The Pictor technique: exploring experiences of collaborative working from the perspectives of generalist and specialist nurses

Interviews are widely used in qualitative research, and can take many different forms (see King and Horrocks, 2010). In this chapter, we will introduce a particular visual tool developed by the authors and colleagues for use in research interviews: the Pictor technique (e.g. King, Bravington, Brooks et al. 2013). The technique requires research participants to construct a ‘Pictor chart’ - a visual representation depicting their role and their work - which the researcher and participant can then use as a basis to explore potentially complex experiences in a research interview setting. We will present here an example from our own applied research to demonstrate how we have used Pictor in research interviews

Supported: supporting, enabling, and sustaining homecare workers to deliver end-of-life care: a qualitative study protocol

Background Homecare workers provide essential care at home for people at end-of-life but are often poorly trained and supported. Aim To explore the experiences and needs of homecare workers and the views of homecare clients and carers, and other community-based health and social care staff about the homecare worker role, including identification of good practice. Methods In this qualitative exploratory study, we will conduct 150 semi-structured interviews with homecare workers within three geographic English localities chosen for maximum socio-demographic variation. Eligible participants will be consenting adults providing care services (workers [n = 45], managers [n = 15] community practitioners [n = 30]), receiving care (clients thought to be in the last 6 months of life [n = 30], family carers [n = 15], or commissioners of homecare services supporting end-of-life care [n = 15]. Interviews may adopt a Pictor-guided or standard semi-structured approach according to their preference. Managers and commissioners can contribute to an online focus group if preferred. A range of recruitment strategies will be used, including through homecare agencies, local authorities, local NHS services, charities, voluntary sector groups and social media. Interviews and focus groups will be recorded, transcribed, anonymised, and analysed adopting a case-based approach for each geographic area within-case and then comparison across cases using reflexive thematic analysis. The design and analysis will be informed by Bronfenbrenner’s Adapted Ecological Systems theory. This study is registered on the Research Registry (No.8613). Contribution We will provide evidence on ways to improve the experiences and address the needs of homecare workers in relation to caring for people nearing end-of-life. It will offer insight into good practice around supporting homecare workers including responding to their training and development needs. Findings will inform subsequent stages of an evaluation-phase study of a training resource for homecare workers

Close-kin mark-recapture informs critically endangered terrestrial mammal status

Reliable information on population size is fundamental to the management of threatened species. For wild species, mark-recapture methods are a cornerstone of abundance estimation. Here, we show the first application of the close-kin mark-recapture (CKMR) method to a terrestrial species of high conservation value; the Christmas Island flying-fox (CIFF). The CIFF is the island's last remaining native terrestrial mammal and was recently listed as critically endangered. CKMR is a powerful tool for estimating the demographic parameters central to CIFF management and circumvents the complications arising from the species’ cryptic nature, mobility, and difficult-to-survey habitat. To this end, we used genetic data from 450 CIFFs captured between 2015 and 2019 to detect kin pairs. We implemented a novel CKMR model that estimates sex-specific abundance, trend, and mortality and accommodates observations from the kin-pair distribution of male reproductive skew and mate persistence. CKMR estimated CIFF total adult female abundance to be approximately 2050 individuals (95% CI (950, 4300)). We showed that on average only 23% of the adult male population contributed to annual reproduction and strong evidence for between-year mate fidelity, an observation not previously quantified for a Pteropus species in the wild. Critically, our population estimates provide the most robust understanding of the status of this critically endangered population, informing immediate and future conservation initiatives

Using Visual Timelines in Telephone Interviews: Reflections and Lessons Learned from the Star Family Study

Visual timeline methods have been used as part of face-to-face qualitative interviewing with vulnerable populations to uncover the intricacies of lived experiences, but little is known about whether visual timelines can be effectively used in telephone interviews. In this article, we reflect on the process of using visual timelines in 16 telephone interviews with women as part of the ‘STarting a family when you have an Autoimmune Rheumatic disease’ study (STAR Family Study). The visual timeline method was used to empower women to organize and share their narratives about the sensitive and complex topic of starting a family. We conducted a thematic analysis of the audio-recorded interview data, using researchers’ field notes and reflections to provide context for our understanding of the benefits of using timelines, to understand the process of using visual timelines during telephone interviews. Resource packs were sent to women before study participation; 11 out of 16 women completed a version of the timeline activity. Six themes were identified in the methodological data analysis: 1) Use and adaptation of the timeline tool; 2) Timeline exchange, 3) Framing the interview: Emphasizing that women are in control; 4) Jumping straight in; 5) Taking a lead, and; 6) Disclosing personal and sensitive experiences. The use of visual timelines facilitated interviewee control and elicited rich narratives of participants’ experiences in telephone interviews. Women created their visual timelines autonomously and retained ownership of their timeline data; these features of the data generation process need to be considered when using visual timelines in telephone rather than face-to-face interviews. Use of visual methods within telephone interviews is feasible, can generate rich data, and should be further explored in a wider range of settings

Can comprehensive specialised end-of-life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK

The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant-led, multidisciplinary team aiming to provide round-the-clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% were for cancer, from a population of about 155 000. Using a mixed method approach, the evaluation comprised: a retrospective analysis of secondary-care use in the last year of life; financial evaluation of the MMSPCS using an Activity Based Costing approach; qualitative interviews with patients, carers, health and social care staff and MMSPCS staff and volunteers; a postal survey of General Practices; and a postal survey of bereaved caregivers using the MMSPCS. The mean cost is about 3000 GBP (3461 EUR) per patient with mean cost of interventions for cancer patients in the last year of life 1900 GBP (2192 EUR). Post-referral, overall costs to the system are similar for MMSPCS and hospice-led models; however, earlier referral avoided around 20% of total costs in the last year of life. Patients and carers reported positive experiences of support, linked to the flexible way the service worked. Seventy-one per cent of patients died at home. This model may have application elsewhere

Using GPS data to evaluate the accuracy of state-space methods for correction of Argos satellite telemetry error

Recent Studies have applied state-space models to satellite telemetry data in order to remove noise from raw location estimates and infer the true tracks of animals. However, while the resulting tracks May appear plausible, it is difficult to determine the accuracy of the estimated positions, especially for position estimates interpolated to times between satellite locations. In this study, we use data from two gray seals (Halichoerus grypus) carrying, tags that transmitted Fastloc GPS positions via Argos satellites. This combination of Service Argos data and highly accurate GPS data allowed examination of the accuracy of state-space position estimates and their uncertainty derived from satellite telemetry data After applying a speed filter to remove aberrant satellite telemetry locations. we fit a continuous-time Kalman filter to estimate the parameters of I random walk, used Kalman smoothing to infer positions at the times of the GPS Measurements. and then compared the filtered telemetry estimates with the actual GPS Measurements. We investigated the effect of varying maximum speed thresholds in the speed-filtering algorithm oil the root mean-square error (RMSE) estimates and used minimum RMSE as a criterion to guide the final choice of speed threshold. The optimal speed thresholds differed between the two animals (1.1 m/s and 2.5 m/s) and retained 50% and 65% of the data for each seal. However, using a speed filter of 1.1 m/s resulted in very similar RMSE for both animals. For the two seals. the RMSE of the Kalman-filtered estimates of location were 5.9 and 12.76 km, respectively, and 75% of the modeled positions had errors less than 6.25 km and 11.7 km for each seal. Confidence interval coverage was close to correct at typical levels (80-95%), although it tended to be overly generous at smaller sizes. The reliability Of uncertainty estimates was also affected by the chosen sliced threshold. The combination of sliced and Kalman filtering allows for effective calculation of location and also indicates the limits of accuracy when correcting service Argos locations and linking satellite telemetry data to spatial covariate and habitat data.</p