Wendy Knibb

Nurse led telephone follow up in ovarian cancer: A psychosocial perspective

Survivorship is a relatively new concept in ovarian cancer due to improvements in diagnosis, surgery and chemotherapy. As more women require long term follow up for ovarian cancer the pressure on these services is increased and the question of how best to care for these women needs to be addressed. This paper considers the results of a pilot study of nurse led telephone follow up in ovarian cancer from a psychosocial perspective. Fifty-two women received telephone follow up over a 10-month period; one aspect of this intervention was the opportunity for women to discuss psychosocial concerns with the clinical nurse specialist. A nurse database held records of patient discussions, and patient feedback regarding the service was collected using FACT Ovarian quality of life questionnaire, plus the satisfaction and experience with follow up questionnaire. Thirty-three women were recorded as discussing psychological concerns with the nurse, 42% discussed feelings of anxiety or depression and 33% discussed fear of disease recurrence. Thirty-nine women were recorded as having discussed social concerns with the nurse, 56% discussed their family (husband, children, etc.), 51% discussed work and/or finances, and 41% discussed sexual intimacy. The majority of women (73%) expressed a preference for nurse led telephone follow up, the main advantages were reported as the relationship and discussions between the patient and the nurse, and the convenience of having follow up appointments over the phone instead of attending clinic. This pilot study suggests that nurse led telephone follow up offers an acceptable opportunity for psychosocial support for women with ovarian cancer.

The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer:

E-technology is increasingly used in oncology to obtain self-reported symptom assessment information from patients, although its potential to provide a clinical monitoring tool in palliative care is relatively unexplored in the UK. This study aimed to evaluate the support provided to lung cancer patients post palliative radiotherapy using a computerized assessment tool and to determine the clinical acceptability of the tool in a palliative care setting. However, of the 17 clinicians identified as managing patients who met the initial eligibility criteria for the study, only one clinician gave approval for their patient to be contacted regarding participation, therefore the benefits of this novel technology could not be assessed. Thirteen key clinicians from the centres involved in the study were subsequently interviewed. They acknowledged potential benefits of incorporating computerized patient assessment from both a patient and practice perspective, but emphasized the importance of clinical intuition over standardized assessment. Although clinicians were positive about palliative care patients participating in research, they felt that this population of patients were normally too old, with too rapidly deteriorating a condition to participate in a study using e-technology. In order to encourage acceptance of e-technology within palliative care, emphasis is needed on actively promoting the contribution of technologies with the potential to improve patient outcomes and the patient experience.

Why are some care homes better than others? An empirical study of the factors associated with quality of care for older people in residential homes in Surrey, England.

This paper reports an empirical study that investigated associations between the quality of care received by older people in residential settings and features of the care homes in which they live. Data were gathered from the first announced inspection reports (2002-2003) of all 258 care homes for older people in one county of England (Surrey). The number of inspected standards failed in each home was used as the main indicator of quality of care. Independent variables (for each home) were: size, type, specialist registration, on-site nursing, ownership, year registered, location, maximum fee, vacancies, resident dependency, whether the home took publicly funded residents, care staff qualifications and managerial quality. Quality of care was modelled using a Poisson count maximum likelihood method based on 245 (91%) of the inspected homes for which relevant data were available. The results showed that quality of care (as defined by failures on national standards) was statistically associated with features of care homes and their residents. A higher probability of failing a standard was significantly associated with being a home that: was a for-profit small business (adjusted risk ratio (RR) = 1.17); was registered before 2000 (adj. RR = 1.22), accommodated publicly funded residents (adj. RR = 1.12); was registered to provide nursing care (adj. RR = 1.12). Fewer failures were associated with homes that were corporate for-profit (adj. RR = 0.82); held a specialist registration (adj. RR = 0.91); charged higher maximum fees (adj. RR = 0.98 per 100 pound sterling unit). A secondary analysis revealed a stronger model: higher scores on managerial standards correlated with fewer failures on other standards (r = 0.65, P < 0.001). The results of this study may help inform future policy. They are discussed in the context of alternative approaches to measuring quality of residential care, and in terms of their generalisability.

Laparoscopic surgery for endometrial cancer: a phenomenological study

AIM This paper is a report of a study of womens perspectives on the experience of laparoscopic surgery for endometrial cancer. BACKGROUND Laparoscopic surgery is increasingly used to treat early endometrial cancer. It is associated with low levels of morbidity and is considered safe as cancer surgery, but research on quality of life and womens experiences is limited. METHOD Heideggerian hermeneutic phenomenology was used to explore the experiences of 14 women who had undergone the procedure in two English cancer centres between February 2008 and July 2009. In-depth interviews were taped, transcribed and analysed using Colaizzis framework. FINDINGS A phenomenological description was produced from five identified themes: having cancer, transfer of responsibility to the surgeon, information and support, independence, and normality. The experience of laparoscopic surgery was overshadowed by the presence of cancer. Fear and lack of knowledge played an important role in entrusting the surgeon with the responsibility for decision-making. Individual, unmet information needs focused on the practicalities of treatment and being in an unfamiliar situation and environment. Loss of control and vulnerability were associated with illness and surgery, but early postoperative mobility and reduced pain, facilitated rapid return to independence and maintained a sense of normality. CONCLUSION Healthcare professionals should deliver care in early endometrial cancer in a way that recognizes the significance of the cancer diagnosis, the role of the surgeon in decision-making and the need for practical information. Women with endometrial cancer should have access to treatments that reduce dependency and maintain normality.

Supporting staff to respond effectively to informal complaints: findings from an action research study

AIM AND OBJECTIVE To understand how nurses and midwives manage informal complaints at ward level. BACKGROUND The provision of high quality, compassionate clinical nursing and midwifery is a global priority. Complaints management systems have been established within the National Health Service in the UK to improve patient experience yet little is known about effective responses to informal complaints in clinical practice by nurses and midwives. DESIGN Collaborative action research. METHODS Four phases of data collection and analysis relating to primarily one National Health Service trust during 2011-2014 including: scoping of complaints data, interviews with five service users and six key stakeholders and eight reflective discussion groups with six midwives over a period of nine months, two sessions of communications training with separate groups of midwives and one focus group with four nurses in the collaborating trust. RESULTS Three key themes emerged from these data: multiple and domino complaints; ward staff need support; and unclear complaints systems. CONCLUSIONS Current research does not capture the complexities of complaints and the nursing and midwifery response to informal complaints. RELEVANCE TO CLINICAL PRACTICE Robust systems are required to support clinical staff to improve their response to informal complaints and thereby improve the patient experience.

Competition and choice in the care home sector for older people: A case study of the market in Surrey

Competition in the care home sector for older people is encouraged as a means of increasing efficiency, driving down prices and raising quality. Choice is promoted to meet user expectations of healthcare and to improve service provision. The purpose of this study is to consider the evidence of care home provider competition and enhanced user choice through analysis of a discrete market area in the south of England. Data were collected from care home directories compiled by the National Care Standards Commission and the inspection reports on care homes. Longitudinal changes to the structure of the care home market are analysed from 1999‐2003. Choice is investigated with reference to fees paid and vacancy rates in homes. Results indicate that the Surrey market reflects national evidence. This exemplifies how immediate choice is only realistically available for those with a willingness and ability to pay higher fees.

Provider Perspectives on Safety in Primary Care in Albania

PURPOSE The purpose of this study was to determine the safety attitudes of specialist physicians (SPs), general physicians (GPs), and nurses in primary care in Albania. DESIGN The study was cross-sectional. It involved the SPs, GPs, and nurses from five districts in Albania. A demographic questionnaire and the adapted Safety Attitudes Questionnaire (SAQ)-Long Ambulatory Version A was used to gather critical information regarding the participants profile, perception of management, working conditions, job satisfaction, stress recognition, safety climate, and perceived teamwork. METHODS The onsite data collectors distributed questionnaires at the primary care clinics and then collected them. Descriptive statistics were used to summarize the responses. The significance of mean difference among SPs, GPs, and nurses was tested using analysis of variance. FINDINGS Five hundred twenty-three questionnaires were completed. The concept of patient safety in relation to job satisfaction received the highest ratings. Stress recognition had low ratings. There was a high level of teamwork in SPs, GPs, and nurses. Healthcare staff agreed that it was difficult to discuss errors in their primary healthcare center. Physicians in contrast to nurses were most likely to affirm that they do not make errors in hostile situations. CONCLUSIONS Errors are difficult to discuss. It was clear that primary care staff, such as physicians, never considered the likelihood of errors occurring during tense situations. CLINICAL RELEVANCE Staff at primary healthcare centers are used to adverse events and errors. Despite the demand for safety improvement and the existing evidence on the epidemiology of outpatient medical errors, most research has only been conducted in hospital settings. Many patients are put at risk and some are harmed as a result of adverse events in primary care. Adequate communication and technical skills should be utilized by primary care providers (PCPs) for improvement of patient safety. The patient safety measures should include assessment of the safety attitudes of PCPs.

Gatekeeping access to the midwifery unit: Managing complaints by bending the rules

While poor communication between service users and front-line staff causes many service user complaints in the British National Health Service, staff rarely reflect on the causes of these complaints. We discuss findings from an action research project with midwives which suggest that the midwives struggled to fully understand complaints from women, their partners and families particularly about restricted visiting and the locked door to the midwifery unit. They responded to individual requests to visit out of hours while maintaining the general policy of restricted visiting. In this way, the door was a gatekeeping device which allowed access to the unit within certain rules. The locked door remained a barrier to women and their families and as a result was a common source of informal complaints. We argue that the locked door and restricted visiting to the midwifery unit were forms of gatekeeping and boundary making by midwives which reveals a tension between their espoused woman-centred care and contemporary midwifery practice which is increasingly constrained by institutional values.

Primary Healthcare Reforms through the Lens of Innovation;- Comparative Case Studies from Western Balkans and Eastern Europe

CONTEXT: Innovation within healthcare can take many forms, ranging from drug therapies, through to new forms of financing. Most transition countries in CEE are engaged in health reform initiatives aimed at introducing primary health care (PHC) to enhance performance of their health systems. This has been challenging with examples of unequal adoption, professional resistance and poor sustainability. PURPOSE OF THIS PAPER: We aim to explore the introduction and diffusion of family-medicine-centered PHC reforms in Western Balkans and Eastern European Context; THROUGH THE LENS OF INNOVATION. DESIGN/METHODOLOGY/APPROACH: A comparative case studies analysis using cases selected from the Western Balkans and Eastern European Countries. We identified our cases based on a systematic search of peer-reviewed articles the grey literature. Overall 5 cases met the inclusion criteria; then developed an analytical framework based on key aspects of the innovation process FINDINGS: PHC reform is a complex innovation, involving organizational, financial, clinical and relational changes. The framework clearly highlights the value of early analysis of change programmes in order that the leaders of these programmes can anticipate and develop strategies which would ensure a more successful and sustainable change process. THE ORIGINAL/VALUE OF PAPER: The study merges different features of PHC in different post-communist countries, providing empirical evidence on PHC reforms in particular CEE countries both in developed and remote areas. Keywords - Innovation, Primary Healthcare Reforms, Post-Communist Countries, Systems in Transition,

A review of lymphoedema service provision in adult hospices in the UK and Ireland

Introduction This study scoped lymphoedema services in adult hospices in the UK and Ireland. It was undertaken to benchmark and inform development of a local hospice lymphoedema service and was completed as part of an MSc in Advanced Practice. Aims The study investigated hospice demographics, lymphoedema services including budget provision, treatments used, staffing levels and qualifications. A secondary aim explored the use of Manual Lymphatic Drainage (MLD) with the palliative population. Methods The study was undertaken in November and December 2010. It adopted a quantitative approach using a postal questionnaire sent to 195 adult hospices, with in-patient units, in the UK and Ireland. This represented the whole population. Data were analysed using SPSS, with open-ended questions grouped and themed. Results A response rate of 65% revealed that 61.4% of respondents provided some level of lymphoedema service. Where services existed, 69.2% of hospices had staff employed solely to treat lymphoedema, 66.7% had ring-fenced budgets for lymphoedema care with 67.3% treating lymphoedema patients from outside the palliative population. Nurses and physiotherapists were the main professional groups involved in lymphoedema management. MLD was employed as a treatment strategy for palliative patients in 75.6% of hospices. It was used holistically, often in an adapted form, with both physical and psychological benefit. Discussion Wide geographical variations exist with a cluster of fully developed services in the Midlands. It appears that different models of care are evolving in Wales and Northern Ireland in response to recent national guidance. Conclusions There is potential inequity of service provision due to geographical variations. Further research is needed to plot the trend of hospice lymphoedema services, explore the impact of new models of care and give further consideration to the use of MLD with palliative patients.