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  • Crisis management for people with dementia at home: Mixed‐methods case study research to identify critical factors for successful home treatment

    Hopkinson, Jane; King, Amanda; Young, Lucy; McEwan, Kirsten; Elliot, Fiona; Hydon, Kate; Muthukrishnan, Sabarigirivasan; Tope, Rosie; Veitch, Anne; Howells, Cristie; et al. (Wiley, 2020-08-27)
    Best practice in dementia care is support in the home. Yet, crisis is common and can often result in hospital admission with adverse consequences. The objective of this mixed‐methods case study research was to identify the critical factors for resolving crisis for a person with dementia living at home. The research was an in‐depth investigation of what happens during crisis for people with dementia and how it is managed by a Home Treatment Crisis Team to resolution and outcome at 6 weeks and 6 months. The methods were; observation of crisis management for 15 patients with dementia (max three observations per patient, total 41), interviews with patients with dementia (n = 5), carers (n = 13) and professionals (n = 14, range one to six interviews per person, total 29), focus group (nine professionals), and extraction of demographics and medical history from medical records. Analysis focused on the identification of factors important for crisis resolution and avoidance of hospital admission. Critical factors for the Home Treatment Crisis Team to enable successful crisis resolution were: immediate action to reduce risk of harm, expertise in dementia care and carer education, communication skills to establish trust and promote benefits of home treatment, shared decision‐making, medication management, addressing the needs of carers independently of the person with dementia and, local availability of respite and other community services. The Home Treatment Crisis Team integrated the seven factors to deploy a biopsychosocial systems approach with embedded respect for personhood. This approach enabled crisis resolution for a person with dementia by creating a system of services, treatments, resources and relationships, ‘Safe Dementia Space’, in the community with avoidance of hospital admission in more than 80% of referrals. The identified critical factors for crisis resolution are important considerations in the design and delivery of home treatment services for people with dementia.
  • The recognition and management of sepsis in urgent care out of hours setting

    Mortimore, Gerri; University of Derby (MAG, 2020-07-11)
    As the majority of sepsis cases occur in the community, Justine Dexter and Gerri Mortimore provide an overview of the assessment, diagnosis and management of the condition for those working in out of hours settings. Sepsis is a life-threatening and common condition prompted by a microbial infection. Sepsis is responsible for the death of more people than prostate, bowel or breast cancer collectively, and it causes the second highest mortality rates after cardiovascular disease. The majority of sepsis cases occur in the community, with 30% developing while the patient is in hospital. In many instances, sepsis is avoidable and treatable. The aetiology of sepsis is not always known, making diagnosis difficult, with only 50% of cases having a confirmed pathogenic organism. The signs and symptoms most obviously connected with sepsis are confusion or unusual behaviour, hypotension and increased respiratory rate. However, some patients have non-specific symptoms, and just complain of feeling extremely unwell. Any patients who have these signs or symptoms should be assessed for the possibility of sepsis, regardless of whether pyrexia is present. To aid in detection and decision making about sepsis, the use of screening tools have been advocated to shorten the period prior to the administration of antibiotics. Children characteristically compensate physiologically for a considerable time and then deteriorate quickly; therefore, a crucial focus is to spot a sick child rapidly. Many urgent care out of hours (UCOOH) services are nurse-led. Therefore, it often falls on advanced nurse practitioners (ANPs) to educate healthcare assistants to spot the sick person, especially as they are usually the first person the patient sees. Leadership plays a key role for ANPs in UCOOH by helping to progress the pathway for patients to ensure the sickest are prioritised.
  • A public health approach to social isolation in the elderly

    Gould, Jill; Day, Patricia; Hazelby, Gayle; University of Derby; Sheffield Hallam University (Wound Care People, 2020-06)
    The recent pandemic has highlighted the impact of social isolation on health. District and community nurses are in daily contact with vulnerable, elderly clients for whom the norm is a world with little social contact. This compounds the health inequalities affecting this population. District and community nurses require support to meet the psychological and social needs of these clients. In order to improve the health of older people with long-term conditions, joint action between agencies, voluntary groups and charities is imperative. Inclusive and creative evidence-based interventions could be the public health solution to the emerging crisis in the psychological health of elderly clients with chronic conditions.
  • ‘Withness’: Creative spectating for residents living with advanced dementia in care homes

    Astell-Burt, Caroline; McNally, Theresa; Collard-Stokes, Gemma; Irons, J. Yoon; London School of Puppetry; University of Derby (Intellect, 2020-07-01)
    Aiming to illustrate the potential for puppetry as a useful resource in dementia care, the authors argue unusually that play with puppets derives not particularly from drama or theatre, but fundamentally from the performative relationship people have with objects. The puppeteers of the study achieved remarkable emotional connection with care-home residents through an experience of puppetry, which dissolved the unitary autonomy of the puppet, recontextualizing it relationally as the puppeteer-with-puppet-with-spectator. It is this ‘withness’ that ignited the creative spark of presence of the residents. For a moment of trust and child-like joy kinaesthetic memories stirred in them, appearing to break down emotional barriers between the person and the world around them and indicating comparatively longer-term therapeutic benefits.
  • Neurosurgeons’ experiences of conducting and disseminating clinical research in low- and middle-income countries: A qualitative study protocol

    Whiffin, Charlotte, J.; Smith, Brandon, G.; Ignatius, Esene, N.; Karekezi, Claire; Bashford, Tom; Khan, Muhammed, M; Solla, Davi, JF; Hutchinson, Peter, J.; Kolias, Angelos; University of Derby; et al. (BMJ, 2020-08-13)
    Low-and middle-income countries (LMICs) face the greatest burden of neurotrauma. However, most of the research published in scientific journals originates from high-income countries, suggesting those in LMICs are either not engaging in research, or are not publishing it. Evidence originating in high-income countries may not be generalisable to LMICs, therefore it is important to nurture research capacity in LMICs so that a relevant evidence base can be developed. However, little is published about specific challenges or contextual issues relevant to increasing research activity of neurosurgeons in LMICs. Therefore, the aim of this study was to understand neurosurgeons’ experiences of, aspirations for and ability to, conduct and disseminate clinical research in low- and middle-income countries. This is a pragmatic qualitative study situated within the naturalistic paradigm using focus groups and interviews with a purposive sample of neurosurgeons from LMICs. First, we will conduct asynchronous online focus groups with 36 neurosurgeons to broadly explore issues relevant to the study aim. Second, we will select 20 participants for follow-up semi-structured interviews to explore concepts in more depth and detail than could be achieved in the focus group. Interviews will be audio-recorded and transcribed verbatim. A thematic analysis will be conducted following Braun and Clarke’s six stages and will be supported by NVIVO software. The University of Cambridge Psychology Research Ethics Committee reviewed and approved this study in January 2020 (REF PRE.2020.006). Participants will provide informed consent, be able to withdraw at any time and will have their contributions kept confidential. The findings of the study will be shared with relevant stakeholders and disseminated in conference presentations and journal publications.
  • Birth shock! What role might arts engagement have to play in antenatal and postnatal care?

    Hogan, Susan; University of Derby (Intellect, 2020-06-17)
    This article shares research findings for an Arts and Humanities Research Council project called The Birth Project (grant ref. AH/K003364/1). The Birth Project has been particularly interested to explore women’s personal experience of birth and the transition to motherhood using the arts, within a participatory arts framework. It ran experiential art-based groups for mothers and a further group for birthing professionals, each over a twelve-week period to solicit in-depth qualitative data. An innovative aspect of this endeavour has been the use of film as research data, as a means of answering the research questions (through selective editing) and as the primary mode of dissemination of the research results. Results elaborated and summarized here explore the ways women and birthing professionals found the intervention useful. The project analyses the distinctive contribution of the arts and concludes that arts engagement can play a vital role in both antenatal and postnatal care.
  • Acute liver failure in paracetamol overdose: management, transplantation and best practice

    Toplis, Emma; Mortimore, Gerri; University of Derby (MA Healthcare, 2020-07-02)
    In the United Kingdom the most common drug taken in overdose is paracetamol, which is recognised as a major cause of acute liver failure. However death rates from acute liver failure have fallen due to the rapid availability and accessibility of the antidote, acetylcysteine or N-acetylcysteine otherwise known as NAC. In this article the authors will critically evaluate the current literature surrounding the assessment and management of patients presenting with paracetamol overdose in order to improve their own clinical practise and promote best practice within their clinical team. This will include discussion of presentation, risk factors, treatment, complications and referral to specialist centres for transplant.
  • Behaving professionally in an age of political and corporate nonsense

    Jinks, Gavin; University of Derby (Human Givens Publishing, 2020-07-03)
    This article explores how a professional might practice in an ethical and value informed manner whilst also being able to subject to scrutiny practices that might be of questionable value. The background to this discussion is the exponential rise in digital communication and the rising power of large corporate organisations.
  • Cultivating learner aspirations and self-belief

    Jinks, Gavin; Harber, Denise; University of Derby (2020-07-13)
    The research team believes that to be a successful learner, the individual has to commit to the desired outcome in two ways: s/he has to want it, so it has to be relevant and important to her/him, and s/he has to believe that s/he can be successful. The team believe that both aspirations and self-belief are affected by personal influences, cultural/community influences and structural and societal influences. The team wishes to find reasons why significant numbers of school students don’t succeed in school, why many university students "drop out" of courses or don’t achieve the standard of which they are capable, and why adults fail to engage with the community activities. The team acknowledges that the influences on prospective learners of their families, their social and cultural groups, their local communities, and wider society in general are significant, but seek to establish whether low aspirations and poor self-belief are fixed or can be changed if leaders of learning and teachers create a culture of success in their settings, and develop a growth mindset in learners. This session explores the characteristics required for a positive learning culture, and the behaviours "teachers" might utilise in order to develop aspirations and self-belief in leaners.
  • Digital technology to facilitate proactive assessment of obesity risk during infancy (ProAsk): a feasibility study

    Redsell, Sarah A; Rose, Jennie; Weng, Stephen; Ablewhite, Joanne; Swift, Judy Anne; Siriwardena, Aloysius Niroshan; Nathan, Dilip; Wharrad, Heather J; Atkinson, Pippa; Watson, Vicki; et al. (BMJ, 2017-09-06)
    To assess the feasibility and acceptability of using digital technology for Proactive Assessment of Obesity Risk during Infancy (ProAsk) with the UK health visitors (HVs) and parents. Multicentre, pre- and post-intervention feasibility study with process evaluation. Rural and urban deprived settings, UK community care. 66 parents of infants and 22 HVs. ProAsk was delivered on a tablet device. It comprises a validated risk prediction tool to quantify overweight risk status and a therapeutic wheel detailing motivational strategies for preventive parental behaviour. Parents were encouraged to agree goals for behaviour change with HVs who received motivational interviewing training. We assessed recruitment, response and attrition rates. Demographic details were collected, and overweight risk status. The proposed primary outcome measure was weight-for-age z-score. The proposed secondary outcomes were parenting self-efficacy, maternal feeding style, infant diet and exposure to physical activity/sedentary behaviour. Qualitative interviews ascertained the acceptability of study processes and intervention fidelity. HVs screened 324/589 infants for inclusion in the study and 66/226 (29%) eligible infants were recruited. Assessment of overweight risk was completed on 53 infants and 40% of these were identified as above population risk. Weight-for-age z-score (SD) between the infants at population risk and those above population risk differed significantly at baseline (−0.67 SD vs 0.32 SD). HVs were able to collect data and calculate overweight risk for the infants. Protocol adherence and intervention fidelity was a challenge. HVs and parents found the information provided in the therapeutic wheel appropriate and acceptable. Study recruitment and protocol adherence were problematic. ProAsk was acceptable to most parents and HVs, but intervention fidelity was low. There was limited evidence to support the feasibility of implementing ProAsk without significant additional resources. A future study could evaluate ProAsk as a HV-supported, parent-led intervention.
  • Using interactive digital technology to predict and prevent childhood overweight

    Atkinson, Pippa; University of Nottingham; Anglia Ruskin University; University of Lincoln; Nottingham University Hospitals Trust (Wiley, 2017-11-12)
    Obesity risk factors can be identified during infancy, providing an opportunity for early intervention. ProAsk is an interactive digital intervention that supports health professionals to quantify and communicate an infant's overweight risk status, prompting discussion of parental strategies to reduce future risk. To investigate user experiences of an interactive digital intervention that assesses overweight risk during infancy and supports motivational behaviour change by parents to reduce their infants' future risk. The study was conducted in four economically deprived localities in the UK. Qualitative data on user experiences of ProAsk were collected at the end of a feasibility study of the intervention in which health visitors (public health nurses) used ProAsk with parents when the infants were three months old. Semi-structured interviews with parents (N = 12) and health visitors (N = 15) were conducted when the infants were 6 months old. Interview data were transcribed and analysed thematically using an inductive, interpretative approach. The analysis identified four key themes: engaging and empowering with digital technology; unfamiliar technology presents challenge and opportunity; trust in the risk score; resistance to targeting. Interactive, digital technology was found to actively engage parents, and enabled them to take ownership of the process of seeking strategies to reduce infant risk of overweight. However, cognitive and motivational biases that prevent effective overweight risk communication represent barriers to targeting the intervention at those infants most at risk of becoming overweight.
  • Development of an evidence-based practice guideline for UK public health nurses (health visitors) to use with parents of infants at risk of obesity.

    REDSELL, S.A.; EDMONDS, B.E.; GLAZEBROOK, C.; SWIFT, J.; NATHAN, D.; SIRIWARDENA, A.N.; WENG, S.F.; Atkinson, Pippa; WATSON, V.; Anglia Ruskin University; et al. (Elsevier BV, 2014-03-31)
    Evidence about effective interventions that reduce obesity risk during infancy is needed. A systematic review of Randomised Controlled Trials (RCTs) of behavioural and non-behavioural interventions which address potential risk factors for childhood overweight and obesity was undertaken to inform a guideline for UK health visitors. The National Institute for Health and Clinical Excellence (NICE) guidelines were followed. The findings were used to develop a guideline which was reviewed internally by a multi-professional Guideline Development Group (GDG) and externally by national experts and practitioners. We identified 35 RCTs reporting behavioural and non-behavioural interventions delivered antenatally and/or during infancy that included infant weight outcomes (e.g. weight-for-length, weight-for-age, weight-for-BMI) or outcomes related to obesity risk (breastfeeding, physical activity, timing of weaning). A number of on-going trials were identified. Good evidence exists for breastfeeding promotion and support interventions. Evidence exists for parental education around responsive feeding, aspects of infant diet and soothing/sleep expectations. These behavioural components informed the guideline, which is freely available on the UK Institute for Health Visiting website. There was equivocal evidence that infants fed lower protein (compared to higher protein) formula milk gained less weight, and this was not incorporated into the guideline. Further research is needed to establish clinically effective interventions for obesity prevention during infancy. Continuous dialogue between commissioners, policy makers, health visitors and parents is essential to inform obesity prevention strategies in the first year of life.
  • Proactive assessment of obesity risk during infancy (ProAsk): enabling health visitors to communicate future risk of childhood overweight to parents through digital technology

    Redsell, S.A.; Rose, J; Ablewhite, J; Swift, J; Siriwardena, A.N.S; Nathan, D; Weng, S; Wharrad, H; Atkinson, Pippa; Watson, V; et al. (2016-09)
  • A preceptorship toolkit for nurse managers, teams and healthcare organisations

    Owen, Patricia; Whitehead, Bill; Beddingham, Elaine; Simmons, Maxine; University of Derby; Chesterfield Royal Hospital NHS Foundation Trust (RCNI, 2020-07-08)
    The transition from student to newly qualified nurse can be challenging. A period of preceptorship is recommended to support newly qualified nurses in their new work environment, and to give them time to adapt and gain confidence. Researchers have developed a toolkit based on previous research that contains several resources that nurse managers, teams and organisations can use to develop and improve preceptorship for newly qualified nurses. The toolkit includes an organisational support tool, a managerial support framework, a supernumerary time tool and a local culture of support tool. This article describes these resources and gives an example of how the toolkit can be adapted locally.
  • A feasibility study of non-invasive continuous estimation of brachial pressure derived from arterial and venous lines during dialysis

    Stewart, Jill; Walker, Thomas; Eldehini, Tarek; Horner, Daniela Viramontes; Lucas, Bethany; White, Kelly; Muggleton, Andy; Selby, Nicholas M; Taal, Martin W; Stewart, Paul; et al. (IEEE, 2020)
    Intradialytic haemodynamic instability is a significant clinical problem, leading to end-organ ischaemia and contributing to morbidity and mortality in haemodialysis patients. Non-invasive continuous blood pressure monitoring is not part of routine practice but may aid detection and prevention of significant falls in blood pressure during dialysis. Brachial blood pressure is currently recorded intermittently during haemodialysis via a sphygmomanometer. Current methods of continuous non-invasive blood pressure monitoring tend to restrict movement, can be sensitive to external disturbances and patient movement, and can be uncomfortable for the wearer. Additionally, poor patient blood circulation can lead to unreliable measurements. In this study we performed an initial validation of a novel method and associated technology via a feasibility study to continuously estimate blood pressure using pressure sensors in the extra-corporeal dialysis circuit, which does not require any direct contact with the person receiving dialysis treatment.\\ The paper describes the development of the measurement system and subsequent \emph{in vivo} patient feasibility study with concurrent measurement validation by \emph{Finapres Nova} experimental physiological measurement device. We identify a mathematical function to describe the relationship between arterial line pressure and brachial artery BP, which is confirmed in the patient study. The methodology presented requires no interfacing to proprietery dialysis machine systems, no sensors to be attached to the patient directly, and to be robust to patient movement during treatment and also to the effects of the cyclical pressure waveforms induced by the hemodialysis pump. This represents a key enabling factor to the development of a practical continuous blood pressure monitoring device for dialysis patients.
  • Overcoming the challenges of role transition for trainee advanced clinical practitioners

    Murphy, Kay; Mortimore, Gerri; Royal Derby Hospital; University of Derby (Mark Allen Group, 2020-06-18)
    Advanced clinical practitioners (ACPs) are being recruited in England to improve care continuity and safety, meet complex needs and ease workforce pressures. These roles are open to experienced, registered health professionals from a variety of backgrounds. This significant career change typically involves a transitional training programme. This article explores the challenges presented by this transition and how they can be overcome. Attaining the postgraduate qualification can be daunting for those who have been outside academic education, especially the initial degree module. The generalist ACP role can be confused with that of clinical nurse specialist, and an ambiguous role identity can cause problems for management, expectations and morale. Trainee ACPs gain wide experience from ward rotations, although they can specialise in some areas. Thus, trainees experience de-skilling as they go from being an expert in one role to a novice in another, as well as potentially developing imposter syndrome. Trainees may be anxious about being expected to fulfil the competencies of a qualified ACP, and their trainee status should be evident in their uniform. Those entering advanced practice can face interpersonal hostility and institutional resistance. Any bullying should be addressed directly, and potential misconceptions should be clarified. There is no overarching national regulatory body for ACPs, and relevant guidelines can diverge. While a clinical supervision assesses a trainee's performance, a separate mentor should support their learning and develop their competence and confidence, especially in the first year. Mentorships should be defined and structured. Trainees can be supported by experienced qualified ACPs. Flexible individual induction plans, with information spaced throughout the year, can help overcome these challenges, and these should make the most of the trainee's achievements in their previous role.
  • Patient centred care in diagnostic radiography (Part 1): Perceptions of service users and service deliverers

    Hyde, Emma; Hardy, Maryann; University of Derby (Elsevier, 2020-06-13)
    There is growing awareness of the importance of patient centered care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents. However, there is limited research evidence exploring whether perceptions of PCC are equivalent between those delivering (radiographers) and those experiencing (patient) care. This study aimed to address this gap by determining compatibility in perceptions of PCC between those using and those delivering radiography services. This is the first step in developing measurable indicators of PCC in diagnostic radiography. A multi-method two stage approach was undertaken using survey and interview data collection techniques. Ethical approval was granted by University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 1 of the study, the online, cross sectional survey. Participants were asked to indicate their level of agreement to a series of attitudinal statements using a 5-point Likert scale. Statements were paired, but not co-located to increase validity. Participants were invited to provide free text comments to supplement their responses. Stage 2 of the project is reported separately. Survey responses were received from all 3 participant subgroups. A minimum response rate of 30 participants per sub-group was set as a target. Response rates varied across subgroups, with only radiography managers failing to meet the expected response threshold. Wide disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident. It is evident that there is still work required to ensure parity between expectations of service users and deliverers on what constitutes high quality PCC. Further work is required to identify measurable service delivery outcomes that represent PCC within radiographic practice.

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