Hilary Piercy

Social research on the under-16s: a consideration of the issues from a UK perspective

This article aims to consider the current situation with regard to the issue of consent in relation to health-based research on the under-16s. It considers the legal situation with regard to the issues of consent, assent and dissent, and their application to research. Although under-16s can consent to treatment if deemed competent according to the ‘Fraser guidelines’, application of this principle in relation to research appears to be less clear with variability in published guidance and the approach taken by ethics committees. Recent policy changes including Research Governance have increased the scrutiny of consent to research, and current changes appear likely to increase the requirement for parental consent for those aged below 18 years. The impact of these ambiguities and changes upon young people as service users are considered with particular reference to sexual health, where they often access the service as autonomous individuals.

School nurse management of children’s questions when they are involved in primary school sex education: an exploratory study

Aim The aim of this paper is to explore school nurses’ experiences of teaching Sex and Relationships Education (SRE) as part of the primary school curriculum. In particular it focuses on the questions that the children ask during the lessons and the strategies which the nurses employ in managing those questions. Background School based Sex and Relationship Education (SRE) is an important aspect of children’s education. However, it is a highly politicised and controversial area which is a matter of concern to a wide number of stakeholders. In the primary school setting, school nurses are commonly involved in delivery of the programme. Their input is particularly valued because they are ‘specialist outsiders’ who create an environment which is conducive to discussion of sensitive topics. To date there is little understanding of the skills that they employ in managing the educational needs of primary school children within the confines of a pre-agreed school curriculum. Methods Semi-structured focus group interviews were conducted with small groups of school nurses from a single geographical location in the Midlands region of England. Data were analysed using a thematic analysis approach. Findings Data identified the ways in which the nurses viewed and responded to the children’s agenda which was realised in the form of questions. In particular it focuses on what they deemed to be inappropriate questions and the basis upon which this label was applied. Five strategies for managing these inappropriate questions were identifiable from the data. Their deployment is explored in relation to the tensions implicit in the realisation of sexualised realities in a classroom setting.

The contribution of the HIV specialist nurse to HIV care: a scoping review

AIMS AND OBJECTIVES To systematically identify and critically examine the evidence of the contribution of the HIV nurse specialist to provision of HIV care in the UK and other developed countries. BACKGROUND The HIV clinical nurse specialist role has evolved over the past two decades in response to changes in two areas of HIV care: first, changes in the treatment and care of those with HIV and second, changes and development in advanced nursing practice. The challenges facing HIV care require the development of innovative services including a greater contribution of HIV specialist nurses. A review of current evidence is required to inform developments. DESIGN A review. METHODS A broad search strategy was used to search electronic databases. Grey literature was accessed through a variety of approaches. Preference was given to UK literature with inclusion of international publications from other developed countries where relevant. RESULTS Fourteen articles were included. Four themes were identified: the diversity of the clinical role; a knowledge and skills framework for HIV nursing practice; the education and training role of the HIV nurse specialist; and the effectiveness of the HIV nurse specialist. The findings mainly focus on the clinical aspects of the role with little evidence concerning other aspects. There is limited evidence to indicate clinical effectiveness. CONCLUSIONS HIV care is facing substantial challenges, and there is a clear need to develop effective and efficient services, including expanding the contribution of HIV nurse specialists. Such developments need to occur within a framework that optimises nursing contribution and measures their impact on HIV care. This review provides a baseline to inform such developments. RELEVANCE TO CLINICAL PRACTICE This review of the literature details current understanding of the role of HIV specialist nurses and the contribution that they make to HIV care.

Knowledge of genital Chlamydia trachomatis infection in family planning clinic attenders

The purpose of this study was to determine the level of awareness of genital Chlamydia infection and level of knowledge related to this infection in family planning (FP) clinic attenders. Clients attending FP clinics during a 3 month study period were invited to complete an anonymous self-administered questionnaire. Five hundred and sixteen questionnaires from female attenders were analysed. Results showed that 54% of respondents had heard of Chlamydia. Subjective knowledge assessment for Chlamydia was low compared to that for other infections. Mean knowledge scores relating to genital chlamydial infection were low. There was no significant age-related trend in knowledge scores. The implications of these findings are discussed in relation to increased Chlamydia screening activity in FP clinics.

Capacity development for knowledge translation : evaluation of an experiential approach through secondment opportunities

Background Experiential approaches to skills development using secondment models are shown to benefit healthcare organizations more generally, but little is known about the potential of this approach to develop capacity for knowledge translation (KT). Aim To evaluate the success of KT capacity development secondments from the perspective of multiple stakeholders. Methods A pluralistic evaluation design was used. Data were collected during 2011–2012 using focus group and individual interviews with 14 clinical and academic secondees, and five managers from host and seconding organizations to gain insight into participants’ perceptions of the success of secondments and the criteria by which they judged success. Six After Action Reviews were undertaken with KT project teams to explore participants’ perceptions of the contribution secondees made to KT projects. Semistructured interviews were undertaken with three healthcare managers on completion of projects to explore the impact of secondments on the organization, staff, and patients. Qualitative content analysis was used to identify criteria for success. The criteria provided a framework through which the overall success of secondments could be judged. Results Six criteria for judging the success of the secondments at individual, team, and organization level were identified: KT skills development, effective workload management, team working, achieving KT objectives, enhanced care delivery, and enhanced education delivery. Benefits to the individual, KT team, seconding, and host organizations were identified. Implications for Practice Hosting teams should provide mentorship support to secondees, and be flexible to accommodate secondees’ needs as team members. Ongoing support of managers from seconding organizations is needed to maximize the benefits to individual secondees and the organization. Linking Evidence to Action Experiential approaches to KT capacity development using secondments can benefit individual secondees, project teams, seconding, and host organizations.

Sexual and reproductive knowledge, attitudes and behaviours in a school going population of Sri Lankan adolescents

The reproductive and sexual health of adolescents is an important health concern and a focus of global attention. In Sri Lanka, a lack of understanding about adolescent reproductive and sexual health needs is a matter of national concern. A survey was undertaken to examine the sexual knowledge, attitudes and behaviours of school going adolescents in Sri Lanka. A random sample of schools was selected from one district. Data were collected by a self-completion questionnaire and analysed using SPSS. Response rate was 90%. 2020 pupils (26% boys, 74% girls) aged 16-19 years (mean=16.9) participated, the majority Sinhalese (97%). Most reported a good parent-child relationship (88%). A minority (34%) discussed sexual issues with parents. Health professionals were the preferred source of sexual information (32%) rather than parents (12.5%) or friends (5.6%). Less than 1% demonstrated satisfactory sexual and reproductive knowledge levels. 1.7% were sexually active (30 boys vs 5 girls), the majority with same age partners. 57% used contraception at first intercourse. There is an imperative to address the lack of sexual and reproductive knowledge. A minority of school going adolescents become sexually active. These individuals are potentially vulnerable and services need to be developed to meet their needs.

The importance of contextualisation in giving a diagnosis of genital chlamydial infection: findings from a qualitative study

Objective To explore the impact of diagnostic communication upon the way in which people receive and respond to a diagnosis of chlamydial infection. Methods A qualitative study examining the responses of individuals to a diagnosis of chlamydial infection. The study was conducted in a genitourinary medicine clinic and a family planning clinic in the Midlands region of the UK. The sample size was 50 and included both males and females. Data collection was by means of unstructured interviews, which were audio-taped and fully transcribed. The principles of grounded theory were followed in the sampling, analysis and exploration of the literature. Results A diagnosis of chlamydial infection was commonly unexpected and associated with negative reactions, which derived from the social construction of sexually transmitted infections as evidence of breaching the moral code. The way in which the health professional communicated the diagnosis contributed to the patient response, either negatively by reinforcing feelings of self-recrimination or positively by the provision of key information that appeared to be helpful in modifying that response. Conclusion Sensitive management and the provision of contextualised information serve an important function for those diagnosed with chlamydial infection.

“It feels good to be told that I’m all clear”: patients’ accounts of retesting following genital chlamydial infection

Objective: To examine the meaning that people with genital chlamydial infection attribute to retesting as part of their treatment management. Methods: Unstructured interviews with 50 heterosexual patients (40 female and 10 male) who had or had had genital chlamydia infection. Recruitment was via a genitourinary medicine clinic and a contraceptive clinic. Results: The return visit was understood in terms of the retest. The retest occupied a pivotal position in the infection experience and was invested with symbolic significance because it provided a means by which to deal with feelings of bodily pollution. It marked the end of dirtiness that was important for the restoration of identity. It also marked the beginning of cleanness that was important in relation to sexual relationships. Conclusion: The sociocultural construction of sexually transmitted infections shapes the individual experience of having chlamydial infection. This perspective sheds light on the meaning that individuals invest in aspects of infection management. It is important for some people to know rather than assume that their infection has been eliminated, a function that is fulfilled by the retest. When retesting is not available, individuals may use increasingly available opportunistic chlamydia testing for this purpose with consequent cost and resource implications.

How does specialist nursing contribute to HIV service delivery across England

This study aimed to examine what specialist nursing contributes to HIV service delivery across England and how it could be optimised. A three part multi-method qualitative study was undertaken, involving (1) interviews with 19 stakeholders representing professional or service user groups; (2) interviews with nurse/physician pairs from 21 HIV services; and (3) case studies involving site visits to five services. A framework analysis approach was used to manage and analyse the data. There was substantial variability in specialist nursing roles and the extent of role development. Most hospital-based HIV nurses (13/19) were running nurse-led clinics, primarily for stable patients with almost half (6/13) also managing more complex patients. Role development was supported by non-medical prescribing, a robust governance framework and appropriate workload allocation. The availability and organisation of community HIV nursing provision determined how services supported vulnerable patients to keep them engaged in care. Four service models were identified. The study showed that there is scope for providing a greater proportion of routine care through nurse-led clinics. HIV community nursing can influence health outcomes for vulnerable patients, but provision is variable. With limited financial resources, services may need to decide how to deploy their specialist nurses for best effect.

Improving capacity in ethnicity and health research: report of a tailored programme for NHS Public Health practitioners

Aim To determine whether an intervention designed to enhance research capacity among commissioners in the area of ethnicity and health was feasible and impactful, and to identify programme elements that might usefully be replicated elsewhere. Background How healthcare commissioners should be equipped to understand and address multiethnic needs has received little attention to-date. Being able to mobilise and apply evidence is a central element of the commissioning process that requires development. Researching ethnicity and health is widely recognised as challenging and several prior interventions have aimed to enhance competence in this area. These have, however, predominantly taken place in North America and have not been evaluated in detail. Methods An innovative research capacity development programme was delivered to public health staff within a large healthcare commissioning organisation in England. Evaluation methodology drew on ‘pluralistic’ evaluation principles and included formative and summative elements. Participant evaluation forms gave immediate feedback during the programme. Participants also provided feedback at two weeks and 12 months after the programme ended. In addition, one participant and one facilitator provided reflective accounts of the programmes strengths and weaknesses, and programme impact was traced through ongoing partnership work. Findings The programme was well received and had a tangible impact on knowledge, confidence and practice for most participants. Factors important to success included: embedding learning within the participants’ work context; ensuring a balance between theory and practical tips to enhance confidence; and having sustained interaction between trainers and participants. Despite positive signs, the challenging nature of the topic was highlighted, as were wider structural and cultural factors that impede progress in this area. Although it is unrealistic to expect such programmes to have a major impact on commissioning practices, they may well make an important contribution to raising the confidence and competence of staff to undertake work in this area.