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This article explores the application of Lipsky's (1980) notion of street-level bureaucracy for nursing staff. This article aims to demonstrate the importance of discretion within the day-to-day work of front-line nursing staff, which is similar to that of other public-sector workers. The findings are from an exploratory case study based within a Scottish inner-city hospital. It specifically focuses on how nurses can be seen to be street-level bureaucrats and how front-line nursing staff interpret policy. Discretion can be seen to be a significant feature within the front-line practice of nursing staff and this may have implications for the implementation of health policy.

Aims and Objectives: to undertake an analysis of UK national daily newspaper coverage of accident and emergency treatment targets, in order to understand if the media could be seen to be creating a scandal.Background: Emergency Department treatment targets have become common in developed countries. In the United Kingdom (UK), hospitals are required to treat and discharge patients within four hours, and statistics are published daily. Breaches of targets are regularly reported by the UK print media. Design: exploratory research of tabloid newspaper articles that reported on four-hour treatment targets in the UK during a seven-month period over the winter of 2014-15 (n=1,317). An interpretivist thematic approach was utilised during analysis.Results: The main 'problem' identified by newspapers was the failure to meet the target, rather than negative effects on patient care (where they existed). Proposed solutions were diverse. Many articles did not describe who was to blame for the failure. Conclusion: We conclude that the media created a feeling of scandal, and hypothesise that this is related to political reasons and the availability of data on a daily basis.

AbstractAs with the general population, people with intellectual disabilities are ageing, are living longer often with coexisting complex needs and with more requiring care and support. The focus of care is community‐based rather than institutional and it is therefore necessary to ensure that the workforce responsible for delivering care has the appropriate knowledge and skills to safely deliver the interventions required. The aim of this review is to evaluate the scope of invasive clinical interventions (ICIs) that social care support workers (SCSWs) are currently delivering and the preparation received to undertake these procedures or the knowledge held about the intervention. A search of educational, health, psychology, and social science databases was conducted, using a variety of combinations of search words to detect relevant literature. Only five studies published between 1999 and 2013 were identified and included in the review. The evidence shows that education can improve social carers' knowledge and when education is undertaken it needs to involve both a theoretical and practice‐related component. The current evidence is limited due to the small number of studies identified and the limitations of the study designs that were adopted. More research is required to identify whether ICIs currently being delivered by these SCSWs and the effectiveness and appropriateness of the education staff are receiving in relation to these.

Developing strategies to support student nurses' health is a global priority for healthcare organisations and governments. This is because emerging international evidence indicates that improvements in student nurses' health are required to increase the longevity of careers and reduce the loss of time, skill and financial cost of sickness absence and workforce exit. However, we do not know what intervention strategies student nurses think would support their health. The study aim was to explore student nurses' views on factors that influence health-related behaviours and strategies that could improve health. Data were collected through participatory activities during focus groups with student nurses in Scotland. Analysis was theoretically informed and involved mapping to the Behaviour Change Wheel framework. Students identified several factors that influenced health-related behaviours. Four were ranked most important: knowledge, culture, time constraints, and stress. Strategies student nurses thought should be prioritised to improve nurses' health-related behaviours were: stimulating a health-promoting environment by reviewing shift work, improving workplace support, increasing staffing levels, subsidising and role-modelling of healthy food and exercise; and creating applied health-promoting curricula by integrating time and stress management training and lifestyle advice into nursing education. Educational and environmental interventions are needed to support student nurses' health.

AbstractBackgroundDementia disproportionately affects people with intellectual disability. Most qualitative studies explore their experiences by utilising proxy‐reports. A smaller number of studies illustrate the possibility of exploring perspectives directly from people with intellectual disability and dementia.MethodThis systematic review synthesised findings from existing studies (n = 8) that involve people with intellectual disability and dementia as participants to understand their experiences of dementia. Searches were conducted using CINAHL, PsychInfo and Social Services Abstracts.ResultsFindings include descriptions of changes in individual functioning, a narrowing of social worlds and of how people made sense of the changes despite often having no knowledge of their dementia diagnosis. Additionally, discussion focuses on how people's experiences are shaped by their environments.ConclusionThe review recognises the complexities of speaking to people with intellectual disability about dementia, challenges views that people with intellectual and dementia cannot be involved in research and makes recommendations to support inclusion in future studies.