• Caregivers' beliefs about dementia: findings from the IDEAL study

      Quinn, Catherine; Jones, I.R.; Martyr, A.; Nelis, S.M.; Morris, R.G.; Clare, L.; IDEAL Study Team (2019)
      Objective: Informal caregivers of people with dementia develop their own beliefs about the condition, referred to as Dementia Representations (DRs), as they try to make sense of the changes they are observing. The first aim of this study was to provide a profile of the types of DRs held by caregivers. The second aim was to examine the impact of caregivers’ DRs on their well-being, satisfaction with life (SwL) and caregiving stress. Methods: Participants were 1264 informal caregivers of people in the mild-to-moderate stages of dementia from time-point 1 of the IDEAL cohort study. Measures: DRs were measured using questionnaire items covering: Identity, Cause, Control, and Timeline. Results: Almost half (49.2%) of caregivers used a diagnostic term to describe the person’s condition, although 93.4% of caregivers stated they were aware of the diagnosis. Higher well-being, SwL, and lower caregiving stress were associated with the use of an identity term relating to specific symptoms of dementia, attributing the cause to ageing or not knowing the cause, and believing the condition would stay the same. Lower well-being, SwL, and higher caregiving stress were associated with believing there was little that could be done to control the effects of the condition. Conclusion: Healthcare professionals should assess and gain an understanding of caregivers’ DRs in order to provide more tailored information and support.
    • 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.
    • Caring, the socialisation of pre-registration student nurses, a longitudinal study.

      Mackintosh, Carolyn (2006)
      Background: This study explores the impact of the process of socialisation on pre-registration student nurses views about care, and their personal ability to cope with becoming a nurse. Objectives: It aims to identify the effect time has on participants attitudes and views of care and becoming a nurse, during pre-registration nurse training, by using a descriptive longitudinal qualitative design. Setting: Data collection took place within the School of Health or on student's clinical placement areas, using a random sample of 16 pre-registration student nurses obtained from a convenience sample of 52 volunteers. Methods: Participants were involved in two semi-structured in depth interviews, the first 6-9 months after entering nurse training and the second 6-9 months prior to completion. Interviews were tape recorded, transcribed verbatim and analysed using Morse and Field's (1996) four stages of analysis. Results: Identified changes between data collection stages suggest socialisation results in a loss of idealism about care within nursing, as well as the identification of negative aspects of care. Loss of care is linked to increased abilities to cope with the nursing role, although this is not uniform and some participants clearly discriminate and reject negative exposures. In conclusion this study identifies an under recognised dichotomy between the caring ethos of professional nursing and the professional socialisation processes student nurses are subject to, which directly mitigate against the individual nurses abilities to care.
    • The carnival is not over: cultural resistance in dementia care environments

      Capstick, Andrea; Chatwin, John (2016-04)
      Within the still-dominant medical discourse on dementia, disorders of language (such as dysphasia, aphasia, and perseveration) feature prominently among diagnostic criteria. In this view, changes in ability to produce coherent speech or understand the speech of others are considered to be a direct and inevitable result of neuropathology. Whilst an alternative psychosocial account of communicative challenges in dementia exists, emphasis here is placed largely on the need to compensate for deficits in the language or comprehension of the diagnosed individual and on his or her social positioning by ‘healthy others’. Rather less emphasis has been placed to date people with dementia as social actors who create meaning and draw on contextual clues in order to give shape to their interactions. In this article we draw on Mikhail Bakhtin’s concepts of the carnivalesque, heteroglossia, polyphony and dialogism to analyse a series of interactions involving people with dementia in day and residential care environments. Two main findings are foregrounded. The first, consistent with previous studies, is that many of the communicative challenges faced by people with dementia arise from the social environments in which they find themselves. The second is that the utterances of people with dementia in the face of these social challenges show many of the hallmarks of cultural resistance identified by Bakhtin.
    • The Case for a Sociology of Dying, Death and Bereavement

      Thompson, N.; Allan, J.; Carverhill, N.; Cox, G.; Davies, B.; Doka, K.; Granek, L.; Harris, D.; Ho, A.; Klass, D.; et al. (2016-01-08)
      Dying, death and bereavement do not occur in a social vacuum. How individuals and groups experience these phenomena will be largely influenced by the social context in which they occur. To develop an adequate understanding of dying, death and bereavement we therefore need to incorporate a sociological perspective into our analysis. This paper examines why a sociological perspective is necessary and explores various ways in which sociology can be of practical value in both intellectual and professional contexts. A case study comparing psychological and sociological perspectives is offered by way of illustration.
    • The case for nurses as central providers of health and social care services for ex-offenders: a discussion paper

      Eshareturi, Cyril; Serrant-Green, L.; Bayliss-Pratt, L.; Galbraith, V.E. (2014-05)
      Ex-offenders re-enter their communities with limited pre-release preparation for the continuity of access to health care once outside prison. Once released, these individuals become hard to reach, do not consider health a priority and consequently use services to address their health and social care needs in a crisis-led way. Nevertheless, how nurses can best support these health-excluded group of individuals in the community remains vague and requires discussion. It is argued that current dominant discourses around equity of care are contradicted in the provision of health and social care services to ex-offenders in the community. Effective engagement with community interventions may be achieved if ex-offenders maintain contact with frontline providers who can support both their structural and health needs. Nurses are uniquely positioned to initiate and sustain contact with ex-offenders, intervening at points of greatest need in the community to address the socially significant health and social care issues that plague them. The use of nurses in the provision of health and social care interventions to ex-offenders is a strategy, which could increase equity in access to health care, reduce reoffending and improve both the health and life chances of these individuals.
    • The case of the missing skills - Business development opportunities using a holistic approach to CSR, incorporating figurational dynamics

      McIntosh, Bryan (2017)
      This paper examines the feasibility of using a holistic approach to sustainability in a business context. The aim is to help organisations from a healthcare perspective increase their adaptability to volatile business environments, by aligning external and internal elements with success, based on internal validation of output. A literature review on existing sustainability theory was conducted and the results divided into versions of sustainability from an initial idea (1.0), to a situation where sustainably will become the nature of business rather than one of its objectives (4.0). In order to align business health and strengthen self-healing powers of businesses, eight pillars of relevance were identified as post conditional. The method adopted to interpret the approaches was informed by a structured process of healthcare perspectiveness healing using figurational dynamics as an analytical lens. Findings indicate that for implementation of an improvement structure based on holistic governance to be successful, acceptance of changes in economic, political and social spheres towards holistic business development need to exist. Secondly, figurational dynamics has to evolve as an overarching or inclusive system to include influences and inspiration from various specialist arenas.
    • Case-mix adjusted hospital mortality is a poor proxy for preventable mortality: a modelling study

      Girling, A.J.; Hofer, T.P.; Wu, J.; Chilton, P.J.; Nicholl, J.P.; Mohammed, Mohammed A.; Lilford, R.J. (2012)
      Risk-adjustment schemes are used to monitor hospital performance, on the assumption that excess mortality not explained by case mix is largely attributable to suboptimal care. We have developed a model to estimate the proportion of the variation in standardised mortality ratios (SMRs) that can be accounted for by variation in preventable mortality. The model was populated with values from the literature to estimate a predictive value of the SMR in this context-specifically the proportion of those hospitals with SMRs among the highest 2.5% that fall among the worst 2.5% for preventable mortality. The extent to which SMRs reflect preventable mortality rates is highly sensitive to the proportion of deaths that are preventable. If 6% of hospital deaths are preventable (as suggested by the literature), the predictive value of the SMR can be no greater than 9%. This value could rise to 30%, if 15% of deaths are preventable. The model offers a 'reality check' for case mix adjustment schemes designed to isolate the preventable component of any outcome rate.
    • Celebrating Nursing Practice: The value of writing for publication

      Kelsey, Catherine (2018-01-08)
      Nursing Lecturer, Catherine Kelsey, reflects on developing her Celebrating Nursing Practice project.
    • Challenges and Opportunities for Ex-offender Support Through Community Nursing

      Eshareturi, Cyril; Serrant, L. (2018)
      This study was a qualitative case study underpinned by “The Silences Framework” aimed at mapping the ex-offender health pathway towards identifying “touch points” in the community for the delivery of a nurse-led intervention. Participants meeting the study inclusion criteria were quantitatively ranked based on poor health. Participants scoring the lowest and endorsing their ranking through a confirmation of a health condition were selected as cases and interviewed over 6 months. Individuals in the professional networks of offenders contextualized emergent themes. The study indicated that pre-release, offenders were not prepared in prison for the continuity in access to healthcare in the community. On release, reintegration preparation did not routinely enquire whether offenders were still registered with a general practitioner or had the agency to register self in the community. Participants identified the site of post-release supervision as the “touch point” where a nurse-led intervention could be delivered.
    • Challenging representations of dementia in contemporary Western fiction film: from epistemic injustice to social participation

      Capstick, Andrea; Chatwin, John; Ludwin, Katherine (2015)
      Fiction film is one of the most influential vehicles for the popularization of dementia. It is likely to have a particular influence on the way dementia is constructed by society at large, not least due to its consumption in the guise of entertainment. In this paper, we will argue that such popularization is rarely innocent or unproblematic. Representations of people with dementia in film tend to draw heavily on familiar tropes such as global memory loss, violence and aggression, extreme dependency on heroic carers, catastrophic prognosis, and early death. Audiences may therefore uncritically absorb discourses which reinforce negative stereotypes and perpetuate the biomedical orthodoxy that everything a person with dementia says or does is ‘a symptom of the disease.’
    • Changes in admission thresholds in English Emergency Departments

      Wyatt, S.; Child, K.; Hood, A.; Cooke, M.; Mohammed, Mohammed A. (2017-12)
      Background: The most common route to a hospital bed in an emergency is via an emergency department (ED). Many recent initiatives and interventions have the objective of reducing the number of unnecessary emergency admissions. We aimed to assess whether ED admission thresholds had changed over time taking account of the casemix of patients arriving at ED. Methods: We conducted a retrospective cross-sectional analysis of more than 20 million attendances at 47 consultant-led emergency departments in England between April 2010 and March 2015. We used mixed- effects logistic regression to estimate the odds of a patient being admitted to hospital and the impact of a range of potential explanatory variables. Models were developed and validated for four attendance subgroups : ambulance-conveyed children; walk-in children; ambulance-conveyed adults; and walk-in adults. Results: 23.8% of attendances were for children aged under 18 years, 49.7% were female and 30.0% were conveyed by ambulance. The number of ED attendances increased by 1.8% per annum between April 2010 – March 2011 (year 1) and April 2014 –March 2015 (year 5). The proportion of these attendances that were admitted to hospital changed little between year 1 (27.0%) and year 5 (27.5%). However, after adjusting for patient and attendance characteristics the odds of admission over the five year period had reduced by: 15.2% (95% CI 13.4% - 17.0%) for ambulance-conveyed children; 22.6% (95% CI 21.7%-23.5%) for walk-in children; 20.9% (95% CI 4%-21.5%) for ambulance conveyed adults; and 22.9% (95% CI 22.4%-23.5%) for walk-in adults. Conclusions: The casemix-adjusted odds of admission via ED to NHS hospitals in England have decreased since April 2010. EDs are admitting a similar proportion of patients to hospital despite increases in the complexity and acuity of presenting patients. Without these threshold changes, the number of emergency admissions would have been 11.9% higher than was the case in year 5.
    • Characterization of Changes in the Proteome in Different Regions of 3D Multicell Tumor Spheroids

      McMahon, Kelly M.; Volpato, Milène; Chi, H.Y.; Musiwaro, P.; Poterlowicz, Krzysztof; Peng, Yonghong; Scally, Andy J.; Patterson, Laurence H.; Phillips, Roger M.; Sutton, Chris W. (2012)
      Three dimensional multicell tumor spheroids (MCTS) provide an experimental model where the influence of microenvironmental conditions on protein expression can be determined. Sequential trypsin digestion of HT29 colon carcinoma MCTS enabled segregation into four populations comprising proliferating cells from the surface (SL), an intermediate region (IR), nonproliferating hypoxic cells from the perinecrotic region (PN), and a necrotic core (NC). Total protein was extracted from each population and subjected to iTRAQ-based quantitative proteomics analysis. From a total of 887 proteins identified, 209 were observed to be up-regulated and 114 were down-regulated in the PN and NC regions relative to the SL. Among the up-regulated proteins, components of glycolysis, TCA cycle, lipid metabolism, and steroid biosynthesis increased progressively toward the PN and NC regions. Western blotting, immunohistochemistry, and enzyme assays confirmed that significant changes in the expression of proteins involved in cellular metabolism occur in the nonproliferating fraction of cells within the viable rim. The presence of full length, functional proteins within the NC was unexpected, and further analysis demonstrated that this region contains cells that are undergoing autophagy. This study has identified possible targets that may be suitable for therapeutic intervention, and further studies to validate these are required.
    • Choosing summary statistics by least angle regression for approximate Bayesian computation

      Faisal, Muhammad; Futschik, A.; Hussain, I.; Abd-el.Moemen, M. (2016)
      Bayesian statistical inference relies on the posterior distribution. Depending on the model, the posterior can be more or less difficult to derive. In recent years, there has been a lot of interest in complex settings where the likelihood is analytically intractable. In such situations, approximate Bayesian computation (ABC) provides an attractive way of carrying out Bayesian inference. For obtaining reliable posterior estimates however, it is important to keep the approximation errors small in ABC. The choice of an appropriate set of summary statistics plays a crucial role in this effort. Here, we report the development of a new algorithm that is based on least angle regression for choosing summary statistics. In two population genetic examples, the performance of the new algorithm is better than a previously proposed approach that uses partial least squares.
    • Chronic pain: clinical features, assessment and treatment

      Mackintosh, Carolyn; Elson, Sue (2008)
      A significant number of people in the UK experience chronic pain, resulting in high levels of suffering and reduced quality of life. Management of chronic pain is complex, time consuming and not always successful. Good communication between patients and healthcare professionals is essential to ensure realistic treatment plans and outcomes can be negotiated. Accurate assessment is also key, and nurses play a fundamental role in ensuring patients with chronic pain receive the most appropriate care.