Implementing and assessing the value of nursing preceptorship.

Preceptorship was first promoted as part of the Project 2000 reforms, and evidence suggests it remains valuable to newly qualified nurses. Although there is a lack of research of its effect on patient care, what research there is highlights various positive aspects of preceptorship programmes for newly qualified nurses, preceptors, and organisations. This article summarises the results of a scoping review of the literature, published since 2009, on preceptorship. It also describes a preceptorship initiative in London led by Health Education England.

An integrative literature review of psychosocial factors in the transition to parenthood following non-donor-assisted reproduction compared with spontaneously conceiving couples.

The paper reports an integrative literature review of research into the psychosocial factors which shape the transition to parenthood in couples following non-donor in vitro fertilization in comparison with those conceiving spontaneously. Nineteen papers of non-donor IVF and SC mothers and fathers were included. Differences between groups were reported for a range of psychosocial measures during the transition from pregnancy to parenthood including: the control couples feel they have over their lives (locus of control), parental adjustment and child behaviour, parental stress, parental investment in the child, self-esteem and self-efficacy, greater levels of protectiveness (separation anxiety) towards child, marital and family functioning, family alliance, marital satisfaction and communication, as well as anxiety, indirect aggression and lowered respect for the child. We have conceptualised these differences as three substantive themes which reflect psychosocial factors shaping transition to parenthood in parents after non-donor AR: namely social support, relationships and emotional well-being, which are in turn influenced by gender differences. These findings have implications for health care professionals' assessment of individual couples' support needs.

Experiences of Oncology and Palliative Care Nurses When Supporting Parents Who Have Cancer and Dependent Children.

BACKGROUND: It is important not to ignore the impact of parental cancer on children, and this is where oncology and palliative care nurses can play a key role, providing support to parents as a regular aspect of oncological nursing care. OBJECTIVES: This study explored the experience, needs, and confidence of nurses working in acute cancer services when supporting parents with cancer who have dependent children. METHODS: Two focus group interviews were conducted with oncology and palliative care nurses in 1 acute hospital trust in the south of England. RESULTS: Nurses described how they identified with their patients as a parent themselves. This identification with patients added to the emotionally charged context of care and resulted in nurse avoidance of the troubling issue of dependent children. Nurses identified the importance of peer support with regular opportunities to reflect on practice when dealing with issues relevant to parents and children. CONCLUSIONS: Oncology and palliative care nurses take a reactive approach to family centred care, taking their cue from patients to initiate or request support for their children. IMPLICATIONS FOR PRACTICE: Guidance was needed on children's developmental stages and how to communicate with children of different ages. In addition, guidance was needed on assessing family needs and access to up to date resources. To enable nurses to engage with the issue of children, strategies of peer support and further educational opportunities need to be implemented.

Breaking significant news: The experience of clinical nurse specialists in cancer and palliative care.

PURPOSE: The aim of the research was to explore specialist cancer and palliative care nurses experience of delivering significant news to patients with advanced cancer. METHOD: A qualitative phenomenological research study was conducted to capture nurses' experiences with the aim of understanding how cancer and palliative care clinical nurse specialists work towards disclosure of advanced and terminal cancer. Data were collected through semi-structured interviews with 10 clinical nurse specialists working in one acute NHS trust. Clinical nurse specialists were recruited from the following specialities: lung cancer, breast cancer, gynaecological cancer, upper and lower gastrointestinal cancer and palliative care. RESULTS: Four themes emerged from the data: importance of relationships; perspective taking; ways to break significant news; feeling prepared and putting yourself forward. The findings revealed that highly experienced clinical nurse specialists (CNSs) felt confident in their skills in delivering significant news and they report using patient centred communication to build a trusting relationship so significant news was easier to share with patients. CNSs were aware of guidelines and protocols for breaking significant and bad news but reported that they used guidelines flexibly and it was their years of clinical experience that enabled them to be effective in disclosing significant news. Some areas of disclosure were found to be challenging in particular news of a terminal prognosis to patients who were of a younger age. CONCLUSION: CNSs have become more directly involved in breaking significant news to those with advanced cancer by putting themselves forward and feeling confident in their skills.

Gatekeeping access to the midwifery unit: Managing complaints by bending the rules.

While poor communication between service users and front-line staff causes many service user complaints in the British National Health Service, staff rarely reflect on the causes of these complaints. We discuss findings from an action research project with midwives which suggest that the midwives struggled to fully understand complaints from women, their partners and families particularly about restricted visiting and the locked door to the midwifery unit. They responded to individual requests to visit out of hours while maintaining the general policy of restricted visiting. In this way, the door was a gatekeeping device which allowed access to the unit within certain rules. The locked door remained a barrier to women and their families and as a result was a common source of informal complaints. We argue that the locked door and restricted visiting to the midwifery unit were forms of gatekeeping and boundary making by midwives which reveals a tension between their espoused woman-centred care and contemporary midwifery practice which is increasingly constrained by institutional values.