing scene by giving overview of trends and influenc- doctoral education. ing factors. Paper 2 draws on Prof McCormack’s References: Whilst there has been a rapid and progressive knowledge of different international models increase in the number of nursing doctoral National Institute of Health Research (NIHR) of doctoral education by analysing these and education programmes in the world from 286 (2015). HEE/NIHR Integrated Clinical comparing their nature and scope. Wider impli- in 2005 to 333 in 2012 (Ketefian et al. 2005, Academic Programme (ICAP) for non-medical cations will be explored. Paper 3 addresses the International Network for Doctoral Education health care profession. (NIHR Online). Available issue of quality by reporting key findings from in Nursing (INDEN) 2012); questions around at: http://www.nihr.ac.uk/funding/nihr-hee- a recent international study of the quality of the international context remain. This proposed ica-programme.htm (accessed 10 November doctoral nursing education in seven different paper seeks to set the international context, 2015) countries. This will provide insights into char- outline the changing landscape and provide a Health Education England (HEE) (2015). (HEE acteristic processes around the world and offer critical analysis of the implications for doctoral Online). Internships. Available at http://hee. recommendations for development. Finally education for nursing. This analysis will take nhs.uk/work-programmes/clinical-academic- Paper 4 will address the neglected topic of the place within the context of the, International careers/internships/ (accessed 10 November outputs of doctoral education in nursing - theses Network for Doctoral Education in Nursing 2015) and dissertations. With the advent of electronic (INDEN), a non-profit professional association theses and dissertations (ETDs), there are major dedicated to the advancement of quality doctoral opportunities for scholars. Dr Macduff will nursing education globally. The key objec- report on recent research studies into nursing’s tives for INDEN are to: foster ongoing global engagement with ETDs, highlighting the need networking and professional advancement; for much greater awareness of these resources. promote curriculum development, enhance- A new initiative in this field - the International ment, and program evaluation and encourage Network for Electronic Theses and Dissertations collaborative research, educational initiatives, in Nursing (INETDIN) will be explained. and the dissemination of innovation in doctoral Taken together these papers will give overview nursing education. of, and insights into, the global scene, providing a platform for discussion and debate. References: European University Association (2014) Doctoral Education: the shape of things to come http://www.eua.be/activities-services/cde/the- shape-things-to-come.aspx International Network for Doctoral Education in Nursing (INDEN) (2012) Directory of international doctoral programs. Retrieved from http:// nursing.jhu.edu/excellence/inden/programs. html on 12 September 2012. Ketefian S., Davidson P., Daly J., Chang E.& Srisuphan W. (2005) Issues and challenges in international doctoral education in nursing. Nursing & Health Sciences 7(3), 150-156.

110 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Paper 2 Research into Higher Education and Open Uni- Murashima S, Keeney S & Khan S (2015) Quality versity Press of nursing doctoral education in seven countries: Innovative models for survey of faculty and students/graduates. doctoral education in nursing Journal of Advanced Nursing 71 (5): 959-1194

Author Paper 3 Professor Brendan McCormack, UK Quality indicators for nursing Paper 4 doctoral education Abstract What do we know about the Global challenges over the last decade have Authors outputs of doctoral education resulted in a ‘knowledge based economy’, where Dr Claire McAuley, UK in nursing? research and doctoral education can no longer regarded as ‘disinterested pursuit of knowledge’ Authors but rather needs to generate new knowledge Abstract Dr Colin Macduff, UK that provides an important strategic resource Questions and concerns around the quality for a countries economy (EUA, 2015). This has of doctoral education in nursing exist. Whilst resulted in the need to develop new and inno- global quality standards, criteria and indicators Abstract vative approaches to doctoral education. Tinker for nursing doctoral programmes, focused on During the period of over 50 years that doctoral and Jackson (2004) suggest that ‘In terms of the key elements such as the research environment; education in nursing has been growing inter- academy, the PhD [or doctorate] is the highest quality of PhD programme; quality of super- nationally, research and critical reflection formal qualification’. vision and quality of thesis examination have have focused primarily on the nature, scope However, different approaches and models for been developed (Kim et al, 2006), questions and quality of provision processes within and doctoral education exist globally, recognising still exist around the overall global quality of across countries (e.g. Kim et al 2015). Within the need to consider aspects such as pre-PhD nursing doctoral programmes. Furthermore a this context it is striking how little research training preparation, innovative curricula, lack of comparative evaluation of global quality and critical reflection have been undertaken faculty scholarship and teaching approaches, of nursing doctoral education has been reported to consider the nature, scope and quality of and wider development of research skills and (Kim et al, 2015). doctoral outputs within and across countries. employability. Within the UK and Europe the This paper will draw on the findings of the MacVicar and Caan’s UK study (2005) is one traditional apprenticeship model of doctoral quality of nursing doctoral education survey of very few that even attempts categorisation in education exists. This is where the focus is on across seven countries and discuss the strategic this area. the doctoral thesis, which can be considered as directions for improving quality. This study The proposed paper seeks to critically address a monograph, outlining clearly their contribu- examined data collected from 2007-2010 from the above issue through the lens of recent inter- tion to knowledge in their field. Questions exist nursing schools in seven countries: Australia, national work examining nursing’s engage- however regarding the currency and applicabil- Japan, Korea, South Africa, Thailand, UK and ment with its electronic theses and disserta- ity of traditional models of education, especially USA. The quality of nursing doctoral education tions (ETDs). The latter outputs have become in light of the changing landscape outlined pre- was evaluated using four domains: Programme, numerous with electronic submission becoming viously and the increased focus on professional Faculty (referring to academic staff), Resource a widespread requirement, and local, national doctorates, taught doctorates, Doctorate in and Evaluation. The perceptions of faculty and and international web based repositories and Nursing programmes and ‘Capstone Projects’. students/graduates about the quality of nursing portals often offering open access to these Such questions and debate were recently high- doctoral education across the seven countries products. However findings from studies of lighted in the Times Higher, with an article by were mostly favourable on all four domains. The nurse scholars in the UK, USA, Australia and Jump (2015) entitled: ‘PhD: is the doctoral faculty domain had the greatest importance for New Zealand (Goodfellow et al 2012) suggest thesis obsolete?’ quality, followed by the programme domain. that nurse scholars have very limited awareness This paper will provide an analysis of different However, the importance of the resource of these and lack skills for locating them. domain gained significance as the overall quality models seeking to compare what could be As such, the paper will argue that nursing of nursing doctoral education increased. These considered a more traditional apprenticeship is currently unable to satisfactorily gauge findings raise interesting questions and debate model, with structured integrated models that the nature and scope of its doctoral outputs, for future strategic developments for nursing exist in Europe and the USA. The development nevermind assay their comparative or collec- doctoral educational. These include: the need of professional, taught and structured models tive quality. Accordingly, in the final part of the to develop educational policy that strengthens of doctoral education will be explored and paper, the presenter will explain a new initiative the faculty and programme domains in nursing compared and contrasted with the traditional to promote nursing’s engagement with ETDs, schools worldwide; the need to develop strate- apprenticeship model. Wider implications for the International Network for Electronic Theses gies to improve the quality of nursing doctoral nursing will be outlined. (280 words) and Dissertations in Nursing (INETDIN). The education at a global level; the potential of the network has recently initiated a website (www. tool to be used as a standard instrument to allow References: inetdin.net) that provides key information for researchers to continue and compare across accessing and constructing electronic theses and European University Association (2014) countries. (279 words) Doctoral Education: the shape of things to come dissertations, and offers a basis for advancing research to address this major knowledge gap. http://www.eua.be/activities-services/cde/the- References: shape-things-to-come.aspx Kim M.J., McKenna H.P. & Ketefian S. (2006) References: Jump (2015) PHD: is the doctoral thesis Global quality criteria, standards and indica- Goodfellow, L; Macduff, C; Leslie, G; Copeland, obsolete? https://www.timeshighereducation. tors for doctoral programs in nursing; literature S; Nolfi, D; Blackwood, D (2012) ‘Nurse Scholars’ co.uk/features/phd-is-the-doctoral-thesis- review and guideline development. International Knowledge and Use of Electronic Theses and obsolete/2020255.article Journal of Nursing Studies 43(4), 477-489. Dissertations’ International Nursing Review 59, Tinker, P and Jackson, C (2004) The Doctoral Kim, MJ Park,GC McKenna H , Ketefian S Park 511-518 Examination Process. Maidenhead: Society for SH , KlopperH, Lee H , Kunaviktikul W, Gregg M F Daly J , Coetzee S , Juntasopeepun P,

111 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Kim, MJ Park,GC McKenna H , Ketefian S Park Symposium 12: Paper 1 SH , KlopperH, Lee H , Kunaviktikul W, Gregg M F Daly J , Coetzee S , Juntasopeepun P, Time: 1:40pm Evaluating the Family Murashima S, Keeney S & Khan S (2015) Quality Nurse Partnership (FNP) Room: Harris 2 (level 1) of nursing doctoral education in seven countries: Programme in England survey of faculty and students/graduates. Journal of Advanced Nursing 71 (5): 959-1194 Family Nurse Partnership in Author McVicar, A and Caan, W (2005) Research capa- the UK - evidence, experience Dr Julia Sanders, UK bility in doctoral training: evidence for increased and adaption diversity of skills in nursing research. Journal of Abstract Research in Nursing 10 (6) pp 627-646 Lead: Dr Julia Sanders, Reader in Midwifery/ Introduction: Supporting teenage mothers Consultant Midwife, Cardiff University, UK is a UK policy priority. The (FNP) Programme provides intensive support to young mothers in The Family Nurse Partnership (FNP)programme selected areas of the UK. FNP consists of struc- is a licensed intensive home visiting intervention tured regular home visits by Family Nurses developed in the US and launched in England during pregnancy and until the child’s second in 2007. A Cardiff University team published birthday. Building Blocks was a RCT which results in October 2015 from Building Blocks investigated the effectiveness of offering FNP, (ISRCTN23019866, the largest trial conducted in addition to usual care, at 18 sites in England. to date testing the effectiveness of this interven- Method: Participants were nulliparous, under tion. 20 and recruited before 25 weeks gestation. Data The Building Blocks trial represented one of the were collected at baseline, late pregnancy and at largest and most complex trials of a nursing inter- 6, 12, 18 and 24 months postpartum. Primary vention ever undertaken and was commissioned outcomes were tobacco use at late pregnancy, in England amongst a background of genuine birth weight, subsequent pregnancy by two years and high expectations that the FNP programme postpartum and emergency hospital episodes would result in measurable improvements for for the child. Secondary outcomes included FNP clients and their children. The trial dem- measures of pregnancy and birth, child health onstrated the committed work of Family Nurses and development, and parental life course. and the high regard with which Family Nurses Results: The study recruited 1645 women are viewed by their clients. Despite the success between June 2009 and July 2010. FNP clients in the delivery of FNP, the overall trial results reported the programme enjoyable, helpful and were disappointing. Several outcomes of policy supportive and received an average of 39 FNP importance were not influenced by the addition programme visits. of FNP to care normally provided to women. The trial demonstrated high levels of underlying The use of routinely collected data enabled high smoking, domestic abuse and repeat pregnan- levels of follow-up. FNP was no more effective cies amongst participants, indicating ongoing than routinely available healthcare in influencing unmet health and social needs, and the need for the four primary outcomes. Mothers allocated to this client group to remain a priority within early FNP reported improved language development years’ policy. in their child at 12, 18 and 24 months, and were less likely to report signs of developmental delay The results of the Building Blocks trial will at 24 months compared to mothers offered usual be presented, with a particular emphasis on care. possible explanatory factors for the unexpected findings. The trial results presented a challenge Conclusion: Our trial found there was little to the FNP central team who have responsibil- advantage to adding FNP to existing health ity for the training of Family Nurses in the UK service provision in England and was not cost- and support to all local sites. The FNP National effective from the perspective of maternal unit are committed to using the trial results to outcomes. There was some benefit for the child further understand and adapt the programme by their second birthday, although evidence for to meet the needs of FNP clients in the UK and child health and development outcomes would their response will be presented and explored. mainly arise in children after the age of two and longer-term follow-up is therefore required for this outcome. ISRCTN23019866

Reference: Robling M, et al. The effect of an intensive nurse home-visiting programme for first-time teenage mothers on maternal and child outcomes to aged two: a pragmatic individually randomised controlled trial (Building Blocks). The Lancet In Press

112 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Paper 2 Paper 3 Barnes, J et al. Trials 2013, 14:285 http://www. trialsjournal.com/content/14/1/285 Understanding how the Adaptive clinical practice: Rising SS, Kennedy HP, Klima CS (2004) Family Nurse Partnership transferable learning from Redesigning prenatal care through Centering (FNP) may better influence Group FNP Pregnancy. Journal of Midwifery and Women’s smoking in pregnancy and Health 49(5): 398-404 cited in Gaudion, A subsequent pregnancies Author (2011) op cit Mary Griffiths, UK Author Abstract: Keira Lowther, UK Paper 4 Group FNP has been developed as a variant of Abstract Family Nurse Partnership over the past six years Successful engagement Background: Following the finding that FNP and is currently the subject of a randomised with first time teen mothers was no more effective than routine services controlled trial. Group FNP shares many model during pregnancy and their in reducing smoking during pregnancy, or elements with FNP and is focused on improving maternal outcomes, maximising child’s devel- child’s first years: The case of avoidance of a subsequent pregnancy within the Family Nurse Partnership two years of birth, the FNP National Unit made opmental potential and increasing parents’ self- a commitment to understanding these results in sufficiency. This programme is aimed at low Programme more depth. resource women not eligible for FNP and their partners, promoting sensitive attuned parenting, Author Method: We reviewed literature for interven- positive choice-making and behaviour modi- Ruth Rothman, UK tions with evidence of effectiveness in smoking fication for the participants. Pregnancy care cessation and avoidance of subsequent pregnan- is delivered in group by a midwife with a focus Abstract cies, conducted group interviews with FNP sites on self-care and learning together, based on the by telephone, purposively selecting sites with CentringPregnancy® model. One of the key aspects of delivery of the Family the highest and lowest prevalence of the two Nurse Partnership (FNP) programme is focusing Family nurses mostly work with women on a one outcomes, and conducted content analysis of the on the concept of engagement. The recent ran- to one basis, developing facilitative therapeutic findings. domised control trial of FNP in England showed relationships as the basis for client learning, high levels of engagement and low attrition from Results: Literature described how profession- exploring, behaviour adaptation and change. the life of the programme (over 2.5 years) with a als are sometimes hesitant to discuss smoking in Clinical practice is supported by a crafted client group that is typically described as ‘hard pregnancy but that counselling, feedback, social learning programme, regular supervision and to reach’. support and incentives can help. ongoing skills practice that enables effective The group interviews found that barriers to delivery of the programme content, skills that Family nurses and supervisors understand that a successful quit attempt are environmental, are augmented for the delivery of Group FNP. client engagement requires constant attention as social, emotional and informational. Group FNP eligibility criteria target women who engagement is not a linear concept. In addition to successfully achieve the many goals of the The literature described consistent associations are comparatively low achievers, have poorly programme, family nurses need to enable clients between short pregnancy intervals and preterm developed inter-personal skills and other social to engage in a number of modes; birth. Parenting is sometimes affected, with a disadvantages. Skilful group leadership enables short inter-birth interval being associated with participants to derive significant personal value With the nurse and their relationship neglectful parenting and poor warmth toward and learning through sharing and exploring With the programme content and learning the first child. their pregnancy and parenting experience and understanding of their child’s development, With making positive decisions and choices as The evidence is consistent that long-acting increasing their self-efficacy and confidence well as changes in behaviours reversible contraceptives are associated with through mutual interest and encouragement and This session will explore the concept of engage- increased birth spacing. The FNP teams were more mature social interactions. ment, based on the learning from FNP, how this clearly divided between planned and unplanned Development of Group FNP over four phases has can be further developed to increase the impact pregnancies. Unplanned pregnancies were of the FNP programme and how it can be used to blamed on chaotic lifestyles and reduced by offered substantial learning and insight that has enriched nurses’ one to one FNP practice and support other services in engaging with similar good access to contraception. Planned preg- groups. nancies were due to a new partner, safeguard- has potential relevance for other areas of clinical ing concerns, successful motherhood experi- practice for example ongoing effective engage- ence, intentional planning to return to work ment, motivational interviewing in groups, after having a closely spaced family and cultural clinical supervision. This presentation will pressures. explores Group FNP - the opportunities, challenges and particularly the transferable skills Discussion: At the FNP National Unit, we’re for nurses and midwives undertaking intensive taking the RCT findings seriously to plan what group work with new parents. our next steps should be. Whilst there are several approaches with proven effectiveness to support women to reduce smoking in pregnancy, References and reduce rapid subsequent pregnancies, sup- Barnes, J & Henderson, J (2012) Summary porting young mums to achieve these goals is of the formative evaluation of the first phase complex: socially, emotionally and culturally. of the group based Family Nurse Partnership programme. Department of Health https://www. wp.dh.gov.uk/publications/files/2012/08/ GFNP-PHASE-1-Evaluation-Summry-report- FINAL-for-PUBLICATION.pdf

113 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Symposium 13: Paper 1 design of nursing work. Considerable challenges Towards a new agenda in remain if this policy agenda is to successfully Time: 1:40pm eliminate PI as a source of patient harm. pressure injury prevention: Room: Ochil (level 1) perspectives on international pressure injury policy Promoting patient Paper 2 safety: International and Authors: intersectoral approaches to Graeme D Smith (Edinburgh Napier University Developing an intersectoral pressure injury prevention Edinburgh, UK), William Li (The University program of research to Lead: Professor Debra Jackson, Oxford of Hong Kong, Hong Kong), Debra Jackson prevent pressure injury: Institute of Nursing and Allied Health (Oxford University Hospitals NHS Foundation the OxPIP collaboration Research, Oxford Brookes University, Oxford Trust and Oxford Brookes University), Marie experience University Hospitals NHS Foundation Trust, Hutchinson (Southern Cross University, Australia), Susan Barnason (University of UK Authors: Nebraska Medical Centre, USA), Judy Mannix Pressure injury (PI) remains a major cause of Cindy Whitbread (Oxford Health NHS (Western Sydney University, Australia), patient harm nationally and internationally. Foundation Trust, Oxford Academic Health Stephen Neville (Auckland University of Individuals experiencing hospital-acquired PI Science Centre), Debra Jackson (Oxford Technology, New Zealand), Donella Piper are known to have higher mortality, both within University Hospitals NHS Foundation Trust (University of New England, Australia), hospital and within 30 days of discharge. Addi- and Oxford Brookes University); Jill Bailey Tamara Power (University of Technology, tionally, while there is compelling evidence that (Oxford Health NHS Foundation Trust, Sydney, Australia), Kim Usher (University of PI occurs outside of hospital and residential care Oxford Academic Health Science Centre); New England, Australia). settings, most prevalence studies and evalu- Sally Beer (Oxford University Hospitals NHS ations are hospital-based. We argue the need Foundation Trust), Ria Betteridge (Oxford for a more collaborative approach to conduct- Abstract University Hospitals NHS Foundation Trust), ing research about PI prevention and manage- Background: Pressure injuries (PI) are associ- Sarah Baines (Oxford Health NHS Foundation ment across a range of clinical contexts. This ated with significant harm to patients, and carry Trust), Sarah Gardner (Oxford Health symposium will focus on the importance of inter- economic consequences for the health sector. NHS Foundation Trust), Marie Hutchinson national and intersectorial approaches to better Internationally, preventing and managing PI is a (Southern Cross University, Australia); understanding the overt and subtle factors that key nursing activity and quality indicator. Stephen Neville (Auckland University of contribute to PI across care settings. Aim: To analyse influential policies that inform Technology, New Zealand); Helen Walthall, Presentation one focuses on the findings of practice related to PI management in Australia, (Oxford Brookes University); Kim Usher a critical analysis of significant international England, Hong Kong, New Zealand, Scotland, (University of New England, Australia). policy documents aimed at preventing and and the United States of America. managing PI and highlights the current narrow Methods: Narrative review and synthesis of PI Abstract interpretations of patient harm, and reveals policies that inform practice. Background: Pressure injury (PI) can occur areas that urgently need addressing if we are to Results: Seven national-level policy or in a number of contexts, meaning preventa- successfully eradicate PI as a significant cause of standards documents and associated practice tive interventions and treatments need to be harm to individuals. guidelines were identified. Primarily, the adaptive across a wide range of community Presentation two describes the formation policies aim to summarise extant evidence and and acute settings. This requires organisational of OxPIP, an intersectoral group of clinical provide guidance on the prevention and man- and individual change and a commitment to and academic nurses, quality improvement agement of PI. The goals of the policies almost effective delivery (NICE 2014). Health care champions and patient representatives intent on exclusively focus upon PI risk assessment, nutri- service providers in and around Oxford (UK) reducing patient PI in hospital and community tional assessment and intervention for those strive for clinical excellence and aim to work in settings through collaborative research-based at risk, relief or redistribution of pressure, and partnership with patients, carers and local com- practice change. optimal wound management. A number are pre- munities. These working partnerships are com- Presentation three will focus on how the dominantly focused upon treatment approaches, plemented by collaborating with universities, incidence of PI can be reduced across both with far less attention given to prevention. health services, private sector organisations and voluntary groups. Nevertheless, PI continues community and acute hospital settings through Discussion: The prime focus of policy is the systematic application of skin care bundles. to be problematic, causing pain and distress on patient risk assessment, compliance with to patients, and a burden to the health service Presentation four will critically explore the documentation and pressure relief. Financial (Cullen Gill 2015; Baldelli 2008). current level of patient involvement in the pre- penalty for institutions is emerging as a strategy vention and management of PI. In this presenta- where pressure injuries occur. Comparisons of Aim: This paper introduces the Oxford Pressure tion we will argue that new models of patient- prevalence rates are hampered by the lack of Injury Project (OxPIP), an intersectoral col- informed active pressure injury prevention consensus on data collection and reporting. To laboration with the specific aim to reduce PI (PIAPIP) are required to ensure that patients at date there has been little evaluation of policy across both hospital and community settings. risk of being harmed by PI are better informed implementation and implemented policy strat- To achieve this aim the OxPIP Collaboration is and enabled to be more active partners in the egies, and associated guidelines continuing to analysing current policy and evidence-based prevention of these avoidable injuries. be founded upon expert opinion and low-level practice involving the prevention of pressure evidence. damage and undertaking research to determine patient need across settings. The OxPIP Col- Conclusions: The PI policy agenda has fostered laboration brings together experienced clini- a discourse of attention to incidents, compliance cians and academics, patient representatives and penalty (sanctions). Prevention and inter- and quality improvement champions. Group vention strategies are informed by technical and members are located in different sectors and biomedical interpretations of patient risk and include some international advisors. The group harm, with little attention given to the nature or

114 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 meets monthly and communicates frequently to Results: Early results indicate a positive impact Results: Evidence supports that active patient maintain momentum. on patient outcomes, with fewer incidents involvement can reduce adverse events and Conclusion: The OxPIP Collaboration is building of acquired PI in both community and acute patient safety incidents (Agoritsas et al. 2015; a comprehensive knowledge base of PI preven- settings. Weingart et al. 2011). Yet, the patient role in PI tion and treatment, patterns of service use, and Discussion: Individuals within community prevention remains passive, with benevolent adequacy of service provision across communi- settings may interface with a diverse range of professional interpretations of patient contribu- ties, all of which inform strategies to reduce the care providers that can be a challenge to con- tions commonplace. Safety frameworks based occurrence of PI. Through OxPIP, activities a tinuity of holistic care. Much of the existing upon increased monitoring and regulation of comprehensive account of the prevalence and evidence around implementation of skin care nursing work, alongside passive patient engage- nature of PI across differing sectors is being bundles involves interventions in acute settings. ment will not eliminate PI (Braithwaite et al. ascertained, providing a real opportunity to Importantly, this project provides much needed 2015). Suggestions for strengthening PIAPIP understand how services can promote PI pre- evidence of this intervention’s effectiveness in theorising, interventions and measurement will vention across various hospital and community community settings, and highlights the need for be presented. health settings. multiservice/agency education and training to Discussion: The elimination of PI remains reduce PI, especially in community settings. resistant to routine interventions, and improve- References: Conclusions: The implementation of skin care ments when made are difficult to sustain. Developing opportunities for effective patient Baldeli, P. (2008) ‘Creation and Implementation bundles in areas where patient contact is limited informed partnership remains a challenge. of a Pressure Ulcer Prevention Bundle Improves highlights the importance of patient and carer Active patient involvement in PI prevention, Patient Outcomes’, American Journal of Medical education. There is a need for a continued col- which is sensitive to the nuances and complexi- Quality. 23 (2) pp 136 - 142 laborative approach to PI prevention to improve processes and streamline communication. Using ties of clinical work are required. To be success- Cullen Gill, E. (2015) Reducing hospital acquired evidence-based QI empowers teams to take ful this will require a major refocus of current pressure ulcers in intensive care’, British ownership and can facilitate safer care. approaches to prevention and a more nuanced Medical Journal Quality Improvement Reports. insight into risk factors. Available at: www.bmjquality.u205599.w3015 References: Conclusions: New models of PIAPIP must National Institute for Clinical Excellence (NICE) harness patient and nursing knowledge to pur- Bennett G, Dealey C, Posnett J (2004) The cost (2014) Clinical Guideline 179. Pressure ulcer posefully focus upon how safer care environ- of pressure ulcers in the UK. Age and Ageing; 33: prevention. The prevention and management of ments can be enabled and strategies for PI pre- 230-235. pressure ulcers in primary and secondary care. vention made more effective. Available at: Resar R, Griffin FA, Haraden C, Nolan TW (2012) Using Care Bundles to Improve Health References. Care Quality. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Health- Agoritsas, T., Heen, A. F., Brandt, L., Alonso- Paper 3 care Improvement; 2012. Available at: www.IHI. Coello, P., Kristiansen, A., Akl, E. A., . . . Elwyn, org. Accessed 5/11/15 G. (2015). Decision aids that really promote Implementation of a skin care shared decision making: the pace quickens. bundle to prevent pressure BMJ, 350, g7624. injury: experiences from the Braithwaite, J., Wears, R. L., & Hollnagel, E. front line Paper 4 (2015). Resilient health care: turning patient safety on its head. International Journal for Towards patient-informed Quality in Health Care, mzv063. Authors: active pressure injury Ria Betteridge and Sarah Gardner Weingart, S. N., Zhu, J., Chiappetta, L., Stuver, prevention: articulating the S. O., Schneider, E. C., Epstein, A. M., . . . Weissman, J. S. (2011). Hospitalized patients’ Abstract way ahead participation and its impact on quality of care Background: Pressure ulcers are a significant Authors: and patient safety. International Journal for source of morbidity and mortality in the NHS Debra Jackson (Oxford University Hospitals Quality in Health Care, 23(3), 269-277. doi: and have been estimated to cost up to Â£2.1 NHS Foundation Trust and Oxford Brookes 10.1093/intqhc/mzr002 billion every year (Bennett et al. 2004). Recog- University); Marie Hutchinson (Southern nised care interventions such as skin inspec- Cross University, Australia). tion, repositioning, continence management, nutritional support and care on an appropriate surface need to be implemented consistently in Abstract order to improve outcomes and reduce pressure Background: Even though attention has been injury (PI) risk. When used collectively, these given to actively involving patients in their own components form a skin care bundle, a set of care, active involvement of patients in prevent- evidence-based interventions that, when imple- ing adverse events and injury remains poorly mented together, are more effective in improving theorised. Current preventive frameworks for outcomes than when implemented individually pressure injury (PI) frame patients as passive (Resar et al. 2012). care recipients, with attention primarily focused Aim: To reduce acquired PI across provider upon monitoring, guiding clinicians and services. improving technical aspects of care delivery. Method: Using agreed terminology and a Aims: This presentation will provide a critical Quality Improvement (QI) methodology, sites reflection on patient-informed active pressure from both community and acute care settings injury prevention (PIAPIP) and identify direc- were selected to test the effectiveness of skin tions for future research. care bundles in reducing the incidence of PI. Methods: A conceptual and literature based analysis.

115 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Symposium 14: Paper 1 Paper 2 Time: 1:40pm Therapeutic photography and Negotiating ‘voice’ in photovoice in mental health photovoice research Room: Kilsyth (level 0) services Photovoice - using research to Author Author Dr Sarah J Rhynas, UK allow the voices of potentially Neil Gibson, UK marginalised groups to reach Abstract policymakers Abstract Background: Experience of two research Lead: Dr Sarah Rhynas, University of projects with groups who have experienced alco- Edinburgh, UK The Mental Health Strategy 2012-15, published by the Scottish Government, calls for peer to hol-related harm has demonstrated that partici- As an emerging methodology, photovoice has peer work to be embedded in mental health pants engage with photovoice in different ways. much to offer healthcare research, specifically practice, as well as addressing self-management Some participants identify as part of a group with around the direct engagement with politicians and self-help approaches. Often, service users clear messages and a voice waiting to be heard. and policymakers. These 4 papers bring together experiencing mental health issues are reluctant Others participate individually, unaware that experience from a range of projects, to explore to speak openly about issues because of stigma, they can contribute to a wider debate or have a how the voices of potentially marginalised fear, and discrimination. In recognition of this, voice which policymakers could learn from. This groups can be heard and understood by policy- services may need to assess how they engage paper explores the challenges for researchers makers. with service users, and how information can be in facilitating the voice of participants, setting Paper one shows how photovoice can facilitate gleaned in a more effective manner. groundrules for participatory research and taking the messages beyond a personal narrative increased disclosure and engagement with the A six week photography intervention was to influence wider debate. research process, allowing potentially margin- conducted with 8 service users from a mental alised mental health service-users to engage health support group in the North East of Findings/Experiences: Individuals with alco- with innovative visual methodologies. The Scotland. The intervention was termed ‘Thera- hol-related brain damage (ARBD) participated second paper draws on two projects to debate peutic Photography’ and participants were in a photovoice study, producing photographs the co-production of findings and the negotiat- encouraged to photograph around the themes of and accompanying narrative about their lives ing of voice in photovoice research. This paper self-portraits, relationships, emotions, personal and experiences, facilitated by a creative writer. questions the roles of participants and research- narratives, and their immediate environment, Analysis of the narratives and participants’ ers, debating how personal narratives and the before culminating in a photovoice project which explanations of their photos allowed research- analytic lens of the researcher can combine to the group defined. ers insights which shaped research findings. In produce robust research findings. a second project with a group recovering from Observations were recorded throughout the six alcohol related harm, participants took inde- Paper three offers a different example of week project, photographs were collated, and a pendent ownership of their narratives, clear engaging with challenging research populations. focus group conducted to ascertain the impact from the start about the story that they wanted The paper demonstrates how photovoice can of participation. Data was analysed using eth- to tell and the importance of their message. be used as a personal reflection tool, allowing nography and interpretive phenomenological participants to contribute personal insights to analysis to study the ways in which participants Discussion: Photovoice can facilitate research the research in a striking, visual way. Modifying interacted with photography, and to identify involvement by potentially marginalised photovoice to work individually then contribute common themes in areas which participants groups. Negotiation and agreement is required to findings through thematic analysis offers a chose to explore. to establish the way in which research findings useful way of thinking about participants’ voices will be co-produced between participants and The results suggest that using photography in the research process. researchers with the necessary support to as an intervention with groups encouraged a facilitate this process. Both participants and The final paper explores one of the key goals high degree of self-disclosure which, in turn, researchers can learn from each other, debating of photovoice - the process of engaging with generated considerable support from peers. The experiences, literature and engaging in two-way politicians and policymakers. Experience from participants exercised control over the informa- analysis. True co-production of findings can research with those recovering from alcohol- tion they shared and learned from one another result in a voice which is personally resonant related harm is used as an example of how that they were facing similar issues. Some par- to participants while contributing to wider political and policymaker engagement can ticipants reported increased positive feelings academic debate. be maximised through the use of different about themselves and the photovoice exercise approaches and opportunities, ensuring that was used to explore the theme of ‘my safe space’ Conclusions: To be effective as a research audience-appropriate key messages are clearly which drew out a common theme of coping strat- approach photovoice must facilitate the voice articulated. egies and warning signs which all of the group of marginalised groups, taking coherent, ana- Together these papers consider the photovoice identified with. lytically robust research findings to policymak- trajectory from participant recruitment to poli- ers. Co-production of findings requires estab- cymaker engagement and highlights debates lished groundrules which ensure that both the around the roles of participants and researchers voice of participants and the analytic lens of the throughgout. This symposium seeks to explore researcher are effectively combined. some of the issues and challenges in using this innovative approach in a way which is empowering to participants and effective in communicating research to policymakers.

116 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Paper 3 Paper 4 3 Oliver K, Innvar S, Lorenc T, Woodman J & Thomas J (2014) A systematic review of barriers Obesity and bariatric surgery: Photovoice: how to use the to and facilitators of the use of evidence by through the patient’s eyes evidence to engage with policymakers. BMC Health Services Research, policymakers 14:2 http://www.biomedcentral.com/1472- Author 6963/14/2 Catherine Homer, UK Author Dr Aisha Holloway, UK Abstract Bariatric surgery is a cost effective treatment Abstract for morbid obesity with an increasing number Background: Innovative and creative methods of patients accessing surgery. Severe obesity is of engaging communities and political leaders to commonly associated with physiological and address public health issues are being called for psychological morbidity. Obese people are likely in the research field; to experience social isolation, have low levels of (1)Photovoice is an emerging innovative meth- self-esteem, confidence and negative feelings odology providing community members with towards their appearance. Access to bariatric training on photography, ethics, critical dis- surgery is through a tiered framework including cussion and policy advocacy (2) Photographs clinical and psychological interventions. are taken by individuals that represent their A longitudinal study was conducted with thoughts, perceptions and feelings about par- patients pre (n=18) and three months (n=16), ticular issues in their community and environ- nine months (n=15) and two years post (n=12) ment. The pictures and accompanying nar- bariatric surgery to explore their pre and post- ratives can be shared with key stakeholders operative experience and expectation. Inter- and policy makers to advocate for community views were informed by a modified version of change. Using Photovoice has the potential to photovoice techniques. Prior to each interview develop successful ways of engaging with mar- ‘assignments’ were given to each participant. ginalised groups in order to empower and have The assignments were changed according to the their voice heard to affect and impact health timeframe of the patient’s journey and included: policy. However, there remain barriers and current life, preparation for the surgery, expec- facilitators to the use of evidence by policymak- tation of life after the surgery, decision to have ers resulting in the potential for gaps between the surgery, what things can do now you didn’t/ research, practice and policy (3) Through the couldn’t before? use of strategic approaches these gaps can be Data is being analysed using Framework Analysis narrowed. as part of a PhD study. Interim analysis of the Aim: This paper aims to provide insight into the data has identified marked differences in the mechanisms, processes and strategic approaches photographs taken at each stage of the research. of producing research evidence that facilitates Photographs taken by participant’s pre surgery engagement with policymakers and political were primarily indoors to signify the challenges leaders in relation to photovoice. of day to day life. Images were of body parts Method: The paper will consider the current rather than the whole self. Clothes participants evidence in relation to the use of research wore were taken alongside clothes they hoped evidence by policymakers. This paper will to be able to wear with their new appearance. present a specific account of how photovoice was Following surgery participants shared pictures used: the mechanics, processes and strategic of themselves with family members and friends approaches that underpinned the policymaking in outdoor spaces. and political engagement that occurred. Using the Photovoice techniques has highlighted Contribution: Despite an increasing focus on some of the day to day burdens of obesity and the uptake and impact of research evidence on how patients manage their home life with cli- policy and the importance of evidence-informed nicians. Participants have reported feeling policymaking, health-related research and spe- empowered by taking the photographs which cifically nurse-related research is often unable has allowed them to reflect on their weight loss to engage with the policymaking and political journey. audience. The proposed Framework for Political Influencing will contribute to the development of the knowledge base from which nurses and health professionals can be guided in future engagement activities.

References 1 Public Health England (2014) Doing, supporting and using public health research. The Public Health England strategy for research, translation and innovation. Public Health England 2 Wang CC, Yi WK, Tao ZW & Carovano K (1998) Photovoice as a Participatory Health Strategy. Health Promotion International, 13 (1), 75-86

117 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Symposium 15: Paper 1 internationally. The strategies based on local context have work and we have consolidated a Time: 1:40pm The Spanish Best Practice network that shares knowledge and strategies Guidelines Implementation and promotes evidence-based culture among Room: Moorfoot (level 0) Project. Methodology and Spanish healthcare settings and evidence-based care to patients. 296 words Best Practice Guidelines framework Implementation Project. The References: Authors: Spanish experience as part González-María, Esther. RN. Scientific advisor. 1. Registered Nurses Association of Ontario. of the Best Practice Spotlight Nursing and Healthcare Research Unit. Toolkit: Implementation of best practice guide- Organizations® international Institute of Health Carlos III. Madrid. Spain. lines (2nd ed.). 2012. Available at: http://rnao. program Albornos-Muñoz Laura. BS. Researcher staff. ca/sites/rnao-ca/files/RNAO_ToolKit_2012_ Lead: Dr Esther Gonzalez-Maria, Unidad de Spanish Collaborating Centre of Joanna Briggs rev4_FA.pdf Investigación en Cuidados de Salud (Investén- Institute. 2. Ruzafa Martínez M, González María E, Moreno isciii), Spain Moreno-Casbas Teresa. RN. Director of the Casbas M, del Río Faes C, Albornos Muñoz L, Escandell García C. Proyecto de implantación Implementation research implies the study of Nursing and Healthcare Research Unit. de Guías de Buenas Prácticas en España 2011 – complex systems and multiple factors. The Best Institute of Health Carlos III. Madrid. Spain. 2016. Enf. Clin. 2011; 21(5): 275–83. Practice Spotlight Organizations® (BPSOs) Grinspun Doris. Executive Director. Registered Program in Spain is multicenter, covers different Nurses’ Association of Ontario. Ontario. health care levels (e.g. hospital, primary care, Canada. long term care, and nursing homes), and address Paper 2 multiple healthcare problems (such as falls, Abstract promotion of breastfeeding, etc.). In this context Background: The Spanish Best Practice Guide- Does the implementation of our proposal is to present a Symposia that intro- lines (BPG) Implementation Project is part of duces the common methodology and framework RNAO guide - breastfeeding the Best Practice Spotlight Organizations® established, and then provide information about improve the results of our (BPSOs) international Program, coordinated by the specific strategies and results obtained in practice? the Registered Nurses’ Association of Ontario each guideline implementation. Besides the (RNAO). The Project is coordinated in Spain by rationale of the selection of each guideline is a the national Nursing and Healthcare Research Authors significant issue, e.g. six from the eight centers Unit (Investén-isciii) of the Institute of Health 1. Nieto-Martínez Cristina. RN, Midwife. selected in first project of the BPSO® Program Carlos III, and the Spanish Collaborating Center Hospital Clínico San Carlos. Madrid. Spain. in Spain, selected ostomy care and management of Joanna Briggs Institute, (named Spanish Host 2. González-Fernández María Ángeles. RN. guideline, as the implementation of recommen- Organization of BPSO® Program). Deputy Director of El Bierzo District Primary dations related to this guideline was perceived as Care Management. Chief of Nursing Care Aim: To influence the uptake of nursing BPGs a necessity to improve care circuits, as a result Unit and in charge of Research and Quality across health care organizations, to enable four new nursing outpatient units for ostomy Department. Ponferrada. Spain. care were opened. Finally the approach of each practice excellence and positive client outcomes. Methods: After translating the RNAO’s BPGs 3. Harillo-Acevedo Francisco David. RN, Best Practice Guideline has peculiarities that Midwife. Hospital Rafael Méndez. Lorca. Spain should be analyzed separately. into Spanish the Host Organization published a formal call for proposals to select healthcare 4. Peña-Benito Laura. RN, Midwife. Hospital settings in Spain to implement the RNAO’s BPGs Clínico San Carlos. Madrid. Spain. and evaluate the results. 5. González-Gallego María. RN. Nursing chief. The approach is: nursing-led and multidisci- Primary Health Care Center Ponferrada II. plinary; context specific; and involving a wide Spain.. range of stakeholders. The Implementation of 6. Ruzafa-Martínez María. RN. Professor. Best Practice Guidelines Toolkit (RNAO, 2012) Faculty of Nursing. University of Murcia. guides the process: cascade training, selection Spain. of recommendations to be implemented, 3 years planned implementation activities, monitor- Abstract ing by measuring process and outcome results Background: WHO recommends exclusive for patients discharged 60 days every year. breastfeeding up to 6 months of age1,2. The Host Organization supports healthcare settings implementation of the RNAO Guide3 endowed selected. our institutions with tools in order to improve Results: The call was launched in 2012. Eight breastfeeding outcomes. healthcare settings/11 sites, attending 1,3 million Aims: Evaluate the results of the recommenda- of people, were selected (hospitals and primary tions implemented by the evolution of indica- health care centers). They chose 10 BPGs, tors: exclusive breastfeeding in the first 2 hours according to their needs. More than 1200 nurses of life, exclusive breastfeeding during 24 hours and 40 other healthcare professionals have before hospital discharge and exclusive breast- been trained, evidence based protocols have feeding at 6th month. been developed or updated, patient education Methods: Quasi-experimental study using his- have been promoted, and international BPSO® torical controls. Scope: 2 hospitals and a primary indicators have been evaluated in an electronic care center. It was used a consecutive non proba- platform. bilistic sampling of mothers attended in the last Discussion and Conclusions: The results 5 lawful days of the month. obtained acknowledge that RNAO implemen- Results: Hospital 1: tation method could be replicated with success

118 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Previous to the intervention: (2009) n=1173. Paper 3 53.5% vs 66.4% vs 69.42%; Patients who fall Exclusive breastfeeding during 24 hours before 2.2% vs 2.7% vs 1.78%, Minor injuries 5 vs 4 vs hospital discharge: 40.95%. Implementation and 4; Severe injuries 2 vs 0 vs 0; Reassessment after fall 27.8% vs. 40% vs. 76.47%. • After the intervention (December 2014) n=92. effectiveness of nursing best practice guideline ‘prevention Discussion and Conclusions: Implementa- • Exclusive breastfeeding in the first 2 hours of tion of BPG has raised awareness of nurses to fill life: 93.9%. of falls’ in Spain clinical records about falls and fall prevention. • Exclusive breastfeeding during 24 hours before Authors Fall risk assessment and allocation of a pre- hospital discharge: 75.2%. Alcañiz-Mesas Ana Isabel. RN. Unit vention plan have improved. The percentage of Hospital 2: of Oncology/Hematology. Complejo patients who fall is lower than other in-hospital studies. Previous (January 2013) n=23. Universitario Hospitalario Albacete. Albacete. • Exclusive breastfeeding in the first 2 hours of Spain. References life: 59.1%. Córcoles-Jiménez Pilar. RN. Nurse in Research and Training Department. Complejo 1. Sebastián-Viana T, García-Martín MR, Núñez- • Exclusive breastfeeding during 24 hours before Universitario Hospitalario Albacete. Albacete. Crespo F, Velayos-Rodríguez EM, Martín- hospital discharge: 60.9%. Spain. Merino G, González-Ruiz JM et al. ¿Cuál es la After (January 2015 - April 2015) n=92. Rodríguez-Soberado María del Pilar. RN. incidencia real de caídas en un hospital?. Enf. • Exclusive breastfeeding in the first 2 hours of Chief Nursing Officer in Training and Quality Clin. 2011; 21(5): 271–4. life: 79.3%. Department. Hospital Medina del Campo. 2. Registered Nurses ́s Association of Ontario. • Exclusive breastfeeding during 24 hours before Valladolid. Spain. Toolkit: Implementation of best practice guide- hospital discharge: 77.9%. Tiñena-Amoros Montserrat. RN. Nurse in Heal lines (2nd ed.). 2012. Available at: http://rnao. ca/sites/rnao-ca/files/RNAO_ToolKit_2012_ Primary Care Center: Wounds, Protocols and Methods. Hospital Vall d’Hebron. Barcelona. Spain. rev4_FA.pdf Previous (February 2012) n=130. Fernández-Núñez María Luz. RN. Nurse in 3. Ruzafa-Martínez M, González-María E, • Exclusive Breastfeeding at 6th month: 26.7%. Quality, Research and Training Department. Moreno-Casbas M, del Río-Faes C, Albornos- After (November 2015) n=237. Hospital Sierrallana. Torrelavega. Spain. Muñoz L, Escandell-García C. Proyecto de • Exclusive breastfeeding at 6 months: 40.3%. Alonso-Poncelas Emma. RN. Nurse in Quality implantación de Guías de Buenas Prácticas and Information Department. Hospital Dr. en España 2011 – 2016. Enf. Clin. 2011; 21(5): Discussion: The measurement method for pre- José Molina Orosa. Arrecife, Lanzarote. Spain. 275–83. implantation has not been uniform and starting positions are different among institutions, which determined that the implementation strategies Abstract have been adapted to each context. Falls are an important health problem both for Paper 4 Conclusions: All institutions have had a sig- their high morbidity and by significant socio- nificant increase in outcome indicators. Imple- economic costs. Registered Nurses’ Associa- Effects of implementing mentation of this best practices guide improves tion of Ontario has developed the Nursing Best the best practice outcomes. Its generalization may be part of a Practice Guideline (BPG) ‘Prevention of Falls guideline ‘Ostomy care strategic line in public health. and Fall Injuries in the Older Adult’. This BPG aims to increase all nurses’ knowledge and and management’ of the References: abilities in the identification of adults at risk of programm Best Practice falling and to define interventions for the pre- 1. WHO: World Health Organization 2015. Spotlight Organization vention. Infant and young child feeding. Fact sheet Nº342. [on line]. Available from: http://www. Aim: To assess the establishment of recommen- Authors who.int/mediacentre/factsheets/fs342/en/ [27 dations of the BPG in Spanish hospitals after 3 Tiñena-Amoros Montserrat. RN. Nurse in Heal January 2016]. years of implementation, as well as its effective- Wounds, Protocols and Methods. Hospital Vall ness for the prevention of falling. d’Hebron. Barcelona. Spain. 2. Kramer MS, Kakuma R. Optimal duration Rodríguez-Soberado María del Pilar. RN. of exclusive breastfeeding. Cochrane Database Methods: Pre-post-implementation design. Chief Nursing Officer in Training and Quality of Systematic Reviews 2012, Issue 8. Art. No.: Area: 5 Spanish hospitals. Sample: ≥65 years-old Department. Hospital Medina del Campo. CD003517. DOI: 10.1002/14651858.CD003517. patients that had been discharged the last 5 days Valladolid. Spain. pub2 of every month. Intervention: training courses, establishment of multidisciplinary teams, Viñoly-Torres Elsa. RN. Supervisor de COT. 3. Registered Nurses Association of Ontario protocols development. Hospital Dr. José Molina Orosa. Arrecife, (2003). Breastfeeding Best Practice Guidelines Lanzarote. Spain. for Nurses. Toronto, Canada: Registered Nurses Variables: Socio-demographic. A) Process: Davin-Durbán Inmaculada. RN. Ostomy Association of Ontario. Fall risk assessment at admission with scale, prevention plan. B) Outcomes: number of Specialist. Ostomy Unit. Hospital Vall falls, fall injuries. Information source: clinical d’Hebron. Barcelona. Spain. records. Three measuring periods: t0 baseline Martín-Monjas Sofía. RN. Supervisor of (May-August-2012), t1 transition (January- Surgical Units. Hospital Medina del Campo. March-2013), t2 consolidation (January- Valladolid. Spain. March-2014). Data analysis: Descriptive statis- Alonso-Poncelas Emma. RN. Nurse in Quality tics. Ethical aspects: anonymous data. and Information Department. Hospital Dr. Results: Patients evaluated: 5333. Men: José Molina Orosa. Arrecife, Lanzarote. Spain. 49.92%. Mean age: 79.75. Results at period t0, t1 Albornos-Muñoz Laura. BS. Researcher staff. and t2 are, respectively: Fall risk assessment at Spanish Collaborating Centre of Joanna Briggs in-hospital admission 69.4% vs 75.2% vs 80%; Institute. Nursing and Healthcare Research Patients identified being at risk 53.7% vs 55.4% vs 54.25%; Risk patients with prevention plan

119 S8-1513.40 – 15.10 Symposia – Friday 8 April 2016 Unit. Institute of Health Carlos III. Madrid. Practice Guidelines for Nurses. Toronto, Canada: Spain. Registered Nurses Association of Ontario.

Abstract Background: Ostomized patients require special evidence-based care and treatment in order to increase their quality of life and independence. The Best Practice Spotligth Organi- zation® Program of the Registered Nurses Association of Ontario (RNAO), coordinated in Spain by the Nursing and Healthcare Research Unit (Investén-isciii) and Spanish Collaborating Center of the Joanna Briggs Institute, promotes the implementation of RNAO’s Best Practice Guidelines (BPGs). Aims: Evaluate the effects of implementing the BPG ‘Ostomy care and management’ in the period 2012-2014. Methods: Study multicenter observational retrospective , through monthly audit of electronic health records of four process indicators in three Spanish hospitals. These process indicators are: comprehensive pre-operative and post-operative ostomy assessment, and pre- operative and post-operative ostomy education intervention. Interventions: dissemination of the program, specific training, incentives based on objectives compliance, data analysis and systematic feedback. Three measurement periods: t0 baseline (June-December-2012), t1 transition (January-December-2013), t2 consolidation (January-December-2014). Results: Organizative structures development, elaboration and adaptation of protocols and procedures, development and revision of electronic health records. Total 314 patients; mean age 66.6 years; ostomy type: 129 urostomy, 156 colostomy, 121 ileostomy. Indicators at t1, t2 and t3 respectively are: comprehensive pre-operative assessment 44.5%, 45%, 54.7%; comprehensive post-operative assessment 70%, 97.8%, 98.7% ; pre-operative education intervention 25.5%, 31.4%, 55.5%; post-operative education intervention 67.6%, 96.7%, 96.2%. Discussion: Better results are achieved, however new strategies are proposed to increase intervention results and assure the sustainability of the BPG implementation. Conclusions: These strategies have demonstrated improvements in the results, since the assessment and education have been increased in pre-operative and post-operative stages. The designation as BPSO® by RNAO have been reached thanks for the healthcare professionals work in introducing recommendations in daily clinical practice.

References 1. Registered Nurses ́s Association of Ontario. Toolkit: Implementation of best practice guidelines (2nd ed.). 2012. Available at: http://rnao. ca/sites/rnao-ca/files/RNAO_ToolKit_2012_ rev4_FA.pdf 2. Registered Nurses Association of Ontario (2009). Ostomy Care and Management Best

120 Posters – Wednesday 6 April 2016

Posters Wednesday 6 April

Poster tour A Poster 2 Conclusion: Lay perspectives of the hospital discharge process has identified key problem Patient experience (49) The development areas which may not be evident to professionals. Leaving registration at: 13.25 of service user-led This approach can potentially smooth the transi- recommendations for older tion out of hospital for the most vulnerable. Led by: Professor Ruth Northway, Univer- people living with memory sity of South Wales, United Kingdom loss discharged from acute hospital to community care. Poster 4 Poster 1 Dr Carole Mockford, DPhil, Royal College of Nursing Research Institute, University of (24) Can nurses play a role in (210) Characterising the Warwick, Coventry, UK screening for autism in non- Hospital Experiences English speaking countries? of Adults with Learning Abstract Turkiya Al Maskari, MSN, Nursing & Health Disabilities (HEALeD) Background: Lay involvement in health Care School, University of Glasgow, Glasgow, Karen Thomson, BSc Psychology; MSc research is a relatively new concept interna- UK Psychology, University of Cambridge, tionally. This study has involved lay participa- Cambridge, UK tion from development to dissemination. It Abstract focuses on hospital discharge planning for older Aim: To explore the feasibility of screening for Abstract people living with memory loss and their carers, autism spectrum disorder (ASD) in non-English an underdeveloped research topic but conse- Background: Following the publication of speaking countries, cultural influences and the quences for poor planning can be far reaching. Death by Indifference (Mencap, 2007) hospitals role of nurses’ in the screening process. sought to improve healthcare for patients Aim: To develop service-led recommendations Background: The prevalence of ASD is rising with learning disabilities (LD). Many general for the transition from hospital discharge to the worldwide and increasing the need for early hospitals have introduced: special LD policies; community for patients living with memory loss interventions to improve outcomes. Screening training events in relevant legislation; informa- and their carers for autism is being explored within different tion systems that alert hospitals to the presence Methods: From July 2014-January 2015, 15 healthcare settings, using a range of assess- of patients with LD; Hospital Passports and pairs of patients with memory loss and their ment instruments and assessors, in an effort Carers’ Agreements. Nevertheless, reports carers from two NHS Trusts, were interviewed to facilitate earlier detection. However, in non- continue to identify serious failings (Parliamen- at three time-points: at discharge, 6 and 12 English speaking countries little is known about tary and Health Service Ombudsman, 2013). weeks post discharge, about their experiences screening for autism, the impact of culture and Aims: To describe the hospital use and of service provision. Fourteen health and social the role of nurses in the screening process. outcomes of adult inpatients with LD using care professionals including Admiral Nurses Design: A systematic review was undertaken routinely collected hospital data, a crucial task were interviewed about their experiences of based on PRISMA guidelines. hospital discharge. for developing robust indicators measuring and Data sources: Psych INFO, MEDLINE, CINAHL, monitoring outcomes for patients with LDs. Lay researchers were actively involved in data EMBASE and ERIC database searches, and hand Methods: Health Episode Statistics were collection and developing a framework analysis. searches, were conducted from 1990-January obtained from two acute NHS hospital trusts in They facilitated focus groups of study partici- 2014. pants where recommendations were drafted the East of England, describing adult patients Result: Five papers were identified from from findings. Health and social care profession- with LD admitted between 1 April 2012 and 31 different geographical regions. In all studies, als provided feedback before study participants March 2014. children were screened using an adapted version finalised the recommendations. Results: A total of 1000 people with LD were of the Modified Checklist for Autism in Toddlers admitted. We present: patient socio-demograph- Results:Three key areas: discharge planning, (M-CHAT) to accommodate cultural sensitivi- ics, primary causes of admission; admission provision of information and support at home, ties in different clinical settings and assessors. duration; and health outcomes as measured by and daily home care have major challenges for Findings suggested that the discriminating items rates of 7 and 30 day readmissions. people living with memory loss. Recommenda- of the adapted M-CHAT were differed across tions included having written documentation Discussion: In the context of the NHS, this cultures. Nurses made up the largest group of and a named co-ordinator as a guide through the research could lead to improvements in: local, assessors. discharge process. regional and national policies; outcomes frame- Conclusions: Screening for ASD is challeng- works; and the development of more robust Discussion: Recommendations were ing and requires the use of knowledge, skills indicators for monitoring the health outcomes of developed from the perspective of receiving and rigorous screening instruments tailored to patients with LD. services by people living with memory problems. a specific nation`s culture. Although screening Improvements can be made to existing services. Conclusions: By improving healthcare prac- with the adapted M CHAT is feasible in some The patient and carer view the transition from titioners’ understanding of the numbers of healthcare settings in non-English speaking hospital to home as a single process, conversely, patients with LD and their standing relative to countries, its use in primary settings would many agencies and separate assessments are non-disabled patients, this research could, in necessitate further exploration. With the appro- involved in providing services which can be the future, lead to the development of better priate training, nurses/professional could play a confusing to families. outcomes indicators for patients with and part in screen children for ASD. without LD.

121 Posters – Wednesday 6 April 2016

Poster 5 Poster tour B Poster 8 (187) Why do patients Service innovation and improvement (367) Tailoring national return to the emergency guideline recommendations Leaving registration at: 13.25 department? to context specific criteria: Dr Rebecca Hoskins, RN, RN child Bsc (Hons), Led by: Dr Alison Twycross, London South using consensus methods in MA,DHSC, Consultant Nurse, University Bank University, United Kingdom the care home setting. Hospitals Bristol NHS Foundation Trust, Jane Wright, RN, BSc(Hons., DN route), MA, Bristol, UK Poster 7 PGCE, Bangor University, Bangor, UK

Abstract (236) The development of Abstract Aims: Unplanned re-attendance is used as a pain assessment scale for Background: This presentation will report a marker of quality in the emergency depart- neonatal transport upon one aspect of a NISCHR funded PhD study, ment (ED). In England the target for unplanned which sought to advance knowledge in the field re-attendance rates is below 5%. This study Dr Lavinia Raeside, PhD,MN, MSc, BSc, PgCertEd, RGN, RM, NICU, Royal Hospital for of improvement science. The study examined the explored why patients seek unplanned follow up process of tailoring national stroke best practice after treatment in an emergency department, if Children, Queen Elizabeth University Hospital, Glasgow, UK recommendations for the care home context. participants could identify the healthcare profes- Experiences around the use of consensus sional (HCP) they were treated by, and whether building with care home staff will be discussed. this had an impact on their subsequent decision Abstract The 2013/2014 audit by the Royal College of to seek follow up. The aim of this study was to develop a pain assess- Physicians reports that acute stroke care is better ment scale for use during neonatal transport. Methods: A mixed method pragmatic approach than ever, but community stroke care, especially Underpinned by the rights of the child to have was used. 200 participants were recruited. in care homes, still lags behind. Research in care appropriate assessment and management of Questionnaires, telephone interviews and focus homes is a complex undertaking (Luff et al., pain and the deleterious effects pain can have groups were used to collect data from September 2011). Engaging with care home end users can on the physiological stability of the neonate, this 2011- April 2013. enhance implementation compliance (Harrison study utilises a qualitative consensus paradigm Results: Quantitative data was analysed using and Graham, 2012). It is essential that care of enquiry to inform the content and structure SPSS version 19. Thematic analysis was used home staff are encouraged to engage in research a pain assessment scale specific to the transport to analyse the telephone interviews and focus as partners; and as end users of the tailored setting. groups. 18% of patients sought unplanned guideline, should be involved in adapting the follow up in the 2 weeks following their initial The three Phases of this study consisted of Phase recommendations for day to day implementa- visit, with no statistically significant difference One: a nominal group meeting with transport tion in the care home. clinicians to ascertain their views on items to between HCPs. Aim: To tailor stroke best practice recommen- include in a pain assessment scale for transport. Discussion: Despite high satisfaction rates, dations, and advance implementation outcomes Phase Two utilised the Delphi technique to gain patients said they preferred to be treated by a by gaining consensus with regards to appropri- consensus from a large cohort of clinicians expe- doctor even though they were unable to identify ateness for the care home context. rienced in the field of neonatal transport on the the treating HCP. Specific issues were identi- Method: Initially consensus methods (Rycroft- fied in reducing unplanned follow up rates. The content, structure and design of a transport pain assessment scale. Malone, 2001) were used in an attempt to define most common were issuing fitness to work cer- levels of agreement between care home staff Results of the first two Phases of the study were tificates, explaining the trajectory of an illness or in relation to the suitability of the stroke best then applied to the adaptation of an existing injury and addressing specific pain management practice recommendations for their setting. pain assessment scale. Face validity of the newly issues. A change in policy would be required for The consensus approach incorporated nominal developed Neonatal Transport Pain Assessment non-medical HCPs to be able to issue fitness to group technique. This method proved unfeasi- Scale (NTPAS) was then tested in Phase Three work certificates but in this study it was found ble for care home staff. Data collection methods by semi-structured interviews with transport to be the single most effective strategy to reduce were therefore adapted to incorporate an clinicians. Initial face validity testing suggested reconsultantion rates. approach that enabled group discussion and positive results in relation to feasibility and Conclusion: Patients seek unplanned follow used cognitive interview technique to unpick clinical utility of the scale, however further up for a variety of reasons and do not revisit care home staff views around individual recom- testing is strongly recommended. the initial emergency department they visit. mendations. Currently there are no pain assessment scales This suggests that nationally this issue is under Conclusion: Researchers should not assume developed for use in the transport setting, and reported. This study shows that non-medical that practitioners automatically have appropri- little evidence on the effects of transport on pain HCPs may have some advantages over junior ate skills (Luff et al., 2011). Effectual tailoring and pain assessment. This study offers a unique medical staff in terms of consultation skills, requires researchers to adopt a responsive approach in adding to the body of knowledge on patient satisfaction and reconsultation rates. approach to data collection, which enables them neonatal pain assessment while facilitating the to interact and react with participant end users, development of a scale adapted to transport. in order to tailor and implement context specific Further research is suggested to undertake best practice recommendations. psychometric testing of the scale and establish validity and reliability in the clinical setting.

122 Posters – Wednesday 6 April 2016

Poster 9 Poster 10 Poster 11 (309) The role of body (105) Using interpretative (202) Supported: The temperature in predicting phenomenology to explore development of an abdominal the incidence and severity person centred care for older support garment for people of sepsis in patients with people in acute hospital with ascites neutropenia Katrina Whittingham, RN, MSc in Nursing, Dr Nancy Preston, PhD BSc (Hons) RGN, Clare Warnock, Weston Park Hospital, PG Cert in HELT, Part time Doctorate International Observatory on End of Life Care, Sheffield Teaching Hospitals NHS foundation Student/Lecturer in Nursing, Robert Gordon Lancaster University, Lancaster, UK Trust, Sheffield, UK University, Aberdeen, UK Abstract Abstract Abstract Background: Ascites is the build-up of large Background: Neutropenia (blood neutrophil Person Centred Care(PCC) is ‘mutually benefi- volumes of fluid in the peritoneal cavity which count below 1.0 x 109/L) is a side effect of cancer cial partnerships between patients, their families is usually drained at 5 litres. If an indwell- chemotherapy that increases susceptibility to and those delivering healthcare services which ing catheter isn’t possible then living with sepsis. Sepsis is a continuum with progressing respect individual needs and values and which large volumes of fluid which are intermittently severity from mild infection symptoms to septic demonstrate compassion, continuity, clear drained, is uncomfortable. A support garment shock. Risk stratification can identify whether communication and shared decision making’ was tested with patients with ascites which patients with neutropenic sepsis require (Scottish Government 2010). Political drivers increased abdominal pressure by 4cm/H2O intensive treatment or could be managed with are ambitiously pushing for consistent PCC (Tubigrip). The patients found the garment oral antibiotics and self-monitoring (Lee 2013). cultures of care, in particular for older people improved discomfort and provided support to Elevated body temperature is used as a diag- in acute hospitals (OPAH). However, there are their large abdomens. However, the garment was nostic indicator in sepsis but the evidence base challenges in meeting these ambitions, given the too warm and also ‘rode up’ making it difficult to underpinning its ability to predict sepsis severity pressures in acute care, and at times it may seem wear especially in warmer weather. and contribute to risk stratification has not been unachievable. Aims: To develop a support garment for use evaluated (NICE 2012). Although there is a growing evidence base sup- with people with gross ascites to offer them Aim: To evaluate the role of body temperature porting PCC, there remains a need to consider support and improve their discomfort. in predicting the incidence and severity of sepsis how PCC is actualised into clinical care (Dewar Methods: Five prototypes for a support in neutropenic patients. and Nolan 2013). It is the author’s plan to use garment using a range of materials to offer Interpretative Phenomenological Analysis (IPA) Methods: A cohort case note review was carried abdominal support were developed with the to explore how OPAH, their families and Multi out on 200 patients admtted consecutively with company Jobskin. The garments were made Disciplinary Team(MDT) experience and make neutropenic sepsis to a regional cancer centre using guidance from previous research and sense of PCC; from the patients’, families’ expe- between October 2013 and July 2015. Data col- feedback from ongoing comfort tests. The rience of receiving PCC and the MDT’s of deliv- lection included temperature recordings, indi- ongoing study with 8 participants with ascites ering it. IPA will allow a rich picture of what cators of sepsis severity, patient and treatment (alcohol related liver disease and malignancy) really matters to these three distinct stakeholder related factors and patient outcomes. Descrip- will assess wear-ability and support require- groups to be realised. tive and regression analysis was carried out on ments including an assessment of comfort, ease the data. Research methodology should fit the research- of putting on/off, mobility and acceptability. The er’s personal motivation, philosophical approach garment, shaped like cycling shorts, can be made Results: Sepsis severity ranged from mild and the research question. IPA is grounded by in a range of sizes and colours. infection to severe sepsis. Highest temperature Gadamer, Heidegger and Merleau-Ponty’s phi- during admission was related to severity but Results:An abdominal support garment was losophy that the researcher’s knowledge can severe sepsis occurred without pyrexia and high developed with the designers by using light influence the research process (Smith, Flowers temperature readings were present with mild weight breathable materials. There were five and Larkin 2012). The author’s personal moti- infection symptoms. Body temperature at pres- sections to the garment offering different types of vation of dissatisfaction with non PCC, links entation, or during the sepsis episode, was not pressurised support including a main abdominal to this philosophical stance. The nature of the a consistent indicator of sepsis or a predictor area which allows for support but can signifi- topic, exploring experiences of acute health- of outcomes. Evidence emerged of tempera- cantly increase to allow for abdominal growth. care using IPA, will use descriptive narratives ture readings alone being used to determine The support garment supported an increase in from 1:1 interviews, to interpret the experiences. treatment pathways. abdominal girth from 70 cm to 110 cm in the These narratives can be powerful in terms of initial participant yet remained comfortable. Discussion: Our findings suggest that, while bringing the research alive, adding to the body Conclusions: A support garment has been elevated body temperature is often present in of evidence in a meaningful way; which in turn created which can allow for increased abdominal patients with neutropenic sepsis, over-reliance could enhance the impact of the research. on temperature readings could contribute to girth yet provide abdominal support. Further The aim is to provide a reflective methodologi- missed diagnosis or inappropriate treatment. research is planned to evaluate whether wearing cal rationale for using IPA to explore the essence a support garment can delay admission to Conclusions: The study has implications for of PCC for OPAH, contributing to the evidence hospital for treatment. patient information, staff education and clinical base for this methodology. guidelines. The presence or absence of fever should be seen as a contributory rather than primary factor in decision-making around neutropenic sepsis.

123 Posters – Wednesday 6 April 2016

Poster tour C poor support is personally and financially costly Poster 15 to the NHS. Workforce and employment issues Conclusions: Double-duty caregiving is sited (126) Is nursing becoming a part time job? New nursing Leaving registration at: 13.25 at the crossroads of two competing policy areas; human resources and health. This small-scale graduate employment Led by: Professor Ruth Harris, King’s study highlights the challenges for NHS staff and preferences the need for larger-scale research. College London, United Kingdom Dr Diana Clarke, Registered Nurse, College of Nursing, University of Manitoba, Winnipeg, Canada Poster 13 Poster 14 (291) A qualitative study Abstract of how nurses who care (371) Developing the research Background: Ensuring a stable and suffi- for a parent with dementia workforce and introducing cient supply of nurses continues to be a serious maintain a healthy work-life new healthcare roles to healthcare challenge globally. Matching the support research nurses employment opportunities with work prefer- balance ences of new graduates is important for recruit- Caroline Parr, RMN, MSc, Dementia Nurse Emma Munro, RN BSc(Hons) PGDip ing and retaining new nurses and for building a Practitioner, Raigmore Hospital, MSc, University Hospital Southampton, sustainable nursing workforce. Southampton, UK Inverness, UK Aims: The data presented here are abstracted from an annual province-wide survey of new reg- Abstract Abstract istered nurse (RN) graduates that aims to inform The NHS Constitution states that all patients the provincial nursing workforce strategy. The Background: Dementia has a greater impact should have the opportunity to participate in purpose of this analysis was to determine the full on women as they are at greater risk of develop- research (DH 2013). There is a struggle to meet time versus part time work preferences of new ing dementia themselves, are more likely to be this demand as the research nurse workforce is nursing graduates six months after graduation. family carers and are more likely to be employed stretched. Recruitment and retention in clinical in healthcare (Erol et al 2015). Double-duty care Methods: All graduates from all RN pre- research nursing is challenging and innovative giving, caring both professionally and in a family licensure university programs in the province roles are required to address this. A review of context, is a particular issue for female nurses of Manitoba, Canada in 2014 were surveyed six clinical trials assistant (CTA) posts in our Trust (Ward-Griffin 2014). months post-graduation. Data collection took revealed that some were performing clinical place from November, 2014 to June, 2015. An Aim: The aim of this research was to explore the tasks with little or no training and with no docu- online survey link was sent using Fluidsurveys. lived experience and work-life balance of female mentation or evidence of competence. com. Seventy-six percent of graduates completed nurses who are double-duty caregivers for a To ensure staff are well-trained and competent, the survey. parent with dementia. with appropriate oversight from qualified nurses, Results: Sixty-one percent of respondents Methods: In-depth semi-structured interviews the role was reviewed, a strategy and a training indicated that their employment preference was were used to collect data, exploring the richness programme defined for recruiting, retaining and part-time. Reasons for their preference included: of nurses’ experiences. Interviews were themati- developing the talent in this growing part of the flexibility, work/life balance particularly with cally analysed. research workforce. regard to family life, prevention of burnout, Results: The exploratory nature of this work A revised job description clarified the clinical and the fact that part-time work provides suf- allowed detailed insights into the lives of two role and provided a basis for training require- ficient income for their needs. The remainder nurses. The main themes emerging from the ments and competencies. A training programme of respondents (39%), who preferred full-time data were; was established for new and existing CTAs which work, cited the enjoyment of the job, the oppor- – The conflicts emerging from balancing the included the Care Certificate, core clinical com- tunity to gain experience and confidence in their caring role with employer needs, petencies and research governance. The aim of chosen profession, the security of income and – Work-life balance policies not always being the programme is to ensure that the necessary benefits, and the need to pay off student loans as available skills, knowledge and behaviours are acquired reasons for their preference. so that CTAs can provide compassionate, high Discussion: The generational shift in values – Inability to plan for the future due to the quality and safe care and support to patients unpredictable nature of dementia and priorities is creating challenges for and research participants. An assessor who employers. They need to balance the needs These issues have potential to impact signifi- is a qualified nurse experienced in research is and preferences of the 21st century workforce cantly on the well-being, sickness/absence and allocated to each CTA for the programme which with the staffing requirements for safe and high effectiveness of NHS nurses. includes face-to-face training sessions. quality patient care. Discussions: Blurring of boundaries between It is anticipated that the programme will take Conclusions: While the majority of graduates professional and personal caring can lead to four months to complete. The success of the new are working part-time and prefer part-time, compassion fatigue (Ward-Griffin 2011). -Par posts and programme will be evaluated after the some graduates do prefer full-time employ- ticipants experienced negative effects when first cohort have completed the programme in ment. Employers need to accommodate the juggling their caring commitments. Maintaining March 2016 and results will be presented. diverse preferences of new graduates in order to a healthy work-life balance, while working in a This workforce development is relevant to an maintain a sustainable nursing workforce. pressurised environment and caring for a parent international audience as news ways of deliver- with dementia, was described as having two ing research across the globe are being shared. fulltime jobs with no time for relaxation. Many research studies are multi-centre and The challenges arising from double-duty car- multi-national and so efforts to ensure success- egiving and the impact this can have on a nurses’ ful recruitment of patients and participants to effectiveness requires further consideration. The research are internationally relevant. potential for stress, sickness, and absence due to

124 Posters – Wednesday 6 April 2016

Poster 16 Poster 17 Poster tour D (97) The effect of nationality (444) Supporting clinical Critical care on job satisfaction and nursing skill acquisition in Leaving registration at: 13.25 intention to leave among Ireland: Is a practice skills nurses in Saudi Arabian record of value? Led by: Dr Calvin Moorley, Senior government hospitals Dr Melissa Corbally, DProf (Health and Social Lecturer, London South Bank University, Husam Almansour, PhD Candidate, Faculty of Care), School of Nursing and Human Sciences, United Kingdom Health Sciences, University of Southampton, Dublin City University, Dublin, IE Southampton, UK Poster 18 Abstract Abstract Background: In Ireland, movement towards a (431) What are the needs Background: Job satisfaction is a vital concept competency based assessment framework within of newly graduated nurses in nurse recruitment and retention. Two reasons nursing education resulted in a perceived need working in an acute cardiac are thought to contribute to the severe scarcity to produce a record of skill acquisition bridging setting in Egypt? A qualitative classroom and practice exposure throughout of nurses in Saudi Arabia: (1) the nursing profes- descriptive exploratory study. sion is considered a low status profession with the four year programme. In response to this, associated negative public perceptions; and (2) a Practice Skills Record (PSR) booklet was Linda Gorman, MScHC, BN (Hons), RN, PGC cultural barriers that restrict female access to developed in 2011 by academics in collabora- (Academic Practice), SPQ (Critical Care), education and employment, particularly in jobs tion with clinical partners and remains current Assistant Lecturer, Gouna Technical Nursing that require contact between genders. A histori- practice. Institute, El Gouna, Egypt cal reliance on significant numbers of non-Saudi Aim: This study explored current practices nurses has led to inequalities in remunera- regarding the day to day utlilisation and comple- Abstract tion and treatment of nurses from different tion of the PSR and evaluated its merit in sup- Background: Little is known about the needs countries. Yet, empirical evidence is limited porting nursing skill acquisition. of newly graduated nurses in Egypt and how in this regard, especially comparisons across Method: A combination of survey method and these relate or contrast from the published lit- nationality groups in Saudi Arabia. documentary analysis was used. 74 fourth year erature. Most literature focuses on the first year Aim: To examine any effect of nationality on undergraduate students completed an online of practice and a modest amount of work has job satisfaction and ‘intention to leave’ among questionnaire measuring retrospective utilisa- explored the transition needs within acute care nurses in Saudi Arabian government hospitals. tion of the PSR and attitudes towards its value. speciality settings. Methods: The McCloskey/Mueller Satisfac- A documentary analysis of 18 PSR’s was also Aim: To identify the needs that newly graduated tion Scale (MMSS) was used to measure nurse undertaken examining content and levels of nurses working in an acute cardiac setting job satisfaction across eight types of satisfac- completion. consider important during the first two years tion. Additional questions addressed intention Results: Findings from the survey indicate of graduation and differences in their perceived to leave and demographic variables. Twenty-six strong usage of the PSR in first year (82% most important needs. semi-structured interviews explored factors in n=59), decreasing substantially in second year Methods: A qualitative descriptive exploratory the work environment influencing nurse satis- (8.3% n=6). Documentary analysis supports method was used. Two nominal group technique faction. The data presented in this paper is taken this finding also, finding high signature rates in interviews were conducted in April 2015 (n=5; from 492 questionnaires from two of the three clinical practice (67%) in relation to first year n=6) according to graduation dates. Needs were major hospitals in Saudi Arabia were the study fundamental skill acquisition. Most respondents identified and prioritised using both rankings was conducted. (84.7% n=61) stated that preceptors did not view and ratings to attain consensus. Content analysis Results/Conclusion: The overall satisfaction PSRs at clinical interview suggesting that it is not of the items generated was conducted to produce mean was 3.3 out of 5. A significant statistical utilised as initially planned. Three themes which themes and enable cross-group comparison. difference related to nationality was found in emerged in qualitative responses included; a Rating scores were standardised for comparison all eight subscales measuring satisfaction, while lack of time, duplication of documentation and within and between groups. PSR skill content. no significant difference in overall job satisfac- Results: Both groups ranked and rated as most tion was found between nationalities. Saudi Discussion: The fact that the PSR is not being important: 1) education, training and continued nurses were least satisfied with six out of eight utilised as planned particularly in Years 3 & professional development; 2) professional facets of the job,while South African nurses were 4 of the programme suggests a clear need for standards; 3) supportive clinical practice envi- more likely to leave their hospitals compared to reform of this document and existing practices ronment; 4) manageable work patterns, and 5) other nationalities. An increased likelihood of surrounding it to enhance its utility particularly organisational structure. Graduates of more than intention to stay in the current job was associ- amongst first year cohort groups. The merit for a one year emphasised needs related to supportive ated with bolstering satisfaction by means of PSR for first years reflects Benner’s theory that clinical practice environments in comparison extrinsic rewards and increased control and need for structure is greater amongst novice to their junior colleagues. Graduates of one-to- responsibility. Improvement of nurse satisfac- student nurses (Benner 1984). Minimisation of two years had much less consensus, which may tion with different aspects of their job could documentary duplication within busy complex suggest their needs are more dynamic in the first result in greater retention in the face of a clinical contexts is recommended. year of practice. shortage crisis. Discussion and Conclusions: The needs of newly graduated nurses working in an acute cardiac setting from an Egyptian perspective were identified. Such needs relate to professional development and the organisational culture. The findings support those in international literature with the exception of the theme of ‘organisational structure’. It is important that health care organisations develop strategies to

125 Posters – Wednesday 6 April 2016

reflect the priorities of new nurses transitioning Poster 20 Poster 21 into practice within Egypt. Further research is needed on meeting the needs of newly graduated (456) Therapeutic (337) Understanding nurses in Egypt. hypothermia post out of body temperature and hospital cardiac arrest - A sepsis: knowledge and research critique practice among staff caring Poster 19 Kirsty Simpson, NHS Lothian, Edinburgh, UK for patients receiving chemotherapy (359) Developing a core Abstract Clare Warnock, Weston Park Hospital, outcome set for cardiac arrest Aim: To present a research critique exploring Sheffield Teaching Hospitals NHS foundation effectiveness trials (COSCA): why a change of practice has occurred in Trust, Sheffield, UK an international Delphi relation to Therapeutic Hypothermia (TH) Post survey Out of Hospital Cardiac Arrest (OHCA) in the Abstract Emergency Department (ED). Kirstie Haywood, University of Warwick, Introduction: Neutropenic sepsis is a poten- United Kingdom Method: A literature search was conducted tially life-threatening complication of anti-can- from 2002-2015 to capture seminal studies and cer therapy, particularly chemotherapy (NICE Background and aim: Clinical effectiveness most current evidence in this research field. A 2012). Elevated temperature is one of the early trials, reviews and meta-analyses are essential variety of search terms were included and limits sign of sepsis and temperature monitoring plays to advance resuscitation science. However, set to include Randomised Controlled Trials a role in its diagnosis and management (Dunkley the quality and utility of research is limited by (RCT), English language and full text articles to and McLeod 2015). Understanding sepsis is inconsistencies in outcome reporting. A system- control results. A wealth of research was found essential knowledge for staff caring for patients atic review(1) of outcome reporting in cardiac and all articles were reviewed if search headings receiving chemotherapy. arrest clinical trials (2000-2012) indicated sig- appeared in title/ abstract. Local guidelines nificant heterogeneity in reporting and a lack Aims: To explore staff members understand- have changed based on findings of a recent RCT ing of body temperature in relation to sepsis and of long-term and patient-reported assessment, therefore it was decided to critique this evidence highlighting the need for a core outcome set their practices around monitoring, reporting against two seminal RCTs to evaluate why and acting on thermometer readings (COS) in this field. COS development begins with practice has changed. identification of ‘What’ should be assessed: that Methods: Semi-structured interviews were is, which outcomes are judged as important by Results: The initiation of TH post OHCA used to explore the knowledge and experiences key stakeholders. was implemented in resuscitation guidelines of medical and nursing staff in a regional cancer following the results of two RCTs reported in Methods: A two-round international Delphi centre. Twenty staff were interviewed between 2002. These utilised small sample sizes, had February and May 2015. Purposive sampling survey explored which outcomes were viewed potential for bias introduction and studied a as important for future cardiac arrest effective- was used to include staff from different roles, limited population. A more recent RCT (2013) grades and experience. Interviews were recorded ness trials. Two complementary surveys were utilising a larger sample size and adhering to conducted: one developed for healthcare profes- and analysed using framework analysis. Ethical strict research methodology has suggested that approval was obtained. sionals/researchers and a second for patients/ there is no benefit in cooling patients post OHCA partners. Surveys listed a range of outcomes to a temperature of 33â’ƒ compared to 36â’ƒ to Results: All staff were able to accurately define across the patient journey, informed by the neurological outcomes or survival rates. Tem- a high temperature but there was variation systematic review and interviews conducted perature management and hyperthermia pre- in knowledge around symptoms of sepsis in with patients and partners. In round 1 par- vention has instead been advised. This research general and the definition and significance of ticipants rated outcomes on a 9 point GRADE critique has raised questions whether there is low readings. Different practices were identified scale of relative importance to decision-mak- strong evidence that TH should be implemented around monitoring temperature, beliefs about ing; in round 2, participants ranked their top or not. the reliability of thermometers and advice given 5 (patients) or 10 (healthcare professionals/ to patients. Variations between staff groups were researchers) outcomes. Conclusion: Reviewing evidence for TH has revealed. Staff confidence in their responses was concluded that this remains a controversial Results: 99 healthcare professionals/research- stronger where clinical guidelines were available subject with current evidence refuting previous and adopted routinely in clinical practice. ers and 69 patient/partners from 15 countries findings. The initiation of TH in resuscita- completed round 1, with a response rate of 60% tion guidelines was based on the findings from Discussion: All staff in the cancer centre in round 2. After 2 rounds 20 outcomes reached two RCT’s that were of limited quality. Local receive training in neutropenic sepsis detection consensus of 70% in at least one stakeholder ED guidelines have now been changed on the and management. Despite this variations in group. Seven additional outcomes reached findings of one RCT. Whilst this is a good quality knowledge and divergence from local guidelines 60% consensus in round 2. The 27 outcomes study, the question remains whether we should and key principles were uncovered. The findings reflected the patient journey across three core be changing guidelines based on the results of identify subjects for education and clinical areas: pathophysiological manifestations (n=7), one study. interventions and highlight the need to develop survival (n=5) and life impact (n=15). approaches that bridge the gap between training Discussion and conclusion: The 27 delivery and clinical practice outcomes. outcomes include a range of short and long Conclusions: Standardised practice is needed term post-arrest outcomes judged to be of to ensure patients receive consistent, high critical importance to cardiac arrest effective- quality care. The findings provide the founda- ness trials. A COS reflects the minimum number tion for targeted education and practice inter- of outcomes, that should be reported in future ventions to achieve this. Further review will be effectiveness trials. Survey results will inform needed to evaluate their effectiveness. an international consensus meeting to identify the most important outcomes to be included in a COS for Cardiac Arrest effectiveness trials.

126 Posters – Wednesday 6 April 2016

Poster tour E describe the practical reality of what is feasible Poster tour for extending and developing CN provision. Ethical issues Late-breaking Leaving registration at: 13.25 Leaving registration at: 13.25 Led by: Professor Julie Taylor, University Poster 24 Led by: TBC of Birmingham, United Kingdom (22) Protecting the innocent: Child safeguarding decision Poster 76 Poster 22 making by professionals in pregnancy (441) Let’s talk FGM: An app (215) What do quality Ciara Close, MSc, BSc (Hons), Ulster to assist health professionals indicators tell us about University, Belfast, UK explore a difficult subject priorities for community Joanne McEwan, RN, MA (ord) MA (geog) nursing? Abstract PGDip (SCPHN HV), Health Visitor, Oxford Health NHS FT Headquarters Warneford Dr Jane Cook, D phil, MSc, HV, RGN, Background: In 2014, 954 children in need Hospital, Oxford, UK University of the West of England, Bristol, UK referrals were made in Northern Ireland (DHSSPS 2014). The highest number of Abstract referrals was made in the South Eastern Health Abstract Background: Community nurses (CNs) and Social Care Trust (n=294) (DHSSPS 2014). Black and Minority Ethnic (BME) people in provide care to housebound people, often with Health and Social Care (HSC) professionals face England and Wales are disadvantaged in health complex, long term conditions. The quality of the daunting task of assessing the risk of harm outcomes. This is highlighted in Female Genital care delivered at home is difficult to assess. to an unborn child. Therefore, understanding Mutilation (FGM) in which 137,000 women and Quality indicators (QIs) are standards of care HSC professional’s decision making in relation girls originate from 28 African countries and against which service quality can be measured. to child safeguarding in pregnancy will enhance some Asian countries where FGM is prevalent. There are difficulties designing indicators that professional practice. The new mandatory reporting duty in England effectively measure nursing quality where nurses Aim: To study decision making by Health and states that Health professionals (HPs) must do not have 24 hour responsibility for patients Social Care professionals where there is a child report to the police and follow local children’s and work alongside other providers. The Com- safeguarding concern in pregnancy. safeguarding board procedures if a girl is at risk of FGM. Asking sensitive questions on FGM missioning for Quality and Innovation Scheme Methods: This is a mixed-method study with requires knowledge and confidence. As the NHS (CQUIN) enables commissioners to incentivise three phases and this paper will focus on Phase promotes technology and innovation in health- service providers by paying a proportion of the 2, focus groups with HSC professionals. The aim care, HPs working in the community are increas- value of their contracts based on service quality. was to determine the relevance of the identified ingly using mobile technology to access informa- A survey of CQUIN indicators applying to CNs risk factors from the structured literature review tion and support patients/clients. This paper undertaken in 2014/15 assessed what these within a Northern Ireland context and to explore discusses a quality improvement project under- might suggest about priorities for commission- the experiences of Midwives and Social Workers taken with Oxford Health NHS FT to design an ers and CNs. in making decisions about cases of child safe- app ‘Let’s talk FGM’. Used collaboratively with Methods: Cross sectional survey of 211 Clinical guarding in pregnancy. the patient/client it aims to navigate discus- Commissioning Groups (CCG) in England. Data Results: Data were collected from four focus sions, identify girls at risk of FGM and offer were analysed descriptively. groups consisting of Midwives (n=14) and support to FGM survivors. The project is imple- Emerging Findings: One hundred and fifty children’s services Social Workers (n=16) and mented over one year and involves: identifying nine (75%) CCGs responded, with 484 ‘local’ analysed using Newell and Burnard’s framework stakeholders, gathering material for content, CQUINs for CNs. Thirteen ‘care themes’ were (2006) for thematic analysis. Twelve themes designing and piloting the app and launching identified; the largest of these were ‘organisa- were identified which impacted upon decision- the final version. This paper will outline key tional issues’ comprising 163 indicators (33% making: Assessing risk, timing, engagement with project findings to date on discussion group of local CQUINs related to CNs). The following women, communication, professional experi- feedback about how the app should support HPs sub-themes emerged as commissioning pri- ence, mental health knowledge/training, impact and clients, and piloting the app. A demo of the orities: integration, the care model, ‘Francis on staff, evidence, case planning, pregnant pilot app will be performed. This is a leadership CQUINs’ (CQUINs stemming from the Francis women behaviour, recording of information and project supported by the Mary Seacole Awards report) and seven-day working. frustration. 2015-16 which gives nurses, midwives and Discussion: Commissioning priorities focused Conclusion: Decision making by HSC pro- health visitors the opportunity to create projects on developing closer relationships with GP fessionals in the area of child safeguarding in that will improve health outcomes for BME com- practices. The Care Model is the principal pregnancy remains a complex and challenging munities while enhancing personal and profes- strategy for enhancing the coordination and process. Professionals are living in a state of sional development. quality of community services, emphasising ‘uncertainty’ as each case presents unique chal- multidisciplinary working. Achieving and sus- lenges. The uncertainty regarding the unique- taining CQUIN goals depends on CN engage- ness of cases requires application of a diverse ment. However, recent research raises questions knowledge base, which further adds to the com- about whether the community infrastructure plexity around decision making. and workforce is sufficiently resilient to make integrated community-based care a reality. Conclusion: Frontline CNs have first-hand experience of how organisational changes work in practice and impact care quality. More than ever, CNs need to actively determine what benchmarks distinguish the quality of their service and

127 Posters – Wednesday 6 April 2016

Poster 77 Poster 78 (442) ADHD one stop shop: a (446) Prevalence and nurse-led, multi-agency drop determinants of frailty and in clinic for young people associated co-morbidities with ADHD among older people in Nepal Gemma Ryan, MSc, University of Derby Online Sirjana Devkota, RGN, Research Nurse, Learning, Derby, UK Research and Developement Aberdeen Royal Infirmary Aberdeen, Aberdeen, UK Abstract Background: ADHD is a behavioural syndrome Abstract characterised by the core symptoms of hyper- Background: Population ageing is increas- activity, impulsivity and inattention (NICE, ing in low income countries. Despite this, there 2008). It is one of the most prevalent psychi- is distinct lack of knowledge about prevalence atric disorders in children (ADISS). Access to of co-morbidities and determinants of frailty high quality, integrated healthcare services is among older people in these countries. often inconsistent and due to the nature of the Method: We examined data from ‘Health and disorder on-going support and care needs vary Social Care Needs Assessment Survey of the dramatically and can have a huge impact on Gurkha Welfare Pensioners’ conducted in 2014. the child and family unit. It can also mean that Participants were age ≥ 60 years from Gorakha, routine and attending fixed time medication Lamjung and Tanahu districts of Nepal. Face to reviews is often difficult. NICE (2008) further face interviews were conducted using validated recommends access to behavioural training and questionnaires. Demographic, socio-economic, social support services in addition to healthcare self-reported symptoms and illnesses were services. collected. Frailty was assessed using Canadian Aim: To implement and evaluate a nurse-led, Study of Health and Ageing (CSHA) scale. Uni- multi-agency drop in clinic for young people variable and multivariable regression models with ADHD. were constructed to identify the determinants of Intervention: Collaboration with a special- frailty defined as CSHA scale ≥4. ist nursing team and a voluntary organisa- Result: A total of 253 participants (32.0% men) tion providing behavioural and social support were included in this study. Most (82.2%) par- services to those with ADHD. Implementation in ticipants were from Janajati ethnic background. a non-NHS, city centre location whereby service Men who were ex-serviceman had higher users could access both health and behavioural educational attainment than women, most of support. whom (95.3%) were widows of ex-servicemen Method: repeated measures observational (p<0.01). 48.5% of women lived with their sons study over 12 months evaluating the impact whereas 43% of the male participants live with on access to services during ‘crisis’ situations, their wives. Women reported higher prevalence regular attendance at medication reviews, of mental health issues such as anxiety and adherence to NICE guidance and service user insomnia compared with men. The prevalence feedback. of frailty was 46.2% (46.3% in men and 46.1% in women). In this population frailty was signifi- Results: 62 parents/carers participated in the cantly associated with older age, smoking, living study. All children attending the clinic received with son, breathing problems, unspecified pain at least one medication review in the 12 month and fatigue, poor dental health, history of falls period. A significant improvement in service and fracture (p<0.001 for all) after controlling user experience pre, during and post implemen- for potential confounders. tation P=0.001. The number of crisis management attendances pre and post implementa- Conclusion: Our study highlights the growing tion significantly increased p=0.005. Service nature of co-morbidity burden and frailty and its users attended for their medication review on or determinants in low income setting. Concerted before their actual due date p=0.011. By previous efforts should be made with regard to how best comparison those who need additional clinic to tackle this globally. time were able to spend more time with the staff p=0.001. Conclusion: The clinic improved accessibility and flexibility of services, improved adherence to NICE (2008) and improved experience. Further research should examine the cost effectiveness and longitudinal impact of the clinic model.

128 Posters – Thursday 7 April 2016

Posters Thursday 7 April

Poster tour F aging attendance. This will be introduced immi- Patient Results: Respondents (n=3) stated nently. they found it easy to understand and all had Patient experience Discussion: This work demonstrates the value discussed it with their primary care practice. It Leaving registration at: 13.30 of ongoing user involvement in the development allowed them to understand the ongoing effects of an intervention, allowing rapid feedback and of radiotherapy and encouraged them to take Led by: Dr Colin Macduff, Robert Gordon insight into experiences. Uptake of our HWBC actions which supported their ongoing health University, United Kingdom will continue to be monitored and in addition to and well-being e.g. accessing services, main- ongoing review by our SUG, we have extended taining a healthy weight and exercising despite our evaluation activities to capture key reasons fatigue. Poster 25 for non-attendance directly from patients. Conclusion: Overall, these are encouraging results and show the necessity to conduct a (260) Using patient quality improvement cycle before embarking on experience and feedback to full implementation. improve attendance at health Poster 26 and well-being clinics (258) End of treatment Debbie Provan, BSc Hons Human Nutrition and Dietetics, NHS Ayrshire and Arran, Ayr, summaries: their local impact Poster 27 to-date in Ayrshire and Arran UK (265) How much is enough? Debbie Provan, BSc Hons Human Nutrition Using Delphi to determine Abstract and Dietetics, NHS Ayrshire and Arran, Ayr, UK minimum clinical contact Background: Transforming Care After time to ensure military Treatment (TCAT), a Macmillan Cancer Support Programme, aims to improve after care for Abstract nurses are ready for people living with and beyond cancer in Scotland. Background: The Transforming Care after contingency operations. Under this programme NHS Ayrshire and Arran Treatment (TCAT) programme aims to improve Gary Kenward, MSc BSc(Hons) RN, MoD. introduced health and wellbeing clinics (HWBC) the after care for people living with and beyond QARANC, Camberley, UK at the end of active treatments for people with a cancer in Scotland. It is a partnership between diagnosis of breast or colorectal cancer. the Scottish Government, Macmillan Cancer Abstract The HWBC aims to identify and meet needs, and Support, NHS Scotland, Local Authorities and Third Sector organisations. A main aim of TCAT Background: There is limited evidence promote health and well-being. Ongoing moni- exploring the time required in practice to toring and evaluation of the clinic revealed that is to introduce ‘End of Treatment Summaries’ (EoTS) documentation to improve communica- maintain clinical competence. Revised NMC uptake and attendance was lower than expected, guidance stipulates a minimum number of with only 57% of invitees attending. tion between secondary and primary care, and the patient regarding consequences of treatment, clinical hours over a 3-year period. However, The issue of lower than expected attendance was signs and symptoms of a recurrence and any in the context of military nurses who may taken to the Service User Group (SUG). The SUG agreed actions. The patient receives a copy to deploy at short notice this may not provide suf- comprises a number of individuals who have enable self-management and to empower the ficient assurance of competence. With multiple had a recent cancer experience, as a patient or patient to actively manage their own health and demands on time a policy is required to ensure carer. They are involved in decision making and well-being. military nurses are prepared for role. service development, ensuring the project is fit Aims: Gain consensus on the amount and type for purpose. Methodology: To inform practice and future decisions about implementation the Ayrshire of clinical contact time needed to ensure nurses Results: The SUG edited the clinic invite letter and Arran TCAT team undertook a Quality are prepared for short notice deployment and, to and recommended a reminder phonecall be Improvement Cycle during September 2015. An develop policy from the evidence. introduced pre-HWBC. The impact is signifi- electronic questionnaire was sent to 19 GPs all Methods: A detailed literature review and a cant: of whom should have received an EoTS. A paper two round Delphi study conducted between 13 Increased overall attendance by 10% questionnaire and stamped addressed return Nov 15 and 11 Jan 16. Delphi panel members Reduced non-attendance without cancellation envelope was posted to 21 patients who had had included Heads of the three nursing services and from 20% to zero an EoTS between Jan 2015 and Aug 2015. nominated senior clinicians who retain a strong link with clinical practice. Increased user cancellation rate from 24% to GP Results: 6 GPs (31%) responded. GPs (n=5) 40%, allowing staff to be more efficient and commented that the EoTS aided discussion with Results: The literature provided themes to increasing availability of appointments for those patients, and supported completion of insurance develop statements for Round 1 of the Delphi, in need. forms, Key Information Summaries and Antici- including; minimum time required in clinical practice for role; returning to practice; per- Clinical Nurse Specialists provide patients patory Care Plans. They also supported decisions ceptions about part-time workers; leadership with verbal information regarding the HWBC, about the patient’s condition/care/management opportunity; confidence and maintaining com- however the volume of information provided at (n=2), helped the GP understand the patients petence. Delphi results available in Jan 2016. this appointment may impact on information diagnosis, treatment and ongoing needs (n=3), retention. Therefore, the SUG also developed a and improved communication with the patient Discussion: Time out of practice results in leaflet outlining the HWBC purpose and encour- (n=2). skill depreciation. Currently there is limited consensus about what constitutes the ‘minimum’

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clinical contact time needed to be competent and suggest a positive impact on service delivery Poster 83 confident in practice. Part-time practice not only from a patient and organisational perspective. affects clinical competence, but also confidence, Lessons learned from the implementation of (128) Findings from an leadership opportunity and the perceptions of this initiative and its progression are potentially ethnographic study of others. This Delphi service evaluation provides informative for other Ambulance Service Trusts governing body nurses’ roles a consensus that will inform policy for military considering adopting a similar approach to using nurses. specialist nurses to triage patients. on clinical commissioning groups in England: embattled Conclusions: This study was conducted in relation to military nursing staff but may be of nursing leaders? interest to employers of bank, agency and other Professor Helen Allan, PhD BSc (Hons) RN part-time workers in the clinical setting. Poster 82 RNT, Chair in Nursing, Middlesex University, (127) A mixed methods Hendon, London, UK evaluation of the impact of Abstract ‘Compassion in practice: Poster 28 Background: Governing body nurses are nursing, midwifery and care expected to bring a nursing view on all aspects (415) Pilot evaluation of our vision and strategy’ on utilising mental health of Clinical Commissioning Group business. The staff experience in NHS role requires a senior level appointment and nurses in the management of Trusts in England. experience of commissioning. Research suggests ambulance service patients that the role of the governing body nurse is Professor Helen Allan, PhD BSc (Hons) RN shaped by the constraints of new public manage- with mental health problems RNT, Chair in Nursing, Middlesex University, ment Angela Harris, Bsc Msc, University Of Hendon, London, UK Sheffield, School Of Health And Related Aim of the paper: to report empirical findings about the governing body nurse role. Research (ScHARR), Health Services Research Abstract Section, Sheffield, UK Methods: Data collection from ethnographic Background: the Compassion in Practice: case studies of two purposively sampled CCGs in Nursing, Midwifery and Care Staff Vision and London, from January 2015 to July 2015 which Abstract Strategy was launched by the Department of were selected for typicality of the governing Introduction: Manging the increased demand Health in 2012 prior to the Report of the Francis body nurse role. Data collection included eth- for emergency care is a problem in the UK and Inquiry in 2013. nographic observations of seven meetings, three internationally. Available evidence highlights Aims: This paper presents findings from the informal ethnographic observation sessions, and scope for improvement in the delivery of care evaluation of the impact of ‘Compassion in eight ethnographic interviews, over a period of for patients with mental health problems. The Practice Strategy’ on staff experience in NHS six months. Transcribed data were analysed the- purpose of this paper is to describe an ongoing Trusts in England. matically. initiative in one Ambulance Service Trust in England utilising specialist triage by mental Methods: The evaluation in 2015 used a mixed Findings: Our findings suggest that GBNs may health nurses since December 2014. methods design including a) an online survey enact their role and their professional identity of 36 randomly selected Trusts in England; very differently depending on whether they have Methods: An exploratory mixed methods b) a scoping of the literature; c) nine qualita- a full time or part time role, but all face challenges evaluation was conducted. Interviews (n=12) tive interviews with staff in 10 case study sites to their professional identity and authority. We with key stakeholders in the ambulance service selected from the Trusts who had participated explore these challenges in this paper: tensions were conducted to explore their experiences of in the NHS England survey; d) analysis of Staff of retaining a patient centred focus in CCG work; service provision for patients with mental health Family and Friends Test data, Patient Family & professional and lay relationships, and; dimen- problems and the impact of introducing Mental Friends Test data in each selected case study site sions of leadership and professionalism within a Health Nurse triage in the EOC. Interview data where it was available and analysis of NHS Staff nursing discourse. was coded and thematically analysed to identify Survey data. There were 2,267 responses to the Conclusions: Our findings capture the key issues around service delivery for patients online survey. with mental health problems. Routine data from complex relationship structures and profes- ambulance service computer aided dispatch Findings/Results: The evaluation found that sional frameworks that effect how governing was used to examine impact on patient care and existing awareness and involvement of staff in body nurses operate within clinical commission- resource allocation. Compassion in Practice is considerable amongst ing groups and the implications of those rela- middle and senior management but limited at tionship for professional identities of GBNs in a Findings: Initial findings indicate that access to ward level. Ward staff face challenges in deliv- multi-professional context. We illustrate how a the specialist expertise of mental health nurses ering compassionate including a bullying work nurse’s professional identity is problematised in has reduced the ambulance response rate by culture and structural constraints related to the CCG in the context of the traditional forms clinically triaging calls for patients with mental staffing levels and funding. of professionalism based on clinical authority. In health problems and only sending a resource doing so, we address a gap in the literature and where appropriate. Staff interviews revealed the Conclusions: The Compassion in Practice suggest future research questions about nursing developmental process and challenges involved Vision and Strategy must be extended to all staff leadership roles. in implementing the mental health triage initia- so that it becomes embedded across all roles and tive, for example, recruitment, training and gov- all types of Trust. Communication about Com- ernance. Staff perceptions of the initial positive passion in Practice should be cascaded more impact of the mental health nurses include effectively across the NHS and good practice the delivery of more appropriate patient care, should be shared. Recognition and action is reduced anxiety for staff managing calls and needed at the Trust leadership level and from improvements in general workforce morale. NHS England to address the challenges staff face in delivering care. We present our recommenda- Conclusions: Despite the relatively short time tions for future policy in this area. period since the inception of this initiative, preliminary findings from this pilot evaluation

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Poster tour G studies of four purposively sampled NHS Acute Poster 34 Trusts. Workforce and employment issues (6) The development of the Chinese Health Improvement Leaving registration at: 13.30 Profile (CHIP) for improving Led by: Professor Bridie Kent, Plymouth Poster 33 the physical health of people University, United Kingdom (310) Compassionate care for diagnosed with severe mental staff?: A scoping study using illness Poster 30 the 6Cs to explore the nursing Dr Daniel Bressington, RN(Mh) PhD PGCAP work environment and BSc(Hons) DipHe, Assistant Professor, School (409) A mixed methods study culture in an older person’s of Nursing, The Hong Kong Polytechnic to examine the organisational unit University, Kowloon, Hong Kong structure of the clinical Dr Jocelyn Cornish, PhD, BSc, RN, CLTHE, Abstract research nurse workforce in Lecturer, King’s College London, London, UK NHS Acute trusts across the Background: People with severe mental UK illness (SMI) frequently receive inadequate Abstract physical health care and die on average 20 years Helen Jones, RGN BSc (Hons) MSc, Matron Background: The 6Cs: care, compassion, younger than the general population. Mental for Research, Guys and St Thomas NHS FT, commitment, communication, competence and health nurses report awareness of the need to London, UK courage, were identified as important values for address physical well-being but often overlook nurses to provide compassionate, quality patient this aspect of their role. Encouraging evidence Abstract care (NHS Commissioning Board 2012). Dem- from western countries shows that comprehen- Aim: To map the development of the national onstration of these values by nurses caring for sive assessment of both the physical health state Research Nurse workforce and determine the patients is a prominent focus in the literature, and health behaviours of patients can help direct most effective structure in order to ensure suc- however, other evidence suggests that attention effective client-centred interventions. cessful recruiting into the research portfolio and to staff well-being and provision of the right Aims: Explore the acceptability of using adherence to relevant legislation. culture and work environment has beneficial enhanced health checks to improve the physical effects on care outcomes (Maben 2012; Dixon- well-being of Chinese people diagnosed with Background: There has been a significant Woods 2014). development of the Clinical Research Nurse role SMI. especially in the last 15 years since the establish- Aims: This study explored how the 6Cs were Adapt the UK-developed Health Improvement ment of the Research Networks and the National demonstrated in the provision of a work envi- Profile (HIP)[1] to suit the cultural/clinical Institute of Health Research (NIHR). Many ronment and culture for nursing staff. context of Hong Kong. organisations now have a growing research Methods: Using a volunteer sample, non- Methods: This qualitative study explored nurse workforce but there are inconsistencies participant observations (n=28 hours; June- Hong Kong Community Psychiatric Nurses’ in their structure, management and awareness September 2014) and interviews with staff (n=7; (CPNs) perceptions of using comprehensive across their local clinical colleagues. There is December 2014) were conducted in one Older physical health checks in SMI. Eleven CPNs also no empirical data on its structure or size. Person’s Unit. The resulting qualitative data attended individual interviews to explore their Method: An online survey was designed around were thematically analysed and mapped to the experiences using the HIP over one year. Data a framework that examined the 6 challenges of 6Cs definitions. were transcribed and analysed using inductive quality improvement (Bate et al). From the 178 Results: The organisation was perceived as thematic analysis. Research active organisations identified using providing a positive work environment with Results: The CPNs appreciated the holistic the NIHR annual recruitment figures, the survey staff reporting access to: training, equipment, physical health screening. They reported an was then sent to the Lead Research Nurse or and opportunities to raise concerns, but this increase in clients’ motivation to improve someone who had awareness of the research varied across the Unit. Staff provided peer their physical health and also noted observ- nurse workforce during summer 2015. support at ward level and were supported by able benefits in well-being. The use of the HIP Results: A response rate of 81.5% (111/136) senior managers. However, examples were also also helped the CPNs identify implementation was achieved. Of these 83% (92/111) were fully reported when staff could not access training, barriers and highlighted areas of the interven- completed. The survey has provided valuable did not work together or have enough equipment tion that required modifications to suit the local date on the wide range of different team struc- and when their concerns were not addressed. context. tures , training support, understanding and Senior managers were constrained by a lack of funding, cumbersome processes or deficient Discussion: The results are similar to those awareness of the role and the impact of organi- reported in non-Asian settings, and highlight sation wide technology changes. infra structure for the acquisition of necessary resources. the benefits/challenges of promoting the Discussion: This survey has identified how physical health of people with SMI globally. different NHS Acute trusts have approached Discussion/Conclusions: Demonstration of Findings suggest that an intervention originally the management and support of their growing the 6Cs in the provision of a positive work envi- developed in the UK is viewed as being accept- research nurse workforce. It has helped to ronment and culture for staff in one Unit was able and potentially beneficial in the Hong Kong initially map some of the contemporary chal- variable. Deficiencies in providing necessary mental health setting. lenges that Research Nurses manage. resources to create the right environment for nurses to perform their role presented potential Conclusions: The suggested modifications Conclusion: This survey has given the first safety risks and showed a lack of compassion- to the HIP tool have been used to develop the initial overview of the national Research Nurse ate care for staff. This was dissonant with the CHIP, which is being tested in a cluster-ran- workforce. It has provided valuable data on the requirement that staff provide compassionate domised controlled trial. experience of the workforce as well as how they care for patients. believe they are perceived by clinical colleagues. Phase 2 of the project will involve in-depth case

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Poster tour H (F=5.022, df 2, p=0.007) were not seen in the Conclusions: The potential impact of this control group. training on the practice of midwives and on the Public health Conclusion: The educational programme diets and lifestyles of the women they support is currently being tested in the Southampton Leaving registration at: 13.30 impacted positively on teachers’ knowledge and attitudes. Health education programmes should PRegnancy Intervention for the Next Genera- Led by: Dr Julie McGarry, University of be integrated into the national child health tion (SPRING). Nottingham, United Kingdom programme.

Poster 35 Poster 37 Poster 36 (266) The impacts of a health (378) Binaural beat education programme on (334) Healthy conversation technology: Can it really primary school teacher’s skills: an intervention affect cardiovascular stress knowledge and attitudes to improve the nursing response? towards type 1 diabetes workforce’s skills in Lieutenant Colonel Melisa Gantt, PhD, RN, mellitus in children in Saudi supporting behaviour change CNOR, RNFA, Director, CNSCI, Landstuhl Regional Medical Center, Landstuhl, Germany Arabia Julia Hammond, RGN RM MSc, Senior Research Sister, MRC Lifecourse Epidemiology Buthaina Aljehany, University of Salford, Unit, University of Southampton, Southampton Abstract Manchester, UK General Hospital, Southampton, UK Background: Binaural Beat Technology (BBT) is an auditory-neurophysiologic technique using Abstract Abstract differing tones, embedded in music, to impact Introduction: The incidence of T1DM for brainwave activity. Although BBT is widely Background: Nurses and other health practi- children <15 years in Saudi Arabia (KSA) is available commercially; only a handful of studies tioners can improve health through supporting 36.99/100,000 (Abduljabbar et al., 2010). have assessed its efficacy. lifestyle changes. Healthy Conversation Skills Annual incidence above 20/100,000 is clas- (HCS) are designed to support behaviour change, Aims: The purpose of this prospective, double- sified as high (Patterson, 2009). Schoolteach- and encourage (1) the ability to create opportu- blinded, randomized control trial was to assess ers are important for secondary prevention, nities to initiate conversation; (2) use of ‘open the effect of BBT (theta brainwave frequency) on treatment and management of T1DM, represent- discovery questions’ (ODQs); (3) listening skills; cardiovascular (CV) stress response. ing potential first-respondents during diabetic and (4) supporting goal-setting. The impact of crises. They need to be knowledgeable about Methods: Seventy-four United States military HCS training on staff practice was examined in common health emergencies and diabetic emer- service members, with post-deployment anxiety, Sure Start Children’s Centres in the UK. gences (Weingarten et al., 2009). were randomized into two groups (music with Aim: to examine the effectiveness of Healthy BBT and music without BBT). Groups were Aim: To assess the impact of a health Conversation Skills training in changing exposed to their respective intervention for education programme on primary schoolteach- practice. 30 minutes minimum at bedtime, three times ers’ knowledge and attitudes towards T1DM a week, for four weeks. Pre and post CV stress Methods: 148 practitioners completed in children attending schools in Jeddah city, tests were conducted to assess the effect of the training. Skill use was assessed immediately Western KSA. technology. before and after training and differences tested Methods: A quantitative, quasi-experi- using Wilcoxon matched-pairs signed-rank test. Results:A 2x2 mixed ANOVA found a sig- mental (repeated measures) non-equivalent Competence was examined 3 months later and nificant difference (F[1, 63]=7.56, p=.008 groups, pre-test, post-test- follow-up design scored against a standardised rubric. A year [Î·2=.107]) in Low Frequency measures; the was adopted. Data collection was undertaken post-training, sustained skill use was assessed Music with BBT group decreased while the Music between September 2013 and March 2014. A by comparing observations of trained staff Only group increased (Pre=77.83, Post=75.33 vs structured, multiple-choice, closed-ended, self- with those of untrained staff. A random effects Pre=66.42, Post=74.41). A significant difference administered questionnaire was employed, logistic model compared frequencies with which was also found in High Frequency measures (F[1, based on the literature and provided in Arabic. A skills were used. 63]=7.56, p=.008 [Î·2=.107]); the Music with total of 540 teachers were recruited (360 experi- BBT group increased while the Music Only group Results: Trainees responded using significantly mental and 180 control group) in equal numbers decreased (Pre=22.17, Post=24.67 vs Pre=33.58, more open-discovery questions after training by gender since schooling in KSA is separated Post=25.94). Finally, the Music Only group sig- than before (p< .001). They demonstrated by gender for pupils and teachers. The interven- nificantly decreased (F[1, 57]=4.39, p=.041 [Î·2 medium to high levels of competence (median tion was an educational programme in the form = .072]) in Total Power measures compared score 3 out of 4 (IQR: 2-3)) in asking ODQs and of a series of lectures and activities. Additional to the Music with BBT group (Pre=2098.90; creating opportunities, but did less well with the reading materials were provided. Data analysis Post=985.26 vs Pre=1249.75; Post=1223.07). was conducting using ANOVA. other skills.168 conversations with clients were observed. The first three skills were used signifi- Conclusion: When placed under an acute Results: At pre-test, there were no significant cantly more by staff in the intervention site than stressor those who used BBT showed decrease differences in teachers’ knowledge or attitude by staff in the comparison site: (1) 48%:29% in sympathetic response and increased in para- between the control and experimental groups. (p=0.02); (2) 59%:20% (p<0.001); (3) 84%:60% sympathetic response; those who did not had At three-month post-test, both knowledge and (p=0.02). the opposite effect. Overall, those who did not attitude were increased significantly in the use BBT exhibited more CV evidence of chronic Discussion: Healthy Conversation Skills experimental group. There were no significant stress exposure. differences in the knowledge or attitudes scores training produces sustained change in the for the control group. In the follow-up test and practice of health care staff who demonstrate Discussion: This technology has shown that over six months, after the pre-test the significant an empowering style of interaction known to be it can indeed affect CV response to stress. Its increase in the knowledge scores of the experi- supportive of behaviour change. easy and inexpensive commercial availability mental group (F=144.605, df2, p=0.001) and warrants further research, distributor oversight, the significant increase in their attitudes scores and consumer safety measures.

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Poster 38 Poster 39 Poster tour J (323) Exploring type 2 (324) An integrated literature Primary and community care diabetes, alcohol use and review to explore the Leaving registration at: 13.30 lifestyle modifications: a factors which facilitate and systematic literature review impede the implementation Led by: Professor Austyn Snowden, Christine Mantzouka, Leeds, UK and reach of lay health Edinburgh Napier University, United worker programmes aimed Kingdom Abstract at promoting influenza Background: The literature identifies an vaccination Poster 40 increase of type 2 diabetes (T2D) in developed Dr Sherrill Snelgrove, PhD RGN, Senior and developing countries. Furthermore, alcohol Lecturer, Swansea University, Swansea, UK (244) How community nurses consumption beyond moderate portions con- perceive the use of health tributes to the onset and exacerbation of T2D. Abstract plans in the communication Individuals with T2D and alcohol use have a of health needs of children two-fold increased risk of exhibiting negative Aim: To explore factors which facilitate and feelings, diminished levels of well-being, and impede the implementation and reach of Lay and young people with negative sentiments. Health Workers (LHW) programmes aimed at learning disabilities. promoting flu vaccination. Aim: To explore interconnectedness of T2D, Lucy Riggs, R.N.M.H. Msc Clinical Research alcohol use and well-being, and to identify the Background: LHW based promotion strate- Methods, , City Health Care Partnership CIC, needs of these individuals in adapting to new gies are recommended for the promotion of Hull, UK lifestyles. immunisation Lewin et al. (2009). There is little information about the factors which facilitate Methods: A systematic literature review was Abstract and impede the implementation and reach of carried out during 2014, using multiple elec- LHW programmes aimed at promoting flu vac- An exploratory study of how community nurses tronic databases as to find relevant studies cination. perceive the use of health plans in the commu- published between 2008 and 2014. nication of health needs of children and young Methods: A comprehensive integrated litera- Results: A total of 1453 relevant articles were people with learning disabilities. ture review was undertaken in the U.K between retrieved and assessed using the inclusion/ 5th and 15th January 2015. The search strategy Background: Children with learning disabili- exclusion criteria (1374 articles and 79 was adapted from Lewin et al. (2009) and ties have both a higher incidence of health con- documents from grey literature). The PRISMA Daniels et al. (2014).The following bibliographic ditions and health inequalities than their peers. flowchart was used as to audit the search process databases were searched:Medline (Ebsco);Cinahl They often require care in multiple environ- that concluded to a total of 30 full-text studies (Ebsco);ASSIA (ProQuest); CENTRAL ments and from multiple caregivers. Community fully meeting the review criteria. The CASP (Cochrane Library via Wiley);SCOPUS;Web of nurses are involved in writing health plans for tool for evaluating qualitative and quantitative Science - Core Collection. these children. studies was used to assess these articles. Results: The electronic search revealed Aims: The aim of this study is to explore the Discussion: A total of five themes were 428 articles. After independent review and perceptions of community nurses on how health developed, namely: 1) T2D and alcohol con- consensus between reviewers the final number plans can effectively be used to communicate the sumption, 2) well-being of alcohol dependent of included articles was 30. The range of litera- health needs of children with learning disabili- T2D individuals, 3) the illusion of change as ture was limited, mainly from North America, ties. a barrier to genuine lifestyle modifications, 4) USA, with few studies having been conducted Methods: This qualitative, exploratory, healthcare professionals’ role in supporting T2D in the UK. Three themes were identified: Lay descriptive study used purposive sampling and individuals and stigma, 5) social networks and health workers in influenza vaccination projects involved eight children’s community nurses, well-being of alcohol dependent T2D individu- and lay health beliefs, organisation and planning participating in focus groups. Two focus groups als. for flu vaccination projects involving LHWs; were audio recorded and the transcriptions were Conclusions: Dealing with the physical, psy- community ownership and partnership working. analysed using thematic analysis. chosocial and environmental aspect of alcohol The quality of the included articles was evaluated Results: The analysed data resulted in three consumption and T2D requires person specific using modified versions of the ‘Critical Appraisal inter-related themes; (i) tension between treatments. Furthermore, it requires support Skills Programme’ assessment tools (CASP), specific health plans vs overall picture of the for rationalizing the T2D condition and for Public Health Intervention evaluative questions child, (ii) writing health plans, and (iii) sharing achieving a balance between the idealised and and economic evaluation criteria. health plans. the pragmatic lifestyle aspirations. Self manage- Discussion: We discuss key findings, the range ment and ownership of the treatment process Discussion: Health plans can provide succinct, and quality of the evidence. For example, many is crucial in addressing the emotional/existen- prescriptive health information as well as more studies reported little about the LHWs in terms tial challenges of living with T2D. Lastly, the detailed and descriptive information about the of their recruitment, characteristics, their per- inclusion of the patients’ social networks in the child. It is unclear who is responsible for writing ceptions of the programme and attrition rates. disease management promotes a sense of health and updating health plans, leading to lack of Studies tended to focus on impact and outcomes and well-being. consistency and clarity regarding the accuracy of mainly vaccination uptake, with limited the plans. Confusion about sharing health plans attention given to process outcomes. with relation to data protection results in the Conclusion: The findings from this review will potential for multiple duplicate plans in multiple inform future provision of lay health worker areas rather than one comprehensive health influenza projects to influence health outcomes plan in use in all areas and with all carers. and contribute to reduction in health service Conclusions: This study highlights that costs. for effective communication of health needs, accurate health plans need to be accessible to parents, caregivers and professionals. Further

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clarification is needed regarding roles and ment in quality of life for elderly people in aged Poster 44 responsibilities with regard to writing, maintain- care. ing and sharing health plans. Findings support (370) Can we enable patients the potential benefits incorporating health plans to express support needs into integrated, shared, digital information in advanced non-malignant systems. Poster 43 disease? Testing a prototype (364) How prepared are tool for use within a new informal carers of patients support needs approach for Poster 41 with advanced COPD and patients (457) Promotion of oral what are their support needs? Dr Morag Farquhar, RGN BSc (Hons) MSc health in elderly residential Dr Morag Farquhar, RGN BSc (Hons) MSc PhD, Senior Research Associate, Dept of PhD, Senior Research Associate, Dept of Public Health & Primary Care, University of care: a review of the Public Health & Primary Care, University of Cambridge, Cambridge, UK literature. Cambridge, Cambridge, UK Brendan Garry, BSc Adult Abstract Nursing(Distinction), District Nursing Student, Abstract Background: The population-based Living Guy`s and St.Thomas NHS Foundation Trust, Aims: Chronic obstructive pulmonary disease with Breathlessness Study identified limited London, UK (COPD) is a chronic progressive condition which, reporting of support needs to health care pro- when advanced, can lead to high carer-burden. fessionals (HCPs) by patients with advanced Abstract We know about carer burden in advanced COPD chronic obstructive pulmonary disease (COPD) Background: Oral healthcare is recognised but lack good research evidence on the needs of and, crucially, the difficulties patients face in internationally as a neglected area of aged care these carers and how best to support them. Our expressing their needs. This has important provision (Kossioni, 2013). Evidence irrefuta- aim is to describe the support needs of carers of implications for support needs identification bly links periodontal disease with numerous patients with advanced COPD and their prepar- and response by HCPs. systemic diseases and can a have a devastating edness to care. Aim: To explore the feasibility and acceptability effect on a person`s quality of life. An aging Methods: Mixed method baseline interviews of a tool to enable expression of support needs population, with increasing co-morbidities with a cohort of 115 informal carers of patients in clinical practice by patients with advanced (Vos et al., 2015) will only add to the task for recruited from a primary care population base COPD. older people and their caregivers in maintain- in the East of England to the longitudinal Living Methods: Informed by, and modelled on, the ing optimal oral health (Public Health England, with Breathlessness study. Quantitative carer evidence-based Carer Support Needs Assess- 2015). measures include Preparedness for Caregiving ment Tool approach (CSNAT) we developed a Aims: The aim of this review was to identify Tool, Carers Support Needs Assessment Tool prototype tool to enable expression of support enablers and barriers to the effective promotion and Hospital Anxiety and Depression Scale needs by patients. The prototype was self-com- of oral health in elderly cohorts within residen- analysed using descriptive statistics. Purpo- pleted by 147 patients with advanced COPD. tial aged care. sively sampled qualitative data analysed using The potential role of the tool in clinical practice Methods: A review of the literature was under- a framework approach and multiple-perspective was explored in qualitative interviews with a taken using databases from EBSCOhost Research case study methodology. purposive sample of HCPs and in a stakeholder including CINAHL Complete, Academic Search Results: Carers had been in their caring role workshop. Data analysis included frequency Complete, Medline, PsycArticles, and PsycINFO for a median duration of seven years, were older counts (quantitative) and a framework approach between 2005 and 2015. Boolean phrasing and and usual spousal. We identified unmet carer (qualitative). commands were utilised with the keywords support needs and a lack of preparedness to Results: The prototype tool enabled patients to ‘oral health ‘, ‘dental health’, mouth care, ‘oral care, as well as a likelihood of clinical anxiety consider and express a range of support needs: hygiene’, ‘aged care’, ‘nursing home’, ‘residen- and depression that was higher than population knowing what to expect in the future (36%), tial aged care’, ‘long-term care’, care*, nurs*, norms. Carer support needs were negatively cor- practical help (36%), understanding their illness caregiver, ‘community nurs*’, ‘older people’, related with mean preparedness to care. (35%), looking after other health problems ‘older adults’, geriatrics, elder*, promot*, limita- Conclusions: Caring in advanced COPD is (35%), knowing who to contact if concerned tion*, constraint*, barrier*. prolonged, yet carers identified unmet support (30%), managing symptoms and medications Conclusions: Thematic analysis established needs and a lack of preparedness to care. (30%), dealing with feelings and worries (27%), educational, attitudinal and organisational Improving carer preparedness to care may go and accessing equipment (27%). Patients were aspects. Subsequent synthesis developed some way to meeting carer support needs in also able to prioritise their needs. These unmet numerous barriers including lack of oral health advanced COPD, and vice versa. support needs existed despite (or because of) education training, lack of support, oral health living with COPD for a median of 10 years. The values, beliefs, resident and practitioner resist- prototype was well received by patients, HCPs ance and limited access to dental treatment. and stakeholders who could envisage use in Enablers included oral health education and oral practice. health assessment tools. Conclusions: The tool is now being formally Recommendations: A multi-disciplinary, developed, grounded in patient data from the multi-faceted approach is required, to remove Living with Breathlessness Study, and will be the barriers at all levels in the promotion of oral tested within a person-centred approach for health in aged care. Consideration should be identifying and responding to patient-identified given to the introduction of oral health educa- support needs. tional programmes and the implementation of oral health assessments. Oral health promotion in domiciled aged care requires further research, as both a preventative measure and improve-

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Poster tour K of patient experience to non-BME patients. Poster tour Some aspects are captured by NPSP surveys, but Long-term conditions others are not and questions around respect and Late-breaking dignity are given less weight by BME patients in Leaving registration at: 13.30 an acute setting. Leaving registration at: 13.30 Led by: Faith Gibson, London South Bank Led by: TBC University, United Kingdom Poster 47 Poster 79 Poster 45 (319) Primary Percutaneous (449) Using the patient (388) The experiences of Coronary Intervention (PPCI) narrative to contribute acute medicine care in patient experiences of cardiac to clinical guideline patients from Black and rehabilitation development Minority Ethnic (BME) Dr Heather Iles-Smith, PhD, MSc, RGN, Head Amy Ferry, BSc, Centre for Cardiovascular backgrounds admitted with of Nursing Research and Innovation, Leeds Science, Univesity of Edinburgh, Edinburgh, heart failure. Teaching Hospitals NHS Trust, Leeds, UK UK Selina Jarvis, BSc (Hons), MSc, B.A, M.A Abstract (Hons), Kings College Hospital, London, UK Abstract Purpose: Less than 53% of PPCI patients Background: Suspected acute coronary attend cardiac rehabilitation (CR) program Abstract syndrome is the commonest reason for (Iles-Smith, 2012) despite the known benefits to emergency admission to hospital (Makam, Introduction: Heart failure (HF) is a common cardiac patients (Hedback, 2001, Balady, 2007). 2015). Strategies to identify low-risk patients long-term condition (LTC) which leads to Few changes have been made to the CR program suitable for immediate discharge would have frequent hospital readmissions.1 Cardiovascu- to accommodate PPCI since its wide scale intro- major benefits. As part of a clinical trial in lar diseases, leading to HF, are more common duction in the UK despite a now younger cohort. patients with acute coronary syndrome (High- in Black and minority ethnic (BME) popula- The CR requirements of PPCI patients is under STEACS/NCT 01852123), the potential for tions and racial disparities are well-recognised.2 explored. This study investigated attendance high-sensitivity cardiac troponin assays to Recently, less positive patient experiences in at CR and explored the experiences of PPCI permit clinicians to rule out myocardial infarc- BME groups have been highlighted by the NHS patients who attended CR. tion earlier and discharge patients directly from patient survey programme (NPSP) during A&E Methods: A mix methods study (n=202) the Emergency Department is being evaluated. and inpatient admissions. Since the NPSP asks investigated attendance at and experiences of Clinical guidance is being developed to incorpo- generic questions, this makes it difficult to gain CR for PPCI patients who were and were not rate this change into clinical practice (Shah et a thorough understanding for reasons under- readmitted (due to potential ischaemic heart al., 2015) pinning such variation. Furthermore, it is not disease (p-IHD) symptoms) within six months clear whether the questions asked by the NPSP Rationale: Understanding the patient experi- of STEMI. Quantitative data included number are representative of patient priorities during ence of chest pain assessment will give valuable of participants (readmission vs no-readmission an acute medical admission 3 Since high quality insight into the practical application of a new groups) attending CR. Qualitative interviews on patient experiences are associated with better chest pain pathway supporting early discharge. one occasion explored the re-admission groups outcomes, gaining a deeper understanding is a Methods: Qualitative methodology using experiences of CR; sampling was purposive, data priority. in-depth, face to face, semi-structured inter- collection and data analysis occurred concur- views for an interpretive analysis of the lived Aims: A qualitative study was designed to rently. Data was organised using Framework experience of chest pain assessment in the understand acute medicine experiences of analysis. Constant comparative analysis based Emergency Department Study participants: 23 patients with HF. on deduction and induction identified themes men and women recruited from a sub-study to Methods: Individual patient interviews were and sub-themes. the High-STEACS clinical trial using purposive conducted in privacy with stable patients recov- Results: 35.1% (13/37) of readmission and sampling to ensure representation across age ering from an acute exacerbation at a tertiary 56.8% (92/162) of non-readmission group and gender. hospital, which serves a high proportion of BME attended CR fully; 25 participants (14 men, Findings: The timing and affective nature of patients. Semi-structured interviews elicited 27-79 years) were interviewed. Themes iden- discussion around diagnostic testing may have spontaneous and prompted descriptions of tified mixed experiences of attendance at CR, an impact on how patients are able to interpret patient experience. Interviews were recorded, 1) CR led to increased confidence and fitness the negative test results on which their discharge transcribed, manually coded and a thematic and helpful information for some attendees, 2) is based. For some patients, the theme of ‘Unfin- extraction using inductive and deductive younger men reported that they believed CR was ished business’ was evident in those receiving a approaches undertaken. for older people and the exercises were too easy, negative troponin result. Results: 27 semi-structured patient interviews 3) participants believed the programme to be too were conducted with BME (48.6%) and non-BME physically orientated and, 4) insufficient stress Conclusion: Consideration of the patient patients (51.4%) with a mean age of 72.7 years. management and symptom regulation education narrative has revealed that confirmation of the Six main themes came were extracted from 27 included. absence of disease does not necessarily satisfy care needs, or fit with the patients’ own interpre- interviews which included good communication, Conclusion: Adaptations to CR programme tation or experience of symptoms. Qualitative timely management, specific attention for HF with increased flexibility of the service may meet methodology has identified how understanding status. Stark differences regarding perceptions the individual needs of more PPCI patients. the essence of patient experience can impact the of ‘being treated with respect and dignity’ were Additional focus on symptom management and effectiveness of new clinical guidelines. observed between BME and non-BME patients. stress reduction with greater education around Conclusions: We gained insight into experi- what exercises are safe and beneficial may all ences of patients with acute HF. BME patients increase up-take of the service by this group. reported some differences in their perceptions

135 Posters – Thursday 7 April 2016

Poster 80 Poster 81 (465) Re-Aiming the SMaRT (467) Evaluating antenatal Intervention weight management Dr Teresa Sakraida, PhD, RN, Associate programmes: What works? Professor, Florida Atlantic University, Boca Sarah Macaulay, Ulster University, Raton, US Newtownabbey, UK

Abstract Abstract Background: Self-management in stage 3 Background: Maternal overweight and obesity Diabetic Kidney Disease (DKD) slows and are major public health concerns with approxi- even halts progression. Effective interven- mately one in five pregnant women in the UK tions actively engage the patient in goal setting, being classified as obese. It is well documented planning, and information use. We implemented in the literature that maternal obesity increases a self-management and resourceful transition a woman’s and baby’s risk of developing com- (SMaRT) intervention that included 5 DKD plications such as gestational diabetes and mac- learning modules delivered via CDROM over rosomia. In response to the increased prevalence 3 weeks in 2-hour lab sessions and telephone of women who are overweight or obese and asso- counseling using motivational interviewing. One ciated complications, guidelines and antenatal means to assess acceptability is by patient satis- weight management programmes have been faction. In this study report, we re-aim (Glasgow, implemented. In order for future programmes to 2001) from assessed patient satisfaction (accept- be effective at improving the short and long term ability) in order to refine the SMaRT modules. health outcomes for the woman and her baby, it Method: Enrollment was from specialty is important to determine what works (or not) clinics. Of 179 patients eligible, 20 did not meet and in what circumstances. inclusion, 88 declined, and 33 were excluded for Aim: To identify and analyse components of the other reasons. Of 38 randomized, 12 withdrew planning and implementation phases that lead with reasons of too busy, moved, dialysis, and to positive outcomes. caregiver burden. Intervention participants Methods: Purposive sampling was used to (n= 13) completed post module (modules 1 to 5 collect data from Trusts (n=162) between May ) evaluation surveys that asked what was least and July 2015 using a web-based questionnaire valuable, most valuable, and needs improved. A to gather information on the components of qualitative content analysis by two expert nurses the planning, implementation and evaluation identified themes. phases of programmes. Preliminary analysis has Results: Withdrawals were balanced, leaving been undertaken using descriptive statistics and 13 subjects per group. Program satisfaction Fisher’s Exact Test. per group did not differ, suggesting the control Results: Fifty-two antenatal weight manage- group was placebo unaware; equal satisfaction ment programmes implemented from January likely contributed to balanced missing data and 2011 for women overweight and/or obese were withdrawals between groups. identified (68%, n=52). Of those programmes Themes were: (a) Module 1- good pace, add that reported at least one positive outcome reference links; (b) Module 2-well put together, (n=24), the most common components of add reference links; (c) Module 3- make longer, the programmes were discussion sessions on add pre-test/post-test; (d) Module 4- make healthy eating (71%, n=17) and discussion longer, current format order good; (e) Module sessions on physical activity (67%, n=16). Sixty- 5- make longer, activity centered learning. Of three per cent (n=15) of programmes used dis- the 13 intervention participants, 10 liked the cussion sessions on gestational weight gain, computer use and 3 did not, with themes of tech- healthy eating plans or written information nology anxiety and person-centered relating. on physical activity, gestational weight gain or Conclusion: Intervention satisfaction occurs healthy eating. Just over half of programmes when participants favor computer assisted were delivered in maternity units (54%, n=13) learning. Determining the intervention match with 29% delivered in a community centre (n=7). to the participant is a factor. Refinements to Conclusions: The findings provide insight into modules include a pre/post assessment with the most common components associated with hypermediated links to module content, more positive outcomes that will inform the future activity centered learning, and hyperlinking ref- development of antenatal weight management erences. programmes.

136 Posters – Friday 8 April 2016

Posters Friday 8 April

Poster tour L experience as a nurse; years of experience in the for sustainability within nursing care provision, work setting; and relationship with colleagues. practice and ultimately, achievable and sustain- Nurse education Other factors affecting nurses’ ability to provide able outcomes of patient care. Leaving registration at: 13.10 language concordant care included expectation Education for sustainable development needs to of patients with LEP were attitudes of other be explicitly advocated by professional nursing Led by: Professor Pam Smith, University patients; attitudes of nurse colleagues; attitudes bodies and implemented by nurse educators in of Edinburgh, United Kingdom of managers; organisational culture; and organi- the curriculum. The possible advantages of this sational policies. approach can improve relevance of education and nursing practice within globally diverse Poster 50 communities and benefit patient safety. (352) Speaking my patient;s Poster 51 language: Nurses perspective about provision of language (207) Nurse educators’ Poster 52 concordant care to patients understanding of education (64) Collaboration between with limited English for sustainable development: clinical and university staff in profeciency A phenomenographic study Rosetta West, London South Bank University, the preparation of children’s Dr Parveen Ali, PhD, MScN, RN, RM, FHEA, Havering Campus, Norfolk, UK University of Sheffield, Sheffield, UK nursing student for their first practice placement Abstract Abstract Mary Brady, Kingston University, Kingston Background: Education for Sustainable Devel- upon Thames, UK Aim: The present study was conducted to opment (ESD) is based on concept that human explore current communication practices of behaviour (individual or collective) and world bilingual nurses when caring for patients from Abstract resource usage directly affect and contribute to a shared linguistic background and to identify Introduction: The first practice placement climate change which impacts health and well- barriers and facilitators to the provision of for nursing students is of upmost importance, being. A lack of explicit reference to utilise ESD language concordant care. causing considerable anxiety (Brien, 2012) in nurse education results in the absence of, and is part way attributed to an increased Background: With an increase in the internal transformative education practices to prepare risk of attrition during and after this experi- and external migration and mobility of people and support students for current and future ence (Melling, 2011). Providing students with from/to different parts of the world, the likeli- decision-making and practice. hood of experiencing language barriers while adequate preparation for and support during Aim: This study aimed to develop a nurse providing and receiving care has augmented. placement is central to their learning and devel- education framework based on the understand- Nurses are responsible for providing care to opment, thus ensuring they are fit for profes- ing of nurse educators regarding ESD in relation patients regardless of their culture, religion, sional practice and registration as a qualified to Nurse Education. ethnic background or language. Language nurse (NMC, 2010). barriers, however, are hurdles that hamper Method: A qualitative phenomenographic Aims: Taken from a study examining the prep- development of effective communication approach was used. Data collection used semi- aration for and support of children’s student between nurses and patients. Eliminating structured interviews, transcribed verbatim nurses during their first practice placement, this language barriers is a crucial step to providing from a cohort of 10 participants (8 female and paper explores existing preparation for this by culturally competent and patient-centred care. 2 male senior lecturers) and analysed using a both clinicians and lecturers. framework supported by Ornek (2008). Methods: Fifty nine nurses, working in various Methods: Data were collected using focus acute NHS trust hospitals contributed to the Results: A framework that comprised a refer- groups (n=9) and the nominal group technique study through 26 individual in-depth interviews ential aspect of relevance and structural aspects was adopted to build consensus around what and three focus group discussions. The data of responsibility, globalisation and professional activities were helpful in preparing and support- were analysed using thematic analysis. A docu- leadership was developed. The framework illu- ing students for practice and also to gain insight mentary review of interpretation and translation minated how, ESD based on relevance, responsi- into future activities to prepare students in the policies of 30 acute NHS Trust was also under- bility, globalization and professional leadership future. can be used to frame pedagogical approaches taken. Results: Rankings from the focus groups used for nurse education practice. Findings: Three themes: ‘current situation suggested activities that were perceived as and my perspective’; ‘when we speak the same Discussion and Conclusion: At a local useful to students occurred at 2 time points language’; and ‘what helps of hinders’ were level the results demonstrated that an ESD those being prior to starting the placement identified. These themes describe participants’ informed curriculum can contribute to address- and as well as during the placement. Activi- views about language concordant communi- ing real world nurse education aims and objec- ties ranked as important before the placement cation in clinical practice, its usefulness and tives, improve and guide institutional culture included researching and making contact with impact on patients and nurses themselves. shift and departmental strategic needs and the practice area, planning travel arrangements Factors that have an impact on nurses’ ability plans. On a wider level there are implications as well as becoming acquainted with the practice to provide language concordant care include: for policy, discussion, action and the need for documentation. Whilst on placement the initial individual factors such as confidence; years of explicit reference to ESD to address the need introduction to the Trust and support from their

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mentors, senior students and the interdiscipli- impacted their knowledge acquisition, learning, Discussion/Conclusion: Majority of the nary team were viewed as crucial. development of role identify and adoption of participants experienced academic and inter- Discussion and Conclusion: Preparing the values of nursing. The complexity of service personal stress therefore; programme review/ students for their first practice placement is improvement in relation to the transition for orientation and regular interaction between the recognised as a crucial time when the student is undergraduate to registered nurses is demon- lecturers and students are advocated. formally welcomed to the clinical area. Integral strated. The impact of barriers and facilitators of Key words: Stress experiences, Undergraduate to this is collaborative working by both clinical service improvement is seen to promote reflec- nursing students and HEI staff. This paper offers some activities tion and learning for participants as they transit to prepare students for their first practice experi- through learning and professional development. ence in the future. Poster tour M Poster 54 Research Methods: Leaving registration at: 13.10 Poster 53 (227) Undergraduate nursing (36) An hermeneutic students’ experiences with Led by: Professor Michael Traynor, phenomenological stress in Nigeria. Middlesex University, United Kingdom study exploring service Dr Patience Edoho Samson-Akpan, RN, PhD, improvement experiences for Associate Professor, University of Calabar, Poster 55 Calabar, Nigeria undergraduate adult nurses (28) Using text mining in and in their post qualifying a qualitative systematic clinical practice Abstract Background: Literature reveals increased literature review of digital Lynn Craig, Northumbria University, stress during medical training (Esti, Radi & health engagement and Newcastle, UK Youssri, 2013) including severe symptoms recruitment - how to search such as depression and acute anxiety (Dahlin, and prioritise large datasets Abstract Joneborg & Runeson, 2005). There is however Siobhan O’Connor, B.Sc., CIMA CBA, B.Sc., RN, Background: High quality, safe and effective no study in Nigeria addressing stress experi- Lecturer in Adult Nursing, School of Nursing, health care is vital. Recently health care has ences of undergraduate nursing students. Midwifery & Social Work, University of experienced a significant growth and prioriti- Aims of the study: To examine and explore Manchester, Manchester, UK sation of service improvement. Nurse’s role in the lived experiences with stress among under- service improvement is fundamental. In order graduate nursing students in the University of to contribute to this at a foundational level, Calabar, Nigeria. Abstract nurses must be prepared within undergraduate Methods: A mixed method (descriptive and Introduction: The search for evidence in a quali- education and also in post registration practice. Hermeneutic phenomenology) design with tative systematic review must be transparent, Aims: To explore service improvement through 63 Direct Entry students purposely selected reproducible and robust, while balancing the the lived experiences of undergraduate adult because they were matured and might be more need for sensitivity and precision in terms of nurses, and later, as registered nurses. experienced in managing stress. The instrument capturing relevant records. This can be complex depending on the breadth of the topic, the Method: Hermeneutic phenomenology. 20 par- for data collection was a modified tool from volume of publications and intricacies of the ticipants were purposively sampled, typifying Inventory of College Students’ Life Experiences research question [1]. A systematic review on the adult pre-registration nursing profile. Data (ICSRLE)(Kohn, Lafreniere & Gurevich, 1990). engagement and recruitment to person-centred collection was 2 in-depth semi structured inter- The instrument has an internal consistency of digital health interventions was challenging views. Interview 1, 3rd year of their undergradu- 0.79 (Cronbach coefficient) and a reliability cor- given its wide focus on technologies used by ate adult nursing programme (January 2013). relation coefficient (r) = 0.77. The qualitative the public, consumers and patients as well as Interview 2, 12 months post registration (April aspect used a focus group discussion involving 15 the vast and diverse literature on eHealth and 2014). students out of the sample of 63. Qualitative data recruitment. Results: 4 themes emerged. 1: Making sense were coded and thematically analysed using the Aim: To explore the use of text mining tech- of service improvement with subthemes of ‘a Hermeneutic circle, while quantitative data were niques to search and prioritise the digital health personal construction of service improvement’, descriptively analysed using SPSS version 20.0. literature for this review. ‘linking theory to practice’ and ‘seeing a need for Data collection (from 8th 19th September, 2015) service improvement’. 2: Socialisation; a sense Ethical approval was obtained from Cross River Methods: A handful of highly relevant papers of Belonging, with subthemes of a desire to ‘fit State Ministry of Health Ethical Committee. identified through scoping searches were used in’, ‘maintaining the status quo’ and ‘role transi- Results: The mean age of participants to build an initial search strategy. This returned tion’. 3: Power and powerlessness, with ‘personal was 34.79+7.10; females 54(85.7), year five 147,734 records via PubMed which were loaded influence’, ‘fear of failure’ and ‘professional 26(41.3%); never married33(52.4%); 61(96.8%) into text mining software (VOSViewer) to create responsibility’ as sub themes. Finally 4: Change were living off campus. The respondents 56 heat maps that helped identify and prioritise theories in nursing practice, includes sub themes (88.9%) and 61(96.8%) said academic stress relevant search terms. A second more compre- of ‘facilitators and resistors to change’, ‘currency and interpersonal stress were very much part hensive search protocol was then developed and of staff’, ‘ritual and practice’ and ‘developing of their lives in the school. Emerged themes tested in Medline to further refine the search confidence to change’. were ‘the academic programme is hectic and strategy. Conclusion: Three interlinked themes of self- stressful’; ‘poor relationship of lecturers with Results: A total of 85,423 records were retrieved efficacy, empowerment and resilience developed students’; ‘some lecture times are stressful’; ‘the from six online databases based on the final for participants as they underwent role transi- environment is not conducive for learning’ etc. search protocol. Deduplication and the removal tion from undergraduate nurses to registrants. The coping strategies identified were balancing of studies related to clinical trials reduced the This transition evidences social constructiv- academics with recreation and avoidance. dataset to 57,367 records. These were loaded ism, where experiences and interactions have into text analysis software called GATE 8.0 and

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three record prioritization rules based on gazet- proposed as a method to improve recruitment Conclusions: The above methods facilitated teers (lists of prioritized search terms relevant to numbers. very high response rates. Participants provided the topic) were applied to the corpus of the texts As yet, it is too early to say whether this strategy positive feedback about the regular contact and exported to Excel. A MIMIR index was used has been successful in increasing participation with the research team and remained engaged to store and query the processed documents in the trial. throughout the study. which produced a final record of 1,423 results. Discussion: Text mining technology can be used to discover and identify relevant concepts to build search strategies and to prioritise large Poster 57 Poster 58 volumes of literature [2]. (205) Not another (261) A historical analysis of questionnaire! Increasing thirteen American Civil War return rates of postal surveys nurses’ autobiographies: Poster 56 in Multiple Sclerosis (MS) history serving nursing (281) Challenges of research studies. identities. recruitment into pragmatic Karl Ward, PG Cert, BSc (Hons), Dip HE, María Victoria Navarta, Universidad de Randomised Controlled Trial Senior Research Nurse, Neurology Research Navarra, Pamplona, Spain Unit, Centre for Neurosciences, D Floor (RCT) in schizophrenia Martin Wing, Leeds General Infirmary, Leeds Abstract Elwira Lubos, RMN, Non Medical Prescriber, Teaching Hospitals NHS Trust, Leeds, UK Introduction: The experience of dramatic Senior Research Nurse, Oxford Health events may excite personal retrospective reflec- Foundation NHS Trust, Oxford Cognitive Abstract tion, and autobiographical stories that reinforce Health Clinical Research Facility, Oxford, UK Introduction: Postal questionnaires are the collective conscience of a profession can commonly used in healthcare research to collect be produced (Choperena, 2014: 257). Looking Abstract large data sets at low cost. However they are through the past facilitates the configuration of EULAST is a pragmatic, multicentre, inter- associated with low response rates which impact personal identity, because it provides self-sense national, randomised and open label study on the validity of the results. In a prospective and helps to construct oneself as a biographi- that compares established treatments of oral longitudinal study investigating the impact of cal being in the world (Llona, 2009: 379). The against long-acting injectable antipsychotic in multiple sclerosis (MS) on employment, data col- nursing profession needs to understand its treatment of Schizophrenia. Primary outcomes lection was by postal questionnaire at baseline, history as a tool for the definition of an identity are all cause treatment discontinuation over 18 8, 18 and 28 months. Methods to improve that can be used to grow and evolve within the months. The study, opened in Oxford in August retention, minimise attrition and increase the discipline (Lewenson & Herrmann, 2007: 2). 2015, involving patients that are currently response rate were devised and used. Knowing the past of nursing, through auto- under follow up from the mental health team, biographical accounts of its protagonists, can Methods: Three focus groups were held to who require medication changes due to lack of become a path for shaping identities. identify themes associated with employment efficacy or poor tolerability of medication. To and MS. This informed the design of the ques- Aim: To show, through the historical analysis facilitate recruitment, community consultants tionnaire and length to ensure it was appropri- of thirteen American Civil War nurses’ autobi- have been signed up to the study as sub investi- ate and not burdensome. The questionnaire was ographies, the connection between the autobio- gators, although with modest results to date. piloted outside the focus groups to assess face graphical gender, the history of nursing, as a tool Reflection on the difficulties identified a number validity. During the study the following strate- of historical perception, and nursing identities of challenges: professionals preferences and gies were used to promote return of postal ques- strengthening. consequent lack of equipoise in relation to tionnaires: Method: Thirteen American Civil War nurses’ treatment arms, have contributed to difficulties Email: Participants were sent questionnaire autobiographies were analyzed, using historical in readiness to randomise, as evidenced in the reminders when due. approach. literature (Howard et al, 2009; Lloyd et al 20015) Conclusions: These autobiographies, under- and complexities related to gaining permission Newsletters: These included updates on stood as a source of historical knowledge, have to approach potential participants. Perceived questionnaire returns, useful contact numbers an important component of self-knowledge as a vulnerability of patient and patients difficulty in and any publications or scientific conferences result of its lived experience reflection. Analyzing making decisions about participation are often attended by the team. these autobiographies not only becomes a way quoted as recruitment challenges in this popula- Celebrations: A non-denominational festive of conveying a reality from the subjective and tion (Patterson et al, 2010; Howard, et al 2009; MS Society card was personally signed by the personal point of view, but it helps to shape a Lloyd et al 2005, Mason et al, 2007). team and included updates on study progress collective identity, which has affected the devel- To address the challenges, Continuing Profes- Flexibility: Some participants preferred com- opment of the nursing profession. sional Development meetings with the sub pleting the questionnaires face to face or over Keywords: Autobiographies; Historical investigators and Principal Investigator were the telephone. The team therefore arranged to analysis; Nurses’ identities. set up, where current evidence on treatment in meet/telephone at convenient times for the par- Schizophrenia is reviewed, as well as discussion ticipants. regarding the trial, as suggested by Fletcher et Results:221 participants were enrolled from al, 2013 and Towsend et al, 2015 who found the MS outpatient clinics at Leeds Teaching that training and information may be helpful in Hospitals. 56% of baseline questionnaires increasing the confidence of recruiters in pre- were returned in one week, rising to 77% after senting study to participants. Inclusion of con- 2 weeks. Using email reminders the baseline sultants that consented participants in a publica- response rate rose to 96%. Questionnaire return tion of systematic review that focuses on factors rate at month 8 was 57%, rising to 94% following which influence recruitment to RCTs has been email reminders. At month 18 the return rate was 92% following reminders.

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Poster 59 Poster tour N Poster 61 (353) A mixed methodology Patient experience/patient education (315) Patients understanding review exploring the of temperature monitoring Leaving registration at: 13.10 perspectives of Nurses and neutropenic sepsis transitioning to clinical Led by: Professor Daniel Kelly, Cardiff Clare Warnock, Weston Park Hospital, research University, United Kingdom Sheffield Teaching Hospitals NHS Foundation Caitlin Thomas, RNCB, Clinical Research Trust, Sheffield, UK Sister, Wellcome Trust/Clinical Research Poster 60 Facility, Birmingham Children’s hospital, Abstract Birmingham, UK (434) A qualitative formative Background: Neutropenic sepsis is a life- evaluation of the PRASE threatening complication of chemotherapy asso- Abstract intervention in collaboration ciated with an increased risk of infection and a A mixed methodology review exploring the with hospital volunteers reduced ability to fight it (de Naurois et al 2010). perspectives of nurses transitioning to Clinical Fever is often the first sign of infection and self- Dr Gemma Louch, PhD, Bradford Teaching research. monitoring of temperature and symptoms of Hospitals NHS Foundation Trust, Bradford, UK infection by patients plays a role in the early The authors are nurses who have recently tran- detection of neutropenic sepsis (NICE 2012). sitioned from various clinical backgrounds and Abstract Little is known about patient’s understanding of felt the transition was challenging due to lack temperature monitoring and its significance in Background: Evidence suggests that patients of prior knowledge and experience in this field. detecting neutropenic sepsis. The researchers aimed to acknowledge the can meaningfully feedback to health services thoughts and feelings of other nurses who have about the safety of their care (Lawton et al, Aim: To explore patients perceptions of the role transitioned into a research post, and identify 2015). The PRASE (Patient Reporting and Action of body temperature in detecting neutropenic any possible improvements to the induction for a Safe Environment) intervention (Sheard sepsis programme. Authors devised, piloted and et al, 2014) provides a way to systematically Methods: Semi-structured interviews were reviewed an anonymous qualitative and quan- collect feedback from patients, and includes an carried out with 21 patients who had received titative, self-report questionnaire. In October iterative action planning cycle for hospital ward a minimum of one cycle of chemotherapy. 2015, after seeking advice from the ethics staff to make changes to services on the basis of Purposive sampling was used to obtain a range committee, an opportunistic approach was used this feedback. The PRASE intervention is being of chemotherapy experience including 14 par- to formulate a questionnaire to be distributed implemented in three NHS Trusts with patient ticipants had been previously treated for neu- to 15 nurses employed by a clinical research feedback collected by hospital volunteers, with a tropenic sepsis. Interviews were carried out facility. 13 completed questionnaires were parallel evaluation exploring effectiveness. between July and October 2015 and analysed returned. Only 38% of the population reported Aims: This paper presents formative evaluation using framework analysis (Ritchie and Lewis the induction programme was sufficient. The findings from the pilot phase of implementa- 2014). main areas of insufficient training were identi- tion, which aimed to explore the feasibility and Results: All participants recalled receiving fied as site file management, consent, assent, acceptability of PRASE in collaboration with advice about the risk of neutropenic sepsis and expenses, anaphylaxis, pharmacy and safety hospital volunteers from the perspectives of key the need to self-monitor. However, there was reporting. Qualitative data showed the transi- stakeholders. significant variation in their understanding tion could be improved by working directly with Methods: A qualitative research design was of neutropenia, symptoms of sepsis, practice an experienced member of staff (62%), more adopted with data collected between July 2014 around temperature recording and triggers for structured induction programme (38%) and and November 2015. We conducted five focus seeking advice. Barriers and facilitators to tem- communication with the wider research team groups with hospital volunteers (n = 18), inter- perature monitoring and taking appropriate (23%). A combination of experienced and new views with ward staff (n = 4) and voluntary action were identified. Family members were research nurses identified improvements that services and patient experience staff (n = 3), pivotal in achieving compliance. could be made to the induction process. employing a framework analysis approach. Discussion: A gap was revealed between infor- In a previous study, Stephen’s- Lloyd (2004) Results: Findings relating to issues with imple- mation given and participants understanding related to realities of CRN’S demonstrating lack mentation will be presented. All stakeholders of, and compliance with, advice. Harmful con- of training, education, support and line manage- supported PRASE and felt hospital volunteers sequences included lack of monitoring, delayed ment with CRN’s describing their working envi- were well placed to facilitate the feedback col- reporting and late presentation. Patients without ronment as intimidating and isolating. lection. However, concerns were raised about immediate access to support from family and We feel that the transition could be improved by the intensive resource required to implement friends may be a high risk group. each member of staff taking responsibility for a PRASE on a larger scale. We will describe how Conclusion: By exploring patient’s perspec- specific area and developing a teaching package key literature from the field of improvement tives the study was able to identify barriers and which could be delivered to new members of science (e.g., Davidoff et al, 2015) has facilitated facilitators to compliance with advice along with staff within the first few weeks of commence- our evaluation approach (e.g., shared under- insights into why it is not always understood ment of post. standing of programme theory), and reflect on or followed. It provides the basis for service Although some work has been done previously challenges faced when evaluating an improve- improvements that address these issues and in this field, we feel that further research is ment project. meet the needs of patients receiving chemo- required across more nurses in more research Discussion and Conclusions: Although therapy. facilities. there are concerns regarding sustainability in practice, PRASE with hospital volunteers is a promising approach to capture the patient voice for service improvement. Volunteers may have an integral role in health services in the future, therefore our findings speak to this topic more broadly.

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Poster 62 oral IMPs. Further research should be carried Poster 64 out to investigate the efficacy of this nurse-led (62) Would a structured IMP consultation on enhancing participants’ (23) Understanding the Research-Nurse led adherence and the capacity of implementing patient experience of a consultation improve structured consultations throughout NHS inves- hospital discharge pathway tigator sites. patient adherence to oral Professor Angela Mary Tod, PhD, MSc, investigational medicinal MMedSci, BA(hons) RN, Professor Of Older products (IMPs) in clinical People and Care, The University of Sheffield, research trials? Poster 63 Sheffield, UK Claire Glendon, Bsc (hons) Adult Nursing, (443) Perceptions of quality Abstract Clinical Research Nurse, Oncology & Haematology Clinical Trials (OHCT), Guys during routine cancer Background: There are increased health, and St. Thomas’ NHS Foundation Trust, follow-up - the challenge of social care and financial motivations for pre- London, London, UK collecting meaningful data in venting avoidable deterioration and maintain- modernising gynaecological ing independence at home following hospital discharge. Various integrated health and social Abstract cancer services. care hospital discharge pathways and intermedi- Background: Patient non-adherence to Helen Manderville, RGN, BSc (Hons), PG Cert, ate and home care services have been developed oral anti-cancer drugs ranges from 16-100%, Macmillan Clinical Project Nurse, Gateshead to meet these needs, prompted further by policy often depending on the complexity of the drug Health NHS Foundation Trust, Gateshead, UK interventions (NHS E 2015) and new NICE regimen1. Four incidents were reported in the Guidance on home care (NICE 2015). last year within our research department of non- Abstract Aims: To examine the patient experience of a adherence to IMPs directly related to inaccurate hospital discharge pathway (HDP), and identify information provision or misunderstanding of This paper describes phase 1 of a service implications for integrated health and social information provided. We believe it is important improvement project aiming to re-design care commissioning and provision. to develop interventions to improve rates of aftercare for women following treatment for adherence to oral IMP as non-adherence can gynaecological cancer in the North of England. Methods: 18 patients (16 female, 2 male) significantly impact upon trial related outcomes Nationally it is recognized that routine follow-up referred onto a HDP in a North of England and clinical outcomes2 is not sustainable and is of little benefit to cancer NHS Trust were recruited between November patients (DH, 2013). The recent guidance rec- 2014 and July 2015. In-depth semi-structured Aims: To investigate if a research nurse-led ommends that the Macmillan Recovery Package individual interviews were conducted within consultation can improve research participant is implemented across all cancer specialties two weeks of referral and again at 3 months. adherence to oral IMP. (NHS, 2015). Framework analysis techniques were used. Method: This pilot study was conducted in Aim: To understand women’s views and expe- Results: The sample were old, vulnerable and August 2015 within a clinical research depart- rience of the current follow-up model, what frail. There were varied reasons for admission ment. elements contribute to a quality consultation but the majority had experienced a fall. Key A semi-structured questionnaire was created and also explore user views on an alternative themes to explain their experience were: ‘Not to identify what information research nurses model of aftercare. Knowing’: Participants reported not being currently provide to research participants during Methodology: Data was collected by a semi- unsure regarding current or future services and oral IMP consultations. The questionnaires were structured questionnaire (n=83) and seven focus had a lack of awareness of services available. distributed to all research nurses (n=10) within groups (n=58). The questionnaire was analysed Accessing information and services could be a our research department. using Excel. Focus groups were tape recorded matter of luck. A systematic literature review was conducted and transcribed using thematic content analysis. ‘Entitlement’: Some participants didn’t know to identify how structured nurse-led IMP con- The aim of analysis was to triangulate the two they could ask for certain things and felt guilty sultations could enhance research participants’ data sets to gain further understanding of the about ‘having’ to ask. adherence. phenomena of cancer follow-up. Social connections: Social networks and con- Results: The semi-structured questionnaires Results: Prior to appointments 30% of nections helped clients understand and access identified inconsistencies in the quality and the respondents report anxiety however, after their services and advice. Loneliness and social quantity of information provided to research appointment 77% report health and wellbeing isolation were prevalent. Having carers or participants. needs are met during the visit but psychological other services at home provided much needed Despite an extensive systematic literature (43%) and sexual concerns (18%) are less well company and social interaction search, no current literature was identified on addressed. This is reflected by comments from Discussion: The study indicates how HDP the impact of a nurse-led IMP consultation on the focus group. Overall 97% of women found services do not always work in an integrated research participants’ adherence. their appointment useful with 99% reporting way. Challenges are heightened for the socially satisfaction with their routine appointment. Discussion: More research is required in isolated. This presentation highlights implica- Despite a high level of satisfaction 50% felt the this area. 20-25% of new anti-cancer drugs are tions for service users and recommendations for appointment could be improved by seeing the expected to be in oral form3. With research practice. same person at every visit. This is echoed by participants becoming increasingly responsible comments from the focus group. In terms of an Conclusions: These findings raise questions for self-administration of oral IMPs without alternative model of aftercare 67% of women regarding integrated HDP services for the future direct supervision of health-professionals, it is would be interested in supported self-manage- if they are to promote health, autonomy and important that measures are implemented to ment however focus group respondents voiced independence. promote adherence. reservations about this. Our findings suggest Conclusion: Based on this research project, a there is little appetite for an alternative model of structured nurse-led IMP consultation should aftercare. Changing clinical practice is difficult be piloted within our research department in an when perceived satisfaction with the current attempt to improve participants’ adherence to model is high.

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Poster tour P patients related to poor clinical condition and Poster 68 mental capacity. Patient experience (242) An exploration of the perception of parents/ Leaving registration at: 13.10 carers of how health plans Led by: Dr Rachel Taylor, London South Poster 67 communicate health needs to Bank University, United Kingdom (77) Measuring multiple caregivers. compassionate care: Is it Lucy Riggs, R.N.M.H. Msc Clinical Research Poster 66 possible or desirable to distil Methods, City Health Care Partnership, CIC, into a single figure? Hull, UK (129) A survey to examine Dr Stephanie Tierney, PhD, Royal College of Abstract whether generic patient Nursing Research Institute, Warwick Medical reported outcome measures School, University of Warwick, Coventry, UK An exploratory study of the perception of (PROMs) are effective in parents/carers of how health plans communicate health needs to multiple caregivers. capturing the impact of Abstract Background: Children with health needs pressure ulcers on quality of Background: Compassion within nursing and may require care from multiple caregivers in life? health services has received increasing attention addition to their family and friends, in a variety over recent years. Strategies to support compas- Dr Simon Palfreyman, BSc RN MSc PhD, of settings. Health plans (used to communicate sionate care have started to be developed. How Assistant Professor, University of Alberta, health needs) are written by a variety of health to measure their effectiveness is not clear. Edmonton, Canada professionals to direct this care. Aims: As part of a study on the meaning of com- Aims: The aims of this study are to explore how passionate care for professionals working with Abstract health plans are used to communicate the health patients with type 2 diabetes, we explored par- needs of children with additional health needs, Background: Economic evaluations require ticipants’ views about measuring compassion. the ability to evaluate the impact on quality of perceived barriers and ideas for improving life. This can be achieved through the use of Methods: A constructivist grounded theory practice. (Charmaz, 2014) approach underpinned the patient reported outcome measures (PROMs) Methods: This is a small scale, qualitative, research. Semi-structured interviews and focus which can be either generic or condition-specific. exploratory study involving a purposive sample groups were conducted between May-October of 16 parents, recruited via a parents’ forum. Aim: To explore the psychometric performance 2015. Purposive and theoretical sampling was Data was collected from three semi-structured, of generic preference based PROMS (EQ-5D and used to recruit a range of healthcare profession- audio recorded focus group discussions during SF-6D) in pressure ulceration. als; 36 took part in total. Analysis involved open January - June 2015. Thematic analysis was Methods: Participants in both acute and and focused coding, developing memos that used to analyse the data. community settings were identified via a asked questions of the codes, and contrasting database of those in receipt of pressure relieving data with data and codes with codes. Results:Analysis of the data resulted in three inter-related themes; (i) Importance of knowing equipment. A handheld tablet device was used Results: Measuring compassion was regarded the child, (ii) Verbal information from parents, in the acute setting to administer a survey and as difficult due to its elusive, complex nature. and (iii) Using written health plans. Parents also a postal survey conducted in the community Categories identified in the data included: identified possible solutions, including improved setting. The survey questions consisted of generic Relying on informal indicators (this was the use of information technology and personal held PROMS (EQ-5D and SF-12), demographic, current way of evaluating compassion in records. wound specific questions, and the Sheffield practice); making the subjective objective (com- EQ-5D dignity bolt-on question. The psycho- passion’s dynamic, multidimensional form could Discussion: There is tension between the metric validity of the PROMS were assessed in be difficult to reflect in a measure); distinguish- need to have clear, safe, written information comparison to each other and clinical indicators ing it from other concepts (narratives referred to for multiple caregivers and the need to share using standard criteria. Linear regression was compassion in terms of communication skills or complex information that comes from knowing used to explore the impact of a range of variables connecting with patients, rather than an active the child. Issues of health plans not being read (including demographic, presence of comorbidi- response to suffering); incorporating external or shared between professionals and caregivers ties, pressure ulcer grade) on EQ-5D and SF-6D influences (it was acknowledged that compas- raised frustration in parents who often feel the utility score. sionate care could be influenced by factors need to then verbally share and repeat informa- Results: A total of 525 patients were screened related to work conditions); putting it to use tion to all involved. for inclusion in the acute setting and 130 ques- (measurement as a form of supportive feedback Conclusion: The study indicates that other tionnaires were sent to community participants. was accepted but there was concern it could be than emergency plans, written health plans are Responses were obtained from 273 patients in used as ‘just another stick to beat people with’). not always in use and when they are in use, are the acute and n=41 in the community setting. Discussion: Difficulties associated with reportedly not always read or shared appropri- Both EQ-5D and SF-12 were able to significantly measuring compassionate care may be chal- ately. Parents remain positive about the use of discriminate between groups based on the ulcer lenging when researching this concept; how will health plans, sharing information, use of one grade. Presence of a pressure ulcer and number we assess if interventions aimed at compassion plan for all and the possibilities for sharing that of comorbidities were significant explanatory are effective? Attempts to measure compassion computer based health records/plans may bring. variables of EQ-5D and SF-6D score. in practice should be employed wisely to avoid Conclusions: The range of diseases and co- demotivating staff and treating them uncompas- morbidities for which pressure ulcers may be a sionately. consequence could mean that a generic rather Conclusions: Findings suggest that measure- than a condition-specific PROM best capture ment of compassionate care is a contentious and the impact of pressure ulcers on quality of life. problematic endeavour. The study also highlighted that significant challenges exist to collecting data from this group of

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Poster 70 Poster tour Q international research placements, and authors present discussion of findings within this poster. (342) Communicating Genetic Nursing, midwifery or support worker Research (GR) in complex education neurological diseases Leaving registration at: 13.10 Poster 73 Concetta Brugaletta, MSc, Royal Free London NHS Foundation Trust, London, UK Led by: Sarah Morey, Northumbria (2) Applying team-based University, United Kingdom learning for nursing Abstract education Background: In the last decade genomic tech- Poster 71 Dr Mei-Chun Lin, PhD, Cardinal Tien Junior nologies have become more readily available College of Healthcare and Management, making pioneering research into the discovery of (219) Developing a practice Taipei, Taiwan new disease related genes with a view to develop- learning opportunity (PLO) ing personalized treatment models more acces- in an experimental medicine sible. Challenges and ethical issues arise when Abstract information about hereditary risk is imparted clinical research setting: Team-based learning (TBL) is a dialectical with no conclusive answers yet available, causing preparing nurse education to learning strategy based on adult learning theory anxiety and dilemmas for those participating. be research active. and a cooperative learning approach. It can also be a method to develop proactive learners and Aims: There are no clear guidelines on how to Margaret Davenport, BSc Clinical Practice, St to enhance critical thinking skills, and team better communicate GR to patients with complex George’s University Hospitals NHS Foundation communication and cooperation. However, the neurodegenerative diseases. To influence future Trust, London, UK practice, we explored how taking part in a nursing education literature suggests that both application of team-based learning application, genetic research study was perceived by both Abstract patients, their families and health professionals and the practical learning process of effective- working in front-line research with volunteers. Clinical research is an essential part of practice ness of TBL are still insufficient. The purpose learning opportunities (PLO) within nurse of this 12 month study was to explore the effec- Methods: An exploratory study, using education. (Evely, Hanson and Naylor, 2014). tiveness of team-based learning on learning purposive sampling, semi-structured interviews, NHS England mandates that every patient outcomes in nursing education. Using a quasi- and qualitative thematic analysis. has the opportunity to be involved in research experimental study design, data were collected Results: 20 interviews were conducted over (NHS England, 2013). Therefore, clinical via self-structured questionnaires, recording of seven months in 2015 with health care pro- research needs to be embedded in clinical the intervention and student learning diaries fessionals, patients with neurodegenerative practice; which requires more clinical staff to be Non-random, purposive sampling method diseases and their families. Seven themes research active, supporting and leading studies. recruited 50 participants. Pre-test assessment emerged from the data analysis, including the However, research roles are often poorly under- focused on learning strategies in college nursing need to understand the research process better, stood and the profile of research needs to be students, the intervention was undertaken, how statistical information was often confused raised. Research and evidence based practice and post-test assessment concentrated on the depending on its framing context, complex is included in pre-registration nurse education, changes in students’ learning outcome. emotions such as guilt, fear and anxiety emerged but a small body of evidence (Evely, Hanson and The results showed statistically significant around inheritance risk and that the clinical Naylor, 2014) and anecdotal accounts attest to differences (t = 7.03, p <0.000), that among experience of people’s disease could not be PLO in clinical research as positive experiences the experimental group following the group- separated from expectations during the research for nursing students. directed learning intervention. The three process. In response, the authors piloted a two week learning patterns are: learning strategies (t = Discussion: There is a need to engage more placement for twenty-one PG Dip RNs nursing 5.57, p <0.000), learning attitude (t = 6.56, p with research participants, offering more students in a clinical research facility with an <0.000) and learning outcomes (t = 6.36, p occasion for education, discussion and explora- emphasis on experimental medicine research. <0.000). These significant differences indicate tion of counseling opportunities. In light of this, The PLO included a bespoke GCP light session, that the team-based learning intervention effec- we are proposing to use the consent process to experience of research in practice in a number of tively impacted upon nursing education. In this introduce more information about genetics, specialties and laboratory teaching. study, using scratch-off cards as one study tool inheritance and the research process in a Evaluation of the project was positive, and for TBL, the Mann-Whitney U test was applied positive, reassuring way. interest has been expressed by other local trusts. to compare differences between students using Conclusion: To improve future practice we Additionally the authors have since built on the and not using these cards. Statistically signifi- propose a standardized level of staff training pilot success by hosting a variety of professionals cant differences in two items of the question- in genetic counseling which is available to par- from other international institutions looking to naire were noted: ‘I think the use of scratch-off ticipants at several times during the research gain an insight into the experimental medicine cards helps me to participate on courses’ (Z = process and PPI literature that uses info-graph- research process in the UK. -1.98, p = 0.048) and ‘I think the scratch-off card ics and accessible language styles. helps me to review of content of the course’ (Z = Since the completion of the pilot, planning for -2.02, p = 0.043). ongoing PLOs has been developed through NHS England reviews like Shape of Caring In Conclusion, TBL helps students to learn to (2015). This makes recommendations towards work with their peer that improves their ability integration,developing greater decision-making to communicate effectively and collaboratively. skills and the routine application of research and innovation should be formalised within education. At the same time, a focus is emerging, in response to financial pressures, on retention of newly qualified nurses. These issues have been explored in relation to providing future local and

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Poster 74 Poster 75 larger reciprocal scale. Students can learn so much about each other’s professions by walking (163) Nurses’ perceptions (298) A qualitative exploration in the other’s shoes. of continuing professional of the effectiveness development across the of interdisciplinary agenda for change bands simulated learning: toward Claire Smith, RN, NT, MSc Healthcare the development of a Education, PG Dip Intensive & High curriculum with embedded Dependency Nursing, PG cert Healthcare Law interdisciplinary learning & Ethics, BA (hons) Nursing Studies (Adult), Sheffield Teaching Hospitals NHS Foundation in the acquisition of clinical Trust, Sheffield, UK skills, decision making and team working Abstract Dr Jennifer Tocher, PhD, BSc, RGN, University Continuing professional development (CPD) in of Edinburgh, Nursing Studies nursing is a ‘hot topic’ thanks to the imminent School of Health in Social Science, Edinburgh, arrival of revalidation creating an impetus to UK explore the efficiency driven context into which revalidation will be plunged. Abstract This study is based in a Constructivist Paradigm Introduction: The Undergraduate programmes and has used a grounded theory methodology of Medicine and Nursing at the University of to explore nurses’ perceptions of CPD across Edinburgh are currently participating in an the Agenda for Change (AFC) Bands. 26 RNs innovative, interdisciplinary teaching approach across Bands 5-7 attended 7 corresponding focus involving the use of medium fidelity simula- groups. tion. The programme involves several elements Key similarities across the AFC Bands were; the of ‘cutting edge’ learning and teaching such as challenges of managing resources, accessing ‘real time’ experiential learning, team work, feed learning, permission & need to undertake CPD forward and debriefing techniques. Crucially and personal & professional barriers. The key the innovative approach involves full student differences were in the strategies & conse- engagement in their learning experience around quences described by the participants. Band 7 a deteriorating patient simulation. This method Ward Managers, Specialist and Newly Qualified of has been shown to enhance learning (Reece nurses relied on others to support CPD and et al 2010). Our multidisciplinary, collabora- used reminiscence to cope. Experienced Band tive team has evaluated this innovation and is 5 & 6 nurses sought respite from the challenges currently embedding this initiative across the involved and this created an undercurrent of two programmes of Bachelor of Nursing and guilt, frustration, reactive learning and difficulty MBcHB. translating knowledge into action, which varied Aims: To evaluate this initiative through both across the AFC Bands. student and staff eyes and assess its impact on The study concluded that without altering the perceived clinical competence and confidence in context within which CPD is delivered, any other the group of undergraduate medical and nursing interventions would only manage the symptoms students. of poor engagement in or usefulness of CPD. Objectives: 1. To prepare students for pro- The recommendations for practice are to fessional interdisciplinary working. 2. To use improve working processes, to release resources experiential learning as an approach to achieve and to improve the current conditions of ward knowledge, skills and effective decision making. based working. Without this, revalidation risks 3. To foster direct research-teaching links within becoming another ‘tick-box’ exercise and failing Nursing Studies and Medicine (Nango et al the same way that Post Registration Education 2010). and Practice (PREP) did. There should be new Method: Focus groups were used to evaluate ways of calculating study allowances rather than the student and staff experience of participat- in terms of percentages of the nursing estab- ing in this learning environment. Data were then lishment. Equally, frontline nurses should be analysed using an emergent theme framework. encouraged and supported to direct their own CPD needs - deciding subjects and influencing Results: Twelve focus groups of between 6-8 assessments. participants were conducted. Experiencing interdisciplinary learning using ‘safe’ scenario This study has implications not only for local based settings allowed both competence and practice but also for the wider professional- confidence attainment to be identified resulting political sphere of nursing and the successful in better patient care skills, decision making and integration of revalidation. team working. Conclusions: This project has emphasised the ‘beauty’ and complexity of interdisciplinary working from an early career stage, with great benefit being seen from both staff and student perspectives. We are keen to develop this on a

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