• Behavioural and neurochemical responses evoked by repeated exposure to an elevated open platform

      Storey, J.; Robertson, Deborah A. F.; Beattie, J. E.; Reid, I. C.; Mitchell, S.; Balfour, David J. K.; University of Chester (Robertson) (Elsevier, 2011-01-18)
      This article investigated the changes in 5-HT release and turnover in the hippocampus evoked by acute and repeated exposure to an inescapable stressor, an elevated open platform, and compared them to the changes evoked in the frontal cortex.
    • The biopsychosocial benefits and shortfalls for armed forces veterans engaged in archaeological activities

      Finnegan, Alan; University of Chester (Elsevier, 2016-03-19)
      Background Organised outdoor activates are advocated as promoting multiple benefits for a veteran's wellbeing, of whom up to 50% have suffered either/both physical and mental health (MH) problems. This has resulted in significant investment in a growing number of outdoor events, one of which is the Defence Archaeology Group (DAG) which utilise the technical and social aspects of field archaeology in the recovery and skill development of injured veterans. Objective To advance knowledge within veterans MH and wellbeing through an understanding of the potential long term psychological benefits and shortfalls for veterans undertaking DAG activities. Design A constructivist grounded theory approach was used to enable identification of the issues from the participant veteran's perspective. Setting: DAG archaeological excavations in April and August 2015. Method Semi-structured interviews with 14 veterans. Results The qualitative coding resulted in the indication of 18 categories subsumed within four clusters: motivation and access; mental health; veteran and teamwork; therapeutic environment and leadership. Discussion The psychological benefits were improved self-esteem, confidence, a reduction in stigma and motivation to seek help. The reduction in situational stressors associated with difficult life conditions also appeared to improve mood, and there was a clear benefit in being in a caring environment where other people actively paid an interest. There were extended social benefits associated with being accepted as part of a team within a familiar military environment, which presented an opportunity to establish friendships and utilise military skill sets. Conclusion Organised outdoor activities offer multi-factorial hope for veterans searching for ways to ease the transition to civilian life and recover from military stress and trauma. The relaxing and reflective environment within a military setting appears to construct a sense of personal safety and thereby offers therapeutic value.
    • The Challenges and Psychological Impact of Delivering Nursing Care within a War Zone

      Finnegan, Alan; Lauder, William; McKenna, Hugh; University of Chester; University of South Florida; University of Ulster (Elsevier, 2016-06-03)
      Background. Between 2001 and 2014, British military nurses served in Afghanistan caring for both Service personnel and local nationals of all ages. However, there have been few research studies assessing the psychological impact of delivering nursing care in a War Zone hospital. Purpose. To explore the challenges and psychological stressors facing military nurses in undertaking their operational role. Method. A Constructivist Grounded Theory was utilised. Semi-structured interviews were conducted with 18 British Armed Forces nurses at Camp Bastion Hospital, Afghanistan, in June - July 2013. Discussion. Military nurses faced prolonged periods of caring for seriously injured poly trauma casualties of all ages, and there were associated distressing psychological effects and prolonged periods of adjustment on returning home. Caring for children was a particular concern. The factors that caused stress, both on deployment and returning home, along with measures to address these issues such as time for rest and exercise, can change rapidly in response to the dynamic flux in clinical intensity common within the deployable environment. Conclusion. Clinical training, a good command structure, the requirement for rest, recuperation, exercise and diet were important in reducing psychological stress within a War Zone. No formal debriefing model was advocated for clinical staff who appear to want to discuss traumatic incidents as a group and this may have contributed to stigma and nurses' feeling isolated. On returning home, military nurses reported being disconnected from the civilian wards and departments. The study raised the question of who cares for the carers, as participants reported a perception that others felt that they should be able to cope without any emotional issues. It is envisioned that the results are transferable internationally to nurses from other Armed forces and will raise awareness with civilian colleagues.
    • Characteristics and Values of a British Military Nurse. International Implications of War Zone Qualitative Research

      Finnegan, Alan; Finnegan, Sara; McKenna, Hugh; McGhee, Stephen; Ricketts, Lynda; McCourt, Kath; Warren, Jeremy J.; Thomas, Mike; University of Chester; Heath Lane Medical Practice; University of Ulster; University of South Florida; British Army; University of Northumbria; University of Chester; UCLan (Elsevier, 2015-08-01)
      Background. Between 2001 and 2014, British military nurses served in Afghanistan caring for both Service personnel and local nationals of all ages. However, there have been few research studies assessing the effectiveness of the military nurses’ operational role and no papers naming the core values and characteristics. This paper is the only qualitative nursing study completed in this period where data was collected in the War Zone. Objective. To explore the characteristics and values that are intrinsic to military nurses in undertaking their operational role. Design. A Constructivist Grounded Theory was utilised. The first author designed the interview schedule, then following a pilot study, conducted and transcribed the discussions. Informed consent and UK Ministry of Defence Research Ethical Committee approval was obtained. Setting. Camp Bastion Hospital, Afghanistan, in 2013. Method. Semi-structured interviews were conducted with 18 British Armed Forces nurses. Results. A theoretical model was developed that identifies the intrinsic characteristics and values required to be a military nurse. Nursing care delivered within the operational environment was perceived as outstanding. Nurses consciously detached themselves from any legal processes and treated each casualty as a vulnerable patient, resulting in care, compassion and dignity being provided for all patients, irrespective of their background, beliefs or affiliations. Conclusion. The study findings provides military nurses with a framework for a realistic personal development plan that will allow them to build upon their strengths as well as to identify and ameliorate potential areas of weakness. Placing nurses first, with a model that focusses on the requirements of a good nurse has the potential to lead to better patient care, and improve the quality of the tour for defence nurses. These findings have international implications and have the potential for transferability to any level of military or civilian nursing practice.
    • Comparing time use in individuals at different stages of psychosis and a non-clinical comparison group

      Hodgekins, Jo; French, Paul; Birchwood, Max; Mugford, Miranda; Christopher, Rose; Marshall, Max; Everard, Linda; Lester, Helen; Jones, Peter B.; Amos, Tim; et al. (Elsevier, 2014-12-23)
      Social functioning difficulties are a common and disabling feature of psychosis and have also been identified in the prodromal phase. However, debate exists about how such difficulties should be defined and measured. Time spent in structured activity has previously been linked to increased psychological wellbeing in non-clinical samples and may provide a useful way of assessing social functioning in clinical settings. The current study compared weekly hours in structured activity, assessed with the Time Use Survey, in three clinical groups at different stages of psychosis: individuals with at-risk mental states (N = 199), individuals with first-episode psychosis (N = 878), and individuals with delayed social recovery following the remission of psychotic symptoms (N = 77). Time use in the three clinical groups was also compared with norms from an age-matched non-clinical group (N = 5686) recruited for the Office for National Statistics UK 2000 Time Use Survey. Cut-off scores for defining social disability and recovery were examined. All three clinical groups spent significantly fewer hours per week in structured activity than individuals in the non-clinical group. Reduced activity levels were observed before the onset of psychosis in individuals with at-risk mental states. Additional reductions in activity were observed in the first-episode psychosis and delayed recovery groups compared to the at-risk mental state group. Assessing time spent in structured activity provides a useful way to assess social disability and recovery across the spectrum of psychosis.
    • Concept analysis as a dissertation methodology

      Baldwin, Moyra A.; Rose, Pat; University of Chester (Elsevier, 2009-05-10)
      This paper introduces the concept of the dissertation as an experiential method of learning about research. Undertaking a dissertation can be seen as proof of graduate-ness and the gold standard of undergraduate and postgraduate assessment. The skills demanded in research and concept analysis are compared. The requirements of demonstrating rigour and scholarship in dissertations, usually associated with traditional research methods, are shown to be present in concept analysis. There is a justification for concept analysis as a dissertation research method on the basis that the purpose of research is to expand a body of knowledge through a process of systematic and scientific enquiry. Institutions in which dissertation modules are studied have a responsibility to cultivate a research culture that encourages creativity. The dissertation is an opportunity for students to move away from the security associated with traditional methods of research: to engage with novel and sophisticated methods.
    • Conflict resolution for student midwives

      Steen, Mary; University of Chester. (Elsevier, 2011-03)
      Poor working relationships, aggressive behaviour and bullying within the midwifery profession are a common phenomenon, with student midwives reporting that they have either experienced or witnessed this within their clinical or educational environments. There is a need to address this unpleasant phenomenon and one way is to introduce conflict resolution strategies. This article describes and discusses how the Start Treating Others Positively (STOP) model has been adapted to develop an educational workshop to assist student midwives in enhancing and developing skills to manage conflict in their working and learning environments.
    • The course of negative symptom in first episode psychosis and the relationship with social recovery

      Gee, Brioney; Hodgekins, Jo; Fowler, David; Marshall, Max; Everard, Linda; Lester, Helen; Jones, Peter B.; Amos, Tim; Singh, Swaran P.; Sharma, Vimal; et al. (Elsevier, 2016-04-28)
      AIMS: To investigate trajectories of negative symptoms during the first 12months of treatment for first episode psychosis (FEP), their predictors and relationship to social recovery. METHOD: 1006 participants were followed up for 12months following acceptance into Early Intervention in Psychosis services. Negative symptom trajectories were modelled using latent class growth analysis (LCGA) and predictors of trajectories examined using multinomial regression. Social recovery trajectories - also modelled using LCGA - of members of each negative symptom trajectory were ascertained and the relationship between negative symptom and social recovery trajectories examined. RESULTS: Four negative symptom trajectories were identified: Minimal Decreasing (63.9%), Mild Stable (13.5%), High Decreasing (17.1%) and High Stable (5.4%). Male gender and family history of non-affective psychosis predicted stably high negative symptoms. Poor premorbid adolescent adjustment, family history of non-affective psychosis and baseline depression predicted initially high but decreasing negative symptoms. Members of the Mild Stable, High Stable and High Decreasing classes were more likely to experience stably low functioning than the Minimal Decreasing class. CONCLUSIONS: Distinct negative symptom trajectories are evident in FEP. Only a small subgroup present with persistently high levels of negative symptoms. A substantial proportion of FEP patients with elevated negative symptoms at baseline will achieve remission of these symptoms within 12months. However, elevated negative symptoms at baseline, whether or not they remit, are associated with poor social recovery, suggesting targeted interventions for service users with elevated baseline negative symptoms may help improve functional outcomes.
    • Editorial. Nurse Education Today Veterans' Special Issue

      Finnegan, Alan; University of Chester (Elsevier, 2016-07-25)
      Editorial from the Nurse Education Today Military Veterans Special Issue
    • Educating nurses to deliver optimum care to military veterans and their families

      Finnegan, Alan; Di Lemma, Lisa; McGhee, Stephen; University of Miami; University of Chester
      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.
    • Educating nurses to provide better care for the military veteran and their families

      Finnegan, Alan; McGhee, Stephen; Leach, Johathan; University of Chester, University of South Florida, NHS England (Elsevier, 2017-05-03)
      Reports that military veterans do not divulge details of their military experiences because others “do not understand” has been accepted for too long. Veterans and their families require a nursing workforce that are knowledgeable of the specific demands associated with a military life, and who are educated and empowered to discuss these issues in a language that the veteran population understand. USA have taken steps to address this challenge through academic programmes that systematically teach nurses how to be pro-actively engaged in improving veteran’s health and wellbeing. These lessons are being absorbed into fully evaluated under-graduate nursing sessions being developed at the University of Chester that will ensure under-graduate nursing students gain the requisite knowledge and understanding of veteran health and social care.
    • An exploration of issues related to nurse led clinics

      Flynn, Sandra D.; Whitehead, Elizabeth; Countess of Chester NHS Foundation Trust ; University of Chester (Elsevier, 2006-05-16)
      This article discusses nurse-led clinics and subsequent problems relating to professional boundaries and role tensions. Other professions may feel uncomfortable with nurse-led clinics and this can lead to distancing and conflict. The article identifies certain issues and discusses ways in which they can be managed in a more constructive manner.
    • Knowledge translation and the power of the nursing academic conference

      Finnegan, Alan; McGhee, Stephen; Roxburgh, Michelle; Kent, Bridie; University of Chester; University of South Florida; University of Highlands and Islands; University of Plymouth (Elsevier, 2018-11-08)
      The national and international conference experiences present a unique learning opportunity. There are differing events that reflect the full nursing employment spectrum from clinical delivery, organizational and policy development and academia in education and research. Many conferences provide a platform for academics with differing levels of experience to come together and welcome contributions from students and all grades of post-registration nurses, educationalists, administrators, and researchers. In selecting the programme, the conference organisers will often circulate a calling notice and potential presenters will submit their abstracts to be blind peer reviewed. Therefore, conferences showcase the best of the best and provide the current perspective of areas of growth within the nursing sector. Conferences have a plethora of delivery routes ranging from posters, oral presentations (both short and long), panel discussions, key notes, seminars, exhibitions and workshops. These present an exceptional chance to listen, present, network and discuss nursing innovation and academic research.
    • Maintaining a safe environment

      Chapman, Hazel M.; Whittam, Susan; University of Chester (Elsevier, 2019-03-30)
      INTRODUCTION Managing our own safety is thought to be a basic survival skill, which all individuals possess. We are not aware of managing our physiological homeostasis (for example, ensuring that our body cells are supplied with sufficient oxygen to produce the energy they need to function), and spend years learning to calculate and avoid risk from the external environment, The ability to control safety, including physiological homeostasis, and using physical ability and intellectual ability to manage risk, depends on a person’s stage in their lifespan development, their physical and mental wellbeing, their cognitive ability and the ability to control environmental factors such as housing, traffic, pollutants and even conflict. Throughout the world there are many differences in the types of hazards and risks that people are exposed to and just as many differences in the way that people manage their own safety. The inclusion of this AL in the Roper et al (1996, 2000) model is to draw your attention to the importance of being able to recognise the threats that exist to human survival and wellbeing and identify the impact that this may have upon any individual at any given time in their lives. In order to develop the knowledge that you need to apply it to your nursing practice, you will also need to read about the underlying physiology (how the body functions), pathophysiology (the disease process), psychology (thoughts, feelings and behaviours) and nursing practice in more depth. Several health psychology and psychology for nursing texts are referred to throughout this chapter, but physiology, pathophysiology and nursing practice are underpinned by core texts (Brooker & Nicol, 2011; Waugh & Grant, 2014). By understanding the processes involved in maintaining a safe internal and external environment for the person, you will learn to assess risk and plan care to maintain the safety of your patients. The model helps us to develop our understanding by focusing upon three key areas: • the human body's ability to protect itself and the biological mechanisms that it employs to carry this out • the ability that individuals have to make choices and take action to keep safe and free from danger • the identification and understanding of the dangers and hazards that exist in the surrounding environment (including the health care environment) and how they pose a threat to individual safety and wellbeing. These three areas will be discussed throughout this chapter within the framework of the model and will help to develop an understanding of the AL and enable nursing interventions to be as individualised and effective as possible. Often concern for our own health and safety only becomes heightened when we become ill, have an accident or hear about a tragedy or event that has had terrible human consequences. However, patient safety is essential for high quality health care, and a requirement in the United Kingdom Code for Nurses, Midwives and Health Visitors (Nursing and Midwifery Council, 2015) is to make the care and safety of people our main concern. Therefore, in nursing, we need to be able to assess and prevent risk, whether it arises from the person’s own health needs, or from the care we give and the way in which we give it. By using the framework of the Roper et al (1996, 2000) model in the following way we can begin to examine and identify how complex and varied health and safety issues really are and also identify the interrelatedness that exists between the other ALs. This chapter will therefore focus on the following: 1 The model of living • maintaining a safe environment in health and illness across the lifespan • dependence and independence in the activity of maintaining a safe environment • factors influencing the activity of maintaining a safe environment. 2 The model for nursing • the nursing care of individuals with health problems that affect their ability to undertake the activity of maintaining a safe environment • understanding of the hazards in the health care setting and how to promote patient safety effectively
    • Mentoring student nurses in Uganda: a phenomenological study of mentors’ perceptions of their own knowledge and skills.

      Mubeezi, Mary; Gidman, Janice; Uganda Nurses Council, University of Chester (Elsevier, 2017-07-29)
      This paper will report on the findings of a qualitative research study exploring mentorship in a rural hospital in Uganda. It explored how mentors perceived their roles and their own knowledge and skills in mentoring nurse students. Participants were confident in their ability to teach clinical skills, but they identified gaps in relation to the application of theory to these skills and they identified the need to update their own knowledge and to act more on their own initiative. The paper reports on the nature of the relationship between mentor and students, the teaching approaches used and the challenges of the role. Recommendations are proposed to develop a bespoke Ugandan curriculum to prepare mentors for their role, and to provide additional support, to enhance students’ experiences of learning in this context.
    • A narrative review of fathers’ involvement during labour and birth and their influence on decision making

      Longworth, Mary K.; Furber, Christine; Kirk, Susan; University of Manchester (Elsevier, 2015-06-14)
      Objective to identify and critically review the research literature that has examined fathers׳ involvement during labour and birth and their influence on decision making. Design the review follows the approach of a narrative review. Systematic searches of electronic databases Social Services Abstract, Sociological Abstracts, ASSIA, CINAHL Medline, Cochrane library, AMED, BNI, PsycINFO, Embase, Maternity and Infant care, DH-Data and the Kings Fund Database were combined with manual searches of key journals and reference lists. Studies published between 1992 and 2013 examining fathers׳ involvement during intrapartum care were included in the review. Findings the findings of this review suggest that fathers׳ level of involvement during labour ranges from being a witness or passive observer of labour and birth to having an active supporting and coaching role. The findings also suggest that there are a number of facilitators and barriers to fathers׳ involvement during labour and birth. There are a limited number of studies that have examined fathers׳ involvement in decision making and specifically how fathers׳ influence decision making during labour and birth. Key conclusions future research needs to address the gap in the literature regarding fathers׳ involvement and influence on decision making to help midwives and obstetricians understand the process in order enhance the transition to parenthood for women and men.
    • Not-patient and not-visitor: A metasynthesis of fathers’ encounters with pregnancy, birth and maternity care

      Steen, Mary; Downe, Soo; Bamford, Nicola; Edozien, Leroy; University of Chester ; University of Central Lancashire ; St Mary's Hospital, Manchester (Elsevier, 2011-08-06)
      The active engagement of fathers in maternity care is associated with long-term health and social benefits for the mother, baby and family. This study's aim was to identify and synthesise good quality qualitative research that explores the views and experiences of fathers who have encountered maternity care in high resource settings. A pre-determined search strategy identified 23 papers published between January 1999 and January 2010. Analysis was based on the metaethnographic techniques of Noblit and hare (1988) as amended by Downe et al, (2007). The emerging themes were: risk and uncertainty, exclusion, fear and frustation, the ideal and the reality, issues of support and experiencing transition.The following synthesis was generated from these themes:Most fathers in the included studies saw themselves as partner and parent, with a strong desire to support their partners and to be fully engaged with the process of becoming a father. However, the experience of maternity care was often as not-patient and not visitor. This situated them in an interstitial and undefined space (both emotionally and physically) with the consequence that many felt uncertain, excluded and fearful.
    • Pre-admission nursing assessment in a Welsh medium secure unit (1991–2000): Part 1 - an analysis of practice and cost

      Watt, Andrew; Topping-Morris, Barry; Mason, Tom; Rogers, Paul; Institute of Cardiff, University of Wales ; Caswell Clinic, Glanrhyd Hospital ; Glanrhyd Hospital / University of Glamorgan / Chester College of Higher Education ; Institute of Psychiatry / Glanrhyd Hospital (Elsevier, 2003-04-16)
      This article discusses the practice of pre-admission assessments and details a method for estimating the cost of forensic nursing assessments in terms of the investment of nursing time.
    • Preparing British Military nurses to deliver nursing care on deployment. An Afghanistan Study.

      Finnegan, Alan; Finnegan, Sara; Bates, David; Ritsperis, Debra; McCourt, Kath; Thomas, Mike; University of Chester (Elsevier, 2015-01-05)
      Background: This paper forms part of the first British Armed forces qualitative nursing research study undertaken on deployment. Aim: To provide an analysis of the impact and effectiveness of the pre-deployment educational preparation and clinical placements provided for military nurses. Theory & methods: A Constructivist Grounded Theory was utilised with data collected through semi-structured interviews with 18 nurses based in Camp Bastion Hospital, Afghanistan during 2013. Results: Initial coding indicated 21 educational preparation and clinical placement categories that influenced the delivery of nursing care. Analysis of these elements led to the identification of four major clusters: Military Nursing Care; Military Nurse Education; Unique Hospital Environment and Clinical Placements. Discussion: Educational preparation consists of completing deployable operational nursing competencies, specialist training and individual tailored courses. This strategywas viewed as proving the appropriate academic requirement. However, training would be enhanced by introducing a formalised military preceptorship programme focussing on fundamental nursing skills. Caring for children was a particular concern, and it was emphasised that educational courses must be combined with a standardised clinical placement policy. Adequate clinical exposure can be challenging as nurses are not routinely exposed to War Zone levels of trauma in the UK. Clinical placements need to be standardised and harmonised, and located in areas where nurses cared for patientswith similar injury patterns to thosewitnessed on deployment. Current NHS Trust placements can reduce the opportunities for employment in suitable clinical environments and diminishing the openings for collective military training. Better use should bemade of clinical rotation programmes, including high dependency units, elective surgery, medical assessment units, paediatrics, and outreach teams such as burns and plastic surgery and pain management. Practice Educators should be utilised to provide education, mentorship, supervision and continuing personal development in the operational arena. The paper considers post-Afghanistan future options.
    • The presentation of depression in the British Army

      Finnegan, Alan; Finnegan, Sara; Thomas, Mike; Deahl, Martin; Simpson, Robin; Ashford, Robert; University of Chester (Elsevier, 2014-01-01)
      Background The British Army is predominately composed of young men, often from disadvantaged backgrounds, in which Depression is a common mental health disorder. Objectives To construct a predictive model detailing the presentation of depression in the army that could be utilised as an educational and clinical guideline for Army clinical personnel. Method and Participants Utilising a Constructivist Grounded Theory, phase 1 consisted of 19 interviews with experienced Army mental health clinicians. Phase 2 was a validation exercise conducted with 3 general practitioners. Results Depression in the Army correlates poorly with civilian definitions, and has a unique interpretation. Conclusion Young soldiers presented with symptoms not in the International Classification of Disorders and older soldiers who feared being medically downgraded, sought help outside the Army Medical Services. Women found it easier to seek support, but many were inappropriately labelled as depressed. Implications include a need to address the poor understanding of military stressors; their relationships to depressive symptoms and raise higher awareness of gender imbalances with regard to access and treatment. The results have international implications for other Armed forces, and those employed in Young Men's Mental Health. The results are presented as a simple predictive model and aide memoire that can be utilised as an educational and clinical guideline. There is scope to adapt this model to international civilian healthcare practice