“Zero to Hero”: Conceptualising Time as a Moderator of Nurses’ Emotional Labour on the Front Line

Aim. We aimed to conceptualise how environmental, institutional, and organisational dynamics of the ED underpin and “moderate” nurses’ emotional labour. Background. Around the globe, EDs are struggling to meet rising patient demand including both UK health systems and public services in the US. In spite of these challenges and the intense and distinctive nature of EDs, an exploration of emotional labour is largely missing from current understanding. This is important, in part because emotional labour is established as an indicator of wellbeing including intention to leave, burnout, and compassion fatigue. We understand little of how the environment moderates emotional labour, and our study addressed this problem in the ED. Understanding the moderators of emotional labour, organisational perspective also offers theoretical development. Methods. Ethnography enabled immersion in the ED setting, gathering the lived experiences and narratives of the ED nursing team. This included 200 hours of observation at one District General Hospital and one Major Trauma Centre in the English NHS with 35 semistructured concurrent formal interviews. Results/Conclusions. The ED calls for an extensive spectrum of emotional labour from staff, influenced and moderated by the restrictions on resources, particularly time. We argue that, despite the often short nature of interactions undertaken in ED, the labour required is effortful and gruelling for staff. Understanding the relevance of environmental elements, namely, time, to the emotional labour offers tangible opportunities for improvement. These new understandings can underpin solutions to negative consequences of this work. Suggested measures and interventions to alleviate the impact of emotional labour should be prioritised by policy makers and those tasked with managing, designing, and leading the delivery of care in ED. Implications for Profession and/or Patient Care. The more “sped up” a service is required to be, the higher the likelihood of emotional labour is. In light of the challenges facing healthcare services around the world and the increased throughput through services, particularly in ED, this is important. This is also critical when considering that there are well-established relationships between emotional labour and wellbeing in nursing. Understanding the relevance of the healthcare environment to staff members’ experiences of emotional labour is critical in designing solutions which counterbalance the potentially negative consequences of this work.</p

What validated instruments, that measure implementation outcomes, are suitable for use in the Paediatric Intensive Care Unit (PICU) setting? A systematic review of systematic reviews

Background/Aims The measurement of implementation outcomes can establish the success of implementingevidence into practice. However, implementation outcomes are seldom measured in acutehealthcare settings, such as Paediatric Intensive Care Units (PICU), and if they are used, arelikely to be non-validated, site or intervention-specific measures. To address this literaturegap, this systematic review of systematic reviews aims to identify validated instruments tomeasure implementation outcomes of new EBP interventions in a PICU setting. Methods A systematic review of systematic reviews was conducted in two phases. Phase One: Fiveelectronic databases were searched between 06/10/22 and 14/10/22. Systematic reviewswere selected using pre-determined eligibility criteria. Methodological quality was assessedusing the Critical Appraisal Skills Programme tool and a data extraction table was used toallow further synthesis. Phase Two: Secondary eligibility criteria were used to extract andreview instruments from the systematic reviews selected in Phase One. Instruments wereanalysed and mapped to the Consolidated Framework of Implementation Research (CFIR). Results  Phase One: Searches resulted in 3195 unique papers. Five systematic reviews were eligiblefor   inclusion.   All   examined   the   psychometric   properties   of   each   instrument,   utilisingdifferent methods to do so; three considered their pragmatic or usability properties; andone identified instruments that were transferrable to different settings. Each systematic review identified that most included instruments had limited evidence of their validity orreliability and had poor psychometric properties. Phase two: 93 instruments were screened,and nine were eligible for analysis. After analysis and CFIR mapping, two instruments wereidentified as potentially adaptable to the PICU setting. Conclusions The   methodological   quality   of   implementation   outcome   measurement   instruments   isinadequate, warranting further validation research. Two instruments were identified thatcover multiple CFIR domains and have scope to be adapted for use when implementingevidence-based practice into the PICU. Further work is needed to adapt and further validatean instrument for use in practice. Registration For transparency of procedures and methods, the protocol for this systematic review was registered with PROSPERO (registration number CRD42022361638L)</p

Discourses of compassion from the margins of health care: the perspectives and experiences of people with a mental health condition

Evidence supports the positive influence of compassion on care experiences and health outcomes. However, there is limited understanding regarding how compassion is identified by people with lived experience of mental health care. To explore the views and experiences of compassion from people who have lived experience of mental health. Participants with a self-reported mental health condition and lived experience of mental health (n = 10) were interviewed in a community setting. Characteristics of compassion were identified using an interpretative description approach. Study participants identified compassion as comprised three key components; 'the compassionate virtues of the healthcare professional', which informs 'compassionate engagement', creating a 'compassionate relational space and the patient’s felt-sense response'. When all these elements were in place, enhanced recovery and healing was felt to be possible. Without the experience of compassion, mental health could be adversely affected, exacerbating mental health conditions, and leading to detachment from engaging with health services. The experience of compassion mobilises hope and promotes recovery. Health care policymakers and organisations must ensure services are structured to provide space and time for compassion to flourish. It is imperative that all staff are provided with training so that compassion can be acquired and developed.</p

Exploring the influence of health management processes on health outcomes among internally displaced persons (IDPs)

Background: Despite global action and policy initiatives, internally displaced persons (IDPs) experience poor living conditions and lack healthcare access compared to refugees. This study sought to understand the relationship between health management processes and health outcomes among camp-dwelling IDPs in northern Nigeria. Method: 73 individuals participated in either a focus group (n = 49) or one-to-one interview (n = 24), comprising IDPs (n = 49), camp managers (n = 9), health workers (n = 7) and government administrative authorities (n = 8). Interviews explored IDP health management processes, partners and perceptions around camp management. Data were analysed using an inductive thematic approach. Results: Four main themes were identified: opinions about healthcare organisation and management, service availability, interventions and information management, and IDP health outcomes. Though many stakeholders, partnerships, and national and international government agencies were involved in the provision of healthcare services, respondents described efforts as disjointed. Reports suggested that the coordination and management of health services and resources were not tailored to the needs of those living in all camps. And because so many national and international agencies were involved, but under weak coordination, access to services was less than optimal and adequate management of critical public health interventions was lacking. Varied allocation of resources such as funding, medication and medically trained staff were viewed as key factors in the availability and the ability to access what was considered as essential healthcare services. Conclusion: The health of IDPs in camp-like settings was compromised by uncoordinated management, treatment, and control of communicable and non-communicable diseases. Government authorities need to be aware and consider the complexity of the multiagency involvement in the management and provision of IDP healthcare services. Introducing systems to streamline, monitor and support IDP healthcare management could be cost-effective strategies for achieving optimal health care

sj-pdf-7-jrn-10.1177_17449871241226911 – Supplemental material for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement

Supplemental material, sj-pdf-7-jrn-10.1177_17449871241226911 for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement by Catrin Evans, Georgia Clancy, Kerry Evans, Andrew Booth, Benash Nazmeen, Stephen Timmons, Candice Sunney, Mark Clowes, Nia Wyn Jones and Helen Spiby in Journal of Research in Nursing</p

sj-pdf-1-jrn-10.1177_17449871241226911 – Supplemental material for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement

Supplemental material, sj-pdf-1-jrn-10.1177_17449871241226911 for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement by Catrin Evans, Georgia Clancy, Kerry Evans, Andrew Booth, Benash Nazmeen, Stephen Timmons, Candice Sunney, Mark Clowes, Nia Wyn Jones and Helen Spiby in Journal of Research in Nursing</p

sj-pdf-2-jrn-10.1177_17449871241226911 – Supplemental material for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement

Supplemental material, sj-pdf-2-jrn-10.1177_17449871241226911 for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement by Catrin Evans, Georgia Clancy, Kerry Evans, Andrew Booth, Benash Nazmeen, Stephen Timmons, Candice Sunney, Mark Clowes, Nia Wyn Jones and Helen Spiby in Journal of Research in Nursing</p

sj-pdf-8-jrn-10.1177_17449871241226911 – Supplemental material for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement

Supplemental material, sj-pdf-8-jrn-10.1177_17449871241226911 for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement by Catrin Evans, Georgia Clancy, Kerry Evans, Andrew Booth, Benash Nazmeen, Stephen Timmons, Candice Sunney, Mark Clowes, Nia Wyn Jones and Helen Spiby in Journal of Research in Nursing</p

sj-pdf-6-jrn-10.1177_17449871241226911 – Supplemental material for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement

Supplemental material, sj-pdf-6-jrn-10.1177_17449871241226911 for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement by Catrin Evans, Georgia Clancy, Kerry Evans, Andrew Booth, Benash Nazmeen, Stephen Timmons, Candice Sunney, Mark Clowes, Nia Wyn Jones and Helen Spiby in Journal of Research in Nursing</p

sj-pdf-4-jrn-10.1177_17449871241226911 – Supplemental material for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement

Supplemental material, sj-pdf-4-jrn-10.1177_17449871241226911 for Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement by Catrin Evans, Georgia Clancy, Kerry Evans, Andrew Booth, Benash Nazmeen, Stephen Timmons, Candice Sunney, Mark Clowes, Nia Wyn Jones and Helen Spiby in Journal of Research in Nursing</p