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Aim: To gain a deeper understanding of what is important to nurses when thinking about shift patterns and the organisation of working time. Design: A cross‐sectional survey of nursing staff working across the UK and Ireland collected quantitative and qualitative responses. Methods: We recruited from two National Health Service Trusts and through an open call via trade union membership, online/print nursing profession magazines and social media. Worked versus preferred shift length/pattern, satisfaction and choice over shift patterns and nurses' views on aspects related to work and life (when working short, long, rotating shifts) were analysed with comparisons of proportions of agreement and crosstabulation. Qualitative responses on important factors related to shift preferences were analysed with inductive thematic analysis. Results: Eight hundred and seventy‐three survey responses were collected. When nurses worked long shifts and rotating shifts, lower proportions reported being satisfied with their shifts and working their preferred shift length and pattern. Limited advantages were realised when comparing different shift types; however, respondents more frequently associated 'low travel costs' and 'better ability to do paid overtime' with long shifts and 'healthy diet/exercise' with short shifts; aspects related to rotating shifts often had the lowest proportions of agreement. In the qualitative analysis, three themes were developed: 'When I want to work', 'Impacts to my life outside work' and 'Improving my work environment'. Reasons for nurses' shift preferences were frequently related to nurses' priorities outside of work, highlighting the importance of organising schedules that support a good work‐life balance. Relevance to Clinical Practice: General scheduling practices like adhering to existing shift work guidelines, using consistent and predictable shift patterns and facilitating flexibility over working time were identified by nurses as enablers for their preferences and priorities. These practices warrant meaningful consideration when establishing safe and efficient nurse rosters. Patient or Public Contribution: This survey was developed and tested with a diverse group of stakeholders, including nursing staff, patients, union leads and ward managers. Reporting Method: The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross‐sectional studies was used to guide reporting. [ABSTRACT FROM AUTHOR]

Aim and Objectives: The aim of this study was to investigate current advanced practice Masters students' experience of clinical supervision, to explore how clinical supervision works in practice and to identify students' perceptions of the facilitators and barriers to clinical supervision in their workplace. Background: Advanced practitioners, and in particular nurses, play a pivotal role in delivering health care across acute and primary care settings. These non‐medical professionals fulfil a rapidly expanding proportion of roles traditionally undertaken by medically qualified staff within the National Health Service in the United Kingdom and often lead specialist clinics and services. To prepare for the advanced practice role, individuals are required to undertake a Master's in advanced practice to develop the required skills and knowledge and work in clinical practice with a clinical assessor/supervisor to demonstrate competence and performance. Design: A mixed method study using an online descriptive cross‐sectional survey and qualitative data were collected via focus groups and has been reported using the Good Reporting of a Mixed Methods Study checklist. Results: A total of 79 students completed the online survey (from 145 AP students), a response rate of 55%. Most respondents were nurses (n = 73) with 49 (62%) in a formal advanced practice trainee role, and the majority believed their clinical supervisor had a good understanding of advanced practice and the advanced practice role. Two focus groups were held with 16 participants in total. Thematic analysis revealed five themes: (a) perceived level and amount of support from clinical supervisors, (b) skill level of clinical supervisors, (c) physicians and their perceptions on supervising, Advanced practitioners (d) clinical supervisors' preparation for the role and (e) transition from trainee to qualified advanced practitioner. Conclusion: The survey revealed that advanced practitioner students perceived that clinical supervisors and workplace colleagues had a good understanding of the advanced practice role with good levels of support in practice. A more coherent approach is required for clinical supervision and an implementation framework that can be formally evaluated. Relevance to clinical practice: Several significant barriers to clinical supervision for advanced practitioner students were identified, and there are currently more barriers (including COVID‐19) than facilitators. [ABSTRACT FROM AUTHOR]

Aims and objectives: To compare diabetes‐related prescribing practices, barriers and facilitators amongst nurse prescribers in New Zealand and the United Kingdom. Background: Nurses have been prescribing in the United Kingdom for many years but nurse prescribing in New Zealand is relatively recent. It is unknown whether similar system factors act to facilitate or limit prescribing. Design: A survey of 250 nurses prescribing in diabetes care in New Zealand (n = 111) and the United Kingdom (n = 139). Methods: A SurveyMonkey questionnaire was used to survey nurses about the extent of their prescribing practices, and barriers and facilitators experienced. Quantitative data were explored descriptively, and qualitative responses were grouped according to content, with quotes provided to exemplify thematic content. This study is reported following STROBE guidelines. Results: Insulin, metformin and sulphonylureas are the drugs most frequently prescribed in both countries. Considerably more New Zealand than United Kingdom nurses reported prescribing for cardiovascular and renal disease. In both countries, direct prescribing to the patient was most common, followed by remote prescribing in New Zealand and via recommendation to other prescribers in the United Kingdom. Most common barriers were lack of time and inadequate mentoring. Most common facilitators were as follows: good supervision; collegial relationships with specialists, pharmacists and peers; and ongoing education. Conclusions: These New Zealand and United Kingdom nurses are prescribing a broad range of diabetes‐related medications. Similar barriers and facilitators were identified in both countries. Adequate supervision, support from multidisciplinary team colleagues and prescribing education and guidelines are paramount. Relevance to clinical practice: Important insights on barriers and facilitators to implementation of nurse prescribing in two countries are highlighted and, despite a considerable difference in the longevity of prescribing practice, similar issues were identified. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate and explore mental health nurses' responses to and experience of an educational intervention to improve attitudes towards people with a diagnosis of borderline personality disorder (BPD). Report findings are concordant with relevant EQUATOR guidelines (STROBE and COREQ). Background: Attitudes towards people with a diagnosis of BPD are poorer than for people with other diagnoses. There is limited evidence about what might improve this situation. One intervention with reportedly good effect uses an underlying biosocial model of BPD. No previous intervention has been co‐produced with an expert by experience. We developed and delivered a 1‐day intervention comprising these elements. Design: A mixed‐methods design was used comprising prospective within‐subjects cohort intervention and qualitative elements. Participants were mental health nursing staff working in inpatient and community settings in one NHS Board in Scotland, UK. Methods: Measurement of cognitive and emotional attitudes to people with a diagnosis of BPD at pre‐ and postintervention (N = 28) and at 4‐month follow‐up. Focus groups were used to explore participants' experiences of the intervention (N = 11). Results: Quantitative evaluation revealed some sustained changes consistent with expected attitudinal gains in relation to the perceived treatment characteristics of this group, the perception of their suicidal tendencies and negative attitudes in general. Qualitative findings revealed some hostility towards the underpinning biosocial model and positive appreciation for the involvement of an expert by experience. Conclusions: Sustained benefits of an educational intervention for people working with people diagnosed with BPD in some but not all areas. Participants provided contrasting messages about what they think will be useful. Relevance to clinical practice: The study provides further evidence for incorporation of a biosocial model into staff training as well as the benefits of expert by experience co‐production. Mental health nurses, however, believe that more well‐resourced services are the key to improving care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the experiences of smoking and quitting attempts in people with type 1 diabetes, including their perceptions of existing services for smoking cessation. Background: In the UK, approximately a fifth of the population with type 1 diabetes smoke and despite the adverse effects of smoking, these individuals continue with their smoking habits. There is limited information on the barriers and facilitators to quitting smoking in people with type 1 diabetes. Methods: This study adopted a qualitative study design using semi‐structured individual interviews guided by PRIME theory. Participants (n = 12) were purposively sampled and recruited from two diabetes outpatient clinics in London (UK). Audio‐recorded interviews were transcribed verbatim and analysed using the Framework method. Results: Most smokers with type 1 diabetes reported lack of motivation to stop smoking due to the addictive nature of cigarettes. Further barriers to quitting included self‐image and habits associated with smoking, such as social activities. Generally, most reported limited awareness about the risks associated with smoking and diabetes. Moreover, the perceived negative attitude towards nicotine replacement therapy and pharmacotherapy impeded their willingness to alter their smoking habits. Nonetheless, these patients suggested that informative guidance from medical professionals and strategies to tackle cravings related to nicotine as helpful approaches to improve quitting attempts. Conclusion: Internal and external factors influence quitting attempts among smokers with type 1 diabetes, with particular emphasis on self‐image and societal norms. It is evident that existing strategies for smoking cessation recommended by the National Institute for Health and Care Excellence have either not been implemented or not well received by people with type 1 diabetes. Relevance to clinical practice: Strategies and resources, such as staff training, to increase delivery of smoking cessation support to patients with diabetes are needed. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to discover and describe how patients, carers and case management nurses define safety and compare it to the traditional risk reduction and harm avoidance definition of safety. Background Care services are increasingly being delivered in the home for patients with complex long-term conditions. However, the concept of safety remains largely unexplored. Deign A sequential, exploratory mixed method design. Methods A qualitative case study of the UK National Health Service case management programme in the English UK National Health Service was deployed during 2012. Thirteen interviews were conducted with patients ( n = 9) and carers ( n = 6) and three focus groups with nurses ( n = 17) from three community care providers. The qualitative element explored the definition of safety. Data were subjected to framework analysis and themes were identified by participant group. Sequentially, a cross-sectional survey was conducted during 2013 in a fourth community care provider (patient n = 35, carer n = 19, nurse n = 26) as a form of triangulation. Findings Patients and carers describe safety differently to case management nurses, choosing to focus on meeting needs. They use more positive language and recognize the role they have in safety in home-delivered health care. In comparison, case management nurses described safety similarly to the definitions found in the literature. However, when offered the patient and carer definition of safety, they preferentially selected this definition to their own or the literature definition. Conclusion Patients and carers offer an alternative perspective on patient safety in home-delivered health care that identifies their role in ensuring safety and is more closely aligned with the empowerment philosophy of case management. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Difficulties with the recruitment and retention of qualified nursing staff have resulted in nursing shortages worldwide with a consequential impact on the quality of care. It is increasingly recommended that evidence-based staffing levels are central to the development of workforce plans. Due to a paucity of empirical research in mental health and learning disability services the staffing needs and requirements for these settings are undefined and the availability of tools to aid staffing decisions is limited., What this paper adds to existing knowledge? This paper provides a valuable insight into the practical uses of these tools as perceived by staff members with day-to-day experience of the requirements of mental health and learning disability wards. It reveals that while workload measurement tools are considered a valuable aid for the development of workforce plans, they are limited in their ability to capture all aspects of care provision in these settings. It further emphasizes the inapplicability of a one-shoe-fits-all approach for determining nurse staffing levels and the need for individual and customized workforce plans., What are the implications for practice? This study demonstrates that the development of tools for use in mental health and learning disability services is in its infancy, yet no tool that has been validated as such. It highlights the potential for workload measurement tools to aid staffing decisions; however, a more holistic approach that considers additional factors is needed to ensure robust workforce planning models are developed for these services., Abstract Introduction The critical challenge of determining the correct level and skill mix of nursing staff required to deliver safe and effective health care has become an international concern. It is recommended that evidence-based staffing decisions are central to the development of future workforce plans. Workforce planning in mental health and learning disability nursing is largely under-researched with few tools available to aid the development of evidence-based staffing levels in these environments. Aim It was the aim of this study to explore the experience of staff using the Safer Nursing Care Tool and the Mental Health and Learning Disability Workload Tool in mental health and learning disability environments. Method Following a 4-week trial period of both tools, a survey was distributed via Qualtrics online survey software to staff members who used the tools during this time. Results The results of the survey revealed that the tools were considered a useful resource to aid staffing decisions; however, specific criticisms were highlighted regarding their suitability to psychiatric intensive care units and learning disability wards. Discussion This study highlights that further development of workload measurement tools is required to support the implementation of effective workforce planning strategies within mental health and learning disability services. Implications for Practice With increasing fiscal pressures, the need to provide cost-effective care is paramount within the services of the National Health Service. Evidence-based workforce planning is therefore necessary to ensure that appropriate levels of staff are determined. This is of particular importance within mental health and learning disability services due to the reduction in the number of available beds and an increasing focus on purposeful admission and discharge. [ABSTRACT FROM AUTHOR]

Aims To investigate student nurses' and midwives' knowledge, confidence and educational needs regarding recognition and responses to domestic abuse. Background Domestic abuse is a serious global problem and has greater, negative effects on long-term health than more obvious diseases, such as diabetes. Nurses and midwives are well-placed to recognize and respond to domestic abuse but many lack confidence in this area. There is firm evidence that training can increase the confidence of Registered Nurses and midwives in responding to domestic abuse. But the issue of undergraduate preparation is significantly under-investigated. Design A qualitative study. Methods Nursing and midwifery students were recruited using purposive sampling. We facilitated eight focus groups with a total of 55 students (student midwives N = 32; student nurses n = 23). Data were collected between May-November 2014. Findings Students in the study viewed the issue of domestic abuse as important and they possessed sound theoretical knowledge of its nature and consequences. However, they lacked confidence in recognizing and responding to abuse and were concerned about the implications of this for their future practice as registered practitioners. Interactive learning opportunities that engaged with service users and involved experts from practice were viewed as important educational requirements. Conclusion Most students in the study felt insufficiently prepared to deal with the issue of domestic abuse. They perceived this as a cyclical state of disempowerment that would impact negatively on their practice and on their own ability to support nursing and midwifery students of the future. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate aspects of care potentially most influencing home recovery following day surgery. Background Elective surgery undertaken on a day-case basis is expanding. Many medical aspects of recovery have been investigated although less is known about the psychosocial view of postdischarge recovery. Greater insight into such issues is required for the development of a more coordinated nurse-led approach. Design Cross-sectional questionnaire. Method As part of a larger study, questionnaires were distributed to 2401 adult patients on the day of operation (September 2010-October 2011) to examine patients' experiences of psychosocial recovery. Participants were requested to complete and return the questionnaire by mail one week after surgery with 684 returned. Results Eighty-five per cent were fully prepared for all events during home recovery. Satisfaction with pre- and postoperative surgical information was high although less so anaesthetic information. Using factor analysis, preoperative information, pain management, postdischarge information, anxiety management, postoperative nausea and vomiting, help and rest once home were central features. Multiple regression analysis demonstrated pre- and postoperative information provision to have a statistically significant positive association with patients' being 'fully prepared for all events during home recover'. Unsatisfactory pain management, increased anxiety and reduced help once home had a statistically significant negative association with patients' being 'fully prepared for all events during home recovery'. Conclusion Focusing on the delivery of surgical and anaesthetic information, managing pain and anxiety and ensuring support once home may help to enhance recovery. A more comprehensive plan embracing such aspects could help enhance the day surgery patients' experience. Relevance to clinical practice Increased satisfaction and surgical/anaesthetic information are central to the continued success of minimal-stay surgery. A broader hospital/home strategy is required as too frequently nursing care can become fragmented between the preoperative outpatient visit, preassessment, day of surgery and postoperative outpatient visit. [ABSTRACT FROM AUTHOR]

Aim To provide depth and breadth in the analysis of nursing students' written narratives of 'most memorable' professionalism dilemmas. Background While nursing students are taught professionalism through formal curricula, they commonly experience workplace-based professionalism dilemmas. Although non-UK studies have begun to explore students' lived experiences of dilemmas, they lack detail about when and where dilemmas occur, who is involved, what students do and why and how students feel. Design Online survey of healthcare students including 294 nursing students from 15 UK nursing schools. Method Nursing students provided a written narrative of their most memorable dilemma (December 2011-March 2012) as part of a survey examining the impact of professionalism dilemmas on moral distress. We conducted thematic and discourse analysis of all narratives and narrative analysis of one exemplar. Findings The most common themes were patient care dilemmas by healthcare personnel or students, student abuse and consent dilemmas. Of the dilemmas, 49·6% occurred over 6 months previously, 76·2% occurred in hospitals and 51·9% of perpetrators were nurses. 79·3% of students reported acting in the face of their dilemma. Of the narratives, 88·4% contained negative emotion talk and numerous significant relationships existed between types of emotion talk and dilemmas. Our narrative analysis demonstrates the impact of dilemma experiences through emotion talk and more subtle devices like metaphor. Conclusion Findings extend previous research with nursing and medical students. Nurse educators should help students construct emotionally coherent narratives to make sense of their experiences, actions and identities and to better prepare them for future professionalism dilemmas. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the training needs and awareness of childhood sexual abuse amongst clinical staff taking cervical screening samples in one inner city primary care trust. Background Studies exploring sexual abuse and nonparticipation in cervical screening have demonstrated that women can experience re-traumatisation if care during examinations is insensitive to their particular needs. Design This was a mixed methods, service evaluation in three phases. Methods A literature review, a questionnaire to cervical screening staff in an inner city primary care trust and a focus group of four staff drawn from questionnaire respondents to explore themes raised in the questionnaire data. Results Data analysis of both quantitative and qualitative data showed that clinical staff underestimated the frequency of childhood sexual abuse although they were aware of the difficulties and reluctance some women experience undergoing gynaecological examinations. When women did disclose childhood sexual abuse or when staff suspected a history of childhood sexual abuse, staff reported feeling unsure of how they should proceed. There was no support or clinical supervision, and unmet training needs were identified. Conclusions Nurses expressed anxiety around the potential of the screening test to cause more harm than good and at their inability to provide more help than listening. Staff wanted support and further training after completing their cervical screening training course to assist in their provision of sensitive care to patients who have experienced childhood sexual abuse. Relevance to clinical practice Whilst our results cannot be generalised to a wider population, they may be meaningful for the community of cervical screening takers. We argue that screening staff require further training and professional support (clinical supervision) to increase their confidence when providing safe and sensitive practice for childhood sexual abuse survivors. If staff feel more confident and competent when responding to disclosure of childhood sexual abuse in screening situations, women who have experienced childhood sexual abuse might participate in the screening programme more readily. [ABSTRACT FROM AUTHOR]