• 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.
    • The management of urinary tract infections in older patients within an urgent care out of hours setting

      Dexter, Justine; Mortimore, Gerri; University of Derby (MAG, 2021-03-26)
      This article critically analyses the prevalence, assessment and management of urinary tract infections (UTIs) in patients over the age of 65, in an urgent care out-of-hours service in order to enhance care. It is undertaken from the perspective of working as an Advanced Nurse Practitioner (ANP). A synopsis of UTI is presented, examining the epidemiology and aetiology. The process of assessment, diagnosis and management of UTI in older people is appraised based on current evidence. Difficulties associated with the recognition of UTI in elderly are evaluated. Finally, recommendations are made for the improvement of future practice as an ANP.
    • 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.
    • Neurotrauma clinicians’ perspectives on the contextual challenges associated with long-term follow-up following traumatic brain injury in low-income and middle-income countries: a qualitative study protocol

      Smith, Brandon George; Whiffin, Charlotte Jane; Esene, Ignatius N; Karekezi, Claire; Bashford, Tom; Mukhtar Khan, Muhammad; Fontoura Solla, Davi Jorge; Indira Devi, Bhagavatula; Hutchinson, Peter John; Kolias, Angelos G; et al. (BMJ, 2021-03-04)
      Traumatic brain injury (TBI) is a global public health concern; however, low/middle-income countries (LMICs) face the greatest burden. The WHO recognises the significant differences between patient outcomes following injuries in high-income countries versus those in LMICs. Outcome data are not reliably recorded in LMICs and despite improved injury surveillance data, data on disability and long-term functional outcomes remain poorly recorded. Therefore, the full picture of outcome post-TBI in LMICs is largely unknown. This is a cross-sectional pragmatic qualitative study using individual semistructured interviews with clinicians who have experience of neurotrauma in LMICs. The aim of this study is to understand the contextual challenges associated with long-term follow-up of patients following TBI in LMICs. For the purpose of the study, we define ‘long-term’ as any data collected following discharge from hospital. We aim to conduct individual semistructured interviews with 24–48 neurosurgeons, beginning February 2020. Interviews will be recorded and transcribed verbatim. A reflexive thematic analysis will be conducted supported by NVivo software. The University of Cambridge Psychology Research Ethics Committee approved this study in February 2020. Ethical issues within this study include consent, confidentiality and anonymity, and data protection. Participants will provide informed consent and their contributions will be kept confidential. Participants will be free to withdraw at any time without penalty; however, their interview data can only be withdrawn up to 1 week after data collection. Findings generated from the study will be shared with relevant stakeholders such as the World Federation of Neurosurgical Societies 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.
    • Nurses' recognition of domestic violence and abuse.

      Byrom, Beth; Collier, Elizabeth; Rogers, Michaela; Salford University; Staff nurse, North Manchester General Hospital; Lecturer in mental health, University of Salford; Lecturer in social work, University of Salford (Mark Allen Healthcare, 2017-12-28)
      Most literature and discourse on domestic violence and abuse (DVA) focuses on women but there is a need to be cognisant of the broader population experiencing DVA and the wide-ranging impacts that can affect anybody whatever their identity or background. Mental Health nurses are in a good position to help people who experience DVA but they need to be able to recognise it first. This paper reports on a review which aims to address the question: How can mental health nurses recognise domestic violence and abuse (DVA)?. The databases CINAHL, Medline, PsychINFO and ASSIA were searched using key terms related to DVA and nursing and recognition. The term ‘nursing’ was used as the ‘mental health nursing’ search term found only two papers. Limits for the search were English language research only papers from 2002-2017. Fifteen papers were included in the review. Most of the located research focused on health care practitioners in multidisciplinary teams with nursing literature focused on adult health nurses rather than mental health nursing. The findings are presented in the categories: education, training and organisational support, and, screening, inquiry and the therapeutic relationship, with an additional category (given the original aim of the review) ‘mental health settings’. The experience of DVA has significant consequences for mental health yet we found only two research papers focused on mental health settings. We therefore discuss and extrapolate from reviewed literature the implications for practice in the context of mental health nursing.
    • Nutrition and malnutrition in liver disease: An overview

      Mortimore, Gerri; University of Derby (MAG Healthcare, 2020-01)
      The term malnutrition is generally understood to refer to a deficiency of nutrition, and it is rarely appreciated that malnutrition can also result from excesses in nutritional status. Relatively recent clinical practice guidelines (CPG) from the European Association for the Study of the Liver (EASL) (Merli et al, 2019) acknowledged that malnutrition includes both nutritional surplus and deficiency, but stated that, for the purpose of the CPG, malnutrition would be referred to as undernutrition.
    • Nutrition and malnutrition in liver disease: an overview.

      Mortimore, Gerri; University of Derby (Mark Allen Group, 2019-07-17)
      The term malnutrition is generally understood to refer to a deficiency of nutrition, and it is rarely appreciated that malnutrition can also result from excesses in nutritional status. Relatively recent clinical practice guidelines (CPG) from the European Association for the Study of the Liver (EASL) (Merli et al, 2019) acknowledged that malnutrition includes both nutritional surplus and deficiency, but stated that, for the purpose of the CPG, malnutrition would be referred to as undernutrition.
    • Online learning as a vehicle for social change.

      Robertshaw, David; University of Derby (2016-07)
      Online learning as a vehicle for social change, how education can change lives. David looks at how the introduction of MOOCs (Massive Open Online Courses is changing the face of education and making it accessible for everyone to learn.
    • Opportunity, support and understanding: the experience of four early trainee nursing associates

      Dainty, Andrew; Barnes, Donna; Bellamy, Erica; Kyte, Nicola; Berry, Katie; University of Derby; Sherwood Forest Hospitals NHS Foundation Trust; Nottingham University Hospitals NHS Trust (Mark Allen Group, 2021-06-11)
      This study aimed to capture the lived experience of some of the first trainee nursing associates (TNAs) during the pilot of the role in the January 2017 cohort of TNAs, based at the University of Derby. A convenience sampling approach was used to recruit participants to this phenomenological study. In-depth, semi-structured interviews were carried out with four participants to capture the experience, as lived by the first cohort of TNAs. Transcripts were transcribed verbatim and were analysed using interpretive phenomenological analysis. Analysis suggests that the participant experience was characterised by six themes, namely: challenges relating to NA training; developing new skills; opportunity; the importance of support; impact of the NA role; and understanding the NA role. This study adds to our understanding relating to the lived experience of some of the first TNAs taking up training for this role within healthcare, and highlights some of the factors that were most pertinent, according to the lived experience of the trainees themselves. The authors hope that the findings of this study will prove useful for those considering taking up training for the role, or indeed establishments considering implementing the role with their settings.
    • Oro-mucosal midazolam maleate: Use and effectiveness in adults with epilepsy in the UK

      Shankar, Rohit; Goodwin, Melesina; Toland, John; Boyle, Andrew; Grant, Amanda; Pearson, Josephine; Storer, Amanda; Higgins, Richard; Hudson, Sharon; Reuber, Markus; et al. (Elsevier, 2021-08-07)
      Oro-mucosal midazolam maleate (OMM) with suitable training to family and carers is being increasingly recognized as the treatment of choice to mitigate the development of status epilepticus in non-hospital community settings. There are no studies to describe the use, effectiveness, and suitable dosing of OMM in adults with epilepsy in community settings. To describe the use, effectiveness, and dosing of OMM in the emergency treatment of epileptic seizures in community settings. A retrospective observational study (2016–17) design was used with participant recruitment from four UK NHS secondary care outpatient clinics providing epilepsy management. Study sample was of adult people with epilepsy (PWE) having had a recent seizure requiring OMM. Data on patient demographics, patient care plans, details of a recent seizure requiring emergency medication, and dose of OMM were collected from medical records. Study data from 146 PWE were included. The mean age of PWE was 41.0 years (SD 15.2) and mean weight was 64.8Kg (SD 18.2). Fifty-three percent of PWE were recorded as having intellectual disability. The most frequently used concomitant medications were lamotrigine (43%). The majority of seizures occurred at people’s homes (n = 92, 63%). OMM was most often administered by family/professional care-givers (n = 75, 48.4%). Generalized (tonic/clonic) seizures were recorded in most people (n = 106, 72.6%). The most common initial dose of OMM was 10 mg (n = 124, 84.9%). The mean time to seizure cessation after administration of this initial dose was 5.5 minutes (SD = 4.5, Median 5.0, IQR 2.1–5.0). Only a minority of seizures led to ambulance callouts (n = 18, 12.3%) or hospital admissions (n = 13, 9%). This is the first observational study describing the use and effectiveness of OMM in adults in community settings. Minimal hospital admissions were reported in this cohort and the treatment was effective in ending seizures in adults in community settings.
    • Orthostatic hypotension: clinical review and case study

      Bailey, Rachael; Mortimore, Gerri; University of Derby (Mark Allen Group, 2020-05-14)
      Transient loss of consciousness (TLOC) accounts for 3% of all attendance in emergency departments within the UK. More than 90% of TLOC presentations are due to epileptic seizures, psychogenic seizures or syncope. However, in England and Wales in 2002, it was estimated that 92000 patients were incorrectly diagnosed with epilepsy, at an additional annual cost to the NHS of up to £189 million. This article will reflect on the case study of a 54-year-old female patient who presented with a possible TLOC, and had a background of long-term depression. Differential diagnoses will be discussed, but the article will focus on orthostatic hypotension. Being diagnosed with this condition is independently associated with an increased risk of all-cause mortality. Causes of orthostatic hypotension and the pathophysiology behind the condition will be discussed, highlighting the importance of obtaining an accurate clinical history. This is extremely pertinent if a patient collapses in an NHS setting and this is witnessed by nurses because they can contribute to the history of the type of collapse, to aid diagnosis and correct treatment. In addition, nurses have a valuable role to play in highlighting polypharmacy to doctors, and non-medical prescribers, as a contributing factor to orthostatic hypotension is polypharmacy. It is therefore important to accurately distinguish TLOC aetiology, not only to provide appropriate management, but to also identify patients at risk of morbidity/mortality related to underlying disease.