Gary Witham

Exploring the decision-making preferences of people with colorectal cancer

Objectives  To explore patient views on participation in treatment, physical care and psychological care decisions and factors that facilitate and hinder patients from making decisions.

Reflections on access: too vulnerable to research?

This paper seeks to highlight the challenges facing researchers when recruiting vulnerable patients to a research study. We explore the difficulties experienced in gatekeeping for a project involving people with dementia, intellectual disabilities and mental health problems who are also having treatment for cancer. It is argued that the challenges in identifying and recruiting vulnerable participants extend beyond ethics committees and governance to the perceptions and judgements of health care professionals in ‘allowing’ access to particular patient groups. These positions and judgements appear to be embedded in certain construction(s) of cancer and discourses surrounding dementia, intellectual disabilities and mental health.

The utility and impact of information communication technology (ICT) for pre-registration nurse education: A narrative synthesis systematic review

OBJECTIVES To evaluate and summarise the utility and impact of information communication technology (ICT) in enhancing student performance and the learning environment in pre-registration nursing. DESIGN A systematic review of empirical research across a range of themes in ICT health-related education. DATA SOURCES Science Direct, Cinahl, AMED, MEDLINE, PubMed, ASSIA, OVID and OVID SP (2008-2014). Further date parameters were imposed by theme. REVIEW METHODS Evidence was reviewed by narrative synthesis, adopting Caldwells appraisal framework and CASP for qualitative methods. Selection and inclusion was grounded in the PICOS structure, with language requirements (English), and further parameters were guided by theme appropriateness. RESULTS Fifty studies were selected for review across six domains: reusable learning objects, media, audience response systems, e-portfolios, computer-based assessment and faculty adoption of e-learning. Educational ICT was found to be non-inferior to traditional teaching, while offering benefits to teaching and learning efficiency. Where support is in place, ICT improves the learning environment for staff and students, but human and environmental barriers need to be addressed. CONCLUSION This review illuminates more advantages for ICT in nurse training than previously. The key advantage of flexibility is supported, though with little evidence for effect on depth of learning.

Carer Experience Supporting Someone With Dementia and Cancer: A Narrative Approach

In this article, we examine the challenges of informal carers supporting someone with dementia and cancer within the United Kingdom. Interviews were conducted with seven informal carers using a narrative approach to examine the construction of their experiences. Our findings demonstrate how informal carers navigate a path through complex cancer treatments and support their relative. A cancer diagnosis often requires multiple treatment visits to an oncology center, and this can be challenging for carers. They find that they need to coordinate and manage both health professionals and their relative in terms of getting access to appropriate services and support. This process can be particularly challenging in the presence of a cognitive impairment that often demands effective communication with different agencies. Carers frequently experienced multiple challenges including dealing with the stigma that is characteristic of the dementia experience and the added complexity of negotiating this within a cancer care context.

Narrative intelligence in nursing: Storying patient lives in dementia care

This paper examines narrative approaches to care within the context of dementia. It reviews the function of stories and explores some of the narrative genres that shape the cultural perceptions of dementia. We argue that narrative intelligence within healthcare is an important element in nurturing communal self-identity for people living with dementia. Listening and responding to stories and the cultural framework that this encompasses is an embodied action that is not just related to cognitive recall but situates us within a cultural community. People with dementia may have challenges in maintaining narrative legitimacy in the face of fractured stories and incoherent narratives. Health professionals can offer support in reframing and presenting counterstories that maintain identities that can potentially be marginalised, silenced and open to narrative foreclosure. This process requires health professionals to be attentive and responsive to how patients with dementia and their supporters construct and position the stories they tell and the meaning(s) they attach to them.

A narrative literature review examining cancer treatment issues for patients living with intellectual disabilities

PURPOSE The experiences of cancer care can be mediated by many different factors and this narrative literature review aims to explore the experiences of cancer care in relation to people with intellectual disabilities receiving cancer treatment. METHOD We undertook a search for articles in English from (Jan) 2000-(Feb) 2018 using Medline, CINAHL, ScienceDirect, ASSIA and Wiley. The inclusion criteria are 2000-2018, English language and focussing on experiences of cancer journey. We used a narrative approach and thematically analysed the data. RESULTS There were 10 papers that met our inclusion/exclusion criteria. The themes generated included communication issues, information giving and decision-making. The literature suggests that communication and decision-making within cancer care are often mediated through support workers or family carers with minimal involvement of the person with intellectual disabilities. Information-giving by health professionals and support workers to people with intellectual disabilities was limited. This was often justified by the perceived distress this may cause. CONCLUSION Training for health professionals and support workers in supporting people with intellectual difficulties is required for more effective communication in cancer care.

The provision of a mental health practitioner within a young people's substance misuse clinical team

Evidence suggests that substance misuse service practitioners attempt to work with dual diagnosis patients but lack the skills and knowledge to address both health problems. This study explores the impact of placing a mental health consultant within a substance misuse community team on knowledge, confidence and willingness to work with dual diagnosis patients. A participant action research method was used to explore the role and effect of the mental health consultant on the effectiveness of the practitioners’ work with dual diagnosis patients. The presence of the mental health specialist demonstrated increased confidence, willingness and ability to work effectively with dual diagnosis patients accessing the service. The conditions required for success for this type of service provision is discussed. The accessibility of the consultant via clinical supervision and training impacted on the confidence of the practitioners and increased the level of complexity at which the practitioners were prepared to work ...