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Background: The COVID-19 pandemic placed a huge strain on healthcare services around the world, including community services. Students also faced substantial disturbance to educational programmes. Student district nurses are usually employed members of staff and can be recalled to the workforce, whereas pre-registration students cannot. Aims: This paper explores the feelings and experiences of student district nurses during the first UK national lockdown of the COVID-19 pandemic. An interpretative phenomenological approach was taken. Method: A semi structured 1:1 interview and focus group was held via zoom in July 2020. A total of eight student district nurses, who were all registered adult nurses, took part. Data was analysed using the Braun and Clarke model to identify themes. Results: The findings related to their experience of being a community adult registered nurse on the frontline, while also being a student district nurse. Three themes were identified from the analysis: anxiety and uncertainty, management of risk and teamwork. Conclusion: This study highlights the contribution that community nurses made in the clinical response to the COVID-19 pandemic. It adds to a paucity of literature available from this clinical setting and specifically from the viewpoint of a student district nurse. There is much written on the strains on hospital care, but it should be remembered that district nursing is the service that never shuts its doors because it has reached capacity. This study found that a lack of communication and uncertainty about their future as students contributed to heightened stress and anxiety. Teamwork and camaraderie are a vital aspect of any team and one that can support resilience in times of heightened stress. A lack of face-to-face interaction can lead to team members feeling isolated. Digital technology can be used to reduce this feeling when possible. [ABSTRACT FROM AUTHOR]

The article presents the discussion on raising the age of the sale of tobacco by one year. Topics include smokefree generation' by phasing out the sale of tobacco by bringing forward legislation that would make it an offence to sell tobacco products to anyone born on or after 1 January; and Vaping is less harmful than smoking as vapes do not contain tobacco, and they are used to support people.

Smoking tobacco is both a pharmacological addiction and a serious social and public health issue. Smoking cessation services for pregnant women save babies' lives and have the potential to improve the health of families and communities. Engaging with pregnant smokers and their households towards quitting smoking requires a whole-team approach. Protected time for the specialist smoking in pregnancy team and freedom to develop the service improvement approach has been key in the setting described in this paper. The approach to smoking cessation described in this paper is of the quality improvement arm within the 'Saving babies' lives' bundle of interventions in Poole Hospital NHS Foundation Trust. The 'plan, study, do, act' model is described with a description of its implementation using sequential learning, enquiry, testing and being open to new ideas and approaches. The main driver questions have been: 'how do we reach pregnant smokers who are not motivated to quit?' and 'what approaches will potentiate success for this group?' [ABSTRACT FROM AUTHOR]

Performing female genital mutilation (FGM) is prohibited within the UK by the FGM Act of 2003. A mandatory reporting duty for FGM requires regulated health and social care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police. An application to the court for an FGM protection order (FGMPO) can be made to keep individual women and girls safe from FGM. This paper reveals the significant disconnect between the number of FGMPO applications and known recorded cases of FGM. The introduction of FGMPOs requires critical exploration as there is insufficient evidence to show that FGMPOs are effective in protecting women and girls from FGM. It is therefore unclear what impact, if any, FGMPOs are having upon the protection of women and girls at risk of FGM. The barriers to the implementation of FGMPOs and possible solutions are discussed. [ABSTRACT FROM AUTHOR]

Background: This is the second part of a series of two papers which explores the use of interpretative phenomenological analysis (IPA) within midwifery education in order to examine students' perspectives of the newborn infant physical examination (NIPE). Part one, featured in the British Journal of Midwifery volume 28, no 2, explains the background to the development of the study and explores the use of IPA within an emerging aspect of midwifery education. Part two of the series will present the research findings and implications for practice. Objectives: This study aims to explore the experiences of student midwives completing the theory and practice aspects of the NIPE within a pre-registration midwifery programme. Design: A qualitative design was utilised to analyse data collected by semi-structured interviews. Setting: A large university in the West Midlands geographical area. Participants: Five student midwives were purposively selected to participate in the study. Methods: This study was conducted using IPA. Findings: Three superordinate themes were generated: learning by doing, mentorship and transition to qualification. The findings demonstrate the significance of student midwives being exposed to the practical aspect of the NIPE during their training. Conclusions: The study findings indicate that standardisation is required within preparation to undertake the NIPE within clinical practice. Higher educational institutes must also provide greater support with regards to the mentorship of student midwife NIPE practitioners. Further research should examine the maintenance of the NIPE role within newly qualified midwives. [ABSTRACT FROM AUTHOR]

Technology within healthcare is a growing industry, and health professionals now use technology within their everyday working life. Within hospitals, it is the norm to see staff using handheld devices to record clinical observations and patient notes being typed into an electronic system. However, the use of technology within community settings is far behind that of hospital counterparts. It has been acknowledged that the use of technology in healthcare will improve efficiency and remove some of the bureaucracy within the NHS, and community areas are beginning to pilot different ways of implementing this. This article describes a pilot trial of using technology to aid mobile working in the author's trust and discusses how district nursing can embrace the use of paperlite culture to improve efficiency and record reliability. [ABSTRACT FROM AUTHOR]

Clinical academic career pathways for nurses, midwives and allied health professionals are a strategic priority for NHS England, and there has been significant investment in the National Institute of Health Research integrated clinical academic programme for non-medical healthcare professionals. Nurses, midwives and allied health professionals face numerous barriers to successfully building a clinical academic career. For those outside the integrated clinical academic programme, clinical academic career approaches are varied and often driven by individual practitioners rather than robust organisational processes or strategy. The vision of 'future midwife' is that midwives maximise opportunities in research and scholarship. However, there is little clarity about how these academic aspirations may be supported. This reflective lived experience discussion paper explores key issues around clinical academic midwifery careers, including how space for clinical academic midwives can be assured and the steps midwives can take to start to develop this rewarding and important career. [ABSTRACT FROM AUTHOR]

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided [ABSTRACT FROM AUTHOR]

Policies in long term conditions care continue to develop rapidly in England. Currently there is a focus on the integration of services and enabling patient and carer choice. Integration of care across disciplines and services is complex and community nursing services are commonly central to reorganization processes in long term condition care. This paper presents the findings of a mapping of the evidence on integration in long term condition services. Literature on horizontal integration including integrated teams will first be discussed, followed by an exploration of the evidence on vertical integration exemplified by integrated care pathways and disease management programmes. As a relatively recent service innovation, the mapping found a lack of evidence of the effectiveness of integration in long term conditions. Furthermore, the paper highlights the potential tension between vertical integration structures such as care pathways and the patient choice and empowerment agenda in long term conditions. [ABSTRACT FROM AUTHOR]

The first two papers in this series described the early development, and ongoing evolution of a caseholding team in the north-west of England (Byrom and Downe, 2007; Fleming and Downe, 2007). We described the outcomes of the scheme and suggested that nine key factors may underpin the success of the project, namely: continuity of carer; visibility in the community; multi-agency involvement; inter-disciplinary collaboration; leadership; strategic partnership; ability to be innovative and flexible; involvement of local community and individuals; and shared group philosophy. Based on principles of service user involvement it was agreed that the ongoing monitoring of the project would include an invitation to all those using the service to write their birth story to summarize their experiences with the scheme. This paper presents a selection of these stories as a reflection on the processes and outcomes of the scheme. The stories indicate that the benefits of the scheme are evident for both the women using the service, and the midwives providing it. They also illustrate many of the nine core factors for success identified in our previous paper. Specifically, the scheme offers the opportunity for women at high clinical and socio-demographic risk to experience positive childbirth experiences. It also offers the opportunity for midwives to exercise their skills in normalizing birth in complex situations. [ABSTRACT FROM AUTHOR]

Emeritus Professor Alan Glasper, from the University of Southampton, discusses aspects of a recently published briefing paper report on dementia from the House of Commons Library [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has impacted healthcare education and delivery, including both theory and practice learning. Academic staff responded rapidly to move teaching online during the first lockdown, with many returning to practice to deliver care or upskill practice staff to work in critical care. Many pre-registration students responded by becoming paid NHS employees, contributing to care delivery while remaining on their programme of study. Practice learning partners, despite the challenges of the pandemic, continued to support students to achieve their registration status. This occurred within the context of the Emergency and Recovery Standards, published by the Nursing and Midwifery Council between March 2020 and September 2021. This paper sets out the response of students, practice learning partners and higher education institutions involved in pre-registration nursing and midwifery programmes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of a telehealth system, using digital pen-and-paper technology and a modified smartphone, to remotely monitor and support the effectiveness of wound management in nursing home residents. Method: A randomised controlled pilot study was conducted in selected nursing homes in Bradford, which were randomised to either the control or evaluation group. All patients with a wound of any aetiology or severity, resident in the selected nursing homes were considered eligible to participate in the study. Residents in the control homes who had, or developed, a wound during the study period, continued to receive unsupported care directed by the nursing home staff (defined as 'standard care'), while those in the evaluation homes received standard care supported by input from the remote experts. Results: Thirty-nine patients with a wound were identified in the 16 participating Bradford nursing homes. Analysis of individual patient management pathways suggested that the system provided improved patient outcomes and that it may offer cost savings by improving dressing product selection, decreasing inappropriate onward referral and speeding healing. Despite initial anxiety related to the technology most nursing-home staff found the system of value and many were keen to see the trial continue to form part of routine patient management. Conclusion: The current study supports the potential value of telemedicine in wound care and indicates the value that such a system may have to nursing-home staff and patients. [ABSTRACT FROM AUTHOR]

This paper follows a previous paper (Hewitt-Taylor et al, 2012) in which the authors summarised their reflections on the literature relating to the application of research in practice. This paper builds on these reflections and reports on the findings from one aspect of a study that explored nurses' views on using research in practice. Quantitative methods of data collection and analysis were used and data were gathered using questionnaires. The findings suggest that nurses generally value research, but this does not necessarily mean that they base individual decisions on particular research findings, or that research is considered the most important form of evidence in direct practice. In addition, the resources that enable nurses to find, appraise and make decisions about using research, are not always readily available in practice settings. From this part of the study, it can be concluded that for research utilisation to increase, time, resources, role models and environments that support this ethos are needed, and that an emphasis on research should not eclipse other key forms of nursing knowledge such as patient views and experiences, and professional expertise in the promotion of evidence-based practice. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the study was to investigate nursing and midwifery students' experiences of electronic health records (EHRs) in practice. Background: As EHRs are increasingly being implemented in the NHS, student nurses and midwives are gaining experience in their use. Method: Three focus groups were conducted on a university campus in England: one with midwifery students (n=6); one with mental health nursing students (n=5); and one with adult nursing students (n=6). The focus group data was analysed thematically after transcription. Results: Students perceived the benefits of EHRs for care delivery as better information availability and quality of record keeping. Their concerns related to practical and logistical issues, and difficulties in adjusting to electronic systems. Conclusion: If students have positive experiences with EHRs during training and have opportunities to use EHR systems while on placement, they are more likely support the implementation of EHRs as they enter the workplace as qualified staff. [ABSTRACT FROM AUTHOR]

This paper aims to present information about the provision of gingival prostheses or gingival veneers. These appliances are most commonly provided for patients with gingival recession and attachment loss. The paper will highlight the indications and advantages for providing prostheses, and inform the reader of the risks or complications that may arise. The clinical and laboratory stages will be explained and advice provided on maintenance. A case series will demonstrate some of the patient-related benefits and difficulties that can be encountered. A final aspect to the paper will present the results of a survey undertaken in the north-east of England, exploring the provision of these appliances in primary care. CPD/Clinical Relevance: Good aesthetics relating to the gingival margin can be difficult to achieve and the use of gingival veneers may provide a solution. [ABSTRACT FROM AUTHOR]

Objective: This audit was designed to identify the need of the population and the clinical activity associated with wounds and the management of lower limb swelling. The exploration focused on lower leg wound management, access to diagnostics and compression therapy across each audit site. The variation across the sites was explored to gather insight into the real-world barriers to providing evidence-based management for leg ulceration. Method: We undertook wound prevalence audits across six diverse community provider sites in England. The audit was undertaken by the local providers, with the inclusion of tissue viability and podiatry leads and key local stakeholders, often local quality leads, primary care leads and nursing directors. Each audit was undertaken with full engagement of local clinicians. Data were collected centrally, and each audit site received their own local analysis and report, with additional analytical support from the local tissue viability lead to ensure the feedback was contextualised for their stakeholders. Analysis was provided by Accelerate CIC Lymphoedema & Leg Ulcer Clinic. Results: A total of 2885 patients were reviewed via an online or a paper audit tool. In total, 2721 patients had one or more active wounds. However, 1350 patients had one or more lower leg wounds, with 164 patients being managed for lower limb swelling or prevention of leg ulceration; bilateral conditions ranged from 11–43% across audit sites. Of the six sites, two included both community and primary care providers, thus generating wound point prevalence data. The remaining four sites audited community nursing and podiatry services only, with two sites collecting data on lower limb wounds only rather than all wounds, generating point prevalence for their services only. Compression usage varied across care locations, with the greatest use being seen in community leg ulcer clinics, where it was >96% for 234 residents. Compression usage was lower in the home with a range of 14–62% among 692 residents. For 263 residents, where the cause of their lower leg wound was unknown, compression usage was very low at 12%. Compression usage decreased with age; for three audit sites this was noteworthy, with 65% of those aged >80 years not in receipt of compression. Compression usage had a direct impact on nursing activity; non-use of compression increased activity by 37%. Conclusion: Through the identification of wound location, this series of wound prevalence audits identified a greater number of patients with lower limb wounds than those recognised and classified as a leg ulcer. Substantial variation in access to diagnostics and compression therapy was observed between audit sites, and also between locations within their boroughs. The factors that reduced access to compression therapy included not classifying the lower leg wound as a leg ulcer, being cared for in the home and increasing age of the patient. Lack of compression usage increased nursing activity. Where there is lack of access to therapeutic intervention, the resultant patient harm is not systematically recognised or documented. [ABSTRACT FROM AUTHOR]

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided [ABSTRACT FROM AUTHOR]

The Nursing and Midwifery Council changed its standards in 2018 regarding student learning and assessment on placements. Previously, students were allocated a mentor with whom they spent at least 40% of their time and who also assessed them; the new standards brought in the separate roles of practice supervisor and a practice assessor and abolished the 40% minimum, with the student being supported by a wider range of practitioners. While extensive literature examines the experiences of qualified staff supporting students, there is little evidence on the student experience. A qualitative approach using semi-structured interviews with student nurses from two universities in the south of England was used to explore their experiences. The students reported benefits of being supported by the wider healthcare team, said being taught and assessed by different people was beneficial and that they felt better prepared for assessments. [ABSTRACT FROM AUTHOR]

Background: The pre-registration BSc Nursing course in the UK is renowned for being challenging due to its requirement for 2300 hours each for theoretical and practice-based learning. It is therefore inevitable that some students may need to interrupt their study at some point during the course. In many cases, these students do not return and leave the course, which has an impact on the future nursing workforce. Aims: To examine the reasons why pre-registration student nurses interrupt their studies and consider ways to enable them to return successfully and complete the course. Methods: The research project was based in one higher education institution (HEI) in the North West region of England. Interrupted students due to return to study in semester 1 of the 2022/23 academic year (n=95) were invited to participate in semi-structured interviews. Findings: Health, including mental health was the dominant factor leading to the interruption of study for the students. Conclusion: This research has led the HEI to introduce an improved support package for students. Alongside other recommendations it is hoped the changes will reduce attrition and lead to an improved interruption/return-to-study experience. [ABSTRACT FROM AUTHOR]

Interprofessional education is a key requirement identified in various professional and regulatory body education standards in the UK. However, recent high-profile investigatory reports into adverse incidents in NHS organisations have demonstrated failures of translating interprofessional education into practice. This paper explores how a university in the south of England uses service improvement projects to address this. Working with key senior clinicians, small groups of students from a variety of professional backgrounds collaborate to address an identified problem in practice to bring about better, safer practice to benefit patients. This style of learning enables students to acquire essential attributes in preparation for employment, such as critical thinking, teamworking, ethical practice and leadership. [ABSTRACT FROM AUTHOR]

Almost one-fifth of the population in England lives in rural areas. Compared to urban populations, the rural population is older and faces greater difficulties in accessing medical services. At the same time, healthcare teams in rural areas face particular challenges in recruiting and retaining staff, travelling between patients and keeping specialised knowledge up-to-date. Drawing upon a recent health needs assessment for people living with long-term neurological conditions in a rural English county, as well as a broader review of the literature, this paper considers the challenges of rurality and discusses potential solutions. Technological and community-based responses have often been suggested as responses to challenges of rurality. However, there is likely to be a need for up-front investment of resources and careful consideration of individual and community needs before these solutions can be applied to rural neurological care. [ABSTRACT FROM AUTHOR]

Prescribing in palliative care was an ‘early candidate’ area for the extension of nurse prescribing authority, but has failed to meet expectations. The low number of nurse prescribers working in palliative care, and the impact of the lack of this kind of professional, has received little attention. This paper gives details of an ‘in-depth service evaluation project’ relating to the prescribing activity of specialist palliative care nurse independent prescribers (SPCNIPs) in one community palliative care team to ascertain the volume of their prescribing activity as well identifications of the outcomes and influences to their prescribing activity [ABSTRACT FROM AUTHOR]

The article summarizes several published research articles relevant to palliative care. It includes the synopses of a paper in "Palliative Medicine" by D. Clark et al investigating the proportion of in-patients in Scottish hospitals that die within certain time points, a report by M. R. O'Brien and colleagues on the experiences of people with motor neurone disease (MND) and a paper by H. Golla et al stating Germany's perception of palliative care.

Reflection is widely regarded as important for learning from practice in Nursing. Academic reflective writing (ARW) is increasingly being used to assess reflective practice. However, there is currently scant literature on ARW, which is extremely complex, requiring students to link their own experiences to published literature. There are also concerns in the literature about the validity of ARW as a medium of assessment. In this paper, an exploratory discussion on ARW is illustrated with reference to the views of 8 self-selected students on a course for post-registered nurses. These students found ARW extremely challenging, and highlighted a range of difficulties associated with it. In conclusion, it is argued that the student experience of ARW warrants further investigation. In addition, it is suggested that either scaffolding should be put in place to facilitate the production of successful ARW, or alternatives should be explored. [ABSTRACT FROM AUTHOR]

For maternity services in Blackburn, Lancashire, the Changing Childbirth (Department of Health, 1993) document was a long awaited publication. Prior to 1993 there had been radical change in local maternity service provision facilitated by inspirational leadership and enthusiastic midwives. Small, under-utilized and expensive GP led maternity homes were closed with an aim to provide one equitable service by blending the philosophies and expertise of low and high risk caregivers. From that time the service has continually striven to improve the continuity of care for women through the development of midwifery led care and team midwifery. In early 2004 a midwifery group practice was established in Blackburn. The development was made possible through an effective partnership between a hospital Trust, a Primary Care Trust, a Sure Start local programme and a Higher Education Institution. This paper tracks the setting up of this midwifery group practice. Future papers will address the ongoing management of the project, impacts and outcomes associated with it, and the arguments used to mainstream, sustain and develop it. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to assess the value of accredited leg ulcer education in influencing changes in practice. This is a before and after educational evaluation that adopted a qualitative survey approach of 12 primary care nurses attending the Nurse-Led Assessment and Management of Leg Ulcers accredited CPD module at a London university. The findings revealed that 6 out of the 8 nurses who completed the final interviews were satisfied that all learning outcomes for the module had been met. All of the nurses commented they had changed at least one aspect of practice following the module with the majority stating a number of improvements had been made relating to improved knowledge, practical skills, treatment and patient concordance. The evaluation was limited to a small cohort of primary care nurses and further longitudinal research is required to investigate the effectiveness across multiple cohorts. [ABSTRACT FROM AUTHOR]

Effective integration of research within healthcare organisations is recognised to improve outcomes. A research strategy within a hospital Trust in South West England was revised, following the launch of a national Chief Nursing Officer (CNO) strategy that promotes research engagement and activity. The aim was to develop, implement and evaluate this revised strategic plan for research. High-level engagement within the organisation was established and previous initiatives evaluated. A 6-year plan with 2-year targets was defined and evaluated at year end. The four pillars of the CNO strategy were central to the revised strategy, underpinned by digital innovation. Evaluation of the earlier strategy indicated excellent engagement with the Chief Nurse Research Fellow initiative and the Clinical Academic Network. The 'Embedding Research In Care' (ERIC) unit was reconfigured to an ERIC model, which aided question generation and project development. Year one objectives were achieved within the revised plan. Implementing a research strategy within an organisation requires a cultural shift and a long-term vision is required with measurable objectives. The team demonstrated significant progress through high-level leadership, mentoring and cross-professional collaboration. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) represent a burden to the health economy and patients alike. Despite national and international guidelines regarding the management of risk, the incidence and prevalence across England remains high. Detecting early the risk of PUs is paramount, and requires using a valid risk assessment tool alongside clinical judgement and management of associated risk factors. There is a need to implement prevention strategies. Introducing care bundles for pressure ulcers, for example SKIN, SSKIN and most recently aSSKINg, is designed to guide clinicians and reduce variations in care. This article presents a review of the evidence on compliance with guidelines, frameworks, pathways or care bundles within primary and secondary care settings. This article focuses on the literature review that was conducted to inform a subsequent clinical audit of compliance with the aSSKINg framework in a Community NHS Foundation Trust in the South East of England. [ABSTRACT FROM AUTHOR]

Background: Primary bone and soft tissue sarcoma of the spine are rare and account for less than 0.2% of all neoplasm incidences. Following a patient and public involvement event, the need to explore patient support pathways was identified, which initiated this service evaluation project. Aim: To determine the acceptability and feasibility of a peer-to-peer support project among people using the spine sarcoma service. Methods: Users were paired and introduced via Microsoft Teams. Quantitative and qualitative data both pre- and post-introduction of a buddy were collected. Findings: Service users felt that, although they would have preferred having a buddy at the time of their diagnosis, being allocated a buddy made them feel reassured and better supported. Conclusion: The project was well received and preliminary data are encouraging. Therefore, due to early findings from the first participants, the service is continuing to roll out the buddy programme. [ABSTRACT FROM AUTHOR]

In community nursing, the administration of insulin for people with type 2 diabetes can be delegated by registered nurses to healthcare support workers. Although a voluntary framework in England provides national guidance, little is known about its uptake. The project aim was to determine the roll-out, characteristics and support needs in relation to the delegation of insulin administration in community settings. An online survey was disseminated to community nursing services in England via social media and nursing networks. Of the 115 responding organisations, 81% (n=93) had an insulin delegation programme, with most initiated since 2018. From these services, 41% (n=3704) of insulin injections were delegated daily, with benefits for patients, staff and services reported, along with some challenges. Delegation of insulin administration is an established and valued initiative. Awareness of the national voluntary framework is increasing. National guidance is considered important to support governance arrangements and safety. [ABSTRACT FROM AUTHOR]

The 11th annual National Lymphoedema Conference, organised by the British Journal of Community Nursing in association with the British Lymphology Society and Lipoedema UK, was hosted at the America Square Conference Centre, London, on 22 February 2024. The conference, which aims to provide new insights into the latests developments in lymphoedema care and management through talks by leading experts in the field, was attended by an impressive number of delegates and exhibitors. The sessions were Chaired by BLS Trustee Rebecca Elwell, and are summarised below. [ABSTRACT FROM AUTHOR]

This paper explores issues around the education and competencies of midwives who are involved in the delivery of high dependency care. It argues that all midwives who provide this specialist care should possess the appropriate clinical skills and knowledge relevant to the management of this cohort of women. It also discusses the rational for the development of high dependency care in midwifery and the role of the midwife, as well as the location for care delivery and preparation for practice. The evidence base for this paper comes from research currently being undertaken into the organisation, provision and education of high dependency care within the midwifery setting. The study is being conducted in maternity units in England with a delivery rate in excess of 3000 per year, and is using a series of individual semi-structured interviews with midwives, consultant obstetricians, consultant obstetric anaesthetists and midwifery educationalists. The study will contribute to the debate on the delivery of high dependency care in the maternity setting and highlights the importance of specialist education relating to this area of practice. [ABSTRACT FROM AUTHOR]

A hospice service in south east England determined to develop a new hospice-at-home service to enable greater patient choice and facilitate patients dying at home, which is often a patient's preferred place. As a first step, a literature review was commissioned to establish the evidence base to inform the design of the new service. A range of research had been reported on hospice-at-home services, but the service configurations evaluated in these studies and the context in which they operated had not been described in detail. This paper briefly summarises the results of the literature review and then describes the new service that was established, including the setting and context. Experiences with the service in terms of activity, acceptability, and problems are described. The aim is to assist providers and commissioners seeking to establish or develop similar services and to help them predict the likely impact of such services. INSETS: Box 1. Case study illustrating how the new hospice-at-home...;Box 2. Examples of carers¿ comments on the new hospice-at.... [ABSTRACT FROM AUTHOR]

In England, there has been a long standing tendency to seek to reform health services via large-scale structural reorganization and via seeking (at least in principle) to boost the power of health care commissioners to redesign services. Based on a review of community nursing services in an urban Primary Care Trust, this paper argues that such an approach has led to a situation where positive service development has stalled as senior managers prepare for the next reorganization (rather than focus on service improvement); where the underlying causes of failure to bring about universal transformation of community health services have not been addressed by ongoing organizational changes; and where providers now seem to look to commissioners to change services (rather than changing them themselves). In contrast, the paper argues that there is significant scope for those working in and managing community health services to focus on what is within their power to change—rather than waiting for others to do it for them. [ABSTRACT FROM AUTHOR]

The design of buildings, particularly interior design, Is acknowledged to have an effect on those who live and work there. Within the context of health care, a number of studies have attempted to identify what works best and least well. The outcomes measured include clinical outcomes, and patient and staff wellbeing. However to date there has been limited research examining the role of design in maternity units. This paper provides the background to a three-year multi-method/multi. site study examining the impact of maternity unit design on satisfaction levels, and of staff perceptions of work performance. Results are given in three accompanying papers. This article provides details of the participants: women who had recently given birth (n=559), and staff (n=227) working within the units. Methods included questionnaire survey, focus group, individual interview and on-site design evaluation. [ABSTRACT FROM AUTHOR]

Palliative care should be fully accessible to all those who need it. However, some individuals may be disadvantaged from a palliative care perspective, for a variety of different reasons. This paper brings together three practitioners working in different professional roles who all have a similar interest: palliative care for people with intellectual disabilities. Each practitioner will describe how they are developing local, practice-based initiatives in an effort to improve palliative care for this marginalised group in North Staffordshire, congruent with local and national policies. [ABSTRACT FROM AUTHOR]

There has been little change in the provision of postnatal care over the last decade. Yet anecdotal evidence suggests that midwives are increasingly concerned about the service they are providing. This study aimed to explore midwives perceptions of the current provision of postnatal care In the North West of England. A stratified random sample of 26 midwives working in a hospital or community setting attended five focus group interviews. Qualitative analysis was undertaken using an open coding mechanism to identify emergent themes. The main themes generated were priorities in postnatal care, societal influences and job satisfaction. This paper will use the views of midwives to debate the way forward in postnatal care. [ABSTRACT FROM AUTHOR]

The article discusses the role of the community nurse in the management of population health. Topics include reason that population health management is important, how population health management will be delivered, and historical background on the holistic approach to care of nurses, taking into consideration the role played by non-clinical factors on health outcomes.

Experience feedback data is increasingly recognised as being helpful in improving healthcare services, and in meeting patient and family needs. This end-of-life care project, based on the principles of appreciative inquiry, sought to learn from the experiences of bereaved people whose relative had died in an acute hospital setting. Informal feedback, offered during a routine telephone call, was thematically analysed and interpreted in an appreciative manner. Confirmatory representations of caring practices and behaviours were identified, categorised and disseminated in a way that enabled staff to come to know and understand end-of-life care at its best, rather than as a set of problematised events. The findings served as a benchmark for individuals and teams to assess and progress their practice reflectively. The authors conclude that staff receptiveness to informal bereaved family feedback may be enhanced by focusing on the positive qualities of end-of-life care within existing practices. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to explore the incidence of impostor phenomenon among 79 nurses in specialist roles in a single NHS trust in England, using an online anonymous questionnaire that included the Clance Imposter Phenomenon Scale and free-text responses. Results indicated a high prevalence of impostor phenomenon, with no specific variables predicting its occurrence. Four main themes emerged: self-doubt, role expectations, fear of exposure as an impostor, and factors leading to burnout. The study highlights the need for targeted support and training for this cohort, particularly as impostor phenomenon was found to be prevalent during career transitions and was not limited by gender. The findings have implications for nursing management and education, offering the opportunity to develop specific support mechanisms to alleviate impostor phenomenon and potentially reduce attrition rates in specialist nursing roles. [ABSTRACT FROM AUTHOR]

Objectives: There is limited literature on the experiences of internationally educated nurses (IENs) who have joined NHS trusts in England in the past 20 years. The objectives of this integrative review included exploring and analysing the experiences of IENs in the NHS in England and identifying the cultural, pastoral and training needs of IENs during their first 2 years working in England and providing research-informed recommendations to better support IENs. Design: An integrative review of primary research studies using quantitative, qualitative, and mixed methods of data collection. Data source: CINAHL, British Nursing Index and Google Scholar. Results: Nine articles met the inclusion criteria for this integrative review. All articles contributed to the findings of three main analytical themes: expectations, challenges and belongingness. Conclusion: Limited research fully met the search criteria. This was concerning since IENs have been working in the NHS for decades, yet so few primary studies have been conducted into their experiences. The findings were in line with previous studies, which found that IENs faced challenges both in the workplace and in settling into an English way of life, and often reported feeling that they were not treated equally to their English counterparts. This integrative review raises issues and increases awareness of how the NHS in England can better support IENs transitioning into their new life and ways of working, to further aid recruitment and retention of the international nursing workforce. [ABSTRACT FROM AUTHOR]

Background/Aims In addition to the high rate of attrition among registered midwives, student midwives are increasingly likely to choose to leave their programme, decreasing the projected number of midwives who would join the NHS. The aim of this study was to understand how students experience clinical practice and if these experiences affect their decision to enter the professional register. Methods Seven student midwives who had experienced clinical placement as part of their pre-registration training were invited to attend semi-structured interviews. Data were analysed following an interpretive phenomonology approach, where descriptive, linguistic and conceptual comments on the transcripts were used to identify emergent themes. Results The 79 identified themes were categorised into five sub-themes within two super-ordinate themes: 'kindness and compassion grows future midwives and strength' and 'resolve through COVID-19 and beyond'. The overarching theme from the participants' interviews was 'I can be a good midwife when I qualify'. Conclusions Students want to feel like they will be good midwives, which will be achieved with positive attitudes and behaviours towards them from senior staff during clinical placements. Staff involved with the care of women and newborns should ensure they show students civility and patience while teaching and supporting them. Understanding the level of knowledge that students possess can make it simpler for staff to recognise what each student may or may not have been exposed to. [ABSTRACT FROM AUTHOR]

Studies showing the impact of maternal depression on the mother, infant and wider family have highlighted the importance of mothers feeling able and entitled to disclose postnatal depression (PND) and seek support from others. This paper reports a subset of findings from an interpretative phenomenological analysis of five women interviewed about their experiences of disclosing symptoms of postnatal depression. The findings extend the literature on in vitro fertilisation (IVF) and PND by identifying that perceived entitlement to have PND or seek support can influence the disclosure process. Entitlement appeared to be influenced by the women's own personal contextual factors, including financial status and lifestyles, having children who slept well, partner support and having successful IVF treatment. The findings have clinical implications for health professionals who have regular contact with women in the antenatal and postnatal periods by creating safe contexts to address their beliefs about PND, facilitating disclosure and implementing intervention more promptly. [ABSTRACT FROM AUTHOR]

This paper is a sequel to the article ‘How often should patients in compression have ABPI recorded?' (Furlong, 2013). Monitoring ankle brachial pressure index (ABPI) is essential, especially in those patients wearing compression hosiery, as it can change over time (Simon et al, 1994; Pankhurst, 2004), particularly in the presence of peripheral arterial disease (PAD). Leg ulceration caused by venous disease requires graduated compression (Wounds UK, 2002; Anderson, 2008). Once healed, compression hosiery is required to help prevent ulcer recurrence (Vandongen and Stacey, 2000). The Royal College of Nursing (RCN, 2006) guidelines suggest 3-monthly reviews, including ABPI, with no further guidance. Wounds UK (2002) suggests that patients who have ABPI<0.9, diabetes, reduced mobility or symptoms of claudication should have at least 3/12 Doppler, and that those in compression hosiery without complications who are able to report should have vascular assessment yearly. [ABSTRACT FROM AUTHOR]

This study explored the uptake of homebirth by healthy pregnant women from the perspective of community midwives (CMs). This paper presents factors that CMs expressed contributed to and/or detracted from their job satisfaction. Interviews were conducted with four practising CMs who were employed by a large acute NHS Trust in England providing a non-continuity model of care. Data were analysed thematically and are presented in two categories: (1) continuity of care and (2) working relationships and workloads. Findings suggest that if maternity service providers attended to factors that enhanced the job satisfaction of CMs inclined to support homebirth, this may contribute to increasing its uptake by pregnant women. [ABSTRACT FROM AUTHOR]