• Improving the patient's experience of a bone marrow biopsy -- an RCT.

      Johnson, H.; Burke, D.; Plews, Caroline M.C.; Newell, Robert J.; Parapia, L. (01/03/2008)
      Improving the patient¿s experience of a bone marrow biopsy ¿ an RCT Aims. To compare nitrous oxide 50%/oxygen 50% (N2O/O2 ¿ entonox) plus local anaesthetic (LA) with placebo (oxygen) plus LA in the management of pain experienced by patients undergoing a bone marrow biopsy. Background. Bone marrow biopsies are a common procedure for many haematological conditions. Despite the use of a LA, pain during the procedure has frequently been reported by patients. Previous research in pain management of other invasive diagnostic procedures (e.g. sigmoidoscopy) has reported N2O/O2 as an effective alternative to LA. Design. Double-blind randomized controlled trial. Methods. Forty-eight patients requiring a bone marrow biopsy were randomized to receive either N2O/O2 or oxygen in addition to their LA. Participants were asked to complete a pain score and comment on their experience of the procedure. Results. Although the overall pain scores were moderate, there was a wide range of scores. N2O/O2 resulted in significantly less pain for men, but not for women. All patients who had had previous biopsies reported significantly more pain, regardless of the gas used. There were no significant adverse effects in either group. Conclusion. N2O/O2 is a safe, effective, easy-to-use analgesic which merits further investigation in potentially painful diagnostic (and other) interventions.
    • Caring for persons with Parkinson's disease in care homes: Perceptions of residents and their close relatives, and an associated review of residents' care plans.

      Armitage, Gerry R.; Adams, Jenny E.; Newell, Robert J.; Coates, David; Ziegler, Lucy; Hodgson, Ian J. (01/04/2009)
      Through qualitative in-depth interviews, we collected the views of persons with Parkinson¿s disease (pwPD) and their close relatives in care homes to establish their collective views of the effectiveness of care. We also reviewed the corresponding care plans. Drawing on these two forms of data collection, we compared similarities and differences between the qualitative interview data and the care plan analysis to elaborate on the experience of residential care for pwPD. Close relatives of care home residents can be a fruitful source of information for care home staff, throughout the care planning process, especially in relation to the specific needs of a pwPD. Although health and social policy advocate active collaboration between people with long-term conditions, their families, and their formal carers, there is limited evidence of such collaboration in the data examined here. There is an apparent shortfall in the knowledge and understanding of PD among care home staff. There are important pragmatic (e.g. drug administration) as well as psycho-social reasons for flexibility in routine care provision to meet the dynamic needs of pwPD. The findings here support the need for further, larger scale research into the quality of care for pwPD who are care home residents.
    • A randomized controlled trial of a specialist liaison worker model for young people with intellectual disabilities with challenging behaviour and mental health needs.

      Raghavan, R.; Newell, Robert J.; Waseem, F.; Small, Neil A. (01/05/2009)
      Background Twenty six young people with intellectual disabilities and mental health needs from Pakistani and Bangladeshi communities were recruited as part of a bigger study to examine the effectiveness of a liaison worker in helping young people and their families access appropriate intellectual disabilities and mental health services. Method Twelve young people were randomly allocated to the treatment group, which had the help of the liaison worker, and 14 young people were allocated to the control group without the help of a liaison worker. Baseline measures were undertaken with all the young people and their carers. This was followed by a 9-month trial, consisting of the liaison worker helping the treatment group to get in touch with and take up appropriate services, mainly in the areas of psychiatric appointments, benefits advice, house adaptations, leisure facilities and support and care for the young person. The control group participants did not have the access to the liaison worker and were accessing services using the normal routine. Assessments were carried out posttreatment to assess whether the use of a liaison worker had had any effect on outcomes for the two groups. Results Twelve young people completed the study in the treatment group and 14 in the control group. Participants allocated to the specialist liaison worker had statistically significantly more frequent contact with services and with more outcomes, than the control group, and significantly lower scores on the Strengths and Difficulties Questionnaire (SDQ). Conclusion The use of specialist liaison services in ensuring adequate access to services for young people with learning disabilities and mental health needs from the South Asian community proved to be significant and effective compared with young people and their families accessing services on their own.
    • Medicine information sources used by nurses at the point of care.

      Ndosi, M.; Newell, Robert J. (01/09/2010)
      Aims: To identify sources of medicine information that nurses use while administering medicines.
    • Reducing senility to 'bare life': are we heading for a new Holocaust at mid-C21?

      Capstick, Andrea (04/12/2013)
      The tradition of the oppressed teaches us that the 'state of emergency' in which we live is not the exception but the rule. We must attain to a conception of history that is in keeping with this insight¿.The current amazement that the things we are experiencing are 'still' possible in the twentieth century is not philosophical. This amazement is not the beginning of knowledge, unless it is the knowledge that the view of history which gives rise to it is untenable. (Benjamin, 1940: 248-249) The German-Jewish critical theorist Walter Benjamin (1892-1940) wrote these lines shortly before his death in exile whilst fleeing from the agents of fascism. They seem particularly relevant to a healthcare policy conference with the title ¿Condition Critical¿ taking place almost 70 years later. In this paper one of the things I hope to do is outline how Benjamin¿s concept of the permanent state of emergency relates to health and social care provision for older people with dementia today. Benjamin believed that the Holocaust came about because of the 'amnestic' view of history as an unbroken, linear process of scientific achievement, including the belief in human perfectibility. He suggested that in order to see history stripped of this ideological myth of progress, we need to wake from a collective 'dream history', from our usual somnolent acceptance of surface appearances (Cohen 1993: 5). Similarly it can be argued today that the 20th century 'dream history' of linear progress away from a never-to-be-repeated Holocaust is a myth. My strong claim in this paper is that present day demographic panic related to the economic 'burden of care' for an ageing population is leading to proposed solutions analogous to the ideological killing of psychiatric patients, the physically disabled, Jews and other victims of Nazism in the mid-20th century. Such 'solutions' are fuelled by media propaganda, the profit motives of what has been described as the 'medical-industrial complex' (Bond et al 2004) and a reductive, medicalised, biological determinist model of the cognitive changes of ageing.
    • The Integration of Problem-Based Learning Within a Feminist Curriculum

      Pansini-Murrell, J.; MacVane Phipps, Fiona E.; Haith-Cooper, Melanie; Ball, D. (1998)
    • Implementing Problem Based Learning in a Midwifery Curriculum

      Pansini-Murrell, J.; Haith-Cooper, Melanie; MacVane Phipps, Fiona E.; Ball, D. (1998)
    • Evaluating the Impact of Primary Nursing Practice on the Quality of Nursing Care: A Nigerian Study .

      Archibong, Uduak E. (1999)
      This paper is abstracted from an action research project on promoting family-centred care in Nigeria through the practice of Nigerian Primary Nursing (NMPN). This article will present results of comparative evaluation of the impact of primary nursing on the quality of care received by patients in a 37-bedded acute medical-surgical, mixed sex ward in a specialist hospital in eastern Nigeria. A total of 44 nurses' interactions with 10 patients in the pre-NMPN period and 58 nurses' interactions with eight patients in the post-NMPN period were assessed using QUALPACS (Quality Patient Care Scale.). Results showed a significant improvement in the quality of nursing care with primary nursing practice. The greatest improvement in quality of nursing appeared to be in the elements that address the individual needs of the patient, while the smallest improvements were in the area of physical care--elements of routine, technical nursing care. Implications of the study and recommendations for further studies are made.
    • Problem Based Learning in a Women-centred Midwifery Curriculum

      Haith-Cooper, Melanie; MacVane Phipps, Fiona E.; Pansini-Murrell, J.; Ball, D. (1999)
    • Implementation Of Problem Based Learning in a Midwifery Curriculum

      Haith-Cooper, Melanie; MacVane Phipps, Fiona E.; Pansini-Murrell, J.; Ball, D. (1999)
    • Interobserver variation in reporting CT arthrograms of the shoulder.

      Fogerty, S.; King, D.G.; Groves, C.; Scally, Andy J.; Chandramohan, M. (20/11/2013)
      Computed tomography (CT) arthrography of the shoulder is an imaging modality of great diagnostic accuracy with regard to glenohumeral instability and in particular labral lesions. Interpretation of the scans is made difficult by the frequent occurrence of normal anatomic variants and the complexity of injuries to the bone and soft tissues. We selected a continuous sample of 50 CT arthrograms of the shoulder and they were reported by two consultant musculoskeletal radiologists. The results were collated and analysed for the level of agreement. Hill¿Sachs showed Kappa (K) statistic to be 0.37 (fair agreement), soft tissue Bankart 0.32 (fair agreement), bony Bankart 0.61 (substantial agreement), anterior capsular laxity 0.41 (moderate agreement) and glenohumeral osteoarthritis 0.20 (slight agreement). All the results were significant with a p value of <0.05. Nine (18%) of the 50 scans were in complete agreement. The results demonstrate that there can be considerable interobserver variation (IOV) in the reports of a CT arthrogram of a shoulder. They highlight the potential difficulties in reporting such images and suggests ways in which the report could be more focussed to provide a clinically reliable report and one which matches the surgical findings accurately.
    • Problem-Based Learning within Health Professional Education, What is the Role of the Lecturer? A review of the literature

      Haith-Cooper, Melanie (2000)
      The profile of an effective facilitator has been likened to that of a saint, unfazed by ambiguity, undaunted by student irritation or personal frustration (Katz 1995, p 52). With the increasing popularity of using problem-based learning (PBL) within health professional curricula, it could be argued that the health lecturer’s role in education is changing. As a lecturer, I have only recently become involved in using PBL. With increasing exposure to the process and through reviewing the literature, I have come to realise that the role of the lecturer is fraught with difficulty. The literature is often conflicting with PBL meaning different things to different people (Barrows 1986). It provides no consistent guidelines as to how the lecturer should adapt to undertake this new role. This article explores the issues around the role of the lecturer within PBL and through reviewing the literature, investigates the level of intervention the lecturer should provide when students are undertaking the PBL process. Suggestions will be made to ‘facilitate’ the lecturer into facilitating an effective teaching strategy.
    • Do animals bite more during a full moon? Retrospective observational analysis.

      Bhattacharjee, C.; Bradley, P.; Smith, M.; Scally, Andy J.; Wilson, B.J. (2000)
      Objective: To test the hypothesis that the incidence of animal bites increases at the time of a full moon. Design: Retrospective observational analysis. Setting: Accident and emergency department at a general hospital in an English city. Subjects: 1621 consecutive patients, irrespective of age and sex. Main outcome measures: Number of patients who attended an accident and emergency department during 1997 to 1999 after being bitten by an animal. The number of bites in each day was compared with the lunar phase in each month. Results: The incidence of animal bites rose significantly at the time of a full moon. With the period of the full moon as the reference period, the incidence rate ratio of the bites for all other periods of the lunar cycle was significantly lower (P <0.001). Conclusions: The full moon is associated with a significant increase in animal bites to humans.
    • Bilateral L1 and L2 dorsal root ganglion blocks for discogenic low-back pain.

      Richardson, J.; Collinghan, N.; Scally, Andy J.; Gupta, S (2000)
      Background It is possible that interruption of nociceptive input from intervertebral discs can be modulated through bilateral L1 and L2 dorsal root ganglia (DRG) blockade. In order to test this hypothesis, we prospectively collected data from patients with low-lumbar pain, accurately diagnosed as discogenic using provocation discography. Methods Twelve patients were recruited with a mean (SD) symptom duration of 13.7 (8.2) years. Bilateral DRG blocks of L1 and L2 were performed using methylprednisolone 80 mg, clonidine 75 µg and 0.5% bupivacaine 4 ml in each patient. Results Analysis of Brief Pain Inventories showed no significant change in pain scores. Conclusion We conclude that blocks of this nociceptive pathway in humans using bilateral DRG blocks has no therapeutic value.
    • Nurses' communication skills: an evaluation of the impact of solution-focused communication training

      Mackintosh, Carolyn; Bowles, N.B.; Torn, Alison (2001)
      This paper describes the evaluation of a short training course in solution-focused brief therapy (SFBT) skills. This evaluation examined the relevance of SFBT skills to nursing and the extent to which a short training course affected nurses¿ communication skills. Nurses¿ communication skills have been criticized for many years, as has the training in communication skills that nurses receive. The absence of a coherent theoretical or practical framework for communication skills training led us to consider the utility of SFBT as a framework for a short training course for qualified nurses, the majority of them are registered nurses working with adults. Quantitative and qualitative data were collected: the former using pre- and post-training scales, the latter using a focus group conducted 6 months after the training. Data were analysed using the Wilcoxon signed-rank test and content analysis. Quantitative data indicated positive changes in nurses¿ practice following the training on four dimensions, and changes in nurses¿ willingness to communicate with people who are troubled reached levels of significance. Qualitative data uncovered changes to practice, centred on the rejection of problem-orientated discourses and reduced feelings of inadequacy and emotional stress in the nurses. There are indications that SFBT techniques may be relevant to nursing and a useful, cost-effective approach to the training of communication skills. Solution focused brief therapy provides a framework and easily understood tool-kit that are harmonious with nursing values.
    • Measuring the well-being of people with dementia living in formal care settings: the use of Dementia Care Mapping.

      Innes, C.; Surr, Claire A. (2001)
      Over the years there have been advances in the quality of care provision for people with dementia. How to measure the impact of care on the person with dementia has challenged researchers as, until recently, no evaluation tool offered a comprehensive overview of the behaviour patterns and well-being of persons with dementia. Dementia Care Mapping (DCM) is a tool used by care practitioners and researchers to capture both the process (behaviours) and outcome (well-being) of care and is therefore of use as a tool to evaluate quality of care. This study aims to assess, through DCM, the experience of dementia care provision in residential and nursing homes in two voluntary organizations in England. The data illustrates similarities in the well-being and behaviour patterns of 76 persons with dementia living in six care settings throughout England. Examples of instances when people with dementia were "put down" and when well-being was enhanced, are outlined. The homes in the study were meeting the physical care but not the broader psychosocial care needs of the observed residents. The action taken by the organizations as a result of the DCM evaluations is summarized.
    • The concept of spiritual care in mental health nursing

      Greasley, Peter; Chiu, L.F.; Gartland, M. (2001)
      In this paper we aim to clarify the issue of spiritual care in the context of mental health nursing. Background. The concept of spirituality in nursing has received a great deal of attention in recent years. However, despite many articles addressed to the issue, spiritual care remains poorly understood amongst nursing professionals and, as a result, spiritual needs are often neglected within the context of health care. Methods. A series of focus groups was conducted to obtain the views of service users, carers and mental health nursing professionals about the concept of spirituality and the provision of spiritual care in mental health nursing. Results. According to the views expressed in our focus groups, spiritual care relates to the acknowledgement of a person¿s sense of meaning and purpose to life which may, or may not, be expressed through formal religious beliefs and practices. The concept of spiritual care was also associated with the quality of interpersonal care in terms of the expression of love and compassion towards patients. Concerns were expressed that the ethos of mental health nursing and the atmosphere of care provision were becoming less personal, with increasing emphasis on the `mechanics of nursing¿. Conclusions. The perceived failure of service providers to attend adequately to this component of care may be symptomatic of a medical culture in which the more readily observable and measurable elements in care practice have assumed a prominence over the more subjective, deeply personal components. In order for staff to acknowledge these issues it is argued that a more holistic approach to care should be adopted, which would entail multidisciplinary education in spiritual care.
    • Behaviour modification and gentle teaching workshops: management of children with learning disabilities exhibiting challenging behaviour and implications for learning disability nursing

      Gates, B.; Newell, Robert J.; Wray, J. (2001)
      Background. Challenging behaviours (behaviour difficulties) represent a problem of considerable clinical significance for learning disability nurses, and a source of much human distress. Gentle teaching is a relatively new approach to dealing with behavioural difficulties, and has been received with enthusiasm by clinicians, but has so far received little empirical support. The current study attempted to compare gentle teaching with a well-established alternative (behaviour modification) and a control group. Objectives. To examine the comparative effectiveness of gentle teaching, behaviour modification and control interventions for challenging behaviour amongst children with learning disabilities. Design. Nonrandomized controlled trial. Setting. Service users¿ homes in East Yorkshire. Participants. Seventy-seven children who presented with learning disabilities and challenging behaviour (behaviour difficulties) and their parents. Procedure. One-day workshops in were offered by recognized authorities in either behaviour modification or gentle teaching that were not otherwise involved with the research project. Forty-one participants were recruited to the gentle teaching condition; 36 to behaviour modification; 26 to the control group. Random allocation was not possible, because of the slow uptake by interested parents. Measures was preintervention, and at assessment points up until 12 months following intervention. Analysis. Quantitative analysis of pre¿post differences between the groups, using t-test. Results. In general, no significant differences were found between the treatment groups and controls. Significant improvements were found for both gentle teaching and behaviour modification children over controls on the AAMR ABS XVII (social engagement) subscale. Controls had more contact with medical practitioner (GP) services than behaviour modification children and less than gentle teaching children. Conclusion. Although very few differences were found between the three groups, those that did exist generally favoured behaviour modification. Implications for service provision and learning disability nursing practice are described.