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A focus on innovation to boost national care standards

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VOL: 97, ISSUE: 39, PAGE NO: 32

Rhona Hotchkiss, RGN, is director of the Nursing and Midwifery Practice Development Unit, Edinburgh

The Nursing and Midwifery Practice Development Unit (NMPDU) aims to ensure that practice development happens in a planned and cohesive way throughout Scotland and that lessons learnt in one area are shared across the country.

The Nursing and Midwifery Practice Development Unit (NMPDU) aims to ensure that practice development happens in a planned and cohesive way throughout Scotland and that lessons learnt in one area are shared across the country.

It was set up in December 1999 and based on proposals for the NHS in Scotland set out in the white paper Designed To Care (Scottish Executive, 1997). The unit endeavours to ensure that:

- Good practice happens for good reasons;

- Innovative practice is not allowed to die of suffocation;

- The dos and don'ts of introducing good practice are shared;

- Master's degrees and PhD theses are used as something other than dust traps;

- Research and practice development get married and live happily ever after.

Why good practice does not happen
Health care is plagued by situations where good practice does not happen and this is because:

- Evidence can be rejected on a whim;

- Innovative practice is limited to its original site;

- Valuable lessons are not shared;

- A thousand theses a year (at least) have no impact whatsoever on practice;

- Despite monumental efforts over the past 10 years, research and practice are still separated by an ocean of deep suspicion.

A tangled mess of tradition, local politics, interpersonal conflict, skills deficit and lack of resources strangle innovative practice before it can grow to maturity (McIntosh, 1995; Carter, 1996). The situation is changing, but far too slowly.

Making the vital difference
There are several important milestones to be reached on the way to achieving a situation where patients receive comparably high standards of care wherever they live. We need:

- Agreement from directors of nursing that where there is evidence or consensus - which they must be party to - concerning best practice, it will be implemented locally;

- Tangible support from managers and other colleagues for nurses and midwives working to implement change in a culture where change can be blocked by those in positions of authority;

- Greater acceptance by the research establishment of the value of qualitative and quantitative research on quality-of-life issues;

- A shift in the research assessment exercise (RAE) culture (the means by which research funding is allocated to universities throughout the UK). Anecdotal evidence suggests that academic staff are encouraged to write for journals with a relatively low circulation because of their perceived academic merit. RAE points should be awarded for work that can or has improved practice - and not simply on the basis of being published in journals that are inaccessible to many nurses and midwives;

- Priority should be given to areas where nursing and midwifery research provides evidence of variations in practice that affect patient outcomes;

- Honesty around instances where the implementation of best practice has prohibitive resource issues, and an agreement on alternatives.

The NMPDU mission
The NMPDU wants to boldly go where lots of nurses and midwives have been before, find out what they have been doing and make sure everyone knows about it.

With 3.5 full-time staff, the unit's success depends on the support of nurses and midwives throughout Scotland. Projects progress via colleagues who attend the unit on short secondments to work on specific topics.

In 2000, the first full year of the unit's operation, it began working through a network of link nurses from every trust in Scotland, from every higher education institution offering courses of study related to nursing or midwifery and from related organisations such as the Nursing Research Initiative for Scotland. The unit enjoys the full support of the directors of nursing in Scotland who contribute to and support its work.

The work programme
The unit's programme is agreed in advance by a multidisciplinary steering group, chaired by the chief nursing officer. The latest strategy for nursing and midwifery in Scotland, Caring for Scotland (Scottish Executive, 2001), will also have a significant influence on the unit's work plan for the foreseeable future. Actions arising from the strategy that require the involvement of the NMPDU are outlined below. Some require the unit to take the lead, others are shared responsibilities and yet others require the unit's involvement under the leadership of another body or group.

The unit's contributions will include:

- Developing a network for carers and professionals who care for children and their families in the community (Box 1);

- Establishing a model for networking to develop, disseminate and implement best practice in the care of older people (Box 2);

- Exploring existing good and innovative practice in the care of people with chronic diseases or those with enduring mental health problems, identifying research priorities and organising a consensus conference on implementing best practice;

- Providing definitions of core competencies for nurses working in A&E

- Identifying examples of how nurse prescribing can or could enhance patient care;

- Examining innovative practice developments in Scotland and making recommendations about implementation of new and expanded roles;

- Identifying good models of support for newly qualified practitioners;

- Identifying current work in relation to ensuring that competency-based frameworks underpin key roles in nursing and midwifery;

- Investigating career pathways that encourage and facilitate development and flexibility;

- Examining, reporting on and subsequently producing a nursing and midwifery research strategy for Scotland.

Additional projects
The NMPDU is also committed to working on:

- A database of role and practice developments, including information of the 'things you would tell your best friend if they were going to do this' variety;

- A quarterly newsletter about the work of the unit;

- Simplifying job titles in nursing and midwifery to ensure they mean the same thing to staff and patients around the country, and ensuring the title, responsibility and salary of any job are consistent;

- Developing best practice statements for nursing and midwifery, working on the principle of applying evidence where it exists, developing consensus where it does not and identifying areas where research is needed;

- Compiling guidelines for nurses doing hospital admissions regarding the assessment of patients with an acute mental health problem;

- Investigating the networking and practice-sharing needs of specialist cancer nurses;

- Running development-related courses for nurses and midwives with the RCN and RCM.

The unit has ongoing funding and a remit to develop productive working relationships with other national bodies, including the Nursing Research Initiative for Scotland, the forthcoming successor to the National Board, the Clinical Standards Board for Scotland and the Scottish Health Advisory Service.

- To comment on any aspect of the unit's work, go to: www.nmpdu.org

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