Supporting health and wellbeing in health care employees: a documentary review of organizational policies, strategies and frameworks.

Background: Health care workers are crucial for a productive and thriving health care system, yet the health and lifestyle behaviour of key groups within this workforce (for example nurses and healthcare assistants/support workers) is typically poor. The extent of health and wellbeing documents that guide action towards improving their health and wellbeing is unknown. Using one health care system, NHS Scotland, as an example, the aim of this study was to assess the number of NHS health boards with workplace documents focused on health and wellbeing of employees, the quality of these documents and the extent to which they reference lifestyle behaviours, namely physical activity. Methods: Documentary analysis was undertaken on employee health and wellbeing policies (and wider documents). These were sourced through online searches on Google search engine and Freedom of Information Requests sent to all 14 Scottish NHS Health Boards. Titles and content were assessed for relevance to employee health and wellbeing. Content analysis was used to analyse the included documents against eight predefined codes. Results: Thirteen documents were retrieved with 11 of the 14 Health Boards having at least one relevant document. The content varied greatly between documents with regards to how many reported the eight codes and the quality of content within these. Nine documents mentioned physical activity but mainly in relation to current activities rather than in the context of a future healthy workforce. Conclusions: Despite the importance of a healthy, health care workforce, more work is needed to ensure high level documents are able to support these efforts, especially with reference to lifestyle behaviours.

"How will we cope?" Couples With Intellectual Disability Where One Partner Has a Diagnosis of Dementia.

BACKGROUND AND OBJECTIVES: People with intellectual disability are at increased risk of dementia at an earlier age. This is the first study to explore experiences of couples with an intellectual disability when one partner has dementia. RESEARCH DESIGN AND METHODS: Four people with intellectual disability whose partner had dementia and one partner who had both an intellectual disability and dementia took part in narrative life story interviews. One of the interviews was conducted as a couple giving direct perspectives from 4 couples overall. Additionally, 13 semistructured interviews were conducted with 9 social care professionals and 4 family members. This provided perspectives of the relationships of a further 4 couples, which collectively led to data on 8 couples. RESULTS: The emotional impact of a dementia diagnosis, planning for the future, and fear of separation was noted by couples with intellectual disability. Partners took on caring roles thus challenging views of being solely care-receivers. Families spoke of commitment and longevity in relationships, whilst social care staff highlighted how their own information needs changed recognizing the importance of intellectual disability and dementia-specific knowledge. DISCUSSION AND IMPLICATIONS: Couples with intellectual disability continue to enjoy intimate relationships into later life and will face common conditions in older age including dementia. Those who provide support need to ensure that they are sensitive to the previous experience and life story of each couple and have specific knowledge of how dementia can affect people with intellectual disability.

Communication to adult patients undergoing cancer care by non-specialist nurses: a scoping review protocol.

INTRODUCTION: Little is known regarding how non-specialist nurses communicate with patients living with cancer when the patients are receiving care outside of their cancer units/teams. This scoping review aims to identify, examine and report on the currently available evidence about communication by non-specialist nurses when caring for adults living with cancer outside of their cancer care unit/teams. METHODS AND ANALYSIS: A scoping review following the JBI methodology for scoping reviews will be conducted. We will search for empirical studies that meet the inclusion criteria in six databases (MEDLINE, PubMed, CINAHL, Embase, Scopus and PsycINFO). Handsearching in references of included articles will be performed to find additional articles. The population of interest will be non-specialist nurses. Three concepts will be explored, namely (1) all adult patients living with cancer, (2) a focus on three stages of the cancer continuum of care (cancer diagnosis, treatment and survivorship) and (3) a focus on communication between non-specialist nurses and patients living with cancer. We will include studies describing all healthcare settings outside patients' specialised cancer units or oncology teams. After article selection, two reviewers will independently screen titles and abstracts and perform a full-text article review, risk of bias assessments and data extraction. A third reviewer will resolve all disagreements. A narrative summary will provide an overview of how the results relate to the research aims and questions. The included articles will be limited to English and published between 2012 and 2023. ETHICS AND DISSEMINATION: No ethical approval is required since we will use publicly available empirical research sources. This review will provide current research on communication by non-specialist nurses with patients with a cancer diagnosis outside of an oncology setting, evidence that will support effective communication. As such, we aim to disseminate the findings in academic conferences and peer-reviewed journals.

Wearable activity trackers for nurses' health: A qualitative acceptability study.

AIM: To assess the practical, social and ethical acceptability of the use of a POLAR® H7 chest-strap wearable device to influence health behaviours among pre-registered nurses. DESIGN: Qualitative acceptability study including a simulated test of use reported using COREQ guidelines. METHODS: Pre-registered nurses simulated nine nursing tasks while wearing the chest strap in a clinical simulation facility in a Scottish university in 2016. Focus groups and semi-structured interviews were conducted to assess technology acceptance with participants who did and did not participate in the simulated nursing tasks. Focus groups and interviews were transcribed and analysed thematically guided by a theoretical model of technology acceptance. RESULTS: Pre-registered nurses thought the use of chest-strap devices to monitor their own health in real-time was acceptable. However, participants shared that it was important that the use of technology was inclusive and supportive of nurses' health and cautioned against misuse of data from wearable devices for individual performance management or stigmatisation.

Experiences of people with intellectual disability and dementia: A systematic review.

BACKGROUND: Dementia disproportionately affects people with intellectual disability. Most qualitative studies explore their experiences by utilising proxy-reports. A smaller number of studies illustrate the possibility of exploring perspectives directly from people with intellectual disability and dementia. METHOD: This systematic review synthesised findings from existing studies (n = 8) that involve people with intellectual disability and dementia as participants to understand their experiences of dementia. Searches were conducted using CINAHL, PsychInfo and Social Services Abstracts. RESULTS: Findings include descriptions of changes in individual functioning, a narrowing of social worlds and of how people made sense of the changes despite often having no knowledge of their dementia diagnosis. Additionally, discussion focuses on how people's experiences are shaped by their environments. CONCLUSION: The review recognises the complexities of speaking to people with intellectual disability about dementia, challenges views that people with intellectual and dementia cannot be involved in research and makes recommendations to support inclusion in future studies.

Strategies to promote nurses' health: A qualitative study with student nurses.

Developing strategies to support student nurses' health is a global priority for healthcare organisations and governments. This is because emerging international evidence indicates that improvements in student nurses' health are required to increase the longevity of careers and reduce the loss of time, skill and financial cost of sickness absence and workforce exit. However, we do not know what intervention strategies student nurses think would support their health. The study aim was to explore student nurses' views on factors that influence health-related behaviours and strategies that could improve health. Data were collected through participatory activities during focus groups with student nurses in Scotland. Analysis was theoretically informed and involved mapping to the Behaviour Change Wheel framework. Students identified several factors that influenced health-related behaviours. Four were ranked most important: knowledge, culture, time constraints, and stress. Strategies student nurses thought should be prioritised to improve nurses' health-related behaviours were: stimulating a health-promoting environment by reviewing shift work, improving workplace support, increasing staffing levels, subsidising and role-modelling of healthy food and exercise; and creating applied health-promoting curricula by integrating time and stress management training and lifestyle advice into nursing education. Educational and environmental interventions are needed to support student nurses' health.

Health-related behaviours of nurses and other healthcare professionals: A cross-sectional study using the Scottish Health Survey.

AIMS: To estimate the prevalence and co-occurrence of health-related behaviours among nurses in Scotland relative to other healthcare workers and those in non-healthcare occupations. DESIGN: Secondary analysis of nationally representative cross-sectional data, reported following STROBE guidelines. METHODS: Five rounds (2008-2012) of the Scottish Health Survey were aggregated to estimate the prevalence and co-occurrence of health-related behaviours (smoking, alcohol consumption, physical activity, fruit/vegetable intake). The weighted sample (n = 18,820) included 471 nurses (3%), 433 other healthcare professionals (2%), 813 unregistered care workers (4%), and 17,103 in non-healthcare occupations (91%). Logistic regression models compared the prevalence of specific health-related behaviours and principal component analysis assessed co-occurrence of health-related behaviours between occupational groups. RESULTS: Nurses reported significantly better health-related behaviours relative to the general working population for smoking, fruit/vegetable intake, and physical activity. No significant difference was found for alcohol consumption between occupational groups. Nurses reported lower levels of harmful co-occurring behaviours (tobacco smoking and alcohol consumption) and higher levels of preventive behaviours (physical activity and fruit/vegetable intake) compared with the general working population. Other healthcare professionals had the lowest level of harmful health behaviours and the highest level of preventive health behaviours. Health-related behaviours were poorest among unregistered care workers. CONCLUSION: Nurses' health-related behaviours were better than the general population but non-adherence to public health guidelines was concerning. IMPACT: Nurses play an important role in health promotion through patient advice and role-modelling effects. To maximise their impact, healthcare providers should prioritise increasing access to healthy food, alcohol awareness, and smoking cessation programmes.

Media Depictions of "Unacceptable" Workplace Violence Toward Nurses.

Violence and aggression toward nurses are global concerns. Despite repeated research on causal factors and widespread zero tolerance campaigns, rates of violence and aggression have not declined. Violence and aggression toward nurses can negatively affect their health and ultimately patient care. Media reporting of violence and aggression toward nurses might shape people's perceptions of the profession, perhaps impeding nurse recruitment and retention efforts in the face of global nursing shortages. The purpose of this study was to determine how print media in Scotland depicted reports of violence and aggression toward nurses. We used qualitative thematic analysis of newspaper articles and online news reporting of incidents of violence and aggression toward nurses between June 1, 2006 and May 31, 2016. Searches of Nexis and British Broadcasting Corporation (BBC) News Online databases returned 92 relevant newspaper articles. Standards for reporting qualitative research informed presentation of results. Key themes included blame (of perpetrator or senior management), helplessness (of nurses specifically or victimization), culture (social or organizational), and prevention and reduction measures. We concluded that media coverage of violence and aggression was overwhelmingly negative and reductionist. Normalization of violence and aggression was an accepted and acceptable part of the nursing role. We conclude with recommendations for policy and call for nurse leaders to challenge this culture of acceptability, especially to support recruitment and retention of nursing staff.

Obesity prevalence among healthcare professionals in England: a cross-sectional study using the Health Survey for England.

OBJECTIVE: To estimate obesity prevalence among healthcare professionals in England and compare prevalence with those working outside of the health services. DESIGN: Cross-sectional study based on data from 5 years (2008-2012) of the nationally representative Health Survey for England. SETTING: England. PARTICIPANTS: 20 103 adults aged 17-65 years indicating they were economically active at the time of survey classified into four occupational groups: nurses (n=422), other healthcare professionals (n=412), unregistered care workers (n=736) and individuals employed in non-health-related occupations (n=18 533). OUTCOME MEASURE: Prevalence of obesity defined as body mass index ≥30.0 with 95% CIs and weighted to reflect the population. RESULTS: Obesity prevalence was high across all occupational groups including: among nurses (25.1%, 95% CI 20.9% to 29.4%); other healthcare professionals (14.4%, 95% CI 11.0% to 17.8%); non-health-related occupations (23.5%, 95% CI 22.9% to 24.1%); and unregistered care workers who had the highest prevalence of obesity (31.9%, 95% CI 28.4% to 35.3%). A logistic regression model adjusted for sociodemographic composition and survey year indicated that, compared with nurses, the odds of being obese were significantly lower for other healthcare professionals (adjusted OR (aOR) 0.52, 95% CI 0.37 to 0.75) and higher for unregistered care workers (aOR 1.46, 95% CI 1.11 to 1.93). There was no significant difference in obesity prevalence between nurses and people working in non-health-related occupations (aOR 0.94, 95% CI 0.74 to 1.18). CONCLUSIONS: High obesity prevalence among nurses and unregistered care workers is concerning as it increases the risks of musculoskeletal conditions and mental health conditions that are the main causes of sickness absence in health services. Further research is required to better understand the reasons for high obesity prevalence among healthcare professionals in England to inform interventions to support individuals to achieve and maintain a healthy weight.

Print media representations of UK Accident and Emergency treatment targets: Winter 2014-2015.

AIMS AND OBJECTIVES: To undertake an analysis of UK national daily newspaper coverage of accident and emergency treatment targets, in order to understand whether the media could be seen to be creating a scandal. BACKGROUND: Emergency department treatment targets have become common in developed countries. In the UK, hospitals are required to treat and discharge patients within four hours, and statistics are published daily. Breaches of targets are regularly reported by the UK print media. DESIGN: Exploratory research of tabloid newspaper articles that reported on four-hour treatment targets in the UK during a seven-month period over the winter of 2014-2015 (n = 1,317). An interpretivist thematic approach was used during analysis. RESULTS: The main "problem" identified by newspapers was the failure to meet the target, rather than negative effects on patient care (where they existed). Proposed solutions were diverse. Many articles did not describe who was to blame for the failure. CONCLUSION: We conclude that the media created a feeling of scandal, and hypothesise that this is related to political reasons and the availability of data on a daily basis. RELEVANCE TO CLINICAL PRACTICE: It is important for nursing staff to understand the influence of the media on patients and how stories are reported.

The experiences of family carers in the delivery of invasive clinical interventions for young people with complex intellectual disabilities: policy disconnect or policy opportunity?

AIMS AND OBJECTIVES: To explore the experiences of family carers in the delivery of invasive clinical interventions within community settings. BACKGROUND: Many young people with intellectual disabilities present with complex health needs and require clinical interventions to sustain life. As the population lives into older age there is growing demand for the delivery of these interventions within the community setting. DESIGN: An interpretivist qualitative design. METHODS: Ten family carers of children with intellectual disabilities and complex care needs requiring invasive clinical interventions participated in semi-structured interviews. RESULTS: There are barriers identified regarding the delivery of invasive clinical interventions in the home setting by social care support workers. These include a reluctance to carry out invasive clinical interventions both for family carers and staff, anxiety, a lack of knowledge and training and difficulties in recruiting appropriate staff. CONCLUSIONS: There needs to be strategic policy developments focusing on this population who are cared for in the community and require invasive clinical interventions. RELEVANCE TO CLINICAL PRACTICE: Registered Nurses have a key role in educating and preparing families and social care support workers to safely deliver invasive clinical interventions in community settings for both children and adults with intellectual disabilities.

How NHS managers are perceived by nurses.

BACKGROUND: The introduction of business principles into the NHS to increase efficiency and value for money has involved bringing in managers who are not necessarily experienced in healthcare, but can offer the right business skills. AIM: To learn more about frontline nurses' perception of senior managers and any areas of potential conflict. METHOD: Interviews with 31 frontline NHS nurses in a Scottish hospital between July and September 2010 to explore their perceptions of the managers' role. RESULTS: Many participants had a poor understanding of senior managers' role. They believed the non-clinical background of some managers meant they cannot understand the pressures at the front line. DISCUSSION: One way to increase staff engagement could be for managers to spend time at the front line experiencing what it is like to give patient care. This could increase their credibility to frontline staff as leaders. CONCLUSIONS: Tensions can arise between managers and nurses because of perceived differences in priorities. Understanding the relationship between senior managers and frontline nursing staff, and involving nurses in decision making, can lead to shared goals.

Treatment targets in emergency departments: nurses' views of how they affect clinical practice.

AIMS AND OBJECTIVES: To understand nurses' views and experiences of four-hour treatment targets in the emergency department and how this impacts clinical decision-making throughout acute secondary care hospitals. BACKGROUND: In many countries, national treatment targets in the emergency department have been introduced. However, research and a recent enquiry into poor clinical care in one hospital in the UK have highlighted that patient care may be compromised by the need to meet these targets. DESIGN: Qualitative descriptive study as part of a case study approach. METHODS: Semi-structured interviews were conducted with 31 nurses working in UK secondary care hospitals which had an emergency department. Nurses were purposively sampled from three specialties: emergency arenas (emergency department, n = 5; medical assessment n = 4 surgical receiving n = 2) (n = 11), surgical wards (n = 11) and medical wards (n = 9). RESULTS: Nurses in emergency arenas reported considerable burden, in terms of a very high workload and pressure from senior staff to meet the target. Respondents reported that negative impact on patient care for the majority of patients, excluding the most sick, for whom emergency arena nurses reported that they ensured received appropriate treatment, regardless of breaching treatment targets. Around half of the nurses working outside emergency arenas felt pressure and amended their work practices to enable colleagues in emergency arenas to meet treatment targets. CONCLUSIONS: Four-hour targets were not viewed as clinically helpful by the majority of nurses, some of whom questioned their appropriateness for patient care. RELEVANCE TO CLINICAL PRACTICE: Policy makers and senior managers should consider the suitability of treatment targets in the emergency department, particularly in relation to working conditions for nurses and other health professionals and its potential for negative impacts on patient care. While targets remain in place, senior nurses and managers should support nurses who breach the target to provide optimum clinical care.

Nurses' perception of senior managers at the front line: people working with clipboards.

AIM: To provide an original perspective on front-line nurses' perception of senior managers who are not nurses. BACKGROUND: A key element of new public management had been the drive for 'hands-on' professional management within the UK National Health Service, meaning the employment of mangers with managerial experience but little or no healthcare experience. DESIGN: An interpretive qualitative study, based on a single case study design with semi-structured interviews. METHODS: Semi-structured interviews were carried out with 31 front-line Scottish National Health Service nurses exploring their perceptions of the role of managers between July-September 2010. RESULTS/FINDINGS: Nursing staff were often unsure of the responsibilities of managers and perceived that there were an unnecessarily high number of managers within the National Health Service. Nursing staff raised concerns over the non-clinical background of managers, including their ability to understand the pressures faced at the front line. CONCLUSIONS: The main reason for conflict between managers and nursing staff was their differing foci. Managers were seen to concentrate on decisions surrounding targets, audits and budgets with little consideration given to the impact of these decisions on patient care.