• Pain and delirium in people with dementia in the acute general hospital setting

      Feast, A.R.; White, N.; Lord, Kathryn; Kupeli, N.; Vickerstaff, V.; Sampson, E.L. (2018-11-01)
      Background: Pain and delirium are common in people with dementia admitted to hospitals. These are often under-diagnosed and under-treated. Pain is implicated as a cause of delirium but this association has not been investigated in this setting. Objective: To investigate the relationship between pain and delirium in people with dementia, on admission and throughout a hospital admission. Design: Exploratory secondary analysis of observational prospective longitudinal cohort data. Setting: Two acute hospitals in the UK. Methodology: Two-hundred and thirty participants aged ≥70 years were assessed for dementia severity, delirium ((Confusion Assessment Method (CAM), pain (Pain Assessment in Advanced Dementia (PAINAD)) scale and prescription of analgesics. Logistic and linear regressions explored the relationship between pain and delirium using cross-sectional data. Results: Pain at rest developed in 49%, and pain during activity for 26% of participants during their inpatient stay. Incident delirium developed in 15%, of participants, and 42% remained delirious for at least two assessments. Of the 35% of participants who were delirious and unable to self-report pain, 33% of these participants experienced pain at rest, and 56 experienced pain during activity. The odds of being delirious were 3.26 times higher in participants experiencing pain at rest (95% Confidence Interval 1.03–10.25, P = 0.044). Conclusion: An association between pain at rest and delirium was found, suggesting pain may be a risk factor for delirium. Since pain and delirium were found to persist and develop during an inpatient stay, regular pain and delirium assessments are required to manage pain and delirium effectively.
    • Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards

      Sampson, E.L.; White, N.; Lord, Kathryn; Leurent, B.; Vickerstaff, V.; Scott, S.; Jones, L. (2015-04)
      Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen–Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (b 5 0.20, 95% confidence interval [CI] 5 0.07- 0.32, P 5 0.002) and at rest (b 5 0.41, 95% CI 5 0.14-0.69, P 5 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia.
    • Pakistani women: feeding decisions

      Meddings, Fiona S.; Porter, Jan (2007-07)
      Lecturers Fiona Meddings and Jan Porter of the division of midwifery and women’s health at the School of Health Studies at the University of Bradford detail the difficulties faced by UK Pakistani women in making informed choices on breastfeeding.
    • Palliative care - the new essentials

      Abel, J.; Kellehear, Allan; Karapliagou, Aliki (2018)
      Background: If global palliative care is to successfully address challenges of unequal access, continuity of care, and health services reductionism, new practice models to address these issues need to be identified, debated and tested. This paper offers one such practice model based on a public health approach to palliative care that has so far shown promising evidence of effectiveness. Methods: We describe how four essential elements within a public health model can work together to address quality and continuity of care as well as addressing the numerous barriers of access. These elements are: (I) specialist, and (II) generalist palliative care services working with (III) communities and neighbourhoods, working in their turn with their (IV) key civic institutions. Results: The positive and negative impact and advantages of each of these elements is described and discussed. Conclusions: A solely clinical model of palliative care is inadequate to addressing the multiple comorbidities and access issues characteristic of modern palliative care. A public health approach based on a close partnership between clinical services and communities/civic institutions is the optimal practice model.
    • Palliative care reimagined: a needed shift

      Abel, J.; Kellehear, Allan (2016-03)
      Palliative care, since its inception over 60 years ago, has set the standard of how to care for people who are dying. Key features among these standards have been the professional development of clinical specialisms such as palliative medicine and palliative nursing; the essential addition of the multidisciplinary team to these two new specialisms that included social, spiritual and allied health workers—an outgrowth of the recognition that routine work with the dying, their carers, and the bereaved required more than solely clinical skills; and the unique partnership with communities that yielded the volunteer movement within palliative care. Professional, evidence-based symptom management and the importance of supportive care in its widest possible sense were and remain the cornerstones of the modern palliative care approach. However, the majority of people with terminal illnesses do not have access to palliative care teams, whose main focus of care remains patients with cancer. In the context outlined above this paper therefore poses two key questions: how can we provide an equitable level of care for all people irrespective of diagnosis and how can we increase the range and quality of non-medical/nursing supportive care in a context of diminishing resources? We argue that an important opportunity and solution can be found by adopting the principles of a public health approach to end-of-life care.
    • 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.
    • Pandora box: The eurozone and the euro crisis

      McIntosh, Bryan; Ferretti, F. (2015)
      The global economy has experienced considerable turbulence since 2007. The financial crisis has been viewed as the trigger for a prolonged period of economic decline. This decline remains an issue for all member states of the European Union, the eurozone and beyond. We argue genesis of this crisis lies in the integration negotiations of 1991, ratified in 1992. These produced a flawed economic model within the eurozone. Given the seeds of decay were planted at origin; we argue the solution can be found through a reconstructed eurozone via looser integration, where countries less equipped to deal with the realities of closer integration will be economically independent.
    • Paper 1: Conceptualizing the Transition from Advanced to Consultant Practitioner: Career Promotion or Significant Life Event?

      Hardy, Maryann L.; Nightingale, J. (2014-12)
      Background The diversification of nursing and allied health profession (AHP) roles has seen unprecedented growth as organizations have sought to optimize limited health care resources. Within the UK health care system, the nonmedical consultant is viewed as the pinnacle of the clinical career ladder. Yet, nearly 15 years after their introduction, recruitment to these positions remains slow. Criticisms of nonmedical consultant practice include a lack of role clarity, a failure to work across the four domains of consultant practice, a lack of suitable applicants, and poor preparedness of new appointments. Although there is evidence exploring the nature and effectiveness of established consultant roles, little research addresses the development phase of aspiring consultants. Objectives To explore the transitional journey experienced by trainee consultant radiographers as they move from advanced to consultant practitioner within a locally devised consultant development programme. Design Longitudinal qualitative enquiry. Methods and Settings Five trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. Results A challenging journey was recounted involving five key emotional stages that occurred in a consistent and predictable order (ie, elation, denial, doubt, crisis, and recovery). The identified stages had close parallels with Hopson's Life Events model, suggesting that transition to consultant practice is a significant life event rather than a straightforward job promotion. Conclusions Current emphasis on the four domains of practice, although providing a clear framework for expected external role outcomes, overlooks the importance of the internal or subjective career development on the perceived success or failure of the role. Employers, educators, and professional bodies have a responsibility to facilitate aspirational consultants to explore and enhance their internal career development, offering more time to define themselves and their role with support to guide them through the transition journey.
    • Paper 2: Conceptualizing the Transition from Advanced to Consultant Practitioner: Role Clarity, Self-perception, and Adjustment

      Hardy, Maryann L.; Nightingale, J. (2014-12)
      Interest in the influence of emotions on behaviour, decision making, and leadership has accelerated over the last decade. Despite this, the influence of emotions on career advancement and behaviour within radiography and radiotherapy has largely been ignored. The ease of transition from one work role to another within an individual's career may be influenced by previous experience, personal characteristics, organizational environment, culture, and the nature of the role itself. Consequently, the transition from the often well-defined role of advanced or specialist practitioner to the more fluid role of consultant practitioner is associated with changing emotions as reported in the first part of this two-part series. What remains unexplored are the emotional triggers that pre-empt each stage in the transition cycle and how our understanding of these might support the successful implementation of consultant practitioner roles. To explore the emotional triggers that pre-empted each stage in the transitional journey of trainee consultant radiographers as they moved from advanced to consultant practitioner within a locally devised consultant development program. Five trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. Although all trainee consultant radiographers experienced the emotional events described in the first part of this two-part series in a predictable order (ie, elation, denial, doubt, crisis, and recovery), the timing of the events was not consistent. Importantly, four emotional triggers were identified, and the dominance of these and the reaction of individuals to them determined the emotional well-being of the individual over time. This study provides a unique and hitherto unexplored insight into the transition journey from advanced or specialist practitioner. Importantly, the findings suggest that commonly adopted supportive change interventions may, in fact, trigger the negative emotions they are intended to alleviate and disable rather than enable role transition.
    • Parenting practices and mothers behavioural and demographic factors influencing their 2 year old child's physical activity.

      Horne, Maria; Bingham, D.D.; Nagy, Liana C.; Clemes, S.; Barber, Sally E. (2015-06)
      To identify maternal factors that influence physical activity behaviour in 2 year old children.
    • Participatory action research into implementing open access in musculoskeletal X-ray: Management and staff perspectives

      Barlow, N.; Owens, Melissa (2018-08)
      Neighbouring Trusts have implemented open access (walk-in) services to shorten waiting times in x-ray. Despite this, staff perceptions of their effectiveness have not yet been studied. This study forms the initial baseline evaluation phase of wider participatory action research investigating the implementation of an open access service for general practitioner musculoskeletal x-ray referrals. Staff perceptions regarding effectiveness of the current service were gathered, including their opinions regarding the effectiveness of open access services. Qualitative data were obtained via three semi-structured interviews with radiology management and two (cross-site) staff focus groups over a 2 month period. Template analysis was used to interpret the data with the aid of NVIVO 11 to facilitate analysis. Template analysis uncovered several drivers for changing the current service including waiting times, external pressures, patient choice and administrative delays. ‘Flexibility’ was the key theme to arise during discussion regarding the effectiveness of the current service. Potential for improved access was highlighted as a major benefit to the implementation of open access, however ‘workload’, ‘staffing’ and ‘communication’ were all identified as potential barriers to its implementation. Although several staff members were satisfied with current service several drivers for change were identified that need to be addressed in order to truly deliver a service that fulfils the patients' needs. Results will inform the wider participatory action research that will investigate the barriers to implementing an open access service and identify whether this is indeed a suitable method of addressing the drivers for change.
    • Participatory approaches to assessing the health needs of African-Caribbean communities.

      Okereke, E.; Archibong, Uduak E.; Chiemeka, Michele; Baxter, C.; Davis, S. (2007)
      Previous attempts to involve African and African-Caribbean communities in a city in north England in identifying and assessing their health needs have been largely unsuccessful. A comprehensive literature review highlighted that research on Africans and African-Caribbeans is limited and uneven, and dominated by studies focusing on cardiovascular disease, diabetes, mental health and blood disorders. Health information on these communities is largely based on immigrant mortality statistics derived from national datasets. This paper highlights how participatory approaches to community participation and engagement were used in the assessment of the health needs of culturally diverse minority communities as a means of reducing health disparities. The study sought to overcome the shortcomings of traditional techniques for health needs assessment by testing a novel method of rapid participatory appraisal using a triangulation approach to ensure that all perspectives were addressed. The research adopted a mixed-methods strategy comprising distinct phases: a comprehensive review of the literature, a qualitative needs assessment involving representatives of the African and African-Caribbean communities using meta-planning, and a review of health service provision. The approach used in the study was efficient, rapid and feasible for the African and African-Caribbean people to use in obtaining data from their peers. The findings showed a convergence between areas of need identified by health providers and community members in this appraisal, and between these results and other published literature. However, there was a divergence on the extent of change necessary, with institutional responses stressing alterations within existing systems, and community members recommending the establishment of targeted services for African and African-Caribbean communities run by ethnically matched staff.
    • Participatory video and situated ethics: a pilot study involving people with dementia.

      Capstick, Andrea (2009)
      It might be argued that visual methods are particularly appropriate in research involving participants whose ability to express themselves verbally (eg by means of formal interviews) is compromised for some reason. One such group of participants is people with dementia, a condition often characterised by fluctuations in memory, concentration, comprehension and speech. Whilst increased research into the subjective experience of people with dementia is vital, this can often be hampered by the difficulties of ascertaining participants¿ capacity to give informed consent. Ideally, also, research should go beyond non-malfeasance, and offer real benefits to those involved. People with dementia are all too often subjected to social exclusion and narrative dispossession (Baldwin 2006), so research practice should reverse these trends as far as possible.
    • Participatory Video and Situated Ethics: Avoiding Disablism

      Capstick, Andrea (2012)
      This chapter considers the adaptations which may need to be made to participatory video in order for it to be accessible to people whose marginalized status stems from a label of 'disability', whether this is physical, sensory or cognitive. To date there has been an ill fit between the emancipatory principles of participatory video, and the technical rationality (Schön, 1996) and hypercognitivity (Post, 2000) of its methods. Because participatory video is intended to enable marginalized, socially excluded and unheard groups of people to make films which reflect their own interests and concerns (Robertson & Shaw, 1997), adaptations to allow people with disabilities to take part would appear vital from an ethical point of view. Yet ethical issues in general do not appear to have been given sufficient consideration in the participatory video literature to date, and there is little evidence of engagement with emergent areas of debate such as the ethics of visual research (Prosser, 2008) and the importance of working in solidarity with people with reduced or fluctuating mental capacity (Nuffield Council for Bioethics, 2009).
    • Participatory video and well-being in long-term care

      Capstick, Andrea; Ludwin, Katherine; Chatwin, John; Walters, Elizabeth R. (2016-01)
      Film-making is an effective way of engaging people with dementia and improving their well-being. Andrea Capstick and colleagues explain how ‘participatory video’ gave one group an opportunity to tell their own story in film.
    • Partnership is alive and underpinning healthcare delivery

      McIntosh, Bryan (2015-12-14)
      Bryan McIntosh, senior lecturer in health management and organisational behaviour at the University of Bradford, explores the role of partnerships in the health service.
    • Pathophysiology and pharmacology for nursing students

      Ashelford, Sarah L.; Raynsford, Justine; Taylor, Vanessa (2016)
    • Patient and other factors influencing the prescribing of cardiovascular prevention therapy in the general practice setting with and without nurse assessment

      Mohammed, Mohammed A.; El Sayed, C.; Marshall, T. (2012)
      BACKGROUND: Although guidelines indicate when patients are eligible for antihypertensives and statins, little is known about whether general practitioners (GPs) follow this guidance. OBJECTIVE: To determine the factors influencing GPs decisions to prescribe cardiovascular prevention drugs. DESIGN OF STUDY: Secondary analysis of data collected on patients whose cardiovascular risk factors were measured as part of a controlled study comparing nurse-led risk assessment (four practices) with GP-led risk assessment (two practices). SETTING: Six general practices in the West Midlands, England. PATIENTS: Five hundred patients: 297 assessed by the project nurse, 203 assessed by their GP. MEASUREMENTS: Cardiovascular risk factor data and whether statins or antihypertensives were prescribed. Multivariable logistic regression models investigated the relationship between prescription of preventive treatments and cardiovascular risk factors. RESULTS: Among patients assessed by their GP, statin prescribing was significantly associated only with a total cholesterol concentration >/= 7 mmol/L and antihypertensive prescribing only with blood pressure >/= 160/100 mm Hg. Patients prescribed an antihypertensive by their GP were five times more likely to be prescribed a statin. Among patients assessed by the project nurse, statin prescribing was significantly associated with age, sex, and all major cardiovascular risk factors. Antihypertensive prescribing was associated with blood pressures >/= 140/90 mm Hg and with 10-year cardiovascular risk. LIMITATIONS: Generalizability is limited, as this is a small analysis in the context of a specific cardiovascular prevention program. CONCLUSIONS: GP prescribing of preventive treatments appears to be largely determined by elevation of a single risk factor. When patients were assessed by the project nurse, prescribing was much more consistent with established guidelines.
    • The patient experience of community hospital - the process of care as a determinant of satisfaction.

      Small, Neil A.; Green, J.R.; Spink, Joanna; Forster, A.; Lowson, K.; Young, J. (Blackwell Publishing, 2006)
      Aims and objectives; We report findings from a qualitative study to identify patient views of community hospital care. We consider how far these were in accord with the hospital staffs' views. This constituted part of a wider randomized controlled trial (RCT). The methodological challenges in seeking to identify patient satisfaction and in linking qualitative findings with trial results are explored. Design A sample of 13 patients randomized to the community hospital arm of the RCT joined the qualitative study. Official documentation from the hospital were accessed and six staff interviewed to identify assumptions underlying practice. Results Analysis of interviews identified a complex picture concerning expectations These could be classified as ideal, realistic, normative and unformed. The hospital philosophy and staff views about service delivery were closely in harmony, they delivered rehabilitation in a home-based atmosphere. The formal, or 'hard', process of rehabilitation was not well understood by patients. They were primarily concerned with 'soft' or process issues ¿ where and how care was delivered. Conclusions We identify a model of community hospital care that incorporates technical aspects of rehabilitation within a human approach that is welcomed by patients. If patients are to be able to participate in making informed decisions about care, the rationale for the activities of staff need to be more clearly explained. Recommendations are made about the appropriate scope of qualitative findings in the context of trials and about techniques to access patient views in areas where they have difficulty in expressing critical impressions.