Presenting research reflexivity in your PhD thesis

Background It is important for researchers to be open and transparent about the relationship between themselves and the subjects of their enquiry. Reflexivity enables them to do this, but although there is much guidance in the literature about reflexivity in general, there is little guidance for PhD candidates on including it in their theses. Aim To provide a practical illustration of how researchers can evidence reflexivity in their theses. Discussion The author presents the reflexive stance and journey she made when completing a PhD study that used constructivist grounded theory. It predominantly depicts the influences on the choices and decisions she made, so the reader can make sense of the journey she undertook. The author depicts how she began her journey as a novice nurse researcher and concluded it as a fully fledged researcher. Conclusion There has been much debate about how to integrate reflexivity in the context of a particular study. This article highlights the importance of reflexivity in research and uses excerpts from the author’s thesis to illustrate how it can be presented in a thesis. Implications for practice The article provides a guide and questions for PhD candidates to consider so they can present and think more deeply about reflexivity in their theses

Shall I tell my mentor? Exploring the mentor-student relationship and its impact on students’ raising concerns on clinical placement

Aims To explore student nurses' and nurse mentors' perceptions and experiences of raising concerns on clinical placement and the influence (if any) of their relationship on this process. A secondary aim is to consider the above, from a regulatory perspective in light of current literature and policy developments. Background Raising concerns whilst on clinical placement has been shown to be challenging for student nurses internationally. Registered nurses in the UK (in this case called “nurse mentors”) facilitate learning and assessment in practice. However, limited research exists on the influence of the relationship between the nurse mentor and student nurse on the raising concerns process. Design A qualitative approach was used to undertake secondary thematic analysis of interview data. The primary data set was generated during a PhD study, focusing on the mentor–student dynamic and the possible influence of this relationship on students' raising concerns. Methods 30 individual semi‐structured interviews were subjected to concurrent and thematic analysis. Interviews were undertaken with student nurses (n = 16) and nurse mentors (n = 14) between April 2016–January 2018. The COREQ 32‐item checklist was used during the preparation of this article. Findings The following three interrelated analytical themes were generated from the data, “developing a mentor‐student relationship," “keeping your mentor sweet” and “the mentor role in the raising concerns process.” Conclusion Our analysis of participants' experiences and perceptions offers an original contribution to understanding the factors associated with student nurses raising concerns in practice. Student nurses and most mentors believed that students should be encouraged and supported to raise concerns, but students' decisions were strongly influenced by their perceptions of the immediate interpersonal and educational context. Similar barriers to raising concerns have been shown to exist regardless of geographical boundaries, therefore the findings of this study are nationally and internationally relevant

Removal of babies at birth and the moral distress of midwives

Background Midwives and nurses appear vulnerable to moral distress when caring for women whose babies are removed at birth. They may experience professional dissatisfaction and their relationships with women, families and colleagues may be compromised. The impact of moral distress may manifest as anger, guilt, frustration, anxiety and a desire to give up their profession. While there has been much attention exploring the concept of moral distress in midwifery, this is the first study to explore its association in this context. Aim This article explores midwives’ experiences of moral distress when providing care to women whose babies were removed at birth and gives valuable insight into an issue nurses and midwives encounter in their profession. Methods Four mothers and eight midwives took part in this research. Narrative inquiry incorporating photo-elicitation techniques was used to generate data; mothers were interviewed face to face and midwives through focus groups. The images and audio data were collected, transcribed and analysed for emerging themes. For the purpose of this article, only the midwives’ stories are reported. This research received a favourable ethical opinion from the University of Surrey Ethics committee. Ethical considerations This study received a favourable ethical approval from a higher education institutes ethics committee. Results Midwives who care for women whose babies are removed at birth report it as one of the most distressing areas of contemporary clinical practice. Furthermore, they report feelings of guilt, helplessness and betrayal of the midwife–mother relationship. Many of the midwives in this study state that these experiences stay with them for a long time, far more than more joyful aspects of their role. Conclusion Midwives experience moral distress. Support systems, education and training must be available to them if we are to reduce the long-term impact upon them, alleviate their distress and prevent them from leaving the profession. </jats:sec

English language skills requirements for internationally educated nurses working in the care industry: barriers to UK registration or institutionalised discrimination?

Editoria

‘Gaps, mishaps and overlaps’: nursing documentation: how does it affect care?

Introduction: Complete, accurate and relevant nursing documentation is essential for the multidisciplinary comprehensive geriatric assessment process which can improve older patient’s outcomes following a hospital admission. Aims: to understand older person nurses experiences of and attitudes to documentation. Methodology: Semi-structured, in depth interviews of eight qualified nurses at an acute hospital trust. Interviews were analysed using the framework approach to identify key themes. Results: three overarching themes were identified: gaps, mishaps and overlaps. Gaps refer to information which was missing, inaccurate or inconsistent; mishaps refer to the consequences of these inaccuracies and inconsistencies and overlaps refer to the problem of duplications in recording of information. Discussion: Older person nurses report many inconsistencies, omissions and duplications in their documentation. This has implications for how nursing contributes to the comprehensive geriatric assessment and the quality of care of older patients. Recommendations for practice: New ways must be found to minimise and streamline existing documentation to ensure that records are complete, timely and person-centred. Nurses should be mindful that emerging digital technology systems do not create further problems. Ward nurses need to take greater control of development of documentation

Updating the UK competence framework for orthopaedic and trauma nurses 2019

This is an accepted manuscript of an article published by Elsevier in International Journal of Orthopaedic and Trauma Nursing on 16/04/2020, available online: https://doi.org/10.1016/j.ijotn.2020.100780 The accepted version of the publication may differ from the final published version.The updated RCN Competence Framework for orthopaedic and trauma practitioners was published in 2019 following completion of a 2 year project undertaken by a working group of representatives from England, Northern Ireland, Scotland and Wales. Expert musculoskeletal practitioners, inclusive of an allied health professional and working across the lifespan, in varying domains of orthopaedic and trauma practice collaborated to produce a working document applicable to trauma and orthopaedic (T&O) practitioners from all NHS pay bands. The 2019 document builds on the original and subsequent versions (2005 and 2012), importing new evidence and reformatting so that it is contemporary and easily cross referenced with the NMC Code (2018). The restructure includes an example of a learning contract demonstrating how the framework can be applied in practice, whether for self-learning, or in conjunction with the revalidation process. This paper reflects on and describes the process undertaken by the working group in the development and restructuring of the 2019 framework, including its evaluation to date and planned in the future.Published versio

Can the Revised UK Code Direct Practice?

The Nursing and Midwifery Council, the United Kingdom regulator of nursing and midwifery has recently revised its professional code of practice. This paper begins by arguing that a professional code must be capable of sustaining close reading and of action guidance. Using four exemplar clauses it is argued that the new revised code does not met this purpose. First, I show that in setting out requirements for consent and documentation, the meaning of the relevant clause has changed significantly during the editing process so that a literal reading of the final document bears little relation to established professional practice. Second, I argue that the clause concerning the nature of professional relationships has also been altered during the editing process so that it is inconsistent with other professional groups and established accounts of the professional nurse-patient relationship. Third, I argue that the clause concerning disclosure of confidential information, which survived revision and editing with its meaning intact is nevertheless factually incorrect and inconsistent with UK law and authoritative guidance. Finally, fourth, I argue that use of the word ‘inappropriate’ is inappropriate as it amounts to meaningless circularity, discussed in relation to a clause on expressing personal beliefs. Taken together, these examples demonstrate that the Code is seriously flawed and does not fulfil its purpose. One way that simple prescriptive clauses in the Code can be usefully understood is through the provision of detailed guidance. I argue that the NMC has changed its position on its view of the value of guidance and has significantly reduced the amount of written guidance and advice is provides. The paper concludes by arguing that in order to meet its action directing function, further clarifying revision and the provision of detailed guidance is required

On-line case discussion assessment in Ultrasound: The effect on student centred and inter-professional learning

In 2009 an asynchronous on-line case discussion assessment was introduced, to replace an existing traditional case-study assessment, within the Medical Ultrasound Programmes at City University London, to help extend collaborative, interprofessional student-led learning skills. Two clinical modules were used to develop the on-line learning method with associated assessments. Students selected and led a clinical case from their department, uploaded anonymised images and case details with questions, to encourage interaction from other colleagues. Thirty students participated in the on-line case discussions. The assessment was evaluated via informal feedback, end of module feedback and an on-line questionnaire. Some students completed two modules, using the on-line discussion, others were involved in only one module, of which 21 out of 26 students completed end of module feedback for the 1st module and 18 out of 20 students completed feedback from the 2nd module. Twelve students out of 30 completed the on-line questionnaire. Feedback suggested that the on-line case discussions were a good learning tool, providing a wide range of cases for students to participate in or read and learn from each other. All students found the cases interesting, engaging and useful, but time consuming. Despite the small numbers involved, useful feedback was provided to assist further development of the assessment, particularly in relation to the number of cases being assessed and length of availability. On-line case discussions are an innovative, engaging method to encourage self directed, collaborative learning which could be utilised in the health care setting to share interesting cases, promote inter-professional and self-directed learning