LET’S DO IT!
How junior staff can make a difference through Research.
It is widely felt that research is the domain of ‘the clever ones’ or those in charge.
This presentation will demonstrate how staff of all levels can be involved in research
and make a difference in their workplace.
Research can be the key to finding out why we do things the way we do, and provide
evidence for the things we should be changing. It does not have to be the preserve
of senior staff – we can all be agents for change.
We all have those “but why?” moments in our work - the little things that just don’t
seem to make sense.
The “that just doesn’t seem right” feeling.
Or the “there has to be a better way of doing this” thoughts.
Instead of waiting for someone else to find the answers to her questions, this
presentation will show how a Band 5 Staff Nurse has been able to bring about
positive changes in her workplace, be a catalyst for further research and improve
care delivered to patients.
Claire Green RN(A), Dip HE, BEd(Hons) is a staff nurse working in
trauma/orthopaedics at Noble’s Hospital. She is currently studying for her
Masters degree.
I have recently completed an MSc in Biomedical Science through Anglia Ruskin
University, with my final research project entitled “The effects of sensor colour
change in negative blood culture bottles; are terminal sub-cultures necessary in
some cases?”
The official abstract section of my project is as follows:
--“Blood culture bottles are seen as the ‘Gold Standard’ of the diagnosis of
bloodstream infections. However, it has been noted that bottles that have been
designated as negative after incubation may share some of the characteristics of
positive bottles, for example comparable sensor colours. This study set out to verify
that bottles indicated as negative by the BacT/ALERT 3D (bioMérieux) analyser do
not contain microorganisms. Additionally, the sensor colour was investigated as a
means to aid the interpretation by the users of this system.
This study was achieved by sub-culturing negative bottles that had been incubated
for 5 days on the BacT/ALERT 3D analyser onto a range of agar types in various
atmospheric conditions for different lengths of time in order to ensure conditions that
are favourable for a wide range of organisms that may have been present in the
bottle, but that had not triggered the analyser algorithm. A small number of samples
were also subjected to molecular-based testing in order to account for factors that
may have restricted organisms present from growing on sub-culture, such as
inactivation by antibiotics given to the patient prior to inoculation of the bottles.
The results of this study showed that the BacT/ALERT 3D system in use at Noble’s
Hospital on the Isle of Man can be seen as highly reliable with regards to the
reporting of negative blood cultures. Furthermore, it was also shown that the bottle
sensors are not a dependable indicator as to the requirement to sub-culture negative
bottles due to the fact that other factors, such as blood volume in the bottles, may
contribute to the observed sensor colour variations”.
--This project revealed that the blood culture analyser in the Medical Microbiology
Laboratory at Noble’s Hospital is accurate in regards to the reporting of negative
results, and therefore did not have any implications for laboratory practice. However,
it can be seen that this was a useful exercise in internal validation of the instrument
for the purposes of auditing and accreditation.
I have obtained feedback for my project, and have already done a PowerPoint
presentation to colleagues in my department regarding how I did my research, my
findings, and the feedback received from the project markers. I feel that a somewhat
streamlined version of this presentation would be of benefit to those who are just
setting out on the road to starting their own project, as others can learn from the
mistakes that I made and the feedback that I received.
Sources for this research project include the following key references:
 bioMérieux, Inc., 2010. BacT/ALERT 3DTM. [user manual] USA: bioMérieux,
Inc.
 Kirn, T. J., et al, 2014. Controlled clinical comparison of BacT/Alert FA Plus
and FN Plus blood culture media with BacT/Alert FA and FN blood culture
media. Journal of Clinical Microbiology, 52(3):839-845



Public Health England, 2014. UK Standards for Microbiology Investigations:
B37 (Issue 8) - Investigation of Blood Cultures (for organisms other than
Mycobacterium species). London: Public Health England
Singer, M., et al, 2016. The third international consensus definitions for sepsis
and septic shock (Sepsis-3). The Journal of the American Medical Association,
315(8): 801-810
Thorpe, T. C., et al, 1990. BacT/Alert: an automated colorimetric microbial
detection system. Journal of Clinical Microbiology, 28(7): 1608-1612
Absract
‘Change the world by writing from the heart’
Denzin 2006: 422
Autoethnography and the Novice Researcher
Autoethnography, expands and opens up a wider lens on the author's world and to use what they
learn there to reflect on, understand and develop (Ellis et al 2011). With the use of a subjective lens
autoethnography gives nurses the opportunity to tell stories that would otherwise not be heard.
Autoethnography is a methodology that offers insights and an opportunity to examine the impact of
nurses’ personal and professional cultural identity on their practice (Peterson 2015).
Whilst autoethnography has far little used in the discipline of nursing research and leadership
development, the literature supports the potential of autoethnography as a method to explore the
use of self within leadership development.
References
Denzin, N. K. 2006. Analytic Autoethnography, Or Deja Vu all over again. Journal of Contemporary
Ethnography, 35: 419-428.
Ellis, C., Adams, T.E., Bochner, A.P. (2011). Autoethnography: An overview. Forum; Qualitative Social
Research/Sozialforschung. 12 (1) January 2011
Peterson, A.L. (2015) A case for the use of autoethnography in nursing research. Journal of Advanced
Nursing 71 (1) 226.233.
Title:
Autoethnography: research based self-understanding
The aim of this presentation is to introduce the audience to the research method of
autoethnography. It will pull from the presenters experience of having critically used
this methodology for his PhD in Educational Research (Struthers 2012). It centres
largely on reflection and reflectivity linked to the analysis of narrative. The
methodology encourages the researcher to analyse what lies behind their own
stories they use as orientation points in their life. The application of various theories
often reveals alternative ways one can create identity. Both professional and other
identities are considered in relation to how they support and maintain current
practice. A model for anayltic autoethnography, constructed by the presenter is
shared with the audience to explain the multiple contexts which inform our use of
self in health care (Struthers 2014). Finally links will be made to the reflective skills
being transferable to revalidation processes and ongoing clinical supervision or
coaching.
The implications for practice:
1 Use self-understanding from autoethnography to review own attachment script /
narrative to develop a more effectively responsive collegiate relationship style.
2 Develop the use of autoethnographic data collection methods within teaching to
develop mental health nurses and other practitioners.
3 Develop and ensure trusting relationships when deconstructing and reconstructing
stories based on memory.
4 Guide others to use creative writing skills to express and challenge dominant
discourse and habitual thinking.
Struthers J. (2012) Analytic autoethnography: a tool to inform the lecturer’s use of
self when teaching mental health nursing? PhD Thesis Lancaster University
http://eprints.lancs.ac.uk/62512/1/Struthers_John_Final_2013_Feb.pdf
Struthers, J. (2014) Analytic autoethnography: one story of the method, in Jeroen
Huisman, Malcolm Tight (ed.) Theory and method in Higher EducationResearch II
(International Perspectives on Higher Education Research, Volume 10) Emerald
Group Publishing Limited, pp183-202.
Saints and scroungers, perils and promise:
Exploring the social construction of arthritis in
British media
Musculoskeletal conditions, including arthritis, have a global impact, causing increased disability and
reduced quality of life (Conaghan et al., 2014), yet conditions are undermanaged and deprioritized
(Broadbent, Maisey, Holland, & Steel, 2008; Sanders, Donovan, & Dieppe, 2004). As illness is
experienced in social world, there are many influences on perceptions and experiences of illness
however the media is arguably one of the most significant (Charmaz & Rosenfeld, 2006; Garthwaite,
2011, 2014, 2015; McEnhill & Byrne, 2014; Rozanova, 2010; Ylänne, Williams, & Wadleigh, 2009).
Hitherto, arthritis in the media is unexplored, but such knowledge would shed light on how arthritis
is constructed and the impact of such constructions on perceptions of the condition. This is essential
as previous research (Cheraghi-Sohi et al., 2013; Grime, Richardson, & Ong, 2010) has highlighted
that negative attitudes and beliefs exist about arthritis, which has a negative impact on illness
behaviour (Alami et al., 2011; Barker et al., 2014) and the media is posited as one source of such
constructions (Smith et al., 2014; Van der Wardt et al., 1999; Arthritis Care, 2004)
This research aimed to investigate media constructions of arthritis through a mixed qualitative
approach which examined the representation, production and reception of media messages about
arthritis. Eleven national newspapers and three monthly magazines were selected according to
circulation and readership statistics. Articles were selected according to broad inclusion criteria
resulting in a final corpus of 1014 newspaper articles and 18 magazine articles. Articles were
analysed using a combination of thematic categorisation, discourse schema and imagery analyses to
study the factors of media representation and production. Media reception was explored through
two focus groups which were convened from pre-acquainted community groups with different age
demographics.
The media study demonstrated that arthritis was represented as a condition that was common but
non-legitimate. Competing discourses about ageing were found within the sampled articles.
Language of ‘successful ageing’, including anti-ageing messages and products, were commonly
found; however these sat alongside understandings of ageing as a time of frailty and expected
chronic illness. Such dichotomous representations were also found in relation to disability, where
impairment due to arthritis was seen as both something that could be overcome and something that
inevitably progressed. These competing messages about arthritis undermined the legitimacy the
condition was afforded within the media, characterising those with the condition as a drain on
society. The main themes found in the media study (competing discourses of ageing and disability)
were reflected in the focus groups.
The findings show that arthritis is constructed as uncertain, and that this uncertainty is compounded
by constructions of ageing and disability. These constructions have an impact on the legitimacy that
arthritis is afforded. When legitimacy is compromised, judgements about the ‘deservedness’ of
arthritis (both the condition itself and those with the condition) emerge. The judgement of
‘deservedness’ has implications on all areas of life for people with arthritis including the ability to
claim state welfare when required. These competing discourses also have implications for
management of arthritis as they could present a barrier to the uptake of treatment and selfmanagement strategies. This presentation explores how these wider social issues, and subsequent
political actions (for example benefit reform and austerity measures), have shaped public
understandings of arthritis.
MSC Project 2016
Are the current screening protocols for Trichomonas vaginalis,
used in the Genitourinary Medicine Clinic in the Isle of Man, fit
for purpose?
This project was submitted to Greenwich University in July 2016 in partial fulfilment of the
requirements for the award of MSC Biomedical Science (online).
Abstract
Introduction: Trichomonas vaginalis is the world’s most common sexually transmitted
infection, with the World Health Organisation estimating in that in 2008 over 276 million
new cases, of infection, occur each year1. It is most frequently observed in females and is
characterised by the production of an offensive vaginal discharge in symptomatic individuals.
In males, the infection is usually transient and has been associated with non-specific
urethritis2. High levels of asymptomatic carriage have been reported in both sexes3. The
recent development of molecular tests, for the diagnosis of T.vaginalis infections, have lead
us to reconsider how best to test for this organisms presence.
Methods: For the duration of this study all patients, who met the inclusion requirements,
were tested for T.vaginalis by AptimaTV (Hologic UK), in addition to the current testing
protocols utilised within the Genitourinary Medicine (GUM) Clinic. A retrospective data
trawl was carried out, regarding the positivity rate of T.vaginalis, Chlamydia trachomatis,
and Neisseria gonorrhoea in previous years, to ensure that any improvements seen in the
detected T.vaginalis positivity rate, are due to the addition of AptimaTV and the adoption of a
universal screening program, rather than a change in the patterns of sexually transmitted
disease observed in the Isle of Man.
Results: The study examined 346 patients; 212 females and 134 males and did not reveal a
single case of T.vaginalis infection. The retrospective data trawl, demonstrated that the study
group’s pattern of sexually transmitted infections were not significantly different to the
patients who had attended the clinic in the previous four years.
Discussion: In the absence of any evidence of T.vaginalis infection during the study period, it
was not possible to make conclusions regarding the specific use of AptimaTV or universal
David Frost MSc BSc (Hons) MIBMS
Senior Biomedical Scientist
Nobles Hospital
Isle of Man
Page 1
MSC Project 2016
screening, other than to confirm that its use, within the GUM clinic, in the Isle of Man, is
unjustified at present. The probable reasons for the absence of T.vaginalis, within the Isle of
Man GUM Clinic attendees, are suggested and the Isle of Man data available for Chlamydia
compared with United Kingdom statistics.
Conclusions: This study demonstrates that the arrangements for the identification of
T.vaginalis infections, currently in place in the GUM Clinic, in the Isle of Man, are fit for
purpose.
Implications for future practice; This study concluded that the current arrangements for the
diagnosis of T.vaginalis were acceptable, but one area of potential improvement, that was
revealed, was the need to increase the detection rate of C.trachomatis. The development of a
formal C.trachomatis screening program, specifically targeting patients in the 16 to 24 years
of age cohort, is essential to reduce the observed C.trachomatis positivity rate.
References
1. World Health Organization. Global incidence and prevalence of curable sexually
transmitted infection; 2011
http://apps.who.int/iris/bitstream/10665/75181/1/9789241503839_eng.pdf
2. Oxford Handbook of Genitourinary Medicine, HIV and Sexual Health Edited by
Richard Patteman et.al. Oxford University Press, 2010
3. BASHH Standards for the management of sexually transmitted disease; 2010
http://www.bashh.org/documents/2513.pdf
Acknowledgements
Many thanks to the Staff of the Pathology Department and Genitourinary Medicine Clinic at
Nobles Hospital, Isle of Man and Hologic UK, for providing the AptimaTV kits to make this
project possible.
In particular; thanks to Chris Helm and Amanda Dawson for your support and advice over
the last year and above all, my wife, Lisa, your patience was endless.
David Frost MSc BSc (Hons) MIBMS
Senior Biomedical Scientist
Nobles Hospital
Isle of Man
Page 2
Abstract for Research Conference (Poster)
Title:
Medical Outliers – Does Occupational Therapy delay discharge?
Reason:
Following the closure of ward 20, verbal feedback from the Acute Occupational Therapy team and
nursing staff indicated that there were many medical outliers on orthopaedic and surgical wards.
Verbal feedback from the Orthopaedic / Surgical OT team indicated that the decreased number of
beds due to outliers increased the pressure on the service to ensure bed flow management for
Orthopaedic and surgical patients was maintained. It was felt that the service had become reactive
to this pressure.
Informal verbal comments indicated that the response time of Occupational Therapy was delaying
discharge.
The Occupational Therapy Acute team is split into specific areas with teams covering
Orthopaedic/Surgical, Medical and Stroke. The existing practice is that transferred patients from any
of these areas remain with their respective OT.
Aim:
The aims of the survey were to identify:


If Occupational Therapy response times were within the operational policy guidelines
stating that patients are to be seen within 2 working days of receipt of referral. (1)
Whether the current practice of specialty specific Occupational therapy input remains or
whether a review is required to determine any alterations required to service delivery.
Method:
Data was collected from 07 March 2016 to 03 June 2016 from Wards 1, 2, 11, 12 and PPU via
Medway and OT Direct patient statistics. Patients admitted and discharged in a single weekend/
bank holiday period were not included as there is no available OT cover at these times.
The information gathered included:
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
Total number of outlying medical patients on each ward.
Those known to OT on admission / transfer
Those referred to OT post admission / transfer
Timescale in days from:
o Admission / Transfer to OT Referral Received.
o OT Referral Received to First OT Contact with Patient.
o First OT contact to last OT contact on ward.
o Last OT contact on ward to discharge / transfer.
In conclusion, from the survey undertaken it was demonstrated that the OT response times were
within operational policy and therefore did not delay discharge.
At present, the OT service will continue to deliver care by specialty and not location. This provides
continuity and consistency of patient care; it also ensured the patients receive therapy from the
appropriately skilled practitioner.
However, as with all good practice this will be monitored and reviewed.
Implications on Practice:
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Ensure effective communication with MDT through clear documentation and involvement in
board rounds. This includes wards being able to easily identify the allocated OT and their
contact number for each outlying patient.
OT to promote appropriate early referral due to median 4 working days between admission
and referral received.
Monitoring of implications on OT practice caused by outlying medical patients.
Monitoring of impact on areas of OT service affected by outlying medical patients.
Medical OT team to monitor and collate number of outlying medical patients referred to
service and number of patients with ongoing OT assessment transferred to wards as outliers.
Authors:
Daniel Kewley – Occupational Therapy Technical Instructor – email: [email protected]
Amanda Exton – Clinical Lead Occupational Therapist - Acute
Reference:
1. Acute Medical Occupational Therapy Service Operational Policy 03.2014
Abstract: Exploring the Benefits of Writing for Wellbeing and Chair Based Exercise Groups
on Wellbeing in clients/patients of an Older Persons Mental Health Service (OPMHS)
Dr Susan Ferry, Consultant Neuropsychologist, OPMHS
Nicki Sinclair, Clinical Team Leader ~ Occupational Therapy, OPMHS
The Older Persons Mental Health Service (OPMHS) provides a community, island wide
multidisciplinary services to older people with mental health problems and their carers.
Creative writing is an important part of the recovery experience of people affected by
mental ill-health (King, Neilsen and White, 2013). Physical activity has significant benefits
for health and can reduce the risk of depression (WHO, 2012). The current research project
aims to compare two group interventions: Writing for Wellbeing and Chair Based Exercise
on the well-being of patients/clients of OPMHS. In addition the research will help formulate
recommendations to enable service development of group provision to progress and be
sustained. Two hypotheses will be tested: 1) There will be an improvement in psychological
well-being after attending a group intervention programme; 2) There will be a greater
improvement in psychological well-being after attending the Writing for Wellbeing Group.
Participants will be adults with a confirmed mental health diagnosis, who are
clients/patients of OPMHS. The study will employ a between subjects design, with two
intervention groups. The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) 2006 will
be used at week 1 & 8. A questionnaire asking about the experience of being in the group
will also be used. In the writing group participants response to a writing exercise completed
in week 1 & 8 will, also, be analysed for themes using grounded theory. Progress to date:
running intervention groups and collecting data. Some initial data shows improvement in
well-being. Implications for practice: i) identify which aspects of the group participants find
most useful and incorporate these into other groups the service delivers. ii) Identify themes
which are prominent at the beginning and end of the writing group and explore these
themes in the writing group to enhance well-being. iii) Share skills and enhance good
practice and staff development.
References:
King, R., Neilsen, P. & White, E. (2013) Creative writing in recovery from severe mental
illness. International Journal of Mental Health Nursing. Vol 22 (5) 444-452
NHS Health Scotland, University of Warwick and University of Edinburgh (2006) The WarwickEdinburgh Mental Well-being Scale (WEMWBS)
World Health Organisation. (2012). Health topics: Physical activity. Retrieved from World Health
Organisation website: http://www.who.int/topics/physical_activity/en/