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In this article I discuss the effects on the patient experience of isolation nursing during the CoronaVirus Disease (COVID)-19 pandemic. An unintended consequence of isolation nursing has been to distance patients from nurses and emphasise the technical side of nursing while at the same time reducing the relational or affective potential of nursing. Such distanced forms of nursing normalise the distal patient in hospital. I consider ways in which this new form of distanced nursing has unwittingly contributed to the continued commodification of nursing care in the British NHS. Autoethnography is used to describe and reflect on the illness experience, the experiences of caregivers and the sociocultural organisation of health care. The findings discuss three areas of the illness experience: intimate nursing care; communication; the 'distanced' patient experience. [ABSTRACT FROM AUTHOR]

Objective: A major issue facing all health systems is improving population health while at the same time responding to both growing patient numbers and needs and developing and retaining the health care workforce. One policy response to workforce shortages has been the development of advanced clinical practice roles. In the context of an English national policy promoting such roles in the health service, we explored senior managers' and senior clinicians' perceptions of factors at the organization level that support or inhibit the introduction of advanced clinical practice roles. The investigation was framed by theories of the diffusion of innovation and the system of professions. Methods: We conducted a qualitative interview study of 39 senior manager and clinicians in 19 National Health Service acute, community, mental health and ambulance organizations across a metropolitan area in 2019. Results: Small numbers of advanced clinical practice roles were reported, often in single services. Four main influences were identified in the development of advanced clinical practice roles: staff shortages (particularly of doctors in training grades) combined with rising patient demand, the desire to retain individual experienced staff, external commissioners or purchasers of services looking to shape services in line with national policy, and commissioner-funded new roles in new ambulatory care services and primary care. Three factors were reported as enabling the roles: finance for substantive posts, evidence of value of the posts, and structural support within the organization. Three factors were perceived as inhibiting developing the roles: confusion and lack of knowledge amongst clinicians and managers, the availability of finance for the roles, and a nervousness (sometimes resistance) to introducing the new roles. Conclusions: While the national policy was to promote advanced clinical practice roles, the evidence suggested there was and would continue to be limited implementation at the operational level. Development scenarios that introduced new monies for such roles reduced some of the inhibiting factors. However, where the introduction of roles required funding to move from one part of a service to another, and potentially from one staff group to another, the growth of these roles was and is likely to be contested. In such scenarios, research and business evidence of relative advantage will be important, as too will be supporters in powerful positions. The paucity of publicly available evidence on the effectiveness of advanced clinical practice roles across the specialties and professions in different contexts requires urgent attention. [ABSTRACT FROM AUTHOR]

Recent social science research in the field of parenting following assisted conception has focused on the experiences of donor-assisted conception and surrogacy. This article draws from a study which explored the experiences of the transition to early parenthood in 16 heterosexual non-donor couples and includes a specific consideration of the experiences of men as they navigate this journey. We argue that these couples' transition to early parenthood can be as complex and provisional as in other newer forms of family making as they struggle with an emerging identity as a parent after successful non-donor in vitro fertilisation following their experiences of infertility. Their family making is contingent upon their ability to work at integrating their experiences of infertility and in vitro fertilisation into their emerging identity as a parent. This struggle is prominent when they contemplate a further pregnancy. Considering a sibling causes them further uncertainty and anxiety because it reminds them of their infertile identify and the possibility of further in vitro fertilisation. We report novel findings about the experiences of this transition to parenthood: how couples' identity as parents is shaped by the losses and grief of infertility and the anxiety of in vitro fertilisation. We argue that their struggle with an emerging parenthood identity challenges the normative, naturalised view of non-donor heterosexual in vitro fertilisation parenthood. Our work contributes to the work on identity in parenthood after in vitro fertilisation in an ongoing effort to understand how assisted technologies shape infertile parents' lives. This article reports a small study with a relatively homogeneous sample recruited from one fertility clinic. Nevertheless as an exploratory study of an under researched topic, we discuss useful insights and ideas for further research with larger and more diverse samples. [ABSTRACT FROM AUTHOR]

Eight Guyanese expatriate women, who had been living in and around London for decades, came together driven by a participatory inquiry approach. Do we just have 'a touch of sugar' or is diabetes a serious affliction were questions asked. The study's objective was to find answers to these questions. Three nurse academics, one a Guyanese/English woman herself, researched alongside participants. After several years of storytelling and group discussion (2010–2015), the women recognised that when they connected socially, the practical effect of togetherness was empowerment. Researching with participants fostered new understandings of diabetes and improved self-management of this chronic condition. This was achieved through the collaborative character of the inquiry and as a practical response to the problems women were facing. They continue to engage with each other and are reaching out to the wider UK Guyanese community. They have a strong voice about living well with diabetes and strongly reject the myth that diabetes is only 'a touch of sugar'. [ABSTRACT FROM AUTHOR]

Clinical commissioning groups were set up under the Health & Social Care Act (2012) in England to commission healthcare services for local communities. Governing body nurses provide nursing leadership to commissioning services on clinical commissioning groups. Little is known about how nurses function on clinical commissioning groups. We conducted observations of seven formal meetings, three informal observation sessions and seven interviews from January 2015 to July 2015 in two clinical commissioning groups in the South of England. Implicit in the governing body nurse role is the enduring and contested assumption that nurses embody the values of caring, perception and compassion. This assumption undermines the authority of nurses in multidisciplinary teams where authority is traditionally clinically based. Emerging roles within clinical commissioning groups are not based on clinical expertise, but on well-established new public management concepts which promote governance over clinically-based authority. While governing body nurses claim an authority located in clinical and managerial expertise, this is contested by members of the clinical commissioning group and external stakeholders irrespective of whether it is aligned with clinical knowledge and practice or with new forms of management, as both disregard the type of expertise nurses in commissioning embody. [ABSTRACT FROM AUTHOR]

This paper explores how reflective practices enabled researchers to achieve a more complex analysis of qualitative data generated from focus groups. Drawing on our experiences as two white British researchers, conducting a study with internationally educated nurses from Black, Asian and minority ethnic backgrounds, we consider how our analysis led us to a more nuanced understanding of the data than might have occurred without reflectivity. We identified our respective standpoints, confronted our feared biases, particularly in relation to social stereotyping and prejudice, and located ourselves as co-producers of the data. This enabled us to consider how we might be representing, holding and paralleling, systemic patterns of discrimination, leading to several new insights. Reflective practice is often referred to in theory, less often in application. We hope that sharing our reflective process will benefit other researchers navigating the complex waters of identifying themselves in their research. [ABSTRACT FROM AUTHOR]

While poor communication between service users and front-line staff causes many service user complaints in the British National Health Service, staff rarely reflect on the causes of these complaints. We discuss findings from an action research project with midwives which suggest that the midwives struggled to fully understand complaints from women, their partners and families particularly about restricted visiting and the locked door to the midwifery unit. They responded to individual requests to visit out of hours while maintaining the general policy of restricted visiting. In this way, the door was a gatekeeping device which allowed access to the unit within certain rules. The locked door remained a barrier to women and their families and as a result was a common source of informal complaints. We argue that the locked door and restricted visiting to the midwifery unit were forms of gatekeeping and boundary making by midwives which reveals a tension between their espoused woman-centred care and contemporary midwifery practice which is increasingly constrained by institutional values. [ABSTRACT FROM AUTHOR]

Objectives: This paper examines how the interaction between financial and clinical risk at two critical phases of health care reform in England has been experienced by frontline staff caring for vulnerable patients with long term conditions. Methods: The paper draws on contracting theory and two interdisciplinary and in-depth qualitative research studies undertaken in 1995 and 2007. Methods common to both studies included documentary analysis and interviews with managers and front line professionals. The 1995 study employed action-based research and included observation of community care; the 2007 study used realistic evaluation and included engagement with service user groups. Results: In both reform processes, financial risk was increasingly devolved to frontline practitioners and smaller organizational units such as GP commissioning groups, with payment by unit of activity, aimed at changing professionals' behaviour. This financing increased perceived clinical risk and fragmented the delivery of health and social care services requiring staff efforts to improve collaboration and integration, and created some perverse incentives and staff demoralisation. Conclusions: Health services reform should only shift financial risk to frontline professionals to the extent that it can be efficiently borne. Where team work is required, contracts should reward collaborative multiprofessional activity. [ABSTRACT FROM AUTHOR]

In this article it is argued that there are barriers to effective and non-discriminatory practice when mentoring overseas nurses within the National Health Service (NHS) and the care home sector. These include a lack of awareness about how cultural differences affect mentoring and learning for overseas nurses during their period of supervised practice prior to registration with the UKNursing and MidwiferyCouncil. These barriers may demonstrate a lack of effective teaching of ethical practice in the context of cultural diversity in health care. This argument is supported by empirical data from a national study. Interviews were undertaken with 93 overseas nurses and 24 national and 13 local managers and mentors from six research sites involving UK health care employers in the NHS and independent sectors in different regions of the UK. The data collected showed that overseas nurses are discriminated against in their learning by poor mentoring practices; equally, from these data, it appears thatmentors are ill-equipped by existing mentor preparation programmes to mentor overseas-trained nurses from culturally diverse backgrounds. Recommendations are made for improving mentoring programmes to address mentors' ability to facilitate learning in a culturally diverse workplace and thereby improve overseas nurses' experiences of their supervised practice. [ABSTRACT FROM AUTHOR]

How nursing as a profession is valued may be changing and needs to be explored and understood in a global context. We draw on data from two empirical studies to illustrate our argument. The first study explored the value of nursing globally, the second investigated the experiences of overseas trained nurses recruited to work in a migrant capacity in the UK health care workforce. The indications are that nurses perceive themselves as devalued socially, and that other health care professionals do not give nursing the same status as other, socially more prestigious professions, such as medicine. Organizational and management structures within the NHS and the independent care home sector devalue overseas nurses and the contribution they make to health care. Our conclusions lead us to question the accepted sociocultural value of the global nursing workforce and its perceived contribution to global health care, and to consider two ethical frameworks from which these issues could be discussed further. [ABSTRACT FROM AUTHOR]

In this paper I draw on the findings of an ethnographic study of fertility nursing in a British fertility unit to explore the relevance and importance of ethnography for illuminating the role of emotions in nursing practice. One of the main findings to emerge from the original study was that infertility was an emotional experience for both staff and patients, and that the organisation of the unit ensured that the potentially disruptive emotions of staff and patients were controlled and remained private. These findings have been reported elsewhere (Allan, 2001, 2002). Drawing on these findings, I discuss the role of ethnography in illuminating the role of emotions in the clinic in two ways. First, I will discuss the nature of the data in ethnography and the relationship between participant observation and interviews. Second, I will discuss the experience of researcher reflexivity and ethnographic authority in ethnography. [ABSTRACT FROM PUBLISHER]

This paper explores the history of the concept of health environment in nursing discourse. The prompt to investigating the subject followed the national research and development (R&D) initiative set up through the Royal College of Nursing and the Centre for Policy in Nursing Research. Subsequent developments in national healthcare policy, particularly in relation to primary care-based commissioning and public health highlight the timeliness of such a debate. A conceptual framework for the health environment is suggested which is dynamic and practice-oriented. It is hoped that this will appeal both to academics and practitioners in order to build a base of research and practice around the health environment within and beyond the nursing professions. [ABSTRACT FROM PUBLISHER]

This paper comments on feminist research and in particular the use of reflexivity in feminist ethnography. Reflexivity in ethnography is the use of self as an instrument of the data collection and the researcher's own awareness of reactions to the research data.Ethnography requires that the researchers immerse themselves in the field and act reflexively while collecting data. I will discuss how using myself reflexively as a researcher during data collection in an assisted-conception unit led me to reconsider an assumption about the methodology underpinning feminist research approaches. It has been argued that feminist research approaches are women-centred and that debates on reproductive technologies are based on the premise that males control assisted conception.My experience of undertaking a feminist ethnography has challenged these two assumptions. Reflection during and after the data collection has led me to question the aims of women-centred research in a field in which men are participants as doctors and patients. By discussing data from field work, I argue that including men in feminist research offers the potential for the emergence of a new type of research. [ABSTRACT FROM PUBLISHER]

The article offers information regarding discrimination faced by non-white overseas nurses in Great Britain. It is stated that overseas nurses faced multi-dimensional discrimination in the workplace. It is noted that promotions of nurses were based on navigating systems of patronage and not on merit. It is stated that in cases of clinical malpractice overseas-trained nurses were over reported to the Great Britain's Nursing and Midwifery Council.