• The perceived impact of an emergency department immediate reporting service: An exploratory survey

      Snaith, Beverly; Hardy, Maryann L. (2013)
      Immediate reporting, commonly referred to as a ‘hot reporting’, has been advocated as a method of effectively supporting clinical decision making. However, its implementation nationally has been limited with poor understanding of its value in practice. A cross sectional attitudinal survey was distributed to emergency department clinicians (medical and nursing staff) and radiographers to explore perceptions of an immediate reporting service in terms of its influence on professional role and autonomy, patient care and service quality. A total of 87 (n = 87/155; 56.1%) completed questionnaires were returned. The findings suggest that significant support for immediate reporting exists. Immediate reporting is believed to improve service quality, reduce clinical errors and provide opportunity for image interpretation skills development. However, responses were not consistent across clinical professions and staff grades. The immediate reporting of emergency department images is perceived to benefit patient, emergency department clinicians and hospital organisation.
    • The Perceptions of Health and Social Care Students of using Mobile 360 Degree Performance Feedback Tools in Practice Placement Settings

      Taylor, J.D.; Dearnley, Christine A.; Laxton, J.C.; Nkosana-Nyawata , Idah D.; Rinomhota, S. (2012)
    • The personal experience of partners of individuals with motor neuron disease

      Oyebode, Jan R.; Smith, H.J.; Morrison, K. (2013)
      Most research on partners' experiences of living with a person with MND is questionnaire-based with no qualitative study focusing on the period between diagnosis and end-of-life care. This study aimed to provide an in-depth qualitative exploration of the experience of living with, and caring for, a partner with MND. Semi-structured interviews were conducted with eight individuals, and transcripts analysed from an interpretative phenomenological perspective. Two main themes were derived. 'Impact on life' included having concern for partner's safety, having social restrictions, being continually tired, struggling with anger and frustration, loss of intimacy and uncertainty around the future; while 'Adjusting to the situation' included trying to be strong, retaining a sense of normality, appreciation of specialist services, adopting a problem-solving approach, living day to day and ability to remain positive. In conclusion, experiences of stress and loss are illustrated in this sample of partners of those with MND, and it is suggested both these aspects should be integrated into understanding of carers' experiences. Carers appear to inhibit their grief in order to appear strong. Greater understanding of the consequences of this would help in providing appropriate emotional support.
    • The perverse psychological contract

      McIntosh, Bryan; Voyer, B.G. (2012)
    • The recruitment of South Asian people into the nursing profession: a knowledge review.

      Darr, Aliya; Atkin, K.; Johnson, M.; Archibong, Uduak E. (2008)
    • The resource costs of wound care in Bradford and Airedale primary care trust in the UK

      Vowden, Kath; Vowden, Peter; Posnett, J. (2009)
      OBJECTIVE: To estimate the resource costs of providing wound care for the 488,000 catchment population of the Bradford and Airedale primary care trust (PCT). METHOD: A wound survey was carried out over a one-week period in March 2007 covering three hospitals in two acute trusts, district nurses, nursing homes and residential homes within the geographical area defined by the PCT. The survey included information on the frequency of dressing change, treatment time and district nurse travel time. The resource costs of wound care in the PCT were estimated by combining this information with representative costs for the UK National Health Service and information on dressing spend. RESULTS: Prevalence of patients with a wound was 3.55 per 1000 population. The majority of wounds were surgical/trauma (48%), leg/foot (28%) and pressure ulcers (21%). Prevalence of wounds among hospital inpatients was 30.7%. Of these, 11.6% were pressure ulcers, of which 66% were hospital-acquired. The attributable cost of wound care in 2006-2007 was pounds 9.89 million: pounds 2.03 million per 100,000 population and 1.44% of the local health-care budget. Costs included pounds 1.69 million spending on dressings, 45.4 full-time nurses (valued at pounds 3.076 million) and 60-61 acute hospital beds (valued at pounds 5.13 million). CONCLUSION: The cost of wound care is significant. The most important components are the costs of wound-related hospitalisation and the opportunity cost of nurse time. The 32% of patients treated in hospital accounted for 63% of total costs. Putting in place care pathways to avoid hospitalisation and avoiding the development of hospital-acquired pressure ulcers and other wound complications are important ways to reduce costs. DECLARATION OF INTEREST: John Posnett is an employee of Smith & Nephew.
    • The Rivermead Mobility Index allows valid comparisons between subgroups of patients undergoing rehabilitation after stroke who differ with respect to age, sex, or side of lesion

      Roorda, L.D.; Green, J.R.; Houwink, A.; Bagley, Pamela J.; Smith, J.; Molenaar, I.W.; Geurts, A.C. (2012)
      OBJECTIVE: To investigate differential item functioning or item bias of the Rivermead Mobility Index (RMI) and its impact on the drawing of valid comparisons with the RMI between subgroups of patients after stroke who differ with respect to age, sex, or side of lesion. DESIGN: Cross-sectional study. SETTING: A rehabilitation center in the Netherlands and 2 stroke rehabilitation units and the wider community in the United Kingdom. PARTICIPANTS: The RMI was completed for patients undergoing rehabilitation after stroke (N=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 269 [43%] right hemisphere lesion, and 304 [49%] left hemisphere lesion). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate differential item functioning of the RMI between subgroups of patients who differed with respect to age (young vs older), sex (men vs women), and side of stroke lesion (right vs left hemisphere). RESULTS: No differential item functioning was found for any of the comparison subgroups. CONCLUSIONS: The RMI allows valid comparisons to be made between subgroups of patients undergoing rehabilitation after stroke who differ with respect to age, sex, or side of lesion.
    • The student experience of piloting multi-modal performance feedback tools in health and social care practice (work)-based settings

      Dearnley, Christine A.; Taylor, J.D.; Laxton, J.C.; Rinomhota, S.; Nkosana-Nyawata , Idah D. (2013)
    • The therapeutic contribution of music in music-assisted systematic desensitization for substance addiction treatment: A pilot study

      Stamou, Vasileios; Clerveaux, R.; Stamou, L.; Le Rocheleuil, S.; Berejnoi, L.; Romo, L.; Graziani, P. (2017-11)
      We previously reported that music-assisted systematic desensitization can counter-condition substance-related cues and reduce the implicated craving responses, as well as improve cognitive and psychopathological components of substance addiction. This follow-up study investigated the therapeutic contribution of listening to recorded New Age relaxing music in counterconditioning external substance-conditioned cues, as well as in the amelioration of everyday life craving reactivity, craving beliefs and depression. Twenty-one substance addicted individuals participated in a three-week randomized controlled trial consisting of two therapeutic sessions per week. Participants were randomly assigned to one of the two study groups, systematic desensitization combined with listening to New Age relaxing music recorded in individual MP3 devices, and systematic desensitization without music. Measurements of craving in response to external substance-conditioned cues, craving beliefs, everyday craving reactivity and depression took place at baseline, post-treatment and one month after the end of treatment. No significant group differences in the outcome measures were observed between both arms of the study but within group and time results suggest that listening to New Age relaxing music significantly enhances systematic desensitization and accounts for significant reductions of craving responses to external substance-conditioned cues and of craving beliefs associated with compulsive behaviour in the music group. Our study provides the first evidence on the potential therapeutic contribution of music to cue counterconditioning in substance addiction treatment. Further investigation on the capacity of music to increase the effectiveness of systematic desensitization seems warranted.
    • 'This is my turn; I¿m talking now¿: findings and new directions from the Ex Memoria project.

      Capstick, Andrea (2009)
      Although training and workforce development are high on the policy agenda at present (eg DoH 2009), there has been less progress in thinking about the kind of education that might be needed in order to provide dementia care that is genuinely person-centred. A continuing obstacle here is the tendency to assume that people who have dementia are to be understood ¿ as a group ¿ by virtue of their shared diagnosis rather than by their lived experience, in which diagnosis is an interruption rather than the whole story. Three approaches to overcoming this obstacle that I will discuss below are arts-based learning, teaching social history awareness, and increasing the involvement of the ¿experts by experience¿, people with dementia themselves.
    • Those who can, teach!

      Beck, Jamie J.W. (2008)
    • Time to make healthcare professions more accessible to women with children

      Archibong, Uduak E.; McIntosh, Bryan; Donaghy, L. (2020-03)
      In response to a recent report published by the Royal College of Nursing, Bryan McIntosh, Uduak Archibong and Louise Donaghy discuss the impact of motherhood, part-time hours and career breaks on the cultural perceptions and experiences of female healthcare professionals.
    • Timely care for frail older people referred to hospital improves efficiency and reduces mortality without the need for extra resources

      Silvester, K.M.; Mohammed, Mohammed A.; Harriman, P.; Girolami, A.; Downes, T.W. (2014-07-01)
      Hospitals are under pressure to reduce waiting times and costs. One strategy that may be effective focuses on optimising the flow of emergency patients. We undertook a patient flow analysis of older emergency patients to identify and address delays in ensuring timely care, without additional resources. Prospective systems redesign study over 2 years. The Geriatric Medicine Directorate in an acute hospital (Sheffield Teaching Hospitals NHS Foundation Trust) with 1920 beds. Older patients admitted as emergencies. Diagnostic patient flow analysis followed by a series of Plan Do Study Act cycles to test and implement changes by a multidisciplinary team using time series run charts. 60% of patients aged 75+ years arrived in the Emergency Department during office hours, but two-thirds of the admissions to GM wards were outside office hours highlighting a major delay. Three changes were undertaken to address this, Discharge to Assess, Seven Day Working and the establishment of a Frailty Unit. Average bed occupancy fell by 20.4 beds (95% confidence interval (CI) -39.6 to -1.2, P = 0.037) for similar demand. The risk of hospital mortality also fell by 2.25% (before 11.4% (95% CI 10.4-12.4%), after 9.15% (95% CI 7.6-10.7%) which equates to a number needed to treat of 45 and a 19.7% reduction in relative risk of mortality. The risk of re-admission remained unchanged. Redesigning the system of care for older emergency patients led to reductions in bed occupancy and mortality without affecting re-admission rates or requiring additional resources.
    • Tools to Assess Pain or Lack of Comfort In Dementia: A Content Analysis

      van der Steen, J.T.; Sampson, E.L.; Van den Block, L.; Lord, Kathryn; Vankova, H.; Sophie, P.; Vandervoort, A.; Radbruch, L.; Shvartzman, P.; Sacchi, V.; et al. (2015-11)
      Context. There is need for tools to help detect pain or lack of comfort in persons unable to communicate. However, pain and (dis)comfort tools have not been compared, and it is unclear to what extent they discriminate between pain and other possible sources of discomfort, or even if items differ. Objectives. To map and compare items in tools that assess pain and the broader notion of discomfort or comfort in people with severe dementia or at the end of life. Methods. Using qualitative content analysis with six classifications, we categorized each item of four thoroughly tested observational pain tools (Pain Assessment in Advanced Dementia [PAINAD], Pain Assessment Checklist for Seniors with Limited Ability to Communicate [PACSLAC], Doloplus-2, and draft Pain Assessment in Impaired Cognition [PAIC]), and four discomfort tools (including distress, comfort, and quality of life in severe dementia or at the end of life; Discomfort ScaleeDementia Alzheimer Type [DS-DAT], Disability Distress Assessment Tool [DisDAT], End-of-Life in DementiaeComfort Assessment in Dying with Dementia [EOLD-CAD], and Quality of Life in Late-Stage Dementia [QUALID] scale). We calculated median proportions to compare distributions of categories of pain and discomfort tools. Results. We found that, despite variable content across tools, items from pain and discomfort tools overlapped considerably. For example, positive elements such as smiling and spiritual items were more often included in discomfort tools but were not unique to these. Pain tools comprised more ‘‘mostly descriptive’’ (median 0.63 vs. 0.44) and fewer ‘‘highly subjective’’ items (0.06 vs. 0.18); some used time inconsistently, mixing present and past observations. Conclusion. This analysis may inform a more rigorous theoretical underpinning and (re)development of pain and discomfort tools and calls for empirical testing of a broad item pool for sensitivity and specificity in detecting and discriminating pain from other sources of discomfort.
    • Towards a collective understanding of Social Cost Benefit and Value

      Nichols, Joanna; Coldwell, Harriet; McIntosh, Bryan; Thornton, G. (2016-03)
      Purpose – The purpose of this article is to argue that a common understanding of the terms social value, social cost benefit, social return on investment etc. would be useful for those seeking to engage with the topic in the fields of health, wellbeing and early family intervention Design/method/approach – The article considers a commissioned study delivered by the authors which reviews the literature pertinent to this field. Findings- The authors suggest that there is considerable confusion with regard to the meaning of terms which are used almost interchangeably in the fields of health, wellbeing and early family intervention. Originality/value – The authors put forward a model to provide consistency of meaning across three levels of interventions.
    • Towards a practice theory of goal setting: assessing the theoretical goal-setting of a leprosy organisation in Nigeria

      Ogbeiwi, Osahon (2020)
      Goal-setting is indispensable for effective healthcare management. Yet, literature evidence suggests many organisations worldwide do not know how to formulate ‘SMART’ goals. Evidence of how existing theories work in practice is scarce, and the practices in low-income countries are unknown. Therefore, this research explored how leprosy project goals were formulated to describe the theoretical practice framework of A leprosy-focused organisation in Nigeria. Using a case-study design, ten managers were interviewed individually concerning their goal-setting knowledge, experience and perspective; and documented goals of six projects were reviewed. A five-step constructionist thematic data analysis generated eleven theoretical frameworks from the concepts of the emergent core themes of ‘stakeholders’, ‘strategies’ and ‘statements.’ Further theorisation reduced them to one general framework. This revealed organisational goal-setting practice as a four-stage centre-led, top-down, beneficiary-focused and problem-based process. The stages were national preparation, baseline needs-survey, centralised goal formulation and nationalised planning. The outcome was the formulation of assigned, ‘non-SMART’ objective statements, which are then used for planning projects. Other theoretical models constructed included a Goal Effects Cycle, ‘SMARTA’ goal attributes and hierarchical criteria for differentiating goal-types. A theory developed from the goal-setting practice postulates that: ‘Assigned non-SMART goal formulation directly results from centralised goal-setting practice and is the predictor of unrealistic project planning.’ Therefore, I propose that goal statements will be ‘SMARTA’ and plans, more realistic and relevant if goal-setting is done collaboratively by all stakeholders at all stages of the process. Also, ‘Change-Beneficiary-Indicator-Target-Timeframe’ and ‘Change-Beneficiary-Location-Timeframe’ frameworks are recommended as templates for writing SMART objectives and aims respectively.
    • Towards diagnostic conversational profiles of patients presenting with dementia or functional memory disorders to memory clinics

      Elsey, C.; Drew, P.; Jones, Danielle K.; Blackburn, D.; Wakefield, S.; Harkness, K.; Venneri, A.; Reuber, M. (2015-09)
      Objective This study explores whether the profile of patients’ interactional behaviour in memory clinic conversations with a doctor can contribute to the clinical differentiation between functional memory disorders (FMD) and memory problems related to neurodegenerative diseases. Methods Conversation Analysis of video recordings of neurologists’ interactions with patients attending a specialist memory clinic. “Gold standard” diagnoses were made independently of CA findings by a multi-disciplinary team based on clinical assessment, neuropsychological testing and brain imaging. Results Two discrete conversational profiles for patients with memory complaints emerged, including (i) who attends the clinic (i.e., whether or not patients are accompanied), and (ii) patients’ responses to neurologists’ questions about memory problems, such as difficulties with compound questions and providing specific and elaborated examples and frequent “I don’t know” responses. Conclusion Specific communicative difficulties are characteristic of the interaction patterns of patients with a neurodegenerative pathology. Those difficulties are manifest in memory clinic interactions with neurologists, thereby helping to differentiate patients with dementia from those with FMD. Practical implications Our findings demonstrate that conversational profiles based on patients’ contributions to memory clinic encounters have diagnostic potential to assist the screening and referral process from primary care, and the diagnostic service in secondary care.
    • Training and action for patient safety: embedding interprofessional education for patient safety within an improvement methodology

      Slater, B.L.; Lawton, R.; Armitage, Gerry R.; Bibby, J.; Wright, J. (2012)
      INTRODUCTION: Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based training program that embeds patient safety within quality improvement methods. METHODS: Kirkpatrick's "levels of evaluation" model was adopted to evaluate the program in health organizations across one city in the north of England. Questionnaires were used to assess reaction of participants to the program (Level 1). Improvements in patient safety knowledge and patient safety culture (Level 2) were assessed using a 12-item multiple-choice questionnaire and a culture questionnaire. Interviews and project-specific quantitative measurements were used to assess changes in professional practice and patient outcomes (Levels 3 and 4). RESULTS: All aspects of the program were positively received by participants. Few participants completed the MCQ at both time points, but those who did showed improvement in knowledge. There were some small but significant improvements in patient safety culture. Interviews revealed a number of additional benefits beyond the specific problems addressed. Most importantly, 8 of the 11 teams showed improvements in patient safety practices and/or outcomes. DISCUSSION: This program is an example of interprofessional education in practice and demonstrates that team-based learning using quality improvement methods is feasible and can be effective in improving patient safety, but requires time and space for participants. Alignment with continuing education arrangements could support mainstream adoption of this approach within organizations.