National Nursing Research Unit Newsletter | September … · National Nursing Research Unit...

Florence Nightingale School of Nursing & Midwifery | 1

Round upMaking an impact!

It has been an exciting and noteworthy year. In June 2013 the unit was described as the ‘‘go to’ organisation for nursing research”, by the Health Service Journal (HSJ) when Professor Jill Maben was listed as one of the top 100 most influential clinical leaders in the country. One month on and another accolade, as Jill was named by the HSJ panel as one of the ‘Most Inspirational Women in Healthcare’. For the Director, and the unit, to be so acclaimed is a true testament to the National Nursing Research Unit’s (NNRU) ability to deliver robust research that addresses key issues in care delivery. The listed influential clinical ‘leaders’ are not just selected for being eminent in their own field, but for having an influence beyond their own disciplinary boundaries and impacts across health care. Research that crosses disciplinary boundaries characterises much of the work that the NNRU undertakes. Both in terms of how we do research (and the wide mix of staff and methods deployed) and how it has an impact on practice and policy.

The whole team has been active this year in delivering our key research findings throughout the UK at conferences such as International Society for Quality in Healthcare, the King’s Fund, the Royal College of

Nursing, and also throughout the world – including Brazil, Australia, Canada, USA, Netherlands and Sweden. We have also led or co-authored over 20 peer reviewed publications and been very active in the media – being interviewed on radio, in the press and on TV.

We are well placed to continue our important work now, and in the future, and held an away day last November where we reviewed our goals. Building on the track record of the last 35 years we want to continue to be “A world leader in high quality research using innovative methods to improve the systems, experiences and quality of healthcare”.

The much awaited second Francis report, and the recently launched ‘Compassion in Practice’ implementation plan, highlight the questions and challenges facing health services in the UK, many of which are currently being addressed by recent NNRU research that focuses on key organisational and service delivery issues including what makes a better experience for patients, and also for staff.

Our Research continues to inspire, inform and contribute in national and international academic arenas, as well as to influence national debates, and government and health policy. We have achieved a wide range of activities, and have been active in providing ministerial briefings, presenting award winning conference posters and presentations, and have also been quoted in the Daily Mail! More recently, NNRU research and deputy director Jane Ball were front page news in The Times and The Metro and Jane was on Sky News and on the Radio 4 Today Programme. Thanks to all in the unit who have worked so hard and thanks to all our supporters. Let’s hope the coming year is half as exciting, and has twice as much impact!

NewsletterNational Nursing Research Unit Newsletter | September 2013 | Issue 7

Jill Maben at the Inspirational Women Awards July 2013

2 | National Nursing Research Unit Newsletter

Project News:Recently awarded projectsMeasuring the culture of care using a barometer toolFunder: NHS London/NHS England

Many tools exist to help teams and organisations measure their cultural health. The ‘Cultural Care Barometer’, developed by a group of senior nurse leaders, is a short survey tool that aims to gauge whether the culture of care in different parts of an organisation is conducive to delivering compassionate patient centred care. But the conversations which the tool stimulates (both at team and board level) are argued to be as important as its diagnostic capabilities.

The barometer has recently been piloted with nursing staff in an acute hospital trust. The next stage is to pilot the Barometer in other settings (including community and mental health services). Its development has been of considerable interest to health and care providers and was referred to in the Robert Francis Inquiry report.

Start date: May 2013End date: April 2014Contact: Jane Ball / Anne Marie Rafferty

Feasibility of Experience-based Co-design in primary and community care: exploring the views of health visiting teams and the parents with whom they workFunder: FNSNM Seed Corn Funding Scheme

This project will explore staff and parent views on the feasibility and desirability of participatory approaches to service improvement in health visiting settings. The objectives are to: carry out a scoping review of the literature on experiences of participatory research approaches in primary and community care settings with a view to identify and critically appraise comparable examples; to conduct focus groups with parents on their attitudes towards and views about becoming involved in quality improvement work for their local health visiting services; to conduct focus groups with health visiting teams and managers on the feasibility of participatory research approaches - such as EBCD - to health visiting improvement; and to carry out an online survey of parents’ views on becoming involved in participatory research initiatives for improving health visiting.

Start date: April 2013End date: January 2014Contact: Sara Donetto

Decommissioning health care: identifying best practice through primary and secondary researchFunder: NIHR Health Services & Delivery Research

Although decommissioning - defined in this project as the planned process of removing, reducing or replacing health care services – is at the forefront of NHS policy it remains strikingly under-researched. This project is designed to address this important knowledge-practice gap. Led by Dr Iestyn Williams and colleagues at the University of Birmingham, the overall aim of the research is to formulate evidence-informed best practice guidance to enable the effective decommissioning of NHS services. To this end the project will address three key research questions: (1) what is the international evidence and expert opinion regarding best practice in decommissioning health care services? (2) how and to what extent are NHS organisations currently decommissioning services? and (3) what factors and processes facilitate the successful implementation of decisions to decommission NHS services?

Start date: May 2013 End date: April 2016Contact: Glenn Robert

Centre for Applied Resilience in Healthcare (CARe)Funder: Guy’s and St. Thomas’ Charity

Resilience is the ability of an organisation to adapt its functioning to produce high quality outcomes even when under pressure. It implies that individuals and teams will adjust how they work to take into account pressures from, for example, a high number of patients, low staffing levels or high patient acuity. The aim is to identify how they can be assisted to do this. A resilience approach is different to traditional approaches to safety which focus on the things that go wrong and emphasise logging and analysing incidents. This approach to safety has limited effectiveness. It assumes that incidents are the result of linear cause and effect relationships that can be identified via analysis of incidents. This often leads to reliance on guidelines, rules and procedures to ensure safe practice. A resilience approach on the other hand emphasises learning from how things go right in everyday clinical work. It suggests that clinicians will always need to adapt rules and guidelines according to the requirements of the situation and a resilience approach aims to support teams to adapt safely when they are under pressure. Although these ideas have intuitive appeal, there has been little work investigating how these concepts can be put into practice to improve the quality and safety of healthcare.

The aims of the Centre are to develop, implement and evaluate interventions to improve resilience and to explore how the relationship between resilience and current indicators of quality and safety, such as infections rates, falls, and patient complaints. The

Project News


work will involve theoretical development of the key concepts involved, and practical application. The Centre will also become a hub for knowledge about how these ideas can be applied in healthcare and will produce material to support NHS organisations wishing to implement a similar approach. We have strong links with international groups and researchers in the United States, Canada, and Scandinavia who are also applying these ideas and this community provides a valuable forum for sharing and discussing approaches. The work will be carried out in King’s Health Partners organisations. The Centre is a partnership between researchers at the NNRU, clinicians at the Simulation and Interactive Learning Centre at GSTT, and clinical governance at GSTT.

Start date: August 2013End date: August 2016 Contact: Janet Anderson

Ongoing projectsEstablishing supportive care needs for frail elders and developing an intervention to address these in older adult acute medical settings. The SCIOaS Study.Funder: NHS National Institute for Health Research (NIHR)

The frail elderly are, and will continue to be, the greatest users of UK hospital services. However high profile reports have shone a light on care practices in which older people feel “done to” rather than cared for. Too often in-patient frail elder care focuses on acute physical interventions excluding on-going social, spiritual, informational and emotional needs- an approach known as supportive care. Primarily developed within cancer services, the aim of supportive care is to assist patients and their carers to maximize quality of life and comfort through all stages of a life-limiting illness. Central to supportive care is the partnership between health professionals and the patient and their carers*. Despite the evident limits to their lives, frail elders are not often recognized as in need of this approach to care. Currently there is no evidence on appropriate definitions and effective interventions to improve supportive care for frail elders on acute medical wards.

The SCIOaS study aims to improve the assessment and delivery of appropriate supportive-care to frail elders. The study uses a 4-phased mixed method design underpinned by the MRC Framework for Complex Interventions. Phase One, currently underway, will advance the concept of supportive care to frail elders and reach a consensus regarding the key elements of supportive-care for frail elders in acute settings. Phase Two will clarify current care practices and the facilitators and barriers to giving supportive care in acute settings. Phase Three will build on this evidence to design a ward-based intervention to facilitate the provision of supportive care. Phase 4 will evaluate the feasibility and acceptability of the intervention.

*Carers are lay people who may or may not be family members, who share in the illness experience of the patient and who undertake vital care work and emotion management.

Start date: January 2013End date: December 2015Contact: Caroline Nicholson

Impact of Releasing Time to Care (in Canada)Funder: CIHR

Members of the project team who worked with the NHS Institute for Innovation and Improvement to determine the learning and impact of the Productive ward: Releasing time to care (RTC) in the UK, are members of the research team for this study assessing the impact of RTC across Saskatchewan, Canada. This three year study aims to develop and implement rigorous evaluation methodology to study how Releasing Time to Care: The Productive Ward (RTC), impacts patient and provider outcomes in 33 hospital units (20 hospitals) and 10 units (10 hospitals) in one province. The evaluation employs qualitative and quantitative methods to answer the questions: (a) does RTC have a positive impact on hospital unit work life quality and patient outcomes? and (b) what contextual factors are important to the effectiveness of RTC? Professors Jill Maben and Peter Griffiths visited the research team in Saskatchewan in September 2012, where data collection was almost complete, and staff were very positive about the changes RTC had brought to their practice. One challenge that became apparent during our visit last year was obtaining sufficient data from staff and another was that the state of Saskatchewan, has switched to implementing LEAN and so further roll out of RTC had been halted.

Start date: April 2010End date: October 2013Contact: Jill Maben

The impact of moving to single room hospital accommodation - Phase 2Funder: NHS National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (HS&DR)

This research is the second phase of a longitudinal study undertaken using a new build hospital in real time as an opportunity for a natural experiment investigating patients and staff experiences before and after a move to single room accommodation at Maidstone & Tunbridge Wells NHS Trust.

This study uses mixed qualitative and quantitative methods to produce a rounded picture of the issues under investigation. The research design includes three main elements:

Case study research examining staff and patient experiences in four case study wards before and after the move.

Project News


Economic analysis to determine nurse staffing costs and overall costs before and after the move. Data collection is complete and analysis is underway.

Comparator study comparing the before and after outcomes and resource use with two control hospitals.

Our collaborators on this study are Maidstone & Tunbridge Wells NHS Trust, Imperial College London and Southampton University.

Together, phases 1 and 2 will deliver a project that answers significant questions for healthcare generally and the NHS in particular. This study will generate robust evidence on which to base future hospital re-design decisions for the NHS.

Full details about the project, including the project protocol, can be accessed via the NIHR HS&DR website at www.netscc.ac.uk/hsdr/projdetails.php?ref=10-1013-42

Start date: January 2012End date: December 2013Contact: Jill Maben

Completed ProjectsNurse staffing and quality of care in UK general practice (stage 2)Funder: Policy Research Programme (PRP)

This work addressed questions about the configuration, composition and organisation of the healthcare workforce within a complex health system:

What types of (diabetes-related) activities are undertaken by different healthcare professionals in GP practices? To what extent does this vary across practices and over time? How does variation in activities undertaken by different types of healthcare professional impact on patient outcomes? Do GP practices where practice nurses undertake a higher proportion of consultations with people with diabetes perform worse, the same or better in terms of patients’ glycaemic control than those practices where practice nurse input is lower?

Patient level data over a ten year period has been used to further our understanding of activity in GP practices in relation to the level of glycaemic control achieved amongst people with diabetes. A greater reliance on practice nurses for delivering care was associated with lower HbA1c levels in the early part of the period, subsequently there was little to choose between practices that made more or less use of practice nurses (i.e. doctors delivering most of the care). Practice nurses are increasingly undertaking more diabetic review which was associated with better glycaemic control.

A survey of 250 THIN practices was undertaken in the summer of 2012 to provide supplementary data on staffing and management of diabetic care for the

economic component of the study. Practices vary in size and composition of their workforce. Practices nurses make up a third of trained clinical staff. Larger practices were more likely to employ experienced nurses and nurses with post-graduate qualifications.

A final report describing the study findings was submitted to the PRP client in May 2013 and is under review.

Start date: April 2010End date: May 2013Contact: Trevor Murrells

Health Visitor ProgrammeFunder: Policy Research Programme (PRP)

Our PRP-funded research supported the roll out of the Government’s Health Visitor Implementation Plan 2011 – 2015, by providing evidence from existing research and fresh insights from empirical work to inform this Health Visitor service expansion.

Our three research studies were:

1. A synthesis of research about health visiting practice: a scoping review of the existing published literature on health visiting practice, and its impact on child and family wellbeing. The final report “Why Health Visiting? A review of the literature about key health visitor interventions, processes and outcomes for children and families” was published in February 2013. The report has been very well received by policy makers and the Health Visiting research and practice community; and the Institute of Health Visiting have used this important evidence to inform parliament about the strengths of health visiting practice.

The report is available on our website: www.kcl.ac.uk/nursing/research/nnru/publications/index.aspx.

We also published a Policy+ (issue 37) summarising this work: “Can health visiting make the difference expected?”

2. Voice of users and service delivery: a scoping review and qualitative exploration of service users’ perspectives on the dimensions of health visiting they find most helpful and valuable. The final report “Health visiting: the voice of service users. Learning from service users” was submitted to the PRP and will be published by September 2013. It will be available on our website: www.kcl.ac.uk/nursing/research/nnru/publications/index.aspx

3. Recruitment, retention and preparation for Health Visiting: a scoping review and qualitative study of recruitment and retention challenges and opportunities and health visitor preparation and continuing professional development. The final report “Start and Stay: The Recruitment and Retention of Health Visitors” will be published by September 2013. It will be available on our website: www.kcl.ac.uk/nursing/research/nnru/publications/index.aspx

Project News


The research team - Jill Maben, Sarah Cowley, Astrida Grigulis, Sara Donetto, Karen Whittaker, Jane Hughes and Mary Malone - presented at the annual Community Practitioners and Health Visitors Association (CPHVA) conference in November 2012 and at the International Collaboration for Community Health Nursing Research (ICCHNR) conference in March 2013.

Start date: April 2011End date: December 2012Contact: Jill Maben

Accelerated Experience-Based Co-Design (AEBCD)Funder: NIHR Service Delivery and Organisation (NIHR SDO) programme

This project led by Louise Locock at the University of Oxford has two components: implementing the intervention (Accelerated Experience-Based Co-Design or AEBCD), and an ethnographic process evaluation. With regard to the intervention, we produced two trigger films, one on intensive care and one on lung cancer, based on secondary analysis of existing patient experience interviews. The service improvement facilitators in the trusts completed staff discovery interviews; organised separate workshops for patients and staff and a joint staff and patient workshop to view the trigger film together, identify joint priorities for improvement work, and agree co-design working groups. The co-design working groups met regularly and implemented their planned changes. Both have held well-attended celebration events to review achievements and disseminate the project to colleagues. With regard to the process evaluation, the organisational ethnographer observed all the workshops at both trusts and a sample of the co-design working group meetings. She also interviewed key participants and got further feedback in the form of reflective diaries and focus groups with patients and carers involved in co-design. Short questionnaires were used at the end of workshops to elicit views about the process. A report consolidating all the evaluation evidence to date was fed into our final report. The early evidence suggests the accelerated approach to EBCD is well received by patients and staff. While patients do not always identify fully with the views expressed in the trigger film, they stimulate very similar conversations to ‘traditional’ EBCD, and may improve staff engagement by removing defensiveness in the face of personal criticism. To date, using an accelerated approach seems to have had no discernible effect on the functioning of the co-design working groups in the ICU pathway or on the type of improvements implemented. Our final report was submitted to the NIHR programme in March and we anticipate the full report being published by the programme later in 2013.

Start date: September 2011 End date: March 2013 Contact: Glenn Robert

Informing the development of NICE Quality Standards through secondary analysis of qualitative, narrative interviews on patients’ experiencesFunder: NIHR Service Delivery and Organisation (NIHR SDO) programme

This 18-month project aimed to i) identify common, core components of patients experiences of the NHS to inform the development, and measurement, of NICE Quality Standards, and ii) examine their reach and limitations in describing the aspects of care that are important to patients from diverse backgrounds, with experience of different conditions and NHS care pathways.

The project team, led by Sue Ziebland at the University of Oxford, undertook a secondary analysis sampled from over 60 collections of qualitative interviews (each containing 40-50 interviews, with ethics approval for this purpose) held by the University of Oxford Health Experiences Research Group, on topics pertinent to current NICE Quality Standards work. Experienced researchers spent 14 months analysing the interview transcripts to identify the core components of patients’ experiences and check their findings in 6 focus groups with service users. The final 4 months included a series of expert facilitated workshops and training with NICE staff. The project aimed to address the needs of the NICE Quality Standards team and the Clinical Guideline Collaborating Centres in a strong and focused collaborative study. We also informed the design of questionnaires to measure patients’ experiences (PROMS), prepared guidelines for qualitative data sharing and ran a training course on qualitative secondary analysis. Our final report will be submitted to the NIHR programme in October 2013.

Start date: November 2011End date: May 2013Contact: Glenn Robert

QUASER (Quality and Safety in Europe by Research)Funder: European Union FP7 programme

The QUASER project was a three year EC FP7 funded project investigating the relationships between organisational and cultural factors and quality in European hospitals which included data collection in the ten case study hospitals (two in each of the five participating countries). We analysed the data from interviews, observations and documents and produced reports for each of the five partner countries. These reports formed the basis of the cross case analysis. For the cross case analysis we identified important themes in the data and analysed these across countries to identify similarities, differences and patterns to interpret. The aim was to answer fundamental questions such as how quality is enacted in the five study countries, the influence of macro and meso level factors on quality improvement initiatives at the micro level, and how leaders influence quality work. The cross case analysis directly informs the development of the Quality and Safety Guide for Hospital Leaders and Framework for Assessing Hospital Quality for payers.

Project News


The consortium held two meetings in 2012. We met in Lisbon, Portugal in February and in Stavanger, Norway in June. The Lisbon meeting focused on analysing the data from the case study hospitals. Researchers presented and discussed emerging themes from the data and refined and iterated the analysis process to ensure reliability between the countries. In Stavanger, preliminary results from the cross case analysis were presented and a process was agreed for completing the analysis. The Guides for Hospital Leaders and Payers were published online in July 2013 and our final report to the European Union will be submitted in August 2013. For further information see: www.quaserproject.eu

Start date: April 2010End date: March 2013Contact: Glenn Robert / Janet Anderson

Enhancing the role of carers in the chemotherapy outpatient setting: a participatory action research projectFunder: Dimbleby Cancer Care Research Fund

This study was funded by Dimbleby Cancer Care and led by Emma Ream at Kings College London. The study aimed to enhance the role of carers in the outpatient setting by using Experience based co-design to develop and implement a carer intervention.

Phase I commenced with observation of the chemotherapy day unit and of scheduled consultations with healthcare professionals. Twenty healthcare professionals were interviewed about their perceptions and experiences of providing support to carers and the challenges and opportunities for improving support. Twenty filmed interviews were also undertaken with carers about their experiences of supporting a friend or relative through chemotherapy. A compilation film of carer experiences was produced and shown to carers and healthcare professionals in Phase II of the study: the co-design events. Three events took place: a staff event, a carer event and a joint staff/carer event. During these events, interview and observational data were fed back and staff and carers subsequently worked together to develop a carer support package to be tested in a feasibility trial in Phase III of the study. The ‘Take Care’ package was produced, A DVD and a leaflet, which aim to improve the support and information provided to carers.

The delivery and impact of the intervention was tested in a feasibility trial. Staff and carer focus groups confirmed the feasibility and acceptability of the intervention.

Feasibility trial results indicated an improvement in carers’ knowledge of chemotherapy and their perceived confidence with their care-giving situation. The final report will be submitted to Dimbleby Cancer Care in August 2013.

Start date: June 2011End Date: April 2013Contact: Vicki Tsianakas/Glenn Robert

Policy+Policy+ is a two-sided briefing which was launched in 2007. It is now circulated to more than a thousand subscribers and aims to provide nurses, healthcare managers, and policymakers a succinct and timely overview of the research related to key issues, and identify the policy implications. And through our partnership with Nursing Times, it reaches an even wider audience.

The Nursing and Care Quality Forum has drawn upon the Unit’s work through Policy+ to inform its initial recommendations and commissioned four of the recent issues.

Policy+ ReviewIn September 2012 we published Policy+ Review, a single volume of 35 issues of Policy+ to mark the 35th anniversary of the NNRU. The volume brings together issues of Policy+ under the four themes:

1) Education and training 2) Nursing workforce 3) Measuring care quality 4) Delivering nursing care.

All issues of Policy+ (including the Review) are available from the unit or can be downloaded from the NNRU website: www.kcl.ac.uk/nursing/research/nnru/policy/policyplus.aspx

For more information, please contact the editors: Jane Ball and Caroline Nicholson.

Project News


Issue 36: November 2012What are the benefits and challenges of ‘bedside’ nursing handovers?In acute hospital settings nursing handover (also known as ‘change of shift’ or ‘nursing report’) has become the traditional and dominant form of communication between nurses caring for patients on one shift to the next. A substantial body of nursing research appraising nurse handover has evolved and the necessity of such handover seems undisputed for enabling nurses to exchange information. The literature identifies four main types of nurse handover: bedside, verbal, taped and nonverbal. However, the impact of the various handover methods on nursing care and patient outcomes remains unclear.

In this Policy+ we examine different approaches to implementation, evidence of the benefits, and challenges associated with bedside handover in acute hospital settings.

Issue 37: February 2013Can health visiting make the difference expected?Evidence suggests that the first few years of life is a critically important time that affects individuals’ future health and social well-being. The Government’s response to this evidence has been to plan to increase by 50% the size of the health visiting (HV) workforce (who provide much early years prevention) and to provide a new vision about how services should be delivered (Health Visitor Implementation Plan, Department of Health 2011-2015). The NNRU were asked to review the research evidence about the impact of health visiting practice on families. In this Policy+ we use the findings of the review to address: can health visiting make the difference expected, and what does it take to get the most out of this workforce?

Issue 38: March 2013What are 12-hour shifts good for? In the UK many hospitals use 12-hour shifts, believing it to be a cost-efficient means of providing 24-hour nursing care on wards. While healthcare organisations need to find ways to deliver nursing care around the clock, and efficiency is a key consideration, nurse leaders have raised concerns about whether nurses can function effectively and safely when working long hours. In this Policy Plus we focus specifically on what is known about the impact of shift length on patient safety, employee health, and quality of care.

Issue 39: May 2013Does NHS staff wellbeing affect patient experience of care?It may be reasonable to presume that patients receive better care from staff who feel happier in their work. However little is known about the strength or possible impact of associations between staff wellbeing and patient outcomes including their experiences of the care provided. Previous research has tended to focus on single aspects or one staff group, or have looked at associations at the whole hospital level (for example using the national staff and patient surveys, and hospital level outcomes). Researchers in the NNRU have completed a study within the English NHS exploring the links between patients’ experiences of health care and staff experiences at work such as staff motivation and wellbeing at work. Staff and patient views were captured at the team/unit level – where possible matching staff to the individual patients they cared for to test associations between staff and patient experience.

Policy+


NNRU Staff NewsPhD StudentsVania Gerova (since 2009)PhD title: “The association between maternity staffing, the organisation of maternity services and outcomes in the NHS trusts in England”

Laura Nasir (since 2009)PhD Title: “Facilitating knowledge exchange between health care sectors, organisations and professions: studying boundary spanning processes and their impact on health care quality”

Clarissa Penfold (since 2010 – part time)PhD Title: “Hospital design: Implications for work practices, care quality and patient safety”

Paola Pierri (since 2012)PhD Title: “Co-designing the experience of care for patient with rare genetic diseases and their families”

Simon Walne (since 2010)PhD Title: “Distractions and Interruptions in Healthcare”

NNRU AssociatesMs Sally Brearley Visiting Senior Research Fellow in user involvement & PPI

Prof Dame Sarah Cowley Emeritus Professor, King’s College London

Prof Peter Griffiths Visiting Professor, University of Southampton

Dr Astrida Grigulis Visiting Research Associate

Prof Donna Havens Visiting Professor, The University of North Carolina at Chapel Hill

Dr Moira Livingstone Visiting Professor, Centre for Workforce Intelligence

Prof Anne Marie Rafferty Professor of Nursing Policy and Director of Academic Outreach

Dr Sarah Robinson Visiting Senior Research Fellow

Prof Pam Smith Visiting Professor, University of Edinburgh

NNRU team news:Dr Janet Anderson, Senior Lecturer is on secondment from the School of Nursing and Midwifery.

Dr Sara Donetto took up the post of Research Fellow working with Professor Robert.

Dr Natasha Doran joins the team as Research Fellow working with Professor Maben.

Dr Vicki Tsianakas joins the team providing maternity cover for Dr Sara Donetto.

Isabell Mayr took up the post of Executive Assistant (job-share) to Prof Maben and Prof Robert.

Karen Pollock joins the team as Executive Assistant (job-share) to Prof Maben and Prof Robert.

Kim Goddard is on secondment to the School of Nursing and Midwifery and is an associate of the team.

Emily Larkins is doing a one month internship with the team in summer 2013.

Esmee van Erp from University of Maastricht spent 3 months, April-July 2013, on an internship with the Pembury single room NIHR team.

Jane Hughes is welcomed back to the team, having left after working on the Health Visitor programme providing maternity leave cover for Dr Astrida Grigulis.

Goodbyes:Dr Astrida Grigulis has left the team and we thank her for her contribution to the Health Visitor programme.

Dr Mary Malone has left the team after completing her secondment from the School of Nursing and Midwifery.

Dr Elizabeth Morrow has left the NNRU after contributing to the team for ten years and we wish her well for all her future work.

Dr Karen Whittaker has left the team after working on the Health Visitor programme.

Clarissa Penfold has left the NNRU to start a new role nearer to her home and we wish her well for her new work.

NNRU Staff News

Caroline Nicholson, Prof Donna Havens & Jill Maben


Congratulations toProfessor Dame Sarah Cowley who was honoured with a DBE in the 2013 New Year’s Honour’s for services to health visiting and whose investiture took place on 7th June with Prince Charles at Buckingham Palace. Prof Cowley was also awarded the position of Emeritus Professor of King’s College London in 2013.

Dr Sara Donetto, baby Alex Kai was born on 9th July 2013. Congratulations to Sara and Eggie on the birth of their first child.

Professor Jill Maben whose Inaugural Lecture entitled: “Care, Compassion and Ideals: Nurses’ experiences of Nursing” took place on 1st May 2013.

Professor Glenn Robert whose Inaugural Lecture entitled: “Bodies on the pavement: The origins and evolution of an approach for improving patient experience of health care services” took place on 5th June 2013.

Dr Caroline Nicholson who commenced her three year NIHR Post Doctoral fellowship in the unit in January 2013. Her study examines “What are the Supportive Care needs of frail older adults and how can they be effectively identified and met in acute medical settings?”

We send them all our very best wishes for the future.

PublicationsIn pressCribb, A. & Donetto, S. “Patient involvement and shared decision-making: an analysis of components, models and practical knowledge”. International Journal of Person-Centred Medicine

Locock, L., Robert, G., Boaz, A., Ziebland, S., Bokhari, F., Shuldham, C., Fielden, J. “Testing accelerated experience-based co-design: using a national archive of patient experience narrative interviews to promote rapid patient-centred service improvement”. In: Patient centred health-care: Achieving co-ordination, communication and innovation, Basingstoke: Palgrave Macmillan

Morrow, E., Cotterell, P., Robert, G., Ross, F., Grocott, P. “Mechanisms for utilising patient experiences of chronic disease: An interpretive synthesis”. Journal of Clinical Epidemiology

PublishedAdams, M., Robert, G., Maben, J. (2013) “Catching up: the significance of occupational communities for the delivery of high quality home care by community nurses”. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 17(4): 422-438

Anderson, J., Kodate, N., Walters, R., Dodds, A. (2013) “Does incident reporting improve safety? Healthcare practitioners’ views of the effectiveness of incident reporting”. International Journal for Quality in Healthcare. doi:10.1093/intqhc/mzs081

Ball, J., Griffiths, P., Murrells, T., Rafferty, A.M., Morrow, E. “’Care left undone’ during nursing shifts: associations with workload and perceived quality of care” BMJ Quality and Safety doi:10.1136/bmjqs-2012-001767

Besser, S., Anderson, J.E., Weinman, J. (2012) “How do osteoporosis patients perceive their illness and treatment? Implications for clinical practice”. Archives of Osteoporosis, 7(1-2): 115-124

Bridges, J., Nicholson, C., Maben, J., Pope, C., Flatley, M., Wilkinson, C., Meyer J., Tziggili, M. (2013) “Capacity for care: meta-ethnography of acute care nurses’ experiences of the nurse-patient relationship”. Journal of Advanced Nursing, 69(4): 760-722

Burnett, S., Fulop, N., Aase, K., Anderson, J.E., Robert, G., Andersson-Gare, B., Calltorp, J., Bal, R., Nunes, F., & the QUASER team (2013) “The eight challenges facing hospitals in Europe”. Health Services Journal, 21 June 2013, http://www.hsj.co.uk/home/innovation-and-efficiency/the-eight-challenges-facing-hospitals-in-europe/5059137.article

Burnett, S., Renz, A., Wiig, S., Fernandes, A., Weggelaar, A.M., Calltorp, J., Anderson, J.E., Robert, G., Vincent, C., Fulop, N. (2013) “Prospects for comparing European hospitals in terms of quality and safety: lessons from a comparative study in five countries”. International Journal of Quality in Health Care, 25(1): 1-7

Publications

Prof Dame Sarah Cowley


Donetto, S. (2012). Commentary: “Talking about power in medical education”. Medical Education, 46(12): 1141-1143

Heinen, M., van Achterberg, T., Schwendimann, R., Zander, B., Kózka, M., Ensio, A., Strømseng Sjetne, I., Moreno Casbas, T., Ball, J., Schoonhoven, L. (2013) “Nurses’ intention to leave their profession: a cross sectional observational study in 10 European Countries”. IJNS Special Issue: Workforce, 50(2): 174-84

Hepgul, N., Kodate, N., Anderson, J.E., Pariante, C., Hotopf, M., Henderson, M., Gopinath, R. (2012) “Understanding clinical risk decision making regarding development of depression during interferon-alpha treatment for hepatitis-C: A qualitative interview study”. IJNS. doi.org/10.1016/j.ijnurstu.2012.07.016

Kodate, N., Ross, A.J., Anderson, J.E., Flin, R. (2012) “Non-technical skills (NTS) for enhancing patient safety: Achievements and future directions”. Japanese Journal for Quality and Safety in Healthcare, 7: 360-370

McCormack, B., McCance, T., Maben, J. (2013) Chapter 10: “Outcome Evaluation in the Development of Person-Centered Practice” in Mcormack B. Manley K and Titchen A (Eds) Practice Development in Nursing and Healthcare, 2nd Edition. Chichester: John Wiley and Sons

Murrells, T., Robert G., Adams, M., Morrow, E., Maben, J. (2013) “Measuring relational aspects of hospital care in England with the ‘Patient Evaluation of Emotional Care during Hospitalisation’ (PEECH) survey questionnaire”. British Medical Journal, Open, 3(1): e002211

Robert, G. (2013) “Participatory action research: using experience-based co-design (EBCD) to improve health care services”, chapter 14. In: S. Ziebland, J. Calabrase, A. Coulter and L. Locock (eds). Understanding and using experiences of health and illness, Oxford, Oxford University Press

Robert, G. & Cornwell, J. (2013) “Rethinking policy approaches to measuring and improving patient experience”. Journal of Health Services Research & Policy, 18(2): 67-69

Robert, G., Waite, R., Cornwell, J., Morrow, E., Maben, J. (2012) “Understanding and improving patient experience: a national survey of training courses provided by higher education providers and healthcare organisations in England”. Nurse Education Today, http://dx.doi.org/10.1016/j.nedt.2012.10.012

Ross, A.J., Anderson, J.E., Kodate, N., Thompson, K., Cox, A., Malik, R. (2012) “Inpatient diabetes care: Complexity, resilience and quality of care”. Cognition, Technology and Work. doi:10.1007/s10111-012-0247-2

Ross, A.J., Kodate, N., Anderson, J.E., Thomas, L., Jaye, P. (2012) “Simulation training for improving the care of older people: An independent evaluation of a novel programme for nurses”. BMJ Quality and Safety. doi:10.1136/bmjqs-2012-000954

Ross, A.J., Kodate, N., Anderson, J.E., Thomas, L., Jaye, P. (2012) “Review of simulation studies in anaesthesia journals, 2001-2010: Mapping and content analysis”. British Journal of Anaesthesia, 109 (1): 99-109

Traynor, M., Stone, K., Cooke, H., Gould, D., Maben, J. (2013) “Disciplinary processes and the management of poor performance among nurses in the UK NHS: bad apple or systemic failure?” Nursing Inquiry, 27 February 2013, doi: 10.1111/nin/12025. [Epub ahead of print]

Whittaker, K. & Cowley, S. (2012) An effective programme is not enough: a review of factors associated with poor attendance at and engagement with parenting support programmes. Children and Society. 26, 138–149.

Whittaker, K. & Carter, B. (2013) “Modernising health visiting practice whilst keeping compassing in care”. Journal of Child Health Care, 17(2): 111-113

Wiig, S., Aase, K., Storm, M., Gjestsen, MT., Solheim, M., Harthug, S., Robert, G., Fulop, N. (2013) “Using patient experiences to improve healthcare quality: a multi-level study of governmental expectations and hospital practices in Norway”, BMC Health Services Research, 13: 206

Young, R. (2013) “How Effective is an Ethical International Recruitment Policy? Reflections on a Decade of Experience in England”. Journal of Health Policy, 111(2): 184-192

ConferencesAnderson, J. and the QUASER Team (2013) Organisational and cultural factors influencing the implementation of quality improvement, Florence Nightingale School of Nursing and Midwifery Research Conference, King’s College, London, 4-5 July 2013

Anderson, J., Jensen, H., Cooney, K., Ross, A., Jaye, P. (2013) Training to improve the quality of nursing care for older people: Development and evaluation of a multi-faceted programme, King’s Health Partners Nursing and Midwifery Conference, London, 10 May 2013

Anderson, J, Ross, A.J., Jaye, P. (2013) Resilience engineering in healthcare: Moving from epistemology to theory, REA Symposium on Resilience Engineering, Soesterberg, Netherlands, 25-27 June 2013

Anderson, J., Robert, G., Fulop, N., Burnett, S., Bal, R., Aase, K., Andersson-Gare, B., Nunes, F. and the QUASER team. (2013) Quality & Safety in European hospitals (QUASER): A guide for senior leadership teams to help improve and sustain hospital quality, European Health Management Association Conference, Milan, Italy, 26-28 June 2013

Ball, J. (2013) A rationale for ratios, invited plenary speaker at Health Education England Workforce Analysts conference, London, 11 June 2013

Ball, J. (2013) Missed care as an indicator of insufficient staffing levels and the implications for workforce planning. International Healthcare Workforce Conference, Canada, Quebec, 7-9 May 2013

Ball, J. (2013) Planning nurse staffing, Safe and Effective Nursing Staffing Levels and Skill Mix, London, March 2013

Ball, J., Knutton, S., Corben, V. et al (2012) Capacity for student nurse mentorship: roles, resources, structures and debates, King’s Fund/NHS London RfW event. 20 November 2012

Publications


Publications

Ball, J., Rafferty, A.M. (2013) Workshop on Culture of Care, NHS Expo, London, 13 March 2013

Ball, J., Rafferty, A.M. (2013) Culture of Care – what is it and how do we measure it? CNO conference, Lead facilitator of workshop, London, 5 December 2012

Ball, J. et al. (2013) Poster: Care that is left undone. International Forum on Quality and Safety, London, April 2013

Burnett, S., Poestges, H., Charles, K., Anderson, J.E., Robert, G., Fulop, N. & the QUASER team (2012) Quality & Safety in Europe by Research (QUASER): a comparative,multi-level study of the system and organisational interactions that shape quality improvement implementation in five European countries. European Public Health Association annual conference, Malta, 7-10 November 2012

Charles, K., Burnett, S., Robert, G., Anderson, J.E., Poestges, H., Fulop, N. (2013) How do hospital leaders balance external and internal demands in delivering quality improvement (QI)? HSRN Symposium 2013, Nottingham, 17-18 June 2013

Cowley, S., Whittaker, K., Grigulis, A., Malone, M., Donetto, S., Wood, H., Maben, J. (2012) What are the key components of health visitor interventions and relationships between the current health visiting service, its processes and outcomes? CPHVA Conference, Brighton, 7 November 2012

Fulop, N., Robert, G., Anderson, J.E., Burnett, S., Poestges, H., Charles, K., Bal, R., Aase, K., Nunes, F., Andersson Gäre, B. & the QUASER team (2013) Approaches to quality improvement in hospitals in five European countries: the QUASER study. HSRN Symposium 2013, Nottingham, 17-18 June 2013

Griffiths, P., Ball, J., Rafferty, A.M., Murrells, T., Jones, S. (2013) Nurse, care assistant and medical staffing: the relationship with mortality in English Acute Hospitals. RCN Research Conference, Belfast, 20-22 March 2013

Locock, L., Robert, G., Boaz, A., Vougioukalou, S., Shuldham, C., Fielden, J., Ziebland, S. (2013) Testing Accelerated Experience-based Co-design: qualitative study of using a national archive of patient experience interviews for rapid patient-centred quality improvement. HSRN Symposium 2013, Nottingham, 17-18 June 2013

Maben, J. (2013) Invited member of a panel discussion: responses to the Francis Inquiry report. David Behan, Jill Maben, Harry Cayton OBE, Professor Sir Ian Kennedy and Peter Walsh give their reactions to the Francis Inquiry report. The Francis Inquiry Conference, King’s Fund, 27 February 2013

Maben, J. (2013) Invited speaker: What we know about the impact of culture on staff and patient experience. King’s Fund leadership summit, London, 23 May 2013

Malone, M., Donetto, S., Grigulis, A., Whittaker, K., Cowley, S., Maben J. (2012) Health Visiting: voice of service users. CPHVA Conference, Brighton, 7 November 2012

Rafferty, A.M., Ball, J. (20130 RN4Cast: building the evidence base for quality and safety of care, FNSNM research conference, London, July 2013

Ross, A.J., Anderson, J.E., Thomas, B., Jensen, H., Schiff, R., Jaye, P.J. (2013) A longitudinal exploration of the effects of simulation training in a three- ward unit for the care of the elderly, Inaugural ASPiH SCSN, Scottish Symposium Examining the impact of simulation on human performance, Edinburgh, UK, 25-26 April 2013

Tsianakas, V. (2013) Poster presentation: Enhancing the role of carers in the chemotherapy outpatient setting: a participatory action research project. MASCC/ISOO International Symposium on Supportive Care in Cancer, Berlin, Germany, 27-29 June 2013

Whittaker, K. (2012) Invited speaker: Responding to the ‘Call to Action’: A programme of research to support the Health Visitor Implementation. NHS North West Health Visitor Professional Mobilisation event, Preston, 28 November 2012

Whittaker, K., Grigulis, A., Hughes, J., Malone, M., Donetto, S., Maben, J., Cowley S. (2012) Start and Stay: examining recruitment and retention of health visitors. CPHVA Conference, Brighton, 7 November 2012

Whittaker, K., Grigulis, A., Nicholson, C., Malone, M., Maben, J., Cowley S., Donetto, S. (2013) Appreciate my practice, appreciate me: the use of an appreciative approach to data collection with health visitor participants. Transforming Community Health: the Nursing Impact, ICCHNR conference, Edinburgh, 13-14 March 2013

Jane Ball at BBC Sunday Politics South, May 2013


About the NNRU

Dr Janet Anderson Senior LecturerJane Ball Deputy DirectorSally Brearley Visiting Senior Research FellowDr Sara Donetto Research FellowDr Natasha Doran Research FellowVania Gerova PhD StudentProf Jill Maben Director/Professor in Nursing ResearchIsabell Mayr Executive Assistant (job share)Trevor Murrells Statistician

Dr Caroline Nicholson NIHR Post Doctoral Research FellowPaola Pierri PhD StudentKaren Pollock Executive Assistant (job share)Prof Glenn Robert Professor of Healthcare Quality and InnovationDr Vicki Tsianakas Research FellowStephanie Waller Project AdministratorSimon Walne PhD StudentDr Ruth Young Reader

Contact information: National Nursing Research UnitKing’s College London, 57 Waterloo Road, London, SE1 8WA

T: 020 7848 3057 | F: 020 7848 3069 | [email protected] | @nursingpolicy | www.kcl.ac.uk/nursing/research/nnru

About the NNRUThe National Nursing Research Unit (NNRU), based at the Florence Nightingale School of Nursing and Midwifery, King’s College London, was founded in 1977.

We aim to produce world class health services research that is of relevance to policymakers and healthcare leaders and which contributes to improving the quality and effectiveness of nursing in its social, political, local, national and global contexts.

Our programme of research seeks to address major questions for nursing as part of contemporary health systems and covers three key themes:

• Care quality, patient experience and outcomes• Organisations, physical environment and ways of working• Nursing and health care workforce

Over the past five years we have secured funding in excess of £5 million from multiple sources including the Department of Health’s Policy Research Programme, NIHR, European Union, Research Councils, Canadian Health Services Research Institute, Health Foundation and the NHS Institute for Innovation.

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