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Is my PhD my midlife crisis? Fiona Dobbie writes in THE

FionaDobbie_afCZNbo6_400x400Fiona Dobbie, Research Fellow in the Institute of Social Marketing has blogged in the Times Higher Education:

“I turned 40 this year, and rather than indulge in the clichéd symptoms of a mid-life crisis (getting a tattoo, having an affair, Botox) I am in my second year of a part-time PhD.

“It’s not that my life isn’t fulfilling or challenging enough. I am typical of my age: happily married with an energetic 6-year-old, fortunate to have friends and family and a full-time job as a university research fellow. So why am I doing a part-time PhD?”

Click here for the full article, published 12 March 2017.

 

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

Shared decisions, shared goals: Trauma amputees’ clinical experiences and communication with their prosthetists

During the Iraq and Afghanistan conflicts there was a rise in the number of trauma related military amputees with complex prosthetic needs.  The level of prosthetic provision from the Ministry of Defence at that time was anecdotally high and the expectation was that the responsibility for this level of provision would be passed to the NHS when military amputees were discharged from the Armed Services. This brought about fears from NHS prosthetic providers and veteran charities around how this transition of care would be funded in the best interest of veteran amputees.

As a trained prosthetist I was also curious about how the switch of care from the Ministry of Defence to the NHS would be managed in a practical sense as well as how the NHS would manage the provision of high end prosthetic limbs within restricted prosthetic budgets.  It was this interest that led me to undertake my PhD at the University of Stirling.

My project aimed to explore the decision making of prosthetists working within the NHS in Scotland with experience of treating amputee veterans. I also wanted to explore military and civilian trauma amputees’ experiences of involvement in their prosthetic care.  This was achieved through analysis of a series of interviews with members of four clinical and managerial groups involved in the delivery of prosthetic care in the NHS and interviews with civilian and trauma amputees. Due to the exploratory nature of this project qualitative semi structured interviews were used to collect data which was then analysed using thematic analysis.  Staff and amputee data was analysed separately.

The stories of the amputees included in my thesis show that the circumstances which led to their amputation can have a lasting effect on their rehabilitation journey.  Those who have lost a limb through trauma, whether in a civilian or military setting, have experienced a unique set of experiences.  This can greatly impact the way they view their amputation as well as the way they interact the clinicians who are involved in their prosthetic rehabilitation.  The effect of this suggests that prosthetists and other clinicians involved in the care of trauma amputees should be conscious of the circumstances which led to their amputation and take that into account in the rehabilitation process.

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Dr Karen Semple (centre) pictured with her supervisors Prof Margaret Maxwell (L) and Prof Helen Cheyne (R)

My thesis Exploring decision making and patient involvement in prosthetic prescription highlighted the importance of the evolving relationship between trauma amputees and their prosthetists and the benefits that were seen by both groups from developing a good relationship and the impact that this could have on the prosthetic prescription process.  Through these developing relationships combined with communication between prosthetists and patients, these groups can work together to create optimal prosthetic prescriptions. Clinical experience and communication are key in enabling prosthetists to prescribe limbs which allow patients to achieve their goals and aspirations in their post amputation lives.

Dr Karen Semple,
Researcher, Faculty of Health Sciences and Sport, University of Stirling
11 July 2016

Prosthetic photo copyright Belahoche on 123RF
Graduation photo copyright University of Stirling

10 things a new PhD student should know at the beginning of their study – postgraduate blog

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Postgraduate Student Andrea Mohan

Starting a PhD can be very exciting, but it can also be very scary to some students. Now that I’m in my final year, I realise that there are things that I had wish known when I first started. I’ve pulled together a list of 10 things (with the help of my peers) that you should know as a new PhD student.

  1. When you first start, you will feel like you don’t know what you’re doing and that’s OK. In fact, that’s NORMAL. Chances are, you will still feel like this a year into your studies. How do you deal with this? Communicate with your supervisors on a regular basis, and speak to your peers as often as you need to. You’ll be amazed to find out how any people feel the same as you!
  2. In your first month, you’ll feel like you’re not doing anything. Relax. In this month, spend your time getting to know your way around your department and the university campus. Trust me. This can save you a lot of time in the future. Find out about specifics like printing, using the library and where the nearest kettle and microwave are located. Take wee walks around the campus and get to know the place better. Also, take the time to get acquainted with your fellow PhDs as well.
  3. Ask your postgraduate tutor or postgraduate representative (staff or student). Chances are, they will have the answer to your questions, or if not, they will direct you to someone who will know.
  4. If you’re new to research, and feel a bit nervous/daunted by the thought of doing a research degree, then find a good book that addresses this. One of my peers recommends Norman Blaikie’s book ‘Designing Social Research’ (Blaikie, N. (2010) Designing Social Research. (2nd edn) Cambridge: Polity Press).
  5. You may be shocked to find out that you are not a proper PhD ‘student’ when you first start. Don’t worry…for all intents and purposes, you are, but in most universities, you only become officially registered after some sort of review process. This usually occurs nine to twelve months after you first start, and the review process differs across institutions. Try to find out from the beginning what this process entails, and make sure that you prepare sufficiently for it.
  6. Try to establish a good working relationship with your supervisors, or at least your main supervisor from the beginning. It’s important that you are able to communicate properly with them. Don’t be afraid to let them know if you are worried about something relating to your study. If you finding it difficult to communicate with your supervisor, then speak to your postgraduate tutor or representative.
  7. Find a sport or a hobby. A lot of people will remind you that your PhD is not the only thing going on it your life, and this is true. Find something that you like to do, that can help you to de-stress. Just make sure that it doesn’t overtake your life and prevent you from doing your work. It’s all about balance.
  8. Take coffee/tea or lunch breaks with your peers. When pursuing a research degree it’s easy to feel isolated. If you’re in one day, and a peer or some peers are around, then ask them if they’d like to go get some coffee or lunch with you – even if it’s once a month. Don’t take it personal if some refuse (they may be genuinely busy).
  9. Try to find out what special events are on for postgraduate students throughout the year in your department and the university. There may also be seminars, writing days and lunches as well. If you can make time to attend some of these events, this will be useful in terms of helping you to meet and network with other peers (or members of staff).
  10. This tip is for international PhDs. I’ve spoken about isolation already, but this can affect international students even more than local students. The best way to deal with being homesick or being lonely is to make friends: befriend your PhD peers, find out if there is a group of students at the university that are from your country, or find a group of students who have similar interests as yourself. If you find yourself feeling really sad, speak to your supervisor or a counsellor.

Always remember that you are not in this alone!

Andrea Mohan
PhD Student, Health Sciences, University of Stirling

Youth Alcohol Intervention – Jonathan Bryce writes about his award-winning research

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Jonathan Bryce, MRes Graduate

Jonathan Bryce graduates from the University of Stirling this Friday 27 November with a MRes – Health Research.

He has been awarded a University Integrating Research Into Learning Award for his Youth Alcohol Intervention dissertation research. Jonathan writes:

What was it about?

I wrote the dissertation as part of the Master of Research in Health Research course at the University of Stirling. The dissertation was made up of three parts – a funding proposal, an ethics application and a journal article.

The overall topic of the work was based around investigating the effectiveness of an intervention to reduce harmful or hazardous alcohol consumption in young people aged 16 – 24 years old. The main component of the proposal was exploring the use of a conversational style of discussing alcohol use with young people. The aim would be to do this in a way that is non-confrontational and that focuses on strengthening the motivation of the individual to make changes about their alcohol use.

Why was it needed?

The motivation behind the choice of topic follows from high rates of alcohol consumption and alcohol-related ill health in Scotland over recent decades. Data shows that approximately one-third of women and almost half of men regularly drink at levels that exceed government guidelines.

Young people also have high rates of harmful or hazardous drinking, meaning they can be exposed short-term risks such as being a victim of crime or injuring themselves. Late adolescent drinking has also been linked to dependence in later life as well as premature death.

How would it be carried out?

The research proposed was designed for use in an informal youth work setting.  Examples of these may include drop-in or outreach services offering support to young people on issues such mental or sexual health, education and careers advice.

Building upon previous research that found that brief alcohol interventions were both acceptable and feasible for use in informal youth settings, interventions would be delivered by youth workers opportunistically. These would then allow the youth worker to engage the young person in a short conversation about their alcohol use and, where appropriate, setting goals such as reducing the quantity or frequency of alcohol the consume.

How will it improve/help practice?

If found to be effective, the intervention has the potential to improve current practice in youth work settings by providing a tool for youth workers that is evidence-based and which can lead to better outcomes for the young people they are in contact with. The most immediate impact is likely to be consideration and discussion about the young person’s alcohol use. Long-term benefits might include improved health and well-being and reductions in alcohol-related ill health.

Jonathan Bryce, MRes Health Graduate
24 November 2015

An award-winning Health Visitor: How Ruth’s Clinical Doctorate research helps improve Health Visitor practice when planning interventions with parents

Photo of Dr Ashley Shepherd, Ruth Astbury and Prof Helen Cheyne at QNIS presentation

Dr Ashley Shepherd, Ruth Astbury and Prof Helen Cheyne

At first, in my career, I wanted to find ways of improving my own nursing practice. That’s only natural in the work setting isn’t it? – wanting to be the best that you can be to provide excellent care for your patients. Over time I began to learn that it was also really important to find ways to influence colleagues’ practice too, in order to collectively have a positive impact on patients, clients, babies, children, young people and families served by the NHS.

So at the beginning of my research career, when I was completing a taught MSc in Nursing (RCN Institute) I explored what it feels like to be a breastfeeding mother working outside the home – because I wanted to be able to support breastfeeding mothers effectively in my Health Visitor practice. And when I completed this piece of work my research supervisor Dr Marilyn Kirshbaum, working at the University of Sheffield, suggested applying for funding for a PhD. ‘But how will that work?’  I asked ‘How will that help me to improve my practice?’ ‘How can I be a health visitor and study at the same time?’

So it was with great delight that I discovered, after a bit of searching, that the University of Stirling – which was right on my doorstep – had just started to provide a Professional Doctorate programme for Nurses and Midwives (and subsequently Allied Health Professionals) and that I could continue to nurse at the same time as pursuing an academic career.

And what was the Clinical Doctorate Programme like? Well it’s been everything that I could have hoped for.

I’ve had the opportunity to discuss, debate and write assignments on a range of provoking subjects related to practice; I’ve been examined on my practice, and I have been given the opportunity to try out quality improvement skills in practice.

I have also been given opportunities, through the wider University community, to improve my IT skills, including managing and using spreadsheets and using research software. I’ve been immersed in the theory and practice of project management and I’ve met some incredibly inspirational people over the years.

I have received amazing support from my peers – both at work, and on the Programme. Who would have thought that a Health Visitor and School Nurse could learn so much from a colleague whose speciality is cancer care, reducing healthcare acquired infections, working with young people with mental health issues or a speech and language therapist? But it happened. And in addition there has been a real respect for each other’s roles and responsibilities in practice as we have tried to understand the healthcare context within which each of us works.

And what gradually dawned on me – as I progressed through the ‘Clin. Doc’ Programme – was that this was just as much about ensuring that I was in a position where I could put my learning into practice and influence the practice of colleagues in my workplace, as it was working through the various assignments and the research study. Basically I needed to ensure that my world of practice ‘kept up’, because (apart from everything else) on the Programme we were constantly being challenged about the need to improve the quality of the service that our organisation provided, and we were also encouraged to have the confidence to move out of our comfort zones to do this if required.

So an opportunity arose and I moved to work in Glasgow City as a Practice Development Nurse supporting Health Visitor and School Nurse teams who are working with some of the most vulnerable and disadvantaged children and families in Scotland. Since my arrival I have been continually impressed by the knowledge, skills, compassion and resilience that the team leaders and team members show in their practice – and I am continually learning from them too.

A few ‘thank-you’s – thank you so much to Jane Walker from the Queen’s Nursing Institute Scotland for the Community Nursing Award presented to me and to Professor Jayne Donaldson and Dr Ashley Shepherd for their nomination.

The Award, for ‘promoting excellence in community nursing’, means a great deal to me, because it implies that the research that I’ve carried out to complete the Clinical Doctorate Programme at Stirling University, School of Health Sciences, is recognised as ‘valuable’ to Health Visitor and School Nurse practice – which became one of my key ambitions during the Programme.

Professor Kate Niven and Dr Kath Stoddart, Directors of the Programme, have been incredibly supportive and helpful in very practical ways, and Dr Ashley Shepherd and Professor Helen Cheyne, my research supervisors, have provided me with guidance through their wisdom and knowledge.

And last, but not least, I am indebted to my husband Tom, and the rest of my family for their patience and support as I have completed the Clinical Doctorate Programme; but they know it’s not ‘the end’ of hard work as they know me well enough to understand that I am still as ambitious as ever to work with Health Visitors and School Nurses so that together we can continue to find ways to improve the lives of babies, children and young people.

If you are interested in my research study I have already presented the findings at the RCN International Research Conference 2015 in Nottingham and a PDF copy of the presentation is available here.

Ruth Astbury, 26 June 2015
Winner of University of Stirling’s QNIS Postgraduate Academic Award in recognition of promoting excellence in community nursing.

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