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Background During the COVID-19 pandemic Ayrshire Hospice piloted a training course for personal carers in North Ayrshire focusing on palliative and end-of-life care. The course was delivered online, comprising four 90 minutes sessions. One of the sessions focused specifically on the practical aspects of carrying out personal care towards the end of a person’s life, and featured a demonstration by two of the hospice’s senior care assistants using a training mannequin. Aims The pilot aimed to increase knowledge and understanding of the principles of palliative and end-of-life care for personal carers. The aim of this particular session was to share, peer to peer, the specialist knowledge and skills required in caring for someone towards the end of their life. Methods During this particular session, two experienced senior care assistants gave a practical demonstration of how they would provide personal care for someone nearing the end of their life, using a mannequin. They shared the practical skills they employ, emphasising the importance of care being carried out gently and slowly, and discussed how they used this as an opportunity to simultaneously assess the person’s condition; looking for any signs of distress, pain, issues regarding skin integrity and oral health. Outcomes Sharing best practice through example peer to peer was well received. Ultimately this will benefit the people being cared for, whilst also building the skills and confidence of all involved. Links were formed, with the hospice now viewed as an invaluable resource. The online nature of the training proved successful, in terms of ease of access for participants, and the flexibility to include demonstrations from hospice team members. Sessions evaluated positively. Further training has since been progressed in North Ayrshire, with the hope that it will be adopted across Ayrshire over the next 18 months.

Background In response to the COVID-19 pandemic Ayrshire Hospice established a ten-week, live online supportive education programme for Care Homes using Project Echo®. Project Echo® is a widely used model for education, aiming to ‘improve care by gathering a community of practice together for learning and support with the goal of improving decision making by collaborative problem solving’. Local care homes were asked what educational support they needed, and the hospice responded, using the multidisciplinary team, to specific topic requests. This gave participants an opportunity to build links, increase knowledge, share practices and experiences through supportive facilitation. Aims To use the hospice team and Project Echo® to connect with and support care home staff dealing with the unprecedented challenges of providing palliative and end of life care during COVID-19. Methods Core facilitation team established. Liaison with Highland and Accord hospices regarding their Project Echo® experience. Establish links with AAHB and HSCP to determine existing practice, need, create awareness. Developed systems required to support the programme. Contacted every care home across Ayrshire to determine interest and need Evaluation developed. Outcomes Responding to COVID-19, an intended service development was quickly established and implemented, providing access to specialist palliative care/advice and support to care homes. Identified learning needs were met, with weekly agendas set by care homes. Safe space to share knowledge and experience without needing to travel Peer support. Established/improved links with the hospice/AAHB/HSCP and care homes across Ayrshire. Evaluated extremely well - evidence of shared learning, improved care, links established and a sense of support and understanding. Aligned with the NHS Scotland’ Palliative and end of life framework. Future plans - Project Echo® to be used as educational model, to improve palliative and end-of-life care in Ayrshire by increasing capacity and capability of community teams.

To consider the scope and quality of mixed methods research in nursing.Focused mapping review and synthesis (FMRS).Five purposively selected journals: International Journal of Nursing Studies, Journal of Nursing Scholarship, Journal of Advanced Nursing, Worldviews on Evidence-Based Nursing, and Journal of Mixed Methods Research.In the target journals, titles and abstracts from papers published between 2015-2018 were searched for the words or derivative words 'mixed methods'. Additional keyword searches were undertaken using each journal's search tool. We included studies that investigated nursing and reported to use a mixed methods approach. Articles that met the inclusion criteria were read in full and information was extracted onto a predetermined pro forma. Findings across journals were then synthesized to illustrate the current state of mixed methods research in nursing.We located 34 articles that reported on mixed methods research, conducted across 18 countries. Articles differed significantly both within and across journals in terms of conformity to a mixed methods approach. We assessed the studies for the quality of their reporting as regard the use of mixed methods. Nineteen studies were rated as satisfactory or good, with 15 rated as poorly described. Primarily, a poor rating was due to the absence of stating an underpinning methodological approach to the study and/or limited detail of a crucial integration phase.Our FMRS revealed a paucity of published mixed methods research in the journals selected. When they are published, there are limitations in the detail given to the underpinning methodological approach and theoretical explanation.目标: 探讨护理学中混合方法研究的范围和质量。 设计: 集中映射审查和合成(FMRS)。 数据来源: 五本精选期刊:《国际护理研究杂志》,《护理学术期刊》,《高等护理学期刊》,《循证护理世界观》,《混合方法研究杂志》。 评审方法: 在目标期刊中,对2015年至2018年间发表的论文标题和摘要进行搜索,以查找“混合方法”一词或其衍生词。使用每本期刊的搜索工具进行额外的关键词搜索。我们将调查护理的研究全部囊括在内,并报告使用混合方法的方式。符合入选标准的文章进行全文阅读,并以预定的形式摘取相关信息。然后,综合各期刊的研究发现,用以说明护理学中混合方法研究的现状。 结果: 我们找到34篇在18个国家和地区进行的混合方法研究做出报告的文章。在对混合方法的方式一致性方面,期刊内和期刊间的文章存在显著差异。我们评估了这些研究在使用混合方法方面的报告质量。19篇研究被评为满意或良好,15篇被评为描述差评。差评主要是由于缺乏说明研究的基本方法论和/或关键整合阶段的细节有限。 结论: 我们的集中映射审查和合成方法显示,精选期刊中发表混合方法研究的极少。在出版时,对基础方法论和理论解释的细节存在局限性。.

Objectives: To translate and study the factor structure of a Japanese version of the Stressors in Nursing Students scale. Methods: The Stressors in Nursing Students scale was translated into Japanese and administered to a large cohort (N = 1298) of female Japanese nursing students across five universities and across all four years of the nursing programme. The data were analysed using exploratory factor analysis. Results: Exploratory factor analysis revealed four factors: ‘Clinical’; ‘Conflict and confidence’; ‘Education’; and ‘Free time’. The relationship between the total score on the Stressors in Nursing Students scale and the demographic aspects of the sample was weak but there was a significant increase in the perception of stressors between first and second year students. Conclusions: There were similarities and differences between the perception of stressors by nursing students in Japan compared with, for example, the United Kingdom and China mainland. While a four-factor structure was found here, the distribution of items in the Stressors in Nursing Students scale differed from previous studies in the United Kingdom and China with the ‘Free time’ factor being unique to this study. Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their work and study. Findings can inform the development of strategies to reduce such stressors among nursing students in multiple, global contexts. Keywords: Nursing students, Factor analysis, Japan, Stressors

Many Chinese people do not contact mental health services when they first develop mental health problems. It is therefore important to find out reasons for low uptake of services so that strategies can be identified to promote early intervention. WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: Most Chinese people only come into contact with mental health services during crisis situations. Language difference, lack of knowledge of mainstream services and stigma attached to mental health problems are barriers to access and utilize mental health services. WHAT THE STUDY ADDS TO THE INTERNATIONAL EVIDENCE?: Chinese people apply both Western medication and traditional healing to manage distress caused by mental health problems. Because of the extreme stigma associated with mental health problems, Chinese people are reluctant to accept support from their own cultural groups outside their family. Family plays a major role in caring for relatives with mental health problems. Families are prepared to travel across the world in search of folk healing if not available in Western societies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is important to recognize the different approaches to understanding and managing mental health problems among Chinese people, otherwise they will be dissuaded from engaging with mental health services if their beliefs are disregarded and invalidated. Services that involve Chinese speaking mental health workers can address the issue of language differences and sensitive mental health issues within the Chinese community.Introduction Late presentation and low utilization of mental health services are common among Chinese populations. An understanding of their journey towards mental health care helps to identify timely and appropriate intervention. Aim We aimed to examine how Chinese populations make sense of the experiences of mental distress, and how this understanding influences their pathways to mental health care. Method We undertook in-depth interviews with fourteen people with mental health problems (MHPs) and sixteen family members. Thematic analysis was used to analyse data. Results/Discussions Different conceptualization of mental distress and the stigma attached to MHPs explained why most participants accessed services at crisis points. Because of mental illness stigma, they were reluctant to seek help outside of the family. Participants used a pragmatic pluralistic approach to incorporate ritual healing and Western interventions to manage mental distress as they travelled further on the pathway journey. Families play a key role in the journey and are prepared to visit different parts of the world to seek traditional healers. Implications for practice Mental health nurses need to adopt a transcultural working approach to address mental health issues so that family will get the support needed to continue their caring role.

Accessible summary: The government and other organisations say that improving health care is important for people with learning disabilities. We asked people with learning disabilities and the people who look after them what it was like for them when they went to the dentist. Those we asked said that when they went to the dentist, they knew that those they saw knew about looking after their teeth. Some of those we talked to though said that certain things needed to be better. Background: The government alongside other health and social care organisation have identified the need to improve the care provided for people with learning disabilities. Materials and Methods: This service evaluation aimed to explore the experiences of people with learning disabilities and their carers who accessed community dental services using a qualitative research design. Adults with learning disabilities (n = 4) and their carers (n = 6) took part in one to one, face to face semi structured interviews. Results and Discussion: Generally, participants were satisfied with community dental services and in particular valued the skills and the competence of practitioners. However, when dissatisfaction was expressed this was generally as a result of poor communication and the transition from child to adult dental services. Conclusions: A number of recommendations are identified and discussed in relation to engagement with adults with learning disabilities and their carers in the development and delivery of community dental services. © 2017 John Wiley & Sons Ltd.

Background: The development of a nurse-led approach to managing epilepsy in adults with an intellectual disability offers the potential of improved outcomes and lower costs of care. We undertook a cluster randomised trial to assess the impact on costs and outcomes of the provision of intellectual disability nurses working to a designated epilepsy nurse competency framework. Here, we report the impact of the intervention on costs. Method: Across the UK, 8 sites randomly allocated to the intervention recruited 184 participants, 9 sites allocated to treatment as usual recruited 128 participants. Cost and outcome data were collected mainly by telephone interview at baseline and after six months. Total costs at six months were compared from the perspective of health & social services, and society, with adjustments for pre-specified participant and cluster characteristics at baseline including costs. Missing data was imputed using Multiple Imputation. Uncertainty was quantified by bootstrapping. Results: The intervention was associated with lower per participant costs from a health & social services perspective of -£357 (2014/15 GBP) (95% CI -£986, £294) and from a societal perspective of -£631 (95% CI -£1,473, £181). Results were not sensitive to the exclusion of accommodation costs. Conclusions: Our findings suggest that the competency framework is unlikely to increase the cost of caring for people with epilepsy and intellectual disability and may reduce costs., This paper presents independent research commissioned by the National Institute for Health Research (NIHR) under its Health Technology Assessment Programme (Grant 10/104/16 PI Dr H Ring). During the time that this research was carried out, H Ring also received support from the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England at Cambridgeshire and Peterborough NHS Foundation Trust.

Aims To report a systematic review of the literature exploring how education, income and occupation influence the uptake of cervical screening and HPV vaccination among eligible women in developed countries, including the United Kingdom, United States, Spain, Germany and Norway. Background Cervical cancer remains a highly prevalent disease despite it being largely preventable through cervical screening and HPV vaccination. Incidence and mortality of cervical cancer are unequally distributed among socioeconomic groups, warranting research into how individual socioeconomic factors contribute to this unbalanced uptake of prevention strategies. Design Systematic review and narrative synthesis. Methods The PRISMA guidelines (PLoS Medicine, 6, 2009, e1000097) guided the selection of papers. MEDLINE, CINHAL, PsychINFO, Science Citation Index and HMIC were searched. Ten articles were suitable. Key findings were then extracted, and a narrative synthesis was completed, using suitable guidance and the AXIS tool. Results Obtaining high school or college education is associated with uptake of both cervical screening and HPV vaccination. Total household income and income in respect of the countries' poverty line was measured less frequently than education, but associated with screening and vaccination in some studies. Occupation was infrequently measured in comparison to education and income, limiting conclusions of its association to uptake. Conclusion Education and income have an association with uptake of cervical screening and HPV vaccination among women. However, evidence is insufficient to affirm a relationship between occupation and uptake of screening and vaccination. Further research would be advised to strengthen these findings. Relevance to clinical practice Interventions to promote cervical cancer prevention strategies should be targeted at women and girls with lower education levels and lower income. However, differences are displayed in the relationships between the individual socioeconomic factors and uptake of preventative strategies between countries and populations and so they should be considered separately. Nurses play a considerable role in people's perceptions and experiences of cervical screening and HPV vaccination. The review findings offer new insight that can inform future policy and nursing practice on targeting interventions to promote uptake among women who are underusing cervical cancer prevention programmes.

The satisfaction of social care among service users provides an important indication of how services are performing. Although there is evidence to suggest that people from black and minority ethnic communities experience less satisfaction with social care than majority groups, there is little literature which focuses specifically on people from Chinese backgrounds in England. This article provides an opportunity to hear the voices of people from Chinese backgrounds and their experiences of\ud social care for a physical disability. Individual semi structured interviews and focus groups were conducted in 2012 and 2013 respectively with people from Chinese backgrounds who lived in England, were aged between 18 and 70, and received social care for a physical disability.\ud Interview and focus group transcripts were analysed using a thematic approach. The findings show that language difference created a structural barrier for most participants to negotiating access to and navigating\ud through social care. Language difference and the cultural expectation that families should look after their own were main factors that explained their late utilisation of social care. Because of limited social support,\ud many families struggled to meet the long-term care needs of their relative with a physical disability and hence initially welcome the input of social care. However, many found that social care could not adequately meet their needs but did not feel that they had the right to voice their dissatisfaction. They would either stop using social care services or become more reliant on their family for support. Chinese welfare organisations play a crucial role to meet the cultural and linguistic needs of people from Chinese backgrounds. Closer collaboration between local\ud authorities and Chinese welfare organisations is needed to enable an effective use of social care and community resources to meet the needs of people from Chinese backgrounds with physical disabilities.

Aims: The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress. Background: Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon. Design: Systematic literature review and narrative synthesis (November 2015–March 2016). Data sources: Ovid MEDLINE® In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO® 1967–Present, CINAHL® Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education Abstracts. Review methods: Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis. Results: In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity. Conclusion: We suggest the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress.

Purpose of the research: This paper is a report of a study of the experiences of individuals with colorectal cancer in the period following their cancer treatment and the physical, psychological and social aspects associated with adjusting to everyday life. Methods and sample: Qualitative interviews using a phenomenological approach were conducted with a purposive sample of 13 individuals who had completed active curative treatment for colorectal cancer. Results: Study findings suggest that colorectal cancer survivors employ a broad range of techniques and approaches to manage adjustment to everyday life such as goal-setting, managing informal networks and adopting strategies for physical and emotional recovery. Personal interests were used to create a sense of meaning and through the cultivation of altruistic and utilitarian outlooks on life, positive emotional gains were obtained. Conclusions: Colorectal cancer survivors employ personal strategies for managing life in the survivorship period following cancer treatment. The study findings demonstrate additional areas for exploration such as the effect of altruism on adjustment and the relationship to other groups of cancer survivors.

Background In adults with intellectual disability (ID) and epilepsy there are suggestions that improvements in management may follow introduction of epilepsy nurse-led care. However, this has not been tested in a definitive clinical trial and results cannot be generalised from general population studies as epilepsy tends to be more severe and to involve additional clinical comorbidities in adults with ID. This trial investigates whether nurses with expertise in epilepsy and ID, working proactively to a clinically defined role, can improve clinical and quality of life outcomes in the management of epilepsy within this population, compared to treatment as usual. The trial also aims to establish whether any perceived benefits represent good value for money. Methods/design The EpAID clinical trial is a two-arm cluster randomised controlled trial of nurse-led epilepsy management versus treatment as usual. This trial aims to obtain follow-up data from 320 participants with ID and drug-resistant epilepsy. Participants are randomly assigned either to a ‘treatment as usual’ control or a ‘defined epilepsy nurse role’ active arm, according to the cluster site at which they are treated. The active intervention utilises the recently developed Learning Disability Epilepsy Specialist Nurse Competency Framework for adults with ID. Participants undergo 4 weeks of baseline data collection, followed by a minimum of 20 weeks intervention (novel treatment or treatment as usual), followed by 4 weeks of follow-up data collection. The primary outcome is seizure severity, including associated injuries and the level of distress manifest by the patient in the preceding 4 weeks. Secondary outcomes include cost-utility analysis, carer strain, seizure frequency and side effects. Descriptive measures include demographic and clinical descriptors of participants and clinical services in which they receive their epilepsy management. Qualitative study of clinical interactions and semi-structured interviews with clinicians and participants’ carers are also undertaken. Discussion The EpAID clinical trial is the first cluster randomised controlled trial to test possible benefits of a nurse-led intervention in adults with epilepsy and ID. This research will have important implications for ID and epilepsy services. The challenges of undertaking such a trial in this population, and the approaches to meeting these are discussed. Trial registration International Standard Randomised Controlled Trial Number: ISRCTN96895428 version 1.1. Registered on 26 March 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1429-7) contains supplementary material, which is available to authorized users.

Aims and objectives. The aim of this paper is to report an integrative review of the literature that focused on innovations aimed at enhancing the physical health of people with serious mental illness. Background. Despite the abundance of literature that highlights the relationship between serious mental illness and physical ill health, the provision of physical health care for the seriously mental ill remains a challenge. Many different strategies have been developed, which endeavour to address the poor physical health of people with serious mental illness. However, there is inadequate evidence to establish the success of these strategies. Design. Integrative literature review. Method. The review was conducted using an adapted version of Whittemore and Knafl’s review method to critically appraise and evaluate the literature. Results. Three main themes derived for the types of intervention in the studies emerged from the review. These included assessment, health education/health promotion and multimodal interventions. Conclusion. Although there is some evidence to demonstrate that health assessments are effective in highlighting physical health problems, the evidence to support health education and multimodal interventions is far from conclusive. Further research is needed, in particular larger intervention and longitudinal studies, to help nurses decide on the best possible interventions that will improve the physical health of the seriously mentally ill. Relevance to clinical practice. Whilst nurses’ continued attempts to develop health-enhancing interventions are commendable, there needs to be a greater focus on conducting research to develop the evidence base to guide and support nurses in this area of their practice. Until robust and convincing evidence is available, policy relating to the advancement of the physical health of people with serious mental illness should be developed cautiously.

hopkins j. & Irvine F. (2012) Qualitative insights into the role and practice of Epilepsy Specialist Nurses in England: a focus group study. Journal of Advanced Nursing68(11), 2443–2453. doi: 10.1111/j.1365-2648.2012.05941.x Abstract Aim. This article is a report of a study that aimed to explore Epilepsy Specialist Nurses’ perceptions of their professional role and the factors that may affect their practice. Background. Previous studies have demonstrated high patient satisfaction with the Epilepsy Specialist Nurse. Although UK national guidelines recommend that all individuals with epilepsy should have access to an epilepsy specialist nurse, many National Health Service trusts disregard these guidelines. The need to introduce cost efficiencies in the National Health Service means that the future of some epilepsy specialist nurses is threatened. Design. A qualitative study using focus groups was designed to elicit a rich understanding of the epilepsy specialist nurse role and its current challenges. Methods. Three focus groups were held with a total of 19 participants in the summer of 2009. Data were subjected to thematic framework analysis. Findings. The work was underpinned by high commitment to nursing values, which helped to define the role. Epilepsy specialist nurses were often the sole providers of expert and personalized care to meet patients’ complex needs. Policy and financially driven changes undermined professional identity and led to service diminution. Conclusion. The provision of epilepsy care in England remains variable and access to epilepsy specialist nurses is inequitable. Trusts are being seduced by the cost savings of reducing a specialist service but consequent gaps in service may drive up costs elsewhere. The challenge is for epilepsy specialist nurses to demonstrate their unique place in enhancing patient care and in improving health and well-being.

© The Author 2012. Published by Oxford University Press on behalf of The British Association of Social Workers. All rights reserved. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1093/bjsw/bcr199

The remit of this paper is to identify what might be the future direction of one of the Ottawa Charter's five main action areas; developing personal skills (DPS). It is contested that this was never going to be an easy task. This opinion article argues that, while a watchful eye should be kept on evolving and innovative DPS strategy and programmes that Ottawa principles generally espouse, that type of activity is not representative of the current location and practice of many health practitioners--particularly clinically located health professionals. Targeting such professionals who, otherwise, might remain unaware of or unengaged with health promotion practice is the main reform required for future DPS activity. It is predicted that, where universal progress can be made, the potential for DPS development would be significant.

Aim To evaluate the Assistant Practitioner (AP) role in terms of service delivery and gain insight into the improvements that could be made in embedding this role effectively. This evaluation was timely as the role had been established in radiography for several years and there was limited research which explored its success in practice. Method A qualitative approach was used to examine the perceptions of radiology managers using a regional focus group ( n = 10) and follow up interviews ( n = 4). These were designed to gain an understanding of the managers' views. Focus groups and interviews were audio recorded and transcribed. Data were analysed using a framework analysis approach to reveal salient issues. Results Three main themes representing the perceptions of the role were uncovered and these related to organisational issues, the educational perspective and the individual perspective. This paper is restricted to in depth reporting and analyses of the organisational and individual perspectives only. Analysis revealed several factors facilitated the role in practice but equally other factors inhibited its effectiveness. Conclusions There is potential for the AP role to support the work of radiographers and more importantly enhance the care of patients. However, certain individual views should be addressed and the identified changes in departmental organisation attended to, if the role is to develop successfully and become firmly embedded in the radiography service structure.

Aim The aim of this study was to gain insight into registered nurses’ experiences of caring for older people in the UK and Japan. Method Critical incident technique was used because of its ability to capture actual incidents from practice. Written, anonymous self-report data were collected during 2010. Participants were asked to recall two critical incidents where they had felt either rewarded or challenged at work. Data were analysed using thematic analysis. Findings Analysis revealed striking similarities in the experiences of nurses from both countries. Four main themes emerged: the challenges of a complex work environment; the challenges of resolving ethical conflicts; the rewards of establishing meaningful relationships; and the rewards of achieving excellence in individual patient care. Conclusion The study provides new evidence from two different countries that although there are some challenges, nurses reap many rewards from working with older people.

Despite the wealth of literature which attests to the relationship between serious mental illness (SMI) and physical ill health, the provision of optimum physical health care for mental health service users remains a challenge. In England the Department of Health has identified the evident health inequalities for people with SMI as a priority area for health improvement, publishing numerous policy directives aimed at addressing these inequalities. However, this is a highly complex process and little is known about why the rhetoric of holistic health care has proved unattainable thus far. In this paper we present an informed commentary of the contemporary literature with the aim of offering a more comprehensive understanding of the health inequalities faced by people with SMI. We searched relevant databases for publications related to: the causes of poor physical health among the mentally ill, strategies to address these health needs and the impact which professional education, culture and services structure has on this facet of service delivery. This enabled us to identify potential strategies that can be adopted by health care practitioners wishing to improve the health of this vulnerable group, and by educationalists to advance professionals' knowledge of this important and ostensibly neglected area.

Summary Aims and objectives This paper reports the findings of part of a larger study that explored the empowerment of nursing students in clinical practice. The focus here is on the phenomenon of ‘voice’ and the extent to which nursing students are able to exercise voice during their clinical practice experiences. Background There is evidence to suggest that nursing students are ‘silenced’ in clinical practice and that they are unable to make their voices heard, even when they witness poor nursing practice. Methods This study explored the experiences of thirteen nursing students in the UK as they progressed through their undergraduate nursing programme. The study was underpinned by hermeneutic phenomenology. Data were generated through annual, semi-structured interviews and focus group discussions. Findings In situations that called for nursing students to ‘speak up’ they did one of two things: exit or voice. However, there was bridging of these actions in the form of ‘negotiating voice’. Discussion Theoretically, findings of this study can be understood in relation to Hirschman's notions of ‘exit and voice’. However, rather than being dichotomised extremes, an exit–voice continuum is proposed. Conclusions Students are often silenced in clinical practice, but to overcome this they negotiate situations in an attempt to be heard. This paper provides new insight into the means by which nursing students can be supported to avoid the exit option, in favour of exercising voice.

Summary Aim The paper reports on a study that highlighted the benefits to nursing students of taking part in research. Background There is a great deal of literature and ethical guidance to protect research participants who take part in research. However, there is limited empirical evidence regarding the beneficial outcomes of research participation. Methods The findings reported in this paper were part of a qualitative, longitudinal study undertaken in the UK between 2007 and 2009. The study explored the empowerment of nursing students in clinical practice. Thirteen undergraduate nursing students were recruited to the study. Data generation was in the form of annual, individual interviews. Over the course of the study, students were asked about their experiences of participating in the research. Findings Nursing students reported significant benefits as a result of research participation. These were threefold: strengthening self; strengthening knowledge; and strengthening clinical practice. Protection of research participants is crucial, but emphasis on protection obscures the potential benefits that result from being a research participant. Conclusions Researchers who recruit nursing students to educational research must protect them from harm. However, in the process of weighing up risks associated with their educational research, they need to be cognizant of potential benefits that can arise for nursing students when they are asked to participate in nursing research.

Aims and objectives. The increasing status and regard of indigenous minority languages across Europe, means the advantages of bilingualism for individuals and communities are now well established. We set out to elicit parents’ and health professionals’ views of the role of health visitors and midwives in promoting bilingualism in the family and to consider whether health professionals acknowledge the contribution that bilingualism makes to public health. Background. A three-year study was completed to measure the impact of a language transmission initiative which depends on the input of midwives and health visitors with new parents and how its effect could be improved. This paper reports on one element of that study. Design. A qualitative approach was used. Methods. Six focus group interviews were conducted with health visitors and midwives and 33 postnatal interviews were completed with parents across four counties in Wales. Thematic content analysis was undertaken by two researchers, a third trailed decision processes and scrutinised categories and themes. Results. Findings suggest that health visitors and midwives perceive their roles relating to the promotion of bilingualism differently. Influences on their involvement include their language profile, contact with parents, personal experience, timing of the interaction and time in their workload. The relationship between promoting bilingualism and public health was accepted by some and denied by others. Data from the interviews with parents suggested that few health professionals discuss issues of language transmission with new parents. Conclusions. Some individual health visitors and midwives are willing to promote bilingualism with parents. However, there are challenges in enlisting the support of health visitors and midwives to discuss language transmission and bilingualism with parents. Relevance to clinical practice. These findings challenge practitioners to consider their role in promoting bilingualism and its effect on public health and suggest the need for more defined responsibilities.

Steps to enhance the rigour of qualitative research are much debated in nursing research. Prolonged engagement in the field, maintaining a journal and member checks (participant feedback) can help with this. This paper examines the latter, principally as we have been intrigued by the opposing viewpoints of nurse scholars regarding this matter. A process of critically analysing our research practice, coupled with an exploration of available literature has led to some clarity on the issue, as shared here.

Aim To explore the nature of the nurse clinical supervisor role. Background Although clinical supervision in nursing has been widely explored, few studies have considered the specific role of nurse clinical supervisors. Method A phenomenological approach was used to explore what it means to be a clinical supervisor. Focus groups interviews were conducted with 12 nurse clinical supervisors within one National Health Service (NHS) Trust. Results Three main categories of themes that represented the essence of the clinical supervisors’ role were uncovered. Conclusions The research demonstrated that nurses who undertake the clinical supervisor role are rarely offered guidelines for fulfilling the role. The findings reveal gaps in the structure of the clinical supervisor’s role which could be hampering successful clinical supervision. Implications for nursing management The study adds to the existing evidence base and serves to inform managers of the nature of the nurse clinical supervisor role and how it could be better facilitated. The data shed light on the needs of nurse clinical supervisors who often adopt this role in addition to their other clinical and professional commitments. The findings indicate that managerial support in the form of prioritizing training and offering support mechanisms help nurses to effectively fulfil the clinical supervisor role.

Aim.? In this paper we explore the congruence of focus group interviews within a phenomenological framework.Background.? Focus groups as a research method are popular in nursing. Similarly, phenomenology is a dominant methodology for nurse researchers globally. A number of nurse researchers have combined focus groups and phenomenology, but there are others who argue that they are incompatible.Discussion.? The argument against using focus groups in phenomenological research is that phenomenology seeks essential characteristics or ?essences? of phenomena in a manner that requires an individual to describe their experiences in an ?uncontaminated? way. We recognize that traditionally most phenomenological interviews are conducted with only one interviewer and one respondent, but we question whether this needs to continue. We suggest means by which individual lived experience can be preserved within a group context. We draw on our own experience and the phenomenological literature to argue that focus groups are congruent with phenomenological research and extend this argument further by proposing that group interviews in phenomenology are actually beneficial because they stimulate discussion and open up new perspectives. Our observation is that some researchers who combine focus groups and phenomenology appear to do so uncritically and we argue that this is unacceptable.Conclusions.? It is important for nurse researchers to develop critical awareness of the research methodologies and methods they employ. We argue that the phenomenological focus group is not an oxymoron. Rather, the use of focus groups can provide a greater understanding of the phenomenon under study.

Summary This paper outlines efforts to improve the teaching and learning methods for research on a second year pre-registration nursing programme in one university in Wales, UK. This focussed on experiential approaches supported by electronic learning resources. A subsequent evaluation aimed to elicit participating students’ and lecturers’ perceptions of the success of the experiential approaches and the supporting resources. A questionnaire was distributed to 53 student nurses who participated in the experiential learning and this was supplemented with an informal qualitative ‘graffiti board’ evaluation with the cohort; and a group interview with 4 of the lecturers who had acted as group facilitators during the experiential research sessions. The findings revealed that similar issues were pertinent for both lecturers and students and these were contained within three distinct themes relating to the structure, process and outcomes of the teaching and learning approaches. The student-led approach to evaluation offers a fresh outlook which ensures that the emic perspective is included through the study. The study sheds light on the strengths and limitations of experiential approaches to research teaching and suggest that this is a challenging approach both for students and lecturers, which should not be entered into lightly.

Current evidence demonstrates that language awareness in nursing contributes to high quality patient care. Although language awareness amongst qualified nurses has been considered, there is a dearth of literature that examines how student nurses respond to language sensitivity in the healthcare setting. The critical incident technique was used to elicit the perceptions of student nurses regarding language awareness. Twenty students produced written descriptions of incidents that they had encountered during clinical practice and they subsequently reflected on these incidents. Data were analysed using framework analysis whereby meaning units were organised into themes and categories. Four distinct themes emerged from the analysis; namely, facilitating language choice, vulnerable groups, quality of care and student learning. Each theme was characterised by a number of subcategories. Student nurses identified positive and negative instances of language matters in health care that are driven by personal and organisational strategies and impact on patient care and student learning. Student nurses were conscious of the influence of language awareness on patient care and noted that structural and process elements relating to language awareness were in play in the healthcare setting. Moreover, they indicated that the consequent outcomes of these elements influenced the quality of care and student learning.

Llinos Haf Spencer reports on the use of the cluster analysis statistical technique in nursing research and uses data from the Welsh Language Awareness in Healthcare Provision in Wales survey as an exemplar She concludes that cluster analysis is a valuable tool to tease out patterns in data that are not initially evident in bivariate analyses and thus should be considered as a viable option for nursing research.

Background The significance of effective interpersonal communication in healthcare is well established, as is the importance of overcoming language barriers. This has a particular bearing for minority language speakers, where denying language choice can compromise the quality of healthcare provision. Nevertheless, there is limited empirical research exploring language awareness in healthcare and the factors that influence language choice for minority language speakers. Objectives This paper reports on the nurses, midwives and health visitors (NMHV) data set of the first phase of a large-scale national study, commissioned by the Welsh Assembly Government, to examine the nature and extent of Welsh language awareness amongst healthcare professionals in Wales, UK. Design The study involved a questionnaire survey of healthcare professionals working in the public, private and voluntary sectors of healthcare. Participants A stratified random sample of 3358 healthcare professionals was surveyed, of which 1842 (55%) were nurses, midwives and health visitors. The researcher-designed self-administered questionnaire was distributed by post to participants between July and September 2003. A total of 1042 (57%) NMHV returned their questionnaires for analysis. Results A strong positive correlation is identified between the NMHV use of the Welsh language in practice and their Welsh language proficiency ( p . 01 ); language attitudes ( p . 01 ); and language region ( p . 01 ). Mean language attitude scores are more positive than expected, particularly amongst those with limited Welsh language proficiency and those working in regions with the lowest proportions of Welsh speakers. Conclusions In view of the universal drive for culturally and linguistically appropriate healthcare practice, the findings have important implications for bilingual and multilingual healthcare settings worldwide. The evidence emerging from this survey confirms that cross-cultural communication is enhanced by NMHV language attitudes as well as their proficiency levels. Language awareness training is therefore recommended as a way of enhancing care delivery for minority language speakers.

Aim. This paper is a report of a study to explore the meaning of empowerment for nursing students in relation to their clinical practice experiences. Background. Empowerment and power are well-researched areas of nursing practice, particularly in relation to Registered Nurses. Furthermore, several studies have considered the experiences of nursing students in terms of nursing culture and socialization. However, few researchers have focused specifically on nursing student empowerment. Method. The critical incident technique was used and anonymous data were collected between November 2005 and January 2006. One hundred and nine written critical incidents were provided by 66 nursing students relating to empowering and disempowering experiences in clinical practice. The data were content analysed. Findings. Nursing students experience both empowerment and disempowerment in clinical placements, centring on three issues: learning in practice, team membership and power. Continuity of placement, the presence of a mentor and time underpinned empowering experiences whereas their absence had a disempowering effect. Conclusion. The consequences of nursing student empowerment are high self-esteem, motivation for learning and positive regard for placement. Supportive mentors play a pivotal role in the empowerment of nursing students and it is essential for the nursing profession that they are supported to undertake their mentorship role.

A 46-year-old woman presented with a symptomatic conjunctival mass of the right eye, appearing 2 months after undergoing right frontal craniotomy to excise a meningioma. MRI of the brain revealed a new iatrogenic encephalocele extending into the right temporal orbit. Our opinion is that the conjunctival mass resulted directly from this encephalocele. To date this has been conservatively managed, and we believe this to be the first report of an iatrogenic encephalocele presenting in this manner.

This article is a report of a study that aimed to explore Epilepsy Specialist Nurses' perceptions of their professional role and the factors that may affect their practice. Previous studies have demonstrated high patient satisfaction with the Epilepsy Specialist Nurse. Although UK national guidelines recommend that all individuals with epilepsy should have access to an epilepsy specialist nurse, many National Health Service trusts disregard these guidelines. The need to introduce cost efficiencies in the National Health Service means that the future of some epilepsy specialist nurses is threatened. A qualitative study using focus groups was designed to elicit a rich understanding of the epilepsy specialist nurse role and its current challenges. Three focus groups were held with a total of 19 participants in the summer of 2009. Data were subjected to thematic framework analysis. The work was underpinned by high commitment to nursing values, which helped to define the role. Epilepsy specialist nurses were often the sole providers of expert and personalized care to meet patients' complex needs. Policy and financially driven changes undermined professional identity and led to service diminution.. The provision of epilepsy care in England remains variable and access to epilepsy specialist nurses is inequitable. Trusts are being seduced by the cost savings of reducing a specialist service but consequent gaps in service may drive up costs elsewhere. The challenge is for epilepsy specialist nurses to demonstrate their unique place in enhancing patient care and in improving health and well-being.

The aim of this mixed methods feasibility study was to demonstrate the acceptability, practicality, and safety of training patients who regularly use deliberate self harm (DSH) to self-administer acupuncture as an alternative coping skill for emotional distress. Ten adult patients with a diagnosis of emotionally unstable personality disorder who regularly self-harmed were recruited to the study following baseline assessment by a psychiatrist. An acupuncturist taught participants to self-acupuncture. During the 6-week intervention participants recorded their emotional distress, coping behaviors, thoughts, and feelings in a diary. Face-to-face interviews were used to explore participants' motives for DSH and their experience of acupuncture. Framework analysis was conducted on interview transcripts and diary entries to identify common themes. Mood at baseline and six weeks was measured using the BDI and changes in the use of coping behaviors and acupuncture were measured using diary entries. Subjects used acupuncture regularly through the six-week intervention and over this period there was a reduction in the frequency of DSH. Qualitative analysis identified two broad themes relating to the process and the effects of acupuncture. There was wide variation in the effects experienced by subjects which broadly mapped onto to the wide range of motives behind DSH. BDI scores showed a near significant reduction (p = 0.055) from 44.4. to 34.4 over the 6-week intervention. Patients presenting with deliberate self harm can be safely trained to self-administer acupuncture as an alternative coping skill. Acceptability and effectiveness may vary between patients depending on the complex motives underlying their self-harming behavior. While the pilot study was designed to explore the feasibility of the intervention, results from this limited sample suggest that use of self-administered acupuncture may reduce the frequency of self harming behavior and reduce emotional distress as measured using the BDI.

The aim of this study was to gain insight into registered nurses' experiences of caring for older people in the UK and Japan.Critical incident technique was used because of its ability to capture actual incidents from practice. Written, anonymous self-report data were collected during 2010. Participants were asked to recall two critical incidents where they had felt either rewarded or challenged at work. Data were analysed using thematic analysis.Analysis revealed striking similarities in the experiences of nurses from both countries. Four main themes emerged: the challenges of a complex work environment; the challenges of resolving ethical conflicts; the rewards of establishing meaningful relationships; and the rewards of achieving excellence in individual patient care.The study provides new evidence from two different countries that although there are some challenges, nurses reap many rewards from working with older people.

Due to the dearth of relevant research, intellectual disability nurses may have difficulty identifying sources of evidence on which they can base their clinical decisions. The aim of the present research was to explore how intellectual disability nurses make decisions and how their decisions are influenced by evidence. The method was guided by interpretative phenomenology and the analysis adopted an idiographic approach. Twelve National Health Service intellectual disability nurses in Wales participated in semi-structured interviews. Four key themes were identified: getting to know the person; working as a team; evidence to support decision making; and understanding of evidence-based practice. In the context of the myriad of other professionals involved in caregiving, the nurses conveyed a commitment towards ensuring that the person with intellectual disability is at the centre of decision making. Although using empirical evidence to support practice was acknowledged, these nurses considered person centred decision making to be paramount.

This paper is a report of a study exploring the empowerment of nursing students in clinical practice.There is a great deal of literature regarding empowerment in nursing but most focuses on the empowerment of patients and registered nurses. There is very little regarding the empowerment of nursing students. Of the limited available studies, most explore empowerment in an academic, rather than a clinical context.This longitudinal study was underpinned by hermeneutic phenomenology. Thirteen first-year nursing students were recruited using a purposive sampling strategy. Annual, in-depth interviews were conducted with the students on their trajectory from the first to third year of the undergraduate programme. Data were collected between 2007 and 2009.By the end of the study, most students felt more empowered than they had at the beginning. They attributed this to increased knowledge and confidence. Empowerment of nursing students in clinical practice can be represented in the form of 'spheres of influence'. Intrinsic, essential structures of having knowledge and confidence are at the core. External spheres influence the extent to which nursing students are likely to experience increased knowledge and confidence, and thus empowerment. However, nursing students use a number of strategies to promote their own empowerment in clinical practice.Efforts to promote the empowerment of nursing students in clinical practice need to be multi-layered and targeted at each of the spheres of influence.

Aim: The aim of the study was to investigate the relationship between personality traits, perception of workplace stress and coping among intensive care unit (ICU) nurses. Background: Research has indicated that ICUs are stressful environments. There is a tendency for research studies to investigate causes of stress and ways of coping, but few studies, particularly in recent years, have considered the personality traits of the staff who thrive in this challenging environment, the work stress they perceive and the coping strategies they use. Method: A convenience sample of critical care nurses (n = 46) completed three standardised questionnaires during September 2007: the revised NEO personality inventory (NEO-PI-R); the nurses stress scale (NSI) and the Brief Coping Orientations to Problems Experienced (COPE) scale. Findings: ICU nurses did not perceive their workplaces to be stressful. Certain personality traits, openness, agreeableness and conscientiousness, were associated with problem-solving coping strategies such as active planning and reframing. Openness and extraversion were associated with less perceived stress from the ‘patients and relatives' dimension of the NSI; there were also negative correlations between conscientiousness and the ‘workload stress' and stress from lack of ‘confidence and competence’ dimensions of the NSI. Conclusion: Certain personality traits may have a buffering effect on workplace stress. Pre-employment screening to identify staff that exhibit personality and coping traits associated with low perceived stress may be considered as part of the recruitment strategy to address problems relating to stress, sickness and retention. Relevance to clinical practice: The retention and recruitment of staff who have lower perceived workplace stress and who utilise problem-focused coping may result in less reported absences and fewer critical incidents and errors.

Summary Aim The aim of the study was to explore the empowerment of nursing students in clinical practice. This paper focuses on ‘being valued’ as an important element of empowerment. Background Empowerment of nursing students is necessary in order for them to foster a sense of control and self-efficacy for those in their care. However, there is very little research on how to empower nursing students. Moreover, there is limited literature that specifically addresses the importance of students being valued in clinical practice. Methods Thirteen, first-year nursing students were recruited using purposive sampling. Data were generated through the means of in-depth, semi-structured interviews. Hermeneutic phenomenology was chosen as the underpinning philosophical approach because of its emphasis on actual experiences. Findings Being valued as a learner, being valued as a team member and being valued as a person are important factors in the empowerment of nursing students in clinical practice. These invariant themes are evident either implicitly or explicitly in the experiences of most students. Discussion When nursing students are valued as learners, team members and people, they feel empowered. Too often however, they experience disempowerment as a result of feeling devalued. This has a detrimental impact on their learning and intention to continue on the programme. According to the accounts of many nursing students effective mentorship and a supportive environment are factors that influence empowerment significantly. Conclusions Strategies to promote the empowerment of nursing students in clinical practice need to address their sense of value.

The significant policy changes in UK health care over the past decade have led to a consequent shift in the delivery of nurse education to ensure the development and sustainability of a knowledgeable nursing workforce. One of the most recent, radical and important initiatives is Modernising Nursing Careers, which outlined four key priority areas for nursing, all of which have implications for nurse education. In light of this initiative, we explore the extent to which the modernisation of nursing careers is rhetoric or reality for UK nurse education - we are on the precipice of great change. To facilitate this, we move chronologically through the issues of recruitment and access; pre-registration preparation; and post-qualification education and careers. In discussing these issues, we demonstrate that more changes are needed to produce nurses who are flexible, visionary and prepared to take risks. We suggest that vision, leadership and strong realignment with health priorities are needed to bring nurse education to a point where nurses are truly prepared for the demands of a 21st century health service.

Summary Research evidence demonstrates that offering language choice to patients enhances the quality of healthcare provision. This has implications for the preparation of nurses for practice in bilingual settings, where legislation often leads to demands for health services in both languages and bilingual competence amongst healthcare providers. This paper reports on a scoping study of bilingual provision in nurse education in the bilingual context of Wales, UK, as a means of informing the evidence base for national strategic planning. The study incorporated three elements: (i) literature analysis (ii) policy review and (iii) stakeholder consultation (n = 70). Six themes emerged from the stakeholder consultation, reflecting the main drivers and barriers associated with bilingual provision in course delivery. These themes aligned with findings identified from the policy and literature review that related to strategic, organisational and individual influences on bilingual educational provision. Strategic planning for bilingual provision in nurse education in Wales should take account of the factors that affect provision at different levels. These factors feature across bilingual settings outside the UK, thus giving the study international relevance and scope to inform the delivery of nurse education that meets the needs of wider diverse language communities.