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Papers by Trevor Murrells

BMC Health Services Research, 2010

Background: Delivering good quality primary care for patients with chronic conditions has the pot... more Background: Delivering good quality primary care for patients with chronic conditions has the potential to reduce non-elective hospital admissions. Practice nurse staffing levels in England have been linked to attainment of general practice performance targets for some chronic conditions. The aim of this study was to examine whether practice nurse staffing level is similarly associated with non-elective hospital admissions in three clinical areas: asthma, Chronic Obstructive Pulmonary Disease (COPD) and diabetes. Methods: This observational study used cross sectional analysis of routinely collected data. Hospital admissions data for the period 2005-2006 (for asthma, COPD and diabetes) were linked with a database of practice characteristics, nurse staffing data and data on population characteristics for the same period. Statistical modelling explored the relationship between non-elective hospital admission rates for the three conditions and the list size per full time equivalent (FTE) practice nurse. Results: Higher practice nurse staffing levels were significantly associated with lower rates of admission for asthma (p < 0.001) and COPD (p < 0.001). A similar association was seen for patients with two or more admissions (p < 0.05 for asthma and p < 0.001 for COPD). For diabetes, higher practice nurse staffing level was significantly associated with higher admission rates (p < 0.05), but this association was not significant in case of patients with two or more admissions. Across all models, increasing deprivation was associated with higher admission rates for all conditions. Conclusions: The inconsistent relationship between nurse staffing and patient outcomes across the different conditions and the fact that for diabetes the relationship between staffing and outcomes was in a different direction from the association between staffing and care quality, highlights the need to avoid making a simple causal interpretation of these findings and reduces the possible confidence in such conclusions. There is a need for more research into the organisation and delivery of diabetes care services in general practice, preferably using patient level data; in order to better understand the impact of the different staffing configurations on patient outcomes.

BMC Nursing, 2008

Background Job satisfaction is an important component of nurses' lives that can impact on pat... more Background Job satisfaction is an important component of nurses' lives that can impact on patient safety, productivity and performance, quality of care, retention and turnover, commitment to the organisation and the profession. Little is known about job satisfaction in early career and how it varies for different groups of nurses. This paper investigates how the components of job satisfaction vary during early career in newly qualified UK nurses. Methods Nurses were sampled using a combined census and multi-stage approach (n = 3962). Data were collected by questionnaire at 6 months, 18 months and 3 years after qualification between 1998 and 2001. Scores were calculated for seven job satisfaction components and a single item that measured satisfaction with pay. Scores were compared longitudinally and between nursing speciality (general, children's, mental health) using a mixed model approach. Results No single pattern across time emerged. Trends varied by branch and job satis...

International Journal of Nursing Studies, 2020

, A comparison between independent nurse prescribing and patient group directions in the safety a... more , A comparison between independent nurse prescribing and patient group directions in the safety and appropriateness of medication provision in United Kingdom sexual health services: a mixed methods study,

Health Services and Delivery Research, 2014

BackgroundThe performance of maternity services is seen as a touchstone of whether or not we are ... more BackgroundThe performance of maternity services is seen as a touchstone of whether or not we are delivering high-quality NHS care. Staffing has been identified in numerous reports as being a critical component of safe, effective, user-centred care. There is little evidence regarding the impact of maternity workforce staffing and skill mix on the safety, quality and cost of maternity care in the UK.ObjectivesTo understand the relationship between organisational factors, maternity workforce staffing and skill mix, cost and indicators of safe and high-quality care.Design and methodsData included Hospital Episode Statistics (HES) from 143 NHS trusts in England in 2010–11 (656,969 delivery records), NHS Workforce Statistics, England, 2010–11, Care Quality Commission Maternity Survey of women’s experiences 2010 and NHS reference costs 2010/11. Ten indicators were derived from HES data. They included healthy mother and healthy baby outcomes and mode of birth. Adjustments were made for back...

The Lancet Diabetes & Endocrinology, 2018

Research involvement among registered dietitians (RDs) is important in advancing dietetics practi... more Research involvement among registered dietitians (RDs) is important in advancing dietetics practice and ensuring high-quality and cost-effective health care. There are no standardized approaches to measuring levels of research involvement. The aim of the study was to develop a standardized measure of research involvement and test its validity and reliability among RDs. The Research Involvement Questionnaire (RIQ) was developed and underwent content validation, resulting in a content validity index of 0.92. A postal questionnaire survey of RDs was undertaken at two time points. RDs were purposively selected and, based on their number of publications and grants, were assigned by the authors to one of four levels of research involvement: evidence-based practice, collaborating on research, leading research, and leadership in research. Of 192 questionnaires mailed, 111 RDs (58%) returned the first RIQ, of whom 82 (74%) also returned the second RIQ. Total scores and scores for each level ...

Journal of Advanced Nursing

Nutrition and Cancer

BACKGROUND AND AIM Over 21,000 new cases of gynecological cancer are diagnosed annually in the Un... more BACKGROUND AND AIM Over 21,000 new cases of gynecological cancer are diagnosed annually in the United Kingdom. There is evidence of cancer patients altering their eating habits before and during treatment. Some women with gynecological cancer make conscious decisions to change their diet as self-management for their cancer symptoms and to adopt a healthier lifestyle. Little is known about the impact of treatment on dietary habits. This study aimed to identify and describe the dietary habits of women with gynecological cancer before, during and after treatment. METHODS This was a longitudinal prospective cohort study using seven-day food diaries to collect dietary intake data before treatment and up to two years after gynecological cancer treatment. Nutritics© software was used for analysis of the diaries. A general linear mixed model was used for the statistical analysis, adjusted for multiple comparisons. RESULTS 15 women with gynecological cancer participated; 69 food diaries were analyzed. There were no statistically significant changes in dietary habits or weight for this cohort during the two-year follow-up, except for caffeine intake which increased at 2 years (p < 0.05). CONCLUSIONS Despite the importance of maintaining a healthy dietary intake and weight after cancer treatment, participants' diets did not change.

Journal of Advanced Nursing

Abstract Aims To describe the characteristics of medication administration (MA) incidents reporte... more Abstract Aims To describe the characteristics of medication administration (MA) incidents reported to have occurred in patients’ own homes (reporters’ profession, incident types, contributing factors, patient consequence, and most common medications involved) and to identify the connection terms related to the most common contributing factors based on free text descriptions. Design A retrospective study using descriptive statistical analysis and text mining. Methods Medication administration incidents (N = 19,725) reported to have occurred in patients’ homes between 2013–2018 in one district in Finland were analysed, describing the data by the reporters’ occupation, incident type, contributing factors, and patient consequence. SAS® Text Miner was used to analyse free text descriptions of the MA incidents to understand contributing factors, using concept linking. Results Most MA incidents were reported by practical (lower level) nurses (77.8%, N = 15,349). The most common category of harm was ‘mild harm’ (40.1%, N = 7,915) and the most common error type was omissions of drug doses (47.4%, N = 9,343). The medications most commonly described were Marevan [warfarin] (N = 2,668), insulin (N = 811), Furesis [furosemide] (N = 590), antibiotic (N = 446), and Panadol [paracetamol] (N = 416). The contributing factors most commonly reported were ‘communication and flow of information’ (25.5%, N = 5,038), ‘patient and relatives’ (22.6%, N = 4,451), ‘practices’ (9.9%, N = 1,959), ‘education and training’ (4.8%, N = 949), and ‘work environment and resources’ (3.0%, N = 598). Conclusion There is need for effective communication and clear responsibilities between home care patients and their relatives and health providers, about MA and its challenges in home environments. Knowledge and skills relating to safe MA are also essential. Impact These findings about MA incidents that have occurred in patients’ homes and have been reported by home care professionals demonstrate the need for medication safety improvement in home care.

Social Science Protocols

There is a complex relationship between social media use and mental health outcomes. To explore t... more There is a complex relationship between social media use and mental health outcomes. To explore this complexity and understand how social media influence adolescent mental health, a two-phase, explanatory sequential mixed-method study will be conducted. Firstly, the quantitative phase will involve surveying a healthy sample of 400 adolescents attending secondary schools in the UK (n=200) and Turkey (n=200). We will use the survey to investigate the moderating effect of relational orientation in a cross-sectional study, in which participants will be selected from secondary schools in Portsmouth, United Kingdom and Kayapinar, Diyarbakir, Turkey. Secondly, the qualitative phase will involve interviewing a mixed sample of 10-12 clinical and non-clinical adolescents in London. In these interviews, we will explore key quantitative findings in more detail, for example, how and why adolescents use social media and the role of social media in the development and maintenance of mental health ...

BMC Health Services Research, 2010

Background: Delivering good quality primary care for patients with chronic conditions has the pot... more Background: Delivering good quality primary care for patients with chronic conditions has the potential to reduce non-elective hospital admissions. Practice nurse staffing levels in England have been linked to attainment of general practice performance targets for some chronic conditions. The aim of this study was to examine whether practice nurse staffing level is similarly associated with non-elective hospital admissions in three clinical areas: asthma, Chronic Obstructive Pulmonary Disease (COPD) and diabetes. Methods: This observational study used cross sectional analysis of routinely collected data. Hospital admissions data for the period 2005-2006 (for asthma, COPD and diabetes) were linked with a database of practice characteristics, nurse staffing data and data on population characteristics for the same period. Statistical modelling explored the relationship between non-elective hospital admission rates for the three conditions and the list size per full time equivalent (FTE) practice nurse. Results: Higher practice nurse staffing levels were significantly associated with lower rates of admission for asthma (p < 0.001) and COPD (p < 0.001). A similar association was seen for patients with two or more admissions (p < 0.05 for asthma and p < 0.001 for COPD). For diabetes, higher practice nurse staffing level was significantly associated with higher admission rates (p < 0.05), but this association was not significant in case of patients with two or more admissions. Across all models, increasing deprivation was associated with higher admission rates for all conditions. Conclusions: The inconsistent relationship between nurse staffing and patient outcomes across the different conditions and the fact that for diabetes the relationship between staffing and outcomes was in a different direction from the association between staffing and care quality, highlights the need to avoid making a simple causal interpretation of these findings and reduces the possible confidence in such conclusions. There is a need for more research into the organisation and delivery of diabetes care services in general practice, preferably using patient level data; in order to better understand the impact of the different staffing configurations on patient outcomes.

BMC Nursing, 2008

Background Job satisfaction is an important component of nurses' lives that can impact on pat... more Background Job satisfaction is an important component of nurses' lives that can impact on patient safety, productivity and performance, quality of care, retention and turnover, commitment to the organisation and the profession. Little is known about job satisfaction in early career and how it varies for different groups of nurses. This paper investigates how the components of job satisfaction vary during early career in newly qualified UK nurses. Methods Nurses were sampled using a combined census and multi-stage approach (n = 3962). Data were collected by questionnaire at 6 months, 18 months and 3 years after qualification between 1998 and 2001. Scores were calculated for seven job satisfaction components and a single item that measured satisfaction with pay. Scores were compared longitudinally and between nursing speciality (general, children's, mental health) using a mixed model approach. Results No single pattern across time emerged. Trends varied by branch and job satis...

International Journal of Nursing Studies, 2020

, A comparison between independent nurse prescribing and patient group directions in the safety a... more , A comparison between independent nurse prescribing and patient group directions in the safety and appropriateness of medication provision in United Kingdom sexual health services: a mixed methods study,

Health Services and Delivery Research, 2014

BackgroundThe performance of maternity services is seen as a touchstone of whether or not we are ... more BackgroundThe performance of maternity services is seen as a touchstone of whether or not we are delivering high-quality NHS care. Staffing has been identified in numerous reports as being a critical component of safe, effective, user-centred care. There is little evidence regarding the impact of maternity workforce staffing and skill mix on the safety, quality and cost of maternity care in the UK.ObjectivesTo understand the relationship between organisational factors, maternity workforce staffing and skill mix, cost and indicators of safe and high-quality care.Design and methodsData included Hospital Episode Statistics (HES) from 143 NHS trusts in England in 2010–11 (656,969 delivery records), NHS Workforce Statistics, England, 2010–11, Care Quality Commission Maternity Survey of women’s experiences 2010 and NHS reference costs 2010/11. Ten indicators were derived from HES data. They included healthy mother and healthy baby outcomes and mode of birth. Adjustments were made for back...

The Lancet Diabetes & Endocrinology, 2018

Research involvement among registered dietitians (RDs) is important in advancing dietetics practi... more Research involvement among registered dietitians (RDs) is important in advancing dietetics practice and ensuring high-quality and cost-effective health care. There are no standardized approaches to measuring levels of research involvement. The aim of the study was to develop a standardized measure of research involvement and test its validity and reliability among RDs. The Research Involvement Questionnaire (RIQ) was developed and underwent content validation, resulting in a content validity index of 0.92. A postal questionnaire survey of RDs was undertaken at two time points. RDs were purposively selected and, based on their number of publications and grants, were assigned by the authors to one of four levels of research involvement: evidence-based practice, collaborating on research, leading research, and leadership in research. Of 192 questionnaires mailed, 111 RDs (58%) returned the first RIQ, of whom 82 (74%) also returned the second RIQ. Total scores and scores for each level ...

Journal of Advanced Nursing

Nutrition and Cancer

BACKGROUND AND AIM Over 21,000 new cases of gynecological cancer are diagnosed annually in the Un... more BACKGROUND AND AIM Over 21,000 new cases of gynecological cancer are diagnosed annually in the United Kingdom. There is evidence of cancer patients altering their eating habits before and during treatment. Some women with gynecological cancer make conscious decisions to change their diet as self-management for their cancer symptoms and to adopt a healthier lifestyle. Little is known about the impact of treatment on dietary habits. This study aimed to identify and describe the dietary habits of women with gynecological cancer before, during and after treatment. METHODS This was a longitudinal prospective cohort study using seven-day food diaries to collect dietary intake data before treatment and up to two years after gynecological cancer treatment. Nutritics© software was used for analysis of the diaries. A general linear mixed model was used for the statistical analysis, adjusted for multiple comparisons. RESULTS 15 women with gynecological cancer participated; 69 food diaries were analyzed. There were no statistically significant changes in dietary habits or weight for this cohort during the two-year follow-up, except for caffeine intake which increased at 2 years (p < 0.05). CONCLUSIONS Despite the importance of maintaining a healthy dietary intake and weight after cancer treatment, participants' diets did not change.

Journal of Advanced Nursing

Abstract Aims To describe the characteristics of medication administration (MA) incidents reporte... more Abstract Aims To describe the characteristics of medication administration (MA) incidents reported to have occurred in patients’ own homes (reporters’ profession, incident types, contributing factors, patient consequence, and most common medications involved) and to identify the connection terms related to the most common contributing factors based on free text descriptions. Design A retrospective study using descriptive statistical analysis and text mining. Methods Medication administration incidents (N = 19,725) reported to have occurred in patients’ homes between 2013–2018 in one district in Finland were analysed, describing the data by the reporters’ occupation, incident type, contributing factors, and patient consequence. SAS® Text Miner was used to analyse free text descriptions of the MA incidents to understand contributing factors, using concept linking. Results Most MA incidents were reported by practical (lower level) nurses (77.8%, N = 15,349). The most common category of harm was ‘mild harm’ (40.1%, N = 7,915) and the most common error type was omissions of drug doses (47.4%, N = 9,343). The medications most commonly described were Marevan [warfarin] (N = 2,668), insulin (N = 811), Furesis [furosemide] (N = 590), antibiotic (N = 446), and Panadol [paracetamol] (N = 416). The contributing factors most commonly reported were ‘communication and flow of information’ (25.5%, N = 5,038), ‘patient and relatives’ (22.6%, N = 4,451), ‘practices’ (9.9%, N = 1,959), ‘education and training’ (4.8%, N = 949), and ‘work environment and resources’ (3.0%, N = 598). Conclusion There is need for effective communication and clear responsibilities between home care patients and their relatives and health providers, about MA and its challenges in home environments. Knowledge and skills relating to safe MA are also essential. Impact These findings about MA incidents that have occurred in patients’ homes and have been reported by home care professionals demonstrate the need for medication safety improvement in home care.

Social Science Protocols

There is a complex relationship between social media use and mental health outcomes. To explore t... more There is a complex relationship between social media use and mental health outcomes. To explore this complexity and understand how social media influence adolescent mental health, a two-phase, explanatory sequential mixed-method study will be conducted. Firstly, the quantitative phase will involve surveying a healthy sample of 400 adolescents attending secondary schools in the UK (n=200) and Turkey (n=200). We will use the survey to investigate the moderating effect of relational orientation in a cross-sectional study, in which participants will be selected from secondary schools in Portsmouth, United Kingdom and Kayapinar, Diyarbakir, Turkey. Secondly, the qualitative phase will involve interviewing a mixed sample of 10-12 clinical and non-clinical adolescents in London. In these interviews, we will explore key quantitative findings in more detail, for example, how and why adolescents use social media and the role of social media in the development and maintenance of mental health ...