Developing therapeutic relationships with people living with HIV: exploring the nurse-patient relationship.

BACKGROUND: The care paradigm for HIV has changed from one of an infectious, life-limiting disease to that of a chronic manageable condition. This shift poses challenges for practitioners working in this area when providing care that is both person centred and reflective of the demands placed on an evolving disease area. OBJECTIVES: The overall aim of this study was to explore how therapeutic relationships are developed and their subsequent use within person-centred care. DESIGN: An interpretative phenomenological analysis research design was used to collect data from 10 purposively recruited HIV specialist nurses in the north-west region of the UK. In-depth, semistructured interviews were used to collect the data. RESULTS: Data analysis revealed three themes that captured person-centredness in HIV care. These were: ways of being; the nurse-patient relationship; and the influence of stigma. CONCLUSION: The research illuminates key features that are important when developing therapeutic relationships and offers a framework to explain how these features were also key elements of person-centred care.

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.

Learning to lead: A scoping review of undergraduate nurse education.

AIM: To explore undergraduate student's preparation for leadership roles upon registration. BACKGROUND: Effective leadership is vital when promoting positive workplace cultures and high-quality care provision. However, newly registered nurses are not always well-prepared for leadership roles. EVALUATION: A scoping review of primary research published in English between 2009 and 2019 was undertaken. Data were analysed using an adapted version of Arksey and O'Malleys' (2005. International Journal of Social Research Methodology: Theory and Practice, 8, 19) framework. Nine papers met the review eligibility criteria. KEY ISSUES: Findings revealed three themes: leadership education content; positioning of leadership education within the nursing programme; and teaching and learning delivery. CONCLUSIONS: The review highlighted some agreement about the knowledge, skills and behaviours to be addressed in leadership education. What varied more was the pedagogical methods used to deliver this, the extent of its integration throughout the programme and the nature of collaborative academic-practice working to ensure good quality clinical supervision. IMPLICATIONS FOR NURSING MANAGEMENT: (a) Students must be exposed to positive leadership practices during clinical placements to facilitate theory-practice integration. (b) Bullying negatively impacts on students' self-efficacy whereas positive role modelling from registered nurses supports development of leadership competence. (c) Leadership theory and competence should be introduced early and revisited throughout the programme.

The wicked problem of healthcare student attrition.

The early withdrawal of students from healthcare education programmes, particularly nursing, is an international concern and, despite considerable investment, retention rates have remained stagnant. Here, a regional study of healthcare student retention is used as an example to frame the challenge of student attrition using a concept from policy development, wicked problem theory. This approach allows the consideration of student attrition as a complex problem derived from the interactions of many interrelated factors, avoiding the pitfalls of small-scale interventions and over-simplistic assumptions of cause and effect. A conceptual framework is proposed to provide an approach to developing actions to reduce recurrent investment in interventions that have previously proved ineffective at large scale. We discuss how improvements could be achieved through integrated stakeholder involvement and acceptance of the wicked nature of attrition as a complex and ongoing problem.

Developing Reflective Thinking through Poetry Writing: Views from Students and Educators.

Aims and Objectives To explore student nurse and educator perspectives on the use of poetry writing as a way to reflect on important nursing practice issues. Background Reflective practice is a well-established method of learning in pre-registration nurse education although student nurses can find reflection a challenging process. Design An exploratory descriptive approach. Methods Data were extracted from unstructured interviews with students and educators (n = 12) from one university in the North-West region of England, United Kingdom (UK). Data were thematically analysed. Results Poetry writing supports a meaningful exploration of events, which have the potential to lead to changes in perspective. Careful planning of the poetry writing process is required, to ensure the potential of this approach is realised. Conclusion Poetry writing is an effective way to reflect on clinical practice. This work has relevance and transferability to a wide range of professional disciplines, where reflective practice is encouraged.

The meaning of living with uncertainty for people with motor neurone disease.

AIMS AND OBJECTIVES: To explore the meaning of living with uncertainty for people diagnosed with motor neurone disease (MND). BACKGROUND: Motor neurone disease is a progressive neurodegenerative condition resulting in multiple needs, arising from the complex nature of the disease trajectory. People with MND are often required to make decisions for symptom management and end-of-life care. Research into the lived experience of MND has previously highlighted the following: the shock of receiving such a diagnosis and prognosis; subsequent concerns relating to the future and loss; and the existential suffering for a person with MND. The lived experiences of MND accentuate the devastating nature of the disease, and this can impact upon how people respond to care. DESIGN: Hermeneutic (interpretive) phenomenology: suitable for studying lifeworld experiences. METHOD: Life story interviews were conducted with four participants and subjected to interpretive analysis. RESULTS: Three phases of the MND illness trajectory emerged: "body failing prematurely and searching for answers," "body deterioration and responses to care" and "body nearing its end and needing to talk." These phases highlight the phenomenon under study, all relating to uncertainty for people living with MND. CONCLUSIONS: This study showed that people with MND are living with uncertainty and other concerns throughout their illness trajectory. People are having to turn to palliative care professionals who are more able to meet their concerns than those caring for other aspects of their disease. RELEVANCE TO CLINICAL PRACTICE: Motor neurone disease is a complex disease, and it is important that professionals continue to provide holistic care throughout the illness trajectory. The identification of three distinct phases of the MND illness trajectory will help nurses and other professionals to better understand the meaning of uncertainty and other concerns for people with MND.

"My mentor didn't speak to me for the first four weeks": Perceived Unfairness experienced by nursing students in clinical practice settings.

AIMS AND OBJECTIVES: To explore the perceived unfairness experienced by student nurses during their undergraduate clinical placements. BACKGROUND: It is important that student nurses feel supported by practice staff during their clinical placement education experiences. However, it has been reported that learners can feel ignored, unsupported and bullied by others in the clinical environment and this has a detrimental effect on their learning. It is important to understand the student nurse perspective and explore ways in which their feelings of belongingness might be enhanced in the clinical area. DESIGN: A descriptive narrative approach was used to explore the qualitative data generated by the survey and interviews. Limited closed-question survey data were acquired to explore a selection of quantified survey responses about placements and mentorship. METHODS: A survey was conducted with 1,425 student nurses from adult and mental health degree nursing pathways, across nine institutions in the North West of England, UK. Unstructured interviews were undertaken with 22 student nurses from across these nine institutions. The data generated from both methods (free-text survey responses and interview) were thematically analysed. RESULTS: There were times when student nurses felt that they had been treated unfairly by various members of the healthcare team during their clinical placements. Unfairness was related to being ignored and unsupported or being used as an "extra pair of hands" and having their supernumerary status ignored. Student nurses want to have feelings of belongingness in the clinical area and value enthusiasm for teaching from mentors. Certain positive mentor qualities were identified through the data in this study. These have been used to inform a tiered model of mentorship, to inform future thinking about student nurse education. CONCLUSION: Student nurses can feel like they are being treated unfairly in the clinical area in numerous ways. Identifying ways in which mentorship practice can be developed to adequately support education is important. This can lead to satisfaction and development on both sides of the student/educator relationship. RELEVANCE TO PRACTICE: Exploring student nurse perceptions of their learning is important when attempting to enhance educational practice in the clinical setting.

The influence of role models in undergraduate nurse education.

AIMS AND OBJECTIVES: To explore the concept of role modelling in undergraduate nurse education and its effect on the personal and professional development of student nurses. BACKGROUND: Effective educative strategies are important for student nurses, who have to cope with learning in both clinical and university settings. Given the contemporary issues facing nurse education and practice in the United Kingdom (UK), it is timely and important to undertake pedagogical research into the concept of role modelling as an effective educative method. DESIGN: A descriptive narrative approach. METHODS: Unstructured interviews were conducted with 14 current/recently discontinued students from Adult and Mental Health branches of nursing degree programmes in the north-west region of England, United Kingdom (UK). Data were thematically analysed. RESULTS: Students valued exposure to positive role models in clinical and university settings and viewed them as beneficial to their learning. Exposure to negative role models occurred, and this provided students with opportunities to consider the type of nurse they aspired to become. In some cases, students' exposure to perceived poor practice had an adverse effect on their learning and led to negative feelings about nursing work. Clinical staff might be perceived as more relevant role models than those in the university setting although there were still opportunities for academic staff to model professional behaviours. CONCLUSION: The study found that role modelling is an effective way to support learning and led to student satisfaction across both clinical and university settings. The findings support the use of role models in nurse education, and further research about conscious positive modelling of practice is required. RELEVANCE TO PRACTICE: Exploring the use of role models is important when examining ways in which the quality of nurse education might be developed.

Using extant literature in a grounded theory study: a personal account.

AIM: To provide a personal account of the factors in a doctoral study that led to the adoption of classic grounded theory principles relating to the use of literature. BACKGROUND: Novice researchers considering grounded theory methodology will become aware of the contentious issue of how and when extant literature should be incorporated into a study. The three main grounded theory approaches are classic, Straussian and constructivist, and the seminal texts provide conflicting beliefs surrounding the use of literature. A classic approach avoids a pre-study literature review to minimise preconceptions and emphasises the constant comparison method, while the Straussian and constructivist approaches focus more on the beneficial aspects of an initial literature review and researcher reflexivity. The debate also extends into the wider academic community, where no consensus exists. REVIEW METHODS: This is a methodological paper detailing the authors' engagement in the debate surrounding the role of the literature in a grounded theory study. DISCUSSION: In the authors' experience, researchers can best understand the use of literature in grounded theory through immersion in the seminal texts, engaging with wider academic literature, and examining their preconceptions of the substantive area. The authors concluded that classic grounded theory principles were appropriate in the context of their doctoral study. CONCLUSION: Novice researchers will have their own sets of circumstances when preparing their studies and should become aware of the different perspectives to make decisions that they can ultimately justify. IMPLICATIONS FOR RESEARCH/PRACTICE: This paper can be used by other novice researchers as an example of the decision-making process that led to delaying a pre-study literature review and identifies the resources used to write a research proposal when using a classic grounded theory approach.

Rehearsing empathy: exploring the role of poetry in supporting learning.

Empathy is an important aspect of therapeutic relationships in health and social care settings. Health educators can foster empathy development in learners through creative writing activities. Drawing on the humanities, specifically poetry, this paper offers strategies for educators to support empathy development in learners, with a focus on service user poetry and associated creative writing activities. We discuss how poetry can enable alternative perspectives about care to emerge thereby challenging previously held assumptions about mental and physical states. Using poetry can enable a rehearsal of empathy by bringing experiences to the learner in a safe and facilitated environment. Through creative writing activities, we believe that students can learn to better understand and empathise with others, as well as explore their own feelings and experiences related to caregiving, to support self-care.

The need to consider 'temporality' in person-centred care of people with motor neurone disease.

AIMS AND OBJECTIVES: The overall aim of this paper is to provide practical insight into the way that professionals caring for a person with motor neurone disease (MND) can recognise, respect and respond to that person's temporality; that is, the person that they have been, that they are now and that they will be in the future. BACKGROUND: MND is an umbrella term for a group of four rare, devastating neurodegenerative terminal diseases of middle/later life. Previously, we have acknowledged the importance of different time periods in the trajectory of MND as an illness, for example, during the diagnosis stage through to end of life and decision-making at that time. Living with MND can cause anxiety at all stages of the disease trajectory especially as it can be difficult for people living with MND to communicate their desires and concerns to professionals and carers. It is important that professionals continue to provide holistic care throughout the illness trajectory and the aim of this paper is to explore past research about caring for someone with MND in relation to the concept of person-centred care. METHOD: The paper is based on the concatenated exploration of the findings of a hermeneutic phenomenological project. Thus, this discursive paper links elements/studies which have been published previously to develop a model of person-centred care for people with MND which recognises and respects their temporality. CONCLUSIONS: We suggest MND has a significant impact on a person's lifeworld. The proposed person-centred care model focuses on understanding (interpreting) a person in a wider temporal frame and beyond the context of their illness. The expected collaborative outcomes are that: a person is acknowledged as more than a 'patient with MND' and that a professional is providing person-centred care based on individuality of the person, through a temporal lens. This requires a collaborative approach between the person, others and professionals. Such person-centred care, focused on individuality, may prevent a person experiencing life in crisis and suffering towards the end of life.

Supporting physiotherapy learners in practice settings: a mixed methods evaluation of experiences of physiotherapy educators.

BACKGROUND: Practice-based education is an essential component of pre-registration physiotherapy programs, and there is a need for a contemporary review of practice-based educational experiences. PURPOSE: The aim of this study was to explore physiotherapy practice educators' experiences of supporting learners to inform considerations for future workforce development. METHODS: This was a mixed methods sequential explanatory study based in the United Kingdom (UK). Phase one of the study utilized an online survey disseminated via the Chartered Society of Physiotherapy (CSP) professional networks. Phase two consisted of three semi-structured focus group interviews with participants who expressed an interest via completion of the online survey. All were registered or associate CSP members who actively support practice-based education. RESULTS: A total of 208 participants completed the online survey and a sub-set of 15 participated in online focus groups. Quantitative survey data were analyzed using descriptive statistics. Initial thematic analysis of qualitative data from both phases was undertaken by one researcher. Subsequent analyses were carried out independently by the remaining research team, and comparisons were made to agree on codes, categories, and themes. The practice educator is vital in developing the future workforce (30%, n = 61, strongly agree). Identified challenges included supervising more than one learner (34%, n = 67 not at all experienced) and using technology to provide alternative placement models (45%, n = 87 not at all experienced). CONCLUSION: Practice educators need accessible opportunities for professional development. Practice-based education should be embedded as an integral component of all staff roles. A team approach is essential to developing the future physiotherapy workforce.

Co-creation to Develop Interventions to Facilitate Deep Reflection for Dental Students.

Background: Deep reflective practice is important in healthcare education to allow students to explore emotions associated with the learning experience, access deeper learning and develop their personal and professional identity. Previous research demonstrated that the current methods of reflective practice using logbooks at the end of a clinical session to facilitate reflection within this setting were viewed as suboptimal by staff and student users. To address this problem co-creation, or a 'students as partners' approach, was used to develop and implement a comprehensive intervention to facilitate deep reflection for undergraduate dental students. This included the production of educational resources, and development of an online safe space to reflect. Approach: In this paper we discuss the process of using co-creation with undergraduate dental students as a research methodology to successfully produce curricular change with respect to reflective practice by involving the voice and experience of student partners. These student partners were part of a team that included researchers and teaching staff and worked with other stakeholders within the institution within a wider team. Evaluation: This paper demonstrates the positive benefits of using co-creation with undergraduate dental students for students such as increased confidence, developing professional and personal skills and impacting meaningful change. Reflection: For researchers and educators, the process gave motivation and enjoyment in curricular development to address pedagogical problems and ensured that the developed intervention was sustainable and appropriate. The paper discusses benefits and challenges of co-creation to develop curricular change. This co-creation approach is recommended for solving similar problems in healthcare education.

A model of empathic reflection based on the philosophy of Edith Stein: A discussion paper.

BACKGROUND: Empathy development is an integral aspect of nurse education in several countries. Empathy supports person-centred care provision by aiding effective communication and promoting feelings of wellbeing by helping people feel understood. AIM: The development of empathy in nursing students is best facilitated through experiential learning and reflective practice, although to date, there are no reflective models specifically designed for this purpose. It is the aim of this paper to present a model designed to promote reflection on the development of empathy. DESIGN: The authors have developed an approach to empathic reflection based on the philosophy of Edith Stein. METHODS: In this paper we outline the Empathic Reflection model which emphasises the need for educator support and an appreciative approach. We then present a narrative example of the model in action in an acute care setting. RESULTS: We have developed a three-stage model to support experiential learning about the development of empathy for nursing students. CONCLUSIONS: This discussion paper explores an interesting area for future nursing research about empathy development through experiential learning and reflective practice. Educators can contribute to the promotion of empathy by working in partnership with students to explore previously held beliefs which might act as barriers to empathic care provision.

Clinical leadership in nursing students: A concept analysis.

OBJECTIVES: To undertake a concept analysis of clinical leadership in nursing students. DESIGN: Concept analysis. DATA SOURCES: A comprehensive search was conducted using the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline and PsychINFO using the following search terms: clinical leadership AND management AND preregistration OR pre-registration OR undergraduate AND nursing student* OR student nurse*. REVIEW METHODS: Nursing student clinical leadership was explored using the eight-step process of concept analysis proposed by Walker and Avant (2014). RESULTS: The defining attributes included effective interpersonal communication skills, contemporary clinical knowledge and being a role model to others. CONCLUSION: This concept analysis provides a definition of clinical leadership in nursing students. It will support understanding of the concept and how it is enacted in clinical placement settings.

Using Heidegger's philosophy of dasein to support person-centred research.

BACKGROUND: Locating and explicating philosophical frameworks, which enable a person-centred approach, is important for nurses undertaking research to respect and value participants during the process. This reflects the ideals of person-centred care. AIM: To explore how Heidegger's philosophical concept of dasein and its relationship with the hermeneutic circle can support person-centred research. DISCUSSION: Dasein is described as 'being in the world' and encourages thinking about the ways in which people are bound to their surroundings and history. Understanding and applying it to nursing research is important as it enables researchers to explore the 'lifeworld' of another and promotes person-centred research practice. CONCLUSION: Developing a person-centred approach to research can be achieved by using Heidegger's concept of dasein, which can enable the development of insight into another person's lifeworld. IMPLICATIONS FOR PRACTICE: Understanding the concept of dasein enables nurse researchers to undertake person-centred research. Dasein recognises individuals in the holistic context of their world and values what is important to them. Situating findings contextually allows nurse researchers to influence nursing practice and policy.

Raising the profile of care home nursing through collaborative working.

AIM: To explore the innovative educational practices of two care home teams based in the United Kingdom (UK). Both homes aimed to provide education and developmental opportunities so that they could further deliver effective nursing care to residents. Through such practices, the care homes sought to enhance nursing career development and improve workforce retention. Meeting the long-term care needs of older people remains a challenge and the nursing workforce need to be adequately supported to deliver effective care. Employers have an important role in supporting the educational and developmental needs of nursing staff so that they can fulfil their challenging roles. CONCLUSION: Using several approaches to nursing education and development, the care homes described in this Discussion Paper were able to show positive impact. Considering the care home workforce shortage and employability churn, it is hoped these ideas can offer inspiration to others in the sector.

A Qualitative Exploration of Existing Reflective Practices Used by Undergraduate Dental Students in Paediatric Dentistry.

Background: Reflection is increasingly significant for dental students and professionals and is a continuing requirement of dental regulatory bodies. There is a paucity of evidence regarding how best to facilitate deep reflection for dental students. This study explored whether the use of clinical logbooks in undergraduate clinical attachments in Paediatric Dentistry was facilitating deep reflection. Methods: This qualitative study used individual interviews for data collection. This was conducted at the University of Sheffield with third year undergraduate dental students and clinical teaching staff. Interviews were immediately transcribed verbatim. A reflexive approach to thematic analysis was used to co-constitute the data, enabling the development of the thematic framework. Results: The sample compromised 10 students and 4 educators. Thematic analysis generated 4 key themes: understanding of reflection, preparation for reflection, importance of learning through experience, and suggestions for development. The findings indicated that students perceived that they were not being supported in engaging in deep reflection by the use of a clinical logbook and that greater preparation for reflection would be beneficial. Conclusions: The current study revealed that using clinical logbooks during clinical attachments in Paediatric Dentistry was not facilitating deep reflection. Further research is required to explore how deep reflection can be facilitated for undergraduate dental students undertaking clinical learning.

Birley Place: a virtual community for the delivery of health and social care education.

Virtual simulation can provide high-quality learning experiences through innovative and engaging activities while also overcoming some of the constraints associated with physical simulation. We developed a virtual community, called Birley Place, to facilitate simulation-based learning activities. Adopting a novel approach, we modelled the virtual community on the large metropolitan city in which our institution is based. Publicly available health and population data were used to ensure that the homes, businesses and services in the community were representative of distinct socioeconomic areas of our city. The residents of the virtual community were also matched with the real-world areas based on health and lifestyle data. Our virtual community is used to facilitate learning activities across our health and social care degree programmes. In this article, we summarise how we developed Birley Place, before providing one example of how it is used to facilitate the delivery of a large-scale interprofessional education project. Birley Place is an innovative tool for delivering online and virtual simulation. The use of this virtual community facilitates learners' understanding of the connection between settings and health status.

"Feel the fear and do it anyway" nursing students' experiences of confronting poor practice.

AIM: The two aims of this study were, first, to explore nursing students' experiences and perspectives of reporting poor care and second, examine the process by which they raised concerns. BACKGROUND: The nursing literature is replete with studies which explore nursing students' experiences of clinical placement. However only a small number explore students experiences of challenging poor care and how this is enacted in the practice setting. SETTING AND PARTICIPANTS: Fourteen nursing students from undergraduate pre-registration nursing programs across three universities, two in the United Kingdom (UK) and one in Australia. DESIGN AND ANALYSIS: This paper reports findings from narrative interviews about students' clinical experiences of reporting poor care. Data were audio recorded, transcribed verbatim and analyzed using a constant comparison approach. Emerging themes were identified, discussed and verified by the researchers. RESULTS: Four montages from the narratives highlight the overarching themes: bullying, patient advocacy, lack of empathy and poor care. They demonstrate how, driven by an ethical imperative, students speak up when they witness poor care despite the difficulties of doing so: in some cases, the students in this study were prepared to continue speaking out even when initial concerns were dismissed. CONCLUSION: Both practice and university teams have a responsibility to support students' development as ethical and courageous practitioners, able to recognize when care falls below an acceptable standard.