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Background: Clinical academic nursing roles are rare, and clinical academic leadership positions even more scarce. Amongst the United Kingdom (UK) academia, only 3% of nurses who are employed within universities are clinically active. Furthermore, access to research fellowships and research grant funding for nurses in clinical or academic practice is also limited. The work of Florence Nightingale, the original role model for clinical academic nursing, is discussed in terms of how this has shaped and influenced that of clinical academic nurse leaders in modern UK healthcare settings. We analysed case studies with a view to providing exemplars and informing a new model by which to visualise a trajectory of clinical academic careers., Methods: A Framework analysis of seven exemplar cases was conducted for a network of Clinical Academic Nursing Professors (n = 7), using a structured template. Independent analysis highlighted shared features of the roles: (a) model of clinical academic practice, (b) infrastructure for the post, (c) capacity-building initiatives, (d) strategic influence, (e) wider influence, (f) local and national implementation initiatives, (g) research area and focus and (h) impact and contribution., Findings: All seven of the professors of nursing involved in this discourse were based in both universities and healthcare organisations in an equal split. All had national and international profiles in their specialist clinical areas and were implementing innovation in their clinical and teaching settings through boundary spanning. We outline a model for career trajectories in clinical academia, and how leadership is crucial., Conclusion: The model outlined emphasises the different stages of clinical academic roles in nursing. Nursing as a discipline needs to embrace the value of these roles, which have great potential to raise the standards of healthcare and the status of the profession., (© 2021 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Rapid response teams, such as critical care outreach teams, have prominent roles in managing end-of-life transitions in critical illness, often questioning appropriateness of treatment escalation. Clinical uncertainty presents clinicians with dilemmas in how and when to escalate or de-escalate treatment., Aims and Objectives: To explore how critical care outreach team decision-making processes affect the management of transition points for critically ill, ward-based patients with a life-limiting illness., Methods: An ethnographic study across two hospitals observed transition points and decisions to de-escalate treatment, through the lens of critical care outreach. In-depth interviews were carried out to elucidate rationales for practices witnessed in observations. Detailed field notes were taken and placed in a descriptive account. Ethnographic data were analysed, categorised and organised into themes using thematic analysis., Findings: Data were collected over 74 weeks, encompassing 32 observation periods with 20 staff, totalling more than 150 hr. Ten formal staff interviews and 20 informal staff interviews were undertaken. Three main themes emerged: early decision-making and the role of critical care outreach; communicating end-of-life transitions; end-of-life care and the input of critical care outreach. Findings suggest there is a negotiation to achieve smooth transitions for individual patients, between critical care outreach, and parent or ward medical teams. This process of negotiation is subject to many factors that either hinder or facilitate timely transitions., Conclusions: Critical care outreach teams have an important role in shared decision-making. Associated emotional costs relate to conflict with parent medical teams, and working as lone practitioners. The cultural contexts in which teams work have a significant effect on their interactions and agency., Relevance to Practice: There needs to be a cultural shift towards early and open discussion of treatment goals and limitations of medical treatment, particularly when facing serious illness. With training and competencies, outreach nurses are well placed to facilitate these discussions., (© 2018 Crown copyright. Journal of Clinical Nursing © 2018 John Wiley & Sons Ltd.)

Aims and Objectives: The aim of this exploratory research was to understand how men experience their advanced cancer in relation to their perceptions of masculinity., Background: There are differences in the way men and women experience illness and health care. There are inequalities in incidence and morbidities of many diseases as well as differences in rates of help-seeking behaviours. Theories on masculinity offer some explanation towards this. Men's experiences of advanced cancer in relation to masculinity are under reported, published literature suggests that there are certain issues or men dealing with advanced disease that justify investigation., Design: A Qualitative approach using a Husserlian Phenomenological design was conducted., Sample: Eight men (aged 26-68) all with advanced cancer, defined as advanced or metastatic disease for which the patient had exhausted all standard therapeutic options., Methods: In-depth interviews were conducted to capture narratives of the experiences of men. Data were analysed using Colaizzi's seven stage framework., Results: Themes included thwarted ambition, changing expectations, protection and provision, stoicism and coping, images of illness versus images of masculinity, importance of being a fighter and loss., Conclusion: Findings showed that the experiences of these men were complex and should be handled sensitively. Ideas for gender-specific interventions and further research were developed from the findings in relation to current literature., Relevance to Clinical Practice: A better understanding and awareness of this in this context will help nurses to consider more subtle challenges that these patients may be dealing with that in turn could affect how they cope with the burden of cancer., (© 2014 John Wiley & Sons Ltd.)

Aims and Objectives: To explore the meaning of end-of-life care for critically ill cancer patients, families, oncologists, palliative care specialists, critical care consultants and nurses., Background: End-of-life care for critically ill patients, of whom nearly 20% will die in critical care, remains somewhat problematic (Truog et al. 2008). End-of-life care is an established domain in cancer; however, research has not been conducted previously into dying, critically ill cancer patients' experiences., Design: Qualitative, phenomenological in-depth interviews were undertaken., Methods: Phenomenology was used to explore experiences of 27 participants: surviving patients at high risk of dying, bereaved families, oncologists, palliative and critical care consultants, and nurses. Purposive sampling from a UK critical care unit was carried out. In-depth interviews were taped analysed using Van Manen's phenomenological analysis framework., Results: A phenomenological interpretation of dying in cancer critical illness, and the impact on opportunities for end-of-life care, is presented. Three main themes included: dual prognostication; the meaning of decision-making; and care practices at end of life: choreographing a good death. End-of-life care was an emotive experience for all participants; core tenets for good end-of-life care included comfort, less visible technology, privacy and dignity. These findings are discussed in relation to end-of-life care, cancer and critical illness., Conclusion: The speed of progressing towards dying in critical illness is often unknown and subsequently affects potential for end-of-life care. Caring was not unique to nurses and end-of-life care in critical care came with considerable emotional cost., Relevance to Clinical Practice: There is an opportunity for nurses to use the care of patients dying in critical care to develop specialist knowledge and lead in care, but it requires mastery and reconciliation of both technology and end-of-life care. Healthcare professionals can help facilitate acceptance for families and patients, particularly regarding involvement in decisions and ensuring patient advocacy., (© 2013 Blackwell Publishing Ltd.)

Aims and Objectives: To understand how men interpret their experiences of regaining continence following robotic-assisted laparoscopic prostatectomy (RALP)., Background: RALP is an innovative surgical technique intended to minimise the risk of long-term postoperative urinary incontinence in localised prostate cancer. Studies have shown that urinary function and quality of life domains can be adversely affected following RALP; however, the impact on men's lives has been hitherto unreported., Design: A qualitative study using hermeneutic phenomenology, Methods: Face-to-face, in-depth audio-recorded interviews with seven men (aged 57-71) who had recently undergone RALP and defined themselves as continent of urine. Data were inductively analysed for themes using an adapted version of Diekelmann et al. [1989, The NLN Criteria of Appraisal of Baccalaureate Programs: A Critical Hermeneutic Analysis, 1st edn. National League for Nursing (NLN) Press, New York, NY] framework., Results: Men's experiences of regaining continence were situated within a wider network of personal and social relationships, and cultural structures. Themes included 'what was forecast', 'after-sales service', 'new plumbing', 'sense of self'. Men adopted a variety of practical coping strategies: preventing incontinence; improving incontinence; and dealing with lack of bladder control., Conclusion: The need to regain a sense of control over their lives resulted in all men developing coping mechanisms in order that they could resume their societal roles, which were salient to their personal identity, inferring that men's ability to cope with incontinence after RALP was dependent on factors other than urinary leakage alone., Relevance to Clinical Practice: Knowledge of the potential impact of RALP could help nurses tailor appropriate interventions. Incontinence is individually interpreted and may not be well-addressed by traditional 'one-size fits all' preoperative programmes or information. Flexible and imaginative options (e.g., activity-focused interventions; buddy systems; internet programmes; telephone follow-up) for preoperative and postoperative support and activities for men may improve men's uptake of such services, through specialist nurse or peer support., (© 2013 Blackwell Publishing Ltd.)