Nursing students experiences of end-of-life care.

BACKGROUND: Undergraduate nursing students spend a significant amount of time in clinical placements where they are involved in care at the end of a person's life and care after death. While their role is to provide compassionate care, some students feel wholly unprepared. AIMS: The aim of this qualitative study was to explore student nurses' experiences of care in death, dying and post death care, and to explore how students can be better prepared to provide such care. METHODS: This is a qualitative descriptive study that is concerned with the subjective reality of participant's experiences. FINDINGS: Six themes were developed from the analysis: first encounters with death and dying; preparedness; mentoring and support received; the caring role; striving to cope; working with families and working through COVID-19. CONCLUSION: Students described their experience of placements in end-of-life care as challenging, yet were also able to adopt ways to develop as compassionate practitioners.

Nurses' early and ongoing encounters with the dying and the dead: a scoping review of the international literature.

BACKGROUND: End-of-life care is high on policy and political agendas in the UK and internationally. Nurses are at the forefront of this, caring for dying patients, 'managing' the dead body, and dealing with the corporeal, emotional and relational dimensions of death. Little is known about nurses' prior or early professional experiences of and reactions to death, dying and the corpse and how these might influence practice. AIMS: To appraise the international literature on nurses' early experiences of death, dying and the dead body, to better understand how these might influence subsequent practice, and how this might inform our teaching of death, dying and last offices. METHODS: A scoping review was undertaken of peer-reviewed publications between, 2000 and 2019, which included nurses working in hospital, care homes and the community. Medline, PubMed, PsychINFO and CINAHL databases were searched and 23 papers meeting the inclusion criteria were read. Arksey and O'Malley's (2005) five-stage approach was adopted to scope the relevant international literature, using where relevant the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Selected papers were independently reviewed and subjected to thematic analysis, leading to the generation of five overarching themes. RESULTS: The five themes were: different philosophies of care; relationships; knowledge; impact of death; and giving care. The studies came from diverse geographical locations across different settings and were primarily qualitative in design. CONCLUSIONS: Students and registered nurses are impacted both positively and negatively by their early encounters with death and dying. Good communication with patients, families and between professionals, understanding of what constitutes a 'good' death, and high-quality mentorship and support were of particular importance.

Barriers and facilitators to adherence to group exercise in institutionalized older people living with dementia: a systematic review.

OBJECTIVES: Research suggests targeted exercise is important for people living with dementia, especially those living in residential care. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to group exercise of institutionalized older people living with dementia. METHODS: We searched all available electronic databases. Additionally, we searched trial registries (clinicaltrial.gov, and WHO ICTRP) for ongoing studies. We searched for and included papers from January 1990 until September 2017 in any language. We included randomized, non-randomized trials. Studies were not eligible if participants were either healthy older people or people suffering from dementia but not living in an institution. Studies were also excluded if they were not focused on barriers and facilitators to adherence to group exercise. RESULTS: Using narrative analysis, we identified the following themes for barriers: bio-medical reasons and mental wellbeing and physical ability, relationships dynamics, and socioeconomic reasons. The facilitators were grouped under the following thematic frames: bio-medical benefits and benefits related to physical ability, feelings and emotions and confidence improvements, therapist and group relationships dynamics and activity related reasons. CONCLUSIONS: We conclude that institutionalized older people living with dementia, even those who are physically frail, incontinent and/or have mild dementia can demonstrate certain level of exercise adherence, and therefore can respond positively to exercise programs. Tailored, individually-adjusted and supported physical activity, led by a knowledgeable, engaging and well communicating therapist/facilitator improves the adherence to group exercise interventions of institutionalized older people living with dementia.

'Doing it for real now' - The transition from healthcare assistant to newly qualified nurse: A qualitative study.

BACKGROUND: There has been increasing international research and policy interest concerning the transition from student to newly qualified nurse (NQN). However, the influence of previous employment as a healthcare assistant (HCA) on students' experiences of this transition is comparatively under-researched. AIMS AND OBJECTIVES: To explore the experiences of NQNs also employed as HCAs during their pre-registration education programme and how this prior and ongoing HCA experience influenced their transition experiences. DESIGN: Qualitative research design using a descriptive method. SETTING AND PARTICIPANTS: Former students (n = 14) of a unique four year, part-time, employer-sponsored pre-registration nursing programme, specifically designed for HCAs and delivered by supported open learning, located in different regions and nations of the United Kingdom who had qualified within the last two years. METHODS: Telephone interviews, digitally recorded, transcribed verbatim and analysed using NVivo8. RESULTS: Four themes described participants' experiences of transition: In at the deep end, Changing identities, Coming together and Scaffolding. Findings confirm existing literature that all NQNs appear to experience a similar overarching experience of transition, including those with prior HCA experience. However, familiarity with people, place and routines afforded by this previous experience appeared to ease transition, particularly if the NQNs stayed in their previous HCA work location. However, managing the dual roles of being both HCA and student and adapting to their changing identities were frequently cited as particular challenges. CONCLUSIONS: Van Gennep's Rites de Passage and Bridge's work on organisational change were combined to theoretically analyse participants' accounts of transition. This illustrated that transition is not always linear with clearly defined and bounded stages but can also be seen as a more undulating or organic process with curving, slanting and overlapping phases. NQNs can therefore simultaneously occupy more than once phase in their journey of transition. Implications for students, higher education and practice are highlighted.

Managers' role in maximising investment in continuing professional education.

Healthcare organisations face the challenge of delivering care in increasingly complex environments. To do so they depend on competent professionals, and continuing professional education (CPE) plays a major part in ensuring that staff maintain and develop their knowledge and skills. However, there is limited evidence of the effect of CPE on healthcare outcomes, and an emphasis on outcomes has overlooked the contribution of the processes that underlie effective CPE. This article reports the results of a study that explored a range of stakeholders' perceptions of the processes that maximise the positive effects of CPE on practice. Analysis of results shows that CPE can help improve care when supported by positive organisational cultures, effective partnership working between stakeholders and supportive learning environments that enable individuals to maximise their learning. This article discusses how managers play a pivotal role in creating positive cultures in which CPE can flourish by being role models and change agents, ensuring organisational strategic objectives are aligned with personal development plans, and by working collaboratively with education colleagues to ensure that learning from CPE is embedded in practice.

Ethnography: principles, practice and potential.

Ethnography is a methodology that is gaining popularity in nursing and healthcare research. It is concerned with studying people in their cultural context and how their behaviour, either as individuals or as part of a group, is influenced by this cultural context. Ethnography is a form of social research and has much in common with other forms of qualitative enquiry. While classical ethnography was characteristically concerned with describing 'other' cultures, contemporary ethnography has focused on settings nearer to home. This article outlines some of the underlying principles and practice of ethnography, and its potential for nursing and healthcare practice.

Illuminating the process: enhancing the impact of continuing professional education on practice.

BACKGROUND: There has been significant global investment in continuing professional education (CPE) to ensure healthcare professionals have the knowledge and skills to respond effectively to the needs of patients/service users. However, there is little evidence to demonstrate that this investment has had a tangible impact on practice. Furthermore, the current emphasis on evaluating outcomes has overlooked the importance of underlying processes which, when positive, are essential to good outcomes. OBJECTIVE: The aim of this study was to identify the processes that key stakeholders perceive to be most important in facilitating a positive impact of CPE on practice. DESIGN/METHOD: A qualitative design using two rounds of semi-structured interviews which were recorded and transcribed prior to analysis, informed by template analysis techniques. SETTING: Two acute trusts, one primary care trust and two higher education institutions in one geographical region in England. PARTICIPANTS: Representatives from four stakeholder groups-students, managers, educators and members of each healthcare organisation's governing board. A total of 35 interviews were conducted in the first round and 31 interviews in the second round (n=66). RESULTS: Four overarching themes were identified that illuminate stakeholders' perspectives of the important factors affecting the process of CPE: organisational structure, partnership working, a supportive learning environment and changing practice. CONCLUSIONS: This study suggests that a positive organisational culture, effective partnership working between key stakeholders with an understanding of each other's perspectives, aspirations and constraints, and a supportive learning environment in both the practice setting and education environment are central to establishing a culture and context where CPE can thrive and exert a positive influence on improving patient/service user experience and care. It is argued that an understanding of the processes that facilitate effective CPE is a crucial first step before it is possible to meaningfully evaluate outcomes.

'Ready to hit the ground running': Alumni and employer accounts of a unique part-time distance learning pre-registration nurse education programme.

BACKGROUND: This study explored the impact of The Open University's (OU) preregistration nursing programme on students' employability, career progression and its contribution to developing the nursing workforce across the United Kingdom. Designed for healthcare support workers who are sponsored by their employers, the programme is the only part-time supported open/distance learning programme in the UK leading to registration as a nurse. The international literature reveals that relatively little is known about the impact of previous experience as a healthcare support worker on the experience of transition, employability skills and career progression. OBJECTIVES: To identify alumni and employer views of the perceived impact of the programme on employability, career progression and workforce development. DESIGN/METHOD: A qualitative design using telephone interviews which were digitally recorded, and transcribed verbatim prior to content analysis to identify recurrent themes. SETTINGS: Three geographical areas across the UK. PARTICIPANTS: Alumni (n=17) and employers (n=7). Inclusion criterion for alumni was a minimum of two years' post-qualifying experience. Inclusion criteria for employers were those that had responsibility for sponsoring students on the programme and employing them as newly qualified nurses. RESULTS: Four overarching themes were identified: transition, expectations, learning for and in practice, and flexibility. CONCLUSIONS: Alumni and employers were of the view that the programme equipped them well to meet the competencies and expectations of being a newly qualified nurse. It provided employers with a flexible route to growing their own workforce and alumni the opportunity to achieve their ambition of becoming a qualified nurse when other more conventional routes would not have been open to them. Some of them had already demonstrated career progression. Generalising results requires caution due to the small, self-selecting sample but findings suggest that a widening participation model of pre-registration nurse education for employed healthcare support workers more than adequately prepares them for the realities of professional practice.

Embodied practice: rediscovering the 'heart' of nursing.

AIM: This article explores the importance of embodiment in nursing. It examines different sources of authoritative knowledge concerning the body and embodiment. It argues that dominant scientific and medical epistemologies of the body have displaced and marginalized embodied epistemologies, creating only a partial understanding of the embodied experiences of our patients and our own embodiment as nurses. BACKGROUND: Over the last 20 years, there has been a rapid expansion of theoretical literature concerning the body and embodiment, spanning a range of disciplines. The potential of these insights to the essentially 'body-based' practice of nursing is highly significant. However, although work in this area is now increasing, theoretical and empirical investigation of the body and embodiment in nursing has remained relatively neglected. DESIGN: Discussion paper. DATA SOURCES: Conventional approaches to systematic searching of the literature were not adopted for this conceptual paper. Seminal texts predominantly from nursing and sociology accompanied by more recent sources were used as a platform for theoretical reflection and to inform development of the conceptual arguments. IMPLICATIONS FOR NURSING: The paper proposes a corporeal (re)turn to nursing practice, one that recognizes the lived embodied experience of the patient and the embodied skill and knowledge of the nurse and examines the implications for contemporary person-centred nursing practice, research and education. CONCLUSION: At a significant juncture in nursing's history, when there is greater international focus on delivering higher standards of care, the paper calls for a repositioning of the place of embodiment in nursing.

A critical literature review exploring the challenges of delivering effective palliative care to older people with dementia.

AIM: This paper considers the challenges of delivering effective palliative care to older people with dementia and the possible strategies to overcome barriers to end-of-life care in these patients. BACKGROUND: In UK alone, approximately 100,000 people with dementia die each year and as the number of older people increases, dementia is set to become even more prevalent. Dementia is a progressive terminal illness for which there is currently no cure. Patients dying with dementia have significant health-care needs and in recent years it has been recognised that palliative care should be made available to everyone regardless of diagnosis, as this improves comfort and quality of life. Despite this, patients dying with dementia are often still not given access to palliative care services. METHOD: A review of English language literature published after 1996 to the present day relating to older people with dementia during the terminal phase of their illness. RESULTS: Twenty-nine articles met inclusion criteria for the review. Most originated from North America and UK and were mostly quantitative in nature. Four key themes were identified: difficulties associated with diagnosing the terminal phase of the illness (prognostication); issues relating to communication; medical interventions; and the appropriateness of palliative care intervention. CONCLUSIONS: This review reinforces the importance of providing appropriate palliative care to individuals suffering from end-stage dementia and identifies some of the barriers to extending such specialist palliative care provision. RELEVANCE TO PRACTICE: There is an urgent need to improve palliative care provision for older people with end-stage dementia and, in addition, more research is required on the needs of patients entering the terminal phase of dementia to assist the allocation of appropriate resources and training to ensure quality and equality in the provision of end-of-life care.

A review of the factors involved in older people's decision making with regard to influenza vaccination: a literature review.

AIMS AND OBJECTIVES: The aim of this paper was to develop an understanding of the factors involved in older people's decision making with regard to influenza vaccination to inform strategies to improve vaccine uptake and reduce morbidity and mortality. BACKGROUND: Influenza is a major cause of morbidity and mortality world-wide. In the UK, it accounts for 3,000-6,000 deaths annually; 85% of these deaths are people aged 65 and over. Despite this, and the widespread and costly annual government campaigns, some older people at risk of influenza and the associated complications remain reluctant to take advantage of the offer of vaccination. METHODS: A review of the English language literature referring to older people published between 1996 and 2005 was the method used. Inclusion and exclusion criteria were identified and applied. RESULTS: The majority of the literature was quantitative in nature, investigating personal characteristics thought to be predictors of uptake, such as age, sex, co-morbidity, educational level, income and area of residence. However, there was little discussion of the possible reasons for the significance of these factors and conflict between findings was often evident, particularly between studies employing different methodologies. Other factors identified were prior experience, concerns about the vaccine, perceived risk and advice and information. RELEVANCE TO CLINICAL PRACTICE: The wealth of demographic information available will be useful at a strategic level in targeting groups identified as being unlikely to accept vaccination. However, the promotion of person-centred ways of working that value the health beliefs, attitudes, perceptions and subjective experiences of older people is likely to be more successful during individual encounters designed to promote acceptance. Without more research in investigating these concepts, our understanding is inevitably limited.

Calculating the costs of work-based training: the case of NHS Cadet Schemes.

BACKGROUND: The worldwide shortage of registered nurses [Buchan, J., Calman, L., 2004. The Global Shortage of Registered Nurses: An Overview of Issues And Actions. International Council of Nurses, Geneva] points to the need for initiatives which increase access to the profession, in particular, to those sections of the population who traditionally do not enter nursing. This paper reports findings on the costs associated with one such initiative, the British National Health Service (NHS) Cadet Scheme, designed to provide a mechanism for entry into nurse training for young people without conventional academic qualifications. The paper illustrates an approach to costing work-based learning interventions which offsets the value attributed to trainees' work against their training costs. OBJECTIVE: To provide a preliminary evaluation of the cost of the NHS Cadet Scheme initiative. DATA SOURCE: Questionnaire survey of the leaders of all cadet schemes in England (n=62, 100% response) in December 2002 to collect financial information and data on progression of cadets through the scheme, and a follow-up questionnaire survey of the same scheme leaders to improve the quality of information, which was completed in January 2004 (n=56, 59% response). PRINCIPAL FINDINGS: The mean cost of producing a cadet to progress successfully through the scheme and onto a pre-registration nursing programme depends substantially on the value of their contribution to healthcare work during training and the progression rate of students through the scheme. The findings from this evaluation suggest that these factors varied very widely across the 62 schemes. Established schemes have, on average, lower attrition and higher progression rates than more recently established schemes. Using these rates, we estimate that on maturity, a cadet scheme will progress approximately 60% of students into pre-registration nurse training. CONCLUSIONS: As comparative information was not available from similar initiatives that provide access to nurse training, it was not possible to calculate the cost effectiveness of NHS Cadet Schemes. However, this study does show that those cadet schemes which have the potential to offer better value for money, are those where the progression rates are good and where the practical training of cadets is organised such that cadets meet the needs of patients which might otherwise have to be met by non-professionally qualified staff.