Swimming in friendly waters – By Dr Rebecca Band

Dr Rebecca Band is a senior research fellow at NIHR CLAHRC Wessex

After several months of thinking ‘I think I’d like to learn how to swim’, last year, I finally made the decision to enrol in adult swimming lessons. I was motivated, I felt fit and so was confident this was something I was capable of doing (and I must admit the lessons were also convenient to get to). Psychologists might say that I had high “self-efficacy”. Self-efficacy is the belief that you will successfully be able to complete a task, activity or performance.

However, my high self-efficacy did not necessarily mean that everything went smoothly or to plan. In the hours leading up to the first lesson I started to make excuses to myself and almost (spoiler alert!) didn’t go. I suspect you’re wondering what has all this got to do with anything?

Qualitative research – where to start?! – Here’s some help

“The idea of the qualitative support group was initiated by Dr Kinda Ibrahim who felt that establishing a peer support network for members within CLAHRC Wessex and the wider University could be helpful to facilitate the use and development of qualitative research in health, illness and care.

This group has been massively supported by CLAHRC central team and Professors Cathy Pope and prof Anne Rogers.

The goal of this group is to encourage an intellectually dynamic yet supportive atmosphere for debate and discussion that examines the place of qualitative research in health research, its core concepts and methods.

The group meets every 2-3 months to share experience and research and are looking to possibly organise training workshops to staff, postgraduate and undergraduate candidates who are conducting or interested in conducting qualitative research. The agenda of this group is driven by its members and their interests and needs.

Dr Teresa Corbett suggested starting a “Qualitative journal club” to form the basis of the discussion in our group and has recently put a call out for recommendations for a “MUST READ LIST” for qualitative researchers on Twitter. The response was fantastic with over 50 replies. Many of those who replied on Twitter asked us to share the list with them once it was compiled.

So we have decided to build this dedicated resource to help and advise people”.

We have also started building up a resource that to be shared so that we can look up the best person(s) within our group that could help, advise, and support. If you would like to add your details, please click here

Polypharmacy and the complexity of deprescribing medications – Dr Kinda Ibrahim

Dr KInda Ibrahim, is a Senior Research Fellow based in the Faculty of Medicine at University Hospital Southampton

The concurrent use of 5 or more medications by one individual – is becoming increasingly a challenging phenomenon that demands attention at clinical policy and practice level. In the past decade, the average number of items prescribed for each person per year in England has increased by 53.8% from 11.9 to 18.3. It is 35-50% of community older people aged 65 years and above take 5 or more medications. The King’s fund ¹ published in November 2018 a report “Polypharmacy and medicines optimisation: Making it safe and sound” where they distinguished between the terms ‘appropriate’ and ‘problematic’ polypharmacy.

Appropriate polypharmacy: means prescribing for an individual for complex conditions or for multiple conditions in circumstances where medicines use has been optimised and the medicines are prescribed according to best evidence.

Problematic polypharmacy where multiple medications are prescribed inappropriately, or where the intended benefit of the medication is not realised.

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..

Learning from failure: lessons from the Checklist project in Wessex – by Dr Kate Lyle and Professor Catherine Pope

Dr Kate Lyle is a Research Fellow based in Health Sciences at the University of Southampton

Professor Catherine Pope is Deputy Director NIHR CLAHRC Wessex

Dr Kate Lyle is a Research Fellow in Health Sciences at the University of Southampton and Professor Catherine Pope (right) is Deputy Director of NIHR CLAHRC Wessex

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As academics, practitioners, and users of healthcare services we are all used to hearing about examples of successful interventions that have improved health services and care.  Indeed one of the core aims of the NIHR CLARHC programme is to improve patient outcomes locally and across the wider NHS. Here in Wessex we have been working hard over the past 5 years to do just that, spreading best practice and evidence based research throughout the NHS.

But what about the things that don’t work? Attempts at service improvement or innovation that went nowhere? Often these are the things we don’t hear about.  Yet, arguably there is as much to learn from our failures, as there is from successful innovations.

Right idea? Wrong time

Overloaded A&Es – Have we got this all wrong? Dr Brad Keogh

Dr Brad Keogh

Accident and Emergency wait times seem to be constantly in the news. Less commonly but equally importantly are headlines that waiting lists for elective operations and procedures are on the rise. Although these topics hit our headlines regularly there is actually very little evidence and understanding behind the reasons for these changes in NHS services, and how the NHS can take positive action to cope with these issues.

From what we understand a lot of the currently held beliefs around the causes for pressure on NHS services come from very basic, non peer-reviewed, and potentially flawed analyses. It does not need too much explaining that making decisions based on these might be a bad idea.

What does it mean to be a nurse? International Nurses Day

To mark International Nurses Day we asked the many researchers who are qualified nurses to answer these three questions:

1. What nursing means to you? And is there a different view of it if you’re originally from another country?
2. How you would encourage other nurses to progress and conduct research?
3. What are the challenges facing the future of nursing that you can see?

Here’s what they said.

Professor of Health Services Research and the lead for CLAHRC research into Fundamental Care in Hospital

Professor Peter Griffiths

I remember being asked in my interview for nursing why I wasn’t applying to be a doctor. There’s no simple answer to ‘what nursing is’ or ‘what it means to me’ but the answer I gave then is probably as close as I’ll ever get.

I’m not that interested in disease but I am interested in people. Nursing is about supporting and helping people, often through their most difficult times. While it’s hard to distinguish this from many other caring professions the key (to me) is that the focus is on the person comes first and the rest follows.

Why might nurses miss people’s ‘danger signs’ at night? – Dr Jo Hope

We know that nurses miss or delay taking patients’ vital signs (such as pulse, temperature and blood pressure) at night. Until now, no one knew why.

The NHS expects hospitals to use ‘Early Warning Scores’ to measure how ill someone is. These are based on the observation of ‘vital signs’ – measurements of things like pulse, temperature, blood pressure and breathing speed. The higher the score, the more often someone’s vital signs should be checked. This is so staff can spot the early danger signs of someone becoming very unwell, in time to help them.

Your local hospital will probably have an ‘early warning protocol’ that says how often people should be checked according to their early warning score. At higher levels observations will need to be done in the middle of the night. Despite this, we know that nurses are much less likely to do the observations that are expected to be done at night.

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).

How do we support each other with our mental health? Professor Anne Rogers

When people talk about managing mental health the most frequent thing to do is to recourse to self help or looking to services to help.  There is less recognition of the power of social networks for help and support based on connections and reciprocity around us.

Separating out the individual from their need for other people and ability to mobilise resources in order to manage effectively, has meant that the notion of a personal community of support (the array of personal ties with which people are located and embedded) has not tended to be included in understanding or responding to mental health need.

Now there’s a nascent social movement about networks.