UK Nurses Research Articles

Linkage and Demographic Indexing for Nursing Dynamics in the Integrated Data Service

Objective and ApproachThis project links UK Nursing and Midwifery Council (NMC) Registrant data to the 2021 England and Wales Census (“Census 21”). The Office for National Statistics (ONS) has composed a framework of index tables to facilitate linkage between prominent datasets in the UK. In linking person-level data to Census 21, ONS’ Demographic Index enables onward linkage to other administrative datasets that are indexed alike. NMC Register and Census 21 records have been initially linked using bespoke deterministic and probabilistic methods, with resulting matches being joined to the Demographic Index. ONS’ Demographic Index Matching Service (DIMS) will also be used to link NMC data to the Demographic Index to enable comparisons between methods. ResultsAnalysis of both approaches will compare quality metrics such as match rate, recall and precision and tools will be used to assess bias in matches made through each method. These metrics will provide an insight into how the index matching services have been designed and whether improvements can be made to account for any shortcomings in their performance. ConclusionsHybrid approaches using both bespoke and indexing methods are proving valuable where sole use of the matching services is not suitable. This research will help ONS to refine which methods will yield the highest quality linkage and when. ImplicationsAs ONS pursues an ‘indexing first’ approach to linkage, the outcomes of this and similar projects will influence the future of utilising indexes in varied capacities when creating or maximising the potential of linked data.

Lifestyle nursing: a leadership opportunity for UK nurses

This article aims to consider the ‘lifestyle medicine’ approach to nursing, which focuses on patients with conditions that would benefit from a lifestyle nursing approach, supporting and empowering people to make lifestyle changes that would benefit their health. Lifestyle medicine in nursing is gaining momentum in the USA and could be a nursing leadership opportunity in the UK. This article explores the importance of lifestyle approaches to health care and why nurses have a pivotal role in the movement.

Exploring the Perceptions and Behaviours of UK Prescribers Concerning Novel Lipid-Lowering Agent Prescriptions: A Qualitative Study.

Reducing low-density lipoprotein cholesterol levels lowers the risk of atherosclerotic cardiovascular disease. With the current and future portfolios of emerging lipid-lowering therapies included in various national and international guidelines, the objectives of this study were (i) to investigate the perceptions of UK prescribers', including doctors, pharmacists, and nurses, on current lipid management for cardiovascular diseases and prescriptions of novel lipid-lowering therapies, and (ii) to explore the challenges and facilitating factors of prescribing novel lipid-lowering therapies through qualitative interviews. Qualitative semi-structured interviews with twelve medical and non-medical prescribers were conducted, around 20-30 min in length. The interviews were audio-recorded and transcribed on an online platform. A thematic analysis was deployed. Four major themes emerged from the analysis: (1) prescribing barriers; (2) prescribing enablers; (3) inter-profession variability; and (4) health literacy. These themes highlighted the contrast between the need for optimal shared decision making and the various constraints in practice. Participants expressed their inexperience with novel lipid-lowering therapies and acknowledged the requirement and importance of these agents for primary cardiovascular disease prevention. Participants recognised confidence and competence as key drivers for prescribing therapies and welcomed further education and training to enhance their skillset. Patients' misconceptions towards current lipid-lowering therapies contributed to their refusal of newer agents, highlighting a requirement to improve patient education. Targeting communities through awareness campaigns was identified as a viable solution.

999 telephone triage: a comparison of UK ambulance nurse and paramedic case mix, outcomes and audit compliance

PurposeMost UK ambulance services undertake remote assessments of 999 calls with nurses and paramedics to manage demand and reduce inappropriate hospital admissions. However, little is known about the differences in the types of cases managed by the two professions comparatively, their clinical outcomes, and the quality and safety they offer.Design/methodology/approachThe retrospective descriptive study analysed data collected at Welsh Ambulance Services University NHS Trust (WAST) from prioritisation, triage, and audit tools between the 17th May 2022 to 8th November 2022. A total of 21,076 cases and 728 audits were included for review.FindingsThere was little difference in the type and frequency of the presenting complaints assessed, and clinical outcomes reached in percentage terms. Whilst paramedics had more highly compliant call audits and fewer non-compliant call audits, there was, again, little difference in percentage terms between the two, indicating positive levels of safety across the two professional groups.Research limitations/implicationsThere continues to be a substantial difference between UK paramedics to those in the Middle East, the United States, and some African nations, which may limit the applicability of findings. This study also looked at a six-month window from only one UK service using one type of prioritisation and triage tool. Future research could explore longer periods from multiple services using various tools. It is important to note that this study did not link outcome data with primary, secondary or tertiary care settings. Thus, it is impossible to determine if the level of care aligned closely with the final diagnosis.Practical implicationsThe practical implications of this work include better workforce planning for agencies who have perhaps only employed one type of clinician or a reaffirmation to those who have employed both. The authors suggest that the training and education of both sets of clinicians could remain general in nature, with no overt requirement for specificity based on professional registration alone. Commissioners and stakeholders in the wider health economy should consider ensuring equitable access to alternative pathways for patients assessed by both nurses and paramedics.Social implicationsIt has been posited that UK nurses and paramedics are, by virtue of their consistency in education, skill set, licensure, and general experience, both able to achieve safe and effective remote outcomes in 999 settings. This study provides evidence to support that hypothesis. These results say more about the two professions' ability to work together rather than just the professions themselves. The multidisciplinary team approach is well-established in acute care settings, and is broadly considered to improve communication, coordination decision making, adherence to up-to-date treatment recommendations, and be positive for shared learning and development for younger colleagues.Originality/valueMost UK services use a mix of nurses and paramedics; however, little is known about the differences in the types of cases managed by the two professions comparatively, their clinical outcomes, and the quality and safety they each offer. The most recent studies of this nature were published in 2003 and 2004 and looked only at low-acuity 999 calls when remote assessment was not even an established role for UK paramedics. This study updates the literature, identifies areas for future research, and applies to the international setting for the most part.

A survey of UK nurses about their care of people with malignant fungating wounds

PurposeTo gain an understanding of the nursing professionals who treat people with malignant fungating wounds (MFW) in the UK and their current practices, including perceived barriers and facilitators to providing MFW care. MethodAn online anonymous questionnaire was created with questions about the role of nursing professionals who reported caring for patients with MFW, the number of people with MFW they regularly cared for, treatment aims, treatments used, and challenges faced. These questions were developed with professional input and piloted. Using a convenience sampling method, we collected responses from UK nurses by distributing the questionnaire via social media and through relevant professional organisations. The questionnaire was constructed in QualtricsXM software and analysed using SPSS. ResultWe received 154 questionnaire responses, with three-quarters from tissue viability nurses and the rest from community and other specialist nurses. The most important treatment aim reported was pain management, followed by odour management. Almost all respondents used antimicrobial and standard dressings for these patients, with a range of products reported. Poor access to MFW care training and lack of local and national guidelines were reported as barriers to providing care for people with MFW. Availability of dressings, access to training, and good communication processes were reported as facilitators. ConclusionThis is the first study to explore MFW wound care practices in the UK. A range of nurses are involved in care delivery with variations in the treatments used. Lack of access to MFW care training, resources, and standardised guidelines may impede care delivery.

Leadership practices that enable healthful cultures in clinical practice: A realist evaluation.

To generate, test and refine programme theories that emerged from a rapid realist review investigating practising UK Nurses' and Midwives' experiences of effective leadership strategies during the COVID-19 pandemic. The realist review of literature generated six tentative theories of healthful leadership practices reflecting, working with people's beliefs and values; being facilitative; multiple means of communication and; practical support. The review yielded little insight into the actual impact of the leadership approaches advocated. A realist study, informed by person-centredness using mixed-methods. Online survey (n = 328) and semi-structured interviews (n = 14) of nurses and midwives across the UK in different career positions/specialities. Quantitative data analysed using descriptive statistics and exploratory factor analysis. Framework analysis for qualitative data using context (C), mechanism (M), outcome (O) configurations of the tentative theories. Three refined theories were identified concerning: Visibility and availability; embodying values and; knowing self. Healthful leadership practices are only achievable within organisational cultures that privilege well-being. Leaders should intentionally adopt practices that promote well-being. 'Knowing self' as a leader, coaching and mentoring practice development is important for leadership development. Nurses who feel valued, heard, cared for and safe are more likely to remain in clinical practice. Job satisfaction and being motivated to practice with confidence and competence will impact positively on patient outcomes. The study addresses the role of leadership in developing healthful workplace cultures. The main findings were six leadership practices that promote healthful cultures. The research will have an impact on strategic and clinical leaders, nurses and midwives. This study used EQUATOR checklist, RAMASES II as reporting standards for realist evaluations. No patient or public contribution.

UK Nurses Delivering Physical Activity Advice: What Are the Challenges and Possible Solutions? A Qualitative Study

There are a multitude of health benefits gained from regular physical activity (PA). Currently, PA advice implementation from NHS nurses is inadequate despite their ever-increasing role in lifestyle and preventive medicine. By assessing their knowledge of current PA guidance, this study proposed to investigate the issues with regular PA advice being given and expand upon nurses’ proposed barriers and solutions. A qualitative approach using semi structured interviews was undertaken between March and August 2023 involving 13 NHS nurses. Thematic analysis was undertaken using Braun and Clarke’s six step approach. Four themes and fifteen subthemes emerged as barriers and solutions in delivering PA advice. Intrinsic barriers included a lack of nurse knowledge on the topic and PA being seen as an afterthought. Extrinsic barriers included time pressures and a lack of staff engagement. Solutions involved increasing staff awareness of guidelines through teaching, policy, encouraging staff to be active and optimising PA advice delivery through a piecemeal approach and utilising online and visual resources. This study displayed an insight into nurses’ thoughts on their consultations with patients regarding PA, and proposed several barriers and solutions. Further work is needed to improve nurses’ PA knowledge and to assess the proposed strategies to improve its delivery.

Parameters of learning during clinical nursing study abroad: Focused analysis of phenomenological data using a change-transformative learning theory lens

AimsTo explore the nature and extent of learning attained as a result of unaccompanied-by-faculty clinical nursing study abroad experiences and to answer the research question ‘what is the nature and extent of learning during study abroad?’. BackgroundFollowing the Covid-19 restrictions, international placement opportunities for student nurses are now resuming. In light of this, it is an opportune time for nurse educators to reflect and consider the effectiveness of clinical study abroad placements as contexts of learning, especially in relation to attainment of desired learning outcomes such as personal and professional growth and the development of culturally competent global graduates. This is an important area to research as specific understanding in relation to the extent of learning and variations in learning between students is limited. Design:The study was situated within the interpretivist paradigm to elicit experiences of study abroad. Aligned to this, a hermeneutic phenomenological methodology was applied to ensure these experiences emerged from the subjective horizon of student nurses. Methods:Following ethical approval, two semi-structured interviews per student (post-return and follow-up) were conducted with student nurses who had undertaken a study abroad experience. Phenomenological hermeneutical data analysis for multiple context research was undertaken and a change-transformative learning theory lens was additionally employed to the analysis to differentiate between the extent of and variations in, learning attained. Twenty UK and European student nurses, who were registered onto a study abroad programme prior to the Covid-19 restrictions participated. Results:Variations between participants were identified in relation to the nature and extent of learning. Participants experienced personal and professional growth and they experienced transformation in relation to self as a person, learner and nurse. However, variations existed when considering the attributes of global graduateness and cultural competence development. Whilst participants changed by expanding their knowledge in relation to global and cultural issues, some participants also appear to have concurrently experienced a reinforcement of ethnocentric frames of reference. ConclusionsAnalysis revealed that study abroad offered opportunities for students to experience change and transformation. Whilst students demonstrated learning in both the domains of change and transformation, transformative learning in all identified outcome areas was not guaranteed. Whilst transformative learning was apparent when considering personal and professional growth, less extensive learning was demonstrated when considering development of the attributes of global graduateness and cultural competence. The paper therefore recognises the complex nature of study abroad experiences and recommends continued investigation in this field.

P2.23-03 The Role of The Mesothelioma UK Nurse Increases the Number of Patients Accessing Legal Representation, Financial Entitlement

P2.23-03 The Role of The Mesothelioma UK Nurse Increases the Number of Patients Accessing Legal Representation, Financial Entitlement

O.2.1-9 Are doctors and nurses engaging in physical activity and its promotion?

Abstract Purpose Healthcare professionals (HCPs) are ideal providers of physical activity (PA) promotion; a large portion of the population have contact with a form of HCP and they are viewed as trusted and respected role models for health advice. Despite this, we have a very limited understanding of HCPs PA counselling practices. The aim of this study was to evaluate PA levels, attitudes towards PA counselling and counselling practices of UK doctors and nurses. Methods The study included two cross-sectional, anonymised, online surveys conducted in 2018/19 (survey 1) and 2019/20 (survey 2). Whether or not participants were achieving the aerobic PA guideline was evaluated using the first 2 questions of the Scot-PASQ survey. Counselling practices were assessed using likert scales to assess the proportion of patients that participants had discussed PA with in the past week and their perceived importance of PA counselling as part of their role. Results 460 doctors and 169 nurses from the UK completed the survey. 78.3% of doctors and 73.4% of nurses met the UK aerobic PA guidelines. Perceived importance of counselling was high but participants were providing PA counselling on average for less than 25% of their patients. PA counselling was more likely in primary care and doctors were marginally more likely than nurses to counsel on PA. Conclusion This cohort of doctors and nurses were active and viewed PA counselling as important. Despite this, PA counselling levels were low especially in secondary care. Efforts should be made to improve knowledge of, and opportunity for, PA counselling in HCPs.

Administration of intravenous fluids and medicines in children and young people.

Managing intravenous (IV) access is a standard proficiency for UK nurses, enabling them to administer IV injections and IV infusions and to manage injection equipment and infusion pumps and devices. In this article the author describes various types of venous access devices that are commonly seen in practice and details the preparation, checking and administration of IV fluids and medicines, including some complications that may arise. The author also discusses the calculation of fluid requirements, types of IV fluids, displacement values and ongoing care of venous access devices.

Competencies of the UK nursing and midwifery workforce to mainstream genomics in the National Health Service: the ongoing gap between perceived importance and confidence in genomics.

The United Kingdom is recognised worldwide as a leader in genomics. The use of genomic technologies in the National Health Service (NHS) is expected to deliver faster and more accurate diagnoses, supporting personalized treatments to improve patient outcomes. The ambition of embedding genomic medicine in the diagnostic pathway requires involvement of the front-line clinical workforce, known as 'mainstreaming'. Nurses and midwives are the largest professionally qualified workforce in the National Health Service thus, it is anticipated that they will play key roles in mainstreaming. This study investigated the level of competence/confidence of practicing nurses and midwives to support mainstreaming and their perception of the importance of genomics in delivery of patient care. A literature review of genetics/genomics competency frameworks, semi structured interviews of lead nurses and stakeholders were conducted to identify relevant competencies needed for mainstreaming. These were then used to survey four cohorts of nurses (n = 153) across England in four consecutive years (2019-22). The confidence level of these professionals in all aspects of genomics was 2.07 ± 0.47 measured on a 5-point Likert scale (1"Low confidence"; 5 "High confidence"). Intriguingly, these professionals all appreciated the importance of genomics for their patient care (4.01 ± 0.06). Whilst the importance scores increased, the confidence scores declined at the time when major genomic transformation took place in the NHS (e.g.: launch of the Genomic Medicine Service, the National Genomic Test Directory). To bridge this gap, relevant genomic education can play key roles. However, nurses and midwives were found to be grossly underrepresented in formal genomic education courses offered by Health Education England Genomics Education Programme since 2014. This may result from the lack of direct applicability of the currently offered courses for their practice and role. Thematic analysis revealed that nurses and midwives wish to support their patients by providing more information on their condition, inheritance, and treatment options in combination with the use of relevant genetic counselling skills. This study identified easy to follow competencies for embedding genomics into routine clinical care. We propose a training programme that addresses the gap that nurses and midwives currently have, to enable them to harness genomic opportunities for patients and services.

Adapt and Overcome: Unraveling the Dynamics of Job Stressors and Coping Mechanisms among Nurses in the UK

This study provides a comprehensive exploration of the multifaceted stressors encountered by nurses working within the UK healthcare system and the coping strategies they deploy in response. As the backbone of healthcare provision, nurses confront numerous occupational stressors, exacerbated by the inherent demands of their profession. These stressors range from high patient loads, long working hours, emotional strain, to evolving professional responsibilities. In the face of these challenges, this research adopts a mixed-method approach, combining quantitative data analysis with in-depth qualitative interviews to offer an illuminating perspective on the stress-coping patterns among nurses. The findings reveal that while these stressors can have deleterious effects on nurses' physical and mental health, they also possess an impressive array of adaptive strategies, involving a blend of problem-focused and emotion-focused coping techniques. These coping mechanisms span from collegial support, personal resilience building, stress management training, use of reflective practices, to organizational strategies such as balanced rosters and enhanced professional development opportunities. The results underscore the critical role of a supportive work environment and proactive personal initiatives in fostering resilience among nurses, while also shedding light on the need for healthcare systems to better recognize and mitigate the unique stressors experienced by nurses. Importantly, the study advances our understanding of how nurses' stress and coping mechanisms interact in a dynamic and reciprocal manner, offering important implications for healthcare policy, nurse education, and management practices. The research emphasizes that strengthening coping mechanisms and reducing job stressors should be seen as dual priorities to promote nurses' well-being, job satisfaction, and ultimately, to enhance patient care. In conclusion, this study offers novel insights into the interplay between job stressors and coping mechanisms among nurses in the UK, urging both individual and institutional responses to promote a more sustainable and resilient nursing workforce. Key words: Job Stressors, Coping Mechanisms, UK Nurses, Healthcare System, Occupational Resilience

The irony of Australia’s bid to lure UK nurses

Is it right for one country to poach the workers of another? From places where there is a known shortage of personnel?

Research placements: are they a suitable alternative for student nurses?

COVID-19 has affected those undertaking courses in higher education, especially programmes in health care with clinical placements. Many student nurses were unable to undertake their planned clinical placements and had to adjust to self-directed learning and an increase in simulated learning. As a suitable alternative to clinical placements, a research placement for two second-year BSc adult nursing students was trialled, and this article presents an account from one placement. The academic team devised specific questions for students to consider for their research electives and provided a template for their written work with the aim of writing up a weekly report to reflect their learning. In particular, the students had to identify how their learning related to the UK Nursing and Midwifery Council code of conduct. The research placement was successful and shows great potential, offering students tangible opportunities to seek out the evidence for themselves and use it to inform their clinical practice.

1367 RECOGNITION AND MANAGEMENT OF ACUTE FUNCTIONAL DECLINE: A QUALITATIVE INTERVIEW STUDY WITH UK CARE HOME STAFF

Abstract Introduction Older people living in care homes sometimes experience episodes of acute functional decline. These represent a diagnostic challenge to healthcare professionals and can result in antibiotic prescriptions or hospital admissions, though this may not always the most appropriate management strategy. We aimed to understand how episodes of acute functional decline are recognised, managed and escalated by care home staff in the UK. Method This was a qualitative interview study with UK care home staff, including managers, nurses and carers. Participants were recruited through advertisements circulated via email, social media and word of mouth. Semi-structured interviews were conducted over the phone between January 2021 and April 2022. Thematic analysis was facilitated by NVivo software. Results 25 care home staff were interviewed. Participants described feeling confident in recognising when residents were less well than usual, especially if they knew them well. However, they sometimes felt it was difficult to differentiate between an ‘off day’ and something more significant. Most participants talked about clear early communication amongst the team to flag a resident of concern. Initial management steps in the care home included checking clinical observations and doing a urine dipstick. Many participants talked about considering the underlying cause for deterioration. Some participants felt comfortable monitoring residents for a few days themselves or trying a simple intervention. Others preferred escalating directly to outside clinical support. Triggers for escalation included perceived severity of illness, gut feeling or failure to respond to initial supportive management. Conclusions These results highlight the skill base of care home staff. However, it has also helped to identify areas for additional support and training including the use and interpretation of the urine dipstick. The findings of this study are being used to inform the design of a feasibility prospective cohort study of UK care home residents.

Strikes must not divide nurses

Tens of thousands of nurses are braced to take industrial action in what is being described as a defining moment for UK nursing.

The Vitruvian nurse and burnout: New materialist approaches to impossible ideals.

The Vitruvian Man is a metaphor for the "ideal man"by feminist posthuman philosopher Rosi Braidotti (2013) as a proxy for eurocentric humanist ideals. The first half of this paper extends Braidotti's concept by thinking about the metaphor of the "ideal nurse"(Vitruvian nurse) and how this metaphor contributes to racism, oppression, and burnout in nursing and might restrict the professionalization of nursing. The Vitruvian nurse is an idealized and perfected form of a nurse with self-sacrificial language (re)producing self-sacrificing expectations. The second half of this paper looks at how regulatory frameworks (using the example of UK's Nursing and Midwifery CouncilCode of Conduct) institutionalize the conditions of possibility through collective imaginations. The domineering expectations found within the Vitruvian nurse metaphor and further codified by regulatory frameworks giverise to boredom and burnout. The paper ends by suggesting possible ways to diffract regulatory frameworks to practice with affirmative ethics and reduce feelings of self-sacrifice and exhaustion amongnurses.

True distance learning – an evaluation of a virtual simulated placement (VSP) for Indonesian nursing students

VSP uses browser-based virtual environments to simulate life-like and challenging clinical scenarios. They are an innovative and creative way to develop proficiency capabilities of healthcare professionals as an adjunct to their studies and practice placement. Evidence suggests that a simulated environment can better equip nursing and allied health professional students for practice [1–3]. The concept of VSP may have been brought forward by the COVID-19 pandemic but was inevitable with the increasing access to technology-enhanced learning and the emerging evidence of its benefit. This VSP was a collaboration between UK simulationists and Indonesian academics with a two-month deadline. Work was completed online using videoconferencing and translation services, the evaluation (with ethical approval) was completed using a JISC online survey in March 2022. The Indonesia VSP consists of four patient scenarios, one scenario from each of the fields of children and young people, adult, mental health and learning disability nursing and is set within the emergency department and is aimed at learners in their final year of a nursing programme in Indonesia. The Indonesia VSP scenarios were designed in line with the UK Nursing and Midwifery Council (NMC) proficiencies and the Indonesian equivalents and were designed based on clinical scenarios that are not commonly seen in clinical practice or may be particularly challenging to enhance learners’ skills and build their confidence with managing such situations. The VSP was designed for 10 hours of learning and was made available to adult nursing students from 37 Poltekkes across the Indonesian continent. The VSP project was delivered on time with the evaluation from the pilot group being overwhelmingly positive with 82% of respondents being satisfied with the quality of VSP (response rate of 30% n=51/171) The key themes identified were: ‘real-life patient scenarios based on holistic and patient-centered care’ and the VSP enabling learners to use ‘critical thinking skills and relate the content to previous knowledge’ gained on their course so far. VSP is a meaningful way of enhancing exposure to experiences that are not guaranteed for all learners leading to greater equity of experience. The reflective and blended nature of the VSP leads to a better understanding of difficult topics. The VSP platform enables knowledge transfer that allows our team to take our in-house digital innovations to a global platform to support the training of the future nursing workforce of Indonesia. 1. Akselbo I, Olufsen V, Ingebrigtsen O, Aune I. Simulation as a learning method in public health nurse education. Public Health Nurs. 2019;36(2):226–232. 2. Bogossian FE, Cant RP, Ballard EL, Cooper SJ, Levett‐Jones TL, McKenna LG, Ng LC, Seaton PC. Locating ‘gold standard’ evidence for simulation as a substitute for clinical practice in prelicensure health professional education: a systematic review. J Clin Nurs. 2019;28(21–22):3759–3775. 3. Mills BW, Carter OB, Rudd CJ, Ross NP, Claxton LA. 2015. Clinical placement before or after simulated learning environments? A naturalistic study of clinical skills acquisition among early-stage paramedicine students. Simul Healthc. 2015;10(5):263–269.

Assessment of motor limb strength by neuroscience nurses: variations in practice and associated challenges.

Limb strength is a central component of neurological assessment and monitoring in nursing practice, yet there is a lack of research examining the tools used by nurses or challenges nurses encounter when using these tools. The evidence base is lacking to inform effective practice and the underpinning educational approaches. To determine which tools are used by UK and Irish neuroscience nurses in the assessment of limb strength and the associated challenges and variations in practice. This study used an online self-reported survey design to ascertain which tools neuroscience nurses used and their experience of using these (n=160). Practices varied, with a dominance of two tools being used in practice: the Medical Research Council scale and the 'normal power' to 'no movement' scale found on the neurological observation chart. Most respondents used the same tool across all conditions. This study highlights variations in assessment practice and the absence of a sound evidence base behind choice of motor limb strength assessment tools used.