Opening up conversations: Collaborative working across sociomaterial contexts in nursing in London.

AIM: To discuss nurses' use of networks to address nursing recruitment and retention in London, UK. DESIGN: Qualitative evaluation of the Capital Nurse programme reporting on 30 narrative interviews with executive, clinical and student nurses in 2019. RESULTS: Executive nurses within the Capital Nurse programme recognized the importance of sociomaterial contexts in the health and social care system in London and worked strategically across these contexts to achieve change. Supported through the Capital Nurse programme, executive nurses from health organizations across London initiated collaborative working to improve recruitment and retention. Primarily by designing and delivering sociomaterial products (organizational and educational) to support nurses to build a career in London. Drawing on ideas from actor network theory, in particular sociomaterial contexts, nurses' actions at all levels to develop and sustain networks to address nursing recruitment and retention across the NHS in London are described. CONCLUSIONS: Capital Nurse supported collaborative working both within single organizations and across organizations in London. There is evidence of change in how nurses across the capital work together to improve patient care, improve recruitment and retention. Findings may resonate with nurses in other settings who seek to address the problem of recruitment and retention. They show how nurses coming together in networks to effect changes in practice can work successfully. IMPACT: Nurses' use of networks led to novel models of communication and action to address the problems of recruitment and retention in London. We argue that sociomateriality should be considered outside the clinical practice setting, as part of nurses' professional development and organizational practice, that is how they plan their career, how they address recruitment and retention, how they communicate across organizations about nursing issues. NO PATIENT OR PUBLIC CONTRIBUTION: This was an evaluation of a staff development project in London, which sought to elicit nurses' experiences of participation in Capital Nurse.

A pilot study for testing feasibility and preliminary influence of early intervention using text messaging for pressure ulcer prevention in individuals with spinal cord injury.

BACKGROUND: This pilot study assessed text messaging as an early intervention for preventing pressure ulcers (PrUs) in individuals with spinal cord injury (SCI) post-hospital discharge. METHOD: Thirty-nine wheelchair-users discharged after acquiring a SCI, underwent randomisation into an intervention group (n = 20) with text messages and a control group (n = 19). All participants received standard post-discharge care and completed a skincare questionnaire before and 6-month after discharge. Primary outcomes included feasibility and acceptability of early intervention using text messaging, alongside performance, concordance, and attitudes toward skincare. Secondary outcomes measured perception and the incidence of PrUs. RESULTS: Baseline demographics were comparable between the intervention and control groups. Eight of 20 participants completed 6-month follow-up questionnaires in the intervention group, six participants completed the 6-month questionnaires in the control group,. Participants expressed high satisfaction with text messages, understanding of content, and increased confidence in preventing PrUs. At 6-month post-discharge, the intervention group showed improved prevention practices, heightened awareness of PrU risks, and increased perceived importance of prevention, which were not observed in the control group. However, there were no significant differences in PrU incidence, possibly due to the small sample size and short follow-up. CONCLUSION: The study demonstrates that using text messaging as an early intervention for PrU prevention in individuals with SCI is feasible and well-received. Preliminary results suggest a positive impact on participants' attitudes and practices, indicating the potential of text messaging to reduce PrU incidence. However, further research with larger samples and extended follow-up is crucial to validate these promising initial findings.

The knowledge and attitudes regarding pressure ulcer prevention among healthcare support workers in the UK: A cross-sectional study.

BACKGROUND: Pressure ulcers cause significant, detrimental effects on personal wellbeing. They represent a serious health and social care burden. Nurses and those working in support roles are primarily accountable for preventing pressure ulcers. Healthcare support workers are an expanding group of key workers in the UK. OBJECTIVE: To examine healthcare support workers' knowledge and attitudes regarding pressure ulcer prevention. METHODS: A cross-sectional study was conducted from December 2020 to June 2021, using Knowledge and Attitudes toward Pressure Ulcer Prevention Assessment Tool. RESULTS: A total of 164 participants completed the questionnaire fully. A low mean knowledge score of 0.42 ± 0.14, but a positive attitude score of 0.76 ± 0.10 per item were reported. The weakest areas of knowledge include aetiology, risk assessment and addressing pressure-reducing interventions for patients at risk. Higher mean scores per item in knowledge of pressure ulcer prevention were reported in participants working in acute hospital wards and nursing homes (0.468 ± 0.15, 0.47 ± 0.08 respectively) than those in other settings (p < 0.05). Participants working in primary care scored lowest (0.33 ± 0.12). The scores of participants with more positive attitudes towards pressure ulcer prevention significantly correlated with higher score of knowledge (p < 0.005). CONCLUSION: While positive attitudes towards pressure ulcer prevention exist among healthcare support workers, this is overshadowed by significant knowledge deficits. Findings highlight the importance of continuing structured education for support workers across both acute and community settings. A future national survey and interventional study are needed to examine support workers' pressure ulcer knowledge and to inform a national continuous education strategy.

'Just have some IVF!': A longitudinal ethnographic study of couples' experiences of seeking fertility treatment.

We present findings from a longitudinal ethnographic study of infertile couples seeking treatment following initial GP referral to specialist fertility services. Repeated observations and interviews were undertaken with the same 14 heterosexual participants over an 18-month period. Heterosexual, non-donor couples comprise the majority of fertility clinic patients; however, research interest in this group has dwindled over time as IVF cycles have increased. In the United Kingdom, IVF is presented as a logical response to involuntary childlessness, and as an entirely predictable, and linear, course of action. The market is well-developed and often patients' first experience of privatised health care in the NHS. Our couples were challenged by this, and while they felt expected to move on to IVF, some wished to explore other options. While IVF is ubiquitous, the discomfort and challenge around fertility treatments remain; experiences are prolonged and characterised by recursive narratives and expressions of disequilibrium, which are rarely acknowledged and reflected in ongoing clinic-patient interactions. Our findings develop understanding of the process of 'mazing' (Image - The Journal of Nursing Scholarship, 1989, 21, 220), the pursuit of parenthood, by showing that the routine and normative status of IVF, at least in the current health care context, is at odds with the lived experiences of individuals.

Reflections on whiteness: Racialised identities in nursing.

In this article, I discuss the structural domination of whiteness as it intersects with the potential of individual critique and reflexivity. I reflect on my positioning as a white nurse researcher while researching international nurse migration. I draw on two large qualitative studies and one small focus group study to discuss my reactions as a white researcher to evidence of institutional racism in the British health services and my growing awareness of how racism is reproduced in the British nursing profession.

Development and preliminary validation of a tool measuring concordance and belief about performing pressure-relieving activities for pressure ulcer prevention in spinal cord injury.

OBJECTIVE: To develop and examine the reliability, and validity of a questionnaire measuring concordance for performing pressure-relief for pressure ulcer (PrU) prevention in people with Spinal Cord Injury (SCI). METHODS: Phase I included item development, content and face validity testing. In phase II, the questionnaire was evaluated for preliminary acceptability, reliability and validity among 48 wheelchair users with SCI. RESULTS: Thirty-seven items were initially explored. Item and factor analysis resulted in a final 26-item questionnaire with four factors reflecting concordance, perceived benefits, perceived negative consequences, and personal practical barriers to performing pressure-relief activities. The internal consistency reliability for four domains were very good (Cronbach's α = 0.75-.89). Pearson correlation coefficient on a test-retest of the same subjects yielded significant correlations in concordance (r2 = 0.91, p = .005), perceived benefit (r2 = 0.71, p < .04), perceived negative consequences (r2 = 0.98, p < .0001), personal barriers (r2 = 0.93, p= .002). Participants with higher levels of concordance reported a greater amount of pressure-relieving performed. Individuals viewing PrU as a threatening illness were associated with higher scores of concordance and tended to report a greater amount of pressure-relieving performance which provides evidence of criterion related validity. CONCLUSION: The new questionnaire demonstrated good preliminary reliability and validity in people with SCI. Further evaluation is necessary to confirm these findings using larger samples with follow-up data for predictive validity. Such a questionnaire could be used by clinicians to identify high risk of patients and to design individualised education programme for PrU prevention.

The 'values journey' of nursing and midwifery students selected using multiple mini interviews; Year One findings.

AIM: To explore how adult, child and mental health nursing and midwifery students, selected using multiple mini interviews, describe their 'values journey' following exposure to the clinical practice environment. BACKGROUND: Values based recruitment (VBR) incorporates assessment of healthcare students' personal values using approaches like multiple mini interviews. Students' experience of adjustment to their values during their programme is conceptualized as a 'values journey'. The impact of VBR in alleviating erosion of personal values remains unclear. DESIGN: A cross-professional longitudinal cohort study was commenced at one university in England in 2016 with data collection points at the end of years one, two and three. Non-probability consecutive sampling resulted in 42 healthcare students (8 adult, 8 child and 9 mental health nursing and 17 midwifery students) taking part. METHODS: Six semi-structured focus groups were conducted at the end of participants' Year One (DC1). Data analysis incorporated inductive and deductive approaches in a hybrid synthesis. FINDINGS: Participants described a 'values journey' where their values, particularly communication, courage and wanting to make a difference, were both challenged and retained. Participants personal journeys also acknowledged the: 'courage it takes to use values'; 'reality of values in practice' and 'need for self-reflection on values'. CONCLUSION: A 'values journey' may begin early in a healthcare student's education programme. This is important to recognize so that appropriate interventions designed to support students in higher education and clinical practice can be implemented. The values incorporated in VBR should be continually evaluated for fitness for purpose.

Preconception care for infertile couples: Nurses' and midwives' roles in promoting better maternal and birth outcomes.

INTRODUCTION: Preconception care promotes better maternal outcomes, may assist in preventing birth defects and improves fertility awareness among healthy childbearing couples. Yet, the significance of preconception care for infertile couples is undeveloped area of practice in Europe. AIMS AND OBJECTIVES: To discuss the importance of nurses and midwives in providing preconception care to infertile couples in the United Kingdom and Spain. DESIGN: Discursive paper. METHOD: A comparison of different midwifery and nursing approaches to preconception care for infertile couples in two European countries. FINDINGS: At present, infertile couples' needs for preconception care are not routinely identified or understood. There is an opportunity for these needs to be considered and identified by nurses at the time of investigation for infertility or when planning pregnancy with assisted conception. CONCLUSIONS: We argue that, by providing preconception care, nurses and midwives have an opportunity to deliver important advice to infertile couples in both primary care and specialist infertility services.

Do governing body and CSU nurses on clinical commissioning groups really lead a nursing agenda? Findings from a 2015 Survey of the Commissioning Nurse Leaders' Network Membership.

AIMS: This paper reports the findings from a 2015 survey of the Commissioning Nurse Leaders' Network. Our aim was to understand how governing body nurses perceive their influence and leadership on clinical commissioning groups. METHODS: An online survey method was used with a census sample of 238 governing body nurses and nurses working in Commissioning Support Units, who were members of the Commissioning Nurse Leaders' Network. The response rate was 40.7% (n = 97). RESULTS: While most governing body nurses felt confident in their leadership role, this was less so for non-executive governing body nurses. Nurses in Commissioning Support Units were much less positive than governing body nurses about their influence on clinical commissioning groups. CONCLUSION: Governing body nurses were satisfied with their impact on clinical commissioning groups and so could be said to be leading a nursing agenda but this evidence is limited to their own perceptions and more objective or diverse measures of impact are needed. The purpose of such roles to 'represent nursing, and ensure the patient voice is heard' may be a flawed aspiration, conflating nursing leadership and patient voice. IMPLICATIONS FOR NURSING MANAGEMENT: This is the first study to explore explicitly the differences between executive and non-executive governing body nurses and nurses working in commissioning support units. Achieving clinical commissioning groups' goals, including developing and embedding nursing leadership roles in clinical commissioning groups, may be threatened if the contributions of governing body nurses, and other nurses supporting clinical commissioning groups, go unrecognised within the profession, or if general practitioners or other clinical commissioning group executive members dominate decision-making on clinical commissioning groups.

Delegation and supervision of healthcare assistants' work in the daily management of uncertainty and the unexpected in clinical practice: invisible learning among newly qualified nurses.

The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile's (Practice-based education: Perspectives and strategies, Rotterdam: Sense, 2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the healthcare assistant. In the British context, delegation and supervision are thought of as skills which are learnt "on the job." We suggest that learning "on-the-job" is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011 to 2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and healthcare assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the "invisible learning" which occurs as newly qualified nurses learn to delegate and supervise.

Supporting staff to respond effectively to informal complaints: findings from an action research study.

AIM AND OBJECTIVE: To understand how nurses and midwives manage informal complaints at ward level. BACKGROUND: The provision of high quality, compassionate clinical nursing and midwifery is a global priority. Complaints management systems have been established within the National Health Service in the UK to improve patient experience yet little is known about effective responses to informal complaints in clinical practice by nurses and midwives. DESIGN: Collaborative action research. METHODS: Four phases of data collection and analysis relating to primarily one National Health Service trust during 2011-2014 including: scoping of complaints data, interviews with five service users and six key stakeholders and eight reflective discussion groups with six midwives over a period of nine months, two sessions of communications training with separate groups of midwives and one focus group with four nurses in the collaborating trust. RESULTS: Three key themes emerged from these data: multiple and domino complaints; ward staff need support; and unclear complaints systems. CONCLUSIONS: Current research does not capture the complexities of complaints and the nursing and midwifery response to informal complaints. RELEVANCE TO CLINICAL PRACTICE: Robust systems are required to support clinical staff to improve their response to informal complaints and thereby improve the patient experience.

Supporting deployed operations: are military nurses gaining the relevant experience from MDHUs to be competent in deployed operations?

AIMS AND OBJECTIVES: To explore how peacetime employment of military nurses in the UK National Health Service Medical Defence Hospital Units prepares them to be competent to practise in their role on deployment. BACKGROUND: Military secondary care nurses are employed within UK National Health Service Trusts to gain clinical experience that will be relevant to their military nursing role. DESIGN: A two-stage grounded theory study using mixed methods: postal questionnaire survey and in-depth interviews. METHODS: In stage one a postal questionnaire was distributed to all serving military nurses. Stage two involved 12 semi-structured interviews. The data from both parts of the study were analysed using grounded theory. RESULTS: Four categories and one core category were identified, which suggested that participants did not feel fully prepared for deployment. Their feelings of preparedness increased with deployment experience and decreased when the nature of injuries seen on deployment changed. Respondents argued that even when unprepared, they did not feel incompetent. The findings suggest that the peacetime clinical experience gained in the National Health Service did not always develop the necessary competencies to carry out roles as military nurses on deployment. This study highlights the unique role of military nurses. We discuss these findings in the light of the literature on competency and expertise. CONCLUSION: The military nurses in this study did not feel fully prepared for deployed operations. We propose a new model for how military nurses could gain relevant experience from their National Health Service placements. RELEVANCE TO CLINICAL PRACTICE: National Health Service clinical placements need to be reassessed regularly to ensure that they are meeting military nurses' clinical requirements. Experiences of nurses returning from deployment could be shared and used as a basis for reflection and learning within National Health Service Trusts and also inform decisions regarding the appropriateness of clinical placements for qualified military nurses.

Cervical screening and the aftermath of childhood sexual abuse: are clinical staff trained to recognise and manage the effect this has on their patients?

AIMS AND OBJECTIVES: To evaluate the training needs and awareness of childhood sexual abuse amongst clinical staff taking cervical screening samples in one inner city primary care trust. BACKGROUND: Studies exploring sexual abuse and nonparticipation in cervical screening have demonstrated that women can experience re-traumatisation if care during examinations is insensitive to their particular needs. DESIGN: This was a mixed methods, service evaluation in three phases. METHODS: A literature review, a questionnaire to cervical screening staff in an inner city primary care trust and a focus group of four staff drawn from questionnaire respondents to explore themes raised in the questionnaire data. RESULTS: Data analysis of both quantitative and qualitative data showed that clinical staff underestimated the frequency of childhood sexual abuse although they were aware of the difficulties and reluctance some women experience undergoing gynaecological examinations. When women did disclose childhood sexual abuse or when staff suspected a history of childhood sexual abuse, staff reported feeling unsure of how they should proceed. There was no support or clinical supervision, and unmet training needs were identified. CONCLUSIONS: Nurses expressed anxiety around the potential of the screening test to cause more harm than good and at their inability to provide more help than listening. Staff wanted support and further training after completing their cervical screening training course to assist in their provision of sensitive care to patients who have experienced childhood sexual abuse. RELEVANCE TO CLINICAL PRACTICE: Whilst our results cannot be generalised to a wider population, they may be meaningful for the community of cervical screening takers. We argue that screening staff require further training and professional support (clinical supervision) to increase their confidence when providing safe and sensitive practice for childhood sexual abuse survivors. If staff feel more confident and competent when responding to disclosure of childhood sexual abuse in screening situations, women who have experienced childhood sexual abuse might participate in the screening programme more readily.

An auto-ethnographic reflection on the nature of nursing in the UK during the Covid-19 pandemic.

In this article I discuss the effects on the patient experience of isolation nursing during the CoronaVirus Disease (COVID)-19 pandemic. An unintended consequence of isolation nursing has been to distance patients from nurses and emphasise the technical side of nursing while at the same time reducing the relational or affective potential of nursing. Such distanced forms of nursing normalise the distal patient in hospital. I consider ways in which this new form of distanced nursing has unwittingly contributed to the continued commodification of nursing care in the British NHS. Autoethnography is used to describe and reflect on the illness experience, the experiences of caregivers and the sociocultural organisation of health care. The findings discuss three areas of the illness experience: intimate nursing care; communication; the 'distanced' patient experience.

Deaf women's experiences of maternity and primary care: An integrative review.

BACKGROUND: An estimated 24,000 people in the UK report using British Sign Language (BSL) as their first language. Misconceptions about deaf culture and language mean that deaf people have less access to health information and their health literacy is lower. Deaf people's health needs go under the radar in primary care with ensuing poorer health outcomes. Deaf women's experiences of maternity care are poorly understood. METHODS: Using Whittemore and Knafl's method for an integrative review, the following databases were searched: EMBASE, MedLine, CINAHL and Maternity and Infant Care. After reviewing 430 journal article titles and abstracts against the inclusion/exclusion criteria, 11 articles were included for final review. Selected studies were conducted internationally and were available in English. 10 were qualitative studies, 1 used survey design. They were reviewed using the Caldwell Framework. FINDINGS: These show that deaf women avoid seeking care, have a lack of access to health information and healthcare providers, including midwives, have a lack of deaf awareness. For deaf women, during pregnancy, birth and postnatal periods, this can mean having longer hospital stays and more complex postnatal care needs in both the hospital and community setting. CONCLUSIONS: Current care provisions do not always meet the needs of the deaf BSL using women who use maternity services. Midwives should be aware of deafness as a culture and how to best meet the needs of the community to improve health outcomes for women and their babies.

Trying for a second chance: Iranian infertile couples' experiences after failed ART.

INTRODUCTION: Despite significant advances, only 35% infertile couples conceive after ART. If IVF is unsuccessful, couples will need to decide whether to proceed again with assisted conception. The aim of this study was to explore Iranian infertile couples' experiences after failed ART to continue treatment. METHODS: In this qualitative study participants were selected using purposeful sampling method. Data were collected using 29 semi-structured face-to-face in-depth interviews at a regional Infertility Center from April 2016 to June 2017. All interviews were recorded, transcribed verbatim, and analyzed with conventional content analysis method using MAXQDA software. RESULTS: Our findings suggest that couples' decisions to continue treatment after unsuccessful ART is shaped by their social, emotional and financial circumstances. We have constructed two themes to describe their experiences: support to continue and trying for a second chance. CONCLUSION: Our findings suggest that good marital and family support networks can support infertile couples during this period of decision making. Considering the depression and anxiety caused by failed ARTs, which itself could affect the success rate of any further ARTs, the clinical team should effectively assess psychological readiness of couples who decide to continue with another ART after unsuccessful treatment.

Experiences of supernumerary status and the hidden curriculum in nursing: a new twist in the theory-practice gap?

AIMS AND OBJECTIVES: This paper aims to increase our understanding about how student nurses' experiences of supernumerary status are embedded in the hidden curriculum in clinical practice and contribute to the theory-practice gap in nursing. BACKGROUND: Current literature suggests that the hidden curriculum exists in many professional curricula and that it functions to socialise students into professional behaviours and practice. However, in nursing, there is a gap in our understanding of how these socialisation processes have been influenced by supernumerary status and what forms the hidden curriculum might take currently in clinical practice. DESIGN: An ethnographic case study design. METHOD: Data were collected in four sites using fieldwork in clinical practice as well as interviews with students, mentors and key stakeholders, an online survey of student bodies and curriculum analysis in four universities. The findings in this paper are drawn from the qualitative fieldwork and interviews and were analysed thematically. RESULTS: The findings suggest that supernumerary status is an important aspect of the hidden curriculum in clinical learning for nursing students; that students are expected by trained staff to work while they learn and that on registration, they are expected to be competent to work immediately as registered nurses. These expectations are at odds with those of academic nurses and contribute to a theory-practice gap for student nurses. These expectations form part of the hidden curriculum that shapes the clinical context, and students have to learn to negotiate their status as supernumerary students in practice to meet these expectations. CONCLUSION: Consequently, students have to learn in a disintegrated learning context where opposing values of learning exist. RELEVANCE TO CLINICAL PRACTICE: To reintegrate student nurses' learning, educators in universities and clinical practice have to understand how the hidden curriculum and expectations around supernumerary status among trained staff affect learning for students.

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

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