Children continue to be held still within pediatric practice for clinical tests, treatments and examinations. Existing literature has focussed on health professionals' and parent's views and experiences of the use of holding and restraint, and children's views and experiences remain largely absent. This study aimed to explore the experiences and perceptions of children with long-term conditions of being held for clinical procedures in hospital environments. A qualitative descriptive design used interviews and participatory arts-based approaches to hear the experiences of children aged 4-12 years. Recruitment occurred through a children's hospital. Data were analyzed using thematic and content analysis processes. Twenty-two children aged 4-12 years were interviewed. Children gave detailed accounts of how they had been held, with many describing experiences of distress and forceful holding. Children shared their understanding of why they had been held and talked of difficult communication during the "horrible moment" because adults were either "not saying anything" or "being angry." They talked of preferring to be held by their parents or given a choice over who holds them. Children discussed that being informed, listened to, and able to rehearse events helped them during a procedure and led to less forceful holding. This study adds important knowledge of children's perspectives of being held for clinical procedures, demonstrating that even young children have complex emotions and understandings of what happened when they were held. Adopting a trauma-informed approach and providing supportive debriefs is key to avoiding the accumulation of fear, distress and harm.

Holding children for procedures is often perceived as a routine, uncontested aspect of pediatric practice. There has been an increase in literature describing parents' experiences of holding their child and professionals reported practice. However, limited research has observed practice and explored what influences healthcare professionals' decisions to hold a child or to encourage parental holding. This study examined how and why healthcare professionals decide to initiate, continue, or stop holding a child during a procedure, and identified the factors that influence these decisions. A descriptive qualitative multi-method design was employed, incorporating semi-structured observations focused on verbal and nonverbal interactions, vignettes constructed from each observation, and semi-structured interviews with healthcare professionals. Purposeful sampling identified children under 10 years of age undergoing a procedure in a tertiary children's hospital in Northwest England. Data from the field notes and transcripts were analyzed thematically. Eight children (aged 1 month to 10 years) and their parents were observed, along with 12 healthcare professionals (doctors, nurses, healthcare assistants, and play specialists). Eleven professionals were interviewed in this study. The findings revealed a lack of explicit discussion or planning regarding the roles of professionals, parents, and children before the procedures. Two themes were identified which highlighted "healthcare professionals assumptions about parents' role" to comfort, distract, support and hold their child during a procedure, and "expectations about children's responses and behaviors during procedures," led professionals to expect that children who had been resistant previously and younger children would be distressed leading to holding being inevitable. This study provides the first in-depth exploration of healthcare professionals' decision-making about holding children based on observed practices. The findings demonstrate that unspoken assumptions and expectations influence procedural trajectories with implications for practice and training.

Introduction: The World Health Organization officially declared COVID-19 a global pandemic in March 2020, resulting in travel restrictions, closure of non-essential shops and services, and the discontinuation of elective healthcare. The escalation of the pandemic impacted on hospital healthcare professionals, who experienced the deaths of colleagues and unprecedented changes in their working conditions. One area that received media attention in the United Kingdom during the pandemic was the role of hospital chaplaincy and spiritual care teams.Methods: An exploratory study advertised via social media, the press and professional bodies resulted in 86 healthcare professionals and 63 chaplains, who had worked clinically in the United Kingdom during the pandemic, completing an open, free text electronic survey. Seven chaplains participated in a follow-up telephone interview, with all the data collected in 2022.Results: The survey demographic data were analysed using descriptive statistics. Free text responses and interviews were subject to thematic analysis. A focus on the support of health professionals was widely reported by all respondents. Two overarching themes were identified: (1) organizational initiatives, with subthemes of structural and virtual support; (2) proactive intervention – “going to the frontline”, with subthemes of emotional and spiritual support, moral support and practical input.Discussion/Conclusion: The overarching finding was that hospital chaplains worked alongside healthcare staff on the clinical frontline. Staff described this as invaluable in its immediacy of support and provision of a valued presence. The chaplain’s role changed to becoming more focused on staff support, which appears to be ongoing, thus impacting on the future role and training for hospital chaplaincy teams.

Hospital chaplaincy teams played a vital role during the COVID-19 pandemic, but the full depth of their experiences and personal impacts is not fully known. This UK study was advertised using social media platforms, local press outlets and chaplaincy professional bodies. An electronic survey was completed by 63 hospital chaplains, with the opportunity for all respondents to participate in follow-up interviews. This option was taken up by seven chaplains and explored the personal impacts, experiences and reflections of working during the pandemic. Their views of the impact of initiatives, practices and organizational changes were explored. Themes included: (1) challenges and personal impact, including reflections on the enormity of the situation, personal fears and sacrifices, and clinical challenges; (2) practical solutions, including personal strategies and the support of colleagues; and (3) organizational issues and suggestions. This article concludes with recommendations for organizations and further research.

Background Spiritual care is a fundamental domain of palliative and end-of-life care. Addressing spiritual care empowers patients to take ownership of what is important to them. All healthcare professionals should feel confident to address patients' spiritual needs and provide tailored individual care and support. Aims To demonstrate that a concise educational intervention improves healthcare professionals' confidence for undertaking assessment and providing spiritual care for every hospice inpatient. Methods A retrospective audit of spiritual assessments within patient electronic records, from January to March 2022, was conducted against agreed audit standards. An evaluation of healthcare professionals' confidence in dealing with spiritual assessment was obtained from hospice inpatient unit clinicians using an anonymous survey. An educational session was created and delivered in response to survey results. Finally, the re-audit was undertaken from September 2022 to November 2022 and a post-educational session anonymous survey used to evaluate confidence in dealing with spiritual assessment. Results Healthcare professionals' confidence when addressing spiritual care needs, following an educational session, which 35/39 (90%) staff attended, demonstrates a significant increase in clinicians' confidence when assessing spiritual needs from 11/37 (30%) to 29/35 (83%) and in providing spiritual care from 5/37 (14%) to 32/35 (86%). The documentation audit findings demonstrate a meaningful increase from 4/30 (14%) to 34/56 (60%) for spiritual needs care plan being developed and documented within patient electronic records to improve quality care for every hospice inpatient. Conclusion Educated and confident staff are more likely to address patients' spiritual needs. Spiritual awareness and its importance for patients' quality of life at the end-of-life empowers healthcare professionals to make changes in the way they deliver care to patients. Educated and confident staff are more likely to assess and document spiritual needs and care information within patient electronic records, to improve quality care for every hospice inpatient.

Background In an ageing population, complex health needs, reduced health and social care resources result in an increased reliance on families to provide care at end-of-life. Family caregivers are reported to have increasing challenges to their own health and wellbeing especially as the patient requires more support. National policies recommend family caregivers be identified, and needs addressed separately. Yet routine assessment is not regularly undertaken. Issues include a lack of staff awareness of the assessment process and experience in undertaking them. Aims To review the assessment of family caregivers within a Hospice at Home (HatH) service and assess clinical staff on their knowledge and experience of the process. Methods (1) Retrospective audit of HatH referrals (January-March 2022) using data from clinical records collected against agreed standards for caregivers' assessment and 18 staff surveyed for knowledge and experience. (2) Education intervention for staff on caregivers' needs and assessment, and repeat survey. Audit repeated – September-November 2022. Results Cycle 1: 88 records examined, 63 included (25 excluded). Documentation included: 30(48%) main family caregiver's name/relationship. 27(43%) main contact details. 1(2%) caregiver's assessment. 0 (0%) caregiver's action plan. Staff Survey 1: demonstrated some knowledge 12(67%) of family caregivers' assessment, but 11(61%) had no assessment experience. Cycle 2: 98 records examined, 72 included (26 excluded). Documentation included: 67(93%) main family caregiver's name/relationship. 62(86%) main contact details. 61(85%) caregiver's assessment. 57(79%) caregiver's action plan. Staff Survey 2: Post educational intervention, all 18(100%) had improved knowledge and 16(89%) had gained experience. Conclusion A targeted educational intervention on the impact of caregiving and importance of undertaking an assessment resulted in improved knowledge and subsequent experience of staff in the assessment process. This helped ensure family caregivers are known to the HatH service, have their own needs assessed and, where required, a targeted caregiver's action plan developed.

An estimated 1.3 million stroke survivors living in the United Kingdom (UK) currently rely on family caregivers for daily support. The needs of stroke family caregivers are, however, not routinely assessed by most clinical services. Early identification of their needs and support is crucial to maintain their well-being and caregiver role. At present, stroke-specific caregiver screening tools are lacking. This mixed method, the multiphase study aimed to develop a Carers’ Alert Thermometer for stroke family caregivers (CAT-S) by adapting the CAT, a short screening tool developed in the context of end-of-life care. Underpinned by principles of action research, qualitative and quantitative data were collected sequentially between February 2016 to December 2017 from purposive samples of stroke family caregivers (n = 76) and staff working within stroke services (n = 238) in the UK. Semistructured interviews were conducted to inform the contents of the CAT-S. Key items for inclusion were identified through a modified Delphi survey and consultation with an expert panel. The CAT-S was then piloted in North West England to test its usability and usefulness in practice to identify the needs of stroke family caregivers. Thematic and content analysis were used to analyse qualitative data. Quantitative data were analysed using descriptive statistics. The CAT-S comprises the key challenges that are experienced by stroke family caregivers. Two additional items not present on the original CAT were identified and included; training needs of family caregivers to provide care and support for caregivers’ emotional needs. The CAT-S was found to be useful and acceptable by both staff and stroke family caregivers and resulted in action plans and support being provided. The CAT-S is a supportive tool for achieving person-centred care and prioritising stroke family caregivers requiring comprehensive assessments.

Background Nurses in critical care are frequently required to facilitate the withdrawal of life-sustaining treatments and provide end-of-life care for deteriorating patients. Providing this care has been shown to cause nurses distress, potentially leading to stress, burnout and cumulative grief. Despite a wealth of research looking at the experiences of intensive care unit nurses regarding end-of-life care, there remains a lack of research focusing on the period of care leading up to withdrawal of life-sustaining treatment and the experiences of high dependency unit (HDU) nurses. Methods 15 qualified nurses took part in digitally recorded individual interviews, conducted within one HDU in in the North West of England. Interviews were analysed using qualitative thematic analysis. University and NHS Ethical approval were obtained. Results Participants reported difficulty caused by conflict in decision making, which they perceived to prolong treatment and suffering for patients who were not expected to survive. Resulting in moral distress, especially in situations where they voiced their concern that the patient was dying but the decision was made to continue life-saving treatments. Coping mechanisms were reported and the need for de-briefing or a talking therapy service was highlighted. The lack of education focused on how to provide optimal care and how to cope with this situation were highlighted Conclusion HDU nurses need time to talk about their experiences in caring for this patient group and education to support them to provide optimal end-of-life care in critical care settings is needed. The impact of this study has resulted in several local changes including debriefing sessions and development of a bespoke education programme has begun to ensure nurses are adequately prepared when caring for deteriorating patients approaching life-sustaining treatment withdrawal.

Background: Nurses in high-dependency units frequently facilitate the withdrawal of life-sustaining treatments and provide end-of-life care. Providing this care has been shown to cause distress, burnout and cumulative grief. There remains a lack of understanding of high dependency nurses' experiences of caring for patients approaching withdrawal of life-sustaining treatments. Aim: To explore experiences of high dependency nurses caring for patients approaching withdrawal of life-sustaining treatment and highlight any support or needs they may have. Methods: Interviews were conducted and analysed using qualitative thematic analysis. Findings: Nurses experienced conflict in decision making, which was reported to prolong patient distress and cause nurses moral anguish. Nurses need time to talk and further education to support them to provide withdrawal of life-sustaining treatment. Conclusion: High-dependency nurses need time to talk following caring for this patient group and more extensive education to support them to provide quality end-of-life care.

Background Motor Neurone Disease (MND) is a progressive terminal neurodegenerative condition, with six people diagnosed every day in the UK, resulting in around 5000 people being affected at any one time (MND Association (UK), 2011). Its rapid progression and deterioration means care needs to be carefully planned and targeted in a timely manner. Multidisciplinary team (MDT) involvement is known to be beneficial for people living with MND (Miller, Jackson, Kasarskis, et al., 2009. Neurology. 73:1218; O'Brien, Whitehead, Jack et al., 2011. Brit J Neurosci Nurs. 7:580). In the North West of England a consultation exercise with families and carers identified a significant need for improved targeted and timely support. To address this a dedicated key worker role was established to support patients and their families and to coordinate that support within the community multi-disciplinary team. Ethical approval was given by Edge Hill University Health-related Research Ethics Committee (ETH2021-0147). Aim To explore the impact of the MND Key Worker on people with MND and their families. Methods An evaluation design using a mixed-method approach to data collection was employed using semi-structured interviews, surveys and assessment of routinely collected data (including referrals and access of services). Data were collected from patients, families and key stakeholders who had experience of the new role over the first 15 months of the post. Results Qualitative data are subject to thematic analysis and descriptive statistics are used to represent routinely collected data. Data from phase one and two of data collection (Interviews n=20, Survey n=24) show increased referrals and uptake of hospice services along with qualitative data demonstrating the positive impact of the role and key benefits experienced by people with MND and their families. Conclusion Early data analysis indicates the introduction of a dedicated key worker post to be beneficial to people with MND and their families. This paper will discuss these results, (together with phase three data collected in summer 2022) and explore what elements of the role are having the maximum impact.

There are approximately 1.3 million stroke survivors in the UK, with the majority of them relying on family caregivers for support. However, the needs of family caregivers are not routinely assessed by most services. The aim of this study was to explore the experiences of stroke family caregivers following the implementation of the Care Act, 2014. A total of 16 semi-structured, digitally recorded face-to-face qualitative interviews were conducted with a purposive sample of stroke family caregivers in north-west England. Thematic analysis was undertaken. Two themes were identified: the effects of caregiving and the unmet needs of the family caregivers. Despite changes to legislation, family caregivers of stroke survivors continue to experience challenges, such as financial problems, information needs, and a lack of respite and emotional support when providing care. Existing approaches to identifying and supporting caregiver needs are insufficient. Proactive approaches are required to ensure the needs of family caregivers are identified and addressed on a regular basis.

This paper reports on a multi-phased, mixed-method consensus-based study conducted with young carers in the UK aged 11–18, and health, social care and education professionals from the UK, USA and Canada, to identify priority items for inclusion in a short screening tool for use with young carers of a family member with a progressive or long-term illness or disability. Following ethical approval from University and local Research Ethics Committees, qualitative and quantitative data were collected between 2017 and 2019 from 267 people (107 young carers; 160 professionals), through interviews, a focus group, a Delphi survey, consensus group meetings and consultations. Qualitative data were analysed thematically, and quantitative data were analysed using measures of central tendency, frequency and levels of dispersion. The resulting Carers’ Alert Thermometer (CAT-YC) contains an identification question followed by ten areas of need across two themes of ‘current caring situation’ and ‘carer’s health and wellbeing,’ along with guidance for possible next steps and space for an action plan to be jointly agreed between the screener and young carer. Preliminary piloting of the CAT-YC provides evidence of identifying and monitoring needs, and is expected to be useful for young carers, a wide range of professionals, and organisations that support young carers.