• A phenomenological exploration of nursing students’ experience of raising a care concern in clinical practice

      Cooper, Elizabeth (University of ChesterUniversity of Chester, 2020-01)
      UK pre-registration healthcare students are expected to raise a care concern about unsafe situations whilst in clinical practice. The UK’s NHS is in the midst of a change to an open, honest and transparent culture which responds to a professional’s concern about patient care, to improve safety and prevent harm. Central to this change is improving the experience of registered healthcare professionals whose decision to raise a care concern is influenced by the organisational culture; this can create a difficult moral choice. The experience of nursing students who decide to raise a care concern has received little attention, and this study sought to explore this under-researched area. A literature review was undertaken which identified that the experience of nursing students who had raised a care concern had not been previously examined. To guide this study, Clarke Moustakas’ (1994) transcendental phenomenological methodology was used to explore nursing students’ lived experience of raising a care concern. Ten nursing students with experience of raising a care concern in clinical practice voluntarily participated in the study. Open interviews conducted between December 2016 and October 2017 were audio recorded and transcribed, exposing individual narratives of raising a care concern in clinical practice. The transcripts were analysed to produce a composite description which summarises nursing students’ lived experience, reflecting four themes or essences: 1) patient centred concern; 2) deciding how to act; 3) having emotional strength; and 4) feedback and support. These typify what it is like for nursing students to raise a care concern whilst in clinical practice. The findings were critically examined and suggest that compassion may motivate nursing students to act when faced with an unsafe situation, seeking to stop patient harm and suffering. Recognising this moral motivation, students described the relevance of emotional strength when dealing with the emotionally complex experience of facing difficult situations, with feedback and support providing comfort plus moral and emotional satisfaction. This study also explores the implications for professional practice, specifically the impact upon future teaching and learning approaches to facilitate nursing students’ ability to detect and act upon unsafe situations; providing listening opportunities to support students in clinical practice; and valuing nursing students who raise a care concern as role models and local clinical leaders. Recommendations include a new national campaign to improve the likelihood of nursing students raising care concerns and updating UK professional guidance.
    • Using and developing evidence in health and social care practice

      Chapman, Hazel M.; University of Chester (Sage, 2020)
      [A] Overview This chapter outlines the processes of developing evidence-based practice and carrying out research and highlights the similarities and differences between the two. This chapter aims to increase your skills and motivation in utilising research evidence to improve your practice, introduce you to the process of research and develop your research skills. [A] Learning Outcomes At the end of this chapter you will be able to: • Critique research papers. • Share best practice with your colleagues. • Assist with research in practice. • Develop your research skills with a view to becoming a researcher.
    • Achieving the unimaginable: Health equity in haemophilia

      Skinner, Mark W.; orcid: 0000-0002-0934-0680; Nugent, Diane; Wilton, Pam; O’Mahony, Brian; Dolan, Gerry; O’Hara, Jamie; Berntorp, Erik; orcid: 0000-0002-1337-7195 (Wiley, 2019-11-13)
    • Prophylactic Treatment in People with Severe Hemophilia B in the US: An Analysis of Real-World Healthcare System Costs and Clinical Outcomes

      Noone, Declan; Pedra, Gabriel; Asghar, Sohaib; O'Hara, Jamie; Sawyer, Eileen K; Li, Nanxin (Nick) (American Society of Hematology, 2019-11-13)
      Introduction The treatment paradigm for people with severe hemophilia B in the US typically involves prophylaxis with factor IX (FIX) replacement therapy, the primary aim of which is to provide sufficient FIX levels to reduce the frequency of bleeding events. The clinical benefits of FIX prophylaxis are well understood, however the cost of FIX products as well as costs associated with healthcare resource utilization present a significant burden to the healthcare system. Substantive costs may also accrue in patients who continue to bleed while on prophylaxis, due to the impact on both short and long-term joint-related outcomes. In the absence of existing data in the US, the 'Cost of Hemophilia Across the USA: a Socioeconomic Survey' (CHESS US) study was conducted to establish a population-based estimate of the real-world US healthcare system burden associated with severe hemophilia. Using data drawn from the CHESS US study, this analysis examines the real-world healthcare system costs and clinical outcomes of people with severe hemophilia B on FIX prophylaxis. Methods CHESS US, a retrospective, cross-sectional dataset of adults with severe hemophilia in the USA, gathered information on patient cost via a patient record form. Data on the following parameters are included in this analysis: FIX consumption, annualized bleeding rate (ABR), the presence of one or more chronically damaged joints ("problem joint"), as well as costs associated with annual (prophylactic) factor consumption and hospitalizations (i.e., number of admissions, number of day cases, total inpatient days, and total intensive care unit [ICU] days). All variables report retrospective data of the 12 months prior to enrolment in the study. Results are presented as mean (± standard deviation) or N (%). Results In total, 132 of 576 patients profiled in the CHESS US study had severe hemophilia B. Among them, 77 patients were on FIX prophylaxis, of whom 44 patients reported FIX dosing regimen and were included in the current analyses. Among them, 20 patients were treated with conventional FIX and 24 patients with extended half-life (EHL) FIX products. The cohort has a mean age of 27.64 (± 11.05) and mean weight (kg) of 75.71 (± 13.41). In the last 12 months, the mean number of international units (IU) prescribed for FIX prophylaxis across the full cohort was 257,216 IU (± 213,591), with an associated annual cost of $610,966 (± $495,869). Among patients treated with conventional FIX, mean prescribed FIX was 287,141 IU (± 264,906) at an annual cost of $397,491 (± $359,788), while patients treated with EHL FIX reported a mean prescribed FIX of 232,278 IU (± 160,914) at an annual cost of $788,861 (± $529,258). The cohort reported a mean ABR of 1.73 (± 1.39); 8 (18%) were reported to have a target joint meeting the International Society on Thrombosis and Haemostasis (ISTH) definition; and 11% were reported to have had at least one chronically damaged joint (i.e., problem joint). Healthcare resource utilization associated with bleed events were reported as follows: hospital admissions days [0.18 (± 0.62)]; inpatient days [0.34 (± 1.22)]; and ICU days [0.23 (± 0.86)]. The direct medical cost to the healthcare system was $2,885 (± $7,857; excluding FIX cost) and $614,886 (± $498,839; including FIX cost). Discussion Data from the CHESS US study showed substantial costs and resource utilization among patients with severe hemophilia B receiving FIX prophylaxis, of which the cost of FIX replacement therapy constituted most of the total cost to healthcare system. Although the ABR observed in the analysis population was low, bleed-related hospitalizations comprised a significant non-drug cost to the healthcare system. A proportion of patients also still experienced joint arthropathy. Such substantial clinical and economic burden highlights that unmet needs remain in patients with severe hemophilia B on FIX prophylaxis in the US. Disclosures Noone: HCD Economics: Employment. Pedra:HCD Economics: Employment. Asghar:HCD Economics: Employment. O'Hara:HCD Economics: Employment, Equity Ownership. Sawyer:uniQure Inc.: Employment. Li:uniQure Inc.: Employment.
    • The clusters and frequencies of adverse social conditions amongst the homeless people

      Mabhala, Mzwandile A. (Oxford University Press (OUP), 2019-11-13)
      Abstract Background A growing body of evidence identifies interconnected social indicators that can lead to homelessness. Several studies identify a catalogue of social disadvantages that starts from childhood and persist throughout the life course that leads to homelessness. Qualitative evidence indicates that their adverse childhood experiences(ACEs) and damage that occurred to them as children had major influences on their ability to negotiate their way through the education system, gain and sustain employment, make appropriate choices of social networks, and form and maintain healthy relationships as adults. However, very little research seeks to objectively investigate these issues. This study aims to use the cross-sectional study to document the cluster and frequency of adverse social conditions amongst the homeless people in North West England in 2019. Methods The study design was cross-sectional. We used IBM SPSS 21, with a significance level set at p < 0.05, CI 95% to analyse the data. Results The mean age was 39.12, range 21-64, 90.5% male. 52%(χ2= 33.4, df = 1, p = 0.001) described their health as poor, 90% (χ2= 61.85, df = 2, p = 0.001) smoked cigarette daily, 83.3% (χ2= 76.4, df = 3, p = 0.001) used drugs daily, 78.6% (χ2= 13.7, df = 1, p = 0.001) saw a doctor in preceding 6 months, 63.4% (χ2= 73.8, df = 3, p = 0.001) left school before age 16; 26.2% (χ2= 37.7, df = 3, p = 0.001) left school at 16, 11.9% (χ2= 33.1, df = 10, p = 0.001) encounterd criminal justice system at the age of 11, 28.6% (χ2= 60.8, df = 8, p = 0.001) had reprimand/caution or conviction at 17. ACES: 57% (χ2= 34.7, df = 3, p = 0.001) experienced humiliation by adults in their household; 54% (χ2= 30.7, df = 3, p = 0.001) threatening behaviour, 50% (χ2= 26.0, df = 3, p = 0.001) physical violence in their household. Conclusions These early stage preliminary results indicate that adverse social circumstances that occur in childhood are disproportionately represented in homeless population. Key messages Homelessness is more complex than the absence of accomodation. Adverse social circumstances that occur in childhood are disproportionately represented in homeless population.
    • Educating nurses to deliver optimum care to military veterans and their families.

      Finnegan, Alan P.; Di Lemma, Lisa; email: l.dilemma@chester.ac.uk; Moorhouse, Ian; email: i.moorhouse@chester.ac.uk; Lambe, Rachael E; email: rachael.lambe@outlook.com; Soutter, Ellen M; email: Ems1968@outlook.com; Templeman, Jenni; email: j.templeman@chester.ac.uk; Ridgway, Victoria; Hynes, Celia; email: celia.hynes1957@gmail.com; Simpson, Robin; email: Robin.Simpson120@mod.gov.uk; McGhee, Stephen; email: stephenmcghee@miami.edu (2019-11-09)
      The aim of the project was to help prepare the future nursing workforce to provide optimum care for the Armed Forces Community. Structured evidenced-based educational sessions were designed and then delivered at two Universities in England. This educational model included a flipped approach, didactic classroom teaching, blended learning, and information technology. Educational sessions were provided to 468 first year Bachelor of Nursing undergraduate students in 2017 and 2018. A mixed methods evaluation included a quasi-experiential design with pre and post-test data followed by research interviews conducted by student nurses and analysed using a modified Grounded Theory. Post session evaluation demonstrated a significant improvement in students' knowledge. 93% agreed that the training was useful, 95% felt that nurses should be aware of the healthcare needs of the Armed Forces Community, and 89% indicated that the subject matter should be included in the undergraduate curriculum. A qualitative theoretical model was built from four major clusters: the military community; student's identity, clinical engagement, and future practice. These educational sessions are being introduced into a growing number of United Kingdom Universities to create future nursing leaders with a better insight into the large and diverse Armed Forces Community. [Abstract copyright: Copyright © 2019 Elsevier Ltd. All rights reserved.]

      Eost-Telling, Charlotte L; Kingston, Paul; Taylor, Louise; Bailey, Jan (Oxford University Press (OUP), 2019-11-08)
      Abstract The Mass Observation Project, established in 1937, documents the lives of ordinary people living in the UK, and explores a wide range of social issues. The Project distributes a set of written questions (“Directives”) to a panel of 500 members of the British public (“Observers”) three times each year; “Observers” respond in writing. From the initial commissioning of a “Directive” to data becoming available for analysis takes between four to six months. This approach offers researchers an opportunity to capture in-depth qualitative data from individuals with a range of demographic backgrounds who live across the UK. As there are no word limits on “Observers’” responses and they remain anonymous, a “Directive” often yields rich, high-quality data. Additionally, compared with alternative methods of collecting large volumes of qualitative data from a heterogeneous population, commissioning a “Directive” is cost-effective in terms of time and resource.

      Bailey, Jan; Kingston, Paul; Taylor, Louise; Eost-Telling, Louise (Oxford University Press (OUP), 2019-11-08)
      Abstract This presentation will offer new and alternate insights into ‘scams’ and the health effects of fraud on older people. It reports data captured from a Mass Observation Project “Directive” focusing on scams and their impact on individuals. Eighty “Observers’” aged 50 and over responded to the “Directive”. Responses indicate that falling victim to a scam may have negative impacts on individuals’ mental wellbeing, self-esteem and relationships with others. Data analysis also identified that fear of victimisation can also affect individuals, resulting in worry, anxiety and maladaptive coping strategies. Offering a sociology of health perspective, we will focus is on these health impacts of scams and the legitimisation of the issue as a socio-political problem. We will also highlight additional important areas for consideration, such as the absence of a common understanding of the concept and nomenclature of ‘scam’, and the ‘vagaries of scams’ by presenting a typology of scams.

      Kingston, Paul; Taylor, Louise; Eost-Telling, Charlotte; Bailey, and Jan (Oxford University Press (OUP), 2019-11-08)
      Abstract This paper considers narratives of 143 respondents (“Observers”) to a Mass Observation Project Directive exploring individuals’ perceptions of dementia. Perceptions of dementia held by “Observers” with experience of dementia and those without differed sharply. “Observers” with experience of dementia offered insight into living with and caring for a person with dementia, and the impact this had on their lives and personal relationships. Whereas, “Observers” with no direct experience of dementia focused more on common disease symptoms such as memory loss and reflected idealised views of care. “Observers” often feared being diagnosed with dementia themselves. This suggests education to facilitate care planning and ameliorate fears held by the public is required.

      Kingston, Paul (2019-11-08)
      AbstractResponding to the opportunities and challenges of an ageing world the University of Chester established the Centre for Ageing, Mental Health and Veterans’ Studies in 2013 to provide research, consultancy and education, with the aim of promoting innovation in health and social care services for older people. This symposium brings together researchers from a wide range of disciplines and career stages, to explore the utility of Mass observation data in social research in the field of gerontology. The Mass Observation Project, established in 1937, documents the lives of ordinary people living in the UK, and explores a wide range of social issues. The symposium comprises four separate papers. The Methodological Relevance of Mass Observation Data: This preliminary overview will outline the mass observation archive, highlighting challenges and issues encountered utilising the data produced in social research. Personal Narratives of Ageing: This paper presents personal narratives reflecting on the ageing process, and growing older in the UK. The Health Impact of Scams: This presentation will offer new and alternate insights into ‘scams’ and the health effects of fraud on older people, using data from the mass observation directive commissioned by the centre. Perceptions of Dementia: This paper presents a perspective on the public knowledge and understanding about dementia not previously considered, where respondents have written openly about their own experiences, and reflected on their perception of the wider public’s knowledge and understanding about dementia.

      Taylor, Louise; Bailey, Jan; Kingston, Paul; Eost-Telling, Charlotte (2019-11-08)
      AbstractThis presentation reflects on self-written narratives from respondents to a mass observation directive, focusing on the experiences of growing older. Narrative methods are theoretically and methodologically diverse, and are helpful in social research to understand events or happenings in human lives. This data presents accounts from a heterogeneous sample in the form of self-penned responses. These experience-centred narratives bring stories of personal understanding into being by means of the first person description of past, present, future or imaginary experiences. This presentation will focus on the findings with reference to physical and mental impacts, both real and anticipated. We will also explore themes arising from the data including gender differences, age-cohort effects and stigma. The data can be used to inform Health and Social Care education and practice, particularly in co-producing appropriate person-centred services with older people.
    • Queering Blackpool: An Ethnographic Study

      Owens, Allan; Moran, Paul; Eadon-Sinkinson, Helen (University of ChesterUniversity of Chester, 2019-11)
      This research explores the notion of identity in relation to drag queens in the seaside town of Blackpool in the North West of England. What I describe is how this complex form of identity is composed not only from the appropriation and cultural manipulation of gendered tropes, in terms of behaviours, dress, and attitudes; but how identity is also composed from the socio-cultural place of Blackpool within the Northwest of England; and from specific genres of entertainment as they manifest in this sea-side town, which suffers from a high level of deprivation. The research employs qualitative data collection methods to build an understanding of how identity is created whilst exploring the ethnographic structure and representation of the town of Blackpool which is reflected in the analysis of the film through an autoethnographic lens. It becomes autoethnographic as it is my personal reaction to the research. I wanted to analyse my findings in terms of a qualitative visual ethnography and critical reportage, which takes the form of a short film which was an appropriate way to present the visual and socio-cultural representations of the data. Blackpool’s identity has been shaped by its raucous history. Early examples of dancing, drunken behaviour and prostitution at the Raikes Garden in the 1870s are documented by Walton (1998) as well as fairground style attractions and a rising number of cheap drinking establishments to cater for the influx of holidaymakers; all of which were difficult to police. Advertising the resort’s entertainment attracted more working-class visitors creating a more downmarket holiday resort which continues to this day. The working-class history of the town gives the resort a particular kind of focus. It also means that the town is vulnerable; it is vulnerable to economic market change, problems of poverty, and unemployment. Therefore, this thesis seeks to discuss the question: how is Blackpool’s social history reflected in both the town and drag performance spaces? This thesis uses the theory of Bakhtin’s Carnival (1984) to highlight certain aspects of the film in order to present the research through an appropriate theoretical lens as well as appropriate supporting literature throughout. I felt it appropriate to use Bakhtin, since even at the level of a superficial joke, Bakhtin’s work is located in celebration, freedom, holiday and the superficial preoccupations of historic and contemporary Blackpool. More significantly perhaps Bakhtin was interested in how the world, in these contexts, can be turned upside down, and what it means for order and identity to be essentially forms of performativity, a theme central to my own work around identity and place with respect to Blackpool. Due to the nature and disclosure of some participants I decided to present the data through the form of a film. Through the initial interview process, it became apparent that some identities needed to be hidden as a means of protecting both the participants and their families as sensitive details were 11 discussed, however their stories still needed to be told. To both explore and mitigate the problems that I have mentioned, visual ethnography seemed to offer both a solution and an interesting way to convey meaning that would otherwise be lost in text. By presenting the data in this way I am creating characters. This becomes unavoidable, rather like the drag queen performers who create characters, therefore I am paralleling that. By creating the characters that are heard and deliberately filming various aspects of Blackpool, I was able to join both person and place to create a visual means that represents the journey and exploration that I went through as a researcher and which further presents the data, as self and other, in the most appropriate way. When I use the word ‘trans,’ I am referring to transvestites, transsexuals and transgender people. Throughout this written part of this thesis, I will refer to the visual aspect as ‘the film.’
    • Elderly Persons Health and Wellbeing

      Ridgway, Victoria; University of Chester (2019-10-01)
      This chapter considers older persons’ health and wellbeing. As the world population changes there are global challenges to ensure that health and social care systems, individuals, communities and countries meet the needs of older people so that they are empowered to lead active and connected later lives. However, these opportunities are heavily dependent on two fundamental characteristics that of good health and wellbeing and healthy ageing. The conceptualisation of ‘being old or older’ first needs to be considered. The use of 65 as a parameter to measure old age is a political and social construct. Baar et al. (2014) for example noted the tendency to use 60 to 65 as the entrance point to old age and although useful to establish understanding writers in the field of gerontology have argued against such use. Culturally older age can occur from 50 upwards (Baar et al. 2014) as consequence of poor health, education, financial situation and environment and there is no typical older person (World Health Organisation (WHO) 2018a). Other authors have defined no age categorisation boundaries but have referred to a third and fourth age. The third age being conceptualised as a life period full of opportunity and good health and wellbeing, whilst the fourth age is perceived as a period of decline, increasing dependency and ultimately death (Higgs and Gilleard 2015). Therefore, being older is difficult to define and for this chapter 60 will be used as a ‘marker of old age’. There are two lenses from which society view and perceive older people, first by some they are considered a burden, a drain on resources and are less valued. Alternatively, older people are considered wise, dependable individuals who contribute to society, local communities and family life. The increasing older demographic has both immense potential for society but also comes with challenges. This chapter will explore population growth, perceptions of ageing, health and wellbeing in later life, factors that negate against healthy ageing and will end with preventive strategies
    • Workplace Health and Well-Being

      Massey, Alan; University of Chester (Springer Nature, 2019-09-06)
      The problems related to the process of industrialisation such as biodiversity depletion, climate change and a worsening of health and living conditions, especially but not only in developing countries, intensify. This chapter looks at the role of workplaces in the drive for global sustainability through the World Health Organisations healthy workplace framework
    • The criminal justice voluntary sector: concepts and an agenda for an emerging field

      Tomczak, Philippa; Buck, Gillian; University of Nottingham; University of Chester (The Howard League and John Wiley & Sons Ltd, 2019-09-04)
      Volunteers and voluntary organisations play significant roles pervading criminal justice. They are key actors, with unrecognised potential to shore up criminal justice and/or collaboratively reshape social justice. Unlike public and for-profit agents, criminal justice volunteers and voluntary organisations (CJVVOs) have been neglected by scholars. We call for analyses of diverse CJVVOs, in national and comparative contexts. We provide three categories to highlight distinctive organising auspices, which hold across criminal justice: statutory volunteers, quasi-statutory volunteers and voluntary organisations. The unknown implications of these different forms of non-state, non-profit justice involvement deserve far greater attention from academics, policymakers and practitioners.
    • Politicisation or Professionalisation? Exploring divergent aims within UK voluntary sector peer mentoring

      Buck, Gillian; University of Chester (Wiley, 2019-09-04)
      Meaningful ‘user involvement’ is an established aim of social work practice, and increasingly, an aspiration of criminal justice, yet there are unique challenges to participatory work within punitive contexts. Drawing upon a study of peer mentoring in the voluntary sector, this article unveils some core tensions related to (ex)service user involvement in criminal justice. Interviews with mentors, mentees, and key stakeholders, along with direct observations of practice, reveal that respondents often see their work as personal-political, emphasising the value of lived expertise and of collective action to address limiting social conditions. Simultaneously, however, mentoring is framed nationally and shaped locally by more established aims to correct, improve, and manage, individual ‘offenders’. There is, therefore, a fundamental tension between processes of politicisation, or coming together to assert a user voice and affect social change; and professionalisation, wherein mentors are co-opted into forms of practice they often critique.
    • Common causes of EID sample rejection in Zimbabwe and how to mitigate them

      editor: Torpey, Kwasi; Chiku, Charles; orcid: 0000-0003-3455-598X; email: charleschiku@gmail.com; Zolfo, Maria; Senkoro, Mbazi; Mabhala, Mzwandile A.; Tweya, Hannock; Musasa, Patience; Shukusho, Fungai D.; Mazarura, Exervia; Mushavi, Angela; et al. (Public Library of Science, 2019-08-08)
      Early infant diagnosis (EID) of HIV provides an opportunity for early HIV detection and access to appropriate Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of exposed infants, born to HIV-positive mothers. However, DBS rejection rates in Zimbabwe have been exceeding the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL), in Harare. The aim of this study was to determine the DBS sample rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the samples were collected. This is an analytical cross-sectional study using routine DBS sample data from the NMRL in Harare, Zimbabwe, between January and December 2017.A total of 34 950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected. Reasons for rejection were insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross-contamination (6%), mismatch of information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities were five times more likely to be rejected compared to those from a central hospital. Rejection rates were above the set target of <2%. The reasons for rejection were ‘pre-analytical’ errors including labelling errors, missing or inconsistent data, and insufficient blood collected. Samples collected at primary healthcare facilities had higher rejection rates.
    • Use of storytelling and audio podcasts in qualitative research

      Sutton, Julie E.; University of Chester (RCNI, 2019-08-01)
      The author discusses the use of service user story telling through the medium of audio podcasts, in service evaluation. The author argues this is an effective way to promote service user participation in service improvement projects and highlights how audio podcasts can stimulate emotional connections in service evaluators leading to informed identification of priorities for change