A critical race analysis of structural and institutional racism: Rethinking overseas registered nurses' recruitment to and working conditions in the United Kingdom.

Language tests for overseas registered nurses (ORN) working outside their home country are essential for patient safety, as communication competency needs to be established in any workforce. We argue that the current employment of existing language tests is structurally and institutionally racist and disadvantages ORNs from non-European Union (EU) and non-White countries seeking to work in the United Kingdom. Using Critical Race Theory (CRT), we argue that existing English language tests for ORNs seeking registration in the United Kingdom are discriminatory due to the UK's racist migration policies and a regulatory body for nursing and midwifery that fails to acknowledge and understand its own institutionally racist practices.

Ethical climate in healthcare: A systematic review and meta-analysis.

BACKGROUND: Ethical climate refers to the shared perception of ethical norms and sets the scope for what is ethical and acceptable behaviour within teams. AIM: This paper sought to explore perceptions of ethical climate amongst healthcare workers as measured by the Ethical Climate Questionnaire (ECQ), the Hospital Ethical Climate Survey (HECS) and the Ethics Environment Questionnaire (EEQ). METHODS: A systematic review and meta-analysis was utilised. PSYCINFO, CINAHL, WEB OF SCIENCE, MEDLINE and EMBASE were searched, and papers were included if they sampled healthcare workers and used the ECQ, HECS or EEQ. ETHICAL CONSIDERATION: Ethical approval was not required. RESULTS: The search returned 1020 results. After screening, 61 papers were included (n = 43 HECS, n = 15 ECQ, n = 3 EEQ). The overall sample size was over 17,000. The pooled mean score for the HECS was 3.60. Mean scores of individual studies ranged from 2.97 to 4.5. For the HECS studies, meta-regression was carried out. No relationship was found between the country of the studies, the study setting (ICU v non-ICU settings) or the mean years of experience that the sample had. For the ECQ, sub-scales had mean scores ranging from 3.41 (instrumental) to 4.34 (law) and were all observed to have significant and substantial heterogeneity. Three studies utilised the EEQ so further analysis was not carried out. CONCLUSIONS: The above results provide insight into the variability of scores as measured by the HECS, ECQ and EEQ. To some extent, this variability is not surprising with studies carried out across 21 countries and in a range of healthcare systems. Results also suggest that it may be that more local and context specific factors are more important when it comes to predicting ethical climate.

A Rapid Review and Narrative Synthesis of the Consequences of Non-Inclusive Sex Education in UK Schools on Lesbian, Gay, Bisexual, Transgender and Questioning Young People.

Relationships and Sex Education (RSE) in schools are predominantly heterocentric. Consequently, lesbian, gay, bisexual, transgender, and questioning young people have reported feeling excluded. This exclusion results in feelings of being "different" and "other," which in turn leads to further disengagement in the sex education classroom, contributing to poor sexual health literacy, greater risk of abusive relationships, and higher rates of sexually transmitted infections. A rapid review was undertaken to identify the impact of non-inclusive sex education. The review makes recommendations for policy and practice, which includes the provision of training courses to school teaching staff with an emphasis on inclusive RSE, appropriate online resources for lesbian, gay, bisexual transgender, and questioning (LGBTQ) young people, as well as offering 1:1 emotional health support for LGBTQ young people as they begin to question their sexual orientation.

A systematic scoping review of undergraduate nursing hub-and-spoke placement models.

BACKGROUND: While nursing education has been forecast to continue to grow, placement capacity is now the key factor precluding growth in supply. AIMS: To provide a comprehensive understanding of hub-and-spoke placements and their ability to increase placement capacity. METHOD: A systematic scoping review and narrative synthesis were used (Arksey and O'Malley, 2005). PRISMA checklist and ENTREQ reporting guidelines were followed. FINDINGS: The search returned 418 results. After a first and second screen 11 papers were included. Results suggest that hub-and-spoke models were generally evaluated favourably by nursing students, with a range of benefits reported. However, many of the studies included in the review were small and of low quality. CONCLUSION: Given the exponential increase in applications to study nursing, hub-and-spoke placements appear to have the potential to better meet these increased demands, while also providing a number of benefits.

Structural injustice and dismantling racism in health and healthcare.

Racism in health and healthcare has long been recognised as a structural issue. While there has been growing research and a number of important initiatives that have come from approaching racism as a structural issue, there is a range of implications that yet have to be explored as they relate to health and healthcare. Conceptualising racism in this way provides a means to consider how it shapes and is shaped by a range of global injustices and serves as a foundation for more egregious harms. It also suggests that if we are to dismantle racism, we need to look both within and beyond the traditional domains of health and healthcare and account for a range of broader forces that sustain and re-enforce racism. We first discuss the issue of responsibility, drawing on Young's social connection model to argue that we all have a responsibility to take action in addressing structural racism. We will then deal with a question that naturally follows, namely how we discharge our responsibilities, with a focus on the role of disruptive action in challenging power and ignorance in dismantling racism in health and healthcare.

Factors influencing older nurses' decision making around the timing of retirement: An explorative mixed-method study.

AIM: This study aimed to understand factors influencing decision making of older nurses around timing of retirement. BACKGROUND: Global nursing shortages require flexible nurse retention strategies. METHODS: An explanatory sequential mixed-method approach: nurses across seven health care organisations within one integrated care system responded to an online survey (n = 524). Semistructured interviews and a focus group were conducted (n = 19). RESULTS: Survey data confirmed age as a key factor influencing nurses' decision making. Factors associated with retention were flexible working conditions, financial considerations and feeling valued. Factors associated with attrition were poor or deteriorating health, stress and wish for more time with family and friends. Logit regression confirmed that flexible work patterns are the strongest predictors for working beyond retirement. Qualitative data revealed that retirement plans are accompanied by personal milestones; the work environment heavily influences these plans. CONCLUSIONS: Reasons for retirement are multifaceted, but many factors are within the control of employers. Organisational policies, practices and workplace culture have a bearing on decisions surrounding the timing of retirement. IMPLICATIONS FOR NURSING MANAGEMENT: Retention strategies that allow older nurses to work part-time are key, and nurse managers need to proactively engage with older nurses to discuss their retirement plans.

Peer learning and collaborative placement models in health care: a systematic review and qualitative synthesis of the literature.

AIMS: To summarise the international empirical literature to provide a comprehensive overview of peer learning and collaborative practice placement models in health care and to synthesise their benefits and challenges. BACKGROUND: Practical placements for students are in high demand due to the need for an increased nursing, midwifery and health professional workforce, thus collaborative placement models are an attractive solution to potentially increase placement capacity and enhance the student learning experience. DESIGN: A systematic search of the literature and qualitative data synthesis using the PRISMA checklist and ENTREQ guidelines. REVIEW METHODS: MEDLINE and CINAHL searched in March 2020. Quality appraisal of studies conducted. Collaborative models and empirical findings summarised. Reported benefits, challenges and implementation recommendations synthesised. Two tables developed for data representation. RESULTS: 172 studies were identified by the search strategy. Of these, 47 articles were included for appraisal and synthesis. 30 articles employed qualitative, seven quantitative and ten mixed-methods approaches. Research took place in eight countries. The majority of studies employed focus groups, interviews as well as questionnaire design. The total participant sample was 3462 consisting of students and educators. CONCLUSIONS: This review confirmed that any peer learning is beneficial in supporting students' confidence and team working skills. It is especially helpful when pairing first year with third-year students. The latter can demonstrate their clinical skills and prepare for working in practice. Simultaneously, expert-led learning is important for role modelling and for the recognition of acquired skills. Evidence on the optimal placement experience is inconclusive; however, it can be concluded that any form of collaborative placement model requires careful planning and continuous preparation for staff and students. RELEVANCE TO CLINICAL PRACTICE: Decision makers should consider implementing at least some form of peer learning to assist students with peer support, and ideally work towards a collaborative learning environment.

An integrative review of the factors influencing older nurses' timing of retirement.

AIMS: To summarize the international empirical literature to provide a comprehensive understanding of older nurses' decision-making surrounding the timing of their retirement. BACKGROUND: The global nursing shortage is increasing. Among some countries it has become an economic imperative to consider raising the state pension age and to extend working lives. DESIGN: An integrative literature review using an integrated design. DATA SOURCES: MEDLINE, CINAHL and Business Source Premier databases were searched for studies between January 2007 - October 2019. REVIEW METHODS: Quality appraisal of the studies was conducted. Findings were summarized, grouped into categories and themes extracted. Two models were developed for data representation. RESULTS: A total of 132 studies were identified by the search strategy. Of these, 27 articles were included for appraisal and synthesis. Sixteen papers were quantitative, seven qualitative, and four mixed methods. The research took place in 13 different geographical locations. Most studies were of a questionnaire design, followed by interviews and focus groups. The total participant sample was 35,460. Through a synthesis of the studies, four themes were identified: Health, Well-being, and Family factors; Employer factors; Professional factors; and Financial factors. CONCLUSION: This review not only revealed the heterogeneity of studies on this subject and confirmed previous findings but also established a ranking of criteria that influences nurses' decision-making: age, followed by personal and organizational factors. Four extracted themes of push and pull factors map onto these factors. No 'one-size-fits-all' strategy exists to ensure the extension of older nurses' working lives. Organizations need to foster an environment where older nurses feel respected and heard and where personal and professional needs are addressed. IMPACT: Organizations need to implement HR policies addressing nurses' personal well-being and retirement preparation. Older nurses are more likely to extend their working lives if they feel committed to their organization and when professional standards are maintained.

Decisions on eating and drinking in older adults admitted with pneumonia and referred for swallowing difficulties.

PURPOSE: Older patients with pneumonia are commonly restricted from oral intake due to concerns towards aspiration. Eating and drinking with acknowledged risks (EDAR) is a shared decision-making process emphasising patient comfort. As part of our project to find the barriers and facilitators of EDAR, we aimed for this initial study to see how frequently EDAR was selected in practice. METHODS: We performed a retrospective cohort study at an acute hospital where EDAR was initially developed, of patients aged ≥ 75 years-old admitted with pneumonia and referred to speech and language therapy. RESULTS: Out of 216 patients, EDAR decisions were made in 14.4%. The EDAR group had a higher 1-year mortality than the modified/normal diet groups (p < 0.001). Pneumonia recurrence rate did not differ significantly between the groups (p = 0.070). CONCLUSION: EDAR decisions were comparatively less common and most were associated with end-of-life care. Underlying reasons for the low EDAR application rate must be investigated to maximise patient autonomy and comfort as intended by EDAR while minimising staff burden.

Health Related Quality of life Amongst Refugees: A meta Analysis of Studies Using the SF-36.

The health of refugees has been widely documented, as has the impact of a range of factors throughout the migration journey from being exposed to violence to the impacts of immigration detention. This study adds to our understanding of health-related quality of life amongst refugees and asylum seekers by evaluating health-related quality of life as measured by the Short-Form 36 (SF-36) Health Survey using meta-analysis. The aims of this study were to (1) provide a summary and overview of health-related quality of life (as measured by the SF-36), including the extent to which this varies and (2) explore the factors that influence health-related quality of life (as measured by the SF-36) amongst refugees and asylum seekers. A search was undertaken of MEDLINE, CINAHL, PSYCINFO and SCOPUS, returning 3965 results. Papers were included if they sampled refugees (or asylum seeker or those with refugee-like experiences) and used the SF-36 (or its variants) as an outcome measure. Mean scores and standard deviations were pooled using a random effects model. The pooled sample size was 18,418. The pooled mean scores for the SF-36 physical summary measures was 54.99 (95% CI 46.01-63.99), while the mental health summary measure was 52.39 (95% CI 43.35-61.43). The pooled mean scores for each of the sub-scales ranged from 49.6 (vitality) to 65.54 (physical functioning). High heterogeneity was found between both summary measures and all sub-scales. In comparison to SF-36 results from general populations in high and middle income countries, these results suggest that refugee quality of life is generally poorer. However, this varied substantially between studies. One issue that is not well clarified by this review are the factors that contributed to health-related quality of life.

A systematic scoping review on the evidence behind debriefing practices for the wellbeing/emotional outcomes of healthcare workers.

Introduction: Debriefings give healthcare workers voice through the opportunity to discuss unanticipated or difficult events and recommend changes. The typical goal of routine debriefings has been to improve clinical outcomes by learning through discussion and reflection of events and then transferring that learning into clinical practice. However, little research has investigated the effects of debriefings on the emotional experiences and well-being of healthcare workers. There is some evidence that debriefings are a multi-faceted and cost-effective intervention for minimising negative health outcomes, but their use is inconsistent and they are infrequently adopted with the specific intention of giving healthcare workers a voice. The purpose of this systematic scoping review is therefore to assess the scope of existing evidence on debriefing practices for the well-being and emotional outcomes of healthcare workers. Methods: Following screening, 184 papers were synthesised through keyword mapping and exploratory trend identification. Results: The body of evidence reviewed were clustered geographically, but diverse on many other criteria of interest including the types of evidence produced, debriefing models and practices, and outcomes captured. Discussion: The current review provides a clear map of our existing understanding and highlights the need for more systematic, collaborative and rigorous bodies of evidence to determine the potential of debriefing to support the emotional outcomes of those working within healthcare. Systematic Review Registration: https://osf.io/za6rj.

Collaborative Learning in Practice (CLiP) in a London maternity ward-a qualitative pilot study.

OBJECTIVES: Collaborative Learning in Practice (CLiP) is one way of addressing an increase in student placement capacity and potentially improving the student learning experience overall. The aim of this article is to report the findings of a CLiP pilot study undertaken in a London hospital maternity ante- and postnatal ward. DESIGN: A qualitative explorative study design employing a descriptive online survey and individual semi-structured interviews to evaluate the experiences. SETTING: A London based hospital maternity ante- and postnatal ward PARTICIPANTS: seven midwifery students from a mix of years (1-3) and six staff (all trained midwives) METHODS: The survey results and interview data were transcribed and thematically analysed to identify the barriers and enablers for CLiP RESULTS: Three themes emerged from the data: 1. Preparation for the CLiP pilot, 2. Peer-learning and collaboration as support and resource, 3. Independence and trust as drivers for learning. CONCLUSIONS: The results are in-line with previously conducted CLiP studies. This study contributes to the findings around the set-up of CLiP in a demanding London maternity ward. It demonstrates that adequate preparation is vital, including the role of the CLiP educator to raise awareness, provide training and to support CLiP midwives. The CLiP hour appears beneficial since it offers protected reflection time. CLiP appeared to increase the clinical confidence of students, particularly more experienced students, through peer learning and independence. Larger-scale research is needed.