Purpose This article presents a reflective account of Patient and Public Involvement (PPI) in the development of obesity and binge eating research. Method We established Patient Advisory Groups (PAGs) at two English regional National Health Service (NHS) weight management services. PPI was evaluated as follows: (i) PAG members completed a Post Participation Evaluation Questionnaire, (ii) PAG meetings captured group discussion on PPI involvement, (iii) practitioner and researchers produced written reflections on PPI and (iv) sources one to three were consolidated during reflections that took place via e-mail and telephone correspondence between researchers and practitioners, culminating in a summary SKYPE meeting between one practitioner and one researcher involved in the PAGs. Results Results in the form of reflections suggest guidelines on undertaking PPI were helpful with regard 'what to do', but less helpful on 'how'. For example, suggestions for the management of interpersonal factors such as eliciting self-disclosure and managing power differentials are insufficiently addressed in existing guidelines. Conclusions The present case study illustrated how interpersonal considerations can help or hinder the optimal use of PPI. Recommendations for practitioners and researchers planning PPI are offered.

Background: This study was undertaken in response to concerns that mentors who assessed practical competence were reluctant to fail student nurses which generated doubts about the fitness to practise of some registered nurses. Limited evidence was available about the experiences of mentors who had failed underperforming students and what had helped them to do this.Aim: To investigate what enabled some mentors to fail underperforming students when it was recognised that many were hesitant to do so.Method: An ethically approved, grounded theory approach was used to explore thirty-one nurses' experiences of failing student nurses in practical assessments in England. Participants were recruited using theoretical sampling techniques. Semi-structured interviews were conducted. Analysis was undertaken using iterative, constant comparative techniques and reflexive processes. The theoretical framework which emerged had strong resonance with professionals.Findings: Five categories emerged from the findings: (1) Braving the assessment vortex; (2) Identifying the 'gist' of underperformance; (3) Tempering Reproach; (4) Standing up to scrutiny; and (5) Drawing on an interpersonal network. These categories together revealed that mentors needed to feel secure to fail a student nurse in a practical assessment and that they used a three stage decision making process to ascertain if this was the case. Many of the components which helped mentors to feel secure were informal in nature and functioned on goodwill and local arrangements rather than on timely, formal, organisational systems. The mentor's partner/spouse and practice education facilitator or link lecturer were identified as the key people who provided essential emotional support during this challenging experience.Conclusion: This study contributes to understanding of the combined supportive elements required for robust practical assessment. It presents a new explanatory framework about how mentors formulate the decision to fail a student nurse and the supportive structures which are necessary for this to occur. (C) 2016 Elsevier Ltd. All rights reserved.

There is growing evidence of a culture of expectation among nursing students in Universities which leads to narcissistic behaviour. Evidence is growing that some student nurses are disrespectful and rude towards their university lecturers. There has been little investigation into whether they exhibit similar behaviour towards their mentors during practical placements, particularly when they, the students, are not meeting the required standards for practice. This paper focuses on adding to the evidence around a unique finding that student nurses can use coercive and manipulative behaviour to elicit a successful outcome to their practice learning assessment (as noted in Hunt et al. (2016, p 82)).Four types of coercive student behaviour were identified and classified as: ingratiators, diverters, disparagers and aggressors, each of which engendered varying degrees of fear and guilt in mentors. The effects of each type of behaviour are discussed and considered in the light of psychological contracts. Mechanisms to maintain effective working relationships between student nurses and mentors and bolster the robustness of the practical assessment process under such circumstances are discussed. (C) 2016 Elsevier Ltd. All rights reserved.

BackgroundPeer support is valued by its users. Nevertheless, there is initial low take-up of formal peer support programmes among patients with chronic kidney disease (CKD), with fewer patients participating than expressing an interest. There is little evidence on reasons for low participation levels. Few studies have examined the perspectives of carers.ObjectiveTo explore with CKD patients and carers their needs, wants and expectations from formal peer support and examine how barriers to participation may be overcome.MethodsQualitative interviews with a sample of 26 CKD stage five patients and carers. Principles of Grounded Theory were applied to data coding and analysis.SettingSix NHS Hospital Trusts.ResultsWhilst informal peer support might occur naturally and is welcomed, a range of emotional and practical barriers inhibit take-up of more formalized support. Receptivity varies across time and the disease trajectory and is associated with emotional readiness; patients and carers needing to overcome complex psychological hurdles such as acknowledging support needs. Practical barriers include limited understanding of peer support. An attractive peer relationship is felt to involve reciprocity based on sharing experiences and both giving and receiving support. Establishing rapport is linked with development of reciprocity.ConclusionsThere is potential to facilitate active uptake of formal peer support by addressing the identified barriers. Our study suggests several facilitation methods, brought together in a conceptual model, including clinician promotion of peer support as an intervention suitable for anyone with CKD and their carers, and opportunity for choice of peer supporter.

Over the last decade, design for behaviour change has become increasingly recognised as a strategy for enabling social change. Despite this, we are far from understanding its implementation, especially through the private and public sectors. This study has surveyed private and public sector stakeholders with regard to their current knowledge of, and approach to, design for behaviour change. The aim was to identify the challenges for professional stakeholders in understanding, accessing and implementing design for behaviour change. Underpinned by a literature review of design for behaviour change theories and approaches, an online survey and two focus groups with private and public sector stakeholders were conducted with particular focus on small and medium size enterprises (SMEs). The results identified that there is a significant disconnect between available theoretical knowledge of design for behaviour change and its practical implementation. Reasons for this include a lack of awareness and common language, of evidence based examples, and of evaluation methods and inter-sector collaborations. In response, a set of recommendations has been developed to propose ways forward for the wider understanding and application of design for behaviour change.

Based on the responses of 74 interviews from 7 dialysis centres, Ian Davison, Sandra Cooke and Robin Gutteridge argue that shared care shouldn't just be seen as a stepping-stone to home haemodialysis. Reasons for this include increased job satisfaction of nursing staff and ultimately more patients dialysing at home. Six organisational recommendations are made to promote vibrant shared care environments

Previous research suggests for patients who are able and willing, it is cheaper and better health-wise to do their haemodialysis at home than for it to be done by nurses in a centre. Patients doing some of their own dialysis in centres (self management) could be a stepping stone to dialysing at home. The aim of this study was to investigate whether the way nurses care for, educate and train patients encourages self management and home haemodialysis. Interviews were undertaken in three hospital and four satellite units across two hospital Trusts in the West Midlands. A total of 75 people were interviewed: 30 patients, 1 consultant, 6 nurse managers and 38 staff nurses. The main findings were: 1) All nurses do a great job caring for their patients. Some enthusiastically encourage independence and home haemodialysis, but most do not. There is no education or training specifically for this. 2) Most nurses educate patients by giving dietary and lifestyle advice; for those training to dialyse at home, the focus is on mastering the complex technique. Initially this is probably good, but can lead to superficial, fragmented knowledge and doesn’t help patients take control. However, some staff want to develop patient independence to increase their confidence, feeling of usefulness and understanding of their illness. This rehabilitation role is stressful, goes against the caring culture, but is needed to encourage patients to look after themselves. 3) Decisions are made by the doctors and nurses, but shared decision making is needed to help patients look after themselves e.g. by interpreting monthly bloods or suggesting dialysis parameters before the nurse does. 4) Some patients are understandably frightened of dialysing on their own, so they should gradually learn to do this safely monitored by nurses before being asked whether they want to dialyse at home. 5) In several centres, patients expect to be passive: this needs to change. If all patients do what they can, then more will slowly become independent.

This study was undertaken in response to concerns raised by Duffy (2003) that assessors of practice were reluctant to fail student nurses in assessments. This generated doubts about the fitness to practice of some registered nurses. An investigation was undertaken into whether quantitative evidence supported the view that pre-registration nurses rarely failed practical assessments. Comparative failure rates from theoretical and practical assessments were requested from all 52 universities in England that offered pre-registration nursing programmes. Responses were received from 27. Findings indicated that a very small proportion of students failed practical assessments; failure rates for theory outstripped practice by a ratio of 5:1. A quarter of universities failed no students in practice. Students were most likely to fail in year one and least likely in year three. This study supports the belief that assessors of practice are reluctant to fail student nurses. It raises a number of questions about the influence that the systems and practices of professional bodies and universities have on practical assessment. However it also indicates that some student nurses have failed practical assessments and that some universities do have systems in place to address this issue.

We conducted a systematic search of qualitative research into the individual’s experience of chronic low back pain. Two reviewers independently read through 740 unique abstracts. Inter-rater reliability was fair. The final sample comprised 19 articles which we critiqued using the Critical Appraisal Skills Programme checklist. This article focuses on the critical appraisal. Limitations include a lack of an adequate rationale for the theoretical framework, a lack of an account for the decisions made across recruitment and data collection, and a lack of reflexivity. Finally we discuss and offer recommendations for reflexivity and the explication of qualitative methodology in research articles.

This paper evaluates the use of storyboarding within a classroom setting as a means of addressing end of life issues and engaging second year student nurses in creative, critical thinking and deeper reflection on practice. Storyboarding is a process that was developed to encourage learners to use the creative right brain and the critical left brain to formulate ideas in front of a group and then to look at those ideas critically (Lottier, 1986). The session was evaluated using a questionnaire and group discussion to elicit perceived learning from students. The activity was to create the storyboards in small groups, then review the content generated by discussion with the whole group. Main themes identified by the students included breaking bad news, dealing with cardiac arrest situation, coping with families following bereavement and the dying patient. Evaluation of the teaching session suggested that students found storyboarding helped to identify cultural aspects and feelings related to the dying patient. Students valued sharing with each other and the opportunity to have their experiences heard. It was noted that although this method provided as valuable learning experience for the student it is staff and time intensive and attention is required to establish a climate of trust and safety. The risk of exposing unexpected emotions within individual students appears no greater than with other approaches to teaching about loss, death and dying.

As part of a larger evaluation study, 20 members of staff in a Faculty of Health were interviewed about the impact of service user and carer involvement on learning and teaching. A qualitative approach was adopted and semi-structured interviews were used to explore current levels of involvement, barriers and solutions. The data generated was analysed using the principles of grounded theory. Findings suggest respondents recognised the requirement to involve service users and carers in their learning activities. Most wanted to develop this aspect of their educational provision but a number of barriers were described. Strategic and operational solutions were proposed to overcome these and respondents were positive about achieving meaningful involvement.

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Barbara Sherman, Sex, Intimacy and Aged Care, Jessica Kingsley Publishers, London, 1999, £13.95 195 pp., pbk, ISBN 1 85302 784 7. Raul C. Schiavi. Aging and Male Sexuality, Cambridge University Press, 1999, 246 pp., no price pbk, ISBN 0 521 65391 6 - Volume 20 Issue 1