The journey to advanced practice: An Interpretative Phenomenological Analysis of reaching destination and beyond for reporting radiographers in Scotland.

INTRODUCTION: Optimising radiographer and radiologist skill-mix is essential to increase efficiency and ensure quality patient care and safety in radiology services. Radiographer reporting, well established within the UK, has been legally and legitimately identified within the scope of radiographer practice for many years. Little research however has focused on perceptions and experiences of practitioners as they journey towards advanced practice in skeletal trauma reporting. METHODS: A two-phase qualitative approach, utilising Interpretative Phenomenological Analysis (IPA), included a homogenous group of radiographer practitioners (n = 12). Phase 1 thematically analysed personal reflective diaries. Phase 2 included one-one, semi-structured interviews which were recorded, transcribed verbatim and reviewed using the IPA six stage thematic analysis. RESULTS: Three super-ordinate themes emerged. This paper reflects the IPA generated from Super-ordinate Theme 3; Review upon and action for the role. Participants had reached destination and beyond with a focus on development of role, self and others. As reporting became firmly embedded, there was increased acceptance, educational development and positive impact on service. Reflections indicated motivation, drive, commitment, increased confidence and self-esteem CONCLUSION: This study provides an insight in to the participant journey towards advanced practice and skeletal trauma reporting in Scotland as participants reached destination and beyond. IMPLICATIONS FOR PRACTICE: Developments within the NHS continue to rapidly evolve and diagnostic imaging, with advancing technology, practice and changing policies, continues to remain in a constant state of change. Continued support and investment for role development, framed within a culture of effective teamworking, positive engagement and professional respect is essential.

Theory and application of research principles and philosophical underpinning for a study utilising interpretative phenomenological analysis.

INTRODUCTION: Qualitative research approaches have potential to provide unique and valuable insights intoperceptions, experiences and behaviours. Reports however indicate that papers often fail to sufficiently detail the underlying principles that explain the philosophical assumptions and ontological, epistemological and methodological perspectives. Primarily directed towards radiographers considering a qualitative approach for doctoral research, this paper will also be informative for other health and social care practitioners. METHOD: Part 1 discusses research principles broadly and how philosophical assumptions can be used for selection of the approach and methodology to explore a particular topic. Part 2 provides a worked example applied in context for a qualitative approach utilising Interpretative Phenomenological Analysis (IPA), that explored perceptions and experiences of lived experiences of radiographers on a journey to advanced practice in skeletal trauma reporting. RESULTS: The paper identifies the need for understanding of the theory and application of research principles broadly. Explanation and justification of choice is expected for the selection of research approach, paradigm, philosophical underpinning, underlying assumptions and methodology, to best answer the research question and inform participant selection, data collection, data analysis and interpretation methods CONCLUSION: Coherent research requires synthesis of ontology, epistemology and methodology with the choice of research design based on the most appropriate approach. Qualitative research has greatly enhanced its reputation for methodological rigour and the uptake of IPA is increasing within health and social care. IMPLICATIONS FOR PRACTICE: Future research within the Interpretative paradigm, utilising IPA as a methodology has potential to expand the body of evidence for Radiography research.

The prevalence of faecal incontinence in myotonic dystrophy type 1.

Faecal incontinence is recognised as a feature of myotonic dystrophy along with other symptoms of bowel dysfunction, but its prevalence is poorly defined. We have surveyed 152 unselected myotonic dystrophy patients. We identified issues with bowel control in 104 (68% of the study population). Forty-eight (32%) reported faecal incontinence in the 4 weeks prior to completion of the questionnaire. Fifty-six patients (37%) reported having to change their lifestyle because of incontinence issues at some point in the prior 4 weeks. This study shows a high frequency of life-changing symptoms in a large unselected, cohort of patients with myotonic dystrophy type 1, and highlights lower gastrointestinal symptoms as an important issue for further research.

Maternal emotions during the first three postnatal months: Gaining an hermeneutic understanding.

BACKGROUND: Maternal emotions in the first three postnatal months are rarely explored yet in the German context despite it is known that they play an important role in the complexity of maternal health and well-being. AIM: Gaining understanding of maternal emotions and how the developmental process of the infant circadian rhythm influences them during the first three months of the postnatal period. METHODS: A Gadamerian-based research method was used to explore the experiences of 15 mothers in Germany. FINDINGS: 'Being needed' and 'being in need' emerged as the first two themes and were further explored hermeneutically. This resulted in the findings of 'emotional balance and conflicting emotions' as underlying maternal emotions during the first three months following birth. DISCUSSION: Understanding maternal emotions during the first three months of the postnatal period has the potential of opening new pathways for improving maternal health and well-being. CONCLUSION: A spectrum of maternal emotions, maternal uncertainties and maternal needs exists in the first three months of the postnatal period.

The technique of delivery of peri-operative analgesia does not affect the rehabilitation or outcomes following total knee arthroplasty.

AIMS: This non-blinded randomised controlled trial compared the effect of patient-controlled epidural analgesia (PCEA) versus local infiltration analgesia (LIA) within an established enhanced recovery programme on the attainment of discharge criteria and recovery one year after total knee arthroplasty (TKA). The hypothesis was that LIA would increase the proportion of patients discharged from rehabilitation by the fourth post-operative day but would not affect outcomes at one year. PATIENTS AND METHODS: A total of 242 patients were randomised; 20 were excluded due to failure of spinal anaesthesia leaving 109 patients in the PCEA group and 113 in the LIA group. Patients were reviewed at six weeks and one year post-operatively. RESULTS: There was no difference in the proportion of patients discharged from rehabilitation by the fourth post-operative day, (77% in the PCEA group, 82% in the LIA group, p = 0.33), mean length of stay (four days in each group, p = 0.540), day of first mobilisation (p = 0.013) or pain (p = 0.278). There was no difference in mean Oxford Knee Scores (41 points in each group, p = 0.915) or the rate of complications in the two groups. CONCLUSION: Both techniques provided adequate pain relief, enabled early mobilisation and accelerated rehabilitation and good patient-reported outcomes up to one year post-operatively. PCEA and LIA are associated with similar clinical outcomes following TKA. Cite this article: Bone Joint J 2016;98-B1189-96.

Family nursing in intensive care. Part two: The needs of a family with a member in intensive care.

It was demonstrated in Part one that the family is a justifiable concern to nurses in intensive care and that family-focused care is appropriate in such an area. If this approach to care is to be considered, it is necessary to identify the needs of families when they have a member in an intensive care unit. This is a well-researched area and some of the relevant literature is discussed within this paper. Before this literature is addressed, an attempt is made to define the concept of need. The methodologies used in the identification of family needs could be adapted to explore whether or not the needs of the families of patients in a particular intensive care unit are being met. This paper suggests that if it was shown that the meeting of family needs was an area of care which could be improved upon, then a family-centred approach to care would be a reasonable option. If however, it is shown that families already perceived their needs as being met, then changing the system of care to a more formal family nursing approach would seem to be unnecessary.

Family nursing in intensive care. Part One: Is family nursing appropriate in intensive care?

Over the past 10 years there has been a growing body of literature on family nursing. Although the term 'family nursing' is not one which is in common use in the UK, a significant amount of literature has appeared which discusses issues relating to the nursing support of families with a member who is ill. This paper will review the concepts involved and will then discuss the appropriateness of such an approach within the specialty of intensive care. As the paper concludes that family nursing could be an appropriate approach to nursing the patient in this type of area, it would seem logical to consider what needs the family may have. The research concerning the identification of the needs of families when they have a member in intensive care is discussed in part two.

Ethical considerations relating to terminal weaning in intensive care.

The ethical considerations relating to terminal weaning from mechanical ventilation will be discussed within this paper. The principles of beneficence, non-maleficence and autonomy are seen to be the key considerations within the discussion. The difference between terminal weaning and regular weaning from a ventilator is that it proceeds as vital signs deteriorate and the expected outcome is death of the patient. A deterioration in vital signs would normally result in a change in the weaning process. The indications for terminal weaning have been classified into three categories by Campbell and Carlson. These are the patient's informed request to have the ventilator withdrawn, reduction of patient pain and suffering and medical futility. These categories will be used to facilitate the discussion which will draw on both the relevant literature and clinical experience.

Have nursing models a place in intensive care units?

The usefulness of conceptual models to guide nursing practice within an intensive care unit is explored within this paper. In order to do this, the term 'nursing model' is first of all defined and the three key types identified. The benefits and difficulties of utilizing a nursing model are then considered. Within this discussion, the relationship of the nursing process to a nursing model is highlighted, as is the opportunity to give a structured and scientific base to clinical practice. Potential problems relating to the language used within the model are acknowledge. Finally, the selection and use of models within this area of practice is explored.