ESSEnCE: amalgamating marginal gains in ESSEntial Nursing CarE

South West PeninsulaGeneric Health Relevance
Start Date: 1 Feb 2016



Nursing care matters a great deal to patients and the public. Distress, unhappiness, and even injury or death can be a result of poor nursing care. In this project, PenCLAHRC researchers are supporting Medical School colleagues in the development of a new method of nursing that improves patients' experiences of nursing care.

This research will look to develop and test nursing methods that focus on communicating with patients, helping patients with eating and drinking, going to the toilet, moving around, and being clean and comfortable - the essentials of nursing care. This will be achieved using a process called the 'amalgamation of marginal gains'. Used very successfully in cycling and other sports, as well as other health care settings, this process has not yet been applied to nursing care.

The new system will help nurses to achieve small improvements in many areas with the combination ('amalgamation') leading to better quality care. For example, nurses must pay attention to how people communicate their care needs, what they drink, how they move around and when they go to the toilet. By making small improvements in all of these areas, patient experience and recovery could improve.

Project Aims and Objectives

The team have been awarded funding via an NIHR Programme Development Grant to carry out preliminary research to address three critical uncertainties:

  1. Understanding how to translate successful performance innovation in the form of ‘Amalgamation of Marginal Gains’ into nursing care.

  2. Synthesizing the existing evidence for essential nursing care behaviours.

  3. Strengthening the Patient and Public Involvement, clinical, methodological and stakeholder elements of the future Programme Grant.

Following on from this work, an application will be submitted to the NIHR Programme Grant for Applied Research in Autumn 2017. If successful, the team will use this award to develop and test a new nursing intervention that focuses on the essentials of nursing care. This will be tested in hospitals, and the feasibility of transferring the intervention to nursing/care homes will be investigated. Guidelines and training programmes will be developed for nurses in hospitals and care homes to improve and standardise the quality of care they provide.

Further information

Professor David Richards