Information in radiotherapy for men with localised prostate cancer: An integrative review.

INTRODUCTION: Men with prostate cancer may receive radiotherapy as part of their management. They encounter a range of information related to radiotherapy, and a crucial role for therapeutic radiographers and other healthcare practitioners is ensuring patients receive appropriate information related to their treatment. This integrative review aims to identify, synthesise and analyse literature reporting experiences of men with localised prostate cancer related to information in radiotherapy. METHODS: A systematic literature search encompassing database and hand searches was carried out between February and March 2017 with date limits of 2000-2017 applied. Initially, 4,954 articles were identified. Systematic screening and detailed examination identified that 33 met the inclusion criteria. Data were synthesised and analysed thematically. RESULTS: Few studies explicitly addressed the issue of information in radiotherapy for men with localised prostate cancer. Themes that emerged and were explored are information needs, information regarding adverse effects, information and time, information preferences, satisfaction with information related to radiotherapy and patient experience related to radiotherapy information. CONCLUSION: This review suggests that although several aspects related to information for men with localised prostate cancer have been documented, few were explored in detail with respect to radiotherapy indicating that further research in this area is warranted.

You cannot choose your family: sociological ambivalence in the hemodialysis unit.

Living with end-stage renal disease is challenging and requires a great deal of self-management, but little is known about the experiences of patients and staff around the subject. We held six focus groups in three hemodialysis units, each unit hosting 1 staff and 1 patient focus group. A total of 15 staff members and 15 patients participated. We employed thematic analysis using a priori and emerging codes. Five key themes emerged: challenges, enablers, complex balancing acts, good patient/bad patient, and the hemodialysis unit as a family. We explored the family metaphor further through the work of Bourdieu, but concluded that relationships in the hemodialysis unit most closely fit the concept of sociological ambivalence. We present an explanatory framework around inherent tensions characterizing relationships within the hemodialysis unit and highlight implications for facilitating self-management and developing collaborative approaches to care.

Evaluation of services for children with complex needs: mapping service provision in one NHS Trust.

AIM: The aim of this paper is to identify and descriptively map the key characteristics of the model of service delivery in operation, and to explore the user, carer and professional experience of service provision. This included an exploration of congruity and mismatch between the different stakeholder groups. BACKGROUND: In the United Kingdom (UK), 15% of the children under five years of age and 20% of the 5 to 15-year age group are reported to have a complex long-term condition, with the likelihood of having a condition increasing according to socio-economic circumstances. An increasing number of young people with complex needs are now surviving into late adolescence and early adulthood. However, service provision for children with complex needs is an area that, nationally, has been underdeveloped. METHODS: An exploratory single-site case study was undertaken across one Primary Care Trust in the UK. Documentary and policy review were undertaken along with in-depth qualitative exploration. Eighteen in-depth interviews were undertaken with relevant stakeholders and professionals across the multidisciplinary teams. Families with children between 12 months and 16 years of age who have continuing complex care needs were invited to take part in an interview to give their views about the care they receive. Interviews focused on the family experience and understanding of the child's condition, transition between secondary and primary care, effectiveness of admission and discharge planning and the overall contribution of different professionals. Professionals were also asked about their experiences of delivering care. Findings This study highlighted issues of communication between professionals and with parents and children as a major factor in determining the quality of service provision. Key aspects relating to the model of service provision, namely, paucity of communication, interagency collaboration and the parent as health worker, are highlighted. CONCLUSIONS: Parents experienced both health and social service communication challenges when seeking care for their child. These challenges can be located within a general systems theory and hierarchy approaches to understand the complexity of service provision.

Case management in long term conditions: an inconsistent journey?

This paper sets out to assess the evidence of the use of a case management approach when dealing with long term conditions in the UK. It draws on published papers, some of which emulated or adapted strategies that were used in the USA. The review found that despite there being a unified definition of case management, patients and carers reported benefits of being case managed. However, the wide differences in the factors relating to outcome measures resulted in inconclusive evidence about the effectiveness of case management.

The anatomy, physiology and pathogenesis of a significant untoward incident.

This paper provides a structured chronology of an investigation into a significant untoward incident in an elderly care ward. Using Reason's Swiss Cheese Model, which has become one of the dominant paradigms for analysing clinical and patient safety incidents, it charts the interplay of national and local policies resulting in unsafe practice. A qualitative approach was used in this multidimensional investigation. This approach aimed to discover what actually happened in the specific and related incidents and the underlying causes. Thus, the anatomy of the incident refers to the structure of staffing, the physiology includes the process in place at the time of the incident and the pathogenesis alludes to the development of the incident. The findings report on the patients involved in the incident. The investigation also explores how strategic financial directions from the Department of Health impact on staffing levels and training. These are contextualised using the concepts of the Swiss Cheese Model to assist understanding of how and why the incident occurred. Key points emanating from a learning event are captured to aid understanding and the importance of being cognisant of the ever present risks in clinical practice. The impact of the investigation on staff and the primary care trust are also presented.

Improving health and care for patients by redesigning services: the development and implementation of a clinical assessment service in Harrow Primary Care Trust.

The redesign of healthcare services in Harrow Primary Care Trust is due to a number of drivers including: centrally imposed targets as outlined in various policy documents; shifting the balance of care; service delivery in a challenging financial climate; response to national consultations which indicate that patients want services nearer to home; and local and national knowledge of providing different types of services. A local enhanced scheme was devised by the trust to support general practitioners to follow care pathways using evidence-based literature, best practice and discussions with clinicians, nurses and patient representatives. The result was an ambitious and innovative service which has attracted attention from neighbouring London primary care trusts, which are seeking to replicate the model.

The health of a nation: perspectives from Cuba's national health system.

This paper focuses on the current healthcare system in Cuba and provides a description of an alternative healthcare provision. The information is based on a visit to the country in 2007 as a member of a health study tour. The purpose of the visit was to explore the functioning of a population-based health service and to interview key people. The data are compared with the literature on Cuba. The effects of the economic crisis, the US embargo and the absence of international debate about Cuba's health achievements are discussed.

The use of cognitive continuum theory and patient scenarios to explore nurse prescribers' pharmacological knowledge and decision-making.

BACKGROUND: Nurses have been involved in prescribing in England since 1996, and to date over 41,000 nurses are registered with the Nursing and Midwifery Council as prescribers. The majority of evaluative research on nurse prescribing is descriptive and relies on self-report and assessment of patient satisfaction. OBJECTIVES: To explore and test nurse prescribers' pharmacological knowledge and decision-making. DESIGN: An exploratory approach to test the usefulness of patient scenarios in addressing the reasons why nurses decide whether or not to prescribe was utilised. Semi-structured interviews with nurse prescribers using patient scenarios were used as proxy methods of assessment of how nurses made their prescribing decisions. SETTING: Two primary care trusts in the southeast of England were the settings for this study. PARTICIPANTS: Purposive sampling to ensure there was a mixed group of prescribers was used to enable detailed exploration of the research objectives and to obtain in-depth understanding of the complex activities involved in nurse prescribing. METHODS: Interviews and case scenarios. The use of cognitive continuum theory guided the analysis. RESULTS: The majority of participants were unable to identify the issues involved in all the scenarios; they also failed to provide an acceptable solution to the problem, suggesting that they would refer the patient to the general practitioner. A similar number described themselves as 'very confident' while seven participants felt that they were 'not confident' in dealing with medication issues, four of whom were practising prescribing. CONCLUSIONS: The effects of social and institutional factors are important in the decision-making process. The lack of appropriate pharmacological knowledge coupled with lack of confidence in prescribing was demonstrated. The scenarios used in this study indicate that nurses are perhaps knowledgeable in their small area of practise but flounder outside this. Further research could be conducted with a larger sample and with more scenarios to explore the decision-making and the pharmacological knowledge base of nurse prescribers, particularly in the light of government policy to extend prescribing rights to non-medical prescribers, including pharmacists.

A qualitative study of the impact of the implementation of advanced access in primary healthcare on the working lives of general practice staff.

BACKGROUND: The North American model of 'advanced access' has been emulated by the National Primary Care Collaborative in the UK as a way of improving patients' access in primary care. The aim of this study was to explore the impact of the implementation of advanced access on the working lives of general practice staff. METHODS: A qualitative study design, using semi-structured interviews, was conducted with 18 general practice staff: 6 GPs, 6 practice managers and 6 receptionists. Two neighbouring boroughs in southeast England were used as the study sites. NUD*IST computer software assisted in data management to identify concepts, categories and themes of the data. A framework approach was used to analyse the data. RESULTS: Whilst practice managers and receptionists saw advanced access as having a positive effect on their working lives, the responses of general practitioners (GPs) were more ambivalent. Receptionists reported improvements in their working lives with a change in their role from gatekeepers for appointments to providing access to appointments, fewer confrontations with patients, and greater job satisfaction. Practice managers perceived reductions in work stress from fewer patient complaints, better use of time, and greater flexibility for contingency planning. GPs recognised benefits in terms of improved consultations, but had concerns about the impact on workload and continuity of care. CONCLUSION: AA has improved working conditions for receptionists, converting their perceived role from gatekeeper to access facilitator, and for practice managers as patients were more satisfied. GP responses were more ambivalent, as they experienced both positive and negative effects.

A critical account of obtaining research governance approval.

Research governance strategies, as currently operated are potentially limiting the conduct of research, especially multi-centre studies. The authors provide an overview of the current research governance framework in the UK and, using the example of one study as an illustrative case, describe and discuss a research team's experience of gaining research governance approval for a multi-centre study.

Decision-making in primary care: outcomes from a study using patient scenarios.

BACKGROUND: Various documents emphasize the importance of new roles and new ways of working to modernise delivery of health service and improve the public's health. In particular nurse practitioners are seen as crucial in the modernization process. AIM: This paper reports the outcomes of a study conducted in 1998 to ascertain the differences, if any, in the decision-making processes of nurse practitioners and general practitioners for diagnosis and treatment when given the same patient scenarios. METHODS: Information processing theory together with 'think aloud' approach were used to understand the cognitive processes of the 22 participants, 11 general practitioners and 11 nurse practitioners, in the study. A reference model was developed for each of the six scenarios of the study; three medical photographs were also used. The data were analysed using NUD*IST computer software. RESULTS: The outcomes of each scenario are presented and comparisons are made with general practitioners. The results show that there were more similarities than differences in the decision-making processes of the two groups. Hypothesis evaluation appears to be the critical component in the decision-making process. Explanations given by the two groups at the end of their 'think aloud' procedure justify their diagnoses and treatment/management plans. CONCLUSIONS: The research adds to existing evidence that encourages health care providers to use nurse practitioners more flexibly and to develop service-based approaches to the delivery of health care as set down in government policies. It also adds to the body of literature using information processing theory because it demonstrates that the two groups use similar decision-making processes to arrive at similar diagnoses and treatment options.

Access to primary care: decision making by GP receptionists.

Current government strategy emphasizes the importance of widening access to health service to better serve the users of the system. There is also burgeoning empirical evidence in decision-making in health care. Yet despite this, little attention has been given to the decision-making of a key group of workers--general practice receptionists. Drawing on a larger study with general practitioners, nurse practitioners, patients and receptionists, this qualitative study explores the decision-making of 15 general practice receptionists in the same number of general practices, in a variety of locations. The study documents how patients are categorized by the receptionist and the control strategies used in processing patients to access general practitioners or nurse practitioners. Implications for practice are highlighted.