• 20 Real talk - beyond advanced communication skills: outcomes of a residential workshop for palliative care doctors

      Whittaker, Becky; Watson, Sharan; Loughborough University, University of Derby (BMJ, 2019-03-19)
      Analysis of filmed data of patient consultations at a UK hospice provides the materials for ‘Real Talk’; a novel and flexible education intervention containing real-life film clips. Communication skills training is more likely to be effective in changing behaviours when it is experiential and interactive, being relevant to trainees’ practice. Methods Experienced palliative care doctors attended a three-day residential workshop in which they explored the Real Talk intervention in facilitated small groups. Discussions linked to the evidence relating to communication strategies, whilst reflective diaries and action planning provided opportunity for linking learning to their clinical and educator roles. The workshop was attended by 29 experienced palliative care doctors who completed a pre and post questionnaire we adapted from a validated tool. Pre-workshop questions asked for workshop expectations; 19 delegates identified all their expectations had been met, 10 did not indicate an answer. Narratives from the expanded answers noted the workshop had exceeded expectations and the ‘train the trainer’ approach was welcomed. Delegates identified the most effective aspects of learning included experiential small group work relating to the content of the Real Talk film clips, opportunity to critique underpinning evidence of how clinicians communicate in relation to conversations in end of life care and having an opportunity to reflect on learning and application to practice in a safe and stimulating environment. Engagement in, and feedback on, the workshop has provided a foundation on which to build our research in understanding complex communication and skills training. Providing interactive experiential learning, embedded in the emerging evidence base underpinning Real Talk, is crucial for clinicians seeking to explore complex communication skills with patients facing the end of life. Ensuring skilled facilitation, a safe environment and programme flexibility are crucial to the learning process.
    • 21 Real talk – a novel evidence-based, video-based communication skills training resource.

      Parry, Ruth; Whittaker, Becky; Pino, Marco; Watson, Sharan; Hamlyn, Sarah; Faull, Christina; University of Nottingham; Loughborough University; LOROS Hospice; DeMontfort University; et al. (BMJ Publishing Group Ltd., 2018-03-01)
      Background Much palliative care communication training draws on sparse evidence about practice. Yet training’s effectiveness depends on the strength of its underpinning evidence. An empirical, observational science of language and social interaction – ‘Conversation Analysis’ holds great promise because: it is generating copious evidence on communication, and healthcare–communication specifically; shows role–played interactions differ from authentic ones in fundamentally important ways; recent quantitative evaluations of interventions based on conversation analytic findings have shown effectiveness. Within a research and training development programme, we designed novel training resources – ‘Real Talk’ incorporating research findings and clips from video-recorded hospice consultations. We designed Real Talk to complement rather than replace existing resources. We report a preliminary evaluation of Real Talk’s strengths and weaknesses. Method Mixed-methods, qualitative evaluation entailing observations, interviews, and participant-completed feedback questionnaires. Results We collected data from 11 events, 10 trainers across England, and 150 trainees. Conclusions Trainees and trainers alike appreciated the video clips and their authentic nature. Observations and reports indicated Real Talk was particularly effective for encouraging participants to both emotionally engage with the nature of palliative care, and actively engage in discussion and overall learning about communication practices. Trainers used the video clips more than they did the research findings components; with a similar pattern seen in most trainees’ feedback. Our decision to design Real Talk for trainers to use without initial intensive training meant we could rapidly and widely distribute the resources and evaluate their use. However, this also meant heavy reliance on trainers’ existing facilitation skills, and on their allocation of adequate time to familiarise themselves with the materials. We argue that this is also why the research findings-based components were not put to full use by trainers. We are revising Real Talk and its delivery on the basis of our evaluation.
    • An a/r/tographic exploration of engagement in theatrical performance: What does this mean for the student/teacher relationship?

      Bird, Drew; Tozer, Katy; University of Derby; University of Derby, UK; University of Derby, UK (Sage, 2018-07-11)
      With an emphasis on self-study and the connections between the personal and the professional domain, the authors reflect upon their teaching practice on a postgraduate theatre-based course using the research methodology of a/r/tography. The aim was to develop understanding of teacher/student roles and how these can affect learning. Through researcher reflexivity, focus groups and questionnaires, data were captured from students/participants responding to a video of the researcher’s solo performance work. The research presents itself through three a/r/tographic renderings. First, the experience of seeing tutors in unfamiliar roles is considered. Second, the impact of witnessing tutors taking risks as a performer and being vulnerable is discussed and, lastly, the work illuminates new ways of opening up as teachers. The authors explore how the student’s/participant’s perception of them as tutors seemed to change after witnessing them as artists and how this impacted upon student’s learning for their own assessed performance pieces.
    • Acceptability of intrapartum ultrasound by mothers in an African population

      Wiafe, Yaw Amo; Whitehead, Bill; Venables, Heather; Dassah, Edward T; University of Derby; Kwame Nkrumah University of Science and Technology, Kumasi, Ghan (Springer, 2019-05-08)
      Intrapartum ultrasound is gaining high acceptance by many women as another method for assessing labour progression. Despite growing evidence of the effectiveness of ultrasound in labour, the acceptance of intrapartum ultrasound has not been previously investigated in black Africans. This study aimed to determine women’s acceptance of intrapartum ultrasound and their preference for transperineal ultrasound or digital vaginal examination (digital VE) in Ghana. An analytical cross-sectional study was conducted among mothers who had had both digital VE and transperineal ultrasound during labour in a tertiary hospital. Information about their sociodemographic characteristics, experience with, and preference for ultrasound or digital VE in labour using a pretested structured questionnaire was obtained. Their experiences were categorised as ‘tolerable, ‘quite uncomfortable’ or ‘very uncomfortable’. Categorical variables were compared using Fisher’s exact test. A p value < 0.05 was considered statistically significant. Altogether, 196 women were recruited into the study. The mean age of the women was 26.7 years (standard deviation, 4.6 years). Nearly half (47%) of the women had never delivered before. Significantly more women considered transperineal ultrasound to be more tolerable than digital VE (66% vs. 40%; p < 0.001). Almost all the women (97.5%) described their experience with transperineal ultrasound to be better than digital VE, and would choose transperineal ultrasound over digital VE in the future (98.5% vs. 1.5%; p < 0.001). The findings of this study are comparable to those of other related studies reported recently. This research confirms high acceptance of ultrasound in labour by mothers from different countries and across continents, implying that cultural differences do not influence women’s responses to and interest in intrapartum ultrasound. Most women found ultrasound in labour to be more tolerable than digital VE. Whenever possible, transperineal ultrasound should be provided as an alternative to digital VE during labour.
    • 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.
    • Acute renal failure in cirrhosis: Is it as bad as we think?

      Rye, Kara; Taylor, Nicholas; Li, Ka Kit; Mortimore, Gerri; Johnson, M.; Freeman, Jan G.; Derby City General Hospital (BMJ Publishing Group Ltd., 2007-04)
      Introduction: Acute renal failure (ARF) is associated with a mortality of 50–60% in critically ill patients admitted to the intensive care unit (ICU). Prerenal causes and acute tubular necrosis (ATN) account for more than 85% of cases and are potentially reversible. ARF frequently complicates cirrhosis, is often attributed to hepatorenal syndrome (HRS), which may preclude aggressive treatment with its mortality up to 90%. Aims & Methods: The aim of this study was to identify factors that may predispose to or precipitate ARF in cirrhosis, and determine outcome and mortality. A retrospective review of cirrhotic patients admitted with or developing renal impairment (defined as serum creatinine >130 μmol/l or oliguria <500 ml/24 h) from October 1999–April 2004. Patients with bleeding gastro-oesophageal varices were excluded. Demographic details, cause of ARF, potential early warning features, management and outcome were recorded. Results: Eighty patients, median age 52 years (25–84), 46 male, median MELD 26 (7–43). Alcohol was causal in 88.8%. ARF occurred in 41/80 (51.3%) on admission, or a median of 6 days after admission (1–34). Median serum creatinine at onset of renal impairment 172 μmol/l (60–589). An identifiable precipitant was found in 62/80 (77.5%) and were concurrent in 51%; nephrotoxic drugs 50%, sepsis 45% (culture positive 27/36), recent paracentesis (preceding month) 28.8%, fluid loss 26.3%, and spontaneous bacterial peritonitis 13.3%. HRS occurred in 17.5%. No parenchymal renal disease or obstructive uropathy was seen. 54% were hyponatraemic (serum sodium <130 μmol/l) at onset of ARF. ARF was heralded by a fall in median mean arterial pressure (MAP) of 14.1 mm Hg from admission (p<0.001, CI 6.8–19.7). 71.2% received volume expansion, 91.1% terlipressin, 79.7% salt poor albumin, 93.4% antibiotics, 7.5% MARS/renal support. MAP did not rise significantly 24 h after initiation of treatment (p = 0.56). 28 day mortality was 61%. HRS patients had higher MELD scores than non-HRS patients (30 v 25; p = 0.0152) but 28 day mortality was not significantly different (64.3% v 60.6% respectively, p = 0.797). Conclusion: ARF in cirrhosis is rarely due to HRS but is most commonly pre-renal in origin and multifactorial. Potential early warning features include hyponatraemia and a falling MAP. Current treatment regimes may not be aggressive enough to reverse renal hypoperfusion. Despite this mortality for our cirrhotic cohort was similar to non-cirrhotic patients admitted to ITU with ARF. Development of ARF in a cirrhotic patient should not preclude aggressive treatment.
    • Addressing negative attitudes, developing knowledge: the design and evaluation of a bespoke substance misuse module.

      Harling, Martyn; Goddard, Zuzia; Higson, Rob; Humphrey, Emma; University of Nottingham; University of Derby; Derby City Council (Social Services Research Group, 2017-08-18)
      Recent calls for the inclusion of substance misuse into social work curricula appear to have been met with a piecemeal and rather sporadic approach from many Higher Education establishments. The research described in this article set out to determine if a bespoke module, delivered to a group of social work students (n=57), might influence their attitudes and values towards substance misuse and working with substance misusers. A mixed methods approach was used, employing an attitudinal Likert scale and a series of semi-structured interviews (n=10). Analysis of the quantitative data indicated that there was no significant change in the students’ established attitudes over the course of the module, but there was a substantial increase in the number of students (35%) who agreed with the Likert statement ‘working with drug users is a rewarding role’. The qualitative element of the research suggested that students felt more prepared for working with substance misusers and had increased their level of substance misuse knowledge since starting training. Whilst it is prudent to remain cautious when reporting the findings of a small scale research study, the results of the study support the effectiveness of the bespoke module in preparing the students to work with substance users/misusers.
    • Advanced liver training: where are the courses

      Mortimore, Gerri; University of Derby (2016-07-01)
    • Advanced nurse practitioners: the NHS England framework.

      Reynolds, Julie; Mortimore, Gerri; University of Derby (Mark Allen Group, 2018-03-02)
    • “Age is just a number, init?”: Interrogating perceptions of age and women within social gerontology

      Hogan, Susan; University of Derby (Taylor and Francis, 2016-02-25)
      The article discusses social gerontology and mentions age and women. Topics discussed include social relations, self-identity and ageing. Other topics which includes women's bodies, menopause and feminism are also discussed. Ethnography, marginalization and sexual attraction towards women are also mentioned.
    • Alcohol- is it all that bad?

      Mortimore, Gerri; University of Derby (The Hypocratic Post, 2018-02-05)
      According to a YouGov poll, 3.1 million people in the UK planned to take part in Dry January this year and give up alcohol. With January now behind us, how many people will continue to abstain or cut back on their alcohol intake, and who will choose to hop back off the wagon? The answer to this question is very dependent on how much we drink or, in other words, the total amount of alcohol units we consume. Of course, many of us who regularly consume alcohol don’t really think about the units we drink unless we are contemplating driving. I think many people will be shocked to realise that they are drinking many more units than is recommended by the Department of Health.
    • Alcohol-use disorders: prevention.

      Mortimore, Gerri; University of Derby (National Institute for Health and Care Excellence (NICE), 2010-06)
    • Alcohol: is it all that bad?

      Mortimore, Gerri; University of Derby (University of Derby, 2018-02-01)
    • ‘Am I a student or a Health Care Assistant?’ A qualitative evaluation of a programme of pre-nursing care experience.

      Whiffin, Charlotte Jane; Baker, Denise; Henshaw, Lorraine; Nichols, Julia J.; Pyer, Michelle; University of Derby; University of Northampton; Senior Lecturer in Nursing; College of Health and Social Care; University of Derby; Head of Allied Health and Social Care; College of Health and Social Care; University of Derby; Head of Post-Graduate Health Care; College of Health and Social Care; University of Derby; et al. (Wiley, 2018-07-10)
      Aim To examine the experiences of pre‐nursing Health Care Assistants during a six‐month programme of pre‐nursing care experience. Background Care experience prior to commencing programmes of nurse education is broadly considered to be advantageous. However, it is not clear how formal care experience prior to nurse education has an impact on the values and behaviours of the aspirant nurse. Design A longitudinal prospective qualitative study using focus group discussions. Methods Data were collected from 23 pre‐nursing health care assistants during September 2013 ‐ February 2014. Three focus groups were held at the beginning, middle and end of the programme of care experience at each of the participating hospitals. A thematic analysis was used to analyse data sets from each hospital. Findings from each hospital were then compared to reach final themes. Results Five major themes were identified in the analysis of qualitative data: personal development; positioning of role in the healthcare team; support and supervision; perceived benefits; and advice and recommendations. These themes were underpinned by deep aspirations for better care and better nurses in the future. Conclusions Pre‐nursing care experience can positively prepare aspirant nurses for programmes of nurse education. The benefits identified were confirmation of aspiration (or otherwise) to pursue nursing; learning opportunities and aspiration to improve patient experience. Risks for the programme included poor supervision; role ambiguity or confusion; demotivation through a deteriorating view of nursing and poor treatment by others. The longer‐term impact on values and behaviours of this cohort requires further evaluation.
    • Another way for student exchanges: A Google + community for collaborative learning related to European public health issues

      Collins, Guy; Koning, Mirjam; van de Velde, Ellen; University of Derby; Rotterdam University (Consortium of Institutes of Higher Education in Health and Rehabilitation in Europe, 2016-04-14)
    • 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.
    • Applying best practice: the venesection clinics of the future

      Mortimore, Gerri; university of Derby (University of Derby, 2019-04-13)
      Discussed patient experiences of venesections and trying to get it right first time across venesection departments across the country.
    • Apprenticeships

      Baker, Denise; University of Derby (2018-11)
    • Approaching development of a new education programme in diagnostic radiography.

      Partner, Alexandra; University of Derby (International Society of Radiographers and Radiological Technologists (ISRRT), 2018-04)
      Introduction: Developing a new Diagnostic Radiography education programme is a large project, and is a multi-facetted complex process. Reviewing the most innovative ways to undertake learning, teaching and assessment and embed them into the University is crucial to enhance the quality of education. Preparing graduates adequately for practice is vital to meet the demands of the workforce. In the UK, removal of NHS Bursaries following the Comprehensive Spending Review (HM Treasury, 2015) has led to a more competitive environment where providers need to look for unique selling points. Methods: A review of current legislation, national guidance and policies was undertaken to check for relevant alterations. A thorough appraisal of all Professional Statutory and Regulatory Body (PSRB) documentation and national level organisations was completed. Project planning started between 2 years and 18 months prior to the planned delivery date. Stakeholders were invited to a number of on-site sessions to brain storm what employers need from graduates over the next 5 years. It’s important that views are sought from a variety of interested parties including; academics, placement providers, employers, service users, students and external examiners. After this the follow-up sessions were divided into placement, curriculum and assessment. Strengths and weaknesses were identified in the current programme and brain storming exercises looking at what new curricula needed implementing. Conclusion: The programme was approved by the University the PSRB’s. The programme was designed using innovative learning and teaching methods and a variety of assessment methods. Having themes which built on topics throughout the programme allowed these to be embedded more effectively. Looking at ways to offer placement in a more creative way and supporting this with simulation allows for increased capacity. Having the right programme impacts on recruitment, student experience, student attainment and employability. Once the programme has been delivered in its first year an evaluation of the individual modules and the year as an overview will be evaluated. It is necessary to keep up to date with new guidance and currency of practice and continually improve educational programmes to be able to produce competent graduates and compete as a business.
    • Are newly qualified nurses prepared for practice?

      Holmes, Dinah; Whitehead, Bill; University of Derby (EMAP, 2011-05)
      While many people find starting a new job stressful, the transition from student to newly qualified nurse comes with additional pressures, as being unprepared could harm patients.