No backstage: the relentless emotional management of acute nursing through the COVID-19 pandemic.

The COVID-19 pandemic disordered the routine delivery of health care. We explored nurses' experiences of working in COVID and non-COVID facing roles, focusing on staff in the acute sector of one Scottish health board. The study covered the period between April and July 2021, and was conducted through twenty in-depth interviews. Interactions between patients, family members and nurses changed due to inflection control measures. Staff experienced a range of conflicting emotions, e.g. fear of infection and transmission but a strong sense professional duty to contribute to the pandemic effort. Nurses were dissatisfied with the care they provided and experienced moral dilemmas, distress and injury from the emotional labour caused not only by working under the infection control measures, but also by the virulence and uncertainty of this new disease. We draw on earlier works - Goffman's (1967) presentation of self, Hochschild's (1983) work on emotional labour, and Bolton and Boyd's (2003) work furthering emotional labour - to illustrate that the usual rules and routines of interaction between patients, family and staff were abandoned. Nurses were able to mask their distress and injury, but were often unable to effectively deliver the correct emotional response due to infection control measures, such as protective clothing (PPE) and social distancing. The 'backstage' spaces, important for dealing with the emotion of front stage performances, were missing for those in COVID-facing roles. The isolating work, and the removal of spaces for the donning and doffing of PPE, resulted in limited or no opportunity for humour and the enacting of collective care. Their private space offered little reprieve with the constant media attention on infection levels, death and nursing 'heroes'

Creative reflections on Enhancing Practice 16: new explorations, insights and inspirations for practice developers

It began two years ago, then Arriving in Edinburgh the enthusiasm abounds. The first day arrives – oozing anticipation. Great to gather old friends, new friends; Clans and clever creativity, having fun Energy in the room, creating, innovating, Creative ways transforming minds, creating impact. The International Practice Development Collaborative (IPDC) is loose network of practice developers, academics and researchers who are committed to working together to develop healthcare practice. The IPDC believes that the aim of practice development is to work with people to develop person-centred cultures that are dignified, compassionate and safer for all. One of its four pillars of work is a biennial Enhancing Practice conference. Moving round the world, the IPDC members take it in turns to host the conference; in early September 2016 it was the turn of Queen Margaret University (QMU) in Edinburgh. This article has been created collaboratively by a number of the people who attended this three-day conference. The IPDJ team invited participants to offer ‘the line of a poem’ that captured or reflected their experience and/or learning. These were then collected and shared, and together we created a series of poems and a collection of haiku (a three-line Japanese poem with 17 syllables, 5-7-5). Other participants have subsequently offered reflections, which we would also like to share with you here. We offer this article to you, as a celebration of our time together; our learning, connections and creating, in the hope that there might be some learning in here for you and that you may consider joining us at our next conference in Basel, Switzerland in 2018

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Objectives To examine the types of choices available to patients in the English NHS when being referred for acute hospital care in the light of the divergence of patient choice policy in the four countries of the UK. Methods Case studies of eight local health economies in England, Scotland, Northern Ireland and Wales (two in each country); 125 semi-structured interviews with staff in acute services providers, purchasers and general practitioners (GPs). Results GPs and providers in England both had a clear understanding of the choice of provider policy and the right of patients to choose a provider. Other referral choices potentially available to patients in all four countries were date and time of appointment, site and specialist. In practice, the availability of these choices differed between and within countries and was shaped by factors beyond choice policy, such as the number of providers in an area. There were similarities between the four countries in the way choices were offered to patients, namely lack of clarity about the options available, limited discussion of choices between referrers and patients, and tension between offering choice and managing waiting lists. Conclusions There are challenges in implementing pro-choice policy in health care systems where it has not traditionally existed. Differences between England and the other countries of the UK were limited in the way choice was offered to patients. A cultural shift is needed to ensure that patients are fully informed by GPs of the choices available to them.sch_nur18pub4185pub