• Real talk facilitator manual: Engaging patients with end of life talk

      Parry, Ruth; Whittaker, Becky; Pino, Marco; Land, Vicky; Jenkins, Laura; Faull, Victoria; Feathers, Luke; Watson, Sharan; Loughborough University; LOROS Hospice; et al. (2020-01-15)
      Video-based communication training Engaging patients in end of life talk. ‘Real Talk’ is a novel and flexible communication training resource designed to use in face-to-face training events. It features real-life video recordings of UK hospice care, and learning points based on cutting-edge communication science. Real Talk has been developed as part of a research programme, and aims to enhance the quality and effectiveness of evidence-based communication skills training in the area of end of life care. The research programme is called VERDIS, which refers to video-based research and training on supportive and end of life care interactions.
    • Real talk facilitator manual: Engaging patients with end of life talk

      Parry, Ruth; Whittaker, Becky; Pino, Marco; Land, Vicky; Faull, Christina; Feathers, Luke; Watson, Sharan; Loughborough University, LOROS Hospice Leicestershire, University of Derby; University of Nottingham, The Health Foundation, NIHR (Real Talk, 2019-03-01)
      Video-based communication training- engaging patients in end of life talk. ‘Real Talk’ is a novel and flexible communication training resource designed to use in face-to-face training events. It features real-life video recordings of UK hospice care, and learning points based on cutting-edge communication science. Real Talk has been developed as part of a research programme, and aims to enhance the quality and effectiveness of evidence-based communication skills training in the area of end of life care. The research programme is called VERDIS, which refers to video-based research and training on supportive and end of life care interactions.
    • The recognition and management of sepsis in urgent care out of hours setting

      Mortimore, Gerri; University of Derby (MAG, 2020-07-11)
      As the majority of sepsis cases occur in the community, Justine Dexter and Gerri Mortimore provide an overview of the assessment, diagnosis and management of the condition for those working in out of hours settings. Sepsis is a life-threatening and common condition prompted by a microbial infection. Sepsis is responsible for the death of more people than prostate, bowel or breast cancer collectively, and it causes the second highest mortality rates after cardiovascular disease. The majority of sepsis cases occur in the community, with 30% developing while the patient is in hospital. In many instances, sepsis is avoidable and treatable. The aetiology of sepsis is not always known, making diagnosis difficult, with only 50% of cases having a confirmed pathogenic organism. The signs and symptoms most obviously connected with sepsis are confusion or unusual behaviour, hypotension and increased respiratory rate. However, some patients have non-specific symptoms, and just complain of feeling extremely unwell. Any patients who have these signs or symptoms should be assessed for the possibility of sepsis, regardless of whether pyrexia is present. To aid in detection and decision making about sepsis, the use of screening tools have been advocated to shorten the period prior to the administration of antibiotics. Children characteristically compensate physiologically for a considerable time and then deteriorate quickly; therefore, a crucial focus is to spot a sick child rapidly. Many urgent care out of hours (UCOOH) services are nurse-led. Therefore, it often falls on advanced nurse practitioners (ANPs) to educate healthcare assistants to spot the sick person, especially as they are usually the first person the patient sees. Leadership plays a key role for ANPs in UCOOH by helping to progress the pathway for patients to ensure the sickest are prioritised.
    • Right hypochondrial pain leading to a diagnosis of cholestatic jaundice and cholecystitis: a review and case study.

      Redfern, Vicky; Mortimore, Gerri; University of Derby (MA Healthcare, 2019-06-19)
      The gallbladder stores bile from the liver and releases it into the duodenum. Imbalance in bile components (typically, cholesterol) can lead to cholelithiasis, the crystallisation of choleliths (gallstones). Cholelithiasis is common, affecting a fifth of people in Western countries. The stones can become lodged in the biliary duct and obstruct bile flow. Bile obstruction affects levels of bilirubin, causing cholestatic jaundice. Associated symptoms include nausea, dark urine and pale stools. Gallstones can also cause cholecystitis, the inflammation of the gallbladder. They also often cause pain (biliary colic), especially sudden-onset, episodic, radiating right hypochondrial pain, and biliary pathology is the main cause of upper abdominal pain. Diagnosing these presentations requires a multispectral, holistic assessment comprising numerous investigations, including clinical history, liver function tests, Murphy's sign and abdominal ultrasound. Treatment is usually gallbladder removal surgery (laparoscopic cholecystectomy), with either bile duct exploration or endoscopic retrograde cholangio-pancreatography (ERCP). Good nurse–patient communication is essential to ensure quality of care. The case study presented here covers the assessment and biliary diagnosis of a female patient presenting with severe right hypochondrial pain. The review of existing evidence and the case study should help hepatobiliary nurses deliver quality care for patients presenting with symptoms of gallstones.
    • Right place right Now

      Naylor, Sarah; University of Derby (Society of Radiographers, 2019-12)
    • Role of the consultant pharmacist in clinical practice.

      Lewis, Rachel; Mortimore, Gerri; University of Derby (Wiley, 2018-08-20)
      It is now 15 years since the Department of Health first announced its plans for the establishment of consultant pharmacist posts in the NHS. This article examines how the role is developing and how it differs from that of an advanced clinical pharmacist practitioner.
    • The Role of the Liver in Iron Homeostasis and What Goes Wrong?

      Robalino Gonzaga, Ernesto; Riestra Guiance, Irene; Henriquez, Richard; Mortimore, Gerri; Freeman, Jan; University of Central Florida, Orlando, FL, USA; University Hospitals of Derby and Burton on Trent; University of Derby (Codon Publications, 2021-09-18)
      Iron is an essential mineral that is vital for growth development, normal cellular function, synthesis of hormones and connective tissue, and most importantly, serves as a component of hemoglobin to carry oxygen to body tissues. The body finely regulates the amount of circulating and stored iron within the body to maintain concentration levels within range for optimal physiologic function. Without iron, the ability for cells to participate in electron transport and energy metabolism decreases. Furthermore, hemoglobin synthesis is altered, which leads to anemia and decreased oxygen delivery to tissue. Problems arise when there is too little or too much iron. This review explores the role of the liver in iron physiology, iron overload and discusses the most common causes of primary and secondary hepatic iron overload.
    • Roles and responsibilities in integrated care for dementia.

      Robertshaw, David; Cross, Ainslea; University of Derby; School of Nursing and Professional Practice, University of Derby, Derby, UK; UDOL, University of Derby, Derby, UK (Emerald, 2019-04-15)
      PURPOSE Effective integrated healthcare systems require capable, trained workforces with leadership, shared governance and co-ordination. This study aimed to provide additional understanding of roles and responsibilities in relation to integrated care from the perspective of massive open online course (MOOC) participants. METHODOLOGY MOOC discussion board posts were analysed using Framework analysis consisting of transcription, familiarisation, coding, developing an analytical framework and application of the framework. FINDINGS Boundaries and key issues surrounding roles and responsibilities were highlighted and participants suggested a number of enablers that could remove barriers, thereby enhancing integrated care. ORIGINALITY/VALUE Enablers included introduction of shared communication and IT systems to support continuity of care. Awareness and understanding of dementia was seen as crucial to promote person centred care and care planning. The roles of education in, and experience of, dementia care were highlighted. Barriers affecting the roles and responsibility professionals exercise include funding, role conflicts, time constraints and time-consuming paperwork.
    • Sexuality and student mental health nurse experience in education and practice

      Milward, Ben; Collier, Elizabeth; University of Derby (Mark Allen Group, 2021-10-07)
      Lesbian, Gay, bisexual and transgender (LGBT) identifying student mental health nurses (MHNs) in higher education can feel less safe than others which affects performance. People ‘come out’ multiple times and this is difficult in a classroom situation. Lecturers can make a difference to LGBT student nurses experience and this can have an impact on clinical practice. The emotional impact of ‘coming out’ in the classroom can have far reaching consequences for their mental health. The response of educational staff can have a huge impact on the ability to learn and the marks achieved. Student lecturer relationships can have transformative consequences. Student MHN’s make meaning from their educational experiences in the classroom and clinical practice. If they do not see themselves (LGBT perspective) this can affect engagement and motivation. Safe nursing practice is role modelled from lecturer to student and has implications for service user experience in clinical settings.
    • Share your experience

      Mortimore, Gerri; University of Derby (University of Derby, 2018-10)
    • Starting to Measure up

      Lloyd, Erica; University of Derby (Redactive Publishing Limited, 2020-10-01)
      How using outcome measures can improve school nurses effectiveness.
    • Student life - First port of call at college

      Kilduff, Alison; University of Derby (Royal College of Nursing, 2014-10-28)
      Being a personal tutor to nursing students is one of the most rewarding parts of my role as a nurse lecturer in a university. There is nothing more satisfying than attending a graduation ceremony knowing you have been an integral part of the students’ journeys as they receive their awards and achieve their dreams. Read More: http://journals.rcni.com/doi/abs/10.7748/ns.29.8.74.s54
    • Supporting families in the context of adult traumatic brain injury

      Clark, Charlotte; Brown, Janice; Bailey, Christopher; Hutchinson, Peter J.; University of Suffolk; University of Southampton; Cambridge University Hospitals (Mark Allen Group, 2013-09-27)
      Families are fundamental to the wellbeing, quality of life and functional and social outcomes of individuals who sustain traumatic brain injury (TBI). However, the family is often vulnerable and at risk from the challenge of supporting an individual who has been left with long-term neurological disability. Considering the young population often affected, the resulting conditions can have significant emotional and financial burden for families and service providing for their long-term needs. The National Service Framework for Long-term Conditions acknowledges that the whole family is affected by neurological disability and it suggests that a 'whole-family' approach to managing TBI may be useful. This paper will argue that both family systems theory and family-centred care are frameworks that may be helpful in achieving the 'whole-family' approach in practice. However, future research is needed that will assess the efficacy of these and other approaches so that health-care services know the true value of any such intervention.
    • Supporting newly qualified nurse transition: A case study in a UK hospital.

      Whitehead, Bill; Owen, Patricia; Henshaw, Lorraine; Beddingham, Elaine; Simmons, Maxine; Chesterfield Royal Hospital; University of Derby; Keele University (Elsevier, 2015-07-26)
      Nurse education in the United Kingdom (UK) has been university based since the mid-1990s but despite careful preparation and assessment of student nurses it has been considered necessary to provide a period of additional support for newly qualified nurses (NQNs) to help them settle into their new role and responsibilities. Preceptorship is the process of supporting NQNs over the transition from student to registered nurse (RN) and it is recognised that this can be a difficult time for NQNs.
    • Supporting newly qualified nurses in the UK: a systematic literature review

      Whitehead, Bill; Owen, Patricia; Holmes, Dinah; Beddingham, Elaine; Simmons, Maxine; Henshaw, Lorraine; Barton, Merryn; Walker, Carl; University of Derby (2013)
      Aim: This is a systematic literature review of the existing published research related to the development of preceptorship to support newly qualified nurses in the United Kingdom (UK). Background: It has been known for some time that newly qualified nurses experience a period of unsettling transition at the point of registration. In the UK, preceptorship has been the professional body’s recommended solution to this for over 20 years. Data Sources: Searches were made of the CINAHL Plus and MEDLINE databases. Review Methods: A systematic review was carried out in August 2011. Twelve separate searches were conducted generating 167 articles, of which 24 were finally reviewed. Papers were critically reviewed and relevant data were extracted and synthesised using an approach based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis ( PRISMA). Results and Discussion: A results table is presented of the twenty-four sources generated by the systematic search. Three themes were identified from the empirical evidence base: ‘Managerial Support Framework’; ‘Recruitment and Retention’; and ‘Reflection and Critical Thinking in Action’;. Conclusion: There is strong evidence that the newly qualified nurse benefits from a period of supported and structured preceptorship, which translates to improved recruitment and retention for the employing organisations. Recommendations for Further Research and Practice: The existing literature provides an evidence base upon which to construct a preceptorship programme and a means by which to measure its efficacy and monitor its future development. Case study research projects should be considered for future preceptorship programmes in order to find the most effective methods of delivery.
    • Tackling the inescapable: Mental ill health in later life. Report on a series of conversations

      Collier, Elizabeth; Ahmed, J; Lamph, Gary; Ahmed, Anya; University of Salford (University of Salford, 2018-04-18)
      Older people with mental health problems (OPMHP) are a sub group of both mental health service users and older people service users. The specific voice OPMHP is therefore diluted within these general groups and there is little evidence to inform our understanding of the experiences of OPMHP. This project aimed to engage in conversation with older people who have experienced mental health problems with a view to hearing OPMHP perspectives and identifying priorities for future research. Twelve people met though contacts with local services and community contacts contributed. Their ages ranged from 52-86 and there were 7 men and 5 women. Six meetings/conversations were held (individually or in small groups) during a three month period April-July 2017. Each conversation built on findings from the previous meeting/conversation. The conversations were shaped by the questions: What does ‘older person’ mean to you? ‘What matters in mental health care for older people’? (Including discussion about what was meant by ‘age appropriate’) and ‘What should be researched’? Conversations about preliminary findings were continued at a feedback event on 3rd July 2017 attended by seven of the contributors. The predefined categories ‘older people’, mental health care and age appropriateness’ and ‘research’ shaped the conversations. The older people category found mixed and contradictory ideas about what older person meant. A content analysis of the categories ‘mental health care and age appropriateness’, and ‘research’ was conducted by ‘within’ and ‘across’ analysis of the transcribed notes from the six meetings/conversations and found eight themes: Mutuality, Sensitivity, Carers, Exclusion, Meaning and purpose, Politics, Physical and mental health integration, and Mortality. Although limitations include: a small number of people, lack of diversity, and took place in only one location, the depth of the discussions was wide ranging. The themes overlapped somewhat but some new insights emerged which are perhaps not well explored in literature or policy. The idea of age appropriateness was confusing and was not defined but was conflated with illness and frailty. There was an emphasis on ageism that is in contrast with mental health policy that does not address the complexity of (indirect) discrimination on the basis of age for OPMH. Although this report only includes the views of twelve people it raises a number of important issues that are worthy of further exploration. This is particularly important for policy and commissioners who need to progress on the basis of up to date evidence. The consultation will inform development for research proposals and bids following exploratory literature reviews on topics raised.
    • Testing real talk: an adaptable evidence-based communication skills intervention in end of life talk

      Watson, Sharan; Whittaker, Becky; Parry, Ruth; University of Derby; Loughborough University (BMJ Journals, 2019-11-17)
      Background Gaps in practice knowledge exist in initiating and navigating through difficult conversations; these new resources provide impactful, evidenced based learning opportunities in developing competence/confidence in engaging patients in end of life talk. 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 video clips. Communication skills training is more likely to be effective in changing behaviours when it is experiential and interactive, being relevant to trainees’ practice. Aim Real Talk interventions were tested out to determine ongoing development of communication skills training for the health and social care workforce. Experienced palliative care doctors attended a three-day facilitated residential workshop in which they explored the Real Talk. Discussions linked to the evidence of communication strategies, reflective diaries and action planning provided opportunity for linking learning to their clinical and educator roles. 29 experienced palliative care doctors attended the workshop who completed a pre/post questionnaire (adapted from a validated tool) and reflective diaries. Delegates identified the most effective aspects of learning as: experiential small group work relating to Real Talk video clips, critiquing underpinning evidence of how clinicians navigate conversations in end of life care and the opportunity to reflect on learning and application to practice in a safe and stimulating environment Engagement and results of the workshop have provided a foundation on which to build flexible communication skills training beyond the hospice setting, in engaging patients in end of life talk. Providing interactive experiential learning, embedded in the evidence base underpinning Real Talk, is crucial for health and social care professionals to develop skills in communicating with patients facing the end of life. The launch of the online Real Talk resources is now recommending that this adaptable approach be skilfully facilitated in safe environments for enhancing skilled practice in end of life care.
    • Tissue advanced glycation endproducts in two populations associated with increased oxidative stress: Normal in cirrhosis but elevated in haemodialysis patients

      Rye, Kara; Mortimore, Gerri; John, Stephen G.; Jefferies, Helen; Korsheed, Shvan; Owen, Paul; Fluck, Richard; McIntyre, Christopher W.; Austin, Andrew; Freeman, Jan G.; et al. (BMJ Publishing Group Ltd., 2009-04)
      Introduction: Advanced glycation endproducts (AGE) result from non-enzymatic glycation between reducing sugars and proteins and are a measure of cumulative metabolic stress. Tissue and serum AGE are known to predict cardiovascular mortality in end stage renal disease. Serum AGE levels are elevated in euglycaemic cirrhotics and correlate with disease severity yet cirrhosis appears to be protective against coronary atherosclerosis. Tissue AGE has not been assessed in cirrhosis. Aims and Methods: We aimed to assess tissue AGE in two populations with increased oxidative stress: cirrhosis and haemodialysis (HD) and determine whether skin AF is a non-invasive marker of liver disease severity. We studied 56 patients (28 cirrhotics, 28 age and sex matched HD patients) and compared with a normal control database (NC). Tissue AGE was measured using UV autofluorescence (AF) (AGE Reader, DiagnOptics, The Netherlands). Three sequential readings were taken from the palmar aspect of the forearm, approximately 10 cm below the elbow, avoiding pigmentation or vascular structures. History of diabetes mellitus (DM) and ischaemic heart disease (IHD) was noted and Child–Pugh (CP) and Model for End Stage Liver Disease (MELD) scores calculated. Results: Mean age 56±15 years, 64% male. 71% alcoholic cirrhosis, median CP score 8, MELD 12. DM and IHD prevalence was similar in both groups; no cirrhotic patient had renal impairment. Compared with NC, mean AF was significantly higher in both HD (3.264 vs 2.218, CI 0.691 to 1.402, p = <0.0001) and cirrhosis (2.632 vs 2.218, CI 0.082 to 0.746, p = 0.016). When cirrhotic patients with DM and IHD were excluded, this became insignificant (2.352 vs 2.157, CI to 0.116 to 0.506, p = 0.209). Mean AF was significantly higher in HD compared with cirrhosis (3.264 vs 2.632, CI 0.180 to 1.084, p = 0.007). Conclusion: Despite high levels of cumulative metabolic stress in both HD and cirrhosis, tissue AGE is only increased in HD. Both conditions are associated with elevated serum AGE levels but the mechanism underlying the differential tissue deposition is unknown. One hypothesis that may explain the reduced cardiovascular risk in cirrhosis is that soluble RAGE acts as a decoy receptor preventing AGE-RAGE interaction and the resulting endothelial dysfunction. Skin AF measurement is unhelpful as a non-invasive tool to detect cirrhosis.
    • Towards noninvasive detection of oesophageal varices

      Rye, Kara; Scott, Robert; Mortimore, Gerri; Lawson, Adam; Austin, Andrew; Freeman, Jan G.; University of Derby; Liver Unit, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK; Liver Unit, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK; Liver Unit, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK; et al. (Hindawi Publishing Corporation, 2012)
      Current guidelines recommend that all cirrhotic patients should undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. This approach places a heavy burden upon endoscopy units and the repeated testing over time may have a detrimental effect on patient compliance. Noninvasive identification of patients at highest risk for oesophageal varices would limit investigation to those most likely to benefit. Upper GI endoscopy is deemed to be the gold standard against which all other tests are compared, but is not without its limitations. Multiple studies have been performed assessing clinical signs and variables relating to liver function, variables relating to liver fibrosis, and also to portal hypertension and hypersplenism. Whilst some tests are clearly preferable to patients, none appear to be as accurate as upper GI endoscopy in the diagnosis of oesophageal varices. The search for noninvasive tests continues.
    • Transition to nursing: Preparation for practice

      Whitehead, Bill; Brown, Michelle; University of Derby (Open University Press, 2017-12-16)
      This book is for you if you’re in the final stage of a pre-registration nursing course or if you are making the transition to becoming a registered nurse. It provides you with a toolkit of advice to help you deal with challenges you’ll face and prepare you with an understanding of what the university and NMC will be looking for. Clear advice is given on the academic skills you will need, how to face the rigours of the final year, and what you need to demonstrate in your behaviour and placements. Professional issues covered include using evidence in practice, managing a caseload, and how far to fi t into or question workplace culture. The features of this book include: • Guidance enriched by the latest research and expert knowledge of this transition period • Reflective learning boxes to help you identify how you can prepare • Case studies raising issues from student and registered nurses’ experience going through this transition • Short chapters enable quick learning to support you now • Knowledge that will build your confidence and enhance your ability to fit into your first job This book is recommended reading for all final year nursing students and nurses new to the profession.