Part One: From Trainee to PhD – Top tips for success

Here at NIHR CLAHRC Wessex we have had the privilege to work with some very talented and determined people who have signed up to become an NIHR Trainee. It’s a demanding process where you are supported to carry out research, normally for a PhD, while continuing often in your day job, be that in the NHS or University. The NIHR has now set up an Academy to support trainees.

More than twenty have made it through the process and we wanted to capture their experience to help others who may be considering the idea. We asked them four questions:

1. What have I got from being a trainee?
2. What advice would you give to someone who’s thinking about applying?
3. How did you manage juggling PhD and work?
4. What is your best single piece of advice

Here is what they had to say..

The rights of people with dementia -Jackie Bridges – Professor of Older People’s Care, University of Southampton

Not so long ago CLAHRC East of England Research Capacity in Dementia Care Programme (RCDCP) joined forces with the University of Southampton Alzheimer’s Society Doctoral Training Centre to provide a European Summer School for 17 dementia care doctoral students. Hosted by the University of Linköping in Sweden, the programme enabled participants to share ideas, build international partnerships, and learn from leaders in dementia care research.

Professor Jackie Bridges explains some of the lessons we can learn about caring for people with dementia.

She was particularly struck by the approach of a day centre she visited whilst on the trip.

Frailty – a team approach to learning. Dr Melinda Taylor and Dr Alex Recio-Saucedo

Dr Melinda Taylor, Senior Research Fellow in Organisational Behaviour, NIHR CLAHRC Wessex Data Science Hub

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The first blog in this series described how health professionals in our study found it difficult to define ‘frailty’ but agreed that it was an extremely broad concept with no defined boundaries. This has an impact on training in frailty care. This second blog outlines our participants’ views on frailty care training.

Our study evaluated particular aspects of four initiatives intended to enhance the care provided to people regarded as frail. The diverse nature of the initiatives further demonstrates the complex nature of frailty.

Let’s learn about Frailty: a blog series on training for healthcare staff in this complex field. By Alex Recio-Saucedo and Melinda Taylor

This is the first of a series of blogs drawing on a study of training for those working in frailty care, with additional reflections from other work.

What is frailty?

Before looking at training in frailty care, it would be helpful to understand something about what frailty is. Descriptions of frailty will almost always refer to the complexity of the condition. But what makes frailty different to other conditions that could be described as complex? We might think perhaps of multiple sclerosis, in which the patient may experience a range of clinical conditions and in which physical, psychological and social factors need to be taken into account. The same can be said for patients diagnosed as frail. Well, in a recent study, our participants considered that the complexity of frailty; how two patients could have such a wide disparity of signs, symptoms and needs; its evolving nature; its acute susceptibility to interventions or to the lack of them, and the high number of professions, sectors and organisations necessary to carrying out effective frailty care, were sufficient reasons for it to stand apart.

What are we missing here? (Are at risk older people spotted early enough in hospital?) – Dr Kinda Ibrahim, Research Fellow at Academic Geriatric Medicine

Nearly two thirds (65%) of people admitted to hospital in the UK are aged over 65 years old. Many of them are frail and at high risk of poor healthcare outcomes – like staying longer in hospital, reduced physical abilities, becoming dependant, going to a care home, and even death.

National recommendations suggest that these high-risk older individuals should be routinely identified when they are admitted to hospital to allow healthcare teams to provide appropriate individual care that meets patient’s needs (1).  It is unclear whether and how those people are identified in hospital. Therefore our study looked at the current practice in one hospital with regard to identification of patients at high-risk of poor healthcare outcomes. To do that, we reviewed a random sample of patient’s clinical notes and interviewed staff members who worked at five acute medicine for older people wards (2).

Dementia care at meal times in acute hospitals – Naomi Gallant

Almost a year on from my last post here and I’ve done a lot of work on my developing my research proposal – reading, learning, literature reviewing – but sadly not a lot has changed for people with dementia in acute hospitals. My desire to improve the quality of care, especially at meal times has certainly grown.

Getting a grip on high risk older inpatients with low grip strength -Dr Kinda Ibrahim and Dr Helen Roberts, Associate Professor in Geriatric Medicine

Our muscles play an important role in our health and grip strength is a good way of measuring how well our muscles are doing. Our grip strength builds through young adulthood to reach its peak in our 30s after which it gradually tails away. It is a reliable and valid way of evaluating someone’s hand strength, which in turns provides an objective measure of the skeletal muscle strength and function in their whole body.

I want to go home: Can modelling the whole health care system reduce the number of patients waiting to leave hospital?

Dr Tom Monks puzzles the opportunities and pitfalls of modelling large parts of the health care system and how this might help patients waiting to leave hospital.

I work as a modeller for CLAHRC Wessex. In part that means I spend a lot of time speaking to health care professionals and commissioners about their priorities and teasing out if modelling could help.  More and more often I am asked “can we model the whole health care system?”.

Why we need to deal with the realities of Dementia in our hospitals – Dr Jackie Bridges Associate Professor, Older People’s and Dementia Care

Dr Jackie Bridges – Associate Professor, Older People’s and Dementia Care, Faculty of Heath Sciences at the University of Southampton

When people with dementia get admitted to hospital, their need for fundamental care can be high. Everyone coming in to hospital wants to be treated with respect and dignity by health care workers who have the time, resources and training needed to keep them safe and well cared for.  But having dementia can put people at higher risk of not having these needs met.

Appetising research – How we’re Introducing Volunteer Mealtime Assistants for older inpatients across University Hospital Southampton

Dr Helen Roberts is Associate Professor in Geriatric Medicine and Theme 2 lead for Improving Routine Care for Ageing and Dementia for NIHR CLAHRC Wessex

Poor nutrition in hospital inpatients is a problem that is becoming increasingly recognised both in the UK and worldwide, and requires a multifaceted approach, including protected meal times, red trays and protein and energy supplementation as required. One factor that particularly affects older inpatients is the amount of assistance they receive at mealtimes. Time-pressured nursing staff may not have the time they need to help patients with their meals.