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Sahota O, Narayanasamy M, Bastounis A, Paskins Z, Bishop S, Langley T, Gittoes N, Davis S, Baily A, Holmes M, Leonardi-Bee J. Bisphosphonate alternative regimens for the prevention of osteoporotic fragility fractures: BLAST-OFF, a mixed-methods study. Health Technol Assess 2024; 28:1-169. [PMID: 38634483 PMCID: PMC11056815 DOI: 10.3310/wypf0472] [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] [Indexed: 04/19/2024] Open
Abstract
Background Bisphosphonates are a class of medication commonly used to treat osteoporosis. Alendronate is recommended as the first-line treatment; however, long-term adherence (both treatment compliance and persistence) is poor. Alternative bisphosphonates are available, which can be given intravenously and have been shown to improve long-term adherence. However, the most clinically effective and cost-effective alternative bisphosphonate regimen remains unclear. What is the most cost-effective bisphosphonate in clinical trials may not be the most cost-effective or acceptable to patients in everyday clinical practice. Objectives 1. Explore patient, clinician and stakeholder views, experiences and preferences of alendronate compared to alternative bisphosphonates. 2. Update and refine the 2016 systematic review and cost-effectiveness analysis of bisphosphonates, and estimate the value of further research into their benefits. 3. Undertake stakeholder/consensus engagement to identify important research questions and further rank research priorities. Methods The study was conducted in two stages, stages 1A and 1B in parallel, followed by stage 2: • Stage 1A - we elicited patient and healthcare experiences to understand their preferences of bisphosphonates for the treatment of osteoporosis. This was undertaken by performing a systematic review and framework synthesis of qualitative studies, followed by semistructured qualitative interviews with participants. • Stage 1B - we updated and expanded the existing Health Technology Assessment systematic review and clinical and cost-effectiveness model, incorporating a more comprehensive review of treatment efficacy, safety, side effects, compliance and long-term persistence. • Stage 2 - we identified and ranked further research questions that need to be answered about the effectiveness and acceptability of bisphosphonates. Results Patients and healthcare professionals identified a number of challenges in adhering to bisphosphonate medication, balancing the potential for long-term risk reduction against the work involved in adhering to oral alendronate. Intravenous zoledronate treatment was generally more acceptable, with such regimens perceived to be more straightforward to engage in, although a portion of patients taking alendronate were satisfied with their current treatment. Intravenous zoledronate was found to be the most effective, with higher adherence rates compared to the other bisphosphonates, for reducing the risk of fragility fracture. However, oral bisphosphonates are more cost-effective than intravenous zoledronate due to the high cost of zoledronate administration in hospital. The importance of including patients and healthcare professionals when setting research priorities is recognised. Important areas for research were related to patient factors influencing treatment selection and effectiveness, how to optimise long-term care and the cost-effectiveness of delivering zoledronate in an alternative, non-hospital setting. Conclusions Intravenous zoledronate treatment was generally more acceptable to patients and found to be the most effective bisphosphonate and with greater adherence; however, the cost-effectiveness relative to oral alendronate is limited by its higher zoledronate hospital administration costs. Future work Further research is needed to support people to make decisions influencing treatment selection, effectiveness and optimal long-term care, together with the clinical and cost-effectiveness of intravenous zoledronate administered in a non-hospital (community) setting. Limitations Lack of clarity and limitations in the many studies included in the systematic review may have under-interpreted some of the findings relating to effects of bisphosphonates. Trial registration This trial is registered as ISRCTN10491361. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127550) and is published in full in Health Technology Assessment; Vol. 28, No. 21. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Opinder Sahota
- Department of Health Care for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Zoe Paskins
- School of Medicine, Keele University and Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
| | - Simon Bishop
- Business School, University of Nottingham, Nottingham, UK
| | - Tessa Langley
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil Gittoes
- Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Birmingham, UK
| | - Sarah Davis
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ann Baily
- Lay Member, Nottingham Osteoporosis Society Patient Support group, Nottingham, UK
| | - Moira Holmes
- Lay Member, Nottingham Osteoporosis Society Patient Support group, Nottingham, UK
| | - Jo Leonardi-Bee
- School of Medicine, University of Nottingham, Nottingham, UK
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Whitehead PJ, Belshaw S, Brady S, Coleman E, Dean A, Doherty L, Fairhurst C, Francis-Farrell S, Golding-Day M, Gray J, Martland M, McAnuff J, McCarthy A, McMeekin P, Mitchell N, Narayanasamy M, Newman C, Parker A, Rapley T, Rodgers S, Rooney L, Russell R, Sheard L, Torgerson D. Bathing Adaptations in the Homes of Older Adults (BATH-OUT-2): study protocol for a randomised controlled trial, economic evaluation and process evaluation. Trials 2024; 25:75. [PMID: 38254164 PMCID: PMC10802044 DOI: 10.1186/s13063-023-07677-3] [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] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/26/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The onset of disability in bathing is particularly important for older adults as it can be rapidly followed by disability in other daily activities; this may represent a judicious time point for intervention in order to improve health, well-being and associated quality of life. An important environmental and preventative intervention is housing adaptation, but there are often lengthy waiting times for statutory provision. In this randomised controlled trial (RCT), we aim to evaluate the effectiveness and cost-effectiveness of bathing adaptations compared to no adaptations and to explore the factors associated with routine and expedited implementation of bathing adaptations. METHODS BATH-OUT-2 is a multicentre, two-arm, parallel-group RCT. Adults aged 60 and over who are referred to their local authority for an accessible level access shower will be randomised, using pairwise randomisation, 1:1, to receive either an expedited provision of an accessible shower via the local authority or a usual care control waiting list. Participants will be followed up for a maximum of 12 months and will receive up to four follow-ups in this duration. The primary outcome will be the participant's physical well-being, assessed by the Physical Component Summary score of the Short Form-36 (SF-36), 4 weeks after the intervention group receives the accessible shower. The secondary outcomes include the Mental Component Summary score of the SF-36, self-reported falls, health and social care resource use, health-related quality of life (EQ-5D-5L), social care-related quality of life (Adult Social Care Outcomes Toolkit (ASCOT)), fear of falling (Short Falls Efficacy Scale), independence in bathing (Barthel Index bathing question), independence in daily activities (Barthel Index) and perceived difficulty in bathing (0-100 scale). A mixed-methods process evaluation will comprise interviews with stakeholders and a survey of local authorities with social care responsibilities in England. DISCUSSION The BATH-OUT-2 trial is designed so that the findings will inform future decisions regarding the provision of bathing adaptations for older adults. This trial has the potential to highlight, and then reduce, health inequalities associated with waiting times for bathing adaptations and to influence policies for older adults. TRIAL REGISTRATION ISRCTN Registry ISRCTN48563324. Prospectively registered on 09/04/2021.
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Affiliation(s)
- Phillip J Whitehead
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Stuart Belshaw
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
| | - Samantha Brady
- Department of Health Sciences, University of York, York, UK
| | | | - Alexandra Dean
- Department of Health Sciences, University of York, York, UK
| | - Laura Doherty
- Department of Health Sciences, University of York, York, UK
| | | | | | - Miriam Golding-Day
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
| | - Joanne Gray
- Department of Nursing, Midwifery and Health, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | | | - Jennifer McAnuff
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Andrew McCarthy
- Department of Nursing, Midwifery and Health, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Peter McMeekin
- Department of Nursing, Midwifery and Health, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | | | - Melanie Narayanasamy
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
| | - Craig Newman
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Adwoa Parker
- Department of Health Sciences, University of York, York, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Sara Rodgers
- Department of Health Sciences, University of York, York, UK
| | - Leigh Rooney
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Laura Sheard
- Department of Health Sciences, University of York, York, UK
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Narayanasamy M, Bishop S, Sahota O, Paskins Z, Gittoes N, Langley T. Acceptability and engagement amongst patients on oral and intravenous bisphosphonates for the treatment of osteoporosis in older adults. Age Ageing 2022; 51:6834153. [PMID: 36413592 DOI: 10.1093/ageing/afac255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/25/2022] [Revised: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Osteoporosis is common in older adults leading to fragility fractures at enormous individual and economic cost. Improving long-term adherence with bisphosphonate treatments reduces fracture risk, but adherence rates for first-line oral bisphosphonate alendronate remains low. Although alternative treatment regimens, including annual intravenous infusions are available, patient acceptability remains unclear. Therefore, understanding patients' acceptability and engagement in different bisphosphonate regimens is important to ensure optimal treatment benefits. METHODS Semi-structured interviews were conducted with 78 patients with a mean age of 69.9 years, who had taken or received bisphosphonates for osteoporosis within the last 24 months. Data analysis included iterative categorisation and used the theoretical framework of acceptability (TFA) to compare the acceptability of treatments regimens. RESULTS Treatment acceptability and engagement were influenced by the extent to which patients understood the prescribed treatment, and evidence of the treatment working. Acceptability and engagement were compromised when treatment was perceived as burdensome, personal costs were incurred, and patients' values were incompatible with the regimen. The balancing of these factors contributed to patients' ability to cope with the treatment and their emotional responses. Intravenous treatment was generally perceived as easier to understand, more effective, less burdensome with fewer opportunity costs, and a preferable regimen compared with oral bisphosphonates. CONCLUSIONS Annual intravenous zoledronate bisphosphonate treatment was generally more acceptable to patients, perceived as more straightforward to engage in, although a small portion of patients on oral bisphosphonates were satisfied with treatment. Further research is needed to identify how acceptability and engagement can be optimised.
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Affiliation(s)
- Melanie Narayanasamy
- Centre for Rehabilitation & Ageing Research, School of Medicine, University of Nottingham, Nottingham, UK
| | - Simon Bishop
- Organisational Behaviour and Human Resource Management, Nottingham University Business School, University of Nottingham, Nottingham, UK
| | - Opinder Sahota
- Geriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Zoe Paskins
- Primary Care and Health Sciences, School of Medicine, Keele University, Staffordshire, UK
| | - Neil Gittoes
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tessa Langley
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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Paskins Z, Bullock L, Manning F, Bishop S, Campbell P, Cottrell E, Jinks C, Narayanasamy M, Scott I, Sahota O, Ryan S. P059 Acceptability of remote consulting during COVID-19 among patients with two common long-term musculoskeletal conditions: findings from three qualitative studies and recommendations for practice. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.058] [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: 11/12/2022] Open
Abstract
Abstract
Background/Aims
The COVID-19 pandemic led to the widespread adoption of remote consultations. Whilst remote consultations offer many potential advantages to patients and healthcare services, they are unlikely to be suitable for all. Guidance encourages clinicians to consider patient preferences when choosing face-to-face vs remote consultations. However, little is known about acceptability of, and preferences for remote consultations, particularly amongst patients with musculoskeletal conditions. This study aimed to explore the acceptability of, and preferences for, remote consultations among patients with osteoporosis and rheumatoid arthritis.
Methods
Data for this study derived from three UK qualitative studies: iFraP (improving fracture prevention study), Blast Off (BO; Bisphosphonate aLternAtive regimenS for the prevenTion of Osteoporotic Fragility Fractures), and ERA (Exploring people with Rheumatoid Arthritis’ experience of the pandemic). Each study explored patient experiences of accessing and receiving healthcare during the pandemic year. Transcripts from each data set relating to remote consulting were extracted. A minimum of two study team members worked independently, following a consistent approach, to conduct a rapid deductive analysis using the Theoretical Framework of Acceptability (TFA). The TFA consists of 7 constructs to understand acceptability of, in this context, remote consultations, including: affective attitudes; intervention coherence; perceived effectiveness; burden; self-efficacy; opportunity-costs; and ethicality. Following coding, the findings of all three studies were pooled. Analysis was facilitated by group meetings to discuss interpretations.
Results
Findings from 1 focus group and 64 interviews with 35 people, who had mostly experienced telephone consultations, were included the analysis. Participants’ emotional attitudes to remote consultations, views on fairness (ethicality) and sense making (intervention coherence) varied according to their specific needs for the consultation and values, relative to the pandemic context; participants perceived remote consultations as making more sense and being ‘fairer’ earlier in the pandemic. Some participants valued the reduced burden associated with remote consultations, while others highly valued, and did not want to give up, non-verbal communication or physical examination associated with face-to-face consults (opportunity costs); although perceived need for physical examination in participants with RA was associated with strong preference for face-to-face consultations, asymptomatic participants with RA and osteoporosis also expressed similar strong preferences. Some participants described low confidence (self-efficacy) in being able to communicate in remote consultations and others perceived remote consultations as ineffective, in part due to suboptimal communication.
Conclusion
Acceptability of, and preferences for remote consultation appear to be influenced by a range of societal, healthcare provider and personal factors and in this study, were not fixed, or condition-dependent. Remote care by default has the potential to exacerbate health inequalities and needs nuanced implementation. The findings have supported the development of patient-centred recommendations for practice that should be considered alongside clinician-focused recommendations when deciding whether remote consultations are appropriate.
Disclosure
Z. Paskins: Grants/research support; NIHR, Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy. L. Bullock: None. F. Manning: Grants/research support; part funded NIHR Clinical Research Network Scholar Programme. S. Bishop: None. P. Campbell: None. E. Cottrell: None. C. Jinks: Grants/research support; part funded by the NIHR Applied Research Collaboration (ARC) West Midlands. M. Narayanasamy: None. I. Scott: Grants/research support; funded by an NIHR Advanced Research Fellowship Award (NIHR300826). O. Sahota: None. S. Ryan: None.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Laurna Bullock
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Fay Manning
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- University of Exeter Medical School, University of Exeter, Exeter, UNITED KINGDOM
| | - Simon Bishop
- Centre for Health Innovation, Leadership and Learning, University of Nottingham, Nottingham, UNITED KINGDOM
| | - Paul Campbell
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Elizabeth Cottrell
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Clare Jinks
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Melanie Narayanasamy
- Nottingham University Business School, University of Nottingham, Nottingham, UNITED KINGDOM
| | - Ian Scott
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Opinder Sahota
- Department of Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UNITED KINGDOM
| | - Sarah Ryan
- School of Nursing, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
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Paskins Z, Bullock L, Manning F, Bishop S, Campbell P, Cottrell E, Partner GP, Jinks C, Narayanasamy M, Scott IC, Sahota O, Ryan S. Acceptability of, and preferences for, remote consulting during COVID-19 among older patients with two common long-term musculoskeletal conditions: findings from three qualitative studies and recommendations for practice. BMC Musculoskelet Disord 2022; 23:312. [PMID: 35366845 PMCID: PMC8976169 DOI: 10.1186/s12891-022-05273-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Guidance for choosing face-to-face vs remote consultations (RCs) encourages clinicians to consider patient preferences, however, little is known about acceptability of, and preferences for RCs, particularly amongst patients with musculoskeletal conditions. This study aimed to explore the acceptability of, and preferences for, RC among patients with osteoporosis and rheumatoid arthritis. Methods Three UK qualitative studies, exploring patient experiences of accessing and receiving healthcare, undertaken during the pandemic, with people with osteoporosis and rheumatoid arthritis. Study team members agreed a consistent approach to conduct rapid deductive analysis using the Theoretical Framework of Acceptability (TFA) on transcripts from each data set relating to RC, facilitated by group meetings to discuss interpretations. Findings from the three studies were pooled. Results Findings from 1 focus group and 64 interviews with 35 people were included in the analysis. Participants’ attitudes to RC, views on fairness (ethicality) and sense-making (intervention coherence) varied according to their needs within the consultation and views of the pandemic. Some participants valued the reduced burden associated with RC, while others highly valued non-verbal communication and physical examination associated with face-to-face consults (opportunity costs). Some participants described low confidence (self-efficacy) in being able to communicate in RCs and others perceived RCs as ineffective, in part due to suboptimal communication. Conclusions Acceptability of, and preferences for RC appear to be influenced by societal, healthcare provider and personal factors and in this study, were not condition-dependant. Remote care by default has the potential to exacerbate health inequalities and needs nuanced implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05273-1.
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Baker P, Coole C, Drummond A, Khan S, McDaid C, Hewitt C, Kottam L, Ronaldson S, Coleman E, McDonald DA, Nouri F, Narayanasamy M, McNamara I, Fitch J, Thomson L, Richardson G, Rangan A. Occupational advice to help people return to work following lower limb arthroplasty: the OPAL intervention mapping study. Health Technol Assess 2020; 24:1-408. [PMID: 32930659 PMCID: PMC7520717 DOI: 10.3310/hta24450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hip and knee replacements are regularly carried out for patients who work. There is little evidence about these patients' needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively. OBJECTIVES To develop an occupational advice intervention to support early recovery to usual activities including work that is tailored to the requirements of patients undergoing hip or knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks. DESIGN An intervention mapping approach was used to develop the intervention. The research methods employed were rapid evidence synthesis, qualitative interviews with patients and stakeholders, a prospective cohort study, a survey of clinical practice and a modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the intervention mapping process. SETTING Orthopaedic departments in NHS secondary care. PARTICIPANTS Patients who were in work and intending to return to work following primary elective hip or knee replacement surgery, health-care professionals and employers. INTERVENTIONS Occupational advice intervention. MAIN OUTCOME MEASURES Development of an occupational advice intervention, fidelity of the developed intervention when delivered in a clinical setting, patient and clinician perspectives of the intervention and preliminary assessments of intervention effectiveness and cost. RESULTS A cohort study (154 patients), 110 stakeholder interviews, a survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, a personalised return-to-work plan and co-ordination from the health-care team to support the delivery of 13 patient and 20 staff performance objectives. To support delivery, a range of tools (e.g. occupational checklists, patient workbooks and employer information), roles (e.g. return-to-work co-ordinator) and training resources were created. Feasibility was assessed for 21 of the 26 patients recruited from three NHS trusts. Adherence to the defined performance objectives was 75% for patient performance objectives and 74% for staff performance objectives. The intervention was generally well received, although the short time frame available for implementation and concurrent research evaluation led to some confusion among patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff. LIMITATIONS Implementation and uptake of the intervention was not standardised and was limited by the study time frame. Evaluation of the intervention involved a small number of patients, which limited the ability to assess it. CONCLUSIONS The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention. FUTURE WORK The intervention warrants a randomised controlled trial to assess its clinical effectiveness and cost-effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure that adoption is sustained. STUDY REGISTRATION Current Controlled Trials ISRCTN27426982 and PROSPERO CRD42016045235. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 45. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Baker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Carol Coole
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sayeed Khan
- Make UK, The Manufacturers' Organisation, London, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lucksy Kottam
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David A McDonald
- Whole System Patient Flow Programme, Scottish Government, Edinburgh, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Nouri
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Melanie Narayanasamy
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Iain McNamara
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Judith Fitch
- British Orthopaedic Association Patient Liaison Group, Royal College of Surgeons of England, London, UK
| | - Louise Thomson
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- Faculty of Medical Sciences, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Stanulewicz N, Knox E, Narayanasamy M, Shivji N, Khunti K, Blake H. Effectiveness of Lifestyle Health Promotion Interventions for Nurses: A Systematic Review. Int J Environ Res Public Health 2019; 17:E17. [PMID: 31861367 PMCID: PMC6981404 DOI: 10.3390/ijerph17010017] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/15/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prior research has investigated various strategies to improve health, wellbeing and the job-related outcomes of nurses. However, the scope of this evidence is not clear and the types of intervention most likely to have positive outcomes are unknown. OBJECTIVE To provide an overview and synthesis of the effectiveness of interventions conducted with the goal of improving health, wellbeing and the job-related outcomes of nurses. METHODS A systematic database search was conducted from January 2000 to December 2018, with pre-defined criteria (Cochrane Central Register of Controlled Trials; MEDLINE and PubMed; EMBASE; CINAHL; PsycINFO; and BioMed Central). In total, 136 intervention studies with a total sample of 16,129 participants (range 9-3381) were included and evaluated. Data extraction, quality assessment and risk of bias analyses were performed. RESULTS Studies included randomised controlled trials (RCTs; n = 52, 38%), randomised crossover design studies (n = 2, 1.5%) and non-randomised pre-post studies with a control group (n = 31, 23%) and without a control group (n = 51, 37.5%). The majority of interventions focused on education, physical activity, mindfulness, or relaxation. Thirty-seven (27%) studies had a multimodal intervention approach. On average, studies had relatively small samples (median = 61; mode = 30) and were conducted predominantly in North America (USA/Canada, n = 53). The findings were mixed overall, with some studies reporting benefits and others finding no effects. Dietary habits was the most successfully improved outcome (8/9), followed by indices of body composition (20/24), physical activity (PA) (11/14), and stress (49/66), with >70% of relevant studies in each of these categories reporting improvements. The lowest success rate was for work-related outcomes (16/32). Separate analysis of RCTs indicated that interventions that focus solely on education might be less likely to result in positive outcomes than interventions targeting behavioural change. CONCLUSIONS Interventions targeting diet, body composition, PA, or stress are most likely to have positive outcomes for nurses' health and/or wellbeing. The methodologically strongest evidence (RCTs) is available for body composition and stress. Interventions relying solely on educational approaches are least likely to be effective. Organisational outcomes appear to be more challenging to change with lifestyle intervention, likely requiring more complex solutions including changes to the work environment. There is a need for more high-quality evidence since many studies had moderate or high risk of bias and low reporting quality.
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Affiliation(s)
- Natalia Stanulewicz
- School of Applied Social Sciences, De Montfort University, Leicester LE1 9BH, UK
| | - Emily Knox
- Infant Nutrition and Metabolism, University of Granada, 52005 Granada, Spain;
| | - Melanie Narayanasamy
- School of Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK; (M.N.); (H.B.)
| | - Noureen Shivji
- School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, UK;
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK;
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK; (M.N.); (H.B.)
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
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Abstract
PURPOSE An ageing workforce means that our understanding of return to work following total hip and knee replacement is of increasing importance. The purpose of this qualitative study was to explore the views and experiences of clinicians in treating working patients undergoing total hip or knee replacement. MATERIALS AND METHODS We conducted semi-structured interviews in primary and secondary National Health Service care using framework methodology. A total of 40 interviews were conducted. Participants included 12 hospital-based Allied Health Professionals and nurses, 12 orthopedic surgeons, and 16 General Practitioners. Data were analyzed thematically. RESULTS A key theme concerned participants' perceptions and experiences around the process and practice of listing working patients for total hip or knee replacement. Four sub-themes were identified; the perceived likelihood of listing employed patients for surgery, expectations and outcomes of surgery, the impact of work issues, and referral procedures and waiting lists. CONCLUSIONS Decisions around listing working patients for total hip and knee replacement are complex and difficult. Clinicians need to consistently consider patients' work issues, and to be supported in this by appropriate commissioning and service delivery decisions. Further research is indicated to better understand the work-related expectations and anticipated outcomes of both patients and clinicians, and the optimum timing of surgery to maintain and improve patients' work performance.Implications for rehabilitationClinicians need to consistently consider patients' work issues, and current evidence, in their consultations and decisions regarding total hip and knee replacement.Clinical practice should reflect the growing proportion of working patients undergoing total hip and knee replacement, and routinely measure work outcomes.Changes are required at commissioning and service levels to support clinicians in changing their practice with this patient population.
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Affiliation(s)
- Carol Coole
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Nouri
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Paul Baker
- James Cook University Hospital, South Tees NHS Hospitals Trust, Middlesbrough, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Nouri F, Coole C, Narayanasamy M, Baker P, Khan S, Drummond A. Managing Employees Undergoing Total Hip and Knee Replacement: Experiences of Workplace Representatives. J Occup Rehabil 2019; 29:451-461. [PMID: 30132175 PMCID: PMC6531398 DOI: 10.1007/s10926-018-9805-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 05/26/2023]
Abstract
Introduction There is little research on return to work (RTW) from a workplace perspective following hip and knee replacement (THR/TKR) despite employers and other workplace personnel having a key role. Our aim was to explore the experiences of individuals in the workplace in managing employees undergoing THR/TKR. Methods Employers and other workplace representatives from a cross-section of employment sectors and sizes, with experience of managing employees undergoing THR/TKR in the previous 12 months, were recruited. Interviewees included small business owners, line managers, colleagues, human resources managers and occupational health advisers. Semi-structured, qualitative interviews were conducted and data were analysed thematically. Results Twenty-five individuals were interviewed. The main themes identified were accommodating the employee, and barriers and facilitators to RTW. Accommodations included changes to the work environment, amended duties, altered hours, changed roles and colleague support. Perceived barriers and facilitators to RTW included the role of GPs and occupational health, surgical issues, characteristics of the work environment and of employees. Conclusions Employers are motivated to effect supported RTW for employees undergoing THR/TKR but have insufficient guidance. Strategies are required to signpost employers to existing RTW advice, and to develop recommendations specific to lower limb arthroplasty. Communication between medical practitioners and employers should be facilitated in order to enhance the RTW experience of individuals undergoing THR/TKR.
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Affiliation(s)
- Fiona Nouri
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Carol Coole
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Melanie Narayanasamy
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Paul Baker
- South Tees NHS Hospitals Trust, James Cook University Hospital, Middlesbrough, TS3 4BW, UK
| | - Sayeed Khan
- The Buckingham Centre, Collingwood Health, 30 Bradford Road, Slough, SL1 4PG, UK
| | - Avril Drummond
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
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Coole C, Nouri F, Narayanasamy M, Baker P, Khan S, Drummond A. Engaging workplace representatives in research: what recruitment strategies work best? Occup Med (Lond) 2018; 68:282-285. [PMID: 29579293 DOI: 10.1093/occmed/kqy047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Workplaces are key stakeholders in work and health but little is known about the methods used to recruit workplace representatives (WRs), including managers, occupational health advisers and colleagues, to externally funded healthcare research studies. Aims To detail the strategies used in recruiting WRs from three areas of the UK to a qualitative study concerning their experience of employees undergoing hip or knee replacement, to compare the strategies and inform recruitment methods for future studies. Methods Six strategies were used to recruit WRs from organizations of different sizes and sectors. Data on numbers approached and responses received were analysed descriptively. Results Twenty-five WRs were recruited. Recruitment had to be extended outside the main three study areas, and took several months. It proved more difficult to recruit from non-service sectors and small- and medium-sized enterprises. The most successful strategies were approaching organizations that had participated in previous research studies, or known professionally or personally to team members. Conclusions Recruiting a diverse sample of WRs to healthcare research requires considerable resources and persistence, and a range of strategies. Recruitment is easier where local relationships already exist; the importance of building and maintaining these relationships cannot be underestimated. However, the potential risks of bias and participant fatigue need to be acknowledged and managed. Further studies are needed to explore how WRs can be recruited to health research, and to identify the researcher effort and costs involved in achieving unbiased and representative samples.
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Affiliation(s)
- C Coole
- School of Health Sciences, University of Nottingham, Medical School, Queens Medical Centre, Nottingham, UK
| | - F Nouri
- School of Health Sciences, University of Nottingham, Medical School, Queens Medical Centre, Nottingham, UK
| | - M Narayanasamy
- School of Health Sciences, University of Nottingham, Medical School, Queens Medical Centre, Nottingham, UK
| | - P Baker
- James Cook University Hospital, South Tees NHS Hospitals Trust, Middlesbrough, UK
| | - S Khan
- Collingwood Health, The Buckingham Centre, Slough SL1, UK
| | - A Drummond
- School of Health Sciences, University of Nottingham, Medical School, Queens Medical Centre, Nottingham, UK
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Johnston B, Coole C, Narayanasamy M, Feakes R, Whitworth G, Tyrell T, Hardy B. Exploring the barriers to and facilitators of implementing research into practice. Br J Community Nurs 2017; 21:392-8. [PMID: 27479853 DOI: 10.12968/bjcn.2016.21.8.392] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
District and community nursing roles have changed rapidly in recent years. Community nurses are increasingly being tasked with carrying out multiple roles, which require them to put research into practice and use evidence-based tools and interventions. The implementation of interventions and tools needs to be developed from empirical research, requiring evidence, to be translated into practice. However, this process may be compromised or enhanced by a number of factors. This exploratory, descriptive qualitative study sought to identify barriers and facilitators to community nurses implementing research into practice. Four focus groups were conducted with registered community nurses and district nurses (n=22). Analysis identified four main themes: keeping up to date with evidence; using a clinical tool; education/training and implementation. Findings suggest that there are barriers at a personal, professional and organisational level. Strategies are suggested to overcome these obstacles.
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Affiliation(s)
- Bridget Johnston
- Florence Nightingale Foundation, Professor of Clinical Nursing Practice Research, University of Glasgow
| | - Carol Coole
- Senior Research Fellow, University of Nottingham
| | | | - Ruth Feakes
- Senior Community Macmillan Clinical Nurse Specialist, Nottingham CityCare Partnership CIC
| | - Gillian Whitworth
- Community Macmillan Clinical Nurse Specialist, Nottinghamshire Healthcare NHS Foundation Trust
| | - Tracy Tyrell
- Director of Nursing and Allied Health Professionals, Nottingham CityCare Partnership CIC
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Johnston B, Narayanasamy M. Exploring psychosocial interventions for people with dementia that enhance personhood and relate to legacy- an integrative review. BMC Geriatr 2016; 16:77. [PMID: 27044417 PMCID: PMC4820853 DOI: 10.1186/s12877-016-0250-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/23/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Epidemiological predictions suggest that dementia will continue to rise and that this will have social and economic ramifications. Effective interventions, beyond pharmacological management are needed. Psychosocial interventions have largely been investigated in relation to carers of people with dementia, or with regards to their ability to manage dementia symptoms, improve cognition, and reduce challenging behaviour. However, since dementia is a life-limiting illness and people with dementia are at risk of having their personhood compromised, psychosocial interventions should seek to enhance personhood, and offer the potential for the person to leave a legacy. METHODS An integrative review was carried out to identify, assess, appraise and synthesise studies featuring interventions, which relate to both personhood and legacy. Search strategies were developed in key databases: MEDLINE; PsycINFO; Embase; Joanna Briggs Institute; CINAHL; Cochrane Database of Systematic Reviews; ASSIA. Grey literature was also identified through free-text searches. RESULTS Thirty six articles were included in the final review, these were tabulated and were assessed based on how the intervention related to personhood and legacy. Classification resulted in three themes being identified: Offering aspects of legacy; Acknowledging the person behind the patient; Facilitating meaningful engagement. Generally, personhood aspects of interventions were well reported, but further research is required to explore legacy potential of psychosocial interventions for people with dementia. CONCLUSION The integrative review provides an overview and exploration of an under-researched area, and provides directions for future research, which will help expand the evidence base and ultimately help improve patient care for people with dementia and their families.
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Affiliation(s)
- Bridget Johnston
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, The University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, England, UK.
| | - Melanie Narayanasamy
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, The University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, England, UK
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Musa I, Seymour J, Wada T, Narayanasamy M, Conroy S. 50 * A SURVEY OF OLDER PEOPLES' ATTITUDES TOWARDS ADVANCE CARE PLANNING. Age Ageing 2015. [DOI: 10.1093/ageing/afv033] [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: 11/13/2022] Open
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Johnston B, Pringle J, Gaffney M, Narayanasamy M, McGuire M, Buchanan D. The dignified approach to care: a pilot study using the patient dignity question as an intervention to enhance dignity and person-centred care for people with palliative care needs in the acute hospital setting. BMC Palliat Care 2015; 14:9. [PMID: 25883533 PMCID: PMC4399754 DOI: 10.1186/s12904-015-0013-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 03/20/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Providing person-centred, dignity-conserving care for hospitalised patients is central to many healthcare policies and essential to the provision of effective palliative care. The Patient Dignity Question (PDQ) "What do I need to know about you as a person to take the best care of you that I can?" was designed from empirical research on patients' perceptions of their dignity at end of life to help healthcare professionals (HCPs) understand the patient as a person. METHODS This mixed method pilot study was designed to inform a larger multisite study in the future. It tests the hypothesis that the PDQ intervention could be used to enhance a more person-centred climate for people with palliative care needs in the acute hospital setting, and provide evidence regarding its acceptability. Outcome measures pre and post intervention Person-centred Climate Questionnaire--patient version (PCQ-P), and the Consultation and Relational Empathy (CARE) measure; PDQ feedback questionnaires were used for all participants post intervention, in addition to qualitative interviews. RESULTS 30 patients, 17 HCPs, and 4 family members participated. Results showed a positive correlation between higher PCQ-P scores and higher CARE scores, indicating that the PDQ can make improvements to a person-centred environment and levels of empathy perceived by patients. Individual results from the PCQ-P and the CARE indicated overall improvements in the majority of fields. The PDQ supported disclosure of information previously unknown to HCPs, has implications for improving person-centred care. Positive results from PDQ feedback questionnaires were received from all participants. Qualitative findings indicated patients' appreciation of staff (Attributes and attitudes), that patients wanted staff to have awareness of them (Know me as a person), take the time to talk, and work flexibly, to allow for patient individuality (Time and place). CONCLUSION The PDQ has potential to improve patients' perceptions of care, and HCP attitudes. Furthermore, it was well received by participants. The PDQ could be incorporated into clinical practice for the care of palliative care patients in the acute setting to the benefit of personalized and dignified care. Further research using the PDQ across wider geographical areas, and more diverse settings, would be beneficial.
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Affiliation(s)
- Bridget Johnston
- />Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, The University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2HA, England UK
| | - Jan Pringle
- />School of Education, Social Work and Community Education, University of Dundee, C.2.16 Carnelley Building, Dundee, DD1 4HN, Scotland UK
| | - Marion Gaffney
- />Royal Victoria Hospital, Roxburghe House, Jedburghe Road, Dundee, DD2 1SP, Scotland UK
| | - Melanie Narayanasamy
- />Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, The University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2HA, England UK
| | - Margaret McGuire
- />NHS Tayside Headquarters, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland UK
| | - Deans Buchanan
- />Ninewells Hospital, NHS Tayside, Dundee, DD1 9SY, Scotland UK
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Johnston B, Larkin P, Connolly M, Barry C, Narayanasamy M, Östlund U, McIlfatrick S. Dignity-conserving care in palliative care settings: An integrative review. J Clin Nurs 2015; 24:1743-72. [DOI: 10.1111/jocn.12791] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Bridget Johnston
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care; School of Health Sciences; The University of Nottingham; Queen's Medical Centre; Nottingham UK
| | - Philip Larkin
- School of Nursing, Midwifery and Health Systems; University College Dublin and Our Lady's Hospice and Care Services; Dublin 4 Ireland
| | - Michael Connolly
- School Of Nursing, Midwifery & Health Systems; Health Sciences Centre; University College Dublin; Dublin 4 Ireland
- All Ireland Institute of Hospice & Palliative Care (AIIHPC); Education and Research Centre; Our Lady's Hospice and Care Services; Harold's Cross Dublin Ireland
| | - Catriona Barry
- Dignity Care Intervention Ireland; All Ireland Institute of Hospice and Palliative Care; Education and Research Centre; Our Lady's Hospice and Care Services; Harold's Cross Dublin Ireland
| | - Melanie Narayanasamy
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care; School of Health Sciences; The University of Nottingham; Queen's Medical Centre; Nottingham UK
| | - Ulrika Östlund
- Division of Nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
- Department of Health and Caring Sciences; Faculty of Health and Life Sciences; Linnaeus University; Kalmar Sweden
| | - Sonja McIlfatrick
- University of Ulster/All Ireland Institute of Hospice & Palliative Care (AIIHPC); Newtownabbey UK
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Nairn S, Hardy C, Harling M, Parumal L, Narayanasamy M. Diversity and ethnicity in nurse education: the perspective of nurse lecturers. Nurse Educ Today 2012; 32:203-207. [PMID: 21419532 DOI: 10.1016/j.nedt.2011.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 02/21/2011] [Accepted: 02/21/2011] [Indexed: 05/30/2023]
Abstract
This paper is a report on a qualitative study which considered the issue of how lecturers feel about teaching and managing the topic of culture and racism within their role as nurse educators. The issue of cultural diversity and the related issue of racism within nursing and society more generally means that the problem cannot be ignored since one of the central tenets of nursing is that care should be delivered in non-discriminatory ways. We interviewed a group of lecturers within a UK university to explore their views on the topic. We produced six themes: Culture; the existence of racism within nursing; challenging racism; political correctness; strategies adopted to address issues in the classroom and the presence of cultural diversity within the curriculum. We identified that the lecturers in our study were keen to address the issue but were also very concerned about their own abilities and confidence in this area.
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Affiliation(s)
- Stuart Nairn
- University of Nottingham, School of Nursing, Midwifery and Physiotherapy, Derby Education Centre, London Road Community Hospital, Derby, DE1 2QY, UK.
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Testoni JE, Pacheco AJ, Napoli DR, Stefanini AM, Corradi L, Million B, Narayanasamy M, Spolaore P, Beghini S, Montagnoli G, Scarlassara F, Segato GF, Signorini C, Soramel F. Near-barrier transfer reactions in the 36S+144,154Sm systems. Phys Rev C Nucl Phys 1992; 45:748-758. [PMID: 9967810 DOI: 10.1103/physrevc.45.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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