Search

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.

The purpose of this study was to identify any differences in the dignity evaluation of geriatric inpatients after 1 month of hospitalization in a long-term care wards (LTC) and predictors of this change. This follow-up study included 125 geriatric inpatients who filled the Patient Dignity Inventory (PDI-CZ), Geriatric Depression Scale, Barthel Index, and Mini-Mental State Examination. In the initial measurement, the patients rated of PDI-CZ item “Not able to perform tasks of daily living” the worst. One month after, the items “Not able to perform tasks of daily living,” “Not able to attend to bodily functions,” and “Not feeling worthwhile or valued” were improved. Patients with higher education, for whom self-sufficiency improved and depression decreased, rated their dignity more positively 1 month after the hospitalization in LTC. Our findings suggest that these factors are important for the maintenance of the dignity of older adults hospitalized in LTC.

During their clinical practice, nursing students learn to manage patient safety through their experiences, emotions, and interpersonal relationships.To explore contextual and mechanistic factors that facilitate a sense of emotional safety for learning in nursing students, particularly regarding patient safety events experienced during their placements.A descriptive qualitative study using narratives and thematic analysis.A university in Northern Italy.Undergraduate nursing students recruited through purposive sampling.Twenty cases relevant to the present study were selected from the "Sharing LearnIng from Practice for Patient Safety" (SLIPPS) project database containing 100 narratives collected using the patient safety learning Event Recording Tool. The data were analysed using thematic analysis according to BraunClarke's methodology. The themes that emerged from the thematic analysis were rearranged in Context-Mechanism-Outcomes.Students identified clinical practice experiences as important occasions for their personal and professional development. Emotional safety and tutoring were the elements that effectively "govern" the students' learning and development process.Emotional safety is key for nursing students because it enables them to constructively overcome any relational and emotional tensions that may develop during their clinical placements.

Background: Underpinning all nursing education is the development of safe practitioners who provide quality care. Learning in practice settings is important, but student experiences vary. Purpose: This study aimed to systematically develop a robust multilingual, multiprofessional data collection tool, which prompts students to describe and reflect on patient safety experiences. Approach: Core to a 3-year, 5-country, European project was development of the SLIPPS (Sharing Learning from Practice for Patient Safety) Learning Event Recording Tool (SLERT). Tool construction drew on literature, theory, multinational and multidisciplinary experience, and involved pretesting and translation. Piloting included assessing usability and an initial exploration of impact via student interviews. Outcomes: The final SLERT (provided for readers) is freely available in 5 languages and has face validity for nursing across 5 countries. Student reports (n = 368) were collected using the tool. Conclusions: The tool functions well in assisting student learning and for collecting data. Interviews indicated the tool promoted individual learning and has potential for wider clinical teams. The project “Sharing Learning from Practice to Improve Patient Safety” was cofunded by the Erasmus+ Programme of the European Union (Grant Agreement 2016-1-UK01-KA203-024-258).

Background: Dignity is a multidimensional construct that includes perception, knowledge, and emotions related to competence or respect. Attitudes to aging are a comprehensive personal view of the experience of aging over the course of life, which can be influenced by various factors, such as the levels of health and self-sufficiency and social, psychological, or demographic factors. \ud \ud Aim: The purpose of this study was to explore the attitudes to aging of home-dwelling and inpatient older adults, and whether dignity and other selected factors belong among the predictors influencing attitudes to aging in these two different groups of older adults. \ud \ud Research design: Cross-sectional study using a set of questionnaires: Patient Dignity Inventory, Attitudes to Aging Questionnaire, and Barthel Index. Pearson and Spearman correlation analyses and multivariable linear regression were used for statistical processing. Participants and research context: 233 inpatients and 237 home-dwelling older adults participated in the research in two regions of the Czech Republic. Ethical considerations: Institutional Review Board approval was received from the authors’ university. \ud \ud Findings: The inpatients had more negative attitudes to aging (M = 74.9±10.9; P

Background: Patient safety is a global concern. Learning to provide safe, high-quality care is core to nursing education. Problem: Students are exposed to diverse clinical practices, and experiences may vary between placements and across countries. Student experience is seldom used as an educational resource. Approach: An international, European Union-funded project, Sharing Learning from Practice for Patient Safety (SLIPPs), aimed to develop an innovative online educational package to assist patient safety learning. Based on student reported data and educational theory, multiple elements were iteratively developed by a multicountry, multidisciplinary group. Outcomes: The educational package is freely available on the SLIPPs Web site. Materials include a student reporting and reflection tool, virtual seminars, student reports data set, pedagogical game, high-fidelity simulation scenarios, scenario development and use guidelines, debriefing session model, and videos of simulations already performed. Conclusions: E-learning enables removal of physical barriers, allowing educators, professionals, and students from all over the world to collaborate, interact, and learn from each other. The project “Sharing Learning from Practice to Improve Patient Safety” was cofunded by the Erasmus + Programme of the European Union (grant agreement 2016-1-UK01-KA203-024-258).

The face of nursing is changing, as health-care organizations are looking to new assistant roles to support the registered nurse and potentially provide a source for apprenticeship toward registration. These developments are within a context of an existing assistant staff group, delivering much of the bedside care. Few studies have explored the dyadic relationship between nursing assistant and patient, despite the potential for their interactions to contribute to the patient experience. This study aimed to gain an understanding of patients’ perceptions of the nursing assistant role using constructivist grounded theory. Constant comparison guided data collection and analysis, and 4 core categories emerged: expectation, observation, meaningful connections, and adaptation. Within these core categories, we suggest the assistant plays a part in how participants adapt from the known self to a self of patienthood and the overall patient experience. We conclude that there is a necessity to understand more fully the dyadic relationship between patients and nursing assistants.

Background Patient safety is key for healthcare across the world and education is critical in improving practice. We drew on existing links to develop the Shared LearnIng from Practice to improve Patient Safety (SLIPPS) group. The group incorporates expertise in education, research, healthcare, healthcare organisation and computing from Norway, Spain, Italy, the UK and Finland. In 2016 we received co-funding from the Erasmus + programme of the European Union for a 3-year project. Aim SLIPPS aims to develop a tool to gather learning events related to patient safety from students in each country, and to use these both for further research to understand practice, and to develop educational activities (virtual seminars, simulation scenarios and a game premise). Study outline The SLIPPS project is well underway. It is underpinned by three main theoretical bodies of work: the notion of diverse knowledge contexts existing in academia, practice and at an organisational level; the theory of reflective practice; and experiential learning theory. The project is based on recognition of the unique position of students as they navigate between contexts, experience and reflect on important learning events related to patient safety. To date, we have undertaken the development of the SLIPPS Learning Event Recording Tool (SLERT) and have begun to gather event descriptions and reflections. Conclusions Key to the ongoing success of SLIPPS are relationships and reciprocal openness to view things from diverse perspectives and cultures.

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: The terms critical incident technique and reflection are widely used but often not fully explained, resulting in ambiguity. PURPOSE: The aims of this review were to map and describe existing approaches to recording or using critical incidents and reflection in nursing and health professions literature over the last decade; identify challenges, facilitating factors, strengths, and weaknesses; and discuss relevance for nursing education. METHODS: A systematic narrative review was undertaken. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature were searched using MeSH terms, returning 223 articles (2006-2017). After exclusions, 41 were reviewed. RESULTS: Articles were categorized into 3 areas: descriptions of the development of an original tool or model, critical incidents or reflection on events used as a learning tool, and personal reflections on critical incidents. CONCLUSIONS: Benefits have been identified in all areas. More attention is needed to the pedagogy of reflection and the role of educators in reflection.

Adverse events are common in healthcare. Three types of victims of patient-related adverse events can be identified. The first type includes patients and their families, the second type includes healthcare professionals involved in an adverse event and the third type includes healthcare organisations in which an adverse event occurs. The purpose of this integrative review is to synthesise knowledge, theory and evidence regarding action after adverse events, based on literature published in the last ten years (2009–2018). In the studies critically evaluated (n = 25), key themes emerged relating to the first, second and third victim elements. The first victim elements comprise attention to revealing an adverse event, communication after an event, first victim support and complete apology. The second victim elements include second victim support types and services, coping strategies, professional changes after adverse events and learning about adverse event phenomena. The third victim elements consist of organisational action after adverse events, strategy, infrastructure and training and open communication about adverse events. There is a lack of comprehensive models for action after adverse events. This requires understanding of the phenomenon along with ambition to manage adverse events as a whole. When an adverse event is identified and a concern expressed, systematic damage preventing and ameliorating actions should be immediately launched. System-wide development is needed. The sixth author would like to thank INVEST Research Flagship funded by the Academy of Finland Flagship Programme (decision number: 320162).

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.

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.

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

This chapter discusses the experiences of student nurses and newly qualified nurses as they transition into independent practice and their learning from and in practice. Findings from the project which investigated the effects of academic award on registered nurses’ ability to re-contextualise knowledge to allow them to deliver, organise, supervise care. The demand for nurses able to manage complex clinical nursing teams is predicted to increase due to an ageing population with people suffering from long-term, manageable conditions. To prepare for the rising demand for nursing, the UK Government has said that nurses, equipped with critical thinking skills, will increasingly take up leadership positions to meet the challenges in future healthcare and delegate care to the unregistered nursing assistant workforce. Alison Steven’s work is a further development of the ideas around the interplay between context, referred to as knowledge contexts, emotions, learning, where she develops a framework for understanding student nurses’ learning in practice as emotional safety” for learning.

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.

BACKGROUND In 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. OBJECTIVE The aim of this study was to examine the implementation of Hydr8 in a sample of care homes in one area in England. METHODS The 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. RESULTS Findings 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. CONCLUSIONS Utilizing 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.

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

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.

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

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

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.

This study explores patients’ perceptions of the health-care assistant within U.K. secondary care. Employing constructivist grounded theory, 20 patient interviews were coded and analyzed using constant comparison to ensure findings were grounded within the data. Data were collected in a large teaching hospital in England between 2014 and 2015. Charmaz’s (2014) grounded theory methodology is underpinned by a constructivist paradigm in which there is recognition of multiple social realities. This was a suitable methodology for capturing the complexities of patienthood and the associated social world and it also supported co construction between researcher and participant. Charmaz’s (2014) guiding principles of intensive interviewing within a semistructured interview schedule helped to ensure that data collected were congruent with a constructivist perspective on co construction. Researcher positionality has the potential to impact upon the co construction of realities, influencing the data collection and subsequent analysis from what is known or not known by them as researcher. Reflection and reflexivity are necessary elements in constructivist grounded theory to understand more deeply how this co construction is made and to ensure transparency of decisions. In addition to traditional methods of journaling and memoing the researcher used a mind-map software package to ensure complexities within the narrative were not lost and to map researcher influences and perceptions as the data analysis took shape. This approach enabled the researcher to present an auditable trail of influences, decisions, and complexities within the findings. This article will address the reflexive journey undertaken by the researcher.

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.

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

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

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.

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

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

The paper describes the current regulatory situation in England with respect to medical devices and healthcare providers. Trusts already produce evidence to the Healthcare Commission that they operate in accordance with standards set out by the Department of Health and the NHS. The paper illustrates how the adoption of an explicit goal-based argument could facilitate the identification and assessment of secondary implications of proposed changes. The NHS is undergoing major changes in accordance with its 10-year modernisation plan. These changes cannot be confined to the Trust level, but will have NHS-wide implications. The paper explores the possibility of an organisational safety case, which could be a useful tool in the management of such fundamental changes.

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.

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

This paper explores certain influences and issues surrounding the implementation and application of the named nurse concept. The author critically examines the proposals that primary nursing increases job satisfaction, cost effectiveness and quality of care, and suggests that as primary nursing appears to be the template for named nursing, these are factors which may have influenced the former British government's decision to implement the concept of named nursing. Owing to problems regarding the reliability and validity of much of the research, the author draws the conclusion that the direct extrapolation from one concept (such as primary nursing) to another (such as named nursing) is perhaps open to question. The author also analyses other issues related to the implementation and use of the named nurse concept including advocacy and accountability, and proposes that the introduction of individualized care, and in particular named nursing, perhaps serves the drive towards the professionalization of nursing first, and the patient second, and if so questions whether there is a need to reconsider the aim of nursing.

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).