Browsing by Person "MacDonald, Kath"

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354 To refer or not to refer?: ethical challenges of appropriate patient selection to obtain optimum survival and quality of life post lung transplant
(ScienceDirect, 2017-06) Robertson, Julie; MacDonald, Kath
Objectives: We present a case study which raises several ethical issues as to refer or not to refer and seek discussion and debate within this session. Currently in the UK there are 321 patients on the active lung transplant list. With a shortfall of available suitable organs, not all patients will receive a transplant. Up to 1 in 6 patients on the active lung transplant list die or become too sick to receive a graft. Successful transplant can achieve a 60% survival to 5 years. Contraindications to transplant can be physical and or psychosocial. This limited supply highlights the responsibility of CF teams to have consensus on referring candidates that are most likely to benefit from receiving this limited resource. The CF team need to be honest with patients and give a realistic account of process, outcomes and survival before a referral is made.
398 Exploring experiences of the in-patient ward round with young people with CF
(ScienceDirect, 2017-06) MacDonald, Kath; Mathews, A.
Objectives: The in-patient ward round, which involves a bedside visit by members of the multidisciplinary team to discuss treatment, progress and discharge plans, is central to the patient experience. However, its impact upon patients is often underestimated [1]. Research suggests that patients can feel anxious or dissatisfied with this vital clinical activity, as echoed by some patients in our Cystic Fibrosis (CF) Service. Our aim was to gain a better understanding of patient perspectives of our in-house ward round with a view to service improvement, if needed.
A Reflection on the Introduction of a Peer and Self Assessment Initiative
(University of Glasgow, 2011-04) MacDonald, Kath
This paper discusses the introduction and evaluation of peer and self assessment elements into two nursing modules, (one undergraduate, (UG) and one postgraduate, (PG). 40 UG nursing students and 22 PG education students participated in a Peer and self assessment exercise within their respective modules. Students evaluated the process by questionnaire and made recommendations for future modules. 32 out of 40 (80%) undergraduate & 20 out of 22 (91%) post graduate students returned the questionnaires. Over two-thirds of each group recommended introducing peer assessment into their modules. Students saw peer and self assessment as motivational, encouraging learning, and a fair and truthful method of assessment. Weaknesses were seen as possibility of personal bias, students unsure about their assessment skills and may disadvantage quiet students or those with English as a second language. Both groups felt peer feedback would further their own learning. Both groups scored their peers at the higher end of the range of scores. Peer and self assessment is seen positively by UG and PG students and is perceived to motivate, facilitate learning, and be fair. Consideration must be given to less dominant group members, as quiet students do not necessarily produce less effort. Peer and self assessment may help students develop sustainable skills which can be used in the workplace, such as judgement and assessment of self and others.
An evaluation of a community youth befriending programme for young people with cystic fibrosis and their carers in Lothian
(QMU, 2007-07) MacDonald, Kath; Goulbourne, Alison
Introduction and background Cystic Fibrosis (CF) is the UK's most common genetically inherited life limiting condition, which currently affects around 700 people in Scotland (CF Trust 2002). The condition is caused by a gene defect and affects primarily the lungs and digestive system. Children with CF become aware that they are different from their peers, they can be small and thin as puberty usually comes late, there is often a chronic cough and lung function is substantially reduced causing restricted energy levels. Issues relating to cross infection make peer support problematic for this group. In addition, treatments and self care behaviours are substantial, time consuming and add to social isolation due to regular hospitalisation, and absences from school. Consequently this group often need practical and emotional support that would not normally be required in this age group, (Hodson et al 1993). Rationale for the study The Butterfly Trust was set up in 2002 to support sufferers and families with CF. In November 2004 the Trust was awarded funding to establish a befriending programme for children with CF in Lothian (aged 8-18) with the intention of mentoring and supporting, relieving stress and boredom, improving self confidence, and enhancing general well being. The existing programme was developed in partnership with the CF community nurses at the Royal Hospital for Sick Children (RHSC). Aims and Methods The purpose of our study was to evaluate the impact of The Butterfly Trust's befriending programme (Cool Friends) on: Young people's self esteem, empowerment and independence Issues such as boredom and social isolation when young people are at home and in hospital. Its function for raising issues of personal importance for young people and their carers. Support for carers; e.g. time out, networking Its potential for influencing concordance with treatment regimens.
An exploration of partnership through interactions between young 'expert' patients with cystic fibrosis and healthcare professionals
(Wiley, 2015-12) MacDonald, Kath; Irvine, Lindesay; Smith, Margaret Coulter
Aims and objectives To explore how young 'expert patients' living with Cystic Fibrosis and the healthcare professionals with whom they interact perceive partnership and negotiate care. Background Modern healthcare policy encourages partnership, engagement and self-management of long-term conditions. This philosophy is congruent with the model adopted in the care of those with Cystic Fibrosis, where self-management, trust and mutual respect are perceived to be integral to the development of the ongoing patient/professional relationship. Self-management is associated with the term; 'expert patient'; an individual with a long-term condition whose knowledge and skills are valued and used in partnership with healthcare professionals. However, the term 'expert patient' is debated in the literature as are the motivation for its use and the assumptions implicit in the term. Design A qualitative exploratory design informed by Interpretivism and Symbolic Interactionism was conducted. Methods Thirty-four consultations were observed and 23 semi-structured interviews conducted between 10 patients, 2 carers and 12 healthcare professionals. Data were analysed thematically using the five stages of 'Framework' a matrix-based qualitative data analysis approach and were subject to peer review and respondent validation. The study received full ethical approval. Results Three main themes emerged; experiences of partnership, attributes of the expert patient and constructions of illness. Sub-themes of the 'ceremonial order of the clinic', negotiation and trust in relationships and perceptions of the expert patient are presented. Conclusions The model of consultation may be a barrier to person-centred care. Healthcare professionals show leniency in negotiations, but do not always trust patients' accounts. The term 'expert patient' is unpopular and remains contested. Relevance to clinical practice Gaining insight into structures and processes that enable or inhibit partnership can lead to a collaborative approach to service redesign and a revision of the consultation model.
Bone loss in CF: A fragmented Picture.
(2009) Roberston, J.; MacDonald, Kath
Chapter 6: Professionalism and practising professionally
(Wiley, 2020-12) Gibson, Caroline; MacDonald, Kath; Deirdre O’Donnell; McCormack, Brendan; McCance, Tanya; Bulley, Catherine; Brown, Donna; McMillan, Ailsa; Martin, Suzanne
Clinical Placements: Pocket Guides for Student Nurses
(Lantern Publishing Ltd, 2017-09-12) MacDonald, Kath; MacDonald, Kath; Paterson, Kirstie; Wallar, Jessica
Clinical placements are an essential part of nurse training, but are extremely daunting, especially for new nursing students. This unique pocket guide provides a wealth of practical detail, tips and advice to help the student nurse get to grips with, and make the most of, their placement. The pocket-sized format means the book is extremely portable (it really will fit in a pocket!) and the ring binding allows it to be opened flat (useful when adding notes, for example). The information is presented in digestible chunks (lists, tables, bullets, even cartoons) so the reader can find the essential information really quickly without wading through pages of text there is even space to add notes specific to the particular placement. Written by recent nursing graduates based on their own experiences, reviewed by students and checked by a clinical supervisor this guidance has been produced specifically with student nurses in mind
"Cool friends": an evaluation of a community befriending programme for young people with cystic fibrosis
(2010) MacDonald, Kath; Greggans, Alison
Aim.: To evaluate the impact of a community youth befriending programme on a group of young people with chronic illness and their carers. Background.: Befriending is said to be highly valued by those who are befriended, improving self-esteem and offering opportunities for increasing skills and social activities. Design.: A qualitative longitudinal pilot study of young people with cystic fibrosis, their carers, their befrienders and other personnel, closely involved with the families. Methods.: Seventeen participants were interviewed over one-year to explore their experiences of befriending. Ten of these were either befriendees (aged 8-18 years) or their parents. Half of these families were interviewed twice; once at the beginning of the befriending relationship and another at one year later. Seven other personnel, closely involved with the young people, were interviewed; two play therapists and two education liaison personnel. A focus group was also held with three befrienders. This range of data sought to reveal a wide perspective on the impact of befriending. Results.: Befriending was seen as a good thing by all parties involved. It offered a distraction from illness, respite for carers and helped young people to raise issues of personal importance. Befriending was challenging for the befrienders given the diagnosis of this group of befriendees. Negative experiences could result if pairs are poorly matched or if befrienders are not committed to the process. Exit strategies were not addressed. Conclusion.: Sustainable befriending relationships are dependent on commitment from both parties and transparency about the expected practices and processes from the beginning to the end of the relationship. Relevance to practice.: The evidence that is available in support of befriending is mixed. To date this is the first study in relation to people with cystic fibrosis and will add to the body of knowledge of befriending in young people with a life-threatening chronic illness. 2010 Blackwell Publishing Ltd.
Dealing with chaos and complexity: the reality of interviewing children and families in their own homes
(Blackwell Publishing Ltd, 2008) MacDonald, Kath; Greggans, Alison
Aims. The aim of this paper is to share our experiences of dealing with chaos and complexity in interview situations in the home with children and young people. We highlight dilemmas relevant to dealing with multiple interruptions, building a rapport, consent and confidentiality. Furthermore, we discuss issues regarding the locus of power and control and offer some solutions based on our experiences. Background. Creating a safe environment is essential for qualitative research. Participants are more likely to open up and communicate if they feel safe, comfortable and relaxed. We conclude that interviewing parents and their children with cystic fibrosis in their own homes, is chaotic and appears to threaten the rigour of data collection processes. Limited attention or print space is paid to this issue, with published articles frequently sanitising the messiness of real world qualitative research. Design. Position paper. Methods. In this position paper, we use two case studies to illustrate ethical and pragmatic challenges of interviewing out in the field. These case studies, typical of families we encountered, help emphasise the concerns we had in balancing researcher-participant rapport with the quality of the research process. Conclusions. Dealing with perceived chaos is hard in reality, but capturing it is part of the complexity of qualitative enquiry. The context is interdependent with children's perceived reality, because they communicate with others through their environment. Relevance to practice. This paper gives researchers an insight into the tensions of operating out in the field and helps raise the importance of the environmental 'chaos' in revealing significant issues relevant to peoples daily lives. Knowing that unexpected chaos is part and parcel of qualitative research, will equip researchers with skills fundamental for balancing the well being of all those involved with the quality of the research process.
Embedding storytelling in practice through CAKE – a recipe for team wellbeing and effectiveness
(Foundation of Nursing Studies (FONS), 2023-05-24) Dickson, Caroline; MacDonald, Kath
Background: CAKE, an interactive resource to promote individual and team wellbeing and effectiveness through storytelling was co-designed with community nurses in 2020. In Phase 1 of this project, CAKE comprised seven slices that guided teams through a process of connecting, storytelling, reflecting and action planning to promote wellbeing. It was developed in response to an increasing awareness of psychological harm experienced by nurses and other healthcare professionals. Levels of stress in the workplace are currently contributing to problems with recruitment and retention, and a lack of resources have impacted on practitioners’ wellbeing, and their ability to be compassionate caregivers and to contribute to healthful teams. Aim: Phase 2 of the project sought to: 1) develop facilitators of CAKE; 2) pilot test the prototype CAKE resource in a range of contexts; and 3) create a digital version of CAKE. Methods: An evaluation approach to pilot testing, using multiple methods of data collection, involved 130 health and social care practitioners at 17 sites across the UK. Eight facilitator support sessions, underpinned by the Critical Ally model were offered and data were analysed using thematic analysis. Findings: The findings revealed two overarching themes: facilitating CAKE and experiencing CAKE. In the former, three themes emerged: preparing for CAKE, trying CAKE and embedding CAKE. The latter had two themes: giving it a go and culture change. Following the study, the number of CAKE slices was increased from seven to eight by separating reflection and action planning, and minor amendments were made around spelling and grammar. Conclusion: We propose CAKE as a novel resource to promote individual and team wellbeing and effectiveness in health and social care teams. CAKE users acknowledge the challenges in creating space to use the resource, but when it is implemented teams embed practices that create healthful teams. As facilitators use CAKE, they develop their facilitation skills but they require preparation and support.
Guest Editorial
(SAGE Publications, 2017-11-29) MacDonald, Kath; Clancy, Marie
The idea for this special issue came about as a result of a meeting at the 2016 Royal College of Nursing (RCN) International Research Conference where we both presented our research through the medium of poetry. Coincidentally for us, Gary Rolfe opened the conference with a keynote called 'More poetry is needed'. Gary's concluding remarks suggested that nursing research should broaden its scope to encompass a wider variety of scholarly activities, and nurse academics should not forget that they are first and foremost nurses. This resonated very strongly with what we were trying to do, which was to connect with peoples' personal narratives, promote empathy and engage with the art of nursing as a way of knowing (Carper, 1978).
Innovative co-evaluation and co-creation of an online learning programme with de Bono's Six Thinking Hats
(2017-05-04) MacDonald, Kath; Oberski, Iddo; Christie, Kim; Stears, Amanda
In order to enhance diversity, internationalisation and widening participation, Queen Margaret University's PgCert in Professional and Higher Education was redesigned for online delivery in 2015-16. This programme has run successfully in a blended learning format for over a decade and this change was anticipated to be a major transition for both staff and students. In order to maximise student engagement in the online environment we involved students in the redesign of the programme and evaluation during and after the first year of delivery. This included a video record of the application of de Bono's (1989) 'Six thinking hats' in facilitating staff reflections, an online survey designed and run by two students representatives and a final collaborative thematic analysis of data with staff and students. We focus on student and staff experiences and perspectives on transitioning to the online environment and reflect on the student-engaged design and innovative evaluation method used.
Living in limbo -- patients with cystic fibrosis waiting for transplant
(2006-05-25) MacDonald, Kath
Lung transplant for patients with end-stage cystic fibrosis (CF) in the UK is recognized as the only successful treatment for CF patients with advanced lung disease. This study uses an exploratory approach to examine how patients with CF and their carers cope with the rigours of chronic illness and life on a transplant waiting list. Eight patients with CF, four awaiting transplant and four who had been transplanted within the previous 3years, along with five of their carers, were asked to recount their experiences using a semi-structured interview technique. Four themes emerged from the interview data; displacement, disorder, life in limbo and readjustment to wellness. Support appears to be particularly important to patients and families after false alarms occur, and upon return home after transplant. The small sample size precludes generalization of the results to all patients with CF but gives an in-depth insight into the lived experience of waiting for transplant.
Negotiating healthcare through partnership: An exploration of the perceived and observed factors that enable or inhibit partnership between young “expert” patients with Cystic Fibrosis and the Healthcare Professionals with whom they interact.
(Queen Margaret University, 2014-01-06) MacDonald, Kath
Since the late eighties healthcare policy has seen a shift from a paternalistic model of care to that of an inclusive partnership approach which encourages engagement, responsibility and self-management of long term conditions. This paradigm shift has given credence to the notion of the “expert patient” (EP); an individual with a long-term condition whose knowledge and skills are valued and utilised in partnership with healthcare professionals. However, there is debate as to the definition of the EP, and an assumption that all patients would want to adopt this role and a partnership model of care. There is also scepticism about the motivation behind the introduction of the EP and the perceived benefits of EP Programmes. This study aimed to explore how young “expert patients” living with cystic fibrosis (CF) and the healthcare professionals (HCPs) with whom they interact perceive partnership and negotiate care. Adopting a qualitative methodological strategy, informed by Interpretivism and Symbolic Interactionism, thirty three consultations were observed between eight patients, two accompanied by a carer and twelve healthcare professionals (HCPs). Following the observed sessions the eight patients, two carers and eleven HCPs were interviewed. Data were analysed thematically using the five stages of “Framework” a matrix-based analysis approach. Three major themes emerged from the data: experiences of partnership, attributes of the expert patient and constructions of illness. Multiple sub themes are also presented, including the power of the nurses, normalcy, the expert patient as navigator and the ceremonial order of the clinic. Implications for practice suggest the need for ground rules outlining both parties’ roles and responsibilities in partnership, a remodelling of the clinic format to ensure patient- centredness and a consideration of the role of decision tools and Telehealth in any new proposed model.
Nursing students' experience of practice placements
(RCN Publishing, 2016-11-02) MacDonald, Kath; Paterson, Kirstie; Wallar, Jessica
Clinical practice placements are an essential component of pre-registration nursing programmes. Integration into a new team in an unfamiliar setting, which has its own values, practices, culture and language, can be stressful for nursing students. This article presents and discusses students' reflections on preparing for, entering and leaving practice placements. Ten students who participated in fortnightly group reflective sessions, discussed and analysed their learning experiences while on practice placements in an acute hospital. The challenges the students encountered were deconstructed using a group narrative approach. The students experienced ethical dilemmas around patient dignity, consent and advocacy as well as factors external to the practice setting, such as navigating systems and processes to access information before starting practice placements, managing household duties and academic workloads while working long shifts, and managing fatigue and loneliness. The students devised recommendations for other students to enable them to navigate their practice placements effectively and enhance their learning experience. Raising awareness among academic and practice placement staff of the challenges students encounter before and during their practice placement is essential to assist students to succeed and maximise their learning potential.
Passing on words of wisdom: Using graduating student nurses' experiences to influence the development of new entrants to a nursing programme
(University of Glasgow, 2012-10) Gibson, Caroline; MacDonald, Kath
The Quality Assurance Agency (Mayes, 2009) recommends increasing student engagement in the first year of higher education. Peer learning can maximise student engagement and facilitate learning. This reflective paper explores the use of 'welcome' letters as part of an orientation and transition programme to year one of a preregistration nursing programme. Welcome letters were written by final year students to inform new entrants about the realities of studying in an honours degree programme. The letters were distributed on the first day of induction. New students shared their letters as part of an icebreaking exercise and completed an evaluation form, reflecting feelings upon reading the letters and identifying any further issues. New entrants reported to feel more reassured about starting the programme and meeting new people. Other issues raised by the letters; clinical placements, the role of the personal tutor and expectations in class work, were responded to by faculty in the remainder of the induction. Using the letter as a tool, new entrants actively constructed their own learning needs about the forthcoming programme. The use of peer written welcome letters appears to be a powerful tool in engaging year one students during induction and may promote conditions for effective adult learning.
Passing on words of wisdom: Using graduating student nurses' experiences to influence the development of new entrants to a BSc Honours Nursing programme
(2008) Gibson, Caroline; MacDonald, Kath
Peer and self assessment: A method of facilitating transferable skills beyond the HEI
(2008) MacDonald, Kath
Prevalence of bone loss in a population with cystic fibrosis.
(2010) Robertson, Julie; MacDonald, Kath
The adverse effect of an increased life expectancy for people with cystic fibrosis (CF) is the increased risk of complications, such as CF-related low bone mineral density (BMD). Diagnosis of CF-related low BMD is confirmed by a dual-energy X-ray absorptiometry (DXA) scan. This study reports the results of an audit of DXA scans in 108 adults with CF in our clinic. The most common risk factors for bone loss were vitamin D deficiency (89%), CF-related diabetes (53%), low body mass index (39%) and post-lung transplant (25%); half of those with bone loss were genotype homozygous DF508. Overall fracture incidence was 5.5%; low BMD was not associated with high fracture rates. Thus BMD may not be a good predictor of fracture risk. Treatment includes bisphosphonates, which are difficult to take and have uncertain long-term effects. It is unknown whether bisphosphonate therapy is justified in this already overburdened group.