Liz Meerabeau

I'm sorry if I panicked you: nurses' accounts of teamwork in cardiopulmonary resuscitation

It seems to be taken as self evident in health care and other organisations that teams and teamwork are beneficial, often based on little evidence. This paper uses data from a small study of cardiopulmonary resuscitation in a trust hospital to reflect upon teamwork in a situation which is stressful, requires prompt, brief action and has clear-cut notions of success and failure. CPR teams resemble what Sundstrom et al. (1990) term action and negotiation teams; their examples include sports teams, combat units and surgery teams. However, although the CPR ‘team’ in this setting had to perform together, they generally did not work together nor practice their skills together, and it is argued that there may be misuse of the concept of teamwork in this and similar instances in health care.

The benefits of prophylaxis: views of adolescents with severe haemophilia

Summary.  It is well known and often reported that patients with long‐term health conditions have problems adhering to treatment regimens. This is often reportedly worst in adolescents who struggle with the physical and psychological impact of adolescence as well as with the limitations that treatment regimens impose on their day‐to‐day activities. This article presents results from a larger study that aimed to discover what living with haemophilia in the 21st century was like for boys with severe haemophilia. The overall study was a multi‐method, cross‐sectional interview based study of 30 boys with severe haemophilia, treated with prophylaxis at a single site in the UK. Although not specifically asked in the interview schedule, opinions about treatment (prophylaxis) were given by 66% of the boys. These boys recognized that prophylaxis offered them protection from bleeding, the older and more sporty boys understood the need for tailored prophylaxis around ‘risk’ activities such as sport or events away from home. For some boys this meant low dose daily prophylaxis, and this further enhanced treatment adherence, as it became firmly embedded in their daily ritual of health care. This study shows that adolescent boys are in fact adherent with treatment, possibly at a schedule decided upon by them rather than one directed by the haemophilia centre. They are able to comprehend complex treatment decisions and make treatment plans that offer them maximum protection with minimal interference in their day‐to‐day activities.

Self-management and skills acquisition in boys with haemophilia.

There is an increasing prevalence of children/young people with long‐term conditions (LTC) in the UK due to improvements in health‐care management and delivery. These children are often involved, from an early age, in their own care and management; yet, there are little data to support how or when they develop the necessary skills and knowledge to become competent at this care.

Changing childbirth: who should be the lead professional?

This paper discusses data drawn from a national survey of midwives, obstetricians, and GPs on the implementation of Changing Childbirth, the 1993 government report aiming to make maternity care more woman-centred. Although the study showed broad agreement in some areas, there was disagreement on whether the midwife should be the lead professional for low risk women, some role overlap, and doubts expressed about the effect of the policy change on teamwork. Changing Childbirth is an example of how policy change can cause interprofessional rivalries to surface.

'Just an unfortunate coincidence': children's understanding of haemophilia genetics and inheritance.

Summary.  This paper presents the results of a study talking to children and young people affected with severe haemophilia A and/or haemophilia B about their knowledge and understanding of genetics and inheritance. These data were gathered in a qualitative study using semi‐structured interviews with thirty boys aged four to sixteen discussing the impact of haemophilia on their lives. Responses were tape recorded, transcribed and analysed, using thematic analysis; one of the themes identified was genetic knowledge which is presented in this paper. Genetic knowledge was formed within the context of normal day‐to‐day lives within families affected by haemophilia, with parents and haemophilia centre staff being sources of information about individual inheritance patterns as well as providers of information about the future genetic impact of having haemophilia.

‘I can always rely on them’: the importance of social support for boys with haemophilia

Abstract Background Little is known about where, and from whom children with haemophilia receive support, as there is a paucity of psychosocial research on this topic. This paper, part of a larger study of living with haemophilia, discusses the importance of social support for boys with haemophilia. Methods Data were collected from 30 boys aged 4-17 years with severe haemophilia A or B from a single Haemophilia Comprehensive Care Centre in the United Kingdom. Age appropriate participatory qualitative research techniques: photo-elicitation, draw and write, focus groups and individual interviews were used. All data were transcribed and the content was analysed using grounded theory. Results Social support was gained in many ways from individuals who were identified by the study participants as supportive. These included parents, siblings (affected themselves or not), family members (who may also be affected) and friends. Being able to share experiences with others was also described as supportive. Conclusion The boys in this study described many sources of social support, which changed over time as they grew older. Commentary, J Haem Pract 2014;1(1):23.

The Research Governance Framework for Health and Social Care: Implications for developing research in primary care

The Research Governance Framework for Health and Social Care is a framework of responsibilities and quality checks formulated by the English Department of Health for researchers and others. Primary care trusts were required to comply with the RGF by April 1, 2003. Implementing research governance within primary care trusts includes establishing systems for being notified of any research activity, peer review and scientific support. This paper discusses findings arising from research commissioned in south London in 2003 by one of the national pilot sites for research governance in primary care. Data were gathered by means of telephone interviews with 23 experienced academics within the four south London higher education institutions included in the project. In particular, the paper explores issues concerning the effects of the research government framework on student projects, and the implications of these for the development of research capacity in primary care. A key message from this paper is that primary care research is still quite fragile, and that a heavy-handed introduction of research governance may deter neophytes and hamper research capacity-building. In particular, the withdrawal of higher education institutions from requiring primary datagathering for MScs because of the increasing hurdles of bureaucracy could make it more difficult for experienced practitioners to develop research skills.

Writing field notes in an ethnographic study of peers – collaborative experiences from the field

This interesting and well written paper claims that in nursing and midwifery research, field notes are generally not discussed explicitly, and therefore the opportunity to build an understanding of this part of the research process is lost. Data were collected from two fields of peers, doctoral research fellows in nursing and midwifery, and other staff in a national research funding agency in Ireland. The research stance, it is claimed, was akin to feminist ethnography, in minimizing power differentials and providing information. This seemed natural with the research fellows, because they shared the same occupational socialization and were also undertaking doctoral study; it is unusual for an ethnographer to be undertaking the same rite of passage as the people she is researching. Reciprocity, a key element of feminist ethnography, was shown by fellows reading the field notes pertaining to them, and adding to them. What is not fully addressed in the paper is how the author identified shared assumptions, or how she attempted to make the research settings anthropologically strange. The author’s status was more marginal in the funding agency and, therefore, perhaps more akin to the usual outsider ethnographer. From the paper, I pick up a sense of unease and constraint in that setting. There is also an awareness that permission for the research was initially given collectively at a team meeting, and that there was, therefore, the possibility for coercion. In the main, members of the organization displayed ‘ambivalence if not disinterest’; the PhD was also somewhat contentious in that it was an important criterion for promotion, and thus competition with other members of the agency. The role of nurse advisor was also somewhat ambiguous. In both settings the ability to take notes varied, depending largely on how obtrusive it would be. Sometimes they were very cryptic, and it was important to supplement them as soon as possible (although on re-reading the chapter by Emerson et al. cited in the paper, I was intrigued to see that some ethnographers eschew note-taking, relying instead on immersion in the setting). In the funding organization, the notes were written without identifiers, although this seems unnecessary when field notes are meant solely for the researcher, and can be anonymized later. The risk in taking this approach is that the notes can lose vitality, and the writer can become selfcensoring. Journal of Research in Nursing ©2008 SAGE PUBLICATIONS Los Angeles, London, New Delhi and Singapore VOL 13 (4) 336–337 DOI: 10.1177/ 1744987107087556 R E V I EW

Immigrants to the New World: Nursing as an academic discipline

The following is an edited version of Professor Liz Meerabeaus inaugural lecture given at the University of Greenwich on April 21, 1998