• Leadership in nursing: default not design.

      Mortimore, Gerri; University of Derby (2018-06-01)
      Discussing nursing over the last 3 decades, touching on bullying within the work place and development opportunities. Developing short term and long term goals.
    • A literature review exploring the preparation of mental health nurses for working with people with learning disability and mental illness.

      Adshead, Stephanie; Collier, Elizabeth; Kennedy, Sarah; University of Salford (Elsevier, 2015-01-23)
      The aim of this literature review is to explore whether mental health nurses are being appropriately prepared to care for learning disabled patients who also suffer from mental ill health. A systematic approach was adopted in order to identify relevant literature for review on the topic. Five electronic databases were searched; CINAHL, Medline, ERIC, PubMed and Scopus. Searches were limited to the years 2001-2013. A total of 13 articles were identified as relevant to the topic area for review. Three main themes were identified relating to (a) attitudes (b) practice and (c) education. There appears to be a lack of research that directly addresses this issue and the existing literature suggests that there are considerable deficits in the ability of mental health nurses to be able to provide appropriate care for those with both a learning disability and mental ill health. The findings of this review would suggest that this topic area is in urgent need of further investigation and research. Further research into this area of practice could possibly help to inform education regarding this subject at pre-registration and post qualifying levels, which could therefore in turn, improve the delivery of mental health nursing care to this particular client group.
    • Literature review of clinical benefits and reasons to prescribe palliative oxygen therapy in non-hypoxaemic patients

      Collis, Steven P; University of Derby; Senior Lecturer, College of Health and Social Care, University of Derby, UK (Mark Allen Healthcare, 2018-11-20)
      Aims: to review current guidelines and studies available to health professionals in the UK and explore the literature to identify reasons for the prescription of palliative oxygen therapy in non-hypoxaemic patients. Background: oxygen therapy is often associated with the palliative treatment for breathlessness. Although prescription guidelines are available and the risks of oxygen therapy are known, the therapy is still prescribed for non-hypoxaemic patients. Design: a literature search was conducted using relevant databases. Cited evidence from published guidelines was also consulted. Results: the findings suggest that oxygen is no more effective than room air for treating dyspnoea for non-hypoxaemic patients, although two small studies of self-reported benefits from patients and carers indicate different perceptions of need. Conclusion: the findings suggest that there is a knowledge gap with regards understanding the reasons for the prescription of oxygen therapy for non-hypoxaemic patients.
    • Literature review of post-traumatic stress disorder in the critical care population.

      Morrissey, Matthew; Collier, Elizabeth; University of Salford (Wiley, 2016-04-24)
      Aim To determine which factors relate to the development of posttraumatic stress disorder, in adult patients who are admitted to critical care units. Background Patient survival rates from critical care areas are improving each year and this has led to interest in the long term outcomes for patients who have been discharged from such environments. Patients typically require invasive and extensive treatment, which places a stress on physical and mental health. Prevalence estimates of posttraumatic stress disorder in the critical care discharge population vary from 5-63%, yet it remains unclear what the predisposing factors are. Design. A systematised review Method Subject heading and keyword searches were conducted in MEDLINE, CINAHL, PsycINFO and ScienceDirect, with 23 articles identified that examined the relationship between critical care and the development of posttraumatic stress disorder. Results Three main themes were identified; Critical Care Factors, Patient Factors and Experience Factors. Eight key and 3 potential causative factors were found: younger age, female, previous psychiatric history, length of ICU stay, benzodiazepine sedation, use of stress hormones, delusional memory and traumatic memory, delirium, GCS score of ≤9 on admission & use of mechanical restraint Conclusions Posttraumatic stress reactions can be strongly related to the development and presence of traumatic and delusional memories. Younger patients may exclude themselves from research to avoid their traumatic thoughts. The role of prior psychiatric illness is unknown. Distinction between ‘factual’ and ‘false’ or delusional memory as occurs in the literature maybe unhelpful in understanding trauma reactions. Relevance to clinical practice There are around 38,000 occupied critical care beds each year in England. The scale of the issue is therefore substantial. Risk factors can be isolated from available evidence and provide a rudimentary risk assessment tool to inform practice development in this area.
    • A Literature Review on the Experience of Long-Term Mental Illness

      Collier, Elizabeth; Grant, Maria J.; Salford University; University of Salford, School of Health & Society, Salford, United Kingdom; University of Salford, School of Health & Society, Salford, United Kingdom (Taylor & Francis, 2018-02-13)
      Purpose To illuminate long-term experiences of mental illness from both research and autobiographical accounts. Design A literature review of English-language papers, 1950-2014, relating to the experience of long-term mental illness indexed in Ageinfo, AMED, ASSIA, British Nursing Index (BNI), CINAHL, MEDLINE, Psychextra and PsychInfo. Findings Twenty-five research papers and nine autobiographic accounts met the review criteria. All research papers were cross-sectional studies. Thematic analysis revealed nine themes: fear, explanation seeking, stigma, disability, coping strategies, control, support, change and learning, and life history. Specific gaps of note relate to age differences, acknowledgement of longevity of mental illnesses, and different cultural perspectives. Research implications There is an absence of longitudinal studies focused on experiences of long-term mental illness. The considerable length of time implicated in the experiences suggests that more individual life experience rather than illness focused studies are needed, enabling a holistic understanding. This includes studies from cultures other than the western world. Greater transparency is needed in justifying age inclusions or passive exclusion of older peoples’ perspectives. Practical implications Knowledge of long-term mental illness experiences is of great importance to mental health practitioners. Evidence based services cannot be provided if we do not have an holistic understanding of long term mental illness. The experience of older people in particular is not well understood due to the lack of evidence available. Social implications This review questions our ability to provide effective support when there is such a lack of evidence about the experience of long-term mental illness, in particular in relation to older people and different cultural perspectives Originality/value There appear to be no literature reviews that focus on the individual experience of long-term mental illness. It highlights the surprisingly small number of research studies available to inform mental health practitioners.
    • Liver disease

      Mortimore, Gerri; University of Derby (National Institute for Health and Care Excellence (NICE), 2017-06)
    • Liver disease presentation and red flags in urgent, primary and community care

      Mortimore, Gerri; University of Derby (2019-03-06)
      Liver Disease Presentations & Red Flags in Urgent, Primary & Community Care- Gerri Mortimore, Advanced Practice Lecturer, ANP Specialist & Expert Advisor for NICE
    • Liver ultrasound scans.

      Mortimore, Gerri; Mayes, JP; University of Derby (Mark Allen Group, 2019)
      Ultrasound scans can be used in a variety of settings to examine internal organs, muscle, joints, tendons and lesions or to monitor foetal growth and development during pregnancy. Ultrasound, is arguably the most frequently requested form of imaging especially within the gastroenterology department. However, to elucidate a cause of abdominal pain, distension, jaundice, abnormal liver function tests; abdominal ultrasound is one of the easiest, quick and cost-effective ways to do so. In addition, ultrasound can assist the practitioner to rule out other considered differential diagnoses. Since the advent of advanced clinical practitioner roles, nurses are increasingly taking on advanced clinical roles within the field of gastroenterology. With these advanced roles, nurses and other allied health professionals, can act autonomously in the assessment, diagnosis and treatment of patients, which includes the ability to order different tests and investigations, which can comprise of radiological and ultrasound requests. However, it is not just the ordering and requesting of radiological and ultrasound scans, but the requirement to understand the scan report and the ability to deal with the findings in an appropriate and timely fashion, that is vital for improving patient care. This article will focus on abdominal ultrasound, with emphasis on liver ultrasound scans. It will discuss what an ultrasound scan is, and some of the terminology used in liver ultrasound reports. In addition, it will compare ultrasound images of normal liver to abnormal and explore the importance of background information which should be presented on the request form, to aid the sonographer or radiologist in their interpretation of the scan.
    • Ludwig's angina: a multidisciplinary concern.

      Parker, Emma; Mortimore, Gerri; University of Derby (MA Healthcare, 2019-05-09)
      Although relatively uncommon, Ludwig’s angina is a potentially life-threatening infection of the floor of the mouth and neck. There is a danger of airway obstruction by swelling in the area and displacement of the tongue, and patients are at risk of deterioration. There are many factors thought to place patients at an increased risk of developing the condition. These include recent dental treatment, dental caries or generally poor dentition, chronic disease such as diabetes, alcoholism, malnutrition, and patients with compromised immune systems (eg AIDS, organ transplantation). This article examines the aetiology of Ludwig’s angina and considers the presentation, diagnosis and treatment of a patient who presented to an out-of-hours streaming area of a local emergency department, with an emphasis on the importance of a multidisciplinary approach. It also considers the need for ongoing education and awareness of health professionals to ensure the successful diagnosis, management and treatment of this condition, particularly in the context of patients with poor access to dental care presenting first to the emergency department.
    • Making sense of complexity: A qualitative investigation into forensic learning disability nurses’ interpretation of the contribution of personal history to offending behaviour

      Lovell, Andrew; Skellern, Joanne; University of Chester; University of Derby (Wiley, 2020-04-01)
      There is growing recognition that an individual's personal history can be extremely influential in shaping their future experience, though there has been a limited exploration in the context of learning disability and offending behaviour. Research questions related to participant interpretation of offending behaviour and individual and service responses. A series of focus groups comprising learning disability forensic nurses were conducted across all secure settings, high, medium and low. Three themes were produced: interpreting offending behaviour; the impact of personal history; responding therapeutically. The difficulties relating to understanding the relationship between offending behaviour and personal history significantly informed the construction of the most effective therapeutic relationships. An increased focus on the impact of someone's background might inform nursing as it seeks to deliver care to individuals with increasingly complex needs in a time of service transition.
    • Making the link between critical appraisal, thinking and analysis

      Whiffin, Charlotte Jane; Hasselder, Alison; University of Derby; University of Suffolk (Mark Allen Group, 2013-09-27)
      Nursing has become an all-graduate profession; as such, student nurses must develop their skills of critical analysis. The need to develop critical analytical thinking has been identified as the single most important skill in undergraduate education and reaching the academic requirements of level six study. In degree-level healthcare programmes, students are frequently asked to complete a structured critical appraisal of research. This paper examines how critical appraisal activities can be an opportunity for students to develop transferable critical thinking skills. Critical appraisal teaches objectivity, reflection, logic and discipline, which encourage students to think critically in both theory and practice.
    • Management of ascites in patients with liver disease

      Mortimore, Gerri; University of Derby (Metropolis International, 2018-09-18)
      Ascites is a distressing symptom that requires demanding treatments such as taking diuretics, reducing dietary salt or fluid intake, and draining ascitic fluid out of the abdomen (paracentesis). It is also often a sign that liver cirrhosis has progressed from a stable to decompensated state - and patients with decompensated liver cirrhosis have a poor prognosis.Nurses in advanced roles deal with many aspects of ascites management, from eliciting patient consent and prescribing albumin to performing paracentesis and monitoring electrolytes. This article offers an overview of ascites, it's causes, diagnosis complications and management, with a focus on ascites due to liver cirrhosis.
    • A mixed methods feasibility study to evaluate the use of a low-intensity, nurse-delivered cognitive behavioural therapy for the treatment of irritable bowel syndrome

      Dainty, Andrew; Fox, Mark; Lewis, Nina; Hunt, Melissa; Holtham, Elizabeth; Timmons, Stephen; Kinsella, Philip; Wragg, Andrew; Callaghan, Patrick; University of Nottingham; et al. (BMJ Open, 2014-06-17)
      Introduction: Irritable bowel syndrome (IBS) is characterised by symptoms such as abdominal pain, constipation, diarrhoea and bloating. These symptoms impact on health-related quality of life, result in excess service utilisation and are a significant burden to healthcare systems. Certain mechanisms which underpin IBS can be explained by a biopsychosocial model which is amenable to psychological treatment using techniques such as cognitive behavioural therapy (CBT). While current evidence supports CBT interventions for this group of patients, access to these treatments within the UK healthcare system remains problematic. Methods and analysis: A mixed methods feasibility randomised controlled trial will be used to assess the feasibility of a low-intensity, nurse-delivered guided self-help intervention within secondary care gastrointestinal clinics. A total of 60 participants will be allocated across four treatment conditions consisting of: high-intensity CBT delivered by a fully qualified cognitive behavioural therapist, low-intensity guided self-help delivered by a registered nurse, self-help only without therapist support and a treatment as usual control condition. Participants from each of the intervention arms of the study will be interviewed in order to identify potential barriers and facilitators to the implementation of CBT interventions within clinical practice settings. Quantitative data will be analysed using descriptive statistics only. Qualitative data will be analysed using a group thematic analysis.
    • A multidisciplinary approach to teaching basic life support

      Lowes, Helen; McNamara, Joanna; Naylor, Sarah; Newton, Emily; Timms, Janine; Sheffield Hallam University (2017-07-12)
    • Narratives of family transition during the first year post-head injury: perspectives of the non-injured members

      Whiffin, Charlotte Jane; Bailey, Christopher; Ellis-Hill, Caroline; Jarrett, Nicola; Hutchinson, Peter J.; University of Derby; University of Derby Derbyshire Chambers and Business Link; Canal Wharf Chesterfield UK; Faculty of Health Sciences; University of Southampton; Highfield, Southampton UK; University of Bournemouth; Poole Dorset UK; Faculty of Health Sciences; University of Southampton; Highfield, Southampton UK; et al. (2014-10-23)
      Aim To explore the narratives created by non-injured family members in relation to themselves and their family in the first year after head injury. Background A head injury is a potentially devastating injury. The family responds to this injury by supporting the individual and their recovery. While the perspective of individual family members has been well documented, there is growing interest in how the family as a whole makes sense of their experiences and how these experiences change over time. Design Longitudinal narrative case study using unstructured in-depth interviews. Methods Data were collected during an 18-month period (August 2009-December 2010). Nine non-injured family members from three families were recruited from an acute neurosurgical ward and individual narrative interviews were held at one, three and 12 months postinjury where participants were asked to talk about their experience of head injury. Analysis was completed on three levels: the individual; the family and between family cases with the aim of identifying a range of interwoven narrative threads. Findings Five interwoven narratives were identified: trauma, recovery, autobiographical, suffering and family. The narrative approach emphasized that the year posthead injury was a turbulent time for families, who were active agents in the process of change. Conclusion This study has shown the importance of listening to people's stories and understanding their journeys irrespective of the injured person's outcome. Change postinjury is not limited to the injured person: family members need help to understand that they too are changing as a result of their experiences.
    • 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.
    • Non-invasive assessment and prediction of clinically significant portal hypertension

      Rye, Kara; Mortimore, Gerri; Austin, Andrew; Freeman, Jan G.; Royal Derby Hospital (BMJ Publishing Group Ltd., 2011-03-13)
      Hepatic venous pressure gradient (HVPG) predicts variceal development, bleeding, clinical decompensation and death. Measurement is invasive, time-consuming and performed in few centres. Reduction of HVPG to ≥12 mm Hg or by >20% significantly reduces bleeding risk and mortality. Detection of non-responders requires repeated HVPG measurement as conventional non-invasive assessment is not accurate in predicting haemodynamic response. Cirrhotics have a hyperdynamic circulation and impaired baroreceptor sensitivity (BRS). The authors assessed whether non-invasive measurement of systemic haemodynamics and BRS detected clinically significant portal hypertension (CSPH, HVPG ≥12 mm Hg).
    • Non-invasive measurement of Systemic Haemodynamics by Finometry in patients with Cirrhosis

      Freeman, Jan G.; Rye, Kara; Mortimore, Gerri; Austin, Andrew; University of Derby (2015-01)
    • "Nurses who become ACPs should not be mini-medics"

      Whitehead, Bill; University of Derby (EMAP, 2016-05-16)
      There is a pressing need to enable registered nurses to reach their full potential at higher-than-basic-registration level in clinical practice. This would fulfil two requirements: personal professional advancement and workplace clinical need.