The South West Clinical School model: an initiative to transform clinical academic career pathways.

Background: The Clinical School Model connects professorial staff from the university directly to practitioners in the National Health Service to promote evidence informed practice and develop clinical academic careers. These are promoted widely, but strategic adoption into organisational culture and workforce plans are challenging to overcome. Aims: To describe the development of the Clinical School Model in Cornwall and explore how it generates impact through staff engagement activities to support clinical academic career pathways. Structure, process and outcomes developments over the last 3-years are reported. Methods: Donabedian's framework (structure, process and outcome) was used to report on the development and impact of the Clinical School Model. Results: Structural and process activities are reported, illustrating strong foundations to embed clinical academic career pathway opportunities. In the absence of empirical reporting standards for such developments, quantitative and qualitative outcomes are reported against the Clinical School's 5-year strategic plan. Conclusions: This paper responds to the lack of reported evidence on developing organisational infrastructure to address the clinical academics aspirations of nurses and their employers. This important contribution leads a call for more organisations to report to the evidence base, enabling shared learning and shaping future research.

Perceptions of healthcare professionals' psychological wellbeing at work and the link to patients' experiences of care: A scoping review.

Background: Healthcare professionals' psychological wellbeing at work affects patients' experiences of care. However, the literature tends to focus on negative aspects of psychological wellbeing, such as stress and burnout, and interventions to support healthcare professionals' wellbeing have limited effectiveness. The growing global concern over the psychological wellbeing of healthcare professionals has escalated following the COVID-19 pandemic. There is an urgent need to review the recent literature on healthcare professionals' psychological wellbeing to identify gaps in our knowledge. This scoping review will help focus the future research to improve the psychological wellbeing of healthcare staff and thereby patients' care experiences. Aim: This scoping review aims to answer two research questions: 1) What do we know about healthcare professionals' and patients' perceptions of healthcare professionals' psychological wellbeing at work? 2) How does the psychological wellbeing of healthcare professionals at work affect patients' experiences of care? Method: We conducted a scoping review using frameworks developed by Arksey and O'Malley (2005) and Levac, Colquhoun and O'Brien (2010). Our comprehensive literature search covered publications dated 2011-2021 in PubMed, CINAHL, Scopus and PsychInfo, NIHR Journals, EThOS, Open Grey, Google Scholar, and the Department for Health and Social Care and Kings Fund websites. We also hand-searched the reference lists of included studies. Two independent reviewers assessed the eligibility of studies. Results: We included 56 articles from 16 countries, most using qualitative methods. We identified five themes: 1) The definition of healthcare professional psychological wellbeing; 2) The relationship between healthcare professionals' psychological wellbeing and nature of healthcare work; 3) The role of organisational culture in healthcare professionals' psychological wellbeing and the importance of organisational culture; 4) The impact the COVID-19 pandemic on of healthcare professionals' psychological wellbeing; and 5) The link between healthcare professionals' psychological wellbeing and patients' experiences of care. We found a complex relationship between organisational culture, healthcare professionals' perceptions of psychological wellbeing, and patients' experiences of care. Conclusion: While there is currently no consensus on the definition of psychological wellbeing in healthcare professionals, our review highlights its relation to organizational culture and its impact on patients' experiences of care. Future research should include patients' perspectives and develop meaningful ways to support, develop, and retain healthcare professionals. Tweetable abstract: Scoping review: wellbeing of healthcare professionals is poorly understood. Basic needs must be met first to support staff to care @KathrynBamforth.

How COVID-19 has affected staffing models in intensive care: A qualitative study examining alternative staffing models (SEISMIC).

AIMS: To understand how COVID-19 affected nurse staffing in intensive care units (ICUs) in England, and to identify factors that influenced, and were influenced by, pandemic staffing models. DESIGN: Exploratory qualitative study. METHODS: Semi-structured, online interviews conducted July-September 2020 with regional critical care leaders including policy leads (n = 4) and directors/lead nurses (n = 10) across critical care networks in England. FINDINGS: The six themes emerging from the framework analysis illustrate how the pre-pandemic ICU culture influenced ICU staffing models during the pandemic. Changes in staffing impacted on the workforce and the care delivered, whilst it was necessary to learn from, and adjust to, a rapidly changing situation. Variation across and between networks necessitated variation in responses. The overwhelming outcome was that the pandemic has challenged the central tenets of ICU nurse staffing. CONCLUSIONS: Pandemic nurse staffing models resulted in changes to ICU skill-mix and staffing numbers. Factors such as the impact of nurse staffing on care practices and on the workforce need to be taken into account when developing and testing future nurse staffing models for ICU. The extent to which ICUs will return to former staffing models is not yet known but there seems to be an appetite for change. IMPACT: In common with many countries, nurse staffing in English ICUs was adapted to address surge requirements during the COVID-19 pandemic. Findings highlight the challenge COVID-19 presented to pre-pandemic ICU nurse staffing guidelines, the impact on patient and staff well-being and the potential legacy for future staffing models. Study findings have implications for ICU nurse managers, researchers and policy makers: nurse staffing models need to be adaptable to the local context of care and future research should investigate the impact of different models on patients, staff and health service outcomes.

Outcomes sensitive to critical care nurse staffing levels: A systematic review.

OBJECTIVE: To determine associations between variations in registered nurse staffing levels in adult critical care units and outcomes such as patient, nurse, organisational and family outcomes. METHODS: We published and adhered to a protocol, stored in an open access repository and searched for quantitative studies written in the English language and held in CINAHL Plus, MEDLINE, PsycINFO, SCOPUS and NDLTD databases up to July 2020. Three authors independently extracted data and critically appraised papers meeting the inclusion criteria. Results are summarised in tables and discussed in terms of strength of internal validity. A detailed review of the two most commonly measured outcomes, patient mortality and nosocomial infection, is also presented. RESULTS: Our search returned 7960 titles after duplicates were removed; 55 studies met the inclusion criteria. Studies with strong internal validity report significant associations between lower levels of critical care nurse staffing and increased odds of both patient mortality (1.24-3.50 times greater) and nosocomial infection (3.28-3.60 times greater), increased hospital costs, lower nurse-perceived quality of care and lower family satisfaction. Meta-analysis was not feasible because of the wide variation in how both staffing and outcomes were measured. CONCLUSIONS: A large number of studies including several with high internal validity provide evidence that higher levels of critical care nurse staffing are beneficial to patients, staff and health services. However, inconsistent approaches to measurement and aggregation of staffing levels reported makes it hard to translate findings into recommendation for safe staffing in critical care.

Visual distraction during word-list retrieval does not consistently disrupt memory.

Glenberg et al. (1998) reported that episodic memory is impaired by visual distraction and argued that this effect is consistent with a trade-off between internal and external attentional focus. However, their demonstration that visual distraction impairs memory for lists used 15 consecutive word-lists, with analysis only of mid-list items, and has never been replicated. Experiment 1 (N = 37) replicated their methodology and found the same pattern of impairment for mid-list recall, but found no evidence of impairment for other items on the lists. Experiment 2 (N = 64) explored whether this pattern arises because the mid-list items are poorly encoded (by manipulating presentation rate) or because of interference. Experiment 3 (N = 36) also looked at the role of interference whilst controlling for potential item effects. Neither study replicated the pattern seen in Experiment 1, despite reliable effects of presentation rate (Experiment 2) and interference (Experiments 2 and 3). Experiment 2 found no effect of distraction for mid-list items, but distraction did increase both correct and incorrect recall of all items suggestive of a shift in willingness to report. Experiment 3 found no effects of distraction whatsoever. Thus, there is no clear evidence that distraction consistently impairs retrieval of items from lists and therefore no consistent evidence to support the embodied cognition account used to explain the original finding.