A qualitative formative evaluation of a patient-centred patient safety intervention delivered in collaboration with hospital volunteers.

BACKGROUND: Evidence suggests that patients can meaningfully feed back to healthcare providers about the safety of their care. The PRASE (Patient Reporting and Action for a Safe Environment) intervention provides a way to systematically collect feedback from patients to support service improvement. The intervention is being implemented in acute care settings with patient feedback collected by hospital volunteers for the first time. OBJECTIVE: To undertake a formative evaluation which explores the feasibility and acceptability of the PRASE intervention delivered in collaboration with hospital volunteers from the perspectives of key stakeholders. DESIGN: A qualitative evaluation design was adopted across two acute NHS trusts in the UK between July 2014 and November 2015. We conducted five focus groups with hospital volunteers (n=15), voluntary services and patient experience staff (n=3) and semi-structured interviews with ward staff (n=5). Data were interpreted using framework analysis. RESULTS: All stakeholders were positive about the PRASE intervention as a way to support service improvement, and the benefits of involving volunteers. Volunteers felt adequate training and support would be essential for retention. Staff concentrated on the infrastructure needed for implementation and raised concerns around sustainability. Findings were fed back to the implementation team to support revisions to the intervention moving into the subsequent summative evaluation phase. CONCLUSION: Although there are concerns regarding sustainability in practice, the PRASE intervention delivered in collaboration with hospital volunteers is a promising approach to collect patient feedback for service improvement.

The fundamentals of integrating service in a post-licensure RN to BSN program.

Integrating service in a post-licensure registered nurse to bachelor of science in nursing (RN to BSN) program provides licensed registered nurse (RN) students the opportunity to learn, develop, and experience different cultures while serving the community and populations in need (McKinnon & Fitzpatrick, 2012). Service to the community, integrated with academic learning can be applied in a wide variety of settings, including schools, universities, and community faith-based organizations. Academic service-learning (ASL) can involve a group of students, a classroom, or an entire school. In the RN to BSN program, the authors use a student-directed service learning approach that integrates service-learning throughout the curriculum. RN students are introduced to service-learning at program orientation prior to the start of classes and receive reinforcement and active engagement throughout the curriculum. The students and volunteer agencies receive and give benefits from the services provided and the life lessons gained through mentorship, education, and hands-on experiences.

Introducing on-ward volunteers to work with patients with dementia.

This article reports on an evaluation of the effect of an on-ward volunteer service in an acute orthopaedic ward with a number of dementia patients. A mixed-methods evaluation was undertaken in 2012. This included interviews with individuals who have strategic, management, operational and clinical roles in the voluntary organisation and the NHS trust, focus group discussions with volunteers, non-participant observations of practice and focused conversations with ward staff. The service had a positive effect on patient experience. Patients were engaged through a variety of activities and enjoyed the volunteers' presence. Staff valued the initiative because they could see the difference that it made to patients and their own working lives. The lessons learned from the evaluation can inform the development of similar initiatives elsewhere and are relevant, given the emphasis in healthcare policy to improve patient experience.

[We cannot care alone: volunteers in dementia care at Nürnberg General Hospital]. / "We cannot care alone" : Ehrenamtliche Demenzbegleiter am Klinikum Nürnberg.

BACKGROUND: People with dementia have specific care needs especially in an acute care setting. Professionals in clinical routine have limited capacities in meeting the needs of dementia patients as far as communication, interaction and orientation are concerned. AIMS: For 2 years, the Department of Internal Medicine and Geriatrics at Nürnberg General Hospital has hosted volunteers in dementia care who accompany and visit people with dementia during their acute care stay. We present the organization of the volunteer training program, training content, and preliminary evaluation results. METHODS: We chose a mixed methods approach for research and evaluation. Baseline data, motivational profile of volunteers, paper and pencil data on attitudes, skills and knowledge before and after training were assessed. RESULTS: Preliminary results show a positive effect on attitudes, skills, and knowledge after volunteer training. Volunteers and professionals need continual support and education to enable volunteers to act as an integrative part of the acute geriatric care team. CONCLUSION: The admission to an acute care setting is often frightening and confusing for dementia patients. Trained volunteers have the potential to make the hospital stay more pleasant for people with dementia.

Evaluation of a pilot 'peer support' training programme for volunteers in a hospital-based cancer information and support centre.

PURPOSE: Volunteers from Peter MacCallum Cancer Centre (Peter Mac) Patient Information and Support Centre (PISC) assist the Cancer Support Nurse by helping patients and families/carers find information and provide face-to-face peer support. Benefits of shared personal experiences between volunteer and patient are clearly different from professional support. Volunteers require specific skill sets and detailed preparation for this role. MATERIALS AND METHODS: Volunteers completed a 3-day training programme adapted from the Cancer Council Victoria's 'Cancer Connect Telephone Peer Support Volunteer' training programme. The focus was role expectations and boundaries for peer support volunteers, debriefing, communication skills training, support services, complementary and alternative therapies and internet information. Assessment included a quiz and observation for a range of competencies. Role-play with simulated patients developed appropriate support skills. RESULTS: Eight volunteers participated. Pre-training questionnaires revealed all volunteers highly self-rated existing skills supporting people affected by cancer. During training, volunteers recognised these skills were inadequate. All agreed that role-play using an actor as a 'simulated patient' helped develop communication skills; however, the experience proved challenging. Post-training all reported increased knowledge of role definition and boundaries, supportive communication skills, supports available for patients and families/carers and importance of self-care. Facilitators recommended seven of the eight participants be accredited PISC Peer Support Volunteers. One volunteer was assessed unsuitable for consistently overstepping the boundaries of the peer support role and withdrew from training. CONCLUSION: Success of the programme resulted in a trained 'face-to-face peer support volunteer' group better equipped for their role. Sixteen months following training, all who completed the programme remain active volunteers in the PISC. Planned educational updates include needs identified by the volunteers. The training programme would require adapting for future peer support volunteers.

Managing volunteers who support patients with dementia or cognitive impairment on acute hospital wards: the NURTURe model.

Volunteers are widely used to support patients with dementia or cognitive impairment on acute hospital wards. However, it appears that traditional volunteer management models do not fully address the challenges posed by managing volunteers in that setting. In a study of the use of volunteers in the care of people with dementia and cognitive impairment on acute hospital wards, interviews with a range of stakeholders revealed challenges regarding the environment, role and image of volunteers. Based on the study findings, an alternative model for managing volunteers on acute hospital wards was developed. This article describes the study and discusses the development of this alternative approach, the NURTURe model.

A volunteer-based Hospital Elder Life Program to reduce delirium.

A community hospital with nearly 50% of its admitted patients 70 years or older adapted the well-established Hospital Elder Life Program (HELP). The primary adaptation entailed an enhanced participation of trained volunteers in HELP interventions designed to prevent and reduce delirium. Integral program elements include detailed volunteer training, required demonstration of competencies, and regular evaluation and feedback of volunteers provided by program staff. Nurse satisfaction with HELP increased from 64% to 91% in the second year of implementation, and a survey of patients and families indicated that 95% were satisfied with HELP. This innovative volunteer-assisted model of elder care support was positively embraced by patients, their families, and the nursing staff and supported by nursing administration. The use of volunteers is a cost-effective method of enhancing the nursing care of vulnerable elders during hospitalization.

Experiences of lay counsellors who provide VCT for PMTCT of HIV and AIDS in the Capricorn District, Limpopo Province.

Human immune deficiency virus (HIV) and acquired immune-deficiency syndrome (AIDS) still carry a stigma in the community. Many people do not know their status and they are still reluctant to be tested including pregnant women despite the fact that Voluntary Counselling and Testing (VCT) is offered for free in South Africa. In South Africa VCT for HIV and AIDS is offered by lay counsellors in public hospitals and clinics. The study conducted by Mate, Bennet, Mphatswe, Barker and Rollins (2009:5483) outlined that in South Africa the prevention of mother-to-child transmission (PMTCT) of HIV guidelines have raised hope that the national goal of reducing perinatal HIV transmission rates to less than 5% can be attained. A qualitative, exploratory, descriptive and contextual study was conducted in 15 public clinics of the Polokwane Municipality in the Capricorn District, Limpopo Province. The purpose of the study was to determine the experiences of the lay counsellors who provide VCT for the PMTCT of HIV and AIDS in the Capricorn District, Limpopo Province. Data were collected through one-to-one interviews using a semi-structured guide (De Vos et al, 2006:296). The findings of the study reflected the following: the content of training and counselling skills received by lay counsellors were satisfactory, there was lack of counsellor support and in-service education. A program for in-service education and support for all lay counsellors who have had VCT training should be conceptualised and implemented.

Volunteers as members of the stroke rehabilitation team: a qualitative case study.

OBJECTIVES: Clinicians are facing increasing demands on their time, exacerbated by fiscal constraints and increasing patient complexity. Volunteers are an essential part of the many healthcare systems, and are one resource to support improved patient experience and a mechanism through which to address unmet needs. Hospitals rely on volunteers for a variety of tasks and services, but there are varying perceptions about volunteers' place within the healthcare team. This study aimed to understand the role of volunteers in stroke rehabilitation, as well as the barriers to volunteer engagement. DESIGN: A qualitative case study was conducted to understand the engagement of volunteers in stroke rehabilitation services within a complex rehabilitation and continuing care hospital in Ontario, Canada. PARTICIPANTS: 28 clinicians, 10 hospital administrators and 22 volunteers participated in concurrent focus groups and interviews. Organisational documents pertaining to volunteer management were retrieved and analysed. RESULTS: While there was support for volunteer engagement, with a wide range of potential activities for volunteers, several barriers to volunteer engagement were identified. These barriers relate to paid workforce/unionisation, patient safety and confidentiality, volunteer attendance and lack of collaboration between clinical and volunteer resource departments. CONCLUSIONS: An interprofessional approach, specifically emphasising and addressing issues related to key role clarity, may mediate these barriers. Clarity regarding the role of volunteers in hospital settings could support workforce planning and administration.

A nurse-led youth volunteering project to support older people on acute hospital wards.

Young people volunteering on acute hospital wards can provide extra support to older patients, for example with eating and drinking, with mobilising and with therapeutic activities. This extra support can reduce nurses' workload while providing older people with opportunities to interact and engage. For the young people involved, volunteering can improve their skills and confidence, as well as providing opportunities for career development. Nurses are well-placed for developing and managing volunteer services due to their leadership, clinical skills and experience. This article describes a volunteer project where young people aged 16 years and above support older people on acute hospital wards in an NHS trust in England. The project was designed and managed by a nurse using the NURTURe model, a framework for planning, developing and organising volunteer services to support older patients on acute hospital wards.

The role of SVS volunteer vascular surgeons in the care of combat casualties: results from Landstuhl, Germany.

With a shortage of active duty vascular surgeons in the military, Society for Vascular Surgery (SVS) members have been called upon to perform short-term rotations at Landstuhl Regional Medical Center (LRMC), the US military's receiving facility for combat injuries sustained in the Iraq and Afghanistan conflicts. From September 2007 to May 2008, 20 SVS vascular surgeons have performed 2-week rotations at LRMC through American Red Cross and US Army sponsorship. Volunteers were surveyed for previous military and/or trauma experience. In addition to reporting number and types of procedures performed, volunteers were queried on their experience and impression of the rotation. Several volunteers have had prior military experience and all have had vascular trauma experience through residency, fellowship, and current practices. With most definitive vascular repairs being done in theater, SVS members were most often called upon for clinical expertise in the care of combat casualties and evaluation of revascularization procedures. The volunteers contributed to daily rounds, patient care, and teaching conferences, as well as actively participated in surgical procedures with the most common being wound examinations under anesthesia for which intraoperative vascular consultation was occasionally requested (5-20 per volunteer). Additional procedures that volunteers performed included: inferior vena cava (IVC) filter placement, thrombectomy, revision of lower and upper extremity interposition vein grafts, retroperitoneal spine exposures, diagnostic and therapeutic angiograms, iliac stenting, and duplex ultrasound scan interrogation of vascular repairs, suspected arterial injuries, and deep vein thrombosis. All volunteers described the experience as valuable and will return if needed. With a limited number of military vascular surgeons and the unpredictable need for a vascular specialist at LRMC, civilian volunteers are playing an important role in providing high-quality vascular care for the nation's wounded soldiers by expanding vascular and endovascular capability at LRMC and contributing to general surgical critical care. As volunteers, SVS members are carrying on a tradition started by our surgical forefathers during previous US military conflicts.

Transforming the experience of cancer care: a qualitative study of a hospital-based volunteer psychosocial support service.

PURPOSE: As volunteer support services for cancer patients evolve and seek to gain credibility and acceptance, it is important that these services be carefully evaluated. This paper describes findings from a research study conducted by the Healing Beyond the Body (HBB) program, a hospital-based volunteer psychosocial support service in a comprehensive cancer center in Toronto, Canada. The goal of this study was to gain insight into the experience of patients who have interacted with HBB volunteers and to evaluate the benefits and risks of this program for these patients. MATERIALS AND METHODS: A qualitative research method, based on semi-structured interviews with 15 patients recruited in the Chemotherapy Daycare Unit, was used. The interviews were transcribed and thematically analyzed. RESULTS: Findings suggest that volunteers can effectively serve an enhanced supportive role in a hospital setting without adverse effects, and that their services are positively received by patients. The following themes were identified in relation to perceived benefits of the HBB volunteer support service: (1) a sense of humanization and normalization; (2) a sense of security; (3) support for non-medical needs; and (4) support for unaccompanied patients. While no negative experiences with the HBB volunteers were reported, the following themes were identified in relation to potential weaknesses of the HBB volunteer service: (1) a limited awareness by patients of the HBB volunteers' roles and responsibilities; and (2) the lack of a structured role definition for the HBB volunteers at the pre-treatment phase. CONCLUSION: Our findings add to the literature on the contribution of volunteer support services and may serve decision-makers concerned with best practices in utilizing volunteer resources within a cancer hospital structure.

Can trained volunteers improve the mealtime care of older hospital patients? An implementation study in one English hospital.

OBJECTIVE: Multinational studies report undernutrition among 39% older inpatients; importantly, malnutrition risk may further increase while in hospital. Contributory factors include insufficient mealtime assistance from time-pressured hospital staff. A pilot study showed trained volunteers could safely improve mealtime care. This study evaluates the wider implementation of a mealtime assistance programme. DESIGN: Mixed methods prospective quasi-experimental study. SETTING: Nine wards across Medicine for Older People (MOP), Acute Medical Unit, Orthopaedics and Adult Medicine departments in one English hospital. PARTICIPANTS: Patients, volunteers, ward staff. INTERVENTION: Volunteers trained to help patients aged ≥70 years at weekday lunchtime and evening meals. MAIN OUTCOME MEASURES: The number of volunteers recruited, trained and their activity was recorded. Barriers and enablers to the intervention were explored through interviews and focus groups with patients, ward staff and volunteers. The total cost of the programme was evaluated. RESULTS: 65 volunteers (52 female) helped at 846 meals (median eight/volunteer, range 2-109). The mix of ages (17-77 years) and employment status enabled lunch and evening mealtimes to be covered. Feeding patients was the most common activity volunteers performed, comprising 56% of volunteer interactions on MOP and 34%-35% in other departments. Patients and nurses universally valued the volunteers, who were skilled at encouraging reluctant eaters. Training was seen as essential by volunteers, patients and staff. The volunteers released potential costs of clinical time equivalent to a saving of £27.04/patient/day of healthcare assistant time or £45.04 of newly qualified nurse time above their training costs during the study. CONCLUSIONS: Patients in all departments had a high level of need for mealtime assistance. Trained volunteers were highly valued by patients and staff. The programme was cost-saving releasing valuable nursing time. TRIAL REGISTRATION NUMBER: NCT02229019; Pre-results.

The many roles of families in family-centered care--part V. Interview by Deborah Dokken.

This article, the fifth of six in a series on roles for family members in family-centered care, focuses on the role of parents as educators of clinicians in the health care system. Two interviews highlight this role. The director of family services at a pediatric hospital, a parent of a child who suffered with a chronic illness, offers suggestions for institutions wanting to further develop this key role. This includes involving patient and family advisors at the "front end" of any initiative or new project; identifying champions (clinical staff, administrators, and patients/family members) for these roles within the institution; preparing family members for the educator role; following-up with thanks and feedback; and tracking successes of projects in which patient and family advisors participate. The father interviewed in this article describes the sense of fulfillment he experiences from teaching health care providers about child and family needs and the emotional side of care. He urges all parents to recognize the important education they can offer professionals when they both ask questions and share about their own child and family.

Hospital administrative characteristics and volunteer resource management practices.

Purpose - The purpose of this paper is to explore the links between various characteristics of hospital administration and the utilization of classes of volunteer resource management (VRM) practices. Design/methodology/approach - This paper uses original data collected via surveys of volunteer directors in 122 hospitals in five Northeastern and Southern US states. Findings - Structural equation modeling results suggest that number of paid volunteer management staff, scope of responsibility of the primary volunteer administrator, and hospital size are positively associated with increased usage of certain VRM practices. Research limitations/implications - First, the authors begin the exploration of VRM antecedents, and encourage others to continue this line of inquiry; and second, the authors assess dimensionality of practices, allowing future researchers to consider whether specific dimensions have a differential impact on key individual and organizational outcomes. Practical implications - Based on the findings of a relationship between administrative characteristics and the on-the-ground execution of VRM practice, a baseline audit comparing current practices to those VRM practices presented here might be useful in determining what next steps may be taken to focus investments in VRM that can ultimately drive practice utilization. Originality/value - The exploration of the dimensionality of volunteer management adds a novel perspective to both the academic study, and practice, of volunteer management. To the authors' knowledge, this is the first empirical categorization of VRM practices.