• 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
    • 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.
    • 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) .
    • 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.
    • 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.
    • Assessing the feasibility of public engagement in a smartphone app to improve well-being through nature connection ( Evaluation of the feasibility of citizen engagement through a smartphone app to improve well-being through connection with nature )

      McEwan, Kirsten; Richardson, Miles; Sheffield, David; Ferguson, Fiona; Brindley, Paul; University of Derby; University of Birmingham; University of Sheffield (Taylor & Francis, 2021-01-08)
      Aside from practical interventions such as providing green infrastructure to improve air quality or water contamination and reduce flooding, wellbeing interventions to increase engagement with the natural environment are one of the fastest growing ways of improving human and environmental health. This feasibility study assessed a novel Smartphone app wellbeing intervention. Over 30 days the app prompted adults, including those seeking help for a common mental health problem, to notice the good things about urban green or built spaces (control condition). Self-referral was successful with 885 people downloading the app, 435 supplying baseline data and 50 supplying post-intervention data. However, the low number of observations (M=6 per participant) indicates that 30 days is too long to remain engaged. There were significant improvements in wellbeing and nature connection, but no difference between green and built space conditions. Limitations, future recommendations regarding improving engagement and marketing to lower socio-economic status groups are discussed.
    • 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.
    • 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.
    • Routledge international handbook of play, therapeutic play and play therapy

      Jennings, Sue; Holmwood, Clive; University of derby; University of Witwatersrand, South Africa (Routledge, 2020-11-30)
      Routledge International Handbook of Play, Therapeutic Play and Play Therapy is the first book of its kind to provide an overview of key aspects of play and play therapy, considering play on a continuum from generic aspects through to more specific applied and therapeutic techniques and as a stand-alone discipline. Presented in four parts, the book provides a unique overview of, and ascribes equal value to, the fields of play, therapeutic play, play in therapy and play therapy. Chapters by academics, play practitioners, counsellors, arts therapists and play therapists from countries as diverse as Japan, Cameroon, India, the Czech Republic, Israel, USA, Ireland, Turkey, Greece and the UK explore areas of each topic, drawing links and alliances between each.  The book includes complex case studies with children, adolescents and adults in therapy with arts and play therapists, research with children on play, work in schools, outdoor play and play therapy, animal-assisted play therapy, work with street children and play in therapeutic communities around the world. Routledge International Handbook of Play, Therapeutic Play and Play Therapy demonstrates the centrality of play in human development, reminds us of the creative power of play and offers new and innovative applications of research and practical technique. It will be of great interest to academics and students of play, play therapy, child development, education and the therapeutic arts. It will also be a key text for play and creative arts therapists, both in practice and in training, play practitioners, social workers, teachers and anyone working with children.
    • Creative critical representation of the choreographer’s creation process

      Collard-Stokes, Gemma; University of Derby (Taylor & Francis, 2020-11-30)
      This review examines Jonathan Burrows: Towards a Minor Dance, a monography by Daniela Perazzo Domm published within the Palgrave Macmillan’s New World Choreographies series. Perazzo Domm’s first monograph introduces British choreographer Jonathan Burrows, whose work is considered an important contribution to contemporary performance practices’ effort to rethink what constitutes choreography. The review focuses of the books main themes of socio-political creativity and collaboration at the intersection(s) of artist, body and composition. The review observes this through the endeavour to question relational aspects between the writer and the choreographer’s creative process.
    • Neuro-dramatic play and a hero's journey: a play-based approach in a UK junior school

      Holmwood, Clive; University of derby (Routledge, 2020-11-30)
      This chapter aims to consider the principles of neuro-dramatic play - NDP (Jennings 2011) as a form of pre-therapy/ structured interventional play. By running nine sessions with a group of 15 children (Years 3 to 6, 7-11 year olds), all of whom had been handpicked by school staff, due to their confidence and self-esteem issues; I will explore the notion of NDP as an effective form of low level play based intervention. By allowing the children to build bridges with each other through the play and going on a fantastical and dramatic hero’s journey, I will consider the appropriateness of NDP as a way of supporting the confidence and self-esteem of a small group of middle school age children in the UK.
    • An iterative run-to-run learning model to derive continuous brachial pressure estimates from arterial and venous lines during dialysis treatment

      Stewart, Jill; Stewart, Paul; Walker, Tom; Viramontes-Hörner, Daniela; Lucas, Bethany; White, Kelly; Taal, Maarten W.; Selby, Nicholas M.; Morris, Mel; University of Derby; et al. (Elsevier BV, 2020-11-28)
      Objective: Non-invasive continuous blood pressure monitoring is not yet part of routine practice in renal dialysis units but could be a valuable tool in the detection and prevention of significant variations in patient blood pressure during treatment. Feasibility studies have delivered an initial validation of a method which utilises pressure sensors in the extra-corporeal dialysis circuit, without any direct contact with the person receiving treatment. Our main objective is to further develop this novel methodology from its current early development status to a continuous-time brachial artery pressure estimator. Methods: During an in vivo patient feasibility study with concurrent measurement validation by Finapres Nova experimental physiological measurement device, real-time continuous dialysis line pressures, and intermittent occluding arm cuff pressure data were collected over the entire period of (typically 4-hour) dialysis treatments. There was found to be an underlying quasi-linear relationship between arterial line and brachial pressure measurements which supported the development of a mathematical function to describe the relationship between arterial dialysis line pressure and brachial artery BP. However, unmodelled non-linearities, dynamics and time-varying parameters present challenges to the development of an accurate BP estimation system. In this paper, we start to address the problem of physiological parameter time variance by novel application of an iterative learning run-to-run modelling methodology originally developed for process control engineering applications to a parameterised BP model. Results: The iterative run-to-run learning methodology was applied to the real-time data measured during an observational study in 9 patients, supporting subsequent development of an adaptive real-time BP estimator. Tracking of patient BP is analysed for all the subjects in our patient study, supported only by intermittent updates from BP cuff measurements. Conclusion: The methodology and associated technology is shown to be capable of tracking patient BP noninvasively via arterial line pressure measurement during complete 4-hour treatment sessions. A robust and tractable method is demonstrated, and future refinements to the approach are defined.
    • Recreational burlesque and the aging female body: challenging perceptions

      Collard-Stokes, Gemma; University of Derby (Taylor & Francis, 2020-10-28)
      Rejecting the association between aging and asexuality that persists in the UK’s cultural representation of the female aging body, this paper reveals the importance of sensuality and maintaining physical agency to older women. It pays attention to the phenomena of participating in recreational burlesque classes to counter and negotiate potentially negative representations. Through in-depth interviews and researcher-as-participant observation, the paper explores the transformative possibilities mediated through participating in theatrically glamorized performance classes and the processes thereby initiated. The author examines the potential of burlesque to offer improvements to wellbeing and healthier self-perceptions for aging women experiencing marginalization through social invisibility.
    • The magic of the mundane: the vulnerable web of connections between urban nature and wellbeing

      Dobson, Julian; Brindley, Paul; Birch, Jo; Henneberry, John; McEwan, Kirsten; Mears, Meagan; Richardson, Miles; Sheffield Hallam University; University of Sheffield; University of Derby (Elsevier, 2020-10-23)
      Cities are sites of human, ecological and institutional stress. The elements that make up the city – its people, landscapes and processes – are engaged in constant assemblage and disassembly, joining and pulling apart. Reporting the findings of a three-year multi-disciplinary deep case study, this paper examines the role of urban nature in mediating the relationship between stressed humans and stressed places. It applies assemblage theory to show how such relationships can be understood in contexts of multiple pressures. From empirical findings it shows how urban nature contributes to mental wellbeing, but also how institutional stresses linked to austerity policies shape efforts to reconnect humans and nature. Across five strands of research, this article foregrounds the importance of multiple everyday experiences of urban nature and practices of care and maintenance. It calls on researchers, policymakers, planners and practitioners to pay closer attention to the ‘magic of the mundane’ in supporting human wellbeing; in caring for spaces and places; and in providing the services that link people and the natural environment.
    • Developing an online qualification for O&P technicians

      Adam, Ian; British Association of Prosthetists & Orthotists (The Australian Orthotic Prosthetic Association, 2020-10-08)
      Over the years the average age of technicians working within orthotics and prosthetics in the United Kingdom had increased and there was a requirement to recruit new staff. No nationally accredited qualification existed, and this was seen as a hinderance when trying to recruit the right type of candidate. Additional barriers included the associated costs of training, and the risk of losing technicians from the workplace while the technician was training. My aim was to develop a nationally accredited qualification that would provide employers with trained orthotic and prosthetic technicians for the future. I first contacted Scottish Qualifications Authority (SQA) to gain a full understanding of the Scottish Qualifications Framework and which type of qualification would be suitable for technicians working in orthotics and prosthetics. I did research into methods of delivery of qualifications and which colleges had experience in these different types of delivery. I also spoke to the British Healthcare Trades Association to understand what the employers training needs were. Working with Scottish Qualifications Authority (SQA) we developed a 7-unit Personal Development Award. After this award had been approved, we worked with Glasgow Clyde College (GCC) using their existing Virtual Learning Environment (VLE) model to design a teaching package for the qualification. The nature of the VLE allows the candidates to undertake the qualification from their working location without having to travel to a central location. The candidate completes five mandatory units, submitting their assessments via the VLE direct to the college and receive feedback when required and assessment results. The candidate then choses two workplace units from a library of 12, the units are chosen depending on their employers’ requirements. Workplace assessors are used to assess the chosen units. All assessments are also checked by an external verifier. To date we have four cohorts of technicians, a total of 60 candidates, undertaking the qualification. The qualification takes approximately 18-24 months to complete. We would also hope to offer the qualification internationally through GCC as the VLE format is suitable for international candidates and SQA already award their qualifications internationally. Our qualification has been widely accepted by the profession and we have started to iron out the teething problems. We are reviewing the qualification and hope to gain ISPO approval in the next couple of years.
    • Delivering patient centred care (Part 2): a qualitative study of the perceptions of service users and deliverers.

      Hyde, Emma; Hardy, Maryann; University of Derby; University of Bradford (Elsevier, 2020-10-07)
      There is growing awareness of the importance of patient centred care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents, but 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 in order to develop measurable indicators of PCC. This project was funded by the College of Radiographers Industry Partnership Scheme. Ethical approval was granted by the University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 2 of the project, which was a series of focus groups and telephone interviews to enable deeper discussion and exploration of PCC. Situational vignettes were used to promote discussion and debate and encourage suggestions for PCC approaches. Audit tools to assess engagement with PCC were developed at individual and organisational level. Four focus groups and six telephone interviews were carried out in total. Focus groups were held in a variety of locations to promote attendance. Telephone interviews were used to capture participants who could not attend a focus group in person. Disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident. Perceived levels of care and the effectiveness of communication appeared to be the key influences on whether PCC was delivered. It is evident from the results of Stage 1 and Stage 2 that we have some way to go before we have parity in how care within diagnostic radiography is perceived, experienced and delivered. Audit tools and an educational toolkit are offered as ways to support increased PCC within diagnostic radiography practice. Several service improvements and audit tools are offered to support the increased delivery of PCC.