• 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)
    • Challenges and solutions during analysis in a longitudinal narrative case study

      Whiffin, Charlotte Jane; Bailey, Christopher; Ellis-Hill, Caroline; Jarrett, Nicola; University of Derby; University of Nottingham; Bournemouth University; University of Southampton (Royal College of Nursing, 2014-03-27)
      Aim To describe the challenges faced by those performing complex qualitative analysis during a narrative study and to offer solutions. Background Qualitative research requires rigorous analysis. However, novice researchers often struggle to identify appropriately robust analytical procedures that will move them from their transcripts to their final findings. The lack of clear and detailed accounts in the literature that consider narrative analysis and how to address some of the common challenges researchers face add to this problem. Data sources A longitudinal narrative case study exploring the personal and familial changes reported by uninjured family members during the first year of another family member’s traumatic brain injury. Review methods This is a methodological paper. Discussion The challenges of analysis included: conceptualising analysis; demonstrating the relationship between the different analytical layers and the final research findings; interpreting the data in a way that reflected the priorities of a narrative approach; and managing large quantities of data. The solutions explored were: the mapping of analytic intentions; aligning analysis and interpretation with the conceptual framework; and the use of matrices to store and manage quotes, codes and reflections. Conclusion Working with qualitative data can be daunting for novice researchers. Ensuring rigorous, transparent, and auditable data analysis procedures can further constrain the interpretive aspect of analysis. Implications for research/practice The solutions offered in this paper should help novice researchers to manage and work with their data, assisting them to develop the confidence to be more intuitive and creative in their research.
    • Changing attitudes with a MOOC on dementia

      Kotera, Yasuhiro; Robertshaw, David; University of Derby (Sciendo, 2019-07-12)
      Dementia is one of the most significant issues of our time and there are varying prevailing attitudes towards dementia, including negative stigma and perception. Massive open online courses (MOOCs) are a widely available online learning resource accessed for free which may present an opportunity to address prevailing attitudes. We conducted a questionnaire before and after a six-week MOOC where participants learned about dementia. We collected data using a survey instrument and analysed them with statistical testing. Although there was no statistically significant change between pre- and post-MOOC questionnaires, the change was observed in some questions and for particular groups. Our findings indicate this MOOC has a greater effect on changing the attitudes of non-healthcare workers, older people and those living in the United Kingdom. We recommend further analysis of MOOC as a change intervention and consideration of their application in other disciplines.
    • Christmas health warnings go down like a sack of coal.

      Mortimore, Gerri; University of Derby; Editorial Board (Mark Allen Group, 2017-12)
    • Cirrhosis in the over 16's: assessment and management

      Mortimore, Gerri; University of Derby (National Institute for Health and Care Excellence (NICE), 2016-07)
    • Collaborative development of an accelerated graduate entry nursing programme outside of traditional funding mechanisms

      Whiffin, Charlotte Jane; Clarke, Helen; Brundrett, Heather; Baker, Denise; Whitehead, Bill; University of Derby (Elsevier, 2017-09-21)
      Financial support for students entering nurse education programmes has typically been the responsibility of Governments who make a substantial contribution to tuition and/or living costs. However, where programmes are not funded by Government bodies, students must make alternative arrangements for financial support. This paper explores how a university worked with local employers to design, recruit and deliver an accelerated graduate entry nursing programme and how this philosophy of collaboration ultimately led to local health employers providing sponsorship for students. Therefore, we offer for debate the benefits of collaborative curriculum design and future considerations of attracting employer funding for graduate entry nursing programmes.
    • Confronting social risk factors for liver disease

      Mortimore, Gerri; University of Derby (2019-02-01)
      This presentation will explore the social risk factors for liver disease and how, as health professionals, we can confront these factors, to enable behavioural change. This session will also explore and reflect on our own social behaviours and how by understanding the complexity of changing our own behaviour, can assist in changing the behaviour of others.
    • Death cafés serve up a welcome taste of reality.

      Watson, Sharan; University of Derby (Final Choices Publishing Ltd., 2017)
      Death Cafés are helping to remove the taboo associated with talking about death. Sharan Watson considers how these local initiatives are providing opportunities for honest conversations and placing talking about dying, death and bereavement firmly on the national agenda
    • Delayed prescribing of antibiotics for self-limiting respiratory tract infections in an urgent care out of hours setting

      Mortimore, Gerri; Holroyd, Justine; University of Derby; Urgent Care South Derbyshire (MA Healthcare, 2020-03-02)
      Long-term overuse of antibiotics and inappropriate prescribing has led to widespread development of antimicrobial resistance. The Department of Health and Social Care recently published a five-year national action plan to reduce antimicrobial resistance, with the aim of reducing inappropriate antibiotic prescribing. This is mirrored in the NHS Long Term Plan, which aims to reduce unintentional exposure through a combination of antibiotic stewardship and leadership at all levels. An acute respiratory tract infection is one of the most common presentations in primary care, with 16.7% of all prescriptions issued attributed to it. Therefore, out-of-hours prescribers contribute significantly to general antibiotic consumption. This article analyses the practice of delayed prescribing of antibiotics for the treatment of self-limiting respiratory tract infections in an out-of-hours service. The advantages and disadvantages associated with delayed prescribing, to safely treat patients whilst facilitating the reduction of antimicrobial resistance, are discussed. In addition, recommendations for future practice are offered. This article also focuses on the development of an advanced nurse practitioner, reflecting on the four pillars of advanced practice, which underpin advanced clinical practice and associated competencies.
    • Delirium: a diagnostic dilemma. Part 1.

      Hardy, Kersten; Brown, Michelle; University of Derby (Mark Allen Group, 2015-09-10)
      Effective symptom management for a patient with a palliative diagnosis can be challenging. There are some symptoms that may be more difficult to control and understand than others. Delirium, as a symptom, may well prove to be a significant challenge for all involved, leaving family and health professionals perplexed and exhausted. Understanding the predisposing factors and the manifestations may aid the health professional in the assessment and identification of this distressing symptom, facilitating more effective management and care of those who are approaching the end of life. This article attempts to address some of the challenges and offer a number of suggestions that may aid in identifying delirium in patients at the end of life, but also examines some of the dilemmas when attempting to treat delirium.
    • Delirium: assessment and treatment of patients with cancer PART 2

      Brown, Michelle; Hardy, Kersten; University of Derby; Community Staff Nurse, Derbyshire (Mark Allen Group, 2016-02-25)
      Delirium at the end of life may present significant ethical dilemmas in clinical practice: whether to simply treat it in order to maximise symptom relief, with the resulting side effect being palliative sedation, or to attempt to reverse delirium and risk prolonging suffering. Determining whether the delirium can be reversed involves comprehensive assessment using established tools, which may or may not provide the answer to the question posed. This article examines the evidence surrounding several assessment tools that have been suggested as effective in identifying delirium, and the consequences of various approaches to the management of delirium in a patient with a cancer diagnosis. It also considers the impact delirium may have on the health professional and those close to the patient.
    • Dementia and stigma: a review of the literature on the reality of living with dementia.

      Kilduff, Alison; University of Derby (Unite, 2014-11)
      This paper provides a review of the literature on the reality of living with a diagnosis of dementia in terms of stigma and ageism, and their effects on care.
    • Designing a curriculum for the assistant practitioner of the future: Ensuring interprofessional care aspects and other stakeholder requirements are met.

      Baker, Denise; University of Derby (Elsevier, 2016-05)
      The role of the Assistant Practitioner in radiography has been established for over 10 years. Wakefield, Spilsbury, Atkin and McKenna13 (2009) describe how the role was originally introduced to overcome a shortage of registered staff at that time. Whilst there are clear overarching descriptions of what the role of the Assistant Practitioner is, Wakefield et al. concluded that there are many interpretations of the role and that there are inconsistencies between employers and subsequent uncertainty in workforce planners. Stewart-Lord, McLaren and Ballinger18 (2011) also found that there were a variety of roles and responsibilities undertaken by Assistant Practitioners in the field of radiography. This article outlines the curriculum design process for a foundation degree to develop Assistant Practitioners in diagnostic imaging and the associated challenges faced
    • Developing a collaborative research partnership.

      Beddingham, Elaine; Whitehead, Bill; University of Derby (Royal College of Nursing, 2015-06-03)
      This article details a collaborative research project undertaken in an acute NHS foundation trust, in partnership with a local higher education institution (HEI). The article identifies enablers and challenges to working in this type of collaboration and discusses the implications for the development of similar projects.
    • 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.
    • Development, validity and reliability testing of the East Midlands Evaluation Tool (EMET) for measuring impacts on trainees’ confidence and competence following end of life care training

      Whittaker, Becky; Parry, Ruth; Bird, Lydia; Watson, Sharan; Faull, Christina; University of Nottingham; LOROS; University of Derby (2017-07-20)
      Objectives: There has been a wide range of education development within end of life care and polices both in the UK and internationally recommend education as a means to increasing competence in end of life care delivery (LACDP, 2014; Gamondi C, Larkin P, Payne S, 2013). Whilst the gold standard means of assessing the impact of training, is to perform before and after workplace observations of staff and patients interacting, this would be highly time consuming and costly. The need to develop a time efficient, reliable and flexible evaluation questionnaire was identified. The East Midlands Evaluation Tool (EMET), for measuring effects of end of life care training events on trainees’ self-reported confidence and competence was developed, tested and validated, as a collaborative project across the region.
    • Development, validity and reliability testing of the East Midlands Evaluation Tool (EMET) for measuring impacts on trainees’ confidence and competence following end of life care training

      Whittaker, Becky; Parry, Ruth; Bird, Lydia; Watson, Sharan; Faull, Christina; University of Derby; University of Nottingham (BMJ Publishing Group Ltd., 2017-02-02)
      Abstract Objectives To develop, test and validate a versatile questionnaire, the East Midlands Evaluation Tool (EMET), for measuring effects of end of life care training events on trainees’ self-reported confidence and competence. Methods A paper-based questionnaire was designed on the basis of the English Department of Health's core competences for end of life care, with sections for completion pretraining, immediately post-training and also for longer term follow-up. Preliminary versions were field tested at 55 training events delivered by 13 organisations to 1793 trainees working in diverse health and social care backgrounds. Iterative rounds of development aimed to maximise relevance to events and trainees. Internal consistency was assessed by calculating interitem correlations on questionnaire responses during field testing. Content validity was assessed via qualitative content analysis of (1) responses to questionnaires completed by field tester trainers and (2) field notes from a workshop with a separate cohort of experienced trainers. Test–retest reliability was assessed via repeat administration to a cohort of student nurses. Results The EMET comprises 27 items with Likert-scaled responses supplemented with questions seeking free-text responses. It measures changes in self-assessed confidence and competence on 5 subscales: communication skills; assessment and care planning; symptom management; advance care planning; overarching values and knowledge. Test–retest reliability was found to be good, as was internal consistency: the questions successfully assess different aspects of the same underlying concept. Conclusions The EMET provides a time-efficient, reliable and flexible means of evaluating effects of training on self-reported confidence and competence in the key elements of end of life care
    • The diagnosis and management of a patient with acute pyelonephritis

      Hudson, Carly; Mortimore, Gerri; University of Derby (Mark Allen Group, 2020-02-13)
      Lower urinary tract infections account for more than 224 000 hospital admissions each year and nearly all of these have the pathophysiological possibility to develop into pyelonephritis, known clinically as an upper urinary tract infection. Acute pyelonephritis is characterised by inflammation of the renal parenchyma caused by bacteriuria ascending from the bladder, up the ureters to the kidneys. Effective history taking, combined with refined physical examination skills, are the two most powerful tools to differentiate upper and lower urinary tract infections as well as assisting the practitioner to exclude other differential diagnoses. Utilisation of these skills by the practitioner, together with the recognised presenting symptom triad of flank pain, fever and nausea in this case study, enabled the diagnosis of acute pyelonephritis to be given.