Exploring the application and significance of case study research in nursing.

BACKGROUND: Case study research (CSR) has gained popularity across disciplines due to its ability to provide detailed insights into specific phenomena. AIM: To explore the philosophy and methodology of CSR, drawing from notable authors who have contributed to its development. DISCUSSION: This article discusses the characteristics of CSR in terms of design and method in both quantitative and qualitative approaches. It examines CSR's advantages and disadvantages as a research method. It draws on two example case studies to emphasise the use of CSR for exploring complex healthcare and social care settings. CONCLUSION: CSR has proven valuable in nursing research for investigating complex clinical problems, patient-care scenarios, and organisational dynamics and phenomena. IMPLICATIONS FOR PRACTICE: CSR provides a methodological framework for nursing research that offers a unique lens for exploring multifaceted, complex issues. This ultimately improves patient care outcomes.

Menopause at work-An organisation-based case study.

AIM: The aim of the study was to explore and understand the organizational culture of a workplace in terms of support and well-being for staff experiencing perimenopausal and menopausal symptoms at work. DESIGN: It is widely acknowledged that perimenopause and menopause symptoms are experienced by a large percentage of the female workforce. There is a lack of research into how nurses are supported through menopause (Cronin et al. Issues in Mental Health Nursing, 42, 2021, 541-548). The perimenopause and menopause transition can be a challenging time where many may require symptom management and support (RCN, The Menopause and Work: Guidance for RCN Representatives, 2020). This paper presents a case study research (CSR) approach to examine one healthcare organization. METHODS: CSR design was used: A survey distributed to all staff employed, a review of the available documentation on menopause and interviews with managers from different levels of the organization. The COREQ consolidated criteria was used for reporting the qualitative research reported this study. RESULTS: The case study generated both quantitative and qualitative data using surveys, interviews and documentation. Data from the organization (n = 6905) showed a majority female workforce of 81.9% with 40.6% aged between 41 and 55 years old, meaning a third of the organization working through perimenopause and menopause. Survey responses (n = 167) collected biographical and psychometric data on the prevalence of perimenopausal and menopausal symptoms. Seven managers were interviewed highlighting two themes: Access to support and culture of menopause and 13 documents from the organization on menopause were analysed for content. The study design permitted an iterative approach to data collection and providing an in-depth understanding of the needs and support for those experiencing perimenopause and menopause. The findings help healthcare organizations to understand their workforce and take in to account the larger numbers of female employees particularly nurses with the need to provide person-centred support mechanisms and an organizational approach for all employees.

Exploring digital interventions to facilitate coping and discomfort for nurses experiencing the menopause in the workplace: An international qualitative study.

INTRODUCTION: The global nursing workforce is predominantly female, with a large proportion working in the 45-55 age group. Menopause is a transition for all women, and; therefore needs recognition as it can impact work performance and consequently staff turnover. BACKGROUND: Women will go through the menopause, but not all women are affected. The menopause transition presents a range of signs and symptoms both physical and psychological which can impact the quality of life and individuals' work/life balance. The nursing workforce is predominantly women that will work through the menopause transition. OBJECTIVES: The study explored perspectives on digital health interventions as strategies to support menopausal women and to understand the requirements for designing health interventions for support in the workplace. DESIGN: A qualitative explorative design. SETTINGS: Nurses working in a range of clinical settings in England, Finland, Denmark, New Zealand, Australia and USA. METHODS: Nurses (n = 48) participated in focus groups from six different countries from February 2020-June 2022 during the pandemic from a range of acute, primary care and education settings. Nurses were invited to participate to share their experiences. Thematic analysis was used. RESULTS: All participants were able to describe the physical symptoms of menopause, with some cultural and possible hemisphere differences; more noticeable was the psychological burden of menopause and fatigue that is not always recognized. Four themes were identified: Managing symptoms in the workplace; Recognition in the workplace; Menopause interventions; and Expectation versus the invisible reality. These themes revealed information that can be translated for implementation into digital health interventions. CONCLUSIONS: Managers of nursing female staff in the menopausal age range need greater awareness, and menopause education should involve everyone. Finally, our results demonstrate design attributes suitable for inclusion in digital health strategies that are aligned with likely alleviation of some of the discomforts of menopause. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Nursing students' experiences of, and socialisation in, dementia care in the acute hospital setting.

BACKGROUND: An ageing population with a range of co-morbidities means the number of hospital admissions of older people with dementia is increasing. People with dementia can find acute hospital settings unsettling and they need to be cared for by a workforce skilled and knowledgeable in dementia care. AIM: To explore nursing students' experiences of, and socialisation in, dementia care in the acute hospital setting in England through a secondary qualitative analysis of data from a phenomenological study of nursing students' cultural beliefs around, and understanding of, dementia. METHOD: Data from ten focus groups with 81 undergraduate nursing students at two universities in the south of England were subjected to content analysis. This was a secondary qualitative analysis of data retrieved from an earlier study. FINDINGS: Two categories emerged: 'exposure to dementia care' and 'socialisation in dementia care'. Participants often felt unprepared to care for patients with dementia and their experiences were negatively affected by staff's views of patients with dementia, who were often considered challenging to manage. Participants also encountered specialist dementia nurses who enabled them to learn more about person-centred dementia care. CONCLUSION: Optimal dementia care knowledge and skills can contribute to enhanced patient outcomes and positive attitudes towards older people's care. To reduce deficits in dementia care education, nurses need regular continuing professional development in dementia care, higher education institutions need to commit to developing dementia care in their curricula, and students need to be socialised in dementia care earlier during undergraduate nurse education.

Using Digital Health Technologies to Manage the Psychosocial Symptoms of Menopause in the Workplace: A Narrative Literature Review.

Many women experience vasomotor, psychosocial, physical and sexual symptoms during their menopausal life-stage. Specifically, the psychosocial symptoms of menopause can include loss of confidence, issues with self-identity and body image, inattention and loss of memory, increased levels of stress, and a higher risk of developing anxiety and depression. In the workplace, such symptoms can impact the woman's capacity to perform to her optimal levels. Even so, many women do not seek help to manage their symptoms due to feelings of embarrassment, the possibility of experiencing adverse reactions from others, or the cultural taboos that are attached to the condition.Digital health technologies, including virtual consultations, therapeutic interventions, and participation in online communities of support, provide an important means by which women can obtain information about menopause. In the field of mental health, digital technologies have an increasing evidence base. This paper considers how mental health practitioners can adapt, utilise or recommend digital health strategies to support older women in occupational settings to manage their psychosocial symptoms of menopause.

The Development and Evaluation of an Analytical Framework to Explore Student Nurses' Cultural Beliefs of Dementia.

BACKGROUND: People diagnosed with dementia need culturally sensitive, person-centered care to promote their health and well-being. Therefore, healthcare professionals should be able to provide culturally competent care, of which an element is the understanding of their own cultural heritage and how this impacts on their beliefs regarding dementia, as cultural norms and values provide meanings and understanding of chronic conditions such as dementia. This study used focus groups to explore the cultural beliefs of student nurses regarding dementia, generating a large set of qualitative data that required structure and a framework to analyze. PURPOSE: One purpose of this article was to present the methodological analysis, which encompasses the analytical framework. The second purpose was to apply the framework to elicit the cultural beliefs regarding dementia among student nurses from multiple national backgrounds. METHODS: Focus groups with student nurses from five higher education institutes in England, the Philippines, Slovenia, and New Zealand were conducted, audiotaped, and transcribed verbatim. The qualitative data were analyzed using the framework method of analysis. Data from the focus groups conducted at the two higher education institutes in England were analyzed by encompassed synthesizing, refining, and agreeing on the codes, categories, and themes that were established separately by four researchers. The developed analytical framework was then tested on the qualitative data obtained from the focus groups conducted in Slovenia, the Philippines, and New Zealand. RESULTS: The results were presented in three parts: the cultural analytical framework, the process of developing the initial categories/themes, and the final themes that emerged from the data obtained from the focus groups. CONCLUSIONS: An analytical framework was developed and applied to understand student nurses' cultural values and beliefs of dementia.

Using the Relating to Older People Evaluation tool to measure ageism in higher education.

BACKGROUND: The global population is ageing and this trend is expected to continue. Attitudes towards older people differ worldwide. Ageism is a complex, multifaceted concept that includes attitudes and behaviours. In the UK, ageism and discriminatory practices exist in nursing, and educationalists and clinicians need to address ageist attitudes and promote the care of older people. In nursing there is a lack of synthesised evidence measuring ageism among nursing students. AIM: To explore the use of the Relating to Older People Evaluation (ROPE) questionnaire in different student populations in higher education, including nursing students. METHOD: A systematic search was conducted for articles written in English describing the use of ROPE, published between 2007 and 2017. Six quantitative studies were identified that met the inclusion criteria. Statistical analysis was not possible and a thematic analysis of these studies was completed. FINDINGS: Two themes emerged: attitudes predict behaviour and socialisation to ageism in higher education. Ageist attitudes were correlated with negative ageist behaviours and the socialisation of nursing students in clinical practice increased ageist attitudes. CONCLUSION: Ageism and the ageist attitudes of nursing students must continue to be explored. ROPE is a suitable tool to measure nursing students' ageist attitudes and behaviours.

Nursing students' cultural beliefs and understanding of dementia: A phenomenological study across three continents.

BACKGROUND: Migrant nurses have reported difficulties adapting to their new culture and providing culturally sensitive care for people with dementia. However, to date no studies have explored the impact of student nurse's cultural heritage on their beliefs and understanding of dementia. OBJECTIVES: To explore the cultural beliefs of dementia of student nurses studying in England, Slovenia, Philippines and New Zealand. DESIGN: An explorative hermeneutic phenomenology design. SETTINGS: Higher Education Institutes delivering undergraduate nursing education in England (University of Greenwich and University of Essex), Slovenia (Angela Boskin Faculty of Health Care), New Zealand (University of Auckland), and the Philippines (University of Silliman). PARTICIPANTS: Student nurses studying nursing in England (n = 81), Slovenia (n = 41), Philippines (n = 53) and New Zealand (n = 6). Participants from England and New Zealand were from diverse cultural backgrounds. Student nurses at the beginning of their studies (n = 100) and towards the end of their studies (n = 81) participated. METHODS: Completion of focus groups (n = 23), in England (n = 10), Slovenia (n = 6), Philippines (n = 6), and New Zealand (n = 1). All focus groups were audio recorded and transcribed verbatim. Data was analysed by applying an inductive theoretical approach of the Framework Method, which supports the generation of themes through open unhindered coding, pinpointing, examining, and recording patterns within the data. RESULTS: Two major themes were identified in the data: familial piety and dementia discourse. Familial piety emerged from the importance of family and caring for family members with dementia, subthemes included: 'my granddad': familial experience, and 'better to be with her': familial home. Dementia discourse emerged from the terminology student nurses applied, such as: 'preconceptions and misconceptions' of aggression, and 'considered crazy' stigma of dementia due to a lack of awareness. CONCLUSIONS: The cultural heritage of student nurses impacted on their beliefs of dementia; however their understanding of the needs, care and support of a person with dementia changed and developed through clinical experience and education.

'Poetry in motion' a place in the classroom: Using poetry to develop writing confidence and reflective skills.

BACKGROUND: Non-traditional students entering nursing programmes at university often experience difficulties with the academic literacy requirements of their courses, in particular academic and reflective writing. Levels of student anxiety may also be affected by other issues including the pressures of managing work, family and study commitments. OBJECTIVES: To explore how classroom-based poetry writing activities might support students in developing their skills as student-writers and reflective practitioners. DESIGN: A qualitative approach was employed to explore emergent themes in students' poems and students' reactions to creative writing teaching strategies. SETTING: A university based in the South East of England. PARTICIPANTS: A cohort of 25 students undertaking a Health Science Foundation Degree. METHODS: Data collected from student poems were analysed thematically using the framework of Braun and Clarke (2006). RESULTS: Students found the experience of writing poetry challenging at first, but ultimately rewarding. Compared with writing more formal academic reflections, many students valued the opportunity to express their emotions and experiences more freely. Analysis of the student poems also revealed a rich bank of data relating to key professional themes and students' lived experiences. CONCLUSIONS: Poetry writing helps students to develop writing craft and reflective skills. It encourages students to articulate often complex emotions associated with their professional worlds, thereby providing invaluable insights into the everyday lives of healthcare workers. This paper should provide others working in nursing education with a deeper understanding of possible benefits of incorporating poetry writing into the curriculum.

The intersection of culture in the provision of dementia care: A systematic review.

AIMS AND OBJECTIVES: To understand the intersection of healthcare professionals' and care workers' culture and their provision of person-centred care for people with dementia. BACKGROUND: Due to the nature of global immigration and recruitment strategies, health care is provided by a culturally diverse workforce. Consequently, there is a need to understand healthcare professionals' and care workers' cultural values of illness, disease and dementia. Cultural values and beliefs regarding dementia and care of the older person differ, and currently, there is a lack of clarity regarding the intersection of culture in the provision of person-centred dementia care. METHOD: A search of the following databases was completed: Medline, CINAHL, Psychology and Behavioural Sciences, PsycINFO and PubMed for papers published from 1st January 2006 to 31st July 2016. RESULTS: A total of seven qualitative studies met the inclusion and exclusion criteria, all explored the impact of healthcare professionals' and care workers' culture in relation to their provision of person-centred dementia care. A meta-synthesis of the data from these studies identified four themes: cultural perceptions of dementia, illness and older people; impact of cultural perceptions on service use; acculturation of the workforce; and cross-cultural communication. CONCLUSION: Limited evidence was found on the impact of healthcare professionals' and care workers' culture on their provision of person-centred dementia care. The intersection of culture and dementia included the understanding of dementia, care and family roles. Acculturation of migrant healthcare workers to the culture of the host country, workplace, and support with the communication was identified as necessary for the provision of person-centred dementia care. RELEVANCE TO CLINICAL PRACTICE: Open access education and training to support communication is required, alongside the development of robust interventions to support the process of acculturation of migrant healthcare professionals and care workers to provide culturally competent person-centred dementia care.

Using case study research as a rigorous form of inquiry.

AIM: To describe how case study research (CSR) was used inductively as an all-encompassing theoretical framework to examine learning in the workplace. BACKGROUND: Case study research is a method with strong philosophical underpinnings which provides a framework for exploratory research in real-life settings ( Yin 2009 ). DATA SOURCES: A study of five students' experiences of learning in healthcare environments to explore real-life contexts over the course of two years. The study was rich with empirical data, offering a pragmatic framework for learning in the workplace. REVIEW METHODS: Observations, interviews and documents were used. DISCUSSION: As a result of using CSR, the findings were analysed systematically and rigorously. Using multiple methods verified data and strengthened the significance of the findings. CONCLUSIONS: This paper focuses on the strengths of using the CSR methodology. CSR embraces qualitative research methods in a rigorous and systematic manner. CSR has been applied to one example of research, addressing each step of the research protocol to use CSR to its full potential. IMPLICATIONS FOR PRACTICE/RESEARCH: CSR enables real-life settings to be studied systematically and rigorously, offering examples of practice in nursing and education.

Why does A&E attract newly qualified registered nurses?

Workforce planning is a particular buzzword that nurse managers must grapple with and now must understand. They must develop strategies to ensure the life and growth of a department while incorporating numerous government targets to ensure the service reaches quality, achieves and meets predetermined goals. To do all this that manager needs a workforce. The recruitment of nursing staff to a specialist area such as Accident & Emergency (A&E) requires a level of creativity and sustained effort. Newly qualified registered nurse working in A&E have, in the past, been considered to be an unusual group of staff to apply to work in A&E. However, many health service managers receive applications from staff in this category and are often encouraged to recruit newly qualified registered nurse's rather than pay for agency workers. Using a qualitative approach this paper explores the key reasons why newly qualified registered nurses choose to work in an Accident & Emergency environment. Data was collected from a sample of 25 newly qualified registered nurses and analysed thematically. Five themes are presented: challenge, teamwork, diversity, support, and learning. These themes have implications for Accident and Emergency units and human resource and workforce planning departments.

First-time mothers - identifying their needs, perceptions and experiences.

The aim of this research was to identify needs, perceptions and experiences of first-time mothers in the postnatal period. Data were collected through focus groups and in-depth interviews from a sample of 13 women, 61% were aged 20 years or less, from an urban city area in Southern Ireland. Through content analysis, key themes were identified relating to birth and hospitalization, support, motherhood and psychological issues. Attendance at antenatal classes was variable and perceptions of being unprepared for birth and motherhood prevailed. Participants appeared shocked at the amount of pain experienced during birth and had little rest during hospitalization. They received physical and emotional support and preparation for childcare from midwives. Breastfeeding, while promoted, by midwives was not acceptable. The 'maternal mother' was key in providing direct childcare, advice and emotional help, support for attendance at school and 'time out' to socialize. Support was reciprocal if the maternal mother had young children. Professional support by public health nurses was well-established. However, emphasis was perceived to be on 'baby's development'. Maternal depression, loneliness, living in homes with limited space and difficulty in 'letting go' of baby care to return to school or work were reported. Implications for antenatal preparation, national policies, motherhood, and the need for further research are discussed.