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ObjectivesThe objectives of this study were to examine post COVID-19 syndrome (PCS) among healthcare workers (HCWs) in England and explore risk factors for the condition.MethodsData were collected by National Health Service (NHS) CHECK, a longitudinal study exploring HCWs’ mental and physical well-being during and after the COVID-19 pandemic. NHS CHECK collected data at four timepoints: the baseline survey between April 2020 and January 2021, and then three follow-up surveys at approximately 6, 12 and 32 months post baseline. PCS data were collected at 12 and 32 months, while risk factor data were from baseline. HCWs were asked what COVID-19 symptoms they experienced and for how long and were classified as having PCS if they had any symptom for ≥12 weeks. Multilevel regressions were used to examine risk factors for PCS.ResultsThis study included 5248 HCWs. While 33.6% (n=1730) reported prolonged COVID-19 symptoms consistent with PCS, only 7.4% (n=385) reported a formal diagnosis of PCS. Fatigue, difficult concentrating, insomnia and anxiety or depression were the most common PCS symptoms. Baseline risk factors for reporting PCS included screening for common mental disorders, direct contact with COVID-19 patients, pre-existing respiratory illnesses, female sex and older age.ConclusionsWhile a third of HCWs reported prolonged COVID-19 symptoms consistent with PCS, a smaller percentage reported a formal diagnosis of the condition. We replicate findings that direct contact with COVID-19 patients, older age, female sex, pre-existing respiratory illness and symptoms of common mental disorders are associated with increased risk of PCS.

Purpose: To investigate ethnographically how patient experience data, as a named category in healthcare organisations, is actively “made” through the co-creative interactions of data, people and meanings in English hospitals. Design/methodology/approach: The authors draw on fieldnotes, interview recordings and transcripts produced from 13 months (2016–2017) of ethnographic research on patient experience data work at five acute English National Health Service (NHS) hospitals, including observation, chats, semi-structured interviews and documentary analysis. Research sites were selected based on performance in a national Adult Inpatient Survey, location, size, willingness to participate and research burden. Using an analytical approach inspired by actor–network theory (ANT), the authors examine how data acquired meanings and were made to act by clinical and administrative staff during a type of meeting called a “learning session” at one of the hospital study sites. Findings: The authors found that the processes of systematisation in healthcare organisations to act on patient feedback to improve to the quality of care, and involving frontline healthcare staff and their senior managers, produced shifting understandings of what counts as “data” and how to make changes in response to it. Their interactions produced multiple definitions of “experience”, “data” and “improvement” which came to co-exist in the same systematised encounter. Originality/value: The article's distinctive contribution is to analyse how patient experience data gain particular attributes. It suggests that healthcare organisations and researchers should recognise that acting on data in standardised ways will constantly create new definitions and possibilities of such data, escaping organisational and scholarly attempts at mastery.

10 years on from the publication of the Francis report, the nursing profession is facing unprecedented challenges; Robert Francis has recently sounded the alarm that the NHS is currently facing ‘the Mid Staffordshire scandal playing out on a national level’. In this perspective, we consider the opportunities missed in the last decade in the attempt to secure safe staffing in nursing.

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ObjectivesThis study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April–June) of the COVID-19 pandemic in the UK.MethodsPreliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale.ResultsAnalyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one’s moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse.ConclusionsOur findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.

:The shortage of nurses worldwide is a well-known issue that has changed the health and social workforce picture. Increased recruitment and migration of internationally educated nurses in the health and social care workforce pose many risks to successful integration into the healthcare system. Understanding the barriers and enablers affecting their integration in their host countries is imperative.

High-quality pre-registration student nurse training and development is integral to developing a sustainable and competent global nursing workforce. Internationally, student nurse recruitment rates have increased since the onset of the COVID-19 pandemic; however, attrition rates for student nurses are high. During the pandemic, many student nurses considered leaving the programme due to academic concerns, feeling overwhelmed, and doubting their clinical skills. Little was known about the extent to which nursing education prior to COVID-19 had prepared students for their role in managing the healthcare crisis or the impact on their resilience. Thus, this study aimed to explore how the COVID-19 pandemic impacted on the resilience levels of student nurses across the United Kingdom.

Supplemental digital content is available in the text.Incident reporting systems are being implemented globally, thus increasing the profile and prevalence of incidents, but the analysis of free-text descriptions remains largely hidden. The aims of the study were to explore the extent to which incident reports recorded staffing issues as contributors to medication administration incidents. Incident reports related to medication administration (N = 1012) were collected from two hospitals in Finland between January 1, 2013, and December 31, 2014. The SAS Enterprise Miner 13.2 and its Text Miner tool were used to excavate terms and descriptors and to uncover themes and concepts in the free-text descriptions of incidents with (n = 194) and without (n = 818) nurse staffing–related contributing factors. Text mining included (1) text parsing, (2) text filtering, and (3) modeling text clusters and text topics. The term “rush/hurry” was the sixth most common term used in incidents where nurse-staffing was identified as a contributing factor. Nurse-staffing factors, however, were not pronounced in clusters or in text topics of either data set. Text mining offers the opportunity to analyze large free-text mass and holds promise for providing insight into the antecedents of medication administration incidents.

Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures.

This paper considers the case for establishing a strategic fund for research in nursing, midwifery and health visiting, and for building capacity in the field. It reviews the key policy documents and staging posts in the process and argues that both professional push and policy pull factors have provided the key catalyst for change.The role and responsibilities of nurses, midwives and health visitors are increasing in the light of government policies and professional aspirations. An appropriate evidence base is essential to understanding, undertaking, commissioning and implementing research. Research capacity-building needs to be integrated into wider strategic plans for the profession, as well as R&D policy per se.Establishing a fund to develop high-calibre research is only the beginning of a much longer process to give nursing research greater influence. Researchers, educators, managers and clinicians need to join forces to build strong communities and strengthen their links with patient and user groups. However, the investment in nursing and midwifery R&D will have failed if it benefits the professional community only. Patient care needs to be part of what could be termed 'payback' for investment and it is essential to develop an evaluation strategy capable of measuring a range of impacts from the outset.

To examine the growth and diffusion through the USA and UK literature of nurses' claims to patient advocacy.

The need for access to a sustainable source of research funding in nursing has been a longstanding issue for debate and there has been intermittent support for the idea of a nursing research council. Although some have argued that a dedicated fund may lead to the marginalising of nursing research instead of a mainstreaming, recent UK government initiatives such as a focus on professional regulation and clinical governance reinforce the need for high-calibre research into nursing, midwifery and health visiting. A more secure funding base for nursing research could strengthen nursing's position in higher education, address issues of research capacity and problems over research careers as well as improve the focus of nursing research as a whole. Different options for research funding are considered and it is argued that a current policy convergence exists that makes arguments for a dedicated fund more compelling than hitherto.

The combined effects of the evidence-based movement, the introduction of the NHS research and development programme and policies intended to modernise the management of knowledge within the National Health Service have heightened the force of the 'implementation impulse' in research. New and experimental ways are being sought to close the conjunction between research and practice. Nurses are the key 'interface' workers in healthcare, therefore the NHS needs to create a research-rich nursing culture if it is to influence the quality and outcomes of patient care. Much depends upon the policies crafted to build capacity in areas of need and the conditions under which the conduct and commissioning of research operate. Nursing has been exercised by perceived 'barriers' to successful implementation of research for more than a decade. But rarely have discussions on the research-practice gap been informed by insights from research policy literature. The aim of this paper is to bring the two together: to use the insights from the one to interrogate the other. We conclude that the research policy literature provides a context and critique within which the new policy organs managing evidence within the NHS might be evaluated.

The aim of this paper is to provide a report of the progress made in the first phase of the national initiative established to identify priorities for R&D for the nursing professions, which was reported earlier in this journal (Kitson et al., 1997). Here we describe how the methods were used, discuss the primary and secondary results achieved in the first phase of the initiative and present an outline of how it is proposed to take these results forward in a second and more strategic phase. The aim of the first phase was to explore the feasibility of establishing a national systematic process for identifying priorities for R&D in the nursing professions*. It is now proposed to establish a strategic alliance for research in nursing, midwifery and health visiting and these proposals are summarised at the end of the paper.

A systematic literature search was undertaken and an annotated bibliography compiled on the effectiveness of alliances for health promotion. Nineteen databases were systematically searched according to a pre-specified search strategy using parts 1 and 2 of the Cochrane Search Strategy for controlled studies which generated 185 discrete references. Of the 110 published empirical studies that were identified, 19 involved macro-alliances and 91 micro-alliances. Studies involved lifestyle behav iours (n=47), reproductive health and parenting (n=20) or focused on disease (n=34). The methods used for the literature search and their considerations are presented in this paper along with a preliminary description of the studies retrieved. The method ological issues are discussed along with their implications and suggestions for further research and health policy.

This paper describes a national initiative to establish a co-ordinated and systematic method for identifying priorities for research and development, jointly set up by the Royal College of Nursing and the Centre for Policy in Nursing Research. It uses an explicit policy-making model described by Lomas1to outline the stages of the project. This model is also used to consider how nursing is influencing the current national clinical effectiveness and research and development agendas. Consideration is given as to whether the priority- setting exercise could make a difference to this wider policy agenda.

This paper considers two 'mapping' exercises designed to survey research activity within nursing, midwifery and health visiting as a means of ascertaining current strengths and weaknesses in the research capacity. Interviews with key opinion leaders and stakeholders of research have been and are being conducted. Two vignettes are included here for the range of views they express about research in terms of its strengths, weaknesses and opportunities for building capacity for research. One of the themes to emerge is the dominance of medicine as a reference point for analysis and the extent to which the problems of, and prospects for, nursing are shared with other groups. But an argument that follows from this is that fixing the 'gaze' upon medicine distracts researchers of nursing from looking to other disciplines for support and opportunities for coalition building. Prospects for research in nursing may have more in common with other groups who perceive themselves as being perched on the periphery of the dominant culture and therefore can be analysed within that framework.

In October 1994 nurse prescribing was launched for the first time in Britain in eight community demonstration sites. Using nurse prescribing as an illustration, this paper aims to explore the regulation of nursing and the influence of medicine on the expansion of the nurse's role. Arguing that professional development and regulation must be understood within the context of state control, the paper questions whether nurse prescribing represents a genuine development in nursing roles or is merely an act of tacit delegation by a medical profession which is itself subject to loss of autonomy. Recognising historical renegotiation in divisions of health-care labour, sections on the introduction of nurse prescribing; changing professional boundaries; and regulation in nursing, medicine and pharmacy, are used to critique nurse prescribing as an example of growing nursing professionalisation.

This paper presents some snapshot views of the problems of, and prospects for, developing a research culture in nursing. It argues that nursing research is enmeshed in political, social and gendered forces. Any achievement has to be set within the framework of nursing's relative youth and its own intellectual history within academe, along with the impact that different research traditions have exerted upon it. It is argued that lessons might be learned from models used to develop research in similar groups, for example by nurses in the USA or among social science researchers in this country.

The authors examine changing trends in the profile and patterns of employment of the workforce in hospitals in the National Health Service (NHS) in the United Kingdom. The effect of the implementation of the NHS reforms is considered, with particular reference to the changing composition of the nursing workforce. The authors note that there are problems with establishing trend data because of altered information requirements as a result of the NHS reforms.

OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Design Cross sectional surveys of patients and nurses. Setting Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. Participants 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. MAIN OUTCOME MEASURES: Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). RESULTS: The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. CONCLUSIONS: Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.

UK nursing research papers 1988–1995, classified by subject area and funding source, were compared with papers in a medical sub-field, anaesthetics research. By comparison with anaesthetics, nursing research papers are growing rapidly but mainly in subject areas related to the profession of nursing. Very few nursing research papers receive external funding, especially in these inward-looking or ‘endogenous’ subject areas. The esteem with which nursing research papers were held, both by researchers and practitioners, bore no relation to the citation scores of the journals. As nursing research matures, there will be a need to concentrate more on patient-oriented, or ‘exogenous’ research and new funding sources for this will have to be developed.