Search

Aim: To critically examine nurses' experiences of speaking up during COVID-19 and the consequences of doing so. Design: Longitudinal qualitative study. Methods: Participants were purposively sampled to represent differing geographical locations, specialities, settings and redeployment experiences. They were interviewed (remotely) between July 2020 and April 2022 using a semi-structured interview topic guide. Results: Three key themes were identified inductively from our analysis including: (1) Under threat: The ability to speak up or not; (2) Risk tolerance and avoidance: Consequences of speaking up; and (3) Deafness and hostility: Responses to speaking up. Nurses reported that their attempts to speak up typically focused on PPE, patient safety and redeployment. Findings indicate that when NHS Trusts and community services initiated their pandemic response policies, nurses' opportunities to speak up were frequently thwarted. Conclusion: Accounts presented in this article include nurses' feeling a sense of futility or of suffering in silence in relation to speaking up. Nurses also fear the consequences of speaking up. Those who did speak up encountered a ‘deaf’ or hostile response, leaving nurses feeling disregarded by their organization. This points to missed opportunities to learn from those on the front line. Impact: Speaking up interventions need to focus on enhancing the skills to both speak up, and respond appropriately, particularly when power, hierarchy, fear and threat might be concerned. Patient or Public Contribution: Nurses working clinically during COVID-19 were involved in the development of this study. Participants were also involved in the development of our interview topic guide and comments obtained from the initial survey helped to shape the study design.

For decades there has been a debate about the relative effects of dynamic versus static stress triggering of aftershocks. According to the static Coulomb stress change hypothesis, aftershocks should not occur in stress shadows—regions where static Coulomb stress has been reduced. We show that static stress shadows substantially influence aftershock occurrence following three M ≥ 7 California mainshocks. Within the modeled static Coulomb stress shadows, the aftershock rate is an order of magnitude lower than in the modeled increase regions. However, the earthquake rate in the stress shadows does not decrease below the background rate, as predicted by Coulomb stress change models. Aftershocks in the stress shadows exhibit different spatial–temporal characteristics from aftershocks in the stress increase regions. The aftershock rate in the stress shadows decays as a power law with distance from the mainshock, consistent with a simple model of dynamic stress triggering. These aftershocks begin with a burst of activity during the first few days after the mainshock, also consistent with dynamic stress triggering. Our interpretation is that aftershock sequences are the combined result of static and dynamic stress triggering, with an estimated ∼34% of aftershocks due to dynamic triggering and ∼66% due to static triggering.

To explore nurses' and midwives' experiences, views, perceptions and impact on their responses to out of work emergencies where first aid may be required.A constructivist grounded theory study was conducted between 2012 and 2019.In-depth, semi-structured interviews were undertaken with 16 nurses and midwives. Participants were recruited via a participant referral process with registered nurses and midwives being accessed from three NHS organizations. Data were analysed and coded using constant comparative analysis with the support of Nvivo 10 software leading to the construction of a substantive grounded theory.A core enduring in vivo theme, 'The Right Thing to Do', emerged as a central conceptual reality constructed via three key in vivo themes; 'Something I've Heard', 'Am I Covered?' and 'Just Who I Am', each with several sub-themes. A pervading anxiety about responding at off-duty situations requiring first aid was persistently evident across these themes.The study showed a strong sense of moral agency among nurses and midwives, despite a powerful underlying feeling of anxiety surrounding broader issues of urban myth, protection and personal and professional identity. The substantive theory emerged as 'doing "The Right Thing" in a climate of anxiety'.The study illuminates an area that has previously been the subject of anecdotal debate. The substantive theory, 'doing "The Right Thing" in a climate of anxiety' illustrates the issues and tensions that exist surrounding the off-duty response. Implications and recommendations for practice and education focus on the fostering of knowledge and understanding of professional identity, position in law and scope of practice, together with potential future research directions. This work provides the first in-depth qualitative study contributing a significant new perspective both nationally and globally.

Aims: To explore younger adults' experiences of stroke rehabilitation to inform practice, education and future health policy. Design: Qualitative analysis of digital and other media sources on public platforms. Methods: Between March and June 2020, the experiences of younger adult stroke survivors aged 18 to 45 at the time of the stroke were collected. Data were gathered from publicly available sources, including social media, and from English-speaking users. In total, 117 accounts from 103 participants were identified from films, autobiographical books, blogs, websites, videos, Twitter and Instagram. Data analysis followed narrative and multimodal analysis with a focus on rehabilitation needs. Results: Younger adult stroke survivors make sense of their experience by reflecting on how stroke has impacted their lives. Accounts reflected an emotional journey between the past self, the present self and evolving self, as well as associated challenges such as the impact on relationships and careers. The majority of accounts presented transitions as problematic, including the receipt of the initial diagnosis, or sometimes misdiagnosis, to returning home and achieving long-term rehabilitation goals. Specialist stroke nurses were considered essential in the rehabilitation process. Conclusion: A complex process of recovery follows stroke for younger adult stroke populations. Challenges to the rehabilitation process need to be better understood and the role of nursing highlighted in future service provision. A series of age-related challenges were highlighted that require attention to improve the care and support offered. Impact: This article informs clinicians, educators, and policymakers of the age-related needs of young adult stroke survivors. Focusing on the individual and the development of age-appropriate person-centred stroke care is important. The study highlights the role of stroke nursing and challenges the current policy focus on older stroke populations as well as arguing for greater awareness of age-appropriate stroke rehabilitation in younger adults following stroke.

Background: A skilled, knowledgeable, and compassionate nurse workforce is pivotal to caring well for older people living in care homes. This requires the provision of continuing professional development and career planning for nurses, which are key also for nurse recruitment and retention. Continuing professional development and career planning strategies and interventions should be evidence-driven. Objective: To identify the extent, range and nature of contemporary evidence regarding professional development and career planning for nurses caring for older people living in care homes. Methods: The methodological framework used was the Joanna Briggs Institute guidance for scoping reviews. The PRISMA extension for scoping reviews was used as the reporting framework. Four databases were searched from January 2010 to July 2021. Results were screened independently by two reviewers using eligibility criteria. Full texts and the reference lists of eligible articles were reviewed. Data were extracted for key elements from the 25 articles included. Results: Of the 25 articles, the majority were authored in the United States (n = 10) and UK (n = 8) with the remaining from Australia (n = 3), Canada (n = 3) and the Netherlands (n = 1). Four articles reported on professional development programmes. Three literature reviews addressed challenges for nurse participation in professional development, experiences of care home nurses as clinical leaders and managers, and leadership. Two expert commentaries reported on the challenges related to professional development and career planning for care home nurses. Sixteen empirical studies investigated a range of topics including: competencies, roles, intention to stay and leave, continuing professional development, and leadership. Key emergent factors that support professional development and career planning were as follows: access to structured learning opportunities addressing knowledge and skills specific to nursing frail older adults, a supportive working environment including adequate staffing, study time and flexible working, and integration of leadership development. Conclusions and implications for practice: This scoping review has highlighted factors that support and challenge professional development and career planning for nurses working in the care home sector. There remain important gaps in the opportunities for professional development and career planning for care home nurses that warrant attention.

BackgroundUK equality law and National Health Service (NHS) policy requires racial equality in job appointments and career opportunities. However, recent national workforce race equality standard (WRES) data show that nearly all NHS organisations in the UK are failing to appoint ethnically diverse candidates with equivalent training and qualifications as their white counterparts. This is problematic because workforce diversity is associated with improved patient outcomes and other benefits for staff and organisations.AimTo better understand the reasons behind underrepresentation of ethnically diverse candidates in first NHS healthcare jobs post-qualification and to identify any structural or systemic barriers to employment for such groups.MethodsThe study was informed by critical theory and the authors’ interdisciplinary perspectives as educators and researchers in the healthcare professions. Data collected from semi-structured face-to-face interviews with 12 nurse and physiotherapy recruiting managers from two NHS trusts in London were analysed using a healthcare workforce equity and diversity conceptual lens we developed from the literature. Using this lens, we devised questions to examine six dimensions of equity and diversity in the interview data from recruiting managers.ResultsRecruiting managers said they valued the benefits of an ethnically diverse workforce for patients and their unit/organisation. However, their adherence to organisational policies for recruitment and selection, which emphasise objectivity and standardisation, acted as constraints to recognising ethnicity as an important issue in recruitment and workforce diversity. Some recruiting managers sense that there are barriers for ethnically diverse candidates but lacked information about workforce diversity, systems for monitoring recruitment, or ways to engage with staff or candidates to talk about these issues. Without this information there was no apparent problem or reason to try alternative approaches.ConclusionThese accounts from 12 recruiting managers give a ‘backstage’ view into the reasons behind ethnic inequalities in recruitment to first healthcare job in the UK NHS. Adherence to recruitment and selection policies, which aim to support equality through standardisation and anonymisation, appear to be limiting workforce diversity and creating barriers for ethnically diverse candidates to attain the jobs that they are trained and qualified for. The Healthcare Workforce Equity + Diversity Lens we have developed can help to ‘raise the curtain on the equality theatre’ and inform more inclusive approaches to recruitment such as contextualised recruitment or effective allyship between employers and universities.

Aims/Questions\ud To explore the barriers and facilitators to nurses accessing clinical supervision; explore the barriers and facilitators to organizations implementing clinical supervision and capture what skills nurses require to facilitate clinical supervision.\ud \ud Design\ud Scoping review of peer-reviewed research and grey literature.\ud \ud Data sources\ud CINAHL, Medline, PsychINFO and Scopus were searched for relevant papers published between 1990 and 2020. Google, Google Scholar, OpenGrey & EThOS were used to search for grey literature.\ud \ud Review Methods\ud PRISMA-ScR guidelines were used during the literature review process. Eighty-seven papers were included, and data were extracted from each paper using a standardized form. Data synthesis was undertaken using Seidel's analytical framework.\ud \ud Results\ud Five themes were identified: Definitions and Models, (Mis) Trust and the Language of Supervision, Alternative Parallel Forums and Support Mechanisms, Time and Cost and Skills required.\ud \ud Conclusion\ud Since its inception in the 1990s, clinical supervision has long been regarded as a supportive platform for nurses to reflect on and develop their practice. However, this review highlights that despite an awareness of the skills required for nurses to undertake clinical supervision, and the facilitators for nurses to access and organizations to implement clinical supervision, there have been persistent barriers to implementation. This review identifies these persistent factors as ‘barriers to overcoming the barriers' in the clinical supervision landscape. These require critical consideration to contribute towards moving clinical supervision forward in the spirit of its original intentions.\ud \ud Impact\ud This review progresses the debate on clinical supervision through critically analysing the barriers to overcoming the barriers. To this end, the review is designed to stimulate critical discussions amongst nurses in different clinical spaces and key stakeholders such as policy makers and regulatory bodies for the nursing profession.

Dynamic rupture models are physics-based simulations that couple fracture mechanics to wave propagation and are used to explain specific earthquake observations or to generate a suite of predictions to understand the influence of frictional, geometrical, stress and material parameters. These simulations can model single earthquakes or multiple earthquake cycles. The objective of this paper is to provide a self-contained and practical guide for students starting in the field of earthquake dynamics. Senior researchers who are interested in learning the first order constraints and general approaches to dynamic rupture problems will also benefit. We believe this guide is timely given the recent growth of computational resources and the range of sophisticated modeling software that are now available. We start with a succinct discussion of the essential physics of earthquake rupture propagation and walk the reader through critical concepts in dynamic rupture model design. We briefly touch on fully dynamic earthquake cycle models, but leave the details of this topic for other publications. We also highlight examples throughout that demonstrate the use of dynamic rupture models to investigate various aspects of the faulting process.

Rats offered free access to sucrose solution in addition to a sucrose-free composite diet develop leptin resistance whereas those consuming a similar amount of sucrose from a dry diet remain leptin responsive. Here we tested whether rats consuming a complete high sucrose diet in liquid form also became leptin resistant. Female Sprague Dawley rats were offered a sucrose free diet (NS), a dry high sucrose diet (HS), NS diet plus 30% sucrose solution (LiqS), NS diet in liquid form (NSLiq) or HS diet in Liquid form (HSLiq). After 30 days LiqS rats were leptin resistant, but all other groups were leptin responsive even though HSLiq rats consumed as much sucrose as LiqS rats and NSLiq rats had the greatest amount of body fat. Therefore, development of leptin resistance is dependent upon the consumption of sucrose independent of any other nutrients. Because LiqS rats consume sucrose throughout the day and night we tested whether limiting sucrose solution access to either the light or dark period prevented development of leptin resistance. Leptin resistant LiqS rats were either given free access to sucrose, had access to sucrose only at night or had access only during the day. The intake of rats with limited access was supplemented to the level of those with free access by tube-feeding. The results of this study show that leptin resistance of LiqS rats is independent of when the sucrose is consumed and is unrelated to total energy intake, body fat mass or serum leptin concentration.

Background: In the UK National Health Service (NHS) provider organisations are mandated to assure racial equality in job appointments and career opportunities. However, recruitment continues to discriminate against ethnically diverse candidates (British and overseas) and NHS providers are failing to attain the many benefits associated with an ethnically diverse workforce. Aim: To explore the extent to which an employer-led open market recruitment approach to first jobs in nursing and the allied health professions is perpetuating racial inequality.Methods: Survey data from newly qualifying students and qualitative interviews with 12 clinical recruiting managers in 2 NHS trusts. Semi-structured face-to-face interviews used a non-judgemental approach. A conceptual lens was developed, a healthcare workforce diversity lens, to explore racial equality issues by drawing on structured searches of the research and policy literature. Questions were devised to examine issues about organisational workforce diversity goals, workforce diversity data, recruitment diversity data, diversity-led recruitment practices, strategies for effective allyship, and transformative change.Results: While recruiting managers appreciated the benefits of an ethnically diverse workforce, they adhered to organisational policies for recruitment and selection that emphasise objectivity and standardization. Some recruiting managers sense there is “an uneven playing field” but lacked information about ethnic diversity in the workforce or recruitment to make informed judgements. In the context of a pressurised health system, recruiting managers prioritise candidate selection of those who can “fit in” and “hit the ground running” rather than taking the long view and building workforce diversity.Conclusion: A recruitment approach optimized for objectivity and standardization, masquerades as equality, while preserving racial inequality in first job success. Inadvertently, recruiting managers are unwittingly complicit in an ‘equality theatre’ that discriminates against candidates from diverse ethnic backgrounds. The lens could help get a grip on race equality and a shift towards asset-based and diversity-led recruitment approaches.

Data walls are a data use practice increasingly being adopted in western, Anglophone countries to display student academic achievement data. The purpose of data walls is to improve teaching and learning by helping teachers and/or students to identify patterns of growth and achievement, set goals, and plan instructional interventions or self-regulate. This paper presents a systematic review of 30 empirical studies to explore how data wall use affectively impacts students and teachers, as well as related effects on their privacy and motivation. The review found that data wall displays elicited a range of positive and negative emotional responses, depending on variables such as the display’s location, contents, and associated social practices. Data walls were reported as enhancing motivation by helping stakeholders to sustain focus on and track progress towards goals, or by fostering comparison and competition. Data walls where class and/or individual students’ data could be identified, for example, through names, pictures, or small sample size, also generated concerns around privacy. These issues highlight the need to consider how data wall use aligns not only with relevant legislation, but also community expectations.

© Crown copyright 2013. Contains public sector information licensed under the Open Government Licence v3.0© Queen’s Printer and Controller of HMSO 2019. This work was produced by Harriset al.under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.20132019Crown copyrightQueen’s Printer and Controller of HMSOBackgroundThe government response to the care failures at the Mid Staffordshire NHS Foundation Trust led to the policy imperative of ‘regular interaction and engagement between nurses and patients’ (Francis R.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013. © Crown copyright 2013. Contains public sector information licensed under the Open Government Licence v3.0) in the NHS. The pressure on nursing to act resulted in the introduction of the US model, known as ‘intentional rounding’, into nursing practice. This is a timed, planned intervention that sets out to address fundamental elements of nursing care by means of a regular bedside ward round.ObjectivesThe study aims were to examine what it is about intentional rounding in hospital wards that works, for whom and in what circumstances.DesignA multimethod study design was undertaken using realist evaluation methodology. The study was conducted in four phases: (1) theory development; (2) a national survey of all NHS acute trusts in England; (3) in-depth case studies of six wards, involving individual interviews, observations, retrieval of routinely collected ward outcome data and analysis of costs; and (4) synthesis of the study findings.SettingThe study was conducted in acute NHS trusts in England.ParticipantsA total of 108 acute NHS trusts participated in the survey. Seventeen senior managers, 33 front-line nurses, 28 non-nursing professionals, 34 patients and 28 carers participated in individual interviews. Thirty-nine members of nursing staff were shadowed during their delivery of intentional rounding and the direct care received by 28 patients was observed.Review methodsA realist synthesis was undertaken to identify eight context–mechanism–outcome configurations, which were tested and refined using evidence collected in subsequent research phases.ResultsThe national survey showed that 97% of NHS trusts had implemented intentional rounding in some way. Data synthesis from survey, observation and interview findings showed that only two of the original eight mechanisms were partially activated (consistency and comprehensiveness, and accountability). The evidence for two mechanisms was inconclusive (visibility of nurses and anticipation); there was minimal evidence for one mechanism (multidisciplinary teamwork and communication) and no evidence for the remaining three (allocated time to care, nurse–patient relationships and communication, and patient empowerment). A total of 240 intentional rounds were observed within 188 hours of care delivery observation. Although 86% of all intentional rounding interactions were observed to be documented, fidelity to the original intervention [i.e. the Studer Group protocol (Studer Group.Best Practices: Sacred Heart Hospital, Pensacola, Florida. Hourly Rounding Supplement. Gulf Breeze, FL: Studer Group; 2007)] was generally low.LimitationsIntentional rounding was often difficult for researchers to observe, as it was rarely delivered as a discrete activity but instead undertaken alongside other nursing activities. Furthermore, a lack of findings about the influence of intentional rounding on patient outcomes in the safety thermometer data limits inferences on how mechanisms link to clinical outcomes for patients.ConclusionsThe evidence from this study demonstrates that the effectiveness of intentional rounding, as currently implemented and adapted in England, is very weak and falls short of the theoretically informed mechanisms. There was ambivalence and concern expressed that intentional rounding oversimplifies nursing, privileges a transactional and prescriptive approach over relational nursing care, and prioritises accountability and risk management above individual responsive care.Future workIt is suggested that the insights and messages from this study inform a national conversation about whether or not intentional rounding is the optimum intervention to support the delivery of fundamental nursing care to patients, or if the time is right to shape alternative solutions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

BACKGROUND Electronic symptom self-reporting systems (e-SRS) have been shown to improve symptoms and survival in patients with cancer. However, patient engagement in using e-SRS for voluntary symptom self-reporting is less optimal. Multiple factors can potentially affect patients’ acceptance and engagement in using home-based e-SRS. However, such factors have not been fully explored in cancer populations. OBJECTIVE The aim of this study is to understand the acceptance and use of home-based e-SRS by patients with cancer and identify associated facilitators and barriers. METHODS PubMed, CINAHL, Scopus, and PsycINFO (January 2010 to March 2020) were searched using a combination of Medical Subject Headings (MeSH) terms and keywords such as symptom self-reporting, electronic/technology, cancer, and their synonyms. Included studies focused on the use of home-based e-SRS by patients with cancer and their families. Studies on patients’ use of e-SRS in clinical settings only were excluded. Of the 3740 papers retrieved, 33 were included in the final review. Factors associated with patient acceptance and use of e-SRS were extracted and synthesized. RESULTS Most e-SRS were web based (22/33, 66%) or mobile app based (9/33, 27%). The e-SRS initial acceptance, represented by patient enrollment rates, ranged from 40% (22/55) to 100% (100/100). High e-SRS acceptance was rated by 69% (59/85) to 77.6% (337/434) of the patients after they used the system. The e-SRS use, measured by patients’ response rates to questionnaires (ranging from 1596/3521, 45.33% to 92%) or system log-on rates (ranging from 4/12, 33% to 99/100, 99%), declined over time in general patterns. Few studies (n=7) reported e-SRS use beyond 6 months, with the response rates ranging from 62% (40/64) to 85.1% (541/636) and the log-on rates ranging from 63.6% (103/162) to 77% (49/64). The availability of compatible devices and technical support, interactive system features, information accessibility, privacy, questionnaire quality, patient physical/psychosocial status, and age were associated with patient acceptance and use of home-based e-SRS. CONCLUSIONS Acceptance and use of home-based e-SRS by patients with cancer varied significantly across studies, as assessed by a variety of approaches. The lack of access to technology has remained a barrier to e-SRS adoption. Interactive system features and personalized questionnaires may increase patient engagement. More studies are needed to further understand patients’ long-term use of home-based e-SRS behavior patterns to develop personalized interventions to support symptom self-management and self-reporting of patients with cancer for optimal health outcomes.

The executive nurse director role is complex and there is significant variation in the expectations and responsibilities placed on it. The main function of the role is to deliver the nursing agenda and ensure that safety and quality remain the focus of the executive board. However, it is unclear what evidence exists regarding the challenges and opportunities experienced by executive nurse directors. This scoping review, undertaken as part of the Stronger Study, explores the literature published from 2009 onwards on the challenges and opportunities affecting executive nurse directors' ability to deliver the nursing agenda in the UK. Findings from the review suggest that the importance attached to the executive nurse director role is not matched by the amount of research available. Strengthening the executive nurse director role requires a stronger evidence base and an awareness of the benefits of the role.

As a member of NATO, Norway supports efforts to enhance deterrence, crisis management and regional security in the North Atlantic and High North — including Scandinavia and northern Russia, as well as the waters of the Arctic Ocean, Barents Sea and North Sea. To inform ongoing strategy and policy development, Norway commissioned RAND to gather insights into other NATO Allies' perspectives on strategic opportunities and challenges in the region.

While the affordances of the digital age certainly enable more diverse students to access higher education, higher education assessment is often underpinned by notions of equality rather than equity. Drawing together key literature and data from interviews with 53 first year undergraduate students from low socio-economic status backgrounds, this chapter identifies three potential causes of assessment inequity which appear to persist into the digital age: student assessment self-efficacy, prior preparation, and external pressures. It then identifies how the affordances of modern technology can be used to help combat these challenges.

This study sought to: understand the strategic defence and security implications of climate change on UK MOD activities; develop a conceptual framework to help decision makers map a range of impacts of climate change in relation to the UK Ministry of Defence (MOD)'s strategic objectives; and produce recommendations to support the UK MOD in mitigating risks and adapting the challenges and opportunities presented by climate change.

This study challenges the traditional relationships between the UK's military, government and people. It examines the relevance of the construct for the 21st Century and what this evolving relationship means for the nature of the utility of force.

Regulation 2017/821 requires EU importers to ensure that minerals with which they work originate from responsible sources and that businesses comply with and report on supply chain due diligence obligations with special focus on so-called conflict-affected and high-risk areas (CAHRAs). This report presents the methodology proposed by RAND Europe to produce an indicative, non-exhaustive, regularly updated list of CAHRAs under Regulation 2017/821.

Most ex-Service personnel transition effectively into civilian life, but some face challenges that hinder a successful transition. This can lead to some individuals committing crimes and finding themselves within the criminal justice system. RAND Europe was commissioned to evaluate the Ex-Service Personnel in the CJS Programme, to understand how projects have helped reduce reoffending and provide support to ex-Service personnel in the CJS.

Background Compassion is integral to professional nursing practice worldwide and a fundamental value in healthcare. Following serious care failures at a healthcare provider in the United Kingdom, a government commissioned report (the Francis Report) made several recommendations for strengthening compassion in nursing care and consequently ‘intentional rounding’ was incorporated into nursing practice in the United Kingdom. Intentional rounding is a structured process implemented primarily in the United Kingdom, North America and Australia, whereby nurses conduct 1–2 hourly checks on every patient using a standardised protocol and documentation. Objectives To examine the role of intentional rounding in the delivery of compassionate nursing care in England from multiple perspectives. Methods This paper reports qualitative findings from one phase of a realist evaluation of intentional rounding which used a mixed-methods approach. Individual, semi-structured interviews were undertaken with 33 nursing staff, 17 senior nurse managers, 34 patients and 28 family carers from three geographically spread case study hospital sites in England. Interviews elicited detailed reflections on the contexts, mechanisms and outcomes of intentional rounding and how it impacted the interviewee and those around them. Results This study found little evidence that intentional rounding ensures the comfort, safety or dignity of patients or increases the delivery of compassionate care. The systematised approach of intentional rounding emphasises transactional care delivery in the utilisation of prescribed methods of recording or tick boxes rather than relational, individualised patient care. It has the potential to reduce the scope of nursing care to a minimum standard, leading to a focus on the fundamentals as well as the prevention of adverse events. Its documentation is primarily valued by nursing staff as a means of protecting themselves through written proof or ‘evidence’ of care delivered, rather than as a means of increasing compassionate care. Conclusions This large-scale, theoretically-driven study of intentional rounding – the first of its kind – demonstrates that intentional rounding prioritises data collection through tick boxes or a prescriptive and structured recording of care. Thus, intentional rounding neither improves the delivery of compassionate nursing care nor addresses the policy imperative it was intended to target. This study raises questions about the role, contribution and outcomes from intentional rounding and suggests a need for a wider, international debate within the nursing profession about its future use. If an intervention to increase compassionate nursing care is required, it may be better to start afresh, rather than attempting to adapt the system currently implemented.

Background Clinically assisted hydration (CAH) at end of life is a contentious issue (Cabanero-Martinez et al, 2016) There is disagreement as to its benefits and this can lead to a lack of concordance between medical and nursing opinions, with nurses feeling unable to challenge doctors (Churchman, 2010; Van Der Riet, 2008; Mayashita, 2007). Prior to introducing a feasibility study on CAH (Davies, 2018) on one hospice site, an unpublished survey of nursing staff revealed widespread dissatisfaction with the standard practice of not routinely offering CAH. Following completion of the study a staff survey was undertaken to see if attitudes had changed. Aims To determine if nurses feel coerced into accepting the current hospice policy on CAH. To examine how nurses interacted with families when asked about CAH. To explore staff engagement with research on CAH. Method A semi-structured questionnaire sent to all nursing staff including HCA’s, with closed and open-ended questions. The responses were analysed using descriptive statistics and thematic analysis. Results The responses indicated that; The majority accept standard care without feeling coerced (68%). Nurses felt they could challenge accepted practice (62%). An overwhelming majority felt the hospice should be engaged in research on CAH (80%). Nursing staff expressed the following; Nurses wanted to be more involved in decision making around CAH. Many felt that a standard practice should be replaced with individual patient decisions. Staff were frequently asked about CAH and felt able to discuss the risks and benefits with families. Conclusions Overall, nurses accepted hospice standard practice on CAH and did not feel coerced. A few opposed further research, most welcomed it to establish an evidence base.

Background: There is growing attention in the UK and internationally to the representation of black and minority ethnic groups in healthcare education and the workplace. Although the NHS workforce is very diverse, ethnic minorities are unevenly spread across occupations, and considerably underrepresented in senior positions. Previous research has highlighted that this inequality also exists at junior levels with newly qualified nurses from non-White/British ethnic groups being less likely to get a job at graduation than their White/British colleagues. Although there is better national data on the scale of inequalities in the healthcare workforce, there is a gap in our understanding about the experience of job seeking, and the factors that influence disadvantage in nursing and other professions such as physiotherapy. Aim: This qualitative study seeks to fill that gap and explores the experience of student nurses (n=12) and physiotherapists (n=6) throughout their education and during the first 6-months post qualification to identify key experiences and milestones relating to successful employment particularly focusing on the perspectives from different ethnic groups. Participants: Participants were purposively sampled from one university to ensure diversity in ethnic group, age and gender. Methods: Using a phenomenological approach, in-depth semi-structured interviews were conducted at course completion and 6 months later. Results: Two main themes were identified. The ‘proactive self’ (‘It’s up to me’) theme included perceptions of employment success being due to student proactivity and resilience; qualities valued by employers. The second theme described the need to ‘fit in’ with organisational culture. Graduates described accommodating strategies where they modified aspects of their identity (clothing, cultural markers) to fit in. At one extreme, rather than fitting in, participants from minority ethnic backgrounds avoided applying to certain hospitals due to perceptions of discriminatory cultures, ‘I wouldn’t apply there ‘cos you know, it’s not really an ethnic hospital’. In contrast, some participants recognised that other graduates (usually white) did not need to change and aspects of their identity brought unsolicited rewards 'if your face fits then the barriers are reduced'. Conclusions: The findings indicate that success in getting work is perceived as determined by individual factors, and fitting in is enabled by strategies adopted by the individual rather than the workplace. Demands for change are more acute for graduates from black and minority ethnic backgrounds. This is an issue for healthcare organisations seeking to be inclusive and challenges employers and educators to acknowledge inequalities and take action to address them. Keywords: ethnicity; employability; nurses; physiotherapists; job seeking activities; equality of employment

Learning professional skills through exposure to real-world contexts demands sophisticated assessment practices. However, complex and often novel genres can be daunting for undergraduate students. This study examined student perspectives as they engaged in Portfolio assessment for the first time within a core undergraduate engineering unit. 42 students were surveyed (27%) with 11 participating in a follow-up telephone interview. Students rated content derived from their contributions to team projects as the most valuable component of their portfolio in terms of demonstrating the unit learning outcomes and developing the skills and dispositions needed in professional practice. The team structure of many learning opportunities encouraged students to collaborate and to draw on each other as instructional resources. The data indicated it is highly worthwhile for instructors to develop static resources that reduce students' need to contact instructors with trivial questions, though lecturer contact was deemed essential and effective for comprehending more complex tasks.

While online courses provide opportunities for a range of assessment tools and resources, little is known about how lecturers might best provide assessment cues to support diverse cohorts. This study explored how lecturers communicate messages about assessment expectations to first-year students in two courses at an Australian regional university (Nursing, n = 323; Engineering, n = 153), and how students accessed the assessment resources. A comparative case study methodology was used. Data included interviews with course coordinators to identify the assessment cues provided, course online content related to assessment and data recording student access of assessment resources. Diverse messaging systems were observed and verbal and written cues were abundant and embedded throughout both courses; however, not all students accessed all cues. What remains unclear is how students might bring together these cues in a productive way. Further research must explore the extent to which students can be better supported to improve their learning.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of interventions for treating or managing faecal incontinence (FI) in older people living in care homes; and to critically appraise and summarise current evidence on the associated resource use, costs and cost‐effectiveness. Note: we are covering treatment (interventions aiming to cure or improve symptoms) and management (interventions aiming to contain symptoms, such as pads or anal plugs, or reduce effects of symptoms, such as skin protection) of FI. Prevention of FI in those who do not currently have the symptom is beyond the scope of this review.

In December 1890, a 22-year-old woman named Gabrielle Bompard was accused of complicity in the brutal murder and robbery of a Parisian bailiff. The audacious view that Bompard had been completely unconscious of her acts was advanced by Jules Liegeois, Professor of Administrative Law at Nancy and the most outspoken disciple of the psychiatrist Hippolyte Bernheim. Liegeois expounded most volubly on the extra-medical realm of hypnosis as early as 1884 when he presented a memoir on its medico-legal implications to the Academie des Sciences Morales et Politiques before an audience of philosophers, publicists, social reformers, and medical men. The fact that the Parisians laboured to have the defendant condemned with a vehemence which matched the prosecution’s tends to suggest that moral and social issues outside the realm of medical doctrine alone influenced the position they upheld so rigidly in the courtroom.

This work analyses Albert Schweitzer's complex relationship to Africa, and places him within the context of medical missionizing. Although he worked in Africa for over fifty years, Schweitzer was strangely indifferent to the continent's culture. Unlike his fellow missionaries, he never learned native languages, and his service was primarily grounded in a Nietzschean rejection of European conventionalities and a desire to develop his unique ‘ethical personality’. Schweitzer's self-belief enabled him to create a village-hospital where the sick could come with their families for treatment and refuge, and contributed to his idea of the ‘reverence for life’, a secularized ethics of compassion and environmental protection that made him famous in the West. The village-hospital enabled him to tend the sick more effectively, but after the First World War it became more hierarchical and de-personalized. Schweitzer's missionary experiment in Lambaréné was simultaneously radical and conformist, daring and self-protectively conservative. His desire to serve was as profound as any of his clerical colleagues, but it was built, as will be seen, upon rebellious ethical foundations. Schweitzer stands out not so much for his therapeutic innovations (though these were important), as for his later formulation of a neo-Christian ecologism that assured his fame in Europe and America.

AIM: To investigate the views of senior nurse and human resource managers of strategies to retain hospital nurses in a metropolitan area.BACKGROUND: Against a global shortage, retaining nurses is a management imperative for the quality of hospital services.METHOD: Semi-structured interviews, thematically analysed.RESULTS: Metropolitan areas have many health organisations in geographical proximity, offering nurses choices in employer and employment. Senior nurse and human resource managers recognised the complexity of factors influencing nurse turnover, including those that 'pulled' nurses out of their jobs to other posts and factors that 'pushed' nurses to leave. Four themes emerged in retaining nurses: strategy and leadership, including analysis of workforce and leavers' data, remuneration, the type of nursing work and career development and the immediate work environment.CONCLUSIONS: In contexts where multiple organisations compete for nurses, addressing retention through strategic leadership is likely to be important in paying due attention and apportioning resources to effective strategies.IMPLICATIONS FOR NURSING MANAGEMENT: Aside from good human resource management practices for all, strategies tailored to different segments of the nursing workforce are likely to be important. This metropolitan study suggests attention should be paid to strategies that address remuneration, progressing nursing careers and the immediate work environment.

In order for nurses and other health care professionals to make important contributions to the literature, there must be an awareness of the many areas where unintentional ethical conflicts can arise. Leading ethical concerns include plagiarism, duplicate submission, authorship standards, bias, and conflicts of interest. Although many sources are available on the variety of ethical concerns, this article takes the position to identify the area of concern and describe why it is an ethical violation. Solutions are posed for resolving the conflict, including why medical librarians can help in the publishing process.

The value and importance of UK nursing research was given a resounding endorsement in a recent assessment of research quality, the Research Excellence Framework 2014 (REF2014). The overview report by the main panel A (MPA) of the REF2014 considered that diversity and quality of research submitted to the sub-panel unit of assessment (UOA) 3 (Allied Health Professions, Dentistry, Nursing and Pharmacy) to be strong. They concluded

OBJECTIVES: to evaluate accuracy, sensitivity, specificity and inter-rater agreement of AVPU (Alert, Voice, Pain, Unresponsive) when used by non-specialist nursing staff assessing consciousness, and to investigate users' views. METHODS: Video-recorded simulations of assessments of consciousness were developed and verified by an expert panel. Participants scored simulations using AVPU and completed questionnaires eliciting views on the scale. AVPU scores were compared with functional levels agreed by the panel. SETTING: A large urban teaching hospital. RESULTS: Fifty-one participants scored 255 simulations. Overall accuracy was 82.4% (95% CI=77.7-87.1%), sensitivity 0.94 (95% CI=0.90-0.98), specificity 0.74 (95% CI=0.66-0.82) and inter-rater agreement (un-weighted kappa) 0.782. Accuracy was low for simulations depicting an orientated patient whose eyes open to speech (49% correct) and a confused patient with spontaneous eye opening (61.5% correct). Sensitivity and agreement for levels corresponding to "Alert" and "Voice" were 0.81 (95% CI=0.69-0.93) and kappa=0.506. Participants expressed uncertainty about aspects of AVPU's use. CONCLUSIONS: AVPU had low rates of accuracy, sensitivity and agreement in distinguishing between "Alert" and "Voice", and low specificity overall, suggesting it may be unsuitable for early warning scoring. Participants expressed doubts about the use of AVPU.