Iceland Final

Embed Size (px)

Citation preview

  • 8/21/2019 Iceland Final

    1/34

    Advanced Practice Nurses: Promotingevidence based practice andcapturing impact: lessons from two

    UK studies

    Ann McDonnell

    Shefeld Hallam University

    UK 

  • 8/21/2019 Iceland Final

    2/34

    The City of Sheeld

    Britain’s 5th largest city• Population of 530,300• Home to two universities and over 45,000 students• England's greenest city: 150 woodlands, 50 public parks

    • One third of the city lies

    within the Peak District NationalPark

    •  A thriving cultural scene

  • 8/21/2019 Iceland Final

    3/34

    !aculty of "ealth and #ellbeing

    • Over 600 staff and over

    7500 students

    • We are one of the largest

    education roviders for

    radiotheray! nursing!

    hysiotheray and sort

    in the "#

  • 8/21/2019 Iceland Final

    4/34

    We are renowned for the $uality of our

    research and have one of the highest

    levels of research generated inco%efro% any new "# university

    http://www.shu.ac.uk/research/hsc/

  • 8/21/2019 Iceland Final

    5/34

    mpowerin! "rontline sta# to deliverevidence $ased care: the contri$ution o"nurses in A%& roles

    'apturin! the impact o" nurse consultantroles

    Two studies

  • 8/21/2019 Iceland Final

    6/34

    !acilitating the lin$ between

    evidence and practice: the processof $nowledge%bro$ering underta$enby advanced practice nurses &APNs'

    (esearch )eam:Shefeld Hallam UniversityUniversity o" Shefeld

    *unded $y Department o" Health +n!land,&ursin! -uality nitiative %olicy (esearch %ro!ramme

  • 8/21/2019 Iceland Final

    7/34

    Any nurse workin! in the area o" adultnursin! or pu$lic health whose roleinvolved an element o" clinical practice in

    which they demonstrated e0pertknowled!e and skill.

    ncluded

    ◦ clinical nurse specialists◦ nurse consultants◦ nurse practitioners

    ◦ practice development nurses

    (e)nition of APN

  • 8/21/2019 Iceland Final

    8/34

    A study e0aminin! the contri$ution o"advanced practice nurses +A%&s, topromotin! evidence1$ased practice amon!

    "ront1line sta# Survey $y postal 2uestionnaire o" A%&s

    workin! in 3 SHAs in n!land +n 4 566,

    'ase studies o" 78 A%&s

    *verview of pro+ect

  • 8/21/2019 Iceland Final

    9/34

    %urposive samplin! o" survey respondents toachieve ma0imum variation in:

    clinical speciality

    type o" role type o" or!anisation

    ways o" workin! with "ront1line sta# 

    !eo!raphical location

    Case study methods % sampling

  • 8/21/2019 Iceland Final

    10/34

    *inal sample o" 78 A%&s were our 9cases9

    6 in1depth case studies and 5 short casestudies

    e.!. ); nurse specialist practicedevelopment nurse lead nurse "or carehomes nurse consultant in se0ual health

    Sample

  • 8/21/2019 Iceland Final

    11/34

    (ata collection , short casestudies &n - ./'

    Particiant Data collection

    APN In-depth interview

    Frontline staff andmanagers

    (n = 3 to 6)

    Semi-struturedindividual interview

  • 8/21/2019 Iceland Final

    12/34

    (ata collection , in depth casestudies &n-0'

    Particiant Data collection

     APN &n'deth interview

    Non'articiant o(servation

    )ollow u in'dethinterview

    )rontline staff and %anagers

    *n + ,0 to -./

    e%i'structured individualinterview

    Patients and fa%ily%e%(ers

    *n + 0 to ,,/

    e%i'structured individualinterview

  • 8/21/2019 Iceland Final

    13/34

    !indings from thecase studies

  • 8/21/2019 Iceland Final

    14/34

    A move away "rom

  • 8/21/2019 Iceland Final

    15/34

     )he human "orces $ehind knowled!etrans"er that help $uild relationships andnetworks "or sharin! e0istin! researchideas and stimulatin! new work +'HS(*

    7@@6,

    A%&s act as knowled!e $rokers $y creatin!links $etween di#erent practice

    communities in particular actin! asintermediaries $etween the clinical andresearch communities +Milner et al 7@@6,

    Knowledge bro$ering

  • 8/21/2019 Iceland Final

    16/34

    see mysel" as a resource "or "ront1line sta# in terms o""acilitatin! evidence1$ased practice. have the in"ormation theevidence i" you like make it availa$le to them and help themapply it in practice. (esearch can $e difcult to understand andso it=s a$out makin! it more accessi$le helpin! them see theimplications "or practice incorporatin! it into !uidelines that they

    can use.Clinical nurse specialist  

     )hey +A%&s, need to $e a$le to translate research knowled!e "orpractical implementation t=s a$out $rid!in! that !ap $etweenthe theoretical and the practical in developin! policy which thendirects practice.

    Director of Nursing

    Knowledge%bro$ering

  • 8/21/2019 Iceland Final

    17/34

     )wo aspects:

    Mana!in! knowled!e

    %romotin! uptake o" knowled!e

    Knowledge%bro$ering

  • 8/21/2019 Iceland Final

    18/34

    !eneratin! knowled!e

    accumulatin! knowled!e

    synthesisin! knowled!e

    translatin! knowled!e

    disseminatin! knowled!e

    Knowlege management

  • 8/21/2019 Iceland Final

    19/34

    mpirical evidence◦ (esearch◦ ?r!anisational evidence B audit / service evaluation

    %ro"essional e0perience◦ It’s through the experience you gain, being in a situation over

    and over again and having to deal with it. The amount of

    observation and contact with patients in terms of seeing what you do and what happens as a result of that. roviding care,evaluating what happens, seeing the e!ect, re"ecting on theoutcome #NC alliative care$

    %ersonal knowled!e a$out patients◦ I wonder if any of the breast care nurses had breast cancer

    because they seem so %nowledgeable about how it really is.They’ve ta%en so much from all of their patients, absorbedthings that have been said to them and put it together #atient$

    2enerating $nowledge

  • 8/21/2019 Iceland Final

    20/34

    They #&Ns$ are a great resource for information to help mein my 'ob. They have up(to(date %nowledge, they will beaware of things that I am not aware of as they are expertsin their own )eld.

    District nurse

    (epository o" evidence◦ %rimary research Cndin!s◦ (esearch products such as clinical !uidelines◦ ;est practice when research was lackin!◦ ?r!anisational in"ormation B how to make thin!s happen◦ n"ormation relatin! to individual patients

    %rocess o" accumulatin!◦ Active searchin!◦ &etworkin!◦ 'onduit "or or!anisational evidence

    Accumulating $nowledge

  • 8/21/2019 Iceland Final

    21/34

    ;rin!in! to!ether di#erent types o"knowled!e to present a composite pictureto in"orm practice

    Synthesisin! research evidencepro"essional e0pertise and patient

    e0perience

    Synthesising $nowledge

  • 8/21/2019 Iceland Final

    22/34

    nterpretin! the si!niCcance o" evidence and e0pressin! itin plainer terms "or di#erent audiences B "rontline sta#patients mana!ers

    valuatin! evidence◦ (esearch evidence not taken at "ace value $ut evaluated

    re!ardin! applica$ility in local settin!s◦ *esearch may indicate that a drug wor%s well for treating a

     particular condition. +ut the trial will have been done in acontrolled way, the sample will have been selected to ful)l particular criteria and the real world is not li%e that. atientsoften have multiple pathologies which mean that the drug maynot be the most appropriate one for an individual patient. eneed to ta%e account of the whole picture before acting on whatappears to be robust evidence. CN-

    nterpretin! evidence◦ %resentin! evidence in a way that is readily

    understanda$le to the audience Distillin! evidence

    ◦ Drawin! to!ether di#erent types and sources o" evidence topresent it in a more concise "ormat that is accessi$le to end

    users

    Translating $nowledge

  • 8/21/2019 Iceland Final

    23/34

    Active versus passive dissemination

    *ormal◦ ducation and trainin!◦

    &etworkin! B e.!. link nurse schemes◦ Multi1disciplinary team meetin!s

    n"ormal◦ mpromptu encounters◦

  • 8/21/2019 Iceland Final

    24/34

    'apacity $uildin! e.!. shadowin! link nurseschemes

    'linical pro$lem solvin! e.!. workin! with"rontline sta# to solve clinical pro$lems and usin!this as an opportunity to promote evidence1$asedpractice

    *acilitatin! chan!e◦ e can ta%e #research into silver coated

    catheters$ to the trust board and say loo% if wego with this we can reduce /TIs #urinary tractinfections$ by this amount’ and argue about

    balancing cost with e!ectiveness 

    Promoting the upta$e of$nowledge

  • 8/21/2019 Iceland Final

    25/34

    %ersonal attri$utes◦ 'linically credi$le street wise

    ◦ %olitical acumen

    ◦ nterpersonal skills◦ )rans"ormational leadership style B compliment

    rather than su$stitute "or *ES Support "rom senior mana!er and doctors 'haracteristics o" role ?r!anisational commitment %ro"essional networks B internal and

    e0ternal

    !actors in3uencing APNs4 abilityto bro$er $nowledge

  • 8/21/2019 Iceland Final

    26/34

    ducational implications "or A%&s

    ◦ &eed to develop skills to $ecome e#ectiveevidence1$rokers

    ducational implications "or "rontline sta# ◦ &eed to develop knowled!e and skills in

    evidence1$ased practice and critical thinkin! n"rastructure to support A%&s in knowled!e1

    $rokerin!◦

    %ractical assistance +e.!. clinical audit, andresources +e.!. ) need to $e availa$le mpact o" A%&s is hard to capture

    Conclusion

  • 8/21/2019 Iceland Final

    27/34

    Capturing the impact of

    Nurse Consultant Posts %a pro+ect to developpractical guidance

    %ro>ect )eam: Kate Ferrish AnnMcDonnell *iona Kennedy

    +"unded $y the ;urdett )rust "or&ursin!,

  • 8/21/2019 Iceland Final

    28/34

    &urse consultants +&', introduced into the &HS inn!land in 7@@@

    Set up to achieve $etter outcomes "or patients $y

    improvin! 2uality and services and to provide analternative career pathway "or e0periencedpractitioners to remain in clinical practice ratherthan move into education mana!ement or

    research

    mpact o" these multi1"aceted roles is inherentlyhard to capture +Fuest et al. 7@@G,.

    5ac$ground

  • 8/21/2019 Iceland Final

    29/34

     )o identi"y a ran!e o" indicators to demonstratethe impact o" nurse consultants on patient sta#and or!anisational outcomes

     )o develop a toolkit/!uidance to help nurseconsultants to demonstrate their impact onpatient sta# and or!anisational outcomes

    *verall Pro+ect Aims

  • 8/21/2019 Iceland Final

    30/34

    7 year pro>ect commenced May 7@@I

    Sta!e 1 Systematic literature review Sta!e 7 1 Mappin! e0ercise o" nurse consultants Sta!e 8 1 'ase studies o" nurse consultants Sta!e G 1 terative specialist panel phase Sta!e 6 1 'omposite toolkit/!uidance

    Pro+ect *verview

  • 8/21/2019 Iceland Final

    31/34

    !ramewor$ for capturingimpact

    %ro"essional competence-uality o" workin! li"e

    Jorkload distri$ution )eam workin!

    ?r!anisational priorities / tar!etsDevelopmento" policy

    Fenerationo" new knowled!e

    %hysical/psycholo!ical well$ein!-uality o" li"e socialwell$ein!%atient $ehavioural chan!e

    %atient e0perience o" healthcare

    'linical

    si!niCcance

    ?r!anisationalsi!niCcance

    %ro"essionalsi!niCcance

    n"ormed $y the work o" Schul et al +7@@7, Ferrish et

    al. +7@@3,

    Capturing impact: A

  • 8/21/2019 Iceland Final

    32/34

    Capturing impact: APractical Tool$it for nurse

    consultants

    Availa$le "or "ree download "rom:

    http://research.shu.ac.uk/hw$/ncimpact/inde0.html

    Key features:• vidence $ased 1 developed throu!h a

    ri!orous research study• A use"ul and practical "ramework is

    introduced to help nurse consultantsconsider the impact they mi!ht have"rom a num$er o" di#erent perspectives

    • Activities and e0amples are provided toconsolidate learnin!

    http://research.shu.ac.uk/hwb/ncimpact/index.htmlhttp://research.shu.ac.uk/hwb/ncimpact/index.htmlhttp://research.shu.ac.uk/hwb/ncimpact/index.htmlhttp://research.shu.ac.uk/hwb/ncimpact/index.html

  • 8/21/2019 Iceland Final

    33/34

    Ferrish K McDonnell A &olan M Fuillaume E Kirsh$aumM )od A.+7@7, *actors inLuencin! advanced practicenurses9 a$ility to promote evidence1$ased practice amon!"rontline nurses. Jorldviews on vidence1;ased &ursin! I+, 8@18I.

    Ferrish K McDonnell A &olan M Fuillaume E Kirsh$aumM )od A. +7@, )he role o" advanced practice nurses inknowled!e $rokerin! as a means o" promotin! evidence1$ased practice amon! clinical nurses. ournal o" Advanced&ursin! N3+I, 7@@GB7@G.

    Kennedy * McDonnell A Ferrish K Howarth A %ollard ' (edman +7@,. valuation o" the impact o" nurseconsultant roles in the United Kin!dom: a mi0ed methodsystematic literature review.  0ournal of &dvanced Nursing.

    6eferences

  • 8/21/2019 Iceland Final

    34/34

    Shefeld