Browsing by Person "Nicol, Kath"

Now showing 1 - 9 of 9

Barriers to uptake of physical activity in community-based patients with schizophrenia
(2009-12) Johnstone, Rosalind; Nicol, Kath; Donaghy, Marie; Lawrie, Stephen
Background: Recent United Kingdom Government Policy documents have emphasized the need to improve the physical health of patients with mental illness. Although physical health could be improved by increasing physical activity levels, uptake of widely available community-based activity programmes is low in this patient population. Aims: To investigate the barriers to uptake of and adherence to physical activity in communitydwelling patients with a diagnosis of schizophrenia. Methods: Qualitative study on 27 community dwelling patients with a diagnosis of schizophrenia from four Community Mental Health Teams (CMHT) in Edinburgh. Patients were individually interviewed using a semi-structured questionnaire. Themes and sub themes from the interviews were identified using Interpretive Phenomenological Analysis (IPA). Results: Four barriers to physical activity uptake were identified: limited experience of physical activity engagement, impact of the illness and effects of medication, effects of anxiety and the influences of support networks. Conclusion: These patients experience complex barriers to physical activity uptake which need to be considered in the design of physical activity interventions to target obesity and related physical health problems.
Delirium in acute stroke: A survey of screening and diagnostic practice in Scotland
(Hindawi Publishing Corporation, 2013-07-13) Carin-Levy, Gail; Nicol, Kath; van Wijck, Frederike; Mead, Gillian
Aims to survey the use of delirium screening and diagnostic tools in patients with acute stroke across Scotland, and to establish whether doctors and nurses felt the tools used were suitable for stroke patients. Methods An invitation to participate in a web-based survey was e-mailed to 217 doctors and nurses working in acute stroke across Scotland. Descriptive statistics were used to report nominal data and content analysis was used to interpret free text responses. Results Sixty five responses were logged (30% return rate). 48% of respondents reported they routinely screened newly admitted patients for delirium. Following initial screening, 38% reported they screened for delirium as the need arises. 43% reported using clinical judgment to diagnose delirium and 32% stated they combined clinical judgment with a standardised tool. 28% of clinicians reported they used The Confusion Assessment Method however, only 13.5% felt it was suitable for stroke patients. Conclusions Screening for delirium is inconsistent in Scottish stroke services and there is uncertainty regarding the suitability of screening tools with stroke patients. As the importance of early identification of delirium on stroke outcomes is articulated in recent publications, validating a screening tool to detect delirium in acute stroke is recommended.
Delirium in acute stroke: screening tools, incidence rates and predictors: a systematic review.
(springer verlag, 2012-08) Carin-Levy, Gail; Mead, Gillian; Nicol, Kath; Rush, Robert; van Wijck, Frederike
Delirium is a common complication in acute stroke yet there is uncertainty regarding how best to screen for and diagnose delirium after stroke. We sought to establish how delirium after stroke is identified, its incidence rates and factors predicting its development. We conducted a systematic review of studies investigating delirium in acute stroke. We searched The Cochrane Collaboration, MEDLINE, EMBASE, CINHAL, PsychINFO, Web of Science, British Nursing Index, PEDro and OT Seeker in October 2010. A total of 3,127 citations were screened, full text of 60 titles and abstracts were read, of which 20 studies published between 1984 and 2010 were included in this review. The methods most commonly used to identify delirium were generic assessment tools such as the Delirium Rating Scale (n = 5) or the Confusion Assessment Method (n = 2) or both (n = 2). The incidence of delirium in acute stroke ranged from 2.3-66%, with our meta-analysis random effects approach placing the rate at 26% (95% CI 19-33%). Of the 11 studies reporting risk factors for delirium, increased age, aphasia, neglect or dysphagia, visual disturbance and elevated cortisol levels were associated with the development of delirium in at least one study. The outcomes associated with the condition are increased morbidity and mortality. Delirium is found in around 26% of stroke patients. Difference in diagnostic and screening procedures could explain the wide variation in frequency of delirium. There are a number of factors that may predict the development of the condition.
How do occupational therapists understand and respond to delirium in acute stroke? A grounded theory exploration
(SAGE, 2018-08-01) Carin-Levy, Gail; Nicol, Kath; McVittie, Chris; Van Wijck, F.; Mead, G.
Purpose and aims: Delirium is a serious complication following a stroke, often leading to severe adverse effects (Carin-Levy et al. 2012). Identifying delirium following a stroke can be challenging due to the complexity of cognitive screening in this population (Lees et al. 2013). This study explored how occupational therapists (OTs) understand delirium and what actions are taken when working with a patient exhibiting delirium symptoms. Design: Abbreviated grounded theory. Methods: Two online focus groups utilising case vignettes conducted with occupational therapists working in acute stroke units across Scotland. Analytical steps consistent with grounded theory methodology led to the emergence of themes. Results: Five participants were recruited. None of the participants received delirium training, and none confidently discussed delirium symptoms, frequently referring to the term ‘confusion’. Participants suggested using generic cognitive assessments rather than delirium-specific tools. Despite this, the key principles of the initial management of delirium were discussed confidently and participants demonstrated the values of person centredness, effective team work and a real care for the welfare of the persons with whom they are working. Conclusion: Occupational therapists can struggle to identify delirium in acute stroke; however, the key principles of delirium management were confidently discussed and an ethos of person centredness was demonstrated. Occupational therapists are experts in cognitive assessment of stroke patients (Scottish Intercollegiate Guidelines Network 2010), therefore, training in delirium identification should be targeted at this professional group in order to be able to comply with best practice guidelines on delirium management (Healthcare Improvement Scotland 2014).
Identifying and responding to delirium in acute stroke: Clinical team members’ understandings
(Sage, 2020-09-24) Carin-Levy, Gail; Nicol, Kath; van Wijck, Frederike; Mead, Gillian; McVittie, Chris; Funder: Chest Heart and Stroke Scotland; FundRef: 10.13039/501100007919
Delirium is associated with increased mortality, morbidity and length of hospital stay. In the acute stroke setting, delirium identification is challenging due to the complexity of cognitive screening in this patient group. The aim of this study was to explore how members of interprofessional stroke unit teams identified and responded to a potential delirium in a patient. Online focus groups and interviews utilizing case vignettes were conducted with 15 participants: nurses, occupational therapists, speech and language therapists, and physiotherapists working in acute stroke services. Participants’ understandings of delirium varied, most participants did not identify the symptoms of a possible hypoactive delirium, and nearly all participants discussed delirium symptoms in tentative terms. Aspects of interprofessional working were discussed through the expression of distinct roles around delirium identification. Although participants demonstrated an ethos of person-focused care, there are ongoing challenges involved in early identification and management of delirium in stroke survivors.
Letter by Carin-Levy et al regarding article, delirium in acute stroke: A systematic review and meta-analysis
(2012-07) Carin-Levy, Gail; Mead, G. E.; Nicol, Kath
Person-centered healthcare practice in a pandemic context: An exploration of people's experience of seeking healthcare support
(Frontiers, 2021-09-09) Curnow, Eleanor; Tyagi, Vaibhav; Salisbury, Lisa; Stuart, Kim; Melville-Jóhannesson, Barbara; Nicol, Kath; McCormack, Brendan; Dewing, Jan; Magowan, Ruth; Sagan, Olivia; Bulley, Catherine
Background: The recent COVID-19 pandemic increased pressure upon healthcare resources resulting in compromised health services. Enforced national lockdown led to people being unable to access essential services in addition to limiting contact with social support networks. The novel coronavirus, and subsequent condition known as long covid were not well-understood and clinicians were not supported by existing guidelines or pathways. Our study explored people's experiences of healthcare during this period with a person-centered “lens.”
Staff response to delirium in acute stroke: Knowledge, awareness and barriers to early identication
(Wiley, 2015-10-23) Carin-Levy, Gail; Nicol, Kath; van Wijck, Frederike; Mead, Gillian; McVittie, Chris
Introduction: Delirium is a serious medical complication, which can have adverse effects on patients. Identifying delirium following a stroke can be challenging due to the complexity of cognitive screening. This study explored how multidisciplinary team (MDT) members understand delirium following a stroke and what actions are taken when working with a patient exhibiting delirium symptoms. Method: A grounded theory exploration utilising two online focus groups and email exchanges with nurses, physiotherapists, speech and language and occupational therapists working in acute stroke across Scotland. 2 case vignettes were used to elicit responses: 1 described a stroke patient with hypoactive delirium, the other, a hyperactive delirium. Results: 15 participants from various professional groups were recruited. A minority of participants who received delirium training in the past were able to identify symptoms and suggest relevant screening tools. Most participants struggled to identify a hypoactive delirium, mistaking it for dementia or depression and using more tentative language to discuss delirium symptoms. Participants placed an emphasis on the roles of MDT members as instrumental in working out the clinical picture: nurses saw their role as identifying the biomarkers as well as using a delirium screening tool. Allied health staff tended to defer to nurses and medical staff to take these actions. Discussion: MDT members can struggle to identify delirium in acute stroke, particularly the hypoactive subtype. Education and raising awareness of all MDT members working in stroke units has the potential to increase identication rates and possibly lead to more favourable outcomes for these patients.
Support after COVID-19 study: a mixed-methods cross-sectional study to develop recommendations for practice
(BMJ Publishing Group, 2022-08-26) Bulley, Catherine; Tyagi, Vaibhav; Curnow, Eleanor; Nicol, Kath; Salisbury, Lisa; Stuart, Kim; McCormack, Brendan; Magowan, Ruth; Sagan, Olivia; Dewing, Jan
Objectives of study stage 1 were to: explore people’s experiences of illness due to COVID-19 while feeling socially isolated or socially isolating; identify perceptions of what would support recovery; and synthesise insights into recommendations for supporting people after COVID-19. Study stage 2 objectives were to engage stakeholders in evaluating these recommendations and analyse likely influences on access to the support identified. Design: A two-stage, multimethod cross-sectional study was conducted from a postpositivist perspective. Stage 1 included an international online survey of people’s experiences of illness, particularly COVID-19, in isolation (n=675 full responses). Stage 2 involved a further online survey (n=43), two tweetchats treated as large online focus groups (n=60 and n=27 people tweeting), two smaller focus groups (both n=4) and one interview (both using MS teams). Setting: Stage 1 had an international emphasis, although 87% of respondents were living in the UK. Stage 2 focused on the UK. Participants: Anyone aged 18+ and able to complete a survey in English could participate. Stage 2 included health professionals, advocates and people with lived experience. Main outcome measures: Descriptive data and response categories derived from open responses to the survey and the qualitative data. Results: Of those responding fully to stage 1 (mean age 44 years); 130 (19%) had experienced COVID-19 in isolation; 45 had recovered, taking a mean of 5.3 (range 1–54) weeks. 85 did not feel they had recovered; fatigue and varied ‘other’ symptoms were most prevalent and also had most substantial negative impacts. Our draft recommendations were highly supported by respondents to stage 2 and refined to produce final recommendations. Conclusions: Recommendations support access to progressive intensity and specialism of support, addressing access barriers that might inadvertently increase health inequalities. Multidisciplinary collaboration and learning are crucial, including the person with COVID-19 and/or Long Covid in the planning and decision making throughout.