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  • An exploration of the impact of SARS-CoV-2 (COVID-19) restrictions on marginalised groups in the UK

    Eshareturi, Cyril; Wareham, C.; Rattray, Marcus; Haith-Cooper, Melanie; McCarthy, R. (2021-08)
    Background: To contain the spread of COVID-19 within the UK over the past year, there have been a series of local and national lockdowns. These restrictions are likely to have impacted upon the health and well-being of marginalised groups who rely on now closed social and community support services to stay healthy. An understanding of the experiences of marginalised people is important; therefore, this study aimed to explore the impact of the COVID-19 restrictions on the health and well-being of marginalised groups in the UK. Methods: In summer 2020, a rapid telephone survey was conducted by trained, trusted volunteers with 76 participants who were from marginalised groups. As part of this survey, 64 participants consented to describe their experience of lockdown. These case studies were thematically analysed to identify patterns of meaning. Results: Findings indicate that lockdown led to the deterioration of health of participants, impacted adversely on their socio-economic positions and affected access to food and essential supplies. In addition, government public health messaging was considered confusing and inadequate. Conclusions: This study highlights the need for pathways into services which support marginalised groups to remain accessible during periods of restrictions and essential supplies and food to be mapped and protected for marginalised individuals within our local communities.
  • Understanding the principles of non-invasive positive pressure ventilation

    Roberts, Alexandra (2021-07)
    Non-invasive positive pressure ventilation (NPPV) provides respiratory support to patients without the need for invasive intubation. Although it has been used for several years in critical care, NPPV has come to prominence as a management option for certain patients with respiratory complications of coronavirus disease 2019 (COVID-19). This has led to increased care provision by nurses with little or no experience and expertise in critical care and NPPV. This article provides an overview of the principles of NPPV and its use in type 1 and type 2 respiratory failure. It explains the pathophysiology of several conditions that often lead to respiratory failure and how NPPV can mitigate respiratory failure and improve gas exchange. An individualised assessment of the patient’s suitability for NPPV and an evaluation of the effectiveness of the therapy are crucial to ensure its safe and effective use. Nurses also have an important role in providing explanations and support to patients.
  • Renal stone detection using a low kilo-voltage paediatric CT protocol – A porcine phantom study

    Mussmann, B.; Hardy, Maryann L.; Jung, H.; Ding, M.; Osther, P.J.; Fransen, M.L.; Greisen, P.W.; Graumann, O. (2021)
    Introduction: Reducing tube voltage is an effective dose saving method in computed tomography (CT) assuming tube current is not concurrently increased. Recent innovations in scanner technology now enable CT tube voltage reduction to 70 kV thereby increasing opportunities for dose reduction in paediatric patients, but it is unclear if the increased image noise associated with 70 kV impacts on ability to visualise renal stones accurately. The purpose was to assess detectability of nephrolithiasis using a bespoke paediatric phantom and low kV, non-contrast CT and to assess inter-observer agreement. Methods: Forty-two renal stones of different size and chemical composition were inserted into porcine kidneys and positioned in a bespoke, water-filled phantom mimicking a 9-year-old child weighing approximately 33kg. The phantom was scanned using 120 and 70 kV CT protocols, and the detectability of the stones was assessed by three radiologists. Absolute agreement and Fleiss’ kappa regarding detectability were assessed. Results: The mean diameter of renal stones as measured physically was 4.24 mm ranging from 1 to 11 mm. Four stones were missed by at least one observer. One observer had a sensitivity of 93 and 95% at 70 and 120 kV, respectively, while the sensitivity for observers 2 and 3 was 98% at both kV levels. Specificity was 100% across readers and kV levels. Absolute agreement between the readers at 70 kV was 92% (kappa = 0.86) and 98% (kappa = 0.96) at 120 kV indicating a strong agreement at both kV levels. Conclusions: The results suggest that lowering the kV does not affect the detection rate of renal stones and may be a useful dose reduction strategy for assessment of nephrolithiasis in children.
  • Delivering informed measures of patient centred care in medical imaging: what is the international perspective?

    Hyde, E.; Hardy, Maryann L. (2021)
    Focus on patient experience and patient centred approaches within healthcare has substantially increased since the Picker Institute (a not for profit organisation) was established in the 1980′s [ [15] ]. The Picker Institute's vision for ‘the highest quality person centred care for all, always’ outlines eight principles of person-centred care which health care providers should strive for [ [15] ]: (1) Fast access to reliable healthcare advice [15]. (2) Effective treatment delivered by trusted professionals [15]. (3) Continuity of care and smooth transitions. [15] (4) Involvement and support for family and carers [15]. (5) Clear information, communication and support for self-care [15]. (6) Involvement in decisions and respect for preferences [15]. (7) Emotional support, empathy and respect [15]. (8) Attention to physical and environmental needs [15].
  • Advanced Practice: Research Report

    Hardy, Maryann L.; Snaith, Beverly; Edwards, Lisa; Baxter, John; Millington, Paul; Harris, Martine A. (Health & Care Professions Council, 2021-01)
    The Health Care and Professions Council (HCPC) regulates fifteen different professions; some of these are large groups like Physiotherapists and some are much smaller such as Speech and Language Therapists (SLT). Most of the people registered by the HCPC work within their own areas of clinical expertise and defined professional scope of practice. However, an increasing number of registrants are undertaking new or additional roles beyond the traditional scope of practice for the defined profession. These roles are often shared with other medical or health professionals and persons undertaking these roles are often, but not consistently, referred to as Advanced Practitioners. Advanced Practitioners are employed within the NHS across all four countries of the UK and are also employed by private healthcare providers. The roles they undertake vary from the highly specialised (e.g. an advanced podiatrist might specialise in biomechanics) to more general roles with greater professional autonomy and decision-making (e.g. a paramedic working in a GP Practice assessing patients with undifferentiated acute problems). As a result, there is currently no consistency in role title, scope of advanced practice, necessary underpinning education or professional accreditation across the HCPC registered professions. This study was undertaken to explore these issues and seek opinion on the need for additional regulatory measures for persons working at an advanced practice level. NB: For the purposes of this study, advanced practice was considered to encompass all roles, regardless of role title, where the level of practice undertaken was considered to be advanced. Method Three approaches to data collection were undertaken to ensure the differing opinions across all HCPC registered professions, different stakeholders and the four nations of the UK were collected. Data were collected through: 1. A UK wide survey of HCPC registered healthcare professionals; 2. A UK wide survey of organisations delivering AHP & scientific advanced practice education; 3. A series of focus groups and interviews across a range of stakeholder groups. Findings The concept of advanced level practice was not consistently understood or interpreted across the different stakeholder groups. Those participants identifying as working at an advanced practice level undertook a range of activities both within and out with the traditional scope of practice of the registered profession adding a further layer of complexity. Educational support and availability for advanced level practice varied across professional groups and inequity of accessibility and appropriateness of content were raised as concerns. There is no consensus across participant groups on the need for regulation of advanced level practice. Perceived advantages to additional regulation were the consistent and equal educational and employer governance expectations, particularly where multiple professional groups are undertaking the same role, all be it with a differing professional educational foundation and lens. However, while some voices across the participant groups felt regulation was essential to assure practice standards and reduce risk of role title misuse, there was equally a lack of appetite for regulation that inhibited agility to respond to, and reflect, the rapidly changing healthcare environment and evolving scope of advanced level practice. Importantly, no evidence was presented from any participant group that advanced level practice within HCPC regulated professions presents a risk to the public. Conclusion The study data presented in this report reflect the complexity of the concept of advanced practice within the HCPC regulated professions. Much of this is a consequence of the differing speeds of professional role development across healthcare organisations and professional groups, often related to service capacity gaps and locally developed education to support local initiatives. Despite this, there is no clear evidence, based on the findings of this research, that additional regulation of advanced level practice is needed, or desired, to protect the public. However, as the HCPC is one of the few organisations with a UK wide remit, it may have a central role in achieving unification across the 4 nations in relation to the future role expectations, educational standards, and governance of advanced level practice.
  • Patient centred care in diagnostic radiography (Part 3): Perceptions of student radiographers and radiography academics

    Hyde, E.; Hardy, Maryann L. (2021-01)
    Introduction: Awareness is growing of the importance of patient centered care (PCC) in diagnostic radiography. PCC is embedded within professional body publications and guidance documents, but there is limited research evidence exploring the perceptions of student radiographers and radiography academics. Methods: This paper reports Stage 1 and Stage 2 of the project from the perspective of radiography academic and student radiographer participants, and compares these to the perspectives of service users, clinical radiographers and radiography managers reported previously. Stage 1 used an online survey tool to gauge participant agreement with a series of attitudinal statements. Stage 2 used situational vignettes to promote discussion and debate about PCC approaches. Results: Response rates to the Stage 1 survey were above the minimum threshold, with 50 responses from student radiographers and 38 responses from radiography academics. Stage 1 participants were asked to participate in Stage 2 on a voluntary basis. As with service users and service deliverers, care communication, event interactions and control over environment were the key influences on PCC. However, students highlighted differences between reported and observed levels of PCC. Conclusion: There is some way to go to embed PCC in diagnostic radiography practice. As impartial observers of radiography practice, student radiographers highlight the difference between service users and service deliverer's perceptions of PCC. Whilst the focus of clinical radiographers remains on efficiency, it is difficult for student radiographers to challenge the accepted norm. Role models are required to promote PCC behaviours and a holistic approach in radiography practice. Implications for practice: A package of educational support and audit tools will be made available to support both service deliverers and student radiographers to deliver PCC
  • Computer based simulation in CT and MRI radiography education: Current role and future opportunities

    Chaka, Brian; Hardy, Maryann L. (2021-05)
    Objective: The use of Computer-based simulation (CBS), a form of simulation which utilises digital and web based platforms, is widely acknowledged in healthcare education. This literature review explores the current evidence relating to CBS activities in supporting radiographer education in CT and MRI. Key findings: Journal articles published between 2010 and 2020 were reviewed (n ¼ 663). The content was evaluated and summarised with the following headings; current utility, overview of CBS types, knowledge acquisition and evaluation, and student perspective. CBS utility in CT and MRI radiography education is limited. Its current use is for pre-registration education, and the interfaces used vary in design but are predominantly used as a preclinical learning tool to support the training of geometric scan planning, image acquisition and reconstruction, and associated technical skills. CBS was positively acknowledged by student radiographers; based on its inherent flexibility, self-paced learning and the ability to practice in a safe environment. Nonetheless, the educational validation of CBS in CT and MRI education pertaining to knowledge and skill acquisition has not been fully assessed through rigorous academic assessments and metrics. Conclusion: The current use of CBS in CT and MRI education is limited. The development of software programmes with functionality and capability that correlates with current clinical practice is imperative; and to enable more research in CBS utility to be undertaken to establish the efficacy of this pedagogical approach. Implications for practice: Due to limited placement opportunities, the use of simulation is increasing and evolving; in line with the approach to design and deliver high quality Simulation Based Education (SBE) in Diagnostic Radiography education. The continued development, utility and evaluation of CBS interfaces to support student radiographers at pre and post registration level is therefore essential.
  • Local diagnostic reference levels for skeletal surveys in suspected physical child abuse

    Mussmann, B.; Hardy, Maryann L.; Rajalingham, R.; Peters, D.; McFadden, S.; Abdi, A.J. (2021-05)
    Introduction: The purpose was to determine if an age based, local diagnostic reference level for paediatric skeletal surveys could be established using retrospective data. Methods: All children below two years of age referred for a primary skeletal survey as a result of suspected physical abuse during 2017 or 2018 (n ¼ 45) were retrospectively included from a large Danish university hospital. The skeletal survey protocol included a total of 33 images. Dose Area Product (DAP) and acquisition parameters for all images were recorded from the Picture Archival and Communication System (PACS) and effective dose was estimated. The 75th percentile for DAP was considered as the diagnostic reference level (DRL). Results: The 75th percentile for DAP was 314 mGy*cm2 , 520 mGy*cm2 and 779 mGy*cm2 for children <1 month, 1e11 months and 12 < 24 months of age respectively. However, only the age group 1e11 months had a sufficient number of children (n ¼ 27) to establish a local DRL. Thus, for the other groups the DAP result must be interpreted with caution. Effective dose was 0.19, 0.26 and 0.18 mSv for children <1, 1e11 months and 12 < 24 months of age respectively. Conclusion: For children between 1 and 11 months of age, a local diagnostic reference level of 520 mGy*cm2 was determined. This may be used as an initial benchmark for primary skeletal surveys as a result of suspected physical abuse for comparison and future discussion. Implications for practice: While the data presented reflects the results of a single department, the suggested diagnostic reference level may be used as a benchmark for other departments when auditing skeletal survey radiation dose.
  • Patient centred care in diagnostic radiography (Part 2): A qualitative study of the perceptions of service users and service deliverers

    Hyde, E.; Hardy, Maryann L. (2020-10)
    Introduction There is growing awareness of the importance of patient centred care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents, but there is limited research evidence exploring whether perceptions of PCC are equivalent between those delivering (radiographers) and those experiencing (patient) care. This study aimed to address this gap by determining compatibility in perceptions of PCC between those using and those delivering radiography services in order to develop measurable indicators of PCC. Methods This project was funded by the College of Radiographers Industry Partnership Scheme. Ethical approval was granted by the University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 2 of the project, which was a series of focus groups and telephone interviews to enable deeper discussion and exploration of PCC. Situational vignettes were used to promote discussion and debate and encourage suggestions for PCC approaches. Audit tools to assess engagement with PCC were developed at individual and organisational level. Results Four focus groups and six telephone interviews were carried out in total. Focus groups were held in a variety of locations to promote attendance. Telephone interviews were used to capture participants who could not attend a focus group in person. Disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident. Perceived levels of care and the effectiveness of communication appeared to be the key influences on whether PCC was delivered. Conclusion It is evident from the results of Stage 1 and Stage 2 that we have some way to go before we have parity in how care within diagnostic radiography is perceived, experienced and delivered. Audit tools and an educational toolkit are offered as ways to support increased PCC within diagnostic radiography practice. Implications for practice Several service improvements and audit tools are offered to support the increased delivery of PCC.
  • Patient centred care in diagnostic radiography (Part 1): Perceptions of service users and service deliverers

    Hyde, E.; Hardy, Maryann L. (2021-02)
    Introduction There is growing awareness of the importance of patient centered care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents. However, there is limited research evidence exploring whether perceptions of PCC are equivalent between those delivering (radiographers) and those experiencing (patient) care. This study aimed to address this gap by determining compatibility in perceptions of PCC between those using and those delivering radiography services. This is the first step in developing measurable indicators of PCC in diagnostic radiography. Methods A multi-method two stage approach was undertaken using survey and interview data collection techniques. Ethical approval was granted by University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 1 of the study, the online, cross sectional survey. Participants were asked to indicate their level of agreement to a series of attitudinal statements using a 5-point Likert scale. Statements were paired, but not co-located to increase validity. Participants were invited to provide free text comments to supplement their responses. Stage 2 of the project is reported separately. Results Survey responses were received from all 3 participant subgroups. A minimum response rate of 30 participants per sub-group was set as a target. Response rates varied across subgroups, with only radiography managers failing to meet the expected response threshold. Wide disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident. Conclusion It is evident that there is still work required to ensure parity between expectations of service users and deliverers on what constitutes high quality PCC. Implications for practice Further work is required to identify measurable service delivery outcomes that represent PCC within radiographic practice.
  • Can dual CT with fast kV-switching determine renal stone composition accurately?

    Mussman, B.; Hardy, Maryann L.; Jung, H.; Ding, M.; Osther, P.J.; Graumann, O. (2020-03)
    Rationale and Objectives: To determine whether a single source computed tomography (CT) system utilizing fast kV switching and low dose settings can characterize (diameter and chemical composition) renal stones accurately when compared infrared spectroscopy. Materials and Methods: The chemical composition of 15 renal stones was determined using Fourier transform infrared spectroscopy. The stones were inserted into a porcine kidney and placed within a water tank for CT scanning using both fast kV switching dual energy and standard protocols. Effective atomic number of each stone was measured using scanner software. Stone diameter measurements were repeated twice to determine intra-rater variation and compared to actual stone diameter as measured by micro CT. Results: The chemical composition of three stones (one calcium phosphate and two carbonite apatite) could not be determined using the scanner software. The composition of 10/12 remaining stones was correctly identified using dual energy computed tomography (83% absolute agreement; k = 0.69). No statistical difference (p = 0.051) was noted in the mean stone diameter as measured by clinical CT and micro CT. Conclusion: Dual energy computed tomography using fast kV switching may potentially be developed as a low dose clinical tool for identifying and classifying renal stones in vivo supporting clinical decision-making.
  • Comparing the supine and erect pelvis radiographic examinations: an evaluation of anatomy, image quality and radiation dose

    Flintham, K.; Alzyoud, K.; England, A.; Hogg, P.; Snaith, Beverly (2021-06)
    Objectives: Pelvis radiographs are usually acquired supine despite standing imaging reflecting functional anatomy. We compared supine and erect radiographic examinations for anatomical features, radiation dose and image quality. Methods: 60 patients underwent pelvis radiography in both supine and erect positions at the same examination appointment. Measures of body mass index and sagittal diameter were obtained. Images were evaluated using visual grading analysis and pelvic tilt was compared. Dose–area product values were recorded and inputted into the CalDose_X software to estimate effective dose (ED). The CalDose_X software allowed comparisons using data from the erect and supine sex-specific phantoms (MAX06 & FAX06). Results: Patient sagittal diameter was greater on standing with an average 20.6% increase at the iliac crest (median 30.0, interquartile range [26.0 to 34.0] cm), in comparison to the supine position [24.0 (22.3 to 28.0) cm; p < 0.001]. 57 (95%) patients had posterior pelvic tilt on weight-bearing. Erect image quality was significantly decreased with median image quality scores of 78% (69 to 85) compared to 87% for the supine position [81 to 91] (p < 0.001). In the erect position, the ED was 47% higher [0.17 (0.13 to 0.33) mSv vs 0.12 (0.08 to 0.18) mSv (p < 0.001)], influenced by the increased sagittal diameter. 42 (70%) patients preferred the standing examination. Conclusion: Patient diameter and pelvic tilt were altered on weightbearing. Erect images demonstrated an overall decrease in image quality with a higher radiation dose. Optimal acquisition parameters are required for erect pelvis radiography as the supine technique is not directly transferable.
  • The scope of carer effects and their inclusion in decision-making: A UK-based Delphi study

    Al-Janabi, H.; Efstathiou, N.; McLoughlin, C.; Calvert, M.; Oyebode, Jan R. (BMC, 2021)
    Background and objective: Health and social care may affect family carers’ health and wellbeing in addition to patients’ lives. It is recommended that such impacts (carer effects) are considered in decision-making. However, the scope of carer effects and range of decisions where carer effects should be considered is uncertain. This study aimed to identify (i) how different categories of healthcare and social care were perceived to impact on family carers and (ii) whether there was consensus about when carer effects should be formally considered in decision-making contexts. Methods: A Delphi study was conducted with 65 UK-based participants with expertise in dementia, mental health, and stroke. Participants considered two broad forms of ‘interventions’ (patient treatment and replacement care) and two broad forms of ‘organisational change’ (staffing and changes in timing/location of care). Participants assessed the likely impacts of health and social care on family carers and whether impacts should be considered in decision-making. The survey was conducted remotely at two time points. Results: Participants predicted widespread impacts from interventions and organisational changes on different domains of family carers’ lives, with ‘emotional health’ the most likely outcome to be affected. Patient treatment and replacement care services (‘interventions’) were associated with positive impacts across all domains. Conversely, timing/location changes and staffing changes (‘organisational changes’) were perceived to have mixed and negative impacts. There was widespread support (80-81%) for considering carer effects in research studies, funding decisions, and patient decision-making. Conclusion: This study highlights a perception that carer effects are widespread and important to consider in economic evaluation and decision-making. It highlights the particular need to measure and value effects on carers’ emotional health and the need to use a societal perspective to avoid cost shifting to family carers when introducing interventions and making organisational changes.
  • A systematic review to identify research priority setting in Black and minority ethnic health and evaluate their processes

    Iqbal, Halima; West, J.; Haith-Cooper, Melanie; McEachan, R.R.C. (PLOS ONE, 2021-05)
    Background: Black, Asian and minority ethnic communities suffer from disproportionately poorer health than the general population. This issue has been recently exemplified by the large numbers of infection rates and deaths caused by covid-19 in BAME populations. Future research has the potential to improve health outcomes for these groups. High quality research priority setting is crucial to effectively consider the needs of the most vulnerable groups of the population. Objective: The purpose of this systematic review is to identify existing research priority studies conducted for BAME health and to determine the extent to which they followed good practice principles for research priority setting. Method: Included studies were identified by searching Medline, Cinnahl, PsychINFO, Psychology and Behavioral Sciences Collection, as well as searches in grey literature. Search terms included “research priority setting”, “research prioritisation”, “research agenda”, “Black and minority ethnic”, “ethnic group”. Studies were included if they identified or elicited research priorities for BAME health and if they outlined a process of conducting a research prioritisation exercise. A checklist of Nine Common Themes of Good Practice in research priority setting was used as a methodological framework to evaluate the research priority processes of each study. Results: Out of 1514 citations initially obtained, 17 studies were included in the final synthesis. Topic areas for their research prioritisation exercise included suicide prevention, knee surgery, mental health, preterm birth, and child obesity. Public and patient involvement was included in eleven studies. Methods of research prioritisation included workshops, Delphi techniques, surveys, focus groups and interviews. The quality of empirical evidence was diverse. None of the exercises followed all good practice principles as outlined in the checklist. Areas that were lacking in particular were: the lack of a comprehensive approach to guide the process; limited use of criteria to guide discussion around priorities; unequal or no representation from ethnic minorities, and poor evaluation of their own processes. Conclusions: Research priority setting practices were found to mostly not follow good practice guidelines which aim to ensure rigour in priority setting activities and support the inclusion of BAME communities in establishing the research agenda. Research is unlikely to deliver useful findings that can support relevant research and positive change for BAME communities unless they fulfil areas of good practice such as inclusivity of key stakeholders’ input, planning for implementation of identified priorities, criteria for deciding on priorities, and evaluation of their processes in research priority setting.
  • An exploration of migrant women’s perceptions of public health messages to reduce stillbirth in the UK: a qualitative study

    Stacey, T.; Haith-Cooper, Melanie; Almas, Nisa; Kenyon, C. (2021-05)
    Background: Stillbirth is a global public health priority. Within the United Kingdom, perinatal mortality disproportionately impacts Black, Asian and minority ethnic women, and in particular migrant women. Although the explanation for this remains unclear, it is thought to be multidimensional. Improving perinatal mortality is reliant upon raising awareness of stillbirth and its associated risk factors, as well as improving maternity services. The aim of this study was to explore migrant women’s awareness of health messages to reduce stillbirth risk, and how key public health messages can be made more accessible. Method: Two semi-structured focus groups and 13 one to one interviews were completed with a purposive sample of 30 migrant women from 18 countries and across 4 NHS Trusts. Results: Participants provided an account of their general awareness of stillbirth and recollection of the advice they had been given to reduce the risk of stillbirth both before and during pregnancy. They also suggested approaches to how key messages might be more effectively communicated to migrant women. Conclusions: Our study highlights the complexity of discussing stillbirth during pregnancy. The women in this study were found to receive a wide range of advice from family and friends as well as health professionals about how to keep their baby safe in pregnancy, they recommended the development of a range of resources to provide clear and consistent messages. Health professionals, in particular midwives who have developed a trusting relationship with the women will be key to ensuring that public health messages relating to stillbirth reduction are accessible to culturally and linguistically diverse communities.
  • A complex intervention to reduce avoidable hospital admissions in nursing homes: a research programme including the BHiRCH-NH pilot cluster RCT

    Downs, M.; Blighe, A.; Carpenter, R.; Feast, A.; Froggatt, K.; Gordon, S.; Hunter, R.; Jones, L.; Lago, N.; McCormack, B.; et al. (Programme Grants for Applied Research, 2021-02)
    Background: An unplanned hospital admission of a nursing home resident distresses the person, their family and nursing home staff, and is costly to the NHS. Improving health care in care homes, including early detection of residents’ health changes, may reduce hospital admissions. Previously, we identified four conditions associated with avoidable hospital admissions. We noted promising ‘within-home’ complex interventions including care pathways, knowledge and skills enhancement, and implementation support. Objectives: Develop a complex intervention with implementation support [the Better Health in Residents in Care Homes with Nursing (BHiRCH-NH)] to improve early detection, assessment and treatment for the four conditions. Determine its impact on hospital admissions, test study procedures and acceptability of the intervention and implementation support, and indicate if a definitive trial was warranted. Design: A Carer Reference Panel advised on the intervention, implementation support and study documentation, and engaged in data analysis and interpretation. In workstream 1, we developed a complex intervention to reduce rates of hospitalisation from nursing homes using mixed methods, including a rapid research review, semistructured interviews and consensus workshops. The complex intervention comprised care pathways, approaches to enhance staff knowledge and skills, implementation support and clarity regarding the role of family carers. In workstream 2, we tested the complex intervention and implementation support via two work packages. In work package 1, we conducted a feasibility study of the intervention, implementation support and study procedures in two nursing homes and refined the complex intervention to comprise the Stop and Watch Early Warning Tool (S&W), condition-specific care pathways and a structured framework for nurses to communicate with primary care. The final implementation support included identifying two Practice Development Champions (PDCs) in each intervention home, and supporting them with a training workshop, practice development support group, monthly coaching calls, handbooks and web-based resources. In work package 2, we undertook a cluster randomised controlled trial to pilot test the complex intervention for acceptability and a preliminary estimate of effect. Setting: Fourteen nursing homes allocated to intervention and implementation support (n = 7) or treatment as usual (n = 7). Participants: We recruited sufficient numbers of nursing homes (n = 14), staff (n = 148), family carers (n = 95) and residents (n = 245). Two nursing homes withdrew prior to the intervention starting. Intervention: This ran from February to July 2018. Data sources: Individual-level data on nursing home residents, their family carers and staff; system-level data using nursing home records; and process-level data comprising how the intervention was implemented. Data were collected on recruitment rates, consent and the numbers of family carers who wished to be involved in the residents’ care. Completeness of outcome measures and data collection and the return rate of questionnaires were assessed. Results: The pilot trial showed no effects on hospitalisations or secondary outcomes. No home implemented the intervention tools as expected. Most staff endorsed the importance of early detection, assessment and treatment. Many reported that they ‘were already doing it’, using an early-warning tool; a detailed nursing assessment; or the situation, background, assessment, recommendation communication protocol. Three homes never used the S&W and four never used care pathways. Only 16 S&W forms and eight care pathways were completed. Care records revealed little use of the intervention principles. PDCs from five of six intervention homes attended the training workshop, following which they had variable engagement with implementation support. Progression criteria regarding recruitment and data collection were met: 70% of homes were retained, the proportion of missing data was < 20% and 80% of individuallevel data were collected. Necessary rates of data collection, documentation completion and return over the 6-month study period were achieved. However, intervention tools were not fully adopted, suggesting they would not be sustainable outside the trial. Few hospitalisations for the four conditions suggest it an unsuitable primary outcome measure. Key cost components were estimated. Limitations: The study homes may already have had effective approaches to early detection, assessment and treatment for acute health changes; consistent with government policy emphasising the need for enhanced health care in homes. Alternatively, the implementation support may not have been sufficiently potent. Conclusion: A definitive trial is feasible, but the intervention is unlikely to be effective. Participant recruitment, retention, data collection and engagement with family carers can guide subsequent studies, including service evaluation and quality improvement methodologies. Future work: Intervention research should be conducted in homes which need to enhance early detection, assessment and treatment. Interventions to reduce avoidable hospital admissions may be beneficial in residential care homes, as they are not required to employ nurses.
  • Sources of emotional challenge for practitioners delivering family centred care after the death of child: an inductive thematic analysis

    Tatterton, Michael J.; Honour, A.; Lyon, J.; Kirkby, L.; Newbegin, M.; Webster, J. (2021)
    Care after the death of a child and support of their bereaved family is an important element of the services offered by children’s hospices in the United Kingdom. The study aims to explore the emotional challenges of those delivering care to families of children in hospice cool rooms. An internet-based questionnaire was sent to all practitioners to explore their perspectives of providing care to bereaved families whilst the child’s body was in the hospice, as well as caring for a child’s body after death. In total, 94.9% (n=56) of staff responded. Two key themes were identified that represent the emotional challenges perceived by staff: the impact of deterioration of a child’s body; and witnessing the acute grief of families. Practitioners seek to provide care that recognises the importance of family and demonstrates family-centred care, as well as supporting families to deal with the changes that occur after death. Organisations can support practitioners to deliver care in cool rooms by providing training and education on anticipating and managing the pathophysiological changes that occur after death as well as training in grief and loss, and how to support a bereaved family.
  • Patients as qualitative data analysts: Developing a method for a process evaluation of the ‘Improving the Safety and Continuity of Medicines management at care Transitions’ (ISCOMAT) cluster randomised control trial

    Powell, Catherine; Ismail, Hanif; Cleverley, R.; Taylor, A.; Breen, Liz; Fylan, Beth; Alderson, S.L.; Alldred, D.P. (2021)
    Background: How to meaningfully partner with patients as data analysts remains obscure. A process evaluation of the ‘Improving the Safety and Continuity Of Medicines management at care Transitions’ (ISCOMAT) cluster randomised control trial of an intervention for improving medicines use for people living with heart failure is being conducted. The intervention includes patient held information on heart medicines and care, enhanced communication between hospital and community pharmacists, and increased engagement of community pharmacists with patient care post-hospital discharge. ISCOMAT patients living with heart failure were interviewed about experiences with the intervention. We sought to gain insights from patients on data collected to enhance our understanding of experiences with the intervention. Objective: To develop a method for involving patients as analysts of qualitative data in a process evaluation. Design: Patients and researchers co-analysed qualitative data. A framework method was applied involving; familiarisation, coding, developing an analytical framework and interpretation. The process was facilitated through home working and a workshop with a training component. Results: The co-designed framework enabled researchers to map all further patient interview data. Patients' specialist knowledge enhanced understanding of how the ISCOMAT intervention can be best implemented. Conclusions: Patients’ unique experiences can enhance validity and rigour in data analysis through sharing their interpretations of qualitative data. The involvement process is crucial in elucidating knowledge and avoiding tokenism. As analysts, patients gain an appreciation of research processes, building trust between researchers and patients. Group dynamics and involving patients throughout the whole research process are important considerations.
  • Living with dementia during the COVID-19 pandemic: coping and support needs of community-dwelling people with dementia and their family carers. Research findings from the IDEAL COVID-19 Dementia Initiative (IDEAL-CDI)

    O'Rourke, G.; Pentecost, C.; van den Heuvel, E.; Victor, C.; Quinn, Catherine; Hillman, A.; Litherland, R.; Clare, L. (Older People and Frailty Policy Research Group, 2021-02)
    We interviewed people with dementia and carers from the IDEAL cohort to find out how the COVID-19 lockdown and continuing restrictions affected those living with dementia. Some people with dementia coped well, while others coped with difficulty or were only just coping. The additional stress of COVID-19 exacerbated pre-existing coping difficulties. For many, social isolation increased anxiety. Some felt that lack of activity or lack of social contact caused a decline in their abilities to manage everyday tasks. Confusion about COVID-19 rules or difficulty remembering what to do led to anxiety when leaving the house. People felt that members of the public might not understand their particular needs. While some carers felt they were coping well, others experienced stress when having to leave the home because the person with dementia might not be safe if left alone. Some experienced increased strain in the caring relationship compounded by an uncertainty about future availability of respite. Some were concerned about the complex health needs of the person with dementia alongside COVID-19 risk and lack of personalised information. Both people with dementia and carers talked about the importance of access to safe outdoor space. People were anxious about how others would react or behave towards them regarding keeping a distance if they went out. Being connected to friends, family and wider community or support groups was important to help combat the effects of isolation. People from BAME communities worried about their increased vulnerability to the virus. A lack of trust in Government guidance and in health care services added to their anxiety. However, some benefitted from strong community and faith group involvement. What might be helpful for people with dementia? • Reablement to help regain or maintain skills • Personalised health advice regarding managing COVID-19 risk and the opportunity to ask questions. • Identification of people with dementia who live alone and an assessment of their needs. What might be helpful for carers? • Needs assessment in regard to respite. • Novel forms of respite care that incorporate social distancing. What might be helpful for both carers and people with dementia? • Access to COVID-safe outdoor spaces. • Continuation and expansion of ‘just checking’ services. • Support to get online and use the internet. • Communication and information through non-digital means. • Community COVID-19 ‘dementia awareness’ initiatives. What might be helpful for people from Black and minority ethnic groups? • Addressing concerns about their increased risk of COVID-19. • Directing information and support through existing community and faith groups.

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