The DINARC© Toolkit - Clinical Academic Research Capacity-Building and Post-Doctoral Development for Nurses, Midwives and Allied Health Professionals (NMAHP)

The challenges of developing nurses, midwives and AHPs (NMAHPs) as clinical academics (CA) have received international attention. Balancing clinical practice and academic pursuit, often where managers are unfamiliar with academic career requirements, is one such challenge; however, the current literature provides limited developmental guidance. The aim of this article is to describe the DINARC© (Dissemination, Implementation, Networking, Active Research and Clinical practice) Toolkit, a continuous practice development aide for NMAHPs who are in the early post-doctoral phase of a clinical academic career (CAC). We identified five DINARC© elements, through evidence review and synthesis, as requisites for supporting the progression of a CAC. An ‘expert reference group’ (CAs, academic supervisors and nurse leaders) advised and assisted in development of the DINARC© concept. A Practitioner Research Plan and Mentor–Mentee Discussion Guide was developed and applied within a large metropolitan UK university teaching hospital; this was designed to identify the essential elements required to successfully navigate a CAC pathway. Early feedback from practitioners and managers suggests that DINARC© aids CAs in navigating an early CAC and offers guidance for managers. Further application and evaluation of DINARC© is now required by those developing a CAC. Implications for practice: DINARC© is a resource to guide practitioners’ CAC development with the goal of integrating and strengthening clinically-based NMAHP research activities, with related improvements in patient care. We believe that DINARC© has wider relevance as a useful tool, worthy of testing internationally

The Clinicians’ Skills, Capability, and Organisational Research Readiness (SCORR) Tool

A research-active healthcare workforce contributes to improved quality of care. Clinicians may be unaware that they are applying early research skills during their everyday practice. Greater understanding of their level of research attainment may improve their awareness and confidence in their research skills. This article describes the development of the Clinicians Skills, Capability, and Organisational Research Readiness (SCORR) Tool, a simple innovation that assesses and captures research skills and attainment at 1) clinician, and 2) organisational level. The SCORR Tool was initially developed to assess levels of research attainment and to promote discussion during annual appraisals for podiatrists working across secondary and community care in a northern region of England. The levels (1 to 5) of attainment recognise UK Health and Care Professions Council (HCPC) registration requirements for chiropodists/podiatrists (Standards 12 to 14). Following testing and feedback, research levels were adapted (Levels 0 to 5) to accommodate all healthcare professionals (with the exception of doctors and dentists). The SCORR Tool may be used individually by clinicians, or in collaboration with their manager, to better understand the level of research attainment and to prompt discussion to increase research activity. It may also be used across a workforce (e.g. during an appraisal) to understand the organisational research readiness. The SCORR Tool requires additional testing and evaluation to validate it as a tool for use across a variety of organisational environments

A call for responsible innovation in mobile mental health:findings from a content analysis and ethical review of the depression app marketplace

Mobile mental health presents many ethical challenges in the wild. These ethical issues and associated values were explored through a content analysis and ethical review of the depression app marketplace. App search and data collection was performed in Google Play Store (UK) and Apple iTunes (UK) between October to November 2018. Iterative data extraction and coding of ethical variables and values were conducted prior to synthetization of issues and themes. Search found 353 unique apps for depression. Analysis uncovered a range of ethical issues including: limited evidence of intervention validity, fidelity, and outcomes; insufficient safeguarding and duty of care; non-multisector development teams; lack of independent certification and regulation; lack of information and transparency for informed user choices; and concerns with privacy, confidentiality, and user permissions. These findings highlighted the presence and absence of ethical values in apps for depression, with most apps failing to reflect many key values. Our findings suggest a need for greater ethical value sensitive design in mobile mental health. This is challenging given the field’s multidisciplinarity and value conflicts. We encourage designers to adopt a responsible innovation approach to creating technologies that meet these ethical demands

A transdisciplinary framework for ethical mobile mental health

Mobile mental health has been touted as a means of increasing access to mental health care. But there are significant challenges to the implementation of mobile mental health, such as limited evidence of effects and concerns with privacy and security. These challenges pose notable ethical concerns that must be addressed in order to ensure good and fair delivery of mental health care. Adding to this complexity is the multidisciplinary nature of the field and the need to involve all stakeholders to ensure ethical development and use of these technologies. In this thesis, I explore multidisciplinary perspectives and ethical experiences in mobile mental health with the aim of developing a transdisciplinary framework. This thesis makes five original contributions. First, it presents a comprehensive cross-disciplinary review of the ethics of mobile mental health (Chapter 3) including an in-depth evaluation of ethical issues in the wild (Chapter 4). These studies found ethical issues and considerations not conveyed in the literature and proposed elements of ethically designed apps for depression. Second, I present similarities and differences in the discussion and prioritisation of ethics across disciplines (Chapters 3) which supported the thesis aims and the importance of multidisciplinarity. Third, I used these findings to develop ethical design cards for digital mental health and show support for their use as a toolkit to help multidisciplinary teams to consider ethical issues when designing and developing digital mental health interventions (Chapter 5). Fourth, I present original research exploring how multidisciplinary stakeholders conceptualise ethical digital mental health (Chapter 5). I found that this was largely grounded in the adage of doing no harm, which was impacted by the values underlying the design and use of the technologies. Finally, I conclude the thesis by amalgamating these findings into a transdisciplinary framework that advances understanding and provides practical guidance on developing and using ethical mobile mental health (Chapter 6)

A systemic ethical framework for mobile mental health:From design to implementation

The burgeoning field of mobile mental health has brought increased awareness of the need for greater ethical and regulatory frameworks to guide the design, use, and implementation of innovative interventions for vulnerable populations. Mental healthcare has long been guided and regulated by ethical principles and codes of conduct aimed at ensuring standards of practice, professional behaviour, and good and fair delivery of care. Key ethical concepts, such as safety, privacy, and competency, form an integral part of the language and behaviours of mental health practitioners. These issues pervade mobile mental health in much of the same way as traditional mental healthcare. Yet, the multidisciplinary nature of mobile mental health demands a broader conceptualisation and application of these ideas. At its most basic level, mobile mental health unites the fields of mental health, computer science, and human computer interaction. Each of these unique disciplines has its own ethical considerations and standards. There is need for greater integration of all disciplines and a more unified approach to understanding these shared and unique ethical concepts. Without a holistic approach to these critical matters, we risk the development and implementation of mobile mental health which falls short of accepted standards and which pose potential risks to individuals and society. The present research seeks to address this challenge with the development of a systemic ethical framework for mobile mental health. Guided by preliminary review of literature, we conceptualised a systems-based framework capturing the interrelation of pertinent ethical concepts across various disciplines and stakeholder groups, from the fundamental unit of the individual user to practitioners, developers, health agencies, and governance

How to Relax in Stressful Situations: A Smart Stress Reduction System

Stress is an inescapable element of the modern age. Instances of untreated stress may lead to a reduction in the individual's health, well-being and socio-economic situation. Stress management application development for wearable smart devices is a growing market. The use of wearable smart devices and biofeedback for individualized real-life stress reduction interventions has received less attention. By using our unobtrusive automatic stress detection system for use with consumer-grade smart bands, we first detected stress levels. When a high stress level is detected, our system suggests the most appropriate relaxation method by analyzing the physical activity-based contextual information. In more restricted contexts, physical activity is lower and mobile relaxation methods might be more appropriate, whereas in free contexts traditional methods might be useful. We further compared traditional and mobile relaxation methods by using our stress level detection system during an eight day EU project training event involving 15 early stage researchers (mean age 28; gender 9 Male, 6 Female). Participants' daily stress levels were monitored and a range of traditional and mobile stress management techniques was applied. On day eight, participants were exposed to a 'stressful' event by being required to give an oral presentation. Insights about the success of both traditional and mobile relaxation methods by using the physiological signals and collected self-reports were provided

A content analysis and ethical review of mobile applications for depression:Exploring the app marketplace

BACKGROUND Research investigating commercial mobile applications for depression have shown a range of concerns from limited research evidence, poor treatment fidelity, and issues with privacy and data security. This study advances this work through a content analysis and ethical review of app store listings of apps for depression. Whilst past content analyses and app reviews have highlighted some ethical and safety concerns, there has been no focussed ethical review to consider how these issues may present to potential users who seek to find help and support through the app stores. METHODS We conducted search of the Google Play Store and Apple iOS App Store in October and November 2018. Apps were included in the review if their description mentioned use for depression. Apps were reviewed for treatment information and ethical issues. RESULTS We identified 353 eligible depression apps. Treatment approach varied across apps, with 24 different treatment approaches being described by developers. Treatment strategies also varied, with 34 different strategies being listed. The review showed the use of several non-evidence-based approaches and strategies. Also evident was the continued lack of research evidence for most apps (314/353) and a general lack of transparency in the information provided to potential users. These ethical issues were further explored within the framework of psychological ethical principles, with the review highlighting issues in areas of beneficence/nonmaleficence, fidelity and responsibility, integrity, justice, and respect of person’s rights and dignity. DISCUSSION Despite advances in mobile mental health, commercial mental health apps continue to trail in evidence and practice. There is need for greater research into the efficacy and outcomes of treatment strategies and combinations of approaches. There is also great need for increased transparency of information to help users to make informed and safe choices. Many of the ethical issues discussed can be addressed by presenting potential users with clear and accurate information

Barriers to research progress for perioperative care practitioners working in cardiothoracic surgery.

Policy and research literature worldwide support the need to build research capacity and capability among non-medical practitioners within healthcare systems. However, there exists a paucity of evidence on whether practitioners in cardiothoracic surgery are attuned to this and on what barriers or enablers exist. A survey was carried out with non-medical practitioners working in cardiothoracic surgery in the United Kingdom to explore attitudes towards health research and audit, and to identify current challenges and barriers to surgical research and audit as perceived by cardiothoracic nurses and allied health professionals. A total of 160 completed questionnaires were returned. 99% of respondents supported the need for research and believed that evidence-based surgical care improves outcomes for patients. Seventy-two percent reported that their employer motivates them to take part in national research or audit but, only 22% were allocated time to do so within their role; 96% reported their interest in being involved in research and audit, yet only 30% believed they had the skills to undertake research, and 96% reported needing additional training. More work is needed to increase awareness, capacity and capability among cardiothoracic surgery care practitioners, and indeed other specialities to achieve research progress

Investigating mortality and morbidity associated with UrINary incontinence during Older Womens Secondary Care Admissions and exploring nurses experiences of delivering related care (U-INconti): a mixed methods research protocol

Introduction: Urinary incontinence (UI) is associated with increasing age and is more frequently experienced by women. Despite 40% prevalence in the community, little is known about the prevalence/incidence of UI in older women during hospital admission. UI during hospital admissions, within this group, has also been under-researched in terms of its relationship to specific clinical conditions and mortality rates. Given that UI has serious implications for both patient care and women’s general health and well-being on discharge, this protocol describes a planned research project which aims to determine mortality, morbidity, prevalence and incidence of UI in older women (≥55 years) during hospital admission to inform nursing practice. Additionally, it aims to explore the experience of nurses who deliver women’s care. Methods and analysis: This is an explanatory mixed-methods study consisting of two phases: (1) retrospecitive analysis of electronic patient care records (EPCR) to determine prevalence/incidence of UI, clinical conditions most likely associated with UI and any associations between UI and death, (2) nurse interviews to explore views, knowledge and perceptions of performing the nursing assessment and providing care for older women (≥55 years) with UI during admission. EPCR will be gained from a National Health Service (NHS) teaching hospital. Nurse interviews will be conducted with nurses from an alternative but similar-sized NHS hospital. Ethics and dissemination: Ethical approval is provided by the University of Salford Ethics Committee and regulatory approval by the NHS Health Research Authority (Integrated Research Application System project ID: 303118). Local NHS trust approval to access electronic care records for the purposes of analysis of anonymised data has been provided by one of the two collaborating NHS hospitals. Findings will be disseminated through open-access geriatric or urogynaecology journals and presented to relevant stakeholders at local, national and international meetings including scientific meetings such as the UK Continence Society and International Continence Society

Evaluation of a COVID ‐19 fundamental nursing care guideline versus usual care: The COVID‐NURSE cluster randomized controlled trial

Aim: To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID‐19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health‐related quality of life and cost‐effectiveness. Design: Parallel two‐arm, cluster‐level randomized controlled trial. Methods: Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID‐19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient‐reported co‐primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention‐to‐treat analyses. Results: We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570–572 (98.1%–98.5%) patient participants in 14 clusters. We found no evidence of between‐group differences on any patient, nurse or economic outcomes. We found between‐group differences over time, in favour of the intervention, for three of our five co‐primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the ‘other’ ethnicity subgroup. Conclusion: We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non‐white British patients' experience of care. Implications for the Profession and/or Patient Care: We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required. Impact: Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non‐white British patients' experience of care. Reporting Method: CONSORT and CONSERVE. Patient or Public Contribution: Patients with experience of hospitalization with COVID‐19 were involved in guideline development and writing, trial management and interpretation of findings