Clair Merriman - Academia.edu (original) (raw)

Papers by Clair Merriman

Cancer nursing practice, May 29, 2024

Research Square (Research Square), Feb 11, 2020

Background: Participation in simulation-based interprofessional education (sim-IPE) may affect st... more Background: Participation in simulation-based interprofessional education (sim-IPE) may affect students' attitudes towards interprofessional learning (through gaining experience with others) and their professional identity (by increasing the 'fit' of group membership). We examined this in two questionnaire studies involving students from four universities in two areas of the UK. Method: Questionnaire data were collected before and after students took part in a sim-IPE session consisting of three acute scenarios. Questionnaires included the Readiness for Interprofessional Learning Scale (RIPLS) and measures of professional identity derived from the social identity theory literature. In Study 1, only identification with Professional Group (doctor or nurse) was measured, while in Study 2 identification with Student Group (medical or nursing student) and the immediate interprofessional Team worked with in the simulation were also measured. Linear mixed effects regression analysis examined the effect of the simulation session, and differences between medical and nursing students, sites and identity measures. Results: A total of 194 medical and 266 nursing students completed questionnaires. A five-item subset of RIPLS (RIPLS Core) was used in analysis. In both studies RIPLS Core increased for all groups following participation in sim-IPE, although this was larger for nursing students in Study 1. Nursing students had consistently higher RIPLS Core scores than medical students at one site. Effects of the session on identity varied between sites, and dimensions of identity. Notably, while positive emotions associated with group membership (Ingroup Affect) increased for Student Group, Professional Group and Team, the sense of belonging (Ingroup Ties) and importance (Centrality) of the group increased only for Team. Nursing students had consistently higher identification scores than medical students.

Intensive and Critical Care Nursing, Nov 30, 2023

Research Square (Research Square), Dec 11, 2019

International Journal of Nursing Studies Advances

BMJ Simulation and Technology Enhanced Learning, Jul 22, 2017

Journal of Interprofessional Care, Feb 3, 2020

The 2016 All Together Better Health VIII Oxford conference brought together interprofessional edu... more The 2016 All Together Better Health VIII Oxford conference brought together interprofessional education (IPE) and values-based practice (VBP) communities. As there is a paucity of research and publications in the area, following the event a working party consisting of representatives from both communities continued to meet and has developed a joint community of practice. This report describes the work achieved by the group so far and is intended for those involved in the planning and implementation of IPE and collaborative working. The authors consider that incorporating principles of VBP within a framework of IPE can provide a different perspective and understanding of the complexities involved in delivering realistic, student centred learning for collaborative practice, relevant in the 21st century workplace. In particular the authors suggest that using the principles of values and VBP in this way can inform the transition between IPE and collaborative practice facilitating effective person centered collaborative care. This process will require not only the incorporation of these principles within IPE sessions, but also incorporation within the training and support of new and established teachers involved in IPE.

Journal of Evaluation in Clinical Practice, Feb 27, 2022

Rationale, Aims and Objectives: Ward rounds (WRs) are complex social processes. Done well, WR dis... more Rationale, Aims and Objectives: Ward rounds (WRs) are complex social processes. Done well, WR discussions and decisions contribute to timely, safe, effective progression of care. However, literature highlights medical dominance; marginalisation or absence of other perspectives, safety risks and suboptimal resource use. This study examined leadership behaviours and what supported good interprofessional WRs, defined as enabling interprofessional collaboration and decision making which progresses patient care in a safe and timely manner. Deepening appreciation of this art should support learning and improvements. Method: Mixed-method appreciative inquiry (AI) into how WRs go well and could go well more often. Context: daily interprofessional consultant-led WRs in a large adult critical care unit. Data: ethnographic and structured observations (73 h, 348 patient reviews); AI conversations and interviews (71 participants). Inductive iterative analysis shaped by Activity Theory. Participants: 256 qualified healthcare professionals working in the unit. Results: Leadership of good WRs supported (and minimized contradictions to): making good use of expertise and time, and effective communication. These three key activities required careful and skilled orchestration of contributions to each patient review, which was achieved through four distinct phases (a broadly predictable script), ensuring opportunity to contribute while maintaining focus and a productive pace. This expertise is largely tacit knowledge, learnt informally, which is difficult to analyse and articulate oneself, or explain to others. To make this easier, and thus support learning, we developed the metaphor of a conductor leading musicians. Conclusions: Whilst everyone contributes to the joint effort of delivering a good WR, WR leadership is key. It ensures effective use of time and diverse expertise, and coordinates contributions rather like a conductor working with musicians. Although WR needs and approaches vary across contexts, the key leadership activities we identified are likely to transfer to other settings.

British journal of nursing, Apr 12, 2012

Following the publication of the Nursing and Midwifery Council's (NMC) (2007) Simulation of P... more Following the publication of the Nursing and Midwifery Council's (NMC) (2007) Simulation of Practice Learning Project, simulated practice learning opportunities are now to be incorporated into preregistration undergraduate nursing programmes across the UK. Since 2008, the Faculty of Health and Life Sciences at Oxford Brookes University has incorporated simulated practice learning into their curriculum to contribute towards students' 2300 direct clinical care hours. This paper presents the findings of an evaluation project that was conducted by academic staff within the faculty to ensure that they could continue to meet the principles set out by the NMC for auditing simulated learning environments used by higher education institutes (HEIs), and to meet the Essential Skills Clusters ( NMC, 2010a ) for registration as part of the quality assurance processes. The evaluation took place over 2 days, with a total of 52 participants, including practice partners, mentors, practice educators, academic staff and students from all four branches of nursing (adult, mental health, learning disability and children). Results indicated that the support of direct care hours through simulated practice learning can permit students to practice essential clinical skills in a designated clinical skills suite. These learning experiences can also offer positive outcomes and the opportunities to maintain partnership for students, placement partners, and mentors.

Nurse Education Today, Apr 1, 2013

Background: Clinical skill development is essential to nurse education. Clinical skills are frequ... more Background: Clinical skill development is essential to nurse education. Clinical skills are frequently taught in higher education institutions using clinical simulation. It is unclear if clinical skills are subsequently consolidated and developed in clinical placements. Objectives: The aim of this survey was to evaluate pre-registration student nurses perceptions of the frequency of opportunities to practise, the level of supervision and assessment of, clinical skills in their clinical placements. Design: This was a cross-sectional survey design using an online, self-report questionnaire including a Likert-type scale and open ended comments. Participants: Four hundred and twenty one students, from all year groups, from a university in the south of England on a wide variety of clinical placements participated. Methods: Participants evaluated the frequency of opportunity to practise, level of supervision and assessment of and feedback on performance of specific clinical skills. Clinical skills evaluated were measurement of vital signs, aseptic non-touch technique, assisting with eating and drinking, and assisting with comfort and hygiene. Data were analysed utilising Statistical Package for the Social Sciences Version 19. Results: The frequency of opportunities to practise skills in clinical placement was variable with some participants reporting that they never had opportunity to practise essential skills. Similarly the level of supervision and assessment was also inconsistent suggesting that participants frequently practised clinical skills unsupervised without being assessed as competent. Conclusions: Inconsistencies in clinical skill development may lead to graduates who are not work ready and as a result, insufficient clinical competence potentially leads to unsafe practice and poor patient care. This calls for stronger partnerships between educators and clinical areas and the prioritisation of mentor preparation and education as well as organisational support in terms of mentor workload planning.

Journal of Advanced Nursing, Aug 20, 2022

AimsTo explore registered nurses' experiences of patient safety in intensive care during COVI... more AimsTo explore registered nurses' experiences of patient safety in intensive care during COVID‐19.DesignA qualitative interview study informed by constructivism.MethodSemi‐structured interviews were conducted and audio‐recorded with 19 registered nurses who worked in intensive care during COVID‐19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework.ResultsTwo key themes were identified. ‘On a war footing’—an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. ‘Doing the best we can’—Safe Delivery of Care which describes the ramifications of the actions taken on short‐ and long‐term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well‐being and Peer Support.ConclusionNurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an understanding of the holistic and long‐term impacts on patient safety and recovery from critical illness.ImpactThis study explored the perceived impact of COVID‐19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long‐term appreciation of patient safety. These findings should be considered as part of future nursing workforce modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health care professionals.

International Journal of Nursing Studies, Oct 1, 2020

In recent years there has been an increase in international nurses and midwives (trained outside ... more In recent years there has been an increase in international nurses and midwives (trained outside of the European Economic Area) recruited to work in the UK. The aim of this review was to synthesise the most recent qualitative research exploring the experiences of international nurses and midwives as they transition and adapt to living and working in the UK. FINDINGS A systematic literature search using the databases psycINFO, CINAHL, MEDline, Web of Science, as well as Google Scholar, resulted in six studies meeting the criteria of primary qualitative research published since 2010 and focussing on the UK as the host country. A lack of research into the experiences of midwives meant that the participants in each of these six studies were international nurses. The findings of these six studies were synthesised into 4 analytical themes: 1) CULTURAL INTEGRATION; 2) INDIVIDUAL CHALLENGES; 3) SUPPORT NETWORKS, and; 4) COMMUNICATION ISSUES. Participants reported difficulties adapting to their new life in the UK, including within their role as a nurse, but also in finding and building positive relationships that would help to ease their transition. Instances of discrimination, an undervaluing of international nurses' skillset, and problems around communication were all detrimental to this process.

Journal of Clinical Nursing, May 1, 2008

Nursing competence 10 years on: fit for practice and purpose yet? Aims and objectives. This paper... more Nursing competence 10 years on: fit for practice and purpose yet? Aims and objectives. This paper examines how nurses are prepared to be clinically competent and safe at registration, so that they are fit for practice and purpose. It follows up two papers on competence published in 1997 and 1998 and investigates subsequent developments. Background. In 1979, major changes in nursing affected nurse education and preparation for competence. In the following two decades, it became clear that nurses lacked clinical skills. This paper examines subsequent changes and asks the question whether this crucial shortcoming has now been remedied. This paper considers the background and context of change in nursing and nurse education in the 1980s. It looks at the new ideology, to prepare the 'knowledgeable doer' and examines the consequences of the change on nursing competency from the 1990s to the present day. Methods. This is a position paper. Professional policy documents from the English National Board for Nursing, Midwifery and Health Visiting, United Kingdom Central Council for Nursing, Midwifery and Health Visiting and Nursing and Midwifery Council, government reports and legislation on nursing and relevant nursing literature are examined and critically analysed and conclusions drawn. Conclusions. From 1923-1977, mandatory nursing syllabuses set by the General Nursing Council of England and Wales required the registered nurse to have acquired certain specific clinical skills. These were rigorously tested to an explicit standard set by the General Nursing Council before a nurse was awarded state registration. Twenty-five years later, the loss of this system for ensuring this competence and the implications of this loss, have been widely recognised. As a result, many nurse training institutions have introduced clinical skills laboratories, simulation of practice and the Objective Structured Clinical Examination. However, to the authors' surprise and contrary to their initial expectations, the Nursing and Midwifery Council has not made these systems uniform or mandatory and so still has no way of ensuring all nurse training is producing safe nurses in the United Kingdom. The authors conclude that the untested educational ideology that brought root and branch change to nurse training in 1983 and which failed to produce nurses 'fit for practice and purpose' may still prevail.

Journal of Interprofessional Care, Nov 30, 2021

Done well, ward rounds (WRs) promote effective, safe care and collaboration; but WR quality varie... more Done well, ward rounds (WRs) promote effective, safe care and collaboration; but WR quality varies. An improvement-focused appreciative inquiry (AI) into a large intensive care unit's WR practices identified a pivotal axis of collaboration between the most senior medical role (the consultant) and the bedside nurse (BSN). This paper examines that axis of interprofessional collaboration (IPC) to deepen understanding of its implications. Data included ethnographic observations, interviews, and co-constructed AI with groups of staff. Four key concepts emerged from cyclical interpretive analysis: "need," "presence," "ability" and "willingness." BSNs and consultants needed the interprofessional WR to enable their work; WR effectiveness was affected by whether they were both present, then able and willing to participate in IPC. BSN presence was necessary for effective and efficient IPC between these key roles. Indirect contributions, based on prior exchanges with colleagues or through written notes, reduced the joint problem-solving through discussion and negotiation that characterizes IPC to less efficient asynchronous interprofessional coordination. Factors affecting "presence," "ability" and "willingness" are discussed alongside potential mitigations and acknowledgment of asymmetric power. Appreciative examination of interprofessional WRs identified mechanisms supporting and undermining effective WR IPC and the centrality of consultants' and BSNs' collaboration.

Clinical Simulation in Nursing, Mar 1, 2014

Background: Clinical simulation in undergraduate nursing programs is prevalent. It is unclear if ... more Background: Clinical simulation in undergraduate nursing programs is prevalent. It is unclear if skills taught by simulation are effectively transferred into clinical practice. This study evaluated the effectiveness of clinical simulation compared with classroom teaching in teaching the assessment of the deteriorating patient. Methods: This study used a phase II, single, randomized, controlled trial with single-blinded assessments. Students were randomly assigned to either a control or an experimental group. Participants underwent pre and post intervention Objective Structured Clinical Examination (OSCE) with objective performance criteria. Participants completed self-reported competence and self-efficacy questionnaires both pre-and post-test OSCE and a student satisfaction form. Results: The experimental group displayed a significantly better performance on post intervention OSCE. There was no correlation between self-reported confidence and self-efficacy and OSCE performance. Participants who received clinical simulation teaching were significantly more satisfied with their teaching experience. Conclusion: The study suggests that clinical simulation is a more effective teaching strategy than classroom teaching for the development of the assessment skills of the deteriorating patient.

Each section starts with an explanation and includes care procedures in a step by step format. Wr... more Each section starts with an explanation and includes care procedures in a step by step format. Written by two experienced nurses, the book is systematic and evidence based, using up to date knowledge and government policy. It is intended to be a practical aid to ...

BMC Medical Education, Mar 4, 2020

Contemporary Nurse, Jan 2, 2023

Background 1 in 4 experience a mental health problem per year, with a 25 year reduced life expec... more Background 1 in 4 experience a mental health problem per year, with a 25 year reduced life expectancy in those with the most severe mental illnesses. Despite the drive to put physical and mental health on equal footing, Psychiatry teaching to non-Psychiatric colleagues is still woefully under-developed leading to trainees who are unequipped in assessing and managing such zpatients in acute hospital settings. This has overall implications on patient safety and care. Simulation Aims: * To assess a patient with a psychiatric illness including performing a mental state examination * To utilise communication skills and recognise these are transferrable to psychiatric patients * To discuss management plans appropriate to an FY1/FY2 at the start of their year * To reflect on the challenges that interactions with psychiatric patients may pose, and how this could be replicated in other scenarios dealing with those without mental health issues * To adopt learning strategies to manage these challenges to facilitate improved outcomes next time. Project Description 36 FY1s were timetabled to participate over two dates. FY1s divided into 3 simulations with actors and facilitators: 1. Assessing capacity in depressed patient 2. Managing the agitated delirious patient 3. Managing the antisocial patient demanding methadone Each simulation had specific learning outcomes for communication skills and clinical knowledge. Plenary session concluded main clinical and communication learning points, with shared peer learning outcomes and reflections on similar situations on the wards. Facilitators were Psychiatric, Medical and Nursing colleagues, enhancing inter-professional learning. Outcomes Pre and post course confidence questionnaire using 1–10 likert scale was administered. Seven questions were posed covering the sessions’ aims. White space text for identifying three learning points and further scenarios they wish to observe. Provisional results from the first session demonstrated a mean increased confidence in all areas measured, with mean score ranges of 1.0–3.6. Largest confidence increase was seen in prescribing methadone and managing the acutely agitated and disturbed patient. Abstract P81 Table 1 Depression/Capacity Delirium Methadone Other Effects of depression on capacity Delirium pathway Opiate withdrawal management Importance of physical signs/history and examination in assessing these patents MSE when capacity assessment Patient may have delirium longer than clinically indicated Call methadone clinic for all those patients Importance of mental health assessment when assessing capacity Not to treat delirium unless emergency Opiate withdrawal pathway Not to label delirious patients with dementia To treat methadone withdrawal symptomatically How to handle acutely confused patients You can test urine for methadone Delirium pathway online How to manage patients demanding methadone Delirium management No one dies from opiate withdrawal Methadone prescribing Not to prescribe methadone on TTA Qualitative data echoed largest learning areas were in managing opiate withdrawal, prescribing methadone and assessing and managing delirium. Conclusions and Recommendations Overall results following the delivery of the second session will provide a clearer description of whether the specified learning outcomes were obtained. Current faculty simulation members who observed suggested scenarios will be suitable for other trainee grades and professionals. Scenarios have therefore been proposed to simulation lead at Trust for further development of this pilot project. Abstract P81 Figure 1 Provisional results session 1: pre and post confidence questionnaires