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Aim: To generate, test and refine programme theories that emerged from a rapid realist review investigating practising UK Nurses' and Midwives' experiences of effective leadership strategies during the COVID‐19 pandemic. Background: The realist review of literature generated six tentative theories of healthful leadership practices reflecting, working with people's beliefs and values; being facilitative; multiple means of communication and; practical support. The review yielded little insight into the actual impact of the leadership approaches advocated. Methods: A realist study, informed by person‐centredness using mixed‐methods. Online survey (n = 328) and semi‐structured interviews (n = 14) of nurses and midwives across the UK in different career positions/specialities. Quantitative data analysed using descriptive statistics and exploratory factor analysis. Framework analysis for qualitative data using context (C), mechanism (M), outcome (O) configurations of the tentative theories. Results: Three refined theories were identified concerning: Visibility and availability; embodying values and; knowing self. Healthful leadership practices are only achievable within organisational cultures that privilege well‐being. Conclusions: Leaders should intentionally adopt practices that promote well‐being. 'Knowing self' as a leader, coaching and mentoring practice development is important for leadership development. Implications for Clinical Practice: Nurses who feel valued, heard, cared for and safe are more likely to remain in clinical practice. Job satisfaction and being motivated to practice with confidence and competence will impact positively on patient outcomes. Impact: The study addresses the role of leadership in developing healthful workplace cultures. The main findings were six leadership practices that promote healthful cultures. The research will have an impact on strategic and clinical leaders, nurses and midwives. Reporting Method: This study used EQUATOR checklist, RAMASES II as reporting standards for realist evaluations. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: We aim to explore healthful leadership practices in nursing and midwifery evident within the COVID‐19 pandemic in the United Kingdom, the contextual facilitators, barriers and outcomes. Background: Globally, the health and care sectors are under pressure and despite nurses and other professionals, demonstrating resilience and resourcefulness in the COVID‐19 pandemic; this has negatively impacted on their health and wellbeing and on patient care. Evaluation: Two searches were conducted in July 2021 and December 2021. Inclusion/exclusion criteria were identified to refine the search, including papers written since the beginning of the pandemic in 2020. A total of 38 papers were included principally from the United States and United Kingdom. Ten were research papers; the others were commentaries, opinion pieces and editorials. MS Teams literature repository was created. A unique critical appraisal tool was devised to capture contexts, mechanisms and outcomes whilst reflecting more standardized tools, that is, the Critical Appraisal Skills Programme and the Authority, Accuracy, Coverage, Objectivity and Date tool for reviewing grey literature to refine the search further. Key issues: Six tentative theories of healthful leadership emerged from the literature around leadership strategies, which are relational, being visible and present; being open and engaging; caring for self and others; embodying values; being prepared and preparing others; and using available information and support. Contextual factors that enable healthful leadership practices are in the main, created by leaders' values, attributes and style. The literature suggests that leaders who embody values of compassion, empathy, courage and authenticity create conditions for positive and healthful relations between leaders and others. Nurse and midwives' voices are however absent from the literature in this review. Conclusion: Current available literature would suggest healthful leadership practices are not prioritized by nurse leaders. Perspectives of nurses' and midwives' about the impact of such practices on their wellbeing is also missing. Tentative theories are offered as a means of identifying healthful leadership strategies, the context that enable these and potential outcomes for nurses and midwives. These will be explored in phase two of this study. Implications for Nursing Management: Nurse leaders must be adequately prepared to create working environments that support nurses' and midwives' wellbeing, so that they may be able to provide high‐quality care. Ensuring a supportive organizational culture, which embodies the values of healthfulness, may help to mitigate the impact of the COVID‐19 pandemic on nurses' and midwives' wellbeing in the immediate aftermath and going forward. [ABSTRACT FROM AUTHOR]

Background: Palliative and end-of-life care services need to be person centred. However, it cannot be assumed that such services are 'naturally' person centred as, in reality, they face the same pressures and challenges as any other service. This is the case in the practice development research reported in this article. While the service had good patient and family feedback/satisfaction, the context of care provision for staff did not reflect these same levels of satisfaction. This contrast poses challenges for organisations in the context of staff wellbeing and the sustainability of person-centred care. The work undertaken in this programme aimed to address this issue. Aim: To implement a programme of practice development to further the development of a culture of person-centred practice in the Marie Curie Edinburgh Hospice. Methods: The programme was theoretically informed by the Person-centred Practice Framework of McCormack and McCance (2017) and operationalised through the methodology of transformational practice development. Thirteen multidisciplinary team members formed a 'core group' and participated in 10 three-hour workshops of learning and development, spread over a 12-month period. Practice development activities were planned in between the workshops to be undertaken by the group members. Evaluation data were collected at the beginning of the practice development programme and as a continuous process throughout the 12 months. Data collected included patient and staff stories, practice observations, creative expressions and routinely collected data. These data were analysed through a participatory approach with the group members and theorised through the lens of human flourishing. Results: The findings are located within a framework exploring the conditions for human flourishing. They illustrate the tension between person-centred care and person-centred cultures. Key findings demonstrate the need for all persons to be 'known' in order for effective person-centred relationships to exist, the significance of shared values, the importance of addressing 'small' practice changes as well as the need to ensure the hearing of different voices. Findings from routine collected data further demonstrate the relationship between the development of a person-centred culture with patient and staff outcomes. Conclusions and implications for practice: This programme is one of the first explicitly to use a framework for human flourishing to analyse the relationship between person-centred culture and care provision. The programme demonstrates the importance of person-centred cultures for sustainable person-centred care. Implications for practice include: • Practice settings need to be clear about the difference between patient- and person-centredness • The engagement of a multidisciplinary team in interdisciplinary systematic transformational practice development has the potential to transform the culture and context of care, and produce sustainable outcomes • Human flourishing is an appropriate focus to adopt in exploring how practice settings embrace the principles of person-centredness for all persons [ABSTRACT FROM AUTHOR]

Aims and objectives To explore family perspectives on their involvement in the timely detection of changes in their relatives' health in UK nursing homes. Background Increasingly, policy attention is being paid to the need to reduce hospitalisations for conditions that, if detected and treated in time, could be managed in the community. We know that family continue to be involved in the care of their family members once they have moved into a nursing home. Little is known, however, about family involvement in the timely detection of changes in health in nursing home residents. Design Qualitative exploratory study with thematic analysis. Methods A purposive sampling strategy was applied. Fourteen semi-structured one-to-one interviews with family members of people living in 13 different UK nursing homes. Data were collected from November 2015-March 2016. Results Families were involved in the timely detection of changes in health in three key ways: noticing signs of changes in health, informing care staff about what they noticed and educating care staff about their family members' changes in health. Families suggested they could be supported to detect timely changes in health by developing effective working practices with care staff. Conclusion Families can provide a special contribution to the process of timely detection in nursing homes. Their involvement needs to be negotiated, better supported, as well as given more legitimacy and structure within the nursing home. Relevance to clinical practice Families could provide much needed support to nursing home nurses, care assistants and managers in timely detection of changes in health. This may be achieved through communication about their preferred involvement on a case-by-case basis as well as providing appropriate support or services. [ABSTRACT FROM AUTHOR]

boomer c.a.& mccormack b. (2010) Journal of Nursing Management  18, 633-644 Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders Aim To evaluate a 3-year practice development (PD) programme for clinical nurse leaders. Background The development of effective leaders is a key objective to progress the modernization agenda. This programme aimed to develop the participants alongside development of the culture and context of care. Methods Programme evaluation methodology to determine the 'worth' of the programme, inform the experience of the participation, effect on workplace cultures and determine effectiveness of the process used. Results Created the conditions for growth under two broad themes: process outcomes demonstrating growth as leaders contributing to cultural shifts; and general outcomes demonstrating practice changes. Conclusions Developing communities of reflective leaders are required to meet demands within contemporary healthcare. PD provides a model to develop leaders to achieve sustainable changes and transform practice. Implications for nursing management Active collaboration and participation of managers is crucial in the facilitation of and sustainability of cultural change. Approaches adopted to develop and sustain the transformation of practice need to focus on developing the skills and attributes of leaders and managers as facilitators. [ABSTRACT FROM AUTHOR]

There is now international recognition of the importance of practice expertise in modern and effective health services. The Expertise in Practice Project in the United Kingdom began in May 1998 and continued to 2004. It included nurses working in all four countries of the United Kingdom, and it covered clinical specialists from pediatrics to palliative care. The project added to the current understanding of what nursing practice expertise is, through the identification and verification of attributes and factors which enable expert practice. The proposed framework offers a language for sharing what constitutes practice expertise and offers insight into what occurs between the expert practitioner and the people that experience their care. The Expertise in Practice Project demonstrates that nurses affect change and facilitate performance and organizational development. [ABSTRACT FROM AUTHOR]

• This paper presents an overview of the work of the Royal College of Nursing (RCN) in developing an assessment tool to determine the need for registered nursing by older people in continuing care. • In the past, healthcare has been provided free and social care ‘means-tested’. • The erosion of the NHS’s responsibility for continuing care provision through the development of eligibility criteria has resulted in the majority of older people having their care services means-tested, including their nursing care. • The RCN has argued that older people have inter-related health and social care needs, that nursing care is an integral component of healthcare provision and that therefore older people should not have to pay for nursing care. • This paper describes the work undertaken by the RCN to develop a tool for use in assessing older people’s need for registered nursing – ‘The RCN Nursing Older People Assessment Tool’. • The underpinning theoretical framework is outlined and the process of constructing the tool is described. • In addition, the stages of assessment using the tool are outlined. • A pilot study in seven nursing homes managed by three different companies was undertaken to test the reliability and acceptability of the tool. 178 paired assessments were completed (89% of the intended sample). • The results of the pilot study demonstrated that the tool has a high degree of reliability and acceptability. • Further testing of the tool is recommended using a larger sample of nursing home residents. [ABSTRACT FROM AUTHOR]

• The notion of clinical leadership is significant in current nursing practice, particularly since recommendations made by the Department of Health in 'The Strategy for Nursing'. However, while it is a concept that many nurses aspire to implement, in reality the operationalizing of such a concept is fraught with difficulty. • This paper aims to explore the issue of clinical leadership through a collegiate model developed in a particular practice area. • The development of this collegiate relationship is articulated through the mediums of reflective practice and clinical supervision. • A model of collegiality is offered as an approach to the integration of the spheres of clinical leadership. • If reflective practice is to be a reality then it is essential that both clinical leaders and practitioners engage in such processes within a supportive culture. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the special issue on topics including dementia and delirium; the changes required in environmental conditions, and treatment regimes while addressing the needs of a person with delirium; and the challenges associated with being effective in caring for older people with dementia or delirium.

The author expresses his opinion that there is a poorly developed intergenerational and lifespan strategic approach to gerontological nursing research. He reports the results of a database search he conducted in preparation for developing the cross-Council 'Lifelong Health and Wellbeing Research Strategy for Healthy Ageing in Great Britain.

Editorial. Comments on requirements to improve healthcare for elderly people in Great Britain. Difficulties experienced by elderly persons gaining access to continuing health care; Details on the health and social care needs of the elderly; Work done by the Clinical Standards Advisory Group organization.

Comments on the incorporation of respect for older people in care settings to the government policy in Great Britain. Problems associated with a lack of respect to older people; Consideration of repeated exposure to situations that challenge the value systems can result in a lack of respect for broader societal values; Consequences of non-person-centered environments.

Background: Care home residents often lack access to end-of-life care from specialist palliative care providers. Palliative Care Needs Rounds, developed and tested in Australia, is a novel approach to addressing this., Objective: To co-design and implement a scalable UK model of Needs Rounds., Design: A pragmatic implementation study using the integrated Promoting Action on Research Implementation in Health Services framework., Setting: Implementation was conducted in six case study sites (England, n = 4, and Scotland, n = 2) encompassing specialist palliative care service working with three to six care homes each., Participants: Phase 1: interviews ( n = 28 care home staff, specialist palliative care staff, relatives, primary care, acute care and allied health practitioners) and four workshops ( n = 43 care home staff, clinicians and managers from specialist palliative care teams and patient and public involvement and engagement representatives). Phase 2: interviews ( n = 58 care home and specialist palliative care staff); family questionnaire ( n = 13 relatives); staff questionnaire ( n = 171 care home staff); quality of death/dying questionnaire ( n = 81); patient and public involvement and engagement evaluation interviews ( n = 11); fidelity assessment ( n = 14 Needs Rounds recordings)., Interventions: (1) Monthly hour-long discussions of residents' physical, psychosocial and spiritual needs, alongside case-based learning, (2) clinical work and (3) relative/multidisciplinary team meetings., Main Outcome Measures: A programme theory describing what works for whom under what circumstances with UK Needs Rounds. Secondary outcomes focus on health service use and cost effectiveness, quality of death and dying, care home staff confidence and capability, and the use of patient and public involvement and engagement., Data Sources: Semistructured interviews and workshops with key stakeholders from the six sites; capability of adopting a palliative approach, quality of death and dying index, and Canadian Health Care Evaluation Project Lite questionnaires; recordings of Needs Rounds; care home data on resident demographics/health service use; assessments and interventions triggered by Needs Rounds; semistructured interviews with academic and patient and public involvement and engagement members., Results: The programme theory: while care home staff experience workforce challenges such as high turnover, variable skills and confidence, Needs Rounds can provide care home and specialist palliative care staff the opportunity to collaborate during a protected time, to plan for residents' last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while harnessing services' complementary expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication. This can improve resident care, enabling residents to be cared for and die in their preferred place, and may benefit relatives by increasing their confidence in care quality., Limitations: COVID-19 restricted intervention and data collection. Due to an insufficient sample size, it was not possible to conduct a cost-benefit analysis of Needs Rounds or calculate the treatment effect or family perceptions of care., Conclusions: Our work suggests that Needs Rounds can improve the quality of life and death for care home residents, by enhancing staff skills and confidence, including symptom management, communications with general practitioners and relatives, and strengthen relationships between care home and specialist palliative care staff., Future Work: Conduct analysis of costs-benefits and treatment effects. Engagement with commissioners and policy-makers could examine integration of Needs Rounds into care homes and primary care across the UK to ensure equitable access to specialist care., Study Registration: This study is registered as ISRCTN15863801., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128799) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 19. See the NIHR Funding and Awards website for further award information.

Introduction: Palliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called 'Palliative Care Needs Rounds' (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life., Methods and Analysis: This implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4-6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents' quality of death and care home staff capability of adopting a palliative approach., Ethics and Dissemination: Frenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds., Registration Details: Registration details: ISRCTN15863801., Competing Interests: Competing interests: Not required., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)