what facilitates/hinders heart failure specialist nurses when

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

JMB/RCBC/Jan 2011-2012

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


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.


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


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


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


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


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,


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?”


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.


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.


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


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


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.


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.


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


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.


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)


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


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.


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)


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)


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.


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.

what facilitates/hinders heart failure specialist nurses when

Documents