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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.
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
To mark International Nurses Day 2016 we asked our nursing students and staff what inspired them to nurse; this is what they said:
“For me, a role that matters and allows me to contribute to the society I live in.”
Ric, second year student nurse
“Circumstances saw me having to support myself through education from the age of 16, I always persevered, knowing my aim was to become a nurse one day. Life and motherhood saw ten years pass. I knew then that if I want to truly encourage my daughters to become whatever they want to be, it was through doing it myself. An HNC, years of work experience and a year of night college later I am exactly where I know I should be! My daughters are proud of me, and I am proud of myself. Nursing is where my heart is.”
Sandra, third year student nurse
“What motivates me is the opportunity I have to make a difference and to improve the quality of life for others, which for me is more of a calling than a career.”
John, second year student nurse
“I wanted to make a difference, sounds corny but it’s true! I never wanted to do anything else, it may have taken me a few years longer than most, I’m now 37 but now I’m finally making that dream become a reality.”
Hazel, first year student nurse
“I was inspired to go into nursing while working in a high school, I witnessed so many young people struggling with their thoughts, feelings and emotions, not knowing how to manage these. I want to be able to help them make a difference in their lives so they can mature and grow into confident individuals who are ready for adulthood.”
Pamela, second year student nurse
“I worked with a lovely probationary teacher last year who went into teacher training later. She inspired me, it’s never too late to achieve your dreams.”
Liz, first year student nurse
“I worked in a dementia unit for nearly 4 years, to begin with it was ‘just a job’ (I was 19 at the time and didn’t know what i wanted to do career-wise!) but as the months progressed and I received additional training and learning regarding the job. I realized how much I deeply cared for the well-being of all the clients and their families and loved how the feeling of providing care, support, comfort and compassion to each client was like receiving a personal reward on a daily basis. My experience of working as a Care Assistant prompted me to start my training, broaden my skills, expand my knowledge and continue onto a career of more person-centred care.”
Kirsty, first year student nurse
“Helping someone when they cannot help themselves even by just making them smile, nursing is such a rewarding career”
Lindsay, first year student nurse
“When I was 17 other people kept telling me that I should go into nursing. They said I had a strong value base, caring and compassionate nature and an ability to influence people. I always wanted to be a teacher, but didn’t apply as I could not spell! Who would have thought I would end up being a nurse teacher!”
Janet Smith, Teaching Fellow
“I’ve always been interested in the science behind the human body, but witnessing the care and compassion shown by nurses when my Granda was dying made me realise that nursing was the dream career for me – I wanted to make an impact on someone’s life like those nurses did for me and my family.”
Holly, second year student nurse
“What motivated me to choose nursing was the never ending possibilities nursing offers, as well as being able to make a difference in someone’s life. I also wanted a career, and not just a ‘job’.”
Michelle, third year student nurse
“When I was young (3/4), I spent a lot of time with my granny around nursing homes and would often help the nurses with tea, biscuits and bingo so I was around the environment from a young age. When I was 16, unfortunately I got ill. Although this allowed me to see all the different departments of the hospital I was in. I always had an interest for some science-based jobs, but personally experiencing the kindness of the nurses on the ward made me decide that it was what I wanted to do. I really wanted to give something back, to make other people experience the high level of care and compassion, like the care I had received. And well, here I am!”
Ryan, second year student nurse
“Seeing several family members working in mental health services, and the public’s perception of mental health issues, inspired me to train as a Mental Health Nurse.”
Sophie, first year student nurse
“I wanted to be a nurse because I care about other people’s health and well-being. Whether that be children or adults. I am a mature student and sadly have lost my own parents and my children are more independent. I suppose there in a need in me to nurture and care for other people and I want to make a difference, however small.”
Liz, first year student nurse
“The film Patch Adams.”
Sandra, third year student nurse
What motivated me to become involved with research was the awareness that when someone is in the same position for too long they can stop questioning, they become too set in their ways and are resistant to change. I didn’t want to become complacent. I was questioning everything and I needed to be involved with finding answers.”
Gaylor Hoskins, Clinical Academic Research Fellow
“I have always enjoyed helping people, in every aspect of life, therefore nursing is something I have always considered. However it wasn’t till after my travels to South Africa – witnessing poverty and severe illness – that it was made clear to me that I wanted to strive and work to the best of my ability to become a successful, compassionate nurse.”
Caitlin, first year student nurse
“I saw nursing as a challenge, a changing challenge and I’ve never looked back. Can’t wait to qualify!”
Kim, second year student nurse
“The reason I went into nursing is because my aunts are Mental Health Nurses. Initially it never really appealed to me. I was always complaining of how bored I was getting in my job. My aunts said they knew I would make a great nurse and to give a shot. I applied to work as a Rehab Assistant to see if I liked it. I did! I then put my application in to Stirling. The thing I like about it is that you’re always busy, no two days are the same, it is very rewarding and there is job satisfaction. I wish I did it earlier. I have never looked back since!”
Blair, first year student nurse
“I have always had a great amount of empathy for others, I chose mental health nursing to utilise this and have a career in which I care for people every day.”
Ela, first year student nurse
“What motivated me to get into nursing research was the opportunity to use my skills in technology, decision making and interventions to support care delivery, and make a meaningful difference to patients and those who care for them.”
Dr Julie Cowie, Lecturer
“I chose to nurse for the opportunity to make a positive impact on people’s lives, no matter how big or small.”
Kourteney, first year student nurse
“I am constantly inspired by patients and I love the feeling I get when I help others, it is so rewarding, the difference you can make to a person’s/family’s life is incredible and to be in a privileged position to do this is so humbling.”
Nicola, first year student nurse
“The idea of nursing being a rewarding career with so many areas that one can work in and the fact that I love working with people inspired me to get into nursing.”
Davinia, first year student nurse
“My mum and older brother work as nursing assistants in our local mental health wards and always talked about how rewarding it is as a career. They have inspired me to become a nurse from their experience and my want to help others.”
Fionnuala, second year student nurse
“I chose nursing because I liked interacting with people and thought it would be an interesting job – I was so right.”
Dr Susanne Cruickshank, Reader in Cancer Nursing
“I always wanted to study at University and, eventually, at the grand age of 46 I started my nursing degree. Now 2 years into my studies I am loving every aspect of it and looking forward to joining the nursing profession. It was definitely worth the wait!!”
Jane, second year student
“As I was born with a heart defect and went through a heart transplant at the age of 8, I have spent a lot of time in the hospital. The people that supported me the most, held my hand through different procedures and was always there for me when I was scared and vulnerable, was the nurses. They inspired me every day through their hard work and always with a smile around their faces which made me look at life in a more positive way even though that wasn’t always the case. That’s why I want to be a nurse, I want to give something back and help other people as they helped me and my family through the hardest times of my life”. Emilie, second year student
And the last word from Hazel:
“Complications after my surrogate baby was born meant an emergency trip to theatre. I will never forget how I felt a nurse suddenly hold my hand, I never saw her face but that hand ‘spoke’ a thousand words.”
Hazel, first year student nurse
In a society that has a low tolerance for uncertainty, cases that challenge our collective notion of the possible fascinate and confuse us. …………
Read Prof Helen Cheyne’s full article in The Conversation.
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.
- 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!
- 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.
- 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.
- 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).
- 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.
- 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.
- 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.
- 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).
- 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).
- 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!
PhD Student, Health Sciences, University of Stirling
Professor Andrew Watterson writes in The Conversation:
The debate about whether or not talcum powder causes ovarian cancer has rumbled on for decades. However, it recently reached fever pitch after a US court awarded damages to the family of a woman who died of ovarian cancer, allegedly as a result of having used talc as a feminine hygiene product for many years. Does that mean women should avoid using talcum powder? What does the science say?
Read the full article here.
Professor Andrew Watterson writes in The Conversation
“Bad news for bacon butty lovers and barbecue afficionados. The World Health Organisation now deems bacon, sausage – and other processed meats – a serious cancer risk.
“With more than 14m new cancer cases occurring around the world each year and more than 8m cancer deaths a year, carcinogens certainly merit serious attention. Asbestos, diesel exhaust fumes, radiation in various forms, nightshift work, tobacco and alcohol are all well-known causes of cancer, but there are lots more besides, including several you may never have heard of.”
Read the full article here.
One in one hundred people will experience schizophrenia in their lifetime. Schizophrenia can be managed well with a person-centred combination of therapy and medication and an emphasis on recovery. Many of us are likely to know people who are affected by the symptoms of schizophrenia but are still managing to lead fairly ordinary lives.
However, for others living with more severe symptoms, schizophrenia can be a distressing and highly debilitating experience. Symptoms experienced such as hearing voices or seeing things (hallucinations) often fail to respond to medication. Even when antipsychotic medication is effective, the side effects of weight gain, apathy, shaking or lack of drive are also debilitating. More effective drugs are urgently needed, however despite promising leads there has not been ground-breaking progress in drug development for schizophrenia for many decades.
One emerging non-drug therapy proposed for the treatment of schizophrenia and the symptom of hearing voices is transcranial magnetic stimulation (TMS). TMS is a device which involves the skilful application of a strong magnetic field close to the scalp surface. TMS is a relatively painless and non-invasive technique which stimulates parts of the brain. Researchers over the last decade have set about assessing whether this promising new therapy TMS could be an alternative treatment for people who do not respond, or do not cope well with medication.
Researchers have typically used ‘randomised controlled studies’ to assess the effectiveness of TMS. This has usually meant randomising people with schizophrenia – with their full consent – into an experiment of either having TMS or having ‘sham’ TMS (i.e. identical process without the magnet switched on). Therefore, randomised controlled studies are a way of comparing two groups of people with schizophrenia who are as identical as possible in every way except for the active ingredient of the TMS itself.
Although many of these study results have now been reported by researchers across the world, the results differed widely and there was no consensus on whether TMS should be routinely used in practice. Therefore we set out to achieve this consensus by reviewing all the reported TMS studies of schizophrenia using Cochrane methodology (the internationally recognised highest standard of review). The purpose of our Cochrane review was to assess the quality of all reported studies, and then combine the results into one analysis (a ‘meta-analysis’) to give summary estimates of whether TMS is effective, or not.
We found that from 41 reported studies (1473 people) there was some evidence to suggest TMS may improve certain symptoms such as hearing voices when compared with ‘sham’ TMS. However, because we also graded many of the studies as ‘low’ or ‘very low’ quality evidence, this meant we were uncertain that TMS was effective, and could not make firm conclusions about using TMS as routine treatment for schizophrenia.
To be clear, this is not the same as researchers doing low quality studies, but rather that frequently the way the study was conducted was not reported to a sufficient standard to rule out risks of bias. This is frustrating, and authors who are reporting on study results are urged to adopt clear reporting practices to remove ambiguity by using standards such as the CONSORT criteria. Journal editors should consider routinely recommending the use of CONSORT criteria and lift restrictions on word limits which inhibit full reporting.
In future, high quality research studies AND high quality reporting of these studies is very likely to have an important impact on whether we can confirm TMS alleviates some symptoms of schizophrenia, but for now we remain quite uncertain. It is important that the research community pursues this aim so that we can improve the quality of treatment provided to people who are living with the debilitating symptoms of schizophrenia.
1 October 2015
Dougall N, Maayan N, Soares-Weiser K, McDermott LM, McIntosh A. Transcranial magnetic stimulation (TMS) for schizophrenia. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.:CD006081.
“Finding your passion will lead you to finding work that motivates and satisfies you”
– Dr Val Gokenbach
I’ve been a volunteer with the Red Cross since high school, after doing some skills sessions over a few weeks as part of personal development. Never did I think though, that signing up to volunteer as an Event First Aider would open up so many opportunities or even lead me into a career in Nursing.
Whenever I’m speaking to people about volunteering, most are generally positive. Of course there will be the odd person who doesn’t understand ‘why anyone would choose to do that and not get paid for it’. For me, volunteering started out as being something that would help fill up my weekends, and let me go to events that I was interested in. Not that I’m saying it doesn’t allow me to do this now, but over time I can see how the experience has helped me change and develop as a person and continues to do so. Not only this, but from the perspective of being a Student Nurse, it has also helped me develop my essential skills which are, undoubtedly, used every day on clinical placement and beyond. Communication, team-working, decision making, leadership, the list goes on. All of them competencies required to be demonstrated in clinical practice, and all of which I have been able to develop and refine through my volunteer work with the Red Cross.
Over my years of volunteering, it’s safe to say that I was bitten by the bug, and became quite passionate about it all. I wanted to bring this passion for the Red Cross to others, but in a way that would be more inclusive and supportive of those who didn’t fit into the ‘regular student’ role i.e. student nurses, as well as the rest of the student body.
We’re all aware that Universities’ and their Student Unions have lots to offer with regards to clubs and societies. Getting involved with them helps to enhance the university experience, shape views and gives skills required for jobs – unarguably a major attraction for students. What a lot of people may not be so aware of however, is that students studying degrees in Nursing are a group with the lowest engagement rate with clubs and societies at the University of Stirling. Why? After speaking with a lot of Student Nurses, the general consensus is that they don’t have the time to fit in extra-curricular activities or voluntary work due to the demands of the course, including placements. They may not have the time to commit to training schedules due to variations in timetables each week, or conflicting off-duty whilst on the wards. Ultimately they aren’t able to access some of the amazing opportunities that are available, which can help them become better practitioners – through their training and post qualification.
With all this in mind, I set up the Red Cross group at the University, at the end of my first year/beginning of second year. I think it’s safe to say that it did, and continues to, require a lot of effort to keep things running smoothly, but it is definitely worth it. We’ve been recognised by the Student’s Union for what our group has achieved, as well as locally and nationally by the British Red Cross, which speaks as a testament to everyone who is involved. Student Nurses have been enabled to develop their practical clinical skills, skills in communication and documentation as well as opening up the door for advanced training in Resuscitation Support Management and Trauma Management, free of charge for example. Above all a flexible approach to how people can access training and events has allowed more people to engage and learn, which is the ultimate aim. Personally I feel I’ve developed my own skills even further by leading the group. I have been able to experience, very early on, management of volunteers, working to meet aims and objectives whilst leading a team, even with pressures such as time and financial constraints. I am certain that my experiences in regards to this will be beneficial and help me in my nursing career in the years to come.
Of course there may be some of you who are reading this who have your own passion for something and are bored of reading about me telling you what you can learn with the Red Cross. What I’m trying to say is it’s about getting involved with something that will expand your horizons and develop you as a person, even if you do see it as just a hobby. Maybe you haven’t had the opportunity to pursue what it is you’re interested in. Well, as the saying goes “if opportunity doesn’t knock, build a door”. Get involved in something you are passionate about, you never know where it will lead and what you can achieve because of it.
Third Year Student Nurse (Adult Branch), University of Stirling
People with high levels of autistic traits are more likely to produce unusually creative ideas, according to new research by the University of Stirling, in partnership with the University of East Anglia (UEA).
Psychologists from the Universities examined the relationship between autistic-like traits and creativity. While people with high autistic traits produced fewer responses when generating alternative solutions to a problem – known as ‘divergent thinking’ – the study found the responses they did produce were more original and creative.
The research, published on Friday 14 August in the Journal of Autism and Developmental Disorders, looked at people who may not have a diagnosis of autism but who have high levels of behaviours and thought processes typically associated with the condition. This builds on previous research suggesting there may be advantages to having some traits associated with autism without necessarily meeting criteria for diagnosis.
Dr Catherine Best, Health Researcher at the University of Stirling, said: “This is the first study to find a link between autistic traits and the creative thinking processes. It goes a little way towards explaining how it is that some people with what is often characterised as a ‘disability’ exhibit superior creative talents in some domains.
“It should be noted that there is a lot of variation among people with autism. There can be people whose ability to function independently is greatly impaired and other people who are much less affected. Similarly not all individuals with the disorder, or the traits associated with it, will exhibit strengths in creative problem solving. Trying to understand this variation will be a key part of understanding autism and the impact it has on people’s lives.”
Co-author of the study Dr Martin Doherty, from UEA’s School of Psychology, said: “People with high autistic traits could be said to have less quantity but greater quality of creative ideas. They are typically considered to be more rigid in their thinking, so the fact that the ideas they have are more unusual or rare is surprising. This difference may have positive implications for creative problem solving.”
Data was analysed from 312 people who completed an anonymous online questionnaire to measure their autistic traits and took part in a series of creativity tests. These included providing as many alternative uses as possible for a brick or paper clip. Responses were rated for quantity, elaborateness and unusualness. People who generated four or more unusual responses were found to have higher levels of autistic traits.
Previous studies using the same tasks have found most people use simple undemanding strategies, for example word association, to produce the obvious answers first. Then, they move on to more cognitively demanding strategies and their answers become more creative. The new research suggests that people with high autistic traits go straight to these more difficult strategies.
Dr Doherty said: “People with autistic traits may approach creativity problems in a different way. They might not run through things in the same way as someone without these traits would to get the typical ideas, but go directly to less common ones. In other words, the associative or memory-based route to being able to think of different ideas is impaired, whereas the specific ability to produce unusual responses is relatively unimpaired or superior.”
The findings could help researchers understand more about the relationship between autistic traits and how the brain adapts to problem solving in the general population.
Media enquiries to David Tripp, Communications Officer on 01786 466 687 or firstname.lastname@example.org.
Blog published 17 August 2015
The two-year project will improve the way researchers use existing qualitative research on health services, to increase the likelihood that it will be used by NHS decision-makers.
The project – titled eMERGe – is funded by the National Institute of Health’s Health Services and Delivery Research Programme. The project involves a partnership with leading academics from the Universities of Edinburgh, Bangor and Cardiff, and working closely with an international group of experts.
Dr Emma France, Senior Lecturer in the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU) based at the University of Stirling, said: “Information about people’s experiences of health services and care should play a major role in improving NHS services, but this kind of data rarely influences decision making.
“Evidence about which treatments and services work is important and already informs health service design, but to create high quality patient-focused health services we also need to consider why and how they work and people’s experiences of using them.”
“Pulling together evidence from many existing qualitative studies, such as those using patient interviews or focus groups, can shed light on factors like why patients or health professionals behave in a certain way, or what it is like to experience an illness.”
The project will focus on the use of a method called meta-ethnography, which is used to combine information from a range of qualitative studies. The team will be working closely with Professor George Noblit from the University of North Carolina, USA, who developed meta-ethnography.
This approach enables researchers to find new insights and conclusions regarding specific health topics, such as people’s experiences of being treated for arthritis.
Dr France said: “Low-quality reporting of meta-ethnographies is common, meaning patient groups, NHS staff and managers often lack trust in the findings and ultimately do not use them to improve decisions, services and patient care.
“The eMERGe project will develop guidelines to assist researchers in carrying out quality meta-ethnographies and reporting them to a high standard, meaning this rich information can be used to create better decision-making and improve outcomes for patients.”
Media enquiries to David Tripp, Communications Officer on 01786 466 687 or email@example.com.
Posted: 16 August 2015