The South West Clinical School model: an initiative to transform clinical academic career pathways.

Background: The Clinical School Model connects professorial staff from the university directly to practitioners in the National Health Service to promote evidence informed practice and develop clinical academic careers. These are promoted widely, but strategic adoption into organisational culture and workforce plans are challenging to overcome. Aims: To describe the development of the Clinical School Model in Cornwall and explore how it generates impact through staff engagement activities to support clinical academic career pathways. Structure, process and outcomes developments over the last 3-years are reported. Methods: Donabedian's framework (structure, process and outcome) was used to report on the development and impact of the Clinical School Model. Results: Structural and process activities are reported, illustrating strong foundations to embed clinical academic career pathway opportunities. In the absence of empirical reporting standards for such developments, quantitative and qualitative outcomes are reported against the Clinical School's 5-year strategic plan. Conclusions: This paper responds to the lack of reported evidence on developing organisational infrastructure to address the clinical academics aspirations of nurses and their employers. This important contribution leads a call for more organisations to report to the evidence base, enabling shared learning and shaping future research.

Challenges and improvements associated with transitions between hospitals and care homes during the COVID-19 pandemic: a qualitative study with care home and healthcare staff in England.

BACKGROUND: Care home residents transitioning from hospital are at risk of receiving poor-quality care with their safety being challenged by the SARS-CoV-2 virus (COVID-19) pandemic. Little is known about how care home staff worked with hospital staff and other healthcare professionals to address these challenges and make improvements to increase patient safety. OBJECTIVE: To gain insight into how the COVID-19 pandemic influenced the safety of transitions between hospital and care home. METHOD: Semi-structured interviews were conducted with care home staff and healthcare professionals involved in hospital to care home transitions including doctors, nurses, paramedics, pharmacists, social workers, and occupational therapists. Commonalities and patterns in the data were identified using thematic analysis. RESULTS: Seventy participants were interviewed. Three themes were developed, first, 'new challenges', described care homes were pressurised to receive hospital patients amidst issues with COVID-19 testing, changes to working practices and contentious media attention, which all impacted staff negatively. Second, 'dehumanisation' described how care home residents were treated, being isolated from others amounted to feelings of being imprisoned, caused fear and engendered negative reactions from families. Third, 'better ways of working' described how health and social care workers developed relationships that improved integration and confidence and benefited care provision. CONCLUSION: The COVID-19 pandemic contributed to and compounded high-risk hospital-to-care home discharges. Government policy failed to support care homes. Rapid discharge objectives exposed a myriad of infection control issues causing inhumane conditions for care home residents. However, staff involved in transitions continued to provide and improve upon care provision.

Characteristics of natural environment use by occupational therapists working in mental health: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify and characterize the use of the natural environment/outdoor space by occupational therapists working in mental health care. INTRODUCTION: Research has shown that the natural environment is beneficial for our health and can be used to help people who are experiencing mental health problems. Occupational therapists are well placed to assess and utilize the environment when treating people with mental health problems; however, the use of the natural environment/outdoor space by occupational therapists working in mental health is unclear. INCLUSION CRITERIA: This scoping review will include both primary research and gray literature relating to the use of the natural environment/outdoor space in mental health occupational therapy practice. The review will be limited to studies published in English. There will be no geographical or age restrictions. METHODS: Embase (Ovid), MEDLINE (Ovid), CINAHL (EBSCO), PsycINFO (ProQuest), AMED (EBSCO), Trip Database, Emcare (Ovid), and OTSeeker will be searched for studies. Unpublished studies and gray literature will be searched using GreyNet and National Grey Literature Collection, alongside professional magazines and websites. Titles and abstracts will be screened by 2 independent reviewers for assessment against the inclusion criteria, followed by a full-text review and data extraction. Any disagreements will be discussed with a third reviewer. Data will be extracted using a data extraction tool developed by the reviewers, and presented in tabular format, accompanied by a narrative summary describing how the results relate to the review objective and question.

The meaning of confidence from the perspective of older people living with frailty: a conceptual void within intermediate care services.

BACKGROUND: Confidence is a cornerstone concept within health and social care's intermediate care policy in the UK for a population of older people living with frailty. However, these intermediate care services delivering the policy, tasked to promote and build confidence, do so within an evidence vacuum. OBJECTIVES: To explore the meaning of confidence as seen through the lens of older people living with frailty and to re-evaluate current literature-based conceptual understanding. DESIGN: A phenomenological study was undertaken to bring real world lived-experience meaning to the concept of confidence. METHODS: Seventeen individual face-to-face interviews with older people living with frailty were undertaken and the data analysed using van Manen's approach to phenomenology. RESULTS: Four themes are identified, informing a new conceptual model of confidence. This concept consists of four unique but interdependent dimensions. The four dimensions are: social connections, fear, independence and control. Each is ever-present in the confidence experience of the older person living with frailty. For each dimension, identifiable confidence eroding and enabling factors were recognised and are presented to promote aging well and personal resilience opportunities, giving chance to reduce the impact of vulnerability and frailty. CONCLUSIONS: This new and unique understanding of confidence provides a much needed evidence-base for services commissioned to promote and build confidence. It provides greater understanding and clarity to deliver these ambitions to an older population, progressing along the heath-frailty continuum. Empirical referents are required to quantify the concept's impact in future interventional studies.

Implementing online patient feedback in a 'special measures' acute hospital: A case study using Normalisation Process Theory.

OBJECTIVE: Online patient feedback is becoming increasingly prevalent on an international scale. However, limited research has explored how healthcare organisations implement such feedback. This research sought to explore how an acute hospital, recently placed into 'special measures' by a regulatory body implemented online feedback to support its improvement journey. METHODS: Semi-structured interviews were conducted with eleven key stakeholders involved in the implementation and/or use of online patient feedback. Data was analysed using deductive thematic analysis with Normalisation Process Theory used as the analytical framework. Research findings are translated into the Engage, Support and Promote (ESP) model, a model of rapid feedback adoption. RESULTS: Participants viewed the implementation of online feedback as an opportunity to learn, change and improve. Factors found to facilitate implementation were often linked to engagement, support and promotion. Although less frequently described, barriers to implementation included staff anxieties about time pressures, moderation processes and responding responsibilities. Such anxieties were often addressed by activities including the provision of evidence based responder training. Overall, staff were overwhelmingly positive about the value of online feedback with 24 impacts identified at an individual and organisational level, including the ability to boost staff morale, resilience and pride. CONCLUSIONS: The rapid implementation of online patient feedback can be achieved in a 'special measures' organisation. However, the difficulties of implementing such feedback should not be underestimated. In order to embed online feedback, staff members need to be engaged and feel supported, with opportunities to provide, respond and invite patient feedback frequently promoted to both patients and staff members.

Strengthening quality assurance by implementing an evidence-based revision of a ward accreditation programme.

Ward accreditation is fundamental in contemporary healthcare delivery. One NHS trust in southwest England that had been placed in special measures introduced a ward accreditation programme - known as the ASPIRE programme - but the trust's senior nursing leadership team raised concerns about the level of quality assurance provided. Therefore, the trust revised its newly created ward accreditation programme, referring to the evidence base to re-evaluate the metrics used for assessment. Five new elements, including direct registered nurse care time and ward climate, were introduced in the accreditation process. The revision improved confidence in the quality assurance provided by the programme, which became central to the trust's overall improvement plans.

Effectiveness of nurse-coordinated, person-centered comprehensive assessment on improving quality of life of community-dwelling, frail older people: a systematic review protocol.

OBJECTIVE: The objective of this systematic review is to determine the effectiveness of nurse-coordinated, person-centered comprehensive assessment on improving quality of life of community-dwelling, frail older people. INTRODUCTION: There is a growing need to meet the challenges of the increasingly frail and older population, and to provide proactive, holistic care close to home. A standardized assessment and care planning intervention could be implemented in primary care, which could be delivered by a primary or community healthcare nurse to address these challenges. However, it is not yet clear if an assessment and care planning intervention will improve outcomes for patients, such as quality of life. INCLUSION CRITERIA: This review will consider studies that evaluate nurse-coordinated, person-centered, comprehensive assessment delivered in partnership with community-dwelling, frail older people, and will compare the intervention to usual care. Studies that include people aged 60 years and older living at home or in supported living accommodation with a recognized level of frailty as assessed by use of frailty screening or assessment tools, will be considered. Studies that include outcomes of health-related quality of life, social functioning, and well-being will also be considered. METHODS: An initial limited search of PubMed and CINAHL has been undertaken to identify articles on the topic. The following sources will be searched for eligible papers: PubMED, CINAHL, Embase, PsycINFO, BNI, AMED, and OpenGrey. Retrieval of full-text studies, assessment of methodological quality, and data extraction will be performed independently by two reviewers. Meta-analysis will be performed, if possible, and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019137886.

A concept analysis of confidence related to older people living with frailty.

Aim: To describe and define a concept of confidence in the context of older people living with frailty, which is important to the worldwide healthy-ageing agenda preventing decline in independence and well-being. Design: Concept analysis informed by Walker and Avant's eight-stage approach. Methods: Electronic databases (MEDLINE, CINAHL and PsychINFO) from 1994-2018 were searched. Published studies exploring confidence and excerpts of papers referencing older people, frailty and confidence informed the concept analysis. Extracted attributes informed model case and additional case development. Appraisal of antecedents, consequences and empirical referents informed the final concept's construction. Results: Three overall defining attributes of confidence were identified in this concept analysis: physical, psychological and social. A central feature is personal control, influencing internal and external factors. These control factors can be enabling factors (positive factors) or dis-enabling factors (negative factors), affecting the frail older persons overall physical health and mental well-being.

Antimicrobial stewardship and the hospital nurse and midwife: how do they perceive their role?

OBJECTIVES: Our aim was to determine the views of nurses and midwives in an acute hospital regarding a potential role in an antimicrobial stewardship programme. METHODS: An online survey about antimicrobial stewardship was distributed to nursing and midwifery staff at the Royal Cornwall Hospitals NHS Trust. Descriptive statistics were used for analysis. RESULTS: Eighty responses were received. Forty-three (54%) claimed to have heard the term antimicrobial stewardship. Only seven (9%) had cause to look at the hospital's antimicrobial guidelines at least once a week. Between 47 (60%) and 68 (87%) respondents agreed they should be involved in a range of stewardship roles. Constraints of time and workload, lack of knowledge and lack of adequate staff training were the three main perceived challenges to a wider role. CONCLUSIONS: Staff in this survey recognise the potential for wider antimicrobial stewardship roles. They also identify challenges to undertaking these roles. Some of these barriers could be overcome by provision of education and support; hospital pharmacists may be able to assist with this role development.

The meaning of confidence for older people living with frailty: a qualitative systematic review.

BACKGROUND: In many countries, the oldest old (those aged 85 years and older) are now the fastest growing proportion of the total population. This oldest population will increasingly be living with the clinical condition of frailty. Frailty syndromes negatively impact on the person as they do the healthcare systems supporting them. Within healthcare literature "loss of confidence" is occasionally connected to older people living with frailty, but ambiguously described. Understanding the concept of confidence within the context of frailty could inform interventions to meet this growing challenge. OBJECTIVES: The objective of this systematic review was to explore the meaning of confidence from the perspective of older people living with frailty through synthesis of qualitative evidence to inform healthcare practice, research and policy. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Studies that included frail adults, aged over 60 years, experiencing acute hospital and or post-acute care in the last 12 months. PHENOMENA OF INTEREST: The concept of "confidence" and its impact on the physical health and mental well-being of older people living with frailty. CONTEXT: Studies that reported on the older person's descriptions, understanding and meaning of confidence in relation to their frailty or recent healthcare experiences. TYPES OF STUDIES: Studies of qualitative design and method. SEARCH STRATEGY: A three step search strategy was used. The search strategy explored published studies and gray literature. Publications in English from the last 20 years were considered for inclusion. METHODOLOGICAL QUALITY: All included articles were assessed by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment Review Instrument (JBI-QARI). DATA EXTRACTION: Data were extracted from included studies using the data extraction tools developed by the Joanna Briggs Institute. DATA SYNTHESIS: Qualitative research findings were collated using a meta-aggregative approach and JBI-QARI software. RESULTS: Synthesized findings of this review were drawn from just four research studies that met the inclusion criteria. Only six findings contributed to the creation of three categories. These informed a single synthesized finding: Vulnerability, described as a fragile state of well-being that is exposed to the conflicting tensions between physical, emotional and social factors. These tensions have the capability to enhance or erode this state. CONCLUSIONS: Assertions that an understanding of the concept confidence has been reached cannot be made. The review data offer limited insight into the concept of confidence being described by the cohort of older people living with frailty.