The use of mindfulness-based cognitive therapy for improving quality of life for inflammatory bowel disease patients:study protocol for a pilot randomised controlled trial with embedded process evaluation

Background: Inflammatory bowel disease (IBD) is a chronic condition with an unpredictable disease course. Rates of anxiety and depression among IBD patients in relapse (active disease symptoms) as well as in remission are higher than in the general population. Previous studies suggest that the prolonged effect of pain, anxiety, distress and depression have a detrimental effect on patients’ quality of life (QoL). Poor QoL in itself is associated with further symptom relapse. Mindfulness based cognitive therapy (MBCT) is a psychological group intervention that has the potential to improve QoL. When used in other chronic conditions, it demonstrated reduced negative effect from pain and psychological factors at completion of an 8-week MBCT course. The effect of MBCT has never been researched in IBD. The aim of this study is to obtain the information required to design a full scale randomised controlled trial (RCT) that will examine the effectiveness of MBCT in improving quality of life for IBD patients.Methods/Design: This is an exploratory RCT with embedded process evaluation. Forty IBD patients will be recruited from NHS outpatient gastroenterology clinics and will be randomised to either a MBCT (intervention) group or to await-list (control) group. All participants will undergo 16 h of structured group training over an 8-week period, with the control group starting 6 months later than the intervention group. Primary outcomes are recruitment, completion/retention rates and adherence and adaptation to the MBCT manual for IBD patients. The secondary outcome is to assess the feasibility of collecting reliable and valid data on proposed outcome measures such as quality of life, anxiety, depression, disease activity and mindful awareness. The process evaluation will use a survey and focus groups to assess the acceptability of the intervention and trial procedures for IBD patients.Discussion: The outcomes of this study will help define the barriers, uptake and perceived benefits of MBCT program for IBD patients. This information will enable the design of a full-scale study assessing the effect of MBCT on quality of life for IBD patients

Research note – barriers and solutions to linking and using health and social care data in Scotland

Integration of health and social care will require integrated data to drive service evaluation, design, joint working and research. We describe the results of a Scottish meeting of key stakeholders in this area. Potential uses for linked data included understanding client populations, mapping trajectories of dependency, identifying at risk groups, predicting required capacity for future service provision, and research to better understand the reciprocal interactions between health, social circumstances and care. Barriers to progress included lack of analytical capacity, incomplete understanding of data provenance and quality, intersystem incompatibility and issues of consent for data sharing. Potential solutions included better understanding the content, quality and provenance of social care data; investment in analytical capacity; improving communication between data providers and users in health and social care; clear guidance to systems developers and procurers; and enhanced engagement with the public. We plan a website for communication across Scotland on health and social care data linkage, educational resources for front line staff and researchers, plus further events for training and information dissemination. We believe that these processes hold lessons for other countries with an interest in linking health and social care data, as well as for cross-sector data linkage initiatives in general.</p

Biogeography as critical nursing pedagogy: Breathing life into nurse education

Insights from the social sciences, including geography, sociology, and anthropology, have long been incorporated into pre-registration nursing programmes. However, scholars have suggested that their inclusion has been sporadic and lacks clear theoretical rationale. In this paper we argue anew that the social sciences – and particularly, human geography – could be central to nurse education. Specifically, we recast the concept of ‘biogeography’ drawn from human geography that emphasises the interplay between life (bio) and place (geo) to propose pedagogy that theoretically justifies and practically enables the inclusion of the social sciences in nurse education. Biogeography can breathe new life into nursing curricula by animating our students through the cultivation of three ‘spirits of nursing’. First, a ‘spirit of empathy’ that can shatter patient-professional dualisms by facilitating person-centred and place-sensitive care. Second, a ‘spirit of engagement’ that situates practice in social structures awakening a desire to effect change by fomenting an acute sense of social justice. Third, a ‘spirit of enquiry’ that holds in critical tension the theory-practice gap by fostering continual questioning and pursuit of evidence. In so doing, biogeographical pedagogy releases the latent potential of the social sciences to revitalise nurse education, reinvigorate our students, and renew ourselves as nurse educator

Zooming out to prioritise population health in nurse education

In this Editorial, we argue that zooming out to prioritise population health in nurse education can: (1) Redefine population health as praxis; (2) Reposition nursing as a significant part of the movement to address global health care challenges; (3) Reinforce the shift from illness care to health care. In doing so we suggest that nurse educators must embrace the potential of population health to radically reshape their educational praxis and awaken students to act justly to serve populations and drive progress towards health equity

Population health as a 'platform' for nurse education: A qualitative study of nursing leaders

Background: Challenges to the sustainability of global healthcare systems are prompting a shift towards more population-focused models of care. Nurse educators need to develop courses that prepare students for population health practice. However, the educational approaches that can support this shift are poorly understood. Publication of new standards for nurse education by the United Kingdom’s (UK) Nursing and Midwifery Council that place greater emphasis on population health presented an opportunity to seek nursing leaders’ views on population health in nurse education.Objectives: To assess the views of nursing leaders within a Scottish context on the connection between nurse education and population health for all students, evaluate what student nurses need to know to support population health practice, and draw insights from the UK for pre-registration programmes internationally.Design: Qualitative interview studyParticipants: Twenty-four nursing leaders from academic (n=15), practice (n=4) and regulatory (n=5) sectorsMethods: Semi-structured interviews were conducted face-to-face (n=21), by telephone (n=2) or Skype (n=1). Interviews were transcribed and analysed, using interview questions as structural themes, followed by thematic and content analyses.Results: Nursing leaders encouraged rebalancing nurse education towards population health, suggesting that population health concepts should sit at the core of spiral curricula to enable students to (re)view learning through a population health lens. Seven outcomes were identified to equip student nurses for practice in any setting. These formed the mnemonic FULCRUM: Find and interpret evidence; Understand the psychology of behavior and change; Link epidemiology to population health; Consider others and themselves in context; Recognise social determinants of health; Understand the impact of policy and politics on health; Motivate to encourage behaviour change.Conclusions: FULCRUM can guide nurse educators globally to support preparation of graduate nurses for the significant shifts in healthcare delivery and service organization toward improving population outcomes

The use of mindfulness-based cognitive therapy for improving quality of life for inflammatory bowel disease patients: study protocol for a pilot randomised controlled trial with embedded process evaluation.

Background Inflammatory bowel disease (IBD) is a chronic condition with an unpredictable disease course. Rates of anxiety and depression among IBD patients in relapse (active disease symptoms) as well as in remission are higher than in the general population. Previous studies suggest that the prolonged effect of pain, anxiety, distress and depression have a detrimental effect on patients’quality of life (QoL). Poor QoL in itself is associated with further symptom relapse. Mindfulness based cognitive therapy (MBCT) is a psychological group intervention that has the potential to improve QoL. When used in other chronic conditions, it demonstrated reduced negative effect from pain and psychological factors at completion of an 8-week MBCT course. The effect of MBCT has never been researched in IBD. The aim of this study is to obtain the information required to design a full scale randomised controlled trial (RCT) that will examine the effectiveness of MBCT in improving quality of life for IBD patients. Methods/Design This is an exploratory RCT with embedded process evaluation. Forty IBD patients will be recruited from NHS outpatient gastroenterology clinics and will be randomised to either a MBCT (intervention) group or to a wait-list (control) group. All participants will undergo 16 h of structured group training over an 8-week period, with the control group starting 6 months later than the intervention group. Primary outcomes are recruitment, completion/retention rates and adherence and adaptation to the MBCT manual for IBD patients. The secondary outcome is to assess the feasibility of collecting reliable and valid data on proposed outcome measures such as quality of life, anxiety, depression, disease activity and mindful awareness. The process evaluation will use a survey and focus groups to assess the acceptability of the intervention and trial procedures for IBD patients. Discussion The outcomes of this study will help define the barriers, uptake and perceived benefits of MBCT program for IBD patients. This information will enable the design of a full-scale study assessing the effect of MBCT on quality of life for IBD patients. Trial registration Current Controlled Trials: ISRCTN2793446

Student nurses' attitudes to social justice and poverty: An international Comparison

Background: In both the United Kingdom (UK) and the United States (US), health inequities are proving resistant to improvement. Nurses are ideally placed to advocate for social justice. It is therefore important that nurse education encourages awareness of the social determinants of health and equips students to act to address health inequity. However, little is known about student nurses’ attitudes to social justice and poverty and the impact of pedagogical strategies used to teach the determinants and patterns of health inequities.Objectives: To assess and compare UK and US student nurses’ attitudes toward social justice and poverty before and after learning about social determinants of health and health inequities.Design: Cross-sectional study with embedded before and after design using validated measures.Setting: Two universities: one urban UK university and one US university with urban and rural campuses.Participants: 230 student nurses in the UK (n=143) and US (n=87) enrolled in courses teaching content including health inequities and social determinants of health.Results: Student nurses generally disagreed with stigmatizing statements about people living in poverty and mostly agreed with statements promoting social justice. However, US studentswere significantly more likely to have positive attitudes towards both social justice (p=0.001) and poverty (

Transfusing our lifeblood: reframing research impact through inter-disciplinary collaboration between health geography and nurse education

The authors wish to thank the Economic and Social Research Council (ESRC) for funding this seminar series (Grant Number: ES/L000741/1).Geographers have long grappled with how their research can positively impact individuals, communities and society. Demonstrating research impact is an increasingly important aspect of academic life internationally. In this paper we argue that agendas for encouraging ‘impact’ would be well-served if impact through teaching was identified and stimulated more explicitly, and if academics better recognised and seized the opportunities that already exist for such impact. We take engagement between health geography and nurse education as an example of how social scientists could demonstrate research impact through inter-disciplinary involvement in the education of health care professionals, and specifically student nurses. We begin by showing how the UK's Research Excellence Framework (widely regarded as the key reference point for research performance management regimes internationally) has tended to produce an undervaluation of impact via education in many disciplines. A comprehensive overview of international scholarship at the intersection between geography and nursing is then presented. Here we trace three ‘waves of enquiry’ that have focused on research interactions before calling for a fourth focused on critical pedagogy. To illustrate the possibilities of this fourth wave, we sketch a case study that outlines how engagement with research around blood donation could help provide a foundation for critical pedagogy that challenges student nurses to practice reflexively, think geographically and act justly. Finally, we call for closer engagement between health geography and nurse education, by encouraging educators to translate, teach, and transfuse ideas and people between health geography and nurse education. In so doing, we argue that work at this interface can be mutually beneficial and demonstrate impact both within and beyond research assessment rubrics. Hence, our ideas are relevant beyond nurse education and geography insofar as this paper serves as an example of how reframing research impact can recover the importance of impact through education.PostprintPeer reviewe

Assessment of the concordance between individual- and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales

ObjectivesMost research on health inequalities uses aggregated deprivation scores assigned to the small area where the patient lives; however, the concordance between aggregate area-level deprivation measures and personal deprivation experienced by individuals living in the area is poorly understood. Our objective was to examine the agreement between individual and ecological deprivation. We tested the concordance between metrics of income, occupation and education at individual and area levels, and assessed the reliability of area-based deprivation measures to predict individual deprivation circumstances.SettingEngland and WalesParticipantsA cancer patient cohort of 9,547 individuals extracted from the ONS Longitudinal Study.OutcomesWe quantified the concordance between measures of income, occupation and education at individual and area level. In addition, we used ROC curves and the area under the curve (AUC) to assess the reliability of area-based deprivation measures to predict individual deprivation circumstances.ResultsWe found low concordance between individual and area-level indicators of deprivation (Cramer’s V statistics range between 0.07 and 0.20). The most commonly used indicator in health inequalities research, area-based income deprivation, was a poor predictor of individual income status (AUC between 0.56 and 0.59), whereas education and occupation were slightly better predictors (AUC between 0.62 and 0.65). The results were consistent across sexes and across six major cancer types.ConclusionsOur results indicate that ecological deprivation measures capture only part of the relationship between deprivation and health outcomes, especially with respect to income measurement. This has important implications for our understanding of the relationship between deprivation and health, and, as a consequence, healthcare policy. The results have a wide-reaching impact for the way in which we measure and monitor inequalities, and in turn, fund and organise current UK healthcare policy aimed at reducing them

Are deprivation-specific cancer survival patterns similar according to individual- and area-based measures? A cohort study of patients diagnosed with five malignancies in England & Wales, 2008-2016

Objective: To investigate if measured inequalities in cancer survival differ when using individual- (‘person’) compared to area- (‘place’) based measures of deprivation for three socio-economic dimensions: income, deprivation and occupation Design: Cohort studySetting: Data from the Office for National Statistics (ONS) Longitudinal Study of England and Wales, UK, linked to the National Cancer Registration DatabaseParticipants: Patients diagnosed with cancers of the colorectum, breast, prostate, bladder or with Non-Hodgkin Lymphoma (NHL) during the period 2008-2016Primary and secondary outcome measures: Differentials in net survival between groups defined by individual wage, occupation and education compared to those obtained from corresponding area-level metrics using the English and Welsh Indices of Multiple Deprivation (IMD).Results: Survival was negatively associated with area-based deprivation irrespective of the type analysed, although a trend from least to most deprived was not always observed. Socio-economic differences were present according to individually-measured socio-economic groups although there was an absence of a consistent ‘gradient’ in survival. The magnitude of differentials was similar for area-based and individually-derived measures of deprivation, which was unexpected.Conclusion: These unique data suggest that the socio-economic influence of ‘person’ is different to that of ‘place’ with respect to cancer outcomes. This has implications for health policy aimed at reducing inequalities. Further research could further consider the separate and additional influence of area-based deprivation over individual-level characteristics (contextual effects) as well as investigate the geographic, socio-economic and healthcare related characteristics of areas with poor outcomes in order to inform policy intervention