Children’s complex health: Maternal experiences of care and decision making

© The Author(s) 2023. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/)An increasing number of children with complex life-limiting and life-threatening conditions are being cared for at home by their parents. Negative impacts on maternal health are now being recognised. This study sought to voice parental experiences to determine what matters most; explore day-to-day decision making and Advance Care Planning; and to inform local service development. Seven mothers from one community nursing service were interviewed using a semi-structured qualitative approach during the Coronavirus disease 2019 pandemic. Seven data-driven themes were identified following six phase thematic analysis: cherishing normality; navigating the system; being proactive; meaningful connections; beginner to expert – and back; they’re not any child – they’re my child; and Coronavirus disease 2019 pandemic. Practice implications include early discussion of what matters most and benefits of written plans to ensure fair access to treatment for children with complex health. Mothers highlighted that sharing their story enhanced their sense of coping and purpose. Increased support at times of vulnerability and permission to explore decisions were highly valued.Peer reviewe

How do student nurses learn to care? An analysis of pre-registration adult nursing practice assessment documents

This document is the Accepted Manuscript version of the following article: Kate Young, Rosemary Godbold, and Pat Wood, ‘How do student nurses learn to care? An analysis of pre-registration adult nursing practice assessment documents’, Nurse Education in Practice, Vol. 28: 168-174, January 2018. Under embargo until 6 October 2018. The final, definitive version is available online at DOI: https://doi.org/10.1016/j.nepr.2017.10.004.There is international concern about the quality of nursing in resource constrained, high technology health care settings. This paper reports findings from a research study which explored the experiences and views of those involved in the education and learning of 'caring' with adult pre-registration students. A novel dataset of 39 practice assessment documents (PADs) were randomly sampled and analysed across both bachelors and masters programmes from September 2014–July 2015. Using an appreciative enquiry approach, the Caring Behaviours Inventory aided analysis of qualitative text from both mentors and students within the PADs to identify how student nurses learn to care and to establish whether there were any differences between Masters and Bachelors students. In contrast with existing research, we found a holistic, melded approach to caring. This combined softer skills with highly technologized care, and flexible, tailored approaches to optimise individualised care delivery. Both of these were highly valued by both students and mentors. Pre-registration MSc students tended to have higher perceptual skills and be more analytical than their BSc counterparts. We found no evidence to suggest that caring behaviour or attitudes diminish over the course of either programme.Peer reviewedFinal Published versio

Exploring New Zealand Paramedic Attitudes Towards Advance Directives: An Ethical Analysis

Paul Davey, Amanda Lees and Rosemary Godbold, 'Exploring New Zealand paramedic attitutes towards advance directives: an ethical analysis', Australasian Journal of Paramedicine, Vol 13(4): 1-10, Article 2, published 1 November 2016. The version of record is available on line via https://ajp.paramedics.org/index.php/ajp/article/view/241/575 © 2016 The Official Journal of Paramedics AustralasiaIntroduction Advance directives are known to present challenging ethical issues in health care practice, however there is a paucity of research into paramedic perspectives of advance directives. In situations where the patient has not considered end-of-life provisions, or is unable to communicate their wishes, this contributes to an ethically complex decision-making environment for practitioners. Ethical deliberation contributes to practitioners’ critical thinking skills and helps prepare them for decision-making under uncertainty. This research aims to highlight and explore underlying values within ethically complex practice-based decisions. Methods An exploratory, interpretive study using the ‘Values Exchange’, a web-based ethical decision-making tool, explored 18 urbanbased New Zealand paramedics’ deliberative perspectives on a controversial end-of-life scenario. Results Thematic analysis of participants’ responses ascertained the breadth of views on advanced directives, with the emergence of three dominant themes; legal tensions, multiple constructs of dignity and seeking solutions that support clinical practice. Conclusion Findings revealed that when considering situations involving advance directives, participants regarded the duty to uphold patient dignity as paramount. There was a desire for greater legal guidance and a call for increased professional education in law and ethics. This study provides insight into New Zealand urban-based paramedics’ views and experiences of this ethically challenging aspect of patient care.Peer reviewe

Reconceptualizing participant vulnerability in Scholarship of Teaching and Learning research: exploring the perspectives of health faculty students in Aotearoa New Zealand

© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC), https://creativecommons.org/licenses/by-nc/4.0/While the need to protect vulnerable research participants is universal, conceptual challenges with the notion of vulnerability may result in the under or over-protection of participants. Ethics review bodies making assumptions about who is vulnerable and in what circumstance can be viewed as paternalistic if they do not consider participant viewpoints. Our study focuses on participant vulnerability in Scholarship of Teaching and Learning (SoTL) research. We aim to illuminate students’ views on participant vulnerability to contribute to critical analysis of the role and processes of ethics review. Additionally, we aim to highlight the importance of seeking the views of participant communities, especially in research environments beyond ethics review’s medical origins. Thirty-four students from a health-related faculty at a university in Aotearoa New Zealand, participated in five focus groups. Participants discussed factors affecting their potential participation in research drawing upon a series of vignettes based on examples of published SoTL projects. Themes, generated using reflexive thematic analysis, built a participant-informed picture of vulnerability. Findings indicate that students do not generally consider themselves vulnerable and instead consider participation in SoTL research through an agentic lens. Students expect that participation will be voluntary, not negatively impact their grades, and not single them out so that others could judge them. Our study also highlights the value students place on relationships with one another and teaching staff and the implications these have for SoTL research participation and future professional practice. This research challenges research ethics committees to think further about vulnerability in the context of SoTL whilst highlighting the importance of providing opportunities for research participants more broadly to explore and vocalize their views as members of participant communities.Peer reviewe

Illuminating the Role of Reflexivity Within Qualitative Pilot Studies: Experiences From a Scholarship of Teaching and Learning Project

© The Author(s) 2022. This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/).Pilot studies within qualitative inquiry are crucial yet often hidden aspects of research design. In this article, we argue for pilots to have greater visibility. We explore the role of a pilot in providing a foundation for enhancing ethical reflexivity, drawing on a recent pilot study within a tertiary healthcare education setting. The Scholarship of Teaching and Learning (SoTL) presents a unique environment with complex stakeholder relationships. There is a lack of consensus nationally and internationally on whether all SoTL projects require consideration by institutional ethics review bodies. A pilot study offers an opportunity for ethical steerage of a research project, reflecting ethics in practice whilst augmenting any procedural ethics review requirements. We propose that a qualitative pilot study, as a design strategy, can enhance ethical conduct by researchers. Within SoTL specifically, the pilot can provide an opportunity for researchers to demonstrate a commitment to a pedagogy of care spanning the project’s duration, signifying a commitment to enduring teacher-student relationships within the broader learning environment. Beyond tertiary settings, we believe the pilot study, as a space for ethical reflexivity, has applicability to research settings where caring for and being seen to care for the wider participant community is a critical ethical consideration.Peer reviewedFinal Published versio

An evaluation of safeguarding training across Hertfordshire and West Essex ICS: The SafeTE study : An evaluation study commissioned by Hertfordshire Safeguarding Adult Board and Safeguarding Children Partnership, Hertfordshire and West Essex Integrated Care System [ICS]

© 2024 The Author(s). This an open access work distributed under the terms of the Creative Commons Attribution Licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited

‘All we’ve ever known is Covid’: A follow-up study with newly qualified nurses who worked as student nurses during the pandemic

© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License https://creativecommons.org/licenses/by/4.0/Aims and objectives: To explore the experiences of nursing students in England who had worked through the first wave and transitioned to qualification in the ongoing pandemic. Background: Experiences of health professionals and student nurses during the pandemic are now well documented, but transition of students to qualification is less well understood. In Summer 2020 we interviewed 16 student nurses who had worked as health care assistants on paid extended placements as part of the Covid-19 response in the East of England, finding surprisingly positive experiences, including perceived heightened preparedness for qualification. A year later we re-interviewed 12 participants from the original study to hear about transitioning to qualification during the ongoing pandemic. This study provides novel insights into their experiences. Design: A qualitative study design was used. Methods: 12 newly qualified nurses who had participated in the original study took part in qualitative, online interviews where they shared their experiences of working and transitioning to qualification during the ongoing pandemic since we spoke to them a year earlier. The data was analysed using thematic analysis. COREQ guidelines were used in developing and reporting this study. Results: 3 themes were identified. Constant change: in the clinical environment and arising out of the transition to newly qualified nurse, mental health and well-being, and reflecting on the past to learn for the future. Conclusions: Participants experienced a unique transition to qualification. The perceived heightened preparedness for qualification that participants who had worked as students during the first wave of the pandemic had become a reality, ameliorating some of the known effects of transition. However, increased expectations and added responsibilities in extremely busy, fluctuating clinical environments with minimal support add weight to calls for mandatory preceptorship programmes. While heightened resilience was evident, provision of ongoing mental health and well-being support is strongly recommended. Relevance to Clinical Practice: We need a partnership approach with nurse educators and practice colleagues which ensures preparation for qualified practice is appropriate. If we do not effectively prepare students for qualified nurse posts, patient care will almost certainly be compromised.Peer reviewe

The experiences of student nurses in a pandemic : a qualitative study

© 2021 The Author(s). Published by Elsevier Ltd. his is an open access article under the CC BY-NC-ND license. https://creativecommons.org/licenses/by-nc-nd/4.0/Aim/objective: To record and learn from the experiences of students working on clinical placement in a pandemic. Background: In March of 2020, final and second year student nurses in England were given the option to join the Covid-19 pandemic work-force, paid as high-level health care assistants. Methods/design: Using qualitative methods and rapid analysis techniques, this study gathered the unique experiences of 16 final year students, from all fields of nursing at a University in the East of England, who chose to complete their final extended placement in a diverse range of clinical placements at the height of the first wave of the pandemic. Data was collected between July and September 2020. Results: Five key themes were identified across our data: rationale for undertaking the extended placement, role tensions, caring for patients and their families, the impact on teaching and learning, and personal health and wellbeing. Conclusions: While our participants reported largely positive experiences including a perceived heightened preparedness for qualification, their experiences provide important insights for nurse educators for the education and support of future students going into similar situations, in particular relating to welfare and support, preparation for placement, resilience, e-learning and learning on the front line.Peer reviewedFinal Published versio

Toxic effects of Pb2+ on growth of cowpea (Vigna unguiculata)

A concentration as low as 1 mu M lead (Pb) is highly toxic to plants, but previous studies have typically related plant growth to the total amount of Pb added to a solution. In the present experiment, the relative fresh mass of cowpea (Vigna unguiculata) was reduced by 10% at a Pb2+ activity of 0.2 mu M for the shoots and at a Pb2+ activity of 0.06 mu M for the roots. The primary site of Pb2+ toxicity was the root, causing severe reductions in root growth, loss of apical dominance (shown by an increase in branching per unit root length), the formation of localized swellings behind the root tips (due to the initiation of lateral roots), and the bending of some root tips. In the root, Pb was found to accumulate primarily within the cell walls and intercellular spaces. (C) 2007 Elsevier Ltd. All rights reserved

A philosophical critique of the best interests test as a criterion for decision making in law and clinical practice

The best interest test is the legal mechanism which governs decision making on behalf of adults who lack the capacity to make their own health care treatment decisions. The test has attracted considerable criticism from health professionals, academics, judges and lawyers for being ill-defined and non-specific. The question of what is meant by 'best interests' remains largely unanswered. As a consequence, the test gives medical and legal decision makers considerable discretion to apply their personal value judgements within supposedly value-free philosophical frameworks - unreasoned and opaque decision making processes are the inevitable result. Because of the dominance of supposedly value-free philosophical frameworks, the place of values in decision making is not always fully understood. Reasoning is not possible without values, which stem from our emotions and passions, our upbringing, our religion, our cultures, our processes of socialisation and from our life experiences. Values help us make sense of our daily lives. I argue that law - like any other social institution - is essentially a human, values based construct. I put forward a theory of values-based law which argues for the recognition that laws, rules and conventions are based on, and contain, individual values. Currently, medical and legal decision makers justify grave decisions on behalf of society's most vulnerable citizens without revealing, or even acknowledging the values which drive and inform their decisions. Any opportunities to scrutinise or debate the values driving decisions are lost. Ultimately, values-based law argues that values underlying best interest determinations must be exposed to facilitate honest, transparent and fulsome decision making on behalf of adults who lack capacity. By applying the theory of values-based law, supposedly value-free decision making processes are exposed as insufficient to facilitate fulsome, honest and transparent legal reasoning