Frailty nurse and GP-led models of care in care homes: the role of contextual factors impacting Enhanced health in care homes framework implementation.

BACKGROUND: The Enhanced Health for Care homes (EHCH) framework is an innovative response to provide more proactive, preventative approaches to care for residents living in care homes. It involves co-producing a shared vision with primary care. As part of EHCH a UK clinical commissioning group supported GP's in two localities to implement their preferred delivery approach involving a new Frailty Nurse-led (FN-led) model in care homes alongside an existing General Practitioner-led (GP-led) model. This paper focuses on implementation of the new FN-led model. METHODS: A qualitative study design was adopted. Forty-eight qualitative semi-structured interviews were undertaken across six care home sites in a Northern locality: three implementing the FN-led and three engaged in an existing GP-led model. Participants included residents, family members, care home managers, care staff, and health professionals working within the EHCH framework. RESULTS: Two overarching themes were generated from data analysis: Unanticipated implementation issues and Unintended consequences. Unsuccessful attempts to recruit Frailty Nurses (FN) with enhanced clinical skills working at the desired level (UK NHS Band 7) led to an unanticipated evolution in the implementation process of the FN-led model towards 'training posts'. This prompted misaligned role expectations subsequently provoking unexpected temporary outcomes regarding role-based trust. The existing, well understood nature of the GP-led model may have further exacerbated these unintended consequences. CONCLUSION: Within the broader remit of embedding EHCH frameworks, the implementation of new FN roles needed to evolve due to unforeseen recruitment issues. Wider contextual factors are not in the control of those developing new initiatives and cannot always be foreseen, highlighting how wider factors can force evolution of planned implementation processes with unintended consequences. However, the unintended consequences in this study highlight the need for careful consideration of information dissemination (content and timing) to key stakeholders, and the influence of existing ways of working.

North Tyneside initiative to introduce a new nursing role in care homes.

Lynn Craig describes plans to appoint advanced care practitioners to improve care for residents and support nurses by offering professional development opportunities and enabling career progression.

Developing and sustaining nurses' service improvement capability: a phenomenological study.

BACKGROUND: Service improvement to enhance care quality is a key nursing responsibility and developing sustainable skills and knowledge to become confident, capable service improvement practitioners is important for nurses in order to continually improve practice. How this happens is an under-researched area. AIM: A hermeneutic, longitudinal study in Northern England aimed to better understand the service improvement lived experiences of participants as they progressed from undergraduate adult nursing students to registrants. METHOD: Twenty year 3 student adult nurses were purposively selected to participate in individual semi-structured interviews just prior to graduation and up to 12 months post-registration. Hermeneutic circle data analysis were used. FINDINGS: Themes identified were service improvement learning in nursing; socialisation in nursing practice; power and powerlessness in the clinical setting; and overcoming service improvement challenges. At the end of the study, participants developed seven positive adaptive behaviours to support their service improvement practice and the 'model of self-efficacy in service improvement enablement' was developed. CONCLUSION: This study provides a model to enable student and registered nurses to develop and sustain service improvement capability.

The role of the registered nurse in supporting frailty in care homes.

People in nursing and residential homes are more likely to suffer frailty. Registered nurses are a crucial component of the care delivery service and can offer support to patients who have complex care needs and comorbidities and are at risk of unplanned admissions to secondary care. This article explores frailty and the role of the nurse in assessing for frailty. Three aspects of patient care-nutrition status, polypharmacy and exercise and cognitive function-are discussed as areas where nurses can target their interventions in order to support those considered as frail, aiming to reduce the impact of frailty and negative health outcomes.

Public health: PART 4 Behaviour change tools.

Lynn Craig, Subject Lead, Adult Nursing, and Senior Lecturer ( L.craig@northumbria.ac.uk ), Emma Senior, Senior Lecturer/Programme Lead, Adult Nursing, and Michelle Mitchel, Graduate Teacher, Northumbria University, Newcastle upon Tyne, discuss tools used to help patients change health behaviours.

Public health: PART 3 Behaviour change.

Emma Senior, Senior Lecturer/Programme Lead, Adult Nursing ( emma.senior@northumbria.ac.uk ), Lynn Craig, Subject Lead, Adult Nursing, and Senior Lecturer, and Michelle Mitchel, Graduate Teacher, Northumbria University, Newcastle upon Tyne, discuss the models used to help patients change health-related behaviours.

Public health: PART 2 Brief interventions.

Emma Senior, Senior Lecturer/Programme Lead, Adult Nursing ( emma.senior@northumbria.ac.uk ), and Lynn Craig, Subject Lead, Adult Nursing, and Senior Lecturer, Northumbria University, Newcastle upon Tyne, discuss how nurses can use brief interventions during their interactions with patients.

Public health: PART 1 Making Every Contact Count.

Lynn Craig, Subject Lead, Adult Nursing, and Senior Lecturer ( L.craig@northumbria.ac.uk ) and Emma Senior, Senior Lecturer/Programme Lead, Adult Nursing, Northumbria University, Newcastle upon Tyne, discuss the nurse's role in public health interventions using the Making Every Contact Count approach.

Service improvement in health care: a literature review.

Service improvements in health care can improve provision, make cost savings, streamline services and reduce clinical errors. However, on its own it may not be adequate for improving patient outcomes and quality of care. The complexity of healthcare provision makes service improvement a challenge, and there is little evidence on whether improvement initiatives change healthcare practices and improve care. To understand the concept of service development within health care, it is necessary to explore the national context and how the NHS has adopted improvement initiatives. To equip the nursing workforce with the skills necessary to make positive change, higher education institutions have developed courses that include the topic within their pre-registration programmes. However, service improvement is a learned skill that nurses need to practise in order to become competent.