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The reality of death and dying is a central facet of life, often surrounded by feelings of sadness, fear and uncertainty. Nurses have an essential role in caring for people who are approaching the end of life and their families, while being mindful of the current demands and challenges in health and social care services. In this article, the author suggests that being more open to the reality of death as part of life may assist nurses in being more attuned to the personal needs of those who are dying. The article emphasises the importance of considering each person's symptoms and concerns through the lens of compassion to address pain, fear and distress. While the focus is on caring for people who are approaching the end of life, the author asserts that there is much that nurses can learn from those they care for about the beauty of life and the naturalness of death., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Children's nurses have an important role in identifying and supporting families who experience domestic abuse. Safeguarding guidance is available to direct nurses working with families, children and young people in these situations. However, nurses working with children and families require the knowledge and ability to assess the parenting approach of mothers exposed to domestic abuse to reduce long-term detrimental effects to the child. The aim of this literature review was to explore research about how maternal experiences of domestic abuse affect the mother's approach to parenting. A search of healthcare databases was undertaken to identify relevant research. The articles were coded by grouping similar findings leading to the identification of three themes: modelling behaviours; compensating behaviours; and coping and parenting. Modelling behaviours involved mothers learning aggressive behaviours and becoming increasingly violent towards their child. Mothers displaying compensating behaviours were lenient in their parenting or provided positive discipline if the child was female, and those who were identified as coping and parenting had suboptimal mental health with an increase in depressive symptoms., Competing Interests: None declared, (© 2020 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

GPs' workload has increased significantly in recent years affecting their ability to provide high-quality services, and consequently there is increasing focus on nurses to provide a solution. There is little evidence of how advanced nurse practitioners (ANPs) experience their role in out of hours (OOH) services, and it is important to understand their perceptions of this and the challenges they may face in supporting service development and improvement. This article evaluates the role and experiences of ANPs working in an OOH urgent primary care service and identifies important factors that affect their roles. Positive factors enable job satisfaction, but challenges associated with knowledge base, perceptions, role definitions and isolation must be considered for quality and governance purposes. The article describes how supportive systems must be in place to enable mentorship, supervision programmes and development of this group of advanced practitioners., Competing Interests: None declared, (©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

[Figure: see text] The aim of this project was to provide training to nursing staff to improve their confidence and knowledge when caring for children and young people with mental health problems. A one-day bespoke training course was given to a purposeful sample of eight children's nurses. The nurses completed questionnaires before and after the training day and a third questionnaire three months after the course. All nurses reported an increase in knowledge and confidence when caring for young people with mental health problems.

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The article provided an overview of care for patients undergoing a limb amputation. It outlined the four phases of care: pre-operative care, post-operative care, discharge planning and community reintegration, and what is involved during each phase.

My daughter Freya has a rare syndrome called cerebro-costo-mandibular syndrome and a tracheostomy.

The theme papers in this issue focus on engaging participants in research and the importance of considering their needs. Notwithstanding the importance of these issues for participants in research, the paper in this issue by Ramjan et al highlights the importance of also looking after the research team.

Background The collection of sensitive data can arouse emotional reactions and researchers may have difficulty distancing themselves from personal stories. Debriefing can address the emotional effect of an experience on researchers. Aim To explore the debrief responses of three research assistants who were involved in the review of retrospective charts and medical notes in a study that examined the risk factors for readmission in young people with anorexia nervosa. Discussion Based on a review of the responses, the principal research team reflected on the value and effectiveness of a debrief tool for research assistants entering sensitive quantitative data. The paper highlights these reflections. Conclusion The use of an electronic debrief tool, while not without its challenges, provides an opportunity for individual reflection and a platform for emotional release for researchers engaged in sustained and intensive collection of sensitive data. This type of tool may serve as a guide for research teams and assist them in monitoring the well-being of those collecting sensitive data. We also advocate that a debriefing tool may contribute to closure for research assistants who become emotionally invested and affected by meticulous quantitative data entry. Implications for practice This paper provides recommendations for future use of an electronic debrief tool for researchers collecting sensitive data.

Background Many nurse researchers have embraced narrative methods because of the power of the stories they produce. Narrative enquiry relies on stories for data. Stories are the tools with which people build a sense of their experience of the world and the vehicle by which they share that sense with others. In narrative research, it is essential to follow themes beyond individual stories through to analysis at the social level. The researcher must understand the significance of the narrative for others and for society. Narrative lends itself particularly well to studies of changes in a society and societal groups. Aim To define and describe approaches to narrative enquiry, address their uses and usefulness, and identify potential issues. Discussion Narrative methods require the development of trust. Researchers and participants must understand their roles as well as the processes and intent of the research. While narrative approaches provide powerful stories through which issues can be understood, they must be approached with careful consideration of the power imbalance in the relationship, the vulnerability of the participant and the potential misuse of empathy in influencing outcomes. Conclusion Narrative enquiry provides powerful data to answer important research questions meaningfully. Researchers using narrative enquiry must be mindful of the power of the bond formed in the sharing of stories and not encourage participants to share more than they intend. Implications for practice Nurse researchers need to understand their role as researcher in their relationships with participants and view the powerful stories they are told as a way of answering research questions, not as a call to engage therapeutically to solve problems.

Background Conceptual frameworks are important to ensure a clear underpinning research philosophy. Further, the use of conceptual frameworks can support structured research processes. Aim To present a partnership model for a reflective narrative for researcher and participant. Discussion This paper positions the underpinning philosophical framework of the model in social constructionism (the idea that jointly constructed understandings form the basis for shared assumptions) and narrative enquiry. The model has five stages - study design, invitation to share a research space and partnership, a metaphorical research space, building a community story, and reading the community story to others. Core principles of the partnership model are continual reflection by the researcher, potential reflections by participants, reciprocal sharing, and partnership in research. Conclusion A 'trajectory of self' for both participants and researchers can be enhanced within reflective partnerships. Implications for practice This model can be applied to studies that use narrative enquiry and are seeking a humanistic approach with participant engagement.

My father and I had a pact - we would never repeat the daft things my grandmother said. We just couldn't bear people laughing at her. My granny had always been warm, witty and wise. Now in her eighties, she was in good form physically, but her memory had left the building.

Jason Warriner held senior NHS nursing positions before becoming clinical director at the Terrence Higgins Trust. He was also a UK director of quality and clinical services at Marie Stopes International, and chair of the RCN public health nursing forum.

Research reveals that almost a third of intensive care nurses have severe burnout, putting them at risk of post-traumatic stress disorder, alcohol abuse and even suicidal thoughts.

Neonatal nurses regularly face complex legal and ethical dilemmas. This article discusses the hypothetical case of Jack, a two-day-old infant diagnosed with trisomy 13 (syndrome), a life-limiting condition. Jack's prognosis is poor, and he is not expected to live past two weeks of age. The legal and ethical perspectives of withholding life-sustaining treatment in infants and children will be explored through the application of ethical frameworks, as well as statute and case law relevant to children and adolescent nursing. The article also discusses the neonatal nurse's role, with reference to local and national guidelines.

Much has been written about reflection in nursing, especially recently given its role in the revalidation process.

How should professionals help clients deal with feelings of envy about their fellow service users? Psychotherapist David O'Driscoll, writing in Learning Disability Practice, uses the case of a young man in a day service who had met all the markers of normal grief after his mother's death. Yet nine months following her loss, he was prone to angry outbursts if other service users mentioned their mothers. His first aim was to help his client acknowledge his envy. Then the client was able to discuss his feelings of injustice and anger at losing his mother.

What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice? The CPD article explored ways to help patients learn about self-management. It stated that patients are expected to learn about their condition and its management, and that nurses have a central role in helping them with this process.

Like the idea or not - and professional opinion appears to be divided - nursing associates are coming. It was announced last week that about 1,000 students will be enrolled on courses next year, before starting work at a selection of test sites that are yet to be identified.

Last week the BBC reported that doctors in England have placed 'do not resuscitate' orders on patients without discussion with their families.

Unlabelled: Theme: Professional issues Aim: To understand nurses' perspective about the presence and participation of parents/caregivers during child's hospitalization., Method: Quantitative, descriptive and exploratory study. Data collection in 2011 through questionnaire., Results: The sample comprised 146 nurses that work in paediatric wards in five different hospitals in the North of Portugal; aged between 23 to 59 years old; 93.1% were female; the average professional time was 10.7 years with 9.4 years of professional practice in an inpatient paediatric ward; 89% recognize the importance of parents/caregivers staying at hospital all day with their children during hospitalization; 63.4% always promote the involvement of parents/caregivers in the basic care; 42.5% involved them in more complex care; 9.6% didn't have the habit of explaining the nursing care to the parents before performing them., Conclusions: It is important that nurses recognize the benefits of effectively involving parents/caregivers in the care, negotiation and decision-making process regarding the child's care.

Rationale and key points ▶ Informing relatives and loved ones of a patient's death is a sensitive and often stressful task frequently undertaken by nurses. ▶ Effective communication skills and demonstrating compassion are essential when informing relatives and loved ones of a patient's death. ▶ The nurse should use suitable language and choose an appropriate environment to ensure that information is conveyed clearly, sensitively and without interruptions. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice when informing relatives and loved ones of a patient's death. 2. How you could use this article to educate your colleagues. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

Complaints and their management are an important indicator of the quality of care. Therefore, effective management of complaints is central to improve services and prioritise an open, honest and transparent health service. However, there is scope for NHS organisations to improve their response to complaints. This article outlines the NHS complaints procedure, focusing on how nurses can develop essential skills to help them to improve their management of any complaints that arise in their clinical area. It provides a structured framework, identifying useful communication skills, and explores how managing complaints relates to a nurse's statutory duty of candour.

Over the past few years, emergency nursing has introduced new roles to allow nurses to practise at advanced levels. The well established emergency nurse practitioner role, which focuses on patients with minor illnesses and injuries, is being expanded and remodelled, partly to fill the gap created by the decline in the number of emergency medicine doctors. One emergency department in Scotland has introduced an extended nursing role called the acute nurse practitioner, which enables nurses to work at an extended level in the majors area of the department. This article discusses findings from a study that examined a range of healthcare clinicians' perceptions of this newly established service. Findings suggest that the service is received positively by colleagues and patients, but also highlight a number of issues that need to be addressed to enhance the service and support implementation in other emergency departments.

As part of her day-to-day job, Robyn Connelly is a nurse, counsellor, women's advocate, safeguarder, social worker and dispenser of many tissues.

Starting a new job can be exciting and daunting in equal measure, but there are things you can do to alleviate nerves on your first day.

A new website from Alzheimer's Research UK aims to help young children, juniors and teenagers to understand dementia and the changes it can cause to a loved one's behaviour. The site also assists nurses to answer children's questions about the condition.

Attitudes are of crucial importance in nursing. Attitudes help us to understand how people perceive issues and processes in care and determine what they deem important, good, relevant and appropriate. We should understand attitudes if we are to provide collaborative, patient-centred care; however, they are poorly understood. This article enables the reader to examine attitudes and their constituent beliefs and values. It explores the function of attitudes, considers how they are formed and reflects on the process of attitude change, examining how persuasion can be used to enable individuals to revisit behaviours that seem problematic or less effective.

Hundreds more adult cancer nurse specialists have been recruited over the past three years, taking numbers in England to the equivalent of 3,000 full-time posts.

Aim: To explore and compare differences between parents' and nurses' perceptions of family-centred care (FCC) for children's acute short-stay admissions., Methods: Mixed-method questionnaires were designed to compare care task delegation between nurse and parent participants in the study., Findings: Parents and nurses had similar perceptions of task allocation in FCC. Parents generally were prepared to undertake basic care tasks only, rather than help with nursing interventions. Nurses had a comprehensive understanding of FCC. Most parents were not able to define FCC but carried it out naturally., Conclusion: In the UK, nurses and parents have similar expectations of FCC. It is unusual for parents to be given information or opportunities to engage in the care of the child beyond everyday tasks. The investigation highlighted the importance of negotiating with family members on each separate admission because, although most parents would be comfortable undertaking care tasks, each family and each situation is different.

PARENTS WHOSE children die while taking part in a randomised controlled trial still wish to be kept in contact with the trial, a new study has found.

Nursing roles have been recognised as pivotal to the delivery of good quality, patient-centred care. At the centre of this debate are the leadership roles of the senior charge nurse (SCN), which in recent years have come under great scrutiny. However, research suggests that these roles have become decreasingly popular as a career pathway. The aim of this study was to develop a clearer understanding of leadership as experienced by newly qualified staff nurses in the acute hospital setting by exploring their perceptions and beliefs of SCN roles. The study supports the view that SCNs remain central to setting standards of care, but suggests that the SCN leadership role appears unattractive to newly qualified staff, who cite responsibility, lack of trust and negative feedback as the most offputting factors.

Moving from curative to palliative care is often difficult for patients, families and healthcare providers, because hospice or end of life care can be seen as a failure of healthcare teams or as patients having given up. Nurses' role in this transition is to provide care, educate and advocate for patients, and encourage reflection on the implications of end of life. Providers face challenges in identifying when end of life begins, impaired communication in healthcare teams and feelings of guilt. Patients and families must come to terms with the idea of death while maintaining dignity. Ensuring older patients are included in discussions can improve their quality of life and sense of dignity. Nurses can help by enabling conversations about the end of life to take place early on, improving communication between staff, and encouraging reflection by healthcare providers.

For some nurses, their commitment to caring goes beyond the bedside into trying to make things better for everyone.

Concordance with therapy is essential in maintaining quality of life for individuals who have human immunodeficiency virus. This article examines the use of motivational interviewing in assisting people to increase their concordance with antiretroviral therapy. It investigates the evidence base for motivational interviewing and discusses its principles and techniques. The article highlights the benefits of adopting a holistic approach to the intervention.

Nurses need to be aware of their professional, legal and ethical responsibilities towards patients. Male nurses in particular face problems in their practice as a result of their gender and the stereotypes associated with male nurses. Such stereotypes can act as a barrier to their duty of care. This article examines the challenges associated with male nurses carrying out intimate, physical care. It discusses the ethical, legal and professional issues that male nurses should consider in relation to maintenance of patient dignity during nursing care provision, particularly in relation to female patients.

Service development and service improvement are complex concepts, but this should not prevent practitioners engaging in, or initiating, them. There is no set blueprint for service development so this article examines the process, describes the skills required, lists some change management tools and offers a guide to the stages involved. The article aims to demystify service development for those considering embarking on the process for the first time.