UK Nurses Research Articles

UK nurses' and midwives' experiences of healthful leadership practices during the COVID-19 pandemic: A rapid realist review.

AimTo explore healthful leadership practices in nursing and midwifery evident within the Covid‐19 pandemic in the UK, the contextual facilitators, barriers, and outcomes.BackgroundGlobally, the health and care sector are under pressure and despite nurses and other professionals demonstrating resilience and resourcefulness in the COVID‐19 pandemic, this has negatively impacted on their health and wellbeing and on patient care.EvaluationTwo searches were conducted in July 2021 and December 2021. Inclusion/exclusion criteria were identified to refine the search, including papers written since the beginning of the pandemic in 2020. A total of 38 papers were included principally from the USA and UK. 10 were research papers, the others were commentaries, opinion pieces and editorials. MS Teams literature repository was created. A unique critical appraisal tool was devised to capture contexts, mechanisms and outcomes whilst reflecting more standardised tools i.e., the Critical Appraisal Skills Programme and the Authority, Accuracy, Coverage, Objectivity and Date tool (AACOD) tool for reviewing grey literature to refine the search further.Key IssuesSix tentative theories of healthful leadership emerged from the literature around leadership strategies which are relational, being visible and present; being open and engaging; caring for self and others; embodying values; being prepared and preparing others and using available information and support. Contextual factors that enable healthful leadership practices are in the main, created by leaders’ values, attributes, and style, as well as the culture within which they lead. The literature suggests leaders who embody values of compassion, empathy, courage, and authenticity create conditions for positive and healthful relations between leaders and others. Nurse and midwives’ voices are however absent from the literature in this review.ConclusionCurrent available literature would suggest healthful leadership practices are not prioritized by nurse leaders but the perspectives of nurses’ and midwives’ about the impact of such practices on their well‐being is missing. Tentative theories are offered as a means of identifying healthful leadership strategies, the context that enable these and potential outcomes for nurses an midwives. These will be explored in phase two of this study.Implications for nursing managementNurse leaders must be adequately prepared to create working environments that support nurses’ and midwives’ wellbeing, so that they may be able to provide high quality care. Ensuring a supportive organisational culture which embodies the values of healthfulness may help to mitigate the impact of the COVID‐19 pandemic on nurses’ and midwives’ wellbeing in the immediate aftermath and going forward.

The impact of COVID-19 on nurses (ICON) survey: Nurses' accounts of what would have helped to improve their working lives.

AimsTo use nurses' descriptions of what would have improved their working lives during the first peak of the COVID‐19 pandemic in the UK.DesignAnalysis of free‐text responses from a cross‐sectional survey of the UK nursing and midwifery workforce.MethodsBetween 2 and 14 April 2020, 3299 nurses and midwives completed an online survey, as part of the ‘Impact of COVID‐19 on Nurses’ (ICON) study. 2205 (67%) gave answers to a question asking for the top three things that the government or their employer could do to improve their working lives. Each participants' response was coded using thematic and content analysis. Multiple response analysis quantified the frequency of different issues and themes and examined variation by employer.ResultsMost (77%) were employed by the National Health Service (77%) and worked at staff or senior staff nurse levels (55%). 5938 codable responses were generated. Personal protective equipment/staff safety (60.0%), support to workforce (28.6%) and better communication (21.9%) were the most cited themes. Within ‘personal protective equipment’, responses focussed most on available supply. Only 2.8% stated that nothing further could be done. Patterns were similar in both NHS and non‐NHS settings.ConclusionsThe analysis provided valuable insight into key changes required to improve the work lives of nurses during a pandemic. Urgent improvements in provision and quality of personal protective equipment were needed for the safety of both workforce and patients.ImpactFailure to meet nurses needs to be safe at work appears to have damaged morale in this vital workforce. We identified key strategies that, if implemented by the Government and employers, could have improved the working lives of the nursing and midwifery workforce during the early stages of the COVID‐19 pandemic and could prevent the pandemic from having a longer‐term negative impact on the retention of this vital workforce.Patient or Public ContributionNo Patient or Public Contribution, due to the COVID‐19 Pandemic, urgency of the work and the target population being health and social care staff.

OA27 Growth of the UK and Ireland paediatric rheumatology nurses’ group

OA27 Growth of the UK and Ireland paediatric rheumatology nurses’ group

Self-rostering, work-life balance and job satisfaction in UK nursing: a literature review.

Nursing vacancies are high across the UK, with some nurses considering leaving the profession. Evidence suggests that employers, including the NHS, need to be more flexible about working times to support employees' work-life balance and job satisfaction. Self-rostering is one approach that has the potential to enhance nurses' work-life balance and job satisfaction, enabling scope for greater autonomy. This could in turn lead to fewer nurses leaving the profession and contribute to making nursing more attractive as a career. This literature review focused on nurses in the NHS and found that self-rostering had a positive effect on their work-life balance and job satisfaction. However, a move to self-rostering can pose challenges and it should be assessed for suitability before implementation. Given the nursing vacancy crisis in the UK and many nurses' intentions to leave the profession, the potential benefits of self-rostering for nurses cannot be overlooked.

Factors influencing fatigue in UK nurses working in respiratory clinical areas during the second wave of the Covid-19 pandemic: An online survey.

Aims and objectivesThis study explores UK nurses' experiences of working in a respiratory clinical area during the COVID‐19 pandemic over winter 2020.BackgroundDuring the first wave of the pandemic, nurses working in respiratory clinical areas experienced significant levels of anxiety and depression. As the pandemic has progressed, levels of fatigue in nurses have not been assessed.MethodsA cross‐sectional e‐survey was distributed via professional respiratory societies and social media. The survey included Generalised Anxiety Disorder Assessment (GAD7), Patient Health Questionnaire (PHQ9, depression), a resilience scale (RS‐14) and Chalder mental and physical fatigue tools. The STROBE checklist was followed as guidance to write the manuscript.ResultsDespite reporting anxiety and depression, few nurses reported having time off work with stress, most were maintaining training and felt prepared for COVID challenges in their current role. Nurses reported concerns over safety and patient feedback was both positive and negative. A quarter of respondents reported wanting to leave nursing. Nurses experiencing greater physical fatigue reported higher levels of anxiety and depression.ConclusionsNurses working in respiratory clinical areas were closely involved in caring for COVID‐19 patients. Nurses continued to experience similar levels of anxiety and depression to those found in the first wave and reported symptoms of fatigue (physical and mental). A significant proportion of respondents reported considering leaving nursing. Retention of nurses is vital to ensure the safe functioning of already overstretched health services. Nurses would benefit from regular mental health check‐ups to ensure they are fit to practice and receive the support they need to work effectively.Relevance to clinical practiceA high proportion of nurses working in respiratory clinical areas have been identified as experiencing fatigue in addition to continued levels of anxiety, depression over winter 2020. Interventions need to be implemented to help provide mental health support and improve workplace conditions to minimise PTSD and burnout.

‘You can't walk through water without getting wet’ UK nurses’ distress and psychological health needs during the Covid-19 pandemic: A longitudinal interview study

BackgroundPre-COVID-19 research highlighted the nursing profession worldwide as being at high risk from symptoms of burnout, post-traumatic stress disorder (PTSD) and suicide. The World Health Organization declared a pandemic on 11th March 2020 due to the sustained risk of further global spread of COVID-19. The high healthcare burden associated with COVID-19 has increased nurses’ trauma and workload, thereby exacerbating pressure on an already strained workforce and causing additional psychological distress for staff. ObjectivesThe Impact of COVID-19 on Nurses (ICON) interview study examined the impacts of the pandemic on frontline nursing staff's psychosocial and emotional wellbeing. DesignLongitudinal qualitative interview study. SettingsNurses who had completed time 1 and 2 of the ICON survey were sampled to include a range of UK work settings including acute, primary and community care and care homes. Interviewees were purposively sampled for maximum variation to cover a broad range of personal and professional factors, and experiences during the COVID-19 pandemic, including redeployment. MethodsNurses participated in qualitative in-depth narrative interviews after the first wave of COVID-19 in July 2020 (n = 27) and again at the beginning of the second wave in December 2020 (n = 25) via video and audio platform software. Rigorous qualitative narrative analysis was undertaken both cross-sectionally (within wave) and longitudinally (cross wave) to explore issues of consistency and change. ResultsThe terms moral distress, compassion fatigue, burnout and PTSD describe the emotional states reported by the majority of interviewees leading many to consider leaving the profession. Causes of this identified included care delivery challenges; insufficient staff and training; PPE challenges and frustrations. Four themes were identified: (1) ‘Deathscapes’ and impoverished care (2) Systemic challenges and self-preservation (3) Emotional exhaustion and (4) (Un)helpful support. ConclusionsNurses have been deeply affected by what they have experienced and report being forever altered with the impacts of COVID-19 persisting and deeply felt. There is an urgent need to tackle stigma to create a psychologically safe working environment and for a national COVID-19 nursing workforce recovery strategy to help restore nurse's well-being and demonstrate a valuing of the nursing workforce and therefore support retention.

Understanding the value of a PhD for post-doctoral registered UK nurses: A survey.

AimsThis study investigated, ‘What is the perceived value of a PhD to doctoral and postdoctoral nurses in the UK?’BackgroundLittle is known about what happens to the careers of nurses who undertake a doctorate and whether they use these skills in the next career steps.MethodsNurses (n = 47) with doctorates were recruited via professional networks and twitter (@NMAHP_DoctorateStudy). Qualitative responses from the nurses were analysed using thematic analysis.ResultsThree themes emerged from qualitative analysis: impact on career, utilization and value, and impact on self.ConclusionsThis study provides one of the few insights into how doctoral trained nurses understand and experience the value and utility of their studies to themselves and others.Implications for nurse managementNurse managers can play a crucial role in generating a research‐led culture within their clinical setting. This would include promoting an understanding of research as something directly related to patient benefit rather than an abstract, intellectual activity.

Obesity and Diet Predict Attitudes towards Health Promotion in Pre-Registered Nurses and Midwives.

Nurses and midwives are integral to public health promotion; in the UK, they are advised to act as role models by their governing body, but overweight or obesity rates are high. We explored whether obesity and dietary habits are related to attitudes towards healthy role modelling and health promotion practice. A total of 346 pre-registered UK nurses and midwives (92.6% female; 18–53 years) completed an online survey. Items included body composition, dietary habits assessed by the Lifestyle Behaviour Questionnaire (LBQ), attitudes towards being role models for health (RA: role attitudes) and attitudes toward health promotion practice (ATHPP): 33.8% of the sample self-reported as overweight or obese; 67.6% did not consume 5-a-day portions of fruit/veg; 31.5% reported a healthy diet; and 89.6% believed their diet could be healthier. Positive RA was significantly linked to health promotion engagement (HP) (ß = 0.33, p < 0.001). Positive ATHPP was significantly predicted by lower BMI (ß = −0.08, p = 0.078), positive RA (ß = 0.67, p < 0.001), lower HP (ß = −0.25, p < 0.001) and male gender (ß = 0.09, p = 0.02). Greater confidence in patients valuing healthcare professional’s advice was predicted by healthier diet (ß = 0.11, p = 0.03), lower BMI (ß = −0. 16, p < 0.01), more positive RA (ß = 0.14, p < 0.01) as well as HP engagement during training (ß = 0.20, p < 0.01). One’s own motivation to promote health, similarly to ATHPP, was predicted by RA (ß = 0.17, p = 0.001) and previous HP engagement (ß = 0.39, p < 0.001). Findings show that overweight and obesity are prevalent in pre-registered nurses and midwives; the majority did not consume a healthy diet. Individual’s body composition, diet and attitudes towards role modelling are positively associated with their attitudes towards, and confidence in, health promotion practice. Experiences of health promotion practice during training can have either a positive or a negative influence on attitudes. Mentors and educators could actively promote healthy lifestyles for pre-registered nurses and midwives and facilitate more opportunities for health promotion practice during placements, which includes time for reflection.

The impact of COVID-19 on the wellbeing of the UK nursing and midwifery workforce during the first pandemic wave: A longitudinal survey study

BackgroundThe specific challenges experienced by the nursing and midwifery workforce in previous pandemics have exacerbated pre-existing professional and personal challenges, and triggered new issues. We aimed to determine the psychological impact of the COVID-19 pandemic on the UK nursing and midwifery workforce and identify potential factors associated with signs of post-traumatic stress disorder. MethodsA United Kingdom national online survey was conducted at three time-points during the first wave of the COVID-19 pandemic between April and August 2020 (T1 and T2 during initial wave; T3 at three-months following the first wave). All members of the UK registered and unregistered nursing and midwifery workforce were eligible to participate. The survey was promoted via social media and through organisational email and newsletters.The primary outcome was an Impact of Events Scale-Revised score indicative of a post-traumatic stress disorder diagnosis (defined using the cut-off score ≥33). Multivariable logistic regression modelling was used to assess the association between explanatory variables and post-traumatic stress disorder. ResultsWe received 7840 eligible responses (T1- 2040; T2- 3638; T3- 2162). Overall, 91.6% participants were female, 77.2% were adult registered nurses, and 28.7% were redeployed during the pandemic.An Impact of Events Scale-Revised score ≥33 (probable post-traumatic stress disorder) was observed in 44.6%, 37.1%, and 29.3% participants at T1, T2, and T3 respectively. At all three time-points, both personal and workplace factors were associated with probable post-traumatic stress disorder, although some specific associations changed over the course of the pandemic. Increased age was associated with reduced probable post-traumatic stress disorder at T1 and T2 (e.g. 41–50 years at T1 odds ratio (OR) 0.60, 95% confidence interval (CI) 0.42–0.86), but not at T3. Similarly, redeployment with inadequate/ no training was associated with increased probable post-traumatic stress disorder at T1 and T2, but not at T3 (T1 OR 1.37, 95% CI 1.06–1.77; T3 OR 1.17, 95% CI 0.89–1.55). A lack of confidence in infection prevention and control training was associated with increased probable post-traumatic stress disorder at all three time-points (e.g. T1 OR 1.48, 95% CI 1.11–1.97). ConclusionA negative psychological impact was evident 3-months following the first wave of the pandemic. Both personal and workplace are associated with adverse psychological effects linked to the COVID-19 pandemic.These findings will inform how healthcare organisations should respond to staff wellbeing needs both during the current pandemic, and in planning for future pandemics.

Learning needs of health visitors and family nurses in the care of preterm infants in Scotland

In Scotland and across the UK, health visitors and family nurses provide ongoing assessment and care for the preterm infant and their family following discharge from hospital. This study demonstrates that health professionals in Scotland feel underprepared for this responsibility and that the causes of are multifaceted. Practitioners highlight areas of concern that will guide educational providers to consider amendments to their curricula or provision of continuing professional development.

Oral care practices in stroke: findings from the UK and Australia

AimsTo examine current practice, perceptions of healthcare professionals and factors affecting provision for oral care post-stroke in the UK and Australia.BackgroundPoor oral care has negative health consequences for people post-stroke. Little is known about oral care practice in hospital for people post-stroke and factors affecting provision in different countries.DesignA cross-sectional survey.MethodsQuestionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing inpatient acute or rehabilitation care post-stroke. The survey was conducted between April and November 2019. Non-respondents were contacted up to five times.ResultsCompleted questionnaires were received from 150/174 (86%) hospitals in the UK, and 120/162 (74%) in Australia. A total of 52% of UK hospitals and 30% of Australian hospitals reported having a general oral care protocol, with 53% of UK and only 13% of Australian hospitals reporting using oral care assessment tools. Of those using oral care assessment tools, 50% of UK and 38% of Australian hospitals used local hospital-specific tools. Oral care assessments were undertaken on admission in 73% of UK and 57% of Australian hospitals. Staff had received oral care training in the last year in 55% of UK and 30% of Australian hospitals. Inadequate training and education on oral care for pre-registration nurses were reported by 63% of UK and 53% of Australian respondents.ConclusionUnacceptable variability exists in oral care practices in hospital stroke care settings. Oral care could be improved by increasing training, performing individual assessments on admission, and using standardised assessment tools and protocols to guide high quality care. The study highlights the need for incorporating staff training and the use of oral care standardised assessments and protocols in stroke care in order to improve patient outcomes.

Student Nurses Undertaking Acute Hospital Paid Placements during COVID-19: Rationale for Opting-In? A Qualitative Inquiry.

The research aim was to evaluate the rationale of undergraduate final-year student nurses to undertake paid clinical placements during COVID-19 (Wave 1). The nursing profession reacted innovatively to meet demands placed on the National Health Service during COVID-19. Temporary changes to professional regulation enabled final-year United Kingdom nursing students to voluntarily undertake paid placements in the National Health Service. Neither full-time employees nor full-time students, volunteers undertook a unique hybrid role bolstering the front-line health workforce. Using reflective qualitative inquiry, 17 volunteers evaluated reasoning for entering practice in acute hospitals. Online surveys based around the UK Nursing and Midwifery Council Competency Framework (NMC 2012) were completed weekly for 6 weeks. Data were thematically analysed. Six themes were identified, including sense of duty, and opting-in or out. These highlighted the importance of collaboration and the tripartite relationship between University, host and student during placement, and the influence of these on the learning experience. Several significant insights emerged for nurse education and curricula during pandemics related to patient safety, safety climate and governance. The insights were used to develop a “Student Nurses Placement Framework” with recommendations for Pre-During-Post placement, offering a guide for future nursing workforce recruitment and retention.

Does oral care knowledge amongst UK nurses effectively support people with intellectual disabilities across their lifespan?

Purpose Poor oral health can negatively impact on the overall health of an individual. Evidence highlights nurses' misgivings about providing oral care. Method Several articles were sourced across three clinical databases and four 'core' papers were critiqued using CASP. Findings A literature review identified two areas which require service improvement: 1) Co-presented oral care training should be delivered to staff teams, incorporating material which is developed in collaboration with allied health and social care professionals; 2) Dental teams should be included in the production of care plans for people with a learning disability. Conclusions Indications of ritualistic practice remain in UK nurses' approach to oral care. Daily issues faced by staff teams and the voices of people with a learning disability are under-represented. Training and integrated care planning could significantly improve oral health outcomes for people with a learning disability. Editor's note: 'Nurse' and 'nurses' refers to general (medical) nurses in this article rather than dental nurses.

Emergency management of neck stoma patients during the coronavirus pandemic: a national nurse survey.

Neck stoma patient care involves significant clinical complexity. Inadequate staff training, equipment provision and infrastructure have all been highlighted as causes for avoidable patient harm. To establish the perception of knowledge and confidence levels relating to the emergency management of neck stomas among UK nurses during the COVID-19 pandemic. A nationwide prospective electronic survey of both primary and secondary care nurses via the Royal College of Nursing and social media. 402 responses were collated: 81 primary care and 321 secondary care; the majority (n=130) were band 5. Forty-nine per cent could differentiate between a laryngectomy and a tracheostomy; ENT nurses scored highest (1.56; range 0-2) on knowledge. Fifty-seven per cent could oxygenate a tracheostomy stoma correctly and 54% could oxygenate a laryngectomy stoma correctly. Sixty-five per cent cited inadequate neck stoma training and 91% felt inclusion of neck stoma training was essential within the nursing curriculum. Clinical deficiencies of management identified by nurses can be attributed to a lack of confidence secondary to reduced clinical exposure and education.

Florence Nightingale's legacy on the role of men in community nursing.

Florence Nightingale is credited with reforming the profession of nursing, and her teachings allowed nursing to be perceived as an almost exclusively female career. However, the long history of men's role in nursing before Nightingale is frequently ignored. Males currently account for one in ten UK nurses, with that figure even less in community nursing, and the ones present receive differential treatment when it comes to hiring and promotion, career opportunities, and stigma associated with gender perceptions. This article attempts to gain a better understanding of the problems that face workforce planning with regards to the lack of men in community nursing.

The Effect of UK Nursing Policy on Higher Education Wound Care Provision and Practice: A Critical Discourse Analysis.

In the United Kingdom, significant ongoing inconsistency exists in wound care nursing education provision and practice. Health economists have identified this to be a major cause of the burgeoning economic and personal cost of successfully, and equitably, healing chronic wounds. While numerous wound care educational resources exist, policies intended to implement a program of reform or change are for some reason not filtering down to, or being implemented by, those who need them most. Policy making processes do not appear to be operating as efficiently as they should, and this merits further scrutiny. A critical discourse analysis of two UK professional body wound care policies provided an innovative insight into the effect of policy production to the research problem. The overarching construct of “Aspiration and Resolution” and its subconstructs were identified. Links between data, analysis, and conclusions were established using Greckhamer and Cilesiz’s (2014) framework to address criticisms over lack of transparency in critical discourse analysis methodology. Findings indicate wound care policy makers must adopt an active, not passive, approach to policy making. An active position, compared with the inertia that appears to currently exist, would take into consideration the capacity to implement policy and not merely increase awareness or disseminate. Wound healing policy making agencies need to make decisions on how to disseminate and implement policy. Active policy making would also adopt target audiences’ decisions to implement policy, instigate activities to improve knowledge and skills, facilitate change, and ensure continued use of policy as part of organizational operations.

Major new survey of care home leaders confirms severe impact of COVID-19

The Queen's Nursing Institute, the world's oldest nursing charity, has published a major new report on the effect of the COVID-19 pandemic on the UK's nursing and residential homes.

Making an impact in healthcare contexts: insights from a mixed-methods study of professional misconduct

ABSTRACT The scarcity of public sector healthcare resources and the vulnerability of service users make the conduct of health professionals critically important. Health regulators, in delivering their core objective of patient protection, use empirical evidence to identify professionals’ misconduct, improve their understanding of why misconduct occurs, and to maximize the effectiveness of regulatory actions that safeguard public trust in the healthcare system. This paper outlines the contribution of comparative academic analysis of three professions in the UK (doctors, nurses & midwives, and allied health professions) based on 6714 individual cases of professional misconduct. Three dynamic strands of ongoing impact are identified: “dialogue”, that creates an international multi-stakeholder community of interest; “knowledge generation”, which advances conceptual and empirical understanding of counterproductive work behaviour through sequential quantitative and qualitative study; and “dissemination”, where practical learning is utilized by regulators, employers and other academics.

How does COVID-19 impact treatment decision-making for clinicians in localised kidney cancer.

How does COVID-19 impact treatment decision-making for clinicians in localised kidney cancer.

Levels of resilience, anxiety and depression in nurses working in respiratory clinical areas during the COVID pandemic

BackgroundThe delivery of healthcare during the COVID pandemic has had a significant impact on front line staff. Nurses who work with respiratory patients have been at the forefront of the pandemic response. Lessons can be learnt from these nurses’ experiences in order to support these nurses during the existing pandemic and retain and mobilise this skilled workforce for future pandemics. MethodsThis study explores UK nurses’ experiences of working in a respiratory environment during the COVID-19 pandemic. An e-survey was distributed via professional respiratory societies; the survey included a resilience scale, the GAD7 (anxiety) and the PHQ9 (depression) tools. Demographic data was collected on age, gender, ethnicity, nursing experience and background, clinical role in the pandemic, and home-life and work balance. ResultsTwo hundred and fifty-five responses were received for the survey, predominately women (89%, 226/255), aged over 35 (79%, 202/255). Nearly 21% (40/191) experiencing moderate to severe or severe symptoms of anxiety. Similar levels are seen for depression (17.2%, 31/181). 18.9% (34/180) had a low or very low resilience score.Regression analysis showed that for both depression and anxiety variables, age and years of qualification provided the best model fit. Younger nurses with less experience have higher levels of anxiety and depression and had lower resilience. ConclusionThis cohort experienced significant levels of anxiety and depression, with moderate to high levels of resilience. Support mechanisms and interventions need to be put in place to support all nurses during pandemic outbreaks, particularly younger or less experienced staff.