Complex programme evaluation of a 'new care model' vanguard: a shared commitment to quality improvement in an integrated health and care context.

NHS vanguards, under-pressure to perform, required better contracting and data management arrangements with evaluation teams, to ensure that integrated service outcomes could be reported effectively. This communication reflects the experience of evaluating an NHS vanguard and suggests how academic teams can improve capacity for complex programme evaluation of rapid improvements in integrated services. This should be based on a shared commitment to data collection and management. Also, robust knowledge exchange processes can enable systems change and sustainability. The identifying features of the particular site have been withheld.

Reducing risks for pregnant women with epilepsy: A qualitative study exploring experiences of using a toolkit at the antenatal booking appointment.

PURPOSE: Epilepsy is a high risk neurological disease associated with an increased risk of indirect maternal mortality due to sudden unexpected death in epilepsy. No evidence exists on the antenatal booking risk management process in women with epilepsy. This study therefore aimed to explore the experiences of midwives' in using a maternity epilepsy toolkit designed by the author to assist with this process. Midwives were chosen as the sample as they are predominantly the first health professional to learn of the diagnosis at the antenatal booking appointment. OBJECTIVES: The objective of this study was to explore the experiences of midwives in using a maternity epilepsy toolkit at the booking appointment. DESIGN: This is a qualitative study using the principles of hermeneutic phenomenology. SETTING: The study setting is in One National Health Service (NHS) Trust in the South of England. PARTICIPANTS: The participants of the study were n = 4 community midwives who used the maternity epilepsy toolkit at the booking appointment. METHOD: In-depth semistructured one-to-one interviews were used. MEASUREMENTS: An interview schedule using main questions, probes, and reinforcers was implemented. Audio-recorded interviews were transcribed verbatim. Transcripts were checked against audio recordings for accuracy. ANALYSIS: Inductive approach organized by phenomenological framework to identify recurrent codes, patterns, and themes were used for analysis. FINDINGS: The following three themes clearly emerged: 'foundations of epilepsy knowledge', 'using the toolkit in midwifery practice', and 'the toolkits influence on learning'. CONCLUSION: Participants described lack of epilepsy knowledge and experience prior to using the 'toolkit' and how being prepared optimized its use. They articulated how it enabled them to collate the epilepsy and treatment history, share risk management strategies, and expedite referrals appropriately. They discussed how it increased confidence, reduced fear, and inspired motivation toward learning. The results of this study will provide a foundation for future research exploring the impact that the 'toolkit' has on multidisciplinary care provision. IMPLICATIONS FOR PRACTICE: This small study demonstrated the 'toolkits' potential as a method of increasing knowledge about epilepsy and risk management. Initiation of its use in early pregnancy is intended to promote effective history taking, facilitate the identification of women at increased risk of morbidity and mortality, and encourage joint working through early multidisciplinary team referral and involvement. This paper is for the Special Issue :Prevent 21: SUDEP Summit - Time to Listen.

First-time mothers' expectations of the unknown territory of childbirth: Uncertainties, coping strategies and 'going with the flow'.

OBJECTIVE: To explore first-time mothers' expectations of labour and birth, coping strategies they adopt during pregnancy towards childbirth and coping strategies they expect to use during labour and birth. DESIGN: A qualitative Straussian grounded theory methodology was adopted, with data collected through semi-structured interviews in the third trimester of pregnancy. Ethical approval was gained. Data analysis included the processes of coding and conceptualising data, with constant comparison between data, literature and memos. SETTING: Three National Health Service (NHS) Trusts in England offering the choice of various birth settings including home, Freestanding Midwifery Unit (FMU) and Obstetric Unit (OU). PARTICIPANTS: Fourteen first-time pregnant women in good general health with a straightforward pregnancy (single fetus) and anticipating a normal birth. FINDINGS: Three themes were identified in regard to women's expectations of childbirth and coping strategies: (a) the unknown territory of labour and birth; (b) waiting for the unknown: coping strategies; (c) going with the flow. First-time mothers acknowledged labour and birth was an unknown territory, irrespective of the planned place of birth. While waiting for the unknown, the women put in place a number of coping strategies during pregnancy: preparing; avoiding; thinking about childbirth as a shared experience among women; relying on maternal instinct; relying on pharmacological pain relief; considering birth partner(s) as voice of reason. Overall, women were flexible in regard to their birth plan and open to change if needed, referring to this open-minded state as 'going with the flow'. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Women and their families may appreciate receiving accurate and realistic information from caregivers starting in pregnancy and continuing during labour and birth to alleviate the state of uncertainty typical of the childbearing event. The midwife should address the woman's uncertainties and help her 'go with the flow' in the labour continuum. The birth plan should also be revised by the midwife and woman together if they can no longer adhere to the original one.

Optimal healthcare delivery to care homes in the UK: a realist evaluation of what supports effective working to improve healthcare outcomes.

INTRODUCTION: care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. METHODS: a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. RESULTS: context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which 'wraps around' care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites. CONCLUSION: activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise.

Nursing priorities in Wales over the next five years.

The strategic goal for nursing and midwifery in Wales is to realise the full potential of the nursing and midwifery professions to meet, in partnership with others, the changing health and well-being needs of the people living in Wales.

Nursing associate role accepted for regulation.

The Nursing and Midwifery Council (NMC) has agreed to regulate the new nursing associate role.

Promoting professional behavior in practice.

Becoming a midwife is the 16th series of 'Midwifery basics' targeted at practicing midwives and midwifery students. The aim of these articles is to provide information to raise awareness of the impact of professionalism on women's experience, consider the implications for midwives' practice and encourage midwives to seed further information through a series of activities relating to the topic. In this fourth article of the series, Jancis Shepherd discusses the issues of maintaining confidentiality, use of social media and veracity of students' practice assessment documents, to demonstrate the need to uphold the NMC Code (2015a) in clinical practice.

Fitness to practise will be fit for the future.

The Nursing and Midwifery Council is often in the news, and most coverage relates to outcomes of our fitness to practise (FtP) hearings.

Let's all get home safely: a commentary on NICE and SCIE guidelines (NG27) transition between inpatient hospital settings and community or care home settings.

Safe and appropriate transition between inpatient settings and the community is one of the major challenges facing the modern NHS. The National Institute for Health and Care Excellence in conjunction with the Social Care Institute for Excellence published guidance on this challenging area in December 2015. This commentary provides context, summary and discussion of the key areas covered. The guidance particularly emphasises the importance of a person-centred approach in which patients are individuals and equal partners in the multidisciplinary team who should be treated with dignity and respect. Additionally, communication and information sharing is crucial both on admission and when taking a proactive approach to discharge, including the role of the discharge coordinator in liaising with community teams and arranging follow-up post-discharge. Self-care and the significance of carers are also highlighted as valuable in facilitating safe discharge and reducing readmissions. It is clear that in older people with complex needs, safe appropriate transition between hospital and community settings has a positive impact on patients and their carers. Given the financial and capacity pressures facing the NHS, strategies to reduce readmissions and prevent delays in discharge are increasingly important. These guidelines are therefore both timely and advocated to improve care for older people.