Clinical leadership for high-quality care: developing future ward leaders

Aim This paper reports upon the development, delivery and evaluation of a leadership programme for aspiring Ward Leaders in one National Health Service Trust in England. Background The ward sister role is fundamental to quality patient care and clinical leadership, however the role is increasingly difficult to recruit to. A lack of formal preparation and skills development for the role has been widely acknowledged. Method An evaluation of a programme of education for leadership. Three cohorts (n = 60) completed the programme. Semi-structured questionnaires were completed by participants (n = 36: 60%) at the conclusion of the programme. Qualitative data from questionnaires was analysed using a thematic approach. Results Participants reported increased political, organizational and self-awareness, increased confidence, feelings of empowerment and the ability to empower others. Opportunities for networking with peers were valued within the action learning approach. For some participants, career intentions were clarified through reflection. Conclusion The majority of participants had benefited from the leadership programme and valued this development as an empowering preparation for future careers. Implications for nursing management Investment in leadership preparation for future ward sister roles is strongly recommended as part of a strategy designed to enhance quality improvement, career path development, workforce empowerment and retention.     

Investigating communication in cancer consultations: what can be learned from doctor and patient accounts of their experience?

This study investigated how doctors and patients diagnosed with advanced incurable cancer experienced the disclosure of bad news. The intention was to gain contrasting perspectives of the processes involved in oncology consultations. Sixteen doctors and 16 patients from a cancer centre in the UK participated in the study. A series of consultations were observed and audio recorded, and the perspectives of doctors, patients and relatives were investigated through semi‐structured interviews. Participants were invited to describe how they experienced and felt about the disclosure of information over a period of time following a specific consultation. Analysis was based on a constant comparative method. This research suggests that patients control what they do or do not do with information to meet their own needs and objectives, but doctors do not necessarily appreciate this. Doctors do not always prepare patients for what is happening to them in an active open awareness context, and this can be stressful for some patients. The results indicate that communication is not just about one person making decisions. They also indicate that in many cases more success could be gained from finding out how patients prefer to manage and control the exchange of bad news, at different points, through their care pathway.     

Older people receiving family‐based support in the community: a survey of quality of life among users of ‘Shared Lives’ in England

Shared Lives (adult placement) is a model of community‐based support where an adult who needs support and/or accommodation moves into or regularly visits the home of an approved Shared Lives carer, after they have been matched for compatibility. It is an established but small service which has been used mainly by people with learning disabilities but which has the potential to offer an alternative to traditional services for some older people. However, there is little research on the outcomes for older users of Shared Lives. This paper presents findings from a survey of 150 older people using Shared Lives support across 10 Shared Lives schemes in England, which took place between June 2013 and January 2014. The aim was to identify outcomes for older users of Shared Lives and compare these to outcomes for older users of other social care services. In the absence of an ideal study design involving randomised allocation, statistical matching was used to generate a comparison group from the Adult Social Care Survey from 2011/12, with 121 cases matched to 121 Shared Lives cases. The main outcome measures were Social Care‐Related Quality of Life (measured by the ASCOT) and overall quality of life. Findings indicated that Shared Lives can deliver good outcomes for older people, particularly for overall quality of life. In comparison to the matched group of older people using other forms of support, there was some evidence that Shared Lives may deliver better outcomes in some aspects of quality of life. Limitations to the research mean, however, that more work is needed to fully understand the role Shared Lives could play in supporting older people.     

Overcoming ignorance and stigma relating to intellectual disability in healthcare: a potential solution

while a.e . & clark l.l. (2009) Journal of Nursing Management  18, 166–172
Overcoming ignorance and stigma relating to intellectual disability in healthcare: a potential solution Aim To propose a strategy for overcoming stigma and discrimination against people with intellectual disabilities within healthcare. Background Evidence of poor healthcare for those with intellectual disabilities resulted in an independent inquiry. The subsequent report has charged healthcare organizations to address current organizational failings. Evaluation The origins of discriminatory practices in health services and the evidence of persisting poor care and stigmatization of this patient group despite UK Government policy are set out. Key issue The stigmatization and resulting discrimination of people with intellectual disabilities persists. Conclusion In addition to investment in core training, organizational change is needed to bring about change and a reduction in health inequality. Implications for nursing management The development of a new framework for nursing is recommended with leadership at all levels of healthcare so that people with intellectual disabilities and their families can expect to receive high quality care in all healthcare settings.