• A Retrospective Cross Sectional Study of the Effectiveness of a Project in Improving Infant Health in Bwindi, South Western Uganda.

      Kamugisha, S. Robert; Dobson, Andrew E.; Stewart, Alex G.; Haven, Nahabwe; Mutahunga, Birungi; Wilkinson, Ewan (2018-10-12)
      Introduction: Low-cost community-based interventions to improve infant health potentially offer an exciting means of progressing toward the Sustainable Development Goals (SDGs). However, the feasibility of such interventions in low-income settings remains unclear. Bwindi Community Hospital (BCH), Uganda implemented a 3-year nurse-led community project to address child-health issues. Nurses supported Community Health Volunteers (CHVs) and visited mothers pre- and/or postnatally to assess and educate mothers and infants. CHVs gathered data and gave basic advice on health and hygiene to mothers. We hypothesized that increased interventions by nurses and CHVs and increased contact with households, would improve health and reduce infant mortality. Methods: This was a retrospective cohort study analyzing routine data of all children born between January 2015 and December 2016. There were three interventions: antenatal nurse visit, postnatal nurse visit and CHV participation. Children received different numbers of interventions. We defined four diverse outcomes: facility-based delivery, immunization completeness, nutritional status, and infant mortality. Odds ratios, adjusted odds ratios, and multivariate logistic regression were used to assess associations between interventions and outcomes. Results: Of the 4,442 children born in 2015 and 2016, 91% were visited by a nurse (81% antenatally and 10% postnatally); 7% lived in villages with a high participating CHV. Households receiving a postnatal visit were more likely to complete immunization (aOR: 1.55, p = 0.016) and have the infant survive (aOR: 1.90, p = 0.05). Children from a hard-to-reach village (no road access) were less likely to be delivered in a health facility (aOR: 0.55, p < 0.001) and less likely to survive in their first year (aOR: 0.69, p = 0.03). Having two or more interventions was associated with a child having all four positive outcomes (aOR 0.78, p = 0.03). Lack of baseline data, a control area, or integrated assessment data limited more detailed evaluation. Conclusion: Visits to mothers after birth, by a nurse to educate and identify child illness, were associated with lower infant mortality and improved infant health as measured by completion of immunizations. Community health interventions could potentially have a greater impact if focused on hard-to-reach areas. Building evaluation into all project designs, whether local or internationally funded, would enable greater learning, and hence better use of resources.
    • A scoping review of clinical skill development of preregistration registered nurses in Australia and five other English‐speaking countries

      Currie, Jane; orcid: 0000-0002-8721-089X; Thompson, Cristina; orcid: 0000-0002-4369-0940; Grootemaat, Pam; Andersen, Patrea; Finnegan, Alan; Carter, Michael; Halcomb, Elizabeth; orcid: 0000-0001-8099-986X (Wiley, 2022-02-10)
    • A systematic review of the organizational, environmental, professional and child and family factors influencing the timing of admission to hospital for children with serious infectious illness

      editor: Ho, Jacqueline J.; Carter, Bernie; orcid: 0000-0001-5226-9878; email: bernie.carter@edgehill.ac.uk; Roland, Damian; orcid: 0000-0001-9334-5144; Bray, Lucy; Harris, Jane; orcid: 0000-0001-6584-1642; Pandey, Poornima; Fox, Jo; Carrol, Enitan D.; Neill, Sarah; orcid: 0000-0001-9699-078X (Public Library of Science, 2020-07-23)
      Background: Infection, particularly in the first 5 years of life, is a major cause of childhood deaths globally, many deaths from infections such as pneumonia and meningococcal disease are avoidable, if treated in time. Some factors that contribute to morbidity and mortality can be modified. These include organisational and environmental factors as well as those related to the child, family or professional. Objective: Examine what organizational and environmental factors and individual child, family and professional factors affect timing of admission to hospital for children with a serious infectious illness. Design: Systematic review. Data sources: Key search terms were identified and used to search CINAHL Plus, Medline, ASSIA, Web of Science, The Cochrane Library, Joanna Briggs Institute Database of Systematic Review. Study appraisal methods: Primary research (e.g. quantitative, qualitative and mixed methods studies) and literature reviews (e.g., systematic, scoping and narrative) were included if participants included or were restricted to children under 5 years of age with serious infectious illnesses, included parents and/or first contact health care professionals in primary care, urgent and emergency care and where the research had been conducted in OECD high income countries. The Mixed Methods Appraisal Tool was used to review the methodological quality of the studies. Main findings: Thirty-six papers were selected for full text review; 12 studies fitted the inclusion criteria. Factors influencing the timing of admission to hospital included the variability in children’s illness trajectories and pathways to hospital, parental recognition of symptoms and clinicians non-recognition of illness severity, parental help-seeking behaviour and clinician responses, access to services, use and non-use of ‘gut feeling’ by clinicians, and sub-optimal management within primary, secondary and tertiary services. Conclusions: The pathways taken by children with a serious infectious illness to hospital are complex and influenced by a variety of potentially modifiable individual, organisational, environmental and contextual factors. Supportive, accessible, respectful services that provide continuity, clear communication, advice and safety-netting are important as is improved training for clinicians and a mandate to attend to ‘gut feeling’. Implications: Relatively simple interventions such as improved communication have the potential to improve the quality of care and reduce morbidity and mortality in children with a serious infectious illness.
    • A Whole Systems Approach to Hospital Waste Management in Rural Uganda

      Kwikiriza, Stuart; Stewart, Alex G.; Mutahunga, Birungi; Dobson, Andrew E.; Wilkinson, Ewan (Frontiers Media S.A., 2019-06-06)
      Introduction: Safe waste management protects hospital staff, the public, and the local environment. The handling of hospital waste in Bwindi Community Hospital did not appear to conform to the hospital waste management plan, exhibiting poor waste segregation, transportation, storage, and disposal which could lead to environmental and occupational risks. Methods: We undertook a mixed-methods study. We used semi-structured interviews to assess the awareness of clinical and non-clinical staff of waste types, risks, good practice, and concerns about hospital waste management. We quantified waste production by five departments for 1 month. We assessed the standard of practice in segregation, onsite transportation, use of personal protective equipment, onsite storage of solid waste, and disposal of compostable waste and chemicals. Results: Clinical staff had good awareness of waste (types, risk) overall, but the knowledge of non-clinical staff was much poorer. There was a general lack of insight into correct personal or departmental practice, resulting in incorrect segregation of clinical and compostable waste at source (>93% of time), and incorrect onsite transportation (94% of time). In 1 month the five departments produced 5,398 kg of hazardous and non-hazardous waste (12; 88%, respectively). Good practice included the correct use of sharps and vial boxes and keeping the clinical area clear of litter (90% of the time); placentae buried immediately (>80% of the time); gloves were worn everyday by waste handlers, but correct heavy-duty gloves <33% of the time, reflecting the variable use of other personal protective equipment. Chemical waste drained to underground soakaways, but tracking further disposal was not possible. Correct segregation of clinical and compostable waste at source, and correct onsite transportation, only occurred 6% of the time. Conclusion: Waste management was generally below the required WHO standards. This exposes people and the wider environment, including the nearby world heritage site, home to the endangered mountain gorilla, to unnecessary risks. It is likely that the same is true in similar situations elsewhere. Precautions, protection, and dynamic policy making should be prioritized in these hospital settings and developing countries.
    • The abused perineum

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (Mark Allen Publishers, 1998-07-02)
      This article discusses whether too many second degree tears are being left to heal themselves, when in fact they should be sutured. There is a need for more research based evidence by randomised controlled trial to help with decisions as to the best treatment
    • Academic induction: Perceptions of newly appointed university lecturers in nurse education: An interpretive phenomenological inquiry

      Ashford, Ruth; Mansfield, Madeleine; Carr, Helen (University of Chester, 2019-01-11)
      Aims: Empirical evidence demonstrates successful expert nurses appointed as nurse lecturers in higher education find themselves as ‘newcomers’ to the role and organisation. New nurse lecturers often find their transition to higher education confusing and challenging. Using the conceptual framework of communities of practice, this study aims to provide original research into what induction means for new nurse lecturers, and gain an in-depth understanding of their perceptions and experiences of their induction into working in a multi-sited university. Method: A qualitative research methodology was employed, using the theoretical approach of Interpretive Phenomenological Analysis (IPA) developed by Smith, Flowers, and Larkin (2009). Eight lecturers, with between one to three years’ experience as nurse lecturers, were recruited from one university in the North West of England. Purposive sampling was utilised and data was obtained through one-toone semi-structured interviews. Verbatim transcripts were analysed following the principles of IPA. Findings: Three super-ordinate themes emerged (partial transition, dual communities of practice, introduction), along with six sub-ordinate themes (expectations of the nurse educator role, career change, contextual influences, location and culture of sites, tick box exercise, and the limited role of the mentor). New nurse lecturers found transition stressful: key aspects included the culture shock and the career change of adopting their new academic identity. Changing identity from a nurse to an educator, working across the boundaries of both practice and academia, was a struggle, particularly in participants with visiting lecturer experience who had mistakenly perceived this would prepare them for the role. Early role preparation was essential to understanding the different cultures and processes within the university. Formal mentoring supported development of self-confidence, but its value was undermined due to the mentors’ workload and lack of understanding of their role, which affected relationship building. Supportive heads of department, and informal mentoring and peer support, were essential in developing new academic identities. Conclusion: This study contributes to practice through the development of an induction framework for new nurse educators. This framework acknowledges the relevance of maintaining a dual community of practice for new nurse educators, in supporting their new identity and their dual continuing professional development. Practical outcomes include: development of an informational resource for new lecturers (including visiting lecturers); development of a community of learning with facilitated workshops and online information resources; development of mentor training and resources for mentors; and mentors being thoughtfully designated by heads of department, with hours attached to their workload for mentoring. A long term online community of practice is needed for new staff to keep in touch and share information. Heads of department need to take ownership of inductions to ensure that their staff feel welcomed and supported in their new environment, with regular evaluation taking place.
    • Academic staff development

      Marriss, Dorothy; University of Chester (SAGE, 2010-10-29)
      This book chapter discusses the cultural context of staff development in higher education; the importance of developing and maintaining the skills of eduators in healthcare; challengers for new educators; and career pathways.
    • Accelerated resolution therapy: an innovative mental health intervention to treat post traumatic stress disorder

      Finnegan, Alan; Kip, Kevin; Hernandez, Diego; McGhee, Stephen; Rosenweiz, Laney; Hynes, Celia; Thomas, Mike; University of Chester (British Medical Journal, 2015-07-03)
      Post-traumatic stress disorder (PTSD) is a disabling trauma and stress-related disorder that may occur after a person experiences a traumatic event, and evokes a combination of intrusion and avoidance symptoms, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Accelerated resolution therapy (ART) is an emerging psychotherapy that provides fast and lasting resolution for mental health problems such as PTSD. ART has been shown to achieve a positive result in one to five sessions, typically over a 2-week period, and requires no homework, skills practice or repeated exposure to targeted events. Initial research, including one randomised control trial, has demonstrated that ART interventions can significantly reduce symptoms of psychological trauma in both civilians and US service members and veterans. These results suggest that ART be considered as either a primary treatment option or for refractory PTSD in those with a suboptimal response to endorsed first-line therapies. Conservative estimates indicate substantial potential cost savings in PTSD treatment. Despite the need for more definitive clinical trials, there is increasing interest in ART in the USA, including in the US Army. The growing positive empirical evidence is compelling, and there appears to be sufficient evidence to warrant UK researchers undertaking ART research. The armed forces offer the potential for comparative international trials. However, equally important are veterans, emergency services personnel and those subjected to violence. ART appears to also have application in other conditions, including depression, anxiety disorders, and alcohol or drug misuse. ART can potentially help personnel traumatised by the unique challenges of war and conflict zones by providing brief psychotherapy in a readily accessible and culturally competent manner. ART facilitates the provision of interventions and resolutions in theatre, thus enhancing forces’ fighting capability.
    • Acceptability, usability and weight loss outcomes in a randomized cross-over study of commercially available portion size tools in an overweight South Asian community

      Ellahi, Basma; Aitken, Amanda; Dikmen, Derya; Erdogan, Bilge Seyhan; Makda, Munibah; Razaq, Rifat; University of Chester; Hacettepe University (MDPI, 2022-06-23)
      South Asian women living in the UK are particularly at high risk of obesity-related complications, such as type 2 diabetes and cardio-vascular disease. Exposure to large portion sizes is a risk factor for obesity. Specifically, designed tableware helps individuals to manage weight through controlling food portion sizes. Thirty-one (n=31) overweight or obese South Asian adult women participated in a randomised cross-over trial aimed to assess efficacy, acceptance and weight change for two guided/calibrated commercially available portion control tools (Utensil set and Crockery Set) used in free-living conditions. Data on acceptance, perceived changes in portion size, frequency, and meal type was collected using paper questionnaires and 3-day diet dairies. Scores describing acceptance, ease of use and perceived effectiveness were derived from five-point Likert scales from which binary indicators (high/low) were analysed for significance using multivariate variance analysis for repeated measurements. A reduction in BMI was observed at each point of measurement (p=0.007). For overall tool use, the crockery set scored higher in all areas of acceptance, ease of use, perceived efficacy for all comparisons. Self-selected portion sizes increased for salads and decreased for cooking oil and breakfast cereals with both tools. Further research to scale up and evaluate similar weight management interventions for this group are warranted.
    • Accountability

      Thomas, Mike; University of Chester (Sage, 2008-03-17)
      This chapter considers the concept of accountability within the nursing profession. It examines how the issue of accountability is no longer placed solely on the line manager and argues that the professional nurse or midwife is accountable for their actions at all times.
    • Achieving the unimaginable: Health equity in haemophilia

      Skinner, Mark W.; Nugent, Diane; Wilton, Pam; O’Mahony, Brian; Dolan, Gerry; O’Hara, Jamie; Berntorp, Erik (Wiley, 2019-11-13)
    • Adherence to treatment - a person-centred approach

      Phipps, Dianne; Bell, Sara; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses reason why people do not adhere to their treatment regimens of advice.
    • Advocacy

      Baldwin, Moyra A.; University of Chester (Sage, 2008-03-17)
      This chapter examines the role of advocacy within the healthcare system, considering the need for advocates to support patients who have to make decisions but may not have the knowledge, confidence or ability to do so. The chapter also discusses the need for an advocate to promote and protect the patient’s autonomy and act on their behalf.
    • Ageing Simulation in Health and Social Care Education: A mixed methods systematic review

      Eost-Telling, Charlotte; Kingston, Paul; Taylor, Louise; Emmerson, Louise; University of Chester
      Abstract Aim: To identify, evaluate and summarise evidence from qualitative, quantitative and mixed method studies conducted utilising age-suits or other age simulation equipment, with health and social care students. Design: Convergent segregated mixed method review design as outlined by the Johanna Briggs Institute Data Sources: CINAHL (+ with Full Text), MEDLINE, PsycINFO, PubMed, SocINDEX, Web of Science, Cochrane Library, Emerald Insight, Proquest nursing, Science Direct, Wiley Online and BioMed Central (January 2000 – January 2020) Review methods: Convergent segregated synthesis was used to synthesise evidence from the studies, and the MERSQI checklist used to appraise quality. Results: A total of 23 studies were reviewed: one randomised control, two post-test only randomised control, three quasi-experimental, 15 one-group pre / post studies and two qualitative studies. Of the seventeen studies carrying out inferential statistics on attitude scores post intervention, 11 reported an improvement, three indicated no significant change and three reported worsening scores. Key themes included use of appropriate scales, type of equipment utilised, location and length of interactions, debriefing, and contextualisation of interventions in broader teaching. Conclusion: The impact of ageing simulation interventions on health and social care student’s attitudes to older people was predominantly positive. However, further high-quality research is warranted to understand the optimal use of such interventions within the context of healthcare for a growing ageing population. Impact: It is important health and social care staff have appropriate knowledge and training to enable them to provide high quality care to older people, and challenge potential ageism in the system. This review adds to the body of work around the use of simulation and experiential learning to educate health and social care students regarding ageing and ageism. It also offers recommendations for using ageing simulations effectively to inform attitudes of prospective professionals who will influence future health and social care. Keywords: Simulation, Ageing, Age-suit, Nursing, Health and social care, Education, Attitudes, Empathy, Experiential learning, Systematic review
    • Ageing, Sexual Orientation and Mental Health: Lesbian, Gay, Bisexual, Transgender and Intersex Older People

      Broadway-Horner, Matthew; University of Chester (Jessica Kingsley Publishers, 2017-02-21)
      Introduction Discrimination against lesbian, gay, bisexual, transgendered and intersex (LGBTi)i people can often mean they are denied the basic human right to live the life they are born to lead (Kimmel et al. 2006). Traditionally, LGBTi people have often had to live in secret, hidden from the dominant heterosexual society, and many older people are still worried about disclosing their sexual identity (Kimmel et al. 2006). In this chapter I will explore some of the many issues facing older LGBTi people. The chapter starts with a brief overview of the history of the LGBTi communities and how they have been treated as ‘invisible citizens’ through mechanisms of the law and the medicalisation of the ‘homosexual’ (Jennings 2007). Then I examine some of the fears and concerns held by members of LGBTi communities when accessing services, and this is discussed in relation to issues of sexuality, mental health and ageing. It is my hope that in reading this chapter you will gain a deeper understanding of the issues raised and then think of areas of application for your own development as a non-discriminatory practitioner, as well as identifying needs for further service development
    • Agencies: Resources for adults with paliative care need in the UK

      Fruin, Helen; University of Chester (SAGE, 2010-10-15)
      This book chapter discusses voluntary sector agencies, private sector agencies, and statutory sector agencies concerned with palliative care.
    • Alleviating perineal trauma - the APT study

      Steen, Mary; Marchant, Paul; Leeds Teaching Hospitals NHS Trust/Leeds Metropolitan University (Royal College of Midwives, 2001-08)
      The objectives of this study were to evaluate the effectiveness of a new cooling device (gel pad) and compare it with a standard regimen (ice pack) and a no localised treatment regimen (control). The study was a randomised controlled trial, initially based in a hospital midwifery unit in the North of England and then continued in the community. Participants were 450 women who had undergone either a normal or an instrumental delivery that required suturing of an episiotomy or second degree tear. The measurements and findings were as follows: 316 (71%) of completed questionnaires were returned. A significant reduction in the levels of oedema was observed in favour of using cooling treatments at day two and day five, p=0.016. p=0.018, and there was a significant reduction in bruising at day ten, p=0.01 (using the Kruskal-Wallis test). Self-reported pain was less in the cooling gel pad group. A significant reduction in pain was demonstrated at day five, day ten and day 14, p=0.023, p=0.007, p=0.058, (Kruskal-Wallis test). A reduction in pain was reported earlier on day two, day three and day five when making a binary comparison of moderate or severe pain, with none or mild, p=0.0038, p=0.037, p=0.017 (chi-squared test). Maternal satisfaction With the cooling gel pad was high and differed statistically significantly compared to the other regimens, p=0.0005, (Kruskal-Wallis test). There were no clinical significant differences monitored between groups when assessing healing. The key conclusions were that this clinical trial confirms earlier findings in a previous study and provides evidence that the use of a specifically designed cooling gel pad is a safe and effective localised method to alleviate perineal trauma, without any adverse effects on healing.
    • Alleviating perineal trauma: The APT study

      Steen, Mary (2000)
      This poster presentation aims to evaluate the effectiveness of a new cooling device (gel pad) with a standard regimen (ice pack) and compare these with no localised treatment regimen (control). 450 women partipcated in this study at St James's University Hospital and their own homes. The trial confirmed earlier findings to support the use of a specially designed cooling gel pad (Feme pad)to alleviate perineal trauma.
    • Alleviating postnatal perineal trauma: To cool or not to cool?

      Steen, Mary; Briggs, Michelle; King, David; UCLan/University of Leeds/Royal College of Midwives (Mark Allen Publishing, 2006-05-01)
      This article discusses the evidence reported from quasi randomised trials and randomised controlled trials on the efficacy and acceptability of localised cooling methods in alleviating perineal trauma. Two types of cooling methods were identified: iced sitz baths and cooling devices. The review suggests that cooling may lower the levels of reported perineal pain after childbirth and reduce the inflammatory response associated with perineal trauma. However, women's preferences as well as the efficacy of the cooling method should be taken into consideration. Women's natural reluctance to sit in iced sitz baths suggests that this cooling method is unpleasant and may explain why there has been a decline in this method being used in clinical practice over the last two decades. The use of localised cooling devices appear to be a more acceptable method for women.
    • An analysis of the acceptability, feasibility, and utility of the Global Mental Health Assessment Tool for Primary Care (GMHAT/PC) in a UK primary healthcare setting: a practice-based mixed methods study

      Mason-Whitehead, Elizabeth; Sharma, Vimal; Quinn, Bennett N. E. (University of Chester, 2021-02)
      Introduction: Published evidence shows that at least one in four people at any one time have mental health symptoms, most commonly of anxiety and depression. This is set against a background where the evidence demonstrates that primary care in general is poorly equipped to identify, diagnose and manage mental health disorders. The effect of these disorders affects the individual’s physical and social wellbeing and has an impact at all levels of Society. This study investigates the acceptability and feasibility of the Global Mental Health Assessment Tool for primary care (GMHAT/PC), and the impact of using it on the confidence and self-rated competence of healthcare workers. The Global Mental Health Assessment Tool for primary care (GMHAT/PC) is a computerised semi-structured interview tool to support a healthcare worker in the assessment of patients presenting with mental health symptoms. While single diagnosis tools are now more widely used in UK general practice, semi-structured mental health interview tools are not. GMHAT/PC was developed in the UK using resources from both community mental health services and primary care. Used in clinical practice, GMHAT/PC guides a healthcare worker through a comprehensive mental health assessment and its greater use has the potential to increase their diagnostic accuracy. With diagnostic accuracy comes more appropriate patient management. Method: The study deploys mixed methods research strategies in a UK general medical practice setting. Fifty-five healthcare workers were trained in the use of GMHAT/PC. They provided pre- and post-training self-ratings and participated in semi-structured interviews to provide views of the feasibility of the tool and its impact on their confidence and self-rated competence in mental health assessments. After training, the healthcare workers interviewed 198 patients with mental health symptoms using GMHAT/PC. The patients completed a questionnaire exploring their views of the time taken for the interview, whether it addressed their symptoms and whether they found it acceptable. Seventeen patients were also interviewed to further explore their opinions. Results: Ninety-nine per cent (99%) of the patient participants found the use of GMHAT/PC in their clinical assessment either “somewhat acceptable” or “very acceptable” (2 (1) = 6.636, N = 198, p = .010). Most healthcare workers identified time as a barrier to GMHAT/PC’s feasibility but viewed its use as feasible, provided that additional time was available for the assessment, such as extra appointment time, arranging an appointment at the end of a consulting session, or delegating the assessment to another healthcare worker with less time pressures. There was a statistically significant improvement in the self-rated competence (T = 253, z = 4.221, p < .001) and confidence (T = 378, z = 4.560, p < .001) of healthcare workers still in undergraduate training. For healthcare workers working under the supervision of a fully qualified general practitioner, statistically significant improvements were also seen in self-rated competence (T = 73, z = 2.801, p = .005) and confidence (T = 150, z = 3.491, p < .001). There was no statistically significant change in the confidence and self-rated competence of fully certified practitioners. Conclusion: The results show that the use of GMHAT/PC is highly acceptable to patients. Its use is feasible provided additional time is made available for the interview. There were improvements in the confidence and self-rated competence of undergraduate healthcare workers and those working under supervision. This research is important because it shows how the use of a tool such as GMHAT/PC could support healthcare workers in their practice, facilitating more accurate diagnoses and hopefully reducing the burden of mental health disorders for the individual and their societal settings. Future research should assess the value of semi-structured interview tools, such as GMHAT/PC, in developing trainee healthcare workers’ skills in mental health assessments, most particularly for common mental health disorders which cause significant disability for a large proportion of Society. Healthcare workers were concerned about the additional consultation time required for the GMHAT/PC interview. Future research could assess the impact of a semi-structured mental health interview on the patient’s subsequent consulting patterns.