• Development of a scale to measure shared problem-solving and decision-making in mental healthcare

      Shoesmith, Wendy Diana; Abdullah, Atiqah Chew; Tan, Bih Yuan; Kamu, Assis; Ho, Chong Mun; Giridharan, Beena; Forman, Dawn; Fyfe, Sue; Universiti Malaysia Sabah, Kota Kinabalu, Malaysia; Curtin University, Miri, Malaysia; et al. (Elsevier BV, 2022-01-15)
      The aim of this study was to create a measure of collaborative processes between healthcare team members, patients, and carers. Methods: A shared decision-making scale was developed using a qualitative research derived model and refined using Rasch and factor analysis. The scale was used by staff in the hospital for four consecutive years (n = 152, 121, 119 and 121) and by two independent patients’ and carers’ samples (n = 223 and 236). Results: Respondents had difficulty determining what constituted a decision and the scale was redeveloped after first use in patients and carers. The initial focus on shared decision-making was changed to shared problem-solving. Two factors were found in the first staff sample: shared problem-solving and shared decision-making. The structure was confirmed on the second patients’ and carers’ sample and an independent staff sample consisting of the first data-points for the last three years. The shared problem-solving and decision-making scale (SPSDM) demonstrated evidence of convergent and divergent validity, internal consistency, measurement invariance on longitudinal data and sensitivity to change. Conclusions: Shared problem-solving was easier to measure than shared decision-making in this context. Practice implications: Shared problem-solving is an important component of collaboration, as well as shared decision-making.
    • Diverticular Disease

      Redfern, Vicky; Mortimore, Gerri; University of Derby (MAG, 2022)
      Diverticular disease is an umbrella term encompassing symptomatic diverticulosis, uncomplicated and complicated diverticulitis. The presence of diverticula increases with age, affecting up 70% of the population by 80 years of age. It is associated with a significant economic burden in terms of health-care costs, hospitalisation, and resource utilisation. Although mortality from non-complicated diverticulosis is extremely rare, morbidity and mortality risk increase ten-fold with complications such as perforation or fistula. This article will examine diverticular disease, its pathogenesis, symptoms, and complications. Additionally, the surgical and non-surgical treatment options will be discussed including the role of antibiotics.
    • Constipation: a clinical review

      Burton, Louise; Mortimore, Gerri; ACP Chesterfield Royal Hospital; University of Derby (MAG, 2022)
      Advanced Nurse Practitioners (ANP) are autonomous practitioners who are required to manage clinical care in partnership with patients, families, and carers. This requires using evidence to undertake complex decision-making (Health Education England, 2017). This clinical review will examine the issue of constipation, with particular emphasis on the older patient group. The aetiology and epidemiology of constipation will be examined, the pathophysiological manifestation considered and the diagnosis and management within this population analysed. In doing so the evidence base will be critiqued to ensure autonomous, safe management of this condition.
    • Acute onset low back pain leading to a diagnosis of cauda equina syndrome: a case study

      Read, Haley; Mortimore, Gerri; University of Derby (MAG, 2022-02-08)
      Cauda equina syndrome is rarely seen in primary care, but advanced practitioners must be aware of the possibility. Haley Read and Gerri Mortimore highlight a case study leading to a diagnosis of the condition One of the most common symptoms managed in primary care is lower back pain, which affects approximately 20% of the UK population at any one time (National Collaborating Centre for Primary Care, 2009). There are many differential diagnoses for the cause of back pain, with one such potential diagnosis being cauda equina syndrome. In this instance, it is of paramount importance that the correct diagnosis is reached quickly with urgent referral into secondary care for the instigation of treatment to prevent paralysis. This case review will examine a patient presenting to primary care with lower back pain and diagnosed with cauda equina syndrome.
    • New year, new lifestyle

      Mortimore, Gerri; University of Derby (Mark Allen Group, 2021-12-14)
    • Neurosurgeons’ experiences of conducting and disseminating clinical research in low-income and middle-income countries: a reflexive thematic analysis

      Whiffin, Charlotte Jane; Smith, Brandon George; Esene, Ignatius N; Karekezi, Claire; Bashford, Tom; Mukhtar Khan, Muhammad; Hutchinson, Peter John; Kolias, Angelos G; Fontoura Solla, Davi Jorge; Paiva, Wellingson S; et al. (BMJ, 2021-09-22)
      Low-income and-middle-income countries (LMICs) are increasing investment in research and development, yet there remains a paucity of neurotrauma research published by those in LMICs. The aim of this study was to understand neurosurgeons’ experiences of, aspirations for, and ability to conduct and disseminate clinical research in LMICs. This was a two-stage inductive qualitative study situated within the naturalistic paradigm. This study committed to an interpretivist way of knowing (epistemology), and considered reality subjective and multiple (ontology). Data collection used online methods and included a web-based survey tool for demographic data, an asynchronous online focus group and follow-up semistructured interviews. Data were analysed using Braun and Clarke’s Reflexive Thematic Analysis supported by NVivo V.12. Setting LMICs. In April–July 2020, 26 neurosurgeons from 11 LMICs participated in this study (n=24 in the focus groups, n=20 in follow-up interviews). The analysis gave rise to five themes: The local landscape; creating capacity; reach and impact; collaborative inquiry; growth and sustainability. Each theme contained an inhibitor and stimulus to neurosurgeons conducting and disseminating clinical research, interpreted as ‘the neurosurgical research potential in LMICs’. Mentorship, education, infrastructure, impact and engagement were identified as specific accelerators. Whereas lack of generalisability, absence of dissemination and dissemination without peer review may desensitise the impact of research conducted by neurosurgeons. The geographical, political and population complexities make research endeavour challenging for neurosurgeons in LMICs. Yet in spite of, and because of, these complexities LMICs provide rich opportunities to advance global neurosurgery. More studies are required to evaluate the specific effects of accelerators of research conducted by neurosurgeons and to understand the effects of desensitisers on high-quality, high-impact clinical research.
    • Enabling safer bathing for people living with epilepsy

      Collier, Elizabeth; Grant, Mandy; University of Derby (University of Derby, 2021-12-14)
      This public involvement consultation (PIC) was set up to explore the opinions and ideas of people living with epilepsy for developing a full research project on the topic of prevention of drowning in the bath. The general advice available for people living with epilepsy (PLE) is to have showers instead of baths, or to have a chaperone and not to bath if alone (Epilepsy Action 2019). However, we know that people with epilepsy do have baths and have them alone, and that there are fatal and non-fatal accidents. Twelve people (7 men and 5 women) took part in the PIC via online meetings and written feedback. Principles of thematic content analysis were applied to detailed notes that were taken, and these were examined independently by the two authors to identify similarities and key issues. Seven categories were identified: Research issues and methods, encouraging language, advice and information, options available, consequences, influencing factors and perceptions of risk. The PIC confirmed that people do bathe alone and that the reasoning behind this is complex and warrants investigation. This includes consideration of language, emotions, personal biography and context, and the role of specialists.
    • The Value and Potential of Qualitative Research Methods in Neurosurgery

      Whiffin, Charlotte J.; Smith, Brandon G.; Selveindran, Santhani M.; Bashford, Tom; Esene, Ignatius N.; Mee, Harry; Barki, M. Tariq; Baticulon, Ronnie E.; Khu, Kathleen J.; Hutchinson, Peter J.; et al. (Elsevier BV, 2021-12-18)
      To explore the value and potential of qualitative research to neurosurgery and provide insight and understanding to this underused methodology. The definition of qualitative research is critically discussed and the heterogeneity within this field of inquiry explored. The value of qualitative research to the field of neurosurgery is articulated through its contribution to understanding complex clinical problems. To resolve some of the misunderstanding of qualitative research, this paper discusses research design choices. We explore approaches that use qualitative techniques but are not, necessarily, situated within a qualitative paradigm in addition to how qualitative research philosophy aids researchers to conduct interpretive inquiry that can reveal more than simply what was said by participants. Common research designs associated with qualitative inquiry are introduced, and how complex analysis may contribute more in-depth insights is explained. Approaches to quality are discussed briefly to support improvements in qualitative methods and qualitative manuscripts. Finally, we consider the future of qualitative research in neurosurgery, and suggest how to move forward in the qualitative neurosurgical evidence base. There is enormous potential for qualitative research to contribute to the advancement of person-centered care within neurosurgery. There are signs that more qualitative research is being conducted and that neurosurgical journals are increasingly open to this methodology. While studies that do not engage fully within the qualitative paradigm can make important contributions to the evidence base, due regard should be given to immersive inquiry within qualitative paradigms to allow complex, in-depth, investigations of the human experience.
    • Principles and Practice of Nurse Prescribing

      Gould, Jill; Bain, Heather; University of Derby; Robert Gordon University (SAGE, 2022-02)
      Feel prepared to take on nurse prescribing with this short and accessible text. Whether you are pre-registration or undertaking a prescribing course, this book is your perfect introduction to the world of nurse prescribing. Covering the legal, professional and pharmacological considerations as well as core skills such as assessment and teamworking, this accessible text explores all aspects of non-medical prescribing in clear, straightforward terms.
    • Improving recognition and support for women experiencing the menopause

      Collier, Elizabeth; Clare, Alicia; University of Derby; BlueSCI Wellbeing Service (RCN, 2021-11-09)
      Menopause most commonly occurs in women aged 45-55 and may last for many years. The experience of menopause is a very individual one though many common symptoms are reported such as insomnia, hot flushes, anxiety and poor memory. Many workplaces have no recognition of the disabling effects that menopause can have nor any supportive infrastructure. Nor do workplaces have well informed managers or staff, unsurprising when women themselves often cannot recognise menopause. In addition, symptoms can be interpreted as mental illness. Medical research tends to conceptualise the psychological effects of menopause as psychiatric disorder, but this is not necessarily helpful when treatments for menopause will alleviate experiences rather than the potential inappropriate prescribing of antidepressants for example. Professional awareness is poor generally but there are many actions that can be taken to improve recognition and support; evaluate your services, introduction of specific assessment and information resources for staff and patients and also provide reasonable adjustments. Taking individual responsibility for improving knowledge and skills in this area will mean we can all contribute to a better and more effective environment for women where they feel that their needs are addressed, without having to wait for access to ‘specialist’ services, if available.
    • Sexuality and student mental health nurse experience in education and practice

      Milward, Ben; Collier, Elizabeth; University of Derby (Mark Allen Group, 2021-10-07)
      Lesbian, Gay, bisexual and transgender (LGBT) identifying student mental health nurses (MHNs) in higher education can feel less safe than others which affects performance. People ‘come out’ multiple times and this is difficult in a classroom situation. Lecturers can make a difference to LGBT student nurses experience and this can have an impact on clinical practice. The emotional impact of ‘coming out’ in the classroom can have far reaching consequences for their mental health. The response of educational staff can have a huge impact on the ability to learn and the marks achieved. Student lecturer relationships can have transformative consequences. Student MHN’s make meaning from their educational experiences in the classroom and clinical practice. If they do not see themselves (LGBT perspective) this can affect engagement and motivation. Safe nursing practice is role modelled from lecturer to student and has implications for service user experience in clinical settings.
    • The needs of clients coming to counselling following second harm: A Q methodology study

      Kenward, Linda; whiffin, charlotte; Townend, Michael; University of Derby (Wiley, 2021-09-30)
      Second harm is the added psychological distress from an inadequate response by healthcare providers in response to medical errors or neglect. This inadequate response may require patients to seek counselling. The counselling needs of patients who have experienced second harm have received limited research attention. This Q methodology study addresses this gap in knowledge in order to further inform counselling practice. Participants sorted 42 pre-determined statements online followed by interviews to establish the rationale for the sorting pattern choices. Data from the online sort were analysed using factor analysis to establish the viewpoints expressed. The interview data added to the interpretation of the viewpoints. Through a factor analysis, two ‘viewpoints’ and 11 counselling needs were identified. Nine of these needs were generic to the counselling relationship and two specific to second harm. This study concluded that people seeking counselling following second harm have needs beyond those expected from a general counselling relationship. These included not being blamed for what happened and a need for the counsellor to be able to demonstrate that they are able to understand the impact of harm. The needs identified in this study as being generic can give counsellors confidence in working with clients that have experienced second harm, knowing that many of the needs identified are not unique. Counsellors can also be confident that those needs that are unique can be understood through extending their knowledge of the topic and listening to those that have been harmed.
    • The Role of the Liver in Iron Homeostasis and What Goes Wrong?

      Robalino Gonzaga, Ernesto; Riestra Guiance, Irene; Henriquez, Richard; Mortimore, Gerri; Freeman, Jan; University of Central Florida, Orlando, FL, USA; University Hospitals of Derby and Burton on Trent; University of Derby (Codon Publications, 2021-09-18)
      Iron is an essential mineral that is vital for growth development, normal cellular function, synthesis of hormones and connective tissue, and most importantly, serves as a component of hemoglobin to carry oxygen to body tissues. The body finely regulates the amount of circulating and stored iron within the body to maintain concentration levels within range for optimal physiologic function. Without iron, the ability for cells to participate in electron transport and energy metabolism decreases. Furthermore, hemoglobin synthesis is altered, which leads to anemia and decreased oxygen delivery to tissue. Problems arise when there is too little or too much iron. This review explores the role of the liver in iron physiology, iron overload and discusses the most common causes of primary and secondary hepatic iron overload.
    • 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, Mandy; 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.
    • 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.
    • 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.