Community nurses perspectives and experiences of the community based on the ground education programme for managing chronic oedema/legulcers: a focus group evaluation

This report is a component of a larger study conducted by Swansea Centre for Health Economics, evaluating chronic oedema management in community settings. The aim of the project reported here was to evaluate the on the ground education programme from the perspective of community nursing staff who care for people with chronic oedema/ leg ulcers. The ultimate goal of the education programme was to enhance community nurses’ of chronic oedema/leg ulcer prevention and management. Chronic oedema/leg ulcers have an enduring and profound, impact on the life quality of those who are affected by these conditions. Community nurses spend a considerable proportion of their time caring for people with chronic oedema/ leg ulcers (Chamanga et al. 2014, Benson et al. 2016). Additionally the conditions place an enormous burden on the National Health Service. As financial austerity continues and the prevalence of these conditions is projected to increase, it is essential that innovative, sustainable solutions in terms of prevention and safe, effective management are found so that positive outcomes for patients and clinical efficiency are optimised. The on the ground education programme for chronic oedema/leg ulcers was conceived and developed by Lymphoedema Network Wales. The intervention was designed to deliver education and support within community nurses’ workplaces, thereby reducing the need for study leave and enabling them to:•Effectively manage chronic oedema/leg ulcers through health technology applications with the right products being utilised at the right time;•Deliver care safely, reducing waste, harm and variation in prescribed treatments which are ineffective;•Reduce inefficient treatments and use of time.This evaluation was conducted over a short period of time at the end of 2016 and utilised a qualitative inductive approach. Data were generated from community nurses (n=12) within one University Health Board by means of focus group interviews (n=3). Participant anonymity was assured and has been preserved and promoted throughout this report. Every study will have methodological constraints and this small scale evaluation is no exception. The sample size is small, confined to one small area of Wales. Staff /caseload ratios were quite heterogeneous and covered disparate areas in terms of geography and the affluence-poverty nexus.The main findings indicated that the education programme had enhanced community nurses’ awareness, knowledge and understanding of chronic oedema management However, concerns were expressed about certain aspects of care promoted within the programme in terms of community nurses’ own professional practice and the conditions in which they operated. The community nurses did indicate that they thought by enhancing their knowledge base benefit might be conferred for patients in relation to the following: improved quality of life; self-efficacy and self-management. However, community nurses perceived that the magnitude of perceived benefit was variable and contingent on engagement with and support for self-management. Finally, while there was broad agreement that the underpinning idea of the intervention was positive, community nurses felt that there was considerable scope for improvement in terms of the intervention’s development and implementation and that long term sustainability of practice change was contingent on the presence of a lymphoedema specialist embedded within the locality to work with and across the different teams engaged in chronic oedema/leg ulcer care

An analysis of hearing aid use: Data-logging as an adjunct with the Glasgow Hearing Benefit Profile Questionnaire

IntroductionThere is significant variability in the ways in which hearing aid use is reported. In part, this is because there is no agreed method of reporting hearing aid use. A recent review by Perez and Edmonds (2012) concluded that a dual-stage approach using dataloggingand self-reported outcome measures is preferable to an approach that uses one method alone. A dual-stage approach may provide a comprehensive understanding of hearing aid use and help further develop a detailed understanding of some of the problems associated with non-use or under-use.ObjectiveThis study aimed to compare the relationship of self-reported hearing aid use using the Glasgow Hearing Aid Benefit Profile questionnaire (GHABP; Gatehouse, 1999) to hearing aid data-logging information, and to establish whether the GHABP can be used to accurately measure hearing aid use.MethodsThis was an observational cohort study conducted in Wales, United Kingdom. A total of 119 participants were recruited at their hearing aid follow-up appointments. The length of time between hearing aid fitting and follow-up was variable. With participants’ consent, data were collected using the Glasgow Hearing Aid Benefit Profile part 2 questionnaire and data-logging information stored in the hearing aid. Correlational analyses were used to assess the relationships between the two measures of hearing aid use.ResultsMean data-logging use was 5.87 hours per day (SD=5.15) and the mean GHABP use was 67.34% (SD=32.98). Both “use” variables failed a Shapiro Wilks test of normality. There was a strong positive Pearson rho correlation between datalogging use and GHABP use (rs, = .645, p <0.01). Analysis of the GHABP questionnaire revealed that 53 participants stated that they used their hearing aids between 81% and 100% of the time. There were some low levels of use when examining data logging in the context of variable GHABP results.ConclusionsIn participants who present higher GHABP use scores with lower levels of data-logging use, some plausible reasons include: I) Inadvertent overestimation of their use by patients (recall error), 2) The GHABP questionnaire may not be sufficiently sensitive or structured in such a way to effectively measure use. For example, “listening in a quiet environment” is not captured in a GHABP question, or 3) The reporting of use as a percentage may not be an appropriate measure of use. For this reason, in keeping with Perez and Edmonds (2012), both self-reported measures of use and data-logging should be used together and audiologists are reminded to consider both measures with some level of caution

Community nurses' perspectives and experiences of the chronic oedema 'on the ground' education programme: a focus group study.

The impact of chronic oedema on community nurses’ work, the NHS and those directly affected by the condition is immense. As chronic oedema prevalence is projected to rise and financial austerity continues, innovative, sustainable solutions which ensure positive outcomes for patients must be found. This paper reports findings from a focus group (n =3) investigation of the effects of an innovative workplace education intervention designed to enhance community nurses’ knowledge for practice in chronic oedema prevention and management in Wales, UK. The main findings indicated that the programme had enhanced community nurses’ awareness, knowledge and understanding of chronic oedema management. By enhancing their knowledge base benefit might be conferred for patients with chronic oedema in terms of improved quality of life; self-efficacy and self-management. However, the magnitude of perceived benefit was variable and contingent on engagement with and support for self-management. Findings indicate the need for a longitudinal study

An exploratory study identifying a possible response shift phenomena of the Glasgow Hearing Aid Benefit Profile (GHABP)

A then-test technique was used to investigate the possibility of a response shift in the Glasgow hearing aid benefit profile (GHABP). Following completion of part 1 of the GHABP, 16 adults were invited for hearing-aid follow up appointments. In accordance with then-test technique, participants were asked to think back to before they had their hearing-aids fitted and the GHABP part 1 was completed again to re-establish the disability and handicap scores. These scores were then compared with the initial GHABP part I scores. Paired T testing and Wilcoxon Rank tests were carried out to investigate the statistical significance of the response shift effect. Statistically significant differences were seen between initial and retrospective GHABP (disability) scores using t test. No significant differences could be seen between the initial and retrospective handicap scores. Results suggest participants may have demonstrated a possible response shift phenomenon with the disability construct of the GHABP questionnaire, related to a possible re-calibration effect or a denial of disability effect. This exploratory study suggests that the GHABP questionnaire may be subject to a response shift phenomena. We suggest that further more robust studies are completed to verify this and recommend that this could have psychological impact on participants when explaining the results of the outcome measure and may affect hearing aid use. There is also potential for this phenomenon to affect global GHABP scores specifically when demonstrating to stakeholders the overall success of an audiology service

Designing and evaluating falls prevention education with residents and staff in aged care homes: A feasibility study

Purpose: The purpose of this study was to co-design a falls prevention education programme with aged care home residents and staff and evaluate its feasibility. The intention of providing the education programme was to assist residents to stay safe and mobile whilst reducing their risk of falling. Design/methodology/approach: A two-phase mixed methods participatory design using a resident (n = 6) and care staff (n = 5) consumer engagement panel, pre- and post-programme resident (n = 35) survey and semi-structured care staff interviews (n = 8) was undertaken in two countries. Findings: A poster, brochure, video and staff education guide featuring 12 safety messages depicting fall prevention behaviours were co-designed. Residents, supported by staff, perceived the falls prevention education programme as enjoyable and informative, but there were no significant differences in capability, opportunity or motivation. However, several residents were observed enacting fall prevention behaviours such as “If I feel unwell, I\u27ll ring the bell” and waiting for staff assistance. Challenges to programme demand, acceptability and implementation which may have impacted residents\u27 exposure and engagement with the programme were identified, along with recommendations to improve feasibility. Practical implications: When developing falls prevention education programmes partnering with residents and staff, providing choices to meet personal and aesthetic preferences along with frequent, shorter duration learning opportunities are important for translating education messages into actions. Originality/value: The use of bespoke resources, novel rhymes, positive messages emphasising safety and co-designing with residents themselves was a welcomed point of programme difference