The choice for colostomy following spinal cord injury: A grounded theory study

AIM

Explore experiences and choices related to bowel management following spinal cord injury.

BACKGROUND

In one UK spinal centre, more are choosing a colostomy soon after injury in contravention of professional guidelines. Reasons for this were unknown.

METHODS

Grounded theory study using semi-structured interviews with 12 individuals living with spinal cord injury.

RESULTS

All 'Experienced Loss' related to bowel function. Those who chose colostomy later 'Progressed into Suffering'. Colostomy transformed lives and was likened to 'Being Alive Again'. 'Failures of Care' contributed to experiences and decision-making.

CONCLUSION

Possessing information and choice emerge as key in transforming lives following spinal cord injury. They allow individuals to make choices from a lifeworld perspective, which may differ from those professionals assume. Present neurogenic bowel management guidelines fail to account for the wider lifeworlds of those they are designed for.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

An imperative emerges to make information and choice available and involve patients in the reconstruction of guidelines.

IMPACT

Unique knowledge emerges about patient experiences and motivations, and points to a patient-led revolution in how bowel management following spinal cord injury is understood and managed. The imperative for adequate access to information and choice is demonstrated.

REPORTING METHOD

EQUATOR Standards for Reporting Qualitative Research (SRQR) were adhered to.

PATIENT OR PUBLIC CONTRIBUTION

The methodology facilitated discussion of areas important to patients and made them co-constructors of theory.

The experiences of people with liver disease of palliative and end-of-life care in the United Kingdom-A systematic literature review and metasynthesis

BACKGROUND

Liver disease is a growing health concern and a major cause of death. It causes multiple symptoms, including financial, psychological and social issues. To address these challenges, palliative care can support people alongside active treatment, and towards the end of life, but little is known about the care experiences of individuals with liver disease in the United Kingdom. This review aimed to explore the palliative and end-of-life care experiences of people with liver disease in the United Kingdom.

METHOD

A systematic review was conducted using a five-stage process and following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. Searches were across Web of Science, Scopus, EBSCO and grey literature until 10 May 2023. The review was registered through International Prospective Register of Systematic Reviews (PROSPERO). NVivo 12.5 was used to facilitate data analysis (systematic review registration: PROSPERO CRD42022382649).

RESULTS

Of 6035 papers (excluding duplicates) found from searches, five met the inclusion criteria of primary research related to adults with liver disease receiving palliative and/or end-of-life care in the United Kingdom, published in English. Reflexive thematic analysis of the data was conducted. The themes identified were the experiences of people with liver disease of relating to healthcare professionals, using services, receiving support, and experiences of information and communication. These were connected by an overarching concept of disempowerment versus empowerment, with the notion of person-centred care as an important feature.

CONCLUSION

This review has found variations in the care experiences of people with advanced liver disease towards the end of life and an overall lack of access to specialist palliative care services. Where services are designed to be person-centred, experiences are more empowering. Further research is needed but with recognition that it is often unclear when care for people with liver disease is palliative or end-of-life.

PATIENT AND PUBLIC CONTRIBUTION

An online public involvement workshop was held on 18 April 2023 through Voice (2023). This included four people with liver disease and four carers to discuss the review findings and to design a qualitative research study to further explore the topic.

How do hospice nurses prepare to give end-of-life care? A grounded theory study of nurses in one UK hospice

BACKGROUND

Literature for preparing hospice nurses to deliver end-of-life care is sparse.

AIM

To investigate how nurses in one UK hospice prepared to deliver end-of-life care in their role.

METHODS

A classic grounded theory approach was used to investigate the experiences of 22 registered nurses in one UK hospice, to discover how they prepared for their role. A total of 17 individual interviews and one focus group were conducted. Constant comparison of data and member checking were performed to establish validity.

FINDINGS

Findings were synthesised into five categories: the 'shared ideal', feeling good at the job, making a difference, experience/exposure to hospice work and the importance of role models. The shared ideal formed the core category, which explained how hospice nurses feel a sense of 'fit' with their work.

CONCLUSION

The feeling of a nurse feeling well-suited to the work and that there the work was a good 'fit' for them was identified as a core element to nurses' feelings of preparedness to provide end-of-life care.

Nurses+QI=better hospital performance? A critical review of the literature

NHS regulators, such as NHS Improvement and the Care Quality Commission, promote staff involvement in quality improvement (QI), while national nursing leaders and the Nursing and Midwifery Council advocate nurses' involvement in improving services. This article critically explores the evidence base for a national nursing strategy to involve nurses in QI using a literature review. A thematic analysis shows that nurse involvement in QI has several positive outcomes, which are also included in the NHS Improvement's Single Oversight Framework for NHS Providers. The article concludes that nurse involvement in QI helps improve hospital performance.

Writing for publication: avoiding the common pitfalls

Sharing research findings has become an increasingly important part of research as nursing is increasing required to base practice on the best available evidence. This editorial offers an insight into some of the common pitfalls to avoid when writing and submitting a paper for publication.

Applying for ethical approval for research: the main issues

The need to obtain research ethical approval is common to all research involving human participants. This approval must be obtained before research participants can be approached and before data collection can begin. The process of ethical review is one way that research participants can be confident that possible risks have been considered, minimised and deemed acceptable. This article outlines some of the main issues researchers should consider when planning an application for research ethical approval by answering the following six questions: 'Do I need research ethical approval?', 'How many applications will I need to make?', 'Where should I apply for research ethical approval?', 'What do I need to include in my application?', 'What do research ethics committees look for?' and 'What other approvals might I need?' Answering these questions will enable researchers to navigate the ethical review process.

Qualitative research

Qualitative research has an important role in helping nurses and other healthcare professionals understand patient experiences of health and illness. Qualitative researchers have a large number of methodological options and therefore should take care in planning and conducting their research. This article offers a brief overview of some of the key issues qualitative researchers should consider.

Planning a research project

The planning stage of any research project is one of the most important stages in the research process. This article offers insight into the important issues a researcher needs to consider when planning his or her research, including how to develop a research protocol, obtaining research funding, seeking academic, peer and social support, gaining research ethics and governance approval and planning a research schedule. Careful planning ensures that the research project is achievable and can be completed on time, with the funding available.

Stages in the research process

Research should be conducted in a systematic manner, allowing the researcher to progress from a general idea or clinical problem to scientifically rigorous research findings that enable new developments to improve clinical practice. Using a research process helps guide this process. This article is the first in a 26-part series on nursing research. It examines the process that is common to all research, and provides insights into ten different stages of this process: developing the research question, searching and evaluating the literature, selecting the research approach, selecting research methods, gaining access to the research site and data, pilot study, sampling and recruitment, data collection, data analysis, and dissemination of results and implementation of findings.

Selecting the right approach

Research can be a complex and challenging endeavour but the outcomes will often change peoples' lives. Such a claim stands not only for clinical trials developing new medicines or therapeutic interventions, but also for qualitative studies that help us to understand how and why people experience health and illness as they do. The real challenge for researchers can be to ensure that the right questions are asked and that the most appropriate methodological approaches are adopted to answer these questions.

Ensure nurse research is rigorous

DR LESLIE Gelling is a Reader in Research Ethics and a nurse in the Faculty of Health, Social Care and Education at Anglia Ruskin University in Cambridge. Between 2008 and this edition, Leslie has been the editor of Nurse Researcher and he is now moving to the Journal of Clinical Nursing.

Ethical Review of Action Research: The Challenges for Researchers and Research Ethics Committees

Action research has repeatedly demonstrated how it can facilitate problem solving and change in many settings through a process of collaboration which is driven by the community at the heart of the research. The ethical review of action research can be challenging for action researchers and research ethics committees. This paper explores how seven ethical principles can be used by action researchers and research ethics committees as the basis for ethical review. This paper concludes by offering some suggestions for a way forward for both action researchers and research ethics committees.