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Background UK endoscopy services face considerable workforce pressures from an increasing demand for procedures. To meet this need, health services have introduced the role of nurse endoscopist (also known as clinical, non-medical or non-physician endoscopist). These roles have grown and developed to include performing many complex diagnostic and therapeutic procedures, as well as the provision of endoscopy training. Aims This study examines the lived experiences of (nurse and medical) endoscopy trainees, especially regarding being trained by nurse endoscopists. Methods The study employed interpretive phenomenological analysis (IPA). Data were collected through semi-structured in-depth interviews of 10 participants, who were selected from a sample of trainees attending a basic colonoscopy skills course. Interviews were preceded by observations to gain contextual insights into the training experience. The data were analysed in stages through a process of reading and re-reading the transcripts, making initial descriptive observations and then annotating with discursive, linguistic and conceptual comments. Findings Four emerging themes were identified. A lack self-confidence was a barrier to progression, compounded by the emotional impact of making mistakes without comprehensible constructive feedback. Attitudes of trainers and other endoscopy staff, as well as their relationships with trainees, had an impact on self-confidence and educational experience. Pressure on endoscopy units to perform procedures led to a tendency to treat training like a burden, although training was seen as an important investment. Trainees sought to differentiate nurse endoscopist and medical endoscopist roles and justify their skills and value, with comparisons between different nurse and medical trainers. Conclusion The emerging themes illustrate the requirement for a collegiate approach to endoscopy training.

Background/introduction\ud Qualified and student nurses remain at the forefront of dealing with, and reporting, patient safety events or incidents. There has been limited exploration of whether and how the patient's perspective is represented by staff or student nurses using formal reporting systems.\ud \ud Objectives\ud The overall aim of the study was to explore the student nurses' experiences in practice of patient safety events they were themselves directly or indirectly involved in. This specifically explored the subsequent reporting and inclusion of the patient perspectives that may or may not have taken place.\ud \ud Design\ud A qualitative approach to this research was selected using the principles of thematic analysis to analyse data gathered from focus groups of student nurses across all year groups.\ud \ud Setting\ud Three universities participated in the study located in the north east, south east and east of England.\ud \ud Participants\ud Student nurses from across the year groups attended focus groups.\ud \ud Methods\ud Following ethical approval and informed consent, participants took part in focus groups within each university setting. Data were transcribed verbatim and analysed using thematic analysis.\ud \ud Results\ud Three themes were identified: the benefit of reporting and patient involvement, the barriers experienced by the students in reporting and the support needed to ensure they do the right thing in practice.\ud \ud Conclusion\ud Learning for students from patient safety incidents is important and seeking patients' views and perceptions adds to the learning experience. There are however challenges for the student in practice in both reporting and patient involvement. Resources are needed that follow and feed into the student learning alongside a workforce that see the benefit of learning from those we care for.

Background - Continuing Professional Development is important for maintaining and developing knowledge and skills. Evidence regarding direct impact on practice is limited. Existing literature often lacks sufficient detail regarding the initiative or its evaluation, making transferability problematic.\ud \ud Objective - To explore the impact and perceived value of multi-disciplinary Continuing Professional Development workshops for Health Visitors who support families with children with complex health needs.\ud \ud Design - Realistic Evaluation principles guided the research. Workshop attendees were invited to participate (n.21), 81% (n.17) agreed. Data collection included a questionnaire and semi-structured interviews. Data analysis included descriptive statistics and qualitative thematic analysis.\ud \ud Setting - One North of England Health Service Trust.\ud \ud Findings - Interrelated temporal themes emerged. Before the workshop expectations included, uncertainty regarding content and ambiguity regarding attendance. During workshops comments focused on networking opportunities, the detail, content and facilitation of the learning experience. ‘Emotional safety’ enabled interaction, sharing and absorption of information, and potentially increased trust, confidence and social capital. Participants viewed the workshop as informative, enhancing insight regarding roles, services and processes. Post-workshop participants reported examples of practice enhancements attributed to workshop attendance including: f building; improved team working; facilitation of early referral and accessing additional support for families.\ud \ud Conclusions - Findings suggest initiative developers aiming CPD at new or existing teams need to consider nurturing social capital and to pay attention to the context and mechanisms, which can prompt attendance, engagement and subsequent practice application.

Drawing on work that aimed to understand factors influencing experience of and engagement with the National Health Service (NHS) Health Check Program, this article discusses how Normalization Process Theory was used throughout the life course of a research project. As a relatively new theory, Normalization Process Theory is still being refined and much work undertaken to develop interactive tools and “test” the utility of it. Although there is little published critique of the theory, two main issues have arisen in the literature: (a) difficulties ensuring interpretation of constructs are congruent to the original theory and (b) the intensity of translation work to contextualize the theory to individual settings. These issues are explored in this article by examining the processes undertaken to translate Normalization Process Theory so that it was usable to shape a qualitative research project from design to analysis and interpretation.

BackgroundIn response to marked concern regarding inadequate fluid intake recording in care homes, an innovative mobile hydration app was collaboratively developed. “Hydr8” aimed to facilitate accurate recording and communication of residents’ fluid intake and ultimately increase care quality and patient safety. ObjectiveThe aim of this study was to examine the implementation of Hydr8 in a sample of care homes in one area in England. MethodsThe principles of Realist Evaluation and Action research were drawn upon throughout the study. Overall, 5 care homes participated in this study, 3 interview-only sites and 2 case-study sites, where interviews and observations were conducted at 3 time-points. Furthermore, 28 staff members participated, including care staff, management, a registered nurse, and administrative staff. ResultsFindings suggest that Hydr8 benefits practice, enhancing the understanding of hydration and person-centered care and improving staff communication. However, technical glitches hindered the seamless embedding of Hydr8 into everyday practice, and enthusiasm for long-term use was dependent on the resolution of issues. In addition, Hydr8 heightened perceptions of personal accountability, and while managers viewed this as positive, some staff members were apprehensive. However, individuals were enthusiastic about the long-term use and potential of Hydr8. ConclusionsUtilizing the findings of this study to further develop and adapt Hydr8 indicates the long-term use of Hydr8 as promising. Although perceptions of Hydr8 were primarily positive, setbacks in its implementation and use created difficulties in normalizing the solution into everyday practice. This study highlights the need for education related to hydration practice and a change of infrastructure in care home settings to implement technical solutions and changes to care.

Objective to explore student midwives' experiences of postnatal genital tract assessment within midwifery preregistration curricula. Design a single, instrumental case study design was employed involving final year student midwives. Ethical approval was gained from the Higher Education Institution at the data collection site. Sampling was purposeful and data were collected using a survey (n = 25); narrative style in depth interviews (n = 11), review of programme documentation and a student midwife / researcher data workshop. Setting one Higher Education Institution in the north of England. Findings three themes were identified from the data analysis, awareness of assessment methods, accessing learning opportunities and actualisation of learning. The awareness theme highlights that most students were aware of potential signs and symptoms associated with genital tract assessment and health however; difficulties were identified concerning assessment of lochia, encountering sequential assessments and recognising potential for deterioration. This awareness was influenced by access to practice based learning opportunities. Access differed due to variation in postnatal provision, service pressures and variety in mentor practices regarding selecting and creating learning opportunities. This study suggests actualisation of learning and confidence in genital tract assessment was achieved when opportunities to integrate theory and practice occurred. Actualisation was hindered by limited allocation of curriculum time specifically for postnatal maternal assessment content and assessment strategies in comparison to other aspects of midwifery knowledge. Conclusions student midwives' experiences, awareness and learning actualisation varied in relation to the development of knowledge and confidence in maternal postnatal genital tract assessment. While clinical and theoretical learning opportunities were available, access and experience varied and limitations were identified. A number of recommendations are outlined to enhance the students learning experiences in practice and HEI settings, which address placement planning, mentor preparation, the student voice and supporting curricula documentation.

Objectives This study investigated the formal and informal ways pre-registration students from medicine, nursing, physiotherapy and pharmacy learn about keeping patients safe. This paper gives an overview of the study and explores findings in relation to organizational context and culture. Methods The study employed a phased design using multiple qualitative methods. The overall approach drew on ‘illuminative evaluation’. Ethical approval was obtained. Phase 1 employed a convenience sample of 13 pre-registration courses across the UK. Curriculum documents were gathered, and course directors interviewed. Phase 2 used eight case studies, two for each professional group, to develop an in-depth investigation of learning across university and practice by students and newly-qualified practitioners in relation to patient safety, and to examine the organizational culture that students and newly-qualified staff are exposed to. Analysis was iterative and ongoing throughout the study, using frameworks agreed by all researchers. Results Patient safety was felt to have become a higher priority for the health care system in recent years. Incident reporting was a key feature of the patient safety agenda within the organizations examined. Staff were often unclear or too busy to report. On the whole, students were not engaged and may not be aware of incident reporting schemes. They may not have access to existing systems in their organization. Most did not access employers’ induction programmes. Some training sessions occasionally included students but this did not appear to be routine. Conclusions Action is needed to develop an efficient interface between employers and education providers to develop up-to-date curricula for patient safety.

The purpose of the present study was to investigate factors influencing the implementation of a model for service delivery and organisation in mental healthcare. A qualitative case-study approach was employed involving in-depth interviews with 25 service providers from across mental health and social care in one local authority area in northern England. Purposive sampling achieved a broad coverage across geographical areas, voluntary and statutory services, and primary, secondary and specialist mental healthcare. The findings indicate that implementation was influenced by three interrelated factors: the means by which the model was introduced to the workforce; use of the model itself by service providers; and the broader service context. Thus, negative reactions to the way the model was initially presented strongly influenced service providers' subsequent views of it. Moreover, observations regarding the broader context of mental healthcare revealed a service that was ill-equipped to manage change because of over-stretched resources and that was disinclined to accept imposed change because of poor staff morale. Finally, differential interpretation of the model's tiers by service providers led to defensive practice that manifested itself as over-referral of service users within the system. Changing practice behaviour is a complex process, particularly at a service level that consists of numerous professional groups with differing cultural norms. Successful reorganisation of services is unlikely if those responsible for delivering care are not part of the process of change. Moreover, unsuccessful attempts to change professional practice may exacerbate existing tensions within a workforce, which may be to the detriment of those requiring care. A full diagnostic analysis of the system, including service providers' concerns, should be carried out before introducing change or reconfiguring services.

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.

Background We sought to investigate the formal and informal ways preregistration students from medicine, nursing, pharmacy and the allied healthcare professions learn about patient safety.Methods We drew on Eraut's framework on formal and informal acquisition of professional knowledge to undertake a series of phased theoretically informed, in-depth comparative qualitative case studies of eight university courses. We collected policy and course documentation; interviews and focus groups with educators, students, health service staff, patients and policy makers; and course and work placement observations. Data were analysed thematically extracting emerging themes from different phases of data collection within cases, and then comparing these across cases.Results We conducted 38 focus groups with a total of 162 participants, undertook 82 observations of practice placements/learning activities and 33 semistructured interviews, and analysed 44 key documents. Patient safety tended to be either implicit in curricula or explicitly identified in a limited number of discrete topic areas. Students were predominantly taught about safety-related issues in isolation, with the consequence of only limited opportunities for interprofessional learning and bridging the gaps between educational, practice and policy contexts. Although patient safety role models were key to student learning in helping to develop and maintain a consistent safety ethos, their numbers were limited.Conclusions Consideration needs to be given to the appointment of curriculum leads for patient safety who should be encouraged to work strategically across disciplines and topic areas; development of stronger links with organisational systems to promote student engagement with organisation-based patient safety practice; and role models should help students to make connections between theoretical considerations and routine clinical care.

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.

Education is crucial to how nurses practice, talk and write about keeping patients safe. The aim of this multisite study was to explore the formal and informal ways the pre-registration medical, nursing, pharmacy and physiotherapy students learn about patient safety. This paper focuses on findings from nursing. A multi-method design underpinned by the concept of knowledge contexts and illuminative evaluation was employed. Scoping of nursing curricula from four UK university programmes was followed by in-depth case studies of two programmes. Scoping involved analysing curriculum documents and interviews with 8 programme leaders. Case-study data collection included focus groups (24 students, 12 qualified nurses, 6 service users); practice placement observation (4 episodes=19 hrs) and interviews (4 Health Service managers). Within academic contexts patient safety was not visible as a curricular theme: programme leaders struggled to define it and some felt labelling to be problematic. Litigation and the risk of losing authorisation to practise were drivers to update safety in the programmes. Students reported being taught idealised skills in university with an emphasis on 'what not to do'. In organisational contexts patient safety was conceptualised as a complicated problem, addressed via strategies, systems and procedures. A tension emerged between creating a 'no blame' culture and performance management. Few formal mechanisms appeared to exist for students to learn about organisational systems and procedures. In practice, students learnt by observing staff who acted as variable role models; challenging practice was problematic, since they needed to 'fit in' and mentors were viewed as deciding whether they passed or failed their placements. The study highlights tensions both between and across contexts, which link to formal and informal patient safety education and impact negatively on students' feelings of emotional safety in their learning.

The purpose of the present study was to investigate factors influencing the implementation of a model for service delivery and organisation in mental healthcare. A qualitative case-study approach was employed involving in-depth interviews with 25 service providers from across mental health and social care in one local authority area in northern England. Purposive sampling achieved a broad coverage across geographical areas, voluntary and statutory services, and primary, secondary and specialist mental healthcare. The findings indicate that implementation was influenced by three interrelated factors: the means by which the model was introduced to the workforce; use of the model itself by service providers; and the broader service context. Thus, negative reactions to the way the model was initially presented strongly influenced service providers' subsequent views of it. Moreover, observations regarding the broader context of mental healthcare revealed a service that was ill-equipped to manage change because of over-stretched resources and that was disinclined to accept imposed change because of poor staff morale. Finally, differential interpretation of the model's tiers by service providers led to defensive practice that manifested itself as over-referral of service users within the system. Changing practice behaviour is a complex process, particularly at a service level that consists of numerous professional groups with differing cultural norms. Successful reorganisation of services is unlikely if those responsible for delivering care are not part of the process of change. Moreover, unsuccessful attempts to change professional practice may exacerbate existing tensions within a workforce, which may be to the detriment of those requiring care. A full diagnostic analysis of the system, including service providers' concerns, should be carried out before introducing change or reconfiguring services.

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).