Recent Submissions

  • Mental health nurses' constructions of compassion: A discourse analysis

    Charles, Ashleigh (2022)
    ABSTRACT 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.
  • Developing and testing a case-management intervention to support the return to work of health care workers with common mental health disorders

    Griffiths, Amanda (2022)
    BACKGROUNDTo 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.
  • In Nightingale's footsteps: A qualitative analysis of the impact of leadership development within the clinical learning environment

    Charles, Ashleigh (2022)
    AIM: 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.
  • PsychStart: a novel mentoring scheme for supporting and valuing medical students interested in psychiatry

    Thomas, Nikki (2021)
    We 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.
  • On the register but 'out of practice'?

    Brennan, Theresa (2019)
    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.
  • Virtual balint group experience due to the COVID-19 pandemic

    Brown, Rebecca; Philips, NIcola (2021)
    Aims 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.
  • Open dialogue and co-production: promoting a dialogical practice culture in the co-production of teaching and learning within nurse education

    Hendy, Corrine (2021)
    Purpose 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.
  • Junior doctors rate online simulation as 'good enough' but not as good as face to face sessions

    Bachra, Josh; Ludvigsen, Anna; Junaid, Kehinde (2021)
    Aims To compare the feasibility and acceptability of delivering a simulation-based learning (SBL) programme for Junior Doctors virtually versus face to face. Method The Nottinghamshire Healthcare Simulation Centre has been delivering a SBL programme for Foundation Year 2 doctors on behalf of Health Education East Midlands for the past three years. Since face to face teaching was not possible during the COVID-19 pandemic the programme was delivered online using the same content and format as for prior cohorts. Feedback questionnaires from 128 face to face participants (F2F) and 133 virtual participants (V) were compared. Result There was a decrease in Likert scale ratings across all domains in the virtual group. This was most apparent when examining the ‘strongly agreed’ responses: the venue/remote format was suitable for the session 34% decrease, the course length was appropriate 24% decrease, the pace of the course was appropriate 20% decrease, the simulation was helpful and relevant 15% decrease, the content of the course was organised and easy to follow 13% decrease, the learning objectives were met 10% decrease, the presenters were engaging 6% decrease, the trainers were well prepared 3% decrease. The virtual group included responses in the ‘strongly disagree’ and ‘disagree’ categories relating to the virtual format, length and pace, which did not occur in any domain for the F2F group. Combining the ‘strongly agree’ and ‘agree’ statements also showed a decrease in satisfaction with 72.5% of responses falling into this category for the V group and 88.3% for the F2F group. Fewer participants in the V group would recommend the course to a colleague (98% V vs 99% F2F). Conclusion Providing the SBL programme using an online format was feasible while also being acceptable to most participants. However, participants did not rate this experience as highly as face to face teaching. The largest decreases in satisfaction were in areas related to the virtual format. An interesting finding is that participants rated the pace and length of the online course as less agreeable, despite the content and scheduling being the same as for the face to face group. Based on these findings face to face teaching should resume when practicable. In the meantime, the virtual delivery may be improved if the course length was reduced. Analysis of qualitative feedback may provide insights into why participants did not rate the virtual simulation as highly as the face to face equivalent.
  • Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff

    Clifford, Naomi (2021)
    OBJECTIVE: COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. DESIGN: Twenty-five semi-structured interviews were conducted (October 2020-January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. RESULT(S): Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. CONCLUSION(S): Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by de-contextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake.
  • A brief acceptance and commitment intervention for work-related stress and burnout amongst frontline homelessness staff: A single case experimental design series

    Tickle, Anna C.; Young, Dave (2021)
    PURPOSERecent intervention research for burnout amongst those working in health and social care contexts has found Acceptance and Commitment Therapy (ACT) interventions to be of use but has provided less clarity on the role of Psychological Flexibility (a key ACT construct). This study further evaluated the usefulness of ACT for burnout and work-engagement and assessed the role of Psychological Flexibility in contributing to therapeutic change.PROCEDUREA nonconcurrent multiple-baseline across-participants single-case experimental design was used. Four participants were recruited from a homelessness organisation in the East Midlands, England. The ACT-intervention was split into three modules to reflect the three aspects of the ACT triflex, and the sequence of delivery was randomised for each participant in order to test the relationship between these aspects.FINDINGSSupport was found for the ACT intervention reducing exhaustion and increasing work-engagement. Psychological Flexibility increased in all participants and was temporally related to increases in other outcome variables in some instances. Delivery of the intervention focussed on any given aspect of the ACT triflex could increase different domains of Psychological Flexibility.IMPLICATIONSThis study adds to the growing body of research in favour of ACT interventions for burnout and adds to the understanding of Psychological Flexibility as a mediating variable.
  • A qualitative study of service users' experiences of mental health nurses' knowledge and skills in relation to medication

    Carter, Tim (2020)
    INTRODUCTIONThe role of the mental health nurse in relation to medications remains complex. Despite an increasing focus on pharmacology within pre-registration nurse education, there is limited research exploring how mental health service users experience mental health nurses' knowledge and skills in relation to medication.AIMTo explore the experiences of service users working with mental health nurses, in relation to the nurses' knowledge and skills associated with medicines management.METHODThe research prioritized the principles of co-production and was undertaken collaboratively with a researcher with lived experience. Data were collected via semi-structured interviews with individuals who have accessed UK mental health services. Interviews were audio-recorded, transcribed verbatim and subjected to thematic analysis.RESULTSThree themes were generated from the data: inconsistencies in knowledge and practice, holistic therapeutic engagement and dialogical approach to medicines.DISCUSSIONService users may have a sense of uncertainty around the role of the nurse, potentially resulting in frustration and anxiety. However, mental health nurses also possess unique skills in relation to medicines management.IMPLICATIONS FOR PRACTICEThe findings emphasize that service users value not only pharmacological knowledge but also unique skills in facilitating dialogue, prioritising shared decision-making and practical support in medicines optimization.
  • Look after your foundation doctors

    Cutajar, Peter (2020)
    BACKGROUND/AIMSThis article reports on the career choice of foundation doctors going through a local foundation programme and whether they planned to take an F3 year. The authors also prospectively gathered views relating to their career choice and the need for an F3 year.METHODData were gathered from 193 foundation doctors training in Nottinghamshire between 2015 and 2020 through an unstructured interview process. Data were anonymised and used to learn about career pathway choices and whether they planned to take an F3 year option. Reasons for this pathway were also explored.RESULTSData showed that there was a steady increase in the proportion of trainees opting for F3 over time.CONCLUSIONSThe local picture in terms of trainees taking an F3 option reflects the national trend. Some trainees find foundation training a stressful time and so need to be offered support. The authors comment on the factors that make a career appealing to trainees.
  • Multidisciplinary mental state examination teaching: towards a shared language

    Holdcroft, Jason (2020)
    Mental state examination (MSE) is taught in a structured and formal way in medical eduction, but often haphazardly and informal in nursing training (if at all). We produced formal MSE teaching for nursing students based on the medical model, and obtained detailed feedback. This indicated that nursing students found the teaching and structure helpful in their clinical placements.
  • Workforce diversity, diversity training and ethnic minorities: The case of the UK National Health Service

    Stickley, Theodore; Repper, Julie (2020)
    This research studied an NHS organization as a case to explore how it is responding to cross-cultural issues against a backdrop of policy expectations about equitable and good quality mental health service provision to service users of a minority ethno-cultural group in the UK. Data were collected by conducting semi-structured interviews with 20 participants from three hierarchical levels of the organization. The research found that the concepts of culture and ethnicity are used in a fixed way in the interventions (staff diversity training and ethnic matching) taken by the case organization. It is argued that this fixed understanding of cultural concepts and related interventions may not be helpful in meeting the needs of service users, especially in the context of United Kingdom, which is characterized as a super-diverse society. It appears that the interventions are developed and implemented on the conceptualization of cultural identity as generic and fixed. Organizations working in a multicultural society, or where they have service users from a variety of ethnic and cultural backgrounds, need to develop and implement interventions based on individualized and fluid understanding of such concepts. The findings of this study contribute to cross-cultural management scholarship by taking a critical stance on the concept of culture, as it is operationalized by a large organization. We show how, even when required by national policy, this one-dimensional model of culture causes human resource management interventions, intended to address cultural diversity, to be perceived as ineffective.
  • An audit of the quality and effectiveness of review meetings between core and higher psychiatry trainees and their educational supervisors

    Majumder, Pallab; Holland, Josephine (2020)
    Purpose The purpose of this paper, an audit, was to explore and evaluate the quality and effectiveness of review meetings between core (CT) and higher psychiatry trainees (HST) and their educational supervisors (ESs). The second aim was to recommend changes in practice to improve the quality and effectiveness of the ES-trainee review meetings to enhance the training experience and overall training quality. Design/methodology/approach A tool was developed to gather anonymous feedback from trainees about their meetings with their ES. Consultation was carried out with CT and HSTs as well as ESs to ensure the questions were clear and acceptable to all. Trainees were requested to complete the feedback form for all pre-annual review of clinical progress (ARCP) meetings for the June-July 2019 ARCP cycle. Completed forms were placed in a sealed box, which was emptied once all meetings were complete. Findings In total, 25 feedback forms were received. On most questions, trainees gave positive feedback on the process, content, supervisor and administration. Four main themes emerged from the qualitative feedback. Trainees found the process supportive and felt listened to. They felt the process was organised and personalised. Trainees' views on suggestions for further improvement was captured and reflected: the ES reading their portfolio in advance, shorter forms with more focus on clinical acumen and less like a tick-box exercise, frequent reminder emails, more specific guidance and to plan ahead for change of supervisor. Research limitations/implications The main research limitation is that this study used only one measure, which was the subjective account of the participating postgraduate Psychiatry trainees. No other objective measures were used in the study to evaluate the effectiveness or the quality of the educational supervision. Practical implications The implications of the findings were discussed, and recommendations were made based on the findings to further enhance the trainees' experience of their educational supervision. It is likely that a positive experience of supervision and training will have implication by improving the overall training quality of the scheme. Social implications The quality of supervision of Psychiatrists in training have a significant contribution in their training progress and completion, and in the long run the quality of service or assessment and treatment they are able to provide to their patients as qualified Psychiatrists. Originality/value Literature searches revealed no previous audits to have been published on quality of educational supervision meetings between postgraduate psychiatry trainees and their ES.
  • Burnout within forensic psychiatric nursing: Its relationship with ward environment and effective clinical supervision?

    Berry, Suzanne (2019)
    WHAT IS KNOWN ABOUT THIS SUBJECT?: Burnout is a prominent issue in psychiatric nursing and associated with significant adverse consequences for staff, service users and at an organizational level. Exploration of the extent and predictors of burnout in secure settings has received little research attention. It is not fully understood why prevalence rates of burnout in forensic settings are not elevated in comparison to other settings, despite the presence of known risk-related correlates. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: In contrast to previous research, findings suggest that clinical supervision may not be an effective, stand-alone intervention to support staff experiencing burnout. Thus, the current focus on clinical supervision to mitigate burnout may be insufficient in forensic services. The ward environment (specifically how safe staff feel, how therapeutic the ward feels and how well service users relate to one another) was found to be more important than clinical supervision in terms of burnout for forensic psychiatric nursing staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Policies regarding staff health and well-being should be developed with due consideration given to the association between burnout and the working environment. It should not be assumed that clinical supervision is sufficient to mitigate burnout in practice. Further research assessing all types of support and the ward environment is needed to gain a better understanding of its relationship to burnout. ABSTRACT: Introduction Despite extensive research examining burnout in psychiatric nursing staff, literature exploring key predictors of burnout in secure psychiatric settings has been relatively neglected. Research has yet to explore burnout in these settings by adopting previously identified predictors such as support or the ward environment. Aim The current study aimed to reduce this gap by exploring burnout, the perceived effectiveness of clinical supervision and ward environment. Method In 2014, nursing staff working in a medium secure forensic psychiatric unit in the United Kingdom (N = 137) provided demographic information and completed the measures assessing: Burnout, clinical supervision and the ward environment. Results Approximately 10% of nursing staff could be classed as "burnt-out". The main predictors of burnout were age and ward environment. Clinical supervision had minimal association with burnout. Discussion The current study sheds doubt on clinical supervision as a potential intervention for burnout and results appear comparable to research within other settings. The implications of the ward environment, supervision and burnout are discussed herein. Implication for Practice Interventions may need to focus on a positive ward environment (including patient cohesion, experienced safety and enhancing the therapeutic atmosphere). Organizations should support younger nursing staff as they appear particularly vulnerable to burnout.
  • Evaluating neuropsychologically informed rehabilitation training for staff within a high secure intellectual disability service

    Annesley, Phyllis; Hamilton, Zoe; Akiens, Sam; Hicks, Rachel; Clarke, Martin (2020)
    Purpose: Neuropsychologically informed rehabilitation (NIR) is one approach to supporting people with intellectual disabilities, cognitive impairment and challenging behaviour. This study aims to evaluate a five-day training course in NIR for staff working with adult male offenders with intellectual disabilities in a high secure hospital. The impacts on both the staff who undertook the training and the patients with challenging behaviour were explored. Design/methodology/approach: Participants were psychology, nursing and day services staff and male patients. The staff completed a post-training questionnaire and three measures at pre-NIR training, post-NIR training and one-year follow-up. Patients completed four questionnaire measures within the same periods. Findings: NIR training was positively evaluated by staff. Staff members’ perceived efficacy in working with challenging behaviour significantly increased post-training which was maintained at follow-up. Thematic analysis showed that the training staff members built their confidence, knowledge and skills. Because of these being high to start with, the study could not evidence statistically significant changes in these. Thematic analysis yielded two main themes, namely, benefits and quality of training, each with their own subthemes. The impacts of the training on patients were difficult to assess related to various factors. Research limitations/implications: The knowledge and confidence measures used were limited in scope with an experienced staff group and required development. Practical implications: NIR training could assist staff in other secure and community settings in working with people with intellectual disabilities and challenging behaviours. Originality/value: This study positively contributes to an area that requires more research. © 2020, Emerald Publishing Limited.
  • Qualities of effective leaders: A staff survey

    Mittal, Shweta (2019)
    Poster from Trent Study Day 2019

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