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Acceptability and feasibility of using coproduction to develop an intervention for final year student nurses, to support retention in the transition to qualified practice

Brook, J. (2022). Acceptability and feasibility of using coproduction to develop an intervention for final year student nurses, to support retention in the transition to qualified practice. (Unpublished Doctoral thesis, City, University of London)

Abstract

The retention of nurses, particularly those in their first year of practice after qualification, is a global concern. The forecast deficit of nurses in the workforce over the forthcoming decade has the potential to impact on patient safety and patient experience.

The aim of this explanatory sequential, mixed methods, two-phase study was to explore the feasibility and acceptability of co-producing and implementing an intervention to increase retention of early career nurses. The study was conducted across a university and a large inner London hospital NHS Trust.

Initially two systematic reviews were conducted, to identify the components of interventions that have previously been shown to be successful at reducing turnover and increasing retention of early career nurses. Interventions implemented both prior to and after qualification were reviewed. Findings from these reviews indicated that beneficial interventions implemented during educational programmes included elements of preceptorship, exposed students to the reality of the clinical environment, and involved collaboration between the academic and clinical institutions. Consideration should be given to whether there is added value to implementing interventions during the undergraduate period if there are established and well-evaluated strategies already in place in the first few months following graduation. For interventions implemented in the post-graduation period, those incorporating internship/residency programmes and orientation/transition to practice programmes, lasting between 27- 52 weeks, with inclusion of a teaching and preceptor and mentor component had beneficial impacts on retention.

Phase 1 involved co-production of an intervention with early career nurses and student nurses and evaluation of the acceptability of the process. The co-produced intervention consisted of four additional days of interactive content to be delivered during the final year of the nursing programmes. Acceptability of the process was evaluated from the perspectives of the group members and facilitators using questionnaires, analysis of reflective facilitator field notes, and semi-structured interviews. The process was perceived as generally acceptable and increasingly acceptable over time. Participants developed transferrable communication skills, felt an increased sense of wellbeing, and enjoyed using the group as a reflective space. Facilitators were aware of navigating tensions between individual benefit and study outputs but recognised that they gained personally from engaging with the process.

Phase 2 aimed to implement the co-produced intervention and evaluate acceptability and feasibility to inform wider implementation. Seventy-four students participated, and academics were involved in the delivery of the intervention. Pre- and post- acceptability questionnaires, semi-structured interviews, focus groups and reflective field notes were analysed to explore acceptability and feasibility. The intervention was perceived as generally acceptable with significant positive increases in acceptability scores over time. Students perceived the intervention equipped them with skills and experience that offered enduring personal benefit. Pressures in the practice and academic environments presented challenges with attendance. The personal benefits that participants reported align with known protective factors against burnout and leaving the profession.

The systematic reviews and findings from both phases of the study offer new knowledge in relation to co-production across clinical and academic settings, and the design and implementation of interventions to increase retention of early career nurses. Wider implementation of the intervention requires planning to take account of differences in higher education and healthcare organisational culture, and the processes that would empower student and early career nurses to make informed career decisions.

Publication Type: Thesis (Doctoral)
Subjects: Q Science
R Medicine > RT Nursing
Departments: Doctoral Theses
Doctoral Theses > School of Health & Psychological Sciences Doctoral Theses
School of Health & Psychological Sciences > Nursing
[img] Text - Accepted Version
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