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Accessible Summary: What is known on the subject?: We know that there are similar rates of borderline personality disorder (BPD) diagnosed in both men and women; however, some research suggests that BPD is diagnosed later and less frequently in men. Some research suggests that males diagnosed with BPD present differently to women, but not much is known about how this influences the care men receive in inpatient mental health hospitals. What the paper adds to existing knowledge?: This paper is the first to specifically ask inpatient staff about men diagnosed with BPD, and to hear about their perceptions and experiences.It identified that some staff do not feel as knowledgeable in identifying and treating BPD in men compared to women. Some staff talked about how emotional difficulties like BPD are often not the first thought when men present with distress compared to women. Staff also talked about needing a safe, open and transparent working culture to be able to ask questions and to be questioned on their own assumptions, biases or lack of training. What are the implications for practice?: This paper suggests that inpatient staff may hold some assumptions about men and their emotions, such as assuming that they are less likely to struggle with emotional difficulties like BPD. Staff anxieties about risk management may influence how they perceive and care for men in inpatient wards. The findings suggest that male‐specific training in identifying and treating BPD should be provided for staff on inpatient wards, to improve knowledge and confidence. Introduction: Research highlights discrepancies in recognition of borderline personality disorder (BPD) in men, despite similar rates of prevalence across genders. Aim: To investigate inpatient mental health professionals' experiences of delivering treatment for males with a diagnosis of BPD. Method: Six mental health professionals working within adult acute inpatient wards completed a semi‐structured interview. All participants were members of the nursing team. Thematic analysis was used to analyse the data. Results: Five themes were identified: Gender Differences, Stereotyping, Facilitators to Care Delivery, Barriers to Care Delivery and Ways to Improve Care. Participants talked of a lack of awareness and understanding of BPD in males impacting both diagnosis and treatment in an acute inpatient setting. Discussion: There may be factors ranging from gender stereotypes, limited knowledge and understanding of gender differences in presentations, and personal/organisational cultures influencing the formulation and treatment of males with a diagnosis of BPD in inpatient settings. Implications for Practice: The findings suggest that gender stereotypes such as masculine norms may influence how male patients' emotional difficulties are understood and managed, and that additional training in male‐specific issues to improve knowledge and care provision. This research will support inpatient staff, service leads and clinical educators to identify ways to adapt care provision for men. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Nurses work in mental health services around the world, constituting the largest professional group.Nurses have been identified as being potentially able to carry out a much wider range of functions than are typically allowed in practice, when provided with suitable training.There are long‐term concerns regarding shortages of mental health nurses in England and many other countries.Workforce data is rarely subject to analysis in peer‐reviewed journals. What the paper adds to existing knowledge?: This paper provides a case study of the workforce patterns of a national mental health nurse (MHN) workforce overtime allowing comparison with other countries and specialities.MHN numbers reduced from 2011 to 2017, then increased to near the 2011 level by 2021, not meeting ambitious national plans for increasing numbers.The mental health nursing proportion of the total NHS nursing workforce decreased through this period.Advanced practice roles and skills are widely, but unevenly, distributed and are provided by a small proportion of nurses.The proportion of nurses working in community settings has increased to constitute more than half of all nurses for the first time.The ratio of support workers to nurses increased in inpatient settings and will continue to change. What are the implications for practice?: Historical challenges in recruiting MHNs suggest that future plans to expand the profession are overly optimistic.To support the development of advanced practice roles and new skill sets, clearer research evidence of impact is required and clearer national guidance regarding best practice models.Good workforce data are essential to inform good workforce planning. Introduction: Data regarding changes in characteristics of the MHN workforce is commonly cited in governmental publications, but is rarely analysed in peer‐reviewed journals, despite ongoing concerns regarding high vacancy rates within mental health services. Aim: The aim of the study was to characterize changes in the MHN workforce, implementation of new nursing roles/skills and alignment with national policy. Method: Analysis of nationally published workforce data, peer‐reviewed publications and governmental policy/planning documents. Results: Nurse numbers declined from 2011 to 2017, subsequently returning to near 2011 levels, but remaining below national targets. Nurses in community settings increased to constitute more than half of all nurses, whilst inpatient numbers declined, although more slowly than bed numbers. The ratio between nurses and support workers changed due to more support workers in inpatient settings. New advanced skills and roles for nurses have increased, but are unevenly distributed, constituting a small proportion of the total workforce. Implications for Practice: This paper provides a case study against which comparisons may be made with the nursing workforce in other countries and specialities. Even clear policy commitment to nursing growth may not deliver planned changes in numbers and introducing new roles may have uneven impact, especially in the absence of a robust evidence base. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: 'Leave' is a common occurrence for patients detained in mental health settings. The term covers multiple scenarios, for example short periods to get off the ward through to extended periods at home prior to discharge.Despite the frequency and importance of leave, there is very little research about how it is implemented and whether, and in what circumstances, it is effective.While there is legislation about leave in the Mental Health Act (1983) mental health services are free to implement their own policies or not to implement one at all. What the paper adds to existing knowledge?: The leave policies of NHS mental health services in England and Wales are highly inconsistent.The extent to which policies are consistent with guidance differs depending on which service is providing care. What are the implications for practice?: It is very likely that, because of inconsistencies between services and policies, practice also differs.Clinicians need to understand their responsibilities in the leave process to ensure that patients are supported in their recovery journey.Policymakers need to revisit leave policies in light of evidence from this study. Introduction: Considerable guidance is available about the implementation of leave for detained patients, but individual mental health services are free to determine their own policies. Aim: To determine how consistent leave policies of NHS mental health services in England and Wales are with relevant guidance and legislation. Method: A national audit of NHS mental health services leave policies. Data were obtained through web searching and Freedom of Information requests. Policies were assessed against 65 criteria across four domains (administrative, Responsible Clinician, types of leave and nursing). Definitions of leave‐related terms were extracted and analysed. Results: Fifty‐seven (91.9%) policies were obtained. There were considerable inconsistencies in how policies were informed by relevant guidance: Domain‐level consistency was 72.3% (administrative), 64.0% (Responsible Clinician), 44.7% (types of leave) and 41.9% (nursing). Definitions varied widely and commonly differed from those in relevant guidance. Discussion: Mental health professionals are inconsistently supported by the policy in their leave‐related practice. This could potentially contribute to inconsistent practice and leave‐related patient outcomes. Implications for Practice: To ensure patients are treated fairly clinicians need to be aware of their responsibilities around leave. In some services, they will need to go beyond their organization's stated policy to ensure this occurs. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Coronavirus disease 2019 (COVID‐19) is a new infectious disease that has spread across the world and infected a large number of people many of whom have died.People with moderate to severe dementia are at very high risk of becoming infected as the disease mainly impacts on older people with other health problems and once infected the person with dementia is more likely to become seriously ill than other people.To prevent infection, people are required to wear masks and isolate from contact with others. It is believed that these measures can reduce the quality of life and general well‐being of people with moderate to severe dementia in hospital or social care. This belief has not yet been demonstrated by research. What does this paper add to the existing knowledge?: We show that people with moderate to severe dementia receiving care on mental health hospital wards and subject to strict infection prevention measures can still achieve high levels of well‐being.We show that mental health nurses alter the focus of their care to deliberately overcome the challenges and particularly the restrictions on visiting by families. What are the implications for practice?: We believe that the changes in practice we observed can occur in other healthcare and social care settings and that whilst restrictions remain in place care staff can protect and possibly enhance well‐being for people with moderate to severe dementia. Introduction: The effect of coronavirus (COVID‐19) on people living with dementia is potentially severe in its clinical impacts. More widely, for this vulnerable group, the social restrictions to limit the spread of infection may be emotionally and psychologically damaging. Aim: To explore the impact of restrictions on well‐being for people with moderate to severe dementia in acute mental health hospital care. Method: "Dementia Care Mapping" was the observational tool used to determine well‐ or ill‐being. Observations were undertaken in two mental health hospital wards during a time of restrictions and the use of personal protective equipment. Results: We report levels of well‐being that are higher than might be expected alongside a change in the focus of psychological care delivered through mental health nursing interventions aimed at enhancing well‐being. Discussion—We postulate that mental health nurses faced with an unprecedented challenge respond by changing practice to mitigate for infection prevention measures and to compensate for family absence. Implications for practice: We suggest that the desirable enhancing actions by nursing staff which raise well‐being in these hospital settings are readily transferable to other settings that are aiming to maintain well‐being but also practising under COVID‐19 restrictions. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Internationally, systematic reviews have identified evidence of equal or improved clinical outcomes comparing advanced practitioner treatment with medical treatment as usual, across a range of specialities.Studies of nurse consultants in the United Kingdom have largely been non‐empirical. Most studies specifically related to nurse consultant roles in mental health services are case studies or reports of views on this role. What this paper adds to existing knowledge?: The study demonstrates that nurse consultant numbers vary over time and by clinical specialty. This is influenced by the value invested in the role by local nursing leadership and by national policy change.A lack of role clarity affects the uptake and sustainability of advanced practice roles internationally and is also an issue for the nurse consultant role in England's mental health services. What are the implications for practice?: Successfully introducing advanced practice nursing roles in mental health services requires role clarity and support from local nurse directors.The continued absence of robust evidence as to the clinical/cost‐effectiveness of nurse consultant roles in mental health settings places an onus on individual posts to generate data to justify the role at a time of financial constraint.Detailed post holder characteristics reported in this paper provide a basis for future comparison with other advanced practice roles in mental health services and other specialties nationally and internationally. Introduction: The nurse consultant is an advanced practice role providing expert clinical practice, consultancy and professional leadership. To date, few studies have examined this role within mental health services and none have described the professional characteristics of post holders. Aims: The main aims of the study were to identify changes in nurse consultant numbers in mental health services, identify post holder characteristics and factors influencing number of posts. Method: We used a triangulated mixed methods approach comprised of a longitudinal examination of national workforce data, a national cross‐sectional survey of post holder characteristics and semi‐structured interviews with directors of nursing. Results: Of 58 mental health organizations, 51 (88%) responded, identifying 123 nurse consultant posts, and a range of 0–12 posts per organization. One in 229 mental health nurses and 1 in 186 learning disability nurses were nurse consultant. An average of 40% of nurse consultants' work time was reported as being in clinical practice. Themes identified as important in relation to role sustainability were cost and value, contribution of individual post holders, role clarity and domains of work. Discussion: Nurse consultants are represented to a greater extent in the mental health service workforce than in nursing generally, but their roles often lack clarity. Attitudes of local professional leaders and national policies are likely to affect post numbers. Implications for practice: Developing and sustaining nurse consultant roles requires role clarity and active support from nurse leaders. Roles need to demonstrate their value to the clinical systems in which they work. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: The practices of mental health nurses in the administration of repetitive transcranial magnetic stimulation (rTMS) treatments for depression in outpatient clinic are crucial for patient outcomesTo date, most research has focused directly on procedural aspects of treatment delivery with limited focus on the delivery of holistic care and treatment.There is a lack of best practice guidance based on the experiences of those involved in clinical delivery to inform and improve rTMS practices What this paper adds to existing knowledge?: This study provides unique insights into service and personalized non‐treatment factors associated with rTMS delivery that may reduce stress and improve the experiences of rTMS patientsIt reviews and updates understanding of the factors that contribute to the delivery of effective rTMS. What are the implications for practice?: The need to apply findings for the development of best practice guidanceFactors to improve practice include (a) rTMS machine demonstrations; (b) constructive, individualized, friendly, and therapeutic conversations; (c) a relaxing, comfortable, 'homely' physical environment; (d) long term supportive management; and (e) careful engagement of nursing and support staff. [ABSTRACT FROM AUTHOR]

thompson c., yang h. & crouch s. (2012) Clinical simulation fidelity and nurses' identification of critical event risk: a signal detection analysis. Journal of Advanced Nursing 68(11), 2477-2485. Abstract Aims. This article is a report of a study exploring the effect of increasing fidelity on nurses' risk detection in clinical simulation and the effect of clinical experience on nurses' risk detection ability. Background. Clinical environments can be recreated successfully using simulation. However, how judgement changes as simulation fidelity increases is unknown. Knowledge of the effects of increased fidelity on judgement may help in the design of educational interventions seeking to improve clinical judgement in nurses. Design. Quasi experimental signal detection study. Method. During 2008-2009, using a quasi experimental signal detection design, 63 nursing students and 34 experienced nurses were presented with 25 paper and 25 human simulator 'cases' based on real patient records from a single UK National Health Service hospital. Nurses judged whether a simulated case was 'at risk' or 'not at risk' of a critical event. Clinical judgement performance was measured using standard signal detection measures. Findings. Judgement performance, as measured by hit rates and signal detection ability were significantly lower in higher fidelity clinical simulations. False alarm rates and bias (β) did not differ according to the fidelity of simulation. Clinical experience did not predict the ability to detect risk. Conclusion. As fidelity of simulation increased, both novice and experienced nurses' were less likely to be able to separate important clinical risk from clinical noise in a simulated clinical environment. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The experience of hearing distressing voices is commonly reported by service users with a diagnosis of first‐episode psychosis, but their access to formal conversations about voices in the form of psychological therapies can be limited.Service users within Early Intervention in Psychosis (EIP) services can benefit from informal opportunities to talk about their voice hearing experiences. However, they can be reluctant to engage with these conversations.Little is known about the experiences of EIP practitioners as they try to engage service users in conversations about their voices. What does the paper add to existing knowledge?: Despite EIP Services specializing in the treatment of the symptoms of psychosis such as voice hearing, practitioners can still be reluctant to initiate and continue informal conversations about voices. What are the implications for practice?: EIP practitioners may benefit from the introduction of interview guides and brief interventions to assist them with the initiation and continuation of conversations about voices. Introduction: Hearing voices is a common and distressing symptom of first‐episode psychosis. Formal and informal conversations about voices are helpful, but service users within Early Intervention in Psychosis (EIP) Services can be reluctant to discuss their voice hearing experiences. There is currently no literature that explores the experiences of EIP practitioners as they try to facilitate conversations about distressing voices. Aim/Question: A qualitative methodology was used to investigate how EIP practitioners work with service users who hear voices. Ten practitioners were interviewed, and interviews were analysed using template analysis. Results: Two themes that offer novel insights are presented: "starting a conversation about voices" and "continuing the conversation about voices." Discussion: Starting and continuing a conversation about voices was considered important but not all practitioners were confident in this respect. The initiation and continuation of these conversations may need to be systematically supported. Implications for practice: To support the initiation of informal conversations, a standardized interview guide for voice hearing could be introduced and systematically utilized. The continuation of these conversations could be supported by practitioners being given the opportunity to receive training in and the opportunity to deliver brief symptom‐specific therapies for distressing voices. [ABSTRACT FROM AUTHOR]

Aims and objectives This systematic review provides an overview of the literature published on Releasing Time to Care: The Productive Ward between 2005 and June 2011. Background Releasing Time to Care: The Productive Ward programme was developed by the NHS Institute for Innovation and Improvement and launched in England in 2007. The programme comprises thirteen modules that aim to increase time for direct patient care, improve the patient and staff experience and make changes to the ward environment to improve efficiency. Design A systematic literature review. Methods The terms ' Releasing Time to Care' and ' Productive Ward' were applied to key healthcare databases; CINAHL, Medline, Science Direct, Pro Quest, Health Business Elite, British Nursing Index, Embase, Health Management Information Consortium and PsychInfo. All papers were read and subject to a quality assessment. Results The literature search identified 95 unique sources. A lack of research on The Productive Ward programme meant it was necessary to include non-empirical literature. In total, 18 articles met the inclusion criteria. Seven key themes were identified: the patient and staff experience, direct care time, patient safety, financial impact, embedding and sustainability, executive support and leadership, and common barriers and determinants of success. It also highlighted areas that require further exploration such as long-term sustainability of the programme and consistent data measurement between organisations. Conclusion The review tentatively reports how The Productive Ward programme has been used to transform nursing practice for the benefit of patients and frontline staff, and how it resulted in cost savings. The literature review identified a potential positive results bias in the current literature whereby favourable outcomes were reported. Relevance to clinical practice This paper summarises the types of evidence and current literature on The Productive Ward providing a reference for frontline staff implementing the programme. [ABSTRACT FROM AUTHOR]

hoare k.j., mills j. & francis k. (2011) The role of government policy in supporting nurse-led care in general practice in the United Kingdom, New Zealand and Australia: an adapted realist review. Journal of Advanced Nursing 68(5), 963-980. Abstract Aim. This article is a report on a review that examined the role of Government policy in primary care and its association with nurse-led care in the United Kingdom, New Zealand and Australia between 1998 and 2009. Background. The United Kingdom, New Zealand and Australia share a similar model of first point access to the healthcare system via general practitioners. General practice is synonymous with the term primary care. Data sources. Medline, CINAHL, EMBASE, Scopus, PsychInfo, Google, Department of Health, England (United Kingdom), Ministry of Health, New Zealand, Department of Health and Ageing, Australia. Searches of electronic databases from 1998 to December 2009 and hand searches of identified leads and key journals. Historical papers accessed to describe the genesis of practice nursing and historical Government policy documents prior to 1998, were examined. Review methods. A modified realist review was used to synthesize research and policy documents relating to government policies pertaining to nurse-led care. In addition, a systematic review was used to identify literature that described practice nurse-led care. Results. Nurse-led primary care services are well described in the United Kingdom with a total of 45 studies meeting the inclusion criteria for the second review. There are no published studies from New Zealand, and only two from Australia describing nurse-led primary care. Conclusion. New Zealand and Australia lag behind the United Kingdom in practice nurse development. Implementation of clinical governance was fundamental to the development of nurse-led care in the UK. [ABSTRACT FROM AUTHOR]

To examine the role of trained health and personal care assistants in supporting district nurses and family carers in providing palliative and end of life care in the community. In the UK, there is a policy directive to improve end of life care and to enable greater numbers of people to die at home. This places considerable demands on community nursing services and family carers. In response to this, the Complex and Palliative Continuing Care Service employing generic health and personal care assistants was developed as part of the Marie Curie Delivering Choice Programme in one city in the UK. This paper draws on findings from an independent evaluation of the scheme. The wider evaluation used a formative evaluation methodology. This paper draws on in-depth interviews with a range of stakeholders ( n = 17), in-depth interviews with bereaved carers ( n = 6) and an analysis of documentation. Stakeholders and bereaved carers perceived that the health and personal care assistants made a vital contribution to community palliative care. Careful recruitment, specific training, case management by district nursing with allocation of specific tasks and close ongoing communication were key features which stakeholders indentified. Family carers welcomed the way assistants developed relationships and became familiar and able to meet the care needs of patients. There were some problems reported which related to capacity, work flow and the need for extensive written care plans. Employing health care assistants under the supervision of district nurses appears to support patients and family at home during end of life care and contribute to good quality nursing care. The needs for community-based palliative and end of life care will increase rapidly over the course of the next 20 years, placing pressure on community nursing services and family carers. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Addressing spiritual issues to maintain a sense of hope, meaning and purpose can be an important aspect of mental health care which goes beyond simply providing facilities for religious observance. Expressions of spiritual need from service users can potentially be confused with symptoms of mental ill health. Little is known about how mental health nurses understand or provide this aspect of care for service users. What the paper adds to existing knowledge?: An understanding from the mental health nurse perspective of how mental health nurses understand and care for service users' spiritual needs, and what influences their practice in this area.Ideas about how education and opportunities for good practice in this area might be advanced. What are the implications for practice?: Nurses need more education and guidance as well as supportive team and management cultures so that they feel comfortable and able to deliver this important aspect of care. Introduction: Mental health nurses have a professional obligation to attend to service users' spiritual needs, but little is known about specific issues related to provision of care for spiritual need faced by mental health nurses or how nurses understand this aspect of care and deliver it in practice. Aim/Question: To explore mental health nurses' ́understandings of spiritual need and their experiences of delivering this care for service users. Method: A qualitative study was conducted in one NHS mental health service. Interviews were undertaken with seventeen mental health nurses practising in a variety of areas. Results: Four themes were generated from thematic analysis of data in the template style: Expressing personal perspectives on spirituality; Expressing perspectives on spirituality as a nursing professional; Nursing spiritually; and Permeating anxiety (integrative). Discussion: Participants had complex understandings of spiritual need and evident anxieties in relation to this area of care. Two different approaches to nursing spiritually are characterised as (a) pragmatic (concerned with procedural aspects of care) and (b) spiritually empathetic. Mental health nurses were uncertain about the acceptability of attention to spiritual issues as part of care and anxious about distinguishing between symptoms of mental ill health and spiritual needs. Implications for practice: Educational experiences need to emphasise both pragmatic and empathetic approaches, and work needs to be organised to support good practice. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There is a drive to use positive and proactive approaches to mental health care to reduce the use of restrictive practices such as seclusion and restraint.Positive behaviour support plans have been used successfully to do this in learning disability services, and in England, it is now a regulatory requirement that anyone with challenging behaviour should have an individualized behaviour support plan.However, positive behaviour support plans specifically have not been evaluated as part of routine mental health care and mental health nurses' and relatives' attitudes towards them are unknown. What this paper adds to existing knowledge?: This evaluation of positive behaviour support plans in routine mental health inpatient care found that they had not been widely implemented or completed as intended.Barriers to the use of the plans included confusion among nurses and relatives around the principles of positive behaviour support, including how, when and for whom the plans should be used, difficulties in being able to describe the function of a patient's behaviour and lack of engagement with relatives and patients.Nevertheless, nurses and relatives valued the plans, in particular for their potential to facilitate holistic care. What are the implications for practice?: To use the plans successfully, mental health nurses will need training to understand fully the rationale behind the positive behaviour support approach and will need to engage more with relatives and patients.Commitment to the approach from the whole care team and organization will be needed to implement the plans consistently for all patients. Introduction: An international drive is to minimize restrictive practices in mental health care. Positive behaviour support plans (PBSPs) help staff prevent behaviour which would require restrictive intervention. Originating in learning disability services, data within mental health care are limited. Aims: To evaluate PBSPs within a mental health inpatient service; understand mental health nurses' and relatives' attitudes to them; and understand the barriers and facilitators for their use in routine mental health care. Methods: Mixed methods—quality ratings and interviews with relatives and nurses. Results: Positive behaviour support plans were poorly implemented. Relatives and nurses valued the potential of PBSPs to facilitate holistic care, though no relative had contributed to one and not every eligible patient had one. Barriers to their use included confusion around positive behaviour support, including how, when and for whom PBSPs should be used, and difficulties describing the function of a behaviour. Discussion: The potential of PBSPs to improve mental health care is recognized. However, there are barriers to their use which should be addressed to ensure that PBSPs have been properly implemented before their impact on patient care can be assessed. Implications for practice: Mental health professionals implementing PBSPs should engage with relatives and patients, gain organizational commitment and ensure that those involved understand fully the positive behaviour support approach. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Stress can impact students on mental health nurse training. This can have implications at the individual level (e.g. their own mental health) and at the level of the organization (e.g. sickness absence and attrition)., What this paper adds to existing knowledge? We interviewed 12 mental health nursing students regarding the stress they experienced during training. Participants described how the academic demands can at times be unbearable during clinical placements. There were also issues with 'being a student' on some placements, with participants describing negative attitudes towards them from staff., The younger participants reported feeling overwhelmed on their initial placements and described some of the main challenges of mental health work for them. Raising concerns about the quality of care on wards was also described as particularly challenging for the students., What are the implications for practice? This paper can be useful to help training providers support mental health nursing students. Recommendations include reducing academic demands during clinical placements and extending and promoting existing support services beyond normal 9 am-5 pm working hours, even if these services are limited. Younger students could be better supported by being allocated to the more well-resourced placements in the early stages of their training., Raising awareness among staff of the tasks students can and cannot perform can help improve staff/student relations. Finally, students should be educated about the issues around raising concerns on placements to help the governments drive for a more open and transparent National Health Service (NHS)., Abstract Introduction Previous studies investigating stress in nursing students focus on general nursing students or adopt quantitative measures. Purpose of study A qualitative study focusing specifically on mental health nursing students is required. Method One-to-one interviews were carried out with mental health nursing students ( n = 12). Data were thematically analysed. Results Participants reported unreasonable demands during clinical blocks, and described how control/support is lowest on placements with staff shortages. Negative attitudes towards students from staff and related issues were also discussed. Younger participants described struggling with mental health work during the early stages of training. Discussion Training providers should strive to provide adequate support to students to help them manage stress during training. Implications for practice Academic demands should be reasonable during clinical blocks and support services outside normal working hours should be available for students, even if these are limited in scope. Greater consideration to the allocation of placements for younger students in the mental health branch could be helpful. Furthermore, staff on placements should be aware of the tasks students can and cannot perform, to help improve staff/student relations. Educating students on the issues of raising concerns can help the governments drive for a more open and transparent National Health Service ( NHS). [ABSTRACT FROM AUTHOR]

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

Accessible Summary: What is known on the subject?: Little is known about how mental health services can cause harm in ways other than medication, talking therapies, diagnosis and detention under the Mental Health Act.The outcomes of people who avoid seeking help from mental health services due to previous experiences of harm are not well known. What this article adds to existing knowledge?: I provide a first‐person perspective of experiences of harm within mental health services, how this impacted my care, the long‐term effects of the harm on my well‐being and my ongoing experiences of avoiding mental health services. What are the implications for mental health nursing?: Healthcare professionals should be aware of the multitude of ways service provision can harm patients, and how, unknown to professionals, patients may create an internal understanding of how to best navigate harmful service environments.Healthcare professionals should have a deeper understanding of the reasons why people may choose not to engage with mental health services, and what impact this may have on them. The recent announcement of the first ever statutory public inquiry into a UK mental health service indicates a growing recognition of iatrogenic harm in mental healthcare. Despite the potential for harm across all services and practices, restrictive practices, psychotherapy, diagnosis and psychiatric medications are often the only areas of mental healthcare given significant attention. While the topic is widely discussed in survivor communities, accounts of harm caused by the everyday workings of services, including team cultures, administrative processes and staff–patient interactions, are missing from academic literature. In this article, I describe my 10‐year journey through mental health services, and how everyday practices, cultures and staff behaviour deeply impacted my ability to receive appropriate care, replicated previously traumatic environments, and damaged my mental health. Taking steps to protect myself from further harm, I self‐discharged and am currently living as a 'service‐avoider'. The ongoing implications of this decision and the long‐term impacts of harm are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives To evaluate the suitability of root cause analysis frameworks for the investigation of community-acquired pressure ulcers. The objective was to identify the extent to which these frameworks take account of the setting where the ulcer originated as being the person's home rather than a hospital setting. Background Pressure ulcers involving full-thickness skin loss are increasingly being regarded as indicators of nursing patient safety failure, requiring investigation using root cause analysis frameworks. Evidence suggests that root cause analysis frameworks developed in hospital settings ignore the unique dimensions of risk in home healthcare settings. Design and methods A systematic literature review and documentary analysis of frameworks used to investigate community-acquired grade three and four pressure ulcers by home nursing services in England. Results No published papers were identified for inclusion in the review. Fifteen patient safety investigative frameworks were collected and analysed. Twelve of the retrieved frameworks were intended for the investigation of community-acquired pressure ulcers; seven of which took account of the setting where the ulcer originated as being the patient's home. Conclusion This study provides evidence to suggest that many of the root cause analysis frameworks used to investigate community-acquired pressure ulcers in England are unsuitable for this purpose. Relevance to clinical practice This study provides researchers and practitioners with evidence of the need to develop appropriate home nursing root cause analysis frameworks to investigate community-acquired pressure ulcers. [ABSTRACT FROM AUTHOR]

Aims: A discussion of the implications and opportunities arising from the Commonwealth of Australia health care reform agenda; linking pricing with quality, with particular reference to directions for nursing‐focused health services outcomes research directed to improve the safety and quality of health care practices. Background: National activity‐based funding in Australia is a policy‐focused development. As the relationship between cost and quality becomes apparent, the role of clinicians and their contribution to high quality care has become a pressing issue for leadership, teaching, and research. Design Discussion paper Data Sources: This paper is based on seven years' experience as a member of a Commonwealth of Australia statutory committee—the Clinical Advisory Committee of the Independent Hospital Pricing Authority—and is supported by relevant literature and theory. Implications for Nursing: To date, unravelling the linkage, especially causal relationships, between direct care nursing and patient safety outcomes has not been well established. New activity‐based funding data elements developed for national implementation in Australia provide accessible and meaningful standardised data for measurement of never events, hospital‐acquired complications, and preventable readmissions. SUMMARY STATEMENT: What is already known about this topic? The advancement of research directed towards finding causal associations attributing nursing interventions to patient outcomes has been constrained by, amongst other things, methodological challengesThe attribution of nursing care interventions to specific patient‐related outcomes is difficult to isolateInvestigating how nursing care interventions contribute to safety and quality health care outcomes is often referred to as the "black box" of nursing‐focused health services outcomes research What this paper adds? Research into the impact of nursing interventions on patient outcomes, such as hospital‐acquired complications, remains immatureActivity‐based funding data provide safety and quality measures relevant to nursing‐focused health services outcomes researchBuilding clinical‐decision support, based on the Australian Commission for Safety and Quality in Healthcare hospital‐acquired complication outcome measures, may assist nurses engage with quality improvement as nurses are likely to act on data relevant to their practice The implications of this paper: The Australian Commission for Safety and Quality in Healthcare hospital‐acquired complication outcome measures have enhanced data specifications, useful to support development of nursing‐focused health services outcomes researchThe potential for benchmarking of hospital‐acquired complications is high at least in Australia and in other countries that apply activity‐based funding models linked to ICD‐10‐AM codes [ABSTRACT FROM AUTHOR]

Abstract: Aim: A discussion of issues associated with Values Based Recruitment (VBR) for nurse education programmes. Background: Values Based Recruitment is a mandatory element in selection processes of students for Higher Education healthcare courses in England, including all programmes across nursing. Students are selected on the basis that their individual values align with those presented in the Constitution of the National Health Service. However, there are issues associated with the use of values as selection criteria that have been insufficiently addressed. These are discussed. Design: Discussion paper. Data sources: This article is based on documents published on the website of the executive body responsible for the implementation of a policy regarding VBR in Higher Education Institutions up until June 2017 and our evaluation of the conceptualisation of VBR, underpinned by contemporary theory and literature. Implications for nursing: Values Based Recruitment influences who is accepted onto a nurse education programme, but there has been limited critical evaluation regarding the effectiveness of employing values as selection criteria. Values are subject to interpretation and evidence regarding whether or how VBR will improve practice and care is lacking. The issues discussed in this article show that Higher Education Institutions offering nursing courses, whether in England or in other countries, should be critical and reflective regarding the implementation of VBR methods. Conclusion: We call for a debate regarding the meaning and implications of VBR and further research regarding its validity and effectiveness. [ABSTRACT FROM AUTHOR]

Aim: To understand how student nurse experiences on clinical placement, within National Health Service (NHS) hospitals, differ for ethnic minority and White British groups. Design: A qualitative thematic analysis with an inductive approach. Methods: Data from semi-structured interviews with 21 London (United Kingdom) hospital-based student nurses were examined using thematic analysis. Participants were interviewed as part of the Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) study and asked about their experiences during clinical placement. Results: Five main themes were identified: (1) Role of mentors, (2) Discrimination and unfair treatment, (3) Speaking up/out, (4) Career progression, and (5) Consequences of adverse experiences. All themes were linked, with the social dynamics and workplace environment (referred to as “ward culture”) providing a context that normalizes mistreatment experienced by nursing students. Students from ethnic minority backgrounds reported racism as well as cultural and/or religious microaggressions. While being valued for their race and ethnicity, White British students also experienced discrimination and inequity due to their age, sex, gender, and sexual orientation. Students from both White British and ethnic minority groups acknowledged that being treated badly was a barrier to career progression. Ethnic minority students also noted the lack of diverse representation within senior nursing positions discouraged career progression within the UK NHS. Conclusion: These initial experiences of inequality and discrimination are liable to shape a student's perspective of their profession and ability to progress within nursing. The NHS is responsible for ensuring that student nurses' developmental opportunities are equal, irrespective of ethnicity. Impact: Ward culture is perpetuated by others who normalize mistreatment and concurrently disadvantage ethnic minority students, making them feel unvalued. This in turn impacts both staff retention and career progression within the NHS. Training assessors should be aware of the existing culture of discrimination within clinical placements and work to eradicate it. [ABSTRACT FROM AUTHOR]

farquharson b., allan j., johnston d., johnston m., choudhary c. & jones m. (2012) Stress amongst nurses working in a healthcare telephone-advice service: relationship with job satisfaction, intention to leave, sickness absence, and performance. Journal of Advanced Nursing 68(7), 1624-1635. Abstract Aims. This paper is a report of a study, which assessed levels of stress amongst nurses working in a healthcare telephone-advice service. We explored whether stress related to performance, sickness absence, and intention to leave. Background. Nurses report high levels of stress, as do call-centre workers. The emergence of telephone health advice services means many nurses now work in call-centres, doing work that differs markedly from traditional nursing roles. Stress associated with these roles could have implications for nurses, patients, and service provision. Design. This paper reports cross-sectional survey results. The design of the overall study included longitudinal elements. Method. A comprehensive study of stress was conducted amongst nurses working for a telephone-advice service in Scotland (2008-2010). All nurse-advisors were approached by letter and invited to participate. A total of 152 participants (33%) completed a questionnaire including General Health Questionnaire-12, Work Family Conflict Questionnaire, Job Satisfaction Scale and a measure of intention to leave the telephone-advice service and rated the perceived stress of 2 working shifts. Nurses' employers provided data on sickness absence and performance. Results. Overall levels of psychological distress were similar to those found amongst Scottish women generally. In multiple regression, work-family conflict was identified as a significant predictor of job satisfaction and intention to leave, and significantly related to sickness absence. There were significant correlations between General Health Questionnaire scores and perceived stress of shifts and some performance measures. Conclusions. Work-family conflict is a significant predictor of job satisfaction, intention to leave, and sickness absence amongst telephone helpline nurses. Minimizing the impact of nurses' work on their home lives might reduce turnover and sickness absence. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? A written plan is designed to improve communication and co-ordinate care between mental health inpatient wards and community settings., Reports of care plan quality issues and staff and service user dissatisfaction with healthcare bureaucracy have focused on working age mental health or general hospital settings., Little is known about mental health staff perspectives on the value of written care plans in supporting dementia care., What this paper adds to existing knowledge? Competing demands on staff time and resources to meet administrative standards for care plans caused a tension with their own professional priorities for supporting care., Mental health staff face difficulties using electronic records alongside other systems of information sharing., Further exploration is needed of the gap between frontline staff values and those of the local organization and managers when supporting good dementia care., What are the implications for practice? Frontline staff should be involved in designing new information systems including care plans., Care plan documentation needs to be refocused to ensure it is effective in enabling staff to communicate amongst themselves and with others to support people with dementia., Practice-based mentors could be deployed to strengthen good practice in effective information sharing., Abstract Background Reports of increased healthcare bureaucracy and concerns over care plan quality have emerged from research and surveys into staff and service user experiences. Little is known of mental health staff perspectives on the value of written care plans in supporting dementia care. Aim To investigate the experiences and views of staff in relation to care planning in dementia services in one National Health Service ( NHS) provider Trust in England. Method Grounded Theory methodology was used. A purposive sample of 11 multidisciplinary staff were interviewed across three sites in one NHS Trust. Interviews were transcribed, coded and analysed using the constant comparative method. Findings Five themes were identified and are explored in detail below: (1) Repetition; (2) the impact of electronic records on practice; (3) ambivalence about the value of paperwork; (4) time conflicts; and (5) alternative sources of information to plan care. Discussion Participants perceived that written care plans did not help staff with good practice in planning care or to support dementia care generally. Staff were frustrated by repetitive documentation, inflexible electronic records and conflicting demands on their time. Implications for practice Frontline staff should be involved in designing new information systems including care plans. [ABSTRACT FROM AUTHOR]

Aim: To discuss nurses' use of networks to address nursing recruitment and retention in London, UK. Design: Qualitative evaluation of the Capital Nurse programme reporting on 30 narrative interviews with executive, clinical and student nurses in 2019. Results: Executive nurses within the Capital Nurse programme recognized the importance of sociomaterial contexts in the health and social care system in London and worked strategically across these contexts to achieve change. Supported through the Capital Nurse programme, executive nurses from health organizations across London initiated collaborative working to improve recruitment and retention. Primarily by designing and delivering sociomaterial products (organizational and educational) to support nurses to build a career in London. Drawing on ideas from actor network theory, in particular sociomaterial contexts, nurses' actions at all levels to develop and sustain networks to address nursing recruitment and retention across the NHS in London are described. Conclusions: Capital Nurse supported collaborative working both within single organizations and across organizations in London. There is evidence of change in how nurses across the capital work together to improve patient care, improve recruitment and retention. Findings may resonate with nurses in other settings who seek to address the problem of recruitment and retention. They show how nurses coming together in networks to effect changes in practice can work successfully. Impact: Nurses' use of networks led to novel models of communication and action to address the problems of recruitment and retention in London. We argue that sociomateriality should be considered outside the clinical practice setting, as part of nurses' professional development and organizational practice, that is how they plan their career, how they address recruitment and retention, how they communicate across organizations about nursing issues. No Patient or Public Contribution: This was an evaluation of a staff development project in London, which sought to elicit nurses' experiences of participation in Capital Nurse. [ABSTRACT FROM AUTHOR]

Aim: To understand the experience of critical care nurses during the COVID‐19 pandemic, through the application of the Job‐Demand‐Resource model of occupational stress. Design: Qualitative interview study. Methods: Twenty‐eight critical care nurses (CCN) working in ICU in the UK NHS during the COVID‐19 pandemic took part in semi‐structured interviews between May 2021 and May 2022. Interviews were guided by the constructs of the Job‐Demand Resource model. Data were analysed using framework analysis. Results: The most difficult job demands were the pace and amount, complexity, physical and emotional effort of their work. Prolonged high demands led to CCN experiencing emotional and physical exhaustion, burnout, post‐traumatic stress symptoms and impaired sleep. Support from colleagues and supervisors was a core job resource. Sustained demands and impaired physical and psychological well‐being had negative organizational consequences with CCN expressing increased intention to leave their role. Conclusions: The combination of high demands and reduced resources had negative impacts on the psychological well‐being of nurses which is translating into increased consideration of leaving their profession. Implications for the Profession and/or Patient Care: The full impacts of the pandemic on the mental health of CCN are unlikely to resolve without appropriate interventions. Impact: Managers of healthcare systems should use these findings to inform: (i) the structure and organization of critical care workplaces so that they support staff to be well, and (ii) supportive interventions for staff who are carrying significant psychological distress as a result of working during and after the pandemic. These changes are required to improve staff recruitment and retention. Reporting Method: We used the COREQ guidelines for reporting qualitative studies. Patient and Public Contribution: Six CCN provided input to survey content and interview schedule. Two authors and members of the study team (T.S. and S.C.) worked in critical care during the pandemic. [ABSTRACT FROM AUTHOR]

The article examines the academic standing of chief nurses. Topics discussed include the publication record of chief nurses in Great Britain, their contribution to the scholarship and knowledge base of the nursing profession, and the academic partnerships that appear to be flourishing. Also discussed are the leadership skills required of these nurse leaders.

Aims and objectives. To explore the experiences of secondary care nurse prescribers to establish how prescribing is employed and what its benefits and disadvantages are perceived to be. Background. Nurse prescribing has developed rapidly since it inception almost 20 years ago and there is a significant body of research evaluating its implementation in primary care. Recent expansion of non-medical prescribing rights has prompted nurses in secondary care establishments to become prescribers. Evaluation of nurse prescribing in this new environment is required, if practice is to be informed and advanced. The lack of such evaluations in the published literature was the impetus for this study. Design. A cross-sectional qualitative study. Methods. A convenience sample of nurse prescribers was interviewed using a single broad question to prompt elaboration. Transcribed interviews were analysed using Colaizzi's procedural steps. Results. Three main themes emerged from the analysis: motivations behind becoming a nurse prescriber; benefits and limitations of prescribing education and continuing professional development and prescribing in practice. Conclusion. Nurses felt nurse prescribing offers clear benefits in relation to patient care. Where nurses were not prescribing, finance arrangements between different NHS trusts appear to be a significant barrier to its successful implementation of prescribing in practice. Nurse prescribing is strongly believed to be the domain of the experienced nurse. There is a clear need for ongoing evaluation of all aspects of nurse prescribing. Relevance to clinical practice. This paper makes key recommendations on the future development and delivery of programmes of education for nurse prescribers and for the delivery of safe and effective prescribing in practice. [ABSTRACT FROM AUTHOR]

Aims and objectives. To develop sustainable resources and activity in one hospital to encourage, support and build research activity and innovation among nurses and midwives. Background. Much resource is spent internationally to enable nurses and midwives to critique and quote research papers. The evidence suggests that little resource is focussed on enabling staff to conduct structured interventions that implement research as a service improvement activity, or enable nurses and midwives to undertake research in their clinical areas. Design. Two cycles of action research took place in the hospital led by a steering group of insiders and outsiders. Each cycle was evaluated through interviews with participants and analysis of steering group meeting records. Method. Action research methodology was used to develop partnership working between the hospital and university. A steering group of participants in the project led the development and made decisions based on findings from the evaluation stages of each cycle. Results. The data demonstrate that the process is one of the slow snowball effects that gathered momentum. Key skills such as leadership, resourcing and time management are required alongside research skills. Conclusions. Nursing research capacity can be developed in institutions where there are individuals with an enthusiasm to drive the agenda. Structures and processes need to be clear and transparent as well as supportive at the individual level. Change of this nature takes time and sustained effort. Relevance to clinical practice. This study demonstrates that a combination of strong leadership, partnership working and development of clear infrastructure enabled nurses and midwives who provide direct patient care to develop, implement and evaluate their own service improvement/research initiatives. Enabling nurses and midwives to use research methods in their practice increases the amount of nurse/midwife-led evidence-based innovation. [ABSTRACT FROM AUTHOR]

Aims and objectives. To evaluate the impact and effectiveness of Flying Start NHS™ on the confidence, competence and career development of newly qualified practitioners. Background. The first year of practice as a registered nurse, midwife, or allied health professional is recognised as challenging. This paper presents the findings of a two-year evaluation of Flying Start NHS™, a web-based programme developed by NHS Education Scotland to support newly qualified health professionals during the transition from student to qualified practitioner. Design. Descriptive design with one to one and focus group interviews, plus a survey. Methods. The evaluation employed a multi-method approach including telephone interviews with Flying Start NHS™ leads/coordinators ( n = 21) and mentors ( n = 22) and focus groups with newly qualified practitioners ( n = 95). An online survey was completed by 547 newly qualified practitioners. Results. A majority of newly qualified practitioners reported that Flying Start NHS™ had been useful in terms of clinical skills development and confidence. Those who were able to take protected time were more likely to complete the learning units and report that the support they received was good. Both newly qualified practitioners and mentors reported a lack of time. Newly qualified practitioners who took up posts in the community expressed greater satisfaction with the support received. Conclusions. NHS Boards should ensure that there is an ethos of support at all levels, as well as an understanding of the purpose of Flying Start NHS™ and what newly qualified practitioners require to do to complete it. The expectation that newly qualified practitioners will enrol on Flying Start NHS™ should be accompanied by an expectation that they will complete the programme in their first year, coupled with support to enable them to do so. Relevance to clinical practice. Undertaking Flying Start NHS™ in the first year of employment increases clinical skills development and confidence. Mentors require training and time to enable them to provide support. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine how the role of the Emergency Nurse Practitioner has evolved in Scotland. Background. In 2001, Cooper and colleagues published a report on their survey (carried out in 1998) which described the extent and nature of Emergency Nurse Practitioner services in Scotland. They described a nascent nursing role and service that existed in almost half of Emergency Departments and that concentrated its activity on the management of minor distal limb trauma and wound management. Since that date, several relevant and important political, professional and local issues have combined to accelerate the development of this role. Design. Longitudinal survey of Scottish Emergency Departments ( n = 97 in 1998, n = 93 in 2009). Method. Census survey of all Scottish Emergency Departments identified by NHS National Services Scotland's Information and Statistics Division Accident and Emergency Waiting Times dataset 2006-07. Results. Emergency Nurse Practitioners are now practising in the majority (89%) of Emergency Departments and Minor Injury Units compared with 47% in 1998. Most departments (78%) use Emergency Nurse Practitioners in dual roles, and most departments (67%) differentiate their Emergency Nurse Practitioners from other nursing staff by use of a title. Wide variations in pay, role and scope of practice still exist. Conclusions. The role of the Emergency Nurse Practitioner has increasingly become part of mainstream health care delivery in Emergency Departments across Scotland and can now be considered to be common place. This study demonstrates that 'Advanced Nursing Practitioners' and 'Nurse Practitioners' cannot necessarily be considered to be synonymous, and nursing roles that are allowed to evolve naturally adopt a non-uniform level of practice. Relevance to clinical practice. This paper is of interest to Nurse Practitioners and workforce planners. [ABSTRACT FROM AUTHOR]

To explore why innovations in service and delivery are adopted and how they are then successfully implemented and eventually assimilated into routine nursing practice. The 'Productive Ward' is a national quality improvement programme that aims to engage nursing staff in the implementation of change at ward level. Mixed methods (analysis of routine data, online survey, interviews) to apply an evidence-based diffusion of innovations framework. (1) Broad and narrow indicators of the timing of 'decisions to adopt' the Productive Ward were applied. (2) An online survey explored the perceptions of 150 respondents involved with local implementation. (3) Fifty-eight interviews in five organisational case studies to explore the process of assimilation in each context. Since the launch of the programme in May 2008 staff in approximately 85% of NHS acute hospitals had either downloaded Productive Ward materials or formally purchased a support package (as of March 2009). On a narrower measure, 40% (140) of all NHS hospitals had adopted the programme (i.e. purchased a support package) with large variation between geographical regions. Four key interactions in the diffusion of innovations framework appeared central to the rapid adoption of the programme. Despite widespread perception of significant benefits, frontline nursing staff report that more needs to be carried out to ensure that impact can be demonstrated in quantifiable terms and include patient perspectives. The programme has been rapidly adopted by NHS hospitals in England. A variety of implementation approaches are being employed, which are likely to have implications for the successful assimilation of the programme into routine nursing practice. This paper summarises the perceived benefits of the Productive Ward programme and highlights important lessons for nurse leaders who are designing (or adapting) and then implementing quality improvement programmes locally, particularly in terms of how to frame such initiatives - and provide support to - ward-level staff. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the choices patients make when offered home-based or hospital-based cardiac rehabilitation. Background. In some countries, patients may be offered a choice of home-based or hospital-based cardiac rehabilitation. While evaluating a home-based programme, Road to Recovery, developed by the British Heart Foundation, we examined patients' experiences of being offered this choice. Methods. Interviews were conducted with 35 patients and 12 staff members delivering the pilot programme in five rehabilitation services during 2006-2008. Findings. While the staff members interviewed reported that all patients were given a clear choice between a home-based and hospital-based or community-based programme, this choice was less clear-cut in the patient interviews. When choice was offered, the choice of a home-based programme was often based on constraints rather than on being a positive choice. Obstacles patients faced in making the choice included lack of information on which to base a choice; inadequate systems of referral; insufficient appropriately trained staff; restricted choice of times to attend the hospital programmes; the geographical location of services and restrictive socio-economic factors (inflexible working hours, access to transport). Conclusion. The possibility of informed choice relies in the first instance on the availability and accessibility of appropriate services. Nurses need awareness and commitment to finding out about and overcoming obstacles that impede patient participation in cardiac rehabilitation. Only in this manner will it be possible to fulfil the calls in national and some international clinical guidelines for 'individualized' or 'menu-based' programmes tailored to specific patient needs. [ABSTRACT FROM AUTHOR]

Aim: There are barriers to midwives engaging in conversations about alcohol with pregnant women. Our aim was to capture the views of midwives and service users to co‐create strategies to address these barriers. Design: Qualitative description. Methods: Structured Zoom‐based focus group interviews of midwives and service users where we presented known barriers and sought solutions to midwives discussing alcohol use in antenatal settings. Data collection took place between July and August 2021. Results: Fourteen midwives and six service users attended five focus groups. Barriers considered were as follows: (i) lack of awareness of guidelines, (ii) poor skills in difficult conversations, (iii) lack of confidence, (iv) lack of belief in existing evidence, (v) women would not listen to their advice, and (vi) alcohol conversations were not considered part of their role. Five strategies to address barriers to midwives discussing alcohol with pregnant women were identified. These were as follows: Training that included mothers of children with Foetal Alcohol Spectrum Disorder, champion midwives, a service user questionnaire about alcohol for completion before the consultation, questions about alcohol added to the maternity data capture template and a structured appraisal to provide a means of audit and feedback on their alcohol dialogue with women. Conclusions: Co‐creation involving providers and users of maternity services yielded theoretically underpinned pragmatic strategies to support midwives to ask advise assist about alcohol during antenatal care. Future research will test if the strategies can be delivered in antenatal care settings, and if they are acceptable to service providers and service users. Impact: If these strategies are effective in addressing barriers to midwives discussing alcohol with pregnant women, this could support women to abstain from alcohol during pregnancy, thus reducing alcohol‐related maternal and infant harm. Patient and public contribution: Service users were involved in the design and execution of the study, considering data, supporting intervention design and delivery and dissemination. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to profile the contemporary advanced clinical practitioner (ACP) role through standardized document sets. Design: Documentary analysis of job descriptions (JDs), person specification and advertisements. Data Sources: England based jobs advertised on NHS jobs website from 22 January to 21 April 2021. Results: A toatal of 143 trainee and qualified ACP roles were identified. A wide range of sectors and specialities were represented from across all English regions. The most common roles were urgent care, emergency medicine and primary care. Most qualified roles were agenda for change band 8A, although this did vary across specialities. Many roles were restricted to a small number of professions, notably nursing, physiotherapy and paramedic. Inconsistent role titles were noted. A lack of understanding of regulation across different professions was noted. Conclusion: The ACP role has become an accepted across healthcare providers in England. Implementation remains varied across specialities and organizations. Eligibility criteria may relate to professional bias. Implications for the Profession and/or Patient Care: ACP roles are expanding but this may be at the detriment to advanced nursing posts. Inconsistency in role eligibility suggests some professional bias exists. Impact: This was scoping of ACP roles across England using job advertisements. ACP roles are common across sectors and specialities but eligibility varies. The research will have impact on those looking to recruit to ACP roles as well as those refining JDs. Reporting Method: No EQUATOR guideline exists for document analysis. Patient or Public Contribution: No Patient or Public Contribution. The research relates to organizational human resource information only. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Exploring the influence of the 100% single‐room environment on staff and patient experience of person‐centred practice in an acute‐care setting. Background: Current building guidance for the NHS advocates increasing the single‐room inpatient environment. There is little evidence of the impact of this design in adult acute‐care settings on the experience and delivery of person‐centred care. Design: Ethnography, underpinned by McCormack and McCance's Person‐centred Practice Framework. Methods: Data collection took place between March and June 2018. Staff and patients in a National Health Service hospital in the United Kingdom took part in observations of practice (n = 108 hours); face to face inpatient interviews (n = 9); and participatory reflective staff groups (n = 3). A reflexive journal was kept by the researcher throughout the study. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Themes relating to care delivery and interactions were identified. Staff and patients' views converged around visibility and isolation. Patients appreciated the privacy afforded by the single rooms, while staff experienced a psychological shift, being viewed (and viewing themselves) as 'visitors'. There was space for more sympathetic presencing, encouraging patients to speak more openly, to facilitate knowing and authentic engagement. However, time remained an issue resulting in more task‐focused care. Conclusion: Changes to the physical environment have an impact on the delivery and experience of person‐centred practice. While the facilities enhance patient experience, the interweaving of engagement, emotional support and the development of therapeutic relationships remain challenging. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the contribution of nurse consultants in relation to UK public health outcomes by contrasting the health and public health skills frameworks with a study of the role of nurse consultants. Background Nurse consultants are the most senior advanced nurse practitioners in the UK. They work clinically, lead, research, develop policy and disseminate knowledge. Design A synthesis of research and data from the UK professional skills frameworks with data from a mixed-methods study of the role of nurse consultants. Method Data collected from nurse consultants and stakeholders in England ( n = 10) were analysed to identify issues impacting on the skills, competencies and effectiveness of advanced nurses. This was contrasted with the skills and career frameworks for public health and advanced healthcare practice. Results Nurse consultants use their clinical expertise to lead practice, facilitate change and monitor effectiveness. Within healthcare organisations, they contribute servicewide to the implementation of public health policy, service delivery and policy development, mirroring expected competencies and improved health outcomes. Two barriers were identified. First, that there was little time or will for nurse consultants to undertake research, precluding them from demonstrating their value. Second, that a lack of interprofessional understanding and support of their roles meant that their worth was often not appreciated by decision-makers. Conclusions Nurse consultants lead and influence public health on many levels and need support to develop needs-led and evidence-based local, national and international public health practice and policy development. Relevance to clinical practice This research contributes to the global discussion currently being held about the nomenclature of advanced nurse practitioner roles, their scope and influence. The challenge for nurses to contribute meaningfully to public health structures at an advanced level is a concern for all nations seeking the common goal of addressing public health needs within their populations and suggests that further development of our understanding of the potential contribution of advanced nurses is needed. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to understand the routes by which nurses, midwives and allied health professionals (NMAHPs) pursue and sustain a research career and the enablers and barriers to career progression. Background: Robust evidence is central to practice and professional decision making of NMAHPs, with generation and translation of research arguably best led by those clinically active. Whilst countries like the UK and USA have fellowship schemes to support research career development, anecdotal reports suggest barriers exist in translating these opportunities into sustainable clinical academic careers. Design: Online survey. Methods: An online questionnaire addressing career choices, facilitators/barriers and support was emailed to 1074 past applicants (doctoral and post‐doctoral) to National Institute of Health Research fellowship schemes (awarded and rejected) in England between March and May 2017; 231 responded (25.6%). Study reporting adheres to STROBE checklist. Results: Overall, 134 doctoral and 96 post‐doctoral applicants participated; two‐thirds were from allied health professions. Most were early in their research career. Interest in research was most frequently sparked by interaction with people in research positions. Nearly half had their first research experience during their BSc project; though less often for nurses/midwives/health visitors (37.5%) than other NMAHPs (51.6%). The award of a fellowship resulted in higher likelihood of being research‐active (doctoral level). Nearly three quarters pursuing a clinical academic career indicated 'clearer career paths' and 'greater integration across clinical and academic departments' were desirable. Most common barriers related to research roles, availability of positions and funding. Conclusions: Fellowship schemes are important to NMAHPs' research careers, but there are serious challenges to establishing and sustaining a career. Relevance to clinical practice: Lack of a clear model of career progression, at national and local level, and barriers to creating joint posts impacts on capacity of clinical academics to strengthen integration of research with practice. [ABSTRACT FROM AUTHOR]

Accessible summary Clinical supervision (CS) is a valuable resource for mental health nurses. Through guided reflection and supportive facilitation, the recipient of CS works towards developing their therapeutic practice., In many parts of the UK, the implementation of CS does not equate to best practice. This provision undermines and thwarts the potential gains that effective CS can produce., The development of a database of clinical supervisors may ensure that best practice guidelines are implemented., Information about a database that focuses on clinical supervisors of psychological therapies, including its rational, clarifying the intention of CS, and criteria of supervisors, are described., Abstract Clinical supervision (CS) is regarded as a valuable resource for mental health nursing. While there is considerable anecdotal reports of its implementation throughout the UK, these attempts are not without difficulty. A common tension reported in the literature relates to its provision being more akin to managerial supervision within a line-management hierarchy which jars with its original intention and spirit. This paper will provide a discussion on the implementation of CS in mental health nursing in the UK, beginning with its suggested importance for the discipline. Following on from this, the rationale for a CS database and description of one NHS Board's attempts at developing a resource, initially focusing on clinical supervisors of psychological therapies, will be presented. [ABSTRACT FROM AUTHOR]

Accessible summary • Suicide and suicidal behaviour evoke strong feelings. That is so not only for those directly affected – the individual, family and friends, but for professional staff and the community at large. • Assessing the risk of suicide demands staff having the ability to connect and maintain rapport with people in varying degrees of distress. • Multidisciplinary training groups allow staff the opportunity to share their experiences and learn from one another. • Suicide awareness training for non mental health staff in the UK is variable and should be more of a priority. There are 300 deaths in Wales each year as a result of suicide. Though the rate in England and Wales has fallen in recent years, it is still the second most common cause of death in men aged 15–44 behind accidental death. The majority of those who die by suicide make contact with health professionals within a relatively short time before their death. For those with mental ill health, relationships with professionals appear particularly important; indeed negative relationships have been cited as a key factor precipitating death by suicide. This paper outlines a suicide awareness programme which aims to restate the values of empathy and relationship building in everyday interaction. It acknowledges risk factors and risk assessment tools, but more than anything strives to demonstrate the value of encouraging personal expression in patients. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore newly qualified nurses' support needs and their perceptions of online peer support. Background: The experience of being a newly qualified nurse is stressful and isolating. Support from colleagues and peers can enhance perceptions of competence and confidence in newly qualified nurses, improve well‐being and aid retention. However, despite initiatives such as preceptorship, support needs may remain unmet in busy clinical environments. Online support has potential to offer a partial solution to professional isolation, but there is a lack of research into how technology can support nurses' emotional and social well‐being. Design: A qualitative exploratory study was designed, employing semi‐structured focus groups, analysed using thematic analysis. The study is reported in accordance with the COnsolidated criteria for REporting Qualitative research checklist. Methods: Eight focus groups, supplemented by one individual interview, were conducted with newly qualified nurses between June 2018–January 2019. Findings: Two main themes arose. The first was Drowning, alotofthetime with two sub‐themes: (i) Feelings and emotions about being a Newly Qualified Nurse: 'Absolutely terrified' and (ii) Support within the role: 'Somebody you can count on'. The second was Potential advantages and disadvantages of online modality: 'Somebody is going to get in that phone!' which included three sub‐themes (i) Potential advantages, (ii) Potential disadvantages and (iii) Preferences and recommendations. Conclusions: This study demonstrates that if barriers can be overcome, then online support has potential to contribute to newly qualified nurses' well‐being. Further research is needed to explore technical and ethical issues around online support and evaluate its effectiveness for newly qualified nurses. Relevance to clinical practice: Online support has the potential to add to existing strategies to support nurses during stressful times. This may be particularly relevant when many staff are working under increased pressure due to the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

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

Aim: To understand how advanced nurse practitioners use knowledge to inform their discharge decision‐making in the emergency department. Background: Advanced nurse practitioner roles have developed globally in a wide range of healthcare settings, including the emergency department, over the past few years. The scope of practice and training vary widely between countries. Little is known about how they use clinical knowledge in the emergency department. Design: An ethnographic study was undertaken in an emergency department in the North of England. Method: Data were collected by observation (n = 5) and semi‐structured interviews (n = 13) between September 2016 and June 2017. Interview transcripts and field notes were coded using Quirkos software. Thematic analysis was used to identify key themes. Findings: In boundary blurring with medicine, advanced nurse practitioners in the emergency department need to make timely, autonomous discharge decisions. Knowledge mobilization is messy and complex; however, shortcuts facilitate autonomous discharge decision‐making. More experienced advanced nurse practitioners rely less on shortcuts as they draw on experiential knowledge. Discussion: Boundary blurring in the advanced nurse practitioner role in the emergency department, requires reliable knowledge shortcuts. Support from senior colleagues and accessible smartphone apps enable advanced nurse practitioners to efficiently make discharge decisions. This study adds to previous research on how knowledge is managed in boundary blurring. Conclusion: Advanced nurse practitioners in the emergency department require timely access to relevant, up to date knowledge. This study has highlighted their preferred knowledge sources to inform discharge decision‐making. In boundary blurring, shortcuts enable ANPs to use knowledge efficiently to inform patient care in the emergency department. Impact: The findings increase our understanding of how to equip advanced nurse practitioners with knowledge to facilitate clinical decision‐making. Clinical managers should provide mentorship and relevant up to date knowledge shortcuts to ensure efficient, evidence‐based discharge decision‐making. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the impact of advanced nurse practitioner triage on the management of medically expected patients referred to an acute National Health Service hospital. The objectives of the study were to determine whether advanced nurse practitioner triage reduced waiting times and hospital admissions and expedited essential investigations and treatments. Background: The effectiveness of employing advanced nurse practitioners to meet service demands has been widely studied in emergency departments and critical care units. However, no studies have evaluated the impact advanced nurse practitioners can have on the management of medically expected patients, who have been referred to hospital because they are acutely unwell and require immediate medical intervention. Design: A pre‐ and postimplementation evaluation. Method: The Revised Standards for Quality Improvement Reporting Excellence guidelines were used as a framework to guide the triaging role of advanced nurse practitioners. The charts of patients attending before and after the implementation of the advanced nurse practitioner triage role were retrospectively analysed. Results: The implementation of advanced nurse practitioner triage for medically expected patients saw a statistically significant reduction in the length of time patients have to wait to be seen. There were also significant improvements in timings to diagnosis and treatment of patients presenting with conditions such as sepsis or community‐acquired pneumonia. Additionally, patient admissions to hospital were reduced, as advanced nurse practitioners instead streamed a number of patients to ambulatory care for same day treatment and/or medical follow‐up. Conclusions: Advanced nurse practitioner triage has made significant improvements to the efficiency and effectiveness of care and management of medically expected patients who were referred to acute hospital settings. Relevance to practice: Utilisation of advanced nurse practitioner triage in the ambulatory care setting is an effective method by which to streamline and improve the management of medically expected patients. [ABSTRACT FROM AUTHOR]

The author reflects on the Francis Report on nursing in Great Britain. He mentions that the National Health Service (NHS) in England was swayed by its findings which involve problems encountered by the Mid Staffordshire NHS Foundation Trust public hospital particularly in nursing care wherein patients are left to lie in excrement for a long time, recognition failure towards their dignity and privacy as well as lack of compassion. He also notes its revelation of deficiencies in training nurses.

Aims and objectives: To understand the social construction of frontline nurse leadership and how power operates at this level. Background: It is argued that frontline nurse leaders are central to the negotiation of care. Evidence suggests they feel ill‐equipped to lead and lack confidence in their ability to do so. Disempowerment has been proposed as a barrier to effective ward leadership. There is a lack of studies about daily frontline leadership practice. Design: Single instrumental case study with embedded cases. Methods: A purposive sample of one acute National Health Service Trust, with a convenience sample of embedded cases, was selected. Multiple methods of data collection were used including semi‐structured interviews, nonparticipant observations, field notes and documentary evidence. Thematic analysis using constant comparison and categorisation of data within, between and across cases was used to generate a theory of ward leadership in its organisational context. COREQ Checklist compliant. Results: These findings suggest the frontline nurse leaders' power is a dynamic and situation‐dependent phenomenon that shapes and is shaped by ongoing interactions between stakeholders in the NHS. In these interactions, power ebbs and flows. These leaders, like all actors involved, were paradoxically both powerful and powerless at the same time. Conclusion: This study offers a new contribution to the discussion about the power of ward leaders and problematises the theoretical assumptions that perpetuate calls for increased power. Relevance to practice: In their efforts to resolve the spontaneous dilemmas that arise in practice, frontline nurse leaders would benefit from regularly participating in communities of reflexive practice. [ABSTRACT FROM AUTHOR]

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

Aims and objectives: To review and analyse current preceptorship programmes within NHS trusts in the North West of England. To evaluate the pedagogic rigour of the programme and suggest recommendations to inform the future design of preceptorship programmes. Background: Enhancing the retention of newly qualified staff is of particular importance given that the journey from a new registrant to a competent healthcare professional poses a number of challenges, for both the individual staff member and organisations. Design: A mixed methods evaluative approach was employed, using online questionnaires and content analysis of preceptorship documentation. Methods: Forty‐one NHS trusts across the North West region employing newly qualified nurses were invited to participate in the completion of an online questionnaire. In addition, preceptorship programme documentation was requested for inclusion in the content analysis. This study used the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines. Results: The response rate for the questionnaire was 56.1% (n = 23). Eighteen trusts (43.9%) forwarded their programme documentation. Findings highlighted the wide variation in preceptorship programmes across the geographical footprint. Conclusions: There were instances of outstanding preceptorship and preceptorship programmes where there was a clear link between the strategic vision, that is, trust policy, and its delivery, that is, preceptorship offering. There was no one framework that would universally meet the needs of all trusts; yet, there are key components which should be included in all preceptorship programmes. Therefore, we would encourage innovation and creativity in preceptorship programmes, cognisant of local context. Relevance to clinical practice: The significant shortage of nursing staff in England is an ongoing issue. Recruitment and retention are key to ameliorating the shortfall, and formal support mechanisms like preceptorship, can improve the retention of newly qualified staff. Understanding current preceptorship programmes is an important first step in establishing the fundamental building blocks of successful preceptorship programmes and enabling the sharing of exemplary good practice across organisations. [ABSTRACT FROM AUTHOR]

Aims and objectives: To report the findings from an evaluation of the impact of the Compassion in Practice Vision and Strategy (National Health Service England (NHSE), 2012) on nursing, midwifery and care staff. Background: The Compassion in Practice Vision and Strategy was a programme of work to highlight the importance of compassionate care following the Francis Report in 2013 into the deficits in care in an NHS Hospital Trust. It was launched by NHS England in 2012 at a time when fiscal cuts were introduced by the Department of Health in England. Design and setting: Mixed methods. Results: Inferential statistics were used to test whether there were significant differences between staff at different levels of seniority with regard to awareness and involvement in Compassion in Practice Vision and Strategy and their attitudes to it. Awareness and involvement of staff in Compassion in Practice Vision and Strategy were high amongst middle and senior management but limited at ward level. Staff involvement in Compassion in Practice Vision and Strategy was limited due to a lack of awareness. Ward level staff who were aware and involved, perceived a lack of support and communication from senior leadership to deliver the Compassion in Practice Vision and Strategy. Discussion: Results reveal professional anger, distress and resistance to the Compassion in Practice Vision and Strategy and a view of the programme as a top‐down initiative which did not sufficiently recognise structural constraints on nurses’ ability to deliver compassionate care. We discuss the implications of our findings for global nursing. Conclusion: Participants emphasised that compassion for patients is only sustainable where there is compassion for staff and many participants felt that they were not being treated with compassion. Relevance for clinical practice: National Health Service England should strongly affirm that nurses and midwives in general provide compassionate care. Trust leadership should provide support for ward level staff who deliver compassionate care in difficult circumstances. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the impact and sustainability of the Care Maker programme across England from the perspective of those involved in its delivery. Background The Care Maker programme was launched in England in 2013. It aims to support the 'Compassion in Practice' strategy, with particular emphasis on the 6 Cs of care, compassion, competence, communication, courage and commitment. Care Makers were recruited in an ambassadorial role. The intention was to inspire individuals throughout the National Health Service in England to bridge national policy with those delivering care. Design A mixed methods design was chosen, but this article focuses on two of the four distinct empirical data collection phases undertaken as part of this evaluation: a questionnaire with Care Makers; and two case studies of separate National Health Service trust sites. Method Data were collected for this evaluation in 2015. An online questionnaire was distributed to the total population of Care Makers across the National Health Service in England. It included a combination of open and closed questions. The case studies involved semistructured telephone interviews with a range of professionals engaged with the Care Maker programme across the trust sites. Results Care Makers reported that participation in the programme had offered opportunities in terms of improving the quality-of-care provision in the workplace as well as contributing towards their own professional development. Conclusion The Care Maker programme has supported and helped underpin the nursing, midwifery and care strategy 'Compassion in Practice'. Relevance to clinical practice This model of using volunteers to embed strategy and policy could potentially be used in other areas of clinical practice and indeed in other countries. [ABSTRACT FROM AUTHOR]