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Background: There is an active strategy to recruit international nurses and midwives to help manage vacancy gaps in the United Kingdom’s healthcare system. However, there is little evidence detailing how recruiting organisations prepare new recruits for the Objective Structured Clinical Exam (OSCE) they are required to pass. Aims and objectives: To gather and analyse feedback from recruiting organisations on the preparation offered to international nurses and midwives on arrival in the United Kingdom, prior to undertaking an OSCE in order to gain Nursing and Midwifery Council professional registration. Design and methods: An online cross-sectional questionnaire. The data was analysed using thematic analysis. Results: Four main themes were generated from thematic analysis of the qualitative data: SAME IDEAS DIFFERENT PRACTICE; PASSING THE OSCE; INDIVIDUALISED SUPPORT; SUPPORT NETWORKS. Conclusion: Differences in how organisations prepare and support international nurses and midwives to undertake the OSCE suggest standardised approaches could benefit new recruits. Impact statement: Addressing an evidence gap, this research suggests recruits may benefit from standardised support around working and living in the UK.

Aim: to develop and explore the validity of a Patient Reported Experience Measure (PREM) for adult inpatient diabetes care. Method: 27 in-depth interviews were conducted to inform the development of the 42-item PREM which was cognitively tested with ten people. A refined 38-item PREM was piloted with 228 respondents completing a paper (n=198) or online (n=30) version. The performance of the PREM was evaluated by exploring (i) uptake/number of responses, and (ii) survey validity by investigating whether the PREM data were of adequate quality and delivered useful information. Results: the PREM had low drop-out or missing data rates suggesting it was appropriately constructed. Analysis of item frequencies and variances, and problem score calculations concluded that questions provided sufficient score differentiation. Conclusions: This new PREM allows for experiences of inpatient diabetes care to be measured, understood and reported on to help identify priority areas for improving care quality.

Objectives: During the SARS-CoV-2 pandemic, clinicians were instructed to move all but emergency consultations to remote means to reduce the spread of the virus. The aim of this study was to evaluate patients’ and clinicians’ experiences of moving to remote means of consultation with their health care professionals during the SARS-CoV-2 pandemic. Methods: The study design was a qualitative service evaluation. Twenty-six clinicians and forty-eight patients who met the inclusion criteria consented to be interviewed. Clinician participants were from either medical, nursing, or allied health professional backgrounds. Patients were recruited from diabetes, acute care, and haematology and cancer areas. Data analysis was conducted using a thematic analysis framework. Results: Following coding and thematic analysis of the data collected from clinicians, five themes were identified: personal and professional well-being; providing a safe and high-quality experience; adapting to a new way of working; making remote consultations fit for purpose and an awareness of altered dynamics during consultation. Patient data was coded into 3 themes: remote consultation adds value; remote consultation brings challenges and concerns about remote consultation. Conclusions: Clinician and patient experiences reported here are reflected in the literature. The study indicates that remote consultation is not suitable for all patients and in all contexts. Whilst maintaining the benefits to patients, remote means of consultation needs organisational support and preparation. A way forward that maintains the benefits whilst addressing concerns seems urgent.

Aims: To explore registered nurses' experiences of patient safety in intensive care during COVID-19.Design: A qualitative interview study informed by constructivism. Method: Semi- structured interviews were conducted and audio- recorded with 19 registered nurses who worked in intensive care during COVID-19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework. Results: Two key themes were identified. ‘On a war footing’—an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. ‘Doing the best we can’—Safe Delivery of Care which describes the ramifications of the actions taken on short- and long-term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well-being and Peer Support. Conclusion: Nurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an under-standing of the holistic and long-term impacts on patient safety and recovery from critical illness. Impact: This study explored the perceived impact of COVID-19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long-term appreciation of patient safety. These findings should be considered as part of future nursing work-force modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health c

Background/Aims. Living with advanced heart failure places a considerable burden on patients and their caregivers. Improving the education and support given to patients and caregivers, with the input of palliative care services, could support them to live well with heart failure. This study evaluated an 8-week programme of education and support delivered in a day hospice for patients diagnosed with heart failure and their informal caregivers. Methods. An 8-week programme was delivered five times between January 2018 and March 2019, with a total of 39 participants (24 patients and 15 caregivers). Two focus groups were conducted at the end of each programme (one with patients and one with caregivers). Groups were recorded and transcribed verbatim, and inductive thematic analysis was performed. Results. Most patient participants were male (92%) and aged >70 years, while most caregiver participants were female (93%) and aged >50 years. The main themes from the patient participants' focus groups regarding the programme were the importance of knowledge; support and communication; having a gateway to resources; and the concept of living with heart failure. The main themes from the caregiver participant focus groups were becoming stronger; altered outcomes for the future; and connection through knowledge. All participants gave positive feedback about the programme, with increased knowledge about heart failure and access to peer support being highlighted as particularly valuable. Conclusions. This hospice-based model of support and education, involving patients and their caregivers, has considerable potential as a means of helping these individuals to live well with heart failure. Greater integration between cardiac services and palliative care is needed to support this growing patient group.

Background: The purpose of this qualitative nursing study has been to understand the experience of death and dying in the emergency department of a hospital, through listening to the experiences of bereaved family members and nursing staff. Death and dying remain taboo subjects in society today and therefore people may come to the end of their life without having thought about what death and dying might be like and what it is to have a good death. Culturally, individuals are unprepared for death, and when death occurs in an emergency setting it is particularly shocking. Methods: A phenomenological study was planned, based on the existential phenomenology of Merleau-Ponty; and framed by the nurse theorist Hildegard Peplau. Eleven bereaved family members and eight registered nurses gave in- depth interviews describing their experiences and the interviews were analysed using an adaptation of the work of Thomas and Pollio (2002) and Hycner (1985), consistent with Merleau-Ponty’s theories. Results: The study brings new understanding of what it is like to die in an emergency setting through new understanding of what the family members of the deceased person experience, aided by new understanding of the experiences of emergency nurses. Uniquely, the voice of the bereaved family member is heard. Conclusions: Recommendations for improvements in education, clinical practice, research practice and policy are made along with suggestions for further research to be carried out on this topic. A nursing model for end-of-life care, based both on the work of Peplau( Peplau, 1991 ) and on the work of the nurse theorists Ruland and Moore (Ruland and Moore, 1998; Zaccara et al., 2017) was devised for use in the Emergency Department.

Acceptance and commitment therapy (ACT) is an adapted form of cognitive behavioural therapy. ACT focuses on how thinking affects behaviour and promotes psychological flexibility. The prevalence of psychological distress among people living with cardiovascular disease (CVD) and/or type 2 diabetes mellitus (T2DM) is high, and ACT may offer an alternative treatment approach. This scoping review explored the use of ACT as an intervention to support adults living with CVD and/or T2DM. A systematic search of the literature resulted in the inclusion of 15 studies. Studies were reviewed using the Joanna Briggs Institute approach to conducting scoping reviews. Most studies (n = 13) related to people living with T2DM, and most (n = 10) used a pre-post design, four studies were randomised controlled trials, and one was a qualitative study. Eight studies reported an improvement in the outcome(s) assessed post-intervention, suggesting that ACT was an acceptable and valid intervention to support people living with CVD or T2DM. However, studies were underpowered and only limited studies involved people living with CVD. ACT was assessed as a valuable approach to improve a range of patient-reported outcomes for those living with CVD or T2DM, and further research involving robust study designs and larger cohorts are warranted.

Objectives. The study aim was to explore experiences of patients with pleural mesothelioma of follow-up care in three National Health Service (NHS) Trusts to develop recommendations for practice. Design. The study design was qualitative and comprised three interlinked phases: a documentary analysis, interviews and consultation meetings. Altheide and Johnson’s Analytic Realism theoretical framework guided the thematic data analysis process. Setting. The study was conducted in three NHS Trusts in South England. Two were secondary care settings and the third was a tertiary centre. Participants. The secondary care trusts saw 15–20 patients with new mesothelioma per year and the tertiary centre 30–40. The tertiary centre had a designated mesothelioma team. Twenty-one patients met the inclusion criteria: >18 years, mesothelioma diagnosis and in follow-up care. Non-English speaking participants, those unable to provide written informed consent or those whom the clinical team felt would find participation too distressing were excluded. All participants were white, 71% were 70–79 years old and 71% were men. Three consultation meetings were conducted with key stakeholders including mesothelioma nurse specialists, patients with mesothelioma, carers and local clinical commissioning group members. Main outcome measures. Specific outcomes were to gain a detailed understanding of mesothelioma follow-up care pathways and processes and to develop coproduced recommendations for practice. Results. Mesothelioma pathways were not always distinct from lung cancer care pathways. All trusts provided follow-up information and resources but there was varied information on how to access local support groups, research or clinical trial participation. Five themes were developed relating to people; processes; places; purpose and perception of care. Coproduced recommendations for improving mesothelioma follow-up pathways were developed following the consultation meetings. Conclusions. This study

Background: The shortage of critical care nurses is a global concern. Although all areas of nursing are affected, critical care areas are especially vulnerable to retention problems. Nurse retention in critical care areas impacts nursing shortages, staff morale, productivity, patient safety, and quality patient outcomes. The issue of nurse retention in critical care areas is evident; however, research into the factors that influence nurses’ intention to leave adult critical care areas is limited. Exploring factors that influence nurses' intention to leave adult critical care areas is therefore important and may help in the development of strategies to improve nurse retention, reduce critical care nursing shortages, and thus improve the quality of patient care. Aim: To examine factors that may influence nurses' intention to leave adult critical care areas and to explore critical care nurses' views and experiences about their working conditions. Method: A sequential explanatory mixed-method design was used. The main purpose was to use qualitative data to expand on the findings generated using a quantitative approach. Data were collected in two phases from November 2017 to April 2018. An adapted version of the Nursing Work Index-Revised (NWI-R) tool was used in phase one to survey all nurses currently working in adult critical care areas across England; 345 surveys were returned. Data were analysed using chi-square tests, t-tests, factor analysis and logistic regression analysis to determine factors that were associated with nurses’ intention to leave. Content analysis was carried out to analyse qualitative comments collected in phase one in response to the three intentions to leave questions. Semi-structured telephone interviews were carried out with a purposive sample of critical care nurses in phase 2 to gain in-depth accounts of the factors identified in phase 1 and to explore possible solutions to retain nurses. Qualitative data were collected from 15 participants

Educational preparation of nursing students for placements in nursing homes. An integrative literature review of UK empirical research.

Background. Heart Failure is highly prevalent with poor outcomes yet only a small proportion of patients receive specialist palliative care services. Aim. To explore if a programme focussing on support and symptom management of people with heart failure in a hospice environment would be acceptable and of benefit to patients. Methods: A pre/post intervention study design using mixed methods was used to evaluate the programme. The programme was delivered in two-hour time slots over a period of 8 weeks. Participants completed 3 questionnaires pre and post and were interviewed within one week of completion. The study was conducted between June 2014 and January 2015. Findings. A response rate of 51.7% gave a final sample size of 12 patients. The questionnaire results showed a positive impact on participants’ well-being and views regarding the use of a hospice, but a desire for greater focus on emotional support. Four key themes emerged from inductive qualitative analysis: demystifying perceptions about hospice; positivity about well-being; learning together and consideration of end of life preparation. Conclusion. This adapted programme provides a useful model for the increased integration of palliative care into the provisions for those living with advancing heart failure.

Stories enable us to explore hidden experiences (East et al 2010) or ‘unknown unknowns’ and are a way for people who have been through illness to share their experiences (Frank 2016). Much research is dependent on human memory (Barusch 2011) and qualitative research in particular relies on people telling stories or accounts to describe their experiences (Palacios et al 2015). Nursing research especially focuses on people's experiences of health and illness (Bonis 2008). Qualitative research can inform and facilitate positive change in health research (Streubert & Carpenter 2011) and focuses on the “meaning rather than the measurement” (Holloway & Biley 2011 p.968). One of the ways meaning can be explored is through asking people about their experiences. Participants are often invited to share their stories with researchers via interviews, focus groups or other means, and their memory is crucial to communicating these. The nature of much nursing research can be described as sensitive (Dempsey et al 2016). Here again memory plays a role, participants are asked to draw on memories of experiences that may be distressing or that may raise unanticipated issues for them. These can have serious consequences and remembering these events can trigger thoughts and emotions which can lead to Post-Traumatic Stress Disorder (PTSD) (McNally 2010). As a concept, memory is rarely discussed or described within qualitative nursing research. Rather, it is taken for granted and there is little acknowledgement that memory is much more complex than a simple storage and retrieval system. A discussion of the implications of this for qualitative nursing research is therefore timely. Furthermore, specific considerations on how to support participants recalling negative or traumatic events are pertinent.

Background. Nursing research is dedicated to improving care, but research into end of life care can be challenging because of a possible reluctance by researchers to invite bereaved people to take part in studies. Aim. To use a focused mapping approach to explore the recruitment to studies of grieving and bereaved people. Discussion. There is no ‘gold standard’ method of recruitment and no best way to approach participants. The outcome of each method, measured by the percentage of potential participants recruited, appears to be unrelated to the approach used. Conclusion. There is no evidence that participation in research harms those who have recently been bereaved, but there is evidence of benefits from participating. Implications for practice. Researchers should not feel they need to protect the bereaved from participating in research and can invite bereaved individuals to join a study without worrying about causing them harm.

Background: Many people are living for longer with advanced cancer because of improvements in cancer treatments. Fatigue is the most prevalent and burdensome symptom in this cohort of patients. Thus, many could benefit from any improvements in the assessment and management of fatigue in advanced cancer care. This PhD explored how fatigue was talked about in advanced cancer care, how oncologists approached it and how patients dealt with it. Methods: A mixed methods design combining video-recordings, questionnaires and interviews was used. The study was divided into three parts: Part A, video-recorded observations of palliative oncology visits; Part B, interviews with patients with fatigue; and Part C, interviews with oncologists. Data from observations were analysed using content analysis and some of the concepts and tools of conversation analysis. Data from semistructured interviews were analysed using thematic analysis. The data were integrated, with the CA findings the primary component of this study and a summary of findings was produced. Results: In Part A, 60 visits were recorded, and 37 patient participants reported clinically relevant fatigue. Talk connected with fatigue occurred in 82% of consultations and was often sequentially linked with discussions around goals of care and end of life issues. Resistance to treatment recommendations and advice giving for fatigue was recurrently observed. In Part B, 22 patients with fatigue were interviewed. The overarching theme ‘interconnectedness’ demonstrated how participants coped with fatigue through an array of interrelated strategies and influences. In Part C, nine oncologists were interviewed. The overarching theme ‘fatigue is perceived as different’ described how fatigue was challenging to assess and challenged the role of the cancer doctor. Conclusions: The findings showed how fatigue is a complex phenomenon in advanced cancer care and how it can be integral to the decision-making surrounding palliative cancer t

Aims: To explore the experience of fatigue and living with fatigue in persons with advanced heart failure. Design: Single-setting, qualitative interview study. Methods: In-depth in-person interviews were conducted with participants from November 2012 to June 2013. Participant responses to open-ended questions were analysed using thematic content analysis. Inclusion criteria were: 18 years and older, diagnosis of New York Heart Association class III-IV heart failure with reduced ejection fraction by a consultant cardiologist, and able to participate in conversational-style interviews in their own language. Major exclusion criteria was cognitive deficit identified by Abbreviated Mental Test Score. Twenty-three adults participated in the study. Results: Participants (age 72.5 ± 9.5 years, 10/23 female, 17/23 New York Heart Association class III, and 6/23 class IV) identified experiencing fatigue almost daily with over 14/23 reporting it as their worst symptom or combined worst symptom with breathlessness. 9/23 identified fatigue as their second-worst symptom. Three key themes were identified: fatigue as a physical barrier, psychological response to fatigue, and living with fatigue as a part of daily life. The three themes however combine to influence a patients well-being and we suggest need to be acknowledged when planning self-care management. Conclusion: As heart failure progresses fatigue influences patients’ daily life and may negatively affect self-care abilities however patients strive to adapt to these limitations. Understanding the patient experience of fatigue and living with fatigue is important to optimize health management strategies.