• A Retrospective Cross Sectional Study of the Effectiveness of a Project in Improving Infant Health in Bwindi, South Western Uganda.

      Kamugisha, S Robert; Dobson, Andrew E; Stewart, Alex G; Haven, Nahabwe; Mutahunga, Birungi; Wilkinson, Ewan (2018-10-12)
      Introduction: Low-cost community-based interventions to improve infant health potentially offer an exciting means of progressing toward the Sustainable Development Goals (SDGs). However, the feasibility of such interventions in low-income settings remains unclear. Bwindi Community Hospital (BCH), Uganda implemented a 3-year nurse-led community project to address child-health issues. Nurses supported Community Health Volunteers (CHVs) and visited mothers pre- and/or postnatally to assess and educate mothers and infants. CHVs gathered data and gave basic advice on health and hygiene to mothers. We hypothesized that increased interventions by nurses and CHVs and increased contact with households, would improve health and reduce infant mortality. Methods: This was a retrospective cohort study analyzing routine data of all children born between January 2015 and December 2016. There were three interventions: antenatal nurse visit, postnatal nurse visit and CHV participation. Children received different numbers of interventions. We defined four diverse outcomes: facility-based delivery, immunization completeness, nutritional status, and infant mortality. Odds ratios, adjusted odds ratios, and multivariate logistic regression were used to assess associations between interventions and outcomes. Results: Of the 4,442 children born in 2015 and 2016, 91% were visited by a nurse (81% antenatally and 10% postnatally); 7% lived in villages with a high participating CHV. Households receiving a postnatal visit were more likely to complete immunization (aOR: 1.55, p = 0.016) and have the infant survive (aOR: 1.90, p = 0.05). Children from a hard-to-reach village (no road access) were less likely to be delivered in a health facility (aOR: 0.55, p < 0.001) and less likely to survive in their first year (aOR: 0.69, p = 0.03). Having two or more interventions was associated with a child having all four positive outcomes (aOR 0.78, p = 0.03). Lack of baseline data, a control area, or integrated assessment data limited more detailed evaluation. Conclusion: Visits to mothers after birth, by a nurse to educate and identify child illness, were associated with lower infant mortality and improved infant health as measured by completion of immunizations. Community health interventions could potentially have a greater impact if focused on hard-to-reach areas. Building evaluation into all project designs, whether local or internationally funded, would enable greater learning, and hence better use of resources.
    • The abused perineum

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (Mark Allen Publishers, 1998-07)
      This article discusses whether too many second degree tears are being left to heal themselves, when in fact they should be sutured. There is a need for more research based evidence by randomised controlled trial to help with decisions as to the best treatment
    • Academic induction: Perceptions of newly appointed university lecturers in nurse education: An interpretive phenomenological inquiry

      Ashford, Ruth; Mansfield, Madeleine; Carr, Helen (University of Chester, 2019-01-11)
      Aims: Empirical evidence demonstrates successful expert nurses appointed as nurse lecturers in higher education find themselves as ‘newcomers’ to the role and organisation. New nurse lecturers often find their transition to higher education confusing and challenging. Using the conceptual framework of communities of practice, this study aims to provide original research into what induction means for new nurse lecturers, and gain an in-depth understanding of their perceptions and experiences of their induction into working in a multi-sited university. Method: A qualitative research methodology was employed, using the theoretical approach of Interpretive Phenomenological Analysis (IPA) developed by Smith, Flowers, and Larkin (2009). Eight lecturers, with between one to three years’ experience as nurse lecturers, were recruited from one university in the North West of England. Purposive sampling was utilised and data was obtained through one-toone semi-structured interviews. Verbatim transcripts were analysed following the principles of IPA. Findings: Three super-ordinate themes emerged (partial transition, dual communities of practice, introduction), along with six sub-ordinate themes (expectations of the nurse educator role, career change, contextual influences, location and culture of sites, tick box exercise, and the limited role of the mentor). New nurse lecturers found transition stressful: key aspects included the culture shock and the career change of adopting their new academic identity. Changing identity from a nurse to an educator, working across the boundaries of both practice and academia, was a struggle, particularly in participants with visiting lecturer experience who had mistakenly perceived this would prepare them for the role. Early role preparation was essential to understanding the different cultures and processes within the university. Formal mentoring supported development of self-confidence, but its value was undermined due to the mentors’ workload and lack of understanding of their role, which affected relationship building. Supportive heads of department, and informal mentoring and peer support, were essential in developing new academic identities. Conclusion: This study contributes to practice through the development of an induction framework for new nurse educators. This framework acknowledges the relevance of maintaining a dual community of practice for new nurse educators, in supporting their new identity and their dual continuing professional development. Practical outcomes include: development of an informational resource for new lecturers (including visiting lecturers); development of a community of learning with facilitated workshops and online information resources; development of mentor training and resources for mentors; and mentors being thoughtfully designated by heads of department, with hours attached to their workload for mentoring. A long term online community of practice is needed for new staff to keep in touch and share information. Heads of department need to take ownership of inductions to ensure that their staff feel welcomed and supported in their new environment, with regular evaluation taking place.
    • Academic staff development

      Marriss, Dorothy; University of Chester (SAGE, 2011)
      This book chapter discusses the cultural context of staff development in higher education; the importance of developing and maintaining the skills of eduators in healthcare; challengers for new educators; and career pathways.
    • Accelerated resolution therapy: an innovative mental health intervention to treat post traumatic stress disorder

      Finnegan, Alan; Kip, Kevin; Hernandez, Diego; McGhee, Stephen; Rosenweiz, Laney; Hynes, Celia; Thomas, Mike; University of Chester (British Medical Journal, 2015-07-03)
      Post-traumatic stress disorder (PTSD) is a disabling trauma and stress-related disorder that may occur after a person experiences a traumatic event, and evokes a combination of intrusion and avoidance symptoms, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Accelerated resolution therapy (ART) is an emerging psychotherapy that provides fast and lasting resolution for mental health problems such as PTSD. ART has been shown to achieve a positive result in one to five sessions, typically over a 2-week period, and requires no homework, skills practice or repeated exposure to targeted events. Initial research, including one randomised control trial, has demonstrated that ART interventions can significantly reduce symptoms of psychological trauma in both civilians and US service members and veterans. These results suggest that ART be considered as either a primary treatment option or for refractory PTSD in those with a suboptimal response to endorsed first-line therapies. Conservative estimates indicate substantial potential cost savings in PTSD treatment. Despite the need for more definitive clinical trials, there is increasing interest in ART in the USA, including in the US Army. The growing positive empirical evidence is compelling, and there appears to be sufficient evidence to warrant UK researchers undertaking ART research. The armed forces offer the potential for comparative international trials. However, equally important are veterans, emergency services personnel and those subjected to violence. ART appears to also have application in other conditions, including depression, anxiety disorders, and alcohol or drug misuse. ART can potentially help personnel traumatised by the unique challenges of war and conflict zones by providing brief psychotherapy in a readily accessible and culturally competent manner. ART facilitates the provision of interventions and resolutions in theatre, thus enhancing forces’ fighting capability.
    • Accountability

      Thomas, Mike; University of Chester (Sage, 2008)
      This chapter considers the concept of accountability within the nursing profession. It examines how the issue of accountability is no longer placed solely on the line manager and argues that the professional nurse or midwife is accountable for their actions at all times.
    • Adherence to treatment - a person-centred approach

      Phipps, Dianne; Bell, Sara; University of Chester (SAGE, 2009)
      This book chapter discusses reason why people do not adhere to their treatment regimens of advice.
    • Advocacy

      Baldwin, Moyra A.; University of Chester (Sage, 2008)
      This chapter examines the role of advocacy within the healthcare system, considering the need for advocates to support patients who have to make decisions but may not have the knowledge, confidence or ability to do so. The chapter also discusses the need for an advocate to promote and protect the patient’s autonomy and act on their behalf.
    • Agencies: Resources for adults with paliative care need in the UK

      Fruin, Helen; University of Chester (SAGE, 2011)
      This book chapter discusses voluntary sector agencies, private sector agencies, and statutory sector agencies concerned with palliative care.
    • Alleviating perineal trauma - the APT study

      Steen, Mary; Marchant, Paul; Leeds Teaching Hospitals NHS Trust/Leeds Metropolitan University (Royal College of Midwives, 2001-08)
      The objectives of this study were to evaluate the effectiveness of a new cooling device (gel pad) and compare it with a standard regimen (ice pack) and a no localised treatment regimen (control). The study was a randomised controlled trial, initially based in a hospital midwifery unit in the North of England and then continued in the community. Participants were 450 women who had undergone either a normal or an instrumental delivery that required suturing of an episiotomy or second degree tear. The measurements and findings were as follows: 316 (71%) of completed questionnaires were returned. A significant reduction in the levels of oedema was observed in favour of using cooling treatments at day two and day five, p=0.016. p=0.018, and there was a significant reduction in bruising at day ten, p=0.01 (using the Kruskal-Wallis test). Self-reported pain was less in the cooling gel pad group. A significant reduction in pain was demonstrated at day five, day ten and day 14, p=0.023, p=0.007, p=0.058, (Kruskal-Wallis test). A reduction in pain was reported earlier on day two, day three and day five when making a binary comparison of moderate or severe pain, with none or mild, p=0.0038, p=0.037, p=0.017 (chi-squared test). Maternal satisfaction With the cooling gel pad was high and differed statistically significantly compared to the other regimens, p=0.0005, (Kruskal-Wallis test). There were no clinical significant differences monitored between groups when assessing healing. The key conclusions were that this clinical trial confirms earlier findings in a previous study and provides evidence that the use of a specifically designed cooling gel pad is a safe and effective localised method to alleviate perineal trauma, without any adverse effects on healing.
    • Alleviating perineal trauma: The APT study

      Steen, Mary (2000)
      This poster presentation aims to evaluate the effectiveness of a new cooling device (gel pad) with a standard regimen (ice pack) and compare these with no localised treatment regimen (control). 450 women partipcated in this study at St James's University Hospital and their own homes. The trial confirmed earlier findings to support the use of a specially designed cooling gel pad (Feme pad)to alleviate perineal trauma.
    • Alleviating postnatal perineal trauma: To cool or not to cool?

      Steen, Mary; Briggs, Michelle; King, David; UCLan/University of Leeds/Royal College of Midwives (Mark Allen Publishing, 2006-05)
      This article discusses the evidence reported from quasi randomised trials and randomised controlled trials on the efficacy and acceptability of localised cooling methods in alleviating perineal trauma. Two types of cooling methods were identified: iced sitz baths and cooling devices. The review suggests that cooling may lower the levels of reported perineal pain after childbirth and reduce the inflammatory response associated with perineal trauma. However, women's preferences as well as the efficacy of the cooling method should be taken into consideration. Women's natural reluctance to sit in iced sitz baths suggests that this cooling method is unpleasant and may explain why there has been a decline in this method being used in clinical practice over the last two decades. The use of localised cooling devices appear to be a more acceptable method for women.
    • Annual report of East London Nursing Society, 1906

      East London Nursing Society (East London Nursing Society, 1906)
    • Annual report of East London Nursing Society, 1907

      East London Nursing Society (East London Nursing Society, 1907)
    • Annual report of East London Nursing Society, 1908

      East London Nursing Society (East London Nursing Society, 1908)
    • Annual report of the East London Nursing Society, 1904

      East London Nursing Society (East London Nursing Society, 1904)
    • 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.
    • Anxiety, bonding and attachment during pregnancy, the transition to parenthood and psychotherapy

      Steen, Mary; Jones, Alun; Woodworth, Barabara; University of Chester ; University of Chester ; Chester and Wirral Partnership NHS Trust (Mark Allen Publishing, 2013-12-01)
      Although becoming and being a parent are considered happy life events, parents can suffer from varying degrees of anxiety and variable mood. Anxiety and mood changes can be missed and this can lead to mental health problems if not recognised at an early stage. An insecure attachment in a parent's early infanthood can contribute to increased levels of anxiety and emotional problems when becoming and being a parent themselves, which can influence mother and child bonding as well as wider difficulties within family relationships. In many instances, attachment styles can be passed on to the infant causing a range of emotional and intellectual difficulties. In certain circumstances, these parents may benefit from psychotherapy. Psychotherapy is a method of addressing troubling emotions along with life difficulties and relationship struggles. Using psychological methods, a psychotherapist can help a person change his or her life for the better by becoming more effective in work or personal relationships. Local community support and befriending approaches have been shown to be beneficial in alleviating anxiety and depression. This article briefly describes what psychotherapy is and demonstrates ways in which interpersonal attachment styles established early on in life can bring difficulties to adult relationships. Two disguised scenarios referring to actual psychotherapy consultations are included to illustrate how plans can be put in place to address interpersonal difficulties related to attachment styles.
    • Applying the Food Multimix concept for sustainable and nutritious diets

      Zotor, Francis B.; Ellahi, Basma; Amuna, Paul; University of Health and Allied Sciences; University of Chester (Cambridge University Press, 2015-08-11)
      Background: Despite a rich and diverse ecosystem and biodiversity, worldwide, more than 2 billion people suffer from micronutrient malnutrition or hidden hunger. Of major concern are a degradation of our ecosystems and agricultural systems which are thought to be unsustainable thereby posing a challenge for the future food and nutrition security. Despite these challenges, nutrition security and ensuring well balanced diets depend on sound knowledge and appropriate food choices in a complex world of plenty and want. We have previously reported on how the food multimix (FMM) concept, a food-based and dietary diversification approach can be applied to meeting energy and micronutrient needs of vulnerable groups through an empirical process. Our objective in this article is to examine how the concept can be applied to improve nutrition in a sustainable way in otherwise poor and hard-to-reach communities. We have reviewed over 100 FMM food recipes formulated from combinations of commonly consumed traditional candidate food ingredients; on average five per recipe, and packaged as per 100 g powders from different countries including Ghana, Kenya, Botswana, Zimbabawe and Southern Africa, India, Mexico, Malaysia and United Kingdom; and for different age groups and conditions such as older infants and young children, pregnant women, HIV patients, diabetes and for nutrition rehabilitation. Candidate foods were examined for their nutrient strengths and nutrient content and nutrient density of recipes per 100 g were compared to reference nutrient intakes (RNIs) for the different population groups. We report on the nutrient profiles from our analysis of the pooled and age-matched data as well as sensory analysis and conclude that locally produced FMM foods can complement local diets and contribute significantly to meeting nutrient needs among vulnerable groups in food-insecure environments. Key words: food multimix, candidate foods, sustainable, food security, resource-poor, nutrition interventions.
    • APT study

      Steen, Mary (Florri-Feme, 2009-02-16)
      To evaluate the effectiveness of a a new cooling device (gel pad) with a standard regimen (ice pack) and compare these with a no localised treatment regimen (control). Design: A randomised controlled trial initially based in hospital and then continued in the community. Setting: A Midwifery Unit in the North of England and then in women's own homes. Participants: 450 women who had undergone either a normal or an instrumental delivery that required suturing of an episiotomy or second degree tear. Key Conclusions: This clinical trial confirms earlier findings in a previous study and provides evidence that the use of a specifically designed cooling gel pad is a safe and effective localised method to alleviate perineal trauma without any adverse effects on healing.