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Article

Julia Halpin, Patricia Wain and Peter Nolan

This paper reports on a study undertaken in one mental health NHS foundation trust in the UK, which sought to examine to what extent advanced practice nursing could…

Abstract

This paper reports on a study undertaken in one mental health NHS foundation trust in the UK, which sought to examine to what extent advanced practice nursing could contribute to advancing new ways of working in the future. The literature on advanced nursing in the UK is critically discussed and where availability permits, reference is made to international literature. The findings of a survey of nurses with a Masters degree or acting at advanced level are reported and discussed. Though the data reported here are largely confirmed by similar studies, nevertheless the insights provided should alert organisations to the complexity of introducing new roles during a time of radical change in the health care system. Despite the efforts of a highly motivated trust, respondents identified barriers and obstacles that were of such significance that some were forced to rethink their readiness to embrace the role. It is hoped that the recommendations derived from this study may assist other organisations at a similar stage of implementing advanced nursing practice roles.

Details

The Journal of Mental Health Training, Education and Practice, vol. 3 no. 4
Type: Research Article
ISSN: 1755-6228

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Article

Juliana Thompson, Anne McNall, Sue Tiplady, Phil Hodgson and Carole Proud

The purpose of this paper is to ascertain primary care advanced clinical practitioners’ (ACP) perceptions and experiences of what factors influence the development and…

Abstract

Purpose

The purpose of this paper is to ascertain primary care advanced clinical practitioners’ (ACP) perceptions and experiences of what factors influence the development and identity of ACP roles, and how development of ACP roles that align with Health Education England’s capability framework for advanced clinical practice can be facilitated in primary care.

Design/methodology/approach

The study was located in the North of England. A qualitative approach was used in which 22 staff working in primary care who perceived themselves to be working as ACPs were interviewed. Data analysis was guided by Braun and Clarke’s (2006) six phase method.

Findings

Five themes emerged from the data – the need for: a standardised role definition and inclusive localised registration; access to/availability of quality accredited educational programmes relevant to primary care and professional development opportunities at the appropriate level; access to/availability of support and supervision for ACPs and trainee ACPs; a supportive organisational infrastructure and culture; and a clear career pathway.

Originality/value

Findings have led to the generation of the Whole System Workforce Framework of INfluencing FACTors (IN FACT), which lays out the issues that need to be addressed if ACP capability is to be maximised in primary care. This paper offers suggestions about how IN FACT can be addressed.

Details

Journal of Health Organization and Management, vol. 33 no. 4
Type: Research Article
ISSN: 1477-7266

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Article

Juliana Thompson, Sue Tiplady, Phil Hodgson and Carole Proud

This study aims to scope the profile and application of an advanced clinical practitioner (ACP) roles in primary care in the North of England and how these roles meet the…

Abstract

Purpose

This study aims to scope the profile and application of an advanced clinical practitioner (ACP) roles in primary care in the North of England and how these roles meet the requirements of Health Education England's (HEE’s) ACP workforce capability framework.

Design/methodology/approach

A two-stage design was used. Stage 1 analysed health and social care workforce intelligence reports to inform scoping of numbers of ACPs working in primary care. Stage 2 used two surveys. Survey 1 targeted ACP leads and collected strategic-level data about ACP application. Survey 2 targeted staff who perceived themselves to be working as ACPs. Survey 2 was in three parts. Part 1 collected demographic data. Part 2 required participants to record their perceived competence against each of the HEE ACP framework capability criteria. Part 3 required respondents to identify facilitators and barriers to ACP practice.

Findings

Despite the introduction of HEE's ACP capability framework, there is inconsistency and confusion about the ACP role. The results indicated a need for standardisation of role definition and educational and practice requirements. The results also suggested that some ACPs are not working to their full potential, while some staff who are employed as “gap-fillers” to provide routine clinical services perceive themselves as ACPs despite not working at the ACP level.

Originality/value

Although previous research has explored the application of ACP practice in primary care, few studies have considered ACP application in the light of the introduction of workforce capability frameworks aimed at standardising ACP practice.

Details

International Journal of Health Governance, vol. 25 no. 3
Type: Research Article
ISSN: 2059-4631

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Article

John Howard and Katie Barnes

The purpose of this paper is to show how competency models can be used to govern the increased autonomy of advanced practitioners in nursing, and to assist in workforce…

Abstract

Purpose

The purpose of this paper is to show how competency models can be used to govern the increased autonomy of advanced practitioners in nursing, and to assist in workforce development.

Design/methodology/approach

The study shows how competency frameworks for advanced nurse practitioners (ANPs) have evolved in the UK. It compares the current thinking in the UK to the latest competency models from the USA. The article uses the authors' own adaptation of Benner's novice‐to‐expert framework to derive a framework from the current approaches. The authors then demonstrate how the resulting framework can be deployed to target development of new ANPs to address workforce development and governance issues over ensuring the right skill mix for safe autonomous practice. Finally, they argue for registration of advanced practitioners as a distinct professional group to address medico‐legal concerns over increased autonomy.

Findings

The study shows that there are currently limited numbers of ANPs constraining the development of new nurse‐led services, for example paediatrics. The study argues that current developments in the UK are unhelpful to the development of new nurse‐led initiatives that could flourish under the new commissioning arrangements. The study demonstrates how an enhanced framework can be used to target potential new ANPs for bespoke training, to assure that existing role holders have the correct level of competency for safe autonomous practice, and could form the basis of professional registration of advanced practitioners.

Research limitations/implications

The small numbers of existing ANPs and the early stage of development of nurse‐led services limit the opportunities for evaluation.

Practical implications

This study suggests that competency modelling can contribute to the effectiveness of ANP education, help to address workforce planning issues and provide re‐assurance for commissioners in terms of governance and safety.

Originality/value

Competency modelling for ANPs in the UK is in its infancy, but the lack of a safe and competent workforce is a barrier to innovation for commissioners of services.

Details

Clinical Governance: An International Journal, vol. 17 no. 4
Type: Research Article
ISSN: 1477-7274

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Article

Alexander Styhre and Rebecka Arman

Institutional theorists treat law and regulations as external factors that is part of the organization’s environment. While institutional theory has been criticized for…

Abstract

Purpose

Institutional theorists treat law and regulations as external factors that is part of the organization’s environment. While institutional theory has been criticized for its inability to recognize the role of agents and to theorize agency, the growing literature on institutional work and institutional entrepreneurship, partially informed by and co-produced with practice theory, advances a more dynamic view of processes of institutionalization. In order to cope with legal and regulatory frameworks, constituting the legal environment of the organization, there are evidence of organizational responses in the form of bargaining, political negotiations, and decoupling of organizational units and processes. The purpose of this paper is to report how legal and regulatory frameworks both shape clinical practices while at the same time they are also informed by the activities and interests of professional communities and commercial clinics.

Design/methodology/approach

This paper reports an empirical study of the Swedish-assisted conception industry and is based on a case study methodology including the use of interviews and formal documents and reports issues by governmental agencies.

Findings

The empirical material demonstrates how scientists in reproductive medicine and clinicians regard the legal and regulatory framework as what ensures and reinforces the quality of the therapies. At the same time, they actively engage to modify the legal and regulatory framework in the case when they believe it would benefit the patients. The data reported presents one successful case of how PGD/PGS can be used to develop the efficacy of the therapy, and one unsuccessful case of regulatory change in the case of patient interest groups advocating a legalization of commercial gestational surrogacy. In the former case, scientific know-how and medicinal benefits served to “push” the new clinical practice, while in the latter case, the “demand-pull” of patient interest groups fails to get recognition in regulatory and policy-making quarters.

Originality/value

The study contributes to the literature on agency in institutional theory (e.g. the emerging literature on institutional work) by emphasizing how legal and regulatory frameworks are in a constant process of being modified and negotiated in the face of novel technoscientific practices and social demands. More specifically, this process include many scientific, technological, economic, political and social relations and resources, making the legal environment of organizations what is the outcome from joint negotiations and agreements across organizational and professional boundaries.

Details

Qualitative Research in Organizations and Management: An International Journal, vol. 10 no. 2
Type: Research Article
ISSN: 1746-5648

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Book part

Evan Ortlieb

As the second volume in the book series, Literacy Research, Practice and Evaluation, this text was envisioned to disseminate salient information about literacy clinics…

Abstract

As the second volume in the book series, Literacy Research, Practice and Evaluation, this text was envisioned to disseminate salient information about literacy clinics. From historical perspectives to cutting-edge practices, this compilation fills a void in existing literature as it relates to best clinical practices. Advancing the mission of literacy clinics requires their relevancy to be widely recognized by literacy professionals; this volume serves to springboard clinical practices back into the limelight.

Details

Advanced Literacy Practices
Type: Book
ISBN: 978-1-78190-503-6

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Article

Terri MacDougall, Shawna Cunningham, Leeann Whitney and Monakshi Sawhney

The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional…

Abstract

Purpose

The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC).

Design/methodology/approach

The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project.

Findings

Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form.

Research limitations/implications

This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide.

Practical implications

Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice.

Originality/value

This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 6
Type: Research Article
ISSN: 0952-6862

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Article

Will Venters and Avgousta Kyriakidou‐Zacharoudiou

This paper seeks to consider the collaborative efforts of developing a grid computing infrastructure within problem‐focused, distributed and multi‐disciplinary projects …

Abstract

Purpose

This paper seeks to consider the collaborative efforts of developing a grid computing infrastructure within problem‐focused, distributed and multi‐disciplinary projects – which the authors term interventionist grid development projects – involving commercial, academic and public collaborators. Such projects present distinctive challenges which have been neglected by existing escience research and information systems (IS) literature. The paper aims to define a research framework for understanding and evaluating the social, political and collaborative challenges of such projects.

Design/methodology/approach

The paper develops a research framework which extends Orlikowski and Gash's concept of technological frames to consider two additional frames specific to such grid projects; bureaucratic frames and collaborator frames. These are used to analyse a case study of a grid development project within Healthcare which aimed to deploy a European data‐grid of medical images to facilitate collaboration and communication between clinicians across the European Union.

Findings

That grids are shaped to a significant degree by the collaborative practices involved in their construction, and that for projects involving commercial and public partners such collaboration is inhibited by the differing interpretive frames adopted by the different relevant groups.

Research limitations/implications

The paper is limited by the nature of the grid development project studied, and the subsequent availability of research subjects.

Practical implications

The paper provides those involved in such projects, or in policy around such grid developments, with a practical framework by which to evaluate collaborations and their impact on the emergent grid. Further, the paper presents lessons for future such Interventionist grid projects.

Originality/value

This is a new area for research but one which is becoming increasingly important as data‐intensive computing begins to emerge as foundational to many collaborative sciences and enterprises. The work builds on significant literature in escience and IS drawing into this new domain. The research framework developed here, drawn from the IS literature, begins a new stream of systems development research with a distinct focus on bureaucracy, collaboration and technology within such interventionist grid development projects.

Details

Information Technology & People, vol. 25 no. 3
Type: Research Article
ISSN: 0959-3845

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Article

Jane Currie, Jane Mateer, Damien Weston, Elizabeth Anderson and Jackson Harding

In 2012, Headquarters 17 Combat Service Support Brigade (HQ 17 CSS Bde) implemented a clinical governance framework. The framework is intended as a quality improvement…

Abstract

Purpose

In 2012, Headquarters 17 Combat Service Support Brigade (HQ 17 CSS Bde) implemented a clinical governance framework. The framework is intended as a quality improvement tool through which excellence in deployed healthcare is achieved. The purpose of this paper is to describe the implementation of this clinical governance framework to 17 CSS Bde and present feedback provided by users on their application of the clinical governance framework.

Design/methodology/approach

An electronic survey was disseminated to the four 17 CSS Bde deployable health battalions (n=1,061). Qualitative data were analysed using descriptive statistics and qualitative data using thematic analysis.

Findings

In total, there were 105 responses providing valid data for analysis. The data identified mixed understanding and awareness of clinical governance amongst participants, and pinpointed aspects of the framework that needed refinement.

Practical implications

The results highlight important challenges implementing a clinical governance framework for deployable health units. The authors propose embedding clinical governance education in all army soldier and officer health courses to remedy deficits in knowledge and understanding. Recommendations for further development of the clinical governance framework are also made with particular emphasis on education, clinical risk and clinical evaluation.

Originality/value

This paper offers unique insight into the implementation of a clinical governance framework to the 17 CSS Bde, Australian Army. The results suggest that levels of understanding and awareness of clinical governance are stalling its translation through the military hierarchy. The data identify that implementation of a clinical governance framework is not easy, even within a military environment where the culture is to follow orders and obey the chain of command.

Details

International Journal of Health Governance, vol. 22 no. 1
Type: Research Article
ISSN: 2059-4631

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Article

Tasnim Uddin, Amina Saadi, Megan Fisher, Sean Cross and Chris Attoe

Emergency services face increasing frontline pressure to support those experiencing mental health crises. Calls have been made for police and ambulance staff to receive…

Abstract

Purpose

Emergency services face increasing frontline pressure to support those experiencing mental health crises. Calls have been made for police and ambulance staff to receive training on mental health interventions, prevention of risk and inter-professional collaboration. Mental health simulation training, a powerful educational technique that replicates clinical crises for immersive and reflective training, can be used to develop competencies in emergency staff. This study aims to evaluate the effectiveness of mental health simulation training for police and ambulance staff.

Design/methodology/approach

In total, 199 participants from the London Metropolitan Police Service and London Ambulance Service attended a one-day simulation training course designed to promote effective and professional responses to mental health crises. Participants took part in one of six simulated scenarios involving mental health crisis before completing structured debriefs with expert facilitators. Participants’ self-efficacy and attitudes towards mental illness were measured quantitatively using pre- and post-course questionnaires while participants’ perceived influence on clinical practice was measured qualitatively using post-course open-text surveys.

Findings

Statistically significant improvements in self-efficacy and attitudes towards mental illness were found. Thematic analyses of open-text surveys found key themes including improved procedural knowledge, self-efficacy, person-centred care and inter-professional collaboration.

Originality/value

This study demonstrates that mental health simulation is an effective training technique that improves self-efficacy, attitudes and inter-professional collaboration in police and ambulance staff working with people with mental health needs. This technique has potential to improve community-based responses to mental health crises.

Details

The Journal of Mental Health Training, Education and Practice, vol. 15 no. 5
Type: Research Article
ISSN: 1755-6228

Keywords

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