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Aims: A discussion of methodological issues and social media recruitment to a feasibility study to investigate mHealth resources for asthma and pregnancy care., Background: Pregnant women with asthma are reported to be poorly supported according to an international research. We sought to establish if a mHealth intervention might be feasible and acceptable to them., Design: A Phase I or modelling study., Methods: A project team designed an intervention to address UK national guidelines for the management of asthma during pregnancy, using other resources already accessible on the web. This was made available on a project website optimized for mobile phone usage. Links were Tweeted and advertised on Facebook, asking participants to access the project website, which included links to the resources and before- and after-use questionnaires to establish baseline symptom data and participant views of the resources., Results: Despite 55,700 Twitter impressions in a 76-day period over winter 2016-2017, this recruitment strategy garnered 402 engagements but only seven respondents for questionnaire 1 and zero respondents for questionnaire 2., Conclusions: We could not recruit to this study despite believing that social media recruitment would be effective and we recommend that social media recruitment be used cautiously. Apparently, we did not sufficiently address the theoretical aspects of communications theory and were not clear enough about our key messages. Publication bias may exist about the non-publication of other failed telemedicine studies using social media; this goes largely unreported in some systematic reviews and may influence researchers' decision-making about social media recruitment., (© 2018 John Wiley & Sons Ltd.)

This paper is the first in a series of two which reviews the contemporary British evidence-base relating to recovery in mental health over a 4-year period. This review uses a systematic approach analysing the British peer-reviewed literature relating to recovery and mental health. The second paper in the series reviews the non-peer-reviewed literature. Recovery is not a new concept; however, it has recently become increasingly prevalent in practitioner, policy and research discourses. In total 12 papers met the inclusion criteria. Five main themes emerged from the analysis: hope and optimism, meaning to life, activities promoting recovery, definitions and discourses and implications for mental health practice. By including only peer-reviewed literature this paper is in a strong position to analyse the theoretical development of the recovery concept and highlight future directions for recovery in mental health services., (© 2010 Blackwell Publishing.)

Over the last 10 years, the social inclusion agenda has been gaining momentum as a policy driver in mental health services. Prior to the seminal Social Exclusion Unit (SEU) report, Mental Health and Social Exclusion, there was a lack of awareness concerning the pervasive links between social exclusion and mental health problems. In the report, the SEU suggested that mental health practitioners themselves may actually be contributing to this social exclusion. This finding has been given limited coverage in both social inclusion literature and research. The current paper is a positioned commentary further exploring the relationship between practitioners and the social exclusion of mental health service users. A literature review was conducted in order to identify themes among factors which appear to moderate and contribute to this relationship. These factors are presented and implications for inclusive practice are explored.

Objective: A review of the use of computer collected audit data in assessing the quality of maternity services., Setting: All maternity units managed by the North West Thames Regional Health Authority., Recommendations: A system of audit must supply information that is both credible and of interest to clinicians managers and consumers. The information should be adjusted for differences in populations to allow valid comparisons between units. It needs to be presented in an easily digested form. One way of implementing audit would be to establish a regional group representative of clinicians, patients and managers who would initially interpret the data and make recommendations. A local group of similar composition would be asked to comment on and respond to these with a plan for the following year. Changes would be monitored by analysis of the routinely collected data., Conclusions: Medical audit in the maternity services requires new concepts if it is to influence the quality of clinical care and the use of resources available to provide that care. The appropriate balance needs to be found between the perspectives of clinicians, patients and managers. A major challenge is the collection of valid data. This has largely been overcome by the St Mary's maternity information system. The next stage is to devise a system of audit that is epidemiologically sound and is acceptable to those who will be asked to implement the lessons that emerge. Only then will it be possible to determine whether clinical practice and the use of resources can be altered to the benefit of patients.

Objectives: To describe antibiotic prescription by veterinarians in general practices in the United Kingdom before referral and analyse if UK antibiotic stewardship guidelines were followed., Materials and Methods: The clinical records from dogs and cats referred to the Internal Medicine and Oncology departments of two referral hospitals were retrospectively reviewed., Results: There were 917 cases included, of which 486 (53.0%) had been prescribed antibiotics for the presentation they were subsequently referred for. Bacterial culture or cytology to guide antibiotic prescription had been performed in 43 of 486 (8.8%) and nine of 486 cases (1.8%) respectively. In four cases, both cytology and culture were performed. For those animals who had received antibiotics, 344 of 486 (70.8%) prescriptions did not comply with UK antibiotic stewardship guidelines. Following investigations at a referral centre, a bacterial aetiology was found or suspected in 17.9% of the cases that received antibiotics., Clinical Significance: Use of diagnostics, including culture and cytology, to prove or determine the likelihood of a bacterial aetiology was infrequently performed before referral and may have contributed to overprescription of antibiotics. Encouraging veterinarians to undertake appropriate diagnostics, in combination with education around compliance with antibiotic stewardship guidelines, might reduce antibiotic prescription., (© 2023 British Small Animal Veterinary Association.)

Objectives: To understand the use, functionality and interoperability of laboratory information management systems (LIMS) in UK transfusion laboratories., Background: LIMS are widely used to support safe transfusion practice. LIMS have the potential to reduce the risk of laboratory error using algorithms, flags and alerts that support compliance with best practice guidelines and regulatory standards. Reporting to Serious Hazards of Transfusion (SHOT), the United Kingdom (UK) haemovigilance scheme, has identified cases where the LIMS could have prevented errors but did not. Shared care of patients across different organisations and the development of pathology networks has raised challenges relating to interoperability of IT systems both within, and between, organisations., Methods and Materials: A survey was distributed to all SHOT-reporting organisations to understand the current state of LIMS in the UK, prevalence of expertise in transfusion IT, and barriers to progress. Survey questions covered LIMS interoperability with other IT systems used in the healthcare setting., Results: A variety of LIMS and version numbers are in use in transfusion laboratories, LIMS are not always updated due to resource constraints. Respondents identified interoperability and improved functionality as the main requirements for transfusion safety., Conclusion: A nationally agreed set of minimum standards for transfusion LIMS is required for safe practice. Adequate resources, training and expertise should be provided to support the effective use and timely updates of LIMS. A single LIMS solution should be in place for transfusion laboratories working within a network and interoperability with other systems should be explored to further improve practice., (© 2023 British Blood Transfusion Society.)

Aim: To analyse the current status and publication trends of funded studies in nursing-related research from 2008 to 2018, available in the Web of Science., Design: A longitudinal bibliometric analysis of publications of funded studies in nursing-related research, obtained from the Web of Science, was conducted., Methods: On 10 May 2019, we accessed 77,772 funded studies (2008-2018) from the Web of Science. Bibliometric methods and indicators were used to classify the publications and summarize the overall number, countries/regions, institutions, journals, and other parameters of the publications., Results: The global output of nursing-related funded research publications increased significantly over time. The three leading countries with the highest number of funded publications were the United States, Australia, and the United Kingdom, with the United States accounting for 15 of the top 20 institutions associated with funded publications, which mostly included institutions of higher education. The most common disciplines of these publications were oncology, psychiatry, and paediatrics. The top three journals that published the largest number of nursing-related funded publications were the Journal of Clinical Nursing, the Journal of Advanced Nursing, and the International Journal of Nursing Studies. Keywords with the highest frequency of occurrence included "nurses," "qualitative research," "older people," "quality of life," "depression," "cancer," and "children.", Conclusions: Nursing-related research has been drawing increasing attention over the years. Analysing the output of funded publications and monitoring the new dynamics of the international development of academic research in the field of nursing are crucial for determining future directions of nursing-related research development., Impact: The results of this study will provide a reference for scholars to evaluate the current utilization efficiency of global nursing-related research funding and demonstrate the development and trends in nursing-related research., (© 2020 John Wiley & Sons Ltd.)

Aims and Objectives: Surveillance of wound infection including signs of infection alongside antimicrobial usage (types, duration, frequency) can highlight knowledge gaps and inconsistencies. This manuscript aims to highlight these, identify and inform opportunities for practice improvement and to show impact of infection management practice may be having on the issue of antimicrobial resistance., Background: Infected wounds pose challenges to healthcare professionals. Balancing risk of wound deterioration and progression to systemic infection with appropriate use of antimicrobials is necessary to minimise development of resistance., Methods: Analysis consisted of a practice survey of 9661 wounds across 70 community sites over a period of one week. Data were collected from projects between 2017 and 2020. The form was available to providers within the UK, Ireland, Norway, Denmark, Sweden and Finland. EQUATOR research guidelines were followed; STROBE checklist for observational research reporting was completed., Results: Infection rates of 8.9% were reported from wounds assessed. These data indicate inconsistencies with diagnosis across practice with non-specialists more likely to be unsure of wound infection. Greater confidence in infection identification was observed as number of signs increased. Inconsistencies were also observed in appropriate treatment; antimicrobials were used in 35% of wounds considered not infected and not used in 41% of wounds that were identified as infected., Conclusions: This investigation of infection management practice of over 9000 wounds provides an insight into diagnosis and treatment of infection. Inconsistencies in diagnosis and treatment of wound infections reported highlight the need for increased education, awareness of diagnosis and treatment of infection., Relevance to Clinical Practice: Variability in management of infected wounds highlights opportunities to aid more effective diagnosis and treatment of infected wounds. Incorporation of support tools or evidence-based pathways into practice may enhance confidence in management of local infection, balanced with appropriate use, potentially minimising resistance and improving outcomes., (© 2022 John Wiley & Sons Ltd.)

Aims and Objectives: To illustrate the scope of different types of transitional, community-based health interventions for formerly incarcerated women, trans and nonbinary people, the eligibility criteria for these interventions, and associated health outcomes., Background: Meeting the health needs of formerly incarcerated people in community, rather than through the criminal justice system, may prevent further experiences of criminalization. Research is needed to understand what community-based health interventions have been implemented internationally to inform the design of an intervention in Canada., Design: Scoping review using the Joanna Briggs Institute scoping review methodology., Methods: In consultation with a medical research librarian, key databases and journals were searched for English language articles, from any country, with no specified date range. Three authors independently screened titles and abstracts to identify articles for full-text review. The study adheres to PRISMA-EQUATOR guidelines., Results: Thirty-six studies met the present criteria and were reviewed in full text. Method, setting, participants, sample, relevant outcomes and relevant findings were extracted from each study for synthesis. Included studies had varied methods and were published from 1999 to 2020. Thirty-one studies were based in the United States, one in Puerto Rico and two each in Canada and the United Kingdom. The most common health issue focus was human immunodeficiency virus and/or hepatitis c virus. The most common outcome was uptake of offered services, such as a transitional clinic., Conclusions: Gaps in the research pertain to a lack of attention to clinical outcomes and patient experience, and a lack of consideration of sexual and reproductive health concerns. Women were the minority population in all studies that included both men and women; transgender participants were mentioned in only four of thirty-six studies. The specific needs of women, trans and nonbinary people must be taken into consideration., Relevance to Clinical Practice: Nurses must be conscious of the elevated health risks associated with exposure to correctional institutions and the risks associated with the period of transition., Patient or Public Contribution: A member of the research team brings lived experience expertise with respect to the criminal justice system., (© 2022 John Wiley & Sons Ltd.)

Aim: To critically appraise and synthesise the current evidence related to the advanced practice nurse (APN) in the children and young people's healthcare setting., Background: A complex landscape of demand and change has influenced the healthcare delivery for children and young people. In the United Kingdom and internationally, governments have endorsed the need for workforce innovation with APN roles introduced to counter these challenges. However, little is known about the impact of these initiatives in the context of children and young people's health care., Design: Systematic review and narrative summary., Data Sources: CINAHL, MEDLINE, DARE, PubMed, Prospero and Cochrane Database of Systematic Reviews were searched for studies published in English language from July 1998 to 2018. Studies were selected based on key search terms and eligibility criteria., Review Methods: The selected studies were appraised using the Effective Public Health Practice Project for quantitative studies. An adapted version of the JBI data extraction tool for experimental/observational studies was used to extract the relevant key findings. This was conducted independently by two researchers., Results: Nine studies were included in the review. The review demonstrated roles were comparable in their clinical practice to medics yet offered higher levels of patient satisfaction, role modelling for staff and led practice initiatives to improve health literacy., Conclusion: This review demonstrates that APN roles in children and young people's health care provide clinical, organizational and professional benefits, with added value to organizations and patients, acting as role models and educators., Impact: The findings from this review indicate further research is required to ascertain contextual issues that may influence the implementation of APNs. This research will impact APNs working with children and young people. Equally, it supports the evidence base for service commissioners outlining areas for future research., (© 2019 John Wiley & Sons Ltd.)

Aim: The aim of this study was to examine the relationship between welfare states and nursing professionalization indicators., Design: We used a time-series, cross-sectional design. The analysis covered 16 years and 22 countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, South Korea, Spain, Sweden, Switzerland, United Kingdom, and the United States, allocated to five welfare state regimes: Social Democratic, Christian Democratic, Liberal, Authoritarian Conservative, and Confucian., Methods: We used fixed-effects linear regression models and conducted Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction. We applied the Amelia II multiple imputation strategy to replace missing observations. Data were collected from March-December 2017 and subsequently updated from August-September 2018., Results: Our findings highlight positive connections between the regulated nurse and nurse graduate ratios and welfare state measures of education, health, and family policy. In addition, both outcome variables had averages that differed among welfare state regimes, the lowest being in Authoritarian Conservative regimes., Conclusion: Additional country-level and international comparative research is needed to further study the impact of a wide range of structural political and economic determinants of nursing professionalization., Impact: We examined the effects of welfare state characteristics on nursing professionalization indicators and found support for the claim that such features affect both the regulated nurse and nurse graduate ratios. These findings could be used to strengthen nursing and the nursing workforce through healthy public policies and increase the accuracy of health human resources forecasting tools., (© 2019 John Wiley & Sons Ltd.)

Background: The incidence of thyroid cancer is increasing globally due to the increase in detection of subclinical, low volume papillary thyroid microcarcinomas (PTMC) (<1 cm). Several international groups have recommended an active surveillance approach for this low-risk disease. In contrast to many other countries, the United Kingdom's (UK's) approach to thyroid nodules is to avoid detection of incidental lesions where appropriate., Objective: This study aims to establish the proportion of patients with thyroid cancer in the UK that would benefit from active surveillance., Design, Participants, and Outcome Measures: Individuals with PTMC in NHS Lothian from 2009-2020 were reviewed from a local thyroid cancer database. The mode of detection of PTMC and proportion of patients who might benefit from active surveillance were established., Results: From 651 individuals with differentiated thyroid cancer managed over 12-year period, 185 individuals with PTMC were identified (28.4%). The majority of PTMC 151/185 (81.6%) were either diagnosed post-operatively following thyroidectomy for benign disease or with nodal disease. Only 24 individuals with PTMC were identified following palpable thyroid nodule, incidental finding on imaging, and surveillance screening. Therefore, when the indication for surgery was considered, only 24/651 (3.7%) patients were identified pre-operatively and would, therefore, be realistic candidates for active surveillance., Conclusion: Less than 4% of patients with thyroid cancer in the UK would be appropriate for active surveillance. Rather than developing programmes to deal with this minority of patients, focus should be maintained on minimising detection of these low-risk cases., (© 2022 John Wiley & Sons Ltd.)

Pollen food syndrome (PFS) is a highly prevalent food allergy affecting pollen-sensitized children and adults. Sufferers experience allergic symptoms when consuming raw plant foods, due to the homology between the pollen allergens and unstable proteins in these foods. The triggers involved can vary depending on the pollen sensitization, which in turn is affected by geographical location. The British Society of Allergy and Clinical Immunology (BSACI) Standards of Care Committee (SOCC) identified a need to develop a guideline for the diagnosis and management of PFS in the United Kingdom (UK). Guidelines produced by the BSACI use either the GRADE or SIGN methodology; due to a lack of high-quality evidence these recommendations were formulated using the SIGN guidelines, which is acknowledged to be less robust than the GRADE approach. The correct diagnosis of PFS ensures the avoidance of a misdiagnosis of a primary peanut or tree nut allergy or confusion with another plant food allergy to non-specific lipid transfer proteins. The characteristic foods involved, and rapid-onset oropharyngeal symptoms, mean PFS can often be diagnosed from the clinical history alone. However, reactions involving tree nuts, peanuts and soya milk or severe/atypical reactions to fruits and vegetables may require additional diagnostic tests. Management is through the exclusion of known trigger foods, which may appear to be simple, but is highly problematic if coupled with a pre-existing food allergy or for individuals following a vegetarian/vegan diet. Immunotherapy to pollens is not an effective treatment for PFS, and although oral or sublingual immunotherapy to foods seems more promising, large, controlled studies are needed. The typically mild symptoms of PFS can lead to an erroneous perception that this condition is always easily managed, but severe reactions can occur, and anxiety about the onset of symptoms to new foods can have a profound effect on quality of life., (© 2022 John Wiley & Sons Ltd.)

Background: Living with a life threatening/limiting condition changes and challenges children's play. The environment is known to support participation in play, yet there is a lack of evidence highlighting its specific factors contributing to children's play. In this study, we investigated the perspectives of children living with life threatening/limiting conditions with regard to the environmental factors that are related to their engagement in play whilst receiving inpatient healthcare., Methods: Twenty-seven children took part in this study. Participants were aged between 5 and 11 years, diagnosed with life threatening/limiting conditions and were receiving care at either a children's hospital or hospice in either Kuwait or the United Kingdom. Children were asked to rank-order a Q set according to their perceived importance. The used Q set composed of social and physical environmental factors. The data were analysed using factor analysis and content analysis., Findings: Two shared viewpoints were identified, which represented children from both countries. For Factor 1, the children's need for social connectivity guided their answers regarding the environmental factors. For Factor 2, although children considered being surrounded by others important, their selections of the play conditions directed their play. For both factors, children had relatively little concern for outdoor and the type of play to engage in, with the exception of arts and crafts play activities, which were deemed important., Conclusions: Play settings are important to support rich, social play experiences and opportunities that match children's play preferences. Children living with life threatening/limiting conditions in Kuwait and the United Kingdom have relatively similar play needs., (© 2021 John Wiley & Sons, Ltd.)

Aim: To investigate attitudes and approaches of UK primary care dentists to carrying out vital pulp treatment (VPT) after carious exposure and with additional signs and symptoms indicative of irreversible pulpitis., Methodology: An electronic questionnaire was openly distributed via publicly funded (NHS) local dental committees, corporate dental service-providers, professional societies and social media. Principally NHS practitioners and those from mixed and private practice were targeted, in addition to community and military dental officers, and dental therapists. Participants were asked questions relating to several clinical scenarios, with responses analysed using descriptive statistics. χ 2 tests with sequential Bonferroni correction were used to explore variables including the method of remuneration, practitioner type (dentist/therapist), postgraduate qualification(s), place of graduation and years since qualification. Variables with a relationship p ≤ .2 were selected for backwards likelihood ratio logistic modelling., Results: In total, 648 primary care practitioners were included for analysis. Calcium hydroxide (CH) was most frequently used for direct pulp caps (DPCs) (398/600; 66.3%) with calcium silicate cements (CSCs) less frequently used (119/600; 19.8%). Rubber dam was used by 222/599 (37.1%) practitioners. A definitive pulpotomy for the management of teeth with signs and symptoms indicative of irreversible pulpitis was selected by 65/613 (10.6%) dentists. The principal barrier for the provision of definitive pulpotomies was a lack of training (602/612; 98.4%). Regression analysis identified NHS practitioners as a good predictor for using CH for DPCs, having shorter emergency appointments, limited access to magnification and not using rubber dam. Non-UK graduates were more likely to select CSCs, appropriately control pulpal haemorrhage, undertake appropriate postoperative evaluation and use rubber dam., Conclusions: Practitioners deviated from evidence-based guidelines in a number of aspects including material selection, asepsis and case selection. A number of other challenges exist in primary care in providing predictable VPTs, including lack of time and access to magnification. These were most evident in NHS practice, potentially exacerbating existing social health inequalities. Possible inconsistencies in the UK undergraduate curriculum were supported by a lack of association between years since qualification and technique employed as well as the fact that non-UK graduates and dentists with postgraduate qualifications adhered more to evidence-based VPT guidelines., (© 2021 British Endodontic Society. Published by John Wiley & Sons Ltd.)

Background: The incidence of pressure injury/ulcers is persistent despite multiple prevention strategies in hospitals across the globe. Current standard of pressure injury/ulcer care supported by subjective skin tissue assessments, risk assessment tools and clinical judgement is ineffective in consistent pressure injury/ulcer prevention., Aim: A pragmatic study, aligning with SQUIRE guidelines, was conducted at Chelsea and Westminster hospitals to measure the impact of adding scanning technology to the prevailing standard of care pathway on the incidence of category 2-4 hospital-acquired pressure injury/ulcers., Methods: Six hundred and ninety-seven mixed-population patients at risk for pressure injuries/ulcers with a Waterlow score of ≥10 and a mean age ≥65 years were enrolled across four wards over a 6-month period. Scanning technology was added to the prevailing standard of care as a device adjunctive to clinical judgement for the detection of deep and early-stage pressure-induced tissue damage. Ward staff completed comprehensive device training by the device manufacturer. Clinical interventions were initiated by clinical judgement informed by injury/ulcer risk assessments, skin and tissue assessments and scanner readings. Incidence of reportable category 2-4 pressure injuries/ulcers from the prior 12-month period from the same wards were used as a control comparator population. All diagnosed category 2-4 pressure injuries/ulcers, unstageable and deep-tissue injuries were recorded., Results: Prior study 12-month pressure injury/ulcer incidence was 0.6% (5/892 patients) in ward A, 4.4% (9/206 patients) in Ward B, 1.1% (12/1,123 patients) in Ward C and 2.6% (16/625 patients) in Ward D. Two pressure injury/ulcers in Ward B were recorded during the study. Zero pressure injuries/ulcers were recorded in the remaining three wards resulting in an 81% incidence reduction across all four wards. Improved clinical decisions from clinical judgement based on Sub-Epidermal Moisture (SEM) Scanner data were reported in 83% patients (n=578/697)., Conclusion: Implementing scanning technology into routine clinical practice achieves consistent reductions in pressure injury/ulcer incidence., (© 2021 John Wiley & Sons Ltd.)

Background: Maternal iodine requirements increase during pregnancy to supply thyroid hormones critical for fetal neurodevelopment. Iodine insufficiency may result in poorer cognitive or child educational outcomes but current evidence is sparse and inconsistent., Objectives: To quantify the association between maternal iodine status and child educational outcomes., Methods: Urinary iodine concentrations (UIC) and iodine/creatinine ratios (I:Cr) were measured in 6971 mothers at 26-28 weeks' gestation participating in the Born in Bradford cohort. Maternal iodine status was examined in relation to child school achievement (early years foundation stage (EYFS), phonics, and Key Stage 1 (KS1)), other learning outcomes, social and behavioural difficulties, and sensorimotor control in 5745 children aged 4-7 years., Results: Median (interquartile range) UIC was 76 µg/L (46, 120), and I:Cr was 83 µg/g (59, 121). Overall, there was no strong or consistent evidence to support associations between UIC or I:Cr and neurodevelopmental outcomes. For instance, predicted EYFS and phonics scores (primary outcomes) at the 25th vs 75th I:Cr percentiles (99% confidence intervals) were similar, with no evidence of associations: EYFS scores were 32 (99% CI 31, 33) and 33 (99% CI 32, 34), and phonics scores were 34 (99% CI 33, 35) and 35 (99% CI 34, 36), respectively., Conclusions: In the largest single study of its kind, there was little evidence of detrimental neurodevelopmental outcomes in children born to pregnant women with iodine insufficiency as defined by World Health Organization-outlined thresholds. Alternative functional biomarkers for iodine status in pregnancy and focused assessment of other health outcomes may provide additional insight., (© 2020 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd.)

Objective: This study aims to investigate the variations in publicly available nasal irrigation recipes published in the United Kingdom (UK)., Design: Internet searches used to identify eligible nasal irrigation recipes. These were then examined for their physical and biochemical properties, through theoretical calculations and experimental measurement., Setting: Recipes produced by healthcare providers or official national bodies in the UK., Participants: No human participants., Main Outcome Measures: Solution osmolality (classified into hypo-, iso- and hypertonic), acidity (pH) and specific gravity., Results: Thirteen unique recipes were identified from 17 sources. Osmolality ranged from 166.2 to 1492.2 mosmol/kg in volumes ranging from 142 to 1136 mLs (isotonic range 275-295 mosmol/kg). Specific gravity ranged from 1.006 to 1.034. pH ranged from 7.74 to 8.11. No recipe produced a solution with isotonic properties. The majority produced hypertonic irrigations., Conclusions: Most publicly available nasal irrigation recipes produce hypertonic solutions but there is great variability in the osmolality and volume. UK organisations should take action to review published recipes to bring these into alignment with latest guidelines (recommending against hypertonic saline use) and reduce variability in patient interpretations., (© 2020 John Wiley & Sons Ltd.)

Aims and Objectives: This paper presents findings from a hermeneutical study which sought to explore how registered nurses experienced and perceived their professional accountability in clinical settings., Background: Professional accountability encompasses the ideals and standards of nursing practice. Nurses are accountable for their actions under civil, criminal and contract law to their; employing organisation, their regulatory body and the patients for whom they care., Design: This paper reports on a Heideggerian hermeneutical study involving seven registered nurses, working in clinical practice in the National Health Service in the United Kingdom. Methods The study adopted purposive sampling, collecting data by means of in-depth interviews. Data were analysed using the hermeneutic circle. COREQ checklist was used as a reporting guideline for this study., Results: The findings suggest that professional accountability in nursing practice is a complex phenomenon, which can be compromised by many factors which are historically, socially or politically driven Participants experienced challenges through a lack of resources and poor managerial support, which compromised their ability to deliver high-quality patient care. However, collegiality strongly impacted upon resilience and positively influenced their well-being., Relevance to Clinical Practice: Amid the challenges of the clinical workplace, a positive workplace culture with visible managerial support is a fundamental requirement in supporting professional accountability, development and retention of nurses. Findings highlight the view that leadership should be seen as a collective responsibility, which empowers staff to positively change the practice environment., (© 2020 John Wiley & Sons Ltd.)

Aim: This survey explored caregivers' perceived training needs in 5 European countries (United Kingdom, Greece, Bulgaria, Poland and Italy)., Background: Training can enhance the professional capacity of caregivers; however, caregivers' training needs within Europe have not been examined recently., Methods: A survey conducted in 2015 captured data from 550 caregivers using a convenience sampling strategy, through a structured questionnaire and additional open-ended items and by conducting statistical and content analysis., Results: The results indicated basic nursing skills and specialization, as well as training in psychology-related skills like time management, emotion regulation, communication and advanced health care systems as the emerging training needs. There were some country differences in specific training need areas., Conclusions: It was concluded that training in basic nursing skills and specialization in nursing specific conditions, in advanced health care systems and in psychology-related skills could add to the professional capacity of European caregivers employed in health and social care., Implications for Nursing Management: The findings inform about employed caregivers' training needs in Europe, which may contribute in the provision of quality care and organisational efficiency in health and social care., (© 2020 John Wiley & Sons Ltd.)

Background: The UK National Institute for Health and Care Excellence (NICE) clinical guidelines recommends the following steps in the transition from child to adult services for young people with attention deficit hyperactivity disorder (ADHD): reassessment before and after transition, transition planning, formal meeting between services, and involvement from young person and carer, completed by age 18., Methods: A UK surveillance study asked clinicians to report young people on their caseloads with ADHD in need of transition to adult services in 2016 to support their continued access to medication need. Clinicians reported young people as they aged to within 6 months of the transition boundary, a prospective questionnaire prior to transition asked about intended transition and the use of local transition protocols. A retrospective questionnaire sent 9 months later established which steps recommended by NICE were followed during transition. Clinicians (38) working in child or adult services were interviewed about their experiences of transition and the use of NICE guidelines during transition and were analysed using a framework approach., Results: Information was shared between services in 85% of the 315 identified transition cases. A joint meeting was planned in 16% of cases; joint working before transfer occurred in 10% of cases. Clinicians were aware of NICE guidelines; they had mixed views on whether (local) guidelines or protocols were helpful. The main reason for not following guidelines was workload and resources: "NICE recommends stuff that is miles above what we will ever be able to provide"., Conclusions: Clinicians involved in the transition process of young people with ADHD judged NICE guidelines to be unrealistic given the current limited resources and service organization. More open dialogue is needed for recommendations on service models to bridge the gap between guideline recommendations and what is viewed as feasible and how implementation of guidance is funded, monitored, and prioritized. This may lead to valuable changes in the consultation process, for example, consideration of a layered (gold, standard, and minimal) system for some NICE guidelines., (© 2019 John Wiley & Sons Ltd.)

Aims: To synthesize qualitative evidence of mental health patients' treatment-related experiences of softer coercion and its effect on their interactions with practitioners., Background: Coercion is controversial but global in mental health care. It ranges from softer to harder forms, but less attention is given in the literature to softer coercion., Design: Qualitative thematic synthesis examining patients' experiences of softer coercion., Data Sources: Electronic databases searched from inception to September 2015 and further updated January 2018., Review Methods: Thematic synthesis of 11 UK/Irish articles, quality appraised using the Critical Appraisal Skills Programme tool., Results: Three analytic themes were developed: Losing a sense of self, Less than therapeutic relationship, and Journey through treatment., Conclusion: Softer coercion is experienced across mental health care in a context of broader coercion., (© 2019 John Wiley & Sons Ltd.)

This paper examines the gender-power relations in heterosexual relationships and discusses the implications for women in attempting to negotiate safer sex. Whilst acknowledging the need for examining both male and female perceptions of sexuality, the paucity of research on men's heterosexual experiences has restricted this paper to the consideration of the woman's standpoint. Reviewing the literature, the complexities of sexual relationships are explored in terms of the power imbalance which arises from the ideologies of femininity and masculinity. The implications for safer sex promotion by practice nurses working in primary health care teams are then discussed within the context of gender divisions of labour and gender role conflict.

WHAT IS KNOWN ON THE SUBJECT?: Inpatient mental health settings pose unique challenges for patient safety, in part because psychiatric disorders are well-known risk factors for self-harm and suicide. Ward staff follow protocols to try and keep patients safe including carrying out in-person safety checks, usually every 15 min, but patients unfortunately still find opportunities to harm themselves. A vision-based patient monitoring system (VBPMS) is a contact-free technology that can help mental health nurses to monitor patients in hospital more effectively. For example, the tool alerts staff to situations where a patient might need assistance, like when they spend a long period of time in their ensuite bathroom. Research has shown that the VBPMS can support staff to prevent safety incidents from occurring and a recent study found a decrease in self-harm after the tool was implemented at one NHS mental health trust. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This paper presents data from five NHS mental health trusts and suggests that the VBPMS can consistently help staff to prevent self-harm on acute mental health wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Managing self-harm behaviours is a challenge for mental health nursing staff. Standard safety protocols are not effective enough - staff need new ways to monitor patients. In general hospitals, technology is used every day to support care. This research shows that the VBPMS can be used to improve patient safety in mental health hospitals. ABSTRACT: Introduction Self-harm is sadly relatively common in mental health inpatient settings, and the effectiveness and appropriateness of strategies used to prevent it have long been disputed. The use of vision-based patient monitoring systems (VBPMS) has been shown to improve various safety outcomes. Their potential to support staff in preventing inpatient self-harm warrants further exploration. Aim This research investigated whether implementing a VBPMS-as an adjunct to existing clinical practice-within acute inpatient services at five NHS England mental health trusts led to reductions in self-harm. Method Five quasi-experimental studies assessed the number of bedroom self-harm incidents, across 12 adult wards, before and 5-12 months after a VBPMS was deployed. Percentage changes were calculated. Four studies used control groups and were included in a fixed-effect meta-analysis. Results In the meta-analysis, a significant inverse-weighted average relative risk percentage change of -38.9% was recorded. For the study with no control groups, reductions in self-harm were seen across all wards (range: -9.1% to -29.8%). Discussion This research demonstrates that VBPMS can support clinicians to create safer ward environments by preventing incidents of self-harm from occurring. Implications for Practice The results provide preliminary support for wider rollout of the technology on acute mental health wards., (© 2024 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: At the outset of the COVID-19 pandemic, little was known about ways of delivering registered nurse practice within CMHTs under restrictions associated with a global pandemic. Emerging research focused on broad healthcare staff wellbeing during the pandemic. Qualitative research explored the overall response of COVID-19 on people with existing health needs or remote working more specifically. Over the past 2 years studies have emerged detailing experiences but no studies have used qualitative research to understand community mental health nurses and service users experience of services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This co-produced qualitative study is the first to explore the changes to CMHT care from the experience of service users and nurses later in the COVID-19 pandemic. The study questions whether recovery-based approaches are possible in a hybrid way of working. The findings identify challenges for nurses' well-being and work-life boundaries when working from home. The study adds to historical professional narratives of mental health nursing. WHAT ARE THE IMPLICATIONS FOR PRACTICE: While hybrid approaches developed in response to COVID-19 restrictions may offer more choice these approaches need further co-produced evaluation on the impact of recovery-focused care and therapeutic relationships. Mental health nurses need to review how future hybrid working continues to impact nurses' mental health and emotional safety. Nurses and service users need to raise awareness within society and policy on the impact that COVID-19 had on people with existing mental health conditions. ABSTRACT: Introduction Community Mental Health Team responses to COVID-19 included fundamental service delivery adaptations. Aim/Question Our co-produced study sought to understand which service delivery changes experienced by service users and registered nurses were helpful or unhelpful to caregiving and receiving. Method Qualitative semi-structured interviews were undertaken with 10 service users and 13 registered nurses from 3 NHS England sites. Co-produced throughout, people with lived experience of mental health services and nurses wishing to improve their research experience undertook interviews following training. Data were analysed thematically. Findings Care radically changed from in-person to large phone or video contact. This reportedly altered therapeutic relationship building and raised questions about whether recovery-focused care was possible. Hybrid working was viewed as helpful but raised challenges for nurse wellbeing. Discussion Changes to care delivery challenged the fundamentals of recovery-focused interventions and therapeutic relationships. Service users and nurses well-being consequently suffered. The impact of the pandemic on people with existing mental health conditions was poorly acknowledged in the media. Implications for Practice Recovery-focused interventions and relationship building need evaluating in the light of ongoing hybrid working. Teams need to consider the well-being of nurses engaged in complex service-user interactions from home., (© 2023 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Introduction: The role of the clinical nurse specialist is complex but is defined differently across the world. The role of clinical nurse specialist stoma care is undefined and it is uncertain what aspects of the role are included in the general day-to-day working role., Aims: The aim was to gain consensus opinion to answer the research question: 'What is the role of the clinical nurse specialist in stoma care?', Design: Delphi consensus., Methods: Previous data gained from a scoping review and expert consultation was utilized to form role statements. At a UK conference the 13 statements and 173 sub-categories were voted upon. Consensus was agreed if 75% of voters voted agree or strongly agree. Two stages of voting occurred with results from the first vote being shared in the second voting session., Results: All 13 statement and most (150/193) statement sub-categories reached consensus, with 20 sub-categories added during voting session one., Conclusions: The four pillars of advanced practice were met by the 13 statements with clinical and education reaching higher consensus and agreement than leadership/management and research. The results of the consensus study provide a clearer articulation of the clinical nurse specialist stoma care role, which is complex and multifaceted which has not been described previously., Implications for Practice: Consideration of role evolution is made possible, to gain a greater expertise in the scope of practice it is necessary to include prescribing, management and research which could improve service delivery and optimize patient outcomes. There was no patient or public contribution, which in hindsight would have potentially improved the process but it was considered that patients might not recognize the full role of the nurse, understanding only aspects of the role that were patient-centred., Patient or Public Contribution: No patients or public were involved in any aspect of this paper-in hindsight this might have been useful., (© 2023 John Wiley & Sons Ltd.)

Background: Children and young people (CYP) with complex neurodisability experience multiple physical, communication, educational and social challenges, which require complex packages of multidisciplinary care. Part of the holistic care required includes supporting the families and parents/caregivers. The aim of the wider study was to introduce a new programme ('Ubuntu') to parents/caregivers and healthcare professionals (HCPs) in order to test the feasibility and acceptability of the concept and content, with the goal of potential adaptation for the UK in mind. Data collection and analysis uncovered rich data on caregiving journeys, navigation of health services, and perceived service gaps. This paper focuses solely on these topics. Further papers will report on the feasibility and adaptation data., Methods: Two rounds of semi-structured interviews were conducted with 12 caregivers of CYP with complex neurodisability and six HCPs from a variety of disciplines, recruited from a community child health service in London Borough of Newham, UK in 2020. The interviews included open-ended questions to explore caregiving journeys, experiences of navigating health services and perceived service gaps. Transcripts were analysed using a data-driven inductive thematic analysis., Results: Three themes were identified that related to the aim of understanding caregivers' experiences and unmet needs relating to current service provision. These were (1) Caregiver Mental Health, (2) The Information Gap and (3) The Need for Holistic Support. Mental health difficulties were reported, particularly around the period of diagnosis. Priority needs included the provision of clear information about the diagnosis and services offered, opportunities to forge peer support networks and for services across the community to collaborate., Conclusions: The delivery of health services for CYP with neurodisability should encompass the broad needs of the family as well as meeting the clinical needs of the CYP., (© 2024 The Author(s). Child: Care, Health and Development published by John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: Co-production aims to value service user voices and is increasingly used in healthcare. Less is known about how co-production in nursing education is experienced by service users. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper shares the experience of one service user who teaches student nurses in a UK university. For the first author, the paper highlights that co-producing nurse education has been valuable and rewarding for both a service user and students. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Co-production has the potential to benefit student nurses, including challenging their perceptions of 'difficult' patients. To achieve this, teaching sessions must be equally produced and delivered. By employing and including service users, universities have the potential to improve experiences for students and service users alike. ABSTRACT: Introduction Co-production is increasingly used in health care but there is less attention to a co-produced mental health nurse education. Aim This article sought to explore the co-production experiences of a service user who teaches mental health nurses, alongside the benefits of this to nurse education. Methods The article is a lived experience narrative co-written with a nursing lecturer. Thesis Co-produced mental health nurse education challenges students' perceptions towards self-harm and encourages empathy and understanding of service user distress. Implications for Practice Co-production has many benefits to nurse education including a positive student experience, and validation of the service user experience to support meaningful recovery., (© 2024 John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: Many studies have investigated the attitudes of mental health nurses towards a range of targets. These targets are person-oriented (for example groups of people with a similar mental health diagnosis) or practice-oriented (for example practices such as seclusion or restraint). It is thought that attitudes contribute to the practice of mental health nurses because research suggests attitudes have a role in shaping behaviour. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To date, research about mental health nurses' attitudes has examined different attitudes in isolation from one another. By demonstrating a lack of connectedness across studies this paper highlights the need for new theory-informed approaches to attitudinal research. By standardizing measurements across different studies this review demonstrates that the most negatively appraised attitudinal targets-indicated by large proportions of respondents who appraise negatively-concern people with diagnoses of borderline personality disorder, substance misuse, and acute mental health presentations. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Significant numbers of mental health nurses may have attitudes, especially towards people with borderline personality diagnoses and those who misuse substances, that may not be concordant with good practice. There is insufficient evidence about what the actual implications this has for practice because the body of relevant research lacks coherence, interconnectedness and a grounding in contemporary theoretical developments. Training programmes that focus on attitudinal change need to be more rigorously evaluated. ABSTRACT: Introduction Attitudes are considered integral to mental health nursing practice. Aims To comprehensively describe the (i) measured attitudes of UK mental health nurses towards people and practice; (ii) effectiveness of interventions to change attitudes; and (iii) relationships between their attitudes, other variables/constructs and practice. Methods Using systematic review methodology, multiple databases (CINAHL, Scopus, PsycINFO, Web of Science Core Collection, Google Scholar) were searched. Eligible studies involved measurement of UK-based mental health nurses' attitudes with multi-item scales. Studies were quality appraised, mean (SD) attitudinal data were standardized, and other results converted to standardized effect sizes. Results N = 42 studies were included. Negatively appraised attitudinal targets were people with a borderline personality disorder diagnosis, substance misuse, and acute mental health presentations. Educational interventions were associated with immediate increases in positive appraisals but sustainability was poorly evidenced. There was very limited study of attitude-practice links. Discussion This review identifies priority attitudinal targets for action but also demonstrates that future work must consider the interconnectedness of attitudes and their relationship with practice. Implications for Practice Priority areas for consideration are attitudes to borderline personality disorder, substance misuse and mental health co-morbidity. Addressing disparities between nurses' attitudes and those of service users is important. More robust research is required into the effectiveness of interventions to change attitudes and into attitude-practice links., (© 2022 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Aims: This is the second of two papers conceptualizing emotional labour in the emergency department (ED). This paper aims to understand the environmental 'moderators' of ED nurses' emotional labour., Design: Ethnography, through an interpretivist philosophy, enabled immersion in the ED setting, gathering the lived experiences and narratives of the ED nurses., Methods: Observation and semi-structured interviews over a 6-month period. Two hospital sites (one district general and one major trauma centre based in the United Kingdom., Results: Over 200 h of observation plus 18 formal/semi-structured interviews were completed. Environmental, institutional and organizational dynamics of the emergency department instrumented the emotional labour undertaken by the nursing team. Time and space were found to be 'moderators' of ED nurses' emotional labour. This paper focusses on the relevance of space and in particular, 'excessive visibility' with little respite for the nurses from their intense emotional performance., Conclusion: Emotional labour is critical to staff well-being and the way in which healthcare spaces are designed has an impact on emotional labour. Understanding how emotional labour is moderated in different clinical settings can inform organizational, environmental and workforce-related decision-making., (© 2022 John Wiley & Sons Ltd.)

Aims: The aim of this study was to explore the impact of the pandemic on the emotional and mental well-being of family carers, care home staff and residents, in light of changing restrictions, increased testing and vaccination rollout in the UK., Design: Longitudinal, qualitative semi-structured interview study., Methods: Remote semi-structured interviews were conducted with family carers of care home residents with dementia and care home staff from different care homes across the UK. Baseline and follow-up interviews were conducted in October/November 2020 and March 2021, respectively. Data were analysed using inductive thematic analysis involving members of the public with caring experiences., Results: In all, 42 family carers and care home staff participated at baseline, with 20 family carers and staff followed up. We identified four themes: (1) Developing anger and frustration; (2) Impact on relationships; (3) Stress and burnout; and (4) Behavioural changes, and perceived impact on residents. The mental health of everyone involved, including family carers, care home staff and residents, has been negatively affected, and relationships between family carers and staff have been severely strained. There was a general lack of adequate mental health support, with little relief., Conclusions: The pandemic has had a detrimental impact on the lives of those surrounding care homes-from residents and staff to family carers. Consideration should be given on how to best support the mental health needs of all three groups, by providing adequate easily accessible mental health care for all. This should also focus on rebuilding the relationships between family carers and care home staff., Impact: This is the first paper to highlight the effects of the long-lasting and miscommunicated restrictions on residents, carers and care home staff, and highlight the urgent need for continued mental health support., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aims and Objectives: To explore moral distress empirically and conceptually, to understand the factors that mitigate and exacerbate moral distress and construct a model that represents how moral distress relates to its constituent parts and related concepts., Background: There is ongoing debate about how to understand and respond to moral distress in nursing practice., Design: The overarching design was feminist empirical bioethics in which feminist interpretive phenomenology provided the tools for data collection and analysis, reported following the COREQ guidelines. Using reflexive balancing, the empirical data were combined with feminist theory to produce normative recommendations about how to respond to moral distress. The Moral Distress Model presented in this paper is a culmination of the empirical data and theory., Methods: Using feminist interpretive phenomenology, critical care nurses in the United Kingdom (n = 21) were interviewed and data analysed. Reflexive Balancing was used to integrate the data with feminist theory to provide normative recommendations about how to understand moral distress., Results: There are five compounding factors that exacerbate/ mitigate nurses' experiences of moral distress: epistemic injustice; the roster lottery; conflict between one's professional and personal responsibilities; ability to advocate and team dynamics. In addition to the causal connection and responses to moral distress, these factors make up the moral distress model which can guide approaches to mitigate moral distress., Conclusions: The Moral Distress Model is the culmination of these data and theorising formulated into a construct to explain how each element interacts. We propose that this model can be used to inform the design of interventions to address moral distress., (© 2021 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: Dementia affects an increasing number of people and a person with dementia requires significant levels of care. Dementia care is often delivered by family members. Caring for someone with dementia places significant demand on the carer and support for the carer is often needed. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Research has been conducted into caregivers' experiences of caring for someone with dementia, but a synthesis of findings for studies from the UK is needed to collate the research evidence and provide an account of the common trends within the existing research. This paper adds to existing knowledge by highlighting the key difficulties experienced by carers of a person with dementia in their caring role and their experiences with support services across the existing research evidence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Improvements to the process of dementia assessment and the process of receiving a dementia diagnosis are needed. Information and support needs to be more accessible for the carer of a person with dementia Cultural differences need to be acknowledged in the support and information offered to carers of a person with dementia. ABSTRACT: Aim To understand the experiences of informal carers' of individuals with dementia in the UK when engaging with services for support in their caring role. Methods Following the PRISMA guidelines, a qualitative systematic literature review was carried out. Six Internet databases were searched. Results were screened, and eligible studies were appraised using Critical Appraisal Skills Programme (CASP, 2019) and data synthesized using Evan & Pearson (2001) and Evans (2002). Results The search returned 231 records, 11 were selected for critical appraisal and data synthesis. Four main themes (information for carers, process of diagnosing dementia, difficulties accessing support and cultural differences of experiences of services) were extracted. Discussion Carers experience services as providing inadequate support for the Person with Dementia (PwD) and themselves for support relating to dementia. Difficulties in receiving information and support were experienced from before diagnosis to end-of-life (EoL) care. Additionally, cultural differences were found in carers' experiences. Implications for practice The provision of and access to dementia support should be improved; more information for carers about dementia and dementia services is needed; cultural differences need to be appreciated in the support and information offered., (© 2020 John Wiley & Sons Ltd.)

Background: Advancing physical therapy interventions for children and young people is a high research priority. This includes research to describe and specify the control condition, typically 'current care', for effectiveness trials. This paper aims to identify physical therapy outcomes commonly targeted, and intervention techniques and approaches commonly used, by physiotherapists working with children (aged 2-19 years) with mobility limitations in the United Kingdom., Methods: A cross-sectional survey. Participants were recruited through the interactive Chartered Society of Physiotherapy members-only online discussion forum, the Association of Paediatric Chartered Physiotherapists, direct emails and snowball sampling within the authors' professional networks and Twitter. Data were collected using a structured online questionnaire and analysed using descriptive statistics., Results: We received 146 responses, 95/146 (65.1%) of which were fully complete. Therapists reported targeting 367 unique outcome constructs, of which 193 (52.6%) mapped onto activities and participation (e.g. moving around using equipment, maintaining body position and walking), 158 (43.1%) on body functions (e.g. muscle strength, joint mobility and gait functions), 11 (3.0%) on body structure (e.g. muscle length) and 3 (0.8%) on environmental factors (e.g. access home environment, access school environment and family confidence). The most commonly used interventions related to postural management (115/133 of respondents, 86.4%) and exercise therapy (116/137, 84.67%) and included techniques such as 'use equipment' (118/137, 86.1%), 'instruct how to do something' (117/137, 85.4%), 'practice' (105/137, 76.6%) and 'stretch' (99/137, 72.3%)., Conclusions: In designing trials, current care can be described as a combination of biomechanical and physiological techniques and approaches targeted at body functions and through that to activity and participation. Although some environmental behaviour change techniques and strategies were reported, the explicit use of these in current care appears limited., (© 2021 John Wiley & Sons Ltd.)

Aims and Objectives: To review interventions and strategies designed to progress UK clinical academic career pathways in nursing and identify barriers and facilitators to aid wider implementation., Background: For over a decade, the UK political agenda has promoted the entry of nurses into clinical academic roles. Partnerships between the National Health Service and academia are known to increase nursing recruitment, retention and quality of care. However, there remains a lack of nurses working in these partnership roles., Design: A systematised review was conducted. An electronic database search was carried out in PubMed, CINAHL, the British Nursing Database and PsychInfo for articles published between September 2006 to June 2020. A narrative approach to data synthesis was used, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed., Results: Ten papers were included in the review. The authors reported a range of programmes, pathways and toolkits. Pathway outcome measures included numbers of nurses recruited onto clinical academic programmes, clinical academic programmes completed, nursing research outputs, impact on clinical practice and impact on nursing recruitment. Barriers and facilitators to pathway development included funding, clinical and research time constraints, infrastructure, strong and strategic clinical academic leadership and effective partnership working. The quality of the included studies was mixed; more high-quality, evidence-based programmes need to be developed and rigorously evaluated., Conclusions: The findings can inform nursing clinical academic research pathway development internationally, by identifying key drivers for success. Sustained and cohesive implementation of clinical academic research pathways is lacking across the UK., Relevance to Clinical Practice: Strong, strategic leadership is required to enable progression of clinical academic nursing research pathway opportunities. Clinical nursing practitioners need to collaborate with external partners to enable development of clinical academic pathways within the nursing profession; this can lead to improvements in patient care and high-quality clinical outcomes., (© 2021 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: During the COVID-19 pandemic, there has been research considering the impact on medical healthcare professionals and the mental health needs of the general population. However, limited focus has been placed on mental health services or mental health staff providing care in the community and in hospitals. While nurses make up the largest section of the mental health workforce in the UK, the impact that this pandemic has had on their work has been largely ignored. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides a unique insight into the experiences and impact that the COVID-19 pandemic has had on mental health nurses across a range of community and inpatient settings to understand what has changed in their work and the care they can and do provide during this crisis. This includes exploring how services have changed, the move to remote working, the impact of the protective equipment crisis on nurses and the difficult working conditions facing those in inpatient settings where there is minimal guidance provided. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: By understanding the impact the pandemic has had on mental health nursing care, we can understand the gaps in guidance that exist, the challenges being faced and the impact the crisis has had on care for mental health service users. By doing so, we can plan for the ongoing nature of this pandemic and the aftermath that the crisis may leave for our service users and workforce alike. ABSTRACT: Introduction While evidence has emerged concerning the impact of COVID-19 on the general population and the challenges facing health services, much less is known regarding how the pandemic has directly affected the delivery of mental health nursing care. Aim This paper aimed to explore how COVID-19 has affected the ability of mental health nurses to deliver care in community and inpatient mental health services in the UK. Method We investigated staff reports regarding the impact of the COVID-19 pandemic on mental healthcare and mental health service users in the UK, using a mixed-methods online survey. A total of 897 nurses across a range of inpatient and community settings participated. Discussion Key themes within the data explore the following: new ways of working; remote working; risks of infection/infection control challenges; and the impact on service users. Targeted guidelines are required to support mental health nurses providing care and support during a pandemic to people in severe mental distress, often in unsuitable environments. Implications for Practice Service developments need to occur alongside tailored guidance and support for staff welfare supported by clear leadership. These findings identify areas requiring attention and investment to prepare for future crises and the consequences of the pandemic., (© 2021 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: More people experience withdrawal symptoms when weaning off antidepressants than previously thought; particularly after taking them for a long time. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: I explore my own experience of weaning off antidepressants; detailing conflicting advice I have received from healthcare professionals, and the mental and physical withdrawal symptoms I experienced. I relate my experiences to a growing body of research, which have important implications for improving care. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Healthcare professionals should make patients aware of potential withdrawal symptoms they may experience before they wean off antidepressants; regularly review their progress; consider helping them access psychological support whilst weaning off; and engage in open and collaborative conversations with patients throughout. Clinical guidance needs to be updated to provide appropriate evidence-based information/advice/recommendations for how best to support patients when coming off of antidepressants. ABSTRACT: A significant proportion of the UK population are taking antidepressants, and have been taking them for at least a year. Clinical guidelines have controversially stated that withdrawal symptoms when weaning off antidepressants are mild and resolve after one week, with the proviso that they can be severe only if the drug is stopped abruptly. However, recent evidence suggests this is not the case. I describe my own experiences of tapering the dose of my antidepressants after several years of taking them. I describe my encounters with healthcare professionals throughout this period, detailing conflicting advice I have received, along with describing the mental and physical withdrawal symptoms I have experienced. My experiences relate to a growing body of research, which have important implications for improving care. Potential learning outcomes are that healthcare professionals should make patients aware of potential withdrawal symptoms they may experience before they wean off antidepressants; regularly review their progress; consider helping them access psychological support whilst weaning off; and engage in open and collaborative conversations with patients throughout the process. Clinical guidance needs to be updated to provide appropriate evidence-based information, advice, and recommendations for how best to support patients when coming off of antidepressants., (© 2020 John Wiley & Sons Ltd.)

Aim and Objective: To explore older people's initial experience of household isolation, social distancing and shielding, and the plans they constructed to support them through the COVID-19 pandemic., Background: Public health guidance for those aged 70 or older was predominantly to undertake stringent social distancing within their household. Little is known about older people's experience of these measures. This paper explores changes experienced by those over the age of 70 during the first two weeks of household isolation, social distancing and shielding in the UK and the Republic of Ireland, and their early perceptions and plans to support them through the pandemic., Methods: An inductive phenomenological study. University staff posted the study invitation flyer on social media, such as WhatsApp neighbourhood groups, the Nextdoor App and Twitter. Qualitative semi-structured interviews were undertaken with 19 participants and repeated at 2-week intervals for 10 weeks; further data collection is still in progress. This paper presents the findings from the baseline interviews, which showed older peoples' early responses. The COREQ (COnsolidated criteria for REporting Qualitative research) checklist was adhered to in the reporting of this study., Results: Three themes emerged from older people's early experiences of social distancing: protective measures; current and future plans; and acceptance of a good life, but still a life to live., Conclusion: People over 70 adapted to household isolation, social distancing and shielding, by using social media and neighbourhood resources. Nurses and other professionals can develop holistic care for older people by listening to their experiences of what works for them, helping them link to local and distant supports. Understanding the holistic life view of older people, including death anxiety, is an important element of care planning; to help older people access the protective resources, they need to reduce the serious risks associated with coronavirus., Relevance to Clinical Practice: Older people engage with social media, and during the current pandemic and beyond nurses can engage with this medium to communicate with older people. The importance of nurses to understand some older people consider quality of life to be more important than longevity, which may impact on their adherence to health advice., (© 2020 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Aim and Objective: To identify training strategies and determine how registered health and social care practitioners change their practice after Mental Capacity Act training., Design: Narrative literature review., Data Sources: Seventeen databases were searched up to December 2019: CINAHL, Social Care Online, PubMed, Social Policy and Practice, Discover, MEDLINE, Science Direct, Ovid, 0of Science, British Nursing Index, DH-Data and King's Fund Library Catalogue., Review Methods: Empirical studies of any design investigating Mental Capacity Act training were searched and screened. Data were extracted to a bespoke spreadsheet and quality assessed. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)., Results: Of 162 papers identified, 16 were included comprising qualitative, quantitative and mixed-methods studies. Trainees valued interactive training with close alignment to practice. Training did not lead to demonstrable practice change. Barriers in the context and cultures of care environments were identified., Conclusion: To facilitate application of Mental Capacity Act legislation, identified barriers should be addressed. Future training should be interactive, scenario-based and relevant to trainees' practice., Relevance to Clinical Practice: The Mental Capacity Act is widely misunderstood and implemented poor. Training is proposed as a solution, but the nature of training that will positively affect practice remains unknown. This review aims to address this gap in the evidence base. Interactive training, using scenarios that reflect practice complexities, has the most positive impact. Cultural norms in care environments may impede application of this legislation. The review has international relevance as there is a global imperative to adhere to the United Nations Convention on the Rights of Persons with Disabilities. The review will inform training design and delivery to ensure that people with impaired capacity to make decisions are given the best opportunity to act autonomously., (© 2020 John Wiley & Sons Ltd.)

Objectives: This paper aims to provide contemporary epidemiological data on squamous cell carcinoma (SCC) of the nasal cavity, which represents a rare type of head and neck cancer., Design, Setting & Participants: A descriptive analysis of people with nasal cavity SCC treated with curative intent from the Head and Neck 5000 study; a multicentre clinical cohort study of people from the UK with head and neck cancer. People with tumours of the nasopharynx, paranasal sinuses and other sub-sites of the head and neck were excluded., Main Outcome Measures: Demographic data and treatment details are presented for all participants. The main outcomes were overall survival and survival according to categories of characteristics (eg, smoker vs non-smoker); these were explored using Kaplan-Meier plots., Results: Thirty people with nasal cavity SCC were included in the study, of which most were male (67%) and current or ex-smokers (70%). The majority (70%) presented with early-stage (T1/2, N0) tumours. Cervical lymph node metastases at presentation were rare, occurring in only one person. Nine people died during the follow-up period (30%). Worse survival outcomes were seen in people with moderate or severe co-morbidities., Conclusions: This paper provides epidemiological data on nasal cavity SCC in the UK. Patterns of disease and survival outcomes are described, identifying high-risk groups. Further studies should explore whether primary treatment modality alters survival., (© 2019 John Wiley & Sons Ltd.)

Research over the past 20 years has demonstrated the significant impact food allergy can have on quality of life and mental health of patients and their families, yet there is a paucity of psychological services to support families in coping with this condition. This paper provides a short overview of the psychological impact of food allergy, followed by a discussion of the use of paediatric psychological services for long-term conditions. To our knowledge, few paediatric allergy clinics in the UK have funding for dedicated clinical psychology services. Two such services are based at Southampton General Hospital and the Evelina London Children's Hospital. This paper includes descriptions of these services and how they are currently being used by patients and families. This is followed by an allergy clinician's perspective on the use of psychological services. Recommendations are made for allergy services to work with hospital psychology services to develop, integrate and deliver psychological services for all patients with allergy and their families who are in need. Future research also needs to focus on the efficacy of psychological therapies and group interventions in food allergy., (© 2019 John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: People with a diagnosis of personality disorder often experience stigma both outside of, and within, mental health services. The media contribute to people's understanding of mental health issues, and negative portrayals appear to lead to increased negative attitudes in readers. Relatively little is known about how the press represent personality disorder, and the types of messages that people with this disorder may be receiving, which may impact on their understanding of themselves and emotional well-being. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The key findings indicate that in a 10-year period, the representation of personality disorder in the popular tabloid press in the UK was characterized by the frequent use of language of violence. The research approach enabled the study to identify significant patterns in the language used, rather than only using a checklist of words that the press are directed to avoid. This adds to our understanding about the images repeatedly presented that may affect how readers treat people with a diagnosis of personality disorder and affect the self-esteem of those with the diagnosis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses are well placed to address issues of stigma both in terms of the general public's beliefs and the impact it has on those who use mental health services. A greater understanding of the messages in the press can help nurses to support service users who are vulnerable to believing that their lives will start to reflect the negative messages they have read. ABSTRACT: Introduction Many people with a diagnosis of personality disorder experience stigma, and the press' representations may contribute to those processes. To date, little is known about how the press write about people with personality disorder and analysis of language used is often limited to checklists of words to avoid. Aim The aim of the study was to explore the linguistic characteristics of press articles about personality disorder in popular tabloids in the UK and consider the implications for stigmatization. Method Corpus linguistics was used to examine a 50% sample of all articles published by the popular press in the UK, from 2008 to 2017, that referred to personality disorder (n = 260). Results The findings identified a range of words that constructed narratives of violence. Discussion The method enabled the findings to expand the current level of knowledge in the field, identifying patterns in the use of the language of violence, which may contribute to the processes of self-stigma. Implications for practice Greater understanding of the messages in the press can sensitize nurses to common misconceptions about the disorder, how these may have become internalised and the need for psycho-social interventions to address the impact of self-stigma on self-esteem., (© 2019 John Wiley & Sons Ltd.)

Aims: This study is the first to systematically document histological features of fractures of known age in infants (≦12 months). It has been used to develop a tabulated database specifically to guide histopathologists to age fractures in children considered to have suffered accidental or non-accidental injury (NAI). Currently in the United Kingdom there are insufficient pathologists with experience in histological ageing of fractures to meet the medicolegal need for this examination. This study provides a practical tool that will allow those skilled paediatric and forensic pathologists currently involved in assessing infants for evidence of accidental or non-accidental injury a basis for extending their assessment into this area of unmet need., Methods and Results: One hundred and sixty-nine fractures of known age at death were obtained from 52 anonymised infants over a period of 32 years (1985-2016 inclusive). Sections stained using haematoxylin and eosin (H&E) and Martius scarlet blue (MSB) were used to identify specific histological features and to relate them to fracture age. In 1999 the data were entered into a tabulated database for fractures accumulated between from 1985 to 1998 inclusive. Thereafter cases were added, and at 2-yearly intervals the accumulated data were audited against the previous database and adjustments made., Conclusions: This paper describes the final data set from the 2017 audit. The study was terminated at the end of 2016, as there had been no material changes in the data set for three consecutive audits., (© 2019 Authors. Histopathology Published by John Wiley & Sons Ltd.)

Aim: To evaluate the delivery of undergraduate endodontic education in UK dental schools using an online survey and to compare the results with those of a previous paper-based survey (Qualtrough & Dummer 1997, Int Endod J, 30, 234). Aspects of delivery were also evaluated in comparison with the Undergraduate Curriculum Guidelines of the European Society of Endodontology (de Moor et al. 2013, Int Endod J, 46, 1105)., Methodology: An online version of an earlier paper-based survey on undergraduate Endodontic education (Qualtrough & Dummer 1997, Int Endod J, 30, 234) was created. Invitations to take part were sent via email to the undergraduate endodontic programme leads in the 16 UK dental schools., Results: The response rate was 94%. The current survey revealed greater convergence amongst dental schools than previously (Qualtrough & Dummer 1997, Int Endod J, 30, 234) on methods of canal preparation, disinfection and filling. Improvements were also noted in staff: student ratios, the involvement of teachers with advanced endodontic training and a greater diversity of teaching methods; developments which align with the recommendations of ESE Undergraduate Curriculum Guidelines (de Moor et al. 2013, Int Endod J, 46, 1105). The majority of schools appeared to be teaching contemporary instrumentation methods and were recommending the application of calcium silicate cements. The exposure of students to advanced topics included in the ESE Undergraduate Curriculum Guidelines (de Moor et al. 2013, Int Endod J, 46, 1105) such as surgical endodontic treatment, root canal re-treatment and the management of complex cases was mixed., Conclusion: Undergraduate endodontic training in the UK has advanced in the last 20 years with more consistency between schools and more contemporary methods adopted., (© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd.)