Public and Stakeholder Engagement & Consensus

Background

As a crosscutting aspect of the work, we wanted to ensure public and stakeholder engagement in the work of the SRA.  We envisaged and actioned this as a two-way process whereby we utilised public and stakeholder opinion to develop the work in the SRA programmes and then disseminated and sense checked the evidence developed from the programmes back with them.

Design

We incorporated appropriate stakeholder engagement in all the work streams. In terms of public engagement, we established links with local charities and Trust PPI groups in year one. We then held an interactive event with these groups in year three to feed back early findings and take soundings and suggestions for the future direction of the work streams. However, the bulk of the public engagement work came through a Consensus Development Project (CDP), an approach one of our senior team members had previous experience of.

CDP methods draw on the views of interested citizens, experts and other stakeholders to debate, discuss, seek clarity and reach consensus on issues of importance. The five stages we followed were: Develop questions; Generate evidence reviews; Recruit and orientate lay panel; Host consensus seminars; Panel member feedback and consultation.

Developing the questions involved evidence and policy reviews on the current challenges in adult nursing and engagement with key stakeholders (including our Advisory Group, our RCN Working Group colleagues, and the Professional Nursing Committee of the RCN). This ran alongside our engaging with the local (to South Yorkshire) PPI groups established in year one. These groups were representative of patients and carers living with a range of conditions and impairments (palliative and end of life care, mental ill health, learning disabilities, memory loss, and dementia). This process proposed five questions relating to “current challenges in adult nursing”:

• What are the best ways of informing and engaging the public about nursing?

• What is the impact of “missed nursing care” or “care not done” on adults in health care?

• What are the essential elements required for safe and effective nursing care provision for adults?

• What are the inhibitors and facilitators to practice person and relationship centred nursing care?

• How can nursing Continuing Professional Development best influence quality of care for patients?

The next stage involved us seeking out international experts in these topic areas and asking them to produce contemporary evidence-based reports for their specific topic area. The third stage involved our sharing full length and summary versions of these reports with eleven lay panel members selected to be representative of people with different perspectives and experiences and of mixed age, gender, occupation, ethnicity and with geographical spread across the UK. Consensus seminars for each of the five topic areas were then established where the lay panel interacted with the topic experts to discuss and debate each topic. We facilitated this process and ensured it was chaired by an experienced public engagement professor. This resulted in written feedback and recommendations from the lay panel which was further refined through an iterative process between UoS academics and the lay panel. The final stage of engagement involved sharing the summary consensus statements and recommendations with key stakeholders.

Key lessons learnt and final consensus statements

This process of stakeholder and public engagement allowed for a period of prolonged engagement with appropriate stakeholders and a diverse group of lay representatives. We not only harnessed their input into important contemporary issues in nursing but also benefited from their enthusiastic engagement in supporting the direction of the work stream programmes, practical support in areas such as recruitment to studies, and ensuring a lay voice. The final consensus statements are as followed. The details of the expert reviews were published in a special issue of Nursing Open (see publications below)

Key messages Topic 1: What are the inhibitors and facilitators to practicing person and relationship centred nursing care?

Organisational efforts should be made in enabling nurses to build therapeutic relationships with people and families, in order to promote health or best facilitate good outcomes in care. Good ‘person-centred’ or ‘relationship-centred’ care requires skills and competencies, and these should be nurtured. It should be recognised that the care of the person, family and support of the nurse and wider healthcare team is important when maintaining an effective care environment.

Key messages Topic 2: What is the impact of missed care or ‘care left undone’ on adults in healthcare?

Nursing requires the application of a complex range of skills at all levels of patient care. There is evidence that organisational pressures result in some aspects of care being missed and patient outcomes affected. There needs to be a heightened understanding in policy making circles of the causes, implications and reporting of missed nursing care. People, families and communities should be empowered to speak out where this occurs.

Key messages Topic 3: What staffing levels are required for safe and effective nursing care provision for adults?

The nursing workforce has a pivotal role in the delivery of safe and effective care. Each care environment places its own unique demands upon the nursing team. Safe and effective staffing levels should consider the impact on providing holistic and person-centred nursing care as well as on a range of other outcomes for people, families and the workforce. There is a need for more evidence on safe staffing across different care settings.

Key messages Topic 4: How can nursing Continuing Professional Development (CPD) best influence the quality of health and social care for/with people and communities?

Effort and investment are needed to ensure nurses have access to CPD as a professional right. A supportive organisational culture with strong leadership and improved coordination between care environments, universities and clinical practice is critical to enable reflective practice, lifelong learning and confidence in raising concerns.

Key messages Topic 5: What are the best ways of informing and engaging the public about nursing?

It should be acknowledged that the public perception of nursing may be limited and often does not take the broad range of professional roles and skills into account. We encourage more positive messaging in helping to promote a realistic understanding of the role that the profession plays in terms of leadership and management of patient and population health. 

Publications

Taylor, B. Robertson, S. Ryan, T. (2021) Editorial: Intelligent effort: Involving citizens in planning for quality in nursing. Nursing Open 9(2): 860-861 https://doi.org/10.1002/nop2.1157

Willis, E., Brady., C. (2021) The impact of ‘missed nursing care’ or ‘care not done’ on adults in healthcare: a rapid review for the Consensus Development Project. Nursing Open 9(2): 862-871 https://doi.org/10.1002/nop2.942

Jackson, C., & Manley, K., (2021) Nursing CPD: Time to change the model to focus on health and care system transformation to meet citizen needs. Nursing Open. 9(2): 880-891 https://doi.org/10.1002/nop2.941

Taylor, B., South, J.,Ryan T., Wood, E., King, R., Senek, M., Tod, A. & Robertson S. (2021) Addressing Current Challenges in Adult Nursing: Describing a virtual consensus development project methodology. Nursing Open 9(2): 900-907 https://doi.org/10.1002/nop2.1072

Ball, J. E., & Griffiths, P. (2021). Consensus Development Project (CDP): An overview of staffing for safe and effective nursing care. Nursing Open. 9(2): 872-879 https://doi.org/10.1002/nop2.989 

Ryan, T. (2021) Facilitators of person and Relationship-Centred Care in Nursing. Nursing Open 9(2): 892-899 https://doi.org/10.1002/nop2.1083