Helping new nurses grow in confidence

Nurse Education in Practice  Volume 19, Pages 19–24

Feeling confident in what one is doing – and conveying that impression to other people – is an important part of being a good healthcare professional. In this study Jennifer Ortiz, from Capella University in Minnesota, looked at “how new graduate nurses accounted for their lack of professional confidence upon entry into professional practice and how it developed during their first year of practice in the hospital setting.” She interviewed 12 nurses and the following themes emerged from her conversations with them:

B0007046 Nurse, artwork
Image source: Neil Webb, Wellcome Images// CC BY-NC-ND 4.0

 Communication is huge

 Making mistakes

 Disconnect between school and practice

 Independence

 Relationship building

 Positive feedback is important

 Gaining experience


She concluded that “new graduate nurses must experience both positive and negative circumstances in order to move toward the attainment of professional confidence.”

Read the abstract of this article here.


Pierce, B. A. & Gormley, D. Journal of Emergency Nursing. Published online: 26 April 2016


A quality improvement (QI) project was completed early in 2015 to evaluate the split flow model of care delivery and a provider in triage model within a newly constructed emergency department. The QI project compared 2 emergency departments of similar volumes, one that splits the patient flow and employs a provider in triage model and the other that blends the patient flow and employs a traditional nurse triage model. A total of 68,603 patients were included in this project.

The purpose of the split flow model is to create a second flow stream of patients through the emergency department, parallel to the regular acute/critical care flow stream, for patients with problems that are not complex. Specific patient outcomes that were evaluated for the purpose of this QI project were door to discharge or discharge length of stay (DLOS) for all ED patients. The provider in triage model enhances patient triage assessment, as well as patient flow within the emergency department, by allowing patients to be evaluated by an ED provider immediately at the point of triage when the patient first presents to the emergency department.

The QI project demonstrated that the split flow model alone reduced DLOS for all ED patients, and when coupled with the provider in triage model, a greater reduction in DLOS, as well as an improvement in front-end throughput metrics, was realized.

Read the abstract here

Can technology save the NHS?

N0037626 Young white female health professional in uniform with laptop
image source: Adrian Wressell, Heart of England NHSFT, Wellcome Images//CC BY-NC-ND 4.0

Can technology save the NHS?  That was the question addressed by a recent Guardian roundtable, supported by the Health and Social Care Information Centre (HSCIC), which brought together clinicians, policymakers and healthcare IT experts.

There was agreement among participants about the broad benefits delivered to the NHS by IT, identified by Andy Williams, chief executive of HSCIC, as making patients’ lives easier; using data for research; and “getting hospitals, GPs and social care organisations across the health and care system to talk to each other and exchange information more effectively.”

Dr Paul Cundy, co-chair of the British Medical Association’s general practitioners committee and the Royal College of GPs’ IT subcommittee, said that IT was well-established in primary care and that his GP practice had been paperless since 1988. He added that the move to electronic records has improved staff efficiency.

Read more about the debate here

Creating an organisation where improvement can flourish

The pressure on NHS organisations to ‘do more and do it better’ is intense, says the Health Foundation’s Improvement Fellow Bryan Jones. In this blog he looks at the challenges organisations are facing, usually financial or demand related, and how they can build an environment that supports improvement, giving people the space to make meaningful change.

Read the full post here



Living positively with dementia

Aging & Mental Health Volume 20, Issue 7, 2016

Objective: Little is known about how and to what extent people with dementia live positively with their condition. This study aimed to review and carry out a synthesis of qualitative studies where accounts of the subjective experiences of people with dementia contained evidence of positive states, experiences or attributes.

B0003527 Alzheimer's disease - digital artwork
image source: Adrian Cousins,  Wellcome images//CC BY-NC-ND 4.0

Methods: A meta-synthesis was undertaken to generate an integrated and interpretive account of the ability of people with dementia to have positive experiences. A methodological quality assessment was undertaken to maximize the reliability and validity of this synthesis and to contextualize the findings with regard to methodological constraints and epistemological concepts.

Findings: Twenty-seven papers were included. Three super-ordinate themes relating to positive experiences and attributes were identified, each with varying and complementing sub-themes. The first super-ordinate theme related to the experience of engaging with life in ageing rather than explicitly to living with dementia. The second theme related to engaging with dementia itself and comprised the strengths that people can utilize in facing and fighting the condition. The third theme captured how people with dementia might transcend the condition and seek ways to maintain identity and even achieve personal growth.

Conclusions: This review provides a first step towards understanding what conceptual domains might be important in defining positive outcomes for people who live with dementia. Highlighting the potential for people to have positive experiences in spite of or even because of their dementia has important implications for de-stigmatizing dementia and will enhance person-centred approaches to care.

Full reference:  Wolverson, E.L. et al. Living positively with dementia: a systematic review and synthesis of the qualitative literature  Aging & Mental Health. Volume 20, Issue 7, 2016 p. 676-699

Using educational video to enhance protocol adherence for medical procedures†

andler, L. et al. British Journal of  Anaesthesia. 2016. 116 (5): pp.662-669.

Background: Better education of clinicians is expected to enhance patient safety. An important component of education is adherence to standard protocols, which are mainly available in written form. Believing in the potential power of videos, we hypothesized that the introduction of an educational video, based on an institutional standard protocol, would foster adherence to the protocol.

Methods: We conducted a prospective intervention study of 425 anaesthesia procedures and teams (202 pre-video and 223 post-video) involving 1091 team members (516 pre-video and 575 post-video) in seven individual operating areas (with a total of 30 operating rooms) in a university hospital. Failure of adherence to safety-critical tasks during rapid sequence anaesthesia inductions was assessed during systematic on-site observations pre- and post-introduction of an educational video demonstrating evidence-based and best practice guidelines.

Results: The odds for failure of adherence to safety-critical tasks between the pre- and post-intervention period were reduced, odds ratio 0.34 (95% confidence interval 0.27–0.42, P<0.001). The risk for failure of adherence was reduced significantly for eight of the 14 safety-critical tasks (allP<0.001).

Conclusions: This study provides empirical evidence for the effectiveness of an educational video to enhance adherence to a standard protocol during complex medical procedures. The introduction of a video can reduce failure of adherence to safety-critical tasks and contribute to patient safety. We recommend the introduction of videos to improve protocol adherence.

Read the abstract here