Challenges of generating qualitative data with socially excluded young people

Recent perspectives in childhood research have tended to emphasise the use of participatory techniques as a method of reducing the unequal power balance between researcher and researched. Increasingly researchers have been concerned with developing inclusive and participatory young people centred methodologies which place their voices at the centre of the research process. But is the ideal of young people?s active involvement in the research process truly achievable or desirable with socially excluded young people in practice? This paper reflects on a range of ethical, methodological and practical issues arising from a study which tracks the lives of a group of young women who have been excluded from secondary school. The paper concludes with reflections on the necessity to overcome such difficulties for the production of in-depth data on some of the most vulnerable, socially excluded young people

Self, interpersonal and organisational acts of compassion amongst nurses during times of acute stress: A qualitative analysis

Background: There is a global shortage of nurses and new strategies are required to recruit, support and retain this staff group. Organisational culture can have a significant impact on staff wellbeing and commitment. Recent years have seen attempts to foster a compassionate culture across healthcare systems. However, little is known about how nurses initiate self-care and how they feel cared for by their organisation, particularly in times of acute stress and need. Aims: This paper aims to address the research question, ‘In what ways do nurses experience compassion (or not) during times of acute stress?’, identifying where and how compassionate acts were enacted by individuals, within teams or organisations. Methods: Semi-structured interviews were conducted with 50 UK National Health Service (NHS) nurses in a longitudinal qualitative study (between March 2020 and September 2022). Results: Three themes were derived from our narrative analysis including: (1) Learning and practising self-compassion; (2) The presence and absence of interpersonal compassion; and (3) Organisational (non) compassionate acts. Findings indicate that self-compassion requires permission and discipline, often being unfamiliar terrain for nurses. Interpersonal compassion can buoy nurses during challenging times but can often be absent across teams. Nurses’ experiences of organisational acts of compassion were limited, and they often felt de-valued, unsupported and replaceable. Conclusions: Compassionate acts are enacted across three levels (self, team and organisation). To retain staff, particularly in acutely stressful or challenging situations, organisations, and those responsible for nursing management and policy need to foster a systems-based approach to compassionate culture.<br/

Psychological impact of the Covid-19 pandemic on nurses and midwives

In response to findings of the Impact of Covid-19 on Nurses survey study, conducted in 2020, a subsequent study explored nurses’ qualitative experiences of the pandemic; this article discusses the results. Most participants struggled to transition to new working practices in altered care settings with more critically ill patients, and most experienced high levels of stress and psychological distress. Key themes included duty and fear, resilience and stigma, changing public responses, nurses’ voices, and leaving the profession. There is an urgent need to support and restore nurses’ psychological wellbeing, and to improve their working conditions to enhance retention rates

‘There was a pivotal moment’. The dynamics, transitions, adaptations and trajectories of nursing at the front-line in the UK during the COVID-19 pandemic

Using qualitative interview data (n=142 interviews) generated with 50 nurses, over the course of the COVID-19 pandemic, this paper traces the trajectories of nurses in the UK and attempts to unpick the interplay between structure and agency in their narratives. Interviews were inductively analysed for themes and an additional narrative analysis was undertaken to preserve the form of each participant’s narrative. We argue that nurses’ pandemic trajectories occurred within the ‘psychological vulnerability-stigma nexus’ which operates within health and social care providers in the UK and whilst constraining nurses’ agency at times it could also provide an impetus to act agentically. We found that the nurses’ COVID-19 trajectories were characterised by: getting by, getting out (job-hopping) getting needs met and getting organised. We call for more considered systemic support to be generated and consistently provided to nurses to ensure retention of nurses and the security of society to avoid exacerbating existing workforce shortages

Speaking up during the COVID‐19 pandemic : nurses' experiences of organizational disregard and silence

Aim To critically examine nurses' experiences of speaking up during COVID-19 and the consequences of doing so. Design Longitudinal qualitative study. Methods Participants were purposively sampled to represent differing geographical locations, specialities, settings and redeployment experiences. They were interviewed (remotely) between July 2020 and April 2022 using a semi-structured interview topic guide. Results Three key themes were identified inductively from our analysis including: (1) Under threat: The ability to speak up or not; (2) Risk tolerance and avoidance: Consequences of speaking up; and (3) Deafness and hostility: Responses to speaking up. Nurses reported that their attempts to speak up typically focused on PPE, patient safety and redeployment. Findings indicate that when NHS Trusts and community services initiated their pandemic response policies, nurses' opportunities to speak up were frequently thwarted. Conclusion Accounts presented in this article include nurses' feeling a sense of futility or of suffering in silence in relation to speaking up. Nurses also fear the consequences of speaking up. Those who did speak up encountered a ‘deaf’ or hostile response, leaving nurses feeling disregarded by their organization. This points to missed opportunities to learn from those on the front line. Impact Speaking up interventions need to focus on enhancing the skills to both speak up, and respond appropriately, particularly when power, hierarchy, fear and threat might be concerned. Patient or Public Contribution Nurses working clinically during COVID-19 were involved in the development of this study. Participants were also involved in the development of our interview topic guide and comments obtained from the initial survey helped to shape the study design

'Pretty cathartic actually': Reflections on the attempt to reduce re-traumatization of researchers and nurses taking part in a longitudinal interview study

Aim To critically evaluate the concepts of harm and re-traumatization in the research process and to explore the ethical implications of conducting research on distressing topics using our research on the experiences of nurses working during the COVID-19 pandemic as an exemplar. Design Longitudinal qualitative interview study. Methods Using qualitative narrative interviews, we explored the impacts of the COVID-19 pandemic on nurses' psychological well-being in the UK. Results To reduce the potential for harm to both research participants and researchers, the members of the research team were keen to establish ways to reduce the power differential between the researcher and participants. We found that our collaborative and team-based approach, with participant autonomy and researcher reflexivity embedded into the research framework, enabled the sensitive generation of data. Conclusion Reduction of potential harm for both participants and researchers in the generation of at times highly distressing data with a traumatized population was achieved through a respectful, honest and empathetic approach within a team that met frequently for reflection

Letter to editor

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

Aims To use nurses' descriptions of what would have improved their working lives during the first peak of the COVID-19 pandemic in the UK. Design Analysis of free-text responses from a cross-sectional survey of the UK nursing and midwifery workforce. Methods Between 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. Results Most (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. Conclusions The 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. Impact Failure 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 Contribution No Patient or Public Contribution, due to the COVID-19 Pandemic, urgency of the work and the target population being health and social care staff