Jenny Morris

Disabled children, child protection systems and the Children Act 1989

It is now widely recognized that disabled children are particularly vulnerable to abuse but that a number of factors get in the way of protecting them. This article discusses research on the implementation of the Children Act as it applies to disabled children and the findings from in-depth interviews with young disabled people. The research concluded that: current child protection systems are not addressing the particular needs of disabled children; the Children Act regulations on short-term and long-term placements are often not complied with; and disabled children and young people have little say in decisions which affect them and few opportunities to communicate their experiences. Copyright

The feasibility of introducing an evidence based practice cycle into a clinical area: An evaluation of process and outcome

The aim was to examine the feasibility of introducing an evidence based practice (EBP) cycle into a practice area within an undergraduate pre-registration programme. The cycle involved four meetings over five weeks on a cardiac intensive care unit. Three 3rd year adult branch nursing students participated with their mentors. A web page for the project was developed to support the process. Evaluation focused on changes in EBP knowledge and skills and issues around implementation and perceived value of the EBP cycle. The findings showed that the EBP cycle was straight forward to set up and was recognised as being of value by both students and mentors. The students demonstrated modest improvements in EBP knowledge and skills. The main problems were lack of time and difficulties in accessing on-line resources.

QUALZICE: A QUALitative exploration of the experiences of the participants from the ZICE clinical trial (metastatic breast cancer) receiving intravenous or oral bisphosphonates

BackgroundThis qualitative sub-study aimed to explore the experiences of participants on the National Cancer Research Institute ZICE clinical trial, a randomised trial assessing two types of bisphosphonate treatment in breast cancer patients with bone metastases. Participants in the clinical trial were randomly allocated to receive either zoledronate, delivered by an intravenous (IV) infusion at clinic, or oral ibandronate, taken at home.MethodsQualitative research interviews were conducted with participant groups organised by treatment and location. Interviews covered experiences and understanding of bisphosphonate treatment, the experience of the delivery mechanisms (IV or oral), side effects and benefits, and quality of life issues. The analytic framework was interpretative phenomenological analysis.ResultsThis paper reports on one of four superordinate themes: participants’ experience of the ZICE trial, which explores the participants’ experiences with clinical trial-related processes. Results show that participants were generally satisfied with their randomised treatment, although most participants had an initial preference for oral bisphosphonates. Some difficulties were reported from participants for both interventions: needle phobia, poor veins, difficulty with swallowing and gastric side effects, but pain control was improved with both modes of delivery. However, the infused bisphosphonate was reported to lose effectiveness after three weeks for some participants, whereas the oral bisphosphonate was reported to give consistent pain control. Geographical location and distance to travel made little difference to convenience of access to clinic as the reported lengths of travel time were similar due to traffic congestion in the urban areas. Most participants understood the trial processes, such as randomisation, and information about bisphosphonates but some participants showed little understanding of certain aspects of the trial. Some participants reported difficulties in accessing dental treatment due to their dentist’s perceptions of bisphosphonate treatment.ConclusionsIn trials of medicinal products, especially when testing for non-inferiority, participants’ preferences and idiosyncrasies in relation to treatments should not be assumed. This study has shown that in a trial context, participants’ views can usefully add to the main trial outcomes and they should be taken into account when prescribing in the real world.Trial registrationISRCTN13914201. Main ZICE MREC: 05/MRE09/57. CRUK E/04/022.

Implementation of a team-based learning course: Work required and perceptions of the teaching team

BACKGROUND Team-based learning was selected as a strategy to help engage pre-registration undergraduate nursing students in a second-year evidence-informed decision making course. OBJECTIVES To detail the preparatory work required to deliver a team-based learning course; and to explore the perceptions of the teaching team of their first experience using team-based learning. DESIGN Descriptive evaluation. METHODS Information was extracted from a checklist and process document developed by the course leader to document the work required prior to and during implementation. Members of the teaching team were interviewed by a research assistant at the end of the course using a structured interview schedule to explore perceptions of first time implementation. RESULTS There were nine months between the time the decision was made to use team-based learning and the first day of the course. Approximately 60days were needed to reconfigure the course for team-based learning delivery, develop the knowledge and expertise of the teaching team, and develop and review the resources required for the students and the teaching team. This reduced to around 12days for the subsequent delivery. Interview data indicated that the teaching team were positive about team-based learning, felt prepared for the course delivery and did not identify any major problems during this first implementation. CONCLUSIONS Implementation of team-based learning required time and effort to prepare the course materials and the teaching team. The teaching team felt well prepared, were positive about using team-based learning and did not identify any major difficulties.