• 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)
    • Anxiety and Compulsion Patterns in the Maintenance of Bingeing/Purging

      Thomas, Mike; Lovell, Andy; University of Central Lancashire; University of Chester (Wiley, 2014-09-12)
      This paper reports on the results of a study into the self-reported coping strategies employed by a small sample (n=12) of individuals diagnosed with Bulimia Nervosa purging sub-type, severe and enduring eating disorder (Seed-BN), referred to an out-patient clinic for psychotherapy. Data collection focused on the vomiting activities of participants through analysis of their self-management from diary extracts, which recorded vomiting patterns. Participants all experienced significant mental health issues, had complex histories of BN over a prolonged period, difficulties maintaining relationships, and many had an additional history of substance misuse including dependence on prescription drugs. The study findings indicated two different self-management strategies, anxiety-containment and compulsion-maintenance. There was a clear association between anxiety and controlled weekly vomiting patterns compared with compulsion and daily vomiting patterns. The implications for nursing practice relate to the potential for assessment of differences in vomiting patterns to indicate self-management status and subsequent interventions focusing on either anxiety or compulsive patterns.
    • Clinical supervision and burnout: The influence of clinical supervision for community mental health nurses

      Edwards, Deborah; Burnard, Philip; Hannigan, Ben; Cooper, Linda; Adams, John; Juggessur, Tara; Fothergill, Anne; Coyle, David L.; Cardiff University; University of Glamorgan; University College Chester (Wiley, 2006-08-01)
      This article discusses a study which aimed to establish the degree to which clinical supervision might influence levels of reported burnout in community mental health nurses in Wales
    • Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance

      Radhakrishnan, Muralikrishnan; McCrone, Paul; Lafortune, Louise; Everard, Linda; Fowler, David; Amos, Tim; Freemantle, Nick; Singh, Swaran P.; Marshall, Max; Sharma, Vimal; et al. (Wiley, 2017-08-31)
      Introduction Early Intervention Services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost-effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG). Methods EIS from the National Eden Study were assessed using a measure of fidelity to the PIG that rated the presence or absence of 64 recommended items relating to team structure and practice. EIS were then classified into three groups: those with fidelity of 75-80 %, 81%-90 %, and 91-95 %. Patient-level resource use and outcomes were measured one year following inception into the service; costs were calculated and combined with quality-adjusted life years (QALYs) gained. Results At a threshold of £20,000 per QALY, the 81-90% fidelity group had a 56.3% likelihood of being the most cost-effective option followed by 75-80% fidelity at 35.8% and 91-95% fidelity group (7.9%). Conclusions The results from England suggest that striving to maximise fidelity may not be warranted, but that dropping below a certain level of fidelity may result in inefficient use of resources.
    • Development and psychometric testing of the online Adolescent Diabetes Needs Assessment Tool (ADNAT)

      Cooper, Helen; Spencer, Joy; Lancaster, Gillian A.; Titman, Andrew; Johnson, Mark; Wheeler, Sarah; Lwin, Rebekah; University of Chester ; University of Chester ; Lancaster University ; Lancaster University ; Bolton University ; University of Chester ; University of Chester (Wiley, 2013-09-03)
      Aim: To report on the development and psychometric testing of the Adolescent Diabetes Needs Assessment Tool. Background: The UK has the fifth largest paediatric diabetes population in the world, but one of the poorest levels of diabetes control, highlighting the need for intervention development. Design: Mixed methods following recommendations for questionnaire design and validation. Methods: A total of 171 young people (12–18 years) participated between 2008– 2011. Methods included item selection using secondary framework analysis, item review, pre-testing, piloting and online transfer. Statistical tests assessed reliability using item-total correlations, interitem consistency and test–retest reliability; and validity using blood glucose (HbA1c) levels and the Self-Management of type 1 Diabetes in Adolescence questionnaire. Results: The Adolescent Diabetes Needs Assessment Tool consists of 117 questions divided between six domains of educational and psychosocial support needs. It combines reflective questioning with needs assessment to raise self-awareness to support adolescent decision-making in relation to diabetes self-care. Thirty-six of the questions provide self-care and psychosocial health assessment scores. Face and content validity of the scoring items were all positively evaluated in terms of appropriateness and readability and tests for validity found significant correlations with Self-Management of type 1 Diabetes in Adolescence and weak correlation with HbA1c, which compared favourably with Self-Management of type 1 Diabetes in Adolescence, the only comparable (USA) tool. Item response analysis validated the use of simple additive scores. Conclusions: The Adolescent Diabetes Needs Assessment Tool combines reflective learning with needs assessment to support patient-centred clinical consultations.
    • Do health consultations for people with learning disabilities meet expectations? A narrative literature review

      Chapman, Hazel M.; Lovell, Andy; Bramwell, Ros; University of Chester (Wiley, 2018-04-06)
      Aim: To explore the benefits and disadvantages of annual health checks for people with learning disabilities, including: • What are the rationales and outcome measures for health checks? • How well do health checks meet the needs of people with learning disabilities? • What areas does research in this topic need to focus on in the future? Background Health consultations are an interpersonal activity that influence health outcomes and attitudes towards self and health professionals for people with learning disabilities. Annual health checks have been introduced to improve health inequalities for people with learning disabilities Method A narrative literature review of health care for people with learning disabilities was undertaken to evaluate health care for this population, and specifically the outcomes from annual health checks. Findings: While annual health checks have made some improvements in terms of health outcomes, attendance for appointments is still low, provision is variable and experiences of health checks for people with learning disabilities are under-researched. Conclusions: Service-user-led research into their health experiences is needed. Research into the attitudes and experiences of health professionals in relation to people with learning disabilities is needed. Health care inequalities are only being partially addressed – improvement is needed in terms of service user experience and engagement.
    • The effectiveness of a short cognitive behavioural training course on awareness, knowledge and transferability of competencies in clinical practice.

      Mitchell, Andrew E. P.; University of Chester (Wiley, 2015-09-21)
      PURPOSE: In this study we investigated the effects of training on knowledge acquisition and core competencies in CBT. DESIGN AND METHODS: Forty three students attended 15 half day, weekly sessions and were tested with the Cognitive Therapy Awareness Scale (CTAS) at weeks 1 and 15 in a before and after study. The students case studies were assessed with competencies items 7-12 on the Cognitive Rating Scale – Revised (CTS-R). FINDINGS: Improvements in the CTAS were modest. Key competencies on the CTS-R subscales at week 15 were also observed. PRACTICE IMPLICATIONS: CBT knowledge acquisition might improve patients’ outcomes through impact on competencies.
    • Experiences of sleep hygiene education as an intervention for sleep problems in children with developmental disabilities: Findings from an exploratory study.

      Sutton, Julie E.; Huws, Jaci C.; Burton, Christopher R.; University of Chester and Bangor University (Wiley, 2019-05-16)
      Behavioural sleep problems in children with developmental disabilities that involves advising parents on sleep‐promoting behaviours; however, it is supported by a limited evidence base. Materials and methods: This exploratory study aimed to enhance qualitative understanding and explore stakeholder perceptions about experience, current practice and ideas around the implementation of SHE. Parents of children with developmental disabilities and sleep problems (N = 9) and sleep practitioners (N = 11) took part in semi‐structured interviews and focus groups, and data were thematically analysed. Results and discussion: The analysis identified four parent themes: Beliefs about sleep problems; Getting professional help; Ways of knowing about sleep; and Visions of sleep support. Two practitioner themes were also identified: Sleep service accessibility and Inconsistent sleep support. Conclusion: The findings provide further insight into how parents of children with developmental disabilities experience sleep problems, and how SHE is currently implemented. These have implications for both policy and practice.
    • Factors influencing the effectiveness of clinical supervision

      Edwards, David R.; Cooper, Linda; Burnard, Philip; Hannigan, Ben; Adams, John; Fothergill, Anne; Coyle, David L.; University of Wales College of Medicine; University of Galmorgan; University College Chester (Wiley, 2005-08-01)
      This article reports findings from a study that aims to identify the factors that may influence the effectiveness of clinical supervision for community mental health nurses (CMHNs) in Wales.
    • Gaining employment: The experience of students at a further education college for individuals with learning disabilities

      Skellern, Joanne; Astbury, Geoff; University of Chester (Wiley, 2012-01-02)
      Employment is widely acknowledged as a key factor to social inclusion, but it is estimated that <7% of people with learning disabilities are in paid employment. It was the aim of the research study to critically examine the experience of gaining employment from the perspectives of students with learning disabilities, parents, education staff and employers. All participants were recruited from one collaborating UK organisation, a college offering further education for young people with learning disabilities. Twenty-three interviews were conducted. Analysis of the data identified three themes surrounding the perceived roles of: Protector, Rescuer and Worker. Recommendations are discussed to improve collaborative working between student, parent, education staff and employer to overcome some of the difficulties influencing employment rates and contribute to the empowerment and inclusion of people with learning disabilities in society.
    • The impact of prostate cancer on men's everyday life

      Appleton, Lynda; Wyatt, Debbie; Perkins, Elizabeth; Parker, Claire; Crane, Julie; Jones, Audrey; Moorhead, Lynne; Brown, Vanessa; Wall, Christine; Pagett, Marie; et al. (Wiley, 2014-09-10)
      Prostate cancer impacts on the daily lives of men, particularly their physical and emotional health, relationships and social life. This paper highlights how men cope with disease and treatment and the strategies they employ to manage their diagnosis alongside daily life. Twenty seven men were interviewed prior to radiotherapy and 6-8 and 12-18 months post radiotherapy, to explore how they managed their disease at different stages of their treatment pathway. A grounded theory approach was used to collect and analyse the data. Five main themes emerged: pathway to diagnosis; interpretation of the diagnosis; making sense of cancer in daily life; managing the impact of treatment and living with prostate cancer in the long-term. Prostate cancer was diagnosed using the PSA test, rectal examination and biopsy. Many men did not understand the consequences of a high PSA reading before they undertook the test. Painful investigative biopsies being viewed as the worst part of the disease experience. Radiotherapy was considered less invasive compared to other treatments, however preparatory regimes were often associated with stress and inconvenience. Men used various strategies to accommodate prostate cancer in the long-term, particularly when masculine identity was challenged as a result of bodily changes arising from treatment.
    • Impact of type of child growth intervention program on caregivers’ child feeding knowledge and practices: A comparative study in Ga West Municipality, Ghana

      Agbozo, Faith; Colecraft, Esi; Ellahi, Basma; University of Ghana; University of Chester (Wiley, 2015-12-02)
      Community-Based Growth Promotion (CBGP) delivered by community volunteers aims at enhancing the traditional Growth Monitoring and Promotion (GMP) programme delivered by community health nurses through the promotion of optimum infant and young child feeding (IYCF) leading to improved child growth. This study compared IYCF knowledge and practices among caregiver-child pairs (0-24 months) receiving child welfare services from CBGP (n=124) and GMP (n=108) programmes. Semi-structured questionnaires were used to interview caregivers on IYCF knowledge/practices and validated food frequency questionnaire used to record infants’ food intakes. Group differences were determined using Chi-square and independent samples t-tests (p<0.05; 95% CI). Mean IYCF knowledge scores were similar (CBGP:10.84±1.69 vs. GMP:10.23±1.38, p=0.062). However, more CBGP caregivers (17%) were highly knowledgeable than their GMP counterparts (5%) (p=0.011). Early breastfeeding initiation (CBGP:54% vs. GMP:28%, p<0.0001), exclusive breastfeeding (CBGP:73% vs. GMP:56%, p=0.001) and timely complementary feeding (CBGP:72% vs. GMP:49%, p=0.014) were reportedly higher among CBGP caregivers. Underweight was 11% (CBGP:8% vs. GMP:14%, p=0.154. Mean dietary diversity scores (10 food groups) were similar (CBGP:4.49±1.89 vs. GMP:3.87±1.89, p=0.057) but more CBGP caregivers (77%) achieved minimum dietary diversity than their GMP counterparts (61%) (p=0.035). Few caregivers achieved minimum meal frequency (CBGP:31% vs. GMP:29%, p=0.486) and minimum acceptable diet (CBGP:23% vs. GMP:21%, p=0.464) indicators. Number of children under 5 years owned by caregiver (AOR: 0.405; 95% CI: 1.13-78.53, p=0.038), her educational level (AOR: 0.112; 95% CI: 0.02-0.90, p=0.040) and IYCF knowledge (AOR: 0.140; 95% CI: 0.03-0.79, p=0.026) significantly predicted optimum child feeding. Nutrition education on optimum complementary feeding and birth spacing strategies should intensify.
    • Learning disability against itself: The self-injury/self-harm conundrum

      Lovell, Andy; University of Chester (Wiley, 2007-10-17)
      The article begins with a critical look at the existing literature explaining self-injury by people with significant learning disabilities and self-harm by those with mental health difficulties. It suggests that the different conceptualizations are perhaps less distinct than might initially appear, and that behavioural similarities between those with and those without learning disabilities might be greater than previously believed. The notion of 'career' is presented as a means of explaining the process by which people with learning disabilities engage in self-injury and subsequently integrate it into their lives. Data are subsequently presented from a number of life histories of people with learning disabilities to illustrate the development of self-injury over the life course. The findings of the research indicate that the development and consolidation of self-injury over time conforms to the expectations of a career and provides reason to question the contemporary separate categorization of the behaviour of people with significant learning disabilities. The evidence suggests that the relationship between self-injury and learning disability is best explicable in terms of its intelligibility, rational behaviour in the context of the individual's life.
    • Learning Disability Nursing in Secure Settings: Working with complexity

      Lovell, Andy; University of Chester (Wiley, 2017-01-04)
      This editorial argues that current changes in secure learning disability provision, particularly the twin imperatives to reduce in-patient beds and simultaneously restrict the use of physical interventions, have implications for direct nursing care. These implications revolve around the increased complexity of the backgrounds of those with a learning disability currently requiring secure care. Learning disability nursing needs to examine its skill and knowledge base and look seriously at the value of psychiatric nursing as a means of addressing current deficits.
    • Lived experiences of negative symptoms in first-episode psychosis: A qualitative secondary analysis

      Gee, Brioney; Hodgekins, Jo; Lavis, Anna; Notley, Caitlin; Birchwood, Max; Everard, Linda; Freemantle, Nick; Jones, Peter B.; Singh, Swaran P.; Amos, Tim; et al. (Wiley, 2018-03-24)
    • Mentor’s perceptions and experiences of support for nursing students

      McIntosh, Annette; Gidman, Janice; Smith, Debra; University of Chester (Wiley, 2013-08-23)
      This paper reports on a funded project that explored the perceptions and experiences of mentors regarding student nurse support in practice. The study employed a mixed-method approach, using questionnaires and focus groups with mentors from one acute Trust and one community Trust. The findings highlighted the multifaceted nature of student learning in practice, with mentors reporting that clinical skills, adjustment to the placement and integrating into the team were the aspects students needed most support with. Mentors were aware of their roles and responsibilities in supporting students and recognized the importance of their own personal attributes. The participants reported a number of challenges, particularly time, competing demands and paperwork, and suggested that a team approach and support groups could help to overcome these. The support for students provided by peers and health-care assistants was recognized, as was the need to ensure that students are prepared to take responsibility for their learning.
    • Mobile app: Living and dying well with dementia

      Bhattacharyya, Sarmishtha; Benbow, Susan M.; Collins, Eve; University of Chester (Wiley, 2017-08-31)
      Digital technology is gaining wider use in healthcare. Here the authors consider whether a mobile application (app) they have developed could help promote understanding of dementia, its impact on those affected and to focus formal and family carers on key issues in end of life care.
    • Narrative collisions, sociocultural pressures and dementia: the relational basis of personhood reconsidered

      Tolhurst, Edward; Weicht, Bernhard; Kingston, Paul; Staffordshire University; University of Innsbruck; University of Chester (Wiley, 2017-02-08)
      The concept of personhood developed by Tom Kitwood highlights that the experience of dementia has relational dimensions that transcend the neurodegenerative impacts of the condition. This relational focus, however, has been narrowly conceptualised, with the impact of broader sociocultural factors on experience underplayed. The empirical exploration of interaction also requires reinforcement: a tendency for dyadic studies to portray findings in an individualised format hinders the interrogation of interpersonal negotiations. This article draws upon qualitative research that employed a joint interview approach, interviewing men with dementia and their spousal carers together. The focus on a dyadic case study from this research enables methodical exploration of the experience of living with dementia. This is realised by considering the socially-framed perspective of each person, and then how their perspectives are interwoven within interactional exchanges. This provides a platform for the evaluation of the current decontextualised notion of personhood and its implications. It is concluded that a sociologically informed perspective can help to reinforce the academic understanding of personhood.
    • 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.