• Balance quality assessment as an early indicator of physical frailty in older people

      Chkeir, Aly; Safieddine, Doha; Bera, Delphine; Collart, Michèle; Novella, Jean-Luc; Drame, M.; Hewson, David; Duchêne, Jacques (IEEE, 2016-10-01)
      Frailty is an increasingly common geriatric condition that results in an increased risk of adverse health outcomes such as falls. The most widely-used means of detecting frailty is the Fried phenotype, which includes several objective measures such as grip strength and gait velocity. One method of screening for falls is to measure balance, which can be done by a range of techniques including the assessment of the Centre of Pressure (CoP) during a balance assessment. The Balance Quality Tester (BQT) is a device based on a commercial bathroom scale that can evaluate balance quality. The BQT provides instantaneously the position of the CoP (stabilogram) in both anteroposterior (AP) and mediolateral (ML) directions and can estimate the vertical ground reaction force. The purpose of this study was to examine the relationship between balance quality assessment and physical frailty. Balance quality was compared to physical frailty in 186 older subjects. Rising rate (RR) was slower and trajectory velocity (TV) was higher in subjects classified as frail for both grip strength and gait velocity (p<;0.05). Balance assessment could be used in conjunction with functional tests of grip strength and gait velocity as a means of screening for frailty.
    • Barriers and enablers for UK home grown South Asian prospective students choosing nursing and midwifery courses and careers

      Ali, Nasreen; Qureshi, Irtiza; Sidika, Tamanna; Mondokova, Andrea; Mahmood, Sultan; Jan, Azra; Garcia, Rebecca; Cook, Erica Jane; Burden, Barbara; Reid, Caroline; et al. (Insight Medical Publishing Group, 2018-08-10)
      Background: UK ‘home grown’ (people of South Asian ethnicity, born or socialised in Britain) South Asian (Pakistanis, Bangladeshis and Indians) are underrepresented in the NHS nursing and the allied health workforce. One of the key goals of Health Education England’s (HEE) national framework- Widening Participation-It matters! is to increase understanding and evidence on the specific needs of underrepresented groups as they apply, commence and progress on healthcare courses and careers. There is a dearth of evidence on the views of UK ‘home grown’ South Asian prospective students. This study aimed to explore UK ‘home grown’ South Asian students views on the barriers and enablers to choosing nursing and midwifery courses and progressing into healthcare employment. Methods: A total of nine focus groups were conducted. Four focus groups in two schools/colleges in the town of High Wycombe (n=28) and five focus group discussions in two schools/colleges in Luton (n=27). Results: The main themes emerging for barriers to choosing nursing and midwifery courses and careers were: limited personal, parental and community knowledge influencing perceptions of nursing and midwifery, the role of religion and culture, gender roles-‘not man’s work’, the end of NHS bursaries and racial and religious discrimination. The main themes for enablers were presented as: good information available on applying for nursing or midwifery courses and suggestions on how to widen participation for South Asian groups. Conclusion: To increase numbers of UK ‘home grown’ South Asians on nursing and midwifery courses and in healthcare employment, targeted interventions that raise the profile and status of nursing in the South Asian community should be designed and delivered.
    • Barriers and facilitators to adherence to group exercise in institutionalized older people living with dementia: a systematic review

      Vseteckova, Jitka; Deepak-Gopinath, Manik; Borgstrom, Erica; Holland, Caroline; Draper, Jan; Pappas, Yannis; McKeown, Eamonn; Dadova, Klara; Gray, Steve; Open University; et al. (BioMed Central, 2018-12-28)
      Research suggests targeted exercise is important for people living with dementia, especially those living in residential care. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to group exercise of institutionalized older people living with dementia. We searched all available electronic databases. Additionally, we searched trial registries (clinicaltrial.gov, and WHO ICTRP) for ongoing studies. We searched for and included papers from January 1990 until September 2017 in any language. We included randomized, non-randomized trials. Studies were not eligible if participants were either healthy older people or people suffering from dementia but not living in an institution. Studies were also excluded if they were not focused on barriers and facilitators to adherence to group exercise. Using narrative analysis, we identified the following themes for barriers: bio-medical reasons and mental wellbeing and physical ability, relationships dynamics, and socioeconomic reasons. The facilitators were grouped under the following thematic frames: bio-medical benefits and benefits related to physical ability, feelings and emotions and confidence improvements, therapist and group relationships dynamics and activity related reasons. We conclude that institutionalized older people living with dementia, even those who are physically frail, incontinent and/or have mild dementia can demonstrate certain level of exercise adherence, and therefore can respond positively to exercise programs. Tailored, individually-adjusted and supported physical activity, led by a knowledgeable, engaging and well communicating therapist/facilitator improves the adherence to group exercise interventions of institutionalized older people living with dementia. Objectives Methods Results Conclusions
    • Barriers and facilitators to adherence to walking group exercise in older people living with dementia in the community: a systematic review

      Vseteckova, Jitka; Dadova, Klara; Gracia, R.; Ryan, G.; Borgstrom, Erica; Abington, J.; Gopinath, M.; Pappas, Yannis; (BioMed Central Ltd, 2020-09-21)
      Summary: Background &amp; Aims: Evidence suggests that targeted exercise is important for people living with dementia. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to walking group exercise of older people living with dementia in the community. Methods: We have searched appropriate electronic databases between January 1990 until September 2019, in any language. Additionally, we searched trial registries (clinicaltrial.gov and WHO ICTRP) for ongoing studies. We included all study designs. Studies were excluded when participants were either healthy older people or people suffering from dementia but living in residential care. Narrative synthesis was used. Findings: 10 papers met the inclusion criteria. The narrative analysis focused on barriers, facilitators, and adherence. All studies reported on barriers and facilitators. Barriers included: bio-medical reasons (including mental wellbeing and physical ability); relationship dynamics; and socio-economic reasons and environmental issues. Facilitators included: bio-medical benefits &amp; benefits related to physical ability; staff, group relationship dynamics and social aspect of walking group; environmental issues and individual tailoring; and participants perceptions about the walks &amp; the program. Most studies did not provide data about adherence or attendance; where reported, adherence ranged from 47 to 89%. Conclusions: This systematic review of literature has highlighted known barriers and facilitators to adherence to walking groups type of exercise for people living with dementia in community. Carers' willingness to engage, their circumstances, perspectives and previous experiences of exercise seem to play a key role in facilitating adherence but there is little research that explores these. Also, the design, location and organisation of walking groups facilitate adherence. This reflects the need for such activities to be part of a wider 'program of care', tailored to the needs of the individual, flexible and convenient. Knowledgeable and well-trained instructors or healthcare professionals are recommended as group exercise leaders.
    • Barriers and facilitators to genetic testing amongst Black African women in the UK

      Kabeya, Valencia; Puthussery, Shuby; Furmanski, Anna L. (Oxford University Press, 2021-10-20)
      Background Black African women have the lowest attendance of genetic testing services and the highest mortality rate of breast and ovarian cancer amongst women from ethnic minority groups in the UK. Therefore, this study aimed to identify the barriers and facilitators to genetic testing to enable these women to make informed choices if found eligible. Methods A qualitative approach was used to explore the perceptions surrounding genetic testing amongst Twenty-four women aged 23-57 Black African women in Luton. Purposive sampling combined with snowballing sampling was used as a recruitment technique. Results The findings revealed that most of the participants had no awareness or knowledge of genetic testing and limited knowledge of their family medical history for eligibility to attend genetic testing services. Facilitators including family member's health, funding by the National Health services and accessibility and awareness and education on genetic testing were identified. Conclusions This study sought to explore the perceptions of Black African women on barriers and facilitators to genetic testing to enable researchers to implement efficient intervention that would increase genetic testing attendance whilst addressing the other barriers and facilitators to alter Black African's women health seeking behaviours.
    • Barriers and facilitators to smart home adoption

      Davidson, Rosemary (2015-11-12)
      This paper explores the social barriers and facilitators to smart home adoption with an analysis of public attitudes. Smart home services aim to improve the comfort, convenience and safety of householders, as well as allowing them to use energy more efficiently and cope with increasing costs. Despite the existence of smart homes and smart home technologies for some time, their prevalence is not widespread, and thus their potential largely untapped. Using in-depth deliberative public workshops this paper explores social barriers and facilitators to smart home technology, and how views vary by socio-economic status, expertise, life-stage and location. The research highlights the importance of themes such as environmental context, older housing stock, city living, perceptions of new homes, financial pressures/exclusion, lack of trust, and acceptability of smart home services.
    • Barriers toward deceased organ donation among Indians living globally: An integrative systematic review using narrative synthesis

      Vincent, Britzer Paul; Randhawa, Gurch; Cook, Erica Jane; ; University of Bedfordshire (British Medical Journal Open, 2022-05-27)
      Objectives: To understand the barriers towards deceased organ donation among Indians living globally. Design: Integrative systematic review using narrative synthesis. Data sources: CINAHL, Medline full-text, PsycInfo, Scopus, Global Health, Web of Science, and PubMed Central, Indian Journal of Transplantation and Google Scholar. Time period: 1 January 1994 to 31 December 2021. Participants: Individuals of Indian origin living globally. Results: Eighty-nine studies were included with more than 29 000 participants and quality of the studies were assessed using Joanna Briggs Institute's critical appraisal tool. Though majority of the participants had knowledge toward organ donation with a positive influence on willingness, the gap between knowledge and willingness was huge, with minimal registration influenced by the complex sociocultural constructs. Various sociocultural constructs such as family, fear and mistrust, religion, and bodily issues play a vital role. Differences were identified in willingness to donate and register between southern and other regions of India. Indian's organ donation behaviour in other geographical locations differed based on the socioreligious background of the country they lived in such as in Malaysia, Canada and the UK. However, they were collective in decision-making and had complex sociocultural interference irrespective of the country the individual lived which differed only in their next generations. Conclusion: Though this study showed the complex relationship, and its influences on organ donation behaviour, lacunae were identified to further understand how such complex interactions determine or inform the behaviour. Also, methodological issues were identified, where this particular population outside India were collectively studied with their neighbouring population which are not homogenous. Studies in India majorly addressed a similar aim using similar methods which produced repetition of studies leading to lack of diversified, wider and in-depth research. Therefore, while this systematic review addressed the barriers toward organ donation among Indians living globally, it also informs various gaps in research and also methodological issues.
    • Barriers towards organ donor registration and consent among people of Indian origin living globally: a systematic review and integrative synthesis - protocol

      Vincent, Britzer Paul; Randhawa, Gurch; Cook, Erica Jane; University of Bedfordshire (BMJ Publishing Group, 2020-06-21)
      Introduction The need for organs is comparatively higher among people of Indian origin due to the higher prevalence of end-stage organ failure. In spite of the higher need, they have a lower number of organ donors. Studies have been carried out among people of Indian origin living globally to understand the reasons for the low donation rate, but there has been no systematic review that has integrated all of these studies to synthesise the current literature. Therefore, the purpose of this review is to examine the barriers towards organ donor registration and consent among Indians living globally. Methods and analysis A systematic search will be conducted using the following relevant databases namely CINHAL, MEDLINE, PsycINFO, Scopus, Web of Science, PubMed Central, Global Health and Grey literature. Studies from 1994 that satisfy our inclusion criteria will be included. Two reviewers will conduct the screening, data extraction and quality assessment of the studies; in event of any disagreement between the two reviewers at any stage, the third reviewer will reconcile any disagreements and consensus will be made. Ethics and dissemination As this study includes only secondary data, ethical approval for secondary data usage has been sought. This study will use Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to report and the study outcomes will be disseminated through a relevant peer-review publication, related conferences and also to various non-governmental organisations globally which are working with this particular community; following which further research can be developed based on this evidence and also helps in building a culturally competent strategy. PROSPERO registration number CRD42019155274.
    • Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China

      Wei, Li; Champman, Sarah; Li, Xiaomei; Li, Xin; Li, Sumei; Chen, Ruoling; Bo, Nie; Chater, Angel M.; Horne, Robert; University College London School of Pharmacy; et al. (BMJ Publishing Group, 2017-10-01)
      OBJECTIVES: To investigate beliefs about medicines and their association with medicine adherence in patients with chronic diseases in China. DESIGN: A cross-sectional questionnaire-based study SETTING: Two large urban hospitals in Hefei and Tianjin, China PARTICIPANTS: Hospital inpatients (313 stroke patients) and outpatients (315 diabetic patients and 339 rheumatoid arthritis (RA) patients) were recruited between January 2014 and September 2014. OUTCOME MEASURES: The Beliefs about Medicines Questionnaire (BMQ), assessing patients' beliefs about the specific medicine (Specific-Necessity and Specific-Concerns) prescribed for their conditions (stroke/diabetes/RA) and more general background beliefs about pharmaceuticals as a class of treatment (BMQ-General Benefit, Harm and Overuse); the Perceived Sensitivity to Medicines scale (PSM) assessed patients' beliefs about how sensitive they were to the effects of medicines and the Medication Adherence Report Scale. The association between non-adherence and beliefs about medicines was assessed using a logistic regression model. RESULTS: Patients with diabetes mellitus had a stronger perceived need for treatment (mean (SD) Specific-Necessity score, 3.75 (0.40)) than patients with stroke (3.69 (0.53)) and RA (3.66 (0.44)) (p=0.049). Moderate correlations were observed between Specific-Concerns and General-Overuse, General-Harm and PSM (Pearson correlation coefficients, 0.39, 0.49 and 0.49, respectively, p<0.01). Three hundred and eleven patients were non-adherent to their medicine (159 (51.0%) in the stroke group, 60 (26.7%) in the diabetes mellitus group and 62 (19.8%) in the RA group, p<0.01). Across the whole sample, after adjusting for demographic characteristics, non-adherence was associated with patients who had higher concerns about their medicines (OR, 1.35, 95% CI 1.07 to 1.71) and patients who believed that they were personally sensitive to the effects of medications (OR 1.44, 95% CI 1.16 to 1.85). CONCLUSION: The BMQ is a useful tool to identify patients at risk of non-adherence. In the future, adherence intervention studies may use the BMQ to screen for patients who are at risk of non-adherence and to map interventional support.
    • A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39

      Reeves, Scott; Fletcher, Simon; Barr, Hugh; Birch, Ivan; Boet, Sylvain; Davies, Nigel; McFadyen, Angus; Rivera, Josette; Kitto, Simon; ; et al. (Taylor and Francis Ltd, 2016-05-05)
      Abstract: Background: Interprofessional education (IPE) aims to bring together different professionals to learn with, from, and about one another in order to collaborate more effectively in the delivery of safe, high-quality care for patients/clients. Given its potential for improving collaboration and care delivery, there have been repeated calls for the wider-scale implementation of IPE across education and clinical settings. Increasingly, a range of IPE initiatives are being implemented and evaluated which are adding to the growth of evidence for this form of education. Aim: The overall aim of this review is to update a previous BEME review published in 2007. In doing so, this update sought to synthesize the evolving nature of the IPE evidence. Methods: Medline, CINAHL, BEI, and ASSIA were searched from May 2005 to June 2014. Also, journal hand searches were undertaken. All potential abstracts and papers were screened by pairs of reviewers to determine inclusion. All included papers were assessed for methodological quality and those deemed as “high quality” were included. The presage–process–product (3P) model and a modified Kirkpatrick model were employed to analyze and synthesize the included studies. Results: Twenty-five new IPE studies were included in this update. These studies were added to the 21 studies from the previous review to form a complete data set of 46 high-quality IPE studies. In relation to the 3P model, overall the updated review found that most of the presage and process factors identified from the previous review were further supported in the newer studies. In regard to the products (outcomes) reported, the results from this review continue to show far more positive than neutral or mixed outcomes reported in the included studies. Based on the modified Kirkpatrick model, the included studies suggest that learners respond well to IPE, their attitudes and perceptions of one another improve, and they report increases in collaborative knowledge and skills. There is more limited, but growing, evidence related to changes in behavior, organizational practice, and benefits to patients/clients. Conclusions: This updated review found that key context (presage) and process factors reported in the previous review continue to have resonance on the delivery of IPE. In addition, the newer studies have provided further evidence for the effects on IPE related to a number of different outcomes. Based on these conclusions, a series of key implications for the development of IPE are offered.
    • Bereaved donor families' experiences of organ and tissue donation, and perceived influences on their decision making

      Sque, Magi; Walker, Wendy; Long-Sutehall, Tracy; Morgan, Myfanwy; Randhawa, Gurch; Rodney, Amanda; University of Wolverhampton; University of Southampton; King's College London; University of Bedfordshire (Elsevier, 2018-01-16)
      To elicit bereaved families' experiences of organ and tissue donation. A specific objective was to determine families' perceptions of how their experiences influenced donation decision-making. Retrospective, qualitative interviews were undertaken with 43 participants of 31 donor families to generate rich, informative data. Participant recruitment was via 10 National Health Service Trusts, representative of five regional organ donation services in the UK. Twelve families agreed to DBD, 18 agreed to DCD, 1 unknown. Participants' responses were contextualised using a temporal framework of 'The Past', which represented families' prior knowledge, experience, attitudes, beliefs, and intentions toward organ donation; 'The Present', which incorporated the moment in time when families experienced the potential for donation; and 'The Future', which corresponded to expectations and outcomes arising from the donation decision. Temporally interwoven experiences appeared to influence families' decisions to donate the organs of their deceased relative for transplantation. The influence of temporality on donation-decision making is worthy of consideration in the planning of future education, policy, practice, and research for improved rates of family consent to donation. PURPOSE METHODS RESULTS CONCLUSIONS
    • Biomechanical analysis of older adults stepping up: a method of evaluating balance

      Michel-Pellegrino, Valerie; Hewson, David; Hogrel, Jean-Yves; Duchêne, Jacques; Troyes University of Technology (Human Kinetics, 2008-04-30)
      The aim of this study was to analyze differences in biomechanical parameters between elderly and control participants when stepping up, to evaluate control of balance. Eleven control and 14 elderly participants performed a step from an initial static posture onto a 7-cm-high force plate. For the spontaneous-velocity condition, elderly participants performed a slower progression velocity than control participants. Elderly participants spent proportionally more time in stance phase, with a corresponding decrease in swing phase, than the control participants, irrespective of movement velocity. In contrast, at spontaneous velocity the parameters related to ground-reaction force (GRF) showed that anteroposterior and mediolateral forces at toe-off of the support limb and the slope of vertical force during weight transfer were significantly smaller for the elderly than for control participants. These GRF parameters depended on the stepping-up velocity. The elderly develop a spatiotemporal strategy and reduced movement velocity to control support balance.
    • Born in the UK: Maternity and postnatal care needs of UK-born ethnic minority women

      Puthussery, Shuby; Twamley, Katherine; Mirsky, Judith; Macfarlane, Alison; Harding, Seeromanie; Baron, Maurina (Radcliffe Publishing Ltd, 2009-09-30)
    • British South Asian male nurses' views on the barriers and enablers to entering and progressing in nursing careers

      Quereshi, Irtiza; Ali, Nasreen; Randhawa, Gurch; University of Bedfordshire (Wiley, 2020-04-06)
      To ascertain British South Asian male nurses' views on the barriers and enablers to entering and progressing in nursing education and careers. There is a shortage of men from Black, Asian and Minority Ethnic groups in the National Health Service nursing workforce. There is a dearth of evidence on the views of British south Asian men on this subject. A qualitative interpretative intersectional approach was used to carry out one to one interviews (n=5) with British South Asian male nurses using a semi-structured topic guide. Interviews took place between July 2018 and February 2019, across England. A Framework Analysis approach was used to analyse the interview transcripts. The main themes emerging as barriers were: poor pay and conditions, negative immediate, extended family, community views and a lack of knowledge and awareness of the nursing profession. The main themes emerging as enablers were: personal circumstances (including role models) and ethnicity (including the role of religion and masculinity). Findings suggest that the intersection between ethnicity and gender presents as an important enabler, as well as inhibitor, for British South Asian men. Nursing careers and salient barriers exist at a systemic level and include institutional racism. Review policies and practice on unconscious bias and institutional racism in the recruitment, retention and progression of British South Asian men. Provide continuous professional development including mentoring support to help career progression for these men. Develop culturally specific interventions to reduce the stigma associated with the nursing profession in the British South Asian community. Consider places of worship as venues for delivery of these interventions when promoting nursing. AIM BACKGROUND METHODS RESULTS CONCLUSION IMPLICATIONS FOR NURSING MANAGEMENT
    • CAM within a field force of countervailing powers: the case of Portugal

      Almeida, Joana; Gabe, Jonathan; Royal Holloway, University of London (Elsevier, 2016-03-03)
      This paper examines the extent to which the position of the medical profession and the state towards complementary and alternative medicine (CAM) practitioners has changed since the late 1990s, taking Portugal as a case study. Using Light’s concept of countervailing powers we consider the alliances, interests, rhetorics and degrees of control between these three actors over time, focusing particularly on the extent to which CAM practitioners have acted as a countervailing force in their relationship with the medical profession and the state. It also brings to the fore the position of supra-state agencies concerning CAM regulation. A critical discourse analysis was conducted on data derived from a systematic search of information from the late 1990s until 2015. Our analysis suggests that CAM has emerged as an active player and a countervailing power in that it has been a significant influence in shaping state policy-making. The medical profession, in turn, has changed from rejecting to ‘incorporating’ CAM while the state has acted has a ‘broker’, trying to accommodate the demands and preferences of both actors while simultaneously demonstrating its power and autonomy in shaping health policy. In sum, the history of countermoves of CAM, the medical profession and the state in recasting power relations regarding CAM regulation in Portugal has highlighted the explanatory value of Light’s countervailing power theory and the need to move away from a professional dominance and corporatist approach where CAM has simply been seen as subjugated to the power of the medical profession and the state.
    • Can an intervention in general practice increase sign-up rates to the NHS Organ Donor Register? a feasibility randomised controlled trial

      Penn-Jones, Catrin Pedder; Papadopoulos, Chris; Randhawa, Gurch; Asghar, Zeeshan; University of Bedfordshire; NHS Blood and Transplant (2017-09-06)
    • Can distance learning become an affective mode of delivery?

      Beckwith, Philip; Sapsed, Susan; University of Bedfordshire (Chinese American Scholars Association, 2007-01-01)
      The term blended learning is becoming more prevalent in the fields of Health and Social Sciences. Although it tends to be synonymous with e-learning; this should not be the case as blended learning involves an integrated delivery strategy. Rossett et al. (2003) suggest that this could include interaction with a supervisor; participation in an online class; breakfast with colleagues; competency descriptions; reading on the beach; reference to a manual; collegial relationships; and participation in seminars, workshops, and online communities. This paper will attempt to explore whether the integration of the Virtual Learning Environment (VLE) to a traditionally taught masters programme through the development of a blended learning strategy, can facilitate its evolution to distance learning.
    • Can non-invasive biomarkers lead to an earlier diagnosis of Alzheimer's disease?

      Bature, Fidelia; Pappas, Yannis; Pang, Dong; Guinn, Barbara-Ann; (Bentham Science, 2021-12-31)
      A lack of consensus on the diagnostic criteria used in the clinical setting limits the early diagnosis of Alzheimer’s disease (AD) and increases the backlog of undiagnosed cases. While AD has no cure, the current aim is to diagnose the disease at the pre-symptomatic stage - the key to successful intervention, better understanding, and enabling the admission of improved therapeutic and nonpharmacological interventions. The major issues include the number of people affected, ignorance of the early signs and symptoms by patients, their families and healthcare staff, all of which are exacerbated by the vagueness and variety of symptoms
    • Capturing debriefing and enhancing reflection within simulated clinical learning environments

      Wareing, Mark; England, Jacqueline A.; Mathew, David; Ball, Carla; Willetts, Amanda; Kemp, Jane; Clifford, Kelly; Thompson, Andrea; Dove, Ian; Adams, Louise; et al. (National Association of Educators in Practice, 2020-05-05)
      This article presents findings from an evaluation of a new A3-size learner notes sheet designed for use by healthcare students engaging in clinical simulation and clinical skills sessions. The notes sheet consists of an adapted form of the SBAR (situation, background, assessment, response) tool, whilst capturing post-simulation oral debriefing provided by a facilitator. Additionally, the Driscoll (2007) model is used to provide students with an opportunity to reflect on their engagement in clinical simulation. Two cohorts of students, who engaged in separate simulation sessions, completed the A3 sheet. The study featured 33 midwifery and 21 operating department practitioner (ODP) students undertaking a simulation. Documentary analysis was undertaken to identify the depth of reflective writing of both groups of students. Midwifery student participants reflected on their experiences of simulation at a slightly deeper level than their ODP counterparts. All students adhered to the structure of the notes sheet when receiving their briefing from the facilitator and when asked to write their reflective accounts. This study has sought to explore an under-researched area of clinical simulation: the extent to which healthcare students can utilise reflection when engaging with a clinical scenario within a simulated learning environment.
    • Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study

      Baillie, Lesley; Gallini, Andrew; Corser, Rachael; Elworthy, Gina; Scotcher, Ann; Barrand, Annabelle; ; London South Bank University; University College London Hospitals; Hospital of St John & St Elizabeth; et al. (Ubiquity Press Ltd, 2014-03-27)
      Introduction: Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services. Theory and methods: The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n = 17); focus groups (n = 9) with ward staff (n = 36); interviews with frail older people (n = 4). The data were analysed using the framework approach. Findings: Three themes are presented: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions. Discussion and conclusions: A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other’s roles and build relationships and trust.