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  • Perineal Trauma & Suturing

    Chapman, Vicky; Independent Researcher (Wiley Blackwell, 2018-01-18)
  • How does a narrative understanding of change in families post brain injury help us to humanise our professional practice?

    Whiffin, C J; Ellis-Hill, C; University of Derby; Bournemouth University (Cambridge university press, 2021-09-17)
    In this paper we critically explore the discourse of change post brain injury and challenge the dominant discourse of negative change which alone leaves little room for other perspectives to exist. These negative changes pose a considerable risk to the well-being of families who may benefit from engaging in richer accounts making room for a more coherent and connected sense of self and family post-injury. We explore how narrative approaches provide opportunities for all practitioners to expand their professional scripts and support families to move toward a future which is not dominated by a discourse of loss. While loss and negative change is an important, and very real consequence, of brain injury, focusing purely on stories of loss is life limiting for family members and can cause psychological distress. The life thread model is offered as a visible tool for all practitioners to engage with and use while working with families; providing a concrete focus for reflection and discussion of narratives relating to change which otherwise can feel quite abstract in everyday practice. We argue that one way we can humanise our professional practice is to support all practitioners to engage in a narrative understanding of family change following ABI.
  • Oro-mucosal midazolam maleate: Use and effectiveness in adults with epilepsy in the UK

    Shankar, Rohit; Goodwin, Melesina; Toland, John; Boyle, Andrew; Grant, Amanda; Pearson, Josephine; Storer, Amanda; Higgins, Richard; Hudson, Sharon; Reuber, Markus; et al. (Elsevier, 2021-08-07)
    Oro-mucosal midazolam maleate (OMM) with suitable training to family and carers is being increasingly recognized as the treatment of choice to mitigate the development of status epilepticus in non-hospital community settings. There are no studies to describe the use, effectiveness, and suitable dosing of OMM in adults with epilepsy in community settings. To describe the use, effectiveness, and dosing of OMM in the emergency treatment of epileptic seizures in community settings. A retrospective observational study (2016–17) design was used with participant recruitment from four UK NHS secondary care outpatient clinics providing epilepsy management. Study sample was of adult people with epilepsy (PWE) having had a recent seizure requiring OMM. Data on patient demographics, patient care plans, details of a recent seizure requiring emergency medication, and dose of OMM were collected from medical records. Study data from 146 PWE were included. The mean age of PWE was 41.0 years (SD 15.2) and mean weight was 64.8Kg (SD 18.2). Fifty-three percent of PWE were recorded as having intellectual disability. The most frequently used concomitant medications were lamotrigine (43%). The majority of seizures occurred at people’s homes (n = 92, 63%). OMM was most often administered by family/professional care-givers (n = 75, 48.4%). Generalized (tonic/clonic) seizures were recorded in most people (n = 106, 72.6%). The most common initial dose of OMM was 10 mg (n = 124, 84.9%). The mean time to seizure cessation after administration of this initial dose was 5.5 minutes (SD = 4.5, Median 5.0, IQR 2.1–5.0). Only a minority of seizures led to ambulance callouts (n = 18, 12.3%) or hospital admissions (n = 13, 9%). This is the first observational study describing the use and effectiveness of OMM in adults in community settings. Minimal hospital admissions were reported in this cohort and the treatment was effective in ending seizures in adults in community settings.
  • 'Mixed white and Black Caribbean' millennials in Britain: An exploration of identity

    Clarke, Yasmine; University of Derby (Wiley, 2021-07-26)
    This study presents a qualitative exploration of individuals identifying as ‘mixed white and Black Caribbean’ (MWBC) in Britain. The focus of this research aimed to answer the question, 'how do mixed white and Black Caribbean millennials in Britain experience their identity?' Six participants, aged 22–31 years, were interviewed about their family, relationships and personal values. The results were analysed using interpretative phenomenological analysis and highlighted three main themes: ‘Public Perception’, ‘Caribbean Heritage’ and ‘Conversations’. Each theme was analysed from an integrative psychotherapeutic viewpoint, before concluding with suggestions for counsellors and psychotherapists working with this client group in clinical practice.
  • An Analysis of Frequency of Continuous Blood Pressure Variation and Haemodynamic Responses during Haemodialysis.

    Latha Gullapudi, Venkata R; White, Kelly; Stewart, Jill; Stewart, Paul; Eldehni, Mohammed T; Taal, Maarten W; Selby, Nicholas M; University of Derby; University of Nottingham (Karger, 2021-07-22)
    Higher beat-to-beat blood pressure (BP) variation during haemodialysis (HD) has been shown to be associated with elevated cardiac damage markers and white matter ischaemic changes in the brain suggesting relevance to end-organ perfusion. We aimed to characterize individual patterns of BP variation and associated haemodynamic responses to HD. Fifty participants underwent continuous non-invasive haemodynamic monitoring during HD and BP variation were assessed using extrema point (EP) frequency analysis. Participants were divided into those with a greater proportion of low frequency (LF, n = 21) and high frequency (HF, n = 22) of BP variation. Clinical and haemodynamic data were compared between groups. Median EP frequencies for mean arterial pressure (MAP) of mid-week HD sessions were 0.54 Hz (interquartile range 0.18) and correlated with dialysis vintage (r = 0.32, p = 0.039), NT pro-BNP levels (r = 0.32, p = 0.038), and average real variability (ARV) of systolic BP (r = 0.33, p = 0.029), ARV of diastolic BP (r = 0.46, p = 0.002), and ARV of MAP (r = 0.57, p < 0.001). In the LF group, MAP positively correlated with cardiac power index (CPI) in each hour of dialysis, but not with total peripheral resistance index (TPRI). In contrast, in the HF group, MAP correlated with TPRI in each hour of dialysis but only with CPI in the first hour. EP frequency analysis of continuous BP monitoring during dialysis allows assessment of BP variation and categorization of individuals into low- or high-frequency groups, which were characterized by different haemodynamic responses to dialysis. This may assist in improved individualization of dialysis therapy.
  • Changing student mental health nurse’s attitudes towards younger and older people through teaching: A qualitative longitudinal study

    Collier, Elizabeth; Foster, Celeste; Sutton, Katie; Holmes, Tracee; Jones, Ben; University of Salford; University of Derby (University of Salford and University of Derby, 2021-08)
    This paper reports on a qualitative longitudinal research (QLR) study investigating the effectiveness of an innovative teaching session focusing on changing the beliefs, perceptions, and attitudes of mental health nursing students towards older and younger people. A QLR design was used to enable exploration of change over time. A pre, post and follow-up approach was implemented over six months, using multiple data collection methods. A Cross-sectional and longitudinal data analysis approach was applied. Post-session themes of: stop and think; shock and surprise; different rules for different people; and new understanding of age-related attributes, were identified. Follow-up revealed changes of: wider awareness of discriminations, more open minded, sensitivity to discrimination across the life course, changed approaches to practice, question everything, ignore age. Longitudinal analysis of individual change demonstrated that real world, attitude-focused teaching was effective in changing student attitudes to younger and older people. Change was complex and non-binary, raising students’ self-awareness and enabling generalisation of change to wider practice issues.
  • Delivering informed measures of patient centred care in medical imaging: What is the international perspective?

    Hyde, Emma; Hardy, Maryann; University of Derby (Elsevier BV, 2021-06-25)
    Focus on patient experience and patient centred approaches within healthcare has substantially increased since the Picker Institute (a not for profit organisation) was established in the 1980’s (Picker Institute, 2021). Picker’s founding principles have been adapted from their original form, to keep pace with changes in health and social care, but remain the cornerstone of research and guidance on person-centred approaches. Organisations such as the National Health Service (NHS) in the UK, the Australian Commission on Safety and Quality in Health Care, and the Canadian Patient Safety Institute, have developed their own guiding principles for patient centred care, reflecting the nature of the health care systems in their respective countries. In the UK professional, statutory and regulatory bodies governing health care professionals, such as the Health & Care Professions Council (HCPC) and College of Radiographers, have also incorporated patient centred approaches and care into their Standards of Proficiency for registrants (HCPC, 2013; CoR, 2018). As guidance and regulation linked to patient care and patient experience has become more widespread, interest in research into patient centred care and approaches has developed. Publications sharing the findings of research projects carried out to investigate patient experience during medical imaging examinations and radiation therapy have also increased. In our research we have sought to define informed measures of patient centred care for medical imaging technologists, and to date have reported the findings from our UK based participant’s (Hyde & Hardy, 2020; Hyde & Hardy, 2021a; Hyde & Hardy, 2021b; Hyde & Hardy 2021c). In this commentary we would like to open up debate about the similarities and differences between UK and international views about patient centred care in medical imaging, and invite expressions of interest from potential collaborators.
  • The experience of families following Traumatic Brain Injury in adult populations: A meta-synthesis of narrative structures.

    Whiffin, Charlotte Jane; Gracey, Fergus; Ellis-Hill, Caroline; University of Derby; University of East Anglia; Bournemouth University (Elsevier BV, 2021-07-21)
    Traumatic brain injury has a significant effect on uninjured family members. Typically, this has been examined with a focus on psychopathological outcomes including stress, depression and anxiety. However, in recent years there has been increasing interest in the subjective experiences of families post-injury leading to a plethora of qualitative studies. Therefore, an in-depth examination and synthesis of this literature is now relevant and timely. To examine the subjective experiences of families following traumatic brain injury in adult populations in the sub/post-acute period through the synthesis of original qualitative research. This paper presents a meta-synthesis using Thomas and Harden’s framework of ‘thematic synthesis’ rooted in a critical realist philosophy. In July 2019 five electronic databases, were searched for the terms ‘traumatic brain injury’, ‘family’ and ‘qualitative’ studies were included if the primary research reported qualitative data about the subjective experiences of family members of adults with traumatic brain injury and had been published in a peer reviewed journal. Studies with mixed brain injury samples, child or adolescent traumatic brain injury or disorders of consciousness were excluded. Hand searching and citation searches were also completed. Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion. Thirty papers were finally agreed for inclusion in this review. Each study was then assessed for relevance, resonance and rigour using the Critical Appraisal Skills Programme (CASP) tool. Line by line coding of the findings in each paper was conducted as the basis for a thematic analysis and synthesis. Descriptive themes were identified followed later by analytical themes. This final stage was informed by a narrative lens and from these, eight narrative functions belonging to four dimensions were identified from the subjective experiences of families post-traumatic brain injury. Specifically, these were: (1) Displacing and Anchoring; (2) Rupturing and Stabilising; (3) Isolating and Connecting; (4) Harming and Healing. The interpretation of the narrative functions revealed the substantial existential work involved in negotiating lives, maintaining family system equilibrium and moving forward. As such, family members have their own unique narrative needs. Despite contemporary service models built around the injured person, service providers are well placed to support families in this everyday narrative work through actively attending to narrative structures and understanding the implications of these for family experience.
  • What next for End Point Assessments?

    Baker, Denise; Robertshaw, David; University of Derby (Emerald, 2021-07-20)
    This paper reflects on changes to End Point Assessment (EPA) brought about as a result of the COVID pandemic and considers how proposed future change will impact on training providers and employers of health apprentices. The paper provides an analysis of apprenticeship policy, the role of end point assessment and consideration of assessment strategies used in higher education and health professions. Implications for policy, training providers and clinical practice are proposed. These changes will bring the completion of EPA closer to education providers and allow them to take a more direct role within the process. Education providers will need to be issued with clear guidance to ensure regulatory compliance. The pedagogical value of end point assessment is questioned. Training providers and policymakers will need to review their processes and guidance appropriately. This paper provides a summary of salient points needing consideration.
  • Opportunity, support and understanding: the experience of four early trainee nursing associates

    Dainty, Andrew; Barnes, Donna; Bellamy, Erica; Kyte, Nicola; Berry, Katie; University of Derby; Sherwood Forest Hospitals NHS Foundation Trust; Nottingham University Hospitals NHS Trust (Mark Allen Group, 2021-06-11)
    This study aimed to capture the lived experience of some of the first trainee nursing associates (TNAs) during the pilot of the role in the January 2017 cohort of TNAs, based at the University of Derby. A convenience sampling approach was used to recruit participants to this phenomenological study. In-depth, semi-structured interviews were carried out with four participants to capture the experience, as lived by the first cohort of TNAs. Transcripts were transcribed verbatim and were analysed using interpretive phenomenological analysis. Analysis suggests that the participant experience was characterised by six themes, namely: challenges relating to NA training; developing new skills; opportunity; the importance of support; impact of the NA role; and understanding the NA role. This study adds to our understanding relating to the lived experience of some of the first TNAs taking up training for this role within healthcare, and highlights some of the factors that were most pertinent, according to the lived experience of the trainees themselves. The authors hope that the findings of this study will prove useful for those considering taking up training for the role, or indeed establishments considering implementing the role with their settings.
  • Chronic limb ischaemia: case study and clinical literature review

    Farrington, Liz; Mortimore, Gerri; University Hospitals of Derby and Burton NHS Foundation Trust; University of Derby (Mark Allen Group, 2021-07-21)
    This article will discuss chronic limb ischaemia as the result of peripheral artery disease (PAD) using a case study. The patient's concurrent diagnosis of metastases meant clinical decision making was complex and treatment options were limited. PAD is the third most common clinical presentation of atherosclerosis after coronary artery disease and stroke. Although advances in radiological technology and biochemical screening offer the potential for earlier intervention and improved survival rates for patients with PAD, a review of the evidence suggests that commitment to more conservative approaches, such as exercise therapy and health promotion, could have more sustainable, longer-term benefits for patients with chronic limb ischaemia. The therapeutic nature of the nurse–patient relationship makes nurses ideally placed for encouraging lifestyle changes and signposting to support services. Active participation from the patient is imperative for any potential modifications, which should be individualised as part of a holistic care plan, to ensure patient engagement and compliance. Therefore emphasis should remain on the management and prevention of modifiable risk factors, for which the nurse's role is an integral part to ensure success.
  • What are the ethical dilemmas in the decision making processes of nursing people given Electroconvulsive therapy? A critical realist review of qualitative evidence

    Sweetmore, Victoria; University of Derby (Wiley, 2021-06-18)
    Electroconvulsive therapy (ECT) has a complex and contentious place in psychiatric care. Mental health nurses (MHNs) are of obligated to be part of this practice despite ethical concerns. To consider the ethical dilemmas and decision-making processes facing MHNs involved in the administration of ECT. A critical realist review of the literature surrounding ethical considerations and ECT was undertaken using thematic analysis. Four key themes emerged: the MHN as an advocate and conflict in their role, issues surrounding consent, questionable efficacy and unknown method of action, side effects, and legal issues and clinical guidelines. Using a critical realist framework for understanding, the decision-making process and ethical considerations are viewed as part of the empirical and actual parts of reality, while the potential for other, unseen causal powers to be at play is acknowledged. MHNs need to ensure they have an adequate ethical underpinning to their practice to enable them to navigate contentious areas of practice such as ECT to practice effectively and preserve safety. This may require moving beyond the traditional biomedical model of ethics. Developing an appreciation of unseen causal factors is also an essential part of MHNs’ developing professional competency.
  • Older people, dementia and neuro-dramatic-play: A personal and theoretical drama therapy perspective

    Holmwood, Clive; University of Derby (Intellect, 2021-05-10)
    This conceptual article will consider Sue Jennings’ neuro-dramatic-play (NDP) as an overall theoretical framework for working with older people with dementia. NDP was developed over a number of years by pioneering UK drama therapist Sue Jennings. It is a culmination of attachment-based play, drama, movement and storytelling, and arts-based approaches that are used within drama therapy and other play and creative-based work with children. The author will consider from a personal and reflective perspective how NDP approaches can be adapted by drama therapists to work with older people with memory loss based on almost 30-years history of being involved in the field of drama therapy as a student and practioner, and his work with older people, at both the beginning of his career and his current reflections many years later.
  • From expert to advanced clinical practitioner and beyond

    Mortimore, Gerri; Reynolds, Julie; Forman, Dawn; Brannigan, Chris; University of Derby (MAG, 2021-06-10)
    This article considers the potential development of advanced clinical practitioners (ACPs) and consultant practitioners, beyond the ‘expert’ status as defined by Pat Benner in 1984. The suggested Derby Model: 7 Levels of Practice Advancement, adapted from Benner's From Novice to Expert, recognises Health Education England's four pillars of advanced practice and how they can be implemented and enhanced within these senior roles, and what that means in a 21st century healthcare system.
  • Fears of compassion magnify the harmful effects of threat of COVID-19 on mental health and social safeness across 21 countries

    Matos, Marcela; McEwan, Kirsten; Basran, Jaskaran; Gilbert, Paul; University of Derby (Wiley, 2021-04-20)
    The COVID-19 pandemic is a massive global health crisis with damaging consequences to mental health and social relationships. Exploring factors that may heighten or buffer the risk of mental health problems in this context is thus critical. Whilst compassion may be a protective factor, in contrast fears of compassion increase vulnerability to psychosocial distress and may amplify the impact of the pandemic on mental health. This study explores the magnifying effects of fears of compassion on the impact of perceived threat of COVID-19 on depression, anxiety and stress, and social safeness. Adult participants from the general population (N = 4057) were recruited across 21 countries worldwide, and completed self-report measures of perceived threat of COVID-19, fears of compassion (for self, from others, for others), depression, anxiety, stress and social safeness. Perceived threat of COVID-19 predicted increased depression, anxiety and stress. The three flows of fears of compassion predicted higher levels of depression, anxiety and stress and lower social safeness. All fears of compassion moderated (heightened) the impact of perceived threat of COVID-19 on psychological distress. Only fears of compassion from others moderated the effects of likelihood of contracting COVID-19 on social safeness. These effects were consistent across all countries. Fears of compassion have a universal magnifying effect on the damaging impact of the COVID-19 pandemic on mental health and social safeness. Compassion focused interventions and communications could be implemented to reduce resistances to compassion and promote mental wellbeing during and following the pandemic.
  • Patient centred care in diagnostic radiography (Part 3): Perceptions of student radiographers and radiography academics

    Hyde, Emma; Hardy, M; University of Derby; University of Bradford (Elsevier, 2021-01-27)
    Awareness is growing of the importance of patient centered care (PCC) in diagnostic radiography. PCC is embedded within professional body publications and guidance documents, but there is limited research evidence exploring the perceptions of student radiographers and radiography academics. This paper shares the findings of a research project seeking to define PCC in diagnostic radiography from the perspective of student radiographers and radiography academics. This paper reports Stage 1 and Stage 2 of the project from the perspective of radiography academic and student radiographer participants, and compare these to the perspective of service users, clinical radiographers and radiography managers, reported previously. Stage 1 used an online survey tool to gauge participant agreement with a series of attitudinal statements. Stage 2 used situational vignettes to promote discussion and debate about PCC approaches. Ethical approval was granted by the University of Derby College of Health & Social Care Ethics committee. Response rates to the Stage 1 survey were above the minimum threshold, with 50 responses from student radiographers and 38 responses from radiography academics. Stage 1 participants were asked to participate in Stage 2 on a voluntary basis. As with service users and service deliverers, care communication, event interactions and control over environment were the key influences on PCC. However, students highlighted differences between reported and observed levels of PCC. There is some way to go to embed PCC in diagnostic radiography practice. As impartial observers of radiography practice, student radiographers highlight the difference between service users and service deliverer’s perceptions of PCC. Whilst the focus of clinical radiographers remains on efficiency it is difficult for student radiographers to challenge the accepted norm. Role models are required to promote PCC behaviours and a holistic approach in radiography practice. A package of educational support and audit tools will be made available to support both service deliverers and student radiographers to deliver PCC.
  • Clinical supervision for advanced practitioners

    Reynolds, Julie; Mortimore, Gerri; University of Derby (MAG, 2021-04-08)
    This article discusses clinical supervision and its importance in supporting the development of advanced clinical practitioners. It will reflect on the impact of clinical supervision using extracts from research data provided by trainee advanced clinical practitioners and their medical supervisors. This article will consider the latest guidance on how to facilitate quality clinical supervision in the workplace and the potential challenges it may face relating to governance, finances, and time.
  • The management of urinary tract infections in older patients within an urgent care out of hours setting

    Dexter, Justine; Mortimore, Gerri; University of Derby (MAG, 2021-03-26)
    This article critically analyses the prevalence, assessment and management of urinary tract infections (UTIs) in patients over the age of 65, in an urgent care out-of-hours service in order to enhance care. It is undertaken from the perspective of working as an Advanced Nurse Practitioner (ANP). A synopsis of UTI is presented, examining the epidemiology and aetiology. The process of assessment, diagnosis and management of UTI in older people is appraised based on current evidence. Difficulties associated with the recognition of UTI in elderly are evaluated. Finally, recommendations are made for the improvement of future practice as an ANP.
  • Neurotrauma clinicians’ perspectives on the contextual challenges associated with long-term follow-up following traumatic brain injury in low-income and middle-income countries: a qualitative study protocol

    Smith, Brandon George; Whiffin, Charlotte Jane; Esene, Ignatius N; Karekezi, Claire; Bashford, Tom; Mukhtar Khan, Muhammad; Fontoura Solla, Davi Jorge; Indira Devi, Bhagavatula; Hutchinson, Peter John; Kolias, Angelos G; et al. (BMJ, 2021-03-04)
    Traumatic brain injury (TBI) is a global public health concern; however, low/middle-income countries (LMICs) face the greatest burden. The WHO recognises the significant differences between patient outcomes following injuries in high-income countries versus those in LMICs. Outcome data are not reliably recorded in LMICs and despite improved injury surveillance data, data on disability and long-term functional outcomes remain poorly recorded. Therefore, the full picture of outcome post-TBI in LMICs is largely unknown. This is a cross-sectional pragmatic qualitative study using individual semistructured interviews with clinicians who have experience of neurotrauma in LMICs. The aim of this study is to understand the contextual challenges associated with long-term follow-up of patients following TBI in LMICs. For the purpose of the study, we define ‘long-term’ as any data collected following discharge from hospital. We aim to conduct individual semistructured interviews with 24–48 neurosurgeons, beginning February 2020. Interviews will be recorded and transcribed verbatim. A reflexive thematic analysis will be conducted supported by NVivo software. The University of Cambridge Psychology Research Ethics Committee approved this study in February 2020. Ethical issues within this study include consent, confidentiality and anonymity, and data protection. Participants will provide informed consent and their contributions will be kept confidential. Participants will be free to withdraw at any time without penalty; however, their interview data can only be withdrawn up to 1 week after data collection. Findings generated from the study will be shared with relevant stakeholders such as the World Federation of Neurosurgical Societies and disseminated in conference presentations and journal publications.
  • An initiative for student nurses to practise clinical skills at home

    Whitehead, Bill; Ansell, Helen; University of Derby (EMAP, 2021-02-15)
    This article describes an initiative for students to practise clinical skills in their own homes using university-supplied instructions and equipment, implemented as a response to the restrictions to on-campus teaching during the coronavirus pandemic. It includes recommendations for future use, concluding that it would also be a useful adjunct to traditional training methods following the end of the pandemic.

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