• The maze of midwife practice

      Steen, Mary; Royal College of Midwives/UCLan (2005-11)
      This presentation discusses the role of a midwife and debates whether she practises as an expert,a specialist or obstetric nurse. Essential midwifery practice focuses on autonomy, normality, holistic care, woman centredness and respecting differences. 'Every Midwife Matters', the challenges and barriers to midwifery care in the UK in the 21st century are explored and debated.
    • Measure of the Rate at which Mortality in Type 2 Diabetes Mellitus Occurs: Protocol for a Systematic Review.

      Nwaneri, Chukwuemeka; Cooper, Helen; Bowen-Jones, David; Agwu-Umahi, Olanike; Osho, A. Temitope; University of Chester; Arrowe Park Hospital; Alder Hey Children's NHS Foundation Trust (Teerthanker Mahaveer University, 2014-07-01)
      Introduction: Type 2 diabetes is the third largest cause of mortality in the United Kingdom, with about 50% of patients’ having developed complications at time of diagnosis. We consider that the evidence which explores the actual hazard ratios of mortality has not been consistent. n this paper we discuss methodology and review the most recent accurate data on mortality in type 2 diabetes. Methods: A systematic review will be undertaken aimed at synthesis of evidence of relative risk of mortality in type 2 diabetes, using the Centre for Reviews and Dissemination guidelines. We will explore conflicting and unanswered questions in relation to mortality. The primary outcome is all-cause, overall-cause or total mortality expressed as hazard ratios. Sub-groups will also be explored; age, gender, socio-economic factors and causes of death. We will review abstracts published after 1990 in the English language. Our data source will include electronic databases; the Cochrane library, the Centre for Reviews and Dissemination, Medline/PubMed, and other grey literature. The study populations are type 2 diabetes patients whose mortality outcome, expressed as hazard ratio, has been evaluated. Data extraction will be undertaken by one reviewer and triangulated by the second and third reviewer. The quality of the included studies will be evaluated in accordance with the inclusion/exclusion criteria; methodological quality that meets the critical appraisal framework and the relevance to the research questions. Evidence from data will be synthesised through a descriptive epidemiological review from included studies; meta-analysis will be used if appropriate. Result & Conclusion: We expect to pool homogenous studies of large population cohorts which explore the hazard ratio of mortality, and to summarise the evidence of the actual mortality risk in type 2 diabetes, with limited bias. This will help direct future research in areas of unanswered questions and may influence healthcare policy decisions.
    • Measurement instruments

      Mitchell, Andrew E. P.; University of Chester (SAGE, 2014-01-01)
      KEY POINTS • Measurement instruments enable the quantification of characteristics of interest to researchers • There are several methods of measuring characteristics, including scaling techniques • Any measurement instrument must be valid and reliable • Measurement instruments are important in healthcare research as they enable the measurement of attributes that are difficult to observe directly, such as cognitive and affective characteristics
    • Men and women’s perceptions and experiences of attending a managing abusive behaviour programme

      Steen, Mary; Downe, Soo; Graham-Kevan, Niki; University of Chester ; University of Central Lancashire ; University of Central Lancashire (Royal College of Midwives, 2009-12)
      Background: Domestic violence is a global and pernicious problem affecting all spheres of society. It has traditionally been seen as a social problem, but is now recognised to be a public health issue and reducing the incidence is a Priority Action 1 within Public Service Agreement 23. Sadly, domestic violence sometimes commences or escalates during pregnancy and during the transition to parenthood. It has been identified as a significant contributor to maternal and fetal morbidity and mortality, through both direct and indirect means. This paper describes the first phase of a study exploring the views of men and women, who had attended Start Treating Others Positively (STOP) a charity based in Leeds, UK. The adapted Appreciative Inquiry model of behavioural change underpins the work of STOP. Aim of the study: To explore the perceptions and experiences of participants attending STOP, to gain an insight of the effect this has had upon their ability to change their abusive behaviour to non-abusive and manage relationship conflict. Method: An exploratory study involving 20 participants (15 men and 5 women) who are parents and attending Start Treating Others Positively (STOP voluntarily. Ethics approval was granted by the university’s health ethics committee and guidance cited in the NHS Research Governance Framework was addressed throughout the study. Semi-structured interviews were undertaken during December 2007 and January 2008. An interview schedule of open and closed questions was used to gain an insight into respondents’ perceptions and experiences. Data were analysed by using a thematic analysis which entailed the identification of 6 primary emerging themes, 3 secondary core themes, then a final core theme, and the development of a synthesis statement. Findings: This first phase of this study explored the perceptions and experiences of 20 participants who attend STOP on how they have learnt to manage their behaviour to prevent themselves being abusive in their family relationships, and the impact this has had on their lives. Participants agreed that there were no excuses for domestic violence. Initially, six sub-themes emerged from the data: emotional regulation, emotional understanding, developing empathy skills, changed behaviour, developing conflict resolving skills, coping strategies. These were integrated into three overarching themes: emotional stability, cognitive empathy, conflict competency. Following synthesis, these were summarised into one phrase: ‘positive life skills’. The interviews demonstrated the participants had developed positive life skills whilst attending STOP to enable them to manage their emotions, behaviour and family relationship conflict. There was also evidence that these positive life skills were being taught to the participant’s own children Conclusions: Domestic violence has enormous implications for the health sector in general and within maternity services. Preventing future cases of domestic violence will reduce both maternal and fetal mortality and morbidity rates. The government has recognised the need to reduce the prevalence of domestic violence as a high priority, yet there is limited research to demonstrate effective preventative measures.
    • Mental Health and Primary Care

      Sharma, Vimal; University of Chester (Insight Medical Publishing Group, 2017-07-21)
      Mental ill-health is a leading cause of disability and most people with mental health problems approach their primary care doctors for help. One in four consultations in primary care is mainly due to mental health related issues. Yet mental health hasn’t received due attention so far in primary care setting. The main challenges in taking mental health services at primary care level include limited mental health specialists, low priority given to mental health, Inadequate training and skills of primary care workforce, Inadequate specialists’ support to primary care workers as well as negative attitude and stigma towards metal illness. Investing in work force’s training and education in identifying and managing mental disorders at primary care is the only way forward to address the huge treatment gap exists for mental illness. The use of technology and computers may assist this process further. An example is use of a pragmatic computer assisted diagnostic and treatment tool such as GMHAT/PC. Psychiatrists and other mental health professionals need to change their mind-set to work differently by supporting primary care workers, spending more time in training front line workers and taking some leadership in keeping the mental health agenda high up in policy makers’ list.
    • Mental Health and the Elderly Population

      Lovell, Andy; Moncur, Thomas; University of Chester; Cornwall Partnership NHS Foundation Trust (Routledge, 2015-11-02)
      This chapter provides an overview of the relationship between the elderly population and the society of which it is part, and how this has changed and developed across the globe over recent decades. The chapter begins by considering the statistics that convey how ageing is beginning to alter the structure of populations, and how there is now a significant difference according to different parts of the world. A broader discussion around ageism, discrimination and stigma then contextualizes the study according to the role of the elderly in particular societies and how this is influenced by issues such conventional approaches to retirement and a need to re-think what it means to be elderly. The chapter then goes on to address current concerns of dementia, gender and end of life issues. One of the authors, Thomas Moncur, goes on to provide a reflective piece on working with the age group clinically, including two clinically-related case studies exploring the impact of the ageing process on specific individuals.
    • Mental health services in Cambodia: an overview.

      Parry, Sarah J; orcid: 0000-0002-9730-3547; email: sarah316103@gmail.com; Wilkinson, Ewan (2019-11-13)
      Mental health services in Cambodia required rebuilding in their entirety after their destruction during conflict in the 1970s. During the late 1990s there was rapid growth and development of professional mental health training and education. Currently, basic mental healthcare is available primarily in urban areas and is provided by a mixture of government, non-government and private services. Despite the initial rapid growth of services and the development of a national mental health strategy in 2010, significant challenges remain in achieving an acceptable, standardised level of mental healthcare nationally. [Abstract copyright: © The Authors 2019.]
    • Mentoring

      Carr, Helen; Gidman, Janice; Wirral Primary Care Trust ; University of Chester (SAGE, 2008-03-17)
      This book chapter discusses the role of the mentor and the role of the student in healthcare education.
    • Mentoring student nurses in Uganda: a phenomenological study of mentors’ perceptions of their own knowledge and skills.

      Mubeezi, Mary; Gidman, Janice; Uganda Nurses Council, University of Chester (Elsevier, 2017-07-29)
      This paper will report on the findings of a qualitative research study exploring mentorship in a rural hospital in Uganda. It explored how mentors perceived their roles and their own knowledge and skills in mentoring nurse students. Participants were confident in their ability to teach clinical skills, but they identified gaps in relation to the application of theory to these skills and they identified the need to update their own knowledge and to act more on their own initiative. The paper reports on the nature of the relationship between mentor and students, the teaching approaches used and the challenges of the role. Recommendations are proposed to develop a bespoke Ugandan curriculum to prepare mentors for their role, and to provide additional support, to enhance students’ experiences of learning in this context.
    • 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.
    • A meta-analysis of type 1 diabetes mellitus, all-cause and cause-specific mortality

      Eloho, Akata; Cooper, Helen; Bowen-Jones, David; Mabhala, Mzwandile A.; University of Chester (PROSPERO, 2016-04-16)
      A meta-analysis of type 1 diabetes mellitus, all-cause and cause-specific mortality
    • Midwifery and psychological care

      Jones, Alun (Mark Allen Group, 2018-12-02)
    • Midwives reflections: Exploring attitudes, feelings and experiences when caring for women who are being abused

      Steen, Mary; Bharj, Kuldip; Leeds Teaching Hospitals NHS Trust/University of Leeds (MIDIRS, 2003-03)
      Domestic violence is a global concern and a major public health issue for midwives. In this article, the authors describe an in-service training programme developed to increase midwives' understanding of domestic violence as well as the use of reflective practice as a learning tool in exploring attitudes and experiences of midwives
    • Mind the Gaps: The rise and implications of cynicism within social work

      Carey, Malcolm; University of Chester (Oxford University Press, 2012-08-24)
      This paper explores the notable rise of cynicism among state social workers in Britain. Theoretically, cynicism has been viewed as ‘deviant emotion’ and pathology or as offering a type of employee resistance that may protect or support a person’s identity. Drawing upon case study research with practising social workers, the article looks at three different case examples of employee cynicism. These include the cynic as organisational survivor, disenfranchised sceptic or altruist. It was found that, although cynicism within social work predominately emerges as an emotional response to structural change, other factors such as those embodied within professional discourses and government or academic rhetoric can also impact. Other factors such as risk-averse assumptions that distance the practitioner from the ‘service user’ or colleagues can also have influence. Although often viewed negatively, cynicism can greatly benefit an organisation or motivate a practitioner to challenge normative principles and promote the needs of service users and carers.
    • Mind your Language: Discursive Practices Produce Unequal Power and Control Over Infectious Disease: A Critical Discourse Analysis

      Mabhala, Mzwandile; Yohannes, Asmait; Massey, Alan; Reid, John; University of Chester
      Abstract Background: Power, socioeconomic inequalities, and poverty are recognized as some of the fundamental determinants of differences in vulnerability of societies to infectious disease threats. The economic south is carrying a higher burden than those in the economic north. This raises questions about whether social preventions and biomedical preventions for infectious disease are given equal consideration, and about social institutions and structures that frame the debate about infectious disease. This article examines how institutionalized ways of talking about infectious disease reinforces, creates, and sustains health inequalities. Methodology: Critical discourse analysis was considered to be epistemologically and ontologically consistent with the aims and context of this study. Results: The study examined three types of infectious disease: • Emerging infectious diseases/pathogens • Neglected tropical diseases • Vector-borne infections. Examination revealed that poverty is the most common determinant of all three. Conclusion: A sustainable reduction in infectious disease in the southern countries is most likely to be achieved through tackling socioeconomic determinants. There is a need for a change in the discourse on infectious disease, and adopt a discourse that promotes self-determination, rather than one that reinforces the hero-victim scenario and power inequalities. Keyword: Critical discourse, inequalities, infectious disease, poverty, power
    • A mixed methods study to evaluate the feasibility of using the Adolescent Diabetes Needs Assessment Tool App in paediatric diabetes care in preparation for a longitudinal cohort study

      Cooper, Helen; Lancaster, Gillian A.; Gichuru, Phillip K.; Peak, Matthew; University of Chester; Keele University; Lancaster University; NIHR Alder Hey Clinical Research Facility; Alder Hey Children’s NHS Foundation Trust (BioMed Central, 2017-07-06)
      An evaluation study was carried out to determine the feasibility of integrating the Adolescent Diabetes Needs Assessment Tool (ADNAT) App into UK paediatric diabetes care, to ascertain best practice standards and to determine methodological recommendations for a future cohort study. Methods A non-randomised, cohort, mixed methods study design was used to ensure equality of access to ADNAT for all participants at three sites in the North West of England. Following UK Medical Research Council guidance, the RE-AIM (reach, effectiveness (potential and perceived), adoption, implementation, maintenance) framework was used to guide study objectives and feasibility outcomes. Patients who completed ADNAT (completers) were compared with those who failed to complete (non-completers). Patients’ glycaemic control (HbA1c) was accessed from their clinical data at baseline and at 6 months, alongside their ADNAT scores which were correlated with changes in HbA1c levels. The diabetes teams (respondents) completed a web-based survey and attended focus group interviews. Results Eighty-nine patients were recruited. Withdrawal rates were low at 4.5% (n = 4). Forty-four patients (49.4%) completed ADNAT, leaving 45 (50.6%) non-completers. There were large baseline differences in HbA1c and variable rates of change at 6 months. After adjusting for baseline HbA1C and site in an analysis of covariance, completers had a lower post-ADNAT mean HbA1C level than non-completers at 6 months (-5.42 mmol/mol, 95% CI −11.48, 0.64). Patients’ glycaemic control (HbA1c) at 6 months correlated reasonably well with their ADNAT scores (Spearman’s rho = 0.46). Survey and focus group data showed that ADNAT was judged to be an effective clinical tool by the diabetes teams. Value to patients was perceived by the teams to be linked to parental support, age and previous diabetes education. The combined data triangulated. It served to capture different dimensions which were used to define changes to achieve practice standards and methodological recommendations. Conclusions The combined data showed that ADNAT has the potential to be a clinically viable tool. It has demonstrated the need for a randomised design that is tailored for a ‘hard to reach’ adolescent population. A cluster randomised controlled trial that involves sequential but random rollout of ADNAT over multiple time periods may be the most appropriate and is currently being considered for the larger study.
    • A mixed methods study to evaluate the feasibility of using the Adolescent Diabetes Needs Assessment Tool App in paediatric diabetes care in preparation for a longitudinal cohort study

      Cooper, Helen; Lancaster, Gillian A.; Gichuru, Phillip K.; Peak, Matthew; University of Chester; University of Lancaster; Alder Hey Children’s NHS Foundation Trust (BioMed Central, 2017-07-06)
      Background. An evaluation study to determine the feasibility of integrating the Adolescent Diabetes Needs Assessment Tool (ADNAT) App into UK paediatric diabetes care, to ascertain best practice standards, and to determine methodological recommendations for a future cohort study. Methods A non-randomised, cohort, mixed methods study design was used to ensure equality of access to ADNAT for all participants at three sites in the North West of England. Patients who completed ADNAT (completers) were compared with those who failed to complete (non-completers). Following UK Medical Research Council guidance, a logic model and the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework were used to define study objectives. Patients’ glycaemic control (HbA1c) was accessed from their clinical data at baseline and at 6 months, alongside their ADNAT scores which were correlated with changes in HbA1c levels. The diabetes teams (respondents) completed a web-based survey and attended focus group interviews. Results 89 patients were recruited. Withdrawal rates were low at 4.5% (n=4). Forty-four patients (49.4%) completed ADNAT, leaving 45 (50.6%) non-completers. There were large baseline differences in HbA1c and variable rates of change at 6 months. After adjusting for baseline HbA1C and site in an Analysis of Covariance, completers had a lower post-ADNAT mean HbA1C level than non-completers at 6 months, suggesting improvement for those using ADNAT (95% CI -11.48, 0.64). Patients’ glycaemic control (HbA1c) at 6 months correlated reasonably well with their ADNAT scores (Spearman’s rho=0.46). Survey and focus group data showed that ADNAT was judged to be an effective clinical tool by the diabetes teams. Value to patients was perceived to be linked to parental support, age and previous diabetes education. The combined data triangulated suggesting validity of the study. It served to capture different dimensions which were used to define best practice standards and methodological recommendations including the need for a team based approach to implementation, broader patient-based outcomes, and non-participant clinic observations. Conclusions The combined data showed that ADNAT was a clinically viable tool and that a future mixed methods, non-randomised, longitudinal cohort study would be feasible following MRC guidance for process evaluation of complex interventions, including use of the piloted logic model and the RE-AIM framework.
    • 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.
    • Mortality in type 2 diabetes mellitus: Magnitude of the evidence from a systematic review and meta-analysis

      Nwaneri, Chukwuemeka; Cooper, Helen; Bowen-Jones, David; University of Chester ; University of Chester ; Alder Hey Children’s NHS Foundation Trust (SAGE, 2013-07-15)
      Type 2 diabetes is associated with an increase in age-related mortality. A systematic review and metaanalysis were performed to define the relative risks (RR) of all-cause or cause-specific mortality in type 2 diabetes and to determine gaps in current research. A comprehensive literature search was undertaken for studies (published 1990–2010) on mortality in type 2 diabetes. The study reports on the measure of mortality as defined by RR for all-cause and cause-specific mortality, heterogeneity, sensitivity analyses and biases. In total 35 studies (220,689 patients; mean follow-up of 10.7 years) were eligible for inclusion: 33 studies reported increased mortality risks; 24 had full data on 95% confidence intervals (CIs), one study reported no excess mortality in men diagnosed after 65 years whereas three reported increased mortality in similar age groups in both sexes. Meta-analysis showed RR = 1.85 (95% CI 1.79–1.92) for all-cause mortality [men RR=1.57 (95% CI 1.46–1.68); women RR=2.0 (95% CI 1.89–2.12)], RR=1.76 (95% CI 1.66–1.88) for cardiovascular mortality and RR=2.26 (95% CI: 1.7-3.02) for stroke. There was no statistically significant evidence of publication bias. Conclusion: Type 2 diabetes increases mortality approximately two-fold increase and macrovascular disease is the principal cause of death.
    • Multi-disciplinary teams

      Baldwin, Moyra A.; University of Chester (SAGE, 2010-10-15)
      This book chapter discusses the importance of multi-disciplinary teamwork - which involves individual professions communicating and collaborating with other disciplines in the team to plan, agree, and implement an excellent standard of palliative care - in contemporary palliative care.