Type 2 Diabetes and Delivery of Compassionate Care
Type 2 diabetes and delivery of compassionate care: A grounded theory study
Start date: April 2015
End date: April 2016
CI: Stephanie Tierney
Collaborators: Kate Seers, Liz Tutton, Joanne Reeve
Description: Compassion has received increasing attention within health settings over recent years, following incidences of poor care that resulted in unnecessary distress to patients and their relatives. Compassion is defined as feelings that emerge through seeing someone else suffering that prompt a wish to help (Goetz et al., 2010). The term ‘compassionate care’ is now seen frequently in health services policy, practice and academic literature. It involves “recognizing vulnerability and suffering; relating to the needs of others; preserving integrity and acknowledging the person behind the illness” (Dewar and Nolan, 2013: 1248). Despite its prominence in health-related documents, little research has investigated how compassionate care is enacted and what it means to healthcare professionals. It is important to develop further knowledge on the delivery of compassionate care to better understand what may make it difficult to act in this way and how to facilitate a culture that enables compassion to be expressed.
Aim: To explore the concept of compassionate care from the perspective of healthcare staff working with patients who have type 2 diabetes. This was selected as a critical case for understanding compassion because it is a long-term condition that involves sustained interactions with a variety of health services.
Progress: Data collection is complete. 36 healthcare staff took part in the study. From their interview and focus group data, we have developed a model of compassionate care that we are writing up for publication.
For further details, please contact Stephanie Tierney.
SHARED study (Services after Hospital: Action to develop REcommenDations)
SHARED: Services after Hospital: Action to develop REcommenDations
Funder: NIHR- Research for Patient Benefit: £238k
Start date: January 2014 End date: December 2015
CI: Carole Mockford (Warwick)
Collaborators: Carole Mockford (Warwick), Kate Seers (Warwick), Sophie Staniszewska (Warwick), Jan Oyebode (Bradford), Matt Murray (Alzheimer’s Society), Rashida Suleman (UNTRAP), Rosemary Clarke (UNTRAP)
Description: Up to 70% of acute hospital beds are occupied by older people and it is estimated that around 40% of these have dementia, many without a formal diagnosis. Recent reports have shown that there is no clear pathway for patients with dementia or their carers when they leave hospital. Families can face many difficulties when health and social care services do not work together, or as expected, and staff may not know how to overcome this. Every hospital has a discharge policy involving the single assessment process potentially enabling health and social care services to provide seamless services but several reports have found major gaps in the hospital discharge process. There is, and has been, substantial lay input into this study at all stages of the research cycle.
This study aims:
· To develop carer and patient-led recommendations for services to enable smooth transition for people with dementia from hospital care to home care which will be disseminated to hospital and social care professionals involved in hospital discharge planning.
· To explore the experiences of carers and people with dementia of service provision from hospital discharge, at 6 weeks (when free intermediate care, if available, stops), and 12 weeks post-discharge, what works well and what can be improved.
· To assess the enablers and barriers to providing good discharge planning by health and social care professionals, including the availability and uptake of services.
· To ascertain the involvement of carers and people with dementia in decision-making around service provision at, and after, hospital discharge.
Progress: Data collection is complete. Analysis has been conducted and emerging themes identified by the lay co-researchers, have been developed into 12 key statements. The statements were presented to study participants at a focus group on 27th August 2015 and using the nominal group technique, facilitated by lay co-researchers, these were further developed into draft recommendations. Health and social care professionals who were also study participants have a copy of the draft recommendations and will be offering their feedback. A further focus group/consensus meeting is planned for 29th October to finalise the recommendations. Two papers are currently underway and others are planned.
Peer reviewed paper: Mockford C. (2015) A review of family carers’ experiences of hospital discharge for people with dementia and the rationale for involving service users in health research. Commissioned paper for Journal of Healthcare Leadership June 2015: 7: 21-28
Accepted for oral presentation: Mockford C, Seers K, Staniszewska S, Murray M, Suleman R and Clarke R (2015) [title] Oral Presentation DementiaUK Congress annual conference 5th November 2015 Telford International Centre.
Accepted for oral presentation with lay researchers: Mockford C, Boex S, Diment Y, Grant R, Leach J and Sharma U (2015) Services after Hospital: Action to develop REcommenDations: SHARED results. Division of Health Sciences seminar, Warwick Medical School, University of Warwick 26th November 2015
Oral presentation and discussion with lay researchers: Mockford C, Boex S, Diment Y, Leach J and Sharma U (2015) A study SHARED. Services after Hospital: Action to develop REcommenDations. Qualitative Methods Interest Group Dept of Health Sciences Warwick Medical School Sept 2015
Oral presentation with lay researchers: Mockford C, Boex S, Diment Y, Grant R, Leach J and Sharma U (2015) A study SHARED. Services after Hospital: Action to develop REcommenDations. Division of Health Sciences seminar, Warwick Medical School, University of Warwick 9th July 2015
Oral presentation: Mockford C, Seers K, Staniszewska S, Murray M, Suleman R and Clarke R (2015) SHARED study: Services after Hospital: Action to develop REcommenDations. Alzheimer’s Society annual research conference Manchester June 2015
Poster presentation: Mockford C, Seers K, Stanisewska S, Oyebode J, Murray M, Suleman R and Clarke R (2014) SHARED: Services after Hospital: Action to develop REcommenDations
Alzheimer’s Society research conference 3rd July 2014 Eastwood Hall, Nottingham.
Optimising acute care for people with dementia: a mixed-methods study
Funder: NIHR, £293,805.45
PI: Mike Crawford (Imperial)
Collaborators: Crome P (University College London), Staniszewska S (RCN RI, WMS), Seers K (RCN RI, WMS), Quirk A (Royal College of Psychiatrists), Wallace D, Royal College of Psychiatrists, Burns A (Manchester)
Dates: 1/07/2016 to: 30/06/2018
The overall aim of the study is to identify aspects of the organisation and delivery of general hospital In-patient services that are associated with better quality care and shorter length of stay for people with dementia and to understand how the way that hospitals and wards are organised influences the quality of care that people receive.
To meet this aim our objectives are:
1. To conduct a secondary analysis of quantitative data from the third round of the National Audit of Dementia to identify features of wards and hospitals that are associated with higher quality of assessment, shorter length of admission, and better carer-rated experience of care.
2. To undertake qualitative case studies of high and low performing hospitals to understand how aspects of organisational form and function including staffing levels, staff training, access to liaison mental health teams and deployment of specialist dementia nurses impacts on the quality of care that people with dementia receive.
3. To develop recommendations for commissioners, providers and users of acute inpatient services about the optimal organisation and delivery of services for people with dementia.
Progress: The first phase of the study, an analysis of national audit data is underway.
Evaluating the Use of Patient Experience Data to Improve the Quality of Inpatient Mental Health Care
PI: Scott Weich (WMS)
Collaborators: Kamaldeep B (Barts), Griffiths F (WMS), Staniszewska S (RCNRI), El Elnany (WBS), Crepaz-K David (Mental Health Foundation) Madan J (WMS), Larkin M (Birmingham), Newton E, (Birmingham), Ade-Odunlade P (Coventry and Warwickshire Partnership NHS Trust) et al
Funder: NIHR, £775,455.02
Dates: 1.1.16 to: 30.4.18
Progress: A research fellow has been appointed for WP1.
Description: All NHS providers collect data on patient experience although there is little evidence about what to measure, how best to collect this information or how to use data to improve service quality. Given significant investment in local solutions, new top-down approaches are unlikely to be readily welcomed and adopted. It is more important therefore to learn from what is a large, ongoing natural experiment. We propose to study inpatient mental health services on the grounds that these are important and costly services, which are unpopular with service users and places where many serious incidents occur.
Research question: Which of the many different approaches to collecting and using patient experience data are the most useful for supporting improvements in inpatient mental health care?
SS is leading work package 1, which aims to systematically identify patient experience themes that are relevant to delivering high quality inpatient mental health care. A literature review will be undertaken to identify the key dimensions of patient experience in the context of mental health services (11), drawing on the approach used to develop the Warwick Patient Experience Framework (WaPEF)
New models for patient experience (MOPE)
Funder: NIHR Total grant £499,000, 2% to RCN RI
PI: Chris Graham (Picker Institute)
Start date: May 2012 End date: April 2014
Collaborators: Fitzpatrick R, Jenkinson, Coulter A, Cornwell J, Staniszewska S.
Description: This study is creating a new architecture for the National Patient Experiences Survey which is used in NHS Trusts. The new survey will be utilised across the NHS.
Progress: The study is complete and the final report submitted.
Health Care Assistant Bereaved Carer Project
Funder: Dimbleby Cancer Care Research Fund. Funding £77,994
Start Date: January 2010 End Date: December 2012
PI: Dan Munday, Warwick Medical School
Collaborators: Kate Seers, Bill Noble(Sheffield), Christine Ingleton (Sheffield), Elizabeth Pitt (Coventry & Warwickshire Partnership Trust)
Description: This study aims to explore in depth the experiences of bereaved carers who have received home care respite services from HCAs.
Progress: Abstract presented at European Association for Palliative Care.
Lovatt, M; Nanton, V; Roberts, J; Ingleton, C; Noble, B; Pitt, E; Seers, K and Munday, D (2015). The provision of emotional labour by health care assistants caring for dying cancer patients in the community: A qualitative study into the experiences of health care assistants and bereaved family carers. International Journal of Nursing Studies. 52(1):271–279 doi: http://dx.doi.org/10.1016/j.ijnurstu.2014.10.013
EUREKA - Experiences of unplanned admission in lung cancer COPD
Funder: MacMillan. Total grant 149,930, £3,948 to RCN RI
Start date: January 2010. End date: January 2013.
PI: Dan Munday (Warwick Medical School)
Collaborators: Collette Clifford (Birmingham), Sophie Staniszewska (Warwick), Frances Griffiths (Warwick), Mark Hocking (UHCW), Marion Corroon (Coventry and Warwickshire Partnership Trust), Roberta Lovick (User Representative)
Description: This study aims to understand patients experiences of the time leading to admission, the admission process itself and their experiences in the immediate period following admission, by addressing the following areas:
1) To understand the mechanisms, processes and contexts which lead to emergency admission for patients with lung cancer and a comparative group of patients with COPD.
2) To understand the experiences of patients following admission and the benefits or problems associated with hospital stay following emergency admission. The study is underpinned by user involvement in all aspects of the research.
Progress: Study completed. Papers being prepared, with SS leading on the paper focusing on the impact of the PPI Reference Group on the research. Four papers from the study were presented at the 8th World Research Congress of the European Association for Palliative Care in Lleida, Spain from 5-7 June 2014
Staniszewska S, Munday D, Bailey C et al (in prep). Patient and public involvement impact in the EUREKA study. (Submission to J Palliative Care).
Karasouli E, Munday, Munday D, Bailey C, Staniszewska S, Hewison A, Griffiths F (2015). A qualitative critical incident study of patients’ experiences leading to emergency hospital admission with advanced respiratory illness. In press, BMJ Open.
Big Lottery Better care study: better lives for life-limited children in West Midlands
Funder: Big Lottery Total bid £499,320. £85,030 to RCN RI.
Start date: September 2010. End date: September 2012.
Grant holder: ACT
Collaborators: Ann Hunt (Lancaster), Sophie Staniszewska (Warwick), Jane Coad (Coventry), Liz West (Greenwich), Nick Hex (York)
Description: The Big Study for Life-limited Children and their Families (The Big Study) is a research project, based in the West Midlands. Funded by Big Lottery Fund, this is the first in-depth study in the UK to examine how well the needs of children with life-limiting conditions and their families are being met. The study will determine and map those services that are currently used by children with life-limiting and life-threatening conditions, identify and document children’s and families’ needs, and explore gaps in service provision and the accessibility of services to those who need them. It has a strong user involvement dimension, working with parents and young people in developing our understanding of acceptable, appropriate and effective services, led by Sophie Staniszewska.
Progress: The study is now complete and the final report has been written and submitted. Papers from study are in progress.
Hunt S, Staniszewska S et al (2013). Why does it happen like this?” Consulting with users and providers prior to an evaluation of services for children with life-limiting conditions and their families. Journal of Child Health Care, in press.
Supervisory Ward Sister Study II - A survey to provide baseline activity in relation to ward sister/charge nurse supervisory roles
Funder: NHS England
Start Date 31st March 2015 End date 31st October 2015
PI: Kate Seers
Collaborators: Sophie Staniszewska, Liz Tutton, Linda Watterson, Lynne Currie.
Description: The aim of the study is to understand the activities that take place as part of supervisory roles for ward sisters/charge nurses. Whilst policy agenda’s promote supervisory practice and leadership through the ward sister role, less is known about the nature and extent of its implementation. This study therefore aims to find out how supervisory roles are working, what is considered important, what the benefits and challenges are, and whether there are any indications of improvement in patient care because of supervisory roles. To do this, we will contact senior nurses such as Chief Nurses or Directors of Nursing Services in England, who have responsibility for providing high quality care, and ask them to take part in a survey of activity. This evidence will be reported to the NHS England and will help to inform policy and practice in the future.
Progress: The survey is completed and analysis is in progress.
Type 2 Diabetes and delivery of compassionate care: A grounded theory study
Start date – April 2015; End date – January 2016
PI: Stephanie Tierney (Warwick)
Collaborators: Kate Seers (Warwick), Liz Tutton (Warwick), Joanne Reeve (Warwick)
Description: Compassion has received increasing attention within healthcare over recent years. The term ‘compassionate care’ is now seen frequently in health services policy, practice and academic literature. Yet despite its prominence, little research has investigated how compassionate care is enacted and what it means to healthcare professionals. Therefore, this study will explore the concept of compassionate care from the perspective of these individuals. It is important to develop further knowledge on the delivery of compassionate care to better understand what may make it difficult to act in this way. Type 2 diabetes was selected as a critical case to explore this topic because it is increasingly prevalent, long-term and involves sustained interactions within health services. A grounded theory approach (Charmaz, 2014) is underpinning the work, which allows for an understanding of social processes.
Progress: Semi-structured interviews (n=13) and focus groups (n=4) have been conducted with doctors, nurses, healthcare assistants, dieticians and podiatrists. Analysis, consisting of coding, constant comparison and memo writing, is in progress to interpret professionals’ perceptions of the nature and delivery of compassionate care. Future funding applications will be developed based on this study’s findings.
Supervisory Ward Sister Study I
Start Date: November 2013 End date April 2015
Research Team: Kate Seers, Linda Watterson, Lynne Currie
Description: A qualitative study, interviewing supervisory ward sisters, and focus groups with other health care staff about their perceptions of the role, interviews with senior nurses in two NHS Trusts in England.
Method: Face to face interviews have been undertaken with 22 ward sisters working as a supervisory ward sister. Interviews with four senior nursing staff and two focus group of other staff (one on each site) were also undertaken. Findings: There was a core category of ‘Being Pivotal’, supported by four key categories: reclaiming all the role, forging a path leading the way and connecting with the organisation.
The full report can be found here and is also available on the RCN website (publication 005026).