Evaluation of a pilot mentoring programme for nurse managers

BACKGROUND: The Institute of Nursing Executives is a professional organization with a membership of approximately 150 Australian nurse managers and administrators. Members of rural zones were concerned by the lack of support available to new managers working in isolated areas and sought to develop a mentoring programme that would establish both professional development and support networks for these managers. A pilot programme was developed for two rural areas of New South Wales and one metropolitan site (the city of Sydney). AIM: The evaluation reported here aimed to determine participant expectations of mentoring and outcomes of the pilot programme. METHOD: The programme included matching and self-selection of mentor and mentee roles and attendance at a full-day Mentoring Workshop. The programme was evaluated by voluntary and anonymous pre- and postworkshop questionnaires sent to all participants, and postworkshop telephone interviews. RESULTS: Thirty-seven participants (79% of those enrolled in workshop) responded to the preworkshop questionnaire (20 identifying as mentees; 17 as mentors). Findings reiterated the lack of professional support and access for rural/remote area nurse managers and illustrated that new nurse managers lacked confidence in coaching and stimulating staff. Expectations of both mentors and mentees were similar in valuing a confidential, on-going mentoring relationship. Postworkshop questionnaires (n = 16) and telephone interviews (n = 11) highlighted issues about personal choice and timing, expectations of a structured programme and making greater use of existing technology to support and maintain networks. CONCLUSION: The pilot mentoring programme was highly successful in identifying strategies for the development of a tailored and sustainable programme for newly appointed nurse managers. Provision of a highly structured and facilitated programme carries high expectations of continued external support. Nurse managers also expressed a desire to choose when, how and whom they would select as mentors. Suggestions for the future included a greater use of technology to facilitate e-mail and internet-based discussion groups and mentor support.     

Student nurses as peer-mentors: collegiality in practice

Mentoring is promoted as a key strategy for supporting nursing students and new practitioners in clinical settings. However, mentoring is also a complex process, requiring the development of bounded and purposeful relationships underpinned by knowledge, experience and opportunities for reflection. This paper reports the findings of an evaluation by second-year nursing student mentors and first-year mentee students of a short peer-mentoring programme. The main objective of the programme was to support students making the transition to the university and nursing. At a more focused professional level, the programme also provided the opportunity for students to be a mentor or to be mentored, as a learning precursor to being mentored in the clinical setting. The programme provided rich learning opportunities for the development of the qualities and skills required for mentoring roles and was a vehicle for encouraging collegial interaction and learning. The students' evaluation of the programme also demonstrated that formal mentoring programmes require considerable organisational investment and ongoing commitment in educational and clinical settings. Mentors and mentees require time for face-to-face meetings and discussion, effective and on-going communication channels, and adequate role preparation.     

An evaluation of the impact of the Gold Standards Framework on collaboration in end-of-life care in nursing homes. A qualitative and quantitative evaluation

BackgroundIn the United Kingdom approaching 20% of people aged 85 years and over live in care homes and most will die there. Improving end-of-life care is a government health priority and homes may work with primary care staff and specialist palliative practitioners to provide comprehensive end-of-life care. Consequently effective collaboration between care home and health service practitioners is vital to ensure high quality end-of-life care.ObjectivesTo evaluate the impact of a training programme to improve end-of-life care in nursing homes, on collaboration between nursing home staff and other health practitioners.DesignEvaluation using survey methods and qualitative case studies.Participants and settingAll 95 nursing homes in the first national ‘Gold Standards Framework in Care Homes’ programme in England were invited to participate in the evaluation.MethodsA survey of homes’ characteristics, the approaches to end-of-life care, and liaison with other services, was completed pre and post programme implementation. Case studies were conducted in a sub-sample of 10 homes to provide important context and depth to the evaluation.ResultsPre and post surveys were returned by 49 (52%) homes. Improved collaborations as a result of the programme were anticipated by 31% of managers. Challenges to collaboration included working with large numbers of general practitioners, out-of-hours services and access to specialist practitioners. Improved collaborations between home staff and health service practitioners were identified by 33% of managers as one of the main programme outcomes. Staff reported increased knowledge of end-of-life care, and enhanced confidence, which in turn resulted in improved communication and collaboration. Post-programme, staff felt more confident initiating contact and discussing residents’ end-of-life care with general practitioners and those working in specialist palliative care services.ConclusionsThe Gold Standards Framework in Care Homes programme can contribute towards end-of-life care by helping to improve the quality and quantity of communication and collaboration between nursing home staff and primary care and specialist practitioners. Further research is needed to determine why this was not consistent across all homes.     

Building bridges in palliative care: evaluating a GP Facilitator programme

The objective of this study was to evaluate the impact of the Macmillan GP Facilitator Programme in Palliative Care on the knowledge, attitudes and confidence in symptom control of general practitioners (GPs), communication with patients and out-of-hours practice. GP Facilitators work on average for two sessions a week with practices in their locality. The design included a before and after study, with geographical controls matched on type of area (inner city, urban and rural) and broadly on Jarman scores using postal questionnaires sent to GPs. Scores measured change in GP awareness, attitudes and practice over two years of the intervention, derived from Likert scale responses to the postal questionnaires. Although overall few significant results were found, we did identify an increase in the use of palliative care guidelines in Facilitator districts, together with an increase in awareness of day care. The programme was associated with increased positive attitudes towards specialist palliative care services and results suggested increased satisfaction with out-of-hours services for patients. No change was found for confidence in symptom control and communication over diagnosis with cancer patients was less than in control districts. The design also incorporated a qualitative component, and from this we found the Facilitator programme to be popular with local GPs who valued the support of a colleague who knew the demands and constraints of general practice. In conclusion, we have demonstrated an impact of the GP Facilitator programme on GP awareness of, use and increased positive attitudes towards specialist palliative care services. By improving communication between primary and specialist palliative care, the programme should contribute substantially to improved care of the dying at home.     

Exploring nursing outcomes for patients with advanced cancer following intervention by Macmillan specialist palliative care nurses

BACKGROUND: Little information exists about the outcomes from nursing interventions, and few studies report new approaches to evaluating the complex web of effects that may result from specialist nursing care. AIMS: The aim of this study was to explore nursing outcomes for patients with advanced cancer that may be identified as resulting from the care of a Macmillan specialist palliative care nurse. METHODS/INSTRUMENTS: Seventy-six patients referred to 12 United Kingdom Macmillan specialist palliative care nursing services participated in a longitudinal study of their care over 28 days. Patients were interviewed and completed the European Organization for Research on Treatment of Cancer Quality of Life Scale and the Palliative Care Outcomes Scale at referral, and 3, 7 and 28 days following referral to a Macmillan specialist palliative care nursing service. A nominated carer was interviewed at baseline and 28 days. Notes recorded by Macmillan specialist palliative care nurses in relation to each patient case were analysed. FINDINGS: Significant improvements in emotional (P = 0.03) and cognitive functioning (P = 0.03) were identified in changes in patients' European Organization for Research on Treatment of Cancer Quality of Life Scale scores, and in Palliative Care Outcomes Scale patient anxiety scores (P = 0.003), from baseline to day 7. Analysis of case study data indicated that overall positive outcomes of care from Macmillan specialist palliative care nursing intervention were achieved in 42 (55%) cases. STUDY LIMITATIONS: Sample attrition due to patients' deteriorating condition limited the value of data from the quality of life measures. The method developed for evaluating nursing outcomes using data from patient and carer interviews and nursing records was limited by a lack of focus on outcomes of care in these data sources. CONCLUSIONS: A method was developed for evaluating outcomes of nursing care in complex situations such as care of people who are dying. Positive outcomes of care for patients that were directly attributable to the care provided by Macmillan specialist palliative care nurses were found for the majority of patients. For a small number of patients, negative outcomes of care were identified.     

Assessor or mentor? Role confusion in professional education

This paper reports on research conducted as part of a multi-professional study involving nursing, medicine and midwifery, which aimed to investigate both mentee and mentor perceptions of the mentorship role and the context within which it is conducted. It is well recognised that mentorship plays a vital part in the support and training of healthcare professionals. Documentation published by regulatory bodies regarding the mentorship role and changes in it's implementation in practice has resulted in confusion among practitioners. This study consisted of questionnaires and semi-structured telephone interviews with both mentors and mentees, within three healthcare professions and focuses on the responses from the nursing profession. The mentors participating in the study struggled with their dual role as assessor and mentor and found conflict within this responsibility. The role of assessor was poorly recognised and the complexity of being both an assessor and a supporter/friend is discussed.     

The value of nurse mentoring relationships: Lessons learnt from a work‐based resilience enhancement programme for nurses working in the forensic setting

This study aimed to evaluate a mentoring programme embedded in a work‐based personal resilience enhancement intervention for forensic nurses. This qualitative study formed part of a wider mixed‐methods study that aimed to implement and evaluate the intervention. Twenty‐four semistructured interviews were carried out with forensic nurse mentees and senior nurse mentors; these explored their experiences of the mentoring programme and any benefits and challenges involved in constructing and maintaining a mentor–mentee relationship. Qualitative data were analysed thematically using the Framework Method. Four key themes relating to the initiation and maintenance of mentor–mentee relationships were identified: finding time and space to arrange mentoring sessions; building rapport and developing the relationship; setting expectations of the mentoring relationship and the commitment required; and the impact of the mentoring relationship for both mentees and mentors. Study findings highlight the benefits of senior nurses mentoring junior staff and provide evidence to support the integration of mentoring programmes within wider work‐based resilience enhancement interventions. Effective mentoring can lead to the expansion of professional networks, career development opportunities, increased confidence and competence at problem‐solving, and higher levels of resilience, well‐being, and self‐confidence.     

Crisis? What crisis?

The fact that 50% of the 4600 hours that constitute a pre-registration nursing programme takes place in the practice setting, means that there is considerable reliance on mentors and other clinicians to support and teach students. Clinical experience is vital if student nurses are to implement the theory they have learnt in the classroom and become competent and safe practitioners (Panther, 2008). There is, therefore, a need for high-quality clinical learning environments which both provide students with the support they need and measure their clinical competence. Mentors play a vital role in both these aspects and are the fulcrum on which practice learning depends (Pellatt, 2006).     

An evaluation study of a mentoring program to increase the diversity of the nursing workforce

Focus group methodology was used to evaluate faculty mentors (n = 10) and student mentees (n = 30) perceptions of a formal mentoring program. Prior to implementing the mentoring program, faculty preparation involved cultural competence and mentor workshops. Overall, both mentors and mentees had positive perceptions of the program. Three themes emerged from each group. The mentor themes were role modeling, caring and academic success and the mentee themes were support system, enhanced perceptions of the nursing profession, and academic enrichment. In addition, there were similarities between the mentors and the mentees when asked what constituted a good mentor and a good mentee.     

From Institutional to Community Support: Consequences for Medical Care

Background Concerns have been raised about the quality of medical care available for people with intellectual disabilities in community‐based services. The aims of this study were to evaluate a model of medical care developed during a programme of deinstitutionalization, based on a specialist physician supporting general practitioners (GPs). Method Postal questionnaire survey of all 36 GPs participating in the specialist physician support programme. Responses were received from 22 participants (response rate 61%). Results The majority of GPs agreed that clients with intellectual disabilities should receive services in primary care settings. While they also reported themselves to be capable of providing medical care to people with intellectual disabilities, they also reported the provision of specialist support to be important. Conclusions It is possible to provide high quality medical care in community‐based settings if specialist support is made available for GPs.     

A Master Class for nursing unit managers: an Australian example

AIM: To design and provide a Master Class leadership course for nursing unit managers. BACKGROUND: The selection and development of nursing unit managers is important to the profession and to the units they manage given their critical role in staff retention. While many in these positions are well-qualified academically they may require ongoing professional development in a cycle of continuous learning that challenges and motivates them to maintain skill mastery. EVALUATION: A review of the literature found examples of a Master Class conducted in the arts but none in leadership development. The elements of a Master Class have been distilled from the literature and applied to the development of a programme for 18 nursing unit managers employed at four hospitals in an area health service in New South Wales (Australia). A Delphi survey using participants determined the 20 most important topics from which to construct the programme. CONCLUSIONS: The programme was positively evaluated by participants in aspects such as allowing the expression of opinions, networking, stretching their minds and time to reflect on their own experiences. Nursing unit managers occupy a pivotal role in health care institutions. Investing resources into the ongoing development of their leadership skills may provide significant benefits for the individuals themselves, their staff and the organization.     

Meeting complex needs: an analysis of Macmillan nurses' work with patients

Macmillan nurses, working as Clinical Nurse Specialists (CNS), are in many ways the public face of specialist palliative care in the UK. However, the way in which they manage their clinical workload is not well understood. Questions about this aspect of their work have emerged from a large-scale evaluation of Macmillan nursing in 12 sites in the Trent and Thames regions of the UK, funded by Macmillan Cancer Relief. This article focuses on how Macmillan nurses enact their patient care role, drawing on caseload data, diaries and semi-structured interviews from the wider evaluation. It concentrates on the following issues: characteristics of referred patients; nature of interventions given; division of time between different aspects of the CNS role; nurses' perceptions of their patient-care role. Findings suggest that activities associated with direct patient care account for the majority of nurses' time, with little time spent in any other individual aspect of the CNS role. The delivery of care to older patients at the end of life is a major part of Macmillan nurses' clinical role. Issues relating to the educational and support needs of Macmillan nurses are raised.     

Service user involvement: Inspiring student nurses to make a difference to patient care

UK policy directives have placed service users/carers at the centre of health care provision and education. Underlying these policy directives is the anticipation that this involvement will produce practitioners capable of delivering enhanced care. This paper reports on the evaluation of an innovation around the introduction of a student nurse pledge to enhance patient care. Following exposure to the service user stories in the classroom students documented a pledge, within their practice assessment documents, to improve one aspect of patient care. Of the 284 pledges evaluated, 219 were successfully achieved with, 171 relating to compassion, communication and nutrition. These aspects of care are often cited as causing the most distress to patients.65 students were unable to fulfil their pledge, citing reasons such as poor resources, lack of time. Disappointingly, mentors validated the students' inability to fulfil their pledge with little guidance as to how to succeed with their pledge. The impact of this innovation on student practice learning and patient care are discussed. The paper concludes that service user involvement can result in enhanced patient care and that educators can support students to narrow the theory/practice gap by making connections between theory and real life experiences.     

Primary mental health workers in child and adolescent mental health services

BACKGROUND: The interface between primary care and specialist services is increasingly seen as crucial in the effective management of child and adolescent mental health (CAMH) problems. In the United Kingdom, a new role of primary mental health worker (PMHW), has been established in order to achieve effective collaboration across the interface through the provision of clinical care in primary care settings and by improving the skills and confidence of primary care staff. However, little is known about the development of this innovative role in service contexts. Issues raised during the early stages of implementation may have important implications for the preparation and development of professionals who undertake the role. AIMS: The aim of this paper is to report on a study that examined key issues in implementation of the PMHW role in six health authorities in England. METHODS: Case study evaluation was conducted, using thematic analysis of 75 qualitative interviews with key stakeholders from different professions (e.g. PMHWs, general practitioners, health visitors, psychiatrists and service managers) and representing different sectors (primary care, specialist services and community child health services). FINDINGS: The study identified three models of organization (outreach, primary care-based and teams). Each was associated with different advantages and disadvantages in its effects on referral rates to specialist services and the development of effective working relationships with primary care providers. Problems associated with accommodation and effective integration of PMHWs with specialist services, and tensions caused by the two different roles that PMHWs could undertake (direct clinical care vs. consultation-liaison) were common across all sites. CONCLUSIONS: The PMHW role is an important development that may go some way towards realizing the potential of primary care services in CAMH. The implementation of new roles and models of working in primary care is complex, but may be facilitated by effective planning with primary care providers, clear goals for staff, and a long-term perspective on service development.     

Direct care staff's need for support in their perceived work role in day activities units

AIMS: This study sets out to investigate direct care staff's views of their need for support, supervision, and training in their practice in day care settings when supporting daily occupations among developmentally disabled persons. BACKGROUND: The first line staff are considered as having a prominent role in the successful delivery of service. METHODS: Three municipalities, one urban and two rural areas in southern Sweden, were chosen for the study. The studied population n = 81 consisted of 94.1% of all staff employed in day activities units supporting the clients' daily occupations or community-integrated, sheltered work employment. The data were collected by means of a questionnaire. FINDINGS: This material identified the staff's perceived work role, and their needs for support, supervision, and training in the areas of communication, environment adaptation, individual activation and training methods, with regard to learning disabilities and special needs. CONCLUSIONS: Care managers should focus upon preparation of staff support programmes to improve the quality and efficiency in this area of care.