What Facilitates/Hinders Heart Failure
Specialist Nurses When Caring for Heart
Failure Patients at End of Life?
Jane Brooks MSc
RCBC first into research 2011/12
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Title: What Facilitates/Hinders Heart Failure Specialist Nurses When Caring for
Heart Failure Patients at End of Life
Author: Jane Brooks
British Heart Foundation Heart Failure Specialist Nurse
Aneurin Bevan Health Board
Cardiac Rehabilitation Department
Nevill Hall Hospital
Brecon Road
Abergavenny
NP7 7EG
Tel No: 01873 732648
Email: [email protected]
For: RCBC Scheme in conjunction with University of Glamorgan
Supervisor: Dr Allyson Lipp Date: 17 January 2011 – 17 January 2012
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Acknowledgements The rewards of being able to undertake the RCBC research scheme have been two fold. Firstly, it has enabled personal growth in an area that I had very little knowledge and no practical experience. This would not have been possible without the guidance and support of Dr Allyson Lipp, Senior Lecturer, University of Glamorgan, The last twelve months have been a challenge but at the same time a positive learning experience. Secondly, it has given me an opportunity to explore with the heart failure specialist nurses in Aneurin Bevan Health Board how to improve the service we, as a team, provide for heart failure patients at end of life. Thank you to Jan Hillman who kindly agreed to facilitate the Nominal Group. Her knowledge and experience proved invaluable within such an emotive topic area. Thank you to all my colleagues in cardiac rehabilitation for the continual support you have given me and for covering my work schedule to enable me to continue my research studies.
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Contents Abstract Page 5 Introduction Page 5 Literature Search and Review Page 6-9 Aim of Research Page 9 Method Page 10 Nominal Group Technique Page 10-11 Sample Page 12-13 Inclusion Criteria Page 13 Exclusion Criteria Page 13-14 Ethical Considerations Page 14 Data Collection of Nominal Group Technique Page 14 Stage 1 Page 15-17 Stage 2 Page 17-18 Discussion Page 19-20 Conclusion and Implications for Service Development Page 20-22 Dissemination Plans Page 22-23 References Page 24-26 Appendix 1 Challenges Faced Page 27 Appendix 2 Outcomes of Writing Report Page 28
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Abstract
Heart failure is a progressive condition with a devastating and often grim outlook for the
individuals concerned (Jaarsma 2005). It has a prognosis worse than some cancers
(Stewart et al 2001) but despite this, heart failure patients, at end of life, will not
routinely have access to specialist services for end of life care, often referred to as
palliative care. Heart failure nurse specialists will inevitably have on their case load,
patients with advanced symptoms, with some being at the end of life and needing
palliative care.
Various heart failure guidelines recommend that palliative care should be provided for
heart failure patients when they approach end of life. In line with these
recommendations this research study was intended to assist in informing a
geographically diverse team of heart failure specialist nurses in the development of
palliative care services for patients with heart failure. Six heart failure specialist nurses,
excluding the author were invited to participate and consider what facilitated/hindered
them when providing palliative care for heart failure patients. This assisted in identifying
gaps in current service provision, developed themes and gained consensus of opinion
in relation to the research question. This allowed the team to formulate an action plan
to shape future palliative care provision for heart failure patients.
Introduction
Recommendation from various heart failure guidelines NICE (2010) and ESC (2008)
indicate that palliative care should be provided for heart failure patients when they
approach end of life. Although the guidelines recommend that palliative care for heart
failure should be provided there is recognition that heart failure service provision across
the UK is diverse and may or may not already provide palliative care. The guidelines do
not stipulate how or to what extent palliative care provision should be incorporated into
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existing heart failure services. Following an evaluation of baseline palliative care
service provision for malignant and non malignant conditions by the care planning group
for Wales, the Sugar Report (2008) outlined that existing specialist palliative care
service provision within Wales was failing. As a specialist service it only had the
capacity to act in an advisory role to heart failure nurses who supported heart failure
patients at the end of life.
Within one local health board that provided heart failure services it was recognised that
palliative care service provision was ad hoc and not included in the heart failure service
provision protocol that was developed by its heart failure specialist nurses. In line with
the NICE(2010) and ESC(2008) recommendation that palliative care should be provided
for heart failure patients when they approach end of life, it was an ideal opportunity to
examine how palliative care for heart failure patients was provided in current heart
failure service provision. This initial stage was needed to develop how heart failure
service provision could or should be provided in the future.
Literature Search and Review
Using Boolean logic, the key words heart failure nurse, palliative care and end of life,
the following data bases were searched: CINAHL, MEDLINE and BNI. Parameters of
full text, English language and the time frame of five years were applied to the search.
A total of 55 references were returned. There were 9 research papers, 8 qualitative and
1 quantitative, as well as 1 literature review and discussion. The other references
pertained to clinical articles, expert opinion anecdotal views.
The disease trajectory of heart failure is often unpredictable and decision making with
regards to transition into the palliative care phase is often viewed as complex (Green et
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al 2010) when compared with other decisions regarding heart failure management.
Recognising when a heart failure patient needed palliative care and the decision making
process associated with this, was acknowledged as notoriously difficult by heart failure
specialist nurses (Dowding et al 2009). Regardless of the complexity of the decision
Thompson et al (2008) in their qualitative study, found that heart failure nurse
specialists did not demonstrate different ways of reasoning for easy or difficult
decisions. However their differing levels of experience and expertise varied their
processing of information, judgements and decision making.
A number of qualitative studies sought to explore the experiences of relatives, informal
carers and next of kin who were caring for people with advanced heart failure
(Braanstrom 2007, Clark et al 2007, Cortis & Williams 2007, McIlfatrick 2006).
Appreciating the narrative content of these experiences within the studies could enable
heart failure specialist nurses to examine how they may be best placed in the context of
service development and delivery for heart failure patients at end of life.
Braanstrom et al (2007) discovered in their small study that close relatives of people
suffering with severe heart failure benefited from knowing the health professional that
provided care for their loved one. In this study the ability to provide „tailor made care‟
enabled a sense of security for the relatives. This was in contrast to the findings of
Cortis & Williams (2007) who sought to explore the experiences of older adults with
heart failure to gain an understanding of their palliative and supportive needs. In this
study, for fear of being a burden, the study participants often found ways of coping and
underutilised the available support from health professionals.
Clark et al (2007) recognised that informal care provided for heart failure patients at
home could be complex. Despite informal carers having very little understanding of the
nature or impact that heart failure could have on the individuals concerned they had
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valuable insight into the individual‟s fluctuating physical and emotional needs The
closeness of the informal carer allowed insight into the patient‟s needs, an insight that
the health professional may not have. The concept of insight is elaborated on in
McIlfatrick (2006) with carers feeling left out of the team of care providers, even though
in reality they were the main care giver and often had insight into their relatives needs.
Both studies suggested that there was a need for carer‟s views to be included in care
giving and acknowledgement that their insight was valuable to this process. The giving
of information to carers, relating to heart failure was also recommended.
Other studies (Waterworth & Jorgensen 2010, Newton et al 2009, Wu & Volker 2009,
Munck et al 2008) focused on the relationship that existed between patient, carer and
health care professional, often an intertwined existence that is based on effective
communication. A review of the literature (Green et al 2010) indicated that
communication was key to aid heart failure patients‟ transition to palliative care
provision. Failures in transition often occurred due to poor communication between
health professional and patient and in-between health professionals. Waterworth &
Jorgensen (2010) proposed that the rapport that builds between a patient with heart
failure and the health professional that cares for them is paramount to develop and
support a relationship that is based on openness, honesty and trust. Qualities which
Newton et al (2009) indicate are essential to introduce the topic of end of life care,
giving the patient and carer opportunity to think about and discuss their preferences for
the future. Although patients may wish to be cared for at home and carers may want
the opportunity to provide end of life care at home Munck et al (2008) acknowledge that
this is not always straightforward. They suggest flexibility in the care giving approach
allowing patient and carers to change their minds and early involvement of a health
professional to support this.
Discussion about palliative care can be controversial and in Wu & Volker (2009) study,
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Taiwanese hospice nurses struggled with cultural stigma of bad luck being associated
with caring for the dying. In this study establishing close relationships with patients at
end of life enabled holistic meaningful care and challenged negative beliefs about the
dying process, for both patient and nurse.
Anecdotal views from Flynn (2008) indicate delivery of good care at end stage heart
failure is dependant on the knowledge, advanced interpersonal and communication
skills with Millerick (2008) recognising that patients at end stage are often
disadvantaged due to delay in health professionals recognising that patients are
approaching end of life. Early referral to palliative care was found to be a positive rather
than negative experience by Chester (2010) who advocated collaborative working with
specialist palliative care services. Collaborative working between heart failure and
palliative care specialist nurses was key to Pooler et al (2007) having a shared vision of
improving care for heart failure patients at end of life.
The literature implies that there are many facets that influence the provision of palliative
care including its complexity, the joint role of carers and the heart failure team in such a
sensitive topic. These are the elements which heart failure nurse specialists‟ needs to
consider when caring for heart failure patients at end of life. There is a dearth of
research which explores the specific role of heart failure nurses at the end of life hence
the need for this study.
Aim of Research
It was essential that the research question had the capacity to inform on current practice
and provide a platform for change for future practice and service development. The aim
of the research question for this study was to establish “What Facilitates/Hinders Heart
Failure Nurse Specialists When Caring for Heart Failure Patients at End of Life?”
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Method
It remained a constant challenge to incorporate evidence based guidelines into practice.
In the current financial climate there were no extra finances to enhance the current
service provision. Providing extra services within an existing service framework and
budget can be burdensome for the staff concerned. Undertaking research could be
useful in managing a changing environment. It was important to the researcher that the
research method chosen would allow the study participants to express individual
thoughts and work as a team to improve palliative care service provision for heart failure
patients. The use of research provided an opportunity to establish current service
provision and identify potential gaps for service development.
A number of research methods that sought group opinion were considered for this
purpose. The researcher chose Nominal Group Technique as appropriate to assess
current service provision, identify potential gaps, generate themes for development and
gain consensus of opinion from study participants. This would provide a foundation for
the study participants to recommend changes and formulate an action plan to shape the
provision of care for heart failure patients at end of life.
Nominal Group Technique
Nominal group technique is traditionally associated with market research and uses a
group of 8-10 people to generate ideas and solutions for many purposes for a variety of
settings. Other areas that have used the nominal group technique are health care,
medicine and education.
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It is recognised by Carney et al (1996) as having dual benefits, one being an essential
process for the researcher to understand the context in which practitioners work and
secondly for the participants to realise the relevance of the work to their practice. The
nominal group technique, also known as the consensus technique is facilitated by a
person skilled in group work techniques.
The Nominal group discussion can open up dialogue and will provide subjective data
dependant on participant‟s own opinions and experience for the basis of data collection.
It is acknowledged that a nominal group discussion is less likely to be dominated by
vocal participants compared with a focus group (Aveyard et al 2005). The nominal
group approach allows the voice of each participant to be heard which contributes to a
group response. In order to gain group consensus of opinion a nominal group
technique will be employed to pose a specific question to the group with Carney et al
(1996) advocating that this technique plays a valuable role to the exploratory process of
a study. The use of nominal group technique allows individual sharing of views, group
clarification and development of themes, ownership of data and having an ongoing role
in planning change and evaluation of that change (Aveyard 2005, Allen 2004).
Inclusivity and ownership is paramount in any process that may lead to change.
Ownership of the nominal group data is encouraged for the group to instigate
collaborative change.
One of the advantages of the nominal group technique described by Aveyard et al
(2005) is that it allows for data collection, categorisation and analysis to be carried out in
real time, therefore allowing for the data to be clarified and categorised. Morse &
Richards (2002) indicate that categorisation of data should be done as soon as it
emerges. This could potentially save time in data collection and organisation and was
appropriate for a one year project.
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The question for this nominal group technique would ask what facilitated/hindered heart
failure nurse specialists when caring for heart failure patients at end of life? Identifying
what facilitated/hindered local heart failure nurse specialists when caring for heart
failure patients at end of life would not have been sufficient to influence future local
service provision. Although gathering of truthful data from a local perspective provided
a foundation, it needed to be analysed and set into action. The use of a nominal group
technique facilitated the truth gathering process and analysis of real time data. The data
retrieved from nominal group discussion is strengthened by gaining consensus of
opinion with emphasis placed on the rank order of importance of the data that emerges.
The data retrieved from the research question is ranked by the group in order of
importance. The consensus of opinion from the group is considered by Allen (2004) as
pivotal in planning service delivery. The rank order of this data informs the action plan
to instigate change for future service provision.
Sample
For the purpose of this study the total population of six local heart failure specialist
nurses working in a variety of primary and secondary care settings, across five
geographical areas within one local health board would be invited to participate. The
researcher, also a heart failure specialist nurse was purposefully not included in the
sample group. Lloyd Jones et al (1999) identifies that participants of nominal group
technique typically have some similarity; in this case they are heart failure specialist
nurses caring for heart failure patients at end of life.
Typical sample methods associated with qualitative research are non-randomised
methods such as purposeful and convenience samples. Selection of a ready-formed
group such as local heart failure nurses to become participants in a study could be
misinterpreted as a convenience rather than purposeful sample. However a true
convenience sample is described by Bryman (2008) as one that is only chosen for ease
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of access, although Proctor et al (2010) imply that all researchers use samples of
population that they have access to, therefore convenient.
Purposeful sampling will not provide objective data although Morse & Richards (2002)
indicate that good qualitative inquiry is dependent on the researcher deliberately
seeking valid representation from the sample method. The sample method for this
study, although convenient for access, will be purposeful for the study.
Purposeful sampling of participants in this study, heart failure specialist nurses, is
intentional as they have real life experience of caring for heart failure patients at end of
life.
Inclusion Criteria
All Heart Failure Nurse Specialists within the locality were invited to participate in the
study. Voluntary participation in a study is considered by Holloway & Wheeler (2010) as
an essential criterion for inclusion into a study. The study participants varied in age,
educational and clinical experience within heart failure and palliative care management.
Heart failure nurse specialists within the locality are banded between 6 and 8 according
to Agenda for Change. The clinical banding will not necessarily reflect clinical expertise
or experience within the specialism of heart failure nursing and the care of heart failure
patients at end of life.
Exclusion Criteria
The researcher‟s role within the nominal group was to collect the nominal data and to be
available to the facilitator and the group to clarify the pre-determined group question if
required, therefore excluding herself from the study. Holloway & Wheeler (2010) deem
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that a reciprocal and equal relationship is more likely to exist when a researcher is
involved in research with their peers. Within nominal group technique, Lloyd Jones
(1999) argues that researcher and group bias is reduced to a minimum, however the
researcher, demonstrating reflexivity (Holloway & Wheeler 2010), had excluded herself
to provide distance from her pre conceived notions around the subject matter and
further minimise bias in the form of influence within the group setting.
Ethical considerations
The research study was approved by the Health Board research scrutiny and the
research risk review committee. The details of the research study were submitted in
accordance with a locally agreed format. As it was a joint venture with the University of
Glamorgan under the RCBC scheme it was further subjected to the approval process of
the research scrutiny and risk review committees of the supporting University. The
details of the research study were submitted in accordance with IRAS. The research
study involved health board personnel and therefore it was not necessary for the
research study to receive ethical approval.
Data collection of Nominal Group Technique
The process of nominal group technique was adapted to fit the needs of the research
participants. Due to patient commitments and time constraints it would have been
difficult for the research participants to attend a meeting that lasted more than 2 hours.
Therefore the nominal group technique process was modified to include initial data
collection and analysis in stage 1. At a further meeting this data would be revisited and
the group asked rank the key points in priority order, stage 2.
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Stage 1
End of life care is a potentially emotive topic area and to set the scene for the research
question the group facilitator asked the study participants to consider and discuss:
What palliative care meant to them
Did they view palliative care as part of their role
How did they provide palliative care for heart failure patients at end of life
Was there engagement with carers in provision of palliative care for heart failure
patients at end of life
What influenced their provision of palliative care for heart failure patients at end
of life
The purpose of the discussion was to allow the group to relax in their surroundings and
become more comfortable in talking and sharing their views about palliative care. For
this reason data was not collected from the 5 questions used to open discussion on
palliative care.
The facilitator asked the study participants “What Facilitated/Hindered Heart Failure
Specialist Nurses When Caring for Heart Failure Patients at End of Life”. Individually
and anonymously, the study participants were asked to think and write down their
thoughts. These thoughts were given to and fed back into the group arena by the
facilitator. With guidance from the facilitator these thoughts were offered to the group
for further discussion and clarification. Allen (2004) places great importance on
acknowledgement of all participant responses with the opportunity for discussion and
clarification of key points to resolve ambiguities, whilst the sharing and challenging of
ideas with others is viewed by Aveyard et al (2005) as having the potential to develop
creativity.
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From this wealth of data there emerged similarities and common threads. With the help
of the group facilitator the participants grouped these together into key points. The
facilitator then wrote the collective key points on to a flip chart for the group to view and
debate accuracy of data collection. The key points that facilitated or hindered the heart
failure nurse specialists were listed in table 1 and 2 respectively.
Table 1
Table 2
Facilitates
Having heart failure colleagues to discuss cases with Clinical experience
Knowing the patient Confidence to deal with palliative care
issues
Access to the palliative care team clinical support and supervision
Good interpersonal skills Own coping strategies
If patient identifies clear needs and requests Patient acceptance of end of life
Hinders
If patient identifies clear needs and requests Lack of patient acceptance
Fear of not getting it right for the patient Relationship with patient
Lack of confidence dealing with palliative care issues Lack of palliative care knowledge
Lack of clinical experience Being aware of self limitations
Own coping strategies Lack of time
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In an attempt to make sense of and organise the data collected, the key points
identified in tables 1 and 2 were placed into categories, by the researcher, of whether
they were associated with the patient, nurse or other health care professional. In
preparation for stage 2 this information was put into a power point presentation.
Stage 2
At the second meeting, a power point presentation was given by the researcher to the
research participants. The data from stage 1 of the nominal group technique was
presented. The purpose of which was for the researcher to revisit the initial research
process and clarify that the key points were a true reflection of the thoughts and views
of the heart failure nurse specialists that were involved in the study. There was full
agreement that the material presented was an accurate representation of the original
data. It also allowed grouping of the key points into patient, nurse and other health care
profession domains. This indicated to the group which areas of care could be positively
or negatively influenced by the points that they thought facilitated or hindered the care
that they gave to heart failure patients at end of life. At the second meeting the
participants had the opportunity to rank, on a numerical scale, their key points into order
of importance. This is a process which Fleck et al (2001) signifies is essential for
prioritisation of themes for action. If more than one question had been used the same
process would be completed in full before moving onto the next. Individually and
anonymously, the study participants were asked to number and write down the key
points in order of importance to them. This is illustrated in tables 3, 4 and 5 respectively.
The number in brackets in the tables below indicates group consensus of importance to
action, with 1 being highest priority. This completed stage 2 in preparation for devising
an action plan for service improvement for heart failure patients at end of life.
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Table 3 Patient
Table 4 Nurse
Table 5 Other Health Care Professions
Table 5 Other Health Care Professionals
Discussion
Facilitates Hinders
If patient identifies clear needs and requests (6) Relationship with patient (3)
Patient acceptance of end of life (7) Lack of patient acceptance (6)
Knowing the patient (3) If patient identifies clear needs and
requests (5)
Facilitates Hinders
Clinical experience (4) Lack of clinical experience (1)Good
interpersonal skills (1) Lack of confidence in dealing with palliative
care issues (4)
Confidence to deal with palliative care issues (5) Being aware of self limitations (2)
Own coping strategies (10) Lack of palliative care knowledge (1)
Having heart failure colleagues to discuss cases with (2) Lack of time (4)
Own coping strategies
Facilitates Hinders
Having access to a palliative care team (9)
Clinical support and supervision (8)
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Discussion
The data retrieved from the research study involving the local heart failure nurses was
sometimes ambiguous and indicated that some of the original comments had a dual
purpose of being both a facilitator and a hindrance. There were many influences as to
whether a comment was deemed to facilitate or hinder the provision of care to heart
failure patients at end of life suggesting that the local heart failure nurses viewed
palliative care as difficult, as was found in Dowding et al (2009).
Having informal and formal ongoing support from each other and the palliative care
team was viewed by the local heart failure nurses as aiding their decision making in
relation to providing end of life care for heart failure patients. From the outset of this
study it was clear that individually, the local heart failure nurse specialists with differing
levels of clinical experience and expertise in heart failure management and minimal, self
limiting, levels of clinical experience and expertise in palliative care management varied
in their approach of processing information and making judgement of what facilitated
and hindered them in providing care to heart failure patients at end of life. This was
demonstrated by the variety of responses that were offered up to the facilitator for
discussion and subsequent ranking of the importance of clinical experience in heart
failure management and palliative care management. Similar findings were
demonstrated by Thompson et al (2008) when heart failure nurse specialists of differing
levels of experience and expertise processed information for judgement and decision
making in palliative care.
For the local heart failure nurses the use of good interpersonal skills to get to know the
patient often gave insight and appreciation of their specific needs, requests and
transition to acceptance of end of life. The depth of the relationship and familiarity with
the patient and condition were two fold. It gave the nurses confidence to address those
needs that were unrealistic but made them aware of developing their own coping
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strategies for dealing with such an emotional topic. The data from the local heart failure
nurse specialists suggests that there is rapport with their patients (Waterworth &
Jorgensen 2010) indicating that they are ideally placed to initiate the topic of end of life
care (Newton et al (2009).
Studies that sought the experiences of relatives and informal carers who were caring for
people with advanced heart failure (Braanstrom 2007, Clark et al 2007,) found that
having support and knowing the health professional provided benefits such as
individualised care and a sense of security whilst Cortis & Williams 2007, Clark et al
2007, McIlfatrick 2006 suggested that informal carers often developed their own coping
mechanisms and underutilised the support available from health professionals.
Reference was made to health professionals under utilising the knowledge and insight
that carers could impart with on caring for people with heart failure. No reference to
family members or informal carers being a facilitator or hindrance to care was made by
the local heart failure nurses.
One fairly high ranking hindrance of the local heart failure nurses was lack of time. This
finding seems to be an original one as lack of time was not referred to in the research
papers reviewed.
Conclusion and Implications for Service Development
In comparing the data retrieved from the study involving the local heart failure nurses to
the literature, similar threads emerged. The challenge was how to construct an action
plan to capitalise on their existing strengths and develop their weaker ones, so that
within their locality, palliative care for heart failure patients at end of life could be
improved. This fits with the Welsh Government (2010) agenda of Delivering a Five Year
Service, workforce and financial strategic framework for NHS Wales which was to
develop nursing roles and innovation of service provision.
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To aid construction of a specific, measurable, achievable, realistic and time orientated
action plan (SMART), the categories of communication; knowledge and education; self
awareness were introduced (tables 6,7,8) with the order of ranked importance
displayed in brackets, the lowest number being considered the most important to the
heart failure nurse specialists. These were areas that were suggested as essential by
anecdotal evidence from Chester (2010), Flynn (2008), Millerick (2008), Pooler. At a
later date the categories would provide a reference point for the components of the
action plan.
Table 6 Communication
Communication
Table 7 Knowledge & Education
Facilitates Hinders
Good interpersonal skills (1) If patient identifies clear needs and
requests requests (5)
Having heart failure colleagues to discuss cases with (2) Lack of patient acceptance (6)
Patient acceptance of end of life (7) Fear of not getting it right for the
patient (7)
Access to palliative care team (9) Relationship with patient (3)
Knowing the patient (3)
If patient identifies clear needs and requests (6)
Lack of patient acceptance
Facilitates Hinders
Clinical experience (4) Lack of clinical experience (1)
Confidence to deal with palliative care issues (5) Lack of confidence dealing with palliative
care issues (4)
Clinical Support and supervision (8) Lack of palliative care knowledge (1)
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Table 8 Self Awareness
With reference to the NICE (2010) and ESC (2008) heart failure guidelines it was
recognised that there would be no instantaneous solutions to developing and enhancing
this element of service provision. Nevertheless as a team and from using a research
process, we had established a firm baseline to work from. It was agreed by all that
where possible the action plan for improvement would be developed in order of agreed
priority. It was accepted that some points could be easier to action than others and may
supersede priority. It was agreed that elements of the action plan would be put on the
agenda of the bi-monthly nurse led heart failure service development group which
consists of heart failure specialist nurses and the locality Consultant Nurse for Heart
Failure Services.
The group would determine the plan of action and delegate responsibility to achieve
each element. In recognition of the existing workload of the local heart failure nurse
specialists, no more than one element of the action plan will be considered at any one
time. Evaluation of the action plan would follow at the subsequent meeting.
Dissemination Plans First and foremost dissemination of the research study will be to the research study
participants and group facilitator.
Facilitates Hinders
Own coping strategies (10) Own coping strategies (8)
Being aware of self limitations (2)
Lack of time (4)
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A final report will be prepared for the RCBC scheme and made available to the
Consultant Nurse for Heart Failure Services, Consultant Cardiologists and Cardiology
Directorate Manager, Health Board Research Scrutiny Committee of Aneurin Bevan
Health Board and University of Glamorgan, and British Heart Foundation.
Two articles will be prepared and submitted for publication in nursing journals. One
article will be the sole work of the research student (RCBC scheme) and the second co
authored with Dr Allyson Lipp, named research supervisor from the supporting
university.
Opportunities will be sought to present locally, regionally and nationally by the means of
poster presentation and verbal presentation. Target audience will be primarily nursing.
In particular the subject matter may be of interest to nurses caring for heart failure
patients at end of life.
The research method may be of interest to nurses who want to action change and value
the contribution of their fellow workers into the change process.
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Appendix 1
Challenges Faced
Being a novice researcher provided challenges in terms of writing a research protocol,
using specified documentation for local health board research scrutiny and risk review
committees which differed from that stipulated by the supporting university. It would
have been useful if all areas had stipulated the IRAS format.
Following the completion of the documentation for both stakeholders involved there was
need to establish if the research study would need to be subjected to ethical approval.
Despite seeking advice from numerous sources, the local health board research and
development department and local ethics committee, this remained unclear. New
ethical guidelines relating to research were produced in September 2011 which clarified
the situation. The overall process was well supported with the allocation of a named
research supervisor from the supporting university for the duration of the RCBC
scheme.
The cost of the research project was met by the funding secured through the RCBC
scheme. The RCBC scheme provided many benefits for the novice researcher. With
the support of a named research supervisor, Dr Allyson Lipp it permitted exploration and
development of a research idea. The idea was guided through the various stages to
completion. Funding gave protected time for the duration of the study. This was
invaluable for all aspects of the research process to be explored and appreciated..
The format for the quarterly RCBC scheme was user friendly. The final report was not
so user friendly so a more traditional approach to writing a research report was adopted.
This made for easier reading and the outcomes specified by the scheme were included
in an appendices section.
JMB/RCBC/Jan 2011-2012 Page 28
Appendix 2
Outcomes of Writing Report
Undertaking the RCBC scheme was a very positive experience; it presented many
learning opportunities and gave valuable insight into the research process. The
research study will have an immediate and longer term positive impact in caring for
heart failure patients at end of life. As the study involved other local heart failure within
the health board team it has engaged us as a team in the continued evaluation of the
study outcomes.
Although the findings of this study were limited to the local heart failure specialist
nurses, the method for this particular study has the potential to be used in other areas
that require consensus of opinion. It has the potential to be developed and used in
areas that would benefit from collaborative working with heart failure nurse specialists,
ie palliative care nurse specialists and district nursing services.
The positive learning experiences of undertaking a supported research study under the
RCBC scheme should be shared with others. It is ideal for those who are novice
researchers and considering undertaking a research study. It has encouraged
deliberation of expanding the current research study and the consideration of new ideas
for development into further studies for the future.