• What are the ethical dilemmas in the decision making processes of nursing people given Electroconvulsive therapy? A critical realist review of qualitative evidence

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

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

      Lloyd, Erica; University of Derby (Redactive Publishing Limited, 2020-10-01)
      How using outcome measures can improve school nurses effectiveness.
    • 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.
    • 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 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.
    • 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.
    • 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.
    • 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.
    • 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.