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sprechblase_leer.gif Please note that, unless otherwise specified, the sessions will be held in English.
In the room Singapore the sessions will be simultaneous translated into German.

11:0012:30
Room: Singapore

Concurrent Session 1

01.01.01

Oral presentation

Quality clinical leadership for improving patient safety with patients, carers and staff centre stage.

Kim Manley

Description

Safety in healthcare is an international concern with impact on quality of care (Hollnagel, et al, 2015). A Regional Patient Safety Collaborative, one of 15 nationally set up to place patients, carers and staff at the heart of quality improvements in patient safety, supported four large acute National Health Service hospital providers with a model to help facilitators use safety and quality improvement tools with frontline teams and to be mutually supported through action learning.

The evaluation used realist evaluation (Pawson & Tilley, 2004). Its aim was to understand what works for whom and why, when: working with frontline teams in large acute hospitals to embed a safety culture, and grow leadership and quality improvement capability. Specifically, to identify which strategies are effective in supporting front line teams to sustain bottom up change and quality improvement driven by the needs of patients and practitioners. The study drew on ethnographic principles across study sites using descriptive case study design. Mixed methods of critical observation of frontline practice, stakeholder evaluation, emotional touch points, self-assessment; qualitative 360 degree feedback; and the Teamwork Safety Climate Survey tool (Sexton et al 2006) were used to facilitate the development of a rich picture for each team and each context so as to answer the evaluation questions. In tandem, interrogation of the literature to distil relationships between context, mechanisms and outcomes generating hypotheses at individual, team and organisational level factors for safety culture.

Key findings identified an interdependence between quality clinical leadership within frontline teams, safety culture, safety behaviours and teamwork echoed in microcosm through safety huddles; the skills and attributes of facilitators; and the impact of organisations on microsystems. The interdependence between patient safety and person centeredness was also identified as was the need for organisational strategies for supporting clinical leaders and frontline teams.

 

Kim Manley

Kim Manley

01.01.02

Oral presentation

“We have to be faster than the pressure ulcer - so let’s go”

Christa Wernli-Fluri

Description

Background

Increasing pressure ulcer (PU) rates primarily affect patients and also affect nurses emotionally, lead to questions and calls for action. Interviews with advanced practice nurses (APN) and nurse leaders resulted in the hypothesis that while our nurses have the guidelines to prevent PU, they don’t use them in their daily practice. A survey among 306 nurses confirmed this assumption. In terms of practice development, the conclusion is clear: technical knowledge alone is insufficient in practice improvement. More important is to understand our nurses in their world of practice and develop shared values.

Methods

We used the established method combination for APN projects. To meet the heterogeneity of patient needs, to progress effectively and to enable several nurses, every ward delegated a nurse in a group as participant. Led by an APN as facilitator, this group developed a shared understanding of PU prevention, creating a visual of our guideline in a common clinical pathway. We used simple pictures, starting with creative associations like ‘time means skin’ and ended in generally accepted definitions for the symbols used.

Along this ‘PU pathway’, each ward worked on its own gap, supported by the leading APN. Besides ward-tailored actions, the groups worked on procedures needed when patients leave or change wards.

Results

Pressure ulcer rates were noticeably reduced, and the awareness, value and implementation of PU prevention was increased. Monitoring critical events by safety crosses shows PU-free days or, in case of incidents, leads to supportive analysis. Nevertheless, enhancing PU prevention is not over, and this will continue to occupy nurses for the foreseeable future.

Literature

Frei, I.A., Massarotto, P., Helberg, D. & Barandun Schäfer, U. (2012). Praxisentwicklung im Trend der Zeit. Padua, 7(3), 110-115.

Manley, K. & McCormack, B. (2003). Practice development: purpose, methodology, facilitation and evaluation. Nursing in Critical Care. 8(1), 22-29.

 

Christa Wernli-Fluri

Christa Wernli-Fluri

01.01.03

Oral presentation

From refusal to enthusiasm – the implementation of the nursing process in a mental care hospital

Therese Hirsbrunner

Description

Background

Since 2010 the mental health services have been working with an electronic nursing documentation system that was developed primarily for acute care hospitals.

Problem

The implementation of the documentation system revealed different views on the nursing process in mental health and acute care. After the implementation of the electronic system, several training sessions were held, some adaptations were made to the system and the nursing assessment, but still the implementation of the nursing process remained poor and nurses were dissatisfied.

Method and sample

A practice development project based on the person-centred practice framework1 was implemented from 2015-2017. All 14 wards of the mental health services were involved. Every ward was represented in one of the three project groups by three staff members, one of them the ward manager. The monthly meetings of the groups were facilitated by two clinical nurse specialists and a member of the nursing management. A range of methods were used in mini-projects to facilitate the participation and collaboration of all team members in the implementation and evaluation activities.

Results

A shared vision of the nursing process in the mental health services was established. Patient-involvement and the communication of the nursing process in the interdisciplinary team were the primary focus. At every ward, the structures to facilitate primary nursing were discussed and improved in a more person-centred way. Analyses of the nursing documentation and observations at the wards reflected patient involvement in the care planning and the implementation of consistently formulated nursing plans to a high degree. All nursing teams found ways to communicate the nursing process in interdisciplinary meetings, with very encouraging experiences and feedback from physicians and therapists.

1 McCormack, B., & McCance, T. (2017). Person-centred practice in nursing and health care theory and practice, West Sussex: John Wiley & Sons Ltd.

Therese Hirsbrunner

Therese Hirsbrunner

11:0012:30
Room: Rio

Concurrent Session 2

01.02.01

Oral presentation

Commitment, Consistency, Creativity and Challenge

Catherine Schofield

Description

Since 2006 Practice Development (PD) in Tasmania has flourished. The growth of PD has been from an initial vision and then an unwavering commitment from a small team of professionals.

This commitment has enabled a consistent focus on the development of person centred cultures of care; on evidence based change; and safe quality patient care. This has had a significant influence in the way in which a growing number of professionals are approaching their work which is evident at all levels of nursing and midwifery in Tasmania.

There has been a creative approach taken to the hosting of PD Schools to support staff participation.

Support is also provided for participants to apply new skills and try them out in practice.

As a result models of care have been transformed that enables practice to focus on patient centred care rather than tasks; and an ongoing commitment to effecting positive person centred workplace cultures.

The implementation of PD has required commitment and investment from the leaders in nursing and midwifery at all levels:

At the local level, nurse unit managers have recognised the importance for staff to have dedicated time to critically reflect on their practice and identify and implement change.

At executive level promotion and role modelling has been evident but at times this has also been challenged due to the organisational changes that have occurred where a more transactional way of working has dominated to the detriment of morale.

At the state-wide strategic level the commitment from the chief nurse and midwife has grown to support the ongoing work to embed practice development ways of working further within our health service.

There are ongoing challenges as our circle of influence grows which our presentation will outline with some of highs and lows that we have encountered along the way.

Catherine Schofield

Catherine Schofield

01.02.02

Oral presentation

Spiritual care: can student nurses learning contribute to leading person-centred practice?

Ann Price

Description

Spiritual care is recognised as a neglected aspect of nurse education (Baldacchino 2011). I undertook a phenomenological study, using semi-structured interviews, to explore the experiences of student nurses learning about spiritual care.  Ten student nurses agreed to take part.

I analysed the data using Van Manen’s (2014) existential themes to examine the phenomena –  exploring lived body, lived relations, space, time, lived things and technology.  The students’ individual context was diverse with some expressing Christian beliefs whilst others were agonist; however, all felt spiritual care was important within nursing practice.  They gave examples where dealing with person centred approach to spiritual care was challenging and they reflected on their learning and contribution to holistic practice.

Six key areas of learning about spiritual care were identified:

  • Connecting through recognition of spiritual individuality
  • Embodiment of spiritual care
  • Spaces of spiritual learning
  • Time dimension as a spiritual factor
  • Materiality as a challenge
  • Technology as ‘taken for granted’ aspect of spiritual care

The students were fearful about saying the wrong thing but their comments showed that asking the patient and meeting their individual needs, was important to provide spiritual care.  They also demonstrated their contribution to leading care by recognising spiritual distress and providing spiritual care; sometimes this involved challenging other staff or offering solutions to spiritual problems.

I wonder whether spiritual intelligence may be important process in learning about spiritual care to enable students to be aware of issues and to develop their leadership in this area.  Spiritual intelligence is poorly defined (Esmaili  et al 2014) but includes self-awareness, human presence dimension and personal meaning  (Kaur et al 2015) aspects, which were reflected within my findings.   Therefore, I will explore whether developing student nurses spiritual intelligence within education may be one way they can learn to be leaders of person centred practice.

 

 

Ann Price

Ann Price

01.02.03

Oral presentation

To move or not to move – this is the challenge for older inpatients!

Erika Wüthrich

Description

Introduction

Activity patterns of human beings have changed over time. In daily life there are many amenities to avoid movements. However, mobility is essential to stay independent in activities of daily living. Evidence shows low to moderate mobility levels of patients during hospitalisation which leads to reduced lower extremity strength and mobility. This is a risk factor for falls and deliriums in older inpatients leading to prolonged hospitalisations. Nurses are key players to motivate and support inpatients to move and keep or regain strength and mobility. To improve mobility levels in older multimorbid patients in internal medicine, a clinical development project will be initiated.

Aims

Patients in hospital care are exercising according to their functional capacity and personal possibilities several times a day, integrated in daily care plans.

Nurses know interventions to activate and move inpatients in different positions and foster them to move and exercise in daily care.

Methods

Participatory action research with its three-phases and cyclic process is used for developing and evaluating activities with internal medicine teams in an university hospital in Switzerland from January to December 2018. To include the criteria “collaboration, integration, participation”, several practice development methods will be used. Every nurse is asked about her actual practice of mobilising inpatients, about her priorities in the mobilisation and about her futures ideas of activating inpatients by a questionnaire. With creative approaches and collaboratively working with physiotherapists, we will develop a program with different options to mobilise inpatients. Sensibility and knowledge of activating inpatients will be deepened with nurses during workshops. A pilot test will be conducted in daily care practice, accompanied with several evaluation activities and a “good enough evaluation” approach. Evaluation data will be used for adapting further project activities.

Results/Conclusions

First results and conclusions of the project will be presented in August 2018.

Erika Wüthrich

Erika Wüthrich

11:0012:30
Room: Nairobi

Creative Space 1

01.03.01

Creative space

Move your Mind!
Motor-Cognitive Dual-Tasking with Dalcroze Eurhythmics

Reto W. Kressig
Gabi Chrisman

Description

The inability to simultaneously walk and talk has been shown a strong predictor for falls in older adults (Lundin-Olsson L et al. 1997). Indeed, safe gate while simultaneously performing cognitive tasks depends on highly automated motor-control. Due to functional losses and/or cognitive impairment among older adults, motor-cognitive dual task situations might exceed the available attentional resources and falls occur. Based on improvised piano music and changing movement patterns going with it, Dalcroze Eurhythmics builds up both motor and cognitive reserve. Not surprisingly, Dalcroze Eurhythmics performed once a week was not only able to improve Dual-Tasking in older community-dwellers but also decreased the fall rate by over 50% (Trombetti A et al. 2011).

After a brief presentation of the theoretical bases linked to motor memory, multi-tasking, music and falls, workshop participants will engage into eurhythmics exercises themselves to experience the challenges of this technique but also to feel why this intervention is highly appreciated by its participants!

Reto W. Kressig

11:0012:30
Room: Mexico

Creative Space 2

01.04.01

Creative space

The value of occupational therapy: exploring authentic practice and research that facilitates human flourishing

Niamh Kinsella

Description

Over the past five decades there has been an increasing focus on ‘doing’ in occupational therapy practice and research as a result of pressure to demonstrate effectiveness by service commissioners. There is an assumption embedded within this focus that engagement in doing (occupation) results in human flourishing. This assumption has resulted in evaluation with an emphasis on the quality and frequency of doing at the expense of practice guided by the fundamental philosophical value of occupational therapy- that attention to ‘being’ or authentic (value-based) existence guides ‘good’ doing which facilitates human flourishing. Thus, research with a concern for being over doing may enable a return to person-centred practice in occupational therapy and research.

 

A recent research project explored the values that underpin occupational therapy practice and the contextual conditions that influence our potential to exist authentically as professionals and researchers, and in turn facilitate human flourishing for the people we work with. The research was underpinned by a critical creative case study methodology that used critical creative reflection on observations of practice to identify espoused and embodied values, processes and outcomes in practice with people living with dementia and in research.

 

The purpose of this creative space is to share and explore the findings of the research. The findings will be shared through the use of the visual metaphors that are derived from paintings and sculptures developed throughout the research analysis process. The exploration will focus on ways of being and contextual conditions that enable authentic existence and human flourishing that were identified during the research. This space will be an opportunity to engage creatively with the findings and collectively share understanding of authentic practice. The findings will inform a framework that aims to guide practice and research in occupational therapy that is concerned with authentic being first- person-centred practice.

 

*This research project was funded by Alzheimer Scotland

Niamh Kinsella

Niamh Kinsella

11:0012:30
Room: Hongkong

Creative Space 3

01.05.01

Creative space

Exploring metaphor ‘self-as-instrument of care’ in nursing leadership: Personal knowing as relational practice

Jasna Schwind
Louela Manankil-Rankin

Description

Traditionally, nurses were viewed as simply ‘users’ of received knowledge. However, more recently, there is a recognition that nurses are also knowledge ‘makers’. In this interactive presentation we explore with the audience how knowledge is created and co-created in practice, and how this process enhances the quality of nursing practice and nursing leadership, as well as the quality of patient healthcare experience. Our work is guided by constructivist philosophical perspectives, where knowledge development is viewed as something that is co-constructed in relationship with self and with the other. We are further guided by Dewey’s (1938) philosophy of experience, Arts-Informed Narrative Inquiry, person-centred care, Carper’s (1978) patterns of knowing, particularly personal and aesthetic ways of knowing, and finally Doane and Varcoe’s (2015) relational practice.

In the creative space we begin by using the principle of ‘starting with ourselves’. We invite the audience to engage in Narrative Reflective Process (NRP), using the metaphor of self-as-instrument of care, specifically focusing on nursing leadership. NRP in this context is used as a creative self-expression personal-knowing development tool, which includes storytelling, metaphors, drawing, letter-writing and reflective dialogue. This creative process serves to turn attention on the self: to develop self-awareness and personal knowing. Aesthetic knowing, builds on this step, exploring more deeply the meaning participants draw from the relationship of the professional self to their practice, specifically focusing on professional and therapeutic relationships, particularly compassionate leadership within practice. Through reflective dialogue, in small and large groups, we explore new ideas with participants by posing thought-provoking questions: How do we build relational capacities, such as commitment, curiosity, compassion, competence, and corresponding, in practice, particularly nursing leadership? How do we teach future practitioners these pillars of relational practice? How do we support the transformation-of-self of current nurses into relationally compassionate practitioners and leaders?

Jasna Schwind

Jasna Schwind

11:0012:30
Room: Guangzhou

Concurrent Session 3

01.06.01

Oral presentation

Using research to develop at scale solutions to seeking and acting on patient feedback

Deborah Baldie

Description

Using experiences of care to inform practice is a key practice development principle. It is however fraught with challenges including: capacity within complex and busy health care systems to regularly collect and share feedback; health care practitioner concerns over validity of feedback methods; availability of systems of feedback that support patients and families to give honest feedback without fear of reprisal; capacity to hear about the experiences of people who cannot engage with traditional methods such as surveys or interviews; and the ability of teams to effectively engage and overcome local and organisational barriers to effectively act on feedback.

This presentation details the development of an infrastructure for inclusive, regular and facilitated patient feedback within health systems. This process has required strong practice development leadership: the creation a compelling need; working where opportunities lie; and innovative use of resources to develop novice research roles that focus on subjects of strategic importance.

We will share our evidence informed model for gathering and use of regular feedback; our research with volunteers and people with dementia or cognitive impairment that has supported the development and introduction of a bespoke toolkit to hear from those usually seldom heard in feedback systems. It will also detail the partnership we have developed with our local education providers to build capacity within undergraduate students and consequently, our health system to regularly collect and learn from people’s experiences of care – a partnership that has provided rich learning experiences for all.

Lastly, we will share how we used critical creativity to combine our local evaluation data and international evidence relating to the use of patient feedback in practice to develop and commence implementation of whole system practice standards and associated support tools and learning opportunities for teams to enhance their patient experiences of care.

Deborah Baldie

Deborah Baldie

01.06.02

Oral presentation

Quality and Safety Culture from bedside to boardroom: how person-centred approaches made it possible

Karen Tuqiri

Description

The ability to support the development of a culture focussed on patient safety in today’s complex and chaotic health environment is pivotal. One such approach is understanding how adopting person-centred approaches to connect leaders and clinicians in meaningful ways, benefit both patient experience and outcomes, staff experience and the workplace environment.

The results of a hospital wide interviews with all nursing and midwifery leaders focusing on exploring their understanding of the current practice program clearly indicated that a change in strategy was required to re-engage with leaders and clinicians. In addition workshops exploring courage and leadership, completion of role clarification process and discussions directed on the elements of a safety culture and how these would then inform more specific unit/ward based work were critical to refocus the leadership group.

A quality and safety framework was developed that included how to capture data on clinical outcomes, patient experience, staff experience and environmental factors. This was provided to each unit manager and they were given the freedom to articulate what was important in their specific speciality and contexts. A baseline measure for this work included the Safety Attitudes Questionnaire alongside tools such as Emotional Touchpoints, quality boards, safety crosses and a safety huddle framework adopted to evaluate care and culture. Key to the success of this hospital wide initiative has been on supporting leaders to adopt person-centred approaches to engage clinicians in evaluating practice.

This presentation will highlight the journey of a newly appointed Director of Nursing and Midwifery and how the development of person-centred strategy can make a difference at the bedside. Specifically gaining the support of the senior leadership team, the use of person-centred approaches to engage staff and to make meaning of the practice context and the enhanced sense of ownership of change processes will be discussed.

Karen Tuqiri

Karen Tuqiri

01.06.03

Oral presentation

Practice Development by "Mini-Audits" in Intensive Care Nursing at University Hospital Basel

Conrad Wesch

Description

Background: Since 2011, hospitals in Switzerland have been obliged to collect nursing-sensitive outcomes on a specific date every year. For the intensive care units (ICUs) at the University Hospital Basel, the prevalence yearly measured on a defined day is not very meaningful. Additionally, such controls do not conform to the idea of evaluation in Practice Development (PD), which strongly promotes the principles of collaboration, inclusion and participation.

Method: In 2015, the ICUs introduced "Mini-Audits": Nurses of the ICU-workgroup “Pressure Ulcer Prevention and Wound Management” (abbreviation: nurse experts) conduct a focused ward round six times a year. In this ward rounds, pairs of nurse experts examine the skin of each patient together with the bedside nurses, assess the risk for pressure ulcer, discuss measures to be taken and review the documentation. This process explicitly focuses on learning in practice. The nurse experts actively involve the bedside nurses with the aim to support them and to facilitate good nursing care. Subsequently, a survey form is completed together. So the results can be compared and graphed. Finally, the teams receive feedback on the results and discuss possible conclusions.

Results: The Mini-Audits are highly accepted by the bedside nurses and they appreciate the opportunity for qualified discussions. The nurse experts regularly reflect their support role.
In our ICUs, the prevalence of pressure ulcers is currently 20.6%, which is comparable to results of the literature. Such results have become more meaningful to the health care team than the prevalence data because of the immediacy to improve quality care.

Conclusion: The process of our Mini-Audits is in line with PD. Meanwhile, Mini-Audits on other topics (e.g. mechanical ventilation, delirium) have been developed. In this presentation, a nurse expert will present the steps of the Mini-Audit and a CNS will illustrate the relation to the PD principles.

Conrad Wesch

Conrad Wesch

11:0012:30
Room: Osaka

Concurrent Session 4

01.07.01

Oral presentation

Building Research capacity In Clinical nurses; through Knowledge Sharing B.R.I.C.K.S

Val Wilson

Description

The Nursing and Midwifery Research Unit of a large Local Health District in Australia is leading the operationalising of the Chief Executives Vision of an organisation that is respected and recognised for research and innovation to improve health care. This leader’s vision has changed the research landscape of the organisation and its staff. However, this vision has required leadership at all levels (macro, meso and micro) and an approach that considers addressing the known barriers to building a research culture.

Knowing these barriers has enabled us to consider how we provide ongoing support and leadership for clinicians engaging in research. Key principles (building bricks) of the research unit are

1) Engage with staff at all levels in particular clinical experts

2) Work with the values of the organisation (Collaboration/Openness/Respect/Empowerment). Thus seeing our role as facilitators of learning and research inquiry rather than research consultants. Sharing our knowledge with individuals and groups of staff who share a common interest e.g. falls prevention. We work alongside clinicians through all stages of the research process enabling them to navigate the complexities of systems and processes required to undertake research

3) Person-centredness is embedded into the research design

4) Using action-orientated research approaches as this aligns to the Quality Cycles of PDSA, which clinicians are familiar with, it is more engaging and hopefully less daunting thereby enhancing clinician confidence in undertaking research.

The number of research projects being led by clinicians has increased significantly within the last 18 months. We believe that leadership is the key to this increase. Within this presentation we will share lesson learned; the ongoing barriers we have encountered and how we are working to overcome these; what has worked well and not so well and illustrate the successes of the research to-date by sharing examples of clinician led research.

Val Wilson

Val Wilson

01.07.02

Oral presentation

Facilitation of person-centred care for families with a preterm or ill newborn

Klaeusler-Troxler Marianne

Description

In neonatal intensive care unit the facilitation of person-centred and effective care for families after birth is essential to quality care. Family nursing interventions support families throughout their babies’ stay in intensive care, and strengthen the family system’s capacity to live with this new, unfamiliar and uncertain life situation. However, nurses often lack the expertise and skill to work with families during unexpected life events, such as the birth of a preterm or ill newborn.

Hence, a practice development project was initiated to increase health care teams’ knowledge and skills in family care and to improve the quality of caring relationship between health professionals and families. The practice initiative was guided by an action research methodology using the three phases of looking – thinking – acting.

First, documentary and stakeholder analyses were conducted (looking phase) to discern current practices and policies related to family. While staff perceived that caring for families was important, there was little evidence of systematic involvement of families, which occurred most often only at admission and discharge. Stakeholders perceived family care as a welcome opportunity to improve quality of care, but were concerned that caring for the whole family would increase their workload. Second, based on these insights, a family care program was devised (thinking phase). Using the CFAM / CFIM, theoretical foundations were defined and practice instruments were adapted to the local context. Third, the family care program was introduced through interprofessional team education and reflective practice sessions and expert and peer coaching (action phase).

Using a collaborative and inclusive approach, the family care program seeks to shift the current care culture from an individual focus to a relational, family-centered one. Inclusive and visionary leadership facilitated health care team’ attitudes towards families, and their ability to work with them.

Klaeusler-Troxler Marianne

Klaeusler-Troxler Marianne

01.07.03

Oral presentation

Challenges and opportunities within the organisation, who's responsibility is it to develop practice?

Honor MacGregor

Description

Shifting cultures and embedding person-centred ways of being in teams requires a transformational practice development approach. Culture transformation is more often realised when supported and taking place at the meso, macro and micro levels within an organisation. However, achieving this can often be hampered by organisations’ requirements to meet targets; a reliance on technical approaches to quality improvement and assurance and a focus on quick fixes. This presentation will tell our story of how we have systematically worked with leadership teams, teams of in-patient ward managers, care teams and non-clinical teams across our organisation, facilitating their exploration and development of increased person centred cultures.

We will share how we have:

• built capacity for the use of practice development as a methodology to effect change at the micro level

• developed meso leadership capacity to embody person-centred ways of being and

• facilitated macro level leaders to shift their approach to monitoring and continuously improving quality of care and care experience to one that is more heavily focused on learning from practice data

This journey has not been one of tight project management. Instead, it has been one of a gradual building of a collective vision; exploring and working in the spaces and places where opportunities lie; systematically reflecting on ourselves and our personal and collective practice and being courageous to evaluate the impact of our micro work in order to build local evidence to influence and build relationships and partnerships at meso and macro levels. 

Honor MacGregor

Honor MacGregor

11:0012:30
Room: Samarkand

Concurrent Session 5

01.08.01

Oral presentation

Advanced practice nurse collaboration enables an integrated, patient-centered care process in liver transplantation across hospitals

Sonja Beckmann

Description

Liver transplant (LTx) is an established treatment for end-stage liver diseases delivered in specialized centers. Based on the illness trajectory, patients often move between their close-by primary care hospital and the LTx center, leading to fragmented care delivery in a patient group with chronic conditions and complex needs. In 2014, the interprofessional teams at the University Hospital Zurich and the Cantonal Hospital St. Gallen were complemented with an advanced practice nurse (APN), responsible for self-management support in LTx and hepatology patients, respectively.

Using the principles of collaboration, inclusion, and participation, the APNs established a pathway for LTx patients across the two hospitals. The pathway encompasses an evidence-based, integrated, and patient-centered care process before and after LTx, embedded in an APN-led consultation service. The consultation service was developed based on a literature review and focus group interviews with patients, caregivers, and health professionals. Additionally, the LTx center developed two brochures, delivered to LTx patients in both settings to guide counseling and provide written self-management support and information. Regular exchanges between the APNs ensures the coordination of care activities, the transition of tasks and equal clinical information. This is essential when patients are transferred between settings and guarantees prompt action in a population with rapidly changing needs.

Forty patients received 167 consultations from both APNs. The comparison between the settings showed differences in structure and content of the consultations, highlighting patients’ diverse and specific health needs subject to their illness trajectory. Patients and team members reported increased satisfaction due to the improved flow of information. Supported by nursing management and lead physicians, the APN-led consultation became an integral part of delivery service in both settings. Moreover, the unique APN-collaboration between the two hospitals provides high-quality care and ensures continuous care planning, self-management support and patient-centered care in the course of LTx.

Sonja Beckmann

Sonja Beckmann

01.08.03

Oral presentation

The challenges of meeting older emergency department patients’ specific care needs

Florian Grossmann
Deborah Allen

Description

Older emergency department (ED) patients are a vulnerable and fast growing patient group with special care needs.  However, most EDs are poorly prepared to meet these. In the ED of the University Hospital Basel several initiatives have been undertaken to improve care of older patients, two of which will be presented and reflected on in this presentation.
The “geriatric fast track” is a pathway which aims to enhance disposition of patients likely to be admitted.  Patients are identified at triage and are treated in a dedicated and specifically equipped area within the ED.  A team of nurses, led by a Clinical Nurse Specialist (CNS), takes an in depth patient history and performs a short geriatric assessment including e.g. delirium screening and falls risk assessment.
The “ED based community nursing” service aims to facilitate discharge of patients who otherwise would have to be admitted to inpatient beds.  After one night in the ED’s observation unit, a CNS assesses patients who meet inclusion criteria for eligibility. Eligible patients are accompanied back home. There, the CNS, together with the patient, elaborates a care plan for the coming days, and installs an emergency call system. The following day, the CNS evaluates the patient situation during a follow-up visit.
Both initiatives were planned carefully, inspired by CIP principles (collaboration, inclusion, participation), and practice development methods. However, after one year, and three months, respectively, we established that far fewer patients than expected were included into both services. Reasons for this are currently being investigated. In our presentation we will describe how the services were developed, reflect on why we fell short of meeting our goals, and facilitate a discussion on how to more effectively transform ED care of older patients.

Florian Grossmann

Florian Grossmann

11:0012:30
Room: Miami

Concurrent Session 6

01.09.01

Oral presentation

Big data and practice development: Lessons learnt from the Australian Nursing Outcomes Collaborative (AUSNOC)

Jenny Sim

Description

The purpose of this presentation is to describe how the Australian Nursing Outcomes Collaborative (AUSNOC) has used data in combination with the principles of practice development to measure, monitor and improve the quality and safety of nursing care.

 

AUSNOC is an Australian indicator set for measuring the quality and safety of nursing care which elucidates the unique contribution that nursing makes to patient outcomes. The indicator set is founded upon a conceptual framework that explores nursing care using the following constructs: Care and Caring; Communication; Coordination & Collaboration; and Safety. Data collected includes administrative data, adverse events, observational studies of the processes of nursing care, and the use of three periodic surveys that use validated tools (Nursing Work Index – Revised: Australian; Caring Assessment Tool; and one of a number of approved Patient Experience Surveys). Feasibility testing of the AUSNOC indicator set was undertaken in three hospitals in NSW, Australia.

 

This presentation will explore the tensions between using big data and data registries to achieve person-centred and evidence-based care that enables individuals at the micro-system level to enact change and improve patient outcomes. The concept of big data may be seen by some as the antithesis of practice development principles. Data registries, metrics and indicator sets are frequently seen as vehicles by which organisations can hold management and staff accountable. Arbitrary benchmarks are used to set key performance indicators and measurement for accountability rather than measurement for improvement then ensues (Solberg et al. 1997). AUSNOC has chosen to use work-based learning, skilled facilitation and evaluation approaches that are participatory, inclusive and collaborative to support micro-system changes in nursing processes to influence patient outcomes. Lessons learnt from the development and feasibility testing of AUSNOC as well as the development of AUSNOC as a collaborative research centre will be shared during this presentation.

Jenny Sim

Jenny Sim

01.09.02

Oral presentation

Evidence building as a leadership concern in practice development (PD)

Greg Fairbrother

Description

The case for building quantitative and mixed study designs into PD work (‘evidence -based PD’) has been made in recent years and received a favourable response from members of the PD community. Key to this response is a view that it’s time that PD-generated change is studied at sufficiently high levels to be evidentiary and become a driver of cross-organisational change. Collaborative leadership is now needed to establish some of the core system requirements for an evidence-based PD to flourish.

To explore the contemporary evidence-related scenario among practice developers, the authors surveyed delegates to E P16 (Edinburgh). Findings of note were: i) most respondents reported feeling up to date with the evidence in their practice domain; ii) respondents varied widely as to what evidence sources they relied upon; iii) only about 25% of respondents reported having used quantitative approaches when evaluating PD work; iv) open-ended responses suggested that the low usage of quantitative methods found in the survey was not related to philosophical objections to positivism. Instead resource-, pragmatic- (e.g. sample size) and knowledge-related barriers were reported.

Sample size is key to effectiveness evidence generation. Well conducted multi-site work enhances the potential for generalisability. If within the PD movement, we were to establish a centralised PD Clearing House (PDCH), formal ‘like-with-like’ project merging may become achievable. This would require outcome measurement to merge, not localised context-specific actions. The diversity of local actions could be tracked via adherence-checking. So a PDCH could work with separate projects targeting aged care falls reduction, data-merge, and generate one international multi-site result.

Our presentation focuses on the survey findings and on related PDCH- and research capacity building-related strategies which would be realisable only if led collaboratively. Audience discussion around strategic intent, feasibility and pragmatic factors will be encouraged.

Greg Fairbrother

Greg Fairbrother

01.09.03

Oral presentation

Developing Academic Nursing Leadership

Shaun Cardiff

Description

Although nursing has been an academic discipline for decades, there is wide variation in how nursing science has developed within various countries. In The Netherlands the first nursing professor was only appointed in 1986 and there have been no studies investigating academic leadership by postdoctoral nurses. Whilst academic nurses are known to advance nursing science and positively influence healthcare (Hafsteinsdóttir et al, 2017), a need for leadership practice development among Dutch post-doctoral nurses has been identified (Brekelmans, 2017).

To strengthen nursing research and improve the research productivity and career development of 12 postdoctoral nurses, a tw0-year Leadership Mentoring in Nursing Research (LMNR) program was ran between February 2016-18. The program was developed by a collaborative of dutch university nursing science departments and international partners. Participants followed intensive (personal and professional leadership development) workshops, worked with Kouzes & Posners (2007) leadership model, and met with leading international experts in health care research. Alongside a personal professional development plan, participants were also mentored by an academic nurse leader and research mentor of choice.

Longitudinal qualitative participant evaluation has been conducted to inform program development and gain insight into the influence the program has had on participant being and doing. Open interviews were conducted at the beginning, middel and after completion of the program.

Results show that the program has influenced participant identity and leadership (mindset and practice). It has also increased contextual awareness as participants continuously cross multiple boudaries between, and within, academia, education and clinical practice.

Having presented the findings of this evaluation study, a critical dialogue with the audience is desirable. The key questions for discussion is: Are (existent) leadership models adequate for post-doctoral nurses leading at macro-/meso-/micro-levels? And, how can more post-doctoral nurses be supported in developing their leadership competency in austere times?

Shaun Cardiff

Shaun Cardiff