Advanced Practice Nurses: Promoting evidence based practice and capturing impact: lessons from two U...
Download
1 / 34

Ann McDonnell Sheffield Hallam University UK - PowerPoint PPT Presentation


  • 96 Views
  • Uploaded on

Advanced Practice Nurses: Promoting evidence based practice and capturing impact: lessons from two UK studies. Ann McDonnell Sheffield Hallam University UK. The City of Sheffield. Britain’s 5th largest city Population of 530,300 Home to two universities and over 45,000 students

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Ann McDonnell Sheffield Hallam University UK' - pascale-cameron


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Advanced Practice Nurses: Promoting evidence based practice and capturing impact: lessons from two UK studies

Ann McDonnell

Sheffield Hallam University

UK


The City of Sheffield and capturing impact: lessons from two UK studies

  • Britain’s 5th largest city

  • Population of 530,300

  • Home to two universities and over 45,000 students

  • England's greenest city: 150 woodlands, 50 public parks

  • One third of the city lies within the Peak District National Park

  • A thriving cultural scene


Faculty of Health and Wellbeing and capturing impact: lessons from two UK studies

  • Over 600 staff and over 7500 students

  • We are one of the largest education providers for radiotherapy, nursing, physiotherapy and sport in the UK



Two studies
Two studies of the highest levels of research generated income from any new UK university

  • Empowering frontline staff to deliver evidence based care: the contribution of nurses in APN roles

  • Capturing the impact of nurse consultant roles


Facilitating the link between evidence and practice: of the highest levels of research generated income from any new UK universitythe process of knowledge-brokering undertaken by advanced practice nurses (APNs)

Research Team:

Sheffield Hallam University

University of Sheffield

Funded by Department of Health (England)

Nursing Quality Initiative, Policy Research Programme


Definition of apn
Definition of APN of the highest levels of research generated income from any new UK university

  • Any nurse working in the area of adult nursing or public health whose role involved an element of clinical practice in which they demonstrated expert knowledge and skill.

  • Included

    • clinical nurse specialists

    • nurse consultants

    • nurse practitioners

    • practice development nurses


Overview of project
Overview of project of the highest levels of research generated income from any new UK university

  • A study examining the contribution of advanced practice nurses (APNs) to promoting evidence-based practice among front-line staff

  • Survey by postal questionnaire of APNs working in 7 SHAs in England (n = 855)

  • Case studies of 23 APNs


Case study methods sampling
Case study methods - sampling of the highest levels of research generated income from any new UK university

Purposive sampling of survey respondents to achieve maximum variation in:

  • clinical speciality

  • type of role

  • type of organisation

  • ways of working with front-line staff

  • geographical location


Sample
Sample of the highest levels of research generated income from any new UK university

  • Final sample of 23 APNs were our 'cases'

  • 5 in-depth case studies and 18 short case studies

  • e.g. TB nurse specialist, practice development nurse, lead nurse for care homes, nurse consultant in sexual health


Data collection short case studies n 18
Data collection – short case studies (n = 18) of the highest levels of research generated income from any new UK university


Data collection in depth case studies n 5
Data collection – in depth case studies (n=5) of the highest levels of research generated income from any new UK university


Findings from the case studies

Findings from the of the highest levels of research generated income from any new UK universitycase studies


Evidence based practice
Evidence-based practice of the highest levels of research generated income from any new UK university

  • A move away from ‘custom and practice’ to a position of being able to justify actions on the basis of robust evidence.

  • Described in terms of process and outcome.

    • Evidence-based practice was a means of :

      • providing care which was based on the best evidence available

      • achieving the best possible outcome for patients

  • Types of evidence

    • Research evidence

    • Organisational evidence

    • Expert knowledge derived from professional practice

    • Information gleaned from interactions with patients


Knowledge brokering
Knowledge brokering of the highest levels of research generated income from any new UK university

  • The human forces behind knowledge transfer that help build relationships and networks for sharing existing research, ideas and stimulating new work (CHSRF 2005)

  • APNs act as knowledge brokers by creating links between different practice communities, in particular acting as intermediaries between the clinical and research communities (Milner et al 2005)


Knowledge brokering1
Knowledge-brokering of the highest levels of research generated income from any new UK university

  • I see myself as a resource for front-line staff in terms of facilitating evidence-based practice. I have the information, the evidence if you like, I make it available to them and I help them apply it in practice. Research can be difficult to understand and so it’s about making it more accessible, helping them see the implications for practice, incorporating it into guidelines that they can use.

    Clinical nurse specialist

  • They (APNs) need to be able to translate research knowledge for practical implementation … It’s about bridging that gap between the theoretical and the practical in developing policy which then directs practice.

    Director of Nursing


Knowledge brokering2
Knowledge-brokering of the highest levels of research generated income from any new UK university

Two aspects:

  • Managing knowledge

  • Promoting uptake of knowledge


Knowlege management
Knowlege of the highest levels of research generated income from any new UK university management

  • generating knowledge

  • accumulating knowledge

  • synthesising knowledge

  • translating knowledge

  • disseminating knowledge


Generating knowledge
Generating of the highest levels of research generated income from any new UK universityknowledge

  • Empirical evidence

    • Research

    • Organisational evidence – audit / service evaluation

  • Professional experience

    • It’s through the experience you gain, being in a situation over and over again and having to deal with it. The amount of observation and contact with patients in terms of seeing what you do and what happens as a result of that. Providing care, evaluating what happens, seeing the effect, reflecting on the outcome (NC Palliative care)

  • Personal knowledge about patients

    • I wonder if any of the breast care nurses had breast cancer because they seem so knowledgeable about how it really is. They’ve taken so much from all of their patients, absorbed things that have been said to them and put it together (Patient)


Accumulating knowledge
Accumulating of the highest levels of research generated income from any new UK universityknowledge

  • They (APNs) are a great resource for information to help me in my job. They have up-to-date knowledge, they will be aware of things that I am not aware of as they are experts in their own field.

    District nurse

  • Repository of evidence

    • Primary research findings

    • Research products such as clinical guidelines

    • Best practice when research was lacking

    • Organisational information – how to make things happen

    • Information relating to individual patients

  • Process of accumulating

    • Active searching

    • Networking

    • Conduit for organisational evidence


Synthesising knowledge
Synthesising knowledge of the highest levels of research generated income from any new UK university

  • Bringing together different types of knowledge to present a composite picture to inform practice

  • Synthesising research evidence, professional expertise and patient experience


Translating knowledge
Translating of the highest levels of research generated income from any new UK universityknowledge

  • Interpreting the significance of evidence and expressing it in plainer terms for different audiences – frontline staff, patients, managers

  • Evaluating evidence

    • Research evidence not taken at face value but evaluated regarding applicability in local settings

    • Research may indicate that a drug works well for treating a particular condition. But the trial will have been done in a controlled way, the sample will have been selected to fulfil particular criteria and the real world is not like that. Patients often have multiple pathologies which mean that the drug may not be the most appropriate one for an individual patient. We need to take account of the whole picture before acting on what appears to be robust evidence. CNS

  • Interpreting evidence

    • Presenting evidence in a way that is readily understandable to the audience

  • Distilling evidence

    • Drawing together different types and sources of evidence to present it in a more concise format that is accessible to end users


Disseminating knowledge
Disseminating of the highest levels of research generated income from any new UK universityknowledge

  • Active versus passive dissemination

  • Formal

    • Education and training

    • Networking – e.g. link nurse schemes

    • Multi-disciplinary team meetings

  • Informal

    • Impromptu encounters

    • ‘popping in’

    • Passing on information – e.g. journal articles


Promoting the uptake of knowledge
Promoting the uptake of knowledge of the highest levels of research generated income from any new UK university

  • Capacity building e.g. shadowing, link nurse schemes

  • Clinical problem solving e.g. working with frontline staff to solve clinical problems and using this as an opportunity to promote evidence-based practice

  • Facilitating change

    • We can take (research into silver coated catheters) to the trust board and say ‘look if we go with this we can reduce UTIs (urinary tract infections) by this amount’ and argue about balancing cost with effectiveness


Factors influencing apns ability to broker knowledge
Factors influencing APNs’ ability to broker of the highest levels of research generated income from any new UK universityknowledge

  • Personal attributes

    • Clinically credible & street wise

    • Political acumen

    • Interpersonal skills

    • Transformational leadership style – compliment rather than substitute for FLS

  • Support from senior manager and doctors

  • Characteristics of role

  • Organisational commitment

  • Professional networks – internal and external


Conclusion
Conclusion of the highest levels of research generated income from any new UK university

  • Educational implications for APNs

    • Need to develop skills to become effective evidence-brokers

  • Educational implications for frontline staff

    • Need to develop knowledge and skills in evidence-based practice and critical thinking

  • Infrastructure to support APNs in knowledge-brokering

    • Practical assistance (e.g. clinical audit) and resources (e.g. IT need to be available

  • Impact of APNs is hard to capture


Capturing the impact of nurse consultant posts a project to develop practical guidance

Capturing the impact of Nurse Consultant Posts - a project to develop practical guidance

Project Team: Kate Gerrish, Ann McDonnell, Fiona Kennedy(funded by the Burdett Trust for Nursing)


Background
Background to develop practical guidance

  • Nurse consultants (NC) introduced into the NHS in England in 2000

  • Set up to achieve better outcomes for patients by improving quality and services and to provide an alternative career pathway for experienced practitioners to remain in clinical practice rather than move into education, management or research

  • Impact of these multi-faceted roles is inherently hard to capture (Guest et al. 2004).


Overall project aims
Overall Project Aims to develop practical guidance

  • To identify a range of indicators to demonstrate the impact of nurse consultants on patient, staff and organisational outcomes

  • To develop a toolkit/guidance to help nurse consultants to demonstrate their impact on patient, staff and organisational outcomes


Project overview
Project Overview to develop practical guidance

  • 2 year project; commenced May 2009

  • Stage 1 - Systematic literature review

  • Stage 2 - Mapping exercise of nurse consultants

  • Stage 3 - Case studies of nurse consultants

  • Stage 4 - Iterative specialist panel phase

  • Stage 5 - Composite toolkit/guidance


Framework for capturing impact

Physical/psychological wellbeing to develop practical guidance

Quality of life & social

wellbeing

Patient behavioural change

Patient experience of healthcare

Clinical

significance

Organisational

Professional

significance

significance

Professional competence

Quality of working life

Organisational priorities / targets

D

evelopment

of policy

Workload distribution

Generation

of new knowledge

Team working

Framework for capturing impact

Informed by the work of Schulz et al (2002) & Gerrish et al. (2007)


Capturing impact a practical toolkit for nurse consultants
Capturing impact: A Practical Toolkit for nurse consultants to develop practical guidance

  • Key features:

    • Evidence based - developed through a rigorous research study

    • A useful and practical framework is introduced to help nurse consultants consider the impact they might have from a number of different perspectives

  • Activities and examples are provided to consolidate learning

Available for free download from:

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


References
References to develop practical guidance

Gerrish K, McDonnell A, Nolan M, Guillaume L, Kirshbaum M, Tod A.(2012) Factors influencing advanced practice nurses' ability to promote evidence-based practice among frontline nurses. Worldviews on Evidence-Based Nursing 9 (1), 30-39.

Gerrish K, McDonnell A, Nolan M, Guillaume L, Kirshbaum M, Tod A. (2011) The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses. Journal of Advanced Nursing 67(9), 2004–2014.

Kennedy F, McDonnell A, Gerrish K, Howarth A, Pollard C & Redman J (2011). Evaluation of the impact of nurse consultant roles in the United Kingdom: a mixed method systematic literature review. Journal of Advanced Nursing.


Sheffield to develop practical guidance


ad