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Biomedical subjects

Graham R Williamson

Publications and source records attributed to Graham R Williamson.

11 recordsLinked to original sources
PubMed2006

Modernising chronic obstructive pulmonary disease admissions to improve patient care: Local outcomes from implementing the Ideal Design of Emergency Access project.

This project illustrates how benefits to patients, carers, staff and NHS trusts can result from service redesign that is targeted at improving services for patients with chronic obstructive pulmonary disease. Using a Continuous Quality Improvement methodology and 'plan-do-study-act' cycles, this project established key local measures for service redesign based on the national Ideal Design of Emergency Care project. These were to improve patients' experiences of care, by: decreasing patient journey time, improving patient, carer and staff experiences and reducing process variability. The result was a reduction in the average length of stay for patients and an increase in the numbers of patients admitted directly to the emergency medical unit and transferred to the respiratory department. Service users were actively involved in developing the changes. Although not generalizable, this project provides useful insights for consideration by others facing similar issues in their own organisations: we conclude that the methodology used in this study has been instrumental in improving key aspects of patient care, and that a similar methodological approach could be effective for other organisations.

Attitude of Health Personnel↗
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↗
PubMed2005

What is eHealth (5): a research agenda for eHealth through stakeholder consultation and policy context review.

BACKGROUND: In 2003, the National Health Service in England and Wales, despite its large investment in information and communication technology, had not set a national research agenda. The National Health Service has three main research and development programs: one is the Service Delivery and Organisation program, commissioned in 2003, and the others are two parallel "scoping exercises" to help set a research agenda. This paper reports on one of those projects. A parallel literature review was carried out by others and has been reported elsewhere. OBJECTIVE: The objective was to explore the concerns of stakeholders and to review relevant policy in order to produce recommendations and a conceptual map of eHealth research. METHODS: There were two parallel strands. For the stakeholder consultation, 37 professionals representing 12 "stakeholder" groups participated in focus groups or interviews. Discussion was prompted by eHealth "scenarios" and analyzed using thematic content analysis. Subsequently, 17 lay participants, in three focus groups, discussed and prioritized these themes. For the policy review, 26 policy makers were interviewed, and 95 policy documents were reviewed. Recommendations were subsequently reviewed in a conference workshop. Recommendations for research from both strands were combined into a conceptual map. RESULTS: Themes from stakeholder consultation and policy review were combined as 43 recommendations under six headings. Four of these headings (using, processing, sharing, and controlling information) describe the scope of eHealth research. The other two relate to how research should be carried out (ensuring best practice is first identified and disseminated) and to the values considered important by stakeholders (in particular, measuring improvement in health). CONCLUSIONS: The scope of eHealth research (using, processing, sharing, controlling information) derived empirically from this study corresponds with "textbook" descriptions of informatics. Stakeholders would like eHealth research to include outcomes such as improved health or quality of life, but such research may be long term while changes in information technology are rapid. Longer-term research questions need to be concerned with human behavior and our use of information, rather than particular technologies. In some cases, "modelling" longer-term costs and benefits (in terms of health) may be desirable.

Delivery of Health Care↗
PubMed2005

Supporting learners in clinical practice: capacity issues.

AIM: The aim of this paper is to report a study exploring, from the perspective of key stakeholders (mentors of nurses, managers of nurses, and modern matrons) in one English acute sector hospital, how decisions are made on how many learner nurses can be supported in clinical practice. The objective was to identify what factors are taken into consideration in making these decisions. BACKGROUND: Supporting increasing numbers of students is a demand of current service provision in the English National Health Service, as part of an expansion in the numbers of all healthcare professionals. This is particularly the case in nursing, where the government announced a required increase in numbers of qualified nurses of 20 000. This expansion of numbers has implications for the quality of placement learning in clinical placements. METHODS: Data were collected using three focus group interviews with a total of 12 participants in 2003/04. Recruitment was on a purposive basis. Subsequent analysis identified themes, which were compared across groups. A short questionnaire was also used to establish participants' biographical details prior to the focus groups. FINDINGS: Three key themes were identified: 'capacity issues', 'enhancing support in practice' and 'issues impacting on learning in practice'. 'Capacity issues' identified factors that impact on the capacity of placements to support learners. 'Enhancing support in practice' identified necessary roles and strategies to enhance learning in practice. Finally, 'issues impacting on learning in practice' identified learner groups where support could be enhanced through structured management of the placement experience. CONCLUSIONS: Decisions on learner numbers to be supported at any one time are complex, with a multitude of dimensions. These include identification of types of learners and numbers of mentors available to support them and other operational issues. 'Educational staff' are needed at operational and strategic levels to support learning in practice. Timely and appropriate audit information to support allocation decisions and identify strategies to enhance the quality and support of learning in practice, are also required. RELEVANCE TO CLINICAL PRACTICE: Increases in learner numbers and National Health Service modernization have had an impact on clinical placements' capacity to support learning, and potentially, on learners' achievements in practice. Findings from this study are thus important in evaluating the impact of these policy initiatives.

Attitude of Health Personnel↗
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

Lecturer practitioners in UK nursing and midwifery: what is the evidence? A systematic review of the research literature.

BACKGROUND: Lecturer practitioner roles have been widely established in the UK, and are seen as having the ability to overcome the theory-practice gap in nursing, as well as offering other benefits including functioning as a link between education and practice. AIMS AND OBJECTIVES: This article systematically reviews the research literature on UK lecturer practitioner roles in nursing and midwifery, in order to construct a picture of the themes that emerge from their national implementation. CONCLUSIONS: Only eight published research studies meeting the inclusion criteria were identified in journals, and five more included from the 'grey literature', totalling 13 suitable research reports. Of these 13 papers, six involved nurses and midwives. Key themes from the literature are outlined and discussed. There is an overwhelming preference for qualitative methodologies, although there is a strong argument for quantitative work in mixed-methods studies. RELEVANCE TO CLINICAL PRACTICE: Lecturer practitioner roles can make an important contribution to nursing and midwifery education, but this is problematic. It is essential that managers clarify the purpose, responsibilities, support and review of lecturer practitioner roles if they are to be successful.

Evidence-Based Medicine↗
PubMed2003

Misrepresenting random sampling? A systematic review of research papers in the Journal of Advanced Nursing.

AIM: This paper discusses the theoretical limitations of the use of random sampling and probability theory in the production of a significance level (or P-value) in nursing research. Potential alternatives, in the form of randomization tests, are proposed. BACKGROUND: Research papers in nursing, medicine and psychology frequently misrepresent their statistical findings, as the P-values reported assume random sampling. In this systematic review of studies published between January 1995 and June 2002 in the Journal of Advanced Nursing, 89 (68%) studies broke this assumption because they used convenience samples or entire populations. As a result, some of the findings may be questionable. DISCUSSION: The key ideas of random sampling and probability theory for statistical testing (for generating a P-value) are outlined. The result of a systematic review of research papers published in the Journal of Advanced Nursing is then presented, showing how frequently random sampling appears to have been misrepresented. Useful alternative techniques that might overcome these limitations are then discussed. REVIEW LIMITATIONS: This review is limited in scope because it is applied to one journal, and so the findings cannot be generalized to other nursing journals or to nursing research in general. However, it is possible that other nursing journals are also publishing research articles based on the misrepresentation of random sampling. The review is also limited because in several of the articles the sampling method was not completely clearly stated, and in this circumstance a judgment has been made as to the sampling method employed, based on the indications given by author(s). CONCLUSION: Quantitative researchers in nursing should be very careful that the statistical techniques they use are appropriate for the design and sampling methods of their studies. If the techniques they employ are not appropriate, they run the risk of misinterpreting findings by using inappropriate, unrepresentative and biased samples.

Data Collection↗
PubMed2003

Do they practise what we teach? A survey of manual handling practice amongst student nurses.

Experience of training students of nursing in manual handling suggested that they did not practise the techniques they had been taught. A search of the literature revealed that there was indeed a theory-practice gap. The aim of the project was to answer three questions: do students know what they should be doing, do they do what they should be doing, and if not, why not. A survey design was used, with questionnaires designed specifically for the study. Self report questionnaires were distributed to students of nursing (n = 148) on the adult branch in one higher education institution in England. One hundred and thirty-nine completed questionnaires were returned. Results showed that students' knowledge of whether particular techniques were 'recommended' was fair. They indicated however, that they were frequently unable to use recommended techniques in practice. The most frequent explanation given was the influence of other nurses. Results of this small study indicated that male students and younger students were more susceptible to socialization into poor ward practice than others. Other reasons for not using recommended techniques were unavailability of manual handling aids, lack of time and patient needs. The complexity of relationships within the nursing team emerged, with students ever aware of the impression they were making with regard to their assessment of practice, and their need to be accepted as a member of the team. Changes to training are suggested, to help reduce the theory-practice gap.

Adult↗
PubMed2002

Action research: politics, ethics and participation.

AIM: This paper contributes to an understanding of the political and ethical aspects of action research (AR). BACKGROUND: Action research is growing in popularity in nursing and health care as a means of changing practice and generating new knowledge. As a methodology, AR relies on a close collaborative working relationship between researcher and participants, but this close relationship is also the source of political and ethical problems faced by researchers and participants. CONTENT: We argue that action researchers and participants working in their own organizations should be clear about the extent to which they are engaged in a political activity, and that AR does not offer the same ethical guarantees concerning confidentiality and anonymity, informed consent, and protection from harm as other research methodologies (both quantitative and qualitative). This argument is illustrated by our experiences of participation in an AR study. CONCLUSION: We outline three areas where AR is implicitly political, and three areas where it is ethically problematic. We recommend that researchers and participants recognize, discuss and negotiate these problematic areas before starting their work.

Attitude of Health Personnel↗