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Purpose: The purpose of this paper is to evaluate the impact of leadership development programmes, underpinned by Transformational Learning Theory (TLT). Design/methodology/approach: A corpus-informed analysis was conducted using survey data from 690 participants. Data were collected from participants' responses to the question "please tell us about the impact of your overall experience", which culminated in a combined corpus of 75,053 words. Findings: Findings identified patterns of language clustered around the following frequently used word types, namely, confidence; influence; self-awareness; insight; and impact. Research limitations/implications: This in-depth qualitative evaluation of participants' feedback has provided insight into how TLT can be applied to develop future health-care leaders. The extent to which learning has had a transformational impact at the individual level, in relation to their perceived ability to influence, holds promise for the wider impact of this group in relation to policy, practice and the promotion of clinical excellence in the future. However, the latter can only be ascertained by undertaking further realist evaluation and longitudinal study to understand the mechanisms by which transformational learning occurs and is successfully translated to influence in practice. Originality/value: Previous research has expounded traditional leadership theories to guide the practice of health-care leadership development. The paper goes some way to demonstrate the impact of using the principles of TLT within health-care leadership development programmes. The approach taken by The Florence Nightingale Foundation has the potential to generate confident leaders who may be instrumental in creating positive changes across various clinical environments. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al., 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al., 2016); however, significant barriers affect its implementation worldwide (Nolan et al., 2014; Wild et al., 2020). This article reports on the implementation, barriers and recommendations of WHO TCC implementation in the context of Nepal and argues for Transformational Leadership (TL) to support its implementation. Design/methodology/approach: Explanatory mixed methods research (Creswell, 2014), comprising quasi-experimental research and a qualitative online survey, were selected methods for this research. A training module was designed and implemented for 10 doctors and 15 nurses from a total of 76 (33%) of clinicians to aid in the introduction of the WHO TCC in an emergency department in a hospital in Nepal. The quasi-experimental research involved a pre- and post-training survey aimed to assess participant's knowledge of the WHO TCC before and after training and before the implementation of the WHO TCC in the emergency department. Post-training, 219 patients were reviewed after four weeks to identify if process measures had improved the quality of care to trauma patients. Subsequently six months later, a qualitative online survey was sent to all clinical staff in the department to identify barriers to implementation, with a response rate of 26 (n = 26) (34%) (20 doctors and 6 nurses). Descriptive statistics were used to evaluate quantitative data and the qualitative data were analysed using the five stepped approach of thematic analysis (Braun and Clarke, 2006). Findings: The evaluation of the implementation of the WHO TCC showed an improvement in care for trauma patients in an emergency setting in a tertiary hospital in Nepal. There were improvements in the documentation in trauma management, showing the training had a direct impact on the quality of care of trauma patients. Notably, there was an improvement in cervical spine examination from 56.1% before training to 78.1%; chest examination 125 (57.07%) before training and 170 (77.62%) post-training; abdominal examination 121 (55.25%) before training and 169 (77.16%) post-training; gross motor examination 13 (5.93%) before training and 131 (59.82%) post-training; sensory examination 4 (1.82%) before training and 115 (52.51%) post-training; distal pulse examination 6 (2.73%) before training and 122 (55.7%) post-training. However, while the quality of documentation for trauma patients improved from the baseline of 56%, it only reached 78% when the percentage improvement target agreed for this research project was 90%. The 10 (n = 10) doctors and 15 (n = 15) nurses in the Emergency Department (ED) all improved their baseline knowledge from 72.2% to 87% (p = 0.00006), by 14.8% and 67% to 85%) (p = 0.006), respectively. Nurses started with lower scores (mean 67) in the baseline when compared to doctors, but they made significant gains in their learning post-training. The qualitative data reported barriers, such as the busyness of the department, with residents and medical officers, suggesting a shortened version of the checklist to support greater protocol compliance. Embedding this research within TL provided a steer for successful innovation and change, identifying action for sustaining change over time. Research limitations/implications: The study is a single-centre study that involved trauma patients in an emergency department in one hospital in Nepal. There is a lack of internationally recognised trauma training in Nepal and very few specialist trauma centres; hence, it was challenging to teach trauma to clinicians in a single 1-h session. High levels of transformation of health services are required in Nepal, but the sample for this research was small to test out and pilot the protocol to gain wider stakeholder buy in. The rapid turnover of doctors and nurses in the emergency department, creates an additional challenge but encouraging a multi-disciplinary approach through TL creates a greater chance of sustainability of the WHO TCC. Practical implications: International protocols are required in Nepal to support the transformation of health care. This explanatory mixed methods research, which is part of an International Fellowship programme, provides evidence of direct improvements in the quality of patient care and demonstrates how TL can drive improvement in a low- to medium-income country. Social implications: The Nepal/UK Hybrid International Emergency Medicine Fellowships have an opportunity to implement changes to the health system in Nepal through research, by bringing international level standards and protocols to the hospital to improve the quality of care provided to patients. Originality/value: To the best of the authors' knowledge, this research paper is one of the first studies of its kind to demonstrate direct patient level improvements as an outcome of the two-year MTI scheme. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present a mixed methods study of child criminal exploitation (CCE), particularly in the form of "county lines", in three local authorities in southeast England. The data is analysed using a framework constructed from two relevant contextual and relational theories to understand experiences of CCE and the safeguarding responses undertaken to protect young people from harm. Design/methodology/approach: Data were drawn from a survey (n = 118); interviews (n = 5) and focus groups (n = 15) with professionals; interviews with parents (n = 4); and from secondary analysis of eight interviews with young people affected by criminal exploitation. The analytic framework was applied to the data to answer two research questions: what is the role and significance of young people's interactions with peers, parents and professionals in their CCE trajectories; and how do professionals understand and address risks within contexts in which young people are exposed to CCE? The mixed methods data collected by the authors were coded and analysed using this framework. Findings: Although professionals were aware of contexts and relational power dynamics, the situated and temporal nature of CCE remained overlooked within safeguarding systems. Professionals required more space, time and support to fully and flexibly engage with young people and their families to increase safety. Originality/value: There is limited research available that critically examines safeguarding responses to CCE in diverse geographic and cultural contexts. This paper contributes a critical account of how professionals might create connections and opportunities for change with young people, identifying structural constraints within practice systems alongside emerging examples of effective practice. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe a response to the needs of mental health workers (MHWs) in India during COVID-19 pandemic, through an online training program on trauma-informed intervention and care. Design/methodology/approach: A four-module online training program was developed. Two modules were aimed to bridge the knowledge gap on trauma for MHWs, so that they could effectively address the associated symptoms of fear and grief. The other two modules aimed to support MHWs' self-care and create supportive connections among colleagues. In this mixed method evaluation study, needs expressed before the training and lessons derived from the training were collected through questionnaires, focus group discussion and interviews. Findings: Of the 3,168 MHWs who registered for the training, 534 completed the pre-questionnaire. Of the 125 post-questionnaire records, 38 had watched all four modules. A great need for learning to work with grief and manage the increased workload without burnout was observed. Post-training gains included skills for working with fear and grief, which increased the confidence of MHWs. The importance of self-care was an eye-opener for many. Social implications: This study indicates a way to equip MHWs to address the trauma that will continue to live in people in the aftermath of crises. Originality/value: This study examined the challenges MHWs in India faced during the COVID-19 pandemic, revealing a knowledge gap on dealing with this level of trauma. It can contribute to the knowledge on how to support MHWs in such crises. [ABSTRACT FROM AUTHOR]

Purpose: Short breaks enable unpaid carers to have a life alongside caring, supporting their physical and emotional well-being. In the UK, short breaks are usually explored during a Carers Assessment. The conversations underpinning these assessments require considerable skill and presently there are few tools to support the exploration of short break needs, desired outcomes and options. Images are used in other conversations to enhance communication, help people consider options and broaden thinking. This study aims to explore whether and how stakeholders thought images might support short break conversations. Design/methodology/approach: To improve access to meaningful short breaks, we need to be guided by the insights of unpaid carers, those they support, practitioners, commissioners and policymakers. We hosted two online involvement events, designed to facilitate the exchange of perspectives and ideas amongst diverse stakeholders. The events explored the acceptability, facilitators and challenges of using images to enhance unpaid carer short break conversations. Findings: The online events were attended by 47 short break stakeholders. These stakeholders saw merit in using images to support short break conversations. They identified several facilitators and challenges to introducing images into practice. The paper highlights how this learning can inform future research and practice development. Originality/value: Supporting the well-being of older unpaid carers is a pertinent concern as the number of older unpaid carers continues to grow. This paper reports on how stakeholders have informed the earliest stages of practice and research development in a relevant area and provides a model of involvement that others can emulate. [ABSTRACT FROM AUTHOR]

Purpose: By older adulthood, the majority of individuals will have experienced at least one traumatic event. Trauma-informed care (TIC) is proposed to improve effectivity of health-care provision and to reduce likelihood of services causing retraumatisation. This study aims to assess the effectiveness of staff training in TIC in older adult services. Design/methodology/approach: TIC training was delivered across eight Older Adult Community Mental Health Teams in the same UK organisation. Questionnaires were administered before and after training: a psychometrically robust measure, the Attitudes Related to Trauma-Informed Care, was used to assess TIC-related attitudes, and a service-developed scale was used to measure changes in TIC competence. Data was analysed using linear mixed effects modelling (LMM). Qualitative data regarding the impact of training was gathered one month after training through a free-text questionnaire. Findings: There were 45 participants, all of whom were white British. LMM on pre- and post-data revealed that staff training significantly increased competencies across all measured TIC domains. Overall, staff attitudes were also significantly more trauma-informed after training. Qualitatively, staff identified time as the only additional resource required to deliver the skills and knowledge gained from training. Practical implications: Training was found to be effective in increasing TIC-related skills and attitudes. Organisations aiming to become trauma-informed should consider staff training as one aspect of a wider development plan. Originality/value: To the best of the authors' knowledge, this paper is the first to examine TIC training for staff working in Older Adults Mental Health Services. Recommendations for services aiming to develop a trauma-informed culture have been provided. [ABSTRACT FROM AUTHOR]

Purpose: Current and predicted continued dramatic increases in international migration and ethnocultural diversity of older adult cohorts pose challenges for health care services. Review studies on ethnoculturally diverse older adults and health care show a lack of focus on their service use experiences. This study aims to report a meta-ethnography that addresses this knowledge gap through answering the review question: How do ethnoculturally diverse older adults who are immigrants experience health careservices? Design/methodology/approach: The authors applied a seven-phase method of meta-ethnography to guide the review. The authors conducted two literature searches (April 2018 and June 2020) in MEDLINE, CINAHL, Embase, Sociological Abstracts and Abstracts in Social Gerontology that yielded 17 papers eligible for review. Findings: "There's always something positive and something negative" is the overarching metaphor for answering the review question. Findings highlight positive and negative tensions within ethnoculturally diverse older adults' health care use experiences of understanding and being understood, having trust in providers and the health care system, having needs, preferences and resources met and desire for self-care over dependency. The majority of experiences were negative. Tipping points towards negative experiences included language, fear, provider attitudes and behaviours, service flexibility, attitudes towards Western and traditional health care and having knowledge and resources. Originality/value: The authors propose concrete actions to mitigate the tipping points. The authors discuss policy recommendations for health care system changes at the micro, meso and macro service levels to promote positive experiences and address mainstream service policy inequities. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the lived experiences of key stakeholders working with homeless people during the implementation of universal credit during the austerity years. Design/methodology/approach: The literature on austerity reveals welfare reforms' impact on support services staff. Service providers' perceptions of the impact of austerity-led policies and welfare reform via nine interviews with people working in homelessness organisations in Brighton and Hove in the UK. Service providers see the situation for their service users has gotten worse and that the policies make it more difficult to extricate themselves from their current situation. Three central themes relating to the impact of austerity-led welfare reforms were, namely, Universal Credit: the imposition of a precarious livelihood on welfare claimants; a double-edged sword: "If people are sanctioned: people can't pay"; and "Hard to maintain my own mental equilibrium". Findings: More precisely, this paper captures service providers' perceptions and experiences of the impact of austerity-led policies on their services and how they believe this, in turn, impacts their clients and their own lives. Research limitations/implications: The dimension cuts across service provision to vulnerable people and is intertwined with health and well-being outcomes. Austerity is detrimental to the health of service users and their clients. It is known that when it comes to the health and well-being of the most vulnerable, who have suffered most from the impacts of austerity policies. However, in times of open austerity, it falls also on those trying to ease their suffering. Originality/value: The data suggest that policies were developed and accentuated by austerity, which led to the stripping of welfare support from vulnerable people. This process has impacted the people who rely on welfare and service providers. [ABSTRACT FROM AUTHOR]

Purpose: Surgery is predominantly a masculine profession worldwide and has largely excluded women in leadership positions. This paper aims to examine the representation of women surgeons in leadership positions in Pakistan. Design/methodology/approach: Data were drawn from larger qualitative research examining the experiences of women surgeons in Pakistani hospitals. The data comprises in-depth interviews with ten doctors working in the Rawalpindi and Islamabad cities. The participants were selected by using the purposive sampling method and data were analyzed using thematic analysis. Findings: This study included participants from diverse surgical specialties from different stages of their career with two having leadership experience. Based on participants' perspectives several factors are responsible for this exclusion of women in leadership positions. The most prominent among these were long working hours for surgical leaders, greater responsibilities assigned to leadership positions, gender stereotypes and work–family conflict. Due to masculine hegemony, women were considered less capable and they were expected to have masculine traits to work as successful leaders. Interestingly, some participants had internalized such stereotypes and showed a lack of interest and lack of capabilities for surgical leadership as evident from their narratives. Research limitations/implications: The findings of this paper are drawn from the perspectives of ten women surgeons working in Islamabad and Rawalpindi cities of Pakistan who were selected using a convenient sampling method. Hence, the results cannot be generalized to the larger population of women surgeons working in other cities of the country. Nevertheless, this study is unique in the sense that it provides useful insight into the experiences of the women surgeons and their perspectives on surgical leadership in Pakistani hospitals. Academically, it contributes to the global debates on surgical leadership by providing empirical evidence from Pakistan. Originality/value: This paper contributes to the larger debates on the under-representation of women in leadership positions in surgery by unveiling the experiences of female surgeons from Pakistan. It calls for the need for structural changes in health management and policy to accommodate women surgeons. Organizational efforts could minimize some hurdles and encourage more women to take on more formal leadership roles. The authors also call for an increasing number of women in surgery to pave the way for creating new leadership opportunities. [ABSTRACT FROM AUTHOR]

Purpose: This qualitative study set within Northern Ireland aims to explore professional perspectives on the application of evidence-informed practice to the adult safeguarding threshold screening process. Design/methodology/approach: Data was gathered from seven social workers in one health and social care trust area, who perform the designated adult protection role, through individual semi-structured interviews in one region of Northern Ireland. The interview schedule comprised of a series of questions examining the role of the designated adult protection officer and included three vignettes (Appendix). A thematic analysis was undertaken using NVIVO software. Findings: This paper reports main findings under the themes of: the role of the designated adult protection officer, threshold decision-making, evidence-informed practice and service improvement. One of the main findings was that professionals viewed the current process as too bureaucratic, and there was a desire to engage in more preventive safeguarding in collaboration with service users. There was a need to promote awareness of evidence-informed practice as it applies to the threshold screening process. Furthermore, the study raised the question of the need to consider the application of models or methods of assessment to the threshold screening process. Originality/value: This in-depth exploration of the role of designated adult protection officers in Northern Ireland provides a valuable insight into the complexity involved in managing adult safeguarding referrals and investigations. This study adds to the existing knowledge base, identifies potential service improvements and highlights the gap in evidence-based practice as it applies to the threshold screening process. Threshold screening of adult safeguarding referrals remains a subjective process and is open to interpretation and differences in professional judgement. The study highlights the need to consider the application of quality improvement methodology to the threshold screening assessment and the need to promote the exchange of safeguarding knowledge. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the roles of psychologists in seclusion in adult mental health services in Ireland, their perspectives on seclusion and its use in recovery-oriented practice and related professional practice issues. Design/methodology/approach: A qualitative hermeneutic phenomenological study was conducted from a social constructivist perspective. Semi-structured interviews with 17 psychologists were analysed using reflexive thematic analysis. Findings: Twenty-four themes were identified, which were clustered into four overarching themes. Participants viewed themselves and psychology in Ireland more broadly as peripheral to seclusion. They believed that seclusion possessed no inherent therapeutic value but viewed it as an uncomfortable and multi-faceted reality. Participants regarded seclusion and recovery as largely inconsistent and difficult to reconcile, and they perceived systemic factors, which had a pervasive negative impact on seclusion and recovery in practice. Practical implications: The findings highlight the perceived complexity of seclusion and its interface with recovery, and the need to conscientiously balance conflicting priorities that cannot be easily reconciled to ensure ethical practice. The findings suggest psychologists are well-suited to participate in local and national discussions on using seclusion in recovery-oriented practice. Originality/value: This study offers a unique insight into psychologists' perceptions of seclusion and considers the implications of these views. Participants' nuanced views suggest that psychologists can make valuable contributions to local and national discussions on these topics. [ABSTRACT FROM AUTHOR]

Purpose: Transition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into hospital. There is little research conducted exploring peer support workers' (PSWs) lived experiences that could provide insight into the key transitions of care, particularly the support required after discharge from inpatient mental health care. The purpose of this paper is thus to provide a particular insight into what it feels like being discharged from psychiatric care from a PSW's perspective, how may support be improved post-discharge and what factors might impact the potential for readmission into inpatient care. Design/methodology/approach: A qualitative, phenomenological approach was adopted to explore and describe PSWs' lived experiences of transitioning from psychiatric care. Four PSWs who were employed by a UK secure mental health facility were recruited. PSW is a non-clinical role with their main duty to support patients, and they were considered for this type of the study for their experience in negotiating the discharge process to better carry out their job as a PSW. Findings: After being discharged from psychiatric care, PSWs experienced issues that had either a negative impact on their mental wellbeing or even resulted in their readmission back into inpatient psychiatric care. This study identified three inter-related recurrent themes – continuity of support, having options and realisation, all concerning difficulties in adjusting to independent community life following discharge. The findings of the study highlighted the importance of ensuring that service users should be actively involved in their discharge planning, and the use of effective post-discharge planning processes should be used as a crucial step to avoid readmission. Research limitations/implications: A deeper insight into the factors that impact on readmission to secure care is needed. The active involvement of service users in effective pre- and post-discharge planning is crucial to avoid readmission. Practical implications: Mental health professionals should consider developing more effective discharge interventions in collaboration with service users; inpatient services should consider creating more effective post-discharge information care and support packages. Their lived experience empowers PSWs to play a key role in guiding patients in the discharge process. Originality/value: This is the first study, to the best of the authors' knowledge, to explore what it feels like being discharged from inpatient mental health care by interviewing PSWs employed at a forensic mental health hospital by adopting a phenomenological approach. This paper offers a deeper insight into the transition process and explores in detail what support is needed post discharge to avoid potential readmission from PSWs' perspectives. [ABSTRACT FROM AUTHOR]

Purpose: Following serious case review, the Transforming Care agenda (DH, 2015) highlights the need for adults with learning disabilities, autism, mental health issues or behaviors that challenge to be supported within communities rather than hospitals. Poor or absent leadership has been identified as contributing to serious cases of abuse in health-care settings [Department of Health (DH), 2012]. This paper aims to focus on identifying the elements required for good leadership and service delivery in community forensic services (CFS). Design/methodology/approach: The perspectives of 12 support workers working in CFS were obtained through semi-structured interviews. Findings: Thematic analysis identified two predominant themes, namely, authentic leadership and effective team practice. A culture of trust and learning occurs when teams are well led. This culture leads to consistent practice which benefits services users and reduces risk of poor practice. Analysis suggests a framework for service delivery which is complimented by aspects of the Total Attachment model. Research limitations/implications: The data set was collected from the same organisation and views may have been aligned to existing organisational policy. However, the sample was taken across different teams and geographical locations to collate more generalised experiences of team dynamics. The lead researcher works for the organisation and this dual role may have affected the candour with which individuals shared information during interviews. Practical implications: Using a model to understand the functional dynamics of teams within CFS may support leaders and practitioners to improve service delivery. Social implications: Improving service delivery within CFS may increase opportunity to meet the Transforming Care Agenda. Originality/value: This paper examines staff perspectives and the application of theoretical frameworks to propose a unique service delivery model for supported living within CFS. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to evaluate pre- and post-formulation findings with multi-disciplinary staff within two secure children's homes (SCHs) in the North East of England. Design/methodology/approach: Multi-disciplinary staff teams involved in formulation across two SCHs were administered pre- and post-formulation questionnaires. The pre- and post-formulation questionnaires focused on five domains: knowledge; confidence; motivation; understanding; and satisfaction with treatment plan. Findings: A total of 338 pre- and post-formulation questionnaires were administered across 43 formulation meetings. The highest proportion of formulation attendees were: residential staff (44%); mental health staff (17%); case managers (12%); and education staff (9%). Paired samples t-tests showed significant post-formulation improvements across all domains including: knowledge [t(337) = 22.65, p < 0.001]; confidence [t(337) = 15.12, p < 0.001]; motivation [t(337) = 8.27, p < 0.001]; understanding [t(337) = 19.13, p < 0.001]; and satisfaction [t(337) = 18.81, p < 0.001]. Research limitations/implications: The SECURE STAIRS framework has supported formulation developments across the Children and Young People's Secure Estate. Preliminary findings within two SCHs suggest multi-disciplinary staff teams find psychologically informed formulation beneficial. Future directions are considered including future evaluation of young person involvement in formulation meetings. Originality/value: There is a notable lack of existing research within the child and young people secure estate evaluating the impact of SECURE STAIRS trauma-informed care developments including the impact of team formulation. This paper adds to the evidence base. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to report the findings of a survey study exploring perceptions about cognitive impairment. These findings are relevant to public health campaigns and education programmes. Design/methodology/approach: A survey exploring respondents' views and knowledge about mild cognitive impairment (MCI) was circulated via UK networks. A total of 417 respondents completed the survey, including people living with cognitive impairment (n = 10), care partners (n = 23), older adults (n = 83), younger adults (n = 83), general health-care professionals (n = 96), dementia specialist health-care professionals (n = 48) and dementia specialists (n = 40). Findings: Respondents were more confident in their knowledge about dementia than cognitive impairment but wanted more information about both conditions. Younger adults were uncertain about many aspects of MCI, and were the most likely to view MCI as a normal part of ageing. Diet (45.1%, n = 188) and personal behaviour (63.8%, n = 266) were the least endorsed possible causes of MCI, suggesting a lack of awareness of lifestyle choices as risk factors for MCI. Originality/value: The results highlight the need to provide education and awareness raising about MCI to enable people to seek help in a timely manner and be able to make informed lifestyle choices that may reduce their risk of MCI and dementia. Implementing education about MCI and dementia in schools is a key target, as younger people were the most uncertain or misinformed about these topics. It is clear that further public health initiatives around MCI are both warranted and welcomed by the general public. [ABSTRACT FROM AUTHOR]

Purpose: Since 2018, Australian paramedics have been regulated under the National Registration and Accreditation Scheme (NRAS) for health practitioners. Established professions have been regulated in Australia for some time, so there is limited knowledge of their entry to regulation. However, as paramedicine has not been previously centrally regulated, this provides a unique case study to explore the transition to regulated practice. Design/methodology/approach: Australian paramedics undertook two surveys: pre- and post-introduction of registration. The first survey was in the month leading up to the commencement of registration (N = 419), and the second survey took place 31 months after registration (N = 407). This paper presents the results of statistical analyses of the post-registration survey including comparisons to the pre-registration survey. Findings: Although support for regulation has increased over time, there remains strong dissent consistent with 2018 levels. After 31 months of regulation, respondents reported increasing knowledge of the scheme and greater ease of navigation. The impacts of regulation are more nuanced and less polarised than in the first survey. Identity is again canvassed, and results suggest a shift from employment status and qualifications as key elements of identity to a community of practice and registration. Originality/value: Paramedics' experiences and understanding of the rationale for registration are developing. Further support is needed to assist with the emerging professional identity and behaviours. Regulation is one of many occupational factors influencing professional identity and professionalism. Exploring the experience of regulation potentially assists regulators in better supporting practitioners and helps better understand professional evolution. [ABSTRACT FROM AUTHOR]

Purpose: At the outbreak of the COVID-19 pandemic, health care was at the centre of the crisis. New demands made existing organizational practices and services obsolete. Primary health care had a great deal of responsibility for COVID-19-related care. The pandemic demanded effective leadership to manage the new difficulties. This paper aims to explore experiences and perceptions of managers in primary health care in relation to their efforts to manage the COVID-19 crisis in their everyday work. Design/methodology/approach: The authors used a qualitative approach based on 14 semi-structured interviews with managers in primary health care from four regions in Sweden. The interviews were conducted during September to December 2020. Data were analysed using conventional qualitative content analysis. Findings: Data analysis yielded three categories: lonely in decision-making; stretched to the limit; and proud to have coped. The participants felt lonely in their decision-making, and they were stretched to the limit of their own and the organization's capacity. The psychosocial working conditions in primary care worsened considerably during the pandemic because demands on leaders increased while their ability to control the work situation decreased. However, they also expressed pride that they and their employees had managed the situation by being flexible and having a common focus. Originality/value: Looking ahead and using lessons learnt, and apart from making wise decisions under pressure, an important implication for primary health-care leaders is to not underestimate the power of acknowledging the virtues of humanity and justice during a crisis. Continuing professional education for leaders focusing on crisis leadership could help prepare leaders for future crises. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study explores the perspective of key informants (educators, preceptors and former students) of the Kintampo Project, on the perceived effectiveness, gains and challenges in delivering this large-scale training innovation in Ghana. The problem of mental health care neglect in Ghana is gradually improving. The Kintampo Project which trained mental health workers in Ghana has played a critical role in increasing access to mental health care. Design/methodology/approach: This qualitative study explored participants' perspectives on the Kintampo Project in three broad areas: perceived effectiveness, gains and challenges. In all, 17 interviews were conducted with former students, preceptors and educators from the project. The interviews were digitally audio-recorded, transcribed, coded and analysed using deductive and thematic methods. Findings: The participants perceived the project to have been successful in increasing the number of mental health workers in Ghana. The project provided a route for career progression for those involved. However, the Kintampo Project faced accreditation issues, low recognition, improper integration and remuneration of trained staff in the Ghana Health Service. This study points to the fact that the sustainability of mental health training in Ghana can be obstructed, because of this career path being less attractive. Further research is needed to explore how best to achieve sustainability of similar mental health innovations. Originality/value: This paper shares the views of participants in the Kintampo Project. [ABSTRACT FROM AUTHOR]

Purpose: There are no existing tools to capture resources needed to support people with intellectual disability in an inpatient setting on an individual patient basis. The purpose of this paper is to describe the development of a new tool called Universal Needs Based Resource Assessment (UNBRA). Design/methodology/approach: Using the Delphi method, focus groups were used to generate factors determining resource use. From these, themes were identified, a scoring system was created and the UNBRA tool was developed. This was piloted in two NHS inpatient units and modified following feedback. Findings: The UNBRA tool holistically assesses resource requirements of an individual with intellectual disability supported in an inpatient setting. It considers ten factors grouped into the six themes of staffing, indirect work, clinical/ multi-disciplinary work, incidents, carer link activity and discharge process. UNBRA scores allow intra- and interpersonal comparison as well as comparison between units and can support resource allocation and operational decision-making. Originality/value: To the best of the authors' knowledge, there is no suitable existing tool to capture individual resource requirements of patients in intellectual inpatient settings. The development of the UNBRA tool fills this gap. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the use of videoconferencing when conducting multi-disciplinary team (MDT) and handover meetings within an NHS Adult Learning Disabilities Intensive Support Team (IST). The IST have been conducting MDT and handover meetings "virtually" since the start of the COVID-19 pandemic in March 2020, in line with government guidance. It is pertinent to evaluate the effectiveness of using videoconferencing, as the move to flexible, remote working is detailed within the NHS Long Term Plan. Design/methodology/approach: Participants were members of the IST. A mixed methods approach using an online questionnaire collected participant's views relating to the use of videoconferencing when conducting MDT and handover meetings, in comparison to previous face-to-face meetings. The questionnaire considered five key areas: accessibility, environment and communication, organisation, continuation of care and data protection and confidentiality. Results were collated and analysed. Findings: Improvements were reported relating to accessibility, as the virtual format allowed for easier attendance, provided greater flexibility in attending and inviting key stakeholders. A reduced sense of team connectedness was reported, related to the virtual environment. The majority of participants reported that they wish to continue to have the option to attend meetings virtually in future. Originality/value: There are no previous papers evaluating the use of videoconferencing within ISTs during the COVID-19 pandemic. This study suggests that the use of videoconferencing to conduct MDT and handover meetings is effective within the IST and highlights points for consideration moving forward. [ABSTRACT FROM AUTHOR]

Purpose: With global migration, the number of ethnic minority and migrant women receiving maternity health care in dominantly Anglo-European societies has increased significantly but they consistently have among the worst pregnancy and maternal outcomes. This paper aims to analyse gaps in structural (migration-related inequalities) and cultural (responsiveness to ethno-cultural practices) competencies among maternal health practitioners in Aotearoa New Zealand (NZ). Design/methodology/approach: Using a semi-structured interview guide, in-depth interviews were conducted with 13 maternal health practitioners in NZ. Data were analysed using a thematic analysis framework. Findings: The results highlight significant barriers around language and communication, cultural stereotyping by professionals, ethnic women's own constraints around family and cultural expectations and their lack of knowledge about reproductive health. In addition, practitioners' own ethnic differences are inseparable from their approach to structural and cultural competencies; there were instances of 'over-' or 'under-' reading of culture, practitioner constructions of ideal pregnancies and anti-racism concerns that shaped maternal care practices that were sensitive to, but also marginalised, ethnic migrant women who attended maternity services. Originality/value: To the best of the authors' knowledge, this is the only study in NZ that examines the impact of complex dynamics of migration and culture on knowledge, beliefs and values of practitioners, in context of their own personal biographies. Identifying strategies to improve the way diversity is practiced in hospital settings can be transformational in improving maternal outcomes for ethnic migrant women in NZ. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present findings from a mixed-methods study on the impact that COVID-19 has had on adult safeguarding. The research sought to explore the challenges and opportunities presented by COVID-19 to both frontline and non-frontline professionals working in adult safeguarding. Design/methodology/approach: A mixed-methods project was undertaken comprising a literature review, survey, semi-structured interviews and a small number of freedom of information requests. This paper presents the findings predominantly from the survey and interviews. Findings: Unsurprisingly, COVID-19 has presented a variety of challenges for professionals working in adult safeguarding. The themes that occurred most often were the day-to-day changes and challenges, relationships across sectors, information and navigating the ethical questions in safeguarding. Originality/value: To the best of the authors' knowledge, the findings represent the first focused qualitative mixed-method study aimed at understanding more about the impact the pandemic has had on adult safeguarding through the eyes of those professionals working in that field. [ABSTRACT FROM AUTHOR]

Purpose: Reciprocal abuse inside care practices remain under-studied due to their invisibility and further research is required. The purpose of this paper is to explore different levels of conflicts inside organisations. Design/methodology/approach: The paper is based on a self-administered questionnaire filled out by care workers (n = 150), in 16 Portuguese care homes. Findings: Results indicated that, overall, 54.7% of care workers had observed abuse, in their daily practice, in the preceding 12 months: 48.7% psychological; 36.0% neglectful care practices; 14.0% physical and 3.3% financial abuse. The figures decreased significantly as regards abuse committed themselves, with 16.7% of those admitting to having committed at least one of these behaviours. The highest figures were also recorded for psychological abuse (13.3%) and neglect (6.7%). However, there is a statistically significant relationship between abuse committed by care workers and abuse committed by residents. Overall, 52.0% of care workers reported having been the target of at least one such behaviour by residents. Research limitations/implications: This paper has its limitations as the sample consisted of only 16 nursing homes (12 not-for-profit and 4 for-profit nursing homes). The fact that only 4 of the 16 LTC homes were for-profit is a potential limitation both in general and in particular because research has shown that lower quality of care and elder abuse and neglect are more common in for-profit nursing homes at least in Portugal. The results were also based on self-reported measures. Practical implications: A reactive behaviour, the risk of retaliation, after a complaint, the difficulty in dealing with dementia and the residents' aggressive behaviour, an absence of a training and support policy in an environment where difficult working conditions prevail, are factors enhancing a reciprocal process of abuse. The analysis followed by a discussion of potential implications to prevent institutional elder abuse and neglect, based on communication and social recognition, including better working conditions and training, and a cooperative work environment. Social implications: Conflict is much more than reducing an interpersonal relationship problem between residents and staff (care workers, professional staff, managers) and extending to the whole organisation. Therefore, there are still uncertainties on how organisations, staff and residents interact between themselves, and affect care practises. Originality/value: Reciprocal abuse in nursing homes is an important area of research and this paper enabled a discussion of potential implications concerning the quality of care, which required the identification of levels of conflict, in an organisational system, including interactions, the context where care is provided, difficult working conditions, lack of training and levels of support. All these factors are important when considering elder abuse and neglect and this calls for special attention by policymakers and researchers. [ABSTRACT FROM AUTHOR]

Purpose: Participation is the active involvement of children and young people in decision-making regarding issues that affect their lives. It is crucial in the context of child protection and welfare systems and how they respond to the needs of children and young people. The purpose of this paper is to report on the evaluation of child and family participation in an early intervention and prevention programme implemented by the Irish Child and Family Agency. It provides an analysis of a comprehensive, "whole organization" approach to understand how participation is embedded in policy and practice. Design/methodology/approach: This paper reports on a comparative qualitative case study of the perspectives of managers and practitioners about participation practice, identifying the facilitators and barriers, as well as their perspectives of the sustainability of participation within the agency and its partners. The authors draw on two complementary, theoretically informed studies evaluating participatory practice within the Agency using qualitative interviews with participants. Findings: Overall, managers and practitioners had a positive attitude towards participation and identified examples of best practices. Facilitators included training, access to resources and the quality of relationships. Challenges for meaningful participation remain, such as the need to engage, hard to reach populations. Differences were identified regarding how embedded and sustainable participation was. Originality/value: This paper provides a critical understanding of participation in practice and how to embed a culture of participation in child protection and welfare. [ABSTRACT FROM AUTHOR]

Purpose: There has been significant growth in the number of people getting tattoos over recent decades. While there might be a myriad of reasons for getting a tattoo, there remains a deficit of knowledge in relation to the potential relationship between tattoos and mental health. This paper aims to explore this potential relationship, from the perspective of those with tattoos, and considers the relevance of this potential relationship for those working in mental health services. Design/methodology/approach: Data was collected through an online qualitative survey which asked participants to share their experiences in relation to their tattoos and mental health. The survey was shared through social media and distributed to tattoo shops within the UK. In total, 17 participants completed the survey; the survey data was then transferred to Nvivo and subjected to thematic analysis. Findings: Three themes emerged from the data. First, tattoos as an expression of relationship with self; second, tattoos as an expression of relationship with others, and third, tattoos as a symbol of change. The three domains provide an insight into the complex relationship between identity and tattoos and suggest that tattoos may hold significant importance in supporting people to make meaning following trauma and to communicate elements of themselves to the world around them. Originality/value: The findings provide an insight into the significance of tattoos which transcends the traditional discourses of tattoos as a marker of risk or deviance. Tattoos may be significant in the process of meaning making and narrating a sense of self and identity. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the extent to which principles of recovery-oriented practice are evident in the published perspectives and experiences of health professionals and service users on seclusion in adult mental health services. Design/methodology/approach: A systematic review informed by PRISMA guidelines was conducted, drawing from four databases, which were searched in August 2018 and August 2022. Only original empirical studies rated as having "major" relevance were included. Data were extracted from 31 studies and qualitatively synthesised through deductive analysis using recovery principles as themes. Findings: There was limited evidence of perceptions of seclusion being being consistent with recovery principles, with greater evidence of perceptions that directly opposed them. Studies of service user perspectives highlighted this more often than staff perspectives. The findings highlight paradoxical relationships between care and control and conflicting rights and emphasise the need to openly acknowledge the complexity of seclusion and its interface with recovery. Research limitations/implications: This review was developed in line with international best practice and the protocol was registered. Using a search string with only three components maximised sensitivity during searches and minimised the risk of relevant literature being missed. Limitations include the focus on studies where the full text was published in English. Originality/value: This review makes a unique contribution, highlighting that, to the best of the authors' knowledge, no studies to date have explicitly explored the perspectives and experiences of staff and service users on the use of seclusion in the context of recovery-oriented practice. The findings are relevant to clinical practice, policy and future research, including amending procedures and practices to partially reconcile seclusion and recovery where the seclusion is deemed necessary. [ABSTRACT FROM AUTHOR]

Purpose: Readmission to hospital can be distressing, costly for the National Health Service (NHS) and legally it should be a last resort as it entails restriction of liberty. This study aims to develop an understanding of factors leading to readmission for a cohort of service users under the care of a community forensic mental health team (CFMHT) in England to consider how support could be improved to reduce incidence of future readmissions. Design/methodology/approach: Thematic analysis was used to examine case recording relating to 13 service users who were readmitted to hospital within a specified time period. The same service users were invited to complete questionnaires regarding their views of what contributed to the readmission to cross-reference with themes identified. Findings: The analysis of case notes produced eight sub-themes. These were sorted into three overarching themes, illustrating the challenges that service users face upon discharge from hospital, the sense they make of these challenges and the impact upon relational patterns, in particular with the CFMHT. Researchers highlight that the multiple challenges can increase service users' sense of being under threat which can lead to distrust of professionals. Practical implications: Practical suggestions arising from the study were fed back to the subject team and are listed at the end of the paper. Originality/value: Findings from this study parallel those previously reported. This study contributes an inter-relational aspect of the factors and the central role of meaning-making in the path of recovery and building a life in the community. [ABSTRACT FROM AUTHOR]

Purpose: Although it is recommended that reflective practice groups (RPGs) are used to support staff in inpatient intellectual disability (ID) services, there is to date no research on their effectiveness or how staff perceive RPGs in these settings. This paper aims to evaluate staff perceptions of the RPGs in an assessment and treatment unit for people with ID and to ascertain the nature of any barriers for staff in attending the group. Design/methodology/approach: Thirteen staff completed questionnaires ascertaining their views on the purpose, process and impact of the RPG run within the service. Questionnaires included a version of the clinical supervision evaluation questionnaire (CSEQ; Horton et al., 2008) adapted for this context and a questionnaire designed by the authors examining barriers to attending the group. Findings: Staff responses indicated that they valued the group and perceived it as improving their clinical practice and their self-awareness. Staff did not always perceive group sessions as having clear aims and did not perceive the group as enhancing their well-being or their awareness of gaps in their skills. RPGs may be most effective if they form part of a service-wide approach to staff support and development. Originality/value: To the best of the authors' knowledge, this is the first evaluation of RPGs in inpatient ID services. The adapted CSEQ was found to be an easily implemented method of evaluating RPGs in an inpatient ID setting. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper was to explore the well-being and experiences of working from home (WFH) for psychology staff across a range of specialties working within one health board in Scotland during the COVID-19 pandemic. Design/methodology/approach: In total, 161 clinical psychology professionals took part in an online survey that explored experiences of WFH during the COVID-19 pandemic and assessed well-being during this period. Findings: A number of challenges with WFH were identified, including challenges with carrying out clinical work (e.g. communication difficulties, risk assessment) and fewer opportunities for collaborative working and technical/equipment issues. During the WFH period, 46% experienced fatigue, 45% felt stressed and anxious and 30% felt lonely and isolated, compared to normal. Physical health complaints were also common with 37% experiencing aches/pains in back compared to normal and 40% experiencing headaches or migraines. Practical implications: Remote therapy should be directed to those with less complex needs or who require straightforward assessments. There should be increased access to occupational health assessments and provision of ergonomic furniture when WFH, and all staff should be supported to access well-being resources available within the health board. Further evaluation should be carried out to support evidence-based practice of remote clinical work. Originality/value: Few studies have explored the experiences of WFH and/or remotely from the perspectives of clinical psychologists in a Scottish health board. It is expected that this way of working will continue, albeit to a smaller extent; therefore, WFH policy will be informed by the findings. [ABSTRACT FROM AUTHOR]

Purpose: While studies on service users' participation and their perceptions on the quality of services exist, agreement between family members' and practitioners' assessments of the family's situation has received less interest. The purpose of this paper is to investigate agreement and its effect on outcomes by comparing the viewpoints of three groups of informants (children, mothers and practitioners) in the context of statutory child protection in two study groups – one applying a systemic approach (SPM) and a service-as-usual control group (SAU). Design/methodology/approach: A quasi-experimental repeated-measures study design was applied. Outcome data comprised 112 cases (SPM cases n = 56 and SAU cases n = 56) at three sites. Data was collected from all participants at baseline and six months later. Findings: First, practitioners' analyses of a child's need for protection did not meet family members' expressed need for help. Second, child–mother agreement on the need for service intervention at T1 predicted a decrease in practitioner-assessed abuse or neglect from T1 to T2. In this sample, no differences were found between the two groups. Originality/value: This study highlights the importance of making explicit the viewpoints of children, parents and practitioners in casework and research to improve understanding of how their perspectives differ over the course of the process and how possible initial disagreements affect outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Whilst recruitment and retention of high-quality staff is vital to providing a good service, at the time of the evaluations, Kent, Surrey and Sussex (KSS) was the only area of the UK without a Higher Specialist Training (HST) scheme in intellectual disability (ID). The purpose of this project was to identify barriers to recruitment and support the need for change. Design/methodology/approach: This evaluation included conducting interviews with 16 practitioners in the region with links to ID to consider the gaps in training and find solutions. Findings: Four themes were identified, namely, good experiences are important to recruiting people into the ID field; bad experiences or lack of exposure to people with ID are likely to prevent engagement with this field; there is an ongoing need for specialist psychiatrists in ID services; and there is a developing need for specialists in neurodevelopmental disorders. Finally, the challenge means we need to think differently about developing a workforce. Seven recommendations to support workforce delivery in KSS were developed. Originality/value: This paper highlights an important rationale for ongoing need for HST in ID work and also reasons to engage people in this field. This has not been undertaken in the ID field in this way previously. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report findings from a service evaluation undertaken within a single specialist child and adolescent mental health service (CAMHS) team. The team works closely with local authority children's services to serve specific populations recognised as experiencing higher levels of mental health need, including children living in alternative care and with adoptive families. The evaluation sought to better understand the experience of this provision during the COVID-19 pandemic and concomitant increase in remote and digitally mediated care delivery. Design/methodology/approach: Analysis of the accounts of 38 parents, carers and professionals involved with the team gathered via telephone interviews and email and postal questionnaires. Findings: Similar views were expressed from participants involved with the team before and following the onset of the pandemic. Overall, satisfaction was high; however, changes in care appeared more challenging for those already involved with the team before the pandemic. Differences in experience between groups were also evident. Whereas foster carers' accounts were generally appreciative of the involvement of clinicians, particularly regarding clinician–patient relationships, amongst adoptive parents and members of children's birth families there were more mixed and negative impressions. Originality/value: Locally based service evaluations can help inform care pathway planning in specialist CAMHS provision as part of wider quality improvement initiatives. This is especially relevant considering the repercussions of the COVID-19 pandemic and as the longer-term acceptability of remote working practices is appraised. [ABSTRACT FROM AUTHOR]

Purpose: Paramedics increasingly attend to mental health-related emergencies; however, there has been little evaluation of the mental health training for paramedics. This study aims to analyze the fit between paramedicine pedagogy, patient needs and the conditions for paramedics' skill development. Design/methodology/approach: Data were collected in a single, qualitative, critical ethnographic case study of pre-hospital mental health and psychosocial care in paramedicine in Ontario, Canada. Transcripts from interviews (n = 46), observation (n ∼ 90h) and document analysis were thematically analyzed using a constant comparative method. The study is theoretically grounded in a feminist political economy framework. Findings: Tensions are explored in relation to the pedagogy of paramedicine and the conditions of work faced by paramedics. The paper presents challenges and insufficiencies with existing training, the ways in which certain work and training are valued and prioritized, increased emergency care and training needs and the limitations of training to improving care. Research limitations/implications: Recommendations include more comprehensive didactic training, including the social determinants of health; scenario training; practicum placements in mental health or social services; collaboration with mental health and social services to further develop relevant curriculum and potential inclusion of service users. Originality/value: This paper addresses the lack of mental health pedagogy in Ontario and internationally and the need for further training pre-certification and while in the workforce. It presents promising practices to ameliorate mental health training and education for paramedics. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to re-conceptualise the hot debrief process after cardiac arrest as a collaborative and distributed process across the multi-disciplinary team. There are multiple benefits to hot debriefs but there are also barriers to its implementation. Facilitating the hot debrief discussion usually falls within the remit of the physician; however, the American Heart Association suggests "a facilitator, typically a health-care professional, leads a discussion focused on identifying ways to improve performance". Empowering nurses through a distributed leadership approach supports the wider health-care team involvement and facilitation of the hot debrief process, while reducing the cognitive burden of the lead physician. Design/methodology/approach: A mixed-method approach was taken to evaluate the experiences of staff in the Emergency Department (ED) to identify their experiences of hot debrief after cardiac arrest. There had been some staff dissatisfaction with the process with reports of negative experiences of unresolved issues after cardiac arrest. An audit identified zero hot debriefs occurring in 2019. A quality Improvement project (Model for Healthcare Improvement) used four plan do study act cycles from March 2020 to September 2021, using two questionnaires and semi-structured interviews to engage the team in the design and implementation of a hot debrief tool, using a distributed leadership approach. Findings: The first survey (n = 78) provided a consensus to develop a hot debrief in the ED (84% in the ED; 85% in intensive care unit (ICU); and 92% from Acute Medicine). Three months after implementation of the hot debrief tool, 5 out of 12 cardiac arrests had a hot debrief, an increase of 42% in hot debriefs from a baseline of 0%. The hot debrief started to become embedded in the ED; however, six months on, there were still inconsistencies with implementation and barriers remained. Findings from the second survey (n = 58) suggest that doctors may not be convinced of the benefits of the hot debrief process, particularly its benefits to improve team performance and nurses appear more invested in hot debriefs when compared to doctors. Research limitations/implications: There are existing hot debrief tools; for example, STOP 5 and Take STOCK; however, creating a specific tool with QI methods, tailored to the specific ED context, is likely to produce higher levels of multi-disciplinary team engagement and result in distributed roles and responsibilities. Change is accepted when people are involved in the decisions that affect them and when they have the opportunity to influence that change. This approach is more likely to be achieved through distributed leadership rather than from more traditional top-down hierarchical leadership approaches. Originality/value: To the best of the authors' knowledge, this study is the first of its kind to integrate Royal College Quality Improvement requirements with a collaborative and distributed medical leadership approach, to steer a change project in the implementation of a hot debrief in the ED. EDs need to create a continuous quality improvement culture to support this integration of leadership and QI methods combined, to drive and sustain successful change in distributed leadership to support the implementation of clinical protocols across the multi-disciplinary team in the ED. [ABSTRACT FROM AUTHOR]

Purpose: One of the most affected groups during the COVID-19 pandemic was health-care providers due to the direct and continuous exposure to the virus and a lack of sufficient medical equipment. Palestinian health-care providers were exposed to several challenges related to their work environment as they worked in war-like conditions; therefore, this study aims to explore health-care providers' perceptions, perspectives, challenges and human rights-related concerns during the COVID-19 Pandemic in Palestine. Design/methodology/approach: The sample comprised 30 health-care providers 26–35 years, who were purposively selected from among health-care providers in two Palestinian cities, Nablus and Tulkarm, located in the north of the West Bank. Thematic content analysis was applied to transcripts of interviews with the practitioners to identify key themes. Findings: The thematic content analysis showed that the pandemic and quarantine negatively affect the mental health outcomes, daily routine and social relations of health-care providers. The main challenges related to human rights violations and faced by the health-care providers include a lack of sufficient infrastructure, lack of medical equipment's and protective gear, military occupation and a shortage of health-care providers in general, especially those who practice in speciality fields such as neurology, oncology, pediatric surgery and clinical psychology. Practical implications: Further investigations are recommended to test different variables related to health-care providers' work during the COVID-19 pandemic. This paper also recommends conducting studies targeting Palestinian health-care providers' training and supervision services to improve their skills and resiliency in dealing with future crises. Originality/value: The present work is the first to examine health-care providers' perceptions, perspectives, challenges and human rights concerns during the COVID-19 pandemic in Palestine. This novel sample resides in a political and social environment characterized by high environmental stressors due to decades of military and political violence (e.g. militarization, poverty, lack of employment opportunities, cultural pressures, human rights violations, etc.) [ABSTRACT FROM AUTHOR]

Purpose: Patient experience (PE) evaluation can identify critical issues in healthcare quality. Various methods are used for PE evaluation in the healthcare system in Ontario; however, evidence suggests that PE evaluation is not systematically performed and has not received substantial buy-in from healthcare providers. This study explores the perspectives of healthcare providers, managers and policymakers in Ontario on PE evaluation methods, barriers, utility and reliability. Design/methodology/approach: The study used a qualitative descriptive design. Twenty-one semistructured interviews were conducted with healthcare providers, managers and policymakers in Ontario between April 2018 and May 2019. The authors used thematic analysis to analyze the data. The Consolidated Criteria for Reporting Qualitative Research quality criteria were used. Findings: Barriers to PE evaluation include evaluation cost and the time and effort required to collect and analyze the data. Several factors affect the reliability of the evaluation, resulting in an unrealistically high level of patient satisfaction. These include the inclusivity of evaluation, the subjective nature of patient feedback, patients' concerns about health service continuity and the anonymity of evaluation. Participants were skeptical about the meaningfulness of evaluation because it may only yield general information that cannot be acted upon by healthcare providers, managers and policymakers for quality improvement. Originality/value: This paper reveals that many healthcare providers, managers and policymakers do not see a tangible value in PE evaluation, regardless of Ontario's patient-centeredness and "patient first" rhetoric. An improvement in evaluation methods and a cultural change in the healthcare system regarding the value of PE are required to foster a better appreciation of the benefits of PE evaluation. [ABSTRACT FROM AUTHOR]

Purpose: Karen people from Burma are a new population in resettlement countries. While research increasingly documents their health needs, few studies describe how health-care providers adapt their practices to serve this group. The purpose of this study was to explore the experiences of providers who work with Karen patients/clients in health settings, documenting the challenges they face, how they adapt their practice and recommendations. Design/methodology/approach: This study used a qualitative survey and one phone interview with a total of 20 providers who had first-hand experience caring for Karen people in health settings. Data were analyzed using qualitative content analysis. Findings: Two main categories described challenges providers faced in working with Karen people in health settings: system-level challenges and interpersonal communication challenges. Five main categories described specific strategies and support needed to adapt practice for Karen patients in health settings: strategies for improving communication and mutual understanding; partnering with Karen staff, interpreters and cultural brokers; strategies for building trust and rapport; addressing needs related to case management, care coordination and social determinants of health; recommendations for provider training. Originality/value: This paper contributes suggestions for adapting practice to meet the health needs of Karen people from the perspective of health-care providers in a location that is nationally recognized for its excellence in refugee health. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to share the lessons learnt during the implementation of a Peer Support Worker (PSW) pilot project within Child and Adolescent Mental Health Services (CAMHS). The project aimed to reduce the barriers experienced by young people and carers during the process of transition between child and Adult Mental Health Services (AMHS). Design/methodology/approach -- The paper combines reflections of staff, PSWs and trainers in order to share the lessons that may be taken from this project. This includes a rough guide for those hoping to employ PSWs to support transitions. Findings -- The PSWs provided the vehicle to support the process of transition by empowering young people and their carers to use their strengths to facilitate a hopeful and timely transition. Recommendations regarding support for peers, staff and the organisation during the process of training and employing peers are discussed. Research limitations/implications -- The paper provides a purely reflective account of the pilot project. These reflectionsmay provide guidance for others wishing to develop peer support positions within CAMHS so that an evidence base for the effectiveness of peer support within transitions may continue to grow. Originality/value -- Rotherham Doncaster and South Humber NHS Foundation Trust are the first NHS Trust in the UK to employ PSWs specifically to support transitions between CAMHS and AMHS. This paper builds on the work of Oldknow et al. (2014) to highlight the first attempts to use peer support to support transitions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate outcomes associated with a training designed to improve interactions between first responders and individuals with autism spectrum disorder (ASD). Design/methodology/approach: Authors examined the responses of a group of first responders (N = 224) who completed a survey before and after a training to assess their (a) knowledge of ASD, (b) confidence for working with individuals with ASD, (c) comfort responding to a call and (d) ratings of the training they received. Findings: Findings indicated first responders demonstrated more knowledge of ASD, increased confidence for working with individuals with ASD and improved comfort when responding to a call. Research limitations/implications: This preliminary report serves as initial evidence of the importance of rigorous work examining trainings designed to improve interactions between first responders and individuals with ASD. Practical implications: The results of this study justify continued rigorous research on the effectivness of ENACT, as a training designed to improve knowledge and comfort of first responders who work with individuals with ASD. Originality/value: This study fills an identified need for research on trainings designed to educate first responders about ASD. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to investigate the relationship between inclusive leadership (IL), psychological safety (PS), affective commitment (AC) and organizational citizenship behavior (OCB) at the workplace. By understanding the sequential linkages, the research aims to provide insights for fostering a positive organizational culture that promotes employee commitment and employees' willingness to go the extra mile for the organization. Design/methodology/approach: The authors study how IL and OCB are related through PS and AC. For this purpose, cross-sectional data from 384 nursing professionals in India was collected and structural equation modeling was conducted on the same using IBM AMOS. Findings: The study found that IL has a major impact on OCB. The study further found that perceived IL leads to PS which is associated with OCB through AC. Research limitations/implications: The study has many theoretical and practical implications. This study uses a framework that is based on Affective events theory. In a health-care environment, IL can foster AC by promoting a culture of respect, collaboration and value for diverse perspectives, which enhances health-care professionals' emotional attachment to their work and the organization. Additionally, by encouraging open communication and a sense of belonging, IL contributes to OCB, as health-care staff are more likely to engage in discretionary behaviors that support the overall effectiveness and positive functioning of the health-care team if PS is improved, ultimately improving patient care outcomes. Originality/value: To the best of the authors' knowledge, this is one of the primary studies that looks into the sequential mechanism through which IL impacts OCB. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the quality of information recorded in Behaviour Monitoring Charts (BMC) for Behaviours that Challenge (BtC) in dementia in an older adult inpatient dementia service in the North of England (Aim I) and to understand staff perceptions and experiences of completing BMC for BtC in dementia (Aim II). Design/methodology/approach: Descriptive statistics and graphs were used to analyse and interpret quantitative data gathered from BMC (Aim I) and Likert-scale survey responses (Aim II). Thematic analysis (Braun and Clarke, 2006) was used to analyse and interpret qualitative data collected from responses to open-ended survey questions and, separately, focus group discussions (Aim II). Findings: Analysis of the BMCs revealed that some of the data recorded relating to antecedents, behaviours and consequences lacked richness and used vague language (i.e. gave reassurance), which limited its clinical utility. Overall, participants and respondents found BMC to be problematic. For them, completing BMCs were not viewed as worthwhile, the processes that followed their completion were unclear, and they left staff feeling disempowered in the systemic hierarchy of an inpatient setting. Originality/value: Functional analysis of BMC helps identify and inform appropriately tailored interventions for BtC in dementia. Understanding how BMCs are used and how staff perceive BMC provides a unique opportunity to improve them. Improving BMC will support better functional analysis of BtC, thus allowing for more tailored interventions to meet the needs of people with dementia. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to identify and synthesise the best evidence on health-care leaders' and professionals' experiences and perceptions of compassionate leadership. Design/methodology/approach: A mixed-methods systematic review was conducted in accordance with the Joanna Briggs Institute methodology for mixed-methods systematic reviews using a convergent integrated approach. A systematic search was done in January 2023 in PubMed, CINAHL, Scopus, Medic and MedNar databases. The results were reported based on Preferred Reporting Items for Systematic Reviews and Meta-analyses. The data was analysed using thematic analysis. Findings: Ten studies were included in the review (five qualitative and five quantitative). The thematic analysis identified seven analytical themes as follows: treating professionals as individuals with an empathetic and understanding approach; building a culture for open and safe communication; being there for professionals; giving all-encompassing support; showing the way as a leader and as a strong professional; building circumstances for efficient work and better well-being; and growing into a compassionate leader. Practical implications: Compassionate leadership can possibly address human resource-related challenges, such as health-care professionals' burnout, turnover and the lack of patient safety. It should be taken into consideration by health-care leaders, their education and health-care organisations when developing their effectiveness. Originality/value: This review synthesised the knowledge of compassionate leadership in health care and its benefits by providing seven core elements of health-care leaders' and professionals' experiences and perceptions of compassionate leadership. [ABSTRACT FROM AUTHOR]

Purpose: Child and adolescent mental health services (CAMHS) has been described as "in crisis" and "not fit for purpose". CAMHS services have undergone a multitude of changes, including policy initiatives, recent growth in demand, decreases in resources and increased pressure. This study aims to explore the experiences of clinical psychologists (CPs) working in CAMHS, leaving CAMHS and working independently with children and families. Design/methodology/approach: A qualitative design with semi-structured interviews of ten participants was used. Interviews were analysed using interpretative phenomenological analysis. Findings: Results are represented within 5 themes and 14 sub-themes. Participants felt that over time there had been undesirable changes in CAMHS, which left them reminiscing about the past. Participants felt unable to do their job in CAMHS, meet the needs of children and young people and use their psychology skills. Participants emphasised the importance of colleagues and being part of an multidisciplinary team, which had been missed since working independently, but they also highlighted difficult relationships with managers. Participants felt that working at CAMHS had negatively impacted their emotional and physical well-being and their family life. In contrast, participants felt that working independently meant they could do the job they had wanted to be doing as a CP and had a better work–life balance. Originality/value: This study had implications for services, where it would be beneficial for the experiences of CPs to be considered in relation to current practice with the view of improving the experiences of staff. Future research would benefit from exploring the experiences of CAMHS staff further. [ABSTRACT FROM AUTHOR]

Purpose: The transtheoretical model (TTM) has been applied to varying areas of physical health, e.g. diabetes. However, research into its applicability to psychotherapy is mixed. The TTM is applied through the University of Rhode Island Change Assessment (URICA). Investigating the utility of the URICA is needed to improve patient care and outcomes. This study aims to assess whether the URICA scores relate to patient outcomes; patient attendance; practitioner ratings of patient readiness, appropriateness, insight, motivation and potential for improvement; and to explore practitioner's perspectives on the URICA. Design/methodology/approach: Correlational methods were used to assess the relationship between the URICA and therapeutic outcome, attendance and practitioner-rated areas. Content analysis was used to analyse practitioner qualitative data. Findings: The URICA did not correlate with either therapeutic outcome or attendance. A significant negative correlation was found between the URICA and practitioner-rated appropriateness of the referral. This means practitioners perceived individuals with lower URICA scores to be a more appropriate referral, despite the score indicating a reduced readiness to change. Qualitative categories included positive views, negative views, ambivalence and changes to measure and process. To conclude, the URICA does not explain a patient's outcome or attendance. The URICA may not be appropriate to use in its current format in mental health services; therefore, assessing the TTM verbally may be more helpful. Originality/value: This study provides research into suitability of using the URICA to assess the TTM and its applicability to attendance and outcome in psychological therapies. [ABSTRACT FROM AUTHOR]

Purpose: Mental health staff often experience significant levels of stress working in the acute psychiatric inpatient setting. Team-building interventions can mitigate stress in health-care settings, via improvements in team-cohesion, staff interactions and communication skills. The "Tree of Life" (ToL) is a specific narrative therapy approach which uses the metaphor of a tree to facilitate the construction and sharing of strength-based stories. This study aims to describe the development of and evaluate the feasibility, acceptability and staff experiences of the "Team Tree", an adapted Professional ToL (PToL) intervention. Design/methodology/approach: A one-hour, Professional ToL intervention was designed for multidisciplinary acute inpatient staff teams working within a psychiatric hospital in London, UK. A mixed methods approach was used to evaluate the feasibility, acceptability and staff experiences of the session. Findings: Participants were 46 multidisciplinary staff (33 women; 13 men) working across four acute psychiatric wards. The intervention was feasible to deliver and was acceptable to participants. Results showed significant improvements in self-reported mental well-being and team-cohesiveness scores post-session. Practical implications: Psychologists face myriad barriers in working with staff teams in the acute inpatient setting. The "Team Tree" intervention was both well received by staff and practical to deliver within the challenging environment of the acute ward. Originality/value: This adaptation of the original PToL emerged from the author's work with distressed inpatient teams with limited time resources. To the best of the authors' knowledge, this is the first description of this intervention using a single tree metaphor to facilitate a reflective and creative session with health-care teams. [ABSTRACT FROM AUTHOR]

Purpose: Recovery Colleges were developed to support the recovery of people with mental health difficulties through courses co-produced by professionals and people with lived experience. This study aims to examine the use of Recovery Colleges to support people with dementia. Design/methodology/approach: A survey was circulated to UK Recovery College and memory service staff, exploring provision, delivery and attendance of dementia courses. Open responses provided insight into participant views about recovery in post-diagnostic support and the practicalities of running dementia courses. Findings: A total of 51 Recovery College staff and 210 memory service staff completed the survey. Twelve Recovery College dementia courses were identified across the UK. Three categories emerged from the qualitative data: post-diagnostic support, recovery in the context of dementia, challenges and areas of innovation. Originality/value: This study highlights the benefits and practicalities of running Recovery College courses with people with dementia. Peer-to-peer learning was seen as valuable in post-diagnostic support but opinions were divided about the term recovery in dementia. [ABSTRACT FROM AUTHOR]

Purpose: Studies show that economic sanctions have had major negative impacts on health systems during the past years. The aim of this study is to identify the impacts of US sanctions on the performance of public hospitals in Iran. Design/methodology/approach: A qualitative research study was conducted between October 2019 and September 2020 in Kermanshah Province, Iran. Semi-structured, face-to-face interviews, lasting between 25 and 90 min, were carried out with 20 participants in seven public hospitals affiliated to the authors' institution in Kermanshah Province. Inductive thematic analysis was used to identify themes in the data. Findings: Five main themes emerged from the analysis: resource management challenges; financial restrictions; interruptions in planning; reductions in the quality of service delivery; and changes in organizational relationships. Originality/value: The results of the present study demonstrate that US economic sanctions have considerably reduced access to necessary medical equipment and medicines for public hospitals in Iran. Policymakers should monitor the distribution of equipment and pharmaceutical products within public hospitals in Iran and take actions to ameliorate shortages during times of economic sanctions. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine to what extent the relationships between hospital workers' perceptions of lean leadership behaviour, their engagement and the hospital unit's perceived performance are mediated by job demands. Design/methodology/approach: The data (n = 1,624) come from a lean implementation study in a Dutch hospital and are analysed using structural equation modelling in Mplus (v8.4). Findings: The results confirm that lean leadership behaviour is related to employee engagement and hospital unit performance as perceived by employees, and these relationships are partially mediated through job demands. More specifically, the authors found that the type of job demand explains the direction of mediation effects. On the one hand, so-called challenging demands positively mediate the relationships between lean leadership behaviour and its outcomes. Conversely, hindering demands negatively mediates the relationship between lean leadership behaviour and perceived unit performance. Practical implications: The authors recommend hospital organisations and human resources managers start by helping hospital leaders understand the underlying mechanisms that explain the effects of leadership on employees' perceptions and, second, support their frontline leaders by providing training, coaching and feedback on how to influence job demands in a way that creates an optimal work environment for hospital employees. Originality/value: The authors contribute to the literature by building upon insights from the job demands-resources model to explain the effects of lean leadership behaviour and by investigating the relevance of lean leadership in a hospital context, given the phenomenon's strong roots in manufacturing. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic has had a disruptive effect on the health system. Health facility leaders were at the forefront of maintaining service delivery and were exposed to varied stressors in the early phase of the pandemic. This study aims to explore the leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in Nigeria's epicentre. Design/methodology/approach: This study conducted an exploratory descriptive qualitative study. To achieve this, 33 health facility leaders of different cadres across primary, secondary, and tertiary levels of the public health care system in Lagos, Nigeria, were remotely interviewed. The key informant interviews were transcribed verbatim and were analysed by using thematic analysis. Findings: The health facility leaders experienced heightened levels of fear, anxiety and stressors during the early phase of the pandemic. They also had genuine concerns about exposing their family members to the virus and had to manage some health-care workers who were afraid for their lives and reluctant. Coping mechanisms included psychological and social support, innovative hygiene measures at health facility and at home, training and staff welfare in more ways than usual. They were motivated to continue rendering services during the crisis because of their passion, their calling, the Hippocratic oath and support from the State government. Originality/value: The experiences of health facility leaders from different parts of the world have been documented. However, to the best of the authors' knowledge, this is one of the first studies that specifically report multi-layer leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Purpose: The current national patient safety strategy for the National Health Service (NHS) in England states that actions need to be taken to support the development of a patient safety culture. This includes that local systems should seek to understand staff perceptions of the fairness and effectiveness of serious incident management. This study aims to explore the perspectives of patient safety professionals about what works well and what could be done better to support a patient safety culture at the level of Trust strategy and serious incident governance. Design/methodology/approach: A total of 15 professionals with a role in serious incident management, from five mental health trusts in England, were interviewed using a semi-structured interview guide. Thematic analysis and qualitative description were used to analyse the data. Findings: Participants felt that actions to support a patient safety culture were challenging and required long-term and clinical commitment. Broadening the scope of serious incident investigations was felt to be one way to better understand patient safety culture issues. Organisational influences during the serious incident management process were highlighted, informing approaches to maximise the fairness and objectivity of investigation findings. Originality/value: The findings of this study offer original insights that the NHS safety system can use to facilitate progression of the patient safety culture agenda. In particular, local mental health trusts could consider the findings in the context of their current strategic objectives related to patient safety culture and operational delivery of serious incident management frameworks. [ABSTRACT FROM AUTHOR]