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Mental toughness describes a set of attributes relating to how individuals deal with challenges, stressors, and pressure. The purpose of this paper is to examine the relationships between mental toughness and perceived stress in police and fire officers.

The participants were 247 police officers and 130 fire fighters. Participants completed questionnaire measures of mental toughness and perceived stress, and provided information about their age, rank, and length of service within the force.

Mental toughness was found to be significantly related to perceived stress, with control of emotion, control of life, and confidence in abilities being particularly important. There was no consistent relationship of age, rank, or length of service with mental toughness and perceived stress. However, police officers reported lower levels of mental toughness and higher levels of perceived stress than fire officers.

The results suggest that assessing police and fire officers on a measure of mental toughness could provide a means of identifying individuals more likely to suffer from stress and stress-related physical and psychological illness. In addition, interventions that may enhance mental toughness could have beneficial effects within this population.

This is the first study to examine mental toughness and perceived stress within this population, and the findings have important implications for the management of stress.

In forensic mental health wards, patients spend more time with healthcare assistants (HCAs) than qualified nurses. Despite this, there is no universally utilised standardised HCA training. The purpose of this paper is to assess the HCAs’ experiences in the HCA role in order to better understand how to build on the HCA role to ensure safe practice, and enhance staff well-being.

HCAs working on low and medium secure NHS forensic mental health units were recruited through purposive methods. HCAs engaged in a semi-structured interview, with questions surrounding their support needs, clinical decision making and perception of risks in the role. Template analysis was used, applying an a priori template based on the existing literature to interview transcripts.

The participants described the HCA experience to be defined by two master themes: “HCA factors” and “organisational factors”. HCAs valued a holistic patient view which prized patients’ experiences. The participants described a lack of role clarity which may be defined through ward expectations and professional experience.

HCAs seek a holistic view of the patient; however, some overlooked patient offences in order to do their job. Future research should address how looking past offences impacts security and HCAs’ well-being long term.

Negative attitudes towards “personality disorder” are common among mental health professionals. This study aims to design a psychoeducational training targeting attitudes to “personality disorder” for staff working in a London psychiatric hospital. Its impact on staff attitudes was evaluated.

Mental health clinicians were recruited from five acute psychiatric wards. Feasibility of implementing the training was measured. A free-association exercise explored baseline attitudes to “personality disorder” and visual analogue scales assessed staff attitudes pre- and post-training. Content analysis of staff feedback was carried out.

Psychoeducational training was found to be feasible, well-attended and highly valued by ward staff (N = 47). Baseline results revealed negative perceptions of “personality disorder”. Post-training, significant improvements in understanding, levels of compassion and attitudes to working with service users with a diagnosis of a “personality disorder” were observed. Staff feedback highlighted desire for further training and support.

The sample size was relatively small and there was no control group, so findings should be interpreted with caution.

The findings highlight the need for support for staff working with service users with diagnoses of “personality disorder” on acute psychiatric wards. Providing regular training with interactive components may promote training as a resource for staff well-being. Planning to ensure service users’ and carers’ views are incorporated into the design of future training will be important.

This study is innovative in that it investigates the impact of a brief psychoeducational training on “personality disorder” designed for mental health staff on acute psychiatric wards.

The purpose of this paper is to investigate how three communication interventions commonly used during discharge planning and care transitions enable inter-professional knowledge sharing and learning as a foundation for more integrated working. These interventions include information communication systems, dedicated discharge planning roles and group-based planning activities.

A two-year ethnographic study was carried out across two regional health and care systems in the English National Health Service, focussing on the discharge of stroke and hip fracture patients. Data collection involved in-depth observations and 213 semi-structured interviews.

Information systems (e.g. e-records) represent a relatively stable conduit for routine and standardised forms of syntactic information exchange that can “bridge” time–space knowledge boundaries. Specialist discharge roles (e.g. discharge coordinators) support personalised and dynamic forms of “semantic” knowledge sharing that can “broker” epistemic and cultural boundaries. Group-based activities (e.g. team meetings) provide a basis for more direct “pragmatic” knowledge translation that can support inter-professional “bonding” at the cultural and organisational level, but where inclusion factors complicate exchange.

The study offers analysis of how professional boundaries complicate discharge planning and care transition, and the potential for different communication interventions to support knowledge sharing and learning.

The paper builds upon existing research on inter-professional collaboration and patient safety by focussing on the problems of communication and coordination in the context of discharge planning and care transitions. It suggests that care systems should look to develop multiple complementary approaches to inter-professional communication that offer opportunities for dynamic knowledge sharing and learning.

The purpose of this paper is to develop a nursing quality indicator (NQI) framework and provide a comprehensive reporting mechanism for nursing care.

Mixed method, including patient records audit, patient experience questionnaire, nurse self-report questionnaire and collecting ward-level information. The sample was 53 patients and 22 nurses.

Outputs from the NQI framework domains offer a more comprehensive understanding of nursing quality compared to when domains are analysed separately. The NQI framework also provides a more inclusive mechanism for assuring nursing care.

Sample size was limited to 53 English-speaking patients who consented to participating in the study.

One design strength was the ability to describe individual patient care across the four domains and subsequently show relationships between nursing knowledge, nursing interventions and patient outcomes/experiences. Additionally, corroborated information from three sources (documentation review, patient and nurse responses) strengthened the conclusion that the NQI framework could provide more comprehensive assurances on nursing quality and identify care improvements.

Patients with extended hospital admissions had no recreation facilities in the ward. They were often confined to spaces around their beds, using the ward corridor for rehabilitation. The purpose of this paper is to outline a quality improvement (QI) intervention-provision of a recreational space for long-stay patients.

An exploratory quantitative pre-, post-test design was utilised, and executed in three phases: patients, visitors and staff survey to explore recreation and comfort needs and preferences; store room refurbishment; and patient, visitor and staff satisfaction with the recreation room.

Overall, 77 questionnaires were completed (n=49 staff; n=28 patient/visitor). Almost two-thirds (64.7 per cent; n=11) of patients had a stay greater than six weeks. Insufficient private space and concerns about disturbing other patients were identified as barriers to taking part in activities. Consequently, a store room was refurbished as a recreation room (9.0 m × 6.0 m) and furnished in three distinct areas. Following refurbishment, over 90 per cent (n=24) of respondents agreed that there was a suitable space where patients could “go and chat” and spend time with family and visitors or speak to the healthcare team.

The physical environment in acute hospitals is seldom prioritised. Needs-based QI projects can improve patient hospital experiences.

This case study highlights how nursing staff can be informed by patients’ and families’ needs and preferences, and initiate QI projects that improve patient hospital experiences.

Healthcare systems are increasing in complexity, and to ensure people can use the system effectively, health organizations are increasingly interested in how to take an organizational health literacy (OHL) approach. OHL is a relatively new concept, and there is little evidence about how to successfully implement organizational health literacy interventions and frameworks. This study, a literature review, aims to explore the operationalization of OHL.

A realist literature review, using a systems lens, was undertaken to examine how and why the operationalization of OHL contributed to changes in OHL and why interventions were more effective in some contexts than others. Initial scoping was followed by a formal literature search of Medline, CINAHL plus, Web of Science, Scopus, Embase and PsychINFO for original peer-reviewed publications evaluating OHL interventions until March, 2018.

The search strategy yielded 174 publications; 17 of these were included in the review. Accreditation, policy drivers, executive leadership and cultures of quality improvement provided the context for effective OHL interventions. The dominant mechanisms influencing implementation of OHL interventions included staff knowledge of OHL, internal health literacy expertise, shared responsibility and a systematic approach to implementation.

This study outlines what contexts and mechanisms are required to achieve particular outcomes in OHL operationalization. The context in which OHL implementation occurs is critical, as is the sequence of implementation.

Health services seeking to implement OHL need to understand these mechanisms so they can successfully operationalize OHL. This study advances the concept of OHL operationalization by contributing to the theory underpinning successful implementation of OHL.

Young people who are looked after by the state face challenges as they make the transition from care to adulthood, with variation in support available. In the past decade, funding has been directed towards organisations to pilot innovations to support transition, with accompanying evaluations often conducted with a single disciplinary focus, in a context of short timescales and small budgets. Recognising the value and weight of the challenge involved in evaluation of innovations that aim to support the transitions of young people leaving care, this paper aims to provide a review of evaluation approaches and suggestions regarding how these might be developed.

As part of a wider research programme to improve understanding of the innovation process for young people leaving care, the authors conducted a scoping review of grey literature (publications which are not peer reviewed) focusing on evaluation of innovations in the UK over the past 10 years. The authors critiqued the evaluation approaches in each of the 22 reports they identified with an inter-disciplinary perspective, representing social care, public health and organisation science.

The authors identified challenges and opportunities for the development of evaluation approaches in three areas. Firstly, informed by social care, the authors suggest increased priority should be granted to participatory approaches to evaluation, within which involvement of young people leaving care should be central. Secondly, drawing on public health, there is potential for developing a common outcomes’ framework, including methods of data collection, analysis and reporting, which aid comparative analysis. Thirdly, application of theoretical frameworks from organisation science regarding the process of innovation can drive transferable lessons from local innovations to aid its spread.

By adopting the unique perspective of their multiple positions, the authors’ goal is to contribute to the development of evaluation approaches. Further, the authors hope to help identify innovations that work, enhance their spread, leverage resources and influence policy to support care leavers in their transitions to adulthood.