Nursing

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24

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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.
Best practice guidelines for the management of lipoedema
(MA Healthcare Limited, 2017-09-29) Hardy, Denise; Williams, Anne F.
The Best Practice Guidelines for the management of lipoedema were published earlier this year by Wounds UK, following a collaborative development and peer review process. This paper provides an overview of the development process, and a summary of key messages from the guidelines. The idea of establishing UK-specific guidelines was first discussed by a group of clinicians in 2015. Supported by Wounds UK, industry and third sector partners, an Expert Working Group was brought together in September 2016. This initial meeting was the start of a creative process, and provided a framework for the subsequent development of the evidence-based guidelines.
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.
Expertise in action: Insights into the dynamic nature of expertise in community-based nursing
(Wiley, 2018-02-01) Dickson, Caroline; McVittie, Chris; Kapilashrami, Anuj
Aim To gain insight into community nurses' experiences and how they make sense of the expertise they offer in their role Background Globally, the spotlight is currently on community nursing expertise because of the movement of hospital-based to community- based care. Caring for people at home is no longer solely concerned with prevention, but delivering complex care to patients who are acutely unwell or at the end of their life. Little is known about the distinct expertise of community nurses, or their contribution to patient outcomes. There is a need to examine expertise in this group in order to inform current and future care provision within community settings. Design A hermeneutic, phenomenological study. Method Semi-structured interviews were conducted with eight community nurses in Scotland, UK, who hold an additional post-registration, professional qualification. Participants also kept audio-journals. Data were analysed using Interpretive Phenomenological Analysis. Findings Participants described their expertise in three themes; negotiating a 'way in' to care, managing complexity, and 'thinking on your feet'. They did not refer to themselves as specialist practitioners, nor did they perceive that they were viewed as specialist by colleagues or management. They appeared to dismiss their range of expertise which included forming trusting relationships, anticipating care needs and problem-solving, enabling them to undertake complex care management. Conclusions Expertise of community nurses in this study is dynamic, contextualised and action-oriented enabling them to be creative problem-solvers. It reflects engagement with patients and families and all aspects of the setting where care is provided, rather than being solely an identifiable set of specialist skills, Relevance to clinical practice It is vital to recognize community-based expertise internationally, especially if current WHO aims for community-based health care are to be achieved. Highlighting this expertise contributes to current discourse and may be considered in education and practice reviews. This article is protected by copyright. All rights reserved.
From root to fruit – flourishing in change. Evaluation of a development programme for practice development facilitators in end-of-life care
(Foundation of Nursing Studies (FoNS), 2018-05-16) Dickson, Caroline; Legg, Melanie; Penman, Pam; Smith, Tracy; Marie Curie
Background: This paper outlines the structure, processes and outcomes of a 12-month development programme for nurses who were transitioning from a practice-based training role to a practice development role. The programme was part of organisational commitment to develop a person-centred culture. A new team of Practice Development Facilitators across the UK was formed at Marie Curie. Marie Curie, a UK-based charity supporting people with palliative and end of life care needs. Aims and Objectives: The overall aim of the programme was to enable PDFs to engage with the theory and practice of practice development to develop as enablers in the delivery of person-centred practice. Methods: A co-designed multi-method evaluation of the programme that adopted emancipatory practice development and active learning methodologies. Data collection included 4th Generation evaluation, reflective writing, participant stories and examples of practice change. Findings: The programme supported a change in focus of their role from technical to emancipatory. The team identified new ways of engaging together which enabled them to embody person-centredness. By experiencing active learning they came to understand themselves and their practice. Throughout the programme the team experienced a range of organisational challenges which impacted on their progress throughout the programme. Development of their facilitation skills and a strong community of practice will assure embeddedness and sustainability of their new role. Conclusions: Facilitators of Practice Development are a catalyst in developing person-centred cultures which are indicative of flourishing organisations but this needs to be included in organisational strategy. Experiencing flourishing creates a sense of well-being and renewed commitment to develop practice in ways that keep person-centred care at its heart. Key messages: • Making explicit values and beliefs at the beginning of a programme enable social learning and innovation in practice • Investment in PD can be a catalyst to developing person-centred cultures • Role-modelling person-centredness has an impact on staff well-being and person-centred practices • Embedding communities of practice will main momentum in new ways of working
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).
Lymphoedema
(Cambridge University Press, 2019-05-16) Williams, Anne F.; Llewellyn, Carrie; Ayers, Susan; McManus, Chris; Newman, Stanton; Petrie, Keith J.; Revenson, Tracey A.; Weinman, John
This chapter provides an overview of the lymphatic system, causes, diagnosis and psychosocial impacts of lymphoedema, and describes treatment and self-management approaches for people living with lymphoedema.
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.
A review of the literature relating to liposuction in women with lipoedema and Dercum’s disease
(Wounds Group, 2019-06-24) Williams, Anne F.
This paper reports on a review of the literature in liposuction for women with lipoedema and those with Dercum’s disease. The aims were: to identify the outcomes from liposuction in these two groups and describe adverse effects reported in the studies. A total of 10 studies met the inclusion and exclusion criteria, dated between 2006-2019. Improvements in pain, quality of life and mobility were common outcomes. There were indications that reliance on conservative treatments reduced after liposuction. The incidence of adverse effects appeared modest, including minor haematomas, postoperative swelling, orthostatic reactions, temporary bruising and burning sensations. However, the numbers studied were relatively small, particularly relating to Dercum’s disease. Findings were limited by retrospective evaluations, use of poorly validated tools, and relatively short follow-up periods in some studies. There were no randomised controlled trials. Lack of standardisation made it challenging to analyse and compare outcomes across different studies. Liposuction appears to play a role as a treatment option for some women in managing symptoms, however, further research is required to better explore efficacy and cost-effectiveness, monitor adverse effects, inform decision-making and identify key advice for women who undergo liposuction.
Support with nutrition for women receiving chemotherapy for breast cancer
(Mark Allen Group, 2018-02-19) Gilmour, Fiona; Williams, Anne F.
Nurses are in a unique position to provide nutritional support and information to women with breast cancer who are undergoing chemotherapy, supporting them with making decisions regarding nutrition and diet. This narrative review evaluated the research evidence relating to: the nutritional challenges experienced during chemotherapy; and the most effective approaches for supporting women with dietary choice. Weight gain was identified as a specific problem for women undergoing chemotherapy. The evidence indicated that information about nutrition and food preparation support may go some way to assisting women in overcoming some of the nutrition related challenges experienced during chemotherapy treatment for breast cancer. However, further research is required to better inform person-centred nursing practice in this area.
Ultrabilitation: Beyond recovery-oriented rehabilitation
(Taylor & Francis, 2017-11-28) Buetow, Stephen A.; Martínez-Martín, Pablo; McCormack, Brendan
PURPOSE: Current rehabilitation models emphasize therapy that attempts to return to normal the lives of persons who are disabled. An opportunity is available to scrutinize whether this recovery orientation of rehabilitation is necessarily optimal. METHOD: This conceptual article uses reasoning, informed by experience and a nonsystematic review of literature across diverse disciplines. RESULTS: For some persons with disability, optimizing recovery might be unwanted or insufficient. To expand rehabilitation, we append the Latin ultra, beyond, to habilitare, make fit. The resulting term, ultrabilitate, commits to human flourishing that moves persons toward, around or beyond recovery of particular functioning. CONCLUSIONS: By expanding the scope of disability management, ultrabilitation could inform therapy selection and facilitate human flourishing. Empirical research is needed to test our ideas. Implications for rehabilitation Despite significant progress, rehabilitation limits some people with disabilities. Modern health systems still benchmark therapy for rehabilitation against normal or species-typical standards to aid recovery. Ultrabilitation, meaning beyond fitness, promotes flourishing, either without an interest in recovery or in moving toward, beyond or around recovery. Biological, social and technological conditions are needed to support ultrabilitation. Ultrabilitation complements rehabilitation when rehabilitation is not sufficient to optimize functioning and personal growth.