Showing papers in "British journal of nursing in 2008"
TL;DR: The purpose of this article is to present a step-by-step guide to facilitate understanding by presenting the critical elements of the literature review process.
Abstract: Nowadays, most nurses, pre- and post-qualification, will be required to undertake a literature review at some point, either as part of a course of study, as a key step in the research process, or as part of clinical practice development or policy. For student nurses and novice researchers it is often seen as a difficult undertaking. It demands a complex range of skills, such as learning how to define topics for exploration, acquiring skills of literature searching and retrieval, developing the ability to analyse and synthesize data as well as becoming adept at writing and reporting, often within a limited time scale. The purpose of this article is to present a step-by-step guide to facilitate understanding by presenting the critical elements of the literature review process. While reference is made to different types of literature reviews, the focus is on the traditional or narrative review that is undertaken, usually either as an academic assignment or part of the research process.
1,079 citations
TL;DR: From the review, the main stressors placed on forensic nurses are identified as interprofessional conflicts, workload, and lack of involvement in decision-making.
Abstract: Forensic mental health nurses who work with patients who have severe and enduring mental health needs have been identified as at risk of suffering from occupational stress, and even developing burnout syndrome. Therefore, this article reviews the available literature on stress and burnout in inpatient forensic mental health nursing to identify the stressors and to highlight recommendations. From the review, the main stressors placed on forensic nurses are identified as interprofessional conflicts, workload, and lack of involvement in decision-making. Recommendations to reduce stress and burnout for nurses within this specialty are highlighted. These are identified as follows: staff should have easy access to support systems including clinical supervision; managers should foster an open and honest culture to enable staff members to express their feelings openly or in confidence and learn how to deal with their frustrations; and staff should be encouraged to rotate wards to increase personal and professional development and reduce boredom and apathy. Furthermore, staff should be provided with, and encouraged to undertake, continuing professional development which may include psychosocial interventions training.
131 citations
TL;DR: Methods that can be used to maintain rigour in a qualitative study, including member-checking, peer debriefing, audit trail and reflexivity are outlined.
Abstract: Qualitative research methodology is a suitable approach for clinical inquiry into nursing practice, leading to theory development and advancement in clinical practice. Rigour is necessary to enhance the consistency and quality of qualitative research. It is the framework for demonstrating credibility and integrity of the qualitative research process. Methodological decisions regarding rigour can have implications for the quality, integrity and interpretability of the findings. Rigour, therefore, is a principle that should be present during all stages of the research study, from its inception to the writing of the final report. For qualitative researchers, reaching the desired goal and meeting the requirements of rigour become particularly problematic due to the considerable debate about what it means to do valid research in the field of qualitative inquiry. This article outlines methods that can be used to maintain rigour in a qualitative study, including member-checking, peer debriefing, audit trail and reflexivity.
83 citations
TL;DR: The data confirm the frequency of interruptions, and their potential as a safety hazard, and it is notable that the longest individual interruptions were from conversations with patients and phone calls.
Abstract: Drug administration errors are a common problem; they contribute to unintended patient harm and may in part be due to distractions during the drug administration round. In this study, a prospective sample of 38 drug rounds on an acute surgical ward were observed, and their duration, time spent dealing with interruptions and nature of the interruptions were recorded. On average, 11% of each drug round was spent dealing with interruptions. There were one or more interruptions in two-thirds of the rounds studied (average 2.61 interruptions per round), with a mean duration of 1 minute per interruption. The interruptions came from doctors (21%), other nurses (17%), patients (11%), telephone enquiries (8%), relatives (3%) or were initiated by the nurse conducting the round (21%). This pattern contradicts the subjective impressions of nurses in previous questionnaire studies, but it was notable that the longest individual interruptions were from conversations with patients (mean 249 seconds) and phone calls (mean 212 seconds). The data confirm the frequency of interruptions, and their potential as a safety hazard. Objective information from direct observation will prove valuable in designing possible solutions to the problem. These will require local knowledge and frontline staff involvement to be sustainable.
78 citations
TL;DR: The first sign of possible leakage of drugs into the tissues is pain and discomfort, so patients must be informed of what symptoms to look out for and be asked to report any change in sensation as soon as they are aware of it.
Abstract: Infiltration and extravasation are complications that can occur during intravenous therapy administered via either peripheral or central venous access devices. Both can result in problems with the siting of future venous access devices, nerve damage, infection and tissue necrosis. The nurse is the key to reducing the risk of infiltration and extravasation, through her knowledge and skill in cannulation and the intravenous administration of drugs (by bolus injection or infusion). The nurse must also be able to recognize the early signs and symptoms of infiltration and extravasation and act promptly and effectively to limit tissue damage. The first sign of possible leakage of drugs into the tissues is pain and discomfort, so patients must be informed of what symptoms to look out for and be asked to report any change in sensation as soon as they are aware of it. Finally, accurate documentation of the event is vital to facilitate patient care and in case of litigation.
75 citations
TL;DR: The effects of honey at the wound bed and its clinical applications, along with the current dressings available are examined, as well as the practical considerations, if, like any wound dressing, honey is to be used safely, appropriately and for the benefit of the patient.
Abstract: The use of honey in wound management has enjoyed a resurgence. This is largely due to the growing clinical problem of antibiotic-resistant bacteria and the combined difficulties for the practitioner in managing chronic wound types, such as burns, leg ulcers or surgical wounds, that may become infected, for example, with methicillin-resistant Staphylococcus aureus or Pseudomonas. The associated costs of treating such wounds are escalating as a result. While the use of honey as a wound dressing has been recognized, at least since Egyptian times circa 2000 BC, it is only more recently, due to the development and licensing of modern honey wound dressings, that such dressings have become more widely available and used in wound management. This article focuses on the use of honey in the treatment of infected wounds and burns. It will examine the effects of honey at the wound bed and its clinical applications, along with the current dressings available. Also discussed are the practical considerations, if, like any wound dressing, honey is to be used safely, appropriately and for the benefit of the patient.
74 citations
TL;DR: The need for educational updates for qualified nurses, adequate supply of oral care equipment and promotion of formal assessment tools usage in the hospital setting is indicated.
Abstract: Aim: To assess nurses’ knowledge and practices concerning oral care on surgical and medical wards in a district general hospital in Ireland Methods: A survey of all qualified nurses on three medical and three surgical wards was carried out. Two hundred questionnaires were distributed and 50 were returned with 43 of these rendered useable. Results: The majority of nurses (90%) viewed oral care as an important aspect of nursing care. However, nurses lacked adequate knowledge of oral care practices, and experienced problems attending to oral care as a result of time constraints, lack of oral care packs, patients being confused or uncooperative, lack of toothpaste and toothbrush, limited education and low status attached to oral care. Although most nurses (over 70%) had received education on oral care, this was of short duration. Sixty-four per cent did not use an assessment tool to measure the condition of the patients oral cavity, while 73% believed that an assessment tool would be important to measure a ba...
72 citations
TL;DR: There is an urgent need to implement stress reduction strategies in this nursing specialty and heavy workloads and violent and aggressive behaviours were among the stressors giving rise to staff experiencing difficulties with switching off from work, poor support from management and fear of blame.
Abstract: Background: While studies into stress in mental health nursing are small, studies specifically looking at acute mental health nurses are even fewer. Acute mental health nurses work in environments that are challenging and unpredictable, and care for some of the most seriously ill patients. This area, therefore, needs staff that are physically and psychologically fit for purpose. However, little is known about this cohort of nurses. Aim: In an attempt to address this imbalance, this study aims to ascertain the stressors – the lived experience and meaning – for acute qualified mental health staff. Methodology: Using a hermeneutical phenomenological tradition, eight qualified staff from a London mental health Trust were interviewed. Results: Heavy workloads and violent and aggressive behaviours were among the stressors giving rise to staff experiencing difficulties with switching off from work, poor support from management and fear of blame. These experiences culminated in feeling professionally compromised,...
67 citations
TL;DR: The impact of globalization as an important determinant of NCD epidemics is explored and the fundamental roles of nursing to promote health, prevent disease and alleviate suffering are explored.
Abstract: In most industrialized nations and many developing countries chronic diseases or non-communicable diseases (NCDs) are the leading cause of death. In 2005, chronic diseases, such as cardiovascular disease, cancer, respiratory disease and diabetes caused 58 million deaths worldwide (World Health Organization, 2005). Despite strong evidence for the magnitude of this burden, the preventability of NCD causes and the threat they pose to already strained healthcare systems, national and global responses have been slow. This article provides a global overview of chronic diseases. It further explores the impact of globalization as an important determinant of NCD epidemics. Finally, in addition to working alongside policy-makers, the fundamental roles of nursing to promote health, prevent disease and alleviate suffering call for expression of caring for humanity and environment through political activism at all levels to bring about reforms of current global economic order.
66 citations
TL;DR: An overview of the key elements of research supervision is provided and what each can and should reasonably expect from supervision, how to identify and address potential supervisory problems and how to maintain an effective working relationship is discussed.
Abstract: Many nurses in the United Kingdom are now undertaking PhDs; however, the process is both complex and time consuming. Research has shown that effective supervision can significantly influence the quality of the PhD and its eventual success or failure. Consequently, many common problems experienced during a PhD often relate to difficulties in the supervisory process. PhD students and supervisors often have different expectations, needs and ways of thinking and working. The purpose of this paper is, therefore, to provide an overview of the key elements of research supervision. The paper is aimed at students, prospective students and supervisors involved in the PhD process and explores the perspectives of a student and a supervisor and discusses what each can and should reasonably expect from supervision, how to identify and address potential supervisory problems and how to maintain an effective working relationship.
64 citations
TL;DR: An overview of the relevant literature together with clinical examples from the authors' ICU, which demonstrates their experiences with smart pumps, suggests that smart infusion technology sets a new minimum safety standard for intensive care.
Abstract: There is overwhelming evidence that medication errors present a risk to patients. This risk is highest in the intensive care unit (ICU) setting and even greater when medications are administered via an infusion pump. Standard pumps will not alert for, or prevent, drug calculation, drug unit, button push, or multiple of ten errors when medication delivery data is inputted. However, the literature suggests that smart pumps programmed with hard (unchangeable) limits can significantly reduce drug errors at the point of administration. Staff at St George's Hospital paediatric ICU wanted to implement an infusion pump system that would be immediately effective in reducing medication errors at the point of administration. This article presents an overview of the relevant literature together with clinical examples from the authors' ICU, which demonstrates their experiences with smart pumps. It is the authors' firm belief that smart infusion technology sets a new minimum safety standard for intensive care.
TL;DR: How to recognize severe sepsis is discussed and how nurses can dramatically improve a patient's chance of survival by ensuring that six simple things are done in the first hour is explained.
Abstract: Sepsis kills more people than lung cancer, and more people than bowel and breast cancer put together. The costs to the NHS are significant; it is estimated that in Europe, patients with severe sepsis cost healthcare funders around 7.6 billion euros per year (Daniels et al, 2007). Costs in the United States are estimated at $16 billion annually (Angus et al, 2001), and in the United Kingdom up to 46% of intensive care unit (ICU) bed days are used by patients with severe sepsis (Padkin et al, 2003), with each ICU bed costing around £1700 per day. In 2002 an international campaign was launched: the Surviving Sepsis Campaign. The main aim of this campaign is to reduce mortality from sepsis by 25% by 2009. A lot of the early work has concentrated on improving sepsis care in intensive care units, but many patients on general wards develop sepsis, and the need to educate nurses throughout all areas of the hospital has been recognized. In September 2007 a new part of the campaign was launched called Survive Sepsi...
TL;DR: It is concluded that interest in the topic goes back to psychiatric patients in the 1960s, with the 1990s seeing a shift to all hospitals, and government policies designed to raise the profile of patients' privacy and dignity are revealed.
Abstract: This article reviews the literature on patients' privacy and dignity and concludes that interest in the topic goes back to psychiatric patients in the 1960s, with the 1990s seeing a shift to all hospitals. A number of databases were used to obtain information for the literature review. Findings revealed United Kingdom (UK) government policies designed to raise the profile of patients' privacy and dignity. UK research on patients' privacy/dignity is limited, although there is universal interest. While a variety of methodologies have been used in previous research, and there is consistency in findings, more research is indicated. Previous research spanned topics such as elderly patients, medical and surgical patients, palliative care, rehabilitative settings and child-bearing women. A conceptual framework and definitions of privacy and dignity were examined. Although healthcare professionals and patients attach importance to patients' privacy, there is insufficient understanding of the problem. Limitations of previous research have been discussed.
TL;DR: Analysis of the data suggests that when experiencing an MI, women delay seeking help for a number of reasons, including not recognizing symptoms, perceiving heart disease as a 'male' problem and preferring to self-medicate.
Abstract: Few studies have explored the factors affecting women's decisions to seek medical assistance at the onset of cardiac symptoms. Although some studies have shown that there are gender differences between men and women in terms of how they cope with having a myocardial infarction (MI) and heart disease, few have explored how women actually experience MI and what influences their help-seeking behaviour. Those studies that have, suggest that women often fail to recognize the signs of MI and delay seeking treatment for symptoms of MI longer than men do. This qualitative study explores the female experience of MI, focusing on some of the thought processes and coping strategies used by women when having an MI. Using a grounded theory research approach, 25 post-MI female patients were interviewed about their experiences during acute MI. Through analysing and coding data, a number of categories emerged that provide insight into the health seeking behaviour of women at the onset of MI. Emergent categories were: a delay in seeking help (main category); an engendered perception of heart disease (sub-category); not recognizing symptoms (sub-category); maintaining control through self-medication (sub-category). Analysis of the data suggests that when experiencing an MI, women delay seeking help for a number of reasons, including not recognizing symptoms, perceiving heart disease as a 'male' problem and preferring to self-medicate.
TL;DR: Examining nurses' perspectives of the consequences of WPV, to identify ways to reduce the impact of these incidents and recommendations for improving the safety of hospitals for staff and patients are made.
Abstract: The consequences of workplace violence (WPV) are far-reaching, and impact on the nurse, the perpetrator and the organization. However, the authors were unable to identify any research in the literature on nurses' perceptions of the consequences of WPV in non-teaching hospital settings. This study therefore aimed to examine nurses' perspectives of the consequences of WPV, to identify ways to reduce the impact of these incidents. A descriptive, exploratory approach was adopted to collect qualitative survey and interview data from nurses working in several areas of one West Australian non-teaching hospital in 2006. Three themes emerged from the data: nurse, perpetrator and organizational consequences. The sub-themes included nurses accepting that WPV is part of their job; physical and emotional effects; not feeling competent; avoiding patients; organizational costs of WPV; adverse effects of restraint; and disruption to patient care. Participants experienced several negative consequences as a result of WPV. Recommendations for improving the safety of hospitals for staff and patients are made in light of the findings.
TL;DR: This study adopted a multi-method approach - a low-structured interview coupled with patients' diaries - and was analysed hermeneutically to confirm the validity of the expressed pain narrative through means that do not enforce illness behaviour, but empower the patient to accept their chronic pain and live with it rather than be ruled by it.
Abstract: Acute pain is often accompanied by physiological changes, such as increased heart rate, unlike chronic pain, which in sharp contrast is often unaccompanied by any physiological changes other than the patients’ self report of pain. Coupled with the lack of physiological changes, chronic pain will outlive the usual healing period if an injury has been sustained thereby leading to the unseen nature of the chronic pain phenomenon.This study (n = 8) adopted a multi-method approach – a low-structured interview coupled with patients’ diaries – and was analysed hermeneutically. ‘Unseen pain’ was identified as a category with subsequent themes of ‘isolation’, ‘needing to prove the existence of chronic pain’, ‘in their head’ and ‘depression’. The unseen nature of the chronic pain phenomenon caused further distress to patients as they could feel disbelieved by society as well as by healthcare professionals. This has a profound effect on patients who then channel valuable psychological resources into appearing credib...
TL;DR: The articles describes the range of emotions which many students experienced and the process of gradual disengagement which may precede student decisions to formally withdraw.
Abstract: Nursing student attrition continues to attract political, organizational and social interest for a number of reasons including: persistent nursing shortages, the age profile of the current nursing population and the economic costs of attrition. While attrition in nursing students is not a new phenomenon, it is surprising that this issue has attracted such little research attention. Completed attrition research in nursing has tended to focus on explanations for attrition obtained from students who persist, rather than the experiences of students who have withdrawn from preregistration nursing courses. The emotional impact on students who decide to voluntarily leave has attracted limited theoretical analysis, so a single case study design was selected to help explain the causes of voluntary attrition in nursing students within a School of Nursing and Midwifery. A semi-structured interview method was used to collect data from study participants. The study population was obtained through purposeful sampling a...
TL;DR: Investigation of first-year nursing students' encounters with patient deaths found that, to the student, every death in clinical practice is a learning experience and potentially a source of emotional distress; some students reported experiencing flashbacks afterwards and were developing avoidance behaviours.
Abstract: End-of-life care, particularly for older people, is often sub-optimal in England, and the Government has introduced several initiatives to improve this care. The authors believe the twin frameworks of emotional labour and ethics of non-abandonment underpin the provision of high-quality care. This article discusses a research project that investigated first-year nursing students' encounters with patient deaths. The research found that, to the student, every death in clinical practice is a learning experience and potentially a source of emotional distress; some students reported experiencing flashbacks afterwards and were developing avoidance behaviours. Students sometimes felt unsupported by mentors and also felt that sometimes dying patients and families were inadequately cared for. The theme of abandonment was evident in the students' stories. The authors conclude that there is still room for improvement in end-of-life care. Good role modelling and pastoral care by mentors is vital to student development. Link lecturers and mentors need to be alert to student distress.
TL;DR: The principles of good practice that underpin intravenous (IV) therapy are provided, including the management of IV equipment and the importance of the nurse's role in the prevention of infection associated with IV therapy.
Abstract: This article provides an overview of the principles of good practice that underpin intravenous (IV) therapy. The indications for choosing the IV route and selecting an appropriate vascular access device (VAD) are explained. Common insertion sites for VAD placement and the care and management of VADs are reviewed. Infection control aspects of IV therapy are be highlighted, including the management of IV equipment and the importance of the nurse's role in the prevention of infection associated with IV therapy. Common complications of IV therapy are explained and strategies suggested for their prevention. The article addresses the issues associated with general IV therapy, it does not address specialist subjects such as parenteral nutrition, chemotherapy or blood transfusion.
TL;DR: The article concludes by demonstrating the personal benefits of using Gibbs' (1988) cycle to varying situations and thus promoting its excellence as a learning tool for student nurses worldwide as a consequence.
Abstract: Reflection is a vital skill in contemporary nursing with student nurses expected to engage in reflective learning from the very beginning of the nurse educational programme. This article demonstrates the meaningful learning that resulted as a consequence of using critical reflection on practice. Gibbs' (1988) cycle aided the process highlighting the practical application of this cyclical framework to the author - a first-year student nurse. Matters concerning gender issues in nursing and professional conduct emerged from the analysis and were inherently explored. The article concludes by demonstrating the personal benefits of using Gibbs' (1988) cycle to varying situations and thus promoting its excellence as a learning tool for student nurses worldwide as a consequence.
TL;DR: Recognizing problems relating to meeting patients' privacy and dignity, the article challenges clinical staff and hospital designers to address the issue, especially as central government initiatives and law demand serious attention to ensuring patients'privacy and dignity.
Abstract: In May–June 2006, a self-report questionnaire was completed by 40 inpatients to assess their experience of privacy and dignity in hospital. The questionnaire comprised closed and open questions, where the latter, among other things, required the patient’s own narrative. Results indicate that patients view privacy/dignity as crucial. Although the staff and inadequate ward layouts compromise and conspire against patients’ privacy and dignity, patients appear to sympathize with how hospitals are run, even if the caring environment fails to provide full privacy. Women have greater concerns, and both genders indicated how their privacy and dignity could be met. Recognizing problems relating to meeting patients’ privacy and dignity, the article challenges clinical staff and hospital designers to address the issue, especially as central government initiatives and law demand serious attention to ensuring patients’ privacy and dignity. Research is indicated to ascertain hospital designs, preferred care strategies ...
TL;DR: Understanding the concept of vulnerability should enable nurses to recognize the centrality of older people in service provision, and to contribute positively to their autonomy and act as their advocates, to help nurses to educate older people about the rights and choices available to them.
Abstract: Many people associate vulnerability with old age, resulting in negative stereotypical views. This concept analysis of the literature on vulnerability examines how and why older people are considered vulnerable, to assess whether the attitudes and assumptions of society at large, or the approaches of health and social care professionals in particular, contribute to this view. The authors used data collected from the literature review, which incorporated holistic approaches to caring for older people, to construct a psycho-social definition of vulnerability and define the attributes of vulnerability according to categories, causes and effects. This definition was underpinned by theoretical knowledge and practice experience of working with older people and teaching nursing students about older people. Understanding the concept of vulnerability should enable nurses to recognize the centrality of older people in service provision, and to contribute positively to their autonomy and act as their advocates. It will also help nurses to educate older people about the rights and choices available to them, enabling them to participate fully in society.
TL;DR: It was found that environmental noise, pain and tension were most likely to disrupt the sleep of surgical patients and four recommendations were established to improve theSleep of hospital patients.
Abstract: Background: Sleep has a common structure and pattern and is thought to be a restorative process. Sleep deprivation and disruption can cause a myriad of physical and psychological changes, which can all have an impact on health care. As such, sleep is recognized as being beneficial to health and an important aspect of nursing care. Method: This study used an expansion component mixed-method design to describe the sleep experience of patients on surgical wards. This involved establishing the factors which disturb sleep and describing patients’ experiences of sleep disruption. Results: 17 of the 24 patients approached participated in the study, providing a 71% response rate. Environmental factors were found to be strongly correlated with sleep disruption with a Pearson’s coefficient of +0.795. Personal factors were also found to be correlated with sleep disruption although, with a Pearson’s coefficient of +0.590, not as strongly as environmental factors. Discussion: This study found that environmental noise,...
TL;DR: The results suggest that the 2LB achieves the required therapeutic pressure necessary for the management of venous leg ulcers, is easy to apply and may provide a suitable alternative to other multi-layer bandage systems.
Abstract: Objective: To measure and compare the interface pressures achieved with two compression bandage systems – a four-layer system (4LB) and a two-layer short-stretch system (SSB) – with a new two-layer system (2LB), which uses an etalonnage (performance indicator) to help achieve the correct therapeutic pressure for healing venous leg ulcers – recommended as 40 mmHg. Method: 32 nurses with experience of using compression bandages applied each of the three systems to a healthy female volunteer in a sitting position. The interface pressures and time taken to apply the systems were measured. A questionnaire regarding the concept of the new system and its application in comparison to the existing two systems was then completed by the nurses. Results: The interface pressures achieved show that many nurses applied very high pressures with the 4LB (25% achieving pressures > 50 mmHg) whereas the majority of the nurses (75%) achieved a pressure of < 30 mmHg when using the SSB. A pressure of 30–50 mmHg was achieved wit...
TL;DR: The cause of catheter pain is often treatable, but should not be regarded negatively or ignored, as it warns of potentially harmful conditions and allows intervention before permanent damage can occur.
Abstract: Urinary catheters can be introduced into the urinary bladder either per urethra or via the suprapubic route; this article examines indications and contraindications to these routes. Catheter pain is subdivided into pain experienced as the catheter is passed, while in situ, and on removal. Relating to pain felt on insertion, risks associated with local anaesthetic/antiseptic gel and the occurrence of paraphimosis are discussed. Once in situ, the type of material used to manufacture the catheter, pressure on the urethra caused by a large Charriere size catheter, or from drainage bag traction, leading to discomfort and possible tissue damage are examined and solutions suggested. Catheter-associated meatal trauma in men and urethral post-menopausal discomfort in women are addressed; likewise, catheter cramp due to bladder spasm or catheter blockage, and interventions are recommended. Encrustation and 'cuffing' may cause pain during catheter removal and again, advice is given. Lastly, the possibility of pain due to fear/non-acceptance of the catheter is raised. In conclusion, once identified, the cause of catheter pain is often treatable, but should not be regarded negatively or ignored, as it warns of potentially harmful conditions and allows intervention before permanent damage can occur.
TL;DR: Current evidence suggests use of 1 to 2 cm excision margins in surgical removal of melanoma, and wider margins may be necessary in patients with thicker melanomas with higher risk for local recurrence, which may lead to the development of novel melanoma therapies.
Abstract: This article reviews current evidence on epidemiology, diagnosis and management of cutaneous melanoma. Incidence of cutaneous melanoma is rising in all Caucasian populations across the world; thus, melanoma represents a significant public health burden. Although, incidence of melanoma is in continuous increase, a decrease of mortality and improved survival has been observed in most western European populations. Clinical characteristics of four major types of melanoma (superficial spreading, nodular, lentigo maligna melanoma and acral lentiginous melanoma) have been described. Surgical removal of melanoma remains the standard care in all primary melanomas. Current evidence suggests use of 1–2 cm excision margins. Wider margins may be necessary in patients with thicker melanomas with higher risk for local recurrence. In the treatment of regional lymph nodes elective lymphadenectomy has been surpassed by the sentinel lymph node biopsy (SLNB). However, although prognostic value of SLNB has been confirmed, it’...
TL;DR: A step-by-step guide for stoma care nurses to implement the prevention programme and/or study within their area and a statistically significant reduction in the incidence of parastomal hernias through the introduction of a simple non-invasive prevention programme are reviewed.
Abstract: Parastomal hernia continues to be a common and distressing problem for patients with stomas, and research investigating prevention strategies is scant. In March 2005 Thompson and Trainor reported that the introduction of a prevention programme for 1-year post-stoma surgery formation had significantly reduced the incidence of development of parastomal hernia. This was further supported by a follow-up study in 2007, strengthening the reliability and validity of the first findings by confirming a statistically significant reduction in the incidence of parastomal hernias through the introduction of a simple non-invasive prevention programme. This article reviews the current literature on incidence, prevention and treatment, together with a step-by-step guide for stoma care nurses to implement the prevention programme and/or study within their area.
TL;DR: Healthcare management strategies for preventing infection when performing peripheral cannulation include the Peripheral Venous Cannulation Policy, which empowers practitioners to challenge poor cannulation skills and standardize practice; education, which provides learning opportunities within programmes such as Infection Control Core Competencies Study Days, and infection prevention strategies directly related to cannula care.
Abstract: Peripheral intravenous (IV) cannulation is a procedure that involves breaching the integrity of the skin, exposing patients to the risk of infection. Acquisition of infection has associated costs both for patients and the NHS. The high number of peripheral IV cannulae (PICs) inserted annually has resulted in serious infection and significant morbidity (O'Grady et al, 2002). Risks associated with PIC infection must be addressed to reduce patient morbidity and increased cost of prolonged hospital admission and treatment. This article discusses the sources and routes of infection associated with peripheral IV cannulation, and examines healthcare management strategies for preventing infection when performing peripheral cannulation. These comprise: the Peripheral Venous Cannulation Policy, which empowers practitioners to challenge poor cannulation skills and standardize practice; education, which provides learning opportunities within programmes such as Infection Control Core Competencies Study Days, designed to promote infection prevention strategies directly related to cannula care and aimed at all levels of Trust staff; and the Peripheral Cannula Care Plan, which ensures accurate documentation of cannulation procedures. This last strategy is simple to use and provides a route for improving cannula-related documentation. A high standard of documentation will also assist audit, which is crucial to reducing PIC infection.
TL;DR: The focus of this article is on exploring the literature on models of support for student nurses with particular emphasis on the concept of preceptorship.
Abstract: Nursing is a practice-based discipline and clinical practice is considered to be an integral part of nurse education. The pivotal role that preceptors play in the socialization, teaching and assessing of student nurses, is vital in helping students to integrate theory with practice. However, some evidence suggests that there can be minimal contact between the stakeholders involved in the students' education process, namely the university lecturers and preceptors. The focus of this article is on exploring the literature on models of support for student nurses with particular emphasis on the concept of preceptorship.
TL;DR: The Reason-Story-Vital Signs-Plan system, used in the Acute Life-threatening Events--Recognition and Treatment (ALERT) course, is easy to remember in an emergency and includes the essential information enabling an experienced clinician to respond appropriate to a call for help from ward staff.
Abstract: Communication failures are a prime cause of patient safety incidents. In a medical emergency, patient survival often depends on ward staff making an early and effective call for help. To improve communication with senior colleagues, ward staff need to create a picture that efficiently and reliably conveys their concerns so that they get the help that they need without delay. This can best be achieved though a structured call for help. The Reason-Story-Vital Signs-Plan system, used in the Acute Life-threatening Events--Recognition and Treatment (ALERT) course, is easy to remember in an emergency and includes the essential information enabling an experienced clinician to respond appropriate to a call for help from ward staff. The use of such a structured call for help could improve patient safety.