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Leadership is a frequently used term, but these uses include various definitions and applications; these uses are sometimes contradictory. This definitional vagueness can be a particular challenge for professions, including social work. In comparison to other similar professions, there is a lack of leadership knowledge generation in social work. In addition, the organisational context in England has been challenging in recent decades, likely hindering development and application of leadership models. Health care has a broader empirical and conceptual development of leadership as a topic of examination. In health care literature, compassionate leadership is gaining momentum as a useful way of developing good clinical leadership. There is a strong tradition in social work of engaging with compassion as an element of social work values. We present models of compassionate leadership and consider their usefulness for the current social work knowledge base. We suggest that compassionate leadership may prove useful for social work practice and academia. [ABSTRACT FROM AUTHOR]

Background: Large system transformation in health systems is designed to improve quality, outcomes and efficiency. Using empirical data from a longitudinal study of national policy-driven transformation of maternity services in England, we explore the utility of theory-based rules regarding 'what works' in large system transformation.Methods: A longitudinal, qualitative case study was undertaken in a large diverse urban setting involving multiple hospital trusts, local authorities and other key stakeholders. Data was gathered using interviews, focus groups, non-participant observation, and a review of key documents in three phases between 2017 and 2019. The transcripts of the individual and focus group interviews were analysed thematically, using a combined inductive and deductive approach drawing on simple rules for large system transformation derived from evidence synthesis and the findings are reported in this paper.Results: Alignment of transformation work with Best et al's rules for 'what works' in large system transformation varied. Interactions between the rules were identified, indicating that the drivers of large system transformation are interdependent. Key challenges included the pace and scale of change that national policy required, complexity of the existing context, a lack of statutory status for the new 'system' limiting system leaders' power and authority, and concurrent implementation of a new overarching system alongside multifaceted service change.Conclusions: Objectives and timescales of transformation policy and plans should be realistic, flexible, responsive to feedback, and account for context. Drivers of large system transformation appear to be interdependent and synergistic. Transformation is likely to be more challenging in recently established systems where the basis of authority is not yet clearly established. [ABSTRACT FROM AUTHOR]

Background: Palliative care day services provide a safe environment for people with palliative care needs, enabling them to access a range of services while acting as a respite services for family caregivers. Viewed as marginal services, they are often under resourced and under researched. The aim of this study was to understand how palliative day care services contribute to client care from the perspective of management and hospice multidisciplinary teams. Methods: A descriptive qualitative study, using six focus groups conducted with staff at three United Kingdom hospices in England, Scotland and Northern Ireland. Thirty-five participants were recruited, including management and staff. Discussions were transcribed and analysed thematically. Results: Four key themes emerged: (1) variations of care, beyond heterogeneity of patients; (2) unclear referrals and inconsistent patient population; (3) recognising strengths and challenges and (4) an uncertain future. A major focus of group discussions was the model of care and the benefits of the service, however the importance of demonstrating services' effectiveness and value for money was highlighted. Conclusions: Management and hospice staff believed day-services to be a helpful introduction to palliative care, providing both social and medical support. Economic pressures and patient demand were influencing them to move from a social model to a hybrid model. Further research is needed to understand the effectiveness of the service. [ABSTRACT FROM AUTHOR]

Background: Palliative Care Day Services (PCDS) offer supportive care to people with advanced, progressive illness who may be approaching the end of life. Despite the growth of PCDS in recent years, evidence of their costs and effects is scarce. It is important to establish the value of such services so that health and care decision-makers can make evidence-based resource allocation decisions. This study examines and estimates the costs and effects of PCDS with different service configurations in three centres across the UK in England, Scotland and Northern Ireland. Methods: People who had been referred to PCDS were recruited between June 2017 and September 2018. A pragmatic before-and-after descriptive cohort study design analysed data on costs and outcomes. Data on costs were collected on health and care use in the 4 weeks preceding PCDS attendance using adapted versions of the Client Service Receipt Inventory (CSRI). Outcomes, cost per attendee/day and volunteer contribution to PCDS were also estimated. Outcomes included quality of life (MQOL-E), health status (EQ-5D-5L) and capability wellbeing (ICECAP-SCM). Results: Thirty-eight attendees were recruited and provided data at baseline and 4 weeks (centre 1: n = 8; centre 2: n = 8, centre 3: n = 22). The cost per attendee/day ranged from £121–£190 (excluding volunteer contribution) to £172–£264 (including volunteer contribution) across the three sites. Volunteering constituted between 28 and 38% of the total cost of PCDS provision. There was no significant mean change at 4 week follow-up from baseline for health and care costs (centre 1: £570, centre 2: -£1127, centre 3: £65), or outcomes: MQOL-E (centre 1: − 0.48, centre 2: 0.01, centre 3: 0.24); EQ-5D-5L (centre 1: 0.05, centre 2: 0.03, centre 3: − 0.03) and ICECAP-SCM (centre 1:0.00, centre 2: − 0.01, centre 3: 0.03). Centre costs variation is almost double per attendee when attendance rates are held constant in scenario analysis. Conclusions: This study highlights the contribution made by volunteers to PCDS provision. There is insufficient evidence on whether outcomes improved, or costs were reduced, in the three different service configurations for PCDS. We suggest how future research may overcome some of the challenges we encountered, to better address questions of cost-effectiveness in PCDS. [ABSTRACT FROM AUTHOR]

Aim: To explore the understanding and experiences of research nurses who obtain informed consent from adult patients participating in emergency care research. Design: Qualitative phenomenographic descriptive study. Methods: Ten research nurses from six hospitals in England were recruited. Data were collected using semi‐structured face‐to‐face and telephone interviews between January 2019 and March 2019. Interviews were transcribed verbatim and analysed thematically, informed by phenomenography. COREQ was followed. Results: Three main themes were identified: (a) emergency research is different, (b) protecting the patient, and (c) experience and confidence with recruitment. It was found that obtaining patient consent in emergency care research was challenging and timing of the process was crucial. Nurses with more experience of emergency care were more confident in approaching patients and their families. There was variability in out‐of‐hours recruitment which was a consequence of the range of informed consent processes used and the different levels of engagement of clinical teams. Conclusion: There is a variety of organisational cultures, processes and procedures which affect the way consent is obtained in emergency care research. A team approach was evident in the hospitals where consent rates were high and was more successful than those reliant solely on the presence of a research nurse. Organisations were able to recruit successfully to emergency care research studies irrespective of size and configuration. Further investigation of their models of working and strategies for engagement is needed. Experienced research nurses made a positive difference to recruitment and were more likely to approach patients to obtain consent. Relevance to clinical practice: The understanding and experiences of recruitment to clinical trials in emergency care research by research nurses can help identify barriers to recruitment. This study provides useful insights for healthcare practitioners, clinical trials coordinators and sponsors about how best to develop protocols and policies to increase recruitment to emergency care research. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to explore compassionate leadership with those involved in leading system-wide end-of-life care. Its purpose was to: define compassionate leadership in the context of palliative and end-of-life care; collect accounts of compassionate leadership activity from key stakeholders in end-of-life and palliative care; and identify examples of compassionate leadership in practice.Design/methodology/approach Four focus groups involving staff from a range of healthcare organisations including hospitals, hospices and community teams were conducted to access the accounts of staff leading palliative and end-of-life care. The data were analysed thematically.Findings The themes that emerged from the data included: the importance of leadership as role modelling and nurturing; how stories were used to explain approaches to leading end-of-life care; the nature of leadership as challenging existing practice; and a requirement for leaders to manage boundaries effectively. Rich and detailed examples of leadership in action were shared.Research limitations/implications The findings indicate that a relational approach to leadership was enacted in a range of palliative and end-of-life care settings.Practical implications Context-specific action learning may be a means of further developing compassionate leadership capability in palliative and end-of-life care and more widely in healthcare settings.Originality/value This paper presents data indicating how compassionate leadership, as a form of activity, is envisaged and enacted by staff in healthcare. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the experiences of patients who have failed to maintain weight loss following the insertion of a laparoscopic adjustable gastric band (LAGB) for the treatment of morbid obesity. Background: Obesity is a global health problem resulting in physical, psychological and economic problems and presenting challenges for health services. Surgical intervention is an increasingly common approach to treatment; however, some patients do not sustain their weight loss following bariatric surgery and little is known about people’s longer-term experiences following LAGB insertion. Design: A narrative-based qualitative interview study. Methods: A purposive sample of ten participants who had undergone LAGB insertion for morbid obesity was recruited. Semistructured interviews were conducted in 2014. Thematic analysis identified codes and emerging themes common to the participants’ experiences. Findings: Three major themes emerged: living with the side effects, regret and lack of support. These reflect the difficulties participants experienced and provide new insights on why weight loss is not sustained after 2 years following surgery. Conclusion: Participants reported that the surgery had a detrimental effect on their lives and some regretted having the band inserted. These findings identify areas of care that need to be addressed if patients undergoing LAGB are to experience its potential benefits and indicate that further research is needed into the long-term effects of gastric band insertion. Patients need to be better informed about the consequences of bariatric surgery if it is to have a lasting impact on their weight reduction. Relevance to clinical practice: Patients require comprehensive information and support before and after LAGB insertion to develop strategies which will help them lose weight and sustain it over the longer term. Clinicians need to be sensitive to patients’ needs when weight loss plateaus or weight is regained and intensify support during these periods. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to report an evaluation of a leading-with-compassion recognition scheme and to present a new framework for compassion derived from the data. Design/methodology/approach Qualitative semi-structured interviews, a focus group and thematic data analysis. Content analysis of 1,500 nominations of compassionate acts. Findings The scheme highlighted that compassion towards staff and patients was important. Links to the wider well-being strategies of some of the ten organisations involved were unclear. Awareness of the scheme varied and it was introduced in different ways. Tensions included the extent to which compassion should be expected as part of normal practice and whether recognition was required, association of the scheme with the term leadership, and the risk of portraying compassion as something separate, rather than an integral part of the culture. A novel model of compassion was developed from the analysis of 1,500 nominations. Research limitations/implications The number of respondents in the evaluation phase was relatively low. The model of compassion contributes to the developing knowledge base in this area. Practical implications The model of compassion can be used to demonstrate what compassion "looks like", and what is expected of staff to work compassionately. Originality/value A unique model of compassion derived directly from descriptions of compassionate acts which identifies the impact of compassion on staff. [ABSTRACT FROM AUTHOR]

Background: Teaching nursing students how to provide patient-centered end-of-life care is important and challenging. As traditional face-to-face classroom teaching is increasingly supplanted by digital technology, this provides opportunities for developing new forms of end-of-life care education. The aim of this article is to examine how a global classroom was developed using online technology to enhance nursing students' learning of end-of-life care in England and the United States. Method: The PDSA (Plan-Do-Study-Act) quality improvement approach was used to guide the design and delivery of this curriculum innovation. Results: The global classroom enhanced the educational experience for students. Teaching needs to be inclusive, focused, and engaging; the virtual platform must be stable and support individual learning, and learning needs to be collaborative and authentic. Conclusion: These findings can be used to inform the integration of similar approaches to end-of-life care education in other health care professional preparation programs. [ABSTRACT FROM AUTHOR]

Background: For the past decade, Maternal Mortality Reports, published in the United Kingdom every three years, have consistently raised concerns about maternal observations in maternity care. The reports identify that observations are not being done, not being completed fully, are not recorded on Early Warning Score systems, and/or are not escalated appropriately. This has resulted in delays in referral, intervention and increases the risk of maternal morbidity or mortality. However there has been little exploration of the possible reasons for non-completion of maternal observations.Methods: The aim of this study was to explore midwives' experiences of performing maternal observations and escalating concerns in rural and urban maternity settings in the West Midlands of England. A qualitative design involving a series of six focus groups with midwives and Supervisors of Midwives was employed to investigate the facilitators of, and barriers to the completion of maternal observations.Results: Eighteen Midwives and 8 Supervisors of Midwives participated in a total of 6 focus groups. Three key themes emerged from the data: (1) Organisation of Maternal Observations (including delegation of tasks to Midwifery Support Workers, variation in their training, the care model used e.g. one to one care, and staffing issues); (2) Prioritisation of Maternal Observations (including the role of professional judgement and concerns expressed by midwives that they did not feel equipped to care for women with complex clinical needs; and (3) Negotiated Escalation (including the inappropriate response from senior staff to use of Modified Early Warning Score systems, and the emotional impact of escalation).Conclusions: A number of organisational and cultural barriers exist to the completion of maternal observations and the escalation of concerns. In order to address these the following actions are recommended: standardised training for Midwifery Support Workers, review of training of midwives to ensure it addresses the increasing complexity of the maternal population, identification and agreement regarding the organisation of maternal observations among staff, an emphasis on increasing the priority placed on maternal observations in all clinical settings, and clarification and reinforcement of escalation procedures for both midwives and senior clinicians. [ABSTRACT FROM AUTHOR]

Background: Providing palliative care support in intensive care settings is beneficial, however, barriers to delivering high-quality end-of-life care remain. To address this, pathways have been used to improve the quality of palliative care in generalist settings. This study describes the views of health professionals using a supportive care pathway in intensive care. Design: Qualitative semi-structured interviews were conducted with ten health professionals working in a surgical intensive care unit. The data were analysed thematically. Results: Participants were positive about the effect of the supportive care pathway on patient care, particularly in enabling consensus in care planning. Some expressed concerns including the difficulty of identifying the 'correct patients' for the pathway, the risk of it becoming a 'self-fulfilling prophecy', and a euphemism for dying. Conclusion: Pathways are one potential mechanism for guiding care planning and communicating the goals of care to colleagues, patients and families, thus contributing to improvements in palliative care. [ABSTRACT FROM AUTHOR]

This paper presents findings from a qualitative study undertaken with 46 African and African Caribbean men exploring their experiences of fatherhood. Data analysis was informed by Connell's theoretical work on changing gender relations. Findings indicate that fathers' lives were mediated by masculinities, racism, gender, migration and generational changes in parenting. Fathers advocated a style of parenting centred on good communication with children. The implications of findings for theory, future research and health and social care policy regarding both children's well-being and the inclusion of fathers by health and social care practitioners are discussed. [ABSTRACT FROM AUTHOR]

Recent policy pronouncements emphasise the importance of engaging fathers with preventive primary care services. However, in England, there is a paucity of literature which examines African and African-Caribbean fathers' experiences of service provision. This paper reports a study that investigated African and African-Caribbean fathers' beliefs about fatherhood, health and preventive primary care services, with the aim of addressing the deficit in the literature. Nine focus groups involving 46 African and African-Caribbean fathers, recruited using purposive sampling, were undertaken between October 2008-January 2009. Fatherhood was seen as a core aspect of the participants' identities. The fathers enacted these identities in a number of ways, such as caring for and protecting children, which were influenced by spirituality, relationships with women, paid work and racism. The fathers had concerns about their bodies, medical conditions, physical activity and forms of consumption. However, their primary focus was on maintaining and improving the well-being of their children. This resulted in them neglecting their own health needs as they had to meet the obligations of family life and paid work. The fathers reported limited contact with preventive primary care services and were unaware of their purpose, function and availability. They identified ethnicity as a positive asset, and felt their families and communities had particular strengths. However they acknowledged that structural constraints, including racism, influenced their perceptions of and access to local health services. The engagement of African and African-Caribbean fathers needs to be addressed more specifically in policy as part of a broader programme of action to tackle health inequalities. In addition, child health services could build on fathers' commitment to children's well-being through practice that addresses fathers' as well as mothers' needs in families. [ABSTRACT FROM AUTHOR]

Hewison A. (2010) Journal of Nursing Management 18, 520–525 Feeling the cold: implications for nurse managers arising from the financial pressures in health care in England Aim The purpose of this short paper is to identify some of the implications and opportunities nurse managers in England face as a result of the current global economic recession. Background Government borrowing and poor global economic conditions have combined to create a £175 billion budget deficit in the UK. The National Health Service in England will be required to make substantial savings in order to help offset this shortfall. Key issues This is a brief critical commentary which examines some of the challenges and opportunities for nurse managers in England. It draws on a number of sources to identify key issues concerning nursing management arising from the financial pressures facing health care. Conclusion The next few years are going to be very difficult for nurses and their managers, however, the current situation also presents opportunities to advance the contribution and influence of nursing and nursing management. Implications for nursing management What nurse managers do next will be crucial in shaping the NHS response to the financial storm and the future nature of health care in England. [ABSTRACT FROM AUTHOR]

Objectives: This paper presents an examination of distinct periods in the development of nursing in order to rediscover a history of nursing management in England. The overall purpose is to demonstrate that uncritical accounts written in the past have not adequately explained the complex factors that have shaped nursing management in England. It is also suggested that the approach taken may be usefully applied to other national contexts. Design: This is a review article which first establishes the value of historical perspectives in increasing understanding of nursing and then goes on to analyse the professional, social and political forces that contributed to the development of nursing management. Data sources: A range of historical and contemporary sources is accessed to support the review. Review methods: The review is informed by an historical approach which also seeks recourse to current literature to develop a critical narrative analysis which has an international dimension. Conclusions: The history of nursing management has been ‘lost’ in celebratory and uncritical accounts of nursing as a whole. The important influence of key figures other than Nightingale has been overlooked and it emerges that nursing management has a longer and more complex history than is generally accepted. [Copyright &y& Elsevier]

The aim of this paper is to consider 'New' Labour's socio-economic and health policies, discuss how they influence preventive health strategies aimed at men, and identify the implications for managers, researchers and practitioners working to improve public health in the primary care sector in England. Policy, theoretical work and empirical research are analysed, critically, to develop the arguments in the paper. Although men may be perceived as a 'hard to reach group', insufficient consideration has been given to how health policy facilitates or restricts successful preventive health work with men. The 'gender duty', which has recently been introduced in England, presents an opportunity to build on earlier successful public health work with men. There is some evidence that innovative public health strategies, informed by an understanding of gender, with men are being developed. This may enable primary care trusts to more successfully, and creatively, target and engage men in health improvement activities. However, the current dominant ideology in public health policy in England is grounded in a perspective that emphasises biomedical, neo-liberal and psychological explanations of health and which neglects the relationship between gender and health inequalities. Recognition of the links between gender, poverty, and the concomitant inequalities, is a priority when planning preventive health work with men. If such inequalities are to be redressed, social and economic policies underpinned by values of equity and social justice are needed, incorporating a more nuanced understanding of the role of gender in health. [ABSTRACT FROM AUTHOR]

Aim. This paper reports findings from a study which investigated the introduction of the Gold Standards Framework for improving end-of-life care into care homes in England. Background. The Gold Standards Framework was developed in primary care to improve the care provided for people at the end-of-life. Following its successful introduction to this setting it was adapted and implemented in care homes. Design. A case study approach was appropriate for this study of a care programme into a ‘real life’ setting. Method. Fourteen managers participated in an initial telephone interview. Ten of these homes participated in the case study phase and 61 staff participated in individual or group interviews. Seven residents and three relatives participated in face to face interviews. Qualitative data were analysed in line with the template approach. Survey data were also analysed and a validated Teamworking Questionnaire was used. Results. It was found that teamwork is central to the successful introduction of the Gold Standards Framework in Care Homes. Good staffing levels and management support were also perceived to be key factors in homes where the Framework became established. Conclusion. Effective teamwork was necessary for changes in end-of-life care to be achieved in the care homes. If end-of-life care and other improvements in practice are to continue, teamwork will need to be supported and developed. Relevance to clinical practice. Effective teamwork appears to be a pre-requisite for successful implementation of new programmes of care. Organisations wishing to implement such programmes should assess the quality of teamwork and may need to address this first. [ABSTRACT FROM AUTHOR]

Background: Organizational culture is considered by policy-makers, clinicians, health service managers and researchers to be a crucial mediator in the success of implementing health service redesign. It is a challenge to find a method to capture cultural issues that is both theoretically robust and meaningful to those working in the organizations concerned. As part of a comparative study of service redesign in three acute hospital organizations in England, UK, a framework for collecting data reflective of culture was developed that was informed by previous work in the field and social and cultural theory.Methods: As part of a larger mixed method comparative case study of hospital service redesign, informed by realist evaluation, the authors developed a framework for researching organisational culture during health service redesign and change. This article documents the development of the model, which involved an iterative process of data analysis, critical interdisciplinary discussion in the research team, and feedback from staff in the partner organisations. Data from semi-structured interviews with 77 key informants are used to illustrate the model.Results: In workshops with NHS partners to share and debate the early findings of the study, organizational culture was identified as a key concept to explore because it was perceived to underpin the whole redesign process. The Patients-People-Place framework for studying culture focuses on three thematic areas ('domains') and three levels of culture in which the data could be organised. The framework can be used to help explain the relationship between observable behaviours and cultural artefacts, the values and habits of social actors and the basic assumptions underpinning an organization's culture in each domain.Conclusions: This paper makes a methodological contribution to the study of culture in health care organizations. It offers guidance and a practical approach to investigating the inherently complex phenomenon of culture in hospital organizations. The Patients-People-Place framework could be applied in other settings as a means of ensuring the three domains and three levels that are important to an organization's culture are addressed in future health service research. [ABSTRACT FROM AUTHOR]

Abstract: Background: In the United Kingdom approaching 20% of people aged 85 years and over live in care homes and most will die there. Improving end-of-life care is a government health priority and homes may work with primary care staff and specialist palliative practitioners to provide comprehensive end-of-life care. Consequently effective collaboration between care home and health service practitioners is vital to ensure high quality end-of-life care. Objectives: To evaluate the impact of a training programme to improve end-of-life care in nursing homes, on collaboration between nursing home staff and other health practitioners. Design: Evaluation using survey methods and qualitative case studies. Participants and setting: All 95 nursing homes in the first national ‘Gold Standards Framework in Care Homes’ programme in England were invited to participate in the evaluation. Methods: A survey of homes’ characteristics, the approaches to end-of-life care, and liaison with other services, was completed pre and post programme implementation. Case studies were conducted in a sub-sample of 10 homes to provide important context and depth to the evaluation. Results: Pre and post surveys were returned by 49 (52%) homes. Improved collaborations as a result of the programme were anticipated by 31% of managers. Challenges to collaboration included working with large numbers of general practitioners, out-of-hours services and access to specialist practitioners. Improved collaborations between home staff and health service practitioners were identified by 33% of managers as one of the main programme outcomes. Staff reported increased knowledge of end-of-life care, and enhanced confidence, which in turn resulted in improved communication and collaboration. Post-programme, staff felt more confident initiating contact and discussing residents’ end-of-life care with general practitioners and those working in specialist palliative care services. Conclusions: The Gold Standards Framework in Care Homes programme can contribute towards end-of-life care by helping to improve the quality and quantity of communication and collaboration between nursing home staff and primary care and specialist practitioners. Further research is needed to determine why this was not consistent across all homes. [Copyright &y& Elsevier]

Objective: This paper reports the findings of an interview-based study undertaken to investigate the introduction of end-of-life (EoL) care pathways in three acute trusts, as part of a larger project examining service redesign. The aim was to examine the barriers to and facilitators of change., Method: Twenty-one in-depth qualitative interviews were conducted with staff working in three National Health Service (NHS) acute hospital trusts. These staff members were involved in end-of-life care, and their accounts were analyzed to identify the key issues when introducing service changes in these settings., Results: Thematic analysis revealed five major themes-two of which, leadership and facilitation, and education and training, indicate what needs to be in place if end-of-life care pathways are to be adopted by staff. However, the remaining three themes of difficult conversations, diagnosing dying, and communication across boundaries highlight particular areas of practice and organization that need to be addressed before end-of-life care in hospitals can be improved., Significance of Results: Organization of end-of-life care in acute hospitals is challenging, and care pathways provide a degree of guidance as to how services can be delivered. However, even when there is effective leadership at all levels of an organization and an extensive program of education for all staff support the use of care pathways, significant barriers to their introduction remain. These include staff anxieties concerning diagnosing dying and discussing dying and end-of-life care planning with patients and their families. It is hoped these findings can inform the development of the proposed new care plans which are set to replace end of life care pathways in England.

Objectives: To examine the current approach to leadership development in the English National Health Service (NHS) and consider its implications for nursing. To stimulate debate about the nature of leadership development in a range of health care settings., Background: Good leadership is central to the provision of high quality nursing care. This has focussed attention on the leadership development of nurses and other health care staff. It has been a key policy concern in the English NHS of late and fostered the growth of leadership development programmes founded on competency based approaches., Design: This is a policy review informed by the concept of episteme., Data Sources: Relevant policy documents and related literature., Review Methods: Using Foucault's concept of episteme, leadership development policy is examined in context and a 'counter narrative' developed to demonstrate that current approaches are rooted in competency based accounts which constitute a limited, yet dominant narrative., Conclusion: Leadership takes many forms and varies hugely according to task and context. Acknowledging this in the form of a counter narrative offers a contribution to more constructive policy development in the English NHS and more widely. A more nuanced debate about leadership development and greater diversity in the provision of development programmes and activities is required. Leadership development has been advocated as being crucial to the advancement of nursing. Detailed analysis of its nature and function is essential if it is to meet the needs of nurse leaders., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Purpose: The aim of this article is to report some of the work undertaken by a nursing "think tank", focussed on examining the causes of poor nursing care in hospitals, and potential solutions., Design/methodology/approach: A "think tank" was convened which incorporated widespread discussion with national, regional and local stakeholders, a critical literature review, and a focus group of senior nurses., Findings: It was found that there are no widespread systems of staff support that help nurses working in hospitals to cope with the emotional component of their work. This is one element that contributes to nurses providing poor care. A number of approaches to staff support have been developed that warrant further study., Practical Implications: If episodes of poor care are to be prevented it is necessary for hospital boards to recognise the importance of supporting nurses in managing the emotional labour of caring. The introduction of routine systems of staff support should be considered., Originality/value: In addition to highlighting and condemning poor care, it is important to seek solutions. This article offers a new perspective on an enduring problem and identifies approaches that can be part of the solution.

Purpose: The purpose of this paper is to report the findings from an evaluation project conducted to investigate the impact of two staff engagement programmes introduced to four National Health Service (NHS) hospital Trusts in England. It seeks to examine this development in the context of current policy initiatives aimed at increasing the level of staff involvement in decision-making, and the related literature., Design/methodology/approach: A mixed-methods approach incorporating document analysis, interviews, a survey and appreciative inquiry, informed by the principles of impact evaluation design, was used., Findings: The main finding to emerge was that leadership was crucial if widespread staff engagement was to be achieved. Indeed, in some of the trusts the staff engagement programmes were seen as mechanisms for developing leadership capability. The programmes had greater impact when they were "championed" by the Chief Executive. Effective communication throughout the organisations was reported to be a prerequisite for staff engagement. Problems were identified at the level of middle management where the lack of confidence in engaging with staff was a barrier to implementation., Practical Implications: The nature of the particular organisational context is crucial to the success of efforts to increase levels of staff engagement. The measures that were found to work in the trusts would need to be adapted and applied to best meet the needs of other organisations., Originality/value: Many health care organisations in England will need to harness the efforts of their workforce if they are to meet the significant challenges of dealing with financial restraint and increasing patient demand. This paper provides some insights on how this can be done.

Objectives: The findings presented in this article were unanticipated and came to light during a study which investigated African and African-Caribbean fathers' views about preventive primary care services. This article reports findings which indicate that African and African-Caribbean fathers strive to enable and protect children's mental well-being and create social, cultural and symbolic forms of capital. It also seeks to identify implications for health and social care policy and practice in England., Design: There is limited literature examining African and African-Caribbean fathers' health experiences in England. Consequently an exploratory research approach was required. This involved nine, in-depth, semi-structured qualitative group interviews undertaken with 46 African and African-Caribbean fathers. The data were analysed thematically using abductive reasoning, informed by Bourdieu's theoretical work., Results: Fathers were striving to enable and protect children's mental well-being through providing authoritative, loving, affectionate fatherhood involving reasoning, good communication and promoting self-esteem. These practices were seen to be necessary if children were to prosper in a harsh social world characterised by structural hazards including racism, negative stereotypes and limited opportunities. The fathers reported their efforts to develop what Bourdieu has termed symbolic, cultural and social capital as means of promoting the mental well-being of their children and the children of others., Conclusion: The implications for theory, future research, public health policy and practice, in relation to the needs of African and African-Caribbean fathers and families, are also discussed, with specific focus on how to realise the potential of African and African-Caribbean fathers' positive contributions to family and community health.

Aim: This paper reports a policy analysis conducted to examine the potential impact of recent mental health policy on team working in Primary Care Mental Health in England., Method: An analysis of relevant policy documents was conducted. From an original selection of 49 documents, 15, which had significant implications for Primary Care Mental Health Teams, were analysed thematically., Findings: There were no clear guidelines or objectives for Primary Care Mental Health Teams evident from the policy analysis. Collaborative working was advocated, yet other elements in the policies were likely to prevent this occurring. There was a lack of clarity concerning the role and function of new professions within Primary Care Mental Health Teams, adding further uncertainty to an already confused situation., Conclusion: This uncertainty has the potential to reinforce professional barriers and increase the current difficulties with team working. IMPLICATIONS TO NURSING MANAGERS: An analysis of recent policy contributes to our understanding of the context of care. The lack of clarity in current health policy presents a significant challenge for those managing primary care mental health teams. Team working is likely to improve if targets, processes and responsibilities are made clearer.