Crossing the 'flaky bridge' - the initial transitory experiences of qualifying as a paramedic: a mixed-methods study.

Introduction: Newly qualified paramedics (NQPs) may experience emotional turbulence as they transition to professional practice. This may negatively affect confidence and have an adverse effect on attrition. This study highlights the initial transitory experiences of NQPs. Methods: The study utilised a mixed-methods convergent design. Qualitative and quantitative data were collected simultaneously and triangulated to more fully interpret participants' experiences. A convenience sample of 18 NQPs from one ambulance trust was used. The Connor-Davidson Resilience 25-point Scale questionnaire (CD-RISC25) was administered and analysed using descriptive statistics. Semi-structured interviews were conducted simultaneously and analysed using Charmaz's constructivist grounded theory approach. Data were collected from September to December 2018. Results: There was a range of resilience scores, with a mean of 74.7/100 (standard deviation 9.6). Factors relating to social support were scored highly, and factors relating to determinism and spirituality were scored lower. Qualitative data constructed a process whereby participants were navigating a new identity across three spheres simultaneously: professional, social and personal identity. Attending a catalyst event such as a cardiac arrest was a trigger for starting to navigate this process. Participants had different pathways through this transitional period. Participants who found this process particularly turbulent seemed to have lower resilience scores. Conclusion: The transition from student to NQP is an emotionally turbulent time. Navigating a changing identity seems to be at the centre of this turbulence, and this is triggered by a catalyst event such as attending a cardiac arrest. Interventions which support the NQP in navigating this change in identity, such as group supervision, may improve resilience and self-efficacy and reduce attrition.

Achieving culturally competent mental health care: A mixed-methods study drawing on the perspectives of UK nursing students.

PURPOSE: This study aimed to examine the degree of cross-cultural competency among UK mental health student nurses, and the care delivery challenges arising from their internalized cultural assumptions. DESIGN AND METHODS: This study adopted a mixed-methods design. Participants were final-year nursing students in the United Kingdom. FINDINGS: The results revealed participants had a moderate level of cultural awareness and competency but highlighted many challenges to providing cross-cultural care arising from the meanings, enablers, and values they attributed to culturally competent mental health care. PRACTICE IMPLICATIONS: As cultural competency is considered an essential characteristic of effective nursing care, greater attention should be paid to how student nurses assimilate cultural awareness to develop confidence in their day-to-day practice.

Stress at work: Factors associated with cognitive disorganisation among private sector professionals.

This study explores psychological and psychological variables associated with perceived stress at work. A total of 100 international participants consented to donating a hair sample and completing a work-related stress survey. Logistic regression was used to investigate associations with low/high cognitive disorganisation using data collected from hair cortisol analysis and self-report questionnaires. High cognitive disorganisation scores were associated with high cardiopulmonary and anger scores. Low perceived self-efficacy was associated with high cognitive disorganisation. An association was found between low cortisol and low perceived self-efficacy. The relationship between high cognitive disorganisation and low self-efficacy endorses previous claims linking performance to perceived high self-efficacy.

Nurses' perceptions of self-management in renal care.

Self-management is vital for patients with long-term conditions in order to ensure wellbeing. It needs to be supported by a healthcare workforce who are knowledgeable and able to work in collaboration with individuals. In this study, ten nurses were selected by means of exclusion/inclusion criteria and then interviewed with a semi-structured approach. Following analysis of the data with an open, axial and selective coding process, clear themes emerged: expectation of roles, lack of confidence and concerns with risk-taking. There were a number of concerns around engaging with self-management for this group of nurses, including a lack of knowledge and skills to assess the suitability of patients for self-management and subsequently to offer support, and concerns that self-management would be too unsafe in a renal setting. This study suggests that nurses would need education in strategies to support and implement self-management. Further studies should be undertaken to explore this possibility with renal patients admitted to the ward.

Personal change amongst mental health nursing students: a longitudinal study.

BACKGROUND: Studies into the socialisation of nursing students have tended to concentrate on entrant's reactions to work and on the development of knowledge and skills in relation to a particular occupational culture. However, the extent and manner of personal and psychological changes experienced by mental health nursing students during occupational socialisation have yet to be thoroughly addressed in the literature. OBJECTIVES: To explore the psychological and personal changes of student mental health nurses over the first 2 years of their pre-registration mental health nursing programme. DESIGN: Students from 2 mental health nursing cohorts at a London university were invited to participate. A semi-structured interview was used and the participants were asked to talk openly about their experiences. Ethics approval and informed consent was sought and obtained. PARTICIPANTS: 20 students were selected at random and invited to be interviewed on 5 occasions over a 2 year period at roughly 6 month intervals. METHODS: A total of 72 interviews were conducted. Interviews were tape recorded and verbatim transcribed for quantitative and qualitative content analyses. RESULTS: Participants described moving from feeling uncertain, to increasing awareness and understanding of self and others, and, ultimately, feeling more accomplished in relation to their occupational world. CONCLUSIONS: This study has highlighted the need for supporting students in developing their confidence and perceptions of self-efficacy and of recognising individual differences in student's responses to uncertainty.

Perceiving risk in dangerous situations: risks of violence among mental health inpatients.

BACKGROUND: Violence in British psychiatric hospitals appears to be escalating, with nursing staff the most frequent victims of assault. There is also public concern about violence on the part of individuals with mental health problems. In this climate, assessing a patient's risk of violent behaviour has become an important part of mental health care. However, little research has been published into how mental health nurses undertake such assessments in their day-to-day clinical practice. AIM: The study focused on how mental health nurses make assessments of risk in clinical crisis situations where there is a perceived likelihood of imminent violence. The study sought to identify skills, cognitive processes or any other mechanisms which nurses draw upon to assist in such assessments. METHOD: Ten experienced mental health nurses working in a secure mental health environment were interviewed and data generated was analysed using a grounded theory approach. An in-depth literature search was also undertaken. FINDINGS: It was found that, in their risk assessments, nurses rely extensively on their personal knowledge of their patients (in particular, previous history of violent behaviour; biographical data; and impact of the mental health problem on violent behaviour). Nurses 'tune in' to potentially violent situations by observing a scenario as a whole, as well as specific aspects of a patient's behaviour, whilst also searching for causes of the violent behaviour. In making clinical risk assessments, nurses often make rapid, intuitive judgements in which various possibilities are considered regarding the likelihood of violent behaviour (such as the capacity and capability of a patient to be violent and the potential in the situation). It was also found that the ability to intervene successfully in potentially violent situations reduced the level of risk that nurses felt exposed to, and here nurses draw on their knowledge of a particular patient. They also perceive lower levels of risk when working in a skilled team. CONCLUSION: The study indicates that the development of nurse-patient relationships and working in a supportive team are perceived as protective factors against risk. Implications of the research are discussed in relation to nurse-patient relationships, particularly in the context of the current nursing climate and the way in which violent behaviour may lead to an erosion of these relationships. The importance of 'working in a team' is discussed, as is the consequence of the findings for education and development. Methodological limitations of the study are also discussed.