Alison is a National Institutes for Health (NIHR) Doctoral Research Fellow. Her specific area of interest for her fellowship is around neurological assessment and monitoring of stroke patients in the acute phase. She is a nurse by background with broad research interests across the stroke pathway but especially interested in aspects of nursing related to acute stroke care.
Alison’s current project Standardised Neurological OBservation Schedule after Stroke (SNOBSS) aims to reduce variation in neurological assessment and monitoring after acute stroke. This is an important element of organised stroke care that currently likes clear guidance of what should be done, when and for which patients. Patients after stroke are at risk from early neurological deterioration (END) an important complication that if identified and where possible treated earlier could prevent secondary brain damage and reduce longer term harmful effects. Her mixed method programme of research will develop a consistent plan of how changes are identified, recorded, monitored and communicated and crucially responded to. Her work has the potential to improve care and outcomes after acute stroke. Alison is an active member of the Stroke Research Team at UCLan and as such helps support in other projects as well as getting involved in teaching where appropriate.
Alison has been involved with academic research since 2008. Immediately prior to her appointment as an NIHR Doctoral Research Fellowship she worked jointly as a stroke specialist nurse and academic research nurse at Lancashire Teaching Hospitals NHS Trust (LTHTR). Her academic research role was within the Clinical Academic Faculty (CAF) at LTHTR. This collaboration between LTHTR and UCLan supports individuals and teams across both organisations to develop collaborations and increase research capacity and capability. Throughout her career Alison has gained networks, specialist knowledge, training and skills in both stroke clinical practice and research. She has worked on numerous studies in terms of set up, recruitment, data collection, data cleansing, validation and adverse event monitoring as would be expected from a clinical research nurse. However, she has had opportunities to develop skills and experience in multiple aspects of project design, delivery and dissemination. These are what she hopes to further expand through her PhD to progress as an independent researcher. Key studies she has been involved in delivering under supervision and the relevant skills, method experience, impact and outputs include: Emergency Stroke Calls; Obtaining Rapid Telephone Triage (ESCORTT) Outputs from this study included an online training package informed by findings for Emergency Medical Dispatchers (EMD). Acute Stroke Telemedicine: Utility Training and Evaluation (ASTUTE) The team developed and tested an internet-based Standardised Telemedicine Toolkit (STT) alongside other collaborations and outputs. Improving Cardiac Arrest Response and Effectiveness (ICARE) Alison was instrumental in the development and adherence to data sharing agreements between other NHS organisations and academic institutions. Head Position in Stroke Trial (HeadPoST) Alison was part of the UK team that developed the DVD based training package for this global trial. She was also the joint PI for her Trust which expanded her skills in terms of oversight and governance of research. In terms of research led she was co-investigator on FacilitAting Research amongst Radiographers through Information Literacy workshops (FARRIL). The resources created as part of the project are available from the project website as well as evaluations and information on outputs to date (Research Engagement Programme). Her MSc Dissertation was entitled “How reliable is the National Institute for Health Stroke Scale (NIHSS) when rated by different members of the stroke multidisciplinary team from telemedicine recordings? “. It used secondary analysis of videos from ASTUTE to assess and calculate inter-rater reliability between different professional groups. She looked at factors related to training, experience and frequency of use to see if they impact on reliability of the scale in clinical and research practice. This project was an ideal precursor to her current project. Alison has been fortunate to gain experience in collaborating with patients and the public across many of the projects she has been involved with and has some established relationships. She looks forward to making new partnerships in this area through her Fellowship and beyond. Within the CAF she was co-facilitator in the setting up the Lancashire Research Advisory Group (LRAG) at the Trust. This now self-led group integrate into all aspects of the research strategy.
- MSc. Advanced Stroke Practice, University of Central Lancashire, 2017
- NETSMART AP- Neurovascular Education and Training: Stroke Management and Acute Reperfusion Therapy Advanced Practice, Arizona State University, 2015
- DipHE. Nursing (Adult), University of Central Lancashire, 2005
- Royal College of Nursing Professional Bursary 2011
- Florence Nightingale Travel Scholarship 2014
- Acute stroke care
- Neurological assessment and monitoring
- Measurement properties
- Nursing and Midwifery Council (NMC)
- Royal College of Nursing (RCN)
- National Stroke Nurses Forum (NSNF)
- Florence Nightingale Foundation (FNF) Alumni
- NETSMART Faculty
Standardised Neurological OBservation Schedule after Stroke (SNOBSS) Summary Background Stroke can be described as a ‘Brain Attack’ where the blood supply is reduced to part of the brain. It is a neurological condition and can cause a range of problems depending upon which parts of the brain are affected. There are approximately 83,000 emergency admissions with stroke per year. Stroke is the fourth single leading cause of death in the UK and the leading cause of disability– almost two thirds of stroke survivors leave hospital with a disability. Despite improvements in preventing stroke total numbers continue to rise. It is therefore crucial good quality organised acute stroke care is provided as it is associated with better outcomes in terms of death and dependency. Stroke symptoms continue to get worse for up to four in ten people in the 24-48 hours after arriving in hospital, often from events that if detected and treated early could reduce long term effects. Careful monitoring by stroke unit nurses could promptly detect change and allow intervention. However there are no specific guidelines about what, how, when and over what period patients should be monitored to identify important changes in neurological status after stroke except for a very small number of patients. Currently, a range of tools are used by different staff at different time points with potentially different interventions resulting in differences in care and possibly poorer outcomes for some patients. Aim To develop a consistent plan of how the neurological effects of stroke are recorded and monitored over time (neurological observation schedule) to promptly identify any changes and decide what should be done if the patient’s condition gets worse (response protocol) with the aim of improving outcomes for patients. Methods In this research all UK stroke units will be surveyed to find out what they currently do to monitor patients soon after having a stroke. All the tools available for monitoring will be identified, reviewed and compared using the evidence found across a range of factors (e.g. whether they are consistent, suitable to detect change, acceptable to staff and patients). Staff will be interviewed about their understanding of neurological observation, why they do or do not monitor patients and what helps or prevents them from carrying this out. This information obtained will help plan the best way to make sure staff and hospitals adopt the neurological observation and response protocol. An expert group will use all this information to agree on what should be done, when and by whom if a patient is seen to be getting worse and the best way to get staff to carry this out. Patient and Public Involvement (PPI) There will be a minimum of two PPI members on the expert group overseeing the findings and outputs of the research. Their views on what is important will be crucial in making changes happen. Dissemination The research would create standard recommendations and training materials to ensure patients are regularly and consistently observed. This would ensure staff are aware of changes in the patient’s condition sooner and if treatment is available it is given without delay, resulting in better outcomes for patients. It will allow better communication and understanding of status between professionals and potentially to patients and families. Research findings would be shared with all UK stroke centres as well as published and presented via stroke and nursing conferences and journals. Future steps would be to implement the schedule and protocol to test its effectiveness.
Use the links below to view their profiles:
- Stroke Research Team, University of Central Lancashire
- NIHR Alumni
- SNOBSS- Standardised Neurological Observation Schedule after Stroke
- IMPROVISE- IMPROVIng Stroke CarE in India (The National Institute for Health Research Global Health Research Group on improving stroke care in India at The University of Central Lancashire) (Funder: NIHR Global Health Research Group)
- FARRIL- FAcilitating Research amongst Radiographers through Information Literacy workshops
- ASTUTE - Acute Stroke Telemedicine: Utility, Training and Evaluation
- ICARE- Improving Cardiac Arrest Recognition and Effectiveness
- ESCORTT- Emergency Stroke Calls: Obtaining Rapid Telephone Triage
- TeRaFS- Technology in Radiotherapy
- National Institute for Health Research, 2018 Doctoral Research Fellowship £236,352.
- CILIP The Library and information association, 2016 Information Literacy Group Research Grant £8,862.
- Health Libraries Group Conference, Overcoming barriers to beginning research: a practical workshop, 2018
- NHS R&D North West Let’s Talk Research Conference 3: Edgewalking Programme, 2016
- I7th UK Stroke Forum Conference, Implementing telemedicine in acute stroke: staff perspective, Harrogate, 2012
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