The Florence Nightingale Foundation’s Chairs of Clinical Nursing Practice Research, October 2015: Travel, Academic Beginnings and Personal Experiences of the NHS

Professor Candy McCabe – University of the West of England and The Royal United Hospitals NHS Foundation Trust

Autumn is here and that ‘start of a new term’ feeling is evident at the university and within my hospital trust. At the university the corridors and canteen are full again with students and my inbox seems to have doubled. My ‘new term’ is focused on working up two grant applications for submission to the National Institute for Health Research (NIHR) early next year. The potential grants focus on improving the management of persistent pain post-limb fracture and the development of a device to help reduce pain. Both bids involve multidisciplinary research teams from academic institutions and NHS Trusts from around the UK, as well as support from finance, human resources, intellectual property advisors and the research and development departments within my host organisations. Excellent and regular communication is key!

The NIHR are the primary funder of clinical research in England and have a wide range of different funding streams as well as excellent fellowship routes for nurses and allied health professionals (http://www.nihr.ac.uk). As a previous recipient of one of these personal fellowship awards I cannot recommend them highly enough as an excellent route to support nurses in the conduct of clinical research/research degrees whilst still maintaining their clinical practice.

Autumn term at the hospital means 2016-17 business planning time for my two clinical services. The challenge is to constantly be increasing the quality of patient care whilst having to reduce costs. In my experience this always feels a very daunting and an impossible task at the start of business planning but it is remarkable how innovative nurses and healthcare professionals can be. Somehow a good solution is always found. As chronic pain is a condition where self-management approaches are advocated, our current business planning includes consideration of a trial to see how patient initiated follow-up may provide our patients with greater ownership of their care whilst helping to channel resources where they are most needed. Watch this space to see how we get on.

Professor Lesley Lowes – Cardiff University School of Healthcare Sciences and Cardiff and Vale University Health Board

I seem to have been juggling many balls in the last month or so, e.g. developing a research proposal to be submitted for funding, writing a research paper that I had hoped would be published by now, developing a nursing and midwifery research strategy for the Health Board…and helping to organise my son’s wedding! It is a great relief that the wedding went without a hitch on one of those rare beautifully sunny days, and the first substantial draft of the research strategy is completed! I am still juggling balls but feel a sense of achievement that my ‘to do’ list is not quite so long. Having said that, it seems that as soon as one task is crossed off, two more are added.

Last week, I attended an excellent Diabetes UK Cymru conference focusing on transition from paediatric to adult services and the use of social media in diabetes care. Transition in diabetes care is challenging and recognised as an area of care that clinical services need to improve. Most young people with diabetes in Wales move to the adult services between the ages of 14-18 years, which coincides with a period of physical, cognitive and psychological change. Young people are also often dealing with other transitions such as leaving home to go to university. Although 25 years of age has been suggested as a preferable time for transition, this would put tremendous pressure on paediatric services that are already stretched. There is no easy answer.

I am out of my comfort zone using twitter but I used the Diabetes UK Cymru conference as an opportunity to practice tweeting, which was appropriate because recently the Welsh Committee of the Florence Nightingale Foundation were charged with tweeting for a week about their activities in Wales.

September and October seem to be popular months for conferences. The Annual Cardiff and Vale University Health Board Nursing and Midwifery Conference is being held on 14th October and offers an excellent opportunity for networking and for nurses and midwives to showcase their audit and research activity. I feel privileged to have been asked to judge the posters. It is inspiring to see the work that nurses and midwives achieve despite their heavy and challenging workloads.

 

Professor Angela Todd – The University of Manchester and Central Manchester University Hospitals NHS Foundation Trust

Much of the research I conduct examines patient experience and seeks to answer questions related to access to health care. As a result my research touches diverse clinical topics including lung cancer, obesity and the health impact of cold homes and fuel poverty. This breadth makes the dissemination of research a fascinating business. In the last month I have been to three very different events to present research findings. At the beginning of September I found myself in Denver, Colorado presenting a selection of papers relating to the role of the lung cancer nurse specialist (LCNS) at the International Society for the Study of Lung Cancer World Lung Cancer Conference. Of particular interest were studies that examine the impact of the LCNS on access to anti-cancer treatment. As I was one of 20 members of the National Lung Cancer Forum for Nurses presenting at this international conference, it was a pleasure to join these UK colleagues and hear about their fascinating research and service evaluation work.

Having returned from Denver, my attention turned to the National Energy Action (NEA) Annual Conference which this year was held in Sheffield. NEA is a National charity that aims to eradicate fuel poverty. Their conference draws together an amazing mix of professionals from various sectors including health, social care, housing, local and national government and energy. I joined a colleague in presenting findings from a range of studies highlighting the importance of understanding factors influencing the behaviour of vulnerable households regarding home heating. As health professionals we are in a unique position to identify people vulnerable to the negative health impacts of being in a cold home. However, nurses and other health staff do require more information to help them identify who is vulnerable, why they are vulnerable, what help is required and available and how to make the required referrals.

The third and final conference was the NHS North West Research and Development Conference, “Let’s talk research…”. This was a fascinating two days, providing an opportunity for new and experienced researchers from a variety of health disciplines to present their work. It was great to witness the growth of health research activity in the North West and hear some of the absorbing work. Throughout the conference there were a series of workshops available to applicants on a range of topics. Along with colleagues I presented two workshops, one focused on research capacity building of nurses, midwives and allied health professionals through the development of a research strategy. This used our work at Central Manchester University Hospitals NHS Foundation Trust (CMFT). The second workshop concentrated on the importance of using different and creative methods of dissemination. The need to use different approaches for different audiences was explored.

Now back at work in Manchester, I am turning my attention in the next month to the completion of various research grant applications. We are also planning to launch our Nursing, Midwifery and Allied Health Professional Research Strategy at CMFT on 5th October. An exciting month ahead!

Professor Lesley Baillie – London South Bank University and University College London Hospitals NHS Foundation Trust

This month I have been busy preparing for the Professional Doctorate Programme, for which I am the course director, and starting supervision with new doctoral students as well as those continuing to their next phase.  It is exciting to hear about their research ideas and to support them as they embark on their long and often daunting journey, adopting a ‘you can do this’ approach while acknowledging the constraints and challenges they face along the way. Most are in senior and challenging roles in the health service and combining these with part-time doctoral study, within an ever-changing environment, is by no means easy. I also facilitate a doctoral forum in the Trust and when we met last week, it was great to hear their progress:  two have just successfully upgraded from MPhil to PhD and another who was struggling with recruitment is now doing well, following tips from her peers at the last forum.

I spend around 15 hours on trains each week while commuting to work and between sites. Whilst I see this as prime writing time, ideal for tackling my backlog of papers (and I also have a new book to write on quality improvement with a scary deadline), train time is frequently absorbed by academic review.  During this month, as usual, I have had numerous requests – some formal (journal papers, grant applications, conference abstracts, research ethics committee applications) but many others are informal, as university or Trust colleagues frequently ask: ‘Could you just look at?’ (a draft journal paper, a fellowship application, a research proposal). I take vicarious satisfaction when the latter result in successful outcomes and this month’s include an NIHR full-time MRES, a short-listed NIHR funded PhD application and a colleague with her first academic journal paper accepted. With the many journal paper review invitations I tend to accept those that most closely match my own research interests. I aim to ‘pull my weight’ with reviewing as I appreciate the role of peer reviewers of my own papers and it is this reciprocity that keeps the academic wheels turning.

On a different note, our undergraduate students started this month and as one of our School’s Alzheimer’s Society Dementia Champions, I delivered Dementia Friends (see https://www.dementiafriends.org.uk/) sessions to over 600 nursing and midwifery students during their induction, with a great response. The new national target is 4 million Dementia Friends by 2020 so I am proud that we are contributing to the goal for a dementia-friendly society and, specifically, for London to be the first dementia-friendly capital city. Last year we carried out an informal evaluation (in press with Nursing Older People) but we are soon meeting as a group to plan a more formal evaluation, following up on our students’ intended actions.

Professor Christi Deaton – The University of Cambridge School of Clinical Medicine and Institute of Public Health

Ah, autumn! I thought of the well-known line from Keats’ Ode to Autumn: “Season of mists and mellow fruitfulness…” as I cycled to work this morning across the very misty fields. I am lucky to be able to cycle on a bike path across the fields that still surround one side of the Cambridge Biomedical Campus.  It’s called the DNA path and has sculptures of the double helix at either end and 4-coloured tiles through the middle representing the base pairs.  This was the first time I’ve had to use my bicycle lights in months, a reminder of the shortening days now that we have passed the autumn equinox.

As my joint post is with the Cambridge University Hospitals FT, I was distressed by the Care Quality Commission Report that gave CUHFT an ‘inadequate’ rating. However the CQC rated caring as ‘Outstanding’ and is credit to the hard-working nursing, midwifery, AHP and medical staff, who, as the report noted, consistently go the extra mile for patients. Professor Kieran Walsh pointed out on twitter that the CQC report ratings grid showed a more nuanced message than the overall inadequate rating would indicate, with many good and outstanding ratings across services, and consistently high ratings for services for children and young people. CUHFT is not the only hospital to be struggling with the challenge of delivering world-class care in the face of increasingly high demand and financial constraints. While it is a difficult time at the Trust, with uncertainty regarding special measures and resignation of the CEO and CFO, I have confidence that care will continue to be delivered at an ‘outstanding’ level.

On the university side, I am busy with grants and papers like my colleagues. I contributed to the NIHR application of my colleagues, Professor Gunn Grande (Manchester) and Dr. Gail Ewing (Cambridge) in September where we are hoping to adapt and implement their Carer Support Needs Assessment Tool (tested and now implemented widely in cancer care) in heart failure. I am submitting a NIHR programme grant on 6th October focusing on developing and testing group exercise-based rehabilitation for older patients with heart failure in primary care. We are also working toward a grant submission in December on increasing referral to pulmonary rehabilitation. Research is a team effort, so I am grateful to expert and collaborative colleagues, and admin staff who work hard to get all of the components of an application just right!

The European Society of Cardiology Congress that I wrote about last month was outstanding, with over 32,000 participants at the Excel Centre in London. Of course as one congress ends, planning for the next begins; ideas for invited sessions had to be submitted by 30 September for Rome 2016. The hundreds of submitted sessions are then graded by the members of the Congress Planning Committee and finally selected at a meeting in November. As Coordinator for Prevention, Rehabilitation, Sports Cardiology, Nursing and Ageing I will lead my sub-committee in selecting the best and most interesting sessions for our topic.

Professor Debbie Carrick-Sen – The Heart of England NHS Foundation Trust and the University of Birmingham.

Interesting emotions returning from a stunning and relaxing holiday cruising around Italy! The start of the academic year is always exciting but busy. It was a pleasure to meet and teach ‘why do research?’ to the new students (our nurses of the future) at the University of Birmingham. Increasing the content and level of research training is critical to building future research capacity and capability in nursing and midwifery. Even in their week, two of the students stated that they really saw their future as nurse researchers and a large number of students reported that they didn’t realise research activity was so broad and interesting. I think that the YouTube video on the health benefits of eating chocolate helped my case! https://www.youtube.com/watch?v=Sep6O52nVag

A number of meetings currently require me to do the Newcastle – London – Birmingham – Leeds – Newcastle circuit on an almost weekly basis. Mobile working is not as easy (or pleasurable) as you may think! However, the AUKUH meetings in London are important and exciting as we move towards the NHS Clinical Academic Careers Implementation Workshop to be held on Monday 26th October 2015, very kindly hosted by the Department of Health. I look forward to updating you in the November BLOG.

Next week I am very fortunate and excited to be attending the MAGNET conference in Atlanta, USA. This will be my first MAGNET conference. The principles and benefit of increasing academic attainment and introducing shared governance is undisputed, however the question remains whether UK healthcare should/could do this via MAGNET accreditation or should we adopt the principles and create a UK accreditation system. HEE and NHS provider organisations continue to debate options. Watch this space!

Working at Heart of England NHS Foundation Trust continues to excite and delight. Nine nurses and two midwives were celebrating this week after being selected on the first cohort on the new Heart of England NHS Foundation Trust Clinical Academic Training Scheme. The scheme aimed at frontline staff are given the opportunity to study at Masters level, undertake a service improvement/research project aligned to clinical priorities and are provided with additional personal leadership training and support. I continue to work with other clinical staff whom are developing doctorate fellowship applications to answer important clinical questions and improve patient care and outcome.

On a personal note I am busy writing papers and adding to existing evidence. My current papers focus on the IC research capacity building model and PTSD following complex birth. Having submitted two grants within the last two months – the waiting game is in progress but no time to ‘stop and stare’ onto the next grant application, as we all know that only 10% are successful – loads of effort for some return. But onwards and upwards … in the words of Florence Nightingale: ‘For us who nurse, our nursing is a thing which, unless we are making progress every year, every month, every week, take my word for it, we are going back.’

Professor Christine Norton – King’s College London with Imperial College Healthcare NHS Trust

Personal experience of the NHS this week has led me to reflect on the best and worst of our beloved institution. I was booked for afternoon day surgery and having already changed dates twice, I was then rung the night before to change again as all the beds were full and they did not want to risk my needing an overnight stay but they did not want to delay me because of the prior cancellations. Happily they could swop surgeons and move me to a morning slot with a new team (with space as major surgeries were all cancelled) and they asked if I could I come at 7.30. A very apologetic service manager called me at 8pm and she had already obviously spent time and energy to re-arrange this with both surgeons.

I pitch up at 7.30 to the admissions ward: they have never heard of me and I am taken to another ward and sat down as the day room was occupied by the handover. They know nothing about me either after the handover: the sister was very apologetic and took me personally back to admissions, where after a lot of phone calls they established that I was on the theatre list but nobody could locate my notes. Anaesthetist and the registrar each came to take a separate history despite having had this done at both several outpatient appointments and a pre-admission clinic. Everyone was very apologetic. It took nearly 10 minutes to log into the hospital computer to find my blood results. Now outdated, would I mind if a medical student takes them again?

I was then collected to go to day care by a lovely nurse who calls me ‘dear’ and ‘my love’ (my admission form asked for my preferred name today: ‘Christine’).  I am then clerked again by another nurse with a student in attendance. They were very competent and thorough. My notes turn up at this point. The surgery and recovery are smooth with a different anaesthetist who repeats the same questions. Nurses back on the day ward were rushed but kind and attentive. Lots more names such as ‘honey’ and ‘dearie’ and I was not convinced they knew which patient I was, however they were very competent technically. Finally, it was time to go home: a really personal service with lots of information and a long phone call to my partner to explain exactly how to park to avoid car park charges for pick-up.

Conclusions: lovely people, all trying really hard; shame about the system which does not support them to work efficiently. How much time and energy is spent by our staff trying to make the system work for patients, rather than giving direct patient care?

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