• Dementia Care Mapping (DCM): initial validation of DCM 8 in UK field trials.

      Brooker, Dawn J.R.; Surr, Claire A. (2006)
      Objectives This paper describes DCM 8 and reports on the initial validation study of DCM 8. Methods Between 2001-2003, a series of international expert working groups were established to examine various aspects of DCM with the intention of revising and refining it. During 2004-2005 the revised tool (DCM 8) was piloted in seven service settings in the UK and validated against DCM 7th edition. Results At a group score level, WIB scores and spread of Behavioural Category Codes were very similar, suggesting that group scores are comparable between DCM 7 and 8. Interviews with mappers and focus groups with staff teams suggested that DCM 8 was preferable to DCM 7th edition because of the clarification and simplification of codes; the addition of new codes relevant to person-centred care; and the replacement of Positive Events with a more structured recording of Personal Enhancers. Conclusions DCM 8 appears comparable with DCM 7th edition in terms of data produced and is well received by mappers and dementia care staff.
    • The end of the road? CPD in the NHS

      McIntosh, Bryan; Hart, Andrew (2016-12-06)
      This article considers how cuts in Government funding will affect continuing professional development and mentorship training for NHS staff
    • Expectations and realities of Student Nurses' Experiences of negative Behaviour and Bullying in Clinical Placement and the Influences of Socialisation Processes.

      Hoel, H.; Giga, Sabir I.; Davidson, M.J. (2007)
      This paper explores nursing students' experiences and perceptions of negative behaviour and bullying in clinical placement measured against expectations at the start of their education. It explores their understanding and how they make sense of their circumstances and their experiences of negative behaviour, emphasizing socialization processes and factors which may prevent or reproduce negative behaviour and bullying. To this end, a focus group study was conducted, and this revealed that many students felt exploited, ignored or were made to feel unwelcome, although few reported personal experience of bullying. These frequent but less severe negative experiences appear to play a key role in institutionalizing an unwelcoming culture within which bullying could easily be triggered or take hold. Students' coping mechanisms may also contribute to reproducing such negative behaviour. The paper concludes that while the vulnerable position of student nurses might offer some protection against outright bullying, it is unable to shield them from unfriendly and negative behaviour, with implications for their learning and professional socialization. If student nurses respond to their experiences by suppressing their feelings and developing a hard front, such responses may themselves contribute to a reproduction of such behaviour with implications for personal wellbeing and retention rates.
    • Muslims and Community Cohesion in Bradford: Factors contributing to community cohesion, as it affects recently arrived migrants and established Muslim communities

      Samad, A. Yunas (2010)
      This study examined factors that either enhance or undermine community cohesion in areas with established Muslim communities and into which Muslim migrants have recently arrived. It explores ethnic and religious interaction; kinship and friendship networks; political and civic participation; community and people's feelings of belonging to Britain; and local policy-maker' and practitioners' views.
    • Not a level playing field: a qualitative study exploring structural, community and individual determinants of greenspace use amongst low-income multi-ethnic families

      Cronin de Chavez, A.; Islam, Shahid; McEachan, R.R.C. (2019-03)
      Greenspace is important for physical and mental health. Low-income, multi-ethnic populations in deprived urban areas experience several barriers to using greenspace. This may exacerbate health inequalities. The current study explored structural and individual determinants of greenspace use amongst parents of young children in an urban, deprived, multi-cultural area situated in the North of England, UK. Semi-structured in-depth interviews and focus group discussions were conducted with 30 parents of children aged 0–3 between December 2016 and May 2017 from a range of ethnic groups. Thematic analyses were informed by the Human Health Habitat Map and the Theoretical Domains Framework. The results show that whilst all families recognised the benefits of greenspaces, use was bounded by a variety of structural, community, and individual determinants. Individual determinants preventing use included lack of knowledge about where to go, or how to get there and confidence in managing young children whilst outdoors. Fear of crime, antisocial behaviour and accidents were the overriding barriers to use, even in high quality spaces. Social and community influences both positively encouraged use (for example, positive social interactions, and practical support by others) and prevented use (antisocial or inappropriate behaviours experienced in greenspace). The built environment was a key barrier to use. Problems related to unsuitable or unsafe playgrounds, no gardens or safe areas for children's play, poor accessibility, and lack of toilets were identified. However, the value that parents and children placed on natural blue and green features was an enabler to use. Contextual influences included external time pressures, difficulties of transporting and caring for young children and poor weather. Multi-sectoral efforts are needed to tackle the uneven playing field experienced by multi-ethnic, urban, deprived communities. Initiatives to increase use should tackle structural quality issues, addressing fears about safety, whilst simultaneously encouraging communities to reclaim their local greenspaces.
    • Palliative curriculum re-imagined: A critical evaluation of the UK Palliative Medicine Syllabus

      Abel, J.; Kellehear, Allan (2018-05)
      The UK Palliative Medicine Syllabus is critically evaluated to assess its relationship and relevance to contemporary palliative care policy and direction. Three criteria are employed for this review: (1) relevance to non-cancer dying, ageing, caregivers, and bereaved populations; (2) uptake and adoption of well-being models of public health alongside traditional illness and disease models of clinical understanding; and (3) uptake and integration of public health insights and methodologies for social support. We conclude that the current syllabus falls dramatically short on all 3 criteria. Suggestions are made for future consultation and revision.
    • Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting.

      Evans, A.L.; Scally, Andy J.; Wellard, S.J.; Wilson, J.D. (2007)
      Objectives: High prevalence of bacterial vaginosis (BV) has been reported in lesbians but most studies were based in sexually transmitted infection clinic settings; therefore, we wished to determine the prevalence and risk factors of BV in lesbians and heterosexual women in a community setting in the UK. Methods: A cross-sectional study recruiting lesbian women volunteers from community groups, events, clubs and bars. Heterosexual women were recruited from a community family planning clinic. They self-swabbed to create a vaginal smear, which was Gram-stained and categorised as BV, intermediate or normal flora. They completed a questionnaire about age, ethnic group, smoking, genital hygiene practices and sexual history. Results: Of 189 heterosexuals and 171 lesbians recruited, 354 had gradeable flora. BV was identified in 43 (25.7%) lesbians and 27 (14.4%) heterosexuals (adjusted OR 2.45, 95% CI 1.25 to 4.82; p¿=¿0.009). Concordance of vaginal flora within lesbian partnerships was significantly greater than expected (27/31 (87%) couples, ¿¿=¿0.63; p<0.001). Smoking significantly increased the risk of BV regardless of sexuality (adjusted OR 2.65; p¿=¿0.001) and showed substantial concordance in lesbian partnerships but less than for concordance of flora. Conclusions: Women who identified as lesbians have a 2.5-fold increased likelihood of BV compared with heterosexual women. The prevalence is slightly lower than clinic-based studies and as volunteers were recruited in community settings, this figure may be more representative of lesbians who attend gay venues. Higher concordance of vaginal flora within lesbian partnerships may support the hypothesis of a sexually transmissible factor or reflect common risk factors such as smoking.
    • Protecting the self: a descriptive qualitative exploration of how Registered Nurses cope with working in surgical areas.

      Mackintosh, Carolyn (Elsevier, 2007)
      Aims This paper aims to explore and describe how qualified nurses working with in, in-patient surgical areas cope with the daily experiences they are exposed to. Background It has long been recognised that many aspects of nursing work can result in high levels of stress, with negative consequences for the individual nurse and patient care. Difficulties in coping with nursing work can also result in burnout, as well as raising concerns about cognitive dissonance, emotional labour and the use of emotional barriers. Why some nurses are more prone to experience these phenomena than others, is unclear. Method A descriptive qualitative approach is taken using a purposive, theoretically congruent sample of 16 qualified registered nurses all of whom participated in a semi-structured interview during 2002. All interviews were tape recorded and transcribed verbatim and then analysed using the four stages outlined by Morse and Field [Morse, J.M., Field, P.A., 1996. Nursing Research: The Application of Qualitative Approaches. Chapman & Hall, London]. Findings Three key themes emerged from analysis; relationships with patients, being a person and the effect of experience. All three interlink to describe a process whereby the individual switches off from the environment around them by adopting a working persona which is different but related to their own personal persona and is beneficially enhanced as a consequence of experience. Conclusion Working as a nurse results in exposure to potentially distressing and stressful events from which it is important to protect the self. Participants in this study achieve protection by the development of a working persona which facilitates switching off and is beneficially enhanced by experience.
    • Reporting drug errors in a British Acute Hospital Trust.

      Armitage, Gerry R.; Newell, Robert J.; Wright, J. (2007)
      Purpose - The purpose of this article is to examine a sample of paper-based incident reports concerning drug incidents to assess the utility of a reporting system. Design/methodology/approach - A 50 per cent random sample of drug-related incident reports between 1999 and 2003 (n=1,253) was reviewed. Details of the incident including error type and contributory factors were identified, as was status of the reporter. Content analysis of the free text established whether the data provided could promote medication safety and organisational learning. Findings The paper finds that all definitive drug errors (n=991) allowed an error type to be identified, but 276 (27.8 per cent) did not include the contributory factor(s) involved. Content analysis of the errors demonstrated an inconsistent level of completeness, and circumstances, causation and action taken were not always logically related. Inter-rater reliability scores were varied. There was sometimes a significant focus on the actions of one individual in comparison to other factors. Research limitations/implications - Incident reports can be biased by psychological phenomena, and may not be representative of the parent organisation other than those who report. This study was carried out in a single health care organisation and generalisability may be questioned. Practical implications - How health professionals interpret drug errors and their reporting could be improved. Reporting can be further developed by reference to taxonomies, but their validity should be considered. Incident report analysis can provide an insight into the competence of individual reporters and the organisation's approach to risk management. Originality/value - This paper highlights the various data that can be captured from drug error reports but also their shortfalls which include: superficial content, incoherence; and according to professional group - varied reporting rates and an inclination to target individuals.
    • A Review of organisational Stress Management Interventions

      Giga, Sabir I.; Cooper, C.L.; Faragher, B.; Noblet, A.J. (2003)
    • Strategies for assessing renal function prior to outpatient contrast-enhanced CT: a UK survey

      Harris, Martine A.; Snaith, Beverly; Clarke, R. (2016)
      The purpose of this paper is to identify current UK screening practices prior to contrast-enhanced CT. To determine the patient management strategies to minimize the risk of contrast-induced acute kidney injury (CI-AKI) risk in outpatients. An invitation to complete an electronic survey was distributed to the CT managers of 174 UK adult National Health Service hospital trusts. The survey included questions related to local protocols and national guidance on which these are based. Details of the assessment of renal function prior to imaging and thresholds for contrast contraindication and patient management were also sought. A response rate of 47.1% was received. Almost all sites had a policy in place for contrast administration (n = 80/82; 97.6%). The majority of sites require a blood test on outpatients undergoing a contrast-enhanced CT scan (n = 75/82; 91.5%); however, some (15/75; 20.0%) sites only check the result in patients at high risk and a small number (7/82; 8.5%) of sites indicated that it was a referrer responsibility. The estimated glomerular filtration rate (eGFR) or serum creatinine (SCr) result threshold at which i.v. contrast was contraindicated varied and 19 different threshold levels of eGFR or SCr were identified, each leading to different prophylactic strategies. Inconsistency was noted in the provision of follow-up blood tests after contrast administration. The wide variation in practice reflects inconsistencies in published guidance. Evidence-based consensuses of which patients to test and subsequent risk thresholds will aid clinicians identify those patients in which the risk of CI-AKI is clinically significant but manageable. There is also a need to determine the value of the various prophylactic strategies, follow-up regimen and efficient service delivery pathways. This survey has identified that further work is required to define which patients are high risk, confirm those which require renal function testing prior to contrast administration and how best to manage patients at risk of CI-AKI. The role of new technologies within this service delivery pathway requires further investigation.
    • Test-retest reproducibility of accommodation measurements gathered in an unselected sample of UK primary school children

      Adler, P.; Scally, Andy J.; Barrett, Brendan T. (2012)
      Purpose To determine the test-retest reproducibility of accommodation measurements gathered in an unselected sample of primary school children. Methods Monocular and binocular amplitudes of accommodation (AA) were collected by five different Testers using the push-up method in an unselected sample of school children (n=137, age: 8.1±2.1-years). Testing was conducted on three occasions (average testing interval: 8-days) in 91.2% of the children. Results The median AA was 19.1D, the variation due to the identity of the Tester was 3.1D (p<0.001) and the within-subject variation (which takes the variation due to Tester identity into account) was 5.2D. Around 75-79% of children exhibited monocular AAs-12D when tested on the first occasion, but more than 90% exhibited an AA-12D when subsequently tested. Around 74-80% of those with an AA<12D on the first occasion had values-12D on subsequent testing even though no treatment had been undertaken. Poorer initial AA measurements were less likely to improve on repeat testing. Conclusions Our results reveal substantial intra-individual variation in AA measurements, raising questions about the usefulness of this test in children aged 4-12-years. We suggest that AA assessment may prove most useful in children in this age range as a pass/fail check for substantially reduced AA, for example, where the AA is <12D. Our sample would suggest that the prevalence of persistently reduced AA may be around 3.2% when tested under binocular conditions and 4-6.4% when tested monocularly.
    • The use of biomedicine, complementary and alternative medicine, and ethnomedicine for the treatment of epilepsy among people of South Asian origin in the UK

      Rhodes, P.J.; Small, Neil A.; Wright, J.; Ismail, Hanif (2008)
      Studies have shown that a significant proportion of people with epilepsy use complementary and alternative medicine (CAM). CAM use is known to vary between different ethnic groups and cultural contexts; however, little attention has been devoted to inter-ethnic differences within the UK population. We studied the use of biomedicine, complementary and alternative medicine, and ethnomedicine in a sample of people with epilepsy of South Asian origin living in the north of England. Interviews were conducted with 30 people of South Asian origin and 16 carers drawn from a sampling frame of patients over 18 years old with epilepsy, compiled from epilepsy registers and hospital databases. All interviews were tape-recorded, translated if required and transcribed. A framework approach was adopted to analyse the data. All those interviewed were taking conventional anti-epileptic drugs. Most had also sought help from traditional South Asian practitioners, but only two people had tried conventional CAM. Decisions to consult a traditional healer were taken by families rather than by individuals with epilepsy. Those who made the decision to consult a traditional healer were usually older family members and their motivations and perceptions of safety and efficacy often differed from those of the recipients of the treatment. No-one had discussed the use of traditional therapies with their doctor. The patterns observed in the UK mirrored those reported among people with epilepsy in India and Pakistan. The health care-seeking behaviour of study participants, although mainly confined within the ethnomedicine sector, shared much in common with that of people who use global CAM. The appeal of traditional therapies lay in their religious and moral legitimacy within the South Asian community, especially to the older generation who were disproportionately influential in the determination of treatment choices. As a second generation made up of people of Pakistani origin born in the UK reach the age when they are the influential decision makers in their families, resort to traditional therapies may decline. People had long experience of navigating plural systems of health care and avoided potential conflict by maintaining strict separation between different sectors. Health care practitioners need to approach these issues with sensitivity and to regard traditional healers as potential allies, rather than competitors or quacks.
    • Variation and interactional non-standardization in neuropsychological tests: The case of the Addenbrooke’s Cognitive Examination

      Jones, Danielle K.; Wilkinson, R.; Jackson, C.; Drew, P. (2020-02)
      The Addenbrooke’s Cognitive Examination (ACE-111) is a neuropsychological test used in clinical practice to inform a dementia diagnosis. The ACE-111 relies on standardized administration so that patients’ scores can be interpreted by comparison with normative scores. The test is delivered and responded to in interaction between clinicians and patients, which places talk-in-interaction at the heart of its administration. In this article, conversation analysis (CA) is used to investigate how the ACE-111 is delivered in clinical practice. Based on analysis of 40 video/audio-recorded memory clinic consultations in which the ACE-111 was used, we have found that administrative standardization is rarely achieved in practice. There was evidence of both (a) interactional variation in the way the clinicians introduce the test and (b) interactional non-standardization during its implementation. We show that variation and interactional non-standardization have implications for patients’ understanding and how they might respond to particular questions.