To explore international experiences of using blended learning in preparing nursing and midwifery... more To explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy. Background: The global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for preregistration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere. Design: Cross-sectional, sequential, mixed methods study Participants/settings: Nursing/nurse education leaders from across International Council of Nurses regions Methods: Exploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants' knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes. Results: Participants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation. Conclusions: Blended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact.
Background Several international studies suggest that the feedback that emergency ambulance servi... more Background Several international studies suggest that the feedback that emergency ambulance service (EMS) personnel receive on the care they have delivered lacks structure, relevance, credibility and routine implementation. Feedback in this context can relate to performance or patient outcomes, can come from a variety of sources and can be sought or imposed. Evidence from health services research and implementation science, suggests that feedback can change professional behavior, improve clinical outcomes and positively influence staff mental health. The current study aimed to explore the experience of EMS professionals regarding current feedback provision and their views on how feedback impacts on patient care, patient safety and staff wellbeing. Methods This qualitative study was conducted as part of a wider study of work-related wellbeing in EMS professionals. We used purposive sampling to select 24 frontline EMS professionals from one ambulance service in the United Kingdom and ...
BackgroundExtensive research has been conducted into the effects of feedback interventions within... more BackgroundExtensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital emergency care has been relatively neglected. Exploratory work suggests that enhancing feedback and follow-up to emergency medical service (EMS) staff might provide staff with closure and improve clinical performance. Our aim was to summarise the literature on the types of feedback received by EMS professionals and its effects on the quality and safety of patient care, staff well-being and professional development.MethodsA systematic review and meta-analysis, including primary research studies of any method published in peer-reviewed journals. Studies were included if they contained information on systematic feedback to emergency ambulance staff regarding their performance. Databases searched from inception were MEDLINE, Embase, AMED, PsycINFO, HMIC, CINAHL and Web of Science, with searches last updated on 2 August 2022. Study quality was apprai...
Background Several international studies suggest that the feedback that emergency ambulance servi... more Background Several international studies suggest that the feedback that emergency ambulance service (EMS) personnel receive on the care they have delivered lacks structure, relevance, credibility and routine implementation. Feedback in this context can relate to performance or patient outcomes, can come from a variety of sources and can be sought or imposed. Evidence from health services research and implementation science, suggests that feedback can change professional behavior, improve clinical outcomes and positively influence staff mental health. The current study aimed to explore the experience of EMS professionals regarding current feedback provision and their views on how feedback impacts on patient care, patient safety and staff wellbeing. Methods This qualitative study was conducted as part of a wider study of work-related wellbeing in EMS professionals. We used purposive sampling to select 24 frontline EMS professionals from one ambulance service in the United Kingdom and ...
BackgroundPrehospital feedback is increasingly receiving attention from clinicians, managers and ... more BackgroundPrehospital feedback is increasingly receiving attention from clinicians, managers and researchers. The effectiveness of feedback in changing professional behaviour and improving clinical performance is strongly evidenced across a range of healthcare settings, but this has not yet been replicated within the prehospital context. Without a firmer evidence base, development in practice relies on isolated initiatives with no clear intervention model or evaluative framework. The aim of this study was to understand how UK ambulance services are currently meeting the challenge of providing prehospital feedback.MethodsThis was a national survey, which formed the first part of a realist evaluation of prehospital feedback. The survey used purposive and snowball sampling. It was advertised on social media and sent to prehospital feedback initiative leads identified through grey literature and networking (n=35). In addition n=8 NHS Ambulance Trusts formally supported this study and id...
This article introduces the reader to the concepts of identity, positionality and reflexivity and... more This article introduces the reader to the concepts of identity, positionality and reflexivity and outlines their relevance to research paramedics. We outline how a researcher’s identity and positionality can influence all aspects of research, including the research question, study design, data collection and data analysis. We discuss that the ‘insider’ position of paramedics conducting research with other paramedics or within their specific clinical setting has considerable benefits to participant access, understanding of data and dissemination, while highlighting the difficulties of role duality and power dynamics. While positionality is concerned with the researcher clearly stating their assumptions relating to the research topic, the research design, context and process, as well as the research participants; reflexivity involves the researcher questioning their assumptions and finding strategies to address these. The researcher must reflect upon the way the research is carried ou...
BackgroundEmergency ambulance staff have a strong desire to receive feedback, but the frequency a... more BackgroundEmergency ambulance staff have a strong desire to receive feedback, but the frequency and effects of prehospital feedback have not yet been explored quantitatively in the UK. Surveys on prehospital feedback prevalence have been conducted in the US, but are limited by retrospective data collection and a potential disconnect in recipients recognising that they were being provided with feedback (Cash et al., 2017; McGuire et al., 2021). Our study seeks to overcome these limitations by collecting data in real-time using a diary study design and providing a clear definition of prehospital feedback: ‘the provision of information to emergency ambulance staff regarding their performance within prehospital practice and/or patient outcomes’. The study aim will be to explore the extent, characteristics, mechanisms and effects of prehospital feedback in the UK from the recipients’ point of view and to describe individual differences in the desire for enhanced feedback.MethodsThis will...
Background: Emergency ambulance staff have a strong desire to receive feedback but the frequency ... more Background: Emergency ambulance staff have a strong desire to receive feedback but the frequency and effects of prehospital feedback have not yet been explored quantitatively in the UK. Surveys on prehospital feedback prevalence have been conducted in the US, but are limited by retrospective data collection and a potential disconnect in recipients recognising that they were being provided with feedback (Cash et al., 2017; McGuire et al., 2021). Our study seeks to overcome these limitations by collecting data in real-time using a diary study design and providing a clear definition of prehospital feedback: 'the provision of information to emergency ambulance staff regarding their performance within prehospital practice and/or patient outcomes'. The study aim will be to explore the extent, characteristics, mechanisms and effects of prehospital feedback in the UK from the recipients' point of view and to describe individual differences in the desire for enhanced feedback. Me...
Background: Hip fracture is a common, serious, complex injury and an important cause of morbidity... more Background: Hip fracture is a common, serious, complex injury and an important cause of morbidity, mortality and rising healthcare costs. Incidence and impact in the under 60s has been under researched. The aim of this study was therefore to explore the recovery experiences of young adults with an isolated hip fracture following a minor fall to inform future care delivery. Methods and Findings The Silences Framework was used to guide a critical interpretivist study. Thirty in-depth, minimally structured, story-telling interviews were conducted with participants between one and 10 years post injury. One cross-cutting theme, ‘Communication’ and four main themes: ‘Experience of care’, ’Impact on self’, ‘Impact on others’ and ‘Moving forward’ were identified. The findings indicated multi-faceted, often long term, physical, social and psychological impact on participants, their family and wider social networks. This included Post Traumatic Stress Disorder type symptoms and impact on work...
Background: Hip fracture is a common, serious, complex injury and an important cause of morbidity... more Background: Hip fracture is a common, serious, complex injury and an important cause of morbidity, mortality and rising healthcare costs. Incidence and impact in the under 60s has been under researched. The aim of this study was therefore to explore the recovery experiences of young adults with an isolated hip fracture following a minor fall to inform future care delivery. Methods and Findings: The Silences Framework was used to guide a critical interpretivist study. Thirty in-depth, minimally structured, story-telling interviews were conducted with participants between one and 10 years post injury. One cross-cutting theme, 'Communication' and four main themes: 'Experience of care', 'Impact on self', 'Impact on others' and 'Moving forward' were identified. The findings indicated multi-faceted, often long term, physical, social and psychological impact on participants, their family and wider social networks. This included Post Traumatic Stress Disorder type symptoms and impact on work, finances and relationships. Inadequacies in the current care pathway and limited relevance of the commonly used patient reported hip fracture outcome measures used for young adults were also identified. Conclusion: The dominant discourse on fragility hip fracture almost exclusively focuses on the elderly and short-term outcomes. This was the first study investigating the longterm impact of fragility hip fracture in young adults from their perspective and the first application of a new research framework in an acute care setting. It found the needs of younger hip fracture patients are not adequately recognised or addressed. Increased awareness and improvements in healthcare provision are needed to minimise the long-term personal and societal impact of fragility fracture in the under 60s.
Background: Abductive Thematic Network Analysis (ATNA) is a qualitative data analysis method, whi... more Background: Abductive Thematic Network Analysis (ATNA) is a qualitative data analysis method, which was first defined by Rambaree and Faxelid (2013). It draws upon the principles of Thematic Analysis (Braun and Clarke, 2006), Thematic Network Analysis (Attride-Stirling, 2001) and Abductive Theory of [for full text, please go to the a.m. URL]
We take it for granted that one of the objectives of nursing is to improve patients' quality ... more We take it for granted that one of the objectives of nursing is to improve patients' quality of life, but this is notoriously difficult to define. A surgery of renal patients revealed some surprising results of what they considered to constitute quality of life, with implications for the future of nursing care.
Background: There is little empirical research on the topic of ‘behaviour’ within UK HE instituti... more Background: There is little empirical research on the topic of ‘behaviour’ within UK HE institutions however USA research has identified negative consequences of inappropriate student behaviour for learning, achievement, persistence and retention, and staff self-esteem. Aims: To evaluate the development and pilot implementation of university-wide guidance that was designed to facilitate a shared understanding of what makes a supportive learning environment within the university community and provide practical guidance for students and staff on tackling inappropriate behaviour should it occur. Methods: Action Research. Findings: Staff and students found the guidance was or would be beneficial, highlighting its practical focus and the shared understanding and enhanced confidence it engendered. Conclusions: Shared, organisation-wide, practical guidance can provide an effective means of support for students and staff. Such guidance can help to clarify and manage varying expectations, th...
To explore international experiences of using blended learning in preparing nursing and midwifery... more To explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy. Background: The global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for preregistration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere. Design: Cross-sectional, sequential, mixed methods study Participants/settings: Nursing/nurse education leaders from across International Council of Nurses regions Methods: Exploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants' knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes. Results: Participants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation. Conclusions: Blended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact.
Background Several international studies suggest that the feedback that emergency ambulance servi... more Background Several international studies suggest that the feedback that emergency ambulance service (EMS) personnel receive on the care they have delivered lacks structure, relevance, credibility and routine implementation. Feedback in this context can relate to performance or patient outcomes, can come from a variety of sources and can be sought or imposed. Evidence from health services research and implementation science, suggests that feedback can change professional behavior, improve clinical outcomes and positively influence staff mental health. The current study aimed to explore the experience of EMS professionals regarding current feedback provision and their views on how feedback impacts on patient care, patient safety and staff wellbeing. Methods This qualitative study was conducted as part of a wider study of work-related wellbeing in EMS professionals. We used purposive sampling to select 24 frontline EMS professionals from one ambulance service in the United Kingdom and ...
BackgroundExtensive research has been conducted into the effects of feedback interventions within... more BackgroundExtensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital emergency care has been relatively neglected. Exploratory work suggests that enhancing feedback and follow-up to emergency medical service (EMS) staff might provide staff with closure and improve clinical performance. Our aim was to summarise the literature on the types of feedback received by EMS professionals and its effects on the quality and safety of patient care, staff well-being and professional development.MethodsA systematic review and meta-analysis, including primary research studies of any method published in peer-reviewed journals. Studies were included if they contained information on systematic feedback to emergency ambulance staff regarding their performance. Databases searched from inception were MEDLINE, Embase, AMED, PsycINFO, HMIC, CINAHL and Web of Science, with searches last updated on 2 August 2022. Study quality was apprai...
Background Several international studies suggest that the feedback that emergency ambulance servi... more Background Several international studies suggest that the feedback that emergency ambulance service (EMS) personnel receive on the care they have delivered lacks structure, relevance, credibility and routine implementation. Feedback in this context can relate to performance or patient outcomes, can come from a variety of sources and can be sought or imposed. Evidence from health services research and implementation science, suggests that feedback can change professional behavior, improve clinical outcomes and positively influence staff mental health. The current study aimed to explore the experience of EMS professionals regarding current feedback provision and their views on how feedback impacts on patient care, patient safety and staff wellbeing. Methods This qualitative study was conducted as part of a wider study of work-related wellbeing in EMS professionals. We used purposive sampling to select 24 frontline EMS professionals from one ambulance service in the United Kingdom and ...
BackgroundPrehospital feedback is increasingly receiving attention from clinicians, managers and ... more BackgroundPrehospital feedback is increasingly receiving attention from clinicians, managers and researchers. The effectiveness of feedback in changing professional behaviour and improving clinical performance is strongly evidenced across a range of healthcare settings, but this has not yet been replicated within the prehospital context. Without a firmer evidence base, development in practice relies on isolated initiatives with no clear intervention model or evaluative framework. The aim of this study was to understand how UK ambulance services are currently meeting the challenge of providing prehospital feedback.MethodsThis was a national survey, which formed the first part of a realist evaluation of prehospital feedback. The survey used purposive and snowball sampling. It was advertised on social media and sent to prehospital feedback initiative leads identified through grey literature and networking (n=35). In addition n=8 NHS Ambulance Trusts formally supported this study and id...
This article introduces the reader to the concepts of identity, positionality and reflexivity and... more This article introduces the reader to the concepts of identity, positionality and reflexivity and outlines their relevance to research paramedics. We outline how a researcher’s identity and positionality can influence all aspects of research, including the research question, study design, data collection and data analysis. We discuss that the ‘insider’ position of paramedics conducting research with other paramedics or within their specific clinical setting has considerable benefits to participant access, understanding of data and dissemination, while highlighting the difficulties of role duality and power dynamics. While positionality is concerned with the researcher clearly stating their assumptions relating to the research topic, the research design, context and process, as well as the research participants; reflexivity involves the researcher questioning their assumptions and finding strategies to address these. The researcher must reflect upon the way the research is carried ou...
BackgroundEmergency ambulance staff have a strong desire to receive feedback, but the frequency a... more BackgroundEmergency ambulance staff have a strong desire to receive feedback, but the frequency and effects of prehospital feedback have not yet been explored quantitatively in the UK. Surveys on prehospital feedback prevalence have been conducted in the US, but are limited by retrospective data collection and a potential disconnect in recipients recognising that they were being provided with feedback (Cash et al., 2017; McGuire et al., 2021). Our study seeks to overcome these limitations by collecting data in real-time using a diary study design and providing a clear definition of prehospital feedback: ‘the provision of information to emergency ambulance staff regarding their performance within prehospital practice and/or patient outcomes’. The study aim will be to explore the extent, characteristics, mechanisms and effects of prehospital feedback in the UK from the recipients’ point of view and to describe individual differences in the desire for enhanced feedback.MethodsThis will...
Background: Emergency ambulance staff have a strong desire to receive feedback but the frequency ... more Background: Emergency ambulance staff have a strong desire to receive feedback but the frequency and effects of prehospital feedback have not yet been explored quantitatively in the UK. Surveys on prehospital feedback prevalence have been conducted in the US, but are limited by retrospective data collection and a potential disconnect in recipients recognising that they were being provided with feedback (Cash et al., 2017; McGuire et al., 2021). Our study seeks to overcome these limitations by collecting data in real-time using a diary study design and providing a clear definition of prehospital feedback: 'the provision of information to emergency ambulance staff regarding their performance within prehospital practice and/or patient outcomes'. The study aim will be to explore the extent, characteristics, mechanisms and effects of prehospital feedback in the UK from the recipients' point of view and to describe individual differences in the desire for enhanced feedback. Me...
Background: Hip fracture is a common, serious, complex injury and an important cause of morbidity... more Background: Hip fracture is a common, serious, complex injury and an important cause of morbidity, mortality and rising healthcare costs. Incidence and impact in the under 60s has been under researched. The aim of this study was therefore to explore the recovery experiences of young adults with an isolated hip fracture following a minor fall to inform future care delivery. Methods and Findings The Silences Framework was used to guide a critical interpretivist study. Thirty in-depth, minimally structured, story-telling interviews were conducted with participants between one and 10 years post injury. One cross-cutting theme, ‘Communication’ and four main themes: ‘Experience of care’, ’Impact on self’, ‘Impact on others’ and ‘Moving forward’ were identified. The findings indicated multi-faceted, often long term, physical, social and psychological impact on participants, their family and wider social networks. This included Post Traumatic Stress Disorder type symptoms and impact on work...
Background: Hip fracture is a common, serious, complex injury and an important cause of morbidity... more Background: Hip fracture is a common, serious, complex injury and an important cause of morbidity, mortality and rising healthcare costs. Incidence and impact in the under 60s has been under researched. The aim of this study was therefore to explore the recovery experiences of young adults with an isolated hip fracture following a minor fall to inform future care delivery. Methods and Findings: The Silences Framework was used to guide a critical interpretivist study. Thirty in-depth, minimally structured, story-telling interviews were conducted with participants between one and 10 years post injury. One cross-cutting theme, 'Communication' and four main themes: 'Experience of care', 'Impact on self', 'Impact on others' and 'Moving forward' were identified. The findings indicated multi-faceted, often long term, physical, social and psychological impact on participants, their family and wider social networks. This included Post Traumatic Stress Disorder type symptoms and impact on work, finances and relationships. Inadequacies in the current care pathway and limited relevance of the commonly used patient reported hip fracture outcome measures used for young adults were also identified. Conclusion: The dominant discourse on fragility hip fracture almost exclusively focuses on the elderly and short-term outcomes. This was the first study investigating the longterm impact of fragility hip fracture in young adults from their perspective and the first application of a new research framework in an acute care setting. It found the needs of younger hip fracture patients are not adequately recognised or addressed. Increased awareness and improvements in healthcare provision are needed to minimise the long-term personal and societal impact of fragility fracture in the under 60s.
Background: Abductive Thematic Network Analysis (ATNA) is a qualitative data analysis method, whi... more Background: Abductive Thematic Network Analysis (ATNA) is a qualitative data analysis method, which was first defined by Rambaree and Faxelid (2013). It draws upon the principles of Thematic Analysis (Braun and Clarke, 2006), Thematic Network Analysis (Attride-Stirling, 2001) and Abductive Theory of [for full text, please go to the a.m. URL]
We take it for granted that one of the objectives of nursing is to improve patients' quality ... more We take it for granted that one of the objectives of nursing is to improve patients' quality of life, but this is notoriously difficult to define. A surgery of renal patients revealed some surprising results of what they considered to constitute quality of life, with implications for the future of nursing care.
Background: There is little empirical research on the topic of ‘behaviour’ within UK HE instituti... more Background: There is little empirical research on the topic of ‘behaviour’ within UK HE institutions however USA research has identified negative consequences of inappropriate student behaviour for learning, achievement, persistence and retention, and staff self-esteem. Aims: To evaluate the development and pilot implementation of university-wide guidance that was designed to facilitate a shared understanding of what makes a supportive learning environment within the university community and provide practical guidance for students and staff on tackling inappropriate behaviour should it occur. Methods: Action Research. Findings: Staff and students found the guidance was or would be beneficial, highlighting its practical focus and the shared understanding and enhanced confidence it engendered. Conclusions: Shared, organisation-wide, practical guidance can provide an effective means of support for students and staff. Such guidance can help to clarify and manage varying expectations, th...
Uploads
Papers by Gillian Janes