Background: In the UK, adult acute mental health nurses use forced touch during physical restraint interventions. Forced touch refers to the quality of the physical force nurses use to restrict patients’ movement. There are few recent UK studies into nurses’ experiences of physical restraint. In particular, the meanings nurses give to forced touch appears to be missing from the literature. Aim: The aim was to explore nurses’ experience of physical restraint procedures and specifically, to inquire into nurses’ experience of forced touch during physical restraint interventions. The research also aimed to provide a critical reflection of the notion of ‘physical restraint’ and ‘forced touch.’ Methods: A Heideggerian hermeneutic phenomenological approach was used to collect and analyse data from 14 nurses who engaged in semi-structured interviews with the researcher. Findings: The overarching interpretation of nurses’ experience of physical restraint procedures was lived inconsistency represented in three major themes: lived moral inconsistency, lived knowledge inconsistency and lived care inconsistency. The nurses’ experience of the procedure included their moral struggles with their role in restraint and a perceived lack of care in the aftermath. Their experience of forced touch illuminated their preference for grasping different parts of the patient’s body and their experience of intimacy. They recalled a complex sequence of touches including forced, gentle, protective and compassionate touches. Discussion and implications: Implications for practice include the importance of re-orientating restraint training towards a conceptualisation of touch to connect nurses with the meaning of bodily contact during restraint, and the potential influence upon care. The provision of ward-based trainers will also support nurses more effectively in their restraint practice, and develop the nursing discourse of forced touch. Research implications: Mental health nursing touch demands greater attention because patients are often vulnerable and lack social contact. It is important to understand how nurses learn to touch patients, their reactions to handling the body during physical restraint, and to understand the phenomenon in different cultures. Patients’ perceptions of being touched during physical restraint are essential if the nursing profession is to develop practice in this area.

This study set out to explore the lived reality of epistemic curiosity in nursing practice in the NHS. It adopted a narrative, post-structuralist approach to inquiry, which included researcher ethnography as integral to the method. In depth, un-structured interviews were conducted with six currently registered and practising NHS nurses, across two U.K. NHS Trusts. Purposive sampling was adopted. Data was collected utilising an innovative rhizomatic approach over a six month period May – October 2013. Interviews were audio-recorded and transcribed verbatim. Twenty hours of un-interrupted, depth data was obtained and inductively,thematically analysed. The thesis suggests a nursing narrative on curiosity which is socially constructed, with curiosity acting as a liberator and antecedent to reflexive knowledge correspondence and construction. Nurses viewed their engagement in curiosity as a key asset for melding the various sources of knowledge required for the provision of person-centered care. However, curiosity is also lived within the tension afforded by organisational compliance discourse, which demands engagement with prescriptive, formulaic forms of knowledge and a felt dismissal of the need for professional nursing knowledge and curiously crafted practice. Acts of resistance to dominant organisational compliance discourse are evident, as nurses engage in curiosity on a moral but covert basis, in an attempt to preserve epistemic truths, subvert and circumvent compliance and prescription and thus exercise professional freedom. Concerns are raised as to ‘knowledge lost’, which may be generated from covert curiosity practices. Nurses lament a lack of discourse on curiously led practice, resulting in perceptions that curiosity is significantly compromised as a critical motive to engage with professional knowledge correspondence, practice improvement or innovation initiatives.

Background; a patient care delivery model describes a method of allocating work at hospital ward level. Four classical models are articulated which involve different work allocation paradigms. Research findings are varied in regard to the association between these models of care and outcomes. This study aimed to (1) describe current approaches to the delivery of nursing care to hospital based patients and (2) examine the association between patient care delivery models and nurse job-satisfaction, quality of care and patient safety. Method: a cross-sectional survey was conducted in two phases: (1) a pilot study and a preliminary survey; and, (2) the main study. Data were collected from general medical and surgical wards in 11 regional hospitals in Thailand from July 2013 to October 2014. Findings: The pilot study (9 wards, 1 hospital) demonstrated that the chosen data collection procedures are feasible and confirmed the reliability of the instruments. The preliminary survey (42 wards, 6 hospitals) suggested that there was a degree of incongruence between the models of care reported by the ward managers and the actual patterns of care delivery as well as dissonance with the classical model‘s characteristics derived from the literature. A revised classification, using the ward managers‘ reported current methods of care delivery was made. The majority of the wards (62%) can be classified as team nursing. However, all characteristics of the classical task allocation, and the patient allocation model existed in wards classified as following the team nursing paradigm. The main study (1,193 staff nurses and their 76 ward managers; 83% and 95% response rate) confirmed that current approaches to care delivery are not based on any single classical model; instead, the approaches observed are eclectic, combining the classical team nursing model with a hybrid assignment of tasks as well as patients, and the duration of responsibility lasting for one shift. Hierarchical modelling was performed. After controlling for nurse-to-patient ratio, skill mix ratio and work environment, it was demonstrated that work allocation patterns derived from the team nursing and patient allocation models were found to be independently significant associated with a likelihood of nurse reported good quality of care (odds ratio 3.1 and 1.5, 95% confidence interval: 1.4-6.7 and 1.1-2.1). No supportive evidence for any benefits of implementing work allocation patterns derived from the primary nursing and task allocation models has been found. Conclusion: The results provided both more accurate knowledge and a better understanding of work allocation mechanisms, at the micro level, within the nursing team. Shifting the emphasis from an evaluation of the patient care delivery model to the components of work allocation is suggested, as the pure classical model no longer exists. However, work allocation patterns that emphasise the formation of explicit nursing sub-teams with the ward compliment (elements of ?team nursing‘) and explicit assignment of nurses to individual patients (elements of ?patient allocation‘) based on nurses skills and patient need appear to be associated with better outcomes than patterns that involve task allocation or those which emphasise continuity of nurse to patient assignment.

The priorities many nursing homes give to physical care often supersede consideration for leisure arrangements and resources with the effect that the range of activities and engagement opportunities for residents are limited. An inactive lifestyle in nursing homes can compromise the residents’ quality of life and their psychosocial wellness through boredom, diminished morale and reinforced dependency. A low level of engagement also exposes residents to a greater risk of developing cognitive impairment and accentuates feelings of loneliness and isolation. Given the demographic trend of an ageing population together with a growing demand for nursing homes in Singapore, this research addresses the current lack of research on lifestyles of nursing home residents and arrangements to promote their personal well-being. In this thesis, I investigate the effect of a participatory visual arts programme on the personal well-being of residents in a Singapore nursing home. The study explores the ways in which well-being is afforded through participatory arts activities and the role an artist can take in relation to human caring. To facilitate evaluation and reflection on my arts-health practice, I brought my arts-health practice into a novel dialogue methodologically with the action-research case study approach of social science. I refer to this hybrid approach as ‘critical arts-health practice’. The empirical data of the study prompted exploration of the link between vitality and participatory arts activities. Participatory arts activities are found to revitalise the sensory, physical, cognitive, emotional, social capacities of older adults and promote self-actualisation. Drawing on Gilles Deleuze’s assemblage theory, I conceptualised the Arts-Health assemblage as a way of understanding the processes through which participatory arts activities contribute to the participants’ well-being, as both dynamic and as involving multiple interrelated elements. I argue that the broad concerns of arts-health practice can be defined as combining individualised attention to the participant, well-being outcome, and ensuring the quality of the environment and activities for participatory arts. I argue that attentiveness to these dimensions will promote a more effective and caring arts-health practice. Lastly, the central importance of these dimensions within an arts-health practice emphasises that the arts-health practitioner is first and foremost a caring artist.

No description available.

Background Patient safety is concerned with preventable harm in healthcare, a subject that became a focus for study in the UK in the late 1990s. How to improve patient safety, presented both a practical and a research challenge in the early 2000s, leading to the eleven publications presented in this thesis. Research question The overarching research question was: What are the key organisational and systems factors that impact on patient safety, and how can these best be researched? Methods Research was conducted in over 40 acute care organisations in the UK and Europe between 2006 and 2013. The approaches included surveys, interviews, documentary analysis and non-participant observation. Two studies were longitudinal. Results The findings reveal the nature and extent of poor systems reliability and its effect on patient safety; the factors underpinning cases of patient harm; the cultural issues impacting on safety and quality; and the importance of a common language for quality and safety across an organisation. Across the publications, nine key organisational and systems factors emerged as important for patient safety improvement. These include leadership stability; data infrastructure; measurement capability; standardisation of clinical systems; and creating an open and fair collective culture where poor safety is challenged. Conclusions and contribution to knowledge The research presented in the publications has provided a more complete understanding of the organisation and systems factors underpinning safer healthcare. Lessons are drawn to inform methods for future research, including: how to define success in patient safety improvement studies; how to take into account external influences during longitudinal studies; and how to confirm meaning in multi-language research. Finally, recommendations for future research include assessing the support required to maintain a patient safety focus during periods of major change or austerity; the skills needed by healthcare leaders; and the implications of poor data infrastructure.

The migration of nurses is currently an important political theme, and it is only expected to intensify in the future, because of the current demographic trends. Considering the facilitating policies and the differences between salaries, the intra-European migration of nurses is rather small, but its monitoring is not very exact. The migration of Czech general care nurses remains under-researched. I used mixed research with explorative sequential design in this study. In the initial embedded qualitative strand, I interviewed informants with expert knowledge on the migration of Czech nurses. The second quantitative strand consisted of a survey of self-selected Czech migrating nurses using an electronic questionnaire. The last strand used a focus group technique with Czech nursing migrants to clarify some of the previously researched topics. Some findings from this study are similar to the previously conducted research, and some differ substantially. Almost all of the respondents and participants felt that their professional skills improved because of their migration. More than half eventually returned to the Czech Republic, often they provided direct care in the Czech Republic, and mostly they reported not being able to utilize all of the new knowledge gained abroad. The main destination country was Saudi Arabia, therefore the respondents often cooperated with a recruiting agency. Their families were typically not involved in the decision to migrate and the migrants only rarely sent remittances home. Instead, they invested their earnings in real estate. Consistent with the literature, the professional communication in a foreign language and the different nursing practices of the destination country were rated as difficult. Findings from all three strands suggested that the nurses were transformed by the migration. It is generally understood that nurses are vital for providing health care services, thus we should offer them motivating working conditions to prevent more extensive migration and use the potential of brain circulation.

Aim This study set out to explore experiences of professional integrity in pre-registration nurse education amongst student nurses, practice-based mentors and lecturers. Methodology A modified grounded theory investigation used interviews and focus groups to gain insights into participants’ experiences of professional integrity. Background Acting with integrity is a central part of nursing practice. However, literature suggests that professional integrity can be absent, or where present face obstacles and erosion. Governmental Inquiries have revealed shocking deficits in the expression of nursing values which underpin professional integrity, in particular caring, compassionate and competent practice that maintains the dignity of patients and service users. Evidence also suggests that it cannot be taken for granted that pre-registration education will have a positive impact on student nurses’ expression of integrity. Findings This research proposes a model of professional integrity that puts people, particularly recipients of healthcare, at the centre, and that requires genuine healthcare practice and the management of complex situations. In this study the areas which most influenced student nurses’ enactment of professional integrity involved maintaining their boundaries, speaking up on behalf of patients and the ability to cope. Professional integrity was developed through students’ experiences, social learning and increased professional knowledge and understanding. Conclusion Pre-registration education can influence the growth of professional integrity by improving students’ understanding of the boundaries of nursing practice and potential threats to these, skills to speak up on behalf of patients, and knowledge of the processes involved in raising concerns about practice and potential barriers to this. The proactive development of student nurses’ strategies to cope, alongside increasing their understanding of the importance of this is also likely to be beneficial.

No description available.

This thesis provides a sociological analysis of the process of the construction of meanings of Patient Public Involvement (PPI) policies within two Local Involvement Networks (LINks) and two Community Health Councils (CHCs), which were citizen-engagement organisations that formed part of the health care systems of England and Wales. Drawing on symbolic interactionism, the study uses the selected bodies as sites to explore comparatively how frontline actors (such as volunteers, salaried staff and NHS professionals) understood and enacted PPI in everyday work. An ethnographic approach was employed to investigate the interaction and the meaning-making activities of stakeholders in local PPI arenas. The research is based on a combination of observations, semi-structured interviews and documentary analysis undertaken over a period of sixteen months. The study shows that the meanings of PPI in LINks and CHCs is shaped by social processes, such as the interplay between informants' understandings of role and everyday relationships between volunteers, officers and NHS professionals in the course of the work. The research suggests that, despite different legislation, Welsh and English informants understood their place in CHCs and LINks in similar ways by drawing on established working practices and a notion of the ideal volunteer. Volunteers made sense of their role by drawing on images of 'the public', viewed as an imagined community of people with negative attributes against which volunteers constructed the positive meaning of their own role. Informants in the study understood PPI in multiple ways that evidenced the relevance of the organisational and social context in 'doing involvement'. In discussing how local stakeholders' concerns to comply with the legal requirement 'to do PPI' were translated into practical devices to show evidence that involvement was proceeding, the concept of juridification is used to develop a better understanding of grassroots actors' interpretations of policy.