• Vaginal breech birth or Caesarean?

      Steen, Mary; Kingdon, Carol; Royal College of Midwives/University of Central Lancashire (2007-11-08)
      This presentation will firstly explore the evidence in supporting the phenomenal shift in clinical practice from vaginal breech birth to routine caesarean breech birth, in particular the impact of a single research trial, the Term Breech Trial (TBT) on current worldwide policy and practice. Secondly, will explore the best available evidence for the use of External Cephalic Version (ECV)and moxibustion to turn a breech baby to a cephalic presentation as this may reduce a woman’s risk of having a caesarean section.
    • Vaginal or caesarean delivery? How research has turned breech birth around

      Steen, Mary; Kingdon, Carol; RCM/UCLan ; UCLan (T G Scott, 2008-09)
      Background: Breech presentation, where a baby is buttocks or feet first rather than head occurs in about 3 to 4% of singleton pregnancies at term. Worldwide, the vast majority of babies identified as breech are now delivered by planned caesarean section. Aim: to identify relevant published research evidence relating to vaginal and caesarean breech birth and then to discuss the evidence, subsequent controversy and clinical implications that have influence an ongoing obstetrical debate. Method: A structured literature review was undertaken using the Cochrane Library, CINAHL, EMBASE and MEDLINE databases. Different permutations of 'breech' ('frank' or 'complete' or 'extended' or 'flexed') and 'vaginal' or 'caesarean' ('cesarean' or 'cesarian' or 'caesarean') and 'term' and 'singleton' in the title, key words or abstracts were the terms used. Results: Over the last 50 years, there has been an increasing trend toward the routine use of caesarean section as a preventive way of reducing the poor outcomes associated with breech presentation. Research evidence has also played a pivotal role in influencing the routine use of caesarean breech birth and, in particular, a single research trial, the Term Breech Trial (TBT) has substantially influenced current policy and practice. There is no other area of research that has such an impact upon clinical practice in such a short period of time. Conclusions: The speed and extent to which the recommendations of the TBT were implemented has given rise to new controversy surrounding the safety of breech birth, while raising important questions about how the findings of research are used in practice.
    • The value of embedded secondary-care-based psychology services in rheumatology: an exemplar for long-term conditions

      Barnes, Theresa; Taylor, Lou; Eost-Telling, Charlotte; Joy, Thomas; Countess of Chester Hospital; University of Chester; University of Chester; Cheshire and Wirral Partnership (Royal College of Physicians, 2020-02-29)
      Rheumatoid arthritis is an exemplar long term condition, complicated by pain, disability, co-morbidities and long term medication use. It has significant effects on mobility, work performance, social role, sexual function and relationships. It is commonly associated with fatigue and mood disturbance as a result of complex interactions of physical (disease related) and psychosocial factors. NICE guidance recommends the availability of psychological support for these patients. We have implemented a psychology service for our patients with chronic rheumatological conditions. This study was set up to capture the value of this service.
    • Value of life

      Baldwin, Moyra A.; Greenwood, Joanne M.; University of Chester (SAGE, 2010-10-15)
      This book chapter explores the concept of the value of life.
    • Views of old age psychiatrists on use of community treatment orders in ageing population in England and Wales - a pilot study

      Bhattacharyya, Sarmishtha; Bailey, Jan; Khan, Farooq; Kingston, Paul; Tadros, George; University of Chester (2017-05-31)
      Background Community Treatment orders (CTO) were introduced in England and Wales during the 2008 reformation of mental health legislation. There is scant research evidence regarding the use of CTOs with older adults (people aged 65 and over). Aims The aims were to explore old age psychiatrists’ rationale for using CTOs with older adults and its efficacy. Method A mixed-method approach with a quantitative questionnaire followed by a series of one-to-one semi-structured interviews was utilised. Results About half of respondents had used a CTO with an older adult and more than half reported they would be comfortable using CTOs with older adults. Data showed that CTOs were predominantly used with patients diagnosed with relapsing mental illnesses with few respondents considering its use in people with dementia. There was also evidence that older people were viewed as being compliant with treatment, which may reflect reality or a stereotype of older people. Conclusions Evidence suggested that old age psychiatrists perceived CTOs to have limited efficacy with older people, considering other legislation more appropriate to their care. Further research is recommended to explore whether CTOs are appropriate for older adults and whether respondents’ perception of treatment compliance is accurate.
    • Violence and under-reporting: Learning disability nursing and the impact of environment, experience and banding

      Lovell, Andy; Skellern, Joanne; Mason, Tom; University of Chester (Wiley-Blackwell, 2011-11-23)
      The study explores the implications of a survey into the discrepancy between actual and reported incidents of violence, perpetrated by service users, within the learning disability division of one mental health NHS Trust. Violence within the NHS continues to constitute a significant issue, especially within mental health and learning disability services where incidence remains disproportionately high despite the context of zero tolerance. A whole-population survey of 411 nurses working within a variety of settings within the learning disability division of one mental health NHS Trust. A questionnaire was administered to learning disability nursing staff working in community, respite, residential, assessment and treatment and medium secure settings, yielding a response rate of approximately 40%. There were distinct differences in the levels of violence reported within specific specialist services along with variation between these areas according to clinical environment, years of experience and nursing band. The study does not support previous findings whereby unqualified nurses experienced more incidents of violence than qualified nurses. The situation was less clear, complicated by the interrelationship between years of nursing experience, nursing band and clinical environment. The conclusions suggest that the increased emphasis on reducing violent incidents has been fairly successful with staff reporting adequate preparation for responding to specific incidents and being well supported by colleagues, managers and the organisation. The differences between specific clinical environments, however, constituted a worrying finding with implications for skill mix and staff education. The study raises questions about the relationship between the qualified nurse and the individual with a learning disability in the context of violence and according to specific circumstances of care delivery. The relationship is clearly not a simple one, and this group of nurses’ understanding and expectations of tolerance requires further research; violence is clearly never acceptable, but these nurses appear reluctant to condemn and attribute culpability.
    • Violence in health and social care settings: A training resource package for organisations and individuals

      Skellern, Joanne; Lovell, Andy; University of Chester (University of Chester Press, 2013-03)
      Violence in health and social care settings is now recognised as a major international concern. Training in the recognition and management of potentially violent situations can assist to prevent situations escalating to the point where violence occurs. This training resource pack contains: • A DVD of 25 simulated scenarios • A training manual on how to use the DVD which also includes a ‘notes for trainers’ section The aim is to provide you with the materials needed to: • Create a forum where violence can be discussed • Encourage reflection on your own and colleagues responses to threatening situations • Facilitate assessment of potentially violent or threatening situations • Enable you and your colleagues to plan for adverse situations • Encourage a review of practices in relation to National and local policies and procedures This training resource package can provide a welcome contribution to induction and training programmes for individuals, managers and trainers working within organisations providing a range of health and social care services.
    • Visual Perceptions of Ageing; A Longitudinal Mixed Methods Study of UK Undergraduate Student Nurses’ Attitudes and Perceptions Towards Older People.

      Ridgway, Victoria; Mason-Whitehead, Elizabeth; Mcintosh-Scott, Annette; University of Chester (Elsevier, 2018-09-11)
      Ageism and negative attitudes are said to be institutionally embedded in healthcare during a time when there are unprecedented increases in older population numbers. As nurses’ care for older people in a range of environments it was timely to examine attitudes and perceptions of undergraduate nurses towards older people. A longitudinal mixed methods study in conjunction with a three-year undergraduate UK nursing programme 2009-2012 was conducted with 310 undergraduate nurses. A questionnaire incorporating Kogan’s attitude towards older people scale and a drawing of a person aged 75 years was completed three times, once each year. Thurstone scale and photo elicitation were also employed. Comparisons were made between individual participant’s attitude score and drawing. The study established 75% of participants had moderately positive attitudes towards older people when the programme began, at the programme end this had increased to 98%. Age, gender, educational qualifications, practice learning, nursing field and contact with older people influenced participants’ overall attitude score. Drawings provided a visual narrative of participants’ perceptions of older people, appearance was a dominant discourse and the images were socially constructed. The study established the undergraduate nursing programme influenced attitudes and perceptions towards older people and suggests nurse education can influence changing attitudes. To date there is no known study that has advanced this understanding.
    • Vulnerability

      Hardy, Jan; Barrows, Tina; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses internal and external factors relating to vulnerability, and the concept of risk.
    • Web-Based STAR E-Learning Course Increases Empathy and Understanding in Dementia Caregivers: Results from a Randomized Controlled Trial in the Netherlands and the United Kingdom

      Hattink, Bart; Meiland, Franka; van der Roest, Henriëtte; Kevern, Peter; Abiuso, Francesca; Bengtsson, Johan; Giuliano, Angele; Duca, Annalise; Sanders, Jennifer; Basnett, Fern; et al. (JMIR Publications, 2015-10-30)
      Background: The doubling of the number of people with dementia in the coming decades coupled with the rapid decline in the working population in our graying society is expected to result in a large decrease in the number of professionals available to provide care to people with dementia. As a result, care will be supplied increasingly by untrained informal caregivers and volunteers. To promote effective care and avoid overburdening of untrained and trained caregivers, they must become properly skilled. To this end, the European Skills Training and Reskilling (STAR) project, which comprised experts from the domains of education, technology, and dementia care from 6 countries (the Netherlands, Sweden, Italy, Malta, Romania, and the United Kingdom), worked together to create and evaluate a multilingual e-learning tool. The STAR training portal provides dementia care training both for informal and formal caregivers. Objective: The objective of the current study was to evaluate the user friendliness, usefulness, and impact of STAR with informal caregivers, volunteers, and professional caregivers. Methods: For 2 to 4 months, the experimental group had access to the STAR training portal, a Web-based portal consisting of 8 modules, 2 of which had a basic level and 6 additional modules at intermediate and advanced levels. The experimental group also had access to online peer and expert communities for support and information exchange. The control group received free access to STAR after the research had ended. The STAR training portal was evaluated in a randomized controlled trial among informal caregivers and volunteers in addition to professional caregivers (N=142) in the Netherlands and the United Kingdom. Assessments were performed with self-assessed, online, standardized questionnaires at baseline and after 2 to 4 months. Primary outcome measures were user friendliness, usefulness, and impact of STAR on knowledge, attitudes, and approaches of caregivers regarding dementia. Secondary outcome measures were empathy, quality of life, burden, and caregivers’ sense of competence. Results: STAR was rated positively by all user groups on both usefulness and user friendliness. Significant effects were found on a person-centered care approach and on the total score on positive attitudes to dementia; both the experimental and the control group increased in score. Regarding empathy, significant improvements were found in the STAR training group on distress, empathic concern, and taking the perspective of the person with dementia. In the experimental group, however, there was a significant reduction in self-reported sense of competence. Conclusions: The STAR training portal is a useful and user-friendly e-learning method, which has demonstrated its ability to provide significant positive effects on caregiver attitudes and empathy.
    • Wellbeing and beyond

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (2007-03-01)
      This article discusses the development of a maternal health, well-being & beyond project in leeds and how large proportions of women have benefited from classes and the support of other mothers in improving their general health through exercise.
    • What is reflective writing?

      Quigley, Jane; University of Chester (McGraw-Hill / Open University Press, 2013-09-03)
      This chapter explores what reflective writing is, why reflection is important, types of reflection and the reflective models available. The chapter goes on to address critical reflective writing, how to structure a reflective essay and summaries how to write reflectively.
    • What’s in a name? Family violence involving older adults

      Benbow, Susan M.; Bhattacharyya, Sharmi; Kingston, Paul (Emerald, 2018-12-10)
    • When food becomes the enemy: Eating disorders

      Steen, Mary; University of Chester (Redactive Publishers: Royal College of Midwives, 2009-04-01)
      There are several eating disorders that may affect the health and well-being of childbearing women. This articles discusses the role midwives can play in identifying, supporting and caring for women with an eating disorder.
    • When Questions are the Answers

      Harlow, Elizabeth; Daley, Maureen; Stone, Karen; University of Chester; University of Nottingham; Independent (British Association of Social Workers, 2015-10)
      Professional supervision enables social work practitioners to reflect on their performance in relation to organizational goals, but also their own developmental needs. Over recent times, front line managers have been encouraged to incorporate reflective techniques in their supervision, such as those associated with coaching. Among coaching theorists there is a consensus that 'questions are the answers'. Good quality questioning conversations, which are part of a trusting supervisory relationship, may be of benefit to social work practitioners as well as the people they aim to help.
    • Why we must say goodbye to 'clinical' pharmacists

      Khan, Nahim; University of Chester (Royal Pharmaceutical Society of Great Britain, 2017-07-11)
      A response to a writing competition on the subject of 'the future pharmacist'.
    • Women’s narratives on their interactions with the first response police officer following an incidence of domestic violence in the UK

      Keeling, June J.; Van Wormer, Katherine; Taylor, Paul J.; University of Chester ; University of Iowa ; University of Chester (OMICS Group International, 2015-06)
      Historically police responses towards the treatment of domestic disturbances regard them as a noncriminal problem. Recent changes to societal and Criminal Justice System attitudes to domestic violence now places an emphasis on first response officers to effectively deal with offenders, manage victim safety and gather evidence. This study explored fifteen women’s interactions with the attending first response police officer following an episode of domestic violence within the home. A qualitative approach using unstructured narrative interviews was chosen to ensure that each woman remained in control of the research interview. Thematic analysis revealed three main themes concerning power relations and officer attitudes, suggesting that personal and cultural factors may negatively impact on officers’ handling of complaints of partner assault, offsetting policy initiatives that guide officers in engaging with victims of domestic violence. The order of the themes reflects the sequential nature of the women’s dialogue. The first theme explores the initial police response, followed by the women’s narratives around feelings of personal disregard for their experiences and evidential considerations. The final theme explores the police response to retraction of statements. Women’s interactions with first response officers following domestic violence illuminates societal issues previously unmentioned. Making womens’ stories visible provides an important insight, contribution and opportunity to examine first response officer’s responses to domestic violence. Integrating the voices of the women (service users) themselves, is arguably an advantageous consideration towards continuing professional development training for all first response police officers.
    • Working through interpreters in old age psychiatry: a literature review

      Farooq, Saeed; Kingston, Paul; Regan, Jemma; University of Chester; Staffordshire University (Emerald, 2015-03-09)
      Purpose – The purpose of this paper is to systematically appraise the effect of use of interpreters for mental health problems in old age. The primary objective of the review is to assess the impact of a language barrier for assessment and management in relation to mental health problems in the old age. The secondary objectives are to assess the effect of the use of interpreters on patient satisfaction and quality of care, identify good practice and make recommendations for research and practice in the old age mental health. Design/methodology/approach – The following data sources were searched for publications between 1966 and 2011: PubMed, PsycINFO, CINAHL and Cochrane Library. The authors found in previous reviews that a substantial number of papers from developing and non-English speaking countries are published in journals not indexed in mainstream databases, and devised a search strategy using Google which identified a number of papers, which could not be found when the search was limited to scientific data bases only (Farooq et al., 2009). The strategy was considered especially important for this review which focuses on communication across many different languages. Thus, the authors conducted a search of the World Wide Web using Google Scholar, employing the search term Medical Interpreters and Mental Health. The search included literature in all languages. The authors also searched the reference lists of included and excluded studies for additional relevant papers. Bibliographies of systematic review articles published in the last five years were also examined to identify pertinent studies. Findings – Only four publications related specifically to “old age” and 33 addressed “interpreting” and “psychiatry” generally. Four articles presented original research (Parnes and Westfall, 2003; Hasset and George, 2002; Sadavoy et al., 2004; Van de Mieroop et al., 2012). One article (Shah, 1997) reports an “anecdotal descriptive account” of interviewing elderly people from ethnic backgrounds in a psychogeriatric service in Melbourne and does not report any data. Therefore, only four papers met the inclusion and exclusion criteria and present original research in the field of “old age”, “psychiatry” and “interpreting”. None of these papers present UK-based research. One is a quantitative study from Australia (Hasset and George, 2002), the second is a qualitative study from Canada (Sadavoy et al., 2004), in the third paper Van de Mieroop et al. (2012) describe community interpreting in a Belgian old home and the final paper is an American case study (Parnes and Westfall, 2003). Practical implications – Interviewing older patients for constructs like cognitive function and decision-making capacity through interpreters can pose significant clinical and legal problems. There is urgent need for training mental health professionals for developing skills to overcome the language barrier and for interpreters to be trained for work in psychogeriatrics. Social implications – The literature on working through interpreters is limited to a few empirical studies. This has serious consequences for service users such as lack of trust in services, clinical errors and neglect of human rights. Further studies are needed to understand the extent of problem and how effective interpreting and translating services can be provided in the routine clinical practice. It is also essential to develop a standard of translation services in mental health that can be measured for their quality and also efficiency. At present such a quality standard is not available in the UK, unlike Sweden (see www.regeringen.se/sb/d/3288/a/19564). This omission is disturbing – especially when decisions on human rights are being considered as part of the Mental Health Act. Such a standard can best be achieved by collaboration between medical profession and linguists’ professional associations (Cambridge et al., 2012). Originality/value – Whilst translation/interpretation has been addressed more generally in mental health: specific considerations related to old age psychiatry are almost absent. This needs urgent rectification given that a large proportion of older people from BME communities will require translation and interpretation services.
    • Working with family carers

      Gant, Valerie; University of Chester (Critical Publishing, 2018-06-06)
      Care-giving transcends race, gender and age and most people will be a care giver or receiver (often both) at some point in their lives. This book explores the extent of caregiving in the UK and discusses its impact on individuals, groups and communities, as well as health and social care professionals. The book covers ways of identifying carers and providing information and advice and, given the likelihood of practitioners themselves providing care, a discussion regarding maintaining resilience and the extent to which personal experiences guide and inform practitioners response to work with carers is included. Exercises allow the reader to explore ways practitioners can engage with and support carers. The recent legislative changes brought about by the Care Act 2014 is discussed, as well as relevant policies. Caregiving has the potential to transcend disciplines, so this text will appeal to students of a variety of undergraduate and postgraduate programmes, and across the professional arena including social work, nursing, occupational and physiotherapy. The author is donating her royalties on this book to Carers UK and Carers Trust
    • Working with people with learning disabilities in varying degrees of security: nurses' perceptions of competencies

      Lovell, Andy; Bailey, Jan; Kingdon, Anne; Gentile, Domenica; University of Chester (Wiley, 2014-02-07)
      This article reports on a three year study conducted into the competencies qualified nurses working with people with learning disabilities and a background of offending behaviour within a range of secure settings (community, low, medium and high), perceived as being crucial to their role. A qualitative approach was taken and data were collected via a series of focus groups and individual interviews. Focus groups were initially conducted in each setting to inform the construction of a semi-structured interview schedule. Thirty-nine interviews were subsequently undertaken with nurses from each setting to develop a fuller understanding of the competencies identified from the focus groups and ascertain if these were influenced by the specific setting which the nurses worked. Data were analysed using qualitative thematic analysis and four competencies encompassing the skills and knowledge nurses perceive as essential to their role emerged: knowledge assimilation and application; team working; communication skills; and decision making. The secure setting influenced how the competencies were manifest in nurses’ practice and experience and practise emerged as crucial variables in how effectively they were applied. Recommendations for application of the research findings in nurse education and further research are made.