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  • Chronic limb ischaemia: case study and clinical literature review

    Farrington, Liz; Mortimore, Gerri; University Hospitals of Derby and Burton NHS Foundation Trust; University of Derby (Mark Allen Group, 2021-07-21)
    This article will discuss chronic limb ischaemia as the result of peripheral artery disease (PAD) using a case study. The patient's concurrent diagnosis of metastases meant clinical decision making was complex and treatment options were limited. PAD is the third most common clinical presentation of atherosclerosis after coronary artery disease and stroke. Although advances in radiological technology and biochemical screening offer the potential for earlier intervention and improved survival rates for patients with PAD, a review of the evidence suggests that commitment to more conservative approaches, such as exercise therapy and health promotion, could have more sustainable, longer-term benefits for patients with chronic limb ischaemia. The therapeutic nature of the nurse–patient relationship makes nurses ideally placed for encouraging lifestyle changes and signposting to support services. Active participation from the patient is imperative for any potential modifications, which should be individualised as part of a holistic care plan, to ensure patient engagement and compliance. Therefore emphasis should remain on the management and prevention of modifiable risk factors, for which the nurse's role is an integral part to ensure success.
  • What are the ethical dilemmas in the decision making processes of nursing people given Electroconvulsive therapy? A critical realist review of qualitative evidence

    Sweetmore, Victoria; University of Derby (Wiley, 2021-06-18)
    Electroconvulsive therapy (ECT) has a complex and contentious place in psychiatric care. Mental health nurses (MHNs) are of obligated to be part of this practice despite ethical concerns. To consider the ethical dilemmas and decision-making processes facing MHNs involved in the administration of ECT. A critical realist review of the literature surrounding ethical considerations and ECT was undertaken using thematic analysis. Four key themes emerged: the MHN as an advocate and conflict in their role, issues surrounding consent, questionable efficacy and unknown method of action, side effects, and legal issues and clinical guidelines. Using a critical realist framework for understanding, the decision-making process and ethical considerations are viewed as part of the empirical and actual parts of reality, while the potential for other, unseen causal powers to be at play is acknowledged. MHNs need to ensure they have an adequate ethical underpinning to their practice to enable them to navigate contentious areas of practice such as ECT to practice effectively and preserve safety. This may require moving beyond the traditional biomedical model of ethics. Developing an appreciation of unseen causal factors is also an essential part of MHNs’ developing professional competency.
  • Older people, dementia and neuro-dramatic-play: A personal and theoretical drama therapy perspective

    Holmwood, Clive; University of Derby (Intellect, 2021-05-10)
    This conceptual article will consider Sue Jennings’ neuro-dramatic-play (NDP) as an overall theoretical framework for working with older people with dementia. NDP was developed over a number of years by pioneering UK drama therapist Sue Jennings. It is a culmination of attachment-based play, drama, movement and storytelling, and arts-based approaches that are used within drama therapy and other play and creative-based work with children. The author will consider from a personal and reflective perspective how NDP approaches can be adapted by drama therapists to work with older people with memory loss based on almost 30-years history of being involved in the field of drama therapy as a student and practioner, and his work with older people, at both the beginning of his career and his current reflections many years later.
  • From expert to advanced clinical practitioner and beyond

    Mortimore, Gerri; Reynolds, Julie; Forman, Dawn; Brannigan, Chris; University of Derby (MAG, 2021-06-10)
    This article considers the potential development of advanced clinical practitioners (ACPs) and consultant practitioners, beyond the ‘expert’ status as defined by Pat Benner in 1984. The suggested Derby Model: 7 Levels of Practice Advancement, adapted from Benner's From Novice to Expert, recognises Health Education England's four pillars of advanced practice and how they can be implemented and enhanced within these senior roles, and what that means in a 21st century healthcare system.
  • Fears of compassion magnify the harmful effects of threat of COVID-19 on mental health and social safeness across 21 countries

    Matos, Marcela; McEwan, Kirsten; Basran, Jaskaran; Gilbert, Paul; University of Derby (Wiley, 2021-04-20)
    The COVID-19 pandemic is a massive global health crisis with damaging consequences to mental health and social relationships. Exploring factors that may heighten or buffer the risk of mental health problems in this context is thus critical. Whilst compassion may be a protective factor, in contrast fears of compassion increase vulnerability to psychosocial distress and may amplify the impact of the pandemic on mental health. This study explores the magnifying effects of fears of compassion on the impact of perceived threat of COVID-19 on depression, anxiety and stress, and social safeness. Adult participants from the general population (N = 4057) were recruited across 21 countries worldwide, and completed self-report measures of perceived threat of COVID-19, fears of compassion (for self, from others, for others), depression, anxiety, stress and social safeness. Perceived threat of COVID-19 predicted increased depression, anxiety and stress. The three flows of fears of compassion predicted higher levels of depression, anxiety and stress and lower social safeness. All fears of compassion moderated (heightened) the impact of perceived threat of COVID-19 on psychological distress. Only fears of compassion from others moderated the effects of likelihood of contracting COVID-19 on social safeness. These effects were consistent across all countries. Fears of compassion have a universal magnifying effect on the damaging impact of the COVID-19 pandemic on mental health and social safeness. Compassion focused interventions and communications could be implemented to reduce resistances to compassion and promote mental wellbeing during and following the pandemic.
  • Patient centred care in diagnostic radiography (Part 3): Perceptions of student radiographers and radiography academics

    Hyde, Emma; Hardy, M; University of Derby; University of Bradford (Elsevier, 2021-01-27)
    Awareness is growing of the importance of patient centered care (PCC) in diagnostic radiography. PCC is embedded within professional body publications and guidance documents, but there is limited research evidence exploring the perceptions of student radiographers and radiography academics. This paper shares the findings of a research project seeking to define PCC in diagnostic radiography from the perspective of student radiographers and radiography academics. This paper reports Stage 1 and Stage 2 of the project from the perspective of radiography academic and student radiographer participants, and compare these to the perspective of service users, clinical radiographers and radiography managers, reported previously. Stage 1 used an online survey tool to gauge participant agreement with a series of attitudinal statements. Stage 2 used situational vignettes to promote discussion and debate about PCC approaches. Ethical approval was granted by the University of Derby College of Health & Social Care Ethics committee. Response rates to the Stage 1 survey were above the minimum threshold, with 50 responses from student radiographers and 38 responses from radiography academics. Stage 1 participants were asked to participate in Stage 2 on a voluntary basis. As with service users and service deliverers, care communication, event interactions and control over environment were the key influences on PCC. However, students highlighted differences between reported and observed levels of PCC. There is some way to go to embed PCC in diagnostic radiography practice. As impartial observers of radiography practice, student radiographers highlight the difference between service users and service deliverer’s perceptions of PCC. Whilst the focus of clinical radiographers remains on efficiency it is difficult for student radiographers to challenge the accepted norm. Role models are required to promote PCC behaviours and a holistic approach in radiography practice. A package of educational support and audit tools will be made available to support both service deliverers and student radiographers to deliver PCC.
  • Clinical supervision for advanced practitioners

    Reynolds, Julie; Mortimore, Gerri; University of Derby (MAG, 2021-04-08)
    This article discusses clinical supervision and its importance in supporting the development of advanced clinical practitioners. It will reflect on the impact of clinical supervision using extracts from research data provided by trainee advanced clinical practitioners and their medical supervisors. This article will consider the latest guidance on how to facilitate quality clinical supervision in the workplace and the potential challenges it may face relating to governance, finances, and time.
  • The management of urinary tract infections in older patients within an urgent care out of hours setting

    Dexter, Justine; Mortimore, Gerri; University of Derby (MAG, 2021-03-26)
    This article critically analyses the prevalence, assessment and management of urinary tract infections (UTIs) in patients over the age of 65, in an urgent care out-of-hours service in order to enhance care. It is undertaken from the perspective of working as an Advanced Nurse Practitioner (ANP). A synopsis of UTI is presented, examining the epidemiology and aetiology. The process of assessment, diagnosis and management of UTI in older people is appraised based on current evidence. Difficulties associated with the recognition of UTI in elderly are evaluated. Finally, recommendations are made for the improvement of future practice as an ANP.
  • Neurotrauma clinicians’ perspectives on the contextual challenges associated with long-term follow-up following traumatic brain injury in low-income and middle-income countries: a qualitative study protocol

    Smith, Brandon George; Whiffin, Charlotte Jane; Esene, Ignatius N; Karekezi, Claire; Bashford, Tom; Mukhtar Khan, Muhammad; Fontoura Solla, Davi Jorge; Indira Devi, Bhagavatula; Hutchinson, Peter John; Kolias, Angelos G; et al. (BMJ, 2021-03-04)
    Traumatic brain injury (TBI) is a global public health concern; however, low/middle-income countries (LMICs) face the greatest burden. The WHO recognises the significant differences between patient outcomes following injuries in high-income countries versus those in LMICs. Outcome data are not reliably recorded in LMICs and despite improved injury surveillance data, data on disability and long-term functional outcomes remain poorly recorded. Therefore, the full picture of outcome post-TBI in LMICs is largely unknown. This is a cross-sectional pragmatic qualitative study using individual semistructured interviews with clinicians who have experience of neurotrauma in LMICs. The aim of this study is to understand the contextual challenges associated with long-term follow-up of patients following TBI in LMICs. For the purpose of the study, we define ‘long-term’ as any data collected following discharge from hospital. We aim to conduct individual semistructured interviews with 24–48 neurosurgeons, beginning February 2020. Interviews will be recorded and transcribed verbatim. A reflexive thematic analysis will be conducted supported by NVivo software. The University of Cambridge Psychology Research Ethics Committee approved this study in February 2020. Ethical issues within this study include consent, confidentiality and anonymity, and data protection. Participants will provide informed consent and their contributions will be kept confidential. Participants will be free to withdraw at any time without penalty; however, their interview data can only be withdrawn up to 1 week after data collection. Findings generated from the study will be shared with relevant stakeholders such as the World Federation of Neurosurgical Societies and disseminated in conference presentations and journal publications.
  • An initiative for student nurses to practise clinical skills at home

    Whitehead, Bill; Ansell, Helen; University of Derby (EMAP, 2021-02-15)
    This article describes an initiative for students to practise clinical skills in their own homes using university-supplied instructions and equipment, implemented as a response to the restrictions to on-campus teaching during the coronavirus pandemic. It includes recommendations for future use, concluding that it would also be a useful adjunct to traditional training methods following the end of the pandemic.
  • Transitioning to an ACP: a challenging journey with tribulations and rewards

    Reynolds, Julie; Mortimore, Gerri; University of Derby (MAG, 2021-02-10)
    Julie Reynolds and Gerri Mortimore, discuss the difficulties advanced clinical practitioners face when taking on this new role, and how drawing on their transferable skills can help them make the transition
  • Can compassion-focused imagery be used as an attention bias modification treatment?

    Leboeuf, Isabelle; McEwan, Kirsten; Rusinek, Stéphane; Andreotti, Eva; Antoine, Pascal; Université Lille Nord de France; University of Derby (Springer, 2021-01-06)
    Compassion focused-imagery (CFI), one of the psychological interventions of compassion-focused therapy, is receiving increasing attention. It is a therapeutic tool that targets the process of self-criticism by prompting individuals to imagine themselves as compassionate or to imagine receiving compassion from an ideal compassionate other. This research examines the role of self-criticism in the attentional processing of emotional stimuli, namely, critical and compassionate facial expressions. It is hypothesized that the activation of positive social emotions through CFI plays a role in broadening attention in the processing of emotional stimuli. The McEwan Faces stimulus set, which includes critical, neutral and compassionate faces, was used to create an attentional bias task called the dot probe task. The processing of emotional faces was assessed before and after exposure to either CFI or neutral imagery, controlling for the process of sensory integration (n = 80). A between-subject analysis was used to test the hypothesis. Before the imagery task, participants tended to look away from critical faces, and their level of self-criticism played a role. Both types of imagery significantly reduced the bias away from critical faces when the stimuli were presented for 1200 ms. This effect was reversed in the neutral condition for participants with high levels of self-criticism but not in the CFI condition. Interestingly, self-criticism impacts the attentional treatment of critical faces and the effect of imagery entailing sensory integration on this treatment. CFI seems to preserve this effect for participants with high levels of self-criticism, possibly due to the activation of positive social emotions.
  • The ascent to advanced practice: challenges, support and opportunities

    Reynolds, Julie; Mortimore, Gerri; University of Derby (Mark Allen Group, 2021-02-02)
    The challenges that impact on the journey to advanced clinical practice are many. However, with structured support the opportunity to develop to this level can be nurtured. This article will reflect upon this development and discuss some of the difficulties for trainee Advanced Clinical Practitioners (ACP), such as imposter syndrome, feelings of inadequacy and role transition. The article will also consider the importance of clinical supervision, mentorship and support mechanisms that may assist in developing advanced clinical practice and facilitate its progression.
  • Tackling the inescapable: Mental ill health in later life. Report on a series of conversations

    Collier, Elizabeth; Ahmed, J; Lamph, Gary; Ahmed, Anya; University of Salford (University of Salford, 2018-04-18)
    Older people with mental health problems (OPMHP) are a sub group of both mental health service users and older people service users. The specific voice OPMHP is therefore diluted within these general groups and there is little evidence to inform our understanding of the experiences of OPMHP. This project aimed to engage in conversation with older people who have experienced mental health problems with a view to hearing OPMHP perspectives and identifying priorities for future research. Twelve people met though contacts with local services and community contacts contributed. Their ages ranged from 52-86 and there were 7 men and 5 women. Six meetings/conversations were held (individually or in small groups) during a three month period April-July 2017. Each conversation built on findings from the previous meeting/conversation. The conversations were shaped by the questions: What does ‘older person’ mean to you? ‘What matters in mental health care for older people’? (Including discussion about what was meant by ‘age appropriate’) and ‘What should be researched’? Conversations about preliminary findings were continued at a feedback event on 3rd July 2017 attended by seven of the contributors. The predefined categories ‘older people’, mental health care and age appropriateness’ and ‘research’ shaped the conversations. The older people category found mixed and contradictory ideas about what older person meant. A content analysis of the categories ‘mental health care and age appropriateness’, and ‘research’ was conducted by ‘within’ and ‘across’ analysis of the transcribed notes from the six meetings/conversations and found eight themes: Mutuality, Sensitivity, Carers, Exclusion, Meaning and purpose, Politics, Physical and mental health integration, and Mortality. Although limitations include: a small number of people, lack of diversity, and took place in only one location, the depth of the discussions was wide ranging. The themes overlapped somewhat but some new insights emerged which are perhaps not well explored in literature or policy. The idea of age appropriateness was confusing and was not defined but was conflated with illness and frailty. There was an emphasis on ageism that is in contrast with mental health policy that does not address the complexity of (indirect) discrimination on the basis of age for OPMH. Although this report only includes the views of twelve people it raises a number of important issues that are worthy of further exploration. This is particularly important for policy and commissioners who need to progress on the basis of up to date evidence. The consultation will inform development for research proposals and bids following exploratory literature reviews on topics raised.
  • A pragmatic controlled trial of forest bathing compared with compassionate mind training in the UK: impacts on self- reported wellbeing and heart rate variability

    McEwan, Kirsten; Giles, David; Clarke, Fiona; Kotera, Yasuhiro; Evans, Gary; Terebenina, Olga; Minou, Lina; Teeling, Claire; Basran, Jaskaran; Wood, Wendy; et al. (MDPI, 2021-01-28)
    Forest Bathing, where individuals use mindfulness to engage with nature, has been re-ported to increase heart rate variability and benefit wellbeing. To date, most Forest Bathing studies have been conducted in Asia. Accordingly, this paper reports the first pragmatic controlled trial of Forest Bathing in the United Kingdom, comparing Forest Bathing with a control comprising an es-tablished wellbeing intervention also known to increase heart rate variability called Compassion-ate Mind Training. Sixty-one university staff and students (50 females, 11 males) were allocated to (i) Forest Bathing, (ii) Compassionate Mind Training or (iii) Forest Bathing combined with Com-passionate Mind Training. Wellbeing and heart rate variability were measured at baseline, post-intervention and three-months follow-up. There were improvements in positive emotions, mood disturbance, rumination, nature connection and compassion and 57% of participants showed an increase in heart rate variability (RMSSD -parasympathetic activity). There were no significant differences between conditions, showing that Forest Bathing had an equivalence with an established wellbeing intervention. The findings will help healthcare providers and policy makers to understand the effects of Forest Bathing and implement it as a feasible social prescription to improve wellbeing. Future research needs to involve clinical populations and to assess the effects of Forest Bathing in a fully powered randomised controlled trial (RCT) .
  • Starting to Measure up

    Lloyd, Erica; University of Derby (Redactive Publishing Limited, 2020-10-01)
    How using outcome measures can improve school nurses effectiveness.
  • Developing a whole-school mental health and wellbeing intervention through pragmatic formative process evaluation: A case-study of innovative local practice within the School Health Research Network

    Gobat, Nina; Littlecot, Hannah; Williams, Andy; McEwan, Kirsten; Stanton, Helen; Robling, Michael; Rollnick, Stephen; Murphy, Simon; Evans, Rhiannon; University of Oxford; et al. (BMC, 2021-01-18)
    The evidence-base for whole school approaches aimed at improving student mental health and wellbeing remains limited. This may be due to a focus on developing and evaluating de-novo, research led interventions, while neglecting the potential of local, contextually-relevant innovation that has demonstrated acceptability and feasibility. This study reports a novel approach to modelling and refining the theory of a whole-school restorative approach, alongside plans to scale up through a national educational infrastructure in order to support robust scientific evaluation. A pragmatic formative process evaluation was conducted of a routinized whole-school restorative approach aimed at improving student mental health and wellbeing in Wales. The study reports seven phases of the pragmatic formative process evaluation that may be undertaken in the development and evaluation of interventions already in routine practice: 1) identification of innovative local practice; 2) scoping review of evidence-base to identify existing intervention programme theory; outcomes; and contextual characteristics that influence programme theory and implementation; 3) establishment of a Transdisciplinary Action Research (TDAR) group; 4) co-production of an initial intervention logic model with stakeholders; 5) confirmation of logic model with stakeholders; 6) planning for intervention refinement; and 7) planning for feasibility and outcome evaluation. The phases of this model may be iterative and not necessarily sequential. Formative, pragmatic process evaluations support researchers, policy-makers and practitioners in developing a robust scientific evidence-base for acceptable and feasible local innovation that does not have a clear evidence base. The case of a whole-school restorative approach provides a case example of how such an evaluation may be undertaken.
  • Anti-neutrophil cytoplasmic antibodies-associated vasculitis: a guide and case study

    Boyer, Helena; Mortimore, Gerri; Royal Derby Hospital; University of Derby (Mark Allen Group, 2020-12-10)
    Vasculitis is a relatively rare and poorly understood condition causing inflammation of the blood vessels, which in turn can affect a patient's respiratory and renal systems. In some cases, ocular involvement can cause loss of sight and hearing loss may also be a red flag for vasculitis, which, if not treated early, can cause complete hearing loss. Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a group comprising granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis (EGP). AAV is fatal if untreated and as increased risk escalates with age, coupled with a decline in renal function, these are the principal predictors of poor outcome. Vital roles for nursing vasculitis patients lie in managing inflammation and pain, as these distressing symptoms are prevalent in the disease. Because of the multiple complications that can occur with vasculitis, treatment-related information is a high priority for these patients. As nurses are well placed to deliver information, value lies in their role in reducing the negative impacts on treatment regimens and compliance that accompany patients' poor insight into their condition.
  • Preceptorship Research Project Report: Chesterfield Royal Hospital NHS foundation trust

    Barton, Merryn; Beddingham, Elaine; Henshaw, Lorraine; Owen, Patricia; Simmons, Maxine; Whitehead, Bill; Chesterfield Royal Hospital NHS Foundation Trust; Keele University; University of Derby (Chesterfield Royal Hospital NHS Trust, 2014-02-19)
    Nurse education in the UK has been solely university based since the mid-1990s but despite careful preparation and assessment of student nurses it has been considered necessary to provide a period of additional support for Newly Qualified Nurses (NQNs) to help them settle into their new role and responsibilities. Preceptorship is the process of supporting NQNs over this transition period from student to registered nurse and it is recognised that this can be a stressful and difficult time for NQNs. This project developed from work already undertaken by the clinical placement learning team at Chesterfield Royal Hospital NHS Foundation Trust and was led by the University of Derby in partnership with them and took a case study approach to evaluating how preceptees and their preceptors are supported in practice; what their expectations are and what factors in the clinical area support or inhibit transition to qualified nurse. A systematic review was conducted as part of this project (Whitehead et al 2012 and 2013). The evidence suggests that properly resourced and organised preceptorship is a positive and essential experience for NQNs and their employers. Negative experiences come from an absence of preceptorship; preceptorship being offered but not fully delivered; and feelings of poor self-confidence despite having sufficient competence. The implication of this is that organisations can improve their likelihood of producing reliable and competent registered nurses (RNs) by the introduction of properly resourced and organised preceptorship frameworks. Recommendations for practice and for further research are made. A modified version of Lincoln and Guba’s Naturalistic Inquiry (1985) was used. This provided an authoritative and reliable ontological framework upon which to base the project. A qualitative case study method was developed and consisted of a multistage approach to data collection including semi-structured interviews with key personnel; documentary analysis of preceptorship material and focus groups with key actors. Ten interviews and five focus groups were undertaken with a total of 40 focus group participants. The participants were purposively sampled from representative groups within the Trust. NVivo was used to support analysis and ethical approval was attained for the project. Findings are grouped under the headings of: preceptor training; preceptor support; experiences of preceptorship; what the nurse should be like at the end of a period of preceptorship and the use of the tool. In addition further themes emerged from the findings in relation to indicators for successful transition; formal recognition of preceptor role; confidence and resilience; culture of support including peer support and management structure to support preceptorship; selection and preparation of preceptors and clinical skills. It is evident that there are a range of factors which are seen to affect the success or otherwise of the preceptorship period and the transition to confident RN. The findings indicate that there are a range of factors which are reported to affect the successful transition from student to NQN with the period of preceptorship in this case. These are : the selection and preparation of preceptors; a need to formally recognise the preceptor role; specific time to engage with preceptorship ; a management structure to support preceptors and preceptorship; the individualisation of preceptorship needs and ways to ensure successful preparation of students and NQNs ; the acquisition of the right clinical skills for the job; the culture of support; peer support for preceptees and preceptors; the confidence and resilience of preceptees and technological support processes. Based on these factors recommendations are made for this case in practice and for further research generally.
  • Preceptorship programmes in the UK: A systematic literature review

    Beddingham, Elaine; Henshaw, Lorraine; Owen, Patricia; Simmons, Maxine; Walker, Carl; Whitehead, Bill; Chesterfield Royal Hospital NHS Foundation Trust; University of Derby (Chesterfield Royal Hospital NHS Trust, 2012-01-19)
    This is a systematic literature review of the existing published research related to the development of preceptorship programmes in the UK. It has been known for some time that newly qualified nurses experience a period of unsettling transition at the point of registration. In the UK preceptorship has been the professional body’s recommended solution to this for over 20 years. Searches were made of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and AMED. A systematic review was carried out based on the following questions: What is the experience of the preceptee? What is the experience of the preceptor? What are the ways of measuring the outcome of the preceptorship process? What are potential ways of measuring the outcome of other transitional periods in industries outside of the nursing profession? What are the ways of assessing the learning environment and learner needs? Papers were critically reviewed and relevant data were extracted and synthesised. A results table is presented of the 39 sources generated by the systematic search. Eight themes were identified from the empirical evidence base: ‘Managerial Support Framework’; ‘Recognition and Status of Role’; ‘Protected Time for Preceptor and Preceptee’; ‘Education Preparation of Preceptors’; ‘Recruitment and Retention’; ‘Competence of Preceptees’; ‘Reflection and critical thinking in action’; and ‘Efficacy of Existing Measurement Tools’. There is strong evidence that the newly qualified nurse wants and benefits from a period of structured preceptorship. This translates to improved patient care and benefits recruitment and retention for the employing organisations. Recommendations for Practice: The existing literature provides an evidence base upon which to construct a preceptorship programme and a means by which to measure its efficacy and monitor its future development. Recommendations for Future Research: Case study research projects should be considered for future preceptorship programmes in order to find the most effective methods of delivery.

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