Recent Submissions

  • 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.
  • 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.
  • 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.

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