The brightest and best academic clinical nurses are fostering six core values to help improve patient experiences and outcomes in everyday clinical care, write Greta Westwood and colleagues
In a resource constrained environment, the NHS is required to improve the quality of care and patient experience at an unprecedented pace. Evidence that some NHS services are not providing high quality care is revealed almost daily; most spectacularly in the Francis report.
The launch of the chief nursing officer’s Compassion in Practice strategy will begin to ensure the six fundamental values – care, compassion, competence, communication, courage and commitment – become part of everyday clinical care.
The Department of Health’s Education Outcomes Framework advocates the healthcare workforce should be responsive to knowledge about best practice, research and innovation that promotes adoption and dissemination of improved service delivery, to reduce variability and poor practice.
Curious, creative and critical thinking clinical academic nurses, midwives and allied health professionals can drive quality improvement programmes and use analytical and research skills to question, investigate, research and innovate to improve clinical care.
Since 2008, the National Institute of Health Research has funded clinical academic training pathways and the success of these is now prompting local initiatives, for example at Southampton University, and regional initiatives such as the South Central Strategic Health Authority, to develop similar schemes in a scalable way.
‘Clinical academics are, for certain, set to change the future landscape of the NHS workforce’
The university’s clinical academic doctoral fellows work 40 per cent in clinical practice and 60 per cent undertaking PhD studies for four years. They work clinically in the partner NHS organisations and are supported by dedicated clinical mentors and academic supervisors.
Together with a growing number of post-doctoral fellows, they form a thriving community of multiprofessionals learning together in a purpose built clinical academic facility.
Clinical academic pathways attract the brightest and best practitioners to undertake research in issues of importance to patients and the NHS, for example the quality, innovation, productivity and prevention programme. These academics work in multidisciplinary and inter-professional teams, use research skills and analytical thinking to understand clinical problems, develop evidence based solutions and implement change.
Case Study: Jacqui Prieto
Dr Jacqui Prieto is an NIHR senior clinical lecturer and nurse specialist in infection prevention at University Hospital Southampton Foundation Trust, and Southampton University. Her research is focused on reducing catheter associated urinary tract infection (CAUTI). She leads a combined programme of quality improvement and research, linked to national initiatives including:
- minimising the initial placement of indwelling urinary catheters;
- optimising care and management of urinary catheters including prompt removal; and
- investigating the patient experience of short term urinary catheterisation.
NHS outcomes have included:
- reduction in catheterisation rate from 3.1 to 2.7 per 1,000 bed days over 10 months, and a decrease in inappropriate catheterisations from 9 per cent to 7 per cent (the CQUIN target is a 2 per cent reduction);
- standardised documentation for recording insertion and care of indwelling catheters in adults and defined indications for catheterisation;
- development and launch of a new evidence based policy for the prevention of CAUTI;
- implementation of a portable bladder ultrasound scanner for the non-invasive assessment of acute urinary retention, saving £130,000 a year by reducing the risk of UTI; and
- non-adoption of routine use of expensive antimicrobial impregnated catheters (including silver alloy), due to insufficient efficacy evidence, saving £133,000 per annum.
Case study: Sue Green
Dr Sue Green is a senior clinical academic post-doctoral fellow and community nurse at Solent Trust and Southampton University. She works within the community nursing service and a recently formed interdisciplinary home enteral nutrition (HEN) team. Her research and clinical role is focused on:
- investigation of factors influencing nasogastric tube blockage and barriers and facilitators to screening for malnutrition by community nurses;
- first line nutritional management of patients by community nurses including development of a core care plan for undernutrition;
- within the HEN team, reviewing patients with gastrostomy feeds in accordance with National Institute for Health and Care Excellence guidelines; and
- revision of screening tool presentation within electronic patient record system to enhance usability.
NHS outcomes have included:
- provision of training concerning nutritional care to community nursing teams; and
- HEN team activity has delivered enhanced patient experience, quality improvements and cost savings and has reduced hospital admission for gastrostomy tube related issues.
Case study: Lisa Roberts
Dr Lisa Roberts is an NIHR senior clinical lecturer at Arthritis Research UK and a senior lecturer and consultant physiotherapist at the Southampton foundation trust and Southampton University. Her clinical and research programme is focused on:
- communication and clinical decision-making between clinicians and patients with back pain;
- treating patients with complex musculoskeletal presentations; and
- leading the clinical effectiveness agenda for therapy services.
NHS outcomes have included:
- £1.5m of research income and £2m pending;
- leading the therapy services department to win the 2012 Chartered Society of Physiotherapy award for “demonstrating the impact of outcomes on patient care”, which included improvements in the quality of care given to patients at risk of falling; successful outcomes for patients with pneumonia; and reduced mean length of stay from 14 to 5.9 days in the intensive care unit; and
- MSK outpatient quality improvement initiative resulted in a better patient experience, 6 per cent decrease in non-attendance and a reduction in waiting times by 12 weeks.
These case studies clearly demonstrate the clinical academic role in developing evidence based patient care through service improvement and research.
The benefits to the NHS are evident. Clinical academic nurses, midwives and AHPs are changing how we care for patients within the NHS. By working and researching simultaneously, there is transfer of knowledge, innovation and practices across the so-called ‘theory-practice gap’.
‘Serving patients, families and carers with compassion requires an intelligent, caring healthcare workforce’
A ‘team’ model, whereby a post-doctoral fellow works with several doctoral students in one clinical area, could transform previously ‘Cinderella’ services, such as care of older people, into areas of clinical academic excellence. Clinical academics are, for certain, set to change the future landscape of the NHS workforce.
To care with compassion and competence needs curiosity – we need to be curious. To speak with courage and confidence, we need advanced communication skills to articulate concerns to convince and compel the right people to take the right action.
Serving patients, families and carers with compassion requires an intelligent, caring healthcare workforce. Building a clinical academic workforce not only creates role models and best practice, but it also builds the evidence base to innovate and deliver quality and safe clinical care.
Dr Greta Westwood is clinical academic coordinator, Southampton University, and head of nursing, midwifery and AHP research at Portsmouth Hospitals Trust; Professor Mandy Fader is director of clinical academic facility, Southampton University; Dr Lisa Roberts, is NIHR senior clinical lecturer and Arthritis Research UK senior lecturer, Southampton University and University Hospital Southampton Foundation Trust; Dr Sue Green, issenior clinical academic post-doctoral fellow, Southampton University and Solent Trust; Dr Jacqui Prieto is NIHR senior clinical lecturer, Southampton University and University Hospital Southampton Foundation Trust; Dr Lisa Bayliss-Pratt is director of nursing, Health Education England