It's not just 'What' you do, it's also the 'Way' that you do it: Patient and Public Involvement in the Development of Health Research.

PURPOSE: This article presents a reflective account of Patient and Public Involvement (PPI) in the development of obesity and binge eating research. METHOD: We established Patient Advisory Groups (PAGs) at two English regional National Health Service (NHS) weight management services. PPI was evaluated as follows: (i) PAG members completed a Post Participation Evaluation Questionnaire, (ii) PAG meetings captured group discussion on PPI involvement, (iii) practitioner and researchers produced written reflections on PPI and (iv) sources one to three were consolidated during reflections that took place via e-mail and telephone correspondence between researchers and practitioners, culminating in a summary SKYPE meeting between one practitioner and one researcher involved in the PAGs. RESULTS: Results in the form of reflections suggest guidelines on undertaking PPI were helpful with regard 'what to do', but less helpful on 'how'. For example, suggestions for the management of interpersonal factors such as eliciting self-disclosure and managing power differentials are insufficiently addressed in existing guidelines. CONCLUSIONS: The present case study illustrated how interpersonal considerations can help or hinder the optimal use of PPI. Recommendations for practitioners and researchers planning PPI are offered.

Peer support for CKD patients and carers: overcoming barriers and facilitating access.

BACKGROUND: Peer support is valued by its users. Nevertheless, there is initial low take-up of formal peer support programmes among patients with chronic kidney disease (CKD), with fewer patients participating than expressing an interest. There is little evidence on reasons for low participation levels. Few studies have examined the perspectives of carers. OBJECTIVE: To explore with CKD patients and carers their needs, wants and expectations from formal peer support and examine how barriers to participation may be overcome. METHODS: Qualitative interviews with a sample of 26 CKD stage five patients and carers. Principles of Grounded Theory were applied to data coding and analysis. SETTING: Six NHS Hospital Trusts. RESULTS: Whilst informal peer support might occur naturally and is welcomed, a range of emotional and practical barriers inhibit take-up of more formalized support. Receptivity varies across time and the disease trajectory and is associated with emotional readiness; patients and carers needing to overcome complex psychological hurdles such as acknowledging support needs. Practical barriers include limited understanding of peer support. An attractive peer relationship is felt to involve reciprocity based on sharing experiences and both giving and receiving support. Establishing rapport is linked with development of reciprocity. CONCLUSIONS: There is potential to facilitate active uptake of formal peer support by addressing the identified barriers. Our study suggests several facilitation methods, brought together in a conceptual model, including clinician promotion of peer support as an intervention suitable for anyone with CKD and their carers, and opportunity for choice of peer supporter.

Manipulating mentors' assessment decisions: Do underperforming student nurses use coercive strategies to influence mentors' practical assessment decisions?

There is growing evidence of a culture of expectation among nursing students in Universities which leads to narcissistic behaviour. Evidence is growing that some student nurses are disrespectful and rude towards their university lecturers. There has been little investigation into whether they exhibit similar behaviour towards their mentors during practical placements, particularly when they, the students, are not meeting the required standards for practice. This paper focuses on adding to the evidence around a unique finding - that student nurses can use coercive and manipulative behaviour to elicit a successful outcome to their practice learning assessment (as noted in Hunt et al. (2016, p 82)). Four types of coercive student behaviour were identified and classified as: ingratiators, diverters, disparagers and aggressors, each of which engendered varying degrees of fear and guilt in mentors. The effects of each type of behaviour are discussed and considered in the light of psychological contracts. Mechanisms to maintain effective working relationships between student nurses and mentors and bolster the robustness of the practical assessment process under such circumstances are discussed.

Failing securely: The processes and support which underpin English nurse mentors' assessment decisions regarding under-performing students.

BACKGROUND: This study was undertaken in response to concerns that mentors who assessed practical competence were reluctant to fail student nurses which generated doubts about the fitness to practise of some registered nurses. Limited evidence was available about the experiences of mentors who had failed underperforming students and what had helped them to do this. AIM: To investigate what enabled some mentors to fail underperforming students when it was recognised that many were hesitant to do so. METHOD: An ethically approved, grounded theory approach was used to explore thirty-one nurses' experiences of failing student nurses in practical assessments in England. Participants were recruited using theoretical sampling techniques. Semi-structured interviews were conducted. Analysis was undertaken using iterative, constant comparative techniques and reflexive processes. The theoretical framework which emerged had strong resonance with professionals. FINDINGS: Five categories emerged from the findings: (1) Braving the assessment vortex; (2) Identifying the 'gist' of underperformance; (3) Tempering Reproach; (4) Standing up to scrutiny; and (5) Drawing on an interpersonal network. These categories together revealed that mentors needed to feel secure to fail a student nurse in a practical assessment and that they used a three stage decision making process to ascertain if this was the case. Many of the components which helped mentors to feel secure were informal in nature and functioned on goodwill and local arrangements rather than on timely, formal, organisational systems. The mentor's partner/spouse and practice education facilitator or link lecturer were identified as the key people who provided essential emotional support during this challenging experience. CONCLUSION: This study contributes to understanding of the combined supportive elements required for robust practical assessment. It presents a new explanatory framework about how mentors formulate the decision to fail a student nurse and the supportive structures which are necessary for this to occur.

Assessment of student nurses in practice: a comparison of theoretical and practical assessment results in England.

This study was undertaken in response to concerns raised by Duffy (2003) that assessors of practice were reluctant to fail student nurses in assessments. This generated doubts about the fitness to practice of some registered nurses. An investigation was undertaken into whether quantitative evidence supported the view that pre-registration nurses rarely failed practical assessments. Comparative failure rates from theoretical and practical assessments were requested from all 52 universities in England that offered pre-registration nursing programmes. Responses were received from 27. Findings indicated that a very small proportion of students failed practical assessments; failure rates for theory outstripped practice by a ratio of 5:1. A quarter of universities failed no students in practice. Students were most likely to fail in year one and least likely in year three. This study supports the belief that assessors of practice are reluctant to fail student nurses. It raises a number of questions about the influence that the systems and practices of professional bodies and universities have on practical assessment. However it also indicates that some student nurses have failed practical assessments and that some universities do have systems in place to address this issue.

No room for reflexivity? Critical reflections following a systematic review of qualitative research.

We conducted a systematic search of qualitative research into the individual's experience of chronic low back pain. Two reviewers independently read through 740 unique abstracts. Inter-rater reliability was fair. The final sample comprised 19 articles which we critiqued using the Critical Appraisal Skills Programme checklist. This article focuses on the critical appraisal. Limitations include a lack of an adequate rationale for the theoretical framework, a lack of an account for the decisions made across recruitment and data collection, and a lack of reflexivity. Finally we discuss and offer recommendations for reflexivity and the explication of qualitative methodology in research articles.

Using a storyboarding technique in the classroom to address end of life experiences in practice and engage student nurses in deeper reflection.

This paper evaluates the use of storyboarding within a classroom setting as a means of addressing end of life issues and engaging second year student nurses in creative, critical thinking and deeper reflection on practice. Storyboarding is a process that was developed to encourage learners to use the creative right brain and the critical left brain to formulate ideas in front of a group and then to look at those ideas critically (Lottier, 1986). The session was evaluated using a questionnaire and group discussion to elicit perceived learning from students. The activity was to create the storyboards in small groups, then review the content generated by discussion with the whole group. Main themes identified by the students included breaking bad news, dealing with cardiac arrest situation, coping with families following bereavement and the dying patient. Evaluation of the teaching session suggested that students found storyboarding helped to identify cultural aspects and feelings related to the dying patient. Students valued sharing with each other and the opportunity to have their experiences heard. It was noted that although this method provided as valuable learning experience for the student it is staff and time intensive and attention is required to establish a climate of trust and safety. The risk of exposing unexpected emotions within individual students appears no greater than with other approaches to teaching about loss, death and dying.

Service user and carer involvement in learning and teaching: a faculty of health staff perspective.

As part of a larger evaluation study, 20 members of staff in a Faculty of Health were interviewed about the impact of service user and carer involvement on learning and teaching. A qualitative approach was adopted and semi-structured interviews were used to explore current levels of involvement, barriers and solutions. The data generated was analysed using the principles of grounded theory. Findings suggest respondents recognised the requirement to involve service users and carers in their learning activities. Most wanted to develop this aspect of their educational provision but a number of barriers were described. Strategic and operational solutions were proposed to overcome these and respondents were positive about achieving meaningful involvement.