Dr Hilary Piercy PhD, MA, BSc (hons), PGCE, PGDip, SFHEA, RN, RM
Associate Professor
Summary
I am an Associate Professor at Sheffield Hallam University and am based in the Department of Nursing and Midwifery.
My research is broadly concerned with health services delivery and uses a range of qualitative methodologies and evaluative approaches to better understand the ways in which services are delivered and experienced to inform an agenda of service development and improvement.
Much of my work focuses on my specialist area of sexual and reproductive health and HIV with a wider range of interests including advanced practice roles.
About
I have been working at SHU since 2007 and am based within Health and Social Care research where I work as a principal lectures/principal research fellow. I was awarded a BSc in Genetics in 1991 an MA in applied research and quality evaluation in 1995, and a PhD in 2005, all from the University of Sheffield.
I have a clinical background in nursing and midwifery and worked in both areas before specialising in sexual and reproductive health. I have been involved in education of health professionals for many years and taught on a wide range of programmes at undergraduate and post graduate level. My research is conducted in collaboration with clinical partners, primarily those based in the local NHS trusts, and primarily focuses on my specialist area of sexual and reproductive health and HIV.
In my capacity as chair of the National HIV Nurses Association (NHIVNA) Research Subcommittee, I am taking forward an agenda to build research capacity and capability in the HIV nursing workforce and to increase the amount of high quality nursing research.
Sexual and reproductive health, Public health, health service workforce development
Teaching
School of Health and Social Care
College of Health, Wellbeing and Life Sciences
My teaching is primarily at post graduate level and is concerned with research. I am programme lead for the Doctorate in Professional Studies programme, a faculty wide interprofessional provision and I supervise a number of part-time and full-time PhD and Professional Doctorate students, the majority of whom are health care practitioners.
Research
Evaluation of the Sheffield Enhanced Primary Care Programme (Prime Minister's Challenge Fund)
Leading an interdisciplinary programme of research for improving the wellbeing of people living with HIV across the lifespan. The programme spans health services research, exercise science and health psychology and is a collaboration with clinical partners at Sheffield Teaching Hospital NHS Foundation Trust. Current projects within this programme include:
- Developing a Community Delivered nursing intervention to improve engagement of HIV patients in care and treatment
- Understanding how co-morbidities for people living with HIV are treated and managed.
A qualitative evaluation to understand what adherence support patients require from an HIV service and whether they receive it. Piercy, H., Bell, G & Bowman, C. 2014
A critical review of interventions to increase the uptake of mammography in minority ethnic populations. Piercy, H., Salway, S & Chowbey, P. 2012
Sheffield Children's Hospital
Sheffield Teaching Hospitals
Publications
Journal articles
Bulut, H., Hinchliff, S., Ali, P., & Piercy, H. (2024). Women's Experiences of Intimate and Sexual Relationships During Menopause: A Qualitative Synthesis. Journal of Clinical Nursing. http://doi.org/10.1111/jocn.17436
Cooper, R., Greig, J., Piercy, H., & Collini, P. (2024). Investigating the Pregnancy and Post-Partum Health Experiences of Women Living with HIV. Maternal and Child Health Journal, 28 (8), 1330-1337. http://doi.org/10.1007/s10995-024-03962-y
Piercy, H., & Nutting, C. (2023). The experiences of parents of children diagnosed with cerebral adrenoleukodystrophy. Child: Care, Health and Development. http://doi.org/10.1111/cch.13184
Hainsworth, E., & Piercy, H. (2023). Evolution of a video project to translate research findings about patient experiences into improved clinical care. British journal of nursing (Mark Allen Publishing), 32 (11), S7-S13. http://doi.org/10.12968/bjon.2023.32.11.s7
Walker, S., Claydon‐Mueller, L., Kabir, R., Piercy, H., Massey, M., & Costanzo, I. (2023). Systematic review of factors predictive of unfavourable vaginal bleeding in women of reproductive age using the contraceptive etonogestrel implant. Reproductive, Female and Child Health. http://doi.org/10.1002/rfc2.22
Snowdon, N., Mclean, S., Piercy, H., Brodie, M.A., & Wheat, J. (2022). Orthotic shorts for improving gait and walking in multiple sclerosis: a feasibility study. Disability and Rehabilitation. http://doi.org/10.1080/09638288.2022.2114018
Piercy, H., Kelly, S., Wills, M., & Croston, M. (2022). Psychological impact of caring during the COVID-19 pandemic on HIV nurses. British Journal of Nursing, 31 (1), S10-S15. http://doi.org/10.12968/bjon.2022.31.1.S10
Hart, A.R., Vasudevan, C., Griffiths, P.D., Foulds, N., Piercy, H., de Lacy, P., ... Vollmer, B. (2021). Antenatal counselling for prospective parents whose fetus has a neurological anomaly: part 2, risks of adverse outcome in common anomalies. Developmental Medicine and Child Neurology. http://doi.org/10.1111/dmcn.15043
Hart, A.R., Vollmer, B., Howe, D., Boxall, S., Foulds, N., de Lacy, P., ... Piercy, H. (2021). Antenatal counselling for prospective parents whose fetus has a neurological anomaly: part 1, experiences and recommendations for service design. Developmental Medicine and Child Neurology. http://doi.org/10.1111/dmcn.15022
Snowdon, N., Booth, S., Mclean, S., Wheat, J., & Piercy, H. (2021). The meaning of fabric orthoses to long-term users with multiple sclerosis: an Interpretative Phenomenological Analysis. Prosthetics and Orthotics International. http://doi.org/10.1097/PXR.0000000000000006
Piercy, H., Nutting, C., & Yap, S. (2021). “It’s Just Always Eating”: The Experiences of Young People Growing up Medium Chain Acyl-coA Dehydrogenase Deficiency. Global Qualitative Nursing Research, 8. http://doi.org/10.1177/23333936211032203
Walker, S., Piercy, H., Shearn, K., & Acton, F. (2019). What consultation resources are available to support delivery of integrated sexual and reproductive health services? A scoping review. BMJ Sexual and Reproductive Health. http://doi.org/10.1136/bmjsrh-2019-200414
Piercy, H., Yeo, M., Yap, S., & Hart, A. (2019). What are the information needs of parentscaring for a child with Glutaric aciduriatype 1? BMC Pediatrics.
Shearn, K., Piercy, H., Allmark, P., & Hirst, J. (2019). Clarity, conviction and coherence supports buy-in to positive youth sexual health services: focused results from a realist evaluation. BMC Health Services Research, 19, 503. http://doi.org/10.1186/s12913-019-4298-4
Piercy, H., McLuskey, J., Croston, M., & Grundy Bowers, M. (2019). A participatory approach to developing the HIV Nursing Research Strategy. HIV Nursing, 19 (1), 2-6. http://www.hivnursing.net/current_articles
Piercy, H., Bell, G., Hughes, C., Naylor, S., & Bowman, C. (2018). A workforce in jeopardy - identifying the challenges of ensuring a sustainable advanced HIV nursing workforce. Journal of Research in Nursing, 23 (8), 646-656. http://doi.org/10.1177/1744987118780913
Kelly, S., Piercy, H., Ibbotson, R., & Fowler-Davis, S. (2018). Who attends out-of-hours general practice appointments? Analysis of a patient cohort accessing new out-of-hours units. BMJ Open, 8 (6), e020308. http://doi.org/10.1136/bmjopen-2017-020308
Fowler-Davis, S., Piercy, H., Pearson, S., Thomas, B., & Kelly, S. (2018). Factors affecting decisions to extend access to primary care- results of a qualitative evaluation of general practitioners views. BMJ Open, 8 (3). http://doi.org/10.1136/bmjopen-2017-019084
Shearn, K., Allmark, P., Piercy, H., & Hirst, J. (2017). Building realist programme theory for large complex and messy interventions. International Journal of Qualitative Methods, 16 (1), 1-11. http://doi.org/10.1177/1609406917741796
Piercy, H., Fowler Davis, S., Dunham, M., & Cooper, C. (2017). Evaluation outcomes for an integrated service delivering post diagnostic care and support for families living with dementia. .
Gee, M., Piercy, H., & Machaczek, K. (2017). Family planning decisions for parents of children with a rare genetic condition: a scoping review. Sexual & Reproductive Healthcare, 14, 1-6. http://doi.org/10.1016/j.srhc.2017.08.001
Piercy, H., Bell, G., Hughes, C., Naylor, S., & Bowman, C. (2017). How does specialist nursing contribute to HIV service delivery across England? International Journal of STD and AIDS, 28 (8), 808-813. http://doi.org/10.1177/0956462416672128
Piercy, H., Machaczek, K., Ali, P., & Yap, S. (2017). Parental experiences of raising a child with medium chain Acyl-CoA Dehydrogenase deficiency. Global Qualitative Nursing research, 4, 1-8. http://doi.org/10.1177/2333393617707080
Rajapaksa-Hewageegana, N., Piercy, H., Salway, S., & Samarage, S. (2015). Sexual and reproductive knowledge, attitudes and behaviours in a school going population of Sri Lankan adolescents. Sexual & Reproductive Healthcare, 6 (1), 3-8. http://doi.org/10.1016/j.srhc.2014.08.001
Rajapaksa-Hewageegana, N., Salway, S.M., Piercy, H., & Samarage, S. (2014). A quantitative exploration of the sociocultural context of teenage pregnancy in Sri Lanka. BMC Pregnancy and Childbirth, 14 (1), 394. http://doi.org/10.1186/s12884-014-0394-y
Gerrish, K., & Piercy, H. (2014). Capacity development for knowledge translation : evaluation of an experiential approach through secondment opportunities. Worldviews on Evidence-Based Nursing, 11 (3), 209-216. http://doi.org/10.1111/wvn.12038
Tunnicliff, S.A., Piercy, H., Bowman, C.A., Hughes, C., & Goyder, E.C. (2013). The contribution of the HIV specialist nurse to HIV care : a scoping review. Journal of clinical nursing, 22 (23-24), 3349-3360. http://doi.org/10.1111/jocn.12369
Salway, S., Piercy, H., Chowbey, P., Brewins, L., & Dhoot, P. (2013). Improving capacity in ethnicity and health research: report of a tailored programme for NHS Public Health practitioners. Primary health care research and development, 14 (04), 330-340. http://doi.org/10.1017/S1463423612000357
Piercy, H., Chowbey, P., Soady, J., Dhoot, P., Willis, L., & Salway, S. (2012). A care pathway approach to identifying factors that impact on diagnosis of heart disease in British Pakistani women. Ethnicity and Inequalities in Health and Social Care, 5 (3), 78-88. http://doi.org/10.1108/17570981211319375
Piercy, H., & Hayter, M. (2009). Effective sex education in primary schools: a study. British Journal of School Nursing, 4 (4), 182-186. http://www.school-nursing.co.uk/
Hayter, M., Piercy, H., Massey, M.-.T., & Gregory, T. (2008). School nurses and sex education: surveillance and disciplinary practices in primary schools. Journal of advanced nursing, 61 (3), 273-281. http://doi.org/10.1111/j.1365-2648.2007.04495.x
Piercy, H., & Hayter, M. (2008). School nurse management of children's questions when they are involved in primary school sex education: an exploratory study. Primary health care research and development, 9 (01), 75-84. http://doi.org/10.1017/S1463423607000527
Piercy, H., & Haynes, G. (2006). Coherent, comprehensive and continuous: Developing a curriculum for effective sex and relationship education in an english primary school. Education and Health, 24 (1), 12-15.
Piercy, H. (2006). The importance of contextualisation in giving a diagnosis of genital chlamydial infection: findings from a qualitative study. Journal of family planning and reproductive health care, 32 (4), 227-230. http://doi.org/10.1783/147118906778586552
Piercy, H. (2006). “It feels good to be told that I'm all clear”: patients' accounts of retesting following genital chlamydial infection. Sexually transmitted infections, 82 (4), 330-333. http://doi.org/10.1136/sti.2005.018838
Piercy, H., & Hargate, M. (2004). Social research on the under 16's: a consideration of the issues from a UK perspective. Journal of child health care, 8 (4), 253-263. http://doi.org/10.1177/1367493504045824
Piercy, H., Kellock, D., Rogstad, K., & Searle, E.S. (2000). Knowledge of genital Chlamydia trachomatis infection in family planning clinic attenders. The British journal of family planning, 26 (4), 195-198. http://doi.org/10.1783/147118900101194779
Kellock, D.J., Piercy, H., & Rogstad, K.E. (1999). Knowledge of Chlamydia trachomatis infection in genitourinary medicine clinic attenders. Sexually transmitted infections, 75 (1), 36-40. http://doi.org/10.1136/sti.75.1.36
Conference papers
Lamb, M., Piercy, H., Humphreys, H., Arden, M., & Rogstad, K. (2023). Interviews with healthcare professionals to understand the barriers and facilitators faced in promoting an active lifestyle to people living with HIV. HIV MEDICINE, 24, 90-91.
Cooper, R., Collini, P., Piercy, H., & Greig, J. (2022). Investigating the pregnancy and post-partum health experiences of women living with HIV: the NESTOR study. HIV MEDICINE, 23, 7-8.
Nutting, C., Piercy, H., & Yap, S. (2021). "It's Just Always Eating": The Experiences of Young People Growing up Medium Chain Acyl-CoA Dehydrogenase Deficiency (Mcadd) [abstract only]. International Journal of Qualitative Methods, 20, 96. http://doi.org/10.1177/16094069211053959
Mair, L., Keeley, A., Collini, P., & Piercy, H. (2020). Managing non-communicable comorbidity in people with HIV: how much is there and who is managing it? A retrospective case-record review in Sheffield. HIV MEDICINE, 21, 53-54.
Piercy, H., Hughes, C., & Greig, J. (2020). Developing and testing a community-based nursing intervention to improve engagement of HIV Patients in care and treatment (Conect) (Abstract only). International Journal of Qualitative Methods, 19. https://journals.sagepub.com/doi/10.1177/1609406920909934#_i810
Piercy, H., & Nutting, C. (2020). Working with young dynamos: the benefits of patient public involvement in research design [Abstract only]. International Journal of Qualitative Methods, 19, 9. http://doi.org/10.1177/1609406920909934
Davies, M., Woodward, A., Speake, H., & Piercy, H. (2019). Experiences of and factors influencing physical activity in people living with HIV: a qualitative systematic review. HIV MEDICINE, 20, 263-264.
Kelly, S., Ibbotson, R., Piercy, H., & Davis, S.F. (2019). Is there some degree of unmet need in primary care?: analysis of a patient cohort accessing a new out of hours units. Journal of Epidemiology and Community Health, 73, A34. http://doi.org/10.1136/jech-2019-SSMabstracts.72
Piercy, H., Bell, G., & Bowman, C. (2017). Models of HIV Specialist Nursing Provision Identified From a National Study. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS, 16 (1).
Piercy, H., & Machaczek, K. (2017). It's Not Food Because You're Hungry; It's Food to Keep You Alive: Parental Experiences of Raising a Child With MCADD. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS, 16 (1).
Fowler-Davis, S., Kelly, S., & Piercy, H. (2017). Pragmatism in evidence synthesis and translation; a perspective on the evaluation of systems transformation Conference of Evidence-Based Health Care. (abstract only). In EBHC International Conference 2017, Taomina, Sicily, Italy, 25 October 2017 - 28 October 2017.
Piercy, H., Bell, G., Naylor, S., Hughes, C., & Bowman, C. (2016). Models of HIV specialist nursing provision identified from a national study. HIV MEDICINE, 17, 67-68.
Piercy, H., Bell, G., Hughes, C., Naylor, S., & Bowman, C. (2016). Developing and sustaining an HIV nursing workforce: insights from a national study. HIV MEDICINE, 17, 66.
Shearn, K., Piercy, H., Allmark, P., & Hirst, J. (2016). Provision of positive sexual health services for young people: a realist evaluation. The Lancet, 388 (Supp2), S105. http://doi.org/10.1016/S0140-6736(16)32341-8
Piercy, H., Bell, G., Naylor, S., Hughes, C., & Bowman, C. (2015). The contribution of advanced nursing practice to HIV care: Preliminary findings of a national study. HIV MEDICINE, 16, 70.
Piercy, H., Bell, G., & Bowman, C. (2014). What adherence support do patients require from an HIV service? HIV MEDICINE, 15, 38.
Salway, S., Piercy, H., & Presto, L. (2013). How can realist synthesis methods contribute to building the evidence base for action on ethnic health inequalities? A narrative assessment. LANCET, 382, 87.
Book chapters
Piercy, H. (2021). Understanding and expanding HIV nursing roles. In Providing HIV Care: Lessons from the Field for Nurses and Healthcare Practitioners. (pp. 17-27). http://doi.org/10.1007/978-3-030-71295-2_2
Formby, E., Piercy, H., & Allmark, P. (2010). Sexuality. In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Allmark, P., Salway, S., & Hyde, M. (2010). Methodology and method. In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Allmark, P., & Grimsley, M. (2010). Socio-economic status or class. In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Allmark, P., Hyde, M., & Grimsley, M. (2010). Age. In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Allmark, P., Hyde, M., & Mcclimens, A. (2010). Disability. In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Salway, S., Karlsen, S., & Hyde, M. (2010). Race and ethnicity. In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Salway, S., Piercy, H., & Hyde, M. (2010). Sex and gender. In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Salway, S., Piercy, H., & Hyde, M. (2010). Sex and gender. In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Salway, S., Hyde, M., & Karlsen, S. (2010). Religion and belief. In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Formby, E., Piercy, H., & Allmark, P. (2010). Gender identity (Trans). In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Formby, E., Piercy, H., & Allmark, P. (2010). Gender identity (Trans). In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Allmark, P. (2010). Introduction and overview. In Allmark, P., Salway, S., & Piercy, H. (Eds.) Life and health: an evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission: http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Piercy, H. (2009). An uncertain future: infertility and chlamydial infection. In Hunter, B., & Deery, R. (Eds.) Emotions in midwifery and reproduction. (pp. 157-172). Basingstoke: Palgrave Macmillan
(n.d.). Exploring the Dirty Side of Women's Health. Routledge: http://doi.org/10.4324/9780203967348
Reports
Piercy, H., Bell, G., Hughes, C., Naylor, S., & Bowman, C. (2015). An examination of the contribution of specialist nursing to HIV service delivery. Sheffield Hallam University.
Piercy, H., Salway, S., & Chowbey, P. (2014). A critical review of interventions to increase the uptake of mammography in minority ethnic populations. NIHR. https://www.e-repository.clahrc-yh.nihr.ac.uk/a-critical-review-of-interventions-to-increase-the-uptake-of-mammography-in-minority-ethnic-populations/
Allmark, P., Salway, S., Piercy, H., Barley, R., Faulkner, M., Formby, E., ... Mcclimens, A. (2010). Life and Health: An evidence review and synthesis for the Equality and Human Rights Commission's triennial review. Sheffield: Equality and Human Rights Commission. http://www.equalityhumanrights.com/uploaded_files/triennial_review/triennial_review_life_health_omnibus.pdf
Theses / Dissertations
Woodward, A. (2021). Physical activity and cardiovascular disease risk in women with polycystic ovary syndrome. (Doctoral thesis). Supervised by Klonizakis, M., Broom, D., Piercy, H., & Metwally, M. http://doi.org/10.7190/shu-thesis-00398
Johnson, M.H. (2020). Risk of Recurrence after Lung Cancer: A Multiple Case Study of Communication. (Doctoral thesis). Supervised by Piercy, H. http://doi.org/10.7190/shu-thesis-00293
Shearn, K.M. (2018). Delivering positive youth sexual health services: a realist evaluation. (Doctoral thesis). Supervised by Piercy, H., Allmark, P., & Hirst, J. http://doi.org/10.7190/shu-thesis-00062
Thomas, B.D. (2017). Staying safe at home in winter: case studies of people with dementia. (Doctoral thesis). Supervised by Piercy, H. http://doi.org/10.7190/shu-thesis-00078
Hall, J.P. (2016). Nurse practitioners' perceptions of their role and value in UK general practice. (Doctoral thesis). Supervised by Piercy, H., & Hodgson, D.
Posters
Laundy, N., Greig, J., Piercy, H., & Bell, G. (2019). Service review: Patients living with HIV admitted to the Infectious diseases Department, Royal Hallamshire Hospital, Shefffield, between October 2015 and October 20166. Presented at: Federation of Infection Societies Annual Conference, Birmingham, England
Shearn, K., Piercy, H., Allmark, P., & Hirst, J. (2018). Interpretations of 'positive' approaches to youth sexual health services: concept defining as one phase of a realist evaluation.
Other publications
Piercy, H. (2007). Sexually transmitted infections and dirt. London , New York: Routledge: http://www.routledge.co.uk/books/Exploring-the-Dirty-Side-of-Womens-Health-isbn9780415383240
Postgraduate supervision
Previous PhD/DPS theses:
- "Delivering positive sexual health services for young people: a realist evaluation.
- "Staying safe at home in winter; case studies of people with dementia."
- "What do advanced nurse practitioners perceive to be the value of their role in UK general practice?"
- "An in-depth exploration of adolescent sexuality and pregnancy in Sri Lanka."
Current students' topics include: ANP roles in paediatrics, effective transitions from paediatric to adult care for complex medical conditions; Operating department practitioners' perceptions of their role; the contributions of domiciliary care services to harm prevention.