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Background: Moral distress is recognized as an international problem that contributes to decreased work productivity, job dissatisfaction and intent to leave for adult Critical Care nurses. Aim: To explore Critical Care nurses moral distress levels using the Moral Distress Scale Revised (MDS‐R) and its relationship with intention to stay. The study reported in this paper was part of a larger study that also investigated Critical Care nurses' work environment in Canada and the Midlands region of the UK. Study design: During January to August 2017 a cross‐sectional survey was distributed to adult Critical Care nurses in the Midlands region of the UK. Methods: Surveys were distributed to adult Critical Care Registered Nurses in the Midlands region of the UK examining moral distress levels and intention to stay in Critical Care, the organization (NHS Trust) and in the nursing profession. Results: Two hundred sixty‐six number of a potential sample of 1066 Critical Care nurses completed the survey (25% response rate). Age and moral distress were significantly positively correlated with intention to stay on their current unit (r = 0.16, P =.05), indicating older nurses were more likely to stay in the critical care unit. Moral distress was negatively correlated with intent to stay scores, showing critical care nurses with higher levels of moral distress were less likely to stay on their unit (r = −0.20, P =.02). Moral distress was also significantly negatively correlated with intention to stay with their current employer (r = −0.28, P <.001). Nurses that stated they had high rates of moral distress were more likely to consider leaving their current employer. Conclusion: Moral distress appears to be an issue among adult Critical Care nurses requiring further exploration and development of effective strategies to reduce this phenomenon and stabilize the workforce by reducing turnover. Relevance to clinical practice: By identifying the top causes of moral distress, tools and strategies can be developed to allow the Critical Care nurse to work within an ethically safe clinical environment and reduce the turnover of experienced adult Critical Care nurses. [ABSTRACT FROM AUTHOR]

The importance of support to breastfeeding success is well established, as are the difficulties many mothers face in accessing the support they need. With the majority of UK mothers now accessing social media for support, Breastfeeding Support Facebook (BSF) groups have increased exponentially. BSF groups vary in type (local or national/international) and in moderation—overseen by breastfeeding mothers and by midwives or trained lactation specialists. Some groups aimed at supporting mothers in a specific geographical area also have associated face‐to‐face groups, facilitated as either professional or peer support. Little is currently known about these specific local groups, their prevalence, impact or value to mothers. This paper examines mothers' experiences of using local BSF groups and why they value them as part of a larger study exploring the impact of midwife moderation on these groups. An online survey consisting of open and closed questions was completed by 2028 mothers. Findings identified that local BSF groups are widely used and highly valued for their connection with local face‐to‐face services and other mothers. They offer access to expertise and shared experience in a format mothers find convenient and timely, improving confidence and self‐efficacy. Local BSF groups enable the formation of support networks and development of breastfeeding knowledge that mothers credit with increased well‐being, motivation and breastfeeding duration. As such, they have the potential to add value to local face‐to‐face services and improve breastfeeding experiences and knowledge in communities. The findings have important implications to support the development of integrated online interventions to improve public health. [ABSTRACT FROM AUTHOR]

Good nutrition in the early years of life is vitally important for a child's development, growth and health. Children's diets in the United Kingdom are known to be poor, particularly among socially disadvantaged groups, and there is a need for timely and appropriate interventions that support parents to improve the diets of young children. The Medical Research Council has highlighted the importance of conducting developmental and exploratory research prior to undertaking full-scale trials to evaluate complex interventions, but have provided very limited detailed guidance on the conduct of these initial phases of research. This paper describes the initial developmental stage and the conduct of an exploratory randomised controlled trial undertaken to determine the feasibility and acceptability of a family-centred early years' nutrition intervention. Choosing Healthy Eating when Really Young ( CHERRY) is a programme for families with children aged 18 months to 5 years, delivered in children's centres in one urban ( Islington) and one rural ( Cornwall) location in the United Kingdom. In the development stage, a mixed-methods approach was used to investigate the nature of the problem and options for support. A detailed review of the evidence informed the theoretical basis of the study and the creation of a logic model. In the feasibility and pilot testing stage of the exploratory trial, 16 children's centres, with a sample of 394 families were recruited onto the study. We hope that the methodology, which we present in this paper, will inform and assist other researchers in conducting community-based, exploratory nutrition research in early years settings. [ABSTRACT FROM AUTHOR]

Background/aim The successful development and maintenance of professional identity is associated with professional development and retention in the health workforce. This paper explores students' perspectives on the ways pre-entry experiences and curricula content shape professional identity. Methods An online cross-sectional survey was sent to students enrolled in the final year of entry-level programmes in five countries. Descriptive statistical analyses of data were completed. Results The results reflect the perceptions of 319 respondents from five countries. Respondents identified professional education (98%) and professional socialisation during placement (92%) as curricula components with the greatest influence on professional identity formation. Discipline-specific knowledge such as, occupation-focussed models and occupational science were ranked lower than these aspects of practice. The students' length of programme and level of entry-level programme did not impact on these results. Conclusion When designing curricula educators need to be mindful that students perceive practice education and professional socialisation have the greatest affect on professional identity formation. The findings reinforce the need for curricula to provide students with a range of practice experiences, which allow the observation and application of occupation-based practices. It highlights a need for educators to provide university-based curricula activities, which better prepare students for a potential dissonance between explicit occupation-based curricula and observed practice education experiences. The study indicates the need for further research into the role curricula content, and in particular practice education, plays in the multidimensional formation of professional development within entry-level programmes. [ABSTRACT FROM AUTHOR]

ABSTRACT Background The first independent paediatric retrieval nurse practitioners ( RNP) in the UK and Europe were appointed in 2006 in one hospital Trust. Since then, many have been appointed around the UK but the range of responsibility and scope of the role is unknown as well as possible geographical variability. Aim The aim of this paper is to explore the role and scope of paediatric retrieval nurse practitioners in the United Kingdom ( UK). Method A two part questionnaire was sent to all RNPs identified by the regional retrieval/transport centres. Information was sought about the role and scope of RNPs and how the role may have changed since appointment. RNPs were asked to self-assess their own ability in a variety of technical and leadership skills. Conclusion The majority of respondents felt their role had expanded since appointment. RNPs reported that they would now lead the team for any critically ill infant or child where previously they were retrieving stable or high dependency patients. Other expansions of their role included being on a middle grade tier of the medical rota, asked to undertake aeromedical transfers, providing the withdrawal of care at referring centres and non-medical independent prescribing. Relevance to Practice This survey has revealed the changing role and scope of RNPs in the UK but most importantly, the increased responsibility of the roles. Over 80% of RNPs rated their leadership skills between proficient and expert on Benner's Novice to Expert Continuum (Benner, 1984). [ABSTRACT FROM AUTHOR]

Introduction: Perinatal palliative care services are increasingly available globally, offering a range of clinical and psychological support services to families during pregnancy, in the neonatal period and following the death of a baby with a life‐limiting or life‐threatening condition. Little is understood about the role of children's hospice care and how it contributes to effective perinatal palliative care. Design: The study aims to answer the question "what is the role of children's hospices in the provision of perinatal palliative care and advance care planning in the United Kingdom?" Methods: An electronic survey was sent to all 54 children's hospices in the United Kingdom between May and June 2022. Results: Thirty hospices responded, representing 54% of the sector. All regions of all four counties are represented. Numbers of referrals to hospices for perinatal palliative care have increased significantly over the last 5 years. Hospices provide a range of services for families and babies, usually from the point of diagnosis or recognition of a life‐limiting or life‐threatening condition, underpinned with counseling and emotional support. Hospices worked with a range of professionals and services, most commonly fetal medicine and neonatal services. Advance care plans were an important element of effective perinatal palliative care, strengthening parent–professional and interprofessional relationships. Conclusion: Children's hospice services play an important and growing role in the perinatal care of babies and families following the diagnosis or recognition of a life‐limiting or life‐threatening condition. The family‐centered approach to care, from a broad, biopsychosocial perspective means that hospices make a unique and meaningful contribution to both the clinical and psychological needs of families. Clinical relevance: The family‐centered approach to care, from a broad, biopsychosocial perspective means that hospices make an important contribution to both the clinical needs of babies, and psychological needs of families antenatally, in the neonatal period and after death. [ABSTRACT FROM AUTHOR]

Background: Globally, initiation of paediatric advance care planning discussions is advocated early in the illness trajectory; however, evidence suggests it occurs at crisis points or close to end of life. Few studies have been undertaken to ascertain the prevalence and determinants of behaviour related to initiation by the healthcare professional. Method: Underpinned by the Capability, Opportunity, Motivation–Behaviour (COM‐B) model for behaviour change, a cross‐sectional online survey was conducted in United Kingdom and Ireland using a purposive sample of health professionals. Descriptive and inferential statistics were applied and nonparametric statistical analysis used. Open‐ended questions were mapped and correlations between COM‐B and demographic profiles identified. Results: Responses (n = 140): Paediatric advance care planning was viewed positively; however, initiation practices were found to be influenced by wide ranging diagnoses and disease trajectories. Whilst some tools and protocols exist, they were not used in a systematic manner, and initiation behaviour was often not guided by them. Initiation was unstandardized, individually led, guided by intuition and experience and based on a range of prerequisites. Such behaviour, combined with inconsistencies in professional development, resulted in varying practice when managing clinical deterioration. Professionals who felt adequately trained initiated more conversations (capability). Those working in palliative care specialties, hospice settings and doctors initiated more discussions (opportunity). There was no difference in Motivation between professions, clinical settings or specialisms, although 25% (n = 35) of responses indicated discomfort discussing death and 34% (n = 49) worried about families' emotional reaction. Conclusion: Although advocated, paediatric advance care planning is a complex process, commonly triggered by the physical deterioration and rarely underpinned by support tools. The COM‐B framework was useful in identifying fundamental differences in initiation behaviour; however, further research is required to explore the complexity of initiation behaviour and the system within which the care is being delivered to identify influences on initiation. [ABSTRACT FROM AUTHOR]

Using an exploratory mixed‐methods approach, we examined thoughts concerning refugees reported by participants from a non‐Western country, Uganda, and the United Kingdom (total N = 113). We explored whether, due to various sociocultural, political and geographic differences, critical features of refugee migration (e.g., migration forcedness and migration‐related perils) would be viewed differently by Ugandan and UK participants. An inductive qualitative content analysis of responses in an online survey yielded 11 categories with 40 subcategories revealing several similarities between Ugandan and UK participants. For instance, similar proportions of participants from both countries acknowledged refugees' suffering before their migration and the forced nature of refugees' migration. However, we also found that more British than Ugandan participants referred to perils refugees suffer during their journeys, possibly resulting from differences in refugees' migration routes (e.g., crossing other countries, travelling by dilapidated boats, migration duration). Furthermore, Ugandan but not British participants took pride in international praise their country received for its forthcoming treatment of refugees. There were no differences regarding the extent to which Ugandan and British individuals exhibited prejudice towards refugees or experienced threats from refugees. We discuss the theoretical and practical implications of our findings for refugee integration. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper reports on a survey of mental health clinician views of including people with psychosis and negative symptoms in outcome research. A questionnaire was forwarded to clinicians (the majority of whom were mental health nurses) completing post-registration undergraduate and postgraduate degree courses in psychosocial interventions for psychosis. Fifty questionnaires were returned (a response rate of 84.7%). A total of 47% of respondents indicated that they might refrain from offering this group as potential participants to clinical trials. Thematic analysis suggests views that negative symptoms are not amenable to treatment inform such decisions. The results highlight the potential difficulties faced by researchers investigating new treatments for people with negative symptoms, and suggest further exploration of clinician views of referring this group to research and psychosocial treatments is warranted. [ABSTRACT FROM AUTHOR]

Background: Implementing task specific training is a commonly reported challenge for less experienced therapists. A potential method to improve the ability of recent graduate and student therapists is to upskill regarding task specific training via an online education resource. Purpose: To evaluate the use and acceptability of the TRAIN program as an online learning resource for physiotherapists. Methods: Data from Google Analytics was sourced to determine use of the program and details about the users. Users of the TRAIN program were also invited to complete two surveys; prior to beginning and upon completion of the program. The surveys collected information about the demographics of the users, perceptions of usefulness of the online resource and overall sentiment. Results: Almost 6000 new users interacted with the TRAIN modules during the 15‐months study period. The surveys indicated a high level of usability (mean score 9/10, SD 1.5) and clinical utility (mean score 8.8/10, SD 1.6) of the TRAIN program. Perceived knowledge and user confidence in implementing task‐specific training was higher for those users completing the post compared to those completing the pre‐module survey (knowledge 1.9 and confidence 1.7 out of 10 points higher). Recurring comments in the open‐ended feedback pertained to the usefulness, clarity, and ease of use of the TRAIN program. Discussion and Conclusion: This study provides preliminary evidence supporting the use and acceptability of the TRAIN program as an online learning resource for physiotherapists. This further contributes to the growing body of literature indicating online learning is generally a well‐received teaching tool for physiotherapists. [ABSTRACT FROM AUTHOR]

Aims: To compare the acceptability, reliability and validity of five contemporary diabetes‐specific quality of life (QoL) scales among adults with type 1 diabetes in the United Kingdom and Australia. Methods: Adults with type 1 diabetes (UK = 1139, Australia = 439) completed a cross‐sectional, online survey including ADDQoL‐19, DCP, DIDP, DSQOLS and Diabetes QoL‐Q, presented in randomised order. After completing each scale, participants rated it for clarity, relevance, ease of completion, length and comprehensiveness. We examined scale acceptability (scale completion and user ratings), response patterns, structure (exploratory and confirmatory factor analyses) and validity (convergent, concurrent, divergent and known groups). To assess cross‐country reproducibility, analyses conducted on the UK dataset were replicated in the Australian dataset. Results: Findings were largely consistent between countries. All scales were acceptable to participants: ≥90% completing all items, and ≥80% positive user ratings, except for DSQOLS' length. Scale structure was not supported for the DCP. Overall, in terms of acceptability and psychometric evaluation, the DIDP was the strongest performing scale while the ADDQoL‐19 and Diabetes QoL‐Q scales also performed well. Conclusions: These findings suggest that the recently developed brief (7 items), neutrally worded DIDP scale is acceptable to adults with type 1 diabetes and has the strongest psychometric performance. However, questionnaire selection should always be considered in the context of the research aims, study design and population, as well as the wider published evidence regarding both the development and responsiveness of the scales. [ABSTRACT FROM AUTHOR]

Objective: To review quality of care in births planned in midwifery-led settings, resulting in an intrapartum-related perinatal death.Design: Confidential enquiry.Setting: England, Scotland and Wales.Sample: Intrapartum stillbirths and intrapartum-related neonatal deaths in births planned in alongside midwifery units, freestanding midwifery units or at home, sampled from national perinatal surveillance data for 2015/16 (alongside midwifery units) and 2013-16 (freestanding midwifery units and home births).Methods: Multidisciplinary panels reviewed medical notes for each death, assessing and grading quality of care by consensus, with reference to national standards and guidance. Data were analysed using thematic analysis and descriptive statistics.Results: Sixty-four deaths were reviewed, 30 stillbirths and 34 neonatal deaths. At the start of labour care, 23 women were planning birth in an alongside midwifery unit, 26 in a freestanding midwifery unit and 15 at home. In 75% of deaths, improvements in care were identified that may have made a difference to the outcome for the baby. Improvements in care were identified that may have made a difference to the mother's physical and psychological health and wellbeing in 75% of deaths. Issues with care were identified around risk assessment and decisions about planning place of birth, intermittent auscultation, transfer during labour, resuscitation and neonatal transfer, follow up and local review.Conclusions: These confidential enquiry findings do not address the overall safety of midwifery-led settings for healthy women with straightforward pregnancies, but suggest areas where the safety of care can be improved. Maternity services should review their care with respect to our recommendations.Tweetable Abstract: Confidential enquiry of intrapartum-related baby deaths highlights areas where care in midwifery-led settings can be made even safer. [ABSTRACT FROM AUTHOR]

Burns are common causes of paediatric emergency care attendance; approximately ten per cent result from maltreatment. Following emergency department (ED) attendance with a burn by 232 under five‐year‐olds, 11 risk factors for maltreatment were collected via health visitor (HV) telephone surveys. Three of these risk factors (domestic violence, social care involvement and developmental impairment) were also available in ED records, and information collected was compared between the two. Non‐parametric Fisher's exact tests were applied. Fifty‐nine per cent of children lived in families with risk factors for maltreatment. Prominent risk factors known by HVs included: prior injuries (n = 55, 23.7%), carer/parent mental health problems (n = 48, 20.7%), domestic violence (n = 47, 20.3%) and social care involvement (n = 45, 19.4%). A total of 158 cases had complete data for all 11 risk factors: 49 (31.0%) lived in households with one factor, 22 (13.9%) with two factors and 27 (17.1%) with three or more risk factors. In cases where HVs recorded the following risk factors as present, EDs recorded five of 47 (10.6%) for domestic violence, ten of 45 (22.2%) with social care involvement and four of 23 (17.4%) with developmental impairment. Many risk factors that were known to HVs were not identified by EDs staff despite being part of a standardised proforma. Maltreatment risk assessment could be improved if EDs staff had access to HV information. Key Practitioner Messages: Fifty‐nine per cent of pre‐school children who attended an ED with a burn live in a family with one or more maltreatment risk factors, as identified by HV records.ED staff should be able to access a child's HV record electronically at the time of presentation, to identify known maltreatment risk factors.The lack of integration of community and acute setting health records is a barrier to comprehensive assessment and treatment decisions for children in EDs, especially in relation to safeguarding risks. [ABSTRACT FROM AUTHOR]

This article reports an international study of research data management (RDM) activities, services, and capabilities in higher education libraries. It presents the results of a survey covering higher education libraries in Australia, Canada, Germany, Ireland, the Netherlands, New Zealand, and the UK. The results indicate that libraries have provided leadership in RDM, particularly in advocacy and policy development. Service development is still limited, focused especially on advisory and consultancy services (such as data management planning support and data-related training), rather than technical services (such as provision of a data catalog, and curation of active data). Data curation skills development is underway in libraries, but skills and capabilities are not consistently in place and remain a concern. Other major challenges include resourcing, working with other support services, and achieving "buy in" from researchers and senior managers. Results are compared with previous studies in order to assess trends and relative maturity levels. The range of RDM activities explored in this study are positioned on a "landscape maturity model," which reflects current and planned research data services and practice in academic libraries, representing a "snapshot" of current developments and a baseline for future research. [ABSTRACT FROM AUTHOR]

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Background: Lay involvement in implementation of research evidence into practice may include using research findings to guide individual care, as well as involvement in research processes and policy development. Little is known about the conditions required for such involvement. Aim: To assess stroke survivors’ research awareness, use of research evidence in their own care and readiness to be involved in research processes. Methods: Cross sectional survey of stroke survivors participating in population‐based stroke registers in six European centres. Results: The response rate was 74% (481/647). Reasons for participation in register research included responding to clinician request (56%) and to ‘give something back’ (19%); however, 20% were unaware that they were participating in a stroke register. Research awareness was generally low: 57% did not know the purpose of the register they had been recruited to; 73% reported not having received results from the register they took part in; 60% did not know about any research on stroke care. Few participants (7.6%) used research evidence during their consultations with a doctor. The 34% of participants who were interested in being involved in research were younger, more highly educated and already research aware. Conclusions: Across Europe, stroke survivors already participating in research appear ill informed about stroke research. Researchers, healthcare professionals and patient associations need to improve how research results are communicated to patient populations and research participants, and to raise awareness of the relationship between research evidence and increased quality of care. [ABSTRACT FROM AUTHOR]

ABSTRACT Background The critical care environment has felt the overwhelming impact of the growing problem of alcohol abuse. However, there is ambiguity concerning the assessment and management of this patient group. Aim The aim of this study was to explore current practice in the use of assessment and management tools for alcohol-related admissions in UK intensive care units ( ICU). Methods Two hundred and forty-eight lead consultants across England, Scotland, Northern Ireland and Wales were sent an electronic survey using the SurveyMonkey® ( www.surveymonkey.com) website. Results A total of 103 (41·05%) lead consultants responded to the survey. Most units (67%) utilized the volume of alcohol consumed per week to assess patient alcohol use. Furthermore, 12 units (11%) used the Clinical Institute Withdrawal Assessment tool, 5 units (5%) used the Glasgow Modified Alcohol Withdrawal Scale and 79 units (73%) used no tool for the management of alcohol withdrawal syndrome. Conclusion There appears to be a diverse approach to the assessment and management of alcohol-related admissions in UK ICUs. Further research is required in this area to identify the most effective way to assess and manage alcohol-related admissions within intensive care. Relevance to clinical practice Under recognition and poor assessment of alcohol use can have major implications for critically ill patients. [ABSTRACT FROM AUTHOR]

The article discusses the study on the earnings of professional advocates and solicitors in Great Britain. The first study which was conducted by the Royal Commission on Doctors and Dentist Renumeration (RCDDR, 1960) has concluded that data on the earnings by age appear to be reasonable when compared with solicitors and other occupations. On the other hand, a survey on solicitors within the industry and commerce was taken by the National Board for Prices and Income (NBPI, 1968) which was also presented. Moreover, the research that covered the income of solicitors in the commerce and industry was carried by the Law Society and the results were regarded by the Royal Commission to give useful illustration of the earnings of solicitors employed as legal advisors in the sector.