Papers by Julie-Ann Maclaren
Journal of community medicine & health education, Oct 20, 2017
S tatement Supervised practice as a mentor is an integral component of professionally-accredited ... more S tatement Supervised practice as a mentor is an integral component of professionally-accredited nurse mentor education, and is essential to the development of robust undergraduate workplace learning and assessment. However, the literature tends to focus on the mentor-student relationship rather than the relationships facilitating mentors' workplace learning. This paper begins to redress this gap in the literature by asking the research question: Which relationships are important in developing nurses as mentors in practice, and how are their mentorship impacted by professional, Organizational and political agendas in NHS settings? A qualitative case study of two NHS Trusts was undertaken utilizing a range of data collection methods. In order to explore supervisory and supportive relationships whilst studying for an approved mentorship award (Nursing and Midwifery Council, 2008) semistructured interviews were undertaken with three recently qualified mentors. A snowball interview technique (Noy, 2008) enabled access to those they identified as significant in their own learning to become mentors, who were similarly interviewed about their developmental and support network in practice. In total six mentors were interviewed. Additional Interviews with nurses in senior NHS Trust-based educational roles, and senior policy-making and education figures augmented these initial interviews. In another strand of the research, professional mentorship standards (NMC, 2008) were mapped across each of the mentors' interview data to gain an idea of their penetration into practice. Finally, each interview participant developed a developmental mentorship network diagram (Dobrow & Higgins, 2005) which identified colleagues significant to their own development as a mentor or educator, and the attributes which enabled this (Andrews & Chilton, 2000; Darling, 1984). The findings reveal complex learning relationships and situational factors affecting mentor development and ongoing practice. They suggest that traditional dyadic forms of supervisory mentorship may not offer the range of skills and attributes that developing mentors require. Mentor network type, orientation to learning, learning strategies and organizational focus emerge as the foci of tensions in learning to be a mentor. The study recommends that nursing teams in acute areas further develop a shared culture of learning and development in providing multiple opportunities for supporting developing mentors.
Australian Critical Care, 2021
OBJECTIVES There is a need for early mobilisation of patients in intensive care units to prevent ... more OBJECTIVES There is a need for early mobilisation of patients in intensive care units to prevent acquired weaknesses which can have a long-term impact on health and quality of life. This need is not always fulfilled. We therefore sought to conduct an integrative review of international evidence to answer the question: What are the barriers to nurses mobilising adult patients in intensive care units? REVIEW METHOD USED We conducted a systematic search and thematic analysis. We were able to present a descriptive quantitative synthesis of the survey articles included. DATA SOURCES We searched CINAHL, MEDLINE, and PsycINFO databases between and including 2010 and 2020 using search terms synonymous with "intensive care unit" and "nurse" and "early mobilisation" and "barrier using Boolean operators" and "truncation". We completed backwards and forwards citation searches on included studies. RESULTS We included seven articles which we synthesised into three themes and 13 subthemes as follows: (i) organisational barriers (subthemes were staffing levels, time and workload, resources, and care coordination), (ii) individual barriers (subthemes were self and team safety, knowledge and training, beliefs about the consequences of early mobilisation, stress, and other barriers), and (iii) patient-related barriers (subthemes were medical instability/physical status, patient safety, neurological deficits and sedation, and nonconcordance of patients). CONCLUSION Nurses' barriers were wide ranging, and interventions to improve concordance with early mobilisation need to be tailored to address this group's specific barriers.
Radiotherapy and Oncology, 2004
Background: Radiation-induced arm lymphoedema is a common and distressing complication of curativ... more Background: Radiation-induced arm lymphoedema is a common and distressing complication of curative treatment for early breast cancer. Hyperbaric oxygen (HBO 2) therapy promotes healing in bone rendered ischaemic by radiotherapy, and may help some soft-tissue injuries too, but is untested in arm lymphoedema. Methods: Twenty-one eligible research volunteers with a minimum 30% increase in arm volume in the years after axillary/supraclavicular radiotherapy (axillary surgery in 18/21 cases) were treated with HBO 2. The volunteers breathed 100% oxygen at 2.4 ATA for 100 min in a multiplace hyperbaric chamber on 30 occasions over a period of 6 weeks. The volume of the ipsilateral limb, measured opto-electronically by a perometer and expressed as a percentage of contralateral limb volume, was selected as the primary endpoint. A secondary endpoint was local lymph drainage expressed as fractional removal rate of radioisotopic tracer, measured using lymphoscintigraphy. Results: Three out of 19 evaluable patients experienced .20% reduction in arm volume at 12 months. Six out of 13 evaluable patients experienced a. 25% improvement in 99 Tc-nanocolloid clearance rate from the ipsilateral forearm measured by quantitative lymphoscintigraphy at 12 months. Overall, there was a statistically significant, but clinically modest, reduction in ipsilateral arm volume at 12 months follow-up compared with baseline (P ¼ 0:005). The mean percentage reduction in arm volume from baseline at 12 months was 7.51. Moderate or marked lessening of induration in the irradiated breast, pectoral fold and/or supraclavicular fossa was recorded clinically in 8/15 evaluable patients. Twelve out of 19 evaluable patients volunteered that their arms felt softer, and six reported improvements in shoulder mobility at 12 months. No significant improvements were noted in patient self-assessments of quality of life. Conclusion: Interpretation is limited by the absence of a control group. However, measurement of limb volume by perometry is reportedly reliable, and lymphoscintigraphy is assumed to be operator-independent. Taking all data into account, there is sufficient evidence to justify a double-blind randomised controlled trial of hyperbaric oxygen in this group of patients.
European Journal of Cancer, 1999
was no significant differences between the two randomization groups. Longterm effect was signific... more was no significant differences between the two randomization groups. Longterm effect was significantly related to continued use of the compression sleeve. Conclusion: Manual lymph drainage did not contribute significantly to reduce edema volume. the treatment and care they receive they may experience suffering and despair. This paper will discuss the concept of hope, systematically review the literature and discuss the application of the concept of hope to the patient with cancer.
City University London has a strong tradition of encouraging pedagogic practitioner-research thro... more City University London has a strong tradition of encouraging pedagogic practitioner-research through the sponsorship of workplace and inter-departmental project working under the auspices of the Learning Development Centre (LDC). Reflecting sector-wide issues, the University’s focus on assessment and feedback as a priority area for academic development has resulted in several studies which have shaped the university’s understanding and practices in this area. In this article I review a selection of recent projects which have a bearing on this area of academic practice. The scope of projects is wide, focusing on many different facets of assessment and feedback, but with an emphasis on improving student experience of this in both classroom and workplace settings. This review starts with a discussion of some of the concerns surrounding assessment and feedback within the University, before exploring how recent studies by staff and Learning Development Associates have explored this agend...
Radiotherapy and Oncology, 2004
Nurse Education in Practice, 2017
Supervised practice as a mentor is currently an integral component of nurse mentor education. How... more Supervised practice as a mentor is currently an integral component of nurse mentor education. However, workplace education literature tends to focus on dyadic mentor-student relationships rather than developmental relationships between colleagues. This paper explores the supportive relationships of nurses undertaking a mentorship qualification, using the novel technique of constellation development to determine the nature of workplace support for this group. Semi-structured interviews were conducted with three recently qualified nurse mentors. All participants developed a mentorship constellation identifying colleagues significant to their own learning in practice. These significant others were also interviewed alongside practice education, and nurse education leads. Constellations were analysed in relation to network size, breadth, strength of relationships, and attributes of individuals. Findings suggest that dyadic forms of supervisory mentorship may not offer the range of skills and attributes that developing mentors require. Redundancy of mentorship attributes within the constellation (overlapping attributes between members) may counteract problems caused when one mentor attempts to fulfil all mentorship roles. Wider nursing teams are well placed to provide the support and supervision required by mentors in training. Where wider and stronger networks were not available to mentorship students, mentorship learning was at risk.
British Journal of Therapy and Rehabilitation, 1996
Effective rehabilitation can be achieved by involving clients in all decisions concerning their c... more Effective rehabilitation can be achieved by involving clients in all decisions concerning their care. This promotes compliance, autonomy and independence, and encourages them to fufil their physical and psychosocial potential. Practitioners can facilitate this client empowerment through unbiased information giving and supporting decisions made.
Supervised practice as a mentor is an integral component of professionally-accredited nurse mento... more Supervised practice as a mentor is an integral component of professionally-accredited nurse mentor education. However, the literature tends to focus on the mentor-student relationship rather than the relationships facilitating mentors' workplace learning. This thesis begins to redress this gap in the literature by asking the research question: Which relationships are important in developing nurses as mentors in practice, and how is their mentorship impacted by professional, organisational and political agendas in NHS settings? A qualitative case study of two NHS Trusts was undertaken with three modes of data collection utilised. Firstly, semi-structured interviews were undertaken with three recently qualified mentors, and those they identified as significant in their own learning to become a mentor. In total six mentors were interviewed. Interviews with nurses in senior NHS Trust-based educational roles, and senior policy-making and education figures augmented these initial interviews. Secondly professional mentorship standards were mapped across each of the mentors' interviews to gain an idea of their penetration into practice. Finally, each interview participant developed a developmental mentorship constellation which identified colleagues significant to their own development as a mentor or educator, and the attributes which enabled this. The findings reveal complex learning relationships and situational factors affecting mentor development and ongoing practice. They suggest that dyadic forms of supervisory mentorship may not offer the range of skills and attributes that developing mentors require. Mentor network type, orientation to learning, learning strategies and organisational focus emerge as the foci of tensions in learning to be a mentor. The study recommends that nursing teams in acute areas further develop a shared culture of learning and development in providing multiple opportunities for supporting developing mentors.
International Journal of Palliative Nursing, 2001
Appropriate skin care and prevention of infection are important cornerstones of effective lymphoe... more Appropriate skin care and prevention of infection are important cornerstones of effective lymphoedema management, which can play a vital role in patient comfort and acceptance of swelling. Management of the patient or client with lymphoedema requires input from an appropriately qualified and skilled practitioner, however skin care is one area of care, which may be addressed by all levels of healthcare professionals involved in direct patient care. This article highlights the pathophysiology of both the skin and lymphatics in lymphoedema. It also aims to give the reader a practical understanding of potential skin problems and suggestions for how they may be identified and remedied.
BMC Nursing, 2021
Aims To understand the experiences of nursing students and academic staff of an intervention to d... more Aims To understand the experiences of nursing students and academic staff of an intervention to decrease burnout and increase retention of early career nurses, in order to identify acceptability and feasibility in a single centre. Background Internationally, retention of nurses is a persistent challenge but there is a dearth of knowledge about the perspectives of stakeholders regarding the acceptability and feasibility of interventions to resolve the issue. This study reports an intervention comprising of mindfulness, psychological skills training and cognitive realignment to prepare participants for early careers as nurses. Methods This is an explanatory sequential mixed methods study, conducted by a UK university and healthcare organisation. Participants were final year pre-registration nursing students (n = 74) and academics (n = 7) involved in the implementation of the intervention. Pre and post measures of acceptability were taken using a questionnaire adapted from the Theoreti...
Nurse Education in Practice, 2020
Co-production is a process employed to solve complex issues, recognising the expertise of all sta... more Co-production is a process employed to solve complex issues, recognising the expertise of all stakeholders. This paper reports on co-production undertaken by nursing students, early career nurses and researchers as part of a larger study to design an intervention to increase retention of early career nurses. Mixed methods were used to evaluate the acceptability and feasibility of the co-production process in a UK university. Data were collected prospectively, concurrently and retrospectively via interview and questionnaire, between April 2018 and January 2019. Twelve co-production group members completed the questionnaire and six group members and facilitators were interviewed. Students and early career nurses reported personal benefit from participating; they developed and practised transferrable communication and problem-solving skills, believed they were able to make a difference, enjoyed contributing, found benefit from using the group as a reflective space and considered that coproduction produced a credible intervention. Findings indicated co-production equipped participants to function more effectively in their nursing roles; incorporating co-production into the development of future interventions may prove beneficial. The relative novelty of this approach, and the potential application of the findings to a diverse range of geographical and organisational settings, add to the utility of the findings.
International Journal of Nursing Studies, 2018
Background: nurse shortages have been identified as central to workforce issues in healthcare sys... more Background: nurse shortages have been identified as central to workforce issues in healthcare systems globally and although interventions to increase the nursing workforce have been implemented, nurses leaving their roles, particularly in the first year after qualification, present a significant barrier to building the nurse workforce. Objective: to evaluate the characteristics of successful interventions to promote retention and reduce turnover of early career nurses. Design: this is a systematic review Data sources: Online databases including Academic Search Complete, Medline, Health Policy reference Centre, EMBASE, Psychinfo, CINAHL and the Cochran Library were searched to identify relevant publications in English published between 2001 and April 2018. Studies included evaluated an intervention to increase retention or reduce turnover and used turnover or retention figures as a measure. Review methods: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were quality-assessed using the Joanna Briggs Institute Critical Appraisal tools for Quasi Experimental and Randomised Controlled Trials. Retention/turnover data were used to guide the comparison between studies and appropriate measures of central tendency and dispersion were calculated and presented, based on the normality of the data. Results: A total of 11, 656 papers were identified, of which 53 were eligible studies. A wide variety of interventions and components within those interventions were identified to improve nurse retention. Promising interventions appear to be either internship/residency programmes or orientation/transition to practice programmes, lasting between 27-52 weeks, with a teaching and preceptor and mentor component. Conclusions: Methodological issues impacted on the extent to which conclusions could be drawn, even though a large number of studies were identified. Future research should focus on standardising the reporting of interventions and outcome measures used to evaluate these interventions and carrying out further research with rigorous methodology. Clinical What this paper adds Promising interventions appear to be either internship/residency programmes or orientation/transition to practice programmes, lasting between 27-52 weeks, with a teaching and preceptor and mentor component. These characteristics can be used as a foundation for developing or refining transition programmes for early career nurses so that maximum return on investment is achieved.
International Journal of Palliative Nursing, 2003
Lymphoedema treatment has long been associated with large lymphology clinics in Austria and Germa... more Lymphoedema treatment has long been associated with large lymphology clinics in Austria and Germany, where many therapists and patients have made pilgrimages to experience or learn techniques for managing the condition. Although these clinics have undoubtedly played an important part in introducing effective treatment techniques, several models of care and service provision have emerged over the past 20 years and a variety of health-care professionals are now involved in lymphoedema treatment across Europe.
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Papers by Julie-Ann Maclaren