Catherine Henshall

The Role of Self-Management Practices as Mechanisms for Re-Establishing Normality in Cancer Survivors

This article explores the relationship between cancer survivors’ use of self-management practices and their search for normality. Using Frank’s illness narratives and other theoretical literature on normality in chronic illness, it draws on findings from a qualitative study to explore different ways cancer survivors use self-management practices to re-establish normality in their lives post-cancer. The findings suggest that “normality” represents different things to cancer survivors. We suggest that normality in survivorship is not a static concept but is fluid, and at certain times, cancer survivors may display some or all of these different versions of normality. The findings show that self-management practices can help cancer survivors experiment with different health and lifestyle processes to help support their “normal” daily lifestyle activities, quality of life, and well-being.

A systematic review to examine the evidence regarding discussions by midwives, with women, around their options for where to give birth

BackgroundDiscussion of place of birth is important for women and maternity services, yet the detail, content and delivery of these discussions are unclear. The Birthplace Study found that for low risk, multiparous women, there was no significant difference in neonatal safety outcomes between women giving birth in obstetric units, midwifery-led units, or home. For low risk, nulliparous women giving birth in a midwifery-led unit was as safe as in hospital, whilst birth at home was associated with a small, increased risk of adverse perinatal outcomes. Intervention rates were reduced in all settings outside hospital. NICE guidelines recommend all women are supported in their choice of birth setting.Midwives have the opportunity to provide information to women about where they choose to give birth. However, research suggests women are sometimes unaware of all the options available.This systematic review will establish what is known about midwives’ perspectives of discussions with women about their options for where to give birth and whether any interventions have been implemented to support these discussions.MethodsThe systematic review was PROSPERO registered (registration number: CRD42015017334). The PRISMA statement was followed. Medline, Cochrane, CINAHL, PsycINFO, Popline and EMBASE databases were searched between 2000-March 2015 and grey literature was searched. All identified studies were screened for inclusion. Qualitative data was thematically analysed, whilst quantitative data was summarised.ResultsThe themes identified relating to influences on midwives’ place of birth discussions with women were organisational pressures and professional norms, inadequate knowledge and confidence of midwives, variation in what midwives told women and the influence of colleagues. None of the interventions identified provided sufficient evidence of effectiveness and were of poor quality.ConclusionsThe review has suggested the need for a pragmatic, understandable place of birth dialogue containing standard content to ensure midwives provide low risk women with adequate information about their place of birth options and the need to improve midwives knowledge about place of birth. A more robust, systematic evaluation of any interventions designed is required to improve the quality of place of birth discussions. By engaging with co-produced research, more effective interventions can be designed, implemented and sustained.

A systematic review to explore influences on parental attitudes towards antibiotic prescribing in children

AIMS AND OBJECTIVESnTo understand the factors influencing parental attitudes towards antibiotic prescribing.nnnBACKGROUNDnOveruse of antibiotics and inappropriate prescribing has resulted in rapid development of antimicrobial resistance (AMR) and is a significant global threat to patient safety. In primary care settings, substantial numbers of antibiotics are prescribed for young children, despite viral nature of illness for which antibiotics are ineffective. Parents play a vital role in decision-making regarding accessing healthcare services and requesting treatment for their children.nnnDESIGNnA systematic review was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (Moher etxa0al., Systematic Reviews, 4, 2015, p. 1).nnnMETHODSnThe CINAHL, MEDLINE, PsycINFO, The Cochrane Library, BRITISH NURSING INDEX, EMBASE and PUBMED databases were searched for primary research published between 2006-2016. All types of primary research were searched and screened against inclusion criteria. The Critical Appraisal Skills Programme tool was used to appraise identified publications. Quantitative data were summarised descriptively, and qualitative data were thematically analysed.nnnRESULTSnA total of 515 publications were initially screened, and 55 full-text articles were eligibility assessed. Twenty papers met inclusion criteria. Four main themes were identified: the quality of relationships with healthcare providers, dealing with conflicting messages, rationalising antibiotic use and parental practices informed by past experience.nnnCONCLUSIONSnParents wanted reassurance and advice regarding childrens illnesses, had poor antibiotic knowledge and were influenced by personal past experiences. More accessible education, including simple information leaflets, is required. Further research on the influence of culture, ethnicity and socio-economic factors would be beneficial.nnnRELEVANCE TO CLINICAL PRACTICEnHealthcare professionals must provide adequate time for reassurance and explanations of decision-making. Easy-to-read information regarding appropriate antibiotic usage should be easily accessible for parents.

Improving the quality and content of midwives’ discussions with low-risk women about their options for place of birth: Co-production and evaluation of an intervention package

OBJECTIVEnWomens planned place of birth is gaining increasing importance in the UK, however evidence suggests that there is variation in the content of community midwives discussions with low risk women about their place of birth options. The objective of this study was to develop an intervention to improve the quality and content of place of birth discussions between midwives and low-risk women and to evaluate this intervention in practice.nnnDESIGNnThe study design comprised of three stages: (1) The first stage included focus groups with midwives to explore the barriers to carrying out place of birth discussions with women. (2) In the second stage, COM-B theory provided a structure for co-produced intervention development with midwives and women representatives; priority areas for change were agreed and the components of an intervention package to standardise the quality of these discussions were decided. (3) The third stage of the study adopted a mixed methods approach including questionnaires, focus groups and interviews with midwives to evaluate the implementation of the co-produced package in practice.nnnSETTINGnA maternity NHS Trust in the West Midlands, UK.nnnPARTICIPANTSnA total of 38 midwives took part in the first stage of the study. Intervention design (stage 2) included 58 midwives, and the evaluation (stage 3) involved 66 midwives. Four women were involved in the intervention design stage of the study in a Patient and Public Involvement role (not formally consented as participants).nnnFINDINGSnIn the first study stage participants agreed that pragmatic, standardised information on the safety, intervention and transfer rates for each birth setting (obstetric unit, midwifery-led unit, home) was required. In the second stage of the study, co-production between researchers, women and midwives resulted in an intervention package designed to support the implementation of these changes and included an update session for midwives, a script, a leaflet, and ongoing support through a named lead midwife and regular team meetings. Evaluation of this package in practice revealed that midwives knowledge and confidence regarding place of birth substantially improved after the initial update session and was sustained three months post-implementation. Midwives viewed the resources as useful in prompting discussions and aiding communication about place of birth options.nnnKEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICEnCo-production enabled development of a pragmatic intervention to improve the quality of midwives place of birth discussions with low-risk women, supported by COM-B theory. These findings highlight the importance of co-production in intervention development and suggest that the place of birth package could be used to improve place of birth discussions to facilitate informed choice at other Trusts across the UK.

Task shifting Midwifery Support Workers as the second health worker at a home birth in the UK: A qualitative study

OBJECTIVEnTraditionally two midwives attend home births in the UK. This paper explores the implementation of a new home birth care model where births to low risk women are attended by one midwife and one Midwifery Support Worker (MSW).nnnDESIGN AND SETTINGnThe study setting was a dedicated home birth service provided by a large UK urban hospital.nnnPARTICIPANTSnSeventy-three individuals over 3 years: 13 home birth midwives, 7 MSWs, 7 commissioners (plan and purchase healthcare), 9 managers, 23 community midwives, 14 hospital midwives.nnnMETHODnQualitative data were gathered from 56 semi-structured interviews (36 participants), 5 semi-structured focus groups (37 participants) and 38 service documents over a 3 year study period. A rapid analysis approach was taken: data were reduced using structured summary templates, which were entered into a matrix, allowing comparison between participants. Findings were written up directly from the matrix (Hamilton, 2013).nnnFINDINGSnThe midwife-MSW model for home births was reported to have been implemented successfully in practice, with MSWs working well, and emergencies well-managed. There were challenges in implementation, including: defining the role of MSWs; content and timing of training; providing MSWs with pre-deployment exposure to home birth; sustainability (recruiting and retaining MSWs, and a continuing need to provide two midwife cover for high risk births). The Service had responded to challenges and modified the approach to recruitment, training and deployment.nnnCONCLUSIONSnThe midwife-MSW model for home birth shows potential for task shifting to release midwife capacity and provide reliable home birth care to low risk women. Some of the challenges tally with observations made in the literature regarding role redesign. Others wishing to introduce a similar model would be advised to explicitly define and communicate the role of MSWs, and to ensure staff and women support it, consider carefully recruitment, content and delivery of training and retention of MSWs and confirm the model is cost-effective. They would also need to continue to provide care by two midwives at high risk births.

Safety of service users with severe mental illness receiving inpatient care on medical and surgical wards: a systematic review

This review aimed to synthesize the evidence on the likelihood of harm and mortality on medical and surgical inpatient wards for people with severe mental illness (SMI). From 937 results identified through database searching, and a further 10 papers identified through citation searching and hand searching, 11 papers met the criteria for inclusion in the final review. This review did not find strong evidence for higher in-hospital mortality in people with SMI. There was evidence that adverse events are higher in people with SMI. A higher likelihood of emergency instead of planned care, and poorer access to treatment were identified as potential contributing factors to these adverse events. In addition, service users with SMI were more likely to have a longer length of stay, associated with a higher cost of care. The severity of the mental illness increased the likelihood of harm or death, and people with schizophrenia were more likely than people with other mental illnesses to experience these adverse outcomes. There is evidence that people with SMI are provided with lower-quality health care, whereas higher-quality, better-planned care is required to overcome the inequalities in access faced by this vulnerable population.

Can rapid approaches to qualitative analysis deliver timely, valid findings to clinical leaders? A mixed methods study comparing rapid and thematic analysis

Objectives This study compares rapid and traditional analyses of a UK health service evaluation dataset to explore differences in researcher time and consistency of outputs. Design Mixed methods study, quantitatively and qualitatively comparing qualitative methods. Setting Data from a home birth service evaluation study in a hospital in the English National Health Service, which took place between October and December 2014. Two research teams independently analysed focus group and interview transcript data: one team used a thematic analysis approach using the framework method, and the second used rapid analysis. Participants Home birth midwives (6), midwifery support workers (4), commissioners (4), managers (6), and community midwives (12) and a patient representative (1) participated in the original study. Primary outcome measures Time taken to complete analysis in person hours; analysis findings and recommendations matched, partially matched or not matched across the two teams. Results Rapid analysis data management took less time than thematic analysis (43 hoursu2009vs 116.5u2009hours). Rapid analysis took 100u2009hours, and thematic analysis took 126.5u2009hours in total, with interpretation and write up taking much longer in the rapid analysis (52 hoursu2009vs 8u2009hours). Rapid analysis findings overlapped with 79% of thematic analysis findings, and thematic analysis overlapped with 63% of the rapid analysis findings. Rapid analysis recommendations overlapped with 55% of those from the thematic analysis, and thematic analysis overlapped with 59% of the rapid analysis recommendations. Conclusions Rapid analysis delivered a modest time saving. Excessive time to interpret data in rapid analysis in this study may be due to differences between research teams. There was overlap in outputs between approaches, more in findings than recommendations. Rapid analysis may have the potential to deliver valid, timely findings while taking less time. We recommend further comparisons using additional data sets with more similar research teams.

Qualitative study of barriers to clinical trial retention in adults with recently diagnosed type 1 diabetes

Objectives Regular physical exercise may preserve β cell function in newly diagnosed adults with type 1 diabetes (T1D). However, clinical trials to test this theory require the recruitment and retention of adults with new-onset T1D, which can be challenging. We sought to determine the overall experiences of newly diagnosed adults with T1D in an exercise study, to understand issues that influence the retention of trial participants in such studies. Design Qualitative methodology using individual face-to-face (n=6) and telephone interviews (n=14). Interview transcripts were thematically analysed using the framework method. Setting The study took place at five participating UK hospitals. Participants Twenty participants, aged 19–55 years, in the Exercise for Type 1 Diabetes study were interviewed to explore their study experiences and identify motivators and deterrents towards the study. Participants in control and intervention arms were interviewed, as were people with T1D who had completed (n=16) and withdrawn (n=4). Results Participants revealed barriers and facilitators to retention; the majority were generalisable to clinical trials of people with newly diagnosed T1D. Coming to terms with a diagnosis of T1D, lack of time, work pressures, level of health professional support, volume, clarity and consistency of information and feedback and a desire for knowledge about their condition were all cited as influencing factors to trial retention. Conclusions To our knowledge, this is the first qualitative study to examine the experience of being involved in an exercise trial by people with T1D. Findings suggest appointments could be shorter, available outside of working hours and planned longer in advance; study information should be clear, consistent and in electronic and paper formats; questionnaires need minimising; healthcare support and feedback needs providing regularly; thought is required around how to support non-exercising arm participants. These considerations may improve participant retention rates in new-onset T1D studies.

The role of the assistant practitioner in the clinical setting: a focus group study

BackgroundAssistant practitioners have knowledge and skills beyond the level of traditional support workers, and work in many clinical settings. However, some assistant practitioners lack a clearly defined role and may be under-used due to issues around accountability and uncertainty about their purpose. This paper explores the assistant practitioner role from the perspectives of assistant practitioners and registered nurses.MethodsThis study aimed to explore the role of the assistant practitioner from the perspectives of assistant practitioners and registered nurses in two NHS hospital trusts in Oxfordshire, United Kingdom. Six qualitative focus groups were undertaken between February–March 2017. Ethical approval was obtained (FREC 2016/05) and written consent was provided by participants. Data was analysed thematically analysed using the Framework method.ResultsNineteen participants (assistant practitioners, nxa0=u200912; registered nurses, nxa0=u20097) were recruited using convenience sampling. Emerging themes related to ‘fluctuating roles and responsibilities of assistant practitioners’, ‘role differences between registered nurses and assistant practitioners’, ‘working relationships’, ‘supervision’ and ‘redefining nursing pathways’.The Results and Discussion sections highlight a lack of role clarity and blurring of boundaries between the roles of assistant practitioners and registered nurses, with many tasks undertaken by both. This lack of ownership of ‘nurse-specific’ roles by registered nurses was evident and clear differences were only encountered with regard to accountability. The development of the Nursing Associate role provides managers with the opportunity to redefine staff banding hierarchies to ensure that clinical staff are aware of their role capabilities and limitations and are practicing safely, whilst promoting career development and progression pathways.ConclusionAddressing issues around role clarity can benefit professional development, satisfaction, role identity and ownership for registered nurses and assistant practitioners, by recognising the individual and collective value they bring to the clinical team. The findings can help inform the development of the Nursing Associate role.

Typologies for Restructuring Relationships in Cancer Survivorship: Temporal Changes in Social Support and Engagement With Self-Management Practices

Background Cancer survivors with good social support are generally more motivated to undertake self-management behaviors and make lifestyle changes. However, the impact of changes in social support over time, from prediagnosis through treatment and into survivorship, on the health and recovery of cancer survivors with a range of cancer diagnoses has not been explored. Objective The aim of this study was to examine how temporal changes in social support offered to cancer survivors by family and friends influence their engagement with self-management practices and adaptation to lifestyle changes. Methods The interview study took place in a teaching hospital in the West Midlands, United Kingdom. Forty participants were purposively sampled. A narrative approach to data collection was chosen, and data were thematically analyzed. Results Six typologies of restructuring relationships postcancer were identified. A greater understanding of the changes to social relationships that a cancer diagnosis can incur and the impact of this on peoples outlook and ability to self-manage was developed. Conclusion The restructuring of social relationships by cancer survivors over time can impact their outlook and ability to self-manage in survivorship, shaping their engagement with health promoting activities and reconciling cancer within the wider context of their lives. Implications for Practice Appropriate clinical nursing processes and tailored interventions are required to support cancer survivors and promote engagement with self-management practices. Nurses are a vital component of the social support that enables patients to make the best health and lifestyle choices available to them.