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Sarah Field Richards

Research Fellow, Faculty of Medicine & Health Sciences

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Biography

Prior to registration as a nurse, I worked for six years as a Health Care Assistant in the specialties of healthcare of older people, palliative care and dementia. I also worked as a Support Worker in the area of mental health, challenging behaviour and learning disabilities.

I graduated from the Master of Nursing Science awarded by the University of Nottingham in 2009, following which I worked in clinical practice as a Staff Nurse and held several practice development and quality improvement roles. After working as a Research Associate on a National Institute for Health Research grant-funded study, I commenced PhD studies in 2011 after securing a Studentship with the School of Health Sciences and Nottingham University Business School. Alongside my Doctoral studies, I currently work as a Research Fellow on a national Department of Health funded study, which aims to explore the impact of prior care experience upon student nurses' caring and compassionate values, attitudes and behaviours.

My current research interests surround sociological and anthropological perspectives as applied to nursing identity, education, knowledge, theory and philosophy, conceptualisations of compassion and caring following the Francis Report, and the nursing professional project, status of knowledge, power and identity construction in the context of organisational innovation and change management. My doctoral thesis aims to explore the lived reality and meaning of a management philosophy called Lean Thinking, for nurses and nursing at a University Hospitals NHS Trust.

I teach students at Undergraduate, Master's and Doctoral level, within the School of Health Sciences in areas including clinical skills, qualitative research methodology and philosophy, evidence-based practice and person-centred care. I work collaboratively with Nottingham University Hospitals NHS Trust to develop capacity and capability with regards to nursing research and the foundation of clinical-academic nursing careers, at a strategic level.

Expertise Summary

Qualifications

Master of Nursing Science (MNurSci Hons)

Registered Nurse (Adult)

Level 2 Award in Understanding Health Improvement. Royal Society for Public Health.

Certificate in Infection Control. People's College Nottingham.

Working with Older People. National Open College Network.

Intensive Learning and Teaching Programme. University of Nottingham.

Good Clinical Practice Certification. University of Nottingham.

Professional Awards

2001 Boots Science Award

2007 School of Nursing Academic Award

2014 Dean Moore Postgraduate Endowed Scholarship Award

Professional memberships

Local

Chair of local Patient Participation Group

Nursing and Midwifery Research Strategy Group

Clinical Academic Careers Task and Finish Group

Centre for Health Innovation, Leadership and Learning

Compassion in Care Strategy and Advisory Group

National/international

Nursing and Midwifery Council

Royal College of Nursing

British Sociological Association

European Sociological Association

European Association of Palliative Care

Funding secured

2010 Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care. Full funding associated with European Association of Palliative Care conference presentation.

2011-2014 PhD Studentship. School of Health Sciences, Nottingham University Business School

2014 Co-applicant on successful grant application to the Department of Health Policy Research Programme. Evaluation of the Impact of Care Experience Prior to Undertaking NHS Funded Education and Training.

Conference presentations

Local

Field-Richards, S.E. (2012). Negotiating the boundary between Paid and Unpaid Hospice Workers: A Qualitative Study of how Hospice Volunteers Understand their Work. Nottingham University Hospitals NHS Trust 2nd Engage, Empower, Enthuse Conference.

Field-Richards, S.E., Timmons, S. (2013). Getting to grips with the basics of research; qualitative research, examples and approaches. Nottingham University Hospitals NHS Trust 3rd Engage, Empower, Enthuse Conference. Workshop.

Field-Richards, S.E. (2014). The Trust-Nurse Game in the context of organisational change. Nottingham University Hospitals NHS Trust Nursing and Midwifery Research Strategy Group. Seminar presentation.

Field-Richards, S.E. (2015). Changing professionalism; new directions in the 'New NHS'. Theorising the professional (identity) project of nursing the context of Lean. Nottingham University Business School 'CHILL' Research Centre (Centre for Health Innovation, Leadership and Learning). Invited speaker seminar presentation.

National

Field-Richards, S.E. (2013). 'Lean on me; nurses' emotional work and labour in Lean times'. British Sociological Association Medical Sociology Annual Conference, York.

Timmons, S., Field-Richards, S.E. (2012). A technical solution to a sociological problem? Predicting mortality post-cardiac arrest. Oral presentation at British Sociological Association Medical Sociology Annual Conference, York.

Field-Richards, S.E., Lymn, J. (2015). The impact of care experience prior to NHS funded education and training. Pre-Nursing Degree Care Symposium. Royal College of Nursing, London. Invited speaker.

International

Field-Richards, S.E. (2010). Negotiating the boundary between paid and unpaid hospice workers: a qualitative study of how hospice volunteers understand their work. 6th Research Congress of the European Association for Palliative Care, Glasgow.

Field-Richards, S.E. (2013). 'Lost amidst Lean? A critical analysis of the implications of crisis-driven change for the profession of nursing'. 11th conference of the European Sociological Association 'Crisis, Critique and Change', Turin, Italy.

Field-Richards, S.E. (2014). The Trust-Nurse Game in the context of organisational change. 8th International Conference on Healthcare Systems and Global Business Issues. Grantham. (Invited speaker and expert panel member).

Field-Richards, S.E., Andrews, S., Callaghan, P., Keeley, P., Redsell, S., Spiby, H., Stacey, G., Lymn, J. (2016). Care experience prior to entry into undergraduate nursing degrees: the recommendation, rhetoric and reality. Royal College of Nursing International Research Conference. Edinburgh.

Field-Richards, S.E., Andrews, S., Callaghan, P., Keeley, P., Redsell, S., Spiby, H., Stacey, G., Lymn, J. (2016). Help, hindrance or indifference? The impact of care experience prior to commencing nurse training, on caring and compassionate practice. Royal College of Nursing International Research Conference. Edinburgh.

Teaching Summary

I teach students at Undergraduate, Master's and Doctoral level, within the School of Health Sciences in areas including clinical skills, qualitative research methodology and philosophy,… read more

Research Summary

1. Title of research: Evaluation of the impact of care experience prior to undertaking NHS funded education and training.

Researchers: Professor Joanne Lymn (PI), Sarah Field-Richards (Research Fellow), Professors Patrick Callaghan, Helen Spiby, Sarah Redsell, Sharon Andrew, Philip Keeley, Dr Gemma Stacey.

Project completion date: March 2019

Introduction: The quality of nursing care in England has recently come under increased scrutiny following the identification of failings in care by the Mid Staffordshire inquiry. Findings included shortcomings in nurses' standards of care, values, attitudes, and emphasised the need for an NHS culture which prioritises and values compassion. With regard to pre-registration nursing, it recommended that individuals undertake Health Care Assistant (HCA) training and experience before commencing a nursing degree.

In 2013 the Department of Health introduced a pilot programme providing individuals intending to study nursing, with hands-on care experience in NHS Trusts, prior to commencing their training. It was envisaged that students would acquire real-life experience and first-hand knowledge of the reality and entailments of healthcare before commencing their course. This also provided employing healthcare organisations with opportunities to ensure that prospective students possessed appropriate caring values and behaviours, before commencing study. There is little evidence however, to suggest that the Government's response will adequately address concerns highlighted, or otherwise. Nor is there evidence to suggest which particular model of prior care experience might be most efficacious in terms of developing the skills, values and behaviours conducive to the provision of compassionate care. This DH-funded study aims to systematically investigate the effect of care experience prior to entering nurse training, upon nursing students' caring skills, values and behaviours.

Aims: To evaluate the impact of care experience prior to undertaking NHS funded education and training, on pre-registration nursing students' skills, values and behaviours, and service users' experiences of care.

Objectives: 1. To investigate the effect of prior experience of care on pre-registration students' caring approach. 2. To determine the longer-term benefit to students upon qualification of formal paid prior experience of care. 3. To identify if, and how, the values and behaviours that students learn during prior care experience are sustained throughout their education and training. 4. To elucidate which model of prior care experience best enhances the newly qualified workforces' caring and compassionate behaviours.

Methodology: Longitudinal study incorporating convergent parallel mixed-methods design. Methods include a systematic search and critical review of published evidence surrounding the impact of prior care experience. The caring and compassionate skills, values and behaviours of students who participated in the DH pilot project, will be compared with three other cohorts of students who did not participate in the pilot, at various intervals over a four year period. Participants will complete questionnaires designed as proxy measures of the 6C's, participate in focus groups and their University academic records will be analysed. The influence of educational attainment and empowerment upon the development of caring skills, values and behaviours, and the influence of a compassion-focussed clinical supervision model, will be explored. Finally, patients' experiences of care received from participants and student-patient interactions will be analysed.

Findings: The findings of the research will inform and advise policy makers, the NHS, clinicians and educators about the effect and value of prior care experience on student nurses' skills, values and caring behaviours. It will help to identify the best model of providing this experience to individuals wishing to train as nurses, so that they can then deliver high quality, compassionate care to patients upon graduation and beyond. Evidence of this nature has the potential to improve quality of care, patient safety and ensure that services meet patient need and regulatory standards, providing reassurance to the public regarding nursing practice. The study has the potential to significantly influence decisions surrounding future nurse education and the quality of patient care.

2. Title of Doctoral thesis: The lived reality and meaning of Lean thinking for nursing and nurses working at a University Hospitals NHS Trust.

Supervisors: Dr Stephen Timmons (School of Health Sciences), Dr Hannah Noke (Nottingham University Business School)

Projected thesis completion date: September 2015

Introduction: Lean thinking (Lean) is a process improvement methodology originating from the Toyota automobile manufacturing company in Japan. Through the critical examination of processes involved in the production of goods and removal of steps which do not add value to the customer, it is suggested that Lean increases the efficiency of production. Since 2001, Lean has been increasingly adopted within the British National Health Service (NHS) as a panacea for addressing the financial, quality and safety challenges that threaten its sustainability.

Literature review: Lean implementation in healthcare has tended to be limited to operational 'tool-based' application which neglects underlying Lean philosophy, despite cautions surrounding this approach. Owing to the poor empirical quality of literature surrounding the anticipated outcomes of Lean applications, the extent to which it is meeting its propositions to improve healthcare is uncertain. Implementation in the NHS continues regardless however and literature is suggestive of implications beyond improving efficiency; Lean is profoundly affecting the way in which healthcare is physically and socially structured, organised and delivered. There is a dearth of research which considers the implications and consequences of these changes for front-line healthcare staff, especially from a cultural perspective. As the largest professional group in healthcare, nurses play a critical role in improving efficiency and successful Lean implementation. They are disproportionately affected by Lean-driven changes, which may hold specific implications and consequences for the profession of nursing. Nurses' perspectives however remain unexplored and research considering the way in which Lean and nursing culture interact is absent.

Research aims and objectives: This study aims to explore the lived reality and meaning of Lean thinking for nursing and nurses working in three settings at a University Hospitals NHS Trust. The objective of research is to address the research question: How does Lean interact with nursing as a practical, socio-cultural, theoretical, philosophical entity and phenomenon?

Methodology: Philosophical 'hues, tones and textures' of interpretivism, hermeneutics, social constructionism and feminism underpin the study which adopts an ethnographic methodological approach, and the methods of participant observation and semi-structured interview. Three purposively sampled clinical areas; palliative care, neurosciences and oncology, form the study setting as areas which form 'uncommon' examples of Lean application, and Registered Nurses, the participants.

Conclusion: It is suggested that any Lean-driven efficiency, quality and safety gains must be balanced with any implications for nurses and nursing, which long-term, may also affect patient care. In order to assess whether Lean is feasible and desirable in healthcare, research which considers the cultural interaction between Lean and nursing, and the associated implications for nursing policy, practice, theory, philosophy and pre- and post- registration education is imperative. It is anticipated that the findings of this research will provide a critical commentary surrounding, and critique to affect, change whilst providing the opportunity to conceptually and empirically explore themes of professional identity, collectivity and culture, boundary work and the division of labour, negotiations of professional power, role and status, meaning/sense-making and provide a contemporary insight into the changing nature of professional knowledge and work in the context of organisational change. In this way, findings hold particular relevance for literatures and understanding surrounding the sociology of professions and organisations, business management of innovation and organisational change, theoretical and practical understandings of Lean in healthcare, and anthropological understandings of healthcare cultures.

I teach students at Undergraduate, Master's and Doctoral level, within the School of Health Sciences in areas including clinical skills, qualitative research methodology and philosophy, evidence-based practice and person-centred care. I have completed the Intensive Teaching and Learning Programme (ILTP), leading to the Associate Teachers' Programme (ATP) accreditation with the Higher Education Academy (Associate Fellow of the Higher Education Academy).

Current supervision: Carmel Bond, Master's dissertation. Discourse analysis of online responses to media reporting following the Francis report's recommendations of the prerequisite for care experience prior to nurse training, at the lay-professional interface

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