• A qualitative investigation into nurses’ perceptions of factors influencing staff injuries sustained during physical interventions employed in response to service user violence within one secure learning disability service

      Lovell, Andy; Smith, Debra; Johnson, Paula; University of Chester; Calderstones Partnership NHS Foundation Trust (Wiley, 2015-04-29)
      Aims: The aim of the study was to examine learning disability nurses’ perceptions of incidents involving physical intervention, particularly factors contributing to injuries sustained by this group. Background: This article reports on a qualitative study undertaken within one secure NHS Trust to respond to concerns about staff injuries sustained during physical interventions to prevent incidents of service user violence from escalating out of control. The context of the study relates to increasing debate about the most effective approaches to incidents of violence and aggression. Design: A qualitative research design was utilized for the study. Methods: Semi-structured interviews were undertaken with 20 participants, 2 from each of the 10 incidents involving staff injury sustained during physical intervention. Results: Four themes were produced by the analysis, the first, knowledge and understanding, contextualized the other three, which related to the physical intervention techniques employed, the interpretation of the incident and the impact on staff. Conclusion: Service user violence consistently poses nurses with the challenge of balancing the need to respond in order to maintain the safety of everyone whilst simultaneous supporting and caring for people with complex needs. This study highlights the need for further exploration of the contributory factors to the escalation of potentially violent situations.
    • A qualitative study exploring midlife women’s stages of change from domestic violence towards freedom

      Keeling, June J.; Smith, Debra; Fisher, Colleen; University of Chester; University of Central Lancashire; The University of Western Australia (BioMed Central, 2016-03-08)
      Background Domestic Violence (DV) remains a significant global health problem for women in contemporary society. Existing literature on midlife women’s experiences of domestic violence is limited and focuses on health implications. Leaving a violent relationship is a dynamic process that often requires multiple attempts and separations prior to final termination. The aim of this study was to explore the process of leaving a violent relationship for midlife women. Methods This qualitative study involved fifteen women aged between 40–55 who had accessed residential and non-residential community support services for domestic violence within the UK. Community-based support agencies provided these women with access to letters of invitation and participant information sheet explaining the study. The women notified agency staff who contacted the research team to arrange a mutually convenient time to meet within a safe place for both the women and researchers. It was stressed to all potential participants that no identifiable information would be shared with the agency staff. Women were considered survivors of DV if they defined themselves as such. Data were gathered through semi structured interviews, transcribed verbatim and thematically analysed. Results Midlife women appear to differ from younger women by transitioning quickly though the stages of change, moving rapidly through the breaking free onto the maintenance stage. This rapid transition is the resultant effect of living with long-term violence causing a shift in the women’s perception towards the violent partner, with an associated reclamation of power from within the violent relationship. A realisation that rapid departure from the violence may be critical in terms of personal safety, and the realisation that there was something ‘wrong’ within the relationship, a ‘day of dawning’ that had not been apparent previously appears to positively affect the trajectory of leaving. Conclusions Midlife women appeared to navigate through the stages of change in a rapid linear process, forging ahead and exiting the relationship with certainty and without considering options. Whilst these findings appear to differ from younger women’s process of leaving, further research is needed to explore and understand the optimum time for intervention and support to maximise midlife women’s opportunities to escape an abusive partner, before being reflected appropriately in policy and practice.
    • Quality assurance and palliative care

      McCarthy, Jill; University of Chester (SAGE, 2010-10-15)
      This book chapter discusses the importance of quality assurance in palliative care as it aims to promote the best care in a timely and cost effective manner.
    • Quality of life and social support in rare genetic skin conditions: A mixed methods study

      Mitchell, Andrew; Mason-Whitehead, Elizabeth; Butterworth, Sondra (University of Chester, 2021-02)
      Aim The aim of this study was to explore the relationship between quality of life (QOL) and social support in adults living with rare genetic skin conditions, specifically Epidermolysis Bullosa (EB) Ehlers-Danlos Syndrome (EDS) and related conditions. Background Measuring QOL has become an increasingly important method of evaluating the effectiveness of health and social care interventions. Living with the effects of a rare genetic condition has a profound impact on QOL for the individual and families. Design Methodological triangulation was adopted, in a sequential mixed methods exploratory design. Three stages were included: a literature review, online survey (n=31), and semi structured interviews (n=8). Outcomes The literature review concluded that professionals should adopt a biopsychosocial approach to the management of rare diseases. The online survey found a positive correlation between QOL and social support. The role of the family was a prominent theme. Most participants indicated that emotional support was provided by family carers, and tangible (practical) support was the highest rated support need. Conclusion This study demonstrated was that health and social care practitioners, policy makers and commissioners have to make room for QOL perspectives that come from the patient. These are wounded storytellers whose narratives are subjective but are spoken through illness. Their collective experiences can influence the direction of their diagnostic journey and must be front and center of any rare disease implementation plans in a post COVID era.
    • 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.’
    • A randomised controlled trial to compare the effectiveness of ice-packs and Epifoam with cooling maternity gel pads at alleviating postnatal perineal trauma

      Steen, Mary; Cooper, Keith; Marchant, Paul; Griffiths-Jones, Martin; Walker, James; Community Midwifery Office, St James University Hospital, Leeds (Churchill Livingstone, 2000-03)
      OBJECTIVE: To evaluate the effectiveness of standard regimes (ice packs and Epifoam) at relieving perineal trauma and compare these with a new cooling device (maternity gel pad). DESIGN: A randomised controlled trial involving three treatment groups. The women were free to choose the time of initial application (within four hours after delivery) in all treatment groups and the number of subsequent treatments up to 48 hours after suturing. SETTING: A midwifery unit in the north of England and then continued in the women's own homes. PARTICIPANTS: 120 women who had undergone an instrumental delivery and had a 48 hours post-delivery stay in a postnatal ward. MEASUREMENTS AND FINDINGS: The ordinal scale of none, mild, moderate and severe was used to determine the levels of perineal oedema and bruising at initial assessment (less than 4 hours), 24 hours and at 48 hours, by use of a newly developed visual evaluating tool. Self-assessed pain was recorded using a 10-point visual analogue scale within four hours, at 24 hours, 48 hours, and finally at five days after suturing. Women's opinions as to the effectiveness of their treatment was rated by use of a 5-point scale describing the categories; poor, fair, good, very good and excellent. A high proportion of women had some perineal oedema at initial assessment. A statistically significant difference in the proportion of women with oedema was found between treatment groups at 48 hours (p = 0.01), which was in favour of the maternity gel pad group. This was particularly noticeable for women with initial levels of mild oedema (p = 0.017). Localised treatment with the gel pad caused a significant decrease in reported pain at 48 hours in women who initially demonstrated moderate or severe pain (p = 0.048). A significant increase in the proportion of women with some bruising was seen across all treatment groups from initial assessment, through 24 hours to 48 hours (p < 0.0005). The bruising was significantly less in the gel-pad group in women who initially had no bruising (p = 0.021). There was no statistically significant effect of treatment at other initial levels of severity for oedema, bruising or pain at 24 hours, 48 hours and five days (for pain). Women in the gel-pad group rated the effectiveness of their localised treatment to be significantly higher than women in the other two treatment groups (p < 0.0005). KEY CONCLUSIONS: This trial demonstrated that a high proportion of women experience perineal oedema, bruising and pain following an instrumental delivery, which continues for at least five days for perineal pain, despite oral analgesia. Maternity gel pads, which were specially designed to cool the perineal region, were more effective in alleviating perineal trauma when compared with hospital standard regimens and were more highly rated by women.
    • A randomised controlled trial to evaluate the effectiveness of localised cooling treatments in alleviating perineal trauma: The APT study

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (MIDIRS, 2002-09)
      This article reports a randomised controlled trial conducted at St James's University Hospital in Leeds comparing the effectiveness of cooling gel pads with ice packs and no localised treatment for relieving pain following perineal injury during childbirth.
    • Reablement and support workers

      Dibsdall, L; Clampin, A.; Chapman, Hazel M.; Ebrahimi, V.A.; University of Chester (Macmillan, 2018-03-30)
      Chapter outline Support workers are key to the delivery of reablement services as they are the people who work on a day-to-day basis with service users. Support workers may join reablement teams without any experience in working in health and social care. More commonly, support workers move into reablement teams from therapy assistant roles or from working in a home care service. These support workers bring a wealth of experience to the role, but differences in both the process and the outcome of reablement and home care can offset the benefits of this experience. Reablement is a change in approach to care from being ‘task-led’ to a ‘doing with’, person-centred and outcomes-based approach. This holistic view of working with people who use these services has been largely welcomed by support workers who enjoy supporting them to do more for themselves. This chapter will consider some key skills and techniques used by support workers in reablement services, such as use of equipment, activity analysis and energy conservation. Support workers need appropriate training and education in reablement so that practice is meaningful, and the concept of reablement is clearly understood and articulated. This is fundamental to an inclusive approach to interacting with the service user, enabling them to grow in confidence and autonomy, and engage in the process of reablement. Suggested topics for inclusion in reablement training are included in this chapter and it is argued that occupational therapists (OT) are suitably experienced, and well placed, to provide this training. Before reading any further, you may want to recap on the concept discussed in Chapter 1 in the section ‘Defining occupation, activity and task (OAT) for reablement interventions’. Chapter objectives By the end of this chapter you should be able to: ➢➢ Outline the development of the reablement support worker role ➢➢ Compare and contrast ‘doing to’ and ‘doing with’ support worker approaches ➢➢ Explain the role of the support worker ➢➢ Evaluate equipment and reablement techniques support workers may use ➢➢ Describe the training requirements for being a support worker ➢➢ Consider the opportunities and challenges of being a support worker
    • Reablement services in health and social care

      Ebrahimi, V.A.; Chapman, Hazel M.; University of Chester (Macmillan, 2018-03-30)
      Edited book with concluding remarks written by the editors.
    • Reactions of patients and carers

      Phillips, Sue; University of Chester (SAGE, 2010-10-15)
      This book chapter discusses the ways in which people react to news of terminal illness.
    • Real-world comparative analysis of bleeding complications and health-related quality of life in patients with haemophilia A and haemophilia B.

      Booth, Jason; Oladapo, Abiola; Walsh, Shaun; O'Hara, Jamie; Carroll, Liz; Garcia Diego, Daniel-Anibal; O'Mahony, Brian (2018-08-09)
      Clinical severity and impact of haemophilia on quality of life have been generally considered to be lower for haemophilia B (HB) compared with haemophilia A (HA) patients. To compare annual bleeding rate (ABR), target joint development and health-related quality of life (HRQoL) between adult (≥18 years) severe HA and HB patients using recent data from the Cost of Haemophilia in Europe: a Socioeconomic Survey (CHESS) study. Multivariate generalized linear models (GLM) were constructed to assess the relationship between haemophilia type, ABR, HRQoL (derived from EQ-5D index scores) and the presence of target joints while controlling for covariates. Of the 1225 patients included, 77% (n = 949) had HA and 23% (n = 278) had HB. Of the 514 patients who completed the EQ-5D, 78% (n = 405) had HA, and 22% (n = 110) had HB. Unadjusted mean ABR was 3.79 in HA and 4.60 in HB. The presence of ≥1 target joint was reported in 59% and 54% of patients with HA and HB, respectively. Unadjusted mean EQ-5D index score was 0.78 in HA and 0.76 in HB. Haemophilia type was not a significant predictor of ABR, target joints or HRQoL when adjusted for confounding factors such as BMI, age and replacement therapy regimen. Data suggest comparable ABR, incidence of target joints and HRQoL between patients with HB and HA indicating comparable clinical severity and disease impact on patient quality of life. [Abstract copyright: © 2018 John Wiley & Sons Ltd.]
    • Real-world evidence on Kovaltry (81-8973) in children with moderate or severe hemophilia A in Europe: a nested cohort analysis

      O’Hara, Jamie; Hirst, Ceri; orcid: 0000-0001-9094-2437; email: ceri.hirst@bayer.com; Cabre Marquez, Jose Francisco; Burke, Tom (BioMed Central, 2021-01-15)
      Abstract: Background: Untreated hemophilia A patients may experience recurrent bleeding events leading to debilitating joint damages. While RCT and pharmacokinetic data support the value of Kovaltry [an unmodified full-length recombinant factor VIII (FVIII) product], real world evidence in children is lacking. This report describes a descriptive and multivariate analysis of the effectiveness of Kovaltry in children with hemophilia A in the real-world setting, using data from medical chart abstraction and cross-sectional surveys of physicians, patients, and caregivers. Results: Male patients aged < 18 years with moderate or severe hemophilia A, residing in five European countries and treated with FVIII were studied. The co-primary endpoints were the annualized bleeding rate (ABR) and the annual FVIII utilization rate. Twenty nine patients treated with Kovaltry were included, of whom 93% had severe disease and 75% were on continuous prophylactic treatment. The mean ABR was 2.66 ± 2.06, with rates decreasing with age. The children received on average 2.45 infusions per week, consistent across age groups (median 3; range 1–3). There were no reports of inhibitor development or adverse events in the study (AEs), and all patients were satisfied or very satisfied with the treatment. An exploratory multivariate analysis suggests no significant difference in ABR or units utilized between Kovaltry and some extended half life products in children with severe hemophilia A, though characteristics of these patient cohorts were markedly different. Conclusion: This analysis demonstrates the effectiveness and safety of Kovaltry in a pan-European pediatric population with severe hemophilia A.
    • Realities from practice: What it means to midwives and student midwives to care for women with BMIs ≥30kg/m2 during the childbirth continuum

      Steen, Mary; Thomas, Mike; Roberts, Taniya (University of Chester, 2016-12)
      Women with raised BMIs ≥30kg/m2 have now become the ‘norm’ in maternity practice due to the recent obesity epidemic. To date only very limited research evidence exists highlighting midwives’ experiences of caring for this group of women. This thesis aims to provide original research on what it means to midwives and student midwives on the point of qualification to care for this client group throughout the childbirth continuum.
    • Reassessing the health impacts of trade and investment agreements: a systematic review of quantitative studies, 2016–20

      Barlow, Pepita; Sanap, Rujuta; Garde, Amandine; Winters, L. Alan; Mabhala, Mwandile A.; Thow, Anne-Marie; London School of Economics and Political Science; Univeristy of Liverpool; University of Sussex Business School; University of Chester; University of Sydney
      To ensure a high level of health protection, governments must ensure that health and trade policy objectives are aligned. We conducted a systematic review of the health impacts of trade policies, including trade and investment agreements (TIAs), to provide a timely overview of this field. We systematically reviewed studies evaluating the health impacts of trade policies published between Jan 19, 2016, and July 10, 2020. Included studies were quantitative studies evaluating the impact of TIAs and trade policies on health determinants or outcomes. We evaluated methodological quality and performed a narrative synthesis. 21 of 28 067 articles identified via searches met our criteria. Methodologically strong studies found reduced child mortality, deteriorating worker health, rising supplies of sugar, ultra-processed food, tobacco, and alcohol supplies, and increased drug overdoses following trade reforms, compared with the time periods before trade reform. However, associations varied substantially across contexts and socioeconomic characteristics. Our findings show that trade policies, including TIAs, have diverse effects on health and health determinants. These effects vary substantially across contexts and socioeconomic groups. Governments seeking to adopt healthy trade policies should consider these updated findings to ensure that opportunities for health improvement are leveraged and widely shared, while harms are avoided, especially among vulnerable groups.
    • Recovery budget in a mental health service: Evaluating recovery budgets for people accessing an early intervention service and the impact of working with self directed services on the team members within a north west of England NHS trust

      Coyle, David L.; University of Chester (University of Chester, 2009-07)
      This report follows a 12 month pilot of implementing Individual Recovery Budgets within an early intervention service across Mersey Care NHS Trust.
    • Recruitment to the “Breast—Activity and Healthy Eating After Diagnosis”(B-AHEAD) Randomized Controlled Trial

      Pegington, Mary; Adams, JE; Campbell, AM; Bundred, Nigel J.; Howell, Anthony; Howell, Sacha J.; Speed, Shaun; Wolstenholme, J; Harvie, Michelle N.; University Hospital of South Manchester; University of Manchester; Central Manchester University Hospitals NHS Foundation Trust; Edinburgh Napier University; The Christie NHS Foundation Trust; University of Oxford; University of Chester
      Excess weight at breast cancer diagnosis and weight gain during treatment are linked to increased breast cancer specific and all-cause mortality. The Breast—Activity and Healthy Eating After Diagnosis (B-AHEAD) trial tested 2 weight loss diet and exercise programmes versus a control receiving standard written advice during adjuvant treatment. This article identifies differences in characteristics between patients recruited from the main trial site to those of the whole population from that site during the recruitment period and identifies barriers to recruitment. A total of 409 patients with operable breast cancer were recruited within 12 weeks of surgery. We compared demographic and treatment factors between women recruited from the main trial coordinating site (n = 300) to the whole breast cancer population in the center (n = 532). Uptake at the coordinating site was 42%, comparable to treatment trials in the unit (47%). Women recruited were younger (55.9 vs 61.2 years, P < .001), more likely to live in least deprived postcode areas (41.7% vs 31.6%, P = .004), and more likely to have screen-detected cancers (55.3% vs 48.7%, P = .026) than the whole breast cancer population. The good uptake highlights the interest in lifestyle change around the time of diagnosis, a challenging time in the patient pathway, and shows that recruitment at this time is feasible. Barriers to uptake among older women and women with a lower socioeconomic status should be understood and overcome in order to improve recruitment to future lifestyle intervention programs.
    • Reflecting on the characteristics and values of military nurses: war zone qualitative research

      Finnegan, Alan; University of Chester
      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 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.
    • Reflection

      Gidman, Janice; Mannix, Jean; University of Chester (SAGE, 2008-03-17)
      This book chapter discusses reflection as a learning, teaching, and assessment strategy and its benefits.
    • 'Reflections on a birthday': An auto-ethnographic account of caring for a child with a learning disability

      Gant, Valerie; University of Chester (Sage, 2016-09-10)
      This commentary offers some of the author’s experiences of parenting a child with a severe learning disability and complex and challenging behaviours. Drawing on principles of auto-ethnography and critical reflection, the author considers issues of transition from children’s to adult social care services and the potential for support from a new piece of UK Legislation, the Care Act, 2014.
    • Registered Nurses’ experiences of working within professional and contractual boundaries: A Grounded Theory study

      Templeman, Jenni; Barton, Janet; Devlin, Bernadette (University of Chester, 2022-06-01)
      Aligned to the Nursing and Midwifery Council’s (NMC) The Code (2018a) and other supporting regulatory documents, Registered Nurses (RNs) are accountable to the healthcare organisation through an employment contract and must work within the remit of professional standards and organisational policies. Falling below explicit professional and organisational standards has the potential for repercussions for the RN, the public and the organisation. This research explores RNs’ experiences of meeting the needs of the patient whilst fulfilling the requirements of The Code (NMC, 2018a) in conjunction with operational policies in a small District General Hospital within the British Isles. As far as can be ascertained, this study is the first to focus on the topic of interest. To explore this subject area and to have generated a substantive theory of Professional Liminality, a qualitative constructivist grounded theory approach situated in the interpretive research paradigm was espoused. Participants were purposefully and theoretically sampled to take part in this study. 12 face-to-face individual semi-structured interviews were conducted with experienced RNs. The interview guide evolved and lengthened over the data collection process in keeping with a grounded theory approach pertaining to emerging theoretical interests from the participants’ answers. The grounded theory principles of data collection techniques, constant comparative method of analysis to code data, construction of categories and the development of theoretical themes were adopted to produce a theory explaining the relationships between the emerging themes. Analysis of the findings uncovered three themes: Governance, Professional discrepancies, and Professional disquiet. These themes highlighted a dichotomy between professional and organisational expectations, significantly affecting RNs’ daily clinical practice, and are contextualised in the theoretical framework of professional liminality, representing the complexity of the findings. A new model, Rules versus Roles (RvR), is proposed as an approach to address and resolve the precarious professional liminal positions in which RNs find themselves. Whilst The Code (NMC, 2018a) and operational policy are both vital; they coexist paradoxically. This research indicates that they would benefit from complementing each other to affect an evolving and dynamic contemporary healthcare organisation.