Developing the Heart Failure Specialist Nurse Competency Framework.

The aim of this article is to outline the underpinning conceptual principles of advanced nursing and competency embedded in the Heart Failure Specialist Nurse Competency Framework, launched in January 2021. The authors refer to Benner's novice to expert pedagogy and explore how this provides a robust framework on which to assess the progress of the heart failure specialist nurse. Some key considerations are discussed, for example the importance of constructive feedback and feed-forward in the individual's learning cycle. Finally, plans for the future are discussed and the importance of evaluation in the authors' ongoing commitment to improving the learning experience.

Test@work: evaluation of workplace HIV testing for construction workers using the RE-AIM framework.

BACKGROUND: Community testing for HIV can reach previously untested populations but is rarely offered in workplaces. Targeting the construction sector could reach workers from high risk populations. METHODS: The RE-AIM framework was used to evaluate Test@Work, a workplace HIV testing intervention for construction workers implemented at 21 events (10 companies) in the UK. Test@Work had three components: 1) an online health toolkit to inform managers about health screening and HIV testing; 2) general health checks; and 3) opt-in HIV consultation and testing. Quantitative data were collected using registration and exit questionnaires with workers (n = 426) and pre/post-event questionnaires with managers (n = 15), with qualitative analysis of free text responses. RESULTS: Reach 426 individuals had health checks. Participants were broadly representative of the UK construction workforce, but with a higher proportion of permanent workers. Most workers reported being in good health but also believed their work had an adverse impact on their health. Effectiveness: 97% of health check participants opted to have a consultation about sexual health (n = 413) and 82% had an HIV test (n = 348), of whom 78% had not previously been tested. All HIV tests were non-reactive. HIV testing at work was considered acceptable by most participants. Participants reported learning new things about their health (74%), said they would make changes as a result (70%) and felt confident of success (median score 8/10). Adoption: Recruitment of companies was challenging and time consuming. Seven of the participating companies were very large, employing over 1000 workers, which is atypical of construction generally. IMPLEMENTATION: All events were completed as planned and were considered successful by all parties. Maintenance: All managers would arrange further events if they were offered them. Six managers incorporated sexual health awareness into their health programmes, but this was not possible for many as health agendas were set centrally by their organisations. CONCLUSIONS: Opt-in HIV testing, when embedded within a general health check, has high uptake and acceptability in the UK construction sector, and reaches individuals at risk for HIV who may not otherwise attend for testing. Cost-effectiveness of this approach is yet to be determined. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04292002 .

Usability and value of a digital learning resource in nursing education across European countries: a cross-sectional exploration.

BACKGROUND: Higher education is responsible for providing education that meets international benchmarks relevant to the needs of the international community. Due to the increase of digital tools in higher education, the possibility of sharing learning resources across nations has expanded. In the current project, a Norwegian university invited universities in Spain and the United Kingdom to adapt and translate e-learning resources originally developed for Norwegian nursing students for use within their respective Bachelor in Nursing programmes. AIM: The aim of the current study was to gain insights into the usability and value for learning of e-compendiums shared and implemented across three European universities. METHODS: The study adopted a descriptive cross-sectional design and included nursing students from the University of Nottingham, Valencia Catholic University, and the University of Stavanger. Data were collected in Autumn 2017 through a questionnaire adapted from the validated "Centre for Excellence in Teaching and Learning Reusable Learning Object evaluation questionnaire" The questionnaire consisted of 19 items that included two aspects: e-compendiums' value for learning and e-compendiums' usability. The different study sites were compared using a binary logistic regression analysis. Subgroups of students were compared based on their gender and age. RESULTS: A total of 480 nursing students participated in the study. The e -compendiums were overall positively rated, especially for reinforcing and retaining knowledge. Compared to the students from the University of Stavanger, students from Valencia Catholic University rated the e-compendiums more positively in most aspects of learning. Students from University of Nottingham found the e-compendiums to be more important for learning engagement compared to students at the Norwegian study site, and no differences were found in any other aspects of learning. Younger students rated the interactivity and visual components as more important compared to older students. CONCLUSIONS: Students from the University of Nottingham and Valencia Catholic University seem to accept the e-compendiums despite the fact that they were originally developed for use in another country. We argue that, when sharing e-learning resources across countries, an adaptation and translation process that includes a multicultural and multidisciplinary perspective should be carried out.

WHIRL Study: Workplace Health Interprofessional Learning in the Construction Industry.

Interprofessional learning (IPL) is essential to prepare healthcare trainees as the future public health workforce. WHIRL (Workplace Health InteRprofessional Learning) was an innovative IPL intervention that engaged volunteer healthcare trainees (n = 20) in multi-professional teams to deliver health checks (n = 464), including tailored advice and signposting, to employees in the UK construction industry (across 21 events, 16 sites, 10 organisations) as part of an ongoing research programme called Test@Work. Volunteers undertook a four-part training and support package of trainer-led education, observations of practice, self-directed learning and clinical supervision, together with peer mentoring. In a one-group post-test only design, IPL outcomes were measured using the Inventory of Reflective Vignette-Interprofessional Learning (IRV-IPL), and the psychometric properties of the IRV-IPL tool were tested. WHIRL demonstrably improved healthcare trainees' interprofessional skills in all five areas of collaboration, coordination, cooperation, communication, and commendation. The IRV-IPL tool was found to be a valid and reliable measure of interprofessional competencies across three scenarios; before and after health promotion activities, and as a predictor of future health promotion competence. This industry-based workplace IPL programme resulted in the attainment of health check competencies and bridged the gap between research, education and clinical practice.

Informal carers' experiences of caring for a person with heart failure in a community setting.

Heart failure (HF) is a life-limiting condition with a poor prognosis and unpredictable disease trajectory. HF brings physical and emotional challenges for patients and their carers. Predominantly the informal carer population consists of older females, however, caring is evolving as longevity increases and complex conditions are becoming more commonplace. Consequently, more men and younger people are contributing to daily care. The aim of this study was to explore the positive as well as negative dimensions of caring in HF across a range of carer characteristics. Fourteen semi-structured interviews were conducted with informal carers of people with HF in the UK (median age 71; female 10). Interviews were transcribed verbatim and analysed with the assistance of NVivo10 using Interpretative Phenomenological Analysis. Findings from the study demonstrated that most participants considered caring as integral to their relationships. Dimensions facilitating positivity in caring included compassion, thoughtfulness and understanding. An ability to cope was influenced by a range of attributes including quality of relationships in the carer/patient dyad and with formal social care providers who offered access to tailored and timely information and support. The unpredictable HF disease trajectory influenced the carer experience and enhanced the challenges encountered. The information needs of carers were not always adequately met and younger adult carers expressed particular difficulties with appropriate information and support. Expectations of our informal carer population are increasing and evolving. Health and social care policy requires innovative proposals for the funding and delivery of health and social care that has the contribution made by informal carers at its core.

Capturing the carer's experience: a researcher's reflections.

AIM: To reflect on the methodological challenges of conducting a study exploring the effects on quality of life of being an informal carer for a person with palliative heart failure, as well as the factors that influence a carer's perception of caring. BACKGROUND: There are multi-faceted influences on the positive and negative effects of being a carer for a patient with palliative heart failure. By conducting a mixed methods study the aim was to examine and explore similarities and differences of the phenomenon of being a carer. DATA SOURCES: Quantitative data obtained from the Family Quality of Life Questionnaire (FAMQOL), and qualitative data obtained from 14 interviews with informal carers of patients living with palliative heart failure. REVIEW METHODS: The study was conducted as part of a PhD, University of Sheffield, and the supervisory team reviewed the research process throughout the study. DISCUSSION: The study had a two-phase sequential mixed methods design. A sample of carers was recruited from heart failure nurse service caseloads in a UK urban setting. Carers were invited to complete the Family Quality of Life Questionnaire, a tool developed for carers of patients with heart failure. Participants were also asked to provide contact details if they were willing to be interviewed for the second phase of the study. CONCLUSION: The study highlights important methodological considerations for recruiting carers. As the intention was to begin the analysis of the questionnaires before beginning the second phase of the study, the researcher was compelled to consider how integration was maintained and how to improve access to carers for research. IMPLICATIONS FOR PRACTICE: The complexities associated with the population in this study led the researcher to use a pragmatic design to address research questions. When reflecting on the research and the challenges associated with recruiting to the quantitative phase of the study, the researcher used an iterative approach to meet the unfolding complexities. Such an approach could prove beneficial for mixed methods studies that aim to engage with hard to reach populations.

Tools to measure quality of life and carer burden in informal carers of heart failure patients: a narrative review.

BACKGROUND: Heart failure is a complex cardiac syndrome prevalent in an older population. Caring for heart failure patients through the disease trajectory presents physical and emotional challenges for informal carers. Carers have to deal with clinically unstable patients, the responsibility of managing and titrating medication according to symptoms and frequent admissions to acute care. These challenges compound the demands on caregivers' physical and psychosocial well-being. Alongside the negative impact of being a carer, positive aspects have also been demonstrated; carers describe feelings of shared responsibility of caring with professional carers and the reward of supporting a loved one, which creates a new role in their relationship. AIM: This review explores the dimensions that impact caregiver burden and quality of life in carers of patients with heart failure and highlights both the negative and positive aspects of being an informal carer for heart failure patients. DESIGN: This review followed the processes recommended for a narrative review. Studies identified were selected systematically following the PRISMA guidelines. DATA SOURCES: Searches were conducted using the Medical Subject Headings (MeSH) and keywords of the following search engines: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Applied Social Sciences Index and Abstracts (ASSIA), PsycINFO and Cochrane for literature published until January 2012. RESULTS: Quality assessment of the studies was conducted using quality indicators, and the studies included in this review were categorised as fair or good according to the criteria. Of the 1008 studies initially identified, 16 studies met the inclusion criteria. A thematic synthesis was undertaken, and the following themes were identified Perceived carer control; Mental and emotional well-being; Types and impact of caregiving tasks; Impact of patients' physical condition; Impact of age/gender/demographic factors; Positive aspects of caregiving. CONCLUSIONS: This review highlights evidence that informal carers supporting patients with heart failure face many challenges impacting their physical and mental well-being. The studies described provide an insight into the individual dimensions that make a carer particularly vulnerable, namely, younger carers, female carers and carers with existing physical and emotional health issues. Additionally, there are external influences that increase risk of burden, including New York Heart Association Score status of the patient, if the patient has had recurrent emergency admissions or has recently been discharged home and the level of social support available to the carer. A further finding from conducting this review is that there are still limited measures of the positive aspects of caregiving.

Carer support from a community-based heart specialist nurse service.

This article describes carers' experiences of the support to them by a specialist heart failure nurse (SHFN) service working in the community. In particular, it focuses on the elements of the service they felt to be beneficial to them in their roles as carers. Four carers were interviewed in their own homes. From the interviews, three key themes emerged: education, rapport/ongoing suport and financial concerns. Overall, there was a high level of satisfaction regarding the education, and particularly the medication advice, the the SHFN provided. The role of the SHFN as a nurse prescriber was highly valued. Carers also appreciated the rapport they had with the SHFN. The case management approach was seen to enhance the relationship with the carer as the SHFN coordinated care throughout the patient's disease trajectory. In addition, participants held a great respect for the SHFN's clinical expertise and were reassured that support was available should they need it. Financial concerns led to the most emotive dialogue. The evaluation has outlined the important role that an SHFN can offer in supporting carers. As case managers, SHFNs work opportunistically and proactively to recognize carer fatigue and implement appropriate strategies. As the health service in England moves into a challenging economic climate of commissioning services, it is important that the added value SHFNs offer in supporting carers is recognized.

Reflect for success: recommendations for mentors managing failing students.

Failing a student nurse for not meeting clinical competency on a practice placement can be a distressing and traumatic event for both student and community nurse mentor. This paper describes how a reflective model can be used to support practitioners' to come to terms with the decision and action of failing a student and dealing with the aftermath of the final interview.