Art engagement and mental health: experiences of service users of a community-based arts programme at Tate Modern, London.

OBJECTIVES: To examine the experiences of mental health service users who took part in an arts-based programme at Tate Modern, a major London art gallery. STUDY DESIGN: Exploratory qualitative design. METHODS: Data were collected using in-depth semi-structured interviews with 10 mental health service users who had taken part in a community-based programme at Tate Modern. Additionally, six art educators from Tate Modern were interviewed. Concepts that emerged from the text were identified using thematic analysis. RESULTS: All participants valued the gallery-based programme. The three overarching thematic areas were: the symbolic and physical context in which the programme workshops were located; the relational and social context of the programme workshops; and reflections on the relationship between the arts-based programme and subsequent mental health. CONCLUSIONS: Art galleries are increasingly seen to function as vehicles for popular education with mental health service users. This study adds to the growing body of evidence related to how mental health service users experience and reflect on arts-related programmes targeted at them. This study indicates that emphasis on how users experience gallery-based programmes may contribute to a more nuanced understanding of the relationship between art and mental health.

Immersive simulated reality scenarios for enhancing students' experience of people with learning disabilities across all fields of nurse education.

Poor preparation of nurses, regarding learning disabilities can have devastating consequences. High-profile reports and the Nursing and Midwifery Council requirements led this University to introduce Shareville into the undergraduate and postgraduate nursing curriculum. Shareville is a virtual environment developed at Birmingham City University, in which student nurses learn from realistic, problem-based scenarios featuring people with learning disabilities. Following the implementation of the resource an evaluation of both staff and student experience was undertaken. Students reported that problem-based scenarios were sufficiently real and immersive. Scenarios presented previously unanticipated considerations, offering new insights, and giving students the opportunity to practise decision-making in challenging scenarios before encountering them in practice. The interface and the quality of the graphics were criticised, but, this did not interfere with learning. Nine lecturers were interviewed, they generally felt positively towards the resource and identified strengths in terms of blended learning and collaborative teaching. The evaluation contributes to understandings of learning via simulated reality, and identifies process issues that will inform the development of further resources and their roll-out locally, and may guide other education providers in developing and implementing resources of this nature. There was significant parity between lecturers' expectations of students' experience of Shareville.

Supporting patient safety: examining communication within delivery suite teams through contrasting approaches to research observation.

OBJECTIVE: to explore the nature of intra- and interprofessional communication on delivery suites, with a particular focus on patient safety. DESIGN: longitudinal study using contrasting forms of observation: ethnographic methods alongside the highly structured Interaction Process Analysis (IPA) framework. SETTING: four contrasting delivery suites offering different models of care and serving different populations: two in the north of England and two in London. PARTICIPANTS: the multidisciplinary delivery suite teams and visiting professionals from related areas. KEY FINDINGS: the ethnographic observations and quantitative findings combine to highlight four principal areas relating to communication: communication underpinning collaboration; effects of workload pressures on communication practices; interprofessional communication; and the influence of architecture on communication. Contextual factors (e.g. case acuity, client throughput, model of care) underscore some inter site differences and attention is drawn to implications for safety. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the use of complementary methods aided exploration of communication in the complex environment of the delivery suite. The findings reflect the complexity of communication patterns and the multiple influences on patterns and norms. Interprofessional tensions, workload pressures and the design of the environment can restrict communication, with implications for safety. As such, these findings have implications for policy in that safety solutions which focus efforts on standardising communication need to be located within wider strategies that also address structural and organisational networks and influences.

Twenty-four hour care: implications for the role and developmental needs of nurses in acute and community settings.

AIM(S): The aim of this study was to explore the challenges of providing continuity within the 24-hour nursing service. It explored why nurses work at night and what issues this raises for them. BACKGROUND: The manner in which new ways of working affect the work or CPD (Continuing Professional Development) requirements of ward-based nurses or their community counterparts has received little attention. The aim of this study was to explore these issues with a diverse sample of practitioners. METHOD(S): Twenty-seven staff from four settings (two acute trusts and two community teams) participated in this qualitative study employing focus groups and interviews. RESULTS: The nature of night nursing is changing; expanded roles and responsibilities are common. However, CPD remains problematic, as a result of constraints around time and access. Context-specific issues shape the nature of night working in acute and community settings and should be considered when planning CPD. CONCLUSION(S): There is a need to re-examine what CPD is available for practitioners providing care around the clock. Traditional forms of CPD may not reflect the evolving reality of practice at night. IMPLICATIONS FOR NURSING MANAGEMENT: There is a need to ensure CPD opportunities are reviewed regularly to reflect changing 24-hour service demands in all settings.

Multidisciplinary obstetric simulated emergency scenarios (MOSES): promoting patient safety in obstetrics with teamwork-focused interprofessional simulations.

INTRODUCTION: We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and the transfer of learning to clinical practice were examined. METHODS: Participants included senior midwives, obstetricians, and obstetric anesthetists, including course faculty from 4 purposively selected delivery suites in England. Telephone or e-mail interviews with MOSES course participants and facilitators were conducted, and video-recorded debriefings that formed integral parts of this 1-day course were analyzed. RESULTS: The team training was well received. Participants were able to check out assumptions and expectations of others and develop respect for different roles within the delivery suite (DS) team. Skillful facilitation of debriefing after each scenario was central to learning. Participants reported acquiring new knowledge or insights, particularly concerning the role of communication and leadership in crisis situations, and they rehearsed unfamiliar skills. Observing peers working in the simulations increased participants' learning by highlighting alternative strategies. The learning achieved by individuals and groups was noticeably dependent on their starting points. Some participants identified limited changes in their behavior in the workplace following the MOSES course. Mechanisms to manage the transfer of learning to the wider team were weakly developed, although 2 DS teams made changes to their regular update training. DISCUSSION: Interprofessional, team-based simulations promote new learning.

Supporting structures for team situation awareness and decision making: insights from four delivery suites.

RATIONALE, AIMS AND OBJECTIVES: 'Human factors' (non-technical skills such as communication and teamwork) have been strongly implicated in adverse events during labour and delivery. The importance of shared 'situation awareness' between team members is highlighted as a key factor in patient safety. Arising from an ethnographic study of safety culture in the delivery suites of four UK hospitals, the aim of this study is to describe the main mechanisms supporting team situation awareness (TSA) and examine contrasting configurations of supports. METHODS: Stage I: 177 hours of lightly structured non-participant observation (sensitizing concepts: safety culture, non-technical skills, teamwork and decision making) analysed to identify a core organizing concept, main supporting categories and preliminary conceptual models. Stage II: (approximately 11 months after first observations) 104 hours of observation to test and elaborate stage I analyses. RESULTS: Handover, whiteboard use and a coordinator role emerged as the key processes facilitating work and team coordination. The interplay between these supporting processes and the contextual features of each site promoted or inhibited TSA. Three configurations of supports for TSA were evident. These are described. CONCLUSIONS: Context configurations of supporting mechanisms and artefacts influence TSA, with implications for the maintenance of patient safety on delivery suites. A balanced model of supports for TSA is commended. Examining contrasting configurations helps reveal how local mechanisms or organizational, environmental and temporal factors might be manipulated to improve TSA.

Bridging the gap: supporting the transition from medical student to practising doctor--a two-week preparation programme after graduation.

Concern exists that the transition from student to doctor is abrupt and stressful, and that new graduates lack both clinical skills and confidence. This paper explores the effect of a preparation programme on the confidence and skills of new graduates commencing their first clinical post. Fifty-three participants in two English hospitals undertook a two-week induction combining life support, emergency and clinical skills training with administrative induction and shadowing the outgoing house officer. Questionnaires and focus groups at the beginning, end, and one month following the programme explored participants' perceptions. Respondents were initially anxious about starting work, concerned mainly about clinical skills; taking responsibility; being alone; non-technical skills; and local geography and procedures. Confidence increased following the programme, and the programme's contents directly mitigated some fears. Shadowing was most highly valued, though experiences varied; acute emergency training was also valued, but clinical skills revision was more variably received. Having commenced work, these perceptions remained. Confidence increased further, but clinical practice still represented a steep learning curve. This programme to support the transition from medical student to practising doctor was useful and effective, but could be improved. Increasing responsibility during shadowing could effect an even smoother transition.

The National Health Service Knowledge and Skills Framework and its implications for continuing professional development in nursing.

The National Health Service Knowledge and Skills Framework has been introduced as part of the Agenda for Change Reforms in the United Kingdom to link pay and career progression to competency. The purpose of this paper is to consider the implications for nurses, their managers and the impact on university departments delivering continuing professional development for nurses. The new system has the potential to increase the human resources management aspect of the clinical nurse managers' role and could have legal implications, for example if practitioners perceive that their needs for continuing professional development have been overlooked to the detriment of their pay and career aspirations. The new system also has implications for providers of continuing professional development in the universities and is likely to demand closer liaison between education providers and trust staff who commission education and training. The Knowledge and Skills Framework is of interest to nurses and nurse educators internationally because the system, if effective, could be introduced elsewhere.

Nurses' experiences of continuing professional development.

Continuing professional development is regarded as part of the nursing role in the National Health Service. Health policy in the United Kingdom is built on the assumption that nurses' roles can be extended through continuing professional development which is also considered to be a key factor in nursing retention. Previous research has considered the provision of learning mainly from the perspective of managers and education providers. The purpose of this paper is to explore nurses' experiences of continuing professional development. The results presented in this paper form part of a larger survey (n=451, response rate=64.9%) designed to examine opportunities for continuing professional development and factors encouraging and discouraging uptake. An unexpectedly high number of respondents (n=125, 27.7%) commented extensively on their personal experiences of continuing professional development. These comments were analysed inductively. Five main themes emerged: who and what is continuing professional development for?; accessing continuing professional development; one size does not fit all; managing work, life and doing continuing professional development; and making the best of continuing professional development. Most responses were positive, but the demands of taking courses were perceived to encroach on life outside work, especially the need to complete lengthy assignments. Managers were perceived to operate as the gatekeepers to course admission and opportunities to implement new knowledge and expertise. No comments were received concerning the role of education staff in continuing professional development.

Modernising cancer and palliative care education in the UK: insights from one Cancer Network.

This article reports on a scoping study into cancer education provision in one UK Cancer Network. A range of professionals (nurses, allied health professionals (AHPs), health care support workers and educationalists) were invited to participate in focus group or individual interviews, or to return questionnaires regarding their perceptions of training needs and current opportunities. This yielded data from a total of 94 participants. In addition, curriculum documents from local universities were subjected to thematic analysis. Findings from the relevant section of The National Cancer Patient Survey were also considered to provide insight into the expressed needs of local service users. Most cancer and palliative care education was directed towards nurses employed in specialist oncology settings. Some groups appeared to be poorly served (including community nurses, senior nurses and AHPs). No evidence could be found of inter-professional cancer or palliative care education within the university sector. Curriculum content did not appear to reflect the ethnic diversity or socio-economic deprivation that characterised the local heath economy. Further research is needed to determine how best to ensure that continuing professional education reflects the needs of all practitioners involved in cancer and palliative care.

Delivering practice-based interprofessional education to community mental health teams: Understanding some key lessons.

This paper describes a project that offered an interprofessional education (IPE) experience to two community mental health teams (CMHTs) based in separate inner city locations. Team members were offered three weekly workshops that aimed to enhance their understanding of interprofessional collaboration and improve their collective work as a team. A multi-method research design was employed to evaluate the impact of the workshops. Data were collected at four points in time: before, directly after, three months and 12 months following the workshops. It was found that participants enjoyed their IPE experience and reported that it was helpful in enhancing their understanding of collaboration. In addition, one team reported that the workshops had contributed to improving their communication with one another. However, two key factors constrained the overall impact of this IPE experience: a limited involvement of medical staff, which undermined the 'value' of the workshops; and a lack of senior managerial support, which impeded efforts to transfer team-based learning into practice. These findings are discussed in relation to the IPE, sociology and change management literature in order to help understand some key lessons associated with delivering practice-based IPE.