Candy McCabe - Academia.edu (original) (raw)
Papers by Candy McCabe
Schematic depiction of the draft STAR trial intervention. (DOCX 39Â kb)
Journal of Clinical Nursing, 2020
IntroductionManagement of rheumatoid arthritis has changed dramatically over the last decade and ... more IntroductionManagement of rheumatoid arthritis has changed dramatically over the last decade and is characterised by early start of intensive treatment and tight monitoring of disease activity until remission. The role of nurse‐led care at early stage of disease is not well understood.AimsTo develop an understanding of rheumatology nurse‐led care from the perspective of patients with early rheumatoid arthritis.MethodsA systematic review of qualitative studies, reported in line with PRISMA checklist. In March 2019, the following databases were searched: MEDLINE, EMBASE, CINAHL, PsycINFO and OpenGrey. Studies were included if they: included adults with rheumatoid arthritis; were qualitative studies with data on patients’ perspectives of nurse‐led care; and published in peer‐reviewed journals, in English, between 2010–2019. Due to few studies in early rheumatoid arthritis, inclusion was extended to adults with established rheumatoid arthritis. Two reviewers screened abstracts and full ...
Trials, Jan 23, 2018
Approximately 20% of people who have total knee replacement experience chronic pain afterwards, b... more Approximately 20% of people who have total knee replacement experience chronic pain afterwards, but there is little evidence about effective interventions for managing this type of pain. This article describes the systematic development and refinement of a complex intervention for people with chronic pain after knee replacement. The intervention is a care pathway involving an assessment clinic and onward referral, with telephone follow-up as required. In the design of this multistage study, we chose to focus on ensuring that the intervention was deliverable, implementable and acceptable. In line with the UK Medical Research Council's recommendations for comprehensive development of complex interventions, multiple phases of work were undertaken. Following on from initial development work to design the intervention, the draft intervention content was refined through consensus questionnaires with 22 health professionals and discussion at meetings with 18 healthcare professionals. T...
Trials, Jan 21, 2018
Approximately 20% of patients experience chronic pain after total knee replacement. There is litt... more Approximately 20% of patients experience chronic pain after total knee replacement. There is little evidence for effective interventions for the management of this pain, and current healthcare provision is patchy and inconsistent. Given the complexity of this condition, multimodal and individualised interventions matched to pain characteristics are needed. We have undertaken a comprehensive programme of work to develop a care pathway for patients with chronic pain after total knee replacement. This protocol describes the design of a randomised controlled trial to evaluate the clinical- and cost-effectiveness of a complex intervention care pathway compared with usual care. This is a pragmatic two-armed, open, multi-centred randomised controlled trial conducted within secondary care in the UK. Patients will be screened at 2 months after total knee replacement and 381 patients with chronic pain at 3 months postoperatively will be recruited. Recruitment processes will be optimised throu...
Musculoskeletal care, Jan 15, 2015
UK guidelines indicate that individuals with complex regional pain syndrome (CRPS) require inform... more UK guidelines indicate that individuals with complex regional pain syndrome (CRPS) require information and education to support self-management. The present qualitative study explored the specific information requirements of patients with CRPS and provides insight into how health professionals can best provide this. Following informed consent, eight semi-structured telephone interviews were conducted with adults living with CRPS. Participants were asked about their experience of receiving information since diagnosis and the information that they would prefer to receive. Interviews were transcribed and data analysed using thematic analysis. Two themes related to individuals' experience of receiving information. These were: 'Facing the unknown', which describes how participants reported that little information was available and the impact of this; and 'The need to be an expert', which describes how they needed to be proactive to seek this information themselves. Th...
British Journal of Nursing, 2015
Thus, there is a need to change the nursing culture to one where nurses feel valued, an approach ... more Thus, there is a need to change the nursing culture to one where nurses feel valued, an approach NICE (2015) recommends line managers should adopt. A low level of wellbeing in a few workforce members can adversely influence the wellbeing of colleagues, and it is likely that the opposite is also true. Praise is effective in changing unwanted behaviours and encouraging and sustaining positive behaviours and attitudes. There is a strong correlation between telling someone that they have done something well and them repeating that behaviour in future (Golawski, 2015). Given the requirement for evidence-based practice and nurses’ despondency about opportunities for career progression, it is surprising that the NICE (2015) guidance does not recommend the provision of support to nurses who wish to study for higher degrees or undertake research. Clinical areas have busy workloads and staff are challenged to find the time or resources to study or undertake research, in today’s financial climate. When nurses have the opportunity to get involved in research, it can be problematic getting managerial support and acquiring resources to backfill posts. Clinical areas with a strong research culture will support nurses to deliver evidence-based care and contribute to the generation of evidence. A main aim of the NICE guideline is to promote leadership in the work environment; effective leaders who are role models and encourage ‘creativity, new ideas and exploring new ways of doing things and opportunities to learn’ (NICE, 2015). Nurses who are given the opportunity to engage in further study or research are likely to be more confident, motivated, engaged and happier at work. These outcomes will have a positive impact on nursing care, the health and wellbeing of patients, including lower levels of mortality (Dixon-Woods et al, 2014) and higher patient satisfaction, and may aid staff retention. I n June 2015, the National Institute for Health and Care Excellence (NICE) published a new guideline that makes recommendations on improving the health and wellbeing of employees, particularly focusing on culture, context and the role of the line manager. Wellbeing is complex, subjective in nature, multi-dimensional and difficult to define (Dodge et al, 2012). There are many conceptual elements (e.g. happiness, psychological functioning, satisfaction with life, positive relationships, personal beliefs, physical health) that constitute wellbeing. The wellbeing of nurses is an important issue in relation to patient care as there is believed to be a positive association between wellbeing, job satisfaction and job performance (Bryson et al, 2014). The Francis Report included evidence of serious failings and unacceptable levels of patient care, with issues of poor workplace culture and lack of leadership featuring prominently in the report (Francis, 2013). In response to many reports criticising nursing, midwifery and care giving, guidelines for nurses were developed concerning the importance of compassionate care and putting the patient first (Department of Health, 2012). While there is recognition that compassionate care promotes the wellbeing of patients and improves the quality of their experience, there is a need to ensure that nurses, too, experience care from employers and others through being recognised for accomplishments and supported by team members (Royal College of Nursing (RCN), 2013a). In 2007, nursing morale was reported to be at a 10-year low (Ball and Pike, 2007). Six years later, this appeared to have worsened with increased despondency about a lack of opportunities to undertake training and limited career progression. Worryingly, 31% of nurses surveyed reported being bullied or harassed by a team member or manager in the previous 12 months (RCN, 2013b). Low morale in nursing may also be linked to the continual poor representation of nursing in the press. Sub-optimal nursing care is widely reported, but the excellent nursing care that most nurses provide on a day-to-day basis is recognised much less. Nurses are required to raise any concerns they may have about the level of patient care, including issues about colleagues’ performance (Nursing and Midwifery Council, 2015). However, it would surely be beneficial to the health and wellbeing of the workforce if they were also encouraged to recognise and acknowledge good nursing care, which would Valuing the workforce: staff wellbeing and patient care
British Journal of Nursing, 2015
British journal of nursing (Mark Allen Publishing), Jan 14, 2015
Disability and rehabilitation, Jan 28, 2015
Patient-led therapy, in which patients work outside therapy sessions without direct supervision, ... more Patient-led therapy, in which patients work outside therapy sessions without direct supervision, is a possible way to increase the amount of therapy stroke patients' receive without increasing staff demands. Here, we report patients' views of patient-led mirror therapy and lower limb exercises. 94 stroke survivors with upper and lower limb limitations at least 1-week post-stroke undertook 4 weeks of daily patient-led mirror therapy or lower limb exercise, then completed questionnaires regarding their experience and satisfaction. A convenience random sample of 20 participants also completed a semi-structured telephone interview to consider their experience in more detail and to capture their longer term impressions. Participants were generally positive about patient-led therapy. About 71% found it useful; 68% enjoyed it; 59% felt it "worked" and 88% would recommend it to other patients. Exercise was viewed more positively than the mirror therapy. Difficulties includ...
Oxford Medicine Online, 2013
Pain and fatigue are the prominent problems for those with a rheumatic disease, and are often und... more Pain and fatigue are the prominent problems for those with a rheumatic disease, and are often underestimated by clinicians. Symptoms may fluctuate in quality and intensity over time and commonly will vary over the course of a day. For pain, clinical signs and symptoms will be dependent on the source of the pain and whether causative underlying pathology is identifiable or not. Fatigue may range from mild effects to total exhaustion and may include cognitive and emotional elements, with a complex, probably multicausal, pathway. Theoretical knowledge of potential mechanistic pathways for pain and fatigue should be used to inform assessment and treatment approaches. Best practice recommends a multidisciplinary and holistic treatment approach with the patient an active participant in the planning of their care, and self-management. Many patients with chronic musculoskeletal conditions will not achieve a pain-free or fatigue-free status. Medication use must therefore balance potential be...
Musculoskeletal Care, 2011
To identify the information needs of patients newly diagnosed with systemic lupus erythematosus (... more To identify the information needs of patients newly diagnosed with systemic lupus erythematosus (lupus), to inform the design of a future education package. Focus groups were conducted in seven rheumatology centres in the UK with 43 purposively selected participants. Data were subjected to thematic inductive analysis. The first major theme, 'Impact of early information', describes how for many individuals information was scant and, as most had little prior knowledge of lupus, the information was difficult to absorb, leaving them with feelings of fear and confusion. 'Information received versus information sought' (theme 2) describes how few participants felt they had received clear, consistent information. For most, information was felt to be insufficient, forcing them to seek it elsewhere, which, if unsuitable, resulted in further distress. 'Early education needs' (theme 3) reflects that patients would rather be informed of potential problems than remain naïve. Patients felt that receiving a comprehensive information pack as an adjunct to verbal information from their clinician would be helpful, along with rapid access to knowledgeable professionals when they were ready to ask questions about their lupus. Participants stated information and support currently provided at diagnosis is inadequate for their needs. They would like detailed information, provided through a variety of formats. Crucially this should be supported by professionals and available at whatever point in the patient's journey they want to access such discussions .The challenge is for health professionals to meet these needs in the most beneficial and cost effective way.
Musculoskeletal Care, 2013
Journal of Hand Surgery (European Volume), 2013
European Journal of Pain Supplements, 2011
European Journal of Pain, 2009
a total energy delivery of 32 J/cm2 at each point. Pain intensity was assessed on a 100mm visual ... more a total energy delivery of 32 J/cm2 at each point. Pain intensity was assessed on a 100mm visual analogue scale (VAS). The lumbar range of motion was measured by fingertip-to-floor method. Results for both methods were recorded before, immediately, 4, 8, 12 and 24 weeks after the treatment. Results: Immediately after LLLT the mean VAS dropped from 78 to 66mm in G1, but increased up to 76mm after 24 weeks (P> 0.05). VAS dropped from 80 to 48mm in G2 and increased to 60mm after 24 weeks but the difference was significant (P < 0.0001). The mean of fingertips and floor distance was decreased immediately in G2 from 41 to 15 cm compared to a decrease from 44 to 35 cms in G1. Six months after the treatments, forward flexion of the lumbar spine improvement remained stable between the assessments in patients exposed to prayers. All changes were significantly in favour of G2. Conclusion: The addition of silent prayers to one session of laser acupuncture resulted in a significant improvement in functional and symptomatic outcomes in this group of patients with CLBP even after 24 weeks follow up.
Schematic depiction of the draft STAR trial intervention. (DOCX 39Â kb)
Journal of Clinical Nursing, 2020
IntroductionManagement of rheumatoid arthritis has changed dramatically over the last decade and ... more IntroductionManagement of rheumatoid arthritis has changed dramatically over the last decade and is characterised by early start of intensive treatment and tight monitoring of disease activity until remission. The role of nurse‐led care at early stage of disease is not well understood.AimsTo develop an understanding of rheumatology nurse‐led care from the perspective of patients with early rheumatoid arthritis.MethodsA systematic review of qualitative studies, reported in line with PRISMA checklist. In March 2019, the following databases were searched: MEDLINE, EMBASE, CINAHL, PsycINFO and OpenGrey. Studies were included if they: included adults with rheumatoid arthritis; were qualitative studies with data on patients’ perspectives of nurse‐led care; and published in peer‐reviewed journals, in English, between 2010–2019. Due to few studies in early rheumatoid arthritis, inclusion was extended to adults with established rheumatoid arthritis. Two reviewers screened abstracts and full ...
Trials, Jan 23, 2018
Approximately 20% of people who have total knee replacement experience chronic pain afterwards, b... more Approximately 20% of people who have total knee replacement experience chronic pain afterwards, but there is little evidence about effective interventions for managing this type of pain. This article describes the systematic development and refinement of a complex intervention for people with chronic pain after knee replacement. The intervention is a care pathway involving an assessment clinic and onward referral, with telephone follow-up as required. In the design of this multistage study, we chose to focus on ensuring that the intervention was deliverable, implementable and acceptable. In line with the UK Medical Research Council's recommendations for comprehensive development of complex interventions, multiple phases of work were undertaken. Following on from initial development work to design the intervention, the draft intervention content was refined through consensus questionnaires with 22 health professionals and discussion at meetings with 18 healthcare professionals. T...
Trials, Jan 21, 2018
Approximately 20% of patients experience chronic pain after total knee replacement. There is litt... more Approximately 20% of patients experience chronic pain after total knee replacement. There is little evidence for effective interventions for the management of this pain, and current healthcare provision is patchy and inconsistent. Given the complexity of this condition, multimodal and individualised interventions matched to pain characteristics are needed. We have undertaken a comprehensive programme of work to develop a care pathway for patients with chronic pain after total knee replacement. This protocol describes the design of a randomised controlled trial to evaluate the clinical- and cost-effectiveness of a complex intervention care pathway compared with usual care. This is a pragmatic two-armed, open, multi-centred randomised controlled trial conducted within secondary care in the UK. Patients will be screened at 2 months after total knee replacement and 381 patients with chronic pain at 3 months postoperatively will be recruited. Recruitment processes will be optimised throu...
Musculoskeletal care, Jan 15, 2015
UK guidelines indicate that individuals with complex regional pain syndrome (CRPS) require inform... more UK guidelines indicate that individuals with complex regional pain syndrome (CRPS) require information and education to support self-management. The present qualitative study explored the specific information requirements of patients with CRPS and provides insight into how health professionals can best provide this. Following informed consent, eight semi-structured telephone interviews were conducted with adults living with CRPS. Participants were asked about their experience of receiving information since diagnosis and the information that they would prefer to receive. Interviews were transcribed and data analysed using thematic analysis. Two themes related to individuals' experience of receiving information. These were: 'Facing the unknown', which describes how participants reported that little information was available and the impact of this; and 'The need to be an expert', which describes how they needed to be proactive to seek this information themselves. Th...
British Journal of Nursing, 2015
Thus, there is a need to change the nursing culture to one where nurses feel valued, an approach ... more Thus, there is a need to change the nursing culture to one where nurses feel valued, an approach NICE (2015) recommends line managers should adopt. A low level of wellbeing in a few workforce members can adversely influence the wellbeing of colleagues, and it is likely that the opposite is also true. Praise is effective in changing unwanted behaviours and encouraging and sustaining positive behaviours and attitudes. There is a strong correlation between telling someone that they have done something well and them repeating that behaviour in future (Golawski, 2015). Given the requirement for evidence-based practice and nurses’ despondency about opportunities for career progression, it is surprising that the NICE (2015) guidance does not recommend the provision of support to nurses who wish to study for higher degrees or undertake research. Clinical areas have busy workloads and staff are challenged to find the time or resources to study or undertake research, in today’s financial climate. When nurses have the opportunity to get involved in research, it can be problematic getting managerial support and acquiring resources to backfill posts. Clinical areas with a strong research culture will support nurses to deliver evidence-based care and contribute to the generation of evidence. A main aim of the NICE guideline is to promote leadership in the work environment; effective leaders who are role models and encourage ‘creativity, new ideas and exploring new ways of doing things and opportunities to learn’ (NICE, 2015). Nurses who are given the opportunity to engage in further study or research are likely to be more confident, motivated, engaged and happier at work. These outcomes will have a positive impact on nursing care, the health and wellbeing of patients, including lower levels of mortality (Dixon-Woods et al, 2014) and higher patient satisfaction, and may aid staff retention. I n June 2015, the National Institute for Health and Care Excellence (NICE) published a new guideline that makes recommendations on improving the health and wellbeing of employees, particularly focusing on culture, context and the role of the line manager. Wellbeing is complex, subjective in nature, multi-dimensional and difficult to define (Dodge et al, 2012). There are many conceptual elements (e.g. happiness, psychological functioning, satisfaction with life, positive relationships, personal beliefs, physical health) that constitute wellbeing. The wellbeing of nurses is an important issue in relation to patient care as there is believed to be a positive association between wellbeing, job satisfaction and job performance (Bryson et al, 2014). The Francis Report included evidence of serious failings and unacceptable levels of patient care, with issues of poor workplace culture and lack of leadership featuring prominently in the report (Francis, 2013). In response to many reports criticising nursing, midwifery and care giving, guidelines for nurses were developed concerning the importance of compassionate care and putting the patient first (Department of Health, 2012). While there is recognition that compassionate care promotes the wellbeing of patients and improves the quality of their experience, there is a need to ensure that nurses, too, experience care from employers and others through being recognised for accomplishments and supported by team members (Royal College of Nursing (RCN), 2013a). In 2007, nursing morale was reported to be at a 10-year low (Ball and Pike, 2007). Six years later, this appeared to have worsened with increased despondency about a lack of opportunities to undertake training and limited career progression. Worryingly, 31% of nurses surveyed reported being bullied or harassed by a team member or manager in the previous 12 months (RCN, 2013b). Low morale in nursing may also be linked to the continual poor representation of nursing in the press. Sub-optimal nursing care is widely reported, but the excellent nursing care that most nurses provide on a day-to-day basis is recognised much less. Nurses are required to raise any concerns they may have about the level of patient care, including issues about colleagues’ performance (Nursing and Midwifery Council, 2015). However, it would surely be beneficial to the health and wellbeing of the workforce if they were also encouraged to recognise and acknowledge good nursing care, which would Valuing the workforce: staff wellbeing and patient care
British Journal of Nursing, 2015
British journal of nursing (Mark Allen Publishing), Jan 14, 2015
Disability and rehabilitation, Jan 28, 2015
Patient-led therapy, in which patients work outside therapy sessions without direct supervision, ... more Patient-led therapy, in which patients work outside therapy sessions without direct supervision, is a possible way to increase the amount of therapy stroke patients' receive without increasing staff demands. Here, we report patients' views of patient-led mirror therapy and lower limb exercises. 94 stroke survivors with upper and lower limb limitations at least 1-week post-stroke undertook 4 weeks of daily patient-led mirror therapy or lower limb exercise, then completed questionnaires regarding their experience and satisfaction. A convenience random sample of 20 participants also completed a semi-structured telephone interview to consider their experience in more detail and to capture their longer term impressions. Participants were generally positive about patient-led therapy. About 71% found it useful; 68% enjoyed it; 59% felt it "worked" and 88% would recommend it to other patients. Exercise was viewed more positively than the mirror therapy. Difficulties includ...
Oxford Medicine Online, 2013
Pain and fatigue are the prominent problems for those with a rheumatic disease, and are often und... more Pain and fatigue are the prominent problems for those with a rheumatic disease, and are often underestimated by clinicians. Symptoms may fluctuate in quality and intensity over time and commonly will vary over the course of a day. For pain, clinical signs and symptoms will be dependent on the source of the pain and whether causative underlying pathology is identifiable or not. Fatigue may range from mild effects to total exhaustion and may include cognitive and emotional elements, with a complex, probably multicausal, pathway. Theoretical knowledge of potential mechanistic pathways for pain and fatigue should be used to inform assessment and treatment approaches. Best practice recommends a multidisciplinary and holistic treatment approach with the patient an active participant in the planning of their care, and self-management. Many patients with chronic musculoskeletal conditions will not achieve a pain-free or fatigue-free status. Medication use must therefore balance potential be...
Musculoskeletal Care, 2011
To identify the information needs of patients newly diagnosed with systemic lupus erythematosus (... more To identify the information needs of patients newly diagnosed with systemic lupus erythematosus (lupus), to inform the design of a future education package. Focus groups were conducted in seven rheumatology centres in the UK with 43 purposively selected participants. Data were subjected to thematic inductive analysis. The first major theme, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Impact of early information&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;, describes how for many individuals information was scant and, as most had little prior knowledge of lupus, the information was difficult to absorb, leaving them with feelings of fear and confusion. &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Information received versus information sought&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (theme 2) describes how few participants felt they had received clear, consistent information. For most, information was felt to be insufficient, forcing them to seek it elsewhere, which, if unsuitable, resulted in further distress. &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Early education needs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (theme 3) reflects that patients would rather be informed of potential problems than remain naïve. Patients felt that receiving a comprehensive information pack as an adjunct to verbal information from their clinician would be helpful, along with rapid access to knowledgeable professionals when they were ready to ask questions about their lupus. Participants stated information and support currently provided at diagnosis is inadequate for their needs. They would like detailed information, provided through a variety of formats. Crucially this should be supported by professionals and available at whatever point in the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s journey they want to access such discussions .The challenge is for health professionals to meet these needs in the most beneficial and cost effective way.
Musculoskeletal Care, 2013
Journal of Hand Surgery (European Volume), 2013
European Journal of Pain Supplements, 2011
European Journal of Pain, 2009
a total energy delivery of 32 J/cm2 at each point. Pain intensity was assessed on a 100mm visual ... more a total energy delivery of 32 J/cm2 at each point. Pain intensity was assessed on a 100mm visual analogue scale (VAS). The lumbar range of motion was measured by fingertip-to-floor method. Results for both methods were recorded before, immediately, 4, 8, 12 and 24 weeks after the treatment. Results: Immediately after LLLT the mean VAS dropped from 78 to 66mm in G1, but increased up to 76mm after 24 weeks (P> 0.05). VAS dropped from 80 to 48mm in G2 and increased to 60mm after 24 weeks but the difference was significant (P < 0.0001). The mean of fingertips and floor distance was decreased immediately in G2 from 41 to 15 cm compared to a decrease from 44 to 35 cms in G1. Six months after the treatments, forward flexion of the lumbar spine improvement remained stable between the assessments in patients exposed to prayers. All changes were significantly in favour of G2. Conclusion: The addition of silent prayers to one session of laser acupuncture resulted in a significant improvement in functional and symptomatic outcomes in this group of patients with CLBP even after 24 weeks follow up.