Access Pathway Research Articles

Implementing a streamlined data access governance process for the release of routinely collected electronic health record data for research

ObjectivesIn Australia, there are no standardised processes for the release of Electronic Health Record (EHR) data for research. We describe our streamlined ethics and data access governance framework for the release of EHR data for research. ApproachIn consultation with our academic and health service partner organisations and with reference to national and international standards, we developed a process to safely and efficiently release EHR data for research. The Five Safes Framework guided our processes ensuring: safe people; safe projects; safe settings; safe data; and safe outputs. Piloting of processes has commenced. ResultsStreamlined data access and release processes acceptable to all stakeholders were implemented using an online system. Independent researcher and consumer review of an Expression of Interest, followed by ethics review/approval from the health service research office ensures projects are methodologically and ethically sound. Completion of a detailed technical assessment form, implementation of a signed data use agreement and release of de-identified data to a secure e-research environment promotes safe data and settings. Constraints around publication are enforced via pre-publication review ensuring safe outputs. Nine projects are in process using our system with an average of 4 days for EOI review and 6 days for TAF review. ConclusionWe have established a streamlined data access pathway to minimise duplication of effort and allow timely and secure access to EHR research data. We have built in efficiencies and promoted a cultural shift for clinicians who have previously not had data access processes governed in this way.

Providing data analytic services for national knowledge users in a federated system: learnings from two Canadian use cases

Objective and ApproachCanada’s federated health data system along with access pathways geared toward academic research, pose challenges for knowledge Users (KUs) requiring timely, pan-Canadian evidence to inform decisions. To understand challenges and explore solutions, we conducted two use cases for a pan-Canadian health technology assessment organization and a federal agency, using health administrative data at one federal and six provincial data centres. The population-based cohort studies described socio-demographics, comorbidities, treatment patterns, service utilization and costs. One focused on spinal muscular atrophy, a rare disease and the other on dementia, a complex chronic disease. ResultsAdministrative challenges included aligning varied ethical review and data access policies/procedures including requiring local and/or academic principal investigators and differing definitions of “research” vs. planning, evaluation, and monitoring. Data-related challenges included differences in structure, timeliness, and completeness across regions resulting in difficulty aligning constructs such as incident cases and episodes of care. Privacy requirements prohibited pooling jurisdictional estimates resulting in “small cells” that couldn’t be shared with KUs. ConclusionsWe provided analytic outputs from multiple regions, albeit with some differences and gaps, increasing knowledge around both diseases while developing capacity for combined analyses and gaining insight into national possibilities for data access. ImplicationsAs decision makers must rely on best available information, some data is better than none. However, to improve data-analytic services for Pan-Canadian KUs, next steps will include improving data harmonization, expanding data assets and filling data gaps, implementing common data models, and exploring options for federated and/or pooled analyses.

WP5.15 - A review of emergency general surgery (EGS) admissions via the direct access pathway (DAP) in a district general hospital in United Kingdom

Abstract Aims Emergency surgical presentations require urgent attention by surgeons to ensure appropriate treatment, However, increased waiting time in A&E often leads to delayed diagnosis and subsequently delayed management. A direct access pathway (DAP) to Surgical Emergency Assessment Unit (SEAU) helps minimize these delays and subsequently improve patient outcome. Methods A retrospective observational study of Emergency General Surgery (EGS) admissions from May 2023 to December 2023 was performed. Structured DAP referral proforma was implemented for patients to be directly referred to SEAU from A&E triage. Factors taken into consideration were - initial presentation, source of referral, time of initial assessment and patient outcome. Results A total of 265 patients were channeled through DAP referrals during the study period, of which 96.6% were appropriate referrals. The main source of the referral the A&E (52.4%), while the UTC-GP and GP constituted the remaining (47.6%). The most common clinical presentations were abdominal pain (32.4%), followed by subcutaneous abscess (17.3%). The median watiting time for initial assessment by the surgical team was 60 minutes. In terms of outcomes - 15 % patients were admitted, 14.7% were discharged after intervention, 35.8 % were discharged without intervention and 28.6% were planned to return for investigations or interventions. Conclusion The DAP for EGS admissions has enabled surgical emergencies to be addressed more promptly, and thus seen to have improved patient outcome as a result of avoiding unnecessary steps and delays before being reviewed by the surgical team through A&E pathway.

Natural and Synthetic Capsaicin Analogues: A Comprehensive Review of Biological Effects and Synthetic Pathways.

Capsaicin analogs, whether sourced from natural origins or synthesized de novo, have garnered significant attention across diverse scientific disciplines. This comprehensive investigation explores the expansive domain of medicinal chemistry and pharmacology, focusing on capsaicin and its analogs. Notably, these analogs exhibit a wideranging pharmacological spectrum, with a particular emphasis on their potent antitumor properties. Researchers frequently explore structural modifications, particularly in region C, consistently enhancing their pharmacological activities. A highlighted finding is that analogs with alterations in both regions A and C manifest a diverse array of effects, spanning from anti-obesity to protection against ischemia. They also demonstrate anti- Alzheimer's, anti-fibrotic, anti-inflammatory, anti-diabetic, antimalarial, and anti-epileptic properties. This underscores the potential of structural adaptations in these regions, expanding the therapeutic applications of capsaicin-like compounds. Additionally, manipulations in regions B and C result in compounds that possess antioxidant and anti-obesity properties, providing valuable insights for the development of novel compounds. The therapeutic potential of capsaicin analogs opens innovative avenues for drug design and development, promising to address a broad spectrum of diseases and enhance global quality of life. Moreover, this article meticulously examines various synthetic methodologies for synthesizing capsaicin analogs, complementing the main review. These methodologies distinguish themselves through their simplicity, mild reaction conditions, and reliance on readily available commercial reagents. The accessible synthesis pathways enable researchers from diverse backgrounds to explore these compounds, fostering investigations and potential therapeutic applications.

Word frequency modulates the selection of semantic access pathways of spoken words in the second language

ABSTRACT: Most second language (L2) learners comprehend words more difficult in its spoken form than the written form (Bekleyen 2009). Based on the findings of previous studies, we assumed that word frequency and language proficiency may be two critical factors in spoken word identification. To investigate how these two factors modulate L2 spoken word identification, we recruited Chinese-English bilinguals with different English proficiency levels, and manipulated words' orthographic consistency, and word frequency. Our results supported the phonological restructuring account, it suggested that only high frequency L2 spoken words can achieve phonological restructuring and rely on orthographic information to access meaning. The less frequently used word has a weak spelling-sound connection, leaving the primitive sound-meaning route the only choice. This effect may be unrelated to language proficiency, the order that orthographic and phonological information is acquired, or the language system. Altogether, these results revealed that Chinese-English bilinguals rely on both the direct route and the orthography-mediation route to process L2 spoken words. The choice of which route is modulated by word frequency. 摘要: 大多数第二语言学习者理解单词的口语形式比书面形式更困难。基于 以往的研究结果，我们认为词频和语言熟练度可能是口语词汇识别的 两个关键因素。为了研究这两个因素是如何调节第二语言口语单词识 别的，我们招募了具有不同英语熟练度的汉-英双语者为被试，并操纵 了单词的正字法一致性和词频这两个因素。我们的研究结果支持语音 重构理论，表明只有高频的二语口语词汇才能实现语音重构，并依赖 正字法信息获取意义。而低频单词的拼写与其发音之间的联系较弱， 这使得原始的音-义直接通路成为唯一的选择。这种出现的词频效应可 能与语言熟练度、正字法信息和语音信息获得的顺序或语言系统无关。 以上结果表明，汉-英双语者在加工二语口语时，既依赖于直接通路， 也依赖于正字法中介通路。且通路的选择是由词频调节的。

Barriers to access of precision guided therapies for children with high-risk cancer.

Accessing compassionate access schemes to obtain novel therapeutic agents for children with hard-to-treat cancers can be fraught with challenges such as regulatory barriers and limited resources. This study aimed to explore clinician perspectives on the barriers, impacts and ethical considerations of accessing novel therapeutic agents within the context of a paediatric oncology precision medicine trial. We gathered data from 37 semi-structured interviews with paediatric oncologists participating in the PRecISion Medicine for Children with Cancer (PRISM) study, a precision medicine clinical trial in Australia. The interviews, conducted over 2years, focused on paediatric oncologist's experiences with the PRISM trial. Interviews were re-analysed to identify themes related to access pathways and any challenges in obtaining novel agents through thematic analysis. The resulting thematic framework was discussed and refined by a multidisciplinary team. Three main themes were identified: (i) barriers to access, including poor drug availability, lack of evidence and the time burden of the application process; (ii) impacts of inaccessibility, encompassing medical consequences and financial burden on families; and (iii) ethical considerations, centred around balancing realistic expectations and providing compassionate care to patients and families. Paediatric oncologists expressed frustration with the complex regulatory landscape and the lack of systematic reporting on applications and outcomes of obtaining novel agents. Lengthy wait times for decision notifications were also highlighted, raising concerns about missed therapeutic opportunities for patients. This study provides insight to the challenges faced when seeking access to novel therapies for paediatric oncology patients. There is a clear need for improved communication, streamlining processes and increased resources to facilitate access to novel agents. Further resource development is necessary to address these complexities in accessing novel therapy agents to ultimately ensure equitable and timely access.

Bonding-Directed Crystallization of Ultra-Long One-Dimensional NbS3 van der Waals Nanowires.

The rediscovery of one-dimensional (1D) and quasi-1D (q-1D) van der Waals (vdW) crystals ushered the realization of nascent physical properties in 1D that are suitable for applications in photonics, electronics, and sensing. However, despite renewed interest in the creation and understanding of the physical properties of 1D and q-1D vdW crystals, the lack of accessible synthetic pathways for growing well-defined nanostructures that extend across several length scales remains. Using the highly anisotropic 1D vdW NbS3-I crystal as a model phase, we present a catalyst-free and bottom-up synthetic approach to access ultralong nanowires, with lengths reaching up to 7.9 mm and with uniform thicknesses ranging from 13 to 160 nm between individual nanowires. Control over the synthetic parameters enabled the modulation of intra- and interchain growth modalities to selectively yield only 1D nanowires or quasi-2D nanoribbons. Comparative synthetic and density functional theory (DFT) studies with a closely related nondimerized phase, ZrS3, show that the unusual preferential growth along 1D can be correlated to the strongly anisotropic bonding and dimeric nature of NbS3-I.

Oxidative Stress in Cerebral Ischemia/Reperfusion Injury

Oxidative stress in cerebral ischemia/reperfusion injury (CIRI) involves reactive oxygen and nitrogen species (ROS and RNS). Despite efficient antioxidant pathways in the brain, hypoxia triggers the production of oxygen free radicals and downregulates ATP, which leads to oxidative stress. Sources of free radicals during CIRI include Ca<sup>2+</sup>-dependent enzymes, phospholipid degradation and mitochondrial enlargement. Upon reperfusion, the abrupt increase of oxygen triggers a massive radical production via enzymes like xantin oxidase (XO), phospholipase A2 (PLA2) and oxide synthases (OS). These enzymes play an essential role in neuronal damage by excitotoxicity, lipoperoxidation, nitrosylation, inflammation and programmed cell death (PCD). Endothelial nitric oxide synthase (eNOS) decreases as compared to neuronal nitric oxide synthase (nNOS). This is associated with neuronal damage, endothelial inflammation, apoptosis and oxidative stress. Strategies promoting activation of eNOS while inhibiting nNOS could offer neuroprotective benefits in CIRI. Understanding and targeting these pathways could mitigate brain damage in ischemia/reperfusion events. Clinically, tissue plasminogen activator (t-PA) has been shown to restore cerebral blood flow. However, serious side effects have been described, including hemorrhagic transformation. Different treatments are currently under investigation to avoid I/R injury. Baicalin has been reported as a potential agent that could improve t-PA adverse effects, which have to do with peroxynitrite synthesis and matrix metalloproteinase (MMP) expression. In this review, CIRI and interventions in oxidative stress are addressed. Special attention is paid to efficient antioxidant mechanisms in the brain and the production of free radicals, especially nNOS-derived nitric oxide (NO). The primary purpose is to describe accessible radical pathways with the activity of Ca<sup>2+</sup>-dependent oxidative enzymes, leading to membrane phospholipids and mitochondrial breakdown. <strong>Key</strong><strong>w</strong><strong>ords</strong>Oxidative stress; cerebral ischemia/reperfusion; nitric oxide; reactive oxygen species; nitric oxide synthase

Amorphizing MnIn2S4 Atomic Layers Create an Asymmetrical InO1S5 Polarization Plane for Photocatalytic Ammonia Synthesis and CO2 Reduction.

Building a polarization center is an effective avenue to boost charge separation and molecular activation in photocatalysis. However, a limited number of polarization centers are usually created. Here, a polarization plane based on two-dimensional (2D) atomic layers is designed to maximize the surface polarization centers. The Mn in a 2D crystal lattice is etched from the MnIn2S4 atomic layers to build a consecutive symmetry-breaking structure of isolated InO1S5 sites. More charges aggregate around O, making the isolated InO1S5 sites highly polarized. Due to the formation of the InO1S5 polarization plane, an enormous polarized electric field is formed perpendicular to the 2D atomic layers and the carrier lifetime can be prolonged from 93.2 ps in MnIn2S4 to 1130 ps in amorphous MnxIn2Sy. Meantime, the formed large charge density gradient favors coupling and activation of small molecules. Benefiting from these features, a good NH3 photosynthesis performance (515.8 μmol g-1 h-1) can be realized over amorphous MnxIn2Sy, roughly 2.5 and 48.9 times higher than those of MnIn2S4 atomic layers and bulk MnIn2S4, respectively. The apparent quantum yields reach 5.4 and 3.3% at 380 and 400 nm, respectively. Meanwhile, a greatly improved CO2 reduction activity is also achieved over MnxIn2Sy. This strategy provides an accessible pathway for designing an asymmetrical polarization plane to motivate photocatalysis optimization.

Bibliometric Patent Review of Minimally Invasive Spine Surgery.

This study analyzes patents associated with minimally invasive spine surgery (MISS) found on the Lens open online platform. The goal of this research was to provide an overview of the most referenced patents in the field of MISS and to uncover patterns in the evolution and categorization of these patents. MISS has rapidly progressed, with a core focus on minimizing surgical damage, preserving the natural anatomy, and enabling swift recovery, all while achieving outcomes that rival traditional open surgery. While prior studies have primarily concentrated on MISS outcomes, the analysis of MISS patents has been limited. To conduct this study, we used the Lens platform to search for patents that included the terms "minimally invasive" and "spine" in their titles, abstracts, or claims. We then categorized these patents and identified the top 100 with the most forward citations. We further classified these patents into 4 categories: Spinal Stabilization Systems, Joint Implants or Procedures, Screw Delivery System or Method, and Access and Surgical Pathway Formation. Five hundred two MISS patents were identified initially, and 276 were retained following a screening process. Among the top 100 patents, the majority had active legal status. The largest category within the top 100 patents was Access and Surgical Pathway Formation, closely followed by Spinal Stabilization Systems and Joint Implants or Procedures. The smallest category was Screw Delivery System or Method. Notably, the majority of the top 100 patents had priority years falling between 2000 and 2009, indicating a moderate positive correlation between patent rank and priority year. Thus far, patents related to Access and Surgical Pathway Formation have laid the foundation for subsequent innovations in Spinal Stabilization Systems and Screw Technology. This study serves as a valuable resource for guiding future innovations in this rapidly evolving field.

Facilitating remote and virtual access provision by European research infrastructures - requirements, issues, and recommendations.

Research Infrastructures (RIs) are strategic assets facilitating innovation and knowledge advancement across all scientific disciplines. They provide researchers with advanced tools and resources that go beyond individual or institutional capacities and promote collaboration, community-building and the application of scientific standards. Remote and virtual access to RIs enables scientists to use these essential resources without the necessity of being physically present. The COVID-19 pandemic restrictions where a catalyst for the expansion and further development of remote and virtual access models, particularly in fields where physical access had been the predominant model. The eRImote project explores pathways for digital and remote RI access through targeted surveys, stakeholder workshops, expert groups discussions, and the analysis of specific use cases. This paper provides a definition of remote and virtual access and remote training and explores their implementation across various RIs, highlighting the implications for their operational processes and the dynamics of interaction between RIs and their user communities. It presents the identified advantages, obstacles, and best-practices, alongside strategies and recommendations to navigate and mitigate challenges effectively. Key issues and recommendations are summed up separately for remote access, virtual access, and remote training, complemented by general recommendations for facilitating remote and virtual access to RIs. These relate to budgeting and funding, the balancing of RI access models, the need for regulatory frameworks for sample shipments, collaboration among RIs, impact assessment of remote and virtual access on user interactions, operational efficiency and the environment footprint of RIs, and the adaption of data sharing policies. Stakeholders are broadly invited to give their feedback on the paper's findings and conclusions, which will be integrated into improved versions of this paper.

How to improve the results of community college transfers

Community colleges can offer access to “social mobility” via bachelor's degree “attainment for students and communities who have not had accessible and affordable pathways,” write the authors of two new companion studies, but, they find, these pathways are “ineffective, inequitable, and not improving fast enough.”

Longitudinal experiences of Canadians receiving compassionate access to psilocybin-assisted psychotherapy

Recent clinical trials have found that the serotonergic psychedelic psilocybin effectively alleviates anxiodepressive symptoms in patients with life-threatening illnesses when given in a supportive environment. These outcomes prompted Canada to establish legal pathways for therapeutic access to psilocybin, coupled with psychological support. Despite over one-hundred Canadians receiving compassionate access since 2020, there has been little examination of these ‘real-world’ patients. We conducted a prospective longitudinal survey which focused on Canadians who were granted Section 56 exemptions for legal psilocybin-assisted psychotherapy. Surveys assessing various symptom dimensions were conducted at baseline, two weeks following the session (endpoint), and optionally one day post-session. Participant characteristics were examined using descriptive statistics, and paired sample t-tests were used to quantify changes from baseline to the two-week post-treatment endpoint. Eight participants with Section 56 exemptions (four females, Mage = 52.3 years), all with cancer diagnoses, fully completed baseline and endpoint surveys. Significant improvements in anxiety and depression symptoms, pain, fear of COVID-19, quality of life, and spiritual well-being were observed. Attitudes towards death, medical assistance in dying, and desire for hastened death remained unchanged. While most participants found the psilocybin sessions highly meaningful, if challenging, one reported a substantial decrease in well-being due to the experience. These preliminary data are amongst the first to suggest that psilocybin-assisted psychotherapy can produce psychiatric benefits in real-world patients akin to those observed in clinical trials. Limited enrollment and individual reports of negative experiences indicate the need for formal real-world evaluation programs to surveil the ongoing expansion of legal access to psychedelics.

How to improve the results of community college transfers

Community colleges can offer access to “social mobility” via bachelor's degree “attainment for students and communities who have not had accessible and affordable pathways,” write the authors of two new companion studies, but, they find, these pathways are “ineffective, inequitable, and not improving fast enough.”

Word Frequency Modulates the Selection of Semantic Access Pathways of Spoken Words in the Second Language

Word Frequency Modulates the Selection of Semantic Access Pathways of Spoken Words in the Second Language

Developing a gender affirming health response for trans and gender diverse Australians: a qualitative study

Introduction As trans and gender diverse populations experience disproportionately higher rates of discrimination, violence, mental health challenges, unemployment, and financial hardship, it is important to develop an evidence-based public health response for trans and gender diverse people seeking gender-affirming surgery (GAS). Resourcing and pathways for access vary across Australian states, with little research exploring the experiences of trans and gender-diverse people seeking GAS in Australia. Methods In-depth semi-structured interviews (N = 9) were conducted with three trans and gender diverse individuals, and six key representatives from community organizations (of which five identified as trans or gender diverse) in Queensland, Australia. Braun and Clarke’s reflexive thematic analysis was employed to analyze interview data. Results Interviews explored experiences with and attitudes toward existing models of gender-affirming care, barriers to the provision of GAS, and opportunities for developing and implementing a publicly funded gender-affirming model in Australia. Findings indicate individual, societal, and structural barriers prohibit access to GAS, with opportunities identified to improve health and wellbeing outcomes for trans and gender diverse people in Australia. Conclusions Findings are relevant to both future research and informing clinical policy, to establish appropriate and accessible pathways to GAS in Australia. Further research is required to inform the development of a publicly-funded model within the Australian context. Exploration of health economics and health service optimization would facilitate better understanding of individual trajectories and health outcomes within Australia, and ensure that any reform applies a person-centered approach to care

MWCNT/Al–Bi–NaCl nanocomposites for enhanced H2 generation

H2 generation through hydrolysis of Al-composites has received eclectic attention for on-demand H2 applications such as low-power proton exchange membrane fuel cells. In this line, we prepared Multi-Walled Carbon Nanotubes (MWCNT)/Al–Bi–NaCl nanocomposites and tested them for enhanced H2 generation. These nanocomposites are prepared using high-energy ball milling followed by uni-axial cold compaction. H2 generation by these nanocomposites was tested using tap water at room temperature. An excellent maximum H2 generation rate of 13.33 mLg−1s−1 with an H2 yield of 98% and an induction time of less than 10 s is achieved. Analysis of different observations shows that adding an optimum percentage of MWCNT to the Al–Bi–NaCl composite results in flaky morphology, which facilitates easily accessible water pathways, enhancing the H2 generation rate of the nanocomposites. Also, an enhanced number of MWCNT/Al–Bi microgalvanic cells, optimum utilization of electrical conductivity of MWCNT, and dissolution of NaCl favored the H2 generation.

Translating 'proportionate universal healthcare' into meaningful system design to optimize equity in child and family services.

To conduct a child and family health nursing service redesign to improve pathways of access, response and outcomes for all families with children aged 0-5 years. The study was conducted as an iterative, mixed-method study of the process and impact of the service redesign, informed by a participatory action research paradigm and the NSW Agency for Clinical Innovation process for developing a model of care. Diagnostic, solution design, implementation and sustainability phases were undertaken. Quantitative analyses were undertaken of administrative data, and child and family health nurse and client surveys. Qualitative analyses were undertaken of design workshops. The administrative data demonstrated that prior to the redesign service provision was the same for all clients regardless of levels of risk. The design solution, developed through a series of diagnostic and visioning workshops, included multiple new client response pathways. Implementation included development of tools and training. Sustainability of the redistribution of resources to the new pathways was assessed though an evaluation demonstrating a positive impact for families with adversity, with no deleterious effects for families receiving a universal response, and improvements in the emotional labour undertaken by nurses. Despite this, nurse burnout increased post-redesign. The shift from equal services (everyone receives the same) to equitable proportionate universal provision in response to need can be achieved and has positive impacts for nurses and families. This study shows the value of undertaking a systematic and participatory approach to service redesign. A proportionate universalism approach can ensure that early childhood nursing services are available to all in relation to needs. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) check-list was used to guide reporting. No patient or public contribution.

The impact of online degree programs on employment opportunities in contemporary India

The contemporary global economy demands a highly skilled and adaptable workforce, yet a persistent gap persists between the skills sought by employers and those possessed by the workforce. Online degree programs have emerged as a transformative solution, offering accessible and flexible pathways for individuals to acquire the skills necessary to meet the demands of the modern job market. However, despite their growing popularity, there remains a research gap in understanding their effectiveness, particularly in India. This research aims to evaluate the effectiveness of online degree programs in bridging the skills gap, preparing students for the workforce, and assessing the relevance of their curricula in meeting contemporary job market demands, particularly in India. The study employs a mixed-methods approach, including surveys with educators, students, and employers, as well as interviews with industry experts. The findings reveal that online degree programs play a significant role in closing the skills gap and fulfilling job market demands in contemporary India. The curricula of these programs are highly relevant and aligned with industry needs, offering practical learning experiences that enhance students’ employability. Moreover, online education provides an inclusive, flexible, and cost-effective approach to education, enabling individuals from diverse backgrounds to access quality education. Overall, this research underscores the importance of online degree programs in preparing individuals for success in a rapidly changing and competitive global economy. By leveraging the full potential of online education, we can create a workforce that is well-equipped to meet current industry needs and adapt to the challenges of the future.

Sarbecovirus disease susceptibility is conserved across viral and host models

BackgroundThe introduction of nursing associates in England (UK) in 2017 as a professional ‘bridging’ role aimed to mitigate chronic staffing shortages, enable career progression of healthcare assistants and release registered nurses to provide more complex care. Limited evidence exists about the alignment between the identity and purpose of nursing associate roles described by the UK independent regulator, the Nursing and Midwifery Council, and the expectations, obligations and team dynamics encountered in practice. PurposeInvestigate the perceptions of nursing associate roles through the views and experiences of role holders, registered nurses and healthcare assistants. SettingTwo National Health Service (NHS) Hospital Trusts in London, England (UK). MethodsFor this registered service evaluation, data were collected via in-person, semi structured interviews. Verbatim transcripts were coded inductively. An adapted framework analysis method, suitable for use with Excel, was applied to support the identification of cross cutting themes. We used the Standards for Reporting Qualitative Research (SRQR) checklist for this study. ResultsEleven registered nurses, five nursing associates and five healthcare assistants participated. Their experiences seldom reflected the policy vision of the nursing associate role in practice. Several likened the nursing associate role to the fable of the ‘Emperor's New Clothes’ in which expectations and reality diverge. With this defined as the over-arching theme, four sub-themes were identified: (1) preparedness of organisational infrastructure to support this role; (2) credibility of the role in practice; (3) perceived organisational “blindness” to the ambiguities of the role and (4) increasing task orientation and segmentation in care delivery. ConclusionThere is a discrepancy between the identity of the nursing associate role as imagined in the policy agenda and its reality in practice. There is a need for more protected and well-defined training, clear role boundaries and accessible career progression pathways. Moreover, honest dialogue at an organisational and policy level must continue, so that the challenges and opportunities of the NA role are properly realised