Confidence

Seven out of the eleven staff interviewed from the PHT 2004 cohort commented that their confidence had been positively affected by the training they received (this represented each of the training interventions as well). Staff cited

improvements in confidence in the following areas: dealing with patients, trouble shooting and identifying problems, approaching (or standing up to) doctors and other interdisciplinary team members and advising junior staff. One member of staff stated that she had always experienced a lack of confidence, but that her training (Autonomous Health Care Practice) had reversed this and given her a new authority, along with her new role:

“Definitely, because my confidence has always been a problem anyway, but since I’ve done this course, at first I didn’t think I could do it, because there is so much hard work to do, but definitely, I’ve more confidence, when I speak to people I’ve got authority which is quite nice. It has helped a lot.” PHT 2004 Staff Interview 6

One staff member stated that her confidence was high already, so had not necessarily been affected by the intervention.

Managers of this cohort (4 managers of Fast Track students and one manager of

Autonomous Health Care Practice student), all commented on the improved confidence of their staff members.

In four out of the five cases managers also commented that this increase in confidence had led to staff taking a more pro-active role in patient care by being willing to negotiate with doctors and put forward their own views/make decisions.

“I think it is a lot of the confidence, whereas I think before they might have stood back slightly, I think now they are more into working with the doctors and the sick patients and will actually give their reasons and will have the knowledge to back up their reasons, so that they can be a better practitioner.” PHT 2004 Manager Interview 2 (Fast Track)

“You really see people blossom into these really confident sort of people that are making really quite complex decisions and that’s one of the biggest things you’ll find. People that have gone through the course, it’s their confidence and their professionalism and they’re changing their practice.” PHT 2004 Manager Interview 3 (Autonomous Health Care Practice)

Just under three quarters of the PHT 2005 Fast Track cohort (11/16), expressed that they felt more confident to deal with critically ill patients as a result of the Hotspots programme. Increased knowledge and skills that they had acquired allowed them to feel more in control and confident in their own abilities.

“I think I’m just more confident in my ability to be able to manage somebody that’s unwell.” PHT 2005 Staff Interview 9

Nurses linked this increase in confidence to particular improvements in their nursing practice, including:

Acting more quickly as a result of greater self belief:

“It’s just having confidence in your knowledge and your understanding to be able to act quicker than you possibly would have done before. It takes away the hesitancy.” PHT 2005 Staff Interview 13

A calmer, more systematic and potentially safer approach to deteriorating patients:

“And before it would be sort of panic, panic, panic. But actually you’re saying ok, he’s going downhill. Gathering the information (right) and being able to articulate that to the right people (OK) and I think that’s just come out of confidence. Where I’d be sort of thinking, oh my God (Yes), he’s going off, what do I do?” PHT 2005 Staff Interview 15

The ability to approach and negotiate with doctors to get the best patient care: “I think it’s made me a little more confident in challenging other people and challenging doctors and not being afraid to you know, say what I think, as opposed to, you know, just being the nurse in the background” PHT 2005 Staff Interview 10

Others claimed an increase in confidence to advise junior staff and deal with patients’ relatives.

Some interviewees gave examples of situations in which they have acted more confidently as a result of their training, such as giving oxygen to someone with Chronic Obstructive Pulmonary Disease (COPD).

A number of the managers of this cohort re-iterated the views of their staff. Managers reported an increase in self-belief making staff more willing to deal with more complex patients, take on more responsibility, teach others or become more assertive.

SUHT

There was a lower proportion of staff mentioning an increase in confidence amongst the SUHT 2004 cohort. Just over half of the 2005 cohort commented that they felt more confident as a result of the Acuity Programme. As with the Portsmouth cohort, the chance to refresh existing knowledge and gain new skills gave the nurses a stronger sense of self-belief and confidence in their own actions.

“A lot of what we did on the course, we had a basic knowledge of and obviously with the input from the course, the knowledge level has increased which gives you more confidence...” SUHT 2005 Staff Interview 8

Areas in which staff found this particularly beneficial were in obtaining doctors’ attention for patients and in teaching and supporting junior colleagues.

“I think for me personally, what I’d expected to come out with is a lot of confidence to know what I’m talking about to staff, so that has really, so I’ve taken on a bigger role in the lead of the acute care on the wards.” SUHT 2005 Staff Interview 7

All of the SUHT 2005 managers felt that their staff had grown in confidence as a result of their training. Managers perceived that staff were more confident and competent to deal with acute patients, taking the lead where perhaps they would not have done so previously. An increased confidence to approach medical staff was also commented on:

“What has come across to me quite strongly is, is their confidence in seeking senior support from the clinicians – medical staff, is their ability to articulate what the need is, in a way that a medic would not dismiss.” SUHT 2005 Manager Interview 4