How commissioning affects community nursing.

Community nurses have direct experience of how changes in the local health economy affect the quality of care patients receive, so it is important that they engage with commissioning to influence decisions made about the quality and direction of their service. This article seeks to demystify commissioning priorities by drawing on findings from a survey of Commissioning for Quality and Innovation indicators for community nursing conducted in England, 2014-15. The article focuses specifically on organisational goals, highlighting the impact of the Francis report and other NHS priorities on quality assessment in community nursing.

Response of UK community hospitals to the COVID-19 pandemic: an appreciative inquiry.

INTRODUCTION: The 500 community hospitals in the UK provide a range of services to their communities. The response of these small, mainly rural, hospitals to the COVID-19 pandemic has not yet been examined and so this study sought to address this gap. METHOD: Appreciative inquiry was used to understand staff perspectives of how community hospitals responded to the COVID-19 (SARS-CoV-2) pandemic. A total of 20 organisations participated, representing 168 (34%) community hospitals in the UK. Qualitative interviews were conducted, with a total of 85 staff members, using an online video platform. 30 case studies were developed from these interviews. RESULTS: Staff described positive changes that were made in the context of the fear and uncertainty experienced in the pandemic. Quality improvements were reported in a wide range of services and models of care such as the use of the inpatient beds, and the access and management of urgent care services. Rapid changes were made in the way that services were managed, such as communications and leadership. Programmes of accelerated training were offered for existing and redeployed staff. Attention to staff health and well-being was a feature and there were a variety of innovations designed to support patients and their families. The impact of the changes was viewed as strengthening of integrated working between staff and sectors, the ability to rapidly innovate and improve quality, and the scope to use local decision-making to make changes. CONCLUSION: Staff of community hospitals described innovative and rapid quality improvements in their community hospitals in response to the pandemic. The case studies illustrated the features of community hospitals, showing that they can be resilient, flexible, responsive, creative, compassionate and integrated. The case studies of quality improvements are being used to encourage sharing and learning across community hospitals and beyond.

How do they measure up? Differences in stakeholder perceptions of quality measures used in English community nursing.

OBJECTIVES: To establish how quality indicators used in English community nursing are selected and applied, and their perceived usefulness to service users, commissioners and service providers. METHODS: A qualitative multi-site case study was conducted with five commissioning organizations and their service providers. Participants included commissioners, provider organization managers, nurses and service users. RESULTS: Indicator selection and application often entail complex processes influenced by wider health system and cross-organizational factors. All participants felt that current indicators, while useful for accountability and management purposes, fail to reflect the true quality of community nursing care and may sometimes indirectly compromise care. CONCLUSIONS: Valuable resources may be better used for comprehensive system redesign, to ensure that patient, carer and nurse priorities are given equivalence with those of other stakeholders.

Monitoring what is real: The effects of modality and action on accuracy and type of reality monitoring error.

Reality monitoring refers to processes involved in distinguishing internally generated information from information presented in the external world, an activity thought to be based, in part, on assessment of activated features such as the amount and type of cognitive operations and perceptual content. Impairment in reality monitoring has been implicated in symptoms of mental illness and associated more widely with the occurrence of anomalous perceptions as well as false memories and beliefs. In the present experiment, the cognitive mechanisms of reality monitoring were probed in healthy individuals using a task that investigated the effects of stimulus modality (auditory vs visual) and the type of action undertaken during encoding (thought vs speech) on subsequent source memory. There was reduced source accuracy for auditory stimuli compared with visual, and when encoding was accompanied by thought as opposed to speech, and a greater rate of externalization than internalization errors that was stable across factors. Interpreted within the source monitoring framework (Johnson, Hashtroudi, & Lindsay, 1993), the results are consistent with the greater prevalence of clinically observed auditory than visual reality discrimination failures. The significance of these findings is discussed in light of theories of hallucinations, delusions and confabulation.

Men affected by prostate cancer: a survey of general practitioners' learning needs.

BACKGROUND: With incidence rates for prostate cancer increasing each year in the UK, information and support for men with prostate cancer is crucial. Yet GPs have identified this as an area where they lack knowledge and confidence. Prostate Cancer UK commissioned a training needs analysis for healthcare professionals to inform the development of their education and training strategy. This paper presents the findings for GPs, taken from a wider study of healthcare professionals. AIM: To complete a review of current education provision and need to inform the development of an educational strategy for UK healthcare professionals. METHOD: A mixed methods study including a web-based review of education provision in prostate cancer in the UK, an online questionnaire and telephone interviews. RESULTS: The web-site search identified five educational opportunities specifically targeted at GPs. A total of 72 GPs responded to the online questionnaire. Of those responding, 39 (54.2%) GPs identified the need for further education and training in order to care effectively for men with prostate cancer. CONCLUSION: GPs identified a number of training needs to enable them to support men with prostate cancer. There was no clear preferred mode of educational delivery, with online learning seen as acceptable.