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Anne Williams

Publications and source records attributed to Anne Williams.

17 recordsLinked to original sources
PubMed2006

Patients' assessments of consulting a nurse practitioner: the time factor.

AIM: This paper reports a study exploring patients' views about consulting with a primary care nurse practitioner. BACKGROUND: United Kingdom based randomized controlled trials comparing the work of doctors and nurse practitioners add considerable weight to the view that patients tend to be more satisfied with primary care nurse practitioner consultations. However, there is a need for qualitative research to explore issues raised by the trials. METHODS: A judgement sample of 10 patients consulting with a primary care nurse practitioner was drawn. In-depth interviews were conducted and analysed thematically. The data were collected in 2000-2001. FINDINGS: The following themes were identified in the data: time spent in the consultation; and time as a commodity in patients' lives. Time matters to patients when they consult on their health, whether it is time to discuss problems or time saved as a result of having issues resolved, thus minimizing further visits. Factors associated with the style and emphasis of consultations are also important. CONCLUSIONS: Understanding the relationship between time, and style and emphasis of consultation may help to explain patients' satisfaction with primary care nurse practitioners.

Adult↗
PubMed2006

Heart failure and palliative care services working in partnership: report of a new model of care.

It is widely acknowledged that people with advanced heart failure have at least as great a need for supportive and palliative care as those with malignant disease. However, specialist palliative care services are seldom involved in their care in the UK. We describe a three-year collaboration between community-based heart failure nurse specialists and existing specialist palliative care services. In the model of care that has evolved, the heart failure nurses remain key workers throughout the illness. They run a regular support group for patients and carers in the setting of a hospice day therapy unit, referring patients for other palliative care involvement as necessary. Activity data and the results of patient interviews are presented. These suggest that the model is a cost effective, sustainable way of providing high quality care for people with heart failure.

Aged, 80 and over↗
PubMed2004

Hospital based palliative care teams improve the insight of cancer patients into their disease.

It is reported that cancer patients want as much information as possible about their diagnosis and prognosis. This input regarding patients' insight into their disease is undoubtedly a major part of providing optimal palliative care. Despite this, there is little information regarding the impact of hospital based palliative care teams. An evaluation study comprising a nonequivalent control group design, using a quota sample, investigated 100 cancer patients who had been admitted to hospital for symptom control. Fifty patients received hospital palliative care team intervention compared with 50 patients receiving traditional care. Outcome was assessed using the Palliative Care Assessment tool (PACA) assessment tool on three occasions that measured the patients self-reported understanding of their illness. A supplementary qualitative approach that included 31 semi-structured interviews with doctors and nurses to explore their perception of the impact of the palliative care team was also undertaken. The results indicated that cancer patients admitted to hospital for symptom control demonstrated an improvement in their insight to their diagnosis. Those patients who had the additional input of the palliative care team had a significantly greater improvement in their insight scores (reported by the doctors and nurses as being invaluable for the patients). Potential explanations are made for these results including enhanced communication skills of the palliative care team are explored.

Adult↗
PubMed2003

Patient comfort during clear corneal phacoemulsification with sub-Tenon's local anesthesia.

PURPOSE: To assess patient comfort with and without intravenous (i.v.) cannulation during 1-quadrant sub-Tenon's anesthesia during phacoemulsification. SETTING: Royal Alexandra Hospital, Paisley, Scotland, United Kingdom. METHODS: This prospective masked controlled clinical trial comprised 119 patients having elective clear corneal phacoemulsification. Fifty had sub-Tenon's anesthesia with an i.v. cannula; 23, sub-Tenon's anesthesia without an i.v. cannula; and 46, topical anesthesia of proparacaine 0.5% without an i.v. cannula. No patient received sedation. All patients had clear corneal phacoemulsification with foldable posterior chamber intraocular lens implantation. The patients' subjective pain experience was measured immediately after surgery by a single independent observer using a 10-point visual analog scale. RESULTS: The mean patient-reported pain was low in all 3 groups. The mean i.v. cannula-related pain score in the sub-Tenon's group with an i.v. cannula (1.00; range 0 to 8) was higher than the mean general pain score (0.46; range 0 to 5) and worst pain experienced during surgery score (0.64; range 0 to 3). In the topical anesthesia group, 8 patients (17%) reported greater discomfort directly or indirectly related to the subconjunctival antibiotic injection at the end of surgery. CONCLUSION: Patient-reported pain caused by placing an i.v. cannula in the sub-Tenon's group significantly altered overall patient comfort during the surgical experience. Thus, the routine use of i.v. access during clear corneal phacoemulsification under sub-Tenon's anesthesia should be avoided to improve patient satisfaction.

Adult↗
PubMed2003

Introducing a nutrition screening tool: an exploratory study in a district general hospital.

BACKGROUND: Concerns have been raised that patients' nutrition is a neglected aspect of care. Accordingly, 'nutrition screening tools' have been devised to ensure that all patients are assessed by nurses and, where appropriate, referred to dieticians. The tool adopted in our hospital was the 'Nursing Nutritional Screening Tool'. AIM: To investigate the impact of this screening tool on: nutrition-related nursing documentation; patient care at mealtimes; dietician referral. METHODS: This study was conducted on two similar general medical wards in a United Kingdom (UK) district general hospital, with the help of staff and patients (n = 175) admitted during two study periods, May 1999 and January 2000. Data were collected over 28 days before and after introduction of the screening tool on one of the wards. For both wards, in each stage of the study, data were collected b: review of patients' notes, non-participant observations of mealtimes. Frequencies of dietician referral and documentation of weight were compared by cross-tabulations and chi2 tests. Nine months later, the findings were discussed with ward sisters in a group interview. FINDINGS: Introduction of the screening tool impacted on the process but not the outcomes of screening. Use of the screening tool increased the frequency of nutrition-related documentation: the proportion of patients with weights recorded increased on the intervention ward (P < 0.001), and decreased on the comparator ward. Frequency of dietician referral decreased on both wards, but differences were statistically insignificant. There was no observable change in patient care at mealtimes. The nurses in charge of the wards felt that introduction of the screening tool had raised awareness of nutrition-related care. CONCLUSIONS: Meeting patients' nutritional needs is a complex aspect of care which may benefit from introduction of structured guidelines. However, the potential of screening tools to improve care is limited by diverse factors, which warrant further exploration.

Adolescent↗
PubMed2003

Application of topical local anesthetic at triage reduces treatment time for children with lacerations: a randomized controlled trial.

STUDY OBJECTIVES: We determine whether application of topical local anesthetic at triage reduces total treatment time for children with simple lacerations. METHODS: This prospective, randomized, double-blind, controlled trial was conducted in an urban pediatric emergency department (ED). Participants were children who were aged 1 to 10 years and had simple lacerations. Exclusions were wounds to digits, ears, penis, nose, or mucous membranes; wounds close to the eye; deep wounds involving bone, cartilage, tendon, or vessels; wounds older than 6 hours; allergy or previous reaction to local anesthetics; trivial wounds unlikely to require any intervention; previous anesthesia to area before presentation; and failure to obtain consent. Participants were randomized to application of adrenaline 1:1,000, lignocaine (lidocaine) 4%, and amethocaine 0.5% (ALA) or placebo (adrenaline 1:1,000 solution) at triage. The primary outcome measure was total treatment time (triage time to discharge time). Secondary outcomes were the proportion of children from each group who required sedation and subgroup analysis by mode of wound closure. Analysis was by Mann-Whitney U test comparing times and chi(2) test comparing sedation rate. RESULTS: One hundred sixty-one patients were eligible for analysis (84 ALA, 77 control). Sixty-five patients were sutured, 84 were treated with glue, 6 were treated with Steristrips, and 6 were not provided with formal closure. The median treatment time for the ALA group was 77 minutes compared with 108 minutes for the control group (effect size 31 minutes; 95% confidence interval 15 to 47 minutes; P =.0019). There was no difference in requirement for sedation between the groups. CONCLUSION: The application of ALA at triage significantly reduces total treatment time for children with simple lacerations.

Anesthesia, Local↗
PubMed2003

Primary care nurse practitioners and the interface with secondary care: a qualitative study of referral practice.

In the United Kingdom nurse practitioners are assuming responsibilities traditionally considered to be within the domain of general practitioners. Important amongst these is the referral of patients to medical consultants in secondary care, a responsibility commonly associated with the general practitioner's role as 'gatekeeper' to health care. This paper describes a study designed to identify issues raised by the challenge that a developing nursing role presents to interprofessional working at the interface between primary and secondary care. When invited to comment, study participants (nurse practitioners, nurse educators, medical consultants and general practice registrars) related nursing referrals to issues associated with professional boundary changes, namely: teamwork, regulation of practice, communication, professional conflict and professional relationships. This paper discusses the views of primary and secondary care practitioners about who should take responsibility for the referral of patients in the light of concerns raised about professional competence and accountability. Individual nurse practitioners and their colleagues have found pragmatic ways to manage their work however, although UK government policy supports development of advanced clinical nursing, there remains much work to be done to provide the professional and legal infrastructure to support the role.

Adult↗
PubMed2003

A stakeholder evaluation of the impact of the palliative care clinical nurse specialist upon doctors and nurses, within an acute hospital setting.

There has been an expansion in the number of palliative care teams based in the acute hospital setting. Although organization of these teams varies both in structure and approach, the clinical nurse specialist is one of the key members. The last decade has seen an escalation in the UK of clinical nurse specialists, and following the Calman-Hine Report and the more recent NHS Cancer Plan, it is anticipated that the number of clinical nurse specialists in palliative and cancer care is likely to grow. This paper presents the qualitative findings of an evaluation study designed to investigate the impact of the clinical nurse specialist within a palliative care team based in an acute hospital setting. A stakeholder evaluation that encompassed 31 tape-recorded semi-structured interviews with senior nurses, consultants, junior doctors and nurses representing different grades were performed. The data was analysed for emerging themes utilising a case and cross case analysis methodology. The results suggested the presence of the clinical nurse specialists is seen as beneficial to both medical and nursing staff. This paper will focus upon exploring these potential benefits, included providing support, advice and education.

Humans↗
PubMed2003

Hospital based palliative care teams improve the symptoms of cancer patients.

Despite the increase in hospital palliative care teams, there is little research into their impact on symptom control in patients. A nonequivalent control group design, using a quota sample, investigated 100 cancer patients who had been admitted to hospital for symptom control. Fifty patients received hospital palliative care team intervention compared with 50 patients receiving traditional care. Data was collected using the Palliative Care Assessment (PACA) symptom assessment tool on three occasions. Both groups showed a statistically significant improvement in their symptoms. This significance failed to meet the criterion of one point on a four point scale and therefore results have to be interpreted with caution. However the intervention group had a greater improvement in all their symptoms, particularly for the pain and anorexia for which there were no differences between the groups on the initial assessment, there was a statistically greater improvement for the intervention group (P < 0.001). Consecutive patients with cancer admitted to hospital for symptom control during this study improved, but those patients who received specialist palliative care had a significantly greater improvement in their symptoms.

Adult↗
PubMed2002

Impact of the palliative care clinical nurse specialist on patients and relatives: a stakeholder evaluation.

Within the last decade, there has been a rapid expansion in the United Kingdom of clinical nurse specialists (CNSs), yet there has been limited evidence of their effectiveness. The clinical area of palliative care has one of the largest numbers of CNSs which has particularly started to escalate in the acute hospital setting. Following the Calman-Hine Report and the more recent NHS Cancer Plan, it is anticipated that the number of CNSs in palliative and cancer care is likely to grow. In light of the current policy emphasis of Clinical Governance and Clinical Effectiveness, there is an urgent need to demonstrate the contribution that CNSs make. This paper presents the qualitative findings of an evaluation study on the impact of the CNS within a palliative care team in a large acute hospital in the North-West of England. A stakeholder evaluation that encompassed tape-recorded semi-structured interviews to explore how the stakeholders saw the impact of the CNS within palliative care was performed. Twenty-seven interviews were conducted with stakeholders across the hospital setting including senior nurses, consultants, junior doctors and nurses representing the different grades. Data were analysed for emerging themes utilizing a case and cross-case analysis. The results indicated that the CNSs within palliative care in an acute hospital are seen to be potentially beneficial for both patients and relatives. This paper will focus on exploring these perceived benefits, which included symptom control, psychological care and being an advocate for patients and relatives.

Journal Article↗
PubMed2002

Parent visual analogue scale ratings of children's pain do not reliably reflect pain reported by child.

OBJECTIVES: To determine whether parent and child visual analogue scale (VAS) scores for the pain associated with acute conditions in the child agree sufficiently for these methods of measurement to be considered interchangeable in pain and analgesia research. DESIGN: This was a prospective, two-group, repeated measures, blinded study in an urban pediatric emergency department. Children aged 8 to 15 years seeking treatment for painful conditions and the parents of these children were asked to rate the child's pain independently using a VAS on as many as four occasions at 20-minute intervals. Both participants were blinded to their previous rating and the rating of the other participant. The main outcome measure was the correlation of child and parent VAS pain scores by Pearson correlation and bias plot (Bland-Altman) analysis of agreement between tests. RESULTS: Seventy-eight child-parent sets participated, yielding 289 VAS pain score comparison pairs for evaluation. The correlation between child and parent VAS pain scores was 0.63 (95% CI, 0.56-0.70). Bias plot analysis revealed a bias of 5% and 95% limits of agreement from -38 to +47 mm. The degree of difference between child and parent scores was variable, but there was an increasing tendency for parents to underestimate the child's pain when the child recorded VAS pain scores at the higher end of the scale. CONCLUSIONS: Parents' VAS score ratings of their children's pain correlate only moderately with the children's VAS pain scores and show poor levels of agreement. The difference between the measures is variable and appears to be more marked when the child reports a higher VAS score. This research raises doubt about whether parental rating of a child's pain is an appropriate surrogate marker in pediatric pain and analgesia research.

Acute Disease↗
PubMed2002

Do hospital-based palliative care clinical nurse specialists de-skill general staff?

A large number of clinical nurse specialists work within the area of palliative care, particularly in the acute hospital setting. This article presents the qualitative findings of an evaluation study that looked at the impact of the clinical nurse specialist within a palliative care team in a large acute hospital in the North-West of England. A total of 31 interviews were conducted with stakeholders from across the hospital setting. The data were analysed for emerging themes using a case and cross-case analysis. The results indicated that the senior stakeholders and the palliative care team felt that the clinical nurse specialists might be de-skilling the general nursing and medical staff, while junior staff did not perceive that they were being de-skilled. This article discusses potential explanations for this, including the possibility that junior staff may not be fully aware of the role of palliative care clinical nurse specialist. The impact that clinical nurse specialists are having on empowering the junior staff is also discussed and recommendations for further research are suggested.

England↗
PubMed2002

The development of a nurse-led angina management programme.

The anxiety caused by living with angina can be very debilitating and affects patients' quality of life. In one trust an angina management programme was set up to provide educational and psychosocial support, with an emphasis on cardiac risk factor modification. Regular monitoring of patients at nurse-led clinics and multidisciplinary teamwork were important elements.

Angina Pectoris↗
PubMed1999

Applying the Delphi technique in a study of GPs' information requirements.

This article describes some dilemmas and problems encountered in a Delphi study of general practitioners' (GPs) information requirements. The research involved a three-round Delphi administered to an expert panel of 50 GPs in one Welsh health authority area. The Delphi is generally perceived as a qualitative METHOD: However, we argue that the requirements of the technique make it difficult to sustain the kind of inductive analysis - faithfully reflecting respondents' perspectives - that is axiomatic to many of the theoretical approaches that underpin qualitative inquiry. We describe how our attempts to incorporate respondents' views in near-verbatim form in the first round were undermined by the need to classify and reduce statements for later rounds, and to impose judgments about what should count as consensus. The iterative 'consensus-building' process, that is so central to the Delphi, was difficult to take forward without active intervention by the research team, but this involved a re-ordering and reduction of the data, which moved the statements included in later rounds further and further from the verbatim responses on which they were based. Whilst the findings of the study were useful on one level, the final consensus statements took a general, virtually context-free form, which contained few references to background preoccupations (largely concerned with the recent NHS reforms) that were exercising GPs at this time. The method also coped badly with the polarized opinions that existed regarding the development of information systems for commissioning. We conclude that the Delphi is best used for large-scale research in areas where opinions are well established, where the problems and choices confronting the study group are well known, and where a major programme of organizational reform is not already underway.

Journal Article↗