Biomedical subjects

Stephen Timmons

Publications and source records attributed to Stephen Timmons.

At least 19 recordsLinked to original sources

PubMed2006

Considering alternatives: student nurses slipping directly from lay beliefs to the medical model of mental illness.

When student nurses enter higher education establishments to commence their nurse education it is expected that they would hold lay beliefs of mental health and mental illness. Lay beliefs are generally informed by the medical model of mental health. It is argued that there are many other beliefs and approaches to mental health that student nurses (of all branches) should consider before graduating into the health care world dominated by the medical model of mental health and mental illness. A number of other approaches and theories are summarised and offered as examples to student nurses for their consideration.

Anthropology, Cultural↗

PubMed2006

Training lay-people to use automatic external defibrillators: are all of their needs being met?

AIMS: We explored the experiences of lay people who have been trained to use automatic external defibrillators. The research questions were: (1) How can training courses help prepare people for dealing with real life situations? (2) Who is ultimately responsible for providing critical incident debriefing and how should this be organised? (3) What is the best process for providing feedback to those who have used an AED? METHODOLOGY: Fifty-three semi-structured, qualitative interviews were conducted, some with those who had been trained and others with trainers. Locations included airports, railway stations, private companies and first responder schemes. Geographically, we covered Nottinghamshire, Lincolnshire, Yorkshire, Staffordshire, Essex and the West Midlands in the UK. RESULTS: Our analysis of the data indicates that most people believe scenarios based within their place of work were most useful in preparing for 'real life'. Many people had not received critical incident debriefing after using an AED. There were a variety of systems in place to provide support after an incident, many of which were informal. CONCLUSION: Training scenarios should be conducted outside the classroom. There should be more focus on critical incident debriefing during training and a clear identification of who should provide support after an incident. Other issues which were of interest included: (1) people's views on do not attempt resuscitation (DNAR); (2) perceived boundaries of responsibility when using an AED; (3) when is someone no longer 'qualified' to use an AED?

Attitude↗

PubMed2006

Wittgenstein's language games as a theory of learning disabilities.

Sociological approaches to the understanding of learning disabilities are perhaps not as fully developed as they might be. Wittgenstein's notion of the language game is elucidated, and its relevance to the analysis of learning disabilities as a social phenomenon is explained. This gives some insight into an alternative conception of what learning disabilities might be, and why people who are classified as having learning disabilities continue, to some extent, to be excluded from full participation in society.

Attitude to Health↗

PubMed2006

Parents' experiences of negotiating care for their technology-dependent child.

The aim of this exploratory study was to understand the negotiation of care as experienced by the parents of technology-dependent children in a hospital context. Qualitative semi-structured interviews were undertaken with a group of six parents. Parents felt that their roles as parents were not considered enough by nurses and they tended to be seen as carers, not parents. Negotiation of care was not always apparent. Instead, nurses often made assumptions about parental involvement in care. Parents wanted to carry out care when in hospital, but were not always given choices. Parents also reported a desire for more confident nurses. This study highlights the need to gain insight into parents' experiences, in order that nurses can provide care in a way negotiated to suit the individual family. Suggestions for further research in this area are offered.

Attitude of Health Personnel↗

PubMed2006

The relationship between technology and changing professional roles in health care: A case-study in teledermatology.

Technology is often viewed as a way of bringing about change in professional roles in health care. While this was the case in the service that we studied, we would contend that there were organisational and cultural factors that were equally, if not more important. This was a qualitative study, using observation and interviews, of a relatively new service in teledermatology. Traditionally, patients with skin conditions that could not be managed by a primary care physician were referred to a hospital consultant dermatologist, often resulting in long waits for an outpatient appointment. This service replaced that system with referral to a specialist dermatology nurse, working in primary care. The nurses were supported by the option of a teledermatology referral to a hospital consultant, and the service was managed by a consultant nurse. We will discuss the movement in professional boundaries that we observed, how these movements were possible, why they took place, and the role that the technology played in this process.

Dermatology↗

PubMed2005

Strengthening workforce relationships: developing practice learning.

A joint partnership between a University and its local hospitals developed and implemented Practice Learning Teams (PLTs) to enhance student nurse learning experiences. In order to achieve this, PLTs arrived at clear aims and purposes, with educators and nurses working collaboratively and being jointly responsible for the quality of students' placement experience. This study occurred after a year of implementation, and a range of stakeholders were interviewed in order to evaluate perceived effectiveness. Findings of this report suggest the majority of respondents thought PLTs should be retained, recognising that they were new, and thus required development. There was a clear difference between effective and ineffective PLTs. Effective teams were considered to support the students' practice-based learning and mentors, while providing a forum for sharing 'good practice', discussion and problem solving. Less effective teams were characterised by having a low attendance or a membership that lacked enthusiasm and/or willingness to participate.

Education, Nursing↗

PubMed2005

An evaluation of using a web-based statistics test to teach statistics to post-registration nursing students.

Part of evidence-based practice is an ability to appraise research. Studies have shown that understanding the statistical components of a study is an area some nursing students struggle with. This paper reports the implementation and evaluation of a web-based statistics test to teach statistics to post-registration nursing students. The evaluation used both the data from the web-based statistics test, to measure students' learning, and from a survey completed after the module, to examine students' attitudes. The survey included some qualitative elements. The evaluation demonstrated that this is a valid and acceptable method of improving knowledge and understanding of statistics within this group of students.

Adult↗

PubMed2005

Variation in outcomes in Veterans Affairs intensive care units with a computerized severity measure.

OBJECTIVE: To quantify the variability in risk-adjusted mortality and length of stay of Veterans Affairs intensive care units using a computer-based severity of illness measure. DESIGN: Retrospective cohort study. SETTING: A stratified random sample of 34 intensive care units in 17 Veterans Affairs hospitals. PARTICIPANTS: A consecutive sample of 29,377 first intensive care unit admissions from February 1996 through July 1997. INTERVENTIONS: Standardized mortality ratio (observed/expected deaths) and observed minus expected length of stay (OMELOS) with 95% confidence intervals were estimated for each unit using a hierarchical logistic (standardized mortality ratio) or linear (OMELOS) regression model with Markov Chain Monte Carlo simulation. We adjusted for patient characteristics including age, admission diagnosis, comorbid disease, physiology at admission (from laboratory data), and transfer status. MEASUREMENTS AND MAIN RESULTS: Mortality across the intensive care units for the 12,088 surgical and 17,289 medical cases averaged 11% (range, 2-30%). Length of stay in the intensive care units averaged 4.0 days (range, mean unit length of stay 3.0-5.9). Standardized mortality ratio of the intensive care units varied from 0.62 to 1.27; the standardized mortality ratio and 95% confidence interval were <1 for four intensive care units and >1.0 for seven intensive care units. OMELOS of the intensive care units ranged from -0.89 to 1.34 days. In a random slope hierarchical model, variation in standardized mortality ratio among intensive care units was similar across the range of severity, whereas variation in length of stay increased with severity. Standardized mortality ratio was not associated with OMELOS (Pearson's r = .13). CONCLUSIONS: We identified intensive care units whose indicators for mortality and length of stay differ substantially using a conservative statistical approach with a severity adjustment model based on data available in computerized clinical databases. Computerized risk adjustment employing routinely available data may facilitate research on the utility of intensive care unit profiling and analysis of natural experiments to understand process and outcome links and quality efforts.

Adolescent↗

PubMed2005

Operating theatre nurses: emotional labour and the hostess role.

Emotional labour has been established as a significant factor in nursing work, although no studies have been done looking at emotional labour specifically in an operating theatre nursing context. Theatre staff (17 nurses and three Operating Department Practitioners (technicians) were observed in practice over a period of nine months by one of the authors. Each of the staff was subsequently interviewed. The transcriptions of the observation fieldwork notes and the semistructured interviews were analysed for themes and content. The (predominantly female) nurses perceived that one of their responsibilities was 'looking after the surgeons'. We have described this as the 'hostess' role. This role consisted of two major areas of activity: 'keeping the surgeons happy' and 'not upsetting the surgeons'. Examples are given of how this was accomplished through talk and actions. The (predominantly male) operating department practitioners did not see this as part of their work. This 'hostess' role is a kind of emotional labour, but performed with coworkers rather than patients. Like other forms of emotional labour, it is strongly gendered. The emotional labour performed by the theatre nurses was necessary to maintain what has been called elsewhere the 'sentimental order'.

Adult↗

PubMed2005

The doctor-nurse relationship in the operating theatre.

This article examines the organisational culture in theatres, specifically the doctor-nurse relationship, based on the literature and the experience of one author (Anika Reynolds) on placement in theatres. The initial motivation for the study was noticing how well these doctors and nurses got on in a friendly, informal and efficient atmosphere. This relationship between the multidisciplinary team was especially surprising when compared with the experience of hospital wards. Why did such a difference exist?

Clinical Competence↗

PubMed2005

Noise levels in PICU: an evaluative study.

High levels of noise in the hospital environment can have an impact on patients and staff increasing both recovery time and stress respectively. When our seven-bedded paediatric intensive care unit (PICU) is full, noise levels seem to increase significantly. This study measured noise levels at various times and places within a PICU using Tenma sound level meter which simulates the subjective response of a human ear. Noise levels were often excessive, exceeding international guidelines. Staff conversation was responsible for most of the noise produced; medical equipment, patient interventions, telephones, doorbell and the air shoot system were also responsible for causing high levels of noise. More can be done to reduce noise and its effects on patients and staff.

Causality↗

PubMed2004

A disputed occupational boundary: operating theatre nurses and Operating Department Practitioners.

Traditionally, surgeons (and to a lesser extent anaesthetists) have been assisted primarily by nurses. This role has been threatened in recent years, in the UK NHS (and elsewhere), by a relatively new profession, that of the Operating Department Practitioner (ODP). The ODP profession is still in the process of establishing itself as a 'full' profession within UK health care. While occupational boundary disputes between professions are common in health care, it is unusual for them to become as overt as the dispute we will analyse in this paper. Drawing on fieldwork observations and interviews conducted in operating theatres, as well as documentary sources, we will show how this dispute arose, how it is manifested at both the micro and the macro level, and how both groups involved justify their positions, drawing on surprisingly similar rhetorical strategies. A further unusual feature of this dispute is the fact that, unlike many attempts by managers to substitute one type of labour for another, issues of cost are relatively unimportant, as both theatre nurses and ODPs earn similar salaries.

Attitude of Health Personnel↗

PubMed2004

Improving transition: a qualitative study examining the attitudes of young people with chronic illness transferring to adult care.

Transition is a process that attends to the medical, psychosocial and educational needs of young people as they transfer to adult-orientated care. With a growing population of adolescents surviving with chronic illness well into adulthood, it is remarkable that empirical research has paid little attention to transition. This qualitative study examined the attitudes of young people with chronic illness who were facing transition, considering what young people wanted from a transition service and the ways in which provision could be improved from a service-user's perspective. A purposive sample of seven adolescents (aged 14-17) attending a hospital youth club were interviewed. To increase the likelihood of successful transition, strategies need to be informal, flexible, highly individualized and prepare adolescents steadily for adult services.

Adolescent↗

PubMed2003

An educational panopticon? New technology, nurse education and surveillance.

This papers raises concerns about the use of new technology in nurse education. It is possible that new forms of computer-based learning and teaching carry with them the possibility of new kinds of 'panoptic' surveillance and control of students. We discuss how this is possible, and set this development within a wider social context. These forms of panoptic surveillance are, we believe, inimical to the underlying values and philosophy of nurse education. New technology does not necessarily have to be used in this way, and can be part of a liberating pedagogy. We would not propose that surveillance of students should never be used, but rather that its use should be considered and debated.

Diffusion of Innovation↗

PubMed2003

Nurses resisting information technology.

Resistance in the workplace, by nurses, has not been extensively studied from a sociological perspective. In this paper, nurses' resistance to the implementation and use of computer systems is described and analysed, on the basis of semistructured interviews with 31 nurses in three UK NHS hospitals. While the resistance was not "successful", in that it did not prevent the implementation of the systems, it nonetheless persisted. Resistance took a wide variety of forms, including attempts to minimise or "put off" use of the systems, and extensive criticism of the systems, though outright refusal to use them was very rare. Resistance was as much about the ideas and ways of working that the systems embodied as it was about the actual technology being used. The patterns of resistance can best be summed up by the phrase "resistive compliance".

Attitude of Health Personnel↗

PubMed2003

Automated intensive care unit risk adjustment: results from a National Veterans Affairs study.

CONTEXT: Comparison of outcome among intensive care units (ICUs) requires risk adjustment for differences in severity of illness and risk of death at admission to the ICU, historically obtained by costly chart review and manual data entry. OBJECTIVE: To accurately estimate patient risk of death in the ICU using data easily available in hospital electronic databases to permit automation. DESIGN AND SETTING: Cohort study to develop and validate a model to predict mortality at hospital discharge using multivariate logistic regression with a split derivation (17,731) and validation (11,646) sample formed from 29,377 consecutive first ICU admissions to medical, cardiac, and surgical ICUs in 17 Veterans' Health Administration hospitals between February 1996 and July 1997. MAIN OUTCOME MEASURES: Mortality at hospital discharge adjusted for age, laboratory data, diagnosis, source of ICU admission, and comorbid illness. RESULTS: The overall hospital death rate was 11.3%. In the validation sample, the model separated well between survivors and nonsurvivors (area under the receiver operating characteristic curve = 0.885). Examination of the observed vs. the predicted mortality across the range of mortality showed the model was well calibrated. CONCLUSIONS: Automation could broaden access to risk adjustment of ICU outcomes with only a small trade-off in discrimination. Broader use might promote valid evaluation of ICU outcomes, encouraging effective practices and improving ICU quality.

Adult↗

PubMed2002

Impact of different measures of comorbid disease on predicted mortality of intensive care unit patients.

BACKGROUND: Valid comparison of patient survival across ICUs requires adjustment for burden of chronic illness. The optimal measure of comorbidity in this setting remains uncertain. OBJECTIVES: To examine the impact of different measures of comorbid disease on predicted mortality for ICU patients. DESIGN: Retrospective cohort study. SUBJECTS: Seventeen thousand eight hundred ninety-three veterans from 17 geographically diverse VA Medical Centers and 43 ICUs were studied, admitted between February 1, 1996 and July 31, 1997. MEASURES: ICD-9-CM codes reflecting comorbid disease from hospital stays before and including the index hospitalization from local VA computer databases were extracted, and three measures of comorbid disease were then compared: (1) an APACHE-weighted comorbidity score using comorbid diseases used in APACHE, (2) a count of conditions described by Elixhauser, and (3) Elixhauser comorbid diseases weighted independently. Univariate analyses and multivariate logistic regression models were used to determine the contribution of each measure to in-hospital mortality predictions. RESULTS: Models using independently weighted Elixhauser comorbidities discriminated better than models using an APACHE-weighted score or a count of Elixhauser comorbidities. Twenty-three and 14 of the Elixhauser conditions were significant univariate and multivariable predictors of in-hospital mortality, respectively. In a multivariable model including all available predictors, comorbidity accounted for less (8.4%) of the model's uniquely attributable chi statistic than laboratory values (67.7%) and diagnosis (17.7%), but more than age (4.0%) and admission source (2.1%). Excluding codes from prior hospitalizations did not adversely affect model performance. CONCLUSIONS: Independently weighted comorbid conditions identified through computerized discharge abstracts can contribute significantly to ICU risk adjustment models.

APACHE↗

PubMed2002

Research fraud.

Explore the source record for details and available documents.

Fraud↗