Exploring the research culture of nurses and allied health professionals (AHPs) in a research-focused and a non-research-focused healthcare organisation in the UK.

AIMS AND OBJECTIVES: To explore the research culture of nurses and allied health professionals (AHPs) in the UK and the influence of a dedicated research strategy and funding. It is important to understand the culture in order to effectively promote evidence-based patient care. The primary aim of this research was to explore the influence of research-focused exposure on the research culture of nurses and AHPs in the UK and to identify whether there was a difference in the research culture between a research-focused and non-research-focused clinical area (City and Riverside Hospitals). BACKGROUND: This is a unique and novel study that explored and compared the research culture stance of both AHPs and nurses. DESIGN: METHODS: A mixed methods design was used in this study. Tools used included the "Research Capacity and Culture tool" as an online survey, three focus group discussions and five semi-structured interviews with senior managers. Focus groups included research-naive groups from both hospitals and a research-active group from City Hospital. RESULTS: There were 224 responses received from 941 surveys with a 24% response rate. Descriptive statistics of the survey results indicated that there was a difference (p = .001) in the mean score of the research culture between City Hospital (5.35) and Riverside Hospital (3.90), but not between nurses and AHPs (p = .12). Qualitative data findings from the framework analysis were congruent and supported the survey results. The results provided empirical evidence to support a whole-level approach in order to improve the research culture. Both findings showed that there may not be any difference in the research culture between professional groups. Importantly, new evidence is presented to suggest that there were crucial communication issues which were hampering the research culture and there was a lack of support at the middle management level which needed to be tackled to improve the research culture of nurses and AHPs. RELEVANCE TO CLINICAL PRACTICE: The study highlighted the need to include a whole-level approach in organisation to improve research culture and to include communication within the Cooke's framework if evidence-based practice is to influence the quality of patient care.

Altruism, honesty and religiosity in nursing students.

AIMS AND OBJECTIVES: To identify, at different stages of nursing education, the extent to which nursing students appreciate altruism, honesty, religiosity and other, sometimes contrasting, values in practice. BACKGROUND: Nursing is informed by values that guide care ethos and activities. Embodiment of these core values has become a matter of concern. Reports outlining deficiencies in health care followed by polemics in nursing journals have called into question whether nursing students are sufficiently motivated by values and educated in their application. This study explores these values among undergraduate nursing students in the Republic of Ireland. Considering the strong religious tradition in health care in Ireland, religiosity was also included. DESIGN: A link to an online survey was distributed via email to all nursing students in the thirteen Schools of Nursing in the Republic of Ireland. METHOD: Quantitative data were collected using an adaptation of the Salford-Scott (Journal of Advanced Nursing, 57(8), 2007, 366) Nursing Values Questionnaire. RESULTS: Participants (n = 158) reported positively to statements related to honesty and altruism. Both altruism and religiosity received support, but the latter was to a lesser extent. Students considered their professionalism more important than altruism, and honesty varied according to the situation. CONCLUSIONS: This study adds new information by confirming that students exhibit support for two of the most essential values in nursing: altruism and honesty. The adapted Salford-Scott instrument has shown reliability and promise in further empirical study in nursing. RELEVANCE TO CLINICAL PRACTICE: Priority given to professionalism over altruism reflects concerns highlighted in the international literature around overly task-oriented care in which compassion gets lost. Also, when loyalty supersedes honesty, problems with accountability in health care may emerge. Uncertainty around religiosity in health care may reflect limitations in competence in nurses to relate to patients with religions or spirituality other than their own.

Carer Experience Supporting Someone With Dementia and Cancer: A Narrative Approach.

In this article, we examine the challenges of informal carers supporting someone with dementia and cancer within the United Kingdom. Interviews were conducted with seven informal carers using a narrative approach to examine the construction of their experiences. Our findings demonstrate how informal carers navigate a path through complex cancer treatments and support their relative. A cancer diagnosis often requires multiple treatment visits to an oncology center, and this can be challenging for carers. They find that they need to coordinate and manage both health professionals and their relative in terms of getting access to appropriate services and support. This process can be particularly challenging in the presence of a cognitive impairment that often demands effective communication with different agencies. Carers frequently experienced multiple challenges including dealing with the stigma that is characteristic of the dementia experience and the added complexity of negotiating this within a cancer care context.

Narrative intelligence in nursing: Storying patient lives in dementia care.

This paper examines narrative approaches to care within the context of dementia. It reviews the function of stories and explores some of the narrative genres that shape the cultural perceptions of dementia. We argue that narrative intelligence within healthcare is an important element in nurturing communal self-identity for people living with dementia. Listening and responding to stories and the cultural framework that this encompasses is an embodied action that is not just related to cognitive recall but situates us within a cultural community. People with dementia may have challenges in maintaining narrative legitimacy in the face of fractured stories and incoherent narratives. Health professionals can offer support in reframing and presenting counterstories that maintain identities that can potentially be marginalised, silenced and open to narrative foreclosure. This process requires health professionals to be attentive and responsive to how patients with dementia and their supporters construct and position the stories they tell and the meaning(s) they attach to them.

Economic impact of routine opt-out antenatal human immune deficiency virus screening: A systematic review.

AIMS AND OBJECTIVES: To evaluate the economic impact of routine testing of human immune deficiency virus in antenatal settings. BACKGROUND: Many children are being infected with human immune deficiency virus through mother-to-child transmission of the virus. Most of these infections are preventable if the mothers' human immune deficiency virus status is identified in a timely manner and appropriate interventions put in place. Routine human immune deficiency virus testing is widely acclaimed as a strategy for universal access to human immune deficiency virus testing and is being adopted by developed and developing poor income countries without recourse to the economic impact. DESIGN: A systematic review of published articles. METHODS: Extensive electronic searches for relevant journal articles published from 1998-2015 when countries began to implement routine antenatal HIV testing on their own were conducted in the following databases: Science Direct, MEDLINE, SCOPUS, JSTOR, CINAHL and PubMed with search terms as listed in Box 2. Manual searches were also performed to complement the electronic identification of high-quality materials. There were no geographical restrictions, but language was limited to English. RESULTS: Fifty-five articles were retrieved; however, ten were eligible and included in the review. The findings showed that many programmes involving routine human immune deficiency virus testing for pregnant women compared to the alternatives were cost-effective and cost saving. Data from the reviewed studies showed cost savings between $5,761.20-$3.69 million per case of previously undiagnosed maternal human immune deficiency virus-positive infection prevented. Overall, cost-effectiveness was strongly associated with the prevalence rate of human immune deficiency virus in the various settings. CONCLUSIONS: Routine human immune deficiency virus testing is both cost-effective and cost saving compared to the alternatives. However, there are wide variations in the methodological approaches to the studies. Adopting standard reporting format would facilitate comparison between studies and generalisability of economic evaluations. RELEVANCE TO CLINICAL PRACTICE: (i) Healthcare decision-makers should understand that routine antenatal screening for human immune deficiency virus is both cost-effective and cost saving. (ii) Addressing late identification of prenatal human immune deficiency virus is crucial to reducing mother-to-child transmission at minimal healthcare spending.

Clinical outcomes of routine opt-out antenatal human immunodeficiency virus screening: a systematic review.

AIMS AND OBJECTIVES: To evaluate the clinical outcome of routine screening of human immunodeficiency virus in antenatal clinic settings. BACKGROUND: Despite the growing advances in human immunodeficiency virus management, nearly 30% of the estimated 1·5 million seropositive pregnant women are undiagnosed. Routine opt-out testing is a strategy endorsed by the World Health Organization in to increase testing rates in clinical settings. DESIGN: A systematic review of relevant published literature. METHODS: A comprehensive electronic search for relevant studies in Science Direct, MEDLINE, SCOPUS, CINAHL and PubMed was conducted with search terms (Box 2). Hand searches were also conducted for additional resources. There were no geographical restrictions. Searches were restricted to English language and studies conducted between 1998-2015; totaling 1097 were retrieved and carefully appraised for review. Eighteen studies were eligible for review: eight from Africa, five from the United States, three from Europe, one from Australia and one from Asia. RESULTS: Fourteen studies reported increases in human immunodeficiency virus testing rate. Following the introduction of routine testing, human immunodeficiency virus testing rates increased from values ranging from 68-99·9% with median value of 88%. The comparison studies reported testing uptake of 22-93·5% with median value of 59%. Maternal human immunodeficiency virus case detection rates nearly doubled following adoption of routine testing at values of 99 and 45% during opt-in. Linkage to treatment and care for prevention of vertical transmission was reported on six studies, and results ranged between 12·9-77·2%. CONCLUSION: The findings show that irrespective of human immunodeficiency virus epidemiological scenarios, routine testing gave more women opportunity to learn their human immunodeficiency virus status and take measures for prevention of mother-to-child transmission of human immunodeficiency virus. Future studies should focus on identifying strategies to improving linkages to treatment and care for prevention of vertical transmission. RELEVANCE TO CLINICAL PRACTICE: Understanding the contributions of Routine opt-out testing in antenatal clinic would help practitioners adopt the novel testing model for more mothers to learn their human immunodeficiency virus status for prevention of mother-to-child transmission.

The cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains.

AIMS AND OBJECTIVES: To examine the cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains. DESIGN: Economic evaluation based on cost-utility analysis. BACKGROUND: Ankle sprains are a source of morbidity and absenteeism from work, accounting for 15-20% of all sports injuries. Semi-rigid ankle brace and taping are functional treatment interventions used by Musculoskeletal Physiotherapists and Nurses to facilitate return to work following acute ankle sprains. METHODS: A decision model analysis, based on cost-utility analysis from the perspective of National Health Service was used. The primary outcomes measure was incremental cost-effectiveness ratio, based on quality-adjusted life years. Costs and quality of life data were derived from published literature, while model clinical probabilities were sourced from Musculoskeletal Physiotherapists. RESULTS: The cost and quality adjusted life years gained using semi-rigid ankle brace was £184 and 0.72 respectively. However, the cost and quality adjusted life years gained following taping was £155 and 0.61 respectively. The incremental cost-effectiveness ratio for the semi-rigid brace was £263 per quality adjusted life year. Probabilistic sensitivity analysis showed that ankle brace provided the highest net-benefit, hence the preferred option. CONCLUSION: Taping is a cheaper intervention compared with ankle brace to facilitate return to work following first-time ankle sprains. However, the incremental cost-effectiveness ratio observed for ankle brace was less than the National Institute for Health and Care Excellence threshold and the intervention had a higher net-benefit, suggesting that it is a cost-effective intervention. Decision-makers may be willing to pay £263 for an additional gain in quality adjusted life year. RELEVANCE TO CLINICAL PRACTICE: The findings of this economic evaluation provide justification for the use of semi-rigid ankle brace by Musculoskeletal Physiotherapists and Nurses to facilitate return to work in individuals with first-time ankle sprains.

Adult Siblings Consider the Future: Emergent Themes.

BACKGROUND: This study aimed to explore the perceptions of adult siblings regarding a future care role and compare with perceived parental wishes as family often provide a key support role in the lives of people who have an intellectual disability. MATERIALS AND METHOD: Semi-structured interviews were undertaken with 15 adult siblings and an approach aligned to IPA was used to analyse the results. RESULTS: Emergent themes demonstrated that intellectual disability has an impact upon sibling lives yet the degree and range of impact varies. Most participants were concerned about the future, service issues were raised as was futures planning, siblings' needs, the positive impact of intellectual disability and influence of life stage upon care giving. CONCLUSION: The findings highlight that whilst the impact of intellectual disability upon adult siblings is variable, siblings are concerned about the future, and that life stage and circumstance appear to influence care giving.

Transcriptionist saturation: knowing too much about sensitive health and social data.

AIM: The paper describes and interprets the experiences of transcriptionists employed to translate recorded auditory research, medical, court data into text and specifically when the research is sensitive and the audio source material may be traumatic to hear. BACKGROUND: This study highlights the ongoing need for transcriptionists to be recognized in the ethics process as a potentially vulnerable group who need greater support and debriefing when transcribing sensitive health and social data. DESIGN: Qualitative research. METHODS: Telephone interviews were conducted with 12 transcriptionists in Australia and New Zealand during 2012, who had transcribed sensitive material and reported issues with transcribing certain topics. Accuracy and confidentiality were paramount in this work. FINDINGS: Seven participants reported negative emotional and physical effects from transcribing sensitive material On the other hand six participants found the work enjoyable. CONCLUSION: The majority of the transcriptionists did not receive any debriefing after transcribing sensitive material. The participants developed their own strategies to deal with the effects of transcribing sensitive materials such as online support groups, relaxation activities and unofficial debriefing with friends and family.

First steps toward understanding the variability in acute pain service provision and the quality of pain relief in everyday practice across the United Kingdom.

BACKGROUND: Pain management for patients in hospital is a major problem. There is significant variation in care provision. Evidence is needed about the ways in which acute pain services are organized in order to understand whether these are linked to important differences in patient outcomes. The National Inpatient Pain Study group is a voluntary collaborative venture of inpatient pain specialists in the United Kingdom who are working toward establishing a national prospective database of service provision and activity. OBJECTIVES: The objectives of this article are (1) to describe current pain service provision and activity (2) to define and monitor the quality and side effects of the primary analgesic techniques, such as central neuraxial block or systemic analgesia, and identify variations in practice. METHODS: Phase 1: Surveys were conducted in two phases during 2010-2011. Information about the organization of services was collected from 121 centers via a live Website. Phase 2: The pilot clinical dataset was collected from 13 hospitals in 2011. RESULTS: Results indicated that staffing varied widely from one to nine nurses per hospital site. Twelve percent of hospitals did not routinely collect data. The main workload was orthopedic and general surgery based on data from 13 hospitals and 29,080 patients in 2011. Thirty-seven percent of patients reported a pain score of moderate to severe pain on the first assessment by the specialist pain team, and 21% reported severe pain. Nausea and vomiting was the most frequent adverse event reported. Sixty-nine major adverse events were logged, of which 64 documented respiratory depression (N = 29,080, 0.22%). CONCLUSIONS: Prospective longitudinal data has the potential to improve our understanding of variation in process and outcome measures and establish future research priorities.

Pain from the inside: understanding the theoretical underpinning of person-centered care delivered by pain teams.

Chronic back pain is globally acknowledged as a common reason why people seek help from health professionals. The complexity of persistent chronic pain can undermine the person's self-esteem and present a number of challenges to an individual's ability to manage their pain. Multi-professional person-centered care is advocated as a key strategy to support people with chronic back pain. However, the impact of these approaches on restoring the person's independence is unclear, and little is known about whether and how person-centered approaches restore autonomy and influence the person's ability to manage their pain. The aim of this grounded theory study was to generate understanding about person-centered care from the perspectives of people with chronic back pain and the multi-professional teams who cared for them. Semi-structured interviews were used to collect data from 17 people with chronic back pain over one year. A constant comparative analytical approach identified five key categories: the skeptical professional, validation, becoming a person, regaining control, and restoring faith. These categories formed the "conditional partnership" as a theory to explain person-centered care, which related to the way in which the partnership developed between the patients and teams. The findings suggest that person-centered care was influenced by the participants' need to be believed and the relationship developed with health care providers. Crucially, these findings suggest that legitimizing the pain experience through person-centered approaches to care can empower people with chronic back pain to regain control of their lives and their pain.

The challenges of health professionals in meeting the needs of vulnerable patients undergoing chemotherapy: a focus group study.

AIMS AND OBJECTIVES: To explore health professionals' perceptions of the needs of patients undergoing chemotherapy treatment for cancer. BACKGROUND: Patients with vulnerabilities face additional challenges. People with learning difficulties are often protected from even basic cancer information; patients with severe mental illness are open to structural discrimination with limited access to diagnostic and treatment services. There is also a much poorer survival rate after a cancer diagnosis for patients living with dementia. DESIGN: A qualitative design was used. METHODS: A focus group design was undertaken for this project using a narrative analytical approach revealing how narrative tales are presented and performed. Eighteen healthcare workers were recruited from a regional oncology centre in North West England. Two focus groups were conducted with nine participants in each. The data were collected from late 2011-2012. RESULTS: Participants were primarily focused on getting patients through treatment. The identification of vulnerability was an 'extra' complication and one that in practice was difficult to define/categorise. The participants appreciated the wider inclusion of family and friends to support vulnerable patients although they felt formalised health care was not particularly facilitative of this process. There were difficulties in achieving support for complex patient needs in the presence of a target driven culture. CONCLUSIONS: Healthcare professionals need wider managerial and cultural support in meeting the needs of vulnerable patients. There appeared to be a tendency by healthcare professionals to minimise the inherent coping abilities of vulnerable patients. RELEVANCE TO CLINICAL PRACTICE: There is a clear need to support health professionals in providing appropriate resources in order to address the complex needs of vulnerable patients. This requires a cultural shift away from targets and an investment into greater resources for effective multidisciplinary working.

As others see us: what PhD students say about supervisors.

AIM: To explore the attitudes that doctoral students share with each other in an online postgraduate discussion forum. BACKGROUND: The supervisory role is pivotal to the successful completion of a PhD. Student satisfaction surveys are implemented by some universities, but there is currently no research that has investigated PhD students' experiences of supervision in the less formal environment of an online postgraduate discussion forum. DATA SOURCES: Data were collected between September and December 2012 from the Postgraduate Forum, which receives posts from the global student community. The keywords used in the search were 'supervisor(s)' and 'supervision'. The data were analysed using thematic analysis. REVIEW METHODS: All relevant titles and posts from between January 2002 and the end of December 2012 were searched. DISCUSSION: The authors discovered five major themes: communication difficulties, control and engagement, academic bullying, lack of trust, and desertion. The relationship between students and supervisors is vital to successful PhD completion, and this study has provided some of the experiences students share with each other in an online postgraduate discussion forum. CONCLUSIONS: The online discussion forum provided an insight into students' perspectives of supervision but as it is asynchronous, there is limited analysis. Further research incorporating synchronous data collection methods would be helpful to examine students' experiences in greater detail. IMPLICATIONS FOR RESEARCH/PRACTICE: This study shows how an online postgraduate forum can be used as a source of data to gain an insight into PhD students' perspectives of supervision.

Measuring and improving the quality of postoperative epidural analgesia for major abdominal surgery using statistical process control charts.

AIMS AND OBJECTIVES: To explore and improve the quality of continuous epidural analgesia for pain relief using Statistical Process Control tools. BACKGROUND: Measuring the quality of pain management interventions is complex. Intermittent audits do not accurately capture the results of quality improvement initiatives. The failure rate for one intervention, epidural analgesia, is approximately 30% in everyday practice, so it is an important area for improvement. Continuous measurement and analysis are required to understand the multiple factors involved in providing effective pain relief. DESIGN: Process control and quality improvement METHODS: Routine prospectively acquired data collection started in 2006. Patients were asked about their pain and side effects of treatment. Statistical Process Control methods were applied for continuous data analysis. A multidisciplinary group worked together to identify reasons for variation in the data and instigated ideas for improvement. The key measure for improvement was a reduction in the percentage of patients with an epidural in severe pain. RESULTS: The baseline control charts illustrated the recorded variation in the rate of several processes and outcomes for 293 surgical patients. The mean visual analogue pain score (VNRS) was four. There was no special cause variation when data were stratified by surgeons, clinical area or patients who had experienced pain before surgery. Fifty-seven per cent of patients were hypotensive on the first day after surgery. We were able to demonstrate a significant improvement in the failure rate of epidurals as the project continued with quality improvement interventions. CONCLUSION: Statistical Process Control is a useful tool for measuring and improving the quality of pain management. IMPLICATIONS FOR NURSING MANAGEMENT: The applications of Statistical Process Control methods offer the potential to learn more about the process of change and outcomes in an Acute Pain Service both locally and nationally. We have been able to develop measures for improvement and benchmarking in routine care that has led to the establishment of a national pain registry.

"Let's stick together"--a grounded theory exploration of interprofessional working used to provide person centered chronic back pain services.

Chronic back pain is a global phenomenon and a common reason why patients seek help from health professionals. Person-centered interprofessional working is acknowledged as the main strategy for chronic back pain management; however, the complexity of chronic pain can present significant challenges for teams. Although methods used by interprofessional teams to collaborate have been previously explored, how they work together to deliver person-centered chronic back pain care has received limited attention. The aim of this study was to explore person-centered care from the perspectives of people with chronic back pain and the interprofessional teams who cared for them. A grounded theory methodology was used to capture the interprofessional team's perspectives of person-centered working. A purposive sample of four chronic back pain management teams participated in semi-structured face-to-face interviews and focus groups. Data were thematically analyzed using a constant comparative method. Three categories emerged, collective efficacy, negotiated space and team maturity, which illustrated the attributes of interprofessional teams that influenced person-centered working. The findings suggest that collective efficacy matures over time within a negotiated coalesced space and re-enforces the need for teams to stick together to ensure effective person-centered care.

Managing a venous leg ulcer in the 21st century, by improving self-care.

This paper examines the context of managing a long-term condition within the community environment using appropriate evidence-based literature. It is a case study that focuses upon concordance with compression bandaging in treating venous leg ulceration and preventing ulcer recurrence through a well leg clinic. The challenges of this episode of care and the interventions put in place to improve concordance and promote self-care will be explained and analysed.

Exploring the case for assisted dying in the UK.

This article discusses the concepts of euthanasia, assisted suicide and physician-assisted suicide, under the umbrella term of assisted dying, from a pro-assisted dying perspective. It outlines the key principles underpinning the debate around assisted dying and refutes the main arguments put forward by those opposing legalisation of assisted dying in the UK.

'This house believes that caring can and should be measured'.

The case for and against the measurement of care is explored by four nursing academics. Supporters of the idea say measurement is essential so that nurses can benchmark improvements and gain a better insight into the quality of care. Their opponents say caring is a 'moral art' or so 'irredeemably vague' it is futile to try measuring it.