INTRODUCTION

This handbook outlines the detail of what is expected for the final year dissertation for the BSc (Hons) Nursing degree. Areas outlined include the content and format of your dissertation, the structure of your written work and the academic standard expected including accurate referencing, the practice focus component, how to draw on the expertise of relevant clinical colleagues and the role of yourself and your supervisor during the supervision of your dissertation.

It also highlights the need for you to maintain confidentiality throughout the writing of your dissertation; which includes practice areas, Trusts and clinicians, and also that you do not break ethics rules for undertaking any primary research while you are reviewing data within your chosen clinical area.

Undertaking your dissertation is often accompanied by several challenges, however, you will be rewarded by achieving a sustained period of private study, working to improve patient care and adding to the body of nursing knowledge you hold. It may also help you make choices for your future career and help career progression if then go on to take the opportunities provided for you by the school to publish your work.

It is advisable that you either print off a hard copy of this handbook or have a permanent electronic copy to enable you to make reference to it quickly during the writing of your dissertation.

If you have any queries about your dissertation please do not hesitate to contact your dissertation supervisor in the first instance.

WHAT IS A DISSERTATION AND WHY WRITE ONE?

Your dissertation is an independent piece of work that you are required to carry out during the final year of your degree programme. It is based on wider reading and a review of the literature base, giving evidence of your own understanding and analysis of your chosen subject area. You are expected to demonstrate your ability to undertake a rigorous search strategy for relevant literature, to engage critically and analytically with the literature in your topic area and be able to apply this to clinical practice, with particular reference to service improvement to improve patient/client outcomes Your dissertation should be:

1. A piece of small scale practice focused work
2. Enjoyable to carry out
3. Organised into chapters with a contents page and accurately referenced, using the APA style of referencing, the Referencing Guide 19/20 can be found by clicking here.
4. Inclusive of personal experiences from your clinical practice as well as insights and information already available from clinical colleagues working in your chosen subject area
5. Leading to some potential change which should have a positive impact on patient care and/or experience
6. Linking theory to practice.

Dissemination of your work to a wider audience

If your work achieves a final grade of 70% or above you will be offered the Opportunity to disseminate it through University internal publication. This Dissemination will be facilitated through an agreement between you and your Supervisor.

YOUR DISSERTATION IS NOT A RESEARCH PROJECT UNDERTAKEN IN CLINICAL PRACTICE.

YOUR DISSERTATION

Dissertation Task

A 6000-word dissertation where students are required to undertake independent study to undertake a literature review, critically analyse findings and make recommendations for practice within their own field of nursing

Your dissertation is a 6000-word (+ 10%) literature review which may inform future practice. You will choose an area of nursing practice that interests you, and which relates to your field of nursing, and with the help of your dissertation supervisor and clinical colleagues; you will investigate and examine this specific field of nursing practice. The overall aim is to inform future outcomes for patients/clients/service users.

You have a broad range of perspectives from which you may wish to choose your subject area, for example nursing roles, nursing care delivery, nursing audit, nursing evaluation, nursing management, service management, nursing education/training, policy, leadership, care pathway development, service reconfiguration and patient centred care to name a few.

It must be stressed that this is a practice-focused project and not research. You will not be gathering empirical data or involving service users or doing primary research. You are required to consider the implications of your literature review for practice and make recommendations accordingly.

The Aim of this Module is to demonstrate the skills necessary to conduct a systematic search of the literature and develop critical appraisal skills in independent study to produce a dissertation that evaluates the quality and effectiveness of Nursing care within your chosen field of Nursing.

General Objectives: On completion of your dissertation you will be able to demonstrate:

• the ability to conduct an enquiry into an aspect of nursing practice by undertaking a robust , systematic and comprehensive literature review and to gather information already available from the area of clinical practice that you have chosen.

• the ability to critically appraise the methodology and outcomes of the literature sourced
• the skill of synthesising this information into some recommendations of how nursing practice may be developed for the benefit of patient/client care or services.
• academic writing skills expected of level 6 study through the presentation of an extended piece of writing.

Learning Outcomes: Students who successfully complete this dissertation will be able to:

1. Utilise a range of evidence from professional Nursing practice to identify and justify a topic area for exploration.
2. Effectively communicate and design a dissertation aim derived from the issue that relates to their own field of professional practice.
3. Undertake a structured search to identify relevant academic literature, including research, policies, guidelines and standards of professional practice.
4. Conduct a comprehensive review of the available literature and critically engage with and systematically analyse a range of relevant evidence.
5. Synthesise findings from research to evaluate the quality and effectiveness of Nursing care and provide further insight into the chosen topic area and identified issues from Nursing practice.
6. Critically analyse the implications of the findings and make recommendations for continuous service improvement in future Nursing care.

Dissertation Proposal to be submitted by Friday 7^th October 2022  (by 1 pm).

Dissertation Assignment to be submitted  Monday 29^th of May 2023 (by 1 pm)

Dissemination of your work to a wider audience

                     If your work achieves a final grade of 70% or above you will be offered the

                     Opportunity to disseminate it through University internal publication. This                   

                      Dissemination will be facilitated through an agreement between you and your

                      Supervisor.

STRUCTURE AND CONTENT OF YOUR DISSERTATION

A dissertation should be a sustained argument. This means that it should draw upon the results of your reading and appraisal of literature, thinking and information gathering in such a way that it persuades readers to accept your understanding of the topic. In other words, the main aim is to use a selection of concepts, theoretical ideas, observations, findings from the literature, guidelines and other policy documentation, and your own faculties of criticism and imagination in an attempt to reach defensive conclusions about a practice focused topic area, which may inform positive outcomes for patient/client care or service development. You are therefore encouraged to identify a clinical area in which your proposed project will be based.

Getting started

The topic area you choose should not only be broad enough to make connections with a modern arena of nursing in your field but also sufficiently narrow in focus to enable you to deal with questions in depth. Topics are best framed as questions which force you into critically exploring mode rather than being merely descriptive. For example “Current issues in privacy and dignity in the NHS” is far too broad and unfocused, but “What factors in privacy and dignity need to be addressed in mixed-sex wards to improve patient satisfaction?” is much more focused and acceptable

Writing your dissertation

The following is a guideline on how to structure your dissertation and what each chapter may include:

Title page: include the course e.g. BSc (Hons) Children’s Nursing, the title of your dissertation, your student number and name of a dissertation supervisor, the date of submission and wordage

Abstract: This is a brief summary of what your dissertation is about. It usually takes the most pertinent points from each of your sections to give a broad overview and should reference literature where applicable and grab the reader’s attention (circa 200 words – This is not included in the total word count)

Keywords: list 3-4 keywords relating to your dissertation

Acknowledgments: keep this brief but it is usual practice to list the people who have helped you to undertake and write your dissertation. This will include your dissertation supervisor and clinical colleagues, but also may include any other member of staff from the university, family or personal friend(s) who may have helped in any way. You must however abide by the university guidance on confidentiality and not give details about their role or place of work (see appendix 4). This is not included in your word count.

Contents page: to show the reader the content of the dissertation with page numbers of each chapter and a note of the word count. Prior to submitting your work make sure your page numbers correspond with the first page of each chapter

Chapter 1: Introduction: this is the chapter in which you introduce your topic area and give a rationale for why you have chosen it. You will also explain how it relates to your field of nursing, and include a summary of the main aspects of the topic area contained in your dissertation, along with the aims and objectives of your project .

Chapter 2: Literature review: You will start by outlining your search questions and then outline your search strategy which includes details of your search terms and how you formulated them using a framework such as PICO for example, if PICO is used or if they were truncated, MESH, Boolean or thesaurus terms used and in what sequence you combined the terms using OR and AND to find your articles. The inclusion and exclusion criteria used for selecting your literature should be outlined and evidence provided to support your decisions. Acknowledgement that an appraisal of the literature (using a CASP tool or other appropriate critiquing tool) and synthesis of the literature findings outlining the themes, perspectives etc and how you reached them. These can be related to local, national and international policy backdrop. You should ensure that your discussion and analysis of the findings from the literature is continually related back to the subject area of your dissertation. A data extraction table of the retrieved articles should be referred to and included in the appendix.

The critique of the literature (which may include book chapters, journal articles, policy and guidelines for example) takes place as an activity before you start writing your literature review chapter. The results of this critique are integrated into the narrative of the literature review and does NOT take the form of simply critiquing a small number of studies. The intention of the literature review is to create an eloquent explanation of the background and body of research evidence relating to your chosen subject. As stated above, this may be structured around themes, perspectives or a review of the historical development of your subject or the main themes relating to your subject.

Your literature review should flow logically and coherently so as to take the reader through your synthesis of the material in a clear, accurate and interesting manner. It should be noted that your search question should not be too broad or you may run the risk of having too large a number of final articles to critique which may be unmanageable, given the word limit for this dissertation. Therefore ensure that your initial search question is refined and concise to avoid this. You should critique ALL the relevant literature which addresses your search question and you DO NOT choose the best ones and critique them only. This does not represent a thorough literature review of your subject and does not provide you with the opportunity to demonstrate your critical and analytical skills. If you fulfil all the above this will demonstrate a thorough and structured approach to your literature search and review which is expected for a piece of work like this at level 7

Chapter 3: Recommendations for Practice: This Chapter offers you the opportunity to consider what the findings of your literature review may mean for practice. For example; Does the literature review suggest a way practice may be improved? Does the review suggest a change to some aspect of care would improve the outcomes for patients or perhaps the experience of patients or staff? It could be that your literature review provides validation for current practice illustrating that care given is based on current best available evidence.

Chapter 4: Conclusion: in this chapter you will summarise how you have achieved what you set out in your introduction. You should not be introducing any new information in your conclusion

References: using the APA referencing system as outlined in the Referencing Guidance handbook. Please note that a bibliography is not required

Appendices: this should include the data extraction table from your literature search and any other relevant information. Information included in the appendices is not included in the word count. There is an example of a data extraction table in the appendices of this handbook.

When writing your dissertation it is important to remember that it may take a few drafts of each chapter before you get to your final draft. This is a normal process so you must allow time for this and not leave it until the last minute. Once you have your topic area and search question approved then you can start by drafting out your aims and objectives of your dissertation so that you can begin to identify the search strategy that you will be using in your literature review.

After defining your aims and objectives, you will have the basis to start your literature search. The aims and objectives will provide you with the terms under which you should start to search and also which databases to utilise. A framework such as PICO(http://www.keele.ac.uk/hltutorials/informationskills/usingpico/story.html) can help to define and organise your search terms to be utilised. Once you have retrieved all the articles that are relevant to your chosen area, you must critique them in a structured way to assess their quality and content, and use a recognised framework to enable you to deduce any themes that emerge from the literature. A full critique of each article is NOT required in the body of your dissertation. It is usual practice to provide information about the data retrieved from your articles and this is easily done in a data extraction table format (See appendix 7) which can then be referred to in the text of your dissertation and placed as an appendix. Your supervisor will guide you in regard to this.

Subheadings within the chapters may be useful to guide the reader, for example to help identify any common themes that emerge from your literature. It is also useful to state clearly what you are going to write about at the beginning of each chapter and then summarise the content at the end. This keeps the reader focused and informed and aids the fluency and coherence of your dissertation.

Your standard of academic writing is crucial and you must ensure that you do not use bullet points, that you write in complete sentences and avoid short detached sentences which break the fluency and flow of the text. Your dissertation should not be written in the first person. You should also write in paragraphs of suitable length; sometimes students write one sentence and make this a single paragraph; on the other hand they might write a whole page as one paragraph. A paragraph is usually about 150 words long and conveys one stage (point) of the critical discussion or argument, which is supported by relevant literature.

SUPERVISION FOR YOUR DISSERTATION

Every student will be allocated an academic supervisor and this person is the initial point of contact for any queries that you have about your dissertation. Once you have been allocated your academic supervisor it is your responsibility to make contact and organise to meet with them. It is expected that you meet with them during the first few weeks of Part 3 and maintain sustained contact throughout the process of writing your dissertation. From experience, it is clear that students who do not maintain regular contact are likely to perform less well and more likely to be unsuccessful with this assignment.

When you meet it is your responsibility to go prepared to those meetings and have areas of discussion ready. You will be asked to complete a Supervision Meeting Action Plan (see Appendix 2) for every meeting that you have. You will be expected to email these to your academic supervisor so that a record of your development can be kept. This will also enable you to remain focused on your dissertation and ensure that you complete it in a timely manner. Dissertations are not like typical essays and they should never be left until the last minute to undertake. You must also remember that you will be working for longer periods in practice during year 3 as well as having to complete this dissertation. This can be challenging for students.

ROLE OF THE ACADEMIC SUPERVISOR

Your academic supervisor will give you advice on the structure and format of your dissertation and the standard of your academic writing. As this is a practice based dissertation you will need to make contacts in the clinical field of your topic area to gain specialist advice as this may not be the specialist area of your academic supervisor. Although the academic supervisor and the clinical staff will give advice it must be remembered that this is your independent piece of work and you must lead on it and take responsibility for the progress of it. You have to demonstrate your ability to work independently.

It is reasonable to expect that you can have up to 6 hours tutorial time with your academic supervisor during the preparation time of your dissertation. The supervision time allocation here includes the time it will take your supervisor to read and offer feedback on draft work. You should discuss with your supervisor the format of supervision you would prefer and this can face to face meetings, e-mail conversations and commenting on drafts. Your academic supervisor may also inform you of any annual leave that they will be taking so that you can take account of this in the writing of your dissertation and when you are expecting to have work reviewed and discussed. It is not recommended you leave the writing of your dissertation until the last minute.

Your academic supervisor will be the person who normally marks your dissertation. Every dissertation is second marked by a different academic member of staff to reduce the risk of any bias and to ensure a rigorous process of marking occurs. The final agreed mark is final and cannot be negotiated by the student.

STUDENT’S RESPONSIBILITY

It is your responsibility to make contact with your academic supervisor and any clinical staff that you will link with during the preparation of your dissertation. For any supervision meetings you must have prepared work to be reviewed and send any written work to your supervisor in plenty of time for them to read it prior to the meeting. This should be at least a week prior to the meeting date set. Supervision meetings may be conducted “online” or using electronic communication mediums as well as in the more usual “face to face” format.

You need to plan your time effectively and ensure that agreed deadlines are met. Always keep the appointments made and if you cannot attend for any reason please ensure that you contact your supervisor or clinical contacts in a timely manner.

It is recommended that you organise your work and maybe have a separate folder for all the information that you retrieve for this dissertation. Split your folder into sections to include literature review, practice focus area and associated information from clinical areas, meetings with supervisors and clinical staff and a section which contains your written work and drafts of each of your chapters. This makes your dissertation more manageable and ensures that you do not have to search for information that you may have misplaced.

Please note that the 10 working day rule for review of any draft work applies to this piece of work on first submission. Once any section has been reviewed by your supervisor and you have received feedback, this cannot be submitted again for further comment. It is also not acceptable to submit a full 6000 word draft of your dissertation in one go for review.

If for any reason you have any concerns about your supervision you should raise this with your supervisor as soon as possible so that any supporting action can be taken. Do not leave this until the last minute when it will become very difficult to provide any support and could impact on the mark awarded. As adult learners it is your responsibility to ensure this is the case. If you are unable to resolve your concerns with your supervisor you should then contact the Dissertation Module Lead, but this should only be done when all efforts to resolve the issue with your supervisor have occurred.

TIMELINE FOR DISSERTATION PREPARATION

These are only suggestions to help you to think about how to plan and use your time effectively to prepare your dissertation. You also need to bear in mind that there are other assessments for Year 3 as well as your dissertation so plan these into your time also.

The library services usually available to you will probably be reduced during the first semester of the new academic year (2021/22) but you will be able to access support from library trainers on request and by mutual agreement. This may be useful in reviewing literature searching skills.

At the start of Year 3, when all the Dissertation Proposal Forms have been submitted, you will be notified of the academic supervisor for your dissertation. It is vital that you contact them and arrange a meeting to take place as soon as possible to discuss your dissertation in detail and to make any arrangements with clinical contacts relevant to your dissertation project.

You should begin work on some of the sections of your dissertation straight away and do not leave it until the last minute. Your literature review takes a long time so do not underestimate how long this will take you to, firstly find the literature, review it and then write it up.

It is sometimes good practice to formulate a “Gantt chart” (See Appendix 8) to plan out your progress on your dissertation and make sure your aims are realistic so that you can achieve them. For example you should allocate at least 3 weeks to undertake a literature review and to critique and analyse the articles that you retrieve. This does not even include writing the literature review chapter, which could take you another 2 weeks. Be realistic with your time allocation and don’t leave everything until the last minute. Please remember that when in placement block you will be working 5 days per week so you will need to plan your time effectively.

For the submission date and results release date please refer to your assessment schedule for the year.

All results are subject to External Examiner approval and ratification by the Award Board

by the Award Board

External examiners:

Adult Nursing: Janice Campsie, Cardiff University and Ivan McGlen from UCLaN

Children’s Nursing: Jill Snodin, Edge Hill University. Mental Health Nursing: Jim Dooher De Montford University

Learning Disability Nursing: Dr John Turnbull University of Northampton

PRESENTATION AND SUBMISSION OF YOUR DISSERTATION

You must take pride in your written work and spend some time on the actual presentation of it. This does count for marks and at this level should be of a high standard. On a basic level your work should be word processed and written in Arial font size 12. You should fully justify your text and ensure that it is double line spaced. You should spell check your work and check the sentence structure and grammar (see School Handbook which is on module information area of the KLE).

Every page should have a page number and your student number as a header or footer and you should label your pages as page 1 of 21 etc. If you have a dyslexia number, this can be included in your header. You are not required to submit a front template sheet for this submission.

Referencing should be done accurately using the APA system,examples of which can be found in the Referencing Guide handbook.

Work has to be submitted via Turnitin by the set date and time as specified on the assessment schedule and you should ensure you identify your dissertation with your name so that your supervisor can easily see which dissertation belongs to their students. Dissertations are not marked anonymously. Any IT problems with the submission of your dissertation should be discussed with IT services.

Late submissions

Work must be submitted by the time and date specified in this handbook. Any work not submitted on time but submitted within 7 days of the submission date will be considered

under the 7 day rule and the mark will be capped at 40%. After this date work not submitted will be considered as a non-submission and fail. If you feel that you cannot submit your work on the submission date please contact your dissertation supervisor or personal tutor for advice. (see Regulation D1 and Regulation B3 for guidance).

HINTS AND TIPS ON ACADEMIC WRITING AT LEVEL 6

Academic writing:

Work that is considered to be “academic” has;

• A logical structure i.e. a beginning (introduction), middle (main body) and an end (conclusion) and a reference list
• A clear focus
• A logical flow from one point to the next
• Clear use of appropriate length paragraphs with a line space between each.
• Supporting use of literature/research/evidence within the text and in the reference list
• Precision, explicitness, objectivity and formality
• Evidence of analysis and interpretation of the work of others
• A cogent argument
• Correct referencing style (refer to referencing guidelines in appendix 3 of this handbook)
• Language that is professional and socially acceptable
• No colloquialism
• Language that is clear and plain. “Flowery”, emotive or descriptive language should be avoided
• Subheadings that organise the work can be used
• Careful presentation including attention to correct spelling, punctuation and grammar
• A length consistent with the assignment specifications
• Ensure that you go back and read feedback from previous assignments and implement these comments.

If you have difficulty with academic writing skills you should seek support from the Keele Study Support team. You may also contact your supervisor or personal tutor who can also refer you to appropriate sources of support.

Writing at level 6

During your course so far you have written many assignments and developed your writing skills. The final year of your course will expect you to develop your writing skills further and to be more critical about what you are reading and writing. This displays a greater depth of understanding of the topic area under study. At level 6 you will be expected to go beyond the basic description and discussion of the facts and to be more critical and bring in argument on a subject area.

To think critically is to examine ideas, evaluate them against literature and what you already know, and to make decisions about their merit. The aim is to maintain an objective position by weighing up all sides of an argument and evaluating its strengths and weaknesses. So you will;

• Actively seek all sides of an argument or discussion area
• Test the soundness of the claims made
• Test the soundness of the evidence used to support these claims
• You will need to keep an open mind and be prepared to question claims made in the literature or within clinical practice. Within your writing you will start to use phrases such as…. “it can be argued that….”, “there is evidence to suggest…. “
• As a student writing at level 6 you must be able to defend an argument against charges such as bias, lack of supporting evidence or incompleteness. You should be able to present and justify any claims you make based on the evidence that you have evaluated, whether that be from the literature base or from clinical practice and policy documentation.

There are certain words you may have come across which are derived from learning theories and these include;

Know: to be aware of and remember information

Comprehend: have an understanding

Apply: use the knowledge in situations

Analyse: to make a methodical and detailed examination of a topic area

Synthesis: where you combine information and ideas into something new

Evaluate: where you make judgements about the value of the information

It is the final three of these terms which you should be developing in your writing at level 6.

What is an argument?: An argument can be said to have four elements, (1) a claim, (2) evidence, (3) a warrant and (4) any qualifications to the argument that might be necessary. The nature of the argument made determines the exact form in which these elements appear. The claim is the point being made; what is being argued for. The evidence is the grounds upon which the claim is made. Sometimes it might be data from a study or it might be a quote or reference to somebody else’s work. The evidence needs to fully support the claim being made or, if it doesn’t, its weaknesses need to be acknowledged and dealt with in some way. The warrant is the general principle that forms the bridge between the claim and the evidence it is based on. It is logical reasoning that connects the evidence to the claim and finally, qualifications are concessions that may have to be made within an argument that limit what someone might be able to claim.

How to evaluate an argument: When you evaluate academic material such as a journal article, you are aiming to form a judgement on the validity of the argument presented. You can do this by looking at the coherence of the argument and the support evidence. Coherence means being able to justify when an argument is valid (e.g. that the claims made are justifiable and support the conclusions). You need to look to see if there are any alternative solutions which have not been examined, or if assumptions have been made. You need to look at the supporting evidence and judge if this evidence is appropriate and if the evidence compares with other evidence on the same subject. If it differs greatly then why is this?

Where you are asked to propose an argument and draw conclusions in an assignment, you need to make a clear argument, identify your claims, present the relevant evidence and draw justified conclusions. You do this by showing clearly the theory or approach and evidence you are using to support your claims. Indicate how you have analysed and evaluated the theories in order to come to your conclusions. You will also need to make clear the steps in your thought processes and show how the different parts of your argument fit together to make a cohesive whole. Finally, you will show that your argument is balanced rather than just taking a stance from one point of view. If you have been asked

to comment on an argument and you think it is flawed then you must make a reasoned case and present evidence to support your views. If you introduce new ideas, draw them logically from the original material.

USEFUL RESOURCES

Aveyard, H. (2019). Doing a literature review in health and social care; a practical guide. Fourth Edition . Maidenhead: Open University.

Centre for Reviews and Dissemination. (2008). Systematic Reviews: CRD’s guidance for undertaking reviews in health care. York: CRD. Accessible at www.york.ac.uk/inst/crd. Date accessed 1st June 2020.

Coughlin. M, Cronin. P, (2016) “Doing a literature review in Nursing, Health and Social Care”,2nd. Edition, Sage.

Cronin, P., Ryan, F., & Coughlan, M. (2008). Undertaking a literature review; a step-by- step approach. British Journal of Nursing. 17(1), 38-43

Gimenez, J. (2018). Writing for nursing and midwifery students. Third Edition. Red Globe Press. Macmillan International..

Greenhalgh, T. (2019). How to read a paper, basics of evidence-based medicine (6th ed.). Chicester: John Wiley and Sons.

Booth. A , Sutton. A , Papaionnu. D , (2018). Systematic approaches to a successful literature review. 2nd Edition. Sage.

Website resources

Website for academic writing skills                                www.phrasebank.manchester.ac.uk

RCN website which outlines various reports, tools and guidance on quality improvement. http://www.rcn.org.uk/development/practice/clinical_governance/quality_improvement

APPENDIX 1

Proposal Form for Dissertation subject

Write a dissertation relevant to your field of practice with a focus on research, evidence- based practice, service improvement and leadership. You will need to discuss this proposal with your dissertation supervisor at your first meeting.

Student Name
Field of Nursing
Topic Area for study: Identify the area of interest for the project.
Initial Plan: This section should include, why you have chosen this area and your initial ideas on how you expect to take the project forward. This will include in the first instance a review of the relevant literature. You will need to indicate how you plan to take your ideas forward after undertaking the literature reviews. Do not exceed 200 words.   This outline will be developed further at your first supervisor meeting.

Initial ideas discussed with personal tutor and to be developed further at supervisor meetings.
Signed (DS)
Signed (Student)
Date

Appendix 2

Dissertation Supervision Meeting Action Plan

Name of student:

Name of supervisor:

Date:

Record of progress to date	Actions to be taken and by whom	Agreed time frame

Date and time of next meeting:

APPENDIX 3

School of Nursing and Midwifery

Guidance for maintaining confidentiality within academic work

STUDENT VERSION

2018 – 2019

The National Health Service Confidentiality Code of Practice (DH 2003) services all professional regulatory bodies. It provides guidance to the NHS and related organisations on patient confidentiality issues. Its intention is to present a consistent message on issues around the processing of patient information. Specific regulatory professional bodies also give clear statements in their codes of conduct on the importance of maintaining confidentiality (HCPC, 2008; NMC, 2008).

If you handle and store information about identifiable, living people – for example, about patients – you are legally obliged to protect that information.

Information Commissioner’s Office ICO (2009)

It is important that as a student undertaking an educational programme within the School of Nursing and Midwifery you are aware of the codes that govern you as a student and ultimately as a qualified registered practitioner. Confidentiality is an essential element of the codes of conduct that govern and protect the public (DH, 1999; HCPC, 2008; NMC, 2008). The School considers it vital that students are conscious of the importance of maintaining confidentiality in practice settings, in assessed work and on university sites. You must recognise that you may be privy to confidential information and that any information or confidence must not be disclosed in the public domain, unless you are concerned someone may be at risk of harm (HCPC 2008; NMC, 2008). It is important that you recognise that in any work submitted (e.g. assignments; projects; reflections; case studies; portfolios; presentations; examinations; reports) and in class based reflections and discussions that you must not identify any person.

To demonstrate agreement to abide by the rules of confidentiality, as a pre-registration student, you are required to sign the school confidentiality document. As part of your employment contract, as a post-registration student, you are required to sign your employer’s confidentiality document.

A breach of confidentiality is the inclusion of any information that may lead to the identification of an individual (including General Practitioner, next of kin), registration details or images containing personal details (e.g. hospital number), within a student’s work (including appendices) that would allow an individual or area to be identified. This includes:

• service users carers

●      colleagues

• clinical areas

●      organisations

Use of personal details will normally constitute a major breach

Use of a clinical area name or organisation will normally constitute a minor breach

Exceptions to these would be:

• signatures of clinical staff who sign official documentation for students in placement areas acknowledgement of staff who have supported students in either the workplace or university (as long as names only are included, not job title or workplace)
• acknowledgement of family/friends xan organisation’s name as part of a reference in the text or list for a policy etc.

As your programme of study requires that you link theory to practice and practice to theory, discussions and assessments are often based on real events and people.

To avoid a breach of confidentiality

• Use pseudonyms (which should be identified as such) e.g. change name to “John Smith”
• Use generalised terms e.g. nurse, midwife, allied health professional, health centre, practice area, young man, surgical area, acute general hospital, community hospital, urban city in the West Midlands
• Avoid the inclusion of documentation, either original or photocopied, that might reveal the identity of an individual or their personal information e.g., referral letters, medical imaging records, assessment records, prescription charts, unless these are anonymised.
• (Exceptions to this are documents or cases that are now in the public domain e.g. Baby ‘P’; Shipman enquiries).
• Remove names on x ray films or other imaging records; use blank charts or pseudonyms on charts.

Frequently asked questions

Q         Can I refer to trust or agency documentation?

A          Yes

Q    I want to reflect on/share an experience from my placements in class.  Can I do  this?

A      Yes you can discuss your placement experiences as long as you do not identify  the area or client. You will also need to adhere to the ground rules agreed at the beginning of the session, module or programme.

Q          Can I print off discussion from online discussion boards such as Blackboard™?

A              Without the agreement of the group this would be a breach in the group’s confidentiality, group name and individual names would need to be anonymised or consent needs to be gained from the whole group

Q         How can I anonymise my work?

A  No identifiable data must be visible, (covering identifiable data with black ink where the data remains visible is not sufficient)

Q         My group wants to set up a group on a social networking site.

A            All modules have a Blackboard™ discussion board that you are to use for all educational discussions.

As a Pre-registration student you should adhere to your code of conduct which clearly states:

You should:

• Respect a person’s right to confidentiality;
• Not disclose information to anyone who is not entitled to it;
• Seek advice from your mentor or tutor before disclosing information if you believe someone may be at risk of harm;
• Follow the guidelines or policy on confidentiality as set out by your university and clinical placement provider;
• Be aware of and follow the NMC guidelines on confidentiality (available from our website www.nmc-uk.org);
• Make anonymous any information included in your coursework or assessments that may directly or indirectly identify people, staff, relatives, carers or clinical placement providers;
• Follow your university and clinical placement provider guidelines and policy on ethics when involved or participating in research. (NMC, 2011).

Or, as a Post-registration student, you should adhere to your code of conduct which clearly states

It is not acceptable for nurses and midwives to:

• discuss matters related to the people in their care outside the clinical setting
• discuss a case with colleagues in public where they may be overheard
• leave records unattended where they may be read by unauthorised persons(NMC 2008).
• The School of Nursing and Midwifery takes all breaches of confidentiality seriously. All incidents relating to a breach of confidentiality will be referred to the Academic Conduct Officer.

This may result in a delay in publication of a result.

A breach involving service user information may be referred to the placement provider/employing

Trust

Process for Dealing with potential breaches of confidentiality

Any potential breaches of confidentiality may result in your mark being with-held and your referral to the Academic Conduct Officer. As a result of an Academic Conduct review you may be referred to the Health and Conduct Committee and your mark may be zeroed. If you are a Postregistration student, you may be referred to your employer for further action.

References:

Department of Health. (1999). HSC 1999/012: Caldicott guardians. London: Department of Health.

Department of Health. (2003). Confidentiality code of practice.                                                             London: Department of Health Health Care Professions Council. (2008). Standards of conduct, performance and ethics.London: Health Care Professions Council.

Information Commissioner’s Office. (2009). Data protection – looking after the information you hold about patients. Accessed from http://www.ico.gov.uk date accessed 20.10.12.

Nursing and Midwifery Council. (2008). Standards of conduct, performance and ethics for nurses and midwives. London: Nursing and Midwifery Council.

Nursing and Midwifery Council. (2011). Guidance on professional conduct – For nursing and midwifery students. London: Nursing and Midwifery Council.

The University of West of England’s guide to maintaining confidentiality in written work is acknowledged as source material.

APPENDIX 4

Ethics Offences (School Student Project Ethics Committees)

The following point has been added to Regulation 8 General Regulations for University Examinations and Assessments Section 11 Conduct with regard to dissertation, projects, essays and other like in course assessments.

11.5 Student projects which involve the participation of human subjects must not be undertaken without the prior approval of a School Student Project Ethics Committee (or another Ethics Committee recognised for this purpose by the relevant School).

An ethics offence takes place if the student’s project requires but has no prior School ethics approval orif the project deviates substantially from what was approved by the School Student Project Ethics Committee (or equivalent).

The offence is minor if:-

• The work carried out would (or would with minor amendments) have been approved by the School had it been submitted for review and

•   The work carried out did not involve any of the following: assessing confidential data without valid consent, deceiving participants, observing them unawares, the study of vulnerable subjects, significant risk of harm to any person, or unlawful behaviour on the part of the student concerned,

All other offences are considered major.

In Schools where there are professional disciplines what constitutes a minor or major offence might be influenced by the governing professional bodies for that School, and such Schools may need to take this into consideration.

School Student Project Ethics Committee (S-SPECs) will themselves be responsible for handling alleged minor offences123. S-SPECs will also be responsible for deciding whether any particular case should be referred to the Academic Misconduct Panel (AMP). Only major offences or repeat minor offences should be referred to the AMP.

Some student behaviour constitutes both an ethics offence (as defined above) AND is a breach of the regulations on student discipline (regulations 20 and 21, for example). In such cases the University may decide to take action on both grounds simultaneously or sequentially and the penalties for both may be applied.

1. Informed by University Guidelines on procedures and penalties

• The range of penalties and the School’s position should be reflected in the School Handbook
• Mark sheets may need to be revised to include ethics

APPENDIX 5

Frequently asked questions by students about the dissertation

QUESTION	ANSWER
Can I include a systematic review as one of my articles?	As part of a thorough literature review it would be expected that systematic reviews would be part of the findings. These should be included. They are also a good source of further literature if you examine the reference lists.
Can I use other methods of searching other than the bibliographic databases in the library?	You should use the electronic databases which are provided by the library, however, you could access Google scholar as an addition to identify any other sources. Your access to databases should be in a structured way which you will then write up in the methods section of your literature review chapter.
What does peer review mean in relation to studies?	Peer reviewed journals are a way of “quality control” in regard to articles published in journals. This means that they have been closely examined by a panel of reviewers who have knowledge on the topic within the study
How many articles should I include?	There is no definite answer to this. It will depend on your subject, and how refined your search question is. You should not exclude relevant articles just because you feel you only have time to review a selection of them. You should ensure that your search question is refined enough and narrow enough at the start to avoid this situation occurring
Do I have to stick to the wordage provided in the handbook for each chapter?	There is flexibility in the wordage of each chapter. They are in the handbook as a guide only. You should stick to the maximum wordage for the whole dissertation

Does the literature review need to be thematically grouped?	You should work to the themes that you have identified from the reading of your articles. You should use a recognised framework to identify your themes from the articles. CASP only evaluates the quality of the methodology of the studies, there are other frameworks which help with identifying the themes from literature in a structured way.
Do I have to demonstrate critical analysis and appraisal of every piece of literature I refer to?	Yes, when reading your articles, you should undertake a critique of each of them. You would then integrate the main findings/themes and strengths and weaknesses of each article into your writing. Such as, whether the study was robust, identifying any potential limitations. You can summarise this also in a data extraction table which is included as an appendix.

Do references count in the overall word count?	No references in the reference list do not count in the overall word count. However, references which are in the text and are part of the sentence do count. Direct quotes also count.
What is included in the overall word count?	Your main chapters count to the overall word count. Your abstract, key words, acknowledgements, contents page and any words within tables/ figures are NOT counted.
Should I include tables and diagrams in the main text or the appendix?	This depends on the relevance of them to the text in which you have discussed them and also their size. You should discuss this with your supervisor taking every table/diagram as an individual consideration.
Are the words in tables included in the word count?	Yes they do (see school handbook on the notice board section of the KLE)
Can I use secondary citations as references?	Reference lists from the final articles should be reviewed; these may bring forth further relevant evidence which fits the inclusion criteria for the search. There should be an attempt to source the original and the library can help you to do this if you do not have access to the journal in which they are published.

Can I name the Trust that I have sought help from when discussing practice?	No. Please see appendix in dissertation handbook about confidentiality.
How many times can I see my dissertation supervisor?	This has to be negotiated with your supervisor and you have up to 6 hours of their time. It is stressed that this is your work and you should not over rely on your supervisor to provide every detail of how you should write your dissertation. The time with your supervisor includes time to read your work as well as seeing you face to face or answering e mails.
Will the supervisor look at the final draft before submission?	Your supervisor will not look at the same chapter more than once.
Can I exclude articles which are not full text in my literature review?	No you should gain access to these and the library can help you. If you exclude them then you are not undertaking a thorough and accurate literature review and this will affect the quality of the rest of your dissertation and show lack of completeness in your literature review.

APPENDIX 6

Data extraction table

Qu: What is the relationship of anxiety and depression to exacerbations of COPD and the resultant admissions to hospital, and are there any other mediating factors involved?

Study (author/date)	design	Sample size	Study setting	Length of follow up	Participant characteristics	Outcomes/findings
Cohort studies
Alcazar et al	Cross	n=127	Spain	12 months	COPD,	Univariate analysis,
2012	sectional		Hospital		had/had not	anxiety and
	observation		outpatient		had	depression significant
	al (cohort)		s		admission in	predictors/factors for
	x2 groups				previous 12	exacerbation/admissi
					months, > 40	on, but didn’t show in
					years of age	multivariate analysis.
						Also related to lower
						BODE score. (HADS
						used to measure
						anxiety and
						depression)
Almagro et al 2002	Prospective cohort study	n=135	Spain, acute inpatient hospital	3 years	All patients admitted with AECOPD between Oct 96 and May 97	Those admitted > 1 per year had increased depression and also increased mortality. Depression associated with increased mortality(3x’s higher) as well as more frequentreadmission
						(Yesavage Scale used to measure depression)

Chen et al 2006

Longitudina l cohort study

n=145

Six rural hospitals in T aiwan

90 days (3 months)

Patients admitted for AECOPD   Excluded those with psychiatric problems and included different cultural sub groups

Only significant factors were age and level of daily functioning. Depression not significant.   (Rural and cultural subgroups may have affected patients perceptions of their condition and depression, also QOL)

Coventr y et al 2011

Prospective cohort study (frequent exacerbators versus in frequent exacerbators)

n=79

Secondary care trusts in Mancheste r which had SED teams

12 months

Participants’ were in SED follow up system so had social support. Excluded if had mental illness (self- selected group). Investigator not blinded to their baseline psychologic al status

Depression significant factor leading to readmission. Anxiety, depression and QOL deteriorated over the 12 month follow up period. Low socioeconomic status also leads to increased readmissions.   Frequent exacerbators are more depressed   (HADS used to measure anxiety and depression)

Dalal et al 2011	Retrospective cohort study using US claims data. COPD +anxiety/depressi on and COPD alone	n=31,48 3	US	2 years	Claims data bases used to identify those who had been admitted and also had diagnosis of anxiety and/or depression and then followed	Higher ER and GP visits in those who had anxiety and depression as well as COPD. Higher cumulative all cause costs and higher COPD related costs
Eisner et al 2010	Prospective cohort study ( control group used)	n=1202	US, Kaiser Permante Medical Care program	1 year	Already on KP program in the US ( care program)	Study concentrates on anxiety not depression.   Increased disease severity linked to increased anxiety and increased exacerbations (exposure/respons e relationship. Dyspnoea showed strongest association to anxiety. Anxiety associated with younger age, females, non-white race, lower socioeconomic class, current smokers. Anxiety also leads to increased perception of symptoms (HADS, BODE, MRC SF12 used)

Fan et al 2007

Prospective cohort study

n=610

US (NETT trial;   patients on medical strand)

3 years. Used clinical trial records to compare all-cause mortality

Had severe COPD. Already on medical strand of NETT trail

26.9% of participants were hospitalised. had ER visits for exacerbations. No association was found with depression and 1 year mortality but it was for 3 year mortality. Female gender associated with increased risk of hospitalisation, but no significant relationship between female

						and depression. High prevalence of depression in severe patients but only 37% receiving medication. Neither depression nor anxiety associated with exacerbations or hospitalisation. (BDI, state trait anxiety inventory used)
Gudmundso n et al 2005	Prospective cohort study	n=406	Nordic countries	12 months (contacted 1 year after discharge re number of readmission s, also checked records)	Admitted > 24 hours with AECOPD Moderate to severe COPD	60.6% readmitted in 1 year More likely to readmit if had decreased QOL, decreased lung function, on LTOT, had previous admissions. There was not significant difference between the group with anxiety and depression and the group without. Significant correlation between QOL and depression in relation

						to admission and anxiety   (HADS, SGRQ)
Jennings et al 2009	Retrospectiv e then prospective for 1 year after completing PR program	n=194	US tertiary care referral centre where PR took place	12 months	All patients completed PR program with moderate to severe COPD	Patients with depression were more likely to have exacerbations and readmit (independent predictor) .They were 2.8 times more likely to have an exacerbation.
						Females with COPD more likely to be depressed.
						(BDI, SF36, Charlston Co morbidity index)
Ng et al 2007	Prospective cohort	n=376	Singapor e x2 secondar y care hospitals	12 months	Fev1% pred <70% 20 pack years (self- report hospital admissions )	44.4% depressed in total sample More deaths after discharge in depressed group (21.5% v10.5%). Increased LOS in depressed group Decrease SGRQ scores in depressed group
						(HADS, SGRQ.cut off point for depression 8 on HADS used)

Quint et al 2008	Prospective cohort study (Frequent v in frequent exacerbator s)	n=169	London Secondar y care	12 months	Taken from London COPD study. Had no exacerbation s in the previous 12 months	Frequent exacerbators had higher baseline depression scores Females more depressed than men Depression significantly increased from baseline to exacerbation and admission.   (CES-D, SGRQ, MRC)
Regvat et al 2011	Prospective cohort study	n=50	Slovinia Hospital based	3 months (june-aug: summer) Interviewe d on day of discharge	Successive patients admitted to a hospital with COPD exacerbation between two dates. Physician diagnosed	Hospitalised patients showed a higher prevalence of anxiety and/or depression (50%), showed less improvement in their dyspnoea, increased PaO2, decreased PaCO2, increased pH on admissions. ? hypersensitivity of receptors in respiratory centre so sense of exacerbation felt much earlier and lead to panic   (PRIME-MD: but didn’t do thequestionnaire just the interview section)
Xu et al 2008	Multicentre prospective cohort study	n=491	China	12 months monitored by telephone after discharge	>30 years of age, COPD diagnosis, no deterioration or change in meds or symptoms 4 weeks prior to start of the study	Depressed patients had a higher proportion of concurrent anxiety and more severe dyspnoea. Had more exacerbations and hospital admissions and lower levels of self- efficacy and social support and QOL Depression identified in patients with stable COPD was significantly associated with a higher risk of exacerbations and hospital admissions

						(overall worse health profile) HAD used
Case control/case series studies
Almagr	Prospective	n=129	Spanish	7 months	All those	Significant factors
o et al	observation		hospitals		admitted	associated with
2006	al (case		in		with	readmission were
	series) no		Barcelona		AECOPD	increased PaCO2 and
	comparison				between Oct	decreased QOL.
	group				96 and May	Depression a factor in
					97	bivariate analysis only
						not multivariate analysis
						(Yesavage scale used to
						measure depression)

Carneir o et al 2010

Case series study

n=45

Portugues e hospital

66 weeks (16 months)

All those admitted with AECOPD between sept 2006 and Jan 2008

Lower QOL related to depression also lower FEV1   Those who were depressed had more readmissions for AECOPD and longer LOS   56% of study population had depression

Kim et al 2010	Retrospectiv e case series study	n=77	Korea University hospital	12 months	All those admitted to respiratory wards in the hospital over a 3 years period. Notes examined for 12 months of data	Anxiety and depression not shown to be significant factors, but there may have been underdiagnoses due to study being retrospective, therefore not picked up true numbers of cases Showed that underweight and hypercapnia on discharge were significant factors for frequent readmission with exacerbation of COPD
Laurin et al 2009	Prospective follow up study (case series)	n=110	Canada out patients at 2 hospitals	2 years	All patients on self- manageme nt program. All had an exacerbatio n previously	For patients with psychiatric disorder had significantly higher rates of exacerbation (outpatient). No difference between in patient exacerbations. Had exacerbations sooner on discharge, particularly outpatient ones. (psychiatric interview/anxiety disorders interview schedule, MRC)
Soler et al 2004	Case control study (control group COPD but no admissions)	n=64	Valencia, Spain Secondary care hospitals	12 months	Fev1%pred <50%, admission in previous 12 months, All male and all severe COPD	QOL significantly poorer in those admitted to hospital Depression not mentioned, only anxiety STAI-S/T-anxiety

Taken from a larger study looking at hospital

Inhaled salmetrol and cardiac arrhythmias seen as significant

					care impact on COPD	factors but they were all severe patients.
Survey design
Abrams et al 2011	Survey (review of electronic databases and records)	n=26591	US, Veterans administratio n hospitals	N/A   No face to face contact	Excluded patients not having any follow up after discharge. Mostly men,>50 years of age, numerous co morbidities as from Veteran association	Depression and anxiety significant predictors of both mortality and readmission (30 days). Also more likely to smoke if depressed so effect COPD severity   (no tool to assess anxiety and depression identified)
Cao et	Cross	n=186.	General	12 months	50 years of	Significant factors were
al 2006	sectional	Decrease	hospitals in		age and	long duration of having
	survey	d to 146	Singapore		only COPD.	COPD > 5 years,
		post			Excluded	severity of COPD
		discharge			those with	(fev1%<50%),
					the most	consumption of
					severe	antipsychotic drugs,
					CODP and	depression, poor family
					also those	support and not had
					with	PR (HADS used to
					psychiatric	measure anxiety and
					disorders	depression)
Qualitative design

Bailey 2004	Focused ethnograph y and narrative analysis	10 patients, 10 nurses and 15 family caregiver s	2 hospitals in the mining community of Northern Ontario, Canada	4 months. x1 interview with each of them while in hospital	Extreme dyspnoea > 2 previous admissions	Suggests that anxiety might provide an important indication of actual illness severity and assist nurses in determining the support and care thatthese patient’s require. Essential thatanxiety is recognised as an emic sign and not necessarily the cause of dyspnoea for patients with COPD in acute exacerbations
Nicolso n 2000	Focus groups	n=20	UK x3 GP surgeries in Sheffield	n/a	Diagnosed with chronic bronchitis only ( excludes emphysem a)	SGRQ   Sense of loss and psychological distress and disruption.   Coping with limitations imposed on them. Less autonomy which increased dependence. Loss of control which lead to increased depression and decreased QOL
Maurer et al 2008	WORKSH OP OF CHEST PHYSICIA NS (report)	n/a	US	n/a	Chest physicians	Depression undertreated Depression linked to decreased QOL which leads to decreased compliance. This leads to increased exacerbations and admissions and also higher mortality risk on discharge following exacerbation

Gruffydd -Jones et al 2007

Prospective observationa l study and focus groups using semi structured interview MIXED METHODS

n=25 n=6 for focus groups with 2 groups of 3

SW England. DGH with no specialist respirator y support post discharge (generic teams)

n/a

Patients admitted to DGH with AECOPD. Purposive sampling for focus groups to reflect heterogeneity of severity of disease and geographical spread. Mean age 76 years

HAD used. Reluctance to seek medical help in an exacerbation.   Fear and anxiety associated with acute breathlessness. Educational needs. Follow up after discharge/lack of planning   Remaining depressed post discharge and nothing done about it.

APPENDIX 7

Gantt Chart example