• Representational diversity

      Archibong, Uduak E.; Ashraf, Fahmida; Bucktrout, A.; Giga, Sabir I.; Jackson, H.; Johnson, M.R.D.; Baxter, C. (2007)
      Although the rationale for equal opportunities has been accepted within the UK public sector, there is little research into people's aspirations and experiences of Positive Action (PA) as a means of achieving equality of opportunity during the whole employment cycle. A research project was carried out to explore meanings of race-, disability- and gender- related PA initiatives and their impact on workforce diversity in Higher and Further Education and the National Health Service in England, with the aim of developing an understanding of the concept of PA and informing good practice in the effective use of such measures in these sectors. Using a combination of research methods including a literature review, interviews and focus groups, the paper highlights understanding of the concept of PA as well as its practice and interpretation amongst key stakeholders including senior managers, designers, current recipients and their peers.
    • Reproductive life histories: can incremental dentine isotope analysis identify pubertal growth, pregnancy and lactation?

      Feuillâtre, C.; Beaumont, Julia; Elamin, F. (2022)
      Background: There are few reliable osteological indicators to detect parity or infer puberty in skeletal remains. Nitrogen (δ15N) and stable carbon (δ13C) isotope ratios in human tissues can be affected by metabolically unbalanced states engendered by pregnancy or rapid growth, offering potential biomarkers. Aim: This pilot study explores the potential of incremental dentine-collagen isotope ratio analysis to identify puberty and gestation. Methodology: Incremental dentine δ15N and δ13C profiles were produced by analysing third molars extracted as part of dental treatment of 10 individuals living in Sudan. Demographic and anthropometric data at the time of tooth extraction was available. Medical histories were unknown. Results: Isotopic signatures potentially related to pubertal growth, with an average δ15N reduction of 0.78±0.29‰, are indicated. Six isotopic signals suggestive of pregnancy, with an average δ15N decrease of 0.48±0.22‰, are also observed. The timing, speed and amplitude of post-partum δ15N patterns seemingly infer infant feeding practices and maternal nutritional status. Conclusion: This pilot study highlights the potential of incremental dentine isotope analysis for the reconstruction of early reproductive histories in skeletal remains. However, controlled studies with larger human cohort are needed to validate these findings, establish isotopic signals linked to puberty and lactation, and improve chronology accuracy.
    • Requesting and interpreting trauma radiographs: a role extension for accident & emergency nurses

      Hardy, Maryann L.; Barrett, Christine (2003-10)
      Government supported expansion of the nursing role within Accident & Emergency (A&E) departments in the United Kingdom (UK) has begun to break down the traditional barriers to professional practice. Today, many nurses working within A&E departments are both requesting and interpreting radiographic examinations as part of their normal working practice. However, role expansion does not occur without increased responsibility. Unsatisfactory requests for radiography and inaccurate radiographic interpretation may result in inappropriate patient treatment, misuse of resources, patient recall and litigation. Nurses undertaking these role extensions need to ensure that their levels of knowledge and skill to perform the role are appropriate and adequately supported. This article summarises the results of a national questionnaire survey of A&E nurse managers that aimed to identify current working practices, including education, training and limitations to practice, with respect to the requesting and interpretation of trauma radiographs by A&E nurses.
    • Research priority setting in obesity: a systematic review

      Iqbal, Halima; West, Jane; McEachan, Rosemary; Haith-Cooper, Melanie (2021-12-03)
      Obesity research priority setting, if conducted to a high standard, can help promote policy-relevant and efficient research. Therefore, there is a need to identify existing research priority setting studies conducted in the topic area of obesity and to determine the extent to which they followed good practice principles for research priority setting. Studies examining research priority setting in obesity were identified through searching the MEDLINE, PBSC, CINAHL, PsycINFO databases and the grey literature. The nine common themes of good practice in research priority setting were used as a methodological framework to evaluate the processes of the included studies. These were context, use of a comprehensive approach, inclusiveness, information gathering, planning for implementation, criteria, methods for deciding on priorities, evaluation and transparency. Thirteen articles reporting research prioritisation exercises conducted in different areas of obesity research were included. All studies reported engaging with various stakeholders such as policy makers, researchers and healthcare professionals. Public involvement was included in six studies. Methods of research prioritisation commonly included both Delphi and nominal group techniques and surveys. None of the 13 studies fulfilled all nine of the good practice criteria for research priority setting, with the most common limitations including not using a comprehensive approach and lack of inclusivity and evaluating on their processes. There is a need for research priority setting studies in obesity to involve the public and to evaluate their exercises to ensure they are of high quality.
    • Research Review of: Singleton breech presentation at term: review of the evidence and international guidelines for application to the New Zealand context

      Firth, Amanda (2018-06-01)
      This paper focuses on vaginal breech birth of singleton babies in New Zealand using a review of international literature to inform discussion on the care of women presenting at term with an uncomplicated breech presentation.
    • Reshaping leadership and management

      Lawler, John A.; Hafford-Letchfield, T. (2013)
    • Rethinking Scholarship in Nurse Education

      Kelsey, Catherine (2016-03)
      The nursing profession is undergoing significant change. The most apparent being: the recent progress to an all-graduate profession; the continued reforms following the findings of the Francis Report (2013) and the sustained restructuring of the health service that seeks to effectively manage the increasing demands placed upon it (NHS 2014). Educational programmes in nursing have developed curriculum that places self-determined learning at the heart of professional practice. This heutagogical approach extols the value of reflective practitioners that empower the development of evidence based practice. Throughout this process students are supported by scholarly mentors. In light of the significant changes and the continued challenges to nurse education this paper will seek to critically analyse the seminal work of Boyer, (1990) in which he sought to challenge the out-moded ideology of scholarship and propose a more enlightened contemporary framework, which all academics can utilise in order to encourage a more dynamic, systematic approach to learning.
    • The return of autonomy in nursing – A way forward

      Cassidy, Andrea M.; McIntosh, Bryan (2014)
      The Mid Staffordshire scandal is a salutary lesson that highlights unacceptable standards of poor care of patients by medical and nursing practitioners. The Francis report (2013) made 290 recommendations and a legal duty to enforce a duty of openness and transparencies has been prioritised. Fischer and Ferlie (2013) argue that rules-based regulation eroded values-based self-regulation, producing professional defensiveness and contradictions that undermine, rather than support, good patient care. The role of managers and clinical leaders will be crucial in achieving positive changes in practice; however, the return of autonomy to the practitioners remains central to re-establishing both public and professional confidence.
    • A Review of organisational Stress Management Interventions

      Giga, Sabir I.; Cooper, C.L.; Faragher, B.; Noblet, A.J. (2003)
    • Reviewing studies with diverse designs: the development and evaluation of a new tool

      Sirriyeh, R. (See also Harrison, R.); Lawton, R.; Gardner, Peter H.; Armitage, Gerry R. (2012)
      RATIONALE, AIMS & OBJECTIVE: Tools for the assessment of the quality of research studies tend to be specific to a particular research design (e.g. randomized controlled trials, or qualitative interviews). This makes it difficult to assess the quality of a body of research that addresses the same or a similar research question but using different approaches. The aim of this paper is to describe the development and preliminary evaluation of a quality assessment tool that can be applied to a methodologically diverse set of research articles. METHODS: The 16-item quality assessment tool (QATSDD) was assessed to determine its reliability and validity when used by health services researchers in the disciplines of psychology, sociology and nursing. Qualitative feedback was also gathered from mixed-methods health researchers regarding the comprehension, content, perceived value and usability of the tool. RESULTS: Reference to existing widely used quality assessment tools and experts in systematic review confirmed that the components of the tool represented the construct of 'good research technique' being assessed. Face validity was subsequently established through feedback from a sample of nine health researchers. Inter-rater reliability was established through substantial agreement between three reviewers when applying the tool to a set of three research papers (kappa = 71.5%), and good to substantial agreement between their scores at time 1 and after a 6-week interval at time 2 confirmed test-retest reliability. CONCLUSIONS: The QATSDD shows good reliability and validity for use in the quality assessment of a diversity of studies, and may be an extremely useful tool for reviewers to standardize and increase the rigour of their assessments in reviews of the published papers which include qualitative and quantitative work.
    • RHAPSODY - Internet-based support for caregivers of people with young onset dementia: program design and methods of a pilot study

      Kurz, A.; Bakker, C.; Bohm, M.; Diehl-Schmid, J.; Dubois, B.; Ferreira, C.; Gage, H.; Graff, C.; Hergueta, T.; Jansen, S.; et al. (2016)
      Background: Young Onset Dementia (YOD), defined by first symptoms of cognitive or behavioral decline occurring before the age of 65 years, is relatively rare compared to dementia of later onset, but it is associated with diagnostic difficulty and heavy burden on affected individuals and their informal carers. Existing health and social care structures rarely meet the needs of YOD patients. Internet-based interventions are a novel format of delivering health-related education, counseling and support to this vulnerable yet underserved group. Methods: The RHAPSODY (Research to Assess Policies and Strategies for Dementia in the Young) project is a European initiative to improve care for people with YOD by providing an internet-based information and skill-building program for family carers. The e-learning program focuses on managing problem behaviors, dealing with role change, obtaining support and looking after oneself. It will be evaluated in a pilot study in three countries using a randomized unblinded design with a wait-list control group. Participants will be informal carers of people with dementia in Alzheimer’s disease or behavioral-variant Frontotemporal degeneration with an onset before the age of 65 years. The primary outcome will be caregiving self-efficacy after 6 weeks of program use. As secondary outcomes caregivers’ stress and burden, carer health-related quality of life, caring-related knowledge, patient problem behaviors and user satisfaction will be assessed. Program utilization will be monitored and a health-economic evaluation will also be performed. Conclusions: The RHAPSODY project will add to the evidence on the potential and limitations of a conveniently accessible, user-friendly and comprehensive internet-based intervention as an alternative for traditional forms of counseling and support in healthcare, aiming to optimize care and support for people with YOD and their informal caregivers.
    • Rising Ambulance Life-Threatening Call Demand in High and Low Socioeconomic Areas

      Portz, K.; Newell, Robert J.; Archibong, Uduak E. (2012)
      Ambulance service demand is increasing in the United Kingdom. A common speculative view makes a link between this rise in demand, deprivation, and certain medical conditions. This study explored factors infl uencing English ambulance service demand in two areas of differing socioeconomic status. Adopting a causal comparative design, the study compared the numbers of life-threatening calls that Yorkshire Ambulance Service receives and serves in two geographical areas within the Hull and East Riding area. The area of lower socioeconomic status generated signifi cantly more life-threatening calls than the area of higher socioeconomic status; these calls often supported younger patients (mean age 59 years versus 71 years) for breathing diffi culties (29% versus 14.5%) more commonly. Tackling inequality will require a whole-systems approach, effective leadership, and recognition of the benefi ts of understanding difference. A key relationship will entail engaging with seldom heard communities.
    • Risk factors for congenital anomaly in a multiethnic birth cohort: an analysis of the Born in Bradford study

      Sheridan, E.; Wright, J.; Small, Neil A.; Corry, P.C.; Oddie, S.J.; Whibley, C.; Petherick, E.S.; Malik, T.; Pawson, Nicole; McKinney, P.A.; et al. (2013)
      Background: Congenital anomalies are a leading cause of infant death and disability and their incidence varies between ethnic groups in the UK. Rates of infant death are highest in children of Pakistani origin, and congenital anomalies are the most common cause of death in children younger than 12 in this ethnic group. We investigated the incidence of congenital anomalies in a large multiethnic birth cohort to identify the causes of the excess of congenital anomalies in this community. Methods: We obtained questionnaire data from the mothers of children with one or more anomalies from the Born in Bradford study, a prospective birth cohort study of 13 776 babies and their families in which recruitment was undertaken between 2007 and 2011. Details of anomalies were prospectively reported to the study and we cross checked these details against medical records. We linked data for anomalies to maternal questionnaire and clinical data gathered as part of the Born in Bradford study. We calculated univariate and multivariate risk ratios (RRs) with 95% CIs for various maternal risk factors. Findings: Of 11 396 babies for whom questionnaire data were available, 386 (3%) had a congenital anomaly. Rates for congenital anomaly were 305·74 per 10 000 livebirths, compared with a national rate of 165·90 per 10 000. The risk was greater for mothers of Pakistani origin than for those of white British origin (univariate RR 1·96, 95% CI 1·56–2·46). Overall, 2013 (18%) babies were the offspring of first-cousin unions. These babies were mainly of Pakistani origin—1922 (37%) of 5127 babies of Pakistani origin had parents in first-cousin unions. Consanguinity was associated with a doubling of risk for congenital anomaly (multivariate RR 2·19, 95% CI 1·67–2·85); we noted no association with increasing deprivation. 31% of all anomalies in children of Pakistani origin could be attributed to consanguinity. We noted a similar increase in risk for mothers of white British origin older than 34 years (multivariate RR 1·83, 95% CI 1·14–3·00). Maternal education to degree level was protective (0·53, 95% CI 0·38–0·75), irrespective of ethnic origin. Interpretation: Consanguinity is a major risk factor for congenital anomaly. The risk remains even after adjustment for deprivation, and accounts for almost a third of anomalies in babies of Pakistani origin. High levels of educational attainment are associated with reduced risk in all ethnic groups. Our findings will be valuable in health promotion and public health, and to those commissioning antenatal, paediatric, and clinical genetic services. Sensitive advice about the risks should be provided to communities at increased risk, and to couples in consanguineous unions, to assist in reproductive decision making. Funding: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care programme.
    • Risk, Fitness to practice and Disabled Health Care Students.

      Walker, Stuart A.; Dearnley, Christine A.; Hargreaves J.; Walker, A. (2013)
      The United Kingdom Equality Act of 2010 poses challenges to regulators, educators, and employers to ensure that disabled people are not excluded from health care professions on the basis of their impairment. Professional bodies must also anticipate the needs of disabled people and facilitate inclusion. In this article, we discuss some of the current tensions that exist between U.K. antidiscrimination legislation and the professional and statutory regulatory bodies that govern registration of health and social care practitioners in the United Kingdom. We present research that used a mixed methods approach to explore the tensions between higher education and placement providers in the health sector. Disabled students and health professionals engaged in semistructured interviews, and a survey explored the knowledge, skills, and attitudes of professional staff from a range of disciplines and institutions. Findings suggest that the negative feelings disabled students report are also evident in responses from health care professionals. Notions of risk emerge as a key issue from the data. We discuss whether the risk is perceived or actual and develop models to challenge existing preconceptions about the risk posed by disabled students when training as health care professionals. Finally, we suggest that while work clearly needs to be done in this area, some of this work can be addressed through the development of an inclusive curriculum for all health care practitioners. This article proposes an educational model of risk with which to guide this process.
    • The role and experiences of responders attending the sudden or unexpected death of a child: a systematic review and meta-synthesis

      Tatterton, Michael J.; Scholes, Sarah L.; Henderson, S.; Croucher, Fiona; Gibson, Carla (2022-01)
      The infrequency of sudden deaths means that professionals have limited exposure, making it difficult to gain experience and feel confident in their role. This meta-synthesis aims to synthesise qualitative research on the experience of professionals responding to cases of sudden or unexpected death. A systematic literature search was conducted using Academic Search Complete, CINHAL, Embase, psycINFO, PubMed and Web of Science, identifying ten papers for inclusion. Studies were appraised and synthesized using the principles of meta‐synthesis. Four superordinate themes were identified: perceptions of role, experience on scene, approaches to coping, and barriers to support. Findings suggest the way responders perceive their role and their experience on scene affect the approach taken to tasks and coping strategies used. The complexity of experience is often not acknowledged by responders or their colleagues. Experiences are compounded by cumulative factors which were expressed by different professional groups and across settings. Several barriers relating to workforce culture within organisations were identified, alongside the implications these have on staff wellbeing and the impact on bereaved families.
    • Role emerging placements in undergraduate occupational therapy training: a case study

      Fitzgerald, Martin; Smith, A.K.; Rehman, N.; Taylor, M. (2017-10)
      Purpose: Role emerging placements in occupational therapy training are contributing to professional and workforce development because of their strong occupational focus and placement of students in emerging practice. This manuscript explores how one role emerging placement challenged and developed student theoretical and clinical skills, presented new ways of working at the recipient site and enhanced service delivery. Methods: The background to role emerging placements in occupational therapy is explored through the use of a case study which reflects on and analyses how the assessment and treatment of occupation enhanced service delivery at a local, no-traditional site is presented. Eight students in England developed and ran a psycho-education group to support the occupational needs of female service users who have experienced domestic abuse. Results: There was an overall increase in self-esteem scores and an expressed increase in knowledge and understanding by participants. Students reported developing a deeper understanding of occupation and the hosts identified the student’s clinical skills as unique contributors to service delivery. Conclusion: By focusing on occupation, role emerging placements draw on the roots of the profession and anchor its future to the theoretical foundations of its past. However, in order to employ occupational therapists, these organisations need to understand what the occupational therapy profession can offer them.