Background: Neurorehabilitation units play an important role in facilitating recovery for those with complex needs following a neurological event. National guidance highlights the importance of providing patients and their families with information and fostering realistic expectations. This may involve the breaking of bad news. The aim of this study is to explore health professionals’ perspectives on breaking bad news in the neurorehabilitation setting. Method: 15 health professionals (physiotherapists, occupational therapists, nurses, speech therapists, psychologists and doctors) working at a 24 bedded neurorehabilitation unit in a National Health Service acute trust in England were recruited. A qualitative study was conducted using patient vignettes to facilitate discussions during semi-structured interviews and a focus group. The results were analyzed using thematic analysis. Results: Four major themes emerged: influencing factors, current approaches used, staff experiences, and strategies to improve breaking bad news. There was a need for better management of patients’ and families’ expectations. Breaking bad news was seen as emotionally demanding yet often unrecognized work. Conclusions: Breaking bad news in the neurorehabilitation setting is complex and under-recognized work, involving multiple health professionals. There is a need for both experience and training to improve skills and confidence in breaking bad news.

Background Nurses, midwives and allied health professionals are integral to research, yet rarely engage simultaneously in research and clinical practice. Clinical academic internships offer a route for accessing academic research training. Aim To determine facilitators and barriers to nurses’ participation and engagement in research internships, and to suggest improvements for future programmes. Discussion The experiences of ten health professional research interns were explored, using a method based on a synthesis between grounded theory and content analysis. Four categories emerged: integrating clinical and research aspirations; support – or lack of it; the hidden curriculum; and the legacy effect. Respondents identified facilitators and barriers to engagement in these categories, including unforeseen challenges. Conclusion Formal support is necessary but is insufficient for fostering engagement and maximising benefits. Participation must be supported by colleagues and enabled by institutional structures. The potential effects of internships on engagement with research is considerable but requires collaboration between all stakeholders. Implications for practice Deeper institutional engagement is needed so that internship opportunities are fully supported by all colleagues and practically enabled by institutional structures. Future schemes should attempt to promote opportunities to collaborate through group projects to reduce researchers’ isolation.

Aims and objectives: To explore healthcare staff's experiences of how dehydration is identified and managed in hospitalised patients after acute stroke, and facilitators and challenges to optimising hydration.Background: Optimal hydration post‐stroke reduces the risk of neurological deterioration and other complications. Patients are at risk of dehydration in acute stroke, particularly those with dysphagia.Design: A descriptive qualitative study reported following the COREQ guidelines.Methods: Semi‐structured interviews, utilising patient vignettes, were conducted in 2018 (Apr–Oct) with a purposive sample of 30 multidisciplinary staff members from two UK stroke units. Interviews were digitally recorded and transcribed verbatim. Content analysis identified common themes which were mapped to the Theoretical Domains Framework and the Behaviour Change Wheel.Results: The themes were mapped to twelve of the fourteen domains in the Theoretical Domains Framework. Participants believed that inadequate hydration management had potentially serious consequences, and described complex knowledge, skills and cognitive elements to effective hydration care. Participants felt that maintaining hydration was a multidisciplinary responsibility requiring good communication. Although the performance of initial dysphagia screening was reinforced by external audit, other areas of post‐stroke hydration management were not; notably, there was no established method of assessing hydration. Barriers to maintaining good hydration included lack of staff, out‐of‐hours working patterns, low priority given to hydration, patients’ comorbidities and complex post‐stroke disabilities such as dysphagia, aphasia, inattention and hemiparesis.Conclusion: Findings highlighted the importance of assessing and maintaining hydration but identified barriers to, and variation in, clinical practice. To provide optimal care, barriers to the prevention and treatment of dehydration after stroke must be further understood and addressed.Relevance to clinical practice: Multidisciplinary teamwork is important in hydration care after stroke, but clarity is required about the specific contributions of each team member. Without this, hydration care becomes ‘everybody's and nobody's job’.

Background: Dehydration and malnutrition are common in hospitalised patients following stroke leading to poor outcomes including increased mortality. Little is known about hydration and nutrition care practices in hospital to avoid dehydration or malnutrition, and how these practices vary in different countries. This study sought to capture how the hydration and nutrition needs of patients’ post-stroke are assessed and managed in the United Kingdom (UK) and Australia (AUS). Aim: To examine and compare current in-hospital hydration and nutrition care practice for patients with stroke in the UK and Australia. Methods: A cross-sectional survey was conducted between April and November 2019. Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing post-stroke inpatient acute care or rehabilitation. Non-respondents were contacted up to five times. Results: We received 150/174 (86%) completed surveys from hospitals in the UK, and 120/162 (74%) in Australia. Of the 270 responding hospitals, 96% reported undertaking assessment of hydration status during an admission, with nurses most likely to complete assessments (85%). The most common methods of admission assessment were visual assessment of the patient (UK 62%; AUS 58%), weight (UK 52%; AUS 52%), and body mass index (UK 47%; AUS 42%). Almost all (99%) sites reported that nutrition status was assessed at some point during admission, and these were mainly completed by nurses (91%). Use of standardised nutrition screening tools were more common in the UK (91%) than Australia (60%). Similar proportions of hydration management decisions were made by physicians (UK 84%; AUS 83%), and nutrition management decisions by dietitians (UK 98%; AUS 97%). Conclusion: Despite broadly similar hydration and nutrition care practices after stroke in the UK and Australia, some variability was identified. Although nutrition assessment was more often informed by structured screening tools, the routine assessment of hydration was generally not. Nurses were responsible for assessment and monitoring, while dietitians and physicians undertook decision-making regarding management. Hydration care could be improved through the development of standardised assessment tools. This study highlights the need for increased implementation and use of evidence-based protocols in stroke hydration and nutrition care to improve patient outcomes.

Background: Despite the increasing evidence base and focus given to Early Intervention in Psychosis (EIP) services, qualitative literature remains sparse, particularly in relation to the ‘At Risk Mental State’ (ARMS) group. Although research has looked to service user experience within EIP, data have not been collated to understand valued aspects of treatment across both EIP groups: first episode psychosis (FEP) and ARMS, particularly regarding cognitive behavioural therapy (CBT). Aims: To conduct a systematic review of qualitative literature to examine service user perspectives on support provided in EIP treatment with a focus on CBT. Method: This was a thematic synthesis of qualitative studies. Nine studies were included in the analysis identified through a systematic database search and citation tracking. Studies were critically appraised using the critical appraisal skills programme tool. Results: Nine studies were identified for inclusion. Six analytical themes and 20 descriptive categories were identified. Conclusions: User perspectives confirm previous findings highlighting importance of therapeutic relationships for treatment success. Normalisation, learning and understanding were valued across both groups, which increased coping, and can be facilitated throughout the EIP journey. Harnessing the support of those involved in users’ care and understanding these relationships further enhances interventions utilised. Understanding the stage the individual is at regarding their experiences is essential in relation to targeting support. Transdiagnostic aspects of CBT were valued across both groups. ARMS referred to more specific strategies and there were some differences regarding coping styles and flexibility preferences; however, this may be due to group differences in problem trajectory and care provision.