Search

Aim/objective\ud Through an exploration of student nurses and lecturers’ professionalism discourses, this study illuminates influences on professional socialization and offers an appreciation of the processes of language (discourse) adoption involved.\ud \ud Background\ud Professionalism is a complex concept to define. Nursing research has predominantly explored professionalism in clinical practice; however, the time spent university is key to professional socialization and identity development. Previous research focused on socialization in the clinical area only. This study examined how student nurses and their lecturers construct their talk regarding professionalism while at university.\ud \ud Design\ud A social constructionism approach was adopted, where it is assumed that we jointly construct our world on shared assumptions and that language is central to this process.\ud \ud Methods\ud Employing a Discourse and Social Psychology (DASP) approach to discourse analysis, seven nursing students (Adult, Child, and Mental Health fields) and 8 lecturers participated in a total of 16 interviews.\ud \ud Results\ud The findings indicated participants drew on several interpretative repertoires. These changed over the 3 year degree. Analysis led to development of a Model of Professional Discourse Adoption, illustrating a three phased process, resonating with theories of professional socialization in nursing.\ud \ud Conclusions\ud The study offers insights into how education strategies may support learning and teaching, and professionalism communication.

The health and wellbeing of doctors are crucial, both for the individuals themselves and their ability to deliver optimum patient care. With increased pressures on healthcare, support mechanisms that attend to doctors’ health and wellbeing may require greater emphasis to safeguard those working in frontline services. To inform future developments, this systematic narrative review aimed to identify, explore and map empirical and anecdotal evidence indicating the relationships between mentoring activities and the health and wellbeing of doctors. Twelve databases were searched for publications printed between January 2006 and January 2016. Articles were included if they involved doctors’ engagement in mentoring activities and, either health or wellbeing, or the benefits, barriers or impact of mentoring. The initial search returned 4669 papers, after exclusions a full-text analysis of 37 papers was conducted. Reference lists and citations of each retrieved paper were also searched. Thirteen papers were accepted for review. The Business in the Community model was used as a theoretical framework for analysis. Mentoring influenced collegiate relationships, networking and aspects of personal wellbeing, such as confidence and stress management, and was valued by doctors as a specialist support mechanism. This review contributes to the evidence base concerning mentoring and doctors’ health and wellbeing. However, it highlights that focused research is required to explore the relationship between mentoring, and health and wellbeing.

Summary Objective To investigate NHS doctors' perceived benefits of being involved in mentoring schemes and to explore the overlaps and relationships between areas of benefit. Design Extended qualitative analysis of a multi-site interview study following an interpretivist approach. Setting Six NHS mentoring schemes across England. Main outcome measures Perceived benefits. Results While primary analysis resulted in lists of perceived benefits, the extended analysis revealed three overarching areas: professional practice, personal well-being and development. Benefits appear to go beyond a doctor's professional role to cross the personal–professional interface. Problem solving and change management seem to be key processes underpinning the raft of personal and professional benefits reported. A conceptual map was developed to depict these areas and relationships. In addition secondary analysis suggests that in benefitting one area mentoring may lead to consequential benefits in others. Conclusions Prior research into mentoring has mainly taken place in a single health care sector. This multi-site study suggests that the perceived benefits of involvement in mentoring may cross the personal/professional interface and may override organizational differences. Furthermore the map developed highlights the complex relationships which exist between the three areas of professional practice, personal wellbeing and personal and professional development. Given the consistency of findings across several studies it seems probable that organizations would be strengthened by doctors who feel more satisfied and confident in their professional roles as a result of participation in mentoring. Mentoring may have the potential to take us beyond individual limits to greater benefits and the conceptual map may offer a starting point for the development of outcome criteria and evaluation tools for mentoring schemes.

This paper reports on part of the evaluation of "The Common Learning Programme in the North East", which offered practice-based interprofessional education (IPE) to pre-qualification students. A realistic evaluation approach was used and data collection methods included interviews and observations in an attempt to look into "the black box" of practice-based IPE. The contexts of the sessions covered a number of clinical settings and involved a range of participants. Mechanisms included the content of the sessions and the procedures involved. Findings illustrate the complex and unpredictable ways in which discussions arise and evolve during IPE sessions and how interplay exists both between the contexts and the mechanisms, and between knowledge types. Issues are raised regarding the facilitation of IPE and the influence of the current evidence-based movement on research types. This study highlights the complexity and unpredictability of practice-based IPE and the usefulness of research approaches that look into the black box of educational practice.

Objectives Knowledge translation (KT) is becoming common vocabulary, but as a concept it is not clearly defined. Many related terms exist; these are often used interchangeably and given multiple interpretations. While there is a growing body of literature exploring these concepts, using it to inform public health practice, strategy, research and education is challenging given the range of sources and need for local ‘contextual fit’. This study explores how various public health stakeholders make sense of, and experience, KT and related concepts. Study design A qualitative mapping study using a phenomenographic approach. Methods Thirty-four academics, students and practitioners working in public health across the north east of England participated in six focus groups and five one-to-one interviews. Discussions were audio-recorded, transcribed and analysed using a thematic framework approach. The framework drew on findings from reviews of the existing literature, whilst allowing unanticipated issues to emerge. Results Three main themes were identified from the stakeholder discussions: (i) Definitions: there was some agreement in terms of meanings and interpretations of core concepts relating to KT, although stakeholders spoke of the differing ‘languages’ across disciplines and sectors; (ii) Process issues: access to funding, targeted messages, the nature of the evidence base, and wider contextual factors were identified as barriers or facilitators to KT; and (iii) People: various KT roles and responsibilities were highlighted for the different stakeholder groups. Conclusions This study has enabled further development of theoretical understandings of the KT discourses at play in public health, and identified the ways in which these may be bound by discipline and context. Ironically, the findings suggest that terms such as knowledge translation, transfer and exchange are seen as themselves requiring translation, or at least debate and discussion.

Introduction: Interactive workshops are often the default mechanism for sharing knowledge across professional and sector boundaries; yet we understand little about if, and how, they work. Between 2009 and 2011, the Research to Reality programme in North East England ran eight stand-alone facilitated multi-agency workshops focused on priority public health issues. Local authorities, the health service, and academe collaborated on the programme to share latest evidence and best practice Methods: A realist evaluation asked the overarching question ‘what worked where, for whom, and under what conditions’ regarding the knowledge exchange (KE) mechanisms underpinning any changes. Data were collected from fifty-one interviews, six observations, and analysis of programme documentation. Results: 191 delegates attended (local authority 46%, NHS 24%, academia 22%, third sector 6%, other 2%). The programme theory was that awareness raising and critical discussion would facilitate ownership and evidence uptake. KE activity included: research digests, academic and senior practitioner presentations, and facilitated round-table discussions. Joint action planning was used to prompt informed follow-up action. Participants valued the digests, expert input, opportunities for discussion, networking and ‘space to think’. However, within a few months, sustainability was lost. There was no evidence of direct changes to practice. Multiple barriers to research utilization emerged. Discussion: The findings suggest that in pressured contexts exacerbated by structural reform providing evidence summaries, input from academic and practice experts, conversational spaces and personal action planning are necessary to create enthusiasm on the day, but are insufficient to prompt practice change in the medium term. The findings question makes assumptions about the instrumental, linear use of knowledge and of change focused on individuals as a driver for organizational change. Delegates’ views of ‘what would work’ are shared. Mechanisms that would enhance interactive formats are discussed. a 2014 Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

Background There is a continuous decline in cervical cancer screening uptake, especially in young women, even though screening saves over 4500 lives annually in the UK. Psychological factors that could influence participation identified in previous studies included anxiety, embarrassment, and fear. The context of these factors is broad and ill-defined. This study aimed to unpick the deeper issues and factors affecting participation and non-participation in young women aged 25–34 years. Methods The method drew on the principles of grounded theory to understand how participants' form meanings and make decisions on issues such as screening. Maximum variation purposive sampling was used to recruit 26 participants from communities (cervical cancer screening call and recall register, three universities, community centre). Data were obtained by semi-structured interviews (16 participants) and a focus group (eight). Analysis aided by mind mapping software (MindGenius Business 6) led to the organisation of data into codes, themes, and categories. Findings Data analysis showed that sexual association was the core underlying category. This association was drawn from four elements: awareness, human issues, emotional attribution, and acceptability. Low awareness was mainly about screening procedure and body anatomy (location of the cervix). Overall, perception of the screening was positive and acceptability was expressed. Factors within emotional attribution and human issues were major impacts on screening behaviour and decision. Non-participation or delayed participation were strongly linked to the basic social psychological process, associating screening with sex, and created negative emotions such as embarrassment and anxiety. These associations included the screening procedure mimicking sex (penetration), the intrusive nature of screening (exposure, intimate, private), and sociocultural beliefs (promiscuity, taboo, and body insecurities). Screening that touched on fundamental human issues such as reproduction (infertility) and mortality (death from cancer) affected participation. These identified issues were sometimes unspoken and unconsciously influenced screening decision in some participants. Interpretation Our findings suggest that sexual association is a hidden issue affecting participation in cervical screening. This research is expected to inform future practices and policy implementation towards increasing screening uptake. Suggested service improvement strategies included alternative screening methods (eg, home self-testing), educating health professionals on sensitivity, and an invitation letter explaining in-depth details of the procedure. These changes could help improve the perception of screening among women of all ages. Funding None.

Objective. To examine how hidden and informal curricula shaped pharmacy students' learning about patient safety. Methods. A preliminary study exploring planned patient safety content in pharmacy curricula at 3 UK schools of pharmacy was conducted. In-depth case studies were then carried out at 2 schools of pharmacy to examine patient safety education as delivered. Results. Informal learning from teaching practitioners was assigned high levels of credibility by the students, indicating the importance of role models in practice. Students felt that the hidden lessons received in the form of voluntary work experience compensated for limited practice exposure and elements of patient safety not adequately addressed in the formal curriculum, such as learning about safe systems, errors, and professionalism. Conclusions. Patient safety is a multifaceted concept and the findings from this study highlight the importance of pharmacy students learning in a variety of settings to gain an appreciation of these different facets.

Education has moved from teacher to student-centred practices. Increasing emphasis is placed on ‘life-long’ learning in the context of a rapidly changing knowledge base. Self-evaluation is seen as one strategy to facilitate student-centred continuous professional development. The literature, however, suggests that learners’ ability to self-assess is mixed, and little is known regarding how students perform self-assessment. This study focussed on senior nurses undertaking a scenario-based clinical skills course. Learners were asked to self-evaluate several times during the course. This research explored the influences on using the self-evaluation exercise. The study drew upon grounded theory methodology and was influenced by constructionist and postmodernist theories. Three methods of data collection were used: semi-structured interviews, observation of supervision sessions and recording of the numerical self-evaluation ratings. Multiple interviews with students (n = 14) and the educational supervisor (n = 1) were conducted. Thematic analysis and data collection were conducted iteratively. The study found that feeling confident and stating that confidence were not necessarily the same. Feeling confident was complex, influenced by changing perceptions of clinical skills and credibility. Changing frames of reference were used to judge feelings of confidence. Stating confidence appeared to be socially negotiated, influenced by social acceptability considerations such as modesty and the need to show progress over time. The discourses of empowerment and surveillance were influential and self-evaluation is discussed using Foucault’s theory of governmentality, illustrating how learners can be both empowered and controlled through self-evaluation. Further consideration of the socially constructed nature of self-evaluations would benefit both educational practice and future research.

The importance of developing workforce knowledge, skills and attitudes in the health and social care workforce in order to improve the quality of end of life care is central to the provision of high quality patient care at the end of life. Community nurses deliver end of life care frequently and are required to be confident and competent in the delivery of this care, although how this is achieved is less clear. The aim of this project was to offer a pathway of learning to community nurses to explore what enhances confidence and competence. The pathway took a learner centred approach underpinned by principles of adult education and built on the 4 competency areas for end of life care. The philosophy underpinning the pathway development was based upon the belief that education and learning are complex social processes which take place in complex settings. A purposeful sample of eight community nurses followed a pathway which involved the participants being linked with a mentor; undertaking a learning needs assessment; then planning a course of action by choosing from a menu of educational activities, both formal and in formal. Participants were interviewed at three points during the process and mentors interviewed once. Interviews were transcribed verbatim, anonymised and analysed using an iterative approach drawing on grounded theory principles of constant comparative analysis A multi facet realistic evaluation methodology was employed allowing exploration of the context, mechanisms and outcomes for the pathway. This approach offers the opportunity of getting inside the ‘black box’ of what actually happens when an initiative is translated into practice, and to unpick what works for whom and in what circumstances. After participating in the educational activities the Training Needs Analysis results indicated significant changes in perceptions of confidence and competence by the end of the project.

Background Bowel cancer is the third most common cancer and the second major cause of cancer deaths in the UK. Research suggests that the risk of death from bowel cancer can be reduced by 16% through regular screening. An initial scientific literature review shows little research in this area. Previous studies identify non-attendance and low uptake as a major challenge and suggest that these factors could be affected by literacy level, fear, and anxiety. However, many of these studies were undertaken in other locations and countries, limiting replication or generalisation in the UK. There is therefore a need for qualitative investigation into the reasons and motives for low uptake. We explored reasons for participation and non-participation in the NHS bowel cancer screening programme, which requires participants to undertake a faecal occult blood test. We aimed to develop an understanding of behaviour regarding bowel cancer and the screening process; explore how people make sense of information gathered and how this influences their decisions; and describe similarities and differences regarding different groups' perceptions of bowel cancer screening. Methods Qualitative research methods are used to unpick participants' sense-making processes. A grounded theory approach has allowed the development and understanding of how participants form meanings and make decisions dependent on factors such as culture and sex. 26 participants were recruited through the bowel cancer screening hub in accordance with ethics approval. Participants were those who completed the faecal occult blood test (with negative result) and those who declined during the first round of the programme. Data were obtained with semistructured, face-to-face interviews and were analysed with grounded theory techniques. Analysis was done by organisation of data into codes, themes, and categories by Nvivo and Mind Genius software. Interviewer bias was minimised by use of credibility strategies such as member checking, reflexivity, and peer review. Findings Data analysis showed participants' low awareness of the faecal occult blood test before they received the invitation for screening. Awareness of bowel cancer was mainly through past experience or family history or was work-related. Data suggested that demography and cultural issues such as age, sex, taboo, attitudes, altruism, so-called ostrich syndrome, and stoicism can affect behaviour and decisions. Knowledge and awareness were identified as factors in breaking some of the cultural barriers affecting uptake. Main reasons for uptake were health protection or peace of mind. All participants viewed screening positively and will continue with screening. Men seemed very keen to participate in screening and seemed as mindful of their health as were women. Possible reasons to decline the invitation included "if I don't know it won't happen to me", "taboo subject", "method of stool sample collection", "fear", and "messy and not pleasant". Limitations of our study included the small number of people who declined screening: only two declined in the first round, but have completed subsequent screening. Several practical issues have been identified that will inform service provision—eg, improvement of the invitation letter and information about sample collection. Interpretation We expect the output of this research to inform future practice and policy implementation towards increased awareness, improved perception and uptake of screening, and service improvement that could lead to a substantial reduction in bowel cancer deaths. The findings will also be drawn on to explore the role of social marketing in improving perception and uptake of the bowel cancer screening programme. Funding Northumbria University at Newcastle upon Tyne in conjunction with North East, Yorkshire and Humber Quality Assurance Reference Centre for Cancer Screening (NEYHQARC).