research profile clinical practice

Research Profile Clinical Practice

Centre for Health and Social Care Research

The core mission of the Centre is the pursuit of practical applied research in the field of and health care and its translation into evidence based policy, practice and clinical protocols.

The Centre benefits from the wider expertise within the University. Sheffield Hallam is one of the largest providers of health and social care professional training in the UK. This means we can access high levels of expertise in areas including • nursing and midwifery • physiotherapy • occupational therapy • radiography • radiotherapy • social work • paramedics and operating departments.

Beyond healthcare, we work with colleagues in areas including • sport and exercise • psychologists • biosciences • design • modeling • engineering • computer science • business management • environmental sciences • town planning. The Centre also benefits from an in-house team of experienced information scientists who support our research staff by conducting literature searches and reference management for bids and funded projects, and providing information skills training.

The Centre hosts a vibrant postgraduate research training program with over 80 doctoral students in health and a further 90 students in Sports and Bio-science.

Attached are a sample of recent research projects undertaken by staff from the Centre for Health and Social Care Research in conjunction with academic colleagues from the Nursing, Allied Health and Social Work Departments of the Faculty of Health and Wellbeing at Sheffield Hallam University.

For further information please contact us by Phone: 0114 2255691 email: [email protected] or visit our website at www.shu.ac.uk/research/hsc

Malcolm Whitfield PhD, MBA, RGN, RMN

Professor of Health Economics and Management Assistant Dean Research, Faculty of Health and Wellbeing Director of the Centre for Health and Social Care Research

About the centre

Contents

Assessing the impact of children with ADHD on the health and wellbeing of their families 4

Approaches to measuring the impact of nurse consultants on patient and professional outcomes 5

ART Adherence support in the treatment of HIV 6

Continence difficulties 7

Health related quality of life in dementia 8

Evaluation of impact of a new model for the recognition and management of deteriorating patients on hospital wards

Evaluation of the clinical assurance toolkit at Sheffield Teaching Hospitals NHS Foundation Trust 1

Neonatal screening 1

Evaluation of the Health Trainer Service in Wakefield 1

Preventing weight gain following stroke 1

An evaluation of the on-ward volunteer initiative at Sheffield Teaching Hospitals NHS Foundation Trust 1

4 www.shu.ac.uk/research/hsc/Centre for Health and Social Care Research

This study, co-ordinated by the University of Sheffield’s School of Health and Related Research (SchARR), set out to fill in a number of important knowledge gaps regarding ADHD and its impact on the child and family members.

Researchers from Sheffield Hallam University carried out fieldwork relating to the project, working in partnership with the clinical trials research unit at SchARR.

The study was divided into two parts:

• Part A - questionnaires were used to collect data from the members of 1000 families in which a child is attending an ADHD clinic, and from the members of 100 control families

• Part B - data was collected from 200 of the parents who participated in Part A, 100 from families with an ADHD-affected child and 100 from control families.

One significant respect in which families with an ADHD-affected child differ is in the number of other family members who also have ADHD. The researchers therefore screened all family members for ADHD, enabling them to determine any additional impact on health and well-being attributable to the multiple occurrence of ADHD within a single family.

This involved recruiting families with school age children with ADHD from areas in Kent and Yorkshire and completing a set of health and well-being questionnaires for both parents and all children in the household. The data from these questionnaires was expressed in generic health-related quality of life (HRQoL) or utility measures for families where at least one child has ADHD.

In an additional measure in one geographical area, the main carer in the family completed an electronic mood diary for one week and this was compared with a control group matched by postcode and family size.

The results should prove to be a valuable resource for economic modeling of future treatments for ADHD and throw light on a range of important issues which have not been adequately addressed in previous studies. The aim is to build on this existing research to provide a more complete and finely-grained assessment of the impacts of ADHD.

Department/centre contact details Rachel Ibbotson Phone: 0114 225 5793 Email: [email protected]

‘Existing research has established that Attention-Deficit Hyperactivity Disorder (ADHD) is associated with poor health and well-being outcomes, not only for children who have the condition, but also for their parents and siblings.’

Research Profile Summary

Assessing the impact of children with ADHD on the health and wellbeing of their families

5www.shu.ac.uk/research/hsc/ Centre for Health and Social Care Research

A joint research team from Sheffield Hallam University and the University of Sheffield have been working to develop a framework for capturing impact and to produce supporting guidance which could be used by nurse consultants to demonstrate their important contribution.

The project, which was funded by the Burdett Trust for Nursing as part of its Building Nurse Leadership Capacity programme, ran from May 2009 to May 2011 and set out to explore approaches to demonstrating the impact of nurse consultant roles on patient, professional and organisational outcomes. The study aimed to:

• identify a range of indicators to demonstrate the impact of nurse consultants on patient, professional and organisational outcomes

• develop a toolkit to help nurse consultants to demonstrate their impact on patient, professional and organisational outcomes.

Major reforms in the way healthcare is commissioned and healthcare services are organised, together with new models of healthcare delivery, means that the nursing workforce is dealing with many challenges. The introduction of a new nursing career framework is enabling nurses to progress from initial registration through to more specialist roles, leading ultimately to that of nurse consultant.

Through this study, a practical, evidence-based resource, ‘Capturing Impact: A practical toolkit for Nurse consultants’ was produced and it is already being used in a variety of settings to help advanced nurses capture their impact on patients, staff and the organisations in which they work.

Ann McDonnell of Sheffield Hallam University said: ‘The practical guidance we produced helped nurses in advanced roles to characterise and define their impact based on the robust theoretical framework we developed as well as helping them to capture their impact in practice.’

Both the theoretical framework and the practical guidance were disseminated through a variety of activities designed to engage the clinical community. The executive summary for the study was sent to the Chief Nurse in every NHS Trust in England and Wales. A dissemination event was attended by 60 nurse consultants and their managers from across the UK and the research findings have also been presented at a number of national and international conferences.

Department/centre contact details Professor Ann McDonnell Phone: 0114 225 2439 E-mail: [email protected]

‘Helping the nursing workforce to respond to the many challenges facing the NHS’


Approaches to measuring the impact of nurse consultants on patient and professional outcomes


Strict adherence to antiretroviral therapy (ART) is essential for HIV patients to avoid illness and death, but it can be difficult for patients to adjust to maintaining a life-long medication regime. The aim of this study, funded by Sheffield Hospitals Charitable Trust, was to:

• explore patient experience of taking HRT

• identify the support they found or would have found most useful

• develop recommendations for the further development of a structured Nurse-led Adherence Support Service (NLASS)

This research, backed by almost £11,000 of funding from the Sheffield Hospitals Charitable Trust, aimed to contribute to the understanding of the social factors that impact on ART adherence and the implications for health care delivery.

The rigours of starting and maintaining a life-long medication regime are challenging for many patients. Adequate preparation and support in the early phase of drug treatment are essential to enable patients to embed treatment regimes within their lifestyle and make the necessary adjustments required for long-term adherence.

The support services currently in place from HIV nurses have so far been developed largely in response to needs identified by staff. This study aimed to contribute to current understanding of ART adherence in HIV positive patients and inform evidence-based developments in the organisation and delivery of cost effective HIV services locally and nationally.

Department/centre contact details Hilary Piercy Phone: 0114 225 5603 E-mail: [email protected]

ART Adherence support in the treatment of HIV

‘Supporting strict adherence to antiretroviral therapy in HIV patients’



The focus of this project was to seek technological, social and service provision intervention as viable methods of reducing the impact of continence difficulties on older people and their families. The research team also aimed to investigate service and environmental barriers associated with the condition. The study aimed to:

• determine the environmental barriers to continence and continence management and identify how they can be removed

• improve continence interventions and services by garnering more effective continence treatments and supporting better service outcomes

• investigate the effectiveness of two assistive devices – an odour sensor and wetness sensing smart underwear – and see whether they were attractive to a focus group.

This research, backed by more than £17,000 of funding from the ESRC’s New Dynamics of Ageing programme, aimed to develop improvements to continence management services, bringing benefits to older people and their families.

The project has already led to the signing of a six-month agreement with a multi-national organisation for the terms of the ‘Smart Underwear’ product, creating the opportunity for product development and production.

The research also highlighted the social taboo that still surrounds the subject and, through frank and open discussion, supported the development of the concept of the ‘Great British Public Toilet Map.’ This concept was positively received by the focus group where it was discussed, with participants feeling it could lead to fewer embarrassing social situations for sufferers.

In addition, patients and professionals underlined the need to establish positive relationships in order to deliver effective continence services, including the discussion of treatments, which could lead to reform in the way health services approach the condition.

Department/centre contact details Health and social work studies department Phone: 0114 2252543

Continence difficulties

‘Continence management has a huge impact on health and social care budgets as well as the quality of life of older people’



Dementia is one of the most common and serious disorders in later life, and the economic and personal cost of caring for people with dementia is immense.

Researchers from Sheffield Hallam University received funding from the National Institute for Health Research’s Health Technology Assessment programme to develop new health-state classifications for use with dementia sufferers using the new Dementia Quality of Life (DEMQOL) outcome measure.

The process involved five phases:

• derivation of the health state classification.

• main population valuation survey.

• patient and valuation survey

• modelling.

• application to trial data.

Existing dementia-specific measures can effectively measure health-related quality of life but in their current form cannot be used directly to inform cost-effectiveness analysis using quality-adjusted life-years as the measure of effectiveness.

The aim of this study was to develop two brief health-state classifications, one from DEMQOL and one from DEMQOL-Proxy, to generate health states amenable to valuation.

(DEMQOL is a 28 item questionnaire answered by the person with dementia. DEMQOL-Proxy is a 31 item questionnaire answered by a caregiver).

All the phases of the study were successful and the process led to the development of the first condition-specific preference-based measures in dementia, an important new breakthrough in this field.

The results were sufficiently encouraging to recommend that the DEMQOL instruments be used alongside a generic measure such as the European Quality of Life-5 Dimensions (EQ-5D) in future studies of interventions in dementia, as there was evidence that they can be more sensitive for patients with less severe forms of the disease.


‘There is a need to be able to evaluate interventions in dementia using cost-effectiveness analyses, but the generic preference-based measures typically used to measure effectiveness do not work well in dementia’


Health related quality of life in dementia


Hospital in-patients are at risk of deterioration during their stay and a growing body of evidence suggests that this deterioration is often not recognised or acted on by hospital staff. This project, funded by Yorkshire and Humber Strategic Health Authority (SHA), aimed to evaluate a new hospital-wide model at Rotherham Hospital, introduced to recognise and respond to early signs of patient deterioration.

The project objectives were to:

• evaluate the impact of the Rotherham Two Tier Warning System (RTTWS) on knowledge, attitudes and confidence of nursing staff in the recognition and management of acutely ill patients

• understand the reasons for any observed changes

• to explore the perceptions of nursing staff on the impact of the new system on their day to day practice

• to explore whether the two tier scoring system has any drawbacks in practice and whether it is more effective than a single scoring system

• to examine ease of use, data collection and accuracy of scoring and to assess links between the quality of the recording of observations and patient outcomes.

Failure to recognise or act on patient deterioration can delay or prevent admission to critical care and thus lead to greater risks of death. The Rotherham Two Tier Warning System (RTTWS) aims to help qualified and unqualified nursing staff in recognising and responding to early signs of deterioration.

The project provided invaluable insight into the real world experience of using track and trigger warning scoring systems in an acute hospital context. A number of areas were identified to improve the detection and management of deteriorating patients on hospital wards, as well as other implications for clinical practice.

The findings of the study have influenced service development and nursing practice in Rotherham NHS Foundation Trust and have been forwarded by the SHA to all acute trusts within the area. The findings also have wider implications for acute hospitals and have been presented at conferences, as well as being published in the Journal of Advanced Nursing.

Department/centre contact details Professor Ann McDonnell Phone: 0114 225 2439 Email: [email protected]

‘Recognising and responding to early signs of deterioration in hospital patients’


Evaluation of impact of a new model for the recognition and management of deteriorating patients on hospital wards


This study, funded by the Sheffield Teaching Hospitals NHS Foundation Trust, aimed to evaluate the Clinical Assurance Toolkit – CAT – by:

• mapping the processes used to complete the CAT across the Care Groups at Sheffield Teaching Hospitals

• identifying factors which help or hinder the completion of the CAT

• mapping the processes used to disseminate the CAT’s findings

• investigating how easy to use and acceptable the staff find the system

• exploring how key strategic stakeholders and senior staff perceive the contribution of the CAT to quality of patient care and organisational improvement

• exploring patients’ attitudes to the CAT

• understanding how frontline staff view the extent to which the CAT impacts on patient care.

The Clinical Assurance Toolkit – CAT – was developed to provide a co-ordinated, comprehensive, up to date range of standards which provide wards and departments at Sheffield Teaching Hospitals NHS Foundation Trust with accurate and timely feedback about the quality of patient care.

The toolkit is presented in a format which reflects that of the Standards for Better health document (D0H 2006) and each section of the CAT contains a detailed set of standard statements, identifies the types of evidence needed to evaluate performance and uses a traffic light scoring system to give an overall assessment of quality for each standard by clinical area.

This study on behalf of the Foundation Trust aimed to evaluate the CAT in terms of its utility and acceptability as well as its impact at a number of levels within the organisation. The findings of the study have been used to inform the on-going development of the toolkit within the Trust.

Department/centre contact details Professor Ann McDonnell Phone: 0114 225 2439 Email: [email protected]

‘Evaluating the usefulness and acceptability of the clinical assurance toolkit’


Evaluation of the clinical assurance toolkit at Sheffield Teaching Hospitals NHS Foundation Trust


Researchers from Sheffield Hallam University provided data collection and capture services as part of a study to identify the degree of support for an extension of the screening programme which tests for five serious conditions in new babies.

The School of Health and Related Research (SchARR) at the University of Sheffield engaged the team from Sheffield Hallam to carry out and report on 160 face to face interviews between November 2009 and February 2010 to help assess public support for additional tests which would screen for:

• maple syrup urine disease

• homocystinuria

• glutaric acidaemia (type 1)

• isovaleric acidaemia

• Long chain fatty acidaemia

The existing screening test is done through taking a pinprick blood sample from the baby’s heel in the first week of life and has been used to test for five serious conditions. The same sample can be used to test for the additional five conditions.

The pilot study found that only 10 respondents from 160 (6.3%) stated that they would choose not to have the expanded screening, indicating a high level of support for the screening even allowing for the possibility of false positive results.

These findings encouraged healthcare organisations to look into offering an extension of the current neonatal screening programme and an extended pilot scheme is now running in five areas (Sheffield, Leeds, Manchester, Birmingham and parts of London).

This one year programme, which began in July 2012, is funded by the National Institute of Health Research which is providing £600,000 to researchers based at Sheffield Children’s NHS Foundation Trust. The results will be evaluated after a year and considered by the UK National Screening Committee.



Neonatal screening

‘More than 400,000 babies will be screened for debilitating, rare inherited conditions as part of a ground breaking pilot to see if more rare illnesses can be identified early on and get babies the best treatment possible so they stand a good chance of leading long, happy lives’ (Department of Health, 2012)


A team from Sheffield Hallam University’s Centre for Health and Social Care Research carried out an evaluation of the Health Trainer Service (HTS) for Wakefield District Primary Care Team between November 2009 and November 2010.

The evaluation consisted of four phases:

• data from the National HT Data Collection Reporting System (DCRS) was used to illustrate the service provision

• a focus group was held with clients who had experience of the HTS with the aim of exploring the perceptions and views of the service and to inform the development of the questionnaire

• a questionnaire survey was produced to inform a wider evaluation of the HTS

• health trainers and clients were interviewed to illustrate the working of the service and a number of recommendations were made to enhance service delivery and improve outcomes.

The aim of this project was to generate a combination of qualitative and quantitative data to inform the on-going development of the Health Trainer Service (HTS) within Wakefield District Community Health Service. There was a particular emphasis on the views not only of health trainers but also of service users for whom the service had worked or had been less successful.

A number of different sources of opinion and experience were called upon in order to make improvements to the way in which the Health Trainer Service in Wakefield operates. Through the focus groups with clients who had used the service, as well as questionnaires and interviews with health trainers, it was possible to pass these observations and suggestions for improvements on to Wakefield District Community Health Service.

Department/centre contact details Sheila Harford Phone: 01142255854 Email: [email protected]

Evaluation of the Health Trainer Service in Wakefield

‘Wakefield’s Health Trainers provide support and motivation to people in the city who want to make healthy lifestyle changes’



CLAHRC SY commissioned researchers from Sheffield Hallam University’s Centre for Health and Social Care Research (CHSCR) to explore the rehabilitation and weight management experiences of stroke survivors under 70 years of age in the South Yorkshire area. The project aimed to identify whether weight gain is a problem for some people following a stroke and, if so, what factors contribute to weight gain. It also explored what potential services could prevent weight gain and be accessible to people after a stroke.

Running from January-March 2013, the study aimed to:

• provide insight into additional services and interventions for stroke patients

• make recommendations for appropriate methods of giving behaviour change information to patients following a stroke

• raise awareness of the support needs of patients for service providers and commissioners.

The incidence of strokes is higher in obese people with high blood pressure or diabetes. Guidelines advise weight reduction following a stroke. Poor lifestyle behaviours prior to a stroke may worsen long term outcomes and impact on rehabilitation. Therefore modification of health behaviour can be crucial in stroke rehabilitation and in preventing avoidable long term problems. Stroke rehabilitation is acknowledged as being crucial to maximising

quality of life, independence, and good well-being for individuals and their carers following a stroke. The wider costs of a stroke are approximately £7 billion per year, with £2.8 billion of this picked up by the NHS.

This project laid the foundations needed for a future external bid funding bid to support larger scale research in this important area. The research team collected information from interviews, surveys and interviews with staff in order to formulate an argument for future funding.

The study also provided recommendations for the development of and improvements to pathways and referral routes to existing services to facilitate patient-focused care and improve patient experience as well as impacting on health care costs.

Department/centre contact details Catherine Homer Phone: 0114 225 5815 E-mail: [email protected]

150,000 people have a stroke in the UK each year. Strokes are the third leading cause of death in developed countries and are the leading cause of long term disability’


Preventing weight gain following stroke


Researchers from Sheffield Hallam University were commissioned to evaluate the impact of the on-ward volunteer initiative which was launched in Sheffield Teaching Hospitals (STH) in November 2011 as a one-year pilot project.

The research aimed to:

• help STH appraise the effectiveness of the programme

• recommend any necessary changes

• inform future decisions about rolling out the initiative to other areas.

Volunteers recruited and trained by RVS worked with a Dementia Nurse Specialist (DNS) employed by Sheffield Teaching Hospitals to provide support to patients through a number of activities including befriending, diversional therapy, companionship, reading, support with eating and drinking and supervised mobility and recreational visits within the hospital, as well as supporting carers and providing respite time.

The findings of the research will be used by both Sheffield Teaching Hospitals and RVS to inform further development of the service within the organisation. The evaluation will also be used to inform a wider roll out of the initiative by RVS within other organisations on a national basis.

Department/centre contact details Professor Ann McDonnell Phone: 0114 225 2439 E-mail: [email protected]

‘Volunteers from the Royal Voluntary Service (previously the Women’s Royal Voluntary Service – WRVS) have been working at Sheffield’s Northern General Hospital to help improve the experience of patients with dementia.’


An evaluation of the on-ward volunteer initiative at Sheffield Teaching Hospitals NHS Foundation Trust

research profile clinical practice

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