Catriona Kennedy

Introduction: Globally, there is demand on police and emergency health services to respond to people in mental distress. Research at this intersect has focused on decriminalisation of people with severe mental health disorders, police custody care or interagency collaborative models. There is little understanding of the experiences of stakeholders where mental distress is not associated with a severe mental disorder or criminal offence. Aim: To determine current knowledge about safeguarding of people in mental distress supported by police and healthcare practitioners. Method: A rigorous integrative review with 10 databases was searched January 2002 to January 2024. Results: The search filtered 12,451 titles and abstracts with 41 full‐text articles appraised. Three overarching themes emerged: Safeguarding and care experiences of people in mental distress; intoxication, self‐harm and aggression; professional perspectives and responses to people in mental distress. Discussion: Experiences are varied. Whilst there is evidence of compassion, many reported negative experiences when self‐harm and intoxication are involved, inconsistent professional responses and gaps in emergency police and mental health systems. Implications for Practice: Unscheduled care and community mental health nurses have a vital role to play in identifying and influencing interdisciplinary gaps in out‐of‐hours emergency health and police processes to support people in mental distress to prevent repetitive distress cycles. This calls for an urgent re‐imagining of unscheduled care mental health pathways, Specifically, where practice gaps impact on people who are intoxicated yet do not require inpatient care. Relevance to Mental Health Nursing (for Peer Reviewers and Editors Only): People in mental distress (PiMD) who come to police attention often require an interdisciplinary response. Unscheduled care and community mental health nurses play a key role in this support. This integrative review suggests there are systems gaps and variety in mental health and policing practice for PiMD, particularly for those who are intoxicated and/or who do not need inpatient care. Some PiMD experience cyclical, and at times, undignified and unsafe care. These gaps should be addressed through service redesign and sharing of evidence across disciplines whilst listening to and responding to perspectives of those experiencing mental distress in our communities.

Extensive research reports caregiver burden and unmet needs when caring for a home‐dwelling family member at the end of life. Interventions are often decided by professionals and are less focused on family carers. There remains a gap in understanding family carers’ preferences for support in their caregiving role. This integrative review summarises family carers’ preferences for support when caring for a home‐dwelling family member at the end of life. We examined what helps family carers cope and the impact of the organisation of end‐of‐life care on their experiences. Seven databases were searched between January 2011 and March 2024. Thirty‐seven articles were included in this review. Data were thematically analysed. ‘Care continuity’ at the end‐of‐life features prominently and underpins four themes: (1) Family carers see themselves as a partner in care to ensure their loved one’s needs were prioritised; (2) balancing the needs of their loved one alongside their caregiving responsibilities and attending to their own psychosocial needs was challenging; (3) timeliness of access to information, knowledge and appropriate services through the illness trajectory and shared decision‐making were important in helping them cope; and (4) preparedness when death was imminent in terms of dealing with the dying process and support beyond bereavement. ‘Care continuity’ can be conceptualised as personal and relational continuity (at microlevel, it is about individuals building relationships with healthcare professionals through recognising their carer’s role, access to contactable and knowledgeable staff and agreed care plan), informational continuity (micro‐ and mesolevel refer to effective transfer of information and knowledge between individuals and between services) and organisational continuity (mesolevel is about organised and coordinated care, early involvement of specialist palliative care and bereavement support). Health professionals should recognise that meeting the needs of family carers is inextricably linked to addressing the needs of their loved ones.

Aim(s): To explore the impact of the COVID‐19 pandemic on nurse's well‐being, experiences of delivering healthcare within acute settings and their emotional management.Design: Sequential mixed methods.Methods: February to July 2021 an online well‐being survey was disseminated to nurses working in acute settings within one Scottish health board. In‐depth interviews with a purposive sample of respondents were conducted. Survey data were analysed descriptively, and interview data using Framework analysis and emotional management as the theoretical framework.Results: Well‐being was poor overall. Infection control measures impeded interactions, with loss of connection between patients, families and nurses. Emotional work was extended in caring for patients and families when visits were forbidden or restricted. Disconnect between colleagues was intensely felt. On COVID and non‐COVID wards, nurses were caring for patients with a significantly reduced workforce and often outside their clinical speciality. Nurses masked their own anxieties, fears, moral distress and exhaustion on the ward. Communal ‘backstage’ spaces, were reduced to enable more infection‐control space but reduced opportunity for collegial support. Formal psychological intervention required access after shift, and/or nurses feared they could not contain their emotions afterwards.Conclusion: Working during the pandemic was emotionally and physically demanding for those in COVID a.nd non‐COVID wards. Unintended consequences of infection control measures significantly extended nurses' emotional management, by caring for isolated patients and families but impeding opportunities to care for each other, compounding their emotions.Implications for the Profession: There is a need to value emotional work in nursing to better support mental well‐being.Impact: We advance the nursing emotional management literature by addressing the gap of exploration in challenging conditions. The importance of emotional management on nurses' mental well‐being has been overlooked but focusing on this in the next crisis could improve nurse's well‐being.Patient or Public Contribution: No patient or public contribution.Reporting Method: GRAMMS.

Introduction: Evidence examines how persons experiencing Long COVID (LC) struggle to secure healthcare for symptoms. However, few studies examine healthcare workers experiencing LC, nor the complex and multiple difficulties faced when seeking and receiving healthcare.Methods: This study is based on two phases of longitudinally conducted qualitative interviews, 6 months apart, with National Health Service (NHS) workers experiencing LC, from different occupational roles at NHS locales in Scotland (first interviews, n = 50; second interviews, n = 44).Results: Multiple factors restricted healthcare access, including worries about pressuring the NHS and concerns over LC being legitimised. When healthcare was sought, workers struggled to secure support, referrals and treatment. The following reasons were included: (1) context: the restrictive pandemic healthcare context; (2) illness climate: low GP knowledge surrounding LC and how this could be treated, trends for ascribing symptoms to other causes and reluctance to diagnose LC; (3) sense‐making of LC: healthcare availability linked to occupational role identity. To visualise and examine healthcare barriers, candidacy theory is applied, drawing inferences between healthcare context, illness climate, sense‐making and identities.Conclusion: NHS workers' complex journeys represent Disrupted Candidacy, intersecting challenges across candidacy domains, restricting the seeking and receiving of LC healthcare. Findings provide insights into why NHS workers resisted and withdrew from healthcare‐seeking, and the barriers they faced when attempting to secure LC support. This study presents a pathway for future LC illness research to use a modified candidacy theory framework.Patient and Public Contribution: This research focuses on amplifying and learning from lived experiences, and the voices of NHS workers in Scotland experiencing LC. Interviews represent primary data for this study; thus, participants and their healthcare journeys are centred in this research and all aspects of production, reporting and output. Explicit discussions of stakeholder group involvement are highlighted in the methods section.

Introduction: International policies and legislation set a precedence of person-centred sustainable integrated Health and Social Care (HSC) that meets the health and wellbeing needs of service users through improved experiences. However, current research focuses on service models, with fewer studies investigating experiences and needs.Methods: This qualitative multi-case [n = 7] study was co-designed with key stakeholders and aimed to explore experiences and needs of people who access and provide HSC at home. Data were collected in a regional area of Scotland (UK) via single [n = 10] or dyad [n = 4] semi-structured interviews with service users [n = 6], informal carers [n = 5] and HSC staff [n = 7] and synthesised using Interpretive Thematic Analysis.Findings: Interpersonal connections and supportive relationships were instrumental in helping all participant groups feel able to cope with their changing HSC needs and roles. They promoted reassurance, information sharing and reduced anxiety; when they were lacking, it negatively impacted upon experiences of HSC.Discussion: Promoting inter-personal connections that encourage supportive relationships between people who access and provide HSC and their communities, could promote person-centred Relationship-based care and improve HSC experiences.Conclusions: This study identifies indicators for improved HSC, advocating co-produced community-driven services to meet the self-defined needs of those who access and provide care.

Aim: To evaluate adoption, implementation and maintenance of the Queen's Nursing Institute Scotland development programme.DesignA comprehensive, longitudinal, qualitative evaluation. Method: Participants from the first two cohorts were interviewed at different stages to explore adoption, implementation and maintenance. Managers of participants engaged in interviews to explore service changes. Facilitators took part in a focus group exploring delivery. A member-checking event was held. Data collection was between March 2017 and October 2019. Data analysis was thematically followed by the application of Normalization Process Theory. Result: Ninety-four interviews, two focus groups and a member-checking event were conducted. Prior to the programme most participants were burnt-out and considering leaving. Engaging led to a journey of self-discovery and transformation. The programme was perceived to change their way of thinking, personally and professionally, unlike any training and development previously experienced. Participants were rejuvenated and reinvigorated, sharing their learning with colleagues, service users and family, implementing new working practices and furthering their careers. They developed communities of practice amongst their cohorts with strong bonds; enabling them to build and sustain learnings. Conclusion: Participants experienced a journey of self-discovery and transformation unlike anything before due to the personal investment in them. Participants were rejuvenated and reinvigorated with many moving into new roles. The programme equipped them with a range of leadership and resilience skills. Impact: The Queen's Nursing Institute Scotland Development Programme had a profound impact on participants, personally and professionally, which was perceived as lifelong. These findings and programmes are transferable beyond Scotland and to different professions.

An ethical value-action gap exists when there is a discrepancy between intentions and actions. For example, people who support environmental sustainability often use cars and short-haul flights because of convenience and time-pressure. This discrepancy may be caused by social and structural obstacles as well as cognitive biases. Current technology can make this worse. For example, social media tends to enhance emotions such as anger or fear, which can result in polarisation and impulsive decisions. Computational models of cognition and affect can provide insights into the value-action gap and how it can be reduced. Such models include dual process architectures, emotion models and behaviour change theories. In particular, metacognition (“thinking about thinking”) plays an important role in many of these models as a mechanism for self-regulation and for reasoning about mental attitudes. This paper outlines a roadmap for translating cognitive-affective models into assistant agents to help make value-aligned decisions. Key principles include “agile” rapid-prototyping using agent-based simulation, and the combination of descriptive and normative models into a single agent architecture.

The Cambridge History of the Napoleonic Wars - June 2022

Objective A regional ‘Be Clear on Cancer’ (BCoC) campaign developed by Public Health England aimed to promote public awareness of key abdominal cancer symptoms in people aged 50 years and over. Methods Data were analysed for metrics at different stages in the patient care pathway including public awareness, GP attendance and referrals, to cancer diagnosis. Results There was significantly higher recognition of the BCoC abdominal campaign in the campaign region compared to the control area (Post Campaign/Control, n = 401/406; 35% vs. 24%, p < 0.05). The campaign significantly improved knowledge of ‘bloating’ as a symptom (p = 0.03) compared to pre-campaign levels. GP attendances for abdominal symptoms increased significantly by 5.8% (p = 0. 03), although the actual increase per practice was small (average 16.8 visits per week in 2016 to 17.7 in 2017). Urgent GP referrals for suspected abdominal cancer increased by 7.6%, compared to a non-significant change (0.05%) in the control area. For specific abdominal cancers, the number diagnosed were similar to or higher than the median in the campaign area but not in the control area in people aged 50 and over: colorectal (additional n = 61 cancers), pancreatic (additional n = 102) and stomach cancers (additional n = 17). Conclusions This campaign had a modest impact on public awareness of abdominal cancer symptoms, GP attendances and cancers diagnosed.