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Moral distress arises when a person is aware of the right course to take but is prevented from acting on it by institutional constraints. While this concept has been considered by nursing ethicists for many years, it has been particularly associated with the unprecedented healthcare conditions caused by the coronavirus disease 2019 (COVID-19) pandemic.To investigate the level of moral distress affecting advanced practice nurses (APNs) in the UK during the COVID-19 pandemic.This was a mixed-methods study in which a bespoke cross-sectional survey was sent to 243 APNs from across the UK who had been recruited to a broader longitudinal cohort study. The survey asked about their experiences, well-being and moral distress. Open-ended questions asked about their concerns regarding the health and well-being of their patients and colleagues.A total of 97 APNs completed the survey, yielding a 40% response rate. Levels of moral distress were significantly higher among APNs working in secondary care (P=0.026) compared with those working in primary care. All of the respondents expressed concerns about patients due to delayed care and about the mental well-being of their colleagues, particularly those who were redeployed to COVID-19 wards.The COVID-19 pandemic has caused moral and psychological distress for APNs. However, the type of distress and its direct causes varied among these practitioners. Tailored support is required to address moral distress and subsequently improve staff retention.

Aim: To explore higher education institution (HEI) perspectives on the development and implementation of trainee nursing associates (NAs) in the primary care workforce in England. Background: Current shortages of primary health care staff have led to innovative skill mix approaches in attempts to maintain safe and effective care. In England, a new level of nursing practice, NAs, was introduced and joined the workforce in 2019. This role was envisaged as a way of bridging the skills gap between health care assistants and registered nurses and as an alternative route into registered nursing. However, there is limited evidence on programme development and implementation of trainee NAs within primary care settings and HEI perspectives on this. Methods: This paper draws from a larger qualitative study of HEI perspectives on the trainee NA programme. Twenty-seven staff involved in training NAs, from five HEIs across England, were interviewed from June to September 2021. The interview schedule specifically included questions relating to primary care. Data relating to primary care were extracted and analysed using a combined framework and thematic analysis approach. Findings: Three themes were developed: ‘Understanding the trainee role and requirements’, ‘Trainee support in primary care’ and ‘Skills and scope of practice’. It is apparent that a more limited understanding of the NA programme requirements can lead to difficulties in accessing the right support for trainees in primary care. This can create challenges for trainees in gaining the required competencies and uncertainty in understanding what constitutes a safe scope of practice within the role for both employers and trainees. It might be anticipated that as this new programme becomes more embedded in primary care, a greater understanding will develop, support will improve and the nature and scope of this new level of practice will become clearer.

Aims Advanced Nurse Practitioners (ANP) are well established within acute medical and Critical Care environments. The evolution of surgical ANPs have tended towards preoperative roles, such as anaesthesia or scrub, with few clinical roles involving the assessment of acute patients or inpatient care. The Royal College of Surgeons of England have recently recognised, by professional membership, the roles of non-medical members of the surgical team, such as ANPs and physician associates. This review explores the areas of impact of ANPs on the emergency General Surgery service provision to help develop the role of the modern surgical ANP. Methods A scoping literature review was performed to identify themes of ANP function and outcome. Search terms such as “Advanced Nurse Practitioners”, “Surgical Assessment Units” and “outcomes” were combined with Boolean operators to query PubMed, BNI, CINAHL, Google Scholar and HMIC databases. Studies in the last decade were included. Results We identified and screened 54 unique articles. 40 articles were reviewed for eligibility and 21 were included in this review. A thematic analysis identified the impact of ANPs on the process of care (such as assessment and treatment waiting times and patient satisfaction) and outcomes of care (readmission rates, length of stay and cost-effectiveness). Conclusion Research into the impact of ANPs are largely focused on objective outcome measures and within non-surgical specialties. Whilst this review demonstrates the positive aspects of ANP care on emergency care, we identify a paucity of evidence on patient-focused outcomes and the impact of ANPs on the patient journey within surgery.

Anxiety disorders are the most prevalent mental health disorder experienced by men. If left untreated, anxiety is predictive of psychiatric disorders including depression and associated suicide risk. Despite the prevalence and impact of men’s anxiety, it remains largely overlooked in the field of men’s mental health. Globally, men are reported to have lower rates of anxiety disorders compared to women; however, these sex-differences do not reflect the complexity and nuance of men’s experiences. There is early evidence to suggest a male-type anxiety phenotype which may go undetected with generic diagnostic classifications. Masculine norms (i.e., stoicism, toughness, invulnerability) appear to be central to men’s experiences and expressions of anxiety as well as men’s help-seeking and coping behaviours. This is particularly concerning given anxiety increases men’s risk of physical and psychological comorbidities and suicide risk. The effective assessment, detection and treatment of men’s anxiety is therefore critical to improve mental health outcomes across the male lifespan. We propose three key recommendations for the field of men’s anxiety: (i) to develop a theoretical model surrounding men’s experiences of anxiety, (ii) broaden mental health resources, interventions and suicide prevention strategies to encompass men’s gendered experiences of anxiety (e.g., sentiments of shame, physical symptom manifestation), and (iii) utilise informal supports (i.e., friends and family) as an avenue of intervention to improve men’s anxiety outcomes. Without a substantial research agenda in men’s anxiety, we will fail to recognise and respond to men’s gendered experiences of anxiety and ultimately fail to reduce male suicides.

Background Physical activity (PA) interventions capable of producing health benefits cost effectively are a public health priority across the Western world. ‘Men on the Move’ (MOM), a community-based PA intervention for men, demonstrated significant health benefits up to 52-weeks (W) post-baseline. This article details the economic evaluation of MOM with a view to determining its cost-effectiveness as a public health intervention to be rolled out nationally in Ireland. Methods Cost-effectiveness was determined by comparing the costs (direct and indirect) of the programme to its benefits, which were captured as the impact on quality-adjusted life-years (QALYs). For the benefits, cost–utility analysis was conducted by retrospectively adapting various health-related measures of participants to generate health states using Brazier et al.’s (2002) short form-6D algorithm. This in turn allowed for ‘utility measures’ to be generated, from which QALYs were derived. Results Findings show MOM to be cost-effective in supporting an ‘at risk’ cohort of men achieves significant improvements in aerobic fitness, weight loss and waist reduction. The total cost per participant (€125.82 for each of the 501 intervention participants), the QALYs gained (11.98 post-12-W intervention, or 5.3% health improvement per participant) and estimated QALYs ratio costs of €3723 represents a cost-effective improvement when compared to known QALY guidelines. Conclusions The analysis shows that the cost per QALY achieved by MOM is significantly less than the existing benchmarks of £20 000 and €45 000 in the UK and Ireland respectively, demonstrating MOM to be cost-effective.

This study investigated, 'What is the perceived value of a PhD to doctoral and postdoctoral nurses in the UK?'Little is known about what happens to the careers of nurses who undertake a doctorate and whether they use these skills in the next career steps.Nurses (n = 47) with doctorates were recruited via professional networks and twitter (@NMAHP_DoctorateStudy). Qualitative responses from the nurses were analysed using thematic analysis.Three themes emerged from qualitative analysis: impact on career, utilization and value, and impact on self.This study provides one of the few insights into how doctoral trained nurses understand and experience the value and utility of their studies to themselves and others.Nurse managers can play a crucial role in generating a research-led culture within their clinical setting. This would include promoting an understanding of research as something directly related to patient benefit rather than an abstract, intellectual activity.

Aim\ud \ud This article describes the development and implementation of a virtual consensus development project to address current challenges in adult nursing care in the UK.\ud \ud \ud Design\ud \ud This is a Consensus Development Project (CDP).\ud \ud \ud Methods\ud \ud The five stages of this CDP were: develop questions (informed by PPI representatives and a documentary review), generate evidence reviews, recruit and orient the lay panel, host consensus seminars, and consult with panel members and stakeholders.\ud \ud \ud Results\ud \ud To the best of our knowledge, a CDP has not previously been conducted in a UK nursing context, and this is the first of its kind to be hosted virtually. This article contributes a detailed outline of the consensus development methodology and constructive commentary to support future consensus development projects. Learning points include reflections on the impact of hosting this event virtually, the relationship between the project coordinator and chair, and the composition of the lay panel.

Masculinity frameworks in men's health research have focused on masculine ideals and norms to describe men's health practices. However, little attention has been paid to inductively deriving insights about what constitutes health-related masculine values among young men. A sequential exploratory mixed-methods design, comprising a qualitative lead to derive health-related masculine values with a follow-up quantitative arm to test the items, was used. Drawing on a sample of 15-29-year-old Canadian male interview participants (n = 30) and survey respondents (n = 600), 5 health-related masculine values were highlighted: (a) selflessness, (b) openness, (c) well-being, (d) strength, and (e) autonomy. Selflessness was characterized by caring for and helping others. Openness included the willingness to gain exposure from new experiences, ideas, and people. Well-being was linked to fitness and masculine body ideals and aesthetics. In terms of strength, men endorsed intellectual, emotional, and physical strength. Regarding autonomy, there was consensus men should be self-sufficient and decisive, whereas being independent drew less endorsement. Highlighting the interdependency of these domains, exploratory factor analysis yielded 2 overarching reliable quantitative dimensions characterized by domains of being inclusive (openness and selflessness; α = .88) and empowered (well-being and autonomy; α = .85). Some inductively derived and pilot-tested values ran counter to long-standing claims that young men are typically hedonistic, hypercompetitive, and estranged from self-health. Study findings are discussed detailing how the evaluation of specific health-related masculine values in subgroups of men might advance masculinities-focused men's health research and inform the next generation of targeted gendersensitized services.

Background: Stroke care is becoming increasingly reliant on advanced nursing practice (ANP); however, little is known about these roles within the stroke specialty. Aims: To explore the current knowledge of advanced nursing practice in stroke services internationally, specifically, the conceptualisation of ANP and the rationale for its implementation. Methods: Arskey and O'Malley's scoping review methodology was employed, and six academic databases were used. Findings: Two key themes were identified; ‘role development’ and ‘four pillars of advanced practice’. The review identifies that ANP is implemented primarily to provide acute stroke care. Conclusions: Current research does not clarify the rationale for implementing these posts or how ANP is conceptualised. This review does identify that stroke ANP incorporates the four pillars of advanced practice (clinical, research, leadership and education) and was implemented to improve the quality of stroke care. Barriers and facilitators to implementation were also identified.

Aim To explore how the COVID‐19 pandemic affected nursing associate work, training and well‐being experiences. Design Cross‐sectional survey. Methods A survey of trainee and newly qualified nursing associates was completed in July 2020. Closed responses were analysed using descriptive statistics with inferential comparisons made between community and secondary care settings. Open questions were analysed thematically. Results Sixty‐four participants responded. Over half (53.2%) experienced an increased workload with 24.2% reporting extensions in their role. One third (32.3%) were redeployed, and a quarter (24.2%) did not feel safety concerns were adequately addressed when raised. Those working in the community reported significantly more concerns about staffing (p = .03), working overtime (p = .03), missed care (p = .02) and safety (p = .04). Despite this, many (75.8%) participants felt able to provide the same standards of care. Several spoke about enhanced teamwork, and the majority (96.8%) were not looking to leave their post.

ObjectiveThe aim of the study was to understand the experiences of advanced practice nurses (APNs) in the UK during the 2020 COVID-19 pandemic, particularly in relation to safety, shortages and retention.DesignA cross-sectional, mixed-methods survey.SettingAPNs in any UK setting.ParticipantsThe survey was sent to an existing UK-wide cohort of APNs. 124 APNs responded (51%).ResultsUK-based APNs in this study reported shortages of staff (51%) and personal protective equipment (PPE) (68%) during the first 3 months of the coronavirus outbreak. Almost half (47%) had considered leaving their job over the same 3 months. Despite difficulties, there were reports of positive changes to working practice that have enhanced care.ConclusionUK APNs report COVID-19-related shortages in staff and equipment across primary and secondary care and all regions of the UK. Shortages of PPE during a pandemic are known to be a factor in the development of mental health sequelae as well as a risk factor for increased turnover and retention issues. Half of APNs surveyed were considering a change in job. The UK risks a further crisis in staff morale and retention if this is not acknowledged and addressed. APNs also expressed concern about patients not receiving routine care as many specialties closed or reduced working during the crisis. However, there were also many examples of good practice, positive changes and innovation.

Aims To examine and explore organisational and role conditions that promote or inhibit job satisfaction and workplace well‐being for advanced practice nurses. Background The advanced practice role is common across the world. Research shows it is well regarded by patients and improves patient outcomes, but there is little evidence about what the role is like for nurses. Methods A subsample of an existing cohort of advanced practice nurses were invited for interview. Twenty‐two nurses were interviewed over the phone. Interviews transcripts were analysed using thematic analysis. Results Four themes were derived from the data; ‘the advanced nurse role and professional identity’, ‘feeling exposed’, ‘support for the advancement of the role’ and ‘demonstrating impact’. Conclusion Nurses report considerable dissatisfaction with role identity and concerns relating to isolation on a daily basis, and these negatively affect well‐being. However, they also identified significant satisfaction with the role, particularly when well‐supported and able to recognize the unique contribution that they made to the lives of patients and to their organisations. Implications for nursing management Clear role definitions, provision of high‐quality clinical supervision and addressing issues of isolation are likely to improve the job satisfaction of advanced practice nurses.

This paper aims is to demonstrate how Bourdieu’s conceptual tools of habitus, capital and field can facilitate the operationalisation of intersectionality. Following an appreciation of the methodological issues arising from the practical application of intersectionality, we introduce data from an Australian study of husbands caring for wives with dementia. With care often being constructed as a feminine practice, men’s caregiving experiences are frequently said to be in tension with many hegemonic masculine practices. However, men are not homogenous, rather their experiences are shaped by intersections of gender, age, class and other identity-defining categories. To help explore some of these intersections, 16 interviews, six of which were enhanced by photo-elicitation methods, were undertaken with a purposive sample of retired husbands caring for a spouse with dementia. Thematic analysis was then employed. In this paper, we present data and themes relating to the husband’s experiences around independence and self-sufficiency and coping strategies and emotional autonomy. However, the main purpose of the paper is not to focus on these empirical findings per se. Rather, we draw on these data to illustrate how Bourdieu’s work was utilised to help address some of the concerns that have been encountered when applying intersectional theory to empirical research; that is to say, this is primarily a methodological paper. The empirical findings highlight the complex and class influenced ways that husband carers look to sustain independence and autonomy. They further illustrate how the cultural capital accrued through past experiences facilitates or restrains coping mechanisms and associated emotional autonomy during their caregiving journeys. Methodologically, we use these empirical data to demonstrate how Bourdieu’s notions of habitus, capital and field can overcome three specific criti-cisms when applying intersectionality in research studies: (1) its supposed inability to adequately address agency and privilege; (2) its apparent lack of a heuristic device illustrating how time, location and context constrain and empower social actors; and (3) an alleged lack of methodological tools to illustrate the interrelated and generative nature of structure and agency.

Objectives\ud \ud Continuing professional development is essential for healthcare professionals to maintain and acquire the necessary knowledge and skills to provide person centred, safe and effective care. This is particularly important in the rapidly changing healthcare context of the Covid-19 pandemic. Despite recognition of its importance in the United Kingdom, minimum required hours for re-registration, and related investment, have been small compared to other countries. The aim of this review is to understand the factors that optimise continuing professional development impact for learning, development and improvement in the workplace.\ud \ud \ud Design\ud \ud A rapid evidence review was undertaken using Arksey and O'Malley's (2005) framework; identifying a research question, developing a search strategy, extracting, collating and summarising the findings.\ud \ud \ud Review methods\ud \ud In addressing the question ‘What are the factors that enable or optimise CPD impact for learning, development and improvement in the workplace at the individual, team, organisation and system level?’ the British Nursing Index, the Cochrane Library, CINAHL, HTA database, King's Fund Library, and Medline databases were searched for key terms. A total of 3790 papers were retrieved and 39 were included.\ud \ud \ud Results\ud \ud Key factors to optimising the impact of nursing and inter-professional continuing development are; self-motivation, relevance to practice, preference for workplace learning, strong enabling leadership and a positive workplace culture. The findings reveal the interdependence of these important factors in optimising the impact of continuing professional development on person-centred care and outcomes.\ud \ud \ud Conclusion\ud \ud In the current, rapidly changing, healthcare context it is important for educators and managers to understand the factors that enhance the impact of continuing professional development. It is crucial that attention is given to addressing all of the optimising factors in this review to enhance impact. Future studies should seek to measure the value of continuing professional development for people experiencing care, nurses and the wider organisation.

Background The shortage of health workers is a global phenomenon. To meet increasing patient demands on UK health services, providers are increasingly relying on temporary staff to fill permanent posts. This study examines the occurrence of ‘care left undone’, understaffing and temporary staffing across acute sector settings. Methods “Secondary data analysis from an RCN administered online survey covering nurses from hospitals and trusts across all four UK countries. Staffing and ‘care left undone’ measures were derived from the responses of 8841 registered nurses across the UK. A locally smoothed scatterplot smoothing regression analysis (Loess) was used to model the relationship between any ‘care left undone’ events and full complement, modest and severely understaffed shifts, and proportions of temporary staff. Results Occurrence of ‘care left undone’ was highest in Emergency Departments (48.4%) and lowest in Theatre settings (21%). The odds of ‘care left undone’ increase with increasing proportion of temporary staff. This trend is the same in all understaffing categories. On shifts with a full quota of nursing staff, an increase in the proportion of temporary staff from 0 to 10% increases the odds of care left undone by 6% (OR = 1.06, 95% CI, 1.04–1.09). Within the full quota staffing category, the difference becomes statistically significant (p Conclusion The odds of a ‘care left undone’ event are similar for fully staffed shifts with a high temporary nursing staff ratio compared to severely understaffed shifts with no temporary nursing staff. Increasing the proportion of temporary nurse staff is associated with higher rates of self-reported care left undone by nursing staff. This has significant implications for nurse managers and policy makers.

Aims: Create a cohort of Advanced Practice Nurses from across the UK. Report the initial questionnaire including demographics, work experiences, and well-being. Background: In the UK, advanced nursing practice is not regulated. This has led to the concern that advanced nurses are working in very different ways with different levels of autonomy and support. Methods: Participants were recruited via university and Royal College of Nursing mailing lists, and social media adverts. They completed the initial questionnaire about their background and workplace, work experiences, credentialing, and well-being. Results: 143 nurses were recruited to the cohort and 86 completed the survey. Over 40 job titles were reported, across five pay bands. Job title was not correlated with pay band (p=0.988). Participant wellbeing was not significantly different from the UK general population, but they reported high rates of work-related stress (44.2%) compared to the NHS national average (37.9%). Conclusion: There is wide disparity in pay which is not reflected in title or setting. The high levels of work-related stress require further exploration. Implications for nursing management: The range of experiences reported here should encourage managers to evaluate whether title, pay, and support mechanisms for APNs in their organisations align with suggested national standards set by Royal Colleges and government departments.

Men’s health and life expectancy, particularly for those men from lower socioeconomic groups, remains an issue of concern in Ireland. This concern is reflected in the recent National Men’s Health Action Plan where important priority has been placed on finding appropriate ways to garner sustained involvement in health promotion interventions for men. Physical activity (PA) has been shown to be a useful ‘hook’ to assist with such engagement. ‘Men on the Move’ (MOM) is a 12 week, community-based, gender-sensitised, PA programme established as a pragmatic controlled trial and aimed at improving the health and well-being of inactive men. The programme was co-created with Local Sports Partnerships (LSP), delivered by experienced PA Coordinators (PACs), and often supported by local community champions. This paper reports on the process evaluation of the MOM programme using data collected from focus groups with the LSP’s and those involved in delivering MOM from all eight counties that took part. Findings highlight the importance of negotiated partnerships at and between national and local levels in terms of providing support, consistent guidance and appropriately branded materials to the LSP’s. The underpinning inclusive ethos of MOM, embodied by the PAC’s, led to the creation of a fun, inclusive and comfortable atmosphere that helped sustain men’s involvement. This was aided by the use of male familiar settings through which to deliver the programme. While PA focused, findings here suggest a much wider impact on mental well-being and social connection and that this was achieved in a very cost-effective way. Importantly, men’s health training (ENGAGE) was a key factor in programme design and implementation assisting in building capacity among service providers to work with men. Joined up service provision and drawing on existing, trusted, local community networks were vital to recruiting men into the programme. Finally, the potential for MOM to signpost and offer an aftercare plan to community support for the men beyond the 12-week programme was noted as important particularly where there is increased need of these among more marginalised groups of men. This process evaluation provides a good example of how health promotion interventions need to recognise and exploit the fact that health and well-being are integrally linked to the communities where people live out and experience their daily lives. Ensuring that MOM was embedded within existing community structures, and supported by community champions with the requisite skills and local knowledge, underpinned programme success and sustainability.

Background Amid increasing concerns about rising obesity rates and unhealthy lifestyle behaviours, physical activity (PA) is seen as a prophylactic to many chronic conditions affecting men. Men respond best to community-based PA programmes, using gender-specific promotional and delivery strategies. ‘Men on the Move’ (MOM) was developed on this basis and targeted inactive adult men in Ireland. Methods Sedentary men (n = 927; age = 50.7 ± 10.9 years; weight = 92.7 ± 16.0 kg; METS = 6.06 ± 2.13) were recruited across eight counties: four ‘intervention group’ (IG; n = 501) and four ‘comparison-in-waiting group’ (CG; n = 426). The MOM programme involved structured group exercise twice weekly for 12 weeks (W), along with health-related workshops with the groups maintained up to 52 W. Primary outcome measures [aerobic fitness, bodyweight and waist circumference (WC)] together with self-administered questionnaires were used to gather participant data at baseline, 12, 26 and 52 W. Results Results show a net positive effect on aerobic fitness, bodyweight and WC, with significant (P < 0.05) net change scores observed in the IG compared to the CG (METS: 12 W = +2.20, 26 W = +1.89, 52 W = +0.92; weight: 12 W = −1.72 kg, 26 W = −1.95 kg, 52 W = −1.89 kg; WC: 12 W = −4.54 cm, 26 W = −2.69 cm, 52 W = −3.16 cm). The corresponding reduction in cardiovascular disease risk is particularly significant in the context of a previously inactive and overweight cohort. The high ‘dropout’ (42.7% presenting at 52 W), however, is of particular concern, with ‘dropouts’ having lower levels of aerobic fitness and higher bodyweight/WC at baseline. Conclusions Notwithstanding dropout issues, findings address an important gap in public health practice by informing the translational scale-up of a small controllable gender-specific PA intervention, MOM, to a national population-based PA intervention targeting inactive men.

This paper draws on research exploring how men narrate their long-term experiences of Weight Loss Surgery [WLS] and is specifically focused on findings relating to male embodiment. Whilst there is concern about increasing obesity and the possible role of bariatric [WLS] surgery in ameliorating this, there has been little research to date exploring men’s longer-term experiences of this. For the purposes of the present study, interviews were conducted with five men who had undergone bariatric surgery at least four years previously. The transcribed interviews were subjected to narrative analysis with the additional incorporation of Watson’s (2000) “male body schema” into this process in order to facilitate focus on the embodied nature of the storied accounts obtained. The findings suggested two seemingly contrasting storylines: “ongoing struggles” and “success”. Struggles related mainly to control over eating habits and the visceral challenges of long-term side effects following surgery. Despite these struggles, the men ultimately presented an overriding storyline of embodied “success” in how the surgery had assisted them to live more normatively male lives. Importantly, narratives around struggles were presented as more private stories in contrast to the public emphasis on success. The silencing dynamic implicit in this suggests the likelihood that other men encountering similar experiences would be reticent to reveal their struggles, thereby perpetuating their suffering and leaving popular obesity and weight loss narratives unchallenged.

Purpose\ud \ud Mesothelioma is a terminal cancer caused by exposure to asbestos. As a cancer with a higher rate in men than women, women's experiences of living with mesothelioma are often underexplored. Furthermore, men's experiences are often taken for granted and therefore have remained underexplored. This paper considers men's and women's experiences across the mesothelioma pathway.\ud \ud \ud Methods\ud \ud This qualitative study incorporated semi-structured interviews with 13 men and 11 women living with mesothelioma. Telephone interviews took place between July and December 2019, and were audio recorded, transcribed and anonymised. Thematic analysis was used to analyse the data.\ud \ud \ud Results\ud \ud Three themes were developed in relation to the gendered experience of mesothelioma: familial responsibility and social perceptions; support preferences; and treatment and trials. Analysis suggests that men and women's sense of familial responsibility varied. Differences in priorities and motivations influenced approaches to seeking support, compensation and, making decisions around treatments and clinical trials.\ud \ud \ud Conclusions\ud \ud The current study reports on how gender can influence the experience of living with mesothelioma. The findings indicate how the patients' role in their families and society can more broadly influence their experiences, choices and preferences. Nurses caring for mesothelioma patients need high quality research on which to base their practice. Recognition and an understanding of the underlying factors influencing patients’ decision-making will enable nurses and other professionals to support their patients better.

This article examines how a 6-week mental health resilience course for people with long-term conditions (LTCs; diabetes, heart disease, and arthritis) increased perceived resilience of older participants. This article examines how peer support assisted participants to develop resilience, considers gender issues, examines the importance of course activities, and explores how resilience enhances quality of life. A mixed methods approach was used. A before-and-after questionnaire was administered 3 times, including 3-month follow-up. Interviews were held with 24 program participants, aged 45 to 80 years. Diaries were kept by participants over 3 months. Survey findings showed significant gains in perceived resilience, at the end of the course, with no significant drop-off after 3 months. Interview and diary narratives highlighted positive experiences around well-being, condition management, and social engagement. Peer support was key to effective processes. Challenges concern ongoing support in communities, and considering age and gender variables when researching what improved resilience means to older people with LTCs.

Men’s Sheds is a growing international movement aimed at providing men with places and activities that facilitate social connectedness. Despite Men’s Sheds’ focus on males, little attention has been paid to masculinities within the specific context of these settings. The current study used a gender relations framework to explore the ways in which attendees discussed Men’s Sheds, with particular attention to discussions that were complicit and counter to traditional, hegemonic views of masculinity, and diverse positions in between these binaries. The data consisted of transcripts and field notes from four focus groups comprising mostly older, White, retired male members of a Canadian shed ( N = 22). The analysis revealed three overall themes: (1) focus on work, (2) independence, and (3) need for male-focused spaces. These themes and associated subthemes suggest that shed members ascribe to dominant masculine values and ideals, but also support more fluid and flexible views of masculinity. Implications are discussed for how working with an array of masculinities within the Men’s Sheds movement will be helpful with respect to their future growth in Canada and internationally.

Aim\ud To demonstrate the prevalence of care left undone and its relationship to registered nurse staffing levels within community nursing.\ud \ud Background\ud Much research has been completed on nursing care left undone in the acute sector. Little has been done in the community nursing context.\ud \ud Method\ud Secondary analysis from a cross‐sectional survey of 3,009 registered nurses working in the community and care home sector was completed. Measures reported are ‘care left undone’, ‘nurse staffing levels’ and ‘type of shift’.\ud \ud Results\ud Only 37% of community respondents, and 81% of care home staff, reported having the planned number of nurses on their last shift. Prevalence of care left undone was 34% in the community sector, 33% in the care home sector and 23% in primary care. Care left undone increased as the proportion of registered nurses fell below planned numbers.\ud \ud Conclusion\ud Care left undone is a significant issue across the community nursing context and is related to registered nurse staffing levels.\ud \ud Implications for Nursing Management\ud This work is the first to look directly at the relationship of registered nurse staffing levels to care left undone in the community. Current policy on safe staffing needs to ensure consideration of the community nursing context.