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Aims and Objectives: To conduct an in-depth exploration of oral hydration care provided to people living with dementia in acute hospital wards, using a person-centred care framework., Background: Oral hydration care is an important, yet rarely explored aspect of fundamental care for people with dementia admitted to acute hospitals. Using person-centred care as a conceptual framework we investigated how oral hydration care is delivered for people living with dementia in acute hospital wards., Design: A qualitative, multiple-case study. The cases were three acute wards in one hospital., Methods: Direct observation of care for 13 people with dementia (132 h), semistructured interviews with ward staff (n = 28), ward leaders (n = 4), organisational leaders (n = 5), people with dementia (n = 6), their relatives (n = 5), documentary analysis of clinical inpatient records (n = 26) and relevant hospital policies. Data were analysed using framework analysis., Results: Four themes were identified: (1) The acute hospital: oral hydration is obscured and not prioritised (2) Overshadowing of oral hydration at ward level (3) Siloed nature of hydration roles (4) Strategies for, and barriers to, delivering person-centred oral hydration care., Conclusions: This study combines the concept of person-centred care and oral hydration care for people living with dementia admitted to acute hospital wards, demonstrating that person-centred hydration care was complex and not prioritised., Relevance to Clinical Practice: Nurses should consider means of improving prioritisation and cohesive delivery of person-centred hydration care in acute hospital wards., (© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Aims and Objectives: To investigate (a) How nursing care is organised on wards where nursing staff work different lengths of day shifts, and (b) How length of day shift affects the staffing of wards., Background: Twelve-hour shifts have become increasingly common worldwide but there are concerns about impact on care quality and safety. Eight-hour shifts, and how day shift length affects how nurses organise their work, and staffing, have been little studied., Design: Case study., Methods: The setting was two older people's wards in an acute hospital in England. Nursing staff on one ward continued to work 12-hr day shifts; staff on the other ward worked 8 hr late and early day shifts, with an afternoon overlap, for 6 months. Qualitative interviews were conducted with 22 nursing staff. Semi-structured observations were conducted from 12-15.00 (5 × 3 hr episodes on each ward). Data analysis was conducted using the Framework approach., Results: Theme 1: Organising nursing care and staff activities, (sub-themes: Care delivery across a 12 hr shift; Care delivery on early and late 8 hr shifts; Staff communication and documentation; Staff breaks; Teaching, supervision and staff development); Theme 2: Staffing wards with different length of day shift (sub-themes:: Adequacy of staffing and use of temporary staff; Recruitment and retention of staff after introducing 8 hr shifts)., Conclusion: Nursing staff organised care on 8-hr shifts similarly to 12-hr shifts but then felt dissatisfied with their care delivery and handovers. Nursing staff on both wards approached care in a task-focused way. There were concerns that adopting an 8-hr shift pattern negatively affected recruitment and retention., Relevance to Clinical Practice: Changing from 12 hr to 8 hr day shifts may affect nursing staff satisfaction with their care delivery and handovers, and have a negative effect on staffing wards., (© 2018 John Wiley & Sons Ltd.)

Background: Dignity is a concept that applies to all patients. Older patients can be particularly vulnerable to experiencing a loss of dignity in hospital. Previous tools developed to measure dignity have been aimed at palliative and end-of-life care. No tools for measuring dignity in acute hospital care have been reported., Objectives: To develop tools for measuring patient dignity in acute hospitals., Setting: A large UK acute hospital. We purposively selected 17 wards where at least 50% of patients are 65 years or above., Methods: Three methods of capturing data related to dignity were developed: an electronic patient dignity survey (possible score range 6-24); a format for nonparticipant observations; and individual face-to-face semi-structured patient and staff interviews (reported elsewhere)., Results: A total of 5,693 surveys were completed. Mean score increased from 22.00 pre-intervention to 23.03 after intervention (p < 0.001). Staff-patient interactions (581) were recorded. Overall 41% of interactions (239) were positive, 39% (228) were neutral, and 20% (114) were negative. The positive interactions ranged from 17%-59% between wards. Quality of interaction was highest for allied health professionals (76% positive), lowest for domestic staff (22% positive) and pharmacists (29% positive), and intermediate for doctors, nurses, healthcare assistants and student nurses (40%-48% positive). A positive interaction was more likely with increased length of interaction from 25% (brief)-63% (longer interactions) (F[2, 557] = 28.67, p < 0.001)., Conclusions: We have developed a simple format for a dignity survey and observations. Overall, most patients reported electronically that they received dignified care in hospital. However, observations identified a high percentage of interactions categorised as neutral/basic care, which, while not actively diminishing dignity, will not enhance dignity. There is an opportunity to make these interactions more positive., (© 2018 John Wiley & Sons Ltd.)

Aims and Objectives: To report the findings from interviews conducted as part of a wider study on interventions to support dignified care in older people in acute hospital care. The data in this study present the interview data., Background: Dignity is a complex concept. Despite a plethora of recommendations on how to achieve dignified care, it remains unclear how to attain this in practice and what the priorities of patients and staff are in relation to dignity., Design: A purposive sample of older patients and staff took part in semi-structured interviews and gave their insight on the meaning of dignity and examples of what sustains and breaches a patient's dignity in acute hospital care., Method: Thirteen patients and 38 healthcare professionals in a single metropolitan hospital in the UK interviewed. Interviews were transcribed verbatim and underwent a thematic analysis., Results: The meaning of dignity was broadly agreed on by patients and staff. Three broad themes were identified: the meaning of dignity, staffing level and its impact on dignity, and organisational culture and dignity. Registered staff of all healthcare discipline and student nurses report very little training on dignity or care of the older person., Conclusion: There remain inconsistencies in the application of dignified care. Staff behaviour, a lack of training and the organisational processes continue to result in breaches to dignity of older people. Clinical nurses have a major role in ensuring dignified care for older people in hospital., Relevance to Clinical Practice: There needs to be systematic dignity-related training with regular refreshers. This education coupled with measures to change the cultural attitudes in an organisation towards older peoples' care should result in long-term improvements in the level of dignified care. Hospital managers have an important role in changing system to ensure that staff deliver the levels of care they aspire to., (© 2017 John Wiley & Sons Ltd.)

Aim: This project aimed to improve the recruitment of locally qualifying student nurses., Background: Newly qualified nurses are an important resource, but the recruitment rate of locally qualifying nurses appeared to be low in one acute hospital NHS Trust. A collaborative working party was established, to address this situation., Method: A survey approach was used to collect data from one group of qualifying students prior to a new strategy for recruitment being implemented. Two subsequent groups of qualifying students were surveyed to evaluate the new strategy, and again 6 months post-employment., Findings: After implementation of the new strategy, recruitment rose from 22% to 82%, with 41% of respondents stating that it had influenced their decision to stay in the Trust. Reasons given for recruitment to the Trust included convenience, familiarity, loyalty, enjoyment of clinical placements and perceived supportiveness of the Trust., Conclusions: Recruitment of qualifying students to their local Trust can be approached more effectively and good results obtained. The benefits of working collaboratively in relation to recruitment issues are also highlighted.

Aim: This action research project aimed to investigate students', newly qualified staff nurses' and ward managers' views about the management skills and knowledge required by staff nurses, and how best students could be prepared for their management role., Background: The importance of the staff nurse's management role is increasingly being recognized but the literature highlights the difficulties in preparing students for management, and personal experience confirmed this., Methods: Focus group interviews were held with senior students and newly qualified staff nurses. A questionnaire was then developed which was completed by 23 ward managers., Findings: A good insight into the management skills and knowledge expected of newly qualified staff nurses, and useful ideas about preparation for the role emerged. An extra 2 weeks in practice, supernumerary and with specific management learning outcomes, was implemented and evaluated well., Conclusions: Preparation of students for their management role as staff nurses benefits from being closely linked to practical experience, with clear learning outcomes and supportive clinical staff. Using an action research approach to investigate the problem and develop a strategy was found to be an appropriate methodology.

The purpose of this study was to gain an understanding of the nature of empathy, as perceived and experienced by registered nurses. A phenomenological approach was selected, with nine experienced staff nurses working in surgical settings being interviewed using an open, unstructured approach. Empathy was evidently felt to be beneficial, displayed both nonverbally and through the nurse's actions, and therefore the ability to empathize, and to feel empathy with the individual patient, needs supporting and promoting in nurses. The importance of learning from experience (both personal and professional), and the ability to communicate effectively, are both highlighted by this study. The nature of empathy is evidently multi-faceted, and the presence of empathy is influenced by a complex relationship between the individual nurse, patient and the environment. It should be recognized that environmental issues, such as high workload and stress, also affect ability to empathize.

The aim of this small study was to explore nurse teachers' feelings about participating in clinical practice. An exploratory design was used entailing focused interviews with 10 nurse teachers which explored their current participation in clinical practice and their feelings about this. Other areas addressed were the perceived benefits and negative effects of participating in practice, as well as the factors which may inhibit or enable teachers participating in practice. It was found that while half the teachers had some participation in practice, only one participated on a regular basis. The teachers were generally dissatisfied with their current level of clinical practice. The teachers identified a number of potential benefits of practising, including keeping in touch with clinical practice, maintenance of clinical skills, improved relationships with trained staff and the opportunity to use knowledge and skills in practice. Perceived negative effects were that their clinical participation may be misinterpreted, or may impinge on other aspects of the role. Some also felt that the limited time which they would have available, would lead to their clinical practice being ineffective. The two major factors which affected whether nurse teachers were able to participate in practice were time and the college philosophy/culture. Other important factors were support from clinical staff, clinical confidence, and the teacher's role perception and attitude towards practice. As recent publications have inferred the need for nurse teachers to remain involved in clinical practice, teachers need to identify how clinical practice may best be achieved, and clarify their aims for practising. Different models of practice may be appropriate for individual teachers. It seems that a supportive environment and a college culture which values nurse teachers practising would be beneficial if clinical practice is to become part of the teacher's role.

The study aimed to explore the question, what factors affect student nurse learning in a community setting? A phenomenological approach was taken by carrying out in-depth interviews with eight Project 2000 students who had just completed 8 weeks of community placements. The factors which emerged centred around three themes: the students themselves, the mentors and the placements. Students recognized that their own approach to the placement was important. They found that the role they fulfilled in the placements affected their learning, preferring a participative role to observation only. The role of the mentor was found to be crucial for learning. Important factors were the mentors' knowledge and attitude towards the Project 2000 course and their professionalism (particularly communication skills), as perceived by the students. Also significant were the mentors' skills at facilitating learning in the placements, by encouraging questions and reflection, and organizing a variety of experiences. Factors relating to the placements concerned their relevance to the course (as perceived by the students) and the breadth of experience available. Whilst this was a small sample, from which no generalizations can be made, the study gives insight into students, teachers and community staff of the experience of learning in the community setting.