Knowing why we do what we do?

Establishing a Unit Practice Council to improve evidence based nursing in acute medicine using

Appreciative Inquiry

Kate Sanders – Foundation of Nursing Studies

Alison Dinning, Jo Cooper, Kathryn Draper – NUH

Wendy Walker – University Of Nottingham

Nottingham University Hospitals NHS Trust

• NUH is the fourth largest teaching hospital in the UK - 87 wards and circa 1,700 beds.

• Employs 13,000 staff. • We provide services to over 5.5 million

residents of Nottinghamshire and surrounding counties

• 3 Sites - Queen’s Medical Centre, Nottingham City Hospital and Ropewalk House.

• Many specialist services, include Trauma, stroke, renal, neurosciences, cancer services and trauma

• One of the biggest EDs in Europe – approx 450 patients per day (164,000 per year)

• The Trust has an annual income of £722.5million

• Strong relationship with University of Nottingham and other universities across the East Midlands, including Loughborough University.

Context of study

• Trust vision to become a Magnet Hospital• Shared Governance – Develop Unit Practice

Councils• UPC Project supported by Jenny Leggott

(Director of Nursing)• Secondment of Critical Skills Nurse Educator to

Trust Preceptorship Team• Focussing on Acute Admissions Areas initially

Why Ward B3?

• Many Acutely ill patients due to direct Patient referrals from GP and ED

• Enthusiastic team• Lots of newly qualified nurses

• 90 WTE registered nurses (16 are newly qualified)• 20 non-registered nurses

Summary of Project

• Establish and evaluate the development of a Unit Practice council on B3 using principles of shared governance

• Research supported by Kate Sanders and Foundation of Nursing Studies

• Bring decision-making to frontline clinical practice in relation to caring for Acutely ill patients.

• Support staff with relevant evidence-based practice

• Use an Appreciative Inquiry Approach

Collection of data• A validated measure of nurse practice

environment collected at month 3, 9 and 13 (Measures autonomy, support, perceived patient safety culture and job satisfaction from Nursing Work Index – revised Aiken and Patrician, 2000)

• Qualitative data from two Appreciative Inquiry guided UPC focus groups / study days

• Focus group interviews (Analysis using Systematic Framework Analysis – Ritchie et al, 2003)

Opportunities

• Develop a Unit Practice Council on B3 (with FONS support) as a pilot site for NUH

• Use Appreciative Inquiry as a methodology

• Opportunity for research lead /team to develop personal knowledge and skills in research and using AI

Challenges

• Commitment and engagement from frontline clinical staff and patients

• Equipping staff with skills and support to implement change.

• Allocation of sufficient time• Adoption of a shared governance

approach• Using AI as our research methodology

However……• Focus of research has already changed from original

aims

• Study Day led by FONS facilitator has identified with the ward team that work needs to be focussed on key areas that were not previously identified

• Appreciative Inquiry is a really effective methodology to use

• Method of collecting data will need to change

Thank you