Caroline Nicholson

Bio: Caroline Nicholson is an academic researcher from St Christopher's Hospice. The author has contributed to research in topics: Health care & Palliative care. The author has an hindex of 21, co-authored 79 publications receiving 2257 citations. Previous affiliations of Caroline Nicholson include University of Surrey & University of Queensland.

Searching for an Operational Definition of Frailty: A Delphi Method Based Consensus Statement. The Frailty Operative Definition-Consensus Conference Project

Abstract: BACKGROUND: There is no consensus regarding the definition of frailty for clinical uses. METHODS: A modified Delphi process was used to attempt to achieve consensus definition. Experts were selected from different fields and organized into five Focus Groups. A questionnaire was developed and sent to experts in the area of frailty. Responses and comments were analyzed using a pre-established strategy. Statements with an agreement more than or equal to 80% were accepted. RESULTS: Overall, 44% of the statements regarding the concept of frailty and 18% of the statements regarding diagnostic criteria were accepted. There was consensus on the value of screening for frailty and about the identification of six domains of frailty for inclusion in a clinical definition, but no agreement was reached concerning a specific set of clinical/laboratory biomarkers useful for diagnosis. CONCLUSIONS: There is agreement on the usefulness of defining frailty in clinical settings as well as on its main dimensions. However, additional research is needed before an operative definition of frailty can be established.

Capacity for care: meta-ethnography of acute care nurses' experiences of the nurse-patient relationship

Abstract: This chapter reports findings of a meta-ethnography of published qualitative research on nurses’ experiences of nurse-patient relationships in acute settings, reported in detail in Bridges et al. (2012a). Concerns are growing that modern healthcare delivery is lacking in compassion and is failing to provide the individualized care required by, for instance, older people with complex needs (Firth-Cozens and Cornwell, 2009). Promoting meaningful connections with patients in which practitioners see each patient ‘as a person to be engaged with rather than a body to do things to’ (Nicholson et al., 2010, p. 12) requires nurses and others to be able to articulate and appreciate the nature of these connections and their impact on patient outcomes, along with an understanding of the factors that can promote or inhibit therapeutic relationships. Nurses and nursing are now often portrayed as lacking in compassion and being distracted from these aspects of care (Flatley and Bridges, 2008). A range of high-profile reports in the United Kingdom into the quality of in-patient care for older people suggest that many of the reported problems centre on a lack of humanity in hospital staff, particularly nurses. While good practice does exist, we understand little about the conditions in which high-quality, compassionate in-patient care is delivered. Insight into nurses’ experiences as they engage with patients is therefore critical to understand how best to support existing good practice and to focus service improvement initiatives. This focus is of particular importance in acute settings where patient throughput, service configuration and staffing patterns reduce contact time between staff and patients. In addition, we lack understanding about how nursepatient relationships, the act of caring and engagement in therapeutic relationships impact on nurses themselves.

Capacity for care

Abstract: Aims To synthesize evidence and knowledge from published research about nurses' experiences of nurse-patient relationships with adult patients in general, acute inpatient hospital settings. Background While primary research on nurses' experiences has been reported, it has not been previously synthesized. Design Meta-ethnography. Data sources Published literature from Australia, Europe, and North America, written in English between January 1999–October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO. Review methods Qualitative studies describing nurses' experiences of the nurse-patient relationship in acute hospital settings were reviewed and synthesized using the meta-ethnographic method. Results Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients. Conclusion The findings of this meta-ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.

My Home Life: Quality of Life in Care Homes

Abstract: This report is a result of a partnership between Help the Aged, the National Care Forum and the National Care Homes Research and Development Forum in collaboration with older people and representatives from the care-home sector. Based on both research and the testimonies of service users, the My Home Life report provides a vision for improving the quality of life of care-home residents and highlights the specific practices, behaviour and attitudes which impact on their quality of life.

A systematic review of the literature

Abstract: OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002