Factors supporting career pathway development amongst advanced practice nurses in Thailand: A cross-sectional survey.

BACKGROUND: Thailand has recently reformed its health care system and this change has contributed to the rapidly increasing need for skilled and experienced specialist nurses and in 2003 a new Advanced Practice Nursing role was formally introduced. While Advanced Practice Nursing is now accepted as a clinical career option, there is little understanding of the factors conducive to successful career development. This study offers the first examination of factors associated with successful career progression for Advanced Practice Nurses in Thailand. OBJECTIVES: 1. To provide a description of the Advanced Practice Nurse population in Thailand, as represented by a purposive stratified national sample. 2. To examine the factors influencing successful career pathway development of Advanced Practice Nurses in Thailand. 3. To examine the factors which influence the extent to which Advanced Practice Nurses in Thailand engage in evidence-based practice and research. DESIGN: National cross-sectional survey. SETTING: Thailand. PARTICIPANTS: 333 currently practicing Advanced Practice Nurses. METHODS: A national cross-sectional survey was conducted in Thailand in order to identify and examine key influencing factors on the successful development of Advanced Practice Nurses. The research tool was a specifically designed questionnaire in the Thai language, informed by international academic literature on the development of the Advanced Practice Nurse role, validated and piloted with 30 Advanced Practice Nurses to assess its reliability using Cronbach's alpha. The data were analysed in SPSS (version 21). Initial parametric testing was done using the Kolmogorov-Smirnov test and Pearson's correlation analysis was performed to examine the relationship between the independent variables (those measuring demographic and support factors) and the dependent variables (measuring career pathway development). RESULTS: A response rate of 90% was achieved. A lack of clear progression routes in the Advanced Practice Nurse structure was identified along with inconsistent patterns of working including variation in the number of days per week (range: 1-5 days) that nurses dedicated to the Advanced Practice Nurse role and the amount of autonomy achieved in this role. The study highlighted a lack of research productivity in and production of outputs (59% had never published) and given the expectation of Advanced Practice Nurses to both produce and utilise research evidence, this constitutes a significant gap in current practice. Other factors reported as important for career pathway development of Advanced Practice Nurses related to the environment, peer networks, institutional (hospitals) and external (government and the Thai Nursing Council) support. CONCLUSIONS: Our study offers insights for national and local policymakers and highlights the need to firmly establish, standardised career pathways in Advanced Practice Nursing to support career progression and the implementation of evidence into practice. These findings also have implications for clinical departments which have a responsibility to ensure they provide an enabling environment for Advanced Practice Nurses to fully carry out their roles. Tweetable abstract: Our study reports findings from a first national survey in Thailand investigating the factors which support career development in Advanced Practice Nurses.

Carers of people affected by cancer and other long-term conditions at end of life: A qualitative study of providing a bespoke package of support in a rural setting.

BACKGROUND: A UK charity, Macmillan Cancer Support has funded a local intervention, whereby carers of people affected by cancer and other long-term conditions at end of life are offered a bespoke package of support. AIM: This short report describes the qualitative experiences of carers in receipt of the intervention. DESIGN: Qualitative research utilising in-depth interviews. Discussions were digitally recorded and transcribed verbatim. Data were analysed using thematic analysis. SETTING/PARTICIPANTS: Participants were carers ( n = 10) in receipt of the intervention. Interviews were conducted between August and September 2014 in Lincolnshire (England). RESULTS: Five themes from the interviews were identified: (1) Awareness and advertising, (2) focus of support on the carer, (3) modes of communication, (4) personal attributes and skills of the support worker (5) streamlining and signposting. CONCLUSION: The intervention was successful within a social care setting. The participants had no overtly negative opinions on the service in its current format and all held it in high regard. Carers felt a sense of reassurance from having background support and maintained that their situation would have been worse had this support not been there.

Patterns of clinical mentorship in undergraduate nurse education: A comparative case analysis of eleven EU and non-EU countries.

BACKGROUND: In spite of the number of studies available in the field and policy documents developed both at the national and the international levels, there is no reliable data available regarding the variation of roles occupied by clinical mentors (CMs) across countries. OBJECTIVES: To describe and compare the CM's role; responsibilities; qualifications; employment requirements and experience in undergraduate nurse education as enacted in 11 European Union (EU) and non- EU countries. DESIGN: A case study design. PARTICIPANTS AND SETTING: A panel of expert nurse educators from 11 countries within and outside of the EU (Croatia, Czech Republic, England, Iceland, Ireland, Italy, Poland, Serbia, Slovenia, Spain, and the USA). METHODS: A questionnaire containing both quantitative and qualitative questions was developed and agreed by the panel using a Nominal Group Technique (NGT); four cycles of data collection and analysis were conducted involving key experts in nursing education in each country. RESULTS: In all countries, there are at least two types of clinical mentorship dedicated to undergraduate nursing students: the first is offered by higher education institutions, and the second is offered by health care providers. Variation was noted in terms of profile, responsibilities and professional requirements to act as a CM; however, the CM role is mainly carried out by registered nurses, and in most countries there are no special requirements in terms of education and experience. Those who act as CMs at the bedside continue to manage their usual caseload, thus the role adds to their work burden. CONCLUSIONS: Whilst it is imperative to have respect for the different national traditions in undergraduate nurse education, the globalisation of the nursing workforce and greater opportunities for student mobility during the course of their undergraduate education suggests that in areas such as clinical mentorship, jurisdictions, particularly within the EU, should work towards greater system harmonisation.

The Ten Essential Shared Capabilities: reflections on education in values based practice: a qualitative study.

BACKGROUND: This paper presents the findings of a study exploring the impact of a values-based training initiative on the practice of mental health workers. This work is set within the context of increasing attention on the values of nurses and other health care workers as a response to national reports on care failure and negative media attention. OBJECTIVE: To examine written response feedback from participants on a national training programme for values-based practice (VBP) in order to examine any intention to change practice. DESIGN: A national evaluation using quantitative and qualitative methodologies was conducted to gather data on reflections and self-report impact of the Ten Essential Shared Capabilities' training programme. SETTING: The training was delivered in a range of hospital, community and third sector training programmes across eight regions in England. PARTICIPANTS: The participants were predominantly nurses but all sectors in the mental health community including service users as co-facilitators and participants were represented. METHODS: This study presents the qualitative findings from a cross-sectional survey. Using NVIVO 10 software, data were analysed using the framework method of qualitative analysis. RESULTS: Four principal themes emerged from the data'Thinking differently''Changes to practice''Creating an effective learning environment and skills for practice development' and 'Increasing self-awareness'. CONCLUSIONS: The quality and safety drive in the NHS has an emphasis on delivery of evidence based practice. It was concluded that an active focus on values based practice merits equal attention and status.

Exploring nurses' experiences of prescribing in secondary care: informing future education and practice.

AIMS AND OBJECTIVES: To explore the experiences of secondary care nurse prescribers to establish how prescribing is employed and what its benefits and disadvantages are perceived to be. BACKGROUND: Nurse prescribing has developed rapidly since it inception almost 20 years ago and there is a significant body of research evaluating its implementation in primary care. Recent expansion of non-medical prescribing rights has prompted nurses in secondary care establishments to become prescribers. Evaluation of nurse prescribing in this new environment is required, if practice is to be informed and advanced. The lack of such evaluations in the published literature was the impetus for this study. DESIGN: A cross-sectional qualitative study. METHODS: A convenience sample of nurse prescribers was interviewed using a single broad question to prompt elaboration. Transcribed interviews were analysed using Colaizzi's procedural steps. RESULTS: Three main themes emerged from the analysis: motivations behind becoming a nurse prescriber; benefits and limitations of prescribing education and continuing professional development and prescribing in practice. CONCLUSION: Nurses felt nurse prescribing offers clear benefits in relation to patient care. Where nurses were not prescribing, finance arrangements between different NHS trusts appear to be a significant barrier to its successful implementation of prescribing in practice. Nurse prescribing is strongly believed to be the domain of the experienced nurse. There is a clear need for ongoing evaluation of all aspects of nurse prescribing. RELEVANCE TO CLINICAL PRACTICE: This paper makes key recommendations on the future development and delivery of programmes of education for nurse prescribers and for the delivery of safe and effective prescribing in practice.

Conscientious objection to termination of pregnancy: the competing rights of patients and nurses.

AIMS: To highlight the potential difficulties in the management of staff with a conscientious objection to abortion, in light of expanding role of nurses. BACKGROUND: Recent years have seen changes in the provision of abortion services. Medical procedures are now gaining popularity and some areas are seeing the integration of outpatient clinics into ward settings. This may involve nurses being required to provide care to women undergoing termination of pregnancy, which may not have previously been within their remit. This has implications for staff with a conscientious objection. METHODS: A review of the academic literature. RESULTS: The advent of medical abortion has led to changes in the way in which abortion services are provided which in turn has re-ignited the debate of the competing rights of nurses with a conscientious objection and those of the patient accessing abortion services. CONCLUSIONS: This extended role of nurses creates challenges for staff working in clinical areas offering termination of pregnancy and these are further compounded when staff have expressed a conscientious objection to abortion. IMPLICATIONS FOR NURSING MANAGEMENT: Managers face new challenges in achieving the fine balance between the rights of staff with a conscientious objection to abortion and women accessing abortion services.

Long-acting, reversible and permanent methods of contraception: insight into women's choice of method.

BACKGROUND: This study aims to explore the views of women concerning their choice of long-acting method of contraception. METHOD: Two-hundred and eighty-six women who had either been sterilised or fitted with an etonorgestrel (ETN) implant or the levonorgestrel intrauterine system (LNG IUS) were invited to take part. A response rate of 54% was achieved. Women from all three groups reported positive and negative experiences with their chosen method. RESULTS: Women frequently choose sterilisation specifically because it is irreversible, does not involve hormonal treatment, and they do not wish to retain choice of future fertility. Women incorrectly regard sterilisation as more reliable than any reversible method. Regret after sterilisation was common, even if this was preceded by full counselling. Even among patients of practices with a special interest in family planning, long-acting methods, although available, were not widely known about. CONCLUSION: This study suggests that women chose sterilisation for one of three main reasons: to avoid the possible side-effects of hormones; to avoid continually having to make decisions regarding child-bearing; and/or a lack of information regarding reversible methods. Sterilisation is often chosen by women specifically because of its irreversibility. This may explain why long-acting reversible methods have remained relatively unpopular.

What impact has England's Teenage Pregnancy Strategy had on young people's knowledge of and access to contraceptive services?

PURPOSE: To describe young people's knowledge and use of contraceptive services over initial stages of England's Teenage Pregnancy Strategy, and to investigate factors associated with use of different services. METHODS: A random location sample of young people aged 13-21 years (n = 8879) was interviewed in 12 waves over 2000-2004. Individual data were analysed to investigate factors associated with knowledge and use of contraceptive services and to observe trends over time. Area-level data were analyzed to explore differences in key variables. RESULTS: In all, 77% of young women and 65% of young men surveyed knew a service they could use to obtain information about sex. Amongst those who had had vaginal sexual intercourse, the most common source of contraceptive supplies was general practice for young women (54%) and commercial venues for young men (54%). Young women's use of school-based services to obtain supplies increased significantly from 15.4% in Year 1 to 24.4% in Year 4, p < .001. Young men's use of the commercial sector declined significantly over the same time period (60.3% to 50.6%, p = .002), while their use of general practice and family planning clinics increased (from 8.9% to 12.4%, p = .008, and 21.2% to 29.1%, p = .054, respectively). Use of family planning clinics and designated young people's clinics was associated with first vaginal intercourse before the 16th birthday and living in a deprived area. CONCLUSIONS: Young people's patterns of contraceptive service use have changed since implementation of the Strategy; although no increase in overall service use was observed. The contribution of school-based services needs further exploration.

Gender double standards in young people attending sexual health services in Northern Thailand.

Concern about the sexual and reproductive health of young people has been mounting recently in Thailand. Unequal gender relations have a considerable influence on the lives of young people, especially young women, yet few studies have explored the ways in which they have impacted on provision of sexual health care. Drawing upon data from a qualitative study in Northern Thailand, this paper explores the views and experiences of young people in seeking health care, highlighting the kinds of gender double standards and power imbalances that may pose obstacles to their use of sexual and reproductive health services. Findings reveal the vulnerability of sexually active young women in seeking support and care from partners, parents, and service providers. Those who experience adverse outcomes of sexual activity, such as unwanted pregnancy or infection, report facing indifference, victim blaming, or the threat of abandonment by their partners. Because of their fear of disclosure to their parents and communities, of their sexual activity, they opt for clandestine and unsafe abortion and seek the counsel of peers and drugstores rather than parents and providers. At the service provider level, young women report facing threatening and judgemental attitudes, indifferent counselling, and possible violation of confidentiality. This is in marked contrast to the treatment of young men, who generally meet with a more sympathetic and accepting response.

Providing information for young people in sexual health clinics: getting it right.

BACKGROUND: The need to improve the quality and availability of information on sexual health is identified as a key element in achieving the aims set out in the National Strategy for Sexual Health and HIV. Providing information about sexual health to young people poses particular challenges because of the sensitive nature of the issues and because of the difficulties that young people may face in sourcing information and asking questions of professionals.