Tuesday 24 – Friday 27 March 2009, Cardiff City Hall, Cardiff, Wales

The 2009 RCN Celebrating 50 years of nursing research: International Looking back, moving Nursing Research forward Conference

Book of Abstracts

1 Contents

Keynote abstracts 3

Vipers 6

Poster sessions 10

Symposiums 30

Concurrent sessions 47 - 115

Tuesday 24 March 47

Wednesday 25 March 64

Thursday 26 March 85

Friday 27 March 107

Workshop abstracts 116

2 Keynote abstracts Tuesday 24 March 2009

Opening address: Nursing excellence through of a Nurse Regulatory body in Scotland and as Dr Peter Carter OBE, Chief Executive and General evidence Nurse Director of a University Trust Health System. Secretary, Royal College of Nursing David C Benton RGN, RMN, BSc, MPhil, FFNF, David has travelled widely looking at various FRCN, Chief Executive Officer, International Council aspects of different health systems and was delighted to receive a Nuffield Policy fellowship in Biography: of Nurses 1999. This enabled him to look at both America and Dr Peter Carter OBE is the Chief Executive & General Spain so as to understand how the professional Secretary of the Royal College of Nursing (RCN); Abstract: voice might be best heard within the new constitu- the world’s largest professional union of nurses In recent years we have witnessed a growing tional arrangements in Scotland. and health care support workers. The RCN has a interest in nursing research and in evidence-based David is the recipient of several awards and membership of 400,000 nurses, midwives, health care driven by the quest for quality and cost- honours. He is particularly proud of being awarded visitors, nursing students, cadets and health care effectiveness from within the profession as well the inaugural Nursing Standard Leadership award support workers. as growing societal demands and expectations. in 1993. He was presented with Fellowship of Before assuming the post of RCN Chief Executive This trend is partly due to the current landscape of the Florence Nightingale Foundation in 2001 and and General Secretary in January 2007, Peter spent socio – economic situation affecting the health care awarded Fellowship of the Royal College of Nursing almost twelve years as the Chief Executive of the environment – globalisation, health care reform, in 2003 for his contribution to health and nursing Central and North West London NHS Trust (CNWL). new and emerging health problems, changing policy. It is one of the largest mental health trusts in the demographics, and rapid advances in science and UK, with an operating budget of over £200 million technology. and an international reputation. In Peter’s final Nurses as key professional health care provider are year the Trust was awarded a rating of excellent for more than ever challenged to be in the forefront quality of care and good for use of resources. The of knowledge production, continual validation Trust was the recipient of several awards related to and application of knowledge in the service of our standards of patient care and innovative staff ini- communities and populations. We are challenged tiatives. In January 2007, CNWL was voted in a poll to find new and better ways of promoting health, by readers of the Nursing Times as the best mental better ways of preventing disease, and better and health trust to work for in the UK. cost-effective way of caring, curing and rehabilita- Peter commenced his career by training as a psy- tion. This is nursing’s contract with society and the chiatric nurse at Hill End Hospital in St Albans for road map for excellence in care. six years. He moved on to work at the then regional ICN places high importance on nursing research, adolescent unit at Hill End Hospital, where he its development, dissemination and application to undertook further training in family therapy and improve quality and cost-effectiveness of care. crisis intervention. Peter is also a general nurse and The aim of this presentation is to showcase trained at St Albans City Hospital and the Institute nursing’s efforts in evidence-based care from a of Urology in London. In addition, he has held a global perspective. More specifically the presenta- number of clinical and managerial posts in Hert- tion aims to: fordshire, Bedfordshire and London. • Provide a context and background for evidence Peter is a graduate and a member of the Chartered based care. Institute of Personnel and Development. He has a Masters Degree in Business Administration and a • Argue for using the power of evidence to achieve PhD – both from the University of Birmingham. excellence in care. Peter has medico legal experience in a wide range • Share ICN’s efforts in promoting and supporting of health related litigation issues, specialising in evidence-based care. bio-mechanical injuries, homicides and suicides. Biography: Peter’s PhD thesis is entitled ‘Understanding reasons why nurses abuse patients in their care’ David Benton took up post as Chief Executive and has lectured extensively on this issue. He has Officer of the International Council of Nurses (ICN) also lectured on leadership issues. on the 1st of October 2008. Immediately prior to this he worked with ICN for three years where Peter was awarded the OBE for services to the NHS he held the role of consultant nursing and health in the 2006 New Year’s Honours List. policy and specialised in regulation, licensing and Since becoming Chief Executive and General education. Secretary of the RCN, Peter has restructured his top He qualified as a general and mental health nurse at team and re-focused the organisation to address the then Highland College of Nursing and Midwifery outstanding issues. in Inverness, Scotland. His MPhil research degree focused on the application of computer assisted learning to post-basic nurse education and has over the past thirty years had articles published in relation to research, practice, education, leader- ship, and policy topics. David has held senior roles for twenty years across a range of organisation. These roles have included working as Executive Director of Nursing at a health Authority in London; as a senior civil servant in Northern and Yorkshire Region; as Chief Executive

3 Keynote abstracts

nursing practice will enhance the patient experi- Wednesday 25 March 2009 ence and improve patient outcomes. It will also Thursday 26 March 2009 provide the basis for identifying quality metrics which will allow the profession to clearly define and evaluate the outcomes of its contribution to Looking back, moving forward: patient care. The contribution of research to Pursuing the science of nursing health improvement Biography: interventions Professor Martin McKee CBE MD DSc FRCP(UK) Dame Jill qualified as a nurse at University College Professor Dame Jill Macleod Clark DBE, PhD, BSc, FRCPI FFPH FMedSci, European Centre on Health Hospital, London and worked in a variety of clinical RGN, FRCN, Deputy Dean, Faculty of Medicine, of Societies in Transition, London School of posts in the hospital and the community. She Health & Life Sciences, University of Southampton, Hygiene and Tropical Medicine, London, UK gained a BSc Hons in Social Psychology from the Southampton, UK London School of Economics and completed her PhD in 1982. She has an extensive research track Biography: Abstract: record and has published widely. Her professional Martin McKee qualified in medicine in Belfast, Looking back, it is clear that the discipline of nursing and academic interests lie in health promotion, the Northern Ireland, with subsequent training in has made great strides over the past 50 years. continued development of professional nursing internal medicine and public health. He is Professor There has been an exponential growth in both the roles and interprofessional education, and her of European Public Health at the London School of quality and quantity of research endeavour and current research focuses on promoting the health Hygiene and Tropical Medicine where he co-directs output. There has also been professional acknowl- and wellbeing of people with long term conditions. of the European Centre on Health of Societies in edgement of the need to ensure that education Dame Jill is currently Deputy Dean of the Faculty of Transition (ECOHOST), a WHO Collaborating Centre is linked to the best available evidence and that Medicine, Health & Life Sciences at the University of that comprises the largest team of researchers this evidence should be thoroughly embedded in Southampton. She has spearheaded the develop- working on health and health policy in central and practice. The discipline now has a confident and ment of interprofessional learning and non-medical eastern Europe and the former Soviet Union. He is mature international research profile with many clinical academic careers within the Faculty. Dame also research director of the European Observa- nurses leading world class programmes and multi- Jill was a member of the 2008 RAE panel for nursing tory on Health Systems and Policies, a unique disciplinary academic teams. and midwifery. She is contributing to a number of partnership of universities, national and regional governments, and international agencies. He has However, whilst there is much to celebrate, a critical national research and education policy initiatives published over 440 scientific papers, 30 books, and look at these achievements reveals some areas of and working parties linked to modernising nursing 75 book chapters. He is one of the editors of the weakness. The rhetoric advocating evidence-based careers and the changing NHS workforce. European Journal of Public Health and a member practice is persuasive but, in reality, the evidence Her husband is Dr Will Bridge, Deputy Rector of the of numerous editorial boards, as well as being an base for many nursing interventions is, at best, University of Arts, London. They have two married editorial consultant to The Lancet. patchy. Even where an evidence base exists, it is sons and 2 baby grandsons. often not consistently applied in practice. Possible He has given many endowed lectures, including the explanations for this phenomenon are explored in Milroy Lecture (Royal College of Physicians), the this paper. There is a paucity of major programmes Cochrane Lecture (UK Society for Social Medicine), of research which examine measures and/or test Ferenc Bojan Lecture (European Public Health Asso- the science of core nursing interventions. These ciation), and DARE Lecture (UK Faculty of Public are the interventions which are central to the Health). He sits on a number of advisory boards nursing care agenda and include the management in Europe and North America, in both the public of symptoms, medicines management, maintaining and private sectors. He is a Fellow of the Royal skin integrity, managing continence and enhancing Colleges of Physicians of the UK and Ireland and mobility and independence. There also remains a the UK Faculty of Public Health. His contributions continued pattern of individual, one-off projects to European health policy have been recognised rather than cohesive researching group activity and by, among others, election to the UK Academy an emphasis on ‘endogenous’ research addressing of Medical Sciences, the Romanian Academy of questions about nurses or the profession rather Medical Sciences, and the US Institute of Medicine, than on ‘exogenous’ questions related to real by the award of honorary doctorates from Hungary practice issues. and The Netherlands and visiting professorships at the Universities of Zagreb and Belgrade and Moving forward it is crucial, therefore, that future the London School of Economics. He was a distin- energies redress this balance by shifting the centre guished international scholar at the University of of gravity of research to the examination, measure- Pennsylvania. In 2003 he was awarded the Andrija ment and testing of common interventions which Stampar medal for contributions to European are located at the heart of nursing practice. Much public health and in 2005 was made a Commander will need to be done to achieve this goal including of the Order of the British Empire (CBE) by HM learning lessons about focus and cohesion from Queen Elizabeth II. international examples of good practice and investing in capacity building and appropriate infrastructures for clinical academic careers. By capturing and owning the science of nursing inter- ventions, the profession will be more empowered to influence research priority setting and funding policy. Pursuing the science of nursing intervention will also provide significant leverage at a time when the measurement of quality and cost effectiveness is a priority. Most importantly, generating a robust scientific evidence base to inform all aspects of

4 Keynote abstracts

Friday 27 March 2009 Thursday 26 March 2009

Nursing research in the trenches: Masterclass: Continuity during transitions for Research and conceptualization individuals with chronic conditions for effective implementation of Professor Margaret B. Harrison, School of Nursing, evidence (finding a way) Community Health and Epidemiology, Project Professor Margaret B. Harrison, School of Nursing, Lead, Canadian Partnership Against Cancer Community Health and Epidemiology, Project Collaboration, Director, Queen’s Joanna Briggs Lead, Canadian Partnership Against Cancer Collaboration and Senior Scientist Practice and Collaboration, Director, Queen’s Joanna Briggs Research in Nursing Group, Queen’s University, Collaboration and Senior Scientist Practice and Ontario, Canada Research in Nursing Group, Queen’s University, Ontario, Canada Abstract: People with chronic conditions present complex Abstract: challenges across the spectrum of health care. Using the Canadian Institutes of Health’s (formerly Maintaining continuity is of primary importance in MRC) framework ‘Knowledge to Action’ explore the their partnership with the health care system and research methodologies that may be used on the those providing care. Typically they access multiple journey to evidence-based practice. Topics could sectors for the care they need (e.g. hospital, include how research and quality processes help ambulatory and home care), undergo shifts in form the alliance, pragmatic planning studies, their independence with therapeutic and self- who’s decision is it at various stages? Ideally the care, and must adjust with the trajectory of their audience will participate and contribute their condition(s) between diagnosis, treatment, man- experience through various formal and informal agement and rehabilitation. The presentation will enquiries undertaken to plan and evaluate an highlight a planning and evaluative framework for evidence implementation. nursing research that bridges health services and practice paradigms. A reflection on the challenges and lessons learned over the 15 years of research program will highlighted.

5 ViPERS

Wednesday 25 March 2009 V2 V3 The relevance of the empirical What do you mean ‘Feminist’? V1 research experience Implications of using the F word in We should be able to bear our Fiona Baguley, The Department of Nursing, research Midwifery and Social Sciences, The Robert Gordon Angela Cotton, Faculty of Health, Edge Hill patients in our teaching in some University, Aberdeen, Aberdeen, UK University, Ormskirk, UK way: Revisiting Menzies to [email protected] [email protected] understand the consequences of nursing’s move to higher education Abstract: Abstract: Helen Allan, Centre for Research in Nursing The subject chosen for this proposed ViPER has Claiming to be doing feminist research invariably and Midwifery Education, Faculty of Health and arisen from my own research experience as a raises many issues for both the researcher and Medical Sciences, University of Surrey, Guildford, nurse/podiatrist who completed an MSc in Health the audience of the academic and professional UK Care in 2007. As part of that educational experi- nursing community. Such issues may relate to the Co-author: Pam Smith ence I had to carry out a piece of empirical research epistemological and ethical subject positions being [email protected] that met with the standards set by the Research taken, but also important are the responses of the Governance Framework introduced by the Depart- listener – whether this is a colleague or a student ment of Health (2001). I now work as a Research Abstract: in an informal setting, or the more public arena Assistant in an academic institution. I intend to This paper explores the experience for nurse lec- of the conference paper or written publication. display the information for discussion on a com- This paper develops and explores the identity of tureres in supporting learning for student nurses parison diagram. In an environment where few in both the university and clinical practice. It ‘feminist researcher’ and, drawing upon auto-eth- nurses who are qualified at Masters level go on nographic reflexive narratives, considers assump- draws from data in a two year study funded by to complete any further research, I will pose the the General Nursing Council Trust for England and tions about what this might mean. Uses of feminist question, ‘is carrying out empirical research at theory within nursing research will be considered, Wales, which focused on leadership and learning in Masters level in nursing relevant?’ The Research clinical practice. This was a two stage multi method along with an analysis of how such theory may be Governance Framework is in place in an attempt to located within the postmodern. The paper will draw study. Stage 1 included a literature study and ensure research is conducted ethically in health and stakeholder interviews with educational leaders upon my recent post doctoral experiences of being social care settings i.e. research must ‘maximize required to disseminate ‘findings’ from an experi- nationally. Using four HEIs in four regional areas, the good and minimize the harm’ (Crookes and Stage 2 included an E-Survey of 4000 students/717 mental ethnographic PhD thesis which purports Davies, 2003, p215). It is a framework which is to be a ‘feminist’ study. This study was concerned response rate in England; participant observation designed to improve research standards and is sig- of clinical shifts where student and mentor activity with women’s narratives of heroin use /abuse, and nificant in a climate where the nursing profession drew upon feminist and critical discourses. was observed; informal interviews with students, is expanding and offers degrees to a Masters level mentors, nursing managers and practice educators and beyond, while the emerging nurse consultant The paper presented here will explore the tensions as well as formal focus group and indiviidual role matures and there is a certain weight attached inherent in representing women’s stories, some interviews with mentors, ward managers,practice to evidence based practice. However, there is a line of the difficulties in ‘doing feminist research’ – educators, a director of nursing, clinical placement of thought which suggests that the Clinical Govern- along with a consideration of the implications of facilitators, link lecturers, modern matrons, ance Framework may have a negative influence on the identity of ‘feminist researcher’. In developing practice development nurses. the research experience of the nurse (Howarth.M, an exposition of such implications, the paper will Using a comment on the move of nursing colleges to 2005). The ViPER will identify the possible positive endeavour to address some of the assumptions higher education and the desire of nurse education and negative educational implications for nurses which are invariably made when the ‘F’ word is leaders to become members of academic depart- of completing an empirical research study that mentioned. ments of nursin by Fabricius (1996), we revisit adheres to the Research Governance Framework at Menzies (1959) paper to argue that the patient MSc level. The practical and methological implica- V4 has become more and more excluded from the tions of the Research Governance . classroom; with the result that nurse tutors find Data saturation in qualitative Recommended reading: in difficult to bear the patient in their teaching. We interviews – when do we stop? see this exclusion as a development of the institu- Crookes. P and Davies. S, (2003) Research into Naomi Reay, School of Healthcare Studies, tional defence mechanism described by Menzies Practice Published by Beilliere Tindall, Edinburgh. University of Leeds, Leeds, UK and discussed by Fabricius and argue that the Howarth. M and Kneafsey. R, (2005) The Impact Co authors: Alan Tennant; Jackie Hill; Claire Hale. move to higher education has altered the location or Research Governance in Healthcare and Higher and manifestation of the defence mechanism but Education Organizations Journal of Advanced Abstract: not caused the exclusion. Nursing Practice Vol 49 (6) p675-683. A common method of qualitative data collec- Recommended reading: Research Governance Framework for Health and tion is one to one interviews; a common tool for Social Care. Department of Health (2001). Menzies, I. E. P. (1970) The Functioning of Social analysis of such data is that of thematic analysis Systems as a Defence Against Anxiety: A Report on (Miles and Huberman 1994). Data saturation is the a Study of a Nursing Service of a General Hospital. term applied to the point at which no new data London: Tavistock. are generated (Parhoo 1997). Prior to commence- Fabricius J (1995) Psychoanalytic Understanding ment of a study, the point of data saturation is not and Nursing: A Supervisory Workshop with Nurse known, and estimates of the number of interviews Tutors, Psychoanalytic Psychotherapy 9(1):17-29 required to achieve data saturation are often made based on factors such as previous similar studies, Fabricius J (1996) Has Nursing Sold its Soul? A or on fulfilment of a sample frame of interviewees Response to Professor Banks, Nurse Education with required characteristics Today 16:75-77 This abstract reports results of a study of thirty- one, one to one interviews, conducted in a study

6 ViPERS

of the Quality of Life of patients with a connective whereby an individual with mental health problems V6 tissue disease. The sample frame for the inter- becomes unemployed, and as a result becomes viewees consisted of characteristics including age, further incapacitated. Undertaking palliative care gender, disease sub-type and disease duration. A pilot study of a computerised multimedia Guided research in developing countries: Following analysis of the themes identified, it was Online Self-Help programme for anxiety disorders, Ethical implications found that no new themes were generated after the Outreach-online, was trialled on a cohort of eight Barbara Jack, Faculty of Health, Edge Hill first four interviews. Therefore, in this study, data participants enrolled on the Welsh Assembly Gov- University, Ormskirk, UK saturation of themes was reached after four inter- ernment and Job Centre Plus’ Want 2 Work scheme [email protected] views. Previous research identified twelve inter- in Rhyl, North Wales. Outreach-online (www.out- views, from a study consisting of sixty interviews, reach-online.co.uk) was awarded a Welsh Innova- Abstract: as the point at which data saturation of themes was tions in Healthcare Award in 2006, and was recog- reached (Guest 2006). These two studies suggest nized in the RCN ‘Nurse of the Year’ awards in 2007 There is a growing need for palliative care research that researchers may conduct more interviews than and the British Journal of Nursing Awards, 2007. It in developing countries to evaluate initiatives and required to achieve data saturation of themes. was developed in North Wales by the North Wales identify areas for expansion of services. However However, the studies do not provide consensus on NHS Trust). it is acknowledged that undertaking palliative the number of interviews required to achieve the care research is not without both practical and The results of our study indicate that there may well point of data saturation of themes. This may be ethical dilemmas due to the vulnerable popula- be a problem of undiagnosed anxiety and depres- due to the many variables in each of the studies tion involved (Bever et al 1999). Within the western sion within the long-term unemployed, and that including differences in researchers, interviewees, world there are formally established research Outreach-online is and acceptable and useable process of thematic analysis and interview topics. ethics processes that act to provide quality mech- tool to address this unmet need. There is some A larger study of data saturation of themes in quali- anisms and to protect participants. In develop- evidence that job-seeking behaviour improves as a tative research is required in order to explore the ing countries there are limited formal systems in result of participating in this programme, reducing relationship of these variables on the point of data place, coupled with low literacy rates that may the beneficiaries distance from the labour market. saturation of themes. prevent truly independent informed consent and We recommend that a larger study is carried out could potentially result in exploitation. It is widely Recommended reading: to produce more robust findings, and to include a accepted that the key principles inherent in under- Miles, M. and A. Huberman (1994). Qualitative Data cost-analysis to look at the cost-effectiveness of taking research in developing countries include Analysis. London, Sage. using Outreach-online as a tool for supporting the the duty to alleviate suffering, to show respect Parahoo, K. (1997). Nursing Research. Principles, long-term unemployed. for people and to avoid exploitation of the vulner- Process and Issues. London, Macmillan. The proposed poster presentation will summarise able. Although the Nuffield Council on Bioethics (1999) provide guidance regarding clinical research Guest, G. (2006). ‘How Many Interviews Are the findings of the study and, if permissible, could that clearly highlights issues for consideration, in Enough?’ Field Methods 18(1): 59-82. allow participants to use the Outreach-online programme first hand (should a computer facility particular surrounding gaining informed consent, Biography: exist). there is limited guidance available for palliative Naomi Reay comes from a professional back- care researchers on the practical implementation References ground as a District nurse, an RSCN and an Allied of key ethical principles. Health Professional. She is currently a doctoral Hain, P. (2007). Mental Health and Employment The aim of this paper is to discuss how palliative student with the School of Healthcare and School – Meeting the Challenge, House of Commons care researchers can transfer good practice sur- of Medicine at the University of Leeds, and her Hansard. 468. rounding ethical principals to developing countries. research interests are Patient Reported Outcomes Dooley, D., J. Fielding and L. Levi (1996). ‘Health and Practical issues surrounding recruitment, obtaining (PROMs), specifically the study of Quality of Life. Unemployment.’ Annual Review of Public Health informed consent, the use of interpreters, payment She currently works in a PCT as Allied Health Pro- 1996(17): 449-465. for participants and the role of the researcher fessional and Healthcare Scientist Commissioning Murphy, G. C. and J. A. Athanasou (1999). ‘The once the project is completed will be discussed. and Quality advisor, and is also lead clinician with Effects of Unemployment on Mental Health.’ Examples from palliative care research undertaken the Primary Care Research Network (PCRN) in West Journal of Occupational and Organizational Psy- in sub-Saharan Africa will be given to illustrate Yorkshire. chology 72: 83-99. examples of good ethical practice. Paul, K. I. and K. Moser (2006). ‘Incongruence as an Recommended reading: V5 Explanation for the Negative Mental Health Effects Beaver K, Luker K, Woods S (1999) Conducting Computerised multi-media guided of Unemployment: Meta-analytic evidence.’ Journal Research with the Terminally Ill:Challenges and of Occupational and Organizational Psychology 79: on line self help programme Considerations. International Journal of Palliative 595-621. Medicine 5(1) 13-17 Steve Cottrell, Consultant Nurse, Clinical Governance Department, Royal Alexandra Nuffield Council on Bioethics (1999) The Ethics of Hospital, Rhyl, Wales, UK Clinical Research in Developing Countries: A Dis- Co-author: Gary Slegg cussion Paper

Abstract: Mental illness can affect the country’s economy, reducing output through time-off sick and unem- ployment. Mental health conditions are now the biggest single cause of both absence from work and people claiming incapacity benefit (Hain 2007). Similarly, periods of unemployment may result in increased mental illness (Dooley, Fielding and Levi 1996; Murphy and Athanasou 1999; Paul and Moser 2006). This may create a vicious circle

7 ViPERS

V7 Thursday 26 March 2009 V9 Invisible birth technology: Post Using method to find methodology: doctoral research reflections V8 Reflexivity as a mirror and window 1999-2009 Using reflection to teach research Elaine Allan, Aberdeen City CHP, NHS Grampian, Marlene Sinclair, School of Nursing. Faculty of Aberdeen, UK Life and Health Science, University of Ulster, concepts in a Chinese nursing Co author: Colin McDuff Jordanstown, UK school [email protected] [email protected] Jean Glover, School of Nursing, Tianjin Medical University, Tianjin, China Abstract: Co author: Zhang Meini Abstract: This ViPER presentation focuses on a dilemma [email protected] Exploring the use of high technology in the labour faced by many researchers, presents one possible ward was the subject of doctoral research using solution, and opens up the issue more generally for multiple –methods in 1999. Ten years later the data Abstract: conference contributions. The dilemma in question is how to choose an appropriate qualitative meth- remains powerful and subsequent research has Helping undergraduate nursing students grasp odology from the many available (Knafl 1985), confirmed many emerging assumptions. However, the key concepts of nursing research in a way that and how to relate this theoretically and practically it is the life journey of the ten years following the stimulates their interest is key to developing and to research method. As this is often particularly original research that offers valuable insights for inspiring the next generation of nursing research- difficult for new and/or less experienced research- doctoral students and post doctoral research- ers, However research lectures may often be ers, the presentation of the dilemma and solution ers. The conclusion that modern childbirth is a perceived as grappling with abstract and seemingly will be led by a doctoral student. The particular high-tech business was muted at the beginning of irrelevant details which smother rather than spark context is that of an experienced professional nurse the research journey and ten years later it is irrefu- interest in the topic. There has been much discus- researching her peers’ experiences and perceptions table. sion of how to improve this situation (Parahoo of change, and related processes of leadership and The overall aim of this paper is to share the doctoral 1999). Learning by engaging in actual projects in teamworking. The poster, produced in concert with research journey, the post doctoral life and the the real world is far more stimulating but ethical colleagues in Art and Design, will use the image of insights learnt from ten years of doctoral research requirements rightly place limits on the degree to the researcher looking into the window of a large supervision. Objectives include describing the which novice researchers can be allowed to make shop which is replete with methodologies such as journey from PhD to post doctoral researcher and mistakes and learn from them. The ability to reflect phenomenology, narrative approaches and critical supervisor; synthesising new data and making and learn from mistakes plays an important part theories. Her face is reflected in the shop window, decisions at the crossroads. The approach is in learning; reflective models help us to do this in to illustrate the point that will be developed in the autobiographical and the sample is self. The data a more organised and systematic manner (Burton presentation i.e. that reflexive methods (Clarkes 2006) can be used as both a mirror and a window is descriptive and includes a synopsis of original 2000) This presentation reports on the use of a for methodological development. research and snapshots of post doctoral research reflective model to help Chinese nursing students undertaken in the past ten years. Data will be understand research concepts. It builds on the Specifically the researcher will summarise a presented as narrative and illustrated with multi- author’s experience of using experiential learning journey of self discovery, enabled through: media. Discussion will be centred on the unknown and simulation to enhance student understand- • self reflection ing of abstract research concepts in the UK. An life journey of the doctoral student to the unknown • literature search career pathway for the post doctoral researcher. analysis of students’ reflective evaluations will be • being interviewed with her own interview Examples from doctoral research students’ will be presented hopefully supported by a Chinese user/ schedule by an academic colleague, and receiving used to illuminate key issues. Recommendations co-presenter. China’s developing nursing research faces many challenges (Li & Acorn 1996) similar feedback and analysis from both the interviewer for guidance and supportive strategies to facilitate and her supervisor transition from doctoral student to post doctoral to those faced in the UK such as perceived inad- researcher will be presented for consideration. equacy and medical dominance; additional chal- • carrying out a small number of preliminary inter- lenges come from Confucian based thinking which views to test method and render visible assump- Recommended reading: does not question the status quo. Teaching by tions-in – action Ihde, D. (1990) Technology and the Lifeworld: From reflection, while common in the West, is very new in Through these means greater clarity about appropri- Garden to Earth. Bloomington, Indiana University China and is extremely useful for crossing linguistic ate methodology has been achieved before starting Press and cultural barriers. It can be usefully applied to the main study. The paper suggests this strategy may be useful for other qualitative researchers, Heidegger, M. (1977) The Question Concerning health care staff in any culture to enable students especially those researching peers. Moreover, in Technology. In: Krell, D.F. (Ed) Basic Writings. to explore the knowledge embedded in experien- opening up the issue for subsequent debate, the Harper & Row, New York tial learning, prior to embarking on actual research projects. paper will contribute by challenging ‘scientific fairy Biography: tale’ reporting (Mitroff 1974) portraying methodol- Recommended reading: ogy as necessarily preceding method. Marlene Sinclair holds a personal chair for midwifery research at the Institute of Nursing Burton A.J. (2000) Reflection: Nursing’s Practice Recommended reading: Research, University of Ulster. and Education Panacea? Journal of Advanced Nursing 31 (5) 1009 – 1017 Clarkes, A (2006). Qualitative Interviewing: Encountering Ethical Issues and Challenges. Nurse Li X. D. & Acorn S. (1996) Nursing Administration Researcher 2006;13 (4): 19-29 in China, Journal of Nursing Administration 26 (2) Knafl, K.A. (1994). Dialogue: Clarifying Phenomeno- 12 – 13 logical Methods. In J. Morse (Ed), Critical issues in Parahoo K. (1999) A Comparison of Pre-project qualitative research methods.(p. 134). Thousand 2000 and Project 2000 Nurses’ Perceptions of their Oaks, CA: Sage. Research Training, Research Needs and of their Use Mitroff, I (1974) The Subjective Side of Science: of Research in Clinical Areas, Journal of Advanced Philosophical Inquiry into the Psychology of the Nursing, 29 (1) 237 – 245 Apollo Moon Scientist. Amsterdam: Elsevier

8 ViPERS

V10 Friday 27 March 2009 V12 Sunbeams and cucumbers? Evidence based commissioning – Developing a programme to V11 respite services for older people research wisdom in nursing The management of patients with with mental health needs Colin Macduff, CeNPRaD, School of Nursing, The Annie Topping, Nursing, University of Robert Gordon University, Aberdeen, UK diabetes by nurse prescribers: Huddersfield, Huddersfield, UK Co authors: Peter Wimpenny; John Gass; Sylvia Nurses views Co authors: Jane Morrell; Idah Nkosana-Nyawata Wilcock Nicola Carey, School of Health and Social care, [email protected] [email protected] University of Reading, UK Co authors: K Stenner, M Courtenay Abstract: [email protected] Abstract: Recent reforms in health and social care puts par- The idea of wisdom in nursing has received increas- ticular emphasis on service commissioning based ing study in recent years, both as manifest within Abstract: on the needs of local communities. This presents nursing practice (Benner 2000; Uhrenfeldt and Hall Aim: To explore the views of nurse prescribers on a particular challenge when a population is ill- 2007) and in terms of nursing education (Haggerty how nurse prescribing has affected work patterns, defined or invisible as is the case for some older and Grace 2008). Nevertheless it remains a and the provision of care for patients with diabetes. people with mental health needs. An individual somewhat elusive concept that seems to have been Background: Approximately 14,000 nurses across with declining cognitive function may be unknown subject to little sustained, programmatic investiga- the UK have undergone training which has provided to specialist services, alternatively they, or their tion. This ViPER presentation presents initial ideas them with virtually the same prescribing rights carer may be fearful or indeed ignorant of what and reflections from a group of nursing research- as doctors. Nearly 80% of these nurses work in support might be available. The issue for those ers who are developing a programme to research primary care (Courtenay & Carey 2008a) and over commissioning and providing care services for wisdom within nursing. The presenters will outline 30% prescribe medicines for patients with diabetes this population is how to model resources to meet approaches that are being developed to research (Courtenay & Carey 2008b). Nurse prescribing is population needs, whilst ensuring individual needs the nature, acquisition and effects of wisdom in expected to optimise the role of nurses in contribut- are met. The various stakeholders frequently hold nursing. In particular there will be consideration ing to the improvement of services for patients with different opinions about how services should be of the ideas of evidence-informed wisdom and diabetes. There is little evidence on the how nurse configured and prioritised. Lack of robust evidence clinical wisdom. This brief overview will be facili- prescribing is being implemented or its impact on to estimate the effectiveness of different elements tated by consideration of an accompanying poster the provision of care for patients with diabetes. of mental health services for older people creates which will be produced in concert with colleagues further problems for strategic planning. Method: A qualitative study involving semi-struc- in Art and Design. The poster will schematise the tured interviews and a purposive sample of 10 This aim of this mixed methods study was to research programme in terms of its three devel- nurses (4 diabetes specialist nurses and 6 nurses examine the appropriateness, effectiveness and oping themes and their integrative nature. This working in general practice) who prescribed cost of existing respite and primary care services positive portrayal will be counterpointed by a for patients with diabetes. Data was collected for older adults with mental health needs and their more critical image derived from Jonathan Swift’s September 2007-September 2008. A thematic carers, served by a primary care trust in the North classic novel ‘Gulliver’s Travels’. This image will analysis was conducted on the interview data. West England. A range of stakeholder informants reflect Swift’s satirical portrayal of an academy of (n=90) participated in a series of focus group or Results: Whilst the roles of diabetes nurses scientists labouring for years on a project to extract individual interviews to assess appropriateness of continued to evolve, prescribing did fit well within sunbeams from cucumbers so that they might services. Carers (n=50) supporting service users existing work arrangements and established warm the air in poor summers. completed the Zarit Caregiver Burden Scale1, Client mechanisms for support. A number of benefits Service Receipt Inventory [CSRI]2, and Hospital Through this combination of words and images were reported: including the ability to deal with co- Anxiety and Depression Scale [HADS]3 to assess there will be overview of: morbidities, increased efficiency, continuity of care, caregiver burden, and amount and cost of services maintaining long-term relationships, and providing • the concept of wisdom in nursing received. Navigation of services and organisations consistent health messages. Initial problems • approaches to researching wisdom in nursing emerged as the greatest challenge to all stakehold- restricting prescribing practice (i.e. lack of pre- ers. Knowledge of, and intelligence about services • related critical considerations scribing pad, inability to prescribe electronically, appeared to be organisationally bounded with con- This will make initial contribution to development formulary restrictions) were now resolved. sequences for service users, carers and providers. of knowledge about what wisdom in nursing is, and Conclusion: Nurses believed that the capacity to Defining support as health or social carried impli- what its study may involve. Moreover, it will set the prescribe had a substantial effect on improving effi- cations and burdens and often served only to limit scene for subsequent facilitated discussion that ciency and the quality of care patients with diabetes support. This paper will discuss these findings can yield further insights by integrating perspec- received. These benefits were ameliorated by the against the future landscape of personalised care. tives from conference delegates. established nurse-led services, and support struc- Recommended reading: Recommended reading: tures that nurses were able to access. Thus high- lighting that pre-established nurse-led services, Zarit, S., Stephens, M. A. P., Townsend, A., Greene, Benner P (2000) The Wisdom of Caring Practice. and having access to good quality support appear R. (1997) Adult Day Care Collaborative Study, Study Nursing Management. 6(10); 32-37 to facilitate the successful implementation of nurse Measures. Penn State University. (developed for Haggerty LA and Grace P (2008) Clinical Wisdom: prescribing. National Institute on Ageing (US) R01 AG11354-02 The Essential Foundation of ‘Good’ Nursing Care. Mental Health of Caregivers of the Elderly – Day Recommended reading: Journal of Professional Nursing, 24(4); 235-240 Care Courtenay, M.,Carey, N. (2008a) Nurse Independ- Uhrenfeldt L and Hall EOC (2007) Clinical Wisdom Beecham. J., & Knapp, M. (1999) Costing Psychiatric ent and Nurse Supplementary Prescribing Practice: Among Proficient Nurses. Nursing Ethics. 14(3); Interventions. Personal Social Services Research National Questionnaire Survey, Journal of Advanced 387-398 Unit, University of Kent at Canterbury. Discussion Nursing, 61, (3), 291-299. Paper 1536. Courtenay, M.,Carey, N. (2008b) Preparing Nurses Zigmond A S, and Snaith RP (1983) The Hospital to Prescribe Medicines for Patients with Diabetes: Anxiety and Depression Scale Acta Psychiatrica Findings from a National Questionnaire Survey, Scandinavica 67: 361-70 Journal of Advanced Nursing, 61, (4), 403-412.

9 Posters

Theme: Midwifery and women’s health 2 3 issues A qualitative study of abortion care: Access to health care services for 1 Perceptions of patients and staff women and children living with An innovative approach to Edna Astbury-Ward, School of Health, Social domestic abuse Care and Exercise Sciences, Glyndwr University, facilitating nursing and midwifery Fiona Duncan, Domestic Abuse Co-ordinator, NHS Wrexham, UK Fife, Dundee, UK research [email protected] Co authors: Thilo Kroll; Julie Taylor Victoria Sellick, Clinical Investigation and Research [email protected] Unit, Brighton and Sussex University Hospital NHS Abstract: Trust, Brighton, UK Co-authors: Proffessor Valarie Hall; Nicky Perry; Background: Abortion is the most common gynae- Abstract: cological procedure performed in the UK, 1 in Elieen Nixon; Ben Skinner; David Crook; Sarah Background: Approximately 26,000 incidences 3 women by the age of 45 experience abortion Young; Jackie Portsmouth; Jane Butler; Karen of domestic abuse (DA) are reported each year in (Argent 2006). Inequitable service provision and Wright Scotland. Most research has focused on screening lack of standardised care is prevalent (Kumar et al for domestic abuse in primary care and maternity 2005). Scotland has 99.8% NHS abortion provision, services. The health impacts of living with domestic Abstract: parts of the UK 46% NHS provision and parts of abuse are well documented (WHO 2002) making it The promotion of research career opportunities for Wales has no service at all. Abortion is illegal in imperative that appropriate care and support is nurses and midwives is fundamental to achieving Northern Ireland (RCOG 2004) available and accessible. the aspirations contained in Modernising Nursing Aims: To explore women’s and staffs perceptions of Aims: This study aimed to identify barriers and Careers the Darzi workforce proposals and the abortion care. To explore why care is not standard- facilitators to access to health care services for National Health Research Strategy. Research active ised. Understanding women’s experiences along women and children experiencing domestic abuse. health professionals will increase the evidenced their abortion journey, may help to inform future base, ultimately contributing to high quality health services which meets women’s needs and, may Methods: For this study, we used a mixed-method- services and patient care. To date, investment in help prevent the experience of repeat abortion ology, including qualitative and quantitative study nursing and midwifery research capacity has been (32% repeat abortion). components. Women’s experiences of access to limited. There remains a culture within clinical health care services were explored in semi-struc- Methods: A qualitative study, using face to face in nursing that sees research as intimidating and tured interviews (n=22), analysed using a thematic depth interviews with 25 participants (17 patients difficult to access framework (Ritchie and Spencer 1994). Community and 8 staff.) Because anomalies exist in the four nurses (n=10) participated in a series of concept One of the key aims of the newly launched Brighton countries of the U.K. Northern Ireland was excluded mapping meetings (Kane & Trochim, 2006), an and Sussex University Hospitals NHS Trust Nursing as abortion remains illegal there except under innovative approach which maximises the direct and Midwifery Research Strategy is to develop a certain circumstances. Scotland was excluded, as involvement of participants in identifying problems culture which encourages nurses and midwives to statistics collected on Scottish abortions are not and formulating solutions. engage in research. included in the Department of Health data. Results: Analysis of the data suggests that there The strategy steering group, made up of Trust Results: Key themes relating to abortion care are three key areas, reported by both women and senior clinicians and academics from the University emerged from the data analysis. Results indicate practitioners, which significantly affect access to of Brighton and the NHS Library service, imple- that abortion care remains variable. Women who health care services: psycho-social factors, health mented an inclusive and participatory process to reported poor care where mostly affected by judge- system-related factors and geographical factors. achieve this aim. A questionnaire designed to find mental attitudes, delays, access and travel issues, out about research ideas and experiences was lack of information, insufficient follow up and inad- Discussion: The extent to which the experience of disseminated throughout the Trust generated 180 equate facilities. Women who reported good care living with domestic abuse can impair a woman’s responses. Research ideas were also gathered received fair and non judgemental care, a speedy ability to negotiate healthcare for herself and from the Trust Nursing and Midwifery Conference and efficient local service, good information, her children was found to be significant. Health and other meetings. The research ideas were adequate facilities and follow up. Staff were often systems which rely on permanency of residence, GP collated and two potential research questions that inclined to self praise and not recognise judge- registration and high levels of patient compliance matched Trust priorities, were identified. All those mental care. Staff also complained about the lack fail to adequately meet the needs of this popula- who had suggested research ideas were invited to of appropriate facilities and felt this impacted on tion. When women and children are able to remain a preliminary workshop to vote on the question the care they were able to provide and this in turn living in their own homes, free from abuse, and to be adopted. Attendees were invited to partici- caused distress for staff who felt they were working maintain established links with health providers, pate in a series of workshops which mirrored the in less than adequate circumstances. access difficulties are greatly reduced. research process. The intention was to demystify Conclusions: Nurses have an important role in Recommended reading: the research process and enable development of ensuring that women and children experiencing research skills by participation in a group project. Argent, V. (2006) How Can Abortion be Made domestic abuse have their health needs identified We anticipate that involving clinicians in a live Simpler for Women? The Journal of Family Planning and access to appropriate healthcare services. research project of genuine interest to them, facili- and Reproductive Health Care, Vol.32, (2), p.51-54. Recommended reading: tated by experienced researchers will overcome Kumar, U. Baraitser, P. Morton, P. and Massil, H. some of the blocks to research. (2004) ‘Decision Making and Referral Prior to Kane and Trochim (2006) Concept Mapping for Planning and Evaluation, Thousand Oaks, CA Recommended reading: Abortion: A Qualitative Study of Women’s Experi- ences’. The Journal of Family Planning and Repro- Ritchie J and Spencer L ( 1994) Qualitative Data DH Modernising Nursing Careers – Setting the ductive Health Care, Vol.30, (1), p.67 Analysis for Applied Policy Research IN Bryman A Direction, 2006. London: DH Royal College of Obstetricians and Gynaecologists and Burgess R G eds Analyzing Qualitative Data, DH NHS Next Stage Review: A High Quality (2004) The Care of Women Requesting Induced Routledge London Workforce, 2008. (Darzi Report) London: DH Abortion. Evidence-based Guideline No. 7. RCOG World Health Organisation (2002) World Report on Promoting Excellence in Care Through Research Press London Violence and Health WHO Geneva and Development: an RCN position statement, 2003. London: Royal College of Nursing

10 Posters

4 Liddell, H.S. Pattison, N.S. and Zanderigo, A (1991) 6 Recurrent Miscarriage – Outcome After Support- Women’s experiences of supportive ive Care in Early Pregnancy. Australian and New Exploring the use of the internet for care in early pregnancy following Zealand Journal of Obstetrics and Gynaecology 31 breastfeeding advice: A descriptive recurrent miscarriage (4), pp 320 – 322 survey Katharine Gale, Obstetrics and Gynaecology, Maria Herron, School of Nursing, Institute of Cardiff University, Cardiff, UK Nursing Research, University of Ulster, Belfast, UK 5 [email protected] Co-authors: Marlene Sinclair; George Kernohan; Experiencing breastfeeding Janine Stockdale [email protected] Abstract: and sexuality in motherhood: Background: Women with a history of recurrent Separating yourself between miscarriage may show signs of increased anxiety motherhood and being a woman Abstract: Background: This is the first stage of a Doctoral in subsequent pregnancies. Supportive care is Isilia Aparecida Silva, Diretora de Unidade de Study that sets out to explore women’s perceived offered to these women in early pregnancy and Ensino, Escola de Enfermagem da Universidade de value of the internet as a support system for usually includes regular early ultrasound scans and Sao Paulo, São Paulo, Brazel emotional support. The research explored women’s breastfeeding mothers. Women are increasingly experiences of supportive care in a large teaching turning to the internet for health information and hospital. Abstract: as a source of advice to support decision making Aims: To investigate women’s experiences of sup- The interface between breast feeding and feminine in pregnancy (Lagan 2007). However, the content portive care in early pregnancy sexuality is an aspect of crucial importance in a of some websites may not always provide relevant woman’s life. Nevertheless, it is not well known responses to health queries (Benigeri and Pluye, Methods: In 2005, 133 women were invited to take by the professionals who assist them, and for 2003) and the internet could play a greater role in part. Quantitative and qualitative analysis was this reason an investigation was begun as to how motivating women to breastfeed. (Stockdale et al., carried out on the data collected. that self-expressiveness happens throughout 2007) • Postal Structured Questionnaire (32) the woman’s point of view. This study has, as its Aims: The aim of this work is to explore and under- • Semi-structured interview (8). principle, the theoretical model “Pesando Riscos stand the searching processes undertaken by Results: Five main categories: The Impact of e Beneficias” (Silva, 1997) Comprehending the women who seek information about breastfeeding Pregnancy Loss – Following miscarriage the meaning of the sexual interface of breast feeding from the internet. for women experiencing this process and to com- majority of women felt sadness, alone, frustra- Objectives: This paper will describe internet search prehend how this dimension attributed the sexual tion and had concern for future pregnancies. The volume trends on breastfeeding at national and interface is shown in a woman’s behavior. It was need for support – Women reported that sup- international levels. portive care was not routinely offered to eligible taken as theoretical and methodological referential symbolic interactions and theory based on data Methods: Internet Surveillance has been under- women who may have benefited. In subsequent taken using various Google tools and Data Capture pregnancies initial excitement was overshadowed and it’s analysis respectively, and was obtained by interviewing 13 women who have been living in Sao Software. Data analysis will provide a breakdown by anxiety focused on ‘waiting for the miscarriage of internet search volume on breastfeeding and to happen’. Technical surveillance – Many of the Paulo’s municipal district, that were either breast feeding or have already had this experience. From associated terms and will be presented as a global women expressed the importance of monitoring overview of breastfeeding traffic online. Analysis pregnancy progress and talked about how there these results emerged three observations: Feeling the body’s change; taking on new duties, and will also include an overview of the main internet was an increased level of hope when reaching each sites commonly featured in relation to the key gestational milestone. neglecting the relationship and separating them- selves between motherhood and relationships. breastfeeding search terms identified. Findings will Why has it happened again? be presented using simple frequencies, bar charts The study revealed that for these women the and figures. Data is analysed using SPSSV14. Dis- Women felt a strong desire to discover their reason breast feeding experience and its interface with the cussion will focus on the usage of breastfeeding for recurrent miscarriage and had a difficulty under- feminine sexuality happens throughout mother- search terms, breastfeeding rates, breastfeed- standing why investigations weren’t carried out hood, by trying constantly to separate themselves ing search profiles for individual countries and an after their second miscarriage. Trying again from motherhood and being a woman. She wants overview of websites accessed using key search There was inconsistent advice about trying again – to mediate the breast feeding and her sexual life terms identified by internet users. This information some women were keen to ‘just get on with it’ and by trying to conciliate these new functions with the will contribute to the development of understand- wanted permission to try again others; understanding, however, that in this phase ing of women’s use of the internet in relation to of her life the priority is the child and its needs. Conclusions: Supportive care was not routinely health and health care. offered, requiring women to demand increased Recommended reading: support. Ultrasound provided reassurance by con- Recommended reading: ABUCHAIM, E. de S.V. Experiencing Breasfeedinf firming ‘signs of life’ but women did not welcome Benigeri M, Pluye P. (2003) Shortcomings of Health and Sexuality in Motherhood:’separanting yourself false hope. Most women had received good care Information on the Internet. Health Promotion between motherhooh and being a woman’. [Thesis] from an efficient and caring service and welcomed International 18 (4): 381-6 individualised care. São Paulo (SP): Escola de Enfermagem, Universi- dade de São Paulo; 2005. Lagan B. (2007) Womens’ Decision Making in Recommended reading: Pregnancy: The Role of the Internet (unpublished PhD dissertation). University of Ulster: Jordans- Clifford, K. Rai, R. and Regan, L. (1997) Future town, Northern Ireland Pregnancy Outcome in Unexplained Recurrent First Trimester Miscarriage. Human Reproduction. 12, pp Stockdale J, Sinclair M, Kernohan WG, Keller JM. 387 – 389 (2007) Exploring the Potential of the Internet to Motivate Breastfeeding. The Royal College of Brigham, S.A. Conlon, C. and Farguharson, R.G. Midwives. Evidence Based Midwifery 5(1): 10-5 (1999) A Longitudinal Study of Pregnancy Outcome Following Idiopathic Recurrent Miscarriage. Human Reproduction. 14 (11), pp 2868 – 2871.

11 Posters

Theme: Child health 8 Maguire, S., Ellaway, B,. Bowyer, V. L., Graham, E.A.M., Sibert, J. Kemp, A., and Rutty, G.N. (2006) 7 Do carers transfer DNA innocently Measurement of DNA Found on the Faces of 30 Developing a caregiver quality of to children during day to day Children Aged 0-5 Years: A Pilot Study Relevant life score for wheezy preschool contact? Preliminary results from to Child Protection Assessments. Royal College of Paediatrics children 20 children Catherine Olden, Respiaratory Care, Brighton and Diane Nuttall, Department of Child Health, Cardiff Lowe A, Murray C, Whitaker J, Tully G, Gill P, The Sussex University Hospital NHS Trust, Brighton, UK University, Cardiff, UK Propensity of Individuals to Deposit DNA and Secondary Transfer of Low Level DNA from Indi- Co-authors: Paul Seddon; Elizabeth Juniper; Cathy Co-authors: Sabine Maguire; Alsion Kemp; W John viduals to Inert Surfaces. Forensic Science Interna- Olden Watkins; Zoe Lawson; Frank Dunstan; David Fone; Guy Rutty; Eleanor Graham; Chloe Swinfield tional. 2002, 129: 24-34. [email protected] Abstract: Assessing asthma control in the preschool age Abstract: group is problematic. Lung function is difficult Theme: Mental health to measure and may not be closely related to the 1in 800 children are abused every year in Wales, 9 quality of life (QOL). Validated QOL tools exist with bruising being the commonest presenting for caregivers of school-age asthmatic children feature. A systematic review of literature spanning Symptoms and depression are (Juniper 1996). 40 years reveals little robust scientific evidence for predictors of health-related quality assessing bruising in children. Such assessments We aim to develop a QOL tool for wheezy preschool of life in both Taiwanese and are made with the naked eye and rely heavily upon children and their families. As the first stage, we the experience of the examining doctor. Small American heart failure patients have explored QOL issues as perceived by caregiv- amounts of DNA can be obtained from touched Tsuey-Yuan Huang, Nursing Department, Chang ers and health professionals. We interviewed 10 Gung Institute of Technology, Tao-Yuan, Taiwan individual parents of children aged 1 to 5 years surfaces and an interpretable profile obtained. Co-authors: Debra K. Moser; Shiow-Li Hwang; with recurrent wheezing, ran 2 parent focus groups Work with adults suggests that DNA left on skin, in Hsieh, Yeu-Sheng; Gau, Bih-Shya; Chiang, Fu-Tien; involving a further 9 parents, and interviewed 5 simulated strangulation can be profiled in the same Terry A. Lennie; Misook L. Chung; Martha Biddle; health professionals. way (Lowe etal). Seongkum Heo Parents were asked open-ended questions about Aims: We hypothesise that this technique may be how wheezing illness affected: valuable in identifying the perpetrator of physical child abuse. Abstract: a) their child’s QOL We will Background: Health-related quality of life (HRQOL) b) their own QOL. Establish background levels of DNA transferred in heart failure (HF) patients is a multidimensional Professionals were asked what aspects of QOL were from parent/carer to the head and neck of infants. construct perceived through the lens of culture. most likely to be affected by wheezing disease in: The HRQOL of HF patients is well known in Western Assess whether the level of background transfer is a) preschool children society, but little is known about HRQOL in Asian inconsequential. b) their carers. countries. It is important to examine the diversity If so DNA analysis of inflicted bruises has potential of HRQOL in different countries in order to improve Prominent themes which emerged were as application in the assessment of suspected HF patients’ outcomes. follows: Parents on their child’s QOL : Missing fun physical abuse in infants. activities, need to limit exercise, sleep disturbance Specific Aims: To compare HRQOL between Parents on own QOL: Anxiety about child catching Methods: Using established methods swabs were American and Taiwanese HF patients and determine respiratory infections, worry about spotting dete- taken for DNA from 12 specified areas of the head predictors of HRQOL in American and Taiwanese rioration, missing work/college, concern about not and neck from a cohort of 20 non-abused children patients. under 5 years of age (Maguire etal). Buccal swabs being listened to by professionals Professionals Methods: HRQOL was compared between 87 were taken from both child and close contacts to on child’s QOL: Sleep disturbance, restriction of Taiwanese (64.3±12.1 age; 69% male; 43% NYHA establish full DNA profiles. These were sent to the activity, upset about taking medications Profes- III/IV) and 96 Americans with HF (61.6±11.7 East Midlands Forensic Pathology Unit, University sionals on caregiver QOL: Stress of remember- age; 74% male; 42% NYHA III/IV). HRQOL was of Leicester, for DNA extraction and amplification. ing to give medication, disturbed sleep, employ- measured using the Minnesota Living with Heart The SGM Plus PCR Amplification system was used ment prospects. Although there was considerable Failure Questionnaire, and symptoms using the at 28 and 34 cycles for DNA profile production. overlap, professionals focussed on the problems Pulmonary Function Status and Dyspnea Question- of medication impinging on quality of life, whereas Results: Initial results show that only partial naire. Hierarchical regression analyses were used caregivers rarely mentioned this. Compared to exogenous DNA profiles are seen. A fuller analysis to examine demographic (age, gender), disease items in the Juniper caregiver QOL questionnaire will be presented with the final version of this severity (ejection fraction, NYHA), symptoms for school-age asthma, issues about acute attacks, paper along with suggested future investigations. (dyspnea, fatigue), and psychological (depression) as opposed to chronic symptoms, predominated. Conclusions and discussion: Results suggest that predictors of HRQOL. Recommended reading: background skin DNA contamination is negligi- Results: The HRQOL of HF patients in the U. S. Juniper, E.F., Guyatt, G.H., Feeny, D.H., Ferrie, P.J., ble. It may be possible therefore to develop this (33.8±23.4) was poorer than in Taiwan (22.4±18.8, Griffith, L.E., Townsend, M. Measuring quality of life technique to explore the potential of obtaining DNA p< .05). Age, symptoms and depression signifi- in the parents of children with asthma. Quality of profiles from abusive bruises that may identify the cantly impacted on HRQOL, accounting for 48.1% Life Research 1996; 5: 27-34 abuser. (p<.05) of the variance of HRQOL for full sample. Symptoms and depression were powerful predic- Recommended reading: tors affecting HRQOL, accounting for 18% and 5% Maguire S, Ellaway B, Bowyer VL, Graham EAM, of the variance in HF patients. Rutty GN. (2008) Retrieval of DNA From the Faces of Discussion: Interventions for improving HRQOL of Children aged 0-5 years: A Technical Note. Journal HF patients in Taiwan and the U.S. need to consider of Forensic Nursing 4 (2008) 40-44. the symptoms of dyspnea, fatigue, and depression

12 Posters

as essential targets. Reasons for the worse HRQOL effect of NSM was found. Despite that, the scores were unchanged it was – 0.53 points; SD 6.2, P in Americans are unclear and further study is achieved by the organizations don’t indicate a >0.05. needed to determine the impact of this difference. high intensity of team learning and a rich learning Conclusions: The Dyspnoea-12, a patient-reported Conclusions: The HRQOL of American HF patients climate. The reciprocality of the team learning- measure of breathlessness severity, can measure is more impaired than Taiwanese. Age, symptoms model is marking. A significant influence of team breathlessness across several disease groups. In of dyspnea, fatigue, and depression are dominant learning on implementation-effect was determined patients with a chronic respiratory condition, the predictors of HRQOL in both groups. Despite and next to it, a significant influence of the innova- Dyspnoea-12 has been found to be reliable, valid, marked cultural differences, factors predicting tion on team learning was found. and responsive. HRQOL in Americans and Taiwanese HF patients Recommended reading: Recommended reading: are similar. Berta, W., Teare, G.F., Gilbart, E., Soberman Yorke J. (2008) Dyspnoea and Pain: An Interesting Ginsburg, L., Lemieux-Charles, L., Davis., Lowry, L. Analogy Journal of Clinical Nursing. 17(7):841-42 10 (1998). The Neuman Systems Model and Nursing Yorke J & Russell AM. (2008) Interpreting the Education: Teaching Offenbeek, M. van (2001). Language of Breathlessness. Nursing Times. The relation between individual Processes and Outcomes of Team Learning. 104(23): 36-39 learning, team-based learning, European learning climate and ward characteristics and implementation 12 of the Neuman System Model in two Theme: Management of long term Factors that influence the use mental health institutions in the conditions of physical assessment skills Netherlands 11 by cardiac nurse; results from a Olaf Timmermans, Division of Nursing Science longitudinal qualitative descriptive and Midwifery, Bachelor of Nursing, University Validation and reliability of the Antwerp, Hogeschool Zeeland, Vlissingen, The Dyspnoea-12 research study Netherlands Janelle Yorke, Salford Centre for Nursing Midwifery Susan Ward, School of Nursing and Midwifery, Cardiff University, Cardiff, UK [email protected] and Collaborative Health Care, IHSCR Salford University, Salford, UK Co authors: Rhian Barnes; Linda Edmunds Co-authors: Janelle Yorke; Anne-Marie Russell; Abstract: Shakeeb Moosavi; Carol Haigh; Paul Jones Abstract: Introduction: This study explores the relation between team learning and implementation- Background: There is a growing opinion that Abstract: effect of Neuman Systems Model (NSM). Near it, physical assessment skills of inspection, palpation, knowledge is generated about team learning in Background: We previously developed the percussion and auscultation should be an integral nursing teams and innovation. Dyspnoea-12, a unidimensional instrument that part of a nursing assessment (Massey 2006, Scott quantifies breathlessness using descriptors and McInness 2006, West 2006). However it is Design: In this cross-sectional, correlational, of dyspnoea that incorporate its physical and unclear as to what extent cardiac nurses utilise survey study, a structured questionnaire of the emotional components. Unlike the majority of these physical assessment skills as part of their type Likert-scale was used. In January and February similar instruments, Dyspnoea-12 is not linked to role. 2008, 170 questionnaires were dissemenated activity or situation. This study (preliminary results among nurses in nursing teams, of two organisa- Objectives: 1. To establish what advanced physical reported here) examines its validity and reliability. tions for mental health in the Netherlands. The assessment skills are being used by cardiac nurses response rate was 109. Methods: 78 patients (asthma n=30, COPD n=26, in their clinical practice after undertaking a clinical interstitial lung disease n=22), 54% male, mean patient assessment module. 2. Explore the factors Methods: Collection of data took place during age 60(SD 14), were recruited from out-patient that influence the use of advanced physical assess- team-meetings of the nursing teams. No patiënts clinics. Forced expired volume-1 (FEV1), 6-minute ment skills by the cardiac nurses. were involved in this study. Nurses completed the walking distance (6MWD), and MRC dyspnoea team learning instrument, the learning climate Methods: A longitudinal descriptive approach, scale (MRC) were measured at baseline, together instrument, the Self Directed Learning Readiness using convenience sampling was employed. Quali- with the Dyspnoea-12 (scaling range 0-36, high Scale, the instrument for Percieved Organiza- tative data was obtained from individual inter- score indicates worse dyspnoea). The Dyspnoea-12 tion Characteristics and the Jopp Neuman Model views, non participant observation within the par- was also measured 14.9 mean days later, together Evaluation Instrument. Quantitative analysis ticipants’ clinical environment and self reported with a global health change score. Reproducibility was performed with the Statistical Package for activities log. of Dyspnoea-12 scores was assessed using Intra- Social Science (SPSS), to calculate means and to Results: Five key themes emerged from seven par- Class Correlation Coefficient (ICCC). Correlations determine relations and degree of association ticipants between Dyspnoea-12 and FEV1, 6MWD and MRC between variables. were tested (Spearman’s r). Responsiveness to 1 Use of advanced physical assessment skills varied Findings: The organization in the Southwest within group change in patients reporting a global 2 Use and development of skills was linked to reached higher scores on the NSM instrument score improvement, n=53 (75%) and a ‘no-change’ personal characteristics (knowledge). A significant influence of learning global score, n=15 (19%) was examined. 3 Use influenced by perceptions of role boundaries, climate towards team learning was determined. Results: The Cronbach alpha (a measure of internal permission and co – operation Team learning and parts of ward context, team consistency) for the Dyspnoea-12 was 0.95, and learning and NSM (use and knowledge) showed a 4 Use influenced by their perception of nursing and ICCC for repeatability was 0.7 (95% CI 0.54-0.78). significant relation. Data showed a linear negative development of own nursing practice Correlations with FEV1 were r = – 0.44 (P<0.01), relationship between team learning and age & 5 Use influenced by the physical environment and 6MWD r = – 0.53 (P<0.01), and MRC score 0.62 experience. In most cases, the scores of team G the human support within it (P<0.01). In patients who reported a global were significant higher, than the other teams. improvement, the mean change in Dyspnoea-12 Discussion and conclusions: Cardiac nurses selec- Conclusions: In this study, a significant relation was – 4 points; SD 9.9, P=0.007 and in those who tively use physical assessment skills, predomi- between team learning and implementation- nately related to the cardio respiratory systems.

13 Posters

Organisational structure and professional relation- different patterns of cumulative fluid balance Conclusions: Dialysis patients have far poorer ships appear to play a significant part in the use of during the first week of ventilation between the results than CKD and transplant patients, the physical assessment skill by these cardiac nurses. groups. Those who failed weaning increased their higher levels of comorbidity and end stage renal These findings have implications firstly, for those cumulative fluid balance by 9 liters; those who failure status, are further compounded in the who provide the education, in terms of what should were successful increased their cumulative fluid diabetic dialysis patients. be taught and facilitated. Secondly for those who balance by 3.5 liters. Recommended reading: manage clinical areas and the nursing staff within Conclusions: Prior to ventilator weaning, evalua- Davison, SN., 2005. Chronic Pain in End-stage them to ensure appropriate staff have assessment tion of cardiovascular function and cumulative fluid Renal Disease. Advanced Chronic Kidney Disease, skills relevant to their role. balance may provide the opportunity to optimize 12(3), pp.326-334 Recommended reading: cardiovascular function and improve the likelihood of weaning success. Murtagh, FE., Addington-Hall, J., Higginson JJ., Massey, D. (2006) Cardiac Assessment part 1: 2007. The Prevalence of Symptoms in End-stage Inspection, Palpation, Percussion. British Journal of Renal Disease: A Systematic Review. Advanced Cardiac Nursing 1(1):7-11 14 Chronic Kidney Disease, 14(1), pp.82-99 Scott, C and MacInnes, J. (2006) Cardiac Patient The distribution and severity of pain Davison, SN., 2007. Chronic Kidney Disease: Assessment: Putting the Patient First. British in subjects with kidney disease Pyschological Impact of Chronic Pain. Geriatrics, Journal of Nursing 15(9); 502-508 62(2), pp.17-23 Kate McCarthy, Warwick Medical School, University West SL (2006) Physical assessment: whose role is of Warwick, Coventry, UK it anyway? Nursing in Co-authors: Robert Higgins; Neil Raymond 15 Learning to care for patients with 13 Abstract: end-stage alcohol liver disease: A Cardiovascular and renal function Background: Pain is a fundamental ‘warning sign’ phenomenological study influence ability to wean from of illness and pain that appears to emanate from the kidneys is a common reason for referral to a Patricia Black, Senior Clinical Nurse Specialist Palliative Care, Lecturer, Lothian Acute Hospitals mechanical ventilation Nephrologist. There are few studies of the epide- Specialist Palliative Care Service, NHS Lothian, Susan Frazier, College of Nursing, University of miological characteristics of pain in renal failure Kentucky, Lexington, KY, United States Napier University, Edinburgh patients. Co-authors: Amani Khalil; Lizbeth Sturgeon; [email protected] Ashley Wellman; Maggie Roberts; Melanie Hardin- Aims: To investigate and analyse the experience of Pierce; Jessie Bafford; Sarah Kelly pain and its relationship with renal disease. Abstract: [email protected] Methods: 462 patients were enrolled. Mean age 57 + 16yrs, mainly White Europeans (85.5%). 65% of Current healthcare strategy in the UK emphasises participants reported a problem with pain. Demo- that all patients with a life-limiting illness have the Abstract: graphic data and medical history were obtained. right to access a high standard of care, which will Background: Cardiovascular dysfunction is associ- Patients were evaluated using the Brief Pain support a quality of life and a peaceful, dignified ated with and worsened by excess fluid volume, a Inventory (BPI), giving composite pain severity death (DOH, 2008: Scottish Government, 2008). result of complex hemodynamic and neurohormo- and interference scores, the SF12v2 quality of life Education for healthcare professionals is regarded nal interactions and renal dysfunction in ventilated (QoL) health survey and an adapted version of the as playing a key role in delivering this agenda, by patients. Few studies have evaluated the associa- Margolis Body Score. supporting application of the principles of pallia- tion of cardiovascular and renal function with venti- tive care in clinical practice within all care settings. Results: Dialysis patients had significantly more lator weaning success. Recent studies have however, questioned the pain interference and severity (p.009), worse use of traditional educational approaches based Purpose: The purpose of this study was to compare QoL (p.000) and greater pain distribution (p.029) clinical indicators of cardiovascular function and on the hospice model of palliative cancer care, than chronic kidney disease (CKD) and trans- in preparing professionals to meet the needs of renal function during the first week of ventilation planted patients, who had similar results to one in intensive care patients who successfully weaned patients with advanced non-malignant life-limiting another. Analysis of underlying renal disease found illnesses in general care settings. during their first weaning trial and those who failed. diabetics to have significantly more pain severity Methods: This retrospective medical records (p.011) and interference (p.032), worse QoL (p.000) This hermeneutic phenomenological study review included a random sample (n= 70) of criti- and greater pain distribution than the comparison explored registered nurses’ experiences of caring cally ill patients who received care at the Univer- interstitial and glomerulonephritis group. Hyper- and learning to care for patients with End-stage sity of Kentucky Chandler Medical Center between tension and renal vascular disease produced signif- Alcohol Liver Disease. Mortality from this life- January 1 and June 30, 2007. Data were abstracted icantly lower QoL (p.009) by comparison. Analysis limiting illness now surpasses many cancers, yet in 2008 from these medical records. Independ- of diabetic and non-diabetic found CKD and trans- little is known about what caring for this group of ent t tests and Chi square analyses compared the planted diabetics had significantly poorer QoL and dying patients’ means and how nurses acquired the groups (weaning success and failure, with and transplanted diabetics suffered greater pain inter- knowledge inherent to their practice. without renal dysfunction as determined by creati- ference. The majority of patients die within the acute setting nine > 1.5 mg/dl). Discussion: Increasing comorbidity resulted in therefore a purposive sample of six nurses was Results: Patients were male (57%), Caucasian increased pain severity and interference, declining recruited from two university teaching hospitals (96%) with a mean age of 54 14 years and were QoL and greater pain distribution. BPI, SF12v2 and in Scotland. Data collected via in-depth interviews ventilated for 7.8 11 days. Patients whose initial Margolis scores became significantly worse with was analysed using the Fleming, Gaidys and Robb weaning trial was successful exhibited greater declining renal function. Progressive renal failure, (2003) strategy for hermeneutic phenomenological cardiac output, higher mean arterial pressure increasing comorbidity, diabetes, hypertension research. and lower heart rate and central venous pressure and renal vascular disease are associated with Findings suggest that the phenomena of caring compared to those who failed (p < 0.05). Patients increased pain severity and interference, poorer and learning to care for patients with ESALD may with renal dysfunction were more likely to fail QoL and greater pain distribution. be inter-related and inter-dependant. Themes will the initial weaning trial (p = 0.05) and there were be presented, which portray the development and expression of nursing knowledge as embodied ways

14 Posters

of knowing within caring practice; including dimen- sideration of the teeth, dentures, soft tissues, lips, life-reconstruction process should be emphasized sions not previously identified in relation to pal- saliva, tongue, gums, palates and pain. Few tools by 6 months after the operation. liative nursing. The implications of study findings addressed all these components of OHC. Less than Recommended reading: in relation to existing knowledge and practice in half the tools reported a pilot phase, with fewer still nursing and nurse education will be discussed and piloted on patients who had suffered a stroke. Gaw, B.(2004) Motivation to Change Life-style Following PTCA. Dimensions of Critical Care Nursing recommendations for future research made. Conclusions: We failed to identify an oral health 11(2) 68-74 References: assessment or protocol tool specifically designed for the delivery and support of OHC in special- Jaarsma, T. and Kastermans, M. (1995) Problems Department of Health (2008) End of Life Care ist stroke care settings. There is an urgent need of Cardiac Patients in Early Recovery. Journal of Strategy http://www.dh.gov.uk/en/Publication- for a comprehensive, evidence based, stroke Advanced Nursing 21 21-27 sandstatistics/Publications/PublicationsPolicy- specific OHC assessment tool to support nurses in Goldsmith, J., Lindholm A., Bute J. (2006) Dilemmas AndGuidance/DH_086277 [accessed July 2008] assessing stroke patients’ oral health. This would of Talking about Lifestyle Changes among Fleming, V., Gaidys, U., & Robb, Y., (2003). Herme- in turn inform the development of a detailed OHC neutic Research in Nursing: Developing A Gadame- plan. rian – based Research Method, Nursing Inquiry. 10 18 (2), pp.113-120 17 The experiences of stroke patients Scottish Government (2008) Living and Dying Well: and carers following discharge A National Action Plan for Palliative and End of Life Efforts to prevent a recurrence of home: A preliminary study Care in Scotland http://www.scotland.gov.uk/ ischemic heart disease in patients Publications/2008/10/01091608/0 [accessed Oct Charles Hendry, School of Nursing and Midwifery, 2008] at 6 months after undergoing CABG University of Dundee, Dundee, UK Mio Machimoto, School of Nursing Faculty of Co-authors: Jan Pringle; Ella McLafferty Medicine, Mie University in Japan, Tsu-city, Mie, [email protected] 16 Japan [email protected] Oral health assessments and Abstract: protocols for patients following Stroke has been recognised as the most common Abstract: stroke cause of complex disability in the community Background: The continuing self-control of their Marian Brady, Nursing, Midwifery and Allied Health (Adamson et al, 2004). A literature review (Pringle Professions Research Unit, Nursing, Midwifery and lifestyle is necessary for patients who have et al, 2008) identified that not only has there been Allied Health Professions Research Unit, Glasgow, undergone coronary-artery bypass grafting (CABG) limited research into experiences during the early UK to recover and maintain their health without days at home, particularly in the UK, but also Co author: Denise Furlanetto suffering a recurrence of ischemic heart disease that patients with aphasia have frequently been [email protected] (IHD). Previous studies reported that patients excluded from stroke research. who had received CABG were highly motivated to The aim of this presentation is to describe an prelim- change their lifestyle1). On the other hand, diffi- inary study carried out in 2007-2008 into the expe- Abstract: culty to encourage them to change their lifestyle as riences of stroke patients and their carers during Introduction: Supporting oral health care (OHC) well as the fact that postoperative patients live with their first month at home following discharge from may be a complex issue with many stroke related various physical pains persistently after discharge hospital. A purposeful sample of 4 patients and 4 impairments including physical, sensory, and have been demonstrated2). When these patients carers took part in the study, which was carried out cognitive difficulties impacting on patients’ ability try to rebuild their lives with attention to preventing in East Scotland. The research design and method, to conduct independent OHC. Pre-existing poor oral a recurrence of the disease, their families are likely including the use of in-depth interviews and par- health, swallowing difficulties (including problems to experience certain hardships and troubles in ticipant diaries, will be detailed giving individual with oral clearance) and reduced nutritional intake helping them continue their efforts3). The purpose examples from the study. The planning and tools will also impact on patients’ oral health. Stroke of this study was to describe efforts to prevent a used to facilitate the inclusion of participants with nurses receive little support in providing OHC to recurrence of IHD in patients at 6 months after communication difficulties will be outlined. this specialist group. undergoing CABG. The presentation will give details of the analysis Methods: We systematically searched electronic Methods: A semi-structured interview was process using Interpretative Phenomenologi- databases (Medline, CINAHL) and contacted spe- conducted to 8 adult patients. Collected data were cal Analysis (Smith et al, 1999) and discuss the cialist stroke care settings across Scotland for subjected to qualitative, inductive analysis. findings, which include the main themes of examples of OHC assessments and protocols in Results: 7 categories regarding efforts to prevent a ‘Fathoming Out’, ‘Adapting to Stroke’ and the ‘Value current use. We then independently appraised recurrence of IHD were identified: find and practice of Support’. This preliminary study allowed the the assessments and protocols identified, extract- their own methods, have time to relax to continue research approach and format to be trialled ahead ing data on a number of elements including their their efforts, shake off temptations, seek support of a more in-depth study, currently underway. The relevance to stroke care settings, quality, linkage to from people around them, be sensitive to burdens findings will serve to further inform those involved the available evidence base, use of training proce- placed on the family, objectively review the current in discharge planning and follow-up services in the dures and piloting arrangements. situation to maintain a positive mental state, and community. Results: We identified 22 published assessments rediscover their feelings to change their view of life. Recommended reading: (plus two assessments published within guideline Discussion: While making efforts to continue their documents) and retrieved six examples from lives with attention to avoid a recurrence of IHD, Adamson J, Beswick A, Ebrahim S 2004 Is Stroke clinical sites. We found 18 published protocols (plus these patients even considered how changes in the Most Common Cause of Disability? Journal of one guideline and one best practice statement). their lifestyle would affect people around them, Stroke and Cerebrovascular Diseases 13 (4) 171-177 We will report the findings of our review including indicating that their life-reconstruction process Pringle J, Hendry C, McLafferty E 2008 A Review of the origins of these tools, the evidence base, was already in the maintenance phase at 6 months the Early Discharge Experiences of Stroke Survivors training and relevance to stroke patients and after the operation. Thus, patients in this phase and their Carers Journal of Clinical Nursing 17 (18) specialist stroke care settings. The components should be cared for with their efforts being closely 2384-2397 addressed varied across tools but included con- monitored. It was suggested that support for their

15 Posters

Smith J A, Jarman M, Osborn M 1999 Doing Inter- Theme: Students attitudes, 21 preatative Phenomenological Analysis. In: Murray experiences and attributes M, Chamberlain K (Eds) Qualitative Health Psychol- An examination of nursing students’ ogy: Theories and Method Sage, London 1999, 20 attitudes about intimate partner p219-240 Do nurses really care? Confirming violence and experiences of the stereotype with a case control physical and sexual victimization 19 study Alison Blasdell, Nursing, Lincoln Land Community College, Springfield, IL, United States Future research priorities for stroke Phil Dean, Trauma and Orthopaedics, Wirral University Hospital, Liverpool, UK Co-author: Raleigh Blasdell, MS service delivery and rehabilitation Co-authors: Geraint Williams; Elisabeth Keir [email protected] Alex Pollock, Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK Abstract: Abstract: Co-authors: Fiona Coupar; Graham Ellis; Peter Background and aims: The Royal College of Nursing The purpose of this study was: Langhorne; Lynn Legg; Jonathan McRea; Peter emphasise the importance of caring in their defini- 1) to examine nursing students’ preconceptions Sandercock; Cameron Sellars; Brenda Thomas tion of nursing. There is little more than anecdotal about domestic violence (IPV), [email protected] evidence that qualified staff nurses are more caring 2) to examine nursing students as victims of and compassionate than average individuals. The childhood and adult physical and sexual violence purpose of this study was to objectively test this Abstract: The sample for this study consisted of all female hypothesis using a case control study. Aims: To develop an objective method to assist nursing students enrolled in an associate degree the setting of future research priorities, and to use Methods: Using the Ten Item Personality Inventory nursing program at a Midwestern community this to explore future research priorities for stroke questionnaire a statistical comparison was made college. 157 students anonymously completed a service delivery and rehabilitation. between from 174 volunteer female qualified 22-item questionnaire that measured childhood nurses and data for 760 adult female controls Methods: A comprehensive list of stroke rehabilita- exposure to domestic violence, beliefs regarding extracted from the instruments original validation tion topics was developed using multifaceted meth- women involved in relationships in which battering study. The questionnaire measures each of the five odologies, including focus groups, a Delphi process occurs, and their personal experiences of violent major facets of personality (openness, extrover- and systematic literature searching. Cochrane sys- victimization. Initial data analysis revealed: 25% of sion, conscientiousness agreeableness and neu- tematic reviews and randomised controlled trials students (as children) witnessed a female parent roticism). Agreeableness: a tendency to be com- (RCTs) were identified from the Cochrane library and being abused by a partner; 65% experienced passionate, considerate and cooperative and was Cochrane stroke group, screened by two independ- physical violence themselves before the age of 18; used as a proxy measure for ‘caring’. Results were ent reviewers and assigned to appropriate topics. 20% experienced sexual violence before age 18; analysed using unpaired students tests. Categories of evidence of effectiveness were deter- 35% experienced physical violence by a partner mined and recommendations for future research Results: Female staff nurses scored significantly since age 18; 16% experienced sexual violence were extracted from associated reviews. A simple higher than female controls concerning the person- by an intimate partner since age 18. Regarding system for categorising the priority level and rec- ality traits; extroversion, agreeableness, conscien- attitudes, 21% felt that ‘battered women can always ommended priority action, based on an objective tiousness and emotional stability (p<0.05). leave the relationship,’ 20% felt that ‘a man who assessment of the data-set, was developed and Discussion and conclusions: Individuals demon- batters has probably been provoked by something applied. strating high levels of extroversion, agreeableness the woman said,’ and 3% felt ‘women who stay in battering relationships like to be treated that way.’ Results: 75 topics covering all aspects of stroke and conscientiousness in continuity display highly Finally, 38% of students felt the need for training on service delivery and rehabilitation were deter- organised cooperative behaviour ideally suited to IPV. Data analysis continues with the remaining 13 mined. 37 out of 75 topics had associated professional team working. In direct comparison items. Nurses, by virtue of their relationship with completed Cochrane reviews. 19 of the Cochrane to normal adult females, staff nurses are signifi- patients, are in a key position to screen women reviews recommended further RCTs only; 13 recom- cantly more caring, conscientious and resilient. The for violence and make referrals to appropriate mended further RCTs plus ‘other’ primary research; personality traits found in female nurses compli- agencies/resources, thereby empowering women 5 recommended ‘other’ primary research but ment their profession and to some extent justify living with violence. This study suggests, however, not further RCTs. 35% of topics had fewer than 5 the caring compassionate nursing stereotype. that some students still adhere to myths regarding RCTs assigned; 35% had between 5 and 24 RCTs Modern nursing often involves exposure to human battering. Furthermore, these nursing students assigned; 21% had between 25 and 100 RCTs suffering, busy working environments and occa- experienced a higher incidence of victimization assigned; and 9% had more than 100 RCTs. The sionally physical or verbal abuse. This may explain than the literature suggests for women in the USA. effect of 16 out of 87 interventions were catego- why nursing staff demonstrate such high levels Both of these findings should be of concern to rised as ‘beneficial’ or ‘likely to be beneficial’, 2 out of emotional stability in comparison to female nurse educators. The authors plan on expanding of 87 interventions were categorised as ‘likely to be controls. Conscientiousness is highly desirable this study to include associate and baccalaureate ineffective or harmful’ and 72 out of 87 interven- nursing trait the importance of which cannot be nursing students in multiple college and university tions were categorised as ‘unknown effectiveness’. overemphasised for all aspects of patient care and specifically for the avoidance of pharmaceutical settings. Discussion and conclusions: An objective method, error. Whether career nursing self selects these based on knowledge of the existing evidence-base, Recommended reading: qualities or nursing staff develop certain aspects has successfully recommended future research Christofides, N. & Silo, Z. 2005 How Nurses’ Expe- of their personality as a product of experience is a action for priority topics. This objective approach riences of Domestic Violence Influence Service subject for debate. could be successfully used to assist the setting of Provision: Study Conducted in North-west Province, future research priorities in other areas of health- South Africa. Nursing and Health Sciences 4, 9-14 care. Sharps, P., Koziol-McLain, J., Campbell, J., McFarlane, J., Sachs, C., & XU, X. 2001 Health Care Providers’ Missed Opportunities for Preventing Femicide. Preventive Medicine 33, 373-380

16 Posters

Zink, T. & Putnam, F. 2005 Intimate Partner Recommended reading: Recommended reading: Violence Research in the Health Care Setting: Alabaster, E. (2007) Involving Students in the Chal- Kanter, R. M. (1977) Some Effects of Proportions on What are Appropriate and Feasible Methodologi- lenges of Caring for Older People Nursing Older Group Life: Skewed Sex Ratios and Responses to cal Standards? Journal of Interpersonal Violence 20 People 19 (6) 23-28 Token Women, American Journal of Sociology, 82, (4), 365-372. Marsland, L. and Hickey. G. (2003) Planning a 5, pp 965-990 Pathway in Nursing: Do Course Experiences Connell, R. W. (1995) Masculinities, Cambridge, 22 Influence Job Plans? Nurse Education Today 23 (3) Polity Press. 226 – 235 ‘I feel quite passionate about this Charmaz, K. (2006) Constructing Grounded Theory, Ritchie, J. and Lewis, J. (2003) Qualitative Research London, Sage Publications Ltd. dignity thing’: Student nurses Practice: A Guide for Social Science Students and experiences of working with older Researchers. London: Sage 24 people Julie McGarry, School of Nursing, Nottingham 23 Negotiating supernumerary status University, Derby, UK as a student nurse in clinical Co-author: Christine Simpson Voice: Male students of practice [email protected] undergraduate nursing Helen Allan, Centre for Research in Nursing Jane Ryan, SONMS, Cardiff University, Cardiff, UK and Midwifery Education, Faculty of Health and Abstract: [email protected] Medical Sciences, University of Surrey, Guildford, UK Background: Changing demography alongside Co-author: Pam Smith shifting patterns of ill health and disability would Abstract: [email protected] suggest that older people will continue to be Background: Numbers of male student nurses have among the chief recipients of health care. While always emulated the concept of the skewed group, historically working with older people has not been where the dominant group features as a ratio of Abstract: viewed as a popular career choice, nurse education 85:15 (kanter 1977). Their number contributes This paper will examine the how student nurses exerts a significant influence on attitudes towards to the notion of investigating whether a minority negotiate supernumerary status in order to learn older people (Alabaster, 2007). Student’s experi- have a voice and can articulate their learning styles in clinical practice using findings from a two year ences of practice are also pivotal in shaping their within a dominant female population. study funded by the General Nursing Council Trust decisions whether to work with older people Aims: How do male students of Wales articulate for England and Wales, which focused on leader- (Marsland & Hickey, 2003). their preferred learning styles in the college pre- ship and learning in clinical practice. This was a two Aims: To explore student nurses experiences of registration nursing environment? Epistemological stage multi method study. Stage 1 included a lit- caring for older people in practice and to examine framework: An interpretive perspective was taken erature study and stakeholder interviews with edu- the factors which impact on their perceptions of to apply the components of hegemonic masculinity, cational leaders nationally. Using four HEIs in four working with this client group. complicity, marginalization and subordination from regional areas, Stage 2 included an E-Survey of Methods: A qualitative research design involving Connell’s (1995) masculinities framework. 4000 students/717 response rate in England; par- ticipant observation of clinical shifts where student focus groups (two initial focus groups and two Methodology and methods: Thirteen participants and mentor activity was observed; informal inter- follow-up) with nine second year adult branch took part in the pilot and eleven in the main study. views with students, mentors, nursing managers pre-registration nursing students in the UK. Data Data was gained from focus groups, individual and practice educators as well as formal focus analysis Analysis was undertaken using thematic interviews, and fieldnotes. Implicit actions and group and indiviidual interviews with mentors, analysis (Ritchie & Lewis, 2003). speech were analysed using the constructivist ward managers,practice educators, a director Findings: Three themes emerged from the data and grounded theory approach (Charmaz 2006). A of nursing, clinical placement facilitators, link form the basis of the presentation: theory grounded from the data emerged. lecturers, modern matrons, practice development • seeing the person: caring for an older patient Results: Four theoretical categories were nurses. From these findings the authors ask in this • the little things that count: the quality of care developed: Coming together – Interact to learn, paper: how do nursing students learn to negotiate Learning styles-finding that voice, Relational gender • looking for a friendly face: the work environment supernumerary status in clinical practice? and observation in the classroom and Becoming a Discussion: The findings suggest that student learner in the face of gendered concerns. The core Recommended reading: nurses entered placements with strong caring category, Voice never hidden, released by mascu- Melia, K. (2006)R000271191 – Nursing in the New values. However, early encounters and obser- linity captures the essence of the four categories. NHS: A Sociological Analysis of Learning and vations challenged students personal and pro- Discussion: The act of coming together allowed a Working fessional ideals and were incongruent with the vocal space to discuss learning styles and their rela- www.esrc.ac.uk/ESRCInfoCentre/Plain_English_ theoretical underpinning of person-centred care tionship to the numerically dominant group. Rela- Summaries/LLH/health_wellbeing/index413. espoused in the classroom, for example experi- tionships within the classroom were de-gendered. Access 14/11/06 ences of routine and ‘task’ orientation, leaving little A small number of participants assumed a neutral opportunity for personal interaction. Mackintosh, C. (2006) The Impact of Socialization identity, ‘the student nurse’. Discriminatory attitudes on Student Nurses’ Ability to Care: a Longitudinal Conclusions: Student nurses enter practice with marginalized opportunities in clinical practice. Qualitative Descriptive Study. Paper Presented at the expectation of translating theoretical concepts Conclusions: The findings suggested hegemonic RCN International Research Conference York, UK and to learn ‘the tools of the trade’. As such the masculinity was rarely practised through the practice setting occupies a pivotal position in Kleinman, S. and Copp, M.A. (1993) Emotions and medium of voice, but male students could call on shaping student’s experiences. It is therefore vital Fieldwork, Qualitative Research Methods Series, the complicit nature of masculinity to voice their that mentors and educationists develop strategies 28, London: Sage Publications learning styles. Learning via a visual route was to promote positive learning environments and complicated by their gender. The participants were support students to retain their values while recon- unable to call on the complicit nature of masculin- ciling the demands of practice. ity to enable delivery of intimate care to female patients.

17 Posters

25 26 Theme: Methodology and methods Nursing as viewed by mainland Student nurses knowledge and 27 Chinese nursing students attitudes to children’s pain Blurring the boundaries Jean Glover, School of Nursing, Tianjin Medical management Kirsteen Jones, Nursing, Glasgow Clinical Research University, Tianjin, China Denise Owens, School of Nursing, University of Facility, Glasgow, UK Co-author: Zhang Meini Salford, Manchester, UK [email protected] Co-authors: Densie Jonas; Carole Haigh Abstract: [email protected] Abstract: Background: Nursing development in Mainland The roles of Research Nurse and Nurse Researcher China includes the definition of nursing and nursing Abstract: are of increasing importance in the rapidly evolving roles. Pang et al 2004 & Lu et al 2008 have explored Background: The assessment and management of needs of the National Health Service (NHS). In a new this in qualified nurses but little has been found pain in children is an important aspect of nursing initiative between a Higher Education Institution exploring the views held by nursing students. care, recommendations for the improvement of (HEI) and one NHS trust in Scotland, two Clinical Aims: This small-scale qualitative study aims to pain management in children have focused on Research Nurse posts have been developed. This explore the perceptions of nursing held by students increasing education to both students and qualified collaboration which is unique in Scotland has resulted in the creation of a post that is part-time Methods: Unstructured interviews were used to health professionals (DH 2003). Whilst the experi- Research Nurse and part-time Nurse Researcher. examine the views of nursing held by undergradu- ence of pain in children is similar to that of adults This type of role is becoming increasingly ate (N=6) and postgraduate nursing students the cognitive developmental differences make this necessary in an environment which is requiring the (N=6) in a medical university in mainland China. a complex area of nursing education. development of clinical academic career pathways. A convenience sample of twelve students partici- Aims: The aim of the project was to determine if However this goes against the notion supported pated in tape-recorded interviews in English during knowledge of pain management in children could in the literature that research experience is only September and October 2008. Students were be changed as a result of a structured education important for those nurses who wish to pursue selected on the basis of willingness to participate programme. The education programme included academic study and it is a common perception and having sufficient level of English. Care was three lectures, two self directed workbooks, that clinical nursing and formal academic research taken during the interview to clarify the meaning an e-learning package, personal development rarely combine effectively. The pioneering alliance of terms used where this was questionable. Inter- planning related to practice and the opportunity between the University of the West of Scotland views were transcribed and themes identified were for a short placement with a tertiary children’s pain and NHS Greater Glasgow and Clyde pre-empted confirmed with the interviewees team. the Finch Report (2007) in which it was envisaged Results: Analysis yielded the following themes: Methods: The project invited 127 second year child a more flexible career structure that will develop Ideals versus reality, the nature of nursing work, health nursing students to complete a question- the clinical academic role – combining clinical and medical dominance, perceived social status and naire before and after the educational programme. academic work – as the norm for those nurses who value of nursing education. Many students have Four cohorts of students were studied over a two successfully pursue a research career, rather than a clear vision of what nursing could be but faced year period. Two cohorts acted as a control and obliging them to pursue one role at the expense of with the realities of clinical practice they need to received a questionnaire at the start and also at the other. reconcile two vastly differing perspectives. the end of this 12 month period, thus receiving the This presentation will discuss how these dual role theoretical input during their third year. Discussion: This study is limited by its small size, posts are successfully working within each of the the constraints of language, single location and Results: Data analysis indicated no change in two very different organisations that they are based. using only bachelors’ and master’s students. These knowledge of practical pain management issues The challenges presented by each dimension of the students’ views are less developed than those such as pain assessment and medication delivery. role will be presented and also the similarities and of qualified nurses described in other studies; There was a significant change in knowledge acqui- differences between each. The unique opportuni- however we can begin to see how Chinese nursing sition in the education group in relation to their ties offered by the formation of this new role will be students are viewing nursing and understand their attitudes to relieving pain, pain transmission and highlighted with the impact such innovative roles conflicts and dilemmas. pharmacology. can have on changing the perception of research as Conclusions: This area would profit from further Conclusions: Values and attitudes acquired by solely an academic pursuit. investigation if we are to understand the issues student nurses from education have the ability to Recommended reading: faced by nursing students and help them through remain deeply rooted and become firmly estab- ‘reality shock’ to stay in and develop professional lished as part of future nursing practice. Therefore UKCRC subcommittee for Nurses in Clinical nursing in China. future teaching sessions for all students will focus Research (Workforce) Report (2007) Develop- upon these areas. Having a sound knowledge ing the Best Research Professionals. Qualified Recommended reading: of pain transmission and physiology could help Graduate Nurses: Recommendations for Preparing Lu H. While A. Louise Barriball K 2008 Role percep- student nurses understand the rationale behind and Supporting Clinical Academic Nurses of the tions and actual role content of Hospital Nurses in analgesia administration and pain assessment. Future (Chairwoman J. Finch) U Mainland China, Journal of Clinical Nursing 17(8) Rattray, J.E and Taylor, J. (2007) Guest Editorial: Recommended reading: 1011 – 1022 Models for Developing Young Nurse Research- Pang S.M.C. Wong T.K.S.. Wang C.S. Zhang Z.J. Chiang, L., Chen, H., Huang, L. (2006) Student ers: A Discussion. Journal of Clinical Nursing 16(6) Chan H.Y.L. Lam C.W.Y. Chan K.L. (2004) Towards a Nurses’ Knowledge, Attitudes and Self Efficacy pp997-999 of Children’s Pain Management: Evaluation of an Chinese Definition of Nursing. Journal of Advanced Ledger, T., Pulfrey, A. and Luke, J. (2008) Develop- Education Program in Taiwan. Journal of Pain and Nursing 46(6) 657 – 670 ing Clinical Research Nurses. Nursing Management Symptom Management. 32(1):82-89. 15(2) 28-33 Coupling, S. (2005) Doctors and Nurses Knowledge of Pain After Surgery. DH(2003) Getting the Right Start: National Service Framework for Children. Standards for Hospital Service. London, Department of Health.

18 Posters

28 29 and even more so to nursing as it continues to develop and promote evidence-based and other Rainbows and bricolage Sportex: An example of research findings. The Honor Society of Nursing, Natalie Yates-Bolton, School of Nursing, University collaborative research between the Sigma Theta Tau International’s (STTI) Virginia of Salford, Salford, UK NHS and an Academic Institution Henderson International Nursing Library (VHINL) [email protected] Nicola Anderson, Wellcome Trust Clinical Research provides a means of disseminating nursing Facility, University Hospital Birmingham NHS Trust, research on a global basis to the largest number of Abstract: Birmingham, UK nurses and other health care professionals. This paper examines the use of bricolage within an Co author: Joanne Plumb Through its mission of, ‘Improving the World’s action research study on meaning and purpose in [email protected] Health through Knowledge’, the VHINL is dedicated the lives of nursing home residents. The study has to enhancing the health of all people through been informed by observations, perceptions and Abstract: knowledge development, knowledge dissemina- knowledge from residents, staff and the researcher. tion, and knowledge utilization. With a continued This paper explores the collaboration between a As the researcher I have not presumed to know for goal of growth in all areas of access, STTI has made University School of Sport and Exercise Sciences the outset of the study the most effective method a commitment to make the VHINL one of the most (SSES) and an NHS Clinical Research Facility (CRF) for studying the reality of the situation being inves- comprehensive resources for nursing information in the undertaking of research studies which tigated. By listening to the participants accounts available on-line. The presentation will inform the explore the role and implementation of lifestyle of their life, care experiences and needs the participants about the power and possibilities of interventions involving physical activity and diet, in study design has been developed in an emergent utilizing the VHINL, as researchers to disseminate disease prevention and health promotion. Nursing fashion. The use of a variety of types of knowledge findings, and as researchers who seek research staff rotate from the main hospital based CRF to and research methods were combined by the findings. an all purpose built satellite clinical facility based researcher as a bricoleur (Crotty,2003). This has in the SSES on the University campus. Nurse led From a structured means to registering scien- resulted in a study design that is uniquely suited research is undertaken in this satellite unit on tific nursing research to a more flexible means to the issue being investigated. Bricolage focuses healthy volunteers and obese subjects with normal of allowing the VHINL to develop innovative on an individual’s ability to employ a large range and impaired glucose tolerance (Aged 20-50). Any templates to present evidence-based research of tools and methods, even unconventional ones, subjects falling outside these parameters are to be findings and conference abstracts, the participants this involves inventiveness, resourcefulness and investigated in the main CRF unit under medical will learn about how they can utilize the library in a imagination (Crotty, 2003:49) This study uses two supervision. Interventions to be performed in the variety of ways for the purpose of developing, dis- different approaches of bricolage; one of being satellite unit include: venous cannulation, oral seminating, and utilizing nursing research. Addi- ‘self-reflexive’ (Denzin and Lincoln,1994 ) and glucose tolerance testing, resting energy expendi- tionally, the presenter will engage the participants second where the researcher makes something ture and diet induced thermogenesis, VO2max test in a discussion related to how the VHINL can work new out of a range of materials that had previously and constant workload exercise, Doppler Ultra- for them as research developers, presenters, and made something different (Levi-Stauss, 1966). The sound, contrast enhanced ultrasound during micro- consumers. As researchers commit to expand the resulting research methodology has been pieced bubble infusion, percutaneous muscle biopsies body of nursing knowledge throughout the scien- together as the research findings were also pieced and stable isotope tracer infusions with repeated tific community, the VHINL presents a means to together. blood sampling. This collaboration reflects the reach nurses and members of transdisciplinary In the study the residents’ life stories, their prior increasing importance of utilising an interdiscipli- teams across the world. experience in the nursing home, the history of nary approach by integrating the expertise, analyti- the nursing home as an organisation and the cal and clinical skills that can be derived from the 31 life history of the staff members pre-exist. The academic and NHS sectors. This project is in line researcher reflexively identified possible methods with the Governments desire that partners from Keeping the ripple effect to a for obtaining data on these subjects, the decision NHS, Academia and Industry collaborate to pioneer minimum on what these methods could be required integra- new treatments and models of care (DOH 2008) Shona McDermott, Education and Training, tive use the researcher’s experience as a nurse and Glasgow Clinical Research Facility, Glasgow, UK research knowledge. The resulting research study Recommended reading: Co author: Karen Duffy is presented as a visual template of a rainbow, with DOH (2008) High Quality Care For All: NHS Next [email protected] a mirror image of research methods being used Stage Review (Final Report). Command Paper with residents and staff. 7432. HMSO: London Abstract: Recommended reading: Performing clinical research within an acute care Crotty M. (2003) The Foundations of Social 30 environment can be a challenging and often Research, Sage, London Research dissemination: The power daunting process for the research nurse. While Denzin N. and Lincoln Y. (1994) Handbook of Quali- and possibilities of the Virginia we strive to encourage participation in clinical tative Research, Sage, USA research, it is clear that the process is only effective Levi-Strauss C. (1966) The Savage Mind, University Henderson International Nursing when there is minimal impact or change of practice of Chicago Press, USA Library required from those staff providing routine care. Karin Morin, Honor Society of Nursing, Sigma While our experience has been extremely positive, Theta Tau International, Indianapolis, United our success in the field is largely a result of Clinical States Research Facility (CRF) staff having developed [email protected] robust strategies for the introduction of a new study, in parallel with a good understanding of the Abstract: methods of routine care delivered within the host unit. Many obstacles can impede the progress of As nursing’s scientific research base grows, it our work and finding solutions to each brings its is critical that the work does not stop with the own unique demands on research personnel and research process and evaluation. Dissemination of managers whilst providing research nurses with scientific works is critical to the research process

19 Posters

the knowledge and systems to perform effectively and the telephone. Application for site-specific Theme: Skin care / infection control in outreach settings. This experience is particularly ethics and Research Governance approvals can 34 relevant to ensure that research nurses are viewed be daunting for clinicians who are unfamiliar with as valuable clinical colleagues and key personnel undertaking research. Obtaining the approvals was Understanding factors impacting on in the research team. In the increasingly regulated time consuming because different Trusts required infection control practices: A mixed environment of clinical research the development different information. methods study of a dynamic structure / service that facilitates an Conclusions: The enthusiasm and commitment of increase in the involvement of both investigators Claire Chalmers, School of Health, Nursing and the whole research team is essential to the success Midwifery, University of the West of Scotland, and participants in clinical research will have a of this and any other multicentre study. Clear lines Hamilton, UK positive impact on future health care delivery and of contact and information are key to the collabo- [email protected] practice. rative process. A study coordinator who is accessi- This presentation will discuss an ‘outreach’ clinical ble and has a thorough knowledge of the research trial performed in the Intensive Care Unit (ICU) of process is imperative. Abstract: Glasgow’s Victoria Infirmary, and the impact an Background: Prevention and control of infection infrastructure of experienced research personnel must be integral to the practices of all personnel can have on conducting such a study. The chal- 33 involved in activities where there is associated lenges of providing a research service in ICU will be ‘Bank it not bin It’ risk to health. Concerned over associated risk to presented and the key elements that are required Alison Davies, Wales Cancer Bank, Cardiff, UK public health from poor hygiene/ infection control to ensure the integrity of the CRF’s work and the Co-author: Alison Parry-Jones practices, in 2006, Scotland implemented regula- transferability of the infrastructure to other acute tion of the tattooing and cosmetic skin piercing [email protected] outreach settings will be detailed. industry. Aims: The aim of this research is to understand the Abstract: 32 impact of regulation on infection control practices Tissue banking for the provision of human bioma- within the tattooing and cosmetic body piercing Issues when setting up a multi- terials for research is recognised as an important industry in Scotland. centred RCT initiative for understanding disease and improving Methods: A mixed methods approach has been health outcomes in the 21st century. Some would Mwidimi Ndosi, Academic & Clinical Unit for adopted, using semi-structured interviews, ques- Musculoskeletal Nursing, University of Leeds, even argue that it is unethical to discard human tionnaires, and non-participant observation to Leeds, UK tissue surplus to diagnostic requirement if it could collect data, in three phases, from users and Co-authors: Claire Hale; Jackie Hill usefully be used to further research into a range enforcers of the regulation. Data will be subjected of diseases, including cancer. A well co-ordinated to both qualitative and quantitative analysis as network of nursing and biomedical scientist staff appropriate. This paper presents findings from Abstract: is needed to ensure that a tissue collection is well Phase 1 pilot work. Background: Multi-centred RCTs are becoming annotated and of good quality. Nurses are a vital more popular in healthcare and nursing research link in the process as they are an important point of Results: A pilot survey (n=5) and observa- because of their ability to access more patients contact for patients and ensure transparency and tional study of practitioners’ (n=5) hand hygiene and provide high quality generalisable results. The accountability. One of the most integral aspects to practices within one tattoo studio found lack of objective of this presentation is to highlight some the success of any tissue bank is the willingness formal education/ knowledge influenced hand of the issues encountered while setting-up a multi- of the patients to donate and to maintain the con- hygiene practice. Pilot interviews with Environmen- centred RCT of effectiveness of nurse-led care in fidence of the public – this is best achieved with tal Health Officers (n=3) identified the need for rheumatology. This will benefit those who wish to knowledgeable, proactive nurses. They are invalua- education as a regulation-related factor impacting embark on similar studies. ble in creating and embedding networks within the upon practitioners’ ability to meet licensing requirements. Key Issues: hospital system and promoting inter-disciplinary integration to help develop an understanding of Discussion: Previous research argues regulation 1. recruiting the collaborating centres the professional and patient perspectives of tissue alone is often insufficient to improve infection 2. refining the protocol banking and cancer research. control practices within this industry (Oberdorfer 3. communication with the collaborators A tissue bank linking hospitals over 8,000 square et al. 2003). Early results indicate that education may be a key ‘regulation-related’ factor capable 4. applying for site-specific ethics and research miles covering a population of approximately 3 of influencing infection control practices and sub- governance approvals million has been successfully set up and, in the first four years of approaching patients, has consented sequently reducing risk to health from tattooing/ The study involved recruiting 12 rheumatology 3,000 patients to donate tissue and blood samples. piercing. This paper will present a critique of the centres with at least a clinical nurse specialist, a Nurses employed by the bank have found being literature related to factors influencing infection rheumatologist and an independent assessor who involved in this new, cutting edge endeavour to control practices and apply this to the early findings would recruit patients and adhere to the study be both challenging and rewarding as it involves from this study. protocol. Finding collaborating centres through- them in research propagated by the patients for Conclusions: It is anticipated that this research will out the UK which all worked in a similar fashion the patients of the future. A quality assured collec- assist in better understanding factors impacting on was not easy. Even after finding the collaborating tion of tissue samples will help identify innovative infection control practices, which are widely rec- centres, changes in their staff levels or workload clinical conclusions which will ultimately lead to ognised as complex and multi-factorial (Larson & affected their willingness to continue with the col- individualised treatment by avoiding unnecessary Kretzer 1995). These findings can then be utilised laboration. Of 23 centres that originally agreed to or ineffective treatment for patients. All this could within wider health and social care arenas to take part, 12 withdrew for a variety of reasons. It be achieved by surplus tissue being ‘banked and enhance infection control compliance. was important to have initial face-to-face setup not binned.’ meetings in order to discuss and refine the Recommended reading: research protocol and organising these for the Oberdorfer A, Wiggers JH, Bowman J, Lecathelinais 12 centres was difficult because of geographic C (2003) Infection control practices among tattoo- locations and limited funding. It was important ists and body piercers in Sydney Australia; Am J subsequently, to communicate regularly via email Infect Control; 31; 447-456

20 Posters

Larson E, Kretzer E (1995) Compliance with hand- 36 37 washing and barrier precautions, J Hosp Infect; 30 (Suppl); 88-106 Using theory to change practice: A view of pressure ulcer prevention, Hand hygiene as an illustrative case from community nurses Judith Dyson, School of Healthcare, The University Jayne Foley, School of Nursing and Midwifery, 35 of Leeds, Leeds, UK Cardiff University, Cardiff, UK Expert panel in development of Co-authors: F M Cheater; C Jackson; R J Lawton Co-authors: Gina Newbury; Panoas Papanikolaou foot care knowledge test (FCKT) for [email protected] visiting nurses Abstract: Abstract: Minna Stolt, Department of Nursing Science, Background: Nurses work have many facets, while University of Turku, Turku, Finland Background: The delay in implementing research keeping their patients comfort and wellbeing in the Co-authors: Päivi Voutilanen; Helena Leino-Kilpi findings into health care practice is a long recog- foreground; they continue to balance a multitude [email protected] nised problem. An example of this is the case of hand of factors, ranging on a paradigm from effective hygiene. In the UK approximately 5000 deaths per treatment patterns at one end to funding issues year are attributable to Hospital Acquired Infections at the other. Understanding how nurses prioritize Abstract: (HAI) (NAO 2004). Hand hygiene is identified as the these aspects allows an understanding of some of Background:Foot problems are prevalent among primary measure to reduce HAI yet compliance with the mechanisms of effective wound care provision, older people. For this reason visiting nurses need recommended practice is less than 50% (Pittet and as well as allowing Healthcare Management to to have sufficient knowledge of foot care. The foot Donaldson 2005). Interventions to change practice effectively support frontline staff. care knowledge can be measured with FCKT. Devel- have had limited success. Two reasons for this have Aims: This Welsh funded pilot study determines opment of the FCKT included an expert panel which been identified in the literature: which factors of pressure ulcer preventive care- evaluated the content validity of the instrument. • Implementation strategies are not based on plans designed for older people are considered the Aims: To describe the use of an expert panel in accurate assessment of barriers and levers to most important to District Nurses, and establishes development of foot care knowledge test (FCKT) for best practice their relative importance. visiting nurses. • The absence of a theoretical basis informing this Methods: The discrete choice modelling technique Methods: The foot care knowledge test (FCKT) is a assessment and implementation interventions was used. Focus group interviews identified five 61-item questionnaire with true-false-I don’t know Aims: This research aims to address these two factors: ease of care-plan management, evidence scale comprising 5 subscales. The expert panel limitations by developing a theory based question- based practice, the affordability of the care-plan, consisted of 9 PhD candidates in nursing science. naire, which aims accurately assess the barriers impact on patient’s lifestyle, and speed of obtaining The experts were asked independently rate the and levers to hand hygiene practice. Its use is equipment. Values were assigned to these factors. clarity, relevance, concreteness and importance of predicted to reduce HAI and reduce mortality. Vignettes were generated and presented in a self- completion questionnaire, mailed to 124 lead each item using a 4-point rating scale (e.g. 1=not Methods: This is a three phase multi-method clear, 4=very clear). The content validity index study. In the first phase, barriers and levers to hand district nurses from three NHS Trusts in 2003-2004. (CVI) of each item was computed by summing hygiene practice are identified through interviews The data were subjected to regression analysis. number of raters giving a rating of 3 or 4 divided with 50 secondary care staff and patients. Two Results: 85 valid questionnaires were returned. with total number of raters. Items were considered interview formats have been developed, one based Response rate was 68.55%. Respondents preferred adequate with >79%, questionable with 70-78% on a theoretical framework (Michie et al. 2005) to a care-plan that is manageable, affordable, evi- and unacceptable with <69% agreement. The evaluate such use of theory. dence-based practice and involves quickly obtain- review was followed by a panel discussion where Results: It is intended to present the results of able equipment. The findings provide a simpli- the experts examined the instrument item by item the thirty five interviews completed. A thematic fied model of the choice process in this clinical and discussed the suitability of the FCKT. analysis is underway and a range of barriers and situation. Results: Of the FCKT’s 61 items, the experts rated levers to hand hygiene practice are emerging. Discussion: The discrete choice modelling 58 as clear and 57 as important. All items were The theory based interview schedule is generat- technique reveals key factors in decision making rated as concrete and relevant. Questionable ing a wider range of responses and has identified and the method can form a useful tool to increas- items (n=7) were re-worded. The panel discussion barriers and levers not previously reported. ing our understanding of reasoning and aspects of decided to limit the amount of the items in every Discussion and conclusions: The next phase of the nursing decisions. subscale to 11, therefore 6 items were eliminated study is to link this comprehensive list of barriers Conclusions: It has been a challenging exercise from the FCKT after careful consideration. and levers to the theoretical framework using a to examine the preferences of District Nurses Discussion: The expert panel verified the content consensus survey. This will inform the construction using this technique. The reasons underlying validity of FCKT, it revealed questionable and unac- of a Likert style questionnaire. the empirical results of this small scale study are ceptable items. Experts who were selected in this explored. From a policy perspective, priority should Recommended reading: panel had wide experience on clinical and home be given to the community staff increase, provision care area. The amount of experts was 9 which is Michie, S., Johnsoton M., Abraham, C., Lawton, R., of financial support for patients, and the design considered sufficient. Parker, D. & Walker, A. (2005) Making Psychologi- of initiatives encouraging the lay-carers for taking Conclusions: Expert panel is reliable and simple cal Theory Useful for Implementing Evidence Based part in care-plan implementation (WAG 2003, method of demonstrating an instrument’s content Practice: A consensus Approach. Quality and Safety 2005, 2007). validity. in Health Care, 14, 26-33 Recommended reading: National Audit Ofiice (2004) Improving Patient Care by Reducing the Risk of Hospital Acquired Infection: Welsh Assembly Government (2007) Community A Progress Report: Report by the Comptroller and Services Framework WAG Cardiff Auditor General. The Stationery Office Welsh Assembly Government (2005) Designed for Pittet, D. & Donaldson, L. (2005) Clean Care is Safer Life: Creating World Class Health and Social Care Care: The First Global Challenge of the WHO World for Wales in the 21st Century. WAG Cardiff Alliance for Patient Safety. Infection Control and Welsh Assembly Government (2003) Strategy for Hospital Epidemiology, 26, 891-894. Older People in Wales WAG Cardiff

21 Posters

Theme: Education / learning 39 40 38 A collaborative approach to Pathway to the future: The Preceptor preparation programmes: developing ‘learning synergy’ in professional doctorate in health Do they achieve their learning primary health care research (DHRes) outcomes? An Irish perspective Cathy Taylor, School of Health Science, Swansea Sarah Russell, Education and Research, Hospice of University, Swansea, UK St Francis, Berkhamsted, Herts, Berkhamsted, UK Mary Brosnan, Department of Nursing and Health Co-authors: Cocilia Ajuo; Sally Boyle; April Brown; Care Studies, Institute of Technology Tralee, Co. [email protected] Michelle Bull; Lorraine Murray; Alison Pointu; Lisa Kerry, Ireland Whiting Co-authors: C Heffernan, E Heffernan Abstract: [email protected] [email protected] Background: Supporting and enhancing clinical learning for pre registration nursing students Abstract: Abstract: continues to be a challenge for nurse educators. Background: The University of Hertfordshire’s pro- Background and context: The allocation of student The drive of recent and contemporary nurse fessional doctorate in health research (DHRes) is nurses to the clinical placement area is an integral education policy in the UK (U.K) has re-emphasised a 6 year part time programme of doctoral health component of the curriculum for the undergraduate the need for nurse educators to be instrumental in research training and development. This type of Bachelor of Science Degree (BSc.) in Nursing. Each the support and development of clinical learning learning promotes research which is grounded in student should be assigned a named preceptor (UKCC 1999, DOH 1999, NMC 2002). practice, compliant with research law and ethics, while on placement. A preceptor is a registered Aims: This poster will present a preliminary study autonomous and able to contribute to health nurse who has been prepared for their role by of an action research project, identifying how nurse research and practice agendas (1). The importance completing a Teaching, Assessing/ Preceptor- educators can facilitate new ways of learning in of integrating clinical and academic careers to ship programme. Preceptorship programmes are practice. ensure the translation of research and interven- locally designed to achieve seven nationally agreed Methods: A first person inquiry approach is tions into practice is well recognised (2, 3). learning outcomes (National Implementation adopted, supplemented by qualitative approaches, Aims: To describe the experience of the benefits Committee 2002). Preceptor preparation is costly reflecting the journey of the author in relation to and challenges of this type of doctoral research for service providers. To date, in Ireland no studies her role as nurse educator in practice. have explored the effectiveness of this preparation. programme Results: Students’ and mentors’ experiences and Methods: The benefits, challenges and experi- Aims: This study evaluates the perceptions of Irish stories, were appraised using qualitative and self- ences of a DHRes cohort of 8 multi professional preceptors of preceptor preparation. reflexive techniques. The role of the nurse educator staff is described using data from the first four Methodology: A formative utilisation focussed in clinical practice is demonstrated, as is the years – including action learning sets, peer discus- evaluation approach was adopted. A sequential tri- importance of successful collaboration between sion and research diary reflections in relation to the angulation approach was implemented: educators and practitioners. content, structure and process of the programme. • Phase 1: o (a) documentary analysis o (b) focus Conclusions: This initial inquiry has achieved Results: Benefits to date include group interviews its aim as regards to its original investigation – 1) self (cohort learning, exposure to different • Phase 2: questionnaire formulation, distribution questioning whether nurse educators can make learning styles and disciplines, self worth, reflexiv- and analysis. a difference to both students and mentors in clinical practice placements. The benefits of action ity) Sample: research lie in its ability to continue to activate 2) structure (yearly goals, exposure to wide variety • Phase 1: o (a) Programme evaluation forms change, allowing the progressive cycle of feedback of research methodologies, inquiry based and (520) over a three year period o (b) Convenience to further influence both practice and educational blended learning approaches, access to expert sample (n = 12) development. topic or methodology supervision team) • Phase 2: o A total of 568 questionnaires. Analysis: Recommended reading: 3) professional role (impact on clinical and strategic roles, career pathways, ongoing publications and Phase 1: Thematic analysis Phase 2: Descriptive UK Central Council for Nursing, Midwifery and direct translation to clinical care of research devel- analysis Summary of Findings: Health Visiting (UKCC), 1999. Fitness for Practice. opment (topic and methodologies) The study identified that the local preceptors (The Peach Report) UKCC London Challenges include were aged between 46 – 55 yrs. With the majority Department of Health, 1999. Making a Difference. (95.1%) being female. There was clear consensus Strengthening the Nursing, Midwifery and Health 1) Time management as a clinician/researcher that the programme is achieving the nationally Visiting Contribution to Health and Healthcare, 2) Support and expectations in the work place and agreed outcomes. However, the majority of precep- DOH, HMSO at home tors (94.3%) agreed that a periodic update was required. This study also identified that despite the Nursing and Midwifery Council, 2002. Standards 3) Being the first cohort for the Preparation of Teachers of Nursing and fact that at the end of the programme 95.5% of pre- 4) Continuing to combine researcher practitioner Midwifery. NMC London ceptors understood their role, 22.8% had not acted role in the future as preceptors and 33.7% had not assessed. Conclusions: The DHRes cohort programme Conclusions: While generalising the findings is not provides a systematic and independent approach the purpose of this study it is envisaged that the to doctoral research facilitating the translation of findings will provide a new insight from the- per research findings, activity and outcomes into the spectives of Preceptorship programme delivery and clinical setting that is necessary for the advanced preceptor selection. health care practitioner of the future. It requires personal, professional, academic, emotional Recommended reading: and practical commitment (including that of the National Implementation Committee (2002) Pre- employing organisation) and resilience like other registration Nursing Education Degree Programme. PhD pathways. Newsletter, Issue (4), Dublin: Stewarts Hospital.

22 Posters

Recommended reading: this cohort of qualified nurses view mentorship Discussion and conclusions: This study suggests Centre for Research into Primary and Community as important to their learning indicating that more three areas of implementation: to promote the Care (CRIPACC) (Sept 2008) Professional Doctorate larger scale studies are needed in this area of nurse students understanding (using examples, stand- in Health Research (DHres), University of Hertford- education. ardizing the language and checking the compre- hension), to focus feedback to communication and shire Recommended reading: self-learning skills and to create a educative setting Dept of Health (June 2008:18) A High Quality Andrews, M. & Chilton, F. (2000) ‘Student and that help students to perceive to be in a formative Workforce NHS Next Stage Review (Darzi) Mentor Perceptions of Mentoring Effectiveness’ contest that promote learning and confidence not UK Clinical Research Collaboration (2007) Devel- Nurse Education Today, Vol. 20, pp. 555-562 only evaluation. oping the Best Research Professionals. Qualified Dorsey, L.E.& Baker, C.M. (2004) ‘Mentoring Under- Recommended reading: Gradate Nurses: Recommendations for Preparing graduate Nursing Students: Assessing the State of and Supporting Clinical Academic Nurses> Report the Science’, Nurse Educator, Vol. 29, no.6, pp.260- Boehler M.L., Rogers D.A., Schwind C.J., Mayforth of the UKCRC Subcommittee for Nurses in Clinical 265 R., Quin J., Williams R.G., Dunnington G. (2006). Research An Investigation of Medical Student Reactions to Nursing and Midwifery Council (July 2008) Feedback: A Randomised Controlled Trial. Medical Standards to Support Learning and Assessment Education, 40, 746-749 41 in Practice. NMC Standards for Mentors, Practice Teachers and Teachers [online]. NMC: London. Ende J. (1983). Feedback in Clinical Medical Postregistration nursing students’ Available from: http://www.nmc-uk.org [Accessed Education. JAMA, 250, 777-781 attitudes towards mentorship 1st August 2008]. Glover P.A. (2000). Feedback: I Listened, Reflected Bridget St George, Nursing, Midwifery and Allied and Utilized’: Third Year Nursing Students’ Percep- Health Professions Research Unit, Glasgow tions and Use of Feedback in the Clinical Setting. Caledonian University, Glasgow, UK 42 International Journal of Nursing Practice, 6, [email protected] Feedback in clinical education: 247-252. Tutors’ use and students’ Abstract: perceptions 43 Background: The subject of mentorship though Letizia Prosperi, Nursing, School of Health Preceptor characteristics: A much discussed within the nursing literature, Education, University of Verona, Nursing Faculty, mostly concentrates upon the needs of preregistra- Department of Trento, Italy, Trento, Italy comparison of preceptor and tion nursing students (Andrews and Chilton 2000, Co-author: Anna Brugnolli student perceptions Dorsey and Baker 2004). The advancement over [email protected] Mary Brosnan, Department of Nursing and Health recent years in the extended role of the nurse has Care Studies, Institute of Technology Tralee, Co. prompted the Nursing and Midwifery Council to Kerry, Ireland Abstract: stipulate that postregistration modules leading to Co authors: Heffernan, C;Heffernan, E a recordable qualification provide nursing students Background: Feedback is central in clinical nursing [email protected] with mentorship (NMC 2008). The author has education in promoting learning, confidence and sought to conceptualise a model of mentorship ensuring that clinical skills are met (Boehler et for postregistration nurse education in order to al., 2006; Ende, 1983; Glover, 2000). There is little Abstract: develop and test a research tool that can measure information about the nature of feedback provided Background and context: The allocation of postregistration nursing students’ attitudes to nursing students in their clinical practice. student nurses to the clinical placement area is a towards mentorship within the practice setting. Aims: To describe tutors’ use of feedback in the component of the curriculum for the undergraduate Aims: The aim of this pilot study was to develop and clinical setting and students’ perceptions. Bachelor of Science Degree (BSc.) in Nursing. Each student while on placement is assigned a named test a questionnaire that examines the attitudes Methods: A descriptive design was employed to preceptor. A preceptor is a registered nurse who of postregistration nursing students towards conduct this study. In 2008, a convenience sample has been prepared for their role by completing a mentorship within the practice setting in order to was recruited which consisted of 8 tutors and 31 Teaching, Assessing/ Preceptorship programme determine whether they view it as important to third-year nursing students randomly selected. 27 (ABA, 2003). their learning structured observations were conducted during Methods: The study is of quantitative, non – clinical practice to describe types and elements of Aims: This study explores preceptor characteristics experimental design. Firstly an in-depth literature feedback; 4 focus group interviews were conducted through a structured comparison of responses from review was conducted and 6 constructs pertain- to analyse the students’ perceptions. A content key stakeholders – preceptors and student nurses. ing to mentorship, namely support and guidance, analysis technique was used to analyse data. Methodology / Sample: A formative utilisation teaching and learning, role modelling, feedback, Results: The analyses showed that the types more focussed evaluation approach was adopted. A assessment and socialisation were identified. The provided were negative and ‘sandwich’ feedback. sequential triangulation approach: generation of items from these constructs were The feedback were oriented: on behaviour or skills, • Phase 1: o (a) documentary analysis developed and refined with the advice of 5 experts with suggestions for improvement, to guarantee -Programme evaluation forms (520) over a three and resulted in a short, structured self-completion an active part of the students. The elements less year period o (b) focus group interviews questionnaire using Likert attitude scaling. Data present were: real examples and the check of -Convenience sample (12 preceptors and 12 student were collected from a group of 20 postregistration student understanding. Mainly feedback was nurses) nursing students undergoing mentorship within focused on technical and cognitive skills, less on practice whilst undertaking the ‘Principles of high communication skills and on self-learning skills. • Phase 2: questionnaire formulation, distribution dependency nursing’ module. The students perceived feedback useful to guide and analysis. Findings: The questionnaire demonstrated good and focus their clinical learning, but sometimes they – Total population of 568 preceptors and 310 reliability although the constructs of socialisa- felt it difficult to understand. Some other students nursing students. tion and assessment require further research and declared difficulty to ask and accept the feedback possibly additional qualitative data to enrich the because they feel it like a definitive evaluation. Analysis: results. Overall the preliminary results show that They would like to receive more positive feedback. Phase 1: Thematic analysis

23 Posters

Phase 2: Descriptive analysis RCN (n=203). A reminder email was sent to non- strong correlation was found between patient satis- Results: The characteristics of a preceptor from respondents 3 weeks after the first communication. faction (PS) and patient perceived caring behaviour the perspective of key stakeholder groups were The survey was conducted between September – (PPCB) but not between carer satisfaction (CS) and explored. Four themes were identified October 2008 and a 75% response was achieved. carer perceived caring behaviour (CPCB). There Responses were benchmarked against the two were statistical significant differences in the BWP • The importance of preceptor characteristics previous surveys and geographical distribution group between pre and post training in terms of PS • The demonstration of preceptor characteristics and migration charted. Funding arrangements were (p<=0.05) but no statistical significant difference • The specific knowledge demonstrated by precep- analysed as a proxy indicator of the development of in PPCB, CS nor CPCB nor in the control group. A tors clinical-academic leadership positions. clinical significant difference is defined as a differ- ence of 5 or more points. Clinically significant dif- • Specific skills demonstrated by preceptors This poster will provide a comparative longitudinal analysis of the numbers of Professors of nursing and ferences between pre and post training were noted Differences were noted between the perceptions midwifery identified in 2008 against those identi- in the BWP group in PS ( 5 points) and PPCB ( 5 of preceptors and students re important preceptor fied in 2005 and 2003. It will discuss these findings points) but not in CS (-1 point) nor CPCB ( 2 points). characteristics and their demonstration of these within the context of recent research policy ini- No clinically significant differences were observed within the preceptor – student relationship. tiatives to develop research capability, implement in the control group. Conclusions: An understanding of what student clinical academic career pathways (UKCRC 2007) Discussion: Majority patients report feeling nurses’ view as important and how this reflects and to assess the quality of research outputs (RAE satisfied with care and report a high level of caring or differs from the perception of the preceptor will 2008) within the nursing and midwifery professions behaviour. Most carers report they provide a high assist in developing preceptorship in the clinical across the UK. In addition, the numbers of nursing level of caring behaviour but report low-moderate learning environment and will help to inform and midwifery chairs and the diversity of this lead- satisfaction. preceptor preparation programmes locally. While ership group will be considered within the wider Conclusions: The BWP programme improved generalising the findings is not the purpose of this context of the nursing and midwifery professions patient satisfaction and perceived caring behaviour study it is envisaged that the findings will provide at large. but did not change carer satisfaction nor carer a new insight from the perspectives of key stake- perceived caring behaviour. holders. Recommended reading: O’Carroll, D., & McMahon, A. (2006), ‘Research Recommended reading: and Development Leadership in Nursing Across the An Bord Altranais (2003) Guidelines on the Key UK: A Biennial Review’, Poster Presentation, RCN Theme: Diabetes Points That May be Considered When Developing Research Conference 2006, York, England a Quality Clinical Learning Environment. Dublin: An 46 UKCRC Subcommittee for Nurses in Clinical Bord Altranais. Research (Workforce) 2007, Developing the Partnering with aboriginal Best Research Professionals. Qualified Graduate communities: Type II diabetes Nurses: Recommendations for Preparing and Sup- prevention in children and youth porting Clinical Academic Nurses of the Future, Theme: Leadership Sheryl Reimer Kirkham, Nursing, Trinity Western UKCRC, London 44 University, Langley, British Columbia, Canada RAE (2008) http://www.rae.ac.uk/ 4.11.2008 Research and development Co-author: Heather Meyerhoff leadership in nursing across the 45 Abstract: UK: A longitudinal study Background: The prevalence of Type 2 Diabetes in Dave O’Carroll, Research & Development Being with patient: Going back to children and youth has been increasing steadily Co-ordinating Centre, Royal College of Nursing, basics – The Newcastle Evaluation Bolton, UK in the last decade (Bloomgarden, 2004). Onset of Debbie Carrick-Sen, Clinical Research Facility, Co-author: Ann McMahon diabetes at a young age and increased years of Royal Victoria Infirmary, Newcastle upon Tyne, UK disease results in earlier manifestation of diabetes dave.o’[email protected] related complications including cardiovascular Abstract: disease, retinopathy, and renal disease. Aboriginal Abstract: populations have an increased burden of disease Background: The Being With Patients (BWP) for both Type 1 and Type 2 diabetes putting abo- The numbers of nurses and midwives holding Pro- concept is a dynamic interactive approach using riginal youth and children at additional risk. The fessorial positions in the UK may serve as a proxy role play to illuminate and improved patient – International Diabetes Federation (2008) has called indictor of the development of nursing research carer interaction and team working. BWP involves for research strategies to address this challenge leadership within the professions, particularly train the trainer sessions and an awareness day including, in part, population-based studies in at when compared with cognate professional groups. for clinical nurses. A small sample multi-method risk populations, innovative approaches to working Consequently, the academic community was evaluation was conducted following the original with children and families, and strategies for pre- surveyed in 2003 and then again in 2005 (O’Carroll, programme (Reid, 2004). Findings reported no dif- vention of Type 2 Diabetes including community D., & McMahon, A., 2006). The 2003 survey ference and recommended further evaluation using participation. provided a baseline assessment against which an increased sample size. progress was measured in 2005. Following a query Aims: In response to this challenge, this three Aims: The aim was to assess patient and carer sat- about the diversity of the Professorial community phase study uses Participatory Action Research isfaction and caring behaviour pre and post BWP within nursing and midwifery in the UK the survey with a First Nation Community in British Columbia programme. was repeated in 2008 and on this occasion, the to explore the issues of Type 2 Diabetes prevention questionnaire was developed to address this Methods: Ten clinical area were selected and for children and youth (Smith, 1999). matched to ten control areas. Patients and carers query. Two new questions on gender and ethnicity Methods: Phase I explored with community completed a self completion validated question- were incorporated within the questionnaire. The members ways to identify and reduce risk factors naire at baseline and post training. questionnaire was sent by email to all nurses and for Diabetes in their young people. Phase II of this midwives known to hold a chair in the UK, whose Results: The response rate was good, 330 (87%) program addressed the strategies identified by details were held on a central database within the eligible patients and 470 (67%) eligible carers. A the community by carrying out a photo voce/video

24 Posters

project with a small group of Youth Ambassadors related QoL with a total score and five subdomains: at least one year previously. To address this with that focused on diabetes prevention, and featured physical function, self-esteem, sexual life, public a mobile, hard to access, often disengaged user voices of various community members. Phase III distress and work. DTSQ and IWQoL-Lite were group we developed a 3-stage recruitment process evaluated the strategies for diabetes prevention administered at baseline and end of trial. with multiple methods. Telephone interviews were and community collaboration. Results: After 26 weeks the perceived frequency conducted, including semi-structured questions. Results, discussion and conclusions: This poster of hyperglycaemia was significantly lower for Interviews were recorded and transcribed, and will outline the three phases of this study, including the highest dose of liraglutide+metformin analysed using thematic analysis. findings, challenges, and implications for future group (mean=-1.6) compared with the Results: Recruitment was arduous, due in part to research. Phase I findings indicated a strong glimepiride+metformin group (mean=-0.8) fragmented services and unwieldy health record community concern for youth health and a desire (p<0.003) and metformin+liraglutide–placebo systems. We recruited and interviewed 26 people for intergenerational community participation in group (mean = – 0.5) (p<0.003). A significant in 6 months. Barriers and constraints to service diabetes prevention. Phase II findings demon- lowering in perceived frequency of hypoglycaemia usage included problems with access around infor- strated the effectiveness of engaging youth in between all liraglutide groups (mean=0.0, – 0.1 mation, eligibility, availability and affordability. the video project. Phase III findings suggest the and 0.0 for 0.6, 1.2 or 1.8 mg/day, respectively) Service characteristics affected user uptake, and potential for community-based action in aboriginal and the glimepiride+metformin group (mean=0.6) regional inequity was keenly felt. Preferences for communities. Challenges related to the method of was observed (p<0.05). Furthermore, a significant modes of service configuration and delivery were PAR are highlighted. reduction in the public distress domain (distress expressed. about weight when in public) scores was observed Recommended reading: Discussion and conclusions: Despite the ‘hard to between the liraglutide groups (mean=-0.3, – 0.8 reach’ nature of this participant group, data were Bloomgarden, Z. (2004). Type 2 Diabetes in the and – 0.6 for 0.6, 1.2 or 1.8 mg/day, respectively) obtained and are informing local service redesign Young: the Evolving Epidemic. Diabetes Care, and the glimepiride+metformin group (mean=0.2) (Phase 2). Subsequently, evaluation of users’ expe- 27(4), 998-1010 (p<0.02). riences, usage and outcomes from the new services The International Diabetes Federation (2008). Discussion: Liraglutide significantly reduced the (Phase 3) will follow. Type 2 Diabetes in Young People: A Serious perceived frequency of hyper – and hypoglycae- Recommended reading: Disease Requiring Improved Understanding and mia, and public distress due to weight. No differ- Care. Available at: http://www.idf.org/home/ ences between the groups in TS and overall weight- Diabetes Australia. 2007. National Review of Tran- index.cfm?unode=146D37ED-00CC-4C80-90BE- related QoL were observed. sitional Care. At http://www.diabetesaustralia. 3093D9335A6C com.au/Resources/Reports/ Conclusions: Liraglutide treatment was associated Smith, L. Tuhiwai (1999). Decolonizing Methodolo- with significant improvements in patient-reported National Diabetes Services Scheme and Diabetes gies: Research and Indigenous Peoples. New York: outcomes among patients with type 2 diabetes. Australia. 2006. Young Adults With Diabetes: University of Otago Press Needs Analysis. At http://www.diabetesaustralia. com.au/Resources/Reports/ 48 Bennett DL, Towns SJ, Steinbeck KS. Smoothing 47 What makes a quality service for the Transition to Adult Care. Medical Journal of Evaluation of patient-reported a ‘hard to access’ group in rural Australia 2005:182:8:373-4 outcomes in patients with type 2 locations? Users’ views of services diabetes treated with the once-daily for young people with Type 1 human GLP-1 analogue liraglutide diabetes in rural New South Wales Theme: Assessment or glimepiride, both as add-on to Lin Perry, Newcastle Institute of Public Health, 49 metformin University of Newcastle, NSW, Newcastle, Australia Psychometric properties of Alison Iredale, Medical Affairs, Novo Nordisk, Co-authors: Julia Lowe; Kate Steinbeck; Janet the Care Dependency Scale for Crawley, UK Dunbabin Rehabilitation (CDS-R) Juliane Eichhorn-Kissel, Department of Nursing Abstract: Abstract: Science, Medical University Graz, Graz, Austria Background: Patient-reported outcome measures, Background: Young people with Type 1 diabetes Co-author: Christa Lohrmann such as weight-related quality of life (QoL), (T1DM) are the largest group with chronic disease [email protected] treatment satisfaction (TS), and perceived transitioning from paediatric to adult services [1]. frequency of hyper – and hypoglycaemia, can be This period presents many challenges to metabolic Abstract: used alongside clinical efficacy endpoints to assess stability, from rapid physiological and psycho- the impact of treatment on outcomes important to social changes. Service disengagement and poor Background: The condition for successful and patients with type 2 diabetes. outcomes have been reported [1-3], yet this period effective rehabilitation lies in adequate medical is critical for establishment of patterns of adult self- treatment and patient-centred comprehensive Aims: In a 26-week, double-blind, placebo-control- management. Healthcare professionals appear to nursing care. Reducing dependency and sup- led trial, patient-reported outcomes were measured encounter particular difficulties meeting these porting independency is of vital importance in as a substudy using the Diabetes Treatment Satis- service users’ needs. this context. Assessment instruments can help to faction Questionnaire (DTSQ) and Impact of Weight evaluate a person’s (in)dependency, thus building on Quality of Life (IWQoL-Lite). Aims: This paper reports the qualitative component of Phase 1 of a service development and evaluation the basis for individual care planning. Psychometri- Methods: The trial investigated three doses study, which aimed to explore perceptions and cally tested instruments for the assessment of of liraglutide (0.6, 1.2 or 1.8 mg/day) added to experiences of diabetes services for young people care (in)dependency are rare in rehabilitation. An metformin compared with metformin+liraglutide– with T1DM in rural locations. adequate instrument might be the Care Depend- placebo or metformin+glimepiride. DTSQ is a ency Scale (Dijkstra et al. 1996), which measures Methods: Key stakeholders of 4 rural NSW services validated measure assessing TS and perceived care (in)dependency regarding various physical are engaged with the project. We planned to frequency of hyper – and hypoglycaemia. IWQoL- and psychosocial aspects. It is used in various recruit and telephone interview 70 people aged Lite is a validated measure assessing weight- European countries and several settings, except 18-28 years who left paediatric diabetes services

25 Posters

rehabilitation. Therefore it is a logical consequence tioner interface. The tool is capable of systemati- Methods: A mixed method approach comprised to test the CDS for rehabilitation. cally capturing information about how LBP affects of three stages was undertaken with a sample of Aims: The study aims at determining the psycho- each individual using valid and reliable instruments nurses working in a day hospital setting (n=11). metric properties of the modified CDS-R. such as health-related quality of life, back-specific This included: observing and recording the nurse- function, work disability, fear-avoidance and pain. patient interaction at the time of the patient’s Methods: A psychometric study was performed in It is capable of capturing robust evidence of the first chemotherapy session; analysing the nurse an Austrian rehabilitation centre over a period of 6 effectiveness of various treatment regimes, thereby critique and self-appraisal on the interaction; and months. A convenience-sample was recruited and informing the clinical decision-making process, undertaking face to face interviews with the nurses data from 1197 informed patients were collected and also incorporates a feedback loop from which to investigate factors that help or hinder nurse- by specially trained nursing staff. Patients were patients and clinicians receive consistent and up- patient communication interaction. A nurse com- assessed twice using the CDS-R and the Barthel- to-date advice on how best to manage LBP. munication schedule modified from the Calgary- Index. The ethical approval for this procedure was Cambridge Guide to the Medical Interview was obtained. Data were analysed by using SPSS 16.0. Results and discussion: The user-acceptability used throughout all the stages of the study. All the To estimate aspects of reliability, Chronbach’s- of both interfaces has largely been supported interviews were transcribed verbatim and content Alpha, Cohens’-Kappa and Percentage-agreement by a sample of volunteer patients and clinicians analysed with the aid of this framework. were calculated. To evaluate the construct-validity, (n=25). This tool has the potential to create and a Factor-analysis was conducted. Criterion-related- utilise an evidence base to inform the clinical Findings: The nursing assessment of these patients validity was examined by comparing data of the assessment and management of individuals expe- tended to focus giving information giving, with a CDS-R with the Barthel-Index and Pearson-calcu- riencing LBP. Further pilot testing will consider the particular focus on physical aspects of treatment, lation. tool’s potential as a teaching resource for clinical often to the detriment of listening and gathering educators. information from the patients. Environmental and Results: The calculation of Chronbach’s-Alpha organisational issues were identified as barriers to showed values of 0.97. Kappa-values were between Recommended reading: communication, whilst enabling factors included 0.89 and 0.96, values of Percentage-agreement Resnik L, Dobrzykowski E. Guide to Outcomes the nurses’ ability to develop a rapport and rela- between 96% and 99% and Pearson r = 0.88. Dis- Measurement for Patients with Low Back Pain tionship with the patient. cussion The results present a high level of homoge- Syndromes. Journal of Orthopaedic and Sports Conclusions: Holistic assessment of patients in neity, interrater-agreement and an almost perfect Physical Therapy 2003 33: 307-316 interrater-reliability. Furthermore, strong correla- ambulatory settings is crucial and improved com- Liddle SD, Gracey JH, Baxter GD. Advice for the tion with an external criterion was demonstrated. munication could assist this. This communication Management of Low Back Pain: A Systematic needs to be balanced between information giving Conclusions: The analyses of the psychometric Review of Randomised Controlled Trials. Manual and information gathering; between the physical properties show satisfying results regarding reli- Therapy 2007; 12: 310-327 and psychosocial aspects of care and between ability and validity, wherefore the CDS-R can be rec- Liddle SD, Baxter GD, Gracey JH. Physiotherapists’ nurse-centred demands and patient centred ommended for application in rehabilitation. Use of Advice and Exercise for the Management of concerns Recommended reading: Chronic Low Back Pain: A National Survey. Manual Recommended reading: Dijkstra, A., Buist, G. & Dassen, T. (1996) Nursing- Therapy: In Press. Botti, M., Watts, R., Cairns, J., Lewis, K. & Kenny, A. care Dependency. Development of an Assessment (2006) Barriers in Providing Psychosocial Support Scale for Demented and Mentally Handicapped for Patients with Cancer. Cancer Nursing, 29(4), Patients. Scand J Caring Sci, 10(3), 137-43. Theme: Communication / staff 309-315 experiences Cohen, M. Z. & Sarter, B. (1992). ‘Love and Work: 50 Oncology Nurses’ View of the Meaning of Their 51 User acceptability of an integrated Work.’ Oncology Nursing Forum, 19(10): 1481-1486 Nurse-patient communication in Kruijver, I., P., Kerkstra, A., Bensing, J., M. & van de low back pain assessment tool the cancer treatment setting: A Wiel, H. B. (2000) Nurse-Patient Communication Sarah Liddle, Faculty of Life and Health Sciences, in Cancer Care: A Review of the Literature. Cancer University of Ulster, Newtownabbey, UK qualitative pilot study Nursing 23(1), 20-31. Co-authors: Marlene Sinclair; Peter Nicholl; Harry Sonja Mcilfatrick, Nursing, University of Ulster, Brown; Jonathan Wallace Newtownabbey, Ireland [email protected] Co-authors: Hazlett, Diane; Jess, Claire [email protected]

Abstract: Abstract: Background: The multidimensional nature of low back pain (LBP) makes it difficult to develop a An exploration of the complex processes and treatment approach that will meet the needs of dimensions of communication between the nurse everyone. To compare the effectiveness of current and cancer patients receiving chemotherapy in a treatments, and make recommendations for future day hospital setting in Northern Ireland. practice requires a consistent approach to outcome Background: Good communication in cancer care is assessment (1), a feature currently lacking in this considered as fundamental to the provision of high area (2, 3). quality care. Objective: To practically address this issue a team 1. However the health professional-patient inter- of researchers from the University of Ulster have action is a complex phenomenon, influenced by developed an interactive electronic LBP data repos- training, skills, attitudes and beliefs of health pro- itory. fessionals alongside the health care environment Methods: The ‘Integrated LBP Assessment Tool’ is 2. Working in cancer care can be demanding for a secure website with two sides, a data collection nurses both in terms of being highly technical interface for patient self-assessment, and a practi- alongside emotional and personal demands

26 Posters

52 53 54 Health experiences of Scottish The patient experience of Older people’s experiences of gypsies/travellers intermittent self-catherisation changed medication appearance Catherine Burton, School of Nursing and Karen Logan, Continence service, Gwent Tracey Williamson, Salford Centre for Nursing, Midwifery, University of Dundee, Dundee, UK Healthcare NHS Trust, Abergavenny, UK Midwifery and Collaborative Research, University [email protected] Co-authors: Chris Shaw; Irene Webber; Sandra of Salford, Greater Manchester, UK Samuels, Lynn Broome, Co-authors: Leah Greene; Arvin Prashar; Ellen [email protected] Schafheutle Abstract: Aims: The aim of this presentation is to report the findings from a study which explored how the wider Abstract: Abstract: determinants of health (Dahlgren and Whitehead Background: Bladder morbidity requiring inter- Background: ‘Generic prescribing’ and ‘parallel 1998) impact upon the health experience of mittent self-catheterisation (ISC) as a treatment import’ pharmacy practices mean that many older Scottish Gypsies/Travellers, in one Local Authority to facilitate bladder emptying imposes a variety people are issued the same tablet medication area. The research findings will subsequently of challenges to patients, both physical and but in different colours, sizes and shapes to their inform the development of local service provision. emotional. Safety, infection rates, and complica- previous prescriptions as a cost saving measure. Background: Central to Scottish health policy is tions of ISC have been investigated but few studies Aims: To elicit older people’s experiences of medi- a drive to address the issues of health inequali- address the practicalities of learning and perform- cation that changed appearance due to ‘generic ties in deprived and disadvantaged communities ing ISC, or of exploring the meaning and impact on prescribing’ and ‘parallel import’ practices and its (Scottish Government (2007). However recent patient’s quality of life . A qualitative study looking impact on their medication taking practices at ISC through the eyes of the patient is important health policy does not address the specific health Methods: An eight-item questionnaire was in order to provide data of the patient’s experiences needs of Gypsies/Travellers. There is an implication developed and distributed to 2000 older people of learning and adjusting to this treatment. that the wider determinants of health adversely (50 years+) across participating PCTs in Greater impact upon the health of Gypsies/Travellers (Parry Aims: The aim of the study is to describe partici- Manchester in 2008. A 29% response rate was et al 2007). There have been no studies which pants’ perceptions of learning to carry out ISC and achieved. The data was analysed using the SPSS have explored the health experiences of Scottish their interactions with service providers, in order statistical package. Gypsies/Travellers. to inform health care professionals to provide Findings: 63.3% experienced a change in the optimum patient-centred care. Methods: An explorative qualitative design was appearance of their tablet medications. • 74.1% adopted. In-depth interviews were conducted with Methods: Qualitative methods were used to assess did not seek advice regarding the change in the eight Gypsies/Travellers from a local authority site patients’ views. In-depth interviews were carried appearance of their tablet medications in 2004. Verbatim transcripts of the interviews were out with 15 respondents: 8 male,7 female, aged Older people noted changes to the actual tablets, analysed using content analysis, which generated between 33-81 yrs (mean age 44yrs), and carrying tablet packaging and written information that four overarching themes. out ISC for a variety of reasons. Grounded Theory accompany tablets. Changes are occurring mostly framework was used and data analysed using Findings: The wider determinants of health do to the colour, size and shape of tablets more than NUD*ist. The data was collected in Wales in 2006. impact upon the health experience of Gypsies/ packaging and written information. The majority Travellers, in particular; cultural, environmental, Findings: Emergent themes revealed common of respondents had experienced changes in the education and access issues. Inextricably linked features across this heterogeneous group. Learning appearance of their prescribed tablet medication to each of these factors is the Gypsies/Travel- ISC is daunting and can have both positive and in the previous two years which were not due to lers experience of racism and discrimination. No negative impacts on quality of life but eventually it is change in medication or dose. For some respond- barriers to accessing Primary Care services were normalised accepted by participants. The interper- ents, these changes prompted negative experi- identified but concern was expressed with the sonal skills of doctors and nurses had a profound ences such as anxiety, confusion and upset. A small provision of Dental Practitioner services. effect on service satisfaction. Experience of the number omitted the affected tablet medications Conclusions: The local policy response will need teaching nurses made learning and adjusting to ISC and did not seek help or advice from GPs, pharma- to take cognisance of these findings and recognise easier and alleviated patient’s embarrassment and cists or relatives. initial anxiety, facilitating information exchange. the inter-relationship between each of the themes. Discussion and conclusions: The findings suggest Improving the health of Gypsies/Travellers is an Conclusions: Adequate information about ISC from older people’s health may be at risk due to frequent issue for all public policies and must be addressed doctors and thorough instruction from experienced changes in medication appearance as a cost-saving across all statutory agencies, not just the NHS. The nurses helps empower patients to take control and measure. The findings from the survey are to be need for multi-agency collaboration to tackle these master the treatment, contributing to ongoing com- presented. Nurses and others have a role to play wider determinants of Gypsies/Travellers health is pliance. Development of a clinical policy support- in promoting better medicines management and recognised. ing evidence based care and a consistent teaching this presentation will contribute evidence to inform programme is highly recommended for use where their knowledge and practice with this regard. Recommended reading: this treatment is regularly employed. Dahlgren G and Whitehead M (1998) Health Ine- Recommended reading: Recommended reading: qualities. London: HMSO Teeling, M and Feely, J (2005) Adverse Drug Parry G, et al (2007) Health Status of Gypsies and Pilloni S, Krhut J Mair D Madersbacher H Kessler Reactions: Reducing the Risk in Older People. Pre- Travellers in England. Journal of Epidemiology and T (2005) Intermittent Catheterisation in Older scriber, 16, 12-19 People: A Valuable Alternative to an Indwelling Community Health. 61:198-204 Overgaard, ABA; Møller-Sonnergaard, J; Christrup, Catheter? Age and Aging 34 (1) 57 – 60 Scottish Government (2007) Better Health, Better LL; Højsted, J; and Hansen, R (2001) Patients’ Eval- Care. Edinburgh: Scottish Government Robinson J (2006) Intermittent Self-catheterisa- uation of Shape, Size and Colour of Solid Dosage tion: Principles and Practice. British Journal of Forms. Pharmacy World and Science, 23, 185-188 Community Nursing 11 4 144-152 Kippen, S (2005) As Time Goes By: Issues For older Naish W (2003) Intermittent Self-catheterisation People with Their Medication Use. Australasian for Managing Urinary Problems Professional Nurse Journal on Ageing, 24, 103-107 18 (10) 534-537

27 Posters

Theme: International 56 57 55 Benefit-finding among people with Examining disaster nursing The use of nutrient supplements of mental illness in Japan education programs for nurse Chinese women in Northern Ireland Rie Chiba, Psychiatric Nursing, Graduate School of administrators Medicine, The University of Tokyo, Tokyo, Japan Fenglin Guo, School of Applied Social Sciences, De Yoshie Takatani, College of Nursing Art & Science, Co-authors: Yuki Miyamoto; Norito Kawakami Montfort University, Leicester, UK University of Hyogo, Akashi, Hyogo, Japan [email protected] Co-author: Marion Wright Abstract: Abstract: Abstract: Background: Given that large-scale natural Background: The realization of positive life influ- Objectives: To investigate the use of nutrient disasters occur frequently all over the world, ences resulting from experiences of chronic illness supplements of Chinese woman (18-59yrs) who effective action by nurse administrators during or traumatic events has been conceptualised as currently live in Northern Ireland (NI), and to disasters greatly affects victims’ health and their ‘benefit-finding’. Previous study has suggested suggest appropriate and culturally sensitive dietary lives in the aftermath. that an understanding of benefit-finding is signifi- information for Chinese women living in the UK. Focusing on nurse directors’ compe- cant in the provision of health care, such as nursing. Objectives: Methods: Questionnaire based cross-sectional tencies during disasters, this study explores nurse This study aims to explore the dimensions of study, including demographic measures, open- Aims: directors’ disaster experiences, and examines benefit-finding among people with mental illness ended questions and a 24-hour dietary record. effective disaster nursing education programs that in Japan. Questionnaires were handed out to one hundred nurse administrators can utilize for disasters. and forty non-pregnant Chinese women aged 18-59 Methods: A cross-sectional questionnaire survey Methods: The study subjects were nine nurse between 2003 and 2004 in Northern Ireland, and was conducted of people with mental illness at directors and one acting nurse director who had fifty questionnaires were returned. selected hospital inpatient units and community experienced natural disasters during their tenure. facilities in Japan from June to September 2008. Results: Nutrient intakes of these women were Based on interviews that inquired about nurse The aims and procedures of the study were analysed from their dietary intakes, excluding directors’ competencies required during a disaster, explained to all who met the inclusion criteria, and nutrient supplements. Intakes of energy, a qualitative analysis was conducted. In addition, the survey was conducted to whom an informed potassium, calcium, magnesium, iron, copper, I performed a qualitative analysis on the basis consent was obtained. A total of 193 out of 227 selenium, iodine and folate were less than of interviews with 5 subjects about the real chal- participants responded to an open-ended benefit- Reference Nutrient Intakes (RNI). By comparison, lenges faced by nurse directors at times of disaster. finding question, and valid data were analysed mean nutrient intakes by those women who took The following competencies for nurse through content analyses. Results: nutrient supplements were apparently better than directors were identified: (1) analysis of circum- those who did not take nutrient supplements. Results: Almost half of the respondents reported stances and judgment skills; (2) integrating About 1/4 of participants took nutrition supple- at least one benefit-finding feature. Benefit-finding knowledge comprehensively and swiftly moving ments. Those supplements were multivitamins, themes derived from content analyses were as to action based on optimal decision making; and vitamin B6, evening primrose oil, calcium tablets, follows: growth in relationship, personal growth, (3) imagination. Furthermore, the nurse directors cod liver oil, ‘Korea shen’ (ginseng), and ‘E jiao’ appreciation of life, increased knowledge of mental pointed out the following as challenges which have (donkey skin). illness, health behavioral changes, new possi- been encountered at times of disaster: ‘inability to bilities and goal-related changes, and religious Conclusions: Regular fortified food intakes and come to a decision about the transfer of patients’, growth. On the other hand, 76 (39%) respondents micronutrient supplement intakes are recom- ‘information necessary when transferring patients reported that they never experienced any benefit- mended. They would be particularly beneficial for is scattered,’ and ‘the application of the knowledge finding or they were not sure what it was. women of reproductive age and during pregnancy, and experience of disaster nurses is difficult’. and during times of particular pressures (for Discussion and conclusions: The results of this Giving consideration to these competencies, I example, exams, when people are too busy to pay study demonstrated that many people with mental examined disaster nursing education programs attention to their nutrition intake), or when food illness had a benefit-finding experience and the utilized for the nurse directors. preference and food choices became a problem. features were rather common as observed in Discussion: Clarifying and analyzing effective admin- previous studies of people with chronic physical Recommended reading: istration competencies enabled us to build a foun- conditions or traumatic experiences in the United dation for educational programs. The study results Department of Health (1991) Dietary Reference States and other countries. The nature and dimen- may provide useful insights into facilitating disaster Values for Food Energy and Nutrients for the UK. sions of benefit-finding may be similar among nursing education programs around the world. Report of the Panel on Dietary Reference Values of people with different health problems living in the Committee on Medical Aspects of Food Policy. different cultures. Report on Health and Social Subjects No. 41. Lon 58 Recommended reading: Tennen, H., & Affleck, G. 2005, ‘Benefit-finding and The role of the hospital nurse in Benefit-reminding’ in Handbook of Positive Psy- health promotion in Saudi Arabia chology, ed. C. R. Snyder, & S. J. Lopez, Oxford Uni- Ameera Aldossary, Florence Nightingale School versity Press, Oxford of Nursing and Midwifery, Kings College London, Siegel, K. & Schrimshaw, E. W. 2000, ‘Perceiving London, UK Benefits in Adversity: Stress-Related Growth in Co-authors: Alison While; Louise Barriball Women Living with HIV/AIDS’, Social Science & [email protected] Medicine, vol. 51, no. 10, pp. 1543-1554 Wright, M. O., Crawford, E. & Sebastian, K. 2007, Abstract: ‘Positive Resolution of Childhood Sexual Abuse Background: The global increase of preventable Experiences: The Role of Coping, Benefit-finding chronic illness and obesity has highlighted the and Meaning-making’, Journal of Family Violence, importance of health promotion. Within Saudi vol. 22, no. 7, pp. 597-608. Arabia there is no clear scope of practice for nurses

28 Posters

and their role in health promotion is unknown. Al- 59 60 Kandari et al (2008) has noted the need to clarify the role of nurses in disease prevention and health Evaluation of the current state of Italian student nurses’ perception promotion including healthy life styles within Japanese nursing research on sleep of the clinical learning environment nursing curricula in Kuwait. intervention and issues in sleep measured with the CLEI tool Aims: The study aimed to describe the role of assessment Serena Perli, Nursing, School of Health Education, nurses in health promotion from the perspective Keiko Tanida, College of Nursing Art & Science, University of Verona, Nursing Faculty, Department of registered nurses, doctors and patients within University of Hyogo, Akashi, Hyogo, Japan of Trento, Italy, Trento, Italy Co-author: Anna Brugnolli hospital settings in Saudi Arabia. Co-author: Yukari Kimura Methods: A cross-sectional survey of nurses, [email protected] doctors and patients in Saudi Arabia was utilized. Abstract: The self-report questionnaire comprised: the Abstract: Nurses’ Views of Health Promotion Interventions Background: Researchers should evaluate sleep using proper procedures in order to verify the Background: The quality of the clinical learning questionnaire (Haddad & Umlauf 1998) and the environment is an important factor in the clinical Primary Care Staff’s Opinions on Promoting Physical effect of intervention on sleep management. How do nursing researchers assess sleep? Are there any experience of a student (Yim & Chan 2004) and is Activity sub-scale (Douglas 2006). The data were determined above all by a good atmosphere in the issues with the assessment methods used? collected between March – June 2008 yielding a ward (Papp et al. 2003). To evaluate the learning response rate of 53.3% (n=1066 respondents) Aims: To examine the trend in Japanese nursing environment, Chan (2001) made up an instrument, (Saudi patients n=322, 64.4%;, registered nurses research that aims at investigating the effects of the Clinical Learning Environment Inventory (CLEI), n=614, 61.4%; doctors n=130, 26.0%). sleep intervention, and to clarify any issues con- which has been found to be homogeneous, but its Results: The nurses, doctors and patients reported cerning sleep assessment, we reviewed research validity has not been established. articles published over the past ten years in Japan different views regarding responsibility for health Aims: The aim of this study is to analyse the and foreign countries. promotion with patients being significantly less student nurses’ perceptions of the hospital clinical supportive of nurses in this role. The perceptions of Methods: Japanese research articles were retrieved learning environment. from the Ichushi database, while those published nurses as health promoters also varied. A number Methods: A descriptive study was carried out using of constraints for effective health promotion were in foreign countries were retrieved from the CINAHL Chan’s Clinical Learning Environment Inventory. A identified including a lack of necessary skills and database. questionnaire (CLEI) (Cronbach values of between shared language and cultural understanding. Results & Discussion: Three issues related to sleep 0.47 and 0.74) was compiled by a suitable sample The views of the nurses, doctors and patients assessment were identified, for which we suggest of 232 Nursing Science Degree Course undergradu- also varied regarding health promotion related to the following solutions. ates of the Verona University, Trento campus. smoking cessation, physical activity and weight In relation to data collection, a paucity of the Results: The results showed that the students management. number of samples was identified. Development perceived a good clinical learning environment. Discussion: There is a lack of clarity regarding role of an efficient data collection method is needed All the students (99%) agreed that practical work of hospital nurses as health promoters in Saudi in research in order to show a higher reliability of experience was useful and not a waste of time. The Arabia. The legitimacy of this area of practice is evidence. lowest scoring item was ‘the trained nurse supervi- contested by both patients and doctors in part Since only the individual understands his/her sors/ clinical tutors stopped what they were doing reflecting the cultural competence of a large to help students’ (40.5% 1-3, M 3.2; Me 4); however own sleep experience, subjective evaluation migrant workforce as well as their skill set regarding it was shown that the students did not expect is important in the evaluation of sleep quality. health promotion. this (34.5% 1-3, M 3.4, Me 4). The students also However, since subjective and objective sleep eval- believed that ‘knowing exactly what they had to do Recommended reading: uation results may differ, more research is needed on the ward’, was an important aspect, (93.5% 4-5, that uses both objective and subjective data for Al-Kandari F, Vidal V L & Thomas D (2008) Health- Me 4) but in reality this was rarely the case (47.8% sleep assessment. prompting Lifestyle and Body Mass Index Among 4-5, Me 2). College of Nursing Students in Kuwait: A Corre- Much of the research reviewed used observation Discussion and conclusions: From the results it lational Study. Nursing and Health Sciences. 10: methods to assess sleep, however, many of the emerges that the students have little possibil- papers did not provide details of the observation 43-50 ity to programme their shift and activities or plan Douglas F., Torrance N., Teijlingen E., Meloni S. method or the criteria applied. Repeatability of working with their own rhythm. From the results it and Kerr A. (2006) Primary Care Staff’s Views and the research will be improved by clearly providing also emerges that the tutorial presence of a clinical Experiences Related to Routinely Advising Patients such information. Additionally, researchers need to tutor and/or trained nurse supervisor actively About Physical Activity. Public Health.6: 138-47 confirm inter-rater reliability of the observational contributes to an innovative learning environment results. Haddad G. and Umlauf M. (1998) Views of Health even when innovative teaching strategies cannot Promotion Among Primary Health Care Nurses and Conclusions: By resolving these issues, highly be guaranteed. reliable data will be collected by Japanese nursing Midwives in Jordon. Health Care for Women Inter- Recommended reading: national. 19: 515-528. researchers, thus contributing further to the global body of work aiming to verify the effects of nursing Chan, D.S.K., (2001). Development of an Innovative intervention on sleep management. Acknowledge- Tool to Assess Hospital/Learning Environments. ment: This work was supported by Grant-in-aid for Nurse education Today, 21, 624-631 Scientific Research (c20592506). Papp, I., Markkanen, M., Von Bonsdorff, M., (2003). Clinical Environment as a Learning Environment: Student Nurses’ Perceptions Concerning Clinical Learning Experiences. Nurse Education Today, 23, 262-268 Yim, W., Chan, DSK., (2004). Hong Kong Nursing Students’ Perception of the Clinical Environment: A Questionnaire Survey. International Journal of Nursing Studies, 42 (6), 665-672.

29 Symposia

Wednesday 25 March 2009 References Discussion Paper. International Journal of Nursing Prout A (2001) Representing Children: Reflections Studies. on the Children 5-16 Programme, Children and Halse C & Honey A (2007) Rethinking Ethics Review Society, volume 15, pp 193-201. as Institutional Discourse, Qualitative Inquiry, Symposium 1 Punch S (2002) Research with Children: The Same Volume 13, pp 336-352. ‘Talkin’ ‘bout my generation’: or Different from Research with Adults? Childhood, Volume 9(3), pp 321–341. Research with children and generational landscapes Paper 2 Duncan Randall, School of Health Sciences, Pith helmet or play pit: Revisiting The University of Birmingham, Edgbaston, Paper 1 Birmingham, UK Mandell’s ‘least adult role’. Co-authors: Bernie Carter; Duncan Randall; Jane Barbarians, Barbicans & Duncan Randall: Lecturer, University of Coad; Paula Reed children safe in the castle keep: Birmingham, Birmingham, UK [email protected] Researchers, reviewers and ethics Before sociologists began to theorise childhood review and point to how children and adults share cultures Abstract: Bernie Carter, Professor of Children’s Nursing, (Corsaro 2005), it was perhaps easier to conceive Background: Policy makers, clinicians and purchas- University of Central Lancashire & Alder Hey of the adult researcher donning their Pith helmet ers of children’s services have become interested in Children’s NHS Foundation Trust (& Visiting and heading off to the sand pits of childhood, to recent times in the views of children. It has been Professor, Edge Hill University) study the child tribe just as colonial anthropolo- acknowledged that parents’ (often mothers’) per- gists had sailed off to foreign climes to study the ceptions of what their children think about health Adult generations often frame childhood as a time natives. However, with the view, now accepted, that services are not the same as those of children of vulnerability. In many countries the default children are full social actors and acknowledgment themselves (Punch 2002). At the same time a view setting, in the context of research governance of the critiques of ethnography’s colonial past it is of children has emerged as competent commenta- and ethical review, is to frame children and young time to re-examine how adults conduct research tors on their social worlds (Prout 2001). The devel- people within this discourse of vulnerability. Those with children. A number of writers have pointed opment of children as consumers of health care seeking to do research with children are auto- to the fact that research with children requires the has highlighted a dilemma for researchers. How do matically required to tick boxes, answer additional adult researcher to be reflexive about their role as adult researchers research the worlds of children? questions and give extra specific assurances. This, an adult (Christensen & Prout 2002). One of the This symposium brings together researchers all of in and of itself, is not wrong although it does frame first to attempt to set out how adults could research whom have had to answer this question in con- research with (or on) children as being inherently children’s worlds was Nancy Mandell (1991). Her ducting research with children in various projects. – although often vaguely – risky. Framed within a ‘least adult role’ has been criticised as too simplis- Drawing on their research practice the speakers discourse of vulnerability children are seen to need tic. However, in this paper I argue that the princi- will explore with delegates the generational land- to be protected and kept safe from the predations ples on which Mandell based her explication of how scapes that surround children. These landscapes of researchers; in fact it seems irresponsible to adults should approach researching with children have vistas beyond the child’s home; they extend argue against this (although this is my intention) have been used by other researchers. The ethno- into schools, hospital wards, clinics, communities (Carter in press). However, framing children graphic principles that Mandell uses, taken from and settings where children encounter other gen- as vulnerable can result in researchers finding Mead’s work, can be adapted to fit the context of erations, as well as their own. All of these shape themselves positioned as being ‘(potentially) the research. Re-examining Mandell’s ‘least adult how children negotiate their interactions with dangerous’ and reviewers being positioned into role’ reveals how more recent developments such researchers. Researchers in children’s nursing having to adopt the role of being (super-) cautious as Christensen and Prout’s (2002) ideas on ethical appeared to have overlooked the effects of gen- defenders of children. Halse and Honey (2007) talk symmetry have built on Mandell’s principles. This eration. Research reports often do not address of this in terms of the researcher being positioned re-examination suggests that these principles how researchers ensured the data they collected as a barbarian and the reviewer positioned as the give a framework for adults to be reflexive about from children were not unduly influenced by adults. research subject’s champion. But, this is only a researching with children. Not addressing generational issues may call into partial picture; researchers and reviewers are het- question how representative the subsequent erogeneous groups each sharing some barbarian References findings are of the child’s voice. This symposium and champion tendencies. Likewise children are a Christensen P and Prout A (2002) Working with will allow delegates and researchers to debate the heterogeneous group with a multiplicity of geog- Ethical Symmetry in Social Research with Children. vital issue of how to get closer to the child’s voice. raphies. A degree of tension between researchers Childhood, Volume 9(4), pp 477–497. and reviewers is vital, constructive and necessary, Intended learning outcomes: Corsaro WA (2005) The Sociology of Childhood,2nd but it can unnecessarily constrain and impede the edn, Thousand Oaks,California, Pine Forge Press/ Delegates will be able to: researcher. If the (barbarian) researcher cannot Sage. get past the castle’s overly well-defended barbican 1. Engage in debate on how children and research- Mandell N (1991) The Least Adult Role in Studying (review committee) then children and young ers respond to issues such as the power differences Children. In: Waksler F, (Ed.) Studying the Social people, especially those who are seen to be par- between children and adults in research projects. Worlds of Children, London, Falmer Press. ticularly vulnerable or marginalised will never be 2. Debate the generational issues that affect able to contribute their perspectives. Children will researching with children and children researching remain guarded and well-defended, but from the with their peers. heights of the keep their voices are muted and may 3. Evaluate the use of data from adults in research drift into the ether unheard. with children. References: Carter B (in press) Tick box for child? The Ethical Positioning of Children as Vulnerable, Researchers as Barbarians and Reviewers as Overly Cautious: A

30 Symposia

Paper 3 Paper 4 Symposium 2 Just talkin’ to my generation: Pictures of dignity: Putting Developing a clinical academic children as peer researchers children’s and adult’s data together research career in nursing Jane Coad, Senior Research Fellow, Centre for Child Paula Reed: Honorary Research Associate, Faculty Andrea Nelson, School of Healthcare, University of and Adolescent Health, University of the West of of Health and Medical Sciences, University of Leeds, Leeds, UK England, Bristol, UK Surrey, UK Co – Authors: Una Adderley; Jill Firth; Simon Palfreyman; Jane Nixon The case for participation of children and young The perception of dignity by children and adults [email protected] people in research has now been framed in is used in this paper to explore how adult’s data countless ways. Advocates of this approach argue can be incorporated into research with children. that this can help to reduce some of the power The promotion of dignity in healthcare has never Sponsored by imbalances in the researcher/researched relation- been more topical (RCN, 2008). However, princi- ship, since both researchers and those researched ples of best practice are formulated with an adult are recognised as active participants in the research in mind and may not be appropriate for children. Abstract: process (Christensen and James, 2008). Research- In this paper I explore the meaning of dignity for Background: Finch chaired the UK Clinical Research ers in health care settings are however increasingly children on an acute hospital ward. My findings Collaboration (UKCRC) Subcommittee for Nurses in engaging children and young people not only using are drawn from a nine month ethnography based Clinical Research to examine the roles of nurses participatory approaches but have included them on a children’s ward and additional pilot work in a as researchers and educators, and investigate as ‘peer-researchers’ in a spectrum of activities school and nursery. I contrast the perspectives of the barriers faced by nurses who want to pursue during the research process (Coad & Evans, 2008). children of dignity with the meanings of dignity research careers. The recent report envisages a This part of the symposia will initially set out some for the adults on the ward, the staff and parents. more flexible career structure that will see clinical I have taken a social constructionist perspective of the key ways this has been undertaken in health and academic work as the norm for nurses who (Goffman 1971) to explain my findings and focus and social care related projects. However, the successfully pursue a research career, rather than less on the age difference between children and main focus of the presentation will be to discuss obliging them to pursue one role at the expense adults, but more on the construction of the child the inter-generational issues of when a child or of the other. Finch envisages new funding streams and the position of children in society. In order to young person carries out research on their own available to support nurses in developing their put children’s data in context, I discuss the ward generation. This may be a range of activities such nursing careers. These include the funding of 4 environment as primarily an adult place. as carrying out interviews, either because they are academic training levels at 4 sequential levels: the same age as the people they are interviewing To highlight the competing notions of dignity MRes /MClinRes, Doctoral level, Postdoctoral and/or they share same life experiences. Murray between the children and adults, I discuss four Career Fellowships, and Senior Clinical Academic (2006) argues that peer-led research can lead to main themes that emerged from the data: Fellowships. In addition, it recommends that fresh insights, or to discussion of issues that would – The ritualised performance of dignity practices mentoring and peer support should be developed not have been discussed with adults present. and their relevance to children for nurse researchers and educators. But others note that there are hidden dangers of – The assumptions of adults and notions of bodily The Smith and Nephew Foundation provide pre such activity if it is not thoroughly considered and ownership and post-doctoral funds for nurses wishing to planned for from the outset (Coad & Evans, 2008). – ‘humanness’ and objectification undertake studies in academic departments with The presentation will draw on key examples of a record of research in skin or tissue viability. The – The ‘relative’ position of children to adults and peer-led work in the health context, including the provision of targeted funding to centres of excel- their assumed vulnerability (Christensen 2000) presenters own field work. Key inter-generational lence has resulted in a cadre of nurse researchers issues will be covered such as age, development, Using dignity as an example I argue that the who can now attract substantial National Institutes role, ethics and peer relationships and lessons to inclusion of adult’s data allows children’s percep- for Health Research Programme Grants, one marker be learned will be shared. tions of dignity, and the enactment of dignity to of success in the health research community. This be placed in a context of an adult centred world. References. symposium will bring together nurses who are Although the inclusion of data from adults risks building a career in clinical nursing research and Coad, J. Evans, R. (2008) Children and Young the voice of the child being lost, it can also help to describe the challenges they have faced and the People’s Engagement in the Data Analysis Process: make sense of children’s data. As in other aspects strategies they used to obtain funding and to A practical framework, Children and Society, of research with children the inclusion of adult’s pursue a career in research. They will also describe Volume 22, pp 41-52 data needs to be considered within a reflexive the challenges they have faced in getting funding, Christensen P & James A (2008) Research with process, where the effect of including adult’s data fitting in, and making the research fit in with Children: Perspectives and Practice 2nd edn on the child’s voice is considered as part of the rela- other commitments. The potential for the initia- Routledge, Abingdon tionship between generations. tives outlined in the Finch report to help capacity Murray, C. (2006) Peer Led Focus Groups and References and capability in nursing research will also be discussed. This symposium will be of interest to Young People, Children and Society, Volume 20, pp Christensen, P.H (2000) Childhood and the Con- people developing their research career. 273-286. struction of Vulnerable Bodies In Prout, A. (ed) The Body, Childhood and Society, Basingstoke, Macmillan, pp.38-59. Goffman, E. (1971) The Presentation of Self in Everyday Life. Pelican Books series, Harmonds- worth: Penguin Books. Royal College of Nursing (2008) Small Changes Make a Big Difference: How You Can Influence to Deliver Dignified Care [online] available from http://www.rcn.org.uk/__data/assets/ pdf_file/0008/191735/003285.pdf [Accessed 28/10/08], Royal College of Nursing, London.

31 Symposia

Paper 1 (shared with the world through publications). Paper 4 At post doctoral level, there are the demands of Research at the ‘coal face’ becoming an expert, combined with the need to Building a research career as Una Adderley RGN MSc (Doctoral student, extend your own skills as a researcher, teach and a methodologist and subject University of York) Team Leader, Specialist Nurses supervise others and attract funding to pay your specialist North Yorkshire and York Primary Care Trust way. Jill will illustrate the process with reference to Jane Nixon Malton Hospital, Malton, North Yorkshire, UK her own transition which is work in progress, and will reflect on the recommendations of the Finch Abstract: report, regarding funding support, mentoring and Abstract: peer support. The NMC requires its registrants to deliver care This paper describes the development of a that is based on the best available evidence and it research career in pressure ulcer prevention and has been found that a better qualified workforce is also as a clinical trialist working in a multi-dis- associated with better health outcomes. Although ciplinary Clinical Trials Unit, with strong links to Paper 3 most nurses would agree that care should be academic and clinical nurse collaborators. It details based on high quality evidence from research, Getting yourself into a position a strategic approach to becoming a specialist trials methodologist, developing a successful portfolio there is some evidence that the academic nurse, where you can grow as a researcher the very person needed to provide this evidence, of pressure ulcer (PU) research and development Simon Palfreyman, Senior Research Nurse, Smith is not highly valued in the clinical workplace. This of academic and clinical collaborations to support and Nephew Foundation Doctoral Student, may mean that clinical nurses who wish to also high quality research, making a significant contri- Sheffield Vascular Institute, Northern General pursue active academic work may face resist- bution in the field. Jane has had ten large grants in Hospital Sheffield, UK ance from their own employers and peers. In the PU and Tissue Viability, spanning NHS and Univer- face of this potential resistance, nurses who can sity careers, including eight as Chief Investigator, deliver both clinically and academically have a Abstract: and grant income of £5.5 million, culminating in a National Institute for Health (NIHR) Programme particular responsibility to nurture the research It has been identified that the nursing profession Grant of £1.99 million over 5 years. In addition as flame within the NHS. Maintaining a ‘foot in both has a shortage of nurses with sufficient skills in a trialist, Jane has collaborated on 6 grants for camps’ is difficult but should result in research that research compared to some other health profes- large multi-centre trials, total grant income of £5.7 not only addresses immediately pressing clinical sions. There also exists a well recognised barrier million in areas including cardiovascular, stroke questions, but is also methodologically robust. between clinical and academic areas and it is this and mental health. Jane will outline her research Indeed these links should also help implementa- that Finch is trying to address. If there is to be career, starting in 1991 in the NHS as a theatre tion of research findings This paper will describe effective collaboration and cooperation clinical nurse and subsequent progression in an NHS and the challenges around gaining the active support nurses will need to acquire detailed skills and University career. of NHS managers, attracting funding to support my knowledge related to research. However, it can be research activity, in particular my PhD, and main- difficult as a clinical nurse to find support in order Key components have been: taining an appropriate balance between research to acquire and hone such skills. In addition to being • Strong collaborations with methodologists and and clinical commitments. able to find resources and time the key is in finding clinicians ‘like-minded people’ who can support and guide • Strategic allies providing mentorship you whilst undergoing research training during a • Changes in funding policies, providing opportuni- PhD and beyond. One possible path to acquiring ties Paper 2 research skills is through the role of research The transition from doctoral student nurse. This role provides a grounding in under- • Relevant research questions standing the research process and the associated • Developing as a trials methodologist to researcher ethical and governance issues whilst also maintain- • Built on the knock backs to develop the next Jill Firth, Senior Research Fellow & Post Graduate ing contact with patients. The step from collecting application Research Tutor, Module Manager HECS 3064 research data to undertaking a leadership role in Rheumatology: disease processes, treatment & research can be daunting but the personnel and In addition she will illustrate how she identified care, School of Healthcare, University of Leeds, support necessary to do this can sometimes be the methodological strengths and weaknesses and Leeds, UK more easily accessed as a research nurse than as new and emerging research questions from each a clinical nurse. This paper will describe the chal- successive research project, maintained an active role/awareness of national initiatives influencing Abstract: lenges and issues in taking the step from research nurse to lead researcher. It will highlight the impor- research funding allocations, and built upon these In this paper Jill will describe her experiences tance of persistence and the difficulties of pursuing to plan and develop ongoing funding applications. of engaging with research as a long term career a research career whilst on short-term contracts. pathway. For a clinician, completing a PhD can be The potential role of the funding streams arising seen as the final academic hurdle to leap, and this from the Finch report in supporting such a research may lead to it being seen as an endpoint in itself. Paper 5: career will be discussed. This loses the essence of a PhD, as it is merely the Andrea Nelson completion of an arduous training programme (or baptism by fire!). The challenge for a post-doctoral The role of mentoring and peer support in building researcher is to use and develop those newly our careers in clinical research In this paper, Andrea acquired skills and to move towards becoming will ask whether we are developing the next wave an independent investigator. The skills required of clinical nurse academics through peer support to develop as a researcher are wide ranging and and mentoring. Andrea will d are actually closely allied to those needed to be an effective clinician. They include recognition of need, planning and collaboration with an inter-dis- ciplinary team to achieve desired outcomes within budgetary confines and the evaluation of outcomes

32 Symposia

Symposium 3 Paper 1 Paper 2 Health knowledge: Information for Assessing the evidence: Mixed- Scoping current health information children and young people method systematic review Authors: Alison Hughes (RA), Anne Williams Anne Williams, Department of Nursing, Health and Werner Vogels(RA), Jane Noyes(Professor), Llinos (Professor), Gaynor Williams (assoc. Lecturer) Social Care Research Centre, School of Nursing Haf Spensor (RA) (Centre for Health Related (School of Nursing and Midwifery Studies, Cardiff and Midwifery Studies, Cardiff University, Cardiff, Research, Bangor University), Deborah Edwards University), Jane Noyes (Professor) (Centre for UK (RA), Alison Hughes (RA), Gaynor Williams (Assoc. Health Related Research, Bangor University). Co-authors: Werner Vogels; Jane Noyes; Llinos Lecturer0, Anne Williams (Professor)(School of Background: Little health information has been Haf Spensor; Deborah Edwards; Alison Hughes; Nursing and Midwifery Studies, Cardiff University). produced for children and young people (Joughlin Gaynor Williams; Odysseus Constantinous; Cindy Carter; Terry Threadgold; Anne Williams; Jane and Law 2005). A review of available current infor- Noyes; Alison Hughes; Deborah Edwards Background: Little is known about the position- mation is urgent, in order to establish where the ing of children and young people regarding health gaps are. [email protected] information in empirical studies, policy and clinical Aims: To establish what current information is guidance. available for specified conditions and commonly Abstract: Aims: To review empirical literature, policies, guide- associated medicines, and in what types and Introduction:Partnership between the public and lines, management plans for IMP and EPIC studies, format. NHS is seen as crucial to a healthier society. A identifying ideas underpinning policy, how children Methods: Sources of information were searched requirement of partnership is provision of high are positioned within policies, effectiveness, cost- (April to January 2007). We employed qualita- quality information and the facilitation of its use effectiveness of information in relation to tracer tive sampling strategies: incremental sampling to in practice. There is little information produced conditions and associated medicines and extent ensure comprehensiveness; judgement sampling for children, young people and their families, to which information needs are made explicit and to produce data amenable to depth – analysis of and little evidence concerning types and formats consistent in best practice, clinical guidance and types and formats of information rather than estab- which could empower their decision making, espe- pathways through care. lishing their frequency. An electronic database of cially concerning medicines which are the most Methods: Mixed-method, systematic reviews health information resources organised according commonly used therapeutic NHS intervention. The (2007 ongoing): conceptual clarification of review to tracer condition was established and will linked symposium papers will contribute methodo- foci; development of protocols; comprehensive continue to be updated. An audit trail of organi- logical insights alongside emerging findings from searching of data bases and quality appraisal pro- sations and individuals contacted has been main- two complementary studies seeking to address this cedures. tained alongside the data base. The paper will lack of evidence. Results: Descriptive empirical work predominates. present sources; and types and formats of health The first, the `Information matters project [IMP]’, Few evaluations of information are evident and information accessed and discuss their signifi- 2007-2010, is qualitative and designed to identify very few studies focus on proposing solutions and cance for children’s self-care and medicines man- types, formats and characteristics of informa- suggestions for change. Emerging key findings agement. tion which are likely to support children’s deci- relate to self-management education for children, Results: Searches produced a range of sources sion-making and choices around medicines and specific information needs, types/ formats of infor- including UK charities, healthcare professionals, clinical options across a range of tracer conditions mation, access to information, parents as proxy, pharmaceutical companies, websites providing including diabetes, asthma, epilepsy, complex con- peer support, relationships between children and child-centred health and medicines information, ditions and selected acute conditions. clinicians, and social identities. For EPIC, we are UK-wide health profession networks, NHS Trusts, The second study `Evidence into practice: infor- intensifying the focus of the systematic review Primary-Care Trusts, children’s health information mation counts (EPIC), 2008-2011’, is designed to for the diabetes tracer condition. We wish to centres, Patient Advisory and Liaison Services. build on evidence from the former to develop and determine factors that support children’s manage- Formats included written information (leaflets) and evaluate by pragmatic randomised-controlled-trial ment of insulin and blood-glucose monitoring in other media (DVDs, interactive websites) as well an individually-tailored, age-appropriate infor- different settings (home and away) and different as locally produced information and teaching aids mation resource to support decision-making and life and illness stages. (dolls/ modified equipment for use with role play, self-care relating to insulin management and elec- Discussion: Policies, clinical guidelines and care- games). tronic blood-glucose monitoring for children with pathways consistently refer to the need to provide Discussion: Discussion will focus on medicines type-1 diabetes, compared with available resources children and families with clear, child-centred and management information; information usage; in routine clinical practice. The research studies age-appropriate information, for example NSF addressing diversity; bespoke, locally produced constitute a UK-wide, multidisciplinary research (DH 2004). Our paper discusses gaps between information and participation of children in collaboration relating to health knowledge and philosophy and reality, linking to the review of producing information. The availability or lack of information for children. The conceptual frame- currently available children’s health information, child-centred, age-appropriate information taking works guiding our approach draw on anthropol- also exploring how policies which have children’s into account sensitivity to gender, ethnicity and ogy and knowledge translation, with an emphasis interests at heart have different approaches with socioeconomic status will be referenced. on understanding processes and relationships some ascribing, inadvertently, a passive role for involved in children’s responses to health informa- Conclusions: With some notable exceptions, there children whereas others point to the need to assist tion, and mechanisms by which evidence is trans- is a lack of child-centred, age-appropriate informa- them in making their own choices regarding health, lated and facilitated in practice to improve health tion across chronic and acute tracer conditions. medicines and self care. Conclusion: The review outcomes. Children’s and young people’s contribu- Moreover, our analysis provides insights into provides clarity regarding identification of gaps in tions to planning both studies are a priority. The aspects of detail required to redress this and other evidence. outcomes will provide evidence from which policy deficits. makers and practitioners may inspire and prepare References: References: children for their future health, self-care and DH (2004) National Service Framework for Children Joughlin and Law (2005) Evidence Available to medicines management as they cross important and Young People and Maternity Services – Support the National Service Framework for Children, life transitions. Standards 1-10. Young People and Maternity Services. http://www. dh.gov.uk/assetRoot/04/11/24/10/04112410.pdf

33 Symposia

Paper 3 References: Conclusions: Focus groups are viewed by the Critical discourse analysis (CDA): Dixon-Woods, M. (2001) ‘Writing Wrongs? An authors as a useful way to gain information from Analysis of Published Discourses About the Use of children and young people about their health infor- Representation of empowerment Patient Information Leaflets.’ Social Science and mation preferences. and medicines in health information Medicine, 52, 1417-1432 References: texts for children Van Leeuwen, T. (2005) Introducing Social Gibbs, A. (1997). Focus groups. Social Research Odysseus Constantinous (RA), Cindy Carter Semiotics. London: Routledge Update, Issue 19. Available at www.soc.surrey. (Senior Lecturer), Terry Threadgold (Professor) Fairclough, N. 2001. ‘CDA as a Method in Social Sci- ac.uk/sru (Journalism, Media and Cultural Studies, Cardiff entific Research.’ In Wodak, R. and M Meyer (Eds.) Gibson, F. (2007). Conducting focus groups with University), Anne Williams (Professor)(School of Methods of Critical Discourse Analysis: 121-138. children and young people: strategies for success. Nursing and Midwifery Studies, Cardiff University), London: Sage Journal of Research in Nursing, 12(5), 473-483 Jane Noyes (Professor) (Centre for Health Related Research, Bangor), Alison Hughes (RA) and Kingry, M. J., Tiedje, L., Friedman, L. L. (1990). Focus Deborah Edwards (RA) (School of Nursing and groups: a research technique for nursing. Nursing Midwifery Studies, Cardiff University). Paper 4 Research, 39:2, 124-125 Engaging with children about Background: Two main discourses are identified in contemporary health information: ‘patient-edu- health information in focus group cation’ & ‘patient-empowerment’ (Dixon-Woods. interviews: Issues surrounding risk 2001). While both are relevant, our interest is in management and methodology patient-empowerment, specifically the positioning Llinos Haf Spencer, Werner Vogels, Jane Noyes of children and young people within health infor- (Centre for Health Related Research, Bangor); mation texts. Alison Hughes, Deborah Edwards, Anne Williams Aim: To identify types and formats of information (School of Nursing and Midwifery Studies, Cardiff which could empower children and young people to University). make decisions and choices about their healthcare and medicines management. Background: Very little is known about the kinds Methodology: This paper explains how we used of information that are likely to inspire children/ critical discourse analysis to meet our aim. young people. Discourse methodology premises that a discourse Aims: The main aim of the focus groups was to is a ‘way of knowing’ or ‘ talking about’ some aspect engage with children and young people with of reality (Van Leeuwen, 2005). CDA is understood diabetes, epilepsy, asthma, and other chronic con- as an approach to discourse concerned with the ditions in order to find out about their health infor- relationship between `meaning making’ and `social mation preferences. structure and change’ (Fairclough, 2001: 123). Thus salient questions for our studies include: what Methodology: Focus groups are becoming a does ‘empowerment’ mean in contemporary child- popular way of obtaining the opinions of children centred health texts? How are children discursively (e.g. Gibson, 2007; Kingry et al., 1990). Fifteen ‘positioned’, especially with regard to decision- focus group interviews were conducted across the making/medicines? The sample of information study sites between October 2008 and March 2009, for discourse analysis is drawn from the database with between 8 and 12 children/young people in of information types and formats and stratified each group. The focus groups were facilitated by according to tracer condition. In this paper we draw the support of the Medicines for Children Research on a sub-sample to demonstrate representation of Network (MCRN). The children were shown infor- empowerment (of children and young people) and mation resources such as leaflets, books, DVDs and medicines in information resources. websites and then these resources were discussed. The risk management strategies, research gov- Results: Four types of empowerment discourse ernance and ethical issues of carrying out focus have been identified in the texts: medical; `patient’; group interviews with children/young people with identity; and `choice’. There are three main textual medical needs will be described in this presenta- strategies at work in the data regarding the repre- tion, alongside the interim results. sentation of medicines to child-readers: appealing to children by representing medicines in a familiar Results: During the focus group sessions context; backgrounding the use of medicines in the conducted to date, the children enjoyed open and represented, ideal lives of children; and presenting interactive dialogue with non-judgmental research- the child with choice. ers (see Gibbs, 1997). This enabled the collection of rich narrative data from children about their health Discussion: The paper will discuss results in information choices, which were later analysed by relation to issues around age-appropriateness of qualitative methods. main messages, as well as their gendered nature and sensitivity to ethnicity. Discussion: Engaging with children outside the school setting in order to collect narrative data for Conclusion: Discourse analysis provides a useful pragmatic research is a challenging but rewarding analytic tool, revealing assumptions underpinning experience and can be a successful method of data current health information for children. collection as well as being a positive experience for children.

34 Symposia

Symposium 4 CIT has become inconsistent. Similarly in relation can make a significant contribution to the interna- to terminology, the diverse and often misleading tional body of nursing knowledge. The Critical Incident Technique: language associated with CIT is exposed. Methodo- References: Exploration and critique of its use in logical and terminological inconsistencies of CIT nursing research are discussed in relation to rigour and an argument Bradbury-Jones C., Irvine F. & Sambrook S. (2007) Empowerment of Nursing Students in the UK and Caroline Bradbury-Jones, School of Healthcare is made that this may be compromised as a result. Japan: A Cross-Cultural Study. Journal of Advanced Sciences, University of Wales Bangor, Archimedes Overall we argue that a great deal of confusion has Centre, Wrexham, UK been created by nurse researchers’ attempts to Nursing, 59 (4) 379-387 Co-authors: Siobhan Tranter; Fiona Irvine; Caroline advance CIT and a more standardized approach to Irvine F., Roberts G., Tranter S., Williams L. & Jones Bradbury-Jones its use is advocated. Because CIT is used by nurse P. (2008) Student Nurses’ Perceptions of Language [email protected] researchers across the world the presentation will Awareness in Healthcare: The Critical Incident be of interest to a number of conference delegates. Technique. Nurse Education Today, 28 (1) 39-47 The aim of this symposium is to offer a critique of References: Liamputtong P. (2008) Doing Research in a Cross- the critical incident technique (CIT) within nursing Cultural Context: Methodological and Ethical Chal- Bradbury-Jones C. & Tranter S. (2008) Inconsistent research and to expose its benefits and pitfalls. To lenges. In: Liamputtong P. (Ed.) Doing Cross-Cul- use of the Critical Incident Technique in nursing facilitate this we draw heavily on our experiences of tural Research. Springer, Netherlands. research. Journal of Advanced Nursing, 64(4), using CIT in several different contexts and balance 399-407. this with a strong theoretical base. In the presen- tations we move through a continuum of analysis. Flanagan J.C. (1954) The critical incident technique. This begins with a critical review of the use of CIT in Psychological Bulletin 51, 4, 327-358. Paper 3 nursing research and a cautionary note regarding Hensing G.K.E., Sverker A.M., Leijon G.S. (2007) The Critical Incident Technique: its inconsistent use. This is followed by an explo- Experienced dilemmas of everyday life in chronic ration of the challenges associated with using CIT neuropathic pain patients – results from a critical approaches to data collection cross-culturally, with particular emphasis on issues incident study. Scandinavian Journal of Caring Caroline Bradbury-Jones, Lecturer in Nursing, of translation and concept equivalence. We bring Science 21, 147-154. Bangor University, Bangor our presentations to a close by sharing our experi- ences of using different approaches to data collec- The issue of whether the critical incident technique tion in CIT studies and the inherent problems and (CIT) is a method or methodology is one that strengths associated with them. Paper 2 lacks clarity (Bradbury-Jones & Tranter 2008). Our presentations should be of interest to Using the Critical Incident However, one thing is certain: all researchers using CIT require some means of collecting data. beginning and experienced healthcare research- technique in cross-cultural research ers who seek to gain a critical perspective on the The purpose of this presentation is to draw on the Fiona Irvine, Professor of Nursing, Liverpool John use of this valuable research approach. The critical diverse research experiences of the symposium Moores University, Liverpool, UK incident technique is popular with nurse research- presenters in relation to CIT. Our collective experi- ers across the globe and therefore the symposium ences are used to appraise the relative advantages should appeal to the international conference The global exchange of nursing knowledge is now and disadvantages of a range of data collection audience. accepted and it is recognised that many research methods that can be used in CIT studies. A strong issues are of international relevance and require focus is on written and oral forms because these cross-cultural investigation. As nurses venture into are the most popular approaches reported in the cross-cultural research, so they have to face the literature. They also reflect the research expertise Paper 1 many methodological and ethical challenges that of the symposium panel. In a manner that sets it arise when working with diverse research partici- apart form other qualitative research approaches Inconsistent use of the critical pants (Liamputtong 2008). Part of the challenge is one of the unique qualities of CIT is that it can be incident technique in nursing to identify methodological approaches that are used anonymously. In our experiences anonymity research suitable to address the aims of the research, whilst has been achieved by collecting data in written ensuring their relevance to participants who may form (Bradbury-Jones et al. 2007, Irvine et al 2008). Siobhan Tranter, Lecturer in Nursing, Bangor not share a common language or culture. In this This has distinct advantages and yet it has inherent University, Bangor, UK paper we highlight the value of the critical incident limitations; all of which are addressed in the pres- technique (CIT) as a methodological approach in entation. Similarly, interviews as a popular method This presentation is based on a recently published cross-cultural research. We draw on our experi- of data collection in qualitative research generally, paper that offered a critique of the use of the ences of using CIT in more than one language take on a particular form in CIT research. These Critical Incident Technique (CIT) in nursing research (Bradbury Jones, et al 2007, Irvine et al 2008) and issues are explored in detail. A strength of CIT lies (Bradbury-Jones & Tranter 2008). The aim is to discuss best practice in conducting such research in its adaptability and potential for creativity in discuss the issues raised in the paper and to when the researchers are: ii. insiders – sharing terms of research design. Delegates who attend show how development and popularity of CIT the same culture and language as participants iii. the presentation will gain insight into the multi- has resulted in inconsistency and confusion. CIT outsiders – where they do not have culture and plicity of ways CIT studies can be designed and the is used globally by nurse researchers to explore language in common with participants. We focus advantages and disadvantages associated with many issues. Its main strength is flexibility and it on the use of bilingual materials, issues of transla- some of the most commonly used data collection can be readily adapted to meet the needs of indi- tion and processes of analysis that are of relevance approaches. vidual studies (Flanagan 1954, Hensing et al 2007). when using CIT. However, its popularity has proved to be a double References: Through the presentation, we highlight some of edged sword because it has resulted in a degree Bradbury-Jones C., Sambrook S. & Irvine F. the limitations of CIT when conducting cross-cul- of ambiguity and confusion. The purpose of this (2007) The Meaning of Empowerment for Nursing tural research and explore how such limitations presentation is to illuminate some inconsistencies Students: A Critical Incident Study. Journal of can be overcome. We show that adopting careful surrounding CIT with particular focus on two areas: Advanced Nursing, 59(4), 342-351 methodology and terminology. The presentation and rigorous procedures throughout the research Bradbury-Jones C. & Tranter S. (2008) Inconsistent shows how from a methodological perspective process ensures that CIT is a credible cross-cultural research approach that can elicit rich data which Use of the Critical Incident Technique in Nursing

35 Symposia

Research. Journal of Advanced Nursing, 64(4), Symposium 5 effectively with older people and their supporters 399-407 and that the needs of all parties must be taken into Drawing upon the past and present Irvine F., Roberts G., Tranter S., Williams L. & Jones account. In this paper, we argue that relationship- P. (2008) Student Nurses’ Perceptions of Language to better understand dignity and centred, rather than person-centred care is the Awareness in Healthcare: The Critical Incident compassion within NHS hospital most appropriate foundation for acute care practice Technique. Nurse Education Today, 28 (1) 39-47 with older people. However, nurses and other prac- care titioners need guidance in identifying ways of inter- Charlotte Wilkinson, Adult Nursing, City University, acting with older people and their families that best London, UK support relationships. Symposium lead: Julienne Meyer, Older Adult Research Team, City University, London, UK Co-authors: Sue Davies; Mike Nolan; Belinda Dewar; Mary Flatley Paper 2 [email protected] Using relationship centred care to This symposium of three papers will draw upon understand and develop action in the expertise of work developed in the late 1990s compassionate caring through the Dignity on the Ward campaign led by Belinda Dewar, Senior Nurse, Leadership in Help the Aged and the University of Sheffield and Compassionate Care Project, NHS Lothian, PhD discuss the applicability of this work in two projects student Napier University, UK promoting compassionate caring. The symposium will address the relevance of the concepts of rela- Within current debates about caring in nursing, tionship-centred care and the senses framework terms like dignity, compassion, holistic, individual- developed over a decade ago in developing ised, person centred, and relationship centred are dignified care within NHS hospitals today. used to describe the type of caring that is valued (Gallagher et al 2008). These terms are often used interchangeably. There is evidence to suggest Paper 1 that patients and their families do value care that focuses on them as a person. The challenge The Dignity on the Ward Campaign however is to identify what is needed to make this and Relationship-Centred Care possible in the organisational context of health Sue Davies and Mike Nolan, University of care and within the nurse patient relationship. A Sheffield, Sheffield, UK close examination of the processes that enable compassionate caring to flourish is the focus of this paper to see what is achievable and desirable to In 1999, the charity Help the Aged launched a staff, patients and their families. This project is part two-year campaign to promote good practice in of a larger action research project called the Lead- acute hospital care for older people. This session ership in Compassionate Care Project, a joint initia- will draw upon findings of a six-month research tive with NHS Lothian and Napier University. This project, carried out as part of the campaign, to part of the action research project took place on a identify good practice in acute hospital care from medicine of the elderly ward. The aim of the project the perspective of older people themselves. The was to identify what compassionate relationship findings of the ‘Dignity on the Ward’ research found centred care looks like from the perspective of the that older patients and their families placed a great staff, patients and families and to identify and test deal of emphasis on their relationships with ward out the processes that enable compassionate care staff, particularly nurses. The findings also suggest to flourish. that experiences of a stay in hospital can be greatly improved by attention to a range of often subtle The researcher used an appreciative inquiry factors. The research team found that the most approach over a period of 10 months in this setting effective care is that which creates an experience and used a range of methods which included, of well-being, both for older people and those stories using emotional touchpoints, observation, working with them. These factors can be consid- and analysis of learning from action learning. Data ered in terms of six ‘senses’: was analysed and themes developed. Using the framework of relationship centred care a process A sense of security then followed which challenged the extent to A sense of significance which each theme could have resonance for staff, A sense of belonging patients and families. The value of this approach A sense of purpose will be discussed particularly in relation to helping us to better understand the theory of relationship A sense of continuity centred care in practice. A sense of achievement References: If older people and their family carers experience these ‘senses’ then they are likely to perceive Gallagher A Li S Wainwright P, Rees Jones I Lee care in a positive light. Importantly, the research D (2008) Dignity in the Care of Older people – A found that the most positive experiences of care Review of the Theoretical and Empirical Literature happened in areas where staff also experienced BMC Nursing 7:1, http://wwwbiomedicalcentral. these six senses. The research suggested that com/1472-6955/7/11 relationships are a critical component of working

36 Symposia

Paper 3 Symposium 6 where the capacity to consent to treatment is an issue, due to cognitive impairment and commu- Applying the Senses Framework Developing the evidence-base to nication disorders (Dye et al. 2004). Scotland has beyond its gerontological origins – improve the care and treatment of developed capacity legislation that aims to protect what is this framework’s currency in people with intellectual disabilities vulnerable groups from participating in research helping to promote dignity in acute without safeguards to ensure care is provided attending general hospitals within the context of a set of principles. general hospital care today? Michael Brown, School of Nursing, Midwifery and Health Care, Napier University, Edinburgh, UK Aims: This paper will set out the evidence of Mary Flatley and Charlotte Wilkinson Lead R&D health needs and the Scottish legislative context in Nurses: Dignity in Care City University, London, UK Co-authors: Margaret Sowney; Juliet MacArthur; Ruth Northway relation to capacity and consent to treatment. Methods: A small-scale research study involving The two earlier papers in this symposium have [email protected] people with severe intellectual disabilities (n = 10) discussed the origins of the senses framework was undertaken to test a tool aimed at identifying associated with the Dignity on the Ward campaign The symposium will present research findings distress while attending for general hospital care. led by Help the Aged and concepts of relationship that focus on people with intellectual disabilities centred care in action to promote compassionate attending for general hospital care. The population Results: Recruiting the 10 subjects with severe care practices. In this final paper, we will discuss of people with intellectual disabilities is increas- intellectual disabilities to the study proved difficult the applicability of these concepts to the wider ing, with more living into old age with a diverse and the aims were not achieved, due to the capacity hospital system in a two year project seeking range of complex health needs and as a conse- and consent challenges despite the legislative to promote dignified care across two large NHS quence many are high users of general hospital framework. Trusts. This work builds on the Dignity on the services. This contemporary issue has been the Discussion: The challenges involved in people Ward campaign undertaken in the late 1990’s and subject of a significant policy focus due to failures with severe intellectual disabilities participating in will describe the applicability of that campaign in general hospital service, that have resulted in research studies due to their inability to consent over a decade ago and its currency for acute care preventable and premature deaths. There is a need independently will be detailed and the impact on practitioners today. Developing dignified care is a to better understand the distinct care needs of increasing the research evidence-base for this major goal within the current NHS agenda, and it people with intellectual disabilities attending for population. general hospital care. The three symposium papers will be argued that earlier work in this field should Conclusions: The current Scottish capacity legis- be adopted to help build, inform and develop present a set of linked issues that will provide an overview of the health needs of the population and lation acts to safeguard and protect while at the current understanding and practice developments. same time potentially excluding those with more However, this earlier work requires consideration the challenges involved in recruiting cognitively impaired participants to participate in research, severe cognitive impairment from participating in within the current NHS milieu e.g. four hour waiting research that may be benefit. time targets in Accident and Emergency depart- despite legislative frameworks. The papers will ments, and how this shapes practitioners under- set out evidence on the issues affecting nurses References: in emergency care settings and provide data on standing of dignified care and currency of the Department of Health (2008) Healthcare for All: service models that are being evaluated, that aim senses framework today. The paper will report on Independent Inquiry into Access to Healthcare for to improve the health outcomes for this group. The action research developments in promoting dignity People with Learning Disabilities. London: Depart- symposium will draw together some of the chal- from the two acute NHS trusts after seven months ment of Health. of research activity. lenges that need to be overcome to develop the evi- dence-base necessary to inform nursing practice in Dye L., Hendry S., Dougal J. & Burton M. (2004) This paper will describe: general hospital settings, bring about equal health Capacity to Consent to Participate in Research: A • An overview of this two year project to promote outcomes and improve health and wellbeing of this Reconceptualisation. British Journal of Intellectual dignity in hospital care vulnerable group. Disabilities 32, 144–149. • The recruitment of participants NHS Health Scotland (2004) People with Learning • The senses framework and its currency for Disabilities in Scotland: The Health Needs Assess- research participants ment Report. Glasgow: NHS Health Scotland. Paper 1 • The relevance of the senses framework to sup- porting changes that promote dignified care in Research involving participants non specialist elderly care environments with significant cognitive Paper 2 impairment: Issues of capacity to Caring for people with intellectual consent disabilities in the emergency care M. Brown ([email protected]) Nurse Consultant, NHS Lothian & Lecturer, School of setting: A focus group study Nursing, Edinburgh Napier University, Edinburgh, Margaret Sowney, ([email protected]) UK Programme Director, Jordanstown Campus, University of Ulster, Antrim, Northern Ireland

Abstract: Abstract: Background: There is increasing evidence of the differing health profile and needs of people with Background: People with intellectual disabilities intellectual disabilities when compared to the are increasingly in contact with healthcare profes- general population (NHS Health Scotland 2004). sionals in the emergency care service (Sowney et There has been a recent policy focus on their care al. 2006). First contact can occur in the emergency experiences in general hospitals and the issues that setting along with a diverse range of other patients. contribute to their poor care and premature death To date experiences of people with intellectual (Department of Health 2008). As a consequence of disabilities attending general hospitals has been their complex health needs many access services reported as negative (Iacono & Davis 2003). The evidence-base is therefore limited regarding the

37 Symposia

experiences of nurses working in general hospitals Paper 3 Differ and Need to be Recognised and Met. British and the nature of the challenges they encounter, in An analysis of the impact of Medical Journal 239, 414-415 providing care to people with intellectual disabili- McConkey R. & Truesdale M. (2000) Reactions ties (Sowney & Barr 2007). Learning Disability Liaison Service of Nurses and Therapists in Mainstream Health Aims: This paper reports a study exploring the Models on addressing the health Sevices to Contact with People Who Have Learning experiences of nurses in emergency care units needs of people with intellectual Disabilities. Journal of Advanced Nursing 32, caring for people with intellectual disabilities. disabilities attending general 158-163 MENCAP (2007) Death by Indifference. Methods: Five focus groups were conducted with England: MENCAP. emergency care nurses (n=27) from five hospitals hospitals in Northern Ireland. The data were then coded, Juliet MacArthur ([email protected]. analysed and recurring themes identified. uk) Values Based Practice Project Manager & Results: This paper focuses on two themes: limited Lead Practitioner Research, NHS Lothian, Royal knowledge of the nature of intellectual disability Infirmary of Edinburgh, Little France, Edinburgh, and the dependence on carers by nurses to provide UK personal care. Discussion: The themes identified have been Abstract: acknowledged in the existing literature; however Background: People with intellectual disabilities they have received limited attention and explora- experience significant health inequalities when tion. The experience of fear and vulnerability was compared to the general population (Cooper considered by participants to be a consequence of et al. 2004). Evidence suggests that some can their lack of knowledge. This limited of understand- experience barriers accessing hospital care and ing of nurses emergency care settings weakens the that professionals may experience difficulties opportunities to reduce the barriers to providing in assessing and identifying their health needs an equitable service for people with intellectual (McConkey & Truesdale 2000). ‘Death by Indiffer- disabilities. The experience of these emotions is ence’ published by MENCAP (2007) highlighted the viewed as a key factor in nurses’ over-dependence tragic consequences that can occur when safety is on patients’ informal carers. compromised within general hospitals. Key issues Conclusions: Increased awareness and education identified are that ignorance, indifference and is needed among professionals in accident and institutional discrimination significantly under- emergency units of the abilities and needs of mines people with intellectual disabilities’ right to people with intellectual disabilities. equity of healthcare access and the opportunity to achieve positive health outcomes. NHS Lothian References: has been at the forefront of developing inclusive Iacono T. & Davis R. (2003) The Experiences of health services for people with intellectual disabili- People with Developmental Disability in Emergency ties, establishing the first liaison-nursing service Departments and Hospital Wards. Research in in 2000. Liaison Services have subsequently been Developmental Disabilities 24, 247–264. developed across the UK. Sowney M. & Barr O. (2007) The Challenges for Aim: The paper will present preliminary findings Nurses Communicating with and Gaining Valid from a mixed-methods Scottish population study Consent from Adults with Intellectual Disabilities comparing four liaison models. Within the Accident and Emergency Care Service. Results: Preliminary analysis of referral data over Journal of Clinical Nursing 16, (9) 1678-86. a 12-month period will be presented and health Sowney M., Brown M. & Barr O. (2006) Caring for profile of the intellectual disabilities population People with Learning Disabilities in Emergency detailed to provide a comparison of the general Care. Emergency Nurse 14, (2) 23-30 hospital utilisation and the delivery of the liaison models. Inferences will be drawn as to how liaison- nursing services can respond to the policy impera- tives that demand focus on reducing health ine- qualities in the learning disability population. Discussion: The issues raised by this investiga- tion will be deliberated alongside qualitative data presenting the perspectives of the learning dis- ability liaison nurses who deliver the service. The wider study also involves focus groups and inter- views with health care professionals, patients and carers, however, this data will not be presented at this stage. Conclusion: Liaison services are increas- ingly being recommended as a model of care for general hospital services. It is essential that they are developed in a way that is responsive to health needs and local context. References: Cooper S-A, Melville C. & Morrison J. (2004) People with Intellectual Disabilities: Their Health Needs

38 Symposia

Paper 1 These reflect the historical background to clinical Thursday 26 March 2009 trials and the paternalistic approach to health care Consulting with children and young provision and to research that continues to pervade Symposium 7 people about research much of modern health care. Consultation with Researching with children: A Lorna A Fern. Research & Development children and young people is now established as Co-ordinator, NCRI Teenagers and Young Adult an important component of major developments; spectrum of participation Clinical Studies Development Group, Department indeed, funding often depends upon demonstrating Christine Moules, Faculty of Health and Social of Oncology, University College Hospital, London, successful engagement with the end user. Local and Care, Anglia Ruskin University, Cambridge, UK UK national initiatives to involve children more com- Co-authors: Lorna A Fern; Margaret Fletcher; Jane prehensively in clinical trial work remain fledgling Coad and run far behind initiatives for involving adults. Abstract: [email protected] The combination of the carrot and stick approach Working with patients as partners in research and already influences grant giving bodies in clinical Participation by children in research is a relatively guiding research strategy is directed by national research, it may start to change attitudes and lead new phenomenon. It is evidenced by a consider- policy. The National Cancer Research Institute to a better informed public as well as a clinical work able shift in methodological approaches from (NCRI) and National Cancer Research Network force better prepared to involve children and young those who see children as ‘objects of concern’ and (NCRN) have a ‘consumer’ model whereby up to people and their families from the outset. This passive recipients of adult socialisation towards three patients or patient representatives attend paper will explore in detail some of the reasons why those who acknowledge children as social actors in tumour specific Clinical Study Group meetings, participation beyond that of research subject is still their own rights and engage them as active partici- advocating their patient voice. They belong to and a major achievement. In addition, myths behind pants in the research process (Christensen & James are supported by a wider NCRI Consumer Liaison non – involvement other than as research subject 2008). But deciding how to engage with children in Group which meets regularly. The NCRI Teenage will be discussed. Focussing on the stages of the the research process is less than straightforward. and Young Adult (TYA) Clinical Studies Develop- research process, from forming an idea through to There is a spectrum of ways in which they can be ment Group (CSDG) was established in 2005, a disseminating the results, examples from practice engaged from being consulted about research national Group promoting and developing research will be used to describe how barriers are being, or through to being peer researchers, each approach for patients aged 13-24 years with cancer. The could be, overcome. being dependent on context (Gibson 2008). This traditional model of NCRI/NCRN involvement was symposium will allow delegates to discuss the deemed to be unsuitable for this Group of patients many and varied ways of involving children and due to the spectrum of tumour types, broad age young people in the research process. It will bring range, and diverse ethnicity of patients aged 13-24 Paper 3 together a number of experienced child health years in the UK. Furthermore, the format of the researchers who will draw on their work, explore CSDG meetings would not deliver age appropriate The spectrum of activities that challenges they have encountered, and discuss information and could potentially be intimidat- seek to involve children and young how they overcame them. ing for some TYA. Rather than adapt the existing people in research model, the Group felt it was appropriate to allow At the end of the presentation delegates will be Jane Coad. Senior Research Fellow, Centre for Child the young people themselves develop their own able to: and Adolescent Health, University of the West of model of patient involvement. This paper describes England, Bristol, UK 1. Understand the different ways children and the development of this model, from conception of young people can be involved in research a ‘showcase day’ to the creation of core Consumer 2. Have explored common challenges and practical Consultation Group who disseminated the Group’s Abstract: solutions when deciding how to involve children research strategy to over 300 patients aged 15-24 The essence of Paper 3 is about the spectrum of and young people years. An electronic hand held questionnaire was collaborative activities that seek to involve children 3. Have had an opportunity to debate common used to gather feedback in addition to an email and young people. Collaboration is important as ethical and methodological issues that may arise address specifically set up to receive comments there is a need to develop ways of researching with when involving children and young people in and further ideas for research: ‘research4U@ or on children and young people based on their research cancer.org.uk’. The next phase of this model will individual abilities, rather than using what may be be to develop TYA specific training, delivering the Presenters will undertake thematic presentations termed ‘traditional and/or adult-based methods’ relating to consulting children about research, tools for young people to be confident in comment- that have been adapted to fit children and young working with children as respondents in clinical ing on research proposals and generating research people collectively as a group (Boyden & Ennew, trials, using participatory methods and working ideas. 1997; Christensen & James, 2008). Guiding princi- with children and young people as co-researchers. ples of participatory research, undertaken by the Following this a debate will take place, which will presenter with or on children and young people, will discuss the ethical and methodological challenges be shared using innovative methods for overcom- Paper 2 that researchers face when undertaking such work. ing such issues and challenges. To begin with, this paper will briefly outline the key contextual issues, The symposia will have much to offer research- Children and young people’s which emerged from a national literature review ers who regularly undertake children and young involvement in clinical trials around the reality of and degrees that children people’s research but it will also be of interest to Margaret Fletcher. Reader in Children’s Nursing, and young people are ‘really’ collaborating in the any researcher new to this field of research. Institute of Child Life & Health, United Bristol UK research health care settings (Coad & Houston, References: Hospital Trust, Co-director, South West Medicines 2007). A framework for the collaborative projects for Children Local Research Network, Bristol, UK Christensen P & James A (2008) Research with with or on children and young people in qualitative Children: Perspectives and Practice 2nd edn approaches will then be shared using two projects Routledge, Abingdon. Abstract: to exemplify this. Firstly, a project will be shared that was collaborative with children and young Gibson F (2008) Building a Culture of Participation: Clinical trials still struggle to embrace full participa- people not as co-researchers but rather included Young People’s Involvement in Research. In Kelly tion in the research process by children and their their input at every stage of the project such as in D, Gibson F eds. Cancer Care for Adolescent and families. Despite all the rhetoric and resources the planning, data collection and analysis. Young Adults. Blackwell Publishing Ltd: Oxford there remain fundamental reasons why this is so.

39 Symposia

Secondly a national Department of Health project project. Secondly some of the more practical chal- Symposium 8 will be discussed that was informed by children lenges will be shared including setting the research and young people but was performed by adults on agenda, collecting data and dissemination. The Clinical research nursing: Where children and young people with genetic conditions paper will conclude by sharing some thoughts from next? in home settings. Challenges such as planning, children and young people who have been involved Leslie Gelling, Faculty of Health & Social Care, resources and ethics will also be covered. Finally it in these and other research projects as research- Anglia Ruskin University, Cambridge, UK will be emphasised in the paper that the effective ers. Co-authors: Sue Boase; Kate Craig; Carol Dealey and active participation of children and young [email protected] References: people can only be achieved in an environment Alderson P (2001) Research by Children. Interna- that encourages their on-going involvement where Clinical research nurses play a significant role tional Journal of Social Methodology. 4(2); 139-153 equity and empowerment is valued. in successful clinical research but it is not clear Hill M (1997) Participatory Research with Children. References: how their roles might change in the future or how Child and Family Social Work. 2; 171-183. their true potential to influence clinical research Boyden, J. and J. Ennew (1997). Children in Focus – Moules T (2005) Research with Children who use might be realised. This symposium will comprise A Manual for Participatory Research With Children NHS Services: Sharing the Experience IN four linked papers that will examine the current Rädda Barnen, Stockholm. Christensen P & James Lowes L & Hulatt I (Eds.) Involving Service Users situation and will explore future possible directions A (2008) Research with Children: Perspectives and in Health and Social Care Research. London: for clinical research nursing. Practice 2nd edn Routledge, Abingdon Routledge The first paper, presented by Dr Leslie Gelling, will Coad, J; Houston, R (2007) Involving Children and examine the recently developed national Compe- Young People in the Decision-making Processes tency Framework for Clinical Research Nurses. It is of Healthcare Services. Action for Sick Children. hoped that this flexible framework will contribute London Department of Health (2004) National Paper 5 to the future training and personal development Service Frameworks for Children. DoH. London. needs of many clinical research nurses in research A spectrum of participation – settings throughout the UK. The subsequent three discussion papers will consider the future of clinical research All presenters nursing from three very different perspectives. Paper 4 In the first paper Sue Boase will consider clinical Children as our co-researchers: Following the presentations there will be an oppor- research nursing in primary care. Until recently participatory research – a spectrum tunity for delegates to critically debate the issues there has been limited involvement of clinical raised. This will provide an opportunity to discuss research nurses outside acute trusts but recent within a spectrum. methodological and ethical challe developments, including the formation of Primary Christine Moules, Director of Research Faculty of Care Research Networks, have highlighted the Health & Social Care, Anglia Ruskin University, need to expand clinical research into new areas Cambridge, UK and to expand the involvement of clinical research nurses. Abstract: Dr Kate Craig will then explore the contribution Prior to the mid 1990s studies that involved made by clinical research nurses in purpose built children and young people as co-researchers were Clinical Research Facilities. In a relatively short rare. In a review of the literature related to social period of time these facilities have demonstrated work research, Hill (1997) found few studies where a considerable contribution to the development of children had been involved as co-researchers in clinical research and clinical research nurses have the setting up of or conduct of the research. More played no small part in this development. recently there is growing evidence of the extent to In the final paper Dr Carol Dealey will consider the which children can be involved as researchers in complex situation in university departments where different parts of a project, and at different levels clinical research nurses frequently play a central (Alderson 2001). The extent to which children can, role as part of interdisciplinary teams. How such or want to, participate in a research project can roles might develop in the future is far from clear. vary throughout its duration (Moules 2005). Hence The symposium will conclude with an opportunity for professionals to work with young researchers for delegates to share experiences and to discuss successfully requires consideration of additional the future of clinical research nursing in the UK. methodological and ethical issues. In particular we need to consider whether we can work together on equal, informed and unpressurised terms. This paper will build on paper 3 by exploring some Paper 1 of these issues. This paper will begin by discuss- Competency framework for clinical ing a spectrum of ways in which children and young people can be actively engaged in the research research nurses process as researchers. Using examples from two Leslie Gelling, Senior Research Fellow, Anglia participatory research projects where children Ruskin University, Cambridge, UK and young people were the co-researchers, the presenter will focus on two main issues. Firstly the Abstract: paper will discuss the contention that ‘participa- The planning, undertaking, closure and reporting tion’ in participatory research can be usefully con- of high quality clinical research is dependent ceptualised in terms of the degree to which children upon the knowledge, skills and competence of and young people (both as individuals and as a the many individuals involved in making research group) make decisions, initiate action and direct a

40 Symposia

possible. These attributes are developed through • Explore the development of a Bank of clinical Paper 4 formal training, through supervision and mentor- research nurses Clinical research nurses in ship, through ongoing personal development and • Consider the potential of research ready general through experience gained in practice. This paper practices universities will provide an overview of the development of Dr Carol Dealey, Senior Research Fellow, University This paper will conclude by emphasising the con- the Competency Framework for Clinical Research of Birmingham, Birmingham, UK siderable potential of clinical research nurses and Nurses. Developed by an International Working research trained primary care nurses to support Group, this Framework covers four key areas of and influence the development of clinical research Abstract: practice for clinical research nurses: in primary care. Clinical research nurses working in university • To demonstrate knowledge and understanding of departments can feel isolated. They are often on the evolution of clinical research short term contracts or will move between depart- • To apply knowledge and skills in the clinical ments making it difficult to communicate with them research environment Paper 3 or to create a sense of professional cohesion. In one • To work within, and adhere to, the requirements Clinical research nurses in clinical NHS Trust of 70 clinical research nurses 16 (22.9%) of research ethics, research governance and leg- research facilities were employed by the local university. Of these 16 islation nurses, 6 were the only nurse in their research team Kate Craig, Facility Manager and Senior Nurse and the remaining 10 worked in a team of clinical • To understand the principles and practice (R&D), Wellcome Trust Clinical Research Facility, research nurses. Most of those working in a depart- of obtaining and maintaining valid informed Cardiff, UK mental team were also working part-time with the consent. result that they frequently did not overlap their These four core competencies are further subdi- Abstract: working hours with research nurse colleagues. In vided into 11 essential competencies. This paper addition many of these clinical research nurses The first wave of Clinical Research Facilities (CRFs), will describe how these Competencies were are not managed by nurses because they tend to funded by the Wellcome Trust, have become centres developed, will suggest how they might be used work in medical schools rather than departments of of excellence for the conduct of clinical research and will consider how they might contribute to the nursing. This can result in a number of challenges in the UK. These first five centres have now been future development of clinical for these clinical research nurses, including: followed by second and third generation facilities with similar aspirations. One of the main roles of a Clinical competence. A wide range of clinical com- CRF is to contribute to skill acquisition, both clinical petencies are required in clinical trials but access Paper 2 and research, for the clinical research nurses to training can be difficult because NHS Trusts working in the CRF and, in some instances, to act as often restrict training to their own employees Clinical research nurses in primary an expert resource to those clinical research nurses Professional awareness. It can be difficult to care working in other areas of the organisation. The maintain awareness of developments in the Sue Boase, Research Nurse Facilitator, General contribution of the ‘first wave’ CRFs to raising the nursing profession national profile and standard of clinical research Practice and Primary Care Unit, University of Personal development. There may be no budget nursing has been considerable and there are two Cambridge, Cambridge, UK available to support personal development and main reasons why the role of the clinical research some employers may be reluctant to allow nurses nurse in the CRF will continue to develop: Abstract: to attend in-house training Increased regulation of Phase I clinical research Clinical research nursing is currently developing Constant short term contracts. These frequently following the Northwick Park incident and the sub- rapidly in Primary Care supported by the UK Clinical make clinical research nurses feel undervalued and sequent Duff Report Research Network (UKCRN) and Primary Care always considering future career options The ever increasing demand for translational Research Networks (PCRN). To date the General Career Structure. There is often no real career research and experimental medicine, which have Practice Research Framework (GPRF) nurses have structure for clinical research nurses and no clear the potential to transfer new technologies and played a key role in undertaking clinical research in view of how the recommendations of the Finch medications into humans for the first time general practice. Outside of the GPRF many nurses Report might change this situation have been involved in research studies, often in an Both of these drivers will have an impact upon This paper will discuss these issues and consider ad-hoc way, with little support and even less recog- the skills and competencies required by clinical how the Finch Report could be used to provide the nition. Key developments for the future are aimed research nurses and will require novel ways of impetus to develop a meaningful career pathway at building a knowledgeable workforce of primary ensuring that individual clinical research nurses are for university-based clinical research nurses. care clinical research nurses that are equipped to able to acquire the skills and knowledge required support the increasing volume of research being to contribute to the important work of CRFs. This undertaken in primary care. Many research nurses paper will conclude with some suggestions for how are now employed by the new networks in order to this might be achieved. facilitate this. This paper will: • Consider the professional development of net- work-based clinical research nurses • Raise awareness of the PCRN and research oppor- tunities within the practice nurse community • Examine the training in research skills currently available to primary care nurses • Link the Competency Framework for Clinical Research Nurses to current practice in primary care • Consider the support and mentorship of primary care nurses involved in clinical research

41 Symposia

Symposium 9 Paper 1 Recommended reading: Is larval therapy an effective The emergence and clarification of Bradley M, Cullum N, Sheldon T. The Debridement of Chronic Wounds: A Systematic Review. Health and acceptable treatment for the research question Technol Assessment 1999; 3(17 (Pt 1). the treatment of venous leg Nicky Cullum[1], Professor and Principal Investigator (Presenter), Jo C Dumville[1], Research ulcers? Results from the VenUS II Fellow and Trial Coordinator, Gill Worthy[1], randomised controlled trial Research Fellow and Trial Statistician, J Martin Paper 2 Nicky Cullum, Health Sciences, University of York, Bland[1], Professor and Senior Trial Statistician, York, UK Christopher Dowson[2] , Professor and Senior The clinical effectiveness of larval Co-authors: Jo C Dumville; Gill Worthy; J Martin Microbiologist, Cynthia Iglesias[1], Research Fellow therapy Bland; Christopher Dowson; Cynthia Iglesias; and Senior Health Economist, Joanne L Mitchell[3], Jo C Dumville[1], Research Fellow and Trial Joanne L Mitchell; E Andrea Nelson; Marta O Microbiologist E Andrea Nelson[4], Reader and Coordinator (Presenter), Nicky Cullum[1], Soares; David J Torgerson Co Investigator, Marta O Soares[1], Research Professor and Principal Investigator, Gill Worthy[1], Fellow and Health Economist David J Torgerson[1], Research Fellow and Trial Statistician, J Martin Venous leg ulceration is a chronic and common Professor and Co Investigator on behalf of the Bland[1], Professor and Senior Trial Statistician, condition that is highly prevalent in older people VenUS II team. [1]Department of Health Sciences, Christopher Dowson[2], Professor and Senior and impacts negatively on quality of life. Larval University of York, UK [2]Biological Sciences, Microbiologist, Cynthia Iglesias[1], Research Fellow therapy, a traditional approach to wound manage- University of Warwick, UK [3]Micropathology Ltd, and Senior Health Economist, Joanne L Mitchell[3], ment, is widely used on venous leg ulcers and has Coventry, UK [4]School of Healthcare, University of Microbiologist E Andrea Nelson[4], Reader and been postulated to speed debridement, stimulate Leeds, UK Co Investigator, Marta O Soares[1], Research healing, reduce bacterial load and infection and Fellow and Health Economist David J Torgerson[1], eradicate MRSA. However until now the evidence Abstract: Professor and Co Investigator on behalf of the for the effects of larval therapy on venous ulcers VenUS II team. [1]Department of Health Sciences, Leg ulceration is a painful, chronic, recurring came from a small RCT (12 participants) which University of York, UK [2]Biological Sciences, condition that affects approximately 1% of people did not follow patients to healing. Furthermore, University of Warwick, UK [3]Micropathology Ltd, at some time in their lives. Leg ulceration is also existing evidence to support the postulated effects Coventry, UK [4]School of Healthcare, University of costly to health service and has been estimated of larvae on microbiology is largely from labora- Leeds, UK to cost the NHS £300 – £600 Million per year, tory studies. In this symposium we will present with nursing care being the main cost driver. Most findings from a large, nurse-led, multicentre RCT chronic leg ulceration is caused by underlying Abstract: that evaluated the effects of both loose and bagged venous disease. The management of venous leg larvae on leg ulcer debridement, healing and micro- Background: Larval therapy has been claimed to ulcers involves provision of sustained, graduated biology. The trial incorporated an economic evalu- remove slough and necrotic tissue, promote wound compression in the form of bandages or hosiery ation and a qualitative study of patient and nurse healing and reduce wound bacteria including and good wound care. It has long been believed perceptions of larval therapy. MRSA. We tested these claims in people with that good wound care includes the cleaning and sloughy and/or necrotic venous leg ulcers. The Background context to the study will be debridement of sloughy or necrotic wounds since Objectives: To compare the clinical effectiveness presented in paper 1 by Nicky Cullum, the Principal slough and necrotic tissue are thought to inhibit Investigator, in which we will outline how the trial of larval therapy with a standard debridement wound healing. Fly larvae have been observed to technique (hydrogel). question emerged from a systematic review and clean wounds since early history and the larvae of how decisions were made regarding the appropri- the fly Lucilia sericata are widely used as a debri- Methods: A pragmatic, three-armed randomised ate design of the trial. dement therapy in the NHS. A systematic review controlled trial comparing hydrogel, loose larvae An overview of the trial design, conduct and its published in 1999[1] identified the lack of good and bagged larvae. Patients with venous or mixed clinical findings will be presented in paper 2 by Jo evidence supporting the role of debridement in aetiology ulcers with at least 25% coverage of Dumville, the Trial Coordinator. promoting chronic wound healing and an absence slough and/or necrotic tissue were eligible. The primary outcome was time to complete healing The design and conduct of the economic evaluation of trials evaluating larval therapy. The review also identified a need for robust evaluation of debriding of the largest eligible ulcer. Secondary outcomes will be presented in paper 3 by Marta Soares, the were: time to debridement, health related quality of trial health economist. agents including larval therapy. The UK HTA Programme subsequently invited bids to conduct life, bacterial load, presence of MRSA and adverse Finally the qualitative investigation of patient and such a trial. In preparing a bid to undertake this events (including ulcer related pain). nurse perceptions will be presented in paper 4 by research the team had to Results: 267 participants were recruited. There Dorothy McCaughan. a) establish an appropriate, multidisciplinary was no statistically significant difference in time to In presenting the trial in this way we will demon- research team healing between either loose or bagged larvae and strate how large, multicentre trials can answer hydrogel (hazard ratio (HR) for healing for all larvae important nursing questions; will illustrate the b) choose a formulation of larval therapy for evalu- vs. hydrogel 1.13, 95% CI: 0.76, 1.68: p=0.54). complexity of designing and running such large ation Larvae significantly reduced the time to debride- trials and how qualitative data collected within a c) identify a suitable comparator treatment that ment (HR 2.31, 95% CI 1.65, 3.2: p<0.0001). There large RCT can illuminate important phenomena. would be clinically relevant and acceptable was no significant difference between larvae and d) design the main study including selection of hydrogel in terms of impact on health-related quality primary and secondary outcome measures of life using SF-12 or change in bacterial load. Only 6.7% of participants had MRSA at baseline. There e) design sub-studies including a qualitative study was no evidence of a difference between larvae and of the perceptions of patients and nurses about hydrogel in their ability to eradicate MRSA by the larval therapy and a quantitative microbiological end of the debridement treatment phase (p=0.34). study People treated with larval therapy had significantly This paper will outline the processes involved in more pain (p<0.001) at the removal of the first planning a large scale evaluation of larval therapy debridement treatment compared with hydrogel; and set the scene for the subsequent papers. mean pain scores for both loose and bagged larvae

42 Symposia

were approximately twice those of the hydrogel £8,826 per QALY gained and £40 per ulcer free day. [Briggs, M, Flemming, K. Living with Leg Ulcera- participants. These estimates were associated with a high level tion: A Synthesis of Qualitative Research. Journal of Discussion/Conclusions: Larval therapy did of uncertainty. Advanced Nursing 2007; 59: 319-328 not increase the rate of healing of sloughy or Conclusions: The nature of the uncertainty associ- Spilsbury, K, Cullum, N, Dumville, J, O’Meara, S, necrotic venous leg ulcers or reduce bacterial load ated with our results indicated that larval therapy Petherick, E, Thompson, C. Exploring Patient Per- compared with hydrogel but significantly reduced is likely to be as costly and as effective as hydrogel ceptions of Larval Therapy as a Potential Treatment the time to debridement. however the use of larval therapy may be justified for Venous Leg Ulceration. Health Expectations in those cases where there is a need for rapid 2008; 11: 148-159. [3] Ritchie J, Lewis J (eds). Quali- wound debridement eg, in preparation for surgery. tative Research Practice: A Guide for Social Science Students and Researchers. London: Sage, 2003 Paper 3

The cost-effectiveness of larval Paper 4 therapy for venous leg ulcers Marta O Soares[1], Research Fellow and Health Larval therapy: acceptability to Economist, (Presenter) Cynthia Iglesias[1], nurses and patients Research Fellow and Senior Health Economist, Dorothy McCaughan, Research Fellow, Department Jo C Dumville[1], Research Fellow and Trial of Health Sciences, University of York, UK on Coordinator, J Martin Bland[1], Professor and behalf of the VenUS II team. Senior Trial Statistician, Nicky Cullum[1], Professor and Principal Investigator, Gill Worthy[1], Abstract: Research Fellow and Trial Statistician, Christopher Dowson[2], Professor and Senior Microbiologist, Background: Leg ulceration is frequently associ- Joanne L Mitchell[3], Microbiologist E Andrea ated with significant negative impact on quality of Nelson[4], Reader and Co Investigator, David life.[1] Treatment using larval therapy is an option, J Torgerson[1], Professor and Co Investigator but evidence regarding its acceptability to patients on behalf of the VenUS II team. [1]Department is limited and there is no evidence concerning of Health Sciences, University of York, UK [2] nurses’ views of larval therapy.[2] Biological Sciences, University of Warwick, UK [3] Objectives: To explore the health beliefs of patients Micropathology Ltd, Coventry, UK [4]School of and nurses in relation to larval therapy Healthcare, University of Leeds, UK To explore the acceptability of larval therapy as a leg ulcer treatment to nurses and patients Abstract: Methods: Interviews were conducted with 22 Background: The cost effectiveness of larval nurses and 18 patients (March 2007-August 2007). therapy as a treatment for sloughy and/or necrotic Purposive sampling ensured inclusion of people venous and mixed aetiology leg ulcers is unknown. with leg ulcers receiving treatment in different We undertook a cost effectiveness analysis clinical settings, from minority ethnic groups and alongside a multicentre RCT that compared larval people who had and had not experienced larval therapy with a standard alternative debridement therapy. Transcribed interviews were subjected to therapy (hydrogel). thematic analysis using the ‘Framework’ approach. [3] Objectives: To assess the cost effectiveness and cost utility of larval therapy compared with Results: Interview data revealed that the majority hydrogel for the management of sloughy and/or of patients (15/18) were willing to try larval therapy, necrotic leg ulcers with no preference for either bagged or loose larvae. Four out of 5 patients were satisfied with the Methods: The clinical evaluation identified no sta- experience of having larval therapy, and reported tistically significant difference in time to debride- a (short term) improvement in their ulcer. Accept- ment between the two forms of larval therapy and ability of larval therapy was high amongst the 22 therefore data from the two larval therapy groups nurse participants. Half the sample (11) stated that were pooled for the economic analyses. Costs they would have ‘no qualms’ about using it, while were estimated from the NHS and Personnel Social 9 nurses said they would overcome innate feelings Services perspective. Cost-effectiveness outcomes of distaste; only two nurses refused to handle were expressed in terms of incremental costs per ‘maggots’. ulcer free day (cost effectiveness analysis) and incremental costs per quality adjusted life years Discussion: Patients’ willingness to accept larval (cost utility analysis). The time horizon was one therapy concurs with previous research and may year. reflect their strong desire for amelioration or cure of their ulcer. This is the first study to highlight Results: 267 people were analysed by intention the importance of nurses’ feelings about applying to treat. Treatment with larval therapy was, on larvae, an important factor which may impact on average, £96.70 more expensive (95% CI £491.9 to the range of treatment options offered to patients. £685.8) than treatment with hydrogel. Participants Conclusion: Larval therapy was generally accept- treated with larval therapy healed, on average, able to both patients and nurses who believed that 2.42 days before those treated with hydrogel (95% it was effective in the debridement of leg ulcers. CI 0.95 to 31.91 days) and had a slightly better health related quality of life (0.011 QALYs, 95% CI – Recommended reading: 0.067 to 0.071). The incremental cost-effectiveness ratio for the base case analysis was estimated at

43 Symposia

Symposium 10 mentors and from the Wounds Group Coordinator question definitively, they can nevertheless guide by email or phone throughout the process. I have practitioners in the areas needed to conduct Systematic reviews with the learned research skills such as specific systematic research within a speciality. Infection Prevention Cochrane Collaboration: A review terminology and statistics as well as more is gaining prominence as a speciality and with the contribution to knowledge and generic skills of searching for evidence and litera- challenges of new pathogens and new technolo- ture appraisal, which can be applied to other areas gies, a good evidence base including systematic practice of my work. Since I have taken on a senior lecturer reviews is essential. Allyson Lipp, Faculty of Health, Sport and Science, role I am able to empathise with students as they University of Glamorgan, Glyntaf Campus, refine their academic work in readiness for submis- Pontypridd, UK sion. Interestingly, this is the first project I have Co-authors: Alex Holmes; Gail Lusardi embarked on purely for my professional develop- Paper 3 ment rather than for a specific qualification, which The academic value of systematic Background: Systematic reviews are a relatively makes it a truly academic endeavour. The chal- recent development within health care and are lenges of preparing the review have been a lack reviews highly rated in the hierarchy of evidence. Nurses of dedicated time in which to undertake the task, Allyson Lipp, Principal Lecturer, Faculty of Health, need to become more involved in their develop- but this is endemic in nursing. The steep learning Sport and Science, University of Glamorgan, ment, through such organisations as the Cochrane curve in acquiring the skills necessary has been Pontypridd, UK Collaboration, in order to contribute to knowledge. demanding combined with a fear of not ‘delivering Aim: This symposium aims to encourage the devel- the goods’. It certainly took me out of my comfort Abstract: opment of systematic reviews with the Cochrane zone, which was unsettling and yet stimulating. Aims: To demonstrate how systematic reviews have Collaboration by explaining the process from three Conclusions: The review process has enabled me provided academic development and enhanced a different perspectives; the novice reviewer, the to demonstrate clinical and more latterly academic programme of research. practitioner as reviewer and the academic reviewer. development. Background: Systematic reviews are a relatively Outline: The Cochrane Collaboration is a world- recent addition to the evidence base and quickly wide independent organisation which is dedicated became the gold standard providing they are based to ‘improving healthcare decision-making globally, on robust randomised controlled trials (NHS CRD, through systematic reviews of the effects of Paper 2 2003). healthcare interventions’. The symposium leader Answering specific questions in has developed three systematic reviews with the Outline: The process of preparing a systematic Cochrane Collaboration with three colleagues. clinical practice. review has the capacity to increase a variety of skills Each review has centred on infection control and Gail Lusardi, Senior Lecturer, Faculty of Health, required by academics. By preparing Cochrane Col- has come under the auspices of the Wounds Group. Sport and Science, University of Glamorgan, laboration reviews, I have learned the software and The symposium will comprise presentations from Pontypridd, UK have attended Cochrane Collaboration workshops. three authors giving their experiences of undertak- I have improved my systematic searching skills using a range of databases, Boolean operators and ing a systematic review. Abstract: MEsH terms in addition to critical appraisal of the Conclusions: Undertaking a systematic review is Aims: To explore how undertaking a systematic evidence. Examining a discrete body of evidence a valuable tool for professional development. It is review can benefit specialist clinical practice. has allowed me to enhance teaching and research recommended as a rewarding process, which has Background: As a specialist nurse in Infection Pre- expertise. In addition it has provided a way into the potential to impact on clinical practice and vention, questions arise in practice where there research. In producing a systematic review I have policy both nationally and internationally. may not be a clear answer. The field of Infection Pre- contributed to practice knowledge in relation to vention is broad and covers all aspects of patient surgical face masks, pre-operative skin antisep- care, staff welfare as well as support facilities. sis and prophylactic antibiotics in PEG placement. Paper 1 The systematic review can assist decision-making This has involved being invited to speak on the and guide the practitioner toward best practice by topics and inclusion in national and international Developing a systematic review: a answering questions which have been debated networks and policies. Dissemination of the novice’s view for years or guided by expert opinion rather than review’s findings has resulted in multiple publica- Alex Holmes, Senior Lecturer, Faculty of Health, research. tions and conference presentations for me and the Sport and Science, University of Glamorgan, Outline: Undertaking a review has increased my team. The reviews have contributed to programme Pontypridd, UK impetus to examine the evidence on which infection of research in acute care in the faculty and relevant prevention practice is based. It has enabled me to to the Research Assessment Exercise, which is in see the bigger picture in terms of evidence, rather the forefront of academic planning. I have mentored Abstract: than be deterred by the effort involved, or the lack and supported academic development undertaken Aims: To encourage novice researchers to of evidence. My systematic review looked at the through the constructive exercise of preparing a undertake a systematic review as part of an expe- benefit of antibiotic prophylaxis in PEG placement. systematic review rather than as a ‘paper’ exercise. rienced team. The idea for the review came after working with two Conclusions: Systematic reviews provide a contri- Background: My experience as a novice author of consultants, one of which gave prophylaxis and the bution to practice knowledge. However, by learning a systematic review began when I was an Infection other who did not on the basis that it increased the process of developing a systematic review Control Nurse in a local NHS trust. Because of my the risk of Clostridium difficile. Other debates in academics can augment their clinical knowledge clinical expertise I was invited to contribute to infection control such as the use of surgical masks, and research expertise which will benefit academia. preparing a systematic review on the effectiveness skin preparation for surgery and shaving pre-oper- of pre-operative antiseptics. atively have been considered for many years but Outline: I have learned a great deal undertaking now have systematic reviews on which to formulate my first systematic review. Developing a review practice and policy. This also provides a foundation with the Cochrane Collaboration provides a very to guide further studies. structured way of working which is ideal for the Conclusions: While the results of a systematic novice. Face-to-face support was available from my review are not always conclusive in answering a

44 Symposia

Symposium 11 Paper 1 Paper 2 Compassionate care in action: Bringing about sustainable Leadership in Compassionate Care Meeting the challenge of change with an appreciative Project: Strategies and challenges complexity eye – reflections, challenges and of feeding back and utilising Morag Gray, Faculty of Health, Life & Social outcomes emergent action research findings Sciences, Napier University, Edinburgh, UK Belinda Dewar, Senior Nurse, Leadership in within a NHS Health Board Co-authors: Belinda Dewar; Stephen Smith; Juliet Compassionate Care Project, NHS Lothian and PhD Stephen Smith, Lead Nurse, Napier University / MacArthur; Jayne Donaldson; Liz Adamson; Janis Student, Napier University, UK Moody; Linda King; Anne Waugh NHS Lothian Leadership in Compassionate Care [email protected] Project, Napier University, Edinburgh Abstract: There is a striking increase in emphasis in policy, Action research is an approach to research that Abstract: practice and research, about the importance of aims to bring about social change through action, Action research is an approach focussed on social caring in healthcare, particularly if quality care is to developing and improving practice, and at the change and organisations and the relationships be achieved as perceived by patients, families and same time generating and testing practice based and involvement of the researcher and participants staff. Recent national policy documents emphasise theory. A criticism of action research can be its (Hope and Waterman, 2003, Kemmis and McTaggart the need for care that is centred around relation- problem solving focus (Reed 2007). By focusing 1998). The nature of the organisation, its environ- ships, and core fundamental person centred caring on the negative this can create a sense of limi- ment and culture are key issues to consider in (Scottish Government 2007; Scottish Executive tation rather than possibility in research work respect of social change (Hart and Bond, 1995). The 2006 a,b; and Department of Health 2005). The that promotes change. Appreciative inquiry is an Leadership in Compassionate Care Project has suf- Leadership in Compassionate Care project is a three approach to research that focuses on exploring ficient duration, appropriate human resource and a year action research initiative that aims to embed with people what is valuable in what they do and core commitment to the transfer and implementa- compassionate care as an integral aspect of all how this can be built on rather than focusing on tion of evidence, to comment on a process of social nurse education and practice in NHS Lothian. It is a problems (Cooperrider et al. 2003). Within this change within the organisation. Key approaches joint initiative between Napier University Edinburgh action research study, examining compassion- aimed at achieving research implementation and NHS Lothian and has four distinct strands which ate person centred caring, the researchers act as involve: providing continuous feed back of findings, deliberately span across and connect education appreciative enquirers, working with staff, patients engaging stakeholders from different levels within and clinical practice. The project strands include: and families to understand compassionate care in the organisation and shaping the presentation embedding the principles of compassionate care Beacon wards. They work with practitioners to sys- of evidence to enable meaningful transfer within into the undergraduate curriculum, supporting tematically discover the best of what is and what clinical practice. At an operational level, examples newly qualified nurses, establishing NHS centres of has been (Grant and Humphries 2006). An overview of this include the use of action learning and both excellence in compassionate care (Beacon Wards) of this approach and its place in action research will informal and proactive sharing of practice devel- and supporting development of leadership skills be discussed as well as a description of the reflec- opments with practitioners. A project reference in compassionate care. This symposium comprises tions of the team (researchers and co-researchers) group consisting of members of the public, profes- of 4 interlinking papers which aim to demonstrate using this approach. Challenges to adopting this sional carers and partnership representatives has the complexities and challenges of using apprecia- approach will be debated including, dealing with focused on the process of transferring evidence tive enquiry and realistic evaluation; demonstrate the negative, the place of this approach in an into practice. This project is equally concerned with the inclusive involvement across all levels of both organisation such as the NHS, false consciousness, compassionate care within education and practice, an NHS Board and a Higher Education Institu- being critical and being positive, and the emotional therefore the issue of utilising findings, crosses tion; share new knowledge from early milestones energy associated with the act of appreciating. Case both clinical and educational boundaries. This within the project and explore horizon gazing in studies presented will illuminate these challenges, paper will identify and critically analyse the strate- respect of moving from compassionate care being and share possible outcomes of this approach on gies employed by the research team to inform and exceptional to becoming routine practice. A thread leadership, and empowerment. By exploring the engage a range of stakeholders to change practice running through all the presentations is the idea challenges, this paper will develop further insights and implement emergent action research findings of working with a complex evolving system – we into the practicalities of using this approach in con- within the organisation, but also how this strategy find ourselves needing to treat each situation as tributing to the development of knowledge in the requires continual review and analysis in response unique and realising that ultimately what comes area of changing health care practice – a difficult to project developments and an ever changing NHS out as actions or outcomes is determined by the nut to crack. It will conclude by exploring the possi- setting. relationship with people and the organisation. bilities of using the idea of positive inquiry in other The symposium will conclude using photo voice to research, policy and practice endeavours. References illuminate the team’s reflections on the complex- Hart, E., Bond, M. (1995) Action research for health References: ity, challenges and learning and their impact on and social care Open University Press Buckingham practice and education. Cooperrider, D. L., Whitney, D., and Stavros, J. Hope, K., M. (2003) The appreciative inquiry handbook. Waterman, H. (2003) Praiseworthy pragmatism? References: Bedford, OH: Lakeshore Communications Validity and action research Journal of Advanced Department of Health (2005) ‘Now I Feel Tall’ Grant, S., and Humphries, M. (2006) Critical evalu- Nursing 44 (2) 120-127 London, Department of Health Department of Health ation of appreciative inquiry. Action Research 4 Kemmis, S., McTaggart, R. (Eds) (1998) The Action Scottish Executive (2006a) Delivering Care, (4) 401-418. Reed J (2007) Appreciative Inquiry: Research Planner Deacon University Press Victoria Enabling Health. Edinburgh, Scottish Executive research for change Sage: Thousand Oaks London Scottish Executive (2006b) Rights, Relationships and Recovery: The Report of the National Review of Mental Health Nursing in Scotland. Edinburgh Scottish Executive Scottish Government (2007) Better Health Better Care http://www.scotland. gov.uk/Publications/2007/12/11103453/0

45 Symposia

Paper 3 Paper 4 Essential Skills Clusters for Nursing and Midwifery. Accessed at http://www.nmc-uk.org/aArticle. Methodological approaches to Embedding leadership in aspx? ArticleID=2553 {on 31/10/08] examine the organisational impact compassionate care into Maben J & Griffiths P (2008) Nurses in Society: of the Leadership in Compassionate undergraduate nursing and Starting the debate. National Nursing Research Care Project within the NHS: a midwifery curricula: Initial findings Unit, Kings’ College, London realistic evaluation from an action research study Juliet MacArthur (MSc; BSc; PG Cert Ed.; RN) Dr. Jayne Donaldson (PhD, MN, BN, PGCE, RN) Lead Practitioner Research, NHS Lothian and PhD School Director of Academic Development student Napier University, Edinburgh, UK (Undergraduate), School of Nursing, Midwifery & Social Care, Faculty of Health, Life & Social Sciences, Napier University. Abstract: Co authors: Liz Adamson, Janis Moody, Linda King, Given the investment and significance of the Lead- Anne Waugh, Stephen Smith ership in Compassionate Care project there is a need to investigate its impact on the wider NHS Abstract: organisation. This paper will examine the meth- odological challenges presented by the concept of The initial phase of the action research project ‘compassionate care’ (Dietze & Orb 2000, Shantz aimed to explore lecturers’ and student nurses` (2007) itself, coupled with scale and complexity views, values, attitudes and their engagement of the organisation. It will present the potential in the principles of compassionate care within for Pawson and Tilley’s (1997) ‘realistic evalu- education and practice. Ethical approval was ation’ design to explore the interplay between gained from Napier University Faculty of Health, organisational context and processes on potential Life and Social Sciences Ethics Committee. A theo- outcomes. The analysis is based on the early retical sample of lecturers and students in nursing stages of a PhD study that has a 3 year longitudinal and midwifery were used. design and employs qualitative research methods Data collection included 6 focus groups with involving a range of stakeholders to answer the lecturers and 4 focus groups with students. Data following questions: were transcribed and analysed using NVIVO and • How is compassionate care expressed within the analysed using the constant comparative method NHS? (Glaser and Strauss, 1967). The focus groups • What are the views, experiences and perceptions revealed the complex and often controversial of stakeholders of the Leadership in Compassion- meaning of ‘compassionate care’(Maben & Griffiths ate Care programme? 2008): emerging themes included, the ‘cost’ of providing compassionate care (resources and • What influence does organisational context play emotional) (Brilowskig & Wendler 2005); the innate on the delivery and outcomes of person-centred qualities of nurses (i.e. what can be learned?); the compassionate care? importance of maintaining professional distance • How are the processes employed within the while demonstrating compassion (NMC 2007); action research framework of the LCC team seen and personal/professional examples and stories to influence the outcomes in different clinical of compassionate care. Lecturers and students settings? agreed that there should be more emphasis within The initial starting point for a realistic evalua- the undergraduate programme on developing/ tion is utilising stakeholders’ knowledge, and the demonstrating compassionate care, including per- selection of appropriate stakeholders within a son-centred care and using service-users/carers complex social organisation is seen as being funda- within the curriculum. mental. Pawson and Tilley identify a number of key The presentation will provide some examples of agents – subjects, practitioners and policy makers service user involvement which have been used – who will create a set of different but complemen- within the undergraduate curricula as a result of tary views, and the study sample (n=21) is drawn these findings. Clinical practice was particularly from each of these groups. Emergent findings from influenced by role-modelling and compassionate Phase 1 of the data collection will be presented mentoring. The presentation will provide some and implications of this for future measurement of examples of good and poor role – modelling and impact will be discussed. There will also be reflec- mentoring and how these have been used within tion on the challenges presented by this type of the undergraduate curriculum and mentorship evaluation where there is inevitable proximity to preparation programmes. As part of the ongoing the project implementation team who are them- action research cycle, the next phase will involve selves research subjects in this study. evaluation of the actions described above and References: further development of the key themes within the Dietze, E. von, & Orb, A., (2000) Compassion- project. There will be reflection on the use of action ate Care: A Moral Dimension of Nursing. Nursing research methodology and the use of ‘stories’ to Inquiry 7, 166-174 provide evidence. Pawson R., & Tilley N. (1997) Realistic Evaluation. References Sage Publications Ltd: London Brilowskig A. & Wendler M.C. (2005), An evo- Shantz, M.L. (2007) Compassion: A Concept lutionary concept analysis of caring, Journal of Analysis. Nursing Forum 42 (2) 48-55 Advanced Nursing, 50 (6), 641-650. NMC (2007)

46 Concurrent session 1 Tuesday 24 March 2009

Theme: Mental health 1.1.2 1.1.3 1.1.1 Self-acupuncture as an alternative Physical health care in mental Delivering a smoking cessation to deliberate self harm: A pilot health practice: A literature review intervention for patients within a study Rebecca Rylance, 5 Boroughs Partnership NHS Trust and Angela Cotton, Edge Hill University, high security psychiatric setting: A Susan Davies, Department Of Psychological Medicine, North West Wales NHS Trust, Bangor, UK Liverpool, UK. focus group study Co-authors: Diana Bell; Fiona Irvine; Richard Tranter Co authors: Judith Ball and Annette Jinks Edward Duncan, Nursing Midwifery and Allied [email protected] Health Professions Research Unit, University of Abstract: Stirling, Stirling, UK Co-authors: Catherine Best; Carol-Ann Topping Abstract: It has been known for some years that people with severe mental illness often have poor physical Background: The incidence of deliberate self health. Explanations range from unhealthy lifestyle harm(DSH) cotinues to rise in the UK, often neces- Abstract: choices, to use of antipsychotic medication and sitating acute medical and mental health inter- factors inherent to the condition itself. As part of an Background: The serious negative impact of vention (Wilkinson et al 2002). Acupuncture is ongoing action research project which is focused on smoking on health and life expectancy is incon- potentially a less damaging and more acceptable an intervention designed to improve the physical trovertible (Doll et al 1994). People with enduring alternative to DSH. It may act through similar bio- health of a group of clients, a thematic review of mental health conditions have a significantly logical mechanisms to blunt emotional distress. higher smoking prevalence (40-83%) than the the literature has been undertaken. Searches were general population (22%) (Kalman et al 2005) with Aims: The aim of the study was to examine the undertaken of MEDLINE, PubMed, the Cumulative the highest prevalence amongst people detained in potential for using self-administered acupuncture Index to Nursing and the Allied Health Literature secure psychiatric settings (83%) (State Hospital as an alterative to DSH. (CINAHL) from 2003 to 2008. Inclusion criteria were Audit 2004). Given this it is imperative that people Methods: Ten adult patients who self-harm were English language literature published in the last who are restricted in their opportunities to use recruited to the study following baseline assess- five years that focused on physical health needs community resources and who have an enduring ment by a psychiatrist. An acupuncturist taught par- in mental health practice. In excess of fifty publica- mental health condition have access to specialist ticipants to self-acupuncture, ensuring competence tions have been reviewed. support to stop smoking. Little evidence about by using a pre-tested assessment schedule. Partici- One of the main policy drivers identified during the such specialist support currently exists. pants were visited weekly to offer support, provide course of undertaking the review was ‘Choosing Aims: To examine the process of developing more needles and collect sharps boxes. During the Health: Supporting the physical needs of people a service to support people who wish to quit six week intervention period, participants recorded with severe mental illness’ (DH 2006). Other lit- smoking whilst resident in a high security psychi- their thoughts and feelings in a diary. Post inter- erature review themes identified include equity of atric hospital. vention assessments were completed to establish access, healthy lifestyles, unmet physical needs, Methods: Four focus groups were conducted over clinical outcomes; and face-to-face interviews and improving physical healthcare in mental health a period of one year. Focus groups were consti- were used to explore participants perceptions of practice. There is an imbalance in focus within the tuted from nursing staff seconded to the smoking the intervention. Data were collected during 2008. literature, with attention directed at describing cessation service. Focus groups were transcribed Framework analysis of diary extracts and interview disparities of access and estimating the extent verbatim. Emerging themes were identified and transcripts (Ritchie and Spencer 1995) was used to of the problem. It was interesting to find that the verified using content analysis. This information identify common themes related to the perceptions concept of physical health in mental health practice was supplemented with individual patient inter- and experiences describedd. LREC approval was is multifaceted and literature themes address- views about their experience of the service. gained for the study. ing both health promotion and screening on one Results: It had been anticipated that encourag- Results and Discussion: We will report on the qual- end of the health continuum through to existing ing quit attempts would lead to increased patient itative data analysis of the diary cards and inter- physical health problems such as incontinence or aggression towards staff which did not in fact views. Three key themes emerged from the data, immobility at the other end of the continuum have occur. The instigation of the cessation service namely DSH, through which participants experi- been identified. However, strategies to address the promoted change in staff attitudes to smoking ences of self harm were revealed; ‘administration’ problem mainly stemmed from the statutory litera- and to patients that smoke. These attitudes were in which the practical issues associated with self- ture where good practice exemplars are frequently initially pessimistic and reactionary but evidence acupuncture were explored and ‘effects’ where given. Nevertheless most of the methodologies of success provoked revision which had a positive the outcomes of self-acupuncture were clarified. used in the literature reviewed utilised survey- impact. Specifically in this environment the closed We will give details of the findings, illustrate these type approaches with very little focusing on robust time-limited group format had to be modified to with data extracts and compare findings to the evaluations of interventions designed to address meet the variable needs of this client group. Close published literature. the problem. liaison between ward staff, pharmacy staff and the Conclusions: The findings show that self-acupunc- Recommended reading: cessation service was necessary to manage medi- ture is a feasible alternative to DSH. The pilot study cation issues effectively. Department of Health (2006) Choosing Health: will be developed into a full trial to further contrib- Supporting the Physical Needs of People with Discussion: This service provides an exemplar of ute to the advancement of clinical practice in the Severe Mental Illness. DH, London how specialist support for smoking cessation can area of DSH. be achieved for people with mental health condi- tions detained in high security. Recommended reading: Ritchie J, Spencer L.(1995) Qualitative Data Recommended reading: Analysis for Applied Social Research. In Analysing Doll R, Peto R, Wheatley K, Gray R, Sutherland I: Qualitative Data. (Eds. Bryman, A and Burgess, Mortality in Relation to Smoking: RG). Routledge, London pp 173-294 Kalman GD, Morrisette SB, George TP: Co-morbidity Wilkinson, S et al (2002) Admissions to Hospital of Smoking Inpatients with State Hospital (2004) for Deliberate Self Harm in England 1995-2000: Audit of Smoking Prevalence. The State Hospital, An Analysis of Hospital Episode Statistics. J Public Carstairs Health Medicine 24, 179-183

47 Concurrent session 1 – Tuesday 24 March 2009

Theme: Medication adherence Wester, W.C., Kim, S., Bussmann, H., Avalos, A., Recommended reading: Ndwapi, N., Peter, T., Gaolathe, T., Mujungira, A., 1.2.1 Wynd C, Schmidt B, Schaefer M (2003). Two Quan- Busang, L., Vanderwarker, C., Cardiello, P., Johnson, titaive Approaches for Estimating Content Validity. Factors infleuncing patients’ O., Thior, I., Mazonde, P., Moffat, H., Essex, M., & Western Journal of Nursing Research, 25(5), adherence to anti-retroviral therapy Marlink, R. (2005). Initial Response to Highly 508-518 in Botswana Haynes S, Kubany E & Richard D (1995). Content Valerie Ehlers, Department of Health Studies, Validity in Psychological Assessment: A Functional University of South Africa, Pretoria, South Africa 1.2.2 Approach to Concepts and Methods. Psychological Co-authors: Esther Kip; Dirk van der Wal Assessment, 7(3), 238-247 [email protected] Content validation of a medication adherence instrument – process and Abstract: outcomes 1.2.3 Elaine Lehane, School of Nursing and Midwifery, Background: Botswana supplies free anti-retroviral University College Cork, Cork, Ireland treatment (ART) to its citizens since 2005. Health visitors’ communications Co-author: Geraldine McCarthy The purpose of this study was to identify with parents about childhood Aims: [email protected] patient-centred and service-centred factors influ- immunisation encing adult patients’ ART adherence levels. Sarah Redsell, School of Nursing, Nottingham Abstract: University, Nottingham, UK Methods: A quantitative descriptive survey was conducted. Structured interviews were conducted Background: Content validity is a fundamental Co-authors: Helen Bedford; Aloysius Niroshan with a random sample of 400 patients attending step in the development of any new, high quality Siriwardena; Jacqueline Collier; Pippa Atkinson four randomly selected ART clinics in Botswana measurement instrument (Wynd et al 2003). A new during April and May 2007. The data were analysed patient focused adherence instrument has been Abstract: developed by the author to serve as a comprehen- using the SPSS version 13. Chi-squares and Background: In England uptake of primary immu- sive measure of the factors influencing medication- p-values were used to test the significance of the nisations is around 93% and MMR 85% [1]. Some taking in patients diagnosed with coronary artery relationships between categories or variables. parents find decision-making around immunisa- disease. In nursing research, concepts such as Results: Patient-centred barriers to ART adherence tion difficult and have unmet information needs [2]. adherence are often complex and difficult to accu- included inadequate knowledge about ART, HIV/ Research has investigated health professionals’ rately measure. Content validity studies offer a sys- AIDS, CD4 cell and viral load results; stigma; trav- views and knowledge about immunisation [3] but tematic mechanism for linking such abstract, multi- elling costs; waiting times at clinics; side effects less is understood about how they communicate faceted concepts with observable and measurable of ART; using traditional medicines and abusing with parents about immunisation. In the UK, health indicators (Wynd et al 2003). alcohol. Service-centred barriers included nurses’ visitors routinely provide immunisation informa- attitudes and knowledge; health care workers’ Aims: To describe the practicalities involved tion for parents, while GPs and practice nurses tend inability to conduct home visits and to contact in undertaking a methodological process to to administer vaccines and respond to parents’/ defaulters; limited clinic hours; waiting times of up assure the content validity of a newly developed carers’ questions. adherence instrument. to eight hours at clinics; delays in getting CD4 and Aims: This study explored health visitors’ percep- viral load results. Methods: The 52 item adherence instrument was tions of their role in the immunisation programme Discussion: Some of the identified factors subject to a panel review of 10 professional and lay with particular emphasis on influencing factors and impacting on patients’ ART adherence levels experts. Each expert was provided with the instru- communication strategies. ment and two content validity forms. The first form could be addressed cost-effectively. By providing Methods: Health visitors were purposively assessed item clarity with the second form evaluat- two months’ ART supplies at each visit, patients’ sampled to include those working with deprived/ ing item relevancy. Experts were also requested to waiting times and the demands on the clinics could affluent/high black and minority ethnic popula- provide suggestions for item exclusion/inclusion. be decreased by 50%. Providing transport tickets tions living in different kinds of locations (city, The Inter-Rater Agreement (IRA) and Content to patients and enabling nurses to conduct home rural, suburbs). Semi-structured interviews (n=22) Validity Index (CVI) were calculated. visits, and even to contact defaulters telephoni- were undertaken using a prompt guide. The tran- cally, could reduce the ART defaulter statistics in Results: The IRA and CVI for each item and the scribed interview data was coded using NVIVOTM Botswana. scale as a whole were calculated. The instrument and analysed for recurring themes. obtained an overall IRA score of .64, with 9 items Conclusions: ART adherence requires more than Results: Five key themes emerged. These were requiring major revision. The CVI for the overall free medicines. Adherence levels will improve if health visitors’ professional role; identity and scale was high at .91. both patient-centred and service-centred barriers barriers, health visitors’ communication strategies, are addressed, some of which might not require Conclusions and Recommendations: The parents’ right to choose, communications with major financial investments. accuracy of concept measurement in healthcare migrant families and MMR. has important implications for the prediction of Recommended reading: Discussion: This study found important differ- behaviour, the design of interventions and the ences in health visitors’ perceptions of their roles, Weiser, S., Wolfe, W., Bangsberg, D., Thior, evaluation of treatment effects (Haynes et al 1995). skills and knowledge and communication strate- I., Gilbert, P., Makhema, J., Kebaabetswe, P., Content validity studies provide objective informa- gies in relation to childhood immunisation. They Dickenson, D., Mompati, K., Essex, M., & Marlink, tion for the improvement of measurement instru- also perceived differences in their approach with R. (2003). Barriers to Antiretroviral Adherence ments. An understanding of content validation, in parents compared to that of other health profes- for Patients Living with HIV Infection and AIDS in terms of its methodological process and outcomes, sionals. Health visitors reported a loss of profes- Botswana is essential for nurses to adapt/create measures sional confidence in the wake of the MMR crisis and Ickovics, J.R., & Meade, C.S. (2002). Adherence to that are inclusive, valid, and simple for patients to most would have liked more support at the time. Antiretroviral Therapy Among Patients with HIV: A complete. Given the evidence that suggests some parents Critical Link Between Behavioural and Biomedical find it difficult to gain the information they need Sciences. The Journal of Acquired Immune Defi- about immunisation [2] and the changing culture ciency Syndrome, 31(3): S98-S102 of health care towards more patient choice, we

48 Concurrent session 1 – Tuesday 24 March 2009

feel that specific communication skills training is a policy Delphi study will then be discussed with with complete data collected from four patients. needed. consideration given to panel selection and recruit- Reasons for incomplete data included unavail- Conclusions: Better communication skills for all ment, defining the ‘expert’, quasi-anonymity, ques- ability to follow up after discharge, voluntary with- health professionals involved in providing immu- tionnaire formulation and revision between rounds, drawal, decline in physical and mental state and nisation information might reduce the impact of data analysis and feedback to panellists, respond- entry into another trial. Nevertheless, patients who another vaccine scare. ent fatigue, administrative concerns and timeframe took part in the study found the data collection management. The policy Delphi technique is an tools acceptable. Recommended reading: underused tool in nursing research, and used Conclusions: The study design, including The Information Centre. NHS Immunisation Statis- appropriately can provide an innovative approach recruitment strategy, was revised following the tics England 2006-2007. http: //www.ic.nhs.uk/ to investigating individual and group perceptions feasibility study. It addresses the issue: how to statistics-and-data-collections/health-and-life- of issues within the health care arena and the format a complex and lengthy assessment schedule styles/immunisation/nhs-immunisation-statistics- direction in which nursing should be moving. Meth- while minimising the impact on the participant england: – 2006-07-%5Bns%5D (accessed 31st odological and administrative observations of the population. October 2007) use of the technique will facilitate the promotion of its future use in nursing research. Recommended reading: Smailbegovic MS, Laing GJ, Bedford H. Why do Parents Decide Against Immunisation? The Effect Davalos A, Ricart W, Gonzalez-Huiz F et al (1996) of Health Beliefs and Health Professionals. Child: Effect of Malnutrition After Acute Stroke on Clinical Care, Health and Development 2003;29(4): 303-311 Outcome. Stroke 27, 6: 1028-1032 1.3.2 Henderson R, Oates K, Macdonald H, Smith WC. Gariballa SE, Parker SG, Taub N et al (1998) General Practitioners’ Concerns About Childhood Developing workable methods: Influence of Nutritional Status on Clinical Outcome Immunisation and Suggestions for Improving Pro- Aligning a research priority, after Acute Stroke. The American Journal of Clinical fessional Support and Vaccine Uptake. Communi- patient involvement and complex Nutrition 68, 2: 275-281 cable Disease & Public Health 2004;7(4): 260-6 Health Advisory Service 2000 (1998) Not Because assessments They are Old. London Susan Jones, School of Health and Social Care, University of Teesside, Middlesborough, UK Theme: Research methods Co-authors: Susan Jones; Sharon Hamilton; Lin Perry; Claire O’Malley 1.3.1 1.3.3 [email protected] The policy Delphi technique in Keeping concept analysis in context nursing education research: Abstract: – a confirmatory and validatory Personal insights into the Background: During the acute phase of stroke, process complexities and use of the deterioration in nutritional status and weight loss Patricia Gillen, School of Nursing, Faculty of Life & is common. Malnutrition has been associated with Health Science, University of Ulster, Jordanstown, UK technique increased morbidity, mortality and dependency Co-authors: Marlene Sinclair; George Kernohan Pauline Meskell, School of Nursing and Midwifery, after a stroke. Changes in taste and smell function [email protected] National University of Ireland, Galway, Galway, have been reported amongst some patients Ireland following stroke, and linked to poor dietary intake, Co-authors: Kathy Murphy; David Shaw Abstract: but have not been comprehensively explored after This methodological paper describes the confirma- [email protected] stroke. tory and validatory processes that were used to Abstract: Aims: To test the feasibility of a study protocol to anchor the concept of bullying within the context of measure taste and smell function in acute stroke Background & context: The Policy Delphi technique midwifery. The use of concept analysis allows the patients. is a variant of the conventional Delphi and differs in researcher to examine the structure and function terms that it does not unequivocally seek to find Methods: Patients were recruited from one Stroke of concepts (Walker & Avant 2005). However, a consensus but rather explores consensus and Unit between November 2007 and January 2008. Unsworth (2000) suggests that one of the criti- reasons for any lack of consensus thereby high- Data were collected at 3 time points; once the cisms of concept analysis is that it removes the lighting a range of options on a particular topic. patients were medically stable, once oral dietary concept from its context. Clearly the researcher This paper will examine the methodological and intake was re-established and one month post- needs to be aware of the context of the research administrative intricacies encountered while con- stroke. Data included assessment of taste and from the outset and to maintain this awareness of ducting a policy Delphi study investigating the smell function, appetite, nutritional status, 24 hour the context throughout. This context-intelligence clinical role of lecturers in nursing in Ireland. food intake and mood. Issues arising from protocol (Holloway 2005) is vital so that the researcher may delivery including barriers to recruitment and fully understand the life world of the participants Aims: To briefly review the mechanism of the Policy patient perspectives of data collection tools were and consequently the phenomenon that is being Delphi technique. To highlight methodological and recorded. studied is seen in its most appropriate context. In administrative factors to be considered when con- this research, Context intelligence was maximised ducting a policy Delphi study. Results: Recruitment from this vulnerable popu- lation, to a demanding assessment schedule, in two ways. Confirmatory focus groups were under- Outline of Main Content: The policy Delphi was challenging. Only seven out of eighty-seven taken with practising midwives, midwife managers, technique was used to investigate the percep- admissions were recruited over the ten-week academic midwives and union representatives tions of the key-stakeholder groups involved in period. Early discharge from the Stroke Unit, once (n=30) to validate and confirm the concept nurse education on the clinical role of the lecturer medically stable, reduced opportunities for recruit- analysis. Secondly, the attributes emerging from in nursing in Ireland. Policy Delphi was used in an ment; while many of those who remained were the concept analysis were tested using a question- attempt to reveal the whole spectrum of different too unwell to be approached. Furthermore, the naire survey with student midwives (n=164). This views and the polarity of these views within and protocol required stroke to be confirmed by CT presentation will focus on design issues including between the different stakeholder groups. A brief scan rather than clinical diagnosis, excluding many rigour, ethical challenges and interpretation. In review of the mechanisms of the technique will suitable patients. Seven participants were recruited addition, it will highlight the unique contribution of be initially considered. Experiences of conducting this research to knowledge.

49 Concurrent session 1 – Tuesday 24 March 2009

Recommended reading: Recommended reading: the integrative working of emergency and urgent Holloway, I. ed. (2005) Qualitative Research in Sheras, P., Abidin, R., & Konold, T. 1998. Stress care for children. Health Care England: Open University Press Index for Parents of Adolescents, Professionals Recommended reading: Manual. Psychological Assessment Resource, Inc., Unsworth, J. (2000) Practice Development: A Eccleston P, Werneke U, Armon K, Stephenson TJ, USA: Concept Analysis Journal of Nursing Management MacFaul R. (2001). Accounting for Overlap? An 8, 317-326 Application of Mezzich’s Kappa Statistic to Test Walker, L. O. and Avant, K.C. (2005) Strategies for Inter-rater Reliability of Interview Data on Parental Theory Construction in Nursing 4th ed. New Jersey: 1.4.2 Accident and Emergency Attendance. Journal of Pearson/Prentice Hall Advanced Nursing Why do parents attend emergency Healthcare Commission (2008). Not Just a Matter departments with children of Time: A Review of Urgent and Emergency Care Theme: Parenting presenting with minor illnesses? A Services in England. London. Office for National Statistics. (2004). Health for 1.4.1 survey Pippa Hemingway, ScHARR, University of Sheffield, Children and Young People. Provision of Use and Emotional well-being of parents of Sheffield, UK Services. Chapter 2. London adolescents who deliberately self Co authors: Ursula Werneke; Roderick MacFaul; Kate Armon; Monica Lakhanpaul; Terence harm Stephenson. Kenneth Sellick, School of Nursing and Midwifery, [email protected] 1.4.3 Monash University, Churchill, Australia Co-author: Jacqui Ward Experience of parents diagnosed [email protected] Abstract: with head and neck cancer who are Background: UK child A&E attendances are rising caring for young children with 3.5 million children attending A&E annually Abstract: Cherith Semple, Cancer Services, South Eastern (Office for National Statistics 2004). The Healthcare Trust NI, Belfast, UK Background: The increasing prevalence of young Commission (2008) reports that in order to support Co-author: Tanya McCance Australians who deliberate self harm is of national the integrative working of emergency and urgent [email protected] concern. Not only is deliberate self harm associ- care, more data on the patient /parent perspective ated with severe psychological distress for the ado- are required from specific groups. One vulnerable lescent, but can have adverse effects on the family. group are parents of children presenting with minor Abstract: Few studies have investigated factors associated illness who may attend emergency care for their Background: The incidence of head and neck with deliberate self harm and none have explored own logical reasons. cancer (H&NC) is steadily rising in the UK, espe- the emotional impact on parents. Aims: To determine the parental reasons for cially in the younger age groups. As a direct conse- Aims: This paper reports findings from a pilot study seeking emergency care for children presenting quence more parents of young children are being to determine the emotional well-being of parents of with minor illness. diagnosed with H&NC. adolescents who deliberately self harm and factors Aims: The aim of this study was to explore the that influence level of emotional well-being. Methods: Prospective questionnaire-based survey based on an opportunistic sample of parents experience of parents diagnosed with H&NC who Methods: Eighteen parents recruited through a of children with minor illness attending the are caring for young children. The objectives were rural Child and Adolescent Mental Health Service Emergency Department at Queen’s Medical Centre, to: – 1. explore what support was provided to assist in Victoria, Australia completed a self-report ques- Nottingham. Parents completed a structured ques- patients to function as a parent 2. identify who tionnaire designed to obtain socio-demographic tionnaire developed from prior qualitative work provided this support 3. explore perceived changes information on the parent and family; medical (Eccleston et al 2001). Uni – and bi-variate analysis in support needs for parents overtime in their details of the adolescent who self-harmed; and was conducted using SPSS ™. cancer journey. a measure of emotional wellbeing. Emotional wellbeing was assessed using selected subscales Results: In 2000, 272 parents of children aged 15 Methods: A qualitative descriptive design was from the Stress Index for Parents of Adolescents years or less were recruited over 12 months, 87% employed, using indepth one-to-one interviews (SIPA: Sheras, Abidin and Konold, 1998). Data were responded and the data were representative of as the method of data collection. The interviews collected during September, 2008 and entered into 8302 child medical attenders on key variables. The were unstructured with a topic guide to frame the SPSS for analysis. five variables most important to parents in deter- interview. Cognitive mapping was used to analysis the data. Results: Sample characteristics of parents and mining their need for paediatric emergency care adolescents who self-harm are presented; along were need for self-care advice (46%), sudden dete- Results: A total of 12 patients were interviewed. with emotional well-being scores of parents and rioration of the child’s condition (14%), parental At diagnosis the overriding emotion was fear; the analysis of factors influencing emotional expectation of expertise in the emergency depart- fear of ‘missing milestones’ and fear of ‘telling the wellbeing. Key findings include the prevalence and ment (9.3%), unsuccessful treatment attempts children’ about their diagnosis. Parents inevitable type self harm, the high percentage of parents with at home (9%) parental need to reduce their own stay in hospital during treatment led ‘to separation low emotional well-being, and the relationship of anxiety about their child’s illness (9%). from the children’ and the need to prepare their parent and child factors to emotional well-being Discussion: The decision to seek emergency ‘children for the first hospital visit’. Parents expe- scores. care for children with minor illness is based on a rienced many debilitating ‘effects of treatment’, Discussion and Conclusions: Findings are complex trade-off of illness related factors in the which impacted on family activities, especially discussed in relation to the frequency and type of child and psychological needs of the parents as those that involved eating. The experience of self-harm, identifying parents at risk for mental well as the need for access to practical advice. parents living with cancer gave them an increased appreciation of life, but simultaneously they were health problems, and the provision of child and Conclusions: Understanding those factors which living with many uncertainties as a result of their adolescent mental health services more attuned may make parents seek emergency care for cancer. After treatment parents had an overriding to the needs of parents. Recommendations are children presenting with minor problems may desire to re-establish a routine for family life. offered for a more extensive study of the psycho- assist in directing resources intended to support logical impact adolescent self-harm has on parents.

50 Concurrent session 1 – Tuesday 24 March 2009

Discussion and Conclusions: Parents’ revealed an approach to nurse prescribing, by some GPs. These appropriately, and clearly understand the limits of internal struggle that centred around their parental range from GPs stipulating times when they were their own competence. Confidence is a major factor, responsibilities and the impact of their diagnosis. available for professional dialogue, to direct super- related to the increased responsibility inherent in This study emphasised the need for increased vision and (dis) approval of a nurse prescribers’s prescribing. Their understanding of medication support with: sharing the news of their cancer activities. management has significantly improved, which has with their children, preparing children for their first Conclusions: Although nurse prescribing was wider beneficial consequences on patient care and hospital visit, financial support and adjustment to expected to enhance inter-professional working the teams they work within. living with cancer. and collaboration in the interest of improved Discussion: Organisational support for mental Recommended reading: service to patients, there is an indication that, for health nurse prescribing often takes the form of some nurses and GPs, relationships focussed on tightening up external governance structures or Barnes J, Kroll L, Burke O, Lee J, Jones A & Stein A. nurse prescribing are less than harmonious. Con- recommending further education prior to practise. (2000) Qualitative Interview Study of Communica- tribution to the development of knowledge and This research suggests that although governance tion Between Parents and Children About Maternal policy and practice within health and health care. and education are clearly vital for safe prescribing, Breast Cancer. British Medical Journal, 321: 479 – As a result of these research findings, relation- individual prescribers are very good at seeking out 482 ships within Primary Care may be re-evaluated. and meeting their own competency needs once Fitch, M, Bunston, TMSW & Elliot, MMD (1999) For educators there is an opportunity to explore practising. Organisational support of these needs When Mom’s Sick: Changes in a Mother’s Role and inter-professional relationships from a practitioner is the next step. in the Family after her Diagnosis of Cancer. Cancer perspective. Nursing, 22(1): 58 – 63 Recommended reading: Recommended reading: Elmberger E, Bolund C & Lutzen K. (2000) Trans- Snowden, A (2008) Quantitative Analysis of Mental forming the Exhausting to Energising of Being: McEvoy, P; & Richards, D. (2003) ‘Critical Realism: Health Nurse Prescribing in Scotland Journal of A Good Parent in the Face Cancer. Health Care A Way Forward for Evaluation Research in Nursing? Psychiatric & Mental Health Nursing, Volume 15, Woman International, 21; 485 – 499 Journal of Advanced Nursing vol 43, no.4 pp 411-420 Number 6, August 2008, pp. 471-478(8) Morrell, K. (2004) ‘Analysing Professional Work Strübing, J. (2007) Research as Pragmatic Problem in the Public Sector. The Case of NHS nurses.’ Solving: The Pragmatist Roots of Empirically Research Series Paper, no.1 Loughborough Univer- Grounded Theorising in Bryant, A. and Charmaz, Theme: Nurse prescribing sity. K. eds. (2007) The SAGE Handbook of Grounded 1.5.1 Theory London: Sage pp580-601 Negotiating the prescribing role: District nurses reveal strategies for 1.5.2 managing conflict The impact of mental health nurse 1.5.3 Richard Fisher, Faculty of Sports Science and Social prescribing in UK Nurse prescribing for patients with Studies, University of Chichester, Chichester, UK Austyn Snowden, School of Health Nursing & diabetes: Stakeholder views [email protected] Midwifery, University of West of Scotland, Paisley, Karen Stenner, School of Health and Social Care, Scotland, UK University of Reading, Reading, UK Abstract: [email protected] Co authors: Nicola Carey; Molly Courtenay Background: Nurse prescribing by District Nurses [email protected] is well established in the UK. Although consider- Abstract: able work has been undertaken which discusses Background: Mental health nurses who are licensed Abstract: nurse prescribing, there is little which focuses on to prescribe medication in Scotland differ from non Background: Appropriately qualified nurses in relationships between prescribers and those with mental health nurse prescribers. The difference the UK have virtually the same prescribing rights whom they interact, in particular the ways in which is both quantitative and qualitative (Snowden, as doctors and over 30% of nurses prescribe prescribing can appear to question established 2008). Although the quantitative findings may be medicines for patients with diabetes. Service professional boundaries. explained as artefacts of the history of non medical provision for patients with diabetes is expected to Aims: This project seeks to explain how District prescribing in UK the qualitative differences are not be enhanced by nurse prescribing, however there Nurses negotiate difficult conflicts related to pre- so easily explained. This current phase of the study is little evidence as to how this may occur or its scribing. therefore sought to explore the nature of prescrib- impact on other members of the healthcare team. ing in mental health nursing, and how it impacted Methods: Using qualitative semi-structure inter- Aims: To explore the views of doctors, receptionists on mental health nurses prescribing in practise. views, District Nurses, Pharmacists and General and non-prescribing nurses on how nurse prescrib- Practitioners explained their working activities Methods: Constructivist grounded theory was ing affects work patterns and the provision of care associated with prescribing. Data were analysed used to interpret all data (Strubing, 2007). In depth for patients with diabetes. after Morrell’s (2004) notion of naïve functional- interviews were conducted with 7 mental health Methods: Interviews with 9 doctors, 9 reception- ism. Critical realism, as espoused by McEvoy and nurse prescribers, 2 mental health nurse senior ists and 3 non-prescribing nurses were conducted Richards (2003) was used as a bridging strategy managers, 2 mental health nurse educators, 1 in 9 case-sites across England between 2007 and in order to link findings to the works of Weber and expert in nurse prescribing research and 1 con- 2008. Case-sites were chosen where a nurse pre- Foucault. sultant psychiatrist. The literature was subject scribed for patients with diabetes either in general to the same interpretist methodology. That is, all Results: For many District Nurses, prescribing practice (5) in hospital (2) or in community clinics data were subject to line by line coding, thematic appears unproblematic; however, for others there (2). Thematic analysis was conducted on the analysis and constant comparison. was evidence showing that GPs were explicit in the interview data. control they exerted over prescribers, even when Results: Mental health nurse prescribers demon- Findings: Participants reported that nurse pre- they had no authority to do so. strate competence through practise. They manage scribing improved service efficiency by reducing the complex concept of concordance by focusing Discussion: Despite having no legal ‘authority’ interruptions. Quality of care was reported to be on individual care. They stop as much medication over nurse prescribers, some prescribers reveal enhanced by nurse’s skill in communicating with practices that show a clearly authoritarian as they start. They seek advice and assistance

51 Concurrent session 1 – Tuesday 24 March 2009

patients. Doctors reported that nurse prescrib- Down’s syndrome is questionable in countries, Aims: This study explored the decision-making ing facilitates the national shift of diabetes care which legally or culturally oppose termination of processes of pregnant women with regard to into community settings and helps clarify lines of pregnancy. Professionals practising within environ- antenatal screening for Down syndrome. responsibility. There were mixed reports regarding ments such as this experience conflict in their role, Methods: An ethnographic research methodology the impact of nurse prescribing on workload. which affects communication with women when was adopted. A purposive sample of 11 pregnant Acceptance of nurse prescribing was dependent discussing screening tests. women was recruited from antenatal booking upon the extent of nurses’ prior experience and Conclusions: As midwives are often the primary clinics at a hospital in Northern Ireland. The awareness of their own limitations. health professional providing information to primary source of data collection was a solicited Discussion: Nurse prescribing was viewed as a women, it is important that midwives are key unstructured diary. Women used paper and elec- positive and welcome addition to the nursing participants in ongoing planning and discussions tronic diaries. Data from the diaries were clarified role. Although the uptake of prescribing had not about screening policy to ensure programmes are using interviews. Inductive analysis was under- markedly reduced workload for participants, it implemented successfully. taken using an established framework. was regarded as an important contributor towards Recommended reading: Findings: Five core concepts were identified. These service improvement for patients with diabetes. concepts were not a ‘bog-standard’ test; just one Green, J.M., Hewison, J., Bekker, H.L., Bryant, L.D. & This work contributes to our understanding of stage of a journey …; ‘liveable with’ levels of risk; Cuckle, H.S. 2004, ‘Psychosocial Aspects of Genetic how care for patients with diabetes within hospital perceptions of Down syndrome and, betwixt and Screening of Pregnant Women and Newborns: a and community settings can be enhanced through between. nurse prescribing. Systematic Review’, Health Technology Assess- ment (Winchester, England), vol. 8, no. 33, pp. iii, Conclusions: This study provides new insights ix-x, 1 into pregnant women’s complex decision-making processes about antenatal screening for Down Lewis, S.M., Cullinane, F.N., Bishop, A.J., Chitty, syndrome. The challenge for midwives is in facili- Theme: Midwifery L.S., Marteau, T.M. & Halliday, J.L. 2006, ‘A Com- tating meaningful and ethically sound engagement 1.6.1 parison of Australian and UK Obstetricians’ and that responds to the needs of pregnant women in Midwives’ Preferences for Screening Tests for Down making such decisions The perspective of midwives Syndrome’, Prenatal Diagnosis, vol. 26, no. 1, pp. offering down’s syndrome serum 60-6 screening Bishop, A.J., Marteau, T.M., Armstrong, D., Chitty, Jenny McNeill, School of Nursing and Midwifery, L.S., Longworth, L., Buxton, M.J. & Berlin, C. 2004, Theme: Research policy and practice Queen’s University, Belfast, UK ‘Women and Health Care Professionals’ Prefer- 1.7.1 Co-author: Fiona Alderdice ences for Down Syndrome Screening Tests: A [email protected] Conjoint Analysis Study’, BJOG UK Department of Health research strategy and funding: A Abstract: historical perspective and future Background: The decision to accept or decline 1.6.2 opportunities for nursing research screening for Down’s syndrome may present ethical Daniel Wolstenholme, Research Team, Sheffield or moral dilemmas for women and their partners An ethnography of pregnant Teaching Hospitals NHS Trust, Sheffield, UK in early pregnancy. Midwives are usually the key women’s decision-making [email protected] professional to offer serum screening for Down’s processes with regard to antenatal syndrome in the UK yet their perspective is rela- Abstract: tively neglected in the literature. As the first point screening for Down Syndrome in of contact for antenatal care midwives are ideally Northern Ireland This concurrent session will critically review the positioned to counsel women regarding antenatal Bernie Reid, Institute of Nursing Research, policy related to research funding and govern- screening, but the extent of their influence on University of Ulster, Derry, UK ance from the creation of the NHS through to the women’s decision-making is not clear and may be Co-authors: Marlene Sinclair; Owen Barr; Frank current changes in Research Governance and the complex. Dobbs; Grainne Crealey new research infrastructure. The key landmarks of this landscape being the National Research Ethics Aims: To explore the perspective of midwives [email protected] Service, the UK Clinical Research Collaborative and offering serum screening for Down’s syndrome in the Topic Specific and Comprehensive Research Northern Ireland Abstract: Networks and their impact on nurses and nursing Methods: exploratory qualitative interviews were Background: In Northern Ireland, it has been research. A fully defined national research strategy conducted with 29 midwives in Northern Ireland proposed that all pregnant women should be has only been in place since Best Research for Best involved in offering serum screening for Down’s offered second trimester screening for Down Health (DH 2006 ). Before this, there have been syndrome syndrome (National Screening Committee 2006). a series of initiatives to unpick the confused and Results: Midwives reported difficulty explaining Yet the momentum towards universal screening fails complicated process of funding and regulating the test to women and felt unable to provide the to adequately consider the complexity of the deci- research (Shergold & Grant 2008) all of which have necessary information to adequately inform women sion-making processes confronting women (Getz led us to the emergent National Research Infra- within their appointment time. The test offered (the and Kirkengen, 2003). There is a demonstrable lack structure we encounter today. triple test) and potential pathway of subsequent of understanding about women’s decision-making With this historical perspective in mind, this paper care, were identified as sources of professional (Williams et al. 2005) and with the development of will identify some of today’s key issues that can and personal conflict by midwives. The expecta- more sophisticated technologies it is imperative potentially benefit nursing and nursing research, tion that midwives would provide a universal offer that midwives have a more informed understand- namely: ing of the factors that influence women’s decision- of Down’s syndrome serum screening but yet be A national strategic direction to fund research unable to support women regarding termination of making before, rather than following, the adoption of routine screening in Northern Ireland. examining the second translational gap, an area pregnancy also created dissonance. of research in which nurses are uniquely placed to Discussion: The feasibility of proceeding with consolidate a strong position and lead multi disci- a universal serum screening programme for plinary, multi method research

52 Concurrent session 1 – Tuesday 24 March 2009

An explosion of opportunities for research nurses in building investments. The paper will draw upon Results: Research education was perceived by the new infrastructure, with a strong push towards annual evaluations obtained over a six year period some as promoting positive attitudes towards clearly defined career paths acknowledging the and an independent survey undertaken by the research and for others, discouraging farther contribution nurses make to clinical research. Health Foundation. However, the main focus will be research. The participants’ supported evidence These benefits are equally relevant for both on process issues. The medium term implications based practice by ‘consulting’ research findings clinical and academic nurses and in fact, partner- for career development will also be addressed as rather than ‘doing’ research. A close analysis of ships between these groups are a prerequisite for contact has been maintained with fellows over the the data revealed the following themes as deter- success in the new funding opportunities. Looking entire span of the project. The paper will conclude minants of conducting and implementing research: back, moving forward is the title of this year’s con- by mapping Consortium outcomes onto policy teamwork, time, opportunity, personal motivation, ference, the author of this session hopes to help debates such as those arising from the Report and conflicting work cultures. nurses make sense of and see opportunities in the of the UK Clinical Research Collaboration Sub- Discussion and Conclusions: The study develops rapidly changing present by understanding how the Committee for Nurses in Clinical Research (UKRC, understanding about graduate nurses and policies have developed over time. 2007). midwives attitudes towards research. The findings are discussed with reference to developing nursing Recommended reading: Recommended reading: and midwifery research in the trust. Key words: UKRC (2007) Developing the Best Research Pro- Department of Health (2006) Best Research for graduate nurses and midwives, conducting and fessionals – Qualified Graduate Nurses: Recom- Best Health – A New National Health Research implementing research, focus group enquiry. Strategy. London, Stationery Office mendations for Preparing and Supporting Clinical Academic Nurses of the Future. London: Depart- Recommended reading: Shergold, M and Grant, J. (2008) Freedom and ment of Health Need: The Evolution of Public Strategy for Bio- Cowman, S (2004) Commentary on Glacken, M & medical and Health Research in England. Health Chaney, D (2004) Perceived Barriers to Implement- Research Policy and Systems, 6(2) ing Research Findings in the Irish Practice Setting. Journal of Clinical Nursing, 13, 731 – 740 Finch, J. (2007) Developing the Best Research 1.7.3 Professionals Qualified Graduate Nurses: Recom- Sitzia, J. (2001) Barriers to Research Utilization: the mendations for Preparing and Supporting Clinical Graduate nurses and midwives Clinical Setting and Nurses Themselves. European Academic Nurses of the Future[online]. UK Clinical perceptions of conducting and Journal of Oncology Nursing, 5, 154 – 164 Research Collaboration Available from: http: // implementing research in one Wilkinson, S. (2001) Nurses Must Seize the www.lincoln.ac.uk health trust. Research Initiative. International Journal of Pallia- tive Care Nursing, Vol 7, No 1, p.4 Sherrill Snelgrove, University of Wales Swansea, School of Health Science, Swansea, UK 1.7.2 Co-authors: Ingaret Eden; Mandy James [email protected] Theme: Education and workforce Research capacity building in 1.8.1 nursing, midwifery and the allied Abstract: Training for CRC Cymru – the new health professions: A seven year Background: The progress made by nurses and review of the Consortium for midwives in research and development is consid- research infrastructure in Wales erable (Cowman 2004). However, a lack of support Joyce Kenkre, School of Care Sciences, University Healthcare Research of Glamorgan, Pontypridd, Wales, UK Bob Heyman, School of Human and Health from organisations and a lack of perceived authority Co author: Susan Figueirido Sciences, University of Huddersfield, Huddersfield, and skills have been shown to preclude implemen- UK tation of research (Sitzia 2001). Education has Co authors: Kathryn Davis; Jacqueline Fitzgerald; also been found to play an important role in the Abstract: formation of positive attitudes towards research Dinah Gould; Jill Maben Aims: To discuss the development of the training but there are concerns that post – graduate studies [email protected] strategy for all professions within the developing ‘gather dust’ and are not implemented because of research infrastructure in Wales nurses’ lack of confidence in their own research Abstract: skills (Wilkinson 2001).There is little known about Design: In 2005, the Welsh Assembly Government In response to a number of UK reports, the Health the perceptions of graduate nurses and midwives funded the development of a research infrastructure Foundation, a major UK charity, funded a major towards conducting and implementing research in Wales. The training and development strategy research capacity building programme in nursing, findings. The following study addresses this aims primarily to develop an expert workforce to midwifery and the allied health professions. important gap and presents qualitative data that support clinical and social care research in Wales. Following a national competition, £2,300,000 develops farther understanding about graduate Results: In Wales there has been funding for was awarded to the Consortium for Healthcare nurses and midwives perceptions of research. the support of ten thematic research networks. Research, a partnership of four universities based Aims: To explore graduate nurses and midwives These are been supported by infrastructure in South East England. An additional £350,000 views about conducting and implementing nursing services including: methodological advice, health was subsequently granted by the Burdett Trust for research in one NHS trust in South Wales, U.K. economics, health informatics, research govern- Nursing, allowing a total of 21 three year doctoral ance, equality and diversity and Welsh language Methods: A mixed methods design was used to and postdoctoral fellowships to be funded over awareness. There is also a co-ordinating centre collect data in 2007/8. Phase one consisted of a a seven year period, starting in 2003. Similar which provides support in the development of survey of all graduate nurses and midwives in a UK projects have subsequently been funded in a research professional network, portfolio man- South Wales NHS trust. Phase two consisted of Scotland and Wales. Fellowship activities have agement, links to industry, service user and carer three focus group discussions that concentrated been complemented by a leadership programme network and training and development. The farther on issues arising from the survey. Par- provided by the King’s Fund. challenge has been to develop an evolving training ticipants for the focus groups were recruited from programme for people with different backgrounds The proposed paper will critically review the Con- the questionnaire responses and by professional such as users of services, academia, clinical sortium project with respect to lessons learned contact. The following paper reports data from practice and laboratories covering a wide range of and implications for any future research capacity phase two that was subjected to thematic analysis.

53 Concurrent session 1 – Tuesday 24 March 2009

thematic network specialities and professional dis- erature describing policy and legislative difficul- Recommended reading: ciplines. Training is continually being evaluated and ties during establishment of reformative health- Moule P (2007) Challenging the Five-Stage Model highly rated. All comments are responded to espe- care roles. We argue for more efficient utilisation for E-learning: A New Approach. Association for cially for information, future training and specialist of NPs and legislative restructure to enable full Learning Technologies Journal (ALTJ) 15 (1), 39-52 needs from the thematic networks. Acknowledged practice privileges. This first census of Australian accreditation is being developed for all courses to NPs provides valuable information about a new European standards. level of healthcare services close to its inception. Conclusions: The training and development The findings have international significance in the of personnel at all levels is crucial to evolving context of establishment of new healthcare roles. research infrastructure to deliver research to inter- national standards, to ethical standards, and the creation of evidence to base future practice and 1.8.3 policy decision making. Recommended reading: Nurse and health care professional UK Clinical Research Collaboration (2006). Igniting education: How are we using the Potential. London: UKCRC e-learning? Pam Moule, Faculty of Health and Social Care, University of the West of England, Bristol, UK Co-authors: Rod Ward; Lesley Lockyer 1.8.2. [email protected] The first national census of Australian nurse practitioners Abstract: Anne Gardner, School of Nursing, Midwifery & Background: The research was conducted for the Nutrition, James Cook University, Townsville, Higher Education Academy Health Sciences and Australia Practice subject centre (HEA HS&P) to scope the Co authors: Glenn Gardner; Sandy Middleton; development and use of e-learning across nursing Phillip Della and health care professions. The uptake of e-learn- ing to deliver nurse and health sciences education varies across higher education institutions (HEIs), Abstract: but reasons for this variation have not been fully Background: The nurse practitioner (NP) role is examined (Moule, 2007). new to Australia. Importantly, the Australian role We aimed to survey e-learning implementa- has title protection and is clearly distinguishable Aims: tion in nursing and health science disciplines in the by legislation and scope of practice from other reg- UK and explore enablers and barriers to use. istered nurse roles. Methods: Following ethical approval, this mixed Aims: The aim of this study was to conduct the first methods study included a postal survey using an national census of Australian NPs. adapted tool from the Joint Information Systems Methods: A five section questionnaire was Committee (http: //www.mlestudy.ac.uk) and case developed, externally reviewed, pilot tested and study visits. From a sample of 95 HEIs, identified by mailed to all 234 Australian NPs authorised in the HEA HS&P subject centre, 25 responses (28%) 2007. were received. Descriptive statistics in the form of Results: An 85% response rate was achieved frequency tables were produced. Survey responses (N=202). Respondents had a mean age of 47.0 were also used to identify four case study sites, years and 84.2% were female. Only 145 NPs (73%) where data was collected from staff and students reported being employed in Australia at the time through interviews and focus groups. Qualitative of the census. Emergency NPs were the most data were transcribed and thematically analysed. common model employed nationally (26.9%). One Results: The findings suggest a number of factors third of employed NPs reported that they were still enable or hinder e-learning development and awaiting approval to prescribe medications despite use. The majority of e-learning applications are this being a core legislated skill. Over 70% stated concerned with information retrieval and database that lack of authority to access national health use. All nursing and health care students have benefits schemes such as patient reimbursement access to a virtual or managed learning environ- for approved tests (through Medicare Benefits ment but there are only limited examples of Web Scheme MBS) and prescriptions (through Phar- 2.0 technologies such as mobile learning, wikis maceutical Benefits Scheme PBS) was extremely (online documents), blogs (online diaries) and limiting to their practice. social networking tools being used. Discussion: PBS and MBS fall under Common- Discussion and Conclusions: E-learning is being wealth legislation and require service-provider used in the education of nurses and health care numbers to which NPs do not currently have access professions to varying degrees. The presentation whereas professional authorisation is legislated at will explore current use, factors affecting this and state level. These inconsistencies between Com- reflect on those issues that need consideration monwealth and state legislation result in consid- if e-learning is applied more widely, providing a erable under-utilisation of this highly experienced framework to support future use. sector of the Australian health workforce. These findings are consistent with the international lit-

54 Concurrent session 2 Tuesday 24 March 2009

Theme: Narrivative investigation 2.2.2 2.2.3 2.2.1 Can unsolicited illness narratives Narrative as a research method in The use of narrative inquiry in be used as research data? understanding experiences of nurse clinical practice based research Mary O’Brien, Evidence-based Practice Research academics Centre, Faculty of Health, Edge Hill University, Maria Joyce, School of Health and Social Care, Caroline Sanders, Royal Liverpool Children’s Liverpool, UK Hospital, Liverpool, UK University of Lincoln, Lincoln, UK [email protected] Co-authors: Bernie Carter; Lynne Goodacre; Alan [email protected] Armstrong [email protected] Abstract: Abstract: Background: Health professionals are increasingly This presentation explores narrative research Abstract: recognising the value of illness narratives to inform methods and outlines findings of primary research them about the personal experiences of living with Aims: To discuss the use of narrative inquiry in in understanding the career influences of nurse illness. Most research involving narratives obtains clinical practice based research academics. Narrative derives from a long history them through interviews, yet a vast amount of Methods: Nursing research often seeks to under- of literary tradition and is increasingly used as written material detailing life with specific illnesses a research method. Narrative in essence is the stand the complex nature of research participants’ is available within the public domain. To date no experiences. Nursing research has the potential stories of our lives and the stories of the lives of published work has sought to investigate the use others. Narrative is open to interpretation. for the discovery of unanticipated or extraordinary of unsolicited illness narratives written by people outcomes. Holloway & Freshwater (2007) suggest with motor neurone disease (MND). Objectives This This interpretation develops through collaboration nursing should not focus solely on science as this study set out to identify published and unpublished of researcher and respondent. Narrative, explored can neglect the biographical model of developing illness narratives written by people with MND and through interpretive research allows access to the understanding. After reading texts including Elliott to compare the genres to establish the characteris- respondent reality via their socially constructed (2005) I considered that narrative inquiry gave par- tics of the authors and their writings. stories. As a term it is a many sided concept. The ticipants the permission and opportunity to tap into terms of life history, autobiography, biography, life Methods: A comprehensive strategy, based on their tacit knowledge embedded within their expe- story and narrative ‘define one another in terms systematic review methodology, was adopted to riences while also allowing me as the researcher of difference’ and ‘every term carries a trace of identify and locate electronic and print medium to learn from the process. Since narrative relies the other terms’ (Denzin 1989: 47). Narrative data narratives written by people with MND. Identified on communication and relationships, this link may be acquired through story telling, life history, literature was assessed according to inclusion/ can facilitate connections between research roles in depth interview, biography or focus group exclusion criteria to obtain a comprehensive and participants, perhaps providing a sense of (Letherby 2003). sample of narratives to subject to analysis. ‘shared’ learning (Gaydos, 2005). Narrative inquiry These definitions highlight not only the similar highlights these close alliances and allows for the Results: A substantial quantity of both published features within narrative and but also the lack of exploration of personal truths and core values of and unpublished personal illness narratives from neat categories. The presentation of narrative both the researcher and participants (Holloway the 1960s onwards was identified. A geographi- generally forms a linear, logical style, unlike real life & Freshwater, 2007). Narrative inquiry offers cally and demographically diverse cross-section experiences. This presentation assesses narrative an in-depth understanding of the situation and of people with MND, including those not normally for unique features and applications. It is struc- meaning for those being studied. Narrative inquiry associated with publication of personal stories, tured in four sections, the first of which is ‘types (using in-depth narrative interviews) provided a have documented their illness experiences within of narrative’. This looks at the meaning of narrative basis for both entering participants’ life worlds print and electronic mediums. Clear differences are as a research method and a vehicle for providing (through their stories) and understanding socially apparent between genres. the individuals story. Then discussing life history, embedded knowledge (through the interpretation Discussion: This study demonstrates the extent life incidents, story telling, biography, autobiogra- and analysis of their narratives). of the availability of writings about the personal phy; affording the opportunity to outline the dis- Results: After exploring the narrative analysis lit- experience of living with MND and has identified tinguishing characteristics of each approach whilst erature I developed a six ‘steps’ approach towards an unparalleled collection of personal illness narra- identifying potential for overlap. The next section understanding, exploring and later interpreting my tives that will help to illuminate what it means to be ‘Collecting narrative data’ reviews the possibilities data. Narrative analysis resulted in three keystone diagnosed with the illness. It clearly indicates that of interviews, diaries and secondary sources, dis- stories which contained aggregate stories and foun- unsolicited written narratives can legitimately be cussing the pros and cons of each source of data dational stories. Interpretation and synthesis of the used as research data. collection. The next section gives some discussion three keystone stories revealed three core elements on the findings of the researcher’s primary study. fundamental to my study participants’ stories. The final section concludes the paper drawing Conclusions: Narrative inquiry, analysis and inter- together findings and summarises the exploration pretation gave the participants in my study a voice. of narrative. I entered into their worlds through stories and was Recommended reading: able to generate new knowledge about partici- Denzin, N.K., (1989). Interpretive Biography. pants search for harmony as evidenced from their Illinois: Sage experiences. Letherby, G., (2003). Feminist Research in Theory Recommended reading: and Practice. Buckingham: Open University Press Elliot, J (2005) Using Narrative in Social Research: Qualitative and Quantitative Approaches. London: Sage Gaydos, H. L. (2005) Understanding Personal Nar- ratives: An Approach to Practice. Journal Advanced Nursing, 49(3), pp. 254-9 Holloway, I & Freshwater, D (2007) Narrative Research in Nursing. Oxford: Blackwell

55 Concurrent session 2 – Tuesday 24 March 2009

Theme: Illness and experiences 2.3.2 Farran CJ, Herth KA, Popovich JM (1995) Hope and Hopelessness: Critical Clinical Constructs. 2.3.1 The illness experiences of people Thousand Oaks The lived experiences of women with idiopathic normal pressure Berger PL, Luckmann T (1966) The Social Construc- with disabilities facing the hydrocephalus: A grounded theory tion of Reality. Middlesex, Penguin Books challenges of pregnancy, childbirth study and motherhood: An interpretative Leslie Gelling, Faculty of Health and Social Care, Anglia Ruskin University, Cambridge, UK 2.3.3 phenomenological study [email protected] Dympna Walsh Gallagher, St Angela’s College, National University of Galway, Sligo, Ireland Hepatitis C: experiences of stigma Co-authors: Marlene Sinclair; Roy McConkey Abstract: when accessing services Background: Idiopathic normal pressure hydro- Kate Frazer, HRB Clinical Research Fellow, School cephalus (iNPH) is a complex and multifaceted of Public Health & Population Science, University Abstract: disorder of cerebrospinal fluid (CSF) circulation College Dublin, Ireland There is limited knowledge about the pregnancy, that can have a devastating impact on the lives childbirth and motherhood experiences of women of those diagnosed with the condition and their Abstract: living with a disability. Yet, becoming a mother families. It is characterised by the clinical triad of Background: Hepatitis C virus infection (HCV) is a when you have a label of being ‘disabled’ in mind gait disturbance, mental deterioration and urinary common infection causing chronic liver disease in or body is viewed very differently by those who incontinence (Hakim and Adams 1965). have a disability and those who do not. This study the European population and an important public explored the impact and challenges facing women Aims: The aim was to develop a substantive theory health problem. The majority of those infected are with a range of disabilities both physical and intel- of what it is like to live with iNPH. unaware of their disease status until symptoms of lectual in Ireland. Methods: This research was undertaken using progressed liver disease present. Many individu- The study employed a qualitative, phenomenologi- a constructivist approach and was underpinned als with HCV are from vulnerable groups and may cal approach, using interpretative phenomenologi- by Grounded Theory. Participants were recruited have previous negative experiences from accessing cal analysis (Smith, 2004). Home based, in-depth through purposive and theoretical sampling. health services. Those experiences can influence a interviews with women who had physical or a Original data was collected through in-depth semi- person’s future decision to access health services mild intellectual disability were undertaken at key structured interviews and personal biographies. in relation to their HCV. stages in their pregnancy and postnatally, spanning Data was analysed using constant comparison and Aims: To explore with persons with HCV, their an eighteen month time frame. Focus groups with thematic analysis, facilitated by NVivo. A favour- primary care health needs and experiences of two multiprofessional groups were undertaken able ethical opinion was gained from a research accessing primary care services. to explore reactions to the data analyses and to ethics committee. Methods: Following ethical approval, a descriptive- identify achievable recommendations. Pregnant Results: 26 participants were recruited; 15 were exploratory qualitative study with non-probabil- women with a range of physical disabilities interviewed and 11 provided personal biographies. ity sampling was undertaken. Semi-structured including, multiple sclerosis, cerebral palsy and The illness experiences of these individuals was interviews were completed with 24 participants, motor neurone disease and mild to moderate intel- dominated by four themes: frustration; isolation; recruited through third parties, between November lectual disabilities were invited to participate in the life-long illness; and hope. Hope is the core theme 2006 and May 2007. Interviews were recorded and study. A purposeful sample of seventeen women and is central to the substantive theory identified transcribed verbatim. NVIVO software was used to was recruited. Nineteen multi professionals were through this research. recruited to the focus groups. manage the data. Discussion: This theory offers an insight into the Analysis: Content analysis guided the data Three major categories emerged: ‘I’m pregnant’, illness experiences of individuals with iNPH. This ‘You’re pregnant’, ‘Birthing memories’ and ‘Mother- analysis process. Two main categories were identi- allows a comparison with alternative theories fied: ‘access to services’ and ‘primary care needs’. hood’. Underpinning these categories were distinct that have explored the concept of illness and the themes to do with physiological, psychological and This presentation focuses on one sub category: complex concept of hope (Farran et al 1995, Berger social need. Women described a parallel world in ‘stigma’. and Luckmann 1966). Hope appears to play a key which they saw themselves as ‘normal’ and health Findings: Stigma was perceived when accessing role in facilitating the transfer between health and professionals saw them as disabled ‘high risk’ services in three distinct areas: with health pro- illness. pregnancies. fessionals, in social settings and with the general Conclusions: If health care professionals, support Professionals identified: lack of knowledge, lack public. Participants all identified episodes of dis- groups and carers are to offer the support that of effective communication and lack of resources. crimination and stigma since their diagnoses, is needed by individuals with iNPH they need a There is a need for a deeper understanding of the which resulted in a lack of trust in health profes- deeper understanding of how these individuals lifeworld of women, who become pregnant whilst sionals’ knowledge of the disease. Participants live their lives and the factors that impact upon living their normal life with a disability, to ensure reported difficulties in confiding their diagnosis in they maintain their independence and autonomy. the various aspects of their lives. The research others. presented in this paper offers a theory that is Health professionals need specific education and Conclusions: Ignorance about HCV and its trans- directly grounded in the experiences of individuals training about pregnancy and disability. mission, leads to a reduced quality of life for who live with iNPH. Recommended reading: those diagnosed. More information on the virus is Recommended reading: required for health professionals to enable them to Mac Kay-Moffat, S. (1997) Disability in Pregnancy deliver a high standard of evidence-based care in and Childbirth. London: Churchill Livingstone Hakim S, Adams RD (1965) The Special Clinical Problem of Symptomatic Hydrocephalus with the primary care setting. Health care professionals Lipson, J. G. and Rogers, l. G. (2000) Pregnancy Birth Normal Cerebrospinal Fluid Pressure: Observations need to be aware of the stigma and discrimination and Disability: Women’s Health Care Experience. on Cerebrospinal Fluid Hydrodynamics. Journal of often experienced by people who have HCV, to help Health Care for Women International, 21, 11-26 Neurological Science. 2, 307-327 them in accessing primary care services. Hughes, G. (1998) Construction of Disability. In: Saraga, E. (1998) Embodying the Social: Construc- tions of Difference. London: Routledge

56 Concurrent session 2 – Tuesday 24 March 2009

Theme: Nurse educators 2.4.2 2.4.3 2.4.1 An evaluation study of lecturer The current and future clinical role Gender, gender roles and practitioners in Ireland of lecturers in nursing: Results from completion of nursing education: A Ann Cummins, Catherine McAuley School of a policy Delphi study. Nursing & Midwifery, University College Cork, longitudinal study Pauline Meskell, School of Nursing and Midwifery, Cork, Ireland National University of Ireland, Galway, Ireland Katrina Mclaughlin, School of Nursing and Co-authors: Irene Hartigan; Liz O’Connell; Brendan Co-authors: Kathy Murphy; David Shaw Midwifery Research Unit, Queen’s University, Noonan; Mary Hughes; Claire Hayes; Patricia Fehin [email protected] Belfast, UK [email protected] Co-authors: Marianne Moutray; Orla Muldoon [email protected] Abstract: Abstract: Introduction: The clinical role of lecturers in Background: Nursing continues to struggle to Abstract: nursing has been identified as instrumental in integrate the theoretical and clinical aspects of strengthening the clinical focus of nursing. The Background: The ongoing worldwide nursing nurse education for the development of competent main focus of debate surrounding the clinical role shortage and high attrition of nursing students practitioners. Collaborative approaches to nurse of lecturers centres on educationalists viewpoints. underpins the need to select those most likely to education as well as the development of joint clini- This paper will examine the spectrum of views complete their course and stay in the nursing pro- cal-academic roles have had questionable success within and between different stakeholder groups fession. to date on merging the theoretical and clinical com- of educationalists, clinicians and policy formula- ponents of nursing. Lecturer practitioners’ posts Aims: The aim of this paper was to investigate how tors, involved in the provision of nurse education are new in Ireland. These posts were created as key psychological attributes and constructions dif- in Ireland. ferentiate between completers and non completers nurse educators were cognisant of the need for of nursing education. students to integrate theory to practice. The role Aims: To present the results from a three round of the lecturer practitioner is unique in Irish health- policy Delphi study investigating perceptions from Methods: This study employed a longitudinal care as they are directly involved in patient care key stakeholder groups on the current and future design. A questionnaire including measures of when in clinical practice The aim of lecturer prac- clinical role for lecturers in nursing. gender role identity (Bem, 1974) and perceived titioner role is to increase the support for student gender appropriateness of nursing specialisms Methods: A Policy Delphi technique (Turoff, 1975) nurses in both academia and practice. (Muldoon & Reilly, 2003) was administered to 384 was employed to reveal the spectrum of views first year students. At the end of the programme Aims: The aim of this study was to evaluate the from different stakeholder groups involved in the attrition rates were obtained from university impact of the lecturer practitioner role in Ireland. provision or delivery of nurse education. A pur- posively selected stratified panel of 50 experts records for a total of 350 students. Methods: A non-experimental descriptive design participated in a three round policy Delphi study. using a quantitative and qualitative approach Results: The majority of nursing specialities were Round 1 questionnaire was informed by the results was used to conduct this study. Non probability, viewed by the students as more appropriate work of an initial qualitative phase. Likert scales of purposive sampling permitted recruitment of 311 for women than for men. Only seven of the 19 spe- measurement were used to assess panelists level participants including student nurses, staff nurses cialities were viewed as occupations suitable for of agreement with outlined statements. Responses and clinical nurse managers where Lecturer Practi- both males and females. These included mental were statistically analysed using SPSS. Panelists tioners are engaged in clinical practice. An adapted health, accident and emergency, learning disabil- re-rated responses in Round 2 following feedback version of a previously validated questionnaire ity, theatre, surgical and medical nursing,as well on group median and IQR item ratings. Policy state- developed by Richardson and Turnock (2003) to as nurse teaching and management. The remaining ments were formulated based on Round 2 results evaluate the impact of the lecturer practitioner role 12 were perceived as feminine or highly feminine and panelists indicated the importance and feasi- in a critical care setting was used in this study with specialities. Chi-squares analyses were performed bility of suggestions in Round 3. to assess associations between course completion permission from the authors. Results: Key findings: Response rates: 96% – and gender, and course completion and gender role Results: Overall, 64% of students and 67% of Round 1, 98% – Round 2, 100% – Round 3. High orientation. There was a significant relationship registered nurse participants perceived lecturer levels of consensus were evident in relation to between gender and course completion (2 = 8.200, practitioners as very effective in increasing student factors surrounding role definition, visibility and df =1, p=0.009); in that males (28.1% of all males) nurses’ knowledge and 59% of students and 39% of clinical connectivity of lecturers. There was polarity were more likely to withdraw from their course than nurse participants identified lecturer practitioners between educationalists and clinicians and policy females (10.7% of all females). as very effective in developing nurses’ knowledge. formulators regarding issues surrounding engage- Discussion and Conclusions: The female Conclusions: The results of this study suggest ment with practice, clinical credibility and teaching dominated nature of nursing, prevalent stereotypes that as lecturer practitioners have both a clinical effectiveness. and gender bias inherent in nursing education and academic remit they can integrate theory to Conclusions: The consideration of perspec- seem to make this an uncomfortable place for both practice through collaborative practice. males, and those with less gender typed views. tives from key stakeholder groups in an innova- The nursing profession need to address this bias Recommended reading: tive approach will assist in the re-evaluation of to ensure their profession is open equally to both Dearmun, A.K., Supporting Newly Qualified Staff the current and future clinical role in terms of its female and male recruits. Until this is established, Nurses: The Lecturer Practitioner Contribution. structure, definition and operationalisation and the nursing shortage will remain an issue. Journal of Nursing Management, 2000. 8 (3): p. implications for practice will be addressed. 159-165 Recommended reading: Recommended reading: Brown, S.J., The Experiences of Lecturer Practition- Bem, S. L. (1974). The measurement of psychologi- Turoff, M. (1975) The policy Delphi. In Linstone, A.H. ers in Clinical Practice. Nurse Educ Today, 2006. cal androgony. Journal of Consulting and Clinical & Turoff, M. (eds) The Delphi Method: Techniques 26(7): p. 601-8 Psychology, 4, 155-162 and Applications. London, Addison Wesley. 84-101 Williamson, G.R., Lecturer Practitioners in UK Muldoon, O. T. & Reilly, J. (2003). Career choice in Nursing and Midwifery: What is the Evidence? A nursing students: gendered constructs as psycho- Systematic Review of the Research Literature. J Clin logical barriers. Journal of Advanced Nursing, 43, 1, Nurs, 2004. 13(7): p. 787-95 93-100

57 Concurrent session 2 – Tuesday 24 March 2009

Theme: Long term conditions All Parliamentary Group on Skin. (2003) Enquiry regarding pt centered factors most affected by into the Impact of Skin Disease on People’s Lives. HF. Pt well-being and morbidity and mortality 2.5.1 A Report. APPGS. London outcomes may rely on our ability to recognize and A national survey to examine Fortune, D. Richards, H. Kirby, B et.al (2003) Psy- appropriately manage these differences. the provision and the nature of chological Distress Impairs Clearance of Psoriasis psychosocial assessment and in Patients Treated with Photochemotherapy. Arch Dermatology support for individuals with skin 2.5.3 disorders Evaluation of the Blackpool budget Terry Adams, Faculty of Health and Applied Social Sciences, Liverpool John Moores University, 2.5.2 holding lead practitioner initiative Liverpool, UK Joan Livesley, Salford Centre for Nursing, Comparison of patient-centered Midwifery and Collaborative Research, University [email protected] variables between patients with of Salford, Salford, UK Co-author: Janet Berry Abstract: heart failure and preserved versus [email protected] Background: The incidence of psychosocial co- non-preserved ejection fraction Debra Moser, College of Nursing, University of morbidity associated with skin disorders is high. Abstract: Numerous studies have explored the impact of Kentucky, Lexington, KingdomStates Background: Blackpool was designated by the psoriasis on life quality in particular. Other studies Co-authors: Terry Lennie; Jia-Rong Wu; Seongkum Heo; Martha Biddle; Donna Corley; Betty Kuiper; DCSF as one of 16 Budget Holding Lead Practitioner have examined psychological distress in a range of Lynn Roser; EunKyeung Song {BHLP) pilot projects, known locally as Blackpool skin conditions, especially the longer term disfigur- Early Action for Change (BEACh). The BEACh ing types. Skin specific life quality measures have [email protected] processes were founded on a comprehensive and evolved as a result of such findings. However, the inclusive purpose that set out to help children and frequency and forms of psychosocial assessment, Abstract: young people (CYP) and families benefit from the and any evidence of efficacy, remain unclear Background: Most heart failure (HF) research has ethos and application of integrated working and Aims: To clarify the frequency and forms of psycho- been conducted among patients (pts) with systolic the Common Assessment Framework (CAF); aiming social assessment and interventions being under- dysfunction and low ejection fraction (SD-LEF). Yet, to promote more effective intervention through taken in dermatology care centres in England HF is not a homogeneous syndrome; up to 40% earlier identification of additional or unmet needs. Methods: Questionnaires (400) were sent to of HF pts have preserved left ventricular ejection Each lead practitioner had access to a budget of centres providing dermatology care addressed to fraction (Pres-EF). Although there are differences £1000 per child via a designated BHLP. Practition- nurses working within the speciality. Responses in morbidity, mortality and epidemiology in these ers were encouraged to involve children and their (130) were loaded in to SPSS and analysed using groups, little is known about potential differences families in the decisions about how the money was descriptive statistics. Qualitative data were in pt-centered variables that could explain differ- used. ences in outcomes. analysed using framework analysis to identify Aims: This presentation reports findings from the common themes and categories that emerged from Aims: To compare pt-centered variables between evaluation that examined: the data. pts with SD-LEF and Pres-EF. • how BEACh project integrated processes contrib- Results and Discussion: The findings of the survey Methods: 2122 HF pts (39% female; age 63 14 uted to a family – centred service for CYP. will be presented and discussed. There appears yrs) were enrolled; 1495 (70%) with SD-LEF and • the impact that access to the BHLP exerted on to be greater knowledge than ever concerning the 627 (30%) with Pres-EF. The pt-centered variables CYP and families. psychosocial impact of skin conditions, not only tested were quality of life, depressive symptoms, on life quality but in some cases, on disease exac- anxiety, perceived social support, adherence • the impact that access to the BHLP pilot exerted erbation and treatment response. However a lack behaviors, and functional status measured by the on lead practitioners. of expert knowledge, skills, time, resources and Minnesota Living with HF Questionnaire (MLHFQ), Methods: An Appreciative Inquiry approach (Coop- the absence of any referral networks continue to PHQ-9, Brief Symptom Inventory, Perceived Social errider and Whitney 1999) was used to discover impede the formal and effective management of Support Scale, Medical Outcomes Study Specific what worked well and why it worked. Eighteen the psychosocial dimensions of skin disease. These Adherence Scale, and Duke Activity Status Index, family interviews and an ‘Openspace’ event with findings will be demonstrated in the presentation respectively. staff (n=27) were undertaken in 2007. Cases were by displaying quantitative data such as percent- Results: The groups differed on adherence examined for cost effectiveness. Data was analysed ages and frequency distributions and using quali- behaviors, physical scale of the MLHFQ, and indi- using modified framework analysis. Formal ethics tative data extracts to illustrate the findings. vidual MLHFQ items. SD-LEF pts were more likely approval was secured. Conclusions: The findings reveal a lack of formal to follow a low salt diet (p=0.001), low fat diet Results: Outcomes for families and individual procedures to assess and address psychosocial (p=0.005), weigh daily (p=0.002), and monitor children demonstrated that the BEACh processes dimensions of skin disease and suggest that this their symptoms daily (p=0.003). Although total worked and should be emulated in a wider sphere. fundamental area of dermatological care remains MLHFQ scores were similar between the groups, Recognition by practitioners of early indicators of inadequately managed. Clearly, attempts to Pres-EF pts reported worse quality of life in the an impending family crisis was vital to effective address the psychosocial needs of dermatological physical scale. Examination of individual items intervention. Joined-up working exerted a positive patients will need to be adequately resourced and on the MLHFQ revealed that Pres-EF pts reported impact on families’ ability to negotiate processes thus limited resources may need to be redistrib- greater distress from edema (p=0.001), difficulty and secure essential services. uted in order to offer patients holistic care. walking (p=0.05), shortness of breath (p=0.001), Contribution to Policy and Practice: The ways of fatigue (p=0.001), and hospital stays (p=0.001). Recommended reading: working promoted by the project were particu- Conclusions: Although similar with regard to larly effective in engaging families which had been Adams, T. Glenn, S. Byatt, K. (2001) The Psycho- anxiety, depression and functional status, SD-LEF persistently service-resistant, and this informed social Assessment of People with Chronic Plaque pts were more adherent than Pres-EF pts. Pres-EF further service developments. Psoriasis. Clinical Effectiveness in Nursing pts reported greater distress related to physical symptoms. This suggests that these groups differ

58 Concurrent session 2 – Tuesday 24 March 2009

Recommended reading: Recommendations: Greater user participation in 2.6.3 Cooperider C, Whitney D (1999) Appreciative is central to developing knowledge and practice Flexible and responsive services Inquiry a Positive Revolution in Change In Holman in health and social care yet requires accessible P, Devane T (Eds) The Change Handbook: Group methods. Centre stage storylines incorporate trans- in cancer care: Service users’ Methods for Shaping the Future. San Francisco, CA: ferable techniques that could be used in a variety of experiences and views Berrett-Joehler Publisher, pp 245–261 approaches within the field of qualitative research. Kate Wilson, Macmillan Research Unit, School of Nursing Midwifery and Social Work, University of Eggenberger S K & Nelms T P (2007) Family Inter- Recommended reading: Manchester, Manchester, UK views as a Method for Family Research. Journal of Charmaz, K. (2000). Grounded Theory: Objectiv- Co-authors: Anne Lydon; Ziv Amir Advanced Nursing 58(3) 282–292 ist and Constructivist Methods. In: N.K. Denzin [email protected] and T.S. Lincoln (Eds.). Handbook of Qualitative Research. 2nd Edition. Thousands Oaks: Sage. Pp. Abstract: Theme: Service user’s views 509-535 Keady, J.; Williams, S. and Hughes-Roberts, J. Background: The UK government is advancing 2.6.1 (2007) ‘Making Mistakes’: Using Co Constructed policies relating to consumer choice in health care, Centre stage storylines: Giving Inquiry to Illuminate Meaning and Relationships and the flexibility and responsiveness of services. However, apart from work on treatment decision- vulnerable people a voice in in the Early Adjustment to Alzheimer’s Disease – a Single Case Study Approach. Dementia: the Inter- making and preferences in end-of life care, there is researching their experiences and national Journal little relevant evidence about the experiences and views of people affected by cancer. co-constructing grounded theory Strauss, A. and Corbin, J. (1998) Basics of Qualita- Sion Williams, School of Healthcare Sciences, tive Research. London: Sage Aims: To explore patient/carer experiences of Bangor University, Bangor, UK and views on the flexibility and responsiveness Co-author: John Keady of services for cancer To draw lessons that can be [email protected] applied when designing and evaluating services 2.6.2 Methods: A purposive sample of 38 patients and Abstract: Using stated preference discrete 26 carers participated in digitally-recorded con- versational interviews. These were transcribed Aims: The presentation discusses the development choice modelling to elicit women’s and analysed thematically using a qualitative data of grounded theory that engages with participants preferences for maternity care. analysis package. The study drew on grounded as equal partners. Charmaz (2000) contends that Bernie Reid, Institute of Nursing Research, theory methods: a flexible interview guide was meaning should be achieved through negotia- University of Ulster, Derry, UK used and analysis ran concurrently with data col- tion to reach a ‘shared understanding’. A research Co-authors: Marlene Sinclair; Owen Barr; Frank lection. approach has been developed that involves the Dobbs; Grainne Crealey. innovative use of diagrams and other visual Results: Specialist cancer services and clinical [email protected] artefacts to identify ‘centre-stage’ events that nurse specialists were cited as the most flexible/ highlight the most important ‘storylines’ for those responsive services, although access to nurse spe- living a life with long term conditions. Abstract: cialists was patchy. Some day-case chemotherapy services and outpatient appointment systems Methods: Centre stage storylines include a Background: Existing evidence suggests that lacked flexibility/responsiveness. Participants had temporal analysis underpinned by a biographical women’s acceptability or preferences for maternity a range of preferences about continuity, treatment perspective. The centre-stage diagrams emerged care interventions have been largely overlooked decision-making and choosing a hospital/service. as crucial from earlier work on co-constructing despite initiatives aimed at promoting evidence- Responsiveness to carers/family and negotiations grounded theory (Keady, Williams and Hughes- based women-centred maternity care. Stated pref- re transitions in care were prominent themes. Some Roberts, 2007). Generated in this way storylines erence discrete choice modelling offers a research service users had to be assertive to get the care are both interactive and literal, with the middle of methodology to examine such preferences. they wanted/needed. the page representing the centre-stage storyline Aims: To critically appraise discrete choice Services vary considerably in terms with other issues being placed close to, or far modelling methodology and to explore its potential Discussion: of flexibility/responsiveness and service users away from, the centre in order to represent their research uses within the context of maternity care. perceived importance at a given moment within a have preferences about a wide range of issues. Methods: Discrete choice modelling methodology frame of reference that has autobiographical and A service user may wish to have a choice and/or is analytically described and some key methodolog- temporal dimensions. negotiate about some aspects of care and at some ical issues are considered. Key stages in the design points in his/her trajectory but remain passive in Analysis: The centre-stage storyline technique and analysis of discrete choice modelling studies other contexts. Professional and peer support can goes beyond simply labelling life events chronolog- are outlined. Strengths and limitations of discrete strengthen assertiveness in service users, which ically or generating categories (Strauss and Corbin, choice modelling are summarised and its potential may promote flexibility/responsiveness in current 1998) and, instead, uses the ‘storyline’ as a thread future uses in midwifery research discussed. and future services. linking together the life course and life events Implications: Midwives are challenged to embrace thereby helping to ‘make sense’ out of people’s Conclusions: Opportunities for developing the use of stated preference discrete choice lives. This presentation will report upon the devel- flexible/responsive services exist in relation to the modelling in evaluating women’s preferences for opment of centre stage storylines with reference role of specialist nurses, follow-up, appointment maternity care interventions. to case exemplars drawn from studies with people systems and outpatient chemotherapy. Issues with early and late-stage Parkinson’s disease (PD) Keywords: Discrete choice modelling; women’s raised by participants could be investigated in and Alzheimers’s Disease (AD). preferences; maternity care, midwifery research. observational research and/or interviews with health professionals. Results: Centre-stage storylines develop a more participatory approach to grounded theory co- developed by/with people with vulnerable people enables their voices to be heard.

59 Concurrent session 2 – Tuesday 24 March 2009

Theme: Academic workforce/work 2008 at: http: www/stlar.org.uk/consultation HR meeting the challenges of continually restruc- based learning Strategic Report 2 tured workplace environments. However, there are Ball L, Curtis P. & Kirkham M (2002) Why do issues arising which need to be resolved if WBL is 2.7.1 Midwives Leave? Women’s Informed Childbearing to be sustained in the health sector. Recruitment and retention of and Health Research Group, University of Sheffield, Recommended reading: Sheffield, UK midwifery academic staff across Garrick, J., & Usher, G. (2000) Flexible Learning, south west England Kirkham M., Morgan R.K. & Daviews C. (2006) Why Contemporary Work and Enterprising Selves. Elizabeth Rosser, School of Health & Social Care, do Midwives Stay? Women’s Informed Childbearing Electronic Journal of Sociology. Available at: www. Bournemouth University, UK and Health Research Group, University of Sheffield, sociology.org/content/vol005.001/garrick-usher. Sheffield, UK Co-author: John Albarran html accessed 20.11.07. Pawson R. and Tilley N. (1997) Realistic Evaluation. Abstract: London: Sage Publications Background: With radical changes being imple- 2.7.2 mented across the UK National Health Service, the A realistic evaluation of work-based need for a skilled educational workforce to prepare 2.7.3. the new generation practitioners has become learning for qualified nurses imperative. However, with national shortages Lesley Moore, Faculty of Health and Life Sciences, Recruiting nurses as research University of the West of England, Bristol, UK of midwifery practitioners and introduction of a participants – what are the issues? [email protected] career pathway to retain experienced professionals Philippa Atkinson, Faculty of Medicine and in practice, recruitment and retention of academic Health Sciences, School of Nursing, Midwifery staff into higher education is becoming a major Abstract: & Physiotherapy, University of Nottingham, Nottingham, UK challenge. The awareness of the importance of work-based Aims: This paper explores factors influencing learning (WBL) as a valid way to effect change is Co-authors: Sarah Redsell; Cris Glazebrook; Judy recruitment and retention of midwife practitioners not just happening in the UK for it has been hailed Swift; Niro Siriwardena; Dililp Nathan into higher education across South West England. as important for raising the international standards Methods: A mixed methods approach was used, of health care. However, critics have identified that Abstract: with a purposive sample of departmental heads there have been no robust evaluations of WBL and Introduction: Improving participation rates within (n= 3) and midwifery lecturers (n=19) . Data col- it’s impacts on healthcare. This paper focuses on a primary care research is a challenge. Whilst it is lection was conducted during August-September longitudinal, realistic evaluation of embedding a known that reaching recruitment targets is a wide- 2008 and included a survey of lecturer demograph- prototype to support WBL (2005-2008), funded by spread problem in randomised controlled trials in ics, one to one interviews and three focus group Faculty and the Burdett Trust for Nursing. primary care (Chew-Graham, Lovell, Roberts et al., interviews. Aims: Project aims were to: 2007), less is known about the process of recruiting Data analysis: Quantitative data were analysed • Explore & examine the impact of work-based health visitors and nurses. Low participation rates for descriptive statistics and qualitative data used learning on practice were reported in a study examining health visitors’ roles in the immunisation programme (18%) a thematic analysis. Findings: focused on three • Explore the sustainability of the preferred mech- (Redsell, Bedford, Siriwardena et al., 2007) and themes: i) context of change including biographi- anisms that have supported the outcomes in in a study exploring General Practitioners’ (GPs) cal data of current academics ii) processes used to practice promote recruitment of academics identifying key and practice nurses’ views of adolescent obesity drivers and strategies used and challenges they • Report on the learning that has been sustained & (23%) (Magnusson, 2008). The Early Prediction face iii) factors influencing retention including job developed over time and Prevention of Obesity in Children (EPPOC) satisfaction, team working and management style. • Explore the nurses’ experience of work-based study requires 5 practice nurses, 10 nursery nurses and 20 health visitors to participate in telephone Conclusions: Our data indicates that within five learning & changing contexts. years, 79% existing midwife academics will be Methods: Pawson & Tilley’s (1997) realistic interviews. Current participation rates are 0, 20 and eligible to retire. However, recruiting suitable pro- framework was used. A triangulation of methods 40% respectively. This paper discusses approaches fessionals has been problematic due to midwife included semi-structured interviews and documen- to recruitment and possible reasons for the low shortages and expectations of higher education as tary analysis. The sample interviewed included 28 participation rate. to the essential qualifications for lecturing posts. learners, 9 academic facilitators and 17 managers/ Methods: To recruit participants to this study pres- Attracting midwives requires improved transpar- mentors. entations have been made at locality meetings; ency over career opportunities and progression, Results: Content and thematic analysis of the data relationships have been developed with health and innovative marketing strategies. Collaboration revealed enabling and disabling mechanisms, visitor managers and the local Primary Care between education and practice sectors is pivotal to transitions and transformations of learners, and Research Network (PCRN) and meetings have been future endeavours. In terms of retention, providing positive patient outcomes. The impacts on patient held with individual health visiting teams. new staff with a period of transition, practice links care included improved communciation, innova- Discussion: There are a number of possible expla- and a facilitative management style are crucial tive change projects and enhanced team working. nations for the low participation rate. Research that in keeping academics motivated, engaged and Main disabling factors were lack of systems, and focuses on issues that are ‘integral’ to a profession- committed, The lack of rewards for excellence in managers and mentors who did not effectively al’s practice could evoke feelings of anxiety about teaching and increasing demands placed upon engage with WBL. Those managers who advocate the prospect of having key knowledge assessed. them are seen to compromise staff retention. WBL had experienced the processes themselves. Health visitors and nurses who have previously participated in research may feel more confident to Recommended reading: Conclusions: A strong recommendation is that systems are in place to support managers devel- participate subsequently but those practising near Strategic Learning and Research Committee (StLaR) Universities could be ‘over researched’. Reimburse- (2004) Developing and Sustaining a World Class opment and understanding of WBL. WBL can be the catalyst for the change in learners to become ment of Service Support Costs through the PCRN Workforce of Educators and Researchers in Health may not be as important for nurses as they are for and Social Care. Accessed on 29th September reflexive and as Garrick & Usher (2000,) said, ‘selves can become enterprising,’ capable of GPs. Unlike GPs, nurses are not private contrac-

60 Concurrent session 2 – Tuesday 24 March 2009

tors and costs may not appear ring fenced spe- this was the collective efficacy of the team that Results: The total mean score on the scale before cifically for the purpose of backfilling their time. In supported the partnerships growth and develop- positioning was 0.27, during 1.93, and 0.10 after the present climate of competing priorities health ment. These two aspects form part of a co-vali- positioning (p=0.000). The indicator facial expres- visitors and nurses may not have adequate time to dation process that created a safe platform from sions showed the greatest increase compared participate regardless of the payments available. which patients could be central to the care process to the base situation, 52% of observations; body through their role in the partnership that confirmed movements increased over 42%; compliance with Recommended reading: their pain, thus empowering patients to take the ventilator, 31%; muscle tension in 24% obser- Chew-Graham, CA., Lovell, K., Roberts, C., Baldwin, control of their pain. These findings have shed light vations. There are slight variations in the physi- B., Morley, M., Burns, A., Burroughs, H. (2007) on previously unknown territory. Understanding ological variables during the procedure compared Achieving Target Recruitment in a Primary Care the co-validation process and the patients experi- with the base rates. The CPOT score during the Trial: Lessons from PRIDE. Primary Health Care ence of multi-professional working could support procedure was higher in surgical patients than Research & Development 8: pp. 264-270 future multi-professional team development and in medical ones, and also in conscious patients Redsell, SA., Bedford, H., Siriwardena, N., Collier, J., enhance patient engagement in back pain manage- compared to the unconscious. In 97.88% of the Atkinson, P. (2007) Health Visitors’ Role in Commu- ment. observations the patients received analgesia/ nicating with Parents about Immunisation. Report sedation one hour before the positioning. Recommended reading: Submitted to the School of Nursing, University of Conclusions: Patients’ behaviour and physiological Corbin J, Strauss A (2008) Basics of Qualitative Nottingham changes during procedures allow the professionals Research. Techniques and Procedures for Develop- Magnusson, J. (2008) Managing Adolescent to objectify pain in nonverbal patients. Prior to a ing Grounded Theory. 3rd Ed. Sage Publications. Obesity in General Practice: The Views of Health nociceptive procedures is recommended to admin- Los Angeles Care Professionals. Presented at the Researching ister additional analgesia. Adolescent Health Conference October 2008 Wanless D (2002) Securing Our Future Health: Taking a Long-Term View. Final Report. London. HM Recommended reading: Treasury Gélinas, C., Fillion, L., Puntillo, K.A., Viens, C., Fortier. M. (2006).Validation of the Critical-Care Theme: Evaluation and care Pain Observation Tool in Adult Patients. American Journal of Critical Care, 15(4), 420-427 2.8.1 2.8.2 Gélinas, C., Johnston, C. (2007). Pain Assessment Patients perceptions of the multi- Pain evaluation in positioning in the Critically Ill Ventilated Adult: Validation of professional team in chronic back procedures for patients with the Critical – Care Pain Observation Tool and Physi- ologic Indicators. The Clinical Journal of Pain, 23(6), pain management services invasive mechanical ventilation Michelle Howarth, School of Nursing, University of 497-505 Maria Angeles Margall, Intensive Care Unit, Clínica Salford, Salford, UK Puntillo, K.A., White, C., Morris, A.B., Perdue, Universitaria de Navarra, Pamplona Navarra, Spain S.T., Stanik-Hutt, J., Thompson, C.L., et al. (2001). [email protected] Co-authors: Pardavila I; Asiain MC; Vázquez M; Lucia M; Aguado Y Patients’ Perceptions and Responses to Procedural Pain: Results from Thunder Project II. American Abstract: [email protected] Journal of Critical Care, 10(4), 238-251. Background: In the UK, chronic back pain affects 437,000 individuals; multi-professional working is Abstract: advocated as one of the key strategies to chronic Background: The evaluation of pain is particularly pain management. Furthermore the Wanless difficult in critical patients who cannot communi- 2.8.3 Report (2002) advocated that patients should be cate verbally. fully engaged in their healthcare. Although evident Evaluation of the Blackpool within policy, there is a dearth of research that has Aims: To compare behavioural responses to pain, Springboard Project: Outcomes of explored the reality of patient engagement within using the Critical-Care Pain Observation Tool (CPOT) scale, and the physiological responses intensive interagency support for multi-professional chronic back pain management chaotic, dependent families services. before, during and after positioning, in patients with invasive mechanical ventilation. To analyse Tony Long, Salford Centre for Nursing, Midwifery Aims: The aim of this study is to elicit the patients’ if there are CPOT scores differences between and Collaborative Research, University of Salford, experience of multi-professional working within a surgical-medical patients, and also between con- Salford, UK chronic back pain management service in order to scious-unconscious patients during positioning. To Co-authors: Mike Ravey; Michael Murphy; Debbie explore for evidence of patient engagement. describe the analgesia/sedation administered to Fallon; Merle Davies; Moya Foster Methods: A grounded theory approach based on patients one hour prior positioning. [email protected] Corbin & Strauss (2008) guided the study. Initially, Methods: This descriptive prospective study was seventeen patients were recruited from four multi- carried out in the 12-bed intensive care unit of a Abstract: professional pain centres across the North West of Spanish teaching hospital. 330 observations in This paper reports evaluation outcomes of a England between November 2007 and September 96 patients were analyzed. Data was gathered virtual multi-agency team approach to interven- 2008. Following this, a theoretical sampling one minute before, during, and 10 minutes after tion with chaotic, dependent families. The cross- framework was used to identify a further three the procedure. CPOT includes: facial expression, agency Springboard project supported marginal- patients and eight team members from the sites. body movements, muscle tension and compliance ised families that placed the highest demands on Data were collected through semi-structured inter- with the ventilator (total range 0-8 points). Simul- services: families described by SET (2007) as the views, which were then transcribed verbatim, and a taneously, were monitored: mean blood pressure, ‘small proportion of families with multiple problems constant comparative analysis was used to identify cardiac rate, respiratory rate and oxygen saturation. which are still struggling to break the cycle of dis- codes, categories, and a final emergent theory. The reliability of CPOT was tested using the Kappa advantage’. Information sharing, co-ordination of This presentation will describe the patient stories index in the first 88 observations. The agreement effort across agencies, and continued support after which highlight professional-patient partner- percentages were 97-100% and the Kappa index crisis management were key feature of the project. ships through which patients were able to share 0.79-1. External evaluation was undertaken from 2006-08, and confirm their experiences of pain. Adjunct to examining both process and outcome criteria.

61 Concurrent session 2 – Tuesday 24 March 2009

The evaluation aims were to measure the project Aims: To explore participants’ experiences after Aims: The overall purpose of the project was to against target outcomes for families (n=60) and to attendance at a chronic pain clinic. determine whether a nurse-led disease manage- identify change in practice amongst practitioners. Methods: Interpretative phenomenological ment programme for GORD could improve patient Formal ethical approval was secured. Instruments analysis (IPA) (Smith 1994) was used to interpret wellbeing, enhance symptom control and reduce were designed for the project: an assessment the semi –structured interview data of nine PPI prescription costs in primary care. This paper matrix to measure the most obvious signs of dis- purposely selected patients who had attended a reports on Stage 1 of the study: devising the advantage and need in families, and a baselines chronic pain clinic. education programme. document for on-going reporting of project team Results: The focus of the presentation is upon the Methods: Using purposive sampling, 669 patients activity and progress. Data was recorded from a three main themes that emerged from the data of on regular repeat PPI medication for at least 6 comparison group of families (n=9) which met the those participants who had received treatment and months were identified from 4 GP practices in recruitment criteria but which were not included experienced a pain free period: rural Norfolk. 176 agreed to take part in the two in the project. Interviews were held with 9 case- stage study. For Stage 1, we conducted 22 semi- • Living without pain: a window of opportunity: study families to elicit perspectives/reflections on structured interviews in July and October 2008. the absence or lessening of pain had offered the involvement in the project. An ‘OpenSpace’ event Respondents were aged 30 – 84 years, matched participants ‘psychological space’ from attending and individual/group interviews were undertaken for gender and age, and were interviewed about to the somatic aspects of the pain. The data to explore cultural change within teams. Senior lifestyle issues in managers were interviewed about wider impact resonated with increased cognitive control as GORD. Interviews were digitally audio recorded, on provision of services. Cases were analysed for these participants spoke about their hopes of the transcribed verbatim and the content analysed cost-effectiveness. Quantitative data from the future. thematically. Data findings were combined with baselines was compared directly with comparison • Adjustment to no pain: there was concern about evidence from a systematic review of lifestyle risk group data, the borough, and national statistics managing unknown boundaries. factors and interventions for GORD, to create an where available. Modified framework analysis was • Acceptance and engagement: maintaining and education programme for Stage 2. applied to remaining data. developing social roles, engaging in activities Results: Stage 1: many patients (N=15, or 86%) Dramatic changes occurred in criminal and anti- Discussion: The data show that the experiences of reported breakthrough symptoms despite regular social behaviour, housing, and education. More the CLBP patients fluctuate and change according PPI use, and wide ranging lifestyle factors affecting subtle changes appeared in health and employ- to personal and social context that includes their wellbeing. ment. Families recognised significant positive treatment changes. These data represent changing impacts on their lives from engagement with the Discussion: A variety of lifestyle changes and strat- illness perceptions and coping strategies that project. The Springboard project resulted in a truly egies were identified in this study which, along support a dynamic model of chronic pain. preventative, early intervention approach to vul- with proven patient education approaches, will be nerable children and their parents in Blackpool, Conclusions: Nurses are in a key position to assess incorporated in the Stage 2 study (group education providing a model for future service development. CLBP patients and offer interventions and support intervention). at appropriate times. Conclusions: Patients perceive that dietary and Recommended reading: Recommended reading: lifestyle aspects, which may be more individual Social Exclusion Task Force (2007) Reaching Out: and varied than previously appreciated, have an Busch, H. (2005) Appraisal and Coping Processes Think Family. London: SET influence on their symptoms. Current guidance Among Chronic Low Back Pain Patients. Scandina- may not support patients effectively, suggesting vian Journal of Caring Sciences, 19, 396 – 402 that a nurse-led disease management programme Smith, J.A (2004) Reflecting on the Development of for GORD has potential. Theme: Patient experience Interpretative Phenomenological Analysis and its 2.9.1 Contribution to Qualitative Research in Psychology. Recommended reading: Qualitative Research in Psychology, 1, 39 – 54 Salyers WJ, Mansour A, El-Haddad B, Golbeck AL, The experiences of patients with Kallail KJ (2007) Lifestyle Modification Counsel- chronic low back pain (CLBP) after ling in Patients with Gastro-oesophageal Reflux treatment at a chronic pain clinic: Disease Gastroenterology Nursing 30 (4) 302-304 2.9.2 An Interpretative Phenomenological Kaltenbach T, Crockett S & Gerson LB (2006) Are Analysis (IPA). Patients’ self-reported experiences Lifestyle Measures Effective in Patients with Gas- troesophageal Reflux Disease? Archives of Internal Sherrill Snelgrove, University of Wales Swansea, of dietary and other lifestyle Medicine 166 965-971 School of Health Science, Swansea, UK influences on gastro-oesophageal [email protected] Wright CC, Barlow JH, Turner AP, Bancroft GV (2003) reflux disease. Self-management Training for People with Chronic Lesley Dibley, Florence Nightingale School of Disease: An Exploratory Study British Journal of Abstract: Nursing and Midwifery, King’s College London, Health Psychology 8 465-476 London, UK Background: CLBP is a variant of chronic pain and an overarching term for a diverse number of painful Co-authors: Christine Norton; Roger Jones and benign conditions. CLBP can be challeng- [email protected] ing for both the patient and the practitioner as it may be resistant to treatment, the symptoms may Abstract: become disproportionate to the original injury and Background: Gastroesophageal reflux disease there may be no evidence of structural damage. A (GORD) is common and impacts on quality of growing body of research into the experiences of life and socio-economic functioning. Up to 50% CLBP patients pay little attention to developmental of GORD patients remain symptomatic despite changes in chronic pain (Busch 2005). The present regular proton pump inhibitor (PPI) therapy. study addresses this important gap in the literature Existing lifestyle management strategies appear to by exploring participants’ experiences over a three be under-utilised or ineffective. year period. The paper reports data from a second set of interviews after treatment.

62 Concurrent session 2 – Tuesday 24 March 2009

2.9.3 Showalter, A., Burger, S., and Salyer, J. (2000) Patients’ and Their Spouses’ Needs After Total Joint Improving the patient experience Arthroplasty: A Pilot Study. Orthopaedic Nursing. through user involvement: Action 19(1): 49-57 research in elective orthopaedic care Brian Lucas, Orthopaedic Department, Whipps Cross University Hospital NHS Trust, London, UK Co-author: Pat Howie [email protected]

Abstract: Background: The presentation will outline user involvement in an action research study designed to change the preparation of patients for Total Knee Replacement (TKR) surgery at one English District General Hospital. Aims: The 2006 study aimed to describe the changes made in the preparation of patients for TKR surgery, explore the process of change and describe the impact of changes made on patients waiting for TKR surgery. Methods: An action research approach was used, enabling participation and collaboration between staff, users and the insider researcher (the presenter). A Project Management Group of staff and five users planned and carried out action cycles, reflected on the outcomes and the need for future cycles. Users were involved in concurrent data analysis as part of the study. Results: A multidisciplinary information and assessment session (the ‘Knee Clinic’) for patients waiting for TKR surgery was developed and is run by staff and users. Analysis using the theoretical framework of Social Cognitive Theory demonstrated that the environment and staff/user personal char- acteristics such as self-efficacy beliefs affected the changes made. Discussion and Conclusions: The study builds on the knowledge related to user involvement in healthcare by extending it to acute orthopae- dic care. Previous work on user involvement has concentrated on chronic illness such as osteoar- thritis rather than acute interventions such as TKR surgery. Studies have indicated that users could become partners in care through involve- ment (Edwards 2003) and this study demonstrates how this involvement can be put into practice. After the study ended the users agreed to set up a user group, the Joint Information Group (JIG), which continues to this day and provides support for patients both before and after surgery. JIG members also represent users on an Orthopae- dic Department project group undertaking further work on the patient pathway. Recommended reading: Coulter, A., Ellins, J. (2006) Patient Focused Inter- ventions: A Review of the Evidence. London: The Health Foundation Edwards, C. (2003) Exploration of the Orthopaedic Patients ‘need to know’. Journal of Orthopaedic Nursing. 7(1): 18-25

63 Concurrent session 3 Wednesday 25 March 2009

Theme: Wound care 3.1.2 Theme: Obesity 3.1.1 The ‘gold’ standard problem in 3.2.1 Results of a randomised controlled researching the diagnosis of wound Sagittal abdominal diameter: An trial comparing honey to infection alternative method of measuring conventional treatment in wound Julie Santy, Faculty of Health and Social Care, abdominal obesity care and the problems arising University of Hull, Hull, UK Valerie Shephard, Faculty of Health and Social Care, Anglia Ruskin University, Chelmsford, UK during the course of the trial Abstract: [email protected] Val Robson, General Surgery, University Hospital Aintree, Liverpool, UK In many aspects of wound care it is important to Co-authors: Susanna Dodd; Steve Thomas know when a wound is infected. In health care, Abstract: [email protected] generally, diagnosing a condition or problem is Background: Increasing epidemiological evidence sometimes simply a matter of applying a standard links excessive central adipose tissue with cancer, diagnostic test (Guyatt, Sackett & Haynes 2006). cardiovascular and metabolic diseases. One of Abstract: On many occasions, however, the issue is more the challenges of providing health care for over- Background: It has been suggested that the use of complex and one example of this is the diagnosis weight and obese people is the limitations of the honey in wound care hastens healing by clearing of wound infection. In order to carry out research available methods to distinguish between weight infection, reducing inflammation, de-sloughing the into interventions that prevent wound infection it change and adipose tissue distribution. Body wound and therefore providing the optimum envi- is necessary to have a standard diagnostic test for mass index (BMI) is the gold standard for clas- ronment for wound healing to take place. Robust wound infection that can be used as an outcome sification of overweight(BMI 25-29.9kg/m2) and evidence on its efficacy compared to standard measure, particularly in randomised control- obesity(BMI≥30kg/m2)(World Health Organisation treatment is lacking. led trials. Two approaches to identifying wound 1998), while waist circumference (WC) and sagittal abdominal diameter (SAD) have been proposed as Aims: Compare healing rates with honey and con- infection are prevalent in the literature: i) Using the clinical signs and symptoms of wound infection methods of measuring central adiposity (Pouliot et ventional wound dressings. The primary aim was to al 1994). assess whether, in a pragmatic setting, the applica- and ii) wound culture. Validity and reliability are To explore the stability of BMI, WC and SAD tion of honey in wound management is beneficial important methodological issues in diagnostic Aims: in a primary care setting in a pragmatic longitudinal compared to conventional dressings. research. Both of these diagnostic options, then, are contentious in terms of their validity (Strainer study. Methods: A sample of 105 patients were involved & Norman 2003) and as with many other diagnostic Methods: 28 working aged men and women in a single centre, open label randomised control- questions a ‘gold’ standard test providing certainty consented to repeated measurement at eight- led trial and received either Medihoney Antibacte- about the diagnosis of infection does not exist week intervals for up to four years (2001-2004). rial Wound Gel ™ or conventional treatments. Data (Knottnerus & van Weel 2002). Recording of BMI(weight/height2), WC using a were collected between September 2004 and May tape measure, and SAD using the Holtain Kahn 2007 The aim of this paper is to discuss how neither of these options provides a ‘reference’ standard for abdominal calipers enabled exploration of the The median time to healing in the honey Results: research into interventions for the prevention of reliability of these methods for measuring central group was 100 days compared to 140 days in the adiposity. SPSS was used to analyse the longitudi- wound infection. It also aims to outline the practical control group. The healing rate at 12 weeks was nal and cross-sectional using Pearson’s correlation problems this creates for a doctoral research study equal to 46.2% in the honey group compared to coefficient and linear regression. of the diagnosis of wound infection as well as offer 34.0% in the conventional group, and the differ- some options for resolving the problem. Results: In the cross-sectional data both SAD and ence in the healing rates (95% confidence interval, WC performed well, however SAD correlated more CI) at 12 weeks between the two groups was 12.2% Recommended reading: strongly with BMI than WC for obese men and (-13.6%, 37.9%). The unadjusted hazard ratio (95% Guyatt, G. Sackett, D. and Haynes, R.B. (2006) Eval- women and overweight men. In the longitudinal CI) for the honey group compared to conventional uating Diagnostic Tests. In: Haynes, R.B. Sackett, data SAD showed significant (p<0.01) stability for dressing from a Cox regression was equal to 1.30 D.L. Guyatt, D.H and Tugwell, P (Eds) Clinical Epi- individual participants. In linear regression, only (0.77, 2.19), p=0.321. When the treatment effect demiology. SAD performed consistently. was adjusted for confounding factors (sex, wound How to do Clinical Practice Research. Third Edition. Discussion: The findings indicate SAD is a better type, age and wound area at start of treatment), Chapter 8 pp 273-322. Philadelphia. Lip predictor of intra-abdominal obesity than WC the hazard ratio increased to 1.51 but was again not because: statistically significant. Knottnerus, J.A. and van Weel, C. General Intro- duction: Evaluation of ddiagnostic Procedures. In: • it is subject to less fluctuation than WC Discussion: There were a number of unforeseen Knottnerus, J.A. (Ed) The Evidence Base of Clinical • more accurately tracks weight change problems that arose during the course of the trial Diagnosis. Chapter 1 p 1-18 London. BMJ Books including failure to recruit sufficient numbers, Conclusions: SAD was demonstrated to be a more inability to blind the trial and compliance with Streiner, D.L. and Norman, G.R. Health Measure- reliable measure to assess central abdominal treatment which impacted on the power and ment Scales. A Practical Guide to Their Develop- adiposity longitudinally in primary care. It provides a tool for continuing clinical assessment of over- resulting statistical significance of the trial. ment and Use. Third Edition. Oxford. Oxford Univer- sity Press weight and obese individuals. Conclusions: The results support the proposition that there are clinical benefits from using honey in Recommended reading: wound care, but further research is needed. Pouliot MC, Després JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, Nadeau A, Lupien PJ. Recommended reading: (1994) Waist Circumference and Abdominal Sagittal Molan PC. A Brief Review of Honey as a Clinical Diameter: Best Simple Anthropometric Indexes of Dressing. Primary Intention. 1998;6(4): 148-58 Abdominal Visceral Adipose Tissue Accumulation and Related Cardio World Health Organisation (1998) Obesity, Prevent- ing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity. Geneva WHO

64 Concurrent session 3 – Wednesday 25 March 2009

3.2.2 Theme: Recruitment and retention 3.3.2 An ethnographic study of student 3.3.1 Leadership, job satisfaction and nurses’ care of obese patients Motivation to nurse: What is the clinical wisdom: A hermeneutic Alexandra Sardani, Health Science, University of place of vocation and altruism in study of charge and clinical nurses´ Wales, Swansea, UK Co-authors: Susan M. Philpin; Daniel Warm primary care careers? experiences Lisbeth Uhrenfeldt, Clinical Nursing Research Unit, [email protected] Melody Carter, Faculty of Health and Life Sciences, University of the West of England, Bristol, UK Horsens Regional Hospital, Horsens, Denmark [email protected] [email protected] Abstract: Background: Obesity is characterised as an Abstract: Abstract: emerging ‘global epidemic’ and the number of Background: The work of nurses and nursing has Background: Charge nurses (CNs) are the largest obese patients in need of health care is increas- always been a complex subject to investigate partly group of hospital leaders and nursing leaders in ing (WHO, 2003). Previous studies (Petrich, 2000; because of its history and because of continual wards. They struggle to operate within budgetary Sardani, 2006) suggest that nursing students hold change and development of arrangements for guidelines to maintain nursing standards and negative attitudes towards overweight and obese health care (Davies 1995, DH 2006). Understanding promote motivation between staff. Nursing in patients. In the latter study students stressed that these changes and their impact on the experience Denmark is influenced by Nordic and US scholars, their attitudes were influenced by external factors, and motivation of nurses to practice is central to with philosophical issues of caring, and scholarly such as unavailability of health care resources, workforce planning and practice development. empirical studies of knowledge development in shortage of nursing staff and their unmet educa- Aims: The ideas of French scholar Pierre Bourdieu clinical practice. tional needs relating to nursing obese patients. (Bourdieu 1986) have been used to explore the Despite their negative attitudes towards obese Aims: to investigate CNs leadership practices and way that career motivations can be expressed patients, nursing students argued that their beliefs proficient clinical registered nurses´ (RNs) job sat- in nursing, with a particular focus on the notions did not affect obese patients’ care, since they isfaction. of vocation and altruism, through the process managed to control them (Sardani, 2006). of acquisition and exchange of various forms of Methods: Gadamerian hermeneutics was used; Aims: To identify if patients’ weight influences capital during a career history. The concepts of field multiple interviews with 10 CNs and 10 RNs (year: student nurses’ care. and habitus have also been applied to the analysis 2004), who received accompanying stipend and were nominated by colleagues as proficient nurses Methods: This paper draws on early findings from of data: with job satisfaction. The data were analyzed doctoral research in hospital wards, in which eth- Methods: In 2005, twelve Community Nurses stepwise inspired by Kvale and Alvesson & nography was utilised to explore nursing students’ were recruited from the NHS in the South West of Sköldberg. practice on their clinical placements. England. In the course of a long interview, they Results: CNs´ leadership practices were caring Results: The findings suggest that obese patients’ related their life histories and views about the focusing on ethical discernment and conscious- care was affected. Students categorized obese place of vocation and altruism in their own career ness towards their own role in ethical dilemmas patients as ‘difficult’ and their physical appearance journey. Using a reflexive methodology a thematic between staff. Three different practices of leader- was described negatively. This process of categori- analysis of the content of these vivid and challeng- ship were identified: zation was complex, characterized by moral judge- ing accounts was undertaken. ments and influenced by qualified nursing staff Results: The following findings have been 1) Patient-oriented attitudes, shortage of nursing staff, and students’ discussed: 2) Interactive unfamiliarity with manual handling equipment. • Atrocity stories: the emergence of challenging 3) Staff-developmental. Intellectual stimulation of This negative categorization influenced the student experiences in the field staff was part of all three leadership practices nurses’ care in that they avoided obese patients. • Symbolic capital and violence in nurse education Students attempted to disguise their negative RNs clinical practices revealed clinical wisdom and career attitudes by utilising humour and social politeness which develops when practice is built on thinking in their interactions with these patients. However, • Vocation and altruism as features of the habitus and conscience. RNs job satisfaction, autonomy, a lack of understanding of obese patients’ needs in women’s work courage and capability was threatened when the was observed, for example obese patients were Discussion: The findings raise questions about nurse-to-patient ratio was low, or there were too not weighed and health promotion was not offered. existing ideas about vocation, altruism and other many tasks to do . CNs leadership practices were In addition nurses’ avoidance resulted in patients’ emotional and ideological expressions of goodwill. decisive factors for RNs autonomy. psycho-social needs remaining unmet. Conclusions: This paper argues that the general- Discussion: Proficient CNs showed their concern Conclusions: These early findings illuminate the ised use of such terms is blind to the conditions of about staff and patients through different leader- complex ways in which patients’ obesity influences situation, class, gender and culture where women’s ship practice; they possessed ethical discernment the care nursing students provide. The findings work is concerned and that it is a risky position to in what Benner et al (1999) describe as clinical of the study could be used to inform students’ have patients’ experience subject to such arbitrary wisdom with clinical grasp & forethought, think- curricula and potentially ameliorate patients’ care. and individually defined motives. ing-in-action and reasoning-in transition. Possible conflicting areas emerged between proficient RN’s Recommended reading: Recommended reading: demands for autonomy, actual staffing and the CNs World Health Organization (2003) Global Strategy Bourdieu P. (1986) Distinction: A Social Critique of with an interactive leadership practice. the Judgment of Taste (translated by Richard Nice) on Diet, Physical Activity and Health. Geneva, Conclusions: CN´s leadership practices were London: Routledge Kegan and Paul World Health Organization decisive for RNs autonomy; as they supported or Petrich B. (2000). Medical and Nursing Students’ Davies C. (1995) Gender and the Professional Pre- curbed the autonomy. RNs job satisfaction was Perceptions of Obesity. Journal of Addictions dicament in Nursing Buckingham: Open University connected with each patient based on the patient’s Nursing 12, 3-16 Press aims and needs working independently with clinical wisdom. Sardani A.W. (2006) Nursing Students’ Attitudes Department of Health (2006) Modernising Nursing Towards Obese Patients. Unpublished Master’s Careers: Setting the Direction London: The Station- Thesis. Swansea, Swansea University ary Office

65 Concurrent session 3 – Wednesday 25 March 2009

Recommended reading: 3.4.2 Theme: Termination and miscarriage Benner, P., Hooper-Kyriakidis, P., & Stannard, D. Human rights in nursing homes 3.5.1 (1999). Clinical Wisdom and Natalie Yates-Bolton, School of Nursing, University Termination of pregnancy: Lu, H., While, A.E., Barriball, K.L., (2005). Job Satis- of Salford, Salford, UK faction Among Nurses: A Literature Review. Interna- [email protected] Implications for nurses tional Journal of Nursing Studies, 42, pp. 211–227 Allyson Lipp, Faculty of Health, Sport and Science, University of Glamorgan, Pontypridd, UK Uhrenfeldt L (2007) Leadership, Job Satisfaction Abstract: [email protected] and Clinical Wisdom: A Hermeneutic Study of Human rights are based on the principles of Charge and Clinical Nurses´ Experiences. Disser- freedom, respect, equality, dignity and autonomy. tation. Faculty of Health Sciences, University of Abstract: There are international and national frameworks of Aarhus: Aarhus conventions, laws and guidance on human rights. Background: This study has been funded as part of There are also cultural, religious and philosophi- a two-year post-doctoral fellowship by the Research cal ideals of the treatment of individuals in society Capacity Building Collaboration, Wales. Advances Theme: Long term care (Griffin, 2008). However, there are accounts of in termination of pregnancy have resulted in more 3.4.1 nursing home care failing to fulfil residents’ human terminations performed through the sole use of rights (JCHR, 2007). pharmacological agents, commonly administered Meeting the needs of individuals by nurses. In addition, a recent House of Commons The aim of this study was to examine the integra- Science and Technology Committee reported and with complex long term conditions tion of human rights in nursing home life. This debated amending the Abortion Act (House of in the community: Exploring study used an appreciative inquiry approach to Commons Science and Technology Committee, identify aspects of nursing home life that enhance professionals’ experiences 2007). This research was undertaken to examine residents’ human rights. Fiona Ross, Faculty of Health and Social Care the potential implications for nurses having more Sciences, Kingston University, St George’s An appreciative inquiry approach was selected as involvement in abortion. University of London, London, UK opposed to a problem solving approach in order Aims: To explore the affective attributes of the Co-author: Sara Christian to identify aspects of current care provision that nurses/midwives involved in termination of [email protected] made a positive contribution to acknowledging pregnancy. residents’ human rights (Elliott, 1999).The study Methods: Following ethical and research govern- Abstract: also identified aspects of nursing home life that could be developed to further enhance the fulfil- ance approval, a grounded theory study was under- Rapidly changing systems in health and social care ment of residents’ human rights. The sensitivity taken in 2007. A convenience sample of 12 NHS create uncertainty and ambiguity for profession- of this method provided an approach that was nurses/midwives experienced in abortion services als, teams and the delivery of care. The literature able to identify the realities of individual’s experi- in the National Health Service in Wales were inter- suggests that little is known about the links between ences. This was the result of the development of a viewed using a semi-structured technique. governance (organisational structures), incentives research experience where participants were able Results: The data were analysed with the aid of (supportive and enabling mechanisms) and the pro- to contribute in a non-defensive way because of NVivo. Through constant comparative analysis, fessional experience of providing care to individuals the non-threatening approach being used. This each interview was refined in response to findings. with complex long term conditions (LTCs). approach also minimised power asymmetries Despite raising non-judgementality as an attribute, This paper reports the findings from a recently between residents and staff within the research data showed that the nurses/midwives conceded completed study focusing on Professionals’ Expe- process. One to one and focus group interviews judging the women for whom they cared. They riences of Governance and Incentives (PEGI ). The were undertaken with residents and staff from two concealed their judgements when providing care study explored: what motivates health and social units at a large nursing home. through various means such as ‘keeping it back care professionals working in primary care to The findings of the study identified aspects of there’. On an abortion continuum, they were more provide ‘good’ care to people with LTCs and the nursing home life where residents and staff held likely to be judgemental about women seeking role of policy, incentives, organisational structures, similar and different views on how human rights repeat abortions. To counteract judgements they teamwork and emotional labour within this. were evident in nursing home life. used maxims to defend women’s predicament such as ‘there but for the grace of God go I’. They were The two year study was carried out in three sites. This study demonstrates the benefits of using an keen advocates of their service recognising the We worked with service users to identify their per- appreciative inquiry in health care research, as women as vulnerable, stigmatised and requiring ceptions of ‘good’ care in the context of their LTCs. the involvement of the community most closely expert care. We carried out three in-depth case studies focusing involved in the situation resulted in findings on senior managers perceptions of how LTCs should grounded in the reality of nursing home life. Conclusions: Although not fully generalisable, best be managed in the community and explored in the findings have elucidated an interesting phe- detail the reality of professionals’ experiences. Recommended reading: nomenon and are worthy of consideration by This paper will present the key findings from the Elliott C (1999) Locating the Energy for Change: An those working in abortion services internationally. study including: the service users perspective of Introduction to Appreciative Inquiry, International Results have also prompted a third phase of theo- ‘good’ and ‘not so good care’; how this relates to Institute for Sustainable Development, Canada retical sampling where the issues of judgementality the organisation of care in the community including Griffin J (2008) On Human Rights, Oxford University will be further explored. the impact of national and local policy and to the Press, UK Recommended reading: professionals’ experience; motivating and de-moti- Joint Commission on Human Rights (2007) The vating factors to do the job; the experience of team House of Commons Science and Technology Human Rights of Older People in Healthcare: Eight- and partnership working; and the influence of rela- Committee. (2007). Scientific Developments eenth Report of Session 2006-07, The Stationery tionships with others and emotional labour on the Relating to the Abortion Act 1967. In House of Office, London experience of caring for individuals with LTCs. Commons (Ed.) (12th Report of the Session 2006-07 ed., Vol. 1, pp. 1-93): TSO The findings contribute towards understanding how incentives work for diverse groups of pro- fessionals working in a variety of organisational contexts in the context of managing LTCs.

66 Concurrent session 3 – Wednesday 25 March 2009

3.5.2 Theme: Long term care 3.6.2 Early miscarriage as ‘matter out of 3.6.1 Self-management in long term place’ Evaluating the outcomes of conditions: Developing a typology Fiona Murphy, School of Health Science, University intermediate care. Whose quality of of the expert patient of Wales, Swansea, UK life is it anyway? Patricia Wilson, Centre for Research in Primary [email protected] and Community Care, University of Hertfordshire, Valerie Thomas, School of Health Science, Hatfield, UK Swansea University, Swansea, UK Abstract: Co-authors: Sally Kendall; Fiona Brooks [email protected] Background: Early miscarriage has been conceptu- Abstract: alised as loss and bereavement where nurses are urged to provide sympathetic, psychological care Background: Intermediate care (IC) is a concept Abstract: which is familiar to many people working in health for women. However, the reality of women’s experi- Background: Self-care expertise in long-term con- and social care in the UK but evidence on the effec- ence is also about blood, ‘dirt’ and failure and this ditions (LTC) is seen as empowering the individual tiveness of IC is scarce. tends to be ignored in the literature. and reducing resource demand, and is character- Aims: To explore the management and care of Aims: The aim of the study was to explore the ised in the UK by the Expert Patient Programme (DH women having an early miscarriage within a perceptions of staff working in and referring to 2001). This paper presents findings of a qualitative hospital setting. community based IC teams. study exploring the expert patient concept. Methods: An ethnographic approach consisting Methods: The paper draws on results from a Aims: The aims of the study were to explore how of 20 months participant observation working Doctoral study (data collection from mid 2006 to patient expertise was: mid 2007). It included 2 focus groups (n=6,n=10) alongside gynaecological nurses in a UK gynae- • defined and experienced by patients and clini- and observations with IC teams (n=6), face to face cological unit. In-depth interviews were also cians conducted with a purposive sample of 8 women interviews with referrers (n=17)and an evaluation • promoted and enabled through the self-manage- experiencing early miscarriage and 16 health pro- of the outcome measures. Data were coded and ment process fessionals including 10 nurses. Data analysis was analysed within and across data sets to identify completed in 2006. themes. • what mechanisms enhanced or impeded the development of patient expertise Results: Vaginal blood loss associated with mis- Results: The teams empower individuals to set carriage emerged as highly significant for both their own rehabilitative goals and to make best use Methods: Using grounded theory underpinned by women and nurses. It was observed that nurses of the services available. However, the measure- critical realism (Bhaskar 1986), data was collected were constantly noting and recording the amount ment of health and health services must be based and analysed between 2003 and 2007. The study and type of vaginal blood loss that women had. To on a specific conceptual approach (Bowling 1997). recruited more than 100 patients with LTCs and 100 the women, the blood loss was feared as to them it Conceptual difficulties, and the interaction of nurses, doctors and physiotherapists in England. signalled the end of the pregnancy. For both, there factors, compound the problem of measuring inde- Methods included semi-structured interviews, was a link between this blood loss, menstruation pendence and quality of life (QoL) in relation to IC. focus groups and observation. Utilising constant and elimination of bodily fluids. Exercising choice may lower the score on commonly comparative method, data was analysed themati- used measurement scales which assumes a lower cally with categories and core category develop- Discussion: Drawing on anthropological litera- QoL. ment. ture and the concepts of dirt and pollution, it will be suggested that miscarriage could be seen as Discussion: Developing an evidence base of the Results: A substantive theory was generated in the an exaggerated form of menstruation, which in effectiveness of a model of care that is character- study. Beyond the stereotypical expert patient, the some cultures is considered polluting. Secondly in ised by diversity and difference in practice is prob- findings suggested a typology of expert patients anthropological terms, miscarriage and the early lematic (Thomas and Lambert 2008). This paper that could be mapped onto four quadrants. The passage of the foetus are anomalous and may be explores the challenges of defining and measuring expert patient type appeared to be dependent on seen as ‘dirt’ or ‘matter out of place’ (Douglas 1966 quality of life issues within the heterogeneity of responses to National Health Services, emotional p.36). services that are labelled IC. responses to LTCs, motive for knowledge seeking, and communication style within the patient-clini- Conclusions: This link to dirt and pollution is rarely Conclusions: Person centred care at home is a key cian consultation. discussed but was an important part of women’s strand in the development of services for Older experience. Nurses tend to emphasise the ‘clean’ People and IC has the potential to achieve this. It Discussion: The differing responses reflected aspects of caring, those relating to emotions rather is necessary to adopt an appropriate range of tools cultural codes of gender discourse (Gilligan 1982), than the ‘dirty’ physical care required (Patistea to which have the ability to identify and measure in particular the category of overt-acceptor was 1999). Raising awareness of this may be a first step the variables and factors that are relevant to the characterised by the masculine gender code and towards nurses managing this sensitively and criti- person being supported by the IC interventions presented as the idealised expert patient within cally examining their practice. (McDowell and Newell 1996). the biomedical paradigm. Expert patients who did not fit with this type were marginalised or had Recommended reading: Recommended reading: unmet needs. Bowling A (1997) Measuring Health: A Review of Douglas M (1966) Purity and Danger. An Analysis Conclusions: Health professionals need to Quality of Life Measurement Scales. Buckingham: of the Concepts of Pollution and Taboo. Routledge. recognise that expert patients are not limited to Open University London the idealized overt-acceptor type. It is suggested Patistea E (1999) Nurses’ Perceptions of Caring as Thomas, V and Lambert, S (2008) An Ethnographic that the skills of a variety of expert patient types Documented in Theory and Research. Journal of Study of Intermediate Care Services in Wales: The are utilised within clinician education for exposure Clinical Nursing. 8: 487-495 Hidden Work. Journal of Nursing Management Vol to a fuller range of patient narratives surrounding 16 pp181-187 the experience of LTCs. McDowell I & Newell C (1996) Measuring Health: A Guide to Rating Scales and Questionnaires.Oxford: Oxford University Press

67 Concurrent session 3 – Wednesday 25 March 2009

Recommended reading: attending the clinic because of easy accessibility Discussion and Conclusions: Results indicate that Department of Health (2001) The Expert Patient – A within school. DCFS and PCTS across the country providing parenting skills courses for grandparents New Approach to Chronic Disease Management for are using this work as evidence to support the is beneficial in assisting them update their skills the 21st century. Stationary Office. London current expansion of sexual health services within and develop confidence in caring for their grand- schools. child. Information gained can also be used to plan Bhaskar R. (1986) Scientific Realism and Human future courses, building on existing strengths and Emancipation. Verso. London Recommended reading: ways of encouraging grandfathers to participate in Gilligan C. (1982) In a Different Voice: Psychological Teenage Pregnancy Strategy Evaluation (2005) the course. Theory and Women’s Development. Harvard Uni- Final Report Synthesis. TPU: London www.teen- versity Press. London agepregnancyunit.gov.uk.DH (2005) You’re Recommended reading: Welcome Quality Criteria. Gateway ref.5673. DH: Moran P, Ghate D, van der Merwe A. (2004). What London Works in Parenting Support? A Review of the Inter- national Evidence, Research Report RR574 Policy Theme: Young people/parenting The KingdomNations Children’s Fund (UNICEF). A League Table of Teenage Births in Rich Nations. Research Bureau, London 3.7.1 (Innocenti Report Card, Issue No. 3, July 2001). Evaluation of a school-based sexual UNICEF Innocenti Research Centre, 2001: Florence, Italy health drop-in service for young Theme: Professional issues people living in areas of high 3.8.1 deprivation 3.7.2 Assistant or substitute: Ambiguities Debra Salmon, School of Maternal and Child in the role descriptions of assistant Health, University of the West of England, Bristol, ‘Granny School’ – Evaluation practitioners UK of a parenting skills course for Co-author: Jenny Ingram Ann Wakefield, School of Nursing, Midwifery [email protected] grandparents and Social Work, The University of Manchester, Jo Corlett, School of Nursing and Midwifery, Manchester, UK University of Dundee, Dundee, UK Co-authors: Karen Spilsbury; Karl Atkinson; Hugh Abstract: Co-authors: Julie Taylor; Carol Murray McKenna Easy access to sexual health services and the [email protected] provision of good quality sex education, particu- Abstract: larly for those young people considered as ‘‘hard Abstract: to reach’’, are essential features of any success- Background: Substantial evidence exists to support ful strategy aimed at lowering rates of teenage the benefit of providing parenting skills classes for Background: Assistant practitioners (APs) are a pregnancy and sexually transmitted infections parents (Morgan et al 2004). Less evidence exists ‘new breed’ of ‘higher-level’ support worker, intro- (TPU 2005, DH 2005, UNICEF 2001). Currently in regarding provision of similar classes for grand- duced to support healthcare delivery across the Bristol a nurse led – drop-in service is being run in parents. Yet with increasing numbers of parents National Health Service (NHS) (Department of 16 schools in areas of high deprivation. This paper returning to work soon after the birth of their child, Health 2000; Modernisation Agency 2002). Data reports on an evaluation of the implementation of or unable to look after their child due to health or for this paper are drawn from a funded study which a sexual health drop-in service in schools in areas social problems, grandparents now often play an is using a mixed methods approach to explore the of high social deprivation. The 2007 evaluation important role parenting their grandchildren. This impact of introducing the AP role in acute NHS sought to identify young people’s patterns of and paper reports the findings of a research study eval- (hospital) Trusts in England. Part of the study spe- reasons for attendance, explore the views of young uating a parenting skills course provided for grand- cifically examines local policy expressions of the AP people and analyse reasons for non-attendance by parents parenting their grandchildren, sponsored role as outlined in job descriptions, so that these ‘hard to reach groups. by the Jennifer Brown Trust Appeal. can be compared and contrasted with national policy expectations. Methods included quantitative and qualitative Aims: To evaluate the impact of the ‘Granny School’ designs. Methods and analysis drew on routine in helping grandparents develop effective, up to Aims: This paper examines AP job descriptions monitoring data from service attendances; com- date parenting skills. from one case site (an acute hospital trust) to explore the potential occupational ambiguities that prehensive data on nurse consultations with 515 Methods: Questionnaires (n = 35) were admin- AP’s may be exposed to as part of their role. young people; 1826 youth work attendances; a istered to grandparents completing a parenting survey of 222 young people highlighting user views course offered by a local Trust. Questionnaires Methods: Sixteen AP job descriptions represent- and interviews with 44 young people focusing on focused on the circumstances in which grandpar- ing all clinical divisions from one acute trust were reasons for non-attendance. Quantitative data ents care for their grandchildren and the usefulness both macro and micro analysed for broad simi- were analysed using SPSS v12 and interview data of the course in giving them confidence in providing larities and differences (Hammersley & Atkinson, were subjected to thematic analysis. such care, these were analysed using SPSS. Focus 1995). The analysis specifically focused on how Results show that unlike traditional provision, groups were also conducted (n =12) to explore clinical tasks were related to clinical responsibili- large numbers of teenagers are accessing these these issues in more detail. These were analysed ties. Following this the job descriptors were then drop-in services, particularly those in ‘hard to using the constant comparative approach. indexed as belonging to one of five discrete cat- egories. reach groups’, including boys, black and minority Results: Quantitative data analysis demonstrates ethnic groups and children excluded from school. the course is helpful and informative, with an Results: Our analysis revealed the following five Young people are attending for information prior appropriate range of topics covered. Qualitative categories: fully assistive (n=1), supportive/ to their first sexual intercourse and are using the data analysis is also positive, highlighting the assistive (n=7), supportive/substitutive (n=4), broad range of services provided, including contra- opportunities provided for grandparents to practice substitutive/autonomous (n=3) and fully autono- ception, STI testing and advice about relationships skills and clarify issues they are unsure about. mous (n=1). From this, a number of anomalies and delaying sex. Useful insights have also been gained regarding manifest in the form of divergent organisational They report high levels of satisfaction, including why fewer grandfathers attend the course. expectations regarding the AP role. perceived high quality of staff input and are

68 Concurrent session 3 – Wednesday 25 March 2009

Conclusions: By definition, job descriptions count was ‘meetings and administration’ (service provide a framework within which a practitioner is related) at 13.6%. The second largest was care expected to work. This study highlights a series of coordination (9.7%) (indirect care). tensions extant between policy visions and imple- Discussion: The findings indicate that Australian mentation of the AP role in practice. Introduction NPs spend a high proportion of their work day in of new healthcare roles requires compromise and indirect care and service related activities and less negotiation to shape and define what social space on direct patient care. NP service is relatively new incumbents of these and existing roles occupy. in Australia and may not yet be fully integrated into However the way in which new roles are defined clinical services. also determines how they become embraced and Conclusions: The potential for NPs in Australia embedded within future healthcare services. to extend the reach of health service is not fully Recommended reading: realised. In-depth research is needed to further Department of Health (2000) The NHS Plan: A Plan explore development of this role. 1 Pelletier, DS, for Investment, A Plan for Reform. HMSO London & Duffield, CM. 2003, ‘Work sampling: Valuable methodology to define nursing practice patterns’, Hammersley M & Atkinson P. (1995) Ethnography: Nursing and Health Sciences, 5, pp. 31 – 38. 2 Principles in Practice. London: Routledge. 1995 Rosenfeld, P., McEvoy, M., & Glassman, K, 2003, Modernisation Agency (2002). Improvement in the ‘Measuring practice patterns among acute care NHS. London: Department of Health nurse practitioners’, Journal of Nursing Administra- tion, 33(3), pp. 159-165. Recommended reading: 3.8.2 Pelletier, DS, & Duffield, CM. 2003, ‘Work Sampling: Investigating the work pattern of Valuable Methodology to Define Nursing Practice Patterns’, Nursing and Health Sciences, 5, pp. 31 Australian nurse practitioners using – 38 work sampling methodology Rosenfeld, P., McEvoy, M., & Glassman, K, 2003, Glenn Gardner, School of Nursing, Queensland ‘Measuring Practice Patterns Among Acute University of Technology, Brisbane, Australia Care Nurse Practitioners’, Journal of Nursing Co-authors: Anne Gardner; Sandy Middleton; Administration, 33(3), pp. 159-165 Phillip Della [email protected]

Abstract: Investigating the work pattern of Australian nurse practitioners using work sampling methodology Background: In 2000 the first nurse practitioner (NP) was authorised in Australia. Numbers now exceed 300 and are increasing daily. This work sampling research is part of a three phase study investigating the profile, work patterns, and patient outcomes of Australian NPs. Aims: The of the study was to conduct work sampling research to measure and investigate the patterns of NP work to gain an understanding of the clinical service and provide a basis for further research. Methods: A national study was conducted with a geographically stratified sample of 30 NPs. They were randomly selected from a frame of 144 registered expressions of interest following a national NP census. Work sampling is an observa- tional technique producing counts from observing practice against a range of activities located across 4 practice categories1,2. Periods for data collec- tion in 10 minute intervals in 2 hour blocks were randomly generated to cover 2 working weeks from a 6 week period. Descriptive statistics were used to measure time spent on activities within each of 4 categories: direct care, indirect care, personal and service related. Results: 12,500 individual observations were recorded. Just one third (31.8%) of NP time was in direct patient care; 28.7% indirect care, and 29.1% service related activities. The largest individual

69 Concurrent session 4 Wednesday 25 March 2009

Theme: Pressure ulcers 4.1.2 4.1.3 4.1.1 An evaluation of albumin and the Pressure Ulcers Risk Evaluation The effect of washing and drying waterlow score in pressure ulcer (PURE) Project practices on skin barrier function risk assessment Jane Nixon, Clinical Trials Research Unit, The University of Leeds, Leeds, UK David Voegeli, School of Nursing and Midwifery, Denis Anthony, De Montfort University, Leicester, Co-authors Jane Nixon; Claudia Gorecki; Lisette University of Southampton, Southampton, UK UK : Schoonhoven; Andrea Nelson; Jose Closs; Tom [email protected] Co-authors: Linda Rafter; Tim Reynolds Defloor; Ruud Halfens; Julia Brown [email protected] Abstract: Abstract: Background: General skin care often consists of The research questions were ‘which sub-scores of Abstract: washing with soap and water and towel drying. the Waterlow score contribute to pressure ulcer risk Background: A major problem with current pressure assessment? ‘ and ‘do serum values add to the pre- Collectively, these factors may disrupt the barrier ulcer (PU) prevention practice and research is the dictive ability of the Waterlow score?’ The sample function of the skin, and increase the risk of inability to identify patients at high risk of PU devel- analysed was 9,409 patients aged over thirteen breakdown (Cork, 1997; Huh 2002, Voegeli 2008). opment. In recent years there has been an increase admitted non-electively who had no pressure ulcer Aims: To investigate skin barrier disruption caused in the number of studies undertaken and in order recorded on admission, of whom 139 developed by washing and drying techniques used in basic to provide a foundation for further research and nosocomial pressure ulcers. The unique (i.e. those nursing care. development of the risk assessment process, the who had no pressure ulcer on admission) nosoco- existing research base has been systematically Methods: An experimental cohort design was used. mial pressure ulcer incidence was thus 1.5%. Mann appraised. Healthy volunteers (n=15) received six different Whitney was used to compare two groups. Binary washing / drying techniques to the volar aspect of logistic regression using the forward conditional Methods: A systematic review of primary research the forearm. Subjects underwent three washing/ method was employed to measure the predictive (Pressure Ulcer Risk Evaluation (PURE) Project) drying techniques on each arm; each technique value of variables and receiver operating charac- was undertaken to identify variables independ- being repeated twice, separated by a 2 hour rest teristic to demonstrate their classification ability. ently predictive of PU development in adult patient period to simulate clinical practice. Skin integrity Factor analysis and Cronbach alpha analysis of the populations. Seven electronic databases searched, was assessed by measuring transepidermal water Waterlow sub-scores were conducted to identify contact with experts, hand searching, and cross- loss (TEWL), skin hydration, skin pH and erythema. if we were measuring several things once or one referencing was undertaken. Inclusion: prospec- Comparisons were made between washing with thing several times. The sub-scores of the Waterlow tive cohorts and RCTs of adult patient populations soap or water alone, and drying using a towel score were explored. in any setting where the primary outcome was (rubbing & patting) or evaporation. the development of (or time to development of) While they constitute a multi-dimensional dataset, a new PU(s); study outcome was clearly defined Results: TEWL increased following each type of many were not found relevant to pressure ulcer as ≥ Grade 1; length of follow-up was at least 3 wash, and with repeated washing. Drying of the risk in this sample. Some sub-scores were not days; multivariate statistical methods used to skin by ‘patting’ with a towel increased TEWL to recorded correctly, and body mass index was par- identify factors affecting PU. Study inclusion was give readings similar to wet skin. Skin pH increased ticularly badly reported. Age was found to be as determined using quality criteria for the publica- with all washing and drying techniques. Erythema predictive of pressure ulcer as the more complex tion of cohort studies (STROBE) and these will be also increased with repeated washing, particularly Waterlow score. Serum albumin was at least as discussed. when soap was used. No significant changes were good as the Waterlow score in risk assessment of observed in skin hydration. pressure ulcers. Matching patients with pressure Results: 47 studies fulfilled the inclusion criteria. Conclusions: These data suggest that washing with ulcers to patients with none, who had identical The studies combined included 32,289 patients in soap and water and towel drying has a significant Waterlow sub-scores, confirmed serum albumin a range of patient populations (ie intensive care, disrupting effect on the skin’s barrier function. as a robust predictive value in pressure ulcers. We surgery, acute care, rehabilitation, nursing homes, There is tentative evidence to suggest that a cumu- conclude that risk assessing patients based on community, and various mixed specific diagnostic lative effect may exist. Drying the skin by patting their age is as good as the more complex Waterlow groups. 112 differently named variables were iden- with a towel offers no advantage to conventional score. Additional risk information can be gained tified as predictive of PU. These were reviewed gentle rubbing as it leaves the skin significantly from knowing the serum albumin value. Nutritional and summarised by theme and will be presented. wetter, and at greater risk of friction damage. support to patients with low albumin levels, who A major finding of importance to practice is the relationship between alterations to intact skin Implications for practice: Routine skin care using may otherwise show low risk according to the including non-blanching erythema and the devel- soap and water disrupts the normal skin barrier Waterlow score, may reduce pressure ulcers in this opment of Grade 2 pressure ulcers. function, and continued use may contribute to skin population. breakdown in vulnerable individuals. Conclusions: There is considerable evidence about PU risk factors, but the interpretation and applica- Recommended reading: tion of this evidence in practice is complicated by Cork, M.J. (1997) The Importance of Skin Barrier the heterogeneity of patient populations, method- Function. J. Dermatol. Treat. 8. S7-13 ological limitations and the absence of a minimum Huh, C.H. et al. (2002) Biophysical Changes After data set in risk factor research. Mechanical Injury of the Stratum Corneum in Normal Skin. Contact Dermatitis. 46. 24-28 Voegeli, D. (2008) Care or Harm: Exploring Essential Components in Skin Care Regimens. British Journal of Nursing. 17(1), 24-30

70 Concurrent session 4 – Wednesday 25 March 2009

Theme: Research with children 4.2.2 Mayall, B. (2008) ‘Conversations with Children: Working with Generational Issues,’ in Research 4.2.1 Interviews with children: Notes with Children: Perspectives and Practices, 2nd The elephant and the bad baby: from the field edn, Christensen P & James A, eds., Routledge, Visual methodologies and Helen Gardner, Department of Nursing and Abingdon, pp. 109-125 Physiotherapy, The University of Birmingham, researching with children Birmingham, UK Duncan Randall, School of Health Sciences, The Co-author: Duncan Randall University of Birmingham, Birmingham, UK [email protected] 4.2.3 [email protected] Measuring the unmeasureable? Abstract: Abstract: Issues in paediatric quality of life Attitudes in Western society, often frame children assessment Using the story of The Elephant and The Bad Baby as vulnerable, incompetent and in need of protec- by Elfrida Vipont (2000-illustrated by Raymond Rachel Taylor, Patient Care Research & Innovation tion (Berman, 2003). This may lead researchers to Centre, Institute of Child Health, University College Briggs), this paper explores how visual method- interview children with their parents present; in London, London, UK ologies can be used in research with children. The the belief that having a familiar adult with them Co-author: Faith Gibson paper also draws on examples from a study of how supports children during the interview process [email protected] children experienced receiving nursing care in (Mayall 2008). However, it has also been noted that community settings to examine inter generational adults often answer for children, or direct children’s issues and the use of visual methodologies. answers in interviews in order, normally, to portray Abstract: The ‘elephant’ in the room, arguably, for research the child, and by extension themselves as carers/ Interest in quality of life (QoL) in health care has with children is that much of research methodology parents, in a positive light (Mayall 2008). increased significantly over the past 25 years. In was designed for use with adults. This paper looks This paper explores the benefits and difficulties 1966 QoL research contributed 0.002% to the sci- at how research methodologies can utilise chil- in interviewing children in the presence of their entific literature while in 2005 this had increased to dren’s skills in image making with in research. By parents (main carers). According to Kortesluma 1.4% (Moons et al. 2006). The increase in publica- linking the visual in children’s cultures, using as an et al (2003) although interviewing has become a tion reflects the increased number of instruments example Briggs illustration of Viponts moral tale, common method in qualitative research, there is that have been developed to measure QoL. This is the paper argues that visual methodologies allow still surprisingly little guidance on conversational especially so in paediatrics. children a way of giving data on their own terms. methods with children and the ‘empirical and con- In a review of QoL measures for use in children, Using examples from a study conducted in 2007 ceptual foundation for the child interview is not Eiser & Morse (2001) noted that prior to 1990 which used Clarke’s (2004) Mosaic approach, it is very clear’ (p. 43). By using data from two separate researchers used a battery of methods to assess further argued that using visual methodologies has studies the authors examine interviews conducted QoL. Since 1990 they identified 21 generic instru- the potential to allow children to usurp the power with and without parents present. ments specifically designed to measure QoL and 24 of adults. However, the visual field is not with out By exploring with delegates the differences and disease specific measures. However, the increased problems. Adults may influence children’s image similarities in the content and process of these number of publications and availability of instru- making just as they can influence other data given interviews the authors intend to debate; ments has sometimes been at the cost of the quality by children. There are legal and ethical considera- of research. For example, in a critical review of QoL • How children, researchers and parents might tion related to data protection, the use of images research in paediatric liver transplantation, accept- construct the interview as a negotiated conversa- made for research and the extent to which using able methodological quality was found in <50% tion visual methodologies may invade children’s privacy of studies and many of these failed to identify what or the privacy of those with whom children live or • How researchers ensure children’s voices are QoL was (Taylor et al. 2005). socialise. heard The aim of this paper is to discuss the methodo- Visual methodologies have been used successfully • The ways in which parents (main carers) partici- logical issues that should be addressed when with children to explore both their health and social pation may support children giving their data, measuring QoL in children and young people. worlds (Wang and Pies 2004; Sharples et al 2003). and/or provide context to children’s data Each of the following questions will be discussed What this paper adds is an analysis of how using These debates may inform how practitioners in detail: Why measure QoL? The reason for visual methodologies may affect the power rela- approach clinical interviews. The experiences of measuring QoL is the first step towards deciding tionships between adults and children in research. the authors suggest a pragmatic approach incor- how it will be measured. What is QoL? The way Recommended reading: porating reflexivity, flexibility and responsive- in which QoL is conceptualised needs to be ness when engaging with children and parents in made explicit. Can you measure QoL? Subjective Clark A 2004, ‘The Mosaic Approach and Research research. The skills of the researcher as interviewer personal experience versus objective measurable with Young Children,’ in The Reality of Research may determine whether parental presence results features? How can it be measured? Generic versus with Children and Young People, Lewis V et al., in joint meaning-making or the dominance of the disease-specific questionnaires? Who measures it? eds., Sage/The Open University Press, London, pp. parental perspective, at the expense of the voice of Self-report versus proxy assessment? Is there an 142-161 the child. instrument available? Validity, reliability and sensi- Sharples M, Davison L, Thomas G V, & Rudman P D tivity to changes over time? (2003) ‘Children as Photographers: An Analysis of Recommended reading: The paper will conclude by proposing standards for Children’s Photographic Behaviour and Intentions Berman, H. (2003) ‘Getting Critical with Children: QoL assessment in children and young people. at Three Age Levels’, Visual Communication, vol. Empowering Approaches with a Disempowered 2(3), pp. 303-330 Group’, Advances in Nursing Science. vol. 26, no. Recommended reading: Wang CC & Pies CA (2004) ‘Family, Maternal and 2, pp. 102-13 Eiser C, Morse R (2001b) Quality-of-life Measures in Child Health Through Photovoice’, Maternal and Kortesluama, R. L., Hentinen, M. and Nikkonen, M. Chronic Diseases of Childhood. Health Technology Child Health Journal, vol. 8(2), pp. 95-102 (2003) ‘Conducting a Qualitative Child Interview: Assessment 5(4): 1-157 Methodological Considerations’ Journal of Moons P, Budts W, De Geest S (2006) Critique on Advanced Nursing. vol. 42, no. 5, pp. 434-441 the Conceptualisation of Quality of Life: A Review

71 Concurrent session 4 – Wednesday 25 March 2009

and Evaluation of Different Conceptual Approaches. Recommended reading: Miles M and Huberman A (1994) An Expanded Sour- International Journal of Nursing Studies 43: 891-901 Bowman C., Whistler J. & Ellerby M. (2004) A cebook Qualitative data analysis, Sage, USA Taylor RM, Franck LS, Gibson F, Dhawan A (2005) A National Census of Care Home Residents. Age and Tang KL and Lee JJ (2006) Global Social Justice Critical Review of the Health-Related Quality of Life Ageing 33, 561-566 for Older People: The Case for an International of Children and Adolescents After Liver Transplan- Robson C (2002) Real World Research., 2nd edn. Convention on the Rights of Older People, British tation. Liver Transplantation 11(1): 51-60 Blackwell, Oxford. Journal of Social Work 36,1135-1150 NRES (National Research Ethics Service) (2007) Defining Research. Issue 3 National Patient Safety Theme: Residential care Agency www.nres.npsa.nhs.uk 4.3.3 4.3.1 The importance of continuity for Decommissioning a care home with older people living in residential 4.3.2 nursing care settings Laura Serrant-Green, School of Health and Social Meaning and purpose in the lives of Adeline Cooney, School of Nursing and Midwifery, Care, University of Lincoln, Lincoln, UK nursing home residents National University of Ireland, Galway, Ireland Co-authors: Angela Knight-Jackson; Kate Deacon; Natalie Yates-Bolton, School of Nursing, University [email protected] Lisa O’Leary of Salford, Salford, UK [email protected] [email protected] Abstract: Background: This paper will introduce the concept Abstract: Abstract: of ‘continuity’ and explore its significance to Care home closures are potentially unsettling for The increasing global population of older people is residents’ quality of life (QoL) and ability to feel at residents and their families because care homes often presented as a problem rather than cause for home in residential settings. are residents’ homes which they anticipate living celebration (Tang and Lee, 2006), similarly aspects Aims: The paper will draw on the findings from a until the end of their lives. In the event of a closure, of life in some nursing homes have been identified study which aimed to understand residents’ experi- residents and their families are faced with the as a negative experience (JCHR, 2007). ences of residential care and focused on whether prospect of making decisions about alternative The aim of this study is to examine meaning and they experienced a sense of home and how this accommodation and adjusting to new environ- purpose in the lives of nursing home residents. This impacted on their QoL. ments. Care home residents, particularly those action research study used an appreciative inquiry in care homes with nursing, are very elderly and Methods: This was a grounded theory study. Semi- approach. typically suffer from a number of disabling physical structured interviews were carried out with 61 and mental health problems (Bowman et al., 2004) This methodology offered an insight into nursing residents living in seven residential care facilities. and facing a major transition of this type may have home life that embraced older people as proactive The settings reflect different types of residential a range of outcomes. members of the research study. It also provided the settings. opportunity to examine nursing home life from a In February 2008, a Midlands based PCT, in col- Results: This research generated the Theory of strengths rather than problem solving perspective. laboration with the local City Council adults and Finding Home (ToFH). The factors central to ‘Finding Life story interviews, semi structured interviews communities directorate, completed the process home’ were ‘continuity’, ‘belonging’, ‘preserving and focus group interviews have been undertaken of decommissioned a privately owned care home personal identity’ and ‘being active and working’. A with residents and nursing home staff at two sites. with nursing. The decommissioning process was a brief overview of the ToFH will be provided but the This comprehensive approach to data collection multi-agency exercise initiated following concerns paper will focus on ‘continuity’, specifically on how provided a 360 perspective of the social construc- relating to safeguarding vulnerable adults and residents can be supported to maintain continuity tion of nursing home life. The interviews have been older people. The PCT and Local Authority com- in life. Atchley’s (1989) theory of continuity will be transcribed and analysed using Miles and Huber- used to contextualise study findings. missioned this evaluative study (NRES 2007) to man’s approach to qualitative data analysis (1994). Discussion: Participants reported that continu- ascertain whether the process of decommission- The residents and staff identified aspects of care ity played an important role in generated home in ing, including the on-going monitoring of residents that already contributed to meaning and purpose generating a sense of home in residential settings. who were involved, was as effective as possible in residents’ lives. In addition actions that could Continuity theory (Atchley, 1989) argues that and to identify learning points. further enhance meaning and purpose in residents’ as people grow older they seek to preserve and The study utilised process evaluation method- lives were identified by residents and staff, imple- maintain continuity in their habits, preferences, ology to document and analyse the develop- mented and evaluated as part of the study. relationships, roles, environments, attitudes and ment and implementation of the decommission- The findings of this study demonstrate that meaning ing programme. The aim was to assess whether values. The extent to which residents experienced and purpose in the lives of nursing home residents continuity, the impact on their QoL when they did the programme progressed as planned and the can be achieved by living in the present; as opposed expected outputs were achieved. and did not experience continuity and how nurses to looking to the past or to their future. The actions can support residents to maintain continuity will be This paper outlines some of the findings from the that contributed to an enhanced sense of meaning examined. evaluation. The evaluation incorporated two main and purpose were practical in orientation, this was data sources, documentary evidence and inter- regardless of age or level of disability or illness. The Conclusions: The paper will examine the concept views with those participating in the programme study demonstrates the value of actively engaging of continuity and the extent to which residents (Robson 2002). Through this method a compre- nursing home residents in research that relates to experience continuity in residential care settings. hensive picture of the decommissioning process their life experience and the impact of autonomy in Understanding continuity and its importance to was gained from the perspectives of those involved the lives of nursing home residents. older people contributes to a fuller understanding so that recommendations may be made to assist of what contributes to residents’ QoL in residential Recommended reading: health and social care managers to maximise settings. Joint Commission on Human Rights (2007) The learning from this decommissioning, and to con- Recommended reading: tribute towards improving standards of care in care Human Rights of Older People in Healthcare: Eight- Atchley, R. C. (1989) A Continuity Theory of Normal homes with nursing and care homes personal care. eenth Report of Session 2006-07, The Stationery Office, London Aging. The Gerontologist. 29(2), 183-190

72 Concurrent session 4 – Wednesday 25 March 2009

Theme: Instruments and psychometrics 4.4.2 Recommended reading: 4.4.1 Development of a modified Marwit, S.J., and Meuser, T.M. (2002) Development and Initial Validation of an Inventory to Assess Grief Usefulness and practicability of the instrument to measure anticipatory in Caregivers of Persons with Alzheimer’s Disease. Care Dependency Scale (CDS) from grieving in Jordanian parents of The Gerontologist, 42 (6), pp.751-765 nurses’ perspective children diagnosed with cancer: The Theut, S.K, Jordan, L, Ross, L.A. & Deutsch, S.I. Juliane Eichhorn-Kissel, Department of Nursing MM-CGI childhood cancer (1991) Caregivers Anticipatory Grief in Dementia: Science, Medical University Graz, Austria Ekhlas Al Gamal, Salford Centre for Nursing A Pilot Study, International Journal of Aging and Co-author: Christa Lohrmann Midwifery and Collaborative Health Care, IHSCR Human Development 33: pp.113-118 [email protected] Salford University, Salford, UK Co-authors: Tony Long; Joan Livesley [email protected] Abstract: 4.4.3 Background: Increasing costs within the health systems require an efficient use of time and staff by Abstract: Reliability and validity of the Adult appropriately satisfying patients’ needs. Therefore Development of a modified instrument to measure Alpha Functional Independence nurses must have an exact knowledge where their anticipatory grieving in Jordanian parents of Measure® patients need support. The application of valid and children diagnosed with cancer: the MM-CGI Janice Hinkle, School of Health and Social Care, reliable measure instruments gives nursing pro- Childhood Cancer Purpose This paper reports on Oxford Brookes University, Oxford, UK fessionals the opportunity to adequately assess the development and field-testing for validity and Co-authors: Jacqueline McClaran; Janette Davies; patients’ needs as a basis for individual and reliability of a modified version of the Marwit and Derek Ng appropriate care. Such an instrument is the Care Meuser Caregiver Inventory for the assessment [email protected] Dependency Scale (CDS), which has been success- of anticipatory grief among Jordanian parents fully psychometrically tested in several versions of children with cancer (the MM-CGI Childhood Abstract: for professionals, patients and relatives, also in Cancer). Aims: The main purpose of this study was to different languages and settings (nursing homes, Background: Parents of children with cancer determine the reliability and validity of the Alpha hospitals, rehabilitation). The Scale was developed endure the shock of diagnosis and the uncertainty Functional Independence Measure (AlphaFIM®). in the Netherlands (Dijkstra et al. 1996), based on of hope mixed with despair as their child passes the human needs according to Virginia Henderson through remissions, recurrences and complica- Theoretical Framework: It is important for clinicians (Henderson 1966) and measures dependency tions. This is commonly known as anticipatory grief. and researchers to have reliable and valid tools to regarding physical and psychosocial aspects. The processes and emotions involved in anticipa- assess patients. There are many reliable and valid Health care professionals in several countries and tory grief may be very different to those associated instruments to measure functional ability but the settings have been using the CDS in daily nursing with post-death grief. reliability and validity have yet to be reported on practice, but till now there has been no evaluation the AlphaFIM® instrument. of this instrument from the users’ perspective. Methods: In 2006, the 50-item MM-CGI Childhood Cancer was administered to 140 Jordanian parents Methods: A research license was obtained for the Aims: The study aims to determine how nurses living with a child with cancer. Both mothers and adult AlphaFIM® instrument that consists of 6 evaluate the practicability and usefulness of the fathers were included, interviewed individually items, 4 motor (eating, grooming, bowel manage- CDS. rather than in pairs. SPSS Version 11 was used ment and transfers) and two cognitive (expression Methods: Informed nurses from several nursing in data analysis. For descriptive elements of the and memory). A 7-point scoring system is used to settings in Austria, like rehabilitation, geriatrics instrument percentage, mean and standard devia- score each item. The six items can be summed to and community care, who had been used the scale tions were computed. Cronbach’s alpha was used generate a total score with 6 indicating complete in daily practice for several months, were asked to to assess internal consistency for the whole scale dependence in function and 42 indicating inde- fill in an evaluation-form. The ethical approval for as well as for each factor. Convergent construct pendence in function. Reliability was estimated this procedure was obtained. validity was analysed by Pearson product-moment in this prospective study using Cronbach’s alpha. Validity was examined by comparing AlphaFIM® Results: Data are currently being analysed using correlation with the Anticipatory Grief Scale (AGS). scores with Barthel Index (BI) scores and by factor SPSS 16.0. First results from the pilot study (N=46) Statistical significance was set at p=< 0.05. analysis in a group of 551 patients admitted to show that most professionals agree that the CDS is Results: The instrument demonstrated strong con- acute medical units. a useful instrument for care assessment, planning vergent validity and excellent internal consistency and documentation, improving continuity in patient reliability. Cronbach’s alpha coefficient was 0.95 Results: Cronbach’s alpha for the six item care as well as communication and cooperation for the total instrument, and for subscales 0.91 AlphaFIM® instrument was 0.90. The correlation within the professional team. Final results will be (personal sacrifice burden), 0.90 (heartfelt sadness between the AlphaFIM® and the BI was 0.682 (p presented at the International Nursing Research and longing), and 0.86 (worry and felt isolation). = .000). The factor analysis supported a one factor Conference. Construct validity was supported by demonstrating solution for the six item AlphaFIM® instrument. Among the 11 categories of medical diagnoses Conclusions: The first analysis shows satisfying a significant positive correlation with the AGS. The patients with cardiac problems had the highest results regarding practicability and usefulness instrument is a valid and reliable measure of antici- AlphaFIM® (mean = 38) scores (F = 8.50, df = 10, of the scale, wherefore the CDS might be recom- patory grief among Jordanian parents living with a p = .000). mended for application in daily nursing practice. child diagnosed with cancer. Conclusions: This new instrument will assist Conclusions: This is the first report of reliability Recommended reading: nurses in identifying parents in need of psycho- and validity on this instrument. This study found Dijkstra, A., Buist, G. & Dassen, T. (1996) Nursing- logical support during anticipatory grief at the time the adult six item AlphaFIM® to be a reliable and Care Dependency. Development of an Assessment of diagnosis and in the months following in order valid tool to measure functional ability. It can be Scale for Demented and Mentally Handicapped to promote coping. Further testing on different used with confidence by clinicians and researchers Patients. Scand J Caring Sci, 10(3), 137-43 medical conditions and parent populations is rec- for older acute medical patients. More research is Henderson, V. (1966) The nature of nursing, ommended. needed on other types of reliability and to test the Macmillan, New York tool in other populations of patients.

73 Concurrent session 4 – Wednesday 25 March 2009

Recommended reading: give due consideration to the issues that affect of the community engagement model reveals a Munro, B. (2005) Statistical Methods for Health provision at different levels. These factors may cross-sector strategy. Care Research, Lippincott Williams & Wilkins, Phila- have commonality with other bilingual settings Discussion: These models will enable community delphia outside the UK, thus giving the study international nurses to participate as partners in community relevance and scope to inform the delivery of Uniform Data System for Medical Rehabilitation environmental health without feeling restricted language appropriate nurse education worldwide. (2006), Vol. 2008 Uniform Data System for Medical by organisational policies or fear of conflict. This Rehabilitation Recommended reading: critical study has shed light on the meaning of nursing advocacy which involves the examination van der Putten, J., Hobart, J. C., Freeman, J. A. and Council of Europe (1992) European Charter for of the multiple agendas of stakeholders involved in Thompson, A. J. (1999) Journal of Neurology, Neuro- Regional and Minority Languages. Council of decisions that affect communities. surgery and Psychiatry, 66, 480-4 Europe, Strasbourg Conclusions: Nurses can become involved in envi- Higher Education Funding Council for Wales (2004) ronmental decision-making and environmental Strategy for Welsh Medium Provision in Higher advocacy in partnership with the community. Ulti- Education. Higher Education Funding Council for Theme: Education and development mately nurses can act as a resource to communi- Wales, Cardiff. 4.5.1 ties and to policymakers. Fulfillment of the role will Jacobs E., Chen A., Karliner L., Agger-Guta N. & also require working within defined geographical A scoping study of bilingual Mutha S. (2006) The Need for More Research on boundaries, a clear environmental health agenda provision in nurse education Language Barriers in Health Care: A Proposed and the development of an environmental informa- Research Agenda. The Millbank Quarterly, 84, 1, Gwerfyl Roberts, School of Nursing, Midwifery and tion base from which to draw. Health Studies, University of Wales, Bangor, UK 111-133 Co-authors: Fiona Irvine; Siobhan Tranter; Llinos Spencer 4.5.3 [email protected] 4.5.2 Nursing work in Saudi Arabia Abstract: Developing the community Ameera Aldossary, Florence Nightingale School environmental health role of the of Nursing and Midwifery, Kings College London, Background: Research evidence demonstrates London, UK that offering language choice to patients enhances nurse in partnership with local Co-authors: Louise Barriball; Alison While the quality of health care provision (Jacobs et communities [email protected] al 2006). This has particular implications for Elaine Carnegie, Centre for Advanced Studies in bilingual countries, where legislation often leads to Nursing, University of Aberdeen, Aberdeen, UK demands for health care services in both languages [email protected] Abstract: and bilingual skills, particularly amongst nurses Background: While there has been much invest- (Council of Europe 1992). Bilingual provision in ment in healthcare provision in Saudi Arabia, much Abstract: nurse education offers a way of preparing nurses nursing care is delivered by a migrant workforce for practice in the bilingual setting. Nevertheless, Developing the community environmental health (Al-Dossary et al, 2008) and little is known about this can be jeopardised by a lack of funding and role of the nurse in partnership with local commu- nursing work with regulated nurse education in strategic planning (HEFCW 2004). nities. Saudi Arabia only being established post-1958. Aims: The aim of this study was to produce an Aims: To describe two models that emerged from Aims: The study aimed to describe the activities overview of bilingual provision in nurse education one qualitative study: the community environmen- undertaken by hospital nurses from the perspec- in Wales, UK and outline plans for developing a tal health model and the community engagement tive of registered nurses, doctors and patients in national strategy. model. Saudi Arabia. Methods: The study was conducted between Background: To participate in an explicit Methods: A cross-sectional survey of nurses, March and September 2008, adopting a qualita- community environmental role demands that doctors and patients in ten hospitals in Eastern tive approach, incorporating a systematic literature nurses challenge professional ideologies in order Province, Saudi Arabia was utilized. The question- review and stakeholder consultation. A system- to partake in the social and environmental dimen- naire drew upon King’s Nurse Performance Scale atic appraisal of the national and international lit- sions of community nursing. (While et al 1996) as modified by Shuriquie et al erature yielded 29 empirical papers and 31 policy Methods: Mixed methods within an interpretive (2008). The data were collected between March – documents that were subject to the integrative approach drawing upon critical social theory. The June 2008 with a response rate of 53.3% from 1066 review method. A stakeholder consultation was study focused on one critical situation as a case respondents (overall response rate 53.3%) (Saudi conducted by telephone, e-mail or post with a study, namely the development of a local waste patients n=322; registered nurses n=614; doctors purposive sample of 71 respondents, including strategy that includes a proposal for a waste incin- n=130). education providers, nursing students and other erator. The sample was derived from documenta- Results: There was consensus that staff nurses allied representatives; and the data were subject to tion related to the case, members of the public, should meet the physical care needs of patients thematic analysis. members of local and national government, expert with some activities shared with nurse aides and Results: Six main themes emerged from the stake- informants and community nurses. Data collection more advanced activities shared with doctors. In holder consultation and these were associated included individual and focus group interviews, the psychosocial and communication domain of with external influences; policies and strategies; observation, local media and policy documentation care, no activities were attributed to nurse aides academic staff; students; resources; and outcomes and was collected between 2003 and 2005. but most activities were shared with doctors or of bilingual provision. These features aligned with Findings: The pursuit of community environmental considered to be only the doctor’s role. In the pro- the three main themes identified from the litera- health requires a framework for dialogue between fessional domain of nursing care, the majority of ture and policy review that were associated with stakeholders. The emergence of the community the activities were attributed to the both staff nurse the strategic, organisational and individual levels environmental health model demonstrates how and doctor. Just over half of the activities in the of education provision. community nurses can support a community with care management domain of the nursing care were Discussion and Conclusions: A national strategy environmental health concerns and the emergence attributed to both the staff nurse and doctor with for bilingual provision in nurse education should the remainder attributed solely to the staff nurse

74 Concurrent session 4 – Wednesday 25 March 2009

or the doctor. Patients’ views were not consistently identified. The guiding principles included: Patient patients/service users, family/carers and practi- aligned with those of nurses or doctors. and Family Centred Care; Enhanced Community tioners. Discussion: While there were similarities regarding Provision: Care Supported by Specialist & Hospital Methods: Five care homes recruited as case nursing work reported in Jordan, there were also Provision. The core components of the model studies represented a range of care environments distinct differences with doctors in Saudi Arabia were identified :as Timely identification of pal- and yielded a purposive voluntary sample of carers reported to undertake more roles perhaps reflect- liative care needs; Holistic Assessment; Integra- and multi-disciplinary (MDT) team staff partici- ing both power relations and a migrant nursing tion of services; Co-ordination of care; End of life pants (N=200). & Bereavement Care; and Public and Professional workforce. Phase 1: Baseline EOL care data were collated from Awareness. Recommended reading: documentary evidence. Perspectives and experi- Conclusions: The model proposed in this paper ences of a range of stakeholders were recorded Al-Dossary A, While A, & Barriball KL (2008) Health- provides a framework around which palliative care using focus groups, interviewing and question- care and Nursing in Saudi Arabia. International services can be developed and made more accessi- naires. Nursing Review. 55: 125-128 ble and effective to the growing numbers of people Phase 2: The implementation of the GSF, ACP & PPC Shuriquie MA, While A & Fitzpatrick JM (2008) who require them. was followed by repeat questionnaire, interviewing Nursing Work in Jordan: An Example of Nursing Recommended reading: and focus groups of carers and MDT staff and a ret- Work in the Middle East. Journal of Clinical Nursing. rospective analysis of hospital admissions for EOL 17: 999-1010 NICE (2004) Guidance on Supportive and Palliative Care for Adults with Cancer. care. While AE, Fitzpatrick JM & Roberts JD (1996) The Data Analysis: Used statistical (SPSS Version 14) Report of the Refinement and Validation of the Fitzsimons, D., Mullan, D., Wilson, J.S. et al (2007). and constant comparative analysis to assess carers King’s Nurse Performance Scale submitted to The Challenge of Patients’ Unmet Palliative Care and MDT staff knowledge, satisfaction, practice the Guy’s and Thomas’s Hospital Trustees. King’s Needs in the Final Stages of Chronic Illness. Pallia- and policy relating to EOL care College, London tive Medicine 21;4, 313 – 322 McIlfatrick, S. (2007). Assessing Palliative Care Results and Discussion: Will focus on data sets Needs: Views of Patients, Informal Carers and showing how GSF, ACP and PPC improved pal- Healthcare Professionals. Journal of Advanced liative care and EOL significantly care and reduced Theme: Palliative care Nursing 57(1), 77-86 hospital admission rates for EOL care, which has implications for the future education of care home 4.6.1 MDT staff, and has significance for policy on EOL Developing a regional model care, locally and nationally and internationally. 4.6.2 of palliative care provision for Recommended Reading: Northern Ireland How does the gold standards Department of Health (2006a) NHS End of Life Care Donna Fitzsimons, Central Nursing Team, Belfast framework, (GSF), advanced care Programme. Progress Report March 2006. www. City Hospital, Institute of Nursing Research, endolifecare.nhs.uk University of Ulster and Belfast Health & Social planning (ACP) & preferred place Care Trust, Belfast, UK of care (PPC) models improve the Department of Health (2006b) Introductory Guide to End of Life Care in Care Homes. www.endolif- Co-author: Sonja McIlfatrick quality of palliative care for older [email protected] ecare.nhs.uk people with dementia at the end of Ellershaw J.E., & Wilkinson S. (2003) Care of the Dying: A Pathway to Excellence. Oxford University Abstract: their lives? Deborah Mazhindu, Senior Research Fellow, Press Aims: To develop a regional model of palliative care Advanced Practice in Health Care, Faculty of provision for Northern Ireland Health, Liverpool John Moores University, Background: Palliative care patients present a Liverpool, UK great challenge to professional service providers, Co-authors: R McClelland; B Roe; S Ashton; 4.6.3 linked with the complex physical needs but also R Gandy; C Mullen; K Wrighley; S McAinish, E Increasing access to palliative the emotional context in which care is provided. Horgan; S Goom; P Stopforth; J Hughes The definition of palliative care was care delivered care: An evaluation of a community to any adult in the last 12 months of life. Abstract: volunteer programme in Sub- Methods: In order to achieve the aim six main Background: In 2006 the Department of Health Saharan Africa work strands were developed: 1. A comprehen- (DOHa, DOHb,) in the UK (UK) aimed to improve end Barbara Jack, Faculty of Health, Edge Hill University, Ormskirk, UK sive review of the literature 2. A regional need of life (EOL) care, including those with dementia, assessment 3. Professional Consultation achieved but models of care for older people with dementia Co-authors: Anne Merriman; Jerif Birakurataki by a variety of different activities, such as email in the UK are not well documented in key texts [email protected] discussions (n= 145 delegates), focus groups nor does it feature specifically to the Liverpool and interviews (n=87 participants included GPs, Care Pathway, (LCP) (GSF) for care of the dying Abstract: District Nurses, Palliative Care Specialists) 4. User (Ellershaw & Wilkinson 2003). In the UK, more than Background: Approx 27,000 new cases of cancer consultation comprised of evidence from separate 95% of people with dementia need 24 hour care at are reported in Uganda in each year affecting 1.5% research studies conducted recently in NI. Through the EOL, are older than those dying from cancer and of the population (Makokha 2006). However a the combined efforts of these studies the views of are more likely to have spent the last year of their shortage of Doctors, wide geographical distribu- approximately 82 patients, 91 carers (both active life in a care home. This paper reports on breaking tion, and poor transport systems leads to many and bereaved) and 123 professionals have been research commissioned in 2006 by NHS Northwest patients especially in rural areas experiencing sought. 5. District Nursing Shadowing Exercise 6. (UK) completed in October 2008. Consultation Workshop (n=60 participants) severe uncontrolled symptoms. Hospice Africa Aims: To evaluate the impact of introducing the Uganda developed a community volunteer worker Results: Following the review of the data obtained GSF, ACP & PPC in EOL care for Older People programme where local villagers are trained to from all the strands of work the key guiding princi- with Dementia in a range of care homes on staff, identify patients with palliative care needs. The vol- ples and core components of service model were

75 Concurrent session 4 – Wednesday 25 March 2009

unteers refer patients to the hospice and provide mix research but existing work sampling methods of nurse practitioners and specialist nurses (Ball basic care and support for patients and families. A are not sensitive enough to capture the complexity 2005) and modern matrons (Scott et al 2004), training course with ongoing support has resulted of NP work because there is scant information to little research has been carried out into the role of in 45 volunteers currently practicing. The volun- date about the generic activities or procedures of the ward manager since the name change in the teers receive no payment, except for a bicycle practice. early 1990’s, the introduction of specialist nurses enabling them to reach remote rural areas. Aims: The aim of the project was to develop, test and the appointment of modern matron. Yet there Aims: The aim of this study was to evaluate the and validate a nurse practitioner specific work is increasing evidence that patient outcomes are impact of the volunteer programme on patients, sampling data collection instrument, develop related to staffing levels and the appropriate skill hospice staff and volunteers. and implement a data collector training program mix (Rafferty et al 2006). Methods: A qualitative methodology using semi with in-built inter-rater reliability assessment and Aims: To examine the ward managers perception of structured individual and group tape recorded operationalise this nation-wide study into NP work their role in the provision of quality care. interviews was adopted for the study. A purposive activity. Methods: This paper presents some of the findings sample of a volunteers(22), patients(11) and Methods: This paper provides information on a from a qualitative study examining the role of the hospice staff involved with the programme(2) new approach to NP research and a framework for ward manger in two NHS Acute Trusts. Semi-struc- were invited to participate in the study. Data was the preparation involved in implementing this inno- tured interviews were conducted with a voluntary analysed for emerging themes using thematic vative research approach in the context of a nation- sample of 16 ward managers, from acute care and analysis. wide study maternity wards. The interviews were taped, tran- Results and Discussion: The volunteers were Findings: The outcome of the project was infor- scribed and their content analysed. seen to be providing a positive impact to patients mation on the logistics and materials developed Results: Despite incessant onerous demands for in helping them to receive appropriate care and for the launching of a nation-wide study into NP managerial information from senior management, intervention from the hospice team; additionally practice. Included in this presentation will be the emphasis on accountability, staffing levels and they were providing basic nursing care, support models and excerpts from the competency-based the lack of feedback, the ward managers 14(87.5%) and advice to patients and their families. For vol- interactive training DVD developed to ensure inter still participated in direct patient care. unteers, the role increased their confidence by rater reliability within the data collection team. Discussion: Ward managers had pride in their providing care for their community. Additionally Conclusions: The paper provides a template and clinical expertise and their ability to play a role for the hospice team it enables patients in rural materials that can be used by other researchers model for junior staff. Only 6(38%) felt valued, a areas with palliative care needs to be identified seeking to replicate this unique NP work sampling factor which could influence recruitment to these and provided with appropriate care. This paper will study. Furthermore the approach to this national posts. discuss the findings from the study and provide an Australian study reported here can inform a stand- Conclusions: Despite the name change, increas- overview of the structure of the programme. ardised approach to NP research internationally to ing responsibilities and the introduction of other Recommended reading: enhance cross boarder collaboration. nursing posts, ward managers still felt they should Makokha T (2006) Africa No Longer Willing to Suffer Recommended reading: play a pivotal role in the provision of quality care. in Silence. Cancer World Dec – Jan Special Issue Pelletier, D. & Duffield, C. 2003. ‘Work Sampling: Recommended reading: 42-45 Valuable Methodology to Define Nursing Practice Ball.J (2005) Maxi nurses. Advanced and Specialist Patterns’. Nursing and Health Sciences, vol. 5, pp. Nursing Roles Royal College of Nursing 31 – 38 Rafferty A M., Clarke S.P., Coles J., Ball J., James P., Theme: Professional roles Urden, L. & Roode, J. 1997. ‘Work Sampling: A Deci- McKee M., Aiken L.H. (2006) ‘Outcomes of Variation sion-making Tool for Determining Resources and 4.7.1 in Hospital Nurse Staffing in English Hospitals: Work Design’. Journal of Nursing Administration, Cross-sectional Analysis of Survey Data and An innovative approach to work vol. 27, no. 9, pp. 34 – 41 Discharge Records’ International Journal of Nursing sampling: Investigating nurse Rosenfeld, P., McEvoy, M. & Glassman, K. 2003. St practitioner work activities in ‘Measuring Practice Patterns Among Acute Care Scott C., Savage J., Read S., Ashman M. (2004) Eval- Nurse Practitioners’. Journal of Nursing Administra- Australia uation of the Modern Matron Role in a Sample of tion, vol. 33, no. 3, pp. 159 – 165. NHS Trusts Royal College of Nursing and University Michelle Gibb, School of Nursing, Queensland of Sheffield School of Nursing and Midwifery University of Technology, Brisbane, Australia Co-authors: Glenn Gardner; Anne Gardner; Victoria Kain; Sandy Middleton; Christine Duffield; Phillip 4.7.2 Della [email protected] Ward managers: Their perceived role in influencing patient care Abstract: Janet Scott, Health Development, School of Health University of Greenwich, London, UK Background: The increasingly ageing population, [email protected] limited resources and rising health care costs means that workforce reform is on the agenda of service providers. Robust evaluation of reforms to Abstract: the health care workforce is essential to develop Background: This study attempted to examine the strategies for future health service needs. The role of ward managers in relation to practice as few nurse practitioner (NP) is a reformative health attempts have been made to consider changes in service model but little is known about the activi- their role as pressure has increased on nurses to ties of NP work in the Australian or international undertake managerial roles. The ward manager context. A useful approach to examination of NP is now expected to spend considerable time work activity is work sampling methods. Work achieving corporate objectives (Scott et al 2004). sampling has been used extensively in nursing skill Whilst research has been carried out into the role

76 Concurrent session 4 – Wednesday 25 March 2009

4.7.3 Maben J, & Griffiths P (2008) Nurses in Society: and Sexual Problems Among Multiple Sclerosis Starting the Debate. National Nursing Research Patients Two to Five Years After Diagnosis’, Multiple Using action research for clinical Unit, King’s College, London Sclerosis, vol. 13, pp. 106-112 role development to enhance the Ritchie J, and Lewis J (eds) (2003) Qualitative quality of patient care Research Practice. London: Sage Loretta Bellman, Nursing Department, University College London Hospitals NHS Foundation Trust, 4.8.2 London, UK Nursing leaflets and brochures. Are Co-authors Philomena Corrigan; Eleanor Higgins; Theme: Long term conditions/neuro : they the most appropriate source of Dorcas Mcasey; Simone Browning; Theresa sciences Rommaney information for chronic neurological 4.8.1 patients and carers? Abstract: Pelvic floor muscle training in Maria Carmen Portillo Vega, School of Nursing, University of Navarra, Pamplona, Spain Clinical leadership and ownership is now con- people with Multiple Sclerosis Co-author: Sarah Cowley sidered fundamental to delivering high quality Doreen McClurg, Nursing, Midwifery and Allied [email protected] healthcare (Maben & Griffiths 2008). This project Health Professions Research Unit, Glasgow, UK evolved from frontline nurses’ concern that thoracic Co-authors: Andrea Lowe-Strong; Robin Ashe patients with complex needs were not receiving [email protected] Abstract: the optimal care they required. They engaged in a Background: Several neurological rehabilitation critical action research project (Bellman 2003) to Abstract: programmes have included written information explore the development of a new Thoracic Support Background: The incidence of multiple sclerosis packs to meet coping and counselling needs of Nurse (TSN) role. (MS) is increasing and up to 98% of people will patients and carers. However, further understand- The objectives of the study were to systematically: develop bladder dysfunction (Nortvedt et al 2007). ing of how to assure the success of these informa- 1. explore the process of change with the TSN and Pelvic floor muscle training (PFMT) is used in the tion packs is still needed. colleagues non-neurogenic population for suppression of idi- Aims: To describe the development and handling 2. highlight the drivers and barriers to developing opathic detrusor overactivity, however there is process of leaflets and brochures, and reflect on the TSN role limited research relating to the retraining of these their usefulness for nurses, and chronic neurologi- muscles in those with neurogenic detrusor overac- cal patients and carers. 3. explore problems within TSN role development tivity. Methods: Data were obtained in an action research 4. evaluate the impact of the TSN role Aims: To determine if PFMT augmented by Elec- project which took place in two neurological wards The participants (n=35) were: the action research romyography (EMG) Biofeedback was feasible in of a hospital in Spain (2002-2006). A social rehabil- facilitator; 6 co-researchers, the total population people with MS and establish if there was a corre- itation programme was planned, implemented and of ward nursing staff and linked multi-disciplinary lation with symptom relief. evaluated with nurses from the wards (n=37), and colleagues. Mixed method data collection encom- Methods: 34 participants, all with a diagnosis of two groups of neurological patients and relatives passed: audio-taped co-researcher meetings; TSN MS and bladder dysfunction were treated using (n1=22/22; n2=18/18), selected through conven- reflective journal; staff focus groups; staff survey; PFMT and EMG Biofeedback. Patients were seen ience sampling. Two leaflets and two brochures for patient survey; semi-structured interview; facili- weekly for 9 weeks, and received an individual- Parkinson and Multiple Sclerosis were developed tator reflexivity. Thematic analysis and content ised PFMT training programme based on the initial and handed, and were also available for the general analysis were undertaken. Also, triangulation assessment and progression, with endurance public in Internet. The contents focused on the enhanced the validity of the findings and extended and relaxation of contraction being emphasised. disease, lay care, architectural hazards, social life, understanding through the use of multiple per- Outcome measures (at 0, 9, 16 and 24 weeks) and community services. Semi-structured inter- spectives (Ritchie & Lewis 2003). included digital and EMG biofeedback assessment views and non-participant observations took place. Five themes emerged reflecting contemporary of the PFMs, number of leakage episodes (bladder Furthermore, opinion emails (n=10) about leaflets change & innovation process and outcomes: diary), amount of leakage (pad test), uroflowmetry, in internet were received after the study concluded (2007-2008). Content analysis (N-Vivo v.2.0) and • It’s the need to improve the quality of care the International Prostate Symptom Score (IPSS: (Barry et al. 1992) and a Visual Analogue Scale statistical analysis (SPSS v. 15.0) were conducted. • Brought research to life (VAS) relating to the bothersomeness of symptoms. Results: Most participants underlined the need • A rollercoaster of emotions and experiences Results: Data analysis was by intention to treat. for leaflets and brochures to ease the informa- • Process is as important as outcome The primary analysis was conducted comparing tion process. After the rehabilitation programme, • We did it ourselves and learnt so much week 0 to week 9 data using a Paired Sample T-Test nurses’ initiative in the educational process sig- nificantly increased (p=0.01) partly due to the sig- The presentation will provide an overview of the and a significance level of 0.05 was set. Statistically nificant use of written resources (p<0.001). Carers recently completed project, including the ethical significant increases in PFM endurance, strength were significantly more involved in the educative approval process. The study appears to be in line and relaxation; reduction in leakage episodes and process (p= 0.01). The contents of the leaflets and with current policy proposals to both improve quantity; improvement in the IPSS and VAS were all brochures were considered very useful even after the quality of care, and enable greater freedom, evident (all, p=0.001). discharge. enhanced accountability and empowerment of staff Conclusions: It is possible to improve the function to make change actually happen (Maben & Griffiths of the PFM in people with MS which appeared to Discussion: Written information eased the 2008). reduce leakage which translated into a better a educative process and constituted a reliable source better quality of life. It would seem practicable to of information because leaflets and brochures were Recommended reading: include some form of PFM training as standard in designed according to individual needs of profes- Bellman L (2003) Nurse-led Change and Develop- people with MS who have bladder dysfunction. sionals and clients. ment in Clinical Practice. Nursing Research Series. Conclusions: This paper will shed light on the Recommended reading: London: Wiley-Blackwell design and use of written sources of information Nortvedt, MW., Riise, T., Frugard, J., Mohn, J., Bakke, for future rehabilitation programmes of chronic A., Myhr, A. 2007, ‘Prevalence of Bladder, Bowel diseases.

77 Concurrent session 4 – Wednesday 25 March 2009

Recommended reading: Thomas S, Sweetnam C (2002) Parkinson’s Disease. Caring for the Carers. Primary Health Care 12: 27-31 Forbes A, While A, Dyson L, Grocott T, Griffiths P (2003) Impact of Clinical Nurse Specialists in Multiple Sclerosis-Synthesis of the evidence. Journal of Advanced Nursing 42 (5): 442-462 Miles MB, Huberman AM (1994) Qualitative data analysis: an expanded sourcebook. 2nd Edition. London: Sage publications

4.8.3 The first 40 years of the American Association of Neuroscience Nurses—It took nerve! Janice Hinkle, School of Health & Social Care, Oxford Brookes University, Oxford, UK Co-authors: Virginia Prendergast; Elizabeth Reedy [email protected]

Abstract: Purpose: The American Association of Neuro- science Nurses (AANN) celebrated 40 years as an organization in 2008. In preparation for this a task force was formed and conducted video-taped inter- views with past presidents to document their his- torical perspectives. Background: The AANN was founded in 1968 as the American Association of Neurosurgical Nurses. The association was suggested by a committee of the American Association of Neurological Surgeons (AANS). Methods: Two of the researchers viewed each of the 16 interviews. Then usable interviews were transcribed. Content analysis was used to identify historical themes and influences on the AANN in it’s first 40 years. The researchers also read early documents from both the AANN and the AANS. Results: The themes that emerged about the his- torical evolution of AANN mirrored the growth and development process seen in children. Past presi- dents in the first decade recalled ‘the birth of the organization’ and made comments such as ‘we were babies’ and ‘here we were infants, didn’t have the vaguest idea of what we were doing’. During the childhood of the organization developmental mile- stones such as learning communication skills were an issue. Past presidents during the middle years felt the organization moved into an adolescent phase of development with conflicts about moving into their own office space and out of space they shared with the AANS. Moving into early adulthood involved learning to manage finances and moving the organization from an executive director to a management firm. Conclusions and Implications: This study adds to the growing body of knowledge about nursing specialty organizations. Remembering the origins of neuroscience nursing helps make connections with the past, present, and future of this specialty.

78 Concurrent session 5 Wednesday 25 March 2009

Theme: Children and parents 5.1.2 Theme: Fasting and operations 5.1.1 Parents of children with ambiguous 5.2.1 Researching experience, genitalia: Stories of experiences of The patients’ priorities for care experiencing research: Living with reconstructive genital surgeries and when fasting for elective surgery autism spectrum disorder finding harmony Jacqueline Chandler-Oatts, Research Team, Royal Sarah Mackay, School of Health, Social Care and Caroline Sanders, Nursing, Royal Liverpool College of Nursing Institute, Oxford, UK Exercise Sciences, Glyndwr University, Wrexham, Children’s Hospital, Liverpool, UK Co-authors: Claire Hawkes; Jo Rycroft Malone; Claire Allen; Kate Seers; Ian Bullock; Nicola UK Co authors: Bernie Carter; Lynne Goodacre; Alan Crichton; Leo Strunin Armstrong Abstract: [email protected] Autism Spectrum Disorder (ASD) involves sig- Abstract: nificant impairment in social communication and Abstract: repetitive, ritualistic behaviour and interests. Aims: To explore and understand parents’ experi- Background: Findings will be presented from a Problems in these areas cause considerable distur- ences of their child’s genital ambiguity and the randomised trial involving 19 NHS Trusts in the UK bance in all aspects of everyday living, and rising reconstructive surgeries for AG. evaluating guideline implementation strategies, on prevalence is a concern for health and social care Background: The determination of sex and gender providers and policy makers (MRC, 2001). patients’ priorities for care when fasting for elective for a child born with AG is an extremely complex surgery. Fasting practice is ingrained in hospital This paper provides a narrative account of the medical and social process (Thyen et al, 2005). rituals often resulting in prolonged fasting times. process of undertaking doctoral research using Academic debate, professional practice, the law and A difference between patient identified outcomes methodological insights from hermeneutic phe- increased political and ethical debate have all more and those identified by the healthcare professional nomenology to explore experiences of living with recently challenged the evidence base for practice. or researcher has been observed (Staniszewska, ASD. Incorporating philosophical questions of Currently the ‘optimal gender policy’ and the 1999), which includes obtaining the patient perspec- being and knowing, this methodological per- ‘informed consent policy’ drive treatment options. tive rather than make assumptions (Mahon, 1996). spective underpinned both fieldwork methods Health, surgical and psychological outcome studies Within the study we explored the patient’s perspec- and thematic analysis using hermeneutic tools from individuals born with ambiguous genitalia are tive about processes and outcome of care in relation of conversation, interpretation and reflection. limited and focus on adults. Little research has been to the time they fasted pre and post operatively. Parents/carers were interviewed to obtain a his- conducted to understand the significance gender torical narrative of living with autism, and young ambiguity has in parents’ lives and how the child’s Approach: Patient advisers were involved in study people (aged 8-21) shared their narratives through genital surgery affects parents. design, development of interview schedules and camcorder and interview. questionnaire, and as members of the project team Methods: An exploratory design of narrative and advisory group. This highlighted the usefulness of pursuing alter- inquiry (Riessman, 2008) was chosen and data native methods of conducting research with young were collected through eighteen in-depth narrative Methods: Information collected through patient people with communication difficulties. Influenced interviews with a purposive non-random sample of organisations informed the development of data by the theoretical work of Benner (1994), the tran- fifteen parents of 11 children (aged 0-11 years). collection tools. All patients recruited in the trial received a questionnaire to complete and return scribed narratives were then subject to systematic Narrative analysis (Holloway & Fresh- Findings: about their experience of care. Semi-structured analysis, enabling movement between ‘whole and water, 2007) resulted in three keystone stories interviews were also conducted with a convenience part’, transparent reflection of interpretations, which contained in total eight aggregate stories sample of patients’ pre and post intervention. and identification of ‘paradigm cases’. As well as and twenty foundational stories. The three gaining insight into the experience and needs of keystone story themes were parents’ stories Key findings: Preliminary findings suggest that those affected by ASD as they journey through about their child, about being a parent of a child thirst (78.9%) (N=1062)) is more of an issue for health, social care and educational provision, the with AG and healthcare professionals. Interpreta- patients than hunger (46.5%) (N=1062). Key aims of the study included the synthesis of evidence tion and synthesis of the three keystone stories themes from seventy interviews included some from literature and narratives regarding historical revealed three core elements fundamental to patients maintained their eating and sleeping and societal influences, and the development of a parents stories; shock, protection and anxiety. The routines irrespective of fasting advice. Receiving rich account documenting the diverse perspectives synthesis reveals how even though parents had to clear and consistent information and being kept of those living with ASD. These insights will contrib- cope with shock, protect their child whilst experi- informed of operation times was important. Low ute to the development of knowledge and practice encing anxiety they were able to achieve a sense expectations and tolerance of less care from busy which reflect the experience and needs of people of harmony about their child. Harmony is a concept staff suggests patients put up with the discomfort affected by ASD. that brought consistency and agreement together of prolonged fasts. resulting in parents embracing their experiences Recommended reading: Conclusions: It is important not to assume the holistically and giving their experiences meaning. effect of care on patients or underestimate the Benner, P. (1994) ‘The Tradition and Skill of Inter- Conclusions: Parents overcame the tensions value of their perspective. Clarity of patients’ priori- pretive Phenomenology in Studying Health, Illness inherent in their experience of their child’s AG and ties suggest they need clearer information on food and Caring Practices’ In: Benner, P. (Ed.) Interpre- found a sense of harmony. Harmony has not previ- and fluids in preparation for fasting. Better commu- tive Phenomenology: Embodiment, Caring and ously been described in the literature. nication between staff and patients is required on Ethics in Health and Illness. California, Sage the impact of fasting and operating schedules. MRC (2001) Review of Autism Research: Epidemiol- Recommended reading: ogy and Causes. London, Medical Research Council Holloway, I & Freshwater, D (2007) Narrative Recommended reading: Research in Nursing. Oxford: Blackwell Mahon PY (1996) An Analysis of the Concept Riessman, C (2008) Narrative Methods for the ‘Patient Satisfaction’ as it Relates to Contemporary Human Science. California: Sage Nursing Care. Journal of Advanced Nursing; 24: 1241-1248 Thyen, U et al (2005) Deciding on Gender in Children with Intersex Conditions: Considerations Staniszewska SH. (1999) Patient Expectations and and Controversies. Treatment Endocrinology, 4(1), Health-Related Quality of Life. Health Expectations; pp.1-8 2: 93-104

79 Concurrent session 5 – Wednesday 25 March 2009

5.2.2 Theme: Prevention and screening Kim K K. (1991) Development and Evaluation of the Osteoporosis Health Belief Scale Research in 5.3.1 Implementing peri-operative fasting Nursing and Health, 14(2): l55-163 recommendations: A process and Factors related to the prevention Horan M L (1998).Development and Evaluation of outcome evaluation behaviors of osteoporosis in urban the Osteoporosis Self—Efficacy Scale, Research in Jo Rycroft-Malone, Centre for Health-Related Chinese Nursing and Health, 21(5): 395-403 Research, University of Wales, Bangor, UK Xiulin Yang, School of Nursing, Tianjin Medical Co-authors Claire Hawkes; Jackie Chandler; Kate : University, Tianjin, China Seers; Ian Bullock; Nicola Crichton; Leo Strunin; Co-author: Chunmei Wang Claire Allen 5.3.2 [email protected] [email protected] An investigation of the factors that influence participation in Abstract: Abstract: mammography screening in Greece Background: There is good quality research Background: Osteoporosis is common among Aikaterina Kaltsa, Faculty of Medicine and evidence translated into national guidance, which elderly. As a disease which can be delayed or even Health Sciences, School of Nursing, Midwifery recommends that it is safe for healthy adults to prevented by lifestyle modification (Larkey 2003), it is important to find an effective way to persuade & Physiotherapy, University of Nottingham, drink clear fluids up to two hours before induction Nottingham, UK people to prevent it in daily life. of anaesthesia for elective surgery and eat up to six Co-author: Karen Cox hours beforehand. However, UK survey data show Aims: To access the factors related to osteoporosis most departments follow traditional rules, i.e. prevention behaviors in Chinese based on health fasting from midnight. Prolonged fasting can lead belief model. Abstract: to dehydration, electrolyte imbalance, nausea and Methods: A questionnaire requesting demo- Background: Breast cancer is a threat for the reduced nutritional intake. This presentation will graphic information, related to intention/clues female population worldwide. In Greece, 1,500- report the results of a process and outcome evalu- of behavior, prevention behaviors survey, Oste- 1,800 women die annually from breast cancer out ation in which recommendations for reducing peri- oporosis Knowledge Test, Osteoporosis Health of the 4,000 who are affected. Interestingly, only operative fasting times were being implemented. Belief Scale(Kim 1991),and Osteoporosis Self- 5% of them are detected at an early disease stage, Approach: Through a pragmatic randomised trial Efficacy Scale (Horan 1998) was administered to through mammography screening. using time series, we evaluated three strategies for 300 Chinese city-dwellers over forty between April Aims: To explore the psychological, socio-econom- the implementation of national fasting guideline and August, 2008. Analysis used Binary Logistic ical and health related factors that influence Greek recommendations in 19 UK NHS Trusts. Duration Regression. women’s decisions to utilise or abstain from mam- of fasting was measured 4 times pre and 4 times Results: 282 valid questionnaires were collected. mography screening. post intervention. Process data from participating Only 46(16.31%) of subjects do regular exercise Methods: Exploratory mixed methods govern the practitioners was obtained through interviews, however 182 (64.54%) have good dietary habit research design. Questionnaires and interviews focus groups, and a learning organisation survey. for osteoporosis prevention. After adjusting were utilized as measurement tools. Data were Patients’ experiences were explored through inter- for confounding factors, barriers to exercise is collected in Athens-Greece, during the period views and a survey. the unique factor related to suitable exercise March-July 2008. 186 questionnaires were collected Findings: Pre intervention duration of fasting P=0.000,OR=1.302 Women (P=0.000,OR=4.049) from 6 women’s associations. Interviewees were results show patients’ mean fluid fast was 9.5 hours and people having previous knowledge about oste- recruited using the questionnaires and 33 semi- (n=1440) and their mean food fast was 14 hours oporosis (P=0.000,OR=2.805), have better dietary structured interviews followed. Descriptive and (n=1435). Nearly 79% (n=1069) patients reported habits. In addition, age (P=0.000,OR=1.060), constant comparative data analysis is in progress, feeling thirsty pre-operatively and 47% (n=1069) barriers to calcium score (P=0.026,OR=1.088) and for the questionnaires and interviews respectively. levels of health belief (P=0.001,OR=1.036) are also feeling hungry. Post intervention results indicate a Results: According to the questionnaires, 85% of positively correlated to dietary habit. small reduction in fasting times. Process data show the participants attend mammography screening. there is a lack of clarity about authority for fasting Discussion: Elder’s poor health (most have chronic However, preliminary findings from the analysis decisions amongst staff; there are big challenges disease, e.g. CHD) increases the perceived barriers of interviews suggest the existence of obstacles co-ordinating services across boundaries and to exercise and hinders them from doing sufficient in the screening procedure, such as the problem- professions and in implementing changes within exercise. Women and people having previous atic communication between women and health a constantly changing NHS environment. Patients knowledge about osteoporosis have better dietary care professionals and deficiencies of the health tended to be tolerant of busy staff, sometimes fast habits, this indicates health education is effective care system. Psychological factors and cancer to suit their own routines, and find ways to cope in helping people take measures to prevent oste- experiences arising from women’s immediate envi- with prolonged fasting. oporosis, but in future this should also focus on ronment determine their participation in breast Discussion: Findings will be discussed in the men. . cancer screening. Lack of familiarisation regarding context of practical and methodological issues of Conclusions: Reasonable and effective exercise education on cancer and early detection is percep- implementation research, including intervention plans for people with chronic disease need to be tible. Women’s role and privacy in the Greek society fidelity being compromised by local contextual developed to help them avoid osteoporosis. The are currently investigated and findings are inter- influences and how patients’ experiences might be next phase of this study will use parallel question- preted using a health behavioural model. used as levers in implementation efforts. naires to evaluate the results of a nurse educator Discussion and Conclusions: Power relationships, working with the same clients based on these education and health taboos in Greek society results. appear to influence women’s behaviour towards breast cancer screening. These issues need to be Recommended reading: taken into account in any future interventions with Larkey L K. (2003) Osteoporosis Prevention: Greek women and breast cancer screening. Knowledge and Behavior in a Southwestern Community. Journal of Community Health, 28(5): 377-388

80 Concurrent session 5 – Wednesday 25 March 2009

Theme: Nurse prescribing DCWGroup (2001). Assessment of Best Practice for Recommended reading: Dermatological Services in Primary Care. London: 5.4.1 Bradley, E.,Nolan, P. (2007) Impact of Nurse Pre- HMSO scribing: A Qualitative Study, Journal of Advanced Nurse prescriber-patient Stenner, K. & Courtenay, M (2008). The Benefits of Nursing, 59, (2), 120-128 consultations: A case study in Nurse Prescribing According to Nurses Prescribing Carey, N., Courtenay, M.,Burke, J. (2007) A National dermatology for Patients in Pain. Journal of Advanced Nursing, Evaluation of Supplementary Nurse Prescribing Molly Courtenay, School of Health and Social Care, 63 (1), 27-35 in Dermatology, Journal of Clinical Nursing, 16, University of Reading, Reading, UK 1230-1237 Co-authors: Nicola Carey; Karen Stenner Courtenay, M., Carey, N.,Burke, J. (2007) Independ- [email protected] 5.4.2 ent Extended Nurse Prescribing for Patients with Skin Conditions: A National Questionnaire Survey, Abstract: Stakeholder views on the impact of Journal of Clinical Nursing, 16, 1247-1255 Aims: To explore the consultations between nurse nurse prescribing on dermatology prescribers and dermatology patients. services Nicola Carey, School of Health and Social Care, Background: Communication skills, consultation Theme: Informal care University of Reading, Reading, UK time, information, and follow-up are central to the Co-authors: Molly Courtenay: Karen Stenner 5.5.1 treatment management of dermatology patients (Dermatological Care Working Group (DCWG) [email protected] A structural equation model of 2001). The contribution nurses make to the care of informal caregiving these patients has significant potential (Courtenay Abstract: Zoe Stamataki, School of Nursing, University of & Carey 2006). Indications are that nurse prescrib- Aims: The aim was to explore stakeholder views Nottingham, Nottingham, UK ing enables a more holistic approach to care and on the impact of nurse prescribing on dermatol- Co-authors: Davina Porock; Alison Edgley greater opportunity for patients to be involved in ogy services. Background Nurse led care enhances [email protected] treatment decisions (Stenner & Courtenay 2008); the services that dermatology patients receive. however there is no evidence specifically exploring Research indicates that care delivered by nurse Abstract: the consultations of nurse prescribers with derma- prescribers can improve efficiency and access to Background: A concept analysis of the informal tology patients. This is important given the high medicines (Bradley & Nolan 2007). Whilst there caregiving has shown that caregiving is a multidi- number of patients with skin conditions treated by is recent evidence which suggests that 75% of mensional concept which may affect every single nurse prescribers. nurses are prescribing for skin conditions (Carey domain of the caregivers’ life. However, it has Methods: A multiple case study of 10 practice et al. 2007, Courtenay et al. 2007), there is no shown that no single study has ever focused on the settings across England in which nurses pre- evidence exploring the impact of nurse prescrib- multidimensional context of the informal caregiv- scribed medicines for dermatology patients. Data ing on the configuration of dermatology services. ing and its consequences. No one has ever tried comprised of semi structured interviews (n=40), This is important given the increasing number of to predict relationships amongst factors that may patient questionnaires (n=165/200) and video- patients with skin conditions, and the high number influence the caregiving experience. taped observations of nurse consultations (n=40). of nurses who prescribe for them. Data analysis included thematic analysis, descrip- Aims: The aim of this paper is to present a struc- Methods: A collective case study of 10 practice tural equation model that can predict caregiving tive statistics, Chi-square and non-parametric settings across England in which nurses prescribed experience tests. Data were collected between June 2006 and medicines for dermatology patients. A thematic September 2007. analysis of semi-structured interview data (n=40) Methods: A cross sectional quantitative study Findings: Nurses believed that their holistic collected during 2006 and 2007. Participants were has been undertaken to explore relationships approach to assessment combined with prescrib- qualified nurse prescribers (n=11), administra- between variables of interest. The scales used for ing knowledge, improved prescribing decisions. tive staff (n=11), doctors (n=12) and non-nurse this purpose include: Mutuality scale, Preparation, Listening and explanation of treatments were prescribers(n=6). Rewards, Partner’s self efficacy, Perceived stress, aspects of nurse communication rated highly by Quality of life, Caregiver reaction assessment and Findings: Nurse prescribing was reported to Overall experience scale. The data were analysed patients. Listening and dealing sensitively with support and facilitate the modernisation of derma- using SPSS, MSP5 for Mokken scale analysis and emotions were also aspects of the video-taped tology services. It enabled nurses to make effective AMOS for structural equation modelling. consultations rated highly by assessors. Nurses use of their knowledge and skills, overcome were less consistent in providing information about delays in treatment and provide faster access to Results: Seventy one spouses of cancer patients medicines. medicines. However a number of organizational recruited in the study between May 2007 and Conclusions: Triangulated data from this study issues including support, access to CPD, and March 2008. The SEM has shown a model that confirms that nurse prescribing enhances the care capacity of the workforce, restricted the success of can predict caregiving experience directly by the of dermatology patient through improved prescrib- the initiative. caregivers’ feelings of burden and perception of ing decisions. If patients are to be more involved quality of life, as indicated by the caregivers’ scores Conclusions: Nurse prescribing is successfully of strain, stress, impact on health, schedule and in this decision making, nurses must provide them being used to support and deliver a range of finances (2(df=54) = 50.8, p=.600; RMSEA= .000, with more information about their medicines. services to dermatology patients. Stakeholders GFI= .908, CFI=1.00, PGFI= .539, NFI= .895, and Benefits provided by prescribing are most evident reported that both patients and staff had benefited TLI= 1.011). Correlations and direct causal relation- in the practices of dermatology specialist nurses. by the adoption of this role by nurses. However ships between variables such as the spousal rela- Further evidence is required to identify whether provision of adequate support and strategic tionships, preparation, self esteem, self efficacy prescribing offers specialist nurses in other thera- planning are essential if the impact of nurse pre- and family support have been found to be indirectly peutic areas similar benefits. scribing is to be fully realised. influence the caregiving experience. Recommended reading: Discussion and Conclusions: Results from the Courtenay, M & Carey, N (2006). Nurse-led Care in SEM analysis describe a model with an excellent Dermatology: A Review of the Literature. British fit, which explains the multidimensional aspect of Journal of Dermatology. 154, 1-6

81 Concurrent session 5 – Wednesday 25 March 2009

the caregiving experience. A simplified model B the chance to develop new friendships. Neverthe- written and IT supported by rules and feedback designed to be used in nursing practice, to assess less the literature suggests that provision of such loops. The outcomes were multilayered, often with caregivers’ experience, and needs. projects is inadequate and under-resourced which hidden meaning secondary to the subjects under may further disadvantage a group of young people discussion. Interactions were influenced by individ- Recommended reading: who are known to come from lower income families. ual scenario assessments using a range of profes- Given, C. W., Given, B., Stommel, M., Collins, C., sional, organisational and personal values/belief Recommended reading: Sharon, K., Franklin, S. (1992). systems. Thus ‘Pre-Game’ strategies emerged to The Caregiver Reaction Assessement (CRA) for Banks,P. Gallagher,E. Hill, M. Rissell,S. (2002) Lit- maximise positive outcomes during transactions. erature Review of Identification, Needs Assess- Caregivers to Persons with Chronic Physical and Conclusions: A contemporary collegiate model of ment and Service Provision for Young Carers and Mental Impairements. Research in Nursing & interaction is emerging, although ‘doctor/nurse Their Families. Edinburgh Research Findings No 23. Health. 15, pp: 271-283 games’ are still played out in the clinical setting. Scottish Executive Central Research Unit. Cohen, S., Karmarck, T., Mermelstein, R. (1983). However, traditional models of interaction and A Global Measure of Perceived Stress. Journal of Clements, L (2004) Carers – The Sympathy and communication based upon the orthodoxy of a Health and Social Behaviour. 24, pp: 385–396 Services Stereotype. British Journal of Learning subjugated profession will need to be revised in Disabilities Vol 32 : 1 the light of new evidence. Archbold, P.G., Stewart, B.J., Greenlick, M.R., National Office for Statistics (2003) April 2001 Harvath, T. (1990). Mutuality and Preparedeness Recommended reading: as Predictors of Caregiver Role Strain. Research in Census: Informal Care UK Statistics Authority, Allen (1997): The Nursing-Medical Boundary: A Nursing & Health. 13, pp: 375-384 London Negotiated Order? Sociology of Health & Illness 19, 498-520 Hughes D. (1988): When Nurse Knows Best: Some 5.5.2 Theme: Communication Aspects of Nurse Doctor Interaction in a Casualty Department. Sociology of Health & Illness 10, 1-22 Evaluation of a Crossroads Young 5.6.1 An ethnographic study of Porter S. (1991): A Participant Observation Study of Carers Initiative Power Relations Between Nurses and Doctors in a Annette Jinks, Evidence-based Practice Research communication between nurse General Hospital. Journal of Advanced Nursing 16, Centre, Faculty of Health, Edge Hill University, specialists and doctors in the UK 728-735 Liverpool, UK Mark Radford, Heart of England NHS Foundation Co-authors: Kathleen Richardson; Brenda Roberts Trust, Sutton Coldfield, UK [email protected] Co-authors: Elaine Denny; Mike Filby; Caroline Williams 5.6.2 Abstract: [email protected] The role of the nurse in breaking It estimated in the UK more than six million people bad news in the inpatient care are carers, which includes 175,000 young carers Abstract: setting under the age of 18 (Office for National Statis- Background: Before Stein (1967) first coined tics 2003). Aims of the research described in this Clare Warnock, Weston Park Hospital, Sheffield the term ‘Doctor Nurse game’, the relationship Teaching Hospitals NHS Trust, Sheffield, UK abstract was to evaluate three Crossroads’ Young between these two groups has been the focus of Co-authors: Angela Tod; Julie Foster; Catherine Persons Carers Projects. A qualitative evaluative much research and debate. Stein, followed by Soreny; Janet Turner; Jeanette Roberts; Judith study of three Crossroad Young Carers Projects in Hughes (1998), Porter (1991) and Allan (1997) have Payneyman the Merseyside and Cheshire area of the UK has sought to understand the complex communication [email protected] been undertaken. As the study did not fall within strategies and cultural behaviours of a unique pro- the remit of the NHS ethical processes, ethical fessional relationship. The NHS has evolved with approval was applied for and granted by a Univer- greater specialisation leading to the development Abstract: sity ethics committee. Focus group discussions of new advanced level nursing roles interfacing pro- Background: The term Breaking Bad News (BBN) is took place with 24 young people aged 11 – 16 fessionally and clinically with doctors. associated with the moment when negative medical years. Data were analysed using a thematic content Aims: The aims of this research are to position the information is shared with a patient or relative. analysis approach. role of the specialist nurse in the contemporary However, BBN can also be seen as a process of Four data themes were identified including experi- healthcare setting and understand the interactions interactions that take place before, during and ences of being young carers and that the groups between them and doctors. after bad news is broken (Fallowfield and Jenkins provide peer support, opportunities for time 2004). This can involve a range of healthcare pro- Methods: This ethnographic study, of fieldwork out and purposeful activities. Most of the young fessionals, including nurses. Little research has observations and follow up interviews, was under- people who took part in the study saw themselves been conducted exploring the role of the nurse in taken with three hospitals based clinical teams as being different. Feelings of being a young carer the process of BBN in the in-patient clinical setting of doctors and specialist nurses. They worked were allied with a sense of embarrassment and for (Dewar 2000). together in specialist areas of surgical, cancer and some being bullying. All of which has resonance emergency care. Aims: Explore the role of the nurse in the process of with the literature reviewed as part of the study. BBN in the inpatient clinical setting For example, Banks et al (2002) describes the stig- Results and Discussion: A model of communica- examine the provision of education and support for matisation experienced by some young carers and tion emerged from the study that was character- nurses carrying out this role Clements (2004) the stereotypes associated with ised by a relationship developed through shared being a young carers. The personal characteristics experience, and long-term interactions. The ‘close’ Methods: The study was carried out in a large of the participants give rise to a number of worrying nature of the relationship meant that a blurred teaching hospital in the UK. A questionnaire was conclusions. That is relatively young people were division of labour existed challenging the orthodox developed to explore the role and experiences found to be undertaking primary caring roles over nurse/doctor perspective. Both groups developed of nurses in BBN. Likert scales and open text long periods of time. However, the groups were overt communication ‘styles’, depending upon the questions were used. Five questionnaires were found to provide opportunities for young carers intended outcome of interaction. Actual communi- sent to nurse managers in 59 inpatient areas. They to participate in purposeful activities and have cation methods used by the teams, included verbal, distributed them to nurses with a range of experi-

82 Concurrent session 5 – Wednesday 25 March 2009

ence and grade. 295 questionnaires were sent and Outcomes: Since the WHITE™ database was first two years of employment and that organizational 212 were returned (71% response rate). introduced into BC in 2004; it has tracked the commitment, in particular affective commitment, Results: The findings indicated that nurses were health of 84,314 healthcare workers (120,244 jobs), is significantly related to turnover intention. Final involved in a range of activities in relation to the representing 39,731 recorded incidents, resulting data will be available by January 2009. process of BBN including helping patients come in 20,704 workers’ compensation claims. Currently, Conclusions: Knowing factors that affect Italian to terms with bad news over time. Challenges that four of BC’s six healthcare regions are tracking hospital nurses’ turnover intentions helps the nurses encountered when involved in BBN were and analyzing incidents and the health of health- organizations to apply differentiated approaches to identified. These often arose from uncontrolled and care workers using WHITE, providing OHSAH and retain their nurses and attract others, to maintain unplanned events. Issues around disclosure were healthcare stakeholders with comparative perform- high quality of care and productivity levels. also commonplace. Very little formal education ance indicators on workplace health and safety. A Recommended reading: in BBN had been received. Support in the clinical number of scientific manuscripts have also been areas was frequently informal from colleagues. published in peer-reviewed journals. Wagner CM. Organizational Commitment as a Predictor Variable in Nursing Turnover Research: Discussion and Conclusions: Nurses are involved Conclusions: The WHITE™ database has been Literature Review. Journal of Advanced Nursing. with BBN as a process that occurs over time. Many very useful for descriptive epidemiological studies, 2007; 60(3): 235-247 challenges to BBN arise from the clinical environ- monitoring health risk factors, benchmarking, and ment. Developments in education and support are evaluating interventions. Meyer JP, Becker TE, Vandenberghe C. Employee required that reflect the reality and challenges that Commitment and Motivation: A Conceptual nurses face when involved in the process of BBN. Analysis and Integrative Model. Journal of Applied Psychology. 2004; 89: 991-1007 Recommended reading: 5.7.2 Meyer JP, Allen NJ. A Three-Component Conceptu- Dewar A (2000) Nurse’s Experiences in Giving Bad The influence of organizational alization of Organizational Commitment. Human News to Patients with Spinal Cord Injuries Journal Resource Management Review. 1991; 1: 61-89 of Neuroscience Nursing 32 (6) 324-330 commitment on Italian nurses’ Fallowfield L and Jenkins V (2004) Communicating turnover intentions – from 5 Italian Sad, Bad and Difficult News in Medicine The Lancet hospitals 363 312-318 Elisa Ambrosi, Nursing, Nursing Faculty, University Theme: Interventions of Verona, Verona, Italy McSteen K and Peden-McAlpine (2006) The Role 5.8.1 Co-authors: Elisa Ambrosi; Adalgisa Battistelli of the Nurse as Advocate in Ethically Difficult Care Moving and handling rehabilitation Situations with Dying Patients Journal of Hospice [email protected] and Palliative Nursing 8 (5) 259 – 269 patients: Exploring nurses’ Abstract: perspectives Background: Organizational commitment is one Rosie Kneafsey, School of Health Sciences, University of Birmingham, Birmingham, UK Theme: Workforce of the variables that literature defines as turnover antecedents, it is the employee’s psychological [email protected] 5.7.1 attachment to the organization and there are three Bridging the knowledge gap: An ‘mind sets’ which can characterize it: affective, Abstract: normative and continuance (Meyer & Allen, 1991). Background: Manual patient handling tasks are an innovative surveillance system There is a negative relationship between organi- to monitor the health of British important contributory factor in nurses’ develop- zational commitment, in particular affective com- ing back pain. Legislation and organisational policy Columbia’s healthcare workforce mitment, and turnover. Although this relationship encourages nurses to risk assess, avoid manual Tony Gilligan, IT, Occupational Health and Safety is verified in the literature, mainly in the field of handling where possible and use patient handling Agency for Healthcare, Vancouver, Canada organizational psychology, it has not been consist- aids (Smith 2005). However, some practitioners’ Co-author: Hasanat Alamgir ently applied in nursing turnover research. argue that the safety focus impedes patients’ reha- [email protected] Objectives: The purpose of the study, conducted bilitation progress by removing opportunities for in 2008, was to analyze the influence of organi- weight bearing. zational commitment and the weight of its three Abstract: Aims: A study was designed to explore nurses’ dimensions: affective, normative and continuance beliefs about; rehabilitation patient handling; the Objective: Healthcare workers are exposed to a on hospital nurses’ turnover intentions and behav- variety of work-related hazards including biologi- impact of patient handling policies and; team- iours. The study was carried out based on the working between nurses and physiotherapists. This cal, chemical, physical, ergonomic, psychological following hypotheses: there is a negative relation- hazards; and workplace violence. The Occupational presentation will discuss the policy and practice ship between organizational commitment and the implications of the study findings. Health and Safety Agency for Healthcare in British intention to leave the job greater affective commit- Columbia (OHSAH), in conjunction with University ment is associated with less intent to leave the job Methods: A multiple case study design was of Britsh Columbia (UBC) and the British Columbia and the nursing profession nurses’ turnover rate is adopted involving a general rehabilitation ward, (BC) health regions, developed and implemented higher in the first two years of work. spinal unit and stroke ward (Stake 1995). Grounded a comprehensive surveillance system that tracks theory methods underpinned data collection and Methods: A suitable sample of 1538 nurses occupational exposures and stressors as well as analysis activities (Strauss & Corbin 1990). 39 (response rate 70%) employed in 5 public general injuries and illnesses among a defined population semi-structured interviews were undertaken (with hospitals in the North-Central Italy answered a of healthcare workers. nurses, physiotherapists and occupational thera- questionnaire administered by an external trouble- pists) plus 43 hours of non-participant observa- Intervention: Workplace Health Indicator Tracking shooter and made up of validated scales concern- and Evaluation (WHITE™) is a secure operational tion. The study secured ethical and Research Gov- ing the factors of interest, and among these there ernance approval. database, used for data entry and transaction was the scale for survey and measuring organiza- reporting. It has five modules: Incident Investiga- tional commitment (Meyer & Allen 1991). Results: Data analysis confirmed a lack of teamwork tion, Case Management, Employee Health, Health related to patient handling. Many nurses perceived Results: The first results confirmed that the and Safety, and Early Intervention/Return to Work. the physiotherapist as the expert. Some respond- intention to leave is more of a concern in the first ents argued that the ‘official line’ constrained

83 Concurrent session 5 – Wednesday 25 March 2009

patients’ rehabilitation progress by reducing the with follow-up at the end of the 2nd week and the ability to take risks. There was confusion over the 4th weeks. The 24-hour average blood pressure interpretation of ‘no-lifting’ policies. data of two groups were collected on the 2nd day, Discussion: Patient handling occurs within a chal- the end of the first, second and third month after lenging context and relies on a ‘negotiated order’ patient’s clinic visit. . Repeated Variance analysis between physiotherapists and nurses (Strauss et. was used to compare before and after measures of al. 1963). Many nurses found their ‘ethic of care’ average blood pressures for the two groups. was incompatible with the ‘no-lifting’ mantra. This Results: Blood-pressure measures showed: left nurses feeling guilty and anxious. Thus, ‘no- systolic: 152.5±12.25, 123.5±3.12, 131.3±3.75, lifting’ policies functioned as a means of organisa- 131.1±2.93 (intervention-group) and 158.6±20.83, tional oppression rather than a mode of protection. 125.3±2.76, 131.3±4.31, 139.2±3.27 (control-group) Conclusions: ‘Honest’ policies are needed and diastolic: 87.5±7.69, 81.0±1.72, 82.6±2.28, which reflect the realities of practice. Nursing 82.5±1.41 (intervention-group) and 88.3±8.42, work continues to be physically demanding and 81.6±1.99, 85.7±2.52, 89.4±1.45 (control-group). managers should ensure that practitioners can Analysis showed a statistically significant drop in access sufficient patient handling equipment. both systolic (P=0.004) and diastolic (P=0.016) Nurses should view patient handling activities as blood-pressure for the intervention group. opportunities for rehabilitation. Discussion: This study is limited by small sample size and the lack of precision of the monitoring Recommended reading: instrument used. However it clearly demonstrates Smith J. (eds) (2005) The Guide to the Handling of the effectiveness of community education in Patients. Backcare in Collaboration with the RCN producing clinically significant reduction in blood- and National Back Exchange, 5th edition pressure. Stake RE. (1995) The Art of Case Study Research, Conclusions: This nursing intervention could effec- Thousand Oaks, Sage Publications tively improve blood-pressure control of adult Strauss A. & Corbin J. (1990) Basics of Qualitative hyperpietics. Research: Grounded Theory Procedures and Tech- Recommended reading: niques. Newbury Park, CA: Sage Publications Celis H, Den Hond E, Staessen JA.( 2005) Self-Meas- urement of Blood Pressure at Home in the Manage- ment of Hypertension[J]. Clin Med Res, 3(1): 19-26 5.8.2 White WB; LaRocca GM. (2002) Chronopharmacol- Effect on ambulatory blood pressure ogy of Cardiovascular Therapy[J]. Blood Pressure Monitoring, 7(4): 199-207 of a continued nursing intervention using chronotheraputics for adult chinese hyperpietics Yue Zhao, School of Nursing, Tianjin Medical University, Tianjin, China Co-author: Jean Glover [email protected]

Abstract: Background: Hypertension, a ubiquitous health problem which, if uncontrolled leads to significant morbidity and premature death, is very common in urban China. Celas et al (2005) Suggests a method of Chronopharmacology using blood-pressure monitoring significantly improves hypertensive control while minimizing side-effects. A nurse led individualized program was instituted to help treatment compliance. Aims: To explore the blood-pressure control effect of a nursing intervention program designed using chronotherapeutics. Methods: During winter 2006, adult hyperpietics (N=72) from a Chinese city were randomized to intervention and control groups. All patients were taking prescribed antihypertensives. . The experi- mental group received a nursing intervention program designed by the investigator. This involved instruction on correct timing of taking medication based on ambulatory blood pressure monitoring using chronotherapeutics at the end of the first week after collecting baseline blood pressure data,

84 Concurrent session 6 Thursday 26 March 2009

Theme: Parkinsons Disease Recommended reading: Recommendations: The strategies used to ‘bridge’ provide new insights into the experiences of living 6.1.1 Behari, M., Srivastava, A. & Pandey, R. (2005). Quality of Life in Patients with Parkinson’s Disease. with, and creating meaning in, late stage PD. As Palliative care for people with Parkinsonism and Related Disorders 11, 221-226 the presentation will highlight, the importance of biography and gaining ‘insider experiences’ of Parkinson’s Disease and their Department of Health (2005). The National Service people living with PD and their carers are crucial if Framework for Long-term Conditions, London, DH. carers person-centred services are to emerge. George Kernohan, School of Nursing. Faculty Department of Health (2005) of Life & Health Science, University of Ulster, Thomas, S. & MacMahon, D. (2004a). Parkinson’s Recommended reading: Jordanstown, UK Disease, Palliative Care and Older People: Part 1. Charmaz, K. (2000). Grounded Theory: Objectivist Co-authors: Felicity Hasson; Mary Waldron; Nursing Older People 16(1), 22-6 and Constructivist Methods. In: N.K. Denzin and T.S. Barbara Cochrane; Dorry McLaughlin; Sue Foster; Lincoln (Eds.). Handbook of Qualitative Research. Helen Chambers; Marian McLaughlin 2nd Edition. Thousands Oaks: Sage. Pp. 509-535 [email protected] Keady, J. and Williams, S. (2007) Co-constructed 6.1.2 inquiry: A New Approach to Generating, Dissemi- Abstract: ‘Bridging’ as a constructivist nating and Discovering Knowledge in Qualitative Background: Whilst management of Parkinson’s grounded theory of adjustment Research. Quality in Ageing, 8(2): 27-36 disease (PD) patients is primarily aimed at pre- serving life expectancy and limited motor dis- and coping through late-stage abilities (Behari et al 2005), a palliative care Parkinson’s disease: A longitudinal approach in management of such conditions has study Theme: Long term conditions/patient been advocated (DH, 2005). However, research Sion Williams, School of Healthcare Sciences, experience suggests that palliative care services are often frag- Bangor University, Bangor, UK 6.2.1 mented and inaccessible resulting in poor quality Co-author: John Keady care for people with advanced PD. (Thompson & [email protected] Hereditary Haemochromatosis: The MacMahon 2004a). lived experience Aims: To explore experiences, palliative care needs Elizabeth O Connell, Nursing Studies, University Abstract: and gaps in service provision from the perspective College Cork, Ireland of the person with PD. Aims: This presentation will explore the experi- Co-author: Orla Sheahan ences of older people (over 60 years) with late- Methods: Exploratory research design using a [email protected] stage Parkinson’s disease (PD) and attempts to qualitative approach. Individual semi structured understand the transitions involved in living with interviews with 54 participants. Data subjected to a degenerative neurological condition. The study Abstract: thematic content analysis. adopted a longitudinal design which has resulted Background: Hereditary Haemochromatosis (HH) Results: The participants’ reported varied diagnos- in 70 collaborative research interviews with 13 is one of the most common hereditary disorders tic experience. Most had little prior PD knowledge. people with PD and their carer over an 18-month (British Haemochromatosis Society, 2008) Some felt there was limited subsequent signpost- period. resulting in excessive intestinal iron absorption, ing to services. PD placed a physical, psycho- Methods: Constructivist grounded theory which is then stored in the liver, pancreas, heart logical and social toll on participants due to loss was the main methodological approach in the and joints resulting in organ damage and impaired of mobility and independence, with increasing study (Charmaz, 2000). The search for mutually function (Adams & Barton, 2007). Recent surveys dependency on informal carers highlighted. Whilst generated knowledge between the person with PD have shown that the risk of hereditary haemochro- most appreciated their medical provision, their and the researcher was augmented by centre-stage matosis amongst people of Northern European experience of medication relief and service delivery storyline generation (Keady and Williams, 2007), a origin is 1 in 400. However, little is known about the was mixed. Some also referred to a lack of informa- process that visually identifies and locates subjec- experiences, needs and expertise of those living tion on financial and social support networks. Pal- tive experience. Interviews were the primary source with this disorder. liative care was generally perceived as related to of data collection and the paper will presented Aims: To explore the experiences of patients living cancer and terminal care. Participants coped with findings from interviews conducted between June with HH. PD by adopting a positive outlook, despite some 2007 and October 2008. anxiety about PD’s rate of progression. They appre- Methodology: A descriptive, qualitative approach ciated the information, advice and supportive role Analysis: This paper reports on 70 interviews with was used to conduct this study. Purposive sampling of the PD Society. 13 people with late-stage PD and their family carers led to the recruitment of 13 participants who who were recruited from the caseload of two spe- were attending a clinic for venesection in a large Discussion: This study highlights the varied experi- cialist Parkinson’s disease nurses working in North teaching hospital. Data were collected using in ence of people with PD suggesting some evidence Wales and one Consultant Geriatrician. All partici- depth interviews and were analysed using Colaiz- of unmet palliative care need for people with PD pants were diagnosed with late-stage idiopathic zi’s Framework. and fragmented available services. There was also PD. variation in the levels of clinical and social care Results: The main themes emerging from the data support and information signposting among par- Results: From this collaborative approach, was that of stoic acceptance of a lifelong condition, ticipants. ‘bridging’ emerged as the centre-stage storyline the search for information about this condition, related to life with late-stage PD. Bridging itself along with the challenge of managing symptoms Conclusions: Although this was a small scale consisted of 4 categories: ‘Building on the Past’ (1); and complying with treatment regimes. exploratory investigation, involving one time-point, ‘Bridging the Present’ (2); ‘Broaching collapse’ (3) it lends support to the development of a proactive Discussion: Patients had very little knowledge and ‘Coming to terms’ (4). These categories were integrative palliative care services approach to about this disease and their need for clear concise underpinned by a number of supporting properties address the needs of people with PD. information was asserted. In particular, patients that have important implications for the under- identified their need for specific dietary guidelines standing of late-stage PD and informing the devel- and education about symptom management. Ven- opment of the nursing role in providing appropriate esection was identified as a frightening experience and tailored supportive interventions. for many patients.

85 Concurrent session 6 – Thursday 26 March 2009

Implications for Practice: There needs to be However, this study illustrated that effective nurse- mothers responded to an investigator developed increased awareness of HH among healthcare pro- patient communication may be a myth rather than a self-reported questionnaire measuring social fessionals and the general public. Standardised reality in some healthcare settings. Effective nurse- support and the Edinburgh Postnatal Depression information needs to be made available to patients patient communication is specifically important Scale (Cox, Holden & Sagovsky, 1987) at 6 weeks on diagnosis and throughout the course of the for the support and care of persons through- post delivery. Data were collected via postal ques- illness. Treatment and the importance of life long out their journey with a chronic illness, such as tionnaire with a response rate of 72%. Data from compliance in preventing complications needs to ESRD. Therefore, it is anticipated that the findings the questionnaires were entered and analyzed be explained. Venesection should be performed by from this study will encourage nurses to be more using the Statistical package for social scientists highly skilled and experienced personnel. Members vigilant about their communication with patients. (SPSS). Descriptive and inferential statistics were of the multidisciplinary team need to embrace a In turn, this would enhance a more patient-centred used to analyse the data. supportive, patient centred approach to all aspects approach to communication and care. Findings: Findings will be discussed with regard of patient care. Recommended reading: to the prevalence of postnatal depression at 6 weeks. In addition, results discussed will focus on Recommended reading: Curtin, R.B., Mapes,D., Petillo, M. & Oberley, E. mothers’ perceptions of the types of support expe- British Haemachromatosis Association. (2007). (2002) Long-term Dialysis Survivors: A Transfor- rienced (informational, instrumental, emotional www.haemochromatosis.org.uk – http: //www. mational Experience. Qualitative Health Research. and appraisal) and from what social network ghsoc.org/home.html(Accessed (31/10/08) 12(5), 609-24 members (mother, partner, friends), including Adams,P.C., & Barton,J.C. (2007). Haemachromato- Diekelmann, N., Allen, D, & Tanner, C. (1989) A healthcare professionals (nurses, doctors). In sis. The Lancet. Vol 370 : 1855 – 1860 Hermeneutic Analysis of the NLN Criteria for the addition, the relationship between social support Appraisal of Baccalaureate Programs. New York, and postnatal depression at 6 weeks post delivery National League for Nursing will be discussed, including implications and rec- Sloan, R.S. (2002) Living a Life-sustained-by-med- ommendations for nursing and midwifery practice. 6.2.2 ical-technology: Dialysis is Killing me. in Diekel- Recommended reading: The person’s experience of mann, N.L. (Ed.) First, Do No Harm: Power, Oppres- O’Hara, M and Swain, A (1996) Rates and Risk of end stage renal disease and sion, and Violence in Healthcare. Wisconsin, The University of Wisconsin Press Postpartum Depression-A Meta-analysis. Interna- haemodialysis therapy tional Review of Psychiatry 8, 37-54 Aoife Moran, School of Nursing, Dublin City Leahy-Warren, P. and McCarthy, G (2007) Postnatal University, Ireland Depression: Prevalence, Mothers’ Perspectives and Co-authors: P Anne Scott; Philip Darbyshire Theme: Mental health Treatments Archives of Psychiatric Nursing 21 (2), [email protected] 6.3.1 91-100 The relationship between social Cox, J., Holden, J. and Sagovsky, R. (1987) Detection Abstract: of Postnatal Depression-Development of the support and postnatal depression Background: Haemodialysis therapy is one form 10-item Edinburgh Postnatal Depression Scale of treatment for end stage renal disease (ESRD). for first-time mothers: An Irish British Journal of Psychiatry 150, 782-786 Patients on haemodialysis therapy have to adhere study to a strict regime of dialysis, dietary and fluid restric- Patricia Leahy-Warren, Catherine McAuley School tions, and medications (Curtin et al, 2002). The of Nursing and Midwifery, University College Cork, 6.3.2 dependency on the technology and the healthcare Ireland team for survival provides haemodialysis therapy Co-author: Geraldine McCarthy Theory-practice gap: Findings from with unique characteristics, making it difficult for [email protected] an evaluative study in CAMHS some individuals to accept (Sloan, 2002). Anne Fothergill, Faculty of Health, Sport and Aims: The overall aim of the study was to provide Abstract: Science, University of Glamorgan, Pontypridd, UK a detailed description of the experience of being a Purpose of this Paper: The aim of this paper is to Co-author: Mair Sinfield patient with ESRD on haemodialysis therapy. present the findings of research which examined [email protected] Methods: The methodology employed was inter- the relationship between social support and pretive phenomenology. A purposive sample of postnatal depression for first-time mothers at 6 Abstract: sixteen participants aged from 20-70 years was weeks post delivery. recruited. Two semi-structured interviews were Background: New modules were developed in Background: Postnatal depression symptomatol- conducted with each participant. An approach to Wales on working with children/young people with ogy is a common condition. Prevalence rates vary interpretive data analysis by Diekelmann & Allen mental health needs. The modules filled an iden- from 4.0% to 73.7%, with the most recent system- (1989) was used to analyse the data. tified gap in the provision of education courses atic review suggesting a rate of 13%, indicating in Wales for practitioners working with this client Results: A theme labelled ‘Communication with a serious clinical issue for nurses and midwives group (NAfW, 2001; Jones and Baldwin 2004). It was Nurses: Myth versus Reality’ was created within providing postnatal care to women (O’Hara & a collaborative development between two Universi- the study. The participants indicated that they Swain, 1996). Social support has been identified ties, the All Wales Senior Nurses Group for CAMHS rarely had the opportunity to communicate with in a number of studies to contribute positively to and clinical practice. The work to be presented is the nurses during haemodialysis therapy. Instead, the transition to motherhood, however, there is a on the findings from a longitudinal, evaluative the nurses’ time seemed to be completely taken paucity of research on social support and postnatal study into the outcomes of these modules on prac- up with the management of the technological and depression with some empirical evidence, albeit titioners’ practice. This paper will contribute to physiological aspects of care. The purpose of this using small samples, attesting to the positive knowledge on the application of theory to practice paper is to critically analyse the participants’ per- effects of social support in reducing postnatal in health and social care. spective of communicating with the nurses. symptomatology (Leahy-Warren & McCarthy, Aims: The aim of this study was to evaluate Conclusions: It is well recognised that effective 2007). the outcomes of the modules on professionals’ nurse-patient communication is a beneficial Methodology: A quantitative descriptive design practice. influence on the person’s experience of illness. was used. Five hundred and twelve first-time

86 Concurrent session 6 – Thursday 26 March 2009

Methods: Mix methods were used. Quantitative the issues that had emerged, during in depth inter- interview content was thematically analysed using questionnaires were administered pre-commence- views. In carrying out this study, I encountered a standard qualitative techniques. Findings Analysis ment of the modules to gain baseline information number of unexpected dilemmas relating to the of interview transcripts generated three core on the practitioners’ knowledge, confidence, com- researcher-participant relationship. The research themes, which are represented by the following: petence and skills. A slightly modified version of literature warns against the exploitation of par- ‘Being there’, ‘welfare of others’ and ‘professionals’ this questionnaire was administered on completion ticipants (Roper & Shapira 2000), encourages management of the event’. of the modules. This was to ascertain if there were reciprocity in the research relationship (Kvale 1996) Discussion: Participants were generally support- changes on the above items. Semi-structured inter- and identifies the problem of role confusion for ive of family witnessed resuscitation, and this views were conducted six months post-completion researcher-practitioners (Reed & Procter 1995). In trend was more evident among patients who had of the modules. practice however, I found that in these issues were been resuscitated. It appears that patients want Results: Thirty students from a variety of health and more complex than I had anticipated and I needed healthcare workers to routinely initiate discussions social care backgrounds were surveyed, 15 were to develop my own strategies to address them. around the subject and to provide family members interviewed in-depth during 2006/7. Knowledge, This presentation will identify some of the meth- the option to be present. Patients identified that confidence and competence had increased for odological and ethical issues encountered during family members benefit from the experience of most of the practitioners. All were implementing this study and present some of the ways in which being present during the resuscitation of a loved newly acquired knowledge, skills/interventions they were addressed. In doing so, I will draw on the one in different ways, but also recognised a need into their practice. research literature and on my own personal experi- to respect the advice of professionals, and that Discussion: These modules have filled a gap in ence of the researcher-practitioner role. the resuscitation team should perform their duties unimpeded. Our data also suggests that patients education provision in Wales for practitioners Recommended reading: working in CAMHS at post registration level (NAfW, appear less unconcerned about confidential health Kvale, S. (1996) Interviews. An Introduction to Qual- 2001). The collaborative approach to developing matters being disclosed in the presence of family itative Research Interviewing London, Sage. the modules was successful. The outcomes have members during their resuscitation. been positive and real, actual changes have been Reed, J Procter, S (1995) Practitioner Research in Conclusions: This study provides a unique and made in practice. Health Care: The Inside Story London. Chapman & in-depth insight into the views of patients, and Hall Conclusions: This evaluative study demonstrated highlights the need for staff to identify their pref- that learning from education courses takes place Roper, J Shapira, J (2000) Ethnography in Nursing erences and wishes in relation to family witnessed and that theory is put into practice; this appears Research. London. Sage resuscitation. to be enhancing the care/services to a vulnerable Recommended reading: client group. Albarran, J.W., Moule, P., Benger, J., McMahon- Recommended reading: 6.4.2 Parkes, K., Lockyer L., 2007 Jones, J. Baldwin, L. (2004) Tiers Before Bedtime: A A qualitative study of the views Witnessed Resuscitation: What do Patients Really Survey Shows Post-Registration CAMHS Education Want? University of the West of England, Bristol is Missing the Mark. Mental Health Practice. 7 (6) and preferences of patients who 14-17 have survived resuscitation and Royal College of Nursing (2004), Children and those who have been admitted as Theme: Education/research context Young People’s Mental Health – every Nurse’s emergency cases regarding the Business, Royal College of Nursing, London 6.5.1 presence of family members during The National Assembly for Wales (2001). Child and Effects of a Masters in Nursing on Adolescent Services. Everybody’s Business. Cardiff resuscitation John Albarran, Faculty of Health and Life Sciences, the professional lives of British and University of the West of England, Bristol, UK German nurses Co-authors: Pam Moule; Jonathan Benger; Kate Dianne Watkins, School of Nursing and Midwifery Theme: Service users McMahon-Parkes Studies, Cardiff University, Cardiff, UK [email protected] 6.4.1 Abstract: Engaging participants in an Abstract: ethnographic study of parental Title: Effects of a Masters in Nursing on the Pro- Background: Despite an increase of interna- fessional Lives of British and German Nurses involvement in neonatal pain tional research inquiries focused around family Focus This presentation reports on the results of a management: Dilemmas for the witnessed resuscitation, the important perspective qualitative study that explored British and German researcher-practitioner of patients, particularly those who have survived nurses’ perceptions of how a Masters in Nursing resuscitation, has been overlooked (Albarran et al Caryl Skene, Jessop Wing, Sheffield Teaching Studies influenced their professional lives. 2007). Practical issues around recruitment and the Hospitals NHS Trust, Sheffield, UK Background: Political, professional and academic sensitive nature of the subject may account for this, [email protected] changes impact on continuing education for nurses, but the views of successfully resuscitated patient the study is placed within this context. Research should be central to policy development. participants were 10 German and 9 British nurses Abstract: Aims: To explore the views and preferences of who undertook a Masters in Nursing between 2003 The aim of this ethnographic study was to explore patients with and without the experience of being and 2006. how parents interact with their babies around the resuscitated, about family members being present Aims: Study aimed to explore: provision of comfort care. It was carried out in during resuscitation. • Why British and German nurses undertook the a regional Neonatal Intensive Care unit, where I Methods: The sample was recruited from four large course? also work as a nurse consultant. Over a period of hospitals in South-West England. We used face-to- twelve months, I observed 12 sets of parents on face interviews to collect data from patients who • What were their expectations and were these 1-4 four occasions each, as they provided care for had survived resuscitation (n= 21) and individuals realised on completion? their baby. After each session, I explored some of admitted as emergency cases (N=40). Hand-written

87 Concurrent session 6 – Thursday 26 March 2009

• How did British and German nurses perceive the 6.5.2 Theme: Experience course had influenced their professional lives? Ouch! that hurt – The challenges 6.6.1 • What facilitated/ inhibited the implementation of learning into practice? and lessons learned from Nurses’ perception of the quality of • What were the differences between these two undertaking research in an care they provide to hospitalized groups of nurses? emergency department setting drug addicts: Testing the theory of Methods: A qualitative interpretivist paradigm was Rebecca Hoskins, Faculty of Health and Social reasoned action adopted and data collected via semi structured Care, University of the West of England, Bristol, UK Merav Ben Natan, Nursing, Pat Mattews Academic interviews undertaken in the UK and Germany School of Nursing Hadera, Israel during 2007. Interview transcripts were analysed Abstract: Co-authors: Beyil Valery; Okev Neta, through a coding template, editing and immersion Conducting effective research in the emergency [email protected] in the data, crystallization of themes and identifica- department is important but challenging. While tion of emerging patterns. all the care delivered to our patients should be Abstract: Findings: indicated that perceived gains related evidence based, it can be difficult to produce high Background: Over the past two decades extensive to an increase in personal confidence, self esteem quality evidence to answer questions generated in research has examined the effect of nurses’ and motivation; improved cognitive functioning clinical practice. The emergency department setting attitudes on the quality of care provided to drug and critical thinking; implementation of evidence presents particular challenges in the successful users. However, there has been no empirical based practice; enhanced professionalism; career completion of the research process. Despite an examination of actual and potential perceptions of promotion; role development and increased cred- experienced research team, the rigorous process quality care provided to drug users within a theo- ibility. These attributes were influenced by the of ethical approval, sponsorship approval and sci- retically based framework. culture of the organisation, perceptions of the entific review the outcome of research projects profession, political changes, support and relation- can still be unsuccessful. It is well recognised that Aims: To examine nursing staff members’ attitudes ships with others. recruiting patients to studies in the emergency and subjective norms manifested in intended and Discussion: Findings are conceptualised into a department is difficult because of the short time actual care of drug users based on the Theory of model presented as a Venn diagram that illustrates frame in which the patients have to consider their Reasoned Action. the overlapping nature of the areas found. participation in the study as well as the speed and Methods: A correlational design was used with Conclusions: In conclusion, Masters education pressure of work, complex ethical issues and the 135 nursing staff members from 3 central Israeli may have a positive effect on the professionalisa- successful engagement of staff (Benger & Carter hospitals. Over the months of October – December tion of nursing and influences the implementa- 2008). Patients in the emergency department are 2007 participants completed a questionnaire tion of research based evidence. These benefits also acknowledged to be a vulnerable population examining theory-based variables as well as socio- may enhance the credibility of the profession and (Moskop 2006). It has also been highlighted that demographic and professional characteristics. improve the quality of nursing care. staff can suffer from ‘research fatigue’ in clinical Findings: Most of the respondents reported a high areas where numerous studies are being under- to very high level of actual or intended care of Recommended reading: taken, this is especially relevant in emergency drug users. Nurses’ stronger intentions to provide Gerrish K, McManus M & Ashworth P (2003) settings where staff may understandably stop quality care to drug users were associated with Creating What Sort of Professional? Masters Level recruiting to studies when they perceive that more positive attitudes. These were based on Nurse Education as a Professionalising Strategy. demand for a service outstrips resources (Monico their own attitudes and beliefs about what others Nursing Inquiry, 10, 2, 103 – 112 et al 2008). Unique barriers to the successful would wish them to do. Nursing staff members had recruitment, consent of participants and the com- Hardwick S & Jordan S (2002) The Impact of moderately negative attitudes toward drug users. pletion of a project were just some of the chal- Part-time Post-registration Degrees on Practice. Nurses were found to hold negative stereotypes of lenges we came across during one project carried Journal of Advanced Nursing, 38, 5, 524 – 535 drug addict patients and most considered the man- out in a busy emergency department. agement of this group difficult. Whyte D A, Lugton J and Fawcett T N (2000) Fit This presentation will identify the issues which for Purpose: the relevance of Masters prepara- Conclusions: The findings offer some support contributed to the termination of the project and tion for the professional practice of nursing. A 10 for previous studies examining general attitudes will also share the lessons learned from undertak- year follow up of post-graduate nursing courses in towards drug users and the Theory of Reasoned ing research within a busy and acute environment the University of Edinburgh. Journal of Advanced Action. Positive attitudes towards drug users, which delivers a service 24 hours a day, 7 days a Nursing, 31 perceived expectations of others, and perceived week, 365 days a year. The presentation will also correctness of the behavior are important in their identify some possible solutions to successful affect on the intention of nurses to provide high recruitment in such a demanding environment. quality care to hospitalized patients addicted to Recommended reading: drugs. It is extremely important to change nurses’ stereotypes of drug users and to hold support Moskop, JC (2006) Informed Consent and Refusal of workshops for nurses treating this population. Treatment: Challenges for Emergency Physicians. Emerg.Med.Clin.North.Am. 24: 605-18 Recommended reading: Monico, E. Larkin, GL. Deguitis, L. (2008) Informed Skinner, N., Feather, N.T., Freeman, T., Roche, A. Consent for Research: Current Pratices in Academic (2007). Stigma and Discrimination in Health-Care Emergency Medicine. Academic Emergency Provision to Drug Users: The Role of Values, Affect, Medicine 15: 1-4 and Deservingness Judgments. Journal of Applied Benger, J . Carter, R (2008) Could Inter-agency Social Psychology, 37(1), 163-186 Working Reduce Emergency Department Attend- Rassool, G.H., Villar-Luis, M., Carraro, T.E., Lopes, ances due to Alcohol Consumption. 25: 331-334 G. (2006). Undergraduate Nursing Students’ Per- ceptions of Substance Use and Misuse: a Brazilian position. Journal of Psychiatric and Mental Health Nursing, 13, 85-89

88 Concurrent session 6 – Thursday 26 March 2009

Ajzen, I., Fishbein, M. (1980). Understand- Recommended reading: duration, further research is required to establish ing Attitudes and Predicting Social Behavior. Lewis C 2004 Confidential Enquiry into Maternal effectiveness in different cultural settings. Funded Englewood Cliffs, N.J: Prentice Hall and Child Health 2000-2002 Royal College of by Research & Development Office for Northern Obstetricians & Gynaecologists Press London Ireland Trial Registration: ISRCTN 47056748 Draycott T, Sibanda T, Owen L, Akande V, Winter C, Recommended reading: Theme: Midwifery Reading S et al. Does Training in Black RS, Brock- Baby Friendly Initiative (1998) Implementing the lehurst P. A Systematic Review of Training in Acute 6.7.1 Ten Steps to Successful Breastfeeding – A Guide for Obstetric Emergencies. BJOG: An UK Maternity Service Providers Working Towards Team collaboration in obstetric Baby Friendly Accreditation U.K. Committee for emergencies UNICEF London http: //www.babyfriendly.org.uk/ guid-ant.htm Karen Madden, Woman & Acute Child Health, 6.7.2 South Eastern Trust NI, Belfast, UK European Commission (2004) Protection, Co-authors: Marlene Sinclair; Marian Wright Testing the effectiveness of a Promotion and Support of Breastfeeding in Europe: motivational program to sustain A Blueprint for Action: www.epha.org/a/1301 Abstract: breastfeeding behaviour Infant Feeding Survey (2005) Office of National Sta- Background: A maternity unit providing care for Janine Stockdale, School of Nursing and Midwifery, tistics http: //www.ic.nhs.uk/pubs/breastfeed 3000 childbearing women per year was the setting Trinity College Dublin, Dublin, Ireland for this research study. Co-authors: Marlene Sinclair; George Kernohan [email protected] Objective: To explore interactions of the maternity Theme: Qualitative research care team in a clinical setting during a simulated 6.8.1 emergency, and identify key factors underpinning Abstract: effective teamwork. Background: Babies, women and society benefit ‘Dear Sally…’ Reflections on using Methodology: A qualitative approach using action nutritionally, psychologically and economically email correspondence as a method research methods was used. Ethical approval for by breastfeeding. As a result the WHO challenges of generating qualitative data in the study was sought and received. Trust access health professionals to achieve higher rates of and governance procedures were completed. breastfeeding. Initiation rates are increasing, health and social care research Obstetric emergencies were simulated and videoed but motivating women to sustain breastfeeding Sally Dowling, Faculty of Health and Life Sciences, University of the West of England, Bristol, UK to explore interaction, behaviour and practices of remains equivocal (Infant Feeding Survey 2005, health care professionals within a framework of European Commission 2004). [email protected] peer support. Video clips were examined using Aims: To examine the effect of a new motivation qualitative analysis. Emerging themes were identi- programme on women’s breastfeeding behaviour, a Abstract: fied and agreed by confirmatory focus groups. randomised control trial was completed, comparing Correspondence as a method of data collection has Findings: Three main themes emerged during the motivationally-enhanced breastfeeding instruction been used by few health and social care research- cycles of research – communication, collaboration by midwives with current best practice (BFI, 1998). ers although email has been employed to generate and control. Good teamwork depended on effective Methods: Following a literature review, an experi- data in a variety of ways. As a tool for academic communication and professional collaboration, ment was designed and subject to Research Gov- research the Internet is used increasingly but email which could be adversely affected by inappropri- ernance and Ethics approval. Primigravida women correspondence presents additional, exciting and ate behaviour and commands. The most dynamic were recruited at their 20 week antenatal appoint- challenging opportunities for nurses and others aspect was the role of team leader, requiring ability ment and written consent obtained. Women were engaged in qualitative research. to multi-task, control the team, and hand over randomised to receive the motivationally enhanced In this presentation I will talk about my experi- responsibilities. instruction or current best practice. Midwives sup- ence of using email correspondence in my PhD Outcome: Inclusive team involvement led to a porting the experimental group attended a one-day research. Correspondence, participant observation number of changes in the processes and systems training course. Women’s motivation to breastfeed and in-depth interviews have been used in an eth- of care in setting. Example-haemorrhage. was measured prior to discharge from hospital by nographic project to understand more about the Estimates of blood loss at delivery are subjective structured interview. Follow-up telephone calls experience of women who breastfeed for longer and generally inaccurate, heightened awareness determined duration of breastfeeding. than six months. In particular I have drawn on the revealed improved reporting. Results: 181 women were recruited. With attrition, work of Kralik et al on the use of correspondence Transferability: Change has been realised that is analysis was performed on an intention to treat (2000) and email (2006), valuing the development transferable and work continues in the emergency basis using Chi Squares. No significant difference of a ‘critical reflective conversation’ with my partici- department to role out the process. in the initiation rates was noted. On discharge from pants. A number of issues arising from the work will be discussed. Is there a difference between ‘corre- Sustainability: Real time drills continue challeng- hospital more intervention cases (44) were breast- ing and supporting team members to develop feeding than controls (33), p<0.01. Persistence at sponding’ and ‘interviewing’ by email’? What are positive relationships and practices. Small and 3-4 weeks was noted in 36 intervention cases (15 the issues raised when researcher and participants significant changes have led to real improvements. controls), p<0.001. Independent t-tests verified view this differently? What are the advantages of Participatory action research involved the staff in the differences in duration of the 69 intervention generating data using this method – and are there the setting testing systems, marrying academia cases that commenced breastfeeding (75 controls). disadvantages? How do these different methods with clinical knowledge. Knowledge, skills and The differences in motivation to breastfeed were complement each other? Ethical issues in research competencies were optimised and team members explained in part by the uptake of relevant breast- of this nature will also be discussed. The use of cor- assisted to explore collaborative solutions to feeding instruction (p<0.001) and increased respondence as a research tool for those drawing improving care. maternal confidence (p<0.01). on feminist principles in qualitative research will be considered, alongside feminist critiques of using Discussion and Conclusions: Breastfeeding is Conclusions: to achieve effective team working the internet for health and social care research. a complex activity with many benefits and influ- an identified leader with skills in controlling and This discussion will be illustrated with examples ences. As motivational enhancement of routine managing the situation is central to optimal care. from my research, reflections on my practice and instruction has a positive effect on breastfeeding

89 Concurrent session 6 – Thursday 26 March 2009

suggestions as to how this might be a useful tool aid the analysis by helping to ‘bracket’ preconcep- for nurse researchers. tions, which is fundamental in phenomenological research. Recommended reading: Kralik, D., Koch, T. and Brady, B.M. (2000). Pen Pals: Recommended reading: Correspondence as a Method for Data Genera- Buzan T. (2003) The Mind Map Book. BBC Books, tion in Qualitative Research. Journal of Advanced London Nursing 31(4), 909-917 Giorgi A. (1997) The Theory, Practice, and Evalua- Kralik, D., Price, K., Warren, J., Koch, T. (2006). tion of the Phenomenological Method as a Quali- Issues in Data Generation Using Email Group tative Research Procedure. Journal of Phenomeno- Conversations for Nursing Research. Journal of logical Psychology. 28(2), p235-260 Advanced Nursing 53(2), 213-220 Tattersall C, Watts A, Vernon S. (2007) Mind-map- ping as a Tool in Qualitative Research. Nursing Times. 103(26), pp 32-33 6.8.2 Mind mapping as a tool in qualitative research Chris Tattersall, Research and Development, Hywel Dda NHS Trust, Haverfordwest, UK Co-authors: Ann Watts; Stephen Vernon [email protected]

Abstract: Introduction: This article attempts to describe, justify, but predominately create discussion around the use of mind mapping as a tool in phenomeno- logical research. Mind Mapping: The mind map starts life as a blank sheet of paper. A central concept as a word or image is then placed in the centre, with sub-headings or related themes branching off. These branches can be sub-divided or related to other branches. Each user develops their own use of shapes, colours, lines or symbols. Information is converted into a combination of written, diagrammatic and graphical representation allowing related ideas or themes to be linked on both paper and in the users mind (Buzan 2003). Mind Mapping in Phenomenological Enquiry: Bracketing in discovering the essence of a phenom- enon, ‘bracketing’ of preconceived ideas needs to take place. There is also a need to ‘awaken pos- sibilities’ therefore becoming aware of features of the phenomenon which are essential, but not immediately obvious (Giorgi, 1997). Mind mapping lends itself well to these processes, as it allows free thinking, and has an aim to: ‘clear the mind of previous assumptions about the subject’. (Buzan, 2003) Transcribing & Analysing Qualitative Data: Tra- ditionally transcribed data is broken down into themes and findings derived. A more valid data analysis would allow the interaction to be con- sidered soon after or even during the interaction. Mind mapping may help in this regard. With mind mapping the boundary between transcribing and analysing may become blurred, as the process of transcribing using a mind map will allow the devel- opment of creative thinking, with links being made between themes, or statements in real time as the transcribing is underway. Conclusions: Mind mapping allows rapid and valid transcriptions of qualitative interviews. It can also

90 Concurrent session 7 Thursday 26 March 2009

Theme: Children’s nursing Giorgi A (1997) The Theory, Practice and Evaluation Recommended reading: of the Phenomenologial Method as a Qualitative 7.1.1 DoH (2004) National Service Framework for Research Procedure Journal of Phenomenological Children, Young People and Maternity Services: Experiences of same-sex couples Psychology 28 pp235-260 Medicines for Children and Young People, Depart- when their children require Mikhailovich K, martin S & Lawton S (2001) Lesbian ment of Health, London. healthcare interventions and Gay Parents: Their Experiences of Children’s Stenner, K.,Courtenay, M. (2008) The Benefits of Lesley Dibley, Florence Nightingale School of Health Care in Australia International Journal of Nurse Prescribing According to Nurses Prescribing Nursing and Midwifery, King’s College London, Sexuality and Gender Studies 6 (3) pp181-191 for Patients in Pain, Journal of Advanced Nursing, London, UK 63, (1), 27-55. [email protected] 7.1.2 Abstract: Nurse prescribing by children’s 7.1.3 Background: Despite increasing numbers of same-sex families, many requiring healthcare nurses: The views of nurses in a A survey of registered nurses support for their children, there is a dearth of specialist children’s hospital knowledge and attitudes regarding research evidence to inform practice for this specific Nicola Carey, School of Health and Social Care, paediatric pain assessment and parent group. Recent changes in UK equality and University of Reading, Reading, UK anti-discrimination law should enhance visibility Co-authors: Karen Stenner; Molly Courtenay management: An Irish perspective of lesbian and gay clients and same-sex parents Eileen Tiernan, PICU, Our Lady’s Children’s [email protected] Hospital, Dublin, Ireland within the health care system and practitioners will need to ensure they meet the needs of this client [email protected] Abstract: group appropriately. Aims: To explore the views of children’s nurses Aims: To improve the healthcare experiences of Abstract: working in a specialist hospital on the adoption of same-sex families by understanding the expe- Aims: To explore nurses’ knowledge and attitudes the prescribing role on their practice. riences of a marginalised group of parents; to regarding paediatric pain assessment and manage- identify parent and professionals’ behaviours that Background: Research indicates that care delivered ment. by nurse independent prescribers and nurse sup- bring about positive or negative experiences; to Methods: Simple random sampling with 292 plementary prescribers can improve access to recommend strategies which eliminate negative nurses, from a children’s hospital. The Paediatric medicines and the quality of care patients receive practices and provide high quality support for Nurses Knowledge and Attitude Survey was utilised (Stenner & Courtenay 2008). Recent UK govern- same-sex families with children. to collect data. Tool is a statistically reliable: Test- ment policy for children and young people empha- Methods: Heidiggerian phenomenology with retest r = 0.859 and Cronbach alpha 0.708. A sizes the role of prescribing by nurses in improving purposive chain-referral sampling; unstructured response rate of 60% (n = 174) was achieved. SPSS access to medicines and choice for patients (DoH interviews to explore the narratives of the experi- used to analysis data and open questions were 2004), however the views of nurses prescribing for ences of same-sex parents in healthcare settings. analysed by thematic content analysis. Descriptive children have not been explored. Narrative data was analysed using McCormack’s and inferential statistics were performed. Methods: A longitudinal qualitative approach was Interpretive Lenses. Insider status – both profes- Results: Total mean score on the PNKAS scale was adopted using thematic analysis on semi-struc- sional and personal – was managed and evidenced 62%. Majority of nurses scored < 80% which has tured interview data collected during 2006 and by adopting a reflexive approach. been identified as a satisfactory level for practice 2007. Participants were seven children’s nurses Results: Findings suggest that although most standards. Nurses had knowledge deficits particu- in one specialist children’s hospital who were respondents (all female) initially identified their larly in regard to pharmacology especially opiates, qualified nurse prescribers. experiences as ‘okay’, deeper exploration revealed pharmacokinetics and non-pharmacological subtle and overt evidence of homophobia – experi- Findings: Nurses varied in their actual and desired interventions. No differences were demonstrated ences ranged from intolerable to good with isolated levels of autonomy, and this was reflected in their between nurses’s age, nursing experience, years episodes of excellent care. Women revealed issues scope of practice. Although the prescribing role that of paediatric experience, nursing grade and having relating to heterosexism, coming out (or not), fear nurses undertook within this setting was limited, a pain education during hospital orientation on the of compromise to their child’s care, and being number of improvements were reported including mean PNKAS score. Statistically significant differ- treated ‘as if we are all the same.’ increased efficiency, opportunity to complete ence (p=<0.001) of moderate to large effect was episodes of care, and improved communication Discussion: Lesbian mother’s narratives illustrate demonstrated between nurses whose main quali- with patients. This was felt to enhance quality of that many healthcare professionals remain skill- fication was Registered Children’s Nurse (RCN) care, and ultimately job satisfaction for nurses. To less and uninformed, that the healthcare system compared to RGN on the mean PNKAS score. Also a varying extent, issues of lack of understanding, perpetuates exclusion and heterosexism, and that between nurses who worked in different speciali- capacity of the nursing workforce, and a lack of these women work hard – even in very stressful cir- ties on the mean PNKAS score (p = 0.003). Nurses appropriate support were identified as barriers that cumstance – to help professionals understand their who had received pain education within the had impacted on the implementation of prescribing family structures and ways of being. previous two years demonstrated a difference (p = within the hospital. 0.003) on the total PNKAS scale. Conclusions: The study can potentially inform Conclusions: The capacity to prescribe medicines the routine inclusion of gender issues in inter- Conclusions: Findings support concerns regarding by children’s nurses contributes towards modern professional education at all levels to overcome unsatisfactory pain management attitudes and health care policy and improvements in care. prejudice, homophobia and heterosexism and so knowledge in nurses. A paediatric nursing quali- However, it is important that nurses have the appro- improve care for same-sex families and other mar- fication, continuing education, including nurse’s priate support, and other health care profession- ginalised groups. area of expertise had a positive influence on als understand nurse prescribing. Communication nurses’ knowledge. Intensive continuing education Recommended reading: across professional boundaries is therefore crucial is needed regarding pain management and espe- Hollway W & Jefferson T (2000) Doing Qualitative to the successful implementation of nurse prescrib- cially in relation to non paediatric qualified nurses. Research Differently: Free Association, Narrative ing in the care of children and young people in the Education is needed in: pain assessment, including and the Interview Method London: Sage hospital setting. self report; pharmacology and pharmacokinetics of

91 Concurrent session 7 – Thursday 26 March 2009

analgesia especially in relation to opiates to dispel Conclusions: With an excellent response rate we focussing on practical goals to provide a formal fears and non-pharmacological interventions. Edu- have a comprehensive overview of the challenges structure for daily life. cational strategies i.e. problem based learning and nurses face in providing adequate oral care for Discussion: The discussion presents i) an analysis reflection should also be considered. patients in stroke care settings. Nurses’ access to of the similarities and differences between the two assessments, protocols and equipment varied con- Recommended reading: specialist units and ii) a conceptual framework for siderably. Access to based tools of oral care should practice that links this study with other research on Brennan, F. and Cousins, M.J. (2004) Pain Relief as not be assumed. hope, dovetailing with person centred practice. a Human Right. Pain, Clinical Updates 12 (5): 1-4 (online) Recommended reading: Conclusions: The study suggests that within the context of valuing specialist knowledge; hope has Finley, G.A. Franck, L.S. Grunan, R.E. and Von Finestone, HM, Greene-Finestone, LS, Wilson, ES shared meanings across disciplines that could be Baeyer, C.L. (2005) Why Children’s Pain Matters. and Teasell, RW, 1996. Prolonged Length of Stay and used to guide practice or as a basis for further Pain, Clinical Updates 13 (4): 1-6 (online) Reduced Functional Improvement Rate in Malnour- ished Stroke Rehabilitation Patients. Archives of research. Manworren, R.C.B. (2001) Development and Testing Physical Medicine & Rehabilitation, 77(4) pp340-5 of the Pediatric Nurses’ Knowledge and Attitudes, Recommended reading: Survey Regarding Pain. Pediatric Nursing 27 (2): Steele JG., Sheihman A, Marcenes W, Walls AWG, Lohne V (2008) The Battle Between Hoping and 151-158. 1998. National Diet and Nutrition Survey: People Suffering: A Conceptual Model of Hope Within a Aged 65 Years and Over. Vol. 2: Report of the Oral Context of Spinal Cord Injury. Advances in Nursing Health Survey, London: HMSO Science 31(2), 237-248 Edwards PJ, Roberts IG, Clarke MJ, DiGuiseppi C, Theme: Stroke care/trauma Morse J M & Penrod J (1999) Clinical Scholar- Wentz R, Kwan I, Cooper R, Felix L, Pratap S. 2007. ship. Linking Concepts of Enduring, Uncertainty, 7.2.1 Methods to Increase Response Rates to Postal Suffering, and Hope. Image: Journal of Nursing Questionnaires. Cochrane Database of Systematic Scholarship 31(2), 145-150 A survey of oral care practices in Reviews 2007, Issue 2. Art. No.: MR000008. DOI: Turner D S & Stokes L (2006) Hope Promoting Strat- Scottish stroke care settings 10.1002/14651 egies of Registered Nurses. Journal of Advanced Marian Brady, Nursing, Midwifery and Allied Health Professions Research Unit, Nursing, Glasgow, UK Nursing 56, 363-372 Co-authors: Ana Talbot; Denise L.C. Furlanetto; Heather Frenkel; Brian O. Williams 7.2.2 [email protected] Comparing the concept of hope on 7.2.3

Abstract: two units: Trauma and stroke Planning post-discharge needs: Liz Tutton, School of Health and Social Studies, Introduction: Impairments that often accompany University of Warwick, Coventry, UK Death, dependency and health stroke (physical or cognitive) may challenge inde- Co-authors: Kate Seers; Debbie Langstaff; Martin status 90 days following acute pendent oral care. Oral health problems impact on Westwood stroke in Australia patients’ nutritional intake, which is in turn linked [email protected] Sandy Middleton, School of Nursing, Australian to their length of hospital stay and rehabilitation, Catholic University National, North Sydney, as well as oral health itself. Australia Abstract: 1 Stroke nurses have the responsibility of support- Co-authors: Chris Levi; Cate D’Este; Simeon Dale; ing patients’ independent oral care or maintaining Background: Hope as a concept has great appeal for Rhonda Griffiths; Jeremy Grimshaw; Jeanette Ward; oral health for patients unable to do so independ- nursing with its focus on the meaning of life and ori- Malcolm Evans; Clare Quinn; Dominique Cadilhac ently. The poor oral care practices within some entation to the future. However there is a gap in the [email protected] healthcare settings have been highlighted. literature in relation to how hope is viewed within the context of daily ward life in acute care. This pres- 2 Little is known about the tools, equipment and entation will compare the findings from an explora- Abstract: support which nurses in stroke care settings have tion of hope on a Trauma Unit and Stroke Unit. Background: Hyperglycaemia, fever and swallowing to conduct adequate oral care. Aims: This study extends existing knowledge by dysfunction are poorly managed following stroke; Methods: We collected information on the oral exploring the meaning of hope for people living and patient outcomes are compromised. Guidelines could care practices in stroke care settings across working in two specialist acute care settings. improve care but are not effectively implemented. Scotland. We designed, piloted and distributed a Aims: To develop and trial a multidisciplinary short postal questionnaire to ward managers or Methods: The study drew on the principles of team building intervention comprising workshops senior nurses in 71 units providing specialist care ethnography undertaking 21 hours of observa- and nurse-initiated clinical treatment protocols to for patients in the acute or rehabilitation stages tion, qualitative interviews with 10 patients and following stroke. Employing some of the strategies 10 multidisciplinary staff members, and two focus improve management of fever, hyperglycaemia and found to be effective in improving response rates groups with staff, on each unit. Data collection swallowing dysfunction following stroke. to postal questionnaires,3 a pre-notification letter commenced in March 2007 and will be completed Methods: Acute Stroke Units (ASUs) in New South and a reminder letter were also circulated one week in October 2008. Data were analysed line-by-line Wales (NSW), Australia are participating in this before and after the distribution of the question- and coded using QSR N6 as a means of managing prospective, multicentre, single-blind, cluster naire. Responses were anonymous. the data. randomised controlled trial. ASUs randomised Results: Our survey had a 99% response rate with Results: The preliminary findings identify the to the intervention group have received: unit- 70 questionnaires completed and returned. Most suffering inherent in living with injury/stroke where based workshops to identify local barriers and units (64/70) received support from dental profes- particularised hope is focussed on the experience enablers; a standardised core education program; sionals on request. Disappointingly, only a third of of hospital life, and gradual progress in regaining nurse-initiated evidence-based clinical treatment nursing staff had recived oral care training in the functional abilities. Generalised hope identified the protocols; and engagement of local staff. Control previous year. Just one fifth used oral care assess- desire to be ‘like they were before’ and to live at group ASUs have received only an abridged version ment tools or protocols. Nurses did not have access home once again. Staff identified the professional of the National Clinical Guidelines for Acute Stroke to toothbrushes or toothpaste in almost a third of process of realistic hopefulness; providing support Management. Baseline patient outcome data are units. through the emotional process of recovery and reported.

92 Concurrent session 7 – Thursday 26 March 2009

Results: A total of 736 patients were recruited to Discussion: The effects of the changes have been and traffic accidents combined(House of Commons the baseline cohort from 19 ASUs; 45 (6%) of these significant. Information is now easy to find and Health Committee, 2005). The safety of patients patients died within 90-days; 48 withdrew or were readily accessible to all caregivers, and informa- is compromised by poor management of warfarin, unable to be interviewed (7%). Of the 643 who par- tion is easily updated throughout the patient’s especially across the primary/secondary care ticipated, over half were male (n=359, 56%). The hospitalization. The home medication list is used interface. mean age was 71 years. Over half (n=408, 65%) to populate the electronic discharge instructions. Conclusions: All professionals need better were independent (BI of > 95) with just over a Complete, accurate, and legible discharge instruc- education and better information to manage third (n=237, 37%) reporting no symptoms or no tions are printed for patients, faxed to primary patients receiving warfarin. significant disability despite symptoms (MRS < physicians caring for patients post-discharge and 1). Thirty five patients (5%) had a further stroke, available online to all caregivers. Recommended reading: 75 patients (10%) reported that their health was Conclusions: As a result of this project it was House of Commons Health Committee (2005) The ‘much better now’ or ‘somewhat better now’ than concluded that computerization can improve Prevention of Venous Thromboembolism in Hospi- one year ago. timeliness and accessibility of communication of talised Patients. London, The Stationery Office Discussion: These data provide an insight into the current medications to all caregivers. level of morbidity experienced 90-days following admission to ASU’s, generating a useful set of ‘norms’ for the planning of future intervention 7.3.3 studies in stroke. In addition, patient 90-day status 7.3.2 The professional jurisdictions of will assist in planning for patient needs post-dis- A baseline study of the charge. nursing and medicine in relation management of anticoagulant Conclusions: These baseline data provides unique, to the supply and prescription of prospectively collected 90-day outcome data for a medication in the UK medicines by nurses in the acute cohort of stroke patients to guide post-discharge Annette Lankshear, Nursing, Health and Social setting Care Research Centre, Cardiff University, Cardiff, UK care. Helen Green, QA Team, Skills for Health, Solihull, Co-authors: Karin Lowson; Jane Harden; Cheryl UK Rogers; Paula Lowson; Ruth Saxby [email protected]

Theme: Medication management Abstract: Abstract: 7.3.1 Background: It is estimated that almost a million Background: Following the publication of the NHS people take warfarin at any one time and this figure Improving the medication Plan (DH 2000), nurse prescribing was extended to is set to rise. Management of the drug requires the reconciliation process: A hospital all nurses.. Guidance was also written around the navigation of a narrow channel between the risks supply and administration of medicines by nurses quality initiative of haemorrhage and thromboembolism. It is one of under Patient Group Directions (NHSE 2000). This Moreen Donahue, Nursing Administration, a small number of drugs frequently implicated in research considered the changes to the jurisdic- Danbury Hospital, Danbury, KingdomStates adverse incident reports. Co-author: Matthew Miller and Joyce Fitzpatrick tions of medicine and nursing as a result of these Aims: In January, 2007 a team from Cardiff and events. [email protected] York Universities was commissioned by the NPSA Aims: This research aimed to critically examine the to undertake a six-month baseline study of antico- changing jurisdictions of nurses and doctors with agulant management prior to the publication of a Abstract: the advent of legalised nurse prescribing and to patient safety alert. Background: Communication is key to managing identify the implications for the professional devel- continuity of care for patients. Medication recon- Methods: The team made visits to twenty randomly opment of nursing. ciliation is a formal process that requires enhanced selected NHS acute trusts to interview chief nurses, Methods: The methodology utilised was qualitative communication to track medications taken at medical directors, chief pharmacists, patient safety case study. Specialist nurses, ward managers and home, ordered at admission, and planned for after managers and consultant haematologists (n=115). senior doctors from two acute hospital sites were discharge. We also interviewed junior doctors (n=52), ward interviewed. The specialist nurses were observed pharmacists (n=56), ward sisters and charge Aims: This study was aimed at improving the in clinics, field notes were kept and documentary nurses (n=76) to determine their educational medication reconciliation process at a community material was collected at both sites. The data was preparation and confidence in managing the drug hospital in order to improve the quality of care. collected between 2004 and 2007. and asked them to share the difficulties they faced Methods: A multidisciplinary team led by senior in practice especially around the management of Discussion: One case study site had promoted leadership involving front line staff and informat- discharge. nurse prescribing to a greater extent than the other. ics experts was formed. The lean Six Sigma process At both case study sites nurses were recognised Results: We found awareness of poor practice at was used to identify areas for improvement; to have great expertise, follow rules better than senior level and limited understanding of correct targeted areas for assessment were suppliers, doctors and so be more careful. Some doctors were loading doses and drug and food interractions inputs, process, outputs, and customers. A com- identified as not supportive of nurses prescrib- amongst the junior doctors, nurses and pharma- puterized medication reconciliation process was ing. Both doctors and nurses in the study felt that cists interviewed. Few ward sisters/charge nurses implemented. there should be locally set boundaries around what had received any specialist education. Discharge nurses could prescribe and that doctors should be Results: Mean time from admission to medication procedures are complicated by the four levels of GP involved in making that decision. reconciliation was used as the measure of change. involvement permitted by the GP contract. Pre-computerized medication reconciliation the Conclusions: With the changes in legislation, the Discussion: A recent House of Commons Health mean time was 27.9 hours; post-computerized profession of nursing had an opportunity to achieve Committee report stated that, despite the avail- medication reconciliation was 11.3 hours. The professional closure around the supply and pre- ability of effective anticoagulant medication, the percent of medications reconciled at discharge pre- scription of medicines and move to a shared juris- annual death toll ascribed to venous thromboem- computerization was 40%; post-computerization diction in relation to prescribing. However, both bolism resulting from a hospital stay exceeded the the percentage was 93%. doctors and nurses felt that doctors should retain total number of deaths from breast cancer, AIDS intellectual jurisdiction over nurses’ prescribing.

93 Concurrent session 7 – Thursday 26 March 2009

The continued requirement to involve doctors in Each theme will be presented using verbatim quo- wish to die at home to achieve this goal. Poor the training of nurses means that they still have the tations to substantiate meaning. discharge planning from the hospital including a power to prevent an organisation wide approach to Conclusions: People with lung cancer and their lack of communication with the community nursing achieving optimum benefits from nurse prescribing families are suddenly placed in a life-changing team, coupled with delays in commencing addi- for both the organisation and the patient. situation, often lacking the experience or resources tional care services and the delivery of equipment are all identified as influencing factors. This paper Recommended reading: to cope. They are confronted with the inescapable reality of ‘living with dying’ on a daily basis. Nurses discusses these findings and recommendations Coombs M. (2004) Power and Conflict Between and healthcare professionals delivering services for improving the services offered to terminally ill Doctors and Nurses. Routledge, London to these people need to understand the reality cancer patients and their families will be given. Department of Health (2000a) The NHS Plan: A Plan and nuances of these issues, in order to deliver Recommended reading: for Investment, A Plan for Reform, HMSO, London improved care. For this population there is no time Davies E, Linklater KM, Jack RH, Clark L, Moller H National Health Service Executive (2000) HSC to make mistakes or omissions in care and we each (2006) How is Place of Death from Cancer Changing 2000/026 Patient Group Directions (England Only). have a role in improving this experience. and What Affects it? Analysis of Cancer Registra- NHSE, Leeds Recommended reading: tion and Service Data. British Journal of Cancer 95, Ryan PJ et al (2008) Lung Cancer: Caring for Car- 593-600 egivers. Palliative Medicine 22;233-238 Department of Health (2008) End of Life Care Theme: Palliative care Krishnasamy M et al (2007) Patients and Carer Strategy –Promoting High Quality Care for all Adults at the End of Life, Stationary Office London 7.4.1 Experiences of Care Provision After a Lung Cancer , Diagnosis. Support Cancer Care 15;327 – 332 National Institute for Clinical Excellence ( NICE) Living with dying: the experiences Proot JM et al (2003) Vulnerability of Family Caregiv- (2004) Improving Supportive and Palliative Care of people with lung cancer and their ers in Terminal Palliative Care at Home; Balancing for Adults with Cancer National Institute for Clinical families Between Burden and Capacity. Scandanavian Excellence, London Donna Fitzsimons, Central Nursing Team, Belfast Journal of Caring Science 17; 113 – 121 City Hospital, Institute of Nursing Research, University of Ulster & Belfast Health & Social Care Trust, Belfast, UK 7.4.3 Co-authors: Lesley Rutherford; Jill McAuley 7.4.2 Dying at home: The impact on [email protected] Why don’t they die at home? The informal carers on cancer patients’ impact of service provision on end place of death Abstract: of life care for patients with cancer Barbara Jack, Faculty of Health, Edge Hill Background: Lung cancer is a devastating Mary O’Brien, Evidence-based Practice Research University, Ormskirk, UK diagnosis. The high rate of complex problems Centre, Faculty of Health, Edge Hill University, Co-author: Mary O’Brien experienced by these people and very low five year Ormskirk, UK [email protected] survival, underline the importance of providing Co-author: Barbara Jack timely and efficient services. Yet recent research [email protected] confirms that patients’ symptoms and the wider Abstract: psychosocial issues experienced by them and their Background: It is estimated that between 50-75% families are difficult to manage. Further informa- Abstract: of those with cancer and over 50% of adults (if tion regarding this experience is required in order Background: Providing service users with a say diagnosed with a terminal illness) would prefer to to develop more responsive care. in their care is integral to UK government health die at home (Higginson 2003). Although UK govern- Aims: The aim of this study is to explore the experi- policies, including initiatives such as the End of ment initiatives such as the introduction of the End ence of patients and carers living with lung cancer Life Care Programme and the recent Department of of Life Care Programme promote patients’ choice in Northern Ireland. Health End of Life Care Strategy (DH 2008). Implicit to die at home, approximately 26% of terminally ill within these policies and development is that the patients are not dying at home (Davies et al 2006). Methods: A qualitative study was undertaken patient’s preferences regarding the location of There are increasing challenges for the informal using semi-structured interviews with a purposive care are followed (wherever possible) (NICE 2004). carers particularly with an increasingly aging popu- sample of 23 participants (12 patients and 11 Despite these policy initiatives, approximately 56% lation. Despite the policy initiatives there remain a carers). Interviews were conducted in patients’ of UK cancer deaths occur in hospital with many persistent number of patients with cancer who had homes and all interviews were taped and tran- patients with cancer who had chosen to die at chosen to die at home being admitted to hospital scribed verbatim. Due the vulnerability of this home being admitted to hospital in the last days in the last days and hours of life. The aim of this population ethical procedures were carefully con- and hours of life. (Davies et al 2006). The aim of study was to explore the factors that influence this sidered and strictly adhered to. Transcripts were this study was to explore the factors that influence outcome. analysed using a standard thematic approach. this outcome. Methodology: A qualitative study using two focus Findings: Eight qualitative themes were derived Methodology: A qualitative study, using audio group interviews with community nurses (district from this data: tape-recorded focus group interviews was nurses and community specialist palliative care • living with dying employed for the study. A purposive sample of 19 nurses) was undertaken across two primary care • pervasive uncertainty district nurses and community specialist palliative trusts in the north west of England. Data was analysed using a thematic analysis approach. • emotional impact care nurses from across two primary care trusts in the North West of England participated in two focus Results and Discussion: All respondents high- • struggling for control groups. Data were analysed for emerging themes lighted the ability of carers to cope as a major • facing loss using thematic analysis. factor affecting whether patients with cancer were • financial hardship Results and Discussion: The findings of this study enabled to die at home. Influencing factors such as • symptom burden suggest that poorly coordinated service provision the ability of the family to cope and the duration of impacts upon enabling patients with cancer, who the illness are also reported. This paper discusses • information needs

94 Concurrent session 7 – Thursday 26 March 2009

the results and explores potential reasons for the their own, with limited input from health services. 7.5.3 findings.. Recommendations for the development There is a need for evidence-based interventions of a carer assessment tool with appropriate sup- to support men and their partners as they deal Continence care for men having portive interventions are made. with the problems and issues which arise from the prostate surgery: Advice and illness and its treatment, in particular in the 4-6 Recommended reading: practical help before and after weeks post-treatment period. Davies E, Linklater KM, Jack RH, Clark L, Moller H radical prostatectomy and TURP (2006) How is Place of Death from Cancer Changing Suzanne Hagen, Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow and What Affects it? Analysis of Cancer Registra- Caledonian University, Glasgow, UK tion and Service data. British Journal of Cancer 95, 7.5.2 Co-authors: Cathryn Glazener; Claire Cochran; 593-600 Adjuvant radiotherapy of women Louise Campbell Higginson, I (2003) Priorities and Preferences [email protected] for End of Life Care. London:National Council for with breast cancer – information, Hospice and Specialist Palliative Care Services support and side-effects Katarina Sjövall, Department of Oncology, Lund Abstract: University Hospital, Lund, Sweden Background: Urinary incontinence is common after Co-authors: Gertrud Strömbeck; Anette Löfgren; prostatectomy. This risk is highest after radical Theme: Cancer Barbro Gunnars surgery for cancer (50-90% prevalence six weeks 7.5.1 [email protected] after surgery). While the risk is lower after surgery for benign disease (5-10% prevalence at six weeks) The quality of life, coping Abstract: the numbers affected after the two procedures are behaviours and needs of men who similar as benign disease is much more common. The aim of this study was to: have localised prostate cancer who Over time, the rates of incontinence fall in both 1) describe the side-effects that women with breast groups, but a significant number of men are left are receiving radical radiotherapy cancer experience after adjuvant radiotherapy, the with long-term incontinence. Men experience wide and androgen deprivation severity and duration of the most reported variation in the amount of advice and help they Oonagh Mc Sorley, Institute of Nursing Research, 2) examine women’s experiences of given informa- receive about continence problems they may expe- University of Ulster, Newtownabbey, UK tion and need of support. rience after prostate surgery. Co-authors: Eilis McCaughan; Brendan Bunting; Aims: To explore the experiences of men who had Kader Parahoo; Joe O’Sullivan; Hugh McKenna; 171 women with breast cancer receiving post- recently undergone prostate surgery relating to the Sonja McIlfatrick surgical adjuvant radiotherapy completed a continence care that they had received. [email protected] questionnaire at four times between the start of radiotherapy and six months after completion Methods: As part of a large randomised control- of radiotherapy. The questionnaire consisted of led trial, a postal questionnaire was sent 3 weeks Abstract: the Oncology Treatment Toxicity Assessment Tool post-surgery to men having radical prostatectomy Prostate cancer incidence is increasing with the (OTTAT) to measure the radiotherapy-related side- and TURP. result that more men are living longer with the effects. Questions regarding the experience of Results: To date 146 men (56 radical, 90 TURP) disease and the side-effects of treatment. This delivered information and support were added. have responded. Most men who had radical prosta- paper focuses on men’s experience of the effects of Most commonly reported side-effects were skin tectomy (98%) had been made aware beforehand radiotherapy treatment and their coping strategies reactions, fatigue and pain. Women treated with that they might leak afterwards, compared to 57% following a diagnosis of prostate cancer. Quantita- mastectomy had a higher prevalence of side-effects of men who had TURP. Respondents most often tive data was collected on quality of life and coping and experienced the side-effects more severe than acquired this information from their hospital doctor at 4 time points (pre – radiotherapy treatment, women treated with breast conservative surgery. (98% radical; 67% TURP), followed by a hospital within 4-6 weeks post-treatment and 6 months The prevalence of side-effects peaked at the end of nurse (38%; 35%), and finding out for themselves and 1 year, thereafter) with a sample of 149 men treatment and three weeks later. At six months after (31%; 22%). Men, particularly radicals, were from the Cancer Centre, in Northern Ireland. A sub- the completion the prevalence of side-effects was commonly offered pads post-operatively (66% sample of 10 men were interviewed in-depth at the still higher than baseline. Psychosocial symptoms, radical; 9% TURP) but more reported using such same time points about the effects of the treatment including difficulty to concentrate, sleep distur- products (77%; 17%). Similarly men reported being on their lives and family, on how they cope bance and feeling depressed increased during the given pelvic floor exercise advice (62% radical; 9% (including sources of information/support they measuring period. The frequency of dyspnoea was TURP), although uptake was lower (48%; 7%). access and self-management strategies). Quanti- also higher six months post-treatment compared to Conclusions: Men having radical prostatectomy tative findings showed that there was a decline in start of treatment. A majority of the women expe- and TURP seem to receive different continence their quality of life at 4-6 weeks post-treatment and rienced the given information and support as sat- care. Whilst this may be appropriate post-opera- for a small but significant group of the men, the isfying. The need for follow-up of the side-effects tively when leakage can be identified as a problem, symptoms were severe. Participants reported using was expressed. Women with breast cancer who all men should be made aware of the potential for a variety of coping methods to steer them through receive adjuvant radiotherapy should be informed post-operative urine leakage prior to surgery. the treatment and post-treatment phases in order about what side-effects that can occur, and also to ‘get on with life’ and remain positive. that those can remain and even get worse during The qualitative data revealed many challenges as the three weeks post treatment. It is a challenging a result of living with the side-effects of radiother- task for the nurse to provide support to handle the apy and hormonal treatments. They experienced side-effects, even after the treatment is completed. distress and anxiety and had difficulties in coping Further research is needed to learn more about with such problems as sexual function, bladder the development of side-effects even after the function, fatigue and hot flushes. They found it six month period post treatment. Future nursing difficult to cope with many of these problems which research also needs to focus on developing disrupted their lives and the lives of their families. strategies to prevent and treat side-effects of This was a time when the men felt they were left on radiotherapy.

95 Concurrent session 7 – Thursday 26 March 2009

Theme: Internationality and nursing 7.6.2 Theme: Mental health/ethics/ 7.6.1 The experiences of internationally information systems International relations: What recruited nurses: Implications for 7.7.1 relationships in the work retention A mapping of UK nursing’s e-theses environment mean in terms nursing Julia Nichols, School of Health, University College and comparison of electronic search Northampton, UK careers. Learning from the career Co Author: Jackie Campbell strategies stories of migrant African nurses [email protected] Colin Macduff, CeNPRaD, School of Nursing, The Robert Gordon University, Aberdeen, UK living in the UK Co-authors: Penny Jones; Sundari Joseph; Colin Jacqueline Fitzgerald, Health Services Research Abstract: MacLean Unit, London School of Hygiene and Tropical This presentation will explore the experiences of [email protected] Medicine, London, UK recently recruited international nurses (IRNs) to the UK and the implications for their retention within Abstract: Abstract: the British workforce. Background: The recent rise in university Institu- This paper is based on a research study of how Background: The current campaign to recruit tional Repositories, national portals to e-theses nurses from Africa based in the UK construct and international nurses began in earnest in the mid (e.g. the British Library ETHOS project), and inter- narrate their careers. The study aimed to explore 1990s in response to staff shortages and policy national gateways (e.g. the Networked Digital how migrant nurses from sub Saharan Africa locate changes (DoH 2000), and has added in the region Library of Theses and Dissertations) means that an migration to the UK within the broader context of of 100,000 overseas nurses to the UK register (NMC exciting range of electronically formatted theses their career. The background to the study is the 2005; 2006; 2007). Many practice areas are now are now freely available in full text to potential global nursing shortage and the flow of nurses from dependent on international nurses as an integral PhD readers and writers (Macduff 2008). As yet, low-income countries already experiencing severe and essential part of their workforce and there is however, there has been no systematic study of shortages to high-income countries. The challenge evidence to suggest that if IRNs choose to leave the what is available in the UK and how best to discover posed for healthcare systems as well national UK in large numbers we could face severe staffing this. This paper will describe a research project that and international policy makers is reflected in the shortages (Buchan 2003). Now that international is addressing this need. World Health Organisation’s 2006 declaration of recruitment has slowed the focus must shift to the the human resource decade. retention of this valuable workforce. Objectives: The research involved a purposive sample of 17 Methodology: A systematic review of empirical 1. To explore and compare the use of a variety of qualified nurses from Africa now based in the studies relating to the experiences of this group search strategies in order to best identify the South East of England, where health services are of migrant nurses was undertaken. Meta synthesis nature and scope of UK nursing PhD e-theses, and heavily reliant on the migrant nursing workforce. techniques were used to appraise the findings and to guide other researchers within nursing who are The inclusion criteria for participants reflected the to allow comparison of themes across studies. new to e-theses policy environment associated with the practice of Findings: Five main themes in the experiences 2. To describe the resultant body of material in international nurse recruitment. Participants were of IRNs emerged from the study: motivation for terms of subject matter and methodology/methods recruited directly in response to a request for vol- migration; adapting to British nursing; experiences used unteers and via snowball technique. of first world healthcare; feeling devalued and 3. To ascertain whether UK nursing doctoral Interviewed twice using a semi-structured approach deskilled; and vectors of racial discrimination. The students are exploiting the potential of the e-thesis and subsequently contacted for an update report a implications of these for retention are analysed and format to incorporate innovative media and other year later, the biographical and narrative analyses recommendations for practice suggested. forms of presentation identified how the boundaries of nurses’ careers Conclusions: This study identifies that action 4. To explore whether UK nursing doctoral students are shaped over time by the social space in which should be taken in the following areas to optimize who publish an e-thesis also publish related work they are experienced and the agency exerted by the chances for retention of IRNs: recognizing in journals the individual. Careers have a relational dimension, economic ambition; robust preparation/adapta- Methods: The research involves comparing use and the analysis identified how relationships tion; matching expectations; recognizing profes- of web portals that harvest from university Insti- have not only an immediate impact but influence sional status; organizational support and manage- tutional Repositories with use of the individual future working relationships and future career. In ment of racism. Contribution to practice: IRNs have repositories themselves. There is also comparison addition to a direct influence, relationships in the in many ways been the saviours of British nursing of use of different search terms. A standardised work environment can also symbolise the broader in the face of a domestic crisis in staffing. If we process and proforma has been developed for clas- relationship within the organization described as are to avoid the scenario of repeatedly recruiting, sifying the theses, informed by the work of McVicar the psychological contract and the structural and retraining then replacing overseas nurses we must and Caan (2005). cultural factors that influence the individual career. listen carefully to their experiences so that we can The lessons the stories provide for all nurses are optimise the potential for retention. Initial Findings and Conclusions: These new search discussed in light of current UK nursing policy engines are variable and formative in terms of user- initiatives towards the modernisation of nursing Recommended reading: friendliness and coverage. The current number careers. Buchan, J. (2003) Here to stay? International of UK nursing e-theses is likely to be under 40, Nurses in the UK. RCN Publications. but definitive initial mapping will be achieved by Recommended reading: Department of Health (2000) The NHS Plan. The January 2009. This will contribute usefully by iden- Department of Health (2006) Modernising Nursing Stationary Office. London tifying this emergent ‘e-academy’ of nursing schol- Careers – Setting the Direction. England UK: DH arship and how best to access it. NMC (2005; 2006; 2007) Statistical Analysis of the Department of Health (2004) Code of Practice for Register www.nmc-uk.org Recommended reading: the International Recruitment of Healthcare Profes- sionals England UK: DH Macduff C (2008) The PhD as a Virtual Guest House. Journal of Clinical Nursing 17, 2381-2383 World Health Organisation (2006) World Health Report: Working Together for Health Geneva: WHO

96 Concurrent session 7 – Thursday 26 March 2009

McVicar, A and Caan, W (2005) Research Capabil- Recommended reading: practices could be in IT implementation. The ity in Doctoral Training: Evidence for Increased Charles, C., Gafni, A., & Whelan, T. 1997, ‘Shared socio-technical approach on IT systems evaluation Diversity of Skills in Nursing Research. Journal of Decision-making in the Medical Encounter: What suggested in the recent literature appears to be an Research in Nursing 10, 627 – 646 Does it Mean? (Or it Takes Two to Tango)’, Social adequate theoretical underpinning on IT evaluation Science and Medicine, vol. 44, no. 5, pp. 681-692 research. Realistic evaluation has proven to be an adequate method for IT evaluation. National Institute for Clinical Excellence 2002, 7.7.2 Schizophrenia: Core Interventions in the Treatment Recommended reading: and Management of Schizophrenia in Primary and Oroviogoicoechea C, Elliott B & Watson R. (2008) A Cochrane systematic review: Secondary Care. London Review: Evaluating Information Systems in Nursing. Shared decision making Journal of Clinical Nursing; 17(5), 567-75 interventions for people with Pawson R & Tilley N (1997) Realistic Evaluation mental health conditions 7.7.3 Sage Publications Ltd, London Edward Duncan, Nursing Midwifery and Allied Health Professions Research Unit, University of A realistic evaluation of the impact Stirling, Stirling, UK of a computerised information Theme: Patient and public involvement Co-authors: Catherine Best; Suzanne Hagen system on clinical practice: The 7.8.1 nurses’ perspective Abstract: Cristina Oroviogoicoechea, Nursing Research Patient and public involvement in Background: Health professionals should involve and Development Unit, Clínica Universitaria de the NHS Navarra, Pamplona, Spain patients in health care decisions on both ethical Sandy Herron-Marx, National Centre for and clinical grounds. Ethically, patients have a right Co-author: Roger Watson Involvement, University of Warwick, Coventry, UK to self-determination. Clinically, patients are more [email protected] Co-authors: Sophie Staniszewska; Helen Bayliss likely to comply with a treatment decision when it [email protected] takes account of their personal values and prefer- Abstract: ences. Shared decision making is one method of Evidence of effective systems imple- addressing the power imbalance between patient Background: Abstract: mented effectively in healthcare organisations and practitioner whereby the patient is encour- Background: Patient and Public Involvement (PPI) appear to be crucial for further design and develop- aged to share their preferences and priorities and is one way on which patients, carers and the public ment. Evaluation research of IT (information tech- the health professional shares their knowledge and have a voice in decisions about how healthcare nology) implementation is moving from a technical preferences; together they negotiate a mutually services are planned, designed, delivered and to a socio-technical approach that incorporates acceptable plan (which may be to do nothing) evaluated. This collective form of involvement user perspectives and context in the evaluation (Charles, Gafni, & Whelan 1997). This approach seeks to create an NHS that will be responsive (Oroviogoicoechea et al, 2008). appears particularly relevant to decision making to local need, ensure transparency in decision in mental health care where treatment decisions Aims: The aim is to explore nurses’ perceptions of making about health care and build future genuine can have a profound effect on a person’s daily life the impact on clinical practice of the use of a com- partnerships with local communities. The health and treatment is often long-term. Encouragement puterised hospital information system. policy driving PPI is now well established. Whilst to undertake shared decision making is included in Design: A realistic evaluation design based on the evidence documents local examples of PPI in recent policy guidance such as the NICE guidance Pawson and Tilley’s work (1997) has been used practice, until recently little was known about how on treatment for schizophrenia (National Institute across all the phases of the study. It is a theory PPI was being implemented across the NHS. for Clinical Excellence 2002). driven approach and focuses evaluation on the Aims: This presentation reports on the collated Aims: To evaluate the effects of interventions to study of what works, for whom and in what cir- findings from two national annual (2007 and 2008) increase shared decision making on patient sat- cumstances. These relationships are constructed surveys of PPI in the NHS across England. isfaction, clinical outcomes and readmission to as context-mechanisms-outcomes configurations Methods: A national online survey (question- hospital for people with mental health conditions. (CMO). naire) using Snap survey software and hosted by Methods: A Cochrane Systematic Review was Methods: A self-developed questionnaire was dis- ‘Snap Online’ was developed. The questionnaire undertaken as part of the Communication and tributed to all nurses working in in-patient units generated both quantitative and qualitative data. Collaboration Review Group. Results: The review of a University Hospital in Spain (n= 227) in May Findings: PPI leads were predominately from a found only two studies meeting inclusion criteria. 2005. Quantitative data were analysed using SPSS nursing background. PPI roles tended to ‘evolve’ These indicated that shared decision making inter- 13.0. Descriptive statistics were used for an overall with little guidance given. PPI leads provided ventions increased patient involvement in decision overview of nurses’ perception. Inferential analysis, support to others in the Trust but often they worked making and increased patient satisfaction. There is including both bivariate and multivariate methods in isolation. A great deal of commitment, energy no evidence that shared decision making interven- (path analysis), were used for cross-tabulation of and enthusiasm was required to be effective in tions effected patient outcomes. variables searching for CMO relationships. the role. There was little consensus of the features Discussion: No evidence of shared decision making Results: 179 nurses participated in the study of PPI and how this was reported and evaluated. interventions effecting patient outcome should not (78.8% response rate). Overall satisfaction with A range of methods to involvement were used be misinterpreted as evidence of no effect. More the IT system is positive. Comparisons with but predominately groups and individuals were research is needed in this field before firm conclu- context variables show how nursing units’ context ‘consulted about’ with often little evidence of how sions are reached on the effects of shared decision had greater influence on perceptions than users’ NHS Trusts were responding to information gained making interventions. This paper will outline the characteristics. Path analysis illustrated that the or how people’s input was influencing change in the review’s findings in the broader context of research influence of unit context variables are on outcomes NHS. Resourcing and payment for involvement was in shared decision making and suggest future and not on mechanisms. not consistent across the NHS and there was little research priorities. Conclusions: Results from the study looking to documented evidence of the sustainable impact of subtle variations in users and units provide a grasp involvement. The implications of these findings for of how important professional culture and working the nursing profession will be discussed.

97 Concurrent session 7 – Thursday 26 March 2009

7.8.2 Kearney N, Kidd L, Miller M et al (2006) Utilising Recommended reading: Developing and evaluating a Handheld Computers to Monitor and Support Department of Health (2006) A New Ambition for Patients Receiving Chemotherapy: Results of a Old Age: Next Steps in Implementing the National complex intervention: Engaging UK-based Feasibility Study. Support Care Cancer Service Framework for Older People. A Resource with users throughout the process 14: 742-752 Document, London: Department of Health Faith Gibson, Centre for Nursing and Allied Health Department of Health (2008) The Case for Change Professions Research, Institute of Child Health, – Why England Needs a New Care and Support London, UK System, London: Department of Health Co-author: Rachel Taylor 7.8.3 [email protected] Health and Social Care Change Agent Team (2004) Older people’s decision-making Avoiding and Diverting Admissions to Hospital: about the use of health and social A Good Practice Guide, London: Department of Abstract: care services Health Background: There is increased interest in using Josephine Tetley, Department of Nursing, The Open technology to overcome barriers to communica- University, Milton Keynes, UK tion in health care. This includes the internet, email [email protected] and mobile phones. A successful example of this is ASyMS©, which is a system utilising mobile phone technology to report symptoms related to chemo- Abstract: therapy. In adults, ASyMS© has been described as Background: Older people often under-use or beneficial to adults with cancer and acceptable to refuse to use health and social care services professionals (Kearney et al. 2006). Young people designed to support them in their own homes. This are frequent users of technology, especially mobile has contributed to increased pressure on acute phones. ASyMS© would therefore potentially be hospital services as older people are admitted to an acceptable and helpful medium for them to hospital or long-term institutional care in circum- report symptoms while undergoing chemotherapy. stances that could be avoided (Department of However, the symptom experience for young people Health, 2006; Health and Social Care Change Agent is less well understood and therefore adopting a Team, 2004). system developed for adults may not necessar- Aims: To improve understandings of the factors ily be acceptable to young people. This paper will that affect older peoples use and uptake of health illuminate an approach to engage young people and social care services and professionals in order to embed ASyMS©-YG Methods: A constructivist and participatory meth- within our sphere of clinical practice. odology was used to guide the study. Data was The study: This is a 4-phase development study gathered through the use of participant obser- underpinned by the UK Medical Research Council vation, interviews and personal narratives. An (MRC) complex intervention evaluation framework inductive analysis of the data was undertaken (Campbell 2007). The study involves young people to generate key themes and an interpretive aged between 13 and 18 years, parents and health framework. professionals. Involvement of the ‘stakehold- Findings: The findings demonstrated that older ers’ of an intervention is fundamental to the MRC people want to remain independent of health and framework (www.mrc.ac.uk/complexinterven- social care services and described using adapting, tionguidance). Developing ASyMS©-YG The study coping and seeking as strategies for self-managing is progressing through the phases of the MRC difficult situations. It was only when personal and framework through an iterative process employing internal resources were exhausted that people mixed methods. Young people and health profes- described seeking professional help. Individual sionals are engaged in study development through narratives, however, illustrated that wider life expe- consultation and collaboration by being involved riences, as well as direct experiences of services, in designing the intervention, participating in also affect decision-making processes. the Steering Group and dissemination of results (Gibson 2008). We will discuss how collaboration Discussion and Conclusions: In 2008 the gov- with stakeholders in each phase of the study has ernment published the case for reforming health fostered understanding of the components and and social care services in England (Department elements of ASyMS©-YG. We will describe the con- of Health, 2008). In this they recognise the need tribution of young people that is invaluable in eval- for radical change in care and support systems if uating the practical effectiveness of ASyMS©-YG services are to meet needs and promote independ- and whether the intervention can work in everyday ence, choice and control. This presentation will practice. therefore focus on findings to illustrate: the aspects service design and individual circumstances that Recommended reading: led to positive and continued use of health and Campbell NC, Murray E, Darbyshire J et al. (2007) social care services, the experiences that led to Designing and Evaluating Complex Interventions to refusal of, or exiting from, health and social care Improve Health Care. BMJ 334: 455-459 services, how services that promote self-manage- Gibson F (2008) Building a Culture of Participation: ment can enable older people to remain independ- Young People’s Involvement in Research. In Kelly ent in their own homes. D, Gibson F eds. Cancer Care for Adolescent and Young Adults. Blackwell Publishing Ltd: Oxford

98 Concurrent session 8 Thursday 26 March 2009

Theme: Learning disability P. J. and Vessey, J. A.) Mosby, St. Louise Missouri, sities but also to other vulnerable family groups pp. 44-59 within the community. 8.1.1 Lieter, V., Krauss, m. W., Anderson, B. and Wells, N. Recommended reading: ‘Too busy looking after everyone (2004) Journal of Family Issues, 25, 379-403 else’s health to worry about Barnes, M. (2006) Caring and Social Justice, Palgrave MacMillan, London. my own!’ Health issues facing Delve, L., Samuelsson, L., Tallborn, A., Fasth, A. and mothers of children with learning 8.1.2 Hallberg, L. (2006) Stress and Well-being Among disabilities The Health Empowerment Learning Parents of Children with Rare Diseases: a Pro- Linda Goddard, School of Nursing, Midwifery and spective Intervention Study, Journal of Advanced Indigenous Health, Charles Sturt University, Albury, Partnership (HELP) model: Nursing, 53, 392-402 Australia Undergraduate nursing students Oliver. S and Peersman, G. (2001) Using Research [email protected] working with families of children for Effective Health Promotion, Open University with disabilities to improve their Press, Buckingham Abstract: health Background: Today in Australia a total of 99% of Linda Goddard, School of Nursing, Midwifery and families care for their child with a disability within Indigenous Health, Charles Sturt University, Albury, Theme: Nursing and management the home. It is often the mothers who become Australia 8.2.1 ‘the health care providers for their children, with Co-authors: Patricia Davidson; Sandra Mackey attendant reverberating effects on other areas of [email protected] The skills gap in nursing their lives’ (Leiter et al., 2004). Numerous chal- management: A comparative lenges face the family including the management of complex treatment regimens, understanding Abstract: analysis of the public and private medical conditions, juggling the needs of other This paper will present the HELP model, an inno- sectors in South Africa family members (Knafl and Santacroce, 2004). vative approach to health promotion that involves Rubin Pillay, School of Business and Finance, Aims: The study aims to address the question a partnership between families, undergraduate University of the Western Cape, Cape Town, South ‘What are the views of mothers and professionals nursing students and lecturers in nursing. Africa regarding the health of families who have children Background: The effect of caring for a child with a [email protected] with disabilities. disability over extended periods of time may result Methods: Key informant semi-structured inter- in anxiety, stress and pain (Barnes 2006). Families Abstract: with more than one child are known to report higher views were held with 13 mothers who had children Background: A lack of management capacity has stress and emotional strain Delve et al., 2006). with disabilities of varying ages and 5 disability been identified as the key stumbling block to health professionals. These interviewers were taped, Aims: To identify the key elements required to delivery in South Africa. Despite nursing managers the data transcribed, and key themes identified develop and implement a partnership, health being central to overcoming the challenges facing through thematic analysis. mentoring model for families with children who health delivery in South Africa, there has been a Results: The mothers focused primarily on physical have disabilities and to identify the impact on the paucity of research that analyses which competen- aspects of health, moving onto the build up of families and nurse partners. cies are important for nursing management and emotional health. The professionals identified Methods: Action research is utilised in the area of whether managers have these skills. mental health issues, risks factors, and physical health promotion to develop complex community Aims: This paper aimed to identify the compe- health issues. interventions involving ‘ordinary people’ who tencies that were perceived to be important for Discussion: The mothers and professionals iden- identify not only their health needs but more effective nursing management in South Africa as tified a range of health issues often chronic and importantly their rights, and issues around care, well as the managers’ self assessed proficiency associated with their childrens’ ongoing needs. coping and cure (Oliver and Peersman 2001, p.169). in these skills. It also compared the skills gap of The health of the mother was not perceived to be The cycles of action research have been used to nurse managers in the public sector with those in a priority, and they experienced higher emotional plan, assess, act and reflect on this project and the private sector. to generate change. Purposive sampling attracted issues when their children exhibited behavioural Methodology: A survey using a self administered participants: 30 nursing students, 20 families and problems. questionnaire was conducted among 420 nursing two lecturers over three years. Conclusions: Mothers’ caring for children with dis- managers in South Africa. Respondents were asked abilities experience physical and emotional health Results: A partnership approach resulted in: iden- to rate the level of importance that 51 proposed issues which may become chronic and complex tification of health issues; family strengths; health competencies had in their job and to indicate their as the child grows. Developing interventions and goals; the development of resources for each proficiency in each one. family. Evaluation indicated increased coping and strategies to increase the knowledge of nurses Results: Managers in the private sector perceived wellness in families and enhanced skills and confi- increases the capacity to both improve the health themselves to be significantly more competent dence in students working with families. care needs of the families and the outcomes for than their public sector colleagues. The largest their children. This study has resulted in a health Discussion: The Health Empowerment Learning skills gap for public sector managers were for mentoring project that involves undergraduate Partnership Model is an approach that empowers ‘ethico – legal’, ‘task related’ and ‘controlling’ nursing students working in partnership with families, nursing students and their lecturers in a skills. The largest gap for private sector managers families with the aim of improving their health. mutually beneficial manner. It has the capacity to were for ‘ethico –legal’, ‘health/clinical’ and ‘task build community capacity and empower families Recommended reading: related’ skills. of children with disabilities through education and Conclusions: This research confirms that there is Australian Institute of Health and Welfare (2006) access to resources. Disability Updates: Children with Disabilities AIHW a lack of management capacity within the health Conclusions: This model has been developed and Canberra sector and also identifies areas in which the skills expanded over a three year period and has the deficits are most significant for both the public and Knafl, K. and Santacroce, S. (2004) In Primary Care capacity to not only expand across other univer- private sectors. of the Children with Chronic Condition. (Eds, allen,,

99 Concurrent session 8 – Thursday 26 March 2009

Implications for Nursing Management: These evidence presented in previous research. These reported higher NA (z=3.30, p<.001) which findings reflect the reality of the local health service factors are not so clearly defined. Measures of persisted for the remainder of the shift (z=3.84, environment and provide valuable information internal consistency ranged fro 0.7 – 0.9. p<.0001). Managerial support was associated for those responsible for the professional devel- Discussion: The findings raise questions for with higher levels of NA (z=2.22, p=.013). Exami- opment of health care managers. It will be useful research using the NWI-R. There is considerable nation of free text responses relating to the key in the conceptualization, design and delivery of variability in the factors models reported in recent events revealed that contact with managers was health management programs aimed at enhancing evidence. Three factors are reported in recent lit- sought in response to the serious clinical incident, current and future management and leadership erature and confirmed by this study. rather than managers being a source of distress. capacity in the health sector in South Africa. Conclusions: The findings raise interesting Discussion: Serious clinical events have both Recommended reading: questions regarding previous research that has immediate and enduring effects on NA. Manage- rial support may be used following serious events Lin L.M., Wu J.H., Huang I.C. and Tseng K.H. (2007) used the NWI-R. It highlights the necessity for and hence is associated with higher NA. This study ‘Management Development: A Study of Nurse Man- a standardized, acceptable statistical approach demonstrates the effects of managerial support agerial Activities and Skills’, Journal of Healthcare to questionnaire validation. Future research is receipt are not negative, however, as such support Management; 52:3; ABI/INFORM Global required into what the NWI-R is actually measuring. is sought in those clinical incidents regarded as Mathena K. (2002) ‘Nursing Manager: Leadership Recommended reading: serious by nurses in acute services. Skills’, Journal of Nursing Administration, 32:3, Aiken, L.H. and Patrician, P.A. (2000). ‘Measuring Recommended reading: p.136 Organizational Traits of Hospitals: The Revised National Center of Healthcare Leadership (NCHL), Nursing Work Index,’ Nursing Research. 49(3):146- Elfering, A., N. Semmer, et al. (2006). ‘Work Stress (2006) Competency Integration in Health Manage- 153 and Patient Safety: Observer-rated ment Education – A Resource Series for Program Choi, J.K., Bakken, S., Larson, E., Du, Y.L. and Stone, Karasek, R. A. (1979). ‘Job Demands, Job Decision Directors and Faculty, NCHL, Chicago P.W. (2004). ‘Perceived Nursing Work Environment Latitude and Mental Strain: Implications for Job of Critical Care Nurses.’ Nursing Research 53(6): Redesign.’ Administrative Science Quarterly 24: 370-378 285-308 Siegrist, J. (1996). ‘Adverse Health Effects of High- 8.2.2 Slater, P., & McCormack, B. (2007). An Exploration of the Factor Structure of the Nursing Work Index. Effort/Low Reward Conditions.’ Journal of Occupa- The Nursing Work Index Revised: Worldviews on Evidence-based Nursing, 4 (1), p30 tional Health Psychology 1(1): 27-41 What is it actually measuring? – 39 Brendan McCormack, Professor of Nursing Research, Institute of Nursing Research University of Ulster, Newtownabbey, Belfast Theme: Family care Co-author: Paul Slater 8.2.3 8.3.1 [email protected] Does the severity of clinical Moving towards a model of family incidents and the managerial centred care: The POPPY Study Abstract support received influence affect in (Experiences of parents with Background: The developed world is facing a nurse nurses? pre-term babies) shortage. Research carried out internationally has Martyn Jones, School of Nursing and Midwifery, Sophie Staniszewska, University of Warwick, shown that nurses’ practice environment plays University of Dundee, Dundee, UK Warwick, UK a vital role in effectively recruiting and retaining Co-authors: Derek Johnston; Sharon McCann; Co-authors: Jo Brett; Mary Newburn; Nicola Jones; nurses and in increasing patients’ quality of care. Lorna McKee Claire Pimm Many of these studies rely on the Revised Nursing [email protected] [email protected] Work Index (NWI-R, Aiken and Patrician 2000) to measure characteristics of the practice environ- ment. However, recent research has questioned Abstract: Abstract: the reliability and validity of the factor model of Background: The effects of variations in Effort- Background: The POPPY study is a national study the instrument, identifying factor models ranging Reward Imbalance (ERI, Siegrist, 1996) and exploring parents’ experiences of having a pre-term from 3 to 7 factors (Choi et al 2004; Slater and Demand and Control (DC, Karasek, 1979) on baby, particularly in relation to information, com- McCormack 2007). negative affect (NA) in nurses has been described munication and information. This paper will focus Aims: The aim of this study is to examine the factor recently (Elfering et al, 2006). However little is on reporting the results of the qualitative phase. model of the NWI-R and measure its psychometric known about the effect of clinical events and the POPPY originated from the experiences of a group properties. managerial support received on mood. The aim of parents in Warwickshire who have been involved Methods: A cross sectional survey design was used of this study was to examine the effect on nurse throughout the study (Staniszewska et al 2007). to gather opinions on a population of registered well-being of the key clinical incident in a shift, and Aims: To explore parents’ experiences of having a nurses in an acute hospital in Northern Ireland in including the effect of incident seriousness and pre-term baby, in relation to communication, infor- 2006. Each participant was distributed a question- receipt of managerial support. mation and support. naire pack containing the NWI-R. A sample of 52% Methods: Some 237 nurses in 4 large district Methods: NHS MREC ethical approval was gained. (n=449) responded. The data was analyzed using general hospitals in England completed compu- Interviews and focus groups were used to explore principal components analysis; confirmatory factor terised behavioural diaries over three shifts. The parents’ experiences during 2007-2008. All data analysis; and measures of internal consistency. diaries measured the severity of the worst incident was transcribed and analysed using content Results: The findings identified a six factor model during a shift, managerial support receipt and NA. analysis and involved parents. Analysis of the data with sound psychometric properties explaining Results were analysed using multilevel modelling moved from the identification of themes to the 56% of the data variance. Three factors were con- (MLwiN 2.10). development of more conceptually driven elements sistent with the factors identified in recent research. Findings: Nurses with generally high levels of which underpinned the development of a new Three further factors emerged from the data unique NA reported incidents as more serious (z=3.67, model of care. to this study and have overlap with factor model p<.001). Immediately after a serious event nurses

100 Concurrent session 8 – Thursday 26 March 2009

Results: In total 47 interviews and 3 focus groups Cronbach’s alpha ranged from 0.91 to 0.95, consid- will capture the nature of children’s lives as lived were carried out across 7 sites in the UK. The ered very good. Questionnaire was well accepted (Greene and Hogan 2005). sample included 13 fathers, a group rarely included by parents. Regarding importance, parents gave Recommended reading: in past studies. The study identified themes which the highest value to the need to trust (94.4%), included the need for preparation of women and followed by the need for information (89.5%), the Clark A and Moss P (2001) Listening to Young families, the need to avoid isolation of the mother, need to be trusted (85.1%) and the needs relating Children. The Mosaic Approach. London. National the need for parents to talk, the role of communica- to the ill child and other family members (83,3%). Children’s Bureau Enterprises tion and the importance of home support. Each of Regarding fulfilment, parents scored higher the Greene S, and Hogan D (2005) Researching Chil- these areas will be discussed. need to trust (84.9%) and to be trusted (76.7%), dren’s Experiences. London. Sage Publications and needs relating to the ill child and other family Discussion: The themes identified by the research- Quortrup j, Bardy M, Sgritta G, and Wintersberger members (71.3%). Females scored higher the need ers in collaboration with parents have been used H (Eds) (1994) Childhood Matters Social Theory, to trust (p<0.05) and needs relating to ill child to construct a new model of care for the UK setting Practice and Politics. Aldershot. Avebury which will be presented. This model represents a and other family members (p<0.05). Portuguese fundamental move from baby-centred care to fam- version of NPQ is now validated. Systematic use ily-centred care. of this questionnaire may contribute to a better knowledge of children and parents in hospital, and Conclusions: The POPPY study has worked Theme: Life crisis/spiritual care to a better quality of care. with parents to develop a new model of care for 8.4.1 neonatal units. This model represents a signifi- cant refinement of current ways of working and A grounded theory of has implications for nursing and for the ethos of 8.3.3 re-normalising after an abrupt life neonatal units. disruption The use of the Mosaic Approach to Recommended reading: Eloise Pearson, School of Nursing and Midwifery, elicit the experiences of children University of Dundee, Dundee, UK Staniszewska S, Jones, N., Marshall, S., Newburn, [email protected] M., (2007) ‘User Involvement in the Development with a chronic illlness of being of a Research Bid: Barriers, Enablers and Impacts’ cared for at home by their family Health Expectations 10 (2), 173 – 183 (1369-6513) and community children’s nurse Abstract: international journals and supervises a number of Marie Bodycombe-James, University of Wales Background: Patients hospitalised as a result of PhD students. Swansea, School of Health Science, Swansea, UK sudden injury become needy individuals who, as Co-authors: Ruth Davies; Susan Philpin a consequence of the reason for their admission, [email protected] have the potential to challenge the nursing team in relation to their care management. Nurses need 8.3.2 to understand the experience from the patient’s Abstract: perspective to enable effective delivery of relevant Parents and child hospitalization: The aim of this paper is to describe the use of the care management. Previous research had explored The Portuguese version of the Mosaic Approach (Clarke and Moss 2001) to elicit the emergency surgical patients journey (Pearson Needs of Parents Questionnaire the experiences of children (7-11years) with a & Kiger 2004) without generating any theory. chronic illness of being cared for at home by their Pedro Ferreira, Faculty of Economics, University of Aims: The purpose of this research was to (a) family and community children’s nurse. The under- Coimbra, Coimbra, Portugal further elucidate the experiences of emergency pinning theoretical perspective of this approach Co-authors: Elsa Melo; Débora Mello surgical patients and (b) formulate a system- is the new sociology of childhood which views [email protected] atic logical and explanatory theory of how these children as ‘beings not becomings’ (Qvortrup et al patients dealt with the consequences of the abrupt 1994), and listening to children’s voices when they incident. Abstract: are recipients of health care. It is a multi method Methods: This study utilised Glaserian principles Paper describing the development of the Portu- approach using children’s narratives and creative and techniques (Glaser 1978) to elicit and analyse guese version of Needs Parents Questionnaire arts to capture their experiences. Narratives are data from 30 emergency surgical patients. (NPQ) in paediatric hospitalization context. Ques- reflections and tales of peoples’ experience; and tionnaire includes 51 sentences, grouped into 6 cat- are a useful way of gaining access to feelings, Results: The theory of re-normalising after an egories: need to trust; need to be trusted; need for thoughts and experience (Holloway and Wheeler abrupt life disruption illuminates a three-phase information; need for support and guidance; needs 2002). Polkinghorne (1995) defines narrative process. Immediately following the critical juncture analysis as the use of stories to describe human related to human and physical resources; needs of disruption to their established lifestyle, the experience and action. Narratives provide nursing related to the ill child and other family members. patients are in an initial phase whereby they expe- scholars access to the human experience of time, Each sentence is seen from three different per- rience the effects of disruption in terms of experi- order, and change, and it obligates them to listen to spectives: importance, fulfilment and independ- encing loss, distress and personal powerlessness. the human impulse to tell tales (Sandelowski 1991). ence. Semantic and linguistic equivalences were Having progressed through this distressing phase, obtained (forward-backward translations). Validity Traditionally childhood and children’s lives have they begin to reframe their expectation of their was tested in a sample of 870 parents from four solely been explored through the views and under- future by a process of reflection, recognition and hospitals. Children aged from two days to 18 years. standings of their adult care takers, however, a rationalising the events and its consequences. This Content validity was guaranteed by two cognitive paradigm shift in childhood research has reposi- led into the final phase of defining the new normal debriefings, with parents and with health providers. tioned children as the subjects, rather than the for themselves by means of anticipating, visualising Reliability was assessed through test-retest and objects of research (Christensen and James 2000). and adjusting which culminated in re-normalising. Studying children as persons implies that they Cronbach’s alpha. Sample was formed by 76% of Conclusions: The theory allows discovery of a are individuals who can act with intention and as mothers, 84.6% married, with a mean age of 32.6 process not readily recognisable in the present agents in their own lives. Researching children’s years, living at a mean distance of 17Km from the trauma care management structure, although experience implies a respect for each child as a hospital. 67% of children had previous experience there is some recognition amongst trauma teams unique and valued experiencer of his or her world, in the same hospital. Correlation values obtained in that outcomes are dependant on an individual’s and this demands the use of research methods that test-retest ranged from 0.78 to 0.90, all satisfactory. adaptability to their circumstances (Duckwoth &

101 Concurrent session 8 – Thursday 26 March 2009

Iezzi 2005). However, whilst paramount attention survivor have been developed. How this reha- Pesut, B., Fowler, M., Johnson-Taylor, E., Reimer- is required to address physiological aspects of bilitation and recovery model can be utilized in Kirkham, S., & Sawatzky, R. (2008). Conceptualis- the trauma patient, psychosocial aspects of care the clinical arena and in policy formation will be ing Spirituality and Religion for Health Care. Journal management also need addressing to enable the discussed. of Clinical Nursing, 17(21), 2803-2810 patient to effectively re-normalise. Recommended reading: Duckworth, M.P. and Iezzi, T. (2005) Chronic Pain 8.4.3 Theme: Diabetes and Posttraumatic Stress Symptoms in Litigating 8.5.1 Motor Vehicle Accident Victims. Clinical Journal of Professional roles in spiritual Pain, 21(3), pp. 251-261 caregiving: Territoriality or Services for young people with Glaser, B.G. (1978) Advances in the Methodology collaboration? diabetes in metropolitan, urban and of Grounded Theory: Theoretical Sensitivity. Mill Sheryl Reimer Kirkham, Trinity Western University, rural locations in New South Wales: Valley. California: Sociology Press Langley, British Columbia, Canada Equitable access, comparable Pearson E. and Kiger, A. (2004) How Emergency uptake and outcomes? Patients Cope with Their Unexpected Surgical Abstract: Lin Perry, Newcastle Institute of Public Health, Event: An Exploratory Study. Journal of Advanced Background: Global patterns of migration are University of Newcastle, Newcastle, New South Perioperative Care, 2(1), pp.11-18 creating unprecedented diversity in our societies, Wales, Australia leading to questions about how today’s predomi- Co-authors: Julia Lowe; Kate Steinbeck; Janet nantly secular health care settings accommo- Dunbabin 8.4.2 date religious, spiritual, and cultural plurality. While spiritual caregiving is now given increased Abstract: Transforming life crisis: Stories of attention in nursing education and research, how metahabilitation after catastrophic it is integrated into health care services varies Introduction: The transition from paediatric to adult considerably (Cavendish et al., 2007; Galliat-Ray, services poses particular difficulties for young life events 2003; Pesut et al., 2008). people with Type 1 diabetes [1]. Services provided Joyce Mikal-Flynn, Division of Nursing, California for these people and service uptake are believed Aims: A study (2006-2009), now in the final phases State University, Sacramento, KingdomStates to differ across geographic locations, particu- of analysis, was designed to analyze the nego- [email protected] larly comparing rural and urban settings, but little tiation of religious and spiritual plurality in health evidence is available, and no information whether care, and to explore how health care encounters there are differences in patient outcomes [2,3]. Abstract: are shaped by individual, organizational, and social Individuals experience a crisis when the estimation factors. Aims: We report audit findings from Phase 1 of a study, which aimed to compare service provision of resources needed to successfully manage and Methods: Ethnographic methods of data collection for young people with Type 1 diabetes in metro- negotiate a catastrophic situation are significantly through interviews and participant observation politan (Sydney), urban (Newcastle) and rural greater than the resources they perceive to be yielded rich data from 59 participants, including areas (Hunter New England) in New South Wales, available to them. However, once these resources health care professionals, spiritual care providers, and to demonstrate service uptake and markers of are discovered, acknowledged and utilized one can administrators, and patients/families. Participants diabetes control in these locations. survive. The current biomedical model of rehabili- represented a range of religious, spiritual, cultural, tation is insufficient in that it largely ignores the and classed backgrounds. Data were collected in Methods: Retrospective case note audit was value of incorporating the patient’s experience of the Greater Vancouver area. undertaken, with a random sample of 210 case trauma in the therapeutic planning for recovery. records (70 from each location) of people with Type Results: This paper will examine how the Important factors such as self concept, self motiva- 1 diabetes aged 18-28 years. Data extracted relate approaches of professionals—whether healthcare tion, perceived benefits of the crisis, and self trans- to service uptake and usage, indices of diabetes or spiritual care providers—to spiritual matters formation have been overlooked. Meta habilita- control, including diabetes-related hospital presen- were influenced by their individual identity, pro- tion recognizes man’s/woman’s profound capacity tation/ admissions, routine monitoring and HbA1c fessional affiliation, and the context in which they and desire to move beyond basic survival and find results. Data were extracted by 2 experienced provided care. The interprofessional negotiation of meaning and purpose in the trauma. Metahabilita- researchers using a specially designed audit tool. roles, with the accompanying expectations of how tion promotes the concept that one has the biologi- other professional groups should address spiritual Results: Analyses describe different models cal, psychological and spiritual ability to be trans- matters, was an important dimension in the study. of service provision and resources in the three formed to a higher level of functioning brought settings. Service access and uptake demonstrated Discussion: Implications for nursing education, about by a major trauma or a personal life crisis different patterns, with significantly greater service administration, and practice will be discussed. (PLC). The crisis ultimately becomes the gift and the use (both planned and unplanned, e.g. Emergency vehicle for a transformative experience giving the Conclusions: Spiritual care providers approaches Dept use and hospital admissions) and contact survivor an opportunity to creatively restructure to spiritual caregiving offer important insights with health professionals in urban and regional the self and find meaning in life. for nursing practice regarding collaboration for compared to rural areas. Establishing complete This original heuristic study revealed, through patient-centred care. datasets was a challenge, particularly in rural areas, but in all settings HbA1c records were generally extensive interviews and in-depth analysis of Recommended reading: survival stories from six individuals who expe- suboptimal both in frequency and reported values. Cavendish, R., Edelman, M., Naradovy, L., Bajo, rienced an extreme personal trauma or PLC and Findings flag geo- M., Perosi, I., Lanza, M. (2007). Do Pastoral Care Discussion and Conclusions: have metahabilitated, insight into this concept graphical inequities in service provision and Providers Recognize Nurses as Spiritual Care and treatment modality. Qualitative results were uptake, and demonstrate scope for service devel- Providers? Holistic Nursing Practice, 21(2):89-98 summarized to explain limitations of the current opment and improvement to outcomes. Data are rehabilitative model and to develop a unique Galliat-Ray, S. (2003). Nursing, Professionalism, informing rural service redesign (Phase 2), with and enhanced model—metahabilitation. Specific and Spirituality. Journal of Contemporary Religion, subsequent evaluation of users’ experiences, stages, facilitating conditions of metahabilita- 18(3), 335-349 usage and outcomes from the new services (Phase tion as well as characteristics of metahabilitated 3).

102 Concurrent session 8 – Thursday 26 March 2009

Recommended reading: Recommended reading: cal therapies may hold greater promise regarding Fleming E, Carter B, Gillibrand W. The Transition Downey, P., et al., An Audit of Glycaemic Control weight management. of Adolescents with Diabetes from the Children’s and Cardiovascular Risk Factors in Patients with Recommended reading: Health Care Service into the Adult Health Care Type 1 Diabetes Mellitus. Irish Journal of Medical Royal College of Physicians (2008) Type 2 Diabetes: Service: A Review of the Literature Journal of Science, 2003. 171 (Supplement 3): p. 11 National Clinical Guideline for Management in Clinical Nursing 2002; 11: 560–567 Muhlhauser, I., et al., Evaluation of an Intensified Primary and Secondary Care (update) London: RCP Visentin K, Koch T, Kralik D. Adolescents with Type Insulin Treatment and Teaching Programme as MRC (2000) A Framework for the Development and 1 Diabetes: Transition Between Diabetes Services Routine Management of Type 1 (insulin-dependent) Evaluation of RCTs for Complex Interventions to Journal of Clinical Nursing 2006;15:761–769 Diabetes: The Bucharest-Dusseldorf Study. Diabe- Improve Health. London: MRC Lam P-Y, Fitzgerald BB, Sawyer SM. Young Adults in tologia, 1987. 30: p. 681-690 Piette JD (2007) Interactive Behaviour Change Children’s Hospitals: Why Are They There? Medical Technology to Support Diabetes Self-management. Journal of Australia 2005;182: 381-384 Diabetes Care. 30(10):2425-32 8.5.3 An exploratory trial to assess 8.5.2 the efficacy, feasibility and Theme: Acute, community, safety and Participants’ perceptions of the acceptability of a nurse-led wellbeing effect of a structured education telephone follow-up intervention 8.6.1 programme on their management of upon weight management in Type 2 Paraprofessionals perceptions of type 1 diabetes diabetes mellitus patient safety culture Dympna Casey, School of Nursing and Midwifery, Lihua Wu, Florence Nightingale School of Nursing National University of Ireland, Galway, Ireland Moreen Donahue, Nursing Administration, & Midwifery, King’s College London, UK Danbury Hospital, Danbury, United States of [email protected] Co-authors: Alison While, Angus Forbes America [email protected] Co-authors: Joyce Fitzpatrick; Lisa Smith; Patricia Abstract: Dykes [email protected] Background and Aims: There are approximately Abstract: 12,000 people living with Type 1 diabetes in Ireland. Background: The prevalence of Type 2 diabetes is Audit data suggest that few Irish diabetics achieve increasing rapidly. Weight loss has clinical benefits Abstract: optimal blood sugar control (Downey 2003). so that weight management is a key focus in the Background: As routine caregivers, paraprofes- Evidence indicates that the Dose Adjusted for clinical care of patients with diabetes (RCP 2008). sional staff (PPS) represent an untapped resource Normal Eating (DAFNE), structured education pro- Studies examining telephone follow-up of patients for improving quality of care and preventing grammes is associated with significant improve- for glycaemic control have shown positive effects adverse patient outcomes such as failure to rescue. ment in control (Muhlhauser et al. 1987). While (Piette, 2007). the DAFNE programme has been delivered inter- Aims: This study was aimed at breaking down nationally and evaluated quantitatively, no-one Aims: An exploratory trial following the MRC barriers to communication and building a culture of has examined the perspectives of participants. The framework (MRC 2000) aimed to assess the patient safety by involving PPS in the process. aim of this research was to examine the factors efficacy, feasibility and acceptability of a telephone Methods: A mixed method design with both quan- that facilitated or hindered self-management of follow-up intervention to promote weight manage- titative and qualitative components was used. diabetes following DAFNE and explore how and ment for those with Type 2 diabetes mellitus. Sample: PPS (n = 182) were surveyed regarding why management may change over time. Methods: An exploratory trial of 46 participants their perceptions of patient safety culture at the Methods: A grounded theory approach was used recruited from a diabetes care centre in a NHS study hospital. In addition, three focus groups were to guide the research as it is most appropriate Trust in England were randomised into an interven- held with representatives of the PPS. The Agency when examining situations and circumstance tion group (n=25) or a control group (n=21). The for Healthcare Research and Quality Culture of which require individuals to adapt (Benoliel, intervention group received a nurse-led telephone Patient Safety Survey was used to measure the 1996). Interviews were carried out with 40 partici- follow-up of the advice given in the dietician’s clinic perceptions of patient safety culture; participants pants, approximately 10% of the total population. weekly for 12 weeks. The control group received accessed the survey via an internet site provided Maximum variation sampling was used to insure routine care. at the hospital. diversity with respect to age, gender, education, Results: There were no significant differences in Results: Thirty-nine percent of the participants had socioeconomic status, and time of diagnosis. Data weight loss, metabolic control and psychological ever reported an event related to patient safety; were analysed using the constant comparative well-being between the groups at 3 months follow- these included reports to nurses, physicians and technique. up, however, more participants in the intervention other members of the interdisciplinary healthcare Results: Four categories emerged from the data: group advanced regarding the level of the Stages team. The majority of respondents were positive changing relationships in health care delivery; of Change compared to those in the control group. about all aspects of the patient safety culture at the knowing more/ becoming aware; learning from The clinical and interview data indicated that hospital. Several key themes were delineated from others and shifting priorities. telephone follow-up was a feasible approach and the focus group discussions. These included: ways well accepted by the participants and their families. to get to know patients and help other PPS to get Conclusions: The findings revealed a change in Discussion: The findings indicate that educa- to know patients, reporting of changes in patient relationships with health care staff and the empow- status, communication strategies (including facili- ering impact of knowing more. What participants tional approaches in isolation may be too weak to impact upon weight management. There are many tators and barriers), teamwork (including facili- want from health care staff and what they need to tators and barriers), and specific ways to keep remain engaged in managing their diabetes well, is other factors that may impact upon behaviour change, such as readiness for change. Nonethe- patients safe. PPS identified some areas that also revealed. This is the first research focusing on needed attention to enhance patient safety culture, participants perspectives. less follow-up and more attention from healthcare professionals may improve patients’ self-esteem including the inadequate support with follow-up on and be motivational. More intensive psychologi- requests that were non-urgent.

103 Concurrent session 8 – Thursday 26 March 2009

Discussion and Conclusions: Based on the baseline Recommended reading: dence in their knowledge of the patient situation data obtained, an educational program for PPS will Food Standards Agency Wales and Welsh Assembly and by evidence of clinical deterioration. be implemented to increase their skills in commu- Government (2003) Food and Well Being Reducing Recommended reading: nicating changes in patient status, thus enhancing Inequalities Through a Nutrition Strategy for Gadamer, H. ([1975]1989) Truth and Method trans- the culture of safety. PPS play an important role in Wales http://www.food.gov.uk/multimedia/pdfs/ lated and edited by Weinsheimer, J. and Marshall effecting change in hospital safety culture. foodandwellbeing.pdf D.G. (2nd revised edition) London: Sheed and Ward Kennedy L.A., Ubido J., Elhassan S., Price National Institute of Health and Clinical Excellence A., Sephton J. (1999) Dietetic Helpers in the (2007) Acutely Ill Patients in Hospital: Recogni- Community: The Bolton Community Nutrition 8.6.2 tion of and Response to Acute Illness in Adults Assistants Project. Journal of Human Nutrition and in Hospital (NICE Clinical guideline 50) London: Sustaining nutrition education Dietetics 12(6), 501-512 in communities: The all Wales National Institute of Health and Clinical Excellence dietetics scheme evaluation Sally-Ann Baker, School of Health, Social Care and 8.6.3 Exercise Sciences, Glyndwr University, Wrexham, Theme: Qualitative research: Theory UK The professional gaze: A study of and practice Co-author: Ros Carnwell nurses’ experiences of recognising 8.7.1 patients with clinical deterioration Abstract: Choosing between Glaser and in an NHS Trust in Wales Strauss: An example Background: The link between disease and Desiree Tait, School of Health Science, Swansea poor diet is well documented and there is a clear University, Swansea, UK Adeline Cooney, School of Nursing and Midwifery, National University of Ireland, Galway, Ireland need for public health interventions that impact Co-authors: Susan Philpin; Hugh Chadderton [email protected] on the food that people eat (Food Standards [email protected] Agency Wales 2003). Community-based ini- tiatives involving training local people to work as Abstract: Community Food Workers or peer educators have Abstract: Background: Doctoral students using grounded been successful (Kennedy et al 1999). In Wales, a This research aims to interpret and present an theory, inevitably come to a stage when they must national dietetics grant scheme was implemented understanding of how nurses experience the recog- choose between Glaser and Strauss. Little has been by the Welsh Assembly Government in 2006. This nition and management of patients’ clinical dete- written on making this choice. aimed to increase the capacity of dieticians by rioration in one NHS Trust in Wales. The rationale training community food workers to deliver con- for this study was prompted by evidence of sub- Aims: This paper will: (1) explore the challenges sistent, accurate information about food, nutrition optimal care in this context that ultimately led to of choosing between Glaser and Strauss, (2) share and, more recently cooking skills, and cascading NICE (2007) publishing guidelines to aid clinical criteria to support the decision making process and this information through community-based activi- staff in the recognition and co-ordination of care (3) trace the decision making process used in one ties. An evaluation was commissioned by the Welsh for these patients. The research approach used is study. Assembly Government to assess the impact of the interpretative and informed by Gadamer’s ([1975] Methods: The study which will be used to provide scheme. 1989) hermeneutic philosophy. Data included a examples aimed to understand residents’ (n = 61) Aims: The aim of the evaluation was to assess historical review of the literature, the research- experiences of residential care and focused on the impact of the grant scheme in increasing er’s pre-understandings and in-depth interviews whether they experienced a sense of home and the capacity of dieticians in Wales to inform and with eight nurses who had experienced caring for how this impacted on their quality of life. Three key support communities in healthy living. patients where clinical deterioration had occurred. issues were considered when determining whether Interviews began in 2004 after receiving ethical to adopt a Glaserian or Straussian approach for this Methods: A community-based formative evalu- approval. The findings produced contribute to the study: ation of the initiative was conducted. Four case historical and contextual understanding of the study areas provided the settings for the evalua- • the general user friendliness of these approaches nurses’ experiences of caring for this group of tion, which employed mixed methods, including for data analysis patients during a period of policy development and group and individual interviews and analysis of implementation. • their potential to generate theory minimum data sets. The evaluation project was This presentation focuses on one aspect of this their compatibility with contemporary thinking. The conducted in two phases and it is the second phase paper will examine each criterion and show how the that will be presented. understanding: ‘the professional gaze’, the process of being alert to and interpreting the patient decision to use Straussian grounded theory was Results: The findings suggest that the scheme situation. One element of this process includes reached. Approach Within the literature, there have has grown in recognition throughout Wales and is the use of the ‘professional scan’, an alertness to been a number of discussions focusing on the dif- impacting upon the wider community. The paper cues that, once triggered, leads to a more focused ferences between Glaser’s and Strauss’s versions will describe the training and its impact, the percep- and detailed observation of the patient described of grounded theory. This paper will add to this dis- tions of the learning that took place and resultant as ‘focused observation’. This element centres cussion through specifically exploring the Glaser- behavioural change. on seeing the patient as a person involved in a Strauss debate in context of choosing between Discussion and Conclusions: Efforts to enhance situation, during which the nurse assesses the them when selecting a study methodology sustainability have included training of health pro- patient’s reaction to the situation and interprets the The paper will be presented in three sections: fessionals, early year’s staff and school staff, as clinical picture through visual signs, clinical obser- • relevant background information on grounded well as community food workers and community vations, investigations, knowledge of the patient theory as a research method groups. They, in turn, have cascaded nutritional and finally, patterns of illness learnt through the • a more in-depth discussion of the differences information through community-base initiatives application of theory to knowledge of related past between Glaser and Strauss, the evolution of – this being key to long term sustainability of the experiences. The final element involves ‘waiting these methodologies and their compatibility with dietetics grant scheme. and balancing’ when to call for help and is influ- contemporary thinking enced by the nurses’ ability to demonstrate confi-

104 Concurrent session 8 – Thursday 26 March 2009

• this analysis will be used to show how the final Recommended reading: Theme: Starting in the nursing decision was reached in this study Donalek, J.G. (2005). The Interview in Qualitative profession Conclusions: This paper will contribute to a fuller Research. Urologic Nursing, 25,124-125 8.8.1 understanding of what is involved in choosing Roulston, K., deMarrais, K., & Lewis, J.B. (2003). between Glaser and Strauss and will be helpful to Learning to interview in the social sciences. An evaluation of undergraduate researchers at this stage in planning their studies. nursing students’ studying abroad Barbara Wood, University of Huddersfield, Huddersfield, UK 8.7.3 Co-author: Pam Cranmer 8.7.2 Analysing narrative data using [email protected] Developing novice qualitative McCormack’s Lenses researcher’s interviewing skills Lesley Dibley, Florence Nightingale School of Abstract: using videorecording Nursing & Midwifery, King’s College London, UK Introduction: The aim of this study was to evaluate Lisbeth Uhrenfeldt, Clinical Nursing Research Unit, [email protected] whether nursing students become more aware of Horsens Regional Hospital, Horsens, Denmark cultural differences and are able to care in a more Co-authors: Barbara Paterson; Elisabeth OC Hall Abstract: culturally competent manner, having taken the [email protected] opportunity to work abroad during their nursing Qualitative nursing inquiry has embraced the use of programme. Third year students are offered the many traditional social science approaches over the chance to undertake an overseas placement Abstract: past decade, and in its increasing quest to under- supported by sponsorship from the School. Background: novice qualitative researchers often stand the patient experience as a starting point to A qualitative approach for data collec- do not receive formal training to develop their qual- delivering timely, appropriate and sensitive care, Methods: tion was used with focus groups interviews. Ethical itative interviewing skills, and may be unprepared often draws on phenomenological approaches. approval was successfully received from the Uni- to deal with the challenges and complexities the One method which assists in phenomenological versity. Anonymity was guaranteed with all par- research setting. Reflexivity is a critical component inquiry is the unstructured interview, which has ticipants. Data was analysed using a thematic and for novice interviewers to discern pertinent the capacity to generate rich, thick text, laden content analysis approach insights. Novice interviewees with clear guidelines with context and meaning. But what to do with all about how to reflect on their practice as interview- that data? Katherine Reissman acknowledges that Results: Preliminary analysis of the data has identi- ers can contribute to their own development, and handling narrative data is difficult, and whilst she fied the following themes: improve the quality of the data they collect. and others offer encouragement to researchers • Cultural differences undertaking the process, the practicalities of how Aims: to foster development of novice qualitative • Cultural sensitivity researchers using videorecorded interviews and a to move from pages of transcribed data to a mean- • Cultural awareness guide for reflection about what they see and hear ingful representation of the story without losing the in the videorecording. voice of the storyteller are much more difficult to • Critical thinking determine. Methods: a literature review was performed on vid- • Problem Solving eorecording in qualitative research interviewing, This paper discusses the use of McCormack’s • Personal development Lenses in the analysis of narrative data from a recent through multiple search strategies and included: Evaluated data has highlighted students feel better Cinahl, Medline, Academic Search Premier, Eric, MPhil study into the experiences of lesbian parents when their children required healthcare interven- prepared to and appreciate the diverse nature of Psycinfo (2005-06). A guided reflection framework caring in an ever changing health care environment. was produced to expand what novice researchers tion. By exploring the problems inherent in dealing Discussion: Statements from the European learn in the analysis by reflecting on aspects of with narrative data, the struggle to find an effective Union advocate mobility of the future workforce, the interview that cannot be readily captured in analysis method which encourages the spirit of the language acquisition, employability and a consist- an interview transcription. The framework draws original story, and drawing on excerpts from the ent qualifications system throughout the European heavily on the work of Whiteley et al (1998). study data, I aim to demonstrate how McCormack’s Lenses enable the researcher to develop a compre- Union. The ICN (2007) stated that curricula must Results: The Guided Reflection Framework fosters hensive ‘perspective of understanding’ of narrative be planned in relation to total health needs and both personal and epistemological reflexivity data – an understanding which encourages the sto- resources of the target population and their social by questioning: paralinguistic communication, ryteller’s voice to be heard in the representation of and cultural background. This initiative provides proxemics, timing and the context of the interview. their experience. students with the opportunity to understand the The use of the framework was tested on a video- needs of a diverse population and to develop taped pilot interview and provided deeper insights Recommended reading: understanding and communication skills that may into the novice researcher’s actions, lack of action, Geertz C (1973) Thick description: Towards an Inter- be utilised in the health care arenas both nationally information and reactions. pretive Theory of Culture. In: The Interpretation of and internationally. Discussion: Based on the assumption that novices Cultures: Selected Essays. New York: Basic Books Conclusions: Supporting the students to undertake researchers´ reflexivity must be guided to assist 37-126. an overseas placement develops their cultural sen- them in their development as qualitative research McCormack C (2000) From Interview Transcript to sitivity and competence in caring for individuals in interviewers this tool transforms subjectivity in Intepretive Story: part 1 – Viewing the Transcript a multi cultural society that promotes understand- interviewing from a problem to an opportunity for through Multiple Lenses. Filed Methods. 12 (4) ing of the needs of communities. Additionally it the novice to learn and grow. This challenges the 282-297. promotes personal and professional development notion that one can be become an expert qualita- Riessman CK (1993) Narrative Anlaysis: Qualitative of the students developing their problem solving tive research interviewer simply by conducting Research Methods Series No. 30. Newbury Park: and critical thinking skills ensuring that on registra- interviews (Donalek 2005) Sage tion they are ‘fit for practice’ within health care. Conclusions: this framework assists the novice Recommended reading: qualitative researcher in continuous development of their interviewing skills, in identifying shortcom- European Union (1999) Bologna Declaration: Joint ings and supports their growth. Declaration of the European Ministers of Education,

105 Concurrent session 8 – Thursday 26 March 2009

convened in Bologna on the 19th June 1999. http:// Recommended reading: Recommended reading: www.europaeum.org/content/view/58/65/. Dept of Health (2007) Student Nurses and Joan Acker. Doing Comparable Worth: Gender. Accessed 9th October 2008. Midwives: A Guide to Good Practice for Strategic Class, and Pay Equity. Temple University Press, Ruddock, H.C & Turner S, (2007) ‘Developing Health Authorities and Higher Education Institutes. Philadelphia, PA, 1989 Cultural Sensitivity: Nursing Students’ Experiences Leeds: Dept of Health. Paula England and Nancy Fobre. Contracting for of a Study Abroad Programme’. Journal of Advanced Schwartz, S. (2004) Fair Admissions to Higher Care. In J. Nelson and M. Ferber, editors, Feminist Nursing, 59, (4) pp. 361-369. Education: Recommendations for Good Practice. Economics Today, pages 61–80. University of ICN (2007), Position Statement. www.icn.ch/ Nottingham: Department for Education and Skills Chicago Press, Chicago, 2003 pfcardev.htm. Accessed 31st October 2008. Paula England, Michelle Budig, and Nancy Folbre. Wages of Virtue: The Relative Pay of Care Work. Social Problems, 49(4):455–473, 2002 8.8.3 8.8.2 Is there a financial penalty for Identifying potential nurses for the working in a caring occupation? healthcare workforce Elizabeth West, Health Services Research Unit, Alison While, Florence Nightingale School of London School of Hygiene and Tropical Medicine, Nursing & Midwifery, King’s College London, London, UK London UK Co-author: David N Barron Co-author: Mary Crawford [email protected] Abstract: Background: Recent evidence from the US suggests Abstract: that people engaged in occupations involving Background: Changed demography and economic providing care for others, such as nursing and constraints have resulted in student recruitment teaching, suffer a wage penalty. In the UK, caring targets coupled with low attrition and employabil- occupations are often seen as low paid, but little ity targets (Dept of Health, 2007). Widening partici- empirical evidence exists about how they compare pation has many benefits including increasing the to other similar jobs. pool of potential recruits and representation of all Aims: To investigate whether nurses and other sectors of the population in the nursing workforce workers in caring occupations in the UK earn less (Schwartz, 2004), however, selection of recruits than people in other similar occupations. remains an inexact ‘science’. Methods: Data for this study are taken from Aims: To explore the contribution of different thirteen waves of the British Household Panel factors upon likely success on pre-registration Survey. A total of 17,383 individuals are included nursing programmes. in the study, giving a total of 80,676 person years. Methods: 1734 pre-registration Diploma in Higher Multilevel models are used to investigate the size Education and BSc student records drawn from six of any wage penalty. intakes were statistically analysed to identify what Results: The results show clear evidence of a sta- factors may predict success. tistically significant wage penalty associated with Results: More than one quarter of students with working in some, but not all, caring occupations. non-standard entry qualifications gained 1st class Those occupations requiring lower levels of educa- or 2nd Class Upper Division BSc awards. Nearly tional qualification, such as nursing assistants, are three quarters of students from widening par- particularly hard hit by the wage penalty. On the ticipation backgrounds gained 1st class or 2nd other hand, some occupations, such as medicine, Class Upper Division BSc awards. These groups nursing, and teaching, have fared better than com- were similarly well represented in the award of a parable non – caring occupations over the same Diploma of Higher Education with Distinction. But period. there were differences in achievement across the Discussion: Although there is a general perception branches of nursing. Age and gender were not that the majority of the caring occupations face a predictors of success, however, non-Caucasians wage penalty, the results reported here show that were under-represented among those who gained a more nuanced understanding of the financial 1st class or 2nd Class Upper Division BSc awards status of care work is needed. The wage penalty and a Diploma of Higher Education with Distinc- associated with working in caring occupations that tion. Students exited the programmes for a number fall in lower socio-economic groups is highly signifi- of reasons which were classified as academic cant. Workers in these groups seem not only to be (including clinical practice difficulties) and non- poorly paid in an absolute sense, but also to suffer academic. The analysis yielded a complex picture relative to their peers in non-caring occupations. indicating that there were confounders. Conclusions: Further research is required to Discussion: Widening participation does not nec- examine the disadvantaged position of some essarily lower standards. Predicting success in pre- groups, such as nursing assistants as well as registration nursing is complex and requires further concerted action by employee organisations to attention. An aptitude test may help improve the seek parity in pay with other similar occupations. selection process.

106 Concurrent session 9 Friday 27 March 2009

Them: Student learning/clinical Wilson-Barnett, J.; Butterworth, T.; White, E.; Twinn, 9.1.3 placement issues S.; Davies, S. and Riley, L. (1995) Clinical Support abd the Prject 2000 Nursing Student: Factors Influ- Student support on placement: 9.1.1 encing this Process. Journal of Advanced Nursing. The student experience and staff Factors which facilitate or hinder 21, 1152-1158 perceptions of the implementation students nurses’ implementation of of placement development teams skills in the clinical area Graham Williamson, Faculty of Health and Social Work, University of Plymouth, Plymouth, UK Catherine Houghton, School of Nursing and 9.1.2 Midwifery, National University of Ireland, Galway, Co-authors: Lynne Callaghan; Emma Whittlesea Ireland Exploration of learning Co-authors: Dympna Casey; Kathy Murphy; David environments in healthcare settings Abstract: Shaw Camille Cronin, Health and Human Sciences, University of Essex, Southend on Sea, UK Background: Supportive placement environments enhance students’ clinical placement learning. [email protected] Abstract: Government and nursing regulatory bodies have The aim of this presentation is to explore the recently introduced contractual requirements factors which may facilitate or hinder student Abstract: and guidance requiring the development of more nurses’ implementation of skills in the clinical area. Background: This research builds on the cumu- effective partnerships to ensure quality placement These findings represent one aspect of a larger lative experience of the researcher in practice, learning. In 2007 Placement Development Teams multiple case study exploring the role of the clinical research, management and education. It also (PDTs) were implemented as such a partnership skills laboratory in preparing student nurses for brings together educational and practice issues on between this Faculty and our NHS Trust placement the real world of practice. The study involved 5 the subject of student learning in the workplace. providers. PDTs manage, organise and deliver sup- portive activities in placement areas. Clinical Skills Laboratories in Ireland and their Aims: The aim of this research was to conduct an affiliated teaching hospitals. In order to explore the exploratory study of learning in healthcare settings Aims: – to gain a baseline needs analysis of influencing factors, non-participant observations focusing on how students engage in learning. students’ perceptions of support provision on were conducted in each of the five hospitals. In placement Methods: Longitudinal research conducted over addition, interviews were conducted with student a two year period (2005-2007) using case study – to evaluate perceptions of staff working with nurses (n=18), newly qualified staff nurses (n=8) design (Yin 2003) was used to explore 5 students PDTs concerning provision and management of and clinical staff (n=15) in order to examine their on work placements whilst on a two year Diploma student support perceptions of these factors. Complex qualitative in Health Studies programme. As part of their voca- Methods: Four focus groups with final year Adult ethical issues were addressed and will be discussed tional practice, learning environments (hospitals, Nursing students were carried out. Telephone inter- briefly. Analysis was conducted according to Miles nursing homes, nurseries) were observed. Through views with PDTs Academic Leads, Trust representa- and Huberman (1994) using NVivo8 software. interviews critical learning incidents have been tives from six Acute Trusts and personnel from the Following coding, three broad thematic concepts examined as well as students’ learning journals Strategic Health Authority were conducted. Semi- were developed: Clinical Environment Factors, and course materials. structured interview and focus group schedules Clinical Staff Factors and Student Factors. Clinical Results: Preliminary findings suggest that 16-18 guided discussions. Data collection took place in Environment Factors explores how the environment year old learners do progress at a steady pace in late 2007. Data were recorded and transcribed. can impact on students’ implementation of skills in their different learning environments. In the two Rigor, trustworthiness and credibility (Cutcliffe the practice setting. Clinical Staff Factors describes years students adapt eventually leading to a trans- and McKenna, 1999) were ensured by independent support measures displayed by clinical staff (for formation through their learning. After an initial data coding by three researchers. Differences were example, what I have termed ‘intervention support’ settling period of being ‘accepted’ by staff and resolved through discussion. Miles and Huber- and ‘peripheral support’) and how these can facili- client(s), anxieties lift and confidence grows (in man’s (1994) framework was used for data analysis. tate or hinder students’ ability to perform skills. stages depending on the individual, the learning Results: Student data revealed needs for Finally, Student Factors examines personal factors environment and what resources exist). such as confidence and previous experience and • direct, personal support how these influence how students perform in Discussion: Learning takes place through a series • organisational support and communication the real world of practice. These findings will be of routine tasks. Once perfected, the task can between placement areas and University. Staff discussed with reference to previous literature. For become more complex making a daunting or elating data revealed experience for the learner. The experience of com- example, whether the appropriate use of supernu- • an understanding of student support needs mery status and working closely with practitioners pleting the task becomes more complex than the can facilitate learning in the clinical area (Wilson- task itself. With each task, if the individual makes • proposals concerning how PDTs can meet these Barnett et al, 1995). Furthermore, students’ ability time to reflect, reveals the complex nature of each needs and enhance the student experience to display confidence appears to facilitate commu- skill and what the learner has learnt, achieved or Discussion: The clearer recent policy focus on nication and socialisation into the clinical area (Day needs to develop further. improving students’ placement support requires et al, 2005). Conclusions: What and how much the learner higher education institutions and NHS Trusts to achieves and the transportation of these skills develop more effective methods and this study Recommended reading: depend very much on the learner’s willingness to outlines one structure by which this is possible. Miles, M.B and Huberman, A.M. (1994) An learn and their willingness to engage in each new Conclusions: PDTs are a major change in our Expanded Sourcebook. Qualitative Data Analysis environment. support structures for students in placement. This (2nd ed) Thousand Oaks, CA: Sage Publications Recommended reading: study has reveals current issues and identified day, R.A.; Field, P.A.; Campbell, I.E. and Reutter, L. areas which placement development teams are (2005) Students’ Evolving Beliefs about Nursing: Yin R, K (2003a) Case Study Research: Design and already beginning to address. From Entry to Graduation in a Four-year Bacca- Methods. London: Sage Publications laureate Programme. Nurse Education Today 25, Recommended reading: 636-643 Cutcliffe, J.R. and McKenna, H.P. (1999) Establish- ing the Credibility of Qualitative Research Findings.

107 Concurrent session 9 – Friday 27 March 2009

The Plot Thickens. Journal of Advanced Nursing, 30: Recommended reading: Conclusions: The findings have important implica- 2, 374-380 Baker, C. and Melby, V., 1996. An Investigation into tions for interventions and supportive services for Miles, M. and Huberman, A. (1994). Qualitative the Attitudes and Practices of Intensive Care Nurses families of children with a chronic illness, consist- Data Analysis (2nd Edition). Thousand Oaks: Sage Towards Verbal Communication with Unconscious ent with Standard 8 of the Children’s NSF (2004). Publications Patients. Journal of Clinical Nursing, 5, pp.185-192 Recommended reading: Elliot, R. and Wright, L., 1999. Verbal Communica- Frank, R. et al. (1998) Trajectories of Adaptation tion: What do Critical Care Nurses Say to Their in Pediatric Chronic Illness: The Importance of the Unconscious or Sedated Patients. Journal of Individual. Journal of Consulting and Clinical Psy- Theme: Communication/children and Advanced Nursing, 29(6), pp.1412-1420 parents chology. 66 (3) 521-532 Holeckova, I.; Fischer, C.; Giard, M.-H.; Delpuech, Wallander, J.L. and Varni, J.W. (1998) Effects of 9.2.1 C. and Morlet, D., 2006. Brain Responses to a Sub- Pediatric Chronic Physical Disorders on Child and Verbal communication with jects’s Own Name Uttered by a Familiar Voice. Brain Family Adjustment. Journal of Child Psychology and Research, 1082, pp.142-152 unconscious patients Psychiatry and Allied Disciplines. 39 (1), 29-46 João Simões, Escola Superior de Saúde, Department of Health (2004) National Service Universidade de Aveiro, Aveiro, Portugal Framework for Children, Young People and Co-authors: Luis Jesus; David Voegeli 9.2.2 Maternity Services: Disabled Children and Young [email protected] People and Those with Complex Health Needs. Parents’ experiences of their child’s London: DH Publications. chronic illness Abstract: Sandra Oldfield, School of Health and Social Care, The importance of using verbal communication in Oxford Brookes University, Oxford, UK the care of critically ill patients has long been known Co-authors: Guida DeAbreu; Luci Wiggs Theme: Assessing and planning care (Elliot and Wright, 1999). Both qualitative (Baker [email protected] 9.3.1 and Melby, 1996) and quantitative (Holeckova, et al., 2006) studies have shown evidence of the ‘It goes without saying’: benefits of effective communication. Increasing Abstract: Understanding the taken for numbers of patients report their experiences. The Background: Whilst it is recognised that parents of granted in nursing practice. A unconscious patient has a considerable need for chronically ill children are at greater risk of depres- information and support, so verbal communication sion and distress than those of healthy children qualitative exploration of what can provide orientating and meaningful sensory (e.g. Frank 1998), it is not known why some parents constitutes nursing assessment input to these patients. Information received by the experience more positive adjustment than others. Sue Beckwith, Centre for Research in Primary unconscious patient may assist in reducing stress, This is an important omission in knowledge as and Community Care, University of Hatfield, can help patients preserve self-identity and self- parent adjustment is also known to be related to Hertfordshire, UK esteem and reduce social isolation. child adjustment and disease management (e.g. Co-authors: Angela Dickinson; Sally Kendall This study aimed to characterise and standardise Wallander & Varni, 1998). [email protected] verbal communication that critical care nurses Aims: To investigate the experiences of parents of and families use with unconscious patients. It also children with asthma or diabetes, particularly in Abstract: aimed at building a stimulus message to be used relation to their social and emotional adjustment. Background: Much skilled nursing practice is with unconscious patients, to examine if the effects Methods: A ‘Grounded theory’ approach informed described by words which at face value apppear of familiar and unknown voices would be sig- the study. Data were collected between April 2005 low-tech and self-explanatory. Despite being nificantly different (blood pressure, pulse, oxygen and May 2006 through semi-structured inter- intrinsic to practice ‘assessment’ has few opera- saturation level, temperature, glycaemia level, views with parents of 16 children with diabetes, 16 tional definitions. Understanding this term is EEG and ECG values were monitored as evidence children with asthma, some health professionals imperative to measuring the quality of nursing of auditory perception). The verbal communica- and a support group leader. Thematic analysis was practice. tion of critical care nurses and patients’ families, as used to identify a range of themes and sub-themes. reported in the literature, was thoroughly analysed, Aims: Explore the research questions: Results: This presentation focuses on parents’ including references related to verbal communi- • How is nursing assessment defined in the litera- experiences of their child’s illness, which is one of cation by the patients’ family and intensive care ture? seven main themes identified in the analysis. Indi- nurses. Results were used to build the stimulus vidual features of their child’s illness (such as the • What professional, philosophical and organisa- message, which was further refined with the coop- predictability and ease of control of symptoms), tional influences affect the nursing role regarding eration of a group of experts (SLTs and psycholo- and also their child’s emotional and behavioural patient assessment? gists). The stimulus message consists of three responses to the illness affected parents’ stress, • What impact does nursing assessment have on parts: presentation and orientation, information coping and adjustment. In addition, parents patients? and functional assessment, and stimulation. The discussed how they were affected personally by most significant person, whose voice we recorded, • Does patient inclusion, involvement and empow- the degree of their child’s involvement with and was selected using a sociometry test. The standard erment happen as a result of a nursing assess- responsibility for their illness management. Dif- speech stimulus developed has shown to facilitate ment? ferences were noted between the experiences of the communication with the unconscious patients • Does the location of a nursing assessment have parents of children with asthma and those with as assessed by the proposed physiological signals. an impact on the assessment? diabetes. Therefore, it is concluded that formal support Design and Methods: Phase 1 Examples of the Discussion: The features of a child’s illness and systems and continued education of nurses about contemporary use of ‘nursing assessment’ were the individual child’s behavioural and emotional the benefits of verbal communication is deemed identified using a systematic review process and responses are considered by parents to be necessary. analysed utilising Glaser’s (1978) Grounded Theory important factors influencing their own stress, method. Phase 2 Field-work comprised partici- coping and adjustment. Theoretical and practice pant recruitment (10 nurses, 10 patients, 5 carers) implications of these findings will be discussed.

108 Concurrent session 9 – Friday 27 March 2009

and audio recording of everyday assessments in of the remaining time available, handover at 11% Results: Care pathway methodology is conceptu- patient’s homes and GP surgeries. Data obtained was the most significant activity. alised as a boundary concept (Lowy 1992) which, was transcribed, synthesised and analysed using The observations of nursing workload in this study precisely because of looseness, has been highly Foucauldian Critical Discourse Analysis comparing; indicated that the nurses were spending consider- effective in aligning a wide range of clinical and • What is said/ not said? ably more time in direct patient care when bench- management interests. However, whilst it is possible to identify a ‘zone of agreement’ between • How is it said? marked against national models (Hurst 2005). This finding was replicated on a second ward these interests, there exists a fuzzy periphery char- • Who says it? which found collectively qualified and unqualified acterized by conflicting agenda. This creates chal- • Exploring ‘problematization’ of power, knowledge nurses spent 57% of their time directly caring for lenges for those charged with inscribing this multi- and ideology (Foucault 1979). patients. During phase two of this study a quali- plicity of interests into the pathway design. Results: Phase 1. Judiicial was identified as the core tative methodology was used to conduct a series Discussion: Pathways are complex ensembles of seven overlapping categories identified from of interviews with the nursing staff from the pilot of clinical and management discourses and the examples of assessment in the literature. Phase 2 wards. Interviews focused not only on the findings developers in this case demonstrated consider- Data analysis provided examples of subject/object from the observation but also on how the nurses able ingenuity in tackling the challenges involved conflations through which power, control and sub- defined and would measure quality in nursing in pathway development. However, the complex- jectivity are demonstrated (Foucault 1994) practice. Nurses expressed surprise at the amount ity of what is being attempted in the creation of of time they spent at the bedside but disappoint- pathways is largely unacknowledged by leaders in Discussion: Phase one’s mixed methods approach ment that it was not more. Finding quality nursing the field. and the implications for practice of the data care difficult to articulate the nurses consequently analysis will be discussed Conclusions: There is a case to be made for found it hard to identify an objective measure of allowing care pathways to be more fully fledged Conclusions: Nurses use a matrix of approaches quality. Nevertheless a common theme emerged actors in the construction of the kind of health to build rapport and assess patients during all that nurses wanted more time to spend talking care organizations we desire. When enrolled into interactions. Hierarchies of nursing practice, gov- with patients; felt that the patients’ experience of a pre-existing system of work they will change ernment policies, inter-professional agendas and nursing care was as important a consideration as practice, but careful thought needs to be given to dissonaces between the rhetoric placing patients the outcome of care when measuring quality and their development and design, if this change is to at the heart of assessment and everyday practice, were frustrated at perceived failings in the system be in the direction that was intended. Studies such cause barriers to meaningful assessments. which prevented them delivering this care. as this, can improve understanding of the issues Recommended reading: Recommended reading: involved and generate a vocabulary through which these can be articulated, in order to inform the Foucault M., (1979) Discipline and Punishment. The Bales R F (1950) Interaction Process Analysis. development process. Birth of the Prison. Penguin Harmonsworth Chicago: University of Chicago Press Foucault M., (1994) Michael Foucault Power – Hurst K (2005) Relationships Between Patient Recommended reading: Essential Works of Foucault 1954-1984 volume 3. Dependency, Nursing Workload and Quality. Inter- Lowy, I (1992) The Strength of Loose Concepts – Edit J. D. Faubion, Translated R. Hurley and Others. national Journal of Nursing Studies 42 75:84 Boundary Concepts, Federative Experimental Strat- Penguin Books, England International Council of Nurses. The ICN Definition egies and Disciplinary Growth: The Case of Immu- Glaser B. G., (1978) Theoretical sensitivity: of Nursing. Available at: http://www.icn.ch/defini- nology, History Sci.: 371-396 Advances in the Methodology of Grounded Theory. tion.htm (accessed 1/06/07) Mill Valley, CA: Sociology Press Theme: Community 9.3.3 9.4.1 9.3.2 The social organisation of care Participatory community research: An exploratory study to identify pathway development: from Reflections on a study of the socio- the range of activities undertaken boundary concept to boundary cultural factors influencing an by qualified nurses in a general object understanding of TB within the medical ward Davina Allen, Health and Social Care Research Somali community Alison Evans, Corporate Nursing, Cardiff and Vale Centre, Cardiff University, Cardiff, UK NHS Trust, Cardiff, UK Kate Gerrish, Centre for Health and Social Care [email protected] Research, Sheffield Hallam University, Sheffield, [email protected] UK Abstract: Co-authors: Mubarak Ismail; Andy Naisby Abstract: [email protected] Background: Care pathways are multidisciplinary Non participant structured observation using inter- care management tools which map out chrono- active process analysis (Bales 1950) was used logically key activities in a particular healthcare Abstract: to generate reliable and quantifiable data on the process. Participatory community research provides a workload of nursing staff; information essential Aims: To examine the multiple purposes for which framework whereby researchers work in partner- to inform decisions on the best use of nursing these technologies are being developed and the ship with members of the community in which resources. The data collection phase extended over inherently political processes through which origi- they are undertaking research. The principal a period of three months and included 91.16 hours nators negotiate and settle upon a given pathway features of this approach include collaboration, of observation. Using the International Council content and design. A mental health safety pathway mutual education, and acting on results developed of Nurses definition of nursing (ICN 2007) initial will be used as an illustrative case. from research questions that are relevant to categorisation found that the majority of time the community. The knowledge, expertise and (56%) qualified nurses were involved in direct care Methods: Three ethnographic case studies of resources of the community are key to the success delivery; indirect care and non patient care repre- care pathway development undertaken in a single of the research (Macaulay et al 1999). This pres- sented 20% and 8% of activities respectively. Out National Health Service Trust in the UK (2007- 2008). entation will provide a reflexive account of the

109 Concurrent session 9 – Friday 27 March 2009

learning that occurred from undertaking a par- 9.4.2 9.4.3 ticipatory ethnographic study of the socio-cultural factors influencing an understanding of TB within Ready, willing and able? Specialist How do community nurses learn the Somali community. Partnerships were estab- community public health nurses skills of cultural competence? lished between academic researchers, health care views of their public health role Julia Quickfall, Queen’s Nursing Institute Scotland, professionals and the Somali community. Data Gill Coverdale, School of Healthcare, University of Edinburgh, UK was collected through fieldwork, in-depth inter- Leeds, Leeds, UK views and focus groups with Somali TB patients, [email protected] Abstract: members of the wider Somali community, and health care professionals. Consideration will be This paper reports on some of the findings from given to the nature of the community involvement Abstract: an ethnographic study to ascertain the factors in the research process. This ranged from collabo- Background: The 3rd part of the Nursing and involved in the delivery of culturally competent ration in developing the research proposal, through Midwifery Council register is for those nurses who primary care nursing for asylum applicants in gaining access to the field, undertaking data col- have a predominantly public health role, having the Glasgow. lection and analysis, interpreting the findings and responsibility to work with both individuals and a Methods: The study used an interpretive theory of disseminating the results using culturally appropri- population (NMC, 2004). These Registered Special- culture (Geertz 1973), to gain an understanding of ate methods. ist Community Public Health Nurses [RSCPHN] are how primary care nurses used the notion of cultural expected to work collaboratively to promote and competence in their care of asylum applicants, a Key issues which will be discussed include: protect health, reduce risky behaviours and health highly vulnerable and ethnically diverse group, • The role of opinion leaders as advocates for the inequalities, and prevent disease (DH, 2004). who may have suffered violence and torture before Somali community, custodians of community This small qualitative research project, part of the seeking UK asylum (Halabi 2005). The methods knowledge, gatekeepers in facilitating access to author’s Masters in Public Health degree, explored used involved participant observation, interviews participants, and champions for promoting the the knowledge, understanding and perceptions of and focussed discussion groups. Informants study. the public health role of a group of active Practice included 38 asylum applicant men and women and • The complimentary roles of members of the Teacher RSCPHN’s. 21 practitioners, including practice nurses, health research team which included Somali community Aims: Three key areas were explored: visitors, community staff nurses and support researchers and a TB specialist nurse in addition workers. Interventions between the practitioners • What their public health role was to an academic researcher. and the asylum applicants were observed, and the • What the influences are on that role are informants were interviewed separately after the • The practicalities of involving Somali community intervention. Field notes were written up within researchers. • What they felt the solutions were to enhance this aspect of their role 48 hours into a word document and were analysed • Recognising and responding to cultural and using a simple File Maker Pro database. ethnic diversity in the research team. Methods: This was a small qualitative study which used 3 focus groups to collect data from 16 Practice Results: The study showed that the practitioners • The place of reciprocity in the research partner- Teachers from Health Visiting, Occupational acquired skills of cultural competence through an ship. Health Nursing and School Nursing. The data was informal community of practice (CoP) and adopted • The challenge of managing the different expecta- combined for thematic analysis of their responses most of the CoP characteristics identified by Wenger tions of the various collaborators. to the three key topics identified using NVivo*. (1998). These skills involved cultural awareness, • The paper will conclude with recommendations Results: The results showed that the participants cultural sensitivity and cultural knowledge; for for further developing participatory community were knowledgeable about their role as public example, knowing when and how to use an inter- research approaches. health nurses, were influenced by lack of resources, preter effectively. The teams used discourse to poor understanding from others of their role and reflect their own perspective, using stories and Recommended reading: tensions with managers and the wider team as to inside jokes to facilitate a common understanding Macaulay A, Commanda L, Gibson N, McCabe the importance of their public health role. They of cultural competence. L, Robbins M & Twohig L (1999) Participatory offered solutions including role clarity for the skill Conclusions: As Scotland becomes more multi- Research Maximises Community and Lay Involve- mix team, a vision for practice, and debated the cultural in nature, cultural competence skills are ment. British Medical Journal 319: 774-778 role of a specific public health nurse in the team. essential for nursing in all areas of health care. Gibson N, Cave A, Doering D, Ortiz L, & Harms P Conclusions: Practitioners are enthusiastic and These skills are not easily gained from text books (2005) Socio-cultural Factors Influencing Preven- knowledgeable about their role but are hampered and primary care nurses need the confidence to tion and Treatment of Tuberculosis in Immigrant by lack of resources, poor understanding by others understand that they can and do learn from each and Aboriginal Communities in Canada. Social of their role and poor use of skill mix within teams. other. Science and Medicine 61(5):931-42 Recommendations for clear roles and responsibili- Recommended reading: Grant G & Ramcharan P (2006) User Involvement in ties, clear protocols for assessing need and identi- Geertz, C. (1973). The Interpretation of Cultures. Research. In K Gerrish & A Lacey (eds) The Research fying priorities are offered. New York, Basic Books Process in Nursing. Blackwell Publishing, Oxford pp Recommended reading: 54-70 Halabi, J. O. (2005). ‘Nursing Research with Refugee Nursing and Midwifery Council (2004) Standards of Clients: A Call for Qualitative Approaches’ Proficiency for Specialist Community Public Health Wenger, E. (1998) Communities of Practice. Nurses. London, Nursing and Midwifery Council Learning, Meaning and Identity, Cambridge Univer- Department of Health (2004) Choosing Health- sity Press, Cambridge Making Healthier Choices Easier. London, HMSO

110 Concurrent session 9 – Friday 27 March 2009

Theme: Nursing students/clinical Recommended reading: Recommended reading: supervision Alabaster, E.S. (2006) Students’ Ideals for Nursing Gibbons, C., Dempster, M. and Moutray, M. (under Older People in Practice, International Journal of review), Stress and Coping in Nursing Students, 9.5.1 Older People Nursing. 1, 66-74 International Journal of Nursing Studies Still learning and working? Nursing Cohen, M.Z., Kahn, D.L. & Steeves, R.H. (eds.) Gibbons, C., Dempster, M. and Moutray, M. (under students experiences of work-based (2000), Hermeneutic Phenomenological Research: review),The Validation of the Index of Sources of placements A Practical Guide for Nurse Researchers. Sage, Stress in Nursing Students, Nursing Education Erica Alabaster, School of Nursing and Midwifery Thousand Oaks Today Studies, Cardiff University, Cardiff, UK Melia, K.M. (1987) Learning and Working: The Occu- Gibbons, C., Dempster, M. and Moutray, M. (in [email protected] pational Socialisation of Nurses, Tavistock, London press), A Confirmatory Factor Analysis on the Index of Sources of Stress in Nursing Students, Journal of Advanced Nursing Abstract: Background: Reformed UK nurse education empha- 9.5.2 sises preparation for practice through workplace experience, while students acquire occupational Stress and coping in nursing 9.5.3 knowledge and values through socialisation. This students presentation aims to fit the conference theme by Chris Gibbons, Queen’s University Belfast, UK Clinical supervision: Findings reporting on research which demonstrates that Co-authors: Martin Dempster, Marian Moutray from an Australian randomised viewing data in its retrospective context has signifi- [email protected] controlled trial cance for future practice. Edward White, School of Psychiatry, University of New South Wales, Sydney, Australia Aims: The research aimed to explore, in-depth, Abstract: pre-registration nursing students’ experiences of Co-authors: Julie Winstanley Most research exploring sources of stress and working with older people. [email protected] coping in nursing students construes stress as Methods: This qualitative, doctoral study drew psychological distress with scant regard to those broadly on interpretive hermeneutics informed by sources of stress likely to enhance well-being Abstract: phenomenological theory. The sample (n=10) was and learning. This study explored the relation- Several national and State-based inquiry recruited from a single educational institution. Data ship between sources of stress and psychological documents have reported long-standing and major were collected using loosely structured interviews, well-being and considered the moderating and concerns about mental health service provision reflexive accounting and supplementary material, mediating role played by sources of stress and in Australia. In particular, accounts of the difficult being completed in 2003. Systematised detailed different coping resources on well-being. A con- circumstances that satellite the recruitment and analysis was performed using bespoke software to venience sample of 171 final year nursing students retention of high quality mental health nurses have aid data management. were surveyed using an electronic questionnaire clearly emerged, independent of State jurisdic- Results: Students were defined by their ability which measured sources of stress, psychologi- tion. The privately experienced cost of working and to assist in managing workload across a variety cal well-being, coping style, support, control and coping in contemporary mental health settings, of settings. This often meant working alongside self-efficacy. Multiple regressions found that the however, especially when the resilience of nursing support workers, as opposed to registered nurses, sources of stress likely to lead to distress were staff is tested after stressful, even harrowing and impeded development. Participants felt driven more often predictors of well-being than sources clinical events, remains poorly understood. to move on to achieve employment-compatible of stress likely to lead to positive, eustress states. Clinical Supervision [CS], a structured staff support competence but some practice mentors discour- However, placement experience was an important arrangement, has shown promise as a contribution aged this. In contrast, access to developmental source of stress likely to lead to eustress. Self-effi- to the clinical governance agenda [Winstanley and opportunities was liable to be supported where cacy, dispositional control and support were other White 2003] and is now found reflected in central practice mentors undertook fundamental care and important predictors. Avoidance coping was the policy themes elsewhere in the world. However, the accepted students as learners. strongest predictor of adverse well-being. Approach concept of CS remains underdeveloped in Australia Discussion: Nursing is characterised by contra- coping was not a predictor of healthy well-being. [Yegdich 2001]. This presentation will present diction, in that it is evolutionary and conducted While the sources of stress likely to lead to distress findings from a groundbreaking randomised con- against a backdrop of unrelenting change, yet a were more frequent, sources of stress rated as an trolled trial [RCT], recently completed in Australia, potent legacy of historic practices influences its opportunity to achieve were important. The mere funded by the Queensland Treasury/Golden Casket performance. Service constraints, realignment of presence of support is beneficial as well as the Foundation [A$248,000]. The RCT has examined roles and ambiguity of the students’ position lend utility of that support. Avoidance coping, even if the efficacy of the most widely adopted model of new dimensions to occupational socialisation. The used infrequently, can have an adverse effect and, group CS that is known to address the promotion duality of learning and working, described by Melia in the short-term at least, approach coping was of standards and clinical audit issues, the devel- (1987) at a time when students held employee not predictive of positive well-being. Initiatives to opment of skills and knowledge and the personal status, persists. promote support and self-efficacy are likely to have wellbeing of the Supervisee [Procter 1986]. For the more immediate benefits to student well-being. the first time, this study has focused not only on Conclusions: Students’ learning on the job still the outcomes for individual mental health nurses, does not necessarily equate with their learning Nurse educators need to consider how course but has also attempted to examine the quality of about the job in terms of acquiring knowledge and experiences might contribute not just to potential care they provide and the effect of both on patient skill for function when registered. Engagement in distress but to eustress during course reviews. outcomes. learning through workplace experience requires How educators interact with their students and consistency in interpreting their role and enabling how they give feedback offers important opportu- The presentation will address the telling meth- them to work in proximity with motivated mentors. nities to promote self-efficacy and provide valued odological and substantive issues that emerged support. Peer support is a critical coping resource and will conclude with a set of practical challenges and can be bolstered through induction and that confront key stakeholders involved the imple- learning and teaching initiatives. mentation of Clinical Supervision. The RCT has made a novel contribution to the development of

111 Concurrent session 9 – Friday 27 March 2009

knowledge which, it will be argued, is generalis- problematic and worked hard to represent and tice partnerships, and KT activities that facilitate able to other health care disciplines and to other reconfigure them as rational acts. the uptake of knowledge regarding social justice, countries elsewhere in the world. Conclusions: Intuitive judgement, though consid- equity, and cultural safety. Recommended reading: ered an essential part of professional decision- Discussion: There is some disjuncture between making and discourse holds particular problems KT and critical inquiry. Moreover, discourses of the Proctor B [1986] Supervision: A Cooperative for nursing because of the profession’s desire to clinic, while accommodating KT, may run counter Exercise in Accountability. In: Marken M and Payne distance itself from traditional views of ‘female’ to discourses of social justice, equity, and cultural M [Eds] Enabling and Ensuring: Supervision in attributes such as intuition. safety. Practice. National Youth Bureau and Council for Education and Training in Youth and Community Recommended reading: Conclusions: KT is a complex endeavor and happens where there is receptiveness to the Work, Leicester Jamous, H. and Peloille, B. (1970), ‘Professions or process. It does not proceed in a linear and predict- Winstanley J and White E [2003] Clinical Supervi- Self-Perpetuating System; changes in the French able pattern and requires considerable administra- sion: Models, Measures and Best Practice. Nurse University-Hospital System’, in Jackson, J. (ed.), tive support to endorse the process and enable Researcher, London Professions and Professionalisation, Cambridge, staff to engage with researchers. Yegdich T [2001] An Australian Perspective on Cambridge University Press Clinical Supervision. In: Cutcliffe J, Butterworth T Recommended reading: and Procter B [Eds] Fundamental Themes in Clinical Anderson, J.M., Browne, A.J., Lynam, J., et al. (2004) Supervision. Routledge, London Cultural Safety and Knowledge Uptake in Clinical 9.6.2 Settings: A Model for Practice for Culturally Diverse Critical conceptions of knowledge Populations. Research Proposal Submitted to CIHR Theme: Knowledge translation/ translation: Fostering social justice, Estabrooks, D., Thompson, D., Lovely, J., & equity and cultural safety Hofmeyer, A. (2006) A Guide for Knowledge Trans- evidence based practice lation Theory. The Journal of Continuing Education Sheryl Reimer Kirkham, Trinity Western University, 9.6.1 in the Health Professions, 26, 25–36 Langley, British Columbia, Canada Intuition and evidence: Findings Kitson, A. (2008) The Uncertainty and Incongruity of Evidence-based Healthcare from focus group research into Abstract: nurses and decision-making Background: Knowledge translation (KT) has been Michael Traynor, School of Health and Social widely taken up to facilitate the uptake of research- Sciences, Middlesex University, London, UK derived knowledge into health care services. As 9.6.3 Co-author: Maggie Boland a new field, theories and models for KT are being Institutionalizing evidence-based [email protected] developed (Estabrooks et al., 2006; Kitson, 2008). This paper presents one such a model. Unique to nursing practice: An organizational this project was that the knowledge being synthe- case study using a model of Abstract: sized and translated was derived through critical strategic change Background: Professionals have been said to inquiry and centred on social justice, equity, and Jo Rycroft-Malone, Centre for Health-Related draw on a mixture of technical knowledge and cultural safety. Research, University of Wales, Bangor, UK expert judgement when making clinical decisions Aims: Build on established partnerships to foster a Co-authors: Cheryl Stetler; Judith Ritchie; Alyce (Jamous and Pelloile 1970). Recently the evidence clinical environment that will facilitate knowledge Shultz; Martin Charns based movement has emphasised the importance uptake [email protected] of formal technical knowledge, making the role of tacit judgement more problematic in professional Synthesize findings from several studies and criti- discourse. cally examine with administrators and front-line Abstract: practitioners how actionable messages can be Aims: This study aims to investigate how qualified Background: There is an expectation that health translated to shape patient transitions between nurses talk about their decision-making in the light care organisations use evidence-based practice hospital and home of the rise of evidence based practice (EBP) to improve the quality of patient care and Translate the principle of cultural safety into Methods: Two rounds of three focus groups were service delivery. However challenges about how to practice to prompt practitioners to reflect critically held in 2003 and 2008 with qualified nurses in make evidence-based practice a reality, particularly on their assumptions about patients, and thereby different specialities, recruited through participa- at an organisational level and on a sustained basis. increase their receptivity to knowledge that will tion in post-qualifying courses at 2 London-based Purpose: To identify key contextual elements in challenge these assumptions universities. Analysis of the transcripts was a nursing organization where evidence-based informed by aspects of discourse analysis. Evaluate effectiveness of this KT model (Anderson, practice was perceived to be used routinely, in 2004) Results: Decision-making was described as con- contrast to one in which it was not. Theoreti- strained by issues of hierarchy within nursing and Methods: Key processes included: cal framework: Pettigrew and Whipps’ Content, across professions. The 2003 participants were • establishing collaborative relationships Context, and Process model of strategic manage- ment of change. more likely to describe research as empowering • implementing specific projects (‘action plans’) their decision-making while the 2008 participants Approach: A mixed method case study was • engaging in responsive dialogue to foster reflec- tended to speak of guidelines and protocols as conducted. Two sites in the KingdomStates were tive practice emerging from outside their realm of influence. purposively sampled to provide contrasting Nurses also spoke of ‘rule-breaking’ when ‘instinct’ Several types of evaluative data were collected. cases; a ‘role model’ site for the institutionaliza- influenced decisions in unusual situations. This Extensive field notes were written, along with inter- tion of evidence-based practice, and a ‘beginning’ paper focuses on talk of ‘instinct’ and intuition. views with 15 patients and 18 health care profes- case that self-identified as early in the journey sionals. Discussion: In each of the 2008 groups a single towards the institutionalization of EBP. Data were nurse spoke about their experience of intuition in Results: The pilot project provided insight into the collected through: a multi-tool survey (n=229); key decision-making. The groups found such accounts types of organizational contexts, academic-prac- informant interviews (n=59); focus groups (n=14); focused observations, and document review.

112 Concurrent session 9 – Friday 27 March 2009

Findings: The extent and pervasiveness of EBP therapeutic approach of nurses and therapy staff Results: Eight studies identified the range of was qualitatively different between the ‘role’ needs to be explored in greater depth. Successful need experienced, with information available on and ‘beginner’ sites. The role site demonstrated teamwork appears to depend on opportunities for problems with movement, personal care, psycho- integrated and widespread EBP activity driven the development of relationships between team logical issues, social activities and communica- by hospital, external priorities and local nursing members as much as the use of formal commu- tion; and needs identified for physical health care, practice problems. In contrast, the beginner nication systems and structures. A coordinated practical information and support for coping, help site was mainly engaged in individual projects approach to education and training, clinical leader- to return to work, information about care options, primarily motivated by external, hospital, regula- ship, a commitment to research, and opportunities aids and adaptations, and support for carers. tory and medically-driven priorities. Key contextual for role and practice development also appear to be Twenty nine studies measured prevalence, with elements that facilitated the institutionalization of key organisational features of stroke unit nursing. information available on dependence in mobility EBP and were pervasive in the role site included; Conclusions: Organisational context appears to and personal care, incontinence, general health key people leading change at multiple levels of the be important in shaping the nursing contribution status, risk indicators for secondary prevention, organisation, development of a supportive organi- to stroke unit services. Recommendations for the levels of social participation or engagement, vision sational context and culture that embedded EBP development of stroke nursing leadership and and swallowing problems, mood disorder, com- into the organisation’s day-to-day processes and future research into teamwork in stroke settings munication problems, cognition problems, levels infrastructures, and co-operative inter-organisa- are made. of institutionalisation, need for care or equipment, tional relations. Survey data broadly supported and carer strain. Nine studies identified the extent these findings. Recommended reading: of unmet need, with information available on unmet Discussion: Empirically little is known about how Stroke Unit Trialists’ Collaboration, 2005. need for help with mobility and personal care, context mediates EBP, therefore this study begins Organised Inpatient (Stroke Unit) Care for Stroke medical follow up, secondary prevention treatment, to offer some evidence of the key contextual (Cochrane Review). In: Cochrane Library (Issue 5). help with speaking difficulties, obtaining aids and elements that may require attention if the institu- Update Software, Oxford adaptations, and for information. tionalization of EBP is to be realized. Langhorne, P., Pollock, A., 2002. What are the Com- Conclusions: This mapping review illustrates a ponents Effective Stroke Unit Care? Age and Ageing methodology for classifying different types of 31, 365–371 research relating to need. The presentation will discuss the processes of a mapping review in com- Yin, R.K., 2003. Case Study Research: Publication Theme: Stroke care parison with full review, including the importance Inc., Thousand Oaks 9.7.1 of a framework that can draw together information Ritchie, J., Spencer, L., 1993. Qualitative Data from diverse research designs. The organisational context of Analysis for Applied Policy Research. In: Bryman, nursing care in stroke units A., Burgess, R. (Eds.), Analysing Qualitative Data. Christopher Burton, School of Healthcare Sciences, Routledge, London Bangor University, Bangor, UK 9.7.3 Co-authors: Andrea Fisher; Theresa Green A survey of urinary continence care [email protected] 9.7.2 practices in Scottish stroke care settings Abstract: Mapping the evidence for long-term need: An example from stroke Katharine Jamieson, Nursing, Midwifery and Background: Internationally the stroke unit is rec- Allied Health Professions Research Unit, Glasgow ognised as the evidence-based model for patient Beverley French, Department of Nursing, Caledonian University, Glasgow, UK University of Central Lancashire, Preston, UK management (1), although clarity about the Co-authors: Marian Brady; Suzanne Hagen; Peter Co-authors: Christopher Burton; Paola Dey; Peter effective components of stroke units is lacking (2). Langhorne; Michael Leathley; Shankar Loharuka; Langhorne; Ann Capewell, Carol Bugge, Doreen Aims: We aimed to explore the organisational Jenny Marsden; Joanna McAdam; Christopher McClurg, Campbell Chalmers context of stroke unit nursing, to determine those Price; Kate Radford; Helen Rodgers; Catherine Sackley; Anil Sharma; Christopher Sutton; Marion features that staff perceived to be important in Abstract: facilitating high quality care. Walker; Caroline Watkins [email protected] Introduction: Urinary incontinence (UI) occurs in Methods: A case study approach (3) was used, 40-60% (approximately 60,000-90,000) of the UK’s including interviews with nurses and members annual stroke hospital admissions of the multidisciplinary teams in two Canadian Abstract: 1. At discharge, a quarter will still have UI and 15% acute stroke units. A total of 20 interviews were Introduction: In 2007 the Stroke Association com- will continue to experience problems a year after completed, transcribed and analysed thematically missioned an information mapping review of the UK stroke. using the Framework Approach (4). Trustworthi- research literature relating to the needs of stroke 2.The burden of UI extends beyond physical ness was established through the review of themes survivors and their carers after discharge from symptoms. Depression is twice as prevalent in and their interpretation by members of the stroke hospital. A mapping review seeks to comprehen- individuals with incontinence post-stroke as those units. sively identify and classify the available research, without. Findings: Nine themes that characterised an organ- to ascertain gaps in the available evidence that isational context that supported the delivery of would require further research. 3. Furthermore, the negative social consequences associated with UI, such as isolation, can impact on high quality nursing care in acute stroke units were Methods: Research published in the UK between both carer and stroke survivor. identified. The study highlighted the importance of 1996-2008, which provided information relating an overarching service model to guide the organisa- to the identification of need or experience, the Stroke nurses have the responsibility of assessing, tion of care and the development of specialist and prevalence of needs or problems, and the extent managing and supporting patients’ continence advanced nursing roles. Whilst multidisciplinary of unmet need was included. Systematic methods needs. Although motivated, the availability of con- working appears to be a key component of stroke were used to search for and categorise the research tinence support, policy, guidelines and products is unit nursing, various organisational challenges to according to study focus and design. Studies were unclear. its successful implementation were highlighted. further classified according to study quality. Methods: We collected anonymised information In particular the consequence of differences in the on the urinary continence care practices in stroke

113 Concurrent session 9 – Friday 27 March 2009

care settings across Scotland. Employing some of contribute to the phenomena of networking in Aims: To describe the nature of cross-boundary the strategies found to be effective in improving nursing. working by nurses in relation to three long-term response rates to postal questionnaires, we Aims: The overall aim of this paper is to present conditions (diabetes, multiple sclerosis & COPD) designed, piloted and distributed a short postal the findings of a 5 country study which suggests and healthcare organisation type (primary care, questionnaire to 69 stroke units. that Networking represents the future vehicle of acute hospital & teaching hospital). Results: Our survey had an 88% response rate working together in nursing Methods: Data were collected by two methods. A with 61 questionnaires completed and returned. Methods: As part of a larger doctoral study a quan- postal survey of randomly selected acute hospitals Continence care support was most often available titative descriptive e-survey data collection meth- (n=100) and primary care organisations (n=55) by request. Three quarters of this support was odology was employed for this research. Survey and all teaching hospitals (n=35) in England. provided by a Continence Advisor or Urology participants completed online questionnaire. A Questionnaires were mailed to nursing service Doctor/Consultant. Disappointingly, in the past data set was generated and readily converted into leads of diabetes, multiple sclerosis and COPD in year, one third of stroke care settings(n=22) SPSS Version 15 for analysis – a range of statisti- each organisation (May 2006-January 2007). The received no form of continence training. Various cal tests were carried out. The total sample for final sample comprised 298 respondents from 190 combinations of assessment tool usage were the study was 1601 potential participants, over different organisations (70.7% response rate). reported. Micturition diaries or fluid balance charts 300 potential participants’ email addresses were Four regional stakeholder conferences were held were used by 31(51%) care settings. 10 of these found to be obsolete. This left a sample of 1300, January – March 2007) across England in which settings added the Barthel Index. 4 care settings in total there were 665 respondents representing a local nurses (n=94) participated in table top dis- used a validated measure and 14 settings used response rate over 50%. cussions using the world café method. local continence assessment tools. 11 care settings Findings: The paper reports on the following Findings: A large range of cross-boundary working did not use any form of continence assessment findings: activity (n= 805 responses) was reported. The tool. extent of reported intra-professional, inter-pro- • Types of networking activities engaged in by Conclusions: With an excellent response rate we fessional, intra-organisational and inter-agency nurses have a comprehensive overview of the challenges working varied both across disorder care group nurses face in providing adequate continence care • The benefits of networking as mean for nurses to and healthcare organisational type. There were for patients in stroke care settings across Scotland. work together only two examples of trans-disciplinary working. Nurses’ access to training, assessments, protocols Recommendations: This paper will demonstrate Examples of cross-boundary working included both and equipment varied considerably. some of the potential benefits of networking for patient (eg discharge planning, multi-disciplinary nurses. Further research is required to demon- clinics) and organisational focused activities (eg Recommended reading: strate that networking among nurses can contrib- clinical protocol development, clinical network- Barrett, JA. Bladder and Bowel Problems after ute to improved patient outcomes. ing) in addition to generic activities such as team- a Stroke. Reviews in Clinical Gerontology working. The survey data were echoed in the stake- 2002;12:253-67 Recommended reading: holder conference data providing a validity check. Patel, M., Coshal,C., Rudd, AG., Wolfe, CDA. Natural Goodwin, N., Peck E., Freeman T., (2006) Managing Conclusions: Nurses are increasingly working History and Effects on 2-year Outcomes of Urinary Network Of Twenty-First Century Organisations. across ‘boundaries’, however, the nature and Incontinence After Stroke. Stroke 2001;32:122-127 Basingstoke:Palgrave MacMillan extent of this activity is contextually bound both by Brittain, KR. Urinary Symptoms and Depression in Benton, D.C. (1997) Networking, Nursing Standard, the organisation in which they work and their field Stroke Survivors. Age and Ageing 1998;27(suppl 1): 35, pp 47-52 of practice including their patient care group. 116-117 Goodwin N., Peck E., Freeman T., Posaner R., Recommended reading: (2004) Managing Across Diverse Networks of Care: While A, Murgatroyd B, Ullman R & Forbes A. (2006) Lessons from Other Sectors. (Final Report to the Nurses’, Midwives’ and Health Visitors’ Involve- NHS SDO R&D Programme). Health Services Man- ment in Cross-boundary working Within Child Theme: Collaboration agement Centre:University of Birmingham Health Services. Child: Care, Health and Develop- 9.8.1 ment.32: 87-99 Networking in nursing: The future of working together 9.8.2 Paul Horan, School of Nursing & Midwifery Studies, The University of Dublin Trinity College, Cross-boundary working involving 9.8.3 Dublin, Ireland nurses Providing person centred care Co-authors: Michael Brown; Fiona Timmins Alison While, Florence Nightingale School of Nursing & Midwifery, King’s College London, UK through partnership working in Co-authors: Billie Coomber; Freda Mold; Angus intermediate Abstract: Forbes Valerie Thomas, School of Health Science, Background: Over the past decade Networks have [email protected] Swansea University, Swansea, UK mushroomed within the nursing profession . The Co-author: Valerie Thomas functions of networks in healthcare have been explained by many writers(Goodwin, 2004, 2006, 6 Abstract: Abstract: et al, 2006, Benton, 1997, Hughes,1997). However Background: High quality healthcare depends a great body of the literature on the topic is theo- upon good team working with all relevant skills Background: Intermediate care (IC) is a concept retical in focus and there would appear to be little being utilised for the patient’s benefit. Much which is familiar to many people working in health empirical evidence to support networking activities healthcare delivery is relocating into the primary and social care in the UK but the term is used to within healthcare or nursing. Formal evaluations of care setting. Little is known about the nature and describe services as diverse as social services rea- how networks function within healthcare or nursing extent of cross-boundary working by nurses with blement teams, residential rehabilitation units and are rare. Universally agreed definitions of network- the exception of one study relating to child health- hospital based nursing units. All services should ing in the nursing profession are scarce. This paper care (While et al, 2006). focus on maximising independence and cross pro- reports on some findings of a quantitative descrip- fessional working. tive study which explores the many key issues that

114 Concurrent session 9 – Friday 27 March 2009

Aims: The aim was to explore the perceptions of staff working in and referring to community based IC teams. Methods: The paper draws on results from a Doctoral study (data collection from mid 2006 to mid 2007). Methods included 2 focus groups (n=6,n=10)and observations with IC teams (n=6), face to face interviews with referrers (n=17)and an evaluation of the outcome measures. Data were coded and analysed within and across data sets to identify themes. Results: Promoting partnership working has resulted in a level of understanding, trust and reflexivity between team members which trans- lates into a person-centred approach, putting the person at the centre of every activity (McAllin and Bamford 2007). The service manager/coordina- tor has facilitated the development of a model of working which transcends disciplinary boundaries, provides a sense of a central purpose and a clear idea of the focus of the work. Discussion: This paper explores the challenges of inter professional working when measuring the effectiveness of services. Challenges facing managers / coordinators include: the heteroge- neity of services that are labelled IC and the com- plexity of the objectives that IC seeks to achieve (Thomas and Lambert 2008). Conclusions: Practitioners and managers need to understand the systems and structures within which they are required to function (Allen et al 2002). This paper explores the hidden work that takes place to facilitate partnership working within this complex model of care. Recommended reading: Thomas, V and Lambert, S (2008) An ethnographic study of intermediate care services in Wales: the hidden work. Journal of nursing management Vol 16 pp181-187 McAllin A. & Bamford A. (2007) Interdisciplinary teamwork: is the influence of Allen D., Lyne P. & Griffiths, L. (2002) Studying complex care interfaces: key issues arising from a study of multi-agency rehabilitative care for people who have suffered a stroke. Journal of Clinical Nursing, 11:297-305

115 Workshops abstracts

about the challenges of peer review for reviewers, Tuesday 24 March 2009 Tuesday 24 March 2009 authors and editors. 13.00 – 15.30 16.00 – 17.30 Recommended reading: Workshop 1 Workshop 2 Kralik D. (2006) What makes a good peer review? Publishing from research: Issues for Learning the ropes of peer An author’s perspective. Nurse Author & Editor, 17 more experienced researchers reviewing: Issues and challenges (2) Alison Tierney, Editor In Chief, Journal of Advanced for reviewers and authors McCook A. (2006) Is peer review broken? The Nursing, Oxford, UK Debbie Kralik, Research Unit, Royal District Scientist http://www.the-scientist.com/article/ Nursing Service, South Australia, Wayville, display/23061 accessed 27 March, 2006. Australia Aims of workshop Co authors: Kader Parahoo 1. To identify and discuss some of the more complex issues and decisions attached to research pub- lishing. Abstract: 2. To highlight various roles of more experienced Most nurse academics and advanced practice researchers in relation to research publishing. nurses will be asked to review manuscripts submitted for publication in journals at some time 3. To identify ways in which journals and publish- during their careers. Peer review is important for ers might better support and promote nursing maintaining the integrity of a journal and can be research in the future. a process for exposing the author to new ideas Abstract: and perspectives. Most nurses, however, are not Outline: This workshop is aimed at more expe- formally taught how to review a manuscript and rienced researchers, including those working on consequently a review may contribute little in the larger-scale externally-funded research projects way of constructive guidance for the author. In or leading a team of researchers or a longer-term this workshop the focus will be on answering the programme of research, or working in the context question ‘What makes a good peer review?’ When of a multi-disciplinary research group. These an author submits a manuscript for publication in more experienced researchers occupy a variety of a journal, it is usually the end result of significant roles in relation to research publishing, including commitment to the research process. teaching less experienced colleagues and research While there are a number of motivations for pub- students about writing and publishing. Some of lishing, the strongest is often the desire to contrib- the more complicated and challenging issues and ute to a body of knowledge. Submission of a manu- decisions attached to research publishing that we script to a journal also marks the beginning of the will discuss in this workshop include: – peer review process. Competition for publishing • Selecting journals and building a publication space is increasing, however, with the numbers of portfolio papers submitted to high impact journals growing at a rate of approximately 15% each year (McCook, • Planning and managing multiple publications 2006). Inevitably, more submissions mean more from a large project or programme rejections, appeals and complaints about the peer • Issues attached to multi-authorship and multi- review process (McCook 2006), but the publishing disciplinary research industry needs to continue to meet authors’ needs • Aspiring to achieve international excellence and in order to maintain a competitive environment. impact The ideal is that the peer review process should • Exploiting developments in e-publishing benefit authors, editors and reviewers (Kralik 2006). Authors have the opportunity to expose The workshop will be based on a powerpoint pres- their work for constructive critique, reviewers have entation, but the intention is for this session to be the opportunity and responsibility to ensure that as interactive as possible, with participants sharing research published in their fields is of high and the their own experiences and ideas and offering sug- editors ensure that the peer review process is fair gestions about ways in which journals and publish- and leads to quality publications. Reviewing manu- ers might be able to better support and promote scripts means applying critical skills to research nursing research in the future. that is often cutting-edge. The reviewer response should be a constructive document demonstrating that the reviewer has comprehended the topic of the paper. At the same time, authors will appreci- ate the identification of any flaws in content or recommendations to strengthen the paper. It is important that authors receive detailed feedback from reviewers about their paper in a non-hostile tone, regardless of the recommendation to revise, accept or reject it. Peer review is a far from perfect process, but it can provide useful guidance for authors when reviewers have commitment to working in the author’s interest. In this Workshop, experienced editorial team members will stimulate discussion

116 Workshop abstracts

adopted Neissen et al’s (2000) evidence-based Wednesday 25 March 2009 Wednesday 25 March 2009 policy-making approach as a framework for the 10.15 – 11.15 14.30 – 16.00 analysis, and DePalma’s (2002) approach to syn- Workshop 3 Workshop 4 thesizing evidence collected from the workforce policies in the five countries. Evidence based pol- Evaluating research for evidence- Nursing workforce policy review: icy-making requires high level, high quality, reliable based nursing practice Methodology, process and outcome robust data (McGovern et al 2001; Muir Gray 2001). Jacqueline Fawcett, College of Nursing and Health Moira Attree, School of Nursing, Midwifery The policy review adopted Pearson’s (2007) defi- Sciences, University of Massachusetts Boston, and Social Work, The University of Manchester, nition of best practice; which ranked levels of Boston, Massachusetts, United States Manchester, UK evidence downwards from ‘research’, through [email protected] Co-author: Lisabeth Uhrenfeld ‘reports of representative or expert committees; [email protected] government reports and policies’, to ‘the opinion Abstract: of representative groups, respected authorities or This workshop focuses on the methodology, individuals’. Nursing research is conducted to generate or process and outcome of a policy review of nursing test middle-range theories, which provide the Muir-Gray’s (2001) hierarchy of evidence ranks workforce policies in five European countries. The evidence used for all phases of the nursing practice five strengths of evidence from type 1: Systematic three papers explore the key issues and chal- process, including assessment, planning, inter- Reviews of RCTs to type 5: Opinions of respected lenges involved in nursing workforce research, vention, and evaluation. Although a considerable authorities. The general consensus is that only policy-making and practice. The papers follow the amount of research that is relevant for nursing evidence at or above level 3 should be used to process of policy review, proceeding from analysis practice already exists, students and practicing guide or change healthcare practice and policy of review methodology, through the review results nurses do not yet routinely evaluate that research making decisions (Muir-Gray 2001; McGovern et al and concludes with a reflection on the challenges to determine its suitability for evidence-based 2001). to evidence based policy making and the process of practice. This workshop is based on the premise This policy review identified various methodologi- conducting an international policy review. that lack of attention to existing research stems cal issues, including lack of concept clarity, low from lack of understanding of the criteria used Paper 1 critically analyses the theoretical and level of data and lack of reliable data. to evaluate reports of research in a systematic methodological issues involved in conducting a References manner. The workshop content will include discus- policy review of nursing workforce policies in five sion of a comprehensive framework of criteria for European countries. De Palma JE (2002) Proposing an Evidence-Based the evaluation of reports of nursing research. The Paper 2 presents the results of the policy analysis Policy Process. Nurs Admin Quarterly, 26 (4):55–61 framework incorporates criteria used to evaluate of nursing workforce polices in five European Niessen LW, Grijseels EWM & Rutten FFH (2000) the essential elements of conceptual-theoretical- countries. The evidence-based approach in health policy and empirical (C-T-E) structures for research—the con- Paper 3 debates the challenges to evidence-based health. Social Science & Medicine 51, 859-869 ceptual model on which the research is based, the policy-making and practice. The workshop will Muir Gray JA (2001) Evidence based Healthcare; middle-range theory that is generated or tested, conclude by drawing together issues, implica- How to make Health Policy Decisions and Manage- and the empirical research methods that are used tions and recommendations for nursing workforce ment Decisions. Churchill Livingstone, Edinburgh to conduct the research. Emphasis will be placed research, policy and practice. on evaluation of the middle-range theories that are the product of all types of qualitative and quantita- Abstract 2: Abstract 1: tive research designs. Workshop participants will Outcome of policy analysis of have the opportunity to apply the framework to Methodological issues conducting published reports of qualitative and quantitative nursing workforce polices in 5 research, with special attention to evaluation of a policy review of nursing workforce European countries the utility of the middle-range theory as a guide for policies in five European countries Moira Attree, Senior Lecturer in Nursing, University evidence-based practice. Moira Attree, Senior Lecturer in Nursing, University of Manchester, Manchester, United Kingdon and of Manchester, Manchester, UK Lisbeth Uhrenfeldt, Clinical Nursing Researcher, Recommended reading: Horsens, Braedstrup & Odder Regional Hospital, Fawcett J. Contemporary nursing knowledge: Denmark analysis and evaluation of nursing models and Abstract: theories, 2nd ed. F.A. Davis, Philadelphia, 2005. This paper will debate the methodological chal- Abstract: Fawcett J, Garity J. Evaluating research for evidence- lenges involved in analysing healthcare policy, based nursing practice. F.A. Davis, Philadelphia, using a review of nursing workforce policies in five A synopsis of the outcome of the policy review 2009 (August 2008). European countries to illustrate the analysis. Policy of nursing workforce polices in five European is a core function of healthcare organisations and countries: Denmark, Finland, Portugal, England Fawcett J. The relationship between theory and is fundamental to healthcare reforms. High quality, and Ireland will be presented. The review identified research, 3rd ed. F.A. Davis, Philadelphia, 1999. evidence-based policy development is central to similarities and differences in national policies. The improvements in the quality and safety of health- nursing workforce situation and policy responses in care systems. However, healthcare professionals the five countries varied. Nurse shortage had been are not familiar with either the process of policy- addressed with different urgency in each country. making or policy review/ analysis. Little guidance England and Ireland addressed the nurse shortage exists on how to do health policy analysis; what in the late 1990s, in response to their current research theories and methods best inform policy national and local situation; policy addressing analysis. Within the policy literature criticisms nursing shortages is at an early stage in Denmark, focus upon the absence of explicit conceptual Finland and Portugal, where the shortage is a rela- frameworks, lack of detail on research design and tively new situation. In Denmark and Finland the methodology, and a preponderance of single case national government adopted generic strategies studies. The focus policy reviews is often descrip- for public employees, as opposed to specifically tive, rather than explanatory. This policy review for nurses. In the remaining three countries more

117 Workshop abstracts

specific policies for the health care workforce were tion of policy and its impact. This paper presents Thursday 26 March 2009 made. reflections on the process of conducting a policy 10.15 – 11.15 The analysis revealed three common organisa- review of nursing workforce policies. The review tional policy-making themes, relating to human authors conducted a SWOT analysis to identify Workshop 5 the strengths, weaknesses, opportunities and resource management issues, dealing with career/ The final hurdles: How to job support and staff development, as well as man- threats to the successful completion of the policy agement and leadership factors that deal with local review. Data were analysed using content analysis successfully complete your work, pay and employment conditions and practice (Graneheim & Lundman 2004), which revealed that doctorate environment. Professional practice, autonomy, the group’s strengths were commitment, collabora- Annie Topping, Nursing, University of ability to influence decision-making, economic tion, support and teamwork. Being able to capital- Huddersfield, Huddersfield, UK reward and external perceptions of the profession ise on the collaborative opportunities produced sat- Co author: Barbara Jack are areas that require attention in order to address isfaction and a sense of achievement in workgroup [email protected] the current crisis in nurse retention. Managers and members. The main threats to effective working policy makers need to focus on increasing nurses’ were funding and time to work on the review, and Abstract: job satisfaction, decreasing unpaid overtime, pressure from existing workloads, which produced lowering stress levels and providing support for dissatisfaction and stress. Conducting the analysis This workshop is aimed at delegates who are nurses, as well addressing nurses’ pay and con- enabled the group to focus our limited resources currently or about to embark on the final stages ditions. Interestingly the review identified that on maximising our collaborative effort. of doctoral study. Undertaking a doctorate is the most commonly occurring recruitment and The workshop will be concluded by drawing undoubtedly a challenging time. In nursing many retention policy themes from the five countries together issues and implications and recommenda- candidates undertake a doctorate on a part time were remarkably similar to the Magnet principles tions for research, policy and practice. basis juggling work, study and life. One of the chal- identified by Kramer in the USA in the 1980s. lenging phases is the final period leading to suc- References: cessful completion – the final hurdles. This is the References Baumann, A., Yan, J., Degelder, J., Malikov, K. 2006. period that includes writing up of the thesis, the Aiken LH, Clarke S, Sloane JA, Sochalski R, & Silber Retention Strategies for Nursing: A Profile of Four viva voce examination and responding to correc- JH (2002) Hospital nurse staffing and patient Countries. Human Health Resource. Series Number tions The aim of this workshop is to explore the mortality, nurse burnout and job satisfaction. 5. particular challenges the final hurdles present and Journal of the American Medical Association. 288: Buchan, J., 2002. Global nursing shortages. Are discuss practical solutions for jumping them. 1987-93 often a symptom of wider health system or societal Intended learning outcomes: Rafferty AM, Clarke S, Coles J, Ball J, James P, ailments. British Medical Journal 30, 751–752. At the end of the workshop participants will be McKee M & Aiken L (2007) Outcomes of variations Graneheim, UH. & Lundman, B. (2004). ‘Qualitative enabled to: in hospital nurse staffing: cross sectional analysis content analysis in nursing research: Concepts, 1. Have examined the writing up process and identi- of survey data and discharge records. International procedures and measures to achieve trustworthi- fied strategies to aid successful completion Journal of Nursing Studies 44 (2): 175-182 ness.’ Nurse Education Today, 24: 105-112. World Health Organisation (WHO) (2006) The world 2. To understand the purpose of viva voce and health report 2006 – working together for health. examine the purpose, roles and possible outcomes The World Health Report 2006. Retrieved on May The workshop will be divided into two parts: 28, 2007 from http://www.who.int/whr/2006/ whr06_en.pdf. A. The writing up process This will explore the inevitable challenges of the writing up process including time management, Abstract 3: self-motivation, overcoming writers block and Challenges to evidence-based managing important others. The role of the super- policy-making and practice visory team in supporting you at this crucial time will be discussed as will what you can do to manage Dr Moira Attree, Senior Lecturer in Nursing, Uni- your supervisors more effectively. In addition what versity of Manchester, Manchester, UK and Lisbeth examiners want to see and strategies for aiding Uhrenfeldt, Clinical Nursing Researcher, Horsens, your reader to navigate your thesis. Braedstrup & Odder Regional Hospital, Denmark B. The Viva Voce Examination Abstract: This part of the workshop will explore how you can Evidence-based policy-making requires high level, get match fit for your Viva. The focus will be defence high quality, reliable, robust data (McGovern et not defensiveness, disarming rather than conflict. al 2001; Muir Gray 2001). This review identified The value of undertaking a mock viva, preparation various methodological issues, including lack of and rehearsal, strategies for dealing with difficult concept clarity, low level of data and lack of reliable questions or unexpected questions, and empha- data. The lack of an agreed definition and stand- sising the positive will all be discussed. Lastly ardised measures of nursing need and shortage, practical steps for managing the outcome including makes comparison and evaluation of policy effec- corrections will be discussed. It is envisaged that tiveness and impact difficult, and compromises this workshop will be interactive and participants the generation of data to inform evidence based will be encouraged to discuss their own challenges policy-making (McGovern et al 2001; Muir Gray and identify possible solutions. 2001). Baumann et al (2006) and Buchan (2002) At the end of the workshop, it is anticipated that comment on the lack of high level, high quality participants will be able to develop a personal nursing workforce data. A further methodological action plan to help them successfully navigate the issue involves the lack of evidence of implementa- ‘final hurdles’

118 Workshop abstracts

Drummond MF, Jefferson TO. Guidelines for authors Thursday 26 March 2009 and peer reviewers of economic submissions to the Thursday 26 March 2009 14.30 – 16.00 BMJ. The BMJ Economic Evaluation Working Party. 16.30 – 18.00 Workshop 6 BMJ. 1996 Aug 3;313(7052):275-83. Workshop 7 An introduction to economic Soares M, Dumville JC. Economic evalua- Nurse education – a dying art? tion of healthcare technologies using primary evaluation and its potential Patrick Crookes, Faculty of Health and Behavioural research. Evidence-Based Nursing 2008;11:67-71; Sciences, University of Wollongong Australia, contribution to nursing research doi:10.1136/ebn.11.3.67 99 Wollongong NSW, Australia and Professor Dame Cynthia Iglesias, Health Sciences, University of Jill MacLeod Clark, Deputy Dean, Faculty of York, York, UK Medicine, Health and Life Sciences, University of Co authors: Nicky Cullum; Marta Soares Southampton, Southampton UK Co authors: Kylie Smith Abstract: Description of Workshop Economic evaluation Abstract: in health care is essential in order to ensure that The role of the nurse educator is coming under finite resources are deployed for maximal societal increasing scrutiny in both Australia and the UK benefit; the information resulting from such evalu- where there are recognised problems in attract- ations enables decision makers to disinvest from ing nurses into teaching careers. This workshop strategies that are not cost effective in favour seeks to explore some of these problems and to of those which are. In the context of health care put forward some considerations for the future. interventions, economic evaluation involves the Drawing on research being undertaken in Australia comparative analysis of alternative strategies into the history of nursing research, the workshop (e.g., drugs, devices, nursing interventions) in argues that the problems of attracting quality terms of their costs and associated health benefits. nurses into research and thus to higher education The workshop will cover the basic principles of and academic careers have a long history that is not economic evaluation (including different designs disconnected from broader social and economic and measures of health outcome) and will be illus- changes. trated with nursing relevant examples. It is no longer enough to argue simply for more Aims: funding, because for many nurses, or trainee nurses, the question is not merely one of salary, • To raise awareness of the value of economic eval- although this is a significant barrier given the uation to nursing decision making. high salaries and flexible work conditions that • To begin to develop skills in the understanding a well trained nurse can earn. More fundamen- and interpretation of economic evaluations tal problems exist in the perceptions held about Level: Introductory Objectives academic life, some of them well founded if we consider the emphasis placed on commodofiable • To be able to identify different types of economic research outcomes in the tertiary sector often at the evaluations of health care interventions expense of curriculum or teacher-training develop- • To be able to recognise some key strengths and ment. These are problems that have already been weaknesses in economic evaluations recognised by various education and health bodies • To be familiar with the most commonly used in the UK, and significant programs have been put measures of health benefit relevant to economic into place which seek to address these issues. The evaluations workshop will discuss some of these programs and • To begin to develop skills in interpreting the seek participant’s input into their practicality and results of economic evaluations success to date. In Australia, the situation is in a state of transition, and the workshop organisers Content are in the process of developing policy suggestions 1. Different designs: Cost benefit analysis; cost for government to address the rapidly aging nurse utility analysis; cost effectiveness analysis educator workforce problem. However, it is already 2. Main differences between designs including evident that the solution does not lie simply with strengths and weaknesses and when they creating more positions, or raising funding levels. should be used. Rather, there are fundamental underlying principles 3. Measuring health benefit in natural units; health that need to be examined, such as the relevance measures incorporating quality of life; valuing of the Nightingale system itself, arguments about health benefit in monetary terms. the delineation between nurses and doctors, and the importance of curriculum development and 4. Introduction to decision rules; cost effectiveness improving clinical placement procedures to ensure planes; cost effectiveness acceptability curves. higher quality education outcomes. Added to this Recommended reading: is the recognition of a generational shift in attitude toward careers, and caring professions in par- Michael F. Drummond, Bernie O’Brien, Greg L. ticular, that need to be understood in the broader Stoddart, George W. Torrance. Methods for the context of modern workplaces, and the construc- economic evaluation of health care programmes, tion of modern subjectivities in advanced capital- second edition. Oxford: Oxford University Press, ist societies. The workshop would be useful for 1997. participants from all levels of practical, clinical and academic experience. It is expected that workshop

119 Workshop abstracts

participants will discuss their own experience in the UK system, in both the past and present, which would add to research being conducted in Australia into the history of the RCN in order to develop solutions for the nurse academic workforce issue. Information gathered at this workshop will be used to complement this research to develop policy proposals for government in Australia. The workshop convener is Prof Patrick Crookes, Dean of the Faculty of Health and Behavioural Sciences, and Head of the School of Nursing, Midwifery and Indigenous Health at the Univer- sity of Wollongong in Australia. UOW is the major teaching institution for nurses in regional NSW, and Professor Crookes, who trained as a nurse in the UK, is involved with all aspects of curriculum development and nurse education at the univer- sity. Professor Crookes expertise in running this workshop comes from over 20 years of experience in nurse education in the hospital and Univer- sity sectors, in both Australia and the UK. He has been involved in all areas of these activities: from clinical teaching, to curriculum development and implementation (UG, PG and Research); classroom teaching and lecturing; simulation teaching and research supervision. Patrick has significant experi- ence in running workshops. He has published as an educator and a researcher and has been a member of the International Editorial Team for Nurse Education Today for over 10 years and was the foundation editor of the journal Nurse Education in Practice (with Karen Hoilland). He holds senior and influential positions in nursing. He is currently Head of a significant Australian nursing school (Uni of Wollongong) and has been since 1999. He has also been Dean of a mulit-discplinary Faculty of Health Sciences since 2004, whilst maintaining a publica- tion, research and research supervison load. He has been a member of the executive of the Austral- ian and New Zealand Council of Deans of Nursing and Midwifery since 2001, this requires being voted on to this committee by Council peers. Professor Crookes is currently Secretary and Deputy Chair of Council and a member of the Global Alliance for Nurse Education and Scholarship (GANES). He was a visiting research fellow at the University of Sheffield from 2000 to 2005 and has an interna- tional profile as a nurse and academic.

120

Produced by RCN Events 20 Cavendish Square London W1G ORN, UK Tel: 0845 772 6100 Web: www.rcn.org.uk Copyright April 2009 RCN Events ISBN 978-1-906633-12-7 Publication code: 003 600