Browsing by Person "Smith, Margaret Coulter"

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A critical review: a combined conceptual framework of severity of illness and clinical judgement for analysing diagnostic judgements in critical illness
(Wiley-Blackwell, 2013-12-27) Smith, Margaret Coulter; Smith, Pam; Crow, Rosemary
Aims and objectives To analyse theoretical literature on severity of illness and clinical judgement and propose a combined conceptual framework for judgements taken to identify patients' clinical states in critical illness and also to critically review and synthesise general severity of illness prognostic models to identify dimensions and attributes of severity of illness in critical illness. Background The effective treatment of the critically ill requires the early identification of severe illness, and in acute wards, this is predominantly addressed by applying early warning scores focusing on indicators of physiological severity. Clinical judgement complements the application of early warning scores, but is generally not the focus of research and so requires further investigation. Design A critical review of the literature. Methods Severity of illness and clinical judgement literature was reviewed to identify themes for a combined conceptual framework for patient assessment in critical illness. MEDLINE and CINAHL (January 1981-December 2011) were searched for general severity of illness prognostic models in critical illness. Eleven research and five systematic review papers meeting review inclusion criteria were selected. Results Severity of illness is found to be a crucial theoretical construct in critical illness. It can enhance descriptive models of clinical judgement (such as social judgment theory and an inference/correspondence model in diagnostic judgment) when used to analyse and reflect on judgements made to diagnose the clinical state of the patient. Conclusions A combined conceptual framework of severity of illness and a descriptive clinical judgement model further informs patient assessments about the identification of clinical states in critical illness, alongside early warning scores. Relevance to clinical practice This article contributes to an understanding of the complexity of patient assessment and diagnostic judgement in critical illness.
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.
Being conductor of the orchestra: An exploration of district nursing leadership
(Mark Allen, 2020-05-07) Dickson, Caroline; McVittie, Chris; Smith, Margaret Coulter
The purpose of the present study was to gain insight into how district nurses understand their leadership role. Data were generated through interviews and audio-journals and analysed using interpretive phenomenological analysis. Findings suggested that district nurses managing teams and caseloads experienced a burden of responsibility. Being creative problem solvers, they adopted facilitative ways of engaging with patients but directive approaches to team management. District nurses sharing leadership with multidisciplinary colleagues did not appear to experience this burden. Their leadership drew on their facilitative approaches to care-giving. If nurses enabled, rather than directed teams, they could create a context for developing autonomy and growth, easing the burden of responsibility.
Cirrhosis Screening with a Portable Fibroscan Device in a Community Alcohol Support Service: Feasibility Study
(BMJ Publishing Group Ltd, 2016-06) Matthews, Karen; MacGilchrist, Andrew; Smith, Margaret Coulter; Cetnarskyj, Roseanne
Alcohol misuse is the major cause of the increase in deaths from liver disease in the UK,1 particularly in Scotland2 and particularly in areas of social deprivation. Liver disease usually presents late, with advanced liver disease and cirrhosis often asymptomatic.3 Patients with alcohol misuse in areas of social deprivation are a hard to reach- population. This study assessed the feasibility of using a portable Fibroscan to measure transient elastography (TE), a non-invasive method of assessing hepatic fibrosis, as a screening tool within a community alcohol support service.
Coproduction of knowledge for practice through a participatory action research and process evaluation project (Lydia Osteoporosis Project 2, LOP 2)
(BioMed Central, 2018-08-17) Smith, Margaret Coulter; Schrag, Anthony; Kelly, Fiona; Pearson, Claire; Bacigalupo, Alison
Background - Participatory action research (PAR) is active, collaborative and seeks to develop knowledge from everyday occurrences (Reason and Bradbury 2013). A creative movement workshop developed from the Lydia Osteoporosis PAR Project 2 (LOP 2) and enabled volunteer local research collaborators and participants to articulate new practice knowledge.
Evaluation of Education for Senior Healthcare Support Workers (SCQF Level 7) and Assistant Practitioners (SCQF Level 8) in Children and Young People-s Health with Optional Pathways
(Queen Margaret University, 2010-07) Smith, Margaret Coulter; O'May, Fiona; Mountain, Kristina; Riddell, Helen; Balaam, Martina
Exploring nursing perspectives on moving and handling in older people with osteoporosis in acute care settings.
(BioMed Central, 2017-06-27) Smith, Margaret Coulter; Pearson, C.; Tropea, Savina; O'May, Fiona; Irvine, Linda; Rush, Robert; Wilson, R.; Anonymous benefactor
Osteoporosis is highly prevalent worldwide and is associated with increased risk of low trauma fracture (LTF) [1], increased morbidity and mortality [2]. Major advances in diagnosis, management and prevention of secondary fractures have occurred [3] but implications for acute nursing care are less well documented. This project investigated practitioners' experiences of caring for people with osteoporosis, knowledge of the disease, explored implications for moving and handling, reported patients' care experiences, and developed education for frontline staff.
Final Report for The Lydia Osteoporosis Project
(Queen Margaret University, Edinburgh, 2016-05-05) Smith, Margaret Coulter; Pearson, C.; O'May, Fiona; Tropea, Savina; Irvine, Lindesay; Rush, Robert; Wilson, R.
Sharing Research and Education Focused on Moving and Handling and Older People with Osteoporosis in Acute Settings
Framing moving and handling as a complex healthcare intervention within the acute care of older people with osteoporosis: a qualitative study
(Wiley, 2016-08-22) Smith, Margaret Coulter; O'May, Fiona; Tropea, Savina; Berg, Jackie; Anonymous
Aims and objectives. To investigate healthcare staff's views and experiences of caring for older hospitalized adults [aged 60+] with osteoporosis focusing on moving and handling. Specific objectives were to explore the composition of manual handling risk assessments and interventions in osteoporosis. Background. Osteoporosis is a skeletal disease that reduces bone density and causes increased fracture risk. Incidence rises with age and osteoporotic fractures cause increased morbidity and mortality. It is major global health problem. In the UK older hospitalized adults are normally screened for falls risk but not necessarily for osteoporosis. As presentation of osteoporosis is normally silent until fractures are evident it is frequently undiagnosed. Healthcare staff's knowledge of osteoporosis is often sub optimal and specific manual handing implications under-researched.
Innovative application of a MOOC (Massive Open Online Course) within the Lydia Osteoporosis Project (LOP 3), an action research, process evaluation and implementation project
(2019-12-05) Smith, Margaret Coulter; Pearson, Claire; Roberts, Denny
Background This presentation focuses on the design, implementation and evaluation of a Massive Open Online Couse (MOOC), a complex online learning intervention within an action research, process evaluation and implementation project (The Lydia Osteoporosis Project 3).
Investigating the experiences of older adults with osteoporosis focusing on the diagnostic journey and pathways to specialist care
(2015-10-08) Smith, Margaret Coulter
Leadership and excellence in the early recognition of critical illness
(Elsevier, 2015-04) Smith, Margaret Coulter; Lyte, Geraldine
The ICCN Editorial Board has great pleasure in presenting this special issue, which focuses on leadership and excellence in the early recognition of critical illness. A stimulating range of topics and methodological approaches are included as follows:
“Like A Dance”: Working creatively with healthcare practitioners to explore mobility and osteoporosis
(Intellect, 2019-12-01) Smith, Margaret Coulter; Schrag, Anthony; Kelly, Fiona; Pearson, Claire
Collaborations between health sciences and creative arts can generate insights into complex health phenomena. This article describes a creative workshop derived from an action research project that aimed to raise awareness of fracture risk in health practitioners supporting people with Osteoporosis. The creative workshop aimed to provide opportunities for practitioners within the action research community to create new knowledge as well as share their practice insights. The article considers the notion of creative arts as a physical, embodied process that can facilitate learning by enabling tacit knowledge to be made explicit. Rather than applying an instrumental approach to arts within healthcare, the workshop became a mechanism for the convergence of ideas, disciplines and support structures and provided a learning environment where old beliefs could be challenged, practice insights shared and new knowledge constructed. We discuss the workshop development and outputs and suggest the utility of this approach for collaborative learning.
A nurse‐led FibroScan® outreach clinic encourages socially deprived heavy drinkers to engage with liver services
(Wiley, 2018-09-05) Matthews, Karen; MacGilchrist, Alastair; Smith, Margaret Coulter; Jones, Jacklyn; Cetnarskyj, Roseanne
Aims and objectives To determine whether a portable FibroScan® device can be an acceptable screening tool for chronic liver disease in a community alcohol support service, through recording uptake, determining apparent prevalence of undiagnosed fibrosis/cirrhosis in participants and report engagement following referral to specialist liver services of those individuals referred because of a FibroScan® reading ≥ 7.1 kilopascals (kPa). Background Alcohol‐related liver disease, including cirrhosis, is a major cause of death in the UK. Liver disease is silent and usually presents late. Socially deprived patients with alcohol‐related liver disease are a “hard to engage” population and at higher risk of death than less deprived. A FibroScan® device is a non‐invasive tool for measuring liver stiffness. A result of ≥7.1 kPa can indicate possible chronic liver disease. Design Prospective observational study. Method Individuals who self‐identified as harmful drinkers were recruited. Consented individuals attended for a liver FibroScan®. Those with a reading ≥7.1 kPa were referred to a nurse‐led liver clinic for further investigations, results of which determined referral to a liver specialist in secondary care. Participants referred were monitored for compliance over a 6‐month period. Results Seventy‐nine consented individuals participated, an uptake of 67% of those informed of the study. Of the 79 scans performed, three were unreliable leaving 76 participants. After scanning, 20/76 (26%) had a FibroScan® ≥7.1 kPa requiring referral on to the nurse‐led clinic. All 20 (100%) engaged in further assessment. Of those, 12 required onward referral to specialist services. Subsequent compliance with specialist services in this sample (n = 12) was ≥90%. Conclusion A nurse‐led FibroScan® outreach clinic encourages socially deprived drinkers to engage with liver services. Relevance to clinical practice A 67% uptake suggests a nurse‐led FibroScan® service in a community alcohol service is acceptable. High engagement gives potential for early intervention and improved health outcomes. What does this paper contribute to the wider global clinical community? Findings from this study should instil confidence in centres planning to deliver early intervention through nurse‐led screening for chronic liver disease with a portable FibroScan® device in community settings. These findings should inform future research in this area.
Obesity matters: The skills that strengthen midwifery practice when caring for obese pregnant women
(Mark Allen Group, 2021-05-02) Greig, Yvonne; Williams, Anne F.; Smith, Margaret Coulter
Obese pregnant women (BMI>30 kg/m²) are at an increased risk of developing complications during pregnancy, labour and birth. Furthermore, their offspring are at risk of short- and long-term health complications. Midwives are ideally situated to inform women about risks and to support them in optimising their health. How midwives raise and maintain dialogue with women about this health issue is not well understood. A qualitative research study was conducted drawing on the principles of social constructionism to explore how midwives practiced and maintained dialogue with women about the risks of living with obesity. Data were analysed thematically, three themes emerged: ‘situational context of practice’, ‘constructing partnerships with women’, ‘midwife as a public health agent’. Midwives appeared to have learnt their communication skills informally ‘on the job’ but utilised institutional questionnaires as a mechanism for opening ‘sensitive’ conversations. This approach appeared to guide appointment dialogue and risked providing woman-centred care to individuals while concurrently inhibiting development of professional autonomy. Providing educational opportunities for midwives with respect to consultation education in midwifery curricula may strengthen midwifery practice with respect to discussing sensitive topics.
Pain management and satisfaction in post-surgical patients
(2012-08) Rodgers, S.; Tocher, J.; Smith, Margaret Coulter; Watts, D.; Dickson, L.
Aims and objectives. To examine the relationship between patient satisfaction and the incidence of severe and enduring pain through a health board wide hospital satisfaction questionnaire. Background. The incidence and management of acute postoperative pain and its relationship to patient satisfaction have been of great interest to clinicians over the last 20 years. Evidence suggests that despite many moves to address this problem with the advent of acute pain nurse specialists and dedicated pain teams, severe and enduring pain continues to be a problem. However, patients appear to report high satisfaction levels. Design. The study design was a postal questionnaire the results of which were analysed statistically. Methods. The postal questionnaire was sent to patients who had been discharged from acute hospitals in one health board in the previous two weeks. A total of three large acute hospitals were included. The data were analysed to produce descriptive statistics for all patients on the pain questions and then for patients with severe and enduring pain on the variables of age, gender, ethnic group, responses to pain questions and type of admission. Results. Twenty-six percent of patients reported having pain all or most of the time. Patients suffering from severe and enduring pain were younger females. Conclusion. Acute postoperative pain continues to be a problem, although patients continue reporting moderate satisfaction levels. Relevance to clinical practice. Acute postoperative pain is an ongoing issue for postsurgical patients. It is crucial to understand and recognise issues that can adversely contribute to increased pain severity.
The response from Scottish health boards to complaint investigations by the Scottish Public Services Ombudsman: A qualitative case-study
(Cambridge University Press, 2023-05-04) McBurnie, Gavin; Williams, Jane; Smith, Margaret Coulter
This article explores how complaint investigations undertaken by health ombudsman contribute to the improvement of the healthcare system. Using a qualitative case-study approach, semi-structured interviews were conducted with participants form the Scottish Public Services Ombudsman (SPSO) and three health boards within its jurisdiction. Health board participants were frustrated by complaints process used by the SPSO, in particular the lack of communication during an SPSO investigation especially when there were differences in clinical judgment. Using Braithwaite’s typologies of motivational postures and Hertogh’s models of administrative control it was found that a sense of capitulation was the primary determinant in ensuring health board compliance with SPSO recommendations and that the relationship between SPSO and health boards was predominantly coercive in nature. For the SPSO to be more effective in contributing to system improvement requires it to review its role and means of conducting complaint investigations.
Time for change in community nursing? A critique of the implementation of the Review of Nursing in the Community across NHS Scotland
(2013-03) Dickson, Caroline; Smith, Margaret Coulter
Aim Current literature underpinning change is examined and a critique offered of the implementation of the role of the generic Community Health Nurse in Scotland, from a leadership and cultural perspective. Background In November 2006, Government strategy outlined a new service model for community nursing to be implemented in four demonstration sites across Scotland. Almost two-thirds of community nurses were not supportive of the model. There was belief this generic role would not meet the health needs of patients and carers. Evaluation Evidence supporting the model is presented and the implementation process evaluated from leadership and cultural perspectives. The literature is examined to offer explanations as to why implementation was unsuccessful. Conclusions Transformational and transactional leadership at all levels of the organization are required to make change happen. Evidence supporting change provides an impetus for change. The culture of an organization should be recognized and harnessed during the change process. Effective facilitation will empower staff to make change happen. Implications for Nursing Management Engagement with staff is vital, at the beginning of the change process. The concept of 'nearby' leadership offers an enabling style of leadership at an individual and group level which will enable effective change. 2012 Blackwell Publishing Ltd.
Trying Not to Break Things [Practice Research Case Study]
(Queen Margaret University, Edinburgh, 2019-09-30) Schrag, Anthony; Smith, Margaret Coulter; Kelly, Fiona; Finbow, Alice
Description: Using a physical ontology and methodologies related to Embodied Cognition and The Anthropology of the Body (Schrag 2016, Schrag 2018), and collaborating with colleagues whose expertise was in osteoporosis, I designed a workshop for participants already engaged in the care of those with osteoporosis (i.e., frontline Care staff) to uncover their practice knowledge and make this more tangible, confront their beliefs and/or construct new aspects into them. This was not a didactic process, but rather an artistic, facilitative, experiential one guided by the learners themselves. This was done by inviting the participants to apply tissue paper ‘exoskeletons’ and then to undertake moving and handling processes: when the tissue paper broke, this explicitly - and externally - showed how osteoporotic bones can break and shatter even from the most simple actions. Thus, this creative technique embodied insights where participants were able to examine how they had worked in the past, and find new ways to challenge, refine and change their knowledge. In other words, the creative activities provided the opportunity for learning, rather than merely being applied for illustrative potentials.