A hermeneutical study of professional accountability in nursing.

AIMS AND OBJECTIVES: This paper presents findings from a hermeneutical study which sought to explore how registered nurses experienced and perceived their professional accountability in clinical settings. BACKGROUND: Professional accountability encompasses the ideals and standards of nursing practice. Nurses are accountable for their actions under civil, criminal and contract law to their; employing organisation, their regulatory body and the patients for whom they care. DESIGN: This paper reports on a Heideggerian hermeneutical study involving seven registered nurses, working in clinical practice in the National Health Service in the United Kingdom. Methods The study adopted purposive sampling, collecting data by means of in-depth interviews. Data were analysed using the hermeneutic circle. COREQ checklist was used as a reporting guideline for this study. RESULTS: The findings suggest that professional accountability in nursing practice is a complex phenomenon, which can be compromised by many factors which are historically, socially or politically driven Participants experienced challenges through a lack of resources and poor managerial support, which compromised their ability to deliver high-quality patient care. However, collegiality strongly impacted upon resilience and positively influenced their well-being. RELEVANCE TO CLINICAL PRACTICE: Amid the challenges of the clinical workplace, a positive workplace culture with visible managerial support is a fundamental requirement in supporting professional accountability, development and retention of nurses. Findings highlight the view that leadership should be seen as a collective responsibility, which empowers staff to positively change the practice environment.

Recognising, managing and supporting dyslexia beyond registration. The lived experiences of qualified nurses and nurse academics.

While there is a growing body of research on the effects of dyslexia on student nurses, this is not the case for registered nurses. The main aim of the study was to identify how dyslexia might affect registered nurses' engagement in lifelong learning and how lecturers can support them. A narrative lifecourse approach was taken to explore the experiences of 14 registered nurses with dyslexia from across Great Britain and nine lecturers from England and Scotland. In depth interviews were conducted between October 2014 and November 2015. Template analysis of the interview data resulted in four main themes: Recognition of Dyslexia; Impact of Previous Learning Experiences; Teaching and Learning Strategies and Reasonable Adjustments. The study demonstrated that previous learning experiences had an emotional impact on nurses with dyslexia and this affected their engagement in lifelong learning. Despite this, they often sought to challenge themselves and recognised the need to engage in continuing professional development. The support for registered nurses with dyslexia was variable and dependent on the education of lecturers, although wider provision of inclusive approaches to teaching, learning and assessment mitigated this.

Sleep quality, sleep duration and sexual health among older people: Findings from the English Longitudinal Study of Ageing.

CONTEXT: How sleep quality and sexual health are associated among community-dwelling individuals remains largely unknown. OBJECTIVE: We examined the association of sleep disturbance and sleep duration with a range of measures assessing sexual activities, functioning and concerns in a representative sample of older people. METHODS: Participants were community-dwelling adults aged 50-90+ years from wave 6 (2012/2013) of the English Longitudinal Study of Ageing (ELSA) who reported any sexual activity in the last year. Sleep disturbance, sleep duration and sexual health were measured by self-report at wave 6. Retrospective reports of restless sleep (waves 1-6 [2002-2013]) were also examined. The association between sleep measures and sexual health was assessed using logistic regressions stratified by gender and adjusted for demographic, health and lifestyle factors with results expressed as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Among both men and women disturbed sleep was associated with reported declines in sexual activity and function over the last year, and increased concern about their sexual desire, frequency of sexual activity and sexual functioning. Robust associations between high sleep disturbance and vaginal pain (OR = 1.67, 95% CI = 1.21, 2.31) and vaginal dryness (OR = 1.69, 95% CI = 1.24, 2.30) were also observed among women. Retrospective reports of restless sleep showed a dose-response relationship with reported declines in sexual health over the last year, and increased concerns about sexual expression and functioning. CONCLUSIONS: Self-reported sleep disturbance and retrospective restless sleep were mainly associated with subjective assessments of recent declines in sexual activity and functioning, and higher levels of sexual concerns.

The education of nurses working in care homes for older people: An Appreciative Inquiry.

AIM: To explore the education and developmental needs of care home nursing staff. BACKGROUND: With an increasing ageing population, the need for high-quality care provision is set to rise and will require nursing staff with the desired knowledge, skills and values. However, multiple concerns have been identified when considering the development of nurses working in care homes. Moreover, challenges in the care home sector have also contributed to a situation where some nurses view care home work as being of low status and choose this work to fit around other commitments, rather than viewing it as a viable career pathway. METHOD: A qualitative approach based on the principles of Appreciative Inquiry. Fifteen participants working in five care homes with nursing, based in England (UK), took part in this study. Data were collected during 2016-2017 and involved managerial, qualified and unqualified staff. RESULTS: Data analysis revealed three distinct themes: an effective learning environment; the care home as a nursing student placement; and the need for financial investment. These themes were found to have the most influence on the development and education of care home nursing staff. CONCLUSION: This research provides important insights into the care home as an educational environment, not only for nursing students but also for those employees already working in such settings. Exploration of the ways in which higher education organisations and care home teams could collaborate more closely could be mutually beneficial to the quality of care and to raising the profile of care home work. IMPLICATIONS FOR PRACTICE: Care homes can provide a rich learning environment for both staff and nursing students. Collaboration and appreciative ways of working enhance opportunities for developing practice and care.

Effects of dyslexia on registered nurses in practice.

While there is a growing body of research on the effects of dyslexia on student nurses, this is not the case for registered nurses. The purpose of this paper is to report key findings of a study that investigated the experiences of registered nurses who have dyslexia. The main aim of the study was to identify how dyslexia might affect registered nurses, with a particular focus on practice. A narrative lifecourse approach was taken to explore the experiences of 14 registered nurses who have dyslexia from across Great Britain. In depth interviews were conducted between October 2014 and November 2015. Template analysis of the interview data resulted in five main themes: career choices, decision to disclose, effect on practice, compensatory strategies, and support from others. The study demonstrated that there is still a perceived stigma attached to having dyslexia and that there continues to be a lack of understanding amongst colleagues, which affects disclosure and access to support. However, the registered nurses had developed many different compensatory strategies to enable them to practise effectively and that patient safety was paramount to them.

Urinary incontinence and sexual health in a population sample of older people.

OBJECTIVES: To investigate the association between self-reported urinary incontinence (UI) and sexual health in a representative sample of older people. SUBJECTS AND METHODS: Participants were community-dwelling women and men aged 50-90+ years from the English Longitudinal Study of Ageing (ELSA) who reported any sexual activity in the last year. The prevalence of UI was assessed both cross-sectionally (ELSA Wave 6; 2012) and retrospectively over the preceding 8 years (ELSA Waves 2-6; 2004-2012). Sexual activities, difficulties and concerns were assessed using a validated Sexual Relationships and Activities Questionnaire. The association between UI and sexual health outcomes was examined using weighted logistic regressions, with adjustments made for demographic, health, and lifestyle factors. RESULTS: At Wave 6, 391 (20.0%) women and 141 (6.9%) men reported 'any UI' in the last 12 months. Compared to those without UI, women with UI reported declines in sexual activity and arousal over the last year, and increased concern about their frequency of sexual activity and ability to become sexually aroused. Men with 'any UI' reported declines in sexual desire, increased erectile and orgasm difficulties, and were more concerned about these sexual functions compared to men without UI. Differences in the patterns of association with sexual health were seen, dependent upon whether UI was reported as sporadic or persistent, and also with respect to the duration of retrospectively reported UI. CONCLUSION: Self-reported UI was associated with impairment in sexual health in women and men, and mainly linked to recent declines in sexual activity and function along with elevated sexual concerns. Our findings highlight that the sexual health of older people should be considered when managing UI.

The impact of multiple sclerosis on the identity of mothers in Italy.

PURPOSE: This paper reports on one of the themes that emerged from the analysis of the study, regarding the perceived influence of multiple sclerosis (MS) on the identity of mothers in the socio-cultural context of Italy. METHOD: In-depth interviews were conducted with 16 women at various stages of MS, with follow up interviews with seven of the women. Phenomenology guided the methodology and the analysis was conducted using interpretative phenomenological analysis. RESULTS: Through the research the value of motherhood to the women who participated emerged. The findings illustrated how many strove to maintain control of their MS, which led to some making comparisons of themselves and other mothers and feeling different. Some women described how they adjusted their roles and found strength in being mothers but others spoke of their feelings of loss. Most women described living in the moment, appreciating the present and living each day as it came. Another significant experience was fear of stigma, both realized in the form of "pity" from others, and the perceived and actual associated stigma for their families. This contributed to why some women were reluctant to disclose their condition. The mothers who took part in this study differed in how they perceived their disabled identity. CONCLUSION: Although this study was conducted in the socio-cultural setting of Italy, the findings have implications for professionals working with disabled mothers and women with MS in Italy and beyond; including recognizing the value associated with fully identifying oneself as a mother, rather than solely focusing on doing mothering tasks. Implications for Rehabilitation Professionals need to be mindful of the value of motherhood for women with multiple sclerosis. Professionals should support women who feel like they are battling with maintaining control of their multiple sclerosis, who may be adjusting their identity as mothers; recognizing that they may be influenced by the stage of their multiple sclerosis and whether they were diagnosed before or after having their children. Women can have feelings of loss related to their ability to fully participate in their children's lives and professionals should work with women to help them identify the value of their mothering role not only in physically participating in activities but also in being emotionally and physically present as a mother.

Older Adults' Experiences of Sexual Difficulties: Qualitative Findings From the English Longitudinal Study on Ageing (ELSA).

There is a growing body of evidence demonstrating that sexual activity is important to the quality of life of older adults, and that it can be influenced by physical, psychological, and social factors. However, older adults' experiences of sexual difficulties remain relatively unexplored. This article draws on qualitative data collected as part of the English Longitudinal Study of Ageing (ELSA). Participants answered a Sexual Relationships and Activities Questionnaire (SRA-Q), which included an open comment box for further details, 1,084 (1/7) of which were completed. These data were analyzed using Template Analysis, and findings on the experiences of sexual difficulties are presented in this article. Sexual difficulties were contextualized within the couple relationship and could be detrimental to the relationship, particularly if the partner would not seek professional help. Participants reported that sexual difficulties could also have a negative impact on psychological well-being, described mainly as frustration, depression, and sadness. For some participants the supportive nature of their relationship buffered these impacts. Few had sought professional help; those who had reported helpful and unhelpful experiences. These findings add to the limited evidence base and have implications for health care in the context of global aging and a growing recognition of older adults' sexual rights.

Building a values-based culture in nurse education.

Nurse education has found itself challenged to select and educate nurses who on completion of? of their programme? have: excellent technical skills, an ability to critically analyse care and work compassionately in ways that support the values of care that are important to service users. Recent reports of care suggest that nursing still needs to develop the values base of its student selection and education processes. Against this backdrop, this paper presents two examples from pre registration nurse education that illustrate how a values based approach is used as part of the selection process in one university and used to inform the development of a reflective poetry initiative in another university. Having presented the two examples the authors debate some of the wider benefits and challenges linked to these ways of working. For example, the importance of connecting nurses' personal beliefs, attitudes and assumptions to service user values in recruitment are discussed. The use of poetry as a way of thinking about practice that moves beyond traditional models of reflection in nursing are also considered. However, the authors recognise that if developments in nurse education are to have a real impact on nursing practice and patient care, there is the need for values based initiatives to be more directly connected to the delivery of healthcare.

Learning to nurse in care homes: student support.

An increasing number of care homes in the UK now provide placements for students undertaking pre-registration nursing programmes, enabling them to develop knowledge and skills in the continuing care of older people. In this article the authors describe an initiative to support nursing staff working in care homes and prepare them for their role in student education. The impetus for the initiative came from student feedback and evaluation of their placement experiences. These suggested that staff in some care homes were not fully prepared to help meet students' learning needs. Students' concerns about the quality of care in some homes also made clear the need for a forum in which the evidence base for practice in continuing care settings could be discussed and debated. The initiative combined the development of new roles with regular opportunities to share information and feedback.