Do grandparents matter? : The impact of Grandparenting on the wellbeing of children

This timely and important report shows the immense value of grandparents in 21st century family life. It reveals a unique relationship that exists between the older generation and the youngest: a relationship of love and trust that enables the children to use their grandparents as confidantes and counsellors as well as playmates and cookery instructors. The report shows that children value the non-critical support, emotional advice and guidance that grandparents offer and enjoy the quality time their grandparents give them. It also found that the relationship has benefits for grandparents adding to their raison d’être and contributing to their health and longevity. The report also notes the change in the nature of family relationships in Britain throughout the 20th century, from the extended family to the nuclear family to the current variety of relationships, formal and informal, in which both the elderly and the young suffer neglect. With today’s increased incidence of divorce and family breakdown, grandparents can sometimes provide the only stable family relationship in a child’s life, and yet grandparents often lose contact with their grandchildren during or after a divorce or relationship breakup and have no legal rights through the Family Court to continue offering loving care and support to their grandchildren. The report concludes that there is need for much greater understanding of the role and function of grandparents in family life today.Final Published versio

A research note on the benefit of patient and public involvement in research: The experience of prostate cancer patients regarding information in radiotherapy.

This document is the Accepted Manuscript version of the following article: L. Gordon, A. Dickinson, M. Offredy, and J. Smiddy, ‘A research note on the benefit of patient and public involvement in research: The experience of prostate cancer patients regarding information in radiotherapy’, Radiography, Vol. 23(2): 167-170, May 2017, doi: http://dx.doi.org/10.1016/j.radi.2017.02.004. Under embargo. Embargo end date: 27 February 2018. © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/. © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.Aim To explore the inclusion of patient and public involvement (PPI) in a qualitative study on the experiences of men with prostate cancer regarding information in radiotherapy. Method The application of PPI to one doctoral research study is explored with respect to two perspectives: firstly, involvement of a patient reference group who informed the research design and materials, and secondly, the involvement of a public involvement in research group (PIRg) in advising the researcher during the design process. Discussion PPI is recognised as an important component of contemporary health research. PPI is becoming a common and essential requirement for high quality research projects and yet literature exploring or reporting the involvement and influence of PPI is sparse. Consideration is given to the national PPI landscape that has shaped public involvement in health research. Conclusion The contribution of PPI to this study appears to have been beneficial to the development and evaluation of the study design, the self-worth of the reference group participants and demonstrates that the value of PPI in health research should not be underestimated.Peer reviewedFinal Accepted Versio

Are you a researcher as well as a medical illustrator?

When we list the areas of practice for medical illustrators we always include research, but how involved in research are we? The aim of this activity is to encourage your professional development not just as a medical illustrator but your involvement with research whether that is undertaking your own research, undertaking evidence based practice (1) , working as part of a research team, advising researchers on the value of medical illustration or supporting a student undertaking a research project for their degree or post-graduate qualification

Learning to prescribe - pharmacists' experiences of supplementary prescribing training in England

Background: The introduction of non-medical prescribing for professions such as pharmacy and nursing in recent years offers additional responsibilities and opportunities but attendant training issues. In the UK and in contrast to some international models, becoming a non-medical prescriber involves the completion of an accredited training course offered by many higher education institutions, where the skills and knowledge necessary for prescribing are learnt. Aims: to explore pharmacists' perceptions and experiences of learning to prescribe on supplementary prescribing (SP) courses, particularly in relation to inter-professional learning, course content and subsequent use of prescribing in practice. Methods: A postal questionnaire survey was sent to all 808 SP registered pharmacists in England in April 2007, exploring demographic, training, prescribing, safety culture and general perceptions of SP. Results: After one follow-up, 411 (51%) of pharmacists responded. 82% agreed SP training was useful, 58% agreed courses provided appropriate knowledge and 62% agreed that the necessary prescribing skills were gained. Clinical examination, consultation skills training and practical experience with doctors were valued highly; pharmacology training and some aspects of course delivery were criticised. Mixed views on inter-professional learning were reported – insights into other professions being valued but knowledge and skills differences considered problematic. 67% believed SP and recent independent prescribing (IP) should be taught together, with more diagnostic training wanted; few pharmacists trained in IP, but many were training or intending to train. There was no association between pharmacists' attitudes towards prescribing training and when they undertook training between 2004 and 2007 but earlier cohorts were more likely to be using supplementary prescribing in practice. Conclusion: Pharmacists appeared to value their SP training and suggested improvements that could inform future courses. The benefits of inter-professional learning, however, may conflict with providing professionspecific training. SP training may be perceived to be an instrumental 'stepping stone' in pharmacists' professional project of gaining full IP status

You Cannot Choose Your Family: Sociological Ambivalence in the Hemodialysis Unit.

Living with end-stage renal disease is challenging and requires a great deal of self-management, but little is known about the experiences of patients and staff around the subject. We held six focus groups in three hemodialysis units, each unit hosting 1 staff and 1 patient focus group. A total of 15 staff members and 15 patients participated. We employed thematic analysis using a priori and emerging codes. Five key themes emerged: challenges, enablers, complex balancing acts, good patient/bad patient, and the hemodialysis unit as a family. We explored the family metaphor further through the work of Bourdieu, but concluded that relationships in the hemodialysis unit most closely fit the concept of sociological ambivalence. We present an explanatory framework around inherent tensions characterizing relationships within the hemodialysis unit and highlight implications for facilitating self-management and developing collaborative approaches to care

Student midwives perspectives on the efficacy of feedback after objective structured clinical examination

Students’ experience of feedback is considered an indicator of the efficacy of the assessment process. Negative experiences of feedback are unproductive in terms of the likelihood that students will act upon and learn from assessment. To understand the impact of feedback on learning this study explored the experiences of student midwives after receiving feedback following Objective Structured Clinical Examination (OSCE). Data were collected from second year undergraduate student midwives who had recently completed OSCE, via a focus group. Students reported raised stress levels, concerns around legitimacy of feedback, and inconsistencies in the manner in which feedback was articulated. Assessment feedback in higher education should be used to empower students to become self-regulated learners. This is important for student midwives for whom a considerable amount of leaning is spent in practice. The study has implications for midwifery academics concerned with modes of assessment and quality of assessment feedback in midwifery education

Decision theory applied to image quality control in radiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

The role of ICT in supporting disruptive innovation: a multi-site qualitative study of nurse practitioners in emergency departments

<p>Abstract</p> <p>Background</p> <p>The disruptive potential of the Nurse Practitioner (NP) is evident in their ability to offer services traditionally provided by primary care practitioners and their provision of a health promotion model of care in response to changing health trends. No study has qualitatively investigated the role of the Emergency NP in Australia, nor the impact of Information and Communication Technology (ICT) on this disruptive workforce innovation. This study aimed to investigate ways in which Nurse Practitioners (NP) have incorporated the use of ICT as a mechanism to support their new clinical role within Emergency Departments.</p> <p>Methods</p> <p>A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs) of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior physicians and five senior nurses. Transcribed interviews were analysed using a grounded theory approach to develop themes in relation to the conceptualisation of the ED nurse practitioner role and the influences of ICT upon the role. Member checking of results was achieved by revisiting the sites to clarify findings with participants and further explore emergent themes.</p> <p>Results</p> <p>The role of the ENP was distinguished from those of Emergency nurses and physicians by two elements: advanced practice and holistic care, respectively. ICT supported the advanced practice dimension of the NP role in two ways: availability and completeness of electronic patient information enhanced timeliness and quality of diagnostic and therapeutic decision-making, expediting patient access to appropriate care. The ubiquity of patient data sourced from a central database supported and improved quality of communication between health professionals within and across sites, with wider diffusion of the Electronic Medical Record holding the potential to further facilitate team-based, holistic care.</p> <p>Conclusions</p> <p>ICT is a facilitator through which the disruptive impact of NPs can be extended. However, integration of ICT into work practices without detracting from provider-patient interaction is crucial to ensure utilisation of such interventions and realisation of potential benefits.</p

Community Nurses' Judgement for the Management of Venous Leg Ulceration: A Judgement Analysis

Background: Nurses caring for the large numbers of people with leg ulceration play a key role in promoting quality in health via their diagnostic and treatment clinical judgements. In the UK, audit evidence suggests that the quality of these judgements is often sub optimal. Misdiagnosis and incorrect treatment choices are likely to affect healing rates, patients’ quality of life, patient safety and healthcare costs. Objectives: To explore the diagnostic judgements and treatment choices of UK community nurses managing venous leg ulceration. Design: A judgement analysis based on Brunswik's psychological Lens Model theory. Setting: UK community and primary care nursing services. Participants: 18 community generalist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses. Methods: During 2011 and 2012, 36 nurses made diagnostic judgements and treatment choices in response to 110 clinical scenarios. Scenarios were generated from real patient cases and presented online using text and wound photographs. The consensus judgements of a panel of nurses with advanced knowledge of leg ulceration judged the same scenarios and provided a standard against which to compare the participants. Correlations and logistic regression models were constructed to generate various indices of judgement and decision “performance”: accuracy (Ra), consistency (Rs) and information use (G) and uncertainty (Re). Results: Taking uncertainty into account, nurses could theoretically have achieved a diagnostic level of accuracy of 0.63 but the nurses only achieved an accuracy of 0.48. For the treatment judgement (whether applying high compression was warranted) nurses could have achieved an accuracy of 0.88 but achieved only an accuracy of 0.49. This may have been due to the nurses giving insufficient weight to the diagnostic cues of medical history and appearance of the leg and ulcer and insufficient weight to the treatment cues of type of leg ulcer and pain. Conclusion: Clinical judgements and decisions made by nurses managing leg ulceration are complex and uncertain and some of the variability in judgements and choices can be explained by the ways in which nurses process the information and handle the uncertainties, present in clinical encounters

Registered nurses' perceptions and experiences of autonomy: a descriptive phenomenological study

Background Professional autonomy is a key concept in understanding nurses’ roles in delivering patient care. Recent research exploring the role of autonomy in the nursing work environment indicated that English and American nurses had differing perceptions of autonomy. This qualitative study aimed to explore the understanding and experiences of autonomy of nurses working in England. Methods A descriptive phenomenological analysis of data from 48 semi-structured interviews with registered nurses from two National Health Service (NHS) hospitals (purposive sample) was used to explore the concept of autonomy. Results Six themes were identified: working independently; working in a team; having professional skills and knowledge; involvement in autonomy; boundaries around autonomy; and developing autonomy requires support. A key finding was that nurses related autonomy to their clinical work and to the immediate work environment of their ward, rather than to a wider professional context. Nurses also perceived that autonomy could be turned off and on rather than comprising an integrated aspect of nursing. Conclusions Findings suggest that nurses in England, as framed by the sample, had a local ward-focused view of autonomy in comparison to nurses in America, who were reported to relate autonomy to a wider involvement in hospital level committees. Findings further indicate that autonomy was practiced occasionally, rather than incorporated into practice. Findings highlight the need for nurses in England to adopt a broader perspective and actively contribute to writing hospital guidelines and policies that recognise the importance of autonomy to nurse training and practice