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Staff in secure mental health-care settings face unique occupational challenges that may conflict with their personal or professional moral code. Initial research has established the presence of moral injury in this population, though insight into the specific sources and driving factors at the root of this syndrome is limited. The purpose of this study was to identify potentially morally injurious events and associated risk factors for secure mental healthcare staff.

To address this gap, a three-round expert Delphi survey was conducted to gain consensus on the conceptualisation, types and drivers of potentially morally injurious experiences (PMIEs) for secure mental health-care workers. Health-care professionals and academics in the field were recruited.

A high level of consensus (= 80%) was achieved on several sources of moral injury, which related to aspects of the health-care system, the secure context, relational dynamics and individual practices, behaviours and attitudes. Experts also agreed on several items relating to the definition of a PMIE, the factors driving the occurrence of PMIEs and the factors increasing risk for the subsequent development of moral injury.

The findings suggest that current definitions of PMIEs may, in isolation, be too narrow, prompting the need to attend to the broad range of PMIEs experienced by secure mental health-care staff. In addition, recommendations for the primary and secondary prevention of moral injury in secure mental health-care staff are offered, recognising the particular need for intervention at a systemic level.

To the best of the authors’ knowledge, this study is the first to consider the range of sources of moral injury faced by staff providing for people with complex forensic and mental health needs.

This study aims to examine whole service effectiveness using a secure version of the Health of the Nation Outcome Scales (HoNOS-Secure), further supplemented in some services by the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) and the Patient Reported Experience and Outcome Measure (PREOM).

The utility of these measures were considered across the full remit of forensic services within a single NHS Trust. A total of 1,038 service users were included (male, n = 876), with the majority of these presenting with HoNOS-Secure ratings. It was predicted that there would be differences pre and post therapy indicated using these measures, that there would be further differences in relation to period of contact with services, and an association was also noted in relation to aggression within services.

Results indicated that HoNOS-Secure scores decreased following treatment and as a function of time spent in secure care. However, no statistically significant improvement or deterioration was observed on patient-reported outcome measures (CORE-OM and PREOM).

The paper concludes with a comparative examination evaluating potential arguments regarding why low levels of distress are observed within forensic populations and why discrepancies exist between clinician-rated and patient-reported routine outcome measures.

Research into this area is limited and yet the HoNOS is a widely implemented tool, without consideration of the core value of this measure.

The aim of this study was to explore and understand the leadership experiences of medical consultants prior to a major hospital move. Health and care is becoming increasingly complex and there is no greater challenge than the move to a new hospital. Effective leadership has been identified as being essential for successful transition. However, there is very little evidence of how medical consultants experience effective leadership.

A qualitative methodology was utilized with one-to-one semi-structured interviews conducted with ten medical consultants. These were transcribed verbatim and analyzed using inductive thematic analysis. The research complied with the consolidated criteria for reporting qualitative research (COREQ).

Four themes were found to influence medical consultants’ experience of leadership: collaboration, patient centredness, governance and knowledge mobilization. Various factors were identified that negatively influenced their leadership effectiveness. The findings suggest that there are a number of factors that influence complexity leadership effectiveness. Addressing these areas may enhance leadership effectiveness and the experience of leadership in medical consultants.

This study provides a rich exploration of medical consultants’ experience of collective leadership prior to a transition to a new hospital and provides new understandings of the way collective leadership is experienced in the lead up to a major transition and makes recommendations for future leadership research and practice.

The findings suggest that there are a number of factors that influence complexity leadership effectiveness. Addressing these areas may enhance leadership effectiveness and the experience of leadership in medical consultants.

Clinical leadership is associated with better outcomes for patients therefore any interventions that enhance leadership capability will improve outcomes for patients and therefore benefit society.

This is the first research to explore medical consultants’ experience of collective leadership prior to a transition to a new hospital.

We examined the attitudes of millennial-aged business students toward economic, social and environmental corporate responsibility (CR). Currently, these individuals are of an age that they have entered the workforce and are now ascending or have ascended into roles of leadership in which they have decision-making power that influences their company’s CR agenda and implementation. Thus, following the ecological systems perspective, we tested both the macro influence of cultural values (survival/self-expression and traditional/secular-rational values) and structural forces (income inequality, welfare socialism and environmental vulnerability) on these individuals’ attitudes toward CR.

This is a multilevel study of 3,572 millennial-aged students from 28 Asian, American, Australasian and European societies. We analyzed the data collected in 2003–2009 using hierarchical linear modeling.

In our multilevel analyses, we found that survival/self-expression values were negatively related to economic CR and positively related to social CR while traditional/secular-rational values was negatively related to social CR. We also found that welfare socialism was positively related to environmental CR but negatively related to economic CR while environmental vulnerability was not related to any CR. Lastly, income equality was positively related to social CR but not economic or environment responsibilities. In sum, we found that both culture-based and structure-based macro factors, to varying extents, shape the attitudes of millennial-aged students on CR in our sample.

Our study is grounded in the ecological systems theory framework, combined with research on culture, politico-economics and environmental studies. This provides a multidisciplinary perspective for evaluating and investigating the impact that societal (macro-level) factors have on shaping attitudes toward businesses’ engagement in economic, social and environmental responsibility activities. Additionally, our multilevel research design allows for more precise findings compared to a single-level, country-by-country assessment.

The main aim of this article is to broaden the notion of strategic intent in public relations. It also develops an understanding of the social value of what can be defined as the first modern health communication campaign in Europe based on strategic intents and the development of modernity.

The study is based on both historical research and empirical material from the Norwegian tuberculosis campaign from 1889 up to 1913, when Norwegian women achieved suffrage. The campaign is analysed in the framework of modernity and social theory. The literature on lobbying and social movements is also used to develop a theoretical framework for the notion of strategic intent.

The study shows that strategic intent can be divided into two layers: (1) the implicit strategic intent is the real purpose behind the communication efforts, whereas (2) the explicit intent is found directly in the communication efforts. The explicit intent may be presented as a solution for the good of society at the right political moment, giving an organisation the possibility to mobilise for long-term social changes, in which could be the implicit intent.

The distinction between explicit and implicit strategic intent broadens our understanding on how to make long-term social changes as well as how social and political changes occur in modern societies. The article also gives a historical account of what is here defined as the first modern health communication campaign in Europe and its social value.