Evaluation of the feasibility of an Education-Career pathway in Healthcare for Older People (ECHO) for early career nurses.

BACKGROUND: Rapid population ageing is driving demand for qualified gerontological nurses. Yet, early career nurse attrition and limited focus on retention in the speciality limits supply. OBJECTIVES: To test the feasibility and acceptability of an Education-Career pathway in Healthcare for Older People (ECHO) intervention for early career nurses to improve retention and capability in gerontological nursing. ECHO is a multicomponent intervention with integrated education, career planning and coaching components, tested over two 6-month cycles. METHODS: A feasibility study with a pre-post design using a multi-methods evaluation. Twenty-nine early career nurse participants were recruited from eight NHS acute and community care Trusts in England. ECHO participants completed online questionnaires at baseline (Time 1), 6-month (T2, end of intervention) and follow-up at 18 months from baseline (T3). Outcome measures were career intention, self-reported knowledge, career planning confidence, and burnout using the Maslach Burnout Inventory. Qualitative interviews were undertaken with participants (n = 23) and organizational stakeholders (n = 16) who facilitated ECHO. Data analysis used descriptive statistics and non-parametric tests for paired data and thematic analysis for qualitative data. RESULTS: Overall, 19 of 29 participants (65%) completed all aspects of the intervention. The evaluation was completed by 23 participants. ECHO was well received by participants and stakeholders. At T3, the 23 participants were working in the speciality, though two had changed organizations. There was a significant improvement in self-reported gerontological knowledge, pre 87 (IQR 81-102), post 107 (IQR 98-112) p = 0.006, but no significant changes in other outcomes. In qualitative data, participants and organizational stakeholders held similar views, presented under four main themes: intended outcomes (personal and professional development, raise gerontological profile, expand horizons); nurse retention-a double-edged sword, ECHO logistics, and sustainability. CONCLUSION: Education-Career pathway in Healthcare for Older People was feasible and may positively impact early career nurse retention, capability and socialization into gerontological nursing. ECHO requires further refinement and piloting, but learning can contribute to retention strategies. IMPLICATIONS FOR PRACTICE: Attracting and retaining early-career nurses to the gerontological speciality requires greater innovation, organizational and senior nurse leadership.

Professional development and career planning for nurses working in care homes for older people: A scoping review.

BACKGROUND: A skilled, knowledgeable, and compassionate nurse workforce is pivotal to caring well for older people living in care homes. This requires the provision of continuing professional development and career planning for nurses, which are key also for nurse recruitment and retention. Continuing professional development and career planning strategies and interventions should be evidence-driven. OBJECTIVE: To identify the extent, range and nature of contemporary evidence regarding professional development and career planning for nurses caring for older people living in care homes. METHODS: The methodological framework used was the Joanna Briggs Institute guidance for scoping reviews. The PRISMA extension for scoping reviews was used as the reporting framework. Four databases were searched from January 2010 to July 2021. Results were screened independently by two reviewers using eligibility criteria. Full texts and the reference lists of eligible articles were reviewed. Data were extracted for key elements from the 25 articles included. RESULTS: Of the 25 articles, the majority were authored in the United States (n = 10) and UK (n = 8) with the remaining from Australia (n = 3), Canada (n = 3) and the Netherlands (n = 1). Four articles reported on professional development programmes. Three literature reviews addressed challenges for nurse participation in professional development, experiences of care home nurses as clinical leaders and managers, and leadership. Two expert commentaries reported on the challenges related to professional development and career planning for care home nurses. Sixteen empirical studies investigated a range of topics including: competencies, roles, intention to stay and leave, continuing professional development, and leadership. Key emergent factors that support professional development and career planning were as follows: access to structured learning opportunities addressing knowledge and skills specific to nursing frail older adults, a supportive working environment including adequate staffing, study time and flexible working, and integration of leadership development. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This scoping review has highlighted factors that support and challenge professional development and career planning for nurses working in the care home sector. There remain important gaps in the opportunities for professional development and career planning for care home nurses that warrant attention.

Metagenomic and HT-qPCR analysis reveal the microbiome and resistome in pig slurry under storage, composting, and anaerobic digestion.

Direct application of pig slurry to agricultural land, as a means of nutrient recycling, introduces pathogens, antibiotic resistant bacteria, or genes, to the environment. With global environmental sustainability policies mandating a reduction in synthetic fertilisation and a commitment to a circular economy it is imperative to find effective on-farm treatments of slurry that maximises its fertilisation value and minimises risk to health and the environment. We assessed and compared the effect of storage, composting, and anaerobic digestion (AD) on pig slurry microbiome, resistome and nutrient content. Shotgun metagenomic sequencing and HT-qPCR arrays were implemented to understand the dynamics across the treatments. Our results identified that each treatment methods have advantages and disadvantages in removal pollutants or increasing nutrients. The data suggests that storage and composting are optimal for the removal of human pathogens and anaerobic digestion for the reduction in antibiotic resistance (AMR) genes and mobile genetic elements. The nitrogen content is increased in storage and AD, while reduced in composting. Thus, depending on the requirement for increased or reduced nitrogen the optimum treatment varies. Combining the results indicates that composting provides the greatest gain by reducing risk to human health and the environment. Network analysis revealed reducing Proteobacteria and Bacteroidetes while increasing Firmicutes will reduce the AMR content. KEGG analysis identified no significant change in the pathways across all treatments. This novel study provides a data driven decision tree to determine the optimal treatment for best practice to minimise pathogen, AMR and excess or increasing nutrient transfer from slurry to environment.

Developing a competency framework for early career nurses undertaking post-registration education in care for older people.

BACKGROUND: Within gerontological nursing as a postgraduate nursing specialty, there is a lack of consensus regarding the standardised competencies and education development required, particularly in the UK. AIM: To develop and evaluate a competency framework for early career nurses undertaking post-registration education in a UK university in care for older people living with frailty. METHOD: The competency framework was developed as part of a broader gerontological education-career pathway intervention to improve competence and retention among early career nurses. A four-step process was used to develop the framework guided by a consensus building approach. A mixed-methods approach to the evaluation was adopted, with an online survey, one-to-one interviews and focus group interviews with students and organisational stakeholders. FINDINGS: A total of 33 students completed the competency framework as part of an academic module, 30 of whom took part in the evaluation. There was consensus among interviewees that the competencies confirmed 'what they knew already' and identified areas they needed to develop. Survey respondents reported that the competency framework was a useful part of the education-career pathway. CONCLUSION: The competency framework was acceptable to students and feasible to complete. It also enabled students to appreciate the unique knowledge and skills that underpin gerontological nursing and to evidence their expertise using a structured approach.

Repressive Moralism: World Making and Petty Fascism in Transgender Politics.

The past decade has seen a shift in the way that minorities exert their influence in society. Where in previous decades the emphasis was on winning the hearts and minds of the population at large, a recent strategy has been to ignore general public discourse and only to target specific influential bodies. In this paper we use the example of transgender issues to analyse the socio-psychological dimensions of this approach. We show how some groups promoting these issues eschew a wider social discourse and debate in the mass media, and how their strategy rests on a self-construction as victims of the hetero-normative society, with a concomitant appeal to moral rather than factual argumentation. This is combined with a programme of aggressive challenge to opponents through social media, and sometimes direct action, which effectively closes discussion on the topic. We conclude that these methods have much in common with the oppressive politics of fascist rule.

Evaluating a specialist education programme for nurses and allied health professionals working in older people care: A qualitative analysis of motivations and impact.

BACKGROUND: Developing clinical leaders is essential for high-quality, safe care for older people. Fundamental to achieving this is specialist continuing professional development for nurses and allied health professionals. OBJECTIVES: To investigate the motivations of nurses and allied health professionals to undertake a national specialist gerontological programme, the Older Persons Fellowship, and its impacts on their development and on older people care. DESIGN: A qualitative descriptive design. METHODS: Participants were nurses and allied health professionals undertaking a national specialist gerontological programme in England. A purposive sample of 63 participants was recruited. Twelve focus groups and four individual interviews were conducted between February 2015 and February 2019. Data were analysed using thematic analysis. RESULTS: Three themes were identified: credible gerontological experts; challenging ageism and suboptimal services; and legitimising gerontological practice as a speciality. CONCLUSIONS: Understanding the motivations to undertake a specialist gerontological programme and the impacts on practitioners and older people care and services will help inform the continuing professional development agenda for nurses and allied health professionals working in this field of practice. Policy makers, commissioners, managers, and educators can use the findings to inform continuing professional development priorities and provision for the gerontological workforce.

A survey of nurses involved in assessing the eligibility of older people for NHS continuing healthcare.

BACKGROUND: Nurses in England play a prominent role in NHS continuing healthcare (CHC) assessments, but there are no overview data on their knowledge and educational needs. AIM: An online survey was conducted to identify the educational status and development needs of nurses involved in CHC assessments. METHOD: The survey was informed by a literature review and focus group discussions, and distributed via email to the members of the Royal College of Nursing older people's forum. Descriptive data analysis was undertaken. RESULTS: Overall, respondents were confident about their ability to undertake CHC-associated work and manage each aspect of the CHC process. However, respondents were less confident about how to determine whether a primary health need exists based on the four main criteria - nature, complexity, intensity and unpredictability - of a person's health and social care needs. This was one of the respondents' priorities for training and development. CONCLUSION: The survey demonstrates the importance of face-to-face and multidisciplinary CHC training delivered locally. It also confirms the need for a standardised approach and more consistency in the CHC assessment process. A CHC competency framework would contribute to standardise the process and benefit all involved.

Assessment and provision of continuing healthcare: an integrative literature review.

NHS continuing healthcare is a package of care that is arranged and funded solely by the NHS where an individual has been found to have a 'primary health need'. Individuals who may be eligible have a right to be assessed for NHS continuing healthcare, and this assessment is undertaken by healthcare professionals using a national framework. However, there is a lack of literature on continuing healthcare and its assessment process. The aim was to review the literature on undertaking and providing continuing healthcare in terms of workforce roles, education and training, and competencies. A literature search was undertaken to identify relevant literature on continuing healthcare. Primary searching of electronic internal databases and indices at the Royal College of Nursing and King's College London was used, alongside a further database search and hand searching. A narrative synthesis of the literature was used to synthesise the findings, and a thematic analysis was undertaken to identify themes from the literature. The literature search identified 100 articles, of which 84 were excluded because they did not meet the inclusion criteria or provided insufficient details in the abstract. A total of 18 articles were included and examined in detail. Four themes were identified in the literature: complexity of care in transitioning care from hospital to home; different care models; importance of education of healthcare professionals; and role of continuing healthcare. Healthcare professionals - including nurses - should receive further training in caring for older people, especially in relation to continuing healthcare. Since there is an increasing ageing population, there is an increasing requirement for continuing healthcare, and thus further research examining all aspects of this care is required.

Incentivising a career in older adult nursing: The views of student nurses.

BACKGROUND AND AIM: Nurse vacancy rates in older adult services are disproportionately high compared to other areas of nursing. This is partly because few student nurses consider it an attractive career option once qualified due to perceptions of low-status, strenuous nature of the work and impoverished care environments. The study aimed to explore students' perceptions of incentives that could counterbalance the barriers for new graduate nurses joining this speciality. METHODS: A qualitative descriptive design using focus group interviews was carried out with six groups of student nurses (n = 27) following completion of their acute care older adult placements in three hospitals. Data were analysed using thematic analysis. RESULTS: The barriers from students' perspectives were constructed as a vicious cycle of staff shortages and inadequate resources that created impoverished environments leading to a dissonance between ideal and delivered care. Over one-third of students were unlikely to consider a career in older adults nursing, but the remaining students could identify incentives that may tempt them. Four main themes and eight subthemes were identified: gerontological status and leadership (ward leadership; respected others); relational care (legitimising emotional support, care vs. cure goals); quality work environment (pay as recognition, 12-hr shifts); and education-career pathways (gerontological knowledge, career progression). CONCLUSION: Radical new approaches, based on student and nurse engagement, are required to incentivise a career in gerontological nursing. A combination of shorter and longer term strategies that include education-career pathways, a focus on relation care, and improved work conditions including financial incentives should be trialled. IMPLICATIONS FOR PRACTICE: In terms of practice, addressing high nurse vacancy rates in older adult services that negaively impacts on patient outcomes requires a suite of incentives informed by 'what matters' to students and nurses working in the speciality.

Deprescribing in older adults: a new concept for nurses in administering medicines and as prescribers of medicine.

Deprescribing is a new and emerging theme in the care of older adults living with multimorbidities including frailty. Deprescribing requires a comprehensive review of risk and benefits of a medication in the context of the quality of remaining life and patient and family priorities and preferences. Nursing to date has not engaged with this issue, yet in their roles administering medicines and prescribing medicines they are a fundamental part of the pathway in deprescribing decisions and in supporting patients to make such decisions. In administering medicines, nurses are in a position to observe the degree of difficulty or burden experienced by patients due to polypharmacy or side effects of medicines. While as prescribers for adults with multimorbidities, active review of the risk and benefits of all medicines using evidence-based instruments is part of prescribing responsibility. This article is calling for a critical examination of nurses' roles in deprescribing and in supporting patients to make informed choices about their treatment. There is a need to articulate the role of nursing in this emerging area of medicines management and contribute to a multidisciplinary discourse on deprescribing. Equally professional standards and continuous professional development for nurses as prescribers and administrators of medicines needs to reflect the complexity of an older population. A deprescribing ethos challenges nurses to actively elicit patients' experiences of medicines burden, while nurse prescribers should recognise that appropriate deprescribing is as much a part of their role as appropriate prescribing.

Value of music.

Groups that engage residents in singing, dancing or music are becoming common in care homes, and are likely to have health and social benefits for many people.

Nurse leaders are vital to reconfiguration.

Earlier this month, NHS England announced major changes to how congenital heart disease surgery is provided. Under the proposal, three trusts will lose their specialist heart surgery services due to the need to comply with NHS England's new minimum standards for congenital heart disease treatment.

Preparation for a crucial role.

Few nurses can have escaped the predictions on population ageing and the expected increase in the number of older people living with frailty and/or multi-morbidity.

The development of the Older Person's Nurse Fellowship: Education concept to delivery.

BACKGROUND: Preparing the nursing workforce to meet the challenges of an ageing population is a priority for many countries. The development of an Older Person's Nurse Fellowship (OPNF) programme for senior clinical nurses is an important innovation. OBJECTIVES: This article describes the philosophical development, delivery and early evaluation of the OPNF. DESIGN: In 2014, Health Education England funded 24 senior clinical nurses to participate in the OPNF. The Fellowship was designed to build clinical leadership and innovation capability and develop a network of nurses to influence local and national strategy for older people's care. The Fellows selected were drawn from mental health (n=4), community/primary care (n=9) and acute care (n=11). The twelve month programme consisted of two Masters-level modules, delivered through study days and e-learning. The first cohort (n=12) commenced the course in November 2014 with a module designed to enhance clinical knowledge and skills. METHODS: Evaluation data were collected from the first cohort using anonymous surveys (n=11) and focus group interviews (n=9). Descriptive statistics are presented for the quantitative data and common themes are described in the qualitative data. RESULTS: The overall satisfaction with the clinical module was high with a median score of 18/20 (range 17-20). Topics such as comprehensive geriatric assessment, frailty, pharmacology and cognitive assessment were regarded as highly relevant and most likely to result in a change to clinical practice. In the focus group interviews students discussed their learning experience in terms of: module specificity, peer-to-peer learning and using the OPNF as leverage for change. CONCLUSIONS: The OPNF is a timely innovation and a positive commitment to developing an academic pathway for senior nurses. It marks an important step in the future development of the older person's nursing workforce.

We value your contribution.

Age UK's briefing on the health and care of older people in England 2015 ( page 8 ) paints a stark picture of the threat to future quality of care. Whether you work in the NHS or the wider care sector, you will need no reminder of the paradox in which costs must be saved while quality of care must be improved. At the time of writing, 13 of the 26 hospitals recently inspected by the Care Quality Commission were rated as 'requires improvement', four as 'inadequate', and only nine as 'good'. None was rated as 'outstanding'.

Put older people on the agenda.

England's chief nurse Jane Cummings is developing a new nursing strategy ( page 8 ). The existing strategy, Compassion in Practice, had little to say about how nursing would respond to the needs of the growing older population. Despite this, nurses are taking the initiative, developing roles in comprehensive old age assessment and care management for frail older people.