Post-surgical patient experiences of weight-loss surgery: what does the research tell us?

Compared with literature on weight loss and comorbidity improvement, there is a paucity of information on the patient-reported experiences of adjusting to life after bariatric surgery. Between 2011 and 2013, nearly 17,000 procedures were performed in the UK, with gastric bypass comprising 55% of the operations. Clearly, there are an increasing number of people living with bariatric surgical procedures, with the majority of these irreversible. A systematic literature review was undertaken to identify post-surgical qualitative literature from the patient perspective between 2000 – 2016. 18 studies met the inclusion criteria. Findings showed that the majority of patients frame their post-surgical experiences within a pre- and post-surgical life, drawing comparisons between the two. Bariatric surgery was described as a ‘second chance’, ‘last resort’, ‘being rescued’ and a ‘rebirth’ by many participants. Core themes of ‘transformation’ and ‘control’ were identified, largely centred around living with bodily changes and learning to deal with new eating habits. The majority of participants felt that although their problems around obesity were resolved, bariatric surgery introduced new problems to be dealt with, which were negotiated through trial and error. The rapid change to physical appearance and different eating habits often invited attention, which was not always welcomed. Many participants were not comfortable disclosing surgery as their methods of weight loss, as this could lead to negative comments, with reported accusations of ‘cheating’ and ‘taking the easy way out’ . Fear of being judged appeared to be linked to previous stigmatisation of the previous obese state, which reinforces the pre and post-surgical dichotomy. Overall, participants reported bariatric surgery as a positive experience, and that problems were expected as part of the surgically-imposed changes. Life after bariatric surgery is a complex process, and the social aspects need to be further researched as more people undergo weight loss surgery

Illuminating Undergraduate Experiential and Situated Learning in Podiatry Clinical Placement Provision at a UK School of Podiatric Medicine

Purpose Situated and experiential learning methodologies are largely under researched in relation to student experience and satisfaction. This research aimed to illuminate the perspectives of students studying on a BSc (Hons) Podiatry degree programme to establish perceptions of their experience in practice. Design/Methodology/Approach Using an Interpretivist methodological framework, Free Association Narrative Interviewing (FANI) was used to provide an insight into the perceived impact that experiential learning in clinical placements had on undergraduate podiatry students. Findings Students perceived that what could not be taught but what could be experienced, contributed much to the confidence that students had gained during their training and which they anticipated would be further developed during the initial years of their training in practice, particularly in the context of the NHS. Research Limitations/Implications This is a study from which it is acknowledged that within the underpinning research design and methodology there is no scope for generalisability. Practical Implications The study highlights an appreciation for the implication and recognition of ‘tacit’ knowledge, currently recognised in medical curricula as an asset which can aid a move towards higher order critical thinking skills. Social Implications Student acknowledgement of the need for emphasis on ‘soft skills’ can be posited, in the context of this small scale study as an appreciation for affective domain learning in the context of podiatric academic and clinical curricula. Originality/Value Limited information from the extant literature is available in relation to the illumination of podiatry student placement experiences, so this research contributes to an effectively under-researched field

Future of digital technology in paramedic practice:blue light of discernment in responsive care for patients?

This discussion explores the significance of digital technology to responsive patient care in applied paramedic practice. The authors' previous research identified the relative ambiguity of the role of digital technology in facilitating and supporting patients in practice, and the findings revealed the relative transferability of this finding to wider allied healthcare clinical and professional practice. The discussion encompasses two key debates, namely a) How best the quality of the digital technology patients engage with can be discerned with regard to the vast availability of information and b) what the fundamental pedagogical implications to the way paramedic education in the UK is currently delivered might be in relation to equipping the future paramedic workforce to empower patients and their families and carers in emergency situations. The discussion paper concludes with an overview of the tensions that unregulated apps pose in practice and how engaging with the public about the use of digital technology could be a key aspect for review in UK undergraduate curricula and staff development

The perceived impact of Technology Enhanced Learning (TEL) across a new pre-registration nursing curriculum

The construction and labelling of a relatively disparate set of university information technology systems as the “Nurse Navigator System” were routed in the principles of broader design research where methodologies of teaching, learning, and assessment were used to drive educational innovation within and between clinical and academic teaching. In terms of pragmatic design and appearance, this was straightforward; however, the theoretical basis of the design was more complex and rooted in core pedagogic design principles. Responding to the outcome of the initial evaluation of the system was therefore critical in the iterative developmental design of the Nurse Navigator System. Evaluation necessitated the collation of data which could tangibly and qualitatively examine whether expectations of such a conglomerate set of information technology criteria were realistic in practice. This pilot period of adjustment was recognized as a time to allow for configuring, fine-tuning, and assessment of purposefulness to the student cohort using it and in keeping with the need to co-construct learning and resource needs of students in practice. Evaluating the effectiveness of the preliminary pedagogic design of the Nurse Navigator System necessitated reliable indicators of engagement and learning. This research methods case study provides an overview of the qualitative evaluation of the impact of the new Nurse Navigator System using anecdote circles as an alternative to Focus Groups

Evaluating interactivity design in the context of technology enhanced learning: an overarching case study methodology integrating anecdote circles and surveys as methods of inquiry for nursing curricula

Integrating digital technology and interactivity design to drive the co-construction of social knowledge was embedded in a new undergraduate nursing curriculum. Labelled as the ‘Nurse Navigator System’ (NNS) within the context of this new programme, this element of interactivity design is an ideal opportunity to examine where previous experience and the use of learning technology nurse education are aligned and can potentially be shaped to improve a pedagogic development that has relevance to nursing curricula nationally and internationally. Aim/focus of the innovation: - The Nurse Navigator System was designed for students to iteratively provide feedback on their experiences of bridging the gap between clinical and academic contexts through interactive networks and social knowledge construction (Wu at al, 2016). At its core, and in keeping with social constructivist principles of any inquiry based learning approach, it was designed to ensure students were facilitated in being accountable for their own learning and the identification of their further learning needs (Draper, Clark and Rogers, 2016; Hogaboam et al, 2016). This session provides an insight into the overall implementation of the innovation in practice. The intention of this pedagogic approach was to facilitate and encourage students to become more autonomous in their academic and clinical practice and for them to engage with digital technology as a valuable and recognised part of their reflexive skill set in person centred care. Methods used to assess the innovation: - Pedagogic evaluation involved the adoption of an overarching case study methodology which subsequently permitted the integration of anecdote circles and semi-structured questionnaires as methods. Data analysis was conducted via Framework Analysis (Ritchie and Spencer, 1994). Key findings: - The four salient findings from the framework analysis provided an insight into: 1.Learner/People Interactivity, 2. Learner Interface, 3. Learner Content, 4. Situational Context Intended learning outcomes

Exploring patient experiences of adjusting to life in the first two years after bariatric surgery

Bariatric surgery is becoming an increasingly common intervention for the management of adult obesity. Bariatric surgery is usually recommended after a person with obesity has unsuccessfully attempted to lose weight through other methods such as diet and exercise. Surgery offers rapid and sustained weight loss, improves obesity-related illnesses and makes significant changes to a person’s appearance and eating habits. As a result, bariatric surgery has a significant impact on a person’s life, especially everyday social situations, which require a period of adjustment. The aim of this thesis was to explore how people adjust their lives in the first two years following bariatric surgery. Constructivist grounded theory was used to establish mutual reciprocity between participants and myself to illuminate their experiences, whilst acknowledging my position as researcher at all times. Symbolic interactionism allowed an in-depth exploration of the meanings and actions of the participants. Semi-structured interviews were conducted with participants who had undergone bariatric surgery at City Hospitals Sunderland NHS Foundation Trust within two years of the time of interview. Eighteen participants were interviewed between January 2014 and April 2015. The findings showed that participants conceptualised the adjustment process as underpinned by risk. Many of these risks were centred on social situations and encounters and participants’ attitudes towards risk and the meaning of risk underpinned their subsequent actions. The risk attitudes were underpinned by the meanings and actions of how participants handled social interactions as a result of learning to live with new ways of eating, a changed physical appearance and social interactions. Three risk attitude profiles were constructed from the data: Risk Accepters, Risk Contenders and Risk Challengers. The act of choosing whether to disclose having bariatric surgery was particularly meaningful to the participants and highlighted a theme of feeling judged by others, which many participants sought to avoid. The findings also showed that participants felt that the social aspects of life after bariatric surgery were not widely understood by the public and healthcare professionals. This theory is a co-construction between the participants and me. As rates of bariatric surgery increase, understanding patients’ experiences of adjusting to life after bariatric surgery will assist patients to prepare for post-surgical life and healthcare practitioners to further support patients during this time