'Fix the issues at the coalface and mental wellbeing will be improved': a framework analysis of frontline NHS staff experiences and use of health and wellbeing resources in a Scottish health board area during the COVID-19 pandemic.

BACKGROUND: Frontline healthcare staff working in pandemics have been reported to experience mental health issues during the early and post-peak stages. To alleviate these problems, healthcare organisations have been providing support for their staff, including organisational, cognitive behavioural and physical and mental relaxation interventions. This paper reports the findings of a study commissioned by a Scottish NHS health board area during the initial outbreak of COVID-19. The study aimed to understand the experience of NHS staff relating to the provision of wellbeing interventions between March and August 2020. METHODS: Data were gathered from free-text comments of eight surveys completed by a wide range of staff across sites within one NHS health board in Scotland. We conducted a framework analysis of the data. RESULTS: Our findings show that despite the provision of relaxational and cognitive behavioural interventions to support staff wellbeing during the early months of the COVID-19 pandemic, there were barriers to access, including heavy workload, understaffing, inconvenient locations and the stigma of being judged. Organisational factors were the most frequently reported support need amongst frontline staff across sites. CONCLUSIONS: While relaxational and cognitive behavioural interventions were well received by staff, barriers to accessing them still existed. Staff support in the context of organisational factors, such as engagement with managers was deemed as the most important for staff wellbeing. Managers play a key role in everyday organisational processes and therefore are in the right position to meet increasing frontline staff demands due to the pandemic and removing barriers to accessing wellbeing support. Healthcare managers should be aware of organisational factors that might increase job demands and protect organisational resources that can promote wellbeing for frontline staff.

'It was quite a shock': A qualitative study of the impact of organisational and personal factors on newly qualified nurses' experiences.

AIMS AND OBJECTIVES: To explore how newly qualified nurses' work experiences are constructed through the interplay between self, workplace and home-life influencing their retention. BACKGROUND: Nurses are critical to achieving the goal of universal health coverage. However, shortages of nursing staff are endemic. Of particular concern, newly qualified nurses are more likely to leave the nursing workforce. The point of transition to working as a newly qualified nurse is a time of vulnerability. Most studies attempt to discover why nurses leave. This study uses the concept of job embeddedness to examine the experience of this transition and first two years of practice to understand what might help newly qualified nurses stay. DESIGN: Qualitative approach using semi-structured telephone interviews. METHODS: Self-selecting sample of nurses (n = 23) who participated 1-year (n = 12) and 2 years (n = 11) post-qualification. Participants were part of a larger longitudinal cohort (n = 867) study which has followed them since September 2013 when they entered nurse education in two Scottish universities. Thematic analysis was used to understand the interplay between organisation/workplace and the individual. RESULTS: Three themes were developed: transition shock; workplace factors and work/life balance. Two further subthemes were developed: experience of support and belonging; and feeling unsupported and alienated. Eight participants had changed job or left, and two were looking to leave nursing. CONCLUSION: This study highlights how the experience of transition shock can be positively or negatively impacted by the workplace environment, and how in turn this impacts the home environment. Ultimately, this impacts retention of newly qualified nurses. RELEVANCE TO CLINICAL PRACTICE: Having adequate support resources, such as staffing, supportive team morale, professional development and family-friendly work environment, can create a work environment where they feel the purpose and meaningfulness of working as a nurse. This 'job embeddedness' can potentially enhance nurse retention. Reporting follows the COREQ checklist.

Understanding HIV-positive drug users' experiences of taking highly active antiretroviral treatment: Identity-Values-Conscious engagement model.

AIM: To explore HIV-positive drug users' experiences of taking antiretroviral medications in Taiwan and further develop a conceptual model that can be used to understand their adherence to the long-term treatment. BACKGROUND: The global vision of ending AIDS by 2030 cannot be achieved without addressing HIV-positive drug users' experience of taking antiretroviral treatment. There remains a paucity of qualitative evidence on HIV-positive drug users' experiences of taking antiretroviral medications globally and in East Asia. Nurses play a key role in supporting HIV-positive drug users throughout their treatment process. Therefore, it is pivotal to understand HIV-positive drug users' experiences of managing long-term anti-HIV treatment. DESIGN: This qualitative study drew on a constructivist grounded theory approach to achieve the aims. Semi-structured in-depth interviews with 22 HIV-positive drug users were conducted in Taiwan between September 2015 and July 2016. Data were analysed using Charmaz's coding principles. The integration and formation of the model began with focused coding and proceeded through the subsequent analytic process. The reporting of this study was based on the Consolidated Criteria for Reporting Qualitative Research checklist. RESULTS: This study shows that integrating HIV-positive identity into sense of self laid a solid foundation for the acceptance of self and antiretroviral treatment. Valuing of antiretroviral treatment played a central role in driving their medication-taking behaviour. While valuing the treatment appeared to drive participants' behavioural change, data revealed that conscious engagement was an important element for their behaviour maintenance. CONCLUSION: The evidence from this study can extend our knowledge of the mechanisms that influence the change and maintenance of HIV-positive drug users' adherence to antiretroviral treatment. RELEVANCE TO CLINICAL PRACTICE: The Identity-Values-Conscious engagement model developed and proposed in this study can serve as a guide for the development of tailored adherence assessment and associated nursing interventions for this population.

The relationship between emotional intelligence, previous caring experience and successful completion of a pre-registration nursing/midwifery degree.

AIM: To examine the relationship between baseline emotional intelligence and prior caring experience with completion of pre-registration nurse and midwifery education. BACKGROUND: Selection and retention of nursing students is a global challenge. Emotional intelligence is well-conceptualized, measurable and an intuitive prerequisite to nursing values and so might be a useful selection criterion. Previous caring experience may also be associated with successful completion of nurse training. DESIGN: Prospective longitudinal study. METHOD: Self-report trait and ability emotional intelligence scores were obtained from 876 student nurses from two Scottish Universities before they began training in 2013. Data on previous caring experience were recorded. Relationships between these metrics and successful completion of the course were calculated in SPSS version 23. RESULTS: Nurses completing their programme scored significantly higher on trait emotional intelligence than those that did not complete their programme. Nurses completing their programme also scored significantly higher on social connection scores than those that did not. There was no relationship between "ability" emotional intelligence and completion. Previous caring experience was not statistically significantly related to completion. CONCLUSION: Students with higher baseline trait emotional intelligence scores were statistically more likely to complete training than those with lower scores. This relationship also held using "Social connection" scores. At best, previous caring experience made no difference to students' chances of completing training. Caution is urged when interpreting these results because the headline findings mask considerable heterogeneity. Neither previous caring experience or global emotional intelligence measures should be used in isolation to recruit nurses.

Mental health nurses' experiences of managing work-related emotions through supervision.

AIM: The aim of this study was to explore emotion cultures constructed in supervision and consider how supervision functions as an emotionally safe space promoting critical reflection. BACKGROUND: Research published between 1995-2015 suggests supervision has a positive impact on nurses' emotional well-being, but there is little understanding of the processes involved in this and how styles of emotion interaction are established in supervision. DESIGN: A narrative approach was used to investigate mental health nurses' understandings and experiences of supervision. METHODS: Eight semi-structured interviews were conducted with community mental health nurses in the UK during 2011. Analysis of audio data used features of speech to identify narrative discourse and illuminate meanings. A topic-centred analysis of interview narratives explored discourses shared between the participants. This supported the identification of feeling rules in participants' narratives and the exploration of the emotion context of supervision. FINDINGS: Effective supervision was associated with three feeling rules: safety and reflexivity; staying professional; managing feelings. These feeling rules allowed the expression and exploration of emotions, promoting critical reflection. A contrast was identified between the emotion culture of supervision and the nurses' experience of their workplace cultures as requiring the suppression of difficult emotions. Despite this, contrast supervision functioned as an emotion micro-culture with its own distinctive feeling rules. CONCLUSIONS: The analytical construct of feeling rules allows us to connect individual emotional experiences to shared normative discourses, highlighting how these shape emotional processes taking place in supervision. This understanding supports an explanation of how supervision may positively influence nurses' emotion management and perhaps reduce burnout.

Emotional Intelligence and Nurse Recruitment: Rasch and confirmatory factor analysis of the trait emotional intelligence questionnaire short form.

AIM: To examine the construct validity of the Trait Emotional Intelligence Questionnaire Short form. BACKGROUND: Emotional intelligence involves the identification and regulation of our own emotions and the emotions of others. It is therefore a potentially useful construct in the investigation of recruitment and retention in nursing and many questionnaires have been constructed to measure it. DESIGN: Secondary analysis of existing dataset of responses to Trait Emotional Intelligence Questionnaire Short form using concurrent application of Rasch analysis and confirmatory factor analysis. METHOD: First year undergraduate nursing and computing students completed Trait Emotional Intelligence Questionnaire-Short Form in September 2013. Responses were analysed by synthesising results of Rasch analysis and confirmatory factor analysis. RESULTS: Participants (N = 938) completed Trait Emotional Intelligence Questionnaire Short form. Rasch analysis showed the majority of the Trait Emotional Intelligence Questionnaire-Short Form items made a unique contribution to the latent trait of emotional intelligence. Five items did not fit the model and differential item functioning (gender) accounted for this misfit. Confirmatory factor analysis revealed a four-factor structure consisting of: self-confidence, empathy, uncertainty and social connection. All five misfitting items from the Rasch analysis belonged to the 'social connection' factor. CONCLUSIONS: The concurrent use of Rasch and factor analysis allowed for novel interpretation of Trait Emotional Intelligence Questionnaire Short form. Much of the response variation in Trait Emotional Intelligence Questionnaire Short form can be accounted for by the social connection factor. Implications for practice are discussed.

Challenges and possible solutions for accessing scholarly literature among medical and nursing professionals and students in low-and-middle income countries: A systematic review.

BACKGROUND: Access to high quality research literature is essential for educating nursing and healthcare students to promote evidence-based practice. Within Low- and Middle-Income countries (LMICs) access is limited due to financial and structural constraints within countries and institutions. Reduced access to research literature limits the achievement of the Sustainable Development Goals through its impact on the education of healthcare staff and on the development of contextually appropriate evidence for practice. OBJECTIVE: To identify the challenges and possible solutions for accessing scholarly literature among medical and nursing professionals and students in low-and-middle income countries. DESIGN: Systematic review. DATA SOURCES: Searches were conducted in MEDLINE, CINAHL PLUS, ERIC, ASSIA, EMBASE, and Google Scholar. REVIEW METHODS: Five bibliography databases were searched using relevant search terms, from January 2002 to July 2022. Additional searches were carried out in Google Scholar. Titles, abstracts, and full texts were independently screened by at least two authors, based on predefined eligibility criteria. Pertinent data were extracted from included studies, and critical appraisal was undertaken. Data were analysed and presented in a narrative approach. RESULTS: Five papers met the inclusion criteria and were included. Three aspects of challenges at different levels emerged: infrastructure and institutional level factors, individual factors, and lack of contextually appropriate evidence. Three solutions were identified: capacity development opportunities, improving Internet access, and increasing awareness of free resources. CONCLUSION: This review provides an overview of common barriers medical and nursing professionals and students encounter whilst accessing scholarly literature in LMICs and identifies some possible solutions to address them. The findings can be used to guide institutions, as well as national and international decision makers to elicit policy which can promote the uptake of research in LMICs. Further research should focus on how these solutions could be harnessed to address the problems identified in this review.

Men's perspectives of caring for a female partner with cancer: A longitudinal narrative study.

Increasing evidence on men's involvement in informal, unpaid care has not transferred to the research literature around men's experiences. The aim was to explore the perspectives of men who are caring for a female partner with cancer over 1 year. Longitudinal narrative interviews (n = 22) were conducted with eight men in the UK from 2018 to 2019. Participants were aged from 32 to 76 years old, were all white British and in heterosexual relationships with women diagnosed with a range of cancer types. Interviews were transcribed and then analysed using a structural and performance approach to narrative analysis. We present, across four scenes, a process of change, transition and emotion management as the men were launched into a role that came with new responsibilities and expectations. Our study advances knowledge by highlighting the way that men perform and reflect on their negotiation with masculine discourses while supporting their partner, with implications for policy, research and practice.

Understanding equality and diversity in nursing practice.

Equality and diversity are terms that are used frequently in nursing, healthcare and workplace settings. Nurses' professional standards of practice and behaviour are underpinned by values of equality and diversity. This means that nurses must treat people as individuals, avoid making assumptions about them, recognise diversity and individual choice, and respect and uphold their dignity and human rights. This article explores what equality and diversity mean in nursing practice, the legal framework that underpins these terms, and the inequalities and discrimination that patients and staff may experience in health and social care settings. It discusses the role of organisational culture in supporting nurses to uphold the values of equality and diversity and encourages nurses to reflect on this topic to enhance their practice.

A two-arm parallel-group individually randomised prison pilot study of a male remand alcohol intervention for self-efficacy enhancement: the APPRAISE study protocol.

INTRODUCTION: The prevalence of at-risk drinking is far higher among those in contact with the criminal justice system (73%) than the general population (35%). However, there is little evidence on the effectiveness of alcohol brief interventions (ABIs) in reducing risky drinking among those in the criminal justice system, including the prison system and, in particular, those on remand. Building on earlier work, A two-arm parallel group individually randomised Prison Pilot study of a male Remand Alcohol Intervention for Self-efficacy Enhancement (APPRAISE) is a pilot study designed to assess the feasibility and acceptability of an ABI, delivered to male prisoners on remand. The findings of APPRAISE should provide the information required to design a future definitive randomised controlled trial (RCT). METHODS AND ANALYSIS: APPRAISE will use mixed methods, with two linked phases, across two prisons in the UK, recruiting 180 adult men on remand: 90 from Scotland and 90 from England. Phase I will involve a two-arm, parallel-group, individually randomised pilot study. The pilot evaluation will provide data on the likely impact of A two-arm parallel group individually randomised Prison Pilot study of a male Remand Alcohol Intervention for Self-efficacy Enhancement (APPRAISE), which will be used to inform a future definitive multicentre RCT. Phase II will be a process evaluation assessing how the ABI has been implemented to explore the change mechanisms underpinning the ABI (figure 1) and to assess the context within which the ABI is delivered. ETHICS AND DISSEMINATION: The APPRAISE protocol has been approved by the East of Scotland Research Ethics Committee (19/ES/0068), National Offender Management System (2019-240), Health Board Research and Development (2019/0268), Scottish Prison Service research and ethics committee, and by the University of Edinburgh's internal ethics department. The findings will be disseminated via peer-reviewed journal publications, presentations at local, national and international conferences, infographics and shared with relevant stakeholders through meetings and events. TRIAL REGISTRATION NUMBER: ISRCTN27417180.

What do HIV-positive drug users' experiences tell us about their antiretroviral medication-taking? An international integrated literature review.

BACKGROUND AND AIMS: HIV-positive drug users' poor adherence to antiretroviral regimens can pose a significant and negative impact on individual and global health. This review aims to identify knowledge gaps and inconsistencies within the current evidence base and to measure HIV-positive drug users' adherence rates and the factors that influence their adherence. METHODS: A search of quantitative and qualitative studies in relation to HIV-positive drug users' adherence to antiretroviral treatment was performed using five databases: Applied Social Sciences Index and Abstract (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Embase and PsycINFO (Ovid interface). Relevant studies were retrieved based on the inclusion and exclusion criteria stated in the review. Findings were compared, contrasted and synthesized to provide a coherent account of HIV-positive drug users' adherence rates and the factors that influence their adherence. RESULTS: The proportion of HIV-positive drug users who achieved ≥ 95% adherence across the studies varied widely, from 19.3 to 83.9%. Adherence rates changed over the course of HIV treatment. The factors that influenced adherence were reported as follows: stigmatization, motivation, active drug use, accessibility and conditionality of HIV and addiction care, side effects and complexity of treatment regimens, forgetfulness and non-incorporation of dosing times into daily schedules. CONCLUSIONS: HIV-positive drug users' medication-taking is a dynamic social process that requires health professionals to assess adherence to HIV treatment on a regular basis.

Emotional intelligence among nursing students: Findings from a cross-sectional study.

BACKGROUND: Emotional intelligence in nursing is of global interest. International studies identify that emotional intelligence influences nurses' work and relationships with patients. It is associated with compassion and care. Nursing students scored higher on measures of emotional intelligence compared to students of other study programmes. The level of emotional intelligence increases with age and tends to be higher in women. OBJECTIVES: This study aims to measure the differences in emotional intelligence between nursing students with previous caring experience and those without; to examine the effects of gender on emotional intelligence scores; and to test whether nursing students score higher than engineering colleagues on emotional intelligence measures. DESIGN: A cross-sectional descriptive study design was used. SETTINGS AND PARTICIPANTS: The study included 113 nursing and 104 engineering students at the beginning of their first year of study at a university in Slovenia. DATA: Emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire (TEIQue) and Schutte Self Report Emotional Intelligence Test (SSEIT). METHODS: Shapiro-Wilk's test of normality was used to test the sample distribution, while the differences in mean values were tested using Student t-test of independent samples. RESULTS: Emotional intelligence was higher in nursing students (n = 113) than engineering students (n = 104) in both measures [TEIQue t = 3.972; p < 0.001; SSEIT t = 8.288; p < 0.001]. Although nursing female students achieved higher emotional intelligence scores than male students on both measures, the difference was not statistically significant [TEIQue t = -0.839; p = 0.403; SSEIT t = -1.159; p = 0.249]. EI scores in nursing students with previous caring experience were not higher compared to students without such experience for any measure [TEIQue t = -1.633; p = 0.105; SSEIT t = -0.595; p = 0.553]. CONCLUSIONS: Emotional intelligence was higher in nursing than engineering students, and slightly higher in women than men. It was not associated with previous caring experience.

Do emotional intelligence and previous caring experience influence student nurse performance? A comparative analysis.

BACKGROUND: Reports of poor nursing care have focused attention on values based selection of candidates onto nursing programmes. Values based selection lacks clarity and valid measures. Previous caring experience might lead to better care. Emotional intelligence (EI) might be associated with performance, is conceptualised and measurable. OBJECTIVES: To examine the impact of 1) previous caring experience, 2) emotional intelligence 3) social connection scores on performance and retention in a cohort of first year nursing and midwifery students in Scotland. DESIGN: A longitudinal, quasi experimental design. SETTING: Adult and mental health nursing, and midwifery programmes in a Scottish University. METHODS: Adult, mental health and midwifery students (n=598) completed the Trait Emotional Intelligence Questionnaire-short form and Schutte's Emotional Intelligence Scale on entry to their programmes at a Scottish University, alongside demographic and previous caring experience data. Social connection was calculated from a subset of questions identified within the TEIQue-SF in a prior factor and Rasch analysis. Student performance was calculated as the mean mark across the year. Withdrawal data were gathered. RESULTS: 598 students completed baseline measures. 315 students declared previous caring experience, 277 not. An independent-samples t-test identified that those without previous caring experience scored higher on performance (57.33±11.38) than those with previous caring experience (54.87±11.19), a statistically significant difference of 2.47 (95% CI, 0.54 to 4.38), t(533)=2.52, p=.012. Emotional intelligence scores were not associated with performance. Social connection scores for those withdrawing (mean rank=249) and those remaining (mean rank=304.75) were statistically significantly different, U=15,300, z=-2.61, p$_amp_$lt;0.009. CONCLUSIONS: Previous caring experience led to worse performance in this cohort. Emotional intelligence was not a useful indicator of performance. Lower scores on the social connection factor were associated with withdrawal from the course.

Exploring the compassion deficit debate.

Several recent high profile failures in the UK health care system have promoted strong debate on compassion and care in nursing. A number of papers articulating a range of positions within this debate have been published in this journal over the past two and a half years. These articulate a diverse range of theoretical perspectives and have been drawn together here in an attempt to bring some coherence to the debate and provide an overview of the key arguments and positions taken by those involved. In doing this we invite the reader to consider their own position in relation to the issues raised and to consider the impact of this for their own practice. Finally the paper offers some sense of how individual practitioners might use their understanding of the debates to ensure delivery of good nursing care.

The relationship between emotional intelligence, previous caring experience and mindfulness in student nurses and midwives: a cross sectional analysis.

BACKGROUND: Emotional Intelligence (EI), previous caring experience and mindfulness training may have a positive impact on nurse education. More evidence is needed to support the use of these variables in nurse recruitment and retention. OBJECTIVE: To explore the relationship between EI, gender, age, programme of study, previous caring experience and mindfulness training. DESIGN: Cross sectional element of longitudinal study. SETTING AND PARTICIPANTS: 938year one nursing, midwifery and computing students at two Scottish Higher Education Institutes (HEIs) who entered their programme in September 2013. DATA: Participants completed a measure of 'trait' EI: Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF); and 'ability' EI: Schutte's et al. (1998) Emotional Intelligence Scale (SEIS). Demographics, previous caring experience and previous training in mindfulness were recorded. METHODS: Relationships between variables were tested using non-parametric tests. RESULTS: Emotional intelligence increased with age on both measures of EI [TEIQ-SF H(5)=15.157 p=0.001; SEIS H(5)=11.388, p=0.044]. Females (n=786) scored higher than males (n=149) on both measures [TEIQ-SF, U=44,931, z=-4.509, p<.001; SEIS, U=44,744, z=-5.563, p<.001]. Nursing students scored higher that computing students [TEIQ-SF H(5)=46,496, p<.001; SEIS H(5)=33.309, p<0.001. There were no statistically significant differences in TEIQ-SF scores between those who had previous mindfulness training (n=50) and those who had not (n=857) [U=22,980, z=0.864, p = 0.388]. However, median SEIS was statistically significantly different according to mindfulness training [U=25,115.5, z=2.05, p=.039]. Neither measure demonstrated statistically significantly differences between those with (n=492) and without (n=479) previous caring experience, [TEIQ-SF, U=112, 102, z=0.938, p=.348; SEIS, U=115,194.5, z=1.863, p=0.063]. CONCLUSIONS: Previous caring experience was not associated with higher emotional intelligence. Mindfulness training was associated with higher 'ability' emotional intelligence. Implications for recruitment, retention and further research are explored.

Recruitment, selection and retention of nursing and midwifery students in Scottish Universities.

BACKGROUND: High attrition rates from pre-registration nursing and midwifery programmes have been reported in both the UK and in other countries. OBJECTIVES: A study was conducted to identify best practice in recruitment, selection and retention across Scottish Universities providing pre-registration programmes. DESIGN: A survey of all universities providing pre-registration programmes in Scotland was conducted. Semi-structured interviews were conducted with key personnel in each university. Documentary evidence was collected to supplement interview data and evidence recruitment, selection and retention practices. SETTINGS: All universities in Scotland providing pre-registration nursing and/or midwifery programmes. PARTICIPANTS: All 10 identified universities agreed to take part and a total of 18 interviews were conducted. METHODS: Semi-structured face to face and telephone interviews were conducted. Relevant documentary evidence was collected. All data were subject to thematic analysis. FINDINGS: Universities are predominantly concerned with recruiting to the institution and not to the professions. Interviews are widely used, and are a requirement in the United Kingdom. However, there is no evidence base within the literature that they have predictive validity despite creating scales and scoring systems which are largely unvalidated. The study identified initiatives aimed at addressing attrition/retention, however most had not been evaluated often due to the multi-factorial nature of attrition/retention and difficulties with measurement. CONCLUSIONS: Recruitment selection and retention initiatives were rarely evaluated, and if so, adopted a relatively superficial approach. Evidence from existing studies to support practices was mostly weakly supportive or absent. The study highlights the need for a coordinated approach, supporting the development of a robust evidence base through the evaluation of local initiatives, and evaluation of new strategies. Evaluation strategies must take account of the local context to facilitate transferability of findings across different settings.