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Maintaining the functional ability and quality of life of patients leaving hospital

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Carrie Milligan

Carrie Milligan graduated from the University of Stirling in November 2016 with a Masters in Advanced Practice. Her dissertation was a Quality Improvement Project and focused within her work place.

She was awarded a Research-Based Learning Prize for her dissertation titled: Maintaining the functional ability and quality of life of patients leaving hospital: improving information sharing with care home staff on discharge from an organic assessment ward.

 We found out about Carrie and her work:

Tell us about your project:

I am a Specialist Occupational Therapist working in older peoples’ mental health. The project was focused in the organic assessment ward that I work within. It looked at the communication process from the inpatient setting to the care home. Our patient group is complex, and admission lengths at the commencement of the project were, on average, 98 days. There is some evidence that patients’ quality of life and functional ability decreases on discharge from hospital.  I wondered if improved information sharing could also lead to improved outcomes for patients.

The discharge communication process is reliant on one nurse disseminating the assessments, interventions and treatments of the multi-disciplinary team on discharge.  This means that important information from other clinical disciplines, such as occupational therapy, were not being shared with care homes when patients were discharged from hospital. Consistent and timely information sharing between the multidisciplinary teams hospital and care home staff sounds simple, but is not as straightforward as it seems.

What was the aim of your project?

I aimed to develop and implement a new information care procedure to make sure care homes were receiving all appropriate information about a patient when they were discharged.  We were interested to find out if this process would also lead to improvements in patients’ quality of life, functional ability and Body Mass Index (BMI) on transfer.

 How did you carry it out?

 I used various methods recommended by the Improvement Science approach. A new discharge form was created through consultation with members of the multi-disciplinary team and community staff, including social work. Staff engagement was vital. Continuous education about the new project was required to inform and engage with new ward staff.

The impact of the project was measured using questionnaires with staff in the ward, care homes, and the liaison mental health team. Patient outcomes were measured using quality of life and functional ability scales, and body mass index (BMI) before and four weeks after discharge. Audits of the new discharge form measured how regularly and correctly staff were using the form.

 What was the impact of your project?

Twenty patients were discharged from the ward over 6 months using the new discharge form: 13 were discharged to a care home and 7 returned to their own home. The 13 patients’ discharged to care home were evaluated pre-discharge and post-discharge at 4 weeks by telephone to the care home. One patient died during this time.

Over the six months of the project 98% of professions engaged in the form’s completion. The 12 patients demonstrated an increase in their BMI, 42% improved or maintained their functional ability and 75% improved or maintained their quality of life. All care homes reported a benefit to the increased information to their care of the patient.

This impact of improved sharing of information from hospital to care home appeared to improve patients’ quality of life, function and BMI on their transfer to a care home setting.

 What were your conclusions?

The use of the new multi-disciplinary discharge form increased the level and consistency of information disseminated to a care home on discharge. The information aided care homes to shape their care for the patient.

There appears to be a positive impact of improving communication between the ward and care homes on patient outcomes as demonstrated through their BMI, Quality of Life and Functional Ability on discharge. However, this improvement was only measured over a short time frame with a limited number of patients, and without any control group.

What next for the project?

This project has shown that improved information sharing systems can increase the range of important clinical information that is shared and may benefit patient outcomes. I hope to continue to improve the discharge information sharing processes on the ward.

27 January 2017

How bucket lists help the terminally ill – and those around them

edward-duncanDr Edward Duncan has written in The Conversation UK:

“Buckets lists – inventories of things to do before you die – are often developed by people who know they have little time left. It seems like a good idea. But are they really beneficial, or can they cause harm? And is it really useful to generate lists that may – either due to expense or illness – be perceived as unrealistic?”

Please click here for the full article.

15 December 2016

Why NHS leaders who blow the whistle on poor care should be applauded

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Dr Edward Duncan

Dr Edward Duncan writes in The Conversation:

“Scotland’s most senior nurse, Fiona McQueen, has publicly apologised after an outcry following her publishing a blog which called for greater professionalism in nursing and midwifery. She shouldn’t have felt she had to do so.”

Read the full article here.

Dr Edward Duncan
Senior Research Fellow in Health Science, University of Stirling

21 January 2016

 

Devolving Care – Centre on Constitutional Change

Photo of Kirstein Rummery

Kirstein Rummery

The devolution of welfare benefits to Scotland, especially those relating to disabled people and carers, provides an opportunity to transform the way Scotland approaches welfare and care policy says Kirstein Rummery.

Source: Devolving Care

Being the First to Breastfeed in a Family: Challenges and opportunities for change

Photo of mother breastfeeding her babyBreastfeeding is widely accepted as having health and wellbeing benefits for mothers and babies.  Consequently national policies have been developed and significant investment made, to encourage more women to breastfeed. Despite this, breastfeeding rates in Scotland have increased very little in the last ten years.

My curiosity about why this might be led me to undertake my PhD with the University of Stirling.  While there are many factors which affect breastfeeding decision making, having a family history of breastfeeding appears to be one of the most important.  Women who were not breastfed themselves are nearly 30% less likely to start breastfeeding than those who were breastfeeding themselves as babies. There are, however, few studies which have investigated this area.

My study begins to fill this gap by investigating the experience of being the first to breastfeed in a family and making a different feeding choice from that of one’s own mother and sisters. This was though the analysis of conversations with fourteen mothers who had breastfed, using semi structured interviews and a new research tool which I developed, the Infant Feeding Genogram, which shares similarities with ‘family tree’ diagrams. Participants were selected through local toddler groups and via social media and a qualitative method, Interpretative Phenomenological Analysis, was used to analyse the data.

The analysis found four high level themes:

  • Breaching family and social norms;
  • Volitions and imperatives;
  • Unprepared for the challenge; and
  • A sacrifice but worth it.

These themes were integrated and demonstrated that breastfeeding was not the straightforward process women were expecting from antenatal classes, rather it could be isolating, painful, distressing and conflictual.

Women found that formula feeding was the default position and that their immediate community and family culture was unsupportive of breastfeeding, involving both overt criticism and more subtle undermining. To avoid this and to maintain relationships, many women adapted their behaviour, for example not breastfeeding in public or in front of family members or avoiding asking for parenting help. There were also, however, powerful moments of joy and connection from the exclusive relationship they formed with their baby. This raised their self-esteem and helped them feel like ‘complete mothers’. This fitted with their understanding of some of society’s positive representation of breastfeeding as being the ‘best and most natural’ way to feed a baby.

Photo of Dr Kirsty Darwent

Dr Kirsty Darwent

Undertaking this research has led me to make some recommendations about how to improve women’s breastfeeding experience. Firstly, breastfeeding needs to be represented in a more realistic way in antenatal classes which acknowledges the physical and emotional difficulties that women often experience. Added to this, policy-makers need to consider the implications of the ‘Breast is Best’ and breastfeeding as ‘natural’ messages that are often used in public health messages, as although they appear to influence some women’s decision making and raise their self esteem, they have implications for women who make formula feed their babies, who were judged by breastfeeding mothers for making a less acceptable decision.

Finally, the health service needs to take a mother and family focussed approach to breastfeeding, recognising the importance of infant feeding history and family members’ limited ability to provide support to their daughters when they breastfeed. This means health professionals need the skills to actively involve women and their families in looking at their family stories which support or undermine women’s breastfeeding and the Infant Feeding Genogram appears to be a useful tool to assist with this.

Having satisfied some of my own curiosity, my next steps involve sharing my ideas and testing them with practitioners and policy makers to see if they also find them interesting and useful. This feedback will shape the next stages, which I hope will involve developing and testing this new focus with women and their families. Please don’t hesitate to get in touch, if you would like to be involved in this process.

Dr Kirsty Darwent, The Family Therapy Training Network
email : Kirsty.darwent@btinternet.com

First published 22 June 2015
Photo Copyright:stockbroker / 123RF Stock Photo

IHI Open School Blog: Three ways for faculty to use IHI Open School courses in the curriculum

Great to see our undergraduate quality improvement work featured in the IHI Open School’s blog post!

Photo of Helen Bevan and group at the University of Stirling in 2014

Helen Bevan (centre right) pictured visiting the University of Stirling in 2014.

View the original blog post here.

Meningitis Day 2015 – diagnosing better outcomes

To mark ‪Meningitis‬ Day on 24 April 2015 our Research Office colleague Rachel Beaton wrote this personal piece for the @longitude_prize blog. The Longitude Prize is for work looking to overcome the global issue of antibiotic resistance.

“Meningitis poses a difficult problem for doctors as it can present either as a bacterial or viral infection; finding out which is present in a patient as quickly as possible is crucial. Rachel Beaton from the University of Stirling shares her personal story of being diagnosed with meningitis, with a doctor’s perspective from Prize Advisory Panel member Professor Chris Butler.”

View the article here:  https://longitudeprize.org/blog-post/meningitis-day-2015-diagnosing-better-outcomes