• 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; University of Derby (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.
    • 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.
    • 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)
    • 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; Senior Lecturer in Nursing; Faculty of Health and Society; University of Northampton; Senior Researcher; Faculty of Health and Society; University of Northampton (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)
    • Apprenticeships

      Baker, Denise; University of Derby (2018-11)
    • 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.
    • Ascites: drainage and management.

      Mortimore, Gerri; University of Derby (2018-01-25)
      This presentation will look at the death rates from liver disease over the last 40 years as well as the causes. Signs and symptoms of decompensated liver disease will be discussed to include the causes and types of ascites. The manifestation of Spontaneous bacterial peritonitis (SBP) will also be discussed along with the treatment of SBP, large volume paracentesis; including it's associated complications and the importance of written consent for these procedures.
    • Attributes of Iranian new nurse preceptors: A phenomenological study

      Borimnejad, Leili; Valizadeh, Sousan; Rahmani, Azad; Whitehead, Bill; Shahbazi, Shahla; Iran University of Medical Sciences; Tabriz University of Medical Sciences; University of Derby (Elsevier, 2017-10-17)
      Preceptors should possess attributes which help them in successfully performing the demanding and challenging role in the preceptorship. This research utilises a qualitative hermeneutic phenomenological approach to explore the attributes of new nurse preceptors. Six preceptors of a teaching hospital in Northwest of Iran who were selected by means of purposive sampling. Data were collected during eight months from July 2014 to March 2015 through in-depth semi-structured personal interviews. Interviews were recorded and transcribed and then were analyzed with the interpretive approach using the Diekelmann's seven-stage method in the MAXQDA10 software environment. Findings included two main themes “feeling proud and honored” and “professionalism” with subthemes including empathy, being nonjudgmental, patience, and spirit of self-sacrifice. The spirit of self-sacrifice was a unique attribute revealed in this research. Preceptors possessed several important attributes which are usually stressed in the literature as selection criteria for preceptors. These attributes could be further drawn upon when selecting new preceptors. Preceptors are role models. Existence of the spirit of self-sacrifice among preceptors could contribute to transferring of such spirit to new nurses and future preceptors as well as to preceptors’ patience with challenges of their role. Effective preceptorship needs preceptors who possess specific professional and personal attributes. These attributes could be drawn upon more objectively in the process of selection, preparation and evaluation of preceptors by clinical and educational nursing managers.
    • Automonic dysfunction measured by baroreflex sensitivity is markedly abnormal in stable cirrhosis despite minimal systemic haemodynamic changes

      Rye, Kara; Mortimore, Gerri; Austin, Andrew; Freeman, Jan G.; University of Derby (BMJ Publishing Group Ltd., 2009)
      Baroreceptor sensitivity (BRS) is well recognised as a composite marker of the overall integrity of the autonomic nervous system, maintaining cardiovascular status both at rest and during physiological stress. Autonomic dysfunction occurs in 43–80% of cases of cirrhosis, affecting both sympathetic and parasympathetic branches. BRS impairment occurs independently of aetiology and correlates with disease severity and the hyperdynamic circulation. BRS has been studied extensively in advanced disease, especially pre-transplantation but less so in more compensated disease. Impaired BRS is associated with a 5-fold increase in mortality, independent of cirrhosis stage, yet can be improved by drugs and liver transplantation.
    • Automonic dysfunction measured by baroreflex sensitivity is markedly abnormal in stable cirrhosis despite minimal systemic haemodynamic changes

      Rye, Kara; Mortimore, Gerri; Austin, Andrew; Freeman, Jan G.; Derby City General Hospital (BMJ Publishing Group Ltd., 2009-04)
      Introduction: Baroreceptor sensitivity (BRS) is well recognised as a composite marker of the overall integrity of the autonomic nervous system, maintaining cardiovascular status both at rest and during physiological stress. Autonomic dysfunction occurs in 43–80% of cases of cirrhosis, affecting both sympathetic and parasympathetic branches. BRS impairment occurs independently of aetiology and correlates with disease severity and the hyperdynamic circulation. BRS has been studied extensively in advanced disease, especially pre-transplantation but less so in more compensated disease. Impaired BRS is associated with a 5-fold increase in mortality, independent of cirrhosis stage, yet can be improved by drugs and liver transplantation. Aims and Methods: The aim of this study was to determine the prevalence of BRS abnormalities in a stable population of cirrhotics. We studied 16 cirrhotic patients with stable disease for >6 months. Systemic haemodynamics and BRS were assessed non-invasively in the supine position on two different days using the Finometer® (TNO instruments, Amsterdam). Data were downloaded to a PC-based analysis program (Beatscope®). Spontaneous BRS was assessed using software studying the relationship between inter-beat variability and beat-to-beat changes in systolic blood pressure. Portal pressure was assessed by measurement of the hepatic venous pressure gradient (HVPG). Results: Median age 47 (30 to 67) years, 63% male, median Child–Pugh (CP) score 6 and MELD 11. 94% alcoholic aetiology, 69% abstinent. 9/16 (56%) concomitant spironolactone. Median haemodynamic data as follows: systolic BP 147 (115 to 169) mm Hg, diastolic BP 82 (65 to 103) mm Hg, MAP 104 (87 to 131) mm Hg, HR 89 (54 to 117) bpm, SV 89 (36 to 164) ml, CO 7.0 (3.5 to 12.0) lpm, PVR 0.98 (0.45 to 2.14) MU, HVPG 18 (7 to 25) mm Hg. 12/16 (75%) had abnormal BRS (normal 8 to 10 ms/mm Hg) with median BRS 3.38 (1.14 to 11.19) ms/mm Hg. Sequential BRS readings were not significantly different (3.38 vs 3.98 ms/mm Hg, p = 0.87). Systemic haemodynamics were not significantly different in patients with impaired BRS compared with those with normal BRS. BRS did not correlate with disease severity (CP A 2.96 vs CP B 3.80 ms/mm Hg, p = 1.0), systemic haemodynamics, serum sodium or variceal size. There was a significant negative correlation between BRS and HVPG (r = −0.523, p = 0.045). Conclusion: Autonomic function as assessed by BRS is frequently abnormal in stable cirrhotic patients. Abnormalities of BRS are not associated with marked haemodynamic changes, suggesting that it is predominantly the vagal aspect that is impaired in stable disease. Abnormalities of BRS are associated with HVPG which may suggest that portal pressure itself plays a pivotal role in its causation. The significance of impaired BRS in this stable group needs to be determined by assessing long-term outcome.
    • Autonomic dysfunction measured by baroreflex sensitivity in markedly abnormal in stable cirrhosis despite minimal haemodynamic changes.

      Rye, Kara; Mortimore, Gerri; Austin, Andrew; Freeman, Jan G.; University of Derby; Derby Hospitals NHS Foundation Trust (British Association for the Study of Liver (BASL), 2008)
      Introduction: Autonomic dysfunction occurs in 43-80% of cases of cirrhosis, but is usually asymptomatic. The baroreflex arc is an important component of the autonomic nervous system main- taining cardiovascular status both at rest and during physio- logical stress. Baroreceptor sensitivity (BRS) is impaired in cirrhosis and correlates with disease severity. It has been stud- ied extensively in advanced disease, especially pre-transplan- tation, where impairment of BRS correlates with the presence of ascites, encephalopathy, and the hyperdynamic circulation. Impaired BRS is associated with a five-fold increase in mortal- ity predominantly from sepsis and variceal bleeding, inde- pendent of the stage of liver disease. Manipulation by ACE inhibitors, aldosterone antagonists and liver transplantation all improve BRS. The aim of this study was to determine the preva- lence of BRS abnormalities in a stable population with well compensated disease. Methods: We studied 11 stable cirrhotic patients. Spontaneous BRS was assessed in the supine position on two different days using software studying the relationship between inter-beat variability and beat-to-beat changes in sys- tolic blood pressure. Systemic haemodynamics (heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), stroke vol- ume (SV), peripheral vascular resistance (PVR)) were assessed non-invasively using the Finometer®. Portal pressure was assessed by measurement of the hepatic venous pressure gra- dient (HVPG). Results: Median age 46 (30-67) years, 64% male, median Child-Pugh (CP) score 6 and MELD 11. Median haemodynamic data as follows: systolic BP 147 (115-169) mmHg, diastolic BP 82 (73-103) mmHg, MAP 103 (87-131) mmHg, HR 90 (63-110) bpm, SV 87 (38-141) ml, CO 8.0 (3.5-10.1) lpm, PVR 0.96 (0.64-2.14) MU, HVPG 18 (12-26)mmHg. 9/11 (82%) had abnormal BRS (normal 8- 10ms/mmHg) with median BRS 2.58 (1.14-9.46) ms/mmHg. Sequential BRS readings were not significantly different (2.58 vs 3.26 ms/mmHg, p=0.8). BRS did not correlate with disease severity (CP A 2.58 vs CP B 3.80 ms/mmHg, p=0.9), systemic haemodynamics, HVPG or serum sodium. Systemic haemody- namics were not significantly different in patients with impaired BRS compared to those with normal BRS. Conclusions: Auto- nomic function as assessed by BRS is markedly abnormal in sta- ble well compensated cirrhosis. Abnormalities are not specific to advanced disease as previously thought and in our group are not associated with marked hyperdynamic changes. Our data suggest that it is predominantly the vagal aspect that is impaired in well compensated disease. The long-term outcome of these patients needs to be assessed.
    • Autonomic dysfunction measured by baroreflex sensitivity in markedly abnormal in stable cirrhosis despite minimal haemodynamic changes.

      Rye, Kara; Mortimore, Gerri; Austin, Andrew; Freeman, Jan G.; University of Derby; Derby Hospitals NHS Foundation Trust (Wiley, 2008-09-24)
      Introduction: Autonomic dysfunction occurs in 43-80% of cases of cirrhosis, but is usually asymptomatic. The baroreflex arc is an important component of the autonomic nervous system main- taining cardiovascular status both at rest and during physio- logical stress. Baroreceptor sensitivity (BRS) is impaired in cirrhosis and correlates with disease severity. It has been stud- ied extensively in advanced disease, especially pre-transplan- tation, where impairment of BRS correlates with the presence of ascites, encephalopathy, and the hyperdynamic circulation. Impaired BRS is associated with a five-fold increase in mortal- ity predominantly from sepsis and variceal bleeding, inde- pendent of the stage of liver disease. Manipulation by ACE inhibitors, aldosterone antagonists and liver transplantation all improve BRS. The aim of this study was to determine the preva- lence of BRS abnormalities in a stable population with well compensated disease. Methods: We studied 11 stable cirrhotic patients. Spontaneous BRS was assessed in the supine position on two different days using software studying the relationship between inter-beat variability and beat-to-beat changes in sys- tolic blood pressure. Systemic haemodynamics (heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), stroke vol- ume (SV), peripheral vascular resistance (PVR)) were assessed non-invasively using the Finometer®. Portal pressure was assessed by measurement of the hepatic venous pressure gra- dient (HVPG). Results: Median age 46 (30-67) years, 64% male, median Child-Pugh (CP) score 6 and MELD 11. Median haemodynamic data as follows: systolic BP 147 (115-169) mmHg, diastolic BP 82 (73-103) mmHg, MAP 103 (87-131) mmHg, HR 90 (63-110) bpm, SV 87 (38-141) ml, CO 8.0 (3.5-10.1) lpm, PVR 0.96 (0.64-2.14) MU, HVPG 18 (12-26)mmHg. 9/11 (82%) had abnormal BRS (normal 8- 10ms/mmHg) with median BRS 2.58 (1.14-9.46) ms/mmHg. Sequential BRS readings were not significantly different (2.58 vs 3.26 ms/mmHg, p=0.8). BRS did not correlate with disease severity (CP A 2.58 vs CP B 3.80 ms/mmHg, p=0.9), systemic haemodynamics, HVPG or serum sodium. Systemic haemody- namics were not significantly different in patients with impaired BRS compared to those with normal BRS. Conclusions: Auto- nomic function as assessed by BRS is markedly abnormal in sta- ble well compensated cirrhosis. Abnormalities are not specific to advanced disease as previously thought and in our group are not associated with marked hyperdynamic changes. Our data suggest that it is predominantly the vagal aspect that is impaired in well compensated disease. The long-term outcome of these patients needs to be assessed.
    • Barriers to Family Caregivers’ Coping With Patients With Severe Mental Illness in Iran

      Ebrahimi, Hossein; Seyedfatemi, Naeimeh; Namdar Areshtanab, Hossein; Ranjbar, Fatemeh; Thornicroft, Graham; Rahmani, Farnaz; Whitehead, Bill; Tabriz University of Medical Sciences; Kings College London; University of Derby; Department of Psychiatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran; Nursing Care Research Center. Iran University of Medical Sciences, Tehran, Iran; Department of Psychiatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran; Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; King’s College London, London, United Kingdom; University of Derby, Derby, United Kingdom; Department of Psychiatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran (2018-02-24)
      The broad spectrum of problems caused by caring for a patient with mental illness imposes a high burden on family caregivers. This can affect how they cope with their mentally ill family members. Identifying caregivers’ experiences of barriers to coping is necessary to develop a program to help them overcome these challenges. This qualitative content analysis study explored barriers impeding family caregivers’ ability to cope with their relatives diagnosed with severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders). Sixteen family caregivers were recruited using purposive sampling and interviewed using a semi-structured in-depth interview method. Data were analyzed by a conventional content analytic approach. Findings consisted of four major categories: the patient’s isolation from everyday life, incomplete recovery, lack of support by the mental health care system, and stigmatization. Findings highlight the necessity of providing support for caregivers by the mental health care delivery service system.
    • Care and compassion at the end of life

      Brown, Michelle; University of Derby (W.S Maney & Sons Ltd, 2012-07)
      Aim: To examine the provision of the ‘end of life care strategy’ and the perception of provision by patients and carers. Introduction: In determining what constitutes excellence in care at the end of life, one must firstly acknowledge ‘what care and compassion is’. Following this it should be established what one should expect as a minimum standard of care. The end of life care strategy was initiated by the Department of Health in 2008. This guidance was intended to drive forward end of life care provision where patients were seen as the priority and encouraged to engage in all decision making at each point in their journey. Standards suggested by NICE (2011) further support patient empowerment and inclusivity in care planning. Method: A literature search was conducted in order to determine whether there has been a change in provision and to identify whether patients and their carers perceive an excellence in the care that has been delivered. Results: The literature is limited but the underlying issues of pre-end of life care strategy (2008) remain apparent. Patients and their carers continue to lack the autonomy they deserve and decisions are made about them rather than by them. Owing to the lack of direction which should come from the patient, care may be fragmented with numerous members of a multidisciplinary team being involved. Conclusion: Patient involvement is paramount. Early discussions relating to choices at the end of life need to be achieved in a timely manner. This should ensure that the patient and carer experience a high standard of excellent care which has been planned with inclusivity in mind
    • Care at the end of life: how policy and the law support practice

      Brown, Michelle; Vaughan, Carol; University of Derby (Mark Allen Healthcare, 2013-08-16)
      The End of Life Care Strategy was introduced in an attempt to achieve a high standard of care for patients nearing the end of life and to improve carer experience. This high standard should not depend on socioeconomic status, geographical location or diagnosis. It was to ensure that individuals felt supported, informed and empowered, and that symptoms and issues were managed by experienced staff who employ evidenced-based practice. In addition, the service provision should involve a multidisciplinary team and have the patient at the centre of all decision-making. This would be facilitated by endorsing the use of end-of-life care pathways. These recommendations are further supported by frameworks and policies, for example the Preferred Priorities for Care Gold Standards Framework in Primary Care. Health professionals must also be cognisant of the legal frameworks that protect patients and facilitate their rights to exert their autonomy, for example the Mental Capacity Act and advanced directives. The issues surrounding care at the end of life with respect to legal frameworks alongside ethical and moral dilemmas will be further explored within this discussion paper.
    • Case study — primary sclerosing cholangitis

      Mortimore, Gerri; University of Derby (Mark Allen Healthcare, 2012-05)