1
|
Roddis J, Dyson J, Woodhouse M, Devrell A, Oakley K, Cowdell F. Barriers and facilitators to pressure ulcer prevention behaviours by older people living in their own homes and their lay carers: a qualitative study. BMJ Open 2024; 14:e080398. [PMID: 38503413 PMCID: PMC10953097 DOI: 10.1136/bmjopen-2023-080398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE To identify barriers and facilitators to pressure ulcer prevention behaviours in community-dwelling older people and their lay carers. DESIGN Theoretically informed qualitative interviews with two-phase, deductive then inductive, thematic analysis. SETTING The study was conducted in one geographical region in the UK, spanning several community National Health Service Trusts. PARTICIPANTS Community-dwelling older patients at risk of pressure ulcer development (n=10) and their lay carers (n=10). RESULTS Six themes and subthemes were identified: (1) knowledge and beliefs about consequences (nature, source, timing and taboo); (2) social and professional role and influences (who does what, conflicting advice and disagreements); (3) motivation and priorities (competing self-care needs and carer physical ability); (4) memory; (5) emotion (carer exhaustion and isolation, carergiver role conflict and patient feelings) and (6) environment (human resource shortage and equipment). CONCLUSIONS There is minimal research in pressure ulcer prevention in community-dwelling older people. This study has robustly applied the theoretical domains framework to understanding barriers and facilitators to pressure ulcer prevention behaviours. Our findings will support co-design of strategies to promote preventative behaviours and are likely to be transferable to comparable healthcare systems nationally and internationally.
Collapse
Affiliation(s)
- Jennifer Roddis
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Judith Dyson
- C-SCHaRR, School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Marjolein Woodhouse
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Anne Devrell
- Patient and Public Involvement representative, Birmingham, UK
| | | | - Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
| |
Collapse
|
2
|
Smith D, Cartwright M, Dyson J, Aitken LM. Use of nominal group technique methods in the virtual setting: A reflective account and recommendations for practice. Aust Crit Care 2024; 37:158-165. [PMID: 37880060 DOI: 10.1016/j.aucc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/19/2023] [Accepted: 09/05/2023] [Indexed: 10/27/2023] Open
Abstract
Nominal group technique methods involve the use of structured activities within groups comprised of purposefully selected stakeholders (nominal groups), with the broad aim of achieving a level of consensus and prioritising information. In this paper, we will report how we facilitated nominal groups, using Microsoft Teams, to prioritise content for a theory-based behaviour change intervention to improve responses to clinically deteriorating patients. Our methods incorporated development and piloting of research materials, facilitation of online nominal groups with different stakeholders, and a structured approach to ranking behaviour change strategies. Practical suggestions are offered based on our experience of using this method in a virtual context.
Collapse
Affiliation(s)
- Duncan Smith
- City, University of London, School of Health Sciences, Northampton Square, London, EC1V 0HB, UK; Patient Emergency Response & Resuscitation Team (PERRT), University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK.
| | - Martin Cartwright
- City, University of London, School of Health Sciences, Northampton Square, London, EC1V 0HB, UK.
| | - Judith Dyson
- Birmingham City University, Westbourne Road, Edgbaston, Birmingham, B15 3TN, UK.
| | - Leanne M Aitken
- City, University of London, School of Health Sciences, Northampton Square, London, EC1V 0HB, UK; School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia.
| |
Collapse
|
3
|
Caley LR, Wood HM, Bottomley D, Fuentes Balaguer A, Wilkinson L, Dyson J, Young C, White H, Benton S, Brearley M, Quirke P, Peckham DG. The gut microbiota in adults with cystic fibrosis compared to colorectal cancer. J Cyst Fibros 2023:S1569-1993(23)01728-9. [PMID: 38104000 DOI: 10.1016/j.jcf.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Gut dysbiosis is implicated in colorectal cancer (CRC) pathogenesis. Cystic fibrosis (CF) is associated with both gut dysbiosis and increased CRC risk. We therefore compared the faecal microbiota from individuals with CF to CRC and screening samples. We also assessed changes in CRC-associated taxa before and after triple CF transmembrane conductance regulator (CFTR) modulator therapy. METHODS Bacterial DNA amplification comprising V4 16S rRNA analysis was conducted on 84 baseline and 53 matched follow-up stool samples from adults with CF. These data were compared to an existing cohort of 430 CRC and 491 control gFOBT samples from the NHS Bowel Cancer Screening Programme. Data were also compared to 26 previously identified CRC-associated taxa from a published meta-analysis. RESULTS Faecal CF samples had a lower alpha diversity and clustered distinctly from both CRC and control samples, with no clear clinical variables explaining the variation. Compared to controls, CF samples had an increased relative abundance in 6 of the 20 enriched CRC-associated taxa and depletion of 2 of the 6 taxa which have been reported as reduced in CRC. Commencing triple modulator therapy had subtle influence on the relative abundance of CRC-associated microbiota (n = 23 paired CF samples). CONCLUSIONS CF stool samples were clearly dysbiotic, clustering distinctly from both CRC and control samples. Several bacterial shifts in CF samples resembled those observed in CRC. Studies assessing the impact of dietary or other interventions and the longer-term use of CFTR modulators on reducing this potentially pro-oncogenic milieu are needed.
Collapse
Affiliation(s)
- L R Caley
- Leeds Institute of Medical Research, Clinical Sciences Building, St James's University Hospital, University of Leeds, LS9 7TF, UK
| | - H M Wood
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - D Bottomley
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - A Fuentes Balaguer
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - L Wilkinson
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - J Dyson
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - C Young
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - H White
- Leeds Beckett University, Nutrition, Health & Environment, Leeds, LS1 3HE UK
| | - S Benton
- NHS Bowel Cancer Screening South of England Hub, Royal Surrey NHS Foundation Trust, Guildford, GU2 7YS, UK
| | - M Brearley
- NHS Bowel Cancer Screening South of England Hub, Royal Surrey NHS Foundation Trust, Guildford, GU2 7YS, UK
| | - P Quirke
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - D G Peckham
- Leeds Institute of Medical Research, Clinical Sciences Building, St James's University Hospital, University of Leeds, LS9 7TF, UK; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.
| |
Collapse
|
4
|
Dyson J, Skinner J, Crick J, Crooks MG. Designing an intervention to help the quitters quit: A qualitative, intervention co-design study. PEC Innov 2023; 2:100141. [PMID: 37214522 PMCID: PMC10194124 DOI: 10.1016/j.pecinn.2023.100141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 05/24/2023]
Abstract
Objective E-cigarettes are increasingly being provided by publicly funded stop smoking services. Our objectives were to understand the challenges and establish the means by which services could best support the use and subsequent discontinuation of e-cigarettes for this purpose. Methods Semi-structured interviews and co-design workshops with service users and providers of a stop smoking service. Results Thematic analysis was conducted. Interviews identified: 1. a reluctance to use e-cigarettes for cessation, 2. struggle to quit e-cigarettes (dependency, fear of relapse, compensatory "puffing") and 3. service development needs (consistency of approach). Co-design workshops suggested: 1. facilitation of e-cigarette use through understanding previous failed attempts, 2. offering a longer, two-staged approach to tobacco then e-cigarette cessation, careful timing of behavioural strategies and 3. enhanced communication between providers. Conclusions Our study suggests additional modifications to smoking cessation support measures when e-cigarettes are used for smoking cessation to address the challenges posed by public health guidance: "smokers should switch to vaping and vapers should stop smoking completely". Innovation Our study is the first to consider experiences of service users and providers about the challenges of using e-cigarettes for cessation; our co-design group of providers informed nine strategies needed to support this approach in practice.
Collapse
Affiliation(s)
- Judith Dyson
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - James Skinner
- Faculty of Business, Law and Social Sciences, Birmingham City University, Birmingham, UK
| | - James Crick
- Hull Clinical Commissioning Group/Hull City Council, Hull, UK
| | - Michael G. Crooks
- Respiratory Research Group, Institute for Clinical and Applied Health Research, Hull York Medical School, Hull, UK
| |
Collapse
|
5
|
Onukwugha F, Dyson J, Howlett H, Combe K, Catterick M, Cohen J, Smith L. Reflections of maternity service users and midwives' on the co-creation of interventions to support midwives addressing alcohol during antenatal care. Patient Educ Couns 2023; 115:107896. [PMID: 37527593 DOI: 10.1016/j.pec.2023.107896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND There are divergent perspectives between midwives and pregnant women on how alcohol consumption during pregnancy could be addressed. Co-creation is an approach where lay people and professionals work together as equal partners, offering the opportunity to bridge the gap. OBJECTIVES Our aim was to evaluate how well we carried out authentic co-creation of an intervention to support midwives have a dialogue about alcohol consumption with pregnant women. PATIENT INVOLVEMENT Recent maternity service users including women with experience of harm due to alcohol during pregnancy provided feedback on the design, conduct and dissemination of the study. METHODS An iterative co-creation approach rooted in participatory research methods was used. Five online workshops were carried out with thirteen midwives and six maternity service users via Zoom July-August 2021. Data were analysed using the core values of co-create as a framework: equality, inclusivity, holistic, resource, positivity, transparency, iterative, and sustainability. RESULTS The co-creation process was productive and rewarding to midwives and maternity service users. There were positive experiences across the co-creation framework with some unintended positive consequences for maternity-service users. DISCUSSION This evaluation provides new knowledge on how well the co-creation process worked in relation to research involving a sensitive topic that can invite stigma. Co-creation projects require generous time and financial resources to ensure a high-quality process and robust outcome for all. PRACTICAL VALUE Co-creation of strategies involving both service providers and service users have potential to facilitate evidence-based practice. FUNDING This research is funded by the National Institute for Health Research (Reference: NIHR201128).
Collapse
Affiliation(s)
- F Onukwugha
- Institute for Clinical and Applied Health Research, University of Hull, Cottingham Road, Hull HU6 7X, UK
| | - J Dyson
- Faculty of Health, Education and Life Sciences, Birmingham City University, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK
| | - H Howlett
- NHS North East and North Cumbria, Parkhouse Building, Baron Way, Kingmoor Park, Carlisle, Cumbria, CA6 4SJ, UK
| | - K Combe
- Faculty of Health Sciences, University of Hull, Cottingham Road, Hull HU6 7RX, UK
| | - M Catterick
- FASD Network, Newtown Community Resource Centre, Stockton-on-Tees, UK
| | - J Cohen
- HYMS, University of Hull, Cottingham Road, Hull HU6 7X, UK
| | - L Smith
- Institute for Clinical and Applied Health Research, University of Hull, Cottingham Road, Hull HU6 7X, UK.
| |
Collapse
|
6
|
Cowdell F, Heague M, Dyson J. Barriers and facilitators to skin hygiene care and emollient use in residential care homes: Instrument design and survey. Int J Older People Nurs 2023:e12550. [PMID: 37246502 DOI: 10.1111/opn.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 04/21/2023] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND The older person care home population is increasing. As skin ages, it becomes vulnerable to dryness, itching, cracks and tears. These are experienced by most older people, they impair quality of life and can lead skin breakdown, increased dependency, hospital stays and greater financial and human costs. Dryness, itching, cracks and tears can be prevented, but despite best practice guidance, concordance is suboptimal. OBJECTIVES (i) develop and test a theory-based diagnostic instrument to accurately and prospectively assess barriers and facilitators and (ii) survey barriers and facilitators to care home staff in the delivery of skin hygiene care. METHODS Instrument development and survey. Barriers and facilitators identified from the literature and pilot study were categorised in a Delphi survey of experts (n = 8) to the Theoretical Domains Framework. This model was tested in three rounds for face validity (n = 38), construct validity (n = 235) and test-retest reliability (n = 11). Barriers and facilitators were surveyed in Round 2 and reported in accordance with TRIPOD. RESULTS A 29-item valid and reliable instrument (SHELL-CH) resulted (χ2/df = 1.539, RMSEA = 0.047, CFA = 0.872). Key barriers were delivering skin hygiene care to agitated or confused residents, pressure to rush or engage in other tasks from colleagues, being busy and the unrealistic expectations of relatives. Knowledge of skin hygiene care was a facilitator. CONCLUSION This study has international significance having identified barriers and facilitators to skin hygiene care including barriers previously unreported.
Collapse
Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Megan Heague
- School of Medicine, University of Leeds, Leeds, UK
| | - Judith Dyson
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| |
Collapse
|
7
|
Raju S, Cowdell F, Dyson J. A Systematic Review of Women's Experiences of Interventions to Prevent Excessive Gestational Weight Gain. Nurs Womens Health 2023; 27:211-219. [PMID: 37080250 DOI: 10.1016/j.nwh.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/14/2022] [Accepted: 03/08/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To synthesize research on women's experiences of interventions to prevent excessive gestational weight gain. DATA SOURCES A systematic search of the following databases was conducted: CINAHL Complete, Maternity and Infant Care Database, American Psychological Association PsycArticles, American Psychological Association PsycInfo, and MEDLINE. STUDY SELECTION Studies were included if they involved primary research regarding the experiences of women who were pregnant or up to 1 year postpartum when reflecting on their involvement in interventions to prevent excessive weight gain during pregnancy. Nonempirical studies and those that examined experiences of women who were not pregnant or who were beyond 1 year postpartum were excluded. DATA EXTRACTION Information was extracted and captured in a summary table that included the study aim, participants, study design, intervention, findings, and summary score, with exceptions to quality. DATA SYNTHESIS Data were synthesized thematically into three themes: (a) Intervention Qualities Valued by Women, (b) Challenges Faced by Women, and (c) Perceived Benefits and Recommendations for Modifications. CONCLUSION Interventions intended to help women prevent excessive gestational weight gain should be tailored to individuals' unique needs to ensure that the interventions are acceptable and effective.
Collapse
|
8
|
Dyson J, Onukwugha F, Howlett H, Combe K, Catterick M, Smith L. Midwives and service users' perspectives on implementing a dialogue about alcohol use in antenatal care: A qualitative study. J Adv Nurs 2023. [PMID: 36861792 DOI: 10.1111/jan.15622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/03/2023] [Accepted: 02/19/2023] [Indexed: 03/03/2023]
Abstract
AIM There are barriers to midwives engaging in conversations about alcohol with pregnant women. Our aim was to capture the views of midwives and service users to co-create strategies to address these barriers. DESIGN Qualitative description. METHODS Structured Zoom-based focus group interviews of midwives and service users where we presented known barriers and sought solutions to midwives discussing alcohol use in antenatal settings. Data collection took place between July and August 2021. RESULTS Fourteen midwives and six service users attended five focus groups. Barriers considered were as follows: (i) lack of awareness of guidelines, (ii) poor skills in difficult conversations, (iii) lack of confidence, (iv) lack of belief in existing evidence, (v) women would not listen to their advice, and (vi) alcohol conversations were not considered part of their role. Five strategies to address barriers to midwives discussing alcohol with pregnant women were identified. These were as follows: Training that included mothers of children with Foetal Alcohol Spectrum Disorder, champion midwives, a service user questionnaire about alcohol for completion before the consultation, questions about alcohol added to the maternity data capture template and a structured appraisal to provide a means of audit and feedback on their alcohol dialogue with women. CONCLUSIONS Co-creation involving providers and users of maternity services yielded theoretically underpinned pragmatic strategies to support midwives to ask advise assist about alcohol during antenatal care. Future research will test if the strategies can be delivered in antenatal care settings, and if they are acceptable to service providers and service users. IMPACT If these strategies are effective in addressing barriers to midwives discussing alcohol with pregnant women, this could support women to abstain from alcohol during pregnancy, thus reducing alcohol-related maternal and infant harm. PATIENT AND PUBLIC CONTRIBUTION Service users were involved in the design and execution of the study, considering data, supporting intervention design and delivery and dissemination.
Collapse
Affiliation(s)
- Judith Dyson
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Franklin Onukwugha
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Helen Howlett
- Department of Health and Life Sciences, Northumbria University, Coach Lane, Newcastle-upon-Tyne, UK
| | | | - Maria Catterick
- Foetal Alcohol Spectrum Disorder Network Newton Community resource Centre, Stockton on Tees, UK
| | - Lesley Smith
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| |
Collapse
|
9
|
Ataiyero Y, Dyson J, Graham M. The barriers and facilitators to hand hygiene practices in Nigeria: A qualitative study: "There are so many barriers ... the barriers are limitless.". Am J Infect Control 2023; 51:295-303. [PMID: 36804099 DOI: 10.1016/j.ajic.2022.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Health care associated infections (HCAIs) are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. This study aimed to understand barriers and facilitators to hand hygiene in a hospital in Nigeria. METHODS A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. RESULTS There were individual and institutional factors constituting barriers or facilitators: (1) knowledge, skills, and education, (2) perceived risks of infection to self and others, (3) memory, (4) the influence of others and (5) skin irritation. Institutional factors were (1) environment and resources and (2) workload and staffing levels. CONCLUSIONS Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed.
Collapse
Affiliation(s)
- Yetunde Ataiyero
- School of Nursing and Midwifery, University of Hull, Hull, United Kingdom.
| | - Judith Dyson
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, United Kingdom
| | - Moira Graham
- School of Nursing and Midwifery, University of Hull, Hull, United Kingdom
| |
Collapse
|
10
|
Dyson J, McCrorie C, Benn J, Richardson D, Marsh C, Bowskill G, Double K, Gallagher J, Faisal M, Mohammed MA. Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study. BMJ Open 2023; 13:e061298. [PMID: 36653055 PMCID: PMC9853152 DOI: 10.1136/bmjopen-2022-061298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19 status. Our aims were to implement the score with a small group of practitioners and understand their first-hand experience of interacting with the score in situ. DESIGN Pilot implementation evaluation study involving qualitative interviews. SETTING This study was conducted in one of the two National Health Service hospital trusts in the North of England in which the score was developed. PARTICIPANTS Medical, older person and ICU/anaesthetic consultants and specialist grade registrars (n=116) and critical outreach nurses (n=7) were given access to CARM. Nine interviews were conducted in total, with eight doctors and one critical care outreach nurse. INTERVENTIONS Participants were given access to the CARM score, visible after login to the patients' electronic record, along with information about the development and intended use of the score. RESULTS Four themes and 14 subthemes emerged from reflexive thematic analysis: (1) current use (including support or challenge clinical judgement and decision making, communicating risk of mortality and professional curiosity); (2) barriers and facilitators to use (including litigation, resource needs, perception of the evidence base, strengths and limitations), (3) implementation support needs (including roll-out and integration, access, training and education); and (4) recommendations for development (including presentation and functionality and potential additional data). Barriers and facilitators to use, and recommendations for development featured highly across most interviews. CONCLUSION Our in situ evaluation of the pilot implementation of CARM demonstrated its scope in supporting clinical decision making and communicating risk of mortality between clinical colleagues and with service users. It suggested to us barriers to implementation of the score. Our findings may support those seeking to develop, implement or improve the adoption of risk scores.
Collapse
Affiliation(s)
- Judith Dyson
- C-SCHaRR, Birmingham City University, Birmingham, UK
| | - Carolyn McCrorie
- School of Human and Health Sciences, University of Huddersfield, Bradford, West Yorkshire, UK
| | - Jonathan Benn
- HR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health Research, University of Leeds School of Psychology, Leeds, UK
| | - Donald Richardson
- Medical Department, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Claire Marsh
- School of Human and Health Sciences, University of Huddersfield, Bradford, West Yorkshire, UK
| | - Gill Bowskill
- Service User and Carer Research Group, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Keith Double
- Service User and Carer Research Group, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Jean Gallagher
- Service User and Carer Research Group, Faculty of Health Studies, University of Bradford, Bradford, UK
| | | | | |
Collapse
|
11
|
Mulligan KM, O'Connell KA, da Silva A, Szeto MD, Sivesind TE, Cowdell F, Dyson J, Dellavalle RP. From the Cochrane library: Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. J Am Acad Dermatol 2022; 87:1428-1431. [PMID: 35944812 DOI: 10.1016/j.jaad.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 11/19/2022]
Affiliation(s)
| | - Katie A O'Connell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexandra da Silva
- College of Medicine, California Northstate University, Elk Grove, California
| | - Mindy D Szeto
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Edgbaston, Birmingham, United Kingdom
| | - Judith Dyson
- Faculty of Health Education and Life Sciences, Birmingham City University, Edgbaston, Birmingham, United Kingdom
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| |
Collapse
|
12
|
White C, Bell J, Reid M, Dyson J. More than signposting: Findings from an evaluation of a social prescribing service. Health Soc Care Community 2022; 30:e5105-e5114. [PMID: 35915879 DOI: 10.1111/hsc.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/03/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
This paper presents findings from an evaluation of a social prescribing service, undertaken between January 2019 and December 2020. Data was collected through interviews and focus groups with a range of groups including social prescribing managers, link workers (LWs), referrers (GPs and social work practitioners), clients, Voluntary and Community Sector (VCS) agencies and groups. Thematic analysis of data was undertaken, and findings were presented in respect of clients' journeys into social prescribing; the support received from LWs; their onward journeys to VCS support. The findings highlight the challenges for individuals in contacting new agencies/groups and the importance of practitioner referral into and onwards from social prescribing, as well as buddying to support clients on initial agency visits. The depth of the LW role is highlighted, as well as the complexity of client circumstances, highlighting a need for 'more than signposting', and challenging the notion of self-referral as an indicator of motivation. Social prescribing has been positioned as amongst the solutions to the challenges of primary care. However, referrals from GPs were low and significantly outnumbered by those from social workers; this suggests a need to explore in greater depth the use of social prescribing by social workers, who have, to date, been absent from social prescribing research.
Collapse
Affiliation(s)
- Caroline White
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Jo Bell
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Marie Reid
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Judith Dyson
- Faculty of Health Sciences, University of Hull, Hull, UK
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
| |
Collapse
|
13
|
Heague M, Dyson J, Cowdell F. Barriers and facilitators to delivering everyday personal hygiene care in residential settings: A systematic review. J Clin Nurs 2022. [PMID: 35765172 DOI: 10.1111/jocn.16413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Globally, the population is ageing, and more people live in residential care. Best practice in personal hygiene care may reduce distressing and debilitating skin and oral problems and improve resident outcomes. Although there is guidance on personal hygiene care, implementation may be a challenge. AIM To identify barriers and facilitators to delivering personal hygiene care for older persons in residential care settings. METHODS Systematic review reported according to PRISMA 2020 guidance. Databases MEDLINE, CIHAHL and PsychINFO were systematically searched using terms and synonyms 'barriers', 'facilitators', 'hygiene', 'older adults' and 'residential care'. Only empirical studies, reporting everyday skin and oral care, in English, peer reviewed and published from 2000 to 2021 were included. Due to methodological heterogeneity, a narrative synthesis was conducted. RESULTS Sixteen papers yielded nine categories of barrier or facilitator. Five related to skin and oral care: (i) knowledge, (ii) skills relating to hygiene care, (iii) skills relating to supporting 'uncooperative' behaviours, (iv) lack of resources and (v) time, workload and staffing levels. The remainder related only to oral care: (vi) resident, family or carer motivation, (vii) dislike of hygiene care, (viii) carer attitudes and beliefs and (ix) social influences and communication. Six papers reported interventions to optimise care. CONCLUSION This review highlights the persistent dearth of research into everyday personal hygiene practices, in particular skin hygiene in residential care. Existing literature identifies a range of barriers; however, there is a mismatch between these and reported interventions to improve practice. RELEVANCE TO CLINICAL PRACTICE Advances in implementation science to support optimal care have yet to be applied to interventions to support hygiene practices in care homes and it is imperative this is addressed. Future interventions should involve: (i) systematically and theoretically assessing barriers, (ii) application of tailored behaviour change techniques (iii) using these co-design pragmatic, locally acceptable strategies.
Collapse
|
14
|
Smith D, Cartwright M, Dyson J, Hartin J, Aitken LM. Selecting intervention content to target barriers and enablers of recognition and response to deteriorating patients: an online nominal group study. BMC Health Serv Res 2022; 22:766. [PMID: 35689227 PMCID: PMC9186287 DOI: 10.1186/s12913-022-08128-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patients who deteriorate in hospital wards without appropriate recognition and/or response are at risk of increased morbidity and mortality. Track-and-trigger tools have been implemented internationally prompting healthcare practitioners (typically nursing staff) to recognise physiological changes (e.g. changes in blood pressure, heart rate) consistent with patient deterioration, and then to contact a practitioner with expertise in management of acute/critical illness. Despite some evidence these tools improve patient outcomes, their translation into clinical practice is inconsistent internationally. To drive greater guideline adherence in the use of the National Early Warning Score tool (a track-and-trigger tool used widely in the United Kingdom and parts of Europe), a theoretically informed implementation intervention was developed (targeting nursing staff) using the Theoretical Domains Framework (TDF) version 2 and a taxonomy of Behaviour Change Techniques (BCTs). Methods A three-stage process was followed: 1. TDF domains representing important barriers and enablers to target behaviours derived from earlier published empirical work were mapped to appropriate BCTs; 2. BCTs were shortlisted using consensus approaches within the research team; 3. shortlisted BCTs were presented to relevant stakeholders in two online group discussions where nominal group techniques were applied. Nominal group participants were healthcare leaders, senior clinicians, and ward-based nursing staff. Stakeholders individually generated concrete strategies for operationalising shortlisted BCTs (‘applications’) and privately ranked them according to acceptability and feasibility. Ranking data were used to drive decision-making about intervention content. Results Fifty BCTs (mapped in stage 1) were shortlisted to 14 (stage 2) and presented to stakeholders in nominal groups (stage 3) alongside example applications. Informed by ranking data from nominal groups, the intervention was populated with 12 BCTs that will be delivered face-to-face, to individuals and groups of nursing staff, through 18 applications. Conclusions A description of a theory-based behaviour change intervention is reported, populated with BCTs and applications generated and/or prioritised by stakeholders using replicable consensus methods. The feasibility of the proposed intervention should be tested in a clinical setting and the content of the intervention elaborated further to permit replication and evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08128-6.
Collapse
Affiliation(s)
- Duncan Smith
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK. .,Patient Emergency Response & Resuscitation Team (PERRT), University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK.
| | - Martin Cartwright
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Judith Dyson
- Reader in Implementation Science, Birmingham City University, Westbourne Road, Edgbaston, Birmingham, B15 3TN, UK
| | - Jillian Hartin
- Patient Emergency Response & Resuscitation Team (PERRT), University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK.,School of Nursing and Midwifery, Griffith University, Nathan, QLD, 4111, Australia
| |
Collapse
|
15
|
Dyson J, Bhatnagar M, Skinner J, Crooks M. Helping the quitters quit: A systematic review and narrative synthesis of the barriers and facilitators to e-cigarette cessation and the support that is needed. Patient Educ Couns 2022; 105:1402-1410. [PMID: 34579994 DOI: 10.1016/j.pec.2021.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the barriers and facilitators to and support needed for e-cigarette cessation. METHODS We systematically searched the subject-specific databases MEDLINE, CINAHL complete and psycINFO and the Cochrane database using synonyms relating to the terms e-cigarettes and cessation including English language, empirical, peer reviewed research papers, published from 2010 to 2021. We included papers that addressed the research question in its broadest sense, including papers reporting reasons for and interventions to support e-cigarette cessation. Data extraction was completed two authors independently using a bespoke spreadsheet. We conducted a narrative synthesis of all data and we were able to extract and combine descriptive quantitative data from included survey papers. RESULTS After reviewing 2593 titles 10 papers fit our criteria. Barriers to e-cigarette cessation were: a fear of returning to tobacco, dependency and stress reduction. Barriers or facilitators were: health and hazard beliefs, degree of enjoyment, social influences and environmental factors. A number of e-cigarette smoking support measures were suggested by participants. PRACTICE IMPLICATIONS E-cigarette cessation poses similar and additional challenges to that of tobacco cessation. E-cigarettes are not the final step on a journey to smoking cessation. Addressing barriers specific to e-cigarettes need to be considered in intervention design.
Collapse
Affiliation(s)
- Judith Dyson
- Social Care, Health and Related Research (C-SCHaRR) Birmingham City University, Westbourne Road, Edgbaston, Birmingham B15 3TN, United Kingdom.
| | | | - James Skinner
- School of Sociology, Politics and International Studies (SPAIS), University of Bristol, Bristol, United Kingdom
| | - Michael Crooks
- Respiratory Research Group, Institute for Clinical and Applied Health Research, Hull York Medical school, Hull HU16 5JQ, United Kingdom
| |
Collapse
|
16
|
Bravington A, Chen H, Dyson J, Jones L, Dalgliesh C, Bryan A, Patnick J, Macleod U. Translating qualitative data into intervention content using the Theoretical Domains Framework and stakeholder co-design: a worked example from a study of cervical screening attendance in older women. BMC Health Serv Res 2022; 22:610. [PMID: 35524217 PMCID: PMC9074234 DOI: 10.1186/s12913-022-07926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Previous screening interventions have demonstrated a series of features related to social determinants which have increased uptake in targeted populations, including the assessment of health beliefs and barriers to screening attendance as part of intervention development. Many studies cite the use of theory to identify methods of behaviour change, but fail to describe in detail how theoretical constructs are transformed into intervention content. The aim of this study was to use data from a qualitative exploration of cervical screening in women over 50 in the UK as the basis of intervention co-design with stakeholders using behavioural change frameworks. We describe the identification of behavioural mechanisms from qualitative data, and how these were used to develop content for a service-user leaflet and a video animation for practitioner training. The interventions aimed to encourage sustained commitment to cervical screening among women over 50, and to increase sensitivity to age-related problems in screening among primary care practitioners. Methods Secondary coding of a qualitative data set to extract barriers and facilitators of cervical screening attendance. Barrier and facilitator statements were categorised using the Theoretical Domains Framework (TDF) to identify relevant behaviour change techniques (BCTs). Key TDF domains and associated BCTs were presented in stakeholder focus groups to guide the design of intervention content and mode of delivery. Results Behavioural determinants relating to attendance clustered under three domains: beliefs about consequences, emotion and social influences, which mapped to three BCTs respectively: (1) persuasive communication/information provision; (2) stress management; (3) role modelling and encouragement. Service-user stakeholders translated these into three pragmatic intervention components: (i) addressing unanswered questions, (ii) problem-solving practitioner challenges and (iii) peer group communication. Based on (ii), practitioner stakeholders developed a call to action in three areas – clinical networking, history-taking, and flexibility in screening processes. APEASE informed modes of delivery (a service-user leaflet and a cartoon animation for practitioners). Conclusion The application of the TDF to qualitative data can provide an auditable protocol for the translation of qualitative data into intervention content. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07926-2.
Collapse
Affiliation(s)
- Alison Bravington
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK.
| | - Hong Chen
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Judith Dyson
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
| | - Lesley Jones
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | | | | | - Julietta Patnick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| |
Collapse
|
17
|
Pape S, Snijders RJALM, Gevers TJG, Chazouilleres O, Dalekos GN, Hirschfield GM, Lenzi M, Trauner M, Manns MP, Vierling JM, Montano-Loza AJ, Lohse AW, Schramm C, Drenth JPH, Heneghan MA, Alvarez F, Andrade R, Arikan C, Assis D, Bardou-Jacquet E, Biewenga M, Cancado E, Cazzagon N, Chazouillères O, Colloredo G, Cuarterolo M, Dalekos G, Debray D, Robles-Díaz M, Drenth J, Dyson J, Efe C, Engel B, Ferri S, Fontana R, Gatselis N, Gerussi A, Halilbasic E, Halliday N, Heneghan M, Hirschfield G, van Hoek B, Hørby Jørgensen M, Indolfini G, Iorio R, Jeong S, Jones D, Kelly D, Kerkar N, Lacaille F, Lammert C, Leggett B, Lenzi M, Levy C, Liberal R, Lleo A, Lohse A, Ines Lopez S, de Martin E, McLin V, Mieli-Vergani G, Milkiewicz P, Mohan N, Muratori L, Nebbia G, van Nieuwkerk C, Oo Y, Ortega A, Páres A, Pop T, Pratt D, Purnak T, Ranucci G, Rushbrook S, Schramm C, Stättermayer A, Swain M, Tanaka A, Taubert R, Terrabuio D, Terziroli B, Trauner M, Valentino P, van den Brand F, Villamil A, Wahlin S, Ytting H, Zachou K, Zeniya M. Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group. J Hepatol 2022; 76:841-849. [PMID: 35066089 DOI: 10.1016/j.jhep.2021.12.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/18/2021] [Accepted: 12/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Autoimmune hepatitis (AIH) has been well characterised and codified through the development of diagnostic criteria. These criteria have been adapted and simplified and are widely used in clinical practice. However, there is a need to update and precisely define the criteria for both treatment response and treatment. METHODS A systematic review was performed and a modified Delphi consensus process was used to identify and redefine the response criteria in autoimmune hepatitis. RESULTS The consensus process initiated by the International Autoimmune Hepatitis Group proposes that the term 'complete biochemical response' defined as 'normalization of serum transaminases and IgG below the upper limit of normal' be adopted to include a time point at 6 months after initiation of treatment. An insufficient response by 6 months was a failure to meet the above definition. Non-response was defined as '<50% decrease of serum transaminases within 4 weeks after initiation of treatment'. Remission is defined as liver histology with a Hepatitis Activity Index <4/18. Intolerance to treatment was agreed to stand for 'any adverse event possibly related to treatment leading to potential drug discontinuation'. CONCLUSIONS These definitions provide a simple and reproducible framework to define treatment response and non-response, irrespective of the therapeutic intervention. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable inter-study comparisons. Future prospective database studies are needed to validate these endpoints. LAY SUMMARY Consensus among international experts on response criteria and endpoints in autoimmune hepatitis is lacking. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable the comparison of results between clinical trials. Therefore, the International Autoimmune Hepatitis Group (IAIHG) herein presents a statement on 5 agreed response criteria and endpoints: complete biochemical response, insufficient response, non-response, remission, and intolerance to treatment, which can be used to guide future reporting.
Collapse
Affiliation(s)
- Simon Pape
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Romée J A L M Snijders
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Tom J G Gevers
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht 6229HX, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Oliver Chazouilleres
- Hepatology Department, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, Saint-Antoine Hospital Assistance Publique-Hôpitaux de Paris, Paris, France; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University of Thessaly Medical School, Larissa, Greece
| | - Gideon M Hirschfield
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Marco Lenzi
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - John M Vierling
- Departments of Medicine and Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Hepatology, University of Alberta Hospital, Edmonton, Canada
| | - Ansgar W Lohse
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Christoph Schramm
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Ataiyero Y, Dyson J, Graham M. An observational study of hand hygiene compliance of surgical healthcare workers in a Nigerian teaching hospital. J Infect Prev 2022; 23:59-66. [PMID: 35340923 PMCID: PMC8941592 DOI: 10.1177/17571774211066774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patients sometimes contract healthcare associated infections (HCAI) which are unrelated to their primary reasons for hospital admission. Surgical site infections are the most investigated and most recurrent type of HCAI in developing countries, affecting up to one-third of surgical patients. Objective This study aimed to assess and offer context to the hand hygiene resources available in a Nigerian teaching hospital through ward infrastructure survey, and to determine the hand hygiene compliance rate among surgical healthcare workers (HCWs) in a Nigerian teaching hospital through hand hygiene observations. Methods Ward infrastructure survey was conducted in the two adult surgical wards of the hospital using the World Health Organisation (WHO) hand hygiene ward infrastructure survey form. Hand hygiene observations were monitored over seven days in the surgical wards using a modified WHO hand hygiene observation form. Results Hand hygiene resources were insufficient, below the WHO recommended minimum standards. Seven hundred hand hygiene opportunities were captured. Using SPSS version 24.0, we conducted a descriptive analysis of audit results, and results were presented according to professional group, seniority and hand hygiene opportunities of the participants. Overall hand hygiene compliance was 29.1% and compliance was less than 40% across the three professional groups of doctors, nurses and healthcare assistants. Conclusion Hand hygiene compliance rates of the surgical HCWs are comparable to those in other Sub-Saharan African countries as well as in developed countries.
Collapse
Affiliation(s)
- Yetunde Ataiyero
- School of Health, Science and Wellbeing,
Staffordshire University, Stafford, UK,Yetunde Ataiyero, School of Health, Science and
Wellbeing, Staffordshire University, Stafford, UK
| | - Judith Dyson
- School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Moira Graham
- Faculty of Health Sciences, University of Hull, Hull, UK
| |
Collapse
|
19
|
Cowdell F, Dyson J, Sykes M, Dam R, Pendleton R. How and how well have older people been engaged in healthcare intervention design, development or delivery using co-methodologies: A scoping review with narrative summary. Health Soc Care Community 2022; 30:776-798. [PMID: 33103313 DOI: 10.1111/hsc.13199] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/17/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
Co-methodological working is gaining increasing traction in healthcare, but studies with older people have been slower to develop. Our aim was to investigate how and how well older people have been engaged in healthcare intervention design, development or delivery using co-methodologies. We conducted a systematic search of four electronic databases to identify international literature published between 2009 and November 2019. We included peer-reviewed empirical research of any design. Three authors screened papers. Our review is reported in accordance with the Joanna Briggs Institute manual for scoping reviews, we have referred to the preferred reporting items for systematic reviews and meta-analyses statement. We data extracted to a bespoke spreadsheet and used the Co:Create Co-production Matrix to guide quality appraisal. Included studies (n = 48) were diverse in nature of interventions, co-methodologies and reporting. We offer a narrative summary of included papers. Establishing how older people were engaged in co-methodological work was largely straightforward. How well this was done was more challenging, however we have identified gems of good practice and offered directions for future practice. The Co:Create Co-Production Matrix was the best fit for evaluating papers, however it is not intended as a measure per se. In essence we argue that notions of 'best' and 'scores' are an oxymoron in co-methodological working, what is important that: (a) researchers embrace these methods, (b) incremental change is the way forward, (c) researchers need to do what is right for people and purpose and (d) have time to consider and articulate why they are choosing this approach and how best this can be achieved for their particular situation. Future evaluation of participant's experience of the process would enable others to learn about what works for who and in what circumstances.
Collapse
Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Judith Dyson
- School of Health Sciences, City University, London, UK
| | - Michael Sykes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rinita Dam
- Department of Zoology, University of Oxford, Oxford, UK
| | | |
Collapse
|
20
|
Popoola M, Dingle M, MacLaren J, Dyson J. What are the barriers to nurses mobilising adult patients in intensive care units? An integrative review. Aust Crit Care 2021; 35:595-603. [PMID: 34756801 DOI: 10.1016/j.aucc.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/08/2021] [Accepted: 09/05/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES There is a need for early mobilisation of patients in intensive care units to prevent acquired weaknesses which can have a long-term impact on health and quality of life. This need is not always fulfilled. We therefore sought to conduct an integrative review of international evidence to answer the question: What are the barriers to nurses mobilising adult patients in intensive care units? REVIEW METHOD USED We conducted a systematic search and thematic analysis. We were able to present a descriptive quantitative synthesis of the survey articles included. DATA SOURCES We searched CINAHL, MEDLINE, and PsycINFO databases between and including 2010 and 2020 using search terms synonymous with "intensive care unit" and "nurse" and "early mobilisation" and "barrier using Boolean operators" and "truncation". We completed backwards and forwards citation searches on included studies. RESULTS We included seven articles which we synthesised into three themes and 13 subthemes as follows: (i) organisational barriers (subthemes were staffing levels, time and workload, resources, and care coordination), (ii) individual barriers (subthemes were self and team safety, knowledge and training, beliefs about the consequences of early mobilisation, stress, and other barriers), and (iii) patient-related barriers (subthemes were medical instability/physical status, patient safety, neurological deficits and sedation, and nonconcordance of patients). CONCLUSION Nurses' barriers were wide ranging, and interventions to improve concordance with early mobilisation need to be tailored to address this group's specific barriers.
Collapse
Affiliation(s)
| | - Maria Dingle
- City, University of London, Northampton Square, London, EC1V 0HB, UK.
| | - Julie MacLaren
- City, University of London, Northampton Square, London, EC1V 0HB, UK.
| | - Judith Dyson
- Birmingham City University, Westbourne Road, Edgbaston, Birmingham, B15 3TN, UK.
| |
Collapse
|
21
|
Tomlinson J, Marques I, Silcock J, Fylan B, Dyson J. Supporting medicines management for older people at care transitions - a theory-based analysis of a systematic review of 24 interventions. BMC Health Serv Res 2021; 21:890. [PMID: 34461892 PMCID: PMC8404335 DOI: 10.1186/s12913-021-06890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Older patients are at severe risk of harm from medicines following a hospital to home transition. Interventions aiming to support successful care transitions by improving medicines management have been implemented. This study aimed to explore which behavioural constructs have previously been targeted by interventions, which individual behaviour change techniques have been included, and which are yet to be trialled. METHOD This study mapped the behaviour change techniques used in 24 randomised controlled trials to the Behaviour Change Technique Taxonomy. Once elicited, techniques were further mapped to the Theoretical Domains Framework to explore which determinants of behaviour change had been targeted, and what gaps, if any existed. RESULTS Common behaviour change techniques used were: goals and planning; feedback and monitoring; social support; instruction on behaviour performance; and prompts/cues. These may be valuable when combined in a complex intervention. Interventions mostly mapped to between eight and 10 domains of the Theoretical Domains Framework. Environmental context and resources was an underrepresented domain, which should be considered within future interventions. CONCLUSION This study has identified behaviour change techniques that could be valuable when combined within a complex intervention aiming to support post-discharge medicines management for older people. Whilst many interventions mapped to eight or more determinants of behaviour change, as identified within the Theoretical Domains Framework, careful assessment of the barriers to behaviour change should be conducted prior to intervention design to ensure all appropriate domains are targeted.
Collapse
Affiliation(s)
- Justine Tomlinson
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Iuri Marques
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Jonathan Silcock
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Beth Fylan
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Judith Dyson
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| |
Collapse
|
22
|
Dyson J, Cowdell F. How is the Theoretical Domains Framework applied in designing interventions to support healthcare practitioner behaviour change? A systematic review. Int J Qual Health Care 2021; 33:6324052. [PMID: 34279637 DOI: 10.1093/intqhc/mzab106] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/21/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The use of theory is recommended to support interventions to promote implementation of evidence-based practices. However, there are multiple models of behaviour change which can be complex and lack comprehensiveness and are therefore difficult to understand and operationalize. The Theoretical Domains Framework sought to address these problems by synthesizing 33 models of behaviour or behaviour change. Given that it is 15 years since the first publication of the Theoretical Domains Framework (TDF), it is timely to reflect on how the framework has been applied in practice. OBJECTIVE The objective of this review is to identify and narratively synthesize papers in which the TDF, (including frameworks that incorporate the TDF) have been used have been used to develop implementation interventions. METHODS We searched MEDLINE, PsychINFO, CINAHL and the Cochrane databases using the terms: 'theoretical domains framework*' or TDF or Capability, Opportunity, Motivation to Behaviour (COM-B) or 'behav* change wheel' or 'BCW' AND implement* or improv* or quality or guideline* or intervention* or practice* or EBP or 'evidence based practice' and conducted citation and key author searches. The included papers were those that used any version of the TDF published from 2005 onwards. The included papers were subject to narrative synthesis. RESULTS A total of 3540 papers were identified and 60 were included. Thirty-two papers reported intervention design only and 28 reported intervention design and testing. Despite over 3000 citations there has been limited application to the point of designing interventions to support the best practice. In particular use of the framework has not been tried or tested in non-western countries and barely used in non-primary or acute care settings. Authors have applied the framework to assess barriers and facilitators successfully but reporting of the process of selection of behaviour change techniques and intervention design thereafter was variable. CONCLUSION Despite over three thousand citations of the framework there has been limited application to the point of designing interventions to support best practice. The framework is barely used in non-western countries or beyond primary or acute care settings. A stated purpose of the framework was to make psychological theory accessible to researchers and practitioners alike; if this is to be fully achieved, further guidance is needed on the application of the framework beyond the point of assessment of barriers and facilitators.
Collapse
Affiliation(s)
- Judith Dyson
- Healthcare Research and Implementation Science, Faculty of Health, Education and Life Sciences, Birmingham City University, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK
| | - Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Nursing and Healthcare Research, Birmingham City University, Westbourne Road, Birmingham B15 3TN, UK
| |
Collapse
|
23
|
Schölin L, Watson J, Dyson J, Smith LA. Midwives' views on alcohol guidelines: A qualitative study of barriers and facilitators to implementation in UK antenatal care. Sex Reprod Healthc 2021; 29:100628. [PMID: 33946025 DOI: 10.1016/j.srhc.2021.100628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Midwives play an important role in health promotion and prevention of alcohol-related harm, but previous research has suggested that although most midwives report advising on abstinence, evidence exist that women are informed that "some" alcohol is not harmful. The aim of this qualitative study was to explore midwives' views on implementation of the 2016 Chief Medical Officers' alcohol guidelines in antenatal care in the UK. METHODS Focus groups and individual interviews with 22 midwives working in maternity and educational settings in the UK were conducted either in person or over telephone. Data were subjected to thematic analysis. RESULTS Conflict between guidelines from different sources and lack of knowledge of the abstinence advice issued in the Guidelines were barriers to discussing abstinence. Communication with women and building relationships were key facilitators supporting alcohol discussions. How alcohol was addressed appeared to vary across the UK with no uniform approach. Building a trusted relationship was believed to be the way in which women can disclose alcohol use, though the first antenatal contact was not always viewed as the best time to discuss what was considered a personal matter. CONCLUSION Despite the release of new guidance in 2016, there was little recognition and awareness of these among midwives. Midwives were by default guided by other national clinical sources or guidelines. Future research should explore how practice-based interventions can address systemic and interpersonal factors to support health professionals to implement the Guidelines, and ensure that women are provided support to change unhealthy behaviours.
Collapse
Affiliation(s)
- Lisa Schölin
- Nursing Studies, School of Health in Social Science, Old Medical School, University of Edinburgh, Teviot Place, EH9 8AG Edinburgh, United Kingdom.
| | - Julie Watson
- Department of Midwifery and Child, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, United Kingdom
| | - Judith Dyson
- Institute of Clinical Applied Health Research, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, United Kingdom
| | - Lesley A Smith
- Institute of Clinical Applied Health Research, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, United Kingdom
| |
Collapse
|
24
|
Tomlinson J, Silcock J, Fylan B, Smith H, Karban K, Dyson J. Identifying behaviour change techniques to support medicines management for older people at care transitions. International Journal of Pharmacy Practice 2021. [DOI: 10.1093/ijpp/riab016.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Older patients are at significant risk of medicines-related harm following a hospital to home transition [1]. Strategies, such as information transfer and medicines reconciliation, have been suggested to promote successful transitions through better medicines management [2]. These interventions, however, are not often underpinned by patient experience or grounded in theory, and therefore have variable effects in real-world contexts.
Aim
To identify which behaviour change techniques (BCTs) could be combined within a complex intervention to support post-discharge medicines management.
Methods
Barriers and facilitators to post-discharge medicines management behaviours were identified from an analysis of interviews with twenty-seven older people (aged 75 years plus) and mapped to the Theoretical Domains Framework (TDF). These participants were recruited during a stay in two large hospitals in the North of England. All potential BCTs targeting the identified TDF domains were found using validated mapping exercises and refined by panel consensus. The panel consisted of two pharmacists, two health services researchers, a social work academic and a patient representative. Next, a convenience sample of key stakeholders (n=40; patients and family carers, healthcare professionals and researchers) were invited to take part in an online survey to prioritise remaining techniques. A total score for each BCT was calculated based on its potential i) effectiveness, ii) acceptability and iii) ability to cause unintended consequences. The BCTs were ranked from lowest to highest scores. As validation, the final selection of BCTs was assessed using the APEASE criteria and mapped back to the behavioural determinants to check the components would enhance facilitators and overcome barriers (Figure 1).
Results
Forty-six behavioural determinants were identified within interviews and classified as barriers (n=19), facilitators (n=10), or both (n=17). These were deductively mapped onto 11 domains of the TDF. Following the mapping, 50 discrete BCTs were identified, which were reduced to 35 after subsequent consensus discussions between panel members to remove any deemed inappropriate. The survey resulted in 25 responses (62.5% response rate). Following visual inspection of the ranking, a natural cut-off was identified by panel consensus at 88% of the total score. This, and further assessment using the APEASE criteria, prioritised eight BCTs that were highly rated to be effective in promoting post-discharge medicines management when combined within a complex intervention. These were: practical social support, goal/ target specified, prompts, triggers or cues, social processes of encouragement, motivational interviewing, rehearsal, review goals, and comparative imagining of future outcomes.
Conclusion
This study has identified eight BCTs that could be valuable when combined within a complex intervention to support post-discharge medicines management for older people. Consensus allowed prioritisation of BCTs that were likely to be effective, acceptable to older people, practical and cost-effective to deliver within current healthcare organisations. Limitations included challenges of coding complex behavioural determinants to the TDF, defining the BCTs within the medicines management context and modest survey sample size. To overcome these limitations, input was sought from a health psychologist with expertise and consensus involved all relevant stakeholders.
References
1. Parekh, N., Ali, K., Stevenson, J. M., et al. Incidence and cost of medication harm in older adults following hospital discharge: a multicentre prospective study in the UK. British journal of clinical pharmacology 2018;84(8):1789–1797.
2. Tomlinson, J., Cheong, V., Fylan, B., et al. Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity. Age and Ageing 2020;00:1–12.
Collapse
Affiliation(s)
- J Tomlinson
- School of Pharmacy and Medical Sciences, University of Bradford, UK
- Medicines Management and Pharmacy Services, St James’ Hospital, Leeds Teaching Hospitals NHS Trust, UK
| | - J Silcock
- School of Pharmacy and Medical Sciences, University of Bradford, UK
| | - B Fylan
- School of Pharmacy and Medical Sciences, University of Bradford, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - H Smith
- Medicines Management and Pharmacy Services, St James’ Hospital, Leeds Teaching Hospitals NHS Trust, UK
| | - K Karban
- Faculty of Life Sciences, University of Bradford, UK
| | - J Dyson
- School of Health Sciences, City, University of London, UK
| |
Collapse
|
25
|
Smith D, Cartwright M, Dyson J, Hartin J, Aitken LM. Barriers and enablers of recognition and response to deteriorating patients in the acute hospital setting: A theory-driven interview study using the Theoretical Domains Framework. J Adv Nurs 2021; 77:2831-2844. [PMID: 33739478 DOI: 10.1111/jan.14830] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/02/2021] [Accepted: 03/05/2021] [Indexed: 12/01/2022]
Abstract
AIM To explore barriers and enablers of recognition and response to signs of patient deterioration by nursing staff in an acute hospital. DESIGN A theory-driven interview study underpinned by the Theoretical Domains Framework of behaviour change. METHODS Between 07/01/2019 and 18/12/2019 a purposive sample of registered nurses and healthcare assistants was recruited to participate in a semi-structured (audio-recorded) interview, to explore the determinants of seven specified behaviours of the afferent limb. Anonymised transcripts were deductively coded (using the 14 Theoretical Domains Framework domains as coding categories) and then extracts within each domain were inductively analysed to synthesise belief statements and themes. Prioritisation criteria from published literature were applied. RESULTS Thirty-two semi-structured interviews were conducted. From 1,888 quotes, 184 belief statements and 66 themes were synthesised. One hundred and forty-six belief statements, represented by 58 themes, met prioritisation criteria. Nine domains of the Theoretical Domains Framework were of high importance: Knowledge; Social, Professional Role and Identity; Beliefs about Consequences; Reinforcement; Intentions; Goals; Memory, Attention and Decision Processes; Environment, Context and Resources and Social Influences. CONCLUSIONS Barriers and enablers most likely to impact on nursing staff afferent limb behaviour were identified in nine domains of the Theoretical Domains Framework.
Collapse
Affiliation(s)
- Duncan Smith
- School of Health Sciences, City University of London, London, UK.,Patient Emergency Response & Resuscitation Team (PERRT), University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Judith Dyson
- School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Jillian Hartin
- Patient Emergency Response & Resuscitation Team (PERRT), University College London Hospitals NHS Foundation Trust, London, UK
| | - Leanne M Aitken
- School of Health Sciences, City University of London, London, UK.,School of Nursing and Midwifery, Griffith University, Nathan, Qld., Australia
| |
Collapse
|
26
|
Smith LA, Dyson J, Watson J, Schölin L. Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives. BMC Pregnancy Childbirth 2021; 21:134. [PMID: 33588774 PMCID: PMC7885406 DOI: 10.1186/s12884-021-03583-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background In 2016, the UK Chief Medical Officers revised their guidance on alcohol and advised women to abstain from alcohol if pregnant or planning pregnancy. Midwives have a key role in advising women about alcohol during pregnancy. The aim of this study was to investigate UK midwives’ practices regarding the 2016 Chief Medical Officers Alcohol Guidelines for pregnancy, and factors influencing their implementation during antenatal appointments. Methods Online cross-sectional survey of a convenience sample of UK midwives recruited through professional networks and social media. Data were gathered using an anonymous online questionnaire addressing knowledge of the 2016 Alcohol Guidelines for pregnancy; practice behaviours regarding alcohol assessment and advice; and questions based on the Theoretical Domains Framework (TDF) to evaluate implementation of advising abstinence at antenatal booking and subsequent antenatal appointments. Results Of 842 questionnaire respondents, 58% were aware of the 2016 Alcohol Guidelines of whom 91% (438) cited abstinence was recommended, although 19% (93) cited recommendations from previous guidelines. Nonetheless, 97% of 842 midwives always or usually advised women to abstain from alcohol at the booking appointment, and 38% at subsequent antenatal appointments. Mean TDF domain scores (range 1–7) for advising abstinence at subsequent appointments were highest (indicative of barriers) for social influences (3.65 sd 0.84), beliefs about consequences (3.16 sd 1.13) and beliefs about capabilities (3.03 sd 073); and lowest (indicative of facilitators) for knowledge (1.35 sd 0.73) and professional role and identity (1.46 sd 0.77). Logistic regression analysis indicated that the TDF domains: beliefs about capabilities (OR = 0.71, 95% CI: 0.57, 0.88), emotion (OR = 0.78; 95%CI: 0.67, 0.90), and professional role and identity (OR = 0.69, 95%CI 0.51, 0.95) were strong predictors of midwives advising all women to abstain from alcohol at appointments other than at booking. Conclusions Our results suggest that skill development and reinforcement of support from colleagues and the wider maternity system could support midwives’ implementation of alcohol advice at each antenatal appointment, not just at booking could lead to improved outcomes for women and infants. Implementation of alcohol care pathways in maternity settings are beneficial from a lifecourse perspective for women, children, families, and the wider community. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03583-1.
Collapse
Affiliation(s)
- Lesley A Smith
- Institute of Clinical and Applied Health Research, Faculty of Health Sciences, University of Hull, Cottingham Road, Hull, HU6 7RX, UK.
| | - Judith Dyson
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Julie Watson
- Care Quality Commission, Citygate, Gallowgate, Newcastle Upon Tyne, NE1 4PA, UK
| | - Lisa Schölin
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| |
Collapse
|
27
|
Glover L, Dyson J, Cowdell F, Kinsey D. Healthy ageing in a deprived northern UK city: A co-creation study. Health Soc Care Community 2020; 28:2233-2242. [PMID: 32445280 DOI: 10.1111/hsc.13036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/18/2020] [Accepted: 04/29/2020] [Indexed: 06/11/2023]
Abstract
With ageing comes an increased risk of poor health and social isolation, particularly in poorer populations. Older people are under-represented in research and as a result interventions may not take account of their context or barriers to participation. In co-creative work, future service users work with professionals on an equal basis to design, develop and produce a service or intervention. Our objectives were to (a) undertake a co-creation study with older people living in a northern city in the United Kingdom, (b) explore maintenance of health and well-being in older age, (c) explore the application of co-creation with an older community population and (d) evaluate the process and inform future work. The study was conducted during 2017 by a project team of 10 lay community dwelling older people and four university researchers. Findings demonstrate that state of mind and of health were key to well-being in older age. Feeling safe, comfortable and pain free were important along with being able to adapt to change, have choice and a sense of personal freedom. Social connectedness was seen as the keystone to support healthy behaviours. Rather than developing new interventions, there was a perceived need to connect people with existing resources and provide a human 'bridge' to address barriers to accessing these. In conclusion, the co-creation process proved productive, even when undertaken on a small scale. The scope of the project needs to be realistic, to use diverse methods of recruitment and skilled facilitators, and to prepare well in terms of accessibility, simple systems and appropriate information provision.
Collapse
Affiliation(s)
- Lesley Glover
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Judith Dyson
- School of Health Sciences, City, University of London, London, UK
| | - Fiona Cowdell
- School of Nursing and Midwifery, Birmingham City University, Birmingham, UK
| | - Debbie Kinsey
- College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
28
|
Credland N, Dyson J, Johnson MJ. Do early warning track and trigger tools improve patient outcomes? A systematic synthesis without meta-analysis. J Adv Nurs 2020; 77:622-634. [PMID: 33128308 DOI: 10.1111/jan.14619] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 09/08/2020] [Accepted: 10/06/2020] [Indexed: 12/23/2022]
Abstract
AIM To determine the effect of Early Warning Track and Trigger Tools on patient outcomes. DESIGN A systematic review: synthesis without meta-analysis. DATA SOURCES Electronic databases were searched from 1 January 2013-1 August 2018 and 221 papers identified. REVIEW METHODS A systematic review and narrative synthesis supported the identification of synthesized findings named and reported according to outcome measure. RESULTS Five international papers representing over 74,000 patients were included in the analysis. Seven key findings were identified, the impact of NEWS on: (a) cardiopulmonary arrest; (b) mortality; (c) serious adverse events; (d) length of hospital stay; (e) hospital admissions; (f) observation frequency; and (g) Intensive/High dependency Unit admission. Papers identified statistically significant improvements in mortality, serious adverse events, hospital admissions, observation frequency, and intensive care unit/high dependency unit admission when an Early Warning Track and Trigger protocol is in use. There were conflicting results regarding length of stay and cardiopulmonary arrest data. CONCLUSION Early Warning Track and Trigger Tools can aid recognition of deteriorating patients. Further research is required in relation to hospital length of stay and cardiopulmonary arrests. IMPACT Early warning track and trigger tools have been implemented nationally and to a lesser degree internationally. There is evidence to suggest improved clinical outcomes following their use. Further research needs to combine the use of the National Early Warning Score with an agreed set of measured outcomes, and then subsequent study data could be combined to provide much stronger levels of evidence.
Collapse
Affiliation(s)
- Nicola Credland
- Faculty of Health Sciences, School of Health and Social Work, The University of Hull, Hull, UK
| | - Judith Dyson
- City University of London, Northampton Square, London, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| |
Collapse
|
29
|
Smith D, Cartwright M, Dyson J, Hartin J, Aitken LM. Patterns of behaviour in nursing staff actioning the afferent limb of the rapid response system (RRS): A focused ethnography. J Adv Nurs 2020; 76:3548-3562. [PMID: 32996620 DOI: 10.1111/jan.14551] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022]
Abstract
AIM To improve understanding of afferent limb behaviour in acute hospital ward settings, to define and specify who needs to do what differently and to report what afferent limb behaviours should be targeted in a subsequent multi-phase, theory-based, intervention development process. DESIGN Focused ethnography was used including direct observation of nursing staff enacting afferent limb behaviours and review of vital signs charts. METHODS An observation guide focused observation on "key moments" of the afferent limb. Descriptions of observations from between 7 January 2019-18 December 2019 were recorded in a field journal alongside reflexive notes. Vital signs and early warning scores from charts were reviewed and recorded. Field notes were analysed using structured content analysis. Observed behaviour was compared with expected (policy-specified) behaviour. RESULTS Observation was conducted for 300 hr. Four hundred and ninety-nine items of data (e.g., an episode of observation or a set of vital signs) were collected. Two hundred and eighty-nine (58%) items of data were associated with expected (i.e. policy-specified) afferent limb behaviour; 210 (42%) items of data were associated with unexpected afferent limb behaviour (i.e. alternative behaviour or no behaviour). Ten specific behaviours were identified where the behaviour observed deviated (negatively) from policy or where no action was taken when it should have been. One further behaviour was seen to expedite the assessment of a deteriorating patient by an appropriate responder and was therefore considered a positive deviance. CONCLUSION Afferent limb failure has been described as a problem of inconsistent staff behaviour. Eleven potential target behaviours for change are reported and specified using a published framework. IMPACT Clear specification of target behaviour will allow further enquiry into the determinants of these behaviours and the development of a theory-based intervention that is more likely to result in behaviour change and can be tested empirically in future research.
Collapse
Affiliation(s)
- Duncan Smith
- School of Health Sciences, City University of London, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Judith Dyson
- School of Health Sciences, City University of London, London, UK
| | - Jillian Hartin
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Leanne M Aitken
- School of Health Sciences, City University of London, London, UK.,School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| |
Collapse
|
30
|
Cowdell F, Jadotte YT, Ersser SJ, Danby S, Lawton S, Roberts A, Dyson J. Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. Cochrane Database Syst Rev 2020; 1:CD011377. [PMID: 32006460 PMCID: PMC6996088 DOI: 10.1002/14651858.cd011377.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ageing has a degenerative effect on the skin, leaving it more vulnerable to damage. Hygiene and emollient interventions may help maintain skin integrity in older people in hospital and residential care settings; however, at present, most care is based on "tried and tested" practice, rather than on evidence. OBJECTIVES To assess the effects of hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. SEARCH METHODS We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL, up to January 2019. We also searched five trials registers. SELECTION CRITERIA Randomised controlled trials comparing hygiene and emollient interventions versus placebo, no intervention, or standard practices for older people aged ≥ 60 years in hospital or residential care settings. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. Primary outcomes were frequency of skin damage, for example, complete loss of integrity (tears or ulceration) or partial loss of integrity (fissuring), and side effects. Secondary outcomes included transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema, and clinical scores of dryness or itch. We used GRADE to assess the quality of evidence. MAIN RESULTS We included six trials involving 1598 residential care home residents; no included trial had a hospital setting. Most participants had a mean age of 80+ years; when specified, more women were recruited than men. Two studies included only people with diagnosed dry skin. Studies were conducted in Asia, Australasia, Europe, and North America. A range of hygiene and emollient interventions were assessed: a moisturising soap bar; combinations of water soak, oil soak, and lotion; regular application of a commercially available moisturiser; use of two different standardised skin care regimens comprising a body wash and leave-on body lotion; bed bath with "wash gloves" containing numerous ingredients; and application of a hot towel after usual care bed bath. In five studies, treatment duration ranged from five days to six months; only one study had post-treatment follow-up (one to eight days from end of treatment). Outcomes in the hot towel study were measured 15 minutes after the skin was wiped with a dry towel. Three studies each had high risk of attrition, detection, and performance bias. Only one trial (n = 984) assessed frequency of skin damage via average monthly incidence of skin tears during six months of treatment. The emollient group (usual care plus twice-daily application of moisturiser) had 5.76 tears per month per 1000 occupied bed-days compared with 10.57 tears in the usual care only group (ad hoc or no standardised skin-moisturising regimen) (P = 0.004), but this is based on very low-quality evidence, so we are uncertain of this result. Only one trial (n = 133) reported measuring side effects. At 56 ± 4 days from baseline, there were three undesirable effects (itch (mild), redness (mild/moderate), and irritation (severe)) in intervention group 1 (regimen consisting of a moisturising body wash and a moisturising leave-on lotion) and one event (mild skin dryness) in intervention group 2 (regimen consisting of body wash and a water-in-oil emulsion containing emollients and 4% urea). In both groups, the body wash was used daily and the emollient twice daily for eight weeks. There were zero adverse events in the usual care group. This result is based on very low-quality evidence. This same study also measured TEWL at 56 ± 4 days in the mid-volar forearm (n = 106) and the lower leg (n = 105). Compared to usual care, there may be no difference in TEWL between intervention groups, but evidence quality is low. One study, which compared application of a hot towel for 10 seconds after a usual care bed bath versus usual care bed bath only, also measured TEWL at 15 minutes after the skin was wiped with a dry towel for one second. The mean TEWL was 8.6 g/m²/h (standard deviation (SD) 3.2) in the hot towel group compared with 8.9 g/m²/h (SD 4.1) in the usual care group (low-quality evidence; n = 42), showing there may be little or no difference between groups. A lower score is more favourable. Three studies (266 participants) measured SCH, but all evidence is of very low quality; we did not combine these studies due to differences in treatments (different skin care regimens for eight weeks; wash gloves for 12 weeks; and single application of hot towel to the skin) and differences in outcome reporting. All three studies showed no clear difference in SCH at follow-up (ranging from 15 minutes after the intervention to 12 weeks from baseline), when compared with usual care. A clinical score of dryness was measured by three studies (including 245 participants); pooling was not appropriate. The treatment groups (different skin care regimens for eight weeks; a moisturising soap bar used for five days; and combinations of water soak, oil soak, and lotion for 12 days) may reduce dryness compared to standard care or no intervention (results measured at 5, 8, and 56 ± 4 days after treatment was initiated). However, the quality of evidence for this outcome is low. Outcomes of erythema and clinical score of itch were not assessed in any included studies. AUTHORS' CONCLUSIONS Current evidence about the effects of hygiene and emollients in maintaining skin integrity in older people in residential and hospital settings is inadequate. We cannot draw conclusions regarding frequency of skin damage or side effects due to very low-quality evidence. Low-quality evidence suggests that in residential care settings for older people, certain types of hygiene and emollient interventions (two different standardised skin care regimens; moisturising soap bar; combinations of water soak, oil soak, and lotion) may be more effective in terms of clinical score of dryness when compared with no intervention or standard care. Studies were small and generally lacked methodological rigour, and information on effect sizes and precision was absent. More clinical trials are needed to guide practice; future studies should use a standard approach to measuring treatment effects and should include patient-reported outcomes, such as comfort and acceptability.
Collapse
Affiliation(s)
- Fiona Cowdell
- Birmingham City UniversityFaculty of Health, Education and Life SciencesCity South CampusWestbourne Road, EdgbastonBirminghamUKB15 3TN
| | - Yuri T Jadotte
- Renaissance School of Medicine at Stony Brook UniversityDepartment of Family, Population and Preventive MedicineStony BrookNYUSA11794‐8434
| | - Steven J Ersser
- Bournemouth UniversityDepartment of Nursing ScienceRoom B401, 4th floor, Bournemouth House17 Christchurch RdBournemouthUKBH1 3LT
| | - Simon Danby
- The University of SheffieldSheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular DiseaseBeech Hill RoadSheffieldUKS10 2RX
| | - Sandra Lawton
- Rotherham NHS Foundation TrustDepartment of DermatologyMoorgate RoadRotherhamUKS60 2UD
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with EczemaNottinghamUKNG5 4FG
| | - Judith Dyson
- City, University of LondonSchool of Health Sciences, Division of NursingLondonUK
| | | |
Collapse
|
31
|
Wright C, Hart SP, Allgar V, English A, Swan F, Dyson J, Richardson G, Twiddy M, Cohen J, Hussain J, Johnson M, Hargreaves I, Crooks MG. A feasibility, randomised controlled trial of a complex breathlessness intervention in idiopathic pulmonary fibrosis (BREEZE-IPF): study protocol. ERJ Open Res 2019; 5:00186-2019. [PMID: 31649946 PMCID: PMC6801212 DOI: 10.1183/23120541.00186-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease that causes breathlessness and cough that worsen over time, limiting daily activities and negatively impacting quality of life. Although treatments are now available that slow the rate of lung function decline, trials of these treatments have failed to show improvement in symptoms or quality of life. There is an immediate unmet need for evidenced-based interventions that improve patients' symptom burden and make a difference to everyday living. This study aims to assess the feasibility of conducting a definitive randomised controlled trial of a holistic, complex breathlessness intervention in people with IPF. Methods and analysis The trial is a two-centre, randomised controlled feasibility trial of a complex breathlessness intervention compared with usual care in patients with IPF. 50 participants will be recruited from secondary care IPF clinics and randomised 1:1 to either start the intervention within 1 week of randomisation (fast-track group) or to receive usual care for 8 weeks before receiving the intervention (wait-list group). Participants will remain in the study for a total of 16 weeks. Outcome measures will be feasibility outcomes, including recruitment, retention, acceptability and fidelity of the intervention. Clinical outcomes will be measured to inform outcome selection and sample size calculation for a definitive trial. Ethics and dissemination Yorkshire and The Humber – Bradford Leeds Research Ethics Committee approved the study protocol (REC 18/YH/0147). Results of the main trial and all secondary end-points will be submitted for publication in a peer-reviewed journal. Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease. This study protocol describes the BREEZE-IPF study: a feasibility, randomised controlled trial of a holistic, complex breathlessness intervention in IPF.http://bit.ly/33eF9im
Collapse
Affiliation(s)
- Caroline Wright
- Respiratory Research Group, Hull York Medical School, Cottingham, UK
| | - Simon P Hart
- Respiratory Research Group, Hull York Medical School, Cottingham, UK
| | | | - Anne English
- Dove House Hospice Palliative Care Physiotherapy Team, NHS Humber Foundation Trust, Willerby, UK
| | - Flavia Swan
- Wolfson Palliative Care Research Group, Hull York Medical School, Cottingham, UK
| | - Judith Dyson
- Institute of Clinical and Applied Health Research, University of Hull, Kingston upon Hull, UK
| | | | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, University of Hull, Kingston upon Hull, UK
| | - Judith Cohen
- Hull Health Trials Unit, University of Hull, Kingston upon Hull, UK
| | - Jamilla Hussain
- Wolfson Palliative Care Research Group, Hull York Medical School, Cottingham, UK
| | - Miriam Johnson
- Wolfson Palliative Care Research Group, Hull York Medical School, Cottingham, UK
| | - Ian Hargreaves
- Respiratory Research Group, Hull York Medical School, Cottingham, UK
| | - Michael G Crooks
- Respiratory Research Group, Hull York Medical School, Cottingham, UK
| |
Collapse
|
32
|
Ersser S, Dyson J, Muinonen‐Martin A. Significant limitations of a systematic review and meta‐analysis of interventions to promote skin self‐examination: reply from the authors. Br J Dermatol 2019; 181:641-642. [DOI: 10.1111/bjd.18131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S.J. Ersser
- Department of Health Sciences University of York York U.K
| | - J. Dyson
- Faculty of Health Sciences University of Hull Hull U.K
| | | |
Collapse
|
33
|
Cowdell F, Dyson J. How is the theoretical domains framework applied to developing health behaviour interventions? A systematic search and narrative synthesis. BMC Public Health 2019; 19:1180. [PMID: 31455327 PMCID: PMC6712870 DOI: 10.1186/s12889-019-7442-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/05/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Enabling behaviour change in health care is a complex process. Although the use of theory to inform behaviour change interventions is advocated, there is limited information about how this might best be achieved. There are multiple models of behaviour change, however, due to their complexity they can be inaccessible to both researchers and healthcare practitioners. To support health care practitioner behaviour change, this was addressed by the development of the Theoretical Domains Framework (TDF) in 2005. Citations of the TDF and associated papers have increased exponentially. Although not predicted or intended by the authors, the TDF has also been used to investigate health behaviour change interventions. Therefore our aim was to narratively synthesize empirical evidence on how the TDF and subsequent iterations have been applied in health behaviour change to inform future intervention development. METHODS Systematic search of four online databases, combined with searches for citations of key papers and key author searches, resulted in 3551 articles eligible for screening. Of these 10 met the pre-determined inclusion criteria. Screening of full-texts, data extraction and quality appraisal were independently performed by both authors. Disagreements regarding eligibility were resolved through discussion. RESULTS Of the 10 included studies three used the TDF and seven used subsequent iterations, the Capability, Opportunity, Motivation to Behaviour / Behaviour Change Wheel to assess and /or categorise behavioural determinants to identify relevant behaviour change techniques. Two studies reported feasibility testing. Most interventions were targeted at diet and exercise. Eight reported an explicit and systematic process in applying the framework. CONCLUSION There is limited evidence of how the framework has been used to support health behaviour change interventions. In the included studies the process of using the framework is not always reported in detail or with clarity. More recent studies use a systematic and judicious process of framework application. From the limited evidence available we tentatively suggest that the steps proposed in the BCW appear to be sufficient for development of interventions that target health behaviour change interventions. Further research is needed to provide evidence in how the framework may be most effectively applied to intervention development. PROTOCOL REGISTRATION PROSPERO CRD42018086896 .
Collapse
Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Judith Dyson
- Faculty of Health Sciences, University of Hull, Hull, UK
| |
Collapse
|
34
|
Bell J, Reid M, Dyson J, Schlosser A, Alexander T. There’s just huge anxiety: ontological security, moral panic, and the decline in young people’s mental health and well-being in the UK. Qual Res Med Healthc 2019. [DOI: 10.4081/qrmh.2019.8200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study aims to critically discuss factors associated with a recent dramatic rise in recorded mental health issues amongst UK youth. It draws from interviews and focus groups undertaken with young people, parents and professionals. We offer valuable new insights into significant issues affecting young people’s mental health and well-being that are grounded in their lived experiences and in those who care for and work with them. By means of a thematic analysis of the data, we identified an increase in anxiety related to: future orientation, social media use, education, austerity, and normalization of mental distress and self-harm. We apply the notion of ontological security in our interpretation of how socio-cultural and political changes have increased anxiety amongst young people and consequent uncertainty about the self, the world and the future, leading to mental health problems. There are also problems conceptualizing and managing adolescent mental health, including increased awareness, increased acceptance of these problems, and stigmatisation. We relate this to the tendency for moral panic and widespread dissemination of problems in a risk society. In our conclusion, we highlight implications for future research, policy and practice.
Collapse
|
35
|
Aleo G, Bagnasco A, Watson R, Dyson J, Cowdell F, Catania G, Zanini MP, Cozzani E, Parodi A, Sasso L. Comparing questionnaires across cultures: Using Mokken scaling to compare the Italian and English versions of the MOLES index. Nurs Open 2019; 6:1022-1028. [PMID: 31367427 PMCID: PMC6650700 DOI: 10.1002/nop2.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/20/2019] [Accepted: 03/18/2019] [Indexed: 11/29/2022] Open
Abstract
AIM The aims of this study were (a) to translate the MOLES index from English to Italian and (ii) to compare the two versions using non-parametric item response theory. DESIGN An online survey was used to gather data. METHODS Forward and back translation was used to prepare the Italian version of the MOLES which was then analysed using the non-parametric item response theory of Mokken scaling. RESULTS Mokken scales were found in both the English and the Italian versions of the MOLES index. However, the two scales-while the total scale score was not significantly different-showed different properties, and Mokken scaling selected different items from each scale.
Collapse
Affiliation(s)
- Giuseppe Aleo
- Department of Health SciencesUniversity of GenoaGenoaItaly
| | | | - Roger Watson
- Faculty of Health SciencesUniversity of HullHullUK
| | - Judith Dyson
- Faculty of Health SciencesUniversity of HullHullUK
| | - Fiona Cowdell
- School of Nursing and MidwiferyUniversity of BirminghamBirminghamUK
| | | | | | | | - Aurora Parodi
- Department of Health SciencesUniversity of GenoaGenoaItaly
| | - Loredana Sasso
- Department of Health SciencesUniversity of GenoaGenoaItaly
| |
Collapse
|
36
|
Ersser S, Effah A, Dyson J, Kellar I, Thomas S, McNichol E, Caperon E, Hewitt C, Muinonen‐Martin A. Early detection of skin cancer by skin self‐examination. Br J Dermatol 2019. [DOI: 10.1111/bjd.17948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Ersser S, Effah A, Dyson J, Kellar I, Thomas S, McNichol E, Caperon E, Hewitt C, Muinonen‐Martin A. 帮助患者通过自我检查早期检测皮肤癌的干预的效果:一项系统回顾、元分析. Br J Dermatol 2019. [DOI: 10.1111/bjd.17965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Ersser S, Effah A, Dyson J, Kellar I, Thomas S, McNichol E, Caperon E, Hewitt C, Muinonen‐Martin A. Effectiveness of interventions to support the early detection of skin cancer through skin self‐examination: a systematic review and meta‐analysis. Br J Dermatol 2019; 180:1339-1347. [DOI: 10.1111/bjd.17529] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 02/05/2023]
Affiliation(s)
- S.J. Ersser
- Department of Health Sciences University of York YorkU.K
| | - A. Effah
- School of Healthcare University of Leeds LeedsU.K
| | - J. Dyson
- School of Health & Social Work University of Hull Hull U.K
| | - I. Kellar
- School of Psychology University of Leeds LeedsU.K
| | - S. Thomas
- Faculty of Health & Social Sciences Bournemouth University Bournemouth U.K
| | - E. McNichol
- School of Healthcare University of Leeds LeedsU.K
| | - E. Caperon
- Leeds Institute of Health Sciences University of Leeds Leeds U.K
| | - C. Hewitt
- Department of Health Sciences University of York YorkU.K
| | | |
Collapse
|
39
|
Warren J, Nanayakkara S, Andrianopoulos N, Brennan A, Dinh D, Yudi M, Clark D, Ajani AE, Reid CM, Selkrig L, Shaw J, Hiew C, Freeman M, Kaye D, Kingwell BA, Dart AM, Duffy SJ, Reid C, Andrianopoulos N, Brennan A, Dinh D, Reid C, Ajani A, Duffy S, Clark D, Freeman M, Hiew C, Andrianopoulos N, Oqueli E, Brennan A, Duffy S, Shaw J, Walton A, Dart A, Broughton A, Federman J, Keighley C, Hengel C, Peter K, Stub D, Chan W, Warren J, O’Brien J, Selkrig L, Huntington R, Clark D, Farouque O, Horrigan M, Johns J, Oliver L, Brennan J, Chan R, Proimos G, Dortimer T, Chan B, Nadurata V, Huq R, Fernando D, Al-Fiadh A, Yudi M, Sugumar H, Ramchand J, Han H, Picardo S, Brown L, Oqueli E, Hengel C, Sharma A, Zhu B, Ryan N, Harrison T, New G, Roberts L, Freeman M, Rowe M, Proimos G, Cheong Y, Goods C, Fernando D, Teh A, Parfrey S, Ramzy J, Koshy A, Venkataraman P, Flannery D, Hiew C, Sebastian M, Yip T, Mok M, Jaworski C, Hutchinson A, Cimenkaya C, Ngu P, Khialani B, Salehi H, Turner M, Dyson J, McDonald B, Van Den Nouwelant D, Halliburton K, Reid C, Andrianopoulos N, Brennan A, Dinh D, Yan B, Ajani A, Warren R, Eccleston D, Lefkovits J, Iyer R, Gurvitch R, Wilson W, Brooks M, Biswas S, Yeoh J. Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention. J Am Coll Cardiol 2019; 73:2846-2855. [DOI: 10.1016/j.jacc.2019.03.493] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
|
40
|
Ataiyero Y, Dyson J, Graham M. Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review. Am J Infect Control 2019; 47:565-573. [PMID: 30470526 DOI: 10.1016/j.ajic.2018.09.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hand hygiene (HH) is the primary measure in the prevention of health care-associated infections; however, from published studies, compliance of health care workers (HCWs) to HH guidelines is low. There is currently no review on HH compliance rates in developing countries, specifically sub-Saharan Africa (SSA), or the barriers to compliance. We therefore, through a narrative review, sought to identify the compliance with and the barriers to HH in SSA. METHODS From 3 databases, we performed a search of peer-reviewed studies from SSA, conducted among HCWs, published in the English language between 2005 and 2017. Only studies that reported HH compliance and/or barriers were included. RESULTS A total of 278 articles were identified, and the final sample of 27 articles was analyzed in full length. Overall, the HH compliance rate was estimated to be 21.1%, and doctors had better compliance irrespective of the type of patient contact. The main barriers identified were heavy workload, infrastructural deficit (eg, lack of water, soap, hand sanitizers, and blocked/leaking sinks), and poorly positioned facilities. CONCLUSIONS HH compliance is poor among SSA HCWs. There is a need for more reports of HH compliance in SSA, and emphasis needs to be placed on surgical wards in which surgical site infections-the most common form of health care-associated infections in SSA-are most likely to occur. Barriers identified in this review are consistent with the findings of studies conducted elsewhere; however, it appears that heavy workload, infrastructural deficit, and poorly positioned facilities are more likely in developing countries.
Collapse
Affiliation(s)
- Yetunde Ataiyero
- School of Health and Social Work, University of Hull, Hull, United Kingdom.
| | - Judith Dyson
- School of Health and Social Work, University of Hull, Hull, United Kingdom
| | - Moira Graham
- School of Health and Social Work, University of Hull, Hull, United Kingdom
| |
Collapse
|
41
|
Dyson J, Marsh C, Jackson N, Richardson D, Faisal M, Scally AJ, Mohammed M. Understanding and applying practitioner and patient views on the implementation of a novel automated Computer-Aided Risk Score (CARS) predicting the risk of death following emergency medical admission to hospital: qualitative study. BMJ Open 2019; 9:e026591. [PMID: 31015273 PMCID: PMC6500336 DOI: 10.1136/bmjopen-2018-026591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The Computer-Aided Risk Score (CARS) estimates the risk of death following emergency admission to medical wards using routinely collected vital signs and blood test data. Our aim was to elicit the views of healthcare practitioners (staff) and service users and carers (SU/C) on (1) the potential value, unintended consequences and concerns associated with CARS and practitioner views on (2) the issues to consider before embedding CARS into routine practice. SETTING This study was conducted in two National Health Service (NHS) hospital trusts in the North of England. Both had in-house information technology (IT) development teams, mature IT infrastructure with electronic National Early Warning Score (NEWS) and were capable of integrating NEWS with blood test results. The study focused on emergency medical and elderly admissions units. There were 60 and 39 acute medical/elderly admissions beds at the two NHS hospital trusts. PARTICIPANTS We conducted eight focus groups with 45 healthcare practitioners and two with 11 SU/Cs in two NHS acute hospitals. RESULTS Staff and SU/Cs recognised the potential of CARS but were clear that the score should not replace or undermine clinical judgments. Staff recognised that CARS could enhance clinical decision-making/judgments and aid communication with patients. They wanted to understand the components of CARS and be reassured about its accuracy but were concerned about the impact on intensive care and blood tests. CONCLUSION Risk scores are widely used in healthcare, but their development and implementation do not usually involve input from practitioners and SU/Cs. We contributed to the development of CARS by eliciting views of staff and SU/Cs who provided important, often complex, insights to support the development and implementation of CARS to ensure successful implementation in routine clinical practice.
Collapse
Affiliation(s)
- Judith Dyson
- Health and Social Work, University of Hull, Hull, East Riding of Yorkshire, UK
| | - Claire Marsh
- Quality and Safety, Bradord Institute for Health Research, Bradford, UK
| | - Natalie Jackson
- Quality and Safety, Bradord Institute for Health Research, Bradford, UK
| | - Donald Richardson
- Renal Medicine, York Teaching Hospital NHS Foundation Trust Hospital, York, UK
| | - Muhammad Faisal
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, UK
| | - Andrew J Scally
- School of Health Studies, University of Bradford, Bradford, UK
| | | |
Collapse
|
42
|
Faisal M, Scally AJ, Jackson N, Richardson D, Beatson K, Howes R, Speed K, Menon M, Daws J, Dyson J, Marsh C, Mohammed MA. Development and validation of a novel computer-aided score to predict the risk of in-hospital mortality for acutely ill medical admissions in two acute hospitals using their first electronically recorded blood test results and vital signs: a cross-sectional study. BMJ Open 2018; 8:e022939. [PMID: 30530474 PMCID: PMC6286481 DOI: 10.1136/bmjopen-2018-022939] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES There are no established mortality risk equations specifically for emergency medical patients who are admitted to a general hospital ward. Such risk equations may be useful in supporting the clinical decision-making process. We aim to develop and externally validate a computer-aided risk of mortality (CARM) score by combining the first electronically recorded vital signs and blood test results for emergency medical admissions. DESIGN Logistic regression model development and external validation study. SETTING Two acute hospitals (Northern Lincolnshire and Goole NHS Foundation Trust Hospital (NH)-model development data; York Hospital (YH)-external validation data). PARTICIPANTS Adult (aged ≥16 years) medical admissions discharged over a 24-month period with electronic National Early Warning Score(s) and blood test results recorded on admission. RESULTS The risk of in-hospital mortality following emergency medical admission was 5.7% (NH: 1766/30 996) and 6.5% (YH: 1703/26 247). The C-statistic for the CARM score in NH was 0.87 (95% CI 0.86 to 0.88) and was similar in an external hospital setting YH (0.86, 95% CI 0.85 to 0.87) and the calibration slope included 1 (0.97, 95% CI 0.94 to 1.00). CONCLUSIONS We have developed a novel, externally validated CARM score with good performance characteristics for estimating the risk of in-hospital mortality following an emergency medical admission using the patient's first, electronically recorded, vital signs and blood test results. Since the CARM score places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.
Collapse
Affiliation(s)
- Muhammad Faisal
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Bradford Institute for Health Research, Bradford, UK
| | - Andrew J Scally
- School of Clinical Therapies, University College Cork, Cork, Ireland
| | | | - Donald Richardson
- Department of Renal Medicine, York Teaching Hospital NHS Foundation Trust Hospital, York, UK
| | - Kevin Beatson
- Department of Renal Medicine, York Teaching Hospital NHS Foundation Trust Hospital, York, UK
- York Teaching Hospital NHS Foundation Trust Hospital, York, UK
| | - Robin Howes
- Department of Strategy and Planning, Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, UK
| | - Kevin Speed
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, UK
| | - Madhav Menon
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, UK
| | - Jeremey Daws
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, UK
| | - Judith Dyson
- School of Health and Social Work, University Of Hull, Hull, UK
| | - Claire Marsh
- Bradford Institute for Health Research, Bradford, UK
| | - Mohammed A Mohammed
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Bradford Institute for Health Research, Bradford, UK
| |
Collapse
|
43
|
Credland N, Dyson J, Johnson MJ. What are the patterns of compliance with Early Warning Track and Trigger Tools: A narrative review. Appl Nurs Res 2018; 44:39-47. [PMID: 30389058 DOI: 10.1016/j.apnr.2018.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early Warning Scores were introduced into acute hospitals in 2000. 99% of acute hospitals employ a EWS to monitor deteriorating patients with 97.9% of these linked to a referral protocol. Despite this high level of adoption, there has been little improvement in the recognition and response to deteriorating patients over the last decade. OBJECTIVE To explore the patterns of compliance with Early Warning Track and Trigger Tools. DESIGN A narrative review. DATA SOURCES Electronic databases (Medline, CIHAHL, EmBase, the Cochrane library, the Centre for Reviews and Dissemination (CRD) and PROSPERO) were searched from 1 January 2000 to 5 July 2018. Titles, abstracts and full text papers were screened (two independent reviewers) against inclusion criteria and seven papers were included in the review. Data were extracted by one reviewer and checked by a second reviewer using a bespoke data collection sheet. REVIEW METHODS All papers were quantitative in design but demonstrated clinical and methodological heterogeneity therefore a meta-analysis was not possible. A qualitative approach was undertaken to synthesise findings using a framework analysis and narrative synthesis. Themes were identified, named, defined and reported according to outcome measure. RESULTS 7/27 papers representing over 3000 patients and 963,000 data points were included in the analysis. Reported studies were conducted in the United Kingdom (n = 4), Denmark (n = 2) and Amsterdam (n = 1). Three key themes were identified, early warning score calculation accuracy, monitoring frequency and clinical response. This review identifies poor compliance with the Early Warning Score (EWS) protocol in all three themes. There is significant scoring inaccuracy with omitted EWS, missing elements of the EWS and incorrectly calculated EWS. Adherence to monitoring frequency is poor with a higher EWS being associated with reduced compliance with the escalation protocol. There is inadequate compliance with the escalation element of the EWS protocol with concerning extended delays to clinical review. There is evidence of worsening clinical response with increasing EWS. Although significant improvement is demonstrated in clinical response with the use of electronic EWS protocols, non-compliance still occurs at all EWS stages. CONCLUSION Compliance with EWS is poor but the cause is unidentified. Outcomes can only improve if staff complete the EWS fully, calculate the score accurately, monitor according to protocol and escalate according to clinical response. Social, environmental and professional behaviours that affect effective use of track and trigger tools should be explored to improve our understanding of suboptimal management of the deteriorating patient.
Collapse
Affiliation(s)
- Nicola Credland
- Faculty of Health Sciences, School of Health and Social Work, Aire building, The University of Hull, Cottingham Road, Hull HU6 7RX, United Kingdom.
| | - Judith Dyson
- Hull York Medical School, Alam Medical Building, University of Hull, Cottingham Road, Hull HU6 7RX, United Kingdom.
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Alam Medical Building, University of Hull, Cottingham Road, Hull, HU6 7RX, United Kingdom.
| |
Collapse
|
44
|
Cowdell F, Dyson J, Long J, Macleod U. Self-reported skin concerns: An epidemiological study of community-dwelling older people. Int J Older People Nurs 2018; 13:e12195. [DOI: 10.1111/opn.12195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences; Birmingham City University; Birmingham UK
| | - Judith Dyson
- School Health and Social Work; University of Hull; Hull UK
| | - Judith Long
- Hull and East Yorkshire Hospitals NHS Trust; Hull UK
| | - Una Macleod
- Hull York Medical School; University of Hull; Hull UK
| |
Collapse
|
45
|
O'Connor CA, Dyson J, Cowdell F, Watson R. Do universal school-based mental health promotion programmes improve the mental health and emotional wellbeing of young people? A literature review. J Clin Nurs 2017; 27:e412-e426. [PMID: 28926147 DOI: 10.1111/jocn.14078] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine evidence-using a range of outcomes-for the effectiveness of school-based mental health and emotional well-being programmes. BACKGROUND It is estimated that 20% of young people experience mental health difficulties every year. Schools have been identified as an appropriate setting for providing mental health and emotional well-being promotion prompting the need to determine whether current school-based programmes are effective in improving the mental health and emotional well-being of young people. METHODS A systematic search was conducted using the health and education databases, which identified 29 studies that measured the effectiveness of school-based universal interventions. Prisma guidelines were used during the literature review process. RESULTS Thematic analysis generated three key themes: (i) help seeking and coping; (ii) social and emotional well-being; and (iii) psycho-educational effectiveness. CONCLUSION It is concluded that whilst these studies show promising results, there is a need for further robust evaluative studies to guide future practice. RELEVANCE TO CLINICAL PRACTICE All available opportunities should be taken to provide mental health promotion interventions to young people in the school environment, with a requirement for educational professionals to be provided the necessary skills and knowledge to ensure that the school setting continues to be a beneficial environment for conducting mental health promotion.
Collapse
Affiliation(s)
- Clare A O'Connor
- Faculty of Health Sciences, School of Health and Social Work, University of Hull, Hull, UK
| | - Judith Dyson
- Faculty of Health Sciences, School of Health and Social Work, University of Hull, Hull, UK
| | - Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Roger Watson
- Faculty of Health Sciences, School of Health and Social Work, University of Hull, Hull, UK
| |
Collapse
|
46
|
Dyson J, Madeo M. Investigating the use of an electronic hand hygiene monitoring and prompt device: influence and acceptability. J Infect Prev 2017; 18:278-287. [PMID: 29344097 DOI: 10.1177/1757177417714045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 05/12/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction Hand hygiene (HH) prevents the transmission of healthcare-associated infections. Electronic HH monitoring and prompt devices have been developed to overcome problems with monitoring HH and to improve compliance. Devices monitor room entry and exit and soap use through communication between ceiling sensors and badges worn by practitioners and the badges sense alcohol rub. Objectives To investigate (1) the impact of devices on HH compliance, (2) how devices influence behaviour and (3) the experience and opinions of practitioners on the use devices. Methods HH compliance was monitored (before, during and after system installation) by observations and alcohol rub usage. Compliance during installation was also monitored by the device. Healthcare practitioner interviews (n = 12) explored how the device influenced behaviour and experiences and opinions of wearing the device. Results HH compliance improved during the period the device was installed. Practitioners reported the device increased their awareness, enhancing their empathy for patients and encouraged patients and colleagues to prompt when HH was needed. Practitioners' reported better HH, gaming the system and feelings of irritation. Conclusion HH prompt and monitoring systems seem to improve compliance but improvements may be undermined by practitioner irritation and system gaming.
Collapse
Affiliation(s)
| | - Maurice Madeo
- Infection Prevention and Control, North Lincolnshire and Goole NHS Foundation Trust, Lincolnshire, UK
| |
Collapse
|
47
|
Dyson J. Hand hygiene and human factors. J Infect Prev 2015; 16:143-144. [DOI: 10.1177/1757177415592963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
48
|
|
49
|
Abstract
Compulsive hoarding affects approximately 2-5% of the adult population. Increasing recognition has led to its inclusion as a distinct condition in forthcoming revisions to the Diagnostic and Statistical Manual V. Hoarding behaviour can have a detrimental effect on the health and well-being of family members. A rigorous review of available evidence using a novel three-stage literature search was undertaken: (1) an extensive scoping review; (2) a traditional search of databases including Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, and psycINFO using combinations of keywords; and (3) review of cited references and hand-searching of selected journals. Evidence was selected using predefined inclusion criteria. Papers included two surveys, one qualitative study and one case study. An integrative review methodology was used to synthesize the evidence presented. Analysis revealed three overriding themes: quality of life, shattered families and rallying around. These illuminated the experiences of family members. These papers revealed families under strain and often at breaking point but with the resolve to pull together if the right support is available. This review concludes that further research is needed to investigate the effects of hoarding on family members and how these may best be met.
Collapse
Affiliation(s)
- T P Büscher
- PSYPHER - Psychosis Service for Young People in Hull and East Riding, Humber NHS Foundation Trust, East Riding of Yorkshire, UK
| | | | | |
Collapse
|
50
|
Dyson J, Cowdell F. Development and psychometric testing of the ‘Motivation and Self-Efficacy in Early Detection of Skin Lesions’ index. J Adv Nurs 2014; 70:2952-63. [DOI: 10.1111/jan.12436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Judith Dyson
- Faculty of Health and Social Care; University of Hull; UK
| | - Fiona Cowdell
- Faculty of Health and Social Care; University of Hull; UK
| |
Collapse
|