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Aim: To explore how nurses working in general practice experienced remote and technology-mediated working during the COVID-19 pandemic. Design: Exploratory qualitative study with nursing team members working in general practices in England and national nurse leaders. Methods: Data were collected between April and August 2022. Forty participants took part in either semi-structured interviews or focus groups. Data were analysed using Framework Analysis informed by the PERCS (Planning and Evaluating Remote Consultation Services) Framework. University of York ethics approval [HSRGC/2021/458/I] and Health Research Authority approval were obtained [IRAS:30353. Protocol number: R23982. Ref 21/HRA/5132. CPMS: 51834]. The study was funded by The General Nursing Council for England and Wales Trust. Results: Participants continued to deliver a significant proportion of patient care inperson. However, remote and technology-mediated care could meet patients' needs and broaden access in some circumstances. When remote and technology-mediated working were used this was often part of a blended model which was expected to continue. This could support some workforce issues, but also increase workload. Participants did not always have access to remote technology and were not involved in decision-making about what was used and how this was implemented. They rarely used video consultations, which were not seen to add value in comparison to telephone consultations. Some participants expressed concern that care had become more transactional than therapeutic and there were potential safety risks. Conclusion: The study explored how nurses working in general practice during the COVID-19 pandemic engaged with remote and technology-mediated working. It identifies specific issues of access to technology, workload, hybrid working, disruption to therapeutic relationships, safety risks and lack of involvement in decision-making. Changes were implemented quickly with little strategic input from nurses. There is now an opportunity to reflect and build on what has been learned in relation to remote and technology-mediated working to ensure the future development of safe and effective nursing care in general practice. Impact: The paper contributes to understanding of remote and technology-mediated working by nurses working in general practice during the COVID-19 pandemic and indicates to employers and policy makers how this can be supported moving forward. Reporting method: Standards for Reporting Qualitative Research (O'Brien et al., 2014). Patient or public contribution: This was a workforce study so there was no patient or public contribution. Implications for the profession and patient care: The paper highlights specific issues which have implications for the development of remote, technology-mediated and blended working for nurses in general practice, care quality and patient safety. These require full attention to ensure the future development of safe and effective nursing care in general practice moving forward. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusions Impact Reporting Method Patient or Public Contribution to the Development of this Study To explore nursing students' lived experience of a clinical placement within healthcare in a prison, to gain an insight into the support provided prior to and during this unique clinical placement.An inductive phenomenological study.Participants included 14 nursing students from three undergraduate nursing programmes in England, Adult (n = 4), Learning Disability (n = 3) and Mental Health (n = 7). Following a clinical placement in a prison, each participant completed a semistructured audio‐recorded interview on MS Teams between October and December 2021. Audio recordings were transcribed verbatim and thematic analysis was completed.Two overarching themes were identified, ‘shock’ due to the (a) reality of prison; (b) overwhelming emotional impact and (c) frequency and severity of self‐harm and ‘surprise’ due to (a) the need to work with prison officers; (b) recognizing and addressing preconceptions of people in prison and (c) the development of clinical knowledge, skills and becoming a nurse.The need remains for a comprehensive strategy of preparation and orientation for nursing students before commencing a clinical placement in prison, which includes the development of knowledge and clinical skills to support the complex health and social care needs of people in prison.Our research identified the support provided to nursing students prior to clinical placement in prison varies considerably. The development of a preparation and orientation programme has the potential to reduce pre‐placement anxiety, emotional burden and support nursing students in addressing their preconceptions of people in prison. This approach is essential to support future nursing students to embrace the unique opportunity of a clinical placement within a prison, enhance their clinical knowledge and skills, and develop as a nurse.Our paper adheres to the consolidated criteria for reporting qualitative research (COREQ).None. [ABSTRACT FROM AUTHOR]

Background: Antibiotics savelives and have been effectively and reliably used for decades to treat infections and improve health outcomes. This trust in antibiotics has contributed to over prescribing and the emergence of antimicrobial resistance. Significant amounts of antibiotics are still widely prescribed and taken, especially in young children. However, there is a paucity of existing literature relating to how mothers, who are the main carers of young children, may be influenced by their trust in antibiotics. Aims: To explore what factors influence mothers' decisions to seek antibiotics for their young children. Design: Qualitative case study using postcode boundaries. Methods: Thematic analysis of qualitative data from mothers of children under 5, recruited via community playgroups within the case. Data were collected between October 2018 and May 2019, from six focus groups (n = 19) and one‐to‐one interviews (n = 14). Thematic analysis of the data consisted of six phases: data familiarization; generating initial codes; searching for themes; reviewing themes; defining and naming themes; and producing the report. Results: Mothers were influenced by their belief and trust in antibiotics. Antibiotics were identified as symbolic of recovery, healing and of providing protection and safety. Conclusion: By understanding the symbolic power of antibiotics on maternal decision making, all antibiotic prescribers may be able to offer and provide reassuring alternative and acceptable treatment options to mothers, rather than using antibiotics. Impact This paper introduces the concept of antibiotics as powerful symbols which influence antibiotic seeking behaviour. This in turn may result in inappropriate use of antibiotics which contributes to the risk of antimicrobial resistance developing. Although the majority of antibiotics are still prescribed by doctors, the number of nurse prescribers has been increasing. Therefore, an increased awareness of antibiotic symbolism, in all prescribing clinicians, is important to enable future local and national strategies to be developed, to support maternal decision making and reduce antibiotic seeking behaviour. [ABSTRACT FROM AUTHOR]

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Abstract: Aim: A discussion of issues associated with Values Based Recruitment (VBR) for nurse education programmes. Background: Values Based Recruitment is a mandatory element in selection processes of students for Higher Education healthcare courses in England, including all programmes across nursing. Students are selected on the basis that their individual values align with those presented in the Constitution of the National Health Service. However, there are issues associated with the use of values as selection criteria that have been insufficiently addressed. These are discussed. Design: Discussion paper. Data sources: This article is based on documents published on the website of the executive body responsible for the implementation of a policy regarding VBR in Higher Education Institutions up until June 2017 and our evaluation of the conceptualisation of VBR, underpinned by contemporary theory and literature. Implications for nursing: Values Based Recruitment influences who is accepted onto a nurse education programme, but there has been limited critical evaluation regarding the effectiveness of employing values as selection criteria. Values are subject to interpretation and evidence regarding whether or how VBR will improve practice and care is lacking. The issues discussed in this article show that Higher Education Institutions offering nursing courses, whether in England or in other countries, should be critical and reflective regarding the implementation of VBR methods. Conclusion: We call for a debate regarding the meaning and implications of VBR and further research regarding its validity and effectiveness. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to report the findings of a qualitative case study that investigated abused women's experiences of an identification and referral intervention and to discuss the implications for nurses, specifically those working in primary and community care. Background Domestic violence and abuse is a significant public health issue globally but it is a hidden problem that is under-reported. In the UK, Identification and Referral to Improve Safety is a primary care-based intervention that has been found to increase referral rates of abused women to support and safety services. This paper reports on the findings of an evaluation study of two sites in England. Design Qualitative study with a case study design. Methods In line with case study design, the entire evaluation study employed multiple data collection methods. We report on the qualitative interviews with women referred through the programme. The aim was to elicit their experiences of the three aspects of the intervention: identification; referral; safety. Data collection took place March 2016. Findings Ten women took part. Eight had exited the abusive relationship but two remained with the partner who had perpetrated the abuse. Women were overwhelmingly positive about the programme and irrespective of whether they had remained or exited the relationship all reported perceptions of increased safety and improved health. Conclusion Nurses have an important role to play in identifying domestic violence and abuse and in referral and safety planning. As part of a portfolio of domestic violence and abuse interventions, those that empower women to take control of their safety (such as Identification and Referral to Improve Safety) are important. [ABSTRACT FROM AUTHOR]

cook c. (2012) Email interviewing: generating data with a vulnerable population. Journal of Advanced Nursing 68(6), 1330-1339. Abstract Aims. This paper describes online recruitment and the email interviewing data collection method with women diagnosed with a viral sexually transmitted infection. The paper highlights the advantages of the method to researchers and participants when conducting research where face-to-face participation may difficult. Background. Online recruitment and in-depth email interviewing have been used by only a small number of nurses internationally. The method enables inclusion of people who might otherwise be excluded from research, for reasons such as geographical distance, incompatible time frames, clinicians''gate-keeping' and participants' desire for anonymity for physical or emotional reasons. Methods. In-depth email interviews were conducted with 26 women in New Zealand, United States of America, Canada and England who had a diagnosis of either human papilloma virus or genital herpes simplex virus. Data were collected during 2007-2008 and analysed using a poststructuralist, feminist thematic analysis. Results. Participant retention was high. Women emphasized satisfaction with the process. Asynchronous interviews allowed for additional reflexivity in the researcher's responses and rich data generation. Conclusion. This method has the potential to enable nurses to include vulnerable and relatively inaccessible participants in 'sensitive' research. In-depth email interviews may generate rich data through a process participants deem to be of personal value. [ABSTRACT FROM AUTHOR]

Aims To report on a survey of sexual health service needs among substance-misusing women attending a substance misuse service. Background Substance-misusing women carry a disproportionate burden of sexual ill health, yet the range and frequency of their sexual health risks, morbidities and service engagement are poorly understood. Design A cross-sectional survey of a convenience sample of substance-misusing women attending a substance misuse service. Methods From 4 April 2010-17 September 2010, substance-misusing women in Hastings & Ore, UK, were invited to complete a paper questionnaire addressing: drug use; cervical cytology, sexually transmitted infection and HIV screening history; pregnancy history, perceived pregnancy risk and contraceptive advice and supply; sexual activity and assault. Of 91 respondents, 77 attended local drug treatment services - results comprise analysis of this sub-sample. Results The study sample was characterized by long-term opioid and crack cocaine use. Of 53% sexually active in the previous 4 weeks, 66% perceived they had experienced sexual intercourse that could lead to pregnancy during that time. Fifty-five per cent had been forced to have sex against their will during their lifetime. High rates of sexually transmitted infections, pregnancy termination, miscarriage and abnormal cervical cytology were reported. Conclusions Findings indicate the need to recognize the breadth of elevated sexual health risks and morbidities experienced by substance-misusing women with long-term opioid/crack use, including those not identifying as intravenous drug users. Poor recall of drop-in and appointment times, reluctance to disclose substance misuse and likelihood of previous sexual assault present significant challenges to nurses, who must take a sensitive, opportunistic approach to referral and provision of sexual health interventions to substance-misusing women. [ABSTRACT FROM AUTHOR]

Introduction: The global nursing workforce is predominantly female, with a large proportion working in the 45–55 age group. Menopause is a transition for all women, and; therefore needs recognition as it can impact work performance and consequently staff turnover. Background: Women will go through the menopause, but not all women are affected. The menopause transition presents a range of signs and symptoms both physical and psychological which can impact the quality of life and individuals' work/life balance. The nursing workforce is predominantly women that will work through the menopause transition. Objectives: The study explored perspectives on digital health interventions as strategies to support menopausal women and to understand the requirements for designing health interventions for support in the workplace. Design: A qualitative explorative design. Settings: Nurses working in a range of clinical settings in England, Finland, Denmark, New Zealand, Australia and USA. Methods: Nurses (n = 48) participated in focus groups from six different countries from February 2020–June 2022 during the pandemic from a range of acute, primary care and education settings. Nurses were invited to participate to share their experiences. Thematic analysis was used. Results: All participants were able to describe the physical symptoms of menopause, with some cultural and possible hemisphere differences; more noticeable was the psychological burden of menopause and fatigue that is not always recognized. Four themes were identified: Managing symptoms in the workplace; Recognition in the workplace; Menopause interventions; and Expectation versus the invisible reality. These themes revealed information that can be translated for implementation into digital health interventions. Conclusions: Managers of nursing female staff in the menopausal age range need greater awareness, and menopause education should involve everyone. Finally, our results demonstrate design attributes suitable for inclusion in digital health strategies that are aligned with likely alleviation of some of the discomforts of menopause. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims The purpose of this article is to correct inaccurate information about both Mary Seacole and Florence Nightingale, material that promotes Seacole as a pioneer nurse and heroine, while either ignoring Nightingale or trivializing her contribution. Background Nursing journals have been prominent in promoting inaccurate accounts of the contribution of Seacole to nursing. Some have intermittently published positive material about Nightingale, but none has published redress. Design Discussion paper. Data Primary sources from 1855-2012 were found, which contradict some key claims made about Seacole. Further sources - not included here - are identified, with a website reference. Implications for Nursing It is argued that Nightingale remains relevant as a model for nurses, with the many crises in patient care and continuing challenges of hospital safety. Conclusion Greater accuracy and honesty are required in reporting about nursing heroes. Without these, great ideas and examples can be lost to nursing and health care. [ABSTRACT FROM AUTHOR]

Aims This paper is a report of a study, which seeks to determine if self-reported estimates of RNs' self-rated confidence in responding to alcohol use in patients is a psychometrically sound measure. Background Alcohol-related harm is a global public health problem. Nurses are the largest group of health professionals worldwide, with evidence showing that despite being well placed to respond, they are not engaging in this important role. Design Instrument development. Method The study was a survey set in a large teaching hospital in England, UK. The Clinical Confidence Questionnaire was made available to a convenience sample of 200 RNs in 2007, with a response rate of 22%. Rasch analysis was used to develop a scale for future learning based on the conjoint estimates of registered hospital nurses abilities to meet needs of patients requiring nursing care of different complexities related to alcohol use in patients. Results Outcomes verify that registered hospital nurses' self-rated clinical confidence measures for their own nursing abilities in responding to alcohol use in patients can be reliably estimated and a hierarchical scale of learning can be generated to inform curricula content and learning processes. Conclusion Current health policy in the UK identifies nurses as having a role in responding to alcohol-related harm. More focus should, therefore, be placed on ensuring that they are prepared to fully engage with patients in assessing and responding to alcohol use through specific education, training and skill development. The self-rated clinical confidence tool offers evidence as an acceptable method of measurement in this area. [ABSTRACT FROM AUTHOR]

Tame S.L. (2013) The effect of continuing professional education on perioperative nurses' relationships with medical staff: findings from a qualitative study. Journal of Advanced Nursing 69(4), 817-827. doi: 10.1111/j.1365-2648.2012.06065.x Abstract Aims. To report perceived changes to UK perioperative nurses' relationships with medical staff following periods of formal, university-based study. Background. Continuing professional development is considered important for nursing internationally; however, practice changes may not result following formal study. The literature did not describe perioperative nurses' experiences of formal study, and it was believed differences may exist due to hierarchical interprofessional relationships in the operating theatre. Design. Descriptive, qualitative. Methods. Unstructured interviews ( N = 23) were conducted between 2006-2007 with a purposive sample of perioperative nurses who had recent experience of continuing professional education. All participants were employed by one National Health Service Trust in the North of England, UK. Audio-taped interviews were transcribed fully into the ethnograph computer-assisted qualitative data analysis programme and data coded and analysed to identify themes. Findings. The findings indicated that whilst continuing professional education did not have a direct impact on practice, development of increased knowledge and confidence facilitated participants' collaboration with and questioning of medical colleagues. Such increased interprofessional collaboration was attributed to indirectly enhancing patient care. Conclusion. Continuing professional education appeared to lead to intrinsic changes to practitioners rather than direct behavioural change. Nurses' increased knowledge and confidence affected the balance of power in the doctor-nurse relationship in British perioperative environments. This paper is of significance to perioperative nursing and may be transferable to other areas of care. [ABSTRACT FROM AUTHOR]

Aim This paper is a report of a qualitative study conducted as part of a randomized controlled trial comparing a lay-facilitated angina management programme with usual care. Its aim was to explore participants' beliefs, experiences, and attitudes to the care they had received during the trial, particularly those who had received the angina management intervention. Background Angina affects over 50 million people worldwide. Over half of these people have symptoms that restrict their daily life and would benefit from knowing how to manage their condition. Design A nested qualitative study within a randomized controlled trial of lay-facilitated angina management. Method We conducted four participant focus groups during 2008; three were with people randomized to the intervention and one with those randomized to control. We recruited a total of 14 participants to the focus groups, 10 intervention, and 4 control. Findings Although recruitment to the focus groups was relatively low by comparison to conventional standards, each generated lively discussions and a rich data set. Data analysis demonstrated both similarities and differences between control and intervention groups. Similarities included low levels of prior knowledge about angina, whereas differences included a perception among intervention participants that lifestyle changes were more easily facilitated with the help and support of a lay-worker. Conclusion Lay facilitation with the Angina Plan is perceived by the participants to be beneficial in supporting self-management. However, clinical expertise is still required to meet the more complex information and care needs of people with stable angina. [ABSTRACT FROM AUTHOR]

gibson j. & watkins c. (2011) People's experiences of the impact of transient ischaemic attack and its consequences: qualitative study. Journal of Advanced Nursing 68(6), 1707-1715. Abstract Aim. This paper is a report of a study of how people's experiences of transient ischaemic attack affect their perception of their health and their uptake of health maintenance measures. Background. Transient ischaemic attack is a well-recognized warning sign of subsequent stroke, but early diagnosis and management of risk factors can substantially reduce this risk. Even though the physical effects of a transient ischaemic attack are transient, it is known to negatively affect quality of life. However, no qualitative studies have explored the impact of transient ischaemic attack on people's everyday lives. Methods. Sixteen participants were recruited from a vascular surgery clinic in a district general hospital in North West England. All had a recent transient ischaemic attack. A qualitative grounded theory study using detailed interviews ( n = 21) was conducted. Findings. Participants experienced conflict between acknowledgement of the transient ischaemic attack as a significant illness episode with implications for their long-term health, and denial of its seriousness. Although they often ignored the initial signs, participants also experienced fear due to increased awareness of their risk of stroke. Often, they believed that they were having a permanent stroke. Many participants were prompted to seek medical advice by a family member or acquaintance. Having a transient ischaemic attack negatively changed their perception of their health and their quality of life, but some also viewed it as a positive event that had warned of their stroke risk and enabled them to take up health maintenance measures. Conclusions. Having a transient ischaemic attack permanently changes people's quality of life and their perception of their health, despite the transience of the symptoms. The ability of people to make positive health changes after a transient ischaemic attack to some extent ameliorates the negative effects of being aware of their heightened stroke risk. Their appreciation of their quality of life may also be enhanced. The transience of the symptoms and lack of knowledge of transient ischaemic attacks lead to delays in seeking medical advice. [ABSTRACT FROM AUTHOR]

beech n., arber a. & faithfull s. (2011) Restoring a sense of wellness following colorectal cancer: a grounded theory. Journal of Advanced Nursing 68(5), 1134-1144. Abstract Aim. This paper reports a study to develop a grounded theory to explain the experience of recovery following surgery for colorectal cancer. Background. Studies have adopted a biomedical framework to measure quality of life and symptom distress following surgery for colorectal cancer. These studies suggest that symptoms of pain, insomnia and fatigue, may persist for many months following treatment. Fewer studies have considered the individual's experiences and perspective of the emotional, social and cultural aspects of recovery. Methods. A longitudinal study using grounded theory was conducted with 12 individuals, who had received surgery for colorectal cancer. Semi-structured interviews were conducted at four time points over 1 year following surgery, between 2007 and 2009. Grounded theory analysis was undertaken using Strauss and Corbin's framework. Findings. Recovery is described in three phases: disrupting the self; repairing the self; restoring the self. The core category is Restoring a sense of wellness; fostered through awareness and enjoyment of the physical, emotional, spiritual and social aspects of life. A sense of wellness exists as a duality with a sense of illness, where both perspectives may co-exist but one usually takes precedence. A sense of illness pervades when the individual is preoccupied with illness and the illness continues to disrupt their daily life. Conclusion. Recovery takes time and energy, particularly when the individual is at home and in relative isolation from health professionals. Opportunities exist for nurses to provide information and support to facilitate the individual in their progress towards achieving a sense of wellness. [ABSTRACT FROM AUTHOR]

kennedy f., harcourt d. & rumsey n. (2011) The shifting nature of women's experiences and perceptions of ductal carcinoma in situ. Journal of Advanced Nursing 68(4), 856-867. Abstract Aim. This paper is a report of a descriptive qualitative study of the evolution of women's perceptions and experiences of ductal carcinoma in situ from the period near to diagnosis to 1 year later. Background. Ductal carcinoma in situ is a non-invasive breast condition where cancer cells are detected but confined to the ducts of the breast. With treatment, the condition has a positive prognosis but ironically patients undergo treatment similar to that for invasive breast cancer. There is a lack of longitudinal qualitative research studying women's experiences of ductal carcinoma in situ, especially among newly diagnosed patients, and how experiences change over time. Methods. Forty-five women took part in an initial interview following a diagnosis of ductal carcinoma in situ and 27 took part in a follow-up interview 9-13 months later. Data were collected between January 2007 and October 2008. Transcripts were analysed using a hybrid approach to thematic analysis. Findings. Women's early perceptions of ductal carcinoma in situ merged and sometimes conflicted with their lay beliefs of breast cancer. Perceptions and experiences of the condition shifted over time. These overriding aspects were evident in four themes identified across the interviews: (i) perceptions of ductal carcinoma in situ vs. breast cancer, (ii) from paradox to acceptance, (iii) personal impact, and (iv) support and interactions with others. Conclusion. This study represents one of the few longitudinal qualitative studies with newly diagnosed patients, capturing women's initial and shifting experiences and perceptions of the condition. The issues identified need to be recognized in clinical practice and supported appropriately. [ABSTRACT FROM AUTHOR]

banner d., miers m., clarke b. & albarran j. (2011) Women's experiences of undergoing coronary artery bypass graft surgery. Journal of Advanced Nursing 68(4), 919-930. Abstract Aim. This paper is a report of a study of women's experiences of coronary artery bypass graft surgery. Background. Worldwide, coronary heart disease is the leading cause of morbidity and mortality. It has traditionally been viewed as primarily affecting men. However, a growing body of literature exploring gender differences in this area is challenging accepted beliefs, particularly in relation to outcomes. Despite this, awareness of how women interpret and respond to the experiences of cardiac surgery remains limited. Methods. At regional cardiothoracic centres in England and Wales, during 2003 to 2006, data were collected from 30 women preoperatively and at 6 weeks and 6 months postoperatively using semi-structured interviews. A constructivist grounded theory approach was adopted and data were analysed using extensive coding and constant comparison techniques. Results. A substantive theory of the public-private dialogue of normality emerged demonstrating that participants faced lifestyle disruptions as they attempted to privately normalize and integrates limitations, while minimizing a public display of illness. During the preoperative period, participants experienced difficulties recognizing and acting on symptoms and endured physical and emotional distress while waiting for surgery. Following surgery, women experienced functional limitations which forced them to relinquish normal activities and roles. As recovery progressed, women came to accept their changed health status and renegotiated state of normality. Conclusion. The findings increase understanding about the adjustments which women undergoing cardiac surgery make as part of living with a long-term condition and support the need to develop innovative gender-sensitive health education and services. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to identify the content of, and participation in, medicine discussion between nurse prescribers and people with diabetes in England. Background. Diabetes affects 246 million people worldwide and effective management of medicines is an essential component of successful disease control. There are now over 20,000 nurse independent prescribers in the UK, many of whom frequently prescribe for people with diabetes. With this responsibility comes a challenge to effectively communicate with patients about medicines. National guidelines on medicines communication have recently been issued, but the extent to which nurse prescribers are facilitating effective medicine-taking in diabetes remains unknown. Methods. A purposive sample of 20 nurse prescribers working with diabetes patients audio-recorded 59 of their routine consultations and a descriptive analysis was conducted using a validated coding tool: MEDICODE. Recordings were collected between January and July 2008. The unit of analysis was the medicine. Results. A total of 260 instances of medicine discussion identified in the audio-recordings were analysed. The most frequently raised themes were 'medication named' (raised in 88·8% of medicines), 'usage of medication' (65·4%) and 'instructions for taking medication' (48·5%). 'Reasons for medication' (8·5%) and 'concerns about medication' were infrequently discussed (2·7%). Measures of consultation participation suggest largely dyadic medicine discussion initiated by nurse prescribers. Conclusion. MEDICODE discussion themes linked to principles of recent guidelines for effective medicine-taking were infrequently raised. Medicine discussion was characterized by a one statement-one response style of communication led by nurses. Professional development is required to support theoretically informed approaches to effective medicines management. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study identifying and describing the essences of patients' experience during the period leading up to the diagnosis of non-Hodgkin lymphoma. Background. Patient and doctor delays occur during diagnosis of non-Hodgkin lymphoma, and families can affect patients' help-seeking behaviours. Current guidelines state the need for immediate referral of patients with suspected non-Hodgkin lymphoma symptoms. Methods. A phenomenological approach was used. A purposive sample of 31 patients diagnosed with non-Hodgkin lymphoma was recruited through a hospital and a support group in the United Kingdom. In-depth interviews were tape-recorded, transcribed and then analysed using Colaizzi's method. Data collection took place over an 18-month period during 2003-2005 and data analysis was completed in 2006. Findings. The overriding theme was: Creating a pathway towards hearing the diagnosis of non-Hodgkin lymphoma. The three themes were as follows: Perceiving individual health and onward movement; Penetrating communication processes and investigations; Advancing towards focusing on the non-Hodgkin lymphoma diagnosis. Patients with non-Hodgkin lymphoma can have a diverse symptom presentation over long periods of time. Their help-seeking behaviours are an interplay of essences, including symptom type, attributions and emotional responses. Patients need tailored information to deal with the uncertainty of their situation at key points during their prediagnosis journey. Conclusion. Nurses should help patients identify and acquire the appropriate information at key points during the diagnosis period as this is a period of great uncertainty. Further research should be conducted into the quality of prediagnosis consultations and the extent to which patients think that their agendums have been met at this time. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to identify factors influencing advanced practice nurses' contribution to promoting evidence-based practice among front-line nurses. Background. Despite widespread recognition that care should be evidence-based, nurses experience challenges implementing evidence-based practice. As opinion leaders, advanced practice nurses can influence the practice of front-line nurses by promoting research use. Little is known about how advanced practice nurses use evidence and their influence on care given by front-line nurses. Method. A cross-sectional survey of 855 advanced practice nurses working in 87 hospital/primary care settings in England. The questionnaire examined understandings of evidence-based practice, sources of evidence used, ways of working with frontline nurses, perceived impact on front-line nurses, skills in evidence-based practice and barriers to promoting evidence-based practice. Data were collected in 2005 and analysed using descriptive statistics. Comparisons were made between advanced practice nurses with Masters qualifications and those with lower qualifications. Findings. Advanced practice nurses used different sources of evidence. They engaged in various activities to promote evidence-based practice and had a positive influence on front-line nurses' practice. Advanced practice nurses' skills in evidence-based practice varied with few considering themselves expert. Advanced practice nurses with Masters qualifications perceived themselves to be more skilled in all aspects of evidence-based practice than those with lower qualifications. Conclusion. Advanced practice nurses are well placed as clinical leaders to promote evidence-based practice by frontline nurses but require further development of their skills in evidence-based practice. In order to maximize their potential, advanced practice nurses require Master's preparation. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the choices patients make when offered home-based or hospital-based cardiac rehabilitation. Background. In some countries, patients may be offered a choice of home-based or hospital-based cardiac rehabilitation. While evaluating a home-based programme, Road to Recovery, developed by the British Heart Foundation, we examined patients' experiences of being offered this choice. Methods. Interviews were conducted with 35 patients and 12 staff members delivering the pilot programme in five rehabilitation services during 2006-2008. Findings. While the staff members interviewed reported that all patients were given a clear choice between a home-based and hospital-based or community-based programme, this choice was less clear-cut in the patient interviews. When choice was offered, the choice of a home-based programme was often based on constraints rather than on being a positive choice. Obstacles patients faced in making the choice included lack of information on which to base a choice; inadequate systems of referral; insufficient appropriately trained staff; restricted choice of times to attend the hospital programmes; the geographical location of services and restrictive socio-economic factors (inflexible working hours, access to transport). Conclusion. The possibility of informed choice relies in the first instance on the availability and accessibility of appropriate services. Nurses need awareness and commitment to finding out about and overcoming obstacles that impede patient participation in cardiac rehabilitation. Only in this manner will it be possible to fulfil the calls in national and some international clinical guidelines for 'individualized' or 'menu-based' programmes tailored to specific patient needs. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an evaluation of the implementation of nurse prescribing in an acute care hospital in England. Background. At the time of the study, evaluation of nurse prescribing had taken place in community settings, but little was known about its impact and effectiveness in acute care. Although nurse prescribing has permitted doctor-nurse substitution in acute episodic care, some doctors have expressed concerns about patient safety in relation to nurse prescribing. Methods. A mixed methods single-case study was conducted in 2005-06, using purposive sampling. Semi-structured interviews were carried out with 18 hospital staff, non-participant observation of two nurses and two doctors undertaking 52 patient-prescriber consultations with 47 patients, and a questionnaire survey with 122 patients (response rate 61%: n = 74). Results. Nurse prescribing was found to benefit patients through service delivery improvement and using staff skills differently. Nurse prescribers and their colleagues were positive about role and service changes and their impact on patient care. No differences were found between the ways in which nurses and doctors performed prescribing roles, but there was a statistically significant difference between the medication-related information satisfaction ratings of patients who had seen a nurse prescriber, compared to those seen by a doctor. Conclusion. Nurses and doctors were found to provide equivalent care. Shared vision, local champions, action learning and peer support were the enabling factors that helped to embed the new prescribing roles within the study site. [ABSTRACT FROM AUTHOR]

Aim. This paper presents research on nursing and healthcare students' experiences and use of e-learning. Background. The inception of e-learning in higher education is supported by a policy background and technological developments, yet little is known of student experience and use in the United Kingdom. Methods. Conducted in 2007 and 2008, this study employed a mixed methods approach. An initial quantitative questionnaire was completed by 25 Higher Education Institutions and nine case study sites were visited. In the sites 41 students took part in focus groups and 35 staff were interviewed. Findings. Twenty-four Higher Education Institutions used a virtual learning environment and all respondents used e-learning to enable access to course materials and web-based learning resources. Three main themes were identified from student interviews, 'Pedagogic use'; 'Factors inhibiting use' and 'Facilitating factors to engagement'. Student's main engagement with e-learning was at an instructivist level and as a support to existing face-to-face modes of delivery. Student use of Web 2.0 was limited, although a number were using social software at home. Limited computer access, computing skills, technical issues and poor peer commitment affected use. Motivation and relevance to the course and practice, in addition to an appreciation of the potential for student-centred and flexible learning, facilitated use. Conclusion. There is scope to broaden the use of e-learning that would engage students in the social construction of knowledge. In addition, experiences of e-learning use could be improved if factors adversely affecting engagement were addressed. [ABSTRACT FROM AUTHOR]

hughes c., knibb w. & allan h. (2010) Laparoscopic surgery for endometrial cancer: a phenomenological study. Journal of Advanced Nursing 66(11), 2500-2509. Aim. This paper is a report of a study of women's perspectives on the experience of laparoscopic surgery for endometrial cancer. Background. Laparoscopic surgery is increasingly used to treat early endometrial cancer. It is associated with low levels of morbidity and is considered safe as cancer surgery, but research on quality of life and women's experiences is limited. Method. Heideggerian hermeneutic phenomenology was used to explore the experiences of 14 women who had undergone the procedure in two English cancer centres between February 2008 and July 2009. In-depth interviews were taped, transcribed and analysed using Colaizzi's framework. Findings. A phenomenological description was produced from five identified themes: having cancer, transfer of responsibility to the surgeon, information and support, independence, and normality. The experience of laparoscopic surgery was overshadowed by the presence of cancer. Fear and lack of knowledge played an important role in entrusting the surgeon with the responsibility for decision-making. Individual, unmet information needs focused on the practicalities of treatment and being in an unfamiliar situation and environment. Loss of control and vulnerability were associated with illness and surgery, but early postoperative mobility and reduced pain, facilitated rapid return to independence and maintained a sense of normality. Conclusion. Healthcare professionals should deliver care in early endometrial cancer in a way that recognizes the significance of the cancer diagnosis, the role of the surgeon in decision-making and the need for practical information. Women with endometrial cancer should have access to treatments that reduce dependency and maintain normality. [ABSTRACT FROM AUTHOR]

nicholson j., slade p. & fletcher j. (2010) Termination of pregnancy services: experiences of gynaecological nurses. Journal of Advanced Nursing 66(10), 2245–2256. Aim. This paper is a report of a study to identify the experience of gynaecological nurses involved with termination of pregnancy. Background. Staff involved with termination of pregnancy have been found to experience both positive and negative views. Varying processes and experiences for staff have been identified, from termination of pregnancy work being emotionally draining and stressful to there being a process of care that evolves with greater experience. Methods. A purposive sample of seven gynaecological nurses currently working in a termination of pregnancy service was recruited. Data were collected between October 2007 and January 2008 using interviews and standardized questionnaires. Transcripts of the interviews were analysed using Interpretive Phenomenological Analysis. Results. Eight superordinate themes emerged from the analysis: (1) Unconditional acceptance and understanding of termination of pregnancy, (2) Strategies for managing the demands and challenges, (3) What we do for patients and job satisfaction, (4) Challenges to unconditional acceptance, (5) Juggling the contrasting needs and demands of patients, (6) The most demanding aspects of the role, (7) The significance of personal experience and (8) The service context. Some of the experiences were interpreted as ways in which nurses justified their role. The themes were understood in terms of a balance between strains, coping and contextual influences. Conclusion. Providing a recognized supportive supervisory environment might allow for the acknowledgement of the unique challenges staff in termination of pregnancy services face, and might enhance a sense of validation within the organization and hence staff wellbeing. [ABSTRACT FROM AUTHOR]

stenner k., carey n. & courtenay m. (2010) Implementing nurse prescribing: a case study in diabetes. Journal of Advanced Nursing 66(3), 522–531. Aim. This paper is a report of a study exploring the views of nurses and team members on the implementation of nurse prescribing in diabetes services. Background. Nurse prescribing is adopted as a means of improving service efficiency, particularly where demand outstretches resources. Although factors that support nurse prescribing have been identified, it is not known how these function within specific contexts. This is important as its uptake and use varies according to mode of prescribing and area of practice. Method. A case study was undertaken in nine practice settings across England where nurses prescribed medicines for patients with diabetes. Thematic analysis was conducted on qualitative data from 31 semi-structured interviews undertaken between 2007 and 2008. Participants were qualified nurse prescribers, administrative staff, physicians and non-nurse prescribers. Findings. Nurses prescribed more often following the expansion of nurse independent prescribing rights in 2006. Initial implementation problems had been resolved and few current problems were reported. As nurses’ roles were well-established, no major alterations to service provision were required to implement nurse prescribing. Access to formal and informal resources for support and training were available. Participants were accepting and supportive of this initiative to improve the efficiency of diabetes services. Conclusion. The main factors that promoted implementation of nurse prescribing in this setting were the ability to prescribe independently, acceptance of the prescribing role, good working relationships between doctors and nurses, and sound organizational and interpersonal support. The history of established nursing roles in diabetes care, and increasing service demand, meant that these diabetes services were primed to assimilate nurse prescribing. [ABSTRACT FROM AUTHOR]

Aims: To explore stakeholder perspectives on the benefits and/or disadvantages of the delegation of insulin injections to healthcare support workers in community nursing services. Design: Qualitative case study. Methods: Interviews with stakeholders purposively sampled from three case sites in England. Data collection took place between October 2020 and July 2021. A reflexive thematic approach to analysis was adopted. Results: A total of 34 interviews were completed: patients and relatives (n = 7), healthcare support workers (n = 8), registered nurses (n = 10) and senior managers/clinicians (n = 9). Analysis resulted in three themes: (i) Acceptance and confidence, (ii) benefits and (iii) concerns and coping strategies. Delegation was accepted by stakeholders on condition that appropriate training, supervision and governance was in place. Continuing contact between patients and registered nurses, and regular contact between registered nurses and healthcare support workers was deemed essential for clinical safety. Services were reliant on the contribution of healthcare support workers providing insulin injections, particularly during the COVID‐19 pandemic. Benefits for service and registered nurses included: flexible team working, increased service capacity and care continuity. Job satisfaction and career development was reported for healthcare support workers. Patients benefit from timely administration, and enhanced relationships with the nursing team. Concerns raised by all stakeholders included potential missed care, remuneration and task shifting. Conclusion: Delegation of insulin injections is acceptable to stakeholders and has many benefits when managed effectively. Impact: Demand for community nursing is increasing. Findings of this study suggest that delegation of insulin administration contributes to improving service capacity. Findings highlight the essential role played by key factors such as appropriate training, competency assessment and teamwork, in developing confidence in delegation among stakeholders. Understanding and supporting these factors can help ensure that practice develops in an acceptable, safe and beneficial way, and informs future development of delegation practice in community settings. Patient or Public Contribution: A service user group was consulted during the design phase prior to grant application and provided comments on draft findings. Two people with diabetes were members of the project advisory group and contributed to the study design, development of interview questions, monitoring study progress and provided feedback on study findings. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to profile the contemporary advanced clinical practitioner (ACP) role through standardized document sets. Design: Documentary analysis of job descriptions (JDs), person specification and advertisements. Data Sources: England based jobs advertised on NHS jobs website from 22 January to 21 April 2021. Results: A toatal of 143 trainee and qualified ACP roles were identified. A wide range of sectors and specialities were represented from across all English regions. The most common roles were urgent care, emergency medicine and primary care. Most qualified roles were agenda for change band 8A, although this did vary across specialities. Many roles were restricted to a small number of professions, notably nursing, physiotherapy and paramedic. Inconsistent role titles were noted. A lack of understanding of regulation across different professions was noted. Conclusion: The ACP role has become an accepted across healthcare providers in England. Implementation remains varied across specialities and organizations. Eligibility criteria may relate to professional bias. Implications for the Profession and/or Patient Care: ACP roles are expanding but this may be at the detriment to advanced nursing posts. Inconsistency in role eligibility suggests some professional bias exists. Impact: This was scoping of ACP roles across England using job advertisements. ACP roles are common across sectors and specialities but eligibility varies. The research will have impact on those looking to recruit to ACP roles as well as those refining JDs. Reporting Method: No EQUATOR guideline exists for document analysis. Patient or Public Contribution: No Patient or Public Contribution. The research relates to organizational human resource information only. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate nursing students' clinical decision‐making by using high‐fidelity simulation of a deteriorated patient scenario. Design: A convergent parallel mixed methods research design was used consisting of quantitative and qualitative data collection. Methods: Twenty‐three students completed the Health Science Reasoning Test before and after the simulation between October 2015 and June 2016. They were presented with a simulated scenario and asked to 'think aloud' during and after the simulation. The students were audio‐video recorded and observations were collected by the researcher. Results: There was a significant moderate increase in the 'deduction' and 'analysis' sub‐scale scores and overall test score, suggestive of improved analytical decision‐making processes through the simulation experience. Think‐aloud and observation data identified that students predominantly applied 'forward' reasoning during the simulated 'patient's' deterioration, focusing mainly on cue acquisition. 'Backward' reasoning with a focus on cue interpretation was most prominent in the debriefing data, in line with the survey outcomes. Accurate cue interpretation of critical, key cues appeared more useful than the total number of cues in solving the main clinical case problem. Conclusion: Students learn different clinical decision‐making skills during the simulation compared to what they learn from debriefing. Using observation and think‐aloud methods have significant benefits for researchers seeking to optimize the evaluation of the clinical decision‐making process. [ABSTRACT FROM AUTHOR]

Aims: To explore how older people's experiences of COVID‐19 restrictions influenced their decision to receive a vaccine and to support nurse–patient vaccination conversations. Design: A longitudinal hermeneutic phenomenological study. The application of the COREQ checklist informed the reporting of this study. Methods: Data were collected through semi‐structured telephone interviews with older people (age ≥70) during two national restrictions implemented in England due to COVID‐19. Phase one of interviews occurred between April and July 2020 (six interviews), and phase two of interviews between January and April 2021 (four interviews). Data analysis was performed through content analysis. Results: Thirteen older people (mean age 78) worked through six stages about their thoughts and beliefs about receiving a vaccine, which encompassed four of the five elements of the 5C model of vaccine hesitancy, confidence, convenience, calculation, collective, but not complacency. Stages included 'our only hope is a vaccine'; 'understanding and acceptance of an effective vaccine'; 'social responsibility to protect others'; 'organized but left with unanswered questions'; 'need to feel secure' and finally 'vaccination alone is not enough'. Conclusion: The experience of COVID‐19 restrictions by older people informed their approach of engaging with scientific information to inform their decisions to be vaccinated but also developed their sense of collective responsibility to younger generations and those at risk, which informed their adherence to restrictions and the vaccination programme. Impact Nurses are optimally placed to support older people to implement and adhere to national government restrictions as appropriate and prevent obsessive routines, and support discussions and the provision of scientific information on COVID‐19 vaccinations, whilst being inclusive of older peoples' sense of collective responsibility. [ABSTRACT FROM AUTHOR]

Aims: To explore healthcare professionals' experiences of patient‐witnessed resuscitation in hospital. Design: Descriptive phenomenology. Methods: Healthcare professionals involved in hospital resuscitation activities were recruited from medical, intensive care, resuscitation and education departments in a university hospital in England. Data were collected through face‐to‐face and focus group interviews, between August 2018 and January 2019. Data were analysed using Giorgi's phenomenological approach. Results: Nine registered nurses, four healthcare assistants and seven doctors participated in four individual interviews and three focus groups. Findings were related to three themes: (1) Protecting patients from witnessing resuscitation: healthcare professionals used curtains to shield patients during resuscitation, but this was ineffective. Thus, they experienced challenges in explaining resuscitation events to the other patients and communicating sensitively. (2) Emotional impact of resuscitation: healthcare professionals recognized that witnessing resuscitation impacted patients, but they also felt emotionally affected from performing resuscitation and needed coping strategies and support. (3) Supporting patients who witnessed resuscitation: healthcare professionals recognized the importance of patients' well‐being, but they felt unable to provide effective and timely support while providing life‐saving care. Conclusion: Healthcare professionals involved in hospital resuscitation require specific support, guidance and education to care effectively for patients witnessing resuscitation. Improving communication, implementing regular debriefing for staff, and allocating a dedicated professional to support patients witnessing resuscitation must be addressed to improve clinical practice. Impact The WATCH study uncovers patients' and healthcare professionals' experiences of patient‐witnessed resuscitation, a phenomenon still overlooked in nursing research and practice. The main findings highlight that, in common with patients, healthcare professionals are subject to the emotional impact of resuscitation events and encounter challenges in supporting patients who witness resuscitation. Embedding the recommendations from this research into clinical guidelines will impact the clinical practice of healthcare professionals involved in hospital resuscitation and the quality and timeliness of care delivered to patients. [ABSTRACT FROM AUTHOR]

Aims: To understand how COVID‐19 affected nurse staffing in intensive care units (ICUs) in England, and to identify factors that influenced, and were influenced by, pandemic staffing models. Design: Exploratory qualitative study. Methods: Semi‐structured, online interviews conducted July–September 2020 with regional critical care leaders including policy leads (n = 4) and directors/lead nurses (n = 10) across critical care networks in England. Findings: The six themes emerging from the framework analysis illustrate how the pre‐pandemic ICU culture influenced ICU staffing models during the pandemic. Changes in staffing impacted on the workforce and the care delivered, whilst it was necessary to learn from, and adjust to, a rapidly changing situation. Variation across and between networks necessitated variation in responses. The overwhelming outcome was that the pandemic has challenged the central tenets of ICU nurse staffing. Conclusions: Pandemic nurse staffing models resulted in changes to ICU skill‐mix and staffing numbers. Factors such as the impact of nurse staffing on care practices and on the workforce need to be taken into account when developing and testing future nurse staffing models for ICU. The extent to which ICUs will return to former staffing models is not yet known but there seems to be an appetite for change. Impact: In common with many countries, nurse staffing in English ICUs was adapted to address surge requirements during the COVID‐19 pandemic. Findings highlight the challenge COVID‐19 presented to pre‐pandemic ICU nurse staffing guidelines, the impact on patient and staff well‐being and the potential legacy for future staffing models. Study findings have implications for ICU nurse managers, researchers and policy makers: nurse staffing models need to be adaptable to the local context of care and future research should investigate the impact of different models on patients, staff and health service outcomes. [ABSTRACT FROM AUTHOR]

Aim: To understand how advanced nurse practitioners use knowledge to inform their discharge decision‐making in the emergency department. Background: Advanced nurse practitioner roles have developed globally in a wide range of healthcare settings, including the emergency department, over the past few years. The scope of practice and training vary widely between countries. Little is known about how they use clinical knowledge in the emergency department. Design: An ethnographic study was undertaken in an emergency department in the North of England. Method: Data were collected by observation (n = 5) and semi‐structured interviews (n = 13) between September 2016 and June 2017. Interview transcripts and field notes were coded using Quirkos software. Thematic analysis was used to identify key themes. Findings: In boundary blurring with medicine, advanced nurse practitioners in the emergency department need to make timely, autonomous discharge decisions. Knowledge mobilization is messy and complex; however, shortcuts facilitate autonomous discharge decision‐making. More experienced advanced nurse practitioners rely less on shortcuts as they draw on experiential knowledge. Discussion: Boundary blurring in the advanced nurse practitioner role in the emergency department, requires reliable knowledge shortcuts. Support from senior colleagues and accessible smartphone apps enable advanced nurse practitioners to efficiently make discharge decisions. This study adds to previous research on how knowledge is managed in boundary blurring. Conclusion: Advanced nurse practitioners in the emergency department require timely access to relevant, up to date knowledge. This study has highlighted their preferred knowledge sources to inform discharge decision‐making. In boundary blurring, shortcuts enable ANPs to use knowledge efficiently to inform patient care in the emergency department. Impact: The findings increase our understanding of how to equip advanced nurse practitioners with knowledge to facilitate clinical decision‐making. Clinical managers should provide mentorship and relevant up to date knowledge shortcuts to ensure efficient, evidence‐based discharge decision‐making. [ABSTRACT FROM AUTHOR]

Aims: To evaluate care planning in advance of end‐of‐life care in care homes. Design: A qualitative study. Methods: Qualitative data were collected from January 2018–July 2019 (using focus groups and semi‐structured interviews) from three care homes in the South West of England. The data were analysed using thematic analysis followed by Critical Realist Evaluation. Results: Participants comprised of registered nurses (N = 4), care assistants (N = 8), bereaved relatives (N = 7), and domiciliary staff (N = 3). Although the importance of advance care planning was well recognized, the emotional labour of frequently engaging in discussions about death and dying was highlighted as a problem by some care home staff. It was evident that in some cases care home staff's unmet emotional needs led them to rushing and avoiding discussions about death and dying with residents and relatives. A sparsity of mechanisms to support care home staff's emotional needs was noted across all three care homes. Furthermore, a lack of training and knowledge appeared to inhibit care home staff's ability to engage in meaningful care planning conversations with specific groups of residents such as those living with dementia. The lack of training was principally evident amongst non‐registered care home staff and those with non‐formal caring roles such as housekeeping. Conclusion: There is a need for more focused education to support registered and non‐registered care home staff to effectively engage in sensitive discussions about death and dying with residents. Furthermore, greater emotional support is necessary to help build workforce resilience and sustain change. Impact: Knowledge generated from this study can be used to inform the design and development of future advance care planning interventions capable of supporting the delivery of high‐quality end‐of‐life care in care homes. [ABSTRACT FROM AUTHOR]

Aims: To describe strategies nursing leaders use to promote evidence‐based practice implementation at point‐of‐care using data from health systems in Australia, Canada, England and Sweden. Design: A descriptive, exploratory case‐study design based on individual interviews using deductive and inductive thematic analysis and interpretation. Methods: Fifty‐five nursing leaders from Australia, Canada, England and Sweden were recruited to participate in the study. Data were collected between September 2015 and April 2016. Results: Nursing leaders both in formal managerial roles and enabling roles across four country jurisdictions used similar strategies to promote evidence‐based practice implementation. Nursing leaders actively promote evidence‐based practice implementation, work to influence evidence‐based practice implementation processes and integrate evidence‐based practice implementation into everyday policy and practices. Conclusion: The deliberative, conscious strategies nursing leaders used were consistent across country setting, context and clinical area. These strategies were based on a series of activities and interventions around promoting, influencing and integrating evidence‐based practice implementation. We conjecture that these three key strategies may be linked to two overarching ways of demonstrating effective evidence‐based practice implementation leadership. The two overarching modes are described as mediating and adapting modes, which reflect complex, dynamic, relationship‐focused approaches nursing leaders take towards promoting evidence‐based practice implementation. Impact: This study explored how nursing leaders promote evidence‐based practice implementation. Acknowledging and respecting the complex work of nursing leaders in promoting evidence‐based practice implementation through mediating and adapting modes of activity is necessary to improve patient outcomes and system effectiveness. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim. In this paper we report on the rates of drug/alcohol use on acute psychiatric wards in relation to levels and intensity of exit security measures. Background. Many inpatient wards have become permanently locked, with staff concerned about the risk of patients leaving the ward and harming themselves or others, and of people bringing illicit substances into the therapeutic environment. Methods. In 2004/2005, a cross sectional survey on 136 acute psychiatric wards across three areas of England was undertaken. A comprehensive range of data including door locking and drug/alcohol use were collected over 6 months on each ward. In 2006, supplementary data on door locking and exit security were collected. Door locking, additional exit security measures and substance misuse rates of the 136 wards were analysed and the associations between these were investigated. Results. No consistent relationships were found with exit security features, intensity of drug/alcohol monitoring procedures, or the locking of the ward door. There were indications that use of breath testing for alcohol might reduce usage and that the use of 'sniffe' dogs was associated with greater alcohol use. Conclusion. Greater exit security or locking of the ward door had no influence on rates of use of alcohol or illicit drugs by inpatients and thus cannot form part of any strategy to control substance use by inpatients. There are some grounds to believe that a greater use of screening might help reduce the frequency of alcohol/substance use on wards and may lead to a reduction in verbal abuse. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Aim: To explore how adult, child and mental health nursing and midwifery students, selected using multiple mini interviews, describe their ‘values journey’ following exposure to the clinical practice environment. Background: Values based recruitment (VBR) incorporates assessment of healthcare students’ personal values using approaches like multiple mini interviews. Students’ experience of adjustment to their values during their programme is conceptualized as a ‘values journey’. The impact of VBR in alleviating erosion of personal values remains unclear. Design: A cross‐professional longitudinal cohort study was commenced at one university in England in 2016 with data collection points at the end of years one, two and three. Non‐probability consecutive sampling resulted in 42 healthcare students (8 adult, 8 child and 9 mental health nursing and 17 midwifery students) taking part. Methods: Six semi‐structured focus groups were conducted at the end of participants’ Year One (DC1). Data analysis incorporated inductive and deductive approaches in a hybrid synthesis. Findings: Participants described a ‘values journey’ where their values, particularly communication, courage and wanting to make a difference, were both challenged and retained. Participants personal journeys also acknowledged the: ‘courage it takes to use values’; ‘reality of values in practice’ and ‘need for self‐reflection on values’. Conclusion: A ‘values journey’ may begin early in a healthcare student's education programme. This is important to recognize so that appropriate interventions designed to support students in higher education and clinical practice can be implemented. The values incorporated in VBR should be continually evaluated for fitness for purpose. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To investigate how mentors form judgements and reach summative assessment decisions regarding student competence in practice. Background: Competence assessment is a significant component of pre‐registration nursing programmes in the United Kingdom. Concerns exist that assessments are subjective, lack consistency and that mentors fail to judge student performance as unsatisfactory. Design: A two‐stage sequential embedded mixed‐methods design. Data collected 2012–2013. Methods: This study involved a whole student cohort completing a UK undergraduate adult nursing programme (N = 41). Stage 1: quantitative data on mentor conduct of assessment interviews and the final decision recorded (N = 330 from 270 mentors) were extracted from student Practice Assessment Documents (PADs). Stage 2: mentor feedback in student PADs was used in Stimulated Recall interviews with a purposive sample of final placement mentors (N = 17). These were thematically analysed. Findings were integrated to develop a theoretically driven model of mentor decision‐making. Results: Course assessment strategies and documentation had limited effect in framing mentor judgements and decisions. Rather, mentors amassed impressions, moderated by expectations of an “idealized student” by practice area and programme stage that influenced their management and outcome of the assessment process. These impressions were accumulated and combined into judgements that informed the final decision. This process can best be understood and conceptualized through the Brunswik's lens model of social judgement. Conclusion: Mentor decisions were reasoned and there was a shared understanding of judgement criteria and their importance. This impression‐based nature of mentor decision‐making questions the reliability and validity of competency‐based assessments used in nursing pre‐registration programmes. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The aim of this study was to explore the experiences of Clinical Research Nurses, with an emphasis on factors that may have an impact on successful study delivery. Background: The Clinical Research Nurse workforce is pivotal to improving health outcomes through supporting research‐active health economies. Investment in research infrastructure has led to nurses and midwives increasingly undertaking extended roles to deliver clinical research. Despite such opportunities, the recruitment of sufficient participants into research studies remains problematic. A growing body of literature is exploring barriers to successful study delivery, indicating the emergence of a caring‐recruiting dichotomy in clinical research staff. Design: This qualitative study investigates the experiences of Clinical Research Nurses delivering research in the United Kingdom National Health Service. Methods: Four Focus groups (total 19 participants) were conducted in a large North East National Health Service Foundation Trust from November 2015 ‐ February 2016. Findings: Thematic analysis identified perceptions of the role in the wider context of professional identity. Role transition, altered relationships and workload complexity, affected participants’ practice, leading to inconsistency between core clinical values and perceived identities as research delivery staff. A duty of care as patient advocates contrasted elements of the work reflecting that of salespeople. The emotional labour of approaching patients and unease regarding peer perceptions of the Clinical Research Nurse role, affected the positive aspects of research delivery. Conclusion: Professional‐identity and self‐concept appear to have an impact on practice in a research delivery role. Further research should explore these issues further, to enlighten the basis on which such feelings are positioned and to work towards practical solutions. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To test the psychometric properties and clinical usability of a new Pressure Ulcer Risk Assessment Instrument including inter‐rater and test–retest reliability, convergent validity and data completeness. Background: Methodological and practical limitations associated with traditional Pressure Ulcer Risk Assessment Instruments, prompted a programme to work to develop a new instrument, as part of the National Institute for Health Research funded, Pressure UlceR Programme Of reSEarch (RP‐PG‐0407‐10056). Design: Observational field test. Method: For this clinical evaluation 230 patients were purposefully sampled across four broad levels of pressure ulcer risk with representation from four secondary care and four community NHS Trusts in England. Blinded and simultaneous paired (ward/community nurse and expert nurse) PURPOSE‐T assessments were undertaken. Follow‐up retest was undertaken by the expert nurse. Field notes of PURPOSE‐T use were collected. Data were collected October 2012–January 2013. Results: The clinical evaluation demonstrated “very good” (kappa) inter‐rater and test–retest agreement for PURPOSE‐T assessment decision overall. The percentage agreement for “problem/no problem” was over 75% for the main risk factors. Convergent validity demonstrated moderate to high associations with other measures of similar constructs. Conclusion: The PURPOSE‐T evaluation facilitated the initial validation and clinical usability of the instrument and demonstrated that PURPOSE‐T is suitable of use in clinical practice. Further study is needed to evaluate the impact of using the instrument on care processes and outcomes. [ABSTRACT FROM AUTHOR]

Aim This article is a report of a study protocol designed to examine patients' and families' knowledge and experiences of peritoneal dialysis-associated peritonitis. Background Peritonitis is a considerable problem for people using peritoneal dialysis, leading to antibiotics, hospitalization and decreased quality of life. For some patients, peritonitis requires changing renal replacement therapy and can be fatal. Peritonitis is distressing and some patients are unfamiliar with the signs and symptoms. Patients with better knowledge of peritonitis and adherence to peritoneal dialysis procedures have lower rates of peritonitis. Little is known about patients' and families' knowledge and experience of peritoneal dialysis-associated peritonitis in the United Kingdom. Design Ethical approval was gained in March 2017. To meet the study aim, a two-phase sequential explanatory mixed methods study is proposed. Methods Phase One: An author-developed questionnaire will be sent to patients using peritoneal dialysis at five sites in England and Wales. Patients will be asked to consider inviting a relative to participate. The questionnaire will assess peritonitis knowledge and experience. Data will be analysed statistically. Phase Two: Semi-structured interviews will be conducted with a purposive sample of Phase One participants ( n = 30) to explore their experiences of peritonitis in further depth. The data will be analysed thematically using Wolcott's (1994) approach. Discussion Data from the two phases will be synthesized to identify patients' and families' peritonitis information needs, to ensure they are appropriately supported to prevent, monitor, identify and report peritonitis. [ABSTRACT FROM AUTHOR]

Aims The aim of the study was to evaluate registered children's nurses' approaches to the assessment and management of withdrawal syndrome in children. Background Assessment of withdrawal syndrome is undertaken following critical illness when the child's condition may be unstable with competing differential diagnoses. Assessment tools aim to standardize and improve recognition of withdrawal syndrome. Making the right decisions in complex clinical situations requires a degree of mental effort and it is not known how nurses make decisions when undertaking withdrawal assessments. Design Cognitive interviews with clinical vignettes. Methods Interviews were undertaken with 12 nurses to explore the cognitive processes they used when assessing children using the Sedation Withdrawal Score (SWS) tool. Interviews took place in Autumn 2013. Findings Each stage of decision-making-noticing, interpreting and responding-presented cognitive challenges for nurses. When defining withdrawal behaviours nurses tended to blur the boundaries between Sedation Withdrawal Score signs. Challenges in interpreting behaviours arose from not knowing if the patient's behaviour was a result of withdrawal or other co-morbidities. Nurses gave a range of diagnoses when interpreting the vignettes, despite being provided with identical information. Treatment responses corresponded to definite withdrawal diagnoses, but varied when nurses were unsure of the diagnosis. Conclusion Cognitive interviews with vignettes provided insight into nurses' judgement and decision-making. The SWS does not standardize the assessment of withdrawal due to the complexity of the context where assessments take place and the difficulties of determining the cause of equivocal behaviours in children recovering from critical illness. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to explore the difficulties experienced by nurses and healthcare professionals when engaging in the process of breaking bad news. Background The challenges faced by staff when breaking bad news have previously been researched in relation to particular settings or participants. This study involved staff from diverse settings and roles to develop broader insights into the range of difficulties experienced in clinical practice. Design The study used a descriptive survey design involving self-reported written accounts and framework analysis. Methods Data were collected using a structured questionnaire containing a free text section that asked participants to describe a difficult experience they had encountered when involved in the process of breaking bad news. Data were collected from healthcare staff from hospital, community, hospice and care home settings attending training days on breaking bad news between April 2011 and April 2014. Findings Multiple inter-related factors presented challenges to staff engaging in activities associated with breaking bad news. Traditional subjects such as diagnostic and treatment information were described but additional topics were identified such as the impact of illness and care at the end of life. A descriptive framework was developed that summarizes the factors that contribute to creating difficult experiences for staff when breaking bad news. Conclusion The framework provides insights into the scope of the challenges faced by staff when they engage in the process of breaking bad news. This provides the foundation for developing interventions to support staff that more closely matches their experiences in clinical practice. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to explore the support worker functions in community mental health teams for older adults in relation to roles, boundaries, supervision and training. Background Support workers in community mental health teams provide important help to older people with complex mental and physical health needs in their own homes. Their numbers have grown substantially in recent years, but without professional registration there is concern that boundaries with qualified practitioners are insufficiently clear and that they do not receive the support they require. Design Qualitative research using interview data and thematic framework analysis investigated support workers' and registered practitioners' perspectives on roles, boundaries, supervision and training. Methods Semi-structured face-to-face interviews were undertaken in 2011, with 42 members of nine teams spread across England, including support workers and community mental health nurses. Coding of transcribed audio-recordings and subsequent analysis was undertaken by four researchers. Results Support workers undertook diverse roles and had considerable autonomy over their duties. Participants agreed about what tasks support workers should not undertake, yet there was evidence of 'negotiated' boundaries and examples of these being breached. Lines of authority were complex, yet support workers were supported through open communication with the wider team. Training was problematic, with few courses tailored for support workers and efforts towards formal qualification hindered by low pay and time pressures. Conclusion Local and national attention is needed to prevent 'drift' into activities that both support workers and registered practitioners consider outside their remit. Barriers to training and further qualification need to be addressed. [ABSTRACT FROM AUTHOR]