• 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.
    • Understanding the arousal of anger: a patient-centred approach

      Hollinworth, Helen; Clark, Charlotte; Harland, Rowena; Johnson, Linda; Partington, Gareth; University of Suffolk (Royal College of Nursing, 2005-05-25)
      The aim of this article is to enable reflection on practice by exploring a nurse-patient scenario and identifying what factors trigger anger and aggressive behaviour. It recommends strategies that can be used to tackle anger among patients, and emphasises the importance of the therapeutic relationship. Anger management, which usually refers to cognitive behavioural therapy designed to enable people to manage anger, is not explored.
    • Understanding violence when the perpetrator has an intellectual disability: The perceptions of professionals

      Lovell, Andrew; Skellern, Joanne; University of Chester; University of Derby (SAGE Publications, 2017-12-18)
      The research sought to enhance professional understanding of the violence perpetrated by some people with an intellectual disability. The violent behaviour exhibited by some people with intellectual disabilities remains poorly understood, particularly with regard to a clear and informative definition. A qualitative study investigated the views and perceptions of professionals working directly with people with an intellectual disability in different settings. Twenty-two semi-structured interviews were undertaken with professionals from a variety of backgrounds, and four themes were generated through data analysis. Themes produced comprised the degree of intellectual disability, impulsivity, intentionality and unpredictability. Findings indicated tension between understanding violence as purposeful and explaining it in relation to the intellectual disability and/or additional conditions. Intellectual disability is central to understanding the impact of the other three themes, though there is a professional reluctance to use such knowledge as evidence to inform practice.
    • Using interactive digital technology to predict and prevent childhood overweight

      Atkinson, Pippa; University of Nottingham; Anglia Ruskin University; University of Lincoln; Nottingham University Hospitals Trust (Wiley, 2017-11-12)
      Obesity risk factors can be identified during infancy, providing an opportunity for early intervention. ProAsk is an interactive digital intervention that supports health professionals to quantify and communicate an infant's overweight risk status, prompting discussion of parental strategies to reduce future risk. To investigate user experiences of an interactive digital intervention that assesses overweight risk during infancy and supports motivational behaviour change by parents to reduce their infants' future risk. The study was conducted in four economically deprived localities in the UK. Qualitative data on user experiences of ProAsk were collected at the end of a feasibility study of the intervention in which health visitors (public health nurses) used ProAsk with parents when the infants were three months old. Semi-structured interviews with parents (N = 12) and health visitors (N = 15) were conducted when the infants were 6 months old. Interview data were transcribed and analysed thematically using an inductive, interpretative approach. The analysis identified four key themes: engaging and empowering with digital technology; unfamiliar technology presents challenge and opportunity; trust in the risk score; resistance to targeting. Interactive, digital technology was found to actively engage parents, and enabled them to take ownership of the process of seeking strategies to reduce infant risk of overweight. However, cognitive and motivational biases that prevent effective overweight risk communication represent barriers to targeting the intervention at those infants most at risk of becoming overweight.
    • Using more healthcare areas for placements

      Sherratt, Lou; Young, Alwyn; Brundrett, Heather; Whitehead, Bill; Collins, Guy; University of Derby (Macmillan Publishing Ltd., 2013-06-26)
      The need for private, voluntary and independent placements in nursing programmes has become more important in recent years due to changes in where health services are delivered. These placements can be used effectively within nursing programmes to show students the realities of healthcare, and to challenge myths and attitudes. Dedicated time and resources need to be provided to discover and maintain these placements, and to ensure appropriate, high-quality learning opportunities. This article presents the findings of a national Higher Education Academy workshop, held at the University of Derby in November 2012. It explores three key issues discussed at the workshop: current practice and opportunities for learning; myths, attitudes and solutions; and maintaining the quality of placements. The use of PVI placements is seen as valuable and a set of recommendations are provided to assist in their use.
    • Using recorded sounds in the clinical skills lab.

      Watkinson, Debbie; Collins, Guy; University of Derby (EMAP publishing limited, 2016-07-18)
      Clinical simulation is embedded in undergraduate nursing education, but does not always reflect real-life situations. As clinical environments are rarely silent, a team of lecturers decided to find out whether background clinical noise could increase authenticity. This article describes how audio recordings were obtained from a variety of settings. Feedback was gathered on the benefits and barriers to widespread implementation.
    • Using specialist nurse mentors to boost placement capacity.

      Bailey, Elaine; Whitehead, Bill; University of Derby (Macmillan Publishing Ltd., 2006-11-28)
      Mentors play a pivotal role in assessing and supporting nursing students. This can be rewarding but stressful. With increasing numbers of students requiring clinical placements, ward mentors are becoming overloaded. This article examines a new method of supporting senior nursing students in placement while alleviating the pressures on overworked mentors. It recommends the use of specialist nurses to support pre-registration students through a structured learning pathway. The scheme also opens up new areas for clinical allocations. This is a summary: the full paper can be accessed at nursingtimes.net.
    • Venesection best practice guidance

      Mortimore, Gerri; Francis, Yvonne; McClements, Neil; University of Derby (Haemochromatosis UK, 2020-01-28)
      This Royal College of Nursing endorsed guidance has been developed to support the care of adult patients undergoing therapeutic venesection, for conditions including genetic haemochromatosis. This guidance represents the culmination of 3 years' collaboration and consultation with practising nurses and healthcare professionals under the auspices of UK registered charity Haemochromatosis UK.
    • Venesection best practice: A guide for nurses and healthcare practitioners

      Mortimore, Gerri; University of Derby (Haemochromatosis UK, 2020-01)
    • We are not the same people we used to be: an exploration of family biographical narratives and identity change following traumatic brain injury

      Whiffin, Charlotte Jane; Ellis-Hill, Caroline; Bailey, Christopher; Jarrett, Nicola; Hutchinson, Peter J.; University of Derby; Bournemouth University; University of Nottingham; University of Southampton; University of Cambridge (Taylor and Francis, 2017-10-26)
      Subjective changes are increasingly recognised as important in recovery and rehabilitation following traumatic brain injury. Accumulation of subjective changes over time has led many to examine the question of ‘continuity of self’ post-injury. Vacillation between feeling the same and different is common and often at odds with the medical narrative preparing families for permanent change. This position of ambiguity was examined in a qualitative narrative study. The aim of this paper is to describe the narrative structures used by uninjured members of a family to understand change. These changes relate primarily, to their perspective of whether and how the injured person had changed, but also secondarily to whether and why they themselves felt they had changed in the first year post-injury. Nine uninjured family members from three families took part in three unstructured interviews during the first twelve months post-injury. In-depth narrative analysis showed family members used biographical attendance; biographical disruption; biographical continuity and biographical reconstruction to understand change. Drawing on these findings it is argued that concentrating on a narrative of change is too limiting and that engaging in biographical narratives may help humanise care provided to injured individuals and their families. Implications for research and practice are discussed
    • We may unknowingly consume dangerous levels of alcohol.

      Mortimore, Gerri; University of Derby (EMAP publishing limited, 2018-05-31)
      Alcohol is the main cause of liver disease and associated death. By raising awareness and offering brief interventions, not only to patients but also to family and friends, nurses can potentially save lives.
    • Why it’s important healthcare professionals talk about dying

      Watson, Sharan; University of Derby (University of Derby, 2020-05-15)
      This week is Dying Matters Awareness Week (May 11-17) – an awareness week led by Hospice UK to provide an opportunity to discuss the importance of talking about dying, death and bereavement. Here, Sharan Watson, Programme Leader for PG Cert Palliative Care at the University of Derby, discusses why it is more imperative than ever that health and social care workers feel confident and supported to talk about bereavement. The theme of this year’s Dying Matters Awareness Week is ‘Dying to be heard’, which feels so much more pertinent in our current challenges of delivering person-centred care during the Coronavirus pandemic. This week marked International Nurses Day (May 12) and 200 years since Florence Nightingale was born. Being a nurse has given so many of us the platform to develop such a diversity across all settings and has highlighted the true importance of interprofessional working.
    • Will graduate entry free nursing from the shackles of class and gender oppression?

      Whitehead, Bill; University of Derby (Macmillan Publishing Ltd., 2010-06)
      Debates in nursing focus on the provision of good nursing care and its relation to academic status. For example, are nurses "too posh to wash" if they believe entry to the profession should require a degree, or is this a case of them having pretensions "above their station"? This article discusses the nature of oppression and its relationship to hierarchy, and concludes that nurses are oppressed through gender and socioeconomic class. It also examines the profession's social position, arguing thatthe majority of nurses identify with the most oppressed social class.