Dr Anna Conolly

Aim To critically evaluate the concepts of harm and re-traumatization in the research process and to explore the ethical implications of conducting research on distressing topics using our research on the experiences of nurses working during the COVID-19 pandemic as an exemplar. Design Longitudinal qualitative interview study. Methods Using qualitative narrative interviews, we explored the impacts of the COVID-19 pandemic on nurses' psychological well-being in the UK. Results To reduce the potential for harm to both research participants and researchers, the members of the research team were keen to establish ways to reduce the power differential between the researcher and participants. We found that our collaborative and team-based approach, with participant autonomy and researcher reflexivity embedded into the research framework, enabled the sensitive generation of data. Conclusion Reduction of potential harm for both participants and researchers in the generation of at times highly distressing data with a traumatized population was achieved through a respectful, honest and empathetic approach within a team that met frequently for reflection. Impact The research participants were not harmed by our research, instead they expressed gratitude at being given space and time to tell their stories in a supportive environment. Our work advances nursing knowledge through accentuating the value of giving autonomy to research participants to control their stories whilst working within a supportive research team with emphasis placed on reflexivity and debriefing. Patient and Public Contribution Nurses working clinically during COVID-19 were involved in the development of this study. Nurse participants were given autonomy over how and when they participated in the research process.

Recent perspectives in childhood research have tended to emphasise the use of participatory techniques as a method of reducing the unequal power balance between researcher and researched. Increasingly researchers have been concerned with developing inclusive and participatory, young people centred methodologies which place their voices at the centre of the research process. But is the ideal of young people's active involvement in the research process truly achievable or desirable with socially excluded young people in practice? This article reflects on a range of ethical, methodological and practical issues which arose from a study which investigtaed the lives of a group of young women who were excluded from secondary school. The article concludes with reflections on the necessity to overcome such difficulties for the production of in-depth data on some of the most vulnerable, socially excluded young people.

This article traces links between subjectivity, peer relations and neighbourhood risk for a group of boys living in an area of London with high levels of crime, gang activity and socio-economic inequality. Drawing on data from a qualitative study of young people and neighbourhood risk, we use a psycho-social approach to analyse how gendered subjectivities are shaped by the specific social context. We found that tough masculinities were performed by boys across different social arenas of school, neighbourhood and in the context of a weekly research group. But the boys were also troubled by these masculinities, and their own engagement in data analysis illuminated some of their fears. While the tough masculine ideal is revealed often to be a masquerade, it nevertheless exerts a powerful and pernicious influence over the subjectivities of young men trying to navigate safely through a context of everyday risks.

This article examines how young people living in a London neighbourhood with high levels of crime, negotiate risk with their parents. Parenting strategies for protecting children from risk have been criticised as authoritarian and overprotective, or as neglectful and chaotic. As they discussed how their own families grappled with anxieties about crime, violence and sexual activity, the young people in this study described complex relationships characterised by sensitive negotiation, bounded trust, and support to manage life in a tough neighbourhood. While many families seemed able to maintain a balance between control and autonomy, and to smooth over discord, for others relationships were fractured, further increasing risks to the young people's safety in a context of routine sexual harassment and gang activity. The article concludes by considering the implications for risk management.

Drawing on data from a study of young people and neighbourhood risk, this paper examines the interconnected discourses utilised by professionals and young people as they talk about youth and their social networks in an urban UK neighbourhood with high levels of youth crime and social deprivation. Working with theories of discourse and subjectivity, we focus in particular on the multiplicity of meanings in talk, with both conscious and unconscious motivations, in order to understand how riskiness and vulnerability are woven into professional accounts and in the young people's narratives. Young people in urban neighbourhoods have often been conceived in dichotomous terms as 'risky' or 'at risk' of entry into cycles of crime and violence. While these discourses were echoed in the talk of professionals we interviewed, their accounts varied considerably in relation to professional accountabilities and personal trajectories. Sometimes, in avoiding labelling young people themselves, professionals constructed signifying chains around the risky family or neighbourhood. Young people both critiqued and creatively reworked these discourses in order to strive for a more resilient, autonomous self-positioning within the neighbourhood. Through tracing how some signifiers are over-emphasised, while others are submerged, we build an account of some of the fragile and disrupted discursive articulations of young people and professionals reflecting on the contexts where they live or work.

Abstract It has long been known that nursing work is challenging and has the potential for negative impacts. During the COVID-19 pandemic most nurses’ working landscapes altered dramatically and many faced unprecedented challenges. Resilience is a contested term that has been used with increasing prevalence in healthcare with health professionals encouraging a ‘tool-box’ of stress management techniques and resilience-building skills. Drawing on narrative interview data (n=27) from the Impact of Covid on Nurses (ICON) qualitative study we examine how nurses conceptualised resilience during COVID-19 and the impacts this had on their mental wellbeing. We argue here that it is paramount that nurses are not blamed for experiencing workplace stress when perceived not to be resilient ‘enough’, particularly when expressing what may be deemed to be normal and appropriate reactions given the extreme circumstances and context of the COVID-19 pandemic.  

Aim: To critically examine nurses experiences of speaking up during COVID-19 and the consequences of doing so. Design: Longitudinal qualitative study Methods: Participants were purposively sampled to represent differing geographical locations, specialities, settings and redeployment experiences. They were interviewed (remotely) between July 2020 and April 2022 using a semi-structured interview topic guide. Results: Three key themes emerged inductively from our analysis including: (1) Under threat: The ability to speak up or not; (2) Risk tolerance and avoidance: Consequences of speaking up; and (3) Deafness and hostility: Responses to speaking up. Nurses reported that their attempts to speak up typically focused on PPE, patient safety and redeployment. Findings indicate that when NHS Trusts and community services initiated their pandemic response policies, nurses’ opportunities to speak up were frequently thwarted. Conclusion: Accounts presented in this paper include nurses’ feeling a sense of futility or of suffering in silence in relation to speaking up. Nurses also fear the consequences of speaking up. Those who did speak up encountered a ‘deaf’ or hostile response, leaving nurses feeling disregarded by their organisation. This points to missed opportunities to learn from those on the frontline. Impact: Speaking up interventions need to focus on enhancing the skills to both speak up, and respond appropriately, particularly when power, hierarchy, fear and threat might be concerned. Patient or Public Contribution. Nurses working clinically during Covid-19 were involved in the development of this study. Participants were also involved in the development of our interview topic guide and comments obtained from the initial (anonymised survey) helped to shape the study design.

Aim To critically examine nurses' experiences of speaking up during COVID-19 and the consequences of doing so. Design Longitudinal qualitative study. Methods Participants were purposively sampled to represent differing geographical locations, specialities, settings and redeployment experiences. They were interviewed (remotely) between July 2020 and April 2022 using a semi-structured interview topic guide. Results Three key themes were identified inductively from our analysis including: (1) Under threat: The ability to speak up or not; (2) Risk tolerance and avoidance: Consequences of speaking up; and (3) Deafness and hostility: Responses to speaking up. Nurses reported that their attempts to speak up typically focused on PPE, patient safety and redeployment. Findings indicate that when NHS Trusts and community services initiated their pandemic response policies, nurses' opportunities to speak up were frequently thwarted. Conclusion Accounts presented in this article include nurses' feeling a sense of futility or of suffering in silence in relation to speaking up. Nurses also fear the consequences of speaking up. Those who did speak up encountered a ‘deaf’ or hostile response, leaving nurses feeling disregarded by their organization. This points to missed opportunities to learn from those on the front line. Impact Speaking up interventions need to focus on enhancing the skills to both speak up, and respond appropriately, particularly when power, hierarchy, fear and threat might be concerned. Patient or Public Contribution Nurses working clinically during COVID-19 were involved in the development of this study. Participants were also involved in the development of our interview topic guide and comments obtained from the initial survey helped to shape the study design.

Nurses are the largest healthcare workforce and have had direct, intense and sustained contact with COVID-19 patients throughout the pandemic playing an essential and frontline role in the COVID-19 response. Nurses have worked tirelessly and undertaken multiple roles during the pandemic including education, treatment, prevention, vaccination and research often in uncertain situations and to the detriment of their physical and mental health. They have also managed and cared for distressed patients and their families, and many have been redeployed to other roles often outside of their usual duties, all factors which have affected their well-being. They have publicly been lauded as ‘heroes’. Yet, their voices and perspectives are seldom heard or included in COVID-19 decision-making and in the development of interventions and responses at all levels from individual health services to national policymaking. Indeed, it has felt like these voices have been muted and excluded. Nurses' unique knowledge, expertise, needs and lived experiences are vital to the COVID-19 response. Without their inclusion, COVID-19 decision-making and initiatives are unlikely to be successful and patient outcomes poorer.

Background Pre-COVID-19 research highlighted the nursing profession worldwide as being at high risk from symptoms of burnout, post-traumatic stress disorder (PTSD) and suicide. The World Health Organization declared a pandemic on 11th March 2020 due to the sustained risk of further global spread of COVID-19. The high healthcare burden associated with COVID-19 has increased nurses’ trauma and workload, thereby exacerbating pressure on an already strained workforce and causing additional psychological distress for staff. Objectives The Impact of COVID-19 on Nurses (ICON) interview study examined the impacts of the pandemic on frontline nursing staff's psychosocial and emotional wellbeing. Design Longitudinal qualitative interview study. Settings Nurses who had completed time 1 and 2 of the ICON survey were sampled to include a range of UK work settings including acute, primary and community care and care homes. Interviewees were purposively sampled for maximum variation to cover a broad range of personal and professional factors, and experiences during the COVID-19 pandemic, including redeployment. Methods Nurses participated in qualitative in-depth narrative interviews after the first wave of COVID-19 in July 2020 (n=27) and again at the beginning of the second wave in December 2020 (n=25) via video and audio platform software. Rigorous qualitative narrative analysis was undertaken both cross-sectionally (within wave) and longitudinally (cross wave) to explore issues of consistency and change. Results The terms moral distress, compassion fatigue, burnout and PTSD describe the emotional states reported by the majority of interviewees leading many to consider leaving the profession. Causes of this identified included care delivery challenges; insufficient staff and training; PPE challenges and frustrations. Four themes were identified: (1) ‘Deathscapes’ and impoverished care (2) Systemic challenges and self-preservation (3) Emotional exhaustion and (4) (Un)helpful support. Conclusions Nurses have been deeply affected by what they have experienced and are forever altered with the impacts of COVID-19 persisting and deeply felt. There is an urgent need to tackle stigma to create a psychologically safe working environment and for a national COVID-19 nursing workforce recovery strategy to help restore nurse's well-being and demonstrate a valuing of the nursing workforce and therefore support retention.