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

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

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

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

      Toplis, Emma; Mortimore, Gerri; University of Derby (MA Healthcare, 2020-07-02)
      In the United Kingdom the most common drug taken in overdose is paracetamol, which is recognised as a major cause of acute liver failure. However death rates from acute liver failure have fallen due to the rapid availability and accessibility of the antidote, acetylcysteine or N-acetylcysteine otherwise known as NAC. In this article the authors will critically evaluate the current literature surrounding the assessment and management of patients presenting with paracetamol overdose in order to improve their own clinical practise and promote best practice within their clinical team. This will include discussion of presentation, risk factors, treatment, complications and referral to specialist centres for transplant.
    • Acute onset low back pain leading to a diagnosis of cauda equina syndrome: a case study

      Read, Haley; Mortimore, Gerri; University of Derby (MAG, 2022-02-08)
      Cauda equina syndrome is rarely seen in primary care, but advanced practitioners must be aware of the possibility. Haley Read and Gerri Mortimore highlight a case study leading to a diagnosis of the condition One of the most common symptoms managed in primary care is lower back pain, which affects approximately 20% of the UK population at any one time (National Collaborating Centre for Primary Care, 2009). There are many differential diagnoses for the cause of back pain, with one such potential diagnosis being cauda equina syndrome. In this instance, it is of paramount importance that the correct diagnosis is reached quickly with urgent referral into secondary care for the instigation of treatment to prevent paralysis. This case review will examine a patient presenting to primary care with lower back pain and diagnosed with cauda equina syndrome.
    • 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- is it all that bad?

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

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

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

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

      Collins, Guy; Koning, Mirjam; van de Velde, Ellen; University of Derby; Rotterdam University (Consortium of Institutes of Higher Education in Health and Rehabilitation in Europe, 2016-04-14)
    • Anti-neutrophil cytoplasmic antibodies-associated vasculitis: a guide and case study

      Boyer, Helena; Mortimore, Gerri; Royal Derby Hospital; University of Derby (Mark Allen Group, 2020-12-10)
      Vasculitis is a relatively rare and poorly understood condition causing inflammation of the blood vessels, which in turn can affect a patient's respiratory and renal systems. In some cases, ocular involvement can cause loss of sight and hearing loss may also be a red flag for vasculitis, which, if not treated early, can cause complete hearing loss. Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a group comprising granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis (EGP). AAV is fatal if untreated and as increased risk escalates with age, coupled with a decline in renal function, these are the principal predictors of poor outcome. Vital roles for nursing vasculitis patients lie in managing inflammation and pain, as these distressing symptoms are prevalent in the disease. Because of the multiple complications that can occur with vasculitis, treatment-related information is a high priority for these patients. As nurses are well placed to deliver information, value lies in their role in reducing the negative impacts on treatment regimens and compliance that accompany patients' poor insight into their condition.
    • Applying best practice: the venesection clinics of the future

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

      Baker, Denise; University of Derby (2018-11)
    • 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.
    • Are we missing a trick? Why is occupational therapy not talking about the role and development of assistant practitioners?

      Biggam, Amanda; University of Derby (2019-06-17)
      The aim of this poster is to present a scoping of recent literature around the role of assistant practitioners within healthcare, and to present the argument that as a profession we need to be more proactive in developing the skills and knowledge of our support staff. Recently, there has been a drive to develop the nursing associate role to help fill the gap between healthcare support workers and registered nurses. Clear guidance on standards of proficiency have been developed; with the role being registered by the NMC aligning it with the nursing family (NMC, 2018). Within allied health professions, literature reviews highlight that Radiography have embraced the formal development of their support workers, with the Society of Radiographers producing a scope of practice (Johnson, 2012) and a clear career pathway from assistant practitioner to registered radiographer. Occupational therapy, however, does not appear in the recent literature to be researching the impact and benefits of the assistant practitioner role. This poster will allow consideration of the barriers and opportunities for a more defined role of assistant practitioners within occupational therapy. Evidence suggests that the formalisation of an occupational therapy based assistant practitioner, with a coherent training and development opportunities, ensures the success of this role (Wheeler, 2017). This poster will aim to generate discussion about how empowering existing staff to complete a foundation degree will not only recognise our existing workforce but will positively impact on our clients’ clinical outcomes.
    • 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.
    • 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.