The changing role of Advanced Clinical Practitioners working with older people during the COVID- 19 pandemic: A qualitative research study.

BACKGROUND: COVID-19 was identified as a pandemic by the World Health Organisation (WHO) in December 2020. Advanced Clinical Practitioners (ACPs) in England working with older people with frailty, experienced their clinical role changing in response to the emergency health needs of this complex population group. In contrast to other countries, in England Advanced Clinical Practitioners are drawn from both nursing and allied health professions. Whilst much of the literature emphasises the importance of ensuring the sustainability of the Advanced Clinical Practitioners' role, the pandemic threw further light on its potential and challenges. However, an initial review of the literature highlighted a lack of research of Advanced Clinical Practitioners' capabilities working with uncertainty in disaster response situations. AIM: To capture the lived experience of how English Advanced Clinical Practitioners working with older people adapted their roles in response to the COVID-19 pandemic (October 2020-January 2021). DESIGN, SETTING AND PARTICIPANTS: A qualitative research design was used. Following ethical approval, 23 Advanced Clinical Practitioner volunteer participants from across England with varied health professional backgrounds were recruited from Advanced Clinical Practitioners' professional and social media networks on Twitter using a snowballing technique. METHODS: Depending on preference or availability, 23 participants (nurses (18), physiotherapists (2), paramedics (2) and a pharmacist (1)) were interviewed singularly (n = 9) or as part of 3 focus groups (n = 14) using Zoom video communication. Audio recordings were transcribed and using qualitative data analysis software, NVivo 12 pro, coded for an essentialist thematic analysis of Advanced Clinical Practitioners' responses using an inductive approach. 27 codes were identified and collated into five themes. For the purposes of this paper, four themes are discussed: experiencing different work, developing attributes, negotiating barriers and changing future provision. FINDINGS: Advanced Clinical Practitioners successfully transferred their advanced practice skills into areas of clinical need during the pandemic. Their autonomous and generic, high level of expertise equipped them for management and leadership positions where speed of change, and the dissolution of traditional professional boundaries, were prioritised. Barriers to progress included a lack of knowledge of the Advanced Clinical Practitioner role and friction between Advanced Clinical Practitioners and physicians. DISCUSSION AND CONCLUSION: The study demonstrated the successful adaption of the Advanced Clinical Practitioner role to enable more creative, personalised and sustainable solutions in the care of older people living with frailty during the pandemic. The potential of Advanced Clinical Practitioner development is in a juxtaposition to the threat of pandemic services being dismantled once the emergency nature of care has passed. Healthcare organisations have a vital part to play in considering the enablers and barriers of Advanced Clinical Practitioner capability-based practice when responding to uncertainty.

The international focus-A neglected curriculum in global undergraduate nursing.

International learning in undergraduate global nurse education is recognised for promoting essential cultural competence. This can be addressed both at university; through the increasing use of collaborative technology and in practice, where the impact of international placements has promoted cultural sensitivity and outward student mobility. The authors debate the barriers that impede students' desire to take up international placements and review initiatives to promote a greater investment in this experience. The complexity and lack of transcultural principles that govern an international placement exchange have been addressed by one initiative to produce a robust pan-European quality audit process for clinical learning environments. In conclusion, the authors call for a greater and evaluated effort to increase global understanding and learning in the context of the COVID-19 response.

Global partnerships in nursing - A qualitative study in lessons for success.

Global nursing partnerships can develop cultural competence and standardisation across international nurse education programmes. Issues of context, cultural awareness and modes of engagement can influence the success of international collaboration. The 'Supporting Internationalisation of Traineeships in the Healthcare Sector' project, funded from 2017, brought together nine international partners from Finland, Poland, Spain and the UK to develop a pan-European quality audit process for clinical learning environments. As part of the evaluation, eight project partners were interviewed about the project and their criteria for a successful global partnership. The interviews allowed insight into previously hidden aspects of implementation. The importance of a scoping period for nursing global partnerships was highlighted that built on cultural diversity to explore common understandings. Attention to the use of prior expertise in internationalisation, or project objectives, could accelerate a global partnership to achieve a greater potential in its outcomes and cultural sensitivity. Framed in a clear structure, it is possible for global partnerships to embed ownership, autonomy and individual voice in partner organisations. The research concludes that only by growing international champions through funded and well constituted projects, that a genuine impact on the global health and educational needs in nursing can be met.

Changing the practice learning landscape.

Engagement in real life practice has long been acknowledged as the most effective way to learn a trade or profession and practice learning is consistently highlighted by nursing and midwifery placement students for its impact on both their professional and personal development. The paper examines the current complexities of practice learning that have emerged from educational reform and policy and debates the increased interest in the development of alternative approaches to practice learning in the UK.

Student life - Hit the ground running.

As part of a doctoral study, 24 first-year nursing students on their first placement were asked their views on how they learn best in practice. They identified the significant roles of trained staff, usually their mentor and healthcare assistants (HCAs), in their placement learning.

Supporting student nurses in practice with additional online communication tools.

Student nurses' potential isolation and difficulties of learning on placement have been well documented and, despite attempts to make placement learning more effective, evidence indicates the continuing schism between formal learning at university and situated learning on placement. First year student nurses, entering placement for the first time, are particularly vulnerable to the vagaries of practice. During 2012 two first year student nurse seminar groups (52 students) were voluntarily recruited for a mixed method study to determine the usage of additional online communication support mechanisms (Facebook, wiki, an email group and traditional methods of support using individual email or phone) while undertaking their first five week clinical placement. The study explores the possibility of strengthening clinical learning and support by promoting the use of Web 2.0 support groups for student nurses. Results indicate a high level of interactivity in both peer and academic support in the use of Facebook and a high level of interactivity in one wiki group. Students' qualitative comments voice an appreciation of being able to access university and peer support whilst working individually on placement. Recommendations from the study challenge universities to use online communication tools already familiar to students to complement the support mechanisms that exist for practice learning. This is tempered by recognition of the responsibility of academics to ensure their students are aware of safe and effective online communication.

Enhancing networking and proactive learning skills in the first year university experience through the use of wikis.

This paper discusses the introduction of blended learning strategies, a combination of traditional and online techniques, into the first year of a new preregistration nursing advanced diploma and degree programme at Bournemouth University (UK). During a ten week sociology of health academic unit, in the first term of a three year nursing course, wikis were introduced as a complementary learning technique to traditional lectures and seminars. Wikis, an online application, provided eleven student seminar groups (each divided into 4 online or elearning groups of 6-8 students) with the potential to communicate collaboratively "anytime, anywhere" (JISC, 2010) to discuss a sociology preparation activity for the preceding week. The implementation of this elearning tool was structured through the application of Salmon's five stage model (Salmon, 2002) and evaluated from 69 students' online contributions to wikis as well as questionnaires completed by both a sample of students and academic staff. As well as the many comments made by students the evaluation indicated that 45% of students' responses valued wikis as a communication tool and 33% believed it promoted or allowed the sharing of group views. The evaluation presents and critiques the initial project management using Salmon's five stage model and the engagement of students and academic staff. In particular it begins to show how wikis have the potential to structure academic learning and promote social networking in the crucial first few months of a course.