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

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

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 ,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. staffs-nursing

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

stoke-staffordshire

Personal responsibility Professional 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

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

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.

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.

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 Francis-inquiry/pageswww.nhsemployers.org/The-

Focus on attitudes and values Professor Juliet Beal: Programme Director NHS CB Commitment Competence Communication Compassion Communication Courage

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.

Care Quality Commission 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

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

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.

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

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

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.

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?