BACKGROUND:Sedation is a fundamental component of critical care and requires regular, accurate assessment to support its safe titration and minimise harm. International guidelines and local policy at the Wythenshawe Hospital's Cardiothoracic Critical Care Unit mandate hourly documentation of the Richmond Agitation-Sedation Scale (RASS). AIMS:This audit evaluated adherence to these standards and explored factors associated with documentation completeness and assessment accuracy. STUDY DESIGN:A prospective, cross-sectional audit of bedside RASS assessment was conducted without prior notification. Nursing RASS scores were compared with expert auditor ratings. Data were collected using an anonymous, secure, auditor-completed online survey. Statistical analysis examined the relationship between documentation completion and RASS accuracy. RESULTS:Seventy-six nursing assessments were included. Most nurses were Band 5, with a median of 3.5 years of experience. Patients were predominantly male, mechanically ventilated and receiving sedation. Overall, 75% of nurse RASS assessments (n = 57) were accurate; however, only 33% (n = 25) were documented hourly as required by policy. Greater nursing experience was associated with improved accuracy in RASS. Deeper sedation was associated with lower agreement between nurse and expert assessments. Higher self-reported confidence was associated with poorer completion of documentation. Most discrepancies were small, with nurse and expert ratings differing by one RASS point. CONCLUSIONS:This audit identified important gaps in the accuracy and documentation of nurse-led RASS assessment in a cardiothoracic critical care setting. The findings suggest that perceived familiarity and confidence may not be sufficient to ensure accurate and consistently documented sedation assessment. RELEVANCE TO CLINICAL PRACTICE:Suboptimal RASS documentation and scoring accuracy may limit reliable titration of sedation in critically ill patients and reduce the effectiveness of protocolised sedation strategies. These findings support targeted staff education, reinforcement of standardised assessment processes and improvements in documentation systems to strengthen sedation monitoring and patient safety.

BACKGROUND:This study explores patient preparedness and support during discharge following coronary artery bypass graft (CABG) surgery. Despite the importance of effective discharge planning, many patients feel unprepared and unsupported, which can hinder recovery and increase readmission risk. AIM:To examine patient experiences of the discharge process post-CABG, focusing on education received and perceptions of person-centred discharge planning. METHODS:A qualitative study using constructivist grounded theory was conducted with eleven participants, interviewed 4-6 weeks post-surgery at a UK Northern NHS hospital. Semi-structured interviews were digitally recorded, transcribed, and analysed using a constant comparative method. Recruitment, data collection, and analysis occurred concurrently. Despite the modest sample size, the study achieved strong information power as the research aim was narrow and clearly focused on exploring the lived experiences of patients who had had a coronary artery bypass graft. This allowed for in-depth engagement with each participant, with relevant experience, enhancing the relevance and the richness of the data. Thematic saturation was observed early in the analysis, indicating that the data sufficiently addressed the research questions. The use of a rigorous analytical approach further ensured that the insights drawn were both meaningful and robust, supporting the adequacy of the sample size. The COREQ checklist guided reporting. RESULTS:Four key themes emerged: Patients avoided seeking support or "making a fuss." Many felt unprepared for discharge. The information booklet was a valuable resource. Lack of post-discharge contact and continuity caused concern. Some participants reported insufficient pre-discharge information and unclear pathways for post-discharge support. The booklet was often the primary source of guidance. The participants' reluctance to seek support could reflect a pattern of self-management shaped by uncertainty, low confidence, a desire not to burden healthcare professionals or a belief that doctors know best. Yet many felt unprepared for discharge perhaps highlighting gaps in communication and discharge planning. There also seems a reliance on written materials, such as the information booklet. Limited post- discharge contact, created further anxiety, where patients were unsure where to turn for advice. These findings point to the need for clearer, more person‑centred discharge processes. Better communication, improved pre‑discharge education, and clear pathways for follow‑up support could strengthen patient confidence and safety. Although booklets are helpful, they should supplement and not replace ongoing contact and personalised guidance. Ensuring continuity of care and enabling patients to seek help without hesitation is essential for effective person‑centred discharge practice. CONCLUSION:Findings highlight the importance of person-centred approaches in discharge planning. Tailored education and support could improve patient confidence and symptom management during recovery, potentially reducing readmission rates.

Polypharmacy is highly prevalent among older adults and is associated with adverse drug events, functional decline, and increased healthcare utilisation. Digital medicines optimisation interventions including clinical decision support systems (CDSS), EHR-integrated tools, and emerging AI-enabled systems have been developed to support medication optimisation, yet their real-world effectiveness, adoption, and sustainability remain highly variable across healthcare settings. This review aimed to develop and refine explanatory programme theories that clarify how, why, and under what circumstances digital medicines optimisation interventions succeed or fail in optimising medication use among older adults with polypharmacy. A realist synthesis was conducted in accordance with RAMESES guidelines. Comprehensive searches of MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, and the Cochrane Library identified empirical and grey literature on digital medicines optimisation interventions. Databases were searched from inception to December 2025 to capture conceptually rich studies informing theory development across the evolution of digital decision support systems. Studies were included based on relevance and rigour for theory building rather than design hierarchy. CMO configurations were extracted and synthesised using abductive and retroductive reasoning, and findings were mapped onto a multi-level GEAR-up conceptual framework. Twenty-three studies were included, spanning primary care, hospital, community, and emergency settings. Seven programme theories were identified, explaining how workflow-aligned integration, alert relevance, human mediation, patient-centred alignment, organisational readiness, limits of automation, and transparency influence adoption, fidelity, sustainability, and conditional use of digital medicines optimisation tools. Most mechanisms driving uptake such as reduced cognitive burden, trust, and professional legitimacy operated at individual and care-team levels, while organisational and system-level contexts determined sustainability and scale-up. Digital medicines optimisation interventions are effective when aligned with clinical workflows, supported by interprofessional mediation, and reinforced by organisational and ethical governance structures. This realist synthesis provides theory-informed guidance to support the design, implementation, and scale-up of digital medicines optimisation strategies to enhance medication optimisation and patient safety in older adults with polypharmacy

Extracorporeal membrane oxygenation (ECMO) is an established technique for managing severe cardiorespiratory failure. However, it is invasive and requires profound analgo-sedation during initiation and often throughout the therapy. Managing sedation in venovenous (VV) ECMO patients is particularly challenging due to the impact of ECMO circuits on pharmacokinetics and specific patient requirements. This can lead to unpredictable sedative effects and require multiple drugs at higher doses. Additionally, sedation is usually managed with traditional scoring methods, which are subjective and invalid during neuromuscular blockade. These uncertainties may impact outcomes. Recent clinical practice increasingly focuses on reducing sedation to enable earlier physiotherapy and mobilisation, particularly in patients awaiting transplants or receiving mechanical circulatory support. In this context, processed electroencephalogram-based (pEEG) sedation monitoring might be promising, having shown benefits in general anaesthesia and intensive care. However, the technology has limitations, and its benefits in ECMO practice have yet to be formally evaluated. This review provides insights into the challenges of ECMO sedation, including pharmacokinetics, unique ECMO requirements, and the implications of inadequate sedation scores. Finally, it includes a brief overview of the practicality and limitations of pEEG monitoring during VV-ECMO, highlighting a significant research gap.

Background: A culturally diverse research workforce benefits patients, the community and the population as patients see health and care professionals who are like them and can build trusting relationships. From our experience, ethnic minority group nurses are less likely to attend research-related workshops and have significantly less awareness about clinical research funding and career pathways. This pilot project aimed to create awareness of clinical research terminology, methods and funding streams among ethnic minorities cardiothoracic nurses and allied health professionals (NAHPs) across specific geographical locations in England. Methods: Participants were invited using social media platforms to attend a research masterclass at various locations across England and 211 were registered but 92 attended. They were also invited to complete a pre- and postworkshop questionnaire to determine their understanding of the topics being taught during the masterclass. Data were collected and then compared before and after the masterclass. Results: A total of 63 out of 92 participants completed the workshop evaluation. There were 88% female and 11% male participants, aged 18 to 60+ years with different educational backgrounds. The participant's pre- and postresearch theory and skills knowledge demonstrated some significant changes after attending the Masterclass on understanding research terminologies (p < 0.001), how study aims, and objectives determine the study methodology (p < 0.001) and the difference between qualitative and quantitative research (p = 0.012). We also asked about the overall experience (98% said 10 out of 10), structure of the workshop (98% said 9 out of 10), venue, food and drinks (95% said 8 out of 10), communication/organisation (98% said 10 out of 10) and relevance of the workshops (100% said 10 out 10). Conclusions: Our study findings suggest that raising awareness about research careers, local/national funding opportunities and research masterclasses can improve NAHPs awareness of opportunities to gain skills and confidence in leading their own research to answer pertinent clinical and care questions related to their practice and ultimately improve patient care. In addition, this study identifies the gap in clinical research and funding among clinical staff, which is crucial for advancing evidence-based practice. Encouraging clinical healthcare staff to engage in clinical research will help foster an evidence-based culture.

Cardiac surgery patients may experience stress and anxiety, negatively impacting recovery. Pharmacological treatments are frequently used but may result in side effects. We aimed to assess the effectiveness of immersive virtual reality mindfulness and music therapy in reducing preoperative and postoperative anxiety. Between March and July 2024, 36 participants were randomised to 15 min of either virtual reality (n = 19) or music therapy (n = 17) preoperatively and on postoperative day 3. Primary endpoints were anxiety levels and salivary cortisol, assessed before and after intervention using the paired Wilcoxon test. Median age was 66 (interquartile range = 58-73); 64% were male. Both music therapy and virtual reality groups showed significant preoperative Spielberger State-Trait Anxiety Inventory score reductions after intervention: music therapy from 40 (30-48) to 23 (21-24) and virtual reality from 40 (31-54) to 23 (20-35) (both p < 0.001); there was no significant difference between groups (p = 0.7). Median virtual reality immersion and absorption scores were 90/100 (interquartile range = 80-90; 80-94). Cortisol levels did not significantly change. Postoperatively, 21 patients participated (virtual reality n = 11, music therapy n = 8), showing reduced anxiety: music therapy from 31 (26-32) to 23 (20-27), virtual reality from 33 (23-41) to 24 (22-30). Results show feasibility, tolerability, and preliminary evidence of anxiety reduction, supporting further research into music therapy and virtual reality for cardiac surgery patients. The trial was registered with the International Standard Randomised Controlled Trial Number Registry (ISRCTN51014051) (https://doi.org/10.1186/ISRCTN51014051).

Background: Approximately 40% of older women in the community report experiencing urinary incontinence (UI); prevalence within secondary care is unknown. Illness, comorbidities, and hospital environments are likely to lead to higher prevalence. Objectives: This study aimed to establish UI prevalence in older women admitted to hospitals and understand the views and knowledge of ward nurses in relation to older women’s UI. Design: An explanatory mixed methods study was conducted including a retrospective study of women ⩾55 years admitted to a large NHS hospital and qualitative interviews with nurses to gain an understanding of views, knowledge and perceptions of women’s UI and related care. Method: UI prevalence was determined using the nursing assessment (elimination) and International Classification of Diseases 10th Revision (ICD-10) codes for women ⩾55 years admitted to the hospital (November 2019 to February 2020); continence and demographic electronic patient care records data were extracted. Twenty ward nurses participated in interviews to explore views, knowledge and perceptions of UI care. Results: 11.0% ( n = 631) of the cohort (5,757) were recorded as having UI. Nurse interviews revealed six themes: (1) Normalisation and misconceptions of UI: nurses believed UI could not be improved, (2) limited knowledge and training: nurses expressed limited UI knowledge and a training need, (3) pad culture: continence pad use was high, (4) barriers to care: staffing issues were expressed as problematic, (5) UI under-reporting: nurses only categorised women with complete UI and others as “having an accident”, (6) catheter use in relation to UI: catheters were reported as a last resort. Conclusion: As community UI prevalence is 40%, our results (11%) suggest that UI is being underreported. Qualitative findings suggest that nurses have limited knowledge and training on continence care and under-report based on UI misconceptions. Our results suggest that ward nurses require dedicated UI training based on older women’s needs.

Abstract Background The Cardio-Thoracic (CT) professional group experienced a significant increase in stress and workload during and after the COVID-19 pandemic. The Society for Cardiothoracic Surgery (SCTS) in Great Britain and Ireland with the aim of endorsing positive change. Aim of this project was to understand the Mental Health (MH) and wellbeing status of the CT professionals and to explore Virtual Reality Mindfulness as an intervention to improve MH and wellbeing. Methods In February 2022, the SCTS created a Mental Health and Wellbeing Working Group to identify the problem and find solutions. This exploratory project was carried out in two stages. Stage one was an online survey conducted in March 2022 and stage two was a Virtual Reality (VR) mindfulness workshop in March 2023, using the Rescape™ VR mindfulness tool. Results Stage one: An online QR code survey was sent out to 150 members with 129 (86%) completed responses. 92% expressed that SCTS should create awareness about mental health and wellbeing. 99% said that they should be allowed to speak up and create interventions for members to access, support and relax. Three main themes identified about why CT staff do not discuss their Mental Health problems were fear of lack of awareness (72%), lack of confidentiality (60%) and impact on career (60%). Stage two: 88 members attended the VR session of which 76 (86%) completed the anonymous questionnaire. 97% reported usage was a pleasurable experience, 91% felt more relaxed, 82% felt less stressed, 90% felt calmer and 89% had their mood enhanced. Conclusion Our study findings indicate that CT staff experience considerable effects on their mental health and wellbeing. However, there is a hesitancy to recognise and seek assistance due to concerns about confidentiality and career repercussions. The virtual reality mindfulness session served as a beneficial supplement, with a positive impact in this pilot cohort.

Policy and research literature worldwide support the need to build research capacity and capability among non-medical practitioners within healthcare systems. However, there exists a paucity of evidence on whether practitioners in cardiothoracic surgery are attuned to this and on what barriers or enablers exist. A survey was carried out with non-medical practitioners working in cardiothoracic surgery in the United Kingdom to explore attitudes towards health research and audit, and to identify current challenges and barriers to surgical research and audit as perceived by cardiothoracic nurses and allied health professionals. A total of 160 completed questionnaires were returned. 99% of respondents supported the need for research and believed that evidence-based surgical care improves outcomes for patients. Seventy-two percent reported that their employer motivates them to take part in national research or audit but, only 22% were allocated time to do so within their role; 96% reported their interest in being involved in research and audit, yet only 30% believed they had the skills to undertake research, and 96% reported needing additional training. More work is needed to increase awareness, capacity and capability among cardiothoracic surgery care practitioners, and indeed other specialities to achieve research progress.

OBJECTIVES:Many women attempt to manage urinary incontinence (UI) independently with variable success while health professionals may be unaware of their needs. This study aimed to (1) understand older women's experiences of UI, their self-management strategies and support needs; (2) explore health professionals' experiences of supporting women and providing relevant services and (3) combine their experiences contribute to development of a theory-based and evidence-based self-management package for UI.DESIGN:Qualitative semi-structured interviews were conducted with 11 older women with UI and 11 specialist health professionals. Data were analysed independently using the framework approach, then synthesised in a triangulation matrix to identify implications for content and delivery of the self-management package.SETTING:Community centres, community continence clinic and urogynaecology centre of a local teaching hospital in northern England.PARTICIPANTS:Women aged 55 years and over who self-reported symptoms of UI and health professionals delivering UI services.RESULTS:Three overarching themes emerged. Older women see UI as a 'fact of life' but many struggle with it: women typically considered UI as part of ageing yet expressed annoyance, distress, embarrassment and had made significant lifestyle changes. Access to information and limited high-quality professional support: health professionals provided specialist UI care and information. Yet less than half of women accessed specialist services, those who had, highly valued these services. 'Trial and error' with different self-management strategies: women had tried or were using different strategies (continence pads, pelvic floor exercises, bladder management and training, fluid management and medication), with mixed success. Health professionals provided evidence-based, personalised support and motivation.CONCLUSIONS:Findings informed the content of the self-management package that focused on providing facts, acknowledging challenges of living with/self-managing UI, sharing others' experiences, using motivational strategies and self-management tools. Delivery preferences were independent use by women or working through the package with a health professional.

Introduction Urinary incontinence (UI) is associated with increasing age and is more frequently experienced by women. Despite 40% prevalence in the community, little is known about the prevalence/incidence of UI in older women during hospital admission. UI during hospital admissions, within this group, has also been under-researched in terms of its relationship to specific clinical conditions and mortality rates. Given that UI has serious implications for both patient care and women’s general health and well-being on discharge, this protocol describes a planned research project which aims to determine mortality, morbidity, prevalence and incidence of UI in older women (≥55 years) during hospital admission to inform nursing practice. Additionally, it aims to explore the experience of nurses who deliver women’s care.Methods and analysis This is an explanatory mixed-methods study consisting of two phases: (1) retrospecitive analysis of electronic patient care records (EPCR) to determine prevalence/incidence of UI, clinical conditions most likely associated with UI and any associations between UI and death, (2) nurse interviews to explore views, knowledge and perceptions of performing the nursing assessment and providing care for older women (≥55 years) with UI during admission. EPCR will be gained from a National Health Service (NHS) teaching hospital. Nurse interviews will be conducted with nurses from an alternative but similar-sized NHS hospital.Ethics and dissemination Ethical approval is provided by the University of Salford Ethics Committee and regulatory approval by the NHS Health Research Authority (Integrated Research Application System project ID: 303118). Local NHS trust approval to access electronic care records for the purposes of analysis of anonymised data has been provided by one of the two collaborating NHS hospitals. Findings will be disseminated through open-access geriatric or urogynaecology journals and presented to relevant stakeholders at local, national and international meetings including scientific meetings such as the UK Continence Society and International Continence Society.

Background: Up to 40% of older women living in the community experience urinary incontinence. In community settings, urinary incontinence impacts the quality of life, morbidity, and mortality rates. However, little is known about urinary incontinence and its impact on older women admitted to hospitals. Objectives: This scoping review aims to establish the current knowledge of urinary incontinence during hospital admission for women (⩾ 55 years of age) with three key objectives: (a) What is the prevalence/incidence of urinary incontinence? (b) What health conditions are associated with urinary incontinence? (c) Is there an association between urinary incontinence and mortality? Eligibility criteria: Empirical studies were included in assessing the incidence/prevalence of urinary incontinence during hospital admissions and its related morbidities and mortality rates. Studies which only included men or younger women (< 55 years of age) were excluded. Only articles written in English and conducted between 2015 and 2021 were included. Sources of evidence: A search strategy was developed, and CINAHL, MEDLINE, and Cochrane databases were searched. Charting methods: Data from each article meeting the criteria were pulled into a table, including study design, study population, and setting, aims, methods, outcome measures, and significant findings. A second researcher then reviewed the populated data extraction table. Results: Overall, 383 papers were found: 7 met inclusion/exclusion criteria. Prevalence rates ranged from 22% to 80% depending on the study cohort. Several conditions were associated with urinary incontinence, including frailty, orthopaedics, stroke, palliative care, neurology, and cardiology. There was a potential positive association between mortality and urinary incontinence, although only two papers reviewed reported mortality. Conclusion: A dearth of literature determined the prevalence, incidence, and mortality rates for older women admitted to hospitals. Limited consensus on associated conditions was found. Further research is needed to fully explore urinary incontinence in older women during hospital admissions, particularly concerning prevalence/incidence and its association with mortality.

AIM:To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID-19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health-related quality of life and cost-effectiveness.DESIGN:Parallel two-arm, cluster-level randomized controlled trial.METHODS:Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID-19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient-reported co-primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention-to-treat analyses.RESULTS:We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570-572 (98.1%-98.5%) patient participants in 14 clusters. We found no evidence of between-group differences on any patient, nurse or economic outcomes. We found between-group differences over time, in favour of the intervention, for three of our five co-primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the 'other' ethnicity subgroup.CONCLUSION:We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non-white British patients' experience of care.IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required.IMPACT:Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non-white British patients' experience of care.REPORTING METHOD:CONSORT and CONSERVE.PATIENT OR PUBLIC CONTRIBUTION:Patients with experience of hospitalization with COVID-19 were involved in guideline development and writing, trial management and interpretation of findings.

Apps for depression can increase access to mental health care but concerns abound with disparities between academic development of apps and those available through app stores. Reviews highlighted ethical shortcomings of these self-management tools, with a need for greater insight into how ethical issues are experienced by users. We addressed these gaps by exploring user reviews of such apps to better understand user experiences and ethical issues. We conducted a thematic analysis of 2,217 user reviews sampled from 40 depression apps in Google Play and Apple App Store, totaling over 77,500 words. Users reported positive and negative experiences, with ethical implications evident in areas of benefits, adverse effects, access, usability and design, support, commercial models, autonomy, privacy, and transparency. We integrated our elements of ethically designed apps for depression and principles of nonmaleficence, beneficence, justice, autonomy, and virtue, and we conclude with implications for ethical design of apps for depression.

AbstractAimsTo identify strategies used by registered nurses and non‐registered nursing care staff in overcoming barriers when providing fundamental nursing care for non‐invasively ventilated inpatients with COVID‐19.DesignOnline survey with open‐ended questions to collect qualitative data.MethodsIn August 2020, we asked UK‐based nursing staff to describe any strategies they employed to overcome barriers to delivering care in 15 fundamental nursing care categories when providing care to non‐invasively ventilated patients with COVID‐19. We analysed data using Framework Analysis.ResultsA total of 1062 nurses consented to participate in our survey. We derived four themes. 1) Communication behaviours included adapting verbal and non‐verbal communication with patients, using information technology to enable patients’ significant others to communicate with staff and patients, and establishing clear information‐sharing methods with other staff. 2) Organizing care required clustering interventions, carefully managing supplies, encouraging patient self‐care and using ‘runners’ and interdisciplinary input. 3) Addressing patients’ well‐being and values required spending time with patients, acting in loco familiae, providing access to psychological and spiritual support, obtaining information about patients’ wishes early on and providing privacy and comforting/meaningful items. 4) Management and leadership behaviours included training, timely provision of pandemic information, psychological support, team huddles and facilitating regular breaks.ConclusionsOur respondents identified multiple strategies in four main areas of clinical practice. Management and leadership are crucial to both fundamental care delivery and the well‐being of nurses during pandemics. Grouping strategies into these areas of action may assist nurses and leaders to prepare for pandemic nursing.ImpactAs these strategies are unlikely to be exclusive to the COVID‐19 pandemic, their global dissemination may improve patient experience and help nurses deliver fundamental care when planning pandemic nursing. However, their effectiveness is unknown. Therefore, we are currently evaluating these strategies in a cluster randomized controlled trial.

OBJECTIVES:Assess the effectiveness of 5* GRIP-rated slip-resistant footwear in preventing slips in the workplace compared to usual footwear (control group). METHODS:A multicentre, randomised controlled trial; 4553 National Health Service (NHS) staff were randomised 1:1 to the intervention group (provided with 5* GRIP-rated slip-resistant footwear) or the control group. The primary outcome of incidence rate of self-reported slips in the workplace over 14 weeks was analysed using a mixed-effects negative binomial model. Secondary outcome measures included incidence rate of falls from a slip, falls not from a slip, proportion of participants reporting a slip, fall or fracture and time to first slip and fall. RESULTS:6743 slips were reported: 2633 in the intervention group (mean 1.16 per participant, range 0 to 36) and 4110 in the control group (mean 1.80 per participant, range 0 to 83). There was a statistically significant reduction in slip rate in the intervention group relative to the control group (incidence rate ratio (IRR) 0.63, 95% CI 0.57 to 0.70, p<0.001). Statistically significant differences, in favour of the intervention group, were observed in falls from a slip (IRR 0.51, 95% CI 0.28 to 0.92, p=0.03), the proportion of participants who reported a slip (OR 0.58, 95% CI 0.50 to 0.66, p<0.001) or fall (OR 0.73, 95% CI 0.54 to 0.99, p=0.04) and time to first slip (HR 0.73, 95% CI 0.67 to 0.80, p<0.001). CONCLUSIONS:The offer and provision of 5* GRIP-rated footwear reduced slips in NHS staff in the workplace. TRIAL REGISTRATION NUMBER:ISRCTN33051393.

Background: In Great Britain, 100,000 injuries due to slips, trips and falls on the level (as opposed to falls from a height, e.g. a ladder) occur in the workplace each year. They are the most common cause of non-fatal injury in the workplace, accounting for 30% of all those injuries reported to the Health and Safety Executive. Nearly 1 million working days are lost because of slips, trips and falls each year. Objectives: To assess the clinical effectiveness and cost-effectiveness of 5-star, GRIP-rated, slip-resistant footwear in preventing slips in the workplace compared with usual footwear. Design: A two-arm, multicentre, randomised controlled trial with an economic evaluation and qualitative study. Setting: Seven NHS trusts in England. Participants: NHS staff aged ≥ 18 years, working at least 22.5 hours per week in clinical, general or catering areas who owned a mobile phone. Staff required to wear protective footwear were excluded. Interventions: Intervention participants were offered 5-star, GRIP-rated, slip-resistant footwear. The waiting list control group were asked to wear their usual work shoes for the duration of the study and were offered the trial footwear at the end of their participation. Main outcome measures: The primary outcome was the incidence rate of self-reported slips in the workplace over 14 weeks. Secondary outcomes included the incidence rate of falls either resulting from a slip or not resulting from a slip, proportion of participants reporting a slip, fall or fracture, time to first slip and fall, health-related quality of life and cost-effectiveness. Results: A total of 4553 eligible NHS staff were randomised (2275 to the intervention arm and 2278 to the control arm). In total, 6743 slips were reported [2633 in the intervention group (mean 1.16 per participant, range 0–36 per participant) and 4110 in the control group (mean 1.80 per participant, range 0–83 per participant)]. There was a statistically significant reduction in the slip rate in the intervention group relative to the control group (incidence rate ratio 0.63, 95% confidence interval 0.57 to 0.70; p < 0.001). Statistically significant reductions were observed in falls from a slip (incidence rate ratio 0.51, 95% confidence interval 0.28 to 0.92; p = 0.03), the proportion of participants who reported a slip (odds ratio 0.58, 95% confidence interval 0.50 to 0.66; p < 0.001) or fall (odds ratio 0.73, 95% confidence interval 0.54 to 0.99; p = 0.04) and the time to first slip (hazard ratio 0.73, 95% confidence interval 0.67 to 0.80; p < 0.001). Half of the intervention participants wore the shoes all the time at work. Incremental cost per quality-adjusted life-year in the base case was £38,900 from the NHS perspective and –£60,400 (i.e. cost saving) from the societal perspective. Limitations: This was an unblinded trial in which outcome data were participant self-reported, which may have led to inaccuracies in the reported slip data. Exposure to the trial footwear was lower than hoped. Conclusions: The offer and provision of 5-star, GRIP-rated footwear reduced slips in the workplace, was acceptable to participants and could be cost-effective. Future work: Replication of the study within other settings may be required to evaluate the clinical effectiveness and cost-effectiveness in other environments settings, such as catering and factories. Trial registration: Current Controlled Trials ISRCTN33051393. Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 3. See the NIHR Public Journals Library website for further project information. The Health and Safety Executive provided some research costs.

AbstractAimThis systematic review identifies, appraises and synthesizes the evidence on the provision of fundamental nursing care to hospitalized patients with a highly infectious virus and the effectiveness of adaptations to overcome barriers to care.DesignSystematic review.Data SourcesIn July 2020, we searched Medline, PsycINFO (OvidSP), CINAHL (EBSCOhost), BNI (ProQuest), WHO COVID‐19 Database (https://search.bvsalud.org/) MedRxiv (https://www.medrxiv.org/), bioRxiv (https://www.biorxiv.org/) and also Google Scholar, TRIP database and NICE Evidence, forwards citation searching and reference checking of included papers, from 2016 onwards.Review MethodsWe included quantitative and qualitative research reporting (i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID‐19, MERS, SARS, H1N1 or EVD or (ii) the views, perceptions and experiences of professional nurses and non‐professionally registered care workers who have provided that care. We included review articles, commentaries, protocols and guidance documents. One reviewer performed data extraction and quality appraisal and was checked by another person.ResultsOf 3086 references, we included 64 articles; 19 empirical research and 45 review articles, commentaries, protocols and guidance documents spanning five pandemics. Four main themes (and 11 sub‐themes) were identified. Barriers to delivering fundamental care were wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges of care. These barriers were addressed by multiple adaptations to communication, organization of care, staff support and leadership.ConclusionTo prepare for continuation of the COVID‐19 pandemic and future pandemics, evaluative studies of adaptations to fundamental healthcare delivery must be prioritized to enable evidence‐based care to be provided in future.ImpactOur review identifies the barriers nurses experience in providing fundamental care during a pandemic, highlights potential adaptations that address barriers and ensure positive healthcare experiences and draws attention to the need for evaluative research on fundamental care practices during pandemics.