Hyperacute stroke and the specialist nursing impact: exploring the cause and context of feelings of secondary traumatic stress - a qualitative inquiry.

Background: Secondary traumatic stress (STS) has been defined as the stress resulting from helping or wanting to help a traumatised or suffering person. The hyperacute nature of stroke specialist nurses' work places them at risk of developing STS. Aims: To explore the factors that are influential in stroke specialist nurses' experience of STS development within hyperacute practice. Methods: This study is qualitative with a narrative design. Data were collected from a purposive sample of stroke specialist nurses (20 female and 2 male) working in hyperacute services during the years 2016 and 2017. Data were analysed using Polkinghorne's approach. Results: This research identified four themes: exposure to acute suffering and death- young presentations; moral distress; interactions with relatives and problematic healthcare systems. Conclusion: The findings from this study suggest that stroke specialist nurses are exposed to multiple triggers which are commensurate with the potential for STS development. The findings contribute a new understanding of the emotional burden of hyperacute specialist stroke nursing that has implications for patient safety and satisfaction, services provision and staff well-being.

Co-production and evaluation of an e-learning resource to improve African-Caribbean families' knowledge about schizophrenia and engagement with services: a pilot randomised controlled trial protocol.

BACKGROUND: A higher proportion of African-Caribbean people in the UK are diagnosed with schizophrenia spectrum disorders than other ethnic groups. High levels of shame and stigma at individual and community levels contribute to delayed access to care, potentially increasing the duration of untreated psychosis and so worsening outcomes. Inferior access, more coercive care, and worse outcomes have created a 'circle of fear' of mental health services within African-Caribbean communities. This further discourages early engagement with statutory services and increases the burden of care for families living with schizophrenia.Providing tailored and relevant information about psychosis (psychoeducation) has the potential for improving outcomes for patients and families. However, there are no culturally appropriate psychoeducation programmes for African-Caribbeans in the UK. We aim to determine whether an e-learning resource, co-produced with African-Caribbean stakeholders to improve knowledge about psychoses, would be culturally acceptable and accessible to members of this population. METHODS: A pilot randomised controlled trial of the feasibility of co-producing and testing a novel e-learning resource to improve knowledge about and attitudes towards schizophrenia in African-Caribbean families. We will seek to recruit 40 participants, aged ≥ 16 years, either to receive the intervention or as controls. They will self-refer or be referred via inpatient and wellbeing services, family and carers' forums, statutory community mental health teams, and voluntary sector/non-governmental agencies (NGOs). Participants will complete the Ca-KAP, ASMI, and SF-12. Acceptability will be explored qualitatively via focus groups and individual semi-structured interviews. DISCUSSION: The proposed trial will demonstrate the feasibility of conducting a fully powered RCT to evaluate the efficacy of an e-learning resource about schizophrenia with African-Caribbean families. Qualitative work will explore the intervention's accessibility and barriers/facilitators to participation, including attitudes to randomisation. These data will facilitate further refinement of the intervention. TRIAL REGISTRATION: ISRCTN11394005, retrospectively registered 20/03/2018.

A narrative literature review examining cancer treatment issues for patients living with intellectual disabilities.

PURPOSE: The experiences of cancer care can be mediated by many different factors and this narrative literature review aims to explore the experiences of cancer care in relation to people with intellectual disabilities receiving cancer treatment. METHOD: We undertook a search for articles in English from (Jan) 2000-(Feb) 2018 using Medline, CINAHL, ScienceDirect, ASSIA and Wiley. The inclusion criteria are 2000-2018, English language and focussing on experiences of cancer journey. We used a narrative approach and thematically analysed the data. RESULTS: There were 10 papers that met our inclusion/exclusion criteria. The themes generated included communication issues, information giving and decision-making. The literature suggests that communication and decision-making within cancer care are often mediated through support workers or family carers with minimal involvement of the person with intellectual disabilities. Information-giving by health professionals and support workers to people with intellectual disabilities was limited. This was often justified by the perceived distress this may cause. CONCLUSION: Training for health professionals and support workers in supporting people with intellectual difficulties is required for more effective communication in cancer care.

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.

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.

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.

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.

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.

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.

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.