• 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.
    • The needs of clients coming to counselling following second harm: A Q methodology study

      Kenward, Linda; whiffin, charlotte; Townend, Michael; University of Derby (Wiley, 2021-09-30)
      Second harm is the added psychological distress from an inadequate response by healthcare providers in response to medical errors or neglect. This inadequate response may require patients to seek counselling. The counselling needs of patients who have experienced second harm have received limited research attention. This Q methodology study addresses this gap in knowledge in order to further inform counselling practice. Participants sorted 42 pre-determined statements online followed by interviews to establish the rationale for the sorting pattern choices. Data from the online sort were analysed using factor analysis to establish the viewpoints expressed. The interview data added to the interpretation of the viewpoints. Through a factor analysis, two ‘viewpoints’ and 11 counselling needs were identified. Nine of these needs were generic to the counselling relationship and two specific to second harm. This study concluded that people seeking counselling following second harm have needs beyond those expected from a general counselling relationship. These included not being blamed for what happened and a need for the counsellor to be able to demonstrate that they are able to understand the impact of harm. The needs identified in this study as being generic can give counsellors confidence in working with clients that have experienced second harm, knowing that many of the needs identified are not unique. Counsellors can also be confident that those needs that are unique can be understood through extending their knowledge of the topic and listening to those that have been harmed.
    • 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.
    • How does a narrative understanding of change in families post brain injury help us to humanise our professional practice?

      Whiffin, C J; Ellis-Hill, C; University of Derby; Bournemouth University (Cambridge university press, 2021-09-17)
      In this paper we critically explore the discourse of change post brain injury and challenge the dominant discourse of negative change which alone leaves little room for other perspectives to exist. These negative changes pose a considerable risk to the well-being of families who may benefit from engaging in richer accounts making room for a more coherent and connected sense of self and family post-injury. We explore how narrative approaches provide opportunities for all practitioners to expand their professional scripts and support families to move toward a future which is not dominated by a discourse of loss. While loss and negative change is an important, and very real consequence, of brain injury, focusing purely on stories of loss is life limiting for family members and can cause psychological distress. The life thread model is offered as a visible tool for all practitioners to engage with and use while working with families; providing a concrete focus for reflection and discussion of narratives relating to change which otherwise can feel quite abstract in everyday practice. We argue that one way we can humanise our professional practice is to support all practitioners to engage in a narrative understanding of family change following ABI.
    • 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.
    • Changing student mental health nurse’s attitudes towards younger and older people through teaching: A qualitative longitudinal study

      Collier, Elizabeth; Foster, Celeste; Sutton, Katie; Holmes, Tracee; Jones, Ben; University of Salford; University of Derby (University of Salford and University of Derby, 2021-08)
      This paper reports on a qualitative longitudinal research (QLR) study investigating the effectiveness of an innovative teaching session focusing on changing the beliefs, perceptions, and attitudes of mental health nursing students towards older and younger people. A QLR design was used to enable exploration of change over time. A pre, post and follow-up approach was implemented over six months, using multiple data collection methods. A Cross-sectional and longitudinal data analysis approach was applied. Post-session themes of: stop and think; shock and surprise; different rules for different people; and new understanding of age-related attributes, were identified. Follow-up revealed changes of: wider awareness of discriminations, more open minded, sensitivity to discrimination across the life course, changed approaches to practice, question everything, ignore age. Longitudinal analysis of individual change demonstrated that real world, attitude-focused teaching was effective in changing student attitudes to younger and older people. Change was complex and non-binary, raising students’ self-awareness and enabling generalisation of change to wider practice issues.
    • The experience of families following Traumatic Brain Injury in adult populations: A meta-synthesis of narrative structures.

      Whiffin, Charlotte Jane; Gracey, Fergus; Ellis-Hill, Caroline; University of Derby; University of East Anglia; Bournemouth University (Elsevier BV, 2021-07-21)
      Traumatic brain injury has a significant effect on uninjured family members. Typically, this has been examined with a focus on psychopathological outcomes including stress, depression and anxiety. However, in recent years there has been increasing interest in the subjective experiences of families post-injury leading to a plethora of qualitative studies. Therefore, an in-depth examination and synthesis of this literature is now relevant and timely. To examine the subjective experiences of families following traumatic brain injury in adult populations in the sub/post-acute period through the synthesis of original qualitative research. This paper presents a meta-synthesis using Thomas and Harden’s framework of ‘thematic synthesis’ rooted in a critical realist philosophy. In July 2019 five electronic databases, were searched for the terms ‘traumatic brain injury’, ‘family’ and ‘qualitative’ studies were included if the primary research reported qualitative data about the subjective experiences of family members of adults with traumatic brain injury and had been published in a peer reviewed journal. Studies with mixed brain injury samples, child or adolescent traumatic brain injury or disorders of consciousness were excluded. Hand searching and citation searches were also completed. Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion. Thirty papers were finally agreed for inclusion in this review. Each study was then assessed for relevance, resonance and rigour using the Critical Appraisal Skills Programme (CASP) tool. Line by line coding of the findings in each paper was conducted as the basis for a thematic analysis and synthesis. Descriptive themes were identified followed later by analytical themes. This final stage was informed by a narrative lens and from these, eight narrative functions belonging to four dimensions were identified from the subjective experiences of families post-traumatic brain injury. Specifically, these were: (1) Displacing and Anchoring; (2) Rupturing and Stabilising; (3) Isolating and Connecting; (4) Harming and Healing. The interpretation of the narrative functions revealed the substantial existential work involved in negotiating lives, maintaining family system equilibrium and moving forward. As such, family members have their own unique narrative needs. Despite contemporary service models built around the injured person, service providers are well placed to support families in this everyday narrative work through actively attending to narrative structures and understanding the implications of these for family experience.
    • What next for End Point Assessments?

      Baker, Denise; Robertshaw, David; University of Derby (Emerald, 2021-07-20)
      This paper reflects on changes to End Point Assessment (EPA) brought about as a result of the COVID pandemic and considers how proposed future change will impact on training providers and employers of health apprentices. The paper provides an analysis of apprenticeship policy, the role of end point assessment and consideration of assessment strategies used in higher education and health professions. Implications for policy, training providers and clinical practice are proposed. These changes will bring the completion of EPA closer to education providers and allow them to take a more direct role within the process. Education providers will need to be issued with clear guidance to ensure regulatory compliance. The pedagogical value of end point assessment is questioned. Training providers and policymakers will need to review their processes and guidance appropriately. This paper provides a summary of salient points needing consideration.
    • 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.
    • Chronic limb ischaemia: case study and clinical literature review

      Farrington, Liz; Mortimore, Gerri; University Hospitals of Derby and Burton NHS Foundation Trust; University of Derby (Mark Allen Group, 2021-07-21)
      This article will discuss chronic limb ischaemia as the result of peripheral artery disease (PAD) using a case study. The patient's concurrent diagnosis of metastases meant clinical decision making was complex and treatment options were limited. PAD is the third most common clinical presentation of atherosclerosis after coronary artery disease and stroke. Although advances in radiological technology and biochemical screening offer the potential for earlier intervention and improved survival rates for patients with PAD, a review of the evidence suggests that commitment to more conservative approaches, such as exercise therapy and health promotion, could have more sustainable, longer-term benefits for patients with chronic limb ischaemia. The therapeutic nature of the nurse–patient relationship makes nurses ideally placed for encouraging lifestyle changes and signposting to support services. Active participation from the patient is imperative for any potential modifications, which should be individualised as part of a holistic care plan, to ensure patient engagement and compliance. Therefore emphasis should remain on the management and prevention of modifiable risk factors, for which the nurse's role is an integral part to ensure success.
    • What are the ethical dilemmas in the decision making processes of nursing people given Electroconvulsive therapy? A critical realist review of qualitative evidence

      Sweetmore, Victoria; University of Derby (Wiley, 2021-06-18)
      Electroconvulsive therapy (ECT) has a complex and contentious place in psychiatric care. Mental health nurses (MHNs) are of obligated to be part of this practice despite ethical concerns. To consider the ethical dilemmas and decision-making processes facing MHNs involved in the administration of ECT. A critical realist review of the literature surrounding ethical considerations and ECT was undertaken using thematic analysis. Four key themes emerged: the MHN as an advocate and conflict in their role, issues surrounding consent, questionable efficacy and unknown method of action, side effects, and legal issues and clinical guidelines. Using a critical realist framework for understanding, the decision-making process and ethical considerations are viewed as part of the empirical and actual parts of reality, while the potential for other, unseen causal powers to be at play is acknowledged. MHNs need to ensure they have an adequate ethical underpinning to their practice to enable them to navigate contentious areas of practice such as ECT to practice effectively and preserve safety. This may require moving beyond the traditional biomedical model of ethics. Developing an appreciation of unseen causal factors is also an essential part of MHNs’ developing professional competency.
    • From expert to advanced clinical practitioner and beyond

      Mortimore, Gerri; Reynolds, Julie; Forman, Dawn; Brannigan, Chris; University of Derby (MAG, 2021-06-10)
      This article considers the potential development of advanced clinical practitioners (ACPs) and consultant practitioners, beyond the ‘expert’ status as defined by Pat Benner in 1984. The suggested Derby Model: 7 Levels of Practice Advancement, adapted from Benner's From Novice to Expert, recognises Health Education England's four pillars of advanced practice and how they can be implemented and enhanced within these senior roles, and what that means in a 21st century healthcare system.
    • Clinical supervision for advanced practitioners

      Reynolds, Julie; Mortimore, Gerri; University of Derby (MAG, 2021-04-08)
      This article discusses clinical supervision and its importance in supporting the development of advanced clinical practitioners. It will reflect on the impact of clinical supervision using extracts from research data provided by trainee advanced clinical practitioners and their medical supervisors. This article will consider the latest guidance on how to facilitate quality clinical supervision in the workplace and the potential challenges it may face relating to governance, finances, and time.
    • 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.
    • 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.
    • An initiative for student nurses to practise clinical skills at home

      Whitehead, Bill; Ansell, Helen; University of Derby (EMAP, 2021-02-15)
      This article describes an initiative for students to practise clinical skills in their own homes using university-supplied instructions and equipment, implemented as a response to the restrictions to on-campus teaching during the coronavirus pandemic. It includes recommendations for future use, concluding that it would also be a useful adjunct to traditional training methods following the end of the pandemic.
    • Transitioning to an ACP: a challenging journey with tribulations and rewards

      Reynolds, Julie; Mortimore, Gerri; University of Derby (MAG, 2021-02-10)
      Julie Reynolds and Gerri Mortimore, discuss the difficulties advanced clinical practitioners face when taking on this new role, and how drawing on their transferable skills can help them make the transition
    • 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.
    • The ascent to advanced practice: challenges, support and opportunities

      Reynolds, Julie; Mortimore, Gerri; University of Derby (Mark Allen Group, 2021-02-02)
      The challenges that impact on the journey to advanced clinical practice are many. However, with structured support the opportunity to develop to this level can be nurtured. This article will reflect upon this development and discuss some of the difficulties for trainee Advanced Clinical Practitioners (ACP), such as imposter syndrome, feelings of inadequacy and role transition. The article will also consider the importance of clinical supervision, mentorship and support mechanisms that may assist in developing advanced clinical practice and facilitate its progression.
    • Starting to Measure up

      Lloyd, Erica; University of Derby (Redactive Publishing Limited, 2020-10-01)
      How using outcome measures can improve school nurses effectiveness.