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Aim: this article proposes a radical new approach to the monitoring and governance of services, and the education and training of nurses to meet ‘failure to rescue’ requirements. Background: healthcare policy in the UK that seeks to ensure safe and effective services for the acutely ill has largely failed, resulting in adult patients dying unnecessarily. Despite grand rhetoric, UK governments have distanced themselves from implementation, resulting in patchy localised developments and creating inconsistent service responses. Design and data sources: this article draws on a review of research and UK policy literature and best international practice to propose a new national framework approach that combines competency development, governance and performance monitoring to address ‘failure to rescue’ shortcomings. Implications for nursing: paramount is a nationally agreed and fit-for-purpose competency tool using simulation to assess staff in order to improve recognition of the deteriorating patient. Service improvements should include increased investment in telemedicine; service performance should be communicated through publicly available ratings and overseen by patient panels; and governance will require strengthening through enhanced Care Quality Commission/Monitor input, which should be linked to the maintenance of foundation trust status. Conclusion: health professional bodies, regulators, providers and the Government must work together to strengthen the safety and effectiveness of acute services. This will require investment in staff competency and enhancement of the governance to ensure services consistently meet public expectations and reduce unnecessary deaths. [ABSTRACT FROM AUTHOR]

Aim: Rapidly evolving roles in nursing require exploration and description. This review aims to examine the role of the clinical nurse specialist (CNS) in stoma care from the UK perspective. Design: A scoping review was undertaken using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Data were synthesised using content analysis to derive meaning units and themes. Data sources: Three electronic databases were used to conduct the search: Embase, AMED and Ovid Medline. Additional sources identified through the reference lists of included studies and guidelines were also included. Methods: Two reviewers undertook the search for articles that described the role of the stoma care CNS in the UK. Any disagreements were to be resolved through discussion. Results: Seven papers met the eligibility criteria. Analysis resulted in 184 unique meaning units. Meaning units were grouped into themes reflecting the four pillars of advanced practice: advanced clinical practice; leadership; facilitation of education and learning; and evidence, research and development. The fewest meaning units were attributed to the evidence theme (n=13) and the most related to advanced clinical practice (n=107) such as having specialist knowledge and skills to manage complications. Conclusion: The stoma care CNS role reflects the four pillars of advanced practice. These practitioners are valuable, carrying out a complex role that involves high-level, specialist decision-making skills. The results from this scoping review could be useful in service development; they will be used to inform the Association of Stoma Care Nurses UK modified Delphi consensus to examine the views of stoma care CNS practitioners. [ABSTRACT FROM AUTHOR]

The article focuses on electronic patient records and the role that they can play in helping health care facilities become paper-light. In the article the author offers his opinions on the benefits of electronic medical records and on an electronic health program policy statement which was released in June of 2008 by the Royal College of Nursing.

Background: New treatment options have significantly improved the life expectancy of myeloma patients such that their cause of death is increasingly likely to be from something other than myeloma. Furthermore, the adverse effects of short- or long-term treatments as well as the disease are impacting on quality of life (QoL) for longer periods of time. Understanding people's QoL and what is important to them, is part of providing holistic care. Although QoL data has been collected for many years in myeloma studies, they have not been used to inform patient outcomes. There is growing evidence that supports the assessment of 'fitness' and consideration of QoL as part of routine myeloma care. A national survey was carried out to discover which QoL tools are currently being used in the routine care of myeloma patients, by whom and at which time point. Methods: An online survey using SurveyMonkey was adopted for flexibility and accessibility. The link to the survey was circulated via Bloodwise, Myeloma UK and Cancer Research UK contact lists. Paper questionnaires were circulated at the UK Myeloma Forum. Results: Data about practices in 26 centres were collected. This included sites across England and Wales. Three out of 26 centres collect QoL data as part of standard care. QoL tools used include EORTC QLQ-My20/24, MyPOS, FACT-BMT and Quality of Life Index. Questionnaires were completed by patients before, during or after a clinic appointment. Clinical nurse specialists calculate the scores and create a care plan. Conclusion: Despite growing evidence to support an holistic approach to management of myeloma patients, there is a lack of evidence to confirm that health-related QoL is being addressed in standard care. This is an area that needs further research. [ABSTRACT FROM AUTHOR]

In order to fully understand and appreciate today's drug problem in the UK, the foundations of drug legislation and the history of drug evolution require exploration. This paper critically examines the history of drug policy and the growth of heroin addiction from the perspective of a novice researcher who works closely with intravenous drug users in relation to leg ulceration and wound care in the acute setting. Today's drug policy has come a long way in understanding the problems of heroin addiction and establishing services to meet intravenous drug users' needs and the needs of society. This paper highlights the early warning signs of drug addiction and growth within the UK from an early stage with key areas such as who the early users were and how addiction grew so rapidly between 1920 and 1960. Current policy and decision makers as well as clinicians and researchers in this field must understand the impacts of past policy and embed it within their decisions surrounding drug policy today. [ABSTRACT FROM AUTHOR]

Patients with spinal cord injuries (SCIs) often have complex needs that require multidisciplinary support in specialist centres. Optimal management depends on seamless transitions between service providers. Delays at any point potentially compromise clinical outcomes and efficient resource utilisation. The Spinal Advisory Working Group aims to develop and implement practical initiatives to improve SCI care, initially focusing on admission and discharge. A literature review identified few relevant papers. In addition, the generalisability of the findings of these papers to SCI centres in the UK is unclear. Therefore, further research is needed to, for example: establish best practice in the UK; quantify the associations between admission criteria and clinical and economic outcomes from a UK perspective; and determine the extent and impact of barriers that influence the transition of SCI patients between NHS care providers. Such research would enable the development of evidence-based strategies to overcome or minimise these barriers. In the meantime, pragmatic consensus guidelines would help standardise management, aid service optimisation, overcome inequities and, potentially, reduce bed blocking. The working group agreed that the robust inclusion and exclusion criteria developed by the Welsh Spinal Cord Injury Rehabilitation Centre could form the basis of a consensus guideline, to be piloted across the five SCI centres represented by members of the group. [ABSTRACT FROM AUTHOR]

Background: metastatic spinal cord compression (MSCC) is an oncology emergency. Prevalence is increasing. Treatment and care are complex and those diagnosed may be faced with life-changing challenges. Aims: to review the impact and management of MSCC in patients with cancer, in order to analyse nursing considerations for supporting patients. Methods: a literature review and thematic analysis of five primary research papers, published between 2009 and 2014. Findings: two themes of prognosis/survival time and independence versus dependence were discovered. Conclusions: the onset of MSCC may result in paralysis and associated loss of independence, impacting on a patient's quality of life. Understanding individuals' prognosis and treatment/care preferences is fundamental for the sensitive, individualised support of patients with MSCC. The findings reinforce the nurses' role in health education, in order to raise awareness of MSCC and promote early diagnosis so that patients maintain function and independence as long as possible. The findings support the need for nurses to be equipped with appropriate communication skills to initiate and engage in sensitive, difficult and proactive conversations with patients and their families, supporting the delivery of humanised care. [ABSTRACT FROM AUTHOR]

The impact of racism on health is undeniable. However, undergraduate nurse education in the UK is not adequately addressing the racism within the profession. Literature on anti-racist nursing education was reviewed to uncover the most effective strategies for nurse educators to develop this approach. The literature describes a climate of denial and defensiveness among nurse educators. It urges nurse educators to develop racial literacy, and explores nursing curricula, recommending intersectionality as a way to teach about health disparities, with a move away from a culturalist perspective. There is growing recognition that institutions need to address issues around the retention of Black students, and robust reporting systems are required to respond to allegations of racism. Institutions also need to provide evidence-based anti-racist training for staff. The conclusion here is that, without institutional support, there is little nurse educators can do alone to change the culture of racism in nurse education. Thus, this review is a starting point for nurse educators interested in anti-racist nursing education. [ABSTRACT FROM AUTHOR]

This paper discusses the UK Government's public consultation into the NHS bursary and the response from the Nursing and Midwifery Council. A public consultation stipulated that the current arrangements for funding, by the State, were not to be considered for discussion. Instead, the consultation only appraised views that would lead to the successful introduction of student finance loans for NHS professional education. Testimonies from nurses, midwives and nursing students expressed concern that the new funding arrangements were unaffordable, dis-incentivising and biased towards the marketisation of student loans in the UK, yet the changes went ahead. The changes to NHS bursary funding resulted from the UK Government's desire for growth in student numbers (and ostensibly not growth in financial figures), and the fact that nursing (and other healthcare) students will become more fiscally indebted, despite society's moral obligation to them. [ABSTRACT FROM AUTHOR]

The coalition Government, in its White Paper Equity and Excellence: Liberating the NHS and in the subsequent paper Liberating the NHS: the new Legislative Framework has advanced its proposals for NHS restructuring. These proposals are intended to provide much enhanced roles for GPs in relation to the commissioning of NHS services in the future. This article explores these proposals and considers whether they can be seen as a return to the 1990s and the approach of the NHS Community Care Act 1990. It also explores the nature of these greater responsibilities and some of the problems that this may give rise to in the future. [ABSTRACT FROM AUTHOR]

Emeritus Professor Alan Glasper, from the University of Southampton, discusses the Council of Deans of Health's recent discussion paper giving their initial views on the key outcomes of future preregistration nurse education [ABSTRACT FROM AUTHOR]

Since the publication of the UK Clinical Research Collaboration's (UKRC, 2007) recommendations on careers in clinical research, interest has grown in the concept of clinical academic nursing careers, with increased debate on how such roles might be developed and sustained (Department of Health, 2012). To embed clinical academic nursing roles in the NHS and universities, a clear understanding and appreciation of the contribution that such posts might make to organisational objectives and outcomes must be developed. This paper outlines an initiative to define the potential practice and research contribution of clinical academic roles through setting out role descriptors. This exercise was based on our experience of a clinical academic career initiative at the University of Southampton run in partnership with NHS organisations. Role descriptors were developed by a group of service providers, academics and two clinical academic award-holders from the local programme. This paper outlines clinical academic roles from novice to professor and describes examples of role descriptors at the different levels of a career pathway. These descriptors are informed by clinical academic posts in place at Southampton as well as others at the planning stage. Understanding the nature of clinical academic posts and the contribution that these roles can make to healthcare will enable them to become embedded into organisational structures and career pathways. INSETS: Level 6¿specific descriptor exemplars;Level 7¿specific descriptor exemplars;Level 8¿specific descriptor exemplars;Level 9¿specific descriptor exemplars [ABSTRACT FROM AUTHOR]

Intermittent self-catheterisation (ISC) is the method of choice for men with lower urinary tract symptoms who need to drain retained urine from the bladder. It is preferred to using an indwelling urinary catheter as it has lower risks of complications and catheter-associated urinary tract infection. Learning ISC can be challenging for men initially but, with the support of knowledgeable nurses experienced in teaching ISC, the technique can be learned, accepted and normalised, improving symptom control and quality of life. This paper discusses the results of a survey exploring men's experiences of learning ISC with the Hydrosil Go™ (C.R. Bard Inc—now part of Becton, Dickinson and Company) silicone catheter and to highlight issues important to men when learning and living with ISC. The survey collected data from four countries: UK, France, Netherlands and Italy. It aims to help nurses who teach ISC and inform them to discuss what matters to men when learning and living with ISC. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: this article shares findings from a service evaluation exploring the views of patients relating to the specialist sexual function education and information provided following a spinal cord injury. Background: education optimises patients' involvement in their own decision-making and care processes, with the aim of promoting adherence to agreed plans, reducing the risks of post-injury complications, promoting independence and improving quality of life. Sexual function is a well-known quality-of-life indicator and it has been widely documented that it is not well addressed following spinal cord injury. A previous service evaluation exploring education provided to patients with spinal cord injury identified the need for improved provision of sexual function education/information. As a result, weekly 1-hour sessions focused on sexual function for up to three patients of the same sex were held, facilitated by a clinical nurse specialist. The sessions had an open forum structure. They were initially designed to discuss thoughts and feelings around intimacy and sex after a spinal cord injury, but focused on group members' requests. In addition, patients were offered a one-to-one session where the 'mechanics' of sex could be discussed in further detail. Design and methods: a service evaluation used a questionnaire survey to collect data from a purposive convenience sample of spinal cord injury patients. Data were collected between July and September 2018. Participants completed a locally designed paper questionnaire, which included Likert-style questions and space to add free text comments. Descriptive analysis of the data was used. Results: survey results suggest that the newly formed sexual function education session is positively evaluated in terms of usefulness and all attendees to date would recommend this session to other patients. Conclusions and recommendations: following completion of data analysis, findings will inform the further development of sexual function education, with a particular focus on tailoring it to the patient and reducing the stigma around talking about sex. [ABSTRACT FROM AUTHOR]

Maintaining competence and keeping skills and knowledge in children's orthopaedic nursing alive are problematic in both the UK and Australia. The dearth of dedicated postgraduate courses for this specialty has resulted in an array of unregulated in-house training, nurses' individual educational needs not being met and potential for children with an orthopaedic problem being put at risk of not receiving optimal care. This paper reports on a travel scholarship used to compare and contrast the UK with Australia, which supported an international scoping exercise to identify nurses' beliefs regarding expertise in children's orthopaedic nursing and explore provision for maintaining pertinent knowledge and skills. Potential ways to improve support for nurses in maintaining expertise in this field of practice are discussed. [ABSTRACT FROM AUTHOR]

Aim: this review aimed to identify and review primary research to address the question: 'Is there evidence that mentors are failing to fail underperforming student nurses?' Design: this was an integrative literature review. Methods: online databases (Medline, Scopus, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)) were searched using specified inclusion and exclusion criteria to focus the review. Critical appraisal was undertaken and key findings, outcomes and emergent concepts were identified from each study. These were then collated and synthesised into themes. Results: five articles met the criteria and review aim. Three main themes were identified. These were the mentors' relationship with the university, documentation when failing a student, and psychological and emotional impacts. Conclusion: the phenomenon of failing to fail continues to concern the nursing profession but there is limited primary research evidence to inform contemporary discussions in the UK regarding the management of this in practice. [ABSTRACT FROM AUTHOR]

The current Ebola virus disease outbreak in West Africa has initiated the request for local and international healthcare workers, including doctors, nurses and healthcare assistants to volunteer to care for patients in Ebola treatment centres. However, there is limited literature available to prepare healthcare workers for this task. There can be reluctance for healthcare workers to volunteer because of fear of the disease. This paper reviews the literature and captures the author’s own experience of working in a treatment centre in Sierra Leone. It is hoped that this paper will inform healthcare workers considering deployment to West Africa to work in a treatment centre. [ABSTRACT FROM AUTHOR]

Continuity of care, in the author's opinion, is synonymous with quality care. The benefits of developing relationship continuity are highlighted as beneficial to patient, department, trust and the NHS. An in-house audit revealed that the care provided in the author's stoma care department was fragmented and how a change in strategy was required to bring about the necessary changes. This paper explores the benefits of patient/relationship continuity and outlines the changes made for over 250 new ostomy patients annually. [ABSTRACT FROM AUTHOR]

In the UK, almost 1 million people are living with heart failure, with heart and circulatory diseases accounting for 27% of all deaths, according to the British Heart Foundation. Current heart failure guidelines support cardiac rehabilitation as an intervention to reduce cardiovascular events, increase exercise tolerance and enhance patients' quality of life. Research indicates that telerehabilitation is an effective component of heart failure management, which helps overcome perceived barriers to cardiac rehabilitation including travel to appointments, long waiting times and accessibility. Understanding patient experiences and increasing telerehabilitation among heart failure patients is pertinent to implementing person-centred care, reducing risk and optimising quality of life. [ABSTRACT FROM AUTHOR]

Despite the efficacy of mammography and the widespread promotion of screening programmes, a significant number of eligible women still do not attend for regular breast screening. An integrative review methodology was considered the most appropriate means to critically analyse the available literature pertaining to factors which influence participation in breast cancer screening. From the extensive literature search, 12 selected core research papers met the inclusion criteria and were incorporated in the literature review. Four themes emerged from the literature which impact on participation in mammography screening: psychological and practical issues, ethnicity issues, influence of socioeconomic status and issues related to screening programmes. The recent Independent Review Panel on Breast Cancer Screening endorsed the importance of access to information which clearly communicates the harms and benefits of breast screening to enable women to make informed decisions about their health. The recommendations from the panel and others have been included in this review. [ABSTRACT FROM AUTHOR]

Smoking cessation services are well established in the community. In recent years, an increase in their availability has been recommended and secondary care settings were identified as suitable locations. This article draws on the evidence base underpinning this move and uses findings from an evaluation of such a service introduced into an acute hospital to illustrate the key principles to be considered. These principles included receptiveness of the hospital environment to the smoking cessation message, the importance of organizational preparation before launching the service, collaboration within the hospital and in the community, resourcing of the initiative, training of staff and providing feedback to staff on progress (e.g. quit rates resulting from initiative). The paper concludes that broad acceptance at all levels within the hospital, which enhances a stop smoking culture, in parallel with an in-depth preparation and training period, is required to successfully launch a hospital-based stop smoking service. [ABSTRACT FROM AUTHOR]

The face of the NHS is set to change enormously during the next decade providing more choice, more personalized care and real empowerment of people to improve their health (Department of Health, 2005b). Fundamental to this approach will be the management of patients' health needs in the community setting. Using a robust clinical governance framework, the MS team at the National Hospital for Neurology, and Neurosurgery worked with the voluntary and commercial sector to design a trial to gather evidence for a new approach to the management of acute MS relapse using intravenous steroids within a home environment. The study was completed in advance of recent governmental initiatives/reforms. This paper focuses on the clinical governance implications of cross-boundary working. It is hoped that by sharing the processes put in place, others contemplating the delivery of acute care outside of hospitals or design of collaborative research trials will find the frameworks useful. [ABSTRACT FROM AUTHOR]

The Government has published a series of papers that aim to turn the NHS into a patient-led service. One aspect of this change is to allow patients choice in their selection of a hospital for elective surgery. This programme hopes eventually to extend choice to other areas of care. This article reviews the literature surrounding patient choice and identifies the issues that affect how patients will reach a decision. Although there is limited information on the subject, a clear difference has been identified between those with acute conditions and those with chronic conditions. Nurses need to be aware of both the policy and the underpinning concepts and patients' views of the topic because it will bring about a major change in the culture of the NHS. INSET: KEY POINTS. [ABSTRACT FROM AUTHOR]

This article looks at the current UK guidelines for a healthy diet for the general population and considers the current debates and changes within that advice and how they may affect health outcomes. It is impossible to read a newspaper, magazine or social media article without being exposed to dietary advice, nutritional research or the latest diet craze. It is essential that nurses are able to advise their patients on research-based UK guidelines for a healthy diet, and be able to respond to patient questions on diet-related matters, ensuring the information they give is not based on current media opinion or celebrity views. This paper summarises the evidence found within current guidelines to help nurses ensure their practice is evidence based. This will help meet the requirements of the Nursing and Midwofery Council’s (2015) Code, including delivering fundamentals of care and being able to practise in line with best available evidence. [ABSTRACT FROM AUTHOR]

Background: Advanced clinical practice roles, usually filled by nurses, have had positive effects on clinical effectiveness, including in patient satisfaction, but their benefits for other stakeholders (such as employers, health professionals, education providers and commissioners and professional/regulatory bodies) are less clear. Aim: This study aimed to identify UK research on the potential benefits of advanced clinical practice and evaluate the evidence base for key stakeholders in this field. Method: A mixed-methods systematic literature review was carried out to inform a narrative interpretive synthesis. Findings: 44 articles of mixed quality were identified. Consensus was found regarding the definition of and barriers and facilitators to advanced clinical practice. This role is split into substitution (eg, of doctors) and supplementation (eg, adding value) aspects, and the clinical practice element dominates. Training for the role varies, as do scope of practice and regulation. Conclusion: There are several barriers to the implementation of advanced clinical practice and therefore the realisation of its benefits for key stakeholders. Areas requiring attention include training, support from others for role expansion and organisational issues. [ABSTRACT FROM AUTHOR]

A diagnosis of medically unexplained symptoms (MUS) is made when a person reports a complaint for which no organic disease can be detected. People with MUS commonly present to primary care services in the UK; however, there is no consensus regarding the evidence base for care. This literature review explores the experiences of these patients when they interact with health services. The following themes emerged: experience of diagnosis; expectations; communication; and healthful relationships. People with MUS report negative experiences of health care. Nurses in primary care have an opportunity to provide person-centred care to support these patients, and research could explore the potential contribution of nurses working in primary care in the UK to support them and enhance the evidence base for practice. [ABSTRACT FROM AUTHOR]

The widening participation agenda has particular significance for worldwide nursing since it is a profession which is under increasing scrutiny in its recruitment and retention practices. Debate about this agenda within nurse education is strengthened by careful scrutiny of the research within the wider context of higher education, some of which challenges commonly held assumptions. This paper examines four areas of relevance to the UK widening participation agenda: disability, ethnicity, socioeconomic status and family responsibilities. Taken together, they indicate that nurse education operates within a particularly complex context with some important implications for the future design of pre-registration programmes. These complexities should be debated in depth by educational commissioners and providers, in tandem with regulatory bodies. [ABSTRACT FROM AUTHOR]

Infusion pumps are commonplace in today's healthcare settings and their design and development has kept pace with technology over the decades. In the 1970s and 1980s infusion pumps began to emerge in the UK market and were basic, mechanical devices with limited functions. Today, infusion pumps have a plethora of functions and features and a range of alarms to help alert the user and the patient that infusions are nearing completion, have ended or their range of sensors has detected that the infusion pump, or patient, requires attention. The role of the nurse in safely managing this ever-changing technology should not be underestimated. This paper reviews the progress made over the past 40 years in the UK healthcare setting and how the nurses have had to keep up to speed with the technology as it develops. It highlights the importance of fully integrating infusion pumps into intravenous (IV) therapy training and assessment. The important role the nurse plays is highlighted as well as exploring how he or she can help organisations better understand infusion pumps in the day-to-day management of patients undergoing intravenous therapy. [ABSTRACT FROM AUTHOR]

Background and aims: Dysphagia is common after stroke, so feeding through a nasogastric (NG) tube may be necessary. These tubes are frequently dislodged, causing interruption to feeding and hydration, and potential aspiration of feed or fluids into the lungs. Interventions to prevent this may include taping tubes to the face; the application of hand mittens or bandaging patients’ hands; inserting the NG tube into the nostril on the stroke-affected side; and nasal bridles. The aims of this survey were to investigate the management of NG feeding for stroke patients, including current tube confirmation and securing techniques, and associated nurse education. This was part of a three-phased sequential mixed-methods study. This paper reports on the second quantitative phase. Methods: A quantitative postal survey, based on initial qualitative findings, was sent to registered nurses (n=528) from the National Stroke Nurses Forum and Scottish Stroke Nurses Forum, in addition to registered nurses working on stroke units within the local health board. Results: The overall response rate was 59% (n=314/528). Tape was the most commonly used method for securing tube position, followed by inserting the tube on the stroke-affected side. Hand mittens were used more frequently than the nasal bridle; bandaging hands was reported once. Taping was considered to be more acceptable and safer than hand mittens or the nasal bridle, but less effective. Training in inserting NG feeding tubes was received by 56% (n=176/314). Methods used for confirming tube position included aspiration and X-ray. Provision of training in confirmation techniques varied. Conclusions: This study shows that the management of NG feeding for dysphagic stroke patients requires standardisation, as does the education for nurses to ensure that this intervention is carried out safely, effectively and acceptably. [ABSTRACT FROM AUTHOR]

This discussion paper presents a review of holistic needs assessments (HNAs) in the care of patients with cancer. HNAs entail a structured review of patient needs as articulated by the patient. This discussion then leads to a care plan grounded in issues pertinent to that patient. Despite policy guidance advocating its use, there are barriers to overcome in order to integrate HNAs into routine care. This article discusses what role communication skills and clinician confidence may have on the use of HNAs in practice, and suggests a strategy to support HNAs becoming the norm. [ABSTRACT FROM AUTHOR]

In the second of two articles exploring the value and application of concordance across nursing practice the discussion is aimed at clinical settings and patient groups where concordance may have been viewed as impractical. The author harnesses Cribb and Entwhistle’s broader conception of shared decision making and the notion of decision-making capacity as a continuum to argue that concordance can be pursued effectively in challenging settings such as childcare practice, mental health and the care of older people. As in the first paper (McKinnon, 2013) the discussion is not limited to medicines management but remains engaged with all aspects of nursing practice. Legal and ethical frameworks, social participation theory and research across healthcare practice are sourced to argue for concordant approaches in the care of patients who may at times have compromised decision-making capacity. Ideas of direct and indirect concordance are explored. [ABSTRACT FROM AUTHOR]

Solution-focused therapy is a model of therapy that builds on the client's strengths, is future-focused and can be generally offered as a brief intervention. It can be used across multiple clinical settings and is not limited to being useful for clients accessing mental health services. Learning the underlying principles and developing a foundation level of skill in the approach was found to be achievable in an undergraduate nursing course, with students reporting an increase in their knowledge of the model and confidence in basic therapeutic skills in just one day of training. In this paper, we introduce the solution-focused approach in relation to nursing practice. We describe the template used for the training day offered to undergraduate mental health nurses. Students reported that this method of learning a therapeutic approach was helpful and increased both their knowledge and skill base. [ABSTRACT FROM AUTHOR]

Thrombolysis treatment for acute ischaemic stroke is effective if it is administered within 4.5 hours of stroke onset. Alteplase is a licensed thrombolytic treatment for ischaemic stroke. The dose of alteplase is dependent on a patient's weight. The stroke team involved in the administration of the treatment usually estimates a patient's weight prior to the treatment in order to ensure the correct dosage. This paper highlights the reliability of body weight estimates in determining the accuracy of thrombolysis dosing and the implication of dosing errors to post-thrombolysed patients. [ABSTRACT FROM AUTHOR]

The implementation of a care bundle approach to delivering fundamental care in practice is now a recognised and effective way of translating research into practice, offering consistent care with resulting positive outcomes for the patient. A care bundle consists of a relatively small number of interventions for every patient to whom the bundle is applied. However, there must be evidence behind each individual intervention to indicate, if delivered, how it will reduce the risk to the patient. This paper reports on a strategy for developing and implementing a pressure ulcer (PU) combined prevention care bundle/care plan into practice. The effectiveness of the care bundle can be measured when it is in use in the practice setting with an audit tool. [ABSTRACT FROM AUTHOR]

The area of simulation within education is fast developing, with many educational providers striving to keep up with current advances in technology. Evaluation of simulation learning appears overwhelmingly positive (Moule et al, 2008; McCaughey and Traynor, 2010; Hope et al, 2011). However, when looking to generate financial support to develop simulation practices within education, little evidence exists regarding its impact within clinical practice. This paper details the findings of a scoping exercise undertaken to ascertain current simulation practice within nursing curricula, in order to identify good practices and a clear evidence-base for embedding and using simulation to enhance education and practice. The project found overwhelming support for simulated learning from students and facilitators. However, it was highlighted that no clear guidance or strategies were universally used to effectively incorporate simulation within curricula, nor to evaluate or audit its effect upon student competency within clinical practice. Further evidence to support the implementation of simulation within nurse education is therefore required to ensure effective implementation and transferability of learning into clinical care settings. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) is a significant public health threat in the UK, and is both underdiagnosed and undertreated. The treatment episode takes between 12 and 48 weeks. In the UK, HCV management is undertaken in secondary and tertiary centres. This does not meet the needs of all patients; they may have to travel long distances, incur travel costs, wait a long time to be seen and negotiate time off work while not divulging their illness. Providing care at home can increase patients' access to and acceptability of treatment, especially in areas remote from specialist centres. This paper describes the feasibility, safety and efficacy of treating HCV-infected patients at home through a partnership between secondary care and a clinical home care company. The home care model had a significantly higher attendance rate than the clinic model. It allowed the trust to improve care at no extra cost. This model can optimise specialist nurses' time, allowing them to focus on patients with more complex needs. [ABSTRACT FROM AUTHOR]

This paper reports on a descriptive qualitative five-year follow-up to an initial UK-based grounded theory study entitled 'Living with Faecal Incontinence.' Both studies collected data using in-depth guided interviews. The aim of the follow-up study was to identify any changes including adaptation and establish determining factors for people with faecal incontinence. Of the 22 participants in the original study,11 joined the follow-up. Of these, nine participants demonstrated degrees of adaptation, assisted by symptom improvement using practical means or accepted what cannot be changed, downgrading their aspirations. One, having progressed, had become static in an intermediate position, while another displayed little adaptation. Health professionals can assist adaptation by being aware of clinical interventions to improve symptoms and practical means available. Where appropriate, the use of role models may help. Role model effectiveness, together with further long-term investigation into living with faecal incontinence, provide topics for future research. [ABSTRACT FROM AUTHOR]

Changes in the delivery of occupational health and wellbeing services can affect the employer, employees and service users. Despite the impact of such changes, many organisations implement them without understanding their true effects. Support of staff and service users is needed if change is to be implemented and services reconfigured to improve overall efficiency. A diagnostic analysis has been recommended as a precursor to assess what impact a change would have. This paper explores the process of a diagnostic analysis before nursing telephone triage assessment for musculoskeletal disorders was implemented in an occupational health and wellbeing service. Mixed methods were used to gather the relevant information. [ABSTRACT FROM AUTHOR]

The Safety Express programme is a national workstream within the Quality, Innovation, Productivity and Prevention (QIPP) programme that is designed to improve health outcomes and quality care, as well as reduce costs associated with the following four patient harms: pressure ulcers, falls, urinary tract infections in patients with catheters and venous thromboembolism (VTE). NHS London developed a pilot project to implement Safety Express across London. This paper presents case studies of the outcomes of the Safety Express pilot in three locations in London. Findings from the pilot showed that the proportion of patients who were harm-free from pressure ulcers, falls, urinary infections (in patients with a catheter) and new VTE compares favourably with the national average, with an overall decrease in all four. [ABSTRACT FROM AUTHOR]

Following the publication of the Nursing and Midwifery Council's (NMC) (2007) Simulation of Practice Learning Project, simulated practice learning opportunities are now to be incorporated into preregistration undergraduate nursing programmes across the UK. Since 2008, the Faculty of Health and Life Sciences at Oxford Brookes University has incorporated simulated practice learning into their curriculum to contribute towards students' 2300 direct clinical care hours. This paper presents the findings of an evaluation project that was conducted by academic staff within the faculty to ensure that they could continue to meet the principles set out by the NMC for auditing simulated learning environments used by higher education institutes (HEIs), and to meet the Essential Skills Clusters (NMC, 2010a) for registration as part of the quality assurance processes. The evaluation took place over 2 days, with a total of 52 participants, including practice partners, mentors, practice educators, academic staff and students from all four branches of nursing (adult, mental health, learning disability and children). Results indicated that the support of direct care hours through simulated practice learning can permit students to practice essential clinical skills in a designated clinical skills suite. These learning experiences can also offer positive outcomes and the opportunities to maintain partnership for students, placement partners, and mentors. [ABSTRACT FROM AUTHOR]

This paper offers guidance for novice nurse researchers on the ethical and methodological challenges of conducting health research in high school settings. Over the course of two studies in UK high schools with students aged 11-16 years, the authors encountered common ethical and methodological challenges. This article draws on these studies to build a critique of approaches to health research in school settings. Issues of consent and assent, confidentiality and participation can highlight tensions between the expectations of schools and health researchers. In this context, feasible research designs raise complex ethical and methodological questions. Ethical and methodological norms for health research may not be suitable for high school settings. Successful school-based health research designs may need to be flexible and responsive to the social environment of schools. [ABSTRACT FROM AUTHOR]

To those starting off on the research journey, the term 'qualitative research' can often seem a daunting prospect. The world of research methodology and theory is emerged in a rich history of its own terminology, meanings and experiences. Research and innovation are integral parts of the nurse practitioner's role, yet many have little understanding of the theoretical frameworks and methodologies surrounding the vast areas of qualitative and quantitative research. As part of a doctorate, the author undertook a small qualitative study, choosing her own method and question. Intrigued by the phenomenon of smoking addiction, she observed the behaviours and interactions of people who smoke. The focus of this article, however, is the process by which the study was carried out, rather than the observations themselves. This paper presents observational research from the perspective of a nurse practitioner embarking on a journey with qualitative designs. [ABSTRACT FROM AUTHOR]

The path that nurse education in the UK has taken since it moved into the higher education (HE) system in the early 1990s has been directly influenced, not only by Department of Health policy, but also by changes to the way in which HE is structured and managed. The White Paper Higher Education: Students at the Heart of the System (Department for Business Innovation and Skills, 2011a) outlined the coalition Government's plans to encourage better standards of teaching in HE and greater responsiveness to student experience. The reforms promote competition and contestability between HE institutions to attract students and recommend removing barriers for new providers to enter the market. The decision to introduce a strong business model for HE has a number of implications for nurse education, both in the way that it is delivered and how student nurses are positioned among their peers. There is a potential conflict of interest between the student as a source of income for the HE institution and the student nurse as a member of a professional organization dedicated to ensuring the safety of the public. The decision to make it easier for alternative providers to obtain degree awarding powers could also encourage providers to take greater ownership of healthcare qualifications in the future. [ABSTRACT FROM AUTHOR]

This paper is the second of a two-part article presenting a new assessment tool (the snapshot) for pre-registration nurses in clinical practice that is being used at Kingston University/St George's University of London during year 3 of the Diploma and BSc programme. Part 1 of this article presented background to the snapshot tool and the research approach used in the evaluative research study. Part 2 will present the data collection, findings and discussion which show that the snapshot is perceived positively by students in terms of the criteria, documentation and process. However, mentor understanding of these factors varied with some mentors having an inadequate understanding and additional question: of assessment validity also arose and need to be addressed. Both parts of this article make a contribution to the practice assessment agenda and to the continuous clinical assessment methods currently in use that tests students' competence against agreed criteria. The snapshot reflects the reality of practice and assesses skills in a realistic environment. [ABSTRACT FROM AUTHOR]

Airway assessment and management skills are vital in an emergency department (ED) as they are the most sensitive indicator of patient deterioration. Problems as common as head injury or alcohol intoxication are associated with an inadequate airway or diminished respiratory function and can cause a patient's condition to decline rapidly. Maintaining a patient's airway and facilitating breathing is the main priority in any emergency situation, although achieving airway control can be difficult. All health professionals need to be able to safely undertake airway management. The key is a thorough assessment to determine whether the airway is patent or not. This paper will discuss the importance and practicalities of airway management and assessment in the emergency and intensive care. [ABSTRACT FROM AUTHOR]

This paper, based on a presentation to the UK Association of Chief Children's Nurses, is the author's personal reflection on the nature and future of children's nursing research. Key constitutive elements of this concept are considered to arrive at the conclusion that children's nursing research is research undertaken by children's nurses into questions of relevance to children's nursing practice and services, or wider issues in which children's nursing has a vital role. Three possible futures are presented, of which only the last is positive and desirable: development in line with the reality of practice and population needs. An integrated approach is necessary, with responsibilities both for those in positions of authority in the service and for researchers themselves. In particular, this partnership is essential for children's nursing to evidence the impact of research and for children and young people to reap the greatest benefit from evidence-based practice. [ABSTRACT FROM AUTHOR]

The article focuses on disability nursing and nurse training in Great Britain in light of a position paper, "Learning from the Past--Setting out the Future: Developing Learning Disabilities Nursing in the United Kingdom," released by the Royal College of Nursing (RCN) in 2011. The Nursing and Midwifery Council's standards for university degree nursing courses, prevalence of learning disabled people, and roles of learning disability nurses are discussed.

Patients with long-term neurological conditions are highly dependent on registered nurses and healthcare assistants for care. This article highlights some of the issues nurses face in providing care to patients with long-term neurological conditions. A synopsis is given of a study currently underway, which is considering these issues. The study aims to explore the education and training requirements of registered nurses and health care assistants in providing care for adults with complex neurological conditions. During the 3-year study, data are being obtained from registered nurses, health-care assistants, and allied health professionals working with adults affected by complex neurological conditions, and from their relatives and families. The results of this study will be the subject of a future paper. It is anticipated that by addressing nursing education requirements in this speciality area, future nursing practice will be improved for this patient group, thus contributing to improved quality of life. [ABSTRACT FROM AUTHOR]

Some years ago the Government set out their plans for the regulation of Nurses and other health professionals in The NHS Plan (Department of Health [DH], 2000) and Making a Difference (DH, 1999). This year the government produced a new series of White Papers, aimed at bringing to fruition the earlier plans and the ideology that underpinned them. This article considers two such papers -- neither produced by a nurse, despite their impact on nursing work. High Quality Care for All (DH, 2008a) and A High quality Workforce (DH, 2008b) are discussed considering the power and control of health care delivery that doctors and nurses now enjoy. A conclusion is reached that whereas there is much talk of innovations in nursing ideology and clinical practice, and significant advances in nurse education and training designed to facilitate advanced and autonomous practice within the nursing profession, it is just that. The real positions of power and influence within clinical provision and practice have remained the same: held by civil servants and members of the medical profession. While nurses are represented it is at a lower level of influence and they are missing from the top table. The political level of decision making for Healthcare directly involves members of the medical profession but not nurses. [ABSTRACT FROM AUTHOR]