A scoping review of Q methodology nursing education studies.

OBJECTIVES: The purpose of this review was to examine the characteristics of published Q methodology nursing education studies including the purposes, the methodological variations, and the major implications to inform best practices. DESIGN: Scoping review design using the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews. DATA SOURCES: Academic Search Complete, CINAHL Complete, Education Research Complete, Embase, ERIC, Proquest Nursing and Allied Health, PubMed, PsycInfo, SocINDEX, and the Web of Science Core Collection. REVIEW METHODS: A comprehensive search of English language journal articles was conducted for Q methodology studies published between 2015 and 2020 that used undergraduate nursing students or nursing faculty as participants. Data were extracted using a modified version of the Assessment Review Instrument for Q Methodology. RESULTS: Eighteen studies from five countries met inclusion criteria. The majority were single-site studies and used nursing students as participants. The number of stimuli for sorting in the Q sample ranged from 21 to 60. Study aims fell into three broad domains: attitudes about patient populations or settings (N = 7), perceptions about teaching methods (N = 9), or beliefs about professional/practice issues (N = 2). Seven studies specifically explored simulation. Unique viewpoints discovered ranged from one to five in each study. Findings were used to inform teaching, create curricula, evaluate programs, and to generate more questions for study. Strategies for reporting the Q methodology research steps and findings varied significantly. CONCLUSION: Q methodology is a useful research approach to discover variations in perspectives to inform best educational practices. Use of a standardized flow sheet could enhance reporting the Q methodological approach which may lead to a better understanding and acceptance of the method in the discipline.

Towards safe nurse staffing in England's National Health Service: Progress and pitfalls of policy evolution.

In 2013, a national inquiry into care failings at a large public hospital in England resulted in major healthcare reforms that included targeting policy aimed at ensuring the adequacy of nurse staffing levels on hospital wards within NHS England. This paper uses a review of publicly available documents to provide a contextual account of the evolution of nurse staffing policy development prior to and following the inquiry. We found that securing safe staffing policy has been impacted by caveats and competing policy, evidence gaps, lack of coordination, and the absence of readily implementable solutions. Consequently, five years on, safe staffing policy for NHS England is described in aspirational terms that ascribes accountability to providers, but fails to adequately address barriers to delivery. Kingdon's 'policy windows' model is used to explain why policy, even when driven by strong public concern and with high inter-sector support, may struggle to gain traction when the conditions necessary for success are not present, and in the face of practical or political constraints. The progress and pitfalls encountered are not unique and the experience of safe staffing policy in England may have lessons for other countries grappling with policy development or implementation in this area.

Safe staffing, safe care - every time.

The inaugural director of the Safe Staffing Healthy Workplaces Unit warns of becoming complacent about 'normalisation' of short staffing and onerous workloads in the health system here.

Puzzling practice: a strategy for working with clinical practice issues.

In this paper we aim to share the evolution of innovative ways to explore, 'unpack' and reframe clinical issues that exist in everyday practice. The elements of these processes, which we call 'puzzling practice', and the techniques associated with them, were delineated over a two year period by the four authors using action theory based processes. The authors have evolved several different frameworks for 'puzzling practice' which we draw on and use in our practice development work and in our research practice. This paper pays attention to a particular form of puzzling practice that we have found to be useful in assisting individual clinicians and teams to explore and find workable solutions to practice issues. The paper uses a semi-fictitious example of 'Puzzling Practice' gleaned from our experience as practice development facilitators. In this example 'puzzling practice' uses seven different elements; naming the issue; puzzling the issue; testing the puzzle exploring the heart of out practice; formulating the puzzle question; visualizing the future; and generating new strategies for action. Each of the elements is illustrated by the story and the key foundations and ideas behind each element is explored.

Exploring the value of dignity in the work-life of nurses.

In this paper the authors draw attention to the value of nurse dignity in the work-life of nurses. How does the profession currently understand this as a concept and construct? How might the valuing of worker dignity in the workplace affect the wellbeing of the workforce? A review of nursing literature and a theoretical lens on worker dignity derived from recent work by Hodson (2001) was used to explore these questions. In the context of current and international workforce issues associated with recruitment and retention, analysis of the construct of worker dignity within the profession takes on a strong imperative. The large existing body of research into nursing workplace environments highlights concern that nurses have in understanding and improving work-life quality. Findings of this inquiry reveal that while there is a degree of coherence between the nursing research and elements of Hodson's (2001) research on worker dignity, the dignity of nurses, as a specific construct and as an intrinsic human and worker right has received little explicit attention. Reasons for this may lie partly in approaches that privilege patient dignity over nurse dignity and which rely on the altruism and self-sacrifice of nurses to sustain patient care in environments dominated by cost-control agendas. The value of dignity in the work-life of nurses has been under-explored and there is a critical need for further theoretical work and research. This agenda goes beyond acceptance of dignity in the workplace as a human right towards the recognition that worker dignity may be a critical factor in sustaining development of healthy workplaces and healthy workforces. Directing explicit attention to nurse dignity may benefit the attainment of both nurse and organisational goals. Hodson's (2001) framework offers a new perspective on dignity in the workplace and leads to new insights and a slightly different view of a 'road well travelled' in nursing literature.