The Nursing Associate

Notes on Contributors xiii  Acknowledgements xvii  Introduction xix  1 Understanding Your Apprenticeship 1  Annabel Coulson  Introduction 1  Aims of This Chapter 1  The History of Nurse Education and the Apprenticeship Model 2  What Is an Apprenticeship? 4  The Apprenticeship Standards for Nursing Associates (ST0827) 5  ‘On-the-Job’ Time 5  ‘Off- the-Job’ Learning 6  Getting the Right Balance 8  Postregistration Opportunities 9  Preceptorship 9  What Are Postregistration Opportunities? 9  Chapter Summary 11  References. 11  2 Embedding the Nursing Associate in Practice 12  Jacqueline Elton  Introduction 12  Aims of This Chapter 12  Related NMC Standards. 12  Why the Need for a New Role? 13  Is the NA a Reinvention of the SEN? 15  Potential Difficulties with the Introduction of New Roles. 17  Understanding of the Role 18  The Reality of the NA Role 18  Annabel – Programme Lead 18  Jenny – Senior Nurse Manager Acute Hospital Inpatient Setting 20  Claire and Amanda – Community NAs 21  Louise – Trainee Nurse Associate Acute Inpatient Trust 22  Steph and Sonal – Nursing Associates Supporting and Developing Other Nurse Associates 23  Chapter Summary 24  References 25  3 Being a Professional: The Importance of Scope of Practice 27  Claire Agnew van Asch  Introduction 27  Aims of This Chapter 27  Related NMC Standards 28  Being a Professional 28  Modern Nursing Origins 28  Defining a ‘Profession’ 28  Professional Regulation 28  Being a Nursing Associate 30  Advocacy 30  Barriers to Effective Advocacy 31  Advocacy Skills 31  Empathy 33  Active Listening 33  Professional Autonomy and Working within Your Scope of Practice. 35  What Is Scope of Practice? 35  Practise Effectively 36  Preserve Safety 36  Ensuring You Are within Scope of Practice 36  Clinical Competence 37  Professional Judgement and Clinical Decision Making 37  Clinical Decision Making 37  Critical Thinking and Using the Evidence 39  Using Evidence-based Practice 39  Foundations for the Nursing Associate Role 40  The Nurse–Patient Relationship 40  Requirements for a Successful Nurse–Patient Relationship 41  Prioritise People 41  Promote Professionalism and Trust 42  How Do You Build a Nurse–Patient Relationship? 42  Holistic Nursing Care 43  The Unpopular Patient. 43  The Nursing Process 44  What Is the Nursing Process? 44  Practise Effectively 47  NMC Proficiencies 47  Chapter Summary 47  Suggested Answers for Advocacy Scenarios 48  References 49  Further Reading 50  4 Applying Person-centred Approaches to Care 51  Leigh-Ann Cowell  Introduction 51  Aims of This Chapter 51  Related NMC Standards 52  What Is Person-centred Care? 52  Nursing Theories and Models 55  Popular Nursing Models 56  Orem (1980) 56  Peplau’s Theory of Nursing (1991) 56  Roper, Logan and Tierney (2000) 57  Recovery Star 57  The Nursing Process. 58  Patient and Family-centred Care 59  Person-centred Care at End of Life 61  Supporting Person-centred Care with Cultural Competence 62  Cultural Awareness 63  Cultural Knowledge 63  Cultural Skill 63  Cultural Encounters 63  Cultural Desire 63  Chapter Summary 64  References 64  Further Reading 65  5 Effective Communication for the Nursing Associate 67  Michelle Richardson  Introduction 67  Aims of This Chapter 67  Related to NMC Standards 67  The Importance of ‘Good’ Communication 68  Underpinning Theories 68  Understanding Ourselves and How We Develop Our Own Communication 69  Developing an Effective Therapeutic Relationship 72  Using Communication to Engage and Develop Care 74  Heron’s (2001) Six-stage Interventional Analysis 74  Recognised Barriers to Effective Communication 75  Communicating with Children 76  Tools to Aid Communication 76  Cultural Awareness 77  Questions to Consider when Developing an Effective Nurse–Patient Relationship 78  Barriers to Supporting Cultural Awareness 79  Sensory and Altered Perceptions 80  Physical Causes of Communication Barriers 82  Challenging Conversations – Breaking Bad News and Emotionally Charged Situations 84  Spikes 85  Setting Up the Interview 86  Perception (Assessing the Patient’s Perception) 86  Invitation (Obtaining the Patient Invitation) 86  Knowledge (Giving Knowledge and Information to the Patient) 86  Emotions (Addressing the Patient’s Emotions with Empathetic Responses) 87  Strategy and Summary 87  Conflict and Challenging Behaviour 87  Application to Practice 89  Professional and Team Communication 90  Resources 90  Chapter Summary 91  References 91  Further Reading 92  6 The Nursing Associate and Duty of Care, Candour, Equality and Diversity 93  Marie Knight  Introduction 93  Aims of This Chapter 93  Related NMC Standards 94  Duty of Care 94  Prioritise People 94  Professional Competence 95  Effective Communication 96  Advocacy 96  Ethical Practice 97  Continuous Improvement 97  Duty of Candour 99  Disclosure of Adverse Events. 99  Supporting the Patient 100  Documentation and Reporting 100  Mental Capacity 100  Equality and Diversity 102  Chapter Summary 104  References 104  Further Reading 105  7 The Team Around the Patient 106  Colette Orton  Introduction 106  Aims of the Chapter 107  Related NMC Standards 107  Teams 107  Barriers to Team Development 109  Changing Roles 109  Changing Settings. 110  Instability of Teams. 110  Communication in Teams. 110  Critical Thinking, Problem Solving and Decision Making 112  Critical Thinking. 113  Problem Solving. 113  Incidents and Accidents: Patient Safety Incident Response Framework (PSIRF). 114  Culture 117  Leadership, Psychological Safety, Learning Environments, Change and Improvements 119  Autocratic 120  Democratic 120  Laissez Faire 120  Chapter Summary 121  References 122  Further Reading 123  8 Nursing Associates and the Importance of Being Curious 124  Rose Webster  Introduction 124  Aims of This Chapter 124  Related NMC Standards 125  What Is Evidence-based Practice? 126  Historical Context of Evidence-based Practice 126  Evidence-based Nursing Practice 127  Using Evidence in Practice. 129  Being Aware of the Evidence Underpinning your Practice 129  Finding Evidence to Support your Practice 129  Evaluating the Available Evidence 129  Finding New Evidence 130  Translating Evidence into Practice 130  Monitoring Evidence-based Practice 130  What Is the Evidence Base for Practice? 130  Finding the Evidence for Practice 131  Clinical Policies and Guidelines as a Source of Evidence for Practice 131  Reviewing the Literature to Find Evidence for Practice 133  What Published Evidence Should I Look At? 134  Finding Evidence Collated by Others 135  Searching the Published Literature 135  Evaluating the Evidence That You Find 136  Finding New Evidence for Practice 136  Evidence from Systematic Enquiry through Research 137  Research Methods 137  Quantitative Methods 137  Qualitative Methods 139  Limitations of Systematic Research as a Source of Evidence to Inform Practice 140  Evidence from Clinical Expertise 140  Evidence from Patient or Service User Experience, Preference and Values 141  Translating Evidence into Practice 142  Clinical Decision Making 143  Monitoring Evidence in Practice 144  Service Evaluation 144  Clinical Audit 144  Chapter Summary 145  References 145  Further Reading 147  Evidence-based practice 147  Research methods 147  Use of clinical guidelines in practice. 147  Patients as sources of evidence for practice 147  Factors influencing the translation of evidence into nursing practice 148  Clinical decision making 148  Clinical audit 148  Service evaluation 148  Hand hygiene 148  Wound dressings and wound care 148  Prevention of pressure ulcers 149  MMR vaccine uptake 149  The nursing associate role 149  9 Supporting Learners: The Role of the Nursing Associate 150  Annabel Coulson  Introduction 150  Aims of This Chapter 151  Related NMC Standards. 151  Platform 4. 151  NMC Standards of Student Support and Supervision 151  Experiences of Student Nursing Associates: Lessons Learnt 153  The Learning Environment 154  SLOT Analysis of a Learning Environment 155  Learning in Practice 156  Learning Cultures 157  Supporting Learners 158  Importance of Your Learners’ Experience 159  Optimising the Learning Experience 159  Teachable Moments: Creating Opportunities to Learn in Practice 160  Using Delegation to Support Learning 161  Barriers to Delegation 162  Impact of Good Delegation 163  Impact of Ineffective Delegation 163  Providing Effective Feedback 164  Struggling Learners 165  Chapter Summary 166  References 166  Further Reading 167  Index169