'People don't realise how much their past experiences affect them in adulthood': A qualitative study of adult siblings' experiences of growing-up with a sister/brother with a childhood life-limiting condition and their perceived support needs.

BACKGROUND: There is a lack of research about the experiences and impact of having a sibling with a life-limiting condition. Studies focus on the sibling experience during childhood but the experience and impact during adulthood is unknown despite the increased life-expectancy of children with life-limiting conditions. AIM: To explore adult siblings' perspectives on the experience of having a sister/brother with a childhood life-limiting condition and to identify their perceived needs and preferences for support. DESIGN: A qualitative exploratory study design with data generated by semi-structured interviews and analysed using reflexive thematic analysis, underpinned by interpretivism. SETTING/PARTICIPANTS: Twenty-two siblings (17-42 years old) were recruited via a children's hospice in England. RESULTS: The experience of having a sibling with a life-limiting condition changes over time in response to how understandings of the meaning of a life-limiting condition develop and changing roles/relationships with parents and siblings. These experiences have an enduring impact on adult sibling's mental health which is compounded by their unmet (and sometimes unrecognised) support needs in adolescence and adulthood. Siblings described the importance of support continuing into adulthood with a focus on the provision of psychotherapy and peer support. CONCLUSIONS: Having a sister/brother with a childhood life-limiting condition appeared to have a significant and ongoing impact on adult siblings but their support needs, particularly for psychotherapy and peer support, are overlooked. The findings highlight the importance of ensuring siblings are included in family assessments and that family-based interventions are developed to promote sibling-parent relationships.

A collaboratively produced model of service design for children and young people with common mental health problems.

BACKGROUND: Little is known about the effectiveness of, and implementation complexities associated with, service delivery models for children and young people (CYP) experiencing 'common' mental health problems such as anxiety, depression, behavioural difficulties and self-harm. This paper outlines how a model for high-quality service design for this population group was developed by identifying available services, their effectiveness, cost-effectiveness and acceptability, and the barriers and enablers to access. METHODS: Sequential, mixed-methods design, combining evidence syntheses (scoping and integrative reviews of the international literature) with primary research (a collective case study in England and Wales). Data from these two elements were collaboratively synthesised in a subsequent model-building phase. RESULTS: The scoping review yielded a service model typology. The integrative review found effectiveness evidence only for four models: collaborative care (the only service model to also have cost-effectiveness evidence), outreach approaches, brief intervention services and an organisational framework called 'Availability, Responsiveness and Continuity'. No service model seemed more acceptable than others. Three case study themes were identified: pathways to support; service engagement; and learning and understanding. The model-building phase identified rapid access, learning self-care skills, individualised support, clear information, compassionate and competent staff and aftercare planning as core characteristics of high-quality services. These characteristics were underpinned by four organisational qualities: values that respect confidentiality; engagement and involvement; collaborative relationships; and a learning culture. CONCLUSIONS: A consistent organisational evidence-base for service design and delivery in CYP's mental health spanning many years appears to have had little impact on service provision in England and Wales. Rather than impose - often inflexible and untested - specific local or national models or frameworks, those commissioning, designing and delivering mental health services for CYP should (re)focus on already known, fundamental components necessary for high-quality services. These fundamental components have been integrated into a collaboratively produced general model of service design for CYP with common mental health problems. While this general model is primarily focused on British service provision, it is broad enough to have utility for international audiences.

Perceptions of the key components of effective, acceptable and accessible services for children and young people experiencing common mental health problems: a qualitative study.

BACKGROUND: Children and young people's (CYP) mental health is a major public health concern internationally and the recent Covid-19 pandemic has amplified these concerns. However, only a minority of CYP receive support from mental health services due to the attitudinal and structural barriers they and their families encounter. For over 20 years, report after report has consistently highlighted the shortcomings of mental health services for CYP in the United Kingdom and attempts to improve services have been largely unsuccessful. The findings reported in this paper are from a multi-stage study that aimed to develop a model of effective, high-quality service design for CYP experiencing common mental health problems. The aim of the stage reported here was to identify CYP's, parents' and service providers' perceptions of the effectiveness, acceptability and accessibility of services. METHODS: Case studies were conducted of nine different services for CYP with common mental health problems in England and Wales. Data were collected using semi-structured interviews with 41 young people, 26 parents and 41 practitioners and were analysed using the Framework approach. Patient and Public Involvement was integrated throughout the study with a group of young co-researchers participating in data collection and analysis. RESULTS: Four key themes defined participants' perceptions of service effectiveness, acceptability and accessibility. Firstly, open access to support with participants highlighting the importance of self-referral, support at the point of need and service availability to CYP/parents. Secondly, the development of therapeutic relationships to promote service engagement which was based on assessment of practitioner's personal qualities, interpersonal skills and mental health expertise and underpinned by relational continuity. Thirdly, personalisation was viewed as promoting service appropriateness and effectiveness by ensuring support was tailored to the individual. Fourthly, the development of self-care skills and mental health literacy helped CYP/parents manage and improve their/their child's mental health problems. CONCLUSIONS: This study contributes to knowledge by identifying four components that are perceived to be central to providing effective, acceptable and accessible mental health services for CYP with common mental health problems irrespective of service model or provider. These components could be used as the foundations for designing and improving services.

How a moderated online discussion forum facilitates support for young people with eating disorders.

INTRODUCTION: Young people with eating disorders are at risk of harm to their social, emotional and physical development and life chances. Although they can be reluctant to seek help, they may access social media for information, advice or support. The relationship between social media and youth well-being is an emotive subject, but not clearly understood. This qualitative study aimed to explore how young people used a youth-orientated, moderated, online, eating disorders discussion forum, run by an eating disorders charity. METHODS: We applied a netnographic approach involving downloading and thematically analysing over 400 messages posted August-November 2012. RESULTS: Data analysis generated five themes: Taking on the role of mentor; the online discussion forum as a safe space; Friendship within the online forum; Flexible help; and Peer support for recovery and relapse prevention. Forum moderation may have influenced the forum culture. DISCUSSION: Our findings are consistent with literature about youth preferences for mental health self-care support. A young person's decision to use this discussion forum can be construed as pro-active self-care. A moderated online discussion forum can make a positive contribution to support for youth with eating disorders, countering negative media perceptions of online groups. CONCLUSION: This study adds to knowledge about how young people access support via social media. Online discussion forums can be safe and acceptable spaces for youth to access help. Further research could provide insights into the impact of forum moderation.

Mental illness research in the Gulf Cooperation Council: a scoping review.

Rapid growth and development in recent decades has seen mental health and mental illness emerge as priority health concerns for the Gulf Cooperation Council (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). As a result, mental health services in the region are being redefined and expanded. However, there is a paucity of local research to guide ongoing service development. Local research is important because service users' experience of mental illness and mental health services are linked to their sociocultural context. In order for service development to be most effective, there is a need for increased understanding of the people who use these services.This article aims to review and synthesize mental health research from the Gulf Cooperation Council. It also seeks to identify gaps in the literature and suggest directions for future research. A scoping framework was used to conduct this review. To identify studies, database searches were undertaken, regional journals were hand-searched, and reference lists of included articles were examined. Empirical studies undertaken in the Gulf Cooperation Council that reported mental health service users' experience of mental illness were included. Framework analysis was used to synthesize results. Fifty-five studies met inclusion criteria and the following themes were identified: service preferences, illness (symptomology, perceived cause, impact), and recovery (traditional healing, family support, religion). Gaps included contradictory findings related to the supportive role of the Arabic extended family and religion, under-representation of women in study samples, and limited attention on illness management outside of the hospital setting.From this review, it is clear that the sociocultural context in the region is linked to service users' experience of mental illness. Future research that aims to fill the identified gaps and develop and test culturally appropriate interventions will aid practice and policy development in the region.

Service design for children and young people with common mental health problems: literature review, service mapping and collective case study.

Background: The mental health of children/young people is a growing concern internationally. Numerous reports and reviews have consistently described United Kingdom children's mental health services as fragmented, variable, inaccessible and lacking an evidence base. Little is known about the effectiveness of, and implementation complexities associated with, service models for children/young people experiencing 'common' mental health problems like anxiety, depression, attention deficit hyperactivity disorder and self-harm. Aim: To develop a model for high-quality service design for children/young people experiencing common mental health problems by identifying available services, barriers and enablers to access, and the effectiveness, cost effectiveness and acceptability of such services. Design: Evidence syntheses with primary research, using a sequential, mixed-methods design. Inter-related scoping and integrative reviews were conducted alongside a map of relevant services across England and Wales, followed by a collective case study of English and Welsh services. Setting: Global (systematic reviews); England and Wales (service map; case study). Data sources: Literature reviews: relevant bibliographic databases and grey literature. Service map: online survey and offline desk research. Case study: 108 participants (41 children/young people, 26 parents, 41 staff) across nine case study sites. Methods: A single literature search informed both reviews. The service map was obtained from an online survey and internet searches. Case study sites were sampled from the service map; because of coronavirus disease 2019, case study data were collected remotely. 'Young co-researchers' assisted with case study data collection. The integrative review and case study data were synthesised using the 'weaving' approach of 'integration through narrative'. Results: A service model typology was derived from the scoping review. The integrative review found effectiveness evidence for collaborative care, outreach approaches, brief intervention services and the 'availability, responsiveness and continuity' framework. There was cost-effectiveness evidence only for collaborative care. No service model appeared to be more acceptable than others. The service map identified 154 English and Welsh services. Three themes emerged from the case study data: 'pathways to support'; 'service engagement'; and 'learning and understanding'. The integrative review and case study data were synthesised into a coproduced model of high-quality service provision for children/young people experiencing common mental health problems. Limitations: Defining 'service model' was a challenge. Some service initiatives were too new to have filtered through into the literature or service map. Coronavirus disease 2019 brought about a surge in remote/digital services which were under-represented in the literature. A dearth of relevant studies meant few cost-effectiveness conclusions could be drawn. Conclusions: There was no strong evidence to suggest any existing service model was better than another. Instead, we developed a coproduced, evidence-based model that incorporates the fundamental components necessary for high-quality children's mental health services and which has utility for policy, practice and research. Future work: Future work should focus on: the potential of our model to assist in designing, delivering and auditing children's mental health services; reasons for non-engagement in services; the cost effectiveness of different approaches in children's mental health; the advantages/disadvantages of digital/remote platforms in delivering services; understanding how and what the statutory sector might learn from the non-statutory sector regarding choice, personalisation and flexibility. Study registration: This study is registered as PROSPERO CRD42018106219. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/08) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.

In this research study, we explored services for children and young people with 'common' mental health problems like depression, anxiety and self-harm. We aimed to find out what services exist, how children/young people and families find out about and access these services, what the services actually do, whether they are helpful and whether they offer value for money. We looked at the international literature (reports and research papers) to identify different approaches to providing support, and to find out whether certain approaches worked better than others and whether children/young people and families preferred some approaches over others. The literature provided very little information about the value for money of services. We also carried out a survey and used the internet to identify 154 relevant services in England and Wales. To explore services in more detail, and hear directly from those using them, we planned to visit 9 of the 154 services to interview children/young people, parents and staff. Unfortunately, coronavirus disease 2019 stopped us directly visiting the nine services and so we conducted phone and video interviews instead. We still managed to speak to, and hear the experiences of, more than 100 people (including children/young people and parents). We combined information from the literature with information from the interviews to create an evidence-based 'model' of what services should look like. This model considers some basic things like how quickly children/young people could access a service, what information was available, the importance of confidentiality and whether staff make the service fit with the child/young person's needs and interests. It also considers whether the service helps children/young people learn skills to manage their mental health and whether staff at a service work well together. We hope our model will help existing and new services improve what they offer to children/young people and families.

"What Works" to Support LGBTQ+ Young People's Mental Health: An Intersectional Youth Rights Approach.

Despite overwhelming international evidence of elevated rates of poor mental health in LGBTQ+ youth compared to their cis-heterosexual peers, we know relatively little about effective mental health services for this population group. This study aims to produce the first early intervention model of "what works" to support LGBTQ+ youth with emerging mental health problems. Utilizing a mixed method case study, we collected data across 12 UK mental health service case study sites that involved: (a) interviews with young people, parents, and mental health practitioners (n = 93); (b) documentary analysis; (c) nonparticipant observation. The data analysis strategy was theoretical using the "explanation-building" analytical technique. Our analysis suggests an intersectional youth rights approach with 13 principles that must be enacted to provide good mental health services as advocated by the United Nations Convention on the Rights of the Child and World Health Organization. This approach should address the multiple forms of marginalization and stigmatization that LGBTQ+ youth may experience, enable informed independent decision-making, and uphold the right to freedom of safe self-expression. A rights-based approach to mental health services for LGBTQ+ young people is not prominent. This needs to change if we are to tackle this mental health inequality and improve the mental well-being of LGBTQ+ youth worldwide.

Crisis care for children and young people with mental health problems: national mapping, models of delivery, sustainability and experience (CAMH-Crisis2). A study protocol.

Background: One in six five 16-year-olds have a probable mental health difficulty. Of these, almost half of older teenagers and a quarter of 11-16-year-olds report having self-harmed or attempted suicide. Currently, there is little research into mental health crisis services for young people, with little understanding of what services exist, who uses them, or what works best. Question: 'How are mental health crisis responses for children and young people up to the age of 25 sustained, experienced and integrated within their local systems of services'? Objectives:     1.    To describe National Health Service (NHS), local authority, education and third sector approaches to the implementation and organisation of crisis care for children and young people across England and Wales.    2.   To identify eight contrasting case studies in which to evaluate how crisis services have developed and are currently organised, sustained, experienced and integrated within the context of their local systems of services.    3.   To compare and contrast these services in the context of the available international evidence, drawing out and disseminating clear implications for the design and delivery of future crisis responses for children and young people and their families. Methods: A sequential mixed methods approach, underpinned by normalisation process theory will be employed. A survey will create a detailed record of how crisis responses across England and Wales are organised, implemented and used. Subsequently, eight contrasting services in relation to geographic and socioeconomic setting, populations served, and service configuration will be identified as case studies. Interviews will be conducted with children, young people and parents/carers who have used the service, as well as commissioners, managers and practitioners. Operational policies and service usage data will also be examined. Analysis of how each service is provided, experienced, implemented and sustained will be conducted both inductively and deductively, reflecting normalisation process theory constructs.

BACKGROUND: There has been a sharp increase in children and young people experiencing extreme emotional distress and/or self-harm, which is also known as 'crisis'. Services for young people in crisis are a priority in the UK but little is currently known about what crisis services exist, who uses them, or what type of service works best. AIM AND OBJECTIVES: This project aims to explore the types of mental health crisis services currently available to children and young people up to the age of 25 in England and Wales, and to examine how they are organised, perceived and integrated within other local care systems. The objectives are to: 1. Find out what NHS, local authority, education and charity sector crisis services exist for children and young people across England and Wales, to describe the services and to create a database of them. 2. Identify eight contrasting services from the database and evaluate how these services are organised, perceived and integrated within local care systems. 3. Compare and contrast these services with the available international evidence, drawing out clear implications for the design and delivery of future crisis responses for children and young people and their families. METHODS: We will use a survey to create a database of crisis response services across England and Wales. From the database we will identify eight contrasting services and we will conduct interviews with children, young people and parents/carers who have used the service as well as managers and staff. We will look at how the services work and explore how they are used and by whom. We will compare and contrast each case study and consider findings of other research studies from around the world to draw clear, actionable, lessons for the future provision of high-quality crisis services for children and young people.

School nurses' perspectives on managing mental health problems in children and young people.

AIMS AND OBJECTIVES: To explore the views of school nurses regarding mental health problems in young people and their potential for engaging in mental health work with this client group. BACKGROUND: Mental health problems in children and young people are an important public health issue. Universal children's services play a key role in identifying and managing these problems and, while school nurses have an important function in this work, little is known about their views on this aspect of their role. DESIGN: A qualitative research design employing focus group methodology. METHOD: School nurses (n = 33) were purposively sampled from four school nursing teams in two English cities for a series of focus groups. The focus group data were audio-recorded, transcribed and subsequently analysed using 'framework'. RESULTS: Four principal themes emerged from the data. In these themes, school nurses were found to value their involvement with the mental health of young people, recognising this as an important area of practice. Several obstacles to their work in this area were identified: heavy workloads, professional rivalries, a lack of confidence and limited education and training opportunities. The importance of support from local specialist mental health teams was emphasised. CONCLUSIONS: School nurses can be engaged in mental health work though, as public health specialists, their role should focus on health promotion, assessment, signposting and early intervention activities. To facilitate mental health work, school nurses are able to draw on established interpersonal skills and supportive networks; however, workload and a lack of confidence need to be managed and it is important that they are supported by constructive relationships with local specialist mental health teams. RELEVANCE TO CLINICAL PRACTICE: This study has implications for nurses and healthcare practitioners interested in enhancing the mental health of children and young people in school settings.

Perceptions of effective self-care support for children and young people with long-term conditions.

AIMS AND OBJECTIVES: To: (1) Examine children's/young people's, parents' and professionals'/workers' perceptions of the effectiveness of different models of self-care support, (2) identify factors that support and inhibit self-care and (3) explore how different models integrate with self-care support provided by other organisations. BACKGROUND: Childhood long-term illness has been largely overlooked in government policy and self-care support under-researched when compared with adults. There is a lack of evidence on which are the most appropriate models and methods to engage young people and their parents in self-care. DESIGN: Case study. METHODS: Case studies of six different models of self-care support were conducted using multiple methods of data collection in 2009. Semi-structured interviews were conducted with 26 young people, 31 parents and 36 self-care support providers. A sample of self-care support activities was observed and relevant documents reviewed. Data were analysed using the Framework approach. RESULTS: The effectiveness of self-care support projects was defined in relation to four dimensions - providing a sense of community, promoting independence and confidence, developing knowledge and skills and engaging children/young people. Self-care support provided by schools appeared to be variable with some participants experiencing barriers to self-management and inclusion. Participants self-referred themselves to self-care support projects, and there was a lack of integration between some projects and other forms self-care support. CONCLUSION: This study adds to knowledge by identifying four dimensions that are perceived to be central to effective self-care support and the contextual factors that appear to influence access and experiences of self-care support. RELEVANCE TO CLINICAL PRACTICE: Study findings can inform the development of self-care support programmes to meet the needs of individuals, families and communities. In addition, the findings suggest that healthcare professionals need to support schools if young people with long-term conditions are to have the same educational and social opportunities as their peers.

Newly qualified nurses' transition from learning to doing: A scoping review.

OBJECTIVES: To identify newly qualified nurses' experiences during transition to professional practice, and explore their and other key stakeholders' perceptions of nursing transition programmes. DESIGN: Scoping review using the Arksey and O'Malley framework. METHODS: Several electronic databases were searched for relevant articles, which were supplemented by hand-searching and internet searches for grey literature. 1823 potentially relevant articles published between 1974 and 2019 were retrieved from the initial search, and an additional ten articles were obtained from the supplemental search. Each article was independently reviewed, leaving 60 articles eligible for inclusion in the review. FINDINGS: Two overarching themes emerged: 1) the transition experience; 2) the perceived benefits of nursing transition programmes. Evidence that nursing transition programmes positively impact the transition experience is inconclusive. Some studies suggest a positive impact on newly qualified nurses' competency, level of confidence and attrition rates; others reported no impact. There was a general consensus that newly qualified nurses still encounter difficulties when transitioning into professional practice. Most articles found were quantitative in nature, focusing on measurable outcomes of nursing transition programmes. Few investigated the experiences and perceptions of newly qualified nurses, preceptors, and managers regarding the transition to professional practice. CONCLUSIONS: Literature mapping suggests that newly qualified nurses frequently struggle to successfully complete the transition into professional practice, and that this transition is complex and multifaceted. There is limited evidence to justify the widespread implementation of nursing transition programmes. Additional research focusing on experiences and perceptions of newly qualified nurses and their transitory process is warranted. Tweetable abstract: Are newly qualified nurses receiving sufficient transition support (e.g. #nursing residency programs or #preceptorship)? #Nurse #Nurses #nursing_intern.

Reciprocity membership: A potential pathway towards recovery from mental illness in a Middle Eastern context.

While recovery has become a popular framework for mental health services, there is limited understanding of its applicability outside of Western countries. In fact, recent studies in non-Anglophone populations suggest that recovery is contextually dependent and that the implementation of mainstream recovery models risks imposing inappropriate values. We used classic grounded theory to explore the main concerns of mental health service users in a Middle Eastern context and the strategies they use to resolve those concerns. The theory of 'reciprocity membership', a process involving ongoing mutual exchange with a group or community, was developed. Reciprocity membership becomes balanced when an individual is satisfied with their 'contribution to' the group, the 'acknowledgement from' other group members, the 'expectations of' the group, and their 'alignment with' the values of the group. Balance among these conditions is appraised by a sub-process called 'valuing', and developed or maintained by two further sub-processes called 'positioning' and 'managing relationships'. Balanced reciprocity membership seems to be associated with recovery. This study is the first in-depth exploration of people's experience of mental illness in a Middle Eastern context; findings provide evidence for a novel potential pathway towards recovery.

Explaining effective mental health support for LGBTQ+ youth: A meta-narrative review.

This meta-narrative review on mental health early intervention support for LGBTQ+ â€‹youth aimed to develop a theoretical framework to explain effective mental health support. Using the RAMESES standards for meta-narrative reviews, we identified studies from database searches and citation-tracking. Data extraction and synthesis was conducted through conceptual coding in Atlas.ti. in two stages: 1) conceptual mapping of the meta-narratives; 2) comparing the key concepts across the meta-narratives to produce a theoretical framework. In total, 2951 titles and abstracts were screened and 200 full papers reviewed. 88 studies were included in the final review. Stage 1 synthesis identified three meta-narratives - psychological, psycho-social, and social/youth work. Stage 2 synthesis resulted in a non-pathological theoretical framework for mental health support that acknowledged the intersectional aspects of LGBTQ+ â€‹youth lives, and placed youth at the centre of their own mental health care. The study of LGBTQ+ â€‹youth mental health has largely occurred independently across a range of disciplines such as psychology, sociology, public health, social work and youth studies. The interdisciplinary theoretical framework produced indicates that effective early intervention mental health support for LGBTQ+ â€‹youth must prioritise addressing normative environments that marginalises youth, LGBTQ+ â€‹identities and mental health problems.

Nurse education: factors associated with attrition.

AIM: This paper is a report of a study to identify the factors having an impact on student completion rates in a preregistration programme. BACKGROUND: Nursing student attrition is an international issue causing concern in many parts of the developed world including Australia, the United States and Europe. In the United Kingdom, nursing student attrition has become a major issue, despite having one of the lowest general university dropout rates in the developed world. METHOD: A retrospective cohort study was conducted in 2007 using routinely-collected demographic and completion data on four cohorts of nursing students (1259 in total) studying at a large English university. FINDINGS: Students who were older on entry were more likely to complete the programme than younger students, and those who had only the minimum educational qualifications on entry were less likely to complete than those with higher-level qualifications. There was some evidence of increased risk of resigning from the course in students taking the child branch, and increased risk of discontinuation (involuntary removal) from the course in both male and black/minority ethnic students. There was also some evidence that the healthcare organization responsible for a student's placement could influence completion rates. CONCLUSION: To improve attrition rates on preregistration nursing programmes, higher education institutions should actively target recruitment at mature candidates; increase the level of qualification required to gain entry; examine course structures for flexibility and provide multi-level student support.

Transitioning to university as a nursing student: Thematic analysis of written reflections.

BACKGROUND: The international literature has largely conceptualised transition to university as a process of adjustment to both the social and the academic demands of university life. Several factors influence this process including: student, parent and university staff expectations; student preparedness; and student belongingness. Moreover, some student groups (groups well-represented in nursing) appear to have particular difficulty in successfully transitioning to university life. STUDY AIMS: To explore first year nursing students' experiences of the transition to university; to compare nursing students' experiences with those of other disciplines and identify ways of easing the transition for nursing students. METHODOLOGY: As part of their coursework, first year nursing students at an English University submitted a 500-word, formative reflection on the transition to university. Anonymised reflections from 161 students were available to the researchers for thematic content analysis; 50 reflections, however, proved sufficient for 'information power'. RESULTS: Two main themes emerged from the data: (i) 'managing expectations', an overarching theme that permeated most of the reflections; and (ii) 'practical tools and support aids', the practical, concrete actions that either the university took, or the students developed themselves, to ease the transition. Both themes embraced inter-related academic, social and personal domains. CONCLUSIONS: Nursing students' transition experiences are similar to those of other university students. However, the particular demographics of nursing student cohorts amplifies certain aspects of the transition experience: more students who are likely to struggle with transition but also more students who embrace the developmental aspects of going to university. Transition requires joint enterprise between students and university staff, especially in terms of expectations and the support required to become independent learners. Transitions can be eased by tapping into student resourcefulness and seeing transition as a gradual process that cuts across academic, social and personal dimensions rather than as a short, one-off event.

Predicting stress in pre-registration midwifery students attending a university in Northern England.

OBJECTIVE: to determine which variables predict stress (psychological distress) in pre-registration midwifery students. DESIGN: a cross-sectional survey, using a range of self-report measures bound together in a 'questionnaire pack'. SETTING: the study reported here is taken from a wider investigation into stress among nursing and midwifery students, undertaken in the nursing and midwifery department of a large university in Northern England. PARTICIPANTS: 120 pre-registration midwifery students pursuing one of three diploma programmes: 'standard', 'enhanced' and 'short'. MEASUREMENTS: multivariate logistic regression was used as the analytical technique. The variables used in the analyses undertaken were all derived from formal and study-specific, self-report measures included in the questionnaire pack. 'Stress' (whether a participant was psychologically distressed or not) was obtained via the General Health Questionnaire. Potential predictors of stress were collected from two formal measures (the Student Nurse Stress Index and the Coping Inventory for Stressful Situations) and from questions in the questionnaire pack designed to elicit demographic data and data of specific interest to nurse and midwife educators. FINDINGS: 102 questionnaire packs (85%) were returned. The prevalence of stress among participants was over 40%. A series of logistic regression analyses resulted in five competing regression models. Through a systematic selection process, two of these models were chosen for discussion. These models suggested that the key predictors of psychological distress in the population studied were self-report of stress levels, the type of midwifery programme being pursued, the use of 'task-oriented' coping and, possibly, whether or not a student smokes cigarettes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: despite the prevalence rate of 40%, the prevalence of stress among midwifery students is generally no better or worse than that of other students or of qualified health-care professionals. Those involved in midwifery education need to know how to manage student stress effectively. This can be achieved by ensuring that personal teachers (continue to) play a key role in supporting students, especially when students self-report high levels of stress. Incorporating formal stress-management training into pre-registration midwifery programmes may also be useful. Sound knowledge of the issues associated with student stress during curriculum design, however, may ultimately prove to be the most effective way of managing student stress. In a discipline such as midwifery, these issues are as divergent as the politics of midwifery, the processes used in recruitment and selection, the role of women in society, and the nature, quality and quantity of the learning experiences and the assessment strategies used.

Predicting stress in pre-registration nursing students.

OBJECTIVE: To determine which variables from a pool of potential predictors predict General Health Questionnaire 'caseness' in pre-registration nursing students. DESIGN: Cross-sectional survey, utilizing self-report measures of sources of stress, stress (psychological distress) and coping, together with pertinent demographic measures such as sex, ethnicity, educational programme and nursing specialty being pursued, and age, social class and highest qualifications on entry to the programme. METHODS: Questionnaire packs were distributed to all pre-registration nursing students (N=1,362) in a large English university. Completed packs were coded, entered into statistical software and subjected to a series of logistic regression analyses. RESULTS: Of the questionnaire packs 1,005 (74%) were returned, of which up to 973 were available for the regression analyses undertaken. Four logistic regression models were considered and, on the principle of parsimony, a single model was chosen for discussion. This model suggested that the key predictors of caseness in the population studied were self-report of pressure, whether or not respondents had children (specifically, whether these children were pre-school or school-age), scores on a 'personal problems' scale and the type of coping employed. The overall caseness rate among the population was around one-third. CONCLUSIONS: Since self-report and personal, rather than academic, concerns predict stress, personal teachers need to play a key role in supporting students through 'active listening', especially when students self-report high levels of stress and where personal/social problems are evident. The work-life balance of students, especially those with child-care responsibilities, should be a central tenet in curriculum design in nurse education (and, indeed, the education of other professional and occupational groups). There may be some benefit in offering stress management (coping skills) training to nursing students and, indeed, students of other disciplines.

Mental health nursing students differ from other nursing students: Some observations from a study on stress and coping.

The study reported here is taken from a wider investigation into stress among preregistration nursing students, undertaken in the nursing department of a large university in northern England. British nursing is divided into four specialties or 'branches': adult, mental health, children's, and learning disability nursing, and the aim of the study was to explore interbranch differences among the students in terms of the sources of stress they identify, the levels of stress they experience, and the ways in which they cope. A cross-sectional survey of all nursing students on the department's roll (n = 1362), using a range of self-report measures bound together in a 'questionnaire pack', was undertaken. The questionnaire pack contained formal measures of sources of stress (Student Nurse Stress Index), stress (specifically, psychological distress) (General Health Questionnaire) and coping (Coping Inventory for Stressful Situations), as well as a set of questions that enabled data on a range of pertinent variables, including the nursing branch being pursued, to be collected. The findings revealed that mental health nurses were notably different from the other three branches in terms of the quantity and characteristics of the sources of stress they faced, the levels of stress they experienced, and the ways in which they coped. These differences were largely advantageous to the students' well-being and speculations are made as to whether the concept of 'hardiness'- especially its focus on a sense of being in control - plays a role in explaining the findings.

Using the nominal group technique to involve young people in an evidence synthesis which explored 'risk' in inpatient mental healthcare.

PLAIN LANGUAGE SUMMARY: We conducted a review of research on the topic of 'risk' in hospital based mental health care for young people aged 11-18. We wanted to include a contribution from young people alongside other stakeholders with expertise to guide the research team in decisions made setting parameters for the review. To achieve this, we held a stakeholder group meeting. We used the nominal group technique, a method designed to create a structure and a process for getting feedback from a group of people in a way that allows everyone to have an equal say. In this study, we show how our use of this approach enabled our stakeholder group to shape the focus of our study towards an area of more importance and relevance to them. BACKGROUND: In this paper we demonstrate how our application of the nominal group technique was used as a method of involving young people with previous experience of using inpatient mental health services in an evidence synthesis. METHODS: Nominal group technique is an approach to group decision-making that places weight on all participants having an equal opportunity to express a view, and to influence decisions which are made. It is an effective way to enable people who might otherwise be excluded from decision-making to contribute. RESULTS: In this study, the focus of the evidence synthesis was significantly shaped following using the nominal group technique in our stakeholder advisory group meeting. The young people present in the group invited the research group to think differently about which 'risks' were important, to consider how young people conceptualised risk differently, focussing on risks with long term impact and quality of life implications, rather than immediate clinical risks. CONCLUSIONS: Using the nominal group technique with young people did offer a method of promoting the equality of decision making within a stakeholder advisory group to an evidence synthesis project, but care needs to be taken to invite sufficient young people to attend so they can be proportionally represented.

Self-care of young people with long-term physical and mental health conditions.

This article examines the evidence about 'what works' in supporting self-care in relation to children or young people with physical and mental health conditions. It is based on two systematic reviews and on research evaluating different self-care support programmes that have been developed in the UK. The authors identify four components for an effective and acceptable self-care programme that nurses can include when developing and providing such support for children and young people with long-term physical and mental health conditions. These are: providing a sense of community, developing knowledge and skills, building independence and confidence, engaging children and young people. The authors highlight the increasingly important role that children's and mental health nurses can play in supporting young people's self-care.