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The last chance to get it right: the experience of health professionals delivering end-of-life care in an in-patient mental health setting. A modified critical review of literatureThe purpose of this modified critical review of literature is to draw upon the contemporary evidence base to explore the lived experiences of healthcare professionals delivering end-of-life care to patients cared for in mental healthcare settings. People of severe and persistent mental illness are a very vulnerable cohort of patients. They often live with higher-than-average co-morbidities, low than average life expectancy and high mortality rates. Little is known about the experience of mental health professionals delivering end-of-life care to those patients whose care needs can only be met in an in-patient facility. This review aims to provide a window into this experience and draw out the barriers and enablers to good care. For this review, 64 unique titles and abstracts were identified through the search of six databases. The appraisal of these papers resulted in six meeting the inclusion and quality criteria and subsequent syntheses of the findings were presented into three themes:1) There was a recurrent lack of preparedness of both services and staff to assess and meet the needs of patients at the end-of-life in mental healthcare settings.2) There was a clear need for collaborative work between mental and physical healthcare professionals; however, this was often difficult to achieve.3) Patients at the end-of-life with Severe Mental Illness poses specifically challenges which professional caring for them need to be aware of.The findings of the review were in keeping with other work in the area and provides four main recommendations for practice:1) Services must have a clearly defined collaborative approach to working relationships between palliative care and mental healthcare professionals.2) Specific training and education for mental healthcare professionals in end-of-life care and visa verse for physical healthcare professionals when caring for a patient with a comorbid serious mental illness.3) Thought should be put into the environment of an in-patient mental healthcare ward. While it is recognised the need to maintain safety of patients in these environments, considerations such as the availability to the correct equipment, décor and access to meaningful activity is invaluable for both care giver and patient.4) Services should consider that their policies and procedures reflect that end-of-life care could be a need of any patient in a services care. The ability to refer to policy and procedure was found to be a comfort and a supportive measure for staff caring for patients at the end-of-life.
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An audit of the prescription and supply of medicines by podiatric surgery teams in the UKAim: To gain a greater understanding of the methods used by podiatric surgeons to access medicines in the UK. Within that, it is also relevant to establish the range and quantity of medicines utilised to support patient care. With the advent of independent prescribing for podiatrists, the authors were keen to identify whether prescribing was being adopted by a sub-speciality of the podiatry profession and whether alternate means of accessing medicines, such as Patient Group Directions or exemptions remain relevant in clinical practice. Methods: The PASCOM 10 system was accessed to generate reports for the 2019 calendar year relating to podiatric surgery. The following reports were requested; procedures, fixations, anaesthesia, demographics, medications, post-treatment sequelae, patient satisfaction (PSQ-10), Manchester Oxford foot/ankle questionnaire (MOXFQ), providers and referrals. Results: In 2019 there were 11189 admissions for podiatric surgery in England recorded on the PASCOM 10 database. A total of 103 surgery centres contributed data resulting in 18497 procedures. Care was primarily offered in NHS settings accounting for 91% of activity, 94% of these procedures were performed under a local anaesthetic block. 18576 medicines were supplied, administered or prescribed from a list of 70 individual items. 29% of all medicines were prescribed by a podiatrist. Controlled drugs accounted for 28.7% of all recorded medicines. Conclusions: Through analysis of PASCOM 10 data, the range of medicines accessed by podiatric surgeons and their teams to support patient care perioperatively and the routes of accessing these medicines have been identified. Encouragingly, independent prescribing appears to be a frequent choice for accessing certain medicines. There is thorough evidence of a need for greater prescribing rights. Of note, it appears the management of postoperative pain could be improved with wider access to controlled drugs, namely opioid analgesics. PASCOM-10 has the capacity to provide revealing data on prescribing in podiatric clinical practice that is unique in the UK, though more work is required to ensure the validity of the dataset.
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Mental health nurses' constructions of compassion: A discourse analysisABSTRACT Compassion is an important element of contemporary nursing work. Compassion has been recognized as necessary for improving health outcomes. However, very little is known about how compassion is understood in the mental health practice setting. We conducted interviews with seven mental health nurses to explore their perspectives on compassion and views on compassion policy. Analysis of the data revealed that compassion was identified and discussed as Compassion as part of the person (and the profession); Compassion: Fundamental to the nursing role; Barriers to compassion; Perspectives on compassion policy. In addition, findings demonstrated ethical constraints on compassion in the mental health context, as well as the administrative burden on nurses more broadly, which was also a reported barrier to compassion. Mental health nurses identified compassion as fundamental to their clinical practice, yet compassion was impeded owing to practical and emotional constraints upon nurses. System-wide action must be taken to increase and support the mental health nursing workforce to strengthen the practice of compassion. This will be fundamental to improving health outcomes that are claimed to be enhanced by compassion. This study is reported according to the COREQ guidelines.
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Correction of hallux abducto valgus by scarf osteotomy. A ten-year retrospective multicentre review of patient reported outcomes shows high satisfaction rates with podiatric surgeryBACKGROUNDCorrective surgery for hallux abducto valgus is one of the most performed elective procedures in foot and ankle practice. Numerous methods of surgical correction have been reported within the literature, with varying clinical and patient reported outcomes. This study reviews the patient experience and outcomes in five podiatric surgery centres using the scarf diaphyseal osteotomy.METHODPatient reported outcome measures (PROMs) were captured using the Patient Satisfaction Questionnaire 10 (PSQ-10), part of the PASCOM-10 podiatric surgery audit tool. PROMs were collated across five hospital sites over a 10-year period.RESULTSOf 1351 patients reported during the period, 1189 had complete retrospective data. The most common patient aim of surgery was 'no/less pain' reported in 70% of patients. 96.8% of patients reported their original foot complaint as 'better' or 'much better' after surgery. 92.8% of patients reported their expectations had been met with 96.6% reporting they would have surgery again under the same conditions. 98.5% of patients noted that the risks, complications, and expectations had been discussed prior to surgery. The most common complication was metatarsal fracture (4.6%).CONCLUSIONThe scarf osteotomy (with or without an Akin phalangeal osteotomy) consistently showed high patient satisfaction with low complication rates using PSQ-10 and this information can be used as part of the pre-operative consenting process. Patient expectations for surgery were often achieved, which may be attributed to the pre-operative work up of the patient. Further investigation into this correlation is suggested.LEVEL OF CLINICAL EVIDENCEIV (retrospective review).
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Developing and testing a case-management intervention to support the return to work of health care workers with common mental health disordersBACKGROUNDTo assess the feasibility and acceptability of conducting a trial of the clinical effectiveness and cost-effectiveness of a new case-management intervention to facilitate the return to work of health care workers, on sick leave, having a common mental disorder (CMD).METHODSA mixed methods feasibility study.RESULTSSystematic review examined 40 articles and 2 guidelines. Forty-nine National Health Service Occupational Health (OH) providers completed a usual care survey. We trained six OH nurses as case managers and established six recruitment sites. Forty-two out of 1938 staff on sick leave with a CMD were screened for eligibility, and 24 participants were recruited. Out of them, 94% were female. Eleven participants received the intervention and 13 received usual care. Engagement with most intervention components was excellent. Return-to-work self-efficacy improved more in the intervention group than in the usual care group. Qualitative feedback showed the intervention was acceptable.CONCLUSIONSThe intervention was acceptable, feasible and low cost to deliver, but it was not considered feasible to recommend a large-scale effectiveness trial unless an effective method could be devised to improve the early OH referral of staff sick with CMD. Alternatively, the intervention could be trialled as a new stand-alone OH intervention initiated at the time of usual OH referral.
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In Nightingale's footsteps: A qualitative analysis of the impact of leadership development within the clinical learning environmentAIM: To identify and describe the impact areas of a newly developed leadership development programme focussed on positioning leaders to improve the student experience of the clinical learning environment. BACKGROUND: There is a need to consider extending traditional ways of developing leaders within the clinical learning in order to accommodate an increased number of students and ensure their learning experience is fulfilling and developmental. The Florence Nightingale Foundation implemented a bespoke leadership development programme within the clinical learning environment. Identifying the areas of impact will help to inform organisational decision making regarding the benefits of encouraging and supporting emerging leaders to undertake this type of programme. METHOD: For this qualitative descriptive study, eight health care professionals who took part in a bespoke leadership development programme were interviewed individually and then collectively. The Florence Nightingale Foundation fellowship/scholarship programme is examined to determine impact. RESULTS: Two key themes were described in relation to impact of the programme. These were 'Personal Development' and 'Professional Impact'. The two key themes comprised several subthemes. The notion of time and space to think was subsumed within each theme. CONCLUSION: Data highlights that the Florence Nightingale Foundation programme had a distinct impact on participants by transforming thinking and increasing self-confidence to enable changes to make improvements both within their organisations and at national level. IMPLICATIONS FOR NURSING MANAGEMENT: Health care managers must continue to invest in building leadership capacity and capability through programmes that can help position individuals to realize their potential to positively influence health outcomes and wider society.
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Establishing the evidence base for ‘multiple site single service’ (MSSS) models of careBackground In England plans for service reconfiguration increasingly include options for clinical services which are delivered across more than one clinical site, often in differing geographical locations or towns. The rationale for such models include the difficult and often conflicting balance between exacerbating inequalities in access to clinical services for patients whilst at the same time trying to improve quality and outcomes through consolidation.Aim The East Midlands Clinical Senate in partnership with Public Health England (PHE) established a proactive workstream to review the clinical evidence for ‘multiple site, single service models of care’ (MSSS) to support clinical senates, commissioners and providers of services better assess the evidence base for these types of models of care.Methods Systematic review (SR) undertaken. Framework developed to Support Clinical Senates through qualitative data collection and consultation with national and local clinical senate meetings to consider the experience of MSSS models and where they have worked successfully to improve outcomes.Results SR identified 18 papers for inclusion. Evidence on this topic was largely service-specific and heterogeneous in study design and outcomes. We found evidence of 10 key enablers and barriers to implementation of MSSS models. There was no universal definition for MSSS models in the literature, but shared characteristics were identified which enabled the development of a descriptive framework. Mortality was the most frequently reported outcome and no study reported increased mortality as a result of service change. 4 studies reported on patient experience related to service change, with some evidence of improvement in patient satisfaction with care delivered via a MSSS modelConclusion Using the systematic review findings and the qualitative feedback, a clinical outcomes based framework has been developed to utilise when reviewing these types of models of care.
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Quality improvement project for out-of-hours clinical handoverAim Nottinghamshire Healthcare NHS Foundation Trust (NHFT) provides a variety of mental health services across Nottinghamshire. During out-of-hours work, junior doctors cover each of these three main hospital sites.The Health Education East Midlands (HEE) Quality Management visit concluded the handover system in NHFT was not fit for purpose, posing significant risks to both patients and junior doctors.The aim of our quality improvement project was to assess these concerns using a mixed methodology, including local surveys and audit; and secondly to make any necessary quality improvements to the handover process and guidance. The pre-implementation evaluation of the handover system in use consisted of a survey and an audit.Methods The quality improvement strategy involved a two-pronged approach, which included the development of a new IT-based handover recording tool and improving education and training in its use.We used Plan-Do-Study-Act (PDSA) cycles between August 2015 and August 2016 to implement changes.Phase 2 of the project involved audit, education and training to consolidate and reinforce the change to make it sustainable through creation of a white board animation video for junior doctors.Results Percentage of recorded handovers was the main outcome measure. Quality outcomes improved after the phase 1 and were sustained during the phase 2 of the project due to introduction of mandatory recording fields.Conclusion We learnt that the active engagement of end users in the designing and implementation of the new IT handover system was a key factor in optimal development. We learnt that continuous induction, training and monitoring are important to sustain high usage of the system. Also, use of project management tools from the start will improve efficiency and time management. This project demonstrates how existing resources within a NHS Trust can be collaboratively and iteratively deployed to improve patient care.
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Stigma, epistemic injustice, and “looked after children”: The need for a new languageAbstract This article examines the processes that contribute to the stigmatization of a group of people typically identified as ?children in care? or ?looked after children.? In particular, we will look at the ways that we (adults, professionals, and carers) interact with these children, based on their status as both children and members of a socially marginalized and disadvantaged group, and how these modes of interaction can inhibit dialogue?a dialogue that is needed if we are to base our conceptions regarding the needs of these children on a more accurate understanding of their experiences and perspective. The problem is particularly challenging because the very terminology we use in the care community to identify this group is a product of the damaging preconceptions that have affected our interactions with its members and, we argue, it serves to reinforce those preconceptions. Using Fricker's work on epistemic injustice, in conjunction with evidence regarding how accusations of abuse and neglect of these children have been addressed in numerous cases, we illustrate the problems we have in hearing the voices of members of this group and the harmful effects this has on their own ability to understand and articulate their experiences. These problems represent ?barriers to disclosure? that need to be surmounted if we are to establish a more inclusive dialogue. Currently, dialogue between these children and those of us charged to ?look after? them is too often characterized by a lack of trust: not only in terms of the children feeling that their word is not taken seriously, that their claims are not likely to be believed, but also in their feeling that they cannot trust those to whom they might disclose abuse or neglect. The goals of the paper are modest in that we aim simply to open up the debate on how to meet this epistemic challenge, noting that there are specific problems that extend beyond those already identified for hearing the voices of other victims of epistemic injustice. Explicitly recognizing the nature and extent of the problem still leaves us a long way from its solution, but it is a crucial start.
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Data Ethics Club: Creating a collaborative space to discuss data ethicsAwareness and management of ethical issues in data science are becoming crucial skills for data scientists. Discussion of contemporary issues in collaborative and interdisciplinary spaces is an engaging way to allow data-science work to be influenced by those with expertise in sociological fields and so improve the ability of data scientists to think critically about the ethics of their work. However, opportunities to do so are limited. Data Ethics Club is a fortnightly discussion group about data science and ethics whose community-generated resources are hosted publicly online. These include a collaborative list of materials around topics of interest and guides for leading an online data-ethics discussion group. Our meetings and resources are designed to reduce the barriers to learning, reflection, and critique on data science and ethics, with the broader aim of building ethics into the cultural fabric of quality data-science work.
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The value of qualitative methods to public health research, policy and practiceThis article reviews the role and use of qualitative methods in public health research.'Signs of quality' are introduced to help guide potential authors to publish their qualitative research in public health journals. We conclude that high-quality qualitative research offers insights that quantitative research cannot. It is time for all public health journals to recognise the value of qualitative research and increase the amount that they publish.
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Proportionate translation of study materials and measures in a multinational global health trial: methodology development and implementationOBJECTIVESCurrent translation guidelines do not include sufficiently flexible translation approaches for different study materials. We aimed to develop a proportionate methodology to inform translation of all types of study materials in global health trials.DESIGNThe design included three stages: (1) categorisation of study materials, (2) integration of existing translation frameworks and (3) methodology implementation (Germany, India, Israel, Tanzania and Uganda) and refinement.PARTICIPANTSThe study population comprised 27 mental health service users and 27 mental health workers who were fluent in the local language in stage 7 (pretesting), and 54 bilingual mental health service users, aged 18 years or over, and able to give consent as judged by a clinician for step 9 (psychometric evaluation).SETTINGThe study took place in preparation for the Using Peer Support in Developing Empowering Mental Health Services (UPSIDES) randomised controlled trial (ISRCTN26008944).PRIMARY OUTCOME MEASUREThe primary outcome measure was the Social Inclusion Scale (SIS).RESULTSThe typology identifies four categories of study materials: local text, study-generated text, secondary measures and primary measure. The UPSIDES Proportionate Translation Methodology comprises ten steps: preparation, forward translation, reconciliation, back translation, review, harmonisation, pretesting, finalisation, psychometric evaluation and dissemination. The translated primary outcome measure for the UPSIDES Trial (SIS) demonstrated adequate content validity (49.3 vs 48.5, p=0.08), convergent validity and internal consistency (0.73), with minimal floor/ceiling effects.CONCLUSIONThis methodology can be recommended for translating, cross-culturally adapting and validating all study materials, including standardised measures, in future multisite global trials. The methodology is particularly applicable to multi-national studies involving sites with differing resource levels. The robustness of the psychometric findings is limited by the sample sizes for each site. However, making this limitation explicit is preferable to the typical practice of not reporting adequate details about measure translation and validation.TRAIL REGISTRATION NUMBERISRCTN26008944.
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Association between mirtazapine use and serious self-harm in people with depression: an active comparator cohort study using UK electronic health recordsBackground Studies report an increased risk of self-harm or suicide in people prescribed mirtazapine compared with other antidepressants.Objectives To compare the risk of serious self-harm in people prescribed mirtazapine versus other antidepressants as second-line treatments.Design and setting Cohort study using anonymised English primary care electronic health records, hospital admission data and mortality data with study window 1 January 2005 to 30 November 2018.Participants 24 516 people diagnosed with depression, aged 18–99 years, initially prescribed a selective serotonin reuptake inhibitor (SSRI) and then prescribed mirtazapine, a different SSRI, amitriptyline or venlafaxine.Main outcome measures Hospitalisation or death due to deliberate self-harm. Age–sex standardised rates were calculated and survival analyses were performed using inverse probability of treatment weighting to account for baseline covariates.Results Standardised rates of serious self-harm ranged from 3.8/1000 person-years (amitriptyline) to 14.1/1000 person-years (mirtazapine). After weighting, the risk of serious self-harm did not differ significantly between the mirtazapine group and the SSRI or venlafaxine groups (HRs (95% CI) 1.18 (0.84 to 1.65) and 0.85 (0.51 to 1.41) respectively). The risk was significantly higher in the mirtazapine than the amitriptyline group (3.04 (1.36 to 6.79)) but was attenuated after adjusting for dose.Conclusions There was no evidence for a difference in risk between mirtazapine and SSRIs or venlafaxine after accounting for baseline characteristics. The higher risk in the mirtazapine versus the amitriptyline group might reflect residual confounding if amitriptyline is avoided in people considered at risk of self-harm.Clinical implications Addressing baseline risk factors and careful monitoring might improve outcomes for people at risk of serious self-harm.No data are available. Data used in the study were provided under licence by CPRD (www.cprd.com) and cannot be shared by the authors. All code lists and the statistical code (in the form of Stata do-files) used to prepare and analyse the data are available on Zenodo.org (https://doi.org/10.5281/zenodo.4779024).
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Assessing the value of a novel "Recovery and Collaborative Care Planning Cafe" initiative for co-designing improvements through a shared learning experience with service users, carers, and practitionersObjective: This paper ascertains the value of a novel approach to creating a participative social learning space with service users, carers, and practitioners to develop recovery-oriented conversations and the experience of collaborative care planning. Methods: A participatory method “World Café” was utilized with taught masterclasses on recovery principles. Evidenced-based practice was a central feature drawn from service user research. The Model for Improvement: Plan-Do-Study-Act (PDSA) framed the sessions to generate and test ideas. Results: Service user and carer attendance was low at the start, although this increased after testing ideas using PDSA cycles to improve this. Shared learning grew over time, which led to ideas to create improved participation in care planning. Conversations also developed towards becoming more recovery oriented after participants incorporated a framing set of recovery concepts into the sessions. Conclusions: The café design proved it was possible to both create a social learning space and change conversations leading to a greater focus on recovery through using CHIME (a conceptual framework incorporating connectedness, hope, identity, meaning, and empowerment). The café successfully generated improvement ideas and created a participative learning space.
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An international adult guideline for making clozapine titration safer by using six ancestry-based personalized dosing titrations, CRP, and clozapine levelsThis international guideline proposes improving clozapine package inserts worldwide by using ancestry-based dosing and titration. Adverse drug reaction (ADR) databases suggest that clozapine is the third most toxic drug in the United States (US), and it produces four times higher worldwide pneumonia mortality than that by agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers, the lowest dose; male smokers, the highest dose). Poor metabolizer status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity, or inflammation with C-reactive protein (CRP) elevations. The Asian population (Pakistan to Japan) or the Americas' original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/mL. In the US, daily doses of 300-600 mg/day are recommended. Slow personalized titration may prevent early ADRs (including syncope, myocarditis, and pneumonia). This guideline defines six personalized titration schedules for inpatients: 1) ancestry from Asia or the original people from the Americas with lower metabolism (obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) ancestry from Asia or the original people from the Americas with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (obesity or valproate) needing 100-200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250-400 mg/day, 5) in the US with ancestries other than from Asia or the original people from the Americas with lower clozapine metabolism (obesity or valproate) needing 150-300 mg/day, and 6) in the US with ancestries other than from Asia or the original people from the Americas with average clozapine metabolism needing 300-600 mg/day. Baseline and weekly CRP monitoring for at least four weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.
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PsychStart: a novel mentoring scheme for supporting and valuing medical students interested in psychiatryWe describe the establishment and evaluation of a career-based mentoring scheme (PsychStart) for medical students interested in psychiatry. Medical students reported multiple benefits of mentoring, including enhanced personal and professional development, increased career and clinical knowledge, and broadened exposure to psychiatry. The mentoring scheme was also found to promote and sustain interest in the specialty. Further evaluation is required to determine the long-term effects of mentoring and how this may compare with other undergraduate enrichment activities. We conclude that mentoring in psychiatry could offer innovative solutions for improving recruitment and retention, and for supporting and valuing medical students who demonstrate an early interest in the specialty.
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On the register but 'out of practice'?The usual return-to-practice courses don’t apply to registered nurses who want to re-route into clinical practice but lack the experience or confidence – but there is another option When NHS England published the interim NHS People Plan this summer, encouraging nurses who have left the profession to return to practice was identified as a priority in tackling the nursing workforce crisis.
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Virtual balint group experience due to the COVID-19 pandemicAims In the changes brought about by remote working, the local psychotherapy case discussion group (Balint Group) has developed as a remote service via video consultation. It is important to consider the effect that this change in method of delivery has had on experience. Method An anonymous survey was distributed to determine the benefits and challenges from participants and facilitators with at least a month of virtual Balint Group experience. The open-ended survey questions captured extended answer responses from 16 students and trainees, and 5 (co-)facilitators, within Nottinghamshire Healthcare NHS Foundation Trust. The qualitative feedback was analysed by thematic analysis, identifying three main themes. Result The first theme of practicalities was centred around access to the group. The virtual format had benefits in terms of reducing travel and time commitment and so improving attendance. However, disadvantages were in technological issues and finding a private and safe environment, individuals often not leaving the work environment on which they were reflecting. The second theme of communication identified how virtual methods are a less natural way of interacting (for example sequential point making), losing both immediacy of reactions and non-verbal communication. There was a loss of essential communication cues, with disjointed conversation affecting contribution. The third theme of group dynamics had some advantages, feeling less intimidating virtually. Yet disadvantages included loss of group cohesion, with participants not building the same relationships (on arriving and leaving a group space), and trust. The more subtle emotions in the group might be missed and opinions given less openly. The facilitators needed to be more directive and experienced difficulties maintaining group engagement and managing the frame. Conclusion The advantages of virtual format are more based on accessibility and the disadvantages more experiential. There are elements of being physically remote that lead to a disembodied experience, that might impact on capacity to reflect emotionally. This might make it more difficult to identify unconscious processes and the experience might be more cognitive. There is a risk that virtually participants will feel more alone with difficult feelings and unsupported by the group. When mental health is being affected by social isolation due to the pandemic, having groups virtually can mimic this isolation in working life. Overall the preference remained for an in-person group. However, it was clear that access to some form of a group was important, to contain anxiety during these unprecedented times.
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Open dialogue and co-production: promoting a dialogical practice culture in the co-production of teaching and learning within nurse educationPurpose The evidence base associated with Open dialogue (OD) continues to develop. However, much of the literature associated with this “whole system philosophy” is focussed within therapeutic clinical practice. The purpose of this paper is to explore another key aspect of OD within a higher education context, the creation of “dialogical practice culture” and the application of key OD principles to enable an open, empowering ethos which permeates all aspects of teaching and learning and supports co-production. Design/methodology/approach The authors use a collective auto ethnographic approach to reflect on their experiences of developing and delivering a series of co-produced seminars within pre-registration mental health nurse education over a period of 4 years. This paper explores the data produced through this process focussing on the pedagogical impact and challenges of applying OD principles to teaching and learning practice. Findings The paper highlights the way in which two core principles of OD, resonate with the co-production process within teaching design and delivery. Moreover, the paper illustrates the impact that threading these principles throughout teaching practice can have: enhancing the learning environment and facilitating mutual empowerment, and thus supporting the students’ development of empowering therapeutic practice with service users. A significant theme in these reflections has been the nature of empowerment and the necessity to openly address power differentials and relationships. Originality/value This innovative paper is the first to explore the application of OD principles within a nurse education context; considering how they support co-production and enable an empowering culture. This exploration helps to provide a foundation for further inquiry and research.
