• 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.
    • The diagnosis and management of pulmonary embolism

      Toplis, Emma; Mortimore, Gerri; University of Derby (Mark Allen Group, 2020-01-09)
      Pulmonary embolism (PE) is a condition characterised by an obstruction of the pulmonary arterial system by one or more emboli. Advanced clinical practitioners are often faced with ruling out a diagnosis of PE in patients with non-specific symptoms such as dyspnoea and pleuritic chest pain, which can be fairly mild and therefore a diagnosis of PE easily missed. PEs can be a challenge to diagnose, especially in elderly people, since it can be difficult to differentiate their symptoms from other less serious illnesses. Widely used scoring tools are helpful to calculate a patient’s probability of having a PE. The Wells score is the most widely used pre-test clinical probability indicator of PE used in the UK, which scores the patient’s probability of having a PE based on their risk factors. The D-dimer test is a relatively simple investigation to rule out venous thromboembolism (VTE) but can be raised for various reasons other than PE. Computed tomography pulmonary angiography (CTPA) is regarded as the gold standard imaging modality for investigation of acute PE but ventilation-perfusion (VQ) scans be used as an alternative imaging technique for diagnosing PE in those where CTPA is contraindicated. Thrombolysis is underused in clinical practice due to the fear of adverse bleeding events. Patients without a massive or sub-massive PE are treated with anticoagulant therapy, usually commencing with subcutaneous lowmolecular- weight heparin and switching over to a direct oral anticoagulant (DOAC). There has been a shift away from treatment with warfarin for the prevention and treatment of VTE over the past decade.
    • Diagnostic radiographers working in the operating theatre: An action research project

      Naylor, Sarah; Foulkes, Denise; Sheffield Hallam University (Elsevier BV, 2017-10-07)
      Failures in interprofessional communication are well-documented and are an established cause of medical error and negative health outcomes. Socio-historical issues like imbalances in power and status are particularly prevalent in the operating theatre environment, adding complications to interprofessional working. Simulation, used in healthcare education, may impact positively on interprofessional working. The aim of this action research study was to develop, pilot and run a simulation experience for Diagnostic Radiography (DRAD) students. Action research was used to structure this study. The first phase of the action research was to look at the problem; this was undertaken using critical incident technique. Findings from the critical incident technique influenced the simulation event. A focus group was held immediately after the event for reflection. A second simulation using a cohort of 48 students and a reflection after a period of three months formed the second round of the project. The simulation took place in a hi-fidelity simulated operating theatre. Thematic content analysis was undertaken of the focus group, data from the critical incident technique, and the reflections. The findings are discussed under the themes; identification, clarity, preparation, and the expert. Identification and lack of clarity in communication were seen as an important issue in the operating theatre. Lack of preparation of the working environment was also highlighted. Lack of confidence in the operating theatre inhibits interprofessional working. Simulation can help prepare students for working in the operating theatre. Realism is important as is scheduling the event to ensure maximum benefit.
    • Digital technology to facilitate proactive assessment of obesity risk during infancy (ProAsk): a feasibility study

      Redsell, Sarah A; Rose, Jennie; Weng, Stephen; Ablewhite, Joanne; Swift, Judy Anne; Siriwardena, Aloysius Niroshan; Nathan, Dilip; Wharrad, Heather J; Atkinson, Pippa; Watson, Vicki; et al. (BMJ, 2017-09-06)
      To assess the feasibility and acceptability of using digital technology for Proactive Assessment of Obesity Risk during Infancy (ProAsk) with the UK health visitors (HVs) and parents. Multicentre, pre- and post-intervention feasibility study with process evaluation. Rural and urban deprived settings, UK community care. 66 parents of infants and 22 HVs. ProAsk was delivered on a tablet device. It comprises a validated risk prediction tool to quantify overweight risk status and a therapeutic wheel detailing motivational strategies for preventive parental behaviour. Parents were encouraged to agree goals for behaviour change with HVs who received motivational interviewing training. We assessed recruitment, response and attrition rates. Demographic details were collected, and overweight risk status. The proposed primary outcome measure was weight-for-age z-score. The proposed secondary outcomes were parenting self-efficacy, maternal feeding style, infant diet and exposure to physical activity/sedentary behaviour. Qualitative interviews ascertained the acceptability of study processes and intervention fidelity. HVs screened 324/589 infants for inclusion in the study and 66/226 (29%) eligible infants were recruited. Assessment of overweight risk was completed on 53 infants and 40% of these were identified as above population risk. Weight-for-age z-score (SD) between the infants at population risk and those above population risk differed significantly at baseline (−0.67 SD vs 0.32 SD). HVs were able to collect data and calculate overweight risk for the infants. Protocol adherence and intervention fidelity was a challenge. HVs and parents found the information provided in the therapeutic wheel appropriate and acceptable. Study recruitment and protocol adherence were problematic. ProAsk was acceptable to most parents and HVs, but intervention fidelity was low. There was limited evidence to support the feasibility of implementing ProAsk without significant additional resources. A future study could evaluate ProAsk as a HV-supported, parent-led intervention.
    • Do H63D homozygote patients have clinically significant iron overload?

      White, Jonathan; Scott, Robert; Mortimore, Gerri; Lawson, Adam; Freeman, Jan G.; Austin, Andrew; Derby Digestive Diseases Centre (2011-03-13)
      Homozygosity H63D is present in 2% of the normal Caucasian population and is thought to carry a small risk of iron overload. The authors aim to characterise patients referred with evidence of iron overload found to be H63D homozygous.
    • Does the risk of reprisal prevent nurses blowing the whistle on bad practice?

      Barker, Denise; Whitehead, Bill; University of Derby (Macmillan Publishing Ltd., 2010)
      Despite the introduction of legislation to protect people who report poor or unsafe practice, whistleblowing can still have serious consequences for nurses.
    • Dry January: the damaging effects of alcohol on your liver.

      Mortimore, Gerri; University of Derby (2018-01-11)
      Over view of causes of liver disease. How to calculate alcohol units. How the strength of alcohol has increased since 1987 in wines. Signs and symptoms of liver disease.
    • Dying from liver disease: the importance of end-of-life discussions

      Watson, Sharan; Mortimore, Gerri; University of Derby; Post-Registration Lecturer, at the College of Health and Social Care, University of Derby; Lecturer, at the College of Health and Social Care, University of Derby (2018-12-21)
      Over the past 50 years, deaths from liver disease have risen dramatically, whereas deaths from many other major diseases have fallen. Liver disease is now the third largest cause of premature death in the UK, with alcohol-related liver disease accounting for nearly 40% of these deaths. With advanced liver disease comes the associated complications of varices, hepatic encephalopathy and ascites, and death from liver disease can be sudden and catastrophic. Supportive and palliative care needs in people with liver disease often go unrecognised and unaddressed. End-of-life care and wishes can be a difficult subject to broach to patients and their loved ones, but it is one that nurses are often best placed to undertake. Therefore, when considering the overall care of patients with liver disease, it is necessary to incorporate anticipatory and concordant end-of-life plans.
    • Dying matters - What can we do in our communities?

      Watson, Sharan; Virk, Navjot Kaur; Brock, Martin; Dickens, Adam; Swanwick, Maelie; Home, Dave; University of Derby; Treetops Hospice Trust (2018-05-14)
      Launch of national Dying Matters Awareness Week in Derbyshire, setting the scene why we need to promote open , honest conversations; multifaith perspectives ; self care for carers ; ReSPECT - Advance care palnning
    • Dying matters - Why we need to talk about death.

      Watson, Sharan; University of Derby (University of Derby, 2018-05-17)
      How many of us are touched by the death of a loved one, friend or colleague? How many of us feel able to talk openly about our own future death? Sharan Watson, Lecturer in Post Graduate Health Care Practice, Award Leader for PG Certificate in Palliative Care, and Chair of Derbyshire Alliance for End of Life Care, explains why it’s important to talk – and plan – for death.