07/11/2017. Kate Young & Louis Hey CQC (2011)

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1 Kate Young & Louis Hey CQC (2011) Those...responsible for the training and development of staff...need to look long and hard at why care often seems to be broken down into tasks... focusing on the unit of work, rather than the person who needs to be looked after....it is not good enough and it is not what people want and expect. Kindness and compassion costs nothing. 1

2 Investigations about care Too task orientated Care needs to be personalised Attitudes matter personal and institutional Relationships should be at the centre of care delivery Indifference to poor quality of care Dignity, nutrition, financial abuse, neglect of basics occurs in social care Understanding Human rights is fundamental CQC (2011); Queen s Nursing Institute (2011); Parliamentary Heath Service Ombudsman (2011) Equality and Human Rights Commission (2011) Patient / User / Carer Focus Group & Cardiac, Elderly care, A & E,Oncology, SCBU, ICU,Community, Surgery (orthopaedic, opthalmic, renal), Medical, Day surgery Nurses who : Provide holistic care Communicate accurate information about care /illness Have the right attitude Treat patients & families with respect /as unique Deliver basic care safely: continence, nutrition, hygiene, oral care Look after confused people properly 2

3 Patient / User / Carer Focus Group & Cardiac, Elderly care, A & E,Oncology, SCBU, ICU,Community, Surgery (orthopaedic, opthalmic, renal), Medical, Day surgery Nurses who : Are identified & responsible for their own actions Monitor / examine a problem & have the skills to deal with it Work well in a team Agree a plan of care with the whole team, and stick to it Set standards for unqualified people and manage their performance Learn about illness experience & care from patients Excellent Nursing a valued commodity, a privilege the nursing care at was excellent, and any issues were competently dealt with Nurses are the most important people to the patient. Its a heavy responsibility, but they do mean in many cases, life or death to their charges. Thank you for all you do. I realise I am talking about Superman or Superwoman! 3

4 DH (2008) High Quality Care for All High quality care for patients Aspirational Dependent on high quality education and training for all staff involved in NHS services Responds to changing healthcare environment (new roles, new technology) Dependent on workforce planning to respond flexibly to dynamic environment. Patients and the public expect personalised care Ross et al (2008) Managers acknowledge quality of care is not just about training it s like putting baubles on a dead Christmas tree p553 4

5 NMC (2010) Essential Skills Clusters Annexe 3 ESC 1 Care compassion and Communication Attitudes Hard to influence 1, 2 Nurses with negative attitudes have difficulty forming positive relationships with clients 2 Poor attitudes poor relationship poor outcomes 2 Combination of simulation, information, exposure to service users and debrief is best method to effect change in attitude 2,3,4 Attitudes change through social learning 5 Snowden (1997) 1,Secombe (2007) 2, Goddard & Jordan (1998) 3, Chan and Cheng (2001) 4 Huston (2008) 5 5

6 Scott (2008) There is a growing emphasis on instrumental competence and this has been accompanied by some erosion of relational care...professionalism is problematic and nursing education faces particular challenges. These include negotiating service-education partnerships which reflect service user involvement and enable the integration of wider notions of competence. p240 Users in the Classroom: The Student view Contact Understanding/ (The more, the better 1) Valuing Users views 1,2,3 Enabled better listening skills 3 Surprised by carers lack of knowledge of condition 3 Majority agree its helpful: 1 You wouldn t find that in a textbook 2 Some feel that teacher component least helpful (18%) 2 Some limits: X talk to pts with LTC about sex and death 2, talk to terminally ill / bereaved carers 3 understandings of flexibility required in NHS 3 Cooper & Spencer-Dowe (2006) 1, Costello & Horne (2001) 2, Turner et al (2000) 3 6

7 Technology use Reasoned / informed judgements for use is poor 1,5 Subjective norms & organisational control governed choices 1 For interactive real time packages, student - instructor interaction is decreased 2 Spontaneous discussion is constrained 2 Difficult to feel connected for DL students 2 Linear PBL for knowledge, attitude and intent to apply learning for web based materials, but PBL takes longer to devise and study 3 CAL may improve knowledge & technical skills competence but gain is short term and not guaranteed 4 Ross (1991) 1, Osler (2002) 2 Smith (2007) 3, Greenhalgh (2001) 4 Cyberspace & User Involvement: The learners view Health professionals interested in observing e-patient dynamics can learn a good deal from going out into the self help neighbourhoods of cyberspace as observers....observe them, and if appropriate, communicate with them...but please don t attempt to direct or control their efforts....the things you learn from observing and communicating with the e-patients you find on line may prove invaluable in your future work. This has certainly been true with us. Lester et al (2004) 7

8 There s a Fork in the Road! We have a choice; the way forward is not very clear, or easy to travel References CQC (2011) Care Quality Commission Dignity and nutrition inspection programme: National overview. CQC retrieved online at d_nutrition_inspection_report_final_update.pdf Parliamentary Health Service Ombudman (2011) Care and compassion? Press release 15 February 2011 retrieved online on at Parliamentary Health Service Ombudman (2011) Care and compassion? Report of the Health Service Ombudsman on ten investigations into NHS care of older people. TSO, Norwich retrieved online on data/assets/pdf_file/0016/7216/care-and- Compassion-PHSO-0114web.pdf Ross,F, Smith, E. Mackenzie, A. & Masterson,A (2008) Identifying research priorities in nursing and midwifery service delivery and organisation: a scoping study. International Journal of Nursing Studies 41 (2004)

9 References contd Scott, SD (2008) New professionalism shifting relationships between nursing education and nursing practice Nurse Education Today, 28, DH (2008) High quality care for all. NHS next stage review final report CM7432 The Stationery Office, Crown Copyright. Snowden, L (1997) An investigation into whether nursing students alter their attitudes and knowledge levels regarding HIV infection and AIDS following a 3 year programme leading to registration as a qualified nurse Jo Advanced Nursing, 25, Secombe, J A (2007) Attitudes towards disability in an undergraduate nursing cirricuulum: A literature review Nurse Education Today, 27, Goddard,L & Jordan,L (1998) The changing of attitudes about persons with disabilities: effects of a simulation Jo Neurosciences Nursing 30(5), Chan,S and Cheng,BS (2001) Creating positive attitudes: the effects of knowledge and clinical experience of psychiatry in student nurse education Nurse Education Today, 21, Smith, CM (2007) Comparison of Web-based instructional design strategies in a pain management program for nursing professional development Doctoral dissertation State University of New York at Buffalo References contd Lester, J Prady, S, Finegan, Y and Hoch, D (2004) Learning from e-patients at Massachusetts General Hospital BMJ, 328: Greenhalgh, T (2001) Computer Assisted Learning in undergraduate medical education BMJ, 322:40-44 Queen s Nursing Institute (2011) Nursing People at Home: The issues, the stories, the actions QNI, London Equality and Human Rights Commission (2011) Close to home: An inquiry into older people and human rights in home care Manchester, Equality and Human Rights Commission 9