VOL: 98, ISSUE: 07, PAGE NO: 38
Irene Schofield, MSc, RGN, RNT, is research fellow in gerontological nursing Glasgow Caledonian University
Nicky Andrew, MN, RNT, RN, is project leader, gerontological nursing demonstration project, Glasgow Caledonian University;Debbie Tolson, PhD, MSc, BSc, RGN, is professor of gerontological nursing, Glasgow Caledonian University;Rhona Hotchkiss, RGN, is director, NMPDU, Edinburgh; Angela Kydd, MSc, PGCE, RGN, RMN, is senior lecturer, University of PaisleyThe need to improve the quality of services for older people and promote best practice is well established (Scottish Executive, 2001a), and nurses have an important role to play.
The need to improve the quality of services for older people and promote best practice is well established (Scottish Executive, 2001a), and nurses have an important role to play.
To bring about change that is meaningful to nurses, a coherent and credible practice development agenda is required. This needs to focus firmly on evidence-based practice. Although it is easy to subscribe to the principle of evidence-based practice, Marsh (2000) reminds us that to achieve it 'requires appraising and integrating available information from multiple sources and then planning and providing patient care based on the best available evidence'.
Gathering and then implementing evidence-based practice is a time-consuming activity that demands a range of skills, including critical appraisal and the synthesis of knowledge, practice expertise and change leadership. It is not something to be undertaken by one or two committed nurses; rather it is the responsibility of the organisation and profession as a whole. Furthermore, experience demonstrates that evidence-based practice will only be accepted by nurses if it reflects their beliefs about care (Foundation of Nursing Studies, 2001).
The web-based practice development project in gerontological nursing described in this article has been devised to meet these challenges.
Policy into practice
The Scottish Executive (2001b) has a clear policy regarding the collection and distribution of best practice. Scotland's Nursing and Midwifery Practice Development Unit (NMPDU) is expected to work with NHS boards, education providers, the Scottish Health Advisory Service and the Scottish Executive Health Department to establish a model of networking that will develop, disseminate and implement best practice in the care of older people.
The executive (2001b) also states that the NMPDU will 'develop a model to demonstrate best practice in care of older people in four clinical areas, complementing the work of the Scottish Health Advisory Service and the Clinical Standards Board for Scotland from 2001-2003'.
Our web-based gerontological nursing demonstration project capitalises on this political and professional intent. It is a collaborative project, led by Glasgow Caledonian University, the University of Paisley and the NMPDU, and is supported by the Queen's Nursing Institute, Scotland, and the Foundation of Nursing Studies. The project's aims are:
- To enable nurses working with older people in Scotland to embrace and acquire the principles of gerontological nursing;
- To facilitate access to, and attainment of, evidence-based practice;
- To facilitate professional networking and encourage practice development.
We felt that establishing a virtual community would overcome the professional isolation that can exist in Scotland because the population is spread over a wide area. It was proposed that, initially, about 30 link nurses would be recruited throughout Scotland. These are experienced nurses who work with older people in a variety of settings including acute hospitals, community hospitals and nursing homes.
They were recruited by distributing information about the project to directors of nursing in both the NHS and the independent sector and through advertisements in the nursing press.
The web-based system mirrors the layout of an actual college building (see Fig 1, for an example) and uses easily identifiable areas such as the reception, common room and library. It is hoped that the use of familiar terminology will encourage link nurses and other nominated people to make full use of the virtual college community.
To 'humanise' the virtual college, users can see photographs of other link nurses and project staff who are visiting the site at the same time. The aim is to enable nurses with a shared interest in enhancing the care of older people to communicate regularly with each other.
A collaborative approach
The project's steering group includes experts from several disciplines and organisations for older people, including Help the Aged and Age Concern.
The virtual college pools the expertise of policy-makers with that of practitioners, older people and academics, enabling each group to contribute its skills to promoting evidence-based practice. The policy-makers explain the strategic mission and provide central support; practitioners bring expert knowledge and applied know-how.
The views of older people are embraced and academics contribute objective critical analysis to underpin the synthesis of knowledge. Through collaborative working and debate, the project aims to create an efficient forum for teasing out and describing desirable best practice.
Definition and principles of care
A first step for the project was formulating a definition of gerontological nursing and a set of principles that underpin contemporary health care practice with older people. However, the definition and principles are not intended to be static.
It is essential that the link nurses share the philosophy that underpins the definition and principles of care, and agree that they can be achieved in practice.
Following the initial training days, one of the first tasks for link nurses when they return to their work base is to log on to the virtual college site and download the definition and principles.
The aim is to encourage them to share the definition and principles with colleagues, and gain their feedback, before engaging in a virtual discussion on any changes or refinements.
It is hoped that this will also help link nurses to gain confidence in using the web-based system and ensure that the definition and principles can be embraced by all those engaged in the project.
One of the major roles for the link nurses will be to contribute to the development and dissemination of best practice at demonstration sites. Each demonstration site will focus on a specific area of practice development.
The first area to be addressed is nutrition, reflecting concerns emerging from major national surveys that many older people in a range of settings are undernourished (Clinical Resource and Audit Group, 2000; Association of Community Health Councils for England and Wales, 1997). It is anticipated that link nurses, stakeholders and steering group members will identify and agree additional areas for practice development.
The demonstration site for the nutrition project is a community hospital within a semi-rural area, considered typical of others within Scotland. The on-site project team benefits from the expertise of a recently appointed nurse consultant for services for older people and a part-time project worker.
We hope to develop evidence-based best practice statements on the nutritional needs of older people.
The gerontological nursing demonstration project is a pioneering initiative intended to create an infrastructure for web-based learning and teaching, and to promote the collection of evidence-based gerontological practice. However, the exciting combination of a virtual web-based college and the challenges of practice development in the real world have yet to prove their worth in terms of enhancing care. Before this concept can be rolled out to other areas of nursing, its effectiveness will need to be carefully evaluated.