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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

Can good fat boost your fitness level? Angus Hunter in The Conversation

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Dr Angus Hunter

Dr Mariasole Da Boit (University of Derby), Dr Angus Hunter (University of Stirling) and Dr Stuart Gray (University of Glasgow) have written in The Conversation:

“Fish oil supplements may seem like a relatively recent health fad but they have actually been produced in the UK on a large scale since 1935 by the company Seven Seas Ltd. Since then, the fish oil supplement market has continued to grow, with many beneficial effects claimed for health……….”

See the full article here.
24 January 2017

My Stirling Crucible: interaction and creation

“Crucible – A situation of severe trial, or in which different elements interact, leading to the creation of something new.”

TonyBlogImage1w Walking into a room with other research academics (either known to each other or complete strangers), one can never be sure if it’ll be a “severe trial” or a motivating and exciting experience “leading to the creation of something new”. In many situations it’s more a case of ‘and’ rather than ‘or’, with the typical academic social awkwardness (faces buried in phones) being mixed with work pressures (faces buried in phones) that make many of us go into our shells at the start of such events. When we are given time and support though, we can usually generate some exciting ideas.

So in April 2016, the Stirling Crucible kicked off with 19 research academics consisting of a mix of postdoctoral researchers, lecturers and senior lecturers. The key idea was for the Crucible to be a space for researchers from across the University to come together to talk, learn and share ideas.

What made this event different to most was the time investment required, with three two-day ‘labs’ spread over 3 months and it being residential, with people staying overnight at the venue and indulging in some organised evening entertainment [insert poor health behaviours here]. Each lab focused on a different topic hosted by three excellent facilitators: Saskia Walcott on impact; Sara Shinton on collaboration; and John Willshire on innovation and leadership.

While the details of what happens during the Crucible need to remain a closely guarded secret (what happens at the Crucible, stays at the Crucible – but check #StirlingCrucible for a few sneak peeks), I can reveal that it was a success, bringing together people from contrasting disciplines to begin thinking about how to collaborate and some people starting to initiate research ideas.

Research collaborations cannot be forced and it does not always work throwing people together in the hope that something sticks. However, the Crucible succeeded in setting up a safe, unhindered and honest environment for sharing ideas and letting people take the time and space to simply make friends first, before expecting anything concrete in terms of collaborations and the future research outputs and impact.

The pressures faced by many academics mean that having this kind of protected time to think and engage with other people, especially those from different disciplines, with no forced expectations, is severely limited and often not given the respect and support it deserves. This process has also been supported by a small research seed fund available to attendees of the Crucible to apply for money to support interdisciplinary pilot projects that can lead to further collaborations and more substantial grant applications. A little cash incentive always helps!

Since finishing the formal Crucible events, I have teamed up with colleagues in the Faculty of Health Sciences and Sport and Education Studies within the Faculty of Social Sciences to apply for funding to support a small research project. This project would use focus groups to look at the barriers and facilitators to career development and progression for women studying part-time for a research doctorate within the Faculty of Health Sciences & Sport. The money provided by the Crucible would help generate positive policy change within the University (largely through the Athena SWAN initiative), but then also lead to further funding applications to explore this topic across disciplines, as well as across institutional and national boundaries.

Amongst the 2016 Crucibilists, there are sure to be plenty of exciting projects to emerge that are hopefully just the start of several years of successful partnership. There may be some severe trials that the Crucibilists face in their careers going forward, but hopefully we’ll continue to be able to face these as colleagues and friends who support each other through these challenges.

For more information about the Stirling Crucible you can email crucible@stir.ac.uk or check out the website.

© Tony Robertson, 1 July 2016
Tony Robertson is a Lecturer in Public Health in the Faculty of Health Sciences & Sport at the University of  Stirling
BiologyOfInequality.com
Email: tony.robertson@stir.ac.uk and on Twitter @tonyrobertson82

Witnessing poverty and severe illness motivated me to nurse

CaitlinUrquhart2I 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.

I went out to South Africa with a charity called GAGA (Goodwill And Growth for Africa) volunteering constructing a vegetable garden in a pre-school. Here we worked as a team to plan and put it all together – this was not as easy as we had first thought. With solid, dry ground and just the basic tools we did our best. But we worked together and finished it within our 2 week visit. We involved the children who attended the school along with some of the teachers, allowing them to learn new skills.

GAGA Logo 2 - Copy [28461]We also had the opportunity to visit other projects that the charity were funding which was fantastic. We went to see another pre-school, a medical centre and a home/family that looked after and cared for people of all ages that suffered from disabilities, illness or children who were left abandoned by their parents. Such amazing work that goes on in this country and they are so grateful for the very little they have.

SAGROUPPICcropThese projects were all difficult things to see, the poverty that they live in and put up with on a daily basis is unreal. People don’t understand until they witness this first hand. What a massive eye-opener this trip was, it has showed me that I want to make a difference and help in anyway I can. I feel that by becoming a nurse this would be possible. I would love to go back and do more volunteering in this country!

Caitlin Urquhart, 1st year Student Nurse, University of Stirling
19 June 2016

A student nurse’s guide to an away placement: Isle of Barra, Outer Hebrides

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Student Nurse Holly McMurray

Many students are not keen on undertaking an away placement – they may think it’s inconvenient, expensive, and that it won’t really add much to their learning or contribute to their future practice. But it’s not at all, it’s a great experience that everyone should try, if they can.

Accommodation
I was lucky enough to be able to rent a room for the duration of my placement from my mentor who runs a guest house as well as being a district nurse. My room was lovely, I got breakfast and dinner, and had access to everything I needed including the washing machine, ironing board etc. I really couldn’t have asked for better accommodation and hosts.

Transport
Travelling from Stirling to Barra is quite a long journey, around 10 hours, if you go by train and ferry, which is the cheapest option, around £25 single. The ferry journey can be quite boring so I would advise taking a book or something to do. I’d also recommend taking a blanket and pillow so you can sleep because the seats are also quite uncomfy. When you arrive at Castlebay one of the nurses will probably collect you and take you to your accommodation, otherwise there are buses and taxis which can be pre-booked.

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Barra runway

The other option is to get the plane from Glasgow airport to Barra, it is quite expensive between £30 and £75 single depending on how far in advance you book from Flybe, but it only takes about an hour. The plane is tiny – seats around 20 including the pilot. It is a really good experience though as Barra has the only tidal airport in the world – the beach is the runway!

Placement
The Island has a 5-bed hospital called St. Brendan’s. The hospital includes 3 single rooms and 1 twin room, a treatment room, a physio room and a dentist. The community nurses are also in the same building and have their own room upstairs.

There is one doctor who is on call 24/7 and is based in the GP surgery which is around 0.5 miles from the hospital, though new plans are currently being developed to build a new hospital which will house everybody together to make working as a team easier.

Within the hospital everything is nurse led as there are no other health professionals which are constant on the island. All Physio therapists, occupational therapists, dieticians, speech and language therapists etc. are all mostly based on the isle of Lewis in Stornoway which is the main hospital for the western isles, and they visit Barra occasionally. There is also only 1 midwife on the island, who only works 7 hours per week, and only 1 health visitor who is very willing to take student nurses on visits and also to baby clinics – I even got to go on the ferry to the Isle of Uist to visit a few new born babies!

Shoreline-HousesWDuring my time in Barra there weren’t many patients, but I got to spend time with lots of different healthcare professionals – health visitor, midwife, diabetic nurse, practice nurse, community nurses. There were also lots of training days whilst I was there – management of the acutely ill patient, psychoactive substances, continence management and advanced life support. So, although it might be quiet compared to Forth Valley there are plenty of opportunities to keep you busy.

The island itself has very few shops and amenities, so if you do go to Barra I’d recommend bringing everything you need.  The islanders are very friendly and welcoming, but during the winter there isn’t much to do.  There are, however, many events during the summer such as a festival and various fetes/open days, and the beaches are lovely as well, even in the winter.

Overall, I’d definitely recommend going to the Isle of Barra for a placement, to experience how it’s done in a remote and rural area.

Holly McMurray, 2nd year Adult Student Nurse
University of Stirling
Published 13 April 2016

Nursing in Shetland – working as an Advanced Nurse Practitioner on a non-doctor island

ChrisShetland has something for everybody, with the northern lights, amazing scenery, wild weather and low crime, and stunning wildlife. Working as an Advanced Nurse Practitioner across these islands offers a new dimension to nursing. I currently work on an island called Bressay.

Bressay is classed as a non-doctor island, thus the role of the nurse is key in the delivery of primary health care. Shetland has 5 non doctor islands – Bressay, Fair Isle, Foula, Fetlar, and Skerries. Each island has a resident nurse who provides a 24 hour service, thus providing all first contact, chronic health management and emergencies. Each island has a varied population ranging from the very young to the elderly, thus nursing practice has to be up-to-date and transverse across age ranges. Each island is only accessible vie ether boat or plane. These island nurses are supported by a General Practitioner who visits, but this can easily be hampered by the weather. Each island, apart from Bressay, has a nurse’s clinic where all up-to-date resources are at the disposal of the resident nurses; this allows for health care delivery to be tailored to meet the needs of individual patients.

This role of the non-doctor island nurse is unique to Scotland. There is very little known about these unique nursing roles. In 2012 I commenced a Clinical Doctorate in nursing with the University of Stirling; this has enabled me to explore the role of non-doctor islands and its uniqueness to nursing practice. The Doctorate has enabled me to reflect on my own practice and allowed me to critically analyse my own clinical areas and the importance that it plays across primary care delivery. I have commenced my final piece of work for the programme; the aim is to explore the role of nurses on these non-doctor islands. We know at this time that remote and rural healthcare practices have significant recruitment and retention difficulties; the aim is to explore what attracts and retains nurses across non-doctor islands. This will allow for strategic planning of service delivery as part of the 2020 vision.

I moved to Shetland in 2014. I trained in Liverpool at Edge Hill University and qualified as a nurse in 2004 and since then I have taken many pathways along the way. I started as a staff nurse in Accident and Emergency, I then took up a lecturer practitioner role with Edge Hill University, and then I specialised and became a Resuscitation Training Officer.  I have always had an interest in remote and rural setting, with this goal in mind I started to look at options available. I first noticed a job in Shetland on one of its non-doctor islands, so I dedicated to join the nursing bank to see if I liked it. Over the following two summers I spend much time visiting Shetland’s more remote islands providing relief for the resident nurse. I was fortunate enough to get offered a job full time as the resident nurse for Bressay.

At the time this was a difficult decision to make, thus leaving family, friends and a career pathway that I enjoyed, but I needed something different. I have currently been in post for 4 years and I love the everyday challenges that remote and rural nursing brings. Shetland life takes a little getting used to. However I would struggle to return to an urban setting although I still have family in Liverpool and it’s a pleasure visiting friends and family.

Chris Rice, Advanced Nurse Practitioner, NHS Shetland
Clinical Doctorate Student, University of Stirling

What do community pharmacists really do? Guest blog by Jonathan Burton

jonathan-burton(4)I’ve been a pharmacist for almost 17 years now, most of that time spent as a patient-facing community pharmacist working in the small pharmacy here on campus at the University of Stirling. Pharmacy is, in some ways, a peculiar profession. Pharmacists receive very thorough training (a four year, science based Masters degree, the MPharm, followed by one year’s practical training and further examination) and work everywhere where there are medicines, from the pharmaceutical industry to hospitals. But it’s in the community (or ‘retail’) setting that we are at our most visible but, arguably, most misunderstood. Where retail space meets the NHS it’s no wonder really that the public often have mixed views regarding what we actually do!

In the last 10 years in particular the role of the community pharmacist has evolved across the UK, with Scotland arguably seeing some of the biggest changes. Our core role remains the same, to effectively & safely check, dispense and advise patients on medicines supplied on prescriptions written by doctors (mainly GPs), dentists and increasingly by nurse colleagues with prescribing qualifications. Interestingly a number of pharmacists also have additional prescribing qualifications, as do some Optometrists, Podiatrists and Physiotherapists.

Increasing pressures within the NHS and a desire for all health professionals to use their knowledge & skills to maximum effect has led to community pharmacists gradually taking on additional ‘walk-in’ clinic roles. For many years now we have offered a range of NHS public health services including:

  • A national smoking cessation programme, community pharmacists manage70% of all quit attempts in NHS Scotland
  • A national emergency hormonal contraception service
  • A range of locally funded services including substance misuse/ opiate replacement therapy, needle exchange, Hepatitis C patient support and alcohol brief interventions
  • Some private services have also become popular, especially influenza and travel vaccination

The traditional ‘over the counter’ sale of non-prescription medicines has also evolved into something more akin to a walk-in clinic service, with community pharmacists also able to assess and treat minor medical conditions as a free NHS service for certain patient groups e.g. children, over 60s, students under 19 and those receiving certain government benefits. All pharmacies in Scotland have private consulting facilities and in some areas, including Forth Valley, community pharmacists are starting to manage a slightly expanded range of common clinical conditions, for example UTIs (urine infections) and minor skin infections through locally funded NHS ‘Pharmacy First’ services.

We are being encouraged to work ever more closely with GP and nurse colleagues and pilots have finally begun to assess the impact of giving pharmacists in the community setting access, with consent, to patient medical records (electronic summaries). I am very supportive of this as, like all health professionals, we just want to be able to do our jobs as safely and effectively as possible. I’ve always loved the fact that I’m perhaps the most easily accessible health professional in my community, you literally never know who will walk through the door next & what you’ll be helping them with. But, despite this, our role isn’t perhaps as clear as that of the doctor or nurse for example, too many years spent hiding in dispensaries perhaps! We need to work on that.

There are many challenges facing community pharmacists as the NHS, our profession and healthcare in general evolves, but I do believe we have an important part to play alongside the other health professions, maximizing the impact of our in-depth knowledge of medicines and our unique accessibility. So, next time you’re feeling poorly or have a question about your medicines don’t forget that one of your options is to ‘ask your pharmacist’!

Jonathan Burton, Community Pharmacist, University of Stirling and
Vice-Chair, Royal Pharmaceutical Society in Scotland