RCN International Nursing Research Conference 2017

Wednesday 5 – Friday 7 April 2017 University of Oxford Examination Schools, 75-81 High Street, Oxford, OX1 4BG, UK

Conference abstracts

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Contents

Keynote speaker abstracts 4 Concurrent session 6 54 Thursday 6 April 2017 2-2.55pm 54 Theme: Focus groups ...... 54 Concurrent session 1 6 Theme: Mixed...... 55 Wednesday 5 April 2017 11.30am-12.55pm 6 Theme: Qualitative approaches/patient safety and experience...... 56 Theme: Qualitative approaches...... 6 Theme: Qualitative approaches/interviews ...... 57 Theme: Qualitative approaches...... 7 Theme: Evidence review...... 58 Theme: Qualitative approaches...... 8 Theme: Qualitative approaches/text and discourse . . . . .59 Theme: Evidence review/patient safety ...... 10 Theme: Questionnaires/other methods ...... 60 Theme: Mixed eHealth...... 11 Theme: Research methodology ...... 13 Concurrent session 7 62 Theme: Mixed methods/patient experience...... 14 Friday 7 April 2017 9.50-10.45am 62 Concurrent session 2 17 Theme: Workforce/review ...... 62 Wednesday 5 April 2017 1.55-3.20pm 17 Theme: Qualitative approaches...... 63 Theme: Qualitative approaches/interviewing ...... 64 Theme: Qualitative approaches/ethics...... 17 Theme: Qualitative approaches...... 64 Theme: Quantitative method and systematic reviews. . . . 18 Theme: Mixed methods/primary and community care . . . 65 Theme: Mixed/patient experience...... 19 Theme: Focus groups ...... 67 Theme: Evidence review...... 21 Theme: Mixed...... 68 Theme: Research process...... 22 ViPER ...... 69 Theme: Qualitative approaches/ interviewing...... 24 ViPER ...... 69 Theme: Patient safety/questionnaires...... 26 Concurrent session 8 70 Concurrent session 3 28 Friday 7 April 2017 11.15am-12.40pm 70 Wednesday 5 April 2017 3.50-4.45pm 28 Theme: Qualitative approaches...... 70 Theme: Measuring quality of life...... 28 Theme: Co-design ...... 71 Theme: Other...... 29 Theme: Qualitative approaches/interviewing ...... 73 Theme: Qualitative approaches/ interviewing...... 30 Theme: Qualitative approaches/ethnography...... 74 Theme: Focus group ...... 30 Theme: Qualitative approaches...... 76 Theme: Qualitative/methodology ...... 31 Theme: Qualitative approaches...... 77 Theme: Action research...... 32 Theme: Qualitative approaches...... 78 Theme: Questionnaire...... 33 Symposia 1 - 5 81 Concurrent session 4 35 Thursday 6 April 2017 3.25-4.25pm 81 Thursday 6 April 2017 10.05-11am 35 Theme: Grounded Theory, nursing, midwifery Symposia 6 – 15 88 or support worker ...... 35 Theme: Mixed/workforce and employment...... 36 Friday 7 April 2017 1.40-3.10pm 88 Theme: Mixed/service innovation...... 37 Theme: Focus groups ...... 38 Posters 100 Theme: Mixed methods...... 39 Poster tour A...... 100 Theme: Qualitative approaches/workforce issues...... 40 Poster tour B...... 101 Theme: Qualitative approaches...... 41 Poster tour C...... 103 ViPER ...... 42 Poster tour D ...... 104 ViPER ...... 42 Poster tour E...... 106 Poster tour O ...... 106 Concurrent session 5 44 Poster tour F...... 109 Thursday 6 April 2017 11.30am-12.55pm 44 Poster tour G...... 110 Poster tour H ...... 111 Theme: Mixed methods...... 44 Poster tour P...... 112 Theme: Quantitative/workforce...... 45 Poster tour I...... 114 Theme: Review...... 46 Poster tour J...... 115 Theme: Quantitative/Leadership...... 48 Poster tour K...... 116 Theme: Evaluation/workforce...... 49 Poster tour L...... 117 Theme: Quantitative...... 50 Poster tour M...... 118 Theme: Quantitative...... 52 Poster tour N ...... 119 Poster tour Q ...... 120

3 Keynote speaker abstracts

Keynote speaker abstracts

between staffing and outcomes. She co-authored Wednesday 5 April Thursday 6 April the WHO’s guide to staffing and skill-mix and wrote the UK guidance on ‘Safe Nurse Staffing’ 10.20-11am 9.10-9.50am whilst a policy adviser at the RCN. After 3 years as Deputy Director of the National Nursing Research Unit, she moved to the University of Location: South School Location: South School Southampton in 2014. She continues to research nurse staffing and the delivery of fundamen- Keynote lecture 1: Keynote lecture 2: tal care. With funding from the Department of Health’s Policy Research Programme, she is Evidence-based policy? The research-policy interface: currently leading a two-year study of the imple- Really? ‘safe-staffing’ as an example mentation of safe staffing policies in England, Professor Trish Greenhalgh OBE, FMedSci, Jane Ball, Faculty of Health Sciences, Univer- following the Francis Inquiry. Professor of Primary Care Health Sciences, sity of Southampton, UK Nuffield Department of Primary Care Health Sciences, University of Oxford, UK Abstract Taking safe staffing as an example, Jane Abstract discusses the theory and reality of translating Surely the opposite to evidence-based policy research results into evidence that can inform is policy that isn’t evidence-based, therefore policy. Decades of research identify a relation- we should start with evidence and drive it into ship between registered nurse staffing levels policy. Whilst this seems a logical sequence, it’s and patient outcomes. Yet the impact that this not how the policy process works. The way to research has had on policy has varied consid- influence policy is, first and foremost, to under- erably. Why is that? Whose responsibility is stand the fundamental nature of the policymak- it to translate research findings into evidence ing process as a struggle over values. Policies are to inform policy? Where does dissemination made through language, and the instrumental end and lobbying begin? Jane reflects on the use of evidence in policymaking is a contact dilemmas, challenges and opportunities of sport, not an exercise in logical decision-making. working at the research-policy interface. It was ever thus. How, given this state of affairs, should the nurse who is keen on evidence-based Intended learning outcomes practice seek to influence the making of policy. • Consider factors that impede and enable the This lecture will offer some ideas and invite dis- translation of research findings into evidence cussion. that has the potential to inform policy • Appreciate the opportunities and limita- Intended learning outcomes tions facing the individual researcher at the • Question received wisdom about evidence into research-policy interface policy • Reflect on their own role in enabling knowledge translation into practice and policy Recommended reading list Greenhalgh T, Russell J. Evidence-based policy: Recommended reading list a critique. Perspectives in Biology and Medicine Whitty CJ. What makes an academic paper useful 2009; 52: 304-18. for health policy? BMC medicine 2015;13:1. Biography Griffiths P, Ball J, Drennan J, et al. Nurse staffing and patient outcomes: Strengths and limitations As Director of the Interdisciplinary Research of the evidence to inform policy and practice. A In Health Sciences (IRIHS) unit, Trish leads a review and discussion paper based on evidence programme of research at the interface between reviewed for the National Institute for Health social sciences and medicine, with strong and Care Excellence Safe Staffing guideline emphasis on the organisation and delivery of development. International journal of nursing health services. Her research seeks to celebrate studies 2016. and retain the traditional and humanistic aspects of medicine while also embracing the unparal- Mitton C, Adair CE, McKenzie E, Patten SB, leled opportunities of contemporary science Perry BW. Knowledge transfer and exchange: and technology to improve health outcomes and review and synthesis of the literature. Milbank relieve suffering. Quarterly 2007;85:729-68.

Biography Jane has been researching nurse staffing and workforce policy since 1990. Using large-scale surveys of nurses she researches the relationship

4 Keynote speaker abstracts

Community Care, University of Hertfordshire Friday 7 April from 2000-2016. 9.10-9.50am Her main research interest is in community health, especially in client/patient experience and in family health research, having developed the TOPSE tool for measuring parenting self- Location: South School efficacy (www.topse.org). This has led to her research with Aboriginal communities in Keynote lecture 3: Western Australia. Influencing policy through She also currently manages the NIHR/HEE nursing research in primary Mentorship Programme for Academic Clinical and community care Careers. Professor Sally Kendall, BSc (Hons), PhD, RN, She is the co-editor of Primary Health Care HV, FQNI, Professor of Community Nursing Research and Development and the co-chair of and Public Health, University of Kent, UK the International Collaboration of Community Health Nursing Research, a UK charity that supports global community nursing research Abstract (www.icchnr.org). All researchers would like to think their findings have impact on and will influence policy. Devel- opments over the past 5-10 years in both the Research Excellence Framework in the UK and the Research Council funding streams have emphasised the desirability of demonstrating how public funds have made a difference to policy, practice and society. Yet the challenges of aligning research ideas and funding opportunities with policy and public priorities are pervasive. How has nursing research contributed to this debate? This presentation will use the example of primary and community health nursing to illustrate the long and winding road to policy influence drawing on some of my own work nationally and internationally. I will explore the policy context of nursing in primary care and community health and show how shifts in ideology and policy change can affect how research may or may not be taken up, provide examples of research that have influenced policy and examine the processes that nurses and health visitors can engage with both as leaders in their fields and as street-level bureau- crats (Lipsky, 1980) to shape the way in which research can influence local and national policy.

Intended learning outcomes • Understand the links between research and policy • Explain the challenges of evidencing the influence of research on policy • Identify ways in which different types of evidence can be influential for policy

Biography Sally Kendall is Professor of Community Nursing and Public Health at the University of Kent. She became a health visitor and family planning nurse in 1982 and worked in SW London until taking up a research post at Kings College London and completing her PhD on the health visitor-client interaction. She was a lecturer in nursing from 1988 to 1996 in Buckinghamshire and had two children during that time. She became Professor of Nursing and Director of the Centre for Research in Primary and

5 111.30am-12.55pm Concurrent session 1 – Wednesday 5 April 2017 Concurrent session 1 Wednesday 5 April 2017 11.30am-12.55pm

social interactions and hierarchy of household Methods: A qualitative study design within Theme: Qualitative approaches decision making in the community. the paradigm of social constructivism was Session no: 1.1.1 Abstract number: 263 Discussion: We established that social support conducted using semi structured interviews. An networks and shared responsibility may not initial plan to collect video diary data had to be Time: 11:30am necessarily promote appropriate child feeding modified due to low recruitment. Data collection practices. Mothers are recipients of public health was conducted between 2011 and 2015. Data ‘First-borns taboo guinea dietary advice for child feeding. Yet, mothers was collected over this timeframe to allow for fowl, so as you see this child... have limited autonomy to implement these rec- adaptations of data collection methods, to com- she will not eat fowl meat.’ ommendations. pensate for slow recruitment of children to the study. Participants shared the child’s experience Feeding children; the cultural Conclusion: Community wide Nutrition viewed through the lens of parents and practi- intervention approaches may be beneficial at context and daily challenges tioners as well as the child themselves. Purposive changing community attitudes and promote for mothers in rural Northern sampling was used; 7 children, 11 parents, 21 uptake of public health nutrition recommenda- Ghana staff. Data were transcribed, analysed using tions. Investigating the cultural competence of narrative analysis (Riessman, 1993), coded and Ms Margaret Kukeba, The University of Man- health professionals may also be valuable. chester, Manchester, UK aligned into themes. Results: The themes that emerged from the Co-author(s): Debbie Fallon, UK; Peter Callery Biography UK data were coping, control and community. I am a nursing tutor from Ghana with special Children varied on their responses dependent interest in Child health and evidence based upon their condition and previous exposure to Abstract practice. isolation. Parents described preferring isolation Background: Only 13.3% of children 6-23 I worked in rural Ghana for five years before in terms of privacy but felt socially isolated. Staff months receive minimum acceptable diet in starting my teaching career in a Nurses Training described the role of parenting and nursing as Ghana. Undernutrition remains high in rural College 13 years ago ago in Northern Ghana. blurring often in isolation, due to the physical northern Ghana especially among under-fives I am currently writing up my PhD thesis at the barrier. showing no improvement in spite of economic University of Manchester and hope to graduate Discussion: Although this study cannot give development and implementation of scientifi- next summer. one structured approach to providing care for cally proven dietary guidelines. Understanding children in isolation, it encourages practitioners indigenous feeding practices may help explain to consider the children in this study within the the suboptimal feeding practices. context of their own care and individualise care Aim: To examine how culture might impact according to their needs. upon the feeding of children under-five years in Session no: 1.1.2 Abstract number: 51 Conclusions: This study generates themes rural northern Ghana. Time: 12pm that practitioners can consider in the context of Methods: Qualitative ethnographic approach their care setting, however further studies are was completed between October, 2014 and May, Children and young people’s necessary to explore this experience in other 2015. Data were collected in a rural Ghanaian experience of source and settings. community via participant observation and sixty-one ethnographic interviews with mothers, protective isolation while in Recommended reading list fathers, and grandparents in 15 households, and hospital spiritual leaders known as ‘diviners’. Themes Mrs Donna Austin BN Hons, Paediatric BARRAT, R., SHABAN, R. and MOYLE, W. were developed through inductive analysis of Intensive Care Unit, Southampton General (2011) ‘Behind barriers: patients’ perceptions of field notes and verbatim transcribed interviews Hospital, Southampton, UK source isolation for Methicillin-resistant Staphy- using a framework approach. lococcus aureus (MRSA)’, Australian Journal of Co-author(s): Dr. Jacqui Prieto, UK, Dr. Helen Advanced Nursing, 28 (2), pp 53-59. Results: We observed that breast feeding Rushforth UK children may consume only water or herbs RIESSMAN, C. K. (1993) Narrative Analysis. London: Sage Publications. brews and breast milk. Most children ate one Abstract meal within 24 hours. Irrespective of age, GAMMON, J. (1999) ‘The psychological conse- Background: Single room isolation is an children mainly ate carbohydrate based family quences of source isolation: a review of the liter- essential part of transmission based precau- foods. Child feeding was primarily influenced ature’, Journal Clinical Nursing, 8 (1), pp 13-21. tions for the purpose of infection prevention. by African traditional beliefs. ‘Satiety’ the com- Literature demonstrates that adults subjected to munity’s notion of food and taboos guided a isolation precautions can experience loneliness, Biography child’s dietary sources. Feeding patterns were depression, feelings of stigma and confinement Donna Austin is a Sister in Paediatric Intensive influenced by food insecurity, mothers emerging (Gammon, 1999; Barratt et al, 2011). There is a Care, Southampton and has been working part roles and beliefs such as sex contaminating dearth of literature that explores the experience time on her PhD with post funding from NHS breast milk. The dominance of these factors on of single room isolation for children. Education South Central as part of the clinical child feeding appeared to be facilitated by col- academic career pathway within University of lective living, physical structures of households, Aims: To explore the child’s experience of single room isolation. Southampton and University Hospitals South- ampton.

6 11.30am-12.55pm Concurrent session 1 – Wednesday 51 April 2017 Session no: 1.1.3 Abstract number: 69 32:1004-1005 doi:10.1136/emermed-2015- their residents. Transition to long-term care can 205372.58 be an emotional and stressful occasion for older Time: 12:30pm Gearing R, Mian I, Barber J, Ickowicz (2006) A people as well as their families. methodology for conducting retrospective chart Aim: The aim of this study was to explore the Non accidental and neglectful review research in child and adolescent psychia- context and nature of the lived experiences of injuries in children: patterns try. Journal of the Canadian Academy of Child nursing home residents as their current ‘home’; and typology and Adolescent Psychiatry, 15 (3): 126-134 and to evaluate the importance and role that Professor Julie Taylor, University of Birming- Thackeray J, Minneci PC, Cooper JN, Groner JI, nursing home staff played in enabling and max- ham, Birmingham, UK Deans J (2016) Predictors of increasing injury imising a ‘homely’ experience for their residents. Co-author(s): Nikos Efstathiou, UK; Pam Rees, severity across suspected recurrent episodes of Design and methods: This grounded theory UK; Birmingham Children’s Hospital Safegua- non-accidental trauma: a retrospective cohort study used qualitative data collection methods. ding Team, UK study. BMC Pediatrics, 16: 8 DOI 10.1186/ A semi-structured interview schedule within s12887-016-0540-y focus groups was operationalised with both Abstract nursing home residents and nursing home staff. Biography Total participants (n=92) Staff Participation Background: Non-accidental injury (NAI) (n=44) Resident Participation (n=48). 8 staff Julie Taylor [PhD; FRCN; RN; MSc; BSc (Hons)] accounts for over 40% of deaths in children groups and 8 resident groups participated in is a nurse scientist specialising in child maltreat- under one. In most cases NAI occurs in the focus groups (n=16). 0-5 year-old group and victims have three fold ment. She is Professor of Child Protection in the higher mortality rates compared to accidental Institute of Clinical Sciences at the University of Analysis: The paradigm model was operation- trauma. There is a lack of regional specific data Birmingham, in partnership with Birmingham alized to establish credibility and authenticity on NAI, inconsistency in terminology and cat- Children’s Hospital NHS Foundation Trust. She for qualitative data analysis, using open, axial egorisation and concern that local factors could has held previous chairs at the Universities of and selective coding. Manual analysis of tran- increase the risk for recurrent NAI. Edinburgh (NSPCC Child Protection Research scripts, charting, collages, occurred initially and Centre) and Dundee (School of Nursing and then QSR NVivo. This enabled the emergence Aims: To develop a typology of injury in order Midwifery). For three years (2010-2013) she was of sub-categories to support core category and to explore the demographics of non-accidental Head of Strategy and Development (Abuse in theory development? and neglect injuries in one large catchment area High Risk Families) with the National Society for and identify patterns from a range of factors Conclusion: The ‘Understanding’ and the Prevention of Cruelty to Children (NSPCC). including geographic location, socioeconomic ‘Knowing’ of the ‘Person’ (even when they status and seasonal variation. can’t find the words) is central to the concept of ‘homely care’ in a Nursing Home, where recog- Methods: Retrospective review of all paedi- nition and acceptance of the fact that as the older atric patients who were NAI and neglect injury person’s life events change, so too must their victims and received medical care at one chil- needs change also. dren’s hospital between Jan 2011 and Dec 2015. Theme: Qualitative approaches This paper reports on phase one, typology devel- Recommended reading list opment (Aug -Nov 2016). Data was extracted Session no: 1.2.1 from Child Protection referral forms and patient Corbin J. and Strauss A. (2008) Basics of Quali- notes (n=120) and recorded on a standardised Withdrawn tative Research, 3rd Edn. Sage, Thousand Oaks, electronic proforma. Health Research Authority California. approval was granted. Narrative analysis of child Ellis, J.M (2010). Psychological transition into protection concerns was undertaken indepen- a residential care facility: older people’s experi- dently by three members of the multidiscipli- Session no: 1.2.2 Abstract number: 37 ences. Journal of Advanced Nursing; 66:1159 - nary team. 1168. Time: 12pm Results: From analytic convergence and team Moore, K.D., and Ryan, A.A., (2014). ‘To Keep synthesis a typology was developed. Head injury The lived experience of a Person in their own Wee Corner’. Evaluating accounted for rotational and impact forces and the Role of Home Care Workers in Health and translational deceleration, including shaken nursing home residents in the Social Care Using a Grounded Theory Approach: baby syndrome. Other categories included context of the nursing home Chapter 11 pp 197-220: In Evaluation as a Tool thermal, skeletal, abdominal, penetrative and as their ‘home’ for Research, Learning associative injuries, ingestions and fabricated Dr Kevin Moore RMN, RGN, RNT, BSc (Hons), and induced illness. PG Dip Ed., MSc, PhD, FHEA, FCHERP, Ulster Biography Discussion: Consistency in description of University, Londonderry, UK Dr Kevin Moore commenced his career in psy- NAI allows meaningful coding that can be used Co-author(s): Ryan, A.A., UK chiatric nursing in 1983 and then in general to guide clinical judgement and prevention of nursing in 1989. He has worked in a variety of recurrence. Nurses in child protection teams Abstract clinical roles until he completed his primary may find using an evidence based typology degree and a Diploma in Community Psychiat- useful in maintaining accurate records. Background: A worldwide demographic trend ric Nursing in 1991. He then took up a post as a Conclusion: The findings could help regionally elucidates significant global transitions to an senior Charge Nurse for Community Psychiatric identifying early children with major injuries older population as people are living much longer Nursing in the UK He returned to study at the resulting from abuse and neglect, and ensure and are in effect ageing in place. This grounded University of Ulster in 1995 and completed his swift transfer to appropriate specialist care. theory study was designed to explore and Post Graduate Diploma in Education and took extrapolate on the lived experience of nursing up his first post as a Nurse Tutor in Southern home residents in the context of the nursing Recommended reading list Ireland. He has worked at Queen’s University home as their ‘home’. Further, the study also Belfast for six years in post-registration and took Davies F, Coats T, Lecky FE (2015) A 10-year explored how staff employed within the nursing up his current post as a Lecturer in Nursing at demographic comparison of major trauma as a home sector in Southern Ireland, enabled and the Ulster University in 2001. His responsibili- result of non-accidental injury versus accidental maximised the nature and meaning of home for ties are primarily within both pre and post-regis- injury in the UK Emergency Medicine Journal,

7 111.30am-12.55pm Concurrent session 1 – Wednesday 5 April 2017 tration education. He completed his MSc in 2005 ‘instilled’ in them through lecturers talk. Finally Theme: Qualitative approaches exploring psychological care in the aftermath student discourses serve as a mechanism for of a stroke; and his PhD in 2013, exploring the critical scrutiny of others within and out-with the Session no: 1.3.1 Abstract number: 62 intrinsic role of home care workers within health profession. This can be likened to Foucauldian and social care. His current research interests notions of governmentality and panoptical sur- Time: 11:30am are within the area of older people nursing and veillance. This study highlights how these dis- as a Post-Doctoral Fellow Kevin are exploring courses operate to ensure that student nurses A qualitative exploration into the lived experiences of nursing homes from the (and the profession of nursing) have a selective Early Inflammatory Arthritis perspectives of both the residents and the staff. status compared to others for the purpose of [EIA] patients’ personal ensuring professional credibility and standing experiences whilst awaiting GP initiated referral. Recommended reading list Miss Frances Chilton RGN,BSc,ONC,NMP, Session no: 1.2.3 Abstract number: 52 Furaker, C (2008) Registered Nurses’ views on MSc, PhD student, University of Worcester, their professional role. Journal of Nursing Man- Time: 12:30pm Henwick Grove, Worcester, Worcestershire, agement, 16: 933-941 UK Potter, J., Wetherell, M (1987) Discourse Co-author(s): Eleanor Bradley, Worcester, UK; Repertoires used by student and Social Psychology: Beyond Attitudes and nurses and lecturers while Dean Wilkinson, Worcester, UK; Janice Clarke, Behaviour. London, Sage. Worcester,UK discussing student nurse Lipscomb, M., Snelling, P.C (2010) Student professionalism during nurse absenteeism in higher education: An Abstract argument against enforced attendance. Nurse university study. Background: Early referral from primary to Education Today, 30, 573-578 Sue Jackson RGN, BSc(Hons.) MPhil, RNT, secondary care is vital to achieving a treatment FHEA, Northumbria University, Newcastle window of opportunity (Stack et al 2014). Upon Tyne, UK Biography Effective communication between patient and Co-author(s): Dr Alison Steven England UK Qualified as an RGN in 1984 in London, I General Practitioner [GP] from first symptom focused my early career within neurosurgical onset is vital to achieving this. However, whilst Abstract nursing. My interest in research developed as it is recognised that delays in early referral a result of coordinating a regional audit of head can be attributed at several levels (Bykerk and Nurse professionalism is a ‘vague’ concept injury management in East Anglia. On moving Emery 2010 and Pelaez et al 2015); there is no (Furaker 2008). Research has focused on to Newcastle upon Tyne I worked as a regional research evaluating how decisions are shared defining behaviours in clinical settings. In mental health audit facilitator and undertook an and finalised between EIA patients’ and GPs, or academia lecturers voice frustrations regarding MPhil exploring ‘What do People need Psychiat- the personal experience and impact that delays students’ lack of professionalism (Lipscomb and ric and Mental Health Nurses for?’ I remained may have in the very early stages of patients’ Snelling 2010) and these ‘voices’ offer insights in mental health research for 11 years focusing illness trajectory. into conceptualisations and discourses sur- my research interest on the needs of people Aim: The aim of this study is to explore EIA rounding professionalism. However, there is in suicidal distress, solution focus therapy limited research in university settings focusing patients’ personal experiences and interpreta- and service user involvement. I moved to the tion of decisions between patient and GP from specifically on student nurse and lecturers talk. Regional Genetics Service in Newcastle, inves- This presentation explores findings from a PhD symptom onset up to GP initiated referral. This tigating quality of life in people with congeni- research forms part of a larger longitudinal PhD study which analysed student nurse (all fields) tal heart defects before joining nurse education and lecturer talk. study exploring shared decision making within at Teesside University. In 2006 I joined the patients’ EIA care pathway. Aim: To make explicit the repertoires and dis- teaching team at Northumbria University where courses at play around language on professional- I am now Principal Lecturer and Director of Methods: 11 patients 7 (f) and 4 (m) were ism and professional identity as used by student Programmes for the Integrated Masters in recruited from one rheumatology department in nurses and lecturers during pre-registration uni- Adult Nursing, BSc Pre-Registration, Operating the West Midlands between October 2015 and versity courses. Department Practitioners and International March 2016. Patients were interviewed within 4 weeks of diagnosis using semi structured Methods: Discourse Analysis Methodology Nursing programmes. I remain committed to taped interviews. Interpretive phenomenology was employed with the purpose of uncovering research in my teaching and in investigating analysis [IPA] was used to explore patients’ Interpretive Repertoires, stylistic ways of talking the student nurse experience and challenges. early experiences and interpretations in shared about objects and events (Potter and Wetherill I am a PhD student due to submit in 2017. My decisions. 1987). Data was collected via interviews with thesis ‘Repertoires used by student nurses and 10 student nurses at 3 points (each year of edu- lecturers while discussing student nurse profes- Results: Several important areas influenc- cational programme) and at one point with 8 sionalism during university study’. ing patients’ experiences and decision making lecturers. were identified. These were grouped into four themes:- Symptom misinterpretation, navi- Results: The analysis surfaced two key con- gational struggles, knowledge fragmentation, flicting discourse repertoires; ‘The University recovery conflict. Student and the student Nurse’ and ‘The Univer- sity Lecturer and the Registered Nurse’. Conclusion: This current study is EIA patient focussed and provides a unique and important Discussion: Lecturer discourse initially served contribution to the patient experience from to ‘instill’ professional values in new student symptom onset to the time of GP initiated nurses and separates them from other univer- referral. sity students. Student repertoires change over three years, starting with tension in their talk Recommended reading list regarding their roles as university student and student nurse. Later student discourses support Stack R.J, Llewellyn Z, Deighton C, Kielly P, and perpetuate the compliant professional role Mallen CD and Raza K. (2014) General practitioners’ perspectives on campaigns to promote

8 11.30am-12.55pm Concurrent session 1 – Wednesday 51 April 2017 rapid help-seeking behaviour at the onset of Aim: To explore breast health awareness and opment and provision of cancer supportive and rheumatoid arthritis. Scandinavian Journal of the early diagnosis and detection methods of palliative care. I am full time PhD student and Primary Health Care; 32: 37-43 BC from the perspective of women and primary I am also involved in teaching Evidence Based Pelaez I, Infante C and Quintana R. (2015) Help- health care providers (HCPs) in the kingdom of Nursing 2 module at QUB. seeking trajectory in patients with rheumatoid Saudi Arabia (KSA). arthritis. Clinical Rheumatology 34 (suppl 1): Methods: This qualitative study carried out s17-s28 in eight states across the Jizan region of KSA Bykerk V and Emery P. (2010) Delay in receiving used purposive sampling to recruit women n= Session no: 1.3.3 Abstract number: 4 rheumatology care leads to long- term harm. (24), GPs n= (20) and Nurses n= (20). Semi- Arthritis and Rheumatism Vol.62, No.12 structured interviews were conducted with par- Time: 12:30pm pp3519-3521 ticipants from November 2015-February 2016. Thematic analysis of data was undertaken and Quality improvement Nvivo used to aid data management. Biography reporting in the surgical Results: The study reiterates, that there are Having qualified in the early ’ 1990 s my post literature is in need of no BC screening programmes available in KSA. registration experience has concentrated within improvement Women reported poor knowledge about the orthopaedics, acute medicine and rheumatology. Ms Emma Jones BSc (hons), MSc, MCSP, impact of BC and the value of screening. Nurses It was whilst undertaking orthopaedic training HCPC, University of Warwick, Coventry, UK felt poorly prepared to provide education and at the Robert Jones and Agnes Hunt orthopaedic screening services to women, believing this to Co-author(s): Professor Mary Dixon-Woods hospital I realised my career direction in rheu- be the role of physicians. In addition to a lack and Professor Graham Martin matology. of screening programs, time, workload and Since working as a clinical nurse specialist at inappropriate facilities are reported barriers to Abstract Warwick hospital I completed an MSc exploring providing education and screening services. Introduction: Perioperative quality improve- patient preferences and treatment choices to Discussion: Saudi women require knowledge ment (QI) research is of vital importance biologic therapies. My passion in nursing has of BC, early detection methods and related sig- (Nicolay et al (2012), but translating learning centred from a belief in challenging and being nificance to health. HCPs should be actively to practice is challenging because reporting is able to combine clinical practice and research. engaged in providing education and screening frequently incomplete. This research is relevant In 2009 I was one of the first West Midland services. This cannot be achieved if HCPs to an international audience who need to nurses to be employed in the combined rheu- themselves do not realize the importance of report where, why and how interventions were matology clinical nurse specialist and research engaging actively in this public health agenda delivered, to enable others to replicate them. nurse role, supported by the West Midlands and addressing the barriers for BC screening as This research identified which reporting items Clinical Research Network[WMCLRN]. a public health imperative. are most frequently incomplete, and why. My enthusiasm for combining practice and Conclusion: National comprehensive policies Methods: A systematic review was conducted research further developed with my ambition to are required to establish screening programmes in 2014. Data was extracted from 100 periopera- move from research nurse to nurse researcher. and increase knowledge of BC. This study tive QI articles. Each article was scored against a Undertaking a PhD is a professional develop- provides new evidence of experiences of breast modified TIDieR checklist (Hoffman et al 2014). ment opportunity that has only been possible health awareness, in a society where such QI authors; QI editors; reporting guideline through the financial assistance from the Royal topics remain taboo, and health services poorly authors; and QI consumers (those using QI College of Nursing Foundation Professional developed. research to change care) were asked (Oct 2015- Bursary Scheme, of which I am ever grateful. March 2016) ‘why is reporting so hard?’ They Recommended reading list explained how they would replicate an inter- Donnelly TT, Hwang J. (2015) Breast cancer vention described in a perioperative QI article. screening interventions for Arabic women: a The article’s authors explained whether their Session no: 1.3.2 Abstract number: 38 literature review. Journal of Immigrant and portrayal of the intervention, matched the participants’. Time: 12pm Minority Health, 17 (3), pp 925-939. Saudi Cancer Registry: Cancer Incidence Report Results: The 100 articles achieved a mean An exploration of breast Saudi Arabia 2007. Kingdom of Saudi Arabia, TIDieR score of 6.31/11; over a third scored five health awareness: uncovering Ministry of Health, Saudi Cancer Registry. or less. Reporting of fidelity was absent in 74% Available at: http://shc.gov.sa/Ar/HealthCent- of articles, and intervention modifications was experiences of Saudi women ers/NCC/CancerRegistry/Pages/CancerRegis- absent in 72%. Miss Norah Madkhali MSc in Cancer Nursing, tryRecords.aspx Participants (N=42) included: 12 consumers, School of Nursing and Midwifery, Queens Saudi Cancer Registry: Cancer Incidence Report 15 authors, 11 journal editors and 4 reporting University Belfast, Medical Biology Centre, Saudi Arabia 2008. Kingdom of Saudi Arabia, guideline authors from England (24), the United Belfast, UK Ministry of Health, Saudi Cancer Registry. States (11), Germany (1), Canada (3), Australia Co-author(s): Olinda Santin, UK; Helen Noble, Available at: http://shc.gov.sa/Ar/HealthCent- (2) and The Netherlands (1). Twenty-eight clini- UK; Joanne Reid, UK ers/NCC/CancerRegistry/Pages/CancerRegis- cians included 13 surgeons, 6 anaesthetists and 9 tryRecords.aspx other perioperative staff. Abstract Reporting QI is hard because: Background: There is a high incidence of Biography • Drivers and barriers inherent in organisations, advanced breast cancer (BC) in young women in I began my journey at King Abdulaziz University, influence reporting the Arab world (SCR, 2007; 2008), but no stand- Jeddah, Kingdom of Saudi Arabia. I graduated • Terminology is confusing ardized information regarding breast self-exam- with a BSc (Hons) in Nursing, and continued on • A scientific framework for QI reporting is ination, nor a national screening programme to do my MSc in Cancer Nursing on 2012 and incomplete which promotes clinical breast examination and my PhD on 2014 at Queen’s University Belfast mammography (Donnelly and Hwang, 2013). (QUB). This opportunity, alongside my personal • Describing context is complicated experiences, furthered my interest in the devel- • QI research is used for different purposes.

9 111.30am-12.55pm Concurrent session 1 – Wednesday 5 April 2017 From these themes emerged 23 recommenda- Theme: Evidence review/patient These mechanisms, along with the associated tions for practice. contexts and outcomes of IR will be presented Conclusion: On average, 43% of items, which safety and discussed. The successes of theory devel- should be present in perioperative QI articles, Session no: 1.4.1 Abstract number: 262 opment in this field along with the challenges are incomplete. Disseminating recommen- of identifying programme theories and other dations for good reporting practice will help Time: 11:30am insights from the process will also be explored. galvanize a renewed sense of importance for reporting. Intentional rounding in Recommended reading list hospital wards: what works, Department of Health (2013). Report of the Mid Recommended reading list for whom and in what Staffordshire Foundation NHS Trust Public Hoffmann TC et al (2014). Better reporting of circumstances? Inquiry, Volumes 1-3. HC-898-I-III. The Sta- tionery Office. interventions: template for intervention descrip- Professor Ruth Harris PhD, MSc, BSc (Hons), tion and replication ( TIDieR ) checklist and RN, King’s College London, London, UK Snelling P (2013). Intentional rounding: a guide. BMJ (1687)1 - 13 critique of the evidence. Nursing Times 109 Co-author(s): Sarah Sims, UK; Nigel Davies, (20):19-21 Nicolay CR et al (2012). Systematic review of the UK; Ros Levenson, UK; Stephen Gourlay,UK; application of quality improvement methodolo- and Fiona Ross, UK gies from the manufacturing industry to surgical Biography healthcare. Br J Surg Mar 99(3)324 - 35 Abstract Ruth Harris is Professor of Health Care for Older Adults, Florence Nightingale Faculty of Nursing The Francis Inquiry (DH, 2013) recommended Biography and Midwifery, King’s College London. She has that, ‘Regular interaction and engagement a clinical background in acute medical nursing Emma’s PhD was undertaken with the Depart- between nurses and patients and those close and care of older people. Ruth’s research ment of Health Sciences at the University of to them should be systematised though regular focuses on the impact of the nursing and mul- Leicester and was funded by The Health Foun- ward rounds’. This recommendation received tiprofessional work on processes of care and dation. Emma’s PhD examined the degree strong government support and the majority of patient outcomes particularly for older people to which quality improvement (QI) methods NHS trusts in England have introduced ‘inten- and those with chronic conditions. Her current and interventions, which are used to improve tional rounding’ (IR), a structured process work includes a NIHR HSandDR funded study patient care in surgery, are described accu- whereby nursing staff carry out regular checks, to evaluate intentional rounding by nurses and rately and helpfully in the literature. From this usually hourly, with individual patients to a NIHR HSandDR funded study using EBCD work recommendations were generated to help address their positioning, pain, personal needs to enhance patient activity in acute stroke units researchers report their findings explicitly to and placement of items. Published USA studies (CREATE study). Her recently completed work enable others to replicate successful interven- have found benefits including a reduction in call includes a scoping review of the evidence for tions in clinical practice. Emma also acts as a bell use, falls and pressure sores and increased 12-hour shifts in nursing and a NIHR HSandDR collaborator with the Oxford Health Experiences patient satisfaction. However, there is little UK funded multimethod study to investigate the Institute on an MRC HTMR research project research to support this. All existing research effectiveness of interprofessional team-working ‘Developing a patient and public involvement to has been criticised for design weaknesses on outcomes and patient and carer experience enhance recruitment and retention in surgical (Snelling 2013). trials.’ Having experienced major elective and of care across stroke care pathways. She is an A mixed-method study is being undertaken, emergency surgery herself, she has taken up associate editor of the International Journal of drawing upon a realist evaluation approach, a new role as a patient reviewer for the BMJ. Nursing Studies and a Fellow of the European to answer the question ‘What is it about IR in Emma runs one clinic a week as an extended Academy of Nursing Science. hospital wards that works, for whom and in scope NHS orthopaedic physiotherapist at Uni- what circumstances?’ The study comprises a versity Hospitals of Leicester NHS Trust, whilst realist synthesis of IR, a national survey of all also helping the team to develop a new virtual NHS acute trusts in England and in-depth case arthroplasty follow up service. studies in six wards across three geographically Session no: 1.4.2 Abstract number: 49 spread hospitals. Time: 12pm This presentation will focus upon the findings of the realist synthesis which included searches Pressure injuries amongst of relevant academic and unpublished grey lit- people with darkly pigmented erature and a stakeholder consultation event to skin: exploring the generate hypotheses on what the mechanisms of IR may be, what particular groups may benefit methodological challenges most or least and what contextual factors might Mrs Neesha Oozageer Gunowa , Oxford be important to its success or failure. 43 papers Institute of Nursing and Allied Health were included. Nine potential mechanisms of IR Research (OxINAHR), Oxford Brookes Uni- were identified: versity, Faculty of Health and Life Sciences, • Anticipation Oxford, UK • Nurse-patient relationships/communication Co-author(s): Marie Hutchinson, Australia; Joanne Brooke, UK; Debra Jackson, UK • Accountability • Consistency and comprehensiveness Abstract • Allocated time Background: Pressure injury (PI) develop- • Visibility/presence ment has been widely researched and docu- • Staff communication mented; however, much of this work does not address ethnicity or race, and assumes Cauca- • Patient empowerment sian-ness (NICE, 2014). • Crafting

10 11.30am-12.55pm Concurrent session 1 – Wednesday 51 April 2017 Aims: Explore the methodological limitations Session no: 1.4.3 Abstract number: 5 Biography of two decades of PI research and identify an Time: 12:30pm Jodie qualified as a Mental Health Nurse in agenda for nursing research and education. 2004. Since then she has worked within Forensic Method: A search of five electronic databases Mental Health while undertaking further self was undertaken for the period 1990-May 2016. Protective factors: bridging funded studies including a BSc in Psychology An integrative literature review of quantitative the gap between recovery and and Criminology, a PgDip in Criminology and an and qualitative evidence was planned to explore violence risk assessment MSc in Clinical Forensic Psychiatry. the depth and breadth of the perceptions of those Ms Jodie Alder RMN, BSc (Hons), PgDIP, MSc, Currently half way through a PhD studentship with darkly pigmented skin and the influence of South Staffordshire and Shropshire Founda- looking at protective factors in violence risk dark pigmentation on identification and -man tion Mental Health Trust, University of Man- assessment for forensic services, she continues agement of PI; however, only quantitative data chester, Stafford, UK to work on a medium secure intensive care ward was found. As a result, a systematic approach of and undertakes unit based audit and research. the literature was undertaken. Abstract Results: Twelve relevant studies were Internationally within mental health services examined with a particular focus on what the over the last two decades, there have been literature explores about people with darkly dramatic strides in the materials available to pigmented skin in relation to PIs. Study meth- improve risk assessment in a society where odology was appraised using component ratings the management and prediction of risks, espe- Theme: Mixed eHealth (National Collaborating Centre for methods and cially in relation to those surrounding violence Session no: 1.5.1 Abstract number: 33 Tools, 2008) and the studies were rated as weak towards others, is highly valued and indeed to moderate. expected. Time: 11:30am Discussion: Most of the studies were based on Arguably this is expected most from mental The J Curve: a theoretical retrospective secondary data analysis and sta- health professionals, and mental health nurses tistical analysis was not always used or appro- are key agents in the assessment of risk, where explanation for the difficult priate. Furthermore, with many of the studies safety planning forms a significant part of process of changing to employing retrospective data analysis, attention everyday practice (Downes et al 2016) whether electronic health records. is drawn to the possible limitations regarding that is in the community or within inpatient Professor Austyn Snowden , Edinburgh Napier reliability of the data sets including categorisa- settings. tion of skin tone as well as coding inaccuracies University, Edinburgh, UK and omissions which could confound results and The nursing assessment of risk is concerned Co-author(s): Hildegard Kolb, Scotland, UK create poor methodological quality. with the prevention and prediction of the likelihood of an adverse outcome (Muir-cochrane and Abstract Conclusion: From the literature reviewed it Wand 2005) which can include patient aggres- can be seen that there is a lack of guidance and sion, suicide and self-harm, substance misuse Background: Electronic health records are evidence, people with darkly pigmented skin and others including social exclusion and vic- considered preferable to paper based systems are more likely in comparison to people with timisation (Muir-Cochrane et al 2011). (Department of Health, 2013). However, white skin to develop higher stage PIs. Further changing from one system to the other is difficult Recovery and risk are concepts that can seem to research regarding nurse education and PIs (Gephart, Carrington, and Finley, 2015). This be at odds with each other. Barker (2012) asked should be carried out to help establish nurse aim of this study was to analyse this change in a how can a person recover, and have hope in their knowledge of PI identification and to develop Scottish hospice. more of an awareness of diversity issues in recovery when the emphasis on their care is upon risk, to themselves or to others. Objectives were to describe change over 30 pressure damage. months in relation to: This presentation will argue that incorporating 1. System usability, Recommended reading list protective factors into the assessment of risk of violence, enables it to be undertaken within 2. Staff engagement, and National Institute for Health and Care Excel- a recovery model of care. It represents a litera- lence (2014) Pressure ulcer: prevention and 3. Staff experience of the system. ture search undertaken as part of a current PhD management. Available from: looking at protective factors and violence risk Method: Prospective longitudinal repeated National Collaborating Centre for Methods assessment. measures mixed methods. and Tools (2008) Quality Assessment Tool for System usability was measured with the System Quantitative Studies. Hamilton, ON: McMaster Recommended reading list Usability Scale. A validated analogue scale University. Available at: http://www.nccmt. measured staff engagement. Staff experience Muir-Cochrane, E and Wand, T (2005) Contem- ca/resources/search/14 (Downloaded: 21 May was derived from concurrent analysis of free porary issues in risk assessment and manage- 2016). text comments and a focus group. Data were ment in mental health. Green acres. Australia. obtained at four time points: November 2013 Biography Muir-Cochrane, E., Gerace, A and Mosel, K (baseline), November 2014, November 2015 and (2011) Managing risk; clinical decision making Neesha is enrolled in a PhD at Oxford Brookes June 2016. Participants were all employees of a in mental health services. Issues in Mental University, and affiliated with The Oxford single hospice in Scotland (n=156). Health Nursing. 32. 726-734. Institute for Nursing and Allied Health Research Results: Mean (SD) system usability scores (OxINAHR). Neesha is a Senior Lecturer at Downes, C., Gill, A., Dole, L., Morrissey, J and were sequentially: 54.51 (18.2) at baseline, 52.33 Kingston University and St. Georges, University Higgins, A (2016) Survey of mental health nurses (15.11), 47.11 (14.07) and 65.3 (15.6) at final of London and is also a qualified District Nurse attitudes towards risk assessment, risk assess- survey. Mean (SD) experience (out of 10) was who has worked in a variety of roles within ment tools and positive risk. Journal of Psychi- 7.78 (1.64) at baseline, 6.76 (1.791), 5.91 (2.78), community nursing. Neesha is a Queens’ Nurse atric and mental health nursing. 23. 188-197. then 6.03 (1.8) at final survey. Staff experience and external examiner at Brighton University was interpreted as a function of technical dif- for the District Nurse and Practice Nurse post- ficulties, but also unexpected cultural issues, registration course. including significant challenges to the way nurses felt the patient story was getting lost.

11 111.30am-12.55pm Concurrent session 1 – Wednesday 5 April 2017 Conclusion: It took 30 months for usability There is currently limited evidence about the Methods: A systematic review of the qualita- and engagement scores to rise above baseline value of these systems. tive literature (O’Connor et al, 2016) informed levels. Scores reflected technical difficulties Aim: To evaluate whether acute ward nurses are the design of an exploratory multi-site case but also cultural challenges to the way nursing able to integrate real-time IT systems into their study. Sixty one interviews (n=72) and five care was communicated and recorded. This working practices, and use them to improve focus groups (n=44) were conducted between process of change is best theorised as a ‘J-curve’ quality and safety. June 2012 and October 2015 with a wide range (Snowden and Kolb, 2016). of stakeholders implementing a range of health Methods: We undertook fieldwork in eight and well-being technologies. Thematic analysis Implications for practice: It took two years wards in four NHS Trusts between April 2015 was performed using the framework approach for staff to begin to get used to the new system. and July 2016. This included observations of and the study was underpinned by Normaliza- The implementation process followed a ‘J curve’. wards practices (n=79 hours) and 37 interviews tion Process Theory (May and Finch, 2009). Understanding the nature of the change and the with ward staff. The Biography of Artefacts unexpected cultural challenges will help compa- approach was used to analyse the data. Results: Five overarching themes affected rable organisations better support their staff in patient and public engagement and enrollment; Results: Ward staff have worked with in-house future. 1) Personal Agency and Perceptions, 2) Personal informatics teams to design and implement Lifestyle and Values, 3) Digital Accessibility, 4) systems. The process is lengthy, with teams Recommended reading list Engagement and Recruitment Strategies, and improving on systems all the time, and the 5) Quality of the DHI. A preliminary concep- Department of Health. (2013). NHS challenged eight wards are currently at different stages of tual model was created to help explain eHealth to go paperless by 2018. Retrieved from https:// maturity. For the first time, nurse managers engagement and enrollment processes. www.gov.uk/government/news/jeremy-hunt- have real-time systems that they can use to challenges-nhs-to-go-paperless-by-2018--2 manage quality and safety, for example through Discussion: Patients and the public need to be better informed about technology, including Snowden, A., and Kolb, H. (2016). Two years the active monitoring of clinical risks. This said, its risks and benefits, and funding models need of unintended consequences: introducing an the systems do not replace the need for clinical to be in place to ensure equity of access to electronic health record system in a hospice in judgement, or for effective communication at eHealth. More investment is needed in technical Scotland. Journal of Clinical Nursing. http:// handover and throughout a shift. Evidence about infrastructure and digital up-skilling. Clinical doi.org/10.1111/jocn.13576 changes in the quality and safety of services is mixed. endorsement and using co-design to create Gephart, S., Carrington, J. M., and Finley, B. more personalised electronic solutions are also Conclusions: Real-time systems are driving a (2015). A Systematic Review of Nurses Experi- required to improve patient and public engage- shift from reactive to proactive management of ences With Unintended Consequences When ment with digital health initiatives in the real patients’ risks. It is too early to judge whether Using the Electronic Health Record. Nursing world. Administration Quarterly, 39(4), 345 - 356. the systems will support sustained improve- Conclusion: Engaging patients and the public http://doi.org/10.1097/NAQ.000000000 ments in the quality and safety of care. in eHealth is complex and more research is needed to explore how to improve their partici- Biography Biography pation in digital health, which will enhance its Austyn is professor of mental health at Emma Ferguson is a full time Research Assistant implementation. Edinburgh Napier University. Hildegard is staff on the NIHR funded ‘Information Systems: Managing and Monitoring from Ward to Board’ nurse at Ayrshire hospice. They have worked Recommended reading list together on other projects, including Hildegard’s project. With background experience in both Mair, F.S., May, C., O’Donnell, C., Finch, T., exploration of factors of noisy breathing in end Social Research and Mental Health Research. Sullivan, F. and Murray, E., 2012. Factors of life care. that promote or inhibit the implementation of e-health systems: an explanatory systematic review. Bulletin of the World Health Organiza- Session no: 1.5.3 Abstract number: 36 tion, 90(5), pp.357-364. Session no: 1.5.2 Abstract number: 196 Time: 12:30pm May, C. and Finch, T., 2009. Implementing, Time: 12pm embedding, and integrating practices: an outline Engaging patients and the of normalization process theory. Sociology, Will real-time IT systems public in eHealth 43(3), pp.535-554. O’Connor, S., Hanlon, P., O’Donnell, C.A., transform quality and safety? Miss Siobhan O’Connor B.Sc., CIMA CBA, Garcia, S., Glanville, J., and Mair, F.S., 2016. Ms Emma Ferguson , University of Leeds, B.Sc., RN, Edinburgh Napier University, Understanding factors affecting patient and Leeds, UK Edinburgh, UK public engagement and recruitment to digital Co-author(s): Justin Keen, UK; Rebecca Co-author(s): Catherine A O’Donnell, UK; health: a systematic review of qualitative studies. Randell, UK; Andrew Long, UK; Jackie Frances S Mair, UK BMC Medical Inform Whittle, UK; Elizabeth McGinnis, UK; Sean Willis, UK Abstract Biography Background: Many technologies such as tel- Siobhan O’Connor is a Lecturer in Nursing at Abstract ehealth, mobile apps and online services are the School of Health and Social Care, Edinburgh Background: Acute hospital nursing staff are available to patients and the public to manage Napier University, UK She has a multidiscipli- required to record a range of nationally mandated health. However, numerous factors affect nary background with a B.Sc Nursing and B.Sc. data about quality and safety, including the people’s ability to engage with and sign up to Business Information Systems. She teaches Safety Thermometer. These data have been of these in real-life settings, which can impact the nursing and informatics at undergraduate and limited value at ward level. Many NHS Trusts are implementation of eHealth (Mair et al, 2012). postgraduate levels and is a Fellow of the Higher introducing real-time IT systems, that ward staff Aims: To explore the barriers and facilitators Education Academy. Her research interests use to capture data and present it immediately that patients and the public experience when focus on how technology can support patients on electronic whiteboards and mobile devices. they try to engage with and enroll in all kinds of and nurses to manage chronic conditions in digital health interventions (DHIs). the home and community settings. Siobhan is

12 11.30am-12.55pm Concurrent session 1 – Wednesday 51 April 2017 currently completing her doctorate at the Uni- emphasised competencies between patient applicable ‘’IPA specific’ quality criteria assess- versity of Glasgow, exploring patient and public and nurse narratives endorses simulation as a ment tool to evaluate IPA research. While there engagement and enrolment in digital health. catalyst in enhancing personal and professional are numerous qualitative evaluation tools, IPA She is a member of the Royal College of Nurses awareness and behavior amongst students. should be judged on its own terms and not (RCN) eHealth Forum, the British Computer The fact that students could exhibit different through a template for quantitative research or Society, the American Nursing Informatics narrative identities in their writing suggests even other qualitative research 2,3. This paper Association (ANIA) and the European Federa- that simulation is useful in preparing them for discusses the methods used to initially develop tion for Nursing Informatics. You can follow her real life complexities in the clinical environment and evaluate an IPA assessment tool to distin- on Twitter: @shivoconnor and potentially encouraging the development guish quality of review papers in a systematic of narrative competence (Corbally and Grant review of IPA research in cancer and cancer 2015). related end of life research and which may be of wider use by clinicians and researchers. Recommended reading list Aims: The aim of this paper is to describe the Theme: Research methodology An Bord Atranais (2005) Requirements and development and preliminary evaluation of an Standards for Nurse Registration Education IPA quality assessment tool Session no: 1.6.1 Abstract number: 67 Programmes. 3rd Edition, An Bord Altranais, Methods: In three phases from 2016 to 2017 we Dublin. Time: 11:30am systematically developed and tested a 14-item Riessman, C.K. (2008). Narrative Methods for IPA assessment tool. Phase 1 was to develop the An exploration of nursing the Human Sciences. CA, USA: Sage Publica- tool based on a literature review and consultations tion between IPA researchers, health profes- competence through the use sionals and experts in systematic review. Phase Corbally, M., Grant, A., (2015) Narrative Com- of written narratives 2 consisted of establishing face validity through petence: A Neglected Area in Undergraduate feedback from a sample of five researchers by Dr Melissa Corbally DProf (Health and Social Curricula. Nurse Education in practice. (doi: means of ten randomly selected IPA articles. Care), Dublin City University, Glasnevin, 10.1016/j.nedt.2015.09.004) Dublin, Ireland Phase 3 was inter-rater reliability testing and feedback with 20 health professionals and Co-author(s): Anne Kirwan, Ireland Biography researchers by means of one IPA article. The Melissa is a lecturer in the School of Nursing and inter-rater agreement was acceptable, but disa- Abstract Human Sciences in Dublin City University. Her greement was seen for some items. Amendments Background: In Ireland, competence in current teaching interests in nurse education were made accordingly. include patient assessment, narrative compe- nursing is most frequently measured through Results: The new assessment tool was based on tence, recognition of deteriorating patients and verbal accounts and observation of clinical IPA principles. The systematic reviewers found clinical judgement and decision-making. Her practice (An Bord Altranais) 2005). To date, the assessment tool simple to use and helpful in research interests include domestic violence/ few studies have explored whether the domains assessing the quality of the articles. of nursing competence are present in students’ abuse, narrative methods and nursing assess- written accounts of practice. ment. She completed her DProf (Health and Conclusion: We have developed an assessment tool for consistent appraisal of IPA research and Aim: This study examined nursing competence Social Care) in 2011 with the University of Salford, England. Her thesis was entitled hope it will be used and developed by clinicians as articulated by the narratives of 72 fourth year and researchers students following two sequential simulated Making Sense of the Unbelievable: A Biographi- practice exercises in which they had to perform cal Narrative Study of Men’s stories of Female Recommended reading list as both a nurse in one exercise and as a patient Abuse. The key relationship between her in another. doctoral research and the study she is present- Smith, JA, Flowers, P, Larkin, M (2009) Inter- ing today relate to the importance of attending pretative phenomenological analysis: Theory, Method: Narrative accounts were analysed to the told story. Method, Research. London: Sage sequentially: firstly, using content analysis for the presence of the five domains of nursing practice, Yardley, L. (2000). Dilemmas in qualitative namely; (1) Professional and Ethical Practice, health research. Psychology and Health, 15, 215 (2) Holistic Approaches to Care/ Integration of - 228. Knowledge, (3) Interpersonal Relationships and Session no: 1.6.2 Abstract number: 176 Smith, J.A. (1995). Semi: structured interview- Communication, (4) Organisation and Manage- Time: 12pm ing and qualitative analysis, In J.A. Smith, R, ment of Care and (5) Personal and Professional Harre and L.van Langenhore (eds), Rethinking Development (Nursing and Midwifery Board of Reviewing IPA studies: the Methods in Psychology. (pp. 9 - 26). London: Ireland 2005). Secondly, an analysis of identity Sage. performance within both patient and nurse nar- development and evaluation ratives using Riessman’s analytic framework of a new tool Biography (Riessman 2008) was undertaken. Dr Sherrrill Snelgrove RGN MPhil PhD, CHHS, Sherrill Snelgrove is a senior lecturer in the Results: Preliminary analysis identified the Swansea University, Swansea, UK College of Health and Human Sciences Swansea presence of all domains of nursing practice Co-author(s): Ann Marie Nelson, UK; University. She teaches undergraduate and within the ‘nurse’ narrative. In the ‘patient’ Stephanie Suvell, UK; Mala Mann UK; Bridie post graduate nursing students in addition to narrative, domains 1 and 5 appeared particu- Evans UK teaching and supervising a range of health pro- larly evident. A clear contrast between nurse and fessionals from undergraduate to PhD level. She patient identity was evident in most narratives, Abstract has published on IPA and chronic pain, nurse with reportative styles predominating in the education and has a keen interest in ethics and Background: Interpretative Phenomeno- ‘nurse’ narratives and observational reflections rigour of research, long term and chronic condi- logical Analysis (IPA ) is a qualitative phenom- predominant in the ‘patient’ narrative accounts. tions and medications management. enological research method embedded in psy- Discussion: This study suggests that written chology but used increasingly across countries narrative can potentially reflect competent and disciplines 1. Despite heightened usage, practical nursing activity. The contrast between we propose there is no formally validated and

13 111.30am-12.55pm Concurrent session 1 – Wednesday 5 April 2017 Session no: 1.6.3 Abstract number: 198 Phillips, J., Ogden, J. and Copland, C. (2015). Aims: To test the feasibility of a specialist Using drawings of pain-related images to under- nurse-led intervention to improve care co-ordi- Time: 12:30pm stand the experience of chronic pain: A quali- nation, anticipatory care planning and quality of tative study. British Journal of Occupational life for patients and carers living with advanced Drawing as a research tool: Therapy, 78(7): 404-411. liver disease. what does it add? Broadbent, E., Niederhoffer, K. Hague, T. Methods: Mixed methods feasibility study. Dr Maria Horne PhD, MA(Health Research), Corter, A. and Reynolds, L. (2009). Headache Patients/carers were recruited following one BA(Hons), University of Leeds, Leeds, UK sufferers’ drawings reflect distress, disability or more unplanned hospital admission due Co-author(s): Samantha Masley, England, UK; and illness perceptions. Journal of Psychoso- to cirrhosis. As case managers, the Support- Janet Allison-Love, England, UK, matic Research, 66: 465-470. ive Liver Nurses, coordinated care between patients/carers and primary and secondary care during the six month intervention. The inter- Abstract Biography vention included providing information and Dr Maria Horne (PhD, MA, BA (Hons), SCPHN Background and topic: Representing an advice about their illness, psychological support (HV), SCM, RGN) is an Associate Professor at epistemological shift within qualitative meth- and assisting with social care issues. Patients/ the School of Healthcare, University of Leeds. odology (Boydell, 2012) healthcare research carers received an initial face-to-face care review Dr Maria Horne attained her PhD at the Univer- has increasingly employed visual methods as a meeting where their thoughts, feelings and sity of Manchester in 2007. Dr Maria Horne’s means to further understand the patient’s expe- understanding of their illness were explored and research falls under two main themes: [1] Chil- rience of health and healthcare (Broadbent, symptom management addressed. We discussed dren’s and older adults’ health and well-being 2009; Phillips et al, 2015). An advantage of planning ahead in the event of any deterioration - with an emphasis on reducing sedentary time, using drawing, rather than any other form visual in their health as well as what was important increasing physical activity levels, promoting method, is its potential to offer a way of com- to them. Monthly follow-up phone calls offered active ageing, psychosocial issues that can affect municating other than speech. We discuss the ongoing support and patients/carers were given the lives of older adults, ethnicity and culture, use of drawing, in an exploratory, qualitative a phone number for direct contact. Liaison with cultural adaptation of interventions [2] Service study, to enrich the narrative account during GPs and allied professionals addressed issues delivery and organisation: with an emphasis on data collection using semi-structured interviews regarding medications, community palliative specialist public health practice, rehabilitation with a purposive sample of palliative healthcare referral, appropriate hospital admissions and delivery of service interventions in primary/ care professionals (n=16) from one hospice in and anticipatory care planning. West Yorkshire, England (February-May 2016). community/secondary care settings. She Results: 47 patients participated. Patient/ This study aimed to utilise drawing as a tool to lectures in primary care, public health, health carer questionnaires and interviews showed that explore the process of drawing to help facilitate promotion and has an interest in health inequali- planning, coordination of care and quality of life the exploration, communication and our under- ties and minority ethnic groups. Dr Maria Horne had improved. Completion of electronic antici- standing of how healthcare staff emotionally is a Fellow of the European Academy of Nursing patory care plans significantly increased. The resource their roles within a Hospice setting. Science and the Higher Education Academy. dimensions and potential of the role of the spe- As such, we were not concerned with an end cialist nurse in advanced liver disease was iden- product, such as a representational image, that tified from the perspective of patients/carers would lend itself to measurement and quantifi- and professional stakeholders. cation, but the process of facilitation. Conclusion: The specialist nurse-led inter- Aims: To outline and debate the use of drawing, Theme: Mixed methods/patient vention was found to be acceptable to patients/ as a visual imagery method, within the research carers and healthcare professionals, feasible and process and (ii) provide a critical reflection of the experience to enhance care. The study also contributes to use of drawing in the research process. Session no: 1.7.1 Abstract number: 275 literature regarding specialist nursing roles in Methodological discussion: Discussion will liver disease and palliative care. focus on the (i) the practicalities of undertaking Time: 11:30am drawing during data collection using semi-struc- Biography tured interviews i.e. participant preparation, A nurse-led intervention informed consent and dynamics (ii) participants providing supportive care for Having worked in the third sector after gaining perspectives in undertaking drawing during people living with advanced a degree in Social Sciences and Health (Health data collection using semi-structured interviews liver disease: feasibility study Psychology), I qualified as a Staff Nurse in 2003. i.e. concern with the production of a ‘good’ Since then, I have mainly worked in the Centre Mrs Andrea Baird BSc Social Sciences and picture (iii) the practicalities of undertaking for Liver and Digestive Disorders in the Univer- Health (Health Psychology), DIp HE Adult data analysis. The presentation will then debate sity Hospitals Division of NHS Lothian. I have Nursing (Shortened Course), NHS Lothian what this visual imagery method adds to: (i) data had several roles during this time, including Royal Infirmary of Edinburgh, Edinburgh, UK collection (ii) the the narrative account and (iii) Sepsis Lead Nurse at local level and Liver Trans- data analysis. Co-author(s): Prof. Scott A Murray, Dr plant Research Nurse as well as taking the Barbara Kimbell, Dr Marilyn Kendall, Prof. exciting secondment opportunity to become a Conclusion: This paper will outline the use of Christopher Weir, Prof. Ronan O’Carroll, Dr Supportive Care Liver Nurse Specialist. (Andrea drawing as a data collection tool alongside semi- Kirsty Boyd, Prof. Peter Hayes, Dr Alastair Baird) structured interviews to enrich the narrative MacGilchrist, Ms Patricia Brooks Young, Dr account. I qualified as a Staff Nurse in 2000 and have Anne Finucane, all Scotland worked in the Royal Infirmary of Edinburgh’s Gastro-intestinal/Liver Unit in various capaci- Recommended reading list Abstract ties since then. After I became Charge Nurse, I Boydell, K.M., Gladstone, B.M., Volpe, T., Background: Liver Disease is the third largest was seconded as a GI Nurse Specialist during the Allemang, B. and Stasiulis, E. (2012). The pro- cause of death in the UK but supportive and winter of 2014, assessing patients as they arrived duction and dissemination of knowledge: A palliative care needs in this group are poorly in AandE or Primary assessment. I very much scoping review of arts-based health research. addressed. enjoyed my time as Supportive Care Liver Nurse Forum: Qualitative Social Research, 13(1): Art. Specialist and I am currently working in the GI/ 32. Liver unit as Senior Charge Nurse. (Heidi Byrne)

14 11.30am-12.55pm Concurrent session 1 – Wednesday 51 April 2017 Session no: 1.7.2 Abstract number: 163 De Gucht V, Dusseldorp E, Janssen V et al (2013) Session no: 1.7.3 Abstract number: 162 ‘Lifestyle modification programmes for patients Time: 12pm with coronary heart disease: a systematic review Time: 12:30pm and meta-analysis of randomized controlled Lifestyle self-management trials.European Journal of Preventive Cardiol- Improving care and support experience of South Asians ogy, vol 4: pp 620â in advanced COPD - six after a heart attack Scarborough, P., Bhatnagar P., Kaur A., Smolina recommendations of the Ms Dilla Davis MSc, School of Nursing, K., Wickramasinghe K., Rayner M. (2010) population-based Living with Midwifery, Social Work and Social Sciences, Ethnic differences in cardiovascular disease; breathlessness study British Heart Foundation Health Promotion Mary Seacole Building, University of Salford, Dr Morag Farquhar RGN BSc (Hons) MSc Research Group. Salford, Manchester, UK PhD, University of East Anglia (UEA), Norwich, UK Abstract Biography Co-author(s): Gail Ewing, UK; Patrick White, Qualified in 1997 as RGN, Dilla Davis joined Background: Coronary heart disease is the UK; Peter Burge, UK; Ravi Mahadeva, UK; Central Manchester University Hospitals as biggest killer in the country (Townsend et Carole Gardener, UK; Caroline Moore, staff nurse in 2001. Since then she has under- al 2012). South Asians carry the burden of UK; Sophie Howson, UK; Sara Booth, UK; taken roles of Practice Education Facilitator and increased incidence and prevalence and have Catherine Saunders, UK; Tom Ling, UK poorer outcomes after a MI than the general UK Education Practitioner in the same Trust. For 3 years she held the post of honorary clinical population (Scarborough et al 2010). Reviews Abstract have shown lifestyle modification including teaching fellow at University of Manchester. At physical activity, healthy diet and smoking present she is completing her PhD at University Background: Chronic obstructive pulmonary cessation, alters the course of heart disease and of Salford, through the graduate teaching stu- disease (COPD) is a chronic progressive reduces recurrences crystallising its signifi- dentship. Her current project include a South condition with high symptom- and carer-bur- cance as a cost-effective public health strategy Asians experience of lifestyle changes after den. National guidance calls for quality end of to reduce the rising burden of this disease heart attack. She has published a protocol for life care for patients with any condition, yet we (De Gucht et al 2013). There is a lacunae of systematic review of the barriers and facilita- rely in non-malignant disease on frameworks knowledge as to what constitutes to guarantee tors of self-management among South Asians. developed for cancer with its largely predictable a therapeutic lifestyle modification for better Her paper ‘undertaking a systematic review’ is trajectory. health outcomes in the South Asian community. due for publishing in Nursing standard. In 2015, Aim: To inform a new framework to improve she won people’s choice award for 3 minutes Aim: One way to conceptualise the necessary care and support in advanced COPD. thesis competition at Salford Postgraduate knowledge and their reflective application for Methods: The Living with Breathlessness Annual Research Conference (SPARC) as well effective lifestyle change was to explore self- Study was a multiple-component, population- as an award for best session in Pecha Kucha management experience of South Asians after a based, mixed-method longitudinal, multi- presentation in the consecutive SPARC 2016. heart attack. ple-perspective programme to identify new She has also presented a poster of her findings evidence on health and social care needs and Method: Pioneering of its kind, this study used at British Sociological Association, Postgraduate preferences of patients with advanced COPD a grounded theory approach to elucidate how Conference at London School of Economics and and their carers. Data collection was staggered South Asians navigate these lifestyle changes. Political Science. She is member of European over a 3-year period: January 2013-January Two phase interviews at 2 weeks and 8 weeks of Society of Cardiology, International Network 2016. The programme followed more than 500 discharge, were conducted with 14 participants for Health Workforce Education and Council on patients and carers for up to 18-months through who were newly diagnosed with heart attack- Cardiovascular Nursing and Allied Professions. interview and survey methods. Qualitative data from 2015 till July 2016. Dilla’s interest includes higher education and on barriers and facilitators to meeting needs qualitative research. Results: Theoretical categories were developed were collected from clinicians. Programme-wide through constant comparison and theoreti- evidence was synthesised to identify recommen- cal sampling - patronage of the family, affinity dations. Stakeholder views were then collected towards the group and conforming to the through a workshop and online survey. religious and health beliefs. Results: Six inter-related recommendations Discussion: A harmony model to deal with emerged, linked by the concept of proactive diagnosis of heart attack and subsequent person-centred care, supported by action points lifestyle changes is proposed. The model homes to enable delivery. Recommendations in brief: in a family centred approach, with an appre- (1) stop focusing on the challenge of prognosti- ciation of the cardiac patient’s religious beliefs cation as a barrier to meeting need, (2) change and cultural priorities, in self-management pro- targets to incentivise person-centred care, (3) grammes. enable identification of patient support needs, Conclusion: Migrant South Asians across the (4) identify and support carers, (5) identify and globe have increased propensity of this disease. respond to psychological morbidity, (6) change To alleviate the burden, there is a need for ethno societal understandings of COPD, breathless- sensitivity rather than an ethnocentricity in the ness, palliative care and informal carers. The delivery of services. This calls for a move from recommendations garnered significant support cultural competence to cultural intelligence. from stakeholders, with caution regarding ease of implementation. Recommended reading list Discussion: The resulting stakeholder- Townsend N, Wickramasinghe K, Bhatnagar P, endorsed recommendations and action points Smolina K, Nichols M, Leal J, Luengo-Fernan- function at a variety of levels: person, system and dez R, Rayner M. (2012) Coronary heart disease societal. They are likely to have resonance for statistics, edition 2012; British Heart Founda- those living with other advanced non-malignant tion: London.

15 111.30am-12.55pm Concurrent session 1 – Wednesday 5 April 2017 long term conditions, and clinicians striving to support them. Conclusion: These six recommendations could inform a new framework for care and support in advanced COPD.

Biography Morag has worked in health services research for over 25 years, predominantly in palliative and supportive care. She has worked for health authorities in London, and within the universities of London, Manchester, Cambridge and East Anglia (UEA). A graduate nurse by background (King’s College London), she holds a Masters in Medical Sociology and PhD (University of London) on the definition and measurement of quality of life in older people. Research interests include breathlessness in advanced disease, palliative care, informal carers, older people, and methodology: particularly the development and testing of interventions and mixed methods. She is a Senior Lecturer at UEA and previously led a research programme on breathlessness in advanced disease at University of Cambridge, including the Living with Breathlessness Study. The Living with Breathlessness Study was a collaboration between Cambridge, King’s College London and RAND Europe on patient and carer need and care preferences in advanced COPD. Morag was lead researcher on the RCT of the Cambridge Breathlessness Intervention Service, developed following the MRC framework for complex interventions in collaboration with Dr Sara Booth (Addenbrooke’s Hospital) and colleagues. She has published with colleagues in Canada and Australia in the field of breathlessness in advanced disease.

16 1.55-3.20pm Concurrent session 2 – Wednesday 52 April 2017 Concurrent session 2 Wednesday 5 April 2017 1.55-3.20pm

Rolfe, G. (2006) ‘Validity, trustworthiness nations for how Rounds work (C-M-O configura- Theme: Qualitative approaches/ and rigour: quality and the idea of qualitative tions) tested in subsequent interviews and focus ethics research’. [Online]. [Accessed 11/01/2015]. groups with expert stakeholders. http://garyrolfe.net/documents/validitytrust- Session no: 2.1.1 Abstract number: 24 Results: Rounds were conceptualised as a worthiness.pdf 4-stage, chronological process, (sourcing stories Time: 1:55pm Harrison, J. and Morton, M. (2001) ‘Regimes and panellists; crafting stories; telling stories in of Trustworthiness in Qualitative Research: The Rounds and post round after effects) each stage Trustworthiness: a Rigors of Reciprocity’. Qualitative Inquiry, 7(3) has a cumulative effect identified in our cross- hermeneutic qualitative pp.323-345. cutting themes (e.g. safety and trust; contextu- research journey alising patients and staff and time and space for Biography ‘stepping off the treadmill’). Mrs Gayatri Nambiar-Greenwood PhD student, MA, Bsc, RGN, Dept. of Nursing, I am a full time nurse academic and part-time Discussion: We draw on theory to suggest Faculty of Health, Psychology and Social Care, final year PhD student within the Department of Rounds provide a ‘counter-cultural’ space Stockport, UK Nursing at Manchester Metropolitan University. outside normal routines allowing staff to connect My main areas of interest of Cultural care for all with their own and others humanity and think through their practice together. Abstract communities, the influence o politics and media on perceptions of the cultural ‘Other’ and ser- Conclusions: Schwartz Rounds are a unique Establishing the trustworthiness of a qualitative vice-user perspectives in increasing satisfaction. organisational intervention which offer health- research study must include a number of strat- care staff a Third space, where profession- egies made explicit during its whole journey. als can ‘hang the confusion and chaos’ of the Trustworthiness, according to Sandelowski workplace (..) while they think through their (1993) is a matter of ‘persuasion whereby practice’ (Britzman 2003). Outcomes include the scientist is viewed as having made those Session no: 2.1.2 Abstract number: 276 increased empathy for colleagues and patients practices visible and, therefore, auditable’ (p.2). Time: 2:25pm and improved teamwork and communication. This broad concept includes ensuring rigour (Rolfe, 2006), credibility (Shenton, 2004) and transferability (Harrison and Morton, 2001). A realist evaluation of Recommended reading list Schwartz Rounds: a complex For a researcher with a sustained interest in Britzman, D. 2003. Practice makes practice: A the subject of cultural care theories, the way intervention to support critical study of learning to teach, New York: it is delivered and service-user satisfaction, healthcare staff deliver State University of New York Press embarking on an interpretive study regarding compassionate care Karin Ikas, Gerhard Wagner (Eds) (2009) Com- municating in the Third space. Routledge. service user perspectives required the conscious, Professor Jill Maben PhD, Msc, BA (Hons), RN, reflexive engagement of a number of strategies to Florence Nightingale Faculty of Nursing and ensure the quality and transparency of the study. Midwifery, King’s College, London, UK Biography This reflexive approach would also contribute Professor Jill Maben towards ensuring an ethical and genuine use of Co-author(s): Mary Leamy, England; Ellie the service-user’s voice and for the reduction of Reynolds, England, Cath Taylor England; Jill Maben is a nurse and social scientist and bias. Imelda McCarthy, England; Caroline Professor of Nursing Research, King’s College Shuldham, England London. Jill’s expertise lies in research in the This paper considers the multilevel strategies healthcare and nursing workforce, particularly that was employed within a doctorate level Abstract the quality of the work environment and nurses’ research study, in relation to maintaining trust- working lives and the effects of these on patient Background: Healthcare staff experience worthiness. Entitled ‘Culturally Appropriate and staff outcomes and on nurses and patient emotional, social and ethical challenges in their Care: A qualitative exploration of service-users’ experiences. Jill’s interests lie in supporting staff work, yet have few places to makes sense of perspective of nursing care’, this study was influ- to care well and her doctoral work examined the these. Implemented in over 150 organisations enced by Gadamerian Philosophical Hermeneu- extent to which nurses could implement their in the UK since 2009 Schwartz Center Rounds tics, especially in relation to the cyclical, herme- ideals and values in practice. She is currently (‘Rounds’) are a multidisciplinary forum in neutic process of understanding. Now, in the evaluating Schwartz Centre Rounds in the UK: which healthcare staff discuss the impact of their final stages of this study, the paper will explore ‘A Longitudinal National Evaluation of Schwartz work and its challenges in a confidential and safe the breadth of employing those strategies that Centre RoundsÂ®: an intervention to enhance environment. contributed towards the trustworthiness of this compassion in relationships between staff and qualitative research study. Aims: to identify causal explanations of how patients through providing support for staff and Schwartz rounds ‘work’, for whom and in what promoting their wellbeing’. Recommended reading list circumstances. Jill was in the Health Services Journal ‘Top Gadamer, H.-G. (2013) Truth and Method. [2nd Methods: Realist evaluation in 9 organiza- 100 leaders’ in 2013 and was also included on ed]. Weinsheimer, J. and Marshall, D.G. (Trans- tions; including Rounds observations (n=46) Health Service Journal’s inaugural list of Most lators). New York: Continuum. (Original work and interviews: Facilitators, Panellists, Audience Inspirational Women in Healthcare 2013. Jill published 1960). (n=178). Data were collected 2015-16 and were was awarded an OBE in June 2014 for services analysed concurrently to identify causal expla- to nursing and healthcare.

17 111.30am-12.55pm Concurrent session 1 – Wednesday 5 April 2017 Session no: 2.1.3 Abstract number: 102 RUSHTON, C. H. 2006. Defining and Address- Sexual Function Index (FSFI), and questions ing Moral Distress. American Association of relating to urinary and faecal incontinence. Time: 2:55pm Critical Care Nursing (AACN) Advanced Critical Descriptive statistics, chi square and Kruskal- Care, 17, 161-168. Wallis tests were used to analyse the data. What is moral distress in Results: Responses indicated that following nursing and how should we Biography anterior lumbar spinal surgery approximately respond to it? Georgina Morley was awarded a Florence Night- 1:5 women were dissatisfied or very dissatis- Miss Georgina Morley MSc, RN, BA, Institute ingale Foundation Travel Scholarship in 2014 fied with their sexual functioning. Reported of Applied Health Research, The University of to undertake travel to the United States to meet complications included a reduction in sensation Birmingham, Birmingham, UK leading nurse ethicists and learn about how they during sexual intercourse, increased difficulty in are working to reduce moral distress in nursing. achieving orgasm, reduced ability to orgasm and reduced orgasm intensity. Abstract In 2015, she was awarded a Wellcome Trust Background: Moral distress (MD) was first Society and Ethics Fellowship to continue her Conclusion: Sexual function in women is introduced to the context of nursing by Jameton study of moral distress and is currently carrying not adequately assessed or reported following (1984) and has become an increasing focus out her doctoral studies at the University of Bir- anterior spinal surgery. This may in part be of research. Most of this research has been mingham in Biomedical Ethics. She is carrying attributable to the lack of general discussion conducted in North America, and it has drawn out an empirical ethics project in which she regarding sexual activity during post-operative attention to the deleterious effects of MD, explores moral distress both empirically and consultations and the use of standardised spinal cementing its significance as a problem within conceptually; combining findings from the lit- outcome measures which do not specifically nursing (Rushton, 2006, Ulrich et al., 2010). erature and empirical data from the lived expe- assess changes in sexual function. Further work Research on MD amongst nurses in the United riences of critical care nurses to propose a new is required to prospectively analyse the change Kingdom (UK) however remains extremely definition of moral distress that is sensitive to in sexual function following spinal surgery and limited. This presentation reports on a study the UK context. Georgina continues to work should be considered a priority within spinal from the UK that addresses that gap. clinically in Cardiac Critical Care at Barts Heart services. Centre, Barts Health NHS Trust in London. Aims: The first aim of this study is to develop Recommended reading list a coherent account of MD in UK nursing and to provide evidence for nursing practice. Albright TH, Grabel Z, DePasse JM, Palumbo MA. and Daniels AH. (2015) Sexual and repro- Methods: The study comprises 1) literature ductive function in spinal cord injury and spinal review 2) qualitative interviews and 3) theo- surgery patients. Orthopedic reviews, 7(3). retical normative analysis. I will provide pre- Theme: Quantitative method and liminary findings from 1 and 2 which will inform Salonia A, Munarriz RM, Naspro R, Nappi RE, later normative analysis regarding how we ought systematic reviews Briganti A, Chionna R, Federghini F, Mirone V, to respond to MD. Interviews with critical care Session no: 2.2.1 Abstract number: 143 Rigatti P, Goldstein I. and Montorsi F. (2004) nurses (n=14) were conducted over four months Women’s sexual dysfunction: a pathophysiologi- (August 2016- November 2016) and analysed Time: 1:55pm cal review. BJU international, 93(8), pp.1156- using Van Manen’s six activities for interpretive 1164. phenomenology. Sexual function in women Hägg O, Fritzell P, Nordwall A. and Swedish Results: The study provides important insights following anterior spinal Lumbar Spine Study Group (2006) Sexual into the issue of MD in nursing. The litera- surgery function in men and women after anterior ture review identified large numbers of papers Dr Jennie Walker PhD, RN, PGCert MedEd, surgery for chronic low back pain. European (n=151) attempting to define and/or measure Nottingham University Hospitals NHS Trust, Spine Journal, 15(5), pp.677-682. MD, but the heterogeneity of the definitions Nottingham, UK identified suggest that prior to determining Biography prevalence or proposing solutions, we need con- Abstract Jennie graduated from the University of Not- ceptual clarity on precisely what MD is. Only Background: Sexual and reproductive health tingham in 1998 as a registered nurse and has then can MD be measured or attempts made is an important aspect of quality of life. Sexual since enjoyed working and teaching in different to reduce MD. Preliminary data and analysis dysfunction following anterior lumbar spinal areas of the musculoskeletal speciality. Jennie suggest that narratives around ethical uncer- surgery has predominantly focused on male currently works as a clinical educator teaching tainty, constraint and implementation, are asso- function with retrograde ejaculation following medical undergraduates as well as working ciated with the psychological factors associated damage to the hypogastric nervous plexus (Hägg to improve clinical standards and profes- with MD. et al 2006), however, no equivalent outcome has sional development at Nottingham Univer- Conclusions: The working hypothesis, at this been reported for women. While sexual dysfunc- sity Hospitals NHS Trust. Jennie has research stage of the study, is that current understand- tion in women can be a multifactorial condition interests in musculoskeletal and neuroscience ings of MD are too limited. Jameton’s original with anatomical, physiological, medical, psy- specialities as well wound infection and infection and subsequent definitions must be broadened chological and social components (Salonia et control. Jennie graduated from the University of in order to meaningfully capture UK nurses’ al 2004), spinal surgery may further impact on Nottingham in 2016 having completed her PhD experiences of MD. sexual and reproductive function due to post- in pin site infection. surgical factors (Albright et al 2015). Recommended reading list Methods: A postal questionnaire was sent JAMETON, A. 1984. Nursing Practice: The to 188 women aged >18 years of age who had Ethical Issues, Englewood Cliffs, NJ: Prentice undergone anterior lumbar spine surgery at Not- Hall. tingham University Hospitals NHS Trust. Ques- ULRICH, C., HAMRIC, A. and GRADY, C. 2010. tionnaires were followed up via telephone after Moral Distress: A Growing Problem in the two weeks if no response had been received. The Health Professions? Hastings Center Report. questionnaire included the Patient Scar Assess- New York, USA: The Hastings Center. ment Questionnaire (PSAQ), a modified Female

18 11.30am-12.55pm Concurrent session 1 – Wednesday 51 April 2017 Session no: 2.2.2 Abstract number: 256 tal factors may improve accuracy of predictive The qualitative data received from clinicians models. with experience of supporting these patients Time: 2:25pm prompted adjustments to the original taxonomy. Recommended reading list Can genetic and epigenetic Results: The taxonomy sub-divided the main Confidential Enquiry into Maternal and Child heterogeneous group into 5 main groups: markers identify women at Health 2007 ‘Saving mother’s lives, Reviewing Elderly and Frail; Mental Health; Substance risk of postnatal depression? maternal deaths to make motherhood safer, Misuse; Chronic Conditions; and Homeless and A systematic review 2003-2005.’ RCOG Press, London Vulnerably Housed. Within each sub-group, unmet needs were identified and further cat- Ms Judith Elwood BSc(Hons) Midwifery Mothers and Babies: Reducing Risk through egorised. This created an inclusive, individual Science, BSc (Hons) Occupational Therapy, Audits and Confidential Enquiries across the care pathway for frequent users of healthcare MSc, Ulster University, Institute of Nursing UK 2014 ‘Saving lives, Imroving Mothers’ Care’ services. and Health Research, Newtownabbey, Belfast, National Perinatal Epidemiology Unit UK Discussion: Through focusing on the unmet Co-author(s): Prof M. Sinclair (N.Ireland), Dr Biography needs that these individuals have, instead of their demographics or self-reported present- J Stockdale (N. Ireland), Dr AF Bell (US), Dr E Judith Elwood is a doctoral student at Ulster ing symptoms, clinical staff can refer and Murray (N.Ireland) University. She graduated from Queen’s Univer- signpost patients into designated services. This sity Belfast with BSc (Hons) Midwifery Science will enable clinicians to support frequent users Abstract in 2014. Her research interests include methods instead of crisis managing their episodic presen- of improving maternal mental illness including Background: Poor maternal mental health has tations. been consistently identified as a major causal the use of eigenetics and genetics and the effect Conclusions: This taxonomy will create factor in morbidities in the perinatal period of the birth experience. clinical effectiveness for each contact and sus- (CEMACH 2007, MBRACE 2014). Postnatal tainability within services, thus benefitting the depression can affect the wellbeing of the patient and their outcome. mother, baby and entire family unit. Worldwide, WHO estimate that 10-15% of women in indus- Session no: 2.2.3 Abstract number: 248 trialised countries and 20-40% of women in Biography developing countries experience depression Time: 2:55pm Nicola is a PhD student at Leeds Beckett Uni- during pregnancy or postnatally. Early diagnosis versity. She is a registered adult nurse and and intervention are very beneficial to both Taxonomy of frequent users has worked in various urgent and emergency mother and baby. to urgent and emergency healthcare settings. In 2014 she completed her Aim: This research investigates the use of bio- healthcare. MSc in Specialist Community Public Health markers in identifying women with a heightened Nursing and was subsequently awarded a Health Mrs Nicola Worrillow MSc Specialist Education England PhD Studentship. risk for PND. Community Public Health Nursing, Leeds Method: A systematic search of five databases Beckett University, Leeds, UK (Medline, Embase, PILOT, Psychinfo and Co-author(s): Michelle Briggs, Uk; Jane South, Scopus) was carried out using the following Uk Mesh terms and keywords: postpartum, depression, postnatal depression, genetics, genetic pol- Abstract Theme: Mixed/patient experience ymorphisms and epigenetics. Inclusion criteria were applied and quality of studies was assessed Background: There is a lack of research Session no: 2.3.1 Abstract number: 40 available that examines the heterogeneous popu- using guidelines laid out in the HuGE Review Time: 1:55pm Handbook. lation of frequent users of urgent and emergency healthcare. Most research explores this popula- Results: 37 studies were identified for inclusion tion by focusing on the patient’s demograph- Talking-past-each-other: in the review. Associations have been found ics or presenting symptom, rather than their health professional and between symptoms of PND and polymorphisms unmet needs that has instigated the urgent and and epigenetic modifications that impact neuro- family perspectives on emergency contact. transmitters, the stress system and reproductive accessing post-stroke hormones. Some associations are only seen in Aim: The aim was to analyse the reasons why information frequent users select and contact the services of the presence of particular environmental factors Dr Dianne Roy RN PhD FCNA(NZ), Depart- either: Out of Hours General Practitioners; NHS such as stressful life events, season of birth or ment of Nursing, Healthcare Pathway, Unitec 111; Ambulance Services; or Emergency Depart- adverse childhood experience. Institute of Technology, Auckland, New ments. Discussion: Genetic and epigenetic markers Zealand Method: A systematic mapping exercise was that may confer susceptibility to PND were Co-author(s): Sue Gasquoine, New Zealand; undertaken to create a comprehensive under- identified. Some models based on these markers Shirin Caldwell, New Zealand; Derek Nash, standing of how these services are currently have shown moderate predictive power within New Zealand the sample cohorts. Women susceptible to PND working with regard to frequent users. The search produced 5094 articles which were appear to have heightened epigenetic sensitiv- Abstract ity to physiological changes brought about by screened against the inclusion criteria, leaving pregnancy or to environmental factors conferred 156 articles to be analysed. Data was extracted Background: The global burden of stroke is by genotype. No study, as of yet, has investigated and a thematic synthesis was used to analyse increasing. Many stroke-survivors live with sig- epigenetic, genetic and environmental factors this diverse population. From this analysis a nificant impairment; the care and support they together. taxonomy of sub-groups of frequent users was and their families require is complex. While formed and their underlying needs identified. research supports the routine provision of infor- Conclusion: This review highlights the impor- mation to stroke patients and their families, Thirty-two clinical semi-structured interviews tance of both biomarkers and environmental the best way to provide information is unclear were undertaken to gain critical feedback on factors in the onset of PND. Measuring the inter- (Forster et al., 2012). Furthermore, stroke-survi- action of epigenetic, genetic and environmen- the robustness and viability of the taxonomy.

19 21.55-3.20pm Concurrent session 2 – Wednesday 5 April 2017 vors and their families continue to report a lack board aims to improve support and outcomes where access to services and transitions in care of knowledge and difficulty in accessing it (Perry for families (Whānau) of clients following a have been identified as poor. Artwork and data and Middleton, 2011). stroke. The project is now in its seventh year can be used to inform healthcare professionals Aim: To ascertain information needs of families and third phase. Dianne lectures across the on the difficulties homeless individuals face. post-stroke through identifying current practice, Bachelor of Nursing programme, particularly resources, appropriateness, accessibility, timeli- in primary health praxis, research, and profes- Biography sional practice. Dianne supervises an enthusi- ness, and information/knowledge gaps. Stephanie Morris. Studies Adult nursing at astic group of post-graduate students across the Methods: Mixed-methods descriptive survey. Bangor University. Passionate about nursing institute, a number of whom complete studies Family members (n=19) and health profes- and improving healthcare services for the within the Stroke Family Whānau Project. sionals (n=23) were recruited using purposive homeless community. Wales representative on sampling. Data were collected via face-to-face the RCN UK student committee and RCN Wales interviews September-October 2010. Descrip- student nurse of the year finalist. tive statistics were used to analyse quantitative data; content analysis for qualitative. This Session no: 2.3.2 Abstract number: 11 analysis will be presented. Time: 2:25pm Results and Discussion: For families, infor- Session no: 2.3.3 Abstract number: 272 mation access was variable, both in quality and Establishing the views of timeliness and compounded by the nature of the Time: 2:55pm experience; the sudden onset and changed family homeless Individuals on dynamics. Most described being overwhelmed homelessness and healthcare Performances and positional initially with information they could not absorb; services through the use of spaces of siblings living in the then later ‘floundering’ as they had to find their art therapy. context of cystic fibrosis. A own way through the maze. Few could recall Miss Stephanie Morris, Bangor University, dramaturgical perspective. information that focused specifically on them as Bangor, UK family members. Health professionals described Dr Amie Hodges PhD,MSc,BSc Hons, Cardiff a range of resources and practices used to University, Cardiff, UK Abstract provide information. They identified barriers to effective provision, including language and This ethnographic, mixed-methods research Abstract other communication barriers, time constraints sought to gain the views and experiences of Background: Siblings are identified as being a and workload issues. Most neither assess health homeless individuals on homelessness and marginalized group because there is limited rec- literacy levels nor considered family needs to be healthcare services by implementing art therapy ognition of their voice within the literature when separate to or different from the stroke survi- sessions at a local homeless drop-in centre. living in the context of cystic fibrosis (CF). vor’s. Furthermore, a gap was identified between A total of 15 homeless participants attended Aim: This study explores the experiences of health professionals’ theoretical understandings one or more art therapy session over a period siblings who are living with a child with CF, to of best practice and their actual practice. of 5 months. Participants were recruited using present specific insight into their worlds. a non-probability, purposive sampling method Conclusion: Information needs specific Participants: n=10 Non-CF Siblings age 7 to 12 to stroke families are often overlooked. It is at the local homeless drop-in centre where the important to communicate effectively with participants were known to. Method: Qualitative methodological narrative inquiry was used to engage siblings within the families and acknowledge that they may have Participants were prompted to express their context of their family with the use of a bricolge needs that are different to the stroke-survivor’s feelings surrounding homelessness and health- of creative participatory methods. Narrative needs. care using the art materials provided. Obser- interviews, observations and a variety of creative vations and knowledge gained has been docu- media, including pictures, poems, songs and Recommended reading list mented in the form of diary entries, before artifacts have provided a platform for sibling’s being formulated into a descriptive narrative FORSTER, A., BROWN, L., SMITH, J., HOUSE, expression/performance. Dramaturgy was used producing 15 case studies in total. Case studies A., KNAPP, P., WRIGHT, J. J. and YOUNG, J. as the exploratory lens in which to view the were analysed and any common themes grouped 2012. Information provision for stroke patients sibling front stage, back stage and centre stage and quantified to reveal both quantitative and and their caregivers. Cochrane Database of Sys- stances (Goffman1959). (Dramaturgy represents qualitative data. Artwork was collected and tematic Reviews 11, CD001919. stage performance). Data collected between described within each narrative, outlining the PERRY, L. and MIDDLETON, S. 2011. An inves- February 2014- June 2015. subject, style and any meaning portrayed within tigation of family carers’ needs following stroke the artwork from the participant. Results: Through interactive performances survivors’ discharge from acute hospital care siblings acted out scenes of multiple presenta- Findings of the study report on experiences of in Australia. Disability and Rehabilitation, 33, tions of self in relation to their performance of homelessness, causes of homelessness and expe- 1890-1900. role, space, position and emotional wellbeing. riences of accessing healthcare services. The This revealed the contradiction between the study found participants expressed, both verbally Biography ideology and reality of their lives in the context and creatively, their negative feelings and expe- of CF. Dr Dianne Roy has a strong background in both riences of homelessness. Causes of homeless- practice and education. She is an Associate ness varied and experiences of accessing health- Discussion: Sibling’s expression of voice goes Professor in the Department of Nursing at the care services were mostly negative. beyond the spoken word and can be seen in Unitec Institute of Technology in Auckland, constructed and co-constructed performance. The findings in this study provide experiences New Zealand. Dianne has extensive clinical, They are skilful in their interactions as they of homelessness and healthcare from a hard research and teaching expertise in issues related fluctuate easily between front stage and back to reach community where there is little docu- to long-term conditions, self-management, stage stances. Despite being seen in a decen- mented evidence. The use of art therapy can be impairment and disability. She is the principal tralised position, siblings are silently central. As repeated on groups who may benefit from a ther- investigator for the multi-phase Stroke Family key members of the family team they play a role apeutic and non-invasive research design. This Whānau Project. This clinically based project in maintaining family equilibrium, but they are research identifies the need for improvement in in collaboration with the local district health containers of emotion of self and others. healthcare services for the homeless community

20 1.55-3.20pm Concurrent session 2 – Wednesday 52 April 2017 Conclusion: There is a need for greater Theme: Evidence review Recommended reading list awareness of the daily impact of CF on the Byrne, K. Orange, J. B. Ward-Griffin, C. (2011) sibling. More emphasis needs to be placed on Session no: 2.4.1 Abstract number: 54 Care transition experiences of spousal caregiv- addressing siblings needs. Time: 1:55pm ers: From a geriatric rehabilitation unit to home. Qualitative Health Research, 21, 10, pp 1371- Recommended reading list Understanding informal 1387. Goffman E (1959) The presentation of self in carers’ experiences of caring Shawler, C. (2007) Empowerment of aging everyday life. Garden City. NY, Double Day. for older people with a hip mothers and daughters in transition during a Edwards R, Hadfield L, Lucey H, and Mauthner health crisis. Qualitative Health Research, 17, 6, (2006) Sibling identities and relationships: fracture: a systematic review pp 838-849. London. Routledge of qualitative studies Noblit, G. W. Hare, R. D. (1988) Meta-ethnog- Mannay D (2015) Visual, Narrative and Creative Dr Liz Tutton PhD RN, RCN Research Institute, raphy: synthesizing qualitative studies. Newbury Research Methods: Application, reflection and University of Warwick and Trauma Research, Park, Sage. ethics. London. Routledge. Oxford, Coventry, UK Co-author(s): Lorena Saletti Cuesta, Biography Biography Argentina; Debbie Langstaff, UK; Keith Liz Tutton is a Senior Research Fellow at the RCN I have worked as a lecturer in children’s nursing Willett, UK Research Institute, Warwick Medical School, studies in the school of healthcare sciences University of Warwick, and Trauma Research, at Cardiff University for 13 years and I am Abstract Kadoorie Centre, John Radcliffe Hospital, currently the student disability manager for the Background: The provision of informal Oxford. Liz has experience in nursing, education school. My experience includes teaching nursing care can be stressful and affect carer’s health. and research. Research areas include: patient students on undergraduate, post graduate and Research suggests that carers who look after and staff experiences of care; recovery and treat- overseas programs, as well as undertaking my older people with a fractured hip have a variety ments; core concepts of care such as comfort, own research in the field of child health. My par- of experiences (Shawler 2007; Bryne et al. 2011). participation and hope. Liz currently has many ticular interest and expertise is focused around In order to understand how these diverse expe- studies exploring recovery from traumatic injury respiratory health, family centered care and riences are similar or different a systematic in adults and older people. siblings of children with chronic illness, as well review was required. This paper will present the as using creative and visual methods in teaching findings of this review. and research. Aim: To reconceptualise informal carers’ As a previous nurse specialist I pioneered the experiences from a variety of papers to provide Session no: 2.4.2 Abstract number: 103 development of a successful children’s respira- direction for research, policy and practice. Time: 2:25pm tory service, I have a breadth of knowledge and Method: The systematic review drew on Meta- experience in caring for children, young people ethnography (Noblit and Hare 1988)and 21 Factors facilitating and and families with acute, chronic, complex and international studies were included. The search specialist problems. Advocating for their needs, strategy was limited to the years 2000-2015. inhibiting a healthy transition to provide excellence in care is the fundamental Findings: The analysis identified a core theme in a long term care facility: motivation in driving forward my research to a systematic review of older influence nursing practice. of ‘engaging in care: struggling through’, as carers who wanted to be involved in caring learnt people, family and care staff Within my career I have disseminated practice to live with the intense and stressful impact of perspectives innovations through publication and presen- caring and changes to their life. The core theme Dr Joanne Fitzpatrick BSc PhD RN PGCEA, tations nationally and internationally. I have is represented through three themes: 1) Helping King’s College London, London, UK contributed to National Policy and setting the another to live which encompassed changing Clinical Agenda to improve children’s services. relationships as a result of dependency; 2) Co-author(s): Vasiliki Tzouvara, UK; Berna- Adapting ways of living which identified the dette Khoshaba, UK challenges of living with stress and their reliance on learning from experience and; 3) Negotiating Abstract the unknown where carers struggled to be heard Background: Relocating to a long term care and find the information they required. facility (LTCF) is a significant life event for Discussion: This review deepens our older people (1). A healthy transition should knowledge of the life changing impact of caring be the desired outcome of relocation. This for an older person with a hip fracture. Despite is characterised by process indicators (e.g. being willing to care, carers struggled with their feeling connected, interacting, developing con- relationships, the burden of dependency and the fidence, and coping) and outcome indicators steepness of the experiential learning curve. (e.g. mastery of skills and behaviour needed to manage the new situation, and development of Conclusion: Nurses may be strategically placed a fluid but integrative identity) (2). Key to sup- to enhance carers’ involvement, education porting older people to transition successfully through experiential learning and support to is to understand the facilitating and inhibiting enable them to develop emotional resilience and factors. This review goes beyond existing reviews the skills required for negotiating the complex by investigating this phenomenon for all older process of recovery. However systems would people relocating to a LTCF and by eliciting the need to be in place to support this activity. perspective of older people, families and care staff. Aim: To synthesise current evidence about factors that facilitate or inhibit a healthy transition following relocation to a LTCF (nursing/

21 21.55-3.20pm Concurrent session 2 – Wednesday 5 April 2017 residential home, assisted living facility) from Session no: 2.4.3 Abstract number: 223 Recommended reading list the perspective of older people, families and care Time: 2:55pm 1. Haywood, K.L., Packham, J.C. and Jordan, staff. K.P. (2013) ‘Assessing fatigue in ankylosing Method: A comprehensive search strategy was spondylitis: The importance of frequency and used to search several electronic databases and Quality and acceptability of severity’, Rheumatology, 53(3), pp. 552 - 556. grey literature sources for the period January patient-reported outcome doi: 10.1093/rheumatology/ket397. 1990 to January 2016. Screening and quality measures (PROMs) used 3. US Food and Drug Administration Guidance appraisal of selected studies was conducted. to assess fatigue in Axial for Industry: Patient-Reported Outcome Data were extracted into Excel using key headers Spondyloarthropathies Measures: Use in Medical Product Development and the findings were described and synthesised (AxSpa): a systematic review to Support Labeling Claims. (2009). Rockville: using Meleis’ Transitions Theory (2). Department of Health and Human Services, Mr Nathan Pearson BSc Psychology, MSc Findings: 1,663 results were obtained and 38 Food and Drug Administration, Centre for Drug Cognitive Neuroscience, Royal College of studies were included, of which 28 were quali- Evaluation and Research Nursing Research Institute, University of tative, 7 quantitative and 3 mixed methods. Warwick, Coventry, UK 2. Sieper, J., Rudwaleit, M., Baraliakos, X., Personal, community and societal conditions Brandt, J., Braun, J., Burgos-Vargas, R., Co-author(s): Jon Packham, UK; Helen that facilitate and inhibit a healthy transition for Dougados, M., Hermann, K.-G., Landewe, Parsons, UK; Kirstie Haywood, UK older people following their relocation to a LTCF R., Maksymowych, W. and van der Heijde, D. were identified and will be discussed. (2009) ‘The assessment of SpondyloArthri- Conclusions: With an increasing older popu- Abstract tis international society (ASAS) handbook: A lation, it is clear that the demand for long term Background: Up to 75% of patients with guide to assess spondyloarthritis’, Annals of the care will increase. This review contributes to AxSpa experience severe fatigue[1]. Assess- Rheumatic Diseases, 68(Suppl 2), pp. ii1–ii44. understanding facilitators and barriers for a ment guidance recommends use of a single item doi: 10.1136/ard.2008.104018. healthy transition following relocation to a fatigue severity visual analogue scale (VAS)[2]. LTCF. The findings will inform the development, However, this limited assessment fails to capture Biography implementation and evaluation of innovative the multi-dimensionality of fatigue and may Nathan Pearson is a second-year PhD student transitional interventions for older people relo- inadequately reflect change in fatigue status. based at the University of Warwick. He is cating to these settings. Aims: To appraise the quality and acceptabil- supervised by Dr Kirstie Haywood and Dr Jon ity of single and multi-item measures of fatigue Packham on a research project that seeks to Recommended reading list used with AxSpa patients. improve the assessment of fatigue in Axial Spon- Davies S 2005 Meleis’s theory of nursing tran- Methods: A two-stage systematic review of major dyloarthropathy. Previously, Nathan completed sitions and relatives experiences of nursing electronic databases (1980-2016): Phase 1 iden- a bachelor of science degree in Psychology and home entry. Journal of Advanced Nursing 52(6): tified all PROMs used to assess AxSpa-fatigue. a master of science degree in Cognitive Neuro- 658-671. Phase 2 identified published evidence of meas- science. His research background focused on the Meleis A I (2010) Transitions Theory- Middle urement and/or practical properties in the AxSpa perception of facial disfigurements using eye- Range and Situation Specific Theories in Nursing population. Both study quality and PROM quality tracking methods, which he continued working Research and Practice. New York: Springer Pub- was assessed against international standards. on as a research assistant prior to beginning his lishing Company. Results: From 387 reviewed abstracts, 112 PhD. His specific interest is in applied research. articles were reviewed in full; 28 provided Biography evidence for 3 multi-item fatigue-specific Jo is a graduate of the University of Ulster where PROMs, 3 single-item PROMs and 1 fatigue- she completed a BSc (Hons) Nursing Studies specific PROM subscale. No PROM was specific with registration as an adult nurse in 1990. Jo to AxSpa-fatigue. Theme: Research process was awarded her PhD in Nursing in 1996 from Evidence for measurement validity was limited, King’s College London. Her clinical background but strongest for the FACIT-Fatigue and the Session no: 2.5.1 Abstract number: 280 is gerontological nursing. Jo is currently a senior single item 10cm VAS. Content validity and Time: 1:55pm lecturer in the Florence Nightingale Faculty of relevance to AxSpa patients was not evaluated. Nursing and Midwifery, King’s College London Evidence of reliability was limited, but accept- Current arrangements for and within her university role, is Head of Post- able for the MFI-20 (both internal consistency graduate Research Studies. Jo’s research areas and test-retest) and the SF-36 Vitality subscale disclosure in nursing and are older person care in acute and long term care (internal consistency only). Responsiveness was health research protocols settings, and healthcare workforce related to rarely evaluated with limited evidence for the Professor George Kernohan BSc PhD, Institute care of older people. SF-36 Vitality scale. Evidence for the remaining of Nursing and Health Research, Ulster Uni- measures was weak. The contribution of patients versity, Newtownabbey, UK was limited and poorly reported. Co-author(s): Emma McFall (Northern Ireland) Discussion: The review highlights the limited and often poor quality evidence to inform PROM Abstract selection, with no assessment of relevance or Many ethical issues have to be considered acceptability to patients with AxSpa. Assessment when identifying personal health status whilst recommendations are therefore difficult; signifi- undertaking nursing and health research. cant methodological and quality issues must be Consent, the dignity and privacy of the research addressed in future PROM development/evalua- subjects, voluntary participation and protection tion. The use of high quality and relevant fatigue from harm - are commonly addressed through PROMs developed and evaluated with patients good practice in data management, informed as equal partners will provide both clinical prac- consent and the application of basic ethical titioners and patients with a powerful resource principles (Holloway, 1995). Disclosure of clini- for routine clinical care and research. cally relevant information, however, generates

22 1.55-3.20pm Concurrent session 2 – Wednesday 52 April 2017 specific ethical problems because of the potential Session no: 2.5.2 Abstract number: 251 Biography conflicts between clinical and research roles, Time: 2.25pm Charlotte Overton is a full time PhD student, privacy and protection, individual vs common sponsored by The Health Foundation, based at goods (Bevan et al, 2012). Nottingham University Business School, Centre To identify current practice, a 12-month Emotional labour: for Healthcare Innovation, Leadership and cohort of research ethics applications (N=96) ethnography and the Learning. Her research interests are in the filed were reviewed using a documentary analysis healthcare worker of Improvement Science. approach, noting cases where any arrange- Mrs Charlotte Overton RN, BSc (Hons), Charlotte is a practicing acute care nurse ments had been put in place to accommodate MMedSci (Clin Ed), RNT, Nottingham Univer- currently working on the nurse bank across a the management of individual findings where sity Business School, Nottingham, UK range of clinical areas. Charlotte has extensive the researchers were able to predict disclosure of Co-author(s): Dr Fiona Moffatt UK experience in the field of Practice Development, potentially relevant information. in Intensive Care and in a Trust wide post. She Findings show three approaches. First, low risk Abstract holds a Masters in Clinical Education and is a descriptive studies of health status in otherwise Registered Nurse Teacher. Prior to undertak- healthy populations where no special disclo- Ethnography is an increasingly used method- ing the PhD she was an undergraduate nurse sure arrangements were found. This category ology in healthcare research. A small number lecturer. included studies that purposively avoiding col- of papers have described the emotional labour inherent in such research, but these have been Fiona Moffatt is a lecturer in the School of lecting personal details, thus making any dis- Health Sciences, University of Nottingham. closure impossible. Second, low risk studies confined to critical ethnographies, or areas of extreme sensitivity. Fiona obtained a B.Sc. (Hons.) in Physiotherapy of patients and carers of people with health from the University of Manchester in 1991. She concerns. Disclosure of previously unreported This paper extends Hochschild’s (1983) concept subsequently completed an M.Sc. in Physiology aspects of the illness can be predicted, only of emotional labour: the process of regulating at University College London in 1997. Fiona’s where the research topic coincides with the dis- feelings to fulfil the emotional requirements clinical expertise is the management of the closure topic: these cases planned to provide of a job - to consider routine ethnographies acutely ill adult and patients with cardio-respir- support and advice to all participants. A third, conducted in a healthcare setting, and by a atory dysfunction. less populated category involved investiga- healthcare professional (HCP). The premise In 2010, Fiona commenced a PhD jointly funded tions at higher levels of risk with vulnerable is that in such a situation, the ‘insider status’ by The Foundation for the Sociology of Health populations. This category included cases where of the researcher confers particular identi- and Illness and The University of Nottingham. specific clinical partners were available to ties, values, virtues and beliefs. The researcher The thesis is titled “Working the production address disclosure through direct referral. The may be exposed to experiences that challenge line: Productivity and professional identity in level of participant anonymity and confidential- these professional ideologies, requiring them to the emergency department” and was awarded in ity varied across the approaches, independently reflexively manage, and conceal, the associated March 2014. of disclosure or risk. discomfort or distress (McQueeny and Lavelle, Ethical consideration is crucial in planning 2015). research: arrangements for disclosure of clini- Such insider status, and the resultant emotional cally relevant details to researchers has been labour, has been discussed as potentially prob- reported (Olsen et al, 2003). Further work is lematic, with implications for data collec- Session no: 2.5.3 Abstract number: 326 tion, analysis, representation and researcher needed to understand the implications of privacy Time: 2:55pm and anonymity. wellbeing. This paper offers an alternative stance. Drawing on reflexive accounts of an Can primary care nurses Recommended reading list ethnography concerning quality improvement, undertaken by an experienced HCP, the authors improve integrated care Bevan, J.L., et al. (2012) Critical social theory suggest that emotional labour can instead be and self-management for approach to disclosure of genomic incidental used to add methodological integrity. findings. Nursing Ethics, vol 19, no 6, pp 819-828. long-term conditions - a Specifically, emotional labour can be utilised by Olsen, D.P., et al. (2003) Ethical considerations feasibility trial process the researcher as a ‘trigger’ to challenge initial in international nursing research: a report from evaluation of the person conceptions, preserve ethical integrity, facilitate the International Centre for Nursing Ethics. connection with the ‘actors’ under observation centred assessment method Nursing Ethics, vol 10, no 2, pp 122-137. and subsequently attain a higher level analytical (PCAM). Holloway, I. (1995) Ethical Issues in Qualitative position. HCP researchers should be cognisant Dr Carina Hibberd PhD, CSO NMAHP Nursing Research. Nursing Ethics, vol 2, no 3, of the value of emotional labour in routine eth- Research Unit, University of Stirling, Stirling, pp 223-232. nographies, in terms of enhancing scholarship. UK Co-author(s): Eileen.Calveley (UK); Patricia Biography Recommended reading list Aitchieson (UK); Nadine Dougall (UK); R.Pratt A health researcher in Palliative Care and Hochschild, A. (1983) The Managed Heart: (USA); Margaret Maxwell (UK) Chronic Illness, Prof Kernohan has 20+ years’ Commercialization of Human Feeling. Berkeley, expertise in nursing research, including current CA: University of California Press. Abstract work to enhance palliative care for people in McQueeney, K., Lavelle K. M. (2015) Emotional Background: - Long-term conditions (LTC) the region in partnership with Doctors, Nurses, Labor in Critical Ethnographic Work: In the affect 15 million people in the UK (DoH,2012), Patients, Carers. Main clinical research work Field and Behind the Desk. Journal of Con- accounting for half of primary care consulta- is with Northern Ireland Hospice, Marie Curie temporary Ethnography. (Accessed August 8th tions. Improving broader biopsychosocial health Hospice, and the local NHS Trusts and other 2016). doi: 10.1177/0891241615602310 and self-care is key to addressing this complex agencies providing health and social care for a problem. But, primary care and patients have population of 1.7m people. George worked on the been largely unable to ptimise self-care. local NHS REC for 10 years and currently chairs the internal review board “filter committee” for Intervention: The PCAM aims to encourage: Ulster University. conversational assessment of biopsychosocial and care needs; and person-centred action

23 21.55-3.20pm Concurrent session 2 – Wednesday 5 April 2017 planning, linking patients with broader statutory Theme: Qualitative approaches/ Recommended reading list and third sector services. Alzheimers Society (2016) http://www.alzhei- Method: A feasibility/pilot cluster RCT with interviewing mersresearchuk.org practices randomised to nurses delivering Usual- Session no: 2.6.1 Abstract number: 41 Braun, C and Clarke, V. (2006) Using thematic care (UC) or PCAM in LTC reviews. Randomisa- analysis in psychology. Qualitative Research in Time: 1:55pm tion followed nurse and patient level baseline Psychology. 3.77-101 data collection. PCAM-arm nurses were then Bryman, A. (2012) Social Research Methods. trained to use the PCAM intervention and same Lost without translation: Oxford. Oxford university press patient outcomes data collection was repeated. practice leaders as code Fidelity to PCAM use was conducted via an audit breakers of consultation recordings pre and post use. A Biography Mrs Jan Furniaux RGN/RMN/BSc/MSc, qualitative process evaluation assessed feasibil- Present appointment: 2gether NHS Trust, Gloucester, UK ity, acceptability and barriers and facilitators to • Service Director: (since May 2013) use. Co-author(s): Siobhan Reilly, Katherine Froggatt • 2gether NHS Trust Findings: Five practices were randomised: with Qualifications: three practices (six nurses) to the PCAM arm and two practices (four nurses) to the UC arm. Data Abstract • RGN; RMN; BSc Professional Studies 1999; was obtained for 133 patients at baseline and 77 Lost without Translation: Practice Leaders as Diploma Serious Mental Illness 2002; MSc patients post intervention. For nurses the PCAM code breakers Applied Ageing Studies 2007. PRINCE2 2009. was fairly easily integrated into consultation, Restrictive intervention management for people Professional registration: although some reflected that support during with dementia in a mental health setting: An • RGN 1986 ‘experiential learning’ was required. All nurses interpretive description reported they would continue to use PCAM • RMN 1988 Background: Dementia is characterized by which helped support a positive nurse/patient • Nursing and Midwifery Council. Pin No: a set of symptoms affecting the brain and it is relationship. Analysis of consultation recordings 83A0245E estimated that there are 850,000 people living showed increased discussion of broader social with dementia in the UK / 46 million people • Previous and other appointments: issues. In LTC reviews, PCAM nurses made worldwide (Alzheimers Socity, 2016). In the • Community Service Manager (2007-2013) increased use of signposting to social supports UK, approximately one third of people with (18% PCAM v 4%UC) which were also more Research experience: dementia live in care settings and may be subject likely make referrals taken up by patients (8% • 2002: 2003 employed as a research project to restrictive interventions. PCAM v 2% UC). nurse. Aim: To understand how mental health workers Conclusions: This feasibility study indicates • Lead researcher in a qualitative care home manage restrictive interventions in practice. that PCAM has potential to be implemented and training needs study 2003. Methods: An Interpretive Descriptive study valued by nurses in a range of practices; and to • MSc dissertation: interview based study: was undertaken in two NHS Trusts. Two groups improve patient access to social supports. Time An exploration of nursing interventions in of participants were purposively sampled. for embedding into practice should be appreci- psychosis: 2007. ated. Group One: practitioners (n=18) and Group Two: organizational policy and practice leads Research training: Recommended reading list (n=5). Vignettes were developed using evidence • MSc research modules 2005-2006 based literature, case law and practice guidance • Current PhD studies: completion of 2 year Department of Health. (2012) Improving quality (Bryman, 2012) and used to frame semi struc- research theory and practice taught modular of life for people with long term conditions. tured interviews (2016). Thematic analysis of programme: 2012-2014 data followed the six phases described by Braun Biography and Clarke (2006) using NVIVO-10. • Introduction to Good Clinical Practice: Redwood Hse - 2013 Carina Hibberd was the study lead researcher Results: Four key themes were identified: and is a mixed methods health services Relevant publications: • Legislation: practitioners rely on translation of researcher. She has a research interest in complex and shifting legislation. • Furniaux, J.and Mitchell, T. (2004) Community patients’ and nurses’ experience of care, and Mental Health Nurse Liaison Nursing. Mental • Policy: driven by legislation / informed training developing and evaluating complex interven- Health Nursing. 24.1.4-8. tions across community, primary care, mental but not accessible to practitioners due to com- • Kukstas, T, and Furniaux, J. (2015) Brain health and acute in-patient care. plexity power: managing the emotional impact on • Training and supervision: essential to practi- staff. Journal of Dementia Care. 23.1.22-24. tioners: translating legislation and policy into practice. • Person-centred care: the core of practice Discussion: Practice leaders interpreted legislation to frame restrictive intervention policy, practice guidance and training content for practitioners. Practitioners described restrictive intervention practice based on person-centred care principles, informed by training and supervision. Conclusions: Person-centred restrictive intervention practice is enabled if service providers invest in practice leadership to translate legislation, case law and policy for practice - via direct training and supervision.

24 1.55-3.20pm Concurrent session 2 – Wednesday 52 April 2017 Session no: 2.6.2 Abstract number: 46 Recommended reading list Method: We used a qualitative design with a convenience sample of seven face-to-face Time: 2:25pm Folkman, S. (1997). Positive psychological states and coping with severe stress. Social science and semi-structured interviews (February 2016). medicine, 45,8, pp 1207-1221. Responses to a scenario were analysed for “What does caregiving mean themes and for abstractness of language using Quinn, C., Clare, L., and Woods, R. T. (2010). to you?” Hearing the voices the Linguistic Category Method. Influences on The impact of motivations and meanings on the abstraction were measured with a Likert scale from Hong Kong Chinese wellbeing of caregivers of people with dementia: (Burgoon et al., 2013). family caregivers of persons A systematic review. International Psychogeriat- with dementia. rics, 22,1, pp 43-55. Results: Participants travelled across psychological distance to think abstractly about The Miss Rebecca Cho Kwan Pang RN, BN, The Folkman, S., and Moskowitz, J. T. (2000). Person in the scenario, but thought concretely Nethersole School of Nursing, Faculty of Positive affect and the other side of coping. when considering pragmatic concerns. Medicine, The Chinese University of Hong American psychologist, 55,6, pp 647-654. Kong, Hong Kong Discussion: CLT is a useful basis for conceptual analysis. When making decisions abstrac- Co-author(s): Diana Tze Fan Lee, Hong Kong Biography tion gives meaning and allows for the clarifica- Miss Rebecca Pang is a PhD candidate of the tion of goals. Abstract Nethersole School of Nursing, The Chinese Conclusion: CLT can be used to analyse the University of Hong Kong. She is a registered Background: The meaning that caregivers conceptual thinking of PDMs, providing insight nurse. Her research interests include gerontol- ascribe to caregiving plays an important role in into concerns and ways to address them, which ogy and long-term care, with particular focus on dementia family caregiving [1]. It influences the can inform the support that nurses and health- dementia caregiving and chronic disease man- behavioural and emotional responses of the car- care professionals provide. egivers, and their psychological adjustment to agement. the caregiving situation [2,3]. Recommended reading list Aim: This study aims to explore the meanings Burgoon, E.M., Henderson, M.D. and Markman, that Chinese family caregivers of persons with A.B. (2013) ‘There Are Many Ways to See the dementia ascribed to their caregiving situation. Session no: 2.6.3 Abstract number: 90 Forest for the Trees: A tour Guide for Abstrac- Methods: A descriptive qualitative study was Time: 2:55pm tion.’ Perspectives on Psychological Science. conducted. Data was collected using unstruc- 8(5), pp.501-520 tured interviews. Fifteen Hong Kong Chinese Proxy decision making and Stonestree, E.L. (2014) ‘Love as a Regulative primary caregivers of persons with dementia Ideal in Surrogate Decision Making.’ Journal of were interviewed. All interviews were audio- dementia care: exploring Medicine and Philosophy. 39(5), pp.523-542 taped and transcribed verbatim. Data was decision maker thinking analysed using thematic analysis. Data analysis using Construal Level Theory Liberman, N. and Trope, Y. (2014) ‘Traversing psychological distance.’ Trends in Cognitive was completed in October 2016. Mrs Helen Convey RN, MA, University of Sciences. 18(7), pp.364-369 Results: Three main themes were identified: (1) Leeds, Leeds, UK Caregiving is a right thing to do; (2) Caregiving Co-author(s): Janet Holt, England, UK; Biography is a suffering; and (3) Caregiving is a sense of Barbara Summers, England, UK achievement. Helen is a part-time PhD student and a Lecturer in the School of Healthcare, University of Leeds, Discussions: This study has illustrated that the Abstract England. Her academic interests and research meaning of dementia family caregiving carries Background: When an individual who is living activities focus on ethical practice, decision- both negative and positive aspects of caregiv- with dementia (The Person) does not have deci- making, professional conduct and innovation in ing. The negative aspects are in the forms of sional capacity a proxy decision maker (PDM) learning and teaching. suffering while positive aspects are in the forms has to make the decision. Where the contempo- Helen holds a Developmental University Student of achievement. Suffering is derived from the rary interests and desires of The Person conflict Education Fellowship, for excellence in learning experience of loss of control and the demanding with their past interests and desires PDMs must and teaching. She teaches healthcare ethics and caregiving duties, while achievement is derived choose which take precedence (Stonestreet, law across a range of professional groups and from helping the care-recipient and others to live 2014). Decision making on behalf of The Person she’s Deputy Chair of the School of Healthcare with the disease. This sense of achievement has in these situations is challenging and knowing Research Ethics Committee. motivated caregivers to continue their caregiv- how proxy decision makers conceptualise issues ing role. In addition, the Chinese cultural values, could assist nurses and healthcare professionals such as filial piety, ‘mianzi (face)’ and ‘yuan’, in offering appropriate support. also play a key role in influencing the caregiving experience, which will affect the meaning car- Aim: We explore the potential of Construal egivers ascribed to caregiving. Level Theory (CLT) as a novel basis for analysing the conceptual thinking of PDMs in these situa- Conclusion: To assist caregivers to go through tions. the caregiving journey, professionals should identify ways to help caregivers to reframe the CLT (Liberman and Trope, 2014) proposes that negative caregiving situation by gaining a sense individuals surmise about/remember the past, of control and finding achievements they have imagine reactions and make predictions about obtained through caregiving. In addition, car- the future by traversing psychological distance. egiving is viewed as a family affair in Chinese Psychological distance can relate to time, space, culture, interventions using a family-centered social distance or consideration of hypotheti- approach may also be beneficial. cal situations. When psychological distance is greater we think abstractly which entails consideration of central features, desirability and end results. In contrast concrete thinking focuses on details, practical concerns and feasibility.

25 21.55-3.20pm Concurrent session 2 – Wednesday 5 April 2017 Theme: Patient safety/ Session no: 2.7.2 Abstract number: 34 Ministry of Health (2010) Strategic plan: 2010- 2020. Riyadh, KSA: Ministry of Health. Time: 2:25pm questionnaires Alamoudi OS (2006) Prevalence of respiratory Session no: 2.7.1 Abstract number: 221 diseases in hospitalized patients in Saudi Arabia: The impact of a school-based, A 5 years study 1996-2000. Annals of Thoracic Time: 1:55pm nurse-delivered asthma Medicine 1(2) 76 health education programme Nurses’ views on challenges on quality of life, knowledge in elderly cannulation: a and attitudes of Saudi survey children with asthma Session no: 2.7.3 Abstract number: 224 Rozita Binti Tamin, University of Brunei Dr Nashi Alreshidi PhD, Hail, Saudi Arabia Darussalam, Brunei Time: 2:55pm Co-author(s): Maswinda Sari Haji Zainal, Abstract An exploratory study of Nuramalina Abd Rahman, Zainatul Ashiqin Background: In Saudi Arabia, more than 2 Haji Salleh, Liling Chaw, Khadizah H. Abdul- registered nurses’ medication million people complain of asthma: 13% being Mumin, Munikumar Ramasamy Venkatasalu administration behaviour aged 6-10 years. This makes asthma one of the most common illnesses among children in Dr Angela Parry RN, PhD, PFHEA, School Abstract Saudi Arabia (Al Frayh et al 2001, Alamoudi of Healthcare Sciences, Cardiff University, Introduction: Increasing number of aging 2006, Ministry of Health 2010). Little has been Cardiff, UK population globally leads to steady increase of explored about children’s ability to learn more usage of hospital services by older people. Older about their own asthma in Saudi Arabia. Abstract people’s veins are more prominent, but fragile Aims: The study was designed to assess Registered Nurse (RN) medication adminis- and easily damaged to venipuncture due to the the impact of a school-based, nurse-deliv- tration error is a significant cause of avoidable aging process which also may be exacerbated by ered asthma heath education programme on patient harm nationally and internationally hypothermia that may cause vasospasm (Fabian, asthmatic children’s knowledge and attitude despite policy initiatives. Error is however the 2010).The existing vein finder has demonstrated towards asthma, quality of life, anxiety level, and outcome of behaviour. Using the Theory of improved venipuncture in invisible veins and school absenteeism. Reciprocal Determinism (Bandura, 1986) as an reduce failure rate in the elderly, however it organising framework, a correlational survey Methods: A quasi-experimental, non-equiv- cannot prevent the risk of accidental arterial was undertaken in a single study site in London alent group, pretest-posttest design was used. puncture during cannulation. with a convenience sample of RNs (n=1004, The education programme was developed RR=87.4%) working in a range of healthcare Aims: To explore nurses’ views on challenges in from existing evidence. The Paediatric Asthma organisations to explore RN medication admin- cannulation practices on older people. Quality of Life Questionnaire, Spence Anxiety istration behaviour. A self-report questionnaire Methods: A survey was conducted to explore Tool, Asthma Knowledge Questionnaire, and collected data regarding three RN medication the views on challenges in cannulation practices Asthma Attitude Questionnaire were employed administration behaviours (safety, violation and on older people among nurses at two of the for data collection in 2013. Intervention (n=130) clinical error) together with person and envi- largest hospitals in Brunei Darussalam. Self- and control (n=98) groups were drawn from ronment factors. Demographic, professional developed questionnaire with both open and 10 schools in Hail region, Saudi Arabia. Both and employment data were also collected. Data close ended questions was used and all of descriptive and inferential statistics were used analysis comprised descriptive and inferential the data were analysed descriptively using R to examine differences between groups. statistical tests. software (version 3.3). Results: The level of asthma knowledge was The three RN medication administration behav- Findings: Of the total 100 questionnaires increased significantly more in the intervention iours were each explained by different factors. distributed, 80 returned (80%). Nurses used group than in the control group (F=26.5746, df This presentation will focus on the findings different conventional methods include by 2, p<0.001). Attitude toward asthma was not related to RN medication administration palpating the vein (56.2% [n=45]), applying changed by the intervention (F=0.0490, df 2, violation behaviour which is an under explored tourniquet (78.7% [n=63]), flicking the skin p=0.9522). There was a significantly reduction research topic. RN violation behaviour provided gently (61.3% [n=49]) and using warm towel in the intervention group than in the control the greatest explanation of RN medication (5% [n=4]). Despite the availability of vein finder group in anxiety (F=3.7599, df 2, p=0.0242), administration clinical error behaviour. Person device in their current working place (46.3% and in absenteeism from school (F=2.98, df factors, most notably role conflict and profes- [n=37]), only 8.1% (n=3) frequently used the 2, p=0.003). Total quality of life increased sional identity contributed a greater explana- device, while 78.4% (n=29) use it sometimes and significantly more in the intervention group tion to RN medication administration violation 3.5% (n=5) never use the device. Although 94.9% (F=87.6534, df 2, p<0.001). behaviour than any of the other factors that were (n=75) agreed that the conventional methods Conclusion: The asthma educational explored. were efficient with only 5.1% (n=5) disagree, but programme impacted positively on students’ It is proposed that a focus on these modifiable half of the total population found it still difficult knowledge, anxiety, quality of life, and school person factors may yield a greater improvement to perform elderly cannulation. attendance. However, asthma education did in RN medication administration behaviour Conclusion: The current vein finder device not change attitudes towards the condition. The than a focus on error behaviour alone or on envi- available at both hospitals is not specifically results, emphasise the benefits of provision of ronments of care. This is not to suggest a return designed for older people. Hence, the preference health education directly to children. Asthma to ‘victim blaming’ of the past but a recogni- to use the conventional methods of performing education should be integrated into the KSA tion instead that RNs are accountable for their older people’s cannulation. Further research national child health programme. professional behaviour. RNs therefore need should be carried out to improve cannulation to recognise the risks that they take when not techniques for elderly. Recommended reading list adhering to the rules of safe medication admin- Al Frayh A, Shakoor Z, ElRab M, Hasnain S istration, and be vigilant to factors that may (2001) Increased prevalence of asthma in Saudi increase their risk-taking behaviour. Limitations Arabia. Annals of Allergy, Asthma and Immu- nology 86(3) 292-296

26 1.55-3.20pm Concurrent session 2 – Wednesday 52 April 2017 to this study will be acknowledged and suggestions for further research identified.

Recommended reading list Bandura, A., 1986. Social foundations of thought and action. Englewood Cliffs NJ: Prentice Hall. Parry, AM., Barriball, KL., While, AE., 2015. Factors contributing to Registered Nurse medication administration error: A narrative review. International Journal of Nursing Studies 52 (1), 403-420

Biography Dr Angela Parry currently works in the School of Healthcare Sciences at Cardiff University having spent much of her working life at the Faculty of Nursing and Midwifery, King’s College London. She is a Registered Nurse and holds Principal Fellowship with the Higher Education Academy. Her education and research interests focus on enabling students and registered healthcare professionals to deliver the highest standards of safe patient care.

27 33.50-4.45pm Concurrent session 3 – Wednesday 5 April 2017 Concurrent session 3 Wednesday 5 April 2017 3.50-4.45pm

Theme: Measuring quality of life Biography Session no: 3.1.2 Abstract number: 269 Margaret Brown: MSc (Gerontology), BA(hons), Time: 4:20pm Session no: 3.1.1 Abstract number: 314 Dip.N, RMN, RNT. Depute Director, Alzheimer Centre for Policy and Practice, University of the Time: 3.50pm West of Scotland. The effectiveness of adventure-based training Quality of life in severe Lifetime Achievement Award: Scotland’s Dementia Awards, 2016. in reducing fatigue and dementia: a collective case enhancing quality of life study approach Best Educational Initiative: Scotland’s Dementia Awards, 2013. among childhood cancer Mrs Margaret Brown MSc, BA(hons), Dip.N, survivor RMN, RNT, School of Heath, Nursing and The Scottish Government Dementia Champions Dr Ho Cheung William Li PhD, University of Midwifery, University of the West of Scotland, programme team (2011-present)] Hong Kong, Hong Kong, China Hamilton, UK Publications and presentations Co-author(s): Dr Joyce Chung, Hong Kong; Co-author(s): Professor Debbie Tolson, Dr • Loughlin, D and Brown, M. (2015) Improving Dr Eva Ho, Hong Kong, and Dr Godfrey Chan, Karen Watchman, Dr Beverley Young Surgical Outcomes for People with Dementia. Nursing Standard. Vol, 29(38) pp. 50-58. Hong Kong Abstract • Brown, M McWhinnie (2015) Using all the Abstract This research study explores multiple per- senses in Telling the Story: Impacts of the Background/Objective: Insufficient partici- ceptions of quality of life of the person with Delivering Dignity Programme. Edinburgh: pation in physical activity remains a common severe dementia living in a care home. Highly Queen’s Nursing Institute for Scotland problem in survivors of childhood cancer. dependent on others for all aspects of living, • Banks, P., Waugh,A., Henderson,J., Sharp, B., This study aimed to test the effectiveness of an there is a risk the person may be perceived as Brown, M., Oliver, J and Marland. G (2013) adventure-based training program in reducing having a limited capacity to experience a positive Enriching the care of patients with dementia fatigue, improving physical activity levels and quality of life, leading to reduced expectations in acute settings? The Dementia Champions promoting quality of life among Hong Kong and ambitions in care. Programme in Scotland. Dementia Chinese children cancer survivors. Drawing on a social constructionist perspec- • M. and K. Updates: Developing Leading-edge Methods: A randomized controlled trial was tive informed a qualitative collective case study Pre-Operative Assessment. Improving Surgical conducted in a pediatric outpatient clinic of an approach. Mixed methods included 18 hours Outcomes for People with Dementia. London, acute hospital and the Children’s Cancer Foun- of observation and 24 interviews, supported by 2016. (invited Speaker) dation. A total of 222 childhood cancer survivors care documents and artefacts. This empirical • Royal College of Nursing Research Conference: were recruited. Subjects in the experimental data was examined through theoretical perspec- Food for Thought: Enhancing dietary prefer- group received a four-day adventure-based tives on quality of life, interwoven with philo- ences in advanced dementia. Edinburgh, 2016. training programme. Subjects in the control sophical concerns about the self and agency in group received the same amount of time and severe dementia. • British Society of Gerontology: Enhanced Sensory Day Care. Newcastle, 2015 attention as the experimental group but not in Cross case analysis, integrating the findings from • Alzheimer Europe Conference: Food for such a way as to have any specific effect on the six in depth individual case reports, identified outcome measures. All subjects were assessed themes interrogated and presented within four Thought: Enhancing dietary preferences in advanced dementia. Slovenia, 2015 for the fatigue, muscle strength, physical activity key assertions. These identify how aspects of levels and quality of life at baseline, 6 and 12 quality of life were expressed through the senses months after the start of intervention. and body of the person, supported by a life Results: Subjects in the experimental group narrative; where a nuanced and shared under- reported significantly lower levels of fatigue), standing by others may influence quality of life; higher levels of physical activity, and quality of how recognition of this fragile balance for the life than those in the control group at 6 and 12 person might be maintained and refined, leading months. to a recognition and refocusing on quality of life for the person with severe dementia. Conclusion: The adventure-based training programme was found to be effective in reducing The implications arising from this study shows fatigue, promoting regular physical activity that aspects of quality of life can be discerned, and enhancing quality of life among childhood influenced and enhanced for the person with cancer survivors. severe dementia. Indications for future practice include a refocus towards sensory-based practice in supporting the fundamentals of daily Biography life, within a shared and nuanced framework of Dr William LI is currently an Associate Professor relationships. As a singular period in the life of at the School of Nursing, the University of the person, emphasis on quality of life should Hong Kong. Dr William Li is currently teaching be more closely integrated into the narrative of nursing research, evidence-based practice and severe dementia. translational nursing research to both under-

28 3.50-4.45pm Concurrent session 3 – Wednesday 53 April 2017 graduate and postgraduate students at the weeks post discharge and were analysed using patient’s experiences of high-dose chemother- School of Nursing, the University of Hong Kong. framework analysis (Ritchie et al 2014). apy and the difficulties encountered by nurses He has a strong research interest in the field of Results: Participants described experiencing and healthcare staff when breaking bad news. child and adolescent care, and has much skill significant physical, psychological and social As well as delivering local and network wide and knowledge in developing, validating and challenges as a consequence of MSCC. These outputs from projects, Clare has published in testing the psychometric properties of instru- were brought into sharp relief on getting home peer reviewed journals and presented at national ments for children. His grants and international and many recounted difficulties with achieving and international conferences. publications encompass a number of child and goals relating to independence, activities of adolescent studies including development and living and mobility. Some problems had not psychometric testing of instruments for Chinese been anticipated by patients prior to discharge children, providing and evaluating psychoso- home. Experiences were shaped by coping strat- Session no: 3.2.2 Abstract number: 190 cial interventions for children and adolescents, egies and the availability of support from family both in the hospitals and community. He has and community healthcare services. Time: 4:20pm published more than 50 peer reviewed journal Discussion: The findings highlight the physical, articles, a scholarly book on paediatric cancer, emotional and social impact that MSCC can have Holistic Needs Assessment 10 book chapters on child and adolescent care on patients and those close to them. They reveal (HNA) after treatment for and over 50 international conference papers. how adjustment to MSCC is an ongoing process colorectal cancer within His research focused on providing psychologi- as patients become aware of the limitations outpatient clinics: Using cal interventions to those children hospitalized and challenges it presents and develop ways of findings to improve practice with cancer and childhood cancer survivors, coping. Gaps were identified between patient implementing therapeutic play to hospitalized preparation for discharge and their experience and policies. children, helping cancer and diabetic patients, of being at home. Mrs Lucy Johnston BA; MSc, School of Health and people attending Aand E Department to Conclusion: The concerns expressed by the and Social Care, Edinburgh Napier University, quit smoking and promoting smoking cessation participants provide useful insights into the Edinburgh, UK to the youth. priorities of care from a patient’s perspective. Co-author(s): Lucy Johnston UK; Jackie Discharge preparation needs to consider the Rodger UK; Karen Campbell UK full range of services that are needed to support patients during the transition from hospital to Abstract home. Introduction: Patients can be unprepared Theme: Other for the impact of cancer and treatment. A pro- Recommended reading list portion have unmet needs. The Transforming Session no: 3.2.1 Abstract number: 246 National Cancer Action Team (2011) Acute Care after Treatment (TCAT) programme in Time: 3:50pm oncology, including metastatic spinal cord Scotland aims to improve after care for cancer compression, measures. Department of Health. survivors. Funded by Macmillan Cancer Support Patients’ experiences of being Crown publications through TCAT, the NHS Tayside project aimed Ritchie, J., Lewis, J., McNaughton Nicholls, C. to identify concerns in colorectal cancer patients discharged home following a using Holistic Needs Assessment (HNA) tool, diagnosis of malignant spinal and Ormston, R. (2014) Qualitative research practice: a guide for social science students and the Concerns Checklist. Our work is helping to cord compression researchers. 2nd Edition. Sage Publications. inform future practice developments, risk strati- Ms Clare Warnock MSc, BSc, BA, Weston Park London fication and staff training approaches. Hospital, Sheffield Teaching Hospitals NHS Warnock C. and Tod A. (2014) A descriptive Material and method: Between October 2015 Trust, Sheffield, UK exploration of the experiences of patients with and November 2016, patients attending for Co-author(s): Jane Lewis, England, UK; significant functional impairment following a follow up after treatment for colorectal cancer, Leslie Crowther, England, UK; Divinia Smith, recent diagnosis of metastatic spinal cord com- were invited to complete an HNA and discuss England, UK pression. Journal of Advanced Nursing, vol 70, this with a CNS. Working with Edinburgh no 3, pp 564-574 Napier University, data on patient demographics, concerns identified and review processes Abstract (length of consultation, location) and actions, Biography Background: Metastatic spinal cord compres- such as referral and signposting routes have sion (MSCC) is a symptom of advanced cancer Clare Warnock is currently the Practice Develop- been gathered for over 400 patients. and patients have to cope with actual or potential ment sister at Weston Park Hospital, Sheffield, Results and discussion: Data from the first disability alongside a poor prognosis (NCAT the cancer services centre for the South year shows that 2 in 5 patients have no concerns 2011). Discharge home from hospital presents Yorkshire region. She has worked in oncology at end of treatment and patients who live alone significant challenges (Warnock and Tod 2014) for over 25 years in London and Sheffield in a or who live in an area of multiple deprivation but experiences of this transition have not previ- variety of clinical settings and roles, moving into have a statistically significantly higher average ously been reviewed. practice development in 1999. number of concerns. We are using this data to Aim: To explore patients’ descriptions of their Clare has been involved in a diverse range of inform approaches to risk stratified follow up. Of experiences of being discharged home following service evaluation, audit and research projects those with concerns three-quarters have one or a diagnosis of spinal cord compression. with a focus on clinical practice and improving more physical concern. The top 3 concerns are Methods: A descriptive interview study was patient care. Research topics have included -tiredness/exhaustion, diarrhoea and getting carried out with eleven patients newly diagnosed factors affecting nutrition among cancer patients around. This data is informing the content of our with MSCC from a regional cancer centre in hospital, patient’s experiences of malignant Health and Wellbeing Events, staff training and between August 2015 and March 2016. spinal cord compression, the care of women signposting materials. receiving intra-cavity brachytherapy for gynae- Two semi-structured telephone interviews were In addition, we will present patient and prac- cological cancer, the relationship between tem- conducted with each participant at one and three titioner feedback that is being used to reflect perature and neutropenic sepsis, nursing com- on the current model of colorectal follow up, petences for survivorship and late effects care, including the timing of assessments and the

29 33.50-4.45pm Concurrent session 3 – Wednesday 5 April 2017 value and outcomes of more person centred con- involving Brighton and Sussex Medical School, Theme: Focus group sultations. the University of Surrey and the Alzheimer’s Conclusion: This important Scottish study is Society, funded by Health Education England Session no: 3.4.1 Abstract number: 285 Kent, Surrey, Sussex. assisting us to improve practice and policies for Time: 3:50pm cancer survivors by ensuring that future service Results: Four categories emerged from Year 1; developments are evidence based and patient led Impact (Making it real, personhood, emotional Nurse and midwives’ impact of caring (carers), changing relation- experiences of leading Recommended reading list ships); Vulnerability (uniform as identity, role conflict); Change of perceptions (dementia and and being part of a quality Snowden A, White C. (2014) Assessment and role of carers) and Reciprocity of relationships. care planning for cancer survivors: a concise improvement collaborative evidence review. Macmillan Cancer Support, Discussion: Hearing the lived experiences of Professor Fiona Murphy PhD, MSc, BN, RN, people with dementia and their carers appeared RCNT, PGCE Fe NDN, University of Limerick, Wells M, Cunningham M, Lang H, Swartzman S, to communicate meaning in a lasting way for Limerick, Ireland Philp J, Taylor L and Thomson J (2015) Distress, students. Regular contact made dementia much concerns and unmet needs in survivors of head Co-author(s): Brid O’Brien, Ireland; Maebh more personal and encouraged students to consider and neck cancer: A cross-sectional survey, Barry, Ireland their approaches to care; prompting changes they European Journal of Cancer Care 2015 Vol. 24 incorporated in practice. Visits provided students no 5 pp 748-760 Abstract with an opportunity to try and adopt the perspec- Armes J; Crowe M; Colbourne L (2009) tive of a person with dementia and their carers, Developing clinical leadership capacity in ‘Patients’ supportive care needs beyond end of to see the world through their eyes and their rela- nursing and midwifery remains an important cancer treatment: a prospective, longitudinal tionships. There was an increased recognition and issue. One strategy is to combine practitioner survey.’ Journal of Clinical Oncology , vol. 27, understanding of the importance of relationships leadership programmes with Quality Improve- no. 36, pp. 6172 - 6179, and how crucial they are to enabling a person to ment Collaborative (QIC) programmes. QICs live well with dementia. are an increasingly common way to implement evidence-based practice in health care through planned implementation of change (Nembhard Recommended reading list 2009). Being part of a QIC gives the oppor- Department of Health (2013) Delivering high tunity to apply skills and attributes taught on Theme: Qualitative approaches/ quality, effective, compassionate care: Develop- leadership programmes to implement practice interviewing ing the right people with the right skills and the changes. This paper explores whether practi- right values. A mandate from the Government to tioners applied the skills taught on a leadership Session no: 3.3.1 Abstract number: 70 Health Education England: April 2013 to March programme to a QIC situation. 2015 Time: 3:50pm Aim: To explore nurse/midwife managers (who Willis (2015) Raising the Bar. Shape of caring: had attended a leadership programme) experi- A Review of Future Education and Training of ences of leading and being part of a QIC. The impact of longitudinal Registered Nurses and Care Assistants. Health Methods: Within a qualitative, descriptive home visits to people with Education England. dementia and their carers: research design (Sandelowski 2010), five focus Department of Health (2015) Prime Minister groups were conducted with a purposive, con- adult student nurses’ Challenge on Dementia 2015-2020, London, venience sample of 18 participants involved in perspectives Department of Health a multi-disciplinary QIC. Data were collected Mrs Wendy Grosvenor currently studying for between April and June 2016, transcribed and PhD, Faculty of Health and Medical Sciences, Biography analysed using thematic analysis. A data analysis Guildford, Surrey, UK Teaching Fellow Dementia/Care of Older Person clinic technique (Rapport 2010) was used to develop and refine emerging themes. RN, BSc (Hons) Clinical Practice (Older Person), Abstract PG Cert, PG Dip. Findings: Five main themes emerged: QIC process enablers and barriers; learning about Background: The education of our nursing Since qualifying as a Registered General Nurse leadership; managing and sustaining change; and care workforce over the next ten years will in 1991 I have specialised working in the NHS benefits of being in a collaborative and ideas for determine the strength of our healthcare system supporting older people with dementia. My future collaboratives. for decades (Willis 2015) professional background has included Acute This research is set against background of Medicine, Rehabilitation, Practice Develop- Discussion: As naturally active leaders, nurses changes to dementia education, UK policy ment and Dementia Specialist Nurse. I started and midwives assumed leadership roles within context is clear that dementia education needs to working at the University of Surrey in 2013 to the QIC groups. However, the connection be improved (DH 2015). A mandate from Health help integrate dementia into the undergradu- between the learning provided on the leadership Education England ensured that by September ate curriculum and proactively prepare nursing programme and leading a QIC was not overtly 2015 all undergraduate nursing courses include students to meet the current and future needs of made. An area of difficulty was in managing the dementia (DH 2013). people with dementia. I am currently involved in perceived non-engagement by some other occu- pations in the QIC groups which practitioners Aims: This qualitative study aims to explore the a 4 year collaborative project with the University felt ill-equipped to deal with. Managing and sus- perceptions of adult nursing students of longitu- of Brighton Medical School and the Alzheimer’s taining the change in practice was also seen as an dinal visits over 3 years to the homes of people Society in a HEKSS funded educational initia- important but challenging issue for participants with dementia and their carers. tive, led by Professor Sube Banerjee called Time for Dementia. I am currently undertaking a PhD that required continued leadership effort. Methods: The study makes use of data genera- as part of a Time for Dementia project exploring Conclusion: Active, focused reflection on tion and analytical techniques of constructivist the perceptions of adult nursing students of leadership experience within the QIC process is grounded theory. Data was generated from their experiences of their visits to people with needed to facilitate participants to make the con- interviews with undergraduate adult nursing dementia and their carers. I am passionate about nections between leadership programme theory students participating in a wider Time for education, the value of research and evidence- and application to the QIC process. Dementia study, a four year collaborative project based care.

30 3.50-4.45pm Concurrent session 3 – Wednesday 53 April 2017 Recommended reading list practice, leading to incongruity between their her own qualitative research interests using Nembhard, I. 2009. Learning and Improving in core clinical values and their perceived identi- focus groups to explore the role and ethical per- Quality improvement collaboratives: which col- ties as research delivery staff. A duty of care ceptions of the clinical research nurse. laborative features do participants value most? as patient advocates, contrasted a sense that HSR: Health Services Research, 44(2 Pt 1) 359 elements of the work reflected that of salespeo- - 378. ple, resulting in a caring-recruiting dichotomy. The emotional labour of approaching patients, Sandelowski, M. (2010) ‘What’s in a Name? and a sense of unease regarding how they were Qualitative Description Revisited’, Research in perceived by the wider organisation, overshad- Theme: Qualitative/methodology Nursing and Health, 33(1), 77-84. owed the positive aspects of contributing to Session no: 3.5.1 Abstract number: 152 Rapport F (2010) Summative Analysis: A New something worthwhile. Qualitative Method for Social Science and Conclusion: A sense of disquiet is linked Time: 3:50pm Health Research. International Journal of Quali- with professional-identity and self-concept in a tative methods 9(3):270-290. research delivery role. Further research should Notes from the field: explore these issues further, to enlighten the comparing face to face, Biography basis on which such feelings are positioned, and telephone and Skype Fiona Murphy is Professor of Clinical Nursing at to work towards practical solutions. Addressing interviews with couples the University of Limerick, Ireland. the concept of the caring-recruiting dichotomy could contribute to tackling recruitment issues, Dr Duncan Randall PhD, subsequently benefitting the health and wealth RGN,RSCN,RNT,RHV, University of South- of the nation, through successful delivery of ampton, Southampton, UK research. Co-author(s): Professor Julie Taylor; UK Vicky Session no: 3.4.2 Abstract number: 128 Robinson; UK Time: 4:20pm Recommended reading list National Institute for Health Research (2016) Abstract From bedside to NIHR CRN High Level Objectives Year End Per- Aim: To explore methodological challenges of businesslike and back again formance Report - 2015/16 interviewing couples in nursing and healthcare - clinical research nurses on Tomlin, Z., deSalis, I., Toerien, M., and Donovan, research professional identity and the J. (2012) Patient Advocacy and Patient Centred- Background: The effects of interviewing caring-recruiting dichotomy. ness in Participant Recruitment to Randomised- people in groups and as individuals is well Controlled Trials: Implications for Informed described in nursing and social care research lit- Mrs Linda Tinkler BSc (Hons), RN, MClinRes Consent. Health Expectations. 17, 670-682 erature (Silverman 2013). However, the effects (Leadership), County Durham and Darlington on qualitative data of interviewing same sex and NHS Foundation Trust, Darlington, UK Arrowsmith, A., Lau-Walker, M., Norman, I., Maben, J. (2016) Nurses’ perceptions and heterosexual couples is less well understood Co-author(s): Victoria Smith, County Durham, experiences of work role transitions: a mixed (lee et al 2011). Yet couples are often involved UK; Yan Yiannakou, County Durham, UK; Lisa methods systematic review of the literature. in delivering care to other family members Robinson, Newcastle, UK; Journal of Advanced Nursing, 72 (8) 1735-1750 particularly children. The rate of relationship breakdown is high in couples with care responsi- Abstract bilities (CAF 2013). Understanding how couples Biography Introduction: The clinical research nurse interact and how these interactions affect care is Linda completed her nursing degree, qualify- workforce is pivotal to improving health therefore key to nursing care. ing as an adult nurse in 2003, working in both outcomes through contribution to research- Method and discussion: In this paper three secondary care and the medical equipment active health economies. Unprecedented recent researchers compare and contrast their experi- industry until she was appointed to her first investment in research infrastructure in the ences of interviewing couples both same sex research role in primary care during 2009. UK has led to nurses and midwives increas- and heterosexual, using face to face, telephone ingly undertaking extended roles to deliver Linda has remained in the research specialty and Skype (electronic communication) in two clinical research. Despite such opportunities, since 2009, where she has been involved in separate studies. Each variation of the semi the recruitment and retention of patients in the design, development, set up and delivery of structured interview method has advantages research studies remains problematic, with the various clinical research projects across NHS, and challenges. Observation of the dynamics continued failure to reach NIHR targets for suc- academia and industry, in collaboration with of a relationship, for example the non-verbal cessful recruitment to time and target. NIHR local clinical research networks. Linda has communications that reflect any power relation- experience in all aspects of clinical research, in This qualitative study investigates the role and ship between couples is key to an understand- numerous disease areas from patient care within ethical perceptions of clinical research nurses ing that provides the context to interpretation the trial environment, to the informed consent and midwives operating in the NHS, and iden- and analysis of the data collected. Finally we process, and data collection. Linda completed tifies sources of discontent and tension in the consider the implications for data analysis of the an MClinRes (Leadership) through an NIHR workforce that may impact on successful study interactions of couples. funded fellowship in 2016, and is involved delivery. Conclusion: Interviewing couples presents with teaching post graduate clinical leadership particular challenges, however observing the Methods: Focus groups (4 groups, 19 partici- through a visiting lectureship at Newcastle Uni- interactions of the couple can be important in pants, split by hospital site and time in post <2 versity. years >2 years) were conducted in a large North understanding the dynamic between people In Linda’s current role as an academic research East NHS foundation trust. Thematic analysis which can inform the analysis of the data. nurse in the NHS, she is responsible for support- identified perceptions and experiences of patient Understanding the context of the relation also ing a specialist Gastroenterology team with the and staff interactions within the wider context of allows the nurse researcher to have a better development of research ideas. Responsible for their professional identity. understanding of the care relationships, which supporting protocol writing, grant applications, can influence care delivery. Results: Role transition, altered relationships, writing for publication, education, and leading and workload complexity, affected participants’ the team’s PPIE initiatives, Linda also pursues

31 33.50-4.45pm Concurrent session 3 – Wednesday 5 April 2017 Recommended reading list • Deciding when concurrent analysis is the best Theme: Action research CAF (Contact a Family) (2013) Relationships method and selecting appropriate data. and caring for a disabled child. Available from • Coding and condensing data. Session no: 3.6.1 Abstract number: 14 [http://www.cafamily.org.uk/media/669849/ • Theorising and situating the resultant social Time: 3:50pm relationshipscurrent_updated_may_2013.pdf] process within the wider literature Silverman D (2013) Doing qualitative research, Results: Selecting appropriate data. Prevention of maternal health 4th ed. Thousand Oaks California. Sage, The first stage is to examine the current state complications: voices of the Lee, E., Taylor, J. and Raitt, F. 2011 ‘It’s not me, of the literature. Where this has moved beyond rural women through the lens it’s them’: How lesbian mothers make sense of initial exploration of a topic, but not yet involved Mrs Alberta David Nsemo BNSc.,PGDE,MSc., negative experiences of maternity care. A her- deductive work, concurrent analysis may be Ph.D, Department of Nursing Science, Univer- meneutic study Journal of Advanced Nursing vol optimal (Snowden and Atkinson, 2012). Appro- sity of Calabar, Calabar, Nigeria 67 no5 pp 982-990 priate data is narrative data gathered to investi- Co-author(s): Prof. Jennifer Chipps, South gate a focussed topic. Biography Africa; D. E. Umoh, Coding and condensing: Concurrent The presenters Dr Duncan Randall, University analysis looks for actions taken by participants, Abstract of Southampton, Professor Julie Taylor, Univer- therefore focuses on gerunds (Snowden and sity of Birmingham and Birmingham Children’s Martin, 2010). Common codes are grouped and Photovoice is a technique based on participa- Hospital NHS Foundation Trust and Vicky connected to explain a social process (Snowden tion, educational empowerment, consciousness- Robinson, University of Southampton, are expe- and Kolb, 2016). raising and self-documentation among ordinary rienced nurse researchers who have completed people, compelling them to be agents of change. Theorising: The findings are situated within numerous research projects and published Local people are given cameras to capture the wider literature to show how, where and why widely. Dr Randall and Professor Taylor have images of their everyday life experiences and the emergent social process is generalizable. worked on children’s palliative care and safe- practices within their community, then describ- guarding. Vicky Robinson is an independent Discussion: Whilst potentially ground- ing the images in the context of their life, thus researcher with experience of palliative care breaking the method is also controversial. Key the critical reflection and dialogue this photog- research. strengths and weaknesses will be discussed and raphy promotes can serve to reveal significant hopefully the audience will contribute to this social, cultural and political issues. discussion. The aim of this paper was to engage community members through photovoice to highlight Recommended reading list Session no: 3.5.2 Abstract number: 30 problems regarding pregnancy and birth Snowden, A., and Atkinson, J. (2012). Concur- practices, identify possible solutions and make Time: 4:20pm rent analysis: a pragmatic justification. Nursing recommendations on communities’ roles in the Philosophy, 13, 126 - 141 prevention of maternal health complications. Generalisable qualitative Snowden, A., and Martin, C. (2010). Concur- Method: The study adopted a qualitative research: paradox or rent analysis: towards generalisable qualita- design that combined photovoice participatory paradigm shift? tive research. Journal of Clinical Nursing, approach and focus group discussion in collect- 20, 2868 - 77. http://doi.org/10.1111/j.1365- ing the data. Purposive sampling was used to Professor Austyn Snowden , Edinburgh Napier 2702.2010.03513.x select 20 participants from Idundu and Anyang- University, Edinburgh, UK Snowden, A., and Kolb, H. (2016). Two years hanse communities of Akpabuyo Local Govern- ment Area of Cross River State, Nigeria. Guba’s Abstract of unintended consequences: introducing an electronic health record system in a hospice in model of credibility, transferability and authen- Aim: To introduce concurrent analysis: an Scotland. Journal of Clinical Nursing. http:// ticity was applied to ensure trustworthiness of original method designed to optimise genralis- doi.org/10.1111/jocn.13576 the data. Ethical principles was adhered to. Data ability of narrative data. was analysed using Tesch’s method of content analyses. Background: Qualitative research in health Biography is considered less robust than quantitative Results: The themes that emerged from the Austyn is professor in mental health at research. Samples are usually smaller, contexts data analyses revealed the following among Edinburgh Napier University. He is getting on unique, and results not considered generaliz- others; men are sole-decision makers regarding a bit. able. This presentation examines the assump- place of delivery, high preference for Tradi- tions underpinning the concept of generalisabil- tional Birth Attendants’ (TBA) care and lack ity to show they are flawed. It instead develops of community structure to support women’s a relativist view of generalisability grounded in health. Suggestions towards improving rural Rorty’s pragmatism and Thagard’s concept of women’s utilization of skilled care included; coherence. The methodological product is con- improving maternal literacy, involving husbands current analysis, a novel method that has been in ante natal care, use of community structures successfully applied by a single researcher, to emphasize facility delivery, TBA training/ unlike related ventures such as realist review for TBA-facility collaboration, and constitution example, that require huge resources. of Community Engagement Group (CEG), to Concurrent analysis produces generalizable monitor and encourage utilization of skilled results by combining analyses of coherent types attendants. of narrative data. Examples are taken from Conclusion: It is believed that the activities of four recent published studies examining: birth the Community Engagement Group may bring satisfaction, nurse prescribing, gatekeeping about increased utilization of healthcare facili- behaviour, and organisational change. ties for skilled care by community women during Method: Case study approach (n=4) (2010- pregnancy, delivery and after delivery, hence 2016) to illustrate key stages of the method: prevention of maternal health complications.

32 3.50-4.45pm Concurrent session 3 – Wednesday 53 April 2017 Recommended reading list Session no: 3.6.2 Abstract number: 89 United Nations Children’s Fund (2016) Female Genital Mutilation/Cutting: A Global Concern. Agan, T. U., Archibong, E. I., Ekabua, J. E., Time: 4:20pm Ekanem, E. I., Abeshi, S. E., Edentekhe, T. A., UNICEF/New York. and Bassey, E. E. (2010). Trends in maternal Mulonga, P., Andrews, S., Hollins, M. (2014) mortality at the University of Calabar Teaching ‘Don’t judge me’: experiences Crossing borders: Discussing the evidence Hospital, Nigeria, 1999 - 2009. International of women living with Female relating to the mental health needs of women Journal of Women’s Health, 2, 249. Genital Mutilation (FGM) exposed to female genital mutilation. Interna- Costello A. (2004). Reducing maternal and Dr Julie McGarry DHSCI, MMEDSCI, BA tional Journal of Mental Health Nursing 24 (4) neonatal mortality in the poorest communities. (HONS), PGCHE, PGDIP, RN, (adult and pp 296-305. British Medical Journal, 329: 1166 - 1168. mental health), School of Health Sciences, Uni- Biography Cooper, C. M. and Yarbrough, S. P. (2010). Tell versity of Nottingham, Nottingham, UK me - show me: Using combined focus group and Co-author(s): Dr Natasha Recchia, UK Dr Julie McGarry is a registered nurse in adult photovoice methods to gain understanding of and mental health practice and an established health issues in rural Guatemala. Qualitative Abstract researcher in the field of gender based violence and domestic violence and abuse with a focus Health Research, 3: 123-134. Female Genital Mutilation (FGM) is a signifi- towards survivors’ experiences and the devel- cant yet largely hidden phenomenon affecting opment of effective health care professionals’ Biography the lives of an estimated 125 million girls and responses. Julie has led on a number of funded NAME: Dr. Alberta David Nsemo women worldwide (UNICEF 2013). It is now research initiatives, working with national and well documented that FGM can result in a range PLACE OF ORIGIN: Calabar, Cross River State, local agencies in the UK in the development of of significant physical and psychological health Nigeria. domestic violence services for older women, issues (Moxey and Jones, 2016). However, while exploring novel approaches to domestic violence OCCUPATION/EMPLOYER: 1. Lecturer 1 with the last decade has seen a rise in the awareness identification and management within health- the Dept. of Nursing Science, University of of FGM within healthcare provision contexts, care contexts and co-participant arts based Calabar, Cross River State, Nigeria. this has been largely associated with particular narrative projects with survivors of gender based Adjunct Senior lecturer, Department of Nursing fields of practice for example, midwifery and and domestic violence and abuse. Julie’s work Science, Abia State University, Uturu. gynaecology with very little exploration of the synthesizes research, education and practice longer term impact of FGM on the health and ACADEMIC RECORDS WITH DATES: and she has recently been awarded the title of wellbeing of women living with FGM (Mulongo, Period Attended Name and Address of Institu- Senior Fellow of the Higher Education Academy. et al. 2014). This represents a significant gap in tion Qualification Julie’s research predominantly utilizes a quali- current knowledge and understanding and one tative approach to enquiry including personal 2013-2016 University of Western Cape, South which this study sought to address. Africa PhD (AdvanceMidwifery/ Neonatology) narrative and ethnography - current work in this The overall aim: To explore the impact of field includes personal accounts of survivorship MAY 2011 Centre for Development and Certifi- FGM on women’s health and wellbeing and for older women survivors of DVA and personal cate in HIV and Innovation, University of AIDS experiences of healthcare provision through a narratives of female genital mutilation (FGM). and Food and Wageningen, The Netherlands. participant led arts based workshop with women Julie has published widely and disseminated her Nutrition Security. survivors of FGM. work through national and international con- 2007 -2010 University of Calabar, Nigeria. Ph.D Methods: A narratives based research ferences and invited keynote speaker presenta- (Medical Sociology) workshop approach was chosen as the use of tions. 2004- 2006 University of Calabar, Nigeria.M.Sc narratives are now well established within (Medical Sociology) qualitative research as a meaningful way in 2002- 2004 University of Calabar, Nigeria.Post- which the voices of participants take precedence graduate Diploma in Education over those of the researcher (author, in press). Women who were living with FGM (n=6) were 1997- 2001 University of Calabar, Nigeria. invited to take part through a local FGM spe- Theme: Questionnaire B.N. Sc. Degree (Nursing) cialist support organisation in one region of the Session no: 3.7.1 Abstract number: 124 MEMBERSHIP OF PROFESSIONAL BODIES: United Kingdom (UK). During the workshops FELLOW: West African College of Nursing the women created artefacts and stories of their Time: 3:50pm (FWCN) experiences. MEMBER: SIGMA THETA TAU INTERNA- Findings and Discussion: The narratives Measuring self-efficacy for TIONAL (University of the Western Cape, informed three main themes which emerged caregiving of caregivers South Africa-Lamba-at-large) Chapter from the workshops i) Pestle and mortar ii) The of patients with palliative knife, the mat and the bracelet, iii) Cooking pots. MEMBER: Association of Nurses in AIDs care care need: validation of the These findings, alongside the implications for (ANAC) nursing and healthcare practice development caregiver inventory REGISTERED NURSE with Anbord Altranais and wider policy context, form the basis of the Dr Doris Yp Leung , The Chinese University of (overseas Nursing Registration Board, presentation. Hong Kong, Shatin, Hong Kong Dublin) Co-author(s): Carmen WH Chan, Hong Kong; REGISTERED MEMBER: Nursing and Recommended reading list Helen YL Chan, Hong Kong; Joseph SK Kwan, Midwifery Council of Nigeria Moxey, J. and Jones, L. (2016)A qualitative study Hong Kong; Patrick KC Chiu, Hong Kong; exploring how Somali women exposed to female Larry LY Lee, Hong Kong; Raymond SK Lo, genital mutilation experience and perceive Hong Kong; Susan ZM Yau, Hong Kong antenatal and intrapartum care in England. BMJ Open. Available at http://bmjopen.bmj. Abstract com/content/6/1/e009846.full.pdf+html Date Background: Providing care to patients with of access 13.10.16 palliative care need can be very stressful because of the chronic nature of the diseases and the lack

33 33.50-4.45pm Concurrent session 3 – Wednesday 5 April 2017 of foresight about the time of its finalization. Session no: 3.7.2 Abstract number: 271 in caring elderly people with different cultures Previous studies showed that increased self-effi- in a nursing home in New South Wales before cacy was associated with both increased positive Time: 4:20pm returning to Hong Kong when she joined the aspects of caregiving and reduced burden in School of Nursing in 2003 as Clinical Instructor. caregivers. Caregiving self-efficacy has been the Relationships among fatigue, In 2007, she subsequently became a Teaching target variable for some interventions aim to physical activity, depressive Consultant and the title of which was changed reduce health risk behaviors in caregivers. Yet symptoms, and quality of to a Lectureship as of 2013. She obtained her there is a lack of validated tools measuring car- life in Chinese young cancer PhD at the Medical School, Australian National egiving self-efficacy of this particular group of University in 2014. Her research interests are caregivers in the Chinese population. survivors on the relation between the emotion and psy- Dr Oi Kwan Joyce Chung PhD, University of Aims: To translate and adapt the Caregiver chosocial aspects of child and adolescents. She Hong Kong, Hong Kong, China Inventory (CGI) into Chinese and examine its especially develops the passion and enthusiasm psychometric properties for use in the Chinese Co-author(s): Dr William Li, Hong Kong; Dr in childhood cancer survivors study. population. Eva Ho, Hong Kong, and Dr Godfrey Chan, Hong Kong Methods: The Caregiver Inventory was translated into Chinese using the WHO translation framework. The final translated scale (C-CGI) Abstract was administered to a convenience sampling Background: Fatigue is the most common of 56 non-paid caregivers of patients with pal- concern reported by childhood cancer survivors. liative care need recruited from three hospitals Assessing its occurrence and severity is a pre- in Sept-Nov 2016 in Hong Kong. Cronbach’s requisite for planning and evaluating appropri- alpha assessed reliability and correlations with ate interventions. Nevertheless, there is a lack caregiver burden and perceived social support of large-scale datasets or population-based assessed construct validity of C-CGI. surveys which examine the impact of fatigue Results: Based on data from 25 males and 31 on survivors’ quality of life. The study aimed to female caregivers with a mean age of 60.0Â±15.6, shed light on this under-researched area. Cronbach’s alpha values for the four dimen- Methods: A cross-sectional study was used. A sions of C-CGI ranged 0.703 - 0.860. The four total of 400 childhood cancer survivors (7- to dimensions in C-CGI were positively and signifi- 18-year olds) who underwent medical follow-up cantly associated with perceived social support in the outpatient clinic were invited to partici- with correlations ranging 0.28 - 0.49 (p-values: pate in the study. The cancer-related fatigue, 0.037 - < 0.001) but not significant associated depressive symptoms, physical activity level, with caregiver burden with Pearson correlations and quality of life of participants were assessed. ranging -0.22 - 0.02 (p-values: 0.11: 0.891). Results: Results indicated that a consider- Discussion and conclusions: The findings able number of childhood cancer survivors were provide preliminary support for the psychomet- found to display symptoms of cancer-related ric properties of the scale in a Chinese sample of fatigue. Besides, results showed that greater caregivers of patients with palliative care need. occurrence and severity of fatigue in childhood However, C-CGI should be further tested for cancer survivors were associated with more self- construct validity using patient data, test-retest reported depressive symptoms, lower level of reliability, and factorial validity with a larger physical activity and quality of life. In addition, sample size. the study revealed that physical activity level is a strong predictor of the cancer-related fatigue. Biography Conclusion: The findings provide further Dr. Doris Y. P. Leung is an Assistant Professor at support that cancer and its treatment have the Nethersole School of Nursing, The Chinese adverse effects on survivors’ fatigue, which can University of Hong Kong. She received her PhD manifest months or even years after the comple- in Biostatistics from the University of Cali- tion of treatment. Most importantly, this study fornia, Los Angeles. Her main interests are in reveals that physical activity is a strong predictor psychometrics and the application of structural of the level of fatigue in children and adoles- equation modeling in educational and health cents. It is crucial for healthcare profession- psychology. She has published numerous journal als to identify strategies that can help children articles and book chapters in these areas. Dr. and adolescents surviving cancer increase their Leung also served on editorial board and invited adoption and maintenance of regular activity reviewers in several international journals. Her throughout their life. current research programs include cancer prevention, palliative care and on-line teaching and Biography learning in higher education. Dr Chung is an experienced nursing educator with over 10 years’ experience in clinical nursing education and teaching. She was trained as a Registered Nurse in Hong Kong, and went to Australia to further her studies obtaining a first degree in nursing from the University of Western Australia in 1995 and a Master degree in Public Health at the University of New South Wales in 2001. She worked as a Registered Nurse in Australia where she gained experiences

34 10.05-11am Concurrent session 4 – Thursday 64 April 2017 Concurrent session 4 Thursday 6 April 2017 10.05-11am

Conclusions: The presentation seeks to illu- Session no: 4.1.2 Abstract number: 76 Theme: Grounded Theory, minate one researchers experience of using a nursing, midwifery or support grounded theory approach addressing both Time: 10:35am worker the highs and lows. Critical reflection aids self development and can resonate with others also Seeking authorization: a Session no: 4.1.1 Abstract number: 157 using or considering using a grounded theory grounded theory exploration approach. Time: 10:05am of mentors’ experiences of assessing nursing students on Getting to grips with Recommended reading list the borderline of achievement Grounded theory: a critical Charmaz.K. (2014) ‘Conducting Grounded of practice competence. theory.’ 2nd Ed. Sage. London reflection Dr Simon Cassidy PhD (Nursing Science), Hutchinson. A.J. Johnston.L.H. Breckon.J.D. RMN, RNLD, BSc (Hons), Dip Prof Prac, Mrs Fiona Barchard RGN, Bsc, Ma., The Uni- (2010) ‘Using QSR NVivo to facilitate the devel- versity of Northampton, UK PGCE, Abertawe Bro Morgannwg University opment of a grounded theory project: an account Health Board (ABMU), Swansea, UK Co-author(s): Sarah Neill UK Judith Sixsmith of a worked example.’ International Journal of UK Clency Meurier UK social research methodology. 13:4 283-302 Co-author(s): Professor Fiona Murphy, Ireland; Associate Professor Michael Coffey, Charmaz. K. (2012) ‘The power and potential of Wales. Abstract grounded theory.’ Medical Sociology online Vol Background to the method: Grounded 6 issue 3 Abstract theory (GT) has been articulated in a number of diverse ways dependent on differing episte- Biography The reluctance of nurse mentors to fail nursing students in practice despite concerns about mological viewpoints (Hutchinson et al 2010). My current role is senior lecturer in adult Classic GT began in the 1960’s with Glaser and competence remains a contemporary issue nursing and programme leader. I commenced in healthcare education. Mentors assessment Strauss (1967) before Glaser (1978) further work at the University of Northampton in 2006. developed GT and Strauss (1987), Strauss and decisions nevertheless have considerable impact I teach across pre-registration and Post registra- for a variety of key stakeholders, not least for the Corbin in the 1990’s and Charmaz and Clarke tion nursing from level 4: level 7. The subjects from 2000, developed the methodology in student themselves as to whether they continue I teach include pathophysiology, recognition of on pre-registration nursing programmes. differing directions. These varied iterations of the deteriorating patient, leadership, reflection grounded theory can lead to misunderstand- and complex care. I gained my PGCTHE in 2008 The aim of this grounded theory study was ings regarding its utilization and critical chal- and was also awarded a teaching fellowship by to develop a substantive theoretical explana- lenges in its application. Critical reflection based the University. In 2011 I commenced my Profes- tion of how mentors make sense of their expe- on personal engagement with GT can lead to sional Doctorate and have completed the two riences where nursing students are on the improved understanding of its utilization and years taught modules and am now in my final borderline of achievement of competence in the challenges posed. year of the Thesis element. My clinical nursing practice. The study explores mentors’ decision- Aims of paper: history is I qualified in 1990 as a registered adult making processes, coping strategies and sense of accountability in these circumstances. • To present the researchers journey and expe- nurse and spent sixteen years in Acute Nursing rience using social constructionist grounded practice. The majority of this time was in Critical Phase one of this study involved twenty indi- theory, consistent with Charmaz (2014). care where I gained experience as a staff nurse, vidual semi-structured interviews with nurse junior sister, senior sister and Practice develop- mentors in one UK National Health Service • To promote critical discussion around the dif- ment Nurse. During this time I gained my ENB Trust. Phase two included eight individual semi- ficulties, challenges and facilitators to using 100, 931 and 998 and Degree in Health care structured interviews and seven focus groups grounded theory. studies and Masters in Clinical Leadership. (n=38) with mentors and practice educators in Methodological discussion: Grounded four further Health Boards. theory is a structured but flexible methodology. Three categories ‘the conundrum of practice Procedures for collecting data and analysis are competence,’ ‘the intensity of nurturing hope- explicit, simultaneous and sequential; a cohesive fulness,’ and ‘managing assessment impasse,’ methodological whole is formed, enabling emerged as critical to the study’s central emergence of a conceptual theory (Glaser storyline - ‘Seeking Authorization: Establish- 2004). A critical reflection will be presented of ing collective accountability for mentorship.’ the researchers journey and experience using This substantive theoretical explanation dem- grounded theory for her Professional Doctorate onstrates how mentors are dependent on key thesis. The difficulties and challenges encoun- sources of support and feedback to validate their tered concern: choosing which iteration of assessment decision-making, notwithstanding grounded theory to use, whether the iterations substantial personal, professional and organisa- relate to each other, the simultaneous nature of tional pressures. Where this authorization does data and analysis against time constraints and not occur, distinct periods of mentorship effort whether a theory will always emerge. These will are effectively devalued and become discon- be critiqued alongside the facilitators to success.

35 410.05-11am Concurrent session 4 – Thursday 6 April 2017 nected from students’ overall trajectory on the Theme: Mixed/workforce and Recommended reading list nursing programme. Gärtner, F. R., Nieuwenhuijsen, K., van Dijk, Drawing on sociological theories of structure employment F. J. H., and Sluiter, J. K. (2010) The impact of and agency, the study concludes that manage- Session no: 4.2.1 Abstract number: 50 common mental disorders on the work function- ment of borderline assessment situations is con- ing of nurses and allied health professionals: siderably developed by mentors’ recognition of Time: 10:05am A systematic review. International Journal of the authorizing effects of a wider community of Nursing Studies, 47(8), 1047 - 1061. assessors. This is in contrast to decision-making How do mental health nurses Mental Health Taskforce (2016) The Five Year resting solely on one mentor’s shoulders. Con- negotiate and manage their Forward View For Mental Health. NHS England; sequently, this study identifies the personal, mental health problems in the 2016. professional and organisational implications social environment at work? Hall, L. H., Johnson, J., Watt, I., Tsipa, A., involved in the preparation, support and regula- and O’Connor, D. B. (2016). Healthcare Staff tion of mentors specifically in borderline assess- Results of a mixed methods Wellbeing, Burnout, and Patient Safety: A Sys- ment circumstances. study tematic Review. PLoS One, 11(7), e0159015 Dr Jennifer Oates PhD, RMN, Florence Night- Recommended reading list ingale Faculty of Nursing and Midwifery, Biography Black, S., Curzio, J., and Terry, L. (2014). Failing King’s College London, London, UK Jennifer Oates is a Lecturer in Mental Health a student nurse: A new horizon of moral courage. at King’s College London. She is a registered Nursing Ethics, 21(2), 224-238. Abstract mental health nurse, with clinical experience in Background: The UK Department of Health Hunt, L. A. (2014). Failing Securely: Enabling acute care, liaison psychiatry and community has recently called for all employers of health Mentors to Fail Underperforming Student mental health. In recent years she has worked in care staff to address employee mental health Nurses in Practical Assessments. (PhD), Bir- a number of healthcare regulation and commis- (Mental Health Taskforce, 2016). Internation- mingham, Birmingham City University. sioning roles. Her research focus is the mental ally, the prevalence of mental health problems Duffy, K. (2013). Deciding to fail: Nurse mentors’ health and wellbeing of mental health nurses, among health professionals has been the subject expereinces of managing a failed practice although she has also researched and published of research and policy concern for many years assessment. Journal of Practice Teaching and on aspects of health care regulation and policy. (Gärtner et al, 2010; Hall et al, 2016). Nurses’ Learning, 11(3), 36-58. own mental health is of paramount important, both in terms of patient safety and the sustain- Biography ability and resilience of the workforce (Gärtner Simon Cassidy registered nurse has worked pre- et al, 2010). Session no: 4.2.2 Abstract number: 64 dominantly within NHS learning disability resi- Aims: The aim of this study was to identify the dential and community settings. Since 2005 he Time: 10:35am ways in which nurses negotiate and manage their has been a Practice Education Facilitator within mental health at work, in their relationships Abertawe Bro Morgannwg University Health How much agency does the with their managers, colleagues and employing Board linking with Swansea University. Based organisations. individual nurse have in at Singleton Hospital Swansea, Simon has lead delivering compassionate Methods: This was a sequential mixed methods responsibilities for pre-registration nursing care? A report of the national mentorship issues across a number of Health study, with data collected between November Board localities. He was awarded a PhD in 2016 2012 and February 2014. In part one a national evaluation of the compassion which concerns mentors’ interpretation of com- sample of 237 UK mental health nurses took in practice vision and strategy petence in their assessment of pre-registration part in an online survey. In part two a purposive in England sample of 27 mental health nurses were inter- student nurses who are on the borderline of Professor Helen Therese Allan RN RNT BSc viewed regarding their mental health, wellbeing achievement in practice. PGDE PhD, Centre for Critical Research in and experiences at work. The ‘following a thread’ Nursing and Midwifery, Middlesex University, approach to presentation of mixed methods London, UK findings was used, reflective of mixed methods epistemology. Co-author(s): Allan H T, Liu L, Corbett K, Serrant L Results: Participants described organisational responses to mental health problems, including their experience of occupational health services. Abstract Stigma was a factor in some of their accounts. Background: The Compassion in Practice For some, the relationship with managers and Vision and Strategy in England emerged at a occupational health was functional. For others it time when nursing and nurses in the UK were was sensitive and supportive. seemingly less trusted, under pressure from Discussion: From this study, recommenda- the government and subject to media reports of tions regarding the management of nurses’ poor care (Paley 2014; Traynor 2014). Similar mental health by managers and by occupational concerns with standards of nursing care have health services can be made, in line with the been raised internationally (Dewar and Christley policy objectives of the Five Year Forward View 2013). for Mental Health. Aim: discuss findings from a national evalua- Conclusion: There is scope to improve the tion of the Impact of the Compassion in Practice occupational ‘mental health and wellbeing’ Vision and Strategy (NHSE 2012) on nursing, offer to nurses. Nurses’ expertise is often not midwifery and care staff. accounted for when management and organi- Methods: A mixed methods design with sational responses are being devised or enacted. four sequential stages: analysis of national survey data; literature scoping; 10 qualitative

36 10.05-11am Concurrent session 4 – Thursday 64 April 2017 telephone; secondary data analysis Family and Theme: Mixed/service innovation Recommended reading list Friends Test (FFT), Staff Family and Friends Dorman, B.P., Hill, C., McGrath, M., Mansour, Test (SFFT) and NHS Staff Survey (NHSSS) data Session no: 4.3.1 Abstract number: 10 A., Dobson, D., Pearse, T., Singleton, J., for defined period of time; integrated analysis of Time: 10:05am Al-Omoush, A., Barry, M., Colongon, A.R., all data. Data were collected 2015. Perez, M., Fitzgerald, D., Zabala, M. (2004) Findings: Awareness and involvement of staff What is the impact of a bowel ‘Bowel management in the intensive care unit’. in Compassion in Practice was considerable Intensive and Critical Care Nursing, 20, 6, pp amongst middle and senior management but management protocol in 320 - 329. limited at ward level. Findings suggest that ward cardiac intensive care? McPeake, J., Gilmour, H., MacIntosh, G. (2011) level staff felt that there was a lack of senior Miss Dawn Warren BSc Hons Adult Nursing, ‘The implementation of a bowel management leadership and support for staff to enable them MSc Clinical Research, Plymouth Hospitals protocol in an adult intensive care unit’. Nursing to deliver compassionate care. Communication NHS Trust, Plymouth, UK in critical care, 16, 5, pp 235 - 42. in teams and from senior staff to ward level staff Co-author(s): Professor Bridie Kent, UK Knowles, S., Mcinnes, E., Elliott, D., Hardy, J., about the strategy was not considered effective. Middleton, S. (2014) ‘Evaluation of the imple- Findings reveal professional anger, distress and Abstract mentation of a bowel management protocol in resistance to a strategy which was perceived intensive care: Effect on clinician practices and as a top down initiative and which did not suf- Background: Bowel Management Protocols patient outcomes’. Journal of Clinical Nursing, ficiently recognise structural issues which were (BMP) may improve the incidence of diarrhoea 23, pp 716 - 7 felt to constrain the ability to deliver compas- and constipation in the intensive care unit (ICU) sionate care. through standardising care (Dorman et al. 2004; McPeake et al. 2011). Although clinician com- Biography Discussion: we discuss our findings in the pliance issues to BMPs have been highlighted context of discourses on compassion and recent I am a registered nurse specialising in critical (Knowles et al. 2014), there is little supporting literature on the Francis Report. We suggest that care and cardiothoracics. I qualified in 2010 with evidence and no reports of compliance rates to these findings can only be fully understood if a BSc Honours in Adult Nursing at Plymouth a BMP throughout the patient’s ICU stay. Fur- there is a meaningful recognition by government University. I have worked in Derriford Hospital, thermore, barriers and enablers following BMP of the relationship between structural systems Plymouth Hospitals NHS Trust, since qualifying implementation have not been explored, an and individual agency in delivering care. and currently work in Cardiac Intensive Care. important aspect of improving compliance. In the near future, I will be moving to London Recommended reading list Aim: To investigate the impact of a BMP on the to take the opportunity to work at the Royal incidence of constipation and diarrhoea, levels Brompton Hospital in the adult intensive care Dewar, B. and Christley, Y. (2013). A critical of compliance, and explore barriers and enablers unit, where I hope to progress professionally in analysis of Compassion in Practice. Nursing to using a BMP in the ICU. my clinical role. Standard, 28(10), pp.46-50. Methods: In 2015/16, a mixed-methods study My passion for research has followed me Traynor, M. (2014). Caring after Francis: moral was conducted in a cardiac ICU using two throughout my nursing career and led me to failure in nursing reconsidered. Journal of phases: retrospective case review of patients’ develop a bowel management protocol for Research in Nursing, 19(7-8), pp. 546-556 hospital notes, before and after the BMP imple- CICU at Derriford Hospital, through a lit- Paley, J. (2014). Cognition and the compas- mentation, establishing levels of diarrhoea, erature review, to standardise bowel care for sion deficit: the social psychology of helping constipation and compliance; focus groups on patients. Following implementation, I was behaviour in nursing. Nursing Philosophy, users of the BMP, six months following the BMP awarded a funded place on a Masters Degree 15(4), pp.274-87. implementation, exploring barriers and enablers in Clinical Research, at Plymouth University, in practice. where I conducted the current study. I have now Biography Results and discussion: 51 notes were completed my Masters with a distinction, and Mike O’Driscoll is an experienced health services reviewed. Post implementation, more patients hope to continue my research career through researcher who has worked in and with nurses were constipated within the first 96 hours completing a Phd. for many years at the University of Surrey and (p = .05), fewer patients experienced severe I have recently presented research findings at the Middlesex University. He has also worked as a diarrhoea (p < .05) and fewer aperients were BACCN conference, and have also collaborated free lance health services research consultant administered. There was evidence of behavioural with intensive care clinicians in Canada, on a and for local authorities. change including less variation in aperients systematic review, investigating bowel protocols given and less varied, shorter time periods in intensive care which has been submitted for between starting enteral feed and administer- publication in Critical Care Medicine. ing aperients. However, full compliance levels to the BMP were low (2.3%). Two focus groups with nursing staff were conducted, generating the following themes: barriers and enablers to the BMP characteristics; barriers and enablers of the dissemination; barriers to bowel assessment; nurse as a barrier; medical involvement and BMP outcomes. Conclusions: Overcoming the identified barriers to using a BMP can improve compliance. However, methods to measure and improve compliance to a BMP in the ICU require further research to identify the impact of a BMP in practice.

37 410.05-11am Concurrent session 4 – Thursday 6 April 2017 Session no: 4.3.2 Abstract number: 18 regulation. Journal of Happiness Studies. two domains represented by the two twister 8(3):393-427 movements. Time: 10:35am Results: Thirty-six links were discussed and Biography A place for sadness: messages refined into 21 areas for analysis. These were John McKinnon PhD is Senior Lecturer in sent to the user group to individually vote for for nursing practice in the Nursing at the School of Health and Social Care their top three: ontology of melancholy at the University of Lincoln. He was a frontline • Is the impact of cancer affected by how much Dr John McKinnon PhD MSc PG Dip practitioner for 20 years working in critical care, support you get from people in similar situa- BA(Hons), School of Health and Social Care, public health and safeguarding children. John tions? was one of the first academic non medical pre- University of Lincoln, Lincoln, UK • Am I less likely to be involved in decision scribing leads in the country and has published making if I am younger? Abstract widely on the nurse patient relationship. He has taught published and researched reflec- • How I feel about my body after cancer affects Background: Sadness is an affective state tive practice and emotional intelligence. His my ability to form new relationships. associated with feelings of loss, sorrow and doctorate centred on harnessing emotion to Conclusions: Given appropriate tools, young regret. The emotion is experienced in the face of guide professional judgement and the outcome people can be involved in generating hypotheses an event with no blameworthy target. Sadness is of this was a new framework for practice. His and can identify linkages between data not nec- accompanied by a deceleration of the physiologi- book ‘Reflection for Nursing Life’ has won praise essarily viewed as important by healthcare pro- cal and cognitive process permitting a recovery from academics, practitioners and students fessionals. This paper will explore the potential period when support can be sought (Rivers et al. for its refreshing and innovative approach to a for utilising other participatory methods, 2007). The view that sadness is a powerless state familiar subject. identify some of the challenges and how these lacking agency (Tiedens, 2001) has recently been can be overcome. challenged (Bower, 2013).

Aim: This paper aims to examine how the Biography ontology of sadness finds purpose and value in nursing practice. Rachel is a children and adult trained nurse Theme: Focus groups with over 20 years of experience working in Method: Thirty- three nurses across research with young people. Rachel is currently community, public health, paediatrics, mental Session no: 4.4.1 Abstract number: 74 co-ordinating the national evaluation of teenage health and acute adult surgery talked exhaus- and young adult specialist cancer services tively in interview about their experiences of Time: 10:05am across England. She has published in numerous sadness in their professional lives. The data journals and has presented at both national and was collected in a London teaching hospital Participatory research: international conferences. Rachel is a member and in three community NHS trusts in the East using board games to guide of the National Cancer Research Institutes Midlands of England between November 2011 secondary analysis of big data (NCRI) Psycho-oncology and Survivorship and August 2012. The interviews were audio- Clinical Studies Group (CSG), Understanding taped and transcribed verbatim. The transcripts Dr Rachel Taylor , University College London Hospitals NHS Foundation Trust, London, UK and Measuring the Consequence of Cancer and were analysed using Grounded Theory Method. its treatment subgroup and Health Services Results: Sadness was experienced as a Co-author(s): Ana Martins, Sarah Lea, Jeremy Research subgroup of the NCRI TYA CSG. She heaviness of heart; a sense of loss and a place S Whelan, Lorna A Fern, UK is a Steering Committee member of the Royal of remedial retreat distinguished from depres- College of Nursing (RCN) Research Society and sion by its temporary nature and functionality. Abstract on the Scientific Committee of the RCN -Inter Sources of sadness included endings in the nurse BRIGHTLIGHT is a national evaluation of national Research Society annual conference. patient relationship, knowledge of patient life teenage and young adult cancer services in Rachel is funded through an NIHR Programme history and the separation of children from their England. Data are collected five times over Grant for Applied research (RP-PG-1209- parents. Sadness was shown to fuel attention three years from 830 young people using a 10013). The views expressed are those of the to detail, a sense of fairness and empathy in bespoke survey. Additional data are collected author(s) and not necessarily those of the NHS, practice. from carers, clinical notes and NHS registries the NIHR or the Department of Health. Conclusion: There is a place for sadness ensuring BRIGHTLIGHT provides a multi- within reflective practice to help identify roots faceted and comprehensive evaluation young of loss without blame and the need for res- people’s experience of cancer care. In addition toration. Sadness affords opportunities for to the primary research question (do specialist greater emotional competence and situational cancer services for teenagers and young adults awareness. Sadness among service users signals add value?) such a wealth of information lends a time when sensitive aspects of care and after itself to further exploration. care can be negotiated. Aim: Identify what young people think is important to investigate for secondary data Recommended reading list analysis. Bower, B. (2013). The Bright Side of Sadness . Methods: A workshop was held with eight Science News, 184 (9): 18-21. members of the BRIGHTLIGHT user group. Tiedens, L.Z. (2001). Anger and advancement To facilitate young people’s understanding of versus sadness and subjugation: the effect of ‘hypothesis generation’, the board game Twister negative emotion expressions on social status was adapted so each movement represented a conferral. Journal of Personality and Social Psy- different domain of data. The game was played chology, 80,(1): 86 - 94. according to the rules with the modification that after each pair of movements, partici- Rivers, SE, Bracket, MA, Katulack, NA, pants discussed possible linkage between the Salovey,P. (2007) Regulating anger and sadness: an exploration of discrete emotions in emotional

38 10.05-11am Concurrent session 4 – Thursday 64 April 2017 Session no: 4.4.2 Abstract number: 241 Theme: Mixed methods Recommended reading list Time: 10:35am Maben J et al. 2012. Exploring the relation- Session no: 4.5.1 Abstract number: 201 ship between patients’ experiences of care and Time: 10:05am the influence of staff motivation, affect and Exploring young liver wellbeing Final report. NIHR patients experiences and NHS. 2009. NHS Health and Well-being needs when transitioning A mixed methods research study: exploring resilience in Boorman Review Final Report London: Station- from paediatric to adult ary Office services: An exploratory contemporary nursing roles in Wales Masten, A. 2001. Ordinary Magic, resilience qualitative study processes in development American Psycholo- Mrs Judith Benbow RGN, School of Healthcare Professor Jane Coad RGN, RSCN, DipN, gist 56 (3), pp. 227 - 238. Sciences, Cardiff University, Cardiff, UK BSc (Hons), PGCert (Teaching), MSc, PhD, Coventry University, Coventry, UK Co-author(s): Supervisors: Professor Daniel Biography Kelly and Dr Aled Jones, UK Co-author(s): Alex Toft, UK; Alison Taylor, Judith Benbow has a background in adult UK; Rachel Taylor, UK; Lee Claridge, UK; critical care nursing and has enjoyed a variety of James Ferguson, UK; Jonathon Hind, UK; Abstract clinical and educational roles. Judith is currently Rebecca Jones, UK; Patricia McClean, UK; Background: Nursing is categorised as a Senior Lecturer and the Lead for International Patrick McKiernan, USA; Marianne Samyn, highly stressful occupation. Low morale, stress Student Mobility at Cardiff University’s School UK; David Adams, UK and compassion fatigue are major consequences of Healthcare Sciences. Judith is exploring the of healthcare workplace adversity which has a concept of resilience among registered nurses Abstract negative impact on care. Staff wellbeing is an in Wales as the focus of her RCN Wales/Cardiff important antecedent of patient care perfor- University funded PhD. The transition from paediatric to adult services mance. Nurses’ ability to deliver compassion- for young people with complex healthcare needs ate care is inextricably linked to individual and can be a period of uncertainty and change. Young organisational professional and personal chal- people have to take ownership of their care lenges and support available (Maben, 2012). whilst accessing new services and working with Session no: 4.5.2 Abstract number: 264 new healthcare professionals. Throughout this Resilience is known to buffer the negative effects period, young people need support and guidance of stress through behaviours that facilitate adap- Time: 10:35am that align to their specific needs. However tation in the context of adversity, resulting in nationally, understanding of the experiences the ability to function above the norm in spite of Nursing mindfully: a mixed- and needs of young people with liver disease is significant stress (Masten 2001). Resilience has method exploration of unclear. Therefore the aim of this study was to the potential to positively influence health and student nurses’ experiences explore the experiences of young liver patients well-being of nurses and subsequent nursing of mindfulness-based stress (16-25 years) moving to adult services. care. Limited research exists that examines the nexus of nurses’ resilience and workplace envi- reduction Data were collected from young people with liver ronments. Dr Graeme Donald BSc DPSN RN PgD PhD, disease (n=21) and professionals (n=18) from University of Manchester, Manchester, UK three supra-regional liver centres in England. Aim: To provide novel insights into the intrinsic Data collection methods involved focus group and extrinsic influences, that shape the resil- Co-author(s): Helen Pusey, Joanne Timpson, interviews using innovative arts-based methods ience of nurses in Wales. Shaun Speed, Elizabeth Lee-Woolf and one-to-one interviews. Data was analysed Methods: Mixed methods two phased using thematic analysis. Full research ethics and approach, a survey followed by case studies in Abstract governance approvals were obtained. three diverse settings; utilising focus groups and Background: Undergraduate students face Findings indicated that young people did not individual semi structured interviews. managing increasingly complex lives as they have enough time to prepare for transition, This presentation will focus upon Phase 1, the complete their studies, whilst wrestling with making it difficult to establish relationships survey. Between October 2016 and November a myriad of stressors: relationships, finances, with professionals from adult services. Fur- 2016, registered nurses in Wales were invited academic work, expectations, and transitions, thermore, young people identified the need for to complete an on line/paper based question- to name but a few (Hurst, Baranik and Daniel disease-specific information and information naire, devised for the study; exploring their 2012). Student nurses face the additional chal- about what to expect from the move to adult views about resilience and their work environ- lenges posed by clinical practice and are exposed services. Findings also indicated the potential, ments. Over 1400 nurses participated, responses to the occupational stress associated with this and acceptability by the young people, of mobile were descriptively analysed utilising SPSS and demanding profession (Watson et al 2008). phone applications in meeting some of these Microsoft word. Mindfulness meditation may be a useful addition to student support services, in both promoting needs such as providing reliable information or Results: Early findings from the survey will be wellbeing and positively influencing behaviour allowing the users to interact with others facing discussed within the context of recent research and clarity of thought. similar health needs through a convenient and and policy. As well as implications for the Phase familiar platform. 2 case studies, will be reported. Aim: The study aim was to conduct a preliminary, mixed-method evaluation of the feasibility, This is the first study in England that has Conclusion: The unique findings will inform acceptability, and intervention effect of Mindful- explored the experiences and needs of young practice, education, policy and research of what ness-Based Stress Reduction (MBSR) in student people with liver disease transitioning from works well and what could work better to develop nurses. paediatric to adult services. It has identified resilience of nurses in Wales. To be applied more a number of outstanding needs that need to broadly to influence the health of other nurses Methods: Participants (n=30) were students be addressed in order to enable young people and so in turn, their patients. recruited from a UK undergraduate nursing to have the best outcomes. Mobile technology programme. The Perceived Stress Scale (PSS) appears to be useful but requires further explo- and Sense of Coherence (SOC) questionnaire ration. were administered before and after MBSR; focus groups were conducted following the course.

39 410.05-11am Concurrent session 4 – Thursday 6 April 2017 Outcomes were analysed descriptively and Theme: Qualitative approaches/ Recommended reading list inferentially; effect size (Cohen’s d) was also Kothari, A. R., Bickford, J. J., Edwards, N., calculated. Focus group data was recorded, tran- workforce issues Dobbins, M. J., Meyer, M. (2011). Uncovering scribed verbatim, and thematically analysed for Session no: 4.6.1 Abstract number: 65 Tacit Knowledge: A pilot study to broaden the feasibility issues and participant experience. concept of knowledge in knowledge translation. Results: The study is currently active but phase Time: 10:05am BMC Health Services Research,11, 198-206. 1 of 2 has been completed; the full results will Johnson, M, Magnusson, C , Allan, H T, Evans, be presented at the conference. Interim analysis Delegation and supervision of K, Ball, E , Horton, K Curtis, K And Westwood, suggests improvements in PSS and SOC scores health care assistants’ work S. (2015). Doing the Writing and Working in and compelling data characterising participant in the daily management of Parallel: Issues with learning delegation and experience. Attrition was 28%. Initial review uncertain and the unexpected supervision in the emerging role of the newly of the transcripts demonstrated that mindful- qualified nurse. Nurse ness training changed participants’ general life in clinical practice: invisible Magnusson, C., Horton, K., Westwood, S., Curtis, perspective and connected them to sense of self learning among newly K., Ball, E., Johnson, M., Evans, K., and Allan, H. and compassion. Participants also said that they qualified nurses T. (2014). An Investigation Into Newly Qualified used course techniques to good effect in clinical Professor Helen Therese Allan RN RNT BSc Nurses’ Ability To Recontextualise Knowledge placement and during examinations. Feasibil- PGDE PhD, Centre for Critical Research in To Allow Them To Delegate And Supervise Care ity issues included the time commitment and Nursing and Midwifery, Middlesex University, (Aark): Project course timing. London, UK Discussion: Improving the wellbeing of Co-author(s): Magnusson C, Ball E, Johnson Biography nurses, internationally, may ultimately lead to a M, Horton K, Curtis K, Evans K. higher quality of patient care. Cultivating nurse Helen Allan is Professor of Nursing at Middlesex resilience is crucial in supporting the workforce University. She worked for many years as Abstract through difficult times: mindfulness training Director of the Centre for Reseqarch in Nursing warrants further exploration. Background: Delegation of nursing work to and Midwifery Education at the University health assistants is a development of workforce of Surrey. She is interested in the application of Sociology in Nursing and researches both Recommended reading list planning to substitute a reduced nursing workforce globally. Little is known about how clinical issues in women’s health as well as the Hurst, C. Baranik, L. Daniel, F. (2012) College nurses learn to delegate to assistant workforce. effects of workforce change on clinical learning. student stressors: a review of the qualitative research. Stress and Health. DOI: 10.1002/ Aim: Evans and Guile’s (2012) theory of recon- smi.2465 textualisation is used to explore the ways in which invisible or unplanned and unrecognised Watson, R. Dreary, I. Thompson, D. Li, G. learning takes place as newly qualified nurses Session no: 4.6.2 Abstract number: 165 (2008) A study of stress and burnout in nursing learn to delegate to and supervise the work of students in Hong Kong: a questionnaire survey. the health care assistant. Time: 10:35am International Journal of Nursing Studies, 45, pp1534-1542 Methods: Using an ethnographic case study approach in three hospital sites in England from Exploring nurses experiences 2011-2014, we undertook participant observa- of working within Biography tion, interviews with newly qualified nurses, organisational constraints I am a lecturer in nursing and my PhD was on ward managers and health care assistants. Dr Claire O’Donnell PhD, MSc, RNT, RM, RGN, exploring mindfulness meditation in people Findings: In the British context, delegation Department of Nursing and Midwifery, Uni- living with HIV. This project was applying many and supervision are thought of as skills which versity of Limerick, Limerick, Ireland aspects of my PhD in delivering and evaluating are learnt ‘on the job’. We suggest that learning mindfulness for student nurses, in particular to ‘on-the-job’ is the invisible construction of explore their stress, resilience, and the feasibil- Abstract knowledge in clinical practice and that del- ity of offering some sort of mindfulness teaching Background: Nurses face constant chal- egation is a particularly telling area of nursing within the curriculum. lenges in the healthcare setting which impact on practice which illustrates invisible learning. I have held previous clinical roles and, for years providing quality patient care. These challenges Discussion: The invisibility of nursing work prior to my PhD, I worked as a nurse therapist centre on recruitment, staff shortages, finance has been discussed in the international literature and researcher at The Christie NHS Foundation and poor resources. Developing theory for but not in relation to learning clinical skills. We Trust, Manchester, UK, where my colleagues practice is essential to understand how nurses discuss the invisible ways newly qualified nurses and I delivered therapies like massage, acupunc- provide care in these challenging situations. learn in the practice environment and present ture, and hypnotherapy for maximising patient Aim: The aim of this PhD study was to explore the invisible steps to learning which encompass wellbeing and symptom control. We adopted a nurses’ main concern when caring for patients the embodied, affective and social, as much as pragmatic and research-focused approach where in the acute general care setting and look to how the cognitive components to learning. we acknowledged the evidence base and contrib- they resolve this concern. Conclusion: We argue that there is a need for uted heavily to it. Method: A classic grounded theory approach greater understanding of the ‘invisible learning’ was utilised where 32 registered general nurses which occurs as newly qualified nurses learn to were interviewed and 20 hours of observations delegate and supervise at a time when the global were undertaken. Data analysis was undertaken qualified nursing workforce takes on more in accordance with classic grounded theory highly skilled work and delegates direct patient methodology. Initial data collection began in care to assistant workers. 2010 and the study was completed in 2016. Results: The main concern for nurses caring for patients in the acute general care setting centres around working within constraints. Constraints in the workplace cause nurses to

40 10.05-11am Concurrent session 4 – Thursday 64 April 2017 engage in a series of behaviours endeavouring Results: HCPs perceptions of patients’ sexual Session no: 4.7.2 Abstract number: 286 to deliver care. The theory generated to resolve health needs differed from those expressed by this concern is the theory of Resigning which patients. HCPs conceptualised sexual wellbeing Time: 10:35am consists of three phases; idealistic striving, in terms of physical function. Although HCPs resourcing and care accommodation. acknowledged the importance of sexual health- Exploring the views and Discussion: The challenges in practice are care, it was not given priority. In contrast, experiences of primary many and varied. Nurses need to consider how patients expected and welcomed information healthcare professionals challenges are looked at, understood, explained about the effects of CVD on sexual wellbeing. (HCPs) who deliver sexual and managed. Working with challenges in Though patients felt it was the responsibility of and reproductive health practice over a long period of time may result HCPs to provide sexual health information and in burnout and reduced quality care. Nursing subsequent care, this was often not received. (SRH) services to unmarried theory needs to underpin current practices to Some participants expressed their willingness adolescents in Malaysia. provide insight and explanations as a fundamen- to discuss experiences of sexual health adversity Mrs Siti Hazariah Abdul Hamid Msc, The Uni- tal in providing good quality patient care. with a HCP who they had rapport. In the absence versity of Manchester, Manchester, UK of information and subsequent care, patients felt Conclusion: Knowledge of this theory has Co-author(s): Debbie Fallon, UK, Peter Callery, they had to accept their experiences of sexual the potential to enable nurses to deal with the UK adversity in silence, detrimentally impacting constraints placed upon them when caring for their self-concept and intimate relationships. patients in acute general care settings. This Abstract theory adds to the current knowledge around the Discussion: Sexual health needs of patients Information about contraception and safe sexual provision of care. are often neglected within the context of CVD. Despite recognising the importance of sexual practices are still not delivered formally to ado- health wellbeing, HCPs often feel ill-equipped lescents in health clinics and schools in Malaysia. Biography in relation to the provision of sexual healthcare. Concurrently, unintended teenage pregnancy Claire is a lecturer in the Department of Nursing and the practice of ‘baby dumping’ are serious Conclusion: HCPs and patients require and Midwifery at the University of Limerick, public health issues amongst unmarried ado- education and support to promote sexual health Limerick, Ireland where she teaches on both lescents. Research in other countries has high- wellbeing and optimal healthcare outcomes undergraduate and postgraduate nursing pro- lighted several factors influencing effectiveness for individuals with CVD. Further research is grammes. Her areas of research to date include of SRH services to adolescents including com- needed to determine how best to support HCPs general nursing care, stroke care, transcultural prehensive sexual education, friendly services and patients’ needs in relation to sexual health care, breastfeeding and internationalisation. She and the use of contraception. Little is known care. completed her PhD study which she is present- about the provision of sexual healthcare for this ing here today in June 2016. group since this has not been examined in-depth Biography in a Malaysian context. Therefore the explora- Associate Professor East is an experienced nurse tion of the experiences and views of HCPs who researcher, and a clinician in the fields of sexual deliver SRH advice and treatments to adoles- health and primary health care. A key objective cents is paramount to understand the situation of her research and scholarship has focused on in primary health care settings. A further aim Theme: Qualitative approaches marginalised groups and conditions, and those was to understand how HCPs’ cultural and Session no: 4.7.1 Abstract number: 100 vulnerable and/or stigmatized as a result of religious beliefs might impact upon the SRH societal norms and/or social determinants of service they provide to adolescents. This was Time: 10:05am health. She has successfully completed a number a qualitative study informed by a pragmatic of funded studies in the fields of sexual health approach. Thirty one HCPs were interviewed Cardiovascular disease and and family disadvantage. Dr East is an experi- between October 2015 and April 2016. Data sexual wellbeing: perceptions enced qualitative researcher, publishing across a were analysed using the principles of grounded and experiences of healthcare wide range of nursing topics. As an experienced theory analysis. The findings indicate that SRH nurse educator, she also actively pursues on provision to adolescents was restricted due professionals and patients research teaching and learning. Dr East was a to socio-cultural and religious beliefs which Dr Leah East PhD, University of New England, visiting research fellow at Oxford Brookes Uni- impact HCPs’ practice and the quality of service Armidale, Australia, Armidale, Australia versity, Faculty of Health and Life Sciences in delivered to adolescents in Malaysia. It has been 2016. She has held the position of Counsellor suggested that SRH provision was given low Abstract of the UWS Xi Omicron chapter for The Sigma priority and become unpopular service amongst Background: Cardiovascular disease (CVD) Theta Tau, Honour Society of Nursing. HCPs in the primary health care system. This is a leading cause of morbidity and hospital situation deprived adolescents from getting admission. Although the symptoms and com- accurate information to make informed choices plications of CVD vary, sexual adversity is com- and decision regarding SRH. It is clear that monplace. access to SRH services by young people has been affected by the constrains in service delivery Aim: To explore the experiences and percep- and underdevelopment of SRH provision. The tions of patients and healthcare professionals evidence generated from this study can assist in (HCPs) regarding the provision of sexual health- the development of the strategies to improve the care within the context of CVD. quality of care and facilitate the changes in SRH Methods: A convenience sampling method was support provision to adolescents in Malaysia. used to recruit HCPs and individuals who had been diagnosed with CVD. Nine HCPs inclusive Biography of 7 Registered Nurses and 13 patients partici- Miss Hazariah Hamid pated in this study. Data were collected between October 2015 and August 2016, and subject to Designation: Tutor at Islamic University of thematic analysis. Malaysia (IIUM)

41 410.05-11am Concurrent session 4 – Thursday 6 April 2017 Academic: ViPER She holds a joint appointment with Heart of • PhD candidate, School of Nursing , Midwifery, England NHS Foundation Trust. Her interests Social Work, The University of Manchester, 4.8.1 Abstract number 296 include workforce development including, the September 2014 till present creation and sustainability of research clinical Excuse me, I want to be a academic roles and maternal health, with a • Master of Community Health Sciences, particularly interest in perinatal mental health. National University of Malaysia (UKM) research clinical academic, She co-chairs the AUKUH Nursing, Midwifery 2010-2012 can you help? and AHP (NMAHP) National Clinical Academic • Bachelor of Health Science (Nursing), Univer- Professor Debbie Carrick-Sen, University of Role Development Group and is a member of the sity Science of Malaysia (USM) 2002-2006 Birmingham, UK National HEE Nursing and Midwifery Advisory Employment: Dr Amelia Swift, UK; Lisa Shepherd, UK; Amy Group. Kerr, UK • Head of Department, Department of Special- Debbie has research expertise in mixed meth- ized Care Nursing IIUM, odology. Her primary focus is in the develop- Abstract ment and execution of randomised controlled • Teaching Subject : Community health Nursing, trials and application of complex interventions. Medical Surgical Nursing, Peadiatrics Nursing There is a National aspiration to grow the number of Nurse, Midwife, and Allied Health She has a strong profile for the attainment of • Staff Nurse: Tengku Ampuan Afzan Hospital Professional (NMAHP) research clinical NIHR funding, especially, supporting NMAHP’s 2008-2009 academics from 0.01% to 1% by 2030 (AUKUH, to attain NIHR Clinical Academic Training fel- Committee: 2014). A number of National organisations have lowships and a growing publication and grant • Facilitator for Problem Based Learning developed and published helpful guides and capture record. In 2011 she was nominated by information to advise and support individu- the Department of Health as one of the top 100 • Examination Coordinator als as well as employing and partner organisa- nurse leaders in the NHS and in 2012 attained • OSPE Coordinator (objective Structural tions. This interactive ViPER session will use a National Florence Nightingale Foundation Practical Examination) three real life case studies (at early, mid and Executive Leadership Scholarship. • Breastfeeding Program Coordinator senior career) to explore key issues, enablers, Professional registration: concerns and potential solutions to maximise opportunities, support, organisation capacity • Committee Member of MNA (Malaysia Nursing building and personal development, utilising Association) existing resources. Available resource includes • Member of QRAM (Qualitative Research Asso- the new AUKUH transforming healthcare ViPER ciation Malaysia) through clinical academic roles (2016), building 4.8.2 Abstract number 270 • Registered Nurse your research career (2016) and NIHR individual support guide (in press). The case study Area of Interest: Experiences of a clinical presenters (co authors) will use a mini 2-minute leadership programme and • Adolescent, Sexual and reproductive health. rapid oral and visual presentation to explain and explore key issues, concerns and enablers. The its impact: a constructivist lead author will respond and provide the expert inquiry review, identifying available resource to assist or Susan Sloan, RGN, Dip DN, RNT, PgCTLHE, improve issues. This will be followed by an inter- NHS Lothian, UK active discussion with the audience regarding Co-author: Professor Jayne Brown, England availability and use of available resource to promote, support and embed research clinical Abstract academic roles. Introduction: The Delivering Better Care Recommended reading list Leadership Programme (DBC LP) has been AUKUH (2010) National Clinical Academic introduced in one Scottish Health Board. It Roles Development Group for Nurses, Midwives uses the Senses Framework (Nolan et al, 2006) and Allied Health Professionals, http://www. as philosophical underpinning, facilitation and aukuh.org.uk/index.php/affiliate-groups/ delivery mechanism. There is minimal evidence nmahps Accessed 14 November 2016 of the impact of clinical leadership development Carrick-Sen, D; Richardson, A; Moore A; programmes. Dolan, S (2016), Transforming Healthcare This ViPER will present an overview of the Through Clinical Academic Roles in Nursing, research study aims, design and exploration of Midwifery and Allied Health Professions: A emerging themes. Practical Resource For Healthcare Provider Research aims: To explore the perspectives of Organisations, AUKUH, London http://www. Nurses, Midwives and Allied Health Profession- medschools.ac.uk/SiteCollectionDocuments/ als: Transforming-Healthcare.pdf Accessed 14th November 2016 • Motivations and expectations of the programme; NIHR (2016) Building your research career handbook http://www.nihr.ac.uk/documents/ • Experiences and whether expectations change faculty/Building-a-research-career-handbook. over time; pdf Accessed 14th November 2016 To develop an understanding of potential long Biography term impacts and factors that facilitate and hinder these. Debbie is a Florence Nightingale Founda- tion Clinical Chair in Nursing and Midwifery Study Design: Using a constructivist approach Practice Research at University of Birmingham. this longitudinal qualitative study comprises 3 phases:

42 10.05-11am Concurrent session 4 – Thursday 64 April 2017 Phase 1 Elements A and B (September 2015 - May 2016). Element A - participants starting the DBC LP in September 2015 (n=9) and their managers. Semi-structured interviews analysed using a Grounded Theory approach (Strauss and Corbin, 1990). Element B - case studies of past participants (n=5), involving their manager, a junior colleague and peer. Phase 2 (August 2016 - April 2017) will explore the participant’s experience on completion of DBC LP, as well as manager’s and colleague’s views. Phase 3 (August 2017 - April 2018) will explore participant’s, manager’s and colleague’s perceptions of impact and how this is influenced or not over time. Progress to Date: Phase 1 data analysis is underway using a constructivist inquiry method (Rodwell, 1998) and is informing Phase 2. Early themes include participants feeling valued having been given permission to develop and lead, which creates a sense of significance. The role of manager is fundamental in developing effective working relationships and on-going support. The findings will inform policy and practice by contributing new evidence to enable individuals, teams and organisations to maximise any impact following leadership development. (300 words)

Recommended reading list Nolan M., Brown J., Davies S., Nolan J., Keady J. (2006) The Senses Framework: Improving Care for Older People through a Relationship Centred Approach, Getting Research into Practice (GRIP) Report No 2 Rodwell M.K. (1998) Social Work, constructivist research, Taylor and Francis Strauss, A.L. and Corbin, J.M. (1990) Basics of Qualitative Research. Sage. Newbury Park,CA.

Biography Sue Sloan has developed considerable expertise in the art and science of nursing throughout her career, which spans 3 decades within the NHS. Over the past 13 years, working as Lead Practitioner Clinical Leadership, has provided the opportunity for Sue to develop professionally as a leadership resource for the workforce, enhancing skills in relation to facilitation, coaching and staff engagement. Sue starts a new role as Organisational Development Consultant in November 2016. Sue is currently a part-time PhD student at De Montfort University, embracing the challenges of working full-time, whilst navigating the research world and developing skills as a researcher, which she is thoroughly enjoying! Sue is passionate about enhancing patient and staff experience, and is committed to develop leadership capacity and capability of staff at all levels of the workforce.

43 511.30am-12.55pm Concurrent session 5 – Thursday 6 April 2017 Concurrent session 5 Thursday 6 April 2017 11.30am-12.55pm

engagement in authentic practice is at its core. ing Care after Treatment’ (TCAT) programme Theme: Mixed methods There is scope to be flexible and inventive as in Scotland: implementation of 25 projects, Session no: 5.1.1 Abstract number: 243 student demographics and learning needs vary each with different local approaches to sup- across a study program. The point of transition porting people to live with and beyond cancer. Time: 11:30am from student to beginning practitioner is a target A key evaluation question is ‘To what extent has for innovation, as is greater flexibility to accom- the programme been successful at influencing Undergraduate nurse clinical modate the needs of the student and address attitudes, behaviours and priorities related to education: an appreciative diversification within healthcare care. after care locally, regionally and nationally? dialogue to explore Conclusion: In the changing healthcare This presentation will showcase our results from innovative approaches. landscape, this is a pivotal time for nurses - cli- two programmes of research, highlighting indi- nicians, academics, and researchers - to promote cators of positive change at practice level for Ms Jan Forber MSc, BSc, RN, Faculty of creativity and quality in designing clinical CNS over the last five years. Health, University of Technology Sydney, learning experiences to meet future need. Sydney, Australia Material and method: A longitudinal mixed methods study of two key projects in transfor- Co-author(s): Michelle DiGiacomo, Australia, Biography mational change. Data collected from focus Bernie Carter, UK, Patricia Davidson, USA, group (n = 6) discussions with CNS (2011); Jane Phillips, Australia and Debra Jackson, UK Having worked both clinically and in education in the UK and Australia, Jan is currently a survey of TCAT wider stakeholders (n=195) lecturer in the Faculty of Health, Univer- (2015 and 2016); local project focus group, at Abstract sity of Technology Sydney. She is involved in two time points (n = 5); stakeholders at two time Background: Clinical experiences are a vital teaching in undergraduate and post graduate points (n=10). component of preparatory nurse education programs with a focus in acute care nursing and Results and Discussion: Data prior to the programs. Internationally, however, reports infection prevention and control. Jan is com- TCAT programme showed that despite policy indicate providing sufficient quality experiences pleting her PhD studies in the field of under- developments relating to cancer survivorship, is increasingly challenging, as the demand for graduate nurse clinical education, exploring challenges remained in terms of the interface student placements intensifies to address nurse the varied approaches taken to the provision of between different professional roles and shortages and growth in healthcare provision. this component of nursing programs and the responsibilities. Three years later, analysis of Aims: This study aimed to identify factors that innovations and challenges across international survey data reveals that over one in 4 respond- ‘work well’ in clinical education and to envision boundaries. Jan has an active keen interest the ents (28%) thought that TCAT has influenced ‘what could be’ in the design of innovative, sus- incorporation of simulation as a teaching and attitudes and behaviours related to after care ‘to tainable clinical learning experiences for the learning strategy at undergraduate and post a great extent’ and a year later two-fifths (41%) future. graduate levels. As part of this she has contrib- reported this highest level. Pre and post project Methods: Guided by an Appreciative Inquiry uted to capacity building strategies for academic focus groups reveals integrated working and framework, a case study design explored clinical staff via a range of training and development ini- partnerships evolving. tiatives at local and national levels. education in two nursing programs: one in the Conclusion: By combining two programmes of UK and one in Australia. Data was collected research Edinburgh Napier University has been using semi structured interviews (academic and able to demonstrate significant transformational administrative staff n=43) and questionnaire change over 5 years influencing attitudes, behav- (staff n=5, final year students n=78). Thematic Session no: 5.1.2 Abstract number: 197 iours and priorities related to after care of people analysis and cross case synthesis were under- with cancer locally, regionally and nationally. taken. Time: 12pm Findings: Three major themes emerged from Biography the data: A longitudinal mixed methods Karen joined Edinburgh Napier University in The unique student journey: engaging in study of transformational 2005 as a Macmillan Practitioner in Cancer authentic practice and ‘becoming’ a nurse. change: indicators of positive Nursing with her teaching commitments spanning both the University and the Edinburgh Bridging healthcare care and education: change in cancer after care cancer centre. In 2011 Karen was awarded a practical and organisational factors across two services. grant from Macmillan cancer Support to develop complex systems Miss Karen Campbell BSc(Hons), MN, and deliver a sustainable cancer education Connecting with the past, creating the future: Edinburgh Napier University, Edinburgh, UK strategy for practitioners caring for people living influences driving the evolution of clinical Co-author(s): Lucy Johnston with and beyond cancer. In 2014 Karen became education a co-lead for the evaluation of the transforming Discussion: Providing meaningful clinical Abstract Care after Treatment’ Scottish programme. learning experiences is dependent on under- Introduction: Edinburgh Napier University Karen’s is currently completing her Clinical standing the complex myriad of influences (ENU) have conducted a programme of educa- Doctorate in Nursing at Stirling University. spanning individual, organisational and profes- tional research since 2011 on the transforma- Karen is an active, member of East of Scotland sional contexts. Re-connecting a shared health- tional change of the Cancer Nurse Specialist Haematology Nurses Group and peer reviews for care and education sector objective in developing (CNS) workforce. In addition, since 2014, ENU Cancer Nursing, Cancer Nursing in Practice and a beginning practitioner is vital and facilitating is carrying out an evaluation of ‘The Transform- Nurse Education in Practice.

44 11.30am-12.55pm Concurrent session 5 – Thursday 65 April 2017 Session no: 5.1.3 Abstract number: 7 Biography research. If mediation is demonstrated, it may be possible to use electronic records of complete Time: 12:30pm Daniel Muya, Nursing officer and a part-time lecturer-mount Kenya - Kenya. A PHD student and timely observation as a leading indicator of - Jomo-Kenyatta University-Nairobi (Midwifery staffing adequacy. Determinants of place of Nursing) delivery among women of Recommended reading list childbearing age seeking child GRIFFITHS, P., BALL, J., DRENNAN, J., welfare services in Kandara DALL’ORA, C., JONES, J., MARUOTTI, A., Sub County, Murang’a County POPE, C., RECIO SAUCEDO, A. and SIMON, M. 2016. Nurse staffing and patient outcomes: Mr Daniel Gachathi MA, Nursing Officer and Theme: Quantitative/workforce Strengths and limitations of the evidence to Lecturer, Mount Kenya University, Nairobi, inform policy and practice. A review and discus- Kenya Session no: 5.2.1 Abstract number: 121 sion paper based on evidence reviewed for the Co-author(s): Dr Rosemary Okova-Kenya, Ms Time: 11:30am National Institute for Health and Care Excel- Fransisca Mwangangi lence Safe Staffing guideline development. Int J Nurse staffing, missed vital Nurs Stud, 63, 213-225. Abstract signs observations and Maternal and child mortalities are major health mortality in hospital wards. Biography problems in developing countries. Most of these Professor Peter Griffiths BA(Hons), PhD, RN, Peter Griffiths is Chair of Health Services deaths are avoidable if women seek delivery care NIHR CLAHRC (Wessex) / University of South- Research at the University of Southampton, services from health professionals. ampton, Southampton, UK England. He is head of the Health Work and The aim of the study was to assess the determi- Systems Research Group and co-lead of the Co-author(s): Missed Care Study Group nants that influence the place of delivery among fundamental care in hospitals research theme mothers. of the National Institute for Health Research Abstract The study looked on how social demographic Collaboration for Leadership in Applied Health Background: Despite many studies demon- characteristics, knowledge on safe mother- Research and Care (Wessex). strating associations between low nurse staffing hood, attitude toward health facility delivery His research focuses on the nursing workforce. levels and higher hospital mortality, the signifi- and accessibility to health facilities influenced He led on outcomes data for the international cance of these findings remains unclear. Few the choice of place of delivery among mothers in RN4CAST study and worked with the National studies have directly linked patients’ exposure Kandara Sub County. Institute for Health and Care Excellence to to low staffing to outcomes and the mechanism The researcher was cleared by the university review evidence for its safe staffing programme through which staffing levels influence mortality and is now undertaking similar work for NHS ethics committee and by the relevant adminis- is unclear (Griffiths et.al. 2016). trations. Respondents privacy, confidentiality Improvement to develop further guidance. Aims: This study aims to explore whether risk and anonymity were ensured throughout the Current research includes studies examining of death is associated with the staffing levels and research process. associations between nurse staffing, missed nursing care experienced by individual patients. vital signs observations and mortality in acute A facility-based cross-sectional survey design Specifically, the study explores: hospital wards, and the costs and consequences was used. pretest of data collections tools in • Associations between patients’ exposure to of the use of the ‘Safer Nursing Care Tool’ to three health facilities was carried out. variation in staffing and risk of death determine nurse staffing levels. The study population was mothers recently • Associations between staffing levels and com- Alex Recio Saucedo is a research fellow in the delivered within a 12 month prior to the study pliance with vital signs monitoring Health Work. Her current research is focused and seeking Child Welfare services at the on nurse staffing and she was part of the team selected health facilities in the Sub County. • Whether compliance with vital signs monitor- that undertook evidence reviews for NICE’s safe Simple random and purposeful sampling ing partially mediates any relationship between staffing guidance. methods were used to identify the facilities . staffing and patient outcomes The desired sample size (352) respondents was Methods: This study uses routinely collected calculated using Fishers et,al 1998 formula. clinical data, records from a system for recording Respondents were identified using systematic vital signs electronically and data from an elec- random sampling method. tronic roster system from 32 general medical / Session no: 5.2.2 Abstract number: 101 Data analysis was done using frequencies and surgical wards in one large NHS hospital. We Time: 12pm percentages. Computer software, Statistical will explore associations between staffing levels, Package for Social Sciences (SPSS) was used to vital signs observations and clinical outcomes Exploring nurse staffing skill analyze the quantitative data. Content analysis using multivariable mixed models. Qualitative data done and results triangulated mix and its effect on quality Results: Over three years we obtained useable of interactions in UK hospital The study found that social demographic (p data on approximately 690,000 nursing shifts, value 0.034), knowledge on safe delivery p value 107,000 patients and 3,000,000 sets of vital wards. of (0.047), accessibility to delivery services signs observations. We will present analyses Miss Emily Oliver BSc Mental Health Nursing, (p value 0.049) all had a significant positive focussing on the relationships between staffing University of Southampton, Southampton, UK influence on the choice of place for delivery. levels that a patient is exposed to (e.g. periods Co-author(s): Ruth Kippering, England. Ines Attitude towards health facility delivery (0.050) where staffing falls below 75% of the required Mesa Eguiagaray, England. showed no significant care hours per day), mortality rates and vital signs observation compliance. The study recommends appropriate strategies Abstract Discussion/Conclusions: Because timely that will influence mothers to make informed Over recent years there has been a growing body observation of deterioration has been hypoth- choice for the place of delivery. of research demonstrating associations between esised as a key mechanism that is disrupted low registered nurse staffing and adverse patient by low staffing, this study will shed light ona safety outcomes in hospitals. A more limited key unresolved issue in this important body of

45 511.30am-12.55pm Concurrent session 5 – Thursday 6 April 2017 evidence base has shown associations between missed vital signs observations and mortality Biography staffing levels and patient reported experience. in acute hospital wards, and the costs and con- After completing my BSc in Nursing and qualify- While missed opportunity to deliver needed care sequences of the use of the ‘Safer Nursing Care ing as a registered nurse, I was awarded a MSc in has been identified as an important mechanism Tool’ to determine nurse staffing levels. Nursing and Midwifery by the UniversitÃ degli explaining the link between low staffing and Studi di Milano Bicocca (Italy); I then decided adverse outcomes, no research has directly to pursue my research interests by enrolling for explored care delivery. In this study we aim to a PhD at the University of Southampton. Here determine if there is an association between Session no: 5.2.3 Abstract number: 116 I currently hold a position of visiting researcher nurse staff levels, skill mix and the quality of for the NIHR CLAHRC Wessex, where I col- relational care that patients receive. Time: 12:30pm laborate daily with a team of national experts in Setting: Data were gathered at two acute workforce organisation. English NHS hospitals in 2015. Six wards for The association of nurses’ My current research interest focuses on the adult patients participated including medicine shift characteristics and organization of the nursing workforce, par- for older people (n=4), urology (n=1) and ortho- sickness absence ticularly on shift work, and its implications for paedics (n=1). Mrs Chiara Dall’ora RN, BSc, MSc, NIHR patient and nurse outcomes, such as patient Methods: Patients were randomly selected CLAHRC Wessex, Faculty of Health Sciences, safety, missed nursing care, nurses’ intention to for observation during 2h observation sessions Southampton, UK leave, nurse job satisfaction and absenteeism. I determined from a balanced random schedule have extensive knowledge of shift work, both for (Monday-Friday, 08:00-22:00h). Staff-patient Co-author(s): Peter Griffiths, UK; Jane Ball, my experience as a registered nurse, and for the interactions were observed using the Quality of UK; Alejandra Recio-Saucedo, UK; Antonello research that I have been carried out since 2013: Interactions Schedule, a validated tool evaluat- Maruotti, UK; Oliver Redfern, UK I analysed data from a large European study, ing the quality of social interactions between the RN4CAST study, to explore the relationship staff and patients. The number of nursing staff Abstract between nurse working hours and measures and patients presented were recorded. Multi- Background: Aspects of shift work have been of care, quality/safety outcomes, and nurse level logistic regression models were used to associated with negative impacts on nurses’ outcomes. determine associations between staffing levels, wellbeing; however, previous studies used sub- The results of this study have been published on skill mix and the odds of negative interactions jective measures, failing to capture the com- an international journal and I have presented between staff and patients, controlling for plexity that encompasses shift work and related them at several international nursing confer- patient and other contextual factors. outcomes. ences. Results: 3111 interactions involving 273 Aim: To investigate the association between patients were observed in 120 sessions. We will shift work characteristics in acute hospital wards report the associations between nurse staffing and sickness absence. levels (RN, HCA) and the odds of a negative Methods: A retrospective observational study interaction. using routinely collected data from March 2012 Conclusion: This study is an important step to March 2015. The study took place in all acute Theme: Review forward because most previous studies have inpatient general wards at a teaching hospital Session no: 5.3.1 Abstract number: 194 been cross-sectional at a hospital level, with in England (n=32). Shift and sickness data no direct linkage between staffing levels expe- were extracted from an electronic system that Time: 11:30am rienced by patients and the outcome observed. contains individual records of shifts worked, Results will shed light on whether staffing levels dates, start and end time, ward and grade for The theory-practice gap: also influence the quality of interpersonal care all nurses employed by the hospital. General- concept analysis and whether associations with quality relate to ised linear mixed models were used to model Mrs Kathleen Greenway MEd, RNT, RN, any particular staff groups. the association between shift work characteris- Oxford Brookes University, Oxford, UK tics (i.e. length of the shift, day/night shift) and Biography spells of absence. We controlled for nurse grade; Abstract wards and nurses’ ID numbers were included as Peter Griffiths is Chair of Health Services The theory-practice gap: concept analysis Research at the University of Southampton, random effects. Background: It is commonly recognised that England. He is head of the Health Work and Results: We accessed 633,525 nurses’ shifts. the nursing profession and, within this, nurse Systems Research Group and co-lead of the Overall, there were 8847 absence spells and education faces a persistent ‘theory practice fundamental care in hospitals research theme 1712 out of 2049 (84%) of staff had at least one gap’ (Rolfe, 2002, Monaghan, 2015). For this of the National Institute for Health Research absence period. Nurses were more likely to call EdD thesis, the primary aim of the research Collaboration for Leadership in Applied Health in sick if the shift was >12 h long, compared to project was to investigate the experiences of Research and Care (Wessex). Previously he an >8 h shift (OR=1.65;95% CI= 1.54-1.77). If 2nd year student nurses in relation to a theory- was director of England’s National Nursing staff was unregistered, they were more likely practice (T-P) gap through the administration of Research Unit at King’s College London, funded to call in sick than a registered nurse (OR= IM injections. However as no definition of the by the Department of Health’s Policy Research 1.45;95% CI=1.29-1.63); if the planned shift was T-P gap existed within the literature and with Programme. Peter has been executive editor of a night shift, nurses were less likely to miss it the term often being used in a ubiquitous but the International Journal of Nursing Studies (OR=0.79;95% CI= 0.73-0.85). implicit way, a concept analysis of the T-P gap since 2005. His research focuses on the nursing Discussion: The relationship of >12 h shifts was deemed necessary. workforce. He led on outcomes data for the and absenteeism suggests that these longer shifts international RN4CAST study and worked with may lead to loss of productivity and increased Data Sources: Literature was retrieved from the National Institute for Health and Care Excel- expenses, due to necessity to hire agency staff searches of the CINAHL, MEDLINE, PUBMED, lence to review evidence for its safe staffing to cover missed shifts. A similar association was BNI and BEI databases covering the years 2005- programme and is now undertaking similar found for unqualified staff. 2016. work for NHS Improvement to develop further Conclusion: >12 h shifts routine implementa- Review Methods: This was performed in guidance. Current research includes studies tion and nurse substitution on the basis of cost May-June 2016, using Rodgers’ (2000) evolu- examining associations between nurse staffing, savings should be questioned. tionary framework, to provide the clarity and

46 11.30am-12.55pm Concurrent session 5 – Thursday 65 April 2017 definitions to the term ‘theory-practice gap’ Session no: 5.3.2 Abstract number: 56 maternal and child health: qualitative evidence requisite for the research project, in addition synthesis. Cochrane Datab to understanding its application within nursing Time: 12pm and its implications for nurse education. Biography Is comprehensive searching Results: Three antecedents, three attributes Helen Aveyard is Senior Lecturer at Oxford and two consequences of the T-P gap were found, always necessary in an Brookes University. Prior to this she held a the central one for each being respectively: undergraduate literature research scholarship in Health Care Ethics at • The education and acquisition of nursing skills review? King’s College University of London where she undertook a doctoral study examining the ways • Practice fails to reflect theory Dr Helen Aveyard PhD, MA, PDCE, BSc (hons) RGN, Oxford Brookes University, Oxford, UK in which informed consent is addressed by • How the T-P gap influences nurses and nursing nurses prior to nursing care procedures. Helen students. Abstract is a registered nurse and has had five years In accordance with Rodgers’ framework a model clinical experience caring for people with HIV/ case (Cornish and Jones 2007) was also iden- Background: Students often undertake a lit- AIDS. She has presented and published widely tified, which evaluated moving and handling erature reviews as the dissertation component on nursing ethics and health care research, training for student nurses and its application to of their final year of an undergraduate nursing including a series of books; ‘Doing a Literature practice. degree. This is because literature reviews are Review in Health and Social Care’ now in its defined pieces of work that can be completed in a 3rd Edition which was nominated for a British Conclusion: This concept analysis sought to short space of time and brought to a conclusion, provide clarity to the term ‘theory-practice’ gap Medical Associated award in 2015, ‘A Beginner’s while displaying a wide appreciation of research Guide to Evidence Based Practice’ (2nd Edition) by giving explanations, causes, context and con- methods. As research methods for doing a lit- sequences. Within nursing there remains unease with Pam Sharp and ‘A Beginner’s Guide to erature review have developed, largely due to Critical Thinking and Writing’ with Pam Sharp and discomfort at the existence of a T-P gap, the influence of the Cochrane Collaboration, with concern about the consequential effects and Mary Woolliams which was nominated for so have our expectations increased regarding a British Medical Association Award in 2012. such as potential cognitive dissonance and its the methods used by undergraduates (Aveyard, ramifications. Suggestions of how resolution can A postgraduate text ‘A post-graduate’s guide Payne and Preston 2016). Traditional Cochrane to doing a literature review’ was published in be sought within nursing and nurse education methods for doing a review require a fully com- will be discussed. early 2016, written with co-authors Sheila Payne prehensive search however this can be unreal- and Nancy Preston. Helen has also co-authored istic for a student researcher and is sometimes ‘Nursing Research’ , the 3rd edition of which was Recommended reading list considered to be unnecessary. published by Sage in November 2016. Monaghan, T. (2015) ‘A critical analysis of the Aim of the session: To consider the extent to literature theoretical perspectives on the theory- which the student is expected to uncover and practice gap amongst qualified nurses within incorporate all the literature that relates to the the United Kingdom’, Nurse Education Today, research question and when, if at all, a smaller Session no: 5.3.3 Abstract number: 29 35(8), pp. e1-e7. sample is sufficient. Cornish, J. and Jones, A. (2007) ‘Evaluation Methodological discussion: The arguments Time: 12:30pm of moving and handling training for pre-regis- for and against the use of a sample of litera- tration nurses and its application to practice’, ture in a review will be considered. There are The state of qualitative Nurse Education in Practice, 7, pp. 128-134. examples in the literature of systematic reviews research in health and social Rolfe, G. (2002) Closing the theory-practice gap. in which authors argue that a sample is sufficient science literature: findings Edinburgh: Elsevier Science Limited. (Glenton et al 2013) and where a comprehensive approach to searching has been advocated (Toye, from a focused mapping Biography Seers and Barker 2014). There are methodologi- review and synthesis cal justifications for both approaches, which will Kathleen Greenway is a Senior Lecturer in Dr Caroline Bradbury-Jones, University of be explored. This is an important question, given Adult Nursing in the Faculty of Health and Birmingham, Birmingham, UK the need for a pragmatic yet methodologically Life Sciences at Oxford Brookes University. Co-author(s): Jenna Breckenridge UK; Maria defensible approach for undergraduate research Kathleen completed her Registered General Clark UK; Oliver Herber Germany; Julie and one that requires close scrutiny. Nurse training at the Oxford School of Nursing Taylor UK; Christopher Wagstaff UK and later completed a BSc in Nursing Studies Conclusions: This presentation and subse- and Registered Nurse Tutor qualification at the quent discussion will describe and analyse the Abstract different approaches to literature searching and University of Hull. After qualification, Kathleen Background: Pluralism and creativity are examine what approaches are suitable in under- had six years clinical experience in Gastrointes- inherent and important parts of the qualitative graduate dissertation. tinal Surgery and two years in Geratology. She endeavour. The multiplicity of approaches and then spent two years working for Oxfordshire methods can, however, be confusing. Mental Healthcare Trust as a tutor/facilitator, Recommended reading list and during this time she completed her MA Methods: We undertook a focused mapping Aveyard H, Payne S and Preston N (2016) A review and synthesis which is a development in Education at the Open University. In 2000, post-graduate’s guide to doing a literature Kathleen joined Oxford Brookes University as a of a mapping review as described by Grant and review in health and social care. Open University Booth (2009). The aim was to profile the rela- Senior Lecturer on the adult nursing programme. Press. Maidenhead Kathleen is currently a final year student on the tionship between qualitative researchers’ philo- Toye F, Seers K, Barker K(2014) a meta-ethnog- EdD programme at Oxford Brookes University, sophical claims and their actual methodological raphy of patients experiences of chronic pelvic where the title of her thesis is ‘An investiga- practices in the context of reporting in health pain: struggling to construct pelvis pain as ‘real’. tion into the effects of a theory-practice gap on and social science journals. Journal of Advanced Nursing 70(12) 2713-2727 student nurses’ understanding of administering Results: We retrieved 102 qualitative articles intramuscular injections. Glenton C, Colvin CJ, Carlsen B, Swartz A, published between January and March 2015 Lewin S, Noyes J, Rashidian A (2013). Barriers from six prominent health and social science and facilitators to the implementation of lay journals - including nursing journals. health worker programmes to improve access to

47 511.30am-12.55pm Concurrent session 5 – Thursday 6 April 2017 Using Creswell’s (2013) ‘Five Approaches’ to Research design: Each of the 5 studies Session no: 5.4.2 Abstract number: 154 qualitative research, articles were scrutinised employed a qualitative methodology (either for alignment between researchers’ reported Grounded theory / Phenomenology). Each study Time: 12pm orientation (methodological or philosophical secured appropriate Human Research Ethics positioning) and the techniques used (methods). Committee approval. Studies involved a wide The heart of caring: using Findings led to the development of a pedagogical range of healthcare professionals (predomi- storytelling to influence resource/teaching aid: the Qualitative Research nantly nurses), involved both genders and took cultures of caring Level of Alignment Wheel™. This diagrammatic place in the UK and Australia between 2001 Mrs Karen Tuqiri Bachelor of Nursing, representation is designed to assist qualitative and 2015. The studies employed questionnaires Masters of Health Leadership and Manage- researchers (particularly those more novice) and and interview methods. Data was analyzed with ment, masters of Health Administration, South research students to locate the orientation and SPSS and NVivo data analysis software. East Sydney Local Health District, Sydney, techniques of their studies and to understand Results: The data points to an understand- Australia and account for points at which they meld tech- ing of the common characteristics most or least niques or blend different orientations. associated with clinical leaders. The results have Abstract Conclusions: In this presentation we will also led to the development of a new leader- explore the methodology used as one that is new ship theory: Congruent Leadership. This theory Background: Within a complex health context to nursing and present the Qualitative Research suggests that leaders demonstrate a match (con- there has been increasing emphasis in policy, Level of Alignment Wheel™. The presentation gruence) between the leader’s values and beliefs, practice and research on the caring dimension will appeal to delegates interested in qualitative and their actions (Stanley 2008, 2011 and 2016). of healthcare .Recent international reports have research. identified the need for a caring and compas- Conclusions: This presentation will offer an sionate nursing and midwifery workforce that is outline of five research studies conducted with focused on the delivery of patient centred care. Recommended reading list a range of health professionals in two countries The delivery of care that focuses on relationships Creswell, J.W. (2013) Qualitative Inquiry over a 14 year period that has led to the devel- is the first step in working towards a workforce and Research Design: Choosing Among Five opment of a new leadership theory specifically that demonstrates compassion. Approaches (3rd Edition). Thousand Oaks, Sage. related to leadership focused on values-based leadership principles. Aims: This research aimed to gain a deeper Grant, M. J. and Booth, A. (2009) A typology of understanding of compassionate care through reviews: an analysis of 14 review types and asso- The presentation will enable the learner / nurse and midwife stories and make them ciated methodologies. Health Information and audience to: available widely, enabling nurses and midwives Libraries Journal, 26, 91 - 108. • Understand the qualitative research processes to reconnect with the ‘Heart of Caring’. that led to the over-arching themes that are the Methods: Using a narrative approach fifty Biography foundations to the theory of Congruent Lead- nurse and midwife stories were collected. The Caroline Bradbury-Jones is a registered nurse, ership underlying principle in story telling of this nature midwife and health visitor. She works full time as • Gain an appreciation for the new leader- is that it will stimulate both focus and reflection a reader in nursing, researching into risk, abuse ship theory of Congruent Leadership while on practice. A thematic analyses was conducted and violence. Caroline has an interest in quali- exploring the research processes that led to the to identify the key elements that support the tative research and particularly how theory and theory’s development. delivery of person centred compassionate care. methodology relate to qualitative approaches. Results: The main themes extracted from Recommended reading list the stories have been used to conceptualise Stanley, D. (2008). “Congruent Leadership: a framework that is aimed at ‘leading person Values in Action”. Journal of Nursing Manage- centred compassionate care’ including con- ment: 64, 84: 95. necting human to human, engaging as a Theme: Quantitative/Leadership Stanley, D. (ED) (2016). Clinical Leadership team, promoting self-care and wellbeing and in Nursing and Healthcare. (2nd Ed). Wiley promoting effective workplace cultures. The Session no: 5.4.1 Abstract number: 284 Blackwell. stories have been published within a reflective resource, The Heart of Caring. Over 400 Time: 11:30am Stanley, D. (2011). Clinical Leadership: Innova- nurse and midwife leaders have participated in tion into Action. Melbourne, Palgrave Macmillan workshops connecting with these stories and The research evidence for reflecting on what compassionate care means to values based leadership: Biography them. congruent leadership David is currently a Professor of Nursing at the Discussion: Effective engagement of nurses explored University of New England. David has under- and midwives utilising reflective practice and taken a number of qualitative studies employing Professor David Stanley NursD, MSc, HS, BA storytelling are critical to enable effective Grounded Theory and Phenomenology. He has Ng, Dip HS (Nursing) RN. RM, The University cultures of caring. The Heart of Caring is an also undertaken a number of mixed methods of New England, Armidale, Australia effective resource used to stimulate critical studies with a more pragmatic approach to dialogue amongst teams and action planning data collection and analysis. David has taught opportunities in relation to providing compas- Abstract research methods to UG and PG nursing and sionate care. Aim: To identify who clinical leaders are and allied health students at a number of universities Conclusion: The Heart of Caring framework explore and critically analyze the experience of in Australia and Asia and supervised a number and reflective resource are pivotal to the devel- being a clinical leader. of Higher Degree Research students to suc- opment and support of a compassionate nursing cessful completion. David’s research interests Background: Offered is information on 5 and midwifery workforce. separate research studies all addressing clinical include clinical leadership, nursing and the media and men in nursing. I have been awarded leadership. When these studies started in 2001 Recommended reading list (in the UK), there was only a limited insight into a number of teaching and research awards over clinical leadership and who the clinical leaders the years and spent 15 years exploring the topic Dewar B (2013), Cultivating compassionate care, where. under consideration. Nursing Standard, vol. 27, no. 34, pp. 48-55.

48 11.30am-12.55pm Concurrent session 5 – Thursday 65 April 2017 Moen, T. (2006), ‘Reflections on the narrative sational learning concerning the development Theme: Evaluation/workforce research approach’. International Journal needs of this group of nurses. The band 7 role of Qualitative Methodology, 5(4), Article 5. was seen by some as unattractive to junior staff, Session no: 5.5.1 Abstract number: 22 Retrieved 6th November 2016 from http:// having lost patient contact time to overwhelm- www.ualberta.ca/~iiqm/backissues/5_4/pdf/ ing managerial responsibility. Time: 11:30am moen.pdf Conclusion: Developing into leadership An exploration of clinical Francis R (2013), Report of the Mid Stafford- positions involved a significant transition that shire NHS Foundation Trust Public Inquiry, has not previously been acknowledged. Job sat- research nurses’ perspectives London: The Stationery Office. isfaction is significantly affected by organisa- on their professional tional factors as well as individual factors. The role identity, in an NHS Biography organisation itself contributes to the role legiti- Foundation Trust Hospital in macy of this role. Sense-making is not inevita- Karen Tuqiri is a Registered nurse with a broad the UK ble and needs to be supported at an individual experience in the management of clinical and organisational level to facilitate learning in Mrs Swapna Kunhunny BSc Nursing, MRes services and facilities. Her particular focus is practice. Clinical Research student, Southend University the use of facilitated group processes to lead Hospital NHS Foundation Trust, Southend-on- clinicians in the improvement of patient care. Sea, UK An experienced nurse manager, she brings Recommended reading list Co-author(s): Professor Debra Salmon and her operational understanding of the clinical Fealy, G, McNamara, M, Casey, M, O’Connor, Michelle Carter, England,UK environment and patient care delivery to the T, Patton, D, Doyle, L, and Quinlan, C (2015) promotion and ongoing development of a skilled Service impact of a national clinical leadership and capable workforce. development programme: findings from a quali- Abstract tative study’, Journal Of Nursing Management. Background and rationale: Clinical research Vol 23,No. 3, pp324-332 nurses (CRN) make a significant contribution to Pegram, A, Grainger, M, Jones K, While, A, healthcare research within the UK However, lack of clarity about their role and scope of practice Session no: 5.4.3 Abstract number: 249 (2015), An exploration of the working life and role of the ward manager within an acute care renders their contribution within the profession Time: 12:30pm hospital organisation Journal of Research in and in the minds of the wider public invisible. Nursing Vol. 20, No. 4, pp 312 - 328 This has implications in terms of promoting the role nurses play not only in terms of recruitment, Preparing the next generation Spehar, I., Frich, J., and Kjekshus, L. (2015) Pro- of clinical leaders retention, and care of research participants, but fessional identity and role transitions in clinical also as research leaders of the future. There is Mrs Judith Enterkin RGN, RSCN, RNT, School managers. Journal of Health Organization and a dearth of international research that explores of Health and Social Care, London South Bank Management. Vol 29, No. 3, pp353-366 the professional role identity of the CRN. University, London, UK Methods: Using a qualitative research design, Biography data were collected from eleven semi-structured Abstract Judith Enterkin is Associate Professor for Lead- interviews with CRNs in an NHS Foundation Background: The Francis report [into the ership and is currently undertaking her PhD. Trust hospital in the UK during May, 2016. Data failings at Mid Staffordshire NHS Foundation She is a qualified general and children’s nurse were analysed using thematic analysis within a Trust] highlights the need for ‘Strong leadership with 20 years paediatric critical care experience, realist paradigm to explore how CRN’s experi- in nursing’ [Francis 2013, p66]. The Ward Sister 8 years as a Lecturer Practitioner developing and ence and define their work. role in the United Kingdom is seen as fundamen- providing critical care education for nurses in Findings: Participants viewed the positive tal to clinical leadership and high quality patient South London, and 9 years in education. aspects of their identity ‘as agents of change’ care; the role is increasingly challenging, increas- Judith’s interests are in service improvement, who were fundamental to the clinical research ingly managerial and difficult to recruit to. A lack leadership and change management, coaching process. Resourcefulness and the ability to guide of formal preparation and skills development for and mentorship for leadership, supporting and members of the research team were valued as the role has been widely acknowledged (Royal facilitating learning concerning clinical leader- key to job satisfaction. Successfully navigating College of Nursing 2009). This research set out ship for learners from all areas of health care through the complexity of advice, support, man- to explore the factors that impact on developing provision. agement and leadership tasks related to their the next generation of clinical nurse leaders. role in caring for patients were role affirming Method: Case study design using: in-depth and generated a sense of pride. interviews with key participants, repeated over However, lack of recognition, clarity of the role time; interviews with key informants and organ- and career development opportunities within an isational exploration through policy and docu- identified structure undermined the CRN identity mentary analysis. The Framework approach was and optimism about progression in the future. used for data analysis. Participants reported feeling invisible to col- Findings: Six nurses and six key informants leagues within the clinical community, isolated participated between 2011 and 2014. Partici- and excluded from wider nursing groups. pants required considerable support to prepare Implications: The study describes UK CRN them for the transition to band 7, clinical ward practice, highlighting the positive benefits and leader positions. Support available varied con- challenges associated with the role, including siderably. Development programmes, mentoring the need to support professional development to and shadowing opportunities when available, maximise their research contribution. Drawing were perceived as valuable. on international comparators the study makes A range of support mechanisms were available recommendations to establish well-defined edu- across the organisation but these were disparate, cational, career and promotional pathways that did not necessarily achieve the desired purpose includes opportunities for research leadership. and there was little if any evidence of organi-

49 511.30am-12.55pm Concurrent session 5 – Thursday 6 April 2017 Recommended reading list Session no: 5.5.2 National HEE Nursing and Midwifery Advisory Bevans, M., Hastings, C., Wehrlen, L., Cusack, Group. G., Matlock, A.M., Miller-Davis, C., Tondreau, Withdrawn Debbie has research expertise in mixed meth- L., Walsh, D. and Wallen, G.R. 2011, “Defining odology. Her primary focus is in the develop- clinical research nursing practice: results of a ment and execution of randomised controlled role delineation study”, Clinical and transla- trials and application of complex interventions. tional science, vol. 4, no. 6, pp. 421-427 Session no: 5.5.3 Abstract number: 297 She has a strong profile for the attainment of Nihr.ac.uk. (2016). Clinical Research Nurses. NIHR funding, especially, supporting NMAHP’s [online] Available at: http://www.nihr.ac.uk/ Time: 12:30pm to attain NIHR Clinical Academic Training fel- our-faculty/clinical-research-nurses.htm lowships and a growing publication and grant [Accessed 10 Jul. 2016]. NIHR Research Funding capture record. In 2011 she was nominated by the Department of Health as one of the top 100 Braun, V. and Clarke, V. (2006). Using thematic Applications: quality and nurse leaders in the NHS and in 2012 attained analysis in psychology. Qualitative Research in success - closing the gap a National Florence Nightingale Foundation Psychology, 3(2), pp.77-101 Professor Debbie Carrick-Sen PhD, MSc, Executive Leadership Scholarship. PGCE, RM, RN, University of Birmingham, Biography Birmingham, UK I qualified as a registered nurse and midwife in 1999 from Mahatma Gandhi University, Kerala, Abstract India. After four years of nursing practice in There is a National aspiration to grow the number India, I moved to Southend on Sea in the UK of Nurse, Midwife, and Allied Health Profes- Theme: Quantitative and has been working in Southend University sional (NMAHP) research clinical academics Session no: 5.6.1 Abstract number: 25 Hospital since 2003. I have recently completed from 0.01% to 1% by 2030 (AUKUH, 2014). A the postgraduate programme, MRes Clinical National NMAHP research career pathway has Time: 11:30am Research at City, University of London. been agreed and includes progression from pre- My professional background includes: registration to Professor. The NIHR fellowship A case study approach to • Lead research nurse for cardiac clinical trials in awards are classified as the gold standard, as they better understand pressure Southend University Hospital provide extensive financial support (including injury in community-dwelling full salary, academic fees and research costs), • Senior cardiac care nurse training and mentorship. patients. Professor Debra Jackson , Oxford Institute of • Mentorship in professional practice This presentation will focus on the number Nursing and Allied Health Research, Oxford, • Advanced life support practitioner of NMAHP applications and success when UK Academic qualification: applying to the NIHR awards since its inception 6 years ago. Key findings include a marked and Co-author(s): Lisa Durrant, UK; Emily Bishop, • 2014-2016: MRes Clin. Research- awaiting growing divide between the number and quality UK; Sarah Gardner, UK; Ria Betteridge, UK; graduation of nurse, midwife and AHP applicants. The data Helen Walthall, UK; Stephen Neville, NZ; • 1999- BSc Nursing: Mahatma Gandhi Univer- confirms that the quality funding gap is closing Marie Hutchinson, Australia; Kim Usher, sity, India. and therefore the scheme is becoming even more Australia • 2007-Diploma Supplement- Holistic Care at competitive. Nurses and midwives continue to the End of Life-Anglia Ruskin University. have poor success with this scheme compared to Abstract • 2009-Diploma Supplement- Management of AHP’s. Background: Many patients with pressure Person Requiring Cardiac Care- Anglia Ruskin This presentation will focus on required actions injuries (PI’s) are based in the community where University. and steps to increase the bar and chance of there is a paucity of PI research. Previous studies have concentrated on large geographic regions • 2009-Diploma Supplement- Therapeutic success in terms of nurse and midwife led NIHR [1,2]; information from smaller communities Interventions In Cardiac Rehabilitation- Anglia funding applications. within these larger regions is often blurred or Ruskin University. Recommended reading list lost. • 2010-Diploma Supplement- Mentorship and Aims: To provide a better understanding of the Work Based Learning and Assessment in AUKUH (2010) National Clinical Academic extent of PI within our local adult community Health and Social Care- Anglia Ruskin Univer- Roles Development Group for Nurses, Midwives sity and Allied Health Professionals, http://www. Methods: In 2016, a case study (defined by aukuh.org.uk/index.php/affiliate-groups/ postal district) was undertaken employing Research Training nmahps Accessed 14 November 2016 community nursing records to investigate PI’s • 2014-2016: MRes Clinical Research student of patients living within the community during • 2015- Introduction to Good Clinical Practice: Biography 2015. Guide to ethical and scientific quality standards Debbie is a Florence Nightingale Founda- Results: The case study region comprised in clinical research tion Clinical Chair in Nursing and Midwifery 50,322 adults; 3086 were >75years. In 2015, • 2013-Essential skills for research nurses. Practice Research at University of Birmingham. 102 individuals were recorded to have 137 PI’s; • 2013-Informed consent in clinical research. She holds a joint appointment with Heart of 2.03 per 1000 adults over 12 month period. England NHS Foundation Trust. Her interests The average age for PI’s was 80.3 years (range • 2013- Human subject protection in clinical include workforce development including, the 53-101years). Females were more likely to have research. creation and sustainability of research clinical PI’s (57% female/43% male) although this academic roles and maternal health, with a approximates to the age-matched study popu- particularly interest in perinatal mental health. lation (52% female/48% male). PI’s increased She co-chairs the AUKUH Nursing, Midwifery with age (24 per 1000 adults > 75 years). The and AHP (NMAHP) National Clinical Academic majority were grade 2; 62% involved buttocks or Role Development Group and is a member of the sacrum.

50 11.30am-12.55pm Concurrent session 5 – Thursday 65 April 2017 Discussion: Suspected deep tissue injuries Session no: 5.6.2 Abstract number: 222 Session no: 5.6.3 Abstract number: 88 and un-stageable data were not routinely recorded and community podiatry patients Time: 12pm Time: 12:30pm reported using a different system. Further- more, there is currently no data for people with Healthcare practitioners’ Intention, beliefs and mood PI’s not reported to any health care provider: a (Hcps) views on the durability from weekly diaries predict hidden population. Thus, our data likely under- and usage of the current attendance at cardiac estimates the level of PI’s in our community- available surgical masks: a rehabilitation patients. Compared to recent UK PI studies our PI rates are high, although direct comparison survey Professor Martyn Jones , School of Nursing between studies is difficult due to variations Hjh Salmanh binti Mohd Noor, Institute of and Health Sciences’ University of Dundee, in data collection timescales and collection Health Sciences, University Brunei Darus- Dundee, UK methods. This study reinforces the importance salam, Gadong, Brunei Co-author(s): Karen Smith, Scotland, UK; of establishing a baseline in individual commu- Co-author(s): Abdul Alif Sulaiman, Faridahani Oliver Herber, Germany: Myra White, nities prior to undertaking further studies. Isahak, Liling Chaw, Khadizah H. Abdul- Scotland, UK; Fiona Steele, England, UK; Conclusions: This study provides a clearer Mumin, Munikumar Ramasamy Venkatasalu Derek Johnston, Scotland, UK indication of the extent of preventable patient harm that exists in the case study community Abstract Abstract and suggests PI’s in community-dwelling Introduction: HCPs are at risk of acquiring Background: Cardiac rehabilitation (CR) is patients may be more widespread than previ- airborne and droplets transmission diseases. effective in promoting physical/psychological ously reported. Proper use of surgical mask as personal protec- recovery following acute coronary syndrome tive equipment (PPE), especially changing the (ACS). Recommended reading list mask when damaged and contaminated is highly Aim: To examine the determinants of attend- Stevenson, R., Collinson, M., Henderson, V., recommended. However there are no specific ance at outpatient CR in ACS patients following Wilson, L., Dealey, C., McGinnis, E., Briggs, M., guidelines in recommending the exact duration discharge until CR commencement. Nelson, E.A., Stubbs, N., Coleman, S. and Nixon, or frequency when a surgical mask should be Methods: Of 488 eligible ACS patients, J., 2013. The prevalence of pressure ulcers in change. recruited March 2012 to June 2013, 214 community settings: an observational study. Methods: A survey was conducted in all consented. Consecutive patients completed a International journal of nursing studies, 50(11), operating theaters and isolation wards of the questionnaire pre-hospital discharge targeting pp.1550-1557. four major hospitals in Brunei Darussalam, age, diagnosis, social-class and smoking history. Vowden, K.R. and Vowden, P., 2009. A survey of where all nurses, midwives and doctors are the A computerised weekly diary measured cardiac- wound care provision within one English health eligible participants. A self-designed and piloted related cognitions and mood. Multilevel struc- care district. Journal of tissue viability, 18(1), questionnaire was developed consisting 20 tural equation models estimated the effects of pp.2-6. questions. There are 18 close-ended questions baseline and change in cardiac-related cognition quantitative data that explored the knowledge, and mood on attendance. Intention to attend CR Biography attitude and practice of wearing mask as PPE was reflected, log transformed, reported thereaf- and two open-ended questions that explored ter as ‘do not intend’. The role of ‘do not intend’ Professor Debra Jackson Professor of Nursing in participants’ experiences qualitatively. The as a mediator of the relationship between dep- the Faculty of Health and Life Sciences at Oxford quantitative data analysed using descriptive rivation, cardiac-related cognition and mood on Brookes University, and Professor of Nursing analysis are presented here. attendance was explored. Research at the Oxford University Hospitals NHS Trust. She is the Director of the Oxford Results: Of the total 200 questionnaires dis- Results: 166 participants provided, on average, Institute of Nursing and Allied Health Research: tributed, 188 returned (94%). 78% (147) agreed 5 weeks of diary entries before CR. Low ‘do not OxINAHR. Nested within the Oxford Academic that it is very important to wear a surgical mask. intend’ following discharge and its reductions Health Science Centre, one of only six Depart- 91% (179) agreed that by wearing a surgical mask over time predicted attendance. Low negative ment of Health accredited centres of excellence, is effective in reducing risk of infection transmis- emotional representation, high perceived OxINAHR forms an essential component of the sion. While, 87% (163) have declared that they necessity, low practical barriers, low concerns partners’ vision of translating research to deliver are following steps recommended internation- regarding exercise, low negative affect, high evidence based care and innovation for patient ally or as documented in local guidelines with positive affect following discharge predicted benefit. regards to infection control in wearing surgical CR attendance. Change over time was not pre- mask. Although 69% (129) had some training on dictive. Baseline and change in ‘do not intend’ Prof Jackson has been a full professor since proper wearing of surgical mask, only 26% (49) mediated relationships between perceived 2005, and prior to her appointment at Oxford always wear surgical mask and 18% (33) always necessity, practical barriers, negative affect and Brookes University, worked in the Faculty of change their surgical mask as part of their daily attendance at CR. People from deprived areas Health at the University of Technology, Sydney work. Our findings indicated that since health- attended CR less often but this was not mediated (UTS) in Australia, where she still holds an care practitioners attended proper wearing of by intention. appointment. surgical mask, it is likely that the design of the Discussion and conclusions: Interven- In 2015, she was the first nurse to be appointed current mask may have some influences in the tion to improve attendance at CR should focus to a Principal Fellowship of the NIHR-funded frequency and consistency of the practices of on improving intention to attend CR following Oxford Biomedical Research Centre, awarded wearing the mask. discharge and during ACS recovery by improving in recognition of the quality and volume of her Conclusion: Our study confirms that nurses patient understanding of CR, reducing perceived internationally excellent research. have substantial knowledge and positive attitude practical barriers and improving negative mood. Prof Jackson leads Pressure Injury Prevention towards the use of surgical mask in relation to Oxford (PipOx) an intersectorial collaboration infection control. Future study should include Recommended reading list of health professionals and academics, working designing, developing and testing new surgical Herber, O. Jones, MC. Smith, K. Johnston, to bring benefits to patients and families through mask with usage indicator and its effect on D. (2012) Assessing acute coronary syndrome reducing pressure ulcer prevalence and severity. reducing infection transmission. patients’ cardiac-related beliefs, motivation and mood over time to predict non-attendance

51 511.30am-12.55pm Concurrent session 5 – Thursday 6 April 2017 at cardiac rehabilitation. Journal of Advanced naire covering care scenarios with persons with programmes. Teaching areas includes: Profes- Nursing, 68, 12, 2778-2788 various health challenges were developed. The sional Practice skills for Health and social care Johnston, M., and Johnston, D. (2013). Useful care scenarios were validated by experts. Pur- students, Critical and Specialist Care, Advancing theories should apply to individuals. British poseful sampling was adopted to explore the Health care Practice, Teaching, Learning and Journal of Health Psychology, 18, 469-473 consistency with which nursing students are Assessing in the Simulated Environment. able to identify the FoC that are relevant to the Cooper, A. F., Weinman, J., Hankins, M., different care scenarios. The students’ were also Jackson, G., and Horne, R. (2007). Assessing asked to identify who is responsible for meeting patients’ beliefs about cardiac rehabilitation as a the patients’ needs. basis for predicting attendance after acute myo- Session no: 5.7.2 Abstract number: 96 cardial infarction. Heart, 93(1), 53-58 Results: 550 responses were received and are currently undergoing analysis, descriptive Time: 12pm frequencies will be calculated using analysis Biography of variance. A full set of analysed results and When are holistic needs not Martyn Jones is Professor of Healthcare findings will be presented during the conference holistic needs? Research in School of Nursing and Health presentation. Sciences in University of Dundee. He is inter- Professor Austyn Snowden , Edinburgh Napier Discussion and conclusions: This unique ested in using real time, computer-based data University, Edinburgh, UK research study will provide a comprehen- collection methods to understand the determi- sive understanding of in what way nurses can nants of patient self-management behaviour in Abstract correctly identify the fundamental care needs acute coronary syndrome patients. Background: Holistic Needs Assessment of patients. We will discuss our findings and (HNA) is a process that helps people living with the implications for the development of robust cancer identify and manage any concerns they international nursing curriculum to ensure the may have. The concerns are grouped into catego- identification and delivery of the FoC. ries: physical, emotional, practical, family, and spiritual concerns. People complete HNA before Recommended reading list Theme: Quantitative consultation then discuss relevant concerns Session no: 5.7.1 Abstract number: 94 Kitson, A, Marshall, A, Bassett, K and Zeitz, K in consultation and agree subsequent actions/ (2013), ‘What are the core elements of patient- referrals. HNA’s a popular, valid method of Time: 11:30am centred care? A narrative review and synthesis of proactive individualised support. The process the literature from health policy, medicine and is usually nurse-led, but other professions have What are the care needs nursing’, Journal of Advanced Nursing, vol. 69, also facilitated the process. The aim of this study of the patient? Nursing no. 1, pp. 4-15. was to establish whether different professions students’ understanding of Jangland, E., Kitson, A. and Muntlin Athlin, would elicit different needs whilst using the fundamentals of care: a study A. (2016), ‘Patients with acute abdominal pain same tool. in five countries describe their experiences of fundamental care Method: Comparative analysis of outcomes of across the acute care episode: a multi-stage HNAs (N=7287) conducted between 2014 and Mrs Clair Merriman MSc, HPCE, RGN, Oxford qualitative case study’, Journal of Advanced 2016 by people living with cancer (all types) dis- Brookes University, Oxford, UK Nursing, 00(0), 000 - 00 cussing their concerns with: Co-author(s): Eva Jangland Sweden, Noeman Kitson, A, Conroy, T, Wengstrom, Y, Profetto- 1. consultant oncologists, Mirza Canada, Tiffeny Conroy Australia, McGrath, J and Robertson-Malt, S (2010), 2. community nurses, Emiko S Japan, Nishimura A Japan, Ann ‘Defining the fundamentals of care’, Interna- Ewans, UK tional Journal of Nursing Practice, vol. 16, no. 4, 3. psychologists, or pp. 423-434. 4. social care workers. Abstract Results: Patients discussing HNAs with oncol- Background: There is evidence that the Biography ogists (n=76) predominantly identified physical nursing profession has not been able to provide Clair Merriman is currently a part time doctorate concerns (84%). Patients seeing nurses (n=5522) the Fundamentals of Care (FoC): as consist- student at Queen Mary University London. also mainly identified physical concerns (44%), ently or adequately as needed (Jangland et al Following qualification as an RGN at the Royal albeit at lower frequency, followed by emotional 2015, Kitson et al 2013). Nurses should be able Berkshire School of Nursing and Midwifery in concerns (32%). Psychologists generated the to identify the FoC needs of their patients and 1992 Clair moved to Oxford as a staff nurse to highest proportion of emotional concerns respond to these accordingly; however evidence become part of its regional Neuroscience Unit at (40%, n=111). Social care workers elicited more suggests variation in the terms and language the Radcliffe Infirmary. During this time Clair practical and family issues than anyone else used to refer to the FoC (Kitson et al 2010). worked as a Clinical Development Nurse and (15% each, n=1578). This international research investigated pre and Ward Sister within the unit. Clair continues to Discussion: Patients adjusted their concerns post registration nursing student’s ability to practice within the unit on a regular basis to in line with their understanding of the role of recognise the FoC needs of patients and appro- ensure academic delivery is current and relevant. the person they were consulting with. Nurses priately identify whose responsibility it is to In February 2002 Clair made the move to full and social care workers elicited the broadest address these needs. time education and now holds the post of Prini- spectrum of needs, consistent with the original Aims: The study addresses three research ciple Lecturer-Head of Professional Practice purpose of the tool. However, bias persisted questions: Skills. Since joining the university, Clair has here too, with housing needs mentioned four • Which FoC are detected by nursing students undertaken responsibility for professional times as often to social care workers as opposed when presented with 3 different care scenarios? practice skills development. Clair has a particu- to nurses. This concept of concordance will be lar interest in interprofessional simulation and used to explain the findings, and to show why • Who do participants identify as being responsi- transferability of simulation based education an objective holistic needs assessment is neither ble to address the FoC articulated in each care into the clinical environment and is an active desirable or achievable. The results instead point scenario? member of course teams within the Pre-reg- to the enduring need for diversity and specialism Methods: A cross-sectional, descriptive study istration and Critical and Advanced Practice design was used in five countries. A question-

52 11.30am-12.55pm Concurrent session 5 – Thursday 65 April 2017 within interdisciplinary teams bridging health and Schutte’s Emotional Intelligence Scale and social care. beginning of year 1 (Sept 2013), year 2 (Sept 2014) and year 3 (May-July 2016). Demograph- Recommended reading list ics included previous caring experience, highest previous qualification and deprivation category. Snowden, A., and Fleming, M. P. (2015). Valida- tion of the electronic Holistic Needs Assessment. Performance was calculated: SpringerPlus, 4(623). http://doi.org/10.1186/ 1. Scale variable: mean score of first attempts at s40064-015-1401-0 all year 3 modules. Snowden, A., Young, J., White, C., Murray, Retention was calculated as: E., Richard, C., Lussier, M.-T., â€¦ Ross, E. 2. Binary variable: timely completion of the (2015). Evaluating Holistic Needs Assessment course or not (July 2016). in Outpatient Cancer Care: a Randomised Con- trolled Trial- the study protocol. BMJ Open, Relationships between EI and performance 5(e006840). http://doi.org/10.113 scores were calculated using Spearman’s rho. Differences in group means between completers Snowden, A., Young, J., and Fleming, M. (2016). and non-completers were calculated using inde- Protocol for a mixed methods longitudinal pendent samples t-tests. enquiry into the impact of a community based supportive service for people affected by cancer. Results: Mean (SD) TEIQue-SF scores were BMC Cancer, 16(1), 720. http://doi.org/10.1186/ 5.31 (0.6) year 1, 5.19 (0.6) year 2 and 5.21 (0.7) s12885-016-2757-4 year 3. SEIS scores were 127.8 (13.8), 125.5 (13.9) and 127 (13.8). 666 (76.6%) nurses successfully completed, with mean performance Biography 64.6% (18%). Neither baseline EI measure was Professor Austyn Snowden is chair in mental associated with performance or retention. health at Edinburgh Napier University. Jenny Discussion: Baseline EI scores were not asso- Young is Research Fellow at Edinburgh Napier ciated with performance. However, students University. scoring higher on ‘social connection’, a factor within the TEIQue-SF, were statistically more likely to complete training. Conclusion: EI was not predictive of perfor- Session no: 5.7.3 Abstract number: 78 mance, but social connection was. This is con- Time: 12:30pm sistent with a more nuanced view of ‘values based selection’, to be outlined in the presenta- Should we be selecting tion. nursing students on the Biography basis of their emotional I am a lecturer in Nursing Studies at Edinburgh intelligence?: findings from University. My nursing background is in mental a prospective longitudinal health, and my research interests are generally study aimed at making spaces for the voices of mar- Dr Rosie Stenhouse PhD RMN, Nursing ginalised groups, such as people who have been Studies,University of Edinburgh, Edinburgh, on the acute psychiatric wards or people with UK dementia, to be heard through the use of creative qualitative and narrative methodologies. My Co-author(s): Dr Norrie Brown, Scotland UK; teaching is focused on research methods, mental Fiona Carver, Scotland UK; Hannah Carver, health and critical issues relating to profes- Scotland UK; Jenny Young, Scotland UK sionalism. My current research (which is being presented here) into issues relating to student Abstract selection arises from participation in the Scottish Background: Selection and retention of Government programme of work focused on student nurses is a global concern. Findings the development of an evidence base for the of UK inquiries into poor care led to a call for selection and retention of nursing students ‘Values based selection’. Emotional intelligence within Scotland until 2013, and then a second- (EI) has been proposed as a necessary attribute ment to NHS Education for Scotland to support consistent with the requisite values for nursing. related work between 2012 and 2014. Along with EI is well theorised with valid measures. This my co-resercher, Professor Austyn Snowden, I paper presents findings from a longitudinal have been successful in getting funding to extend study exploring whether EI might be a useful our longitudinal study of nursing students into criterion for ‘values based selection’. their first two years of qualified practice. Aims: To understand the relationship between EI, performance and retention in pre-registration nursing students. Method: Prospective longitudinal design. 869 student nurses from two Scottish universities completed Trait Emotional Intelligence Questionnaire (Short Form) (TEIQue-SF)

53 62-2.55pm Concurrent session 6 – Thursday 6 April 2017 Concurrent session 6 Thursday 6 April 2017 2-2.55pm

Students’ ‘values education’ needs are con- there is a lack of evidence-based literature that Theme: Focus groups sidered as well as whether the NHS Constitu- examines FtP and the decision-making process Session no: 6.1.1 Abstract number: 205 tion values are fit for purpose in a recruitment which needs to addressed in light of the increas- context. ing number of FtPs presenting to the regulatory Time: 2pm bodies. Research scrutinizing FtP processes Recommended reading list exists (Haycock-Stuart et al 2015) but there Exploring the ‘values journey’ is no research surrounding the decisions how Francis, R. (2013). Report of the Mid Stafford- decisions are arrived at within the following of student nurses who have shire NHS Foundation Trust Public Enquiry. health and social care professions, Nursing, been recruited using vales- London: The Stationary Office Paramedic Practice and Social work. based approaches Department of Health (2013). Delivering high Aim: The aim of the study was to examine the Dr Alison Callwood PhD, University of Surrey, quality, effective, compassionate care: develop- decision-making processes involved in FtP for Guildford, UK ing the right people with the right skills and the nursing/paramedic/social work students with a right values: A mandate from the Government Co-author(s): Sarah Bolger, UK view to improving current understanding of the to Health Education England April 2013-March factors that influence these processes. 2015. London: Depart Abstract Methods: The researcher created and filmed Chen, D., Kirshenbaum, D., Kirshenbaum, E., People accessing health care have a view about three simulated FtP panels informed by real life Aseltine, R. (2012). Characterising changes in how they wish to be treated. Compassion, cases and the expertise of health professionals. student empathy throughout medical school’. empathy, privacy, dignity, respect and to be Purposive sampling was used to construct 4 Medical Teacher, 34 (4), pp. 305-311. ‘listened to’ are considered important but these distinct focus groups (12 in total) that examined have found to be lacking in care provision1. The each of the simulated cases. reasons for this are complex; questions have been Biography Findings: Thematic content analysis identi- raised regarding health professionals’ capacity to Alison works part-time in teaching and research fied a hierarchical structure of influence with sustain high standards of care. Erosion of values at the University of Surrey. She completed her members deferring to the authority of the chair. with exposure to clinical practice has been iden- PhD in 2015; research which focused on devel- Different roles were adopted with academic staff tified2. Attempting to address this, the United oping and piloting multiple mini interviews focusing predominately on professional conduct Kingdom government has adopted values based (MMIs) in student midwife selection. She is and clinical staff focussing on the impact of the recruitment (VBR) where healthcare students currently involved in longitudinal studies further student’s behaviour in practice and the risk to are selected according to the National Health examining the utility of MMIs as well as work the public. Other influences identified included Service (NHS) Constitution values3. Students’ exploring enhancement or erosion of student’s the personality of the panel members, the pres- ‘values journey’ specifically in a VBR context is values during their programme. She has collabo- entation of the student and the explicit use of unevaluated to date. rated with international colleagues in relation to guidelines during the discussion. Aim: To explore how student nurses, recruited health care student selection using MMIs to try Conclusion: Recognising and understanding using values-based approaches, describe adjust- to enhance our understanding of how students influential factors surrounding FtP decision- ment to their values following exposure to the most suited to a caring role can be selected for making and those involved in that process will clinical environment. education programmes. inform HEIs in the management of FtP. This Methods: The September 2015 nursing cohorts, promotes consistency and fairness in FtP deci- selected using VBR approaches at one Univer- sion-making. sity, were invited to take part in a three year longitudinal follow-up study. Twenty-six students Session no: 6.1.2 Abstract number: 185 Recommended reading list (adult n= 9, child n= 9 and mental health n=8) Haycock-Stuart, E James, C., McLachlan, A and volunteered to participate. Four semi-structured Time: 2:30pm MacLaren, J. (2015) Students’ and Mentors’ focus groups were conducted in July 2016 at the understandings of fitness to practise processes end of the students’ first year. Interviews were Understanding in pre-registration nursing programmes in audio recorded and transcribed verbatim before undergraduate fitness Scotland- ‘these terrifying three words’ Report being entered into Nvivo for thematic analysis to practise decisions: for NHS Scotland. using a framework approach. a simulated case study Results: Year One findings are presented. approach Biography Students articulated ‘values adjustment’ within Dr Julie-Ann Hayes PhD, MRes, MA, BSc, RN, three principle themes: 1) ‘the courage it takes Julie is a Senior Lecturer within the Faculty of Liverpool John Moores University, Liverpool, to use your values’ e.g. intimidation from other Education, Health and Community at LJMU. UK professional groups; 2) ‘the reality of your values She is a registered nurse with experience ranging in practice’ e.g. nursing is more than caring for from general medicine and surgery to Intensive Abstract the sick; 3) ‘self-reflection on values’ e.g. what Care and High Dependency Nursing. being non-judgemental means. Fitness to Practise (FtP) is a high profile issue Her teaching expertise is within medical law within the health and social care professions Conclusions: Novel data offers an emerging and ethics and she teaches across several pro- and their regulatory bodies. Although descrip- insight into the ‘values journey’ of nursing grammes within the faculty and module leads on tive accounts of FtP across professions exist, students selected using VBR approaches. the BSc and MSc programme. Julie’s research

54 2-2.55pm Concurrent session 6 – Thursday 66 April 2017 interests surround creative research meth- found lack of clarity in who was the physician munication processes to account for clinician odology, Fitness to Practise and Educational lead. Not being able to access clinicians when activity. research. needed was identified as causing high levels of Results: Eleven pressures were identified, Julie completed her PhD in 2016. The aim of stress and anxiety for both patients and families. patient load being the most commonly reported her study was to examine the decision-making Feedback relating to the Trauma Service was by nurses and doctors. Nurses indicated a high processes involved in ‘Fitness to Practise’ panels overwhelmingly positive. prevalence of ‘bed capacity’ and ‘inexperienced (FtP) for undergraduate healthcare students Conclusion: From the results strategies were staff’ while doctors reported ‘ineffective com- with a view to improve current understanding of implemented to improve communication. This munication’ and the challenges of being ‘short the factors that influence these decision-making included the development of a Discharge Infor- staffed’ throughout the healthcare system. Both processes. mation Leaflet which summarised the teams groups agreed the 4 hour target underpinned all involved in their care; implementation of a Tele- identified pressures. health programme to facilitate discharge process TMS observations were organised according to and follow up and planned out-patient Trauma a taxonomy of tasks; indirect care such as, docu- Clinics to support patients post discharge. mentation, test referral, handover, accounted for Further evaluation of these strategies is planned. the majority of actions. Direct care constituted Theme: Mixed 25% of nurse’s time 14% of doctors time (n= 412; Session no: 6.2.1 Abstract number: 132 Biography X2 = 7.1, p<.01). Current - Trauma research coordinator (6 Time: 2pm Three corresponding strategies were identified months) to manage pressure; optimised workload effi- An evaluation of a newly Previous - Clinical Nurse - Case Manager - ciency being most commonly implemented, with Trauma Service (2 years), Clinical Nurse/Reg- specific strategies opted by doctors being Main- established trauma service in istered Nurse, Band 6, Band 5 - Intensive Care taining Safety while nurses opted to Optimise a tertiary hospital in South efficiency. East Queensland Conclusion: We have demonstrated multiple Mrs Elizabeth Wake Bachelor of Science - sources of pressure that affect emergency depart- Nursing, Diploma in Nursing, Master of Health Session no: 6.2.2 Abstract number: 158 ment staff. Some pressures are common to all Professional Education, Gold Coast Hospital staff members, while others are role specific. and Health Service,, Southport, Australia Time: 2:30pm Co-author(s): Tania Battistella, Australia, Recommended reading list Renee Nelson, Australia, Kate Dale, Australia, Time, Triage and Trade- Pending Peer review EMJ Matthew Scott, Australia, Emma Baxendale, offs: how do emergency Australia, Nerolie Bost, Australia department clinicians Biography manage care safely under I have assumed a range of roles internationally Abstract pressure? A mixed methods and within the UK at world class institutions Background: A newly established Trauma study in leadership positions spanning clinical care, Service was evaluated using a satisfaction survey research and development as well as teaching, Mr Daniel Johnston RN, BSc, MRes, ORLA of patients and relatives to ensure high standards within the field of emergency nursing and Healthcare Limited, Harlow, UK of practice were achieved. The survey aligned medicine. Co-author(s): Dr Janet Anderson UK, with the Australian Commission National Safety (Beth Israel Deaconess Medical Center, Boston Professor Ann Marie Rafferty UK, Dr Adrian and Quality Health Service Standards. MA, USA, Cambridge University Hospitals NHS Boyle UK, Dr Alastair Ross UK Aims: Evaluate the service provided to patients’ Foundation Trust, King’s College London, Guy’s and their family’s case managed by the Trauma and St Thomas’ NHS Foundation Trust) Abstract Service. As a result of practicing in a variety of emergency Methods: The project ran from 01.10.14 to Background: There is acknowledged departments I have gained comprehensive 31.12.2015. Patients were included if they necessity to build resilience within English NHS insight into the contemporary challenges of were >16 years old and excluded if undergoing Emergency Departments (ED), where nurses emergency healthcare provision within the cognitive testing. and doctors are expected to maintain high UK and overseas (USA, Iceland, Denmark and quality, efficient and safe care in an increasingly A mixed methodology approach was used. Data Haiti). This has led to an interests in how quality challenging setting. Pressure is a significant emergency care is effectively delivered. were collected retrospectively from the Trauma factor in ED care provision, but there is limited Registry and analysed using descriptive statis- understanding of its sources and the strategies The synergy of clinical knowledge and under- tics. used to manage complex clinical workloads. standing local organisational challenges in the Data were also collected via telephone interviews context of quality improvement science is a This study aims to identify and describe sources growing interest that stems from research into post discharge and thematic analysis was used to of experienced ED pressure and the strate- analyse the results. organizational resilience in emergency depart- gies deployed by nurses and doctors to manage ments (supported by National Institute of Results: A total of 188 patients and 77 relatives fluctuating and varied pressure demands in an Health Care Research Fellowship). were recruited. Patients had a median Injury urban ED. Currently, I am actively involved in leading and Severity Score of 15 and hospital LOS of 7 days. Methods: A mixed methods approach was A total of 71 (37%) of patients were admitted to developing an innovative consultant led tele- adopted using ethnographic observations, semi- medicine service, that applies state of the art the Intensive Care Unit (ICU) and 26 (14%) went structured interviews and Time and Motion to rehabilitation. 32 patients and 12 relatives technology to support a ‘virtual ward at an acute Study (TMS) data to evaluate three nurses and NHS Trust’ to deliver acute medical and nursing (17%/15%) were lost to follow and 25 patients three doctors over 24 hours in the ED. Pressures and 8 relatives (13%/10%) could not recall the hospital level care within the patient’s home- and strategies were thematically analysed from setting. Trauma Service visiting them while in hospital. transcribed interviews and informed by TMS Thematic analysis revealed communication to data capture method to identify tasks and com- be an issue for both patients and relatives. They

55 62-2.55pm Concurrent session 6 – Thursday 6 April 2017 Theme: Qualitative approaches/ findings hold implications for nurse leaders and daily ward life. Challenges identified were: care human resource (HR) management to nurture processes are separated into isolated and pri- patient safety and experience and support discretionary nurse citizenship oritised tasks; nurses focus on coordinating care Session no: 6.3.1 Abstract number: 99 behaviours thus, optimising nurses’ relational and their therapeutic input is limited; and the approaches to patient safety. passive nature of the patients’ role. Time: 2pm Discussion: The literature focuses on stand- Biography ardising and formalising assessment, whereas Discretionary nurse Ashlyn Sahay is a PhD Candidate at Deakin this study presents assessment as a complex, citizenship behaviours and University.Having had experience working in flexible process of navigation with profession- patient safety: an exploratory both the private and public health care systems als valuing informal processes alongside formal study in Australia, Ashlyn has embarked on her PhD approaches. journey to explore the discretionary nature and Conclusions: CGA needs to be considered Miss Ashlyn Sahay, Deakin University, characteristics of nurse-nurse interactions and in conjunction with navigating and informal Geelong, Australia their influence on patient safety. Ashlyn is pre- and formal ways of working. In addition, the Co-author(s): Ashlyn Sahay, Australia; Marie senting to you the findings of her PhD research separated task approach, the position of older Hutchinson, Australia; Leah East, Australia topic: Nurse citizenship behaviour and patient people, and the nurses’ role needs considera- safety: an exploratory study. tion within existing organisational structures of Abstract hospital care. Background: Considerable attention has been given to understanding and improving Recommended reading list operational efficiency, productivity and safety Session no: 6.3.2 Abstract number: 125 NHS England, South. (2014) “Safe, compassion- of healthcare organisations. A key human factor ate care for frail older people using an integrated theorised to contribute to productivity and Time: 2:30pm care pathway: Practical guidance for commissio- work satisfaction is organisational citizenship naers, providers and nursing, medical and allied behaviour (OCB). As a form of discretionary Exploring the assessment health professional leaders”. NHS England, pp workplace behaviour, OCB is defined in terms process on a ward for older 1-38. of altruism, courtesy, sportsmanship, conscien- people: a constructivist Charmaz, K. (2014) Constructing Grounded tiousness and civic virtue. However, whilst the Theory, 2nd edition, London: SAGE publication. concept of OCB has been widely researched in grounded theory nursing, little attention has been given to identi- Miss Hanneke Wiltjer MSc, BSc, RGN, Univer- Ellis, G., Whitehead, M. A., Robinson, D., O’Neill, fying discretionary citizenship behaviour unique sity of Warwick, Coventry, UK D. and Langhorne, P. (2011) “Comprehensive to nursing or the relationship between nurses’ Co-author(s): Prof. Kate Seers, UK; Dr. Liz geriatric assessment for older adults admitted discretionary citizenship behaviours and patient Tutton, UK to hospital: meta-analysis of randomised con- safety. trolled trials”. British Medical Journal, vol 343, d6553, pp 1-10. Aim: To identify the nature and characteristics Abstract of discretionary nurse citizenship behaviours Background: International and national Biography that promote patient safety. guidelines advocate Comprehensive Geriatric Method: A qualitative exploratory descrip- Assessment (CGA) for hospitalised older people My name is Hanneke Wiltjer. I am from Dutch tive design, employing semi-structured inter- (NHS England, 2014), as research has shown origin and have lived in the UK for almost five views with a purposeful sample of 20 Australian some positive effects (Ellis et al., 2011). Their years. In 2007 I graduated in the Netherlands nurse leaders and 10 beginner registered nurses use in practice remains unclear and improved with a bachelor’s degree in Nursing and since (April - August 2016). Interview transcripts were understanding was required regarding how 2008 I have worked as a registered general analysed using thematic analysis. older people are assessed in hospital. nurse in a variety of settings specialising in care for older people. This includes acute, subacute Results: Six themes emerged that characterised Aim: To explore the assessment process on a and community settings, in both the Nether- the nature of discretionary citizenship behav- ward for older people from patients’ and health- lands and the UK In 2012 I received a Master iours linked to patient safety: helping behaviour, care professionals’ perspectives. Degree in Clinical Health Science at Utrecht respect, trust, peer-collaboration, voice Methods: This Constructivist Grounded Theory University (the Netherlands) and at the same behaviour and attentiveness to maintaining (Charmaz, 2014) included patients without time I started a part-time PhD in Nursing at professional practice. Thus, citizenship behav- cognitive impairment and professionals working the University of Warwick. My PhD focuses on iours described how nurses related together in on a ward for older people in an NHS University exploring the assessment process on a ward for generating cooperative behaviours and collec- Hospital in the UK Data were collected between older people, and is supervised by Prof. Kate tive responsibility to support colleagues’ patient March 2015 and February 2016, including 37 Seers and Dr. Elizabeth Tutton. Currently I am safety practices. Nurse leaders were described interviews with patients and professionals, a aiming for graduation in 2017 after which I hope to influence peer-collaboration and the overall focus group with professionals, and 45 hours of to continue with research focusing on care for dynamics of citizenship within nursing teams. fieldwork including observation and review of 18 older people. Discussion: The operationalisation of citi- patient notes. zenship in nursing describes the discretion- Results: The process of ‘navigating’ was ary nature of nurse behaviours. These behav- identified as the core category. Three themes iours are described to be positive indicators of were found: ‘elements of assessment’, ‘ways voluntary forms of nurse-nurse behaviour that of working’, and ‘daily ward life’. Navigat- supports and influence nurses’ task perfor- ing is a way of steering assessment through mance, professional and patient safety practice. different elements of assessment at three stages: Conclusion: This study provides new insights knowing, understanding, and if needed, acting. into discretionary nurse citizenship behaviours. Professionals value informal ways of working, These behaviours foster an environment of colle- combining it with formal ways of working to giality, positivity and safety consciousness. The meet competing demands within the context of

56 2-2.55pm Concurrent session 6 – Thursday 66 April 2017 Theme: Qualitative approaches/ Biography ties at which participants were studying or had Stephanie Tierney works as a Senior Research recently completed studies (one North West, UK interviews Fellow in Compassionate Care at the Royal and two from the Western Cape, SA). Session no: 6.4.1 Abstract number: 20 College of Nursing Research Institute (Univer- Qualitative: Interviews and questionnaire sity of Warwick). She has an interest in under- Analysis: Grounded theory Time: 2pm standing people’s experiences of receiving and Findings: This research project on RN’s PPD delivering treatment and services, focusing par- revealed patterns of perceptions, approach, Flow of compassion in ticularly on long-term conditions. She has run barriers, coping strategies and aspirations. Some healthcare: moving beyond several studies using a range of Methods: ques- of these results are disturbing, as they demon- tionnaires with people who have diabetes, focus an individual towards a strate the extra-ordinary actions that women groups with health professionals, qualitative systemic focus (and their families) have had to undertake PPD. interviews with people who have cystic fibrosis, Knowledge from this research project can be Dr Stephanie Tierney PhD, Royal College of heart failure or an eating disorder, creative tech- used to change the way we think globally about Nursing Research Institute, University of niques with children who have a cleft palate. She PPD, how to reduce the barriers and create Warwick, Coventry, UK has also conducted several systematic reviews/ better ways of working to enable all nurses to Co-author(s): Kate Seers, UK; Joanne Reeve, meta-syntheses. have opportunities to undertake PPD activities UK; Liz Tutton, UK and work at their full potential. Abstract Recommended reading list Background: Compassion is an underpinning Session no: 6.4.2 Abstract number: 220 Ali.S., Coate.K. and Goro.W.W. (2000) Global construct in nursing, an ideal that is a motivat- Feminist Politics Identities in a changing world. ing force for those working in healthcare. Nev- Time: 2:30pm Routledge: London ertheless, delivering compassionate care (CC) is not always easy or achieved. Little research has A risky research project; A Nakray.N., Alston.M. and Whittenbury.K. (2016) investigated how it is enacted and what it means cross cultural comparison Social Science Research Ethics for a Globalizing to healthcare professionals (HCPs). on Registered Nurses (RN) World Interdisciplinary and Cross-Cultural Per- spectives. Routledge: London Aims: To explore the meaning of CC for HCPs using a feminist approach. working with patients with type 2 diabetes. Exploring UK and South All-Party Parliamentary Group on Global This was selected as a critical case because as a Health (APPG) (2016) Triple Impact. Available long-term condition it involves sustained inter- African (SA) women’s at http://www.who.int/hrh/com-heeg/triple- actions within health services. experiences and perceptions impact-appg/en/ (Accessed: 12 May 2016) Methods: A grounded theory study (Charmaz, of Personal and Professional 2014) was conducted. Purposive and theoretical Development (PPD). Biography sampling were used. Semi-structured interviews Miss Lindy Hatfield PhD candidate, MSc, Lindy Hatfield is a Senior Lecturer at the Uni- and focus groups were carried out with 36 HCPs BA (hons), RN, University of Cumbria, PhD versity of Cumbria. She teaches on personal and during May-October 2015. Analysis moved from candidate at The University of Edinburgh, professional development courses. Currently open to focused coding. It involved the devel- Carlisle, UK nearing the completion of a PhD at The Uni- opment of memos that asked questions of the versity of Edinburgh. Her research has been codes, and contrasting of data with data and Abstract focused on registered nurses’ (RN) experiences codes with codes. and perceptions of personal and professional Background: Feminist research is on one development, a cross cultural comparison Results: Data suggested that an innate drive to hand celebrated yet on the other de-valued. The between UK and South African (SA) women. provide CC needs to be supported by the right definition of ‘feminist’ can pose negatively as Her main research interests is the impact that external conditions. This resulted in the devel- feminism continues to be misunderstood. The the changing world of employment and the role opment of flow as a key concept. Flow of CC majority of RN’s have individually experienced of the RN is having on womens’ personal and was sustained by what HCPs defined as ‘pro- PPD and have already formed their own concept professional development and the approach and fessional compassion’ and a wish to improve of PPD. It could be argued that putting PPD and use of feminist enquiry. patient health. It could also be affected by feminist together, risks dis-interest. Yet, there is factors impeding its momentum (e.g. time and lack of knowledge on the causes and effects of resources) or factors upholding this drive to be individual women’s PPD journeys. The feminist compassionate (e.g. supportive colleagues and approach and use of grounded theory encour- drawing on faith). The presentation will outline aged the researcher to see and hear the indi- this model of flow and CC and highlight the vidual. The cross cultural comparison gave a drainers and defenders associated with it. greater clarity of the research findings for data Discussion: Although CC tends to be perceived was compared, variables were established and on an individual level, our model emphasises new knowledge was more easily identified. broader contextual factors affecting its delivery, Aims: To compare women’s perceptions and which are often not acknowledged in policy experiences of PPD in the UK and South Africa documents. (SA). Conclusion: Our model can help those working To identify the ways in which women as RN’s in healthcare to anticipate and manage disrup- approach their PPD journeys and how this can tion to the CC flow, whilst also promoting factors influence theory and knowledge in supporting that defend and maintain the energy required the development of nurses. for it to flourish. Sample: Data was collected between 9/2013 - Recommended reading list 4/2014 from 39 RN’s at different stages of their Charmaz K. (2014) (2nd Ed) Constructing nursing careers. Ages ranged from 25- 62 years grounded theory. Sage: London. old. Ethics approval was obtained from universi-

57 62-2.55pm Concurrent session 6 – Thursday 6 April 2017 Theme: Evidence review drugs provided have adequate strength to take Session no: 6.5.2 Abstract number: 105 effect when administered appropriately. Session no: 6.5.1 Abstract number: 108 Time: 2:30pm Recommended reading list Time: 2pm Care bundles to reduce Caldwell, K., Henshaw, L. and Taylor, G. (2011) Developing a framework for critiquing health Central Line-Associated Interventions to support Bloodstream Infections parents when managing research: An early evaluation, Nurse Education Today, 31 (8), pp. e1 - e7. DOI:10.1016/j. (CLABSIs) in the neonatal their child’s pain at home: an nedt.2010.11.025. intensive care unit: a integrative review Popay, J., Roberts, H., Sowden, A., Petticrew, systematic review and meta- Mrs Roslyn Parker PG Diploma Nursing M., Arai, L., Rodgers, M., Britten, N., Roen, K. analysis (child), BSc Psychology, London South Bank and Duffy, S. (2006) Guidance on the conduct Miss Victoria Payne , Advanced Neonatal University, London, UK of narrative synthesis in systematic reviews, A Nurse Practitioner and Visiting Fellow, Uni- Co-author(s): Stephen McKeever, UK; Theresa Product from the ESRC Methods Programme versity Hospital Southampton NHS Trust and Wiseman, UK; Alison Twycross, UK Version, 1, pp. b92. University of Southampton, Southampton, UK Centre for Reviews and Dissemination (2008) Co-author(s): Dr Mark Johnson, UK; Dr Mike Abstract Undertaking systematic reviews of research on Hall, UK Background: Internationally children with effectiveness CRD guidelines for those carrying acute and long-term conditions are increasingly out or commissioning reviews. University of Abstract receiving most of their care outside of hospital. York. Available from: http://www.opengrey.eu/ For children with pain, this results in a shift item/display/10068/457284 Background and aims: CLABSIs are associ- in responsibility for pain management from ated with increased mortality, prolonged hos- healthcare professionals to parents. Effective Biography pitalisation and increased healthcare costs. The estimated incidence of neonatal CLABSIs interventions are required to support parents. Roses Parker is a full-time doctoral student is between 3.2-21.8 per 1000 central line days. Little is known about which interventions are examining how parents of children with cancer Care bundles have reduced CLABSIs in adult likely to be successful. manage their child’s cancer pain at home. She ICUs but replication in paediatric ICUs has Aim: To identify effective interventions to help is also a part-time children’s cancer nurse at been challenging, possibly due to small numbers parents manage their child’s pain at home. The Royal Marsden NHS Foundation Trust. and substantial variations in CLABSI rates. Roses is passionate about research as well as the Method: An integrative review was conducted A systematic review was performed to assess children she cares for and hopes her research searching MEDLINE; CINAHL Plus; the evidence for the efficacy of care bundles in will go some way to eliminating unnecessary PsychINFO; PsychArticles; AMED; PubMed; reducing CLABSIs in the NICU. childhood pain. Prior to nursing, Roses worked Scopus; Web of Knowledge databases. Data were for the London Ambulance Service as an AandE Methods: MEDLINE, CINAHL and EMBASE extracted and subject to a risk of bias assessment support personnel treating patients in response were searched from January 2010 up to August using either Critical Appraisal Skills Programme to 999 calls in an ambulance. Roses has a BSc in 2016. The Cochrane Library, Web of Science, or Caldwell et al.’s framework (Caldwell et al., Psychology from Warwick University and a Post Zetoc and Ethos were searched for additional 2011). A narrative synthesis was conducted Graduate Diploma in Nursing (child) (pass with studies. RCTs, quasi-experimental and obser- following Centre for Reviews and Dissemination distinction) from King’s College London. After vational studies were eligible. A meta-analysis (Centre for Reviews and Dissemination, 2008), spending time in New Zealand working for the was performed using Review Manager v5 with and Economic and Social Research Council Ministry of Health and as a research assistant random effects modelling. guidance (Popay et al., 2006). Content analysis for Victoria University Wellington, Roses was was conducted on reasons attributed to success Results: Forty-two quasi-experimental studies, successful in gaining a fully funded PhD scholar- of interventions. performed in Level II/III NICUs, met inclusion ship from London South Bank University. In her criteria. Twenty-three were published studies; Results: From 2,534 papers, 17 were included. spare time Roses enjoys baking, walking, and five were performed in Europe, fourteen in North Several interventions were found which targeted swimming. America and four in developing countries. The parents directly, child-parent interactions, remaining nineteen were conference abstracts. and healthcare professional-parent interac- There was a statistically significant reduction tions. Three studies reduced children’s pain in CLABSIs following the introduction of care and seven increased analgesic drug adminis- bundles (RR= 0.41, CI 0.32, 0.53). This effect tration. Content analysis revealed characteris- remained when abstracts were included (RR tics of interventions, components of parental 0.39, CI 0.33, 0.47. Common bundled technical pain management, and key features of research interventions included having a skin preparation which aid researchers in designing and evaluat- protocol (81%), using maximal standard barrier ing interventions. precautions (65%) and daily assessment of the Conclusion: Parent-targeted interventions need for a central line (65%). Education (100%), were most successful in reducing child pain. audit and feedback (65%, and the use of check- Many interventions attributed lack of statistical lists (60%) were the most common professional significant to inadequate strength of analgesic interventions. drugs. Parent-targeted interventions and those Conclusions: Care bundles appear to reduce targeting healthcare professional-parent inter- neonatal CLABSIs, though it is unclear which actions showed most promise in increasing elements may have the greatest impact. General- analgesic drug administration. Many interven- isability is complicated by variations in CLABSI tions did not demonstrate statistically significant definitions and intervention elements. There is a effect due insufficient sample size. These results need to reach a consensus definition of CLABSI have implications for the design and evaluation across research groups, and to better understand of future interventions. Interventions should be which elements of the care bundles work best in sufficiently powered and ensure the analgesic specific settings.

58 2-2.55pm Concurrent session 6 – Thursday 66 April 2017 Recommended reading list Theme: Qualitative approaches/ Conclusions: Combining these tools for data Bion J, Richardson A, Hibbert P, Beer J, Abrusci collection and subsequent analysis enhances the T, McCutcheon M, Cassidy J, Eddleston J, text and discourse inter-connectivity of language, ideals, attitudes, Gunning K, Bellingan G, Patten M and Harrison Session no: 6.6.1 Abstract number: 149 values and behaviour expressed, and in doing D (2013) ‘Matching Michigan’: a 2-year stepped so strengthens the trustworthiness of data interventional programme to minimise central Time: 2pm collected. venous catheter-blood stream infections in intensive care units in England. BMJ Qual Saf The inter-connectivity of Recommended reading list 22(2): pp 110-23 tools for analysis: combining Charmaz, K. (2014) Constructing Grounded Folgori, L., Bielicki, J., and Sharland, M. (2013) textual and visual data to Theory. 2nd edition. London: Sage Publications A systematic review of strategies for reporting of construct a substantive Limited. neonatal hospital-acquired bloodstream infec- theory of professional Traynor, M. and Buus, N. (2016) Professional tions. Archives of Disease in Childhood Fetal identity of adult nursing identity in nursing: UK students’ explanations and Neonatal Edition, 98:F518-F523 for poor standards of care. Social Science and Mrs Jacqueline Ridge RN; BA (Hons) Health Pronovost P, Needham D, Berenholtz S, Sinopoli Medicine, 166,186-194 Studies; MA Women’s Studies; PGCTHE, D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh Pink, S. (2007) Doing Visual Ethnography. FHEA, PhD student, The University of North- R, Roth G, Bander J, Kepros J and Goeschel C Images, Media and Representation in Research. ampton., Northampton, UK (2006) An intervention to decrease catheter- 2nd edition. London: Sage Publications Limited. related bloodstream infections in the ICU. N Abstract Engl J Med, 355 Biography Background: Research around the problem- Hello, my name is Jacquie Ridge, a full time Biography atic nature of professional socialisation is well Senior Lecturer and part-time PhD student at documented in nursing literature; what appears I am an Advanced Neonatal Nurse Practitioner the University of Northampton. With a pro- to be less well understood is the development of working at the Princess Anne Hospital in South- fessional background in emergency medicine, professional identity from the insider perspec- ampton, on a tertiary level Neonatal Intensive enjoyed for the variety of social interaction and tive (Traynor and Buus, 2016). A constructivist Care Unit (NICU). In this role I work on the the spontaneity of care provision. Taking time grounded theory approach investigating identity medical rota, leading ward rounds, attending out to study full time for BA (Hons) Health, and formation has combined textual and visual data high-risk deliveries, complex resuscitations and MA Womens’ Studies was followed by returning to capture this narrative for those aspiring to be undertaking advanced clinical skills. I am also to full time practice, transitioning into practice an adult nurse. an independent nurse prescriber. In addition, development, offering the opportunity to help I also work as a Visiting Fellow at the Univer- Aim: To share insights of the construction and others to develop professionally via facilitation sity of Southampton, teaching on the neonatal sustainability of professional identity of adult and training. advanced clinical practice MSc programme, nursing. Building on these foundations saw a move into focusing on evidence-based practice and the Methods: A constructivist grounded theory higher education which has offered a range of transition to advanced nursing practice. My approach was used to collect data with 10 exciting, challenging and rewarding experi- interests are in evidence-based practice and the female pre-registration education undergradu- ences, in an ever changing employment sector, translation of evidence into clinical practice. ate students in the field of adult nursing. They working with both traditional and non-tradition I am currently undertaking Doctorate in Clinical were recruited using convenience sampling applicants to nurse education. The key to which Practice at the University of Southampton, following ethics approval from the University of is seeing aspirations being met and lives being which is focused on the implementation of care Northampton. Data was collected (May 2012 to changed, whilst recognising the value that being bundles to reduce late-onset sepsis in the NICU. December 2013), using semi structured inter- a nurse and nursing makes no matter the envi- I have recently presented (2016) at the Neonatal views and photo elicitation on three occasions ronment. Society meeting and the European Academy of with each participant. Analysis of both tran- More recently this perspective has led to a focus Paediatric Societies conference in Geneva. scribed and visual data used a constant compar- on a part-time doctorate investigating profes- ative approach, with concurrent memo writing, sional identity of adult nursing, asking “who do thematic sensitivity and researcher reflexivity you think you are?” via a constructivist grounded (Charmaz 2014). theory approach. Due for completion in 2018, Findings: Collecting visual and textual data with further studies to follow investigating the through an ‘interview with images’ format was role of men in nursing linked to their profes- the process initially proposed to elicit partici- sional identity. pant response (Pink, 2007 pg. 82). It was soon recognised that combining imagery and text created an intimate familiarity redressing power dynamics. The sharing of imagery reinforced collaboration between participant and researcher, with often unusual and unexpected reflections being disclosed. Discussion: Using photo elicitation within the interview format was purposeful decision, enriching co-collaboration through participant selection of imagery, making meaningful discussion informing the subjective reality of the construction of self as adult nurse. This combination opened up discussion between participant and researcher via narrative the imagery provoked, whilst being mindful of the gaze employed (Pink 2007).

59 62-2.55pm Concurrent session 6 – Thursday 6 April 2017 Session no: 6.6.2 Abstract number: 168 Recommended reading list Theme: Questionnaires/other Time: 2:30pm Fairclough, N. and Fairclough, I. (2012); Political discourse analysis: A method for advanced methods Extending the reach of policy students. New York, Taylor and Francis. Session no: 6.7.1 Abstract number: 172 Wodak, R. (2011); The discourse of politics in and strategy research using Time: 2pm action: Politics as usual. New York, Palgrave political discourse analysis: Macmillan. the development of the The Southampton Model: Fairclough, N. and Graham, P. (2002); “Marx ensuring effective research Health and Social Care Act as a critical discourse analyst: The genesis of a 2012 critical method and its relevance to the critique delivery through innovative Dr Michelle Laing DBA, MBA, BSc (Hons), of global capital.” Sociolinguistic Studies 3(1). workforce development RGN, RNT, Liverpool John Moores University Mrs Emma Munro RN, BSc Hons, MSc, Uni- Faculty of Education, Health and Community, Biography versity Hospital Southampton NHS Founda- Liverpool, UK Michelle has worked at Liverpool John Moores tion Trust, Southampton, UK University for 15 years as a highly experienced Co-author(s): Marie Nelson, England, Jennifer Abstract nurse, academic, manager and more recently Allison, England, Christine McGrath, England In line with the growing interest in discursive researcher. Michelle’s early clinical background perspectives of strategy and policy as practice was in surgical nursing including Ophthalmic’s Abstract and Urology. In her previous role as an academic this research explores Health and Social Care All patients should have the opportunity to par- manager she has led teams of inter-professional policy development and in doing so highlights ticipate in research (DH 2013). Clinical Research staff to innovate and successfully deliver NHS the weaknesses in communication: both in Nurses are under pressure to deliver an ever licence to practice programmes. Michelle has a developing a narrative, and also in being able expanding portfolio of studies and increasing passion for nursing and education, with a keen to use it persuasively with important audiences: patient recruitment targets. Many of the studies sense of justice and an interest in policy devel- demonstrating a lack of engagement with stake- are complex interventional clinical trials often opment. Michelle has recently taken on a role of holders. The study also features some analysis of in high pressure areas including emergency, Associate Dean for Leadership in Liverpool John Strategy-as-Practice that exposes the growth of theatres and Intensive care. The increasing Moores University, she is a keen advocate of well executive arrogance within the specific parlia- workload and challenges faced with recruitment led and good governance of organisations and mentary agents involved. and retention of qualified nurses required an hopes o use her leadership skills to good effect. The conceptual framework of this research innovative approach to workforce development is based on the under-explored relationship Michelle is proud to be a staff governor at LJMU in order to meet the infrastructure challenges. and a nominated governor at Liverpool Heart between discourse, strategy and practice. Meth- The Southampton Model includes all research and Chest Hospital Foundation Trust. These odologically, the research is underpinned by nurses /midwives and AHPs receiving roles have given her opportunity to influence political discourse analysis (Fairclough and Fair- permanent contracts, ending years of short fixed and develop higher education and healthcare at clough, 2012). Analytical tools were used to con- term contracts undervaluing the role. The model local, national and international levels. She has ceptualise those discursive practices that provide uses a centralised team approach with research recently championed projects on carers support strategies and arguments within the trajectory of nurses managed by nurses, and released from with the Department of Health and the Queens the policy-as-discourse, thus offering an oppor- medical line management, ensuring opportu- Nursing Institute. These innovations have had tunity to reach the parts of policy, strategy and nities for joint clinical and research roles are high level national impact resulting in the devel- practice that other theories and methods are included to enhance the embedding of research opment of national policy guidance and online unable to reach. Critical analysis of the dialogical in clinical areas. Supportive management infra- packages to support carers. relationship between theory and method in the structure with clear lines of accountability and context of discourse and strategic policy analysis team specialty definition were introduced in line thereby reveals how discourse and the neglected with hospital divisional structures. Job titles field of political argumentation can shape reality were aligned with clinical roles to ensure synergy and influence strategies for action. between research and clinical staff. Researching health policy and strategy from a The model supports flexible working and oppor- post- perspective in this way allows for engage- tunities for career break and winter month ment with the discursive and ideological char- working, alongside retire and return to research acteristics of policy and strategy, in line with work posts for Gen X. Clinical academic career arguments for action-focused critical perspec- pathways are developing that are part of tives (Wodak, 2011). The focus of this research research nursing, thus removing the step on and is concerned with the ways in which political dis- off approach. courses are persuasive: based on specific argu- A dedicated clinical research education team mentative structures (Fairclough and Graham, working to a training and education framework, 2002). includes study delivery,feasibility and consent The study contributes to the theoretical and training, and facilitates student nurse place- practice knowledge of strategy to underpin ments. Development of research staff to support health policy reform. The research also adds to nursing includes a clinical trials assistant existing bodies of theory in political discourse training programme. We have a dedicated analysis, strategic practice and policy implemen- Research physician and medical fellows to tation and potentially contributes to the politics support study delivery. of democracy and pluralism. Staff support in the model includes research forums, peer group meetings, wellbeing sessions, and resilience workshops. There are clinical trials day events, community and public

60 2-2.55pm Concurrent session 6 – Thursday 66 April 2017 engagement activities, international investigator Method: Development of the survey tool Nurses and Associates and a busy portfolio of meetings. included pilot to senior CRN’s (n=9). Cohort research across two clinical directorates; Renal, identified using staff records and forum mailing Transplant and Urology and GI surgery and Gas- Recommended reading list list. Using purposive sampling, the final tool was troenterology. Naomi is passionate about the self-administered electronically during April Clinical Research Nurses role and embedding Department of Health (2013) The NHS Consti- 2016. Results analysed using descriptive statis- research into clinical practice. Naomi sits on an tuion for England London, March 2013 tics and thematic analysis. HRA REC as an expert member as well as local steering boards for Renal and Gastro Research Biography Results: 118 staff participated, over 85% of which were nurses. Of these 48 % (n=56) were projects as a professional member. Emma has responsibility for the management Band 7 level and 42 % (n=50) Band 6. Staff and leadership of over 250 nurses, midwives and worked across 44 clinical or research areas. 60% allied health professionals working on research (n=69) of the workforce were educated to at least studies, both commercial and non-commercial, degree level with a further 10% (n=12) working within the SCBR incorporating the BRC, BRU, towards their degree and 22% (n=26) a Masters NIHR WTCRF, cancer and Trust-wide nursing qualification. Staff predominantly coordinated a teams. Emma has a wealth of experience in mixed research portfolio, with screening for eli- research nursing and her clinical specialism gibility (75%) and providing study information was breast cancer and cancer genetics. She has (85%) as the most frequently reported activity. a strong belief in providing a supportive and 20% (n=21/110) of the workforce were involved educational environment to foster excellence in in nurse or midwife- led studies, 4% (n=4) as nursing care and following a Florence Nightin- Principal Investigators. gale Foundation Scholarship to the NIH in the US, she led the development of the NIHR Fun- Discussion: Gaining a comprehensive under- damentals of Clinical Research Nursing course. standing of the CRN/M role and the nature of Her postgraduate qualifications include a post their caseload, facilitates effective workforce graduate diploma in counselling and a masters planning and enables a greater understanding in social research awarded with merit, by the of training priorities. Articulation of the nature University of Surrey. and expertise of the CRN/M workforce assists in demonstrating its importance as a significant Emma qualified as a nurse at The Middlesex component of the overall nursing workforce. Hospital, London and her career in research includes senior roles at the Royal Marsden and Conclusion: CRN/Ms are central to successful Addenbrookes Hospital, Cambridge. She is a study implementation, recruitment of partici- member of the NIHR Research Nurse Strategy pants and safe patient care. More work is being group and the CRN:Wessex Workforce Devel- undertaken to understand the time and motion opment Group. She is also a member of the of clinical research activity. steering group of the UK forum for research nurses, midwives, AHPs and CTA’s. Recommended reading list Department of Health (2015), The NHS Consti- tution, London: DH Hastings C et al (2012), Clinical Research Session no: 6.7.2 Abstract number: 173 Nursing: A Critical Resource in the National Research Enterprise, Nursing Outlook, 60: Time: 2:30pm 149-156 Clinical Research Nurse and National Institute for Health Research (2015), Growth Through Health Research- The NIHR as Midwife’s (CRN/M): a key an engine for growth, London: NOCRI workforce at the centre of clinical research delivery Biography Mrs Naomi Hare MRes, BSc, Guys and St Naomi Hare graduated from Oxford Brookes Thomas NHS Foundation Trust, London, UK in 2004, working in Sussex and London as a Co-author(s):Helen Jones UK Staff Nurse in both Orthopaedic Trauma and Intensive Care for the next 5 years. Naomi’s sub- Abstract sequent Research Nurse career included a range of clinical areas and a variety of research studies. Background: Clinical research activity has Her research career has even taken her to South grown over the preceding ten years (NIHR Australia, where she worked as a Cardiology 2015), becoming embedded as core NHS Research Nurse for 12 months. business (DoH, 2015). CRN/Ms are central to the delivery of research (Hastings et al 2012) In 2013 Naomi was awarded an NIHR fellowship yet with a diversity of responsibilities, the role is to undertake a Masters in Clinical Research at poorly understood and lacks the recognition or KCL. During this year Naomi undertook feasibil- progression of other nursing roles. ity research at Kings College Hospital, exploring the use of focused-echocardigraphy by nurses Aims: To characterise a growing and diverse within critically ill patients. She graduated with CRN/Ms workforce structure primarily to Distinction, presenting her results at both British quantify, describe core roles and understand and European Intensive Care conferences. caseload demands. Naomi currently works as a Research Matron, managing and overseeing a team of Research

61 79.50-10.45am Concurrent session 7 – Friday 7 April 2017 Concurrent session 7 Friday 7 April 2017 9.50-10.45am

ing emphasis within contemporary politics. Session no: 7.1.2 Abstract number: 202 Theme: Workforce/review This can be understood as unhelpful because it Session no: 7.1.1 Abstract number: 114 deflects attention from the structural causes of Time: 10:20am workplace adversity. Time: 9:50am Recognising European Recommended reading list Cancer Nursing (RECaN): Resilience research in Neocleous, M. (2013). “Resisting resilience.” A systematic review of the nursing: part of the solution Radical Philosophy 178: 6. Stockholm Resilience changing roles of cancer or part of the problem? Centre (2012). What is resilience? An introduc- nurses tion to social-ecological research. Stockholm, Professor Michael Traynor, Middlesex Univer- Professor Mary Wells PhD MSc BSc(Hons) Stockholm Resilience Centre,. sity, London, UK RGN, NMAHP Research Unit, University of Jackson, D., A. Fau - Firtko and M. Edenborough Stirling, Stirling, UK Abstract (2007). “Personal resilience as a strategy for Co-author(s): Pauline Campbell UK, Claire surviving and thriving in the face of workplace Background: Resilience has been promoted Torrens UK, Daniel Kelly UK on behalf of the adversity: a literature review.” Journal of by governments as a solution to a range of social RECaN group and economic challenges (Neocleous 2013). Advanced Nursing 60(1): 1-9. Resilience has become a topic for research Abstract among nurses and it has also been promoted Biography Background: Nurses play a central role in the among nurses as a way of helping them to survive Born in London. Read English Literature at care of patients with cancer, delivering essential workplace adversity e.g. (Jackson et al 2007). Cambridge, then completed general nursing and nursing care, education and support through- health visiting training. After working as a health Aims: out the cancer journey. Cancer nurses increas- visitor in London moved to Australia where he • to describe the development of the concept of ingly take on extended and advanced roles, was a researcher for the South Australian Health resilience in psychological literature; administering treatments, managing follow-up, Commission. Worked at the Royal College of providing complex psychosocial interventions • to review a selection of nursing research which Nursing in London from 1991-6 and undertook and leading research. Although specialist cancer focuses on resilience among practising nurses; a three year study of nursing morale in the wake nursing is associated with a range of improved • to critique this literature by placing it in the of the 1991 National Health Service reforms. outcomes and experiences in people with cancer, context of neoliberal governments’ attempts to Drawing on his background in literature, his significant variations exist in the recognition of ‘responsibilise’ populations. PhD examined the language employed by nurses cancer nurses across Europe. Several profes- and their managers. He worked at the Centre Method: By examining key publications in the sional bodies have attempted to clarify roles and for Policy in Nursing Research at the London field, this paper traces the origins of the notion enhance recognition, but a lack of consensus School of Hygiene and Tropical Medicine. He is of resilience in child psychology and psychoana- continues to impede research and clinical now Professor of Nursing Policy at the Centre for lytic theory. To identify the way the concept has practice. been taken up in nursing a search was carried Critical Research in Nursing and Midwifery at Aims: This systematic review aimed to identify, out via EBSCOhost of the CINHAL database. Middlesex University in London. He researches appraise and synthesise the available evidence The keywords used were nurs* and resilien*. professional identity and the application of relating to the value and impact of cancer Peer-reviewed research articles written in discourse analysis and approaches from literary nursing on patient experience and outcomes, English were included. The search brought up theory and psychoanalysis to nursing policy and in order to inform cancer policy across Europe. 278 articles. Articles without direct relevance to health care issues. He is editor of the journal This paper reports on the first part of the review: nurses and nursing practice were discarded. The Health: an interdisciplinary journal for the identifying the roles and contributions of cancer critical review focuses on 15 papers published social study of health, illness and medicine and nurses. between 1997 and 2011. European editor of Nursing Inquiry. He recently wrote Critical Resilience for nurses, published Methods: Ten electronic databases (from 01 Discussion: Although early psychological by Routledge. January 2000: 31 May 2016) were searched for studies often understood resilience in ecological all randomised and controlled before-and-after terms, nursing research focuses on individual studies of cancer nursing interventions. No nurses’ ‘resilience’. This literature tended to language restrictions were applied. Eligibility exhibit the following characteristics: under- and methodological quality were independently standings of resilience were often taken from assessed. Data were extracted in accordance other nursing papers with little knowledge of with TiDieR guidelines. original studies; authors acknowledge severe structural pressures on nursing work; there Results: We identified 22450 records, screened was little attempt to assess workplace adversity; 16169 abstracts and retrieved 925 full text resilience is conceptualised as an individual articles. 569 papers were included in final characteristic/skill; there is pessimism about the synthesis, grouped by stage of cancer trajectory. possibility of changing nursing environments. Discussion: This review highlights the devel- Conclusion: Research on resilience among opment and variation in cancer nursing roles nurses has tended to reflect the individualis- since 2000 and illustrates that evidence for

62 9.50-10.45am Concurrent session 7 – Friday 77 April 2017 certain cancer groups and stages of the trajec- nised by patients and health care practitioners Session no: 7.2.2 Abstract number: 187 tory is limited. It also reveals deficiencies in the (HCPS). Time: 10:20am reporting of educational preparation and role Aims: To explore the experience of fatigue for definitions in intervention studies. patients with chronic heart failure. Conclusions: As the first review to synthesise Exploring stroke survivor Methods: A qualitative study design using and informal carer need: evidence from studies across the entire cancer semi-structured interviews was adopted, spectrum, this work provides crucial insights to enabling the patient to tell their story of living informing a new primary care underpin the development and recognition of with fatigue as a symptom of CHF. Interviews model cancer nursing over the next twenty years. were conducted between November 2012 and Dr Caroline Moore RGN RSCN RHV BSc June 2013. The sample size was 25 obtained (Hons) MSc PhD, University of Cambridge, Biography through purposive sampling. Interviews were Cambridge, UK Mary is a cancer nurse with a clinical academic analysed thematically. Each transcript was Co-author(s): Dominika Pindus, UK, Lizie background in health services research within coded for fatigue. The coded data were reviewed, Kreit, UK, Lisa Lim, UK, Ricky Mullis, UK, oncology. Her research is mainly focussed on discussed and grouped into themes. Full ethical Jonathan Mant, UK the supportive care of people with cancer and in approval was granted particular the needs, experiences and outcomes Three themes were identified: character- Abstract of people who have completed treatment. Mary istics of fatigue, negative emotional response Background: Longer term needs of stroke works closely with a number of cancer charities to fatigue and living with fatigue. Within these survivors and their carers are not being ade- with a major interest in improving experiences, three main themes, a number of sub-themes quately addressed. Research has focussed on outcomes and cancer care practice. She was a emerged which gave a full picture of fatigue as improving access to specialist services rather member of the Executive Board of the European a symptom and the experience of living with than considering the role of primary care Oncology Nursing Society (EONS) www.cancer- fatigue on a daily basis. nurse.eu from 2009 - 2015(and Secretary from in stroke management. Presently no formal Discussion: Participants were able to give 2011-2015) and she is currently co-chair of the primary care based model of care exists to graphic accounts of the experience of fatigue EONS Research Working Group. support stroke survivors and their carers. for them and how their lives were affected by it. Aim: To explore how the needs of stroke Mary’s methodological expertise includes quali- Interestingly, they found it less easy to explain survivors and informal carers are being met by tative and quantitative research methods, and changes in fatigue levels to HCPs, and the primary care and how a new primary care model she has experience in a range of qualitative majority of participants reported fatigue did not could best address the impact of unmet needs. approaches including case study and qualita- feature in conversations with their HCP carers. tive meta-synthesis, as well as surveys and Methods: 22 stroke survivors and 14 carers Conclusion: A better understanding and randomised controlled trials. Her PhD inves- were recruited to the Improving Primary Care assessment of a patient’s experiences of fatigue tigated the role of context in randomized trials After Stroke (IPCAS) interview study from five could enhance the management of this symptom of complex interventions, and she is particularly GP practices in the East of England and partici- and improve patient outcome. interested in the development and evaluation of pated in audio and video- recorded semi-struc- complex interventions led by NMAHPs. tured qualitative interviews. Verbatim data was Recommended reading list transcribed and analysed using a Framework Abshire M, Xu, J, Himmelfarb CD, Davidson P, approach. Sulmasy D, Kub, J, Hughes M, Nolan M. (2015) Results: Experiences of primary care following Symptoms and fear in heart failure patients stroke and expectations on how primary care approaching end of life: a mixed methods study. could meet participants’ long-term unmet needs Theme: Qualitative approaches Journal of Clinical Nursing; 24, 3215-3223. were identified. The GP practice was the first Session no: 7.2.1 Abstract number: 73 Perez-Moreno AC, Jhund PS, Macdonald MR, point of contact for survivors and carers but not Petrie MC, Cleland JG, BÃ¶hm M, van Veld- all were offered annual stroke reviews and many Time: 9:50am huisen DJ, Gullestad L, Wikstrand J, Kjekshus felt abandoned. Survivor and carer-identified J, Lewsey JD, McMurray JJ (2014) Fatigue as patient, organisational and professional barriers What do patients’ with a predictor of outcome in patients with heart to meeting need in primary care included chronic heart failure say failure: analysis of CORONA (Controlle cognition problems, the focus on medical about their experience of National Institute for Cardiovascular Outcomes agendas rather than person-centred care and a fatigue? Research (2013) National Heart Failure Audit lack of continuity of care. Survivor and carer- 2012-2013. University College London. Found identified facilitators to meeting need included Dr Helen Walthall PhD, PGDE, BSc (hons), at http://www.ucl.ac.uk/nicor/audits/heartfail- trust, stroke knowledge and accessibility. Unmet RGN, Oxford Brookes University, Oxford, UK ure/documents/annualreports/hfannual12-13. physical, psychological, health service and infor- Co-author(s): Professor Mary Boulton, UK, pdf mation needs were identified which included Professor Crispin Jenkinson, UK mobility problems, depression, lack of available Biography services and not knowing who to contact. Abstract Dr Helen Walthall is a Principal Lecturer in Conclusion: These findings have informed the Background: Chronic heart disease (CHF) is Nursing at Oxford Brookes University. She components of a new primary care model which a complex clinical syndrome which is increasing undertakes Postgraduate teaching and research include a structured person-centred review of in prevalence (NICOR, 2013). It is progressive supervision within Nursing and Health Care. She patient needs and a practice-based single point in nature with two main symptoms: dyspnoea is an active member of The Oxford Institute for of contact. This new approach will be tested in a and fatigue. Both symptoms are burdensome for Nursing and Allied Health Research (OxINAHR) trial and will lead to better long-term meeting of patients and cause anxiety and distress (Abshire and leads the Nursing Research group. Her stroke survivor and carer needs. et al, 2015). Perez-Moreno et al (2014) identify research interests include; patients with heart fatigue is an important indicator for patient failure, chronic illness and patient safety. Biography outcome and quality of life. However, less Caroline has a paediatric nursing and health emphasis is placed on fatigue as an indicator of visitor background and worked in the NHS for worsening CHF, or how altered fatigue is recog- 25 years. Caroline joined the Department of

63 79.50-10.45am Concurrent session 7 – Friday 7 April 2017 Public Health and Primary Care at the Univer- Recommended reading list to dental practices; long waits in busy waiting sity of Cambridge in 2012, working on the mixed Norman I, Redfern S, Tomalin D, Oliver S. rooms; and lack of support from informal carers. methods longitudinal Living with Breathless- (1992) Developing Flanaghan’s critical incident Facilitators to accessing services included: long ness (LWB) Study with Dr Morag Farquhar. technique to elicit indicators of high and low standing positive relationships with dental staff; Caroline is currently working on the Improving quality nursing care from patients and their recognised value of preventive advice; require- Primary Care after Stroke (IPCAS) study. Caro- nurses. Journal of Advanced Nursing. 17, pp. ment for oral health care to be included in clients line’s research interests include informal care 590-600. care plans; and support from carers both in giving, long term health conditions, intergenera- arranging appointments and moral support. Flanagan, J. (1954) The critical incident tional family relationships and visual methods. technique, Journal of Psychological Bulletin, 51 Discussion: The notion of access to dental (4), pp. 327: 358 services is complex and multifaceted; complexities which are compounded when the patient Schluter J., Seaton P. And Chaboyer W. (2007) group has learning disabilities. It is clear that Critical incident technique: a user’s guide for some of the identified barriers in this study nurse researchers. Journal of Advance Nursing, Theme: Qualitative approaches/ were related more to environmental factors 61(1), pp. 107 - 114. interviewing that could be modified, rather than the participants’ learning disabilities. Minor environmen- Session no: 7.3.1 Abstract number: 27 Biography tal changes, particularly at the dental practice, Time: 9:50am Stacey Rees, PhD student from the university of could therefore improve access and patient south wales experience for this group (Shield et al. 2013). Critical Incident Technique: Background is community learning disability a useful method for exploring nursing Recommended reading list the health liaison role of Shield, J. Turner, L. Pierce, S. and Wheatcroft, D. (2013). Dental Services for People with Learning the Community Learning Disabilities. Learning Disability Practice 16(1), Disability Nurse (CNLD)? Session no: 7.3.2 Abstract number: 81 pp12-15. Miss Stacey Rees BSc (hons), University of South Wales, Pontypridd, UK Time: 10:20am Biography Sharon is Professor of Nursing and a Director Abstract People with learning of the Teesside Centre for Evidence-Based Background: Critical Incident Technique disabilities and their carers: Practice: A Joanna Briggs Institute Centre of (CIT) is a ‘systematic, inductive, open-ended experiences of the barriers Excellence. She trained as a registered nurse in procedure for eliciting verbal or written infor- and facilitators to dental care London and after specialising in neurosciences mation from respondents’ (Norman et al 1992. nursing for a number of years, she moved into a Professor Sharon Hamilton PhD, MA, p592). It involves the collection of data in the research career. During this time she completed BA(Hons), RN, Teesside University, Middles- form of factual accounts of actual events, activi- a masters degree in social policy and a PhD brough, UK ties or role behaviours ‘which affect the outcome focusing on the implementation of evidence- of [a] system or process and are memorable Co-author(s): Pat Watson. UK Kamini Shah. based practice in acute stroke care. Sharon’s to those involved in the system’ (Schluter et UK current research programme focuses on the al. 2007, p.108). Data collection using CIT is evaluation of complex interventions. typically dependent on the qualitative interview. Abstract CIT was originally developed by Flanagan (1954) Background: Dental care is an important and continues to evolve in nursing research. It public health intervention particularly for more has been used in nursing research to facilitate vulnerable groups such as people with learning understanding of role and interactions across disabilities. There is however sparse information multiple settings, but until this study has not on the experiences and perspectives of this client Theme: Qualitative approaches been used in community learning disability group and their carers in relation to accessing Session no: 7.4.1 Abstract number: 174 nursing research. CIT is suggested to address dental services. complex nursing issues more rigorously than Time: 9:50am Aim: To identify barriers and facilitators, in-depth interviews. experienced by people with mild to moderate Aim: To give an overview of CIT and to give learning disabilities and their carers when Access to and impact of examples from the author’s PhD study to dem- accessing dental services. psychological support for onstrate how it has been used to explore the Methods: A qualitative approach was used, healthcare professionals role of the CNLD supporting adults to access incorporating focus groups and interviews. working in palliative care secondary healthcare in Wales. These were taped and transcribed, and analysed settings. Discussion: This paper will draw upon wider thematically. A purposive sample of 59 partici- Dr Maria Horne PhD, MA(Health Research), literature and personal experience of using pants were included, comprising: 48 people with BA(Hons), University of Leeds, Leeds, UK CIT in the context of a doctoral study. It will mild to moderate learning disabilities; 6 carers discuss using qualitative interviews within the of people with learning disabilities living inde- Co-author(s): Janet Allison-Love, England, CIT approach in exploring an area of profes- pendently or with family; 4 professional carers UK, Samantha Masley, England, UK sional practice which may be considered to be in residential settings and 1 service provider. of a sensitive nature. A review of lessons learned Abstract Results: The majority of participants (n=31/48) using CIT methodology will also be presented. attended for regular dental care. A number of Background: Palliative healthcare profes- Conclusion: An outline and evaluation of using barriers and facilitators to accessing dental sionals’ wellbeing and the degree to which CIT will be presented. This paper will be useful to services were identified. Barriers included: they experience themselves as stressed is an those wishing to undertake qualitative research negative past experiences; lack of perceived important part of quality care delivery and in professional practice issues, especially those treatment need; difficulties with physical access ensuring patients receive good compassion- deemed to be of a sensitive nature. ate care (Hospice UK, 2015). Caring for dying

64 9.50-10.45am Concurrent session 7 – Friday 77 April 2017 patients involves high levels of emotional dren’s and older adults’ health and well-being and limited training opportunities due to high engagement (Meier and Beresford, 2006) and - with an emphasis on reducing sedentary time, workloads. repeated exposure to suffering and death (Peters increasing physical activity levels, promoting Conclusion: Awareness of the demands of et al, 2013). Healthcare professionals can find active ageing, psychosocial issues that can affect end of life care on professionals can assist in it difficult to balance compassionate care and the lives of older adults, ethnicity and culture, the development of support and training pro- self-care and need support to cope with the cultural adaptation of interventions [2] Service grammes to help them deliver effective care for associated stress of caring in this environment, delivery and organisation: with an emphasis on young cancer patients. but little is known about psychological support specialist public health practice, rehabilitation availed by palliative healthcare professionals. and delivery of service interventions in primary/ Recommended reading list Aims: To: (i) explore the impact of psychologi- community/secondary care settings. She Bisset, M., Hutton, S. and Kelly, D. (2008) Palli- cal support for healthcare professionals working lectures in primary care, public health, health ation and end of life care issues. In: Kelly, D. and in palliative care; (ii) identify helpful forms of promotion and has an interest in health inequali- Gibson, F. (Eds) Cancer Care for Adolescents psychological support alongside any potential ties and minority ethnic groups. Dr Maria Horne and Young Adults. Oxford: Wiley: Blackwell, barriers to accessing such support. is a Fellow of the European Academy of Nursing Science and the Higher Education Academy. 192-212. Methods: Exploratory, qualitative research Sorensen R, Iedema R. (2009) Emotional design. Semi-structured interviews and labour: clinicians’ attitudes to death and dying”, drawing (to enrich the narrative account), Journal of Health Organization and Manage- with a purposive sample of palliative health- ment, 23 Iss: (1): 5 - 22 care professionals (n=16) from one hospice Session no: 7.4.2 Abstract number: 175 in West Yorkshire, England (February-May Kehl K.A. (2006) Moving toward peace: an 2016). Ethical approval was granted. Data were Time: 10:20am analysis of the concept of a good death. The analysed using framework approach of verbatim American Journal of Hospice and Palliative transcripts. Professionals’ perceptions Care. 2006;23(4):277-86. Results: Four main themes emerged through of the transition from active Biography data analysis (i) types of support (ii) coping to palliative care in young strategies (iii) barriers/facilitators to accessing cancer patients. RCN Chair of Nursing Research at Cardiff University since 2011. Main research clinical psychological support (iv) developing/main- Professor Daniel Kelly PhD MSc RN, Cardiff research interests are in cancer and pal- taining resilience. Staff participated in various University, School of Healthcare Sciences, liative care, including the needs of specific formal and informal psychosocial support and Cardiff, UK coping strategies to reduce their vulnerability. patient groups. He is currently President of the Co-author(s): Sofia Vougioukalou, UK Several barriers and facilitators to accessing psy- European Oncology Nursing Society and is also chological support and ways of developing and leading research in workforce and safety issues strengthening their own personal resilience were Abstract at Cardiff. identified. Background: Features of the ‘good death’ Discussion and conclusion: Palliative have commonly included the management of healthcare professionals use a diverse portfolio symptoms, the promotion of control by the of psychosocial support and coping strategies patient and family and the application of appropriate models of palliative care. However, some to promote their personal well-being. Having Theme: Mixed methods/primary the opportunity to access psychological support trajectories towards death are inherently more during working hours is an important part complex and reveal a need to question current and community care practices. This is especially true in adolescent of staff support strategies in the workplace. Session no: 7.5.1 Abstract number: 142 Managers have a key role in providing access to and young adult (AYA) patients where death psychological support to help reduce vulnerabil- may be an unexpected feature of this life stage, Time: 9:50am ity to and impact of stress in the workplace. and is challenging to manage. Aim: To provide understanding of healthcare Growing spaces: a mixed Recommended reading list professionals’ (HCPs) experiences of the tran- methods evaluation of sition to end of life care and the goal of a good Hospice UK (2015). A framework for support- death in young cancer patients; against the Therapeutic Horticulture on ing hospice staff to flourish in stressful times. backdrop of multidisciplinary team working and social inclusion for people London: Hospice UK family dynamics. with mental health problems. Peters, L., Cant, R., Payne, S., O’Connor, M., Design: Thematic analysis of 20 qualitative Dr Michelle Howarth RGN, MSC, PGCHE, McDermott, F., Hood, K., Morphet, J. and Shi- interviews with a range of professionals on the PhD, School of Nursing, University of Salford, moinaba, K. (2013) How Death Anxiety Impacts transition from active to end of life care using the Salford, UK Nurses’ Caring for Patients at the End of Life: eleven attributes of good death (Kehl 2006) as a A Review of Literature. Open Nursing Journal, Co-author(s): Michaela Rogers, Neil Withnell, framework. 7:14-21. Cath McQuarrie University of Salford Data sources: In-depth telephone inter- Meier, J. and Beresford, L. (2006). Preventing views with a purposive sample of experienced Abstract Burnout. Journal of Palliative Medicine 9:5, healthcare professionals (doctors, nurses, social 1045-1048. Background: Therapeutic Horticulture (TH) is workers, dieticians). a nature-based approach that promotes wellbeing Biography Results: HCPs reported experiencing varying for people with mental health problems using levels of emotional demands, including issues green activities such as gardening (Howarth et Dr Maria Horne (PhD, MA, BA (Hons), SCPHN of engagement and burnout risk, particularly al 2016). This type of ‘Ecotherapy’ is promoted (HV), SCM, RGN) is an Associate Professor at among junior staff. Issues that were highlighted globally as one approach that can reduce social the School of Healthcare, University of Leeds. as increasing these risks included limited clinical isolation for people with mental health problems Dr Maria Horne attained her PhD at the Univer- supervision, disjointed transitions between (Burls et al 2007). TH is used in some Mental sity of Manchester in 2007. Dr Maria Horne’s paediatric and adult services, failure of com- Health Recovery Programmes (MHRP) to research falls under two main themes: [1] Chil- munication between acute and palliative care, promote social re-engagement.

65 79.50-10.45am Concurrent session 7 – Friday 7 April 2017 Aim: To evaluate the impact and use of a MHRP Michelle co-leads the ‘Creative Wellbeing’ group quality of life for stroke-survivors and family based on TH for people with mental health at the University. The group brings together a members. The trial provided indicators that problems on social inclusion. collection of academics from a variety of dis- this role could enhance rehabilitation pathways, Methods: A mixed methods approach ciplinary backgrounds ranging from nurses reduce length of in-patient stay, provide families evaluated the impact of the therapeutic horti- and public health researchers to geographers, with tools to support their stroke-survivor and culture based MHRP. Data was collected from environmental scientists, psychologists, built themselves to actively manage their health and September 2015: current date from a purposive environment specialists and many more and well-being, and increase options for home-based sample. Qualitative data from interviews were are currently working to evaluate the impact of care and support. thematically analysed and triangulated with green space on health and wellbeing. Conclusions: Integrated models of care, such participant’s progression data taken from their as a Stroke Navigation Service, that ease tran- Mental Health Recovery Star (MacKeith 2013) sitions and support families across the care scores which were later statistically analysed for continuum are needed to reduce the burden on trends and progression. Session no: 7.5.2 Abstract number: 39 hospital, community, and aged-care residential Results: Data from 13 qualitative interviews services. which indicated that the MHRP has supported Time: 10:20am social integration through providing a space Recommended reading list to grow and reaffirmation of their identity. In Stroke navigation service DUTHIE, A. J., ROY, D. E. and NIVEN, E. N. total, 23 quantitative Recovery Star data sets trial: an integrated care 2015. Duty of care following stroke: Family expe- have been analysed and the findings suggests innovation riences in the first six months. Nursing Praxis in that people are working towards self-reliance. Dr Dianne Roy RN PhD FCNA(NZ), Depart- New Zealand, 31, 7-16. When triangulated, findings suggest a positive ment of Nursing, Healthcare Pathway, Unitec ROY, D. E., GASQUOINE, S. E., CALDWELL, impact on employment, social networks and Institute of Technology, Auckland, New S. and NASH, D. 2015. Health professional and self-esteem. Zealand family perceptions of post stroke information Discussion: These local findings indicate that Co-author(s): Allanah Harrington, New Nursing Praxis in New Zealand, 31, 7-24. ‘Ecotherapy’ approaches can support people Zealand; Roslyne McKechnie, New Zealand; FISCHER, R., ROY, D. E. and NIVEN, E. N. 2014. with mental health problems re-engage in the Victoria Andersen, New Zealand; Gerry Different folks, different strokes: Becoming community. This form of ‘social prescribing’ Fennelly, New Zealand; Sue Gasquoine, New and being a stroke family. Kai Tiaki Nursing encourages partnership working which could be Zealand; Gillian whalley, New Zealand; Research, 5, 5-11. replicated in other countries. Arun Deo, New Zealand; Tatsuya Unno, New Conclusion: The use of TH within a MHRP can Zealand; Yogini Ratnasabapthy, Biography reduce social isolation for people with mental Dr Dianne Roy has a strong background in both health problems and is integral in the rehabilita- Abstract practice and education. She is an Associate tion process. Background: Globally, stroke is the second Professor in the Department of Nursing at the The presentation will discuss the research leading cause of death, a major cause of dis- Unitec Institute of Technology in Auckland, methods used, interim findings and potential ability, and impacts not only on the stroke- New Zealand. Dianne has extensive clinical, impact on service development. survivor but also their family. There is often research and teaching expertise in issues related limited continuity between hospital level care to long-term conditions, self-management, Recommended reading list and community care, especially for families who impairment and disability. She is the principal Burls, A. (2007). People and green spaces: are instrumental in ensuring positive outcomes investigator for the multi-phase Stroke Family promoting public health and mental well-being for stroke-survivors. Evidence suggests that Whānau Project. This clinically based project through ecotherapy. Journal of Public Mental improving support and education for families in collaboration with the local district health Health. Vol. 6, . No. 3,pp.4-39. will reduce the burden of stroke on individuals board aims to improve support and outcomes and the community [references-anonymised]. for families (Whānau) of clients following a Howarth, ML, McQuarrie, C, Withnell, N, Smith, stroke. The project is now in its seventh year E. (2016). The Influence of Therapeutic Horti- Aim: To trial and evaluate a Stroke Navigation and third phase. Dianne lectures across the culture on Social Integration. Journal of Public Service for stroke-survivors and their families Bachelor of Nursing programme, particularly Mental Health. Vol. 15,. No. 3,. pp. 136-140. across the care continuum; acute to rehabilitation services and into the community. in primary health praxis, research, and professional practice. Dianne supervises an enthusi- Biography Methods: A mixed-method intervention study astic group of post-graduate students across the of a stroke navigation service compared with Michelle is a qualified nurse who has been institute, a number of whom complete studies usual care. Convenience sampling was used to working as a senior lecturer for 12 years. During within the Stroke Family Whānau Project. this time, Michelle has developed strong part- recruit seven stroke-survivors and their families nerships with local health care organisations to the intervention group and four families to to evaluate a governance system that has since the comparison group (total n=32) during April- been used nationally. A general theme of work October 2015. Stroke Navigators worked with emerged out of these projects which focused on intervention families for six months. Data were partnership working in a range of contexts. collected from both groups at baseline, three and six months (April 2015-April 2016). Qualitative The theme of person centred care has been data were analysed thematically. These themes developed through Michelles current research will be explored in this presentation. which focusses on how therapeutic horticulture can be used to support person centred Results and discussion: Families valued approaches to recovery for people in the being able to work with the Stroke Navigators community. Michelles recent funded project is across the care continuum. Having continuity of exploring the impact of a Therapeutic Mental contact with one specific person was an important Health Recovery programme with a local social component. Benefits included reduction in enterprise. stress, increased opportunities for education, personalised interventions, and improved

66 9.50-10.45am Concurrent session 7 – Friday 77 April 2017 Theme: Focus groups Recommended reading list patients discharged. 14 practitioners and 5 NHS Scotland 2014. Scottish Palliative Care carers joined two final workshops. FGs/inter- Session no: 7.6.1 Abstract number: 104 Guidelines. Available at: http://www.palliative- views/workshops explored current discharge processes and potential value of using CSNAT. Time: 9:50am careguidelines.scot.nhs.uk/ [accessed on 15th October 2016] Thematic framework analysis was conducted. CHOICE: A model of NHS England 2014. Five Year Forward View. Results: Both practitioners and carers viewed integrated working to provide Available at: https://www.england.nhs.uk/ CSNAT as highly relevant in supporting carers wp-content/uploads/2014/10/5yfv-web.pdf at discharge. Discharge processes were heavily person-centred end of life [accessed 10th November 2016] focussed on patients: carers were consulted but care at home. about patients’ needs; there was no systematic approach to supporting carers. CSNAT was iden- Dr Caroline Dickson D H and SSc, Queen Biography Margaret University, Edinburgh, UK tified as a means of facilitating much needed My research interests are in community nursing EOL conversations which often were absent, Co-author(s): Professor Brendan McCormack, practice, end of life care, leadership and practice of enabling carers to articulate concerns, and Scotland, UK; Helena Kelly, Scotland, UK development. I am an affiliate member of the managing carers’ expectations of their caregiv- Person-centred Practice Research Centre at ing role at EOL and support in the community. Abstract Queen Margaret University, a member of the However, palliative care discharges were Background: WHO is committed to ensuring International Collaborative for Community complex: from many different wards involving people are not subjected to unnecessary hospital Health Research and the International Practice different practitioners. No single professional admission at end of life. As in other westernised Development Collaborative. These member- group was identified as best placed to support countries, UK legislation is driving the reform of ships provide networking, support and partner- carers. Feasibility issues included skills, con- health and social care advocating organisations ship from international researchers. My doctoral fidence and time for carer assessment and find new ways of working1,2 research explored the meaning of specialisation support. from the perspective of district nurses. This was Aim: To develop and pilot test a framework of Discussion: Carers and practitioners identi- a qualitative study, adopting interpretive phe- integrated working that facilitates person-cen- fied the possibility of a two stage process of sup- nomenological analysis as a methodology. More tred care for patients and families at the end of porting carers as a potential way forward: using recently my research has involved participa- their life who are being cared for in their home. CSNAT earlier in hospital admission and then tory methods which are aligned to my interest as a carer-held record to manage transition to Methods: The CHOICE model was developed in practice development and is enabling me to home. through adopting a realist methodology. A range address my personal aim of improving patient of evidences were analysed and synthesized. and family experiences of being cared for at Conclusion: CSNAT was viewed positively by The resultant model was refined and pilot tested home. carers and practitioners. It shows good potential using a series of ‘creative’ focus groups with to enhance carer support at hospital discharge community nurses and social care workers. and play a role in preventing readmissions Findings: The model supported the existing towards EOL. evidence that integrated working within sup- Session no: 7.6.2 Abstract number: 254 portive organisational structures provides the Biography context required for person-centred caring. Time: 10:20am Gail Ewing is a senior research associate at Potential outcomes identified, although need the Centre for Family Research, University of further testing, include the streamlining of care, Enabling successful hospital Cambridge. Her background is in nursing and team efficiency and effectiveness. We also iden- discharge to home at end health services research, with 20 years of expe- tified greater potential for promoting patient of life: can a Carer Support rience of palliative care research with patients, autonomy, facilitation of choice together with carers and practitioners in primary, secondary, improved self-management. Indications are Needs Assessment Tool and hospice home care. She is co-developer overall experience of patients and families (CSNAT) help improve of the Carer Support Needs Assessment Tool was improved. This was achieved through an support for family carers? (CSNAT) with Professor Gunn Grande at The explicit focus in the CHOICE model of holistic Dr Gail Ewing BSc PhD RGN, University University of Manchester: working in the last caring, working in partnership with patients and of Cambridge, Centre for Family Research, 10 years on a programme of studies on carers’ families, collaboration and effective care coordi- Cambridge, UK support needs. nation. Co-author(s): Lynn Austin, UK; Debra Gibson, Discussion: By adopting a realist approach, UK; Gunn Grande, UK mechanisms, context and outcomes have emerged for both patients and their families Abstract and teams engaged in integration. Litera- ture would suggest, whilst there are pockets of Introduction: In end of life care, successful effective working, this is inconsistent. CHOICE hospital discharge and prevention of readmis- can develop practice in an integrated, person- sion often depend on family carers’ ability to centred way. support patients. Conclusion: CHOICE has the potential to Aim: To investigate how carers are supported impact on quality of delivery of end of life care for during patient discharge from acute care towards patients, their families and practitioners. Given end of life (EOL) and suitability of using a Carer policy direction toward integrated health and Support Needs Assessment Tool (CSNAT) to social care, and drive toward enabling people to improve this support. die where they chose, this work has potential to Methods: Data collection December 2014: inform current policy implementation. November 2015. Qualitative design: focus groups (FGs) with 40 practitioners supporting patient discharge from three English acute hospital trusts; interviews with 22 carers of

67 79.50-10.45am Concurrent session 7 – Friday 7 April 2017 Theme: Mixed Conclusion: Further research is required to Aim: To improve our understanding of patient a. evaluate the reliability of the PAMMO using surveillance at night through a description Session no: 7.7.1 Abstract number: 261 larger student groups b. students’ experiences of knowledge, beliefs and attitudes of nurses of medicines management in practice; thereby working night shifts. Time: 9:50am informing future curriculum development and Methods: In June 2015, we sent email invita- practice support strategies. Peer assessed medicines tions to a web-based survey to all registered nurses, midwives, and health care support staff management objective Recommended reading list working in a 1200-bed NHS hospital Trust. We structured clinical Manias E (2009) Pharmacology content in used exploratory factor analysis to correlate examination (PAMMO) using undergraduate nursing programs: Is there survey items. Using multivariable linear regres- criterion and global scoring enough to support nurses in providing safe and sion we related factor scores with nurse charac- systems- student nurses effective care? International journal of nursing teristics (e.g. role, experience) to predict nurses’ Studies 46 (1): 1-3 knowledge, beliefs and attitudes about vital clinical reasoning of safe signs observations. practice Nursing and Midwifery Council (NMC, UK) (2010) Essential skills Clusters London: NMC Results: Of 695 surveys received, 497 (71.5%) Dr Allison Wiseman RGN, ENB 100, D. Clin respondents worked at least one night shift (RNs Meechan R, Jones, H., Valler-Jones, T. (2011) Practice, MSc, BSc, School of Health Sciences, 321 (64.59%); HCSWs 120 (24.14%); midwives Do medicines OSCEs improve drug administra- University of Surrey, Guildford, UK 24 (4.83%); student nurses 32 (6.45%)). Survey tion ability British Journal of Nursing20 (13): items correlated into four factors. Nurses 728-731 Abstract with greater experience believed workload and capacity to impact work at night (factor 1: Aim: To identify the basis for third year student Biography nurses’ judgements of safe medicines manage- workload and resources). Student nurses and ment practice Allison is a Senior Teaching Fellow in Integrated midwives reported greater inclination to priori- Care in the School of Health Sciences, UK She tise tasks at night. Respondents working only or Background: Medicines management is a teaches a range of health disciplines at under- more often at night, used knowledge over early complex skill requiring a wide range of undergraduate and post graduate levels. She has used warning scores to prioritise tasks during night pinning scientific, professional knowledge, and developed simulated learning activities for shifts (factor 2: prioritization). Role, number of problem solving and decision making, supported a range of students to facilitate the development night shifts worked, and shift patterns affected by practical experience. The Nursing and of their clinical skills, confidence and decision perceptions of quality of care delivered at night Midwifery Council (NMC, 2010) mandate that making. Allison is a Registered Nurse who (factor 4: responsibility and control). medicines management is an essential skill for specialised in critical Care nursing (adult and Discussion: The extraction of four independ- registrants. The components of medicines man- child) and currently works in a local Foundation ent factors showed the multidimensional aspect agement are often learnt and assessed sepa- Trust. Allison is research active and previously of nurse work at night. Nurse characteristics rately, consequently the complexities of real completed studies exploring acute pain assess- (role, experience, and number of night shifts world medicines management practice may not ment in critical care, Inter-professional learning worked) associated with completion of care be addressed (Meechan, Jones and Valler-Jones, and is currently in two studies evaluating and tasks. These correlated to prioritisation strate- 2011). Although Objective Structured Clinical developing an emerging simulation technology. gies of care tasks (attitudes and behaviours) and Examinations (OSCEs) are resource intensive, Allison has recently completed her Doctorate in having a sense of control over the care at night. evidence suggests that peer assessment may Clinical practice and this paper presents part of overcome this (Donon et al, 2013) her thesis. Conclusion: Results of the regression model Methods: Mixed method explanatory sequen- indicated the need to understand how nurse tial study. Phase 1: Quantitative descrip- characteristics influence compliance with sur- tive approach evaluating the reliability of the veillance protocols in acute care wards. PAMMO using criterion and global assessment Session no: 7.7.2 Abstract number: 238 scores. n= 66 (80% statistical power) third year Biography student nurses assessed 3 video vignettes of Time: 10:20am Dr Alejandra Recio-Saucedo is a Research fellow peer students’ medicines management. Phase in the Faculty of Health Sciences. As member of 2: Interpretative phenomenology; three focus Factors affecting observations the Health work and systems research group she group interviews exploring global judgements of of vital signs in hospital is currently working on two studies funded by safe medicines management (n=15). during the night shift: nurses’ the NIHR Health Services and Delivery Research Results: Phase 1: poor to moderate agreement programme (HSandDR). These studies are (Fishers exact test 0.064-.541 [CI0.05]) between perspectives looking at associations between nurse staffing criterion and global scores between 2 groups of Dr Alejandra Recio , University of Southamp- and mortality mediated by the completion of students for each vignette. Phase 2: students ton, Southampton, UK vital signs observations and the efficacy of the socially construct their decisions of safe Co-author(s): Antonello Maruotti, UK; Peter Safer Nursing Care Tool in determining the medicines management based upon their own Griffiths, UK; Paul Meredith, UK; Gary B. nurse establishment in adult hospital wards. knowledge, understanding and experiences. Smith, UK; Greta Westwood, UK; Nicky Sayer, Students judgements were aided by 5 modes UK; Carole Fogg, UK; Anya de Iongh, UK; of decision making: intuition, reflection, peers, Yvonne Alton, UK; Paul E. Schmidt, UK systems and experiential research and practice. Discussion: This small study gives insight into Abstract how students experiences of medicines manage- Background: Innovations to improve identi- ment influence their decision making and views fication of physiological decline in hospitalised of safe practice. PAMMO may provide students patients rely on timely measurement of vital more exposure to medicines management. signs. However, studies have indicated obser- Students can actively lead and assess their own vations may be delayed or omitted, especially learning. during night shifts.

68 9.50-10.45am Concurrent session 7 – Friday 77 April 2017 ViPER cations/revised-new-nmc-code.pdf (accessed advice. This was influenced by multiple factors 10/08/2015). including information provision, presenting 7.8.1 Abstract number 92 Tsai LY, Huang CY, Liao WC, Tseng TH and Lai symptoms, individual patient beliefs and family TJ (2013) Assessing student nurses’ learning involvement. Characteristics that could promote Student nurses’ role in the needs for addressing patients’ sexual health or deter appropriate action were identified. delivery of sexual health: concerns in Taiwan. Nurse Education Today 33 Discussion: The findings revealed the influence how can we promote holistic (2) 152-159. of diverse factors on actions taken in response nursing care? to symptoms of neutropenic sepsis. The identi- Biography fication of characteristics that act as barriers or Emma Pascale Blakey, Oxford Institute facilitators provides potential areas for inter- Emma Pascale is on a clinical academic of Nursing, Midwifery and Allied Health ventions to encourage patients to recognise programme. She works clinically as a staff Research, UK symptoms and seek advice. nurse in infectious diseases. Academically she Co-author: Helen Aveyard, UK; Charlie Wells, UK is a PhD candidate at the Oxford Institute of Conclusion: Participant’s descriptions of their Nursing, Midwifery and Allied Health Research actions following the onset of symptoms of neu- Abstract (OxINMAHR) looking at unplanned readmis- tropenic sepsis provide insights that can be used Background: Providing holistic, person centred sions to hospital. Prior to nursing she worked to develop services that reflect patient’s experi- care is a central tenant of nursing (Manley et al. in public health and health improvement with ences and needs. They highlight the importance 2011, NMC 2015) and one that incorporates the a special interest in sexual health and health of patient assessment to identify individual risk need to consider sexual health care. Students are inequalities and has worked in the UK, Spain, factors that may act as barriers to seeking advice. also expected to provide holistic care, however Uganda and Thailand. anecdotal evidence suggested that this was not Recommended reading list routinely undertaken. We undertook a litera- Singer, M., Deutschman, C., Seymour, C., ture review to explore the way in which sexual Shankar-Hari M., Annaned D. et al (2016) The health care is experienced by students in clinical third international consensus definitions for practice and whether this forms part of an holistic sepsis and septic shock. Journal of the American approach to care delivery. ViPER medical association, vol 315, no 8, pp 801-810 Aim of this ViPER: To explore the results of 7.8.2 Abstract number 195 National Institute for Health and Care Excel- our literature review and the implications for lence (NICE) (2012) Neutropenic sepsis: pre- practice. Barriers and facilitators vention and management of neutropenic sepsis Literature review: Following a comprehen- to seeking advice in in cancer patients NICE guidelines [CG151] sive electronic search of nursing databases, we cancer patients at risk of Ritchie, J., Lewis, J., McNaughton Nicholls, C. identified 8 studies that explored the experiences neutropenic sepsis and Ormston, R. (2014) Qualitative research and perceptions of student nurses regarding the practice: a guide for social science students and Clare Warnock, Sheffield Teaching Hospitals delivery of sexual health care. Findings indicated researchers. 2nd Edition. Sage Publications. NHS Trust, UK that student nurses generally have a positive London attitude towards sexual health care; however Co-authors: Clare Warnock, England, UK; student experiences varied widely (Tsai et al. Martina Page, England, UK; Gail Lambarth, Biography 2013). Many felt uncomfortable about address- England, UK; Will Leaver, England, UK; ing sexual health and were reluctant to initiate a Angela Tod, England, UK Clare Warnock is currently the Practice Develop- conversation; many students lacked knowledge; ment sister at Weston Park Hospital, Sheffield, the cancer services centre for the South they also lacked role models at university and on Abstract clinical placement, indicating that sexual health Yorkshire region. She has worked in oncology Background: Sepsis is a life-threatening care is not routinely undertaken by qualified for over 25 years in London and Sheffield in a response to infection associated with significant staff. variety of clinical settings and roles, moving into morbidity and mortality (Singer et al 2016). practice development in 1999. Points for discussion: The main findings Patients with neutropenia caused by chemo- Clare has been involved in a diverse range of from the literature review will be presented by therapy are at increased risk of sepsis being service evaluation, audit and research projects a clinical academic who is a qualified nurse and more susceptible to infections and less able to with a focus on clinical practice and improving PhD student. A senior nurse from the Trust and fight them. Early self-reporting by patients is patient care. Research topics have included a senior lecturer from the university will lead the fundamental to early detection as symptoms factors affecting nutrition among cancer patients discussion. The following questions to begin the often occur outside of the hospital setting (NICE in hospital, patient’s experiences of malignant discussion are proposed: 2012). A review of local practice found that spinal cord compression, the care of women • Is it realistic to propose that sexual health care patients may delay seeking advice. receiving intra-cavity brachytherapy for gynae- forms part of a holistic nursing assessment? Aim: To explore the barriers and facilitators to cological cancer, the relationship between tem- • How can we facilitate holistic nursing care in seeking advice from the perspective of patients perature and neutropenic sepsis, nursing com- relation to sexual health? with neutropenic sepsis petences for survivorship and late effects care, • How can role models be fostered in both Methods: Semi structured interviews were patient’s experiences of high-dose chemother- clinical and educational settings? carried out with 24 patients admitted to a apy and the difficulties encountered by nurses regional cancer centre with neutropenic sepsis. and healthcare staff when breaking bad news. Recommended reading list 14 interviews were conducted between July and As well as delivering local and network wide October 2015 and preliminary analysis carried outputs from the projects she has been involved Manley K, Hills V and Marriot S (2011) Person- out to identify themes. These were then explored in, Clare has published in peer reviewed journals centred care: Principle of Nursing Practice D. in additional interviews with 10 patients between and presented at national and international con- Nursing Standard 25 (31) 35-37. June and September 2016. Data was analysed ferences. Nursing and Midwifery Council (NMC) (2015) using framework analysis (Ritchie et al 2014). The Code Available at: http://www.nmc.org. Results: Responses to the onset of symptoms uk/globalassets/sitedocuments/nmc-publi- varied with evidence of delays in seeking

69 811.15am-12.40pm Concurrent session 8 – Friday 7 April 2017 Concurrent session 8 Friday 7 April 2017 11.15am-12.40pm

a new normal. Exploring the dynamic interplay April-November 2015, we purposively recruited Theme: Qualitative approaches between intrapersonal, interpersonal and 18 participants who met the inclusion criteria: Session no: 8.1.1 Abstract number: 305 societal factors has provided theoretical insights <18 years; BMI <25; attending commercial into critical illness survivorship and the legacy weight loss service; and self-reporting PMP. Time: 11:15am of critical care. Face-to-face semi-structured interviews were audio-recorded and verbatim transcriptions Constructing a grounded Biography analysed for emerging themes. theory of the critical illness Pam Page is the Academic Quality Manager and Results: The complexity of the weight/pain trajectory the NMC correspondent within the School of relationship was apparent. Several superordi- Dr Pamela Page RN, PhD, BSc (Hons), HDQC Nursing and Midwifery at Anglia Ruskin Uni- nate themes emerged; ‘pain - motivator and (Physiology), PGCE, Anglia Ruskin University, versity. Having qualified as a RN at University barrier to weight loss’; ‘fear of weight causing Faculty Health Social Care and Education, College London, she specialised in adult critical more damage’ and ‘activity is positive’. Bishop Hall Road, Chelsmford, UK care and worked at Guys Hospital, London. Pam Discussion: Pain motivates some individuals completed a BSc(Hons) Health Studies, regis- to lose weight while simultaneously inhibiting Abstract tered her teaching qualification with the NMC efforts by reducing their ability to engage with and undertook a Higher Degree qualification Background: In the context of increasing sur- weight-loss promoting activities/contributing to in Physiology. She has recently completed her vivorship from critical illness it is important behaviour resulting in weight gain. Overweight doctoral studies at City, University of London. to enhance our understanding of the subjec- promotes fear and catastrophizing in partici- Her research interests relate to the patient and tive experience of survivors and their families. pants who believe that even during minimal relative experience in and post critical care, The need to consider the legacy of critical care physical activity the extra pressure caused by patient safety and emotional literacy of nursing beyond physiological survival is imperative. their weight will further damage joints. Fear staff and she has published and presented in can be exacerbated by health care profession- Aims of the study: The study aimed to these areas. als’ descriptions of musculoskeletal damage or formulate a substantive, middle range theory their attitude towards overweight people with in relation to patient and family’s critical illness PMP. Conversely, individuals acknowledged the trajectory. benefits of becoming more active e.g. reduced Methods: Working within a relativist ontology Session no: 8.1.2 Abstract number: 200 pain, increased positivity and healthier choices. and a constructivist grounded theory methodol- Conclusion: Overweight/obese adults with ogy, a series of in-depth interviews were under- Time: 11:45am co-existing PMP who are actively trying to lose taken with survivors of critical illness (n=16), weight find their efforts hampered by pain, fear family members (n=15). All interviews were Perceptions and experiences of causing harm or increasing pain. Weight- transcribed verbatim. Constant comparative of overweight/obese adults loss services need to acknowledge these fears analysis and data collection occurring concur- and employ strategies to support individuals rently with theoretical sampling commencing living with persistent musculoskeletal pain to gradually increase physical activity and gain from the outset. confidence. Health care providers need to ensure Findings: Survivors of critical illness invariably (PMP); an interpretative language used with this group does not cause or entered a liminal state between life and death on phenomenological analysis exacerbate fear of normal movement. admission and during their stay in Critical Care. Mrs Lesley Cooper RGN RNT MSc, Teesside They frequently experienced vivid, hallucinatory University, Middlesbrough, UK Biography experiences which placed them in a different Co-author(s): Cormac Ryan; England, UK; Registered nurse since 1983. Spent most of my world or liminal space where they could move or Louisa Ells, England, UK; Denis Martin, career in nurse education with a brief spell in transcend in and out of different realities. The England, UK research. Decided to embark on a full time Ph.D core difficulty can be summarised as follows; in October 2014. The goal of my Ph.D work is to survivors have little recall of the factual events Abstract develop a pain neurophysiology education inter- of their critical illness but relatives have lived vention targeted at overweight and obese adults the whole event in a very real and ingraining Background: Overweight/obesity and PMP with co-existing chronic musculoskeletal pain manner. This can result in family members and are prevalent conditions with widespread impli- survivors experiencing totally different versions cations. Quantitative research establishes links of the critical illness episode. between weight and pain, however qualitative studies describing the complexities of the rela- Conclusion: Survivors of critical illness, tionship are scarce. together with family members experience challenges and adversities when endeavouring to Aim: We designed this study to gain insight readjust to life post critical care. This study has into how overweight/obese adults seeking to identified a middle range theory of dualistic manage their weight understand the relation- worlds between and within the survivor and ship between their weight and pain and the family member experiences. These temporal wider biopsychosocial aspects of comorbidity. events occur during and after critical illness Methods: The qualitative design was based on and expose a non-linear, fluid journey towards interpretative phenomenological analysis (IPA).

70 11.15am-12.40pm Concurrent session 8 – Friday 78 April 2017 Session no: 8.1.3 Abstract number: 160 Recommended reading list ment. Co-design is one methodology that is being explored to deliver such engagement. This Time: 11.15am-12.40pm Nursing and Midwifery Council (NMC) (2010) Standards for Pre-registration Nursing project was undertaken to translate knowledge Education. NMC: London from a doctoral study investigating reasons for Newly qualified nurses’ non-attendance with a hepatitis C outreach Gallagher RW and Polanin JR (2015) A meta- (NQN’s) perceptions of clinic (Poll et al, 2016) into potential solutions analysis of educational interventions designed to improve engagement with the service and culturally competent practice to enhance cultural competence in professional therefore patient outcomes. Miss Jane Wray RN, Msc, BA, University of nurses and nursing students Nurse Education Hull, Hull, UK Today 35 (2) (2015) 333 - 340 The project: Service users and key stakeholders were invited to three workshops that, Co-author(s): Professor Uduak Archibong, UK, Lie D, A Lee-Ray E, Gomez A, Bereknyei S and using creative design-led methods, supported Dr Sean Walton, UK Braddock CH (2011) Does Cultural Compe- a co-productive approach to the: identification, tency Training of Health Professionals Improve shared prioritisation and ideation of service Patient Outcomes? A Systematic Review and Abstract proposals. Outputs included videos of service Proposed Algorithm for Future Research. Background: The Nursing and Midwifery proposals, redesigned patient information Journal of General Internal Medicine 26 (3) Council (NMC) expects NQN’s to be culturally and a feasibility study of using incentives to competent in their interactions with patients encourage attendance. The authors will present (NMC, 2010) as this is key to tackling health Biography the methods and a selection of outputs from the inequalities (Lie et al, 2011). Pre-qualifying Jane Wray is Senior Research Fellow, Faculty project to demonstrate how the coproduction education enhances knowledge and awareness, of Health and Social Care, University of Hull delivered outputs that were created and owned however this may not necessarily translate suc- has managed a number of different projects by all stakeholders and that were grounded in cessfully into culturally competent practice promoting inclusion in Higher Education, the context of peoples lived experiences of using following completion of an approved programme employment and the voluntary and community and delivering Hepatitis C services. (Gallagher and Polanin 2015). health and social care sectors. She has published Conclusions: This abstract provides an Aim: The study aimed to explore NQNs’ percep- and presented her work nationally and interna- example of how a co-design led approach tions of culturally competent practice during the tionally and is a founding member of the Inter- allowed knowledge mobilisation of research first 9 months post qualification as part of a PhD national Advisory Board for the peer reviewed evidence, involving patients and key stakehold- study. Journal of Intellectual Disabilities [Sage Pub- ers, to make evidence-based improvements to lications, London]. Jane was a member of the Methods: This qualitative study used a the delivery of services. Royal College of Nursing National Equality and volunteer sample of 14 NQNs recruited from Diversity Committee and is currently complet- the north of England. Data was collected using Recommended reading list ing her PhD examining cultural competence and directed reflections (at 2-3 and 5-6 months post- the experiences of newly qualified nurses in the Rycroft-Malone, Jo and Burton, Christo- qualification) and semi-structured interviews (at NHS. pher R. and Bucknal, Tracey and Graham, 8-9 months) between 2014 and 2016. Content Ian D. and Hutchinson, Alison M. and Stacey, and thematic analysis was undertaken. Dawn, Collaboration and Co-Production of Results: NQNs’ perceptions were linked to the Knowledge in Healthcare: Opportunities and following; (a) Culturally Competent Nursing Challenges (March 1, 2016). Int J Health Policy Practice as a generic competency (compassion, Manag. 2016;5(4):221 - 223. doi:10.15171/ individualised patient care, person-centred Theme: Co-design ijhpm.2016.08. Available at SSRN: https://ssrn. care) and/or diversity specific (application of com/abstract=2740954 Session no: 8.2.1 Abstract number: 55 knowledge/awareness to patient assessment Poll, Ray and Allmark, Peter and Tod, Angela. or care delivery); (b) Self-perceived compe- Time: 11:15am (2016) Reasons for missed appointments with a tence and confidence (self-image, professional hepatitis C outreach clinic: a qualitative study. identity, reflection and new/novel experiences) Co-designing hepatitis C International Journal of Drug Policy (In Press). and (c) Organisational context of care (support services of peers/colleagues, team working, professional Biography socialisation, role models, patients/families). Dr Ray Poll RMN, RGN, BA (Hons), MA Public Health, DProf, Sheffield Teaching Hospitals Ray is Nurse Consultant for Viral Hepatitis at Discussion: Self-perceived competence and NHS Foundation Trust, Sheffield, UK the Royal Hallamshire Hospital in Sheffield. He confidence in caring for and interacting with runs nurse led clinics both within the hospital Co-author(s): Daniel Wolstenholme, England, patients from diverse backgrounds developed and in drug misuse services. Ray also devises UK and changed with experience and/or exposure. and delivers ongoing programmes of education This may be insufficient in of itself to enhance and training, and is actively involved in research Abstract the cultural competence of NQN’s. An ability and service improvement. His research interest to reflect upon and learn from novel experi- Aim: This abstract seeks to demonstrate a is how to improve access to hepatitis C services. ences was important as well as an enabling ward practical response to two key challenges in culture which responded positively to nurses nursing research and practice, namely how to seeking advice and support. get research knowledge into practice and how Conclusions: Understanding culturally to do this in a co-productive way. The authors competent nursing practice requires the integra- will do this by describing and critically reflecting tion of models of cultural competence focused on an innovative project drawing on co-design on the individual with that of broader organisa- methods. tional issues as they are interdependent. Background: There is an emergent body of evidence around the potential use of co-production in knowledge mobilisation (Ryecroft- Malone et al, 2016) but there is less evidence in, practically, how to achieve meaningful engage-

71 811.15am-12.40pm Concurrent session 8 – Friday 7 April 2017 Session no: 8.2.2 Abstract number: 231 Biography makers and healthcare professionals to a single WC event. Time: 11:45am Dr Marjorie Ghisoni is a lecturer in mental health nursing at the School of Healthcare Sciences, Using the WC format, meant a variety of stake- Bangor University in North Wales, in the UK holders met and actively shared and connected Co-production by Marjorie has worked with service users and diverse perspectives with collective discover- design: methodological professional colleagues to design and improve ies (Schieffer et al. 2004). Priorities for service considerations for service nursing and healthcare services locally. Marjorie improvement and research were successfully user involvement in research. has written and travelled widely to explore identified but further refinement of these is Dr Marjorie Ghisoni PhD, MSc, BSc, RN (MH) service user involvement in care planning and needed. Careful content planning to ensure SCMH,LPE, Bangor University in mental health recovery, in health and social a clear focus and logistical planning such as care. Marjorie is a Florence Nightingale Founda- organising venues and invitations was required. School of Healthcare Sciences, Bangor, UK tion (FNF) Scholar after being awarded a travel WC was also resource intensive e.g. in providing Co-author(s): Dr Seren Roberts, Wales, UK; scholarship in 2011 to look at peer support in appropriate facilitators for each table. Jois Bailey, Wales, UK ; Wendy Scrase, Wales, mental healthcare in the USA, the Netherlands, Conclusion: WC is potentially a successful UK; Ann Jones, Wales, UK; Susan Roberts, Scotland and England. strategy within EBCD to engage stakeholders Wales, UK; Kay Smith,Wales, UK; Gwyn in identifying priority areas for research and Parry, Wales UK service improvement.

Abstract Session no: 8.2.3 Abstract number: 28 Recommended reading list Background: Service user and carer involve- Time: 12:15pm Bate P, Robert G. (2006) Experience-based ment in research and practice are consid- design: from redesigning the system around the ered to be good practice that can contribute patient to co-designing services with the patient. to improving the quality of research, service Using a World Café within Quality and Safety in Health Care. 15(5):307- design and delivery (RCN 2007). The benefits of experience-based co-design 310. doi:10.1136/qshc.2005.016527. involvement practices are not in question but the to engage stakeholders Schieffer, A., Isaacs, D., Gyllenpalm, B., (2004) practical application of involvement practices including service users in can become a quagmire of policies and proce- The World Café: Part One and Part Two. Trans- dures that are unfamiliar and often unnecessary identifying priority areas for formation. 18(8):1-7 and 18(9): 1-9 for service users (Beebejaun et al 2015). research Brown, J., Isaacs, D. and the World Café Aims: This paper will discuss from our own expe- Professor Fiona Murphy PhD, MSc, BN, RN, Community., (2005). The World Café: shaping riences the application of involvement practices RCNT, PGCE Fe NDN, University of Limerick, our future through conversations that matter. that are fair and achievable for both service users Limerick, Ireland San Francisco, CA: Berrett-Koehler. and staff when carrying out research within a Co-author(s): Maria Noonan, Ireland; Una co-production design. We will debate how we Dee, Ireland; Margaret Hynes, Ireland; Maria Biography involved service users from the creation of the O’Dwyer, Ireland; Sinead Doherty, Ireland; Fiona Murphy is Professor of Clinical Nursing at study idea to employing service users as Service Audrey Lyons, Ireland; Deirdre Munroe, the University of Limerick Ireland. This is a joint User Project Assistants (SUPAs). We will create Ireland appointment between the University and the a narrative of our experiences and the challenges health service with the remit to facilitate practic- that we faced, with recruiting the project team Abstract ing nurses and midwives to do research. to include service users and staff, recruiting Background: Experience-based co-design and training SUPAs and navigating ethical and (EBCD) is a participatory action research organisational procedures. Whilst co production approach drawing on subjective experiences of is becoming a more familiar term within health providing and receiving care to identify priority and social care research, there appears to be areas for quality improvement (Bate and Robert some confusion about what it means for service 2006). The challenge is to ensure meaningful users and staff (NIHR 2015). engagement of stakeholders including service Conclusion: We will conclude the debate users at all stages of the research process, by identifying what works well and what can beginning with identifying research priori- prevent the collaboration of service user involve- ties. As World Cafés aim to facilitate meaning- ment in research and practice. We will discuss ful and co-operative dialogue around questions co-production as a method within research that count leading to collective thinking and design that would benefit from clearer guide- identification of innovative solutions and col- lines and exemplars. lective action (Schieffer et al. 2004), they could be used to involve service providers and users in Recommended reading list research priority setting. Beebeejaun Y, Durose C, Rees J, Richardson Aim: This methods paper aims to report our J, Richardson L, (2015) Public Harm or Public experiences in using the World Café (WC) format Value? Towards Co-Production in Research with (Brown and Isaacs 2005) as a strategy to engage Communities. Environment and Planning C: service users and service providers in identifying Government Policy. Vol.33 PP 552-565 priority areas for research. RCN (2007) User Involvement in Research by Discussion: The seven design principles of a Nurses. London Royal College of Nurses. WC were used (Schieffer et al. 2004), with the NIHR (2015) Going the Extra Mile: Improving purpose to explore the low rates of initiation the nation’s health and wellbeing through and duration of breastfeeding in the Mid-West involving the public in research. London. Region of Ireland. We invited stakeholders National Institute for Health Improvement. (n=45) which included women with babies who may or may not be breastfeeding, fathers, policy

72 11.15am-12.40pm Concurrent session 8 – Friday 78 April 2017 Theme: Qualitative approaches/ Conclusion: Data collection has just been the data analysis. Audio-recordings were tran- completed therefore data analysis is ongoing. scribed verbatim and translated to English. Data interviewing Full results will be available at the time of con- was managed using NVivo 11.0. Session no: 8.3.1 Abstract number: 230 ference. Data analysis: Charmaz’s grounded theory approach was used to transcribe and analyse Time: 11:15am Biography the data. The emerging themes are as follows: I have worked within the NHS since 1991. I asthma is a tiring illness, being asthmatic means Interpersonal trauma, completed my RN education in 1994. My first I am different, asthma destroyed everything good substance misuse post was within a surgical high dependency in my life, family support is crucial in beating and pregnancy - A unit, followed by post-registration midwifery asthma. From the perspective of Omani women, phenomenological exploration education. I qualified as a RM in 1996. I worked other several themes were to be found unique. These are: bukhoor is a trigger that doesn’t like of pregnant women and as a rotational midwife within a busy regional hospital from 1996-2001 and gained experience to avoid, fear of asthma inhalers, inhalers are midwives in Scotland working in antenatal, postnatal, special care not like tablets, asthma is like having a common Mrs Naomi Waddell BSc Midwifery, baby unit and delivery suite. I completed my BSc cold. Edinburgh Napier University, Edinburgh, UK Midwifery on a part-time basis during this time. Conclusion: The aim of this study was to Co-author(s): Professor Thanos Karatzias, I gained a community midwifery post in 2001. provide better insight and understanding of Professor Michael Brown, Dr Catherine My PhD journey began on a part-time basis in the experience of living with asthma for Omani Mahoney October 2013 whereupon I combined studying women. Understanding these participants’ on a part-time basis with part-time clinical experience might promote improved support practice. At the end of August 2015, I began a Abstract for women with asthma in Oman and the Gulf two year career break, in order to complete my region. Aims: This study aims to: gain a unique insight PhD on a full time basis. I have regular keeping Term meaning: Bukhoor are scented bricks to into the lived experience of pregnant women in touch days to keep my knowledge and practice perfume the home and clothing with a rich thick with problematic substance use and the lived up to date. NHS Lothian began a Midwifery smoke. experience of midwives with experience of sup- Research Champion initiative in 2012. We have porting them. It aims to (i) chronologically map been successful in the aim of promoting and Recommended reading list out pregnant women’s past abuse experiences helping recruit women into pregnancy related and past substance use in order to illustrate research projects and increasing awareness of Masoli, M., Fabian, D., Holt, S., and Beasley, R. common pathways through which these occur and promoting midwife-led research. (2004). ‘The global burden of asthma: Executive and explore possible mechanisms underlying summary of the GINA Dissemination Committee these, (ii) explore pregnant women’s experi- report’, Allergy, 59(5): 469-78. ences of their journey to motherhood and (iii) Andrews, K. L., Jones, S. C., and Mullan, J. explore midwives experiences and perceptions (2012). ‘Perceptions and practices of adults with of supporting this client group. Session no: 8.3.2 Abstract number: 287 asthma: a social cognitive analysis’, Journal of Methods: Purposive sampling was used to Time: 11:45am Asthma and Allergy Educators, 4(2): 49-56. recruit participants from Central Scotland. Par- Anderson, J., Blue, C., and Lau, A. (1991). ticipants - five pregnant women with a history Adult Omani women’s ‘Women’s representatives on chronic illness: of problematic substance use and trauma were perspectives on living with Ethnicity, ideology and restructuring of life’, recruited. Data was collected using a life history Social Science and Medicine, 33(2): 101-13 calendar (LHC), followed by an in-depth, semi- asthma: an exploratory study structured interview. Six eligible midwives were Mrs Badriya Al Riyami MA in Nursing Science, Biography recruited. In depth, semi-structured interviews University of Manchester, Manchester, UK were carried out. Data collection began in Mrs Badriya Al Riyami, from Oman October 2015 and was completed in November Abstract Current status: Currently a PhD Nursing Student 2016. Background: The literature indicates that in University of Manchester, UK (Third Year) Data analysis: Individual LHC will be asthma morbidity in women is increasing. Qualification: converted into chronological timelines that Women report a greater severity of asthma • Master in Nursing Science from Villanova Uni- map the sequencing of negative life events and symptoms and their utilization of health services versity, USA, 2006 substance use/misuse. Transcribed interviews is higher. A global burden of asthma summary will be analysed using Interpretative Phenom- recorded significant evidence of a high - preva • BSC in Nursing from Villanova University, enological Analysis. lence of asthma in the Middle East region. In USA, 2001 Preliminary results: Pregnant women - Early Gulf countries and in Oman in particular, no • Diploma in Nursing, Oman, 1998 emergent themes are ‘Psychological trauma’, study was found that explored perception of Previous Experience: women’s experience of living with chronic illness ‘Seeking oblivion’, ‘Addiction’ and Recovery’. • Worked as a nursing lecturer in Rustaq Nursing in general and asthma specifically. Midwives - Early emergent themes are: ‘Psy- Institute (one of the educational health institu- chological trauma’, ‘Women just like you and Aim: The study is conducted to explore the tions in Oman) experience of adult Omani women living with me’, ‘Managing unmanageable situations’ and • taught several courses to diploma and BSC asthma disease. ‘Stigma’. Nursing students. Adult health nursing, Discussion: As far is the researcher is aware, Method: A qualitative research design, driven Research, Fundamentals of Nursing and this is the first UK based study which aims to by constructivist grounded theory methodol- Anatomy and Physiology were some of the shed light on these issues. The findings have ogy was used. 29 Adult Omani women with courses I taught. moderate to severe asthma were recruited education and practice implications for all • supervised Diploma and BSC student in the through purposive sampling from three health health and social care professionals involved in clinical practice. supporting people with problematic substance care institutions in Oman. Semi-structured • worked as a course level coordinator and year use, in particular, pregnant women and new interviews were conducted. Theoretical sampling level coordinator. mothers. was employed as the categories emerged from

73 811.15am-12.40pm Concurrent session 8 – Friday 7 April 2017 • am a member in several committees within and education and information during the women’s Theme: Qualitative approaches/ outside Rustaq nursing institute. Some of those consultations, long waiting times due to over- committees were learning resource committee, crowding and incompetent appointment system, ethnography Quality Assurance committee and research inadequate privacy and interruption of care Session no: 8.4.1 Abstract number: 63 committee. by other pregnant women and professionals, • worked as a member in Directorate General of limited physical space and lack of facilities. The Time: 11:15am Education and Training task force committee importance of the use of diagnostic and educa- of year one program/ fundamentals of nursing tional technology during pregnancy was high- Is caring oxymoronic in Course lighted. commissioning? • was actively involved in planning the Ministry Conclusion: The study is providing an in-depth Professor Helen Therese Allan RN RNT BSc of Health Five Year Strategic Plan along with understanding of perspectives and issues sur- PGDE PhD, Centre for Critical Research in other members from different sectors in the rounding antenatal care for women with low risk Nursing and Midwifery, Middlesex University, ministry. pregnancies. London, UK • attended several conferences, symposiums, Implications for practice: It is the first quali- Co-author(s): C.Tapson, Savage J, Dixon R, workshops held in Oman. tative study in Oman and may help in improving Lee G. pregnancy care for pregnant women in future. Abstract Biography Background: Globally health systems are Session no: 8.3.3 Abstract number: 281 Miss Fatma Hamdan Al- Maqbali under pressure to contain and reduce costs Designation: Tutor at the Ministry of Health (Allan et al 2016). This has meant the introduc- Time: 12:15pm Educational institute, Oman tion of increasingly managerialist restructuring Telephone: 07476557294 (Rudge 2015) based on forms of new public man- An exploration of antenatal agement (Berg et al 2008) as well as budget cuts Academic: care for women with low (Rudge 2015). Clinical Commissioning Groups risk pregnancies in Oman: A • September 2014 until now: PhD student at (CCGs) in England form part of this trend (Allan grounded theory study school of Nursing, Midwifery and Social Work, et al 2016). Governing body nurses (GBNs) were University of Manchester appointed to CCGs to provide nursing leadership Miss Fatma Hamdan Al Maqbali , University • May 2006: MSc Nursing, Villanova University, to commissioning services. of Manchester, Manchester, UK USA Aim: to present findings from an observational Co-author(s): Tracey Mills, UK, Christine • May 2001: BSc nursing Villanova University, study of governing body nurses on clinical com- Furber, UK USA. missioning groups in England. • September 1998: RN, Sohar Nursing Institute, Design: Observational case study Abstract Sultanate of Oman. Sampling: Purposeful Background: Regular attendance for antenatal Employment: health care during pregnancy is important Methods: Observations of seven formal to ensure a healthy pregnancy outcome and • AY 2012-2014: Acting Dean of Sohar Nursing meetings, three informal observation sessions, to prepare pregnant women for labour and Institute and eight interviews from January 2015 to July postnatal period. Antenatal care attendance for • 2002-september 2014 worked as a tutor: a 2015 in two CCGs in the South of England. at least one visit in Oman reached more than coordinator for year one and year three, coor- Findings: Retaining a patient centred focus on 99% in 2013. However 35% of women attended dinating and teaching Anatomy and Physiol- clinical commissioning groups is problematic as the first visit late in pregnancy and 21% did not ogy I and II, and involved in teaching Theory, the GBNs’ authority is contested. Four themes attend for the recommended four to six visits Laboratory and Clinical of Maternal Health are presented: retaining a patient centred focus; during their pregnancies. This low attendance Nursing and Community Health Nursing, nursing leadership in commissioning; part time suggested a need to explore and understand Adult Health Nursing and Fundamentals of and full time executive roles and negotiating the experiences, views and issues surrounds Nursing I course. leadership within CCGs; negotiating profes- antenatal care in Oman. • May 2001- January 2002: Staff Nurse- Sohar sional relationships outside the CCG. Methodology and methods: An explora- Hospital Discussion: Inherent in the nursing role is the tory qualitative design informed by grounded • September 1998- December 1999: staff nurse- enduring and sometimes contested assumption theory methodology. In-depth semi-structured Sohar Hospital that nurses embody the virtues of caring and interviews conducted with initial sample of compassion. New emerging public manage- nine pregnant women, followed by a theoreti- Committees: ment roles - such as those within CCGs - are not cal sample of non-participant observations of • Academic year 2013/2014: member in the based on clinical knowledge or the traditional the care of thirteen pregnant women, inter- Quality Assurance committee nursing virtues and nurses struggle to articulate views with ten health care professionals and • Chairperson for examination task force a nursing leadership role. six pregnant women who started their first committee of Anatomy and Physiology I and II Conclusions: The authority of nurses in visit to the antenatal clinic late and frequently at national level. commissioning groups is contested by nurses approaching private health institutions. • A coordinator of Examination task force. themselves, members of the CCG and external Data analysis: A constructivist grounded stakeholders irrespective of whether it is aligned Professional registration: theory analytical framework that consists of with clinical knowledge and practice or with initial, focused and theoretical coding of tran- • Member of Honor Society of Nursing, Sigma new forms of management, as both disregard scripts of interviews, field notes of observations Theta Tau International, Alpha Nu Chapter the type of expertise nurses in commission- and memos are followed. April, 2005 ing embody. The implications of these findings Findings: Preliminary data analysis identi- • Member in the College of Nursing alumni, for nursing globally are discussed in relation to fied issues with health care delivery including Villanova University, USA from August 1998 similar commissioning roles in rapidly changing poor interactions between pregnant women until now health systems. and health care professionals, limited health • Oman Nursing and Midwifery Council

74 11.15am-12.40pm Concurrent session 8 – Friday 78 April 2017 Recommended reading list many couples self-financing, and is successful in Session no: 8.4.3 Abstract number: 8 less than half of all cycles undertaken. Allan, H., Savage, J., O’Driscoll, M., Tapson, C., Time: 12.15pm Lee, G. and Dixon, R. (2016). Are senior nurses Aim: To investigate the experiences of couples on Clinical commissioning groups in England seeking medical assistance in their desire for inadvertently supporting the devaluation of biological children. Critical realist ethnography: from philosophy to the their profession? A critical integrative review of Design: Ethnography, utilising a longitudinal the literature. Nursing Inquiry, 23(2) pp.178-187 design. practice of research analysis Burawoy, M. (1998). The extended case method. Data collection (March 2013 to September Mrs Gemma Sinead Ryan DHSci MSc, Univer- Sociological Theory, 16(1), pp. 4-33 2014): Iterative rounds of observation (22) and sity of Derby Online Learning, Derby, UK Berg, E., Barry, J. and Chandler, J. (2008). New interviews (22) with the same participants from public management and social work in Sweden first medical encounter and then after any subse- Abstract and England. Challenges and opportunities for quent consultations until an outcome event. Introduction: High quality research should staff in predominantly female organizations. Findings: The ‘infertility journey’ is a recursive be informed by a Philosophical framework. International Journal of Sociology and Social rather than a linear experience, and it does not The reasons are: to demonstrate transpar- Policy, 28(3-4), pp.114 end with medical treatment even if the outcomes ency of method, enhance the trustworthiness are conclusive in terms of biological pregnancy and credibility in the scientific community, Biography or not. The meanings of the fertility treatment provide direction as to the research methods The authors are a collective of researchers inter- experience are challenging for patients, for and data collection processes to be employed ested in the effects of the 2012 Health and Social couples’ relationships and sense of self, and par- and for guiding the inquirer to decide on what Act for nursing and health systems more widely. ticularly for men as they find themselves -mar they believe to be real (ontology) and what they ginalised at all stages of treatment. The biomedi- believe to constitute knowledge of this ‘reality’ Helen Allan is lead investigator of a small cal model also simultaneously reinforces and (epistemology). programme of work exploring the role of senior legitimises infertility as a stigmatised condition, nurses in commissioning. Helen is Professor Bhaskar’s critical realism has 6 core principles: and reproductive technologies which are now of Nursing and has been actively engaged in transitive and intransitive dimensions of science, presented as routine, are not experienced as teaching nurses and researching nursing for stratified reality, fallible truth, modified objec- such by couples. Finally patients are often forced 20 years. She is particularly interested int he tivity, open and closed systems and finally, the to behave as consumers to access care but are application of Sociology in Nursing and has co- components of ‘reality’. These components are: not emancipated by this role. written a book on the topic Exploring Sociology entities, tendencies, structures, events, actions in Nursing with Danny Kelly, Pam Smith and Conclusions: Medical treatments for infer- and mechanisms. Analysis should take the form Michael Traynor. She and Anne Arber are tility rarely alleviate the uncertainty felt by of retroduction and ‘theory’ testing using trian- currently writing a book for nurse and health infertile couples. Instead they are experienced as gulated data from several sources. reserachers with Anne Arber on the emotions recursive processes, including repetitive exami- While there are authors in nursing who have evoked in the research field with their PhD nation of familiar issues, technological strange- conducted critical realist ethnography, there students. ness and feelings of no progress or change. is limited detail about how to actually conduct critical realist analysis that aligns to the princi- Recommended reading list ples. It is necessary to present a process aligned Department of Health (2014) NHS Choices. to the philosophical principles. Session no: 8.4.2 Abstract number: 245 Infertility [Online]. GOV.UK Available: http:// Aim: Present a theoretically informed analysis www.nhs.uk/conditions/Infertility/Pages/ framework that may be applied in critical realist Time: 11:45am Introduction.aspx [Accessed 26 September ethnographic research. 2016. Method: The framework was developed in An ethnographic exploration HFEA (2016) Getting started - Your guide to order to meet Bhaskar’s 6 principles of critical of commencing infertility fertility treatment. Version 4. London: Human realist philosophy: 1. DESCRIPTION of the investigations and treatment: Fertilisation Embryology Authority. current context 2. Coding of data using the COM- couples experiences of the NICE (2013) Fertility problems: assessment and PONENTS above 3. Mapping the RELATION- ‘infertility journey’ treatment. NICE guidelines CG156. Manchester: SHIPS between the components 4. MAPPING National Institute for Health and Care Excel- and MODELLING of components for different Ms Ginny Mounce RM, NDOG/University of lence. scenarios 5. Hypothesise the possible EXPLAN- Oxford and University of Surrey, Oxford, UK ATORY THEORY 5. TESTING the explanatory theories and 6. Theoretical FRAMEWORKS that Co-author(s): Nicola Carey, UK; Helen Allan, Biography UK may be applied in practice. Midwife since 2004, based at John Radcliffe Conclusion: This project presents an inno- hospital, Oxford. Now research nurse at Nuffield Abstract vative and new method of analysis for critical Department Obstetrics and Gynaecology, Uni- realist research. It is philosophically informed Background: Infertility is estimated to affect versity of Oxford based at Institute of Repro- and has been tested in practice and offers a around one in seven couples in the UK [1]. By ductive Sciences which includes Oxford Fertility practical, structured and consistent approach to seeking medical attention to overcome this clinic. Also part time PhD student at University critical realist research analysis that is currently condition, couples are understood to have begun of Surrey. an ‘infertility journey’, which now often includes absent in the nursing literature. treatment by technological means such as In Vitro Fertilisation (IVF) [2]. The perception Recommended reading list that treatments like IVF are routine steps along Bhaskar, R. (1994) A critical realist science. the ‘journey’ towards pregnancy is reinforced Vespo, London by information from both public and private Reed, MI. (2005) Critical realism: philosophy, healthcare providers and biomedical literature method or philosophy in search of method? [3]. Despite this, IVF is unevenly funded, with in Buchanan, D. and Bryman, A. (2005) Sage

75 811.15am-12.40pm Concurrent session 8 – Friday 7 April 2017 handbook of organizational research methods. consensus and agreement to be reached in the Session no: 8.5.2 Abstract number: 255 SAGE, London UK identification of quality indicators for the first Time: 11:45am Porter, S (1993) Critical Realist Ethnography: postnatal visit. The Case of Racism and Professionalism in Aims: To identify process indicators for a Medical Setting. Sociology. 27(4): 591-609 inclusion in a QCM for first postnatal visit Exploring the role of health visitors in supporting http://soc.sagepub.com/content/27/4/591. Methods: Following qualitative interviews with Abstract PHNs and new mothers a two-round ‘modified mothers with mental health Delphi’ with 21 national and international problems. Biography experts was undertaken. A total of 60 state- Mrs Catherine Lowenhoff M.Sc, B.Sc(Hons), Gemma is a qualified teacher with QTLS/QTS ments were reviewed for consensus, agreement SRN, HV(dip) FiHV, Oxford Brookes Univer- and is also a registered adult nurse(teacher). and priority ranking. sity, and Oxford Institute of Nursing and Allied Her experience includes secondary, further and Results: The final QCM contained 28 indica- Health Research, Oxford, UK higher education, research management, service tors for new mothers and newborns. In total 60 innovation/improvement, private and NHS indicators were reduced across the two rounds. Abstract healthcare (community and acute setting) and 56 indicators achieved consensus and priority Background: Up to 30% of women experi- currently practices as a nurse in elderly care. ranking identified 13 indicators for new mothers ence mental health problems during pregnancy specifically. With extensive experience in online and distance or in the year after delivery(1). Historically, education she is also the research co-ordinator Discussion: A two round ‘modified Delphi’ health visitors (HV’s) have offered an inter- for UDOL health team and supports income gen- and combined qualitative findings identified vention called ‘listening visits’ to mothers with eration in UDOL. process indicators to enable benchmarking of depression. The updated NICE guideline (2014) PHN practice. Feasibility testing will allow for suggested that there was insufficient evidence Gemma has and currently works on a range of further development and refinement before to indicate that ‘listening visits’ are effective research projects with a particular interest in being implemented. (2). HV’s are still expected to offer support to Facebook and social media in healthcare and mothers with mental health problems (3). There healthcare education along with systematic Conclusions: Developing a QCM for PHN are mixed views about the best way to do this. review and rapid evidence synthesis. practice using a ‘modified Delphi’ technique has enabled a platform to provide consensus Aims: To explore the current attitudes, beliefs and agreement amongst a panel of experts and and practice of health visitors with regard to provides an insight into key processes of care how they understand, organise and deliver the identified by PHNs and service users for practice. support they provide to mothers with mental health problems; to identify the contextual Theme: Qualitative approaches Biography factors that influence their practice; to list the core components that health visitors think Session no: 8.5.1 Abstract number: 109 Ms. Martina Giltenane is a registered general should form the basis of a health visitor-led and public health nurse; currently employed intervention. Time: 11:15am as a Project Officer developing Nursing and Midwifery Quality Care-Metrics in a Nursing Method: Folllowing University ethics Developing a quality care- and Midwifery Planning and Development Unit committee approval, an electronic survey was metric to measure public in Dublin. She is a recipient of a PhD Scholar- offered to all members (n= 9474) of the Institute health nursing practice ship December 2013 and is currently undertak- of Health Visiting (March: May 2016) ing a PhD in nursing. Martina has previously Ms Martina Giltenane BSc, PGDip, MHSc, Results: 1500 surveys completed. The majority been awarded a BSc General Nursing, and MSHc RGN, PHN, Midwifery and Health Sciences, of HV’s believed that supporting mothers with degree, a Graduate Diploma (Public Health University College Dublin, Dublin, Ireland mental health problems should be part of their Nursing) and a Diploma in Health Service Man- role. Respondents reported variations in support Co-author(s): Dr. Kate Frazer, Ireland; Dr. agement. from commissioners and managers; conflict- Ann Sheridan, Ireland; Mr. James Lynch, She is leading the development and implemen- ing work-based demands and priorities; lack of Ireland. tation of Quality Care-Metrics for the Public support from other services; limited workforce Health Nursing Service nationally. Martina has capacity; lack of experience, confidence and Abstract presented evidence from practice in her current training; and lack of clarity regarding the format Background: Measurement of care using role nationally, published her PhD protocol and expected outcomes of a health visitor- metrics plays an integral role in quality improve- paper (Journal of Advanced Nursing, 2016) and led intervention contributing to variations in ment. Quality care-metrics (QCMs) measure published findings from her Master’s research practice. The majority of HV’s agreed on the core the quality of nursing and midwifery practice project (Australian Journal of Advanced components that should be included in a HV-led and are aligned with evidence-based standards Nursing, 2015). intervention and wanted additional training and internationally. manualised guidance. Developing QCMs is a means of measuring Conclusions: If we are to improve mental public health nursing (PHN) processes and health outcomes for mothers it is important to practices and is important in improving care understand and address the determinants of outcomes. The first postnatal visit is acknowl- practice. Interventions need to be feasible as edged as the most important contact PHNs have well as effective and clearly described in order to with new mothers and babies. It is acknowl- facilitate shared expectations, consistency, repli- edged that PHNs provide physical, social and cability and sustainability. emotional care for new mothers, but little is known about the processes involved and quality Recommended reading list of this care. A ‘modified Delphi’ study was Gavin NI, Meltzer-Brody S, Glover V, Gaynes undertaken including: views of PHNs and new BN (2015) Is population-based identification mothers, review of relevant literature and a of perinatal depression and anxiety desirable? two-round review by a panel of experts to enable In JW Milgrom, AW Gemmill (Eds) Identifying

76 11.15am-12.40pm Concurrent session 8 – Friday 78 April 2017 Perinatal Depression and Anxiety. Chichester, sister role from both the employer and employee Theme: Qualitative approaches West Sussex: John Wiley and Sons. perspective. Department of Health, Public Health England, This presentation will focus on the interventions Session no: 8.6.1 Abstract number: 9 Local Government Association, NHS England, identified by the ward sisters as helping them Time: 11:15am Early Intervention Foundation and Health to become established in their role. It will also Education England. (2014) Overview of the six demonstrate the variables calculated by linear Family and community early years high impact areas. London : Depart- regression (formal qualifications (p=.045), ment of Health https://www.gov.uk/ attending conferences (p=.034) and shadowing nursing in Italy. NICE (2014) Antenatal and postnatal mental a more experienced peer (p=.021)) that were Organizational proposals for health: clinical management and service shown to have a positive effect on the time it a new welfare guidance. NICE guideline 192. https:// took for a ward sister to establish themselves in Dr Alessandro Stievano PhD, Centre of Excel- www.nice.org.uk/guidance/cg192?un post. There were 14 independent variables. lence for Nursing Scholarship, Ipasvi Rome, lid=496781995201621742617 (last accessed To conclude the following statements summarise Italy., Rome, Italy 25th August 2016) the original contribution this study made to Co-author(s): Silvia Marcadelli, Italy; nursing knowledge by Gennaro Rocco, Italy. Biography • identifying the learning needs of nurses who Catherine is a full-time Ph.D. student in the aspire to be ward sisters Abstract Department of Psychology, Social Work and • establishing the development needs of ward Background: Primary health care nurses Public Health at Oxford Brookes University. sisters integrate personal care with health promotion For her research, she is exploring the role of • ascertaining the interventions before and after and are fundamental to foster the sustainability the health visitor in supporting mothers with becoming a ward sister that reduce the time of the health systems in ageing societies. In this mental health problems during pregnancy period taken to reach the stabilisation phase framework, an investigation to identify the intro- and the year after the baby is born. Before her (Nicholson and West (1988) transition model) duction of organizational models for family and Ph.D., Catherine worked for many years as a in the transition to the ward sister role and community nursing all over Italy was conducted. health visitor and then as a Nurse Consultant in Aims: To build a new theoretical model and perinatal and infant mental health. Her teaching • designing a framework for ward sister prepara- describe the characteristics and challenges for experience has included running three, five and tion and ongoing development. family and community nursing in Italy. eight-day programmes on early intervention in emotional and behavioural problems in children, Recommended reading list Methods: A mixed method research was and detecting and managing maternal mental Bradshaw, A. (2012) Do ward sisters have accomplished via a parallel concurrent model. health problems in primary care. Catherine influence over care? Nursing Times 108 (3), A web survey through the National Federation has also written elearning modules for Health 17-18. of Ipasvi Colleges website was carried out for Education England on core concepts of attach- the quantitative element, while relevant stake- Nicholson, N. and West, M. (1988) Managerial ment theory, using attachment theory to inform holders (140), with different backgrounds (GPs, job change in transition. Cambridge: Cambridge practice and supporting mothers with mental nurses, nurse managers), using semi-structured University Press health problems in the year after delivery. questions, were interviewed for the qualitative Johnson, R., Onwuegbuzie, A. and Turner, L. part. (2007) Toward a definition of mixed methods Results: The research showed different research. Journal of Mixed Methods Research 1, organizational models employed to foster the 112-133. Session no: 8.5.3 Abstract number: 234 continuum of care in different Regions of Italy but also the lack of a defined representation for Time: 12:15pm Biography family and community nursing. In some Regions Jacqueline trained as a Registered Nurse at the role of the primary health care nurses was The ward sister: factors that King’s College Hospital, London and had a not well delineated. Furthermore, a lack of a aid transition clinical career in gynaecology. Jacqueline formal recognition of family and community achieved a PhD in Nursing in 2016 from the Uni- nurses with specific forms of working contracts Dr Jacqueline McKenna PhD, MMedSci, DipN, versity of Greenwich. Jacqueline is the Director emerged. RN, NHS Improvement, London, UK of Nursing - Professional Leadership at NHS Discussion: In this study the challenges that Improvement and was previously the Deputy the Italian National Health Service is experienc- Abstract Director of Nursing at the NHS Trust Develop- ing in trying to introduce family and community It has long been acknowledged that the ward ment Authority. Before this she held Director nursing were described. The research produced sister is a pivotal role in healthcare (Bradshaw, of Nursing posts at the Medway NHS Founda- a theoretical model for family and community 2012), however, in England the preparation tion Trust and at Southmead NHS Trust in nursing by centering primary care services and support available for these nurses remains Bristol. She implemented the first British model through health centres (Fig.1). variable. This study investigated what prepara- of shared governance which improves staff Conclusion: This research contributes to have tion and support helps nurses manage the tran- involvement in 1994, and won the HSJ award for a better knowledge of the role of primary health sition to the ward sister role. patient safety in 2005 for the development of the care nurses to foster social innovations at wider Medway Nursing and Midwifery Accountability A mixed method research approach (Johnson level. With this new theoretical model, nurses System. Jacqueline received an MBE for services et al, 2007) was used including focus groups would guarantee the sustainability of the Italian to nursing and health care in the 2010 Queen’s and surveys. The responses from the 174 ward National Health System and a better continuum birthday honours list. You can follow Jacqueline sisters gave a unique insight into their develop- of care through integrated primary care services on twitter @mrsjmckenna. ment needs and they suggested how, in future, in health homes managed by them. preparation and support should be delivered to Fig. 1 An organizational proposal for family and be most effective. community nursing in Italy. This study is significant as it was the first multi- centre UK study that investigated the developmental needs of nurses in transition to the ward

77 811.15am-12.40pm Concurrent session 8 – Friday 7 April 2017 Biography all stages of the research process to explore how Theme: Qualitative approaches Alessandro Stievano, PhD in nursing, Adjunct this can be facilitated in an ethical manner. faculty at Michigan State University (USA), Conclusion: Whilst there are ethical chal- Session no: 8.7.1 Abstract number: 295 author of publications on national (Italian) and lenges to promoting meaningful involvement Time: 11.15am international level. He is the research coordi- of some groups of people in the development of nator of the Centre of Excellence for Nursing research there are also ethical consequences of What do healthcare Scholarship of Ipasvi Rome in Italy. He is the non-involvement and hence researchers need to President of the Italian Transcultural Nursing develop ethical strategies to support participa- professionals do when Association and the Executive Director of a new tion. the patient with dementia Foundation for “Health research” in Italy. He says ‘no’ to a healthcare teaches at several undergraduate and post-grad- Recommended reading list procedure? uate nursing courses in various Italian universi- Beauchamp, TL and Childress, JF (2013) Princi- Dr Sarah Goldberg BSc, RN, PhD, University ties, such as the University of Rome Tor Vergata. ples of Biomedical Ethics, 7th edition. New York: of Nottingham, Nottingham, UK Oxford University Press. Co-author(s): Becca O’Brien, UK, Rebecca Fricker, B. (2007) Epistemic Injustice. Power Allwood, UK, Suzanne Beeke, UK, Alison and the Ethics of Knowing, Oxford: Oxford Uni- Pilnick, UK, Rowan Harwood, UK Session no: 8.6.2 versity Press Abstract Withdrawn Biography Background: Poor communication is a barrier Ruth is Professor of Learning Disability Nursing to processes essential for good treatment and at the University of South Wales, a post she has care. People with dementia and those who work held for 13 years. Her current role also includes with them can experience difficulties in com- Session no: 8.6.3 Abstract number: 85 leading the Unit for Development in Intellectual municating and interacting. Much of healthcare Disabilities within the University. She teaches involves a healthcare professional requesting an Time: 12.15pm on a range of undergraduate and post graduate action from a patient (for example, to stand up courses working with both learning disability or to open their mouth). People with dementia The ethical implications of nurses and nurses working in other fields of often initially refuse these requests for action. facilitating the involvement practice. She also supervises a number of PhD Aims: To identify the communication skills that of groups considered students. Her research interests lie in the health healthcare professionals use when a request for ‘vulnerable’ in the needs of people with learning disabilities and in action is refused by the patient with dementia. development of research safeguarding people from abuse. Her PhD study used a participatory research approach and Methods: Non-participant observational study Professor Ruth Northway PhD, MSc(Econ), since that time she has undertaken a number using video recorded data of conversations RN(LD), Cert Ed(FE), University of South of studies working with people who use services between healthcare professionals and patients Wales, Pontypridd, UK to develop and undertake research. She has with dementia in the acute hospital analysed published widely in relation to participatory using conversation analysis. Abstract research and in the field of learning disabili- Results: 40 naturally occurring commu- Background: Funders of research are increas- ties. She is Editor of the Journal of Intellectual nications between healthcare professionals ingly requiring applicantions for funding to Disabilities, and Co-Chair of the Welsh Gov- (nurses, doctors and therapists) and patients detail how those who are (or are likely to be) ernment Learning Disability Advisory Group. with dementia were video recorded between affected by the focus of the research have been She also chairs the All Wales Implementation September and December 2015. All the patients involved in the development of the proposal and Group for Strengthening the Commitment (the were identified as having some degree of com- how they will be involved in the research if it is UK Learning Disability Nursing Strategy) and munication impairment. The analysis identified funded. Whilst there are sound ethical reasons as is taking a UK lead in respect to the research techniques healthcare professionals use (whilst to why this is important it can also raise ethical related recommendations of this strategy. behaving in a person-centred way) that appear challenges if such involvement is to be meaning- to make the patient with dementia more or less ful particularly when those to be involved are likely to agree to a request for action. Examples viewed as belonging to ‘vulnerable’ groups. include how the healthcare professional displays their entitlement to make the request, use of Aims: To explore what ‘involvement’ means simple directives, making the task appear less in this context and how this may be facilitated onerous and suggestions of joint action. In the when working with groups who may be consid- presentation, selected video recordings will be ered vulnerable. shown to illustrate findings. Presentation: This session will use the four Discussion: How we frame requests to patients ethical principles identified by Beauchamp and with dementia will influence the likelihood of the Childress (2013) (Beneficence, non-maleficence, patient granting that request. If the patient lacks autonomy and justice) to explore the reasons why capacity and completion of the task is in the involvement in the development of research is patient’s best interest, then healthcare profes- important and the ethical consequences of non- sionals need to use communication to maximise involvement. In particular it will be argued that their chances of successfully completing the task. non-involvement is a form of epistemic injustice (Fricker, 2007) that reinforces marginalisation. Conclusion: Healthcare is delivered through The utility of the term ‘vulnerable group’ will communication. This study has identified be critically examined and it will be argued that practical ways healthcare professionals can epistemic injustice is itself a source of vulner- improve their communication with patients with ability. The presentation will also use personal dementia. experience of seeking to promote involvement at

78 11.15am-12.40pm Concurrent session 8 – Friday 78 April 2017 Biography decision in some circumstances (Barbour 2007). Session no: 8.7.3 Abstract number: 304 The presentation will debate such decisions and Sarah Goldberg is an academic nurse working Time: 12.15pm at the University of Nottingham’s School of the consistency and coherence of the research Health Sciences. Her research aims to improve design versus the flexibility and inclusivity of the health and quality of life of older people, adding individual interviews where focus groups The perceptions of particularly those with cognitive impairment. alone are impractical. implementing the bar-code Her current research includes the development Conclusion: Focus groups can generate rich medication administration of a dementia communication skills training data through the interactions that occur but from nurses’ perspective: a course; an intervention to improve activity and can be difficult to recruit to. Where individual qualitative systematic review. independence whilst reducing falls in people interviews are used to supplement focus groups, Ms Wan-Shiuan Lin, Doctoral Student, School with mild dementia and a study of patients with researchers should be transparent about such of Nursing, National Yang-Ming University, dementia who call out repetitively. Previously decisions and how the data are used within the Taipei, Taiwan, Taipei, Taiwan her research included the evaluation of a medical analysis. and mental health unit for older patients with Abstract cognitive impairment and the development of Recommended reading list the role and competencies for advanced nurse Background: Research shows that it is Barbour, R.S. (2007) Doing Focus Groups. Los practitioners specialising in frailty. important to integrate the system into the Angeles: Sage Publications. nursing workflow in the process of the BCMA Kitzinger, J. (1994) The methodology of focus system implementation for operating more group interviews: the importance of interac- easily and enhancing nurses’ receptiveness. tion between research participants. Sociology of Qualitative studies have been conducted with Session no: 8.7.2 Abstract number: 57 Health and Illness 16:103 - 121. the view to understanding the perceptions of the Time: 11.45am Cleary, M., Horsfall, J., Hayter, M. (2014) Data ease of use and usefulness. collection and sampling in qualitative research: Aim: This study intends to understand the per- Including individual does size matter? Journal of Advanced Nursing. ceptions of nurses about the implementation of interviews in a study using 70, 3, 473-475. the bar-code medication administration. focus groups: a pragmatic Methods: Cochrane Library, Joanna Biography solution or a threat to Briggs Institute, Academic Search Complete Professor Lesley Baillie was appointed Florence coherence? (EBSCOhost), Pubmed, and Theses and Chinese Nightingale Foundation Chair of Clinical electronic periodical services were searched in Professor Leslie Baillie, London Southbank Nursing Practice in 2012, a joint post between Desember 2016. The participants of interest University and University College London London South Bank University (LSBU), Univer- included the registered nurses who had used the Hospitals, UK sity College London Hospitals (UCLH) and the barcode medication administration system. The Florence Nightingale Foundation. Since 2015, phenomenon of interest included their percep- Abstract Lesley has also been Director of the Centre for tions, opinion, expectations, or impact about the Background: Focus groups are widely used Nurse and Midwife-led Research and Honorary barcode medication administration system. This in healthcare research, with a key attribute Professor at University College London. Lesley review considered studies that used qualitative being that the interactions between participants is the Course Director for the Professional methods to investigate perceptions of nurses stimulate further ideas for discussion. These Doctorate in Health and Social Care and Post- about the implementation of the bar-code data created through interactions are a fun- Graduate Research Director at LSBU. Lesley’s medication administration. The Joanna Briggs damental component of focus groups and can nursing background is in acute hospital care Institute Qualitative Assessment and Review provide insights into public discourse (Kitzinger and she has a particular interest in quality care Instrument (JBI-QARI) were used to be the 1994). In practice, focus groups can be difficult and dignity for older people, improving care standardized critical appraisal instrument. The to recruit to for a range of reasons including for people living with dementia and integrated JBI-QARI was used to be the standardized data working patterns and geographical locations. care. Lesley’s PhD thesis (completed 2007) was extraction tool for extracting qualitative data Subsequently, researchers may include individ- a qualitative case study of patient dignity in an and pooling the qualitative research findings ual interviews in studies where they planned to acute hospital. Lesley has published in a range from papers included in the review. of academic and professional journals and has use focus groups alone, particularly when they Results: A total of three qualitative papers were published a number of books, most recently: wish to include people with particular character- included in the review (one phenomenology and ‘Improving healthcare: a handbook for prac- istics who cannot attend planned focus groups. two qualitative inquiry). Four syntheses were titioners’. Lesley is on the editorial board for derived: (1) Facilitation nursing workflow; (2) Aim: This presentation aims to debate how Nurse Researcher and is consultant editor for Establishing a second gatekeeper; (3) Encoun- adding individual interviews into a study that Nursing Ethics. primarily uses focus groups affects the overall tering operational difficulties; and (4) The data set and coherence of the study design. impact of the nursing profession. Discussion: The discussion will include critical Conclusions: The research findings have reflections from a study that planned to conduct derived the perceptions of nurses about the focus groups with hospital staff but included implementation of the bar-code medication some individual interviews with ward-based administration. nurses who could not leave their wards to attend Implications for practice: The promoter and focus groups. The data collected through individ- designers must listen and accept nurses’ percep- ual interviews inevitably differed from the focus tions about the new technology, workflow, and groups as one-to-one interviews cannot lead to use, and serve as a basis for prioritizing practice the ‘synergistic sparking-off’ between group solutions. members that occurs in focus groups (Cleary et al. 2014, p.474). Nevertheless, the use of some individual interviews within an overall focus group design has been recognised as a pragmatic

79 11.15am-12.40pm Concurrent session 8 – Friday 7 April 2017

8Recommended reading list Huang, Hsiu-Ya. (2009). “The Effects of Bar Cord Medication Administration on Nursing (unpu-blished doctoral dissertation)”. Taipei: National Taipei College of Nursing. Zadvinskis, I. M., Chipps, E., and Po-Yin, Y. (2014) “Exploring nurses’ conï¬rmed expectations regarding health IT: A phenomenological study”. International Journal of Medical Infor- matics, 83, pp 89-98. Taliercio, V., Schachner, B., Borbolla, D., Luna, D., Villalba, E., and Quiros, F. (2014) “The expectations of nurses about the implementation of a barcoded medication administration system: a qualitative study”. Studies in health technology and informatics

Biography Wan-Shiuan Lin received her master degree in community health nursing from National Yang-Ming University, Taipei, Taiwan. She has special interests in ‘Maternal and Child Health’, ‘Medical Sociology and Science’, ‘Technol- ogy and Society(STS)’. Now she is a third-year student of the Doctoral Program, Department of Nursing, School of Nursing, National Yang - Ming University, Taipei, Taiwan. Moreover, she has been working at Taipei Veterans General Hospital for ten years and focusing on providing the expert advice for clinical care.

80 3.25-4.25pmS1-5 Symposia – Thursday 6 April 2017 Symposia 1 - 5 Thursday 6 April 2017 3.25-4.25pm

Symposium 1 Paper 1 References Rose, N. (1998). Inventing Our Selves: Psy- Time 3.25pm Governing the online self: the chology, Power, and Personhood. Cambridge: Room: 6 accomplishment of identity in Cambridge University Press. online nursing research Hacking, I. (2007). Kinds of People: Moving Who am I, and who are you? Authors and affiliation targets. Proceedings of the British Academy, 151, Identity, engagement and Dr Nigel Cox, Senior Lecturer, Department of 285–318. collaboration in the era of Nursing, Manchester Metropolitan University Douglas, M. (2002). Purity and Danger online nursing research (Routledge Classics Edition). London: Routledge. Lead: Abstract Dr Nigel D. Cox, Senior Lecturer, Faculty of With a focus upon how people represent their Health, Psychology and Social Care (Nursing), identities in online nursing research, this paper Manchester Metropolitan University, will provide an opportunity for critical debate Paper 2 Manchester, UK about the theoretical concepts and methodological concerns that frame research in virtual Fractured realities: This symposium addresses the theory and or digital environments. The presentation navigating the online practice of digital, online nursing research. Col- will employ three theoretical standpoints: the lectively, the papers acknowledge the emergence governing of the ‘online self’, the interaction research terrain with of service user or patient voice as a service delivery between researcher-defined and participant- participants managing mental philosophy and modality, a standpoint which is chosen classifications, and the ritualistic nature ill-health also reflected in the movement towards collabo- of ethical risk assessment processes. Authors and affiliation rative and co-creative research methodologies. The first standpoint, ‘governing’ (Rose, 1998), Dr Eula Miller, Manchester Metropolitan Individually, each paper problematizes the nature considers how people are made ‘visible’ to University, UK; Dr Karen Wright, University of personal identity in online research and, in researchers through the guidelines and processes of Central Lancashire, UK different ways, asks the question: ‘Who am I, and used in research practice. These techniques who are you?’. Each paper frames this question incite or oblige people - researchers and partici- differently in order to create a discussion about Abstract pants - to behave and act in particular ways. The the different ways it might be answered. paper will explore this theoretical standpoint This aim of this presentation is to provoke The opening paper by Cox, a nurse/healthcare and apply it to nursing research conducted in the critical interrogation and reflection upon researcher and anthropologist, considers three online environment. issues that may occur when engaging in online theoretical standpoints: how the ‘online self’ is research with individuals who are coping/living The second standpoint, ‘classifying’ (Hacking, governed (by people or researchers), how people with mental ill-health. Although the benefits of 2007), considers how people become subjects of are classified (or classify themselves), and the working collaboratively with such individuals is professional knowledge, and how people interact ritualistic nature of ethical risk assessment well documented (Ramon, 2000), the complexi- with the classifications conferred upon them processes. ties and intricacies are less well-voiced within by others. In the online environment, this is of research literature (Helchem, 2012), specifically The second paper by Miller and Wright, nurse critical importance in circumstances where the when exploring online research engagement. researchers and mental health practitioners, well-being of the ‘self’ is central, for instance for aims to provoke critical interrogation and reflec- people identifying the mental health concerns of Through the use of case studies and vignettes, tion upon potential issues that may occur when themselves or others. the issues presented will promote delibera- engaging and collaborating in online research tion and focus upon how engaging in online A final standpoint, ‘rituals and risk’ (Douglas, with individuals who are coping/living with research can present issues unique to this client/ 2002) considers how researchers identify and mental ill-health. patient group. Consideration of such are deemed navigate the risks of the online encounter. important, as if left unchecked can fracture the The closing paper by Haigh, a nurse researcher Anthropological theory can show how ethical relationship dynamic between the researcher and leader in healthcare ethics, gathers together checklists can help to identify risk and so protect and participant, and the research process, (Rose, and integrates Cox’s consideration of identity people from harm. However, we may need to 2003). and ritual and Miller’s exposition of fractured consider how risk-managing rituals might also reality in order to progress discussion about the obscure the very people we are aiming to protect. Additionally, as mental health service users online self, personality disguise, and matters of may choose to disengage with services, so too, Summarising, this paper will note how online governance. may they choose to disengage with research. research provides a venue for identity negotia- A crucial difference here is that mental health These emerging theoretical standpoints tion, brokerage and accomplishment. In doing workers have a duty of care to the service user and practical contexts for nursing research so, discussion will be invited about how the and can assertively seek to re-engage them out present challenges for service users/patients, research encounter is theoretically framed, and of concern for their wellbeing. The researcher, researchers, ethicists, and their sponsors. This how nursing practice in methodology and ethics however, must respect a participants’ decision symposium will be of interest to researchers may need to continually adapt to the challenges to opt out of the research and have no way of and practitioners interested in advancing online and innovations of online research. methodologies, people working with vulner- knowing if they have been adversely affected by able or hard-to-reach populations, and people the research experience. working in the field of research governance.

81 S1-53.25-4.25pm Symposia – Thursday 6 April 2017 By addressing such issues through raising of the research depends upon the reliability Symposium 2 awareness and understanding of the same, it and veracity of the data and the extent to which is hoped that stakeholders engaged in such that data can be linked to a specific persona. Time: 3.25pm situations will enhance their ability to navigate The peculiar intimate nature of online interac- ethically and morally the research terrain and tion, coupled with the disinhibiting effect that Room: 7 encounter the least disruption to researcher- is initiated when one cannot see the reaction Chair: Hjh Jainah binti Hi Musa, participant relationships when working with of one’s statements (the “you can’t see me, you University Brunei Darussalam, Brunei people living with mental ill-health, the research don’t know me” phenomenon), rendering some process, and research outputs. areas of cyberspace potentially risky to both the well-being of participants and the integrity of the Impact of British Colonialism References research. on development of Nursing Helchem, H (2012), Ethics of clinical research This paper explores these issues through the and Midwifery in a South with mentally ill persons, European Archives lens of personality construction and cyber-space East Country, The Brunei Psychiatry Clinical Neuroscience, 262:441–452 immersion. Darussalam: A historical Ramon, S. (2000) Participative mental health Inquiry References research: users and professional researchers Lead: working together. Mental Health Care, 3, 7, Bruckman, A (2002) Ethical guidelines for Dr. Munikumar Ramasamy Venkatasalu, 224-228. research online. http://www.cc.atech.edu/~asb/ Professor in Cancer and Palliative Care at Rose, D. (2003) Collaborative research between ethics/ (accessed 08/11/16) Institute of Health Sciences (IHS) UK users and professionals: peaks and pitfalls. Psy- Suler, J.R., 2002. Identity management in chiatric Bulletin, 27, 404-406. cyberspace. Journal of Applied Psychoanalytic The profession of nursing and midwifery still Studies, 4(4), pp.455-459. believes itself as art and vocation. Our world Van Selm, M. and Jankowski, N.W., 2006. Con- of research was bigger and more is yet to be ducting online surveys. Quality and Quantity, explored within context of Brunei Darussalam. Paper 3 40(3), pp.435-456. We embarked to enquire ‘who we were’ that led to conduct a historical inquiry of nursing and You don’t see me, you don’t midwifery in Brunei Darussalam. Firstly, student know me: the ethical issues midwife Nourfaidzoul Aidzoul binti Hj Zulkifli/ surrounding cyber-space Hj Basar shares her findings on power, relation- research ship and politics of early nursing development in Brunei Darussalam, second speaker student Authors and affiliation midwife Rosnah binti Kambar will be present- Professor Carol Haigh, Department of ing on Water Village Midwives: older midwives Nursing, Manchester Metropolitan University reminiscence on early midwifery and finally, student midwife Zarinah binti Hj Mohammad Abstract will illustrate the older Bruneian’s narratives on transitions in midwifery care: A historical Following on from Cox’s consideration of inquiry. This presentation also encompasses consensus reality, and Miller and Wright’s expo- the challenges and opportunities of undertaking sition of fractured reality, this paper explores undergraduate research projects. the concept of immersion of self in cyber-reality from the perspective of personality disguise. Many of the concerns that exercise cyber-ethicists are those of real world research, Concepts Paper 1 such as ensuring confidentiality and privacy of respondents, gathering informed consent English Matron, Chinese from participants and the prevention of harm Managers and Strict (Jankowski and van Slem, 2006). That these are Doctors: historical lessons issues of joint concern to both techno and real world researchers is conceded, however certain learned from early nursing issues require greater consideration in cyber- development in Brunei space than was generally expected from real Darussalam world human subject research. Authors and affiliation Concealment of real world identity in virtual Hjh Salmah binti Mohd Noor, Brunei; Armah settings is a common practice and as one moves Tengah, Brunei Darussalam, Munikumar progressively through the layers of cyberspace Ramasamy Venkatasalu, Brunei Darussalam real world identities become more obscured. Physical attributes, age, sex and gender are Abstract unclear and lack of certainty regarding individual ‘real world’ characteristics presents quite Introduction: Similar to many countries, obvious problems to the researcher. Conceal- nursing profession in Brunei Darussalam had ment may include strategies such as gender experienced various developments and chal- switching (Suler 2002), the use of pseudonyms lenging issues, since the formal Health care (Bruckman, 2002) or the use of Avatars. system introduced by the British Residency in 1907. However, little is historically explored the As with other forms of research, the aim of influence of British colonisation and nursing techno-research is to protect the well-being of development. the subject by minimising risks. The integrity of the research depends upon this and validity

82 3.25-4.25pmS1-5 Symposia – Thursday 6 April 2017 Aim: To explore the early nursing trends and tions, findings showed how peoples’ beliefs and Symposium 3 development in Brunei Darussalam since British practices around birth services were challenged residency, 1907. and changed to adopt ‘inserted’ westernised Time: 3.25pm practices. Methods/Contents: A qualitative descrip- Room: 9 tive research design with historical approach Conclusions: Our study conclude that tran- utilizing in-depth face-to-face semi structured sitions in midwifery services were achieved Trials and Tribulations of interviews were conducted with 12 retired through ‘collaborative work’ between traditional nurses. Data were analysed thematically by village midwives and trained midwives, power of delivering research within using continuous comparative process. ‘government’ midwife through ‘given responsi- the NHS: presented by the Findings/Results: The analysed data revealed bilities’ and ‘secure hospital environments’ with FRONT nurses group three subthemes which were constantly scru- qualified multi-disciplinary professionals, At Lead: tinized and grouped into four main themes, this current context of promoting cost effective Dr Heather Iles-Smith, Head of Nursing which were: Theme 1: English Matron, Chinese health care deliveries, Future attempts of tran- Research and Innovation, Leeds Teaching Managers and Strict Doctors; Theme 2: Senior’s sitions in midwifery services in should adopt Hospitals, UK Choices and Theme 3: We Were Better. above criterion for successful implementation. Conclusion: Our study highlight the power This symposium is presented by the UK Forum and politics in early development of nursing in for Trust/Healthboards Research Leads (nursing) – FRONT. The FRONT Nurses group Brunei Darussalam. Bruneian nurses were rec- Paper 3 ognized through their attainment in education, comprises of around 100 senior nurses (across quality of nursing services and professional and England, Scotland, Wales and Ireland) who are Image and power responsible for strategic leadership of the clinical personal values of the nurses. The local nurses relationships of water village confronted challenges by pursuing higher research delivery workforce in their respective education and improving their competence and midwives during British organisations. The purpose of the group is to skills to attain professional identity and recogni- Colonization: older midwives share good practice and ways of working related tion. reminiscence of on early to research delivery. midwifery The aim of the symposium is to cover the current and future evolution of the research delivery Authors and affiliation service and workforce within the NHS and Rozita binti Tamin, Brunei; Norashikin Sofian, Paper 2 internationally, and highlight the opportunities Brunei Darussalam, Munikumar Ramasamy for advancing nursing and the non-registered Venkatasalu, Brunei Darussalam Older Bruneian Women’ clinical research roles. Narratives on Transitions in The three presentations progress from pres- Midwifery Care since British Abstract entation one that covers research study and Colonisation: A Historical Background: Professional identity often participant acuity, skill mix, suitable compe- Inquiry remain struggle for midwives. In many countries tency assessment, application of the Calderd- midwives often miss-labeled as nurses and ale Framework and past and present research Authors and affiliation viewed lower than nurses in their grading. There delivery roles: these will include registered, such Hjh Jainah binti Hj Musa, Brunei; Munikumar is lack of knowledge on how professional identity as advanced roles, and non-registered posts Ventakasalu, Brunei of midwives in Eastern world. including volunteer. Aim: To investigate the history of midwifery in The presentations then move on to developing Abstract terms of practices and training in Brunei Darus- an innovative and responsive future workforce, Introduction: Rapid technological advance- salam from the reminiscences of older midwives. highlighting the predicted future challenges, ments in Midwifery practices influenced swift Methods: A historical qualitative descriptive identifying the real issues and exploring solutions shifts in its traditional practices. In particular, study was undertaken. In total of 18 midwives through examples of international and clinical westernised practices during British colonisa- who were trained during 1950- 1960s. Six roles. We will explore future opportunities tion at global level challenged and changed in-depth, face to face interviews were conducted. based on new changes to the clinical workforce nature and delivery of midwifery services across A purposive and snowball sampling was adopted. (in the UK) such as the nurse associate role, the the world. The interviewed transcripts were analysed using nurse apprentice and the national apprentice- Aim: To explore on how the transitions in the thematic analysis. ship agenda. This presentation will be delivered jointly by a Head of Nursing with expertise in midwifery services in Brunei Darussalam were Findings: Collectively, two major themes Workforce and Education and a Nurse Leader of experienced by older Bruneians who gave birth were observed: the theme on “Power Relation- the research delivery workforce. since 1940s. ship” reflects the bonds between midwives with Design: A qualitative narrative historical other health care professionals and public, The final presentation addresses opportuni- approach was used. Purposive and snowball and ‘Images’ which disclose the perceptions of ties for the registered nurse research delivery sampling was chosen as appropriate to obtain 18 midwives and public on midwifery as a profes- workforce and how we might better engage them face to face interviews with older Brunei women. sion. in developing their own research ideas. The challenges around better sign posting and creatively A semi-structured interview guide was used. A Conclusion: The professional identity of capturing their enthusiasm and passion for thematic analysis was undertaken to analyse the midwives were rooted in colonial British nursing research in a way that can translate into them transcripts. era. Often older midwives seems to appreciate developing as clinical academics and Principle traditional practices in their practice and trust Results: Analysis illustrated on the shared Investigators of the future, will be explored. experiences of older Bruneian participants’ from pregnant women were influencing factors transitions in midwifery services from the for development of midwifery as profession. year 1940s until early 1990s. Three transitions were observed: in-house wise women as traditional village midwives, government midwives and hospital midwives. During those transi-

83 S1-53.25-4.25pm Symposia – Thursday 6 April 2017 Paper 1 International Association of Clinical Research the research delivery workforce, and how new Nurses. (2016) Clinical Research Nursing Scope clinical workforce solutions might be applied to Meeting the evolving research and Standards of Practice. United States of this key workforce area. agenda through effective and America: American Nurses Association. References efficient research delivery The Calderdale Framework, (2016). [online] Hooker, R. S., Hogan, K., Leeker, E. (2007) Authors and affiliation Available at: http://www.calderdaleframework. The Globalization of the Physician Assistant Karen Palmer, Research Nurse Manager, com/ [Accessed 11 Nov. 2016] Profession. The Journal of Physician Assistant Lancashire Care Foundation NHS Trust, Education. 18(3) 76-85 FRONT group Secretary and Hilary Campbell, Lead Research Nurse Co-ordinator, York Juraschek, S.P., Zhang, X., Ranganathan, V., Hospital and FRONT group Secretary Paper 2 Lin, V.W. (2012) United States Registered Nurse Workforce Report Card and Shortage Forecast. Developing an innovative and American Journal of Medical Quality. 27(3) Abstract responsive future workforce- 241-249, doi: 10.1177/1062860611416634 Background: Changing patterns in health what are the real issues and Health Education England (HEE) (2015) The care have created an ever evolving research solutions? Shape of Caring Review- Raising the Bar: Health agenda, with a need for a progressive, competent Authors and affiliation Education England’s response. https://www. workforce to deliver clinical research. Healthcare hee.nhs.uk/our-work/developing-our-work- professionals have historically worked within Heather McClelland, Head of Nursing and Midwifery Workforce and Education, Leeds force/nursing/shape-caring-review - accessed their clinical role boundaries when participating 13 11 2016 in the delivery of clinical research, often working Teaching Hospitals NHS Trust and Dr Heather in task limited roles. Iles-Smith, Head of Nursing Research and Innovation, Leeds Teaching Hospitals NHS Clinical research delivery has traditionally been Trust and Chair of FRONT Nurses Group, UK coordinated by qualified nurses in a research Paper 3 nurse role. This an internationally recognised nursing speciality acknowledged through pro- Abstract Registered nurses fessional development tools, such as the RCN Background: The ever-changing nature transitioning between Competency Framework (2011) for Clinical of research delivery has required increasing research delivery to research Research Nurses, first published in December flexibility and development of the respective leader - is it actuality or 2008 and recently the International Association workforce. Growth of clinical research in the UK of Clinical Research Nurses – Clinical Research since implementation of the National Institute fiction? Nursing Scope and Standards of Practice (2016). of Health Research (NIHR) 10 years ago, has Authors and affiliation Historical and current research delivery: required expansion and increased efficiency of Emma Munro, Head of NursingAHP Research As research becomes an integral part of the NHS the research delivery workforce through flexible and DEvelopment, University Hospital with 100 per cent of NHS trusts supporting working across portfolios of research. Southampton NHS Foundation Trust- FRONT opportunities for people to actively participate The UK traditional model of purely employing Nurses- member UK in clinical research and 42% of General Medical research nurses is challenged due to the dearth of practices now research active, clinical research registered nurses (RN’s); likewise, in the United Abstract managers have had to adapt and examine new States RN shortages are predicted to increase Background: The global scarcity of research service delivery models, to create a diversified incrementally to the year 2030 (Juraschek, et expertise and doctorly prepared clinical and edu- workforce. al., 2012). The additional shrinkage of research cational based nurses limits the opportunity to This presentation will discuss historical and budgets and the need to do more with less has embed research in nursing practice (McDermid, current workforce models including registered led to more junior and non-nursing roles and et al. 2012). and non-registered nurses, advanced roles within the need to engage clinical staff in the delivery During the last decade, clinical academic career research nursing, generic roles, allied health of research. (CAC) pathways for nurses have received care professionals and volunteers, with a focus Future research workforce models: increasing attention (Department of Health, on research study and participant acuity and Future challenges related to ensuring sufficient 2006). Dedicated National Institute for Health skill mix. There will be a consideration of service resource is available through a suitably educated, Research (NIHR) funded training streams for delivery tools such as the Calderdale Framework competent research delivery workforce, are nurses, midwives and Allied Healthcare Profes- (2016) to develop a competent workforce that is only likely to become more compounded. The sionals have also been implemented. encased within a robust training and governance application of current models such as the Physi- structure. cian’s Assistant (Hooker et al, 2007), the nurse Sign posting career opportunities: In 2012 the Association of UK University Hospitals Conclusion: This session will provide an apprentice, and evolving clinical models, such (AUKUH) established a clinical career ladder overview of past and present research delivery as the Nurse Associate (HEE, 2015) and the and a generic knowledge and skills framework across different professional roles, skill mix, UK national apprenticeship agenda, as well as for non-medical (including nurses) clinical- workforce adaptability and the impact this may joint clinical and research delivery roles, may be academic roles (Westwood et al., 2012). Other have on participant acuity. potential future solutions. resources have also been developed and This presentation will discuss these clinical launched to support individuals, managers and References workforce models and how they might be applied organisations in developing CAC’s. RCN Research Nurse Competency Framework, to the delivery of research and best achieve Research delivery nurses would appear to be (2011). [online] Available at: coordinated and increased flexible models of working. Early findings and experiences of the well placed to access training opportunities https://www2.rcn.org.uk/__data/assets/pdf_ and resources to develop their careers as inde- file/0019/201466/Research Nurse Competency UK Nurse Associate scheme will be shared by one of the 11 nurse Associate pilot centres. pendent researchers. However, despite having Framework - Version 2 - Full – Oct 2011.pdf a broad understanding of research language, [Accessed 11 Nov 2016] Conclusion: Delegates will have the oppor- systems and processes, and being embedded in tunity to hear of the challenges and potential a research environment, only limited numbers solutions related to expanding and growing

84 3.25-4.25pmS1-5 Symposia – Thursday 6 April 2017 of the reportedly 4000 strong NIHR research Symposium 4: fessional nursing? Yet a substantial amount of nurse workforce undertake doctoral training and health related research remains unpublished go on to become independent researchers. Time: 3.25pm and much more virtually unread. A survey of 635 completed clinical trials funded by the National This presentation discusses the range of Room: 11 resources and training opportunities to support Institutes for Health (NIH) found that less than half the results were published within 30 months the development of CAC’s and the potential Publishing evidence for reasons why research delivery nurses are not of completion and a third of results remain currently accessing them on a wider scale. impact on practice unpublished 51 months following completion Suggested interventions and how nursing Lead: (Ross et al 2012). In this presentation senior academics and research nurse leaders may work Ian Norman BA, MSc, PhD, RN, FEANS, editors of the International Journal of Nursing together through Higher Academic Institutes FAAN, FRCN, FKC, Professor of Mental Studies (currently ranked 3rd in Thomson and the FRONT group, to address and harness Health Nursing and the Executive Dean of the Reuters’ 2013 Impact Factor list of 106 academic the interest of these uniquely placed practition- Florence Nightingale Faculty of Nursing and nursing journals) will highlight reasons for non- ers will also be explored. Midwifery at King’s College London, UK, and publication of nursing research and share their top-tips for researchers about how to improve Conclusion: This session covers the devel- the Editor-in-Chief of the International Journal their chances of publishing research findings in opment of clinical research nurses as future of Nursing Studies high impact nursing journals and ensure that Principle Investigators and how as research This symposium will explore the contribution of those findings will be used by practitioners and leaders we can continue to collaborate and academic publication to the development of an researchers. The purpose of the presentation is to influence up-take of training and development evidence base for professional nursing practice. provide the audience with information which will opportunities by this research ready group. The three papers included in this symposium improve the quality of their published outputs and draw out their implications for nursing References will examine the changing landscape of academic publication in nursing and healthcare. The first practice and policy. The target audience is pro- Department of Health (2006) Modernis- paper examines the reasons for non-publication fessional nurses, midwives and other healthcare ing Nursing Careers. Setting the direction. of nursing research and considers the factors professionals who write or are thinking about http://webarchive.nationalarchives.gov. that can improve the likelihood of publication. writing for publication and healthcare students uk/20071104143406/dh.gov.uk/en/Publica- The second discusses the merits and limitations who are undertaking research as part of their tionsandstatistics/Publications/Publications- of different forms of publication for maximis- professional development. PolicyAndGuidance/DH_4138756: Department ing the impact of nursing research. The third of Health, London. provides an overview of research publication Reference McDermid, F., Peters, K., Jackson, D., Daly, J. trends, publication metrics and new dissemina- Ross, J.S., Tse, T., Zarin, D.A., Xu, H., Zhou, L., (2012) Factors contributing to the shortage of tion channels for nursing research. and Krumholz, H.M., 2012. Publication of NIH nurse faculty: A review of the literature. Nurse The symposium will provide expert advice on funded trials registered in ClinicalTrials.gov: Education Today. 32(5) 565-569 how to successfully publish nursing research in cross sectional analysis. British Medical Journal. Westwood, A. and Richardson, A. (2012) high impact journals and how to maximise the 343: d7292. Clinical Academic Careers Pathway Capabil- impact of these publications on nursing policy ity Framework. Association of UK University and practice. The symposium will be presented Hospitals (AUKUH). http://www.aukuh.org.uk/ by senior editors of a leading nursing journal and index.php/affiliate-groups/20-nmaphps/128- a senior publisher and will encourage audience Paper 2 clinical-academic-careers-pathway-capability- participation and debate. framework. Accessed- 13 11 2016 Maximizing the impact of your publications in an open access environment Paper 1 Authors and affiliation Author 1: Professor Peter Griffiths: Professor Leading the development of Health Services Research, School of of nursing practice and Health Sciences, University of Southampton, policy through successful Southampton, UK Executive Editor, publication International Journal of Nursing Studies Authors and affiliation Author 2: Professor Ian Norman: Professor Author 1: Professor Ian Norman : Professor of Mental Health Nursing and Executive Dean of Mental Health Nursing and Executive Dean at King’s College London, UK Editor-in-Chief, at King’s College London, UK Editor-in-Chief, International Journal of Nursing Studies International Journal of Nursing Studies Author 3: Sarah Davies, Senior Publisher, Author 2: Professor Peter Griffiths: Professor Elsevier, Oxford, UK of Health Services Research, School of Health Sciences, University of Southampton, Abstract Southampton, UK Executive Editor, The pressure on nursing scholars to publish International Journal of Nursing Studies their research findings has never been greater. Author 3: Sarah Davies, Senior Publisher, Publications bring scholars and their employing Elsevier, Oxford, UK institutions recognition, raise the likelihood of further research funding and are the pathway to Abstract a successful academic career. However, publishing practices and the publishing environment Publication of research findings may be regarded are changing. Whereas frequency of publication as a moral duty – after all what good is research was once the main criterion for academic success if it does not inform the evidence base of pro- the emphasis (Norman and Griffiths 2008)

85 S1-53.25-4.25pm Symposia – Thursday 6 April 2017 today is on producing fewer papers, but ones Paper 3 Symposium 5: that are highly used and cited and published in high impact journals. Added to this the long Examining the trends Time: 3.25pm and sometimes heated debate about the merits of nursing evidence Room: 14 or otherwise of open access publishing (Griffiths based research and the 2014) of research findings seems to have been superseded by a commitment of major funding measurements of quality Domestic violence: bodies internationally to open access publica- Authors and affiliation Exploration of education tion as a requirement of research funding (HEFC Author 1: Sarah Davies, Senior Publisher, and training to support 2014). Elsevier, Oxford, UK effective identification and So what implications do all these changes in pub- Author 2: Professor Peter Griffiths: Professor management in practice of Health Services Research, School of lication practices have for nursing scholars and contexts. the evidence base of nursing practice? Is open Health Sciences, University of Southampton, access publication really a good thing and what Southampton, UK Executive Editor, Lead: do we know about its impact on nursing practice International Journal of Nursing Studies Dr. Parveen Ali, Lecturer, School of Nursing and scholarship? What is the role of social media Author 3: Professor Ian Norman: Professor of and Midwifery, University of Sheffield UK in the dissemination of research outputs? And Mental Health Nursing and Executive Dean Intimate partner violence (IPV), which is also how can nursing scholars maximise the impact at King’s College London, UK Editor-in-Chief, referred to as domestic violence and abuse of their research on practice? The purpose of this International Journal of Nursing Studies presentation is to increase the audience’s under- (DVA) in the United Kingdom (UK), is now standing of debates within academic healthcare acknowledged as a significant health concern Abstract care publishing about the merits of different globally (World Health Organisation, 2015). IPV forms of publication and the use of social media It will have been demonstrated earlier in the impacts significantly on the physical and mental to disseminate research findings and increase symposium how the pressures of increasing health and wellbeing of those who experience the likelihood of them informing nursing policy demand of research output, and the changing abuse. This also includes wider family members and clinical practice. The target audience of this publishing landscape, has resulted in a boom and especially children. In 2014 in the UK, the presentation is professional nurses, midwives period for nursing publications. In this paper we National Institute for Health and Care Excel- and other healthcare professionals. A secondary will examine the analytical tools employed by the lence (NICE, 2014) published clear guidance for audience are healthcare leaders and managers research community to measure the ‘impact’ of health professionals, and other associated pro- who are interested in increasing the reputation this output (McKenna 2015). We will also take a fessional groups, in terms of their professional of their organisation through contributing to the look at new channels of dissemination and their responsibility for the effective identification and evidence base of nursing practice. potential effect on the evaluation of the clinical/ management of IPV in practice situations. community use of the evidence-based research. Effective identification and the provision of References In this presentation, a senior publisher of the support for those who have experienced IPV, Higher Education Funding Council for England. International Journal of Nursing Studies, will however, is arguably underpinned by the 2014. Policy for open access in the post-2014 (1) examine the trends of publication output in provision of the requisite education, prepara- Research Excellence Framework. HEFC, nursing over the last decade, using tools such as tion and on-going professional development London, UK term maps and journal citation maps to dem- for nurses and other care professionals. This symposium, therefore, provides an opportu- Retrieved from http://www.hefce.ac.uk/pubs/ onstrate the changing landscape of nursing evi- nity for nurses across a range of disciplines and year/2014/201407/ dence-based publication; (2) provide an overview of the measurements used to assess nursing career pathways both within the UK and inter- Griffiths, P., 2014. Open access publication and publications and their perceived “value” to the nationally to critically explore existing gaps in the International Journal of Nursing Studies: All research community; and (3) consider some of in preparation, to examine current education that glitters is not gold. International Journal of the new channels available to disseminate, share provision and to consider the future needs of the Nursing Studies 51 (5): 689-690. and measure the clinical relevance and impact nursing workforce, both at pre and post registra- Norman, I.J., Griffiths, P., 2008. Duplicate pub- of the published evidence – looking at new tion levels. lication and ‘salami slicing’: Ethical issues and technologies and new tools (Elsevier 2014). The Drawing on their collective experiences of IPV practical solutions. International Journal of purpose of this presentation is to increase the research and background in nurse education, Nursing Studies 45 (9): 1257-1260. audience’s understanding of trends in academic the presenters have identified three areas of nursing publishing, the ways in which the quality IPV research within the one overarching theme of published papers in nursing and healthcare of education and professional preparation. The are assessed and to a critical awareness of the first presentation will examine the results ofa use and potential abuse of publication metrics. national survey that aimed to measure nurses, The target audience of this presentation is pro- midwives and pre-registration nursing and fessional nurses, midwives and other healthcare midwifery students’ knowledge, attitudes and professionals who write or are thinking about practice related to DVA. The second presen- writing for publication and healthcare leaders tation will explore the particular preparation and managers who are interested in increasing needs of senior nursing students as they make the reputation of their organisation through con- the transition to newly qualified registrants. tributing to the evidence base of nursing practice. While the final presentation will consider the education and support needs among qualified References nurses alongside other healthcare professionals. Elsevier. 2014. Elsevier for editors: Journal and articles metrics. http://www.elsevier.com/editors/journal-and- article-metrics (Accessed 24 December 2014) . McKenna, H.P., 2015. International Journal of Nursing Studies 52 (1): 1-3.

86 3.25-4.25pmS1-5 Symposia – Thursday 6 April 2017 Paper 1 Paper 2 Paper 3 Domestic violence: nurses, Working with survivors of Intimate partner violence midwives, pre-registration IPV in contemporary health presentations in health care nursing and midwifery care contexts: preparation for contexts: identifying and students’ knowledge, transition to registrant supporting qualified nurses attitudes, and practices Authors and affiliation in practice Authors and affiliation Dr. Julie McGarry, University of Nottingham, Authors and affiliates Dr. Parveen Ali, School of Nursing and UK Dr. Parveen Ali School of Nursing and Midwifery, University of Sheffield UK Midwifery, University of Sheffield UK; Dr. Abstract Julie McGarry, University of Nottingham, UK Nurses and midwives working in any health care settings can play a crucial role in identifica- In February 2016 the UK National Institute for Abstract tion, prevention and management of DV (NICE, Health and Care Excellence (NICE) published 2014) as they may regularly encounter DV the DVA quality standards (NICE, 2016). A In the UK as elsewhere, it is increasingly recog- victims, who visit health care settings frequently pivotal component of the quality standards nised as a central part of their role that nurses, (Houry et al., 2008). Pre-registration nursing centres on the delivery of the requisite midwives and other health care profession- and midwifery students need to be able to dis- education/training to support nurses, and other als are professionally confident and practically tinguish between injuries resulting from DV or front line professionals, in the effective recogni- competent in the effective recognition, support other causes. They need to be able to provide tion, support and management of IPV for those and management of IPV for those who access person centred, sensitive and empathetic care who access health services as a result of abuse. health services as a result of experiencing abuse. to such patients. However, DV victims report However, while those who have experienced IPV A number of training and support interven- that health care professionals (HCPs) often may access a range of health care environments tions have developed and utilised in order to blamed them for abuse, do not show a concern, including the emergency department, primary enhance the skills and knowledge of healthcare and do not address the abuse even when DV was care, acute hospital services and mental health professionals across a range of settings including obvious. Evidence also suggests that nurses and services to date, there is a paucity of available primary care and the emergency department other HCPs are often unprepared to deal with targeted healthcare focused educational/ (ED) (Feder, et al. 2011, McGarry and Nairn, DV victims (Sundborg, Saleh-Stattin, Wandell, training resources to support the NICE recom- 2015). However, IPV is complex in terms of pres- and Tornkvist, 2012). To be able to effectively mendations. In this climate of changing roles entation for example, secondary presentations identify and respond to DV victims, nurses, and responsibilities for nurses within the context or those presenting to mental health services, midwives as well as pre-registration nursing of the NICE quality standards, it is also clear that which may be related to IPV but may not be and midwifery students need to understand there needs to be adequate educational and pro- immediately apparent or disclosed as such. DV and associated complexities. However, not fessional preparation provided within pre-regis- Drawing on two recently evaluated initiatives much emphasis is placed on preparing nursing tration nursing programmes to support students within the ED, acute hospital and community and midwifery students and registered nurses particularly during their final year (McGarry, settings, in the UK the authors will consider the and midwives to deal with DV issues in clinical et al. 2015). This is particularly important for strengths and limitations of IPV training and practice. There is a need to explore DV related senior students as they move towards greater support interventions to date within the wider knowledge, attitude and skills of registered independence and autonomy and as they make context of the existing evidence base. In so nurses, midwives and nursing and midwifery the transition to newly qualified registrants doing, it is intended that there will be the oppor- students. Such knowledge will help in identify- where they will be required to make informed tunity to critically examine and consider the ing the training and education needs of nurses, decisions in IPV presentations. The aim of this ways in which current education and training for midwives and nursing and midwifery students. presentation therefore is to consider the current nurses and other healthcare professionals may The aim of this presentation is to share findings landscape of pre-registration nurse education be developed effectively in the future to meet of a cross sectional national survey conducted to alongside the findings of a recent study under- the needs of those who present in healthcare measure registered nurses, midwives, pre-regis- taken by the author to explore the perceptions of contexts as a result of experiencing IPV. tration nursing and midwifery students’ level of current senior pre-registration nursing students knowledge, attitude and skills related to DV and around preparation and areas for development its management. Responses collected from more in order to support the effective recognition than 900 nurses, midwives and pre-registration and management of IPV among newly qualified nursing and midwifery students from England graduate nurses. and Wales provide useful information about the training needs of the future workforce.

87 S6-111.40-3.10pm Symposia – Friday 7 April 2017 Symposia 6 – 15 Friday 7 April 2017 1.40-3.10pm

Symposium 6 Paper 1 CWEQ-II Structural Empowerment Scale were utilised to measure continuing professional Time: 1.40pm Concept Analysis: Continuing competence. The Nurse Competence Scale Room: 6 Professional Competence (NSC) was deemed unsuitable for the research. Authors and affiliation Conclusion: The concept analysis established Developing a concept analysis Elizabeth Heffernan, MBA, MA, BSc (Hons), that continuing or ongoing professional compe- prior to undertaking a H.Dip (Ed), H.Dip (Mgt) RNT, RM, RGN, tence consists of a number of antecedents and Doctorate Candidate attributes distinct from basically measuring research project. discrete competencies. Therefore, it was instru- Director of Nurse Education, Kerry Centre of Lead: mental in informing the methodology and Nurse and Midwifery Education, University Dr. Catrina Heffernan, MBA, MA, BSc (Hons), variables measured in the research study. Hospital Kerry and Nurse Lecturer, H.Dip (Ed), H.Dip (Mgt) RNT, RM, RGN, Department of Nursing and Health Care Doctorate Candidate, Lecturer, Department of Sciences, Institute of Technology Tralee, Co. References Nursing and Health Care Sciences, Institute of Kerry, Ireland Garside, J.R. and Nhemachena, J.Z.Z (2013) A Technology, Tralee, Ireland, Adjunct Professor concept analysis of competence and its transi- at Sacred Heart University, Connecticut tion in nursing. Nurse Education Today 33(5), Abstract The purpose of this symposium is to promote 541-545. understanding about the benefits of develop- Background: Professional competence is Laschinger, H.K.S., Finegan, J., Shamian, J. ing a concept analysis prior to undertaking a an ongoing process, context and time specific and Wilk, P. (2001) Impact of structural and research project. The following five papers link encompassing a repertoire of knowledge, psychological empowerment on job strain in together by demonstrating the value and appli- skills and attitudes which change based on the nursing work settings: Expanding Kanter’s cation of a Concept Analysis prior to embarking demands of the clinical setting (Garside and model. Journal of Nursing Administration 31(5), on a research project. Each paper addresses Nhemachena, 2013). Clients/ patients/ service 260-272. users are entitled to be treated by competent the researchers own unique research study, Walker, L.O. and Avant, K.C. (2005) Strate- nurses and midwives, who are up-to-date and undertaken as part of a Professional Doctoral gies for Theory Construction in Nursing. 4th programme with a particular focus on a concept work in fit for purpose facilities with regulatory ed. Upper Saddle River, New Jersey: Pearson under study. The concepts under study include oversight. There is a need for an instrument Prentice Hall. anxiety, continuing professional competence, to measure common dimensions of profes- hope, resilience and help-seeking. Each concept sional competence. Utilising a concept analysis is unique and not related to the other concepts, approach described by Walker and Avant (2005) demonstrating the rigorous and precise analysis enabled the key antecedents, attributes and con- of each concept analysis. sequences of continuing professional compe- Paper 2 Each paper addresses a concept that was tence to be examined. Concept Analysis: Hope analysed using Walker and Avant (2005) Defining attributes, antecedents and con- Authors and affiliation framework before embarking on a research Joan Murphy, MA Advancing Practice, Dip. study. Using a framework ensured that the core sequences of professional competence Higher Ed, (Mid), Dip (Psychotherapy), BSc concept/s selected were analysed using a step The antecedents involve performance ability (Hons), RM, RGN, RPN, Doctorate Candidate, by step approach. The Walker and Avant (2005) based on educational preparation (knowledge, Nurse Lecturer, Department of Nursing and framework is a step by step approach giving rise skills, attitudes, beliefs and values), registra- Health Care Sciences, Institute of Technology to the defining attributes, antecedents and con- tion, regulatory requirements, accountability Tralee, Ireland, Moira O’Donovan, Ireland sequences of the concept which enables an oper- and responsibility (nurse’s perception and the ational definition to be developed. This is crucial Scope of Practice) and employer empower- to allow the research variable/s to be measured ment. The attributes encompass self-awareness/ Abstract and thus the research to be undertaken. self-assessment (attitudes, beliefs and values), Background: Hope has been described as Concept analysis methodology is vital in order CPD with the application and integration of both the catalyst and linchpin in the process of to gain scientific and conceptual clarity to guide knowledge and skills in active practice hours. recovery from mental illness (Andresen et al. research (Wilson 1963). A number of different The emerging consequences are safe, effective 2011). Therefore, if mental health nurses are to concept analysis methodologies exist within the and ethical practice, high standards and quality conceptualise recovery, they also need a clear nursing science literature (Walker and Avant patient/ client care, public confidence, lifelong- concept of hope. Using the concept analysis 1994, Morse 1995 and Chinn and Kramer (1995). learning (motivation), competence demonstra- method described by Walker and Avant (2005) According to Fitzpatrick and McCarthy (2016) tion (assurance) and development of the profes- the meaning of hope in mental health recovery the Walker and Avant (2005) method of concept sion. is clarified and its antecedents, attributes, con- analysis is the most frequently used method in Operational definition: The ability sequences and empirical referents are identified. nursing. (knowledge, skills technical/ practical and The intended benefits of this symposium is attitudes/beliefs/ values) of the registered nurse Defining attributes, antecedents and twofold: 1) To support nurses and researchers to practice safely, ethically and effectively based consequences of hope in mental health to advance nursing practice through the sharing on evidence, fulfilling his/her professional recovery: of evidence from individual projects, and 2) To responsibility within his/her scope of practice. Five attributes of hope have been identified in the stimulate discussion and debate on discipline Empirical referents: A researcher develop- literature which are: a) Cognitive goal directed specific research methodology. ment tool incorporating Laschinger et al. (2001) process b) Emotional energy c) Enabling the

88 S6-111.40-3.10pm Symposia – Friday 7 April 2017 possible d) Interelational process and e) Socially Paper 3 ideation in the community: Risks and opportu- constructed. nities for public suicide prevention campaigns. Eleven antecedents of hope were identified Concept Analysis: Help- Psychiatry Research 219, 525-530 including uncertainty, hopeful others, mental seeking Puustinen M., Lyyra A.L., Metsapelto R.L. and distress, a belief that growth can come from chal- Authors and affiliation Pulkkinen L. (2008) Children’s help seeking: lenging experiences and meaningful informa- Michael Anthony Reen, MSc, BSc, Doctoral The role of parenting. Learning and instruction tion. Ten consequences of having hope emerged Student, Ireland 18, 160-171. and these included increased motivation, the belief that recovery is possible, personal efficacy and improved physical and psychological health. Abstract Empirical Referents: Thirty two scales have Background: The concept of seeking help is a Paper 4 identified for assessing hope in the mental health relatively new one and, according to Puustinen population. Snyder et al.’s hope scales have et al. (2008), the revolution in the domain of Concept Analysis: Resilience been tested more often than others (Schrank et help seeking was triggered just three decades Authors and affiliation al. 2012). The Herth Hope Index has also been ago by Nelson-Le Gall (1981, 1985). However Gerardina Harnett, Head of Department of validated for use. This scale has 3 factors relating it has been widely explored and within many Nursing and Health Care Sciences, Institute of to temporality and the future, positive readiness different contexts such as: Adolescents and help Technology Tralee, Ireland and expectancy and interconnectedness with self seeking sources in education (Cakar and Savi and others. Finally Schrank et al. (2010) have 2014); Help seeking for suicidal ideation in the Abstract developed an Integrative Hope Scale measuring community (Calear et al. 2014); Assessment of four factors: trust and confidence; positive mental health on help seeking in the perinatal Background: If nurses are to advance resil- future orientation, social relations and personal period; Children, communication and help ience as a caring strategy nurses themselves must perspective. seeking . be resilient and consciously cultivate workplace environments that recognise and foster resil- Conclusion: What has been established from Defining attributes, antecedents, and ience (McAllister and Lowe, 2011). Applying this concept analysis of hope in mental health consequences of help seeking in mental a concept analysis method underpinned by recovery is its criticality to mental health health recovery. Walker and Avant’s framework (2005) the nursing practice. Furthermore, the identifica- meaning of resilience will be explained through tion of attributes, antecedents, consequences In order to provide more illumination on the the examination of the attributes, antecedents and empirical referents allowed the researcher concept of help seeking, the following aspects and consequences. in-depth insight into the concept subsequently are based on a scenario whereby a young male is experiencing depression or low mood. Four informing the methodological approach used in Defining attributes, antecedents and con- her research study. defining attributes of help seeking are identified in the literature. sequences of resilience Defining attributes include supporting health, References: 1) Decision-making seeking support, engaging fully in life and Andresen, R., Oades, L. and Caputi, P. (2011) 2) Weighing up and choosing options balancing recreation, rest and responsibility. Psychological Recovery: Beyond Mental Illness. 3) Openness to seeking help Antecedents include adversity, stress and a Oxford: Wiley-Blackwell. 4) The help seeking person must initiate help realistic worldview. Consequences of resilience Schrank, B., Woppmann, M., Sibitz, I. and themselves are psychosocial adaptation and growth. Lauber, C. (2010) Development and validation The potential antecedents are as follows: The Operational Definition: Resilience in a regis- of an integrative scale to assess hope. Health young person is experiencing a loss of interest tered nurse is the ability to psychosocially adapt Expectations 14, 417-428. in the things he once enjoyed. He is experiencing and grow in the face of adversity by supporting Schrank, B., Bird, V., Rudnick, A. and Slade, low mood and he feels different from his friends. health, seeking support, engaging fully in life and balancing recreation, rest and responsibil- M. (2012) Determinants, self-management and The potential consequences are as follows: The ity. interventions for hope in people with mental young person will initiate recovery through disorders: systematic search and narrative seeking help. He may experience a sense of relief Empirical Referents: The Resilience Scale 14 review. Social Science and Medicine 74, 554-564. in that he has finally made a decision to recover. (Wagnild and Young, 1993) was used to measure Walker, L., Avant, K. (2005) Strategies for He will also have access to services and informa- resilience in registered nurses. Theory Construction in Nursing. 4th ed. Prentice tion that are available. Conclusion: The concept of resilience clearly Hall, New Jersey. Empirical referents: While there are many pertains to registered nurses. Identification scales and questionnaires that set out to measure of defining attributes, antecedents and conse- the concept of help seeking, I have chosen the quences enabled the development of the opera- General Help Seeking Questionnaire (GHSQ) as tional definition and subsequent measurement the tool that most closely epitomises the aspect of resilience in nurses. of help seeking that have been addressed. Conclusion: It is hoped that by completing this References analysis of help seeking, more research will be McAllister, M. and Lowe, J. (Eds.) (2011) The carried out on the concept, which will, in turn Resilient Nurse: Empowering Your Practice. reflect on more adolescents presenting for help. Springer: New York. Wagnild, G.M. and Young, H.M. (1993) Develop- References: ment and psychometric evaluation of the resil- Cakar F.S. and Savi S. (2014) an Exploratory ience scale. Journal of Nursing Measurement 1, Study of Adolescent’s Help-Seeking Sources. 165-178. Social and Behavioral Sciences 159, 610-614. Walker, L.O. and Avant, K.C. (2005) Strate- Calear A.L., Batterham P.J. and Christensen H. gies for Theory Construction in Nursing. Upper (2014) Predictors of help-seeking for suicidal Saddle River, NJ, USA: Pearson/Prentice Hall.

89 S6-111.40-3.10pm Symposia – Friday 7 April 2017 Paper 5 Symposium 7 Paper 1 Concept Analysis: Anxiety Time: 1.40pm Improving pain management Authors and affiliation through educational Room: 7 Dr. Catrina Heffernan, DN, MSc, PGDE, BSc intervention: current status (Hons), RGN, RNT, Lecturer at the Department and methods. of Nursing and Health Care Sciences, Institute Setting the research agenda of Technology, Tralee, Ireland and an adjunct for pain education research Authors and affiliation Professor at Sacred Heart University, in the United Kingdom Professor Michelle Briggs. University Connecticut of Manchester and Central Manchester Lead: University Hospitals NHS Foundation Trust; Dr Amelia Swift, Senior Lecturer in Nursing, Kate Thompson, Centre for Pain Research, Abstract Clinical Academic Lead at a large NHS Trust, Leeds Beckett University, UK Background: Anxiety is a global health and last year winner of a National award as problem (Oliveira et al 2008). It is well estab- Nurse Educator of the Year, UK lished that nursing practice produces consider- Abstract Education for healthcare professionals is driven able anxiety. Using the concept analysis method Pain management has long been recognised as by policy developed at Government level, trans- described by Walker and Avant (2005), the sub-optimal across all patient groups with many lated by professional regulators (for example the meaning of anxiety will be explicated and the people continuing to experience unnecessary Nursing and Midwifery Council), and enacted by attributes and characteristics will be examined. moderate to severe pain. There is also evidence higher education institutions (HEIs). HEIs oper- that current pain education provision across Defining attributes, antecedents and con- ationalise educational standards, working with health professional courses is insufficient given sequences of anxiety provider organisations and regulators to ensure the prevalence and burden of pain described students meet a minimum standard at the point Three attributes of anxiety have been identi- (Briggs et al. 2015, Briggs et al. 2011). Evaluat- of qualification. HEI-based and workplace fied in the literature which are; a) A subjective ing the effect of pain education is likely to be learning are also influenced by national and unpleasant feeling, b) An unknown source, and heterogeneous and complex. Outcomes of pain international care priorities identified by spe- c) An emotional response. education may include evaluation of knowledge cialist groups representing the combined views The two antecedents of nurse anxiety were iden- and skills both theoretically and practically. of academe, research, and clinical practice – for tified as capable of feeling emotion and the per- In addition, evaluating the effect of health example in the case of pain, the International ception of potential threat. The consequences education and training on patient outcomes Association for the Study of Pain. Research- that emerged based on the analyses reviewed is difficult in that the outcome (improved ers have found pain management in clinical have been identified as: personal growth, pain management) is some distance from the practice to be sub-standard, and much of the positive change in behaviour, physical illness education received in pre-registration training. effort to address has focused on measuring the and negative change in behaviour. A recent scoping review (Thompson et al. 2016) effects of ‘education’. There have been repeated had the following aims:- Operational Definition: From the attributes efforts to demonstrate that education improves the following definition of anxiety was proposed: pain management but we have yet to witness a 1. Review the extent, range and nature of A state in which a registered nurse experiences sustained change. There is now a sufficient body research that has examined or evaluated pain a subjective unpleasant feeling that cannot be of evidence to suggest a different or supplemen- education in professional health courses from observed or measured directly, where the source tary approach is needed in order to effect the online education and medical databases e.g. is unknown, that manifests in an emotional desired change. Medline/ERIC (presented in paper 1). response, unique to the nurse, that may or may The first paper in this symposium explores the 2. Review the extent and nature of guidance for not be observed and measured. research in which education is used as a change- pain education from key organisational websites Empirical Referents: The State Trait Anxiety agent: methodological weaknesses will be iden- e.g. professional regulatory bodies, membership Inventory (STAI) (Spielberger et al. 1983) was tified. The second paper builds on this theme, and special interest organisations (presented in used to measure Anxiety in my research study. exploring the influence of policy and professional paper 2). Conclusion: What has been established from guidance on the pain education curriculum. The This scoping review found research reports that this concept analysis is that anxiety is a distinct third explores the art of curriculum development examined or evaluated pain education across 12 concept relevant to nursing practice. The presenta- and shows how the current approach focuses on countries with nearly half conducted in the USA tion of attributes related to the concept, along with knowledge acquisition at the expense of devel- (n=22). Methodological approaches to evaluate antecedents, consequences and the operational opment of useable skills and attitudes. The or examine pain education included survey ques- definition allowed for the researcher to identify fourth paper explores the assessment processes tionnaires (n=26), observational/cohort studies and measure nurse anxiety in her research project. used to evaluate the effectiveness of education, (n=13), experimental designs (n=3), qualitative and demonstrates that these fail to recognise approaches (n=5), and document analysis (n=2). References the key attributes of successful pain manage- The patient’s ‘voice’ was found to be very poorly ment practice, and ignore the patient voice. The Oliveira N., Chianca C.M., and Hussein Rasool represented; of 49 research papers included in symposium finishes with a facilitated discus- G. (2008) A Validation Study of the Nursing this review only 1 included patients as partici- sion in which delegates to respond to the issues Diagnosis Anxiety in Brazil. International pants. raised with the intention of generating novel Journal of Nursing Terminologies and Classifi- This interactive symposium will explore the approaches to the challenges outlined. cations 19(3), 102 – 110. research to date and stimulate discussion as Spielberger C.D., Gorsuch R., Lushene P., Vagg to what research we should be undertaking to P. and Jaobs G. (1983) Manual for State-Trait understand and improve practice. Anxiety Inventory (STAI). Consulting Psycholo- gists Press, Palo Alto, CA. References Walker L. and Avant K. (2005) Strategies Briggs EV, Battelli D, Gordon D, Kopf A, Ribeiro for theory construction in nursing. (4th ed.). S, Puig MM and Kress HG (2015): Current pain Pearson/Prentice Hall, Upper Saddle River, New education within undergraduate medical studies Jersey. across Europe: Advancing the Provision of Pain

90 S6-111.40-3.10pm Symposia – Friday 7 April 2017 Education and Learning (APPEAL) study. BMJ Paper 3 Paper 4 Open 5, e006984. Briggs EV, Carr CJ and Whittaker MS (2011): The challenge of curriculum The challenge of Survey of undergraduate pain curricula for design competencies and assessment healthcare professionals in the United Kingdom. Authors and affiliation Authors and affiliation European Journal of Pain 15, 789-795. Professor Alison Twycross, London South Dr Amelia Swift, University of Birmingham Thompson K, Milligan J, Johnson MI and Briggs Bank University. Dr Amelia Swift, University and University Hospitals Birmingham NHS M (2016): Pain education in pre-registration of Birmingham and University Hospitals Foundation Trust. professional health courses: a protocol for a Birmingham NHS Foundation Trust UK Professor Alison Twycross, London South Bank scoping review. BMJ Open 6. University UK Abstract Over a number of years, the International Abstract Paper 2 Association for the Study of Pain (IASP) have The RCN Pain Knowledge and Skills Framework published curricula for pre-registration training (PKSF, Royal College of Nursing 2015) articulates The influence of policy on for a range of healthcare professionals. These clearly the minimum requirements for unregis- professional pain education consist of lists of topics specifying the knowledge tered and registered nurses at all career stages. students need to obtain about pain manage- Authors and affiliation It describes minimum levels of understanding of ment during their pre-registration course. This Professor Michelle Briggs. University pain physiology, assessment strategies, a range reflects the traditional approach to curriculum of Manchester and Central Manchester of interventions, and participation at an appro- design where learning outcomes tend to focus University Hospitals NHS Foundation Trust; priate level in service development. Expected on theoretical knowledge and pay little attention Kate Thompson, Centre for Pain Research, achievement against each domain is defined in to application in practice (Paper 1). Indeed, Leeds Beckett University UK terms of competence (Benner 1984) and level research in this area has tended to focus on of responsibility or seniority (Skills for Health knowledge and curricula deficits (Twycross and 2010). Assessment strategies are suggested for Abstract Roderique 2013). This is despite the fact that each competency and include direct observa- we know that knowledge alone does not always Thompson et al.(2016) identified example pain tion, evidence of training or education, audit and change practice (Twycross 2007). education curricula and competency/guidance research participation or leadership, discussion, frameworks from special interest and profes- If we are to ensure patients no longer experi- objective setting, appraisal or individual perfor- sional bodies such as the International Asso- ence unnecessary unrelieved pain we need to mance review, and reflection. ciation for the Study of Pain (IASP) and the adopt evidence based approaches to education: The RCN PKSF, therefore, offers the opportunity Royal College of Nursing (RCN). These are focusing on knowledge gain alone is no longer to define minimum standards of practice but freely available providing very useful resources sufficient. Curriculum planners could account we propose that the assessment strategy limits for pre-registration pain education. Fourteen better for the theory-practice gap and known its utility due to a reductionist approach, and standards of education or training relevant to limitations to translation. However, there is a perhaps risk-aversion and a missed opportunity pain education across the regulatory bodies of lack of pedagogical awareness and criticality for creativity. For example, attainment in one twenty-nine health professions; General Medical even among those who clinical staff who are domain is isolated from attainment in others, Council (n=2), Nursing and Midwifery Council directly affected by this, who believe that more the competencies and their assessment are not (n=3), Health and Care Professions Council of the same (educational strategies) will prepare linked to values, and the voice of patients and (n=1), General Dental Council (n=7), General them better. carers are not included. Chiropractic Council (n=1), General Pharma- Curricula need to be developed to take into This paper will provide the background and the ceutical Council (n=0) were identified. The pain account the time and resources needed to stimulus to generate a discussion on… content varied across the health professions promote the use of educational initiatives that ● Stakeholder (NHS organisation, HEI, with only the General Dental Council (GDC) are effective in helping students gain useable regulator, clinical area, patient and carer) per- providing a specific standard for pain education knowledge and the skills to apply it. There must spectives on competence within a biospychosocial model of care. also be robust evaluation of the curriculum This paper will identify the standards contained using evaluation strategies like that outlined by ● Assessment methods that facilitate translation in the professional guidance, and set the scene Thompson et al. (2016). of theory to practice for a discussion that will explore how far educa- ● Assessment methods that capture demonstra- tional standards and policy should be influenced References tion of values-based critically thoughtful care. by regulatory bodies and specialist organisa- Thompson K, Milligan J, Johnson MI and Briggs tions. M (2016): Pain education in pre-registration References professional health courses: a protocol for a Benner P (1984) From Novice to Expert: Excel- Reference scoping review. BMJ Open 6. lence and Power in Clinical Nursing Practice. Thompson K, Milligan J, Johnson MI and Briggs Twycross A (2007): What is the impact of theo- Prentice Hall. M (2016): Pain education in pre-registration retical knowledge on children’s nurses’ post- Royal College of Nursing (2015) Pain Knowledge professional health courses: a protocol for a operative pain management practices? An and Skills Framework. RCN, London. scoping review. BMJ Open 6. exploratory study. Nurse education today 27, Skills for Health (2010) Key elements of the 697-707. career framework. Skills for Health, London. Twycross A and Roderique L (2013): Review of pain content in three-year preregistration pediatric nursing courses in the United Kingdom. Pain Management Nursing 14, 247-258.

91 S6-111.40-3.10pm Symposia – Friday 7 April 2017 Paper 5 Symposium 8 Paper 1 Research priorities – Time: 1.40pm Working with patients, Identifying the way forward public and service to identify Room: 9 Authors and affiliations priorities Professor Michelle Briggs. University Improving fundamental care Authors: of Manchester and Central Manchester in hospitals: how priority Anya De Iongh, PPI Champion, NIHR CLAHRC University Hospitals NHS Foundation Trust; Wessex; Jane Ball, research fellow, University Dr Amelia Swift, University of Birmingham setting drives research of Southampton; and University Hospitals Birmingham NHS Lead: Claire Ballinger, Principal Research Fellow Foundation Trust; Professor Alison Twycross, Lisette Schoonhoven is Professor of Nursing and Lead, Patient and Public Involvement, London South Bank University, UK at the University of Southampton. President NIHR CLAHRC Wessex, University of of the European Pressure Ulcer Advisory Southampton; Chiara Dall’Ora, Doctoral Panel, associate editor of the Journal of Tissue student NIHR CLAHRC Wessex, University of Abstracts Viability, and Fellow of the European Academy Southampton; Sally Crowe, Crowe Associates; In the course of this symposium we will have of Nursing Science. Alex Recio Saucedo, research fellow, University explored previous efforts to improve pain man- of Southampton; Peter Griffiths, Professor, agement practice through educational interven- She also co-leads the Fundamental Care in University of Southampton, UK tions, the competencies that nurses are encour- Hospitals theme in the National Institute for aged to acquire, the curricula that should guide Health Research Collaboration for Leadership that development and the assessment that iden- in Applied Health Research and Care (NIHR Abstract: tifies attainment. In this part of the symposium CLAHRC) Wessex, together with Professor Peter Background: The provision of high quality fun- delegates will be invited to engage with the panel Griffiths, UK damental care in hospitals is a top priority for in setting the agenda for further development of The quality of fundamental care delivered to the NHS. However, it is unclear what research the existing guidance, and curricula, and identi- patients in hospital, mainly by nurses and care should be prioritised to improve care. fying sound collaborative research projects and assistants, is a major public concern. A series Aim: In this section we will describe and methods that will evaluate and drive improve- of investigations into high profile failures (such discuss our approach to involving patients/ ment. as the Francis Inquiries) have highlighted sub- carers/public, clinicians and other stakehold- Delegates will be divided into three facilitated stantial and significant variations in the quality ers to identify issues that are priorities for groups. of fundamental care in NHS hospitals. For research which could improve fundamental care patients, the consequences of poor fundamen- A) Methodology in hospital. We focus on how we ensured that tal care can be devastating, leading to suffering, patient and public involvement was central to In this group the delegates will be discuss the long term disability and avoidable death. Experi- this process. limitations of methods previously employed ence of poor care – first-hand or through reports and create a recommendation for future studies – is likely to contribute to a loss of confidence Methods: Patient and public involvement was to ensure rigour and to facilitate multi-site col- and trust in the NHS. integral to this project, with a patient leader/ laborative studies. The focus of the studies will service user being a member of the core team However, good quality evidence to inform the be the evaluation of educational intervention in who designed and executed this research. improvement of fundamental care is largely relation to measuring care quality and improve- We developed an inclusive approach which lacking. ‘Common sense’ solutions to fundamen- ments in patient care. consisted of six main phases: 1) Development tal care problems are implemented but oppor- of a conceptual framework of fundamental care, B) Educational intervention tunities to learn, evaluate and embed them in based on reports and literature 2) Consultation This group will discuss and create a pedagogi- practice are missed. Solutions may not clearly with a wide range of stakeholders through a cally sound educational intervention that could address the issues most important to patients survey, focus groups and interviews 3) Identify- be employed in undergraduate, post-graduate or, in addressing single problems, may fail to ing themes from the responses to the consulta- and clinical settings to improve pain manage- address cumulative failures that interact to tion phase 4) Analysis to identify the most fre- ment practices. affect patient experience and outcome. quently cited topics 5) Prioritisation of the top 15 C) Assessment In this symposium we will present the develop- themes through a half day workshop, which led This group will discuss how competence is ment and delivery of a programme of research in to a shortlist of five themes 6) Development of assessed and develop an assessment process that fundamental care within the National Institute the top 5 themes into research areas. for Health Research Collaboration for Lead- includes knowledge, skills, attitudes and behav- Results: Three hundred forty stakeholders ership in Applied Health Research and Care iours, and takes into account multiple stake- completed the consultation survey. Analysis of (NIHR CLAHRC) Wessex region and beyond. holder perspectives. the survey responses and of focus groups and This programme is developed and delivered in interviews led us to identify 15 high scoring collaboration with PPI and key stakeholders to themes. We presented these at the prioritisation ensure it meets the needs of patients, public and workshop, attended by 39 participants. After a the NHS. voting exercise we identified the 5 top research priorities. Conclusions: The process provided a means of reaching consensus as to the important issues for future research to focus on to improve fundamental care on hospital wards.

92 S6-111.40-3.10pm Symposia – Friday 7 April 2017 Paper 2 Paper 3 data will be collected on key outcomes: patients’ and nurses’ perception of patient-centredness of Mapping research activities Improving fundamental care care, quality of staff-patient interactions, funda- onto priority areas in hospitals mental care activities. Authors and affiliation Authors and affiliation Peter Griffiths, Professor, University of Lisette Schoonhoven, professor, University Southampton; Jane Ball, research fellow, of Southampton; Jo Hope, research fellow, University of Southampton, UK University of Southampton; Ewa Crunden, Symposium 9 research assistant, University of Southampton; Time: 1.40pm Anya De Iongh, PPI Champion, NIHR CLAHRC Abstract: Wessex; Jackie Bridges, professor, University Room: 11 Our priority setting exercise identified 5 themes of Southampton; Peter Griffiths, professor, that were highest priority for fundamental care University of Southampton, UK Are we seeing the whole in the Wessex region picture? Capturing the • Nurse staffing Abstract: impact of treatments and • Individualised patient care Background: The relationship between the interventions on HRQoL in • Staff communication patient and health professional, and patient par- clinical settings. • Staff attitudes and relationships with patients ticipation and involvement are core elements of Lead: • Information about care/communication patient-centred care, and have been identified as Simon Palfreyman, Assistant Professor, priorities for fundamental care research in our University of Alberta, Faculty of Nursing, One key element in formulating a response region. Edmonton, Alberta. Canada to these priorities was to identify the extent to which current research programmes within our This presentation will outline a new study within The ability to capture the impact that treat- group, which had been developing alongside the our group. ments and interventions have on health related priority setting exercise, was already address- In this study we will combine promising inter- quality of life (HRQoL) is central to the evalu- ing these. This would help us to identify gaps ventions to improve patient-centred care, into ation of healthcare delivery. The collection of and to determine gaps that would be the highest one integrated intervention: these data on HRQoL through self-completed priority for the development of future projects. • Improving nurse-patient relationships: Patient Reported Outcome Measures (PROMs) In this presentation we outline the ongoing ‘Creating Learning Environments for Compas- has become routine within health services programme of work and discus how this was sionate Care (CLECC)’ – developing leadership research and economic evaluation. However, the already addressing many of these priorities, and team practices that enhance team capacity inclusion of HRQoL as a measure of the outcome focussing in particular on our programme to provide compassionate care. of clinical care, outside of some specific surgical of research on safe staffing which has been • Improving patient participation and involve- procedures, has been sporadic and patchy in the informed by research priorities emerging from ment: the ‘Tell-Us’ Card – uncomplicated, UK the Francis enquiries into care deficits at the structured tool for patients to make clear what This symposium will examine ways of incor- Mid Staffordshire NHS Trust, evidence reviews is important to them. porating HRQoL as an outcome within patient undertaken for the national Institute for Health care and as means of improving services. The and Care Excellence to support its safe staffing • Tailoring care to the individual patient: symposium will review the methodological chal- guidance and collaboration with our partners in adapting available care planning algorithms lenges of finding, evaluating and capturing the the NIHR CLAHRC (Wessex). to take patients’ needs and preferences into account. impact of HRQoL. The first paper will explore the We will consider the challenges of responding to challenges and potential rewards using examples We will explicitly target mobility, nutrition, the demand and implicit expectation created by drawn from vascular disease and learning dis- continence, skin care, and sleep. These activi- priority setting undertaken within the context of abilities. It will also examine the practicalities of ties cannot be seen in isolation in nursing care an ongoing research programme as opposed to using recent frameworks in the use of PROMS in and are at the basis of several nurse sensitive priority setting undertaken by a research funder. clinical practice (ISOQoL 2015 and Porter et al outcomes, like pressure ulcers, falls, and mal- 2016). The second paper will examine whether nutrion. We hypothesize that improving these incorporating qualitative data collection into activities will decrease adverse events. the selection of PROMs can guide selection and Aim: To assess the feasibility and acceptability provide a more complete picture of HRQoL. The of a combined intervention to improve patient- final two papers will examine the practicalities centred fundamental care activities. of using PROMs in the clinical setting using the Methods: First, we will develop the inter- examples of learning disabilities and vascular vention by adapting the Tell-Us Card and the disease. These will discuss the challenges and tailoring algorithms for use in the NHS, during benefits but also provide pragmatic guidance on 8 focus groups with recently discharged patients the selection and use of PROMS. Details will also and nursing staff. be shared about the development of an electronic patient questionnaire which will be incorporated Second, we will implement the CLECC training into the routine care of vascular patients. and the adapted tools on 4 intervention wards (adult medical/surgical) in two NHS Trusts, with 2 wards serving as control. Feasibility and acceptability will be assessed through a mixed-method process evaluation using questionnaires, qualitative interviews with patients and staff, analysis of relevant documents, and observations of staff-patient interactions. Baseline and post-intervention

93 S6-111.40-3.10pm Symposia – Friday 7 April 2017 Paper 1 in clinical practice: evidence, challenges and Paper 3 opportunities.” Journal of Comparative Effec- The challenges of capturing tiveness Research 5, no. 5: 507-519. Including people with HRQoL to evaluate clinical learning disabilities in quality care of life measurement: a Author and affiliation Paper 2 methodological discussion Simon Palfreyman. Assistant Professor, Author and affiliation University of Alberta, Canada The use of qualitative data to examine which Rosie Duncan, Student Nurse Learning HRQoL domains are important to patients. Disabilities, Sheffield Hallam University Authors and affiliation Abstract Elizabeth Lumley, Research Associate, Patient Reported Outcomes Measures (PROMs) University of Sheffield. Patrick Phillips, Abstract are being used within the UK NHS as an Sheffield, UK; Rosie Duncan, Sheffield, UK; Background: There are approximately 1.5 indicator of the quality of service and to compare Helen Buckley Woods, Sheffield, UK; Georgina million people with a learning disability in the service providers. Since 2009 patients undergo- Jones, Leeds, UK; Jonathan Michaels’ Sheffield, UK It has been found that people with learning ing four common surgical procedures (hip and UK disabilities are institutionally discriminated knee replacement, varicose vein surgery, hernia against in the services they receive in the NHS repair) have been asked to complete PROMs. (Mencap, 2012). In addition to mortality and Abstract However, the wide, routine and effective use morbidity, quality of life (QoL) outcomes are of PROMs within the clinical area, like nuclear Background: Patient reported outcome increasingly being used in routine NHS services. fusion, seems to be just over the horizon. measures (PROMs) allow measurement of These are usually completed before and after There are a number of challenges to the wide- outcomes elicited from patients; therefore treatment and can be completed by the patient, spread use of PROMs in the clinical care. Firstly, PROMs should include domains that are a clinician or by a proxy. As Jaydeokar (2015) a top down implementation and imposition can relevant to patients. One source of this infor- reported, measuring outcomes for people with have a significant impact. Clinicians and patients mation may be existing qualitative research learning disabilities needs to be done across all need to be clear about the relevance and benefit describing patient experiences and their impact services not only specialist learning disability of using PROMs. Secondly, the selection of a on quality of life (QoL). services; however, there is little routine guidance specific PROM can be difficult due to the quality, Aims: The aim of this qualitative evidence on including people with learning disabilities or number and range of PROMs available. It is synthesis was to examine the symptoms and low literacy levels in QoL measurements across important that PROMs cover domains (aspects) QoL domains that are important from the per- services. Therefore people with learning disabil- that are important to a specific group of patients spective of a patient with varicose veins (VV), ities may be being excluded and marginalised and that the PROM is valid for the particu- and compare them to existing PROMs domains. from these data. lar group or disease. Thirdly, there can also be Methods: Eight electronic databases were Aim: This discussion paper will explore and criti- issues about timelines and how best to adminis- searched to identify qualitative research cally appraise the measurement of QoL for people ter PROMs Responses from participants may be published in English of the experiences of adults with learning disabilities, and examine research influenced by recall bias and whether the PROM with VV. A thematic analysis was conducted and regarding implementation into practice. was completed electronically or not. Finally, resulting themes were compared to existing VV Methodological discussion: In this talk there is still a lack of convincing evidence that PROM domains to evaluate if they captured the research looking at the implementation of QoL the collection of such PROM data improves impact the VV have on patients. measurements in practice for people with a patient outcomes or service delivery. Findings: A total of 1804 citations were identi- learning disability will be outlined. Evidence will A critical examination will be presented of fied; after screening only three studies met the be presented on the challenges of collecting QoL these and other challenges that still need to be inclusion criteria. Five overarching themes were data in this heterogeneous group; including dif- overcome for the widespread use and adoption described in the studies; physical impact, psy- ferences between self-report and proxy report. of PROMs in clinical practice. This will provide chological impact, social impact, adapting to VV The challenges of including people with more the context and background for the other papers and reasons for seeking treatment. profound learning disabilities in assessments which will examine how these issues may be Discussion: The range and intensity of and the issues of adapting validated measures addressed in the clinical context. reported symptoms and the participant’s expe- will also be discussed. It will explore work that has been done to aid implementation and References rience of VV was very varied. One key theme to emerge was adaptation, as there was evidence integration into practice, and reflect on where Aaronson, N., Elliott, T, Greenhalgh, J., Hess, that patients attempted to adapt to the physical, further research is needed to encourage the R., Miller, D., Reeve, B., Santana, M., Snyder, C. psychological and social impact of VV. No inclusion of people in outcome measurement. (2015). User’s Guide to Implementing Patient- PROM currently exists that would capture how Conclusion: Further research and guidance is Reported Outcomes Assessment in Clinical VV patients adapt their lives. needed to ensure people with learning disabili- Practice. International Society for Quality ties are included in QoL outcome measurement. of Life Research. http://www.isoqol.org/ Conclusion: The use of PROMS to gather UserFiles/2015UsersGuide-Version2.pdf information is well established in the NHS but those currently used may not capture the full References: Independent Cancer Taskforce (2015). Achieving impact. Qualitative research methods allow Jaydeokar, S., Tanzarella, M., Guinn, A., World-Class Cancer Outcomes: A Strategy for an in-depth understanding of the range and Hassiotis, A., McCarthy, J., and Roy, A (2015). England 2015-2020. http://www.cancerre- severity of symptoms experienced by patients, An Intellectual Disability Outcomes Framework searchuk.org/sites/default/files/achieving_ and the impact these may have. Dimensions of for improving the quality of services for people world-class_cancer_outcomes_-_a_strategy_ PROMs should be based on patient experiences, with intellectual disability. Faculty report, for_england_2015-2020.pdf best generated by qualitative research methods. London: Faculty of Psychiatry of Intellectual Porter, I., Gonçalves-Bradley, D., Ricci- Disability. Cabello, I, Gibbons, C., Gangannagaripalli, Mencap (2012) Death by Indifference: 74 Deaths J., Ray Fitzpatrick, R., Black, N., Greenhalgh, and Counting. A Progress Report 5 Years On. J., Valderas, JM. “Framework and guidance London: Mencap. for implementing patient-reported outcomes

94 S6-111.40-3.10pm Symposia – Friday 7 April 2017 Paper 4 large-scale assessment of the psychometric Symposium 10 properties of an electronic version with around Development of an electronic 850 vascular patients. Time: 1.40pm personal assessment Room: 14 questionnaire to capture the impact of living with Chair: Cecilia Anim OBE, President, Royal a vascular condition: the College of Nursing ePAQ-VAS. The experiences of Black and Authors and affiliation Patrick Philips, Research Associate, University Minority Ethnic Nurses in the of Sheffield and Research Nurse, Sheffield NHS: seeking equality and Teaching Hospitals NHS Foundation Trust; fairness Elizabeth Lumley, Sheffield, UK; Ahmed Aber, Lead: Sheffield, UK; Stephen Radley, Sheffield, Elizabeth West, Professor in Applied Social UK; Georgina Jones, Leeds, UK; Jonathan Science, Faculty of Education and Health, Michaels, Sheffield, UK University of Greenwich, London, UK

There are concerns about the persistence of Abstract inequalities in our society and health service Background: Vascular conditions are pre- and about how fairly and justly some groups are dominantly chronic in nature, with treatment treated (NHS England, 2015). This symposium focused on risk and symptom management. explores the experiences (mainly) of BME nurses Assessment of the symptoms of vascular disease, in the NHS. The first paper (Harris et al) builds and impact on quality of life (QoL), is therefore on work which showed that BME graduates find important. it more difficult to get a job and presents qualita- This presentation explores the development of tive evidence that recent graduates believe that a self-administered electronic questionnaire success in finding a job is mainly down to them (ePAQ-VAS) for use with vascular patients. as individuals, although they perceive consider- It will share findings from ongoing research able cultural barriers that might influence their relating to its development and evaluation. ability to ‘fit it’ to some NHS organisations. The second paper (Nayar and West) follows BME Methods: and internationally recruited nurses (IRNs) 1. Synthesis of primary qualitative research into the work place, gathering together all of the investigating QoL impacts for those with studies of their experiences of work in the NHS. vascular conditions was conducted using sys- This systematic review shows that there is now a tematic review methodology. great deal of evidence suggesting that BME and 2. Systematic reviews were used to identify IRN nurses suffer discrimination and experience existing PROMs used with vascular patients, many challenges to working in the NHS. The and their psychometric properties were assessed third paper then follows BME nurses through the using standard criteria. regulatory process, testing widely held percep- 3. Semi-structured interviews (n=55) were tions, often promulgated in the media, against conducted with vascular patients to explore data provided by the NMC. The study confirms signs, symptoms and impacts of vascular disease. that BME nurses are more likely to be referred to the NMC, particularly by employers, but does not 4. A multi-disciplinary team used an iterative support the claim that they are likely to receive approach to develop a provisional version of a more severe penalty. The paper asks whether ePAQ-VAS; analysis of the research in stages BME nurses are more likely to be in jobs that 1-3 informed the domains and individual items carry greater risk or whether their negative expe- included. riences in the workplace are linked to referrals. Findings: The evidence synthesis and semi- Finally, we end on a positive note. Paper four structured interviews demonstrated a significant reports on the success of a programme of work impact on QoL across all vascular conditions; designed to raise the confidence, aspirations and however, the specific issues faced, and symptoms achievements of BME nurses in one Trust. This experienced, varied between individuals and symposium is timely, important and likely to across vascular populations. The current version stimulate an interesting debate. of the ePAQ-VAS is provisional and paper based, collecting data on symptoms and QoL issues in four sections; generic, Carotid Artery Disease, Abdominal Aortic Aneurysm and combined arterial and vascular lower limb problems. It is based on multiple-choice questions in domains of pain, sensation, weakness, mobility, central nervous system, vision, activities of daily living, quality of life, anxiety and ulceration. Further development will include assessment of face validity, acceptability and appropriateness of the instrument, with patients and clinicians, before

95 S6-111.40-3.10pm Symposia – Friday 7 April 2017 Paper 1 of their identity brought unsolicited rewards ‘if Review methods: Data were extracted using your face fits then the barriers are reduced’. the CASP. A narrative summary of findings and Equality of employment The findings indicate that success in getting work statistical outcomes was undertaken. opportunities: perspectives is perceived as determined by individual factors, Results: Eighteen UK studies (13 qualitative; 2 of graduating nurses and and fitting in is enabled by strategies adopted by quantitative; 3 mixed methods) were included. physiotherapists. the individual rather than the workplace. There is evidence to suggest that Black, minority ethnic and internationally recruited nurses Authors and affiliation Reference: experience three key challenges that can affect Ruth Harris, Professor of Health Care for their practice. These include: issues of commu- Older Adults, Florence Nightingale Faculty Harris, R., Ooms, A., Grant, R., Marshall- nication, differences in cultural knowledge and of Nursing and Midwifery, King’s College Lucette, S., Chu, C.S.F., Sayer, J. and Burke, professional skills, and perceptions of discrimi- London, UK L. (2013) ‘Equality of employment opportunities for nurses at the point of qualification: An nation and racism. Given the majority of studies Sylvie Marshall-Lucette, Lecturer, Faculty of exploratory study’, International journal of were qualitative, sample sizes were relatively Health, Social Care and Education, Kingston nursing studies, 50 (3), pp. 303-313. small; therefore, caution needs to exercised in University of London and St George’s, interpreting findings. University of London; John Hammond, Conclusion: Without BME and IRNandM the Associate Professor, Faculty of Health, Social NHS workforce would be unable to provide high Care and Education, Kingston University Paper 2 quality care to all patients. There is an urgent of London and St George’s, University of need to understand how their experiences at London; Nigel Davies, Professor of Healthcare The experiences of Black, work are related to clinical practice as well as Leadership and Workforce Development, Minority and Internationally their career aspirations and achievements. Faculty of Health and Social Sciences, University of Bedfordshire; Fiona Ross CBE, Recruited Nurses and Professor of Nursing, Faculty of Health, Social Midwives in the UK Care and Education, Kingston University of Healthcare system: A Paper 3 London and St George’s, University of London, systematic review of the UK literature The progress and outcomes Professor Helen Therese Allan RN RNT BSc of Black and Minority Nurses Abstract: PGDE PhD, Centre for Critical Research in and Midwives through the A recent study identified ethnicity as a significant Nursing and Midwifery, Middlesex University, Fitness to Practise process London, UK predictor for success in securing employment for Author and affiliation nurses at graduation (Harris et al 2013). Newly Authors and affliation Elizabeth West, Professor of Applied Social qualified nurses from non-White/British ethnic Shoba Nayar, Research Fellow, Faculty Science, Faculty of Education and Health, groups were less likely to get a job. However, of Education and Health, University of University of Greenwich, UK the reasons why this inequality occurred were Greenwich, UK not addressed. Similar disadvantages are antici- Elizabeth West, Professor of Applied Social pated for physiotherapists. Science, Faculty of Education and Health, Abstract: This in-depth qualitative study explores the University of Greenwich, UK Background: Across all the healthcare profes- experience of student nurses (n=12) and physio- sions there is an increasing focus on equality and fairness in regulatory procedures. Some therapists (n=6) throughout their education and Abstract: during the first 6-months post qualification to evidence exists that Black and Ethnic Minority identify key experiences and milestones relating Background: A significant proportion of (BME) nurses and midwives (NandM) are over- to successful employment particularly focusing the NHS workforce is composed of Black and represented in disciplinary procedures and on the perspectives from different ethnic groups. Minority Ethnic (BME) and Internationally reports to the regulator. Recruited Nurses and Midwives (IRNandM). Participants were purposively sampled from one Aims: The Nursing and Midwifery Council However, there are concerns about how some university to ensure diversity in terms of ethnic (NMC) commissioned an investigation into the groups are treated when working in the UK group, age and gender. The university ethics progress and outcomes of BME NandM through healthcare system. Anecdotal evidence suggest committee approved the study. In-depth semi- their ‘Fitness to Practise’ process. structured interviews were conducted at course that BME and IRNandM may experience Data: Two sources of data were provided by the completion and 6 months later. bullying and discrimination, as well as being over-represented in local disciplinary proce- NMC; the first had data on all registrants up to Two main themes were identified; the proactive dures and employers’ referral to the regulator. December 2014 (n=681,258) and the second had self (‘It’s up to me’) and fitting in with organiza- data on cases referred to the NMC from April Aims: The purpose of this study is to increase tional culture. The proactive self-theme included 2012 to December 2014 (n=5,851). perceptions of employment success being due our understanding of the relationships among Methods: Descriptive statistics included per- to student proactivity and resilience; qualities different ethnic groups in the healthcare centages, histograms and cross-tabulation valued by employers. The second theme workplace by identifying, appraising and syn- analysis. Causal models were estimated using described the need to ‘fit in’ rather than the thesising all of the recent peer reviewed litera- ordinal and binary logistic regression. culture being inclusive and valuing difference. ture and reports on the experiences of BME and Some participants avoided applying to certain IRNandM working in the UK healthcare system. Results: BME NandM are referred to the NMC hospitals due to perceptions of discriminatory Design: An integrative literature review was more frequently than would be expected given cultures, ‘When I was a student someone told undertaken. their number on the register and are more likely to progress through to adjudication, the final me, I wouldn’t apply there ‘cos you know, it’s Data Sources: A comprehensive search was stage of the Fitness to Practise (FtP) process. not really an ethnic hospital, you wouldn’t fit in undertaken using Nursing Index; CINAHL; However, in causal models, BME status becomes after a little while’. Alternatively accommodat- EBSCO; ERIC; Google Scholar; NHS Evidence; insignificant once the source of referral is taken ing strategies were described, ‘needing to modify Nursing@OVID; Medline; Pubmed and Scopus into account. The most common source of self to fit in’. Some participants recognized that databases January 2000-December 2015. they did not need to change and that aspects referral for BME NandM is employers whereas

96 S6-111.40-3.10pm Symposia – Friday 7 April 2017 for White NandM, it is members of the public. and organisational development as a building Symposium 11 The study did not find that BME NandM are block to achieve safe and compassionate care. A more severely penalised; NandM of Unknown film on BME staff experience has been developed Time: 1.40pm or White ethnicity are the most likely, and BME and has been used as part of both national and NandN are the least likely to receive a penalty international Recruitment Drive Room: 15 which prohibits them from working. Discussion and conclusions: This case study Maximising the impact of Discussion and conclusions: This study highlights the positive impact that diversity confirms the perception that BME nurses are interventions such as targeted Career develop- nursing research more likely to be referred to the NMC but not ment programmes for BME and female NHS Lead: that they are likely to receive a more severe staff can have on outcomes for staff, NHS organ- Dr Ann McMahon, Research and Innovation penalty. This is the first quantitative study of FtP isations and in the long run, improving patients Manager, Royal College of Nursing; Co-Editor in the UK and could make a significant contri- experiences of care. in Chief of the Sage publication Journal of bution to the design of interventions to ensure Research in Nursing; Institute of Leadership fairness and equality in NHS employment and and Management (ILM) accredited trainer; regulatory practises. Visiting Research Fellow at Glasgow University and an Honorary Professor at Plymouth University.

Paper 4 The Royal College of Nursing is the world’s largest nursing union and professional body. Practising diversity and The overall aim of this symposium is to consider promoting inclusion: Impact the potential for nurse scientists to increase the of an intervention to raise impact of their research by working with their professional body and exploring how they might the confidence, aspirations do so. At this international conference, the Royal and achievement of Black, College of Nursing of the United Kingdom is Minority Ethnic and Female considered as a case in point. staff in an Acute NHS Trust In paper 1 Kelly and McMahon examine the Author and affiliation international requirement for nurse scientists to Oyebanjii Adewumi, Associate Director demonstrate the impact of their research. They Inclusion, Bart’s Health NHS Trust, London, explore the ambition of the RCN to be evidence UK informed and consider where nurse scientists may potentially contribute to the work of the RCN and in turn maximise the impact of their Abstract: research. Background: Barts Health, one of the country’s The following 3 papers focus on an area where largest NHS Trusts, has a diverse workforce of the RCN is working to ensure it is evidence over fifteen thousand with 47% stating that they informed: the development and quality are from a BME background. assurance of professional resources published Aims: To design, implement and assess the and endorsed by the RCN. In paper 2, O’Carroll impact of a programme on the confidence, aspi- describes the RCNs recently published lifecycle rations and attainment of BME and female staff. approach to assuring the quality of the wide range of professional resources highlighting Methods: A baseline assessment of the Trusts the contribution of research and evaluation workforce showed under-representation of BME evidence. Papers 3 and 4 present case studies and female staff in senior positions. illustrating where sections of the framework have A programme of practical and motivational been tested in practice. In paper 3 Bayliss illus- workshops was co-designed and delivered by a trates where the RCN’s in-house evidence team leading life coach and motivational speaker. were commissioned to support the refreshment Data on staff achievements were gathered and of professional standards in IV Therapy: here compared to the baseline assessment. Evalu- the team managed the development of evidence ation forms completed by participants were reviews. In the final paper Currie discusses and analysed. critiques a pragmatic approach to evaluating the Results: Twelve cohorts with approxi- use and perceived value of RCN travel health mately 150 staff completed the programme by guidance and considers the lessons learned from September 2016. Outcomes included an increase the approach. The symposium concludes with in the number of staff gaining promotion, a discussion on whether nurse-scientists see or secondments, Women in Science and Engi- indeed have realised the potential of working neering (WISE) Fellowships, and joining the with their professional body to increase the NHS Leadership Academy programme. Indi- impact of their research. viduals also made decisions such as learning to drive, seeking further education, mentoring or shadowing that will have a positive impact on their job prospects. Positive outcomes for the Trust include the development of a Trust Career Service and an improvement plan that incorporates leadership

97 S6-111.40-3.10pm Symposia – Friday 7 April 2017 Paper 1 Paper 2 Paper 3 Maximising the Impact of The Quality Framework for An evidence-informed approach to developing nursing research through RCN professional resources professional nursing publications: the case of RCN Standards for Infusion Therapy and a rapid collaboration Author and affiliation: evidence review Authors and affiliations Dave O’Carroll, Programme Manager, Information and Resources, RCN, UK Authors and affiliation Professor Daniel Kelly, Cardiff University; Ann Anda Bayliss, Research and Innovation McMahon, Research and Innovation Manager, Manager (Evidence); Lynne Currie, Research RCN (UK) As the professional body for UK nursing, and an evidence-informed organisation, the Royal and Innovation Analyst, RCN (UK) College of Nursing (RCN), through its membership forums, is committed to producing high Abstract Abstract quality professional resources, including com- The UK assessment of academic research has The RCN Research and Innovation (Evidence) and will continue to require nurse research- petencies, guidance, standards, statements and research reports. A Quality Framework (RCN, Team was commissioned in 2015 to undertake ers to demonstrate both the academic and the a rapid evidence review to support the refresh wider impact of their research. As a professional 2016) has been developed (Jun 2015-Apr 2016) with the aim of ensuring a co-ordinated and of the RCN Standards for Infusion Therapy, practice-facing discipline, nursing is arguably last published in 2010. Following developments very well placed to demonstrate its impact on well-governed approach to the development and quality assurance of all RCN published profes- such as the Quality Framework for RCN profes- health and social care policy and practice. An sional publications, the Standards production analysis of REF 2014 impact case studies, that sional resources and our endorsement of externally developed resources. group (comprising a project and an advisory made reference to nursing, highlighted not group) took an evidence-informed approach to Through its lifecycle approach, the Quality only the immediately visible impact but also developing a professional nursing publication Framework supports members and staff to build the hidden contribution of nursing in research and applying organisational quality guidelines. (Kelly et al 2016). This paper examines the inter- quality into their work and draw upon the latest pretation of impact within UK assessments of available evidence (where it exists) when devel- Evidence comes in at various points in the quality research, reflect on nursing’s experiences of oping and reviewing professional resources. cycle: of need for the professional resource, demonstrating research impact to date (ibid). It Based on the Canadian Institutes of Health of what constitutes effective and safe clinical will consider the implications for contemporary Research instrument for the appraisal of guide- practice and service delivery to be included in health and social care policy, and the future of lines for research and evaluation (AGREE, 2013), the resource, of quality of resource, of impact of nursing science, education and practice. Fur- the framework sets out nine quality standards resource. This paper will present an example of thermore it will consider strategies for increas- that all professional resources produced by the how a practice standards production group used ing the visibility of the impact of nursing science RCN should meet. evidence to support their decision making about the development of content and the presentation and the need to plan for the next REF. A resource’s lifecycle begins with the identifica- of that content in a way that indicates the level tion of the evidence of its need (either a new or The paper will then discuss the role and function of confidence in the evidence that the advice was adapted resource) and progresses through the of the world’s largest professional union of based on. nurses, the Royal College of Nursing of the UK stages of business definition, detailed planning, (RCN): representing nurses and nursing; sup- development and testing, assurance and sign off, The evidence input consisted of the following porting members; providing expert advice and dissemination, implementation, evaluation and strands: (1) formal membership of an evidence influencing on behalf of nurses and nursing; revision or withdrawal. team representative of the Standards project group; (2) counsel to the advisory group building, assuring, sharing and using nursing This paper will outline how we developed the regarding options to meet evidence needs; (3) knowledge. It will consider the synergies Quality Framework, before considering each commissioning, management and publica- between nursing scientist’s need to demonstrate stage of the lifecycle. It will discuss the merits of tion of a rapid evidence review; (4) steer on the impact and the role and function of the RCN. In including a hierarchy of evidence (DID, 2014), representation of evidence (type and strength) conclusion the paper will consider the potential and the implications of attempting to map these in the Standards content and general quality of maximising research impact on health and onto different types of professional publication. assurance. social care policy and nursing practice through Finally, it will consider ways to evaluate the collaboration and how this may be realised. impact on practice and policy of the professional The benefits and challenges of the approach publications we produce. will be discussed with particular reference to References resource identification and management, using nurse and non-nurse researchers, stakeholder Kelly, D., Kent, B., McMahon, A., Taylor, References relations, some technical aspects of the review J., Traynor, M. (2016) Impact case studies RCN (2016), “The Quality Framework for RCN and how this process tested the RCN Quality submitted to REF 2014: the hidden impact of professional publications”, RCN, London Framework. Reflections will also be presented nursing research AGREE next steps consortium (2013), about the impact of an evidence function to Journal of Research in Nursing 21:4 256-568 “Appraisal of guidelines for research and evalu- promote understanding of and commitment to ation II instrument”, Canadian Institutes of the evidence-based practice agenda. Health Research Department for International Development (2014), “How to Note: Assessing the strength of evidence”, DID, London

98 S6-111.40-3.10pm Symposia – Friday 7 April 2017 Paper 4 Evaluating a Professional Resource for Travel Health Nursing Authors and affiliation Lynne Currie, Research and Innovation Analyst; Julian Russell, Research and Innovation Analyst; Anda Bayliss, Research and Innovation Manager (Evidence), RCN (UK)

Abstract Background: The resource “Travel Health Nursing: career and competency development’ contains information on guidelines and standards for the care of travellers by registered professionals (RCN, 2012). Aim: To capture users’ perceptions of the resource with a view to inform decision-making about its future revision. Method: Face-to-face interviews with key stakeholders and a survey to a wider set of users. Prior to the survey an interview schedule was developed which informed the development of appropriate survey questions. Findings: The qualitative findings revealed participants perceptions of using the document, its content, format and benefits. Participants also expressed their views of the wider context of travel health medicine, including its evolution and key benefits, how it might be evaluated, and any drawbacks to the delivery of good travel health advice. The survey reported most respondents as registered nurses (93%) with the majority providing direct care (88%). Most travel health advice was delivered through consultations in a GP surgery (76%). While a fifth of respondents reported no knowledge of the resource, over a third (36%) had undertaken a training course in travel health. More than half the respondents (58%) reported using the resource for personal development. The sections of the document most used and highly rated were pre-travel risk assessment and risk management. Over two thirds of respondents (71%) reported being mostly or fully satisfied with the resource. In terms of additions to the resource, 80% of respondents identified vaccine preventable diseases and migrant/ refugee health issues, and 95% wanted further emphasis beyond vaccinations and immunisations. Conclusions: Travel health nurses working in the UK have a recognised set of standards linking grade and career progression to their clinical skills. These are well regarded and are identified as an important benchmark for training requirements.

References RCN (2012) Travel Health Nursing: Career and competency development. London. RCN.

99 Posters – Wednesday 5 April 2017

Posters

Poster tour A Poster 2 (Abstract 189) ers can be enhanced and sustained. Through case studies of two projects the challenges and Theme: Quality and safety: Mixed How can national evaluators successes of smaller service evaluations influ- methods enhance evidence from local encing wider practice and decision making will be illustrated. Leaving North School entrance at: 1.25pm transformational change to influence policy and decision Poster 1 (Abstract 127) making? Lucy Johnston, Ba; MSc, Senior Research Poster 3 (Abstract 235) Accuracy of sedation boluses Fellow, School of Health and Social Care, documentation in PICU Edinburgh Napier University, Edinburgh, UK Towards person-centred Stacey Orr, Degree in child health, NHS Karen Campbell, UK care: development of a Lothian, Royal Hospital for Sick Children, patient support needs tool Edinburgh, Scotland Abstract for patients with advanced A. Centola, C. Burney, K. Jack, J. McCormick, Background: A multi-disciplinary team at Chronic Obstructive J. Wilson, T. Lo, Scotland Edinburgh Napier University are evaluating the Pulmonary Disease (COPD) Macmillan Cancer Support funded Transform- Carole Gardener, CQSW, MA MSc, Research Abstract ing Care after Treatment programme in Scotland assistant, Dept. of Public Health and Primary Introduction: In paediatric ventilated (TCAT) which established 25 local projects, each Care, University of Cambridge, Cambridge, UK patients, in addition to continuous IV sedation, with different local approaches to improving the Gail Ewing, UK; Morag Farquhar, UK boluses of sedation are required to achieve after care of people living with and beyond cancer. A substantial component of the programme optimal comfort, and safety. The accuracy of Abstract sedation boluses documentation in our unit was evaluation is to support individual projects unknown. evaluate change by contributing to a programme Background: Patients with advanced COPD of education and support to increase the capacity have difficulty articulating their support needs to Aim: We aim to determine the accuracy of health care professionals, undermining person- sedation boluses documentation in our PICU, of local cancer nurses and professionals to conduct robust service evaluations, ensure con- centred care. A new intervention, the Support and to assess staff’s knowledge and the useful- Needs Approach for Patients (SNAP), informed ness of existing guidelines on sedation boluses sistent data collection across the programme and maximise impact on policy decisions. by, and modelled on, the evidence-based Carer documentation. Support Needs Assessment Tool (CSNAT), may Discussion: Researchers at Edinburgh Napier Methods: A pre-designed electronic proforma enable patients to identify and express their University are ensuring and enhancing local on the clinical information system (CIS) was support needs. SNAP is underpinned by an evi- evidence from TCAT ‘test’ sites which has included: used to collect data on the total amount of dence-based tool to help patients consider and sedation boluses delivered per patient and • Facilitation of 4 evaluation practice workshops express their support needs. whether the sedation boluses were documented • Establishment of a support/advice mechanism Aim: This study aimed to develop the SNAP during a two week period randomly selected by with named point of contact within the evalua- tool, suitable for use in clinical practice. our nursing audit/research team. All nursing tion team for each local project staff in PICU was also surveyed to determine Methods: Two-stage qualitative study. Stage • Face to face meetings with projects to under- their knowledge on sedation boluses documenta- 1: domains of support need in advanced COPD stand the proposed local evaluation methods tion. Existing guidelines on drug administration were identified through a rapid review of the and approaches and IV sedation were examined to determine if literature, analysis of data from an established there was specific guidance on sedation boluses • Specification of minimum data for all local dataset (n=20 purposively sampled patients documentation. evaluations with advanced COPD) and patient focus groups. • Provision of local reporting guidance and Stage 2: the draft SNAP tool was developed based Results: 80% of all sedation boluses delivered on the identified domains of support need, then was not documented on the CIS during the report template reviewed and refined in stakeholder workshops audit period. The existing guidelines on drug • Provision of patient/service user feedback to ensure acceptability and suitability. The administration and IV sedation did not have survey tools and analysis of returns established dataset was collected between Jan guidance on documentation of sedation boluses. • Review of potential for Health Economic 2013-Jan 2016. Data collection within this study Majority (79%) of the junior staff did not know analysis of each local project took place between June-August 2016. how to document sedation boluses on CIS. Drug administration guideline was updated to include By working to ensure and enhance local evidence Results: A comprehensive range of evidence- guidance on sedation boluses documentation. of change and improvement, we are co-pro- based domains of support need were identified ducing valuable data to inform evidence based and formulated into items for inclusion on the Conclusion: Poor documentation of sedation practice, developing research awareness and draft SNAP tool. The draft tool asked patients boluses delivered in PICU is caused by lack of skills among cancer nurses and creating and dis- to consider whether they need more support in clear guidance and training on documenta- seminating a wide knowledge base that is influ- relation to 15 broad areas (domains) of support tion procedures. Updating drug administration encing practice. need e.g understanding their illness and getting guideline and a tailor-made training programme Conclusion: The production and dissemina- out and about. Patients, carers and clinical may improve documentation and warrants stakeholders broadly endorsed the content further study. tion of high quality practice and service evaluations is key to influencing policy and political and wording of the draft tool and the proposed decision making. This presentation will discuss Support Needs Approach for Patients. how the evaluation activities of local practition-

100 Posters – Wednesday 5 April 2017

Discussion: The evidence supports implemen- local multi-component interventions within Results: All the demographic and baseline data tation enabling delivery of good practice recom- a complex regional and national programme were collected. Participants had a mean age of 57 mendations on person-centred care. structure. years, 54.7% were male, 82.8% had completed Conclusion: The SNAP tool has the potential This presentation will discuss the benefits a secondary school or higher education. The to help patients with advanced COPD identify and challenges of combining these theoreti- baseline outcome measures did not differ sig- and express their support needs to clinicians in cal approaches into our fieldwork and a more nificantly between groups (p= .199 for the order to enable delivery of person-centred care. in depth discussion regarding building CMO’s self-care behavior; p= .683 for the self-efficacy; Future work will test tool validity and feasibility (context, mechanism and outcome) for future p= .701 for the diabetes distress). The 3-month in clinical practice. research hypothesis. follow-up data collection is now in progress and the result will be available in December 2016. Conclusion: The results of the study will demonstrate the effectiveness of e-health technology Poster 4 (Abstract 191) Poster tour B on self-care behavioral change, self-efficacy and psychological outcome. It will inform the devel- Realistic and appreciative: Theme: Quality and safety: Quantitative opment of the mobile application for T2DM developing a dual model of Leaving North School entrance at: 1.25pm patients in self-management in HK. evaluation of ‘Transforming Care after Treatment’ Poster 5 (Abstract 140) programme in Scotland Poster 6 (Abstract 218) Lucy Johnston, Ba; MSc, Senior Research The effectiveness of e-health Fellow, School of Health and Social Care, mobile application on Mothers’ experiences of Edinburgh Napier University, Edinburgh, UK improving self-management using phototherapy device Stephen Smith, UK; Lucy Johnston, UK of adult patients with type 2 in postnatal wards at a diabetes. central hospital in Brunei Abstract Yuen Yee Lam, Master of Science in Nursing; Darussalam: a market survey Background: The Transforming Care after Master in Diabetes, Endocrinology and Hjh Jainah Binti Hj Musa, Institute of Health Treatment programme in Scotland (TCAT) aims Metabolism, The Nethersole School of Nursing, Sciences, University Brunei Darussalam, to improve the after care for people living with The Chinese University of Hong Kong, Hong Gadong, Brunei Kong and beyond cancer by focussing on improving Nur Syarfa Syazana Ahmadyani, Darinah patient experience/outcomes, enhancing service Janet WH Sit, Hong Kong; Eliza ML Wong, Haji-Abdul-Manaf, Liling Chaw, Khadizah integration/coordination, increasing the patient Hong Kong; Tracy S L Lau, Hong Kong; Doris H. Abdul-Mumin, Munikumar Ramasamy voice and empowering practitioners with the YP Leung, Hong Kong; Emmy Lau, Hong Venkatasalu skills, knowledge, attitudes and behaviours to Kong; SY Chair, Hong Kong support excellence in survivorship. Funded by Macmillan Cancer Support, TCAT established Abstract Abstract national and regional structures to support Introduction: Phototherapy is a device used the implementation of 25 projects, each with Background: Type 2 diabetes(T2DM) affects for treating hyperbilirubinemia in newborns. different approaches. one in 10 people in Hong Kong(HK). For It is usually bulky, occupying space and cause patients with T2DM, there is growing interest The methodological approach applied to the maternal-infant separation even though it is just in self-management which emphasizes the programme evaluation is Realistic Evaluation next to mother’s bed. Yet, little is known on the patient’s central role in managing their illness. in combination with Appreciative Inquiry, to use of phototherapy in terms of its convenience, Using e-health technology provides a widely all fieldwork and analysis. Our findings to date safety, the effects to maternal-infant bonding accessible, 24-hour platform to promote disease illustrate the added value of evaluating change and breastfeeding. self-management. through these theoretical ‘lens’. Aim: This study investigate nurses, midwives and Purpose: The study aims to determine the Methodological Discussion: Combining mothers’ perception on the current phototherapy effectiveness of a newly developed mobile appli- evaluation models provides a focus for fieldwork device for its convenience, safety, the effects to cation- iCare for T2DM patients in HK. We and analysis aiming to enhance understanding maternal-infant bonding and breastfeeding. hypothesize that people with T2DM receiving regarding: context of the projects, the drivers Methods: A survey was conducted at postnatal i-Care, compare with control subjects, will dem- of change and resulting outcomes. In addition, wards in a central hospital in Brunei Darus- onstrate 1) more frequent practices of self-care there is a deliberate focus on what works well salam. All mothers with jaundiced babies and on behavior, 2) greater self-efficacy, and 3) a better and understanding why and how success can phototherapy, admitted in a period of one week psychological well-being at 3 months. be generalised and deliberately replicated and of data collection, nurses and midwives were transferred to other areas. Methods: A two-armed randomized con- invited to participate by answering a self-admin- trolled trial has been conducted at a diabetes Fieldwork (May 2014 to October 2016) will be istered questionnaire. Data were tabulated and clinic in HK from Feb to Dec, 2016. A total of used as an exemplar of this dual model. The analysed descriptively using ‘R’ Software version 170 eligible participants were recruited by con- mixed methods include the demographics and 3.3. venience sampling and randomized to a control concerns of over 2,000 people, in depth inter- Results: Mothers whom babies were jaundiced group or intervention group. Following baseline views with stakeholders (n=21); focus group dis- (n=31), and nurses and midwives having experi- measures, all participants who were allocated cussions with local projects at the start and end enced caring for jaundiced babies (n=58) all par- to the intervention group install iCare to their of implementation (n = 14) and an annual online ticipated in the study (100%). Although all the smartphone on top of the usual care. Those survey of wider stakeholders (n = 195 in 2015 mothers (100% [n=31]) understand that pho- participants in the control group continue with and n=220 in 2016) with a 55% response rate. totherapy reduces jaundice, they are faced with usual care within the whole study period. All challenges during phototherapy that include less Conclusion: This combination has been outcome measures are assessed at baseline and time to breast feed the baby (64.5% [n=20]); dif- adopted to recognise and understand key 3 months after in both groups. Data is analyzed ficulties in caring for the baby (58.1% [n=18]); findings in the real world from numerous according to the intention-to-treat principle. and separation from baby (48.4% [n=15]). Only

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12.9 % (n=4) mothers with babies on standing and level of functioning (p=0.002) than the con- for statistical analysis. To preserve confidential- phototherapy and 19.2% (n=5) mothers on Bili ventional psycho-education group and usual care ity, results with less than 10 cases could not be bed can breastfeed their baby without inter- alone at the one-week and six-month follow-up. reported separately. ruptions. Nurses and midwives also reported Conclusions: The findings suggest that mind- Outcome: The data retrieved from the HBS that mothers have difficulty while nursing their fulness-based psycho-education programme can has proved invaluable as a phase of a research jaundiced baby on Bili bed (58.7% [n=37]), and be useful in improving the short- to medium- study which informed subsequent phases. It standing phototherapy (31.7% [n=19]). The Bili term clinical outcomes of outpatients with schiz- is important to note the levels of application bed phototherapy (67.7% [n=42]) and standing ophrenia, not only in terms of their mental state and ethical approval, the need to have prior phototherapy (28.3% [n=17]) also caused a lot of and risk of relapse, but also their insight into knowledge of Excel, SPSS and data linkage and interruptions during breastfeeding. illness/treatment and psychosocial functioning. the lengthy process of accessing, recoding and Conclusion: Although nurses, midwives, and reclassifying free text into a format suitable for mothers understand the purpose of photother- analysis. apy, they are concerned that the current design of the phototherapy might injure the mothers or Poster 8 (Abstract 268) their babies or both. It is suggested that future study should include designing, developing and Experiences of using the Poster 19 (Abstract 293) testing phototherapy devices that reduce inter- Honest Broker Service for ruptions in maternal-infant bonding. analysis of a maternity ‘Should I Stay or Should I dataset and a prescribing Go Now?’ A study exploring dataset to determine the mothers’ lived experiences of abusive relationships and Poster 7 (Abstract 12) profile of women in Northern Ireland who have accessed how to survive A controlled trial of maternity services and who Diane Phimister, RMN, BSc, MA, Coventry a mindfulness-based have heart conditions University, UK intervention for people with Mary Gillespie, MSc; BSc (Hons); RGN; RM, schizophrenia Midwife and PhD Student, Ulster University, Abstract Professor Wai Tong Chien, PhD, MPhil, BN UK This study completed in November 2016 inves- (Hons), RMN, Professor and Associate Head, Prof Marlene Sinclair, Dr Janine Stockdale, Dr tigated the lived experience of 9 mothers who The Hong Kong Polytechnic University, Hung Joan Condell, Dr Inez Cooke, Northern Ireland survived abusive interpersonal relationships. Hom, Kowloon, Hong Kong The study explores social attachment experi- Sally WC Chan, Australia; Thanos Karatzias, ences in particular the role of motherhood and Abstract Scotland, UK how the consequences of abusive interactions Background: The Honest Broker Service can significantly influence their decision making (HBS) (2016), offered by the Health and Social processes. Abstract Care Business Services Organisation, facilitates Methods: The study used interpretative phe- Background: Mindfulness-based interven- access to health and social care data. Datasets nomenological analysis (IPA) employing semi- tions have been increasingly evidenced to be have been imported to the data warehouse structured interviews. The sample population effective in different mental illnesses but limited where they are pseudonymised, anonymised were adult mothers who had been free from an in schizophrenia. and linked to other datasets, if requested. A fee abusive partner for at least one year. Aim/Objectives: This randomized controlled is charged at a daily rate (Sinclair, 2015). Findings: The analysis revealed that an extraor- trial tested the effects of a mindfulness-based Online application process: Online applica- dinary series of traumatic relationships that take psycho-education group programme (MPGP in tion requesting access to linked data from the place from early childhood and throughout par- addition to usual care), versus a conventional Northern Ireland Maternity System (NIMATS) ticipants’ lives. This pattern of abuse led to dys- psycho-education group programme and treat- and the Electronic Prescribing Database (EPD) functional coping strategies such as withdrawal ment-as-usual alone, in schizophrenia over a was made to the HBS. NIMATS records medical, and a vulnerability to suicide. However, mothers 12-month follow-up. social, previous pregnancy, present pregnancy, often demonstrated the ability to make complex Methods: This was a single-blind, multi-site labour, birth and postnatal details. The EPD and subtle risk assessment decisions in order randomised controlled trial with three study records dispensed prescription medication. to minimise and protect themselves and their arms. In each of two study sites (outpatient Ethical approval from the University and the children from harm. clinics), 69 outpatients with schizophrenia or Office for Research Ethics Committees Northern Conclusions: The relationship difficulties its subtypes (N=138) randomly allocated to one Ireland (ORECNI) was granted. The HBS across the life course are explained through the of the three study groups (n=46) after baseline provided mandatory Safe Researcher Training. use of attachment theory and theories of power measurements and underwent six months The application was approved by the HBS Gov- and control and highlights: 1) interpersonal of intervention. Primary outcomes including ernance Board. violence does not take place in a social vacuum; patients’ mental state and re-hospitalization rate Data Access: Data were available in the Safe 2) continuously living in a world which provokes and other secondary outcomes were assessed at Haven, a secure room within the HBS, where anxiety and fear alters perceptions of attach- entry and at one week and six months. no internet or telephone access is permitted. ment relationships; 3) a combination of partner Results: Multivariate analyses of variance Data was supplied in two Excel files. Multiple infidelity; feeling ‘unfulfilled’ and a realisation (followed by univariate contrast tests) indicated conditions were presented as multiple lines that their children were ‘in danger’ seemed to that the MPGP participants indicated significant of data. These needed condensed into one line trigger a significant break in the relationship. greater reductions in their psychotic symptoms and exported into the Statistical Package for the Implications: For practitioners there needs to [F(2,136)=6.07; p=0.003], and length/duration Social Science (SPSS, 2013). Although NIMATS be an ideological shift away from understanding of re-hospitalizations (p=0.005) at 6-month contains pre-defined categories for data col- domestic abuse as an isolated social event, but follow-up. Patients in the MPGP group also lection, much of the information was stored in as deeply entrenched within women/mothers’ reported significant greater improvements in free text fields, which required categorisation. experiences throughout the course of their lives; their insight into illness/treatment (p=0.001) SPSS syntax was used to merge both datasets 2) Formal support agencies need to recognise

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that the decision making skills of mothers can be overlap in symptoms and impact indicates there Results: Data analysis identified three themes enhanced by promoting methods that empower may be a place for a PROM that can be used and a number of subthemes that exemplified a the ‘self’ and encourage wider social engagement across all conditions. Good Ward Round: 3) Interventions should be made available to ‘Good Use of Time’ help mothers ‘rediscover’ and ‘reinvent’ them- ‘Good Use of Expertise’ selves, and thereby present the possibility of a future without violence. Poster tour C ‘Good Use of Communication’ Theme: Quality and safety: Action Discussions and conclusions: Unpacking the complexities of the WR provided new ways Research/Evaluation of ‘looking’ at and reflecting upon WR practices Poster 20 (Abstract 186) Leaving North School entrance at: 1.25pm generating new understandings of what the WR ‘is’ and what it needs to look ‘like’ to have an Living with vascular disease: impact on patient safety and efficiencies of staff A qualitative study. Poster 9 (Abstract 66) time. It is hoped that this work will yield conclusions which are valuable to HCPs, policy makers Elizabeth Lumley, RGN, BA (Hons), MSc What are the components Clinical Research, Staff Nurse, Research and future researcher of the WR. Associate, The University of Sheffield/Sheffield of a ‘good’ ward round in Teaching Hospitals Foundation Trust, a large adult critical care Sheffield, UK unit and how can we make Patrick Phillips, UK; Rosie Duncan, UK; Simon them happen more often? an Poster 10 (Abstract 182) Palfreyman, Canada; Angela.M.Tod, UK; appreciative inquiry study Implementation of an Georgina Jones, UK; Jonathan Michaels, UK Clair Merriman, MSc, HPCE, RGN, Oxford international quality Brookes University, Oxford, UK improvement initiative for Abstract children with Inflammatory Background: This qualitative study examined Abstract Bowel Disease (IBD) at the impact of vascular conditions on patients’ Background: The ward round (WR) and its quality of life (QoL). The findings were used to Cambridge University place in the promotion of quality care is of par- help inform the development and selection of Hospitals: Improve Care Now ticular concern in critical care, where the increas- Patient Reported Outcome Measures (PROMs) ing complexity of work demands excellent com- (ICN) for vascular patients. This study formed part munication within the multidisciplinary team Claire Lee, BSc (Hons), RN Child, MSc Clinical of an NIHR Research Programme that aims to (MDT) and effective ways of organising inter- Research, Cambridge University Hospitals develop a system for using PROMs in clinical related interventions of critical ill patients. NHS Foundation Trust, Addenbrooke’s practice and make recommendations for service Given the high workloads and emotionally and Hospital and Paediatric Gastroenterology, development and patient care. technically demanding nature of work in critical Hepatology and Nutrition Team, Cambridge, Aims: To explore the signs, symptoms and care, the traditional WR is viewed as too time UK impacts of five vascular conditions on QoL, in consuming. Dr Matt Zilbauer (UK), Dr Rob Heuschkel order to guide the choice of PROMs for these Aims: (UK), Dr Franco Torrente (UK), Dr Marco groups. The five conditions were; periph- Gasparotto (UK), Dr Megan Maidment (UK), • Study current WR practices in a large regional eral arterial disease (PAD), abdominal aortic Deborah Cunion (UK), Anna Folan (UK), Mary ACCU and contextualize findings within aneurysm (AAA), carotid arterial disease (CAD), Brennan (UK) venous leg ulcers (VLU) and varicose veins (VV). relevant literature and policy. Methods: A purposive sample of 55 vascular • Understand and improve multidisciplinary WR Abstract patients was recruited, providing a range of practices. diagnoses, ages and gender. Semi-structured • Work with MDTs to prioritise WR practice Background: IBD are conditions causing interviews were conducted and Framework improvements, propose solutions, develop chronic relapsing inflammation of the gastro- Analysis used to analyse the data. A matrix of materials and processes, innovate and evaluate. intestinal tract [1]. Up to 30% of patients are diagnosed in childhood, where IBD has profound condition specific themes, and themes common Methods: A collaborative service improve- negative impact on growth and development as across all five conditions, was generated. ment-focused methodology was utilised. Data well as psychological and educational needs [2]. Findings: The findings demonstrate the range collection was underpinned by Appreciative Given the complex nature of IBD, standard of and extent of impact on QoL across the five con- Inquiry (AI) (Cooperrider, and Srivastva, 1987) care varies substantially amongst centres, which ditions. Eight overarching themes were identi- and used contrasting methods to gain a holistic is likely to influence long term outcome. ICN is fied; symptoms, pain, mobility, comorbidities, understanding: the largest IBD registry worldwide [3] aiming to impact on physical function, social impact, • Ethnographic Observations improve and standardise the care for children psychological impact, financial impact and diagnosed with IBD by creating a collaborative lifestyle. Themes applied across the five condi- • Key Informant Interviews community of patients, families and health care tions; however the extent and nature of patient • Recording Quantitative information about the providers. experience differed between conditions. Some conduct of the WR Aim: To present an overview of the experiences symptoms appeared in each condition group. • A pre validated questionnaire: Team Psycho- of Cambridge University Hospitals (CUH) Pae- Comorbidities were common in most conditions logical Safety and had a cumulative impact on the vascular diatric IBD Team with joining ICN, challenges Guided by question from the AI framework condition; where this occurred QoL and func- encountered and directions for the future. qualitative data was scrutinised using iterative tioning were more severely affected. Results: Challenges faced by the CUH team thematic analysis (DeSantis and Ugarriza, included securing agreements for data transfer Conclusion: This study presents a unique 2000). Descriptive summaries of quantitative to the US, ethical approval, obtaining funding, overview of patient experience related to five data were provided. vascular conditions. It maps the symptoms and designing information for children and families impact across the conditions. The apparent and organising the recruitment process. Imple-

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mentation of a novel electronic hospital health- Using a method combining clinical and research Poster tour D care record system (i.e. EPIC) at CUH in 2014 services to collect longitudinal data from this provided an ideal platform for standardised data large cohort of patients attending the Difficult Theme: Quality and safety: collection and transfer. However, major hurdles Asthma clinic was feasible and successful. The Questionnaires/Case study had to be overcome in order to implement ICN majority of patients approached were consented, within EPIC at CUH. participated and stayed in the study. Leaving North School entrance at: 1.25pm At the time of approval, 218 patients were eligible for registration. Currently 84 children have been Poster 13 (Abstract 13) registered (39%), and 67 (80%) of these have also given informed consent for their data to Poster 12 (Abstract 232) Socio-demographic contribute towards future research. Our next predictors and clinical aim is to achieve a registration rate of 75% (of Co-operative inquiry: a methodology for working nurses’ knowledge and total population) as this will allow us to generate utilization of research in Abia meaningful reference data and benchmark our collaboratively with people performance against leading US centres. living with dementia State University Teaching Conclusion: ICN has great potential to Katie Davis, MSc Advanced Nursing, Bachelor Hospital, Aba, Abia State, transform the care of paediatric patients, as well of Nursing (Mental Health), PhD Student, Nigeria as providing a unique dataset to perform future University of Manchester, Manchester, UK Alberta David Nsemo, BNSc.,PGDE,MSc., research studies ultimately improving the life of Dr Caroline Swarbrick (UK), Dr Penny Bee Ph.D, Academia, Department of Nursing children and young people with IBD. (UK), Professor John Keady (UK) Science, University of Calabar, Calabar, Nigeria

Abstract Abstract Poster 11 (Abstract 282) Dementia is a neurodegenerative condition which currently affects over 850,000 people in Evidence suggests lack of knowledge, negative The Wessex AsThma CoHort the UK It is estimated that worldwide, there is attitude and low utilization of research findings (WATCH) difficult asthma a new diagnosis every four seconds. With the among clinical nurses which is linked to their study; integrating research number of people with dementia rising, the educational background, years of experience and into the clinic. study of this condition is recognised as being exposure to research activities. The importance increasingly important and with that, a call for of research in determining the quality of Nursing Yvette Thirlwall, BN (hons), Respiratory people with dementia to have their voice heard. Care and also changing Nursing practice for Research Sister, University Hospital Within the literature, it is noted that although better cannot be overemphasised. This study was Southampton Foundation Trust, Southampton, participatory approaches to enquiry are being therefore carried out to ascertain the influence of UK adopted to study the experiences of people with educational background and years of experience Fernando Gonzales, Clair Barber, Kerry Gove, dementia, the voice of people with dementia is of clinical nurses on their level of knowledge of Kamran Tariq, Paddy Dennison, Ramesh J often lost. Therefore, it is important to consider research process, and the level of utilization of Kurukulaaratchy, England, UK methodologies that enhance the inclusion of research findings respectively, as well as identify people living with dementia in research. barriers to research utilization in Abia State University Teaching Hospital, Aba, Abia State, Abstract Heron and Reason (2006) propose a model of Nigeria. The study adopted a descriptive design. co-operative inquiry, whereby the traditional The WATCH Study is a longitudinal study of A stratified random sampling was used to select research roles of researcher and participant patients under the Difficult Asthma Clinic at Uni- a sample of 120 Registered Nurses and data are replaced by a partnership that fosters a versity Hospital Southampton, UK To create a collection was done using questionnaire. SPSS creative, practical collaboration. New to the better real life understanding of difficult asthma version 17.0 was used for data analysis using field of dementia research, co-operative inquiry (British Thoracic Society (BTS) step 4/5), a percentages and Chi square analyses technique. is an approach to participatory research that process of clinical dataset compilation, meeting The result showed that the respondents had involves cycles of action and reflection and aims clinical and research needs, was adopted. good knowledge of research process (88.7%), to address the concerns of the population being One objective was to trial feasibility of longitu- and sometimes utilize research findings in researched. dinal data collection in a large outpatient clinic practice. Educational status was found to have a cohort. Other aims included: This poster will present an example of how significant relationship with clinical nurses’ level co-operative inquiry can be used to enhance of knowledge of research process while years of a) Merging research and clinical objectives; the involvement of people with dementia in experience is not significantly related to their uti- meeting needs of the BTS Difficult Asthma research. The study draws upon the expertise lization of research findings in nursing practice. registry plus data collation needed for research of a group of people living with dementia in the Some of the barriers identified were lack of time purposes North West of England to explore how such a to read and understand research, lack of skills to b) Ensuring all eligible patients have the oppor- group is facilitated. Potential challenges to the carry out research, lack of incentives, and lack tunity to participate in research, current and research including that of capacity and consent of co-operation from the administration. Based future will also be presented. The term ‘co-researchers’ on these, the study recommended that research c) Gathering all relevant clinical data to support is being used in this research to define the col- teams be formed in the clinical settings, col- clinical phenotyping laborative nature of the research (Swarbrick, laboration between nurse educators and the 2015) and is used to describe members of the d) Ensuring data was collected in a time efficient clinical team in carrying out researches should public and experts by their own lived experience, manner be upheld, and the research results should be actively working in partnership with ‘academic made known to the hospital management for Number of patients recruited to date (279). researchers’ in all - or parts - of the research necessary implementation. Recruitment rate (18.6 per month). Total process. recruitment failures; due to lack of asthma KEYWORDS: Clinical Nurses, Educational back- severity (17). Number declining participation ground, Years of experience, Research process, (14). Number withdrawn (2) (no reason given). Knowledge, Research utilization, Barriers.

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Poster 14 (Abstract 288) Poster 15 (Abstract 31) Poster 16 (Abstract 133) Wide range of interventions Testing staff’s ability to gauge Trauma tertiary survey on offer at palliative care day fluid intake compliance and missed injury services: evidence from a Chris Tattersall, RN (Adult), Research and rates after the introduction of detailed mapping exercise Development Manager, Hywel Dda University a dedicated trauma service at Professor George Kernohan, BSc, PhD, Health Board, Haverfordwest, UK a major trauma centre Professor of Health Research, Institute Elizabeth Wake, Bachelor of Science - Nursing, of Nursing and Health Research, Ulster Abstract Diploma in Nursing, Master of Health University, Newtownabbey, UK Background: Accurate fluid balance records Professional Education, Gold Coast Hospital Kevin Brazil, Felicity Hasson, Joanne Jordan, are a fundamental aspect of the nursing role due and Health Service, Southport, Australia Sonja McIlfatrick, Joanna Coast, Louise Jones, to the crucial importance of maintaining health, Kate Dale, Australia, Don Campbell, Australia, Kathy Armour, Anne Finucane, Lisa Graham, especially in the elderly. However, little is known Martin Wullschleger, Australia, Gerben UK regarding the real inaccuracies of recorded Keijzers, Australia input. Abstract Aim: To evaluate the accuracy of staff’s ability to Abstract Background: In the UK, palliative care day gauge fluid intake in elderly care settings when faced with vessels containing residual fluid. Background: Keijzers et al (2011) evaluated services have been developed to support people trauma tertiary survey (TTS) performance in a with life-limiting illness who live in their own Method: Members of staff from a variety of regional trauma hospital without a dedicated home. Despite the growth of PCDS over the past elderly care areas in hospital (at mandatory Trauma Service. This audit evaluated change twenty years, ambiguity concerning their organi- training sessions) and private nursing homes in TTS performance and missed injury rates sation and content persists. (random homes at handover periods) were since the commencement of a dedicated Trauma Aim: We aimed to address this ambiguity by asked to estimate the amount of fluid consumed Service at the same hospital. Missed injury mapping services at three sites in England, by a fictitious patient from six commonly used patterns relating to mechanism of injury were Scotland and Northern Ireland. containers. Each container had a representa- also evaluated. Results of each study were tive ‘fluid’ remaining (solid Polyurethane Resin) compared. Methods: A systematic review of: in order that all participants assessed the same • policy and operational documents provided examples. For each container the participant was Methods: A retrospective chart audit was evidence on the organisation of care, and; asked to estimate how much has been consumed undertaken of all patients triggering a ‘Trauma by the patient. Call’ with high risk mechanism, two or more • the records of a 25% random sample of new body systems injured or complex isolated chest patients attending in 2015 provided evidence Results: 123 staff responded to the research or abdominal injuries at a Major Trauma Centre on the content of care. (sample size target: 50 hospital staff, 50 nursing admitted from 1st July 2014 to 30th June 2016 Results: Based on a mixed medical and social home staff), 66 from hospital areas and 57 from identified via the Trauma Registry. Missed model of care, the three services are character- private nursing homes. 58 participants were injury was defined as: ised by: qualified nurses and 65 were care staff. 75% of all estimates were outside an acceptable level of • Type I, in-hospital, (injury missed at initial • wide ranging patient care and support, error (up to a 10% error in volume estimated). assessment, detected within 24 h); spanning physical, psychological, emotional There was no significant difference between • Type II, in-hospital (detected in hospital after and social domains; qualified nurses and care staff (p=0.27), or 24 h, missed at initial assessment and by TTS). • caring for both patients and their informal between hospital staff and care home staff Results: 2613 patients were audited and had a carers; (p=0.67). Time in healthcare was also not found mean age of 37. The mean injury severity score • proactive care, based on regular assessment to be a factor. Data was collected between May was 11. Of patients with a LOS > 24 hours, 90% and follow-up; and December 2015. received a TTS, of these 89% were completed • being able to respond to a majority of identified Discussion and conclusion: Very little dif- within 24 hours. Of the 1573 patients that needs ‘in-house’; ferences between qualified or unqualified staff received a TTS 8% were diagnosed with a missed injury (Type I and II combined). The cohort with • where such response in unavailable, ensuring and whether employed in a hospital or nursing the highest missed injury rates (11%) were those onward referral and follow-up; home were found when estimating volumes of consumed fluid. Estimates of fluid volume with a LOS of 0-12 hours and >72 hours. • extensive liaison with other health and social by staff were poor when faced with estimating Conclusion: TTS completion improved by 70% care providers consumption from vessels containing a residual and identification of missed injuries increased Conclusion: Findings demonstrate a breadth fluid. Further research on the best strategies for with the introduction of a dedicated Trauma and depth to provision as day services act as a improving this aspect of care is required. Service. Only 10% of patients discharged within community-based ‘locus’ of highly responsive, 12 hours received a TTS. Interestingly, this coordinated, multi-disciplinary and cross-sec- cohort of patients had the highest missed injury toral care. rate of 11%.

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Poster tour E Poster 18 (Abstract 97) Poster tour O Theme: Quality and safety: Qualitative Oral health in care homes: Theme: Late Breaking Abstracts a patient and public Leaving North School entrance at: 1.25pm Leaving North School entrance at: 1.25pm involvement project in the local community. Poster 17 (Abstract 119) Poster 60 (Abstract 308) Dr Camille Cronin, PhD, School of Health Managing night-time and Human Sciences, University of Essex, Prospective observational vital signs observations: Southend-on-Sea, UK pilot study assessing the role the conflicting care work Phoebe Purcell, UK of the Actiwatch in diagnosing of supporting sleep and restless legs syndrome (RLS) preventing deterioration Abstract in patients with myotonic Dr Jo Hope, PhD, MSc, BSc, University of Background: Dental diseases are a major dystrophy Type 1 (DM1) Southampton, Southampton, UK public health problem despite being prevent- Donna Clements, BSc, Norfolk and Norwich able. On average, 80% of the people in care Carole Fogg, UK; Peter Griffiths, UK; Alex University Hospital NHS Foundation Trust, homes are living with dementia and rely on staff Recio-Saucedo, UK; Gary Smith, UK; Greta UK Westwood, UK; Paul Schmidt, UK on behalf of to assist them with day-to-day activities such as Dr Kath Mares, England, UK the Night Surveillance Study team. brushing their teeth. Aim: The objective was to work in partnership with care homes in the local community to Abstract Abstract develop a small-scale project and collect views Title: Prospective observational pilot study Background: Regular vital signs monitoring and opinions on oral health from service users, assessing the role of the Actiwatch in diagnosing is important in identifying deterioration in the their carers, healthcare workers and the care Restless Legs Syndrome (RLS) in patients with condition of hospitalised patients. Early warning home managers. Myotonic Dystrophy type 1 (DM1). scores are used to determine the risk of deteriora- Method: A qualitative research design was Background: Around 9,500 people in the tion and observations are scheduled to reflect this utilised and focus groups (n=12) were conducted UK have DM1Â¹. One of the most troublesome risk. However, while evidence suggests nurses using a patient and public involvement (PPI) symptoms of this disease is excessive daytime often omit scheduled vital signs observations at approach. Information collected from focus sleepinessÂ². It is theorised that a possible cause night, there is little research exploring why. groups was transcribed and thematically is disturbed sleep due to RLSÂ³. Currently, Method: As part of a multi methods study on analysed. diagnosis of RLS is made using diagnostic night time surveillance in hospitals, interviews Results: A number of themes were identified: criteria gained through consultation. This can be were conducted with nursing staff and Health mouth care routine, barriers, challenges and unreliable in people with DM1 who often have Care Assistants to explore reasons for not taking ‘how would you see this working?’ Teeth are learning difficulties. vital signs at night. Interviewees worked in a cleaned with toothpaste and a toothbrush but Aims: This project aimed to measure any hospital that uses an electronic monitoring there are different levels of ability. The most movement recorded with an Actiwatch as an system to record and determine the required common barriers were time, refusal, pride and objective tool to better diagnose RLS in people frequency of observations. Staff were purpo- dementia. The most common challenges were with DM1. sively recruited from the previous survey stage dementia itself, depression and end of life. A of this study from wards with differing levels of Methods: This single centre observational reoccurring theme was difficulties in accessing night time observation compliance. study had a 3-night observation period occurring Dental Care Professionals (DCPs). in September 2016. 8 patients with DM1 were Results: Seventeen interviews were undertaken Discussion: Those living with dementia want screened for eligibility, 2 eligible participants in March and April 2016. Interviewees reported to see improved access and more dementia completed the RLS severity scale, the sleep diary not believing all scheduled observations were friendly notes being used at the dentist. A sig- and wore the Actiwatch. The results of those 2 necessary. Although they took observations they nificant output from working with service users participants were written up as narrative case perceived as ‘unnecessary’ during the day, at and healthcare workers was the development of studies. night these conflicted with the perceived need picture guides to help with the tooth brushing to support sleep, so were missed or delayed. Results: The results show that the Actiwatch process. The outputs of the PPI work provided Decisions about whether or not to take observa- was successful as an objective tool in recording valuable information and forms an integral part tions at predetermined times were influenced by leg movements in people with DM1 who met to pursuing and contributing to further research patient group characteristics, ability to minimise criteria for RLS, as per current subjective clinical in this area. sleep disruption, ward-level clinical decision guidelines. making processes, the influence of hospital sur- Conclusions: The outputs would suggest that Discussion: This study demonstrates that the veillance, and individual staff reputation. a community based participatory approach is Actiwatch, worn for three consecutive nights, needed and a need for organisational change in Discussion: Findings suggest that as a result records leg movement activity in people with care homes in terms of living with dementia. The of decisions on taking night time observations, RLS and DM1 when sleeping. This is consist- service users and healthcare workers have iden- certain patient groups may be under-monitored ent with current literature although should be tified a need for DCPs to work with care homes at night. Complex care issues are involved in treated with caution due to the sample size. in the community. balancing patients’ need for sleep with the Developing a RLS objective diagnostic aid for need to check and manage deterioration. Con- people who find it difficult to give a clinical clusion: Practice recommendations focus on history is important to aid both the design of methods for supporting sleep while maintain- clinical trials and in clinical practice leading to ing safety, particularly in groups with complex better management of RLS in people with DM1. needs, (e.g. people with dementia or chronic Conclusion: Recommendations for future conditions), and taking into account ward and research would include a wider study to validate individual exceptions to the hospital-wide obser- the use of the Actiwatch as a diagnostic tool for vation frequency policy during the night. RLS in this population.

106 Posters – Wednesday 5 April 2017

Poster 61 (Abstract 317) Poster 62 (Abstract 306) Poster 63 (Abstract 315) ‘Exploring the attitudes of Intermittent fasting An analysis of enquiries colorectal oncology patients interventions for the relating to Men B vaccination towards pre-operative treatment of overweight and received to a regional exercise: a qualitative study’ obesity in adults aged 18 years immunisation advice service Laura Gallego, BsC (Hons) Critical Care and over: a systematic review for health professionals Nursing, University College London Hospital Professor Sharon Hamilton, PhD, MA, Karen Ford, MSc(Public Health), Post Grad NHS Trust, London, UK BA(Hons), RN, Professor of Nursing, Teesside Certificate (Medical Education), BN (Hons), Dr Caroline McGraw, UK University, Middlesbrough, UK Oxford Vaccine Group, Leanne Harris, Scotland. Liane Azevedo, University of Oxford Department of Abstract England. Joan Olajide, England. Caroline Paediatrics, Oxford, UK DeBrun, England, Vicki Whittaker, England. Background: Emerging evidence suggests that Catherine Hankey, Scotland. Louisa Ells, pre-operative exercise could optimise patients’ Abstract England. baseline physical condition and may mitigate Background: Vaccination against Meningo- some of the post-operative complications. coccal group B (Men B) was introduced routinely Abstract Regular exercise can also reduce some of the in UK in September 2015 (PHE 2016). When negative cancer-related symptoms. Background: Intermittent energy restriction MenB vaccine is administered alongside other Despite the potential benefits of pre-operative diets such as alternate day fasting, intermittent routine infant immunisations fever had been exercise, many patients decrease their physical fasting and the ‘fast diet’ are popular weight-loss reported in up to 61% of infants (Gossger, 2012), activity levels following colorectal cancer interventions. However the supporting evidence therefore practice changed to recommend pro- diagnosis. In order to effectively implement of effectiveness is currently limited. phylactic paracetamol for routine infant immu- pre-operative exercise in clinical practice, it is Aim: To systematically review the effective- nisations. necessary to understand why this may happen ness of intermittent energy restriction in the Aims: To review the nature of enquiries about and how health professionals can assist patients treatment for overweight and obesity in adults MenB vaccination received to a specialist in maximising their engagement and adherence. (BMI ≥25 kg/m2), when compared to usual care immunisation service within the Thames Valley Aims: The study aimed to understand the per- treatment [continuous energy restriction (CER)] comparing enquiry content over a three month spectives and attitudes towards pre-operative or no treatment (ad libitum). period at the start of vaccination programme 1st exercise of oncology patients who had recently Method: A systematic search strategy was Sep 2015 - 30th Nov 2015 (quarter 2015) with a undergone major elective colorectal surgery and developed and run in November 2015 to identify three month period one year into the programme to identify potential barriers and motivators to peer reviewed RCTs and pseudo-RCTs. The 1st Sep 2016 - 30th Nov 2016 (quarter 2016). engagement. review protocol (Ells et al. 2015) followed the To review if the change of practice to routinely Methods: A qualitative research design was Joanna Briggs Institute approach (JBI 2014). recommend prophylactic paracetamol generated adopted. During July 2016 to January 2017, ten Two reviewers independently assessed retrieved enquiries. papers for methodological quality and indepen- patients were invited to take part in a semi-struc- Method: Enquiries received in quarter 2015 dently extracted data. All results were subject to tured interview. Interviews were audio-recorded and quarter 2016 relating to MenB vaccination double data entry. Data were, where possible, and transcribed verbatim. Main themes were were analysed and grouped into categories. Nine pooled in statistical meta-analysis using Com- identified from the data using thematic analysis. main themes emerged. Enquiries that had par- prehensive Meta-Analysis software. Effect sizes acetamol or Calpol recorded in their description Findings: Three key themes emerged from the were expressed as weighted mean differences were reviewed as a subset to further investigate data which were: and their 95% confidence intervals were calcu- content. (1) Barriers to engagement with pre-operative lated for meta-analyses. Results: 590 enquiries were received in quarter exercise. The main sub-themes identified were: Results: Six studies were included in this 2015, 75 (13%) related to MenB compared to (i) cancer-related side effects, (ii) competing review (mean duration of interventions: 5.6 34 (8%) in quarter 2016 (total enquires 426). priorities, (iii) advice received, (iv) fear, (v) months; range: 3 months to 12 months). Four Themes of MenB enquiries changed within the perceived current levels of physical activity, (vi) studies included CER as a comparator interven- quarters. Surprisingly, only six enquiries related misconceptions about exercise. tion and two studies included a no treatment to paracetamol in quarter 2015 and 2 in quarter (2) Motivators to pre-operative exercise. The control. Meta-analyses reported that intermit- 2016. main sub-themes identified were: (i) previous tent energy restriction was more effective than experience of physical activity, (ii) enjoyment, no treatment for weight loss (-4.22 kg; 95% CI Discussion: As a change to a vaccination pro- (iii) perceived psychological benefits, (iv) social -5.48 kg to -2.97 kg; p > 0.001). However, the grammes matures the nature of the enquiries encouragement, (v) impact of cancer diagnosis, pooled estimate for studies that investigated the that health professionals have about it alter. (vi) perceived physical effects of exercise. effect of intermittent energy restriction in com- Conclusion: Training and resources created (3) Facilitators to successfully introduce a parison to CER revealed no significant difference to inform health professionals about a change future pre-operative exercise programme: The in body weight loss (-1.03 kg; 95% CI -2.46 kg to to policy are vital to ensuring its effective main sub-themes identified were: (i) exercise 0.40 kg; p = 0.156). implementation in practice. With any change programme nature (ii) flexibility and indi- Discussion: This review demonstrated that questions will arise from those delivering it and viduality, (iii) presentation style, (iv) provision intermittent energy restriction is as effective as resources need to be in place to respond to them. of safety and reassurance, (v) emphasis on CER for short-term weight loss. Future research potential benefits. on the long-term effectiveness is warranted as Discussion and Conclusion: By utilising the only one study reported a longer-term interven- identified themes, health professionals could be tion: this revealed that change in body weight better prepared to identify potential barriers and was sustainable in both intermittent and CER support patients to engage with and adhere to conditions over the 12 months intervention pre-operative exercise routines. period.

107 Posters – Wednesday 5 April 2017

Poster 70 (Abstract 311) ‘What are post-stroke community patients’ experiences of a secondary stroke prevention (SSP) package offered by a Community Neurological Rehabilitation Team (CNRT) in the South East of England and their views on how it could be improved?’ A work based formative service evaluation. Karen Jephson, RN. DN. MA Health Promotion, Community Neurological Rehabiltation Nurse, Sussex Community NHS Foundation Trust, Brighton, UK

Abstract Stroke is a leading cause of disability and death especially in Low and Middle Income Countries highlighting that prevention should be a global health priority (Feigin et al 2015 and Norving et al 2015). Somewhere in the world a stroke happens every two seconds and up to 30% of all global strokes are thought to be secondary (WHO 2011). Secondary Stroke Prevention (SSP) aims to help people reduce their risk of having another stroke. This project aimed to evaluate a SSP package which helped patients identify their risk factors and suggested ways to help change behaviours. During September-November 2016 ten community post-stroke patients who had had their stroke within the previous six months were questioned about their experience of receiving a SSP package. The SSP package consisted of an assessment followed by structured sessions. It was flexible and enabled patients to help themselves reduce their risk of having a secondary stroke. Semi-structured interviews were digitally recorded then transcribed and analysed using a thematic framework. Participants valued the SSP package and wanted to know what had happened to them, they welcomed explanations and felt supported and empowered to identify their risk factors. Minimal suggestions were made for improvement but ideas on how to enhance the SSP package were discussed. The SSP package should remain being delivered in its current adaptable format by staff that value empowerment. Focus should be placed on refining tools that address dietary intake, as this was a risk factor consistently identified. The value of incorporating aides such as anatomical models should not be underestimated. The SSP package is a relatively cost effective tool that can be used in a variety of settings. Ideas could be scoped on how to provide peer support in the longer term through groups to help sustain any positive lifestyle changes.

108 Posters – Thursday 6 April 2017

Poster tour F • A standardised induction booklet for all CRNs iours in the workplace and PR offers a platform in conjunction with CRF, University and for collaboration and empowerment of nurses to Theme: Workforce and employment: Research Networks engage in research to address an important and Policy/Improvement • All job descriptions rewritten to reflect roles controversial aspect of organisational culture. and responsibilities Leaving North School entrance at: 1.25pm • Standardised process for recruitment and selection and overview of resource planning. Poster 24 (Abstract 183) Poster 21 • Expert oversight of clinical and research gov- Withdrawn ernance issues Innovative research roles Maxine Burry, Leeds Teaching Hospitals Trust, UK Poster 23 (Abstract 188) Co-author: Karen Ingham, RGN, Senior Poster 22 (Abstract 277) Research Nurse, Leeds Teaching Hospitals Research debate: Trust, UK Managing clinical research participative research as nurses: the Edinburgh an approach to prevent Abstract experience and pre-empt negative staff Background and Objectives: The changing Jean Bruce, RGN, BSc PG Dip, NHS Lothian, behaviours in the workplace landscape of healthcare and how we deliver Edinburgh, UK research in the UK has encouraged new, inno- Jane Dundas, MSc, PgCE, BSc, RGN, Kingston vative and cost-effective ways of working. The University, UK Abstract role of the Senior Clinical trials Assistant (SCTA) initially evolved due to financial and manpower Background: In Scotland, Clinical Research Abstract pressures particularly in relation to the dearth Nurses (CRN) were working in isolation, had of registered nurses in the UK At our centre, the varying levels of contractual accountability Background: Bullying in the workplace role was developed to support the CRUK Strati- arrangements, inadequate job descriptions remains an issue of serious concern. 25% of fied Medicine Programme (SMP). The purpose and variable supervision, performance review, nurses experience harassment, bullying and of this poster is to inform, encourage and inspire induction and continuing professional develop- abuse from other members of staff, (NHS other researchers in creatively developing new ment. A new role was introduced, in 2014, to England, 2016); and evidence suggests many roles within their research teams. NHS Lothian, Edinburgh - a Clinical Research more staff witness bullying behaviours, than Nurse Manager (CRNM). Although similar roles report it (Carter et al, 2013). The detrimental Methods: This new role, developed by the exist in the Clinical Research Facilities (CRF) impact of workplace bullying on staff is well clinical research nursing team, to deliver patient in Scotland this was the first position to line documented, yet international research fails to recruitment and sample collection, to support manage stand alone CRNs and have professional demonstrate unequivocal evidence for effective, the SMP programme, has been instrumental accountability for those working for Edinburgh preventative interventions, (Illing et al, 2013). in identifying systematic barriers preventing University. Aim: Critically discuss methodological implica- effective participant recruitment and helped to develop effective pathways and processes as Aim: To ensure consistent ways for CRNs giving tions of participatory research to pre-empt and solutions. With effective support, education and specialist and professional support and promote prevent bullying behaviours in the workplace. skills training, the SCTA’s role has expanded to on going education and training. To provide Participatory Research (PR): Underpinning include: a cohesive, safe, effective, flexible workforce inquiry strategies in PR are participation and providing quality research across NHS Lothian. collaboration; all people engaged in the inquiry • Identifying, recruiting and retaining of patients to several translational and observational Methods: A scoping exercise with all CRNs to act as co-researchers and co-subjects. Benefits studies. identify line management structures, completed and drawbacks of two participatory research using face to face discussion and telephone approaches will be discussed: Co-operative PR, • Supporting research nurse colleagues conversations. Links made and relationships and Participatory Action Research. • Close interaction with Principle Investigator built with Principle Investigators, Research and Issues for debate: The presentation provides and Sub-Investigators. Development, Lead Nurses, Edinburgh Univer- an opportunity to critically discuss methodologi- • Sample collection, sample tracking, collates sity Human Resources and Clinical Research cal differences between two PR approaches and data and provides reports to Stakeholders. Facility. to consider ethical and political dilemmas that • Developed relationships and pathways with might be entailed. Currently accepted defini- Results: A varied and large scope of practice other departments to facilitate effective com- tions of bullying (behaviours must be frequent with conflicting priorities and differing expec- munication. tations of stakeholders. The cultural change and repeated) are also contentious; is the bar • Inspiring other Healthcare professionals, required to change management structure met of tolerance set too high and do parameters through explaining her SCTA role and offering both resistance and acceptance. A need for for reporting discourage staff from recognis- shadowing opportunities. education and training to develop a standard ing negative behaviour as it occurs? Is policy induction programme. language a contributing factor in an embedded Conclusion: Encouraging research teams to culture of widespread tolerance of staff incivility find solutions to workforce and skill mix chal- Outcomes: A clear line management structure and negative behaviours? lenges provides a platform for new ideas and for CRNs who work out with the CRF, either by creative solutions. In this example enhancing the CRNM or by head nurse of speciality direc- Conclusion: As a senior lecturer in clinical delivery of the SMP 2 programme. Recognising torates. leadership and management I am interested to explore ways to enable healthcare staff to every team member brings different skills and • An advocate to tackle operational issues pre-empt and prevent negative behaviours and experiences through their role to the wider team • A quarterly Professional Research Nurse conflict situations in the workplace and to con- builds confidence, role development opportu- Forum meeting enhances communications and tribute to raising awareness of a significant but nities and cohesive teams which contributes to creates a sense of teamwork. neglected issue. There is an urgent need to take research delivery in a cost effective manner. action to prevent and pre-empt bullying behav-

109 Posters – Thursday 6 April 2017

Poster tour G Poster 26 (Abstract 35) Poster 27 (Abstract 107) Theme: Workforce and employment: Social media as an Professional identity in Qualitative/Mixed methods engagement strategy to nursing: a focus group study Leaving North School entrance at: 1.25pm inform nursing policy Professor Michael Traynor, Middlesex Siobhan O’Connor, B.Sc., CIMA CBA, B.Sc., RN, University, London, UK Edinburgh Napier University, Edinburgh, UK Niels Buus, Australia Poster 25 (Abstract 6) What do nurses do on Abstract Abstract Facebook and why should we Background: Health policy would benefit Background: Research often concludes that care? from the expertise of front-line and managerial professional socialisation in nursing is problem- nursing staff across all settings. However, nurses atic because new recruits start out identifying Gemma Sinead Ryan, DHSci MSc, University are often not directly involved in policy creation, with the profession’s ideals but lose this idealism of Derby Online Learning, Derby, UK as some do not see it as a key area to become as they enter and continue to work in the profes- involved in or a process they can easily influence sion e.g. (Maben, Latter et al. 2007). Abstract (Toofany, 2005; Spenceley et al, 2006). Aims: This study set out to examine the topic Background: Online Social Networks such Aims: To examine social media as an engage- and asks ‘what characterises the development as Facebook have rapidly diffused through the ment tool to aid policy discussion among nurses of the professional identity of student nurses as nursing profession with an estimated 60% using and explore their views on the future develop- they talk about experiences of clinical work in social media every day. There have been a range ment of the profession. the UK NHS?’ of concerns linked to unprofessional behaviours Methods: A Twitter chat, under the hashtag Methods: Six focus groups were held from 2011 on Facebook despite professional guidance #CNOScot, was hosted by the Chief Nursing to 2016 with a total of 49 volunteering 2nd and being in place. However, there is little evidence Officer for Scotland (CNO) in May 2016. Formal 3rd year BSc nursing students studying at a uni- that explores the causal and influencing factors ethical approval was not necessary, due to the versity in London, UK 12% were male and the that lead to nursing behaviour and actions on openness of the online public platform, but best mean age was 28. Analysis: We drew on the ideas Facebook. practice ethical guidelines were followed. The of Bucholtz and Hall regarding the emergence Aim: To explore the causal relationships CNO and her team posed and responded to a of identity from interaction (Bucholtz and Hall between nurse’s actions and behaviours in series of questions to stimulate policy debate 2005). Facebook groups. among participants. A mixed study design was Results: The groups featured high degrees of Method: Bhaskarian critical realist ethnogra- used to address the research aims. Data were consensus in the ideas expressed and the identi- phy (CRE) employing structured observation gathered using NCapture software and imported ties that were developed. Participants’ talk was and reflective field notes of publicly accessi- into NVivo. An exploratory case study, using strongly dualistic and inflected with anxiety. ble, groups and profiles on Facebook explicitly the constant comparative method, aided quali- They identified with caring as an innate - char relevant to the nursing profession. For ethical tative thematic analysis. Descriptive statistics acteristic. They described some qualified nurses approval reasons, these groups and pages will were also generated from social media analytics as either not possessing this characteristic or as remain anonymous. (Skiba, 2008). having lost it. Observations were conducted over a 6 month Results: Sixty-five people took part in the Discussion: There is a tendency in existing period during 2015-2016 by applying a selective Twitter chat, posting 444 tweets over one hour. literature to take students’ talk at face value. case sampling approach to post. Observations Nurses felt proud to deliver person-centred Students’ identification with caring needs to be occurred at two time points during the 6 month care but called for investment in technology, understood as a discursive move in response to period by a single researcher. This allowed for a education, nursing research and mental health. anxiety in the practice setting. It is a move that range of ‘typical’ and extreme behaviours to be Primary care and advanced practice roles to can distance their identity from senior members observed. support older adults with complex health and of the profession and enact group solidarity. social care needs were also seen as vital to Analysis: A selection of extreme and typical This identification as ‘caring’ exists alongside develop. cases of behaviours were examined and the an apparently contradictory identification as relationships presented diagrammatically based Discussion: Social media can help reach and cynical. on the components of CRE: entities, tenden- engage nurses in policy discussion and ensure Conclusions: Understanding both identifica- cies, morphogenic and morphostatic structures, there is continuity between policy and practice tion with ‘caring’ and cynicism as a response to events and actions. but some groups risk being excluded using this anxiety is one way to make sense of this apparent medium. Results: Two separate professionally linked contradiction. Facebook groups were followed. From this the Conclusion: Nursing leaders should include underlying causal mechanisms that explain social media as one of many engagement strate- the relationship between the components of gies to guarantee nurses can participate in policy analysis were explored and ‘tested’ within the debate and inform future strategy development. data collected. The impact of online socialisation, social capital, social activism and diffusion of shared values were of influence on the acceptability of unprofessional or unacceptable behaviours in the Facebook environment. Conclusion: A theoretical framework is presented. This explains the causal factors for professional and unprofessional types of behaviours on Facebook and concludes that professional values should acknowledge the unintended consequences of actions.

110 Posters – Thursday 6 April 2017

Poster tour H Poster 30 (Abstract 45) Poster 31 (Abstract 148) Theme: Workforce and employment: Failure to fail: factors Comparison of three clinical Quantitative/Case study that support and prevent assessment tools for pin site Leaving North School entrance at: 1.25pm preceptors failing a student infection on clinical placement. Dr Jennie Walker, PhD, RN, PGCert MedEd, Professor Fiona Timmins, Phd MSc BSc BNS Clinical Educator, Nottingham University Poster 29 (Abstract 206) BA RGN RNT, [email protected], Trinity College Hospitals NHS Trust, Nottingham, UK Exploring the reality of Dublin, Dublin, Ireland clinical research nursing Orla Nugent, Christina Lydon, Siobhan Part, Abstract Lisa Keane, Geraldine Prizeman, Caitriona Background: Pin site infections are one of in acute NHS Trusts: a Dennehy, Helen Fenn qualitative study in four the most common complications associated with the use of skeletal pins and wires. Clinical organisational case studies Abstract assessment tools can be used to consistently Helen Jones, MSC, BSc (Hons) RGN, Guy’s and define and categorise pin site infection to enable Introduction: The issue of failing nursing St Thomas’s NHS Foundation Trust, London, UK reliable assessment. An ideal tool is quantifiable, students is extensively written about in the lit- valid, and sensitive enough to allow a range of erature as an on-going dilemma for preceptors. values across the spectrum, while being respon- Abstract Gainsbury (2010) highlights that over one third sive to changes. It should also be easy to perform of mentors (preceptors) have passed students Background: Research with patients in the with high inter- and intra-observer reliability to whilst acknowledging they had concerns about clinical setting has increased exponentially in ensure consistent use in clinical practice. recent years. The role of the Clinical Research their performance. Given that ethically and Nurse (CRN) has gained importance and many legally nursing professionals must protect the Method: To determine inter-observer NHS organisations now have a highly developed public and uphold the reputation of nursing, agreement of three validated pin site assess- network of CRNs. However, research is often preceptors play a fundamental role in giving ment tools (Santy et al 2011, Patterson 2005 viewed as separate to ‘routine’ clinical care with constructive feedback, pivotal to developing and Checketts et al 1993) eleven nurses indepen- lack of understanding for CRN contribution competent practitioners (Vinales, 2015). dently scored ten images of pin sites using each of the assessment criteria. These assessments were (Coulson and Grange 2012).This paper presents Aim/Objectives: To explore the extent of repeated two weeks after the initial assessment. results from phase 2 of a larger study. Four case failing to fail nursing students in the Irish Intraclass correlation was calculated for each studies were purposively selected from a national context. Preceptors’ views on giving feedback to tool calculating for absolute agreement. Test- survey of the CRN workforce (sample size = 111). students and the perceived supports and barriers retest data was analysed with two-way multiple Selection was based on CRN workforce size and for failing nursing students were also explored. a previous workforce review. measures analysis of variance (ANOVA). All cal- Methods: A descriptive quantitative approach culations were performed using SPSS. Aims: To explore the experience of CRNs was used. Purposive sampling was employed. Results: Single measures intraclass corre- working within acute NHS Trusts and under- Data were collected from two large teaching lation coefficient was reported at 0.814 for stand the reception they receive within the hospitals, using an adapted validated ques- Checketts (Cronbach’s Alpha 0.981), 0.621 for clinical environment. tionnaire (McCarthy and Murphy 2008) which Patterson (Cronbach’s Alpha 0.95) and 0.866 was distributed to all qualified nurses involved Methods: 14 semi-structured interviews with for Santy (Cronbach’s Alpha 0.989). Results formal feedback and assessment. Data presented Lead CRNs, Principal Investigators and R and were excluded from two assessors due to incom- here relates to two open-ended questions and D Directors and 4 focus groups with CRNs were plete re-test data. Based on six clinicians test-re- were analysed using content analysis. carried out. Questions were structured using a test score data significant interaction between quality framework (Bate et al, 2008). Data was Outcomes: In total 367 nurses, working in the observer and the time were identified for analysed using NVIVO 10 and thematic analysis a variety of clinical settings, took part in the the Checketts tool, F(5, 45)=5.392, p=0.01. No to identify key themes. survey. The main factors supporting preceptors significant interaction was observed for the Results: Staff reported numerous challenges. failing students included, documented evidence, Patterson scoring tool F(5, 45) =1.051, p=0.4 or Lack of time and competing priorities mean dangerous practice, behaviour and attitude Santy F(5, 45) =3.953, p=0.05. of student, support from other hospital staff frontline staff are often too busy to support Conclusion: The tool developed by Santy et and management, absenteeism, lack of skill, research and fail to understand the CRN role. al (2011) demonstrates high inter and intra- knowledge and competence, poor communica- CRNs struggle to identify dedicated clinical observer reliability indicating that this tool tion and indifference to nursing career. space and frequently compromise requirements. offers a more consistent and reliable approach Strategies to overcome this include raising While poorly documented evidence, lack of to assessing for PSI. awareness, negotiation and reciprocal assis- support from other staff, appropriate time and tance. poor skills were factors preventing failing a Discussion: Staff may struggle to view research student, student personality (approachable, as clinical care. Strategies are required to mental state) and staff attitude (guilt, compas- integrate research into clinical care and support sion) as well as fear of legal repercussions and the National Institute Health Research (NIHR) backlash from colleagues were reported. aim of ‘an integrated clinical research system Conclusion: Findings identified areas where driving research from bench to bedside for the preceptors require support to facilitate them benefit of patients’ (NIHR 2015). in their preceptorship role. Additionally, areas Conclusion: Clinical Research forms an where staff involved in assessment require integral part of most NHS strategy documents support, in managing students who are not but the reality is often fraught with challenge meeting the required level of competence, were and compromise. CRNs constantly negotiate identified. with frontline staff working at capacity within busy healthcare systems.

111 Posters – Thursday 6 April 2017

Poster 32 (Abstract 115) Poster tour P Poster 66 (Abstract 316) So much more than patient Theme: Late Breaking Abstracts The Vaccine Knowledge recruitment - using the Project: an analysis of website Leaving North School entrance at: 1.25pm BRIS-TOOL to define clinical use from January 2013 to research nursing December 2016 Poster 65 (Abstract 318) Paula Tacchi, BSc (Hons). RGN. RNLD, Sarah Loving, BA Hons, Manager, Vaccine University Hospitals Bristol NHS Foundation Adolescents in research - the Knowledge Project, Oxford Vaccine Group, Trust, Bristol, UK challenges of recruitment Department of Paediatrics, University of Oxford, Oxford, UK Rachel White, Research Nurse, Oxford Vaccine Abstract Group, University of Oxford, Oxford, UK Background: Research teams undertake a vast Abstract range of duties from the development of study Background: The World Health Organization Abstract proposals, applications for funding, submissions regards vaccine safety as a high priority (1) and for approvals, recruiting patients, delivering Background: In December 2016 the UKCRC has set up the Vaccine Safety Net (VSN) (2), an the research, caring for the patients, collect- announces that ‘Methodological research international network of websites which provide ing data, writing reports, ensuring safety and addressing recruitment challenges has been reliable information on vaccine safety. Vaccine archiving all documents. Each study requires identified as a priority for UK Clinical Trial Units misinformation on the internet can easily be clinical skills, study management skills and in order to identify effective interventions and found, especially by using ‘negative’ search research knowledge at all levels (Hastings et al, reduce research wast(1). terms (3). The Vaccine Knowledge Project (VKP) 2012). Staff working in research develop spe- Participation of adolescents in research is highly is a vaccine information website embedded in an cialist research knowledge which enables more valuable as a specific population group. It holds academic research group. It is a member of the efficient set up and delivery of studies. The Uni- the potential to set up trajectories that have a VSN and provides evidence-based information versity Hospitals BRIStol research workplan profound influence on health and wellbeing for to address concerns about vaccine safety. Much TOOL (BRIS-TOOL) was originally developed to the long term, an issue which is high on the gov- of this is relevant worldwide and the VKP gets identify skill mix within a research team; its data ernment agenda (2). Yet this remains a popula- many international visitors. can provide an evidence base to allow a better tion which present very specific challenges and Aims: To identify triggers that increased use of understanding of the breadth of research activi- remain amongst the most difficult to recruit and the VKP website between 2013 and 2016. ties undertaken by the clinical research profes- retain (3). Method: We used Google Analytics to investi- sional. Aim: This poster will present a critical reflection gate trends in overall website traffic and visits Method: Clinical research staff from Univer- on the challenges of recruitment of adolescents to individual pages. Where peaks occurred we sity Hospitals Bristol NHS Foundation Trust into research, with specific reference to a case looked at vaccine-related news and events to completed the BRIS-TOOL over a 4 week study undertaken in 2016. attempt to explain them. period. The tool used a standardised set of Method: A study in 2016 recruited adolescents Results: Website traffic has increased nearly activity descriptors and listed the studies being aged 16-18 in the Thames Valley Area, to inves- seven-fold, from 69137 page views in 2013 to delivered. tigate the carriage of meningococci in a teenage 480757 page views in 2016. Peaks in activity that Results: The data gathered was analysed to population, involving a throat swab and comple- appear to relate to current issues were noted. produce illustrations of the activities undertaken tion of a questionnaire. Flu vaccine pages peak during each flu season, by each staff group; build profiles of roles and Methods of recruitment employed, included with a maximum in Oct/Nov (29565 views in posts; and highlight the combination of activities amongst other strategies: Oct/Nov 2016, 26% of total). In Jan/Feb 2015, required to deliver individual research studies. • Effective communication with sixth forms following the US Disneyland measles outbreak, Discussion: The BRIS-TOOL supports the there was a surge in visits to the vaccine ingredi- determination of skill mix for a research team; it • Public engagement swabbing demonstrations ents webpage (23469 page views, 19.5% of total) can also be used to demonstrate that: • Provision of research study days for selected in addition to measles/MMR pages (63569 page • Research offers the opportunity for staff to students views, 53% of total). In contrast, there have been develop a range of skills and experience Many challenges were addressed including no noticeable peaks in HPV pages even when the vaccine has been in the news. • Research teams manage competing demands provision of age-appropriate modes of communication, time constraints with schooling, and Conclusion: Monitoring web traffic helps • Research nursing is patient focussed keeping it interesting and relevant. identify current areas of concern around • Clinical research nurses have the potential to Results: Recruitment was highly success- vaccines. Being embedded in an academic better inform study design ful, quick and effective: 58 sixth forms were research group enables the VKP to flag up and Conclusion: The BRIS-TOOL provides approached, 32 participated (total students respond to these concerns quickly. evidence about the complexity of research 7181), 2145 sixth formers were enrolled over 4 nursing and helps to define research roles. months; a 30% recruitment rate. Conclusion: The specific successes and challenges of adolescent recruitment as experienced through this case study, can be learnt from and developed upon, improving the quality of adolescent research. The interventions used in this case study have international applicability and are likely to be enhanced through the consideration of novel approaches which acknowledge the uniqueness of adolescents and their world.

112 Posters – Thursday 6 April 2017

Poster 67 (Abstract 322) Poster 42 (Abstract 16) Expedited delivery of Ebola Shared understandings of vaccine trials: recruiting spiritual care among the to a phase 1 vaccine trial in members of an innovative response to an epidemic Spirituality Interest Group in Danielle Campbell, Bachelor of Science in the Republic of Ireland Nursing, Diploma in Tropical Nursing, Oxford Professor Fiona Timmins, Phd MSc BSc BNS Vaccine Group, University of Oxford, Oxford, BA RGN RNT, [email protected], Trinity College UK Dublin, Dublin, Ireland Malick Gibani, England, UK; Juliette Meek, Sĺlvia Caldeira, Jacqueline Whelan, Maryanne England, UK; Andrew Pollard, England, UK Murphy, Carole King, Vivienne Brady

Abstract Abstract Background: During the 2013-2015 Ebola Spirituality is receiving unprecedented attention epidemic in West Africa, the WHO published an in the nursing literature (McSherry and Jamieson Ebola Response Roadmap, pledging to acceler- 2011). Recently the UK has made recommen- ate the development of vaccines against Ebola dations for the nurses’ role in this area (RCN virus disease (EVD)[1]. The UK has been at the 2011). A Spirituality Interest Group (SIG) was forefront of international efforts to expedite set up in the School of Nursing and Midwifery, testing of candidate vaccines. The delivery of Trinity College Dublin, in March 2013. This phase 1 vaccine trials in the context on an infec- poster reports the results of the survey regarding tious diseases emergency could offer lessons for the establishment of the SIG and the develop- future epidemic preparedness. ment of a shared understanding of spiritual Methods: We setup one of the first phase I, care among the members. A 13-item survey was randomised, observer-blinded clinical trials distributed in 2014 containing both closed and designed to assess the safety and immunogenic- open-ended items. A total of 15 members partic- ity of a prime-boost vaccine combination of ipated. Responses revealed majority agreement two viral-vectored vaccines expressing Ebola with Ramezami et al (2014) dimensions of glycoproteins (Ad26.ZEBOV [Crucell, Nether- the concept of spiritual care, which was also lands] and MVA-BN-FiloÂ® [Bavarian Nordic, confirmed in open responses, after qualitative Denmark]). Using an independent, multidisci- analysis. As such attributes were identified as the plinary team of doctors, nurses, laboratory tech- following: healing presence, therapeutic use of nicians and trial administrators we were able to self, intuitive sense, exploration of the spiritual expedite delivery of the study. perspective, patient-centredness, meaning- Results: Setup of trial, including protocol centred, therapeutic intervention and creation development, document preparation and of a spiritually nurturing environment. There is staff training was completed within 3 weeks. consensus that the spiritual care in health care Following expedited submission and review, settings is a shared responsibility of the whole regulatory approval was granted within eight ought to be an integrated effort across the health working days by the Medicines and Healthcare care team. However understandings of spiritu- products Regulatory Agency (MHRA) and within ality and spiritual care are not always clear. By ten days by the Research Ethics Committee developing shared understandings of spirituality (NRES Committee South Central - Oxford A). and spiritual care the Spirituality Interest Group hopes to be able to underpin both research and Within 7 weeks we screened 168 volunteers and practice with a solid conceptual understanding vaccinated 87 participants. Concurrently, daily and foundation. safety reviews of clinical and laboratory participant data, continued eligibility assessment and immunological testing of samples occurred. Discussion and conclusions: Our response to the Ebola outbreak is our second test of expedited vaccine testing in the last decade[2] and demonstrates the capacity to respond quickly in an epidemic. Researchers in the UK have arguably benefited from a robust and flexible research environment, with critical support across the relevant government departments, and dependent on an experienced multidisciplinary team. Preparedness for future epidemics could be aided by lessons learned from the EVD outbreak and the pre-emptive development of vaccine protocols for potential outbreak pathogens.

113 Posters – Friday 7 April 2017

Poster tour I Poster 37 (Abstract 240) Poster 38 (Abstract 144) Theme: Patient Experience: Quantitative/ Patients’ experience of radical Quantifying the impact of Qualitative treatment for mesothelioma: surgical scars following Leaving North School entrance at: 1.10pm the MARS 2 trial anterior lumbar spine Clare Warnock, MSc, BSc, BA, Practice surgery Development Nurse, Weston Park Hospital, Dr Jennie Walker, PhD, RN, PGCert MedEd, Poster 36 (Abstract 110) Specialist Cancer Services, Sheffield Teaching Clinical Educator, Nottingham University Mindfulness in maternity Hospitals NHS Trust, Sheffield, UK Hospitals NHS Trust, Nottingham, UK Karen Lord, England, UK; Angela Tod, Dr Sian Warriner, RM, MSC,DClinPrac, England, UK: Peter Allmark, England, UK; Liz OUH NHS Foundation Trust, John Radclliffe Abstract Darlinson, England, UK Hospital, Oxford, UK Background: The effects of surgical scars Dr Maret Dymond: Oxford UK can be far reaching and life changing for many Abstract women. Understanding and quantifying the Background: Malignant pleural mesothelioma impact of scars is an important aspect of patient Abstract is an aggressive cancer of the lining of the chest management, however, scar size or placement Introduction/Background: The OUHFT wall and lung that is associated with a high is not routinely considered as a prominent maternity service in conjunction with The Uni- mortality (Cao et al, 2014). The Mesothelioma outcome for anterior lumbar spine surgery. versity of Oxford is running a project to evaluate and Radical Surgery 2 (MARS 2) Trial was estab- Methods: A postal questionnaire was sent and research Mindfulness Based Childbirth lished in the UK to evaluate the role of surgery in to 188 women aged ≥18 years of age who had and Parenting courses (MBCP). A traditional mesothelioma treatment by comparing chemo- undergone anterior lumbar spine surgery at Not- MBCP course runs for 3hrs a week over 9 therapy and surgery to chemotherapy alone. tingham University Hospitals NHS Trust. Ques- weeks however; providing the resource for this A nested sub-study was carried out to explore tionnaires were followed up via telephone after approach within a NHS setting is challenging. experiences of trial interventions. two weeks if no response had been received. The Aims/hypotheses: This study explored the Aim: To explore patients’ perspectives of chem- questionnaire included the Patient Scar Assess- feasibility and efficacy of running an adapted otherapy and surgical treatment for malignant ment Questionnaire (PSAQ), a modified Female 4 week MBCP course in a Children’s Centre mesothelioma Sexual Function Index (FSFI), and questions setting. Methods: The study utilised an in-depth relating to urinary and faecal incontinence. Methods: Study participants were self-referrals longitudinal qualitative approach. 14 partici- Descriptive statistics, chi square and Kruskal- to face-to-face MBCP courses based in Oxford- pants were interviewed following randomisa- Wallis tests were used to analyse the data. shire. The intervention was evaluated for adapt- tion to chemotherapy (n=7) or chemotherapy Results: Reported difficulties relating to ability and acceptability and validated measures and surgery (n=7). Additional interviews were surgical scars largely focused on aesthetics and were used pre- and post-intervention. conducted post treatment and at 6 and 12 the impact on quality of life rather than actual Results: Women (n=36) improved signifi- months after the initial interview. Data was scar symptoms. Despite >80% women reporting cantly in perceived stress, anxiety, depression, collected between August 2015 and October the appearance of the scar as ‘excellent’, ‘good’ pregnancy-related distress, labour worry and 2016 and analysed using Framework analysis or ‘okay’, many women reported that their scars positive and negative pregnancy experiences. (Ritchie et al, 2014). were ‘very’ or ‘fairly’ noticeable to others, with Men (n=19) improved significantly in anxiety, Results: Participants described diverse and approximately 1:5 women reporting that they depression and showed a trend for perceived challenging physical, social and psychological were very self-conscious of their scar. A hori- stress. Dispositional mindfulness significantly problems due to their treatment which changed zontal scar would be preferred by the majority increased for both samples. over time. Interventions to manage the conse- group of women, in contrast to the vertical scar which was received by the majority of women. Discussion: The samples of men and women quences of treatment were recounted and the Annotated comments predominantly focused began with different scores at baseline, with support of healthcare staff was appraised posi- around the ease or ability to hide scars as well women averaging high stress and distress and tively. Uncertainty was expressed in relation to as the impact of the scar on body image and on moderate anxiety and depression but men rehabilitation, treatment plans and outcomes. sexual relations. showing a mild average mood. Given their For some this was influenced by the range of differing start points it is significant that both staff involved in their care due to the trial design. Conclusions: Holistic discussions are needed groups should improvements especially as Discussion: Participants’ descriptions of their during pre- and post-operative consultations to research investigating interventions for perinatal experiences of treatment for mesothelioma ascertain women’s ideas, concerns and expec- mental health for men is lacking. provided valuable insights into their impact. tations regarding surgical scars as well as to establish the actual and potential impact of Conclusions: Although there are limitations, Healthcare staff supported coping, however, for surgical scars. this study shows promise for using MBCP some patients trial participation may have led courses to improve mood in prospective parents. to fragmentation of care due to the absence of a single point of contact. Conclusion: The findings highlight the valuable contribution that patients’ perspectives provide in evaluating the impact of trial interventions. The potential impact of trial participation on uncertainty and care fragmentation should be considered.

114 Posters – Friday 7 April 2017

Poster 39 (Abstract 155) Poster tour J Poster 43 (Abstract 267) What factors influence the Theme: Patient Experience: Case Study/ The Christie Patient pathway continuity of care following Trial Recruitment to oncology early phase completion of a clinical trial? Leaving North School entrance at: 1.10pm clinical trials. The role of the A qualitative study of patient advanced nurse practitioner. experiences Lorraine Turner, RGN, BSc, MA (Hons), Poster 40 (Abstract 177) Nicola Johnson, RN BA(Hon) PG Dip, Senior MSc(Hons), Advanced Nurse Practitioner, The Clinical Research Nurse, Guy’s and St Thomas’ Building research Christie NHS Foundation Trust, Manchester, NHS Foundation Trust, Great Maze Pond, partnerships: development UK London, UK Philip Higham, Manchester, UK; Emma Dean, of a pain research Patient Manchester, UK Dr Mary Malone, UK; Dr Jaqualyn Moore, UK and Public Involvement (PPI) Group Abstract Abstract Karl Ward, PG Cert, BSc (Hons), DIP HE, RN, Background: Participation in phase one Background: The need for clinical interven- Pain Management Research Department, clinical trial is a potential treatment option tions to be evidenced based, more efficient Regional centre for Neurosciences, Leeds for patients with advanced cancer. It became and cost effective has led to a rapid increase in Teaching Hospitals, Leeds, UK NHS investment in clinical research. More than apparent at The Christie that patient referrals Mrs Tracey Crowther, Leeds, UK, Dr Helen 618,000 people participated in clinical research were limited from various teams internally and Radford, Leeds, UK during 2014-2015 (NIHR 2016). Research geographically. An audit was undertaken to look suggests that patients decide to participate in at patient referrals to the Phase one team. Abstract clinical research to gain access to individualised Methods: A retrospective audit to collect data care regimes and novel treatments not otherwise Historically Patient and Public Involvement from patients who were referred to the Phase available clinically. For research nurses recruit- (PPI) in research has been underdeveloped. one team from January to December 2012. ing patients to clinical trials, it is important to The inclusion of the public in clinical research is This included patient demographics, distance understand whether enabling access to special- vital as it ensures research is of scientific quality, travelled, referral timelines and outcome of ised care and treatment regimes contribute to value for money and relevant. PPI brings a referral. a positive experience of trial participation. Fur- unique viewpoint of those living with the health conditions being examined to the research Results: Ninety nine patients were referred. thermore, if providing enhanced care and disease The median patient age was 60 years (range, monitoring during study enrolment impacts process. In addition there is increasing demand from ethical and regulatory bodies to evidence 18-79 years), and 52% were male. The majority on patients’ expectations of their ongoing care of patients referred were from clinicians within needs once the trial has completed. PPI involvement in research studies or justification for exclusion. the Christie Hospital (70% medical oncologists; Method: A qualitative methodology was 28% clinical oncologists; 2% surgery). 13% were adopted to explore the lived experience of Based at Leeds Teaching Hospitals, the Pain referred from oncologists within the Greater clinical trial participation, care management Research Group specialises in neuromodula- Manchester Cancer Network and 23% externally. at conclusion and provision of ongoing care tion and persistent pain research. The Group Almost a quarter (24%) of patients travelled over following trial completion. Seven participants submitted a novel study to the HRA who 50 miles to attend the phase one clinic. The mean who had completed a clinical trial at the same requested evidence of PPI involvement. No PPI time taken from referral to patient attending Hospital Trust in the last year were purposively involvement had been sought which identified Phase one clinic was 22 days. The mean number selected. Data were collected via semi-struc- a clinical need to establish a pain PPI group. of days from patient’s last treatment to referral tured, in-depth interviews between July and The Group launched a Pain PPI recruitment was 66 days. 35% of patients were not eligible October 2016. Interviews were recorded and campaign through social media (Facebook/ to participate due to poor performance status fully transcribed verbatim. Interpretative phe- Twitter) and at a neuromodulation public or medical history. 10% of referrals withdrew nomenological analysis was used to develop and engagement event run by colleagues. Invitations interest at first consultation. interpret the findings. were also sent to patients who had expressed interest in clinical research. The campaign was Outcome: The results led to initiatives which Findings: Access to novel treatments and successfully completed in three weeks. the ANP has developed and include a quick and intensive monitoring enabled better disease easy referral proforma for clinicians. This asks control and enhanced trust in the clinical team. Twenty people with diverse experiences of persis- for specific details to reduce length of referral Some participants felt under-prepared for trial tent pain volunteered to join the PPI group from time including inappropriate referrals. Since conclusion due to a fear of losing the close the campaign. A meeting was arranged to foster September 2015 an ANP works between the rapport built up with their research team during collaboration and develop the Group’s research Experimental Cancer Medicine Team (Phase the trial. Participants who maintained contact agenda. Terms of Reference were developed with I) and Breast oncology team to help raise the with their research nurse after trial conclusion the PPI members and 60% (n=12) expressed pref- awareness of early phase research, identify were associated with better post trial outcomes. erence for PPI activities (i.e. review of protocols eligible patients, promote research to patients and participant facing documentation) to be Conclusions: Integration of research nursing as well as members of the MDT; producing a conducted via email due to issues with travel practice into standard clinical care will improve seamless referral process. Within a six month and personal commitments. This was agreed and continuity of care for study participants period the ANP identified 24 patients as incorporated into the Pain PPI Members Terms following clinical trial completion. Further potential candidates for early phase trials from of Reference which will be reviewed annually. research examining strategies to embed a three clinical oncology clinics compared to no research nursing culture within existing clinical Introduction of a PPI group has led to several referrals in 2012. care environments are recommended. independent studies in persistent pain being successfully reviewed. The use of flexible approach to PPI has been shown to be an effective model which has embedded the patient in the centre of our research portfolio, whilst increasing the scientific value.

115 Posters – Friday 7 April 2017

Poster tour K Poster 45 (Abstract 136) Poster 46 (Abstract 179) Theme: Patient Experience: Action Relationships between “I know what to do to help Research/Mixed Methods total amount of sedation myself and I know who Leaving North School entrance at: 1.10pm given in PICU and the risk else can help me”: a mixed of developing ventilator methods memory service associated pneumonia (VAP) evaluation Poster 44 (Abstract 283) Alessandra Centola, NHS Lothian, Royal Shanlee Higgins, BSc Mental Health Nursing, Children’s experiences of Hospital for Sick Children, Edinburgh, UK Mental Health Liaison Nurse/ PhD student, bone marrow transplantation K. Jack, J. McCormick, C. Burney, J. Wilson, Camden and Islington NHS Foundation Trust, - a translational research T. Lo London, UK project for local quality improvement Abstract Abstract Background: An estimated 850,000 people Camilla Duran-Persson, RN, BSc, MRes, Great Introduction: Ventilator associated live with dementia in the UK (Alzheimer’s Ormond Street Hospital NHS Foundation pneumonia (VAP) is a serious acquired infection Society, 2014). Memory services provide Trust, London, UK in intensive care, potentially increasing dementia assessment and treatment; there is Kate Oulton, UK, Katherine Curtis-Tyler, UK morbidity and mortality. Sedation is required for ventilated patients to maintain patient comfort a paucity of research into the post-diagnostic experience of people accessing memory services Abstract and safety of endotracheal tubes but over-sedation may potentially increase the risk of develop- (Willis, et al., 2009). Introduction: In 2015 over 300 children in ing VAP. It is unclear if patients with VAP have This study explores user satisfaction following a Great Britain underwent donor Bone Marrow received more IV sedation in our unit. We aim diagnosis in one London memory service; espe- Transplant (BMT), and with improved therapies to determine if larger total amount of sedation cially relating to the question, ‘Do you know numbers are increasing. It’s a high risk interven- during PICU stay increases patients’ risk of what to do to help yourself and who else can help tion that requires an average of 6-8 weeks hos- developing VAP. you?’ which consistently received low satisfac- pitalisation. Methods: 46 consecutive patients were tion on the service’s quarterly client satisfaction Patient’s views need to be sought in order to included in a prospective observational study questionnaire. inform health services to fit the needs of its in a single PICU. A predesigned proforma was Aims: users. Children’s views are increasingly sought in used to collect data which included total amount order to evaluate the services they use. However, • To investigate reasons for consistently low of sedation (IV morphine and midazolam) given except for two recent studies, from the USA and levels of satisfaction in relation to the area pre- during PICU, physiological data, durations Iran, little research has been undertaken on the viously mentioned. of PICU stay and mechanical ventilation, and topic of children’s experiences of BMT. • To gain an understanding of the needs of evidence of VAP. Non-parametric tests were patients and carers who have contact with the The study was undertaken to explore children’s employed to determine statistical significance. experiences of BMT for local quality improve- service. Results: 11 of the 46 patients studied fulfilled ments, and to add knowledge from a UK centre. • To develop a change in the way the service the diagnostic criteria for VAP. Patients with This presentation aims to share our experiences. addresses patient’s needs. VAP had significantly longer duration of Methods: A qualitative approach was adopted. mechanical ventilation and PICU stay (p < 0.05, • To elicit staff experience of post-diagnostic Semi-structured interviews were undertaken Mann Whitney U test). Median total amount of support and identify any barriers to enabling using play, photo-elicitation and drawing. morphine given were 1.6 and 2.6 mg/kg respec- patients and carers to self-manage. Dyadic interviews were conducted with parents. tively in patients with and without VAP (p=NS). Methods: Qualitative, semi-structured inter- Data collection took place between May-August Median total amount of midazolam given were views with 11 service users, transcribed and 2015 during the children’s hospitalisation. 15.1 and 14.5 mg/kg in patients with or without analysed using thematic analysis. 5 children and 5 parents took part. All children VAP p=NS). Quantitative questionnaires with staff members were boys, aged between 5-12 years. Data was Conclusion: VAP causes prolonged duration involved in post-diagnostic follow-up analysed analysed using a thematic approach. of mechanical ventilation and PICU stay, but using descriptive statistics. Results: Children and parents reported difficult the total amount of IV sedation given in PICU Results: Six themes were discovered from experiences relating to the specific treatments and did not differ between patients with or without the semi-structured interviews. Seven out of a cares. However, they also shared a hope that the evidence of VAP. A larger study is required to possible 10 staff members returned their ques- BMT would help them get better. Children demon- validate this finding. tionnaire. strated a range of ways to help them get through. Discussion: The participants agreed with Areas for local quality improvements were the statement mentioned above, the discus- suggested regarding play, isolation and restric- sions about this enable us to understand which tions, food, medication and the environment. aspects of self-management are important for During dissemination and implementation play people who agree with the statement. This may was identified as a priority for improvement. A be useful to identify the information that those further exploration into children’s specific needs who disagree with the statement would find for play during their BMT has resulted in recom- useful. Staff were confident delivering post-diag- mendations regarding play provision and nostic support but felt some elements were not Conclusion: This study demonstrates the fea- part of their job role. sibility and value of involving children to inform Conclusions: People with dementia can take the services provided to them. It also provides part in qualitative research, nurses are ideally an example of how translational research can placed to conduct this research, given their skills be applied in a local setting for quality improve- and ability to engage with this group and their ment. families.

116 Posters – Friday 7 April 2017

Poster tour L Conclusions: This study is the first to explore Poster 49 (Abstract 236) the experiences of carers providing BABC to pal- Theme: Education Mixed methods/ liative patients. These findings have implications Exploring the impact that evaluation for how nurses see carers and the support and the identification with the guidance offered. Leaving North School entrance at: 1.10pm patient’s symptoms has on nursing students’ quality of life Poster 47 (Abstract 19) Poster 48 (Abstract 23) Mrs Agni Nakou, BSc, MSc, Nurse, Ioannina “It is what it is”: How General Hospital “G.hatzikostas”, Greece Evaluation of Peripherally informal carers experience Stefanos Mantzoukas, Greece; Evangelia Inserted Central Catheter providing bladder and bowel Kotrsotsiou, Greece; Chryssi Hatzoglou, (PICC) care training Greece; Konstantinos Letsios, Greece; and care to palliative patients programme to improve Mary Gouva, Greece compared with palliative clinical skills and knowledge community nursing staffs’ in an Integrated Care Abstract perception of that experience: Organisation (ICO). Introduction: Nursing students during their a qualitative two-phase study. Ash Purran, RN, Whittington Health NHS, practice placement education are often influ- Sarah Combes, RN, BSc (Hons), King’s College London, UK enced by the incidences they participate in London, London, UK caring for. This can in cases go beyond empathis- Dr Sue Woodward, London, UK; Professor ing with patient needs to the point that students Abstract Christine Norton, London, UK exhibit similar symptoms with those of the In April 2011 the trust became an Integrated patients’ and may believe that they themselves Care Organisation (ICO). Integrated care is suffer from the same illness as their patients. Abstract the process where organisations merge their Aim: To investigate the effect that the empa- Background: Around 90% of palliative patients services and virtual integration, allowing thising process with the patient has on nursing spend their final year in the community. Approx- providers to work together through networks students and the impact this has on students’ imately 55% of their care is provided by informal and alliances (Hamm and Curry, 2011). Evidence quality of life. carers. One element is bladder and bowel care indicates that the benefits of the Transforming Methods: Quantitative random sampling (BABC) which most palliative patients require Community Services programme will be realised method was used. A total of 200 3rd and 4th at some point. However, BABC can be difficult only if organisational integration is used to year nursing students at the Higher Educational for patients and carers and there is a paucity of promote clinical and service integration (Hamm Institute of the TEI of Epirus, Greece during research about carers providing it. and Curry, 2011). To deliver the ICO’s strategy 2016 took part. Questionnaire on identifications Aims: To explore carer’s experiences of requires a flexible workforce with variable skill and the SF-36 quality of life scale were used. providing BABC to palliative patients, and how mix in all care settings. In order to achieve its Descriptive and inferential statistics analysis they make sense and meaning of these. The strategy the organisation has to ensure education was performed. views of palliative community nursing staff were and training is maintained to support safe, high explored to facilitate deeper understanding. quality care that demonstrates value for money, Results: The great majority of student partici- promotes flexibility and widens participation pants were identified to empathise with patients Method: A two-phase qualitative design, with with its expansion of services. to the point that they themselves exhibited data collected during May and June 2016: patients’ symptoms or even a false perception Following integration, it was observed that since Phase one Interpretative phenomenological that they suffered the same conditions as the the merging and expansion of the organisation’s analysis of semi-structured interviews with patients they cared for. acute and community services, the nursing carers purposively selected from the community workforce were dealing more with patients Discussion: Students’ direct contact with real service of a London hospice having long-term therapy through a PICC. At the life patients in the practice placement often leads Phase two Thematic analysis, following Braun same time it was also noted that the rate of PICC students to a false perception of illness which is and Clarke, of a focus group of nurses selected related complications had increased. A lack of correlated to student mental distress and con- from the same study site. Predefined criteria training and awareness were identified as the sequently negatively impacts on the students’ ensured sample breadth major issues as those factors were causing PICC sense of well-being and quality of life with mani- Results: Phase one: Five interviews with complications and an increase in admission rate. festations of bodily pain, physical and mental mothers of terminally ill daughters were The gap in knowledge and poor practice were ill-health and delimitations of social functioning analysed. One overarching theme, It is what it causing discomfort to patients and their relatives capacities. is, and three superordinate themes emerged: and financial pressure on the organisation. Conclusion: The above state impacts on Whatever my daughter needs, Mum knows best, This project describes the evaluation of a new student well-being and quality of life, and una- Coping with caring. PICC training programme that was developed voidably affects their learning potential and per- Phase two: Six participants attended. Three and implemented to fill in the gap. The outcome ceptions about the nursing profession. Finally, themes emerged: It’s not normal, BABC is a huge and findings of the evaluation will provide the supportive mechanisms such as debriefing after challenge, Even for us it’s not simple. ICO with information to reflect on and for devel- significant incidences in practice placement and reflective sessions at the end of each week can Discussion: Differences were identified oping other potential training needs that might function as supportive mechanisms in main- between the views of carers and nurses. Nurses arise in the future to facilitate integration of care. taining student well-being, increasing levels of saw BABC as abnormal and best when carried learning and creating a sense of satisfaction for out by professionals. While carers agreed BABC being part of the nursing profession. could be challenging, situated within the context of their daughter’s disease it was not a major concern. Instead it engendered closeness and the opportunity to provide better care than most felt professionals could.

117 Posters – Friday 7 April 2017

Poster 50 (Abstract 137) Poster tour M Poster 52 (Abstract 260) Effectiveness of targeted Theme: Education: Qualitative Strategies for communicating intensive training on with young people with bone Leaving North School entrance at: 1.10pm improving the accuracy cancer about clinical trial of sedation boluses participation Poster 51 (Abstract 225) documentation in PICU Dr Verna Lavender, PhD, PGCTHE, Stacey Orr, Degree in child health, NHS ‘Postgraduate nursing BSC(Hons), RGN, Oxford Brookes University, Lothian, Royal Hospital for Sick Children, education in Nigeria: Oxford, UK Edinburgh, UK understanding students’ Faith Gibson, UK; Alexandra Brownsdon, UK; Lorna Fern, UK: Jeremy Whelan, UK: and A. Centola; C. Burney; K. Jack; J. McCormick; journeys to programme J Wilson; T. Lo. All Scotland Susie Pearce, UK completion or withdrawal’. Simon Onwe, MSc, BSc, RN, University Abstract Abstract Lecturer, Queen Margaret University, Post Background: Sedation boluses are given to Graduate School Edinburgh, Edinburgh, UK Background: Poor accrual to bone sarcoma achieve optimal sedation, comfort, and safety in clinical trials is related to limited improvements David Banks, Scotland; Philippa Derrington, paediatric ventilated patients. We have demon- in survival. Low recruitment of teenagers and Scotland; Lindesay Irvine, Scotland. strated poor documentation of sedation boluses young adults in cancer clinical trials is widely given in our study. reported, but limited research has explored reasons for this. Pearce and colleagues (2016) Aim: We aim to determine the effectiveness Abstract described the importance of forming trusting of targeted intensive training on improving the Nigerian nursing education grew from initially relationships between young people and health accuracy of sedation bolus documentation in the limited numbers of missionary establishments professionals to facilitate communication about short and medium term post-training. to a more substantial expansion of urban participation in bone cancer clinical trials. Method: A pre-designed electronic proforma hospital based schools from 1945. Post colonial Aims: We sought to explore strategies described on the clinical information system (CIS) was emancipation sparked the University of Ibadan by health professionals that promote trusting used to collect data on the total amount of into opening the first Department of Nursing in relationships when communicating with young sedation boluses delivered per patient and Nigeria in 1965 (NDATSU, 2004). This stimu- people regarding participation in two bone whether the sedation boluses were documented lated the creation of further university based cancer clinical trials, EURAMOS-1 and Euro- during a two week period randomly selected undergraduate programmes across Nigeria, Ewing’s-99. by our nursing audit/research team. Teaching though many hospital nursing schools offering materials on how to check and sign for sedation diploma level training were retained to the end Methods: This study used narrative inquiry. boluses including standardised guidelines were of the twentieth century. In-depth interviews were conducted with delivered to all nursing staff on PICU during the The first postgraduate nursing programme eighteen health professionals between November targeted intensive training weeks. The audit was commenced in 1988 at the Obafemi Awolowo 2011 and February 2012 at a supra regional bone repeated 1 and 6 months after the completion of University, Osun State. The University of Ibadan and soft tissue sarcoma centre, which was also targeted intensive training using the same pre- in Oyo State and the University of Nigeria, a teenage and young adult principal treatment designed electronic proforma to assess its effec- Nsukka in Enugu State started their own post- centre. Findings reported here arise from tiveness in improving documentation. graduate courses in 1996 and 2003 respectively. thematic analysis of interview transcripts. Result: In the initial audit, only 20% of all These three universities remain the only post- Results: Strategies used by health professionals sedation boluses delivered were documented on graduate nursing education providers in Nigeria to develop trust-based relationships with young the CIS during the 2-week audit period. Re-audit for a population of approximately 180 million people included: having credibility through following targeted intensive training demon- people; they are therefore significant players expertise of the team; developing communica- strated a significant improvement in sedation in developing nursing practice and research tion skills through reflecting on practice; having boluses documentation with 80% and 99% at 1 in Anglophone Western Africa (NMCN, 2012). inclusive approaches to education and training; and 6 months post-training respectively. Nonetheless, Government and professional finding commonalities with the young people; stakeholders, including the Nigerian Nursing creating time needed to form trusting relation- Conclusion: Targeted intensive training with and Midwifery Council, are concerned by the ships; and effective team working. standardised teaching materials tailored to low graduation rate of these students (10%), and Discussion: We developed a diagrammatic the need of our unit was highly successful in their relatively high rate of attrition (20%). improving sedation boluses documentation in framework that aligned our findings with the short and medium term, thereby enhancing This paper reports on the experiences of those four characteristics of patient-physician trust patient safety. postgraduate nursing students. Other partici- described by Hillen and colleagues (2011): pants included lecturers and staff of nursing perceptions of technical competence, patient- education coordinating bodies. They were centred communication, and honesty, and the recruited to this study purposively and by snow- organisation of clinical services. Our findings balling. The research method used was qualita- have the scope to be transferred to other contexts tive inquiry utilizing face-to-face interviews, the of clinical trial recruitment adding to knowledge methodology being guided by a critical realist about how information can be effectively com- perspective with regard to agency and structure municated as part of the trial recruitment and (Maxwell, 2012). enrolment process (Freyer et al, 2015). The paper will expand on key findings which Conclusions: This study provides in-depth reveal that students’ experiences of delay in insight of strategies used by health professionals graduation hinge on students-factors (full- to build trusting patient-professional relation- time workers/full-time students), lecturers- ships to communicate with young people about factors (workload and mentoring), policy issues bone cancer clinical trial participation. (programme structure and implementation), and social structures and mechanisms in Nigeria.

118 Posters – Friday 7 April 2017

Poster 53 (Abstract 43) Poster 54 (Abstract 265) Poster tour N Evaluating the use of High Fidelity Silicone Patient Theme: Education: Action research/ reflective analysis and peer Simulation [HFSPS] (Mask evaluation review in a Doctor of Nursing ED TM KRS): confidence Leaving North School entrance at: 1.10pm Practice (DNP) online competence and decision program making in first year student Poster 55 (Abstract 141) Dr Michelle Beauchesne, DNSc, RN, CPNP, nurses FAAN, Northeastern University, Boston, Dr Allison Wiseman, RGN, ENB 100, D. Clin The development and United States of America Practice, MSc, BSc, Senior Teaching Fellow, evaluation of a stress School of Health Sciences, University of Surrey, management program for Abstract Guildford, UK undergraduate nursing Background: The American Association of students in Hong Kong Colleges of Nursing (AACN) asserts that nursing Abstract King Yin Wong, The Chinese University of requires both practice experts and nurse scien- Aim: Evaluation of HFSPS on healthcare Hong Kong, Hong Kong, China tists to achieve quality patient care outcomes. students’ confidence, competence and decision Graduates of Doctor of Nursing Practice (DNP) making Dr Chau P.C., Hong Kong, China programs, which prepare nurses at the highest Background: Healthcare students need level of practice inquiry, need competencies in opportunity to develop their confidence and Abstract analysis and critical appraisal to determine the competence in supportive learning environ- Background and Aims: Stress among best practice evidence. With the proliferation of ments, using different levels of simulation such nursing students is a global problem. Perceived online education formats, it remains a struggle to as High Fidelity Patient Simulation (HFPS) stress among them would lead to detrimental replicate the intimate seminar format essential (Lasater, 2007; Wolf, 2008). Students may find consequences on health, clinical learning, and to engaging students in scholarly discourse. immersing themselves in simulated learning performance. Evidence suggested that many Purpose and goal: The purposes of this study problematic due to a lack of realism and inter- students tend to adopt avoidance strategies and were 1) to conduct an in-depth evaluation of the personal interaction. One solution may be High the most effective stress management program introduction to reflection and peer review as a Fidelity Patient Silicone Simulation [HFPSS], remained doubtful. The aims of the study are credible pedagogy used to transform an online Kable, Levatt-Jones, Reid-Searl,(2013)highlight to: (1) evaluate the effectiveness of stress man- discussion board into an interactive group its potential for assisting students to immerse agement program for nursing students and (2) dialogue; and 2) to assess its contribution to and transfer their professional skills and develop an evidence-based stress management DNP students’ competency development of knowledge between different learning environ- program for nursing students in Hong Kong. analysis and critical appraisal. ments and contexts. HFSPS permits dynamic, unscripted learning activities facilitated by the Methods: Literature were searched in seven Conceptual Framework: Freire’s student databases with 12 relevant studies identified. One centered approach to learning is used within an educator behind the masked character. This creates a platform for realistic patient encoun- is systematic review, three randomized control online hybrid delivery format. Reflective writing trials and eight quasi-experimental studies. is a documented means to assist students to ters where students link theory to practice, reflecting in and on action. There is strong evidence related to the use of analyze and critically appraise selected issues relaxation therapy, with breathing exercise the aimed toward accomplishing specific learning Methods: Quantitative descriptive study most common. Several studies report therapies outcomes. evaluating students’ perceptions of HFSPS. including spiritual learning program, mindful- Methodology: Three DNP student cohorts 90 first year student nurses participated in3 ness based stress reducing program, cognitive (n=74, 92.5%response rate) who completed Year clinical encounters with the HFSPS during their behavioural training, and hardiness education 1 of study participated in a 15-minute web-based simulated clinical learning. Semi-structured intervention can help significantly reduce stress survey. The survey, consisting of five open-ended questionnaires exploring the influence HFSPS among nursing students. The systematic review questions, focused on an in-depth reflective had on students’ confidence, competence and recommended the combination of breathing evaluation of the students’ experience in relation decision making and the authenticity of HFSPS. exercise and cognitive behavioural training to the pedagogy of reflection and peer review. Results: 84% of participants positively would be the most beneficial in stress manage- Participation was not connected to grades or perceived their HFSPS encounters. 16% of par- ment program. However, some studies are at a credits. There is no intended follow-up. The ticipants negatively viewed the encounters. higher risk of gender bias, low feasibilities and faculty project team completed content analysis Free form comments indicated these students weak generalizability. of responses to identify themes until saturation. found interacting with simulators problem- Results: This presentation will cover the con- This project was determined quality improve- atic. Students felt their confidence, competence struction of a stress management program ment by the university ethical review board. and decision making skills were significantly based on best available research evidence. The Implications for Curricular Development: An increased following their HFSPS encounters due program consists of eight two-hour sessions analysis of strengths and weaknesses from the to the authenticity and interaction. including face to face lecture on stress, practice perspective of these students assists in curricu- Discussion: This study highlights its potential of breathing exercise, group discussion with lar refinement and provides data to develop and for enhancing the realism of simulated patient reflection of cognitive behaviour training, enhance future directions in competency-based encounters without the need for scripted and formulate individual stress management online education. encounters required by simulated patients plan. Perceived Stress Scale, Stress in Nursing (actors). It facilitates two way interactions with Students and General Self-Efficacy Scale will be the HFSPS characters, whereby educators use used to compare the outcomes before and after their expertise to deliver dynamic and spontane- the program. ous learning events. Conclusions: The evidence-based stress man- Conclusion: HFSPS is an emerging technology agement program aims at reducing stress and that requires larger UK evaluation studies. It has enhancing their confidence in managing stress. the potential to enhance simulated learning not It is expected that students will have improved replace current simulation technology.

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confidence and competency in managing stress, Poster 57 (Abstract 72) Poster tour Q higher capability to stay calm, and greater public health influence afterwards. Achieving ‘Linchpin’ Theme: Late Breaking Abstracts effectiveness in clinical Leaving North School entrance at: 13.10 research nursing practices Poster 56 (Abstract 135) Jessica Taylor, Nursing Diploma/BSC Acute Care, Research Sister, Addenbrookes Clinical Poster 69 (Abstract 312) Improving effectiveness in Research Centre, ED nurses’ perceptions managing high-resolution NIHR/Wellcome Trust Clinical Research and understanding of older clinical data for both clinical Facility, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital people’s dignity and research use: a Scottish Cambridge Biomedical Campus, Cambridge, Bhupinder Pawar, MSc, BA, PGCE, DipHE, PICU’s perspective UK RN, Faculty of health and life sciences, Alessandra Centola, NHS Lothian, Royal Caroline Saunders England, UK Nursing and Midwifery, Coventry University, Hospital for Sick Children, Edinburgh, UK Coventry, UK S. Orr, K. Jack, J. McCormick, C.Burney, Abstract L.Reekie, J.Richardson, J. Wilson, J, Abstract McCormack, T,lo The perception that research nurses are ‘linchpins’ is not a novel theory (Bradshaw, Background: A number of high profile reports 2010; Pick, 2011). Nevertheless, compari- in the last two decades have highlighted the Abstract son of clinical research nurses (CRNs) to the importance of maintaining the dignified care of Introduction: Electronic clinical-information- written account for a linchpin provides a unique older people in all health care settings. In the system (CIS) collects accurate physiological and concept. A ‘linchpin’ by definition is a ‘fastener UK, the emergency department (ED) provides clinical data to guide clinical management and used to prevent a wheel from sliding off the axle preliminary care and treatment to a wide range provides a valuable high-resolution data source upon which it is riding’ or ‘Something/Someone of older patients and for many of these, this is for quality assurance and clinical research. If that holds the various elements of a complicated the start of their health care journey. In line research and clinical data management teams structure together’. This classification provided with all health care settings, nurses are, and will work independently, prospective research data the ideology behind the phenomenon that CRNs continue to be, the main providers of care in the collection and retrospective analyses of the high- are this ‘linchpin’, since not only are they the ED. resolution clinical data for research and quality supporting mechanism for a continually moving Aim: The experiences of ED nurses caring for assurance can be time consuming. We aim to wheel, the research facility; but they are that older patients were explored to discover their demonstrate the effectiveness in managing high- integral centre piece between both participant perceptions and understanding of dignity and resolution clinical data for research and quality and investigator. the factors that can facilitate or hinder dignified assurance through close collaboration between This ‘CRNs are Linchpins’ philosophy enabled care within the emergency care setting. our research and clinical data management for the rationalisation for a CPD tool in the Methods: Ten ED nurses in one teaching teams. form of a simple board game. To play the game, hospital were interviewed in depth in a qualita- Methods: Our research team predefined their players spin a spinner to land on 1 of 5 priorities: tive study, guided by a descriptive phenomenol- data requirement (e.g. the total amount of self-awareness, leadership, teamwork, education ogy methodology. boluses of intravenous sedation given in each and patient advocate. On landing on the priori- Results and discussion: The findings showed patient) and discussed this requirement with the ties, the players then verbalise why they feel it is that ED nurses viewed older patients’ dignity as clinical data management team which consists a priority for the ‘Linchpin’. The aim of the game inherent to autonomy. Dignity was described as of a data manager, a senior charge nurse and is to promote research nurse awareness on the seeing and treating the older person as an indi- a senior critical-care physician (consultant/ key elements required to achieve ‘linchpin’ effec- vidual human being. The ED was described as a staff physician level). The data management tiveness, to ultimately support both participants complex care environment; lack of privacy, poor team then developed a real-time data collection and investigators robustly. staffing levels, pressures of meeting specific algorithm drawing the relevant automated data The linchpin concept and game was presented government targets and nursing patients in within the CIS. The research team then checked on a unit team day within a NIHR/Wellcome corridors were considered factors hindering the data generated fulfilled their requirement Trust Clinical Research Facility. CRNs who took dignified care. prior to using the custom-design data collection part (n=7). Feedback was very positive and the Conclusion: The study showed that ED nurses tool in their projects. aim going forward is to use the game to prepare knew and understood what comprises dignified Results: Custom-designed data collection junior CRNs as they make the transition into care. However, the pressures of the complex ED algorithm for quantifying total IV sedation more senior CRN roles. environment prevented them from delivering boluses was successfully developed offline from The ability to successfully enforce ‘linchpin’ pri- this care. data of 10 patients in our PICU. The algorithm orities upon CRNs is vital for individual empow- was then validated online in 10 consecutive erment, development as well as for service patients by the research team before using it live improvement. The significance of the need for in research projects. such CPD game is evidently a transferable phe- Conclusion: Close collaboration between nomenon that requires further investigation if it research and clinical data management teams is to be proposed for mainstream CRN develop- enables custom design of real-time prospective ment. research data collection and time-efficient retrospective analyses of clinical data for research and quality assurance. K. Jack, J. McCormick, C. Burney, L. Reekie, J. Richardson, J. Wilson, J. McCormack, T. Lo

120 Posters – Friday 7 April 2017

Poster 71 (Abstract 324) Poster 72 (Abstract 310) Poster 33 (Abstract 111) Reflections on a rapid Reflections on working Mindfulness for midwives evidence assessment to with an interpreter when Dr Sian Warriner, RM, MSC,DClinPrac, inform standards of nursing conducting qualitative OUH NHS Foundation Trust, John Radclliffe practice in-depth interviews Hospital Oxford, Oxford, UK Lynne Currie, BSc (Hons) Dip Soc Sci, Debbie Chagadama, RGN; BSc; MSc; PhD Dr L Hunter: Oxford, UK Research Analyst, Royal College Nursing, student, Lead Nurse, Barts Health NHS Trust, London, UK Department of Rheumatology, Mile End Abstract Dr Anda Bayliss, UK Hospital, London, UK Background: As part of a larger project to engage staff in personal and workplace wellbeing Abstract Abstract the maternity services provided staff with the opportunity to learn the practice of mindfulness REAs provide an assessment of what is already Background/Context: This paper will provide a reflective review of the experience meditation. Evaluations carried out immediately known about an issue or topic by using sys- post-course and after 4-6 months indicated a tematic review methods to search and critically of conducting qualitative in-depth interviews through an interpreter, with Bangladeshi people positive impact in both personal and organisa- appraise available research evidence. REAs aim tional domains. to be rigorous, explicit and systematic, but com- who are living with Ankylosing Spondylitis. The promises are often necessary through limiting complexities of using interpreters in research Objective: An 8-week course was made particular aspects of the systematic review (Edwards 1998) have often led to the exclusion of available with the intention of supporting staff process. How quickly this happens will depend people whose preferred language is not English. to manage stress and anxiety, increase resilience on how quickly the assessment is required, the However, there is little guidance available on and self-compassion, and improve the culture of resources available and the extent to which the working with interpreters when conducting the organisation as a whole. review team are prepared to limit the systematic research interviews (Squires 2008). I had no Method: The ‘Frantic World’ course is designed review process. All compromises made during previous experience of this process and being for non-clinical groups, providing an introduc- the process must be justified. from an ethnic minority background (though a tion to mindfulness. Participants learn formal different one from the participants), I was aware Undertaking an REA requires dealing pragmati- and informal meditation practices enabling there are not always equivalent words between cally with the messiness of real life evidence not them to examine the way they think and feel languages. I was also concerned about feeling least the financial and time constraints applied about experiences, increase engagement with a lack of control in the interview. According but also dealing with particularly tricky situ- the present, allowing for a clearer understanding to Kvale (1996: 147) the ‘interviewer is him or ations that may arise when research evidence of how thoughts and emotions impact on health herself the research instrument’, therefore the does not make it through the sifting process. and quality of life. interpreter’s role needs consideration too. Additional considerations include the availabil- Evaluation: Immediately post-course, par- Preparation and process: The same Bengali ity of review expertise, lack of clarity regarding ticipants were invited to evaluate the course; interpreter assisted throughout and she had the purpose, scope and review questions, response rate 79% (n=34). Participants were previous experience of conducting research inter- agreeing the search strategy in relation to invited to complete a follow-up questionnaire views as a health advocate in a community social inclusion and exclusion criteria, sifting, quality 4-6 months after attending the course; response work team. The preparation included selection assessment tools for quantitative and qualita- rate of 53% (n=23). of the interpreter, building a relationship with tive research evidence, data extraction; limited Outcomes: Participants reported benefit in the interpreter, clarifying the interpreter’s role, access to databases, synthesis and writing up, home life (87%) work-life (91%) and the culture agreeing the style of interpretation (active or external review prior to publication and the of their work place (59%). Participants reported passive), training and preparation for the inter- strategy for dissemination. a sustained positive impact on stress (83%), preter, practicalities (e.g. seating arrangements anxiety (68%), resilience (70%), self-compas- The example of an REA carried out during 2016 during the interview) and agreeing the process sion (74%) and mindfulness (91%). will be used to highlight the key stages of decision for reflection. All study documents including the making in an assessment of evidence related to interview topic guide were translated to Bengali Conclusion: This project has demonstrated infusion therapy, which was undertaken in three and the interpreter found them clear and easy to that investing in mindfulness and staff wellbeing concurrent stages. These stages include commis- use. Reflective review following each interview has been beneficial on an individual, organi- sioning the review of Randomised Control Trials allowed the interpreter to raise any difficulties sational and cultural level. Future qualitative and Systematic Review evidence to an external in translation, identify any other problems and research is planned to explore the impact that organisation; a review of other non-RCT designs consider solutions. midwives perceive mindfulness has on their about infusion therapy nursing practice, and practice in more detail. Conclusion: Despite the complexities of inter- a review of the patient perspective of infusion viewing with an interpreter, I collected rich and therapy. meaningful data and therefore interpreters can be seen as active partners with the researcher working together with the interpreter as the research instrument.

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