• 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.
    • 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.
    • 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.
    • Guest editorial

      Skellern, Joanne; University of Chester (Emerald, 2016-06-13)
    • A multidisciplinary approach to teaching basic life support

      Lowes, Helen; McNamara, Joanna; Naylor, Sarah; Newton, Emily; Timms, Janine; Sheffield Hallam University (2017-07-12)
    • Evaluating interprofessional simulation in the operating theatre

      Naylor, Sarah; Foulkes, Denise; Sheffield Hallam University (2017-06)
      The operating theatre is an area of practice that newly qualified Diagnostic Radiographers find challenging. Interprofessional education (IPE) and simulation are becoming widely used in healthcare education in order to prepare students for practice. Failures in interprofessional communication are well-documented with poor communication an established cause of medical error and negative health outcomes. Socio-historical issues like imbalances in power and status are particularly prevalent in the operating theatre environment, and add complications to interprofessional working. As part of an action research study to develop and pilot an interprofessional simulation experience for Operating Department Practitioner (ODP) and Diagnostic Radiography (DRAD) students. Diagnostic Radiography students took part in a simulation in the mock operating theatre on the university campus with an ODP student, ODP and Diagnostic Radiography lecturers. A purposive convenience sample of 48 second year Diagnostic Radiography students participated in the simulation. Following the simulation students were asked to evaluate the session using Padlet and later reflect on the impact of the experience on practice. The simulation was a positive experience. The timing and organisation of the simulation is important for the students to get the most out of the experience. There are benefits of being immersed in a high fidelity simulation and the realism plays a role in preparing students for real life experiences.
    • Exploring the transition from student to practitioner in diagnostic radiography

      Naylor, Sarah; Ferris, C.; Burton, M.; Sheffield Hallam University (Elsevier BV, 2015-10-20)
      This study explores the expectations and experiences of newly qualified diagnostic radiographers during their transition into practice. This was a longitudinal study using interpretative phenomenological analysis methodology. Data were gathered from four students who participated in a focus group. This informed semi structured interviews with a further eight students who were interviewed prior to starting work and three times over the following twelve months. Themes generated from the data included; experience, fitting in, and identity. This study brings to light the experiences of newly qualified diagnostic radiographers. The findings are open to theoretical generalizability and raise issues that may be used by academic staff in the preparation of students and managers who support newly qualified staff members.
    • An exploration of service user involvement in the assessment of students

      Naylor, Sarah; Harcus, J.; Elkington, M.; Sheffield Hallam University (Elsevier BV, 2015-02-25)
      This paper is an exploration of service user involvement in assessing first year diagnostic radiography students' ability to practise and interact with the public safely prior to attending placement. Service users took the role of patients during a simulation exercise undertaken in a general X-ray room. In recent years the importance of involving service users in all aspects of healthcare has been promoted; this includes being involved in the education of healthcare workers. The evaluation of service user involvement in the education of healthcare workers is limited, as is any literature about service user involvement outside nursing, mental health, and social work. Feedback was obtained via email and face to face via a focus group from academic staff, service users and students using open questions. The benefits of service user involvement were that it made the exercise more relevant and meaningful. It was perceived as a valuable exercise for the students to interact with service users in terms of developing, and for assessing, patient care, communication and positioning skills. The service users valued the experience. Issues highlighted include travel to the venue and the physical demands on the service user. Concerns highlighted by previous authors of preparation of the service users for their role, and remuneration had been addressed prior to the exercise. There is increasing diversity in the ways in which service users are involved in education. Service user involvement as patients in a simulation exercise for student assessment was deemed successful in this setting.
    • Breast compression techniques in screening mammography – A Maltese evaluation project

      Naylor, Sarah; Cassar Agius, E; Sheffield Hallam University; National Breast Screening Programme, Lascaris Wharf, Valletta (Elsevier BV, 2018-04-05)
      In screening mammography, the radiographer should be responsible for providing mammograms of high diagnostic value, possibly without subjecting clients to a painful experience. This skill is demonstrated via the technique of breast compression and is explored in this study by analysing insights about methods and underlying principles in regards to this procedure. One-to-one semi-structured interviews were conducted with radiographers who perform screening mammography in Malta. For data analysis, a descriptive phenomenological approach following a simplified version of Hycner's (1985) method was adopted. Five general themes were extracted from the data; meeting the client, preparing the client, the mammography procedure, pain from compression and client turnout. It was determined that the participants alter their breast compression technique according to the client rather than following a rigid step-by-step process and that explanation and requesting client feedback are essential to obtain cooperation. Additionally, mammography positioning and compression application are tailored in a way that encourage compliance, however not at the expense of degrading image quality. Ultimately, it is also believed that a proper breast compression technique positively influences client turnout. The results of this study demonstrate that radiographers should be flexible in their approach in order to carry out a successful breast compression technique. However, it has also been shown that such effectiveness in practice is gained from experience rather than initial training. If exposed to this study's findings, new mammographers would be able to form a robust core of knowledge before embarking on the challenging specialisation of mammography.
    • Diagnostic radiographers working in the operating theatre: An action research project

      Naylor, Sarah; Foulkes, Denise; Sheffield Hallam University (Elsevier BV, 2017-10-07)
      Failures in interprofessional communication are well-documented and are an established cause of medical error and negative health outcomes. Socio-historical issues like imbalances in power and status are particularly prevalent in the operating theatre environment, adding complications to interprofessional working. Simulation, used in healthcare education, may impact positively on interprofessional working. The aim of this action research study was to develop, pilot and run a simulation experience for Diagnostic Radiography (DRAD) students. Action research was used to structure this study. The first phase of the action research was to look at the problem; this was undertaken using critical incident technique. Findings from the critical incident technique influenced the simulation event. A focus group was held immediately after the event for reflection. A second simulation using a cohort of 48 students and a reflection after a period of three months formed the second round of the project. The simulation took place in a hi-fidelity simulated operating theatre. Thematic content analysis was undertaken of the focus group, data from the critical incident technique, and the reflections. The findings are discussed under the themes; identification, clarity, preparation, and the expert. Identification and lack of clarity in communication were seen as an important issue in the operating theatre. Lack of preparation of the working environment was also highlighted. Lack of confidence in the operating theatre inhibits interprofessional working. Simulation can help prepare students for working in the operating theatre. Realism is important as is scheduling the event to ensure maximum benefit.
    • 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.
    • An exploration of family in the context of head injury: a narrative understanding of change

      Secretary, SRR; whiffin, charlotte; Bailey, Christopher; Ellis-Hill, Caroline; Nikki, Jarrett; Peter, Hutchinson J.; University of Derby; University of Nottingham; Bournemouth University; University of Portsmouth; et al. (SAGE Publications, 2020-02-13)
      Traumatic brain injury is potentially devastating. Families commonly respond by supporting the injured individual and their recovery. However, family members are at risk of negative psychological outcomes and family functioning has emerged as a key variable post injury. What is less understood are the subjective changes experienced by families and the impact these have post injury. A longitudinal narrative case study using in-depth narrative qualitative interviews. Data were collected a one, three and 12 months post injury. Nine non-injured family members from three families were recruited from an acute neurosurgical ward. Five interwoven narrative threads were identified: trauma, recovery, autobiographical, suffering and family. The narrative approach emphasized that the first-year post-head injury was a turbulent time for families, who were active agents in the process of change. Families’ stories of illness from a nonpatient perspective need recognition and validation in their own right. understanding this experience in terms of biographical narratives helps to recognize the vacillation between change and continuity. Adopting a narrative approach to rehabilitation may be more positive than adopting a model of loss. Change is not limited to the injured person and family members need help to understand that they too are changing as a result of their experiences. In addition, it is proposed that there be a shift in the discourse in research and practice literature away from loss and towards transition, with greater recognition of the role that uninjured family members play in making sense of change post injury.
    • Delayed prescribing of antibiotics for self-limiting respiratory tract infections in an urgent care out of hours setting

      Mortimore, Gerri; Holroyd, Justine; University of Derby; Urgent Care South Derbyshire (MA Healthcare, 2020-03-02)
      Long-term overuse of antibiotics and inappropriate prescribing has led to widespread development of antimicrobial resistance. The Department of Health and Social Care recently published a five-year national action plan to reduce antimicrobial resistance, with the aim of reducing inappropriate antibiotic prescribing. This is mirrored in the NHS Long Term Plan, which aims to reduce unintentional exposure through a combination of antibiotic stewardship and leadership at all levels. An acute respiratory tract infection is one of the most common presentations in primary care, with 16.7% of all prescriptions issued attributed to it. Therefore, out-of-hours prescribers contribute significantly to general antibiotic consumption. This article analyses the practice of delayed prescribing of antibiotics for the treatment of self-limiting respiratory tract infections in an out-of-hours service. The advantages and disadvantages associated with delayed prescribing, to safely treat patients whilst facilitating the reduction of antimicrobial resistance, are discussed. In addition, recommendations for future practice are offered. This article also focuses on the development of an advanced nurse practitioner, reflecting on the four pillars of advanced practice, which underpin advanced clinical practice and associated competencies.
    • The diagnosis and management of a patient with acute pyelonephritis

      Hudson, Carly; Mortimore, Gerri; University of Derby (Mark Allen Group, 2020-02-13)
      Lower urinary tract infections account for more than 224 000 hospital admissions each year and nearly all of these have the pathophysiological possibility to develop into pyelonephritis, known clinically as an upper urinary tract infection. Acute pyelonephritis is characterised by inflammation of the renal parenchyma caused by bacteriuria ascending from the bladder, up the ureters to the kidneys. Effective history taking, combined with refined physical examination skills, are the two most powerful tools to differentiate upper and lower urinary tract infections as well as assisting the practitioner to exclude other differential diagnoses. Utilisation of these skills by the practitioner, together with the recognised presenting symptom triad of flank pain, fever and nausea in this case study, enabled the diagnosis of acute pyelonephritis to be given.
    • How to conduct a systematic search for a systematic literature review

      Whiffin, charlotte; University of Derby (iOH: The Association of OH & Wellbeing Professionals, 2020)
    • 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.
    • 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.
    • Venesection best practice: A guide for nurses and healthcare practitioners

      Mortimore, Gerri; University of Derby (Haemochromatosis UK, 2020-01)
    • Primary biliary cholangitis: An update on treatment

      Mortimore, Gerri; University of Derby (MAG Healthcare, 2020-01)
      Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is a chronic but progressive disease that, over many years, causes damage to bile ducts, leading to cholestasis and, in some patients, cirrhosis. The rate at which PBC progresses varies from person to person, but significant damage takes decades to occur. It predominately affects women aged 40–60 years with a female to male ratio of 9:1, but can affect anyone from the age of 20. There is no cure for PBC other than liver transplant, but medications can be given to slow down disease progression and for the treatment of symptoms. Health professionals should monitor for complications, including the development of osteoporosis, vitamin deficiencies and liver cirrhosis, which caries the associated complications of portal hypertension, varices and ascites.
    • The diagnosis and management of pulmonary embolism

      Toplis, Emma; Mortimore, Gerri; University of Derby (Mark Allen Group, 2020-01-09)
      Pulmonary embolism (PE) is a condition characterised by an obstruction of the pulmonary arterial system by one or more emboli. Advanced clinical practitioners are often faced with ruling out a diagnosis of PE in patients with non-specific symptoms such as dyspnoea and pleuritic chest pain, which can be fairly mild and therefore a diagnosis of PE easily missed. PEs can be a challenge to diagnose, especially in elderly people, since it can be difficult to differentiate their symptoms from other less serious illnesses. Widely used scoring tools are helpful to calculate a patient’s probability of having a PE. The Wells score is the most widely used pre-test clinical probability indicator of PE used in the UK, which scores the patient’s probability of having a PE based on their risk factors. The D-dimer test is a relatively simple investigation to rule out venous thromboembolism (VTE) but can be raised for various reasons other than PE. Computed tomography pulmonary angiography (CTPA) is regarded as the gold standard imaging modality for investigation of acute PE but ventilation-perfusion (VQ) scans be used as an alternative imaging technique for diagnosing PE in those where CTPA is contraindicated. Thrombolysis is underused in clinical practice due to the fear of adverse bleeding events. Patients without a massive or sub-massive PE are treated with anticoagulant therapy, usually commencing with subcutaneous lowmolecular- weight heparin and switching over to a direct oral anticoagulant (DOAC). There has been a shift away from treatment with warfarin for the prevention and treatment of VTE over the past decade.