Anne Marie Rafferty

• Doctor of Philosophy
• Professor at King's College London

Background Maintaining the mental health of healthcare workers is vital to reduce staff absences and high turnover, which in turn should improve patient care. Most research in this area focusses on clinical staff, despite the important contributions non-clinical staff make to the health system, and uses data from one time point. Our objectives were...

Background Maintaining the mental health of healthcare workers is vital to reduce staff absences and high turnover, which in turn should improve patient care. Most research in this area focusses on clinical staff, despite the important contributions non-clinical staff make to the health system, and uses data from one time point. Our objectives were...

Background During the COVID-19 pandemic, care homes for older adults in England implemented isolation, social distancing and other restriction measures to help protect residents from contracting the virus. Little was known about the physical and psychological impacts that these measures would have upon residents and their relatives. Aim To explore...

Background Older people living in care homes are at high risk of poor health outcomes and mortality if they contract coronavirus disease 2019. Protective measures include social distancing and isolation, although implementation is challenging. Objectives To explore the real-life experiences of social distancing and isolation in care homes for olde...

Introduction: Nursing students internationally entered challenging clinical placements during COVID-19. Lessons learnt could inform nurse education planning, particularly in preparation to implement future workforce plans. Aim: This study aimed to explore the impact of COVID-19 on nursing students undertaking clinical placements across the UK, part...

Aim To investigate nurses' and other users' perceptions and knowledge regarding patient safety incident reporting software and incident reporting. Design A cross‐sectional online survey. Methods The survey, ‘The Users' Perceptions of Patient Safety Incident Reporting Software’, was developed and used for data collection January–February 2024. We...

Objectives A positive work environment (WE) is paramount for healthcare employees to provide good quality care. To stimulate a positive work environment, employees’ perceptions of the work environment need to be assessed. This study aimed to assess the reliability and validity of the Dutch version of the Culture of Care Barometer (CoCB-NL) survey i...

Introduction Like many countries, England has a national shortage of registered nurses. Employers strive to retain existing staff, to ease supply pressures. Disproportionate numbers of nurses leave the National Health Services (NHS) both early in their careers, and later, as they near retirement age. Research is needed to understand the job prefere...

Aim To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID‐19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health‐related quality of life and cost‐effectiveness. Design Parallel two‐arm, cluster‐le...

Previous chapters have identified several recommendations for increasing health equity, highlighting areas where nurses can influence outcomes. These recommendations must be translated into direct action via evidence-based initiatives researched, driven, and implemented by nurses. Nurses should be empowered and supported by the systems they are par...

Background: Whether implicit or explicit, professional judgement is a central component of the many nurse staffing systems implemented in high-income countries to inform workforce planning and staff deployment. Whilst a substantial body of research has evaluated the technical and operational elements of nurse staffing systems, no studies have syst...

Background Pandemics such as COVID-19 pose threats to the physical safety of healthcare workers and students. They can have traumatic experiences affecting their personal and professional life. Increasing rates of burnout, substance abuse, depression, and suicide among healthcare workers have already been identified, thus making mental health and p...

Introduction High-quality pre-registration student nurse training and development is integral to developing a sustainable and competent global nursing workforce. Internationally, student nurse recruitment rates have increased since the onset of the COVID-19 pandemic; however, attrition rates for student nurses are high. During the pandemic, many st...

Background During the COVID-19 pandemic, concern has been raised about suicide risk among healthcare workers (HCWs). We investigated the incidence risk and prevalence of suicidal thoughts and behaviour (STB), and their relationship with occupational risk factors, among National Health Service HCWs in England between April 2020 and August 2021. Met...

Purpose: to investigate ethnographically how patient experience data, as a named category in healthcare organisations, is actively ‘made’ through the co-creative interactions of data, people, and meanings in English hospitals. Design: we draw on fieldnotes, interview recordings and transcripts produced from 13 months (2016-2017) of ethnographic re...

Background: Interorganisational collaboration is currently being promoted to improve the performance of NHS providers. However, up to now, there has, to the best of our knowledge, been no systematic attempt to assess the effect of different approaches to collaboration or to understand the mechanisms through which interorganisational collaborations...

Aim: To explore the challenges and opportunities facing executive nurse directors in the UK and identify factors to strengthen their role and support more effective nurse leadership. Design: A qualitative descriptive study using reflexive thematic analysis. Methods: Semi-structured, telephone interviews were carried out with 15 nurse directors...

Staff in the National Health Service (NHS) are under considerable strain, exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. We interviewed 48 healthcare workers from 18 NHS Trusts in England about their...

Background Medication errors regardless of the degree of patient harm can have a negative emotional impact on the healthcare staff involved. The potential for self-victimization of healthcare staff following medication errors can add to the moral distress of healthcare staff. The stigma associated with errors and their disclosure often haunts healt...

Background: Moral injury is defined as the strong emotional and cognitive reactions following events which clash with someone’s moral code, values or expectations. During the COVID-19 pandemic, increased exposure to Potentially Morally Injurious Events (PMIEs) has placed healthcare workers (HCWs) at risk of moral injury. Yet little is known about t...

Background Resilient Healthcare research centres on understanding and improving quality and safety in healthcare. The Concepts for Applying Resilience Engineering (CARE) model highlights the relationships between demand, capacity, work-as-done, work-as-imagined, and outcomes, all of which are central aspects of Resilient Healthcare theory. However,...

Objective: This study aims to co-design an evidence- and theory-based behavioural intervention to reduce the impact of chemotherapy-induced peripheral neuropathy (CIPN) symptoms on patients' quality of life. Methods: Guided by the Medical Research Council Framework for developing and evaluating complex interventions, our intervention development...

Introduction The increasing burden of mental distress reported by healthcare professionals is a matter of serious concern and there is a growing recognition of the role of the workplace in creating this problem. Magnet hospitals, a model shown to attract and retain staff in US research, creates positive work environments that aim to support the wel...

Staff in the National Health Service (NHS) have been placed under considerable strain during the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. Moreover, the research that does exist typically includes only clinical st...

Background Moral injury is defined as the strong emotional and cognitive reactions following events which clash with someone’s moral code, values or expectations. During the COVID-19 pandemic, increased exposure to potentially morally injurious events (PMIEs) has placed healthcare workers (HCWs) at risk of moral injury. Yet little is known about th...

Objective To examine variations in impact of the COVID-19 pandemic on the mental health of all types of healthcare workers (HCWs) in England over the first 17 months of the pandemic. Method We undertook a prospective cohort study of 22,501 HCWs from 18 English acute and mental health NHS Trusts, collecting online survey data on common mental disor...

Background In 2021, during the COVID-19 pandemic, England’s Department of Health and Social Care (DHSC) released a White Paper outlining proposed legislative reform of the National Health Service (NHS). Key to the proposals is the shift from relationships between providers based on competition, to cooperation, as the central driver of improved perf...

Aims: To examine the psychometric properties of the Chinese version of the Culture of Care Barometer in healthcare organisations. Background: There is a lack of tools to gauge the caring culture in Chinese hospitals. The Culture of Care Barometer is a psychometrically sound measure for caring culture developed in Western settings. Methods: Thi...

Aims To identify strategies used by registered nurses and non‐registered nursing care staff in overcoming barriers when providing fundamental nursing care for non‐invasively ventilated inpatients with COVID‐19. Design Online survey with open‐ended questions to collect qualitative data. Methods In August 2020, we asked UK‐based nursing staff to de...

Background Inter-organisational collaborations (IOCs) in healthcare have been viewed as an effective approach to performance improvement. However, there remain gaps in our understanding of what helps IOCs function, as well as how and why contextual elements affect their implementation. A realist review of evidence drawing on 86 sources has sought t...

Older people living in care homes are at high risk of poor health outcomes and mortality if they contract COVID-19 or other infectious diseases. Measures used to protect residents include social distancing and isolation, although implementation is challenging. This review aimed to assess the social distancing and isolation strategies used by care h...

Healthcare workers must balance competing priorities to deliver high-quality patient care. Rasmussen's Dynamic Safety Model proposed three factors that organisations must balance to maintain acceptable performance, but there has been little empirical exploration of these ideas, and little is known about the risk trade-offs workers make in practice....

Racially and ethnically minoritised healthcare staff groups disproportionately experience and witness workplace discrimination from patients, colleagues and managers. This is visible in their under‐representation at senior levels and over‐representation in disciplinary proceedings and is associated with adversities such as greater depression, anxie...

Background The specific challenges experienced by the nursing and midwifery workforce in previous pandemics have exacerbated pre-existing professional and personal challenges, and triggered new issues. We aimed to determine the psychological impact of the COVID-19 pandemic on the UK nursing and midwifery workforce and identify potential factors ass...

Background Patient experience of nursing care is associated with safety, care quality, treatment outcomes, costs and service use. Effective nursing care includes meeting patients’ fundamental physical, relational and psychosocial needs, which may be compromised by the challenges of SARS-CoV-2. No evidence-based nursing guidelines exist for patients...

Helping organisations to perform in a resilient manner is an emerging area of research in healthcare, but despite philosophical development there remains a lack of practical tools that can be used by practitioners. Tools and methods for analysing resilient performance are needed to inform organisational improvement. This chapter describes a new met...

Objective: To improve patient experience of chemotherapy-induced peripheral neuropathy (CIPN), it is crucial to identify how patients develop their understanding and perception of CIPN. A wider understanding of the experiences of clinicians who provide CIPN information and support is also needed. This study explored clinician and patient experienc...

Background The early stages of the coronavirus disease 2019 pandemic prompted unprecedented displays of gratitude to healthcare workers. In the United Kingdom, gratitude was a hotly debated topic in public discourse, catalysing compelling displays of civic togetherness but also attracting criticism for being an unhelpful distraction that authorized...

Purpose The processes and mechanisms of action which explain how behavioural interventions for chemotherapy-induced peripheral neuropathy (CIPN) work or not are unclear. We describe a co-design process for developing an evidence and theory-based behavioural intervention to reduce the impact of CIPN symptoms on patients’ quality of life. Methods Gui...

Introduction Older people living in residential and nursing care homes often have complex needs and are at high risk of poor health outcomes and mortality, especially if they contract COVID-19. Care homes use infection prevention and control measures such as social distancing and isolating residents to protect them from COVID-19. The care home sect...

Aims Aim of this study is to better understand the role of nurses’ professional judgment in nurse staffing systems. Design Qualitative comparative case study design of nurse staffing systems in England and Wales. Methods Data will be collected through a variety of sources: individual interviews, observations of relevant meetings and analysis of k...

Introduction The COVID-19 pandemic has had profound effects on the working lives of healthcare workers (HCWs), but the extent to which their well-being and mental health have been affected remains unclear. This longitudinal cohort study aims to recruit a cohort of National Health Service (NHS) HCWs, conducting surveys at regular intervals to provid...

Introduction Patient experience of nursing care is correlated with safety, clinical effectiveness, care quality, treatment outcomes and service use. Effective nursing care includes actions to develop nurse–patient relationships and deliver physical and psychosocial care to patients. The high risk of transmission of the SARS-CoV-2 virus compromises...

Over the last three decades, sociomaterial approaches to the study of health care practices have made an important contribution to the sociology of health care. Significant attention has been paid to the role of technology and artefacts in health care and the operation of actor-networks but less space has been given to questions of ontological mult...

Resilient Healthcare is an emerging theoretical field that has developed with influence from engineering, safety science, psychology, ergonomics, human factors, and aeronautics. Resilient Healthcare research has centred on understanding and improving the quality and safety of healthcare delivery. Theory is increasingly well-developed, but so far ha...

Objective To identify, appraise and synthesise evidence of interventions designed to promote family member involvement in adult critical care units; and to develop a working typology of interventions for use by health professionals and family members. Design Mixed-method systematic review. Data sources Bibliographic databases were searched withou...

Background Chemotherapy-induced peripheral neuropathy (CIPN) can result in functional difficulties. Pharmacological interventions used to prevent CIPN either show low efficacy or lack evidence to support their use and to date, duloxetine remains the only recommended treatment for painful CIPN. Non-pharmacological interventions such as exercise and...

Rationale: Restriction or prohibition of family visiting to intensive care units (ICU) during the COVID-19 pandemic poses substantial barriers to communication, and family- and patient-centred care. Objectives: Our objective was to understand how communication between families, patients and the ICU team was enabled during the pandemic. Secondary...

Introduction There has been no previous study of stakeholders’ views on recruitment and retention concerns in high secure forensic settings. Aim To identify factors affecting recruitment and retention in high secure hospitals, from the perspectives of stakeholders with experience in forensic mental health nursing. Method Framework analysis of dat...

Research into gratitude as a significant sociological and psychological phenomenon has proliferated in the past two decades. However, there is little consensus on how it should be conceptualized or investigated empirically. We present a meta-narrative review that focuses on gratitude in health care, with an emphasis on research exploring interperso...

en Aims To describe the characteristics of medication administration (MA) incidents reported to have occurred in patients’ own homes (reporters’ profession, incident types, contributing factors, patient consequence, and most common medications involved) and to identify the connection terms related to the most common contributing factors based on f...

Purpose The NHS is facing unprecedented financial strain. These significant economic pressures have coincided with concerns regarding the quality and safety of the NHS provider sector. To make the necessary improvements to performance, policy interest has turned to encouraging greater collaboration and partnership working across providers. Methods...

Aims: To identify the experiences of nursing in high secure forensic mental health settings that may affect staff recruitment and retention. Background: Recruitment and retention of Registered Nurses is a vital international concern in the field of mental health. The high secure forensic setting presents unique challenges for the nurse. Studies of...

Context: People with prior health conditions are susceptible to severe and sometimes fatal outcomes of the novel coronavirus SARS-CoV-2, that causes the disease COVID-19. The protection of the capacity of systems for social care was thus an important consideration for governments in the early stages of the global pandemic. Objectives: This paper re...

Background: Achieving high quality care and retention of nurses are major concerns for nurse leaders in hospitals. The organisational context is theorised to influence the quality of care and patient and nurse outcomes. This review focuses on China where the healthcare system is different from most Western countries in terms of government healthca...

In UK, since 2010 shortages of nurses and policy changes led many health service providers to become more active in recruiting nurses from the European Union Member States. This article analyses the experience of Portuguese nurses working in the English NHS considering the individual and organizational factors that affect the quality and duration o...

Background Inter-organisational collaboration is increasingly prominent within contemporary healthcare systems. A range of collaboration types such as alliances, networks, and mergers have been proposed as a means to turnaround organisations, by reducing duplication of effort, and enabling resource sharing, greater influence, and novel innovations...

Background Inter-organisational collaboration is increasingly prominent within contemporary healthcare systems. A range of collaboration types such as alliances, networks, and mergers have been proposed as a means to turnaround organisations, by reducing duplication of effort, enabling resource sharing, and promoting innovations. However, in practi...

Background Efforts to address the complex global problem of antimicrobial resistance (AMR) highlight the need for imagination and innovation. However, nursing has not yet leveraged its potential to innovate to prevent AMR advancing. Aims This paper focuses on the initial phase of an ongoing research and development study that seeks to foster nursi...

Objectives: The aims of the study were to describe medication administration incidents reported in England and Wales between 2007 and 2016, to identify which factors (reporting year, type of incident, patients' age) are most strongly related to reported severity of medication administration incidents, and to assess the extent to which relevant inf...

Background: Some medications carry increased risk of patient harm when they are given in error. In incident reports, names of the medications that are involved in errors could be found written both in a specific medication field and/or within the free text description of the incident. Analysing only the names of the medications implicated in a spe...

Background Although NHS organisations have access to a wealth of patient experience data in various formats (e.g. surveys, complaints and compliments, patient stories and online feedback), not enough attention has been paid to understanding how patient experience data translate into improvements in the quality of care. Objectives The main aim was...

Background: There has been an identified need for greater patient and family member involvement in healthcare. This is particularly relevant in an intensive care unit (ICU), as the family provides a key communicative and practical link between patient and clinician. Family members have been deemed a positive beneficial influence on ICU care and re...

AIMS AND OBJECTIVES: To examine the association between registered nurses’ (referred to as “nurses” for brevity) shifts of 12 hours or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers. BACKG...

Nurses make an important contribution to the organisation and coordination of patient care but receive little formal educational preparation for this work. This paper builds on Allen's care trajectory management framework to specify evidence‐based and theoretically informed competencies for this component of the nursing role and proposes how these...

Incident reporting systems are being implemented globally, thus increasing the profile and prevalence of incidents, but the analysis of free-text descriptions remains largely hidden. The aims of the study were to explore the extent to which incident reports recorded staffing issues as contributors to medication administration incidents. Incident re...

Patient stories have been identified as a powerful tool to improve quality of care. Healthtalk.org is a digital resource (specific health-related website) presenting patients’ experiences of illness and healthcare through trigger films, videos and articles. Data have been generated from narrative interviews conducted by experienced researchers, bas...

Background: Medication administration errors may contribute to patient mortality, thus additional understanding of such incidents is required. Objectives: To analyse medication administration errors reported in acute care as resulting in death, to identify the drugs concerned, and to describe medication administration error characteristics (locati...

Background Perineal trauma affects large numbers of women who have a vaginal birth. This study explores the incidence, etiology and women's experiences of wound infection/breakdown associated with spontaneous second degree tears. Methods This was an exploratory mixed methods study set in an urban tertiary National Health Service hospital in 2014‐2...

Objectives To inform healthcare workforce policy decisions by showing how patient perceptions of hospital care are associated with confidence in nurses and doctors, nurse staffing levels and hospital work environments. Design Cross-sectional surveys of 66 348 hospital patients and 2963 inpatient nurses. Setting Patients surveyed were discharged i...

Background: Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery. Aim: Examine if miss...

Objective Concerns about care quality have prompted calls to create workplace cultures conducive to high-quality, safe and compassionate care and to provide a supportive environment in which staff can operate effectively. How healthcare organisations assess their culture of care is an important first step in creating such cultures. This article rep...

Abstract Background Twenty-four hour nursing care involves shift work including 12-h shifts. England is unusual in deploying a mix of shift patterns. International evidence on the effects of such shifts is growing. A secondary analysis of data collected in England exploring outcomes with 12-h shifts examined the association between shift length, jo...

This paper reports an ethnographic study examining health professional jurisdictions within three intensive care units (ICUs) in order to draw out the social processes through which ICU clinicians organised and delivered life-saving care to critically ill patients. Data collection consisted of 240 h observation of actual practice and 27 interviews...

Hospitals are awash with patient experience data, much of it collected with the ostensible purpose of improving the quality of patient care. However, there has been comparatively little consideration of the nature and capacities of data itself. Using insights from actor-network theory, we propose that paying attention to patient experience data as...

Objectives To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Design Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic r...

European enlargement provides an opportunity for the nursing profession to gain traction on policy change but our research demonstrates that the European Commission mechanisms to process compliance need to be robust and designed to deliver such change. These opportunities also increase when the nursing leadership operates across a united front and...

Aims: To determine factors associated with variation in ‘care left undone’ (also referred to as “missed care”) by registered nurses in acute hospital wards in Sweden. Background: ‘Care left undone’ has been examined as a factor mediating the relationship between nurse staffing and patient outcomes. The context has not previously been explored to d...