Biomedical subjects

Christine Webb

Publications and source records attributed to Christine Webb.

At least 19 recordsLinked to original sources

PubMed2006

Novel Rho kinase inhibitors with anti-inflammatory and vasodilatory activities.

Increased Rho kinase (ROCK) activity contributes to smooth muscle contraction and regulates blood pressure homeostasis. We hypothesized that potent and selective ROCK inhibitors with novel structural motifs would help elucidate the functional role of ROCK and further explore the therapeutic potential of ROCK inhibition for hypertension. In this article, we characterized two aminofurazan-based inhibitors, GSK269962A [N-(3-{[2-(4-amino-1,2,5-oxadiazol-3-yl)-1-ethyl-1H-imidazo[4, 5-c]pyridin-6-yl]oxy}phenyl)-4-{[2-(4-morpholinyl)ethyl]-oxy}benzamide] and SB-7720770-B [4-(7-{[(3S)-3-amino-1-pyrrolidinyl]carbonyl}-1-ethyl-1H-imidazo[4,5-c]pyridin-2-yl)-1,2,5-oxadiazol-3-amine], as members of a novel class of compounds that potently inhibit ROCK enzymatic activity. GSK269962A and SB-772077-B have IC50 values of 1.6 and 5.6 nM toward recombinant human ROCK1, respectively. GSK269962A also exhibited more than 30-fold selectivity against a panel of serine/threonine kinases. In lipopolysaccharide-stimulated monocytes, these inhibitors blocked the generation of inflammatory cytokines, such as interleukin-6 and tumor necrosis factor-alpha. Furthermore, both SB-772077-B and GSK269962A induced vasorelaxation in preconstricted rat aorta with an IC50 of 39 and 35 nM, respectively. Oral administration of either GSK269962A or SB-772077-B produced a profound dose-dependent reduction of systemic blood pressure in spontaneously hypertensive rats. At doses of 1, 3, and 30 mg/kg, both compounds induced a reduction in blood pressure of approximately 10, 20, and 50 mm Hg. In addition, administration of SB-772077-B also dramatically lowered blood pressure in DOCA salt-induced hypertensive rats. SB-772077-B and GSK269962A represent a novel class of ROCK inhibitors that have profound effects in the vasculature and may enable us to further evaluate the potential beneficial effects of ROCK inhibition in animal models of cardiovascular as well as other chronic diseases.

Animals↗

PubMed2006

What makes a good midwife? An integrative review of methodologically-diverse research.

AIM: This paper reports an integrative review aimed at answering the question: 'What makes a good midwife?' BACKGROUND: A research-based definition of a good midwife which can be used as an operational definition in research and as a basis for curriculum development could not be found. Research in nursing has identified that patients and nurses may give different responses when asked about the most important aspects of nurses' contribution to care. It is also possible that views of how to define a good midwife might differ. METHODS: A four-stage systematic review process was used, consisting of protocol development, carrying out the search, appraisal/analysis of the papers retrieved, and synthesis of the information. The initial search covered the period from 1993 and used the keywords 'midwi*', 'nurse-midwi*' and 'good'. This was later extended to include the terms 'exemplary', 'excellent' and 'superb' as synonyms of 'good', and 'bad' as its antonym. The integrative review was descriptive and focussed on extracting from the papers the findings that contributed to answering the research question. FINDINGS: Thirty-three research-based papers were included in the review, and these had used a range of approaches and methods. Eight key concepts were derived from the data: attributes of a midwife, education, research, what a midwife does, care organization, other professionals, partners and an international perspective. CONCLUSION: Having good communication skills made the greatest contribution to being 'a good midwife', while being compassionate, kind, supportive (affective domain), knowledgeable (cognitive domain) and skilful (psychomotor domain) also made major contributions. Being involved in education and research were necessary requirements, and midwives' abilities to treat women as individuals, adopt a caring approach, and 'be there' for women were essential. A good midwife can compensate for poor management systems, but women should be able to choose who provides their care, and partners should be involved in this care.

Clinical Competence↗

PubMed2006

Change on the horizon: issues and concerns of neophyte advanced healthcare practitioners.

AIMS AND OBJECTIVES: The aim was to interview new entrants to a Master's level programme of educational preparation for advanced healthcare practice roles. The objectives were to gain an understanding of their issues and concerns as they looked ahead to their future development and to illuminate issues concerning their experiences as students and as employees. BACKGROUND: As advanced practice roles become more widespread in the United Kingdom and abroad, nurses and other healthcare professionals are becoming more involved in innovation and service development and experiencing greater autonomy in many areas, particularly in regard to clinical examination and diagnosis. DESIGN: A qualitative design was employed to illuminate issues and concerns of new students on a Master's degree programme of educational preparation for advanced healthcare practitioners. METHODS: Two focus group interviews were conducted in 2004. Sixteen students from two programme cohorts participated in the two groups. FINDINGS: Two main themes were outlined. These were: 'opportunities for development' and 'time pressures'. Subcategories within these two themes are also discussed. CONCLUSIONS: Students undertaking Master's level preparation for advanced healthcare practitioner roles perceive personal and professional benefits and opportunities to develop innovative services to improve patient care as accruing from the programme. These opportunities and benefits were related to the United Kingdom national health policy agenda. Some role difficulties were experienced. The additional burdens that the programme of study provided were an issue for some, but these were perceived as a temporary problem, worth undergoing for the likely long-term benefits. RELEVANCE TO CLINICAL PRACTICE: Students undertaking educational preparation for advanced practice roles see themselves as innovators, specifically aiming to develop and improve aspects of service provision. Education for advanced practice roles should not be undertaken lightly, but can equip students with various skills, particularly regarding clinical assessment, and these skills should underpin practitioners' autonomy.

Adaptation, Psychological↗

PubMed2006

Nurse consultants: organizational influences on role achievement.

AIMS: This paper reports on organizational influences on nurse consultant post holders. The influence of individual characteristics has been the subject of another paper. BACKGROUND: Nurse consultant posts were set up in the United Kingdom from the late 1990s onwards and, therefore, there has been little opportunity to report on evaluations of these innovative initiatives. DESIGN: A cross-sectional design, using a convenience sample, was adopted. METHODS: Ten nurse consultants working in a variety of settings and specialties participated in in-depth, tape-recorded interviews. The data were analysed using the Framework approach. FINDINGS: Support systems were important influences on nurse consultants' role achievement levels. These took the form of internal trust networks, nurse consultant forums and links with higher education institutions. Post holders both gave and received support and acted to empower other nurses. Thus, relationships were vital to successful role integration. The culture and structures of the National Health System were also a powerful influence in terms of local and national modernization policies, and participants had to be careful in their choice of strategies to deal with the traditional medically dominated culture. CONCLUSIONS: The new nurse consultant role is challenging and innovative, but a major area of contention is how much post holders are expected to take on work previously done by doctors rather than developing their nursing role. Organizational support and commitment are needed if nurse consultants are to maximize the benefits of this innovation. RELEVANCE TO CLINICAL PRACTICE: The findings show that new nursing roles are not always easily accepted in multidisciplinary settings and that holders of such post need to have the appropriate previous knowledge, skills and personal characteristics, as well as the ability to negotiate their way through organizational influences.

Agonistic Behavior↗

PubMed2005

Nurse consultants: their characteristics and achievements.

AIM: This paper reports one aspect of a larger study of nursing research strategies in one English region, focusing particularly on nurse consultants' characteristics and achievements in the role. BACKGROUND: Nurse consultant posts have only been established in the United Kingdom since 1999 and, although much comment has appeared in the professional literature, there is very little research-based evidence of how the roles are developing. The role is intended to integrate four domains: expert practice; professional leadership and consultancy; education, training and development; and practice and service development. DESIGN: A cross-sectional design, using a convenience sample, was adopted. METHODS: Ten nurse consultants working in a variety of settings and specialties participated in in-depth, tape-recorded interviews. The data were analysed using the Framework approach. RESULTS: Four themes were identified from the data: characteristics of the postholder, role achievement, support systems and National Health Service influences. The first two themes are discussed in this paper and the data show that the nurse consultants varied in terms of their academic background and previous experience. Not all had the recommended minimum of Master's degree level preparation and some had limited research experience. These background characteristics seemed to influence the degree to which they were able to achieve the four domains of the role, with those with lower qualifications and from a mental health background appearing to struggle most. CONCLUSIONS: New appointments to these roles should only be made when candidates possess the recommended levels of educational preparation and professional experience of change management. It is also important that there is clarity about the scope of the role, which should not include management responsibilities. On-going research is essential to evaluate how the roles develop for postholders, the extent to which they fulfil policymakers' expectations and what difference they make to patient care from a patient perspective. RELEVANCE TO CLINICAL PRACTICE: The findings show that holders of such posts need to have appropriate previous knowledge, skills and personal characteristics, as these seem to influence their ability to integrate the four domains of the role and thus achieve the requirements of the post.

Achievement↗

PubMed2004

Mature women's experiences of preregistration nurse education.

BACKGROUND: The government of the United Kingdom is encouraging more flexible recruitment strategies to overcome the shortage of qualified nurses. Mature women returning to education, often after completing their families, are a major target, but there has been little evaluation of their experiences as higher education students of nursing. AIM: The aim of the study was to follow-up a previous quantitative study of mature women students' outcomes on preregistration diploma courses in order to gain a deeper understanding of their experiences, and consider ways in which their needs might be addressed. METHODS: Five focus groups were conducted in one higher education institution, and data were analysed using thematic analysis, assisted by the 'spike' feature of Word for Windows. FINDINGS: Three major themes were identified: 'Didn't know what to expect', 'Reality shock' and 'Learning the game'. Subthemes of 'Learning the game' were 'Academic study', 'Practice placements and shift work', 'Managing the effect of course workload on domestic roles', 'Personal growth and changing relationships', and 'Support systems and friendships'. CONCLUSIONS: The findings are discussed in relation to reports of women's experiences in higher education in general. We conclude that the situation and needs of mature women preregistration nursing students are such that fundamental curriculum redesign is needed so that they can participate in higher education in ways that allow integration of their family and student lives, and permit them to benefit from the higher education experience in the same ways as younger students. The study is limited by its local nature, but the findings mirror those of other work, giving reassurance of its wider applicability. Recommendations are made for changes in the philosophy and organization of future programmes to improve their appropriateness and acceptability to mature women nursing students.

Adult↗

PubMed2004

Editor's note: analysis of papers published in JAN in 2002.

Explore the source record for details and available documents.

Bibliometrics↗

PubMed2004

Making portfolios work in practice.

BACKGROUND: A portfolio captures learning from experience, enables an assessor to measure student learning, acts as a tool for reflective thinking, illustrates critical analytical skills and evidence of self-directed learning and provides a collection of detailed evidence of a person's competence. AIMS: This paper reports data on how assessors and nursing students match learning outcomes and/or competencies to their practice and then reconstruct those experiences into the format required by the portfolio documentation. The data were gathered as part of a larger study to evaluate the use of portfolios in the assessment of learning and competence in England. METHODS: This three phase stakeholder evaluation was designed to gain the views of those involved in designing, implementing and using portfolios in nurse education. In phase 2, 122 students and 58 nurse teachers were interviewed about their perceptions of portfolio use, and a further 32 students and 26 assessors were interviewed after they had been observed taking part in an assessment process. Thematic data analysis was used. FINDINGS: Assessors and students underwent a complex process of deconstructing learning outcomes/competences to fit these to their practice. These then had to be reconstructed through the written medium to fit the structure of the portfolio. Confirmation that this met teachers' expectations was essential to allay feelings of insecurity. CONCLUSIONS: To achieve maximum benefit from the portfolio as a learning tool to link theory and practice, there needs to be a clear fit between the model of portfolio and the professional practice that is to be assessed. Outcomes and competences, as well as the type of evidence required to demonstrate their achievement, and integration of the whole experience should match the students' stage of professional and academic development. Over-complex approaches to practice assessment, particularly in the early stages of students' careers, can detract from clinical learning in favour of learning how to complete the portfolio successfully.

Clinical Competence↗

PubMed2004

Developing lecturer practitioner roles using action research.

BACKGROUND: Lecturer Practitioner roles are well established in the United Kingdom. The national literature demonstrates that these staff are valuable to National Health Service trusts and universities however, their roles are busy and demanding, with conflicting expectations from the two employers. In addition, their role in addressing the theory-practice gap - a major reason for their establishment - is at best unclear. Although a number of qualitative studies have explored the topic, there have been no systematic attempts to develop the role or to quantify the effects on postholders. AIM: This paper reports a study that aimed to develop aspects of Lecturer Practitioners' work roles, examine the effects of this on individuals at one English university, and to quantify Lecturer Practitioners' occupational stress and burnout. METHODS: A flexible, 'spiral' action research framework and 'collaborative group approach' were used, with mixed methods of data collection. Data were collected through focus groups, meetings and participant feedback, and participants' reflective diaries. A questionnaire using previously validated psychological attitude rating scales was also used to measure occupational stress and burnout, the extent to which the project influenced these, and the influence of Lecturer Practitioners' experience and qualifications. Six null hypotheses were constructed to measure these ideas. Findings from qualitative and quantitative perspectives were triangulated to give depth to the analysis. FINDINGS: Five themes emerged from the focus groups: personal motivation, workload pressures, role clarity, preparation and support, and gains from the role. Specific policies and documentation were developed as a result of this initial project planning work. The findings from the questionnaire indicated that Lecturer Practitioners were no more stressed or burnt out than comparable workers. Synthesis of findings indicated, broadly speaking, that these LPs were 'thriving rather than just surviving'. CONCLUSION: Action research was an effective methodology for uncovering new knowledge, and bringing about organizational change in this project.

Burnout, Professional↗

PubMed2004

Exploring nurses' experiences of providing high dependency care in children's wards.

The care of critically ill children has received much attention in the past decade, and many of the recommendations from reports relating to the provision of paediatric intensive care have been addressed. In comparison, high dependency care has received less attention. This level of care is often provided on 'general' children's wards, yet its impact on nursing staff and care delivery have received little attention. This article presents a study which explores nurses' experiences of providing high dependency care on children's wards using focus groups. Following analysis, six categories emerged: definitions and perceptions of high dependency care; having a high dependency unit; problems in district general hospitals; the skills needed for high dependency care; team working; and staffing for high dependency care. These findings have implications for current clinical, managerial and educational practice and for future developments in the field of high dependency care for children.

Attitude of Health Personnel↗

PubMed2003

Evaluating portfolio assessment systems: what are the appropriate criteria?

PURPOSE: The purpose of this paper is to discuss how portfolio assessment processes should be evaluated. BACKGROUND: Articles in the nursing literature discuss the use of validity and reliability as criteria for evaluating portfolio assessment processes, and recommendations include tighter specification of grading criteria, a standardized national approach to assessing clinical competence in nursing students, and inter-rater reliability checks. On the other hand, some general practitioner educators suggest that these may not be the appropriate criteria because the nature of the evidence in portfolios is descriptive and judgement-based rather than quantifiable. METHOD: Drawing on multi-method case study data from a recent study evaluating the use of portfolios in the assessment of learning and competence in nursing education in England, we suggest that criteria developed to evaluate qualitative research may be more appropriate for evaluating portfolio assessment processes. DISCUSSION: Multiple sources of evidence from the varied perspectives of students, teachers, practice assessors and external examiners are tapped as part of the portfolio assessment process. Tripartite meetings between students, teachers and clinical assessors to review placements are crucial in verifying both the written evidence and students' ability to communicate and critically analyse their performance. The variety of evidence collected would potentially allow monitoring, using qualitative research evaluation criteria, both of the portfolios themselves and the systems by which they are monitored and evaluated. However, not all this information is collected consistently and systematically, as called for in curriculum documents. CONCLUSIONS: Use of qualitative research evaluation criteria offers a potentially productive way forward in evaluating portfolio assessment processes but some aspects of current practice need to be tightened, particularly double marking, internal moderation and external examining.

Clinical Competence↗

PubMed2003

Portfolios and assessment of competence: a review of the literature.

BACKGROUND: The literature review presented here was conducted as part of an English National Board for Nursing, Midwifery and Health Visiting funded project to evaluate the use of portfolios in the assessment of learning and competence. Initial consideration of the topic revealed the need to clarify the terminology and approaches used to assess competence using portfolios, and therefore the literature review was conducted to inform the study. AIMS: To clarify definitions, theoretical bases and approaches to competence and the use of portfolios in the assessment of learning and competence in nursing education. METHODS: A comprehensive literature review was conducted using the CINAHL and MEDLINE databases and the keywords competenc*, portfolios and nursing. Articles published in the period 1989-2001 in English were obtained and their reference lists scrutinized to identify additional references. Twenty articles were found using a combination of the keywords competenc* and portfolios, and 52 using the combination portfolios and nurse education. Articles were included in the review if they focused on the use of portfolios in nursing, and those concerned with professional or transitional portfolios were excluded. This article will analyse definitions of and approaches to competence and its measurement and to portfolios and their use as discussed in the articles identified. RESULTS: Three approaches to competence were identified, each with its appropriate forms of assessment. With regard to portfolios, a number of definitions were again found, but there was a consensus that the theoretical basis of their use is theories of adult learning. A number of reasons for and advantages and disadvantages of their use were found, as well as varying ideas about what a portfolios should consist of and how it should be assessed. CONCLUSION: A holistic approach to competence seems to be compatible with the use of portfolios to assess competence in nursing students, but the concept and its implementation is still evolving. A variety of assessment methods are needed for assessment and portfolios appear to have the potential to integrate these. Reflection is an essential component of a portfolio, as are the student-teacher relationship and explicit guidelines for constructing the portfolio. Issues of rigour in assessment of portfolios need to be addressed, but the assessor's professional judgement will inevitably enter into this assessment.

Clinical Competence↗

PubMed2003