Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study

AIMS AND OBJECTIVES: To explore hospice, acute care and nursing home nurses' experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.

BACKGROUND: Pain management in end-stage dementia is a fundamental aspect of end of life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.

DESIGN: A qualitative study using semi-structured interviews and thematic analysis to examine data.

METHODS: 24 registered nurses caring for people dying with advanced dementia were recruited from ten nursing homes, three hospices, and two acute hospitals across a region of the United Kingdom. Interviews were conducted between June 2014 and September 2015.

RESULTS: Three core themes were identified: challenges administering analgesia, the nurse-physician relationship, and interactive learning and practice development. Patient-related challenges to pain management were universal across care settings; nurse- and organisation-related barriers differed between settings. A need for interactive learning and practice development, particularly in pharmacology, was identified.

CONCLUSIONS: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.

RELEVANCE TO CLINICAL PRACTICE: Nurses considered pain management fundamental to end of life care provision; however, nurses working in acute care and nursing home settings may be under-supported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology. This article is protected by copyright. All rights reserved.

The potential contributions of concept maps for learning website to assessment for learning practices

The purpose of this paper is to examine the promising contributions of the Concept Maps for Learning (CMfL) website to assessment for learning practices. The CMfL website generates concept maps from relatedness degree of concepts pairs through the Pathfinder Scaling Algorithm. This website also confirms the established principles of effective assessment for learning, for it is capable of automatically assessing students' higher order knowledge, simultaneously identifying strengths and weaknesses, immediately providing useful feedback and being user-friendly. According to the default assessment plan, students first create concept maps on a particular subject and then they are given individualized visual feedback followed by associated instructional material (e.g., videos, website links, examples, problems, etc.) based on a comparison of their concept map and a subject matter expert's map. After studying the feedback and instructional material, teachers can monitor their students' progress by having them create revised concept maps. Therefore, we claim that the CMfL website may reduce the workload of teachers as well as provide immediate and delayed feedback on the weaknesses of students in different forms such as graphical and multimedia. For the following study, we will examine whether these promising contributions to assessment for learning are valid in a variety of subjects.

Addressing the theory practice gap in nurse education: evaluating teaching through audit against NMC standards and final management placement

Introduction
This paper outlines an innovative approach to auditing and evaluating the content of a management and leadership module for undergraduate nursing students after their final management clinical placement. Normally evaluations of teaching in a module take place at the end of a teaching module and therefore do not properly reflect the value of the teaching in relation to practical clinical experience.
Aim
This audit and evaluation sought to explore both the practical value of the teaching and learning, and also the degree to which it the teaching reflected against the NMC Standards of Education and Learning (2010 domain 3).
Methods
Having piloted the evaluative tool with an earlier cohort of nursing students, this evaluation explored both a quantitative assessment employing a Personal Response System (n =172), together with a qualitative dimension (n=116), thus delivering paper-based comments and reflections from students on the value and practicality of the module teaching theory to their final clinical management experience. The quantitative audit data were analysed for frequencies and cross tabulation and the qualitative audit data were thematically analysed.
Results
Results suggest a significant proportion of the students, appreciated the quality of the standard of teaching, but more importantly, ‘valued or highly valued’ the teaching and learning in relation to how it helped to significantly inform their management placement experience. A smaller proportion of the students underlined limitations and areas in which further improvement can be made in teaching and learning to the module.
Conclusion
Significantly positive evaluation by the students of the practical value of teaching and learning, to the theoretical management module. This has proved a useful auditing approach in assessing the theoretical teaching to student’s Level 3 clinical experience, and facilitated significant recommendations as far as developing the teaching and learning to better reflect the practice needs of nursing students

HRM and Innovation: A Multi-level Organizational Learning Perspective

Drawing on the 4I organizational learning framework (Crossan et al., 1999), this article develops a model to explain the multi-level and cross-level relationships between HRM practices and innovation. Individual, team, and organizational level learning stocks are theorized to explain how HRM practices affect innovation at a given level. Feed-forward and feedback learning flows explain how cross-level effects of HRM practices on innovation take place. In addition, we propose that HRM practices fostering individual, team, and organizational level learning should form a coherent system to facilitate the emergence of innovation. The article is concluded with discussions on its contributions and potential future research directions.