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Publication History View all

  • Medical Engineering & Physics 02/2013;
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    ABSTRACT: End of life care is an important aspect of acute stroke nursing because stroke mortality rates remain high, despite advances in care. There is a national drive to improve the quality of end of life care in all clinical areas, including for stroke patients. Patients who have had a stroke should not be excluded from acute stroke care at the end of life. Stroke care should incorporate multidisciplinary working, anticipatory care planning and prescribing, and effective communication with patients and families. The use of end of life care pathways is widely recommended as best practice. Palliative care specialists may provide support where patients' needs are complex, while decisions to withhold cardiopulmonary resuscitation should be avoided immediately following stroke. Spiritual care extends beyond religious care and is the responsibility of the multidisciplinary team. Although more research is required about stroke care at the end of life, providing high-quality, patient-centred services for patients who have had a stroke and their families during this time is achievable.
    Nursing standard: official newspaper of the Royal College of Nursing 03/2012; 26(27):42-6.
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    ABSTRACT: The care of patients with inflammatory bowel disease (IBD) frequently falls short of the highest standards. This is noted in several publications, including national standards, despite nursing students being taught the importance of listening to and understanding patients. Teaching staff at the University of Glasgow primarily responsible for teaching third year undergraduate nursing students undertook a radical rethink of the planning, delivery and assessment of lectures on IBD. The subject had previously been delivered in a modified lecture format. Although the topic could be included in the end-of-year exams, there was little evidence to show whether this traditional teaching method had any effect on students' clinical practice. In a novel approach to learning and assessment, students were invited to research and produce an information leaflet for newly diagnosed patients with IBD. The leaflets were then assessed and grades awarded by an expert panel of patients and carers. Such enquiry based learning (EBL) intended to demonstrate in practice, the key role patients can play in both undergraduate nurse education and in service planning and delivery in the National Health Service (NHS). The panel found the exercise both interesting and insightful, while the students reported being invigorated and felt the expert assessment meant they were forced to achieve a higher level of work.
    Nurse education today 12/2011; 32(2):139-45.
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    ABSTRACT: To determine what influences the decision to insert an indwelling urinary catheter in acute stroke patients. A prospective casenote review and semi-structured interviews were conducted and corporate catheterization policy in the study sites was investigated. Three teaching hospitals, typical of stroke service provision in most developed countries. Casenotes from 70 consecutive acute stroke admissions; 50 doctors, nurses and physiotherapists working in acute stroke units and medical receiving units. Stroke patients were catheterized for output monitoring, relief of urinary retention or, especially for older patients, continence-related issues. Half of all catheterizations occurred in acute stroke units. Continence and catheterization were considered less important than other aspects of acute stroke care. No catheterization policy or standardized continence assessment tool was in use. Documentation was often lacking. Patients and relatives were not fully involved in the decision to catheterize. Continence assessment and catheterization practices varied widely. Complex unwritten rules relating to gender proliferated. Such rules demonstrated heuristic problem-solving could potentially cause conflict. Decisions to catheterize 'belonged' to doctors or nurses depending upon clinical indications. Clinical assessment and specialist referrals were often seen as 'not my job'. Clear corporate policy on catheterization is required to direct practice. Use of standardized continence assessment tools is recommended to set and monitor standards of care. Documentation relating to urinary catheterization needs to improve.
    Clinical Rehabilitation 11/2011; 26(5):470-9.
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    ABSTRACT: The purpose of this study was to investigate the use and perceived benefit of complimentary and alternative medicine (CAM) and physiotherapy treatments tried by people with chronic fatigue syndrome (CFS) to ease painful symptoms. This study used a descriptive, cross-sectional design. People with CFS who experienced pain were recruited to this study. Participants were asked during a semistructured interview about the treatments they had tried to relieve their pain. Each interview was conducted in the home of the participant. Fifty participants were recruited, of which, 10 participants were severely disabled by CFS. Eighteen participants were trying different forms of CAM treatment for pain relief at the time of assessment. Three participants were currently receiving physiotherapy. Throughout the duration of their illness 45 participants reported trying 19 different CAM treatments in the search for pain relief. Acupuncture was reported to provide the most pain relief (n=16). Twenty-seven participants reported a total of 16 different interventions prescribed by their physiotherapist. The results of this study suggest some physiotherapy and CAM treatments may help people manage painful CFS symptoms. Future research should be directed to evaluating the effectiveness of interventions such as acupuncture or gentle soft tissue therapies to reduce pain in people with CFS.
    Physiotherapy Theory and Practice 11/2010; 27(5):373-83.
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    BMJ (online) 01/2010; 340:c2845.
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    ABSTRACT: This article is a report of a study conducted to explore the perceptions of adults with type 2 diabetes towards the service redesign. Diabetes is reaching epidemic proportions and the management of this chronic illness is changing in response to this challenge. In the United Kingdom, there is ongoing restructuring of healthcare services for people with chronic illnesses to ensure that their general health and clinical needs are met predominantly in primary care. An explorative qualitative approach was used. Eight focus groups were conducted with 35 people with type 2 diabetes in one urban location between 2003 and 2004. Five focus groups were conducted with people who had recently experienced the restructured service and three groups with people who had up to 2 years' experience of the new service. Concurrent data collection and thematic analysis were conducted by three researchers and credibility and verification sought by feedback to participants. Five main themes were identified: impact of living with diabetes; understanding diabetes; drivers for organizational change; care in context and individual concerns. Participants identified issues for ongoing development of the service. People with type 2 diabetes appreciate their care management within the primary care setting where there has been investment in staff to deliver this care. Healthcare resources are required to support the development of staff and the necessary infrastructure to undertake management in primary care. Policy makers need to address the balance of resources between primary and secondary care.
    Journal of Advanced Nursing 05/2009; 65(7):1432-41.
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    ABSTRACT: This paper is a report of a study to describe nurses' perceptions of decision-making and the evidence base for the initiation of insulin therapy. Several theoretical perspectives and professional's attributes underpin decision-making to commence insulin therapy. The management of type 2 diabetes is moving from secondary to primary care and this affects how clinical decisions are made, by whom and the evidence base for these decisions. A postal survey was conducted with a stratified sample of 3478 Diabetes Specialist Nurses and Practice Nurses with a special interest in diabetes across the four countries of the United Kingdom. A total of 1310 valid responses were returned, giving a response rate of 37.7%. The questionnaire was designed for the study and pilot-tested before use. Responses were given using Likert-type scales. Data were collected during 2005 and 2006, and one reminder was sent. People with diabetes are seen as having little influence in decision-making. Consultant physicians appear to be influential in most decisions, and the nursing groups held varying perceptions of who made clinical decisions. Nurses' identified different responsibilities for those working solely in secondary care from those working in both community and secondary care. Practice nurses were not as involved as anticipated. Nurses working with people with diabetes need to encourage them to become more active partners in care. Clinical guidelines can assist in decision-making where nurses are least experienced in initiating insulin therapy.
    Journal of Advanced Nursing 02/2009; 65(1):35-44.
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    ABSTRACT: For an older person in hospital a fall can have devastating consequences, prolonging hospital stay and leading to loss of confidence. Falls cost the NHS between pounds 5340 and pounds 12,500 per patient in delayed discharge, and can cause nurses to question their own practice and blame themselves. Further, the efforts of clinicians and researchers implementing falls prevention interventions are hampered because of inconsistencies in assessing risk. The use of falls risk assessment tools varies throughout the U.K. In Scotland some hospitals use them while others do not. Unlike England and Wales, Scotland has no national guidelines. To deal with this problem, the authors conclude that it is important to develop an evidence-based guideline that covers the whole of the UK.
    Nursing older people 10/2007; 19(7):33-6; quiz 37.
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    ABSTRACT: This paper describes an evaluation of a change in health visiting service delivery from GP caseload management to corporate caseload working, in one inner city health centre located in a deprived area of Glasgow. The aim of the study was to identify if moving to corporate caseload working provides the reported benefits cited in the limited literature available. A purposive sample consisting of ten health visitors, one GP, one manager and three clients volunteered to participate in this mixed methods evaluation study. Data were collected by means of a stress questionnaire, public health nursing diary, focus groups and semi-structured interviews. Findings show that immediate improvements were seen in team working, staff communication, sharing practice, enhanced clinical reflection and standards of documentation. However, corporate caseload working did not appear to reduce staff stress levels, increase public health nursing activity or improve quality of client service. Further research conducted over a longer time period with a full staffing complement is needed to validate these findings.
    Community practitioner: the journal of the Community Practitioners' & Health Visitors' Association 10/2007; 80(9):20-4.
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