Audrey I. Stephen

Bereavement and Bereavement Care in Health and Social Care: Provision and Practice in Scotland

The interview study described here aimed to explore current views of and practice in bereavement care and identify priorities for service development in Scotland. Fifty-nine participants who worked with the bereaved in some way, or whose interest was in bereavement or bereavement care, were interviewed. They represented National Health Service organizations, chaplaincy departments, educational institutions, academic departments, voluntary groups, and other related bodies, such as funeral directors. Transcripts were read repeatedly and initial emerging themes were identified, coded and shared between research team members to reach a consensus for key themes. Priority areas for development were related to raising public awareness, coordination of services, guidance, and professional education.

The Economic Cost of Bereavement in Scotland

Aspects of the socioeconomic costs of bereavement in Scotland were estimated using 3 sets of data. Spousal bereavement was associated with increased mortality and longer hospital stays, with additional annual cost of around £20 million. Cost of bereavement coded consultations in primary care was estimated at around £2.0 million annually. In addition, bereaved people were significantly less likely to be employed in the year of and 2 years after bereavement than non-bereaved matched controls, but there were no significant differences in income between bereaved people and matched controls before and after bereavement.

A national study of selection processes for student nurses and midwives.

BACKGROUND This paper presents the main findings from a project that aimed to evaluate selection processes for the recruitment of student nurses and midwives. OBJECTIVES The main objectives were to: Design The evaluation was designed principally to achieve explanation, with multiple case study methodology adopted as the main approach. Within this ambit mixed methods of data collection involving questionnaires and interviews were used. Participants Seven of the Scotland-based Higher Education Institutions participated in the research, with participation from Admissions Tutors, clinical interviewers, academic interviewers, and students. METHODS The methods included: a scoping questionnaire with follow-on questionnaire to elicit views on the strengths and limitations of chosen selection processes; interviews and focus groups to build on these findings. Analytical approaches were congruent with the chosen data collection approaches. Findings HEIs typically have rationales for their various chosen approaches to selection. However, our findings indicate that there is a lack of evidence for most selection approaches particularly in relation to interviewing. There is a growing evidence-base for the use of multiple mini interviews, and emotional intelligence testing. CONCLUSIONS There is a need to work collectively cross-UK to bring together the evidence-base around selection so that processes and decision-making are as valid, reliable, effective and transparent as possible.

Decision precision or holistic heuristic?: Insights on on-site selection of student nurses and midwives

Concerns about quality of care delivery in the UK have led to more scrutiny of criteria and methods for the selection of student nurses. However few substantive research studies of on-site selection processes exist. This study elicited and interpreted perspectives on interviewing processes and related decision making involved in on-site selection of student nurses and midwives. Individual and focus group interviews were undertaken with 36 lecturers, 5 clinical staff and 72 students from seven Scottish universities. Enquiry focused primarily on interviewing of candidates on-site. Qualitative content analysis was used as a primary strategy, followed by in-depth thematic analysis. Students had very mixed experiences of interview processes. Staff typically took into account a range of candidate attributes that they valued in order to achieve holistic assessments. These included: interpersonal skills, team working, confidence, problem-solving, aptitude for caring, motivations, and commitment. Staff had mixed views of the validity and reliability of interview processes. A holistic heuristic for overall decision making predominated over belief in the precision of, and evidence base for, particular attribute measurement processes. While the development of measurement tools for particular attributes continues apace, tension between holism and precision is likely to persist within on-site selection procedures.

The impact of spousal bereavement on hospitalisations: evidence from the Scottish longitudinal study.

This paper estimates the impact of spousal bereavement on hospital inpatient use for the surviving bereaved by following the experience of 94,272 married Scottish individuals from 1991 until 2009 using a difference-in-difference model. We also consider the sample selection issues related to differences in survival between the bereaved and non-bereaved using a simple Cox Proportional-Hazard model. Before conducting these estimations, propensity score approaches are used to re-weight the non-bereaved to generate a more random-like comparison sample for the bereaved. We find that those bereaved who survive are both more likely to be admitted and to stay longer in hospital than a comparable non-bereaved cohort. Bereavement is estimated to induce on average an extra 0.24 (95% CI [0.15, 0.33]) hospital inpatient days per year. Similar to previous studies, we estimate the bereaved have a 19.2% (95% CI [12.5%, 26.3%]) higher mortality rate than the comparable non-bereaved cohort.

Bereaved relatives’ experiences in relation to post mortem: a qualitative exploration in North East Scotland

Abstract When a family is grieving the loss of a member the consideration of post mortem is an additional concern. This study set out to explore how relatives are supported to give authorisation and throughout the post mortem process. Thirteen relatives with varied experiences of a relatives death took part in interviews. Data analysis revealed the post mortem as part of the narrative of the death, with more significance for some than others. Important aspects for relatives were being able to say ‘goodbye’ properly, and engagement with staff in hospital and procurator fiscal (public prosecution) services in more substantive communicative relationships, rather than only receiving basic information. Relatives valued receiving results they could understand. There may be opportunities, particularly in coroner or procurator fiscal services, for development of roles in liaison between relatives and pathology services, and support for relatives.

Competencies for the multi-disciplinary team caring for severely obese patients undergoing bariatric surgery: a systematic review.

Bariatric surgery is the only intervention leading to sustained weight reduction for severely obese individuals. However, there is variability across the UK in organisation of bariatric services, and perceptions of how to develop and deliver optimum care. This means lack of clarity on competencies and skills required for roles within the multidisciplinary bariatric surgical team. This systematic review was carried out to synthesise literature identifying the competencies required by members of the multidisciplinary team for provision of safe, meaningful and appropriate care for severely obese patients undergoing bariatric surgery. The databases CINAHL; Medline; ERIC; PsycINFO; IngentaConnect; The Knowledge Network, and Web of Knowledge were searched to identify key papers. Papers selected were independently appraised for methodological quality by two reviewers using Joanna Briggs Institute systems. Thirty-six papers were included in the review. The literature was poorly developed, largely consisting of text and opinion, and lacking evaluative content. Pooling of papers generated three synthesised findings: 1) Safe, meaningful and appropriate care may be delivered if staff in each role in the multidisciplinary team achieve a minimum set of competencies; 2) Safe, effective and meaningful care may require a minimum set of competencies for managing a bariatric surgery unit and the multidisciplinary team; 3) To achieve competencies for safe, effective and meaningful care certain approaches to education may be developed. Sensitive care, pre-operative psychological assessment, post-operative care and identification of complications, and team management may be areas in which educational interventions develop, but the conclusion remains tentative because of lack of empirical research in the area.

competencies and skills to enable effective care of severely obese patients undergoing bariatric surgery across a multi-disciplinary healthcare perspective: a systematic review

Background The incidence of severe and complex obesity with co‐morbidity and high risk of mortality is increasing globally. Bariatric surgery is the only intervention leading to sustained weight reduction, and the number of procedures carried out is increasing. There is variability across the UK in the provision of bariatric services and in perceptions of optimum care. A key factor believed to be integral is a multidisciplinary team (MDT) specifically skilled for the speciality. However, there is a lack of clarity on the competencies required for specific roles within the bariatric surgery team. Objectives This review synthesized literature on perceived competencies and skills required to provide safe, meaningful and appropriate care for severely obese patients undergoing bariatric surgery. Inclusion criteria Types of participants The review initially concentrated on four key roles: surgeon, nurse, dietitian, and psychologist. Where available, literature pertaining to other practitioners such as physiotherapists and anesthetists was included. Phenomenon of interest Competencies and skills required by MDT members to provide care for severely obese patients undergoing bariatric surgery. Types of studies The review included qualitative research studies, policy documents, standards for clinical care, guidelines, narratives, opinion pieces and discussion papers. Search strategy A search strategy was designed to access both published and unpublished materials in the following databases: CINAHL, Medline, ERIC, PsycINFO, IngentaConnect, The Knowledge Network, and Web of Knowledge. Grey literature was searched in British Library Ethos and National Institute for Social Care & Health Research (NISCHR). Methodological quality Papers selected were independently appraised for quality by two reviewers using the Joanna Briggs Institute Narrative, Opinion and Text Assessment and Review Instrument (JBI‐NOTARI). Data collection Data were extracted using JBI‐NOTARI data extraction tool. Extracted data included participant information, logic of argument, and author conclusions. Results Thirty‐six papers were screened, and 13 were excluded because they lacked information about competencies. Twenty‐three papers met the inclusion criteria and proceeded to quality assessment. The literature was poorly developed, consisting of text and opinion type articles. Papers were pooled using JBI‐NOTARI, involving the synthesis of publication conclusions into categories, which were then amalgamated in meta‐syntheses. Three overall synthesised findings emerged: • Safe, meaningful and appropriate care of severely obese patients undergoing bariatric surgery may be delivered if staff in each role achieve a minimum set of competencies. • Safe, effective and meaningful care for bariatric surgery patients may require a minimum set of competencies for managing a bariatric surgery unit and the MDT. • To achieve the competencies for safe, effective and meaningful care for bariatric surgery patients, certain approaches to education may be developed. Conclusions Reviewed articles gave some broad indication of areas in which to develop competencies. Consensus between practitioners is required to take forward strategies for competency development. Implications for practice Sensitive care, preoperative psychological assessment, postoperative care, including identification of complications and team management, are areas in which competencies in the MDT should be developed. Implications for research Mixed methods studies to establish best practice and required competencies. Evaluative component in all educational interventions. Comparison studies of methods of delivery of competency based education, and measurement of effectiveness. (498 words)