Research priorities for respiratory nursing:A UK-wide delphi study

Respiratory nurses make a significant contribution to the delivery of respiratory healthcare, but there is a dearth of nurse-led, practice-focused, published research. Using a modified three-round Delphi, this study sought to identify research priorities for respiratory nursing to inform a national research strategy. Study information and the survey link were sent electronically to members of UK professional respiratory organisations. Round 1 had 78 items across 16 topics, informed by a systematic literature review. Respondents suggested additional items which were content analysed to inform Round 2. Respondents rated all items and ranked the topics in all rounds. To ensure rigour, rounds had an explicit focus with pre-determined criteria for consensus (70%). In total, 363 responses were received across Rounds 1, 2 and 3 (n=183, 95 and 85, respectively). The top five research priorities were: 1) “Patient understanding of asthma control”; 2) “The clinical and cost-effectiveness of respiratory nurse interventions”; 3) “The impact of nurse-led clinics on patient care”; 4) “Inhaler technique”; and 5) two topics jointly scored: “Prevention of exacerbations” and “Symptom management”. With potential international significance, this is the first UK study to identify research priorities for respiratory nursing, providing direction for those planning or undertaking research

Children’s learning from a Smokefree sports programme: implications for health education

Objective: This article reports on a qualitative evaluation of the Love Life, Smokefree Sports primary school pilot intervention. This 8-week programme used sports and physical activity sessions to convey Smokefree messages to 120 children aged 10 and 11 in two primary schools in Sheffield in 2018. The study aimed to understand children’s experiences of participating in the programme. Its objectives were to explore children’s recall of the health promotion messages associated with each of the learning sessions; explore children’s perceptions of the meaningfulness of those messages in the context of their everyday lives; and identify and understand any contextual factors that might impact upon children’s recall and/or the meaningfulness of the Smokefree messages. Method: Qualitative data were generated with 25 children through focus groups after the programme concluded. Data were analysed thematically using cross-sectional, categorical indexing. Results: Learning from the programme was particularly likely to be described as meaningful by children when they could interact with material and visual representations of complex ideas and when sessions involved strongly embodied experiences. However, children did not always find it easy to relate learning to their everyday lives and sometimes struggled to reconcile pre-existing, contextualised understandings with intervention messages. We mobilise the concept of critical health literacy as a theoretical lens through which to interpret these findings. Conclusion: Health education should be meaningful in the context of children’s everyday lives. Starting from the premise that children are active critical health literacy practitioners and working with them to design and evaluate health education initiatives can promote this

What is unique about quality of life in Motor Neurone Disease?: A qualitative analysis.

Background: Quality of Life (QoL) is an important consequence in neurological clinical care. The debate about generic and disease specific measures of quality of life reflects uncertainty about whether there are unique aspects to understanding QoL in different diseases. If there are commonalities to different disabling neurological diseases, it may be credible to extrapolate from more common and better-studied conditions, like multiple sclerosis (MS) to rarer diseases like motor neurone disease (MND). Distinctions across neurological conditions would suggest that strategies to maximise QoL must be disease specific. Objectives: In this analysis our aim was to explore psychosocial factors affecting QoL in MND in comparison with MS. Methods: The study employed both semi-structured interviews and focus groups. Each focus group was consisted of either MND or MS. All interviews and group discussions were audio recorded and transcribed verbatim for a thematic analysis. Themes were inductively developed within a condition before they were compared across the two conditions for cross-sectional exploration. Results: Data was collected from 40 people with MND: 26 interviews (male=14; mean age= 64yrs; mean illness duration=1.6yrs); 14 in focus groups (male=9; mean age=62yrs; mean illness duration=3.5yrs); and from 61 people with MS: 43 interviews (male=16; mean age=52yrs; mean illness duration=15yrs); 18 in focus groups (male=6; mean age=47yrs; mean illness duration=9yrs). A codebook for each condition was developed for the analysis and saturation was achieved in both MND and MS. Whilst the analysis identified the same psychosocial domains to be important for QoL irrespective of disease, there was an aspect unique to MND of it being a terminal condition. Both MS and MND patients valued their lives, but MND patients recognised their shorter life expectancy and differed from MS patients because thoughts of imminent death adversely impacted QoL. Participant’s concerns about their death were not restricted to themselves, but extended to impact on significant others. The differences between MND and MS were further observed with regard to factors that were beneficial to QoL. Although the positive influence of environmental factors and spirituality were found in both conditions, additional implications of these factors were found amongst the MND group: it was found that the importance of environment included the place of death, and spirituality was described to provide hope even beyond death. Discussion and conclusions: The current study reveals complexity in ascertaining QoL across neurological diseases. Despite distinct illness trajectories, the same psychosocial factors were identified to be important for QoL in MND and MS. Nevertheless, MND as a terminal condition was found to further challenge patient’s QoL. The findings confirm the importance of addressing this aspect of the condition in addition to commonly investigated psychosocial factors

Young people’s perspectives of e-cigarette use in the home

There is concern that the emergence of e-cigarettes could result in an increase in young people's intake of, and exposure to, nicotine. This UK study used friendship group interviews to elicit the perspectives of young people from socioeconomically contrasting backgrounds regarding e-cigarettes. Young people from both advantaged and disadvantaged backgrounds described similar e-cigarette practices in the home environment, and, for both health and sensory reasons, viewed these as preferable to tobacco smoking. Space-related practices of adult e-cigarette use in the home were revealed to be more malleable than those of tobacco use. Results also highlighted that e-cigarettes offered young people new opportunities for nicotine consumption in the home. Methods of storing e-cigarettes in domestic spaces posed safety risks to younger children and easy access to e-cigarettes for others

E-cigarette use: a qualitative exploration of the views and experiences of children and young people from contrasting socio-economic backgrounds

There is concern that the emergence of e-cigarettes could result in an increase in children’s and young people's consumption of, and exposure to, nicotine. Understanding children’s and young people’s perceptions and experiences of e-cigarette use is regarded as a research priority, but there is a dearth of qualitative work that investigates any similarities and differences in their views and experiences across socio economic backgrounds. This study drew upon Childhood Studies and the Capability Approach, both of which emphasise the plurality of human experience. Its primary aim was to understand how children and young people of contrasting ages and socio-economic backgrounds view and experience e-cigarette use, and to explore the factors that influence these views and experiences. Twenty friendship group interviews were conducted with older (16-17 years) and younger (11-12 years) pupils from two socio-economically contrasting secondary schools in Merseyside, UK. In total, 64 pupils were interviewed. Thematic analysis was utilised to analyse the data. The study findings report that children’s and young people’s understandings and experiences of vaping are highly contextualised and comprise multiple meanings. E-cigarettes are understood to have advantages over tobacco cigarettes in sensory, practical, social and health terms, but positive assessments of vaping are frequently outweighed by notions of risk. Many views and experiences of e cigarette use are shared across age groups and socio economic backgrounds, but these demographic characteristics, as well as social and familial networks, also account for important differences in understandings and experiences. This thesis concludes that children’s and young people’s views and experiences of e-cigarette use can be understood in terms of their valuation of core capabilities - possibilities relating to physical, mental and social well-being. It demonstrates that the potential for e-cigarette use to realize or hamper different capabilities is dependent on the context in which it is undertaken

Disadvantaged mothers, young children and smoking in the home: mothers’ use of space within their homes

Breathing tobacco smoke is linked to poor health in young children, with their homes identified as the primary place of exposure. This UK study uses focus group discussions to explore how mothers living in disadvantaged areas use space within their homes to smoke while looking after children aged 0–4 years, and critically examines how they define non-smoking or smoking homes. Many women imposed temporary and ad hoc restrictions, and this research highlights how the mothers’ desire to create a smoke-free environment for their children competes with their caring responsibilities, and how their efforts are restricted by the limitations of the physical environment of their homes

'Imagine all that smoke in their lungs': parents' perceptions of young children's tolerance of tobacco smoke

Despite knowing the risks to their children's health, parents continue to expose their children to tobacco smoke prior to and after their birth. This study explores the factors influencing parent's behaviour in preventing the exposure of their (unborn) children to environmental tobacco smoke (ETS) and any changes to their smoking behaviour in the home during the first years of their children's lives. Whether or not they stopped smoking during pregnancy, the women did not protect themselves from breathing in other people's smoke. Yet once the baby was born, parents actively protected the baby from environmental tobacco, believing that the lungs of newborn babies were too immature to tolerate smoke. This protection lasted only for a matter of weeks for some babies, or stopped when they were 6–12 months old, linked to their parent's belief that older babies could tolerate or avoid smoke. These findings suggest that changes made to smoking during the first weeks of a baby's life are unlikely to be sustained, and key messages about the risks if ETS exposure need to be delivered repeatedly over the first 2 years of life and re-enforced as the child gets older