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Schizophrenia is a global concern, and, this paper, describes the caring roles of health professionals who are mothers of adult children with schizophrenia. A thematic analysis of data from a doctoral study identified a blending of expertise into an informed care model. Caring roles included: constant carer; coordinator carer; watchful bystander carer; and life coach carer. Previous research has not explored these dual roles. This paper elucidates their responsive approaches and contributions to mothering and caregiving roles. Informed by a fusion of professional and mothering knowledges, their insights into mental health care have been forged by their experiences and is an untapped resource. [ABSTRACT FROM AUTHOR]

Scotland is faced with pernicious health inequalities, which stem from inequalities in living conditions and the societal structures that create them. While action is needed to address the wider structural causes of health inequalities, the role of general practitioners (GPs) merits attention due to health care's potential to mitigate or exacerbate health inequalities. Minimal research, however, has explored how GPs understand the fundamental causes of health inequalities nor how they conceptualise their role in mitigating these. This paper aims to fill this gap using in-depth qualitative interviews with 24 GPs working in some of Scotland's most socio-economically disadvantaged, urban areas. Using Raphael's SDH discourse framework, this paper found clear linkages between GPs' perceptions of their patients, how they defined the 'problem' of health inequalities, and what they thought could be done to tackle them in disadvantaged areas. In general, there was convergence on how interviewees viewed their role in mitigating health inequalities through their work with individual patients. However, greater variation was found when describing the boundaries of their role and how far these extended beyond individual encounters. Specifically, only those GPs fluent in discussing structural causes of health inequalities discussed obligations to change local systems via strengthening community linkages and to influence higher level policies related to the SDH. This suggests that while there is a degree of what Metzl and Hansen deem 'structural competency' amongst some GPs working in disadvantaged areas, the scope remains to deepen this competency more broadly. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Internationally, health technology assessments ( HTAs) are ubiquitous drivers to health policy. Within Scotland, the Scottish Medicines Consortium undertakes the medicine review process. Input from clinical experts, involved in frontline care, is an integral component of the assessment process. This paper explores the relationship between the clinical experts and the HTA agency within Scotland to better understand what motivates expert clinicians to devote their time to the medicine review process with no remuneration. Methods Twenty-seven clinical experts from 16 different clinical specialties took part in one-to-one interviews at their place of work between October 2011 and March 2012. Data analysis was inductive and comprised the organization of data into a framework and a subsequent thematic analysis. Results Three distinct themes were identified: (1) recruitment, which identified two types of explanations for the experts' appointment: external justification (nominated by another) and internal justification (being recognized as an expert); (2) flexibility of the procedures, with experts able to determine their own response style and negotiate timelines; (3) health care systems, demonstrating that their affiliation to the health system underpinned the relationship and their motivation to be clinical experts. Conclusions The findings of this study provide insight into the elements important to clinicians who voluntarily contribute to HTA processes. Examination of these elements in the context of the organizational citizenship behavior literature provides a foundation on which to improve understanding of this relationship and sustain and improve clinical expert participation in an increasingly intensified clinical environment and within cash-limited HTA systems. [ABSTRACT FROM AUTHOR]

Aim: To evaluate Advanced Nurse Practitioner (ANP) role implementation in primary care across Scotland in contributing to primary care transformation, and establish what works, for whom, why and in what context. Design: A realist evaluation using multiple case studies. Methods: Two phases, conducted March 2017 to May 2018: (1) multiple case studies of ANP implementation in 15 health boards across Scotland, deductive thematic analysis of interviews, documentary analysis; (2) in‐depth case studies of five health boards, framework analysis of interviews and focus groups. Results: Sixty‐eight informants were interviewed, and 72 documents were reviewed across both phases. ANP roles involved substitution for elements of the GP role for minor illness and injuries, across all ages. In rural areas ANPs undertook multiple nursing roles, were more autonomous and managed greater complexity. Mechanisms that facilitated implementation included: the national ANP definition; GP, primary care team and public engagement; funding for ANP education; and experienced GP supervisors. Contexts that affected mechanisms were national and local leadership; remote, rural and island communities; and workload challenges. Small‐scale evaluations indicated that ANPs: make appropriate decisions; improve patient access and experience. Conclusions: At the time of the evaluation, the implementation of ANP roles in primary care in Scotland was in early stages. Capacity to train ANPs in a service already under pressure was challenging. Shifting elements of GPs workload to ANPs freed up GPs but did little to transform primary care. Local evaluations provided some evidence that ANPs were delivering high‐quality primary care services and enhanced primary care services to nursing homes or home visits. Impact ANP roles can be implemented with greater success and have more potential to transform primary care when the mechanisms include leadership at all levels, ANP roles that value advanced nursing knowledge, and appropriate education programmes delivered in the context of multidisciplinary collaboration. [ABSTRACT FROM AUTHOR]

In the UK, transformation of the nursing workforce, including development of the role of the advanced nurse practitioner within general practice, is essential to meet healthcare demands. This article presents the results of a small, qualitative study conducted among students at one university in Scotland, describing their experiences of participation in advanced practice education. Data were collected through semi-structured interviews to generate in-depth descriptions and to identify the facilitators and barriers to learning. The study identified that a shared responsibility for patient care creates opportunities for learning. The facilitators to learning were identified as foundation level education in history taking and clinical examination, finance, having a supportive network and mentorship. Barriers included pressure of work and a lack of clarity about roles and training needs. Given the key role that these nurses will have in future healthcare models, there is a requirement for a national education standard. It is recommended that the Nursing and Midwifery Council leads on defining advanced nurse practitioner in general practice programme learning outcomes. The overall aim of such courses is to enhance the experience for future nurses to encourage recruitment and transform the nursing workforce. [ABSTRACT FROM AUTHOR]