Clinical research nursing and factors influencing success: a qualitative study describing the interplay between individual and organisational leadership influences and their impact on the delivery of clinical research in healthcare

Background Clinical research delivery is a term increasingly used to describe the work undertaken to implement studies which explore and test prevention, diagnosis and treatment in healthcare. Such studies range from multi-site clinical trials to single site observational projects. Whilst widely acknowledged as fundamental to effective healthcare, clinical research is complex to deliver and is met with challenges in the busy clinical environment. The perceptions and experiences of Clinical Research Nurses, whose work is central to this agenda, have emerged as important, yet frequently overlooked insights in relation to the potential success of research delivery. Increased understanding of these insights is essential to address the barriers and maximise facilitators to success in clinical research. Aim To better understand how the perceptions and experiences of Clinical Research Nurses relate to potential for success in research delivery. Methods Seven focus groups and two one-to-one interviews (27 participants) were conducted in a large tertiary North East England National Health Service Foundation Trust between March and June 2017. Results Clinical Research Nurses’ described perceptions and experiences of working to co-ordinate and deliver a range of research as individuals, within their teams, throughout the wider organisation, and beyond. Two key elements situated within an overarching theme of leadership emerged as likely to impact on how successfully they were able to practise: • the individual (self-leadership). • the organisation (leadership culture). Conclusions The framework emerging from this study illustrates a complex interplay between personal attributes and organisational culture, mediated by national strategies and targets associated with the clinical research agenda. When situated within the concept of leadership, it broadens the potential for understanding the underlying issues and increases the range of possible support mechanisms to improve experiences for Clinical Research Nurses. Framing the challenges in this way contributes new knowledge to the dialogue surrounding clinical research delivery.

How can we make renal medicine careers more appealing to UK trainees?

Background There is a global decline in interest in careers in renal medicine. This is concerning given the increasing global burden of kidney disease. Previous studies in the USA and Australia have identified factors such as a poor work–life balance, lack of role models and the challenging nature of the speciality as possible reasons behind recruitment struggles. This study aimed to identify factors associated with declining interest among trainees in the UK. Methods We conducted a survey of 150 National Health Service Foundation trainees (interns) and Core Medical Trainees in Health Education West Midlands. Participants completed a 14-part paper-based questionnaire capturing data on trainee demographics, medical school and postgraduate exposure to renal medicine and perceptions of a career in renal medicine. Results There was limited early clinical exposure to renal medicine both in terms of time spent in the speciality and perceived exposure to the range of domains of the speciality. Trainees perceived the speciality as complex with a heavy workload. Very few trainees considered the speciality to be lifestyle oriented. There was also disinterest in taking on the associated general medicine commitments of the training programme. Job experience and identification of role models increased the likelihood of consideration of the speciality. Conclusion This survey has identified key areas to drive interest in the speciality, including early engagement, enthusiastic supervision and increased training flexibility. Urgent attention is required to address these areas and make renal medicine careers more appealing.

Paliperidone Palmitate-Induced Delirium in an Adolescent with Schizophrenia: Case report

Schizophrenia is a serious long-term mental disorder which usually presents in adolescence or early adulthood. However, poor adherence to oral antipsychotics can lead to relapse and rehospitalisation. We report an adolescent male with schizophrenia who was referred to the South London & Maudsley National Health Service Foundation Trust, London, UK, in 2015 due to worsening psychotic symptoms. Following poor compliance with oral medications, a four-week regimen of paliperidone palmitate long-acting injections was initiated, with an initial positive response. However, 10 days after the second dose, the patient developed severe acute-onset delirium with fluctuating levels of consciousness. Paliperidone palmitate was discontinued and the patient instead underwent a course of zuclopenthixol decanoate long-acting injections with a favourable outcome.Keywords: Adolescent Psychiatry; Schizophrenia; Antipsychotic Agents; Delirium; Paliperidone Palmitate; Zuclopenthixol; Case Report; United Kingdom.

Mogadishu calling: mental health awareness in Somalia via an innovative, live video-based mental health teaching programme established between Liverpool and Mogadishu

In 2013 the Federal Government of Somalia contacted the Mersey Care National Health Service Foundation Trust (MCFT), asking whether they could formulate a teaching programme tailored towards improving mental health provision in Somalia, and the E-learning Mental Health Training Programme (SOM-Health) was eventually conceived. The fundamental aim was to provide mental health awareness to practitioners and trainees in Somalia so that they could deliver mental healthcare services confidently and effectively.

Trainee Leadership Board: learning about NHS leadership

IntroductionThe development of a new generation of clinical leaders in the NHS has been increasingly endorsed by most recent literature in medical leadership and management. Despite providing academic rationale and argument, however, current training programmes fail to integrate the theoretical and practical aspects of clinical leadership and to implement them in practice within medical training curricula.MethodsIn Oxford Health National Health Service Foundation Trust, a Trainee Leadership Board programme was offered to a small group of next-generation clinical leaders as an opportunity to learn about current leadership and management in the Trust. This programme provided insights and practical experiences through an integrated educational and experiential approach in resolving a real issue facing the Trust.Results and conclusionOverall, the programme proved successful in creating a culture of increased interest and promoting change in attitude and behaviour around leadership and management. Time constraints and implementation of change represented significant challenges for the Trainee Leadership Board. However, the programme holds promise for its diffusion across the country.

What is the impact of research champions on integrating research in mental health clinical practice? A quasiexperimental study in South London, UK

ObjectivesKey challenges for mental health healthcare professionals to implement research alongside clinical activity have been highlighted, such as insufficient time to apply research skills and lack of support and resources. We examined the impact of employing dedicated staff to promote research in community mental health clinical settings.DesignQuasiexperiment before and after study.SettingSouth London and Maudsley National Health Service Foundation Trust.Participants4455 patients receiving care from 15 community mental health teams between 1 December 2013 and 31 December 2014.Outcome measuresThe proportion of patients approached for research participation in clinical services where research champions were present (intervention group), and where research champions were not present (comparison group).ResultsPatients in the intervention group were nearly six times more likely to be approached for research participation (Adj. OR=5.98; 95% CI 4.96 to 7.22).ConclusionsInvesting in staff that promote and drive research in clinical services increases opportunities for patients to hear about and engage in clinical research studies. However, investment needs to move beyond employing short-term staff.

The use of patient feedback by hospital boards of directors: a qualitative study of two NHS hospitals in England

BackgroundAlthough previous research suggests that different kinds of patient feedback are used in different ways to help improve the quality of hospital care, there have been no studies of the ways in which hospital boards of directors use feedback for this purpose.ObjectivesTo examine whether and how boards of directors of hospitals use feedback from patients to formulate strategy and to assure and improve the quality of care.MethodsWe undertook an in-depth qualitative study in two acute hospital National Health Service foundation trusts in England, purposively selected as contrasting examples of the collection of different kinds of patient feedback. We collected and analysed data from interviews with directors and other managers, from observation of board meetings, and from board papers and other documents.ResultsThe two boards used in-depth qualitative feedback and quantitative feedback from surveys in different ways to help develop strategies, set targets for quality improvement and design specific quality improvement initiatives; but both boards made less subsequent use of any kinds of feedback to monitor their strategies or explicitly to assure the quality of services.Discussion and conclusionsWe have identified limitations in the uses of patient feedback by hospital boards that suggest that boards should review their current practice to ensure that they use the different kinds of patient feedback that are available to them more effectively to improve, monitor and assure the quality of care.

CogStack - Experiences Of Deploying Integrated Information Retrieval And Extraction Services In A Large National Health Service Foundation Trust Hospital

Traditional health information systems are generally devised to support clinical data collection at the point of care. However, as the significance of the modern information economy expands in scope and permeates the healthcare domain, there is an increasing urgency for healthcare organisations to offer information systems that address the expectations of clinicians, researchers and the business intelligence community alike. Amongst other emergent requirements, the principal unmet need might be defined as the 3R principle (right data, right place, right time) to address deficiencies in organisational data flow while retaining the strict information governance policies that apply within the UK National Health Service (NHS). Here, we describe our work on deploying structured and unstructured data search and information extraction technologies within King's College Hospital, the management of governance concerns and the associated use cases and cost saving opportunities that such components present.