The persistent “what works” question in nurse education research conceals a conceptual trap. We seek universal interventions that reliably produce outcomes regardless of context, building an evidence base where promising interventions repeatedly fail to transfer across settings. Critical realism and its methodological offspring, realist evaluation, offers a transformative alternative from the social sciences. Rather than asking “does this work,” realist evaluation asks: for whom, in what circumstances, through what mechanisms, producing which outcomes? This Big Ideas paper introduces the Context Mechanism Outcome (CMO) configuration framework as analytical architecture for understanding how educational interventions operate. Using Resilience Based Clinical Supervision as an exemplar, I demonstrate how realist approaches generate middle range theories - conditional, contextualised knowledge about what tends to work for whom in what circumstances. Nurse education's characteristic features (diverse student populations, constitutive context, complex interventions, multiple stakeholders) make realist approaches essential rather than optional. The transformation required is epistemological: abandoning false universalism to build cumulative knowledge about how mechanisms operate under varying conditions. This produces an evidence base adequate to nursing education's complexity, offering practitioners sophisticated conceptual resources for contextually intelligent implementation rather than simplistic prescriptions.

AIM:To explore the experiences of healthcare staff in organisations undergoing regulatory scrutiny and to identify the professional and organisational impact. DESIGN:Integrative review. DATA SOURCES:Medline, CINAHL, Scopus, and Google Scholar. REVIEW METHODS:This review followed Whittemore and Knafl's framework, adhering to PRISMA guidelines. Searches identified peer-reviewed studies from 2010 to 2025 examining healthcare staff under regulatory scrutiny. Studies employing diverse methodologies were included and synthesised using the constant comparison method to identify and refine key themes. RESULTS:Eight studies were included. Four interrelated themes were identified: (1) workforce wellbeing, autonomy, and professional identity; (2) regulatory culture, organisational adaptation, and quality improvement; (3) communication and relationships; and (4) impact on patient care and contextual variation. CONCLUSION:Regulatory scrutiny profoundly shapes healthcare quality and professional culture but can unintentionally undermine workforce adaptability and innovation essential for effective care. These findings highlight the need for nursing-sensitive regulatory approaches that support professional autonomy, reduce burden, and enhance patient-centred care. IMPACT:This evidence will inform nursing and midwifery policy and practice globally by providing support to inform nuanced, context-sensitive regulatory approaches that safeguard professional autonomy, reduce administrative burden, and promote safe, person-centred care across diverse healthcare settings. It will assist policymakers, healthcare leaders, and educators worldwide in enhancing workforce sustainability, patient safety, and care quality, facilitating the transfer of learning to varied healthcare environments and systems. PATIENT OR PUBLIC CONTRIBUTION:Not applicable.

Abstract This chapter explores the concept of caring in mental health nursing and locates the art of caring in twenty-first-century practice. The reader will be introduced to the ethics of caring and be asked to reflect on their own values, choices, and actions when caring. Throughout the chapter the reader will be provided with opportunities to consider some of the core skills involved in mental health nursing, including using reflection and how to communicate using a caring approach. The chapter also includes consideration of the contemporary context in which caring occurs, and the potential complexities involved in communicating care and developing therapeutic relationships. Therapeutic relationships are discussed in more detail in chapter 6.

AIM:Identify the skills and knowledge future nurse and midwife leaders might require in the next 6 years. Design/methodology/approach: An online questionnaire elicited health professionals' perspectives on the future requirements for nurse and midwife leaders. Qualitative data were generated in response on health care and the likely leadership skills for the future. Data were extracted and analysed using qualitative content analysis. FINDINGS:Four generic categories were abstracted from the core category 'Nursing and Midwifery Leadership'. These were values/traits; creating positive healthcare cultures; digital capability/competence; and systems thinking. Limitations/implications. This first stage evaluation has gained a wide variety of perspectives regarding the perceived skills and knowledge future nurse and midwife leaders might need. This is important to enable those who deliver leadership development programmes to plan appropriately, ensuring their programmes are designed and adjusted in response to the needs of a shifting health and care landscape. However, over 50% of respondents were White, so the data may not be representative of the diversity of registered nurses and midwives. The findings may not have direct relevance to the global context due to geographical limitations.

Background Raising concerns is essential for the early detection and appropriate response to patient deterioration. However, factors such as hierarchy, leadership, and organizational culture can impact negatively on the willingness to raise concerns. Objectives This study aims to delve into how leadership, organizational cultures, and professional hierarchies in healthcare settings influence healthcare workers, patients, and caregivers in raising concerns about patient deterioration and their willingness to do so. Methods The study used a qualitative approach, conducting focus group discussions (N = 27), utilizing authentic audio-visual vignettes to prompt discussions about raising concerns. Deductive thematic analysis was employed to explore themes related to hierarchy, leadership, and organizational culture. Results Positive leadership that challenged traditional professional hierarchies by embracing multidisciplinary teamwork, valuing the input of all stakeholders, and championing person-centered practice fostered a positive working culture. This culture has the potential to empower clinical staff, patients, caregivers, and family members to confidently raise concerns. Staff development, clinical supervision, and access to feedback, all underpinned by psychological safety, were viewed as facilitating the escalation of concerns and, subsequently, have the potential to improve patient safety. Conclusions This study offers crucial insights into the intricate dynamics of leadership, hierarchy, and organizational culture, and their profound impact on the willingness of staff and patients to voice concerns in healthcare settings. Prioritizing the recommendations of this study can contribute to reducing avoidable deaths and elevating the quality of care in healthcare settings.

Background: Compassion is critical to the provision of high -quality healthcare and is foregrounded internationally as an issue of contemporary concern. Paid care experience prior to nurse training has been suggested as a potential means of improving compassion, which has been characterised by the values and behaviours of care, compassion, competence, communication, courage, and commitment. There is however a dearth of evidence to support the effectiveness of prior care experience as a means of improving compassion in nursing. Objective: To explore the impact of paid prior care experience on the values and behaviours of pre -registration nursing students indicated as characterising compassionate care. Design: Longitudinal mixed methods design employing a modified concurrent triangulation strategy, comprising two work packages. Work package 1 was qualitative, and work package 2 adopted a concurrent embedded strategy with a dominant quantitative component. Research is reported in accordance with the Good Reporting of a Mixed Methods Study framework. Setting(s): Three United Kingdom universities. Participants: Pre -registration nursing students attending one of three universities, and individuals who had previously participated in a Health Education England paid prior care experience pilot. Participant numbers at time point 1 were questionnaires n = 220, telephone interviews n = 10, and focus groups n = 8. Methods: Work package 1 consisted of longitudinal semi -structured telephone interviews. Work package 2 comprised validated online questionnaires measuring emotional intelligence, compassion satisfaction and fatigue, resilience, psychological empowerment, and career commitment (as proxies of compassionate values and behaviours), and focus groups. Qualitative data were thematically analysed. Quantitative data were analysed via Analysis of Variance in SPSS v 26. Results: Qualitative findings suggest that prior care experience has both positive and negative effects on students' compassionate values and behaviours, however positive effects do not extend to qualification. No statistically significant differences were found in any of the quantitative outcome measures between participants with and without paid prior care experience. A statistically significant increase in compassion fatigue was identified in both groups of participants post -qualification. Paid prior care experience did not prevent participants from experiencing reality shock on becoming a student or on qualification. Conclusions: There is insufficient evidence of longitudinal beneficial impact to recommend paid prior care experience as an effective intervention to foster nursing students' compassionate values and behaviours. These findings do not support mandating a period of paid care experience as a prerequisite for entry into nurse education. Registration: N/A. Tweetable abstract Insufficient evidence of longitudinal beneficial impact to recommend prior care experience as an effective intervention to foster nursing student compassion @PriorCareExp @Sarah_F_R (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

PurposeThe purpose of this paper is to evaluate the impact of leadership development programmes, underpinned by Transformational Learning Theory (TLT). Design/methodology/approachA corpus-informed analysis was conducted using survey data from 690 participants. Data were collected from participants' responses to the question "please tell us about the impact of your overall experience", which culminated in a combined corpus of 75,053 words. FindingsFindings identified patterns of language clustered around the following frequently used word types, namely, confidence; influence; self-awareness; insight; and impact. Research limitations/implicationsThis in-depth qualitative evaluation of participants' feedback has provided insight into how TLT can be applied to develop future health-care leaders. The extent to which learning has had a transformational impact at the individual level, in relation to their perceived ability to influence, holds promise for the wider impact of this group in relation to policy, practice and the promotion of clinical excellence in the future. However, the latter can only be ascertained by undertaking further realist evaluation and longitudinal study to understand the mechanisms by which transformational learning occurs and is successfully translated to influence in practice. Originality/valuePrevious research has expounded traditional leadership theories to guide the practice of health-care leadership development. The paper goes some way to demonstrate the impact of using the principles of TLT within health-care leadership development programmes. The approach taken by The Florence Nightingale Foundation has the potential to generate confident leaders who may be instrumental in creating positive changes across various clinical environments.

Objectives: Compassion in nursing and interventions to support it are of international relevance and concern. Prior care experience as a prerequisite for entry into pre-registration nurse education is suggested as a means of improving compassion. The impact of prior care experience has not been comprehensively reviewed, therefore the potential effectiveness of prior care experience as a means of improving compassion is unknown. The scoping review question was 'What is known about the impact of care experience prior to commencing pre-registration nurse education and training?' The primary objective was to scope and synthesise existing literature relating to the topic and ascertain key themes pertaining to impact. A secondary objective was to appraise literature, to contextualise findings and assess the state and stage of knowledge and research in the area.Design: The review was guided by Arksey and O'Malley's methodological framework and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist.Data sources: Health sciences databases CINAHL, Medline and PubMed.Methods: Databases were searched in February 2019, updated August 2021. Data (study characteristics, findings, methodological observations) were extracted from papers meeting inclusion criteria (including peer-reviewed empirical papers with English language, electronic full-text available) and findings thematically analysed. Results: Forty-five papers from 14 countries were included. The majority (64.4 %) were published in Europe (31.1 % in the United Kingdom) between 2010 and 2021 (69 %), 60 % from 2013. Four qualitative themes (compassionate care, commitment, competence and communication) describe the impact of prior care experi-ence, which was variable.Conclusions: Evidence to support the effectiveness of prior care experience as a prerequisite for entry into nurse education to improve compassion, is inconsistent and insufficient. The literature displays methodological limi-tations and conclusions should be interpreted in light of these caveats. Recommendations are made for future research, to improve quality and comparability.

What to do to get your voice heard by politicians and policymakers whose decisions affect your working life and quality of care

Background As COVID-19 hit the UK, it was apparent that frontline healthcare workers would be faced with challenges they had never encountered before. The longer-term leadership support needs of nurses and midwives were considered central to how they would psychologically emerge from the COVID-19 response. In response, a national leadership support service for nurse and midwife leadersat all levels, was rapidly established. Methods A collaborative approach was used, drawing from an established community of healthcare leadership development consultants and senior healthcare leaders. Practical plans for how the service would run were formulated via online meetings, held between February and March 2020. An internal questionnaire was distributed to attendees, requesting demographic data and feedback to capture the perceived impact of the service on leadership. Results Overall, confidence in leadership ability/skills increased after attending the service; 68.8% of those who completed post-attendance questionnaires reported having learnt new leadership skills and a motivation to facilitate co-consulting sessions for their teams. The service was positively appraised and there were reports of a degree of influence on leadership, and improved confidence after attending. Conclusion Leadership and well-being support provided by an independent and external organisation can offer a unique and safe forum for reflection and for healthcare leaders to decompress. This requires a sustainable investment to mitigate the predicted impact of the pandemic.

AIM:To identify and describe the impact areas of a newly developed leadership development programme focussed on positioning leaders to improve the student experience of the clinical learning environment. BACKGROUND:There is a need to consider extending traditional ways of developing leaders within the clinical learning in order to accommodate an increased number of students and ensure their learning experience is fulfilling and developmental. The Florence Nightingale Foundation implemented a bespoke leadership development programme within the clinical learning environment. Identifying the areas of impact will help to inform organisational decision making regarding the benefits of encouraging and supporting emerging leaders to undertake this type of programme. METHOD:For this qualitative descriptive study, eight health care professionals who took part in a bespoke leadership development programme were interviewed individually and then collectively. The Florence Nightingale Foundation fellowship/scholarship programme is examined to determine impact. RESULTS:Two key themes were described in relation to impact of the programme. These were 'Personal Development' and 'Professional Impact'. The two key themes comprised several subthemes. The notion of time and space to think was subsumed within each theme. CONCLUSION:Data highlights that the Florence Nightingale Foundation programme had a distinct impact on participants by transforming thinking and increasing self-confidence to enable changes to make improvements both within their organisations and at national level. IMPLICATIONS FOR NURSING MANAGEMENT:Health care managers must continue to invest in building leadership capacity and capability through programmes that can help position individuals to realize their potential to positively influence health outcomes and wider society.

Aim: To describe the common elements of Graduate Entry Master of Nursing curricula and identify a set of standards and quality indicators for benchmarking purposes within and across jurisdictions. Background: Internationally, there has been an increase in universities offering Graduate Entry Masters programs in Nursing. Such programs specify a bachelor degree as an entry requirement and then offer an intensive program of study that prepares graduates for registration as a nurse. To date, no formal standards exist to guide evaluation of these curricula. Design: A two phased sequential mixed-methods design comprising thematic content analysis of curricula and a Delphi study. The setting was the Australian and New Zealand tertiary education sectors. Participants were nurse academics who were recruited to participate in the Delphi study. Quota sampling was used to identify educators from the education providers meeting organisational inclusion criteria (program coordinator and one lecturer working as a subject coordinator of the program) and nominated by their Head of Department. Methods: Phase One of the study involved a thematic analysis of the curricula of nine Graduate Entry Master of Nursing programs to identify common elements of curricula and domains of quality. In Phase Two these themes were used in a series of Delphi rounds to identify a set of agreed quality domains, statements and indicators. Results: Participants (n = 16) responded over three Delphi rounds. A total of nine domains of quality were determined, a set of 26 quality statements were identified based on the acceptance threshold of > 75% level of agreement and 27 quality indicators were established. Conclusions: Our research provides an agreed set of indicators for evaluating the quality of Graduate Entry Master of Nursing programs. This work will also make it possible to measure the immediate and longer-term impacts of Graduate Entry Master of Nursing programs for the nursing workforce. Future work must focus on testing feasibility and optimising utility while refining indicators across jurisdictions.

Global mobility, technological developments, and evolved organizational design have expanded the scope of workplace teams beyond traditional arrangements, giving rise to global virtual teams. As universities across the world encourage mobility, there are unprecedented opportunities to create discipline-specific international networks, increase cross-cultural understanding, and create rich interactions in research. Team structure, trust formation, and communication processes are known to positively influence global virtual team performance. They are discussed to illustrate the value of a structured model of work in an international research-focused collaboration of nursing academics from the United States, the United Kingdom, and Australia.

BACKGROUND:There is a need for higher education policy to consider how student nurses might be supported to help them to develop the resilience and mental wellbeing needed to cope with stressful environments. Reviews and qualitative research in this area suggest that compassion can improve wellbeing, however, compassion-based feedback is yet to be explored as a pedagogical intervention using quantitative methods.PURPOSE:To explore the effect of different feedback types on subjective wellbeing.METHODS:In this experimental design, nursing students were presented with three feedback types, 'compassion-based feedback, simple descriptive feedback, and utilitarian feedback' and were asked to provide post-trial ratings of subjective wellbeing, in relation to each type, whilst undertaking a nursing-related task. Participants also rated the helpfulness of 'Type of Feedback'.RESULTS:We report a significant difference of 'Type of Feedback' with higher ratings of wellbeing when participants were presented with compassion-based feedback.CONCLUSION:Compassion-based feedback could lead to higher wellbeing in educational tasks related to nursing.