ORCID Profile
0000-0002-2507-0350
Current Organisation
University of Kent
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Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.IJNURSTU.2012.10.007
Abstract: Current projections indicate that the UK faces a 252% increase in people aged over 65 with one or more long term conditions (LTC) by 2050. Nurses, managing their own caseloads and clinics, working across sectors and organisational boundaries and as part of a wider multi-disciplinary team, are frequently seen as key to managing this growing demand. However, the evidence base informing the nursing role in managing LTC, the most effective configuration of the multi-disciplinary team and the policy evidence relating to the infrastructure required to support cross organisational working, remains weak. To explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to such models. Case study whole systems analysis using qualitative interview methods. Two community matron services, two primary care (GP) practice nursing services, two hospital based specialist nursing services were purposefully s led from across England and Wales. Selection criteria were derived using a consensus conference. The nurses in the service, all patients and carers on the caseload, members of the multi-disciplinary team and stakeholders were invited to participate. Semi-structured interviews with all participants, thematic analysis within a whole system framework. The study found high levels of clinical nursing expertise which in the case of the community matrons was meeting the aim of reducing hospital admissions. Both the primary care and hospital nurse specialist indicate similar levels of clinical expertise which was highly valued by medical colleagues and patients. Patients continued to experience fragmented care determined by diagnostic categories rather than patient need and by the specific remit of the clinic or service the patient was using. Patient data systems are still organised around the impact on services and prevalence of disease at an in idual level and not around the patient experience of disease. Nurses are making a major contribution to meeting the policy objectives for long term conditions. Primary care nurses and hospital nurse specialists do broadly similar roles. The scope of the nursing roles and services studied were idiosyncratic, opportunistic and reactive, rather than planned and commissioned on an analysis of local population need.
Publisher: SAGE Publications
Date: 04-2018
Abstract: To explore how embedded patient and public involvement is within mainstream health research following two decades of policy-driven work to underpin health research with patient and public involvement in England. Realist evaluation using Normalization Process Theory as a programme theory to understand what enabled patient and public involvement to be embedded as normal practice. Data were collected through a national scoping and survey, and qualitative methods to track patient and public involvement processes and impact over time within 22 nationally funded research projects. In research studies that were able to create reciprocal working relationships and to embed patient and public involvement this was contingent on: the purpose of patient and public involvement being clear public contributors reflecting research end-beneficiaries researchers understanding the value of patient and public involvement patient and public involvement opportunities being provided throughout the research and ongoing evaluation of patient and public involvement. Key contested areas included: whether to measure patient and public involvement impact seeking public contributors to maintain a balance between being research-aware and an outsider standpoint seen as ‘authentically’ lay scaling-up patient and public involvement embedded within a research infrastructure rather than risk token presence and whether patient and public involvement can have a place within basic science. While patient and public involvement can be well-integrated within all types of research, policy makers should take account of tensions that must be navigated in balancing moral and methodological imperatives.
Publisher: JMIR Publications Inc.
Date: 21-11-2022
DOI: 10.2196/32757
Abstract: Internationally, there is increasing emphasis on early support for pregnant women to optimize the health and development of mothers and newborns. To increase intervention reach, digital and app-based interventions have been advocated. There are growing numbers of pregnancy health care apps with great variation in style, function, and objectives, but evidence about impact on pregnancy well-being and behavior change following app interaction is lacking. This paper reports on the qualitative arm of the independent multicomponent study exploring the use and outcomes of first-time mothers using the Baby Buddy app, a pregnancy and parenting support app, available in the National Health Service App Library and developed by a UK child health and well-being charity, Best Beginnings. This study aims to understand when, why, and how first-time mothers use the Baby Buddy app and the perceived benefits and challenges. This paper reports on the qualitative arm of an independent, longitudinal, mixed methods study. An Appreciative Inquiry qualitative approach was used with semistructured interviews (17/60, 28%) conducted with new mothers, either by telephone or in a focus group setting. First-time mothers were recruited from 3 study sites from across the United Kingdom. Consistent with the Appreciative Inquiry approach, mothers were prompted to discuss what worked well and what could have been better regarding their interactions with the app during pregnancy. Thematic analysis was used, and findings are presented as themes with perceived benefits and challenges. The main benefit, or what worked well, for first-time mothers when using the app was being able to access new information, which they felt was reliable and easy to find. This led to a feeling of increased confidence in the information they accessed, thus supporting family and professional communication. The main challenge was the preference for face-to-face information with a health care professional, particularly around specific issues that they wished to discuss in depth. What could have been improved included that there were some topics that some mothers would have preferred in more detail, but in other areas, they felt well-informed and thus did not feel a need to seek additional information via an app. Although this study included a small s le, it elicited rich data and insights into first-time mothers’ app interactions. The findings suggest that easily accessible pregnancy information, which is perceived as reliable, can support first-time mothers in communicating with health care professionals. Face-to-face contact with professionals was preferred, particularly to discuss specific and personalized needs. Further studies on maternal and professional digital support preferences after the COVID-19 global pandemic and how they facilitate antenatal education and informed decision-making are recommended, particularly because digital solutions remain as a key element in pregnancy and early parenting care. RR2-10.1017/S1463423618000294
Publisher: Cambridge University Press (CUP)
Date: 07-2007
Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2020-046078
Abstract: Self-regulation is a modifiable protective factor for lifespan mental and physical health outcomes. Early caregiver-mediated interventions to promote infant and child regulatory outcomes prevent long-term developmental, emotional and behavioural difficulties and improve outcomes such as school readiness, educational achievement and economic success. To harness the population health promise of these programmes, there is a need for more nuanced understanding of the impact of these interventions. The aim of this realist review is to understand how, why, under which circumstances and for whom, early caregiver-mediated interventions improve infant and child self-regulation. The research questions guiding this review were based on consultation with families and community organisations that provide early childhood and family services. Realist reviews take a theory-driven and iterative approach to evidence synthesis, structured around continuous refinement of a programme theory. Programme theories specify context-mechanism-outcome configurations to explain what works, for whom, under which circumstances and how. Our initial programme theory is based on prior work in this field and will be refined through the review process. A working group, comprising service users, community organisation representatives, representatives from specific populations, clinicians and review team members will guide the evidence synthesis and interpretation, as well as the development and dissemination of recommendations based on the findings of the review. The review will involve searching: (i) electronic databases, (ii) connected papers, articles and citations and (iii) grey literature. Decisions to include evidence will be guided by judgements about their contribution to the programme theory and will be made by the research team, with input from the working group. Evidence synthesis will be reported using the Realist and MEta-narrative Evidence Synthesis: Evolving Standards guidelines. Ethical approval is not required as this is a review. Findings will be disseminated to our working group and through peer-reviewed publications and conference presentations. The protocol is registered with Open Science Framework osf.io/5ce2z/registrations .
Publisher: Cold Spring Harbor Laboratory
Date: 14-10-2020
DOI: 10.1101/2020.10.12.20211300
Abstract: Self-regulation is a modifiable protective factor for lifespan mental and physical health outcomes. Early caregiver-mediated interventions to promote infant and child regulatory outcomes prevent long-term developmental, emotional, and behavioural difficulties and improve outcomes such as school readiness, educational achievement, and economic success. To harness the population health promise of these programmes, there is a need for more nuanced understanding of the impact of these interventions. The aim of this realist review is to understand how, why, under which circumstances, and for whom, early caregiver-mediated interventions improve infant and child self-regulation. The specific research questions guiding this review were based on consultation with families and community organizations that provide early childhood and family services. Realist reviews take a theory-driven and iterative approach to evidence synthesis, structured around continuous refinement of a programme theory. Programme theories specify context-mechanism-outcome configurations to explain what works, for whom, under which circumstances, and how. Our initial programme theory is based on prior work in this field and will be refined through searching peer-reviewed and grey literature to identify relevant evidence. A working group, comprising service users, community organization representatives, representatives from specific populations, clinicians, and review team members will be formed to guide the evidence synthesis and interpretation, as well as the development and dissemination of recommendations based on the findings of the review. The review will involve searching: (1) electronic databases (e.g. EMBASE, Medline, PsycInfo), (2) connected papers, articles and citations, and (3) grey literature. Decisions to include evidence will be guided by judgements about their contribution to the programme theory and will be made by the research team, with input from the working group as required. Evidence synthesis will be reported using the RAMESES guidelines and disseminated through peer-reviewed publication. The protocol is registered with Open Science Framework osf.io/5ce2z/registrations Uses a realist approach to provide insight into what works, for whom, under which circumstances, and how for caregiver-mediated interventions designed to promote self-regulation outcomes among infants and young children. Research questions were developed in consultation with families and service providers. Decision-making will be transparently documented, and all review materials made available on the Open Science Framework repository. The programme theory will be largely derived from peer-reviewed journal articles, and therefore may be subject to publication bias.
Publisher: Hindawi Limited
Date: 16-03-2007
DOI: 10.1111/J.1365-2524.2007.00701.X
Abstract: Self-care is seen as a key element in managing resource demand in chronic disease and is also perceived as an empowering right for patients. The Chronic Disease Self-Management Programme developed in the USA has been adopted in a number of countries and in the UK has been as adapted as the Expert Patients Programme. However, despite its potential as a lay-led empowering initiative, the Expert Patients Programme has been criticised as perpetuating the medical model and failing to reach those in most need. This paper revisits a critique of the Expert Patients Programme, and drawing upon a qualitative study seeks to explore whether the Expert Patients Programme enables empowerment or replicates traditional patterns of the patient-professional relationship. A grounded-theory approach was adopted utilising focus groups, in-depth interviews and participant observation. Data were analysed through the constant comparative method and the development of codes and categories. Conducted in the relatively affluent area of the south-east of England, this paper draws on data from 66 in iduals with a chronic illness who were knowledgeable, active and informed. The study revealed a number of characteristics common to expert patients that were linked to a systematic, proactive and organised approach to self-management, a clear communication style and the ability to compartmentalise emotion. The study included participant observation of an Expert Patients Programme and a professional-led self-management course. The paradoxical nature of the Expert Patients Programme was revealed, for whilst there was evidence that it reinforced the medical paradigm, there was a concurrent acknowledgement and support for the subjective experience of living with a long-term condition. Furthermore, whilst the policy emphasis has been on in idual empowerment within the Expert Patients Programme, there is some evidence that it may be triggering a health consumer movement.
Publisher: Cambridge University Press (CUP)
Date: 07-2008
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.WOMBI.2019.06.012
Abstract: Culturally secure care is considered foundational for good perinatal outcomes for Indigenous women. It is unknown what literature reports on whether Indigenous women giving birth in urban areas receives appropriate cultural care. The aim of this scoping review was to examine and summarise relevant evidence which reports on culturally secure care for Indigenous women using urban maternity services at any time during the perinatal period. Ten journal databases plus grey literature and theses databases were searched for relevant material dated 1986-2018. Articles were included if they were about Indigenous women from Australia, New Zealand, Canada or the USA care was provided anytime during the perinatal period, in an urban area and cultural security (or variations of this term) were used. 6856 titles and abstracts were screened, of these: 25 studies, 15 grey literature documents and 9 theses matched the search criteria. Studies were mostly qualitative (13/25) and from Australia (18/25). Studies showed women's access to and experiences of culturally secure maternity care in urban areas as variable. The grey literature originated from Australia (8/15) New Zealand (4/15) and Canada (3/15) while theses were from Canada (7/9) and Australia (2/9). The scoping review results showed substantial qualitative evidence on Indigenous women's experience during the perinatal period in urban areas. In-depth analysis of these studies is required to inform future practice and policy on what works and what needs improvement. Culturally secure midwifery care shows promising results.
Publisher: JMIR Publications Inc.
Date: 02-11-2021
Abstract: nternationally, there is an increasing emphasis on early intervention in the first 1000 days to support pregnant mothers and optimise the health and development of newborns. To increase intervention reach, digital and app-based interventions have been advocated. This paper reports on the qualitative arm of the independent multicomponent evaluation of the Baby Buddy app, a pregnancy related app supported by several professional bodies and developed by a UK young child health and wellbeing charity Best Beginnings. o understand when, why and how first-time mothers use the Baby Buddy app and the perceived potential benefits. n Appreciative Inquiry (AI) qualitative approach was used with semi-structured interviews (n = 17) undertaken with pregnant mother either by telephone or in a focus group. Thematic analysis was used to synthesise the rich data and present findings. our over-riding themes were collated with regard to women’s use of the Baby Buddy app and its influence on interactions with health care professionals and family: Accessibility of information, Knowledge, Reassurance and Reliability, and Confidence. he findings demonstrated a cyclical pattern between the emergent themes, which could provide a framework on which to support first-time mothers’ engagement with digital health management tools. A R2-10.1017/S1463423618000294
Publisher: Informa UK Limited
Date: 04-2015
DOI: 10.2147/JMDH.S71030
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.AAEN.2007.09.001
Abstract: To explore patients' and staffs' perceptions of a pilot service which dispatched a nurse and paramedic to low-priority ambulance calls. However, Patients' opinions of both pilot and standard service groups were obtained through qualitative questionnaire data and in idual interviews. Staffs' perceptions were explored via two focus groups. Questionnaires were sent to a convenience s le of 128 patients attended by the pilot service and 128 patients receiving the standard service. Initially 19 questionnaire participants agreed to be interviewed. Focus group participants (n=11) included nurses and paramedics involved in the pilot service. Sixty-four questionnaires were returned and 11 interviews were conducted. Patients receiving the pilot service were enthusiastic about opportunities for care to be provided in their home. Involvement in the pilot service was a positive experience for staff. They felt confident in managing calls effectively because of their combined knowledge and skills, and believed that the quality of patient care had been improved. They also experienced increased job satisfaction and skills development. Both patients and staff expressed positive views about the pilot service. Patients appreciated being treated at home and staff believed that working together provided more appropriate care for patients and enhanced interprofessional development.
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.IJNURSTU.2007.01.014
Abstract: Nurses have been involved in prescribing in England since 1996, and to date over 41,000 nurses are registered with the Nursing and Midwifery Council as prescribers. The majority of evaluative research on nurse prescribing is descriptive and relies on self-report and assessment of patient satisfaction. To explore and test nurse prescribers' pharmacological knowledge and decision-making. An exploratory approach to test the usefulness of patient scenarios in addressing the reasons why nurses decide whether or not to prescribe was utilised. Semi-structured interviews with nurse prescribers using patient scenarios were used as proxy methods of assessment of how nurses made their prescribing decisions. Two primary care trusts in the southeast of England were the settings for this study. Purposive s ling to ensure there was a mixed group of prescribers was used to enable detailed exploration of the research objectives and to obtain in-depth understanding of the complex activities involved in nurse prescribing. Interviews and case scenarios. The use of cognitive continuum theory guided the analysis. The majority of participants were unable to identify the issues involved in all the scenarios they also failed to provide an acceptable solution to the problem, suggesting that they would refer the patient to the general practitioner. A similar number described themselves as 'very confident' while seven participants felt that they were 'not confident' in dealing with medication issues, four of whom were practising prescribing. The effects of social and institutional factors are important in the decision-making process. The lack of appropriate pharmacological knowledge coupled with lack of confidence in prescribing was demonstrated. The scenarios used in this study indicate that nurses are perhaps knowledgeable in their small area of practise but flounder outside this. Further research could be conducted with a larger s le and with more scenarios to explore the decision-making and the pharmacological knowledge base of nurse prescribers, particularly in the light of government policy to extend prescribing rights to non-medical prescribers, including pharmacists.
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.IJNURSTU.2011.10.023
Abstract: The global response to the rise in prevalence of chronic disease is a focus on the way services are managed and delivered, in which nurses are seen as central in shaping patient experience. However, there is relatively little known on how patients perceive the changes to service delivery envisaged by chronic care models. The PEARLE project aimed to explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to the models. Design, settings and participants Case study design of seven sites in England and Wales ensuring a range of chronic disease management models. Participants included over ninety patients and family carers ranging in age from children to older people with conditions such as diabetes, respiratory disease, epilepsy, or coronary heart disease. Semi-structured interviews with patients and family carers. Focus groups were conducted with adolescents and children. A whole systems approach guided data collection and data were thematically analysed. Despite nurses' role and skill development and the shift away from the acute care model, the results suggested that patients had a persisting belief in the monopoly of expertise continuing to exist in the acute care setting. Patients were more satisfied if they saw the nurse as diagnostician, prescriber and medical manager of the condition. Patients were less satisfied when they had been transferred from an established doctor-led to nurse-led service. While nurses within the study were highly skilled, patient perception was guided by the familiar rather than most appropriate service delivery. Most patients saw chronic disease management as a medicalised approach and the nursing contribution was most valued when emulating it. Patients' preferences and expectations of chronic disease management were framed by a strongly biomedical discourse. Perceptions of nurse-led chronic disease management were often shaped by what was previously familiar to the patient. At a strategic level, autonomous nursing practice requires support and further promotion to wider society if there is to be a shift in societal expectation and trust in the nurse's role in chronic disease management.
Publisher: Springer Science and Business Media LLC
Date: 09-01-2017
Publisher: Cambridge University Press (CUP)
Date: 2022
DOI: 10.1017/S1463423621000384
Abstract: This article documents the impact of a Nurse Practitioner-led primary health service for disadvantaged children living in housing instability or homelessness. It identifies that First Nations children miss out on essential primary care, particularly immunisation, but have less severe health conditions than non-First Nations children living in housing insecurity. Health services for homeless populations focus on the 11% of rough sleepers, little is done for the 22% of children in Australia living in housing instability many of whom are from First Nations families. Little is known of the health status of these children or their connections to appropriate primary health care. This research implemented an innovative model of extended health care delivery, embedding a Nurse Practitioner in a homeless service to work with families providing health assessments and referrals, using clinically validated assessment tools. This article reports on proof of concept findings on the service that measured immunisation rates, developmental, medical, dental and mental health needs of children, particularly First Nations children, using a three-point severity level scale with Level 3 being the most severe and in need of immediate referral to a specialist medical service. Forty-three children were referred by the service to the Nurse Practitioner over a 6-month period, with nine identifying as First Nations children. Differences in severity levels between First Nations/non-First Nations children were Level 1, First Nations/non-First Nations 0/15% Level 2, 10/17% and Level 3, 45/29%. Forty-five percent of First Nations children had no health problems, as compared to 29% on non-First Nations children. Immunisation rates were low for both cohorts. No First Nations child was immunised and only 9% of the non-First Nations children. While numbers for both cohorts are too low for valid statistical analysis, the lower levels of severity for First Nations children suggest stronger extended family support and the positive impact of cultural norms of reciprocity.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.IJNURSTU.2005.10.011
Abstract: Against the backdrop in the western world of increasing prevalence of chronic disease, active and informed patients and a policy emphasis on self-management, this English study explored health professionals' responses to expert patients. To: A grounded theory approach was utilised with two concurrent data strands. A relatively affluent English county including community, primary and secondary care settings. Via purposeful and theoretical s ling 100 health professionals (nurses, doctors, physiotherapists) and 100 adults affected by chronic disease participated. Focus groups, interviews and observation. Nurses were found to be most anxious about expert patients when compared to other professionals, which appeared to be linked with a lack of professional confidence and unfounded fears regarding litigation. However, nurse specialists often provided a negative case for this. As a whole, nurses were most able to meet the emotional needs of patients, but apart from nurse specialists did not articulate this as a skill. Apart from nurse specialists the majority of nurses appeared limited in appropriately facilitating self-management. It is suggested that this is linked to an ongoing nursing culture of patient as passive, an over-emphasis on empirical knowledge and a feeling of vulnerability on the nurses' part towards expert patients. The findings also indicate a rhetoric rather than reality of autonomous nursing roles within the chronic disease management agenda.
Publisher: Informa UK Limited
Date: 06-2013
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Sally Kendall.