Competency versus proficiency: trying to develop an understanding of these terms in the context of practice learning.

The language of nurse education in the UK has shifted from 'competency' to 'proficiency' since 2018. The shift in language has been poorly articulated leaving individual higher education institutions, practice supervisors and assessors to interpret what these terms mean in relation to assessing student nurses. There appeared to be some confusion regarding the interpretation of the term proficiency among those who engaged in an exchange on the topic via Twitter. Students may focus on the procedure-based checklists within the standards. The relationship between proficiency and implementing a person-centred approach to care remains unclear.

An integrative review exploring the impact of Electronic Health Records (EHR) on the quality of nurse-patient interactions and communication.

AIM: To explore how nurses' use of electronic health records impacts on the quality of nurse-patient interactions and communication. DESIGN: An integrative review. DATA SOURCES: MEDLINE®, CINAHL®, PscyINFO, PubMed, BNI and Cochrane Library databases were searched for papers published between January 2005 and April 2022. REVIEW METHODS: Following a comprehensive search, the studies were appraised using a tool appropriate to the study design. Data were extracted from the studies that met the inclusion criteria relating to sample characteristics, methods and the strength of evidence. Included empirical studies had to examine interactions or communication between a nurse and patient while electronic health records were being used in any healthcare setting. Findings were synthesized using a thematic approach. RESULTS: One thousand nine hundred and twenty articles were initially identified but only eight met the inclusion criteria of this review. Thematic analysis revealed four key themes, indicating that EHR: impedes on face-to-face communication, promotes task-orientated and formulaic communication and impacts on types of communication patterns. CONCLUSION: Research examining nurse-patient interactions and communication when nurses' use electronic health records is limited but evidence suggests that closed nurse-patient communications, reflecting a task-driven approach, were predominantly used when nurses used electronic health records, although some nurses were able to overcome logistical barriers and communicate more openly. Nurses' use of electronic health records impacts on the flow, nature and quality of communication between a nurse and patient. IMPACT: The move to electronic health records has taken place largely without consideration of the impact that this might have on nurse-patient interaction and communication. There is evidence of impact but also evidence of how this might be mitigated. Nurses must focus future research on examining the impact that these systems have, and to develop strategies and practice that continue to promote the importance of nurse-patient interactions and communication. PATIENT OR PUBLIC CONTRIBUTION: Studies examined within this review included patient participants that informed the analysis and interpretation of data.

Giving nurses a voice through 'listening to staff' conversations to inform nurse retention and reduce turnover.

Health and social care employers in the UK cannot afford to lose nurses given the current nursing workforce crisis. A variety of staff engagement initiatives aim to improve employee retention. This article describes how Listening to Staff (L2S) events were used as part of a service review to inform nurse retention strategies in one acute hospital trust. Over a 3-year period, 576 nurses took part in L2S events that examined nurses' perspectives of teamworking and support as well as career plans in areas with high nurse turnover rates. Comparative content analysis was used to analyse narrative data, which informed managers' retention plans. Examination of retention data before and after L2S events showed nursing turnover decreased, suggesting a variety of strategies to retain staff may have improved nurse retention. Findings imply capturing nurses' perceptions through staff engagement events may offer solutions for nurse retention.

Reducing variations in clinical nurse educator roles: a service improvement project standardising roles and career pathways.

BACKGROUND: There is limited research evaluating the implementation and effectiveness of clinical nurse educator (CNE) roles in clinical practice. UK employers tend to use generic nursing job profiles, although the definition, expectations and implementation of nurse educator roles are interpreted differently between employers. AIM: This project intended to reduce variation and standardise job titles, job descriptions and job plans for CNEs ranging from band 5 to band 7 and identify the academic requirements and professional experience required of each band. METHODS: An evaluative service review of existing CNE roles was conducted across a large division of a major NHS hospital trust. Focus group interviews were conducted to identify CNEs' and matrons' perceptions of the role. FINDINGS: Themes identified from the coding of narrative data included: the importance of the role; variations in expectations of the role, job titles, job descriptions and plans; and a lack of career progression pathways. CONCLUSION: This service improvement project demonstrates that a standardised approach to the implementation of CNE roles can be achieved with the support of a unified senior nursing team. Clearer role definition and career progression pathways would improve job satisfaction and may help retain CNEs in post.

Interprofessional education in geriatric medicine: towards best practice. A controlled before-after study of medical and nursing students.

OBJECTIVES: To investigate nursing and medical students' readiness for interprofessional learning before and after implementing geriatric interprofessional education (IPE), based on problem-based learning (PBL) case scenarios. To define the optimal number of geriatric IPE sessions, the size and the ratio of participants from each profession in the learner groups, the outcomes related to the Kirkpatrick four-level typology of learning evaluation, students' concerns about joint learning and impact of geriatric IPE on these concerns. The study looked at the perception of roles and expertise of the 'other' profession in interprofessional teams, and students' choice of topics for future sessions. Students' expectations, experience, learning points and the influence on the understanding of IP collaboration, as well as their readiness to participate in such education again were investigated. DESIGN: A controlled before-after study (2014/2015, 2015/2016) with data collected immediately before and after the intervention period. Study includes additional comparison of the results from the intervention with a control group of students. Outcomes were determined with a validated 'Readiness for Interprofessional Learning' questionnaire, to which we added questions with free comments, combining quantitative and qualitative research methods. The teaching sessions were facilitated by experienced practitioners/educators, so each group had both, a clinician (either geratology consultant or registrar) and a senior nurse. PARTICIPANTS: 300 medical, 150 nursing students. SETTING: Tertiary care university teaching hospital. RESULTS: Analysis of the returned forms in the intervention group had shown that nursing students scored higher on teamwork and collaboration post-IPE (M=40.78, SD=4.05) than pre-IPE (M=34.59, SD=10.36)-statistically significant. On negative professional identity, they scored lower post-IPE (M=7.21, SD=4.2) than pre-IPE (M=8.46, SD=4.1)-statistically significant. The higher score on positive professional identity post-IPE (M=16.43, SD=2.76) than pre-IPE (M=14.32, SD=4.59) was also statistically significant. Likewise, the lower score on roles and responsibilities post-IPE (M=5.41, SD=1.63) than pre-IPE (M=6.84, SD=2.75).Medical students scored higher on teamwork and collaboration post-IPE (M=36.66, SD=5.1) than pre-IPE (M=32.68, SD=7.4)-statistically significant. Higher positive professional identity post-IPE (M=14.3, SD=3.2) than pre-IPE (M=13.1, SD=4.31)-statistically significant. The lower negative professional identity post-IPE (M=7.6, SD=3.17) than pre-IPE (M=8.36, SD=2.91) was not statistically significant. Nor was the post-IPE difference over roles and responsibilities (M=7.4, SD=1.85), pre-IPE (M=7.85, SD=2.1).In the control group, medical students scored higher for teamwork and collaboration post-IPE (M=36.07, SD=3.8) than pre-IPE (M=33.95, SD=3.37)-statistically significant, same for positive professional identity post-IPE (M=13.74, SD=2.64), pre-IPE (M=12.8, SD=2.29), while negative professional identity post-IPE (M=8.48, SD=2.52), pre-IPE (M=9, SD=2.07), and roles and responsibilities post-IPE (M=7.89, SD=1.69), pre-IPE (M=7.91, SD=1.51) shown no statistically significant differences. Student concerns, enhanced understanding of collaboration and readiness for future joint work were addressed, but not understanding of roles. CONCLUSIONS: Educators with nursing and medical backgrounds delivered geriatric IPE through case-based PBL. The optimal learner group size was determined. The equal numbers of participants from each profession for successful IPE are not necessary. The IPE delivered by clinicians and senior nurses had an overall positive impact on all participants, but more markedly on nursing students. Surprisingly, it had the same impact on medical students regardless if it was delivered to the mixed groups with nursing students, or to medical students alone. Teaching successfully addressed students' concerns about joint learning and communication and ethics were most commonly suggested topics for the future.

Developing and evaluating a foundation preceptorship programme for newly qualified nurses.

In 2014, an innovative, three-tiered foundation preceptorship programme for newly qualified nurses was developed in Oxford University Hospitals NHS Foundation Trust. The programme was to be mandatory for newly qualified nurses commencing Band 5 posts in the trust, and has a structured curriculum that integrates skills development, preceptorship and clinical supervision. Aim To evaluate the Oxford University Hospitals NHS Foundation Trust foundation preceptorship programme for newly qualified nurses commencing Band 5 posts in the trust. Method Data were collected through questionnaires and focus groups with newly qualified nurses and nurse managers in the trust. Findings Respondents indicated the foundation preceptorship programme had positive value and improved the experience of newly qualified nurses during their first year of clinical practice. Newly qualified nurses wished to regularly reflect with experienced nurses and obtain feedback on their practice from clinical experts to develop their clinical skills. A professionally-regulated agreed percentage of preceptor-preceptee supervision time may enhance preceptorship standards. Conclusion The foundation preceptorship programme had several benefits for newly qualified nurses and nurse managers, and their feedback on the programme was positive. The development and evaluation of the foundation preceptorship programme may inform the future education and training of newly qualified nurses during their first year in clinical practice.

Intentional Rounding: a staff-led quality improvement intervention in the prevention of patient falls.

AIMS AND OBJECTIVES: This study designed and evaluated the use of a specific implementation strategy to deliver a nursing staff-led Intentional Rounding intervention to reduce inpatient falls. BACKGROUND: Patient falls are a common cause of harm during hospital treatment. Intentional Rounding has been proposed as a potential strategy for prevention, but has not received much objective evaluation. Previous work has suggested that logical interventions to improve patient care require an integrated implementation strategy, using teamwork training and systems improvement training, to instigate positive change and improvement. METHODS: Customised Intentional Rounding was implemented and evaluated as part of a staff-led quality improvement intervention to reduce falls on a neuroscience ward. Intentional Rounding was instigated using a prespecified implementation strategy, which comprised of: (1) engagement and communication activities, (2) teamwork and systems improvement training, (3) support and coaching and (4) iterative Plan-Do-Check-Act cycles. Process (compliance with hourly visiting to patients by staff) and outcome (incidence of falls) measures were recorded pre- and postintervention. Falls measured on the active ward were compared with incidence of falls in 50 wards across the rest of the same Trust. RESULTS: There was a 50% reduction in patient falls on the active ward vs. a minimal increase across the rest of the Trust (3·48%). Customised Intentional Rounding, designed by staff specifically for the context, appeared to be effective in reducing patient falls. CONCLUSIONS: Improvement programmes based on integrating teamwork training and staff-led systems redesign, together with a preplanned implementation strategy, can deliver effective change and improvement. RELEVANCE TO CLINICAL PRACTICE: This study demonstrates, through the implementation of a specific strategy, an effective improvement intervention to reduce patient falls. It provides insight into the effective design and practical implementation of integrated improvement programmes to reduce risk to patients at the frontline.

Intentional rounding: a review of the literature.

Intentional rounding is a structured approach whereby nurses conduct checks on patients at set times to assess and manage their fundamental care needs. Concerns about poor standards of basic nursing care have refocused attention on the need to ensure fundamental aspects of care are delivered reliably. A literature review was conducted to inform nurses planning to use this approach in their practice and to direct future research in this area. The aim is to explore the implementation and use of intentional rounding and its effectiveness in improving patient care.