Towards best practice in nursing care

1. Towards best practice in nursing care Beyond competencies: the institutional and personal impact of attitudes and values Beattie Dray 2013

2. Aims and objectives • To contextualize current concerns regarding poor nursing care in UK • To explore the social policy response • To understand the impact of organizational culture on nursing care • To acknowledge and actualize our own personal and professional responsibilities to be reflective practitioners

3. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry 2013 • Between 2005 and 2008 conditions of appalling care , resulting in higher than average mortality rates. Estimates that between 2005-2009 400- 1,200 patients died unnecessarily due to poor care. patients were left starving, thirsty and in soiled bedclothes, while some patients received the wrong medication or none at all. www.telegraph.co.uk/healthnews/9937904/mid-staffs-nursing

4. Institutional culture of regard for business and finances above patients’ interests • Failure to respond to complaints from both staff and patients • Assumptions that monitoring, performance management or intervention was the responsibility of someone else

5. www.bbc.co.uk/news/uk-england-stoke-staffordshire-21339330

6. Personal responsibilityProfessional accountability • Specific examples where as a result of inquiry named nurses have been referred to Nursing Midwifery Council, ultimate sanction : removal from register • Examples of a nurse who failed to resuscitate a patient on discovering an unresponsive patient, later wrote in notes that patient was asleep

7. Accountability • Case of Health Care Assistant working in Mid Staffs , was in process of seeking registration as midwife, which she received. As a result of Mid Staffs inquiry removed from NMC register, but free to work as HCA • Evidence heard that she shouted at patient with dementia “ I hate you , you are an animal” Physically pushed him into chair

8. The Francis Report 2013 • Initial inquiry focused on in depth review of serious and critical incidents which had occurred at one NHS Hospital Mid Staffs.

9. System failure • Importance of understanding how serious deficiencies in care could go without check for so long. • Report has 290 recommendations which will be applicable at all levels of care and considers training of health staff.

10. Key recommendations • Commitment to common values throughout all healthcare systems • Readily accessible fundamental standards • Greater monitoring and accountability • Zero tolerance of non compliance • Strengthening of nurse leadership www.nhsemployers.org/The- Francis-inquiry/pages

11. Focus on attitudes and values Professor Juliet Beal: Programme Director NHSCB Commitment Competence Communication Compassion Communication Courage

12. Values • Courage enables us to do the right thing for the people we care for, be bold when we have good ideas, and to speak up when things are wrong • Commitment will make our vision for the person receiving care, our professions and our teams happen. We commit to take action to achieve this.

13. Care Quality Commissionwww.cqc.org. • Deprivation of liberty Safeguards 2011/2012 • Safeguards aim to protect people’s human rights in circumstances where they can not consent to their care or treatment • Mental Capacity Act : Hospitals and care homes must apply to supervisory body before they can deprive of liberty: forcibly give medication, preventing from personal contacts, physically restraining them , locked in

14. Values based recruitment • Problems with traditional question based interview, lacking in evidence base. • Multiple Mini Interview approach : Originated in Canada in medical schools, widely used in medical school selection in UK • Kingston University first school of Nursing to implement in UK

15. Evidence base • MMI approach results in each applicant receiving a numerical score based on total score from each assessor. Normally a minimum of five assessors, five scenarios. • Strict criteria for scoring , therefore reduction of subjective bias • This data can be tracked for longitudinal analysis of performance on Programme.

16. References • Eva KW,(2009) “ Predictive validity of the Multiple Mini-Interview for selecting medical trainees” Medical Education Aug:43(8) 767-75 • General Medical Council Research Report (2012) Identifying best practice in the selection of medical students (literature review and interview survey)

17. Kingston MMIs • Scenarios based upon assessing following competencies and values: communication skills, problem solving skills, non-judgmental approach, empathy , honesty and integrity • Variety of scenarios and tasks , including role play

18. Reflective, courageous practitioner • Courage to critique own competencies and performance, self reflective and self aware. • Courage to be assertive , particularly in context of unequal power dynamic . Patient interest must always be central.

19. Personal reflection • Please write on pink post it what you consider you have done well in this conference. Consider evidence for your feelings. Why did it go well? • Please write on green post it , what on reflection you could have done better, what have you learned from this experience? What do you need to do in order to change?