Understanding the experience of older people in acute health care

An interest in older people's experiences of acute care and how they make sense of that experience was the starting point for this thesis. Using the epistemological base of social constructionism the thesis examines the experiences of care older people have within acute health care settings and explores the qualified nurse's experiences of care in relation to older people in the context of acute care. Thirteen patients and fourteen nurses from one hospital participated, through semi-structured interviews, in the study. Field notes were used to further illuminate the context of the research. Data was coded using an inductive coding approach, followed by a refining of categories through the use of concept mapping. Data analysis was undertaken manually and cross checking undertaken to establish clear findings. Patient's understandings and explanations of their care were identified, along with the nurse's views and accounts of care within an organisational context. Many factors were found to be influential in the older person's experience of care. Media coverage of care experiences, along with comparison of personal experiences affected the older person's view of their care experience. The impact of the organisational approach to acute care was seen as a major factor in the care experience from the patient and nurse perspective. Lack of a shared philosophy of care within the nurse population led to a lack of continuity and consistency of care for patients. Similarly differing perspectives on the nature of the patient – nurse relationship led to tensions within the care environment causing stress and de-motivation in the nurse population that ultimately affected the patient experience. A conceptual framework was developed that illustrated the complicity between patients and nurses to maintain the illusion of a caring nurse.sub_nurunpub95_ethesesunpu

Duality of practice in clinical research nursing

Mairghread Ellis - ORCID: 0000-0002-3474-533X https://orcid.org/0000-0002-3474-533XBackground: International evidence suggests that Clinical Research Nurses (CRN) can have a dual role incorporating both clinical care and research responsibilities. This duality of role often assists in meeting the clinical care and research needs of the participants and can contribute to the credibility of the CRN role. Conversely, it can also lead to feelings of confusion and role conflict as CRN’s time is divided. Aim: To identify and explore experiences of clinical and research roles among CRNs. This emerged as a theme in a wider research project exploring CRNs’ experiences of working with clinical nurses. Methods: Following an Interpretative Phenomenological Analysis approach, 10 CRNs participated in face-to-face semi-structured interviews. Transcribed data were analysed and a number of themes emerged. Duality of role was one of these. Findings: Findings indicated that if CRNs fulfil a dual role, this can assist in care provision, research delivery and in building positive relationships with clinical nurses. However, there were also instances when a dual role led to clinical nurses questioning the value of research and to issues with competing demands of clinical care and research. These experiences had an important impact on some of the CRNs and led to reflection on the value of their role. Conclusions: This study identifies new understandings of a dual role of the CRN. The findings will inform the preparation and practice of this group of nurses, whilst also leading to a deeper understanding of the CRN’s role in care and research delivery. It will also contribute to a wider appreciation of organisational factors and social interactions that impact on health care research.https://doi.org/10.1177/1744987121107097627pubpub1-

Third-generation professional doctorates in nursing: the move to clarity in learning product differentiation

Context: Professional doctorates have been a part of the academic landscape for many years. Over this time, their focus, structure and mode of delivery have changed significantly as the terrain of professional practice has developed. In this paper we articulate this development over time through discussion of the evolution of first- and second-generation professional doctorates, and argue that there is a need for a third-generation doctorate with greater clarity regarding focus, structure and mode of delivery, in the context of advanced professional practice. Aims: A scoping review was undertaken of the development of professional doctorates in the discipline of nursing to inform thinking with regard to future design work for a post-masters (nurse practitioner endorsement) professional doctorate. Conclusion: In the context of the absence of any identified published outcome-based evidence of the value of first- or second-generation professional doctorates in general, and specifically in nursing, a third-generation evolution is proposed. This is based on the conclusion that the lack of identified outcomes is based not only on the axiomatic absence of research, but also that this may be symptomatic of a prevailing lack of clarity in programme design. A third-generation professional doctorate for nursing offers an opportunity to focus on congruence and internal consistency between the aims of the programme, learning outcomes, learning content and design, and the assessment. Implications for practice development: - The third-generation professional doctorate would no longer need to be distinguished from other degrees via an expression of what it is not, but rather would set out what it is - The educational product, with clear processes and content that are congruent with the course aims, could be clearly described as a self-contained entity more capable of producing measurable outcomes - Practice development is an integral part of the learning product through being a prescribed method in the research component of the coursesch_nur7pub5315pub2 [4

Final Report for The Lydia Osteoporosis Project

Sharing Research and Education Focused on Moving and Handling and Older People with Osteoporosis in Acute Settingssch_nurAge UK www.ageuk.org.uk accessed 30th June 2016 Biggs J and Tang C 2011 Teaching for Quality Learning at University (Society for Research into Higher Education) SRHE and Open University Press Imprint, Maidenhead, UK. Blaikie, N. 2009 Designing Social Research. Polity Press, Cambridge, UK. Colon-Emeric, CS., Lyles, KW., House, P., Levine, DA., Schenck, AP., et al. 2007 Randomised trial to improve fracture prevention in nursing home residents American Journal of Medicine 120 (10) 886 -892 Coulter Smith M A, O'May F, Tropea S, Berg J 2016 Framing moving and handling as a complex intervention in the acute care of older adults with osteoporosis: A qualitative study. Journal of Clinical Nursing. Accepted for publication 19th April 2016. Wiley Open Access. Unique ID: 5511802- 1606658. Cox, H., Puffer, S., Morton, V. et al. 2008 Educating nursing home staff on fracture prevention: a cluster randomised trial Age and Ageing 37 167-172 Foss, NB., Pal, H., Kehlet, H. 2005 In hospital hip fractures: prevalence, risk factors, and outcome. Research Letter. Age Ageing 34, (6) 642-645. Doi:10.1093/ ageing/alfi198 Giangregorio, L., Fisher, P., Papaioannou, A., Adachi, JD. 2007 Osteoporosis knowledge and information needs in healthcare professionals caring for patients with fragility fractures Orthopaedic Nursing 26 (1) 27 - 35 Haentjens P, Magaziner J, Col_n-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S 2010 Meta-analysis: Excess Mortality After Hip Fracture Among Older Women and Men. Ann. Intern. Med. 152, (6), 380-390. doi: 10.7326/0003-4819-152-6-201003160- 00008. Harvey, G., & Kitson, A. 2015 Implementing Evidence Based Practice in Healthcare. A Facilitation Guide. Routledge, London. Hignett, S. 2003 Systematic review of patient handling activities starting in lying, sitting and standing positions. Journal Advanced Nursing 41 (6) 545-552 Hignett, S., Crumpton, E., Ruszola S. et al. 2004 Evidence-Based Patient Handling. Tasks, Equipment and Interventions Routledge, London Hippisley-Cox, J., Coupland, C. 2012 Derivation and validation of updated QFracture algorithm to predict risk of osteoporotic fracture in primary care in the United Kingdom: prospective open cohort study. BMJ. 344, e3427. doi: 10.1136/bmj.e3427. International Osteoporosis Foundation (IOF) 2015 http://www.iofbonehealth.org/factsstatistics Accessed 21st December 2015 International Osteoporosis Foundation 2010 The Breaking Spine http://www.iofbonehealth.org/ publications/the-breaking-spine.html Accessed 2nd March 2011 Jonassen, D., & Land, S. 2012 Theoretical Foundations of Learning Environments 2nd edition Oxon, Routledge Joop, PW., van den Bergh., Tineke ACM van Geel., Willem, FL., et al. 2010 Assessment of Individual Fracture Risk: FRAX and Beyond Current Osteoporosis Reports 8 131-137 Kanis, JA., McCloskey, EV., Johansson, H., Cooper, C., Rizzoli , R., Reginster, JY. 2013 European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 24, 23-57 doi 10.1007/ s00198-012-2074-y Kanis, JA. , Johnell, O., Oden, A. et al. 2008 European guidance for the diagnosis and management of osteoporosis in postmenopausal women Osteoporosis International 19 399-428 Kanis, JA. 2007 on behalf of World Health Organization Scientific Group. Assessment of osteoporosis at the primary health care level. Technical report. UK: World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield; 2007. Available from https://www.shef.ac.uk/ FRAX/pdfs/WHO_Technical_Report.pdf Accessed 6th December 2015 Kanis, JA, Borgstrom, F., De Laet, C., et al. 2005 Assessment of fracture risk Osteoporosis International 16 581-589 Kneafsey, R., Clifford, C., Greenfield, S. 2013 What is the nursing team involvement in maintaining and promoting the mobility of older adults in hospital? A grounded theory study International Journal of Nursing Studies 50 1617-1629 http://dx.doi.org/10.1016/j. ijnurstu.2013.04.007 Kneafsey, R., & Haigh, C. 2009 Moving and handling rehabilitation patients: A survey of nurses' views International Journal of Therapy & Rehabilitation 16 (8) 431- 440 McCormack, B. 2015 Action research in complex interventions Chpt. 31. In Richards D A., & Rahm Hallberg I. Eds. 2015 Complex Interventions In Health. An Overview of Research Methods. Routledge, London McLellan, AR., Reid, DM., Forbes, K., et al. 2004 Effectiveness of Strategies for the Secondary Prevention of Osteoporotic Fractures in Scotland Executive Summary CEPS: 99/03 NHS Quality Improvement Scotland Mezirow, J. 2009 An overview on transformative learning. In: Illeris, K. ed. Contemporary Theories of Learning. Oxon: Routledge. p. 90 Moon, JA. 2004 A Handbook of Reflective and Experiential Learning. Theory and Practice London, New York: Routledge Moorchilot, R., Masud, T. 2010 The role of fracture prediction in managing osteoporosis Geriatric Medicine 40 (12) 671-2, 674-5 Mortiboys, A. 2012. Teaching with Emotional Intelligence: A Step-by-step Guide for Higher and Further Education Professionals. Oxon: Routledge National Osteoporosis Society (NOS) 2015 http://www.nos.org.uk accessed 29th June 2016 National Osteoporosis Guidelines Group (NOGG 2000) http://www.shef.ac.uk/NOGG/ accessed 2nd November 2010 NICE 2008 Osteoporosis: Assessment of fracture risk and the prevention of osteoporotic fractures in individuals at high risk National collaborating centre for nursing and supportive care Osteoporosis Evidence Review NICE accessed March 2011 NICE 2004 Technologies for the prevention and treatment of osteoporosis and prevention of osteoporotic fractures in postmenopausal women http://www.nice.org.uk/guidance/index. jsp?action=article&r=true&o=32980 accessed March 2011 QMU 2011 QMU Research Code of Practice. Queen Margaret University, Edinburgh Reason, P., Bradbury, H. 2006 Eds. Handbook of Action Research. Sage. London Rizzoli, R., Branco, J., Brandi, M.L., Boonen, S., Bruyre, O., Cacoub, P., Cooper, C., Diez-Perez, A., Duder, J., Fielding, R.A., Harvey, N.C., Hiligsmann, M., Kanis, J.A., Petermans, J., Ringe, J.D., Tsouderos. Y., Weinman, J., Reginster, J.Y. 2014. Management of osteoporosis in the oldest old. Osteoporosis Int. 25 (11), 2507-2529. SIGN 2015 Scottish Intercollegiate Guideline Network Management of Osteoporosis. SIGN 142. Management of osteoporosis and the prevention of fragility fractures. A national clinical guideline RCP, Edinburgh Smith, J. (Ed) 2005 The Guide to the Handling of People. 5thEdition. Backcare in collaboration with RCN & National Back Exchange, Teddington Taylor, J., Hill, H., Kay, K. 2016 NS835. An integrated practice approach to mobility care for older people. Nursing Standard. 30 (29) 51-59 Tashakkori, A., & Teddlie, C. 1998 Mixed Methodology. Combining Qualitative and Quantitative Approaches. Applied Social Research Methods Series. Volume 46. Sage Publications, London Teddlie, C., & Tashakkori, A. 2009 Foundations of Mixed Methods Research. Integrating Quantitative and Qualitative Approaches in the Social and Behavioral Sciences. Sage, London. Van Merrinboer, J.J.G., & Kirschner P. A. 2013 Ten Steps to Complex Learning. A Systematic Approach to Four-component Instructional Design. 2nd ed. Routledge, London. Vered, I., Werner, P., Shemy, G., Stone, O. 2008 Nurses' knowledge and perceptions about osteoporosis: a questionnaire survey. International Journal of Nursing Studies 45 (6) 847 - 854 WHO 2008 FRAX tool http://www.shef.ac.uk/ FRAX/ accessed 30th June 2016pub4419pu

Development of the Scottish HE mentorship provision programme and the National Practice Teacher programme.

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Development of the Scottish HE mentorship provision programme and the National Practice Teacher programme.

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The carer's role in planning care for persons with dementia.

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