Overcoming potential barriers to investigating and treating myxomatous mitral valve disease

Achieving a diagnosis of mitral valve disease (MMVD) can be relatively straightforward. Persuading owners to investigate and treat, and then maintaining adherence to a therapeutic regimen can be significantly more challenging. While heart murmurs are most likely to be detected during the annual health check or booster consultation, recent evidence suggests this might not be an ideal time to discuss MMVD. This article reviews some of the potential barriers to owners following practitioners’ recommendations, and suggests some solutions

Boundary spanning and identity work in the clinical research delivery workforce: a qualitative study of research nurses, midwives and allied health professionals in the National Health Service, United Kingdom.

BackgroundResearch nurses, midwives and allied health professionals are members of an important emergent profession delivering clinical research and, in the United Kingdom, have been the focus of considerable investment by the National Institute for Health Research (NIHR). This paper considers the experiences of research nurses, midwives and allied health professionals in relation to professional identity work, recognizing these are coproduced alongside others that they interact with (including patients, clinical staff and other research staff).MethodsSemi-structured interviews were conducted with 45 nurses, midwives and allied health professionals in the UK about their experiences of working in research delivery. Interviews were transcribed verbatim and thematically coded and analysed.ResultsOur analysis highlights how research nurses, midwives and allied health professionals adjust to new roles, shift their professional identities and undertake identity work using uniforms, name badges and job titles as they negotiate complex identities.ConclusionsResearch nurses, midwives and allied health professionals experience considerable challenges as they enter and transition to a research delivery role, with implications for their sense of professional identities. A change in the work that they undertake and how they are (or perceive they are) viewed by others (including clinical non-research colleagues and patients) has implications for their sense of professional and individual identity. The tensions involved extend to their views on symbols of professional identity, such as uniforms, and as they seek to articulate and demonstrate the value of their conjoined role in research and as a healthcare professional, within the unfolding landscape of health research. We embed our study findings in the context of the newly emerging clinical research practitioner workforce, which further exacerbates and complicates the role and identity complexity for nurses, midwives and allied health professionals in research delivery

Randomised feasibility study of a novel experience-based internet intervention to support self-management in chronic asthma.

ElectronicPeer reviewedPublisher PD

Women's experience of transfer from midwifery unit to hospital obstetric unit during labour: a qualitative interview study.

Acknowledgements RER was funded by a Researcher Development Award from the National Institute for Health Research (NIHR) (RDA/03/07/066). The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The authors would like to thank the midwives and voluntary organisations who helped with recruitment and, in particular, all the women who took part in the study.Peer reviewedPublisher PD

Understanding the child-doctor relationship in research participation : a qualitative study

Funding Data collection for the Dutch interviews was funded by the University of Groningen as part of the MD/PhD program of Malou Luchtenberg. The UK data collection was supported by the National Institute for Health Research. The Academy Ter Meulen Grant provided by the Royal Netherlands Academy of Arts and Sciences enabled the research stay of ML at the Health Services Research Unit, University of Aberdeen, and supported this collaboration. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision o submit the manuscript for publication. Acknowledgements: We want to thank all participants who were interviewed in the UK and the Netherlands. We thank Lesley Powell, who was responsible for the primary data collection in the UK. In addition, we want to show our gratitude to the Academy Medical Sciences Fund for providing Malou Luchtenberg with the Academy Ter Meulen Grant to enable her research stay at the Health Services Research Unit, University of Aberdeen that supported this collaboration.Peer reviewedPublisher PD

‘You probably won’t notice any symptoms’ Blood pressure in pregnancy:discourses of contested expertise in an era of self-care and responsibilisation

Pregnancy is not a disease or illness, but requires clinical surveillance as life-threatening complications can develop. Preeclampsia, one such potentially serious complication, puts both mother and baby at risk. Self-monitoring blood pressure in the general population is well established, and its potential in pregnancy is currently being explored. In the context of self-monitoring, the information and guidance given to women regarding hypertension, and the literature they themselves seek out during pregnancy, are vital to perceptions of disease risk and subsequent responses to, and management of, any symptoms. Drawing on online, offline, official, and unofficial sources of information, discourses are examined to provide analysis of how self-responsibilization is reflected in contemporary information, advice, and guidance drawn from multiple sources. A paradox emerges between the paternalistic and lay discourses that seek to challenge and regain control. Findings are discussed in the context of Foucault’s governmentality and medical power

Is self monitoring of blood pressure in pregnancy safe and effective?

Guidelines encourage the use of self-monitoring of blood pressure in pregnancy, and research suggests that women prefer it. But the blood pressure monitoring in pregnancy group (BUMP) explain that our enthusiasm may run ahead of the evidence. They outline what is known and call for better understanding before self-monitoring is implemented

Research shapes policy: but the dynamics are subtle

Major policy initiatives such as the Quality and Outcomes Framework (QOF) in the national contract for UK general practitioners might variably be informed by evidence at their inception, implementation and subsequent evolution. But what evidence gets admitted into these policy debates—and what is left out? Using QOF as an example, this article demonstrates what an analysis of the relationship between policy and the associated research can tell us about the underlying policy assumptions and about the role of evidence in policy debates

Reclaiming and redefining the Fundamentals of Care: Nursing's response to meeting patients' basic human needs

Executive Summary: A group of nurse leaders, health policy, health care researchers and clinicians attended a seminar at Green Templeton College, University of Oxford in June 2012 to debate and draw up an action plan around integrating the fundamentals of care (FOC) into the patient centred care (PCC) agenda. Participants at the seminar acknowledged that despite significant improvements in delivering more compassionate and patient-centred care, health systems continue to face challenges in meeting the basic needs of many of our most vulnerable patients due to a range of complex factors. The invitational group, over the course of two days, discussed a number of initiatives being used by health systems to improve patient care in this area. These included issues around regulation of care; preparation and training of nurses; ways that factors such as dignity, compassion and kindness can be promoted in health systems; the use of techniques such as hourly rounding, patient involvement in systems redesign and a number of other innovations required to build and redesign the health system around the patient. A framework to guide and shape the ongoing debate has emerged from the meeting. This framework, called The Fundamentals of Care (FOC) Framework comprises three core dimensions: statements about the nature of the relationship between the nurse and the patient within the care encounter; the way the nurse and the patient negotiate and integrate the actual meeting of the fundamentals of care; and the system requirements that are needed to support the forming of the relationship and the safe delivery of the fundamentals of care. The group has produced an implementation plan which is meant to stimulate discussion and debate within key stakeholder groups. These suggested actions are an attempt to turn the more abstract parts of the framework into practical actions at the level of the care encounter between any nurse and any patient in any health system where nursing takes place. There are proposed actions for clinicians and managers; the educators of nurses; and for researchers and policy makers. The framework will be further refined as part of the ongoing work of the International Learning Collaborative (ILC),one of the core groups of nurse leaders and academics who are leading this international agenda. Feedback is welcomed on this position paper.Alison Kitson, Tiffany Conroy, Kerry Kuluski, Louise Locock, Renee Lyon