Spiritual Dimensions of Nurse Practitioner Consultations in Family Practice.

Purpose of Study: To explore the spiritual dimensions of nurse practitioner consultations in primary care through the lens of availability and vulnerability. Design of Study and Methods Used: A hermeneutic phenomenological enquiry exploring the spiritual dimensions of primary care consultations consisting of two interviews per participant over an 18-month period was conducted with nurse practitioners in the United Kingdom. A purposive sample of eight nurse practitioners were recruited and interviewed. Interviews were fully transcribed and analyzed thematically. Findings: Participants identified that spirituality can be difficult to conceptualize and operationalize in practice. Participants articulated the meaning of spirituality and gave examples of when they had witnessed a spiritual dimension in practice. Key themes included how nurse practitioners conceptualize spirituality, the context for spirituality to be integrated into care, and the importance of spirituality as an aspect of holistic care. The concepts of Availability and Vulnerability were used intentionally as a lens in the study to explore whether these concepts and approaches to practice could enhance integration of spirituality into practice. Conclusion: Knowledge and understanding regarding spirituality in nurse practitioners consultations in primary care has been uncovered. A framework for operationalizing spirituality has been developed.

Effective involvement: a report on the evaluation of a research awareness training package for public involvement in health research.

BACKGROUND: As the role of Patient and Public Involvement contributors expands to all stages of the research cycle, there is increasing demand for training that meets the needs of this diverse population. To help meet this demand the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Yorkshire and Humber, worked with members of the public to develop a bespoke training package. The University of Huddersfield's Public Partnership Group were invited to host the training and undertake an independent evaluation. METHODS: Participatory action research was used to structure the evaluation, such that participants in the training and public members of the evaluation team were co-collaborators with a robust, significant and visible share in the process. This is evidenced by public team members' roles in undertaking the majority of data gathering, including surveys, non-participant observation and interviews, and analysis, engaging in all reflective discussions, leading on producing a formal report and contributing significant sections of this paper.The evaluation was approved by a University ethics panel.Public involvement consisted of the 13 participants who received the training, and 3 of the 6 members of the evaluation team. Data collection took place between November 2017 and March 2018. RESULTS: The evaluation found that participants understood more about the research process from attending the training, gaining greater confidence in their ability to volunteer to get involved. It also highlighted the difficulties of meeting the training needs of a diverse group with varying experiences and expectations. Skilful facilitation was needed to maintain pace, whilst engaging people with different levels of interest and knowledge. The management of the environment to maximise comfort and involvement was important. Early feedback to the delivery team enabled timely updating of the package.Involvement in the evaluation was initially daunting for the three public members of the team, but hugely enjoyable and fulfilling, as well as enriching the process and outcomes. In particular, public involvement in the analysis and interpretation stages increased the authenticity of the evaluation findings. CONCLUSIONS: This evaluation validated the training package and demonstrated the value and impact of Public Involvement at all levels in research.

Humanitarian nursing with Médecins Sans Frontières: Foregrounding the listening guide as a method for analysing oral history data.

AIMS: To demonstrate how the listening guide contributed to oral history data analysis. To better understand the continuing inclination of nurses to engage in humanitarian work, foregrounding the nurses' lives. BACKGROUND: The voice-centred relational method or listening guide is a method of qualitative data analysis used to analyse oral history data. DESIGN: A conventional approach to oral history interviews was adopted; intervention into the "flow" of participants' narrative was kept to a minimum. A small number of prompts, how they came into nursing, recruitment to, life with and since Médecins Sans Frontières, were used. METHODS: Oral history interviews were conducted with seven nurses who had worked for Médecins Sans Frontières. Interviews were digitally recorded. This paper will demonstrate the application of the listening guide to historical data analysis and critique its applicability and value. The listening guide advocates four readings (listenings) of the text. Firstly, locating the plot in the narrative; secondly, actively listening for the use of "I?" ("we", or "you"), the "self" in context of the story being told and "I poem" development; thirdly, listening for relationships and finally, locating accounts in relation to wider social, political and societal contexts. RESULTS: Analysis revealed: "becoming", "being" and "leaving" Médecins Sans Frontières as chronological thematic areas. At one extreme creating "I poems" foregrounded individual voices while cross-referencing to contemporaneous records of world events locates this in an International context. CONCLUSION: It is argued that subjecting historical data to the listening guide can enable legitimate, creative exploration and analysis of data.

Evaluating service user pedagogy in UK higher education: Validating the Huddersfield Service User Pedagogy Scale.

BACKGROUND: There is global recognition that the inclusion of service users in the education of health and social care students in higher education can lead to more compassionate professional identities which will enable better decision making. However, to date there is no systematic tool to explore learning and service user involvement in the curriculum. OBJECTIVES: To generate and validate a psychometric instrument which will allow educators to evaluate service user pedagogy. DESIGN: Construction and validation of a new scale. PARTICIPANTS AND SETTINGS: 365 undergraduate students from health and social care departments in two universities. RESULTS: A two correlated factor scale. Factor 1 - perceived presence of service users in the taught curriculum and factor 2 - professionals and service users working together (correlation between factor 1 and factor 2 - r = 0.32). CONCLUSIONS: The Huddersfield Service User Pedagogy Scale provides a valid instrument for educators to evaluate student learning. In addition, the tool can contribute to student reflections on their shifting professional identities as they progress through their studies.

Nurses' contributions to the resolution of ethical dilemmas in practice.

BACKGROUND: Complex and expensive treatment options have increased the frequency and emphasis of ethical decision-making in healthcare. In order to meet these challenges effectively, we need to identify how nurses contribute the resolution of these dilemmas. AIMS: To identify the values, beliefs and contextual influences that inform decision-making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice. DESIGN: An interpretive exploratory study was undertaken, 11 registered acute care nurses working in a district general hospital in England were interviewed, using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification. Participants and context: Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis. Ethical considerations: Ethical approval was obtained from the local National Research Ethics Committee. FINDINGS: Four major themes emerged: 'best for the patient', 'accountability', 'collaboration and conflict' and 'concern for others'. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single-site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas. DISCUSSION: Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision-making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro- and micro-decision-making. CONCLUSION: Nurses' professional relationships are central to nurses' contributions to the resolution of ethical dilemmas.

Preparing disabled students for professional practice: managing risk through a principles-based approach.

AIM: A discussion exploring the ways disabled students are managed in practice settings. It proposes and argues for morally and legally viable principles to guide risk assessment and inclusive decision-making in practice. BACKGROUND: Equality law means that universities are bound not to discriminate against students on the basis, amongst other things, of disability. As a consequence in the UK, there is a perceived increase in numbers of disabled people applying for and succeeding as health professionals. Whilst placement providers are equally obliged by the law to have inclusive policies, competing needs including patient safety, public confidence and professional regulations mean that adjustments that can be made in an educational environment to appropriately support student learning may prove to be more difficult in placements that provide direct care to the public. DATA SOURCES: This discussion is an outcome of recommendations from published research by the authors and their research partners. It is supported by related literature, critical debate amongst academics, disabled students and disabled and non-disabled practitioners. IMPLICATIONS FOR NURSING: Ensuring a nursing workforce that mirrors the diversity of the population it serves is of universal importance. Effective management of disabled students can contribute to achieving this goal and to promoting a positive view of disabled practitioners. CONCLUSION: Legislation is necessary to protect disabled people from discrimination. To respect this legislation, when preparing nurses and other health professions, a clear understanding of the law and a principles-based approach to guiding risk is important.

Story in health and social care.

This paper offers a brief consideration of how narrative, in the form of people's own stories, potentially figures in health and social care provision as part of the impulse towards patient-centred care. The rise of the epistemological legitimacy of patients' stories is sketched here. The paper draws upon relevant literature and original writing to consider the ways in which stories can mislead as well as illuminate the process of making individual treatment care plans.

Aesthetic, emotion and empathetic imagination: beyond innovation to creativity in the health and social care workforce.

The Creativity in Health and Care Workshops programme was a series of investigative workshops aimed at interrogating the subject of creativity with an over-arching objective of extending the understanding of the problems and possibilities of applying creativity within the health and care sector workforce. Included in the workshops was a concept analysis, which attempted to gain clearer understanding of creativity and innovation within this context. The analysis led to emergent theory regarding the central importance of aesthetics, emotion and empathetic imagination to the generation of creative and innovative outcomes that have the capacity to promote wellbeing in the health and social care workforce. Drawing on expertise in the field, this paper outlines the concept analysis and subsequent reflection.

The under-used resource of historical research.

Nurse educationalists in Britain face the charge that the system is no longer producing nurses who are competent when they qualify. Research into these issues led to an historical approach, using life story and documentary analysis, to understanding how nurses from the 1940s and 1950s talked about nursing. This article by Janet Hargreaves considers the value of such an approach and argues that an understanding of how nursing was crafted in the past illuminates the present.

So how do you feel about that? Assessing reflective practice.

Despite a lack of evidence base, reflective practice remains a central feature of education for many professional groups. In addition, current trends in learning, teaching and assessing require a robust alignment between learning outcomes and assessed course work [Active Learning Higher Educat. 2 (2002) 145)]. Varied definitions of what it means to be a 'reflective practitioner' and limited research make it difficult to know how and what to assess [Reflective Practice in Nursing, Blackwell Science]. Assessment of reflective practice frequently requires students to recount narratives about their practice and both formative feedback and assessment criteria make it clear that such narratives must demonstrate the students' application of appropriate and safe professional practice. This paper suggests that only three 'stories' are legitimate and identifies these as 'valedictory' 'condemnatory' and 'redemptive' This conclusion drawn is that the imperative to do well academically discourages students from engaging in honest and open reflection. This being the case, it may be argued that the assessment of reflective practice is a potential barrier to the personal growth and integrity that programmes are trying to nurture.