The progress and outcomes of black and minority ethnic (BME) nurses through the Nursing and Midwifery Council's "Fitness to Practise" process: Final report

BACKGROUND This is the first investigation of the relationship between ethnicity and regulation of the nursing profession conducted internationally. The study was commissioned by the Nursing and Midwifery Council which is the regulator of the professions in the UK. AIMS OF THE STUDY “To establish whether the progress and outcomes of Black and minority ethnic (BME) nurses in relation to fitness to practice, from the point of referral to the point of case closure, is different from that of White nurses and midwives (N&M); and whether we can from the data account for any differences identified” (Call for research, NMC 2015). The study was designed to investigate whether BME N&M nurses are more likely to be referred and whether they were more likely to progress through the stages of the Fitness to Practise (FtP) process (screening, investigation or adjudication) and whether they were more likely to receive a severe penalty at the end of the process. DATA The NMC made available a copy of the register which had socio-demographic information on 681,258 nurses and midwives between April 2012 and December 2014 as well as data on referrals from April 2012 to December 2014 which totalled 5,851. Over that period the total number of cases that went to adjudication was 946. VARIABLES The main independent variable is ethnicity which we divided into Black, Asian, White, Other and Unknown. The latter category accounted for 40% of all referrals. The outcomes studied were rates of referral, the imposition of interim orders (where the referred individual is not allowed to work, progression through screening, investigation, adjudication and final outcome, which was dichotomised into “can work” or “cannot work”. The regression models also controlled for: age, gender, source of referral (9 categories), region of qualification (Africa, Asia, Europe, Other, UK), country of referral (4 counties of the UK) and whether or not the individual referred had a representative, such as a Union. METHODS OF ANALYSIS Descriptive statistics, cross-tabulation analysis, logistic regression and ordinal logistic regression FINDINGS Descriptive statistics showed that BME nurses are more likely to be referred than white nurses and to progress through the FtP process. Having trained in Africa is also a risk factor for referral. Older N&M and males are more likely to be referred. Most referrals come from employers but members of the public are also an important source of referral. Inferential statistics show that relative to Whites, being Asian, Black or of Unknown ethnicity is associated with progressing through FtP process. However, when “source of referral” is entered into the regression model only the “Unknown ethnicity” category remains significantly more likely to progress than White N&M. Males are more likely to progress through the FtP process but age, though positive, is not significant. There were few significant differences among the countries of the UK. The imposition of interim orders did not vary by ethnicity. The presence of a representative seems to reflect the stage of the FtP process rather than being a factor that contributes to the outcome. Finally, at adjudication, being Asian or Black is associated with a less severe penalty than White. Only those of Unknown ethnicity are more likely than Whites to get a severe penalty. These results are not altered by controlling for the source of referral. STRENGTHS AND WEAKNESSES OF THE STUDY The strengths include: the fact that this is the first study of its kind, the datasets analysed are large and the statistics are appropriate. Weakness include the fact that in 40% cases the ethnicity of the referred individual is not known. Some of the registered N&M may not be working which means that their risk of being referred to the NMC is low which could be a threat to the comparison of different ethnic groups. The administrative data which we analysed did not provide information about the specialty (e.g. mental health, maternity), job setting (care home, acute hospital) or level of seniority (staff nurse or Director of Nursing of the individuals referred were not amenable to analysis. RECOMMENDATIONS The analysis reported here could be enhanced in the future if the information on ethnicity, the setting in which the referred individual is working and their grade is made available. Some jobs may simply carry a higher risk of referral to the NMC and BME nurses may disproportionately occupy those positions. The main finding, which is that the relationship between ethnicity and FtP is mediated by referral by the employer, directs our attention to the need for further research to understand how the working environment leads to an over-representation of BME nurses in the FtP process. Within the NMC, further research needs to be conducted to understand why White nurses are more likely to be given a severe penalty at adjudication even though they are underrepresented in referrals and less likely to progress through the process. With the introduction of the NMC code and revalidation, the collection of data by the NMC and the FtP process will undoubtedly change. At the same time, the NHS has introduced policies to directly affect the working environment of BME nurses and midwives. This means that this study should be repeated to take account of these changes in the wider environment

The nursing work environment and quality of care: Content analysis of comments made by registered nurses responding to the Essentials of Magnetism II scale

Aim: To report a qualitative study of themes Registered Nurses raised spontaneously about their work environment, in a cross‐sectional survey study when responding to the Essentials of Magnetism II (EOMII) scale. Design: Qualitative descriptive survey. Methods: At the end of the EOMII scale, a free form text section was included asking nurses to add comments about their ward/work environment. Of the 247 nurses who completed the EOMII scale, 30% (N = 75) provided comments. Inductive content analysis was used to analyse the textual information generated. Results: Three key themes emerged: “nurses need nurses to nurse”; working as a team and workplace environment. Participants described issues they were facing which comprised high turnover rates, inadequate staffing levels, increasing workload and high stress levels. Particular attention was drawn to the role of the ward manager in promoting a positive work environment, good teamwork and quality patient care

Cross-cultural acceptability and utility of the strengths and difficulties questionnaire:views of families

Abstract Background Screening children for behavioural difficulties requires the use of a tool that is culturally valid. We explored the cross-cultural acceptability and utility of the Strengths and Difficulties Questionnaire for pre-school children (aged 3–5) as perceived by families in New Zealand. Methods A qualitative interpretive descriptive study (focus groups and interviews) in which 65 participants from five key ethnic groups (New Zealand European, Māori, Pacific, Asian and other immigrant parents) took part. Thematic analysis using an inductive approach, in which the themes identified are strongly linked to the data, was employed. Results Many parents reported they were unclear about the purpose of the tool, affecting its perceived value. Participants reported not understanding the context in which they should consider the questions and had difficulty understanding some questions and response options. Māori parents generally did not support the questionnaire based approach, preferring face to face interaction. Parents from Māori, Pacific Island, Asian, and new immigrant groups reported the tool lacked explicit consideration of children in their cultural context. Parents discussed the importance of timing and multiple perspectives when interpreting scores from the tool. Conclusions In summary, this study posed a number of challenges to the use of the Strengths and Difficulties Questionnaire in New Zealand. Further work is required to develop a tool that is culturally appropriate with good content validity

Autism community priorities in diverse low-resource settings: a country-wide scoping exercise in India

While studies to map the priorities of the autistic community have been undertaken in some high-income countries, there has been little or no such systematic assessment in the global south. India alone is home to an estimated >5 million autistic individuals. To address this gap in the literature, this study conducted a survey of the Indian autism community on their priorities for three areas: skills training, intervention and research. Individuals with a clinical diagnosis of autism spectrum disorders and parents/guardians of autistic individuals were invited to take part in the study. Data from 280 respondents were collected online and followed up with interviews on a subset (n = 40) chosen through stratified random selection. Results highlighted a unanimous prioritisation for self-help skills as the most important area in skills training, as it was considered the foundation for acquiring all other skills. Speech and language therapy was identified as the most important intervention for autistic individuals. Within research, identifying the most effective ways for the community to support autistic people was given the topmost priority. Researchers, clinicians and policymakers may use these insights to develop services and shape future research that is more in accord with the community’s needs

Registered nurses' perceptions and experiences of autonomy: a descriptive phenomenological study

Background Professional autonomy is a key concept in understanding nurses’ roles in delivering patient care. Recent research exploring the role of autonomy in the nursing work environment indicated that English and American nurses had differing perceptions of autonomy. This qualitative study aimed to explore the understanding and experiences of autonomy of nurses working in England. Methods A descriptive phenomenological analysis of data from 48 semi-structured interviews with registered nurses from two National Health Service (NHS) hospitals (purposive sample) was used to explore the concept of autonomy. Results Six themes were identified: working independently; working in a team; having professional skills and knowledge; involvement in autonomy; boundaries around autonomy; and developing autonomy requires support. A key finding was that nurses related autonomy to their clinical work and to the immediate work environment of their ward, rather than to a wider professional context. Nurses also perceived that autonomy could be turned off and on rather than comprising an integrated aspect of nursing. Conclusions Findings suggest that nurses in England, as framed by the sample, had a local ward-focused view of autonomy in comparison to nurses in America, who were reported to relate autonomy to a wider involvement in hospital level committees. Findings further indicate that autonomy was practiced occasionally, rather than incorporated into practice. Findings highlight the need for nurses in England to adopt a broader perspective and actively contribute to writing hospital guidelines and policies that recognise the importance of autonomy to nurse training and practice

Two becoming one: immigrant Indian women sustaining self and well-being through doing: a grounded theory study

Using a grounded theory methodology, this research sought to describe the occupational change process Indian women experience as they settle in a new environment, with a focus on how they sustain their sense of self and well-being. Semi-structured interviews were carried out with eight women of Indian origin who had immigrated to New Zealand within the past five years in an attempt to generate theory about the processes that these immigrants' experience. A constant comparative analysis revealed a central change process, Two Becoming One, which encompassed three interconnecting occupational processes. The first process women experience is Oh God, Where Did I Come?. In this process, where the environment is new and unfamiliar, the women feel compelled to do familiar activities that they know they can accomplish, thus increasing confidence and supporting well-being. The second process, Being In The Change, sees the women learning more about their new environment and engaging in new occupations, while continuing to hold on to doing familiar activities. A New Zealander with an Indian Soul finds the women doing more as they embrace a strengthening sense of self and well-being and strive to build their future in a new land. Central to these three processes is the core category Two Becoming One. This process is a commentary on the women's journeys of integrating the demands of two cultures, each with its own unique environment and ways of doing things, while supporting a healthy sense of self and well-being throughout the experience. The study findings demonstrate the dynamic interplay that occurs within a person-environment-occupation interface. Situating the findings within current literature reveals the limitation of previous understandings of the person-environment-occupation dynamic, in relation to people performing in an unfamiliar environment. With an increasing trend of immigration worldwide, this study brings to light the importance of understanding the bearing that environmental context has on occupation and the resulting impact for persons' sense of self and well-being. Further research in this area is required to gain deeper awareness of the ways in which people interact with their environment over time, and the resultant effect on occupation

WFOT Special Issue

[Abstract not available.

Poetry as a medium for articulating stories

Qualitative researchers are utilizing diverse ways to present and analyze data to capture people’s narratives. One such way is through the use of poems. The use of poems in research has been widely documented; however, what remains underdeveloped in the literature is an understanding of the use of poems and its alignment with narrative inquiry. In particular, the use of poems as a way to gather stories for analyzing data, especially when participants are not very articulate. Narrative inquiry is interested in the stories that people tell and retell. It provides the flexibility to share stories in diverse ways. Poems are a way of telling a person’s story. This paper highlights the use of poems as a medium to gather stories of wonderfulness of young people with autism. Young people with autism have diverse verbal expression. The use of poems provided a way to capture the stories as well as honor the voice of these young people. This paper offers a detailed description of the creation of poems from participants’ transcripts and how these poems were analyzed in the context of narrative inquiry. Engaging in the poetry making process presented challenges, along with unexpected benefits. These will be explored and discussed in the context of undertaking narrative research among populations with diverse communication needs

Mental health practitioners becoming qualitative researchers: Experiences from an Indian Not-for-Profit Organization

Across India, qualitative research remains poorly understood and underutilized as a way of developing new knowledge. Ummeed Child Development Center (UCDC) provides transdisciplinary care to children and families experiencing developmental disabilities in Mumbai, India. In 2009 the UCDC mental health team began training in narrative ideas and practices as a framework that aligns with Indian values of collectivism and storytelling. Subsequently, all mental health therapists in the organization have adopted this therapeutic approach in practice. Anecdotally, clients and therapists have had transformative experiences using narrative practices; however, due to limited experience in conducting research, the team has lacked any empirical evidence to support such claims. In 2019, the UCDC mental health team engaged in training to develop their skills and knowledge as qualitative researchers. As narrative practitioners, they already had an affinity towards a qualitative paradigm. Their motivation was to undertake research that would bring to light the myriad ways in which narrative practices were being used by the team and the challenges and benefits of such an approach, both for their own organization and more broadly in an Indian context. This paper explores the journey of the UCDC mental health team to becoming qualitative researchers. The teaching and activities that have facilitated their learning of qualitative research will be discussed, along with challenges encountered with conducting qualitative research in the practice setting (e.g., obtaining IRB approvals) and strategies to overcome these issues