Recent Submissions

  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Bronchiolitis: Treatment and management in an urgent out of hours care setting

    Mortimore, Gerri; Dexter, Justine; University of Derby (MAG, 2020-06-11)
    Bronchiolitis is an acute inflammation of the bronchioles that predominately affects children but is most common in the first 12 months of life. Viral bronchiolitis is the principal cause of admission in England and Wales, with numbers exceeding 30 000 annually. Occurrence is seasonal, in winter months incidence is typically at epidemic proportions for approximately six weeks. Bronchiolitis presents initially with coryza and a persistent cough; as the infection progresses, tachypnoea, chest recession, or both, may be present alongside wheeze or crackles. The assessment of an unwell child is challenging and as an advanced nurse practitioner, working in an out of hours service, the importance to prevent further deterioration should focus on spotting the sick child at an early stage. Therefore, an initial assessment should be undertaken, prior to taking a history and examination, to ensure patient safety. Bronchiolitis is usually a self-limiting illness, that requires supportive management only with treatment directed at fluid input. However, management approaches to bronchiolitis continue to be a subject of substantial debate with vast differences in practice exhibited in the UK, and beyond. with a lack of consensus regarding management. Therefore, the appropriate management of children presenting with bronchiolitis is challenging and can be overwhelming. Nurses must be aware of the pathophysiology, presentation, diagnosis, and management of children presenting to an out of hours service with bronchiolitis, to manage patients safely.
  • Real talk facilitator manual: Engaging patients with end of life talk

    Parry, Ruth; Whittaker, Becky; Pino, Marco; Land, Vicky; Faull, Christina; Feathers, Luke; Watson, Sharan; Loughborough University; LOROS Hospice; University of Derby (2020-01-15)
    Video-based communication training Engaging patients in end of life talk. ‘Real Talk’ is a novel and flexible communication training resource designed to use in face-to-face training events. It features real-life video recordings of UK hospice care, and learning points based on cutting-edge communication science. Real Talk has been developed as part of a research programme, and aims to enhance the quality and effectiveness of evidence-based communication skills training in the area of end of life care. The research programme is called VERDIS, which refers to video-based research and training on supportive and end of life care interactions.
  • Implementing real talk: interprofessional education intervention enabling clinicians to develop confidence in open and honest conversations about dying

    Watson, Sharan; Whittaker, Becky; University of Derby; Loughborough University (BMJ, 2020-03-18)
    National reports highlight the need to break down the barriers between the evidence to practice gap in talking with patients about dying. Our programme of research incorporates evidence and video clips from UK hospice consultations. Real Talk is designed to fit into existing communication skills training, disseminated across diverse interprofessional groups/settings, aiming to promote confidence and competence. Real Talk holds great promise because: practicalities of short video clips ensure flexibility for practitioners to engage in detailed conversation and debate, enhancing the learning potential in any environment; the depth of evidence underpinning our resources helps demystify complex communication strategies, promoting confidence when talking about dying; clinicians using the resources span diverse professional groups and clinical settings helping promote talk in broaching dying and planning ahead with diagnostic uncertainty.
  • Why it’s important healthcare professionals talk about dying

    Watson, Sharan; University of Derby (University of Derby, 2020-05-15)
    This week is Dying Matters Awareness Week (May 11-17) – an awareness week led by Hospice UK to provide an opportunity to discuss the importance of talking about dying, death and bereavement. Here, Sharan Watson, Programme Leader for PG Cert Palliative Care at the University of Derby, discusses why it is more imperative than ever that health and social care workers feel confident and supported to talk about bereavement. The theme of this year’s Dying Matters Awareness Week is ‘Dying to be heard’, which feels so much more pertinent in our current challenges of delivering person-centred care during the Coronavirus pandemic. This week marked International Nurses Day (May 12) and 200 years since Florence Nightingale was born. Being a nurse has given so many of us the platform to develop such a diversity across all settings and has highlighted the true importance of interprofessional working.
  • Orthostatic hypotension: clinical review and case study

    Bailey, Rachael; Mortimore, Gerri; University of Derby (Mark Allen Group, 2020-05-14)
    Transient loss of consciousness (TLOC) accounts for 3% of all attendance in emergency departments within the UK. More than 90% of TLOC presentations are due to epileptic seizures, psychogenic seizures or syncope. However, in England and Wales in 2002, it was estimated that 92000 patients were incorrectly diagnosed with epilepsy, at an additional annual cost to the NHS of up to £189 million. This article will reflect on the case study of a 54-year-old female patient who presented with a possible TLOC, and had a background of long-term depression. Differential diagnoses will be discussed, but the article will focus on orthostatic hypotension. Being diagnosed with this condition is independently associated with an increased risk of all-cause mortality. Causes of orthostatic hypotension and the pathophysiology behind the condition will be discussed, highlighting the importance of obtaining an accurate clinical history. This is extremely pertinent if a patient collapses in an NHS setting and this is witnessed by nurses because they can contribute to the history of the type of collapse, to aid diagnosis and correct treatment. In addition, nurses have a valuable role to play in highlighting polypharmacy to doctors, and non-medical prescribers, as a contributing factor to orthostatic hypotension is polypharmacy. It is therefore important to accurately distinguish TLOC aetiology, not only to provide appropriate management, but to also identify patients at risk of morbidity/mortality related to underlying disease.
  • Understanding violence when the perpetrator has an intellectual disability: The perceptions of professionals

    Lovell, Andrew; Skellern, Joanne; University of Chester; University of Derby (SAGE Publications, 2017-12-18)
    The research sought to enhance professional understanding of the violence perpetrated by some people with an intellectual disability. The violent behaviour exhibited by some people with intellectual disabilities remains poorly understood, particularly with regard to a clear and informative definition. A qualitative study investigated the views and perceptions of professionals working directly with people with an intellectual disability in different settings. Twenty-two semi-structured interviews were undertaken with professionals from a variety of backgrounds, and four themes were generated through data analysis. Themes produced comprised the degree of intellectual disability, impulsivity, intentionality and unpredictability. Findings indicated tension between understanding violence as purposeful and explaining it in relation to the intellectual disability and/or additional conditions. Intellectual disability is central to understanding the impact of the other three themes, though there is a professional reluctance to use such knowledge as evidence to inform practice.
  • Guest editorial

    Skellern, Joanne; University of Chester (Emerald, 2016-06-13)

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