Dr Khim Horton

Senior Lecturer (Care of Older People)

Qualifications: PhD, BSc (Hons), RN, RCNT, RNT, PGCEA

Email:
Phone: Work: 01483 68 4555
Room no: 15 DK 04

Office hours

Monday - Friday 7.30 am - 4.30 pm by appointment only

Further information

Biography

Khim Horton is a Senior Lecturer (Clinical) in care of older people. She is a Registered Nurse and Nurse Teacher with a clinical background in medical and gerontological nursing.
She had a research studentship funded by the Economic and Research Council, in the Department of Sociology, University of Surrey where she obtained her Ph.D in the sociology of ageing: ‘Gender and Falls: Perceptions of Older People and their key Family Members’.
She has spent much of her professional life teaching in Higher Education institutions. Her research programme focuses on aspects relating to care of older people, telecare, nursing and nurse education using both qualitative and quantitative research methodologies. She has methodological expertise in grounded theory as well as mixed method research. She also has extensive experience in supervising students on both undergraduate and postgraduate programmes, including PhD and Doctoral in Clinical Practice.
Currently based in the Centre for Research in Nursing and Midwifery Education where she had previously worked as a Post-Doctoral Research Fellow during 2005-07, Khim contributes to the learning and teaching activities for undergraduates and postgraduates in the Division.
Khim Horton has published in peer reviewed journals and books. Khim Horton is also a member of the Editorial Advisory Board, for the Ageing and the Lifecourse series, published by the Policy Press, Bristol and a reviewer for several journals.
She is currently a member of the Royal College of Physicians’ Falls Pathway Workstream Advisory Group and a committee member of the Royal College of Nursing Older People’s Forum. She is an Erasmus Co-ordinator and has teaching exchange at the University of East Finland, Kuopio, Finland.
She works closely with national agencies as well as local and county social care services and health care providers such as the Royal Surrey County Hospital and Ashford and St Peter’s Hospital where she holds honorary contracts.

Research Interests

Dr Khim Horton’s research interests include gender, culture and diversity, value of and values in nursing and aspects of gerontological nursing (e.g. falls in older people, risks and safe guarding, dementia care, telecare and community care).

Expert Panel member for ‘Safe Walking for people with Dementia’ project at the University of Stirling, funded by National Institute for Health Research;  
Expert Panel member for a project led by Brunel University on inter and intra-generational care for older people amongst minority community, which is funded by Leverhulme.
Member of North West Surrey Implementation Group for Dementia Care.
Member of the Pan Sussex NHS leads group on Safeguarding;
 

Current Projects: 

Co-Investigator (with Dr Helen Allan): An investigation into the effects of Academic Award on Registered nurses’ ability to recontextualise Knowledge to allow them to deliver, organise and supervise Care: an ethnographic study (AarK). Funded by the General Nursing Council Trust, UK. (April 2011-April 2014).

Shaheen A, Horton K & Jackson J Does ballet help us age better? EPSRC- University of Surrey. £31,119.03

Ewin D (PI, Faculty of Engineering and Physics) & Horton K, with Industrial partner, Chas A Blatchford & Sons Ltd. Project title: Walking in cluttered environments: visual influences on gait in Parkinson's disease.  June –Dec 2013. The aim of the project is to develop a set of protocols and associated test environments for assessment of mobility (walking) in the older person (above 65 years of age). In parallel an age-appropriate normative database will be developed. Pump priming from EPSRC. (June-Dec 2013)

Completed projects:

Horton, K (PI) (with Dr Anne Arber) ‘A study on FosteRing Empathy between Students and older people- a practical approach’ (AFRESh) Funded by Averil Osborn Trust.

Horton, K (PI) (with Prof Helen Allan, Alison Rhodes and Sharon Markless): ‘An Action reSearch on SUpeRvision of Disserations (ASSUREeD)’, a project supported by FHMS, University of Surrey.

Co-Investigator (with Dr Helen Allan): An investigation into the effects of Academic Award on Registered nurses’ ability to recontextualise Knowledge to allow them to deliver, organise and supervise Care: an ethnographic study (AarK). Funded by the General Nursing Council Trust, UK. (April 2011- for two years).

Engel, B. and Horton K  Evaluation of Healthy Eating Programme in the Southeast of England.  Commissioned by Fit as a Fiddle programme- National Lottery.

2007/8 ‘Supporting the transition from doctorate to post doctoral employment: Developing and piloting a tool for personal development and training needs analysis’. Funders: Roberts Monies from the University of Surrey - £21,000. PI, Dr Allan; Dr K Horton, Dr W Knibb, Dr J Anderson (lecturers) and Mr M O’Driscoll (RA1).

Travel Grant to University of Sao Paulo, Brazil from June-Dec 2011. Funded by Santander.
Co-Investigator (with Dr Salim Ghoussayni, Centre for Biomedical Engineering, University of Surrey):
A study into domestic stair lighting and its impact on the risk of falling for the visually impaired. July 2008–March 2010; Funded by Thomas Pockington Trust. £28,219

Erasmus Transversal Programme: Promoting the improvement of elderly ICT skills and well being by inter-generational and multi-sectoral education with partners from Slovenia, Austria and Dublin.
January 2009 –December 2011; 484.672, 00 EUR.

Lead role for Work Package 7: Development of Staff and Student mobility and development of Intensive Programme on an Erasmus Lifelong Learning EU funded ’Online MSc Gerontological Nursing Programme’ Oct 2007-Sep 2010; 237.933, 00 EUR

Principal Investigator (co-investigator: Dr J Anderson, Robens Centre, FHMS): Preventative Technologies Grant (DH), managed by Surrey County Council: “An evaluation of telecare across Surrey’ 1 Mar 2007– 1 Aug 2008.

Co-Investigator (with Dr V. Tschudin, P.Mweu and J. Leng) Good Work in Nursing at FHMS builds on the work of the GoodWork® Project developed by Dr Howard Gardner (Gardner, 2007). This Project has to date interviewed over 1200 people in nine professions (journalism, medicine, acting, legal services etc). The Good Work in Nursing project is a new ‘arm’ of this overall Project. Dr Khim Horton is a member of the steering group of the project group.

Erasmus Intensive Programme (IP) (with University of Maribor, Slovenia, and University College Dublin): Healthy Living. June 2009.

Co-Investigator (with Dr V Tschudin & Dr A Gallagher, University of Surrey) The Good Nurse – a project initially involving partners from South East Asian countries. A small European pilot project completed in the UK.  

Principal Investigator (co-investigator: Dr J Anderson, FHMS): An evaluation of telecare across Surrey; 1 March 2007–1 August 2008. Preventative Technologies Grant (DH), managed by Surrey County Council.

Principal Investigator (co-investigator: Dr J Anderson, FHMS): Surrey Safe at Home: An evaluation project; March 2006–1November 2007. Preventative Technologies Grant (DH), managed by Guildford Borough Council.  

Principal Investigator (Co-investigator: Dr J Anderson, FHMS A case study of the use of telemonitoring in the management of patients with Chronic Obstructive Pulmonary Disease: September 2006-July 2007; Guildford Borough Council and Waverley Borough Council, Change Agency.

Principal Investigator (Co-Award holder: Professor K. Bryan and W. Knibb). An evaluation of the Assessment and Treatment Centre in Ashford Hospital, Middlesex: December 2002-March 2003. Funded by North Surrey Primary Care Trust.  

Principal Investigator: A quasi experiment on the use of falls detectors and bed occupancy sensor on Falls Efficacy: September 2003-March 2004. Funder: Guildford & Waverley PCT & DH Change Agency, Guildford Borough Council.

Co-Grant holder (with Dr A Dickinson, University of Hertfordshire) Facilitators and barriers to older people accepting and complying with interventions to reduce falling and fractures: October 2004-September 2006. Funded by Department of Health.

Co-Grant Holder (with Dr R Gray, Consultant at RSCH). A Case-control study of osteoporosis screening in older women”: July 2004-December 2005. Funded by Royal Surrey County Hospital R & D.

 

Research Collaborations

Can Ballet help us age better? (Interdisciplinary Mini Sabbatical)
1st February 2013 - 14 June 2013
Collaborators: Khim Horton (Health and Social Care), Jennifer Jackson (Arts), Aliah Shaheen (Mechanical Engineering Sciences)
There is a recent move towards the employment of dance techniques to improve the interaction of older people with their environments and reduce risks of injury. Ballet is believed to improve spatial awareness, posture, movement coordination and proprioception; and could be used to inform rehabilitation of older people. However, it is not yet known whether the skills gained from ballet training translate when performing functional activities of daily living, and the effects of ageing on movement and stability parameters are also not well understood. The study aims to understand the effect of ballet dance and ageing on movement and stability.

Publications

Highlights

  • Darling AL, Hakim OA, Horton K, Gibbs MA, Cui L, Berry JL, Lanham-New SA, Hart KH. (2013) 'Adaptations in tibial cortical thickness and total volumetric bone density in postmenopausal South Asian women with small bone size.'. Bone, 55 (1), pp. 36-43.

    Abstract

    There is some evidence that South Asian women may have an increased risk of osteoporosis compared with Caucasian women, although whether South Asians are at increased risk of fracture is not clear. It is unknown whether older South Asian women differ from Caucasian women in bone geometry. This is the first study, to the authors' knowledge, to use peripheral Quantitative Computed Tomography (pQCT) to measure radial and tibial bone geometry in postmenopausal South Asian women. In comparison to Caucasian women, Asian women had smaller bone size at the 4% (-18% p<0.001) and 66% radius (-15% p=0.04) as well as increased total density at the 4% (+13% p=0.01) radius. For the tibia, they had a smaller bone size at the 4% (-16% p=0.005) and 14% (-38% p=0.002) sites. Also, Asians had increased cortical thickness (-17% p=0.04) at the 38% tibia, (in proportion to bone size (-30% p=0.003)). Furthermore, at the 4% and 14% tibia there were increased total densities (+12% to +29% p<0.01) and at the 14% tibia there was increased cortical density (+5% p=0.005) in Asians. These differences at the 14% and 38% (but not 4%) remained statistically significant after adjustment for Body Mass Index (BMI). These adaptations are similar to those seen previously in Chinese women. Asian women had reduced strength at the radius and tibia, evidenced by the 20-40% reduction in both polar Strength Strain Index (SSIp) and fracture load (under bending). Overall, the smaller bone size in South Asians is likely to be detrimental to bone strength, despite some adaptations in tibial cortical thickness and tibial and radial density which may partially compensate for this.

  • Darling AL, Hart KH, Lanham-New SA, MacDonald HM, Horton K, Kang'Ombe AR, Berry JL. (2013) 'Vitamin D deficiency in UK South Asian Women of childbearing age: A comparative longitudinal investigation with UK Caucasian women'. Osteoporosis International, 24 (2), pp. 477-488.

    Abstract

    This is the first 1-year longitudinal study which assesses vitamin D deficiency in young UK-dwelling South Asian women. The findings are that vitamin D deficiency is extremely common in this group of women and that it persists all year around, representing a significant public health concern. Introduction: There is a lack of longitudinal data assessing seasonal variation in vitamin D status in young South Asian women living in northern latitudes. Studies of postmenopausal South Asian women suggest a lack of seasonal change in 25-hydroxy vitamin D [25(OH)D], although it is unclear whether this is prevalent among premenopausal South Asians. We aimed to evaluate, longitudinally, seasonal changes in 25(OH)D and prevalence of vitamin D deficiency in young UK-dwelling South Asian women as compared with Caucasians. We also aimed to establish the relative contributions of dietary vitamin D and sun exposure in explaining serum 25(OH)D. Methods: This is a 1-year prospective cohort study assessing South Asian (n = 35) and Caucasian (n = 105) premenopausal women living in Surrey, UK (51 N), aged 20-55 years. The main outcome measured was serum 25(OH)D concentration. Secondary outcomes were serum parathyroid hormone, self-reported dietary vitamin D intake and UVB exposure by personal dosimetry. Results: Serum 25(OH)D <25 nmol/L was highly prevalent in South Asians in the winter (81 %) and autumn (79.2 %). Deficient status (below 50 nmol/L) was common in Caucasian women. Multi-level modelling suggested that, in comparison to sun exposure (1.59, 95 %CI = 0.83-2.35), dietary intake of vitamin D had no impact on 25(OH)D levels (-0.08, 95 %CI = -1.39 to 1.23). Conclusions: Year-round vitamin D deficiency was extremely common in South Asian women. These findings pose great health threats regarding the adverse effects of vitamin D deficiency in pregnancy and warrant urgent vitamin D public health policy and action. © 2012 International Osteoporosis Foundation and National Osteoporosis Foundation.

  • Curtis K, Horton K, Smith P. (2012) 'Student nurse socialisation in compassionate practice: A Grounded Theory study.'. Nurse Educ Today,

    Abstract

    Compassionate practice is expected of Registered Nurses (RNs) around the world while at the same time remaining a contested concept. Nevertheless, student nurses are expected to enact compassionate practice in order to become RNs. In order for this to happen they require professional socialisation within environments where compassion can flourish. However, there is concern that student nurse socialisation is not enabling compassion to flourish and be maintained upon professional qualification. In order to investigate this further, a Glaserian Grounded Theory study was undertaken using in-depth, digitally recorded interviews with student nurses (n=19) at a university in the north of England during 2009 and 2010. Interviews were also undertaken with their nurse teachers (n=5) and data from National Health Service (NHS) patients (n=72,000) and staff (n=290,000) surveys were used to build a contextual picture of the student experience. Within the selected findings presented, analysis of the data indicates that students aspire to the professional ideal of compassionate practice although they have concerns about how compassionate practice might fit within the RN role because of constraints on RN practice. Students feel vulnerable to dissonance between professional ideals and practice reality. They experience uncertainty about their future role and about opportunities to engage in compassionate practice. Students manage their vulnerability and uncertainty by balancing between an intention to uphold professional ideals and challenge constraints, and a realisation they might need to adapt their ideals and conform to constraints. This study demonstrates that socialisation in compassionate practice is compromised by dissonance between professional idealism and practice realism. Realignment between the reality of practice and professional ideals, and fostering student resilience, are required if students are to be successfully socialised in compassionate practice and enabled to retain this professional ideal within the demands of 21st century nursing.

  • Dickinson A, Horton K, Machen I, Bunn F, Cove J, Jain D, Maddex T. (2011) 'The role of health professionals in promoting the uptake of fall prevention interventions: a qualitative study of older people's views'. Age and Ageing, 40 (6), pp. 724-730.

    Abstract

    Background: uptake of and adherence to fall prevention interventions is often poor and we know little about older people's perceptions of and beliefs about fall prevention interventions and how these affect uptake. Objective: to explore older people's perceptions of the facilitators and barriers to participation in fall prevention interventions in the UK. Methods: we undertook a qualitative study with older people who had taken part in or declined to participate in fall prevention interventions using semi-structured interviews (n = 65), and 17 focus groups (n = 122) with older people (including 32 Asian and 30 Chinese older people). This took place in community settings in four geographical areas of the South of England. The mean age of participants was 75 years (range 60–95). Data analysis used a constant comparative method. Results: older people reported that health professionals and their response to reported falls played a major role in referral to and uptake of interventions, both facilitating and hindering uptake. Health professionals frequently failed to refer people to fall prevention interventions following reports of falls and fall-related injuries. Conclusions: consideration should be given to inclusion of opportunistic and routine questioning of older people about recent falls by practitioners in primary care settings. Referrals should be made to appropriate services and interventions for those who have experienced a fall to prevent further injuries or fracture.

  • Horton K, Dickinson A. (2011) 'The role of culture and diversity in the prevention of falls among older Chinese people.'. Can J Aging, 30 (1), pp. 57-66.

    Abstract

    This grounded-theory study explored the perceptions of Chinese older people, living in England, on falls and fear of falling, and identified facilitators and barriers to fall prevention interventions. With a sample of 30 Chinese older people, we conducted two focus groups and 10 in-depth interviews in Mandarin or Cantonese. Interview transcripts, back translated, were analyzed using N6. Constant comparative analysis highlighted a range of health-seeking behaviors after a fall: Chinese older people were reluctant to use formal health services; talking about falls was avoided; older people hid falls from their adult children to avoid worrying them; and fatalistic views about falls and poor knowledge about availability and content of interventions were prevalent. Cost of interventions was important. Chinese older adults valued their independence, and cultural intergenerational relations had an impact on taking action to prevent falls. Cultural diversity affects older adults' acceptance of fall prevention interventions.

  • Dickinson A, Machen I, Horton K, Jain D, Maddex T, Cove J. (2011) 'Fall prevention in the community: What older people say they need'. British Journal of Community Nursing, 16 (4), pp. 174-180.
  • Bunn F, Dickinson A, Barnett-Page E, Mcinnes E, Horton K. (2008) 'A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions'. AGEING SOC, 28, pp. 449-472.
  • Horton K. (2008) 'The use of telecare for people with chronic obstructive pulmonary disease: implications for management'. JOURNAL OF NURSING MANAGEMENT, 16 (2), pp. 173-180.
  • Horton K. (2008) 'Falls in older people: The place of telemonitoring in rehabilitation'. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT, 45 (8), pp. 1183-1194.
  • Horton K, Tschudin V, Forget A. (2007) 'The value of nursing: a literature review.'. Nurs Ethics, England: 14 (6), pp. 716-740.

    Abstract

    This article is part of a wider study entitled Value of Nursing, and contains the literature search from electronic databases. Key words for the search included 'values of nursing', 'values in nursing', 'organisational values' and 'professional identity'. Thirty-two primary reports published in English between 2000 and 2006 were identified. The findings highlight the importance of understanding values and their relevance in nursing and how values are constructed. The value of nursing is seen to be influenced by cultural change, globalization, and advancement in technology and medicine. These factors are crucial in providing a more structured and measured view of what nursing is, which will result in greater job satisfaction among nurses, better nurse retention and enhanced patient care within a supportive and harmonious organization. The findings of this review have implications for policy makers in recruitment and retention in determining the global value of nursing.

Journal articles

  • Johnson M, Ball E, Magnusson C, Horton K, Curtis K, Westwood S, Allan H, Evans K. (2015) ''Doing the writing' and 'working in parallel': How 'distal nursing' affects delegation and supervision in the emerging role of the newly qualified nurse'. Nurse Education Today, 35 (2), pp. e29-e33.

    Abstract

    Background: The role of the acute hospital nurse has moved away from the direct delivery of patient care and more towards the management of the delivery of bedside care by healthcare assistants. How newly qualified nurses delegate to and supervise healthcare assistants is important as failures can lead to care being missed, duplicated and/or incorrectly performed. Objectives: The data described here form part of a wider study which explored how newly qualified nurses recontextualise knowledge into practice, and develop and apply effective delegation and supervision skills. This article analyses team working between newly qualified nurses and healthcare assistants, and nurses' balancing of administrative tasks with bedside care. Methods and Analysis: Ethnographic case studies were undertaken in three hospital sites in England, using a mixed methods approach involving: participant observations; interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers. Data were analysed using thematic analysis, aided by the qualitative software NVivo. Findings: Multiple demands upon the newly qualified nurses' time, particularly the pressures to maintain records, can influence how effectively they delegate to, and supervise, healthcare assistants. While some nurses and healthcare assistants work successfully together, others work 'in parallel' rather than as an efficient team. Conclusions: While some ward cultures and individual working styles promote effective team working, others lead to less efficient collaboration between newly qualified nurses and healthcare assistants. In particular the need for qualified nurses to maintain records can create a gap between them, and between nurses and patients. Newly qualified nurses require more assistance in managing their own time and developing successful working relationships with healthcare assistants.

  • Johnson M, Magnusson C, Allan H, Evans K, Ball E, Horton K, Curtis K, Westwood S. (2014) ''Doing the writing' and 'working in parallel': how 'distal nursing' affects delegation and supervision in the emerging role of the newly qualified nurse.'. Nurse Educ Today, Scotland: 35 (2), pp. e29-e33.

    Abstract

    The role of the acute hospital nurse has moved away from the direct delivery of patient care and more towards the management of the delivery of bedside care by healthcare assistants. How newly qualified nurses delegate to and supervise healthcare assistants is important as failures can lead to care being missed, duplicated and/or incorrectly performed.

  • Allan HT, Magnusson C, Horton K, Evans K, Ball E, Curtis K, Johnson M. (2014) 'People, liminal spaces and experience: understanding recontextualisation of knowledge for newly qualified nurses.'. Nurse Educ Today, Scotland: 35 (2), pp. e78-e83.

    Abstract

    Little is known about how newly qualified nurses delegate to health care assistants when delivering bedside care.

  • Dollard J, Vanlint S, Braunack-mayer A, Horton K. (2014) 'Why older women do or do not seek help from the GP after a fall: A qualitative study'. Family Practice, 31 (2), pp. 222-228.

    Abstract

    Background: It is recommended that older people report their falls to their general practitioner (GP), to identify falls risk factors. However, many older people do not report falling to their GP. Little is known about the reasons why older people do and do not seek help about falling. Objective: To explore why older women do or do not seek GP help after a fall. Methods: A qualitative study, using semi-structured interviews with 11 community-dwelling women aged ≥ 65 years, living in Adelaide, Australia, who had fallen in the last 12 months. Interviews focused on women's experience of falling and seeking GP help. Interviews were analysed using constant comparison. Results: Four women sought GP help when they believed their fall-related injury was serious enough. Family and a bystander persuaded three women to attend for a fall-related injury. The four women who did not seek help believed their fall or fall-related injury was not serious enough to seek help and justified this by using internal rationales (they monitored and managed the outcome of falling, they wanted to be associated with a positive image and attitude, and they recognized and interpreted the cause and control of falling) and external rationales (they did not want to waste GPs' time for trivial reasons and they believed they did not have timely access to their GP). Conclusions: Given the reasons why some older women do not seek help for falling, GPs should routinely ask older women for their 12-month fall history. © The Author 2014. Published by Oxford University Press. All rights reserved.

  • Darling AL, Hart KH, Gibbs MA, Lanham-New SA, Gossiel F, Eastell R, Kantermann T, Horton K, Johnsen S, Berry JL, Skene DJ, Vieth R. (2014) 'Greater seasonal cycling of 25-hydroxyvitamin D is associated with increased parathyroid hormone and bone resorption'. Osteoporosis International, 25 (3), pp. 933-941.

    Abstract

    This analysis assessed whether seasonal change in 25-hydroxyvitamin D concentration was associated with bone resorption, as evidenced by serum parathyroid hormone and C-terminal telopeptide concentrations. The main finding was that increased seasonal fluctuation in 25-hydroxyvitamin D was associated with increased levels of parathyroid hormone and C-terminal telopeptide. Introduction: It is established that adequate 25-hydroxyvitamin D (25(OH)D, vitamin D) concentration is required for healthy bone mineralisation. It is unknown whether seasonal fluctuations in 25(OH)D also impact on bone health. If large seasonal fluctuations in 25(OH)D were associated with increased bone resorption, this would suggest a detriment to bone health. Therefore, this analysis assessed whether there is an association between seasonal variation in 25(OH)D and bone resorption. Methods: The participants were (n = 279) Caucasian and (n = 88) South Asian women (mean (±SD); age 48.2 years (14.4)) who participated in the longitudinal Diet, Food Intake, Nutrition and Exposure to the Sun in Southern England study (2006-2007). The main outcomes were serum 25(OH)D, serum parathyroid hormone (sPTH) and serum C-terminal telopeptide of collagen (sCTX), sampled once per season for each participant. Results: Non-linear mixed modelling showed the (amplitude/mesor) ratio for seasonal change in log 25(OH)D to be predictive of log sPTH (estimate = 0.057, 95 % CI (0.051, 0.063), p < 0.0001). Therefore, individuals with a higher seasonal change in log 25(OH)D, adjusted for overall log 25(OH)D concentration, showed increased levels of log sPTH. There was a corresponding significant ability to predict the range of seasonal change in log 25(OH)D through the level of sCTX. Here, the corresponding parameter statistics were estimate = 0.528, 95 % CI (0.418, 0.638) and p ≤ 0.0001. Conclusions: These findings suggest a possible detriment to bone health via increased levels of sPTH and sCTX in individuals with a larger seasonal change in 25(OH)D concentration. Further larger cohort studies are required to further investigate these preliminary findings. © 2013 International Osteoporosis Foundation and National Osteoporosis Foundation.

  • Darling AL, Hakim OA, Horton K, Gibbs MA, Cui L, Berry JL, Lanham-New SA, Hart KH. (2013) 'Adaptations in tibial cortical thickness and total volumetric bone density in postmenopausal South Asian women with small bone size.'. Bone, 55 (1), pp. 36-43.

    Abstract

    There is some evidence that South Asian women may have an increased risk of osteoporosis compared with Caucasian women, although whether South Asians are at increased risk of fracture is not clear. It is unknown whether older South Asian women differ from Caucasian women in bone geometry. This is the first study, to the authors' knowledge, to use peripheral Quantitative Computed Tomography (pQCT) to measure radial and tibial bone geometry in postmenopausal South Asian women. In comparison to Caucasian women, Asian women had smaller bone size at the 4% (-18% p<0.001) and 66% radius (-15% p=0.04) as well as increased total density at the 4% (+13% p=0.01) radius. For the tibia, they had a smaller bone size at the 4% (-16% p=0.005) and 14% (-38% p=0.002) sites. Also, Asians had increased cortical thickness (-17% p=0.04) at the 38% tibia, (in proportion to bone size (-30% p=0.003)). Furthermore, at the 4% and 14% tibia there were increased total densities (+12% to +29% p<0.01) and at the 14% tibia there was increased cortical density (+5% p=0.005) in Asians. These differences at the 14% and 38% (but not 4%) remained statistically significant after adjustment for Body Mass Index (BMI). These adaptations are similar to those seen previously in Chinese women. Asian women had reduced strength at the radius and tibia, evidenced by the 20-40% reduction in both polar Strength Strain Index (SSIp) and fracture load (under bending). Overall, the smaller bone size in South Asians is likely to be detrimental to bone strength, despite some adaptations in tibial cortical thickness and tibial and radial density which may partially compensate for this.

  • Darling AL, Hart KH, Lanham-New SA, MacDonald HM, Horton K, Kang'Ombe AR, Berry JL. (2013) 'Vitamin D deficiency in UK South Asian Women of childbearing age: A comparative longitudinal investigation with UK Caucasian women'. Osteoporosis International, 24 (2), pp. 477-488.

    Abstract

    This is the first 1-year longitudinal study which assesses vitamin D deficiency in young UK-dwelling South Asian women. The findings are that vitamin D deficiency is extremely common in this group of women and that it persists all year around, representing a significant public health concern. Introduction: There is a lack of longitudinal data assessing seasonal variation in vitamin D status in young South Asian women living in northern latitudes. Studies of postmenopausal South Asian women suggest a lack of seasonal change in 25-hydroxy vitamin D [25(OH)D], although it is unclear whether this is prevalent among premenopausal South Asians. We aimed to evaluate, longitudinally, seasonal changes in 25(OH)D and prevalence of vitamin D deficiency in young UK-dwelling South Asian women as compared with Caucasians. We also aimed to establish the relative contributions of dietary vitamin D and sun exposure in explaining serum 25(OH)D. Methods: This is a 1-year prospective cohort study assessing South Asian (n = 35) and Caucasian (n = 105) premenopausal women living in Surrey, UK (51 N), aged 20-55 years. The main outcome measured was serum 25(OH)D concentration. Secondary outcomes were serum parathyroid hormone, self-reported dietary vitamin D intake and UVB exposure by personal dosimetry. Results: Serum 25(OH)D <25 nmol/L was highly prevalent in South Asians in the winter (81 %) and autumn (79.2 %). Deficient status (below 50 nmol/L) was common in Caucasian women. Multi-level modelling suggested that, in comparison to sun exposure (1.59, 95 %CI = 0.83-2.35), dietary intake of vitamin D had no impact on 25(OH)D levels (-0.08, 95 %CI = -1.39 to 1.23). Conclusions: Year-round vitamin D deficiency was extremely common in South Asian women. These findings pose great health threats regarding the adverse effects of vitamin D deficiency in pregnancy and warrant urgent vitamin D public health policy and action. © 2012 International Osteoporosis Foundation and National Osteoporosis Foundation.

  • Abdala G, Kimura M, Koenig H, Horton K. (2012) 'RELIGIOSITY AND QUALITY OF LIFE IN OLDER ADULTS: AN INTEGRATIVE LITERATURE REVIEW'. JOURNAL OF AGING AND PHYSICAL ACTIVITY, 20, pp. S60-S60.
  • Horton K. (2012) 'Active ageing and fall prevention among older Chinese people'. JOURNAL OF AGING AND PHYSICAL ACTIVITY, 20, pp. S111-S112.
  • Horne M, Cacchione P, Horton K. (2012) 'CULTURE, ETHNICITY & PHYSICAL ACTIVITY: PROMOTING ACTIVE AGEING IN OLDER PEOPLE FROM BLACK & MINORITY ETHNIC GROUPS'. JOURNAL OF AGING AND PHYSICAL ACTIVITY, 20, pp. S110-S110.
  • Curtis K, Horton K, Smith P. (2012) 'Student nurse socialisation in compassionate practice: A Grounded Theory study.'. Nurse Educ Today,

    Abstract

    Compassionate practice is expected of Registered Nurses (RNs) around the world while at the same time remaining a contested concept. Nevertheless, student nurses are expected to enact compassionate practice in order to become RNs. In order for this to happen they require professional socialisation within environments where compassion can flourish. However, there is concern that student nurse socialisation is not enabling compassion to flourish and be maintained upon professional qualification. In order to investigate this further, a Glaserian Grounded Theory study was undertaken using in-depth, digitally recorded interviews with student nurses (n=19) at a university in the north of England during 2009 and 2010. Interviews were also undertaken with their nurse teachers (n=5) and data from National Health Service (NHS) patients (n=72,000) and staff (n=290,000) surveys were used to build a contextual picture of the student experience. Within the selected findings presented, analysis of the data indicates that students aspire to the professional ideal of compassionate practice although they have concerns about how compassionate practice might fit within the RN role because of constraints on RN practice. Students feel vulnerable to dissonance between professional ideals and practice reality. They experience uncertainty about their future role and about opportunities to engage in compassionate practice. Students manage their vulnerability and uncertainty by balancing between an intention to uphold professional ideals and challenge constraints, and a realisation they might need to adapt their ideals and conform to constraints. This study demonstrates that socialisation in compassionate practice is compromised by dissonance between professional idealism and practice realism. Realignment between the reality of practice and professional ideals, and fostering student resilience, are required if students are to be successfully socialised in compassionate practice and enabled to retain this professional ideal within the demands of 21st century nursing.

  • Dickinson A, Horton K, Machen I, Bunn F, Cove J, Jain D, Maddex T. (2011) 'The role of health professionals in promoting the uptake of fall prevention interventions: a qualitative study of older people's views'. Age and Ageing, 40 (6), pp. 724-730.

    Abstract

    Background: uptake of and adherence to fall prevention interventions is often poor and we know little about older people's perceptions of and beliefs about fall prevention interventions and how these affect uptake. Objective: to explore older people's perceptions of the facilitators and barriers to participation in fall prevention interventions in the UK. Methods: we undertook a qualitative study with older people who had taken part in or declined to participate in fall prevention interventions using semi-structured interviews (n = 65), and 17 focus groups (n = 122) with older people (including 32 Asian and 30 Chinese older people). This took place in community settings in four geographical areas of the South of England. The mean age of participants was 75 years (range 60–95). Data analysis used a constant comparative method. Results: older people reported that health professionals and their response to reported falls played a major role in referral to and uptake of interventions, both facilitating and hindering uptake. Health professionals frequently failed to refer people to fall prevention interventions following reports of falls and fall-related injuries. Conclusions: consideration should be given to inclusion of opportunistic and routine questioning of older people about recent falls by practitioners in primary care settings. Referrals should be made to appropriate services and interventions for those who have experienced a fall to prevent further injuries or fracture.

  • Wiseman A, Horton K. (2011) 'Developing clinical scenarios from a European perspective: Successes and challenges.'. Nurse Educ Today, 31 (7), pp. 677-681.

    Abstract

    This paper presents developmental work involving students from the University College Dublin (UCD), Ireland (n=9), University of Surrey, England (n=8) and University of Ljubljana and University of Maribor, Slovenia (n=5) participating in the Erasmus Intensive Programme. The Erasmus programme offers a two week 'Summer School' in the Faculty of Health Sciences, University of Maribor, Slovenia. Using a participatory approach, facilitators from both the UCD and Surrey engaged with students from all of the universities to develop scenarios for simulated learning experiences, in the care of older people, for utilisation on an e learning facility and within the simulated clinical learning environment. Students developed key transferable skills in learning, such as information literacy, cultural diversity, team working, communication, and clinical skills acquisition whilst exploring differences in healthcare delivery in other European countries.

  • Horton K, Dickinson A. (2011) 'The role of culture and diversity in the prevention of falls among older Chinese people.'. Can J Aging, 30 (1), pp. 57-66.

    Abstract

    This grounded-theory study explored the perceptions of Chinese older people, living in England, on falls and fear of falling, and identified facilitators and barriers to fall prevention interventions. With a sample of 30 Chinese older people, we conducted two focus groups and 10 in-depth interviews in Mandarin or Cantonese. Interview transcripts, back translated, were analyzed using N6. Constant comparative analysis highlighted a range of health-seeking behaviors after a fall: Chinese older people were reluctant to use formal health services; talking about falls was avoided; older people hid falls from their adult children to avoid worrying them; and fatalistic views about falls and poor knowledge about availability and content of interventions were prevalent. Cost of interventions was important. Chinese older adults valued their independence, and cultural intergenerational relations had an impact on taking action to prevent falls. Cultural diversity affects older adults' acceptance of fall prevention interventions.

  • Bachtiar NS, Hussain R, Lanham-New SA, Horton K. (2011) 'Infant Feeding Practices in The Klang Valley, Malaysia'. PROCEEDINGS OF THE NUTRITION SOCIETY, 70 (OCE6), pp. E359-E359.
  • Dickinson A, Machen I, Horton K, Jain D, Maddex T, Cove J. (2011) 'Fall prevention in the community: What older people say they need'. British Journal of Community Nursing, 16 (4), pp. 174-180.
  • Gallagher A, Horton K, Tschudin V, Lister S. (2009) 'Exploring the views of patients with cancer on what makes a good nurse--a pilot study.'. Nurs Times, England: 105 (23), pp. 24-27.

    Abstract

    This article presents and discusses findings from a qualitative pilot study that surveyed patients with cancer to discover their views on what makes a good nurse. Ten outpatients at a U.K. specialist cancer hospital, who had received inpatient treatment for cancer, were interviewed. The interview data was analysed thematically and four themes identified: good nurse virtues; knowledge; skill; and, organisational culture.

  • Allan H, Tschudin V, Horton K. (2008) 'The devaluation of nursing: A position statement'. NURSING ETHICS, 15 (4), pp. 549-556.
  • Bunn F, Dickinson A, Barnett-Page E, Mcinnes E, Horton K. (2008) 'A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions'. AGEING SOC, 28, pp. 449-472.
  • Horton K. (2008) 'The use of telecare for people with chronic obstructive pulmonary disease: implications for management'. JOURNAL OF NURSING MANAGEMENT, 16 (2), pp. 173-180.
  • Horton K. (2008) 'Falls in older people: The place of telemonitoring in rehabilitation'. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT, 45 (8), pp. 1183-1194.
  • Horton K, Tschudin V, Forget A. (2007) 'The value of nursing: a literature review.'. Nurs Ethics, England: 14 (6), pp. 716-740.

    Abstract

    This article is part of a wider study entitled Value of Nursing, and contains the literature search from electronic databases. Key words for the search included 'values of nursing', 'values in nursing', 'organisational values' and 'professional identity'. Thirty-two primary reports published in English between 2000 and 2006 were identified. The findings highlight the importance of understanding values and their relevance in nursing and how values are constructed. The value of nursing is seen to be influenced by cultural change, globalization, and advancement in technology and medicine. These factors are crucial in providing a more structured and measured view of what nursing is, which will result in greater job satisfaction among nurses, better nurse retention and enhanced patient care within a supportive and harmonious organization. The findings of this review have implications for policy makers in recruitment and retention in determining the global value of nursing.

  • Horton K. (2007) 'Gender and the risk of falling: a sociological approach.'. J Adv Nurs, England: 57 (1), pp. 69-76.

    Abstract

    This paper reports a grounded theory study of the influence of gender on older people's perceptions of their risk of falling and their actions to prevent future falls.

Conference papers

  • Anderson J, Horton K, Bust PD. (2008) 'EVALUATION OF THE EFFECTIVENESS OF TELECARE FOR INDEPENDENT LIVING IN SURREY'. TAYLOR & FRANCIS LTD CONTEMPORARY ERGONOMICS 2008, Univ Nottingham, Nottingham, ENGLAND: Annual Meeting of the Ergonomics-Society, pp. 8-13.

Publications

Horton K, Brown B, Herniman H & Young H (2009) A report about the Erasmus Lifelong Learning International Summer School, 8-19 June 2009. Generations Review, 19 (3), 1-5 online

Gallagher A, Horton K & Tschudin V (2009) Exploring the views of patients with cancer on what makes a good nurse-a pilot study. Nursing Times, 105, 23, early online publication.

Horton K (2008) Falls in older people: the place of telemonitoring in rehabilitation.  Journal of Rehabilitation Research and Development, 45 (8), 1183-1194.

Horton K. (2008) The use of telecare for people with Chronic Obstructive Pulmonary Disease: Implications for management.  Journal of Nursing Management, 16, 173-80.

Bunn F, Dickinson A, Barnett-Page, E, McInness E, Horton K (2008) Fall prevention and older people: a systematic review of barriers and facilitators. Ageing and Society, 28, 449-472.

Allan H, Tschudin V & Horton K (2008) The devaluing of nursing: a position statement. Nursing Ethics 15, 549-556.

Horton K, Tschudin V and Forget A (2007) The value of nursing: a literature review.  Nursing Ethics, 14, 716-740.

Horton K (2007) Gender and the Risk of Falling: A sociological approach. Journal of Advanced Nursing, 57(1), 69-76.

Horton K (2006) Balancing risk and independence in gerontological nursing’ IN Godin, P (ed) Risk and Nursing Practice, Basingstoke, Palgrave,. Pp150-162.

Horton K. (2004) ‘Cultural experiences in research’ IN Gregory S. Hallowel N. and Lawton J. (eds) The Pleasures, Perils and Pitfalls of Doing Social Science Research. Buckingham, Open University Press. Pp 51-3.

Horton K. and Arber S. (2004) Gender and the negotiation between older people and their carers in the prevention of falls. Ageing and Society, 24, 1-20

Horton K (2004) Self, In Lawton J, Hallowell N, and Gregory S. (eds) Reflecting upon research: the perils, pitfalls and pleasures of doing social science research. London, McGraw Hill. p 53.  

Horton K (2004) Assistive technology: Recruiting older people. IN, Challenging Perceptions of Later Life. Centre for Research in Ageing and Gender, British Society of Gerontology, 33rd Annual Scientific Meeting, University of Surrey, p.82

Easterbrook, L. Horton, K. Arber, S. and Davidson, K. (2002) Going, going, gone- reducing falls. Working with Older People, 6, 1, 19-22.

Horton K (2000) ‘Gender difference in the meaning and experience of falls among older people’ , in Dickinson A, Bartlett H & Wade S (eds) ‘Old Age in a New Age’, British Society of Gerontology Conference Proceedings, Oxford Brooks University, pp. 338-342.


Research Reports
Horton K & Magnusson C (2008) A review of student exit interview processes. A report for the University of Surrey [Widening Access Fund].

Horton K & Anderson J (2008) South West Surrey Safe at Home Project Evaluation. A report for Guildford Borough Council.

Allan H, Anderson J, Horton K, Knibb W & O’Driscoll M (2008) Supporting the transition from doctorate to post doctoral employment: developing and piloting a tool for personal development and training needs analysis A report for Fund for Researcher Development, Roberts Monies.

Bunn F, Barnett-Page, E, McInness E, Dickinson A and Horton K (2008) ‘Facilitators and Barriers to fall prevention and older people’  A report for the Department of Health.

Horton K & Anderson J (2007) Surrey Preventative Technologies Grant Project Evaluation. A Report for Surrey County Council.

Anderson J & Horton K (2007) Medical Scenarios for System Test and Evaluation. A Guardian Angel project report.

Horton K, Gray R, Lovell D & Lawrenson R (2006) A Case-Control Study of Osteoporosis Screening in Women. A report to the Royal Surrey County Hospital, Guildford.

Westwood O, Horton K, Faithfull S (2006) Learning Tool for Europe. A Toolkit for Oncology Nursing  European Oncology Nursing Society.

Horton K, Knibb W & Bryan K (2004) An evaluation of the Medical Assessment and Treatment Centre at Ashford Hospital. A report for Ashford and St. Peter’s Hospitals NHS Trust.

Horton K (2003) An evaluation of telemonitoring in responding to falls among older people. A report for the Guildford and Waverley Primary Care Trust, Surrey County Council and Guildford Borough Council.   

Easterbrook L, Horton K, Arber S & Davidson, K. (2001) International Review of Interventions in Falls among Older People. Department of Trade and Industry. A report for the Health Development Agency.

Teaching

Research for Practice (M level)
MSc Dissertation modules
Research and Innovations (on-line) module
MSc Dissertation (on-line) module

Departmental Duties

Erasmus Co-ordinator
Member of Faculty International Affairs Committee
Member of Healthcare Practice research theme
Member of Dissertation and Supervision group

Trustee of Age UK Surrey

 

Conference papers (selected):

Dollard J, Braunack-Mayer A, Horton K, Vanlint S. (2012) Help seeking about falls by older community dwelling South Australian women. Abstract submitted for the 5th Biennial Australian and New Zealand Falls Prevention Conference, 28-30 October 2012, Adelaide Convention Centre, South Australia.

Horne M, Cacchione P, Horton K. Invited Symposium: Culture, ethnicity and physical activity: promoting active ageing in older people from Black and Minority Ethnic Groups.  8th World Congress on Active Ageing - Glasgow 13th-17th August 2012

Faculty Festival of Research: Carin Magnusson, Helen Allan and Khim Horton- The AaRK project: Academic award and Recontextualising/Re-using Knowledge. July 2012.

Horton K (2012) Engaging in Active Living among older people. Invited keynote speaker at the International Seminar: Service Design in Welfare Provision and Business Models. City of Pori, Turku School of Economics at the University of Turku, 23 April 2012.

Collins R, Horton K & McDonnell S (2011) Using Blended Learning to Teach Computer Skills in a Residential Care Setting. CARDI conference, Dublin. November 2011.

Curtis K, Horton K, Smith P (2011) The Student Experience of Socialisation in Compassionate Care. Nurse Education Today Conference, Cambridge. September 2011.

Mweu P & Horton K (2011) ‘Doing Good Work: perspectives of student nurses from the University of Surrey’. 12th International Centre for Nursing Ethics Conference, September 7-8th.

Curtis K, Smith PA and Horton K (2011) ‘The Student Experience of Socialisation in Compassionate Care’- oral paper. 22nd International Networking for Education in Healthcare Conference, Tuesday, 6- Thursday, 8 September 2011, Churchill College, University of Cambridge, UK.

Horton K (2011) ‘Promoting ICT skills among older people to enhance well being and quality of life: an EU perspective’- invited oral paper at the Asia Pacific Conference on Ageing (APCA) 2011, Dignity & Grace of Ageing, Marina Mandarin Hotel, Singapore, March 24-26th.

Horton K (2010) ‘Development of European Projects on Ageing and Technologies ‘ – invited presentation, at the International Conference on Sustainable Ageing, Hotel Macia Real of Alhambra, Granada, Spain, 3-5th November.

Horton K (2010) ‘The use of telecare in the care of older people in the United Kingdom’ – invited paper, presented at the International Conference on Sustainable Ageing, Hotel Macia Real of Alhambra, Granada, Spain, 3-5th November.

Blazun H, Kokol P, Horton K & Collins R (2010) Innovations and collaborations with older people through funded EU projects- lessons learnt. Poster presentation at the European Nursing Congress, Older Persons: The Future of Care, De Doelen, Rotterdam, Netherlands. October 4-7th,

Horton K (2010)  Symposium lead on ‘An inter-disciplinary and participatory approach in the development of a European MSc in Gerontology’, 39th Annual Conference British Society of Gerontology, Brunel University, 6- 8th July.  

Horton K (2009) ‘The role of culture and diversity in the prevention of falls’ in Symposium led by S. Nyman ‘The state of the art: Falls prevention in older people’, The 38th Annual British Society of Gerontology ‘Culture, Diversity and Ageing’, Bristol University, 2-4th September.

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