LEARNING OUTCOMES
After completing this module the paramedic will be:
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Compassion in Practice was launched by the Chief Nursing Officer (CNO), Jane Cummings, at the CNO's Conference in December 2012 (Cummings and Bennett, 2012). The values and behaviours of this 3-year plan have been embraced. It has driven the NHS action and change agenda with calls for every nurse, midwife and member of the care team to implement the 6 Cs into practice (NHS Commissioning Board, 2013) and, furthermore, into all areas of health, public health and social care services.
The values and behaviours of the 6 Cs are:
This article explores how the Compassion in Practice vision and actions can be embedded into the world of clinical research. While it is accepted that not all clinical research is undertaken within the NHS, this article focuses on those research patients within the public service, but with recognition that the principles discussed have the potential to be translated with ease into other areas.
Exploring the 6 Cs
Clinical research nurses and allied health professionals (AHPs) strive to undertake high-quality research while maximising the enjoyability of research patients' experience. They must ensure that high-quality data is captured while protecting the patients from harm. That being said, many would argue that all research could be potentially harmful to patients (Long and Johnson, 2007), either through clinical trials testing new drugs or devices or research seeking evidence about sensitive topics. Either of these things could cause inadvertent emotional distress and potential damage (Royal College of Nursing, 2009). This subject will be discussed in more depth in a separate article later in this series.
The Department of Health's (DH) (2005) Research Governance Framework outlines the need for quality research cultures within the NHS and lists the key elements as follows:
It is essential that each and every patient taking part in research is treated and managed in such a way as to maximise the quality and enjoyment of that experience. Whatever the motivator behind patients' decision to participate in research, each person should be managed with dignity, respect, and with the highest level of care delivered by a highly qualified workforce with effective and supportive leadership. Patients and families participating in research give up their time and bodies to developing the treatments and services of tomorrow. This can involve completing a simple questionnaire or taking part in complex trials involving early developmental phase medication—sometimes over a period of months (or even years). Researchers have performance matrices, benchmarks and targets, yet their main focus is (or should always be) on delivering the highest quality care.
It is suggested that embedding the vision and actions of the 6 Cs into research care and management would further enhance the quality of care. This could also further enhance research patients' experience while facilitating closer working relationships with the existing clinical teams within the different specialties. Partnership working varies greatly from specialty to specialty and from trust to trust. If we are ever to get to the point where research truly becomes a part of the NHS patient pathway, we need to continue to work closely with our clinical colleagues and there are a number of ways in which this can be done. Agreeing to present regularly at clinical governance or ward meetings is a great way of updating staff and involving them more closely in your work. Securing a research-dedicated board is an excellent communication method for both staff and patients. The production of a regular newsletter is also an effective communication method, particularly if circulated in paper and electronic formats.
It is also recommended that research teams have a direct link with senior clinical leaders. Research team leaders should enjoy the benefits of a research manager and clinical lead joint appraisal/review. In addition to keeping everyone informed of any updates, either within research or trust practices, formalised direct links facilitate further validated acceptance and attachment to the clinical team or directorate if this had previously been lacking. The 6 Cs were launched in 2012 to drive the Compassion in Practice vision with calls for every healthcare professional to implement them into practice (NHS Commissioning Board, 2013). The 6 Cs can be embedded into the world of clinical research so that research patients are afforded the same levels of compassionate care by all members of the research workforce and, indeed, to drive compassion in practice for the researchers themselves. It is suggested that this will result in high quality, compassionate personalised care for all and that the biggest voices will be those of the patients themselves.
Evaluation
Evaluation is a statement which appraises or adds value to something (Simpson et al, 1986). Evaluation is regularly paired with assessment which encompasses benchmarking and ranking; however, there are significant differences. Evaluation gives the learner the opportunity to think about the content, delivery and direction of training courses rather than a grade (Scriven, 1991; Phillips, 1997; Newble and Cannon, 2001). The Health and Care Professionals Council (HCPC) suggest that the use of operational evaluation and monitoring contributes to the creation of correct and current assessment standards (HCPC, 2009).
The NHS North West has an Education Governance (2008) which supports the development of the workforce and ‘real service improvement’ (NHS North West, 2008: 4). To achieve improvement, Education Governance (EG) needs to demonstrate commitment to the following four areas:
The benefits of having the EG include retention of staff, boosting staff morale and the promotion of team work at all levels of the organisation. This enables increased flexibility within the work force which in turn increases the quality of care, efficiency and patient safety.
The EG is NHS-wide and has strategic documentation for the North West of England. It is vital therefore that any education or training, non-clinical or clinical, delivered within the North West Ambulance Service NHS Trust (NWAS) is designed in line with EG.
To monitor NWAS engagement with the four areas of EG it is important to have accurate and robust information. An implementation of an evaluation process in all teaching and learning activities within NWAS is an effective way to do this. This enables a benchmark picture of the four areas in line with EG, allowing the education and training to be developed to build the weaker areas within the organisation (NHS North West, 2008). It enables data collection, reflection/analysis and the results interpreted for future planning and development of training. This creates a virtuous circle of improvement from the whole learning process and strengthens awareness, environment, leadership and empowerment, as everyone has an opportunity to feedback and improve.
The theory of evaluation
Certain theorists such as Pawson and Tilley (1997), Scriven (1991) and Rossi et al (2004) discuss evaluation as an enhancement of teaching and learning. Evaluation is not only a valuable source of gathering information but can also be used to improve the process in which the training is designed and implemented. Through participation in evaluation learners affect the decision process for the design and implementation of courses by providing insight as participants (Walden and Baxter, 2001).
Early theorists, Kirkpatrick and Kirkpatrick (1959), looked specifically at what can be evaluated in terms of teaching, learning, and their effectiveness within an organisation. Their original ideas remain today and inform the new NWAS evaluation process. Kirkpatrick and Kirkpatrick divide evaluation into four levels: reaction, retention, behaviour, and results.
Overall, the purpose at all levels is to evaluate the effectiveness of training and to use the results to evidence change and improvement which compliments EG.
The aim of the Mandatory Training team and Learning and Development teams is to develop focused learning specific to the needs highlighted through evaluation. The NWAS evaluation form at the moment only looks at the first of Kirkpatrick and Kirkpatrick's levels of evaluation. The form allows for collection of learners' regarding their reaction to the training or trainer; however, the tick box format is quite limiting.
The design of evaluative material is an essential, so the areas of evaluation and EG are identified and monitored to track improvements. This gives clear reasons to why the NWAS Learning and Development Team alongside the Mandatory Training Team have designed a new evaluation process on Kirkpatrick and Kirkpatrick's model and EG. This new process will empower every NWAS employee to add depth and value to all learning and training processes, and as a results we, as an innovative workforce, can improve future through education.