The researcher (an experienced advanced nurse practitioner) examined and interpreted twenty videos of consultations between six nurse practitioners and patients aged between 18 and 65 years. A qualitative visual research method (VS) was used drawing on phenomenology, video elicitation, reflexivity, and narrative hermeneutics. The findings demonstrated shared verbal and visual aspects of conversations. The majority of the videos elicited knowledge-based, rather than predominately emotion or movement-based conversations with both parties both empathic and engaged or task focused. The consultation dynamic in most interviews was harmonious rather than in tension, although there were occasions where the nature of the communication varied during the consultation. Furthermore, each NP demonstrated preferences for one of the three different conversation styles (i.e. knowledge, emotion or movement), as well as different ways of responding to patients who were either active or passively involved in an interaction. This theoretically derived video schema was further developed into a video tool (a process and coding guide along with a coding form). The video tool (VT) provided evidence of good video coding interrater reliability when compared with the results of the VS. The study recommends that WiC NPs could use the video schema to reflect on their personal consultation styles as there is potential to develop greater awareness of emotion, movement and knowledge in shared conversations, and a facilitative approach that asks open questions and encourages active shared and flexible approaches to consultation communication. Additionally, research using the video tool could further investigate the psychometric properties of the VT and ultimately the effect of the different styles on patient outcomes such as compliance and satisfaction.

Background: Peritoneal dialysis is a daily, life-saving treatment for end-stage renal disease, performed at home by patients and their relatives. Increasing numbers of patients are requiring treatment for this disease and therefore clinicians are calling for more patients to use peritoneal dialysis. However, the literature revealed only a small number of qualitative studies that considered patients’ experiences of their treatment, while a dearth of studies that explored relatives’ perspectives was noted. Aim and research questions: The study aimed to explore the experiences of patients and their families living with peritoneal dialysis. The specific research questions were: • What influences patients’ decisions to choose peritoneal dialysis? • How does peritoneal dialysis impact on life and the home environment? • How is peritoneal dialysis managed at home and integrated into everyday life? • How do families perceive having a relative with peritoneal dialysis at home and what contribution do they make to the process? Methodology and methods: The study employed ethnographic methodology and the methods included in-depth interviews and ethnographic observations with sixteen patients using peritoneal dialysis at home in Wales, and their relatives. Additionally seven specialist nephrology healthcare professionals were interviewed, who provided contextualising information about the care they give to patients and their families. The data were analysed thematically using Wolcott’s (1994) approach of description, analysis and interpretation. Findings: The sociological theory of illness trajectories was adopted as a conceptual framework, which guided the analysis and presentation of study findings. Participants reflected on the difficult process of choosing peritoneal dialysis, which was influenced by a preference for home, aversion to hospital and hope for control. The challenges of living with the treatment were described and observed, including medicalisation of the home, while participants tried to minimise their disrupted lives through creativity and flexibility. The future was associated with fear and uncertainty about deterioration, although participants maintained hope that they might receive a kidney transplant. Conclusions: Through the use of ethnography, this study revealed the challenges of living with peritoneal dialysis, but also the ability of families to integrate the treatment into everyday life. The study also demonstrated the usefulness of ethnographic methodology to explore how patients and their families live with home medical treatments.

In the National Health Service (NHS) there appears to be a culture of substantial change, with many nurses highlighting the impact of this on their own wellbeing (BPS, 2014). Reports following negative healthcare experiences, such as those reported at Mid Staffordshire (Francis, 2013), led to a number of initiatives emphasising the importance of nurses delivering compassionate care. However, there is a dearth of literature focusing on how nurses care for themselves as they try to provide compassionate care in a challenging job within a climate of constant change. The literature places a focus on the more negative aspects associated with providing care such as compassion fatigue, burnout and vicarious traumatisation, rather than on nurse's ability to look after themselves through self-care and self-compassion. The purpose of this study is to focus on experiences of self-care and self-compassion in nursing and how these experiences may relate to compassionate care giving. Constructivist Grounded Theory was used, and purposive and theoretical sampling were utilised to recruit nurses working within two NHS Trusts in the UK. Semi structured interviews were undertaken with 30 nurses from general, mental health and learning disabilities and at different levels of seniority. Data analysis was conducted in line with the Constructivist Grounded Theory approach as suggested by Charmaz (2014) and resulted in the emergence and construction of three concepts: 1) 'Hardwired to be caregivers' - vocation versus role 2) Needing a stable base and; 3) Managing the emotions of caring. All three concepts were then linked with a core process: needing permission to self-care and be self-compassionate. Nurses needed permission from others and from themselves in order to be self-caring and self-compassionate. An inability to do this appeared to impact upon their own wellbeing and compassionate care giving to others. Nurses in this study described how they struggled particularly with self-compassion. Helping nurses to be proactively more self-caring and self-compassionate may increase their ability to manage emotions and prevent some of the more negative consequences of nursing such as burnout and compassion fatigue. Participants identified that if they had formal permission (e.g. within nursing guidance) to look after themselves then they would be more likely to engage in it and benefit from self-care and self-compassion. Future research within this field is recommended in order to gain an understanding of the effects of self-care and self-compassion initiatives.

Background: Patient involvement in practice assessment was first introduced in 1996 but failed to establish itself as a routine part of nurse training. Fourteen years later, in 2010 the UK Nursing and Midwifery Council restated this requirement in response to concerns that university-based nursing education was not producing caring and compassionate nurses. This concern speaks to two enduring discourses around the professionalisation of nursing. First, there is a discourse of nursing as a caring vocation, predicated upon a model of practical, ward-based training. Second, there is a discourse of nursing that regards it as an adjunct medical profession, predicated upon technical-scientific education. Aim: To critically explore how these discourses influence and affect the contributions, involvement and subject positions associated with patients and their involvement in the summative assessment of pre-registration adult nursing students during hospital placements. Methods: This study adopted a poststructuralist logics approach that involved analysis of documentary and narrative texts. Six patients, six adult nursing students, six mentors and six nurse lecturers from one UK university and one acute hospital placement provider were interviewed using semi-structured interviews (24 in total). Hajer’s ten analytical steps guided data analysis. Findings: The empirical characterisation of patient involvement as a social logic identified three distinct sets of practices, logics of experientialisation, protectionism and systematisation. These social logics demonstrate the on-going tensions between patient and practitioner appraisals of patient involvement. The analysis of political and fantasmatic logics demonstrates how boundaries between vocation versus technical-scientific nursing are established and maintained to create a hegemonic normative frame that constitutes patient involvement as a solution to ‘fix’ nursing. Conclusion: This research demonstrates that involvement of patients in practice assessment remains largely tokenistic, in no small part due to tensions between discourses of vocational and technical-scientific nursing. It is not until these tensions are addressed that patient involvement will be able to fulfil its real potential for patients and for the nursing profession.

Aim and research question: The aim of this study was to explore pre-registration students’ experiences of the use of humour in the clinical settings in the United Kingdom. Method: The chosen methodological approach was interpretative phenomenological analysis (IPA). IPA enabled investigation into the students’ experience of humour with patients and mentors and to understand their idiography of their experiences due to different professional journeys. Ten semi-structured interviews were conducted with nursing students. Each interview was analysed, descriptively, conceptually and linguistically, which is consistent with the IPA approach. Then a cross group analysis elicited common or shared themes within the group. Findings: Students acknowledged the individuality of humour and how it reflects their personality and how they can be embroiled in a tug-of-war with the people around them on the use of humour within the clinical setting. Three superordinate themes were identified: 1) the professional journey, 2) the humanity of humour, and 3) humour influences and characteristics which led to the formation of a humour awareness compass for nurses. This study offers a novel insight into pre-registration students’ experiences of humour in the clinical setting, within the United Kingdom.

Background and aim: Epidemiological studies on incidence, prevalence, and other epidemiological variables of Oman’s treated kidney failure population have been limited, and questionable as to their use of rigorous research methods. The main aim of this study was to identify the epidemiological variables of treated patients with advanced kidney disease in Oman, the status of publishing on the studied population, and describing the dialysis sub-population characteristics in the northern region of Oman. Methods: First, a secondary data analysis was performed using data from the Oman's renal replacement therapy (RRT) register (1980-2015). The studied epidemiological variables included: incidence, prevalence, death figures, causes of death and treatment costs of the Oman’s treated kidney failure population, especially dialysis sub-population. The publications on chronic kidney failure population of Oman were explored at this stage. Secondly, a multi-centre, cross-sectional study (i.e. survey research) was conducted covering the dialysis sub-population of the northern region of Oman. The basic aim of the survey was to assist in developing the first description of the main characteristics (e.g. demography, primary diagnoses, and co-morbidities) of dialysis-treated patients with advanced kidney disease living the northern region of Oman. A convenience sample (n = 341) of participants were recruited from four renal dialysis centres (RDCs). Those who met the pre-specified study inclusion criteria were surveyed using a researcher-administered survey during October and November 2014. SomeFrom December 2014 to December 2015, there were some additional data was gathered (e.g. death figures) from December 2014 to December 2015. Results: The first RRT care that started in Oman was peritoneal dialysis (PD) in April 1980, while the well-structured PD programme started in 1992 and was boosted in 2007. In 1983, the first dialysis center was opened with seven machines for haemodialysis, serving 35 patients. By the end of 2015, the Ministry of Health (MOH) had 18 RDCs serving 1,439 patients on dialysis per annum for Oman’s population. The analysis of the RRT register's data showed that the mean prevalence for all years (1983-2015) was 724.9 dialysis patients per year. The mean incidence for the same years was 203.7 kidney failure patients per year. The mean death rate calculated for all years (1983-2015) was 58 deaths per year. The recorded causes of death were cardiovascular diseases, and infection. Over the years, it was described that death due to infections and cardiovascular diseases were increasing among the RRT population and particularly within dialysis cohort. The cost of the dialysis sessions increased dramatically from 2,246,627 OMR (~ 4.5 million GBP) in 1998 to 9,543,572 OMR (~20 million GBP) in 2015, which is a 325% increase. Among the databases searched, there were 44 articles, which either focused on, or mentioned Oman’s chronic kidney failure population. Most of these articles focused on kidney transplantation and were of limited and questionable methodologies. In the multi-centre cross-sectional study, the northern region of Oman was divided into two subdivisions. The average age of this population was 51.7 ± 15.8 (mean ± SD) with no statistical evidence of difference between the subdivisions of the northern region of Oman (P = 0.177). There were more males (n = 187 = 54.8%) than females (n = 154 = 45.2%), with no significant difference between subdivisions (P = 0.598). It was described that the divorce frequency was low in this population (n = 22 = 6.4%), with no significant difference between subdivisions (P = 0.49), but unemployment was high (n = 292 = 85.9%), showing no significant difference between subdivisions (P = 0.537). Nearly half of this population were illiterate (n = 164 = 48.1%), with more illiterate females (n = 103= 66.9%) compared to males (n = 61= 32.6%), and no significant difference between subdivisions (P = 0.174). Nearly half of the participants had been on dialysis for five years at the time of data collection (n = 165 = 48.4%). The most common co-morbidities reported by these participants were hypertension and diabetes combined (n = 156 = 32.4%). The main reported causes of death shown by the data gathered were cardiovascular diseases (n = 41 = 41.5%) and infection (n = 10 = 10.2%). More than half of the participants were hoping to have kidney transplantations as soon as possible (n = 173 = 50.7%). Conclusion: This study is a comprehensive description of the Oman’s RRT epidemiology. The data showed a significant increase in the incidence and prevalence of treated chronic kidney failure in Oman. It showed the increase in the cost of dialysis in Oman for the past 17 years (1998-2015), which is in line with the recent publications from Oman (Al-Alawi et al., 2017; Al-Ismaili et al., 2016) and is in line with global findings. This research’s results have contributed to providing a deeper understanding of the Oman’s treated chronic kidney failure population. It appears that there is a heavy burden borne by the country, the health sector and the patients on dialysis because of the complex nature of life-long treatment. Oman’s publications on this health problem were limited. Therefore, it is necessary to conduct additional research with rigorous methods to obtain a complete picture of this health problem in Oman.

This study investigated the impact of two changes on the assessment of student nurses in practice in one University in England; the introduction of the ongoing achievement record and the development of the sign off mentor role (NMC, 2008). As contemporary literature showed nurse mentors were failing to fail student nurses, these changes to assessment in nursing practice were introduced (Duffy, 2003; Gainsbury, 2010). A literature review was conducted to identify key themes in the nurse mentoring literature and led to the research question for the study; What impact has the introduction of the ongoing achievement record and sign off mentor had on the robustness of mentors’ assessment practices? Using a qualitative interpretive methodology, a two phase study firstly examined forty six assessment records for forty students who had failed in practice. These were examined for common issues and themes before semi structured interviews with eight mentors were completed as phase two, to ascertain links between what assessment documents showed and how the mentors felt these changes had affected the assessment of student nurses. Four themes were drawn from data from both phases of the research: Using the assessment documents, failing a student, accountability and the sign off mentor and finally mentor assessment of behaviours and levels of progress. Data was used to support a discussion on each of these themes. It was found that the introduction of the ongoing achievement record (OAR) has had a positive impact on mentors and the quality of assessment practices as mentors use prior records to inform their role. This was reliant however on prior mentors’ commitment to completion of the document accurately, which was variable. The introduction of sign off mentors was shown to have a negative impact on the robustness of assessment practice. Mentors were reluctant to become sign off mentors due to the perception of the increased accountability. Mentors interviewed identified that mentors earlier in the programme were delegating the assessment decision to the sign off mentor as the accountable gatekeeper. This reduced the reliability of the mentorship process and it is recommended that this role should be removed and instead support for novice mentors should be given by experienced mentors to ensure robust assessment takes place. An emerging theme showed that mentors assess students throughout their nursing programme for key values and behaviours required to be a nurse. This strengthens the profession at a time when it has been under fire in the media for lack of compassion and care (The Patients Association, 2011). It is reassuring for the profession and the public to see that student nurses are assessed consistently against these values as part of their course. Use of the OAR alongside the impact of sign off mentors and assessment of values and behaviours had not been found in prior literature. This study presents these findings as new knowledge and they will be used to guide local strategy on mentorship models and ensure new mentors have access to experienced mentors. They will also be disseminated nationally to enable other educators and the Nursing and Midwifery Council to become aware of this evidence base for the OAR and sign off mentor in order that they can explore changes that may be needed as they revise their mentor standards to improve the assessment process and mentor support for nursing education.

No description available.

ENPs are practising throughout the different types of A&E department in Scotland, but educational preparation, scope of practice, job titles and grading vary considerably. The modified NGT was found to be an effective method to develop the Documentation Audit Tool which had good inter-rater reliability and stability. The RCT of ENP-led care was sufficiently large to demonstrate higher levels of patient satisfaction and clinical documentation quality with ENP-led compared to SHO-led care. The methods and tools developed for use in this trial could be used in other A&E departments to measure the quality of NEP-led care. Missed injuries were relatively rare, however around a fifth of patients sought unplanned follow-up; most from GPs, a smaller proportion returned to A&E. Monitoring returns to A&E may be a useful procedure to assess the quality of minor injury care. In summary, ENPs can provide care to patients with minor injuries, which results in high levels of patient satisfaction. Their clinical documentation is of a higher quality an complications in terms of missed injuries are low. However, A&E departments should consider ensuring they have systems in place to identify patients who re-attend, or who attend another health-care provider for unplanned follow-up, in order to ensure that missed injuries can be effectively monitored.

This descriptive study examines the role of nurses in management within the NHS in Scotland between 1994-1995. The general aim of the study was to provide information about the emerging role of nurses in management in the NHS after the Reforms in 1990. Data collection tools were a postal questionnaire to all subjects (N=284) and later interviews with 27 participants. The Questionnaire was carried out between MayJuly 1994. Overall response rate was 64.4%. The interviews were conducted in February and March 1995. All nurses in management working in hospitals and the community, in Scotland, with the exception of those meeting exclusion criteria, were invited to participate in the study. In this study the men were slightly younger than the females and the men were more likely to be married than the females. There were 44 different job titles used by the 158 respondents. Approximately one in four of subjects had a degree. In total 76 (48%) respondents had had a formal "management training" qualification but only 10% had degree level management education. Almost all the subjects stated that their job had changed greatly after the NHS 1990 reforms and their responsibilities had increased. In total 68 respondents perceived the role of nurses in management negatively. In terms of future career developments of the subjects 17% expected their next career step to be a more into general management role within the NHS. The study provides lessons which will be of value in planning the selection and training of future nurse managers. In this study it was suggested that nurses in management should undertake proper management training that would meet their individual needs. In addition first line managers in particular should be supported and encouraged to take up roles in general management. It was suggested that individuals should take more responsibility for shaping their own careers and the NHS should provide support for their staff. It was also believed that this study provides a benchmark where there is little information.