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 2005-2009 4001,200 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/midstaffs-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
www.bbc.co.uk/news/uk-englandstoke-staffordshire-21339330
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
www.nhsemployers.org/The- Francis-inquiry/pages
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
www.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
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) 767-75
• 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?